Review Ati nur 223a sect 4 pediatrics final exam

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Ati nur 223a sect 4 pediatrics final exam

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Total Questions : 93

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Question 1:

Emergency Department - 0900: • Two-year-old toddler brought in by parents due to concerns about child’s breathing. • Parents report child has a history of asthma and woke up today with a bad asthma attack. • Parents state child has had a runny nose and occasional cough for 2 days and has not been eating or drinking well. • Child is restless and crying intermittently while clinging to parent. • Appears ill with flushed face. • Large amount of clear thick nasal drainage from bilateral nares and marked nasal flaring noted. • Oral mucosa pink and slightly dry. • Moderate to severe suprasternal and substernal retractions. • Bilateral wheezes in upper lobes throughout inspiration and expiration. • Diminished breath sounds in bilateral bases. • Frequent dry hacking cough when crying. Pediatric Unit - 1200: • Two-year-old toddler admitted from the emergency department due to exacerbation of asthma. • Child currently asleep in parent’s arms but rouses easily when touched. • Oral mucosa pink and moist. • No nasal flaring noted. • Mid substernal retractions noted. • Mild bilateral expiratory wheezes auscultated in upper lobes with breath sounds diminished in bilateral bases. • No cough noted. • O2 at 2 L/min via nasal cannula.

0900: • Temperature: 38.3°C (100.9°F) • Heart rate: 130 bpm • Respiratory rate: 40 breaths/min • Oxygen saturation: 88% on room air 1200: • Temperature: 37.8°C (100.0°F) • Heart rate: 120 bpm • Respiratory rate: 32 breaths/min • Oxygen saturation: 94% on 2 L/min O2 via nasal cannula

0900: • Child appears ill with flushed face. • Large amount of clear thick nasal drainage from bilateral nares. • Marked nasal flaring noted. • Oral mucosa pink and slightly dry. • Moderate to severe suprasternal and substernal retractions. • Bilateral wheezes in upper lobes throughout inspiration and expiration. • Diminished breath sounds in bilateral bases. • Frequent dry hacking cough when crying. 1200: • Child currently asleep in parent’s arms but rouses easily when touched. • Oral mucosa pink and moist. • No nasal flaring noted. • Mid substernal retractions noted. • Mild bilateral expiratory wheezes auscultated in upper lobes with breath sounds diminished in bilateral bases. • No cough noted.

• Chest X-ray: Hyperinflation of lungs, no focal consolidation. • Blood gas analysis: pH 7.35 (7.35-7.45), PaCO2 45 mmHg (35-45 mmHg), PaO2 60 mmHg (80-100 mmHg), HCO3 24 mEq/L (22-26 mEq/L). 1200: • Chest X-ray: No significant change from previous. • Blood gas analysis: pH 7.38 (7.35-7.45), PaCO2 42 mmHg (35-45 mmHg), PaO2 75 mmHg (80-100 mmHg), HCO3 24 mEq/L (22-26 mEq/L).

0900: • Albuterol nebulizer treatment every 4 hours. • Prednisolone 2 mg/kg/day PO divided into two doses. • Oxygen therapy at 2 L/min via nasal cannula. • IV fluids at maintenance rate. 1200: • Continue Albuterol nebulizer treatment every 4 hours. • Continue Prednisolone 2 mg/kg/day PO divided into two doses. • Continue oxygen therapy at 2 L/min via nasal cannula. • Continue IV fluids at maintenance rate.

A nurse is caring for a 2-year-old toddler in the pediatric unit who was admitted from the emergency department due to concerns about the child’s breathing.

Exhibits

Which of the following findings should the nurse on the pediatric unit identify as an indication that the treatment plan is effective? (Select all that apply)

A. Nasal flaring B. Retractions C. Oxygen saturation D. Respiratory rate E. Pulse F. Breath sounds in bilateral bases G. Heart rate

Answer and Explanation

Choice A:

Nasal flaring is a sign of respiratory distress. The absence of nasal flaring would indicate improvement, but the presence of nasal flaring indicates ongoing respiratory distress.

Choice B:

Retractions are also a sign of respiratory distress. The reduction or absence of retractions would indicate improvement, but their presence indicates ongoing respiratory distress.

Choice C:

Oxygen saturation is a key indicator of respiratory function. An improvement in oxygen saturation levels (from 88% on room air to 94% on 2 L/min O2) indicates that the treatment plan is effective in improving the child’s oxygenation.

Choice D:

Respiratory rate is an important vital sign to monitor in respiratory conditions. A decrease in respiratory rate (from 40 breaths/min to 32 breaths/min) indicates that the treatment plan is effective in reducing the child’s respiratory distress.

Choice E:

Pulse rate can be influenced by various factors, including fever, anxiety, and respiratory distress. While a decrease in pulse rate may indicate improvement, it is not as specific an indicator of respiratory function as oxygen saturation and respiratory rate.

Choice F:

Breath sounds in bilateral bases are important to assess for improvement in lung function. The presence of mild bilateral expiratory wheezes and diminished breath sounds in the bases indicates some improvement compared to the initial assessment.

Choice G:

Heart rate can be influenced by various factors, including fever, anxiety, and respiratory distress. While a decrease in heart rate may indicate improvement, it is not as specific an indicator of respiratory function as oxygen saturation and respiratory rate.

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Question 2:

Client presents to the ED with guardian. Client reports that they began having pain around their “belly button” the previous evening around 2100. Reports that pain is now in right lower quadrant and became worse earlier this morning. Reports nausea. Abdomen soft with tenderness to palpation in right lower quadrant. Bowel sounds positive in all four quadrants. Verbalizes increase in pain when right hip is flexed and rotated internally. Rates pain as 6 on a 0 to 10 pain scale. Notified provider of client’s arrival and assessment data. Prescriptions received.

• Temperature: 37.7°C (99.9°F) • Pulse rate: 98/min, strong and regular • Respiratory rate: 22/min • Blood pressure: 124/64 mm Hg • Oxygen saturation: 99% on room air

• CBC and C-Reactive Protein drawn and sent to lab

Client continues to report right lower quadrant pain, now rated as 7 on a 0 to 10 pain scale. Reports increased nausea and has vomited once. Abdomen remains soft with increased tenderness in the right lower quadrant. Bowel sounds remain positive in all four quadrants. Client appears more uncomfortable and is guarding the right lower quadrant. Notified provider of client’s status and updated assessment data.

• Temperature: 38.1°C (100.6°F) • Pulse rate: 102/min, strong and regular • Respiratory rate: 24/min • Blood pressure: 126/68 mm Hg • Oxygen saturation: 98% on room air

• WBC count: 22,000/mm³ (5,000 to 10,000/mm³) • RBC count: 4.5 million/mm³ (4.0 to 5.5 million/mm³) • Hgb: 14 g/dL (9.5 to 14 g/dL) • Hct: 44% (30% to 40%) • Platelets: 350,000/mm³ (150,000 to 400,000/mm³) • C-Reactive Protein: 11.8 mg/dL (less than 1.0 mg/dL)

A nurse in the emergency department (ED) is caring for a 13-year-old client who presented with right lower quadrant abdominal pain, nausea, and fever.

Exhibits

The nurse has notified the provider of the client’s 0800 assessment data and lab results. Which of the following prescriptions should the nurse anticipate?

A. Give promethazine 50 mg intermittent IV bolus B. Obtain informed consent for surgery C. Administer acetaminophen 800 mg D. Initiate IV antibiotics E. Maintain NPO status F. Obtain abdominal ultrasound G. Administer enemas until clear

Answer and Explanation

Choice A:

Administering promethazine 50 mg intermittent IV bolus is not typically indicated for managing acute abdominal pain and suspected appendicitis. Promethazine is an antiemetic and antihistamine, but it does not address the underlying cause of the symptoms.

Choice B:

Obtaining informed consent for surgery is crucial as the client’s symptoms and lab results (elevated WBC count and C- Reactive Protein) strongly suggest appendicitis. Surgery, specifically an appendectomy, is the definitive treatment for appendicitis.

Choice C:

Administering acetaminophen 800 mg may help alleviate pain and reduce fever, but it does not address the underlying cause of the symptoms. It is important to manage the pain, but the primary focus should be on diagnosing and treating the appendicitis.

Choice D:

Initiating IV antibiotics is essential in managing suspected appendicitis to prevent infection and complications such as perforation or abscess formation. Antibiotics help control the infection until surgical intervention can be performed.

Choice E:

Maintaining NPO (nothing by mouth) status is important to prepare the client for potential surgery and to prevent exacerbation of symptoms. Keeping the client NPO helps reduce the risk of aspiration during anesthesia and surgery.

Choice F:

Obtaining an abdominal ultrasound is important to confirm the diagnosis of appendicitis. Imaging studies such as ultrasound or CT scan can help visualize the appendix and assess for inflammation or other abnormalities.

Choice G:

Administering enemas until clear is not appropriate in this scenario. Enemas are not indicated for managing acute abdominal pain and suspected appendicitis. They could potentially worsen the condition or mask important symptoms.

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Question 3:

(0700 hrs)

Temperature: 36.7°C (98.0°F)
Pulse rate: 114/min
Respiratory rate: 30/min
Blood pressure: 92/66 mm Hg
Oxygen saturation: 90%

(0700 hrs)

Furosemide 40 mg IV every 6 hr. Administered at 0600.
Digoxin 250 mcg IV now. Administered at 0600.

(0700 hrs)

Jugular vein distention noted.
Lower extremity edema 2+ bilaterally.
Extremities cool with decreased skin pigmentation.
Peripheral pulses weak bilaterally.
Lung sounds with wheezing noted throughout.

(0700 hrs)

Chest X-ray: Cardiomegaly noted.
Echocardiogram: Left ventricular hypertrophy, mitral valve stenosis.
BNP: 1200 pg/mL (Reference range: <100 pg/mL)

Based on the information provided, what is the most appropriate initial nursing action?

A. Increase the oxygen flow rate. B. Administer an additional dose of furosemide. C. Notify the healthcare provider. D. Reposition the client to a high Fowler’s position.

Answer and Explanation

Choice A:

Increasing the oxygen flow rate may help improve oxygen saturation, but it does not address the underlying issue of fluid overload and heart failure exacerbation.

Choice B:

Administering an additional dose of furosemide may help reduce fluid overload, but it is not the most immediate action to improve the client’s respiratory status and comfort.

Choice C:

Notifying the healthcare provider is important, but the nurse should first take immediate action to improve the client’s respiratory status and comfort.

Choice D:

Repositioning the client to a high Fowler’s position is the most appropriate initial nursing action. This position helps improve lung expansion and reduces the work of breathing, providing immediate relief for the client experiencing dyspnea and respiratory distress.

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Question 4:

• Diagnosis: Bilateral pneumonia • Past medical history: Cystic fibrosis • Plan: Aggressive airway clearance therapy, intravenous antibiotic therapy

• 0700 hrs: Caregiver reports child has had increased coughing, fatigue, and a poor appetite for the past several days. Wheezing and rhonchi auscultated bilaterally. Respirations labored with accessory muscle use. Frequent cough productive with thick, yellow blood-streaked sputum. Dyspnea noted with activity. Child reports “a bit of a stomachache” and rates the discomfort as 3 on a scale of 0 to 10. Abdomen soft and non-tender to palpation. Active bowel sounds auscultated. • 0900 hrs: Respirations rapid with accessory muscle use. Dyspnea noted while at rest. Frequent cough. Thick yellow sputum expectorated following airway clearance therapy. Child reports chest discomfort as 4 on a scale of 0 to 10. Child consumes approximately 50% of meals. Denies abdominal pain. Passed three large, frothy, foul-smelling stools.

• 0700 hrs: o Oral temperature: 39.1°C (102.4°F) o Heart rate: 116/min o Respiratory rate: 32/min o Blood pressure: 102/60 mm Hg o Oxygen saturation: 95% on room air • 0900 hrs: o Oral temperature: 38.1°C (100.6°F) o Heart rate: 128/min o Respiratory rate: 32/min o Blood pressure: 88/48 mm Hg o Oxygen saturation: 88% on room air

• 0900 hrs: o Chest X-ray: Bilateral infiltrates consistent with pneumonia o Complete Blood Count (CBC):  WBC: 15,000/mm³ (Reference range: 4,500-11,000/mm³)  Hemoglobin: 11 g/dL (Reference range: 12-16 g/dL)  Platelets: 250,000/mm³ (Reference range: 150,000-450,000/mm³)

A nurse is caring for a school-age child in the hospital.

Exhibits

Which of the following assessment findings should the nurse report to the provider? (Select all that apply)

A. Oxygen saturation: 88% on room air B. Heart rate: 128/min C. Child reports chest discomfort as 4 on a scale of 0 to 10 D. WBC: 15,000/mm³ E. Passed three large, frothy, foul-smelling stools

Answer and Explanation

Choice A:

Oxygen saturation of 88% on room air is significantly below the normal range (95-100%) and indicates hypoxemia. This finding should be reported to the provider as it may require supplemental oxygen or other interventions.

Choice B:

A heart rate of 128/min is elevated for a school-age child and may indicate increased work of breathing, fever, or other underlying issues. This finding should be reported to the provider for further evaluation.

Choice C:

While the child reporting chest discomfort as 4 on a scale of 0 to 10 is important, it is not as critical as the other findings. The provider should be aware of the discomfort, but it may not require immediate intervention.

Choice D:

An elevated WBC count of 15,000/mm³ indicates an infection, which is consistent with the diagnosis of bilateral pneumonia. While this is important information, it is expected in the context of the current diagnosis and may not require immediate reporting.

Choice E:

Passing three large, frothy, foul-smelling stools is significant in a child with cystic fibrosis as it may indicate malabsorption or other gastrointestinal issues. This finding should be reported to the provider for further evaluation and potential adjustment of the treatment plan.

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Question 5:

(0700 hrs) • Temperature: 39°C (102.2°F) • Heart rate: 148/min • Respiratory rate: 42/min • Blood pressure: 87/44 mm Hg • SpO2: 89% on room air

(0700 hrs) • The toddler presents with a high fever, cough, and difficulty breathing. • The mother reports that the child has been irritable and not eating well for the past two days. • The child is observed to have nasal flaring and intercostal retractions. • Breath sounds are diminished with wheezing heard bilaterally. • The child is restless and crying intermittently. • The mother denies any known allergies or recent travel. • The child has a history of frequent upper respiratory infections.

(0700 hrs) • Rapid RSV antibody test: Positive (per nasal swab) • Blood culture: Pending • Hgb: 10 g/dL (9.5 to 14 g/dL) • Hct: 40% (30% to 40%) • WBC: 10,000/mm³ (5,000 to 10,000/mm³) • Platelets: 230,000/mm³ (150,000 to 400,000/mm³) • Glucose: 82 mg/dL (60 to 100 mg/dL) • BUN: 18 mg/dL (5 to 18 mg/dL)

(0700 hrs) • Albuterol 2.5 mg via nebulizer now. May repeat every 20 min for 1 hr as needed for wheezing and retractions. • Oxygen 2 L/min via nasal cannula.

A nurse is caring for a 2-year-old male toddler in the emergency department.

Exhibits

Which of the following findings should the nurse identify as an indication that the treatment plan is effective? (Select all that apply.)

A. Nasal flaring B. Retractions C. Oxygen saturation D. Breath sounds in bilateral bases E. Respiratory rate F. Heart rate

Answer and Explanation

Choice A:

Nasal flaring is a sign of respiratory distress. The absence of nasal flaring would indicate improvement, but the presence of nasal flaring indicates ongoing respiratory distress.

Choice B:

Retractions are also a sign of respiratory distress. The reduction or absence of retractions would indicate improvement, but their presence indicates ongoing respiratory distress.

Choice C:

Oxygen saturation is a key indicator of respiratory function. An improvement in oxygen saturation levels (from 89% on room air to higher levels) indicates that the treatment plan is effective in improving the child’s oxygenation.

Choice D:

Breath sounds in bilateral bases are important to assess for improvement in lung function. The presence of clear breath sounds or reduced wheezing indicates improvement in the child’s respiratory status.

Choice E:

Respiratory rate is an important vital sign to monitor in respiratory conditions. A decrease in respiratory rate (from 42 breaths/min to a lower rate) indicates that the treatment plan is effective in reducing the child’s respiratory distress.

Choice F:

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Question 6:

A child is admitted with a suspected diagnosis of Wilms tumor.
The nurse should place a sign with which of the following warnings over the child’s bed?

A. Do not palpate abdomen. B. No venipuncture or blood pressure in left arm. C. Collect all urine. D. Contact precautions.

Answer and Explanation

Choice A:

Wilms tumor, also known as nephroblastoma, is a type of kidney cancer that primarily affects children. It is crucial not to palpate the abdomen of a child with a suspected Wilms tumor because this can cause the tumor to rupture and spread cancerous cells to other parts of the body.

Choice B:

This choice is incorrect because there is no specific restriction on venipuncture or blood pressure measurements in the left arm for children with Wilms tumor. This precaution is typically associated with conditions like lymphedema or after a mastectomy.

Choice C:

Collecting all urine is not a specific precaution for Wilms tumor. While monitoring urine output can be important in various conditions, it is not a primary concern for Wilms tumor.

Choice D:

Contact precautions are not necessary for Wilms tumor as it is not an infectious disease. Contact precautions are typically used for conditions that are contagious or spread through direct contact.

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Question 7:

The nurse would teach the mother of a boy with Tetralogy of Fallot that if the child suddenly becomes cyanotic and dyspneic, the mother should:

A. Place him in knee-chest position. B. Have him lie supine with the head turned to one side. C. Have him lie prone, being sure he can breathe easily. D. Place him in semi-Fowler’s position in an infant seat.

Answer and Explanation

Choice A:

Placing the child in a knee-chest position helps increase systemic vascular resistance, which reduces the right-to-left shunt and improves oxygenation during a cyanotic spell in children with Tetralogy of Fallot.

Choice B:

Having the child lie supine with the head turned to one side does not help in managing a cyanotic spell and may not improve oxygenation.

Choice C:

Lying prone does not specifically address the cyanotic spell and may not be the most effective position for improving oxygenation.

Choice D:

Placing the child in a semi-Fowler’s position in an infant seat does not specifically address the cyanotic spell and may not be the most effective position for improving oxygenation.

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Question 8:

A 3-month-old is admitted with severe diarrhea.
Yesterday, the infant weighed 11 pounds (5 kg). Today, this infant weighs 9 pounds, 8 ounces (4.3 kg). Based on this information, the nurse documents that the infant has:

A. Failure to thrive. B. Malabsorption syndrome. C. Severe dehydration. D. Risk for fluid volume deficit.

Answer and Explanation

Choice A:

Failure to thrive is a condition where a child does not gain weight or grow as expected. While severe diarrhea can contribute to failure to thrive, the immediate concern in this scenario is the significant weight loss indicating severe dehydration.

Choice B:

Malabsorption syndrome involves the inability to absorb nutrients properly, leading to malnutrition and weight loss. However, the acute weight loss in this case is more indicative of severe dehydration.

Choice C:

Severe dehydration is characterized by significant fluid loss, which can be life-threatening in infants. The weight loss from 11 pounds to 9 pounds, 8 ounces indicates a substantial fluid loss, pointing to severe dehydration.

Choice D:

Risk for fluid volume deficit is a potential diagnosis, but the significant weight loss and clinical presentation indicate that the infant is already experiencing severe dehydration.

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Question 9:

When planning care for children, the nurse knows that which factor has the largest impact but is not able to be altered to influence the growth and development of children?

A. Environment. B. Genetics. C. Socialization. D. Nutrition.

Answer and Explanation

Choice A:

Environment plays a significant role in a child’s growth and development, including factors like socioeconomic status, access to education, and living conditions. However, it can be altered to some extent.

Choice B:

Genetics is the largest factor impacting growth and development that cannot be altered. Genetic factors determine physical characteristics, susceptibility to certain diseases, and overall growth patterns.

Choice C:

Socialization influences a child’s development, including social skills and behavior. While important, it can be influenced and altered through various interventions.

Choice D:

Nutrition is crucial for growth and development, affecting physical and cognitive development. However, it can be modified through dietary changes and interventions.

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Question 10:

A nurse is planning care for a 6-year-old child who has bacterial meningitis.
Which of the following nursing interventions is unnecessary in the client’s plan of care?

A. Measure head circumference every shift. B. Implement seizure precautions. C. Admit the client to a private room. D. Place the client in a semi-Fowler’s position.

Answer and Explanation

Choice A:

Measuring head circumference every shift is unnecessary for a 6-year-old child with bacterial meningitis. This intervention is more relevant for infants where head circumference changes can indicate increased intracranial pressure.

Choice B:

Implementing seizure precautions is necessary as bacterial meningitis can cause seizures due to increased intracranial pressure and inflammation.

Choice C:

Admitting the client to a private room is necessary to prevent the spread of infection, as bacterial meningitis can be highly contagious.

Choice D:

Placing the client in a semi-Fowler’s position helps reduce intracranial pressure and promotes comfort.

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Ati nur 223a sect 4 pediatrics final exam

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