Peds Exam 2

Clinical manifestations of increased ICP in children include all of the following except:

1. Headache2. Vomiting, w/ or w/o nausea3. Seizures 4. Setting-sun sign

FYI: late signs of inc’d ICP

• Dec’d LOC• Dec’d motor response to command• Dec’d sensory response to painful stimuli• Alterations in pupil size & reactivity• Papilledema (optic nerve swelling)• Cheyne-Stokes repsirations• Decerebrate or decorticate posturing

Nurse caring for 8yo w/ dx of basilar skull fracture. Which order would nurse question?

1. Clear liquid intake2. Maintain patent IV line3. Daily weight4. Suction as needed

Nurse monitoring child for bleeding post brain tumor resection. Checks head dressing & notes colorless drainage on back of dressing. Which

would be most appropriate intervention?

1. Circle area of drainage & continue to monitor2. Reinforce dressing3. Notify physician4. Document findings & continue to monitor

Post op removal of brain tumor, physician order to maintain child in flat position. Nurse monitoring

notes child is restless, pulse rate is elevated & BP has dropped significantly from baseline. Suspects shock.

Which would be most appropriate nursing action?

1. Place child in Trendelenburg’s position2. Elevate head of bed3. Increase IV fluids4. Notify physician

Lumbar puncture performed on child w/ suspected bacterial meningitis. Which of the following CSF results

would verify dx?

1. Cloudy CSF, dec’d protein, dec’d glucose2. Cloudy CSF, inc’d protein, dec’d glucose3. Clear CSF, inc’d protein, dec’d glucose4. Clear CSF, dec’d pressure, elevated protein

Which statement regarding meningitis is true?

1. Both viral & bacterial meningitis may have an associated fever

2. Stiff neck is the most common symptom in infants w/ bacterial meningitis

3. Headaches only occur w/ bacterial meningitis 4. Viral meningitis is more easily detected than

bacterial meningitis is children

Which of the following vaccine(s) protects infants from bacterial meningitis (there may be

more than one)?

1. IPV (polio)2. PCV (pneumococcal)3. DTaP (diptheria, tetanus, pertussis)4. Hib (haemophilus influenzae type b)

Which of the following positions is the most effective in preventing a further increase in ICP?

1. Left side lying, head flexed, knees drawn up2. Trendelenburg position3. Fowlers position4. Supine w/ 30o head elevation

Adolescent discharged w/ prescription for phenytoin (Dilantin). Which of the following by father indicates

discharge teaching has been effective?

1. I need to admin her medicine in the morning & evening

2. I will keep the annual appt for f/u on her med3. I will be sure to encourage good oral care &

regular dental visits4. I can allow her to stop taking the med after

6wks, as long as there are no seizures

Parent of 9yo w/ GH deficiency asks nurse how long son will need to take injections for his growth

problem. Which is most appropriate?

1. Injections are usually cont’d until age 10 for girls & 12 for boys

2. Injections need to continue until child reaches the 5th percentile on the growth chart

3. Injections should be cont’d until bone maturation is complete, usually between 14-16yrs

4. The injections will need to be administered throughout the child’s entire life.

During which of the following periods of growth & dev’t should a nurse anticipate behavioral problems

form a child w/ untreated GH deficiency?

1. Infant2. Preschooler3. School-age4. Adolescent

When providing health teaching to group of adolescents w/ type 1 d.m., a nurse instructs them

that a hypoglycemic reaction can occur b/c of:

1. Too much glucose in the body2. Eating too much junk food3. Exercising strenuously4. Not enough insulin in the body

Nurse caring for child w/ type 1 d.m. who has been taking insulin for 3 mos. Which diagnostic

study will provider likely order to determine how well child’s diabetes is being managed?

1. Morning faster blood glucose2. 2hr oral glucose tolerance test3. Hb1Ac4. Diary of child’s daily blood glucoses

Place the following steps in order when treating hypoglycemia:

• Recheck blood glucose• Treat w/ 15g carbs• If still low, give 15g more carbs• Stop activity & sit down• Recheck blood glucose

Child brought by parents to ER w/ 1st degree burns to shoulders from sun exposure. Which

interventions are indicated?

1. Start IV of NS2. Apply cool, wet compresses3. Scrub area w/ soft-bristle brush4. Admin morphine sulfate for pain relief

Child experiences 3rd degree burns to both legs after they were immersed in boiling water.

Which nursing diagnoses will receive priority during the first 24 hours?

1. Deficient fluid volume2. Imbalanced nutrition: less than body

requirements3. Impaired breathing pattern4. Disturbed body image

Mother of 3yo arrives at clinic & tells nurse that child has been scratching the skin continuously

& has developed a rash. Nurse assess & suspects scabies. Nurse bases this suspicion on

which finding:

1. Clusters of fluid filled vesicles2. Fine, threadlike lines3. Purple-colored lesions4. Thick, honey colored crusts

Which of the following orders should a nurse implement first for a child w/ a UTI?

1. Ampicillin 250mg IV q 12hr2. Blood & urine cultures3. Sitz bath prn for pain4. Voiding cystourethrogram (VCUG)

3yo being admitted w/ nephrotic syndrome. Best roommate is:

1. 16yo recovering post-op from ruptured appendix

2. 8yo w/ leukemia3. Another toddler w/ rheumatic fever4. No roommate because isolation is required

Admission assessment on 2yo who has been dx’d w/ nephrotic syndrome. Nurse knows that most

common characteristic assoc’d w/ it is?

1. Generalized edema2. Frank bright red blood in urine3. Inc’d urinary output4. hypertension

Parents of child w/ glomerulonephritis concerned about activity restrictions after discharge. Nurse

bases response on the fact that urinary findings are near normal.

1. Activity must be limited for 1 mo2. Child must not play active games3. Child must remain in bed for 2 wks4. Activity does not affect course of disease

Which nursing intervention has highest priority when caring for child w/ acute glomerulonephritis?

1. Assess for dysuria2. Monitor BP3. Monitor temp4. Assess for jaundice

• A child is admitted w/ glomerulonephritis. Nurse should expect to see a recent _______ infection in the history given by the mother.

Failure to repair hypospadias can lead to testicular cancer later in life.

1. True2. False

To prevent swelling of casted extremity, elevate the extremity above heart level & apply ice to cast.

1. True2. False

Which of the following is an early sign of impaired neurovascular function in a child w/ an

arm cast?

1. Cool, cold fingers2. Pain3. Inability to detect a pulse distal to cast4. Inability to move distal extremity

Choose the most appropriate roommate for a 16yo in a full body cast.

1. 12 yo w/ inguinal hernia repair2. 9 yo w/ gastroenteritis3. 6 yo w/ fractured femur4. 15 yo w/ pneumonia

When caring for child in Bryant’s traction, nurse should be aware that this traction is:

1. Skin traction to the affected leg2. Attached to a pin placed in the affected

femur3. Used to allow child to turn from side to side4. Skin traction & elevates hips slightly from

bed

Nurse detects a positive Ortolani sign in a newborn. What is the nurse assessing?

1. Broadening of perineum2. Shortening of one leg3. Audible click on hip manipulation4. Unilateral droop of hip

13mo old dx’d w/ L hip dysplasia & scheduled for surgery & spica cast. Child’s mother questions why a

pavlik harness is not being used. Appropriate response is:

1. Pavlik harness is used for children w/ scoliosis, not hip dysplasia

2. Pavlik harness is used for school-age children3. Your child’s condition is too severe for a

pavlik harness4. Pavlik harness is only used for infants <6mos

Mother brings 2wk old to clinic for tx following dx of clubfoot made at time of birth. Which statements,

indicates need for further teaching?

1. I need to bring my infant back to clinic in 1 mo for a new cast

2. Tx needs to be started as soon as possible3. I need to come to clinic every week w/ my

infant for casting4. I realize my infant will require follow-up care

until full grown

Nurse providing instructions to parents of child w/ scoliosis regarding use of a brace. Which statement

indicated need for further instructions?

1. I should apply lotion under the brace to prevent skin breakdown

2. I should avoid the use of powder b/c it will cake under the brace

3. I will have my child wear soft fabric clothing under the brace

4. I will encourage my child to perform prescribed exercises

To prevent loss of joint fxn in a child w/ JRA, nurse should teach parents to avoid letting

child:

1. Ride a bike2. Walk to school3. Do frequent isometric exercises4. Watch TV for prolonged periods

Child scheduled for debridement of leg wounds. In what order should nurse perform procedures?

1. Remove dressing2. Medicate for pain3. Pour water on dressing to loosen it4. Assess need for dressing supplies

Which of the following are manifestations of scabies? (all that apply)

1. Nits present2. Threadlike rash between fingers & other

moist areas3. Circular rash on extremities4. Pruritus5. Eczematous eruption in infants

Match skin disorder w/ cause

1. Impetigo contagiosa2. Scabies3. Lyme disease4. Cold sore, fever blister5. ringworm

A. Fungal infectionB. Bacterial infectionC. Viral infectionD. Caused by spirocheteE. Caused by burrowing

mite

Match type of dermatitis w/ it’s description

1. Diaper dermatitis2. Infantile eczema3. Acne4. Seborrheic dermatitis

A. Weeping, red vesicles & papules

B. Comedones & pustulesC. Red, inflamed skinD. Thick, yellow scaly

areas

Which of the following meds can be used for children w/ eczema? (all that apply)

1. Corticosteroids2. Accutane3. Peroxide4. Antihistamines5. Calamine lotion

Diaper dermatitis can be largely prevented by changing an infant’s diapers frequently & keeping the

diaper area clean & dry.

1. True2. False

Eczema usually appears on cheeks of a 4yo child.

1. True2. False

A complication that may occur w/ acne & most types of dermatits is cellulitis.

1. True2. False

Nurse reviewing sick day mangement w/ parent of a child w/ type 1 diabetes. Which of following should

be included in teaching? (all that apply)

1. Monitor blood glucose every 4 hr2. Discontinue taking insulin until feeling better3. Drink 8 oz fruit juice every hour4. Test urine for ketones5. Call PCP if blood glucose is >250mg/dL

Providing health teaching to group of adolescents w/ D.M., nurse teaches them to observe for s/s of hypoglycemia. Which of following should be

included? (all that apply)

1. Frequent urination2. Inc’d energy level3. Nausea4. Nervousness & irritability5. Sweating & pallor6. Deep, rapid & labored respirations

Hypoglycemic rx can occurs b/c of:

1. Too much glucose in body2. Eating too much junk food3. Exercising strenuously4. Not enough insulin in body

Child w/ type 1 D.M. on insulin for 3 months. Which of the following diagnostic studies will provider order

to how well child’s D.M. is being managed?

1. Morning fasting blood glucose2. 2hr oral glucose tolerance test3. Hb1Ac4. Diary of child’s daily blood glucoses

When teaching child w/ newly dx’d type 1 D.M., priority should be placed on:

1. Wt loss measures2. Self-monitoring of blood glucose3. Need to reduce physical activity4. Elimination of sugar from diet

During scheduled exam, child’s HbA1c level is 9%. Child has had type 1 D.M. for 1 yr. Which of the

following actions should nurse take?

1. Assess signs of infection & child’s intake for past 24hr

2. Explore child’s general dietary patterns for past 3 mos

3. Review parents’ understanding of diabetic foot care

4. Immediately admin child’s rapid acting insulin dose.

Nurse asks 12yo w/ GH deficiency to draw a pic off herself playing w/

children on a playground. List potential characteristics that might represent positive & negative self-

esteem.

Nurse asks 12yo w/ GH deficiency to draw a pic off herself playing w/ children on a playground

Positive • Child playing w/ other

children• Child smiling• Interaction between

children• True height discrepancy• Bright, colorful picture

Negative • Child standing off to side

while other children are playing

• Drawing indicates teasing &/or ridicule

• Child appears much smaller than others

• Dark picture that is scribbled

Match diagnostic test w/ findings r/t growth disorders.

1. X-rays of wrist & hand2. IGF-13. MRI4. GH stimulation/

suppression test

A. Determines GH levelB. Id’s pituitary gland

tumorC. Determines bone ageD. Measures effect of

glucose on GH

6yo who has been bladder trained w/o enuresis since age 4 has begun having accidents both at night &

occasionally during the day. Which of the following should be ruled out as possible causes? (all that

apply)

1. Glomerulonephritis2. UTI3. New onset D.M.4. Epispadias5. Bladder exstrophy

Match structural GU disorder w/ definition

1. Hypospadias2. Epispadias3. Phimosis4. Bladder

exstrophy5. Cryptorchidism6. Chordee7. Hydrocele

A. Ventral curvature of penisB. Narrowed opening in urinary

meatus preventing retraction of foreskin over glans penis

C. Failure of 1 or both testicles to descend into scrotum

D. Collection of fluid in scrotal sacE. Urethral meatus is located on

ventral side of glans penisF. Eversion of bladder through

lower abd wallG. Urethral meatus located on

dorsal side of glans penis

Multiple surgeries will be required for child w/ bladder exstrophy to repair damage to bladder

& pelvic area.

1. True2. False

6yo admitted to acute care w/ dx of possible UTI. Which of following should nurse expect to find?

1. Dysuria, thirst, light colored urine, ammonia odor in urine

2. Dysuria, L sided pain, foul odor to urine, dark color to urine

3. Polyuria, lower abd pain, yellow urine, sweet odor to urine

4. Oliguria, epigastric pain, yellow skin tones, ammonia odor to breath

Nurse preparing discharge teaching for mother of 6yo girl who had severe UTI. Which instructions are

beneficial? (all that apply)

1. Avoid bubble baths2. Change child’s bathing suit immediately after

swimming3. Encourage child to go to BR q6hr4. Have child wear cotton underpants rather

than nylon5. Observe child wiping back to front after

voiding

Child admitted w/ glomerulonephritis. Which of following indicates need to call PCP?

1. Specific gravity decrease from 1.022 to 1.0202. Crackles in bases bilaterally3. Absence of S3 on auscultation4. Wt gain of 0.91kg overnight

Child admitted w/ nephrotic syndrome. Which of following classic symptoms should nurse observe for?

1. HTN, hypoNa, hemoconcentration2. hyperNa, hypoalbuminenia, hyperlipidemia3. Hematuria, hypoaldosteronemia, hyperNa4. Hemodilution, hyperalbuminemia,

hypoproteinemia

Parent of child w/ excess fluid vol & weeping skin tells nurse he would like to be more involved in

cares. Which should nurse encourage?

1. Admin IV Lasix under supervision of nurse2. Read to child from bedside chair3. Reposition child q30min4. Assist in changing linens as they become wet

Toddler w/ nephrotic syndrome has plt count of 700,000mm3. For which s/s should nurse monitor?

1. Thrombosis2. Bruising3. Pulm congestion4. Cardiac enlargement

3 yo w/ meningitis is documented as having photophobia. Which of following interventions is

most effective in minimizing this symptom?

1. Avoid using the TV2. Keep volume down on radio3. Bandage both eyes temporarily4. Elevate HOB

Child admitted w/ possible Reye syndrome. Which factors in health history might be supportive of this

dx?

1. Recent h/o UTI2. Recent h/o bacterial otitis media3. Recent episode of gastroenteritis4. Recent episode of haemophilus influenzae

meningitis

Which manifestations are indicative of Stage II of Reye syndrome? (all that apply)

1. Coma2. Fixed pupils3. Hyperventilation4. Combativeness5. Hyperactive deep tendon reflexes

Lack of which is a warning sign of palsy in 3mo old infant?

1. Crawling2. Sitting up w/o assistance3. Hold head upright4. Babbling simple words

Match type of CP w/ correct description

1. Hemiplegia/ hemiparesis

2. Diplegia/ diparesis

3. Quadriplegia/quadriparesis

4. Dyskinetic/ athetoid

5. ataxic

A. Will cause child to experience difficulty w/ quick or precise mvmts (writing, buttoning)

B. Causes slow & uncontrollable writhing mvmts of hands, feet, arms, &/or legs

C. Delays ability to walk in children (may walk on tips of toes b/c of tight heel tendon)

D. Tightness in certain leg muscles makes legs move like arms of scissor (scissor walking)

E. Will interfere w/ child’s ability to speak (child often hard to understand)

Child w/ spina bifida should be instructed in intermittent bladder catheterization using clean

latex catheter.

1. True 2. False

Priority nursing dx for child who sits in wheelchair all day is risk for impaired skin

integrity.

1. True2. False

School-age child w/ spina bifida has shunt in place for hydrocephalus. Which s/s are manifestations of inc’d

ICP? (all that apply)

1. Fever2. Hypotension3. Headache4. Lethargy5. Bulging anterior fontanel6. Seizures7. Change in school performance

Match each type of seizure below w/ its definition.

1. Tonic-clonic2. Absence seizure3. Febrile seizure4. Complex partial

seizure

A. Occurs w/ temp > 38.8 (101.8)

B. Generalized mvmt of all extremities

C. Dec’d consciousness w/ staring, lip smacking, chewing during seizure

D. 5-10sec loss of consciousness that looks like daydreaming

A single seizure lasting >10mins or a series of seizures lasting 20-30mins is called ________.

Which vitals is indicative of Cushing’s reflex in a 6yo?

1. Temp 37.2 (99), pulse 100, RR 22, BP 100/702. Temp 37.9 (100.2), pulse 140, RR 26, BP

60/303. Temp 35.6 (96), pulse 50, RR 18, BP 80/504. Temp 37.8 (100), pulse 64, RR 20, BP 140/40

Child w/ concussion being discharged home w/ parent. Which statement indicates need for further

teaching?

1. I will keep him awake all night to make sure there is no change

2. I should call the hospital if I cannot arouse him

3. His pupils should remain equal & get smaller when I shine a light into them

4. I should call the doctor if he starts to vomit

6mo old infant admitted to critical care w/ basilar skull fracture. Which findings should

nurse expect? (all that apply)

1. Two black eyes2. Nuchal rigidity3. Split cranial sutures4. Bruising of neck posterior to infants ear5. Nosebleed

Which are priority assessments for adolescent postop for insertion of Harrington rod secondary to

scoliosis?

1. Ability to eat a balanced diet2. BP & pulse3. O2 sat4. Assess for body image disturbance5. Neurvascular assessment6. Pain assessment7. Assess for wound infection

8 yr old R femur fracture after falling off skateboard. After 3 wks traction w/ pin, casted & discharged.

Teaching instructions include: (all that apply)

1. Wash cast carefully if it becomes soiled2. Allow cast to remain uncovered until it dries

completely3. Support wet cast carefully & avoid denting it4. Make sure nothing is placed inside cast5. Check leg frequently for signs of swelling

Inc’d pain, erythema & fever are 3 signs that compartment syndrome is occurring w/in casted

extremity.

1. True2. False

Adolescent w/ rheumatoid arthritis reports severe pain during PT exercises & states she doesn’t want to

go back to PT again. Intervention to solve this problem:

1. Medicate w/ morphine sulfate before PT2. Use ice packs before PT to dec inflammation3. Take warm bath or use warm packs before

PT4. Perform passive ROM for adolescent before

PT

What measures can be taken to dec pain & prevent deformity during sleep for child w/ RA?

What measures can be taken to dec pain & prevent deformity during sleep for child w/ RA?

• Splinting of knees, wrists, hands• Sleeping on firm matterss w/o pillows under

knees may help dec pain & prevent flexion deformities

5 yo child unable to sit through meals, easily distracted. At night, gets up while family is

sleeping & wanders about house. Doing poorly in kindergarten d/t inability to concentrate on work. Which should child be evaluated for?

1. Mental retardation2. Down syndrome3. ADHD4. Autism

Nurse is discussing w/ parents of 3mo w/ Down syndrome ways to help prevent recurrent resp infections. Which interventions should nurse

discuss? (all that apply)

1. Practice frequent handwashing2. Keep infant in Fowler’s position most of time

to prevent choking3. Use bulb syringe to remove nasal mucus4. Keep infant’s mouth moist by rinsing

frequently w/ water

Nurse assessing 4yo for autism. Should be alert for:

1. Constant talking & impulsive behavior2. Poor language & interpersonal skills3. Frequent resp & UTI’s4. Constant clinging to parents & wanting to be

cuddled

9yo w/ autism continually hits head on desk. During planning w/ teachers, school nurse has devised one outcome for the problem, which states child “will

develop self-control measures to prevent behavior”. Nurse should evaluate this outcome to be met when

child:

1. Wears his helmet continually to prevent injury2. Begins cutting his arm instead of banging his

head3. Seeks out a staff member instead of head

banging4. Is placed in seat w/o desk to prevent this

unacceptable behavior

3mo old FTT being bottle fed. Following techniques nurse should teach mom: (all that apply)

1. Simulate feeding environment in common dining room

2. Maintain eye contact w/ infant during feeding

3. Burp infant frequently during feeding4. Give infant as much formula as she can hold

during each feeding5. Develop structured feeding routine

Nurse evaluating family in which child abuse has occurred. Which is best indicator that parents

are making progress toward resolution of violence?

1. Parents plan weekly outings to park2. Parents are attending parenting classes3. Parents report high expectations for their

children4. Parents relate an understanding of normal

growth & development

Nurse assessing family of child brought in for severe injuries. Which behaviors by parents indicates

probable abuse?

1. Delay in seeking treatment for child’s injuries2. Detailed description of events prior to

injuries3. Anxious, concerned attitude4. Encouraging child to explain injuries