儿科29到36章疾病试题374-479_在线真题试卷与模拟练习_儿科29到36章疾病试题374-479_考试宝

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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?

An overweight toddler is diagnosed with iron deficiency anemia. Which is the most likely explanation for the anemia?

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?

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?

The nurse assesses a child with intussusception. Which assessment findings require priority intervention?

The nurse assesses a child with intussusception. Which assessment findings require priority intervention?

Intussusception occurs when part of the intestine telescopes into another adjacent part and causes a blockage. This leads to swelling and decreased blood supply to the intestine. Tissue death as well as perforation to the bowel may result. If perforation occurs, the client could develop peritonitis in which the peritoneum in the abdomen becomes inflamed due to infection. This can quickly lead to sepsis and multiple organ failure. Peritonitis is characterized by fever, abdominal rigidity, guarding, and rebound tenderness. This condition can be fatal if it is not treated quickly.

The parent of a 21-day-old male infant reports that the infant is "throwing up a lot." Which assessments should the nurse make to help determine if pyloric stenosis is an issue? Select all that apply.

The nurse is caring for a 2-year-old who is receiving a saline enema for treatment of intussusception. Reporting which client finding to the health care provider (HCP) is most important?

A newborn had a bowel resection with temporary colostomy for Hirschsprung's disease. The nurse should alert the health care provider (HCP) for which assessment finding postoperatively?

Infant formula is readily available as ready-to-feed, concentrate, or powder. Parents should exactly follow the manufacturer's recommendations for preparation. Basic guidelines for preparation, safe storage, and handling of formula include: Keep bottles, nipples, caps, and other parts as clean as possible (ie, boil or wash in dishwasher). Wash the tops of formula cans (eg, concentrated formula) with hot water and soap prior to opening to prevent contamination (Option 3). Refrigerate any unused, prepared formula or unused, opened formula (eg, ready-to-feed, concentrated), but use within 48 hours or discard to reduce the risk of bacterial growth (Option 5). Warm bottles in a pan of hot water or under warm tap water for several minutes. Test formula temperature on the inner wrist before serving to the infant (should feel lukewarm, not hot). (Option 1) Never overdilute or overconcentrate formula. Dilution reduces necessary calories, vitamins, and minerals, which hinders growth and development. Overconcentration results in intake of excessive proteins and minerals beyond the excretory ability of the infant's immature kidneys. (Option 2) Never microwave formula as it causes "hot spots" in the milk that can burn the infant's mouth. (Option 4) Any formula in a bottle left over after feeding should be discarded because the infant's saliva has mixed with it, which can foster bacterial growth. Educational objective: Infant formula should never be overdiluted, overconcentrated, or microwaved. Unused, prepared formula should be stored in the refrigerator and, if unused, discarded after 48 hours. Formula left over in a bottle after feeding should be discarded.

The parent of a 7-month-old reports that the child has been crying and vomiting with a distended belly for the past 4 hours. The infant is now lying quietly in the parent's arms with a pulse of 200/min and respirations of 60/min. Which of the following components of SBAR (situation, background, assessment, recommendation/read-back) communication is most important for the nurse to report to the health care provider?

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. 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 parent brings a 6-month-old child to the primary health care provider after the child abruptly started crying and grabbing intermittently at the abdomen. The client's stool has a red, currant jelly appearance. What intervention does the nurse anticipate?

Intussusception is an obstructive gastrointestinal disorder caused when a segment of the bowel slides, or telescopes, into another section. This typically occurs in infants and children age <6. Once the bowel telescopes in, pressure increases within the bowel, causing ischemia and leakage of blood and mucus into the lumen of the bowel. Classic clinical manifestations of intussusception include episodes of sudden, crampy abdominal pain; a palpable sausage-shaped abdominal mass; and red, "currant jelly" stools (Options 2 and 5). Other manifestations include inconsolable crying with the knees drawn up to the chest and vomiting (Option 4). The child may appear normal and calm between painful episodes. (Options 1 and 3) A palpable, epigastric, olive-shaped mass and nonbilious projectile vomiting (ie, up to 3-4 feet [~1 meter]) are clinical manifestations often seen with pyloric stenosis. Projectile vomiting may also be a symptom of elevated intracranial pressure. However, intussusception typically causes bilious, nonprojectile vomiting and involves a sausage-shaped mass. Educational objective: Classic symptoms of intussusception include sudden, crampy abdominal pain; a palpable sausage-shaped abdominal mass; "currant jelly" stools; inconsolable crying with the knees drawn up to the chest; and bilious, nonprojectile vomiting. An olive-shaped mass is characteristic of pyloric stenosis. Projectile vomiting is frequently associated with pyloric stenosis or increased intracranial pressure.

The nurse cares for a child newly diagnosed with cystic fibrosis. What should be included in the client's multidisciplinary plan of care to be discussed with the parents? Select all that apply.

Cystic fibrosis (CF) is a genetic disorder involving the cells lining the respiratory, gastrointestinal (GI), and reproductive tracts. A defective protein responsible for transporting sodium and chloride causes secretions in these areas to be thicker and stickier than normal. These abnormal secretions plug smaller airway passages and ducts in the GI tract, which can impair digestive enzymes and result in ineffective absorption of essential nutrients. These sticky respiratory secretions lead to a chronic cough and inability to clear the airway, eventually causing chronic lung disease (bronchiectasis). As a result of these changes, the client's life span is shortened; most affected individuals live only into their 30s. Chest physiotherapy helps remove sticky secretions that cause ineffective airway clearance (Option 2). Aerobic exercise is beneficial to promote removal of airway secretions, improve muscle strength, and increase lung capacity (Option 1). Financial needs must be discussed, as clients with CF have a large financial burden due to health care costs, medications, and special equipment (Option 3). (Option 4) A diet high in fat and calories is recommended due to defective digestive enzymes and impaired nutrient absorption. (Option 5) Fluids are not restricted; liberal intake is recommended to assist in thinning respiratory secretions. Educational objective: Clients with cystic fibrosis should have a diet high in fat and calories to combat nutrient malabsorption. Liberal fluid intake is encouraged to loosen thick secretions. Chest physiotherapy and aerobic exercise are performed to remove airway secretions. Financial needs are addressed as clients have a large financial burden.

The triage nurse is assessing an unvaccinated 4-month-old infant for fever, irritability, and open-mouthed drooling. After the infant is successfully treated for epiglottitis, the parents wonder how this could have been avoided. Which response by the nurse would be most appropriate?

The triage nurse is assessing an unvaccinated 4-month-old infant for fever, irritability, and open-mouthed drooling. After the infant is successfully treated for epiglottitis, the parents wonder how this could have been avoided. Which response by the nurse would be most appropriate?

A 6-month-old client has been diagnosed with cystic fibrosis. Which of the following would be appropriate for the registered nurse to teach to the parents?

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