NUR 122 Study Guide With Correct Answers Graded A+
A 2 year old is admitted to the neurosurgical unit following a head injury. The nurse is using the
Glasgow Coma Scale to measure neurological functioning. Which of the following assessment
findings indicate the lowest level of functioning for this child?☑️Correct Ans-No response to
painful stimuli
The nurse is caring for a 4-month old infant who has had an isolated cleft lip repair. What is the
best position for the child in the immediate postoperative period?☑️Correct Ans-Supine
A 2 month old infant is brought to the pediatric clinic. The infant has had vomiting and diarrhea
for 24 hours. The infant is irritable and his anterior fontanel is sunken. Which of the following
will help confirm the diagnosis of dehydration?☑️Correct Ans-Analysis of serum electrolytes
A nurse is caring for a newborn infant with spina bifida (myelomeningocele) who is scheduled
for surgical closure of the sac. In the preoperative period, the priority nursing diagnosis would
be:☑️Correct Ans-Risk for infection
A nurse is caring for a child recently diagnosed with cerebral palsy and the parents of the child
ask the nurse about their disorder. The nurse bases her response on understanding that cerebral
palsy is:☑️Correct Ans-A chronic disorder characterized by impaired muscle movement and
posture.
The nurse is caring for a 4 year old who weighs 15 kg (33lbs). At the end of a 10- hour period,
the nurse notes the urine output to be 150 mL. The nurse determines that the urinary output for
,this child during the period is:☑️Correct Ans-within the expected range of output---(child
normal range is 0.5 to 1ml/kg/hr)
Which of the following will the nurse recognize as a major goal of treatment for children with
cerebral palsy?☑️Correct Ans-Promoting a maximum level of independence
The nurse is teaching the familiy about nephrotic syndrome and explains the clinical
manifestations are due to which of the following?☑️Correct Ans-Increased permeability of the
glomeruli
Urinary output ranges:☑️Correct Ans-Check: The normal range for 24-hour urine volume is
800 to 2000 milliliters per day (with a normal fluid intake of about 2 liters per day). Oliguria is
urine output < 500 mL in 24 h (0.5 mL/kg/h) in an adult. Oliguria is urine output < 1 L in 24 h (1
mL/kg/h) in a child.
Calculating urinary output:☑️Correct Ans-Check: Pediatric Urine Output Calculation. The
expected urine output for an adult is > 0.5mL/kg/hour, so an average adult of 70kg would be
expected to produce 35-40ml/hour of urine. For children, the expected urine output is closer to
1ml/kg/hour. The normal urine output for adults is 1 ml/min, regardless of weight.
The predominant signs of or symptoms of hydrocephalus are different in infants as compared to
older children.☑️Correct Ans-True (due to anterior and posterior fontanels closures in infants)
The nurse is caring for a 14 year old girl with celiac disease. The nurse knows that the patient
understands the diet instructions by ordering which of the following meals?☑️Correct Ans-
cheese, banana slices, rice cakes and whole milk (must be gluten free)
, GI differences in a pediatric patient:☑️Correct Ans-Small stomach capacity (spits up more if
full & fed more often in smaller amts); relaxed cardiac sphincter (When relaxed, a sphincter
allows materials to pass through the opening. When contracted, it closes the opening.); bowel
mvmts several x per day; decreased enzymes (difficulty digest proteins except for breast milk);
belly distention from gas (colicky, gasey); immature liver (decreased enzymes for digestion);
usually health babies, sometimes premies
Cardiac sphincter☑️Correct Ans-circular muscles located where the lower end of the esophagus
joins the stomach. The muscle serves as the valve that contracts to prevent acid reflux and
relaxes to allow food to pass.
Assessment guidelines for The Child With a Gastrointestinal Condition:☑️Correct Ans-Inspect,
auscultate, palpate, percuss, mouth and esophagus, nutrition, stool, family history
Abdomen—inspection☑️Correct Ans-• Observe the shape of the abdomen.
• Note any abdominal distention. Measure abdominal girth.
• Observe the umbilicus for protrusion.
• Observe for peristaltic waves (visible rhythmic contractions of the intestinal wall smooth
muscle).
• Observe for jaundice, bruising, and increased bleeding.
Abdomen—auscultation☑️Correct Ans-• Auscultate for bowel sounds in all four quadrants
prior to palpation.
A 2 year old is admitted to the neurosurgical unit following a head injury. The nurse is using the
Glasgow Coma Scale to measure neurological functioning. Which of the following assessment
findings indicate the lowest level of functioning for this child?☑️Correct Ans-No response to
painful stimuli
The nurse is caring for a 4-month old infant who has had an isolated cleft lip repair. What is the
best position for the child in the immediate postoperative period?☑️Correct Ans-Supine
A 2 month old infant is brought to the pediatric clinic. The infant has had vomiting and diarrhea
for 24 hours. The infant is irritable and his anterior fontanel is sunken. Which of the following
will help confirm the diagnosis of dehydration?☑️Correct Ans-Analysis of serum electrolytes
A nurse is caring for a newborn infant with spina bifida (myelomeningocele) who is scheduled
for surgical closure of the sac. In the preoperative period, the priority nursing diagnosis would
be:☑️Correct Ans-Risk for infection
A nurse is caring for a child recently diagnosed with cerebral palsy and the parents of the child
ask the nurse about their disorder. The nurse bases her response on understanding that cerebral
palsy is:☑️Correct Ans-A chronic disorder characterized by impaired muscle movement and
posture.
The nurse is caring for a 4 year old who weighs 15 kg (33lbs). At the end of a 10- hour period,
the nurse notes the urine output to be 150 mL. The nurse determines that the urinary output for
,this child during the period is:☑️Correct Ans-within the expected range of output---(child
normal range is 0.5 to 1ml/kg/hr)
Which of the following will the nurse recognize as a major goal of treatment for children with
cerebral palsy?☑️Correct Ans-Promoting a maximum level of independence
The nurse is teaching the familiy about nephrotic syndrome and explains the clinical
manifestations are due to which of the following?☑️Correct Ans-Increased permeability of the
glomeruli
Urinary output ranges:☑️Correct Ans-Check: The normal range for 24-hour urine volume is
800 to 2000 milliliters per day (with a normal fluid intake of about 2 liters per day). Oliguria is
urine output < 500 mL in 24 h (0.5 mL/kg/h) in an adult. Oliguria is urine output < 1 L in 24 h (1
mL/kg/h) in a child.
Calculating urinary output:☑️Correct Ans-Check: Pediatric Urine Output Calculation. The
expected urine output for an adult is > 0.5mL/kg/hour, so an average adult of 70kg would be
expected to produce 35-40ml/hour of urine. For children, the expected urine output is closer to
1ml/kg/hour. The normal urine output for adults is 1 ml/min, regardless of weight.
The predominant signs of or symptoms of hydrocephalus are different in infants as compared to
older children.☑️Correct Ans-True (due to anterior and posterior fontanels closures in infants)
The nurse is caring for a 14 year old girl with celiac disease. The nurse knows that the patient
understands the diet instructions by ordering which of the following meals?☑️Correct Ans-
cheese, banana slices, rice cakes and whole milk (must be gluten free)
, GI differences in a pediatric patient:☑️Correct Ans-Small stomach capacity (spits up more if
full & fed more often in smaller amts); relaxed cardiac sphincter (When relaxed, a sphincter
allows materials to pass through the opening. When contracted, it closes the opening.); bowel
mvmts several x per day; decreased enzymes (difficulty digest proteins except for breast milk);
belly distention from gas (colicky, gasey); immature liver (decreased enzymes for digestion);
usually health babies, sometimes premies
Cardiac sphincter☑️Correct Ans-circular muscles located where the lower end of the esophagus
joins the stomach. The muscle serves as the valve that contracts to prevent acid reflux and
relaxes to allow food to pass.
Assessment guidelines for The Child With a Gastrointestinal Condition:☑️Correct Ans-Inspect,
auscultate, palpate, percuss, mouth and esophagus, nutrition, stool, family history
Abdomen—inspection☑️Correct Ans-• Observe the shape of the abdomen.
• Note any abdominal distention. Measure abdominal girth.
• Observe the umbilicus for protrusion.
• Observe for peristaltic waves (visible rhythmic contractions of the intestinal wall smooth
muscle).
• Observe for jaundice, bruising, and increased bleeding.
Abdomen—auscultation☑️Correct Ans-• Auscultate for bowel sounds in all four quadrants
prior to palpation.
