CPN Review Questions

Behavioral and emotional responses MOST typical of preschool-age children whose parents are divorcing include A) eating and sleeping disturbances. B) conflicts about parental loyalties. C) withdrawing from friends. D) blaming self.

D) blaming self Rationale: Several factors influence how children respond to their parents' divorce, such as the age and gender of the child and the quality of the parent-child relationship both preceding and following the divorce. In response to parental separation, children experience feelings of loss, grief, and helplessness. Long-term effects depend on how well the children and parents adjust. While studies have often focused on the negative effects of divorce, there can be positive long-term outcomes if greater stability in the home is achieved following the divorce. Considering behavioral and emotional responses, children blaming themselves for their parents' divorce is a reaction that crosses many age groups but is particularly true at the preschool stage of development. Children between the ages of 3 to 5 years often have "magical thinking." They may believe they caused negative events by thinking bad thoughts or being disobedient, and, as a result, experience guilt. It is important to reassure children of all ages that they are not responsible for parental separation or divorce. Disturbances in eating and sleeping are most common in children under the age of 2 years. Conflicts about parental loyalties is more typical in later school-age children, as is withdrawing from friends.

Celiac disease is SUSPECTED in a 3 year old with chronic diarrhea. During the INITIAL diagnostic evaluation period, caregivers should be instructed to A) remove all known sources of gluten from the child's diet. B) limit the child's intake of cereal and baked goods. C) provide fat-soluble vitamin supplements. D) continue the child's regular diet.

D) continue the child's regular diet. Rationale: No dietary changes should be made until the diagnostic evaluation for celiac disease (CD) is complete, so that proper identification can occur. Once a diagnosis of CD is confirmed, caregivers should remove all known sources of gluten from the child's diet. Because gluten occurs in wheat, rye, barley, and oats, foods containing these grains, such as cereals and baked goods, are eliminated. Corn, rice, and millet are among the substitute grain foods. Children with untreated CD disease may also have lactose intolerance, which usually improves as the mucosa heals after gluten withdrawal. Fat-soluble vitamin supplementation may be recommended following a diagnosis of celiac disease but are not indicated during the evaluation period.

When a family is preparing to take their child home after a spinal cord injury, which of the following is taught as a strategy for preventing autonomic dysreflexia? A) splinting and exercising extremities daily B) monitoring of heart rate and blood pressure C) layering clothing to ensure temperature regulation D) ensuring maintenance of bowel and bladder regimens

D) ensuring maintenance of bowel and bladder regimens Rationale: To reduce the risk of autonomic dysreflexia associated with spinal cord injury, bowel and bladder management routines must be maintained. Visceral distention or irritation, particularly of the bladder and bowel can trigger excessive sympathetic activity such as flushing of the face, sweating forehead, pupillary constrictions, marked hypertension, headache, and bradycardia that can lead to a catastrophic event unless the irritation is relieved.

The presence of a latex allergy would be MOST common in the child with: A) asthma B) leukemia C) nephrotic syndrome D) spina bifida

D) spina bifida Ratioanle: Children with spina bifida are significantly more likely to have a latex allergy as compared to the general public because of repeated exposure to latex during procedures. Therefore, asking about latex allergy is an important part of the history taking for all children with spina bifida. It is highly important to recognize signs and symptoms of latex allergy such as urticaria, wheezing, watery eyes, rash and, in rare cases, anaphylaxis. More severe reactions occur when latex comes in contact with mucous membranes, wet skin, the bloodstream, or an airway. Children with asthma, nephrotic syndrome or leukemia are not at higher risk of having a latex allergy.

With use of an opioid analgesic, when is it MOST important to monitor for the adverse effect of respiratory depression? A) when monitoring system detects signs of distress B) immediately following administration C) within 1 to 2 hours of administration D) while the child is sleeping

D) while the child is sleeping Rationale: Respiratory depression is a life-threatening complication associated with opioid medications. Red flags indicating clinical deterioration include sleepiness, small pupils, and shallow breathing, which can progress to unresponsiveness and respiratory arrest. Frequent assessments of a child's respiratory status are indicated after administration of an opioid analgesic. Vigilant nursing assessment can usually identify signs of potential respiratory compromise prior to the triggering of a monitoring system alarm. Monitoring systems are important tools but are not substitutes for actual nursing assessments. While opioid induced respiratory depression can occur at any time, it is most likely to occur when the child is sleeping due to the decreased level of consciousness and the potential for the tongue to obstruct the airway. Naloxone, which counteracts opioid effects, should be readily available to administer in the event that respiratory depression occurs

What would be early health assessment concerns reported by a 17 year old patient that would assist the health care team in diagnosing Hodgkin's lymphoma? A) Gastrointestinal distress, vomiting and weight loss B) Enlarged lymph nodes in the neck and night sweats C) Deep bone pain and abdominal pain D) Lack of energy, myalgia and a need for increased sleep

B) Enlarged lymph nodes in the neck and night sweats Rationale: This malignant neoplasm of the lymphoid tissue usually originates in a localized group of lymph nodes which are most commonly found in the lower cervical lymph node region. Domain: Childhood Cancer

Which laboratory finding is most concerning in the child with sickle cell disease, who reports that they have recently had a viral illness? A) Hemoglobin- 8.8 g/dL B) Reticulocyte Count- 0.3% C) BUN- 7 mg/dL D) Urinalysis- bilirubin

B) Reticulocyte Count- 0.3% Rationale: patients with sickle cell disease may develop aplastic crisis follow infection (particularly with Parvovirus), which typically initially presents with a low reticulocyte count. Without treatment and supportive care, the patient can become significantly anemic since the bone marrow ceases RBC production, which is exacerbated by the hemolytic nature of sickle cell disease. A hemoglobin of 8.8 may be considered at patient's baseline for children with sickle cell disease. BUN is normal, and bilirubin present in the urine, while not considered a normal finding, may occur in patients with more severe sickle cell disease (due to hemolysis) and is not the most concerning at this time given the reticulocyte count. Domain: Hematologic Conditions

An eight year old girl is admitted to your unit with a recently diagnosed brain tumor. The nurse's best response to the parents about the care and prognosis of their child is: A) "There is nothing we can do, spend as much time as possible with your daughter." B) "It seems you have a lot of questions about your child's condition. You can talk about it at your child's next outpatient clinic visit." C) "Why don't we go to a quiet area and discuss your daughter's condition." D) "Don't worry, your child's brain tumor is most likely benign."

C) "Why don't we go to a quiet area and discuss your daughter's condition." Rationale: Giving the parents time and privacy to discuss their daughter's condition helps them to adapt and plan for their daughter and family's needs. Domain: Neurologic Function

Risk factors for eating disorders include: A) Peer pressure B) History of obesity as a toddler C) Marital status of parents D) A gymnast who aspires to qualify for the Olympics

D) A gymnast who aspires to qualify for the Olympics Rationale: While risk factors for eating disorders are complex and individual, there is some understanding of general major risks. Neither peer pressure, history of obesity in early childhood, nor the marital status of parents are general risk factors. Adolescents participating in activities that emphasize a certain weight are found to be at increased risk. Domain: Psychological Conditions

Which of the following interventions is the priority for the child with carbon monoxide poisoning? A) Administer continuous positive airway pressure (CPAP) B) Open the airway such as tracheostomy or intubation C) Administer 100% oxygen or hyperbaric oxygen therapy

D) Administer 100% oxygen or hyperbaric oxygen therapy Rationale: Administer 100% oxygen or hyperbaric oxygen therapy for carbon monoxide poisoning. Domain: Respiratory Conditions

Mandated reporting to child protective services for potential abuse is MOST warranted for which of the following children? A) 2 year old with a glove-patterned burn on hand B) 3 year old with scattered bruising bilaterally on lower extremities C) 8 year old with cerebral palsy needing several stitches on forehead D) 13 year old with healing horizontal scars on the forearm

A) 2 year old with a glove-patterned burn on hand Rationale: Burns that are glove or stocking pattern in appearance on the hands or feet are suspicious for being intentionally inflicted. Stocking and glove patterns are seen when feet or hands are submerged in hot water. The line of demarcation is possible evidence that the injury was not accidental. When there are suspicions of potential abuse, the nurse is legally obligated to report. While chronic illness is a risk factor for abuse in children, an injury on the forehead is not a typical injury site for suspicion of potential abuse. Children with cerebral palsy may have difficult or inefficient ambulation, which could increase the risk of falls. Bruising on extremities occurs in ambulatory toddlers and young children and are not immediately suspicious of abuse. An exception would be specific patterned bruising that match handprints or knuckles, which is concerning for abuse. Healing scars on the forearm of an adolescent are more likely to be self-inflicted than indicative of abuse. Further evaluation is required, and the adolescent may need to be referred for mental health assessment and treatment.

When a parent caring for a dying child at home states, "Sometimes I wonder if I am doing what is right for my child," it is MOST likely A) an invitation to open discussions and to explore feelings. B) a sign that the parent is in the bargaining stage of grief. C) a reason to review options including treatment. D) an indication of the need for respite support.

A) an invitation to open discussions and to explore feelings Rationale: A family's decision to provide care at home for a child who is dying presents many challenges and demands. The assistance of nurses and other members of the healthcare team can be important to support the family throughout this journey, and the responsibility demands honest communications when discussing difficult issues that are likely to arise. Caregivers expressing occasional uncertainty is a normal response and should be considered an opportunity to explore feelings. These communications are best broached through the use of open-ended questions that convey non-judgement. The goal of these communications will not only be providing the caregiver an opportunity to convey and explore feelings, but to also identify their wishes.

A 3 year old has poor appetite, documented weight loss, and diminished energy. Which lab result would indicate a need for lead exposure screening? A) decreased hemoglobin B) decreased platelet C) increased magnesium D) increased neutrophil

A) decreased hemoglobin Rationale: Children under 5 years of age are most at risk for lead poisoning because of frequent hand to mouth activity. Acute or chronic lead poisoning can occur with children who ingest lead-based paint chips. Lead-based paint and lead-contaminated dust in homes built before 1978 are the most common sources of lead poisoning in children. Other sources include contaminated air, water, and soil. Iron deficiency appears to be a factor in lead being more readily absorbed. Lab values in lead poisoning usually reveal a normocytic anemia with a low hemoglobin, but other red blood cell indices are normal. The white blood count and platelets are not affected and the magnesium level is decreased because of renal tubular dysfunction. Initial signs and symptoms of lead poisoning can be difficult to detect. Mild and moderate lead poisoning can manifest in behavioral changes in young children including decreased appetite, sluggishness, and fatigue, along with abdominal pain, vomiting, and constipation. Long-term signs of lead poisoning include developmental delay, lowered academic performance, learning disabilities, and lowered intelligence quotient (IQ).

When performing an otoscopic exam on an uncooperative toddler, in addition to having the caregiver help immobilize the child, which technique BEST reduces the risk of injury? A) hold the otoscope so that fingers are resting against the skull B) hold the otoscopic upright using the dominant hand to stabilize the head C) place one hand above the ear tilting the child's head to the opposite shoulder D) use nondominant hand to distract child while holding otoscope with dominant hand

A) hold the otoscope so that fingers are resting against the skull Rationale: Making the examination of the ear a game may help reduce distress in a young child. However, for their protection and safety, infants and toddlers must be gently restrained during an otoscopic examination. It is important to hold the otoscope in such a way that should the child become uncooperative or move suddenly, the instrument will move with the child. This is accomplished by holding the otoscope upside down or sideways so that the examiner's fingers are resting against the child's skull. In this way, the examiner's hand and the otoscope naturally follow any movement of the child's head. To better view the tympanic membrane, the child's head may be tilted slightly towards the opposite shoulder, but this will not reduce the risk of injury. The otoscope may be held in either the dominate or non-dominate hand, whichever is more comfortable for the examiner. Painful areas should always be examined last as this is the most stressful part of the examination for the child.

The PRIMARY nursing responsibility when caring for children with growth discrepancies is to A) identify delays early. B) assess for signs of tumor. C) assist with diagnostic tests. D) provide emotional support.

A) identify delays early. Rationale: To achieve maximum growth potential, early diagnosis and intervention for growth delays in children are essential. Nurses should assess growth parameters for all children and make referrals as needed. Although it is part of the nurse's role to assist with diagnostic procedures, it is not the primary consideration. Diagnostic studies are often used to eliminate pituitary tumor as a causative factor after growth disorders have been identified. Emotional problems are not uncommon in children who differ in appearance from their peers, but identification of growth problems is the first and most important step in order to initiate early intervention and improve outcomes.

A mother expresses concern that her 9 month old is resistant to eating solid foods. What would be the BEST advice? A) offer a small amount of breast milk or formula and then try solids B) mix the solid food in the bottle and enlarge the nipple hole C) provide a stimulating environment during feedings D) vary the feeding schedule on a daily basis

A) offer a small amount of breast milk or formula and then try solids Rationale: Solids are typically introduced at 4 to 6 months of age. If the infant exhibits negative feeding behavior, parents are often inclined to give up but should be taught to be persistent. Guidelines for feeding children with food refusal include providing a quiet, non-stimulating atmosphere, introducing new foods slowly, and attempt when the infant is hungry. Solid foods can be offered after ingestion of some breast milk or formula to help the infant associate solids with a pleasurable activity. A healthy infant should not be offered solid food in a bottle due to choking hazard and because it deprives the infant of learning new tastes and mastering a new developmental task. Parents should be encouraged to develop a structured routine by feeding the child in the same manner and location as often as possible.

The FLACC pain scale assesses which of the following factors? A) patient's movement while observed in bed B) patient's rating of pain with cartoon faces C) parent's report based on a numeric score D) changes in vital signs from baseline

A) patient's movement while observed in bed The FLACC scale is a behavioral pain assessment tool that is used primarily with infants and nonverbal children. This tool scores the patient's Facial expression, Leg positioning, Activity, Cry and Consolability. The FLACC scale accounts for the child's movement in bed when assessing his/her activity. The FLACC tool does not assess changes in vital signs or the patient's or caregiver's numeric scoring report of pain. The FACES scale is used by children 3 years of age and older as a self-reported pain assessment tool and utilizes 6 cartoon faces to represent a range for rating pain from no pain to worst pain.

Which of the following is the MOST concerning electrolyte abnormality resulting from treatment of diabetic ketoacidosis (DKA)? A) hypochloremia B) hypokalemia C) hypercalcemia D) hyperphosphatemia

B - hypokalemia Even though patients in diabetic ketoacidosis (DKA) may present with high, normal, or low potassium levels, once treatment is begun the development of hypokalemia occurs. As a consequence of both insulin treatment and correction of acidosis, potassium shifts into cells and out of the bloodstream resulting in decreased serum levels of this essential ion. Potassium replacement therapy is required and must be closely monitored, since abrupt changes in serum potassium concentration can precipitate cardiac arrhythmias. DKA usually results in severe fluid deficits that must be carefully corrected with gradual replacement of fluids and electrolytes. Fluid overload can result in cerebral edema. Hypophosphatemia may occur during treatment of DKA and phosphate administration is often added to counteract this imbalance. If phosphorus is added, the serum calcium must be monitored because of the risk of hypocalcemia. In most cases of DKA, hyperchloremic metabolic acidosis occurs, although the excess chloride is usually of no clinical significance or danger.

3-month-old Johnnie, has a diaper rash. Which of the following should the mother be instructed to do? A) Wipes containing alcohol should be used. B) Change diaper as soon as soiled and at least every 2 hours during the day. C) Use hot water to cleanse the perineal area. D) Leave barrier products on all day.

B) Change diapers as soon as they are soiled and at least every 2 hours during the day. Rationale: Keeping wet/soiled diapers away from the skin promotes healing. Domain: Dermatologic Conditions

The nurse is caring for a pediatric patient admitted to the hospital. Which of the following practices best promotes family centered care for this patient? A) Allowing the child to sleep through vital signs. B) Delaying interdisciplinary rounds until the family is available. C) Encouraging the family to bring the child's comfort items from home. D) Retiming medications to match the child's home routine.

B) Delaying interdisciplinary rounds until the family is available. Rationale: Having the family attend rounds promotes information sharing and collaboration, two key components of family centered care. Domain: Growth & Development

Muffled and hoarse speech is most commonly heard when assessing which of the following conditions? A) Croup B) Epiglottitis C) Asthma D) Cystic fibrosis

B) Epiglottitis Rationale: Muffled, hoarse or absent speech is commonly seen in the epiglottitis. Domain: Respiratory Conditions

Which of the following is NOT a reason that infants are more susceptible to dehydration than adults? A) Increased metabolic demands B) Higher percentage of intracellular water C) Greater ratio of body surface area to body weight D) Higher rate of insensible water loss

B) Higher percentage of intracellular water Rationale: Infants have a higher percentage of extracellular water than adults. Domain: Renal and Genitourinary Conditions

Which of the following dietary modifications is indicated for a school-age child with cystic fibrosis who is complaining of frequent frothy, fatty, foul smelling stools? A) open the enzyme capsules and sprinkle the powder on food B) add extra pancreatic enzymes when a high fat meal is consumed C) restrict high fat meals and chew the pancreatic enzymes thoroughly D) pancreatic enzymes should be taken between meals for better absorption

B) add extra pancreatic enzymes when a high fat meal is consumed Rationale: Management of cystic fibrosis (CF) includes decreasing the frequency of bulky, fatty, frothy, and foul-smelling stools. Children with CF generally require a high-protein, high-calorie diet, and fat is usually unrestricted because intestinal absorption is impaired. Due to pancreatic insufficiency, pancreatic enzymes are required and when high fat meals are consumed, extra enzymes should be given. The enzymes are provided in capsules filled with enteric coated beads, which should not be chewed or crushed as it can lead to their inactivation and excoriation of the oral mucosa. Enzymes should be taken within 30 minutes of meals to ensure their mixing with foods in the duodenum. Although sprinkling the capsule contents on food is sometimes necessary with younger children, this should be done cautiously because inhalation may trigger a bronchospasm. There is risk that when sprinkled on food, the enzymes may not work as effectively as swallowing the capsule. It is also important to sprinkle on foods that will not require chewing, such as applesauce.

Which of the following interventions is MOST likely to promote continued normal development for a toddler who is hospitalized for an extended period? A) encouraging caregivers to room-in with the child B) arranging for safe exploration of the environment C) facilitating interaction with children of a similar age D) providing projects that can be successfully completed

B) arranging for safe exploration of the environment. Rationale: Achieving autonomy is the primary developmental task of the toddler. Hospitalization can interfere with the development of autonomy when the toddler's ability to explore the environment is limited. Providing opportunities for the toddler to safely explore the surroundings promotes a sense of autonomy and facilitates learning. These opportunities may include expanding the toddler's environment by visiting the playroom, taking wagon rides on the unit, or planning off-unit excursions. If the need for isolation or other aspects of the child's health status make these kinds of activities impossible, it is still important to provide choices of age-appropriate play activities within the child's room. For a toddler, this may include playing with stacking toys, blocks, punching balloons, or other energy expending activities. While toddlers enjoy being with other children, they tend to engage in parallel play with limited interaction. Interacting with peers is much more important to the school-age child and adolescent. School-age children need to be able to successfully complete designated projects, which is why activities such as model building can be helpful to their development of a sense of industry during hospitalization. In contrast, it is important for toddlers to have unstructured activities. This allows the child to make more choices, contributing to a sense of control. Although rooming-in is an appropriate intervention for children of all ages, developmentally this need is most closely related to the infant's task of establishing trust. Even with the presence of caregivers and rooming-in, extended hospitalization can negatively affect a toddler's progression in the development of autonomy.

Which of the following actions should be the INITIAL response when there is concern that a family may have given UNINFORMED consent? A) relay concerns to the unit manager B) confirm the caregivers' understanding C) explain the risks related to the procedure D) suggest caregivers list questions for the healthcare provider

B) confirm the caregivers' understanding Rationale: Advocacy for the child and caregiver is an essential role in pediatric nursing. When the nurse is concerned that the caregivers do not have an adequate understanding of a procedure requiring informed consent, the nurse must serve as the advocate and act to address this concern. This process begins with assessing or confirming the families understanding, which will include asking them pertinent questions. It may be necessary to have the healthcare provider return if the family remains uncertain in their understanding. Consent includes an understanding of the right to refuse, which is always important to convey, but especially important to reinforce when the family is lacking confidence with their understanding.

A child is admitted for pneumonia. The parents, who are from Southeast Asia, acknowledge that the bruising on the child's back is caused by cupping used to treat their child's respiratory symptoms. The MOST appropriate response is to A) ask the family to rate the effectiveness of the cupping. B) develop a mutually agreed upon goal for the child's care. C) explain how the bruising can be considered potential abuse. D) provide instruction on alternative therapies for airway clearance.

B) develop a mutually agreed upon goal for the child's care Rationale: Certain cultural practices can be misinterpreted by healthcare providers as child abuse and while it may be important for the family to understand this risk, it is essential that the family does not feel that their cultural practices are being judged. Conveying that the practice of cupping is non-therapeutic and harmful will most likely block further communication and could result in parental rejection of healthcare practitioner recommendations for alternative therapies. Generally, the practice of cupping does not cause infection or long-term harm. The healthcare provider's approach to the family in a culturally sensitive manner should include focusing on developing a mutually accepted goal for the child's treatment.

When an infant is admitted for failure to thrive, which is the PRIORITY family assessment? A) current housing status B) family financial situation C) educational level of the primary caregiver D) family member who has the most authority

B) family financial situation Rationale: The term failure to thrive (FTT) refers to inadequate growth in infants and children, typically related to insufficient weight gain. Multiple factors may contribute to FTT including developmental or physical disabilities, malabsorption disorders, and alterations in metabolism. FTT may also be due to neglect, abuse, lack of appropriate caregiver interaction, or a caregiver's knowledge deficit or mental health problems. When a child presents with FTT, a thorough physical assessment and comprehensive family assessment is warranted. Research reveals that poverty is the single greatest contributing risk factor for failure to thrive in both developed and developing countries. The family's financial status should be assessed in relation to the ability to meet the needs of the child, including nutritional requirements. Multidisciplinary interventions should be considered including referrals to social services for potential sources of financial assistance and possible home nursing visits.

Among adolescents, the GREATEST risk factor for suicide is: A) a history of substance abuse B) having an active psychiatric disorder C) a family history of domestic violence D) having interpersonal problems with parents

B) having an active psychiatric disorder Rationale: Suicide is currently the third leading cause of death during adolescence, surpassed only by motor vehicle crashes and homicides. Although family and social factors have been implicated in suicide, and substance abuse is also a strong risk factor, the single most important factor associated with suicide is the presence of an active psychiatric disorder. This includes depression, bipolar disorder, and psychosis, among other psychiatric conditions. Although all adolescents should be screened for suicidal thoughts, it is especially critical for those diagnosed with psychiatric conditions.

When a 7 week old is admitted after an acute life threatening event, which of the following details in the history increases concern regarding the risk of abuse as a possible precipitating cause of the event? A) difficulty breathing B) inconsolable crying C) listlessness D) vomiting

B) inconsolable crying Rationale: Caregiver frustration when an infant's crying seems inconsolable has been shown to be a risk factor in abusive head trauma (AHT), also known as shaken baby syndrome. Colic is often cited as the cause of prolonged, inconsolable crying in young infants when there is no identifiable cause and the infant is growing and gaining weight satisfactorily. In order to mitigate potential abuse resulting from caregiver frustration, it's important to educate parents regarding the nature of the infant's crying, reassure that colic typically resolves spontaneously around 3 to 4 months of age, and suggest methods to help parents cope effectively with the situation. Vomiting, listlessness, and difficulty breathing are not known risk factors for abuse but may be symptoms associated with other possible underlying causes of an acute life-threatening event (ALTE). Vomiting, listlessness, poor feeding, and irritability are symptoms that can occur as a result of AHT rather than precipitating factors and may be mistaken as common infant ailments.

Which of the following strategies BEST demonstrates a family's effective coping with the management of their child's long-term chronic illness? A) devote time and resources to researching possible new cures B) obtain help from others with burdens imposed by the chronic illness C) focus the family's energies and attention on the needs of the child that is ill D) plan for child's future mirroring the expectations for other children in the family

B) obtain help from others with burdens imposed by the chronic illness Rationale: An effective long-term coping strategy of families who have children with a chronic disease is the sharing of the burdens of chronic illness with other people, both in and outside the family. This strategy has been found to raise the level of family functioning amid ongoing stress associated with a long-term severe chronic illness. In addition to the practical assistance, emotional support, and respite care families require, nurses can provide information regarding expectations for the child with the chronic illness and help in coordinating health and social services. Caregivers of a child with a chronic illness should be regarded as experts in the care of their child, consulted regarding the best methods of managing the child's care, and offered expressions of appreciation for a job well done. Ineffective or avoidance behaviors of families living with chronic illness include placing complete faith in religion that results in inaction, entertaining future plans for the adolescent without regard for how the illness impacts those plans, or failing to make changes in the family's lifestyle to address other family members' needs. These avoidance or denial behaviors result in moving away from adjustment to the crisis.

Based on patient data provided during the shift report, prompt nursing assessment is a PRIORITY for which of the following children? A) preschooler with leukemia scheduled for chemotherapy later today but complaining of a sore throat. B) school-age child with asthma having moderate retractions and an SaO2 of 90% on room air. C) school-age child with postoperative pain reported as 7 out of 10 after an appendectomy. D) adolescent with diabetes requesting insulin before eating breakfast.

B) school-age child with asthma with moderate retractions and an SaO2 of 90% on room air. Rationale: Among the four children, the priority is the child with asthma who is exhibiting symptoms of a worsening respiratory status. The earlier a respiratory deterioration is identified, the better the opportunity for timely treatment and the prevention of further decline. Therefore, this child should be assessed FIRST. While the other children's needs are important, they do not have the same immediacy as the child with the decline in respiratory status. A sore throat in an immunocompromised child scheduled for chemotherapy requires further evaluation, and it may be necessary to hold the treatment. However, the chemotherapy is scheduled for later in the day so there is sufficient time to assess the child. The pain reported in the child who is post appendectomy is important and requires evaluation but does not constitute an emergency. The child with diabetes can be allowed to eat prior to the oncoming nurse's assessment, since insulin can be administered following the meal, if necessary.

A 14 month old boy is admitted to the hospital with a Hb of 5.0 g/dL. When completing the nursing history, what is an expected history finding with this patient admitted with iron deficiency anemia? A) "My son is a very picky eater. He love his cereal and will eat chicken fingers but does not eat many vegetables." B) "My son is a very active boy and goes to daycare full time since I am a full-time working mother." C) "My child loves milk! We make sure he gets a fill bottle of milk with each meal and he also may have some with his snacks. He just cannot get enough of it!" D) "My child is relatively healthy except for the recent upper respiratory congestion that he has had."

C) "My child loves milk! We make sure he gets a fill bottle of milk with each meal and he also may have some with his snacks. He just cannot get enough of it!" Rationale: Milk does not contain sufficient dietary iron and a child who has excessive milk intake may not be consuming adequate amounts of iron in their diet from iron rich or iron fortified foods such as cereals. Domain: Hematologic Conditions

Which of the following parental statements regarding their adolescent child is MOST indicative of potential illicit drug use? A) "Our teen has blood shot eyes and has been sleeping excessively the past few weeks." B) "We are concerned about our child's erratic mood swings and recent poor grades." C) "Some prescription pain medication is missing from the medicine cabinet." D) "Our younger child has been prescribed a stimulant for ADHD."

C) "Some prescription pain medication is missing from the medicine cabinet." Rationale: Early identification of adolescent use or experimentation with illicit substances is essential for prevention and treatment. The American Academy of Pediatrics recommends the use of validated screening tools to assess for adolescent substance use as part of routine healthcare. One widely used screening tool is the CRAFFT (Car, Relax, Alone, Friends/Family, Forget, Trouble), which quickly assesses for problems related to substance use, although it is not a diagnostic tool. Nonspecific characteristics are often the first symptoms noted by family and friends. These may include scleral injection, changes in sleep habits, erratic mood swings, and deteriorating academic performance. While these are all potential warning signs of illicit drug use, each sign taken individually does not point directly to drug abuse. However, the more signs that are present, the more likely the adolescent is using drugs. Of most concern is the fact that prescription pain medication is missing from the home. Adolescent use of prescription drugs for nonmedical purposes has reached epidemic proportions in the U.S. Since these drugs are often prescribed for adult family members following surgery or other procedures, they are easily obtainable from the home medicine cabinet. Consequences of opioid misuse include addiction, overdose, and death. In a study reported in the American Academy of Pediatrics' journal, "Safe Storage of Opioid Pain Relievers Among Adults Living in Households with Children", it was identified that storage practices for opioid pain relievers (OPR) are suboptimal contributing to unintentional poisonings in younger children and increasing the risk of nonmedical use among older children. In this study of 681 adults who had OPR use in the last year and had children living in their home, 32.6% of respondents with children ≤ 6 years reported using locked storage for their OPR, while only 11.7% with children 7 to 17 years used lock storage. Among the study's conclusion was that more research was needed to determine effective means of storing OPR and how to promote their adoption among households with children. While anticipatory guidance for families of young children routinely includes measures to prevent access to medications, this same guidance is important for families of older children. If substance abuse is suspected, a mental health referral for the child and family is indicated. Community-based counseling may be beneficial in addressing issues that factored into the adolescent's vulnerability to use drugs, as well as to resolve family issues and to facilitate changes in behavior and lifestyle. In option C, the younger sibling's ADHD medication also needs to be stored safely.

Parents preparing for discharge with their newborn are asked about their concerns. Which of the following comments made by the father should be addressed FIRST? A) "Both sets of grandparents smoke." B) "My wife seems to be depressed lately." C) "We need to make sure the formula lasts until I get paid." D) "We don't agree on whether to have our son circumcised.

C) "We need to make sure the formula lasts until I get paid." Rationale: According to Maslow's hierarchy, the most fundamental human needs are physiological, including air, food, water, warmth, and rest. Therefore, although each of the options reflect a situation that needs to be addressed, food insecurity is the most basic physiological need and must be satisfied first. Programs like Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP) are available to assist families who are concerned about the ability to feed their infant. It is also important to address this concern as new parents may think that it is acceptable to dilute formula to help stretch the supply and thereby put the infant at risk for hyponatremia. Issues of potential exposure to second-hand smoke from extended family members, possible post-partum depression, and decisions regarding infant circumcision all require intervention, but are not as life-threatening as food insecurity.

An infant weighing 7.5 kg has IV fluids ordered for 1.5 times the maintenance rate. How many mL of fluid should be given over a 24-hour period? A) 375 mL B) 750 mL C) 1125 mL D) 1500 mL

C) 1125 mL Rationale: Approximately 75% of a newborn's total body weight is water and 50% of the fluid is extracellular, which is lost more easily than intracellular fluid. Therefore, infants are at much greater risk for fluid loss than older children. Infants also have little reserve, which increases their risk for dehydration during episodes of fluid loss, such as vomiting or diarrhea. When fluid replacement is necessary, the pediatric nurse is expected to calculate and verify accurate fluid volumes. Intravenous fluids delivered at the maintenance rate for an infant weighing 10 kg or less is 100 mL/kg/24 hours. The correct calculation for maintenance fluids for this child weighing 7.5 kg is then 750 mL/day. This infant's order is for 1.5 times maintenance, which is: 750 mL (maintenance) + 375 mL (1/2 maintenance) = 1125 mL

Which of the following children is MOST at risk for the development of slipped capital femoral epiphysis? A) 7 year old female with congenital adrenal hyperplasia B) 10 year old female with a mid-femur fracture C) 13 year old male receiving growth hormone therapy D) 17 year old male with Klinefelter syndrome

C) 13 year old male receiving growth hormone therapy Rationale: Slipped capital femoral epiphysis (SCFE) is a spontaneous displacement of the proximal femoral epiphysis. The majority of cases are idiopathic. However, it occurs most frequently during periods of accelerated growth and is a risk associated with growth hormone therapy. Other risk factors for SCFE include male gender, obesity, and the onset of puberty. There is no correlation between SCFE and femur fractures that do not occur at the epiphyseal plate, congenital adrenal hyperplasia, or Klinefelter syndrome.

Your patient is an infant with a diagnosis of gastroesophageal reflux (GER). You are teaching the parent regarding the best time to administer her ranitidine (Zantac). You teach her to: A) Administer the medication right before you feed the baby to optimize the effect. B) Administer the medication after the baby eats so you don't upset her stomach. C) Administer the medication 30 minutes before feeding to maximize the benefits. D) Administer at night before the baby goes to bed.

C) Administer the medication 30 minutes before feeding to maximize the benefits. Rationale: Medications are administered 30 minutes prior to feeding to maximize the benefits of the medication. Domain: Gastrointestinal Conditions

Eli has been running a fever between 99.5-99.8 degrees the last couple of days. Eli's mother is worried. He is acting fine. What should his mother do? A) Give the child acetaminophen or ibuprofen. B) Give the child aspirin since he is over 8 years old. C) Continue to monitor the fever and comfort level of the child.

C) Continue to monitor the fever and comfort level of the child. Rationale: Eli is running a low grade fever that does not require medication unless the fever increases and is >101 degrees F (38.5C), or he complains s of any discomfort. Giving antipyretics can mask other symptoms of infection. Domain: Immune System Dysfunction

To promote culturally sensitive care as a part of the nursing plan it is MOST important to A) determine the race, culture, or ethnicity of the family. B) follow standard guidelines provided for the family's culture. C) ask open-ended questions about the family's values and beliefs. D) ensure care focuses on the family's perceptions of the child's needs

C) ask open-ended questions about the family's values and beliefs Rationale: Holistic care optimally considers the child and family's sociocultural background. The best way to learn a family's values, cultural needs, and health beliefs is through open-ended questions so the child and family members can share what is important to them and how best to do things related to patient care. A key part of assessment is to learn from the family their beliefs, values, and preferences so these can be incorporated into the plan of care. If the plan is congruent with their values, it is more likely to be followed resulting in better patient outcomes and a higher level of satisfaction. Differences within a culture are often more abundant than those between cultures, so it is wise to avoid making assumptions or referring to stereotypes as they will seldom prove helpful in understanding a family or patient. While important information is available regarding guidelines for approaching families and patients of different cultural backgrounds, it is important to understand the family's unique views, experience, and needs. The family's perception of the child's needs must be taken into consideration when providing care, but the focus of care is based on assessment of the child.

Extravasation of a chemotherapeutic agent has occurred at a child's peripheral IV insertion site. After stopping the infusion, which of the following actions is MOST appropriate? A) apply warm compresses B) apply pressure to the insertion site C) disconnect the tubing leaving IV catheter in place D) remove the IV catheter and notify the healthcare provider

C) disconnect the tubing leaving IV catheter in place Rationale: Many chemotherapeutic agents are vesicants capable of causing tissue necrosis. Extravasation is the term used when a vesicant medication infiltrates subcutaneous tissue. If extravasation occurs, the IV catheter should initially be left in place in order to facilitate aspiration of any residual medication from the device and to infuse an antidote if indicated. The IV tubing should be disconnected and an empty syringe attached. Pressure should not be applied to the insertion site as this could cause the vesicant to disperse further. Warm compresses are contraindicated for most chemotherapeutic agents since heat induces vasodilation, which could lead to increased absorption and distribution of the cytotoxic medication. Instead, cold compresses are used to help alleviate discomfort and tissue irritation. There are topical, subcutaneous, and intravenous antidotes available for many chemotherapeutic agents. Antidotes are administered around the area of extravasation in order to decrease tissue damage. The healthcare provider should be notified prior to removing the IV catheter so that an antidote may be administered, if prescribed.

An adolescent with a chronic illness expresses frustration in managing the unceasing treatment regimen. Which of the following suggestions is MOST appropriate to discuss with the child and caregiver? A) explain to the adolescent the potential consequences of non-adherence B) encourage the caregiver to assume primary control of disease management C) encourage shifting the responsibility from the child to the caregiver on occasion D) allow a short-term holiday from treatment while maintaining contact with the health care provider

C) encourage shifting the responsibility from the child to the caregiver on occasion Rationale: Ongoing motivation to adhere to a regimen is difficult. Encouraging temporary shifting of responsibility is a strategy that provides an important respite. Foregoing treatment options, even for a short time, is not acceptable as this places the child's health at risk. Although the child does need to understand the implications of the disease, explaining the consequences of non-adherence does not typically foster compliance in adolescents. The adolescent's independence in self-management is the key to close control and should be encouraged with appropriate support.

When auscultating heart sounds, a normal sinus arrhythmia can be distinguished from an abnormal arrhythmia by asking children to A) breathe normally. B) breathe slowly. C) hold their breath. D) take deep breaths.

C) hold their breath. Rationale: A normal sinus arrhythmia is common in children. It is a benign condition in which the heart rate varies with inspiration and expiration. Heart rate tends to increase slightly with inspiration and decrease with expiration. This variability is thought to improve energy efficiency in ventilation and perfusion by inhibiting unnecessary heart beats during periods of lower blood oxygenation. Although this is a normal finding, children with respiratory sinus arrhythmias are routinely referred for unnecessary cardiology evaluation. Familiarity with identifying this rhythm can help decrease healthcare costs. When assessing children, asking them to hold their breath during cardiac auscultation will help differentiate whether an arrhythmia is a true abnormal arrhythmia or a benign finding. During this momentary cessation of breathing, the heart rate will remain steady if the irregularity is a normal sinus arrhythmia.

A toddler is admitted with an altered level of consciousness, light sensitivity, and vomiting. Assessment findings include a purpuric rash to both lower extremities. The INITIAL response should be to A) administer ordered antibiotics and antiemetics. B) obtain immunization and admission data. C) implement isolation precautions D) prepare for a lumbar puncture.

C) implement isolation precautions. Rationale: Clinical manifestations of bacterial meningitis can include fever, chills, headache, photophobia, alterations in sensorium, irritability, nuchal rigidity, and a purpuric rash to lower extremities. When bacterial meningitis is suspected, it is critical that the healthcare team immediately initiate the appropriate isolation precautions. Meningococcal meningitis is readily transmitted by droplet infection from nasopharyngeal secretions. While infant immunizations have decreased the incidence of bacterial meningitis in children, over 75% of cases are still in children under the age of 5. Preparing the child for lumbar puncture, administering medications, and obtaining immunization / admission data are all important, but should be done after the appropriate isolation precautions are implemented.

A child with sickle cell disease (SCD) is in vasoocclusive crisis with severe lower extremity pain and a fever of 102° F (39° C). Which of the following interventions should be anticipated as the MOST appropriate management of the crisis? A) antibiotic to treat probable infection B) oxygen administration to reverse the sickling C) intravenous fluids to promote adequate hydration D) ibuprofen to reduce the temperature and decrease pain

C) intravenous fluids to promote adequate hydration Rationale: Adequate hydration to prevent further sickling and delay the vasoocclusion and hypoxia-ischemia cycle is the most important intervention for sickle cell crisis. It should be anticipated that a child in pain is not likely to feel well enough to ingest sufficient fluids or foods. Therefore, intravenous fluid orders are expected at a rate higher than maintenance. Although infection must always be ruled out, fever in the absence of infection is a common presenting symptom during sickle cell crisis. When mild to moderate pain is reported, acetaminophen or ibuprofen may be used, but is not the priority treatment. Often severe pain is not controlled with acetaminophen or ibuprofen alone and opioids are added. Short-term oxygen therapy is helpful if the child is experiencing respiratory difficulty and while it may help to prevent further sickling, oxygen will not reverse sickling that has already occurred.

A school-age child with Grave's disease is experiencing elevated thyroid levels. Which is the MOST appropriate guidance related to the child's activity? A) allow continued participation in usual play and sports activities B) restrict vigorous activity to no more than one hour a day C) limit activity to attending school for classwork D) restrict to bed-rest with bathroom privileges

C) limit activity to attending school for classwork Rationale: Graves' disease is the most common cause of hyperthyroidism in children. Signs and symptoms include weight loss, increased resting heart rate, and elevated blood pressure. The choice of treatment is controversial due to the various side effects associated with available treatment options. Typically, initial therapy consists of antithyroid drug (ATD) administration. Many children experience complete remission after one to four years of ATD therapy. If remission does not occur, partial destruction of the thyroid gland with radioiodine or a subtotal thyroidectomy may be considered. While on ATD, periodic dosage adjustments are frequently required, primarily due to the child's changes in growth. Since laboratory values of thyroid hormone fluctuate, dosage is based on clinical presentation as well as thyroid levels. If a child is exhibiting signs and symptoms of hyperthyroidism, activity should be limited to school attendance only. A consultation with the child's teacher is important to emphasize the need for the child to remain quiet and get adequate rest. Due to the dangers associated with tachycardia, dyspnea on exertion, heat intolerance, and diaphoresis, vigorous exercise is restricted until thyroid levels are decreased to normal or near-normal values

The prophylactic administration of penicillin in children with sickle cell disease beginning at 2 months of age is effective in decreasing the risk of: A) acute chest syndrome (ACS) B) meningococcal sepsis C) pneumococcal infection D) vasoocclusive crisis

C) pneumococcal infection Rationale: The poorest prognosis for a child with sickle cell disease (SCD) is generally within the first 3 years of life, and the majority of deaths in this age group are due to overwhelming infection. Oral penicillin prophylaxis is recommended beginning at 2 months of age to reduce the risk of pneumococcal sepsis. It is also recommended that children with SCD receive pneumococcal and meningococcal vaccines, as well as a yearly influenza vaccine. Several research studies have tested the effectiveness of using only the pneumococcal vaccine as opposed to combining the vaccine with prophylactic oral penicillin. Each study provided evidence that the combination of routine vaccines plus an oral penicillin regimen is more effective for children with SCD. Most experts recommend continuing penicillin prophylaxis through 5 years of age.

For a school-age child who is dying, which approach BEST encourages the child to convey emotional needs? A) arrange for peer visits to promote opening up to friends B) ask straightforward questions regarding how the child is feeling C) provide opportunities for the child to express feelings through play and art D) have caregiver discuss feelings and share the child's responses with the healthcare team

C) provide opportunities for the child to express feelings through play and art Rationale: For many children, talking about their feelings is difficult. Direct questions regarding their emotions often prove to be more stressful than therapeutic for children. Instead, use of books, games, art, play and music provide a means of stimulating dialog and is an effective technique to communicate with a dying child. For example, asking a child to draw a self-portrait can be especially enlightening as it enables the child to express feelings in a nonverbal format and may open up conversation as the child explains the drawing. It's important to be accepting of whatever emotion is expressed. Any questions asked by the child should be answered honestly and accurately at the child's developmental level. Communicating with caregivers and encouraging peer visits are appropriate interventions, but not the best approach for determining the child's emotional needs.

Parents of a child on life-support after a traumatic brain injury need to be approached about transitioning to endof-life care. Which of the following is MOST appropriate when introducing this transition? A) ensure a clergy member of their faith is present B) inform that most insurance covers palliative care costs C) reassure that the change in care does not mean abandonment D) discuss the need to confirm a Do-Not-Resuscitate (DNR) status

C) reassure that the change in care does not mean abandonment Rationale: When the focus of care transitions to end-of-life care, family members can often be concerned about abandonment by the healthcare team. Reassurance should be offered that the child and family are not being abandoned, but care is being focused on the comfort of the child throughout this phase. There are important issues that may need to follow this introduction, such as establishing a Do-Not-Resuscitate (DNR) status (also referred to as "allow natural death"), and organ or tissue donation, but those discussions should be separate. While access to clergy may be important to some families, especially as they begin to process the implications of this transition, it is not critical that the clergy be present for the initial discussion. The team should be prepared to provide information on services, such as hospice care, that can provide support throughout the end-of-life.

The BEST way to assist an adolescent with muscular dystrophy in achieving a sense of identity is to A) facilitate achievement of future educational goals. B) discuss potential career options with the child and family. C) support participation in appropriate peer-related activities. D) enhance physical capabilities through an at-home exercise program.

C) support participation in appropriate peer-related activities. Rationale: During the adolescent period, children struggle to achieve a sense of identity. A key feature in shaping an adolescent's sense of self is interaction with others. Due to diminished physical capabilities, children with muscular dystrophy (MD) tend to become socially isolated at the age when they most need outside relationships. Appropriate peer-related activities are critical to the adolescent's development of identity. Online communities accessed through social media is one means of facilitating social connections. Because MD is a fatal disease, it is inappropriate to focus on long-term plans such as career and educational goals. At-home exercise is an important treatment component but does not promote peer interaction.

A child admitted with severe dehydration has received a normal saline fluid bolus. Which of the following assessments is the HIGHEST priority before implementing an order to change to an IV fluid with added potassium? A. intravenous insertion site B. level of consciousness C. urinary output D. heart rate

C) urinary output Rationale: In severe dehydration, there is reduced blood flow to the kidneys which results in little to no urinary output. Since potassium is cleared by the kidney, administration of potassium prior to the restoration of kidney function could result in cardiac arrhythmias and death. Adequate urinary output provides evidence that fluid volume has been restored, resulting in sufficient circulation to the kidneys to reestablish organ function. Therefore, it is imperative to assess urinary output prior to administering solutions which contain potassium. Although heart rate should be monitored closely due to the effects of both hypo- and hyperkalemia on cardiac rate and rhythm, neither tachycardia nor bradycardia would necessitate withholding potassium. In a child with hypokalemia, administration of potassium may be required to correct cardiac dysfunction. Drowsiness and changes in level of consciousness are also possible manifestations of hypokalemia and would not necessitate withholding administration of potassium solutions. It is important to assess the patency of the IV insertion site since potassium is a vesicant that could cause extravasation and tissue necrosis if infiltration occurs. However, peripheral tissue necrosis is not as life threatening as cardiac arrhythmia and potential cardiac arrest. Therefore, urinary output would be the priority assessment over IV insertion site.

Which of the following communications made by the nurse to a parent BEST reflects family-centered care? A) "You do the bath and change the linen and I'll give the meds." B) "I'll give your child a bath, so you can relax while you're here." C) "While I give your child a bath, would you like to get breakfast?" D) "Are you comfortable giving your child a bath or do you want help?"

D) "Are you comfortable giving your child a bath or do you want help?" Rationale: Asking the parent if they are comfortable in sharing in the daily care of their child promotes equal responsibility, collaboration, and partnership. It gives the parents the opportunity to decide if they are ready or comfortable with participating in their child's care as opposed to having it delegated to them by the nurse. In the other options, the nurse controls and directs the activities either by taking over and undermining the role of the parent, excluding the parent from the child's care, or acting like a host and treating the parent like a guest.

Which of the following indicates a successful teaching for the parents of the child with tracheostomy during discharge? A) "I need only one extra same size trach at the bedside." B) "I need to allow two fingertips between ties and neck." C) "I insert suction catheter until obstruction is felt." D) "I set the suction machine to 80-100mmHg."

D) "I set the suction machine to 80-100mmHg." Rationale: Suction machine should be set to 80-100mmHg. Do not insert suction catheter until obstruction is felt, as this will cause trauma. There is an extra same size trach and a size smaller required at bedside. Trach tie should allow only one fingertip between ties and neck. Domain: Respiratory Conditions

You are a nurse in a pediatric clinic and are performing teaching with a patient and parents of a child with sickle cell disease who is taking hydroxyurea. Which of the following statements by the patient's parents indicate that more teaching is needed? A) "Supplementation with iron will not help to decrease my child's sickle cell anemia" B) "I will ensure my child is dressed appropriately when the weather is cool and they are dried off quickly after getting out of the pool" C) "If my child has a fever, I will call his/her hematologist immediately" D) "I will be sure not to give my child ibuprofen due to the risk of bleeding"

D) "I will be sure not to give my child ibuprofen due to the risk of bleeding" Rationale: NSAIDS are an appropriate pharmacologic intervention for children with sickle cell disease. The other statements are correct: in sickle cell disease, anemia is caused by hemolysis, not by a deficiency of iron. In fact, some children may be at risk for iron overload if they have received multiple transfusions. Drying off a child quickly and protecting from cool/cold weather can prevent a vaso-occlusive crisis. Fevers require immediate attention in children with sickle cell disease due to their risk for infection and functional asplenia as they progress through childhood. Domain: Hematologic Conditions

In addition to screening for suicide risk at each health care encounter with an adolescent, which question is MOST important to ask? A) "How do you like to spend your free time?" B) "What do you like best and worst about school these days?" C) "How much sleep do you usually get on school nights?" D) "What problems are you dealing with in your close relationships?"

D) "What problems are you dealing with in your close relationships?" Rationale: Because adolescents are typically seen for episodic care, each encounter should be considered a health promotion opportunity regardless of the reason for the visit. Although generally accompanied by a caregiver, it is important to also speak privately with the adolescent. Establishing rapport should be the initial priority in order to gain trust and elicit honest responses. Since time is often limited, it is important to prioritize which topics to address. Screening for safety issues is of primary importance with adolescents. Due to the high incidence of suicide, adolescents should be evaluated for suicide risk at each visit. Risk factors include a history of depression or other mental health disorder, substance abuse, and changes in behavior. Interpersonal violence is also a serious threat to adolescent safety. The term "dating violence" is often used to describe interpersonal violence that occurs in the adolescent population. To screen for dating violence, ask what is going well and is not going well in intimate relationships. Ask if the adolescent ever feels unsafe when on a date, with friends, at school, or at home. Recognize risk factors, such as alcohol and drug use, which are often associated with interpersonal violence. Provide information regarding community resources to contact and where adolescents can go if they feel unsafe or are hurt. Additional teaching topics pertinent to adolescents include vehicle safety, sports injury prevention, contraception and sexual health, the importance of adequate sleep, nutrition, school performance, and planning for the future.

Which of the following children is at HIGHEST risk for the development of dyslipidemia? A) 3 year old with congenital adrenal hyperplasia B) 6 year old with amyloidosis C) 8 year old with diabetes insipidus D) 11 year old with type 2 diabetes

D) 11 year old with type 2 diabetes Rationale: Dyslipidemia refers to abnormalities in the lipid profile such as elevated total cholesterol, LDL cholesterol, or triglycerides, and/or low levels of HDL cholesterol. These abnormalities are associated with atherosclerosis and coronary artery disease. Dyslipidemia is a common co-morbidity in children with type 2 diabetes. If a family history of high cholesterol or cardiovascular disease exists, a lipid profile should be obtained at diagnosis. If there is no family history, a lipid panel should be obtained at puberty as risk increases with age. Treatment of dyslipidemia in children begins with dietary and lifestyle modifications. None of the other listed disorders are known risk factors for dyslipidemia.

A school-age child is admitted to the hospital with a diagnosis of acute lymphoblastic leukemia. The nurse formulates a nursing diagnosis of risk for infection. What is the most effective way for the nurse to reduce the child's risk for infection? A) Restrict visitors to the patient to only the parents. B) Maintain universal precautions. C) Require staff and visitors to wear masks. D) Practice thorough hand washing.

D) Practice thorough hand washing. Rationale: The nurse should take measures to decrease pathogens in the environment - hand washing is the best method. Domain: Childhood Cancer

Which caregiver behavior is MOST consistent with factitious disorder imposed on another (previously called Munchausen syndrome by proxy)? A) ignores child's discomfort and is emotionally distant B) is critical of medical care and blames staff for lack of recovery C) appears quiet, timid, and avoids eye contact with unfamiliar people D) appears knowledgeable and seeks attention of the healthcare team

D) appears knowledgeable and seeks attention of the health team Rationale: Factitious disorder imposed on another (previously called Munchausen syndrome by proxy) is a relatively rare psychological disorder in which a caregiver, usually the mother, fabricates illness in a child. It is a form of child abuse where the caregiver invents, exaggerates, or induces signs and symptoms in order to make the child appear sick. Presenting symptoms are usually vague and witnessed only by the perpetrator. Harmful medical interventions and painful invasive procedures are often encouraged by the caregiver, whose behaviors toward the healthcare team are frequently attention-seeking and manipulative. Perpetrators typically have some exposure to the medical field and act in an assertive, competent manner that may be quickly accepted by medical professionals. The child abuser will often feign care and concern for the child during medical treatment and are generally attentive to the point of refusing to leave the hospital. The diagnosis is confirmed when symptoms resolve after the child is separated from the perpetrator.

Which of the following is not an organ in the endocrine system? A) Adrenal gland B) Liver C) Pancreas

B) Liver Rationale: Liver. By definition, an endocrine gland secretes hormones. Domain: Endocrine/Metabolic Conditions

Hormone secretion is regulated by a feedback loop that is _________________. A) Corrective B) Negative C) Positive

B) Negative Rationale: Hormone secretion is regulated by a negative feedback loop. Domain: Endocrine/Metabolic Conditions

Which of the following interventions for a child with poison ivy would not help prevent a secondary infection? A) Using calamine lotion. B) Cool baths with oatmeal based products. C) Over the counter cortisol cream D) Wash resin from the clothes.

D) Wash resin from the clothes. Rationale: Scratching puts children at risk for secondary infections, washing resin from clothes will not help prevent itching. Domain: Dermatologic Conditions

You are preparing Cami, an 8-year-old for a Voiding Cystourethrogram (VCUG). What education would be most appropriate to prepare him for the procedure? A) "You will need to go to the bathroom before the procedure so they can see your bladder." B) "You will not need an IV, but you we will have to put a catheter in your bladder." C) "You have to remove your necklace before the procedure. Metal is not allowed in the procedure area." D) "We will inject a special medicine through your IV. The medicine might make you feel all warm, kind of like you peed yourself, but don't worry, you won't."

B) "You will not need an IV, but you we will have to put a catheter in your bladder." Rationale: A VCUG shows the bladder and surrounding anatomy with a full bladder and on emptying. Contrast is injected into the bladder through a catheter. A VCUG is an XRay, not a MRI, so metal is allowed, as long as it does not interfere with the area being imaged. Cami does not need an IV for this procedure. Domain: Renal and Genitourinary Conditions

You are teaching a cardiac defects class to a group of graduate nurses. You know the nurses understand the typical course of treatment for obstructive defects when they state... A) "Most patients do not require any intervention" B) "Immediate surgical intervention is required to sustain life" C) "Obstructive defects are treated with indomethacin" D) "Cardiac catheterization is the preferred approach"

D) "Cardiac catheterization is the preferred approach" Rationale: Obstructive defects include pulmonary stenosis, aortic stenosis, and coarctation of the aorta. Cardiac catheterization is the first approach at correction, although severe defects may require more in depth surgical intervention. Domain: Cardiovascular Conditions

In which situation is it appropriate to provide teaching about the principle of double effect for a family of a terminally ill child? A) child is receiving multiple antibiotics B) parents disagree about appropriate supportive measures C) child wishes to stop treatment and parents disagree D) parents are concerned that pain medications will cause child's death

D) parents are concerned that pain medications will cause child's death Rationale: The ethical principle of double effect applies when there is concern that administering high doses of opioids for pain control in the terminally ill child will likely cause death. The principle centers on the idea that there is one good effect and one bad effect of an act. The good effect must be the true intent of the act; the bad effect cannot cause the good effect, and therefore a justifiable reason exists to allow the bad effect to occur.

Which of the following explains why the pituitary gland is called the "master" gland? A) It controls the release of other hormones. B) It is responsible for the largest number of hormones. C) It secretes the largest amount of hormones.

A) It controls the release of other hormones. Rationale: It is called the "master gland" because it controls the release of hormones. Domain: Endocrine/Metabolic Conditions

A pediatric nurse can apply evidence-based practice by: A) Collecting data B) Participating in a research study C) Apply research to practice via creation of policies and development of clinical pathways D) Change practice by analyzing data collected

C) Apply research to practice via creation of policies and development of clinical pathways Rationale: Evidence-based practice occurs when a nurse applies current research to practice by creating or revising hospital policies and clinical pathways. Domain: Professional Role

A patient is having a generalized seizure. The nurse's first reaction is to: A) Notify the physician or healthcare provider B) Place the child on a firm surface and begin CPR C) Place a tongue blade in the patient's mouth D) Stay with the patient, position them on their side

D) Stay with the patient, position them on their side Rationale: The priority of care is to maintain a patent airway. Turning the patient on their side allows the tongue to move forward so it does not block the airway and saliva can drain freely and not pool at the back of the mouth. Domain: Neurologic Function

April, a 12 year old female with sickle cell disease is admitted with a pain crisis. Your nursing interventions include all of the following except A) Promoting pain management with ice packs to affected area B) Administering IV hydration C) Promoting ambulation D) Encouraging deep breathing and use of an incentive spirometer

A) Promoting pain management with icepacks to affected area Rationale: Ice may promote vaso-occlusion which may exacerbate the sickling process and worsen the vaso-occlusive crisis. Hydration, ambulation, and encouraging deep breathing and incentive spirometer use are all appropriate interventions to maximize patient outcomes and prevent complications including acute chest syndrome. Domain: Hematologic Conditions

A common site for impetigo in children is? A) The face B) The trunk C) The upper arms D) The perineal area.

A) The face Rationale: The face is a common site for impetigo. Domain: Dermatologic Conditions

You are bathing a 2-year-old when you notice a red area on their back that resembles a bulls-eye with a red outer ring, a central area of clearing, and a red center. You know that this is caused by: A) Tick bite B) Black widow spider C) Mosquito D) Brown recluse spider

A) Tick bite Rationale: A painless red rash that starts as a red macule or papule and expands over days or weeks. It may have a bull's eye appearance or it may look like a bruise in a darker skin person (Ball, Bindle, & Cowan, 2015). Domain: Infectious Disease

A parent states, "I know my child needs me, but I just can't stay in the room for this procedure." Which of the following is the MOST appropriate response? A) reassure that staff will be available to support the child B) suggest going to the hospital café to take a needed break C) ask what specifically bothers the parent about the procedure D) offer to explain anything that might help dissuade the parent

A) reassure that staff will be available to support the child Rationale: When parents express that they are not able to assist or observe a procedure, it is important that the nurse convey respect for that decision, and that any response, verbal or nonverbal, is nonjudgmental. Reinforce that staff will support the child throughout the procedure, but encourage parents to stay close by so they are available to comfort the child immediately following the procedure.

Which of the following would be noted as abnormal in the developmental assessment of a 12 month old? A) uses raking motion to pick up objects B) walks holding onto furniture C) speaks 3-4 word D) clings to parents

A) uses raking motion to pick up objects Rationale: A 12 month old easily recognizes when a person is a stranger and will react by clinging to the caregiver. The majority of infants this age are able to walk holding onto furniture and are beginning to say "mama" and "dada" and 1 - 2 other words. At 12 months of age the normally developing child uses a well-defined pincer grasp and is also beginning to grasp very small objects. Therefore, when assessing the development of a child this age, use of a raking motion to pick up objects would constitute an abnormal finding that could be indicative of developmental delay

Claire, a 4 month old, is brought into the Emergency Department for a seizure. Her serum sodium is 128. Which statement by the mother helps you better understand Claire's presentation? A) "Claire voids 6 times a day." B) "Claire has had loose, foul smelling stools for the last week." C) "Claire was recently put on a special formula that is very expensive." D) "Claire has been sleepier than usual and not eating as much."

C) "Claire was recently put on a special formula that is very expensive." Rationale: Claire has hypotonic dehydration which is can be caused by adding additional water to formula to make it last longer. Infants do not require extra water. Normal serum sodium is 135-145 mEq/L. Seizures can be a sign of hyponatremia. Domain: Renal and Genitourinary Conditions

A 6-year-old child is admitted to your unit with suspected bacterial meningitis. Your prioritized nursing care will include: A) Notifying the provider your patient is on the unit. B) Documenting your completed history and physical into the child's record C) Maintaining airway and seizure D) Provide pain management

C) Maintaining airway and seizure Rationale: Children with bacterial meningitis are at risk for alterations on airway and seizures. The nurse's priority of care is safeguarding the airway and maintaining seizure precautions. Make sure a resuscitation bag and oxygen are by bedside. Provide a low stimulus environment and safe surroundings to prevent injury if the child has a seizure. Domain: Neurologic Function

A 16 year old female is to be started on isotretinoin for treatment of severe acne. It is MOST important to explain that A) picking or squeezing skin eruptions can lead to scarring. B) scrubbing skin and using harsh cleansers must be avoided. C) using two forms of contraception is necessary if engaging in intercourse. D) donating blood is contraindicated for up to 6 months following treatment.

C) using two forms of contraception is necessary if engaging in intercourse. Rationale: Isotretinoin is indicated for the treatment of severe nodular acne that is not responsive to conventional therapies. It has been approved by the FDA for children >12 years. Since patients in this age group may be sexually active, it is required that all patients, both male and female, as well as prescribers and pharmacists, participate in the iPLEDGE risk management program. The purpose of the program is to prevent fetal exposure to isotretinoin because of the high risk of birth defects. Requirements of the iPLEDGE program for females of childbearing age include a commitment to use two forms of contraception and to undergo a monthly pregnancy test. To facilitate compliance, providers are limited to prescribing a maximum 30-day supply of isotretinoin. Blood donation is contraindicated during treatment and for one month after completion. Patients need to be taught to avoid excessive scrubbing, harsh cleansers, and squeezing eruptions since these practices can irritate the skin, aggravate the condition, and lead to infection and potential scarring. However, the prevention of fetal exposure to this medication is the highest priority.

An example of a pediatric nurse applying the ethical principle of justice to practice would be: A) Refusing to care for patient Jeremiah because he comes from a single parent home B) Wearing a fundraiser T-shirt for patient Samantha C) Providing the same standard of patient care to Kyrie, Jeremiah, and Samantha D) Buying patient Kyrie a stuffed dinosaur in the gift shop

D) Providing the same standard of patient care to Kyrie, Jeremiah, and Samantha Rationale: The nurse is required to treat all people fairly without regard to socioeconomic status, personal attributes, or nature of the patient's health problems. Domain: Professional Role

Infants who are born post term are MOST at risk for which of the following conditions? A) frequent apneic episodes B) hyaline membrane disease C) fluctuations in body temperature D) intrauterine nutritional deprivation

D) intrauterine nutritional deprivation Rationale: Post-term infants are those born after 42 weeks gestation. A common finding in post-term infants is an emaciated physical appearance. This results from intrauterine nutritional deprivation associated with decreasing efficiency of the placenta. Fluctuations in body temperature, frequent apneic episodes, and hyaline membrane disease are all characteristic of preterm infants.

Sex hormones are secreted by what glands? A) Adrenals B) Ovaries/Testes C) Pituitary

B) Ovaries/Testes Rationale: Insulin release is controlled by the endocrine portion of the pancreas. Domain: Endocrine/Metabolic Conditions

You are administering IVIG to a patient diagnosed with Kawasaki disease. What complication of IVIG administration will you be watching for? A) Anaphylaxis B) Congestive heart failure C) Chorea D) Arthralgia

A) Anaphylaxis Rationale: IV immune globulin is made from human plasma and carries the risk of severe anaphylactic reactions. Domain: Cardiovascular Conditions

A general contraindication for all immunizations is: A) Vomiting B) Headache C) Common Cold D) Febrile illness

D) Febrile illness Rationale: This precaution avoids adding the risk of adverse side effects from the vaccine to an already ill child or mistakenly identifying a symptom of the disease as having been caused by the vaccine (Hockenberry & Wilson, 2015). Domain: Infectious Disease

Corrie is a 7 year old girl who just finished a school lunch and is now on the playground. She has hives, her throat is itchy. Another student gets a teacher who notices Corrie is also pale. Which of the following is she experiencing? A) Asthma B) Food Allergy C) Influenza

B) Food Allergy Rationale: Classic symptoms of food allergies typically occur quickly after eating and she displays signs of an allergic reaction to an unknown food. Food allergy symptoms include: hives, itchy skin, watery eyes, eczema, nausea and/or vomiting. Domain: Immune System Dysfunction

Educational supports for a child diagnosed with ADHD often include: A) A detailed 504 plan B) Removing the child from the regular classroom C) Providing unstructured classroom time to allow for increased creativity D) Ensuring that 1:1 adult support is always available for safety

A) A detailed 504 plan Rationale: Section 504 is part of the Rehabilitation Act of 1973 that is coordinated through school to evaluate for individualized classroom accommodations. Removing the child from the regular classroom isolates him/her from peers and may negatively impact self-esteem. Symptoms generally worsen in unstructured group situation, therefore, providing unstructured time in the classroom offers many distractions which may decrease focus and success. The need for constant adult supervision is individual. Domain: Psychological Conditions

Which of the following questions is of GREATEST significance while obtaining a health history from a parent of a healthy 19 month old? A) "How have you childproofed your home?" B) "What does your child prefer to eat?" C) "How is the toilet training progressing?" D) "When did your child start to walk?"

A) "How have you childproofed your home?" Rationale: Injuries cause more deaths in children between the ages of 1 and 4 years than in any other childhood age-group except adolescence. Major factors in the critical increase of injures during early childhood are the freedom achieved through ambulation combined with an unawareness of danger within the environment. Asking the parent how the home is childproofed is the most important part of the health history in early childhood. Infants and young children are at higher risk because of their inability to protect themselves. Parental education related to protecting the child by adapting the environment is a key determinant in injury prevention. A 19 month old is not developmentally ready for toilet training. Developmental milestones are important but are not as significant to the child's overall well-being as is safety. Food preferences are common at this age and are significant only if the child's diet is deficient in important nutrients.

An 8 year old is diagnosed with chicken pox. At what stage may the child return to school? A) Immediately, as chicken pox are not contagious B) When all the lesions have scabbed over C) 4-6 days from diagnose D) When fever free for 24 hours

B) When all the lesions have scabbed over Rationale: Keep the child home and away from susceptible individuals until vesicles have dried (usually 1 week after onset of disease). Notify school or daycare of child's illness (Hockenberry & Wilson, 2015). Domain: Infectious Disease

A neighbor asks for advice about her school-age child's daily headaches that have been occurring over the last month. There has been no history of head trauma or fever. The MOST appropriate response is to recommend that the parent A) consider having the child's vision checked. B) determine if the child is experiencing anxiety. C) keep a diary to document when headaches occur. D) have the child evaluated by a healthcare provider.

D) have the child evaluated by a healthcare provider. Rationale: It is not unusual for caregivers to seek health-related guidance or information from a neighbor who is a nurse. It is the nurse's responsibility to recognize the legal boundaries of his/her state licensure and role. Those boundaries limit the nurse's responses to this concern about a child's headaches. The appropriate response is to suggest the child be evaluated by a healthcare provider as the RN scope of practice does not include diagnosing or prescribing.

To prevent a common long-term problem, children who have had surgical repair of a cleft palate are MOST often referred for which of the following therapies? A) cognitive/behavioral B) occupational C) physical D) speech

D) speech Rationale: Children born with cleft lip and/or palate face a variety of challenges. In the initial newborn period, feeding is often the primary concern as sucking may be difficult. Long-term complications include potential speech problems, especially with a cleft palate. Because the palate creates the floor of the nasal cavity, it is critical in forming sounds and allowing normal speech. Speech may be further complicated by frequent ear infections and potential hearing loss, both of which are risks associated with cleft palate. Dental development is also frequently affected. A multi-disciplinary team is required to meet the needs of the child and family. While the child with cleft palate may require the other listed therapies, the most common referral is for speech therapy.

In the outpatient clinic you notice a group of children playing in the waiting room. You see one small child squatting by himself in the middle of the room. You recognize the child as one of your Tetralogy of Fallot patients. How do you intervene to assist the child? A) Immediately call the rapid response team B) Take the child to an exam room and administer oxygen C) Take no action D) Have the child lie flat with his legs raised

C) Take no action Rationale: During Tet spells many children with assume a squatting or knee-chest position during periods of exertion or agitation to increase systemic return and shunt blood to the head and trunk. Do not interfere with squatting during a tet spell. Domain: Cardiovascular Conditions

As the nurse caring for a patient with constipation you know that: A) Most constipation is organic in nature B) Children with constipation have substantial amounts of fiber in their diet C) The most common cause of constipation is stool withholding, due to a trigger event. D) Increasing the child's fluid intake will increase liquid stooling.

C) The most common cause of constipation is stool withholding, due to a trigger event. Rationale: There are both organic and non-organic causes for constipation, however, the most common is stool withholding due to a trigger event that may be related to change in diet, painful stool or forced toileting. Domain: Gastrointestinal Conditions

When teaching a new group of pediatric oncology nurses about the bone marrow involvement of children on chemotherapy, the nurse explains: A) That pancytopenia is defined as low platelet counts B) How neutropenia relates only to radiation therapy C) That bone marrow recovery between chemo treatments is always lengthy D) That periods of immunosuppression are common and the family needs to understand neutropenic precautions

D) That periods of immunosuppression are common and the family needs to understand neutropenic precautions Rationale: Periods of neutropenia are common and expected for children receiving chemotherapy. To save lives by preventing infections, families must learn and implement neutropenic precautions Domain: Childhood Cancer

The nurse is teaching a parenting group about patterns of growth & development. What is the best example to use to explain cephalocaudal development? A) After sitting independently, the baby will begin to reach for objects. B) First the baby will play with sounds, like babbling, then say simple words. C) Learning to run and jump comes after mastering walking. D) The baby gets control of their head before their arms and hands.

D) The baby gets control of their head before their arms and hands. Rationale: Cephalocaudal means head to toe therefore head control develops before control of the arms and hands. Domain: Growth & Development

An experienced nurse is teaching newly hired nurses in an orientation program. An orientee asks, "Why do we have to listen to the heart and lungs for a minute?" What is the experienced nurse's best response? A) Breathing may be irregular and pulse varies with inspiration and expiration. B) Children may move during assessment requiring a longer listening time. C) Counting for one minute eliminates mathematical errors. D) Listening that long allows the nurse to assess lung and heart sounds while counting.

A) Breathing may be irregular and pulse varies with inspiration and expiration. Rationale: Infant breathing is irregular and the heart rate increases and decreases with inspiration and expiration. Because of the irregularity, counting for less than 60 seconds and multiplying may result in inaccurate rates. Domain: Growth & Development

Section 504 of the Rehabilitation Act of 1973 states that reasonable accommodations should be made to assist an individual in being successful. An example of these accommodations would be: A) Creating wheelchair accessible entrances to school buildings B) Providing nutrition support to students at home during the school day C) Transporting students home during the day for respiratory treatments D) Having stairs accessible for all students

A) Creating wheelchair accessible entrances to school buildings Rationale: Examples of accommodations include wider doors for wheelchairs; ramps/curb cuts/elevators for those in wheelchairs; special desks and chairs; computers, telecommunication devices, or special devices for communication; performing tube feedings or percussion and postural drainage within the school setting so that the child can attend school. Domain: Professional Role

Pediatric tumors can be described as: A) Occurring in rapidly differentiating tissues bone marrow or neurologic cells B) Slowly growing and difficult to treat C) Commonly mimicking adult tumors in location D) Highly responsive and achieve remission within weeks of diagnosis

A) Occurring in rapidly differentiating tissues bone marrow or neurologic cells Rationale: The only correct answer is the first one as it is accurate to state that pediatric cancers present in rapidly differentiating (much like original tissues) tumors, especially in cells of the bone marrow and neurological tissues such as neuroblastoma Domain: Childhood Cancer

When providing anticipatory guidance for parents regarding follow-up recommendations for children with autism, the nurse includes which one of the following recommendations? A) Planning for lifelong treatment and support B) Dietary modifications and restrictions C) Taking a wait and see approach D) initiating pharmacotherapy treatment once the child enters puberty

A) Planning for lifelong treatment and support Rationale: It is important for parents to understand that children with autism require lifelong support. There is little evidence currently available that diet changes are helpful. Early interventions improve outcomes/prognosis. Initiating pharmacotherapy treatment is an individualized decision. Medications often not helpful for core autistic features and many children develop side effects. Domain: Psychological Conditions

Nurse Hannah works on a pediatric oncology floor and a patient's father asked to "friend" her on Facebook. What should Hannah do? A) Accept the request because she likes taking care of the patient B) Accept the request because her co-workers are also friends with the patient's father C) Decline the request because it is against hospital policy D) Decline the request because Hannah is afraid of what her friends will post on her wall

C) Decline the request because it is against hospital policy Rationale: Pediatric nurses need to maintain professional boundaries when caring for patients and their families. Following hospital policy regarding the use of social media should be followed in this situation. Domain: Professional Role

You have just admitted a post-op cleft lip repair. As the nurse caring for the patient your priority would be to: A) Monitor for adequate circulation. B) Ensure that the child can breathe through his mouth. C) Monitor for airway edema and cyanosis. D) Not handle the child too much to prevent any damage to the surgical site.

C) Monitor for airway edema and cyanosis. Rationale: Increased edema from the palate closure may result in apneic episodes. To assist with maintaining a patent airway position the infant on their abdomen or side. Domain: Gastrointestinal Conditions

The nurse is caring for a hospitalized 24-month old child who is receiving chelation therapy for lead poisoning. What potential side effects of lead poisoning must the nurse be alert for? A) Anaphylaxis B) Fever and chills C) Seizures D) Congestive Heart Failure

C) Seizures Rationale: In severe cases of lead poisoning, signs of encephalopathy, such as seizures and coma, may occur. Domain: Neurologic Function

The rate of blood cell production is controlled by the body's needs. Which of the following conditions triggers increased production of platelets? A) Low oxygen B) Bleeding C) Infection

B) Bleeding Rationale: The bone marrow produces and releases more platelets in response to bleeding. Platelets stick together, helping blood to form a clot that stops bleeding. Domain: Immune System Dysfunction

Which immunization is particularly important for college-bound adolescents planning to live in a dormitory? A) influenza B) meningococcal (MCV) C) pneumococcal polysaccharide (PPSV) D) tetanus, diphtheria toxoids and acellular pertussis (Tdap)

B) meningococcal (MCV) Rationale: The highest number of fatalities for invasive meningococcal disease occurs in adolescents between 15 and 21 years of age. This is particularly true of college freshmen living in dormitories since it is easy for infections to spread in crowded dorms or enclosed areas where students often meet. The CDC recommends meningococcal vaccination for all adolescents. If the vaccination is received before 16 years of age, adolescents need a booster dose for maximum protection before going to college. Many colleges require proof of vaccination before starting school. Tdap boosters should be given at 11-12 years of age and subsequently every 10 years. The influenza vaccine is recommended every year but is given prior to flu season and not before leaving for college typically in late summer. The pneumococcal polysaccharide vaccine is given for certain medical high-risk groups and healthy college bound adolescents are not included.

You are caring for a 6 -week old male with suspected diagnosis of pyloric stenosis. As the nurse caring for this patient you know that this patient may present with: A) nausea B) projectile vomiting C) weight gain D) bilious vomiting

B) projectile vomiting Rationale: Pyloric Stenosis is an increasing hyperplasia and hypertrophy of the circular muscle at the pylorus, which narrows the pyloric canal as it exits the stomach. This results in an obstruction and prevents digestion. Initial vomiting may be described as "spitting up" but will increase in frequency as the pylorus thickens and progress to projectile vomiting. Domain: Gastrointestinal Conditions

Which of the following is the MOST appropriate guidance for a caregiver asking about setting limits and minimizing misbehavior in a preschooler? A) "Provide incentives to get your child to respond to your requests." B) "Use 'you' statements such as, 'You are mean when you hit your brother.'" C) "Discuss in a logical, thorough manner why some behaviors are inappropriate." D) "Offer explanations such as, 'I'm sorry you can't color, we need to run errands.'"

D ) "Offer explanations such as, 'I'm sorry you can't color, we need to run errands.'" Providing sympathetic explanations for not granting a request acknowledges the child's request and feelings and provides an explanation for why the request cannot be met. Explanations should be brief and to the point. Children at this level of cognitive development do not think logically, so in-depth discussions are typically ineffective. Incentives can provide positive reinforcement following good behavior but should not be used as enticements to induce obedience. When talking to children about undesirable behaviors, "I" statements should be used instead of "you" statements. For example, "I feel upset when your brother gets hurt. Hitting hurts."