Question 1

A nurse is aware that the physiologic compensatory mechanism that is activated to counteract the effects of acid-base imbalance in a child with severe dehydration is:

Accepted Answer

A nurse is aware that the physiologic compensatory mechanism that is activated to counteract the effects of acid-base imbalance in a child with severe dehydration is increased respirations. In metabolic acidosis, the lungs try to compensate by blowing off excess carbonic acid in the form of carbon dioxide.

Question 2

A three-month-old infant was admitted to the pediatric unit for confirmation of the diagnosis of ventricular septal defect. During the initial assessment, the nurse would expect to find:

Accepted Answer

During the initial assessment, the nurse would expect to find a murmur at the left sterna border. Murmur at the left sterna border is the most characteristic finding in children with a ventricular septal defect.

Question 3

A four-year-old child was admitted due to severe burns. Laboratory results show that the child is suffering from hypophosphatemia. When assessing this patient, the nurse would expect to find:

Accepted Answer

When assessing this patient, the nurse would expect to find hemolytic anemia and tremors. Other symptoms of hypophosphatemia include irritability, seizures (progressing to coma), decreased myocardial function, and respiratory failure. Other options are symptoms of hyperphosphatemia.

Question 4

A child with glomerulonephritis has a urinary output that decreases to 100 mL in 24 hours. The patient's creatinine clearance is 60 mL per minute and there is an irregular apical pulse. What would be the most significant laboratory finding after a diagnosis of acute renal failure is made?

Accepted Answer

The most significant laboratory finding after a diagnosis of acute renal failure is made is serum potassium of 6.3 mEq/L. High potassium levels can cause cardiac dysrhythmias; the normal range for serum potassium in a child is 3.4 to 4.7 mEq/L (others would say 3.5 to 5.5 mEq/L). There will be hyponatremia.

Question 5

What data would a nurse expect to assess in a sixteen-year-old patient admitted with right-sided heart failure?

Accepted Answer

Data that a nurse would expect to assess in a sixteen-year-old patient admitted with right-sided heart failure is nausea and anorexia. In right-sided heart failure, the viscera and peripheral tissues become congested. Venous engorgement and venous stasis in the abdominal organs lead to nausea and anorexia in right-sided heart failure. Other options occur in left-sided heart failure.

Question 6

A ten-year-old patient with a history of seizure disorder was admitted to the pediatric unit due to frequent seizure activity. The mother said that the child has been compliant with the medication (Phenytoin) therapy. Subsequently, a sample for the serum phenytoin level is drawn. The nurse determines that the medication has been most effective if the value is:

Accepted Answer

The nurse determines that the medication has been most effective if the value is 12 mcg/mL. The therapeutic level for serum phynetoin is 10 - 20 mcg/mL. Seizure activity may continue if the level is below 10 mcg/mL. Toxicity may happen if the value is higher than 20 mcg/mL.

Question 7

Christine, a six-year-old patient, had a supratentorial craniotomy for removal of a large left tumor. After the surgery, the nurse should place the patient:

Accepted Answer

After the surgery, the nurse should place the patient with the head in midline position. After a supratentorial surgery, the patient should have the head of the bed elevated 30 degrees to aid in venous drainage from the head. The patient is positioned to avoid extreme hip or neck flexion and the head is maintained in a midline neutral position. If a large tumor has been removed, the patient should be placed on the nonoperative side to prevent displacement of the cranial contents.

Question 8

A nurse is caring for a pediatric patient who had a basilar skull fracture. The nurse assessed that there is a clear fluid leaking from the ears of the child. The nurse concludes that it is cerebrospinal fluid if the fluid:

Accepted Answer

The nurse concludes that it is a cerebrospinal fluid if the fluid separates into concentric rings and tests positive for glucose. CSF can be distinguished from other body fluids because the drainage will separate into bloody and yellow concentric rings on dressing material, called a "halo sign." The fluid also tests positive for glucose.

Question 9

A nurse is caring for a pediatric patient with a fiberoptic transducer-a tipped catheter placed in the subdural space to monitor intracranial pressure. The nurse would become most concerned if the readings drifted to and stayed in the vicinity of:

Accepted Answer

The nurse would become most concerned if the readings drifted to and stayed in the vicinity of 20 mmHg. Normal intracranial pressure readings range from 5 to 15 mmHg pressure. Pressures ?20 mmHg are considered to represent increased intracranial pressure, which seriously impairs cerebral perfusion. Studies indicate that intracranial pressure requires treatment ? 20 mm Hg although some doctors believe that infants and young children may need treatment at lower pressures.

Question 10

A nurse is assessing fluid balance in a fourteen-year-old patient after a craniotomy. The nurse should assess for which of the following as a sign of dehydration, which could aggravate cerebral edema?

Accepted Answer

The nurse should assess for serum osmolality of 205 mOsm/kg H20 as a sign of dehydration, which could aggravate cerebral edema. The normal serum osmolality is 285 - 295 mOsm/kg H2O. BUN is within the normal range. A difference of 50 ml in intake and output in a shift is insignificant.

Question 11

A seven-year-old child was admitted to the hospital with a possible diagnosis of an infratentorial brain tumor. The nurse identifies the common presenting sign of this type of tumor when the child demonstrates:

Accepted Answer

The nurse identifies the common presenting sign of this type of tumor when the child demonstrates ataxia. The cerebellum controls coordination. The parents sometimes describe their child as clumsy, which becomes progressively worse.

Question 12

A clinical nurse specialist must be aware that the shift of body fluids associated with intravenous administration of albumin occurs in the process of:

Accepted Answer

A clinical nurse specialist must be aware that the shift of body fluids associated with intravenous administration of albumin occurs in the process of osmosis. It is the movement of fluid from an area of lesser solute concentration to an area of greater solute concentration.

Question 13

A clinical nurse specialist is caring for a child who is diagnosed with bacterial meningitis. During the assessment, the child extends her leg and the hamstring muscle goes into spasm. The nurse documented that the child exhibited a positive:

Accepted Answer

The nurse documented that the child exhibited a positive Kernig's sign. This sign is indicative of meningitis, which is demonstrated by a spasm of the hamstring muscles when the legs are extended.

Question 14

A six-year-old child was admitted to the hospital with a tentative diagnosis of lead poisoning. To help in confirming the diagnosis of plumbism, the nurse should observe for:

Accepted Answer

To help in confirming the diagnosis of plumbism, the nurse should observe for clumsiness. Any behavioral change like clumsiness would be an important clue to early identify lead poisoning.

Question 15

A unit manager discusses the issue of patients' rights and the unit nurses to enumerate a situation that represents a case of invasion of a patient's privacy. The first nurse who replied was correct when she said:

Accepted Answer

The first nurse who replied was correct when she said performing bedside care without the patient's permission. Invasion of privacy takes place with unreasonable intrusion into an individual's private affairs. Option A is false imprisonment. Option C is assault. Option D is battery.

Question 16

A clinical nurse specialist is caring for a preschooler with a diagnosis of acute glomerulonephritis. The child has been on bed rest for almost two days and the nurse saw the child in the playroom. The nurse is also aware that the child stayed three times in the playroom on the previous shift. To best meet the child's needs, the nurse should:

Accepted Answer

To best meet the child's needs, the nurse should place the child in the room of another preschool-aged patient with liver lacerations. The patient is at the age of being active and sociable; they enjoy the company of others and get bored easily when they are isolated.

Question 17

A five-year-old child diagnosed with leukemia is hospitalized for chemotherapy. The patient is fearful of hospitalization. The nurse's most appropriate action to alleviate the patient's fears is to:

Accepted Answer

The nurse's most appropriate action to alleviate the patient's fears is to encourage the parents to stay with the child. Illness adds a stressor that makes separation more difficult for a preschooler. Option A may not be appropriate for a child who is immunocompromised and at risk for infection.

Question 18

A fifteen-year-old patient is scheduled for a skin biopsy. She is concerned and asks the nurse how painful the procedure is. The nurse's most appropriate action is to explain that there will be:

Accepted Answer

The nurse's most appropriate action is to explain that there will be a local anesthetic and may cause a burning or stinging sensation. This is the most common source of pain. Preoperative medication is not necessary with this procedure.

Question 19

A sixteen-year-old patient with ascending paralysis was intubated and is receiving mechanical ventilation. The nurse should include what plan of care to help the patient cope with his illness?

Accepted Answer

The nurse should provide information, encourage relaxation, and give positive feedback in the plan of care to help the patient cope with his illness. The patient with Guillain-Barré syndrome experiences fear and anxiety from the ascending paralysis and sudden onset of the disorder. The nurse can alleviate these fears by providing accurate information about the patient's condition, giving expert care and positive feedback to the patient, and encouraging relaxation and distraction. The family can become involved with selected care activities and provide diversion for the patient as well.

Question 20

A clinical nurse specialist is caring for a fifteen-year-old female patient who is a victim of sexual assault. The patient said that she still feels as if the incident just happened recently, even though it was several months ago. The nurse should respond correctly by stating:

Accepted Answer

The nurse should respond correctly by stating, "Tell me more about the incident that causes you to feel like the incident just occurred." This statement allows the patient to express her ideas and feelings more fully. It portrays a nonhurried, nonjudgmental, and supportive attitude on the part of the nurse.

Quiz 3: Pediatrics