UWorld Pediatric Nursing, complete questions & answers (elaborated)

Pediatric Nursing Respiratory Cystic Fibrosis - Pancreatic Enzymes Test Id: Question Id: 30371 () 1 of 36 A A A The mother of a 6-year-old child with cystic fibrosis (CF) has received instruction on the use of pancreatic enzymes. Which statement made by the mother indicates a need for further teaching? Unordered Options Ordered Response 1. "I need to monitor the total amount of this medication that I give to my child every day." 2. "I should give this medication with or just before my child has a meal or snack." 3. "It is okay for my child to chew this medication." 4. "It is okay to open the capsule and sprinkle the medicine on a tablespoon of applesauce." You answered this question incorrectly. Time Spent: 74 Seconds 62% of people answered this question correctly. Last Updated: 10/31/2015 Explanation In CF, unusually thick mucus obstructs the pancreatic ducts, preventing pancreatic enzymes (amylase, trypsin, and lipase) from reaching the small intestine. The result is malabsorption of carbohydrates, fats, and proteins; the inability to absorb fat-soluble vitamins (A, D, E, and K) is of particular concern. Gastrointestinal signs and symptoms of CF include flatulence, abdominal cramping, ongoing diarrhea, and/or steatorrhea. Nutritional therapy includes the administration pancreatic enzyme supplements with or just before every meal or snack (Option 2). These enzymes are enteric-coated beads designed to dissolve only in an alkaline environment similar to that of the small intestine. They must not be mixed with a substance that would cause them to dissolve prior to reaching the jejunum. Capsule contents may be sprinkled on applesauce, yogurt, or acidic, soft, room-temperature foods with pH <4.5. Capsules should be swallowed whole and not crushed or chewed; chewing the capsules could cause irritation of the oral mucosa. Excessive intake of pancreatic enzymes can result in fibrosing colonopathy (Option 1). (Option 4) This is a true statement; some children have difficulty taking a whole capsule. Capsule contents can be sprinkled in acidic substances such as applesauce. Capsules should not be taken with milk as they can cause it to curdle. Educational objective: Pancreatic enzyme supplements are used to aid the absorption of carbohydrates, fats, and proteins in a child with CF. They are taken with or just before every meal (not as needed); should be swallowed whole or sprinkled on an acidic food; and should not be crushed or chewed. They should not be taken with milk. Excessive intake could result in fibrosing colonopathy. Neurologic Priority Peds Clogged Shunt Test Id: Question Id: 32143 () 2 of 36 A A A The emergency department triage nurse is assessing 4 pediatric clients. Which client is a priority for further diagnostic workup and definitive care? Unordered Options Ordered Response 1. 1-year-old with ventriculoperitoneal shunt who has "lethargy" and pulse of 78/min 2. 3-year-old with history of meningocele who has unilateral ear pain and urinary incontinence 3. 6-year-old with muscular dystrophy who has "flu-like" symptoms and temperature of 100.4 F (38 C) 4. 8-year-old with history of cerebral palsy who has foot injury and spastic clonus You answered this question correctly. Time Spent: 183 Seconds 72% of people answered this question correctly. Last Updated: 8/31/2015 Explanation A ventriculoperitoneal shunt is used to treat hydrocephalus and is usually placed at age 3-4 months. Blockage and infection are complications of shunt placement. Blockage results in signs of increased intracranial pressure (ICP). The normal pulse range for a 1-year-old is 100-160/min. A pulse of 78/min is considered bradycardia, a part of Cushing's triad (bradycardia, slowed respiration, widened pulse pressure). (Option 2) Meningocele is a saclike protrusion through a bony defect that contains meninges and cerebrospinal fluid; it is corrected with surgery. In some children, residual bowel and bladder incontinence can result despite surgery. If bowel and bladder control is obtained but incontinence reoccurs, the child should be evaluated for infection (a common complication). Although the child with ear pain (eg, otitis media) may need antibiotics, this is not urgent and the client with neurological signs is the priority. (Option 3) Muscular dystrophy is an inherited condition of muscle fiber degeneration and muscle wasting. Respiratory and cardiac problems are the leading causes of mortality. These clients should take precautions to prevent respiratory infections (eg, pneumococcal and influenza vaccination, avoiding contact with infected individuals). This client is the second priority after