. A 6-month-old boy is diagnosed with pyloric stenosis. When you take a health history from his mother, which symptom would you expect to hear her
... [Show More] describe?
A) Refusal to eat.
B) Vomiting about 2 hours after feeding.
C) Chronic diarrhea.
D) Vomiting immediately after feeding.
2. An infant has surgery to relieve pyloric stenosis. Which of the following nursing diagnoses would apply in the immediate postoperative period?
A) Excess fluid volume related to increased fluid intake prescribed postoperatively.
B) Risk for infection of incision line, related to disruption of skin barrier during surgery.
C) Ineffective tissue perfusion related to pressure on heart chambers.
D) Anxiety related to new feeding method used postoperatively.
3. When providing diaper care to an infant after pyloric stenosis surgery, which approach is indicated?
A) Diapers should be folded so that the incision line is well covered to prevent infection.
B) Diapers should be folded so that the incision line does not become contaminated.
C) Diapers should not be used.
D) Sterile diapers should be used.
4. After surgery for pyloric stenosis, an infant should be well-bubbled following feedings primarily to prevent
A) pressure on the incision line.
B) abdominal discomfort.
C) contaminating flatulence.
D) intestinal obstruction.
5. Which of the following positions is most appropriate following a feeding for an infant who has had surgery for pyloric stenosis?
A) Supine with feet elevated.
B) Fowler's.
C) Prone.
D) Right side.
6. Which of the following assessments would suggest that a child's postoperative feeding schedule following pyloric stenosis surgery should be slowed?
A) Flatulence.
B) Vomiting.
C) Semiformed bowel movements.
D) Falling asleep at each feeding.
7. A 2-month-old boy is admitted to the emergency room with severe diarrhea. Intravenous fluid is prescribed for him. Before adding potassium to this solution, which assessment would you record?
A) He has voided.
B) He cries with tears.
C) His hands are restrained.
D) He “attunes” to a music box.
8. The acid–base imbalance that tends to occur with diarrhea is
A) metabolic acidosis.
B) metabolic alkalosis.
C) high serum pH.
D) normal serum pH.
9. Which of the following assessments suggests that an infant with diarrhea is severely dehydrated?
A) Skin is moist and flushed, fontanelles depressed.
B) Saliva is salty, and the infant tears with crying.
C) Elevated hematocrit and depressed eye globes.
D) Low specific gravity of urine, moist skin.
10. You are advising a group of new parents on how to care for their infant at home if she develops diarrhea. Which of the following statements would assure you that a parent has understood the correct action?
A) “I should offer foods and fluid frequently to prevent dehydration.”
B) “I could give Kaopectate as long as I follow the directions on the bottle.”
C) “I should offer milk after each episode of diarrhea.”
D) “I should take the baby's temperature and call my physician.”
11. You care for a 12-year-old girl with Crohn's disease. A primary assessment you would want to make when caring for her would be to note if
A) lung sounds are clear.
B) she has a temperature.
C) her joints are not swollen.
D) she has a headache.
12. A school-age girl with Crohn's disease will receive total parenteral nutrition (TPN) for the next 6 weeks. Which of the following would best help her accept this?
A) Help her ambulate with the bottles.
B) Provide some time to talk to her several times a day.
C) Help her give the bottles nicknames and personalities.
D) Explain that TPN substitutes for normal food.
13. An adolescent boy is diagnosed with hepatitis A. Which problem should be considered when planning care?
A) He will become easily fatigued.
B) He will be very irritable and perhaps require sedation.
C) Hypothermia is common.
D) His urine will be dark and infectious.
14. If an adolescent has hepatitis B, what would be an important nursing action?
A) Conscientious collection of stool for ova and parasites.
B) Strict calculation of caloric and vitamin B intake.
C) Strict enforcement of standard precautions.
D) Close observation to detect cerebral hallucinations.
15. A preschooler has celiac disease. Her mother is preparing a gluten-free diet. By preparing which breakfast foods would you believe she understands the diet?
A) Eggs and orange juice.
B) Wheat toast and grape jelly.
C) Cheerios (oat cereal) and skim milk.
D) Rye toast and peanut butter.
16. How long do children with celiac disease remain on their restricted diet?
A) Until symptoms fade.
B) Until early school age.
C) Until age 21.
D) For life.
17. You telephone a physician on call because a 10-year-old boy has been admitted to the emergency room with symptoms of appendicitis. She asks you to assess for rebound tenderness to help with assessment. Which of the following would be the best technique to do this?
A) Palpate the child's right lower abdomen, quickly release your hand, and ask him if he has increased pain.
B) First palpate the left lower abdomen then the right, and ask the child to compare the levels of pain.
C) Ask the child to perform a Valsalva maneuver, and note if pain is increased after the maneuver.
D) Tell the child to bend forward and then ask him if he notices bounding abdominal pain afterward.
18. A school-age boy has an emergency appendectomy. Which assessment would you report to his physician if noticed in the immediate postoperative period?
A) Abdominal pain.
B) A feeling of “tugging” at the incision line.
C) Thirst.
D) A rigid abdomen.
19. A 10-year-old recovering from liver transplant surgery is receiving medications to prevent rejection of the new liver. As a result of taking these drugs, which of the following nursing diagnostic categories would best apply?
A) Deficient fluid volume deficit.
B) Constipation.
C) Risk for infection.
D) Risk for activity intolerance.
20. You care for a newborn in danger of developing necrotizing enterocolitis syndrome. Which of the following findings would lead you to believe the newborn is at high risk for this?
A) Experienced period of apnea.
B) Received breast milk.
C) Showed little movement with crying.
D) Born to a mother who is 16 years old.
21. Which of the following symptoms would make you suspect an infant is developing necrotizing enterocolitis?
A) Makes a grunting sound on expiration.
B) Cannot maintain temperature.
C) Has loose, green stools.
D) Exhibits increasing abdominal circumference.
22. If you discover that an infant is developing necrotizing enterocolitis, what would be your best action?
A) Institute NPO status.
B) Insert a glycerin suppository.
C) Count respirations.
D) Dilute next formula feeding to 13 calories/ounce.
23. A 3-year-old boy is diagnosed with intussusception. Which symptom reported by the parents would have led the nurse to suspect this diagnosis?
A) Projectile vomiting.
B) Right lower quadrant pain.
C) Bloody-mucus stool
D) Rebound tenderness.
24. A 3-month-old boy is brought to the physician's office with black stools. Which characteristic may lead to the diagnosis of Meckel's diverticulum?
A) The infant had meconium-stained amniotic fluid at birth.
B) The infant was full term at delivery.
C) The infant was preterm at delivery.
D) The infant was born by cesarean delivery. [Show Less]