NCLEX Pediatrics questions

A nurse is providing instructions to the mother of a child with juvenile idiopathic arthritis regarding measures to take if a painful exacerbation of the disease occurs. Which statement by the mother indicates the need for further instruction?

*1. "The full range-of-motion (ROM) exercises must be performed every day, even during the exacerbations."* 2. "Hot or cold packs will assist in reducing discomfort." 3. "The painful joint should be splinted and positioned in a neutral position." 4. "I should have my child perform simple isometric exercises during exacerbations." *Rationale:* During painful episodes, hot or cold packs and splinting and positioning the affected joint in a neutral position help reduce the pain. Full ROM exercises will cause significant pain during exacerbation and should be avoided during this time. Although resting the extremity is appropriate, it is important to begin simple isometric or tensing exercises as soon as the child is able. These exercises do not involve joint movement.

A female adolescent with type 1 diabetes mellitus will become a member of the school's football cheerleader team. The adolescent excitedly reports to the school nurse to obtain information regarding adjustments needed in the treatment plan for the diabetes. The school nurse would instruct the adolescent to:

*1. Eat six graham crackers or drink a cup of orange juice before practice or game time.* 2. Eat half the amount of food normally eaten at lunchtime. 3. Take the prescribed insulin one half hour before practice or game time rather than in the morning. 4. Take two times the amount of prescribed insulin on practice and game days. *Rationale:* An extra snack of 15 to 30 g of carbohydrate eaten before activities such as cheerleader practice will prevent hypoglycemia. Six graham crackers or a cup of orange juice will provide 15 to 30 g of carbohydrate. The adolescent should not be instructed to adjust the amount or time of insulin administration. Meal amounts should not be decreased.

An adolescent with diabetes mellitus is attending gym class and suddenly becomes flushed and complains of dizziness and a headache. The gym teacher quickly takes the adolescent to the school nurse's office. The nurse obtains a blood glucose level, and the results indicate a level of 65 mg/dL. The appropriate initial nursing intervention is to:

1. Call the child's mother for permission to treat the child. 2. Call the school health care provider immediately. 3. Let the child rest until the blood glucose has an opportunity to rise. *4. Give the child 6 oz of a regular cola drink.* *Rationale:* A blood glucose level below 70 mg/dL indicates hypoglycemia. The child is participating in an activity that requires more energy than that of the normal routine at school. Insulin and food requirements change with situations that require more energy. When signs of hypoglycemia occur, the child needs an immediate source of glucose. Options 1, 2, and 3 do not address the hypoglycemic state immediately and delay required treatment.

A nurse is assisting in developing a plan of care for a 10-year-old child diagnosed with acute glomerulonephritis. Following review of the plan of care, the nurse determines that which of the following is the priority for the child?

1. Restricting oral fluids 2. Allowing the child to play with the other children in the playroom *3. Promoting bedrest* 4. Encouraging visits from friends *Rationale:* Bedrest is required during the acute phase, and activity is gradually increased as the condition improves. Providing for quiet play according to the developmental stage of the child is important. Fluids should not be forced or restricted. Visitors should be limited to allow for adequate rest.

A 2-year-old child is admitted to the hospital with a diagnosis of nephrotic syndrome. In planning care for this child, which of the following nursing interventions would be of highest priority?

1. Weigh morning and afternoon. 2. Maintain a strict intake and output. *3. Dipstick the urine for protein every 4 hours.* 4. Take vital signs with blood pressure every 4 hours. *Rationale:* Continuous monitoring of fluid retention and excretion is an important nursing intervention in the care of the child with nephrotic syndrome. Although it is important to maintain a strict intake and output in monitoring fluid retention and excretion, the goal of treatment with this child is to decrease the amount of protein lost in the urine. Because this is the goal, option 3 has the highest priority. Although weight is monitored, it is not necessary to check the weight morning and evening. Taking vital signs with blood pressure is important but is not the priority in this situation.

After a tonsillectomy, which of the following fluid or food items would be appropriate to offer to the child?

*1. Yellow Jell-O* 2. Cold ginger ale 3. Vanilla pudding 4. Cherry Popsicle *Rationale:* After a tonsillectomy, clear, cool liquids should be administered. Citrus, carbonated, and extremely hot or cold liquids need to be avoided, because they may irritate the throat. Milk and milk products (pudding) are avoided, because they coat the throat and cause the child to clear the throat, thus increasing the risk of bleeding. Red liquids need to be avoided, because they give the appearance of blood if the child vomits.

An infant returns to the nursing unit after the surgical repair of a cleft lip located on the right side of the lip. The best position in which to place this infant at this time is:

1. A flat position 2. A prone position *3. On his or her left side* 4. On his or her right side *Rationale:* After the repair of a cleft lip, the infant should be positioned on the side opposite to the repair to prevent contact of the suture lines with the bed linens. In this case, it is best to place the infant on his or her left side. Additionally, the flat or prone position can result in aspiration if the infant vomits.

A nurse is assigned to care for a child who is scheduled for an appendectomy. Which prescriptions does the nurse anticipate will be prescribed? *Select all that apply.*

1. Administer a Fleet enema. *2. Initiate an intravenous line.* *3. Maintain nothing-by-mouth status.* *4. Administer intravenous antibiotics.* *5. Administer preoperative medications.* 6. Place a heating pad on the abdomen to decrease pain. *Rationale:* During the preoperative period, enemas or laxatives should not be administered. In addition, heat should not be applied to the abdomen. Any of these interventions can cause the rupture of the appendix and resultant peritonitis. Intravenous fluids would be started, and the child should receive nothing by mouth while awaiting surgery. Antibiotics are usually administered because of the risk of perforation. Preoperative medications are administered as prescribed.

A nurse reinforces instructions to the mother about dietary measures for a 5-year-old child with lactose intolerance. The nurse tells the mother that which of the following supplements will be required as a result of the need to avoid lactose in the diet?

1. Fats 2. Zinc *3. Calcium* 4. Thiamine *Rationale:* Lactose intolerance is the inability to tolerate lactose, which is the sugar that is found in dairy products. Removing milk from the diet can provide relief from symptoms. Additional dietary changes may be required to provide adequate sources of calcium and, if the child is an infant, protein and calories.

A child is diagnosed with intussusception. The nurse collects data on the child, knowing that which of the following is a characteristic of this disorder?

1. The presence of fecal incontinence 2. Incomplete development of the anus 3. The infrequent and difficult passage of dry stools *4. Invagination of a section of the intestine into the distal bowel* *Rationale:* Intussusception is an invagination of a section of the intestine into the distal bowel. It is the most common cause of bowel obstruction in children age 3 months to 6 years. Option 1 describes encopresis. Option 2 describes imperforate anus, and this disorder is diagnosed in the neonatal period. Option 3 describes constipation. Constipation can affect any child at any time, although it peaks at ages 2 to 3 years. Encopresis generally affects preschool and school-age children.

A 3-year-old child has returned to his room following a tonsillectomy. Which assessment finding needs immediate notification of the registered nurse?

1. Pulse rate 90, respirations 24 per minute *2. Nasal flaring and rib retractions* 3. Drooling slightly blood-tinged saliva 4. Refusal to take sips of his favorite soda *Rationale:* Nasal flaring and rib retractions are signs of respiratory distress, a major concern following a tonsillectomy. These signs require immediate notification. The vital signs are normal for a 3-year-old child. Drooling slightly blood-tinged saliva and refusal to take sips of liquids are common after a tonsillectomy.

A nurse prepares a teaching plan regarding the administration of eardrops for the parents of a 2-year-old child. Which of the following would be included in the plan?

1. Wear gloves when administering the eardrops. 2. Pull the ear up and back before instilling the eardrops. *3. Pull the earlobe down and back before instilling the ear drops.* 4. Hold the child in a sitting position when administering the ear drops. *Rationale:* When administering eardrops to a child who is less than 3 years old, the ear should be pulled down and back. For children who are more than 3 years old, the ear is pulled up and back. Gloves do not need to be worn by the parents, but handwashing needs to be performed before and after the procedure. The child should be in a side-lying position with the affected ear facing upward to facilitate the flow of medication down the ear canal by gravity.

The mother of a child with juvenile idiopathic arthritis calls the nurse because the child is experiencing a painful exacerbation of the disease. The mother asks the nurse if the child should perform range-of-motion (ROM) exercises at this time. The nurse makes which response to the mother?

1. "Avoid all exercise during painful periods." 2. "The ROM exercises must be performed every day." *3. "Have the child perform simple isometric exercises during this time."* 4. "Administer additional pain medication before performing the ROM exercises." *Rationale:* During painful episodes, hot or cold packs, splinting, and positioning the affected joint in a neutral position help to reduce the pain. Although resting the extremity is appropriate, it is important to begin simple isometric or tensing exercises as soon as the child is able. These exercises do not involve joint movement.

A nurse is caring for a child with a diagnosis of intussusception. Which of the following symptoms would the nurse expect to note in this child?

1. Watery diarrhea 2. Ribbon-like stools 3. Profuse projectile vomiting *4. Blood and mucus in the stools* *Rationale:* The child with intussusception classically presents with severe abdominal pain that is crampy and intermittent and that causes the child to draw in his or her knees to the chest. Vomiting may be present, but it is not projectile. Bright red blood and mucus are passed through the rectum and commonly described as currant jelly-like stools. Ribbon-like stools are not a manifestation of this disorder.

Antibiotics are prescribed for a child following a myringotomy with insertion of tympanostomy tubes, and the nurse provides instructions to the parents regarding the administration of the antibiotics. Which statement, if made by a parent, would indicate that the instructions were understood?

*1. "We will administer the antibiotics until they are gone."* 2. "We will administer the antibiotics if the child has a fever." 3. "We will administer the antibiotics until the child feels better." 4. "We will begin to taper the antibiotics after 3 days of a full course." *Rationale:* Antibiotics need to be taken as prescribed, and the full course needs to be completed. It is important that parents are instructed regarding the administration of antibiotics. Options 2, 3, and 4 are incorrect. Antibiotics are not tapered but administered until they are completed.

A nurse is assigned to care for a child after a myringotomy with the insertion of tympanostomy tubes. The nurse notes a small amount of reddish drainage from the child's ear after the surgery. On the basis of this finding, the nurse takes which action?

*1. Documents the findings* 2. Notifies the registered nurse immediately 3. Changes the ear tubes so that they do not become blocked 4. Checks the ear drainage for the presence of cerebrospinal fluid *Rationale:* After a myringotomy with the insertion of tympanostomy tubes, the child is monitored for ear drainage. A small amount of reddish drainage is normal during the first few days after surgery. However, any heavy bleeding or bleeding that occurs after 3 days should be reported. The nurse would document the findings. Options 2, 3, and 4 are not necessary.

A nurse is reviewing a health care provider's prescription for a child with sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescriptions documented in the child's record should the nurse question? *Select all that apply.*

*1. Restrict fluid intake.* 2. Position for comfort. 3. Avoid strain on painful joints. 4. Apply nasal oxygen at 2 L per minute. 5. Provide a high-calorie, high-protein diet. *6. Administer meperidine (Demerol) 25 mg for pain.* *Rationale:* Sickle cell anemia is one of a group of diseases called hemoglobinopathies in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the red blood cell, and insufficient oxygen causes the cells to assume a sickle shape; the cells become rigid and clumped together, thus obstructing capillary blood flow. Oral and intravenous fluids are important parts of treatment. Meperidine (Demerol) is not recommended for the child with sickle cell disease because of the risk for normeperidine-induced seizures. Normeperidine, which is a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. Therefore, the nurse would question the prescriptions for restricted fluids and meperidine for pain control. Positioning for comfort, avoiding strain in painful joints, oxygen, and a high-calorie, high-protein diet are important parts of the treatment plan.

Griseofulvin (Gris-PEG) is prescribed for a child with tinea capitis. The nurse provides instructions to the family regarding administration of the medication. Which statement by the mother indicates a need for further instructions?

1. "I need to keep my child out of the sun." 2. "I need to continue the therapy as long as it is prescribed." *3. "I need to administer the medication 2 hours before meals."* 4. "I need to shake the oral suspension before preparing the dose." *Rationale:* Gris-PEG is given with or after meals to avoid gastrointestinal (GI) irritation and to increase absorption. Oral suspensions should be shaken well. Parents are instructed to continue therapy as prescribed and not to miss a dose. Exposure to the sun is avoided during treatment.

A nurse provides discharge instructions to the mother of a child following a myringotomy with insertion of tympanostomy tubes. Which statement by the mother indicates a need for further instructions?

1. "I will not allow my child to swim in lake water." 2. "I will not allow my child to swim in deep water." 3. "I will put earplugs in my child's ears during bathing." *4. "I need to be sure my child uses soft tissues to blow his nose."* *Rationale:* Parents need to be instructed that the child should not blow the nose for 7 to 10 days. Bath and lake water are potential sources of bacterial contamination. Diving and swimming deeply under water are prohibited. The child's ears need to be kept dry. Options 1, 2, and 3 are appropriate statements.

Choose the interventions for a child older than 2 years of age with type 1 diabetes mellitus who has a blood glucose level of 60 mg/dL. *Select all that apply.*

1. Administer regular insulin. 2. Encourage the child to ambulate. *3. Give the child a teaspoon of honey.* 4. Provide electrolyte replacement therapy intravenously. 5. Wait 30 minutes and confirm the blood glucose reading. *6. Prepare to administer glucagon subcutaneously if unconsciousness occurs.* *Rationale:* Hypoglycemia is defined as a blood glucose level less than 70 mg/dL. Hypoglycemia occurs as a result of too much insulin, not enough food, or excessive activity. If able, the nurse should confirm hypoglycemia with a blood glucose reading. Glucose is administered orally immediately; the rapid-releasing sugar (such as honey) is followed by a complex carbohydrate and protein, such as a slice of bread or a peanut butter cracker. An extra snack is given if the next meal is not planned for more than 30 minutes or if activity is planned. If the child becomes unconscious, cake frosting or glucose paste can be squeezed onto the gums, and the blood glucose level is retested. If the child does not improve within 15 minutes, administration of glucagon may be necessary, and the nurse should be prepared for this intervention. In the hospital setting the nurse should be prepared to administer dextrose intravenously. Encouraging the child to ambulate and administering regular insulin will result in a lowered blood glucose level. Providing electrolyte replacement therapy intravenously is an intervention to treat diabetic ketoacidosis. Waiting 30 minutes to confirm the blood glucose level delays necessary intervention.

A child with a diagnosis of a hernia has been scheduled for a surgical repair in 2 weeks. The nurse reinforces instructions to the parents about the signs of possible hernial strangulation. The nurse tells the parents that which of the following signs would require health care provider (HCP) notification by the parents?

1. Fever 2. Diarrhea *3. Vomiting* 4. Constipation *Rationale:* The parents of a child with a hernia need to be instructed about the signs of strangulation. These signs include vomiting, pain, and an irreducible mass. The parents should be instructed to contact the HCP immediately if strangulation is suspected. Fever, diarrhea, and constipation are not associated with strangulation of a hernia.

Which of the following are characteristics of scabies? *Select all that apply.*

1. It is caused by a fungal infection. *2. It appears as burrows or fine, grayish-red lines.* *3. It is transmitted by close personal contact with an infected person.* *4. It is endemic among schoolchildren and institutionalized populations.* 5. Meticulous skin care and the application of antifungal cream are components of treatment. *6. Household members and contacts of the infected child need to be treated at the same time that the child is being treated.* *Rationale:* Scabies usually appears as burrows or fine, grayish-red lines. It is not caused by a fungal infection, and it is treated with the application of a topical scabicide. It is transmitted by close personal contact with an infected person, and it is endemic among schoolchildren and institutionalized populations. Household members and contacts of the infected child need to be treated at the same time that the child is being treated.

A nurse is reinforcing instructions to the mother of a preschool child who was recently diagnosed with pediculosis capitis (head lice). Which item should be included in discussions to prevent a reinfestation?

1. Machine wash all of the child's clothing, towels, and bed linens, and place in a warm dryer for at least 20 minutes. 2. Shave the child's hair if pediculicide and nit-removal combs prove ineffective. 3. Spray the home's furniture and beds with insecticide. *4. Seal nonwashable items in a plastic bag for 2 to 3 weeks in a warm place if they cannot be vacuumed or dry cleaned.* *Rationale:* The adult louse can survive up to 48 hours away from a host, although nits can hatch in 7 to 10 days if they are shed into the environment. Thus, 2 weeks represents a safe interval of time that prevents reinfestation from occurring. Hot water and hot air should be used in the washer and dryer. Shaving the hair is unnecessary with proper treatment and would have an adverse psychological effect on the child. Insecticides can endanger children and animals and should not be sprayed on furniture and beds.

A preschool child who was admitted to the hospital for a minor surgery develops a rash on the second day after hospitalization and is diagnosed with chickenpox (varicella). The nurse should take which of the following actions to provide safety for all children on the unit?

1. Place only the infected child in isolation. 2. Keep siblings from visiting the infected child. 3. Place the child and any other child who were exposed in isolation. *4. Place the infected child and any immunocompromised children in isolation.* *Rationale:* The period of communicability for chickenpox is 1 day before the eruption of vesicles to about 1 week when crusts are formed. The infected child should be isolated until vesicles have dried, and other high-risk children (immunocompromised) should be isolated from the infected client.

A nurse provides instructions to parents regarding the methods that will decrease the risk of recurrent otitis media in infants. Which of the following should the nurse include in the instructions?

*1. "Feed the infant in an upright position."* 2. "Maintain bottle-feeding as long as possible." 3. "Discontinue breast-feeding as soon as possible." 4. "Allow the infant to have a bottle during nap time." *Rationale:* To decrease the risk of recurrent otitis media, parents should be encouraged to breast-feed during infancy, discontinue bottle-feeding as soon as possible, feed the infant in an upright position, and avoid giving the infant a bottle in bed. Parents should be told not to smoke in the child's presence because passive smoking increases the incidence of otitis media.

A newborn infant is diagnosed with gastroesophageal reflux (GER). The mother of the infant asks the nurse to explain the diagnosis. The nurse plans to base the response on which description of this disorder?

*1. Gastric contents regurgitate back into the esophagus.* 2. The esophagus terminates before it reaches the stomach. 3. Abdominal contents herniate through an opening of the diaphragm 4. A portion of the stomach protrudes through the esophageal hiatus of the diaphragm. *Rationale:* GER is regurgitation of gastric contents back into the esophagus. Option 2 describes esophageal atresia. Option 3 describes a congenital diaphragmatic hernia. Option 4 describes a hiatal hernia.

A nurse is caring for a 1-year-old child following a cleft palate repair. Which solution should the nurse use after feedings to cleanse the child's mouth?

*1. Water* 2. Diluted hydrogen peroxide 3. A soft lemon glycerin swab 4. Half-strength povidone-iodine (Betadine) solution *Rationale:* Following a cleft palate repair, the mouth is rinsed with water after feedings to clean the palate repair site. Rinsing food and residual sugars from the suture line reduces the risk of infection. Options 2, 3, and 4 are incorrect procedures, and the solutions identified in these options should not be used.

A hospitalized 2-year-old child with croup is receiving corticosteroid therapy. The mother asks the nurse why the health care provider did not prescribe antibiotics. The nurse makes which response to the mother?

1. "The child may be allergic to antibiotics." 2. "The child is too young to receive antibiotics." *3. "Antibiotics are not indicated unless a bacterial infection is present."* 4. "The child still has the maternal antibodies from birth and does not need antibiotics." *Rationale:* Antibiotics are not indicated in the treatment of croup unless a bacterial infection is present. Options 1, 2, and 4 are incorrect. In addition, the question does not include any supporting data to indicate that the child may be allergic to antibiotics.

A child is scheduled for a tonsillectomy in the day-stay surgical unit. On the day following surgery, the mother calls the surgical unit and expresses concern because the child has a very bad mouth odor. The nurse makes which response to the mother?

1. "The child probably has an infection." 2. "You need to contact the health care provider immediately." *3. "Bad mouth odor is normal and may be relieved by drinking more liquids."* 4. "Have the child gargle with mouthwash." *Rationale:* Bad mouth odor is normal following tonsillectomy and may be relieved by drinking more liquids. Options 1, 2, and 4 are incorrect. Additionally, mouthwash gargles will irritate the throat.

A nurse is assisting with performing admission data collection on a 2-year-old child who has been diagnosed with nephrotic syndrome. The nurse collects data knowing that a common characteristic associated with nephrotic syndrome is:

1. Hypotension *2. Generalized edema* 3. Increased urinary output 4. Frank, bright red blood in the urine *Rationale:* Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, and edema. The urine is dark, foamy, and frothy, but microscopic hematuria may be present. Frank, bright red blood in the urine does not occur. Urine output is decreased, and the blood pressure is normal or slightly decreased.

Following tonsillectomy, which of the health care provider's prescriptions would the nurse question?

1. Monitor vital signs. 2. Monitor for bleeding. *3. Allow ice cream when awake.* 4. Offer clear, cool liquids when awake. *Rationale:* Clear, cool liquids are encouraged. Milk and milk products are avoided initially because they coat the throat, which causes the child to clear the throat, increasing the risk of bleeding. Options 1 and 2 are important nursing interventions following any type of surgery.

A nurse instructs the mother of a child with sickle cell disease regarding the precipitating factors related to pain crisis. Which of the following, if identified by the mother as a precipitating factor, indicates the need for further instructions?

1. Stress 2. Trauma 3. Infection *4. Fluid overload* *Rationale:* Pain crisis may be precipitated by infection, dehydration, hypoxia, trauma, or general stress. The mother of a child with sickle cell disease should encourage a fluid intake of 1.5 to 2 times the daily requirement to prevent dehydration.

A nurse is reviewing the record of a child with a diagnosis of pyloric stenosis. Which data would the nurse expect to note as having been documented in the child's record?

1. Watery diarrhea *2. Projectile vomiting* 3. Increased urine output 4. Vomiting large amounts of bile *Rationale:* Clinical manifestations of pyloric stenosis include projectile, nonbilious vomiting; irritability; hunger and crying; constipation; and signs of dehydration, including a decrease in urine output.

A nurse is admitting a child with a diagnosis of lactose intolerance. Which finding does the nurse expect to assess?

*1. Frothy stools* 2. Foul-smelling ribbon stools 3. Profuse, watery diarrhea and vomiting 4. Diffuse abdominal pain unrelated to meals or activity *Rationale:* Lactose intolerance causes frothy stools. Abdominal distention, crampy abdominal pain, and excessive flatus may also occur. Option 2 is a clinical manifestation of Hirschsprung's disease. Option 3 is a clinical manifestation of celiac disease. Option 4 is a clinical manifestation of irritable bowel syndrome.

A mother of an infant diagnosed with Hirschsprung's disease asks the nurse about the disorder. The nurse plans to base the response on which of the following?

*1. It is a congenital aganglionosis or megacolon.* 2. It is a complete small intestinal obstruction. 3. It is a condition that causes the pyloric valve to remain open. 4. It is a severe inflammation of the gastrointestinal tract. *Rationale:* Hirschsprung's disease, also known as "congenital aganglionosis" or "megacolon," is the result of an absence of ganglion cells in the rectum and to varying degrees upward in the colon. Options 2, 3, and 4 are incorrect.

A nursing student is asked to discuss juvenile idiopathic arthritis (JIA) at a clinical conference scheduled for the end of the clinical day. Which statement by the nursing student indicates the need to further research this disorder?

1. "The cause of this disease is unknown." 2. "JIA most often occurs by age of 10 years." *3. "This disease is twice as likely to occur in boys rather than girls."* 4. "Clinical manifestations include morning stiffness and painful, stiff, swollen joints." *Rationale:* JIA is twice as likely to occur in girls as in boys. The cause of JIA is unknown. JIA has two peak ages of onset: between 1 and 3 years of age and between 8 and 10 years of age. This autoimmune inflammatory disease causes painful inflammation of joints.

A nurse provides instructions to the parents of an infant with gastroesophageal reflux (GER) regarding proper positioning to manage reflux. The nurse tells the parents that the infant should be maintained in:

1. A 30-degree angle when supine 2. A 60-degree angle when prone *3. An upright angle 24 hours a day* 4. A 20-degree angle when side-lying *Rationale:* Proper positioning is an important component of reflux management. Ideally the goal is to maintain the infant in an upright angle 24 hours a day, at a 60-degree angle when supine, and at a 30-degree angle when prone. This position is maintained until the infant remains asymptomatic for 6 weeks.

A nurse provides instructions to the mother of an infant with cleft palate regarding feeding. Which statement by the mother indicates a need for further instructions?

*1. "I need to use a nipple with a small hole to prevent choking."* 2. "I need to stimulate sucking by rubbing the nipple on the lower lip." 3. "I need to allow my infant time to swallow." 4. "I need to allow my infant to rest frequently to provide time for swallowing what has been placed in the mouth." *Rationale:* The mother should be taught the ESSR method of feeding the child with a cleft palate: ENLARGE the nipple by cross-cutting a hole so that food is delivered to the back of the throat without sucking; STIMULATE sucking by rubbing the nipple on the lower lip; SWALLOW; then REST to allow the infant to finish swallowing what has been placed in the mouth.

A nurse is caring for a child who is scheduled for an appendectomy. When the nurse reviews the health care provider's preoperative prescriptions, which of the following would be questioned?

*1. Administer a Fleet enema.* 2. Maintain nothing per mouth (NPO) status. 3. Maintain intravenous (IV) fluids as prescribed. 4. Administer preoperative medication on call to the operating room. *Rationale:* In the preoperative period, enemas or laxatives should not be administered. No heat should be applied to the abdomen because this may increase the chance of perforation secondary to vasodilation. IV fluids would be started and the child would be NPO. Prescribed preoperative medications most likely would be administered on call to the operating room.

A nurse is reviewing the record of a child admitted to the hospital with nephrotic syndrome. Which finding would the nurse expect to note documented in the record?

*1. Proteinuria* 2. Weight loss 3. Increased appetite 4. Hyperalbuminemia *Rationale:* The term "nephrotic syndrome" refers to a kidney disorder characterized by proteinuria, hypoalbuminemia, and edema. The child experiences fatigue, anorexia, increased weight, abdominal pain, and a normal blood pressure.

A nurse is monitoring for signs of dehydration in a 1-year-old child who has been hospitalized for diarrhea and prepares to take the child's temperature. Which method of temperature measurement should be avoided?

*1. Rectal* 2. Axillary 3. Electronic 4. Tympanic *Rationale:* Rectal temperature measurements should be avoided if diarrhea is present. The use of a rectal thermometer can stimulate peristalsis and cause more diarrhea. Axillary or tympanic measurements of temperature would be acceptable. Most measurements are performed via electronic devices.

An 8-year-old boy is being treated with percussion treatments for cystic fibrosis. How would the nurse determine whether the treatment is effective?

*1. The child has a productive cough of thick sputum.* 2. The child no longer has a fever. 3. The child's skin is no longer high in sodium. 4. The child's bowel movements are firmer. *Rationale:* Percussion treatments are intended to produce sputum. Thick sputum is characteristic of cystic fibrosis. Being afebrile is not necessarily reflective of effectiveness of percussion treatments. Although a high sodium content in the skin is a sign associated with cystic fibrosis, percussion treatments will not help this characteristic. The percussion treatments will not help bowel movements.

A nurse is caring for an 18-month-old child who has been vomiting. The appropriate position in which to place the child during naps and sleep time is:

1. A supine position *2. A side-lying position* 3. Prone, with the head elevated 4. Prone, with the face turned to the side *Rationale:* The vomiting child should be placed in an upright or side-lying position to prevent aspiration. Options 1, 3, and 4 will place the child at risk for aspiration if vomiting occurs.

A nurse is caring for an infant. A urinalysis has been prescribed, and the nurse plans to collect the specimen. The nurse implements which appropriate method to collect the specimen?

1. Catheterizes the infant, using a No. 5 French Foley *2. Attaches a urinary collection device to the infant's perineum* 3. Obtains the specimen from the diaper, using a syringe, after the infant voids 4. Monitors the urinary patterns and prepares to collect the specimen into a cup when the infant voids *Rationale:* Although many methods have been used to collect urine from an infant, the most reliable method is the urine collection device. This device is a plastic bag that has an opening lined with adhesive so that it may be attached to the perineum. Urine for certain tests, such as specific gravity, may be obtained from a diaper. Urinary catheterization is not to be done unless specifically prescribed because of the risk of infection. It is not reasonable to monitor urinary patterns and attempt to collect the specimen in a cup when the infant voids.

A nurse is reviewing the laboratory results of a child scheduled for tonsillectomy. Which laboratory value would be significant to review?

1. Creatinine 2. Urinalysis *3. Platelet count* 4. Blood urea nitrogen (BUN) *Rationale:* Before the surgical procedure, the child is assessed for signs of active infection and for redness and exudate of the throat. Because the tonsillar area is so vascular, postoperative bleeding is a concern. The prothrombin (PT), partial thromboplastin time (PTT), platelet count, hemoglobin and hematocrit (H&H), white blood cell (WBC) count, and urinalysis are performed preoperatively. The platelet count result would identify a potential for bleeding. The BUN and creatinine would not determine the potential for bleeding but rather evaluate renal function.

A nurse is administering medications to a 6-year-old child with nephrotic syndrome. To reduce proteinuria, the nurse should expect that which medication would be prescribed?

1. Enalapril (Vasotec) *2. Furosemide (Lasix)* 3. Prednisone 4. Cyclophosphamide *Rationale:* The child is usually placed on diuretic therapy with furosemide (Lasix) until protein loss is controlled. Enalapril is most commonly used to control hypertension. Corticosteroids, such as prednisone, may be prescribed to decrease inflammation. Corticosteroids also suppress the autoimmune response and stimulate vascular reabsorption of edema. Cyclophosphamide is an alkylating agent and may be used in maintaining remission.

A mother of a 6-year-old child with type 1 diabetes mellitus calls the clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it showed positive ketones. Which of the following would the nurse instruct the mother to do?

1. Hold the next dose of insulin. 2. Come to the clinic immediately. *3. Encourage the child to drink liquids.* 4. Administer an additional dose of regular insulin. *Rationale:* When the child is sick, the mother should test for urinary ketones with each voiding. If ketones are present, liquids are essential to help with clearing them. The child should be encouraged to drink liquids. It is not necessary to bring the child to the clinic immediately, and insulin doses should not be adjusted or changed.

A nurse is assigned to care for a child who is suspected of having glomerulonephritis. The nurse reviews the child's record and notes that which finding is associated with the diagnosis of glomerulonephritis?

1. Hypotension *2. Red-brown urine* 3. Low urinary specific gravity 4. A low blood urea nitrogen (BUN) level *Rationale:* Gross hematuria resulting in dark, smoky, cola-colored or red-brown urine is a classic symptom of glomerulonephritis, and hypertension is also common. A mid to high urinary specific gravity is associated with glomerulonephritis. BUN levels may be elevated.

A child suspected of sickle cell disease is seen in the clinic, and laboratory studies are performed. The nurse reviews the results of the laboratory studies and expects to note which of the following that is a characteristic of this disease?

1. Increased hematocrit count 2. Increased platelet count *3. Increased reticulocyte count* 4. Increased hemoglobin count *Rationale:* A laboratory diagnosis is established on the basis of a complete blood cell count, examination for sickled red blood cells (RBCs) on the peripheral smear, and hemoglobin electrophoresis. Laboratory studies will show decreased hemoglobin, hematocrit, and platelet count, increased reticulocyte count, and the presence of nucleated red blood cells. Elevated reticulocyte counts occur in children with sickle cell disease because the life span of their sickled RBCs is shortened.

A nurse receives a call from the mother whose child has a foreign body in the eye. The object is clearly visible and not embedded. When the mother asks for the most effective way to get it out, the nurse responds:

1. Irrigate the eye with natural tears. 2. Irrigate the eye with running tap water. 3. Let the object just "work its way out" of the eye. *4. Touch the object gently with a cotton swab, and lift it out.* *Rationale:* The most effective method that would cause the least amount of trauma would be to lift the foreign body from the eye. It should not be allowed to remain and "work its way out." Irrigating the eye may cause the foreign body to move and cause trauma in another area of the eye.

An adolescent with diabetes mellitus becomes flushed and complains of hunger and dizziness. A blood glucose level is drawn and the results indicate a glucose level of 60 mg/dL. The appropriate intervention is to:

1. Keep the child NPO. 2. Contact the health care provider. *3. Give the child a glass of fruit juice.* 4. Let the child rest until the dizziness subsides. *Rationale:* A blood glucose less than 70 mg/dL indicates hypoglycemia. When signs of hypoglycemia occur, the child needs an immediate source of glucose. Options 1, 2, and 4 do not address the hypoglycemic condition.

A nurse is reviewing the laboratory results of an infant suspected of having hypertrophic pyloric stenosis. Which of the following would the nurse expect to note in this infant?

1. Metabolic acidosis *2. Metabolic alkalosis* 3. Respiratory acidosis 4. Respiratory alkalosis *Rationale:* Laboratory findings in an infant with hypertrophic pyloric stenosis include metabolic alkalosis as a result of the vomiting (depletes acid) that occurs in this disorder. Additional findings include decreased serum potassium and sodium levels, increased pH and bicarbonate, and decreased chloride level.

The appropriate child position after a tonsillectomy is which of the following?

1. Supine position *2. Side-lying position* 3. High Fowler's position 4. Trendelenburg's position *Rationale:* The child should be placed in a semi-prone or side-lying position after tonsillectomy to facilitate drainage. Options 1, 3, and 4 will not achieve this goal.

Following a cleft lip repair, the nurse provides instructions to the parents regarding cleaning of the lip repair site. Which of the following solutions would the nurse use in demonstrating this procedure to the parents?

1. Tap water *2. Sterile water* 3. Full-strength hydrogen peroxide 4. Half-strength hydrogen peroxide *Rationale:* The lip repair site is cleansed with sterile water using a cotton swab after feeding and as prescribed. The parents should be instructed to use a rolling motion from the suture line out. The parents should also demonstrate performance of the correct procedure to the nurse.

A health care provider prescribes intravenous potassium for a child with hypertonic dehydration. The nurse assigned to assist in caring for the child would check which highest-priority item before administration of the potassium?

1. Weight *2. Urine output* 3. Temperature 4. Blood pressure *Rationale:* The priority assessment would be to check the status of urine output. Potassium should never be administered in the presence of oliguria or anuria. If urine output is less than 1 to 2 mL/kg/hr, it should not be administered. Although options 1, 3, and 4 may be a component of the data collected, they are not specifically related to the administration of this medication.

A nurse obtains a health history from a mother of a 15-month-old child before administering a measles, mumps, and rubella (MMR) vaccine. Which of the following is essential information to obtain before the administration of this vaccine?

*1. Allergy to eggs* 2. A recent cold 3. The presence of diarrhea 4. Any recent ear infections *Rationale:* Before the administration of MMR vaccine, a thorough health history needs to be obtained. MMR is used with caution in a child with a history of allergy to gelatin or eggs because the live measles vaccine is produced by chick embryo cell culture. MMR also contains a small amount of the antibiotic neomycin. Options 2, 3, and 4 are not contraindications to administering this immunization.

A nurse is assisting in developing a plan of care for a diagnosed with acute glomerulonephritis. The nurse includes which intervention in the plan of care?

*1. Encourage limited activity and provide safety measures.* 2. Force intake of oral fluids to prevent hypovolemic shock. 3. Catheterize the child to strictly monitor intake and output. 4. Encourage classmates to visit and to keep the child informed of school events. *Rationale:* Activity is limited and most children, because of fatigue, voluntarily restrict their activities during the active phase of the disease. Catheterization may cause a risk of infection. Fluids should not be forced. Visitors should be limited to allow for adequate rest.

A 1-year-old child is diagnosed with intussusception. The mother of the child asks the nurse to describe the disorder. The nurse tells the mother that this disorder is:

1. An acute bowel obstruction *2. A condition in which a proximal segment of the bowel prolapses into a distal segment of the bowel* 3. A condition in which a distal segment of the bowel prolapses into a proximal segment of the bowel 4. A condition that causes an acute inflammatory process in the bowel *Rationale:* Intussusception occurs when a proximal segment of the bowel prolapses into a distal segment of the bowel. It is a common cause of acute bowel obstruction in infants and young children. It is not an inflammatory process.

A child is seen in the clinic, and the primary health care provider documents a diagnosis of primary nocturnal enuresis. The mother asks the nurse about the diagnosis. The nurse bases the response on the fact that primary nocturnal enuresis:

1. Does not respond to treatment 2. Is caused by a psychiatric problem 3. Requires surgical intervention to improve the problem *4. Is common and most children will outgrow bed-wetting without therapeutic intervention* *Rationale:* Primary nocturnal enuresis is bedwetting and is described as occurring in a child that has never been dry at night for extended periods. It is common in children, most of whom will outgrow bedwetting without therapeutic intervention. The child is not able to sense a full bladder and does not awaken to void. The child may have delayed maturation of the central nervous system (CNS). It is not caused by a psychiatric problem. Behavioral conditioning with use of alarms has been used for treatment in the older child with nocturnal enuresis. A device that contains a moisture-sensitive alarm is worn on the child's pajamas. As the child starts to void, the alarm goes off, awakening the child. The alarm system may need to be used consistently over 15 weeks for resolution.

A nurse is caring for a hospitalized child newly diagnosed with type 1 diabetes mellitus. At 11:00 AM, the child suddenly complains of weakness, headache, and blurred vision. The nurse should immediately:

1. Give the child ½ cup of orange juice to drink. *2. Obtain a blood glucose reading.* 3. Call the dietary department and ask that the lunch tray be delivered early. 4. Contact the health care provider. *Rationale:* The signs of hypoglycemia and hyperglycemia may be difficult to distinguish. Weakness, headache, and blurred vision can occur in either blood glucose alteration. A blood glucose reading will assist in confirming the diagnosis so that the appropriate action can be taken. Option 1 would be implemented if the child had hypoglycemia. Option 3 is inappropriate because the child should eat meals at basically the same time each day to achieve the best diabetic control. Contacting the health care provider would not be the immediate action; however, the nurse should inform the registered nurse of the situation.

A child suspected of having sickle cell disease (SCD) is seen in a clinic, and laboratory studies are performed. Which laboratory value is likely to be increased in sickle cell disease?

1. Platelet count 2. Hematocrit level 3. Hemoglobin level *4. Reticulocyte count* *Rationale:* A diagnosis is established on the basis of a complete blood count, examination for sickled red blood cells (RBCs) in the peripheral smear, and hemoglobin electrophoresis. Laboratory studies will show decreased hemoglobin and hematocrit levels and a decreased platelet count, an increased reticulocyte count, and the presence of nucleated red blood cells. Increased reticulocyte counts occur in children with SCD because the life span of their sickled RBCs is shortened.

The mother of a child arrives at the clinic because the child has been experiencing scratchy, red, and swollen eyes. The nurse notes a discharge from the eyes and a culture is sent to the laboratory for analysis. Chlamydial conjunctivitis is diagnosed. Based on this diagnosis, which of the following would require further investigation?

1. Possible trauma *2. Possible sexual abuse* 3. The presence of an allergy 4. The presence of a respiratory infection *Rationale:* A diagnosis of chlamydial conjunctivitis in a non-sexually active child should signal the health care provider to assess the child for possible sexual abuse. Allergy, infection, and trauma can cause conjunctivitis but not chlamydial conjunctivitis.

A child with diabetes mellitus is brought to the emergency department by her mother, who states that her daughter has been complaining of abdominal pain and has a fruity odor on the breath. Diabetic ketoacidosis (DKA) is diagnosed. The nurse assisting to care for the child checks the intravenous (IV) and medication supply area for which of the following?

1. Potassium 2. NPH insulin 3. 5% dextrose IV infusion *4. 0.9% normal saline IV infusion* *Rationale:* Rehydration is the initial step in resolving DKA. Normal saline is the initial IV rehydration fluid. NPH insulin is never administered by the IV route. Dextrose solutions are added to the treatment when the blood glucose levels reach an acceptable level. IV potassium may be required depending on the potassium level, but would not be part of the initial treatment.

A nurse is assisting a health care provider with an assessment of a child with a diagnosis of suspected appendicitis. In assessing the intensity and progression of the pain, the health care provider palpates the child at McBurney's point. The nurse understands that McBurney's point is located midway between the:

1. Right anterior inferior iliac crest and the umbilicus 2. Left anterior superior iliac crest and the umbilicus *3. Right anterior superior iliac crest and the umbilicus* 4. Left anterior superior iliac crest and the umbilicus *Rationale:* McBurney's point is midway between the right anterior superior iliac crest and the umbilicus. It is usually the location of greatest pain in the child with appendicitis. Options 1, 2, and 4 are incorrect.

After a tonsillectomy, a child is brought to the pediatric unit. The nurse places the child in which appropriate position?

*1. Prone* 2. Supine 3. Trendelenburg's 4. High Fowler's *Rationale:* The child should be placed in a prone or side-lying position after tonsillectomy to facilitate drainage. Options 2, 3, and 4 will not achieve this goal.

A nurse is monitoring a child following a tonsillectomy. Which finding may indicate that the child is bleeding?

*1. Restlessness* 2. A decreased pulse rate 3. Complaints of discomfort 4. An elevation in blood pressure (BP) *Rationale:* Frequent swallowing, restlessness, a fast and thready pulse, and vomiting bright red blood are signs of bleeding. An elevated BP is not an indication of bleeding. Complaint of discomfort is an expected finding following a tonsillectomy.

A nurse is reinforcing instructions to the mother of an 8-year-old child who had a tonsillectomy. The mother tells the nurse that the child loves tacos and asks when the child can safely eat one. The nurse makes which response to the mother?

1. "In 1 week". *2. "In 3 weeks".* 3. "Two days following surgery". 4. "When the health care provider says it's OK". *Rationale:* Rough, scratchy foods or spicy foods are to be avoided for 3 weeks. Citrus juices, which irritate the throat, need to be avoided for 10 days. Red liquids are avoided because they will give the appearance of blood if the child vomits. A full liquid diet is allowed on the second postoperative day, and soft foods are allowed as the child tolerates them.

A school-age child with type 1 diabetes mellitus has soccer practice three afternoons a week. The nurse reinforces instructions regarding how to prevent hypoglycemia during practice. The nurse tells the child to:

*1. Drink a half a cup of orange juice before soccer practice.* 2. Eat twice the amount that is normally eaten at lunchtime. 3. Take half of the amount of prescribed insulin on practice days. 4. Take the prescribed insulin at noontime rather than in the morning. *Rationale:* An extra snack of 10 g to 15 g of carbohydrates eaten before activities and for every 30 to 45 minutes of activity will prevent hypoglycemia. A half cup of orange juice will provide the needed carbohydrates. The child or parents should not be instructed to adjust the amount or time of insulin administration, and meal amounts should not be doubled.

A nurse is caring for an infant with a diagnosis of Hirschsprung's disease. The nurse should check for which clinical findings that are consistent with Hirschsprung's disease? *Select all that apply.*

*1. Fever* *2. Constipation* *3. Failure to thrive* 4. Intolerance to wheat *5. Abdominal distention* *6. Explosive, watery diarrhea* *Rationale:* Clinical manifestations of Hirschsprung's disease during infancy include failure to thrive, constipation, abdominal distention, episodes of diarrhea and vomiting, signs of enterocolitis, explosive and watery diarrhea, and fever. The infant appears significantly ill. Intolerance to wheat occurs in celiac disease.

A corticosteroid cream is prescribed by a health care provider for a child with atopic dermatitis (eczema). The nurse teaches the mother how to apply the cream. Which instruction is appropriate?

1. Apply the cream over the entire body. 2. Apply a thick layer of cream to affected areas only. 3. Avoid cleansing the area before applying the cream. *4. Apply a thin layer of cream, and rub it into the area thoroughly.* *Rationale:* Corticosteroid cream should be applied sparingly and rubbed into the area thoroughly. The affected area should be cleansed gently before application. The cream should not be applied over extensive areas. Systemic absorption is more likely to occur with extensive application.

A 4-year-old child is diagnosed with otitis media, and the mother asks the nurse about the causes of this illness. The nurse responds, knowing that which of the following is an unassociated risk factor related to otitis media?

1. Bottle-feeding 2. Household smoking 3. A history of urinary tract infections 4. Exposure to illness in other children *Rationale:* Factors that increase the risk of otitis media include exposure to illness, household smoking, bottle-feeding, and congenital conditions such as Down syndrome and cleft palate. The use of a pacifier beyond age 6 months has also been identified as a risk factor. Allergies are also thought to precipitate otitis media. Urinary tract infections are not with a risk factor for otitis media.

A nurse provides instructions to the mother of a child with impetigo regarding the application of antibiotic ointment. The mother asks the nurse when the child can return to school. Which response by the nurse is accurate?

1. Ten days after using the antibiotic ointment 2. One week after using the antibiotic ointment *3. Forty-eight hours after using the antibiotic ointment* 4. Twenty-four hours after using the antibiotic ointment *Rationale:* The child should not attend school for 24 to 48 hours after the initiation of systemic antibiotics or for 48 hours after the use of the antibiotic ointment. The school should be notified of the diagnosis. Therefore options 1, 2, and 4 are incorrect.

A child is admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which findings would the nurse expect to observe? *Select all that apply.*

*1. Pallor* *2. Edema* *3. Anorexia* *4. Proteinuria* 5. Weight loss 6. Decreased serum lipids *Rationale:* Nephrotic syndrome is a kidney disorder that is characterized by massive proteinuria, hypoalbuminemia, edema, elevated serum lipids, anorexia, and pallor. The urine volume is decreased, and the urine is dark and frothy in appearance. The child with this condition gains weight.

A nurse provides home care instructions to a client with sickle cell anemia. Which statement by the client indicates a need for further instruction?

1. "I'm going to take a painting class." 2. "I've learned to knit and sew my own clothes." *3. "When I'm feeling better, I'm returning to the soccer team."* 4. "I'm using a schedule to maintain my increased fluid intake." *Rationale:* Clients with sickle cell anemia are advised to avoid strenuous activities. Quiet activities as tolerated are recommended when the client is feeling well. Increasing fluid intake is encouraged to assist in preventing sickle cell crisis.

A nurse is providing discharge instructions to the mother of a child who had a myringotomy with insertion of tympanostomy tubes. The nurse instructs the mother that if the tubes fall out, she should:

*1. Contact the health care provider.* 2. Bring the child to the emergency department immediately. 3. Replace them immediately. 4. Immediately immerse the tubes in half-strength hydrogen peroxide. *Rationale:* The size and appearance of the tympanostomy tubes should be described to the parents following surgery. They should be reassured that if the tubes fall out, it is not an emergency, but the health care provider should be notified. Therefore options 2, 3, and 4 are incorrect.

A child with sickle cell anemia is being discharged after treatment for a crisis. Which instructions should the nurse provide to prevent another crisis from occurring? *Select all that apply.*

*1. Drink plenty of fluids.* 2. Avoid foods high in folic acid. 3. Use cold packs to relieve joint pain. 4. Restrict all activity to quiet board games. *5. Wash hands before meals and after playing.* *6. Report a sore throat immediately.* *Rationale:* Sickle cell crisis can be precipitated by cold, dehydration, stress, or infection. Increasing the amount of fluids will reduce the viscosity of blood, thus preventing vascular occlusion. A conscious effort to wash hands can improve the child's health by preventing infection. A sore throat is a sign of an infection and must be reported. It is important to avoid cold temperatures of any kind because this can cause vaso-occlusion. Folic acid avoidance is not necessary. Children need to be encouraged to set their own limits in play.

A nurse is assisting in developing a plan of care for a child who will be returning from the operating room following a tonsillectomy. The nurse plans to place the child in which position on return from the operating room?

*1. Side-lying* 2. Trendelenburg's and on the right side 3. Supine 4. High Fowler's and on the left side *Rationale:* The child should be placed in a prone or side-lying position following tonsillectomy to facilitate drainage. Options 2, 3, and 4 will not facilitate drainage.

A child with a tracheal obstruction is brought to the emergency department by emergency medical services. The child aspirated a grape, and the foreign body was removed by direct laryngoscopy. Following the procedure, the nurse plans to inform the mother of the child that:

*1. The child will need to be hospitalized for observation.* 2. The child may go home with a prescription for antibiotics. 3. The child will need to return to the hospital for a chest x-ray in 1 week. 4. The child will require a bronchoscopy for follow-up evaluation in 1 month. *Rationale:* Removal of foreign bodies from the respiratory tract may need to be performed by direct laryngoscopy or bronchoscopy. After the procedure the child should remain hospitalized for observation for laryngeal edema and respiratory distress. Cool mist is provided, and antibiotic therapy is prescribed if appropriate. Options 2, 3, and 4 are incorrect.

A nurse is collecting data from a child with a diagnosis of diabetes insipidus. Which clinical finding is consistent with this diagnosis?

*1. Urinary output is increased.* 2. Urinary output is decreased. 3. Serum sodium is decreased. 4. Urine specific gravity is increased. *Rationale:* A child with a diagnosis of diabetes insipidus experiences increased urinary output, increased serum sodium, and decreased urine specific gravity. Decreased urinary output, decreased serum sodium, and increased urine specific gravity are consistent with a diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH).

A nurse provides instructions to the mother of a child diagnosed with pediculosis (head lice). Permethrin (Nix) has been prescribed. Which statement by the mother regarding the use of the medication indicates a need for further instructions?

1. "After rinsing out the medication, I need to avoid washing my child's hair for 24 hours." 2. "I need to shampoo my child's hair, apply the medication, leave it on for 10 minutes, and then rinse it out." *3. "I need to shampoo my child's hair, apply the medication, and leave the medication on for 24 hours."* 4. "I need to purchase the medication from the pharmacy." *Rationale:* Permethrin is an over-the-counter antilice product that kills both lice and eggs with one application and has residual activity for 10 days. It is applied to the hair after shampooing and left for 10 minutes before rinsing out. The hair should not be shampooed for 24 hours after the rinsing treatment.

A nurse is collecting data on a child recently diagnosed with glomerulonephritis. Which of the following questions to the mother would elicit information about the cause of this disease?

1. "Did your child sustain any injuries to the kidney area?" *2. "Did your child recently complain of a sore throat?"* 3. "Has your child had any diarrhea?" 4. "Have you noticed any rashes on your child?" *Rationale:* Group A beta hemolytic streptococcal infection is a cause of glomerulonephritis. Often the child becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1 to 2 weeks. The questions to the mother in options 1, 3, and 4 are unrelated to a diagnosis of glomerulonephritis.

A nurse is providing information to the mother of a child with nephrotic syndrome regarding the edematous appearance of the child. Which of the following statements should the nurse make to the mother?

1. "Dress the child in loose-fitting clothing to hide the extra weight." 2. "Children always look a little bit fat, so don't be concerned." *3. "The fluid retention should be controlled by medication and diet."* 4. "The child will always have this appearance, and preparing the child for the body image change is important." *Rationale:* Most children experience remission with treatment and corticosteroids. Diuretics also may be a component of the treatment plan, and a restricted sodium diet is recommended. It is important to give the parent information in a matter-of-fact manner and address the issue that is the parent's concern. Options 1, 2, and 4 are inaccurate and inappropriate statements to the mother.

The school nurse is visiting a kindergarten classroom to teach the students the importance of handwashing. During the teaching session the nurse notes that one girl is scratching her head. On inspection the nurse determines that the child has pediculosis capitis. When teaching the mother about care of this condition, which statement by the mother indicates that she needs further teaching regarding this condition?

1. "I will put all the stuffed animals in a sealed plastic bag for 14 days." *2. "I will call a carpet cleaning service to clean all my carpets in the house."* 3. "My two daughters should not share their hairbrushes or hair ribbons." 4. "I will machine wash all the washable clothing, towels, and bed linens in hot water." *Rationale:* Teaching about measures to prevent the spread of pediculosis capitis includes washing items in hot water, vacuuming carpets, discouraging sharing of personal items, and sealing items in plastic bags that cannot be vacuumed. Option 2 is too costly for many families and is unnecessary. Option 2 indicates the mother does not understand the measures that will prevent the spread of the parasite.

A mother brings her 5-month-old daughter into the pediatrician's office with complaints that the child has been vomiting during feedings. The mother also states that the child is sometimes very fussy. The nurse's initial action would be to:

1. Assess the child's growth status. *2. Obtain a complete history of the child's feeding habits.* 3. Assess whether any other children in the family have had the same problem. 4. Explain to the mother that the health care provider will prescribe a barium swallow and upper gastrointestinal (GI) series. *Rationale:* In most situations, a complete history and physical examination of the child is the initial step in diagnosing gastroesophageal reflux disease. The child's feeding habits will give the nurse an indicator of the growth status. The child is weighed and measured after the initial interview is completed with the parent. Hereditary factors are not the priority. Further diagnostic studies may be ordered but only after a complete history is obtained.

A nurse is collecting data on a 12-month-old child with iron deficiency anemia. Which of the following findings would the nurse expect to note in this child?

1. Bradycardia *2. Tachycardia* 3. Hyperactivity 4. A reddened appearance to the cheeks *Rationale:* Clinical manifestations of iron deficiency anemia will vary with the degree of anemia but usually include extreme pallor with porcelain-like skin, tachycardia, lethargy, and irritability.

When checking a child's glossopharyngeal nerve function, the nurse would perform which data collection technique?

1. Have child shrug the shoulders while applying mild pressure. 2. Have child follow a light in the six cardinal positions of gaze. *3. Test sense of sour or bitter taste on the posterior segment of the tongue.* 4. Test sense of sweet or salty taste on the anterior section of the tongue. *Rationale:* To test glossopharyngeal nerve function, the nurse would test the sense of sour or bitter taste on the posterior segment of the tongue. Option 1 is the data collection technique for checking the accessory nerve. Option 2 is the technique for checking the oculomotor nerve. Option 4 is the data collection technique for checking the facial nerve.

Oral iron is prescribed for a child with an iron deficiency anemia, and the nurse provides instructions to the mother regarding the administration of the iron. The nurse instructs the mother to administer the iron:

1. Just before a meal 2. Just after a meal *3. Between meals* 4. With a fruit low in vitamin C *Rationale:* The mother should be instructed to administer oral iron supplements between meals. The iron should be given with a citrus fruit or juice high in vitamin C because vitamin C increases the absorption of iron by the body.

A 3-year-old child is brought to the emergency department. The mother states that the child has had flulike symptoms with vomiting and diarrhea for the past 2 days. On data collection the nurse finds that the child's heart rate is slightly elevated and the blood pressure is normal. The child is irritable and crying only a few tears. The mother states that the child's weight before the illness was 33 pounds. The nurse finds the current weight to be 31 pounds. The nurse correctly interprets this as what level of dehydration?

1. Mild dehydration 2. Severe dehydration 3. Very mild dehydration *4. Moderate dehydration* *Rationale:* Moderate dehydration demonstrates itself with a weight loss in children of 6% to 8% of weight. Mild dehydration would not present with these symptoms. In severe dehydration, additional findings would include lethargy and listlessness. The symptoms listed are all characteristics of moderate dehydration. Very mild dehydration is not a term used to describe dehydration.

A nurse is assisting in admitting to the hospital a 4-month-old infant with a diagnosis of vomiting and dehydration. The nurse assists in developing a plan of care for the infant and suggests including in the plan to position the infant in a(n):

1. Prone position *2. Side-lying position* 3. Modified Trendelenburg's position 4. Infant car seat with the head of the seat in a flat position *Rationale:* The vomiting infant or child should be placed in an upright or side-lying position to prevent aspiration. The positions identified in options 1, 3, and 4 will increase the risk of aspiration if vomiting occurs.

A 4-year-old child is hospitalized for severe gastroenteritis. The child is crying and clinging to the mother. The mother becomes very upset and is afraid to leave the child. Which of the following nursing interventions would be most appropriate to alleviate the child's fears and the mother's anxiety?

1. Reassure the mother that the child will be fine after she leaves. 2. Give the mother the telephone number of the pediatric unit, and tell the mother to call at any time. *3. Ask the mother if she would like to stay overnight with the child.* 4. Tell the mother to bring the child's favorite toys the next time she comes to the hospital to visit. *Rationale:* Although a 4-year-old may already be spending some time away from his or her parents at a day care center or preschool, illness adds a stressor that makes separation more difficult. The only option that addresses the mother's anxiety, while at the same time alleviating the fears of the child is option 3. Options 1, 2, and 4 do not address the fears and anxieties of the mother and child.

A nurse caring for a child with nephrotic syndrome reviews the medication record. The nurse notes that prazosin hydrochloride (Minipress) is prescribed for the child. The nurse determines that this medication has been prescribed to:

1. Reduce proteinuria. 2. Decrease inflammation. 3. Suppress the autoimmune response. *4. Control hypertension.* *Rationale:* Prazosin hydrochloride (Minipress) may be used to control hypertension. The child also may be placed on diuretic therapy until protein loss is controlled. Corticosteroids, such as prednisone, may be prescribed to decrease inflammation. Corticosteroids also suppress the autoimmune response and stimulate vascular reabsorption of edema. Cyclophosphamide is an alkylating agent and may be used in maintaining remission.

A 1-year-old child is seen in the health care provider's office with complaints of an elevated temperature that began the previous evening. When gathering subjective data from the mother, the nurse notices that which of the following would most likely indicate the child has acute otitis media?

1. The child is crying and irritable. 2. The temperature is 40° C (104° F). 3. The child is pulling at her ear and rolling her head from side to side. *4. The mother states the child had purulent discharge from the ear last night.* *Rationale:* Subjective data are what the mother tells the nurse. Therefore option 4 is correct because the mother is describing the child's ear drainage that occurred last night. The other options are considered objective data, which are observations that the nurse makes.

A 9-year-old child is diagnosed with chlamydial conjunctivitis. The nurse consults with the primary health care provider regarding necessary follow-up because this infection can be associated with:

1. The presence of systemic allergies 2. The cleanliness of the home environment 3. The presence of otitis media *4. Possible sexual abuse* *Rationale:* A diagnosis of chlamydial conjunctivitis in a child who is not sexually active should signal the health care provider to assess the child for possible sexual abuse. Allergy and infection can cause conjunctivitis, but the infecting organism would not be chlamydial. Although the infection can be transmitted, it is not directly associated with cleanliness in the home. Chlamydial conjunctivitis also may be suspected in a sexually active adolescent with chronic infection that is unresponsive to other treatment.

A lethargic, pale child is brought to the health care provider's office with symptoms of periorbital edema and reduced quantity of urine output. The urine is cloudy and smoky in color. The nurse asks the mother if the child has had any recent infections, to which the mother responds that the child had a very sore throat a few weeks ago. The health care provider suspects that the child might have acute poststreptococcal glomerulonephritis. Which of the following laboratory tests would rule out a past streptococcal infection in the child?

1. Urinalysis 2. Throat culture *3. Antistreptolysin titer* 4. Creatinine clearance *Rationale:* Option 3 is the only laboratory test that will determine if a streptococcal infection was present. The other options do not relate to a past streptococcal infection. Option 1 will determine if protein is present in the urine, which is present in glomerulonephritis. Option 2 will determine if a current throat infection is present. Option 4 will determine glomerular filtration rate.

A nurse is checking a child for dehydration and documents that the child is moderately dehydrated. Which of the following symptoms would be noted in determining this finding?

*1. Oliguria* 2. Pale skin color 3. Severely depressed fontanels 4. Slightly dry, mucous membranes *Rationale:* In moderate dehydration, the fontanels would be slightly sunken, the mucous membranes would be very dry, the skin color would be dusky, and oliguria would be present. Options 2 and 4 describe mild dehydration. In mild dehydration, urine output would be decreased, but oliguria would not be present. Option 3 describes severe dehydration.

A child is admitted to the hospital with sickle cell crisis. The nurse checks this child for which frequent symptom of the disorder?

*1. Pain* 2. Diarrhea 3. Bradycardia 4. Blurred vision *Rationale:* Sickling crisis often causes pain in the bones and joints, accompanied by joint swelling. Pain is a classic symptom of the disease and may require large doses of opioid analgesics when it is severe. The symptoms listed in the other options are not part of the clinical picture.

A nurse is reviewing the health record of a child who has been recently diagnosed with glomerulonephritis. Which finding noted in the child's record is associated with the diagnosis of glomerulonephritis?

1. The child fell off a bike and onto the handlebars. 2. The child has had nausea and vomiting for the last 24 hours. 3. The child had urticaria and itching for 1 week before diagnosis. *4. The child had a streptococcal throat infection 2 weeks before diagnosis.* *Rationale:* Group A β-hemolytic streptococcal infection is a cause of glomerulonephritis. The child often becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1 to 2 weeks. The data presented in options 1, 2, and 3 are unrelated to a diagnosis of glomerulonephritis.

A child is brought to a clinic after developing a rash on the trunk and on the scalp. The parents report that the child has had a low-grade fever, has not felt like eating, and has been generally tired. The child is diagnosed with chickenpox. Which statement by the nurse is accurate regarding chickenpox?

1. The communicable period is unknown. 2. The communicable period ranges from 2 weeks or less up to several months. 3. The communicable period is 10 days before the onset of symptoms to 15 days after the rash appears. *4. The communicable period is 1 to 2 days before the onset of the rash to 6 days after the onset and crusting of lesions.* *Rationale:* The communicable period for chickenpox is 1 to 2 days before the onset of the rash to 6 days after the onset and crusting of lesions. In roseola the communicable period is unknown. Option 2 describes diphtheria. Option 3 describes rubella.

A mother of a 3-year-old child tells the nurse that the child has been continuously scratching the skin and has developed a rash. On data collection, which finding indicates that the child may have scabies?

*1. Fine, grayish-red lines* 2. Purple-colored lesions 3. Thick, honey-colored crusts 4. Clusters of fluid-filled vesicles *Rationale:* Scabies appears as burrows or fine, grayish-red lines. They may be difficult to see if they are obscured by excoriation and inflammation. Purple-colored lesions may be indicative of various disorders, including systemic conditions. Thick, honey-colored crusts are characteristic of impetigo. Clusters of fluid-filled vesicles are seen in clients with herpesvirus.

A nurse is assigned to care for a child with hypertrophic pyloric stenosis who is scheduled for pyloromyotomy. Which of the following positions would the nurse place the child in during the preoperative period?

*1. Prone with the head of the bed elevated* 2. Prone with the head of the bed lowered to promote drainage 3. Supine with the head of the bed at a 30-degree angle 4. Supine with the head of the bed at a 45-degree angle *Rationale:* In the preoperative period, the infant is positioned prone with the head of the bed elevated to reduce the risk of aspiration. Options 2, 3, and 4 are inappropriate positions to prevent this risk.

The nurse is reinforcing instructions to an adolescent with type 1 diabetes mellitus regarding insulin administration and rotation sites. Which statement, if made by the adolescent, would indicate an understanding of the instructions?

1. "I need to use a different site for each insulin injection." 2. "I should use only my stomach and my thighs for injections." 3. "I need to use the same site for 1 month before rotating to another site." *4. "I need to use one major site for the morning injection and another major site for the evening injection for 2 to 3 weeks before changing major sites."* *Rationale:* To help decrease variations in absorption from day to day, the child should use one location within a major site for the morning injection. The child should then rotate to another site for the evening injection, and a third site for the bedtime injection. The child should follow this pattern for a period of 2 to 3 weeks before changing major sites.

A nurse provides home care instructions to the parents of an infant following surgical intervention for imperforate anus and tells the parents about the procedure for anal dilation. Which statement by the parents indicates the need for further instructions?

1. "I need to use only dilators supplied by the health care provider." 2. "I need to use a water-soluble lubricant." 3. "I will insert the dilator no more than 1 to 2 cm into the anus." *4. "I will insert a glycerin suppository before the dilation."* *Rationale:* Following this surgery, anal dilation at home by the parents is necessary to achieve and maintain bowel patency. Inserting a glycerin suppository before dilation is not a component of this procedure. Options 1, 2, and 3 are accurate instructions and will prevent damage to the rectal mucosa.

A nurse has provided instructions to the mother of a child who has been diagnosed with bacterial conjunctivitis. Which of the following, if stated by the mother, would indicate the need for further instructions?

1. "I need to wash my hands frequently." 2. "I need to clean the eye, as prescribed." *3. "It is OK to share towels and washcloths."* 4. "I need to give the eyedrops, as prescribed." *Rationale:* Bacterial conjunctivitis is highly contagious, and infection control measures should be taught; these include frequent handwashing and not sharing towels and washcloths. Options 1, 2, and 4 are correct measures.

The mother of a child who had a myringotomy with insertion of tympanostomy tubes calls the nurse and tells the nurse that the "tubes" fell out. The nurse makes which response to the mother?

1. "Replace the tubes immediately so that the created opening does not close." 2. "This is an emergency and requires immediate intervention. Bring the child to the emergency department." *3. "This is not an emergency. I will speak to the health care provider and call you right back."* 4. "Soak the tubes in alcohol for 1 hour before replacing them in the child's ears." *Rationale:* The size and appearance of the tympanostomy tubes should be described to the parents following surgery. They should be reassured that if the tubes fall out, it is not an emergency but that the health care provider should be notified. Options 1, 2, and 4 are incorrect.

A nurse reviews the record of a 3-week-old infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse understands that which of the following symptoms led the mother to seek health care for the infant?

1. Diarrhea 2. Projectile vomiting 3. The regurgitation of feedings *4. Foul-smelling, ribbon-like stools* *Rationale:* Chronic constipation that begins during the first month of life and that results in foul-smelling, ribbon-like or pellet-like stools is a clinical manifestation of Hirschsprung's disease. The delayed passage or absence of meconium stool during the neonatal period is a characteristic sign. Bowel obstruction (especially during the neonatal period), abdominal pain and distention, and failure to thrive are also clinical manifestations. Options 1, 2, and 3 are incorrect.

A child is scheduled for a tonsillectomy. Which of the following would present the highest risk of aspiration during surgery?

1. Difficulty swallowing 2. Bleeding during surgery 3. Exudate in the throat area *4. The presence of loose teeth* *Rationale:* In the preoperative period, the child should be observed for the presence of loose teeth to decrease the risk of aspiration during surgery. Options 1 and 3 are incorrect. Bleeding during surgery will be controlled via packing and suction as needed.

A nurse who is caring for a child with aplastic anemia reviews the laboratory results and notes a white blood cell (WBC) count of 6000 cells/ mm3 and a platelet count of 27,000 cells/mm3. Which nursing intervention should be incorporated into the plan of care?

1. Encourage naps. 2. Encourage a diet high in iron. *3. Encourage quiet play activities.* 4. Maintain strict isolation precautions. *Rationale:* Precautionary measures to prevent bleeding should be taken when a child has a low platelet count. These include no injections, no rectal temperatures, the use of a soft toothbrush, and abstinence from contact sports or activities that could cause an injury. Strict isolation would be required if the WBC count was low. Naps and a diet high in iron are unrelated to the risk of bleeding.

A nurse provides feeding instructions to a mother of an infant diagnosed with gastroesophageal reflux (GER). To assist in reducing the episodes of emesis, the nurse tells the mother to:

1. Thin the feedings by adding water to the formula. *2. Thicken the feedings by adding rice cereal to the formula.* 3. Provide less frequent, larger feedings. 4. Burp less frequently during feedings. *Rationale:* Small, more frequent feedings with frequent burping are often tried as the first line of treatment in GER. Feedings thickened with rice cereal may reduce episodes of emesis. Thickened feedings do not affect reflux time, however. If thickened formula is prescribed, 1 to 3 teaspoons of rice cereal per ounce of formula is most commonly used and may require cross-cutting the nipple. Options 1, 3, and 4 are incorrect.

A nurse is collecting data on an infant with a diagnosis of suspected Hirschsprung's disease. Which of the following questions to the mother will most specifically elicit information regarding this disorder?

*1. "Does your infant have foul-smelling, ribbon-like stools?"* 2. "Is your infant constantly vomiting?" 3. "Does your infant constantly spit up feedings?" 4. "Does your infant have diarrhea?" *Rationale:* Chronic constipation, beginning in the first month of life and resulting in pellet-like or ribbon-like stools that are foul smelling, is a clinical manifestation of Hirschsprung's disease. Delayed passage or absence of meconium stool in the neonatal period is the cardinal sign. Bowel obstruction, especially in the neonatal period, abdominal pain and distention, and failure to thrive are also clinical manifestations. Options 2, 3, and 4 are not specific clinical manifestations of this disorder.

A nursing student caring for a 6-month-old infant is asked to collect a urine specimen from the infant. The student collects the specimen by:

*1. Attaching a urinary collection device to the infant's perineum for collection* 2. Obtaining the specimen from the diaper by squeezing the diaper after the infant voids 3. Catheterizing the infant using the smallest available French Foley catheter 4. Noting the time of the next expected voiding and preparing to collect the specimen into a cup when the infant voids *Rationale:* Although many methods have been used to collect urine from an infant, the most reliable method is the urine collection device. This device is a plastic bag that has an opening that is lined with adhesive so that it may be attached to the perineum. Urine for certain tests, such as specific gravity, may be obtained from a diaper by collection of the urine with a syringe. Urinary catheterization is not to be done unless specifically prescribed because of the risk of infection. It is not reasonable to try to identify the time of the next voiding to attempt to collect the specimen.

A nurse is assigned to care for a child admitted to the hospital with a diagnosis of suspected bacterial endocarditis. The nurse prepares the child for which of the following diagnostic tests that will confirm the diagnosis?

*1. Blood cultures* 2. Chest x-ray 3. Echocardiogram 4. Transesophageal echocardiography *Rationale:* When endocarditis is suspected, a definitive diagnosis is achieved through blood cultures. A negative blood culture does not rule out the existence of endocarditis; it just indicates a lesser likelihood of its existence. A chest x-ray, echocardiogram, and transesophageal echocardiography are performed to aid in the diagnosis of endocarditis.

A nurse is reviewing the laboratory results of a child with aplastic anemia and notes that the white blood cell (WBC) count is 2000 cells/mm3 and the platelet count is 150,000 cells/mm3. Which of the following nursing interventions will the nurse incorporate into the plan of care?

*1. Maintain strict isolation precautions.* 2. Encourage the child to use a soft toothbrush. 3. Avoid unnecessary injections. 4. Encourage quiet play activities. *Rationale:* The normal WBC ranges from 5000 to 10,000 cells/mm3 and the normal platelet count ranges from 150,000 to 400,000/mm3. Strict isolation procedures would be required if the WBC count were low to protect the child from infection. Precautionary measures to prevent bleeding should be taken when a child has a low platelet count. These include no injections, no rectal temperatures, use of a soft toothbrush, and abstinence from contact sports or activities that could cause an injury.

A nurse is collecting data from a child suspected of having juvenile idiopathic arthritis (JIA). Which findings would the nurse expect to note if JIA were present? *Select all that apply.*

*1. Malaise, fatigue, and lethargy* *2. Painful, stiff, and swollen joints* *3. Limited range of motion of the joints* 4. Stiffness that develops later in the day 5. Cool temperature of the skin over the affected joints *6. History of late afternoon temperature, with temperature spiking up to 105° F* *Rationale:* Clinical manifestations associated with JIA include intermittent joint pain that lasts longer than 6 weeks and painful, stiff, and swollen joints that are warm to the touch, with limited range of motion. The child will complain of morning stiffness and may protect the affected joint or refuse to walk. Systemic symptoms include malaise, fatigue and lethargy, anorexia, weight loss, and growth problems. A history of a late afternoon fever with temperature spiking up to 105° F will also be part of the clinical manifestations.

In planning care for a child with contact dermatitis, which concern is the highest priority for the child?

*1. Pain* 2. Skin breaks 3. Infection 4. Parental knowledge about care *Rationale:* In any skin disorder, the goal with children is to offer comfort interventions so that the child can rest. Once pain has decreased, the skin can be assessed for integrity and infection. Although important, teaching is not the priority in this situation.

After a tonsillectomy, the child begins to vomit bright red blood. The initial nursing action would be to:

*1. Turn the child to the side.* 2. Notify the RN or health care provider (HCP). 3. Administer the prescribed antiemetic. 4. Maintain nothing-by-mouth (NPO) status. *Rationale:* After a tonsillectomy, if bleeding occurs, the child is turned to the side, and the RN or HCP is notified. An NPO status would be maintained, and an antiemetic may be prescribed; however, the initial nursing action would be to turn the child to the side.

A pediatric nursing instructor asks a nursing student to describe the cause of the clinical manifestations that occur in sickle cell disease. Which is the correct response by the nursing student?

1. "Bone marrow depression occurs because of the development of sickled cells." 2. "Sickled cells increase the blood flow through the body and cause a great deal of pain." 3. "The sickled cells mix with the unsickled cells and cause the immune system to become depressed." *4. "Sickled cells are unable to flow easily through the microvasculature, and their clumping obstructs blood flow."* *Rationale:* All the clinical manifestations of sickle cell disease are a result of the sickled cells being unable to flow easily through the microvasculature, and their clumping obstructs blood flow. With reoxygenation, most of the sickled red blood cells resume their normal shape. Options 1, 2, and 3 are inaccurate.

A nurse is preparing a 2-year-old child with suspected nephrotic syndrome for a renal biopsy to confirm the diagnosis. The mother asks the nurse, "Will my child ever look thin again?" The nurse appropriately responds by saying:

1. "Do you feel guilty because about your child's weight gain?" *2. "In most cases, medication and diet will control fluid retention."* 3. "Wearing loose-fitting clothing should help conceal the extra weight." 4. "When children are little, it's expected that they'll look a little chubby." *Rationale:* It is important to give the mother information that addresses the issue that is the parent's concern. Most children experience remission with treatment. Options 1 and 3 are nontherapeutic and may add to the mother's guilt. Option 4 does not acknowledge the concern and is a stereotypical response.

A nurse assists with providing an instructional session to parents regarding impetigo. Which statement by a parent indicates the need for further instruction?

1. "It is extremely contagious." 2. "It is most common during humid weather." *3. "Lesions are most often located on the arms and chest."* 4. "It begins in an area of broken skin, such as an insect bite." *Rationale:* Impetigo is most common during the hot and humid summer months. It begins in an area of broken skin, such as an insect bite. It may be caused by Staphylococcus aureus, group A β-hemolytic streptococci, or a combination of these bacteria. It is extremely contagious. Lesions are most often located around the mouth and nose, but they may be present on the extremities.

A nurse provides instructions regarding the use of permethrin 1% (Nix) to the parents of a child who has been diagnosed with pediculosis capitis (head lice). Which statement by a parent indicates the need for further instruction?

1. "The hair should not be shampooed for 24 hours after treatment." 2. "The medication can be obtained over the counter in a local pharmacy." *3. "The medication is applied to the hair after shampooing and left on for 24 hours."* 4. "The medication is applied to the hair after shampooing, left on for 5 to 10 minutes, and then rinsed out." *Rationale:* Permethrin 1% is an over-the-counter anti-lice product that kills lice and eggs with one application and that has residual activity for 10 days. It is applied to dried hair after shampooing and left for 5 to 10 minutes before it is rinsed (not shampooed) out. The hair should not be shampooed for 24 hours after the treatment.

A nursing student is assigned to help administer immunizations to children in a clinic. The nursing instructor asks the student about the contraindications to receiving an immunization. Immunization is contraindicated in the presence of which condition?

1. A cold 2. Otitis media 3. Mild diarrhea *4. A severe febrile illness* *Rationale:* A severe febrile illness is a reason to delay immunization, but only until the child has recovered from the acute stage of the illness. Minor illnesses such as a cold, otitis media, or mild diarrhea are not contraindications to immunization.

Laboratory studies are performed on a child suspected of iron deficiency anemia. The nurse reviews the laboratory results, knowing that which of the following would indicate this type of anemia?

1. An elevated hemoglobin level with a low hematocrit level 2. A decreased reticulocyte count 3. An elevated red blood cell (RBC) count *4. RBCs that are microcytic and hypo chromic* *Rationale:* The results of a complete blood cell count in children with iron deficiency anemia will show low hemoglobin levels and microcytic and hypochromic RBCs. The reticulocyte count is usually normal or slightly elevated.

Permethrin 5% (Elimite) is prescribed for a 4-year-old child with a diagnosis of scabies. The nurse instructs the mother regarding the use of this treatment. Which instruction is appropriate?

1. Apply the lotion and leave it on for 4 hours. 2. Apply the lotion to the hair, the face, and the entire body. 3. The child should wear no clothing while the lotion is in place. *4. Apply the lotion to cool, dry skin at least half an hour after bathing.* *Rationale:* Permethrin is applied from the neck downward, with care taken to ensure that the soles of the feet, the areas behind the ears, and the areas under the toenails and fingernails are covered. The lotion should be kept on for 8 to 14 hours, and then the child should be given a bath. The lotion should be applied at least 30 minutes after bathing, and it should be applied only to cool, dry skin. The child should be clothed during treatment.

A nurse is reviewing the record of a child scheduled for a health care provider's visit. Before data collection, the nurse notes documentation that the child has enuresis. Based on this diagnosis, the nurse plans to focus on which of the following when collecting data?

1. Bowel function *2. Bladder function* 3. Motor development 4. Nutritional status and weight gain *Rationale:* Enuresis refers to a condition in which the child is unable to control bladder function, although he or she has reached an age at which control of voiding is expected. Nocturnal enuresis, or bed-wetting, is common in children.

A nurse is monitoring for fluid volume deficit in an infant who is vomiting and having diarrhea. The nurse weighs the infant's diaper after each voiding and stool and carefully calculates fluid volume, knowing that:

1. Each gram of diaper weight is equivalent to 0.5 mL of urine. *2. Each gram of diaper weight is equivalent to 1 mL of urine.* 3. Each gram of diaper weight is equivalent to 2 mL of urine. 4. Each gram of diaper weight is equivalent to 2.5 mL of urine. *Rationale:* When monitoring for fluid volume deficit, the nurse should weigh the infant's diaper after each voiding and stool. Each gram of diaper weight is equivalent to 1 mL of urine. Therefore options 1, 3, and 4 are incorrect.

A nurse is reviewing the health record of an infant with a diagnosis of gastroesophageal reflux. Which clinical manifestation of this disorder would the nurse expect to note documented in the record?

1. Excessive oral secretions 2. Bowel sounds heard over the chest *3. Hiccupping and spitting up after a meal* 4. Coughing, wheezing, and short periods of apnea *Rationale:* Clinical manifestations of all types of gastroesophageal reflux include vomiting (spitting up) after a meal, hiccupping, and recurrent otitis media related to pooled secretions in the nasopharynx during sleep. Option 1 is a clinical manifestation of esophageal atresia and tracheoesophageal fistula. Option 2 is a clinical manifestation of congenital diaphragmatic hernia. Option 4 is a clinical manifestation of hiatal hernia.

A mother of a child who underwent a myringotomy with insertion of tympanostomy tubes calls the nurse and reports that the child is complaining of discomfort. The nurse tells the mother to:

1. Give the child children's aspirin for the discomfort. 2. Be sure that the child is resuming normal activities. *3. Give the child acetaminophen (Tylenol) for the discomfort.* 4. Speak to the health care provider because the child should not be having any discomfort. *Rationale:* Following myringotomy with insertion of tympanostomy tubes, the child may experience some discomfort. Acetaminophen can be given to relieve the discomfort. Aspirin should not be administered to the child. The child should rest if discomfort is present.

A mother brings her child to the clinic because the child has developed a rash on the trunk and scalp. The child is diagnosed with varicella. The mother inquires about the infectious period associated with varicella, and the nurse tells the mother that the infectious period:

1. Is unknown *2. Is 1 to 2 days before the onset of the rash to 5 days after the onset of lesions and the crusting of lesions* 3. Is 10 days before the onset of symptoms to 15 days after the rash appears 4. Ranges from 2 weeks or less up to several months *Rationale:* Varicella is known as chickenpox. The infectious period for varicella is 1 to 2 days before the onset of the rash to 5 days after the onset of lesions and the crusting of lesions. In roseola, the infectious period is unknown. Option 3 describes rubella. Option 4 describes diphtheria.

A nurse determines that a child with type 1 diabetes mellitus is having a hypoglycemic reaction. The nurse should give the child which of the following to treat the reaction?

1. One sugar cube 2. 1 teaspoon of sugar 3. ½ cup of diet cola *4. ½ cup of fruit juice* *Rationale:* Hypoglycemia is immediately treated with 10 to 15 g of carbohydrate. Glucose tablets or glucose gel may be administered. Other items used to treat hypoglycemia include ½ cup of fruit juice, ½ cup of regular (nondiet) soft drink, 8 ounces of skim milk, 6 to 10 hard candies, 4 cubes of sugar or 4 teaspoons of sugar, 6 saltines, 3 graham crackers, or 1 tablespoon of honey or syrup. The items in options 1, 2, and 3 would not adequately treat hypoglycemia.

A nurse is assisting in preparing a plan of care for a 4-year-old child hospitalized with nephrotic syndrome. Which dietary intervention is most appropriate for this child?

1. Provide a high-salt diet. 2. Provide a high-protein diet. 3. Discourage visitors at mealtimes. *4. Encourage the child to eat in the playroom.* *Rationale:* Mealtimes should center on pleasurable socialization. The child should be encouraged to eat meals with other children on the unit. A diet that is normal in protein with a sodium restriction is normally prescribed for a child with nephrotic syndrome. Parents or other family members should be encouraged to be present at mealtimes with a hospitalized child.

A child is scheduled to receive a measles, mumps, and rubella (MMR) vaccine. The nurse who is preparing to administer the vaccine reviews the child's record. Which finding should make the nurse question the health care provider's prescription?

1. Recent recovery from a cold 2. A history of frequent respiratory infections *3. A history of an anaphylactic reaction to neomycin* 4. A local reaction at the site of a previous MMR vaccine injection *Rationale:* The MMR vaccine contains minute amounts of neomycin. A history of an anaphylactic reaction to neomycin is considered a contraindication to the MMR vaccine. The general contraindication to all immunizations is a severe febrile illness. The presence of a minor illness such as the common cold is not a contraindication. In addition, a history of frequent respiratory infections is not a contraindication to receiving a vaccine. A local reaction to an immunization is treated with cool packs for the first 24 hours after injection, and this is followed by warm or cool compresses if the inflammation persists.

A licensed practical nurse (LPN) is assigned to assist in caring for a hospitalized child who is receiving a continuous infusion of intravenous (IV) potassium for the treatment of dehydration. The LPN monitors the child closely and notifies the registered nurse if which of the following is noted?

1. Temperature of 100.8° F rectally 2. Weight increase of 0.5 kg *3. A decrease in urine output to 0.5 mL/kg/hr* 4. Blood pressure (BP) unchanged from baseline *Rationale:* The priority assessment is to monitor the status of urine output. Potassium should never be administered in the presence of oliguria or anuria. If urine output is less than 1 to 2 mL/kg/hr, potassium should not be administered. A slight elevation in temperature would be expected in a child with dehydration. A weight increase of 0.5 kg is relatively insignificant. A BP that is unchanged is a positive indicator unless the baseline was abnormal. However, there is no information in the question to support such data.

A nurse is providing home care instructions to the mother of a child with bacterial conjunctivitis. The nurse should tell the mother:

1. That the child may attend school if antibiotics have been started 2. To save any unused eye medication in case a sibling gets the eye infection *3. That the child's towels and washcloths should not be used by other members of the household* 4. To wipe any crusted material from the eye with a cotton ball soaked in warm water, starting at the outer aspect of the eye and moving toward the inner aspect *Rationale:* Bacterial conjunctivitis is highly contagious, and infection control measures should be taught. These include good handwashing and not sharing towels and washcloths with others. The child should be kept home from school until 24 hours after antibiotics are started. Bottles of eye medication should never be shared with others. Crusted material may be wiped from the eye with a cotton ball soaked in warm water, starting at the inner aspect of the eye and moving toward the outer aspect.

An adolescent is admitted to the hospital with complaints of lower right abdominal pain. The health care provider prescribes laboratory tests to rule out ectopic pregnancy rather than appendicitis. Which of the following is most significant in ruling out an ectopic pregnancy?

1. Urinalysis 2. White blood count 3. C-reactive protein *4. Serum human chorionic gonadotropin* *Rationale:* The test to rule out an ectopic pregnancy is the serum human chorionic gonadotropin. The other tests may be prescribed to rule out appendicitis, but because the client is an adolescent it would be necessary to rule out an ectopic pregnancy as well. Urinalysis will rule out a urinary tract infection, and the white blood count and the C-reactive protein will rule out some other types of infection.