Question 1

When assessing a newborn for developmental dysplasia of the hip, the nurse would expect to assess which of the following:

Accepted Answer

It is the abnormal clicking sound when the hips are abducted. The sound is produced when the femoral head enters the acetabulum. Letter A is wrong because it should be "asymmetrical gluteal fold". Letter B and C are not applicable for newborns because they are seen in older children.

Question 2

Which of the following immunizations would the nurse expect to administer to a child who is HIV (+) and severely immunocompromised:

Accepted Answer

IPV or Inactivated polio vaccine does not contain live micro organisms which can be harmful to an immunocompromised child. Unlike OPV, IPV is administered via IM route.

Question 3

A mother asks the nurse about Vitamin A supplementation. The best response is that giving Vitamin A starts when the infant reaches 6 months and the first dose is:

Accepted Answer

An infant aging 6-11 months will be given Vitamin supplementation of 100, 000 IU and for Preschoolers ages 12-83 months 200,000 "IU" will be given.

Question 4

Which of the following would require careful monitoring in the child with ADHD who is receiving Methylphenidate (Ritalin):

Accepted Answer

Ritalin can affect the child's Growth and development. Dental problems are more likely to occur in children under going TCA therapy. Mouth dryness is an expected side effect of Ritalin since it activates the SNS. Also loss of appetite is more likely to happen, not increase in appetite.

Question 5

Which of the following statements by the family of a child with asthma indicates a need for additional teaching:

Accepted Answer

Asthmatic children don't have to avoid exercise. They can participate on physical activities as tolerated. Using a bronchodilator before administering steroids is correct because steroids are just anti-inflammatory and they don't have effects on the dilation of the bronchioles.

Question 6

A child was scheduled for a palliative surgery, which creates anastomosis of the subclavian artery to the pulmonary artery. This procedure is called:

Accepted Answer

Blalock-Tausig procedure its just a temporary or palliative surgery which creates a shunt between the aorta and pulmonary artery so that the blood can leave the aorta and enter the pulmonary artery and thus oxygenating the lungs and return to the left side of the heart, then to the aorta then to the body. This procedure also makes use of the subclavian vein so pulse is not palpable at the right arm.

Question 7

A client with tetralogy fallot will become cyanotic and dyspneic after crying. To relieve this clinical manifestation, the nurse should place the infant in what position?

Accepted Answer

Knee chest position is done by flexing the hips and knees. This way, there will be a decrease venous return to the heart from the legs; as a result, cardiac workload is decreased. Assuming a sitting position does reduce pressure of the abdominal organs on the diaphragm but does not put enough pressure on the femoral vein and vena cava to sufficiently reduce venous return to the heart.

Question 8

Which of the following would be an indicative of impending heart failure among infants:

Accepted Answer

Dyspnea and tachycardia are signs that occur in infants if there's an impaired myocardial function. It is directly related to sympathetic stimulation. Note that the pulse is elevated even when the infant is at rest. There will be a decreased urinary output; abdominal respirations would be a late sign that occurs when pulmonary congestion sits in; neck vein distention is only seen in adult clients.

Question 9

An infant with heart failure was fed and burped, after burping; he was repositioned in semi-fowler then had a bowel movement. Afterwards, the infant became diaphoretic and cyanotic. The nurse is aware that these were most likely caused by:

Accepted Answer

This is caused by defecating and the valsalva maneuver during bowel movement. The maneuver occasionally causes tet spell or blue spell that results in increased intrathoracic pressure, decreased blood return to the heart, increased venous pressure, and decreased pulse rate.

Question 10

What explanation would a nurse give to a parent of a pediatric client who will undergo a cardiac catheterization:

Accepted Answer

The procedure will identify the exact location of ventricular septal defect and also assess pulmonary pressure. Other options can be identified by using ECG and stethoscope.

Question 11

Michael, a toddler, was admitted at the hospital with a diagnosis of Wilm's tumor. The nurse should be aware that:

Accepted Answer

The nurse should be aware that vigorous palpation of the mass must be avoided. The abdominal mass should be carefully examined. Palpating a mass too vigorously could lead to the rupture of a large tumor into the peritoneal cavity. There are hospitals that require nurses to put signs like" DO NOT PALPATE".

Question 12

Michael was diagnosed with Wilm's tumor and started on chemotherapy as treatment. The doctor ordered a Dactinomycin 0.015mg/kg slow IV push now. The nurse on duty should:

Accepted Answer

The nurse should administer the medicine and watch out for nausea and vomiting. The dosage is safe for a pediatric client, we can administer until 1.5mg in 3 weeks time. Dactinomycin may cause nausea, vomiting, diarrhea and stomatitis.

Question 13

Britney, a mother of a child who was diagnosed with Guillain-Barre syndrome, asks the nurse about the treatment plan for her child. The nurse is aware that:

Accepted Answer

Currently, plasmapheresis and high-dose immunoglobulin therapy are used to lessen the severity of the illness and speed the recovery in most patients. Plasmapheresis is a method by which whole blood is removed from the body and processed so that the red and white blood cells are separated from the plasma, or liquid portion of the blood. The blood cells are then returned to the patient without the plasma, which the body quickly replaces. In high-dose immunoglobulin therapy, doctors give intravenous injections of the proteins that, in small quantities, the immune system uses naturally to attack invading organisms

Question 14

Olga is a 4 year old girl who was diagnosed with Trisomy 21. During the clinical check-up the nurse would expect to find:

Accepted Answer

Children with Trisomy 21 or Down's syndrome are typically recognizable based on some physical characteristics that includes: retarded growth and slower-than-normal development, head that is smaller than typical, wide hands with short fingers, as well as palms with a single crease, rather than multiple creases, and protruding tongue.

Question 15

A nurse is caring for a child who has Trisomy 13. During a morning rounds, the mother asks how her child acquired the syndrome. The nurse's response will be based from the fact that:

Accepted Answer

Trisomy 13 is a genetic disorder in which a person has three copies of genetic material from chromosome 13, instead of the usual two copies.

Question 16

A mother of a child with heart failure questions the necessity of weighing the baby everyday. The nurse's best response should be guided by the fact that the daily weight is essential in determining:

Accepted Answer

Retention of fluid is reflected by excessive weight gain in just a short period of time. Insufficient cardiac output lowers flow to the kidneys that leads to intracellular fluid increase and hypervolemia. Weight gain or loss due to nutrition is gradual. Dosage of medication is not recalculated everyday based on weight gain.

Question 17

The nurse scans the laboratory values of a pediatric client with rheumatic fever. Which data should be treated as insignificant:

Accepted Answer

This is related to anemia. There would be a positive titer as a result of previous exposure to streptococcal infection; possitive C-reactive protein and elevated ESR are indicative of inflammatory process.

Question 18

A pediatric client was returned to the unit after a heart surgery. Contraptions are: Left chest tube drainage attached to a bottle system; an IVF of D5 NSS at 32 gtts/min; and an NGT to gravity. The client was then attached to a cardiac monitor. What would be the priority nursing intervention:

Accepted Answer

Vital signs should be the priority to determine the child's status and compare it with the dtata obtained during the pre-operative period.

Question 19

Included in the plan of care of a 7 year old client with diabetes is glucose monitoring. As a nurse, we must be aware that the most accurate way to evaluate the effectiveness of client and insulin therapy over time is the test that measures:

Accepted Answer

GHb test provides an accurate long-term index of the client's average blood glucose level for the 100-120 day period before the test. The more glucose the RBC was exposed to, the greater the GHb percent.

Question 20

Channel is a 3 year old girl who has Thalassemia. She underwent several blood transfusion and folate intake as treatments. After 2 months, the doctor planned a therapy to remove too much iron in the blood. The nurse is aware that this therapy is called:

Accepted Answer

Person who received significant numbers of blood transfusions need a treatment called Chelation therapy to remove excess iron from the body. The chelating agent may be administered intravenously, intramuscularly, or orally, depending on the agent and the type of poisoning

Quiz 3: Pediatrics