Pediatric Endocrine Nursing Exam: Nrsg 435 Comprehensive Assessment

The correct answer is urinary tract infection. Urinary incontinence in a young child can be a symptom of a urinary tract infection. It is important to rule out any underlying medical conditions before considering other potential causes such as attention deficit hyperactivity disorder or school phobia. Glomerulonephritis is a possibility, but urinary tract infection is more common in this age group.

Intussusception refers to the condition where one portion of the bowel telescopes or invaginates into another portion. This can lead to obstruction and impaired blood flow to the affected area. Symptoms may include severe abdominal pain, vomiting, and bloody stools. Intussusception is most commonly seen in infants and young children. Prompt medical attention is necessary to prevent complications such as bowel perforation and infection. Pyloric stenosis, tracheoesophageal fistula, and Hirschsprung disease are unrelated conditions and do not involve the invagination of the bowel.

The presence of the Moro, tonic neck, and withdrawal reflexes in a 2-month-old infant after a car accident suggests neurologic health. These reflexes are normal and expected in infants at this age, indicating that the infant's nervous system is functioning properly. Decorticate and decerebrate posturing, on the other hand, are abnormal postures that indicate damage to specific areas of the brain. Therefore, the presence of these reflexes does not suggest severe brain damage.

The nurse should suspect esophageal atresia because the symptoms described, including frothy saliva in the mouth and nose, frequent drooling, and regurgitation of fluid through the nose and mouth, are consistent with this condition. Esophageal atresia is a congenital condition where the esophagus does not properly connect to the stomach, leading to difficulty in swallowing and regurgitation of fluid. Cleft palate, anorectal malformation, and biliary atresia would not typically present with these specific symptoms.

Immobilization in children can lead to circulatory stasis, which means that blood flow becomes stagnant or slows down. This stagnant blood flow can increase the risk of thrombus (blood clot) formation. If a blood clot dislodges and travels to another part of the body, it can cause an embolus, which can be life-threatening if it blocks a blood vessel. Therefore, circulatory stasis due to immobilization can lead to thrombus and embolus formation.

Minimizing the risk of infection is an appropriate nursing goal for a hospitalized child with nephritic syndrome receiving high doses of prednisone. Prednisone is an immunosuppressant medication that can weaken the immune system, making the child more susceptible to infections. By minimizing the risk of infection, the nurse can help prevent complications and promote the child's overall health and well-being. This can be achieved through proper hand hygiene, maintaining a clean environment, and educating the child and their family about infection prevention measures.

The primary objective of care for a child with MCNS (Minimal Change Nephrotic Syndrome) is to minimize the excretion of urinary protein. MCNS is characterized by excessive protein loss through the urine, leading to hypoalbuminemia and edema. Minimizing urinary protein excretion helps to preserve the body's protein levels and reduce edema. The other options, increasing tissue ability to retain fluid, lowering serum protein levels, and reducing blood pressure, are not specific to the primary objective of care for MCNS.

Exophthalmos, or protruding eyeballs, is a symptom commonly associated with hyperthyroidism. Hyperthyroidism is a condition in which the thyroid gland produces an excessive amount of thyroid hormones, leading to an overactive metabolism. This can cause various symptoms, including weight loss, increased heart rate, and bulging eyes. The excess thyroid hormones can stimulate the tissues behind the eyes, causing them to become inflamed and push the eyeballs forward. Therefore, option b, hyperthyroidism, is the correct answer.

The priority nursing care in this situation is to calmly ask the child to point to where the pain is worst and to wiggle fingers. This approach allows the nurse to gather important information about the location and severity of the pain, as well as assess the child's range of motion and neurological function. It also helps to establish trust and rapport with the child, which is crucial in order to proceed with further examination and treatment. Initiating an intravenous line and administering morphine may be necessary for pain management, but it should not be the first priority. Having the parents hold the child or sending the child to radiology can be considered once the initial assessment is completed.

Pyloric stenosis is a condition where the muscle between the stomach and small intestine becomes thickened, leading to blockage and causing symptoms like excessive vomiting. When a child with pyloric stenosis vomits, they lose stomach acid which can result in a loss of hydrogen ions. This loss of hydrogen ions can lead to an increase in blood pH, causing metabolic alkalosis. Therefore, metabolic alkalosis is a potential complication in a child with pyloric stenosis.

In celiac disease, the body is unable to properly digest gluten, a protein found in wheat, barley, and rye. This leads to damage in the small intestine, which can result in malabsorption of nutrients. One of the common symptoms of malabsorption is steatorrhea, which is characterized by fatty, frothy, bulky, and foul-smelling stools. This occurs because the body is unable to break down and absorb fats properly, leading to their presence in the stool. Therefore, option a is the correct answer.

Frequent urination is considered a cardinal sign of diabetes mellitus. This is because in diabetes, the body is unable to regulate blood sugar levels properly, leading to high levels of glucose in the blood. The kidneys try to remove the excess glucose by producing more urine, causing frequent urination. This symptom is often one of the first signs of diabetes and is commonly experienced by individuals with the condition.

Reduced serum albumin is a laboratory finding that indicates MCNS (Minimal Change Nephrotic Syndrome). MCNS is a kidney disorder characterized by the loss of protein in the urine, leading to low levels of serum albumin in the blood. This condition often presents with symptoms such as edema, foamy urine, and hyperlipidemia. Normal platelet count, low specific gravity, and decreased hemoglobin are not specific indicators of MCNS and may be seen in other conditions.

A urine pH of 4.0 is considered abnormal because it indicates acidic urine. The normal range for urine pH is typically between 5.0 and 8.0. A pH of 4.0 may be indicative of conditions such as diabetic ketoacidosis, metabolic acidosis, or urinary tract infections. It can also be caused by certain medications or diet. An abnormal pH level may require further investigation and medical intervention to determine the underlying cause and appropriate treatment.

Hirschsprung disease is a condition characterized by the absence of nerve cells (ganglion cells) in a segment of the colon. This results in a lack of normal peristalsis and movement of stool through the affected segment. As a result, individuals with Hirschsprung disease may experience difficulty passing stool, leading to constipation, distention, and other symptoms. This explanation aligns with the given correct answer which states that Hirschsprung disease is characterized by an aganglionic segment in the colon.

The correct answer is c. Hepatitis B vaccine. This vaccine is now recommended for the immunization of all newborns because hepatitis B is a serious viral infection that can cause chronic liver disease and liver cancer. By vaccinating newborns, it helps protect them from acquiring the infection from their mothers during childbirth or from other sources. The vaccine is safe and effective in preventing hepatitis B and its complications.

The most appropriate initial reaction by the nurse should be to stay with the child and make sure that emergency medical services are called. This is because the child is experiencing a tonic-clonic seizure, which lasts more than five minutes. This type of seizure can be potentially life-threatening and requires immediate medical attention. The nurse should stay with the child to ensure their safety and well-being, while also contacting emergency medical services to provide the necessary medical intervention.

Taking the immobilized preschool child for a "walk" by wagon outside the room is helpful during this period because it provides a change of environment and stimulation for the child. It allows the child to experience different sights, sounds, and sensations, which can help alleviate boredom and promote psychological well-being. Additionally, being outside the room can also provide opportunities for social interaction and engagement with other people, which is important for the child's overall development and emotional well-being.

When caring for an unconscious child, it is important to monitor their fluid intake and output carefully to prevent fluid overload and cerebral edema. Unconscious children are at a higher risk of developing cerebral edema, which is the accumulation of fluid in the brain. Monitoring fluid intake and output helps ensure that the child's fluid balance is maintained within normal limits and prevents complications associated with fluid overload.

Peritoneal dialysis is an advantage over hemodialysis because it is easy to learn and safe to perform. This means that patients can be trained to perform the dialysis themselves at home, reducing the need for frequent visits to a healthcare facility. Additionally, the simplicity and safety of the procedure make it a viable option for patients who may not be able to undergo hemodialysis due to various reasons.

The correct answer is c. Painless rectal bleeding, abdominal pain, or intestinal obstruction. Meckel Diverticulum is a congenital abnormality where a small pouch forms in the wall of the small intestine. It is the most common congenital anomaly of the gastrointestinal tract. The clinical manifestations can vary, but the most common symptoms are painless rectal bleeding, abdominal pain, and intestinal obstruction. These symptoms occur because the diverticulum can become inflamed, infected, or twisted, leading to complications. Other symptoms may include nausea, vomiting, and diarrhea.

Diplopia, or double vision, and blurred vision are both clinical manifestations of increased intracranial pressure in children. Increased intracranial pressure can cause compression of the cranial nerves, leading to abnormalities in vision. This can result in the perception of double vision or blurred vision.

In this scenario, the correct answer is to stabilize the neck and spine. This is because the child has been hit by a car, which can cause significant trauma to the head and neck. Stabilizing the neck and spine helps to prevent any further damage or injury to the spinal cord, which could result in paralysis or other serious complications. It is important to prioritize this action before checking for bleeding or taking other vital signs.

Dry skin is a common clinical manifestation of juvenile hypothyroidism. Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormone, which can lead to various symptoms. Dry skin is a result of reduced sweating and oil production in the skin due to the decreased metabolic activity caused by low thyroid hormone levels. Other symptoms of juvenile hypothyroidism may include fatigue, weight gain, constipation, slow growth, and delayed puberty. Insomnia, diarrhea, and rapid growth are not typically associated with hypothyroidism.

It is important to discuss with the family of a child born with PKU that consumption of decreased amounts of protein and dairy products is advised. This is because PKU is a genetic disorder that affects the body's ability to break down an amino acid called phenylalanine, which is found in protein. Consuming too much protein can lead to a buildup of phenylalanine in the body, causing intellectual disability and other health problems. Therefore, it is crucial for the family to understand the importance of managing protein intake to prevent complications associated with PKU.

Intranasal administration of Desmopressin Acetate (DDAVP) is used to treat diabetes insipidus. Diabetes insipidus is a condition characterized by excessive thirst and urination due to a deficiency of antidiuretic hormone (ADH) or a resistance to its effects. Desmopressin Acetate is a synthetic form of ADH that helps to reduce excessive urination and control fluid balance in the body.

Paresthesia refers to abnormal sensations such as tingling or numbness, which can indicate nerve damage or compromised blood flow. In the context of assessing ischemia in a child with a fracture, paresthesia would be considered an ominous sign because it suggests inadequate blood supply to the affected area. This can lead to further complications and potentially irreversible damage if not addressed promptly.

Melena, the passage of black, tarry stools, suggests bleeding from the upper GI tract. This is because when there is bleeding in the upper GI tract, the blood gets partially digested by stomach acid, resulting in the stools appearing black and tarry. Hemorrhoids or anal fissures (option a) typically cause bright red blood in the stool. Bleeding from the perianal or rectal area (option b) may also result in bright red blood in the stool. The lower GI tract (option c) may cause bright red or maroon-colored blood in the stool. Therefore, the correct answer is option d.

The correct answer is immune complex formation and glomerular deposition. Post infectious glomerulonephritis is characterized by an immune response to an infection, usually caused by streptococcal bacteria. During the infection, immune complexes are formed when antibodies bind to antigens on the surface of the bacteria. These immune complexes can then deposit in the glomeruli of the kidneys, leading to inflammation and damage. This immune response is believed to be the main pathologic process involved in post infectious glomerulonephritis. Infarction of renal vessels, bacterial endotoxin deposition, and embolization of glomeruli are not typically associated with this condition.

Early detection of hypothyroidism and phenylketonuria is essential in preventing mental retardation in infants. Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormone, which is crucial for brain development. Phenylketonuria is a genetic disorder that affects the body's ability to break down an amino acid called phenylalanine, leading to a buildup of this substance in the blood and causing brain damage. Detecting and treating these conditions early can help prevent the development of mental retardation in infants.

A fixed and dilated pupil is a sign of increased intracranial pressure, which can be caused by a brain injury or bleeding in the brain. This is a serious condition that requires immediate medical intervention, making it a neurosurgical emergency. It indicates that there is a critical problem in the brain that needs urgent attention to prevent further damage or even death.

The correct answer is "Replacement therapy requires daily subcutaneous injections." This means that the child with hypopituitarism will need to receive growth hormone therapy through daily injections under the skin. This knowledge is important for nursing considerations because it will involve teaching the child and their family about the proper technique for administering the injections, as well as ensuring that they have a consistent and reliable supply of the medication.

The most appropriate nursing action in this situation is to consult the MD about which analgesia can be safely administered. The child has sustained a head injury and multiple fractures, and the parents have reported that the child is exhibiting signs of pain such as periodic crying and restlessness. It is important to address the child's pain and provide appropriate pain relief, but due to the head injury, it is necessary to consult the MD to determine which analgesia can be safely administered without worsening the child's condition.

The appropriate answer is 4) Until your vertebral column has reached skeletal maturity. This means that the patient will have to wear the brace until their spine has finished growing and reached its full maturity. This is important because wearing the brace helps to correct the curvature of the spine and prevent further progression of scoliosis. Once the spine has reached skeletal maturity, the brace is no longer needed as the growth of the spine is complete.

A subdural hematoma is a type of bleeding that occurs between the dura (the outermost layer of the meninges) and the cerebrum (the largest part of the brain). It is typically caused by a head injury that tears the veins bridging the dura and the brain. This type of bleeding is usually venous rather than arterial, and the blood accumulates slowly over time, causing compression and potentially leading to symptoms such as headache, confusion, and neurological deficits. The parietotemporal region is a common location for subdural hematomas, but it can occur in other areas of the brain as well.

Thickening feedings and enlarging the nipple hole can help decrease the number and total volume of emesis in an infant with gastroesophageal reflux. Thickening the feedings can help to prevent the stomach contents from flowing back up into the esophagus, reducing the likelihood of emesis. Enlarging the nipple hole can allow for a faster flow of milk, which can help prevent the infant from swallowing air and reduce the amount of air in the stomach, also decreasing the likelihood of emesis. Surgical therapy is not indicated for this issue. Placing the infant in a prone position for sleep after feeding can actually increase the risk of choking and should be avoided.

The correct answer is 1 because initiating antibiotic therapy as soon as medication is received from the pharmacy and labs have been drawn is crucial in the treatment of bacterial meningitis. Bacterial meningitis is a serious infection that can rapidly progress and cause severe complications. Starting antibiotic therapy promptly can help to control the infection and prevent further damage. Waiting for the diagnosis to be confirmed or for culture results may delay the initiation of treatment, which can be detrimental to the patient's health. Restoring fluid and electrolyte balance is important, but it should not delay the start of antibiotic therapy.

The amount of hematuria is not a reliable indicator of the seriousness of renal injury because even a small amount of blood in the urine can indicate significant renal trauma. In some cases, there may be a large amount of blood in the urine without any significant renal injury. Therefore, it is important for the nurse to consider other signs and symptoms, such as flank pain and the mechanism of injury, when assessing for possible renal trauma in a child. The other options are not accurate because flank pain can occur in children with renal injuries, kidneys can be injured in children despite being well protected, and nonpenetrating injuries can cause renal trauma in children.

As children grow older, the rapidity of healing for fractures decreases. This is because the bones become less pliable and more porous as they mature, making it more difficult for them to heal quickly. Additionally, the periosteum, which is the outer layer of the bone responsible for bone growth and repair, becomes thinner and weaker in children, further slowing down the healing process. Therefore, the older the child is, the slower their fractures will heal.

Monitoring and maintaining systemic blood pressure is the primary nursing intervention for a 14-year-old girl in the intensive care unit after a spinal cord injury. This is important because spinal cord injuries can lead to autonomic dysreflexia, which is a potentially life-threatening condition characterized by a sudden increase in blood pressure. By monitoring and maintaining systemic blood pressure, the nurse can prevent complications and ensure the stability of the patient's condition.

To identify cleft palate, it is important for the nurse to palpate the palate with a gloved finger. This allows the nurse to feel for any abnormalities or gaps in the palate that may indicate a cleft. Assessing the sucking ability of the infant and the color of the lips may provide additional information, but they are not specific to cleft palate and may not always be indicative of the condition. Palpation of the palate is a more direct and reliable method for identifying cleft palate.

Cerebral palsy is a condition that affects movement and coordination. It can be caused by various factors, but the most common cause is prenatal or neonatal brain lesion or maldevelopment. This means that during pregnancy or shortly after birth, there may be damage or abnormal development in the brain, leading to cerebral palsy. This can be due to a variety of reasons such as infections, genetic factors, or complications during pregnancy or delivery. Other potential causes mentioned in the options, such as cerebral trauma, birth asphyxia, or CNS disease, can also contribute to cerebral palsy, but they are not as commonly observed as prenatal or neonatal brain lesions or maldevelopment.

The adolescent's hostile and uncooperative behavior is likely a normal response to her situation. It is common for individuals with spinal cord injuries to experience anger, frustration, and a sense of loss. The nurse should recognize that this behavior can be redirected in a healthy way through appropriate counseling and support. It is not indicative of severe depression or denial, and it is not solely a normal phase of adolescent development.

Vesicoureteral reflux (VCR) is a condition where urine flows backward from the bladder into the ureters and sometimes up into the kidneys. It is a common cause of pyelonephritis (kidney infection) in children. Since VCR can be hereditary, it is important to have siblings examined for VCR to detect and address the condition early. Surgery may be indicated to correct VCR and prevent further scarring of the kidneys. Limiting fluids may help reduce reflux, but it is not the most important aspect to address in this situation. Cranberry juice is not specifically mentioned as a treatment for VCR or pyelonephritis.

Acromegaly is the correct answer because it is a condition that can occur if there is an excessive secretion of growth hormone (GH) after the closure of the epiphyseal plates. In this condition, the bones and tissues continue to grow, leading to enlargement of the hands, feet, and facial features. It is different from gigantism, which occurs when there is hypersecretion of GH before the closure of the epiphyseal plates, resulting in excessive growth in height. Cretinism is a condition caused by congenital hypothyroidism, while dwarfism is generally caused by various genetic or hormonal factors, not hypersecretion of GH.

Hyperglycemia associated with diabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than 330 mg/dL. This means that if a person's blood glucose level exceeds 330 mg/dL, they may be experiencing hyperglycemia in the context of diabetic ketoacidosis. It is important to monitor blood glucose levels closely in individuals with diabetes to prevent complications such as diabetic ketoacidosis.

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Urinary tract anomalies are often associated with malformed or low-ears in fetus development. This suggests that there may be a common underlying cause or genetic factor that affects the development of both the urinary tract and the ears. It is important to note that this association does not necessarily mean that all individuals with urinary tract anomalies will also have malformed or low-ears, but there is a higher likelihood of this irregularity occurring together.

The signs of hyperglycemia include blurred vision, weakness, and polyphagia. Blurred vision can occur due to the high levels of glucose in the blood affecting the lens of the eye. Weakness is a common symptom of hyperglycemia as the body is not able to effectively use glucose for energy. Polyphagia refers to excessive hunger and increased appetite, which can be a result of the body's cells not receiving enough glucose for energy. These symptoms are commonly seen in individuals with high blood sugar levels.

The correct answer is 3) About 55% of affected children have normal intelligence. This answer suggests that there is a possibility that the infant with cerebral palsy may have normal intelligence. It provides a statistic that indicates that more than half of affected children have normal intelligence, implying that mental retardation is not a certainty in all cases of cerebral palsy.