NUR1142 Paediatric Q&As: Best Exam Solutions for Managing Child Health Issues, Exams of Nursing

Download NUR1142 Paediatric Q&As: Best Exam Solutions for Managing Child Health Issues and more Exams Nursing in PDF only on Docsity! NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ PEDIATRICS FULL ANALYSIS WITH PRACTICAL ANALISED CASES 2024. The nurse planning teaching for the parents of a child newly diagnosed with hemophilia will include information about which long-term complication? 1. Heart valve injury [33%] 2. Intellectual disability [3%] 3. Joint destruction [54%] 4. Recurrent pneumonia [8%] Explanation: Hemophilia is a bleeding disorder caused by a deficiency in coagulation proteins. Clients with classic hemophilia, or hemophilia A, lack factor VIII. Clients with hemophilia B (Christmas disease) lack factor IX. When injured, clients with hemophilia should be monitored closely for external as well as internal bleeding. The most frequent sites of bleeding are the joints (80%), especially the knee. Hemarthrosis can occur with minimal or no trauma, with episodes beginning during toddlerhood when the child is active and ambulatory. Over time, chronic swelling and deformity can occur. NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ (Option 1) Heart valve injury is common with rheumatic heart disease not hemophilia. (Option 2) Intellectual disability in children is commonly seen with fetal alcohol syndrome, Down syndrome, hypothyroidism, and lead poisoning. In rare cases, hemophilia can cause life-threatening intracranial bleeding. However, isolated intellectual disability is not seen. (Option 4) Recurrent pneumonia is commonly seen with cystic fibrosis not hemophilia. Educational objective: Clients with hemophilia are at risk for permanent joint destruction due to frequent bleeds into the joint spaces. Assisting clients with decreasing the incidence of bleeding episodes and prompt treatment when bleeding occurs can help minimize joint destruction. A A A A 2-month-old infant is brought to the pediatric emergency department due to vomiting and diarrhea for 4 days. Assessment findings include lethargy, poor feeding, sunken fontanel, temperature 100.4 F (38 C), heart rate 134/min, and respiratory rate 28/min. Which prescription from the health care provider would be the priority? Acetaminophen elixir 50 mg by mouth every 6 hours [1%] Intravenous (IV) ampicillin 240 mg every 12 hours [2%] 3. IV normal saline bolus 20 mL/kg over 1 hour [92%] 4. Obtain a stool culture [4%] NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ cause irritation of the oral mucosa. Excessive intake of pancreatic enzymes can result in fibrosing colonopathy (Option 1). (Option 4) This is a true statement; some children have difficulty taking a whole capsule. Capsule contents can be sprinkled in acidic substances such as applesauce. Capsules should not be taken with milk as they can cause it to curdle. Educational objective: Pancreatic enzyme supplements are used to aid the absorption of carbohydrates, fats, and proteins in a child with CF. They are taken with or just before every meal (not as needed); should be swallowed whole or sprinkled on an acidic food; and should not be crushed or chewed. They should not be taken with milk. Excessive intake could result in fibrosing colonopathy The nurse is caring for a pediatric client with end-stage leukemia who is on comfort care and is unresponsive. The child's parent asks, "How can you tell if my child is in pain?" Which of these would the nurse describe as signs of discomfort? Select all that apply. 1. Blank facial expression 2. Facial grimacing 3. Groaning NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ 4. Knees bent up near chest 5. Lying still Explanation: FLACC scale (face, legs, activity, cry, consolability) The nurse will provide teaching on signs that should prompt the parent to administer as- needed pain medication to the child. (Option 1) A child who is comfortable will usually have a neutral facial expression. A child in pain is likely to exhibit grimacing, frowning, or clenching of the jaw, based on the FLACC face assessment. (Option 5) A child who is comfortable will be lying quietly. A child who is squirming and moving is more likely to be in pain, based on the FLACC activity assessment. Educational objective: It is difficult to assess for pain in the nonverbal client, particularly if the person is unresponsive at the end of life. The FLACC scale is an accurate method of assessing pain in the nonverbal child. This tool should be used to teach parents how to promote comfort for their nonverbal child A A A A nurse is leading a discussion with a group of new parents. A parent asks about the first food to introduce to a 5-month-old infant. What is the best response by the nurse? NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ 1. "Finely mashed fruit, such as bananas, is given." [8%] 2. "Iron-fortified cereal, such as rice cereal, is offered." [82%] 3. "Mashed egg yolk is a good choice." [0%] 4. "Pureed carrots are well tolerated." [8%] Explanation Before age 6 months, an infant should receive only breast milk or formula. The infant is ready physiologically and developmentally for the addition of solid foods to the diet at age 4-6 months as iron stores have declined. Iron-fortified cereals (rice, barley, oatmeal, high protein) should be offered. Rice cereal is preferred due to the low risk of allergy and ease of digestion (Option 2). (Options 1, 3, and 4) Fruit juices and pureed fruit are typically offered next as a source of vitamin C. Vitamin C increases iron absorption. These are followed by strained vegetables, with yellow preferred due to the higher vitamin content. Foods are introduced one at a time to identify any allergies. Foods known to commonly induce allergy (eg, peanuts, eggs, seafood, whole milk) should not be introduced before age 1 year. Educational objective: Solid foods are introduced at age 4-6 months, with iron-fortified cereals (usually rice) offered first due to their low allergy potential and ease of digestion. Fruit juices and pureed fruits containing vitamin C are then offered, followed by strained vegetables. Egg yolks and whites are introduced at age 1 year. NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ Emesis 120 mL Wet diaper 1 50 g Wet diaper 2 52 g Wet diaper 3 46 g *Weight of a dry diaper = 30 g Answer: 178 (mL) Explanation: To measure the urinary output of an infant in diapers, subtract the weight of the diaper when dry from its weight when wet. One (1) gram of weight is equal to one (1) milliliter of fluid. Adequate urinary output for an infant is 2 mL/kg/hr. Calculation: NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ Urine output in diapers: Diaper 1: 50 − 30 = 20 g Diaper 2: 52 − 30 = 22 g Diaper 3: 46 − 30 = 16 g Total mg of urine: 58 g = 58 mL Total output (Emesis) + (Urine) = 120 mL + 58 mL = 178 mL Educational objective: Urinary output for a child in diapers is calculated by subtracting the dry weight of the diaper from its weight when wet. One (1) gram of weight is equal to one (1) milliliter of fluid. A A A The clinic nurse supervises a graduate nurse who is teaching the parents of a 2- year-old with acute diarrhea about home management. The nurse would need to intervene when the graduate nurse provides which instruction? 1. "Do not administer antidiarrheal medications to your child." [26%] 2. "Follow the bananas, rice, applesauce, and toast diet for the next few days." [32%] 3. "Record the number of wet diapers and return to the clinic if you notice a decrease." [28%] NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ 4. "Use a skin barrier cream such as zinc oxide in the diaper area until diarrhea subsides." [12%] Explanation: During bouts of acute diarrhea and dehydration, treatment focuses on maintaining adequate fluid and electrolyte balance. The first-line treatment is oral rehydration therapy, using oral rehydration solutions (ORSs) to increase reabsorption of water and sodium. Even if the diarrhea is accompanied by vomiting, ORS should still be offered in small amounts at frequent intervals. Continuing the child's normal diet (solid foods) is encouraged as it shortens the duration and severity of the diarrhea. The BRAT (bananas, rice, applesauce, and toast) diet is not recommended as it does not provide sufficient protein or energy. (Option 1) Use of antidiarrheal medications is discouraged as these have little effect in controlling diarrhea and may actually be harmful by prolonging some bacterial infections and causing fatal paralytic ileus in children. (Option 3) Parents should be taught to monitor their child for signs of dehydration by checking the amount of fluid intake, number of wet diapers, presence of sunken eyes, and the condition of the mucous membranes. (Option 4) Protecting the perineal skin from breakdown during bouts of diarrhea can be accomplished by using skin barrier creams (eg, petrolatum or zinc oxide). Educational objective: When a child is experiencing acute diarrhea, the priority is to monitor for dehydration. Treatment is accomplished with oral rehydration solutions and early reintroduction of the child's normal diet (usual foods). NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ the lumen, which produces the characteristic stool mixed with blood and mucus (ie, red, "currant jelly"). Initially, some infants may have only general symptoms (eg, irritability, diarrhea, lethargy). Subsequently, episodes of sudden abdominal pain (cramping), drawing the knees up to the chest, and inconsolable crying are seen. After an episode, the infant may vomit and then appear otherwise normal. Assessment may show a sausage-shaped abdominal mass. (Option 1) Melena (dark red or black, sticky stool) is an indication of an upper gastrointestinal (UGI) bleed. Gastritis is a common cause of UGI bleeding in infants and toddlers. (Option 2) Oily or bulky, foul-smelling stool is an indication of excess fat in the stool (steatorrhea) from malabsorption. This is characteristic of pancreatic insufficiency, cystic fibrosis, or celiac disease. NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ (Option 4) Thin, ribbon-like stool is characteristic of Hirschsprung disease (congenital aganglionic megacolon). Bowel obstruction is caused by failure of the internal sphincter to relax. Educational objective: The classic symptom triad of intussusception is abdominal pain, "currant jelly" stools, and a sausage-shaped abdominal mass. However, it is more common for clients to have episodes of sudden abdominal pain, inconsolable crying, and vomiting followed by periods of normal behavior. A A A The registered nurse is performing triage at a pediatric emergency department. Which client should be seen first? 1. Child with history of cystic fibrosis (CF) has new yellow sputum and cough today [18%] 2. Crying infant with fiery redness and moist papules in the diaper region [6%] 3. Grade-school client with swollen ecchymotic ankle after playing basketball [2%] 4. Adolescent client with abdominal pain, heart rate 120/min, and respirations 26/min [72%] Explanation: The client with abdominal pain has abnormal vital signs, which is a sign of a systemic condition. Adult criteria apply to adolescent clients in terms of NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ physiological signs/symptoms. A pulse of 120/min signals dehydration and this client's respirations are above normal. This is the most serious acuity. (Option 1) The client with a history of CF would be treated second as clients with CF have chronic respiratory issues related to the thick mucus plugging the airways. This client will probably need antibiotics but is stable and can wait. The severity of the situation is considered when prioritizing client care based on airway, breathing, and circulation (ABC). The seriousness of the adolescent client's condition related to "C" (dehydration) is a priority over a relatively stable "B." There is nothing indicating that this client is in respiratory distress. (Option 2) The infant has diaper dermatitis from irritation of urine and stool on the skin. A secondary infection with Candida albicans can occur. Diaper dermatitis is most common in infants age 9-12 months. Ointment will be provided. Mild diaper dermatitis is treated with a topical water-impermeable barrier (eg, zinc oxide). If the infant has an infection with Candida albicans, an antifungal topical medication is also used. When care must be NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ Including synthetic proteins and special formulas (eg, Lofenalac, Phenyl-Free) in the diet (Option 4) Eliminating high-phenylalanine foods (eg, meats, eggs, milk) from the diet (Option 2) Encouraging the consumption of natural foods low in phenylalanine (most fruits and vegetables) (Option 5) Restriction of dietary tyrosine is not necessary. Tyrosine levels in clients with PKU may be normal or slightly decreased. Educational objective: Phenylketonuria requires lifetime dietary restrictions. Infants should be given special formulas (eg, Lofenalac). For children and adults, high-phenylalanine foods (eg, meats, eggs, milk) should be restricted and replaced with protein substitutes. A A A A nurse is assessing a 1-month-old infant with an atrial septal defect (ASD). Which assessment finding does the nurse expect? 1. Muffled heart tones [19%] 2. Murmur [53%] 3. Cyanosis [19%] 4. Weak femoral pulses [6%] Explanation: The nurse would expect to hear a murmur with an atrial septal NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ defect. This defect is an abnormal opening between the right and left atria, allowing blood from the higher pressure left atrium to flow into the lower pressure right atrium. The back-and- forth flow of blood between the 2 chambers causes a vibration that is heard as a murmur on auscultation. ASD has a characteristic systolic murmur with a fixed split second heart sound. Some clients may also have a diastolic murmur. (Option 1) Muffled heart tones are not typical in ASD. Muffled heart tones that are heard postsurgical intervention are concerning for cardiac tamponade. (Option 3) Atrial and ventricular septal defects are acyanotic congenital heart defects because the blood from the high pressure left side (oxygenated blood) goes to the low pressure right side. NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ (Option 4) Weak lower and strong upper extremity pulses are present in coarctation of the aorta. Educational objective: In a child with atrial septal defect, the nurse would expect to hear a heart murmur on auscultation of heart sounds. A A A The nurse is caring for an infant diagnosed with Hirschsprung disease who is awaiting surgery. Which assessment finding requires the nurse's immediate action? 1. Abdominal distension with no change in girth for 8 hours [6%] 2. Did not pass meconium or stool within 48 hours after birth [26%] 3. Episode of foul-smelling diarrhea and fever [26%] 4. Excessive crying and greenish vomiting [39%] Explanation: Hirschsprung disease (HD) occurs when a child is born with some sections of the distal large intestine missing nerve cells, rendering the internal anal sphincter unable to relax. As a result, there is no peristalsis and stool is not passed. These newborns exhibit symptoms of distal intestinal obstruction. They have a distended abdomen and will not pass meconium within the expected 24-48 hours. They also have difficulty feeding and often vomit green bile. Surgical removal of the defective section of bowel is necessary and colostomy may be required. NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ constipation, diminished deep tendon reflexes, and generalized weakness. Additional symptoms are lack of head control, difficulty in feeding, and decreased gag reflex, which can progress to respiratory failure. Isolation of the organism from the child's stool can take several days; therefore, diagnosis is usually made by history, and treatment with botulism immune globulin is started before laboratory results are known. (Option 1) Apple pie is not the best way to serve apples to a 6-month-old as the other ingredients add too much fat and sugar. This would need to be addressed but is not a priority over the use of honey. (Option 2) Raw fruits are appropriate for a 6-month-old. (Option 4) Although TV dinners contain meat and vegetables, they are not the best source of food for an infant due to the high sodium content. This would need to be addressed after the use of honey is addressed. Educational objective: NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ Due to the risk of infant botulism, honey should not be given to children under age 1 year. A A A The home health nurse is visiting an infant who recently had surgery to repair tetralogy of Fallot. The nurse should teach the parents to report which findings indicative of heart failure to the health care provider (HCP)? Select all that apply. 1. Cool extremities 2. Increase in appetite 3. Puffiness around the eyes 4. Reduction in number of wet diapers 5. Weight loss Explanation: Heart failure may develop after surgical repair of tetralogy of Fallot, and infants and children can quickly decompensate hemodynamically when it occurs. Clinical manifestations are grouped into 3 primary categories— impaired myocardial pumping, pulmonary congestion, and systemic venous congestion. (Option 2) The infant would have a decrease in appetite with heart failure symptoms. (Option 5) The infant would more likely have experienced weight gain due to fluid retention. Educational objective: The nurse should teach parents of an infant or child with a repaired congenital heart NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ defect to recognize and report signs and symptoms of heart failure to the HCP. These may include rapid breathing rate; rapid heart rate at rest; dyspnea; activity intolerance (especially during feeding in infants); pale, cool extremities; weight gain; reduction in wet diapers; and puffiness around the eyes. NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ bleed include lethargy, headache, irritability, and vomiting. An intracranial bleed is lethal if unchecked, so administration of factor VIII to a client with hemophilia A is the first order of action, followed by a CT scan. (Option 2) Ondansetron (Zofran) can be given to treat nausea/vomiting, but administration of factor VIII is the priority. (Option 3) Laboratory studies, particularly hemoglobin and hematocrit levels, are necessary, but the priority is to administer factor VIII. (Option 4) A CT scan should be performed for diagnostic purposes, but the bleeding must be stopped emergently. Even if bleeding is evident on CT scan and the client is taken to the operating room, surgery cannot be performed without simultaneous factor VIII replacement. Educational objective: A client with hemophilia A and a head injury is at risk for intracranial bleeding (which sometimes occurs spontaneously). When intracranial or another form of bleeding is suspected, administration of factor VIII is a priority as the client's body cannot form a clot without it. A A A The school nurse is teaching a class of 10-year-old children about prevention of dental caries. Which recommendations would be part of the nurse's teaching plan? Select all that apply. 1. Chew sugar-free gum NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ 2. Drink fruit drinks/juices instead of sugary, carbonated beverages 3. Include milk, yogurt, and cheese in dietary intake 4. Minimize consumption of sweet, sticky foods 5. Rinse mouth with water after meals when brushing is not possible Explanation: Dental caries (ie, cavities) form when bacteria (eg, Streptococcus mutans) digest carbohydrates in the mouth, producing acids that break down tooth enamel and cause mineral loss. Oral hygiene and dietary intake are significant factors contributing to the development of caries. Clients should increase intake of cariostatic foods, which have an inhibitory effect on the progression of dental caries (eg, dairy products, whole grains, fruits and vegetables, sugar- NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ free gum containing xylitol) (Options 1 and 3). Cariogenic foods increase the risk for cavities and should be avoided. These include refined, simple sugars; sweet, sticky foods such as dried fruit (eg, raisins) and candy; and sugary beverages (eg, colas and other carbonated beverages, fruit drinks/juices) (Option 4). Additional practices to prevent dental caries include: Brushing after meals Flossing at least twice a day Rinsing the mouth with water after meals or snacks (Option 5) Drinking tap water rather than bottled water (most tap water sources add fluoride to promote dental health, whereas most bottled water does not contain fluoride) Finishing meals with a high-protein food (Option 2) Fruit drinks/juices contain high amounts of simple sugars; substituting these for other sugary beverages does not prevent dental caries. Whole fruits are better choices. Educational objective: Risk for dental caries can be reduced by avoiding highly cariogenic foods (eg, refined, simple sugars; sugary beverages; sweet, sticky foods), increasing intake of cariostatic foods (eg, dairy products, whole grains, fruits and vegetables), and maintaining oral hygiene (eg, brushing teeth, rinsing after meals). A A A NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ The nurse is planning care for a child being admitted with Kawasaki disease and should give priority to which nursing intervention? 1. Apply cool compresses to the skin of the hands and feet [10%] 2. Monitor for a gallop heart rhythm and decreased urine output [60%] 3. Prepare a quiet, non-stimulating, and restful environment [21%] 4. Provide soft foods and liberal amounts of clear liquids [7%] Explanation: Kawasaki disease (KD) is a childhood condition that causes inflammation of arterial walls (vasculitis). The coronary arteries are affected in KD, and some children develop coronary NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ aneurysms. The etiology of KD is unknown; there are no diagnostic tests to confirm the disease, and it is not contagious. KD has 3 phases: Acute - sudden onset of high fever that does not respond to antibiotics or antipyretics. The child becomes very irritable and develops swollen red feet and hands. The lips become swollen and cracked, and the tongue can also become red (strawberry tongue). Subacute - skin begins to peel from the hands and feet. The child remains very irritable. Convalescent - symptoms disappear slowly. The child's temperament returns to normal. Initial treatment consists of IV gamma globulin (IVIG) and aspirin. IVIG creates high plasma oncotic pressure, and signs of fluid overload and pulmonary edema develop if it is given in large quantities. Therefore, the child should be monitored for symptoms of heart failure (eg, decreased urinary output, additional heart sounds, tachycardia, difficulty breathing). (Option 1) During the acute phase (swollen hands and feet), skin discomfort can be eased with cool compresses and lotions. No treatment is needed in the subacute phase (skin peeling), but the new skin might be very tender. (Option 3) The child will be very irritable during the acute phase of KD. A non- stimulating, quiet environment will help to promote rest. After a KD episode, it is important for parents to understand that their child's irritability may last for up to 2 months and that follow-up appointments for cardiac evaluation are important. (Option 4) During the acute phase (painful swollen lips and tongue), the child should be given soft foods and clear liquids as these are tolerated best NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ Educational objective: Kawasaki disease causes inflammation of the arterial walls and can lead to scarring of the coronary arteries or development of coronary aneurysms. Treatment consists of aspirin and substantial infusion of IV gamma globulin. The affected child must be monitored for signs of heart failure. A A A A school-age child is brought to the emergency department due to nausea, vomiting, and severe right lower quadrant pain. The child's white blood cell count is 17,000/mm3 (17.0 x 109/L). Which statement by the child is of most concern to the nurse? 1. "I am hungry and they will not let me eat." [5%] 2. "I don't like hospitals and I want to go home." [1%] NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ identifying individual triggers (eg, dust, mold, pollen, dander) and implementing strategies to reduce or avoid exposure to known allergens. Key measures to reduce exposure to household and environmental allergens include the following: Installing high-efficiency particulate air filters in the home air conditioning system Keeping windows closed and staying indoors, particularly during times of heavy pollen Using hypoallergenic pillow and mattress covers to prevent exposure to dust mites (Option 2) Reducing or eliminating carpet and area rugs from the home (Option 5) Regularly mopping hard floors and damp-dusting furniture (at least weekly) (Option 1) (Option 3) If the client is not allergic to animal dander, keeping a household pet may be acceptable. However, to prevent pets from bringing environmental allergens into the home, further precautions may need to be implemented, such as more frequent baths or additional doormats. (Option 4) Open windows allow environmental allergens, such as pollen, to enter the home. To prevent exposure to these particles, susceptible clients should keep exterior windows closed and avoid spending long periods of time outdoors. Educational objective: NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ Prevention of symptoms plays an important role in the management of chronic allergic rhinitis. Preventive measures to reduce exposure include using hypoallergenic pillow and mattress covers, eliminating carpet in the home, keeping windows closed, installing high- efficiency air filters, regularly mopping hard floors, and frequently damp-dusting furniture A A A A 3-month-old infant has irritability, facial edema, a 1-day history of diarrhea with adequate oral intake, and seizure activity. During assessment, the parents state that they have recently been diluting formula to save money. Which is the most likely cause for the infant's symptoms? 1. Hypernatremia due to diarrhea [9%] 2. Hypoglycemia due to dilute formula intake [16%] 3. Hypokalemia due to excess gastrointestinal output [11%] NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ 4. Hyponatremia due to water intoxication [63%] Explanation: Water intoxication (water overload) resulting in hyponatremia may occur in infants when formula is diluted to "stretch" the feeding to save money. Hyponatremia may also result from ingestion of plain water (eg, caregiver attempting to rehydrate an infant who has been ill). Infants have immature renal systems with a low glomerular filtration rate, which decreases their ability to excrete excess water and makes them susceptible to water intoxication. Symptoms of hyponatremia include irritability, lethargy, and, in severe cases, hypothermia and seizure activity. Breast milk and/or formula are the only sources of hydration an infant needs for the first 6 months of life. Formula should be prepared per the manufacturer's instructions. (Option 1) Hypernatremia may be caused by dehydration (eg, decreased oral intake, vomiting, diarrhea) and presents with similar neurological symptoms (eg, restlessness, seizures). The infant's history indicates adequate oral intake and signs of fluid overload (eg, facial edema), not dehydration. (Option 2) Hypoglycemia may present with irritability and seizures, but facial edema and recent history of over-diluting the formula should alert the nurse that water intoxication with hyponatremia is the most likely cause. (Option 3) Hypokalemia secondary to diarrhea may present with irritability, muscle weakness, and cardiac arrhythmias. Educational objective: Infants are susceptible to hyponatremia secondary to water intoxication, which can NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ systolic murmur [8%] 4. Preschool client with tetralogy of Fallot who has finger clubbing and irritability [34%] Explanation: Ventricular septal defect (VSD) is a congenital abnormality in which a septal opening between ventricles causes left-to-right shunting, leading to excess blood flow to the lungs. This places the client at risk for congestive heart failure (CHF) and pulmonary hypertension. Clinical manifestations of VSD include a systolic murmur auscultated near the sternal border at the third or fourth intercostal spaces, and hallmark CHF signs (eg, diaphoresis, tachypnea, dyspnea). The client is currently showing signs of increased respiratory exertion (eg, grunting) and requires further assessment for CHF (Option 2). (Option 1) Coarctation of the aorta (COA) is an abnormal aortic narrowing that results in decreased cardiac output. The client will exhibit elevated pulse pressure in the upper NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ extremities and diminished pressures in the lower extremities. Further assessment is needed, but this client is not the current priority. (Option 3) A systolic murmur with a machine sound and poor feeding are expected, nonurgent findings in clients with patent ductus arteriosus (PDA). PDA commonly resolves within 48 hours and requires no intervention in full-term newborns. (Option 4) Tetralogy of Fallot (TOF) is a cyanotic congenital heart defect commonly manifested by signs of irritability and clubbing of fingers due to oxygen saturation chronically remaining between 65-85% until the client can undergo surgical repair. Further evaluation of the client's oxygenation is necessary but not urgently required. Educational objective: Ventricular septal defect is a cardiac abnormality, with a septal opening between ventricles, that may progress to congestive heart failure (CHF). The client should be closely monitored for respiratory exertion and signs of CHF (eg, dyspnea, tachypnea). A A A The parent of a 3-year-old calls and tells the nurse of finding the child in the bathroom with an empty bottle of mouthwash. The parent thinks that the bottle was about one quarter full. What is the nurse's priority response? 1. "Call the poison control center. I will give you the number." [29%] 2. "Give your child about a cup of water to dilute the mouthwash." [7%] 3. "How did your child get hold of the mouthwash?" NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ [0%] 4. "What is your child doing right now?" [62%] Explanation: Many mouthwashes have an ethanol (alcohol) content ranging from the equivalent of wine to half the strength of hard liquor. Because children's bodies absorb alcohol quickly, the symptoms of alcohol poisoning can occur within 30 minutes or less after consumption. Clinical indications include confusion, vomiting and seizures, difficulty breathing, flushed or pale skin, and coma secondary to low blood sugar. The exact amount of alcohol that this child presumably ingested is unknown. It is most important to assess the child's condition (eg, behavior, mental status, physical signs and symptoms) to determine if immediate emergency measures (eg, calling 911, cardiorespiratory support) are necessary or if the parent should be instructed to contact the poison control center (Option 4). (Option 1) It is the nurse's professional responsibility to provide instruction and guidance to the parent. Although caregivers should have the number of the poison control center NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ (Option 2) This infant is aspirating and in immediate distress, which should be addressed without delay. After suctioning the excess saliva and ensuring a clear airway, the nurse may perform further assessments. (Option 3) This infant's cyanosis is a result of aspirating secretions and does not indicate a circulatory problem. The knee-chest position is appropriate to increase pulmonary blood flow in infants with a cyanotic heart defect (eg, tetralogy of Fallot). Educational objective: The initial nursing action for a client experiencing cyanosis and excess oral secretions is oropharyngeal suctioning to ensure airway patency. A A A The nurse is teaching a class on nutrition and feeding practices for young children. What would the nurse recommend as the best snack for a toddler? 1. ½ cup orange juice [7%] 2. Animal cracker cookies [26%] 3. Raw carrot sticks [18%] 4. Strips of cheese [46%] Explanation: When choosing snacks and meals for toddlers (age 1–3), 3 factors must be considered: NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ Safety – small, hard, sticky and/or slippery foods pose a choking risk and should not be offered to children under age 3. Examples include hot dogs, grapes, nuts, raw carrot sticks, popcorn, peanut butter, hard candy, and raisins. Nutrient density (the nutrients a food provides relative to the number of calories it contains). The snack should be of high nutritional value rather than "empty calories." Potential for food-borne illness – children are at higher risk for developing a food- related infection if given raw, unpasteurized foods such as juice, partially cooked eggs, raw fish, or raw bean sprouts. Examples of healthy snacks for children under age 3 include pieces of cheese, whole- wheat crackers, banana slices, yogurt, cooked vegetables, mini pizzas, and cottage cheese with cut- up fruit. NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ (Option 1) Although orange juice is a source of vitamin C, it is considered a "sugary" beverage and lacks the fiber of whole fruit. It is recommended that young children have no more than 4–6 ounces of fruit juice per day. It is best to serve juice with a meal so the child does not become accustomed to snacking on sugary foods. (Option 2) Cookies do not have high nutritional value. Graham crackers or whole- wheat crackers with cream cheese would be better snack choices. (Option 3) Raw carrot sticks pose a choking risk. Carrots and other hard vegetable should be served grated or cooked. Educational objective: Food choices for young children should be of high nutritional value and pose little risk of choking or food-borne infection. Examples of healthy snacks for children under age 3 include pieces of cheese, whole-wheat crackers, banana slices, yogurt, cooked vegetables, mini pizzas, and cottage cheese with cut-up fruit. A A A For the past month, the nurse has been providing care to a 7-year-old client recently diagnosed with type 1 diabetes mellitus. Initially, the family seemed devastated over the diagnosis. The client's parent stated, "Our lives will never be the same." What statement now made by the parent best indicates that nursing interventions have been effective? 1. "Our child will not be able to participate in sporting events." [0%] 2. "Our whole family will have to make sacrifices to deal with this disease." [5%] NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ 2. Administer oxygen via mask [19%] 3. Assess infant's vital signs and pulse oximetry [7%] 4. Place the infant in the knee-chest position [73%] Explanation: Tetralogy of Fallot is a congenital cardiac defect that typically has 4 characteristics: pulmonary stenosis, right ventricular hypertrophy, overriding aorta, and ventricular septal defect. This infant is experiencing a hypercyanotic episode, or "tet spell," which is an exacerbation of tetralogy of Fallot that can happen when a child cries, becomes upset, or is feeding. The child should first be placed in a knee-to-chest position. Flexion of the legs provides relief of NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ dyspnea as this angle improves oxygenation by reducing the volume of blood that is shunted through the overriding aorta and the ventricular septal defect. (Option 1) Morphine may be considered if the dyspnea is not relieved by the knee- to-chest position. (Option 2) If oxygen saturation remains low, oxygen may need to be administered. (Option 3) Vital signs and pulse oximetry may be checked after the infant has been placed in the knee-chest position. Educational objective: To relieve a hypercyanotic episode, or "tet spell," the nurse should place the infant or child in the knee-chest position. A A A An 8-month-old infant is scheduled for a balloon angioplasty of a congenital pulmonic stenosis in the cardiac catheterization laboratory. Which finding should the nurse report to the health care provider (HCP) that could possibly delay the procedure? 1. Auscultation of a loud heart murmur [8%] 2. Infant has been NPO for 4 hours [9%] 3. Infant has polycythemia [52%] NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ 4. Infant has severe diaper rash [29%] Explanation: The presence of severe diaper rash should be reported to the HCP. This could potentially delay the procedure if the rash is in the groin area where access is planned for arterial cannulation. Candida, yeast, or bacteria may be present on the rash and could be introduced into the bloodstream with the arterial stick. (Option 1) A loud heart murmur can be an expected finding in a child with pulmonic stenosis. (Option 2) Children are allowed nothing by mouth for 4-6 hours or longer before the procedure. Younger children and infants may have a shorter period of NPO status and should be feed right up to the time recommended by the HCP. (Option 3) Infants and children with polycythemia may need IV fluids to prevent dehydration and hypoglycemia. Polycythemia will not cause a delay in the procedure. Educational objective: The nurse should report the presence of severe diaper rash to the HCP in an infant who has an interventional catheterization procedure planned. If the rash is near the groin area, the procedure may be delayed due to possible contamination at the insertion site. A A A When monitoring an infant with a left-to-right-sided heart shunt, which findings NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ A 12-month-old with Kawasaki disease received IV immunoglobulin (IVIG) 2 months ago. The child is in the clinic for follow-up and scheduled immunizations. Which vaccine should be delayed? Select all that apply. 1. Haemophilus influenzae type b (Hib) 2. Hepatitis B (Hep B) 3. Measles, mumps, rubella (MMR) 4. Pneumococcal conjugate (PCV) 5. Varicella Explanation: Kawasaki disease is treated with aspirin and IVIG to prevent coronary artery aneurysms. Antibodies acquired from the IVIG therapy will remain in the body for up to 11 months and may interfere with the desired immune response to live vaccines. Therefore, NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ live vaccines (eg, varicella, MMR) should be delayed for 11 months after IVIG administration as this therapy may decrease the child's ability to produce the appropriate amount of antibodies to provide lifelong immunity (Options 3 and 5). (Option 1) Hib vaccine is not a live vaccine, and final dose (fourth) is recommended between age 12-15 months, according to the Centers for Disease Control and Prevention (CDC). (Option 2) Hep B vaccine is not a live vaccine; the CDC recommends that the final dose (third) be administered between age 6-18 months. (Option 4) PCV is also not a live vaccine, and the final dose (fourth) is recommended between age 12-15 months, according to the CDC. Educational objective: Live vaccines (eg, varicella, MMR) should be delayed for up to 11 months after IVIG administration as IVIG therapy may decrease the child's ability to produce the appropriate amount of antibodies to provide lifelong immunity A A A Several clients check into the emergency department at the same time. Which client should be seen first? 1. 6-year-old with blood-streaked stools [19%] 2. 10-year-old with epilepsy who had a short seizure at home and is asleep [26%] 3. 15-year-old with dental trauma and tooth avulsion [25%] NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ 4. Newborn who spits up after every feed [28%] Explanation: At age 15, clients should have their permanent teeth. If tooth avulsion occurs, there is limited time (≤1 hour, longer if placed in cold milk) until death of the tooth. This is a time-sensitive condition and the client should be seen first to avoid loss of a permanent tooth. (Option 1) This client needs to be assessed for the cause of blood in the stool. However, this is not considered a medical emergency as long as only streaks and not large volumes of blood are present. Large volumes can represent a gastrointestinal bleed, which is an emergency. NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ The classic clinical triad of intussusception is intermittent, severe, crampy abdominal pain; a palpable sausage-shaped mass on the right side of the abdomen; and currant jelly stools. A A A The registered nurse is teaching the parent of a 6-year-old about behavioral strategies for treating fecal incontinence due to functional constipation. Which statement by the parent indicates a need for further teaching? 1. "I will give my child a picture book to look at during toilet time." [29%] 2. "I will give my child a reward for each bowel movement while sitting on the toilet." [34%] 3. "I will keep a log of my child's bowel movements, laxative use, and episodes of soiling." [23%] 4. "I will schedule regular toilet sitting time for my child." [11%] Explanation: Fecal incontinence (ie, encopresis, soiling) refers to the repeated passage of stool in inappropriate places by children age ≥4 years. In more than 80% of cases, it is due to functional constipation (retentive type); in about 20% of cases, it may be caused by psychosocial triggers (nonretentive type). Management of fecal incontinence/constipation primarily includes 3 components: Disimpaction followed by prolonged laxative therapy, dietary changes (increased fiber and fluid intake), and behavior modification. Behavioral strategies are used to NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ promote and restore regular toileting habits and to gain the child's cooperation and participation in the treatment program. NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ Behavioral interventions include the following: Regularly schedule toilet sitting times 5-10 minutes after meals for 10-15 minutes (Option 4) Provide a quiet activity for the child during toilet sitting, which will help pass the time and make the experience more "enjoyable" (Option 1) Initiate a reward system to boost the child's participation in the treatment program; the reward would be given for effort, not for success of evacuation in the toilet (children with retentive encopresis have dysfunctional anal sphincters and little control over bowel movements; giving a reward for something the child has no control over would not be effective) (Option 2) Keep a diary or log of toilet sitting times, stooling, medications, and episodes of soiling to evaluate the success of the treatment (Option 3) Educational objective: A reward system is one of the behavioral strategies used in the treatment of functional incontinence (due to constipation). The reward is given to encourage the child's involvement in the treatment to restore normal bowel function. Rewards are given for the child's effort and participation, not for having bowel movements while sitting on the toilet. A A A The nurse teaching the parents of a child diagnosed with cystic fibrosis will advise the parents to choose foods that satisfy which recommended diet? NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ 4. Does the health care provider want to order a laxative? [3%] Correct Answered correctly 88% Time: 37 seconds Updated: 07/27/2017 Explanation: SBAR (situation, background, assessment, recommendation/read-back) is an established reporting format used to communicate with the health care provider (HCP). Use of SBAR ensures that the HCP receives the necessary information to make a clinical judgment regarding treatment or need for immediate assessment. In this situation, the client's presentation indicates worsening symptoms that require immediate intervention. The client's lethargy represents a declining level of consciousness. NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ The client also has significantly abnormal vital signs (normal infant pulse rate is 110- 160/min, respirations generally around 40/min). These are ominous signs that should be reported immediately (Option 3). (Option 1) Although it is helpful to know that the change is fairly recent, it is most important to report the current concerning change in the client's clinical presentation and vital signs. (Option 2) Abnormal vital signs with a decreased level of consciousness are not improvements; rather, these findings indicate deterioration. (Option 4) It would not be appropriate to assume and treat potential constipation in this client without further assessment and diagnostic procedures. The nurse needs to assess additional aspects, including bowel sounds, abdominal characteristics, and temperature. Vital signs this significantly abnormal would not be caused by constipation. Educational objective: SBAR (situation, background, assessment, recommendation/read-back) is used to transmit complete essential information to the health care provider. Any abnormal vital signs or current deterioration should be communicated immediately. A A A Several children seen at a local pediatric clinic are found to have a hemoglobin level of 10- 11 g/dL (100-110 g/L). Which strategy would most likely help increase the hemoglobin levels in these clients? NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ 1. Encouraging intake of milk and other dairy products [3%] 2. Ensuring adequate intake of meat, fish, poultry, and legumes [80%] 3. Increasing consumption of fruits and vegetables [8%] 4. Using orange juice fortified with vitamin D [7%] Explanation: Iron deficiency (ID) is the most common nutritional deficiency of children and adolescents in the United States and worldwide. In most individuals with ID, the cause is inadequate intake of foods high in iron. In this type of anemia, the red blood cells are small (microcytes) and have reduced hemoglobin, appearing paler (hypochromic) under a microscope. NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ The schedule of recommended routine immunizations for a 6-month-old client includes Hep B, DTaP, RV, Hib, IPV, and PCV; a mnemonic is Be DR HIP (Hep B, DTaP, RV, Hib, IPV, PCV). (Options 3 and 5) The first MMR and VZV vaccines are given at age 12-15 months. Educational objective: The recommended immunization schedule for a 6-month-old client includes Hep B, DTaP, RV, Hib, IPV, and PCV. MMR and varicella vaccines are given at age 12-15 months. NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ A A A The nurse in the pediatric clinic is triaging telephone messages. The nurse should call the parent of which child first? 1. 2-year-old with bilateral tympanostomy tubes who has a small piece of plastic in the right outer ear [18%] 2. 4-year-old post adenotonsillectomy who is now reporting ear pain [53%] NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ Vital signs Temperature 98.6 F (37 C) Heart rate146/min Respirations 42/min O2 saturation 98% 1. Call the health care provider (HCP) immediately [6%] 2. Document the assessment finding [76%] 3. Place the neonate in a knee-chest position [10%] 4. Provide oxygen to the neonate [6%] Explanation: Atrioventricular (AV) canal defect is a cardiac anomaly often associated with trisomy 21 (Down syndrome). As an echocardiogram is already scheduled for that day, documenting the assessment finding would be the appropriate action for the nurse to complete at this time. (Option 1) The neonate has stable vital signs and the echocardiogram will be completed. This is not an emergency and the HCP does not need to be contacted immediately. (Option 3) A knee-chest position is used to treat episodes of hypoxia and cyanosis in infants and young children with tetralogy of Fallot (TOF). This neonate likely has an AV canal defect, not TOF. There is also no indication of cyanosis or hypoxia that would necessitate knee-chest positioning. (Option 4) The normal respiratory rate in a neonate is 30-60/min; pulse can be NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ up to 160/min. The vital signs are stable and the oxygen saturation level is appropriate for a neonate. Educational objective: Trisomy 21 (Down syndrome) is often associated with the cardiac anomaly AV canal defect. Assessment typically includes a loud murmur that requires no immediate action when vital signs are stable. Surgery will correct the anomaly when the neonate grows in size and can tolerate the invasive procedure better Block Time Remaining: 00:31:01 NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ A A A A 3-month-old who weighs 8.8 lb (4 kg) has just returned to the intensive care unit after surgical repair of a congenital heart defect. Which finding by the nurse should be reported immediately to the health care provider (HCP)? 1. Chest tube output of 30 mL in the past hour [18%] 2. Heart rate of 180/min [47%] 3. Temperature of 97.5 F (36.4 C) [4%] 4. Urine output of 12 mL in the past hour [28%] Explanation: Chest tube drainage >3 mL/kg/hr for 3 consecutive hours or 5-10 mL/kg in 1 hour should be reported immediately to the HCP. This could indicate postoperative hemorrhage and needs immediate intervention. Cardiac tamponade can develop rapidly in children and can be life-threatening. This child weighs 4 kg and an output of 30 mL in 1 hour is excessive. (Option 2) For infants age 1-12 months, the normal heart rate is 100-160/min. However, this can be increased slightly with crying or surgery. (Option 3) Hypothermia is common after surgery and warmers are often used. (Option 4) Hourly urine output should be measured in the postoperative infant. A urinary catheter is often placed during surgery. Urine output should be between 1- 2 mL/kg/hr. NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ Educational objective: Nurses who care for dying children experience many of the same feelings that the family of the dying child does, resulting in stress that may lead to compassion fatigue. To remain effective in the care-giving role, nurses should utilize professional and personal support systems, share in end-of-life celebration rituals, and take time off from work when distancing is needed. The family and the nurse can gain support by remaining in contact during the grieving process. A A A An overweight toddler is diagnosed with iron deficiency anemia. Which is the most likely explanation for the anemia? 1. Excessive intake of meat products [3%] NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ 2. Excessive intake of milk [64%] 3. Gastrointestinal blood loss [18%] 4. Impaired iron transfer from the mother [13%] Explanation: Iron deficiency anemia is the most common chronic nutritional disorder in children. There are many risk factors for iron deficiency, including insufficient dietary intake, premature birth, delayed introduction of solid food, and consumption of cow's milk before age 1 year. One common cause in toddlers is excessive milk intake, over 24 oz/day. In addition to becoming overweight, toddlers who consume too much milk develop iron deficiency due to the likely exclusion of iron-rich foods in favor of milk, a poor source of available iron. Treatment of iron deficiency anemia includes oral iron supplementation and increased consumption of iron-rich foods (eg, leafy green vegetables, red meats, poultry, dried fruit, fortified cereal). It is also important to limit milk intake (16-24 oz/day) in toddlers to ensure a balanced diet. (Option 1) Red meat and other meat products are considered good sources of dietary iron. However, clients may be at risk for obesity if meat consumption exceeds protein and caloric needs. (Option 3) Gastrointestinal blood loss, which can occur if infants under age 1 year are fed cow's milk, is a potential cause of iron deficiency anemia. However, excessive milk intake is a more common cause, particularly in clients over age 1 year. (Option 4) Impaired or decreased iron transfer is a potential cause of iron NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ deficiency anemia, particularly in preterm infants or infants born in multiples. However, iron stores received from the mother are typically depleted by age 5-6 months (2-3 months for preterm infants); after this point, iron must be acquired through dietary sources. Because this client is a toddler (age 1-3 years), impaired iron transfer is not a likely cause of the current anemia. Educational objective: Iron deficiency anemia is the most common nutritional disorder in children. Risk factors include premature birth, cow's milk before age 1 year, and excessive milk intake in toddlers. Prevention and treatment are achieved through proper nutrition (eg, meat, leafy green vegetables, fortified cereal) and supplementation. A A A NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ A A A The nurse is gathering data on a 5-week-old admitted with a suspected diagnosis of pyloric stenosis. The nurse should expect to find which laboratory value? 1. Blood pH of 7.1 [34%] 2. Hematocrit of 57% (0.57) [22%] 3. Potassium of 5.2 mEq/L (5.2 mmol/L) [24%] 4. White blood cells of 28,500/mm3 (28.5 x 109/L) [19%] Explanation: In pyloric stenosis, a hypertrophied pyloric muscle causes postprandial projectile vomiting secondary to an obstruction at the gastric outlet. An olive-shaped mass may be palpated in the epigastric area just to the right of the umbilicus. Emesis is nonbilious (formula in/formula out) and leads to progressive dehydration. Infants will be hungry constantly despite regular feedings. A hematocrit of 57% (0.57) is elevated and indicative of hemoconcentration caused by dehydration (Option 2). Elevated blood urea nitrogen is also a sign of dehydration. (Option 1) The stomach contains acid, which becomes depleted with excess vomiting (or during nasogastric [NG] suctioning), leading to metabolic alkalosis (increased bicarbonate and pH of >7.45). (Option 3) A potassium level of 5.2 mEq/L (5.2 mmol/L) is considered slightly elevated. However, vomiting or prolonged NG suctioning would cause hypokalemia, not hyperkalemia. NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ hernia or pneumothorax. (Option 4) A newborn with EA/TEF may experience apnea, choking, and cyanosis due to aspiration of fluid while eating. Projectile vomiting after feeding is a classic manifestation of hypertrophic pyloric stenosis. Educational objective: Clinical manifestations of EA/TEF include frothy saliva, coughing, choking, drooling, and a distended abdomen. Clients may also develop apnea and cyanosis while feeding. These findings must be reported to the health care provider for further evaluation. A A A A nurse is admitting a child who has leukemia. Several rooms are available on the pediatric unit. Which client could share a room with this child? NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ 1. A client recovering from a ruptured appendix [25%] 2. A client with cystic fibrosis [20%] 3. A client with minimal change nephrotic syndrome [49%] 4. A client with rheumatic fever [4%] Explanation: Leukemia is characterized by unrestricted proliferation of abnormal white blood cells (lymphoblasts), resulting in depression of normal bone marrow activity. This disorder is the most common form of childhood cancer. Infection is a major concern due to neutropenia. In addition, anemia occurs due to decreased red blood cell production, and bleeding is common as a result of decreased platelet production. It would be appropriate for this client with leukemia to share a room with a client with minimal change nephrotic syndrome (MCNS). MCNS is a non-infectious condition of the glomeruli and poses no risk to a client with leukemia. (Option 1) Appendicitis is a result of viral or infectious processes and can lead to rupture of the appendix. A client recovering from a ruptured appendix poses a threat of infection to the child who has leukemia. (Option 2) A client with cystic fibrosis has pulmonary complications due to thick mucus that traps bacteria. The tracheobronchial tree is colonized with bacteria and respiratory infections are a lifelong problem. This client poses a threat of infection to the child with leukemia. (Option 4) Rheumatic fever occurs following pharyngitis caused by group A β- NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+ hemolytic Streptococcus. A client with this condition poses a threat of infection to the child with leukemia. Educational objective: Leukemia is a cancer of the blood and organs involved in hematologic function. Due to myelosuppression, clients are at risk for problems related to infection, anemia, and bleeding. A A A The nurse who is caring for a 1-month-old with Tetralogy of Fallot will report which finding to the health care provider as a priority? 1. Hemoglobin level of 24.9 g/dL (249 g/L) [18%] NUR1142 PAEDIATRIC Q&AS BEST EXAM SOLUTION GUARANTEED SUCCESS 2024 GRADED A+