Exam 3 Quizzes

The nurse overhears a group of student nurses in the break room discussing the role of the health care professional in suspected child abuse. The nurse concludes that the student who most accurately understands the role is one who makes which of the following statements?"

"Nurses are required to report any case of suspected child abuse to child protective services."

The nurse and a new nurse are caring for a child who will require palliative care. Which of the following statements made by the new nurse would indicate a correct understanding of palliative care?

"Palliative care provides pain and symptom management for the child."

The parent of a child with neuroblastoma verbalizes regret at not coming in earlier for the child's complaints. An appropriate response is:

"This is a silent tumor, which is difficult to diagnose early."

At what age do most children have an adult concept of death as being inevitable?

9 to 11 years

What is Munchausen Syndrome by Proxy?

A caregiver who fabricates or induces illness on a child in order to gain control over him or her or because they crave the attention it brings.

A pediatric client who is known to have cancer is being admitted for mild neutropenia and a severe oral monilial infection. The nurse should assign the child to which room?

A private room without further precautions

During rounds, the interdisciplinary team is discussing a child with leukemia who has just been diagnosed as terminal. The nurses describe the mother's behavior as angry, claiming the nurses are not providing care for her child. The team leader then focuses on which of the following, which is most likely the cause of the mother's anger?

A stage of bereavement over the anticipated loss of the child

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. Which is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments?

Administer an antiemetic before chemotherapy begins.

The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. Which of the following is the major priority of nursing care?

Administer antibiotic therapy as soon as it is ordered

A child with leukemia has developed pancytopenia. The nurse would institute which measures designed to reduce stomatitis in this child during the course of chemotherapy? (Select all that apply.)

Administering pain medication as ordered Rinsing the mouth several times a day with plain water

At what developmental period do children have the most difficulty coping with death particularly if it is their own?

Adolescence

A nurse is caring for a school-age child who has suspected osteosarcoma. Which of the following laboratory values is likely to be elevated if this diagnosis is correct?

Alkaline phosphatase

A 3-year-old child is admitted to the hospital unit with a diagnosis of viral meningitis. The nurse should take which of the following actions in the care of this child? (Select all that apply)

Allow the child to assume a position of comfort, Administer acetaminophen for pain, Monitor the child for seizures

Several nurses tell their nursing supervisor that they want to be able to attend the funeral of a child for whom they had cared. They say they felt especially close to both the child and the family. The supervisor should recognize that attending the funeral is:

Appropriate because it can assist in the resolution of personal grief.

A child has been treated with chemotherapy for cancer. The nurse anticipates that neutropenia is an expected consequence and teaches the parents to:

Avoid crowded spaces

A 3-year old child with meningitis is documented as having photophobia. Which of the following interventions is most effective in minimizing this symptom?

Avoid using the TV

The nurse is providing support to a family who is experiencing anticipatory grief related to their child's imminent death. Which of the following is an appropriate nursing intervention?

Be available to family.

A school-age child with spina bifida has a shunt in place for hydrocephalus. Which of the following signs and symptoms is not a manifestation of increased intracranial pressure?

Bulging anterior fontanel

A nurse is assessing the family of a child brought in for severe injuries. Which of the following behaviors by the parents indicates probable abuse?

Delay in seeking treatment for the child's injuries

The nurse is assigned to the postoperative care of a child with a below-the-knee amputation for osteogenic sarcoma. The nurse plans to include which of the following in nursing care of the child?

Encourage early visits from friends

At the time of a child's death, the nurse tells his mother, "We will miss him so much." The best interpretation of this is that the nurse is doing which of the following?

Expressing personal feelings of loss.

The nurse is caring for a child who has just died. The parents ask to be left alone so that they can rock their child one more time. The nurse should do which of the following?

Grant their request.

A child is receiving chemotherapy to induce remission in acute leukemia. When considering common side effects of chemotherapy, the nurse would write which of the following as appropriate nursing diagnoses early in the course of therapy? (Select all that apply.)

Impaired oral mucous membranes Imbalanced nutrition: less than body requirements related to nausea and vomiting

A 10-year-old boy receives a blow to his head with a hard baseball and is admitted to the hospital for observation. If the child were to develop an epidural hematoma, he would most like display symptoms:

In the emergency room or soon after arriving on the unit

Probably the most important criterion on which to base the decision to report suspected child abuse is which of the following?

Incompatibility between the history and injury observed

A nurse is assessing a new admission. The 6-month-old infant displays irritability, bulging fontanels, and setting-sun eyes. The nurse would suspect.

Increased intracranial pressure

A 10-year-old client presents with weakness in legs and history of the flu. The medical diagnosis is Guillain-Barre syndrome. It would be imperative for the nurse to inform the physician after observing which of the following?

Increasing hoarseness

A child with myelomeningocele is started on a bowel management plan. The child's mother questions why this is being done. The nurse's response will be based on the understanding that lack of:

Innervation to the anal sphincter predisposes the child to being incontinent

Which of the following is most descriptive of a school-age child's reaction to death?

Is very interested in funerals and burials

A child is being treated for increased intracranial pressure (ICP). Appropriate actions to decrease ICP would include: (Select all that apply).

Keeping head of bed at a 30-degree angle, Providing supplemental oxygen, Administering IV osmotic diuretics as ordered

Which of the following is an appropriate nursing intervention when providing comfort and support for a child when death is imminent?

Limit care to essentials.

A child with a history of a seizure was admitted 2 hours ago. The history indicates fever, chills, and vomiting for the past 24 hours. In report, the nurse is told that the child has a positive Brudzinski's sign. The nurse infers this most likely caused by:

Meningeal irritation

A 2-year-old is admitted to the neurosurgical unit following a head injury. The nurse is using the Glasgow Coma Scale to measure neurological functioning. Which of the following assessment findings indicate the lowest level of functioning for this child?

No response to painful stimuli

The nurse is caring for a toddler who has had surgery for a brain tumor. During an assessment the nurse notes that the child is becoming irritable and pupils are unequal and sluggish. The most appropriate nursing action is to:

Notify the practitioner immediately

A 6-month old infant is admitted to the PICU with a basilar skull fracture. Which of the following assessment findings would the nurse not expect?

Nuchal rigidity

An 8-year-old client with a ventriculoperitoneal shunt was admitted for shunt malfunction. He presents with symptoms of increased intracranial pressure. The mechanisms of the development of his symptoms is most probably related to:

Obstructed flow of cerebrospinal fluid

A 15-year-old client is seen in the emergency department following a head injury from football. During the first few hours after admission, he sleeps unless awakened, but he can be aroused easily and is oriented. In charting assessment findings, the nurse would describe this level of consciousness as:

Obtunded

The nurse observes a client with the neck and back arched and extremities severely extended. The mother asks why the child is doing that. The nurse explains that this posturing is called:

Opisthotonos

The nurse is providing client education for a family whose child has cerebral palsy and is receiving baclofen epidural therapy to control spasticity. Which of the following is most important for the nurse to include in the discussion?

Parents must bring the child back to the clinic on a regular basis to have more medicine added to the pump

A nurse is evaluating a family in which child abuse has occurred. Which of the following best indicates that the parents are making progress toward resolution of the violence?

Parents relate an understanding of normal growth and development

Upon performing a physical assessment of a 7-month-old child, the nurse notes the following findings. The nurse concludes that which finding is abnormal and could suggest cerebral palsy (CP)?

Positive tonic neck reflex

Which of the following best describes how preschoolers react to the death of a loved one?

Preschooler may feel guilty and responsible for the death.

A common characteristic of those who sexually abuse children is which of the following?

Pressure victim into secrecy

An 18-month-old child is observed having a seizure. The nurse notes that the child's jaws are clamped. The priority nursing responsibility at this time would be:

Protect the child from harm from the environment

The parents of a child with neutropenia secondary to chemotherapy have been taught protective isolation behaviors. Nursing observations that indicate a need for further education is when the parents:

Pull the child in a wagon around the nursing unit for entertainment

The nurse is doing a neurologic assessment on a child whose level of consciousness has been variable since sustaining a cervical neck injury 12 hours ago. Which of the following is the priority assessment for this child?

Reactivity of pupils

A preschooler is found digging up a pet bird that was recently buried after it died. The best explanation for this behavior is which of the following?

Reassurance is needed that the pet has not gone somewhere else.

A child is admitted with possible Reye syndrome. Which of the following factors in the child's health history might be supportive of this diagnosis?

Recent episode of gastroenteritis

An adolescent receiving cyclophosphamide (Cytoxan) for acute lymphocytic leukemia (ALL) asks the nurse to come quickly to evaluate "blood in my urine." The most important action by the nurse would be to:

Recognize that this is untoward and report the event

The nurse is caring for a child with multiple injuries who is comatose. The nurse should recognize that pain:

Requires astute nursing assessment and management

Which of the following is a clinical manifestation of increased ICP in infants?

Shrill, high-pitched cry

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt to correct hydrocephalus. Which of the following should the nurse include?

Shunt malfunction or infection requires immediate treatment

A nurse is caring for a 14-year-old adolescent boy who has been diagnosed with osteosarcoma of the left proximal tibia. The adolescent is 4 days preoperative for an above-the-knee amputation and is admitted to the hospital for preoperative chemotherapy. The adolescent knows about the surgery. Which of the following is the nurse's responsibility in the next 4 days regarding this adolescent's emotional health?

Spend time with the adolescent to answer any questions he may have.

The nurse is administering an IV chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action?

Stop drug infusion immediately.

Which of the following is characteristic of most neonatal seizures?

Subtle and barely discernible

Which of the following positions is the most effective in preventing a further increase in pressure for a child with increased intracranial pressure?

Supine with 30° head elevation

Which of the following sets of vital signs is indicative of Cushing's reflex in a 6-year-old child?

Temperature 37.8°C, pulse 64/min, respiratory rate 20/min, and blood pressure 140/40 mm Hg

The nurse notes that the parents of a critically ill child spend a large amount of time talking with the parents of another child who is also seriously ill. They talk with these parents more than with the nurses. The nurse should recognize that this behavior indicates:

That parent-to-parent support is valuable.

A child has just been diagnosed with bacterial meningitis. The parent asks the nurse how long the child will be in isolation. The nurse's reply will be based on a protocol that isolation continues until:

The antibiotics have been administered for 24 hours

The nursing diagnosis for a child undergoing chemotherapy for leukemia is "Imbalanced nutrition: less than body requirements related to nausea and anorexia." The nurse would formulate which of the following as an appropriate goal for this client?

The child's caloric intake will be within normal range

A 5-year-old girl's sibling dies from sudden infant death syndrome. The parents are concerned because the girl showed more outward grief when her cat died than for her sibling's death. The nurse should explain that:

The death may be so painful and threatening that the child must deny it for now to protect her psyche.

A cure is no longer possible for a young child with cancer. The nursing staff recognizes that the goal of treatment must shift from cure to palliation. Which of the following is an important consideration at this time?

The family is included in the decision to shift the goals of treatment.

Which of the following describes a child who is abused by the parent(s)?

Unintentially contributes to the abusing situation

A 3-year-old child is brought to the Emergency Department for treatment of injuries the father stated were obtained when the child fell off of his tricycle. Upon assessment, numerous bruised areas, old and fresh, are noted on the child's back, buttocks, and shoulders. Radiologic examination reveals fractured ribs and a healed fractured humerus. Based on these findings, the nurse's next course of action would be to:

ask the father to provide further details of the incident, obtain a medical history of the child, and then interview the child separately

A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. The nurse should explain that:

terminally ill children know when they are seriously ill.

Which of the following statements is correct about young children who report sexual abuse by one of their parents?

They may exhibit various behavioral manifestations

Generalized movements of all extremities which would be which type of seizure?

Tonic-clonic

A 3-month-old infant has been admitted with a diagnosis of encephalitis. The first nursing priority would be to assess:

Ability to maintain airway

The nurse places a young child scheduled for a lumbar puncture in a side-lying position with the head flexed and knees drawn up to the chest. The mother asks why the child has to be positioned this way. The nurse explains the rationale for the positioning is that:

Access to the spinal fluid is facilitated

All of the following are preparations the nurse should do to prepare the room for an admission of a child with seizures except?

Administer Tylenol for comfort

The nurse is providing discharge instructions for a child who has suffered a head injury within the last four hours. The nurse determines there is a need for additional teaching when the mother states:

"My child should sleep for at least 8 hours without arousing after we get home."

Lab calls the nurse with results of the CSF sample that was obtained during the lumbar puncture of the child. The nurse would suspect bacterial meningitis with which of the following CSF results?

Decreased glucose, elevated protein

A 4-year-old is diagnosed with acute lymphocytic leukemia (ALL). Following teaching about the testing and therapy, the nurse evaluates the family's understanding of the problem. The statement by the family that indicates appropriate knowledge would be: "Tests will:

Determine the extent of the malignant process and stage of the leukemia.

A 17-year-old is being admitted for an amputation related to a bone tumor. The nurse is developing a nursing care plan and determines the most appropriate age-related diagnosis is:

Disturbed body image

A 4-year-old child is being evaluated for hydrocephalus. The nurse notes which of the following as an early sign of hydrocephalus in this child?

Early morning headache

The school health nurse has seen a child several times with the same complaints. The school health nurse would suspect a brain tumor after noting the presence of which of the following symptoms that is compatible with this health problem?

Early morning headache and vomiting

The adolescent is discharged with a prescription for phenytoin (Dilantin). Which of the following statements by the father indicates that discharge teaching has been effective?

"I will be sure to encourage good oral care and regular dental visits."

A child who has a concussion is being discharged home with her parents. Which of the following statements by the parent indicates a need for further teaching?

"I will keep him awake all night to make sure there is no change."

A child has sustained a fall from a window. Her father finds her completely unconscious and not speaking or moving.What should her Glasgow Coma Scale score be?

3

When performing the initial assessment, the nurse found that when the infant's head was flexed his knees and hips also flexed. The nurse should document this finding as a

Brudzinski's sign

The nurse is caring for a child dying from cancer. Physical signs that the child is approaching death include which of the following?

Change in respiratory pattern

A child is to receive chemotherapy with a vesicant drug by the IV route. The nurse can ensure safe administration of this drug by doing which of the following?

Checking for blood return before, during, and after administration of the drug

A child diagnosed with Ewing's sarcoma is being treated with chemotherapy. The results of a complete blood count (CBC) indicate severe thrombocytopenia. Nursing interventions related to this finding would include: (Select all that apply.)

Clearing the floor of the child's room to prevent falls and bruises, Minimizing needle sticks and intrusive procedures

A child will be undergoing chemotherapy. The nurse discusses the issue of hair loss with the child and family before chemotherapy begins. Later the family asks the nurse why this information was given to the child at this time. The nurse's response will include the information that:

The presence or absence of hair is related to body image. Strategies for handling hair loss should precede the event.

A young child has just been diagnosed with spastic cerebral palsy. The nurse is teaching the parents how to meet the dietary needs of their child. The nurse would explain that children with cerebral palsy frequently have special dietary needs or feeding challenges because:

The spasticity of their muscles increases their caloric needs

The nurse is talking with the parents of a child who died 6 months ago. They sometimes still "hear" the child's voice and have trouble sleeping. They describe feeling "empty" and depressed. The nurse should recognize which of the following?

These are normal grief responses

Which of the following best describes the 4-year-old's concept of death?

Death is temporary.

A 3-month-old infant dies shortly after arrival to the Emergency Department. The infant has subdural and retinal hemorrhages but no external signs of trauma. The nurse should expect:

shaken-baby syndrome