CH 73 AND 74

The school nurse is teaching adolescents about sexually transmitted infections (STIs). Which of the following accurately describes a characteristic of these disorders? Select one: A. In the United States, most STIs occur in people older than 25. B. The incidence of some STIs is decreasing owing to condom use and public education. C. A history of reproductive or urinary tract disorders may mask STIs. D. By law, physicians must report STIs treated in adolescents to their caregivers.

A history of reproductive or urinary tract disorders may mask STIs. EXPLANATION Sexually active young adults with a history of reproductive and/or urinary tract disorders may have STIs that are not obvious or have not been detected. Most STIs in the United States occur in people younger than age 25. Physicians must, by law, treat an adolescent with an STI without reporting the condition to the adolescent's family caregivers. The incidence of certain STIs is increasing, even with the massive amount of public education about safer sex and condom use.

1) Which pregnant mother is at greatest risk for having a child with Down syndrome? a. A 25-year-old mother who smokes b. A 35-year-old mother with 4 children c. A 16-year-old mother without prenatal care d. A 45-year-old mother with a previous child with Down syndrome

A 45-year-old mother with a previous child with Down syndrome

1) A school-aged child is diagnosed with the common cold. The parent is concerned that the child did not receive an antibiotic and wants to know how the child can get rid of the cold without it. What is the best response by the nurse? a. A virus causes a cold and antibiotics are used for bacterial infections. b. Your primary care provider must have forgotten to write the prescription. c. An antibiotic will worsen the cold symptoms. d. If the cold is not better in 3 days, an antibiotic will be prescribed.

A virus causes a cold and antibiotics are used for bacterial infections. RATIONALE The cold is caused by a viral infection and is not treated with an antibiotic. Antibiotics are ineffective as an agent to treat viruses but they do treat bacterial infections. The healthcare provider needs to be called if symptoms worsen or persist longer than 7 to 10 days. High-risk individuals are more likely to develop complications such as pneumonia. An antibiotic is not effective but it will not make the symptoms worse.

@ A client is diagnosed with juvenile glaucoma. Which of the following accurately describes this disorder? Select one: A. Retinal degeneration that causes blindness B. Abnormally high intraocular pressure C. Abnormally low intraocular pressure D. Night blindness

Abnormally high intraocular pressure EXPLANATION Glaucoma refers to abnormally high intraocular (within the eyeball) pressure, resulting in eye damage and decreased vision. It may be caused by trauma, hemorrhage into the eye, tumor, inflammatory eye disease, or developmental abnormalities during infancy and early childhood. Retinitis pigmentosa (RP) is characterized by a slowly progressive, bilateral retinal degeneration that often causes blindness.

During a routine medical examination of a 12-year-old client, the nurse notices that the client's fasting sugar level is above 160 mg/dL. After further evaluation, the client is diagnosed with diabetes mellitus type 1. Which of the following teachings should the nurse provide the family when caring for this client? Select one: A. Self-administration of insulin should be discouraged. B. Diabetics are at a higher risk for gaining weight. C. Adolescent clients often rebel against treatment. D. Diabetics should avoid frequent physical exertion.

Adolescent clients often rebel against treatment.

@ The nurse is providing patient teaching for an adolescent diagnosed with mononucleosis. Which of the following teaching points should the nurse include? Select one: A. Be sure to finish the entire course of antibiotics even if symptoms disappear. B. Avoid playing contact sports during the acute phase of the illness. C. Wash your towels and clothes separately from the rest of the family. D. Arrange to have schooling at home for the next 3 to 4 months.

Avoid playing contact sports during the acute phase of the illness. RATIONALE Mononucleosis, which typically infects the salivary glands, is transmitted by droplets in saliva, coughs, and sneezes, and by direct contact with mucous membranes (mouth-to-mouth). It is not transmitted by washing towels and clothing with the laundry of others. Treatment for mononucleosis is symptomatic; it includes rest, fluids, and analgesics, not antibiotics. If liver or spleen enlargement is present, the greatest risk of rupture is present during the first 2 to 4 weeks of the illness. Strenuous exercise and contact sports should be avoided while the organ(s) are enlarged. The school nurse and teachers need to make arrangements for schooling at home during the acute phase (first 2-4 weeks).

@ An adolescent is diagnosed with anorexia nervosa. Which of the following is a life-threatening complication of this disorder? Select one: A. High blood pressure B. Hypercalemia C. Mental illness D. Bradycardia

Bradycardia RATIONALE Life-threatening complications of anorexia nervosa include lowered blood pressure, bradycardia, hypokalemia (low potassium), and congestive heart failure. Death may occur.

@A 12-year-old client is diagnosed with sleep apnea. Which of the following are symptoms of this disorder? Select one: A. Sleep walking without recall of event B. Uncontrollable urge for prolonged sleep C. Breathing stops for short periods of time during sleep D. Brief attacks of irresistible sleep

Breathing stops for short periods of time during sleep EXPLANATION Sleep apnea occurs when a person stops breathing for short periods of time during his or her regular sleeping hours. Physical defects may be the causative factor, and this condition is not uncommon in individuals who are obese. Somnambulism, also referred to as sleep walking, is a common sleep disorder in children, characterized by walking in the sleep, followed by inability to recall the event the following morning. The uncontrollable urge to sleep, characterized by prolonged sleep periods (12-18 hours), is often seen in clients with hypersomnia. Brief attacks of irresistible sleep are characteristic of clients with narcolepsy.

Question 3 @The school nurse teaches a class of adolescents about eating disorders. Which of the following disorder is characterized by loss of control during overeating, followed by purging? Select one: A. Enuresis B. Bulimia Nervosa C. Obesity D. Anorexia nervosa

Bulimia Nervosa RATIONALE Bulimia nervosa, known as "gorge-purge syndrome," is an eating disorder characterized by loss of control during overeating, followed by purging. Typically, affected individuals rapidly eat large amounts of food, usually in secret. Following such binges, they attempt to purge their systems of food through self-induced vomiting or laxative and diuretic use. Anorexia nervosa is characterized by extreme weight loss with no underlying physical cause. Obesity is defined as being in excess of 20% of optimum weight, and enuresis is bedwetting.

@For many emotional disorders, nurses may set up an appointment with a counselor. Which of the following disorders requires long-term counseling to overcome? Select one: A. Bulimia nervosa B. Retinitis pigmentosa C. Mittelschmerz D. Sleep apnea

Bulimia nervosa EXPLANATION Feelings of guilt and depression are common during binges of bulimia nervosa. Long-term counseling is necessary to overcome the disorder. Sleep apnea is a sleep disorder with a physical cause. Mittelschmerz is pain during ovulation. Retinitis pigmentosa is a eye disorder that is an hereditary disease and may require genetic counseling to prevent it.

@ A newborn is diagnosed with neurofibromatosis. Which of the following is a physical symptom of this disease? Select one: A. Vision loss B. Cafe-au-lait spots C. Mongolian spots D. Large head and chin

Cafe-au-lait spots EXPLANATION Neurofibromatosis is characterized by café au lait spots and benign skin tumors. Mongolian spots are benign bluish-purplish spots found on the back of newborns, usually of African American descent. Newborns with Tay-Sachs disease present with vision loss and children with fragile X syndrome have a large head and chin and a long face.

@The nurse is teaching an adolescent with type 1 diabetes how to plan a nutritious menu related to her disease state. Which of the following would the nurse teach this client? Select one: A. Children with diabetes need a diet rich in protein. B. Children with diabetes need extra fat in their diets. C. Children with diabetes need regular and consistent meals. D. Children with diabetes need extra sugar in their diets.

Children with diabetes need regular and consistent meals. EXPLANATION The diabetic child requires the same nutrients as other children, with consistency in quantity of intake and regularity of mealtime.

1) An Ashkenazi Jewish couple is suspected to be pregnant but concerned about the child having Tay-Sachs disease. For what testing option should the nurse prepare the mother? a. A complete blood count (CBC) at 16 to 18 weeks b. An MRI upon confirmation of pregnancy c. Chorionic villus sampling between 10 to 12 weeks d. An amniocentesis between 4 to 5 weeks

Chorionic villus sampling between 10 to 12 weeks Explanation A mother can get prenatal testing via chorionic villus sampling (CVS) between the 10th and 12th week of pregnancy for testing of Tay-Sachs. An amniocentesis can be done between the 15th and 18th week of pregnancy. An MRI is not diagnostic of Tay-Sachs in the fetus. A CBC is not diagnostic of any form of hereditary disorders.

A nurse is planning care for a 15-year-old boy who has acne vulgaris. Which of the following is a long-term goal for this client? Select one: A. Client will identify the causes of acne and preventive measures. B. Client will verbalize measures for appropriate skin care and control of acne. C. Client will describe acne and its treatment measures. D. Client will verbalize a decrease in lesions by next visit.

Client will verbalize a decrease in lesions by next visit. EXPLANATION Determining the client's understanding of acne and its treatments are short- term goals that provide a baseline from which to develop a teaching plan and appropriate strategies. Voicing a decrease in lesions is a long-term goal following treatment.

The nurse is counseling the parents of a child who has stated that he wishes to commit suicide because "life isn't worth living anymore." Which of the following should the nurse teach these parents? Select one: A. Consider using a no-suicide contract with the child. B. Talking is more effective than listening about a child's sadness or unhappiness. C. Do not take suicide ideation, gestures, and attempts too seriously in this age group. D. Treat the adolescent with suicide ideation in the home for as long as possible.

Consider using a no-suicide contract with the child. EXPLANATION Parents should consider using a no-suicide contract with the child, wherein the child agrees not to attempt suicide for a specified period and will contact help immediately if he or she feels suicidal. Children are usually very conscientious about wanting to keep their word, and a no-suicide contract can be effective in some situations. The nurse should warn the family to take suicide ideation, gestures, and attempts seriously. Adolescents with severe depression and suicidal thoughts may require hospitalization and close monitoring until suicide is no longer an immediate threat. Listening is more effective than talking to children about sadness, unhappiness, or depression.

A nurse is caring for a newborn diagnosed with neonatal abstinence syndrome. How can the nurse provide supportive care to the infant? Select one: A. Avoid use of pacifiers. B. Decrease environmental stimulation. C. Avoid rocking the newborn. D. Carry the newborn often.

Decrease environmental stimulation.

@An 8-year-old client is diagnosed with stage II Legg-Calvé-Perthes disease. What are the characteristics of this disease? Select one: A. Deposit of new connective tissue because of new blood supply B. Regeneration and completion of bone growth; the shape of joint fixed C. Granulation of new bone replaces connective tissue D. Interruption of circulation to hip joint, resulting in necrosis of the femoral head

Deposit of new connective tissue because of new blood supply RATIONALE Stage II is the depositing of new connective tissue because of a new blood supply. Stage I is an interruption of circulation to the hip joint, resulting in necrosis of the femoral head. Stage IIIa is granulation of new bone replaces connective tissue, and stage IIIb is regeneration and completion of bone growth; the shape of joint fixed.

A 6-year-old child is brought into the healthcare facility by his family with complaints that he appears to be very sad, depressed, and exhibiting a drastic change in personal appearance. The healthcare provider diagnoses the child with childhood schizophrenia. What nursing considerations should be kept in mind when caring for such a client? Select one: A. Stop medications when symptoms disappear. B. Encourage supportive counseling for the family. C. Talk to the client rather than listening. D. Encourage hospitalization over home care.

Encourage supportive counseling for the family. RATIONALE Supportive counseling must be provided for the family. Home care with respite care, medical assistance, and social service assistance is preferred to hospitalization. Listening is more effective than talking to children about sadness or depression. When symptoms disappear or diminish, it is an indication that medical management is effective; however, it is not an indication to discontinue medications. The nurse should encourage the client and the caregivers to maintain the regimen of medications. These clients require frequent monitoring to ensure medication compliance.

@The nurse is providing teaching for a school athlete who has tinea pedis. Which of the following is a guideline for care of this disorder? Select one: A. Expose the feet to air whenever possible. B. Keep wearing the same shoes until the infection subsides. C. Do not expose feet to sunlight. D. Apply antifungal medication between baths.

Expose the feet to air whenever possible. RATIONALE The client with tinea pedis (athlete's foot) should expose the feet to air when possible, apply antifungal medication after each bath, expose the feet to sunlight and fresh air, and alternate wearing at least two pairs of shoes.

A 16-year-old client has been diagnosed with anorexia nervosa. The client appears very thin. The client does not have proper dietary intake and is obsessed with losing weight. Which of the following is true for a client with anorexia nervosa? Select one: A. Weight loss is associated with an underlying physical cause. B. There is usually a long-term history of being underweight. C. Extreme and persistent hunger is an important sign. D. Even slight weight gain is followed by depression.

Extreme and persistent hunger is an important sign.

A school nurse is teaching parents what to watch for as risk factors for suicide. Which of the following would the nurse list? Select all answers that apply. Select one or more: A. Chronic illness B. Family history of suicide C. Feelings of being too close to people D. Impulsive or aggressive tendencies E. Easy access to lethal methods F. Willingness to seek help for mental disorders

Family history of suicide, Chronic illness, Easy access to lethal methods, Impulsive or aggressive tendencies

@ A client is undergoing an appendectomy. Which of the following is accurate information regarding appendicitis? Select one: A. Untreated appendicitis leads to pericarditis. B. Appendicitis is always treated with IV antibiotics. C. Abdominal pain localizes to the left upper quadrant. D. Fever, nausea, and vomiting are commonly present.

Fever, nausea, and vomiting are commonly present. RATIONALE Appendicitis is an acute infection of the vermiform appendix. Abdominal pain begins in the periumbilical area and localizes in the right lower quadrant. Fever, nausea, and vomiting are commonly present. Without treatment, the infection progresses rapidly, causing perforation and peritonitis owing to the gastrointestinal bacteria. Pericarditis is inflammation of the sac around the heart. If the appendix ruptures, the client receives IV antibiotics.

A 12-year-old child is diagnosed with a specific learning disability. The nurse is instructed to provide a teaching plan to the child's family caregivers. What are the important considerations that the nurse should keep in mind during the teaching process? Select one: A. Use sign language for learning and communication. B. Give one or two instructions at any particular time. C. Use a tape recorder for a child with a listening deficit. D. Use visual reminders for a child with a speech deficit.

Give one or two instructions at any particular time. RATIONALE The nurse should teach the family caregivers to give only one or two instructions at a time, which may be repeated periodically to promote good understanding and listening. Sign language and speech therapy are critical tools for learning and communication in children with hearing impairments, not for those with learning disabilities. Visual reminders should be used in a child with a listening deficit and not speech deficit. A tape recorder should be used to reinforce information in clients with visual processing deficits.

@ A 32-year-old client with a history of regular consumption of alcohol for the past 5 years delivered a baby boy at a healthcare facility. The newborn is diagnosed with fetal alcohol syndrome (FAS). Which of the following characteristic features is seen in children with fetal alcohol syndrome? Select one: A. Macrocephaly B. Hypoactive behavior C. Growth retardation D. Vascular defects

Growth retardation RATIONALE Infants with FAS experience severe facial abnormalities and growth retardation. Fetal alcohol syndrome is the most severe form of fetal alcohol spectrum disorders related to maternal alcohol consumption during pregnancy. Children with FAS exhibit microcephaly, not macrocephaly. FAS is characterized by hyperactive behavior, not hypoactive behavior. Vascular defects are not seen in infants with FAS.

A nurse is administering an intelligence quotient (IQ) test for an 11-year-old child with complaints of decreased memory and difficulty concentrating. What is the significance of standard IQ tests? Select one: A. IQ tests indicate different types of intelligence. B. IQ tests are used to determine success in life. C. IQ tests are good predictors of academic achievement. D. IQ tests are good predictors of work productivity.

IQ tests are good predictors of academic achievement.

During the routine medical examination of a 5-year-old client, the client's parents ask the nurse for suggestions regarding a nutritious diet for their child. What suggestion should the nurse provide? Select one: A. Instruct the parents to introduce new foods in small servings. B. Encourage the child to learn by himself about good food choices. C. Provide a maximum of 500 mg of cholesterol daily. D. Instruct the parents to provide only 10% of calories from fat.

Instruct the parents to introduce new foods in small servings. EXPLANATION When introducing new foods at the table, the client's parents are instructed to offer them one at a time in small servings. A maximum of 300 mg of cholesterol is to be provided to prevent the incidence of heart attack. The client's parents are suggested to teach the child how to make good food choices and to avoid completely nonnutritive, high-calorie, high-fat snacks. A minimum of 30%, and not 10%, of the calories should come from fat, with only 10% coming from saturated fats.

@When performing a physical assessment of a 12-year-old girl, the nurse documents "dysfluency." What occurs with this condition? Select one: A. Interruption in the natural flow of speaking B. Interruption in the natural flow of running and jumping C. Interruption in the natural flow of the thinking process D. Interruption in the natural flow of walking

Interruption in the natural flow of speaking RATIONALE A dysfluency is an interruption in the natural flow of speaking. An example is the child who stutters. Stuttering is normal for preschool children because, at this age, the ability to understand is more developed than vocabulary and command of the language. Stuttering in school-age children requires evaluation.

A 9-year-old autistic child is admitted to a pediatric rehabilitation center for the first time, for special care and support. Which of the following measures should the nurse undertake when working with this child toward rehabilitation? Select one: A. Avoid involving the client in group activities, such as sports. B. Provide assistance with all routine activities. C. Involve the family caregivers in treatment planning. D. Promote understanding of instructions using baby talk.

Involve the family caregivers in treatment planning. RATIONALE The nurse must involve the family caregivers in treatment planning. This provides emotional support to the child. The nurse should not use baby talk because this may lead to confusion. The nurse should encourage the child to be as independent as possible; this will help to maintain a balance between the need for assistance and achieving independence in daily activities. Encouraging the client to perform all the normal things that others do emphasizes normalcy. The child should actively participate in group activities such as sports, music, and art.

Following an IQ test, a child is diagnosed with moderate cognitive impairment. Which of the following are characteristic of this type of impairment? Select all answers that apply. Select one or more: A. Language development is minimal B. Achieves a mental age of 3 to 7 years C. Requires complete assistance with all aspects of daily life D. Functions independently with assistance of special education E. May develop reading skills at fifth- or sixth-grade level F. Is unable to function independently

Is unable to function independently, Achieves a mental age of 3 to 7 years

@ An 8-year-old client returns from a camping trip with complaints of flu-like symptoms and distinct red ring-shaped rashes over the trunk. The client is diagnosed with Lyme disease. Which of the following information should the nurse provide to the client's mother? Select one: A. The bacteria are transmitted to humans through the wood tick. B. All clients with Lyme disease develop the rash over the skin. C. It can lead to the development of angina and facial palsy. D. Symptoms appear immediately following the tick bite.

It can lead to the development of angina and facial palsy. EXPLANATION Several weeks after a tick bite, if the condition is left untreated, the affected individuals may begin to complain of angina, facial palsy, chronic fatigue, or intellectual impairment. The bacteria causing Lyme disease are transmitted to humans from the deer tick and not the wood tick. Many clients with Lyme disease never develop the rash over their skin; however, the bacteria responsible for causing the condition enter the blood and settle in tissues, where they multiply. Symptoms of Lyme disease usually appear 3-31 days after the bite and not immediately.

@An adolescent is diagnosed with narcolepsy. Which of the following is a characteristic of this disorder? Select one: A. It is a brief attack of irresistible sleep. B. It is caused by an underlying physical condition. C. It interrupts nighttime sleep. D. It involves talking during sleep.

It is a brief attack of irresistible sleep. EXPLANATION Narcolepsy is a brief attack of irresistible sleep. An alteration in the young person's emotional state often precipitates this condition. Underlying contributing factors for narcolepsy may be traced to some type of conflict, competition, or unacceptable aggression. Boys are more likely to be affected than girls.

An adolescent is diagnosed with narcolepsy. Which of the following is a characteristic of this disorder? Select one: A. It is an extended attack of irresistible sleep. B. It is caused by an underlying physical condition. C. It interrupts nighttime sleep. D. It is accompanied by an early appearance of REM sleep.

It is accompanied by an early appearance of REM sleep. EXPLANATION Narcolepsy is a brief attack of irresistible sleep. An alteration in the young person's emotional state often precipitates this condition. Underlying contributing factors for narcolepsy may be traced to some type of conflict, competition, or unacceptable aggression. Boys are more likely to be affected than girls. Nighttime sleep is basically normal; however, tests usually detect an earlier appearance of REM sleep, which under normal circumstances, occurs toward morning and is marked by dreams.

@ A 15-year-old boy visits the healthcare facility for information on acne. Which of the following should the nurse tell him about acne vulgaris? Select one: A. It is a relatively rare skin disease B. It is influenced by stress and hormonal changes. C. It is not influenced by cigarette smoking D. It is caused by a lack of sebum secretion.

It is influenced by stress and hormonal changes. EXPLANATION Acne is a very common skin disease. It is usually caused by hormonal changes during puberty, along with oversecretions of sebum. Acne vulgaris is generally influenced by stress, because emotional stress seems to cause flare-ups of the condition. Cigarette smoking increases the frequency and severity of acne.

QUESTION 1 A 15-year-old boy visits the healthcare facility for information on acne. Which of the following should the nurse tell him about acne vulgaris? Select one: A. It is not influenced by stress and hormonal changes. B. It is not influenced significantly by the client's diet. C. It is caused by a lack of sebum secretion. D. It is slightly more common in girls than in boys.

It is not influenced significantly by the client's diet. EXPLANATION Diet plays no significant role in the development or progression of acne; however, a well-balanced, nutritional diet is essential for the overall good health of the client. Acne vulgaris usually develops during puberty and is slightly more common in boys than in girls. Acne is usually caused by hormonal changes during puberty, along with oversecretions of sebum. Acne vulgaris is generally influenced by stress, because emotional stress seems to cause flare-ups of the condition.

@ A nurse is caring for a child with impetigo contagiosa. What are the nursing activities for preventing the spread of infection? Select one: A. Avoid exposure to sunlight. B. Keep the child's towels and linens away from others. C. Use only warm water to remove crusts. D. Use antifungal medication, as necessary.

Keep the child's towels and linens away from others. EXPLANATION The nurse caring for the child should ensure that the child's towels and linens are kept away from others to prevent spread of infection. Good handwashing is essential to prevent spread of infection. Crusts should be removed with soap and water. Antibacterial topical or systemic medications are used to treat the infection. The client need not avoid exposure to sunlight.

@A parent brings his son to a community clinic with concerns about his posture. On assessment, the nurse notes that there is an abnormal curvature of the thoracic spine that results in a "hunchback" appearance. What disorder would the nurse suspect? Select one: A. Juvenile rheumatoid arthritis B. Scoliosis C. Lordosis D. Kyphosis

Kyphosis EXPLANATION Kyphosis is an abnormal curvature of the thoracic spine that results in a "hunchback" appearance. It can result from disease (e.g., tuberculosis), compression fractures, or arthritis. Lordosis is an exaggerated curvature of the lumbar spine in which the pelvis tips forward. It may result from a disease process, or it may be idiopathic. Scoliosis is a lateral curvature, resulting in an S-shaped spinal appearance. Juvenile rheumatoid arthritis (JRA) is a generalized systemic disease of the entire musculoskeletal system. It can lead to deformities, contractures, and impaired movement.

@The nurse is caring for a child with special needs. Which of the following should be kept in mind? Select all answers that apply. Select one or more: A. Praise and reward successful accomplishments as soon as possible after completion. B. Do not act impatient or in a hurried manner. C. Make instructions simple and specific for each step. D. Encourage self-care. E. Consistency in activities is not important.

Make instructions simple and specific for each step., + Praise and reward successful accomplishments as soon as possible after completion., + Encourage self-care., + Do not act impatient or in a hurried manner.

An adolescent is diagnosed with depression. What is the primary clue in diagnosing this condition? Select one: A. Moodiness B. Feelings of sadness C. Withdrawn D. Marked change in behavior

Marked change in behavior RATIONALE Depression can be difficult to identify and differentiate from other disorders. Young children and adolescents often have difficulties expressing themselves and their feelings, and their depression can go unnoticed. Many adolescents are sometimes sad, moody, and withdrawn, and family caregivers may be unable to differentiate typical adolescent moods from clinical depression. The primary clue is a marked change in behavior.

A pregnant woman is undergoing an amniocentesis to determine any chromosomal defects present in the fetus. The results show an elevated alpha-fetoprotein (α-fetoprotein, AFP). What does an increased AFP level indicate? Select one: A. Duchenne muscular dystrophy B. Down syndrome C. Fragile X syndrome D. Neural tube defects

Neural tube defects RATIONALE Many disorders can be detected prenatally through amniocentesis, although the procedure carries a certain risk to the fetus. One test, AFP, is performed on amniotic fluid or serum; increased AFP levels indicate possible neural tube or ventral wall defects.

@A woman who is 3 months' pregnant changes her cat's litter box and develops toxoplasmosis. What can fetal exposure to toxoplasmosis cause? Select one: A. Birth defects B. Seizures C. Mental retardation # Intellectual disability D. Paralysis

Mental retardation # Intellectual disability EXPLANATION Fetal exposure to chickenpox or toxoplasmosis can result in intellectual disability and microcephaly. Toxoplasmosis also can cause deafness or cognitive impairment. Maternal herpes simplex virus can cause seizures and paralysis in newborns. The outcome of prenatal exposure to rubella (German measles) includes various birth defects, including intellectual disability, developmental disabilities, hearing loss, and visual impairment

A 14-year-old girl complains of painful menstruation and is diagnosed with primary dysmenorrhea. What is the recommended treatment for this disorder? Select one: A. Cold compresses on the abdominal area B. Hot baths C. Antibiotic therapy D. NSAIDs 1 to 2 days before menses begin

NSAIDs 1 to 2 days before menses begin EXPLANATION Treatment of primary dysmenorrhea is symptomatic. Administration of NSAIDs 1 to 2 days before the beginning of menses prevents the formation of prostaglandins and helps reduce discomfort and inflammation. Warm baths and relaxation techniques also help reduce pain. In severe cases, oral contraceptives may be used. Antibiotic therapy is not used to treat dysmenorrhea.

A nurse is explaining the difference between an acquired disorder and a genetic disorder to a couple during genetic counseling. Which of the following would the nurse use as examples of genetic diseases? Select all that apply. Select one or more: A. Fetal alcohol syndrome B. Sickle cell disease C. Neurofibromatosis D. Down syndrome E. Tay-Sachs disease F. Neonatal abstinence syndrome

Neurofibromatosis, Tay-Sachs disease, Down syndrome, Sickle cell disease RATIONALE A genetic disorder is a physical or mental abnormality resulting from a defect in genetic structure. Neurofibromatosis, Tay-Sachs disease, Down syndrome, and sickle cell disease are all genetic disorders. Many conditions are congenital, but not genetic; they are acquired. Examples of acquired disorders are those that are caused by teratogens, such as alcohol, drugs, maternal diseases, and toxic substances. Fetal alcohol syndrome and neonatal abstinence syndrome are acquired disorders related to the mother's alcohol and drug use, respectively.

During a routine medical examination of a 15-year-old boy, the attending nurse notices that the client is overweight for his age group. On further examination, the client is found to be overweight by more than 40% of his optimum weight. Which of the following client teachings must the nurse provide when caring for the client and his family members? Select one: A. Obesity usually increases the risk of developing lordosis. B. Calorie intake needs to be reduced by at least 5%. C. Obesity is often caused by slow thyroid function. D. Obesity is often related to an underlying disease.

Obesity usually increases the risk of developing lordosis. EXPLANATION Clients who are obese are at a higher risk of developing an exaggerated curvature of the lumbar spine (lordosis) because of the excess abdominal weight that distorts the person's center of gravity. Clients who are obese are usually suggested to decrease their total calorie intake by at least 30%, and not just 5%. Obesity is rarely caused by slow thyroid function. Obesity is rarely related to underlying causes (<5%).

1) A newborn is observed to have tremors, hyperactive reflexes, a high-pitched cry, and irritability. What action does the nurse anticipate performing first? a. Obtain urine and meconium for drug screen. b. Report the mother to child protective service. c. Increase stimulation of the newborn. d. Withhold all feedings.

Obtain urine and meconium for drug screen. RATIONALE The symptoms described may be indicators of maternal drug use that has been transferred to the neonate. Diagnosis of drug use is based on observation of the infant's behaviors and toxicology tests. A drug test may be done by urine. Meconium (the first bowel movement) may be tested for drugs. A maternal drug history may be helpful; however, the mother may deny use of any drugs for fear of legal repercussions. Facilities may require notification of child protective services if illicit drugs are suspected or confirmed after results of drug screens. It is also important to rule out other disorders that may mimic symptoms of drug effects in the neonate. The nurse should decrease rather than increase the stimulation of the neonate. Withholding feedings is not an appropriate intervention for the neonate; rather, ensure adequate nutrition.

@ A 9-year-old child is diagnosed with attention deficit-hyperactivity disorder (ADHD) at the healthcare facility. When caring for this client, the nurse should be aware of which of the following features? Select one: A. Difficulty finishing tasks B. Hypoactive behavior C. Poor attention span D. Difficulty talking

POOR attention span EXPLANATION Children with ADHD have a distinctively poor attention span. The child is extremely distractible and fails to pay adequate attention to details. Clients with ADHD have difficulty both getting started and finishing the tasks. Clients with ADHD express impulsivity as disruptive and hyperactive behavior, not hypoactive behavior. Clients with ADHD often talk excessively.

@ A young couple with a 3-year-old child brings their daughter to a healthcare facility with complaints that the child is hyperactive, complains of abdominal pain, and has intermittent vomiting. The couple also states that they were fixing up an older home and scraping paint off the banisters when they caught their daughter eating the paint chips. Which of the following diseases would the nurse expect based on this information? Select one: A. Cerebral palsy B. Autism C. Plumbism D. ADHD

Plumbism EXPLANATION These are signs and symptoms of plumbism or lead poisoning. One of the most common causes of lead poisoning in children is the ingestion of leaded paint chips. A 1978 federal law prohibiting the use of lead in paints has reduced the number of lead poisoning cases. Individuals living in older homes, usually in inner cities, remain at risk.

A nurse is caring for children with specific disabilities in a pediatric rehabilitation center. What special consideration should th nurse keep in mine when helping in behavior modification of these children? a. Teach feeding skills in a group b. use baby talk with those who have speech impairments c. Praise them for all work that is done well d. Do not allow family members to interfere

Praise them for all work that is done well RATIONALE The nurse should praise the children for all work that is done well and refrain from punishing them even if they are not able to do something as directed. Feeding and dressing skills are better taught in a quiet place away from distraction and not in a group. Baby talk should not be used with children who have speech impairments. Involving family members in their care helps ensure that the children feel a sense of belonging to the family. Family members should be included in the care of such children as feasible.

@ A mother brings her 10-year-old daughter to the pediatrician with concerns about her early sexual development. What is the term for this condition? Select one: A. Bulimia nervosa B. Precocious C. Mittelschmerz D. Dysmenorrhea

Precocious RATIONALE The development of secondary sexual characteristics is of particular concern to many adolescents. Precocious (early) and delayed sexual development may occur. These conditions are particularly distressing for adolescents because peer pressure is so significant at this developmental stage. Mittelschmerz is painful ovulation and dysmenorrhea is pain on menstruation. Bulimia nervosa is an eating disorder.

A nurse is examining a 2-year-old child diagnosed with ataxic cerebral palsy. The child is unable to perform fine leg movements and has a wide-based gait. What other distinguishing features should the nurse look for in this client? Select one: A. Writhing involuntary movements B. Increased muscle tone or spasticity C. Problems with depth perception D. Evidence of full or partial paralysis

Problems with depth perception

The nurse is caring for children with sensory disorders. Which of the following would be a teaching point for the parents of these children? Select one: A. Promote dependent functioning in the environment. B. Teach the child that there are limitations in the environment. C. Discourage dependency on computers for children with speech disorders. D. Promote communication for the child with a hearing impairment.

Promote communication for the child with a hearing impairment. RATIONALE Communication and safety are major issues for families with hearing-impaired children, and promoting communication is critical. The nurse should teach family caregivers to remove limitations in the surrounding environment and to promote independent functioning for children with visual impairment. Children with impaired hearing face the related problem of poor speech development. Computers are especially valuable for children with speech disorders.

@ A 15-year-old client with complaints of night blindness, nearsightedness, and tunnel vision has been diagnosed with retinitis pigmentosa. Which of the following statements are true in a client with retinitis pigmentosa? Select one: A. Retinitis pigmentosa is often associated with hearing disorders. B. Cataracts and glaucoma are uncommon in clients with retinitis pigmentosa. C. The client is advised to avoid using dark glasses during the day. D. Retinitis pigmentosa generally occurs owing to a viral infection of the eye.

Retinitis pigmentosa is often associated with hearing disorders. EXPLANATION Clients with retinitis pigmentosa often develop hearing disorders along with macular degeneration. Retinitis pigmentosa is often associated with other ocular disorders, such as cataracts, glaucoma, or blind spots. Retinitis pigmentosa is a hereditary condition and is not caused by viral infections. The client with retinitis pigmentosa is usually advised to wear dark glasses in bright sunlight to avoid further eye irritation and to enhance remaining vision.

@The nurse is caring for a 10-year-old boy diagnosed with chronic ulcerative colitis. Which of the following is a prominent symptom of this disorder? Select one: A. Severe abdominal pain in the right lower quadrant B. Eye damage and decreased vision C. Hip pain or soreness D. Severe diarrhea that may be bloody

Severe diarrhea that may be bloody RATIONALE Chronic ulcerative colitis (CUC) is a relatively common disorder in adolescents and young adults. It results in inflammation of the colon and rectum. One of the most pronounced symptoms of CUC is severe diarrhea, which may be bloody, and which may be accompanied by weight loss, anorexia, and growth delays. Appendicitis is an acute infection of the vermiform appendix in which abdominal pain begins in the periumbilical area and localizes in the right lower quadrant. Glaucoma refers to abnormally high intraocular (within the eyeball) pressure, resulting in eye damage and decreased vision. Hip pain or soreness is associated with Legg-Calvé-Perthes disease.

The nurse working with children with genetic disorders compares the characteristics of Down syndrome and fragile X syndrome. Which of the following is common for both disorders? Select one: A. Upward, outward slant of eyes B. Small, low-set ears C. Simian creases on the hands D. Round, small, short head

Simian creases on the hands

@ The nurse is explaining the side effects of the drug methylphenidate HCl (Ritalin) to a couple whose son was diagnosed with attention deficit hyperactivity disorder (ADHD). Which of the following is one of those side effects? Select one: A. Dry, itchy skin B. Sleep disturbances C. Increased growth rate D. Decreased heart rate

Sleep disturbances EXPLANATION Methylphenidate HCl (Ritalin), a central nervous system (CNS) stimulant, affects mental, rather than motor, activities. Side effects include decreased growth rate, increased heart rate and blood pressure, and sleep disturbances, not dry, itchy skin.

A 35-year-old client had a normal, spontaneous vaginal delivery. The mother's social history includes use of oral contraceptives and smoking. The physical appearance and chromosomal studies for the baby confirm Down syndrome. Which of the following features would be seen in the baby? Select one: A. Large, round head B. Small, low-set ears C. Small, high-set ears D. Big, pointed nose

Small, low-set ears EXPLANATION Newborns with Down syndrome have small, low-set ears, which are distinctive physical features. They have a flattened facial profile, small, round head—not large head—and a small, flat nose.

A mother brings her 9-year-old son to a community health clinic with concerns about his sleep habits. The mother tells the nurse that her son walks in his sleep in the middle of the night and doesn't recall it in the morning. What condition is the mother describing? Select one: A. Narcolepsy B. Somnambulism C. Somniloquism D. Insomnia

Somnambulism EXPLANATION Somnambulism (sleep walking) usually occurs during the later stages of non-REM sleep. Children usually do not recall sleep-walking episodes the next morning. Somniloquism (sleep talking) is common in young people. It may or may not be associated with sleep walking. The person can often carry on a logical conversation but will not remember it the next morning. Insomnia is difficulty falling asleep. Narcolepsy is a brief attack of irresistible sleep.

@ The nurse is performing a physical assessment of a child diagnosed with cerebral palsy. The child exhibits increased muscle tone or spasticity, affecting one side of his body. The child also has speech deficits. Which of the following type of cerebral palsy would the nurse suspect? Select one: A. Mixed B. Spastic C. Ataxic D. Dyskinetic

Spastic EXPLANATION These symptoms match the category known as spastic cerebral palsy. Dyskinetic CP is characterized by slow, writhing involuntary movements, such as twisting, grimacing, and sharp jerks. Tremors cause clients with ataxic CP to have difficulty controlling their hands and arms when they reach for an object. The most commonly seen type of mixed CP has spasticity and dyskinetic movements.

@ The nurse is caring for a newborn of Jewish descent who has an inborn error of metabolism in which the child becomes hypotonic and loses vision. What genetic disorder is this newborn manifesting? Select one: A. Hemophilia B. Tay-Sachs disease C. Fragile X syndrome D. Duchenne muscular dystrophy

Tay-Sachs disease EXPLANATION Tay-Sachs disease is an inborn error of metabolism, primarily affecting children of Ashkenazi Jewish descent. Symptoms begin at about 1 year of age. The child becomes hypotonic and loses vision. Death usually occurs before 4 years of age. Fragile X syndrome is a genetic, sex-linked abnormality of the X chromosome that results in cognitive impairment and distinctive physical features. Hemophilia is a blood clotting disorder Duchenne muscular dystrophy is the most common degenerative muscular disorder in children

The nurse is assisting an intellectually impaired child to eat. Which of the following is a recommended guideline for this procedure? Select one: A. Teach or remind the child to chew and, if necessary, manipulate the jaw up and down. B. Place the child in a semisitting position with the head flexed slightly backward. C. Keep the atmosphere quiet and, if possible, feed the child alone. D. Place food in the center of the mouth, not on the side, and do not rush.

Teach or remind the child to chew and, if necessary, manipulate the jaw up and down.

The nurse is caring for children with special needs. Which of the following is a recommended nursing consideration when dealing with the families of these children? Select one: A. Tell parents to assign the child household chores and responsibilities. B. Encourage the family to be very protective of their child. C. Assist the family to set realistic long-term goals. D. In the hospital, first show the family the best way of carrying out a procedure.

Tell parents to assign the child household chores and responsibilities.

A 3-year boy is diagnosed with Duchenne muscular dystrophy following several noticeable developmental delays. The child appears to waddle and a positive Gower's sign is exhibited. What occurs when this sign is documented? Select one: A. The child has a scissor-like gait and crosses one foot in front of the other to walk. B. The child walks on his toes. C. The child uses upper extremity muscles to compensate for weak hip muscles. D. The child falls to one side while hopping.

The child uses upper extremity muscles to compensate for weak hip muscles. EXPLANATION Symptoms of Duchenne muscular dystrophy begin to appear around the age of 3 years. Before this, the child may have noticeable developmental delays. The child's gait appears as a waddle and a positive Gower's sign occurs. A positive Gower's sign is exhibited when the child needs to use the upper extremity muscles to compensate for weak hip muscles. The child also may walk on the toes, fall frequently, and have difficulty hopping or running, but these are not the Gower's sign. With cerebral palsy, the child has a scissor-like gait.

An 8-year-old client with abnormal posture is diagnosed with functional scoliosis. Which of the following nursing measures is helpful for the nurse to employ when caring for the client and informing his family members? Select one: A. Restrict the client from activities that require exercise. B. Encourage the family to assist the client with activities of daily living. C. The client is provided with counseling to improve posture. D. Encourage the client to stand or sit up straight.

The client is provided with counseling to improve posture. EXPLANATION Functional scoliosis occurs because of poor posture and, hence, the client may benefit from counseling in such cases. Frequently encouraging the client to stand or sit up straight usually does not help the client with scoliosis. Clients with scoliosis are usually encouraged to perform routine activities for themselves as much as possible. The client's family members are asked to encourage and promote as much independence as possible by allowing the client to function on his own and providing assistance only if the need arises for it or if requested by the client.

1) An adolescent arrives in the clinic reporting a rash and feeling "flu-like" after finding a tick embedded in the leg 2 weeks ago on a camping trip. What does the nurse anticipate discussing with the teen? a. The laboratory results that will give a definitive diagnosis b. The use of physical therapy to prevent contractures from arthritis c. The use of an antibiotic for 2 to 4 weeks d. Hand washing to prevent disease transmission

The use of an antibiotic for 2 to 4 weeks EXPLANATION Treatment consists of 2 to 4 weeks of antibiotics (doxycycline, amoxicillin, erythromycin). Early treatment usually prevents the development of more serious illnesses and long-lasting systemic illness. Laboratory results do not give a definitive diagnosis so treatment with antibiotics is used. Arthritic symptoms may occur if the child is not treated as well as other complications of the disease. Handwashing will not prevent disease transmission.

An 8-year-old client is brought into the healthcare facility with facial twitching and multiple involuntary movements. The healthcare provider identifies these features to be typical tics seen in children with Tourette syndrome (TS). What are the nursing considerations to be kept in mind when recommending a teaching plan to the client and caregivers? Select one: A. Psychiatric counseling helps in reducing tic episodes. B. Tic symptoms have no definite course of treatment. C. Tic locations remain constant throughout the course of the syndrome. D. Tic symptoms increase as children near adulthood.

Tic symptoms have no definite course of treatment. EXPLANATION The nurse should keep in mind that there is no definite course of treatment for Tourette syndrome and that the treatment is only symptomatic. Psychiatric counseling does not decrease tics, but helps the child and the caregivers cope with TS. Many of the tic symptoms decrease as children reach adulthood. Tic locations keep changing periodically throughout the course of TS.

The nurse is teaching an adolescent about medications to treat his acne. Which of the following is a nursing consideration for the use of topical and systemic agents? Select one: A. Retinoic acid, a topical agent, is available in many over-the-counter topical agents. B. Topical agents may cause bleaching of hair or clothing. C. Tetracycline should be taken 2 hours before, or 1 hour after, any food consumption. D. Topical agents, when combined with other agents, may cause excessive oiliness of skin.

Topical agents may cause bleaching of hair or clothing.

The nurse is teaching parents about the effects of marijuana on a child's body systems. Which of the following is one of these effects? Select one: A. Visual disturbances B. Uncoordinated motor skills C. Weight loss D. Arrhythmias

Uncoordinated motor skills EXPLANATION The child who is using marijuana will experience uncoordinated motor skills along with many other signs and symptoms. Weight loss, arrhythmias, and visual disturbances may occur with cocaine use.

@ The school nurse is counseling children with specific learning disabilities. Which of the following is a nursing consideration when caring for these children? Select one: A. Do not adjust healthcare teaching for the child. B. Set higher goals than they are considered to achieve. C. Create a stimulating environment for the child. D. Use positive reinforcement and patience when teaching the child.

Use positive reinforcement and patience when teaching the child. RATIONALE If the child with an SLD has a problem listening and understanding, the nurse should use positive reinforcement and significant amounts of patience. When caring for a child with an SLD, the nurse should learn about the specific disability and set achievable goals. The nurse should also create a soothing, nonstimulating environment to aid the child to meet expectations. The nurse needs to adjust healthcare teaching for the child.

The camp nurse is teaching campers how to prevent Lyme disease. Which of the following is recommended advice? Select one: A. Wear sandals instead of sneakers. B. Wear dark-colored clothing. C. Use tweezers to remove a tick. D. Do not use spray repellants on children.

Use tweezers to remove a tick.

@The nurse is examining a 7-year-old girl who presents at the clinic with classic symptoms of diabetes mellitus type 1. Which of the following describes one of these symptoms? Select one: A. Decrease in urinary output B. Loss of appetite C. Decrease in desire for fluids D. Weight loss

Weight loss EXPLANATION Children with diabetes mellitus type 1 often have an abrupt onset of the classic symptoms of polyuria (dramatic increase in urinary output, probably with enuresis), polydipsia (abnormal thirst), and polyphagia (increased hunger). These symptoms are usually accompanied by weight loss or failure to gain weight and a lack of energy.

A newborn infant is diagnosed with Down syndrome. Where would the nurse find BRUSHFIELD spots in the infant? a. Irises b. Hands c. Tongue d. Cheeks

a Irses RATIONALE Brushfield spots are characteristic white dots seen on the irises in children affected with Down syndrome. Brushfield spots are seen only on irises and not on hands, tongue, or cheeks.

1) A client is diagnosed with hemochromatosis. What should the nurse be sure to include when reinforcing education? Select all that apply. a. Avoid vitamin C supplements. b. Avoid iron supplements. c. Avoid vegetables. d. Avoid eating raw shellfish. E Avoid alcohol intake

a. Avoid vitamin C supplements. b. Avoid iron supplements. d. Avoid eating raw shellfish. E Avoid alcohol intake RATIONALES HemoChromatosis # toxic absorbed irons. Nursing implications for the treatment of hemochromatosis include teaching the client methods that will help prevent complications. Avoid iron supplements, multivitamins containing iron, and vitamin C. Vitamin C, especially if taken with food such as orange juice, will increase the absorption of iron. Avoid eating raw shellfish because individuals with hereditary hemochromatosis are more susceptible to infections caused by bacteria in raw shellfish. Avoid alcohol, which has the risk of increasing liver damage. Drink tannin-rich teas that may slow the storage of iron. Avoiding vegetables will not affect a client with hemochromatosis.

1) An adolescent client is diagnosed with irritable bowel syndrome and the nurse is providing nutritional information to assist the client with control of symptoms. What food triggers should the nurse suggest the client avoid? Select all that apply. a. Fatty foods b. Dairy products c. Chicken and fish d. Alcohol e. Bread and pasta

a. Fatty foods b. Dairy products d. Alcohol RATIONALE Treatment is palliative. Initially, a food diary (record of what is eaten) is helpful. If a specific food, condition, or stressful situation is identified as a possible trigger, actions need to be taken to avoid the issue. Educate the client and other caregivers to avoid common triggers such as caffeine, fatty foods, dairy products, and alcohol. Chicken, fish, and breads, and pastas are generally well-tolerated and not usually seen as a trigger.

1) A child with attention deficit hyperactivity disorder is taking methylphenidate (Ritalin). What instructions should the nurse give the parents? a. Measure height, weight, and plot on growth chart. b. Give several directions at one time so the child can learn to prioritize. c. Alter routines to prevent boredom. d. Point out negative behaviors.

a. Measure height, weight, and plot on growth chart. RATIONALE The height and weight of the child on stimulants (Ritalin) should be measured at frequent intervals and plotted on a growth chart. Failure to gain in either area should be reported. Teach family caregivers to minimize environmental stimuli, use consistent discipline, set limits, and focus on positive behaviors. Encourage caregivers to give directions one step at a time, e.g. brush your teeth or wash your face and hands. Avoid generalizations such as "get ready for school." They should give the child just one direction at a time so that the child is not overloaded with details to remember and organize. Praise such as "good job" is more effective than criticism.

1) A parent brings a school-age child to the clinic with a sore throat due to a streptococcus infection. What should the nurse be sure to inform the parent to do if drooling or difficulty breathing occurs? a. Seek immediate medical attention. b. Gargle with warm saline solution. c. Use ibuprofen to decrease the swelling. d. Increase the dose of the antibiotic.

a. Seek immediate medical attention. EXPLANATION Often, a sore throat is an early indicator of more serious problems. When a sore throat occurs, monitor the individual for fever, dry mouth, drooling, difficulty breathing, poor skin turgor, lethargy, decreased intake and output, headache, and few or no tears when crying. A healthcare provider needs to be contacted if breathing or swallowing difficulty develops, pus forms on the back of the throat, a body rash develops, or blood-tinged secretions occur. Excessive drooling may indicate a swollen esophagus or blocked trachea caused by inflammation.

A neonate born to a client who used narcotic analgesics during the last trimester of her pregnancy is diagnosed with Neonatal Abstinence Syndrome. Which feature would the nurse observe in the baby? a. Blue-black line on the gum b. Hyperactive Moro reflex c. Positive Gowers signs d. White spots on the iris

b Hypere MORO reflex RATIONALE The nurse should look for hyperactive Moro reflex in clients with neonatal abstinence syndrome. A blue-black line on the gums near the teeth is seen in clients with lead poisoning. Positive Gowers sign occurs as a characteristic feature in clients with Duchenne muscular dystrophy. White spots on the irises are a distinctive feature in children with Down syndrome.

1) An adolescent is treated for bacterial conjunctivitis. What instruction should the nurse include when discussing care? a. Save the eye drops not used in case the infection comes back. b. Avoid touching or rubbing the area around the affected eye. c. Contact lenses may continue to be worn during treatment. d. Use a little bit of saliva on the contact lenses to clean them.

b. Avoid touching or rubbing the area around the affected eye. RATIONALE Nursing considerations for conjunctivitis include teaching awareness of and avoiding touching or rubbing the area around the eyes. If contacts are worn, discharge instructions typically include guidelines to remove and discard any contact lenses, storage solutions, or storage containers. Regular glasses need to be worn during the entire time of the infection. There is a high probability of recurrent conjunctivitis due to cross-contamination if lenses or storage supplies are not replaced. Never use mouth saliva on a lens. Conjunctivitis in contact lens wearers can be an early symptom of more severe and permanent eye damage.

An 11yo child with Down syndrome hospitalized to undergo minor dental surgery. Which nursing measure should the nurse perform when caring for the client? a. Assist with All activities of daily life b. Avoid using the child's personal items. c. Note any verbal or nonverbal expression d. Give a detailed explanation of the surgery

c. Note any verbal or nonverbal expression RATIONALE The nurse should note any verbal or nonverbal expressions, because nursing care is based on the client's unique responses to the stress of illness. Assistance should be offered as needed, and not with all activities of daily living, in order to minimize the feelings of frustration. Use of personal items should be recommended to reduce the level of stress and promote the child's comfort. Explanation of the surgical procedure should be simple, in a manner the child can easily understand.