Ati nur235 paediatrics final exam
Total Questions : 62
Showing 25 questions, Sign in for moreA newborn is admitted to the pediatric unit to rule out congenital hypothyroidism. Which of the following findings would the nurse expect if this diagnosis is confirmed?
Explanation
Rationale:
A. Bradycardia, constipation, and hypotonia are common symptoms associated with congenital hypothyroidism due to the reduced metabolism that results from decreased thyroid hormone levels.
B. Elevated serum T3 and T4 would not be expected in congenital hypothyroidism; these levels are typically low.
C. Tachycardia, diarrhea, and tremors are more indicative of hyperthyroidism, not hypothyroidism.
D. In congenital hypothyroidism, the thyroid-stimulating hormone (TSH) is typically elevated as the body attempts to stimulate the thyroid gland to produce more hormones.
A nurse is performing a developmental assessment on a 4-year-old client. What assessment finding would warrant further investigation?
Explanation
Rationale:
A. Urinary and bowel continence is expected by age 4, so this does not warrant further investigation.
B. Tying shoes is a skill typically developed later, around 5-6 years of age, so not being able to do so at age 4 is not concerning.
C. Having an imaginary friend is common in children around this age and is not a cause for concern.
D. Speaking in 2-3 word sentences is typical for a younger child, around 2 years of age. By age 4, a child should be able to speak in more complex sentences, so this finding warrants further investigation.
The nurse is reviewing the record of a pediatric client diagnosed with pyloric stenosis. Which assessment finding would the nurse expect to find in the electronic health record?
Explanation
Rationale:
A. Projectile vomiting is a classic sign of pyloric stenosis, where the thickened pylorus muscle obstructs the passage of food from the stomach to the small intestine, causing forceful vomiting.
B. Large amounts of bilious emesis would suggest an obstruction beyond the pylorus, which is not characteristic of pyloric stenosis.
C. Watery diarrhea is not associated with pyloric stenosis, which typically causes dehydration and constipation.
D. Steatorrhea, or fatty stools, is not a feature of pyloric stenosis but rather is associated with malabsorption syndromes.
An infant has been admitted to the pediatric unit with a diagnosis of pyloric stenosis. What would the nurse expect in the plan of care for this client?
Explanation
Rationale:
A. While pain management is important, the primary treatment for pyloric stenosis is surgical correction, not just analgesic medication.
B. Preparation for surgical correction, specifically a pyloromyotomy, is the standard treatment for pyloric stenosis to relieve the obstruction.
C. A barium enema is not used in the diagnosis or treatment of pyloric stenosis; it is typically used to diagnose other gastrointestinal conditions.
D. Thickened feedings with rice cereal are not indicated for pyloric stenosis and would not resolve the obstruction.
.A nurse is providing teaching to the parents of a toddler who has iron-deficiency anemia and is taking iron supplements. Which statement by the parents indicates an understanding of the teaching?
Explanation
Rationale:
A. Restricting fiber is not necessary; instead, administering vitamin C with iron can enhance absorption.
B. Iron supplements can cause dark stools, but not blood in the stools. Blood in the stools requires further investigation.
C. Routine monitoring of blood counts is crucial to assess the effectiveness of the iron supplementation and to adjust the dosage as needed.
D. Iron supplements are better absorbed on an empty stomach; taking them with meals can reduce their absorption.
.During the assessment of a pediatric client with celiac disease, the nurse would most likely note which physical finding?
Explanation
Rationale:
A. Tender inguinal lymph nodes are not associated with celiac disease and are more indicative of localized infections or lymphadenopathy.
B. An enlarged liver is not typically related to celiac disease but may occur in other conditions such as fatty liver disease.
C. A protuberant abdomen is a common finding in children with celiac disease due to malabsorption and gas accumulation in the intestines. This is often accompanied by abdominal distension and discomfort.
D. Periorbital edema is not characteristic of celiac disease and is more commonly seen in conditions like nephrotic syndrome.
A nurse is closely monitoring a pediatric client following a tonsillectomy. Which finding would alert the nurse to a postoperative complication?
Explanation
Rationale:
A. Dry mouth is expected postoperatively, especially if the child is not drinking adequate fluids, but it is not a sign of a complication.
B. Mild to moderate pain is expected after a tonsillectomy and should be managed with analgesics.
C. Dried flecks of blood in oral secretions can be normal immediately after surgery, but active bleeding would be concerning.
D. Frequent swallowing is a sign of possible postoperative bleeding, which is a serious complication that requires immediate evaluation and intervention.
.A 4-year-old client presents to the emergency department with drooling, agitation, and inability to cough. The nurse should recognize these findings are associated with which diagnosis?
Explanation
Rationale:
A. Bronchiolitis usually presents with wheezing and difficulty breathing, not drooling or inability to cough.
B. Asthma typically presents with wheezing, shortness of breath, and coughing, but not with drooling or an inability to cough.
C. Nasopharyngitis, or the common cold, usually causes symptoms like runny nose, cough, and sore throat, but not drooling or agitation.
D. Bacterial epiglottitis is a life-threatening condition characterized by drooling, agitation, inability to cough, and potential airway obstruction. The child often appears anxious and sits leaning forward in a "tripod" position.
A 5-year-old girl presents to the clinic with a urinary tract infection (UTI). After educating the family on preventing recurrent infections, what statement by the family indicates further teaching is needed?
Explanation
Rationale:
A. Increasing fiber intake is beneficial for overall digestive health and can prevent constipation, which may help in reducing the risk of UTIs.
B. Wiping from front to back is crucial in preventing the spread of bacteria from the anal area to the urinary tract, reducing the risk of recurrent UTIs.
C. Follow-up with a specialist may be necessary if the child has recurrent UTIs, to rule out underlying issues such as vesicoureteral reflux.
D. No additional testing after antibiotics might be needed for a simple UTI, but in cases of recurrent UTIs, further testing is often required to ensure the infection has resolved and to investigate any underlying causes.
.A nurse is caring for an infant in the post-anesthesia care unit following cleft lip and palate repair. What is an appropriate action for the nurse to take?
Explanation
Rationale:
A. Offering a pacifier is contraindicated after cleft lip and palate repair as it can disrupt the surgical site and interfere with healing.
B. Maintaining elbow restraints prevents the infant from touching or putting objects in their mouth, which could disrupt the surgical site and compromise healing.
C. The Trendelenburg position is not recommended as it can increase pressure on the surgical site and compromise breathing.
A
D. An ice collar may be used for pain relief in older children or adults but is not typically used in infants, and it may not be feasible in this population.
The mother of a 4-year-old client tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment, the mother tells the nurse that their child is eating well and that their activity level is unchanged. The nurse, suspecting the possibility of Wilms tumor, should avoid which action during the physical assessment?
Explanation
Rationale:
A. Monitoring the temperature for fever is appropriate as part of a general assessment and could help identify signs of infection.
B. Monitoring blood pressure is important because hypertension can be associated with Wilms tumor.
C. Assessing the urine for hematuria is appropriate, as hematuria can be a symptom of Wilms tumor.
D. Palpating the abdomen is contraindicated in suspected Wilms tumor cases because it could cause the tumor to rupture, potentially spreading cancerous cells. Therefore, palpating the abdomen should be avoided until further diagnostic procedures are performed.
In caring for a pediatric client with nephrotic syndrome, which intervention should be included in the plan of care?
Explanation
Rationale:
A. Regular testing of urine for glucose is not specific to nephrotic syndrome and is more relevant for managing diabetes.
B. Weighing the child on the same scale each day is essential for monitoring fluid status and detecting early signs of fluid retention or loss, which are critical in managing nephrotic syndrome.
C. Increasing oral fluid intake may not be recommended due to the risk of fluid retention and edema, which are common in nephrotic syndrome.
D. While monitoring potassium levels is necessary when on diuretics like furosemide, a low-potassium diet is not routinely required unless hyperkalemia is present.
A nurse has developed a plan of care for a family whose 7-year-old has been experiencing enuresis. Which of the following statements by the parents indicates that further teaching is needed?
Explanation
Rationale:
A. Limiting caffeinated beverages is a good strategy as caffeine can increase urine production and contribute to enuresis.
B. Limiting fluid intake during the day is not recommended as it can lead to dehydration. Instead, fluids should be limited in the evening before bedtime.
C. Waking the child at scheduled intervals to void is a common behavioral strategy to help manage enuresis.
D. Anticholinergic medications may be prescribed if behavioral strategies are ineffective, indicating that the parents have received proper education on this potential intervention.
The nurse is reviewing the medical record of a pediatric client suspected to have acute glomerulonephritis. What finding should the nurse expect to note in a client with this diagnosis?
Explanation
Rationale:
A. Decreased urine specific gravity is not typical; rather, increased specific gravity may be noted due to concentrated urine.
B. Hypotension is not usually associated with acute glomerulonephritis; hypertension is more common due to fluid retention and renal impairment.
C. A positive antistreptolysin O titer indicates a recent streptococcal infection, which is often the cause of post-streptococcal glomerulonephritis.
D. Elevated blood urea nitrogen (BUN) and creatinine levels are expected due to impaired kidney function, not low levels.
While assessing a preadolescent client, the nurse notes curvature of the client's spine. Which statement by the parent supports this observation?
Explanation
Rationale:
A. The child’s reluctance to change clothes in front of others might suggest body image issues, but it doesn’t directly indicate spinal curvature.
B. Difficulty finding pants that fit evenly over the hips could indicate a scoliosis-related curvature, where one hip may be higher than the other.
C. Back pain could be related to various conditions, including scoliosis, but by itself, it’s not definitive for spinal curvature.
D. Daily use of ibuprofen for hip pain may indicate musculoskeletal issues but doesn’t directly relate to spinal curvature or scoliosis.
A child allergic to insect stings presents to the school nurse stating, "A bee stung me on the playground." Which action by the school nurse should be prioritized?
Explanation
Rationale:
A. Applying topical diphenhydramine may help with local itching but is not the priority in a child with a known allergy to insect stings.
B. A cool pack can reduce swelling but is not the priority action if an allergic reaction is suspected.
C. Positioning the child with legs elevated is appropriate if there are signs of shock but does not address the immediate risk of airway compromise.
D. Assessing the client's airway and breathing rate is the priority because a child with a known allergy to insect stings is at risk for anaphylaxis, which can cause airway obstruction and respiratory distress. Early recognition and intervention are critical.
A nurse is caring for a 3-day-old newborn and suspects Hirschsprung disease. What finding best supports the nurse's concern?
Explanation
Rationale:
A. Passing tar-like stools is normal for newborns within the first few days of life and does not indicate Hirschsprung disease.
B. Limited stooling and poor weight gain may suggest feeding issues but are not as indicative of Hirschsprung disease as the absence of stool.
C. The absence of stool (failure to pass meconium within 24-48 hours) is a classic sign of Hirschsprung disease, a condition where the absence of ganglion cells in the intestines leads to a blockage.
D. Passing hard, pellet-like stools may indicate constipation but is not specific to Hirschsprung disease, especially in a newborn.
A nurse is planning care for a client who has acute glomerulonephritis. Which intervention should the nurse include in the plan when caring for this client?
Explanation
Rationale:
A. Fluid intake is usually restricted to prevent fluid overload, which can worsen edema and hypertension in acute glomerulonephritis.
B. Administering antibiotics may be necessary, especially if the condition is secondary to a streptococcal infection, which is a common cause of acute glomerulonephritis.
C. Rest is typically encouraged rather than frequent ambulation, as activity can exacerbate symptoms.
D. Daily weights, not weekly, are crucial for monitoring fluid balance in acute glomerulonephritis.
A nurse is caring for a 3-year-old child who has had 160 mL of urine output over the past 8 hour period. The child weighs 33 lb. After calculating the client's urinary output, which action is appropriate?
Explanation
Rationale:
A. There is no need to notify the provider if urine output is within the normal range.
B. Oral rehydration may not be necessary if the child is adequately hydrated.
C. A bladder scan is not required if the urine output is within the normal range.
D. Continue to monitor the client as the urine output is within the normal range. For a 3-year-old child (15 kg), normal urine output is 1-2 mL/kg/hr. This child’s output is approximately 1.3 mL/kg/hr, which is normal.
The nurse has taught the parents of a school-aged child with a newly placed ventriculoperitoneal (VP) shunt to monitor for early signs of shunt malfunction. The nurse determines the parents understand the instructions if they understand they should notify the provider if the child develops which early manifestation?
Explanation
Rationale:
A. Lethargy is an early sign of increased intracranial pressure (ICP) due to possible shunt malfunction and requires immediate medical attention.
B. Seizure activity can be a late sign of shunt malfunction and is also concerning but lethargy typically appears earlier.
C. Rapid weight gain is less directly related to shunt malfunction and more associated with conditions like hypothyroidism or edema.
D. Disinterest in school could suggest general malaise but is not a specific or early sign of shunt malfunction.
A pediatric client is admitted to the unit with failure to thrive. The mother states that the child has been "spitting up" and excessively crying immediately after every bottle. What diagnostic test will the nurse anticipate to confirm a diagnosis?
Explanation
Rationale:
A. An upper gastrointestinal series is commonly used to diagnose gastroesophageal reflux (GER), which can cause symptoms like spitting up and crying after feedings, leading to failure to thrive. This test helps visualize the esophagus, stomach, and duodenum for abnormalities.
B. A biopsy of the small intestine is typically done to diagnose celiac disease, which is less likely in this clinical scenario.
C. An ultrasound is used to diagnose pyloric stenosis, which presents with projectile vomiting and is less consistent with the described symptoms.
D. A lower gastrointestinal series is used to detect intestinal blockages, which are not suggested by the symptoms of spitting up and crying immediately after feeding.
A nurse is caring for an infant who has diaper dermatitis. What is an appropriate action for the nurse to take when caring for this client?
Explanation
Rationale:
A. Barrier creams should not be washed off with each diaper change; they should be left intact to protect the skin.
B. Cloth diapers can sometimes exacerbate diaper dermatitis due to moisture retention; disposable diapers may be better at wicking moisture away from the skin.
C. Talcum powder is not recommended due to the risk of inhalation, which can cause respiratory issues in infants.
D. Exposing the excoriated area to air frequently allows the skin to dry out, reducing moisture and irritation, which is beneficial in managing diaper dermatitis.
A nurse is caring for a newborn who was recently delivered. Which of the following clinical signs would cause the nurse to suspect tricuspid atresia?
Explanation
Rationale:
A. Profound cyanosis is a key sign of tricuspid atresia, a congenital heart defect where the tricuspid valve is absent, leading to poor oxygenation of the blood.
B. Periorbital edema is not typically associated with tricuspid atresia; it might be seen in other conditions like nephrotic syndrome.
C. Absent femoral pulses suggest coarctation of the aorta rather than tricuspid atresia.
D. Decreased blood pressure in the lower extremities is also more indicative of coarctation of the aorta, not tricuspid atresia.
A nurse is caring for a 4-year-old who was admitted with acute diarrhea and dehydration. Which finding indicates that oral rehydration therapy has been effective?
Explanation
Rationale:
A. A capillary refill greater than 3 seconds suggests ongoing dehydration and poor perfusion, indicating that oral rehydration has not been fully effective.
B. A respiratory rate of 24/min is within normal limits for a 4-year-old but is not a direct indicator of hydration status.
C. A urine specific gravity of 1.015 is within the normal range, indicating adequate hydration and that oral rehydration therapy has been effective.
D. A heart rate of 130 bpm, while potentially normal for a 4-year-old, does not specifically indicate the effectiveness of rehydration therapy.
The nurse is reviewing the treatment plan with the parents of a newborn with hypospadias. Which statement should the nurse include in the teaching when describing this disorder?
Explanation
Rationale:
A. Circumcision is often delayed in newborns with hypospadias because the foreskin may be needed for the surgical repair of the urethra.
B. While surgery is necessary, it is not typically an emergency; it is planned and performed later in infancy.
C. In hypospadias, the urethral opening is located on the underside (ventral side) of the penis, not the top.
D. Undescended testicles (cryptorchidism) are a separate condition from hypospadias.
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