The nurse is providing care to a pediatric client, diagnosed with inflammatory bowel disease, who is prescribed daily prednisone. Which parental statement regarding administration of this drug indicates correct understanding of the teaching provided by the nurse?
- “I will administer this medication between meals.”
- “I will administer this medication at bedtime.”
- “I will administer this medication one hour before meals.”
- “I will administer this medication with meals.”
4
Which assessment data would cause the nurse to suspect that a 3-year-old child has Hirschsprung disease?
- Clay-colored stools and dark urine
- History of early passage of meconium in the newborn period
- History of chronic, progressive constipation and failure to gain weight
- Continual bouts of foul-smelling diarrhea
3
An adolescent client reports recurrent abdominal pain with diarrhea and bloody stools. Which type of inflammatory bowel disease does the nurse suspect based on these data?
- Necrotizing enterocolitis (NEC)
- Ulcerative colitis (UC)
- Crohn disease
- Appendicitis
2
The nurse is assessing abdominal girth for a pediatric client who presents with abdominal distension. Which nursing action is appropriate?
- Measuring the girth just below the umbilicus
- Measuring the girth just below the sternum
- Measuring the girth just above the pubic bone
- Measuring the girth around the portion of the stomach
4
Which is the priority nursing diagnosis when planning care for a newborn who is born with esophageal atresia and tracheoesophageal fistula?
- Ineffective Tissue Perfusion
- Ineffective Infant Feeding Pattern
- Acute Pain
- Risk for Aspiration
4
A newborn diagnosed with an omphalocele defect is admitted to the intensive care nursery. Which nursing action is appropriate based on the current data?
- Placing the newborn on a radiant warmer
- Placing the newborn in an open crib
- Preparing the newborn for phototherapy
- Preparing the newborn for a bottlefeeding
1
The nurse is planning care for a school-age client who is postoperative for the surgical removal of the appendix. In addition to pharmacologic pain management, which should the nurse include in the plan of care to address pain?
- Applying a warm, moist pack every 4 hours
- Applying EMLA cream to the incision site prior to ambulation
- Applying a cold, moist pack every 2 hours
- Applying a pillow against the abdomen to splint the incision site when coughing
4
Which parental statement at the end of a teaching session by the nurse indicates correct understanding of colostomy stoma care for the infant client?
- “We will change the colostomy bag with each wet diaper.”
- “We will expect a moderate amount of bleeding after cleansing the area around the stoma.”
- “We will watch for skin irritation around the stoma.”
- “We will use adhesive enhancers when we change the bag.”
3
A nurse is preparing for the delivery of a newborn with a known diaphragmatic hernia defect. Which equipment should the nurse have on hand for the delivery?
- Bag-valve-mask system
- Sterile gauze and saline
- Soft arm restraints
- Endotracheal tube
4
A child returns from exploratory surgery following a gunshot wound to the abdomen. Which nursing intervention should be excluded for the plan of care?
- Immediate initiation of oral feedings
- Assessment of the surgical site
- Administration of opioid narcotics for pain management
- Visitation at the bedside
1
A neonate is born with a bilateral cleft lip that was not detected during the pregnancy. The parents are distressed about the appearance of their infant. Which nursing actions are appropriate to assist the parents to bond with their newborn? Select all that apply.
- Calling the newborn by the chosen name
- Keeping the newborn’s lower face covered with the blanket
- Smiling and talking to the newborn in the parents’ presence
- Showing the parents before and after pictures of other children with cleft lips
- Discussing positive features of the baby
1,3,4,5
The nurse is unsuccessful in inserting a nasogastric tube for a newborn client. The nurse suspects the newborn has esophageal atresia/tracheoesophageal (EA/TE) fistula. Which nursing action is appropriate while waiting for the healthcare provider to further assess the neonate?
- Position the newborn in semi-Fowler position.
- Allow the newborn to be taken to the mother’s room for bonding.
- Offer the newborn formula feeding instead of breastfeeding.
- Wrap the newborn in blankets and place in a crib by the viewing window.
1
A nasogastric tube to suction is ordered for a neonate diagnosed with a diaphragmatic hernia. Which complication related to gastric drainage is the priority when planning care for this neonate?
- Weight loss
- Metabolic alkalosis
- Dehydration
- Hyperbilirubinemia
2
Which statements, made by the adolescent following dietary teaching for Crohn disease, indicate correct understanding of the content presented by the nurse? Select all that apply.
- “I can promote solid stools by increasing fiber in my diet.”
- “Small, frequent meals are preferred over three meals a day.”
- “I should identify foods that cause distress and eliminate them from my diet.”
- “High-calorie dietary supplement shakes can help me to meet my nutritional requirements.”
- “Socialization during my meal times is important even if my parents do not agree with my food choices.”
2,3,4
Which parental action, observed during a home care visit for an infant diagnosed with gastroesophageal reflux, requires intervention by the nurse?
- The infant’s formula has rice cereal added.
- The mother holds the infant in a high Fowler position while feeding.
- After feeding, the infant is placed in a car seat.
- The mother draws up the ranitidine (Zantac) in a syringe for oral administration.
3
Which is the priority nursing action when preparing a neonate born with a gastroschisis defect for transport to a pediatric hospital for corrective surgery?
- Covering the exposed intestines with sterile moist gauze
- Wrapping the newborn warmly in two or three blankets
- Providing a sterile water feeding to maintain hydration during transport
- Allowing the parents of the newborn to see their child prior to transport
1
A toddler is admitted to the surgical unit for a planned closure of a temporary colostomy. Which medical prescription should the nurse question?
- Clear liquids today. NPO tomorrow
- Type and cross-match for 1 unit of packed red blood cells.
- Rectal temperatures every 4 hours
- Start an intravenous line with D5NS at 20 mL per hour.
3
Which gastrointestinal defects, often diagnosed shortly after birth, should the nurse include in the assessment process of all newborns? Select all that apply.
- Pyloric stenosis
- Biliary atresia
- Hirschsprung disease
- Umbilical hernia
- Diaphragmatic hernia
3,5
The nurse is providing care to a newborn client who presents in the pediatric clinic for a 2-week health maintenance visit. The parents of the newborn are concerned, as their baby has “gas all the time.” Which responses from the nurse are appropriate? Select all that apply.
- “Your baby has a relaxed lower esophageal sphincter, which is causing the gas.”
- “Your baby lacks the enzyme amylase, which is causing the gas.”
- “Your baby lacks the enzyme insulin, which is causing the gas.”
- “Your baby has an immature liver, which is causing the gas.”
- “Your baby lacks an enzyme that helps to digest fats, which is causing the gas.”
2,5
Which statements should the nurse include in a presentation related to the general function of the gastrointestinal (GI) system for parents of pediatric clients? Select all that apply.
- “The GI tract is responsible for the ingestion and absorption of food.”
- “Newborns have smaller stomachs but increased peristalsis.”
- “All children require smaller, more frequent feedings.”
- “Infants lack certain digestive enzymes which increases the risk for regurgitation.”
- “By the second year of life a child is able to accommodate three meals each day.”
1,2,5
Which are the leading causes of pediatric abdominal injuries for which the nurse should provide client teaching during scheduled health maintenance visits? Select all that apply.
- Motor vehicle crashes
- Falls
- Blunt trauma
- Stabbing
- Impalement
1,2,3
Which topics should the nurse include in discharge instructions related to enhanced safety for a pediatric client who experienced an abdominal injury after a biking accident? Select all that apply.
- Use of hand signals
- Age-appropriate use of child safety seats
- Age-appropriate bicycles
- Use of a helmet
- Avoid assigning blame
1,3,4
Which factors in the maternal medical history should cause the nurse concern regarding the development of cleft lip or cleft palate during pregnancy? Select all that apply.
- Cigarette smoking
- Alcohol use
- Excessive folate intake
- Glucocorticoid use
- Anticoagulant use
1,2,4
