Child Theory Exam 2

What is the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

A The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools are a later manifestation of CF. Recurrent respiratory infections are a later sign of CF.

The father of an infant calls the nurse to his son's room because he is "making a strange noise." A diagnosis of laryngomalacia is made. What does the nurse expect to find on assessment? a. Stridor b. High-pitched cry c. Nasal congestion d. Spasmodic cough

A A Stridor is usually present at birth but may begin as late as 2 months. Symptoms increase when the infant is supine or crying.B High-pitched cries are consistent with neurologic abnormalities and are not usually respiratory in nature.C Nasal congestion is nonspecific in relation to laryngomalacia.D Spasmodic cough is associated with croup; it is not a common symptom of laryngomalacia.

What should the nurse recommend to prevent urinary tract infections in young girls? a. Wearing cotton underpants b. Limiting bathing as much as possible c. Increasing fluids; decreasing salt intake d. Cleansing the perineum with water after voiding

A Cotton underpants are preferable to nylon underpants. No evidence exists that limiting bathing, increasing fluids, decreasing salt intake, or cleansing the perineum with water decreases urinary tract infections in young girls.

The emergency department nurse notices that the mother of a young child is making a lot of phone calls and getting advice from her friends about what she should do. This behavior is an indication of a. stress. b. healthy coping skills. c. attention-getting behaviors. d. low self-esteem.

A Hyperactive behavior such as making a lot of phone calls and enlisting everyone's opinions is a sign of stress. The behavior described is not a healthy coping skill. This may be an attention-getting behavior but is more likely an indicator of stress. This mother may have low self-esteem, but the immediate provocation is stress.

The nurse is caring for a child with probable intussusception. The child had diarrhea before admission, but while waiting for administration of air pressure to reduce the intussusception, the child passes a normal brown stool. What is the most appropriate nursing action? A. Notify the physician B. Measure the abdominal girth C. Auscultate for bowel sounds D. Check vital signs, including blood pressure

A Passage of a normal stool indicates that the intussusception has resolved. Notification of the physician is essential to determine whether a change in treatment plan is indicated.

Before giving a dose of digoxin the nurse checked an infant's apical heart rate and it was 114 beats/minute. What should the nurse do next? a. Administer the dose as ordered. b. Hold the medication until the next dose. c. Wait and recheck the apical heart rate in 30 minutes. d. Notify the physician about the infant's heart rate.

A The infant's heart rate is above the lower limit for which the medication is held (100 beats/minute in an infant). The dose can be given. No other action is needed.

The primary clinical manifestations of acute kidney injury are which of the following? a. Oliguria and hypertension b. Hematuria and pallor c. Proteinuria and muscle cramps d. Bacteriuria and facial edema

A The principal feature of acute kidney injury is oliguria, and many children are hypertensive. Hematuria, pallor, proteinuria, cramps, bacteriuria, and edema are not principal features.

The nurse should teach parents of a child with cystic fibrosis to adjust enzyme dosage according to which indicator? a. Stool formation b. Vomiting c. Weight d. Urine output

A When there is constipation, less enzyme is needed; with steatorrhea, more enzyme is needed for digestion of nutrients. Vomiting, weight, and urine output do not affect dosing.

Which classification of drugs is used to relieve an acute asthma episode? a. Short-acting beta2-adrenergic agonist b. Inhaled corticosteroids c. Leukotriene blockers d. Long-acting bronchodilators

ANS: A A short-acting beta2-adrenergic agonist is the first medication administered. Later, systemic corticosteroids decrease airway inflammation in an acute asthma attack. They are given for short courses of 5 to 7 days. Inhaled corticosteroids are used for long-term, routine control of asthma. Leukotriene blockers diminish the mediator action of leukotrienes and are used for long-term, routine control of asthma in children older than 12 years. A long-acting bronchodilator would not relieve acute symptoms.

Bismuth subsalicylate, clarithromycin, and metronidazole are prescribed for a child with a peptic ulcer to a. Eradicate Helicobacter pylori. b. Coat gastric mucosa. c. Treat epigastric pain. d. Reduce gastric acid production.

ANS: A A This combination of drug therapy is effective in the treatment of H. pylori.B This drug combination is prescribed to eradicate the H. pylori.C This drug combination is prescribed to eradicate the H. pylori.D This drug combination is prescribed to eradicate the H. pylori.

Therapeutic management of the child with acute diarrhea and dehydration usually begins with a. Clear liquids b. Adsorbents, such as kaolin and pectin c. Oral rehydration solution (ORS) d. Antidiarrheal medications such as paregoric

ANS: C A Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea.B Adsorbents are not recommended.C Orally administered rehydration solution is the first treatment for acute diarrhea.D Antidiarrheals are not recommended because they do not get rid of pathogens.

A major complication in a child with chronic renal failure is a. hypokalemia. b. metabolic alkalosis. c. water and sodium retention. d. excessive excretion of blood urea nitrogen.

ANS: C Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia is a complication of chronic renal failure. Metabolic acidosis is a complication of chronic renal failure. Retention of blood urea nitrogen is a complication of chronic renal failure.

What may cause hypovolemic shock in children? (Select all that apply.) a. Hyperthermia b. Burns c. Vomiting or diarrhea d. Hemorrhage e. Skin abscesses

A, B, C, D Hypovolemic shock is due to decreased circulating volume and can be caused by fluid loss due to hyperthermia, burns, vomiting or diarrhea, and hemorrhage. An abscess will not cause hypovolemia.

The mother of an HIV-positive infant who is 2 months old questions the nurse about which childhood immunizations her child will be able to receive. Which immunizations should an HIV-positive child be able to receive according to the American Academy of Pediatrics recommendation for immunizing infants who are HIV positive? Select all that apply. a. Hepatitis B b. DTaP c. MMR d. IPV e. HIB

A, B, D, E Routine immunizations are appropriate.Incorrect The MMR vaccination is not given at 2 months of age. If it were indicated, CD4+ counts are monitored when deciding whether to provide live virus vaccines. If the child is severely immunocompromised, the MMR vaccine is not given. The varicella vaccine can be considered on the basis of the child's CD4+counts. Only IPV should be used for HIV-infected children.

A child who weighs 37 pounds needs a dose of lidocaine prior to cardioversion for ventricular tachycardia. What dose does the nurse prepare to administer? Write your answer using a whole number. _____ mg Lidocaine: 1mg/1kg

ANS: 17 First determine the child's weight in kg: 37/2.2 = 16.6666. Lidocaine is dosed at 1 mg/kg 16.6666 × 1 = 16.6666. Round up to the nearest whole number = 17 mg.

A child with inflammatory bowel disease (IBD) is experiencing an acute flare-up. Which type of diet will the nurse recommend to help the child maintain adequate nutrition during this episode? a. An elemental diet b. A high-fiber, high-residue diet c. A diet high in folate and vitamin C d. Total parenteral nutrition (TPN) and lipids

ANS: A

A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of a. Bronchitis b. Bronchiolitis c. Viral-induced asthma d. Acute spasmodic laryngitis

ANS: A A Bronchitis is characterized by these symptoms and occurs in children older than 6 years.B Bronchiolitis is rare in children older than 2 years.C Asthma is a chronic inflammation of the airways that may be exacerbated by a virus.D Acute spasmodic laryngitis occurs in children between 3 months and 3 years.

The earliest clinical manifestation of biliary atresia is a. Jaundice b. Vomiting c. Hepatomegaly d. Absence of stooling

ANS: A A Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera, may be present at birth, but is usually not apparent until age 2 to 3 weeks.B Vomiting is not associated with biliary atresia.C Hepatomegaly and abdominal distention are common but occur later.D Stools are large and lighter in color than expected because of the lack of bile.

What is an expected outcome for the child with irritable bowel disease? a. Decreasing symptoms b. Adherence to a low-fiber diet c. Increasing milk products in the diet d. Adapting the lifestyle to the lifelong problems

ANS: A A Management of irritable bowel disease is aimed at identifying and decreasing exposure to triggers and decreasing bowel spasms, which will decrease symptoms. Management includes maintenance of a healthy, well-balanced, moderate-fiber, lower fat diet.B A moderate amount of fiber in the diet is indicated for the child with irritable bowel disease.C No modification in dairy products is necessary unless the child is lactose intolerant.D Irritable bowel syndrome is typically self-limiting and resolves by age 20 years.

The nurse notes on assessment that a 1-year-old child is underweight, with abdominal distention, thin legs and arms, and foul-smelling stools. The nurse suspects failure to thrive is associated with a. Celiac disease b. Intussusception c. Irritable bowel syndrome d. Imperforate anus

ANS: A A These are classic symptoms of celiac disease.B Intussusception is not associated with failure to thrive or underweight, thin legs and arms, and foul-smelling stools. Stools are like "currant jelly."C Irritable bowel syndrome is characterized by diarrhea and pain, and the child does not typically have thin legs and arms.D Imperforate anus is the incomplete development or absence of the anus in its normal position in the perineum. Symptoms are evident in early infancy.

Which is the most appropriate action for stopping an occasional episode of epistaxis (nose bleeding)? A. Have the child sit up and lean forward B. Apply ice under the nose and above lip C. Have the child lie down quietly with feet elevated D. Apply continuous pressure to the nose with the thumb and forefinger for at least 1 minute

ANS: A A. The position used to prevent the child from aspirating the blood is to have the child sit up and lean forward.B. Pressure is indicated and ice is not.C. This position could potentially lead to aspiration.D. Continuous pressure for 10 minutes is recommended.

During a presentation on behavioral disorders in children, the nurse is currently explaining the most commonly seen disorder. Which topic would the nurse be covering? A. Attention deficit-hyperactivity disorder B. Depression C. Eating disorders D. Sexual abuse

ANS: A ADHD is the most common chronic behavioral disorder that emerges during childhood. Depression can occur, but it is not the most common chronic behavioral disorder that emerges during childhood. Eating disorders are not the most common chronic behavioral disorder that emerges during childhood. Sexual abuse is not a chronic behavioral disorder that emerges during childhood.

A limp, unresponsive 2-month-old is brought to the emergency room by her parents after she began "jerking." During the initial assessment the nurse notes no external head trauma, flat fontanels, and no marks on the baby's head. Which further assessments would the nurse expect to provide the most essential information? A. Ophthalmic B. Developmental C. Cardiac D. Respiratory

ANS: A Abusive head trauma, formerly known as shaken baby syndrome/shaken infant syndrome, should be considered in any infant with signs of increased intracranial pressure, with retinal hemorrhage, seizures, subtle hydrocephalus, and papilledema. Shaken baby syndrome is a widely recognized form of physical child abuse that often is caused by vigorous shaking of the infant while the child is held by the extremities or shoulders. This type of physical abuse leads to whiplash-induced intracranial and retinal bleeding. There is generally no external sign of head trauma, which makes this syndrome difficult to detect. A developmental assessment cannot be done if the infant is limp and unresponsive. There is no data from the history or initial assessment that there is a cardiac or respiratory issue.

A beneficial effect of administering digoxin is that it a. decreases edema. b. decreases cardiac output. c. increases heart size. d. increases venous pressure.

ANS: A Digoxin improves cardiac output, which will lead to decreased edema although it is not a diuretic. It does not increase heart size or increase venous pressure.

Which statement is true regarding how infants acquire immunity? a. The infant acquires humoral and cell-mediated immunity in response to infections and immunizations. b. The infant acquires maternal antibodies that ensure immunity up to 12 months age. c. Active immunity is acquired from the mother and lasts 6 to 7 months. d. Passive immunity develops in response to immunizations.

ANS: A Infants acquire long-term active immunity from exposure to antigens and vaccines. Immunity is acquired actively and passively. The term infant's passive immunity is acquired from the mother and begins to dissipate during the first 6 to 8 months of life. Passive immunity is acquired from the mother. Active immunity develops in response to immunizations.

During a visit to a pediatrician's office, the mother of a toddler states that he has begun bumping into walls and doesn't have as much energy as he used to. Which question is most important for the nurse to ask initially? A. "Have you noticed your son chewing on anything unusual?" B. "How many hours at night does your son sleep?" C. "How often does your child bump into the walls?" D. "Does anyone else in the house have a neurologic problem?"

ANS: A Ingesting unusual objects could provide a source of lead to the child. The lead can cause abnormal neurologic behaviors such as clumsiness and can cause anemia, which can be the reason for his decreased energy. The number of hours he sleeps has nothing to do with the cause but could be related to the anemia, which can cause fatigue. The frequency with which he bumps into the walls is good to know, but the nurse needs to focus on factors affecting ingestion of a toxic/poisonous substance. The nurse needs to focus on the toddler initially, but can ask this later.

A nurse is teaching a class on acute kidney injury. The nurse relates that acute kidney injury as a result of hemolytic-uremic syndrome (HUS) is classified as a. Intrinsic renal. b. Prerenal. c. Postrenal. d. Chronic.

ANS: A Intrinsic renal acute renal failure is the result of damage to kidney tissue. Possible causes include HUS, glomerulonephritis, and pyelonephritis. Prerenal acute renal failure is the result of decreased perfusion to the kidney. Possible causes include dehydration, septic and hemorrhagic shock, and hypotension. Postrenal acute renal failure results from obstruction of urine outflow. Conditions causing postrenal failure include ureteropelvic obstruction, ureterovesical obstruction, or neurogenic bladder. Renal failure caused by HUS is of the acute nature. Chronic renal failure is an irreversible loss of kidney function, which occurs over months or years.

A teenager suddenly develops a sudden onset of obsessive-compulsive disorder symptoms and is brought to the pediatrician by his father. What assessment would the nurse expect to be done to determine the actual problem? A. A throat culture B. A urinalysis C. An electrocardiogram D. A brain scan

ANS: A Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) refer to the abrupt onset of OCD symptoms or tic disorder symptoms following a group A beta-hemolytic streptococcal infection. Research suggests that the disease is not caused by the bacteria but rather by the antibodies that attack neural tissue in the basal ganglia of the brain. The urinary tract is not involved. The heart is not involved unless antibiotics are not given and rheumatic fever can occur. A brain scan cannot detect the problem.

A child with pulmonary atresia exhibits cyanosis with feeding. On reviewing this child's laboratory values, the nurse is not surprised to notice which abnormality? a. Polycythemia b. Infection c. Dehydration d. Anemia

ANS: A Polycythemia is a compensatory response to chronic hypoxia. The body attempts to improve tissue oxygenation by producing additional red blood cells and thereby increases the oxygen-carrying capacity of the blood. Infection, dehydration, and anemia are not clinical consequences of cyanosis.

A nurse is assessing lab results on four patients in the general pediatric unit. What child should the nurse go see first? a. Urine specific gravity: 1.025 b. Urine ketones: positive in large amounts c. Serum BUN 21 mg/dL d. Serum creatinine 0.7 mg/dL

ANS: B Ketones should not be present in the urine. When found, they are indicative of starvation, diabetic ketoacidosis, fever, prolonged vomiting, anorexia, and severe diarrhea. The nurse should see this child first. The other lab values are normal.

Which statement about suicide is correct? a. Children younger than 10 years of age do not attempt suicide. b. Suicide risk decreases with age. c. Suicide is usually an isolated event in a school community. d. The prevalence of suicide attempts is higher among males.

ANS: A Suicide by children under the age of 10 is uncommon although it is the third leading cause of death in children ages 5 to 10. The risk of suicide increases with age. It is common for suicide to occur in a cluster within a community (e.g., schools). Males have a 4% rate of suicide attempts compared to 8% in females; however, males are more likely to die after a suicide attempt.

The nurse is reviewing urine test results. About which value should the nurse alert the physician? A. pH: 4.0 B. Specific gravity: 1.020 C. Protein level: absent D. Glucose level: absent

ANS: A The expected pH is 4.8 to 7.8. A specific gravity of 1.020 is within the normal specific gravity range of 1.010 to 1.030. Protein should not be present in the urine. It would indicate an abnormality in glomerular filtration. Glucose should not be present. If present, it could indicate diabetes mellitus, glomerulonephritis, or a response to infusion of fluids with high glucose concentrations.

In which situation is there a risk that a newborn infant will have a congenital heart defect (CHD)? a. Trisomy 21 detected on amniocentesis b. Family history of myocardial infarction c. Father has type 1 diabetes mellitus d. Older sibling born with Turner syndrome

ANS: A The incidence of congenital heart disease is approximately 50% in children with trisomy 21 (Down syndrome). A family history of congenital heart disease, not acquired heart disease, increases the risk of giving birth to a child with CHD. Infants born to mothers who are insulin dependent have an increased risk of CHD. Infants identified as having certain genetic defects, such as Turner syndrome, have a higher incidence of CHD. A family history is not a risk factor.

The nurse observes a rash on a teen's face which is characteristic of systemic lupus erythematosus (SLE). What action by the nurse is most appropriate? a. Teach the teen about using sunscreen. b. Prepare the teen for a bone marrow biopsy. c. Educate the teen on proper use of antibiotics. d. Demonstrate how to use an Epi-pen.

ANS: A The nurse needs to provide education on managing the disease; one facet includes minimizing sun exposure so the nurse teaches the teen about the correct use of sunscreen. The teen will not have a bone marrow biopsy, need antibiotics, or have to use an Epi-pen.

The mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about "casts" in the urine. The nurse explains that casts in the urine indicate a. glomerular injury. b. glomerular healing. c. recent streptococcal infection. d. excessive amounts of protein in the urine.

ANS: A The presence of red blood cell casts in the urine indicates glomerular injury. Casts in the urine are abnormal findings and are indicative of glomerular injury, not glomerular healing. A urinalysis positive for casts does not confirm a recent streptococcal infection. Casts in the urine are unrelated to proteinuria.

What information should the nurse teach families about reducing exposure to pollens and dust? (Select all that apply.) a. Replace wall-to-wall carpeting with wood and tile floors. b. Use an air conditioner. c. Put dust-proof covers on pillows and mattresses. d. Keep humidity in the house above 60%. e. Keep pets outside.

ANS: A, B, C Carpets retain dust. To reduce exposure to dust, carpeting should be replaced with wood, tile, slate, or vinyl. These floors can be cleaned easily. For anyone with pollen allergies, it is best to keep the windows closed and to run the air conditioner. Covering mattresses and pillows with dust-proof covers will reduce exposure to dust. A humidity level above 60% promotes dust mites. It is recommended that household humidity be kept between 40% and 50% to reduce dust mites inside the house. Keeping pets outside will help to decrease exposure to dander but will not affect exposure to pollen and dust.

Which nursing interventions are significant for a child with cirrhosis who is at risk for bleeding? Select all that apply. a. Guaiac all stools b. Provide a safe environment c. Administer multivitamins with vitamins A, D, E, and K d. Inspect skin for pallor and cyanosis e. Monitor serum liver panels

ANS: A, B, C Correct: Identification of bleeding includes stool guaiac testing, which can detect if blood is present in the stool; protecting the child from injury by providing a safe environment; administering vitamin K to prevent bleeding episodes; and avoiding injections.Incorrect: A skin assessment would likely reveal jaundice. Pallor and cyanosis are associated with a cardiac problem. These may be late signs of a significant bleeding episode, but not significant in the prevention stage of the nursing process. Monitoring serum liver panels is important but would not provide information on coagulation status or risk factors associated with bleeding.

The nurse is assessing a child for epiglottitis. What findings are consistent with this condition? (Select all that apply.) a. Drooling b. Dysphagia c. Dysphonia d. Distressed inspiratory efforts e. Decreased oxygenation

ANS: A, B, C, D The cardinal signs of epiglottitis are drooling, dysphagia, dysphonia, and distressed inspiratory efforts. While the child may develop decreased oxygenation if the airway is severely compromised, this is not a cardinal sign.

The nurse is caring for a child diagnosed with Crohn's disease. Which assessment findings would be concerning?Select all that apply. a. Nocturnal diarrhea b. Loss of 5 pounds in 1 week c. Gain of 2 pounds in 3 days d. Decreased albumin and hemoglobin levels e. Rapid recoil when skin of the sternum is pinched

ANS: A, B, D

A nurse is planning care for an asymptomatic child with a positive tuberculin test. What should the nurse include in the plan? (Select all that apply.) a. Administration of daily isoniazid (INH) b. Instructing family members about administration of INH to all close contacts of the child c. Administration of the bacillus Calmette-Guérin vaccine d. Reporting the case to the health department e. Administration of INH and rifampin (Rifadin) simultaneously

ANS: A, B, D After a chest radiograph is obtained, asymptomatic children with positive tuberculin tests and no previous history of TB receive daily INH for 9 months. Asymptomatic contacts should receive INH for at least 8 to 10 weeks after contact has been broken or until a negative skin test can be confirmed (a second test is taken at least 10 weeks after the last exposure). Reporting cases of TB is required by law in all states in the United States. Bacillus Calmette-Guérin vaccine is the only anti-TB vaccine available, but it is given only to children who have negative test results. For asymptomatic TB, only INH is administered, not both isoniazid and rifampin together. Rifampin is used if the child has resistance to isoniazid.

The nurse is providing discharge teaching to the parents of a child with pyloric stenosis. Which statements, made by the parents, indicate that teaching was effective?Select all that apply. a. "After surgery, I will be allowed to change my child's diapers." b. "This condition will affect the way my child absorbs my breast milk." c. "I can't talk with my friends about my child's condition because they don't understand." d. "We will have to get a second job to afford the medication that will cure him." e. "I have the number for the support group the social worker gave me this morning, and I will call today."

ANS: A, B, E

The mother of a newborn asks the nurse what causes the baby to begin to breathe after delivery. What changes in the respiratory system stimulating respirations postnatally can the nurse explain to the mother? (Select all that apply.) a. Low oxygen levels in the infant's blood b. Rubbing the newborn with a towel or blanket c. Surfactant, a special lubricant in the lungs d. Increased blood flow to the infant's lungs e. Cold environment in the delivery room

ANS: A, B, E Hypoxemia, cold, and tactile stimulation all encourage the infant to breathe. Surfactant in the lungs lowers surface tension and facilitates lung expansion. It does not stimulate respirations. Pulmonary blood flow increases after birth, but this does not stimulate respirations in the newborn.

A child with right lower quadrant pain and anorexia has begun vomiting. Which assessments are necessary to evaluate the outcome of nursing care for this patient? Select all that apply. a. Palpate the skin b. Auscultate the chest c. Measure urine output d. Obtain a food diary e. Measure arterial blood gases (ABGs)

ANS: A, C

The nurse is caring for a child with esophageal atresia who has been diagnosed with failure to thrive. Which assessment findings indicate the expected outcomes have been met for this patient?Select all that apply. a. Weight gain b. Normal sleep patterns c. Increased head circumference d. Normal urine specific gravity e. Normal cognitive milestones met

ANS: A, C, D

Which home care instructions should the nurse provide to the parents of a child with acquired immunodeficiency syndrome (AIDS)? Select all that apply. a. Give supplemental vitamins as prescribed. b. Yearly influenza vaccination should be avoided. c. Administer trimethoprim-sulfamethoxazole (Bactrim) as prescribed. d. Notify the physician if the child develops a cough or congestion. e. Missed doses of antiretroviral medication do not need to be recorded.

ANS: A, C, D The parents should be taught that supplemental vitamins will be prescribed to aid in nutritional status. Bactrim is administered to prevent the opportunistic infection of Pneumocystis pneumonia. The physician should be notified if the child with AIDS develops a cough and congestion.Incorrect The yearly influenza vaccination is recommended and any missed doses of antiretroviral medication need to be recorded and reported.

The nurse is caring for a school-aged child after a submersion injury causing the loss of circulatory and respiratory function for 4 minutes. What assessments or goals would be indicated while caring for this child on life support? (SELECT ALL THAT APPLY.) A. Listen to breath sounds frequently. B. Monitor the child for hyperthermia during the first 12 hours after rescue. C. Watch for capillary refill to take no more than 2 seconds. D. Check for tachycardia. E. Maintain the body temperature between 36.5 and 37.4° C (97.7 and 99.3° F). F. Position the head midline with the head of the bed at 45 degrees.

ANS: A, C, D, E Breath sounds will be checked frequently to detect adventitious lung sounds as well as monitoring the need for suctioning or readjustment of the endotracheal tube. A capillary refill taking no more than 2-3 seconds is a desired goal. Checking for tachycardia is indicated. Maintaining the body temperature between 36.5 and 37.4° C (97.7 and 99.3° F) is desired The child will be monitored for hypothermia during the early period after resuscitation. Positioning the head midline is done, but the head of the bed should be at 20-30 degrees.

The nurse should implement which interventions for an infant experiencing apnea? (Select all that apply.) a. Stimulate the infant by gently tapping the foot. b. Shake the infant vigorously. c. Have resuscitative equipment available. d. Suction the infant. e. Maintain a neutral thermal environment.

ANS: A, C, E An infant with apnea should be stimulated by gently tapping the foot. Resuscitative equipment should be available, and the infant should be maintained in a neutral thermal environment. The infant should not be shaken vigorously nor suctioned.

A nurse working on the pediatric unit should be aware that children admitted with which of the following assessment findings are suggestive of physical child abuse? (Select all that apply.) a. Bruises in various stages of healing b. Bruises over the shins or bony prominences c. Burns on the palms of the hands d. A fracture of the right wrist from a sports accident e. Rib fractures in an infant

ANS: A, C, E Bruises in various stages of healing and burns on the palms of the hand may be indicative of physical abuse. Rib fractures in an infant are another indicator of physical abuse. Bruises over the shins or bony prominences are seen in children beginning to walk. A fracture of the right wrist can occur as the child begins to participate in sports activities.

A nurse is assessing an infant for urinary tract infection (UTI). Which assessment findings should the nurse expect? (Select all that apply.) a. Change in urine odor or color b. Enuresis c. Fever or hypothermia d. Voiding urgency e. Poor weight gain

ANS: A, C, E The signs of a UTI in an infant include fever or hypothermia, irritability, dysuria as evidenced by crying when voiding, change in urine odor or color, poor weight gain, and feeding difficulties. Enuresis and voiding urgency should be assessed in an older child.

The nurse is caring for an infant immediately after returning from having a pyloromyotomy. What actions would the nurse to perform in the immediate post-operative period? (SELECT ALL THAT APPLY.) A. Maintain the infant's head in an elevated position B. Keep the infant on his left side with the head slight elevated C. Irrigate the nasogastric tube with sterile water D. Provide oral care frequently until the infant begins drinking E. Assure bowel sounds are present before feeding the infant F. Weigh diapers after oral feedings have been started

ANS: A, D, E

A nurse is providing patient teaching to a couple whose infant has just had surgery for cleft lip. What information does the nurse provide regarding feeding to ensure the child receives adequate nutrition? Select all that apply. a. "Feed the infant with a straw." b. "Stop feeding frequently to burp." c. "Feed the infant in an upright position." d. "Use a syringe with a rubber tip for feedings." e. "Withhold feeding for 12 hours after the surgery."

ANS: B, C, D

The nurse educator is explaining characteristics of sexually abused children during a special class for pediatric nurses. Which of the statements should the nurse educator include in the presentation? Select all that apply. A. Children who are sexually abused may deny that the abuse happened, even with direct questioning. B. Children were less likely to delay disclosure if they were younger than 7 years old, if they were boys, or if the abuse occurred within the family. C. Previously toilet-trained children may experience accidents with stool. D. Children of sexual abuse may experience sleep disturbances, decreased appetite or sudden refusal to participate in gym. E. Sexually abused adolescents may be promiscuous.

ANS: A, D, E It is true that children who are sexually abused may deny that the abuse happened, even with direct questioning. Children of sexual abuse may experience sleep disturbances, decreased appetite, or sudden refusal to participate in gym. Sexually abused adolescents may be promiscuous. Children were more likely to delay disclosure if they were younger than 7 years old, were boys, or the abuse occurred within the family. Previously toilet-trained children may experience urinary accidents.

A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child (Select all that apply)? a. Apples b. Bananas c. Cheese d. Carrot sticks e. Strawberries

ANS: A, D, E Moderate sodium restriction and even fluid restriction may be instituted for children with acute glomerulonephritis. Foods with substantial amounts of potassium and sodium are generally restricted during the period of oliguria. Apples, carrot sticks, and strawberries would be items low in sodium and allowed. Bananas are high in potassium and cheese is high in sodium. Those items would be restricted.

A 3-week-old neonate has been admitted to the hospital because of an inability to feed well and not growing as expected. What actions should the nurse implement when caring for this infant with suspected heart failure? Select all that apply. A. Allow extra time to feed the infant. B. Hold the infant securely in a supine position during feeding. C. Allow 45 minutes for each feeding to provide the ordered amount of formula. D. Watch for diaphoresis or tachypnea while feeding the infant. E. Encourage the mother to breastfeed, but allow 30 minutes for the total feeding. F. Watch for signs of hunger and irritability soon after the feeding is finished.

ANS: A, D, E, F Allowing extra time to feed the infant should help the nurse provide the relaxed environment that this infant needs. Knowing that 30 minutes should be allocated for each feeding helps the nurse with time management. If diaphoresis or tachypnea is seen while the infant is feeding, then the infant may need a feeding tube to conserve energy. Encourage the mother to breastfeed, but allow 30 minutes for the total feeding. Signs of hunger and irritability soon after the feeding is finished may indicate that the feeding did not fill up the infant so that comfort and fullness would be felt. Holding the infant securely in an upright position may provide less stomach compression and improve respiratory effort during the feeding. Allow 30 minutes for each feeding to provide the ordered amount of formula

A child with nephrotic syndrome who is steroid-dependent: a. will have an antibiotic added to the steroid b. initially responds well to prednisone, relapses while on tapering schedule c. requires kidney biopsy to determine the exact cause of the disease. d. will eventually require dialysis

ANS: B

Apnea of infancy has been diagnosed in an infant who will soon be discharged with home monitoring. What should be part of the discharge teaching by the nurse for the parents? A) Always keeping the infant in the same room with adults B) Cardiopulmonary resuscitation C) Reassurance that the infant cannot be electrocuted during monitoring D) Advising that the infant not be left with other caretakers, such as babysitters

ANS: B

The nurse is evaluating a patient with cleft lip to determine whether collaborative care was able to achieve the expected outcome. Which action should the nurse take to determine whether a child with cleft lip and palate is achieving adequate nutrition? a. Monitor feeding technique. b. Measure height and weight. c. Measure head circumference. d. Make sure the child is burped after each feeding.

ANS: B

A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. What should the nurse suggest to minimize reflux? a. Place in Trendelenburg position after eating. b. Thicken formula with rice cereal. c. Give continuous nasogastric tube feedings. d. Give larger, less frequent feedings.

ANS: B A Placing the child in a Trendelenburg position increases the reflux.B Small frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula has been recommended. Milk thickening agents have been shown to decrease the number of episodes of vomiting and to increase the caloric density of the formula. This may benefit infants who are underweight as a result of GERD.C Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive.D Smaller, more frequent feedings are recommended in reflux.

Which statement about Crohn disease is the most accurate? a. The signs and symptoms of Crohn disease are usually present at birth. b. Signs and symptoms of Crohn disease include abdominal pain, diarrhea, and often a palpable abdominal mass. c. Edema usually accompanies this disease. d. Symptoms of Crohn disease usually disappear by late adolescence.

ANS: B A Signs and symptoms are not usually present at birth.B Crohn disease can occur anywhere in the GI tract from the mouth to the anus and is most common in the terminal ileum. Signs and symptoms include abdominal pain, diarrhea (nonbloody), fever, palpable abdominal mass, anorexia, severe weight loss, fistulas, obstructions, and perianal and anal lesions.C Diarrhea and malabsorption from Crohn disease cause weight loss, anorexia, dehydration, and growth failure. Edema does not accompany this disease.D Crohn disease is a long-term health problem. Symptoms do not typically disappear by adolescence.

An infant with short bowel syndrome will be discharged home on total parenteral nutrition(TPN) and gastrostomy feedings. Nursing care should include a. Preparing family for impending death b. Teaching family signs of central venous catheter infection c. Teaching family how to calculate caloric needs d. Securing TPN and gastrostomy tubing under the diaper to lessen risk ofdislodgment

ANS: B A The prognosis for patients with short bowel syndrome depends in part on thelength of residual small intestine. It has improved with advances in TPN.B During TPN therapy, care must be taken to minimize the risk of complicationsrelated to the central venous access device, such as catheter infections,occlusions, or accidental removal. This is an important part of family teaching.C Although parents need to be taught about nutritional needs, the caloric needs andprescribed TPN and rate are the responsibility of the health care team.D The tubes should not be placed under the diaper due to risk of infection.

What is the best response by the nurse to a mother asking about the cause of her infant's bilateral cleft lip? a. "Did you use alcohol during your pregnancy?" b. "Do you know of anyone in your family or the baby's father's family who was born with cleft lip or palate problems?" c. "This defect is associated with intrauterine infection during the second trimester." d. "The prevalent of cleft lip is higher in Caucasians"

ANS: B A Tobacco during pregnancy has been associated with bilateral cleft lip.B Cleft lip and palate result from embryonic failure resulting from multiple genetic and environmental factors. A genetic pattern or familial risk seems to exist.C The defect occurred at approximately 6 to 8 weeks of gestation. Second-trimester intrauterine infection is not a known cause of bilateral cleft lip.D The prevalence of cleft lip and palate is higher in Asian and Native American populations.

A father phones the pediatrician's office and says his son just knocked out a permanent tooth. What directions should the office nurse give to the father? A. Rinse the tooth in hot water B. Hold the tooth by crown and not by root area C. Take the child and tooth to a dentist within 48 hours D. Take the child to a hospital emergency department if his mouth is bleeding

ANS: B A. Rinsing with hot water will destroy the root and thus the viability of the tooth. The current direction from the American Dental Association is to place the tooth in a cool glass of milk (not cold) rather than water and take the child and the tooth to the dentist on an emergency basis.B. The root area should not be touched. Not rinsed, not cleaned, not touched.C. Reimplantation should occur within 30 minutes by the child, parent, or nurse, and stabilized by a dentist as soon as possible.D. The child needs to be seen by a competent dentist, not an emergency room physician, as soon as possible, regardless of whether he is still bleeding.

You are the nurse caring for a 4-year-old child who has developed acute renal failure as a result of hemolytic-uremic syndrome (HUS). Which bacterial infection was most likely the cause of HUS? a. Pseudomonas aeruginosa b. Escherichia coli c. Streptococcus pneumoniae d. Staphylococcus aureus

ANS: B Children with HUS become infected by Escherichia coli, which is usually contracted from eating improperly cooked meat or contaminated dairy products. Pseudomonas aeruginosa, Streptococcus pneumoniae, and Staphylococcus aureus are not associated with HUS.

The nurse is preparing to administer digoxin (Lanoxin) orally to a 9-month-old infant. The nurse checks the dose and prepares to draw up 4 mL of the drug. What are the most appropriate nursing actions? A. Mix the dose with several milliliters of juice to disguise the drug's taste. B. After checking the dosage with another nurse, hold the dose. C. Check the heart rate, and then administer the dose by placing it at the side of the mouth. D. Check the heart rate, and then give the dose by letting the infant suck it through a nipple.

ANS: B Digoxin is often prescribed in micrograms. Rarely is more than 1 mL administered to an infant. Because it is a potentially dangerous drug, administration guidelines are very precise. Pediatric medication dosages should be checked with another licensed professional before administration. Checking the heart rate and administering the dose by placing it at the back and side of the mouth are correct procedures, but the dosage is too high. Checking the heart rate and administering the dose by letting the infant suck it through a nipple are correct procedures, but the dosage is too high. The dosage is too high and should not be given. The physician must be immediately notified about the dosage error so the infant can receive the dose needed as close to the administration schedule.

A nurse is caring for a child diagnosed with septic shock. He develops a dysrhythmia and hemodynamic instability. Endotracheal intubation is necessary. The physician feels that cardiac arrest may soon develop. What drug do you anticipate the physician will order? a. Atropine sulfate b. Epinephrine c. Sodium bicarbonate d. Inotropic agents

ANS: B Epinephrine is the drug of choice for the management of cardiac arrest, dysrhythmias, and hemodynamic instability. Atropine sulfate is used to treat symptomatic bradycardia. Sodium bicarbonate is given to treat severe acidosis associated with cardiac arrest. Inotropic agents are indicated for hypotension or poor peripheral circulation in a child

What is an appropriate intervention for a child with nephrotic syndrome who is edematous? a. Teach the child to minimize body movements. b. Change the child's position every 2 hours. c. Avoid the use of skin lotions. d. Bathe every other day.

ANS: B Frequent position changes decrease pressure on body parts and help relieve edema in dependent areas. The child with edema is at risk for impaired skin integrity. It is important for the child to change position frequently to prevent skin breakdown. Good skin hygiene consists of daily baths to remove irritating body secretions and applying lotion.

The nurse is caring for three children with cardiac conditions who are taking digoxin (Lanoxin). Prior to giving the medication, the nurse would check which lab results because of the risk for digoxin toxicity? A. Hemoglobin and hematocrit B. Potassium and magnesium C. Glucose and phosphorus D. BUN and platelets

ANS: B Hypokalemia and hypomagnesemia can increase the risk for digoxin toxicity. In children with altered renal function, the dose needs to be decreased. Glucose and phosphorus levels are not related to digoxin toxicity. An elevated BUN could indicate altered renal function and affect the digoxin level but not the platelet level. Hemoglobin and hematocrit are not related to digoxin toxicity.

An adolescent being seen by the nurse practitioner for a sports physical is identified as having hypertension. On further testing, it is discovered the child has a cardiac abnormality. The initial treatment of secondary hypertension initially involves a. weight control and diet. b. treating the underlying disease. c. administration of digoxin. d. administration of beta-adrenergic receptor blockers.

ANS: B Identification and treatment of the underlying disease should be the first step in treating secondary hypertension. Weight control and diet are non-pharmacologic treatments for primary hypertension. Digoxin is indicated in the treatment of congestive heart failure. Beta-adrenergic receptor blockers may be indicated in the treatment of secondary hypertension, but the main focus is on identifying and treating the underlying cause.

An infant is born with bladder exstrophy. What action by the nurse is the priority? a. Obtain surgical consent for the corrective operation. b. Cover the exposed bladder with non-adherent plastic wrap. c. Insert an indwelling catheter to collect all the urine. d. Obtain consent for genetic testing on parents and infant.

ANS: B In bladder exstrophy, the bladder is outside the body and must be covered with a non-adherent plastic wrap until surgical correction. This is the priority action. Consent will be obtained prior to surgery. A catheter is not needed. Genetic testing is not necessarily done.

What intervention can be taught to the parents of a 3-year-old child with pneumonia who is not hospitalized? a. Offer the child only cool liquids. b. Offer the child favorite warm liquid drinks. c. Use a warm mist humidifier. d. Report a respiratory rate less than 28 breaths/min.

ANS: B Offering the child favorite fluids will facilitate oral intake. Warm liquids help loosen secretions. A humidifier may or may not be helpful. Typically parents are not taught to count their children's respirations and report abnormalities to the physician. Even if this were the case, a respiratory rate of less than 28 breaths/min is normal for a 3-year-old child. The expected respiratory rate for a 3-year-old child is 20 to 30 breaths/min.

A 6-year-old male patient watches everything that is going on in his room and outside his room, and he sleeps very little. What might the nurse suspect the child is experiencing based on his behavior? A. Obsessive-compulsive disorder B. Post-traumatic stress disorder C. Bipolar behavior D. Separation anxiety

ANS: B PTSD interferes with the child's ability to concentrate, may contribute to sleep problems, and may cause the child to be hypervigilant or agitated. Bipolar disorder is characterized by chronic, fluctuating, and extreme mood disturbances. Separation anxiety is disabling anxiety about being apart from one's parents or another significant person to whom the child is attached or anxiety about being away from home. Obsessive-compulsive disorder (OCD) manifests as repetitive unwanted thoughts (obsessions) or ritualistic actions (compulsions), or both. Obsessions are recurrent intrusive thoughts, feelings, and ideas. Compulsions are behaviors or actions that are repetitive and recurrent.

The narrowing of preputial opening of foreskin is called a. chordee. b. phimosis. c. epispadias. d. hypospadias.

ANS: B Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

Which statement is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. It is preferred means of renal replacement therapy in children. c. Children can receive kidneys only from other children. d. The decision is difficult, since a normal lifestyle is not possible.

ANS: B Renal transplant offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease. It can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes. Renal transplantation affords the child a more normal lifestyle than dependence on dialysis.

The parent of a toddler calls the nurse, asking about croup. What is a distinguishing manifestation of spasmodic croup? a. Wheezing is heard audibly. b. It has a harsh, barky cough. c. It is bacterial in nature. d. The child has a high fever.

ANS: B Spasmodic croup is viral in origin; is usually preceded by several days of symptoms of upper respiratory tract infection; often begins at night; and is marked by a harsh, metallic, barky cough, sore throat, inspiratory stridor, and hoarseness. Wheezing is not a distinguishing manifestation of croup. It can accompany conditions such as asthma or bronchiolitis. Spasmodic croup is viral in origin. A high fever is not usually present.

Parents ask the nurse, "When should our child's hypospadias be corrected?" The nurse responds that correction of hypospadias should be accomplished by the time the child is a. 1 month of age. b. 6 to 12 months of age. c. school age. d. sexually mature.

ANS: B The correction of hypospadias should ideally be accomplished by the time the child is 6 to 12 months of age and before toilet training. One month of age is too young for this procedure. It is preferable for hypospadias to be surgically corrected before the child enters school so that the child has normal toileting behaviors in the presence of his peers. Corrective surgery for hypospadias is done long before sexual maturity.

A teenager who needs dialysis decides to use continuous cycling peritoneal dialysis (CCPD) or continuous ambulatory peritoneal dialysis (CAPD) with her physician's blessing. What information can the nurse explain to the teenager's parents to help them understand the advantage for their child? A. Dietary restrictions are no longer necessary. B. The teenager can carry out the procedure herself after training. C. Hospitalization is only required several nights per week. D. Insertion of the catheter does not require surgical placement.

ANS: B The procedure can be done at home and often during the hours the child is sleeping. This type of dialysis provides the most independence for adolescents with end-stage renal disease and their families. Hospitalization is needed for catheter placement and only if the teenager runs into difficulty. The catheter is surgically implanted in the abdominal cavity. Dietary restrictions are still required but are less strict.

What is the appropriate priority nursing action for the infant with a CHD who has an increased respiratory rate, is sweating, and is not feeding well? a. Recheck the infant's blood pressure. b. Alert the provider. c. Withhold oral feeding. d. Increase the oxygen rate.

ANS: B These are signs of early congestive heart failure, and the provider should be notified. Rechecking the blood pressure is not necessary. Withholding the infant's feeding is an incomplete response to the problem. Increasing oxygen may alleviate symptoms, but medications such as digoxin and furosemide are necessary to improve heart function and fluid retention. Notifying the provider is the priority nursing action.

The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur. What action by the nurse is most appropriate? a. Educate parents on daily low-dose aspirin regime. b. Prepare to administer indomethacin. c. Administer next dose of enalapril early. d. Position infant in the knee-chest position.

ANS: B This murmur is characteristic of a patent ductus arteriosus, which is treated medically with indomethacin. A daily low-dose aspirin is indicated for 6 months following repair of an ASD. ACE inhibitors (enalapril) are used to reduce afterload in a VSD. The knee-chest position is helpful in tet spells that occur in tetralogy of Fallot.

A child is admitted to the hospital with right lower abdominal pain, anorexia, and fever. Which nursing actions are appropriate to achieve an optimum outcome for this patient?Select all that apply. a. Provide clear liquids only. b. Provide emotional support. c. Administer intravenous fluids. d. Administer IV analgesic medication. e. Administer oral antipyretic medication.

ANS: B, C, D

A child has allergies to animal dander but is distraught at having to give away the family dog. What actions could the nurse suggest that might avoid this? (Select all that apply.) a. Choose a dander-free pet like a lizard. b. Keep the dog outside as much as possible. c. Install air cleaners in the house. d. Use dust-proof pillow covers. e. Keep the windows closed in the summer.

ANS: B, C, D Options for the child with allergies to the household pet include keeping the dog outside as much as possible, installing air cleaners, and using dust-proof pillow covers. Getting a lizard won't help because this child has a dog he or she wants to keep. Ventilating the house will also help.

The nurse working in the newborn nursery notices an infant who is having circumoral cyanosis. Which CHD does the nurse suspect the child may have? (Select all that apply.) a. Patent ductus arteriosus (PDA) b. Tetralogy of Fallot c. Pulmonary atresia d. Transposition of the great arteries e. Ventricular septal defect

ANS: B, C, D Tetralogy of Fallot is a cyanotic lesion with decreased pulmonary blood flow. The hypoxia results in baseline oxygen saturations as low as 75% to 85%. Even with oxygen administration, saturations do not reach the normal range. Pulmonary atresia is a cyanotic lesion with decreased pulmonary blood flow. The hypoxia results in baseline oxygen saturations as low as 75% to 85%. Even with oxygen administration, saturations do not reach the normal range. Transposition of the great arteries is a cyanotic lesion with increased pulmonary blood flow. PDA is failure of the fetal shunt between the aorta and the pulmonary artery to close. PDA is not classified as a cyanotic heart disease. Prostaglandin E1 is often given to maintain ductal patency in children with cyanotic heart diseases. VSD is the most common type of cardiac defect. The VSD is a left-to-right shunting defect; however, it may be accompanied by other defects.

During abdominal assessment, the nurse notes hypoactive bowel sounds, abdominal distention, vomiting, and currant jelly stools. Which interventions would the nurse expect to provide for this patient? Select all that apply. a. Antipyretic b. Barium enema c. IV normal saline d. Intravenous antiemetic e. Abdominal ultrasonography

ANS: B, C, D, E

A 4-year-old male is continuing to have periodic daytime and nocturnal enuresis. His mother is very worried and calls the pediatrician's office nurse for advice. What information would be appropriate for the nurse to give? Select all that apply. A. He needs evaluation by a psychiatrist before having a medical workup to determine if there are anxiety issues present. B. Diet modifications can be made including avoidance of extraneous sugar and caffeine intake after late afternoon. C. Reassure the mother that the cause will be found through testing. D. It's important to limit the child's interactions with others until the situation is corrected. E. The child needs to realize that he can control the enuresis if he wants to. F. Urinary tract infections can cause enuresis.

ANS: B, C, F It is true that diet modifications can be made, including avoidance of extraneous sugar and caffeine intake after late afternoon. The nurse can reassure the mother that the cause will be found through testing. This is not a false promise. It is true that urinary tract infections can cause enuresis. He needs evaluation by a pediatrician and or urologist before having a psychiatric workup to determine if there are anxiety issues present. It is important to allow the child the usual interactions with others while the situation is corrected. The child cannot control the enuresis even if he wants to.

The nurse is caring for a child who has inflammatory bowel disease with severe malabsorption and anemia who can no longer attend school because of the condition. Which nursing actions are appropriate? Select all that apply. a. Administer oral pain medication as needed. b. Assess electrolyte and albumin levels regularly. c. Question the child about feelings related to body image. d. Assess the child's height and weight and plot these values on a growth chart. e. Encourage the parents and child to establish a regular bowel elimination regimen.

ANS: B, D, E

The nurse is preparing a child for pyloromyotomy. The child has a plasma CO2 of 30 mEq/L. Which nursing actions are appropriate before surgery? Select all that apply. a. Place infant in isolation b. Place a nasogastric tube c. Administer an antipyretic d. Assess serum electrolytes e. Withhold oral food and fluids

ANS: B, D, E

A school-age child has been admitted to the hospital with an exacerbation of nephrotic syndrome. Which clinical manifestations should the nurse expect to assess (Select all that apply)? a. Weight loss b. Facial edema c. Cloudy, smoky brown-colored urine d. Fatigue e. Frothy-appearing urine

ANS: B, D, E A child with nephrotic syndrome will present with facial edema, fatigue, and frothy-appearing urine (proteinuria). Weight gain, not loss, is expected because of the fluid retention. Cloudy, smoky brown-colored urine is seen with acute glomerulonephritis but not with nephrotic syndrome because there is no gross hematuria associated with nephrotic syndrome.

A child is experiencing intestinal cramping, diarrhea, and mucosal lesions. Which allergens would the nurse suspect are triggering these responses? (Select all that apply.) A. Pears B. Strawberries C. Apples D. Pollen E. Wheat F. Grass

ANS: B, E A. Pears do not generally trigger allergic reactions.B. Foods which trigger as allergic reaction include milk, wheat, eggs, strawberries, tomatoes, oranges, chocolate, nuts, and shellfish.C. Apples do not generally trigger allergic reactions.D. Pollen is an environmental allergen and would not cause the symptoms listed. It would cause sneezing; red, itchy nose, eyes, pharynx, and palate; edematous nasal passages; tongue clicking; runny or congested nose; mouth breathing; chronic cough; dark circles under eyes; nose wrinkling; and pale, boggy nasal mucous membranesE. Wheat is a common trigger for allergic reactions.F. Grass would cause the same reaction as pollen does.

A child is diagnosed with and treated for inflammatory bowel disease (IBD). Which action by the child best indicates that the desired outcomes have been met? a. Decrease in crying b. Drinking milk with dinner c. Playing a game with a sibling d. Decrease in bowel movements to 6 per day

ANS: C

What maternal assessment is related to an infant's diagnosis of TEF? a. Maternal age more than 40 years b. First term pregnancy for the mother c. Maternal history of polyhydramnios d. Complicated pregnancy

ANS: C A Advanced maternal age is not a risk factor for TEF.B The first term pregnancy is not a risk factor for an infant with TEF.C A maternal history of polyhydramnios is associated with TEF.D Complicated pregnancy is not a risk factor for TEF.

What is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux? a. Teach parents to position the infant on the left side. b. Reinforce the parents' knowledge of the infant's developmental needs. c. Teach the parents how to do infant cardiopulmonary resuscitation (CPR). d. Have the parents keep an accurate record of intake and output.

ANS: C A Correct positioning minimizes aspiration. The correct position for the infant is on the right side after feeding and supine for sleeping.B Knowledge of developmental needs should be included in discharge planning for all hospitalized infants, but it is not the most important in this case.C Risk of aspiration is a priority nursing diagnosis for the infant with gastroesophageal reflux. The parents must be taught infant CPR.D Keeping a record of intake and output is not a priority and may not be necessary.

Which viral pathogen frequently causes acute diarrhea in young children? a. Giardia organisms b. Shigella organisms c. Rotavirus d. Salmonella organisms

ANS: C A Giardia is a bacterial pathogen that causes diarrhea.B Shigella is a bacterial pathogen that is uncommon in the United States.C Rotavirus is the most frequent viral pathogen that causes diarrhea in young children.D Salmonella is a bacterial pathogen that causes diarrhea.

What clinical manifestation should a nurse be alert for when suspecting a diagnosis of esophageal atresia? a. A radiograph in the prenatal period indicates abnormal development. b. It is visually identified at the time of delivery. c. A nasogastric tube fails to pass at birth. d. The infant has a low birth weight.

ANS: C A Prenatal radiographs do not provide a definitive diagnosis.B The defect is not externally visible. Bronchoscopy and endoscopy can be used to identify this defect.C Atresia is suspected when a nasogastric tube fails to pass 10 to 11 cm beyond the gum line. Abdominal radiographs will confirm the diagnosis.D Infants with esophageal atresia may have been born prematurely and with a low birth weight, but neither is suggestive of the presence of an esophageal atresia.

Which parasite causes acute diarrhea? a. Shigella organisms b. Salmonella organisms c. Giardia lamblia d. Escherichia coli

ANS: C A Shigella is a bacterial pathogen.B Salmonella is a bacterial pathogen.C Giardiasis a parasite that represents 15% of nondysenteric illness in the United States.D E. coli is a bacterial pathogen.

What information should the nurse include when teaching the parents of a 5-week-old infant about pyloromyotomy? a. The infant will be in the hospital for a week. b. The surgical procedure is routine and "no big deal." c. The prognosis for complete correction with surgery is good. d. They will need to ask the physician about home care nursing.

ANS: C A The infant will remain in the hospital for a day or two postoperatively.B Although the prognosis for surgical correction is good, telling the parents that surgery is "no big deal" minimizes the infant's condition.C Pyloromyotomy is the definitive treatment for pyloric stenosis. Prognosis is good with few complications. These comments reassure parents.D Home care nursing is not necessary after a pyloromyotomy.

The postoperative care plan for an infant with surgical repair of a cleft lip includes a. A clear liquid diet for 72 hours b. Nasogastric feedings until the sutures are removed c. Elbow restraints to keep the infant's fingers away from the mouth d. Rinsing the mouth after every feeding

ANS: C A The infant's diet is advanced from clear liquid to soft foods within 48 hours of surgery.B After surgery, the infant can resume preoperative feeding techniques.C Keeping the infant's hands away from the incision reduces potential complications at the surgical site.D Rinsing the mouth after feeding is an inappropriate intervention. Feeding a small amount of water after feedings will help keep the mouth clean. A cleft lip repair site should be cleansed with a wet sterile cotton swab after feedings.

Which should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia? A. Death usually occurs by 6 months of age B. Prognosis for full recovery is excellent C. Liver transplantation may be needed eventually D. Children with surgical correction live normal lives

ANS: C A. If untreated, death will usually occur by 2 years of age. Long-term survival is possible with surgical intervention.B. Liver transplantation is usually required.C. Approximately 80% to 90% of children with biliary atresia will require liver transplantation.D. Even with surgical intervention, most children experience liver failure and require transplantation.

A nurse is caring for a 2-year-old child who is unconscious but stable after a car accident. The child's parents are staying at the bedside most of the time. Which nursing intervention is appropriate? A. Suggest that the parents go home until the child is alert enough to know they are present B. Use ointment on the child's lips, but do not attempt to cleanse the teeth until swallowing returns C. Encourage the parents to hold, talk, and sing to the child as they usually would D. Position the child with proper body alignment and head of bed lowered 15 degrees

ANS: C A. It is not recommended to suggest the parents go home until the child is alert. The child may be able to hear that they are present.B. Oral care is essential in the unconscious child. Mouth care should be done at least twice daily.C. The parents should be encouraged to interact with their child. Senses of hearing and tactile perception may be intact, and stimulation of these senses is important.D. The head of the bed should be elevated, not lowered.

Which food should the nurse serve to a child with celiac disease? A. Macaroni and cheese B. A turkey sandwich C. Cottage cheese and peaches D. Spaghetti and meatballs

ANS: C A. The macaroni has gluten, which must not be served.B. The bread for the sandwich has gluten, the protein found in wheat, barley, rye, and oats.C. Cottage cheese with peaches does not have gluten.D. Spaghetti has gluten and should not be served.

A child has a nasogastric tube (NG) after surgery for acute appendicitis. What is the purpose of the tube? A. To maintain electrolyte balance B. To prevent spread of infection C. To prevent abdominal distention D. To maintain an accurate record of output

ANS: C A. The nasogastric tube may adversely affect electrolyte balance by removing stomach secretions.B. There is no relationship to the spread of infection.C. The nasogastric tube is used to maintain gastric decompression until the return of intestinal activity.D. Nasogastric drainage is one part of the child's output. The nurse would need to incorporate the drainage with other output.

For which problem should the child with chronic otitis media with effusion be evaluated? a. Brain abscess b. Meningitis c. Hearing loss d. Perforation of the tympanic membrane

ANS: C Chronic otitis media with effusion is the most common cause of hearing loss in children. The other options are all possible complications but not seen frequently.

The nurse is admitting a child who has been diagnosed with Kawasaki disease. What is the most serious complication for which the nurse should assess in Kawasaki disease? a. Cardiac valvular disease b. Cardiomyopathy c. Coronary aneurysm d. Rheumatic fever

ANS: C Coronary artery aneurysms are seen in 20% to 25% of children with untreated Kawasaki disease. Cardiac valvular disease can occur in rheumatic fever. Cardiomyopathies are diseases of the heart muscle, which can occur as a result of congenital heart disease, coronary artery disease, or other systemic disease. Rheumatic fever is not a complication of Kawasaki disease.

Teaching safety precautions with the administration of antihistamines is important because of what common side effect? a. Dry mouth b. Excitability c. Drowsiness d. Dry mucous membranes

ANS: C Drowsiness is a safety hazard when alertness is needed, especially with a teenage driver. Nonsedating brands should be used if possible. None of the other three problems is a safety issue.

A child is brought to the emergency department after ingesting an acidic substance. What action by the nurse is best? a. Induce vomiting in the child. b. Give syrup of ipecac. c. Ensure a patent airway. d. Attach the child to a cardiac monitor.

ANS: C Ensuring a patent airway is always the priority. Since the child ingested an acid that causes corrosive damage, inducing vomiting (which is what syrup of ipecac does) is not advised. The child may need a cardiac monitor, but airway is the priority.

What is a common trigger for asthma attacks in children? a. Febrile episodes b. Dehydration c. Exercise d. Seizures

ANS: C Exercise is one of the most common triggers for asthma attacks, particularly in school-age children. Febrile episode, dehydration, and seizures are not triggers.

A home health care nurse is working with a child whose parents seem to be quite rigid in their rules and expectations and seem very distrustful of the nurse. What action by the nurse is most appropriate? a. Ask the parents why they don't trust outsiders. b. Interview the parents separately. c. Monitor the child for signs of abuse. d. Assess the parents for substance abuse.

ANS: C Families that hold very rigid rules and expectations and who are distrustful of outsiders fit some of the characteristics of an abusive family. The nurse should be alert for signs of abuse in the child. Asking "why" questions puts people on the defensive. There is no need to separate the parents to interview them. Substance abuse is not indicated.

A 9-year-old child with a known peanut allergy has an allergic reaction right after eating potato chips with his classmates served from a large bowl during a party. After the child has been cared for, what action is most important for the nurse to initiate? A. A further investigation of the potato chips. B. Asking if the child is allergic to potatoes. C. Washing the serving bowl with soap and hot water. D. Asking the child if this reaction happens often.

ANS: C For children with allergies to peanuts or other nuts, an anaphylactic reaction can occur with exposure to nut oils, surfaces contaminated with nuts, shell fragments, or cooking and serving utensils used previously for nut products. The bowl needs to be washed well.

Which condition is characterized by a history of bloody diarrhea, fever, abdominal pain, and low hemoglobin and platelet counts? a. Acute viral gastroenteritis b. Acute glomerulonephritis c. Hemolytic-uremic syndrome d. Acute nephrotic syndrome

ANS: C Hemolytic-uremic syndrome is an acute disorder characterized by anemia, thrombocytopenia, and acute renal failure. Most affected children have a history of gastrointestinal symptoms, including bloody diarrhea. Anemia and thrombocytopenia are not associated with acute gastroenteritis. The symptoms described are not suggestive of acute glomerulonephritis. The symptoms described are not suggestive of nephrotic syndrome.

A nurse is conducting a class for nursing students about fetal circulation. Which statement is accurate about fetal circulation and should be included in the teaching session? a. Oxygen is carried to the fetus by the umbilical arteries. b. Blood from the inferior vena cava is shunted directly to the right ventricle throughthe foramen ovale. c. Pulmonary vascular resistance is high because the lungs are filled with fluid. d. Blood flows from the ductus arteriosus to the pulmonary artery.

ANS: C Resistance in the pulmonary circulation is very high because the lungs are collapsed and filled with fluid. Oxygen and nutrients are carried to the fetus by the umbilical vein. The inferior vena cava empties blood into the right atrium. The direction of blood flow and the pressure in the right atrium propel most of this blood through the foramen ovale into the left atrium. Most of the blood in the pulmonary artery flows though the ductus arteriosus into the descending aorta.

Which intervention for treating croup at home should be taught to parents? a. Have a decongestant available to give the child when an attack occurs. b. Have the child sleep in a dry room. c. Take the child outside. d. Give the child an antibiotic at bedtime.

ANS: C Taking the child into the cool, humid, night air may relieve mucosal swelling and improve symptoms. Decongestants are inappropriate for croup, which affects the middle airway level. A dry environment may contribute to symptoms. Croup is caused by a virus. Antibiotic treatment is not indicated.

Which child requires a Mantoux test? a. The child who has episodes of nighttime wheezing and coughing b. The child who has a history of allergic rhinitis c. The child whose babysitter has received a tuberculosis diagnosis d. The premature infant who is being treated for apnea of infancy

ANS: C The Mantoux test is the initial screening mechanism for patients exposed to tuberculosis. Nighttime wheezing and coughing are consistent with a diagnosis of asthma. Allergic rhinitis requires an allergy workup. The Mantoux test is not used to evaluate apnea.

Which defect results in increased pulmonary blood flow? a. Pulmonic stenosis b. Tricuspid atresia c. Atrial septal defect d. Transposition of the great arteries

ANS: C The atrial septal defect results in increased pulmonary blood flow. Blood flows from the left atrium (higher pressure) into the right atrium (lower pressure) and then to the lungs via the pulmonary artery. The other three diseases do not result in increased pulmonary blood flow.

Which intervention is appropriate for a child receiving high doses of steroids? a. Limit activity and receive home schooling. b. Increase the amount of carbohydrates in the diet. c. Substitute a killed virus vaccine for live virus vaccines. d. Monitor for seizure activity.

ANS: C The child on high doses of steroids should not receive live virus vaccines because of immunosuppression. Limiting activity and home schooling are not routine for a child receiving high doses of steroids. Children on high doses of steroids sometimes get carbohydrate intolerance; the diet should not contain high levels of carbohydrates. Children on steroids are not typically at risk for seizures.

Which finding confirms a diagnosis of cystic fibrosis? a. Chest radiograph shows alveolar hyperinflation. b. Stool analysis indicates significant amounts of fecal fat. c. Sweat chloride is greater than 60 mEq/L. d. Liver function levels are abnormal.

ANS: C The diagnosis of cystic fibrosis requires a positive sweat test. A chloride level greater than 60 mEq/L is considered diagnostic for cystic fibrosis. Hyperinflation is one of the first findings on a chest radiograph of a child with cystic fibrosis. It does not confirm a diagnosis. A 72-hour fecal fat determination may be included in a diagnostic workup. Inability to secrete digestive enzymes causes steatorrhea. Liver function tests may be part of the diagnostic workup for cystic fibrosis.

The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate? a. pH b. Osmolality c. Creatinine clearance d. Protein level

ANS: C The most useful clinical indication of glomerular filtration is the clearance of creatinine. It is a substance that is freely filtered by the glomerulus and secreted by the renal tubule cells. The pH and osmolality are not estimates of glomerular filtration. Although protein in the urine demonstrates abnormal glomerular permeability, it is not a measure of filtration rate.

In counseling an adolescent who is abusing alcohol, the nurse explains that alcohol abuseprimarily affects which organ of the body? a. Heart b. Liver c. Brain d. Lungs

ANS: C The primary effect of substance abuse is on the brain and residually on the rest of the body. Alcohol affects the entire brain by decreasing its responsiveness. Although an excessive amount of a chemical can cause cardiac abnormalities, the brain is the most commonly affected organ. Long-term alcohol use is known to impair the liver; however, brain function is decreased by any amount of alcohol intake. The pulmonary system is not the primary target; however, one commonly abused drug known to cause pulmonary problems is tobacco.

A child has had cold symptoms for more than 2 weeks, a headache, nasal congestion with purulent nasal drainage, facial tenderness, and a cough that increases during sleep. The nurse plans to teach the parents about which treatment regime? a. Antihistamine use b. Cold washcloths on the face for comfort c. Antibiotic treatment with amoxicillin d. Referral for a sinuplasty

ANS: C These manifestations are those of a sinus infection. The parents need to be taught about antibiotic use. A common antibiotic used for sinusitis is amoxicillin. Antihistamines are not recommended because they dry up secretions, making them more difficult to remove. Warm wet washcloths can be used for comfort. A sinuplasty may be needed if the child does not improve or if sinus infections are recurrent or frequent.

A 14-year-old admits to using marijuana every day with friends after attending school. What phase of substance abuse does this behavior exemplify? a. Experimentation b. Early drug use c. True drug addiction d. Severe drug addiction

ANS: C True drug addiction is identified as regular use of drugs. Physical dependence may be present. Social functioning has a drug focus. With experimentation, the individual tries the drug to see what it is like or to satisfy peers. Early drug use is identified as using drugs with some degree of regularity for their desirable effects. In severe drug addiction, the physical condition of the individual deteriorates, and all activities are related to drug use.

The nurse observes abdominal breathing in a 2-year-old child. What does this finding indicate? a. Imminent respiratory failure b. Hypoxia c. Normal respiration d. Airway obstruction

ANS: C Young children normally exhibit abdominal breathing. When measuring respiratory rate, the nurse should observe the rise and fall of the abdomen. A very slow respiration rate is an indicator of respiratory failure. Nasal flaring with inspiration and grunting on expiration occurs when hypoxia is present. The child with an airway obstruction will use accessory muscles to breathe.

A child with irritable bowel disease presents with complaints of severe intestinal cramping, diarrhea, and bloating. Which intervention is most important in achieving the desired outcome for this patient? a. Administer oral prednisone. b. Administer IV pain medication. c. Administer oral metronidazole. d. Administer intravenous (IV) normal saline bolus.

ANS: D

The nurse is assessing a child with a tracheoesophageal fistula who has been coughing and choking during feeding. The child is in the 45th percentile for weight, and vital signs are normal. Which nursing intervention is appropriate to ensure that the expected outcome is achieved for this patient? a. Administer intravenous fluids. b. Place child in prone position. c. Provide the child with a pacifier. d. Place child on a chalasia board.

ANS: D

The nurse walks into a patient's room shortly after surgical correction of intussusception and notices that the patient is very lethargic. Which nursing action is a priority? a. Assess pain b. Check vital signs c. Check urine output d. Call the rapid response team

ANS: D

When assessing a child treated for intussusception, which behavioral finding would indicate the expected outcomes had been met for that child? a. Guarding b. Flexing the legs c. Crying while standing d. Knocking over blocks

ANS: D

Why is a humidified atmosphere recommended for a young child with an upper respiratory tract infection? A) It liquefies secretions. B) It improves oxygenation. C) It promotes ventilation. D) It is soothing to inflamed mucous membrane.

ANS: D

What should the nurse teach a school-age child and his parents about the management of ulcer disease? a. Eat a bland, low-fiber diet in small, frequent meals. b. Eat three balanced meals a day with no snacking between meals. c. The child needs to eat alone to avoid stress. d. Do not give antacids 1 hour before or after antiulcer medications.

ANS: D A A bland diet is not indicated for ulcer disease. The diet should be a regular diet that is low in caffeine, and the child should eat a meal or snack every 2 to 3 hours.B The child should eat every 2 to 3 hours.C Eating alone is not indicated.D Antacids can interfere with antiulcer medication if given less than 1 hour before or after antiulcer medications.

An infant is born and the nurse notices that the child has herniation of abdominal viscera into the base of the umbilical cord. What will the nurse document on her or his assessment of this condition? a. Diaphragmatic hernia b. Umbilical hernia c. Gastroschisis d. Omphalocele

ANS: D A A diaphragmatic hernia is the protrusion of part of the abdominal organs through an opening in the diaphragm.B An umbilical hernia is a soft skin protrusion of abdominal stricture through the esophageal hiatus.C Gastroschisis is the protrusion of intraabdominal contents through a defect in the abdominal wall lateral to the umbilical ring. There is no peritoneal sac.D Omphalocele is the herniation of the abdominal viscera into the base of the umbilical cord.

Which nursing diagnosis has the highest priority for the toddler with celiac disease? a. Disturbed Body Image related to chronic constipation b. Risk for Disproportionate Growth related to obesity c. Excess Fluid Volume related to celiac crisis d. Imbalanced Nutrition: Less than Body Requirements related to malabsorption

ANS: D A Body Image disturbances are not usually apparent in toddlers. This is more common in adolescents. It is not the priority nursing diagnosis.B Celiac disease causes disproportionate growth and development associated with malnutrition, not obesity.C Celiac crisis causes deficient fluid volume.D Imbalanced Nutrition: Less than Body Requirements is the highest priority nursing diagnosis because celiac disease causes gluten enteropathy, a malabsorption condition.

A nurse is teaching parents about the importance of immunizations for infants because of immaturity of the immune system. The parents demonstrate that they understand the teaching if they make which statement? a. "The spleen reaches full size by 1 year of age." b. "IgM, IgE, and IgD levels are high at birth." c. "IgG levels in the newborn infant are low at birth." d. "Absolute lymphocyte counts reach a peak during the first year."

ANS: D A The spleen reaches its full size during adulthood.B IgM, IgE, and IgD are normally in low concentration at birth. IgM, IgE, IgA, and IgD do not cross the placenta.C The term newborn infant receives an adult level of IgG as a result of transplacental transfer from the mother.D Absolute lymphocyte counts reach a peak during the first year.

Which intervention should be included in the nurse's plan of care for a 7-year-old child with encopresis who has cleared the initial impaction? a. Have the child sit on the toilet for 30 minutes when he gets up in the morning and at bedtime. b. Increase sugar in the child's diet to promote bowel elimination. c. Use a Fleets enema daily. d. Give the child a choice of beverage to mix with a laxative.

ANS: D A To facilitate bowel elimination, the child should sit on the toilet for 5 to 10 minutes after breakfast and dinner.B Decreasing the amount of sugar in the diet will help keep stools soft.C Daily Fleets enemas can result in hypernatremia and hyperphosphatemia, and are used only during periods of fecal impaction.D Offering realistic choices is helpful in meeting the school-age child's sense of control.

The mother of an infant who is to have surgery for a patent ductus arteriosus (PDA) asks what the beneficial effect of performing surgery is. Which statement by the nurse best explains prevention of which complication by performing the surgery? A. Pulmonary infection B. Right-to-left shunting of the blood C. Decreased workload on left side of the heart D. Increased pulmonary vascular congestion

ANS: D A patent ductus arteriosus (PDA) allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary congestion can occur. The increased pulmonary vascular congestion is the primary complication. The blood is shunted left to right. The increased pulmonary vascular congestion is the primary complication.

The school nurse is called to the cafeteria because a child "has eaten something causing an allergic reaction." The child is in severe respiratory distress. What should be the first action by the nurse? A. Determine what the child has eaten B. Administer diphenhydramine (Benadryl) C. Move the child to the nurse's office or hallway D. Have someone call for an ambulance-paramedic rescue squad

ANS: D A. Because severe respiratory distress is occurring, treatment of the response is indicated first. The cause of the response can be determined later.B. Diphenhydramine will not be effective for this type of allergic reaction.C. The child should not be moved unless the child is in a place that puts the child at greater hazard.D. Because the child is in severe respiratory distress, the nurse should remain with the child while someone else calls for the rescue squad.

Which should the nurse recognize as an early clinical sign of compensated shock in a child? A. Confusion B. Sleepiness C. Hypotension D. Apprehension

ANS: D A. Confusion is indicative of uncompensated shock.B. Sleepiness is not an indication of shock.C. Hypotension may be a symptom of decompensated shock.D. Apprehension is indicative of compensated shock.

A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse's best response should be that the: a. Blood pressure will stabilize. b. Child will have more energy. c. Urine will be free of protein d. Urinary output will increase.

ANS: D An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output.

The long-term treatment plan for an adolescent with an eating disorder focuses on a. Managing the effects of malnutrition b. Establishing sufficient caloric intake c. Improving family dynamics d. Restructuring perception of body image

ANS: D The treatment of eating disorders is initially focused on reestablishing physiologic homeostasis. Once body systems are stabilized, the next goal of treatment for eating disorders is maintaining adequate caloric intake. Although family therapy is indicated when dysfunctional family relationships exist, the primary focus of therapy for eating disorders is to help the adolescent cope with complex issues. The focus of treatment in individual therapy for an eating disorder involves restructuring cognitive perceptions about the individual's body image.

A nurse is assigned to care for an infant with an unrepaired tetralogy of Fallot. What should the nurse do first when the baby is crying and becomes severely cyanotic? a. Place the infant in a knee-chest position. b. Administer oxygen. c. Administer morphine sulfate. d. Calm the infant.

ANS: D Calming the crying infant is the first response. An infant with unrepaired tetralogy of Fallot who is crying and agitated may eventually lose consciousness. Placing the infant in a knee-chest position will decrease venous return so that smaller amounts of highly saturated blood reach the heart. This should be done after calming the infant. Administering oxygen is indicated after placing the infant in a knee-chest position. Administering morphine sulfate calms the infant and depresses respirations. It may be indicated sometime after the infant has been calmed.

Which intervention is appropriate when examining a male infant for cryptorchidism? a. Cooling the examiner's hands b. Taking a rectal temperature c. Eliciting the cremasteric reflex d. Warming the room

ANS: D For the infant's comfort, the infant should be examined in a warm room with the examiner's hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold. A rectal temperature yields no information about cryptorchidism. Testes can retract into the inguinal canal if the infant is upset or cold or if the cremasteric reflex is elicited. This can lead to an incorrect diagnosis.

Hypospadias refers to a. absence of a urethral opening. b. penis shorter than usual for age. c. urethral opening along dorsal surface of penis. d. urethral opening along ventral surface of penis.

ANS: D Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present in hypospadias but not at the glans. Hypospadias refers to the urethral opening, not to the size of the penis. Epispadias is where the urethral opening is along the dorsal surface of the penis.

A child is being discharged home on a regimen of oral corticosteroids. What information is most important for the nurse to explain to the parents? A. Reduce the dosage as quickly as possible so dependence on the medication is avoided. B. Any new cuts should be washed with soap and water then covered with a bandage. C. All spurts of energy and increased appetite are interpreted as a positive response. D. If the child becomes ill, notify the physician who ordered the medication.

ANS: D If the child becomes ill, the physician who ordered the medication should be notified because of the increased stress. Supplemental glucocorticoids might be necessary during times of increased stress to prevent adrenal insufficiency.

What is the most common causative agent of bacterial endocarditis? a. Staphylococcus albus b. Streptococcus hemolyticus c. Staphylococcus albicans d. Streptococcus viridans

ANS: D S. viridans and S. aureus are the most common causative agents in bacterial (infective) endocarditis. The others are not common causative agents.

Which statement made by a parent indicates understanding of restrictions for a child after cardiac surgery? a. "My child needs to go to bed early for a few weeks." b. "My son is really looking forward to riding his bike next week." c. "I'm so glad we can attend religious services as a family this coming Sunday." d. "I am going to keep my child out of day care for 6 weeks."

ANS: D Settings where large groups of people are present should be avoided for 4 to 6 weeks after discharge, including day care and other public places such as churches. The child should resume his regular bedtime and sleep schedule after discharge. Due to fatigue, the child may initially need some naps during the day.

The nurse is admitting a child to the hospital for a cardiac workup. What is the first step in a cardiac assessment? a. Percussion b. Palpation c. Auscultation d. History and inspection

ANS: D The assessment should begin with the least threatening interventions—the history and inspection. Assessment progression includes inspection, auscultation, and palpation because each step includes more touching. Percussion of the chest is usually deferred. Palpation can be threatening to the child because it requires a significant amount of physical contact. For this reason it is not the initial step in a cardiac assessment. Auscultation requires touching the child and is not the initial step in a cardiac assessment.

Which information should be included in the nurse's discharge instructions for a child who underwent a cardiac catheterization earlier in the day? a. Pressure dressing is changed daily for the first week. b. The child may soak in the tub beginning tomorrow. c. Contact sports can be resumed in 2 days. d. The child can return to school on the third day after the procedure.

ANS: D The child can generally return to school on the third day after the procedure. The day after the cardiac catheterization, the pressure dressing is removed and replaced with a Band-Aid. Bathing is limited to a shower, a sponge bath, or a brief tub bath (no soaking) for the first 1 to 3 days after the procedure. Strenuous exercise such as contact sports, swimming, or climbing trees is avoided for up to 1 week after the procedure.

What is an appropriate beverage for the nurse to give to a child who had a tonsillectomy earlier in the day? a. Chocolate ice cream b. Orange juice c. Fruit punch d. Apple juice

ANS: D The child can have clear, cool liquids when fully awake. Ice cream is not a clear liquid, and dairy products can cause the child to clear the throat repeatedly, increasing the risk of bleeding. Citrus drinks are not offered because they can irritate the throat. Red liquids are avoided because they give the appearance of blood if vomited.

The nurse is planning care for infants and children with congestive heart failure. Nursing care is correct if the nurse takes which approach? A. Forcing fluids appropriate for the patient's age B. Monitoring respirations during active periods C. Giving larger feedings less often to conserve energy D. Organizing activities to allow for uninterrupted sleep

ANS: D The child needs to be well rested before feeding. The child's needs should be met as quickly as possible to minimize crying. The nurse must organize care to facilitate a decrease in the child's energy expenditure which is known as clustering care. The child who has congestive heart failure has an excess of fluid. Monitoring of vital signs is appropriate, but minimizing energy expenditure is a priority. The child often cannot tolerate larger feedings.

The most common cause of acute kidney injury in children is a. pyelonephritis. b. tubular destruction. c. urinary tract obstruction. d. severe dehydration.

ANS: D The most common cause of acute kidney injury in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. This is a prerenal cause. Pyelonephritis, tubular destruction, and urinary tract obstruction are not common causes of acute kidney injury in children.

The mother of a child who is to have an echocardiogram asks what the test will do. Which explanation by the nurse is best? A. The procedure uses high-frequency sound waves created by a transducer to produce an image of cardiac structures. B. The heart's electrical impulses are recorded on a screen, and a paper copy is also made. C. Your child's heart vessels are measured with a catheter threaded into the heart. D. Your child's heart structures will be painlessly visualized using sound waves while your child lies quietly on an exam table.

ANS: D This is the clearest explanation without using technical terms. Echocardiography uses high-frequency sound waves. The child must lie completely still. With the improvements in technology, diagnosis can sometimes be made without cardiac catheterization. The explanation is very technical. This is the description of electrocardiography, which is a tracing of the electrical path of the depolarization action of myocardial cells. This is the description of a cardiac catheterization, which is an invasive procedure in which a catheter is threaded into the heart.

The nurse is caring for a child with Kawasaki disease. The child weighs 33 pounds. When initiating aspirin therapy, what dose does the nurse prepare to administer? a. 75 mg orally once a day b. 81 mg orally twice a day c. 200 mg three times a day d. 375 mg orally four times a day

ANS: D When initiating aspiring for Kawasaki disease, it is started at the anti-inflammatory dose of 80 to 100 mg/kg divided into four doses a day. This child weighs 15 kg so 100 mg × 15 kg = 1500 mg. Divided into four doses is 375 mg four times a day. 75 mg once a day is the maintenance dose used for antiplatelet aggregate purposes. 81 mg a day is the adult antiplatelet aggregate dose.

Asthma is now classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to differentiate these categories include (Select all that apply.) A) Lung function B) Age of the child C) Associated allergies D) Frequency of symptoms E) Frequency and severity of exacerbations

ANS: D, E

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for what conditions? (Select all that apply.) a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. UTI e. Diabetes mellitus

ANS: D, E Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. If accompanied by excessive thirst and weight loss, these symptoms may indicate the onset of diabetes mellitus. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.

Which observations made by an emergency department nurse raises the suspicion that a 3-year-old child has been maltreated? a. The parents are extremely calm in the emergency department. b. The injury is unusual for a child of that age. c. The child does not remember how he got hurt. d. The child was doing something unsafe when the injury occurred.

B An injury that is rarely found in children or is inconsistent with the age and condition of the child should raise suspicion of child maltreatment. The nurse should observe the parents' reaction to the child but must keep in mind that people behave very differently depending on culture, ethnicity, experience, and psychological makeup. The child may not remember what happened as a result of the injury itself, for example, sustaining a concussion. Also, a 3-year-old child may not be a reliable historian. The fact that the child was not supervised might be an area for health teaching. The nurse needs to gather more information to determine whether the parents have been negligent in the care of their child.

The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding? a. Increased urine output b. Hypotension c. Tea-colored urine d. Weight gain

C Acute poststreptococcal glomerulonephritis is characterized by hematuria, proteinuria, edema, and renal insufficiency. Tea-colored urine is an indication of hematuria. In acute poststreptococcal glomerulonephritis the urine output may be decreased. In acute poststreptococcal glomerulonephritis blood pressure may be increased. Edema may be noted around the eyelids and ankles in patients with acute post streptococcal glomerulonephritis and can contribute to weight gain; however, weight gain is associated more with nephrotic syndrome.

A 9 year old is admitted to the hospital with acute glomerulonephritis. In taking the child's history, the nurse is not surprised to find that the child has had: a. back pain for a few days b. dysuria since the previous night c. hx of HTN d. a sore throat last week

D

The nurse assesses a neonate immediately after birth and suspects a tracheoesophageal fistula. Which assessment data would cause the nurse to suspect this defect? A. Sneezing B. Flat fontanels C. Absence of sucking and swallowing D. Excessive amount of frothy saliva in the mouth

D Excessive salivation and drooling is indicative of tracheoesophageal fistulas. With a fistula, the child has difficulty managing the secretions causing choking, coughing, and cyanosis.

For what reason might a newborn infant with a cardiac defect, such as coarctation of the aorta, that results in a right-to-left shunt receive prostaglandin E1? a. To decrease inflammation b. To control pain c. To decrease respirations d. To improve oxygenation

D Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus arteriosus patent. This will improve oxygenation. It is not given for inflammation, pain, or to decrease respirations.

A young child with tetralogy of Fallot may assume a posturing position as a compensatory mechanism. What position would the nurse expect the child to assume? A. Low Fowler's B. Prone C. Supine D. Knee-chest

D The squatting or knee-chest position decreases the amount of blood returning to the heart and allows the child time to compensate. Low Fowler's position would assist with respiratory issues but would not assist with the need for cardiac compensation. Prone does not offer any advantage to the child. Supine does not offer any advantage to the child.

The nurse is caring for a child whose cardiac condition is classified as a mixed-blood cardiac defect. What diagnosis would the nurse expect to see on the patient's chart? A. Pulmonic stenosis B. Atrial septal defect C. Patent ductus arteriosus D. Transposition of the great arteries

D Transposition of the great arteries allows the mixing of blood in the heart. Pulmonic stenosis is classified as an obstructive defect. Atrial septal defect is classified as a defect with increased pulmonary blood flow. Patent ductus arteriosus is classified as a defect with increased pulmonary blood flow.