PN VATI Nursing Care of Children 2019 - Questions, Answers and Rationales A nurse is providing pre-procedure teaching to the parents of a preschooler who
... [Show More] has nephrotic syndrome and is scheduled for a percutaneous renal biopsy. Which of the following statements should the nurse include? "Your child can eat and drink up to 2 hours prior to the test." "Your child will need to be on bed rest for 6 hours following the test." "Your child will have a pressure dressing on the biopsy site following the test." "Your child will receive contrast dye via an IV during the test." -To minimize bleeding. The nurse also might use a sandbag to maintain pressure to the puncture site. *contrast dye not used **bed rest for 24 h **NPO status A nurse is reviewing the admission laboratory report of a school age child who has glomerulonephritis. Which of the following laboratory results should the nurse expect to find? -BUN 32 mg/dL -Absence of urine protein -Urine specific gravity 1.020 -Potassium 3.3 mEq/L. -Above the expected reference range of 5-18 mg/dL for a child. A child who has glomerulonephritis will have an elevated BUN because of the impaired glomerular filtration rate, which results in retention of urea in the blood. *The nurse should identify this finding as within the expected reference range of 1.016 to 1.022 for a child who has normal fluid intake. An expected finding for a child who has glomerulonephritis would be an increased urine specific gravity. **The nurse should identify this potassium level as below the expected reference range of 3.4 to 4.7 mEq/L for a child. A child who has glomerulonephritis will have a potassium level that is either increased or within the expected range A nurse is planning to obtain a rectal temperature from a toddler. Which of the following actions should the nurse take? -Insert the tip of the thermometer 5 cm (2 in) into the rectum. -Place the child in prone position. -Stabilize the thermometer at the distal end. -Direct the tip of the thermometer toward the spine during insertion. -The nurse should place the child in a side-lying, Sim's or prone position to obtain a rectal temperature. A nurse is assessing an infant who has Tetralogy of Fallot. Which of the following clinical manifestations should the nurse expect? SATA -Anemia -Stridor -Bounding peripheral pulses -A heart murmur -Cyanotic spells -Tetralogy of Fallot exhibit a systolic murmur that is moderate in intensity. -Experience anoxic spells when the infant's oxygen requirements exceed the oxygen available in the blood supply, such as when the infant is crying or following a feeding. A nurse is teaching about injury prevention to the parent of a toddler. Which of the following safety measures should the nurse include in the teaching? -Place a throw rug under the crib. -Select a toy box with a lid that locks in the closed position. -Offer popcorn as a snack food. -Set the water heater temperature to 54.4° C (130° F). -The toddler can fall out the crib. The nurse should also instruct the parent to move the toddler to a youth bed when they are able to climb out of the crib. A nurse is providing teaching about food choices to the parent of a school age child who has celiac disease. Which of the following statements by the parent indicates an understanding of the teaching? "I can offer popcorn as a snack food." "I will make sandwiches on rye bread." "I will purchase graham crackers to pack in their lunchbox." "I can make beef barley soup for dinner." -Unable to digest gluten found in grains, such as wheat, barley, rye, and oats. Corn is an acceptable substitute grain and is gluten-free. Therefore, popcorn is an appropriate food for the parent to offer the child as a snack. A nurse is assessing a child who has full-thickness burns of the legs. Which of the following manifestations should the nurse expect? -Fluid-filled blisters -Injured skin is cream to black in color -Injured skin blanches with pressure -Intense, continuous pain -Variable colors, including cream to brown or black. The injury reaches through the epidermis to the dermis, and possibly to the muscles, tendons, and bone. Areas with a full thickness burn are less painful than partial thickness burned areas because of the nerve destruction involved. A nurse is assessing a child who has heart failure. Which of the following clinical manifestations should the nurse expect? -Warm extremities -Frequent headaches -Distended neck veins -Weight loss -Manifestations of increased blood volume, such as distended neck veins. This occurs because of the secretion of the hormone ADH, which holds onto sodium and water in response to decreased cardiac output and renal perfusion. A nurse is providing nutritional teaching to the parents of a 2-year-old child. Which of the following statements by the parent indicates an understanding of the teaching? I should feed my child 1 cup of vegetables per day. -A variety of vegetables should be introduced to the toddler. *2 oz of protein **no more than 20-30oz of milk ***consume 1000-1400 cal A nurse is planning care for a child who is postoperative following a below-the-knee amputation. Which of the following interventions should the nurse include in the plan of care? [Show Less]