Child Health Nursing (NURS 4140) Final Exam Questions & Answers (Explained Solutions)

Child Health Nursing (NURS 4140) Final Exam Questions & Answers (Explained Solutions)-The nurse is caring for a special needs infant. Which intervention will be most important in helping the child reach her maximum developmental potential? A. Monitoring her progress in elementary school B. Directing her parents to an early intervention program C. Serving on an individualized education program committee D. Preparing a plan for her to transition to college - B. Early intervention is critical to maximizing the child's developmental potential by laying the foundation for health and development. While important, intervention in elementary or secondary school does not have the impact of early intervention. When the time arrives, it is important to have a written plan for transition to college, if this is a possibility for the grown child. A child is diagnosed with hemolytic-uremic syndrome (HUS). Review of the child's laboratory test results would reveal which of the following? A. Respiratory acidosis and proteinuria B. Decreased blood urea nitrogen (BUN) and creatinine C. Hypernatremia and hypokalemia D. Decreased platelets and leukocytosis - D. The child with HUS typically exhibits severe thrombocytopenia (decreased platelets) and leukocytosis. BUN and creatinine are elevated. Hyponatremia, hyperkalemia, metabolic acidosis, and proteinuria also may be noted. A 2-month-old infant is admitted with suspected Spinal Muscular Atrophy. Which of the following findings is the nurse likely to assess? Select one or more a. Scoliosis b. Generalized weakness c. Low weight-to-length ratio d. Weak cry - B. C. D. A 2-year-old has a tonic-clonic seizure while in the hospital crib. The child's jaws are clamped. Which is the most important nursing action at this time? a. Place a padded tongue blade between the child's jaws. b. Restrain the child to prevent injury. c. Prepare the suction equipment. d. Stay with the child and observe his respiratory status. - D. It is important for the nurse to stay with the child to assess for any changes in the child's respiratory status. Place the child in side-lying position, if possible, to allow secretions to drain. Monitor for adequate oxygenation. The child is at risk for hypoxic injury if the respiratory status is compromised. A 15-year-old boy comes to the emergency department accompanied by his parents. The boy reports an abrupt onset of sudden pain on the right side of his scrotum. When asked to rate his pain on a scale of 1 to 10, with 10 being the most severe, the boy states, "It's a 12." Further assessment reveals a blue-black swelling on the affected side. The nurse suspects testicular torsion and immediately notifies the physician based on the understanding of which of the following? A. The condition is a surgical emergency. B. Renal failure is imminent. C. Intravenous antibiotics need to be initiated D. The boy is at risk for sepsis. - A. Testicular torsion is a surgical emergency that necessitates immediate surgical correction to prevent testicular necrosis and possible gangrene. There is no infection with testicular torsion, intravenous antibiotics are not used to treat this condition, and renal failure is not imminent. Ordered: IV + PO to equal maintenance Child's weight: 6.3 kg IVF ran at full maintenance all night while the child slept. At 0800, child drinks 46 mL formula. Adjust the rate for the next four hours. - 6.3 kg * 100ml/day = 630 ml/day = maintenance = 26.3 ml/hour 4 hours worth = 105.2 Minus the 46 the child took po = 59.2 to be made up with IVF/4 hours = 14.8 ml/hr The nurse assesses a child's level of consciousness, noting that the child falls asleep unless he is stimulated. The nurse documents this finding as: A. Confusion B. Obtunded C. Stupor D. Coma - B. Obtunded is a state in which the child has limited responses to the environment and falls asleep unless stimulation is provided. Confusion involves disorientation; the child may be alert but responds inappropriately to questions. Stupor exists when the child responds only to vigorous stimulation. Coma is a state in which the child cannot be aroused even with painful stimuli. Ordered: D5 1/2 NS with 20 mEq KCl/L at maintenance. Child weighs 11.5 kg. What is the appropriate hourly rate? - First 10 kg = 1000 mL/daY Next 1.5 kg *50 mL/day = 75 ml/day Maintenance for 24 hours: 1075 ml Hourly rate: 44.8 ml/hr A child weighs 8 pounds 8 ounces. Ordered: Ampicillin 400 mg/kg/day in divided doses q 6 hours IV Available: Ampicillin 100 mg/mL What dose will you administer in a single dose? ____ mL - 8.5 lbs / 2.2 lbs/kg = 3.8636 kg x 100 mg/dose = 386.4 mg Alternately: 8.5 lbs / 2.2 lbs/kg = 3.8636 kg x 400 mg/day = 1545.45 mg / 4 times a day = 386.4 mg 386.4 mg/ 100 mg/mL = 3.86 mL Chronic sorrow is the periodic recurrence of grief-related feelings associated with an ongoing disparity from a loss experience. Which of the following families are at high risk for developing chronic sorrow? Select one or more a. Parents of a child who experienced pelvis and femur fractures in an automobile/bicycle accident who must spend 3 months in full spica cast. b. Parents of a child with Pierre-Robin sequence who is trach dependent c. Parents of a child admitted with pneumonia right before Christmas d. Parents of a child with spina bifida who is wheelchair bound - B and D Spina bifida: This child will have some limitations on "normal" activities of childhood. He/she may want to be involved with other children, but be unable to participate in the same activities or visit friends home because of limited wheelchair access. These represent ongoing periodic reminders of the loss of a healthy child and the expected experiences that brings. Pierre-Robin Sequence: This child will have limitations on "normal" activities of childhood. He/she may want to be involved with other children, but be unable to participate in the same activities because he/she is dependent on technology and on specific training. What if he/she was at a friend's house and the trach was coughed out? What would the other parents do? These alterations in expectations represent ongoing periodic reminders of the loss of a healthy child. A child with a myelomeningocele corrected at birth is now 5 years old. What is a priority nursing diagnosis for a child with corrected spina bifida at this age? a. Risk for altered urinary elimination b. Risk for altered comfor c. Risk for infection d. Risk for impaired tissue perfusion-cranial - A. Children with spina bifida are prone to neurogenic bladder. The bladder may not empty completely with voiding, resulting in urinary retention. A nurse is doing a postop assessment on an infant who has just had a ventroperitoneal shunt placed for hydrocephalus. Which assessment would indicate a malfunction in the shunt? a. Bulging fontanelle b. Negative Brudzinski sign c. Incisional pain d. Movement of all extremities - A A nurse is conducting a physical examination of an infant and observes the urethral opening on the dorsal side of the penis. The nurse documents this finding as which of the following? Select one: A. Hypospadias B. Varicocele C. Hydrocele D. Epispadias - D. Epispadias is a urethral defect in which the opening is on the dorsal surface of the penis. Hypospadias is a urethral defect in which the opening is on the ventral surface of the penis rather than at the end. Varicocele is a venous varicosity along the spermatic cord manifested as a scrotal swelling. Hydrocele is a benign condition in which fluid accumulates in the scrotal sac.