Carolinas college Nu 170. Children and Adolescent Final Exam

Question 3

Carolinas college Nu 170. Children and Adolescent Final Exam. Which assessment finding should raise the greatest concern for possible new-onset type 1 diabetes mellitus?

• A 7-year-old with intermittent abdominal pain and decreased appetite for 3 days
• A 9-year-old who has had recent nighttime bedwetting episodes after being dry for 2 years
• A 13-year-old with a BMI in the 95th percentile who reports increased appetite
• An 11-year-old who reports increased fatigue and difficulty concentrating at school over the past month

Question 19

Which statement should the nurse include when teaching the mother of a toddler regarding liquid iron preparations?

• Do not give with orange juice.
• Give the iron with a spoonful of yogurt.
• Her stool will turn a tarry, green color.
• If vomiting occurs, stop immediately.

Question 20

The nurse is assessing a 11-year-old child who has been brought in by their parent with a report of abdominal pain. Which action should the nurse take during this appointment?

• Allow the child to handle the medical equipment before starting.
• Ask mainly the parent for the information.
• Ask the parent to leave the room during the examination.
• Ask the child direct questions.

Question 21

A 4-year-old girl is brought to the emergency department. She is agitated, cries that her throat hurts, refuses to swallow, and insists on sitting upright. The nurse should do which intervention?

• Place in position of comfort, continuous monitoring, and alert physician.
• Start an IV and administer pain medication as ordered.
• Have her lie down and remain quiet, providing oxygen by mask.
• Examine her oral pharynx for exudate while collecting a throat culture.

Question 22

The parents of 9-year-old twin children tell the nurse, “They have filled up their bedroom with collections of rocks, shells, stamps, and bird nests.” The nurse should recognize that this is which of the following?

• Characteristic of cognitive development at this age
• Indicative of typical twin behavior
• Characteristic of psychosocial development at this age
• Indicative of giftedness

Question 23

What is a major goal of therapy for children with cerebral palsy (CP)?

• To prevent injuries due to optic nerve degeneration.
• To recognize early and promote optimum development.
• To reverse degenerative processes that have occurred.
• To decrease spasticity by limiting exercise

Question 24

A nurse is teaching a patient newly diagnosed with celiac disease about the disease process. Which statement best explains why patients with celiac disease experience malabsorption?

• “Gluten damages the intestinal villi, which decreases nutrient absorption.”
• “Gluten interferes with pancreatic enzyme secretion, slowing digestion.”
• “Gluten causes inflammation of the stomach lining, reducing acid production.”
• “Gluten increases bile production, leading to fat malabsorption.”

Question 25

The nurse starts the morning shift with the following patient assignment. After report, which patient would be the highest priority for the nurse to assess first?

• 4-year-old asthmatic transferred from the Emergency Department at 0400
• 10-year-old, 2-day post-operative appendectomy
• 2-month-old with meningitis on IV antibiotics for 24 hours
• 13-year-old with sickle cell crisis given IV morphine sulfate 2 hours ago

Question 26

The nurse observes that a 2-year-old has abrasions on his shins with bruises in various stages of healing. How does the nurse interpret these findings?

• These findings are normal for this stage of growth and development.
• These findings are evidence of physical abuse.
• These findings are suggestive of emotional maltreatment.
• These findings are signs of physical neglect.

Question 27

The nurse is assessing a 6-month-old child. The parent asks when the soft area in the child’s head will go away. What is the best response by the nurse?

• “The area is called a fontanel. They remain open to allow for rapid brain growth in the first months of life.”
• “The soft spots may stay open until your child is 2 or 3 years old.”
• “Soft spots on the child’s head should have closed by now.”
• “The area is called the anterior fontanel and typically closes anytime up to 18 months of age.”

Question 28

What is the priority for the nurse to include in the discharge plan for a child with idiopathic thrombocytopenia (ITP)?

• Providing a diet that contains iron-rich foods.
• Monitoring the child’s hemoglobin every 2 weeks.
• Establishing a safe, age-appropriate home environment. Carolinas college Nu 170. Children and Adolescent Final Exam
• Teaching parents to report excessive fatigue.

Question 29

Which patient problem is common for a patient with acute asthma?

• Altered tissue perfusion related to decreased peripheral blood flow.
• Activity intolerance related to decreased oxygen consumption.
• Fluid volume excess related to inflammation in the lungs.
• Risk for electrolyte imbalance related to dysfunctional sodium/chloride transport.

Question 30

The nurse assesses an 18-month-old who had surgery to correct an intussusception and is now at risk for the development of a paralytic ileus postoperatively. Which assessment should be the priority?

• auscultation of bowel sounds
• inspection of the first stool passed
• measurement of gastric output
• measurement of urine specific gravity

Question 31

The nurse understands that the clinical manifestations of cystic fibrosis (CF) are due to which physical dysfunction?

• atrophic changes in mucosal wall causing impairing digestion
• dysfunction of the autonomic nervous system caused by high serum sodium
• mechanical obstruction caused by increased viscosity of mucous gland secretions
• hyperactivity of sweat glands causing an increase in serum potassium

Question 32

Which suggestions are appropriate for the nurse to make for a 14-month-old child with iron-deficiency anemia? Select ALL that apply.

• There is no need to change the child’s diet if supplements are given.
• The iron supplements may cause constipation and/or make their poop look dark or black.
• Brush the child’s teeth after giving liquid iron.
• Give the iron supplement between meals.
• Allow the toddler to drink the iron supplement from a small medicine cup.
• Limit milk ingestion during meal times.
• Untreated iron deficiency can affect your child’s growth and development.
• Include iron-fortified cereals, strawberries, and spinach in the child’s diet.

Question 33

The physician has ordered 2x maintenance IV fluids on a 54 kg sickle cell patient recently admitted. At what IV rate (mL/hr) would the nurse run the IV pump for this patient? (Round to the nearest whole number.)

• 182

Question 34

The medication order: ceftriaxone sodium (Rocephin) 1900 mg IV every day Pharmacy supplied the medication in a concentration of 50 mg/mL Continuous IV fluid D5 0.25 NaCl @ 25 mL/hr In a medication resource the nurse has identified the following information: ceftriaxone sodium (Rocephin) must be further diluted to a concentration of 19 mg/mL ceftriaxone sodium (Rocephin) must be administered over 2 hours The nurse has decided to administer this medication with all ordered medications What is the medication VTBI, medication rate, flush volume and flush rate to safely administer this medication?

• 100 50 100 25

Question 35

The nurse is admitting a 15-year-old with the diagnosis of asthma. During the admission history, the patient admits to smoking. While incorporating a long term goal of smoking cessation, what would be most effective in assisting this adolescent to quit smoking?

• Show the patient pictures of the inside of a smoker’s lungs.
• Talk to the patient’s parents about restricting his/her activities until they stop smoking.
• Ask the teen open ended questions about why he/she feels the need to smoke.
• Have the teen attend a smoking cessation group led and attended by other teens.

Question 36

The nurse is caring for an infant Day 1 post-op cardiac repair. The following assessment data is collected: HR = 120, RR = 28, BP = 85/50, and tires while feeding. Which of the following is the best action by the nurse?

• Ask for a respiratory therapy consult.
• Continue to monitor.
• Administer PRN order of analgesia.
• Report findings to the physician.

Question 37

The nurse is preparing to provide information to the parents of a 14-year-old who is within normal limits for growth and development. What information is appropriate for the nurse to include?

• Growth, although slowed, can still be significant.
• The child of this age no longer worries about their about sexual identity.
• Children of this age cannot anticipate long-term consequences of choices.
• Family influence is often stronger than peer group influence.

Question 40

The nurse understands that the type of precautions needed for children receiving chemotherapy is based on which action of chemotherapeutics?

• anticipated alopecia
• decreased creatinine level
• gastrointestinal disturbances
• bone marrow suppression

Question 41

A 9-month-old is admitted because of dehydration. What is the most accurate method for the nurse to monitor the infant’s fluid intake and output?

• counting the number of wet diapers Carolinas college Nu 170. Children and Adolescent Final Exam
• changing breast feedings to bottle feedings
• obtaining an accurate daily weight
• restricting fluids prior to weighing the child

Question 40

The physician has ordered hydrocodone bitartrate/acetaminophen (Lortab) 7 mL po q4 prn. The resource states that the safe dose is hydrocodone bitartrate 2.5 mg/acetaminophen 10 mg per kg/dose. The nurse identifies that the patient weighs 22.7 kg and dosing is based on the acetaminophen. What is the calculated safe dose for hydrocodone bitartrate/acetaminophen (Lortab)? (Round to the nearest whole number)

• 227

Question 41

An 8-year-old patient has been hospitalized with myelosuppression secondary to chemotherapy for Leukemia. The nurse anticipates the doctor will order epoetin alpha (Epogen) which works to stimulate the production of RBCs. The nurse should plan to monitor the patient’s hemoglobin levels and for signs/symptoms of bleeding.

Question 42

When teaching injury prevention during the school-age years, what should the nurse include?

• Teach basic rules of water safety.
• Teach children to fear strangers.
• Avoid letting child cook in microwave ovens.
• Caution child against engaging in competitive sports.

Question 43

A nurse is caring for a 14-year-old patient with a cerebellar brain tumor. The nurse formulates a nursing diagnosis of Risk for Injury. Which “related-to” phrase should the nurse add to complete the nursing diagnosis statement?

• Related to difficulty swallowing
• Related to impaired balance
• Related to visual disturbances
• Related to hemiparesis

Question 44

When giving liquid medication to a crying 10-month-old infant, which approach minimizes the possibility of aspiration?

• Administer the medication as rapidly as possible with the infant securely restrained.
• Keep the child upright with the nasal passages blocked briefly after administration.
• Administer the medication with an oral syringe along the side of the infant’s tongue.
• Mix the medication with the infant’s regular formula or juice and administer by bottle.

Question 45

The nurse should recognize which finding as one of the best indicators of a patient’s long-term compliance with Type 1 diabetes mellitus management?

• Random blood glucose level of 180 mg/dL
• A glycosylated hemoglobin level of 6.5%
• Oral glucose tolerance test of 100 mg/dL
• A fasting glucose level of 120 mg/dL

Question 46

The physician has ordered ertapenem sodium (Invanz) 500 mg/100mL NS IV piggyback every 12 hours. The IV fluids ordered are D5 0.225NS at 75 mL/hr. When researching this medication, the nurse reads ertapenem sodium (Invanz) is incompatible with dextrose. How should the nurse incorporate this information in giving this medication?

• Notify IV team to have a second IV site placed, then administer medication via the Alaris pump.
• Hold the medication and wait for physician rounds to discuss the incompatibility.
• Discontinue ordered IV fluid, flush IV access, hang new primary tubing with a 500 mL bag of 0.9% NS, complete medication administration and flush, flush IV access, reconnect ordered IV fluid.
• Stop ordered IV fluid, appropriately run medication on a syringe pump via the y-port access, once medication completed restart ordered IV fluid.

Question 53

An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) to be administered via central line. Discharge instructions to the parents should include which statement by the nurse?

• Calculate caloric needs of the infant so you can adjust the TPN rate.
• Keep the infant away from children who are sick.
• Call the physician if the infant has a fever. Carolinas college Nu 170. Children and Adolescent Final Exam
• Change the central line dressing every other day.

Question 54

A nurse is caring for a child with type 1 diabetes. The child is currently nauseous, sweaty, and has clammy skin. Which nursing intervention would take priority?

• Obtain a glucose reading.
• Administer a dose of ondansetron.
• Check the child’s temperature.
• Provide the child with a cup of orange juice.

Question 55

A school nurse is preparing to teach a group of high school students about health promotion. Which statement(s) by the students will confirm that the teaching was successful? Select all that apply.

• I should get 8 to 10 hours of sleep each night.
• Skipping breakfast is okay as long as I eat a good dinner.
• Vaping is better than smoking cigarettes.
• I should aim to get 60 minutes of exercise each day.
• I should not sleep with any electronic devices in my bedroom.
• Energy drinks are a safe way to stay awake during exams.
• I will limit sugary drinks and choose water instead.

Question 56

The parents of a preschool child admitted to the hospital comment about the child’s fear of being there. What is the most appropriate action for the nurse caring for this child?

• Have the child to confront the frightening object or experience in the presence of their parents.
• Use logical persuasion to explain away their fears and help them recognize how unrealistic the fears are.
• Make light of the child’s fears so that they understand that there is no need to be afraid.
• Actively involve the child in finding practical methods to deal with the frightening experience.

Question 57

The nurse is caring for a 5-year-old child, with a history of hemophilia, presenting to the emergency department with severe nosebleed, bleeding of the gums, and bleeding of the eyes. Based on these assessment findings, what will the nurse include in the plan of care? Select all that apply.

• Apply heat packs to bleeding areas to improve circulation.
• Suction the nose frequently to remove blood.
• Control the nosebleed with pressure to the nose.
• Place the child in Trendelenburg position.
• Administer Factor VIII as prescribed.
• Administer desmopressin acetate (DDAVP).
• Take the temperature rectally to avoid injury to the mouth.
• Raise the HOB to no more than 15°.

Question 58

Which postoperative intervention would the nurse decide as most appropriate for a child following a cardiac catheterization?

• keep the affected leg elevated above heart level
• encourage the child to ambulate to prevent clots
• apply warm compresses to the insertion site
• check for an intact pressure dressing

Question 59

When the nurse is performing a physical assessment of a 10-month-old patient, what is the best approach to take?

• Encourage the patient to participate in the assessment.
• Work to gain the trust of the parents to gain the trust of the patient.
• Perform the assessment in a fixed head-to-toe order.
• Ask the parents to step out of the room during the assessment.

Question 60

The nurse is calculating the maximum safe dose of diphenhydramine HCL (Benadryl). The nurse identifies that the patient weighs 33.6 kg and the safe dose for diphenhydramine HCL (Benadryl) is 1.25 mg/kg/dose every 6 hrs. What is the calculated safe dose for this medication? (Round to the nearest whole number)

• 42

Question 61

Which patient problem would be most appropriate for a patient diagnosed with pyloric stenosis?

• Risk for impaired gas exchange related to aspiration
• Nutritional alteration, more than body requirements related to increased PO intake Carolinas college Nu 170. Children and Adolescent Final Exam
• Fluid volume deficit related to frequent vomiting episodes
• Abdominal pain related to enlargement of the pylorus

Question 62

The nurse is discussing long-term care with the parents of an infant who has a ventriculoperitoneal shunt to correct hydrocephalus. Which statement should the nurse include? Select ALL that apply.

• “You should restrict normal activity as your child grows.”
• “You may notice your child’s fontanel is bulging for the first six weeks.”
• “Your child should avoid tummy time to protect the shunt.”
• “Report temperature of 101.5° F. to physician immediately.”
• “Report emesis to the physician immediately.”
• “Notify the physician if the infant has a seizure.”
• “Expect the infant to have cognitive delays.”
• “Expect the infant to have a high pitched cry.”

Question 63

Which nursing intervention would be the highest priority for a pediatric patient with bacterial meningitis?

• timely administration of IV antibiotics
• prompt treatment with antipyretics
• initiate seizure precautions
• strict I&O measurement

Question 64

Which outcome is most appropriate for a 3-year-old with the nursing diagnosis of delayed growth and development related to chronic illness?

• Child will draw using large crayons in 2 months.
• Child will attain age-appropriate milestones in 3 months.
• Child will have fewer tantrums in 3 months. Carolinas college Nu 170. Children and Adolescent Final Exam
• Child will attain normal weight and height in 2 months.

Question 65

The nurse is caring for a child with history of asthma who presents to the emergency department with wheezing, tachypnea, and dyspnea. What will the nurse do first?

• Assess the child’s pulse oximetry reading.
• Apply oxygen via nasal cannula at 2 liters.
• Place the child in high-Fowler position.
• Ask what may have triggered the attack.

Question 66

An appropriate outcome for a cancer patient with the patient problem, Risk for altered nutrition: less than body requirements related to malignant disease should be which of the following?

• Patient will gain an average of 5 lbs/week.Patient will gain an average of 5 lbs/week.
• Patient maintains weight or limits weight loss.
• Patient will have fewer mouth ulcers.
• Patient will eat 100% of each meal provided.