Peds Exam 2
Clinical manifestations of increased ICP in
children include all of the following except:
1.
2.
3.
4.
Headache
Vomiting, w/ or w/o nausea
Seizures
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.
2.
3.
4.
Clear liquid intake
Maintain patent IV line
Daily weight
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.
2.
3.
4.
Circle area of drainage & continue to monitor
Reinforce dressing
Notify physician
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.
2.
3.
4.
Place child in Trendelenburg’s position
Elevate head of bed
Increase IV fluids
Notify physician
Lumbar puncture performed on child
w/ suspected bacterial meningitis.
Which of the following CSF results
would verify dx?
1.
2.
3.
4.
Cloudy CSF, dec’d protein, dec’d glucose
Cloudy CSF, inc’d protein, dec’d glucose
Clear CSF, inc’d protein, dec’d glucose
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.
2.
3.
4.
IPV (polio)
PCV (pneumococcal)
DTaP (diptheria, tetanus, pertussis)
Hib (haemophilus influenzae type b)
Which of the following positions is the most
effective in preventing a further increase in ICP?
1.
2.
3.
4.
Left side lying, head flexed, knees drawn up
Trendelenburg position
Fowlers position
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 med
3. I will be sure to encourage good oral care &
regular dental visits
4. 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 1416yrs
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.
2.
3.
4.
Infant
Preschooler
School-age
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.
2.
3.
4.
Too much glucose in the body
Eating too much junk food
Exercising strenuously
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.
2.
3.
4.
Morning faster blood glucose
2hr oral glucose tolerance test
Hb1Ac
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.
2.
3.
4.
Start IV of NS
Apply cool, wet compresses
Scrub area w/ soft-bristle brush
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 volume
2. Imbalanced nutrition: less than body
requirements
3. Impaired breathing pattern
4. 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.
2.
3.
4.
Clusters of fluid filled vesicles
Fine, threadlike lines
Purple-colored lesions
Thick, honey colored crusts
Which of the following orders should a nurse
implement first for a child w/ a UTI?
1.
2.
3.
4.
Ampicillin 250mg IV q 12hr
Blood & urine cultures
Sitz bath prn for pain
Voiding cystourethrogram (VCUG)
3yo being admitted w/ nephrotic syndrome.
Best roommate is:
1. 16yo recovering post-op from ruptured
appendix
2. 8yo w/ leukemia
3. Another toddler w/ rheumatic fever
4. 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.
2.
3.
4.
Generalized edema
Frank bright red blood in urine
Inc’d urinary output
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.
2.
3.
4.
Activity must be limited for 1 mo
Child must not play active games
Child must remain in bed for 2 wks
Activity does not affect course of disease
Which nursing intervention has highest priority when
caring for child w/ acute glomerulonephritis?
1.
2.
3.
4.
Assess for dysuria
Monitor BP
Monitor temp
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. True
2. False
To prevent swelling of casted extremity, elevate the
extremity above heart level & apply ice to cast.
1. True
2. False
Which of the following is an early sign of
impaired neurovascular function in a child w/ an
arm cast?
1.
2.
3.
4.
Cool, cold fingers
Pain
Inability to detect a pulse distal to cast
Inability to move distal extremity
Choose the most appropriate roommate for a
16yo in a full body cast.
1.
2.
3.
4.
12 yo w/ inguinal hernia repair
9 yo w/ gastroenteritis
6 yo w/ fractured femur
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 leg
2. Attached to a pin placed in the affected
femur
3. Used to allow child to turn from side to side
4. Skin traction & elevates hips slightly from bed
Nurse detects a positive Ortolani sign in a
newborn. What is the nurse assessing?
1.
2.
3.
4.
Broadening of perineum
Shortening of one leg
Audible click on hip manipulation
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 children
3. Your child’s condition is too severe for a
pavlik harness
4. 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 possible
3. I need to come to clinic every week w/ my
infant for casting
4. 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.
2.
3.
4.
Ride a bike
Walk to school
Do frequent isometric exercises
Watch TV for prolonged periods
Child scheduled for debridement of leg wounds. In
what order should nurse perform procedures?
1.
2.
3.
4.
Remove dressing
Medicate for pain
Pour water on dressing to loosen it
Assess need for dressing supplies
Which of the following are manifestations of
scabies? (all that apply)
1. Nits present
2. Threadlike rash between fingers & other
moist areas
3. Circular rash on extremities
4. Pruritus
5. Eczematous eruption in infants
Match skin disorder w/ cause
1.
2.
3.
4.
5.
Impetigo contagiosa
Scabies
Lyme disease
Cold sore, fever blister
ringworm
A.
B.
C.
D.
E.
Fungal infection
Bacterial infection
Viral infection
Caused by spirochete
Caused by burrowing
mite
Match type of dermatitis w/ it’s description
1.
2.
3.
4.
Diaper dermatitis
Infantile eczema
Acne
Seborrheic dermatitis
A. Weeping, red vesicles
& papules
B. Comedones & pustules
C. Red, inflamed skin
D. Thick, yellow scaly
areas
Which of the following meds can be used for
children w/ eczema? (all that apply)
1.
2.
3.
4.
5.
Corticosteroids
Accutane
Peroxide
Antihistamines
Calamine lotion
Diaper dermatitis can be largely prevented by
changing an infant’s diapers frequently & keeping the
diaper area clean & dry.
1. True
2. False
Eczema usually appears on cheeks of a 4yo child.
1. True
2. False
A complication that may occur w/ acne & most
types of dermatits is cellulitis.
1. True
2. 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.
2.
3.
4.
5.
Monitor blood glucose every 4 hr
Discontinue taking insulin until feeling better
Drink 8 oz fruit juice every hour
Test urine for ketones
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.
2.
3.
4.
5.
6.
Frequent urination
Inc’d energy level
Nausea
Nervousness & irritability
Sweating & pallor
Deep, rapid & labored respirations
Hypoglycemic rx can occurs b/c of:
1.
2.
3.
4.
Too much glucose in body
Eating too much junk food
Exercising strenuously
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.
2.
3.
4.
Morning fasting blood glucose
2hr oral glucose tolerance test
Hb1Ac
Diary of child’s daily blood glucoses
When teaching child w/ newly dx’d type 1 D.M.,
priority should be placed on:
1.
2.
3.
4.
Wt loss measures
Self-monitoring of blood glucose
Need to reduce physical activity
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 selfesteem.
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.
2.
3.
4.
X-rays of wrist & hand
IGF-1
MRI
GH stimulation/
suppression test
A. Determines GH level
B. Id’s pituitary gland
tumor
C. Determines bone age
D. 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.
2.
3.
4.
5.
Glomerulonephritis
UTI
New onset D.M.
Epispadias
Bladder exstrophy
Match structural GU disorder w/ definition
1.
2.
3.
4.
Hypospadias
Epispadias
Phimosis
Bladder
exstrophy
5. Cryptorchidism
6. Chordee
7. Hydrocele
A. Ventral curvature of penis
B. 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 sac
E. Urethral meatus is located on
ventral side of glans penis
F. Eversion of bladder through
lower abd wall
G. 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. True
2. 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 baths
2. Change child’s bathing suit immediately after
swimming
3. Encourage child to go to BR q6hr
4. Have child wear cotton underpants rather
than nylon
5. Observe child wiping back to front after
voiding
Child admitted w/ glomerulonephritis. Which of
following indicates need to call PCP?
1.
2.
3.
4.
Specific gravity decrease from 1.022 to 1.020
Crackles in bases bilaterally
Absence of S3 on auscultation
Wt gain of 0.91kg overnight
Child admitted w/ nephrotic syndrome. Which of
following classic symptoms should nurse observe for?
1.
2.
3.
4.
HTN, hypoNa, hemoconcentration
hyperNa, hypoalbuminenia, hyperlipidemia
Hematuria, hypoaldosteronemia, hyperNa
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.
2.
3.
4.
Admin IV Lasix under supervision of nurse
Read to child from bedside chair
Reposition child q30min
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.
2.
3.
4.
Thrombosis
Bruising
Pulm congestion
Cardiac enlargement
3 yo w/ meningitis is documented as having
photophobia. Which of following interventions is
most effective in minimizing this symptom?
1.
2.
3.
4.
Avoid using the TV
Keep volume down on radio
Bandage both eyes temporarily
Elevate HOB
Child admitted w/ possible Reye syndrome. Which
factors in health history might be supportive of this
dx?
1.
2.
3.
4.
Recent h/o UTI
Recent h/o bacterial otitis media
Recent episode of gastroenteritis
Recent episode of haemophilus influenzae
meningitis
Which manifestations are indicative of Stage II
of Reye syndrome? (all that apply)
1.
2.
3.
4.
5.
Coma
Fixed pupils
Hyperventilation
Combativeness
Hyperactive deep tendon reflexes
Lack of which is a warning sign of palsy in 3mo
old infant?
1.
2.
3.
4.
Crawling
Sitting up w/o assistance
Hold head upright
Babbling simple words
Match type of CP w/ correct description
1. Hemiplegia/
hemiparesis
2. Diplegia/
diparesis
3. Quadriplegia/qu
adriparesis
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. True
2. 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.
2.
3.
4.
5.
6.
7.
Fever
Hypotension
Headache
Lethargy
Bulging anterior fontanel
Seizures
Change in school performance
Match each type of seizure below w/ its
definition.
1.
2.
3.
4.
Tonic-clonic
Absence seizure
Febrile seizure
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 100/70
2. Temp 37.9 (100.2), pulse 140, RR 26, BP
60/30
3. Temp 35.6 (96), pulse 50, RR 18, BP 80/50
4. 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.
2.
3.
4.
5.
Two black eyes
Nuchal rigidity
Split cranial sutures
Bruising of neck posterior to infants ear
Nosebleed
Which are priority assessments for adolescent postop
for insertion of Harrington rod secondary to scoliosis?
1.
2.
3.
4.
5.
6.
7.
Ability to eat a balanced diet
BP & pulse
O2 sat
Assess for body image disturbance
Neurvascular assessment
Pain assessment
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 soiled
2. Allow cast to remain uncovered until it dries
completely
3. Support wet cast carefully & avoid denting it
4. Make sure nothing is placed inside cast
5. 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. True
2. 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.
2.
3.
4.
Medicate w/ morphine sulfate before PT
Use ice packs before PT to dec inflammation
Take warm bath or use warm packs before PT
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.
2.
3.
4.
Mental retardation
Down syndrome
ADHD
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 handwashing
2. Keep infant in Fowler’s position most of time
to prevent choking
3. Use bulb syringe to remove nasal mucus
4. Keep infant’s mouth moist by rinsing
frequently w/ water
Nurse assessing 4yo for autism. Should be alert
for:
1.
2.
3.
4.
Constant talking & impulsive behavior
Poor language & interpersonal skills
Frequent resp & UTI’s
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 injury
2. Begins cutting his arm instead of banging his
head
3. Seeks out a staff member instead of head
banging
4. 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 feeding
4. Give infant as much formula as she can hold
during each feeding
5. 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 park
2. Parents are attending parenting classes
3. Parents report high expectations for their
children
4. 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 injuries
2. Detailed description of events prior to
injuries
3. Anxious, concerned attitude
4. Encouraging child to explain injuries