PEDS (Pediatrics) Exam 2023/2024

Parents bring their infant to the clinic, seeking treatment for vomiting and diarrhea that has lasted for 2 days. On assessment, the nurse in charge detects dry mucous membranes and lethargy. What other findings suggest a fluid volume deficit? A sunken fontanel The nurse is palpating the fontanels of a 2-month-old. The fontanels should feel flat and firm. A child with croup is placed in a cool, high-humidity tent connected to room air. The primary purpose of the tent is to liquefy secretions and relieve laryngeal spasm. Kim is using bronchodilators for asthma. The side effects of these drugs that you need to monitor this patient for include tachycardia, nausea, vomiting, heart palpitations, inability to sleep, restlessness, and seizures. At the community center, the nurse leads an adolescent health information group, which often expands into other areas of discussion. She knows that these youths are trying to find out “who they are,” and discussion often focuses on which directions they want to take in school and life, as well as peer relationships. According to Erikson, this stage is known as: identity vs. role confusion. The adolescent patient has symptoms of meningitis: nuchal rigidity, fever, vomiting, and lethargy. The nurse knows to prepare for the following test: Lumbar puncture Beta-adrenergic agonists such as albuterol are given to Reggie, a child with asthma. Such drugs are administered primarily to do which of the following? Dilate the bronchioles Which of the following respiratory conditions is always considered a medical emergency? Epiglottitis An 8-year-old is admitted with drooling, muffled phonation, and a temperature of 102F. The nurse should immediately notify the doctor because the child’s symptoms are suggestive of: Epiglottitis A 5-year-old child is brought to the emergency department with copious drooling and a croaking sound on inspiration. Her mother states that the child is very agitated and only wants to sit upright. What should be the nurse's first action in this situation? Prepare intubation equipment and call the physician (This child has symptoms of epiglottitis, is acutely ill, and requires emergency measures) What should be the initial bolus of crystalloid fluid replacement for a pediatric patient in shock? 20 ml/kg Baby Ellie is diagnosed with gastroesophageal reflux (GER). Which of the following nursing diagnoses would be inappropriate? Impaired oral mucous membrane While examining a 2-year-old child, Nurse Victoria sees that the anterior fontanel is open. She should: Notify the doctor - Cereal is not added until the child is at least 4 months old. The clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which symptom most likely led the mother to seek health care for the infant? Foul-smelling ribbon-like stools The parents of a child with a cleft palate are concerned and ask the nurse when the palate will be repaired. The nurse should plan to base the response on which information about cleft palate repair? Repair usually is performed between 6 months and 2 years A child is diagnosed with intussusception. On performing an assessment of the child, the nurse keeps in mind which finding as a characteristic of this disorder? Invagination of a section of the intestine into the distal bowel Will is being assessed by Nurse Lucas for possible intussusception; which of the following would be least likely to provide valuable information? Family history What sign is indicative of respiratory distress in infants? Nasal flaring NCLEX Cleft Lip and Palate The nurse is caring for a 1-year-old child after cleft palate repair. On completion of feeding, the nurse should plan for which appropriate nursing action? Rinsing the mouth with water The nurse in the hospital is giving at-home feeding instructions to a family whose child is being discharged after being born with a cleft lip. Which statement by the mother would indicate that further teaching is indicated? "I must always feed my baby with a syringe and not use a nipple." The nurse is preparing a plan of care for an infant who will be returning from the recovery room following the surgical repair of a cleft lip located on the right side of the lip. On return from the recovery room, the nurse should plan to place the infant in which position? On the left side The parents of a child with a cleft lip are concerned and ask the nurse when the lip will be repaired. With which statement should the nurse respond? Cleft-lip repair is usually performed during the first weeks of life. The parents of a child with a cleft palate are concerned and ask the nurse when the palate will be repaired. The nurse should plan to base the response on which information about cleft palate repair? Repair usually is performed between 6 months and 2 years The nurse is providing discharge instructions to the mother of a child who had a cleft palate repair. Which statement should the nurse make to the mother? "You need to use a short nipple on the child's bottle." A nurse provides home care instructions to the mother of a child who had a cleft palate repair 4 days ago. Which statement by the mother indicates the need for further instruction? "I need to buy some straws for drinking." Baby Jonathan was born with cleft lip (CL); Nurse Barbara would be alert that which of the following will most likely be compromised? Sucking ability. - Elbow restraints for cleft palate repair. NCLEX Pyloric Stenosis Nurse Nancy is assessing a child with pyloric stenosis; she is likely to note which of the following? Projectile vomiting The nurse is reviewing the laboratory results for an infant with suspected hypertrophic pyloric stenosis. What should the nurse expect to note as the most likely finding in this infant? Metabolic alkalosis (due to vomiting) The nurse is reviewing the laboratory test results for an infant suspected of having hypertrophic pyloric stenosis. The nurse should expect to note which value as the most likely laboratory finding in this infant? Blood pH of 7.50 (increased blood pH and bicarbonate) An infant is seen in the health care provider's office for complaints of projectile vomiting after feeding. Findings indicate that the child is fussy and is gaining weight but seems to never get enough to eat. Pyloric stenosis is suspected. Which prescription would the nurse anticipate having the highest priority in the care of this child? Prepare the family for surgery for the child. The nurse is developing a plan of care for an infant being admitted with hypertrophic pyloric stenosis who is scheduled for pyloromyotomy. In the preoperative period, which position should the nurse suggest to document in the plan of care? Supine with the head of the bed elevated (to reduce the risk for aspiration) The nurse is caring for a 7-week-old infant scheduled for a pyloromyotomy in 24 hours. Which would the nurse expect to see in the plan of care? Keep infant NPO; begin intravenous fluids at maintenance; place nasogastric tube (NGT) to low wall suction. Gastroesophageal Reflux (GER) Which of the following parameters would Nurse Max monitor to evaluate the effectiveness of thickened feedings for an infant with gastroesophageal reflux (GER)? Vomiting (Thickened feedings are used with GER to stop the vomiting) Baby Ellie is diagnosed with gastroesophageal reflux (GER). Which of the following nursing diagnoses would be inappropriate? Impaired oral mucous membrane The nurse is caring for a 4-month-old with gastroesophageal reflux (GER). The infant is due to receive Zantac (rantadine). Based on the medication’s mechanism of action, when should this medication be administered? Zantac decreases gastric acid secretion and should be administered 30 minutes before a feeding. Gastroesophageal Reflux Disease (GERD) In pediatric gastroesophageal reflux disease (GERD), the immaturity of lower esophageal sphincter function is manifested by frequent transient lower esophageal relaxations, which result in retrograde flow of gastric contents into the esophagus. Which statement about the esophagus is true? Select all that apply. It has upper and lower sphincters, and it is a highway for food and drinks to travel along to make it to the stomach. An infant is seen in the health care provider's office for complaints of frequent vomiting and spitting up after feedings. Findings indicate that the infant is not gaining weight and gastroesophageal reflux is suspected. Which would the nurse anticipate being prescribed initially in the care of this child? Change the formula to predigested formula and feed small, frequent feedings. The nurse provides feeding instructions to a parent of an infant diagnosed with gastroesophageal reflux disease. Which instruction should the nurse give to the parent to assist in reducing the episodes of emesis? Thicken the feedings by adding rice cereal to the formula. The nurse knows that the Nissen fundoplication involves which of the following? The fundus of the stomach is wrapped around the inferior esophagus, mimicking a cardiac sphincter. Appendicitis A 10-year-old is being evaluated for possible appendicitis and complains of nausea and sharp abdominal pain in the right lower quadrant. The child vomits, finds the pain relieved, and calls the nurse. What is the nurse's priority action? Immediately notify the physician of the child's status. Parents bring their child to the emergency department and tell the nurse that the child has been complaining of colicky abdominal pain located in the lower right quadrant of the abdomen. The nurse suspects that the child has which disorder? Appendicitis A nurse is caring for a child who was brought to the clinic complaining of severe abdominal pain and is suspected of having acute appendicitis. The child is lying on the examining table, with the knees pulled up toward the chest. The nurse assists the health care provider with further assessment of the progression of the child's pain, knowing that the health care provider will palpate the abdomen in which location? Midway between the right anterior superior iliac crest and the umbilicus (McBurney's point) A nurse is assigned to care for a child who is scheduled for an appendectomy. Select the prescription(s) that the nurse anticipates will be prescribed. Select all that apply Initiate an IV line, maintain an NPO status, administer intravenous antibiotics, administer preoperative medications. An 8-year-old is being evaluated in the ER for suspected appendicitis. The physician has them lie on their left side and extend the hip, eliciting pain in the RLQ. What is this test called? Psoas Sign Hirschsprung's disease A child is diagnosed with Hirschsprung's disease. The nurse is teaching the parents about the cause of the disease. Which statement, if made by the parent, supports that teaching was successful? "Special cells are not present in the rectum, which caused the disease." A nurse is caring for a child who has Hirschsprung's disease. Which of the following actions should the nurse take? Prepare the family for surgery. Dustin who was diagnosed with Hirschsprung’s disease has a fever and watery explosive diarrhea. Which of the following would Nurse Joyce do first? Notify the physician immediately. Mr. and Ms. Byers’ child failed to pass meconium within the first 24 hours after birth; this may indicate which of the following? Hirschsprung’s disease Crohn's Disease abdominal distensions are more common in Crohn’s disease For what condition does the nurse taking care of a 5-year-old newly diagnosed with Crohn disease teach the parents that their son may be at risk later? Cancer Gastroenteritis A child admitted to the hospital with a diagnosis of gastroenteritis and dehydration weighs 17 pounds 2 ounces. The parents state that his preadmission weight was 18 pounds 4 ounces. Based on weight alone, what type of dehydration does the nurse expect? Moderate dehydration (Mild dehydration is a weight loss of 3% to 5%; moderate dehydration is 6% to 10%; severe dehydration is greater than 10% weight loss.) A nurse is caring for an infant with gastroenteritis who is being treated for dehydration. The nurse reviews the health record and notes that the health care provider has documented that the infant is mildly dehydrated. Which assessment finding should the nurse expect to note in mild dehydration? Pale skin color. (Anuria, Sunken fontanels = severe dehydration) (Dry mucous membranes = moderate dehydration) While preparing to discharge an 8-month-old infant who is recovering from gastroenteritis and dehydration, the nurse teaches the parents about their infant’s dietary and fluid requirements. The nurse should include which other topic in the teaching session? Safety guidelines Pneumonia What intervention can be taught to the parents of a 3-year-old child with pneumonia who is not hospitalized? Offer the child her favorite warm liquid drinks. Asthma Select all the following that can trigger an asthma attack: A. Sulfites B. Smoke C. Caffeine D. GERD E. Cold, windy weather F. Beta agonist G. Cockroaches A, B, D, E, and G (Caffeine has the same properties as theophylline, which is a bronchodilator and is not known to cause asthma. In addition, beta adrenergic blockers that are nonselective (NOT beta agonist...which are used to treat asthma) can cause an asthma attack) Which medication below blocks the function of Leukotriene for the treatment of asthma? Montelukast A patient received a nebulizer of Albuterol. What is a side effect of this medication? Tachycardia, nervousness, nausea, headache A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests asthma. Following parental teaching, the nurse is evaluating the parents understanding of environmental control for their child’s asthma management. Which statement by the parents indicates appropriate understanding of the teaching? We will replace the carpet in our child’s bedroom with tile. An 11-year-old is admitted for treatment of an asthma attack. Which of the following indicates immediate intervention is needed? Intercostal retractions. A 12-year-old with asthma wants to exercise. Which of the following activities should the nurse suggest to improve breathing? Swimming An adolescent with chest pain goes to the school nurse. The nurse determines that the teenager has a history of asthma but has had no problems for years. Which of the following should the nurse do next? Obtain a peak flow reading A 7-year-old child with a history of asthma controlled without medications is referred to the school nurse by the teacher because of persistent coughing. Which of the following should the nurse do first? Call a parent to obtain more information. When developing a teaching plan for the mother of an asthmatic child concerning measures to reduce allergic triggers, which of the following suggestions should the nurse include? Keep the humidity in the home between 50% and 60%. After discussing asthma as a chronic condition, which of the following statements by the father of a child with asthma best reflects the family's positive adjustment to this aspect of the child's disease? "Although our child's disease is serious, we try not to let it be the focus of our family." An 8-year-old child with asthma states, "I want to play some sports like my friends. What can I do?" The nurse responds to the child based on the understanding of which of the following? Most children with asthma can participate in sports if the asthma is controlled. The Andrews family has been taking good care of their youngest, Archie, who was diagnosed with asthma. Which of the following statements indicate a need for further home care teaching? "We'll make sure that he avoids exercise to prevent attacks." Alice is rushed to the emergency department during an acute, severe prolonged asthma attack and is unresponsive to usual treatment. The condition is referred to as which of the following? Status asthmaticus An adolescent, with chronic asthma, who has been hospitalized several times during the winter with severe asthmatic exacerbations confides, "I wish I could stay here in the hospital because every time that I go home, I get sick again!" The pediatric nurse's best response is “Let's talk about preventing and managing your asthma on a daily basis at home." Which finding would alert a nurse that a hospitalized 6-year-old child is at risk for a severe asthma exacerbation? History of steroid-dependent asthma A patient with asthma is prescribed to take inhaled Salmeterol and Fluticasone for long-term management of asthma. You observe the patient taking these medications. Which option below best describes the correct order in how to take these medications? The patient inhales the Salmeterol first and then waits 5 minutes before inhaling the Fluticasone. Select all the correct options that represent the pathophysiology of an asthma attack. The mucosa lining experiences severe inflammation, the goblet cells within the mucosa lining produce excessive amounts of mucous. Bronchiolitis The nurse is providing care to an infant in the emergency department. Upon assessment, the infant is noted to have to be experiencing tachypnea, wheezing, retractions, and nasal flaring. The infant is irritability, and the parents state the infant has had poor fluid intake for two days. Pulse ox reading is currently at 85% on room air. The infants blood gas is pending. Which diagnosis does the nurse anticipate for this infant? Bronchiolitis Wheezes cystic fibrosis Betty is a 9-year-old girl diagnosed with cystic fibrosis. Which of the following must Nurse Archie keep in mind when developing a care plan for the child? Pulmonary secretions are abnormally thick. A 9-month-old child with cystic fibrosis does not like taking pancreatic enzyme supplement with meals and snacks. The mother does not like to force the child to take the supplement. The most important reason for the child to take the pancreatic enzyme supplement with meals and snacks is the child needs these pancreatic enzymes to help the digestive system absorb fats, carbohydrates, and proteins A client's diagnosis of cystic fibrosis was made 13 years ago, and he/she has since been hospitalized several times. On the latest admission, the client has labored respirations, fatigue, malnutrition, and failure to thrive. Which nursing actions are most important initially? Applying an oximeter and initiating respiratory therapy. Which vitamin supplements are necessary for children with cystic fibrosis? Vitamins A, D, E, and K (Fatsoluble vitamins are poorly absorbed because of deficient pancreatic enzymes in children with cystic fibrosis; therefore, supplements are necessary) The nurse should teach parents of a child with cystic fibrosis to adjust enzyme dosage according to which indicator? Stool formation Which finding confirms a diagnosis of cystic fibrosis? Sweat chloride is greater than 60 Bronchopulmonary Dysplasia (BPD) also known as Chronic Lung Disease Baby Melody is a neonate who has a very low birthweight. Nurse Josie carefully monitors inspiratory pressure and oxygen (O2) concentration to prevent which of the following? Bronchopulmonary dysplasia (BPD) (Need supplemental oxygen for 28 days)