PN 223 OB AND PEDS FINAL EXAM QUESTIONS AND ANSWERS RATED A+ LATEST UPDATE 2022/2023

PN 223 OB AND PEDS FINAL EXAM QUESTIONS AND ANSWERS RATED A+ LATEST UPDATE 2022/2023 The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm. Which instructions should be included on the list? SATA A. Use the fingertips to lift the cast while it is drying B. Keep small toys and sharp objects away from the cast C. Use a paddle ruler or another padded object to scratch the skin under the cast if it itches D. Place a heating pad on the lower end of the cast and over the fingers if the finders feel cool E. Elevate the extremity on pillows for the first 24-48 hours after casting to prevent swelling F. Contact the HCP if the child complains of numbness or tingling in the extremity A nurse is caring for a 10-month-old infant who is in a cast for developmental dysplasia of the hip (DDH). Which of the following strategies would the nurse implement to promote the infant's growth and development? A. Tie colorful latex balloons to the side of the crib. B. Provide a small electronic toy. C. Change the infant's diaper as soon as soiling occurs. D. Allow infant to stand in the crib. D. Allow infant to stand in the crib. Rationale: The infant should not be restricted from normal activities. The infant can be held and allowed to walk in a cast or orthotic device. Allowing the child to participate in normal developmental activities will promote growth and development. A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take? 1. administer an analgesic 2. release the skin traction 3. apply ice to the extremity 4. notify the HCP A child is placed in skeletal traction for treatment of a fractured femur. The nurse creates a plan of care and should include which intervention? 1. ensure that all ropes are outside the pulleys 2. ensure that the weights are resting lightly on the floor 3. restrict diversional and play activities until the child is out of traction 4. check the HCP's prescriptions for the amount of weight to be applied 3. The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction? 1. "I will encourage my child to perform prescribed exercises." 2. "I will have my child wear soft fabric clothing under the brace." 3. "I should apply lotion under the brace to prevent skin breakdown." 4. "I should avoid the use of powder because it will cake under the brace." 3. "I should apply lotion under the brace to prevent skin breakdown." 4. Parents bring their 2-week-old infant to a clinic for treatment after a diagnosis of clubfoot made at birth. Which statement by the parents indicates a need for further teaching regarding this disorder? 1. "Treatment needs to be started as soon as possible." 2. "I realize my infant will require follow-up care until fully grown." 3. "I need to bring my infant back to the clinic in 1 month for a new cast." 4. "I need to come to the clinic every week with my infant for the casting." Clubfoot is a complex deformity of the ankle and foot that includes forefoot adduction, midfoot supination, hindfoot varus, and ankle equinus; the defect may be unilateral or bilateral. Treatment for clubfoot is started as soon as possible after birth. Serial manipulation and casting are performed at least weekly. If sufficient correction is not achieved in 3 to 6 months, surgery usually is indicated. Because clubfoot can recur, all children with clubfoot require long-term interval follow-up until they reach skeletal maturity to ensure an optimal outcome. 7, A nurse is providing teaching to a parent of a child who has a fracture of an epiphyseal plate. Which of the following statements should the nurse make? Normal bone growth can be affected 8, A home health nurse is developing a plan of care for a child who has hemiplegic cerebral palsy. which of the following goals is the priority for the nurse to include in the plan of care? A. provide respite services for the parents B. improve the clients communication skills C. foster self-care activities D. modify the environment Correct answer: D. modify the environment 9, A nurse is caring for a school-age client who possibly has Reye syndrome. Which of the following is a risk factor for developing Reye syndrome? A. Recent history of infectious cystitis caused by Candida B. Recent history of bacterial otitis media C. Recent episode of gastroenteritis D. Recent episode of Haemophilus influenzae meningitis 10, A nurse is caring for a client who has suspected meningitis and a decreased level of consciousness. Which of the following actions by the nurse is appropriate? A. Place the client on NPO status. B. Prepare the client for a liver biopsy. C. Position the client dorsal recumbent. D. Put the client in a protective environment 10, A nurse is caring for a child who has increased intracranial pressure. Which of the following are appropriate actions by the nurse? (Select all that apply.) A. Suction the endotracheal tube every 2 hr. B. Maintain a quiet environment. C. Use two pillows to elevate the head. D. Administer a stool softener. E. Maintain body alignment. 11, A nurse is taking care of a 10-year-old child that weighs 30 kg. The doctor has ordered azithromycin PO 300 mg x 1 dose. Azithromycin comes in an oral suspension 100mg/5 mL in a 15 mL bottle. According to the drug handbook for children 2-15 years of age, 10 mg/kg/day but not to exceed 500 mg/day. How many milliliters should be given? 3 mL 12, A nurse is caring for a child who is on a clear liquid diet. At lunch, the child consumed ½ cup of juice, 3 oz gelatin, 1 oz of an ice pop, and 20 mL ginger ale. How many mL should the nurse record as the child's fluid intake? 260 mL 13, What is the most important thing for a nurse to teach parents of a child with Duchenne Muscular Dystrophy to do for their school- aged-child? A/ Maintain high caloric diet B/ Institute seizure precautions C/ Restrict the use of larger muscles D/ Perform range of motion exercises D/ ROM exercises Rationale: ROMs are essential to help achieve primary objectives of maintaining optimal muscle function for as long as possible and preventing the development of contractures. High caloric diet would make them fat, which would push them to a wheel-chair faster than you can say "fat guy in a little coat". Seizures have nothing to do with duchenne, and restricting large muscles could result is disuse atrophy and contractures. 14, The nurse is counseling the parents of a 12-year-old child with Duchenne muscular dystrophy about problems that may develop during adolescence. What body system does the nurse expect will be affected? Cardiopulmonary Muscle degeneration is advanced in the adolescent with Duchenne muscular dystrophy. The disease process involves the diaphragm, auxiliary muscles of respiration, and the heart, resulting in lifethreatening respiratory infections and heart failure. Central nervous system function is not affected by Duchenne muscular dystrophy; nor is the integumentary system. Nutritional problems related to the gastrointestinal system are less significant than cardiopulmonary problems. 15, A 16-year-old boy comes into the office of the school nurse complaining of left hip pain that began when playing basketball in gym class. The boy is in the 85th percentile for height and weight. He complains of increased pain with weight bearing. The nurse observes out-toeing of the left leg with ambulation. Which nursing action is a priority? Refer the boy to the emergency department. 16, A 12 year-old comes into the clinical with left thigh pain and a lump over the distal femur. The nurse is aware that these symptoms can be linked to which of the following medical problems. Osteosarcoma 17, The child has been complaining of joint pain in the knees and jaw for the last 6 weeks, both joints are swollen and warm to touch, but not red. The physician is ordering blood to rule out Junior Idiopathic Arthritis. Which of the following lab tests would the nurse expect the physician to order? (Select all that apply) Antinuclear antibodies CBC with differential 18, A nurse is planning care for a 6-year-old child who has bacterial meningitis. Which of the following nursing interventions should the nurse include in the plan of care? Implement seizure precautions. 19, The 17 year-old Asian patient comes to the clinic with a butterfly rash on the face, photosensitivity, and recently had strep throat. What diagnosis would you expect the doctor to make? Systemic Lupus Erythematosus (SLE) 20, A patient recently came into the Emergency Department with a diagnosis of Guillain-Barre Syndrome (GBS). What is the priority system to initially monitor for this patient? Respiratory 21, Which assessment findings should the nurse note in a school- age child with Duchenne Muscular Dystrophy (DMD)? (Select all that apply.) Lordosis Gower sign Waddling gait 22,The mother brings her child with cerebral palsy in to the clinic and is afraid the child is having seizures as the child has the slow worm like movements in her arms and she drools when this occurs. The nurse explains to the mother that this is not a seizure but what type of activity? Athetoid 23, An 11 year-old child has a recurrence of Ewing sarcoma and is verbalizing wanting to stop all treatments. The nurse is aware that the best ethical practice would be which of the following plan? Plan a meeting with the parents, child, and the medical team to provide an opportunity to discuss the child's concerns. 24, The nurse is assessing a child after a cardiac catheterization. Which complication should the nurse be assessing for? A. Cardiac arrhythmia B. Hypostatic pneumonia C. Heart failure D. Rapidly increasing blood pressure 24, Nursing interventions for the child after a cardiac catheterization should include which actions? (Select all that apply.) A. Allow ambulation as tolerated. B. Monitor vital signs every 2 hours. C. Assess the affected extremity for temperature and color. D. Check pulses above the catheterization site for equality and symmetry. E. Remove pressure dressing after 4 hours. F. Maintain a patent peripheral intravenous catheter until discharge. 25, Ryan is an 11 month old with Down’s syndrome and Atrial Septal Defect. His parents report that Ryan has been lethargic and has had diarrhea the last 24 hours. His weight is 7 kg (15.4lb). His Vital signs are: • Temperature 36.5C (97.7F) rectal • Pulse 80 beats/minute • Respirations 35 breaths/minute • Pulse ox 95% on room air His lab results are: • Potassium 2.9 mmol/L • Digoxin 2.5 mg/mL 1. The nurse questions digoxin toxicity. What results support this? (Select all that apply). Dig level 26, Nisha is a 14 year old girl with sickle cell anemia. She comes into the clinic with complaints for severe generalized pain following a softball game. She is admitted to the pediatric unit. Her vital signs are: • Temperature 37.7 C (99.7 F) orally • Pulse 110 beats/minute • Respirations 30 breaths/minute • Blood Pressure 96/70 • O2 sat. 89% • Pain 8/10, sharp, stabbing • Weight 110 lbs Her lab results: • Hemoglobin= 9g/L • Hematocrit= 24% • WBC= 12,000 cells/mm2 • Platelet count= 140,000 cells/mm2 The physician has written the following orders for Nisha. Which if any of these orders should the nurse questions? Incorrect answer: Vital signs q 4 hours. Notify the health care provider if temp 38 C (100.4 f). CBC with manual differential in the morning. , Not Selected IV fluids of 3% dextrose in water with 0.43% normal saline to infuse at 175 ml/hr , Not Selected PCA Meperidine 20 mg continuous with 3mg every 8 minutes PCA dose , Not Selected Oxygen 2L per nasal cannula titrating to maintain oxygen sat. 94% , Not Selected All are fine , Not Selected 27, An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of: a. Air embolism. c. Hemolytic reaction. b. Allergic reaction. d. Circulatory overload. ANS: D The signs of circulatory overload include distended neck veins, hypertension, crackles, dry cough, cyanosis, and precordial pain. Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Allergic reactions are manifested by urticaria, pruritus, flushing, asthmatic wheezing, and laryngeal edema. Hemolytic reactions are characterized by chills, shaking, fever, pain at infusion site, nausea, vomiting, tightness in chest, flank pain, red or black urine, and progressive signs of shock and renal failure. 28, Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply. 1. Maintain the child in a semiprivate room. 2. Reduce exposure to environmental organisms. 3. Use strict aseptic technique for all procedures. 4. Ensure that anyone entering the child's room wears a mask. 5. Apply firm pressure to a needle stick area for at least 10 minutes. • 2. Reduce exposure to environmental organisms. • 3. Use strict aseptic technique for all procedures. • 4. Ensure that anyone entering the child's room wears a mask. 29, The nurse is conducting a staff in-service on sickle cell anemia. Which describes the pathologic changes of sickle cell anemia? a. Sickle-shaped cells carry excess oxygen. b. Sickle-shaped cells decrease blood viscosity. c. Increased red blood cell destruction occurs. d. Decreased adhesion of sickle-shaped cells occurs. 30, A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicles, and juices, are left. Which statement best explains this? The parent is trying to restore normal balance through appropriate "hot" remedies In several cultures, including Filipino, Chinese, Arabic, and Hispanic, hot and cold describe certain properties completely unrelated to temperature. Respiratory conditions such as pneumonia are "cold" conditions and are treated with "hot" foods. The child may like broth but is unlikely to always prefer it to Jell-O, Popsicles, and juice. The evil eye applies to a state of imbalance of health, not curative actions. Chinese individuals, not Hispanic individuals, believe in chi as an innate energy. 31The nurse is preparing to assess a 10-month-old infant. He is sitting on his father's lap and appears to be afraid of the nurse and of what might happen next. Which initial actions by the nurse should be most appropriate? Ans: Initiate a game of peek-a-boo 32, What should nursing care of an infant with oral candidiasis (thrush) include? Ans: Continue medication for the prescribed number of days 33,. Phenylketonuria (PKU) is a genetic disease that results in the bodys inability to correctly metabolize: a. glucose. b. phenylalanine. c. phenylketones. d. thyroxine. ANS: B