Nrsg 435 Exam 2

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1. A child with hypopituitarism is being started on growth hormone therapy. Nursing considerations should be based on knowledge of which of the following?
- Therapy is most successful if it is started during adolescence
- Replacement therapy requires daily subcutaneous injections
- Hormonal supplementation will be required throughout child’s lifetime
- Treatment is considered successful if children attain full stature by adolescence

About This Quiz

NRSG 435 EXAM 2 assesses nursing considerations for pediatric endocrine disorders, focusing on conditions like hypopituitarism, hypersecretion of GH, juvenile hypothyroidism, and diabetes insipidus. It evaluates key nursing interventions and clinical manifestations relevant to aspiring pediatric nurses.

Questions and Answers

2.
1. Which of the following is a condition that can result if hypersecretion of GH occurs after epiphyseal closure?
- Cretinism
- Dwarfism
- Gigantism
- Acromegaly
Correct Answer

A. Acromegaly

Explanation

Acromegaly is the correct answer because it is a condition that can occur if there is an excessive secretion of growth hormone (GH) after the closure of the epiphyseal plates. In this condition, the bones and tissues continue to grow, leading to enlargement of the hands, feet, and facial features. It is different from gigantism, which occurs when there is hypersecretion of GH before the closure of the epiphyseal plates, resulting in excessive growth in height. Cretinism is a condition caused by congenital hypothyroidism, while dwarfism is generally caused by various genetic or hormonal factors, not hypersecretion of GH.

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3.

Which of the following is a common clinical manifestation of juvenile hypothyroidism?
- A. Insomnia
- B. Diarrhea
- C. Dry skin
- D. Rapid growth
Correct Answer

A. C. Dry skin

Explanation

Dry skin is a common clinical manifestation of juvenile hypothyroidism. Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormone, which can lead to various symptoms. Dry skin is a result of reduced sweating and oil production in the skin due to the decreased metabolic activity caused by low thyroid hormone levels. Other symptoms of juvenile hypothyroidism may include fatigue, weight gain, constipation, slow growth, and delayed puberty. Insomnia, diarrhea, and rapid growth are not typically associated with hypothyroidism.

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4.

Intranasal administration of Desmopressin Acetate (DDAVP) is used to treat:
- A. Hypopituitarism
- B. Diabetes insipidus
- C. Syndrome of inappropriate ADH
- D. Acute adrenocortical insufficiency
Correct Answer

A. B. Diabetes insipidus

Explanation

Intranasal administration of Desmopressin Acetate (DDAVP) is used to treat diabetes insipidus. Diabetes insipidus is a condition characterized by excessive thirst and urination due to a deficiency of antidiuretic hormone (ADH) or a resistance to its effects. Desmopressin Acetate is a synthetic form of ADH that helps to reduce excessive urination and control fluid balance in the body.

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5.
1. Exophthalmos (protruding eyeballs) may occur in children with of the following conditions?
- A. Hypothyroidism
- B. Hyperthyroidism
- C. Hyperparathyroidism
- D. Hyperparathyroidism
Correct Answer

A. B. Hyperthyroidism

Explanation

Exophthalmos, or protruding eyeballs, is a symptom commonly associated with hyperthyroidism. Hyperthyroidism is a condition in which the thyroid gland produces an excessive amount of thyroid hormones, leading to an overactive metabolism. This can cause various symptoms, including weight loss, increased heart rate, and bulging eyes. The excess thyroid hormones can stimulate the tissues behind the eyes, causing them to become inflamed and push the eyeballs forward. Therefore, option b, hyperthyroidism, is the correct answer.

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6.
1. Which of the following is considered a cardinal sign of diabetes mellitus?
- A. Nausea
- B. Seizures
- C. Impaired vision
- D. Frequent urination
Correct Answer

A. D. Frequent urination

Explanation

Frequent urination is considered a cardinal sign of diabetes mellitus. This is because in diabetes, the body is unable to regulate blood sugar levels properly, leading to high levels of glucose in the blood. The kidneys try to remove the excess glucose by producing more urine, causing frequent urination. This symptom is often one of the first signs of diabetes and is commonly experienced by individuals with the condition.

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7.
1. Hyperglycemia associated with diabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than:
- A. 185 mg/dL
- B. 220 mg/dL
- C. 280 mg/dL
- D. 330 mg/dL
Correct Answer

A. D. 330 mg/dL

Explanation

Hyperglycemia associated with diabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than 330 mg/dL. This means that if a person's blood glucose level exceeds 330 mg/dL, they may be experiencing hyperglycemia in the context of diabetic ketoacidosis. It is important to monitor blood glucose levels closely in individuals with diabetes to prevent complications such as diabetic ketoacidosis.

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8.
1. Signs of Hyperglycemia include:
- A. Tremors, sweating, headaches
- B. Hunger, nausea, lethargy
- C. Confusion, slurred speech, anxiety
- D. Blurred vision, weakness, polyphagia
Correct Answer

A. D. Blurred vision, weakness, polyphagia

Explanation

The signs of hyperglycemia include blurred vision, weakness, and polyphagia. Blurred vision can occur due to the high levels of glucose in the blood affecting the lens of the eye. Weakness is a common symptom of hyperglycemia as the body is not able to effectively use glucose for energy. Polyphagia refers to excessive hunger and increased appetite, which can be a result of the body's cells not receiving enough glucose for energy. These symptoms are commonly seen in individuals with high blood sugar levels.

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9.
1. Which teaching would be important to discuss with the family of a child born with PKU?
- A. Studies have shown that children with PKU outgrow the disease
- B. Consumption of decreased amounts of protein and dairy products is advised
- C. High protein and high dairy products consumption must be maintained
- D. Exclusively breastfeeding is encouraged for maximal nutrition for the child
Correct Answer

A. B. Consumption of decreased amounts of protein and dairy products is advised

Explanation

It is important to discuss with the family of a child born with PKU that consumption of decreased amounts of protein and dairy products is advised. This is because PKU is a genetic disorder that affects the body's ability to break down an amino acid called phenylalanine, which is found in protein. Consuming too much protein can lead to a buildup of phenylalanine in the body, causing intellectual disability and other health problems. Therefore, it is crucial for the family to understand the importance of managing protein intake to prevent complications associated with PKU.

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10.
1. Early detection of hypothyroidism and phenylketonuria is essential in preventing what in infants?
- A. Short stature
- B. Accelerated growth
- C. Mental retardation
- D. Obesity
Correct Answer

A. C. Mental retardation

Explanation

Early detection of hypothyroidism and phenylketonuria is essential in preventing mental retardation in infants. Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormone, which is crucial for brain development. Phenylketonuria is a genetic disorder that affects the body's ability to break down an amino acid called phenylalanine, leading to a buildup of this substance in the blood and causing brain damage. Detecting and treating these conditions early can help prevent the development of mental retardation in infants.

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11.
1. The nurse is preparing a community outreach program for adolescents about the characteristic differences between type 1 and 2 diabetes mellitus, which of the following concepts should the nurse include?
- A. Type one DM has an abrupt onset
- B. Type 1 is often with oral glucose agents
- C. Type one DM occurs primarily in Caucasians
- D. Type two requires insulin therapy
- E. Type 2 DM frequently has a familial history
- F. Type 2 DM occurs in people who are overweight
Correct Answer(s)

A. A. Type one DM has an abrupt onset
A. C. Type one DM occurs primarily in Caucasians
A. E. Type 2 DM frequently has a familial history
A. F. Type 2 DM occurs in people who are overweight

Explanation

The nurse should include the concepts that type 1 diabetes mellitus has an abrupt onset, occurs primarily in Caucasians, type 2 diabetes mellitus frequently has a familial history, and occurs in people who are overweight. These concepts are important for adolescents to understand the characteristic differences between type 1 and type 2 diabetes mellitus.

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12.
1. Which of the following statements best describes Hirschsprung disease?
- A. It results in frequent evacuation of solids, liquids and gas
- B. There is a passage of excessive amounts of meconium in the neonate
- C. The colon has aganglionic segment
- D. It results in excessive peristaltic movements within the GI tract
Correct Answer

A. C. The colon has aganglionic segment

Explanation

Hirschsprung disease is a condition characterized by the absence of nerve cells (ganglion cells) in a segment of the colon. This results in a lack of normal peristalsis and movement of stool through the affected segment. As a result, individuals with Hirschsprung disease may experience difficulty passing stool, leading to constipation, distention, and other symptoms. This explanation aligns with the given correct answer which states that Hirschsprung disease is characterized by an aganglionic segment in the colon.

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13.
1. A child with pyloric stenosis is having excessive vomiting. Which of the following is a potential complication?
- A. Hyperkalemia
- B. Metabolic acidosis
- C. Metabolic alkalosis
- D. Hyperchloremia
Correct Answer

A. C. Metabolic alkalosis

Explanation

Pyloric stenosis is a condition where the muscle between the stomach and small intestine becomes thickened, leading to blockage and causing symptoms like excessive vomiting. When a child with pyloric stenosis vomits, they lose stomach acid which can result in a loss of hydrogen ions. This loss of hydrogen ions can lead to an increase in blood pH, causing metabolic alkalosis. Therefore, metabolic alkalosis is a potential complication in a child with pyloric stenosis.

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14.

A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. The nurse includes in the teaching:
- A. Surgical therapy is indicated
- B. Reduce frequency of feeding by encouraging larger volumes of formula
- C. Place in prone position for sleep after feeding
- D. Thicken feedings and enlarge the nipple hole
Correct Answer

A. D. Thicken feedings and enlarge the nipple hole

Explanation

Thickening feedings and enlarging the nipple hole can help decrease the number and total volume of emesis in an infant with gastroesophageal reflux. Thickening the feedings can help to prevent the stomach contents from flowing back up into the esophagus, reducing the likelihood of emesis. Enlarging the nipple hole can allow for a faster flow of milk, which can help prevent the infant from swallowing air and reduce the amount of air in the stomach, also decreasing the likelihood of emesis. Surgical therapy is not indicated for this issue. Placing the infant in a prone position for sleep after feeding can actually increase the risk of choking and should be avoided.

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15.
1. Melena, the passage of black, tarry stools, suggests bleeding from the:
- A. Hemorrhoids or anal fissures
- B. Perianal or rectal area
- C. Lower GI tract
- D. Upper GI tract
Correct Answer

A. D. Upper GI tract

Explanation

Melena, the passage of black, tarry stools, suggests bleeding from the upper GI tract. This is because when there is bleeding in the upper GI tract, the blood gets partially digested by stomach acid, resulting in the stools appearing black and tarry. Hemorrhoids or anal fissures (option a) typically cause bright red blood in the stool. Bleeding from the perianal or rectal area (option b) may also result in bright red blood in the stool. The lower GI tract (option c) may cause bright red or maroon-colored blood in the stool. Therefore, the correct answer is option d.

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16.
1. Which of the following is now recommended for the immunization of all newborns?
- A. Hepatitis A, B, and C vaccines
- B. Hepatitis A vaccine
- C. Hepatitis B vaccine
- D. Hepatitis C vaccine
Correct Answer

A. C. Hepatitis B vaccine

Explanation

The correct answer is c. Hepatitis B vaccine. This vaccine is now recommended for the immunization of all newborns because hepatitis B is a serious viral infection that can cause chronic liver disease and liver cancer. By vaccinating newborns, it helps protect them from acquiring the infection from their mothers during childbirth or from other sources. The vaccine is safe and effective in preventing hepatitis B and its complications.

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17.
1. The clinical manifestations of Meckel Diverticulum include:
- A. Fever, vomiting, and constipation
- B. Weight loss, hypotension, and obstruction
- C. Painless rectal bleeding, abdominal pain, or intestinal obstruction
- D. Abdominal pain, bloody diarrhea, and foul smelling stool
Correct Answer

A. C. Painless rectal bleeding, abdominal pain, or intestinal obstruction

Explanation

The correct answer is c. Painless rectal bleeding, abdominal pain, or intestinal obstruction. Meckel Diverticulum is a congenital abnormality where a small pouch forms in the wall of the small intestine. It is the most common congenital anomaly of the gastrointestinal tract. The clinical manifestations can vary, but the most common symptoms are painless rectal bleeding, abdominal pain, and intestinal obstruction. These symptoms occur because the diverticulum can become inflamed, infected, or twisted, leading to complications. Other symptoms may include nausea, vomiting, and diarrhea.

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18.
1. An invagination of one portion of the bowel into another is called:
- A. Intussusception
- B. Pyloric stenosis
- C. Tracheoesophageal fistula
- D. Hirschsprung disease
Correct Answer

A. A. Intussusception

Explanation

Intussusception refers to the condition where one portion of the bowel telescopes or invaginates into another portion. This can lead to obstruction and impaired blood flow to the affected area. Symptoms may include severe abdominal pain, vomiting, and bloody stools. Intussusception is most commonly seen in infants and young children. Prompt medical attention is necessary to prevent complications such as bowel perforation and infection. Pyloric stenosis, tracheoesophageal fistula, and Hirschsprung disease are unrelated conditions and do not involve the invagination of the bowel.

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19.
1. Symptoms in celiac disease include stools that are:
- A. Fatty, frothy, bulky, and foul smelling
- B. Currant-jelly appearing
- C. Small frothy and dark green
- D. White with an ammonia like smell
Correct Answer

A. A. Fatty, frothy, bulky, and foul smelling

Explanation

In celiac disease, the body is unable to properly digest gluten, a protein found in wheat, barley, and rye. This leads to damage in the small intestine, which can result in malabsorption of nutrients. One of the common symptoms of malabsorption is steatorrhea, which is characterized by fatty, frothy, bulky, and foul-smelling stools. This occurs because the body is unable to break down and absorb fats properly, leading to their presence in the stool. Therefore, option a is the correct answer.

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20.
1. The nurse observes frothy saliva in the mouth and nose of the neonate, as well as frequent drooling. When fed, the infant swallows normally, but suddenly the fluid returns through the infant’s nose and mouth. The nurse should suspect what condition?
- A. Esophageal atresia
- B. Cleft palate
- C. Anorectal malformation
- D. Billiary atresia
Correct Answer

A. A. Esophageal atresia

Explanation

The nurse should suspect esophageal atresia because the symptoms described, including frothy saliva in the mouth and nose, frequent drooling, and regurgitation of fluid through the nose and mouth, are consistent with this condition. Esophageal atresia is a congenital condition where the esophagus does not properly connect to the stomach, leading to difficulty in swallowing and regurgitation of fluid. Cleft palate, anorectal malformation, and biliary atresia would not typically present with these specific symptoms.

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21.
1. An important assessment for the nurse to perform in identifying cleft palate is to:
- A. Assess the sucking ability of the infant
- B. Assess the color of the lips
- C. Palpate the palate with a gloved finger
- D. Do all the above
Correct Answer

A. C. Palpate the palate with a gloved finger

Explanation

To identify cleft palate, it is important for the nurse to palpate the palate with a gloved finger. This allows the nurse to feel for any abnormalities or gaps in the palate that may indicate a cleft. Assessing the sucking ability of the infant and the color of the lips may provide additional information, but they are not specific to cleft palate and may not always be indicative of the condition. Palpation of the palate is a more direct and reliable method for identifying cleft palate.

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22.
1. Which child may need extra fluids to prevent dehydration? Select all that apply.
- A. 7-day-old receiving phototherapy
- B. 6-month-old with newly diagnoses of pyloric stenosis
- C. 2-year-old with pneumonia
- D. 2-year-old with full-thickness burns to the chest, back and abdomen
- E. 13-year-old who has just started her mensus
Correct Answer(s)

A. A. 7-day-old receiving phototherapy
A. B. 6-month-old with newly diagnoses of pyloric stenosis
A. C. 2-year-old with pneumonia
A. D. 2-year-old with full-thickness burns to the chest, back and abdomen

Explanation

All of the children mentioned in options a, b, c, and d may need extra fluids to prevent dehydration.
- A 7-day-old receiving phototherapy may need extra fluids because phototherapy can increase the risk of dehydration due to increased insensible water loss.
- A 6-month-old with newly diagnosed pyloric stenosis may need extra fluids because this condition can cause vomiting and fluid loss.
- A 2-year-old with pneumonia may need extra fluids because fever and increased respiratory rate can lead to dehydration.
- A 2-year-old with full-thickness burns to the chest, back, and abdomen may need extra fluids because burns can cause significant fluid loss through the damaged skin.
However, a 13-year-old who has just started her menses does not necessarily need extra fluids to prevent dehydration.

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23.

Which of the following is a clinical manifestation of increased intracranial pressure in children?
- 1. Diplopia, blurred vision
- 2. Increased blood pressure
- 3. Low-pitched cry
- 4. Sunken fontanel
Correct Answer

A. 1. Diplopia, blurred vision

Explanation

Diplopia, or double vision, and blurred vision are both clinical manifestations of increased intracranial pressure in children. Increased intracranial pressure can cause compression of the cranial nerves, leading to abnormalities in vision. This can result in the perception of double vision or blurred vision.

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24.

The nurse is carefully monitoring a child who is unconscious after a fall and notices the child suddenly has a fixed and dilated pupil. The nurse should interpret this as which of the following?
- 1. Indication of brain death
- 2. Severe brainstem damage
- 3. Eye trauma
- 4. Neurosurgical emergency
Correct Answer

A. 4. Neurosurgical emergency

Explanation

A fixed and dilated pupil is a sign of increased intracranial pressure, which can be caused by a brain injury or bleeding in the brain. This is a serious condition that requires immediate medical intervention, making it a neurosurgical emergency. It indicates that there is a critical problem in the brain that needs urgent attention to prevent further damage or even death.

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25.

The nurse is doing a neurologic assessment on a 2 month old infant after a car accident. Moro, tonic neck, and withdrawal reflexes are present. The nurse should recognize that these reflexes suggest which of the following?
- 1. Decorticate posturing
- 2. Neurologic health
- 3. Severe brain damage
- 4. Decerebrate posturing
Correct Answer

A. 2. Neurologic health

Explanation

The presence of the Moro, tonic neck, and withdrawal reflexes in a 2-month-old infant after a car accident suggests neurologic health. These reflexes are normal and expected in infants at this age, indicating that the infant's nervous system is functioning properly. Decorticate and decerebrate posturing, on the other hand, are abnormal postures that indicate damage to specific areas of the brain. Therefore, the presence of these reflexes does not suggest severe brain damage.

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26.

I’m afraid my camera cut off the question, but here are the answers to choose from!!!
- 1. Turn head side to side every hour
- 2. Suction child frequently
- 3. Provide environmental stimulation
- 4. Avoid activities that cause pain or crying
Correct Answer

A. 4. Avoid activities that cause pain or crying
27.

An important nursing intervention when caring for an unconscious child would be which of the following?
- 1. Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema
- 2. Avoid using sedatives and narcotics to provide comfort and pain
- 3. Change the child’s position infrequently to minimize the chance of ICP
- 4. Give tepid sponge baths to reduce fevers above 101 F because antipyretics are contraindicated?
Correct Answer

A. 1. Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema

Explanation

When caring for an unconscious child, it is important to monitor their fluid intake and output carefully to prevent fluid overload and cerebral edema. Unconscious children are at a higher risk of developing cerebral edema, which is the accumulation of fluid in the brain. Monitoring fluid intake and output helps ensure that the child's fluid balance is maintained within normal limits and prevents complications associated with fluid overload.

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28.

A 10 year old on a bicycle has been hit by a car in front of the school. The school nurse immediately assesses airway, breathing and circulation. The next nursing action should be which of the following?
- 1. Place on side
- 2. Take blood pressure
- 3. Check scalp and back for bleeding
- 4. Stabilize neck and spine
Correct Answer

A. 4. Stabilize neck and spine

Explanation

In this scenario, the correct answer is to stabilize the neck and spine. This is because the child has been hit by a car, which can cause significant trauma to the head and neck. Stabilizing the neck and spine helps to prevent any further damage or injury to the spinal cord, which could result in paralysis or other serious complications. It is important to prioritize this action before checking for bleeding or taking other vital signs.

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29.

Which of the following statements best describes a subdural hematoma?
- 1. Bleeding is generally arterial, and brain compression occurs rapidly
- 2. Bleeding occurs between the dura and the skull
- 3. Bleeding occurs between the dura and the cerebrum
- 4. The hematoma commonly occurs in the parietotemporal region
Correct Answer

A. 3. Bleeding occurs between the dura and the cerebrum

Explanation

A subdural hematoma is a type of bleeding that occurs between the dura (the outermost layer of the meninges) and the cerebrum (the largest part of the brain). It is typically caused by a head injury that tears the veins bridging the dura and the brain. This type of bleeding is usually venous rather than arterial, and the blood accumulates slowly over time, causing compression and potentially leading to symptoms such as headache, confusion, and neurological deficits. The parietotemporal region is a common location for subdural hematomas, but it can occur in other areas of the brain as well.

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30.

A school aged child has sustained a head injury and multiple fractures after being thrown from a horse. The child’s LOC is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. The most appropriate nursing action is which of the following?
- 1. Explain that analgesic is contraindicated with a head injury
- 2. Consult the MD about which analgesia can be safely administered
- 3. Teach parents that analgesia is unnecessary when child is fully awake and alert
- 4. Have parents describe the child’s previous experience with pain
Correct Answer

A. 2. Consult the MD about which analgesia can be safely administered

Explanation

The most appropriate nursing action in this situation is to consult the MD about which analgesia can be safely administered. The child has sustained a head injury and multiple fractures, and the parents have reported that the child is exhibiting signs of pain such as periodic crying and restlessness. It is important to address the child's pain and provide appropriate pain relief, but due to the head injury, it is necessary to consult the MD to determine which analgesia can be safely administered without worsening the child's condition.

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31.

A ten year old child, without a history of seizures, experiences a tonic-clonic seizure at school that lasts more than five minutes. Breathing is not impaired. Some postical confusion occurs. The most appropriate initial reaction by the nurse should be which of the following?
- 1 .Notify parent that the child should go home
- 2. Stay with the child and make sure that emergency medical services are called
- 3. Notify parent and MD
- 4. Stay with child, offering calm reassurance
Correct Answer

A. 2. Stay with the child and make sure that emergency medical services are called

Explanation

The most appropriate initial reaction by the nurse should be to stay with the child and make sure that emergency medical services are called. This is because the child is experiencing a tonic-clonic seizure, which lasts more than five minutes. This type of seizure can be potentially life-threatening and requires immediate medical attention. The nurse should stay with the child to ensure their safety and well-being, while also contacting emergency medical services to provide the necessary medical intervention.

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32.

A toddler is admitted to the pediatric unit with presumptive bacterial meningitis. The initial orders call for isolation, IV access, cultures and antimicrobial agents. The nurse knows that antibiotic therapy should begin:
- 1. When medication is received from the pharmacy and labs have been drawn
- 2. Once diagnosis is confirmed
- 3. As soon as MD is notified of culture results
- 4. After the child’s fluid and electrolyte balance has been restored
Correct Answer

A. 1. When medication is received from the pharmacy and labs have been drawn

Explanation

The correct answer is 1 because initiating antibiotic therapy as soon as medication is received from the pharmacy and labs have been drawn is crucial in the treatment of bacterial meningitis. Bacterial meningitis is a serious infection that can rapidly progress and cause severe complications. Starting antibiotic therapy promptly can help to control the infection and prevent further damage. Waiting for the diagnosis to be confirmed or for culture results may delay the initiation of treatment, which can be detrimental to the patient's health. Restoring fluid and electrolyte balance is important, but it should not delay the start of antibiotic therapy.

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33.

Which of the following is a late sign of ICP in an infant or child? Check all that apply.
- 1. Headache
- 2. Seizure
- 3. Bradycardia
- 4. Papiledema
- 5. Increased sleepiness
- 6. Decreased consciousness
- 7. Lethargy
Correct Answer(s)

A. 3. Bradycardia
A. 4. Papiledema
A. 6. Decreased consciousness

Explanation

Bradycardia, papilledema, and decreased consciousness are all late signs of increased intracranial pressure (ICP) in an infant or child. Headache, seizure, increased sleepiness, and lethargy can also be signs of increased ICP, but they are considered early signs. It is important to monitor for these signs and seek medical attention if they occur, as increased ICP can be a serious condition requiring intervention.

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34.

Which of the following is a physiologic effect of immobilization on children?
- 1) Venous return improves, since child is in supine position
- 2) Metabolic rate increases
- 3) Circulatory stasis can lead to thrombus and embolus formation
- 4) Bone calcium increases, releasing excess calcium into the body
Correct Answer

A. 3) Circulatory stasis can lead to thrombus and embolus formation

Explanation

Immobilization in children can lead to circulatory stasis, which means that blood flow becomes stagnant or slows down. This stagnant blood flow can increase the risk of thrombus (blood clot) formation. If a blood clot dislodges and travels to another part of the body, it can cause an embolus, which can be life-threatening if it blocks a blood vessel. Therefore, circulatory stasis due to immobilization can lead to thrombus and embolus formation.

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35.

The nurse is caring for an immobilized preschool child. Which of the following is helpful during this period?
- 1) Keep child away from other immobilized children if possible
- 2) Encourage wearing pajamas
- 3) Take child for a “walk” by wagon outside the room
- 4) Let child have few behavioral limitations
Correct Answer

A. 3) Take child for a “walk” by wagon outside the room

Explanation

Taking the immobilized preschool child for a "walk" by wagon outside the room is helpful during this period because it provides a change of environment and stimulation for the child. It allows the child to experience different sights, sounds, and sensations, which can help alleviate boredom and promote psychological well-being. Additionally, being outside the room can also provide opportunities for social interaction and engagement with other people, which is important for the child's overall development and emotional well-being.

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36.

Which of the following is characteristic of fractures in children?
- 1) Fractures rarely occur at the growth plate site because it absorbs shock well
- 2) Periosteum of a child’s bone is thinner, is weaker, and has less osteogenic potential
- 3) Pliable bones of growing children are less porous than those of the adult
- 4) Rapidity of healing is inversely related to the age of the child
Correct Answer

A. 4) Rapidity of healing is inversely related to the age of the child

Explanation

As children grow older, the rapidity of healing for fractures decreases. This is because the bones become less pliable and more porous as they mature, making it more difficult for them to heal quickly. Additionally, the periosteum, which is the outer layer of the bone responsible for bone growth and repair, becomes thinner and weaker in children, further slowing down the healing process. Therefore, the older the child is, the slower their fractures will heal.

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37.

Parents bring a 7-year-old to the clinic for evaluation of an injured after a bicycle accident is upset, and the child will not allow an examination of the injured arm. The priority nursing care is?
- 1) Calmly ask the child to point to where the pain is worst and to wiggle fingers
- 2) Initiate and intravenous line and administer morphine for the pain
- 3) Have the parents hold the child so that nurse can examine the arm thoroughly
- 4) Send the child to radiology so that an x-ray film can be taken
Correct Answer

A. 1) Calmly ask the child to point to where the pain is worst and to wiggle fingers

Explanation

The priority nursing care in this situation is to calmly ask the child to point to where the pain is worst and to wiggle fingers. This approach allows the nurse to gather important information about the location and severity of the pain, as well as assess the child's range of motion and neurological function. It also helps to establish trust and rapport with the child, which is crucial in order to proceed with further examination and treatment. Initiating an intravenous line and administering morphine may be necessary for pain management, but it should not be the first priority. Having the parents hold the child or sending the child to radiology can be considered once the initial assessment is completed.

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38.

A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracic brace. The patient asks how long she will have to wear the brace. The appropriate answer is:
- 1) Most preadolescents us the brace for 6 months
- 2) It will be necessary to wear the brace for the rest of your life
- 3) For as long as you have been told
- 4) Until your vertebral column has reached skeletal maturity
Correct Answer

A. 4) Until your vertebral column has reached skeletal maturity

Explanation

The appropriate answer is 4) Until your vertebral column has reached skeletal maturity. This means that the patient will have to wear the brace until their spine has finished growing and reached its full maturity. This is important because wearing the brace helps to correct the curvature of the spine and prevent further progression of scoliosis. Once the spine has reached skeletal maturity, the brace is no longer needed as the growth of the spine is complete.

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39.

The nurse uses the five Ps to assess ischemia in a child with a fracture? Which of the options is an omninous sign?
- 1) Positioning
- 2) Petaling
- 3) Paresthesia
- 4) Posturing
Correct Answer

A. 3) Paresthesia

Explanation

Paresthesia refers to abnormal sensations such as tingling or numbness, which can indicate nerve damage or compromised blood flow. In the context of assessing ischemia in a child with a fracture, paresthesia would be considered an ominous sign because it suggests inadequate blood supply to the affected area. This can lead to further complications and potentially irreversible damage if not addressed promptly.

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40.

Cerebral palsy may result from a variety of causes. It is now known that the most common cause of CP is which of the following?
- 1) Cerebral trauma
- 2) Birth asphyxia
- 3) Prenatal or neonatal brain lesion or maldevelopment
- 4) CNS disease
Correct Answer

A. 3) Prenatal or neonatal brain lesion or maldevelopment

Explanation

Cerebral palsy is a condition that affects movement and coordination. It can be caused by various factors, but the most common cause is prenatal or neonatal brain lesion or maldevelopment. This means that during pregnancy or shortly after birth, there may be damage or abnormal development in the brain, leading to cerebral palsy. This can be due to a variety of reasons such as infections, genetic factors, or complications during pregnancy or delivery. Other potential causes mentioned in the options, such as cerebral trauma, birth asphyxia, or CNS disease, can also contribute to cerebral palsy, but they are not as commonly observed as prenatal or neonatal brain lesions or maldevelopment.

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41.

The parents of an infant with cerebral palsy ask the nurse if their child will be mentally retarded. The answer should be based on which of the following?
- 1) Around 20% of affected children have normal intelligence
- 2) Mental retardation is expected if motor and sensory deficits are severe
- 3) About 55% of affected children have normal intelligence
- 4) Affected children have some degree of mental retardation
Correct Answer

A. 3) About 55% of affected children have normal intelligence

Explanation

The correct answer is 3) About 55% of affected children have normal intelligence. This answer suggests that there is a possibility that the infant with cerebral palsy may have normal intelligence. It provides a statistic that indicates that more than half of affected children have normal intelligence, implying that mental retardation is not a certainty in all cases of cerebral palsy.

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42.

A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. Primary nursing intervention for the child includes which of the following?
- 1) Monitoring and maintaining systemic blood pressure
- 2) Minimizing environmental stimuli
- 3) Discussing long-term care issues with the family
- 4) Administering immunoglobulin
Correct Answer

A. 1) Monitoring and maintaining systemic blood pressure

Explanation

Monitoring and maintaining systemic blood pressure is the primary nursing intervention for a 14-year-old girl in the intensive care unit after a spinal cord injury. This is important because spinal cord injuries can lead to autonomic dysreflexia, which is a potentially life-threatening condition characterized by a sudden increase in blood pressure. By monitoring and maintaining systemic blood pressure, the nurse can prevent complications and ensure the stability of the patient's condition.

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43.

An adolescent with a spinal cord injury is admitted to a rehabilitation center. Her parents describe her as hostile, and uncooperative. The nurse should recognize that this is suggestive of which of the following?
- 1) Severe depression that will require long-term counseling
- 2) Denial response to her situation that makes rehabilitative efforts more difficult
- 3) Normal response to her situation that can be redirected in a healthy way
- 4) Normal phase of adolescent development
Correct Answer

A. 3) Normal response to her situation that can be redirected in a healthy way

Explanation

The adolescent's hostile and uncooperative behavior is likely a normal response to her situation. It is common for individuals with spinal cord injuries to experience anger, frustration, and a sense of loss. The nurse should recognize that this behavior can be redirected in a healthy way through appropriate counseling and support. It is not indicative of severe depression or denial, and it is not solely a normal phase of adolescent development.

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44.

Urinary tract anomalies are frequently associated with which of the following irregularities in fetus development?
- Cardiovascular anomalies
- Myelomeningocele
- Defects in lower extremities
- Malformed or low-ears
Correct Answer

A. Malformed or low-ears

Explanation

Urinary tract anomalies are often associated with malformed or low-ears in fetus development. This suggests that there may be a common underlying cause or genetic factor that affects the development of both the urinary tract and the ears. It is important to note that this association does not necessarily mean that all individuals with urinary tract anomalies will also have malformed or low-ears, but there is a higher likelihood of this irregularity occurring together.

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45.

Which of the following urine tests would be considered abnormal?
- PH 4.0
- Specific gravity 1.020
- WBC 1 or2 cells/ml
- Protein level absent
Correct Answer

A. pH 4.0

Explanation

A urine pH of 4.0 is considered abnormal because it indicates acidic urine. The normal range for urine pH is typically between 5.0 and 8.0. A pH of 4.0 may be indicative of conditions such as diabetic ketoacidosis, metabolic acidosis, or urinary tract infections. It can also be caused by certain medications or diet. An abnormal pH level may require further investigation and medical intervention to determine the underlying cause and appropriate treatment.

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46.

A girl, age 5 ½ years, has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurses should recommend to her parent that the first action is to have the child evaluated for which of the following?
- Attention deficit hyperactivity disorder
- Urinary tract infection
- School phobia
- Glomerulonephritis
Correct Answer

A. Urinary tract infection

Explanation

The correct answer is urinary tract infection. Urinary incontinence in a young child can be a symptom of a urinary tract infection. It is important to rule out any underlying medical conditions before considering other potential causes such as attention deficit hyperactivity disorder or school phobia. Glomerulonephritis is a possibility, but urinary tract infection is more common in this age group.

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47.

Vesicoureteral reflux with infection is the most common cause of pyelonephritis in children. In teaching the patient of a newly diagnosed 2- year-old, the nurse includes:
- Surgery is indicated to reverse scarring
- Having siblings examined for VCR
- Limited fluids to reduce reflux
- Give cranberry juice twice a day
Correct Answer

A. Having siblings examined for VCR

Explanation

Vesicoureteral reflux (VCR) is a condition where urine flows backward from the bladder into the ureters and sometimes up into the kidneys. It is a common cause of pyelonephritis (kidney infection) in children. Since VCR can be hereditary, it is important to have siblings examined for VCR to detect and address the condition early. Surgery may be indicated to correct VCR and prevent further scarring of the kidneys. Limiting fluids may help reduce reflux, but it is not the most important aspect to address in this situation. Cranberry juice is not specifically mentioned as a treatment for VCR or pyelonephritis.

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48.

The pathologic process for post infectious glomerulonephritis is believed to be:
- Immune complex formation and glomerular deposition
- Infarction of renal vessels
- Bacterial endotoxin deposition on and destruction of glomeruli
- Embolization of glomeruli by bacteria and fibrin endocardial vegetation
Correct Answer

A. Immune complex formation and glomerular deposition

Explanation

The correct answer is immune complex formation and glomerular deposition. Post infectious glomerulonephritis is characterized by an immune response to an infection, usually caused by streptococcal bacteria. During the infection, immune complexes are formed when antibodies bind to antigens on the surface of the bacteria. These immune complexes can then deposit in the glomeruli of the kidneys, leading to inflammation and damage. This immune response is believed to be the main pathologic process involved in post infectious glomerulonephritis. Infarction of renal vessels, bacterial endotoxin deposition, and embolization of glomeruli are not typically associated with this condition.

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49.

Which of the following laboratory findings, in conjunction with presenting symptoms, indicates MCNS?
- Reduced serum albumin
- Normal platelet count
- Low specific gravity
- Decreased hemoglobin
Correct Answer

A. Reduced serum albumin

Explanation

Reduced serum albumin is a laboratory finding that indicates MCNS (Minimal Change Nephrotic Syndrome). MCNS is a kidney disorder characterized by the loss of protein in the urine, leading to low levels of serum albumin in the blood. This condition often presents with symptoms such as edema, foamy urine, and hyperlipidemia. Normal platelet count, low specific gravity, and decreased hemoglobin are not specific indicators of MCNS and may be seen in other conditions.

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Nrsg 435 Exam 2

A child with hypopituitarism is being started on growth hormone therapy. Nursing considerations should be based on knowledge of which of the following?

Which of the following is a condition that can result if hypersecretion of GH occurs after epiphyseal closure?

Which of the following is a common clinical manifestation of juvenile hypothyroidism?

Intranasal administration of Desmopressin Acetate (DDAVP) is used to treat:

Exophthalmos (protruding eyeballs) may occur in children with of the following conditions?

Which of the following is considered a cardinal sign of diabetes mellitus?

Hyperglycemia associated with diabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than:

Signs of Hyperglycemia include:

Which teaching would be important to discuss with the family of a child born with PKU?

Early detection of hypothyroidism and phenylketonuria is essential in preventing what in infants?

The nurse is preparing a community outreach program for adolescents about the characteristic differences between type 1 and 2 diabetes mellitus, which of the following concepts should the nurse include?

Which of the following statements best describes Hirschsprung disease?

A child with pyloric stenosis is having excessive vomiting. Which of the following is a potential complication?

A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. The nurse includes in the teaching:

Melena, the passage of black, tarry stools, suggests bleeding from the:

Which of the following is now recommended for the immunization of all newborns?

The clinical manifestations of Meckel Diverticulum include:

An invagination of one portion of the bowel into another is called:

Symptoms in celiac disease include stools that are:

The nurse observes frothy saliva in the mouth and nose of the neonate, as well as frequent drooling. When fed, the infant swallows normally, but suddenly the fluid returns through the infant’s nose and mouth. The nurse should suspect what condition?

An important assessment for the nurse to perform in identifying cleft palate is to:

Which child may need extra fluids to prevent dehydration? Select all that apply.

Which of the following is a clinical manifestation of increased intracranial pressure in children?

The nurse is carefully monitoring a child who is unconscious after a fall and notices the child suddenly has a fixed and dilated pupil. The nurse should interpret this as which of the following?

The nurse is doing a neurologic assessment on a 2 month old infant after a car accident. Moro, tonic neck, and withdrawal reflexes are present. The nurse should recognize that these reflexes suggest which of the following?

I’m afraid my camera cut off the question, but here are the answers to choose from!!!

An important nursing intervention when caring for an unconscious child would be which of the following?

A 10 year old on a bicycle has been hit by a car in front of the school. The school nurse immediately assesses airway, breathing and circulation. The next nursing action should be which of the following?

Which of the following statements best describes a subdural hematoma?

A ten year old child, without a history of seizures, experiences a tonic-clonic seizure at school that lasts more than five minutes. Breathing is not impaired. Some postical confusion occurs. The most appropriate initial reaction by the nurse should be which of the following?

A toddler is admitted to the pediatric unit with presumptive bacterial meningitis. The initial orders call for isolation, IV access, cultures and antimicrobial agents. The nurse knows that antibiotic therapy should begin:

Which of the following is a late sign of ICP in an infant or child? Check all that apply.

Which of the following is a physiologic effect of immobilization on children?

The nurse is caring for an immobilized preschool child. Which of the following is helpful during this period?

Which of the following is characteristic of fractures in children?

Parents bring a 7-year-old to the clinic for evaluation of an injured after a bicycle accident is upset, and the child will not allow an examination of the injured arm. The priority nursing care is?

A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracic brace. The patient asks how long she will have to wear the brace. The appropriate answer is:

The nurse uses the five Ps to assess ischemia in a child with a fracture? Which of the options is an omninous sign?

Cerebral palsy may result from a variety of causes. It is now known that the most common cause of CP is which of the following?

The parents of an infant with cerebral palsy ask the nurse if their child will be mentally retarded. The answer should be based on which of the following?

A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. Primary nursing intervention for the child includes which of the following?

An adolescent with a spinal cord injury is admitted to a rehabilitation center. Her parents describe her as hostile, and uncooperative. The nurse should recognize that this is suggestive of which of the following?

Urinary tract anomalies are frequently associated with which of the following irregularities in fetus development?

Which of the following urine tests would be considered abnormal?

A girl, age 5 ½ years, has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurses should recommend to her parent that the first action is to have the child evaluated for which of the following?

Vesicoureteral reflux with infection is the most common cause of pyelonephritis in children. In teaching the patient of a newly diagnosed 2- year-old, the nurse includes:

The pathologic process for post infectious glomerulonephritis is believed to be:

Which of the following laboratory findings, in conjunction with presenting symptoms, indicates MCNS?