Module 12 Pediatric Gastrointestinal and Respiratory

What explanation should the nurse give to the parent of a child with asthma about using a peak flow meter? a. It is used to monitor the child's breathing capacity. b. It measures the child's lung volume. c. It will help the medication reach the child's airways. d. It measures the amount of air the child breathes in.

A The peak flow meter is a device used to monitor breathing capacity in the child with asthma. A child with asthma would have a pulmonary function test to measure lung volume. A spacer used with a metered-dose inhaler prolongs medication transit so medication reaches the airways. The peak flow meter measures the flow of air in a forced exhalation in liters per minute.

A nurse is teaching a group of parents about TEF. Which statement made by the nurse is accurate about TEF? a. This defect results from an embryonal failure of the foregut to differentiate into the trachea and esophagus. b. It is a fistula between the esophagus and stomach that results in the oral intake being refluxed and aspirated. c. An extra connection between the esophagus and trachea develops because of genetic abnormalities. d. The defect occurs in the second trimester of pregnancy.

A When the foregut does not differentiate into the trachea and esophagus during the fourth to fifth week of gestation, a TEF occurs. A TEF is an abnormal connection between the esophagus and trachea. There is no connection between the trachea and esophagus in normal fetal development. This defect occurs early in pregnancy during the fourth to fifth week of gestation.

Which vitamin supplements are necessary for children with cystic fibrosis? a. Vitamin C b. Vitamin D c. Vitamin A d. Vitamin E e. Vitamin K

BCDE Fat-soluble vitamins (A, D, E, and K) are poorly absorbed because of deficient pancreatic enzymes in children with cystic fibrosis; therefore supplements are necessary. Vitamin C is not fat soluble.

What should be included in the care for a neonate who was diagnosed with pertussis? a. Monitoring hemoglobin level b. Hearing test before discharge c. Serial platelet counts d. Prophylactic antibiotics for all close contacts

D Erythromycin, azithromycin, or clarithromycin is given to all close contacts for the child diagnosed with pertussis. Pertussis does not affect the hemoglobin level. A complication of pertussis is not hearing impairment. Pertussis does not affect platelets.

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

D Offering realistic choices is helpful in meeting the school-age child's sense of control. To facilitate bowel elimination, the child should sit on the toilet for 5 to 10 minutes after breakfast and dinner. Caffeine to stimulate the bowels is not recommended. Daily Fleet enemas can result in hypernatremia and hyperphosphatemia and are used only during periods of fecal impaction.

Why do infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system? a. They have a widened, shorter airway. b. There is a defect in their sucking ability. c. The gag reflex increases mucous production. d. Mucus and edema obstruct small airways.

D The airway in infants and young children is narrow, and respiratory distress can occur quickly because mucus and edema can cause obstruction to their small airways. Sucking is not necessarily related to problems with the airway. The gag reflex is necessary to prevent aspiration. It does not produce mucus.

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

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

Which statement best describes why infants are at greater risk for dehydration than older children? a. Infants have an increased ability to concentrate urine. b. Infants have a greater volume of intracellular fluid. c. Infants have a smaller body surface area. d. Infants have an increased extracellular fluid volume.

D The larger ratio of extracellular fluid to intracellular fluid predisposes the infant to dehydration. Because the kidneys are immature in early infancy, there is a decreased ability to concentrate the urine. Infants have a larger proportion of fluid in the extracellular space. Infants have proportionately greater body surface area in relation to body mass, which creates the potential for greater fluid loss through the skin and gastrointestinal tract.

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

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

Which statement made by an adolescent girl indicates an understanding about the prevention of sexually transmitted diseases (STDs)? a. "I know the only way to prevent STDs is to not be sexually active." b. "I practice safe sex because I wash myself right after sex." c. "I won't get any kind of STD because I take the pill." d. "I only have sex if my boyfriend wears a condom."

A Abstinence is the only foolproof way to prevent an STD. STDs are transmitted through body fluids (semen, vaginal fluids, blood). Perineal hygiene will not prevent an STD. Oral contraceptives do not protect women from contracting STDs. A condom can reduce but not eliminate an individual's chance of acquiring an STD. However, the nurse should encourage condom use 100% of the time to decrease the risk.

An infant has laryngomalacia. What assessment finding correlates with this condition? a. Stridor b. High-pitched cry c. Nasal congestion d. Spasmodic cough

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

Which diet would the nurse recommend to the mother of a child who is having mild diarrhea? a. Rice, potatoes, yogurt, cereal, and cooked carrots b. Bananas, rice, applesauce, and toast c. Apple juice, hamburger, and salad d. Whatever the child would like to eat

A Bland but nutritious foods including complex carbohydrates (rice, wheat, potatoes, cereals), yogurt, cooked vegetables, and lean meats are recommended to prevent dehydration and hasten recovery. Bananas, rice, applesauce, and toast used to be recommended for diarrhea (BRAT diet). These foods are easily tolerated, but the BRAT diet is low in energy, density, fat, and protein. Fatty foods, spicy foods, and foods high in simple sugars should be avoided. The child should be offered foods he or she likes but should not be encouraged to eat fatty foods, spicy foods, and foods high in simple sugars.

A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. What action by the nurse is most appropriate? a. Prepare to administer a bronchodilator. b. Give ordered antibiotics on time. c. Provide oxygen via face tent. d. Assess the airway for a foreign body.

A Children with asthma usually have these chronic symptoms. The nurse will prepare to administer a bronchodilator. Antibiotics are not used in asthma unless the child also has a bacterial infection, but there is no indication that this is the case. There is also no indication the child needs oxygen at this point. These manifestations do not suggest a foreign body aspiration.

An infant's parents ask the nurse about preventing OM. What should be recommended? a. Avoid tobacco smoke. b. Use nasal decongestant. c. Avoid children with OM. d. Bottle feed or breastfeed in supine position.

A Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other upper respiratory infection (URI) symptoms. Children should be fed in an upright position to prevent OM.

The nurse should assess a child who has had a tonsillectomy for which of the following as the priority? a. Frequent swallowing b. Inspiratory stridor c. Swelling of the throat d. Abnormal lung sounds

A Frequent swallowing is indicative of postoperative bleeding. Inspiratory stridor is characteristic of croup. The nurse assesses the throat for clots or bleeding, not swelling. Lung sounds are assessed on every postoperative patient.

A nurse is caring for four infants. Which one should the nurse assess first? a. Nasal flaring b. Respiratory rate of 55 breaths/min c. Irregular respiratory pattern d. Abdominal breathing

A Infants have difficulty breathing through their mouths; therefore nasal flaring is usually accompanied by extra respiratory efforts. A respiratory rate of 55 breaths/min is a normal assessment for an infant. Irregular respirations are normal in the infant. Abdominal breathing is common because the diaphragm is the neonate's major breathing muscle.

The earliest clinical manifestation of biliary atresia is a. jaundice. b. vomiting. c. hepatomegaly. d. absence of stooling.

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

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

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

What is the best response for the nurse to give a parent about contacting the physician regarding an infant with diarrhea? a. "Call your pediatrician if the infant has not had a wet diaper for 6 hours." b. "The pediatrician should be contacted if the infant has two loose stools in an 8-hour period." c. "Call the doctor immediately if the infant has a temperature greater than 100° F." d. "Notify the pediatrician if the infant naps more than 2 hours."

A No urine output in 6 hours needs to be reported because it indicates dehydration. Two loose stools in 8 hours is not a serious concern. If blood is obvious in the stool or the frequency increases to one bowel movement every hour for more than 8 hours, the physician should be notified. A fever greater than 101° F should be reported to the infant's physician. It is normal for the infant who is not ill to nap for 2 hours. The infant who is ill may nap longer than the typical amount.

The nurse expects the initial plan of care for a 9-month-old child with an acute otitis media infection to include a. symptomatic treatment and observation for 48 to 72 hours after diagnosis. b. an oral antibiotic, such as amoxicillin, five times a day for 7 days. c. pneumococcal conjugate vaccine. d. myringotomy with tympanoplasty tubes.

A Select children 6 months of age or older with acute otitis media are treated by initiating symptomatic treatment and observation for 48 to 72 hours. Acute otitis media may be treated with a 5- to 10-day course of oral antibiotics. When treatment is indicated, amoxicillin at a divided dose of 80 to 90 mg/kg/day given either every 8 or 12 hours for 5 to 10 days may be ordered. Pneumococcal conjugate vaccine helps to prevent ear infections but is not included in the initial plan of care for a child with acute otitis media. Surgical intervention is considered when the child has persistent ear infection despite antibiotic therapy or with otitis media with effusion that persists for more than 3 months and is associated with hearing loss.

The nurse getting an end-of-shift report on a child with status asthmaticus should question which intervention? a. Administer oxygen by nasal cannula to keep oxygen saturation at 100%. b. Assess intravenous (IV) maintenance fluids and site every hour. c. Notify provider for signs of increasing respiratory distress. d. Organize care to allow for uninterrupted rest periods.

A Supplemental oxygen should not be administered to maintain oxygen saturation at 100%. Keeping the saturation around 95% is adequate. Administration of too much oxygen to a child may lead to respiratory depression by decreasing the stimulus to breathe, leading to carbon dioxide retention. When the child cannot take oral fluids because of respiratory distress, IV fluids are administered. The child with a continuous IV infusion must be assessed hourly to prevent complications. A provider should be notified of any changes indicating increasing respiratory distress. A child in respiratory distress is easily fatigued. Nursing care should be organized so the child can get needed rest without being disturbed.

The parents of a child with acid-base imbalance ask the nurse about mechanisms that regulate acid-base balance. Which statement by the nurse accurately explains the mechanisms regulating acid-base balance in children? a. The respiratory, renal, and chemical-buffering systems b. The kidneys balance acid; the lungs balance base. c. The cardiovascular and integumentary systems d. The skin, kidney, and endocrine systems

A The acid-base system is regulated by chemical buffering, respiratory control of carbon dioxide, and renal regulation of bicarbonate and secretion of hydrogen ions. Both the kidneys and the lungs, along with the buffering system, contribute to acid-base balance. Neither system regulates acid or base balances exclusively. The cardiovascular and integumentary systems are not part of acid-base regulation in the body. Chemical buffers, the lungs, and the kidneys work together to keep the blood pH within normal range.

Parents report their 3-year-old child appears restless at night and frequently scratches her anal area. What action by the nurse is best? a. Educate parents on the cellophane tape test. b. Review hygiene practices with the parents. c. Suggest the child sleep only in pajama tops. d. Ask parents to bring in a stool sample.

A The cellophane tape test is used to diagnose pinworms. The parents place a strip of cellophane tape on the child's anus at bedtime and brings it to the clinic for microscopic evaluation. There is no need to review hygienic practices, suggest sleeping in a pajama top only, or to bring in a stool sample.

What food choice by the parent of a 2-year-old child with celiac disease indicates a need for further teaching? a. Oatmeal b. Rice cake c. Corn muffin d. Meat patty

A The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Oatmeal contains gluten and is not an appropriate food selection. Rice, corn, and meat are appropriate selections.

Which intervention is appropriate for a hospitalized child who has crops of lesions on the trunk that appear as a macular rash and vesicles? a. Place the child in strict isolation with airborne and contact precautions. b. Continue to practice Standard Precautions. c. Pregnant women should avoid contact with the child. d. Screen visitors for immunity to measles.

A The child's skin lesions are characteristic of varicella. Varicella is transmitted through direct contact, droplets, and airborne particles. In the hospital setting, children with varicella should be placed in strict isolation, and on contact and air borne precautions. The purpose is to prevent transmission of microorganisms by inhalation of small-particle droplet nuclei and to protect other patients and health care providers from acquiring this disease. Standard Precautions are not sufficient for this disease. Certain viral illnesses such as rubella and fifth disease are known to affect the fetus if the woman contracts the disease during pregnancy. This child appears to have varicella. Pregnancy is not a contraindication to caring for a child with varicella. However, all health care personnel should be vaccinated or show immunity to varicella. Screening visitors for immunity to measles is irrelevant. It is important to screen visitors for immunity to varicella.

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

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

A baby is scheduled for abdominal surgery for hypertrophic pyloric stenosis and has an NG tube to intermittent suction. When the family asks why the child has the tube, what response by the nurse is best? a. "The nasogastric tube decompresses the abdomen and decreases vomiting." b. "We can keep a more accurate measure of intake and output with the tube." c. "The tube is used to decrease postoperative diarrhea." d. "The nasogastric tube makes the baby more comfortable after surgery."

A The nasogastric tube provides decompression and decreases vomiting. A nursing responsibility when a patient has a nasogastric tube is measurement of accurate intake and output, but this is not why nasogastric tubes are inserted. Nasogastric tube placement does not decrease diarrhea. The presence of a nasogastric tube can be perceived as a discomfort by the patient.

Which treatment provides the best chance of survival for a child with cirrhosis? a. Liver transplantation b. Treatment with corticosteroids c. Treatment with immune globulin d. Provision of nutritional support

A The only successful treatment for end-stage liver disease and liver failure may be liver transplantation, which has improved the prognosis for many children with cirrhosis.

Which action is the primary concern in the treatment plan for a child with persistent vomiting? a. Detecting the cause of vomiting b. Preventing metabolic acidosis c. Positioning the child to prevent further vomiting d. Recording intake and output

A The primary focus of managing vomiting is detection of the cause and then treatment of the cause. Metabolic alkalosis results from persistent vomiting. Prevention of complications is the secondary focus of treatment. The child with persistent vomiting should be positioned upright or side-lying to prevent aspiration. Recording intake and output is a nursing intervention, but it is not the primary focus of treatment.

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

A These are classic symptoms of celiac disease. They are not related to intussusception, irritable bowel syndrome, or an imperforate anus.

A 5-year-old child is brought to the emergency department with copious drooling and a croaking sound on inspiration. Her mother states that the child is very agitated and only wants to sit upright. What action by the nurse takes priority? a. Prepare intubation equipment and call the provider. b. Examine the child's oropharynx and call the provider. c. Obtain a throat culture for respiratory syncytial virus (RSV). d. Obtain vital signs and listen to breath sounds.

A This child has symptoms of epiglottitis, is acutely ill, and requires emergency measures. If epiglottitis is suspected, the nurse should not examine the child's throat. Inspection of the epiglottis is only done by a provider, because it could trigger airway obstruction. A throat culture could precipitate a complete respiratory obstruction. Vital signs can be assessed after emergency equipment is readied.

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

A This combination of drug therapy is effective in the treatment of H. pylori, the most common cause of ulcers in children.

Alterations in acid-base balance can affect cellular metabolism and enzymatic processes. When alterations in pH become too much for buffer systems to handle, compensatory mechanisms are activated. If the pH drops below normal, then acidosis will occur. Is this statement true or false? a. true b. false

A True. Acidosis is the result of a drop in blood pH. The respiratory rate and depth will increase, removing carbon dioxide and raising blood pH. Conversely, in the presence of alkalosis, respiratory rate and depth decrease, lowering blood pH.

Which assessment finding after tonsillectomy should be reported to the surgeon? a. Vomiting bright red blood b. Pain at surgical site c. Pain on swallowing d. The ability to only take small sips of liquids

A Vomiting bright red blood and swallowing frequently are signs of bleeding postoperatively and should be reported to the surgeon. It is normal for the child to have pain at the surgical site and pain with swallowing after tonsillectomy. Small sips of liquid are preferred.

The nurse is caring for a neonate with a suspected tracheoesophageal fistula (TEF). Nursing care should include which of the following? a. Elevating the head but give nothing by mouth b. Elevating the head for feedings c. Feeding glucose water only d. Avoiding suction unless infant is cyanotic

A When a newborn is suspected of having TEF, the most desirable position is supine with the head elevated on an incline plane of at least 30 degrees. It is imperative that any source of aspiration be removed at once; oral feedings are withheld. Feedings should not be given to infants suspected of having TEF. The oral pharynx should be kept clear of secretion by oral suctioning. This is to avoid cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx.

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

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

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

AB CIdentification of bleeding includes stool guaiac testing, which can detect if blood is present in the stool; protecting the child from injury by providing a safe environment; administering vitamin K to prevent bleeding episodes; and avoiding injections.

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

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

A preschooler is diagnosed with helminths. The child's mother is very upset and wants to know how her child could have contracted this illness. After obtaining a detailed history, the nurse identifies all possible transmission modes. What do they include? (Select all that apply.) a. Playing in the backyard sandbox b. Not washing hands before eating c. Placing hands in the mouth and nail biting d. Skin-to-skin contact with other children e. Scratches from a neighborhood cat

ABC Common helminths include roundworm, pinworm, tapeworm, and hookworm. Children are frequently infected as the result of frequent hand-mouth activity (unwashed hands, nail biting, not washing hands after using the toilet) and the likelihood of fecal contamination from sandboxes (especially if dogs and cats deposit fecal material in them). Other causes include not adequately washing fruits and vegetables before eating them and drinking contaminated water. Skin-to-skin contact with other children and scratches from a cat are not transmission modes for helminths.

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

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

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

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

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

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

The nurse cares for many children with different types of hepatitis. What information about this disease is correct? (Select all that apply.) a. Hepatitis A can be contracted from contaminated water. b. Only a small percentage of children infected with hepatitis B fully recover. c. People infected with chronic hepatitis C are usually asymptomatic. d. Hepatitis D is the most likely to cause a fulminating illness. e. Hepatitis E is the most common type in children in the United States.

ACD Hepatitis A can be contracted from contaminated food or water. Hepatitis C infections usually are asymptomatic. Hepatitis D is the strain most likely to cause a fulminating illness. Most children with hepatitis B recover fully. Hepatitis E is rate in the United States.

Which assessment findings indicate to the nurse that a child has excess fluid volume? (Select all that apply.) a. Weight gain b. Decreased blood pressure c. Moist breath sounds d. Poor skin turgor e. Rapid bounding pulse

ACE A child with fluid volume excess will have a weight gain, moist breath sounds due to the excess fluid in the pulmonary system, and a rapid bounding pulse. Other signs seen with fluid volume excess are increased blood pressure, edema, and fatigue. Decreased blood pressure and poor skin turgor are signs of fluid volume deficit.

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

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

Which interventions should a nurse implement when caring for a child with hepatitis? (Select all that apply.) a. Provide a well-balanced low-fat diet. b. Schedule playtime in the playroom with other children. c. Teach parents not to administer any over-the-counter medications. d. Arrange for home schooling because the child will not be able to return to school. e. Instruct parents on the importance of good handwashing.

ACE The child with hepatitis should be placed on a well-balanced low-fat diet. Parents should be taught to not give over-the-counter medications because of impaired liver function. Hand hygiene is the most important preventive measure for the spread of hepatitis. The child will be in contact isolation in the hospital so playtime with other hospitalized children is not scheduled. The child will be on contact isolation for a minimum of 1 week after the onset of jaundice. After that period, the child will be allowed to return to school.

The nurse should provide which information to parents about preventing parasitic infections? (Select all that apply.) a. Perform good handwashing. b. Diaper a child when swimming. c. Avoid cleaning the bathroom facilities with bleach. d. Shoes should be worn outside. e. Fruits and vegetables should be washed before eating.

ADE Children are more commonly infected with parasites than adults, primarily as a result of frequent hand-to-mouth activity and the likelihood of fecal contamination. Good handwashing can prevent the transmission. Shoes should be worn when outside to prevent transmission, and fruits and vegetables should be washed before eating. The child should not swim in a pool that allows diapered children. The bathroom facilities should be cleaned with bleach to decrease the chance of transmission.

What is an expected outcome for a 1-month-old infant with biliary atresia? a. Correction of the defect with the Kasai procedure b. Adequate nutrition and age-appropriate growth and development c. Adherence to a salt-free diet with vitamin B12 supplementation d. Remaining compliant with a high-protein diet

B Adequate nutrition, preventing skin breakdown, adequate growth and development, and family education and support are expected outcomes in an infant with biliary atresia. The goal of the Kasai procedure is to allow for adequate growth until a transplant can be done. It is not a curative procedure. Vitamin B12 supplementation is not indicated. A salt-restricted diet is appropriate. Protein intake may need to be restricted to avoid hepatic encephalopathy.

What is the best response by the nurse to a parent asking about antidiarrheal medication for her 18-month-old child? a. "It is okay to give antidiarrheal medication to a young child as long as you follow the directions on the box for correct dosage." b. "Antidiarrheal medication is not recommended for young children because it slows the body's attempt to rid itself of the pathogen." c. "I'm sure your child won't like the taste, so give extra fluids when you give the medication." d. "Antidiarrheal medication will lessen the frequency of stools, but give your child Gatorade to maintain electrolyte balance."

B Antidiarrheal medications may actually prolong diarrhea because the body will retain the organism causing the diarrhea, further increasing fluid and electrolyte losses. The use of these medications is not recommended for children younger than 2 years old because of their binding nature and potential for toxicity. Antidiarrheal medications are not recommended for children younger than 2 years old. This action is inappropriate because antidiarrheal medications should not be given to a child younger than 2 years old. It is not appropriate to advise a parent to use antidiarrheal medication for a child younger than 2 years old. Education about appropriate oral replacement fluids includes avoidance of sugary drinks, apple juice, sports beverages, and colas.

Which STD should the nurse suspect when an adolescent girl comes to the clinic because she has a vaginal discharge that is white with a fishy smell? a. Human papillomavirus b. Bacterial vaginosis c. Trichomonas d. Chlamydia

B Bacterial vaginosis is characterized by a profuse, white, malodorous (fishy smelling) vaginal discharge that sticks to the vaginal walls. Manifestations of the human papillomavirus are anogenital warts that begin as small papules and grow into clustered lesions. Infections with Trichomonas are frequently asymptomatic. Symptoms in females may include dysuria, vaginal itching, burning, and a frothy, yellowish-green, foul-smelling discharge. Many people with chlamydial infection have few or no symptoms. Urethritis with dysuria, urinary frequency, or mucopurulent discharge may indicate chlamydial infection.

A parent of a child with asthma asks if his child can still participate in sports. What response by the nurse is best? a. "Children with asthma are usually restricted from physical activities." b. "Children can usually play any type of sport if their asthma is well controlled." c. "Avoid swimming because exhaling underwater is dangerous for people with asthma." d. "Even with good asthma control, I would advise limiting the child to one athletic activity per school year."

B Children can usually play any type of sport if their asthma is well controlled. Children with asthma should not be restricted from physical activity. Sports participation depends on each child's response to the activity. Swimming is recommended as the ideal sport for children with asthma because the air is humidified and exhaling underwater prolongs exhalation and increases end-expiratory pressure.

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

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

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

B Common manifestations of Crohn disease include abdominal cramping, diarrhea, and weight loss. Signs and symptoms are not usually present at birth. Edema does not accompany this disease. Symptoms do not typically disappear by adolescence.

Which assessment finding should the nurse expect in an infant with Hirschsprung disease? a. "Currant jelly" stools b. Constipation with passage of foul-smelling, ribbon-like stools c. Foul-smelling, fatty stools d. Diarrhea

B Constipation results from absence of ganglion cells in the rectum and colon and is present since the neonatal period with passage of frequent foul-smelling, ribbon-like, or pellet-like stools. "Currant jelly" stools are associated with intussusception. Foul-smelling, fatty stools are associated with cystic fibrosis and celiac disease. Diarrhea is not typically associated with Hirschsprung disease but may result from impaction.

Which statement made by a parent indicates an understanding about the genetic transmission of cystic fibrosis (CF)? a. "Only one parent carries the cystic fibrosis gene." b. "Both parents are carriers of the cystic fibrosis gene." c. "The presence of the disease is most likely the result of a genetic mutation." d. "The mother is usually the carrier of the cystic fibrosis gene."

B Cystic fibrosis follows a pattern of autosomal recessive transmission. Both parents must be carriers of the gene for the disease to be transmitted to the child. If both parents carry the CF gene, each pregnancy has a 25% chance of producing a CF-affected child. The disease will not be present if only one parent is a carrier of the cystic fibrosis gene. Cystic fibrosis is known to have a definite pattern of transmission. It is transmitted as an autosomal recessive trait. A carrier parent can transmit the carrier gene to the child. The disease is present when the carrier gene is transmitted from both parents.

A child has irritable bowel syndrome. The nurse is teaching the parents about the pathophysiology associated with the symptoms their child is experiencing. Which response indicates to the nurse that teaching has been effective? a. "My child has an absence of ganglion cells in the rectum causing alternating diarrhea and constipation." b. "The cause of my child's diarrhea and constipation is disorganized intestinal contractility." c. "My child has an intestinal obstruction; that's why he has abdominal pain." d. "My child has an intolerance to gluten, and this causes him to have abdominal pain."

B Disorganized contractility and increased mucous production are precipitating factors of irritable bowel disease. The absence of ganglion cells in the rectum is associated with Hirschsprung disease. Intestinal obstruction is associated with pyloric stenosis. Intolerance to gluten is the underlying cause of celiac disease.

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

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

Which type of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)

B Epiglottitis is always a medical emergency that requires antibiotics and airway support for treatment. The other illnesses are not medical emergencies although LTB can progress to emergent status in some children.

The nurse who provides care for young children with fluid and electrolyte imbalance understands that they are more vulnerable to changes in fluid balance than adults. Under normal conditions the amount of fluid ingested during the day should equal the amount of fluid lost. Sensible water loss is that which occurs through the respiratory tract and skin. Is this statement true or false? a. true b. false

B False. Sensible water loss occurs through urine output. Insensible water loss occurs through the skin and respiratory tract. Insensible water loss per unit of body weight is significantly higher in infants and young children due to the faster respiratory rate and higher evaporative water losses.

What is the most important action to prevent the spread of gastroenteritis in a daycare setting? a. Administering prophylactic medications to children and staff b. Frequent handwashing c. Having parents bring food from home d. Directing the staff to wear gloves at all times

B Handwashing is the most the important measure to prevent the spread of infectious diarrhea. Prophylactic medications are not helpful in preventing gastroenteritis. Bringing food from home will not prevent the spread of infectious diarrhea. Gloves should be worn when changing diapers, soiled clothing, or linens. They do not need to be worn for interactions that do not involve contact with secretions. Handwashing after contact is indicated.

The nurse is caring for an infant with bronchopulmonary dysplasia (BPD) who has RSV. Which treatment measure does the nurse prepare to provide? a. Pancreatic enzymes b. Cool humidified oxygen c. Erythromycin intravenously d. Intermittent positive pressure ventilation

B Humidified oxygen is delivered if the oxygen saturation level drops to less than 90%. Pancreatic enzymes are used for patients with cystic fibrosis. Antibiotics are ineffective against viral illnesses. Assisted ventilation is not necessary in the treatment of RSV infection

What should be included in health teaching to prevent Lyme disease? a. Complete the immunization series in early infancy. b. Use insect repellant with DEET in heavily wooded areas. c. Give low-dose antibiotics to the child before exposure. d. Restrict activities that might lead to exposure for the child.

B Insect repellant with DEET can prevent insect bites. Currently there is no vaccine available for Lyme disease. Antibiotics are used to treat, not prevent, Lyme disease. Children should be allowed to maintain normal growth and development with activities such as hiking.

What is the most important factor in determining the rate of fluid replacement in the dehydrated child? a. The child's weight b. The type of dehydration c. Urine output d. Serum potassium level

B Isonatremic and hyponatremic dehydration resuscitation involves fluid replacement over 24 hours. Hypernatremic dehydration involves a slower replacement rate to prevent a sudden decrease in the sodium level. The child's weight determines the amount of fluid needed, not the rate of fluid replacement. One milliliter of body fluid is equal to 1 g of body weight; therefore a loss of 1 kg (2.2 lb) is equal to 1 L of fluid. Urine output is not a consideration for determining the rate of administration of replacement fluids. Potassium level is not as significant in determining the rate of fluid replacement as the type of dehydration.

What should the nurse expect to observe in the prodromal phase of rubeola? a. Macular rash on the face b. Koplik spots c. Petechiae on the soft palate d. Crops of vesicles on the trunk

B Koplik spots appear approximately 2 days before the appearance of a rash. The macular rash with rubeola appears after the prodromal stage. Petechiae on the soft palate occur with rubella. Crops of vesicles on the trunk are characteristic of varicella.

Which statement indicates that a parent of a toddler needs more education about preventing foreign body aspiration? a. "I keep objects with small parts out of reach." b. "My toddler loves to play with balloons." c. "I won't permit my child to have peanuts." d. "I never leave coins where my child could get them."

B Latex balloons account for a significant number of deaths from aspiration every year. The other statements show good understanding.

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include which of the following? a. Forcing fluids b. Monitoring pulse oximetry c. Instituting seizure precautions d. Encouraging a high-protein diet

B Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. Maintenance of vascular volume and hydration is important and should be done parenterally. Seizures are not a side effect of ARDS. Adequate nutrition is necessary, but a high-protein diet is not helpful.

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

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

A home health care nurse is doing a home assessment for a family whose child is oxygen dependent. What finding by the nurse requires intervention? a. Tanks are stored only in an upright position. b. Oxygen tank is placed 3 feet away from the heater. c. Smoking is not allowed in the house. d. Fire extinguisher expires at the end of the month.

B Oxygen tanks or sources should be at least 5 feet away from heat sources. The other findings are safe although the nurse might remind the family to replace the extinguisher prior to its expiration.

What is an expected outcome for the parents of a child with encopresis? a. The parents will give the child an enema daily for 3 to 4 months. b. The family will develop a plan to achieve control over incontinence. c. The parents will have the child launder soiled clothes. d. The parents will supply the child with a low-fiber diet.

B Parents of the child with encopresis often feel guilty and believe that encopresis is willful on the part of the child. The family functions effectively by openly discussing problems and developing a plan to achieve control over incontinence. Stool softeners or laxatives, along with dietary changes, are typically used to treat encopresis. Enemas are indicated when a fecal impaction is present. This action is a punishment and will increase the child's shame and embarrassment. The child should not be punished for an action that is not willful. Increasing fiber in the diet and fluid intake results in greater bulk in the stool, making it easier to pass.

How should the nurse respond to a parent who asks, "How can I protect my baby from whooping cough?" a. "Don't worry; your baby will have maternal immunity to pertussis that will last until approximately 18 months old." b. "Make sure your child gets the pertussis vaccine." c. "See the doctor when the baby gets a respiratory infection." d. "Have your pediatrician prescribe erythromycin."

B Primary prevention of pertussis can be accomplished through administration of the pertussis vaccine. Infants do not receive maternal immunity to pertussis and are susceptible to pertussis. Pertussis is highly contagious and is associated with a high infant mortality rate. Prompt evaluation by the primary care provider for respiratory illness will not prevent pertussis. Erythromycin is used to treat pertussis. It will not prevent the disease.

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

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

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

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

Which assessment finding is the most significant to report to the physician for a child with cirrhosis? a. Weight loss b. Change in level of consciousness c. Skin with pruritus d. Black, foul-smelling stools

B The child with cirrhosis must be assessed for encephalopathy, which is characterized by a change in level of consciousness. Encephalopathy can result from a buildup of ammonia in the blood from the incomplete breakdown of protein. One complication of cirrhosis is ascites. The child needs to be assessed for increasing abdominal girth and edema. A child who is retaining fluid will not exhibit weight loss. Biliary obstruction can lead to pruritus, which is a frequent finding. An alteration in the level of consciousness is of higher priority. Black, tarry stools may indicate blood in the stool. This needs be reported to the physician. This is not a higher priority than a change in level of consciousness.

The nurse encourages the mother of a toddler with acute LTB to stay at the bedside as much as possible. Which of the following best explains the nurse's rationale? a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease the child's respiratory efforts. c. Separation from the mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's respiratory efforts.

B The family's presence will decrease the child's distress, which in turn helps decrease respiratory efforts. Guilt is not the main rationale. Toddlers do suffer from separation anxiety, but that is not the primary reason for the mother to stay. The child should have constant monitoring by cardiorespiratory monitor and noninvasive oxygen saturation monitoring, but the parent should not play this role in the hospital.

A nurse is conducting a health education class for a group of school-age children. Which statement made by the nurse is correct about the body's first line of defense against infection in the innate immune system? a. Nutritional status b. Skin integrity c. Immunization status d. Proper hygiene practices

B The first lines of defense in the innate immune system are the skin and intact mucous membranes. Nutritional status is an indicator of overall health, but it is not the first line of defense in the innate immune system. Immunizations provide artificial immunity or resistance to harmful diseases. Practicing good hygiene may reduce susceptibility to disease, but it is not a component of the innate immune system.

What is the best response to a parent of a 2-month-old infant who asks when the infant should first receive the measles vaccine? a. "Your baby can get the measles vaccine now." b. "The first dose is given any time after the first birthday." c. "She should be vaccinated between 4 and 6 years of age." d. "This vaccine is administered when the child is 11 years old."

B The first measles, mumps, rubella (MMR) vaccine is recommended routinely at 1 year of age. The other statements are not correct.

A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. What home care measure does the nurse educate parents about? a. Taking the full course of antibiotics b. Providing humidity and increased fluids c. Treating any fever with aspirin d. Isolation from family until symptoms resolve

B This child has bronchitis which is a viral illness treated symptomatically. Humidity and increased fluids provide comfort, ease symptoms, and prevent dehydration. Antibiotics are not used unless an overlying infection occurs as well. Aspirin is not given to children due to the association with Reye syndrome. The child does not need to be isolated. PTS: 1

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

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

The nurse has educated the parents of a child with celiac disease on diet modifications. Which food choices by the child's parents indicate understanding of teaching? (Select all that apply.) a. Oatmeal b. Steamed rice c. Corn on the cob d. Baked chicken e. Peanut butter and jelly sandwich on wheat bread

BCD Rice, corn, and chicken do not contain gluten and so are appropriate choices. Oatmeal and wheat bread are not.

A hospitalized child has developed a methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse plans which interventions when caring for this child? (Select all that apply.) a. Airborne isolation b. Administration of vancomycin c. Contact isolation d. Administration of mupirocin ointment to the nares if colonized e. Administration of cefotaxime (Cefotetan)

BCD Vancomycin is used to treat MRSA along with mupirocin ointment to the nares. The patient is placed in contact isolation to prevent spread of the infection to other patients. The infection is not transmitted by the airborne route so only contact isolation is required. This infection is resistant to cephalosporins.

The nurse is providing home care instructions to the parents of an infant being discharged after repair of a bilateral cleft lip. Which instructions should the nurse include? (Select all that apply.) a. Acetaminophen (Tylenol) should not be given to your infant. b. Feed your infant in an upright position. c. Place your infant prone for a period of time each day. d. Burp your child frequently during feedings. e. Apply antibiotic ointment to the lip as prescribed.

BDE After cleft lip surgery the parents are taught to feed the infant in an upright position to decrease the chance of choking. The parents are taught to burp the infant frequently during feedings because excess air is often swallowed. Parents are taught to cleanse the suture line area with a cotton swab using a rolling motion and apply antibiotic ointment with the same technique. Tylenol is used for pain, and the child should never be placed prone as this position can damage the suture line.

The nurse caring for a child with suspected appendicitis should question which order from the physician? a. Keep patient NPO. b. Start IV of D5/0.45 normal saline at 60 mL/hr. c. Apply K-pad to abdomen prn for pain. d. Obtain CBC on admission to nursing unit.

C A K-pad (moist heat device) is contraindicated for suspected appendicitis because it may contribute to the rupture of the appendix. NPO status, an IV, and a CBC are all appropriate for this child.

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

C A maternal history of polyhydramnios is associated with TEF. Advanced maternal age, first term pregnancy, or complicated pregnancy are not related.

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

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

Which assessment is most relevant to the care of an infant with dehydration? a. Temperature, heart rate, and blood pressure b. Respiratory rate, oxygen saturation, and lung sounds c. Heart rate, sensorium, and skin color d. Diet tolerance, bowel function, and abdominal girth

C Changes in heart rate, sensorium, and skin color are early indicators of impending shock in the child. Children can compensate and maintain an adequate cardiac output when they are hypovolemic. Blood pressure is not as reliable an indicator of shock as are changes in heart rate, sensorium, and skin color. Respiratory assessments will not provide data about impending hypovolemic shock. Diet tolerance, bowel function, and abdominal girth are not as important indicators of shock as heart rate, sensorium, and skin color.

Which statement made by parents of a child with cystic fibrosis indicates that they understood the nurse's teaching on pancreatic enzyme replacement? a. "Enzymes will improve my child's breathing." b. "I should give the enzymes 1 hour after meals." c. "Enzymes should be given with meals and snacks." d. "The enzymes are stopped if my child begins wheezing."

C Children with cystic fibrosis need to take enzymes with food for adequate absorption of nutrients. Pancreatic enzymes do not affect the respiratory system. Pancreatic enzymes are taken within 30 minutes of eating all meals and snacks. Giving the medication 1 hour after meals is inappropriate and ineffective for absorption of nutrients. Wheezing is not a reason to stop taking enzyme replacements

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

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

What is used to treat moderate to severe inflammatory bowel disease? a. Antacids b. Antibiotics c. Corticosteroids d. Antidiarrheal medications

C Corticosteroids, such as prednisone and prednisolone, are used in short bursts to suppress the inflammatory response in inflammatory bowel disease. Antacids and antidiarrheals are not used. Antibiotics may be used to treat complications.

A nurse is teaching a student nurse in the pediatric clinic about vomiting in children. The nurse states that getting parents to estimate the amount a child has vomited is quite difficult. What is the best explanation for this problem? a. Parents are too upset by the vomiting to pay close attention. b. Parents don't know how to accurately estimate the amount. c. Descriptions about vomitus are vague and non-specific. d. Infants and small children often swallow the vomitus.

C Descriptive words used to describe vomitus are often vague and used inconsistently. The astute nurse uses specific questions to elicit the most accurate information. See Nursing Quality Alert Box 43-2 for examples of good questions to ask. Parents may or may not be too upset to pay attention. It is belittling to state that parents don't know how to estimate amounts. Infants and children may swallow some vomitus, but that is not the main problem.

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

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

What is a priority concern for a 14-year-old child with inflammatory bowel disease? a. Compliance with antidiarrheal medication therapy b. Long-term complications c. Dealing with the embarrassment and stress of diarrhea d. Home schooling due to extreme absenteeism

C Embarrassment and stress from chronic diarrhea are real concerns for the adolescent with inflammatory bowel disease. Antidiarrheal medications are not typically ordered for a child with inflammatory bowel disease. Long-term complications are not a priority concern for the adolescent with inflammatory bowel disease. Exacerbations may interfere with school attendance, but home schooling is not a usual consideration for the adolescent with inflammatory bowel disease.

A nurse has admitted a child to the hospital with a diagnosis of "rule out" peptic ulcer disease. Which test will the nurse expect to be ordered to confirm the diagnosis of a peptic ulcer? a. A dietary history b. A positive Hematest result on a stool sample c. A fiberoptic upper endoscopy d. An abdominal ultrasound

C Endoscopy provides direct visualization of the stomach lining and confirms the diagnosis of peptic ulcer. Dietary history may yield information suggestive of a peptic ulcer. Blood in the stool indicates a gastrointestinal abnormality, but it does not conclusively confirm a diagnosis of peptic ulcer. An abdominal ultrasound is used to rule out other gastrointestinal alterations such as gallstones, tumor, or mechanical obstruction.

A small child with cystic fibrosis cannot swallow pancreatic enzyme capsules. The nurse should teach parents to mix enzymes with which food? a. Macaroni and cheese b. Tapioca c. Applesauce d. Hot chocolate

C Enzymes can be mixed with a small amount of nonacidic foods. Macaroni and cheese and hot chocolate are not good choices because enzymes are inactivated by heat and starchy foods. Tapioca is also a starchy food.

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

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

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

C Giardiasis a parasite that represents 15% of nondysenteric illness in the United States. The other organisms are bacterial.

Which statement best characterizes hepatitis A? a. Incubation period is 6 weeks to 6 months. b. Principal mode of transmission is through the parenteral route. c. Onset is usually rapid and acute. d. There is a persistent carrier state.

C Hepatitis A is characterized by a rapid acute onset. The incubation period is approximately 3 weeks for hepatitis A. The principal mode of transmission for hepatitis A is the fecal-oral route. Hepatitis A does not have a carrier state.

Which statement indicates that a father understands the treatment for his child who has scarlet fever? a. "I can stop the medicine when my child feels better." b. "I will apply antibiotic cream to her rash twice a day." c. "I will give the penicillin for the full 10 days." d. "My child can go back to school after 7 days of antibiotics."

C It is necessary to give the entire course of antibiotic for 10 to 14 days. Penicillin is the preferred treatment for any streptococcal infection. The bacteria will not be eradicated if a partial course of antibiotics is given. Treatment of scarlet fever does not include topical antibiotic cream. The child is no longer contagious after 24 hours of antibiotic therapy and can return to daycare or school.

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

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

Therapeutic management of the child with acute diarrhea and dehydration usually begins with a. clear liquids. b. IV solutions while the child is NPO. c. oral rehydration solution (ORS). d. antidiarrheal medications.

C Orally administered rehydration solution is the first treatment for acute diarrhea. Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. The child might need an IV but would not be NPO. Antidiarrheals are not recommended because they do not get rid of pathogens.

What is an appropriate statement for the nurse to make to parents of a child who has had a barium enema to correct an intussusception? a. "I will call the physician when the baby passes his first stool." b. "I am going to dilate the anal sphincter with a gloved finger to help the baby pass the barium." c. "Your baby can't have anything to eat or drink until bowel function returns." d. "Add cereal to the baby's formula to help him pass the barium."

C Post procedure, the child is kept NPO until bowel function returns. The physician does not need to be notified when the infant passes the first stool. Dilating the anal sphincter is not appropriate for the child after a barium enema.

What assessment should the nurse make before initiating an intravenous (IV) infusion of dextrose 5% in 0.9% normal saline solution with 10 mEq of potassium chloride for a child hospitalized with dehydration? a. Fluid intake b. Number of stools c. Urine output d. Capillary refill

C Potassium chloride should never be added to an IV solution in the presence of oliguria or anuria (urine output less than 0.5 mL/kg/hr). Fluid intake does not give information about renal function. Stool count sheds light on intestinal function. Renal function is the concern before potassium chloride is added to an IV solution. Assessment of capillary refill does not provide data about renal function.

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

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

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

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

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

C Rotavirus is the most frequent viral pathogen that causes diarrhea in young children. The other organisms are bacterial.

What is the major focus of the therapeutic management for a child with lactose intolerance? a. Compliance with the medication regimen b. Providing emotional support to family members c. Teaching dietary modifications d. Administration of daily normal saline enemas

C Simple dietary modifications are effective in management of lactose intolerance. Symptoms of lactose intolerance are usually relieved after instituting a lactose-free diet. Medications are not typically ordered in the management of lactose intolerance. Providing emotional support to family members is not specific to this medical condition. Diarrhea is a manifestation of lactose intolerance. Enemas are contraindicated for this alteration in bowel elimination.

Which statement made by a parent indicates an understanding about treatment of streptococcal pharyngitis? a. "I guess my child will need to have his tonsils removed." b. "A couple of days of rest and some ibuprofen will take care of this." c. "I should give the penicillin three times a day for 10 days." d. "I am giving my child prednisone to decrease the swelling of the tonsils."

C Streptococcal pharyngitis is best treated with oral penicillin two to three times daily for 10 days. Surgical removal of the tonsils is a controversial issue. It may be warranted in cases of recurrent tonsillitis. It is not indicated for the treatment of acute tonsillitis. Comfort measures such as rest and analgesics are indicated, but these will not treat the bacterial infection. Corticosteroids are not used in the treatment of streptococcal pharyngitis.

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

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

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

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

What should the nurse teach a child about using an albuterol metered-dose inhaler for exercise-induced asthma? a. Take two puffs every 6 hours around the clock. b. Use the inhaler only when the child is short of breath. c. Use the inhaler 30 minutes before exercise. d. Take one to two puffs every morning upon awakening.

C The appropriate time to use an inhaled beta2-agonist is before an event that could trigger an attack. Taking the medication every 6 hours will not prevent the exercise-induced asthma. Waiting until symptoms are severe is too late to begin using a metered-dose inhaler. Taking puffs every morning may be the child's usual schedule for medication. If exercise causes symptoms, additional medication is indicated.

Which description of a stool is characteristic of intussusception? a. Ribbon-like stools b. Hard stools positive for guaiac c. "Currant jelly" stools d. Loose, foul-smelling stools

C The characteristic stool of intussusception is described as "currant jelly." Ribbon-like stools are characteristic of Hi rschsprung disease. With intussusception, passage of bloody mucous stools occurs. Stools will not be hard. Loose, foul-smelling stools may indicate infectious gastroenteritis.

What goal has the highest priority for a child with malabsorption associated with lactose intolerance? a. The child will experience no abdominal spasms. b. The child will not experience constipation and malabsorption syndrome. c. The child will not experience diarrhea associated with malabsorption syndrome. d. The child will receive adequate nutrition as evidenced by a weight gain of 1 kg/week.

C The child with lactose intolerance will have diarrhea and malabsorption, so a good goal would be no longer having these manifestations. A child usually has abdominal cramping pain and distention rather than spasms. The child usually has diarrhea, not constipation. One kilogram every week may or may not be appropriate depending on the child's age and how long the goal is in place for.

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

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

Once an allergen is identified in a child with allergic rhinitis, the treatment of choice the nurse educates the parents about is which of the following? a. Using appropriate medications b. Beginning desensitization injections c. Eliminating the allergen d. Removing the adenoids

C The first priority is to attempt to remove the causative agent from the child's environment. Medications are not a first-line treatment but can be helpful in controlling allergic rhinitis. Immunotherapy is usually the final component of controlling allergic rhinitis. Adenoids are tissues that can swell with constant rhinitis; however, a surgical procedure is not indicated for allergic rhinitis. Dealing with the cause is the first priority.

A parent brings a child to the emergency department and reports fever, foul smell coming from the throat, and a gray covering over the tonsils. What action by the nurse takes priority? a. Place the child on a cardiac monitor. b. Attach a pulse oximeter to the child. c. Assess respiratory status immediately. d. Start an IV and draw blood cultures.

C The manifestations are characteristic of diphtheria, which can cause respiratory compromise and airway obstruction. The nurse first assesses the child's respiratory status. Putting the child on a cardiac monitor and oximeter are important interventions, but first the nurse needs to assess the respiratory system. The child will need an IV, but that can be started after the respiratory assessment.

A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. What is the purpose of these drugs? a. Prevent reflux b. Prevent hematemesis c. Reduce gastric acid production d. Increase gastric acid production

C The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and to prevent esophagitis.

The mother of an infant with multiple anomalies tells the nurse that she had a viral infection in the beginning of her pregnancy. Which viral infection is associated with fetal anomalies? a. Measles b. Roseola c. Rubella d. Herpes simplex virus (HSV)

C The rubella virus can cross the placenta and infect the fetus, causing fetal anomalies. Measles is not associated with congenital defects. Most cases of roseola occur in children 6 to 18 months old. HSV can be transmitted to the newborn infant during vaginal delivery, causing multisystem disease. It is not transmitted transplacentally to the fetus during gestation.

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

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

The nurse in the pediatric clinic is caring for a child and assesses this skin rash. What action by the nurse is best? a. Inform parents the child will be contagious for one week. b. Arrange for immediate hospitalization and IV antibiotics. c. Instruct parents to offer the child a soft, bland diet. d. Advise parents the child can maintain normal activities.

C This rash is characteristic of scarlet fever. The parents should provide soft, bland food. The child is not contagious 24 hours after starting antibiotics. There is no indication the child is sick enough to need hospitalization. The parents should encourage rest.

Which type of hernia has an impaired blood supply to the herniated organ? a. Hiatal hernia b. Incarcerated hernia c. Omphalocele d. Strangulated hernia

D A strangulated hernia is one in which the blood supply to the herniated organ is impaired. A hiatal hernia is the intrusion of an abdominal structure, usually the stomach, through the esophageal hiatus. An incarcerated hernia is a hernia that cannot be reduced easily. Omphalocele is the protrusion of intraabdominal viscera into the base of the umbilical cord. The sac is covered with peritoneum and not skin.

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

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

Which statement made by a parent about intervention for a child's fever shows the need for further education? a. "I should keep her covered lightly when she has a fever." b. "I'll give her plenty of liquids to keep her hydrated." c. "I can give her acetaminophen for a fever." d. "I'll look for over-the-counter aspirin or ibuprofen."

D Aspirin products are avoided because of the possibility of development of Reye's syndrome. The parent should check labels on all over-the-counter products to be sure they do not contain aspirin. Ibuprofen is alright to give children. Dressing the child in light clothing and using lightweight covers will help reduce fever and promote the child's comfort. Adequate hydration will help maintain a normal body temperature. Acetaminophen is also recommended for fever in children.

The child with lactose intolerance is most at risk for which imbalance? a. Hyperkalemia b. Hypoglycemia c. Hyperglycemia d. Hypocalcemia

D Because high-calcium dairy products containing lactose are restricted from the child's diet, alternative sources such as egg yolk, green leafy vegetables, dried beans, and cauliflower must be provided to prevent hypocalcemia. The child with lactose intolerance is not at risk for hyperkalemia. Lactose intolerance does not affect glucose metabolism. Hyperglycemia does not result from ingestion of a lactose-free diet.

Which intervention is appropriate for the infant hospitalized with bronchiolitis? a. Position on the side with neck slightly flexed. b. Administer antibiotics as ordered. c. Restrict oral and parenteral fluids if tachypneic. d. Give cool, humidified oxygen.

D Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible fluid loss from tachypnea. The infant should be positioned with the head and chest elevated at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm. The etiology of bronchiolitis is viral. Antibiotics are only given if there is a secondary bacterial infection. Tachypnea increases insensible fluid loss. If the infant is tachypneic, fluids are given parenterally to prevent dehydration.

What should the nurse stress in a teaching plan for the mother of an 11-year-old boy with ulcerative colitis? a. Preventing the spread of illness to others b. Nutritional guidance and preventing constipation c. Teaching daily use of enemas d. Coping with stress and avoiding triggers

D Coping with the stress of chronic illness and the clinical manifestations associated with ulcerative colitis (diarrhea, pain) are important teaching foci. Avoidance of triggers can help minimize the impact of the disease and its effect on the child. Ulcerative colitis is not infectious. Enemas are not used in this disease.

A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. Which statement by the parent indicates a correct understanding of the teaching? a. "I will keep my child on a clear liquid diet for the next 24 hours." b. "I should encourage my child to drink carbonated drinks but avoid food for the next 24 hours." c. "I will offer my child bananas, rice, applesauce, and toast for the next 48 hours." d. "I should have my child eat a normal diet with easily digested foods for the next 48 hours."

D Easily digested foods such as cereals, cooked vegetables, and meats should be provided for the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness. Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. The BRAT diet (bananas, rice, applesauce, and toast) is no longer recommended.

A parent asks the nurse how she will know whether her child has fifth disease. The nurse should advise the parent to be alert for which manifestation? a. Bull's-eye rash at the site of a tick bite b. Lesions in various stages of development on the trunk c. Maculopapular rash on the trunk that lasts for 2 days d. Bright red rash on the cheeks that looks like slapped cheeks

D Fifth disease manifests with an intense, fiery red, edematous rash on the cheeks, which gives a "slapped cheek" appearance. The bull's-eye rash at the site of a tick bite is a manifestation of Lyme disease. Varicella is manifested as lesions in various stages of development—macule, papule, then vesicle, first appearing on the trunk and scalp. Roseola manifests as a maculopapular rash on the trunk that can last for hours or up to 2 days.

A child taking oral corticosteroids for asthma is exposed to varicella. The child has not had the varicella vaccine and has never had the disease. What intervention should be taken to prevent varicella from developing? a. No intervention is needed unless varicella develops. b. Administer the varicella vaccine as soon as possible. c. The child should begin a course of oral antibiotics. d. The child should be prescribed acyclovir.

D For children who are immunosuppressed (such as from corticosteroids), acyclovir is the treatment of choice to prevent infection. Action is needed due to the risk of serious complications. The varicella vaccine is a live virus vaccine and is contraindicated for an immunosuppressed child. An antibiotic is not effective in treating varicella zoster, which is a virus.

Careful handwashing before and after contact can prevent the spread of which condition in daycare and school settings? a. Irritable bowel syndrome b. Ulcerative colitis c. Hepatic cirrhosis d. Hepatitis A

D Hepatitis A is spread person to person, by the fecal-oral route, and through contaminated food or water. Good handwashing is critical in preventing its spread. The virus can survive on contaminated objects for weeks. The other conditions are not contagious.

Which statement is characteristic of acute otitis media (AOM)? a. The etiology is unknown. b. Permanent hearing loss often results. c. It can be treated by intramuscular (IM) antibiotics. d. It is treated with a broad range of antibiotics.

D Historically AOM has been treated with a range of antibiotics, and it is the most common disorder treated with antibiotics in the ambulatory setting. The etiology of AOM may be Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis or a viral agent. Recent concerns about drug-resistant organisms have caused authorities to recommend judicious use of antibiotics and that antibiotics are not required for initial treatment. Permanent hearing loss is not frequently caused by properly treated AOM. Intramuscular antibiotics are not necessary.

Which action is initiated when a child has been scratched by a potentially rabid animal? a. No intervention unless the child becomes symptomatic b. Administration of immune globulin around the wound c. Administration of rabies vaccine on days 3, 7, 14, and 28 d. Administration of both immune globulin and vaccine as soon as possible after exposure

D Human rabies immune globulin and the first dose of the rabies vaccine are given after exposure. Transmission of rabies can occur from bites with contaminated saliva, scratches from the claws of infected animals, airborne transmission in bat-infested caves, or in a laboratory setting. Rabies is fatal if no intervention is taken to prevent the disease. Human rabies immune globulin is infiltrated locally around the wound, and the other half of the dose is given intramuscularly. This is only part of the treatment after rabies exposure. The rabies vaccine is given within 48 hours of exposure and again on days 3, 7, 14, and 28.

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

D Imbalanced Nutrition: Less than Body Requirements is the highest priority nursing diagnosis because celiac disease causes gluten enteropathy, a malabsorption condition. A psychosocial diagnosis (Disturbed Body Image) would not take priority over a physical diagnosis. Celiac disease causes disproportionate growth and development associated with malnutrition, not obesity. Celiac crisis causes deficient fluid volume.

A nurse is teaching parents about diarrhea. Which statement by the parents indicates understanding of the teaching? a. Diarrhea results from a fluid deficit in the small intestine. b. Organisms destroy intestinal mucosal cells, resulting in an increased intestinal surface area. c. Malabsorption results in metabolic alkalosis. d. Increased motility results in impaired absorption of fluid and nutrients.

D Increased motility and rapid emptying of the intestines result in impaired absorption of nutrients and water. Electrolytes are drawn from the extracellular space into stool, and dehydration results. Diarrhea results from fluid excess in the small intestine. Destroyed intestinal mucosal cells result in decreased intestinal surface area. Loss of electrolytes in the stool from diarrhea results in metabolic acidosis.

What information should the nurse teach workers at a daycare center about RSV? a. RSV is transmitted through particles in the air. b. RSV can live on skin or paper for up to a few seconds after contact. c. RSV can survive on nonporous surfaces for about 60 minutes. d. Frequent handwashing can decrease the spread of the virus.

D Meticulous handwashing can decrease the spread of organisms. RSV infection is not airborne. It is acquired mainly through contact with contaminated surfaces. RSV can live on skin or paper for up to 1 hour. RSV can live on cribs and other nonporous surfaces for up to 6 hours.

Therapeutic management of most children with Hirschsprung disease is primarily a. daily enemas. b. low-fiber diet. c. permanent colostomy. d. surgical removal of the affected section of the bowel.

D Most children with Hirschsprung disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. Preoperative management may include enemas and a low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. The colostomy that is created in Hirschsprung disease is usually temporary.

A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of a. protein intolerance. b. parasitic infection. c. fat malabsorption. d. bacterial gastroenteritis.

D Neutrophils and red blood cells in stool indicate bacterial gastroenteritis. This does not signify protein intolerance, a parasitic infection, or fat malabsorption.

After an infant is born the nurse notices that the child has herniation of abdominal viscera into the base of the umbilical cord. What will the nurse document about this condition? a. Diaphragmatic hernia b. Umbilical hernia c. Gastroschisis d. Omphalocele

D Omphalocele is the herniation of the abdominal viscera into the base of the umbilical cord. This does not describe a diaphragmatic hernia, umbilical hernia, or gastroschisis.

An adolescent has been diagnosed with the Epstein-Barr virus. What discharge information should the nurse give to the parents? a. It is important to protect the adolescent's head during physical activities. b. The teen will feel like himself and be back to his usual routines in a week. c. Treatment of the Epstein-Barr virus is several months of prolonged bed rest. d. Fatigue may persist, so increase school activities gradually.

D The recovery period is often lengthy and fatigue may continue, necessitating a gradual return to school activities. During the acute and recovery phases, activity restrictions, which include no contact sports or roughhousing, are implemented to protect the child's enlarged spleen from rupture. The recovery process from infectious mononucleosis is a slow and gradual one. Prolonged rest (not bedrest) is indicated during the acute stage of the illness only.

What is the priority nursing intervention for a 6-month-old infant hospitalized with diarrhea and dehydration? a. Estimating insensible fluid loss b. Collecting urine for culture and sensitivity c. Palpating the posterior fontanel d. Measuring the infant's weight

D Weight is a crucial indicator of fluid status. It is an important criterion for assessing hydration status and response to fluid replacement. Infants have a greater total body surface area and therefore a greater potential for fluid loss through the skin. It is not possible to measure insensible fluid loss. Urine for culture and sensitivity is not usually part of the treatment plan for the infant who is dehydrated from diarrhea. The posterior fontanel closes by 2 months of age. The anterior fontanel can be palpated during an assessment of an infant with dehydration.

A child has a 2-day history of vomiting and diarrhea. He has hypoactive bowel sounds and an irregular pulse. Electrolyte values are sodium, 139 mEq/L; potassium, 3.3 mEq/L; and calcium, 9.5 mg/dL. This child is likely to have which of the following electrolyte imbalances? a. Hyponatremia b. Hypocalcemia c. Hyperkalemia d. Hypokalemia

D A serum potassium level less than 3.5 mEq/L is considered hypokalemia. Clinical manifestations of hypokalemia include muscle weakness, decreased bowel sounds, cardiac irregularities, hypotension, and fatigue. The normal serum sodium level is 135 to 145 mEq/L. A level of 139 mEq/L is within normal limits. A serum calcium level less than 8.5 mg/dL is considered hypocalcemia. A serum potassium level greater than 5 mEq/L is considered hyperkalemia.