NSG 3600 Exam 3

The nurse is caring for a 14-year-old with celiac disease. The nurse knows that the patient understands the diet instructions by ordering which of the following meals? 1. Eggs, bacon, rye toast, and lactose-free milk. 2. Pancakes, orange juice, and sausage links. 3. Oat cereal, breakfast pastry, and nonfat skim milk. 4. Cheese, banana slices, rice cakes, and whole milk.

1. Rye toast contains gluten. 2. Unless otherwise indicated, pancakes are made of wheat flour, which contains gluten. 3. Oat cereal and breakfast pastry contain gluten. 4. Cheese, banana slices, rice cakes, and whole milk do not contain gluten. TEST-TAKING HINT: The test taker needs to recall that children with celiac disease cannot tolerate gluten, which is found in wheat, barley, rye, and oats. Answers 1, 2, and 3 contain gluten.

The parent of a child with glomerulonephritis asks the nurse why the urine is such a funny color. Which is the nurse's best response? 1. "It is not uncommon for the urine to be discolored when children are receiving steroids and blood pressure medications." 2. "There is blood in your child's urine that causes it to be tea-colored." 3. "Your child's urine is very concentrated, so it appears to be discolored." 4. "A ketogenic diet often causes the urine to be tea-colored."

1. Steroids and antihypertensives do not cause urine to change color. 2. Blood in the child's urine causes it to be tea-colored. 3. The tea color of the urine is due to hematuria, not concentration. 4. The child with glomerulonephritis is not on a ketogenic diet. The ketogenic diet does not cause the urine to change color. TEST-TAKING HINT: The test taker can immediately eliminate answer 4 because the child is not placed on a ketogenic diet.

Which is the best position for an 8-year-old who has just returned to the pediatric unit after an appendectomy for a ruptured appendix? 1. Semi-Fowler. 2. Prone. 3. Right side-lying. 4. Left side-lying.

1. The semi-Fowler position does not provide the most comfort to the postoperative appendectomy child. 2. The prone position does not allow the nurse to visualize the incision easily and would probably be uncomfortable for the child. 3. The right side-lying position promotes comfort and allows the peritoneal cavity to drain. 4. The left side-lying position may not provide as much comfort and will not allow the peritoneal cavity to drain as freely as will the right side-lying position. TEST-TAKING HINT: The test taker should be led to answer 3 because lying on the same side as the abdominal incision is usually the most comfortable for the child.

An expectant mother asks the nurse if her new baby will have an umbilical hernia. The nurse bases the response on the fact that it occurs: 1. More often in large infants. 2. In white infants more often than in African American infants. 3. Twice as often in male infants. 4. More often in premature infants.

1. Umbilical hernias occur more often in low- birth-weight infants. 2. Umbilical hernias occur more often in African American infants than in white infants. 3. Umbilical hernias affect males and females equally. 4. Umbilical hernias occur more often in premature infants. TEST-TAKING HINT: The test taker needs to be familiar with the occurrence of umbilical hernias.

The nurse is planning care for a child with a T12 spinal cord injury. Which lifelong complication should the child and family know about? Select all that apply. 1. Skin integrity. 2. Incontinence. 3. Loss of large and small motor activity. 4. Loss of voice. 5. Spasticity.

1, 2, 3, 5. 1. Spinal cord-injury clients experience many issues because of the loss of innervation below the level of the injury. Skin integrity and incontinence are issues because of immobility and loss of pain receptors below the level of the injury. 2. Skin integrity and incontinence are issues because of immobility and loss of pain receptors below the level of the injury. 3. Loss of motor activity is also a result of loss of innervation below the level of the injury. 4. Loss of voice is not a complication of T12 injury. 5. With incomplete severing of the spinal cord, flaccid spasticity occurs initially as a result of the injury and shock, but oftentimes converts to muscle spasticity during the rehabilitation stage. TEST-TAKING HINT: The test taker must know the long-term effects of spinal cord injuries.

A 5-year-old has been diagnosed with pseudohypertrophic muscular dystrophy. Which nursing intervention(s) would be appropriate? Select all that apply. 1. Discuss with the parents the potential need for respiratory support. 2. Explain that this disease is easily treated with medication. 3. Suggest exercises that will limit the use of muscles and prevent fatigue. 4. Assist the parents in finding a nursing facility for future care. 5. Encourage the parents to contact the school to develop an IEP.

1, 3, 5. 1. Muscles become weaker, including those needed for respiration, and a decision will need to be made about whether respiratory support will be provided. 2. This is a progressive disease, which medications do not treat. 3. Physical therapy will be part of the treatment plan, but respiratory support is a priority. 4. The parents need to decide eventually if they will keep the child home or cared for in a nursing facility, but that is not an immediate concern. 5. Parents should be encouraged to allow the child to go to school and participate in activities as tolerated. TEST-TAKING HINT: Pseudohypertrophic muscular dystrophy is a progressive neuromuscular disease with no cure. Children can have a good quality of life if parents are guided in how to help their child.

The nurse is caring for a child who has been in a motor vehicle accident (MVA). The child falls asleep unless her name is called or she is gently shaken. This state of consciousness is referred to as: 1. Coma. 2. Delirium. 3. Obtunded. 4. Confusion.

1. "Coma" describes a state of consciousness in which the child is not responsive to any stimulation, including painful stimulation. 2. "Delirium" describes a state of consciousness in which the child is extremely confused and anxious. 3. "Obtunded" describes a state of consciousness in which the child has a limited response to the environment and can be aroused by verbal or tactile stimulation. 4. "Confusion" describes a state of consciousness in which the child is not oriented to person, place, and time. TEST-TAKING HINT: The test taker needs to be familiar with terms describing states of consciousness.

Which gross motor skills should the nurse assess in a 3-month-old with spina bifida? 1. Head control. 2. Pincer grasp. 3. Sitting alone. 4. Rolling over.

1. A 3-month-old should have good head control. 2. Pincer grasp occurs at about 9 months. 3. Sitting alone occurs at about 6 months. 4. Rolling over occurs at about 4 months. TEST-TAKING HINT: The test taker must know normal developmental milestones.

Which statement by a parent is most consistent with minimal change nephrotic syndrome (MCNS)? 1. "My child missed 2 days of school last week because of a really bad cold." 2. "After camping last week, my child's legs were covered in bug bites." 3. "My child came home from school a week ago because of vomiting and stomach cramps." 4. "We have a pet turtle, but no one washes their hands after playing with the turtle."

1. An upper respiratory infection often precedes MCNS by a few days. 2. Bug bites are not typically associated with MCNS. 3. Vomiting and abdominal cramping are not typically associated with MCNS. 4. Pet turtles often carry salmonella, which can cause vomiting and diarrhea but not MCNS. TEST-TAKING HINT: The test taker should be led to answer 1 because MCNS is most often associated with upper respiratory infections.

The nurse is caring for a child receiving radiation therapy for a brain tumor. The parents ask if their child will likely have any learning disabilities. Select the nurse's best answer. 1. "All children who receive radiation have some amount of learning disability. As long as they receive extra tutoring, they usually do well in school." 2. "Because your child is so young, she will likely do well and have no problems in the future." 3. "Response varies with each child, but younger children who receive radiation tend to have some amount of learning disability later in life." 4. "Response varies with each child, but younger children who receive radiation tend to have fewer problems later in life than older children."

1. Not all children who receive radiation experience learning disabilities. 2. Younger children tend to experience more learning difficulties than do older children. 3. Although variable, younger children tend to experience more learning difficulties than do older children. 4. Although variable, younger children tend to experience more learning difficulties than do older children. TEST-TAKING HINT: The test taker should be familiar with radiation therapy. The test taker should be led to answers 3 and 4 because they both state that difficulties are variable.

A child presents with a history of having had an upper respiratory tract infection 2 weeks ago; complains of symmetrical lower extremity weakness, back pain, muscle tenderness; and has absent deep tendon reflexes in the lower extremities. Which is important regarding this condition? 1. The disease process is probably bacterial. 2. The recent upper respiratory infection is not important information. 3. This may be an acute inflammatory demyelinating neuropathy. 4. CN involvement is rare.

1. When children present with recurring respiratory symptoms, the disease etiology is frequently viral. 2. When children present with neurological symptoms after a viral respiratory illness, the nurse should consider the symptoms to be a complication of the viral illness until proved otherwise. 3. This child probably has GBS, which is an acute inflammatory demyelinating neuropathy. 4. When neurological symptoms follow an acute viral illness, the CNs are frequently involved. TEST-TAKING HINT: Having a prior upper respiratory infection usually means this condition is not caused by bacteria, which eliminates answers 1 and 2. That leaves the choice between answers 3 and 4

Which of the following would be included in the plan of care for a hospitalized newborn following surgical repair of a myelomeningocele? Select all that apply. 1. Skull x-rays. 2. Daily head circumference measurements. 3. MRI scan. 4. Vital signs every 6 hours. 5. Holding to breastfeed.

2, 3. 1. Diagnostic tests include MRI scan, CT scan, ultrasound, and myelography. These tests give much more needed information than do skull x-rays. 2. Daily head circumference measurements are done to assess for hydrocephalus. 3. Diagnostic tests include MRI scan, CT scan, ultrasound, and myelography. 4. Vital signs should be taken at least every 4 hours. 5. Infants with repaired myelomeningocele are kept prone to prevent pressure on the surgical site. TEST-TAKING HINT: The test taker needs to be familiar with postoperative care for infants with myelomeningocele.

Which instructions for a child diagnosed with encopresis should the nurse question? Select all that apply. 1. Limit the intake of milk. 2. Offer a diet high in protein. 3. Obtain a complete dietary log. 4. Follow up with a child psychologist. 5. After dinner, have the child sit on the toilet for 10 minutes.

2, 4. 1. Dairy products are limited because they can lead to constipation. 2. A diet high in protein will cause more constipation. 3. A complete dietary log should be kept to correlate the foods that lead to constipation. 4. The child and family would not be encouraged initially to seek counseling unless a psychological component to the encopresis had been identified. 5. Children with constipation/encopresis are advised to sit on the toilet for 10 minutes after dinner to take advantage of the gastrocolic reflex. TEST-TAKING HINT: Recall foods and behaviors that cause constipation in children and successful approaches to meet their needs.

Which foods would be best for a child with Duchenne muscular dystrophy? Select all that apply. 1. High-carbohydrate, high-protein foods. 2. No special food combinations. 3. Extra protein to help strengthen muscles. 4. Low-calorie foods to prevent weight gain. 5. Thickened liquids and smaller portions that are cut up.

4, 5. 1. As the child with muscular dystrophy becomes less active, diet becomes more important. Attention should be paid to quality and quantity of food, so the child does not gain too much weight. 2. Good-quality foods are important as the child continues to grow. 3. Extra protein will not help the child recover from this disease. 4. As the child becomes less ambulatory, moving the child will become moreof a problem. It is not good for the child to become overweight for several health reasons in addition to decreased ambulation. 5. As the child loses muscle control, the need for thickened liquids and small, well-cut-up solids becomes essential. TEST-TAKING HINT: Nutrition is important for every child; as the child becomes less ambulatory, weight concerns arise.

The nurse is interviewing the parents of a 6-year-old who has been experiencing constipation. Which could be a causative factor? Select all that apply. 1. Hypothyroidism. 2. Muscular dystrophy. 3. Myelomeningocele. 4. Drinks a lot of milk. 5. Active in sports.

62. 1, 2, 3, 4. 1. Hypothyroidism can be a causative factor in constipation. 2. Weakened abdominal muscles can be seen in muscular dystrophy and can lead to constipation. 3. Myelomeningocele affects the innervation of the rectum and can lead to constipation. 4. Excessive milk consumption can lead to constipation. 5. Activity tends to decrease constipation and increase regularity. TEST-TAKING HINT: The test taker needs to know which of these conditions can cause constipation.

The parent of an infant diagnosed with a neuroblastoma asks the nurse what the prognosis is. The nurse's best response is: 1. Excellent, because a neuroblastoma is always cured. 2. Excellent, because infants with a neuroblastoma have the best prognosis. 3. Poor, because infants with a neuroblastoma rarely survive. 4. Variable, depending on the site of origin.

1. Neuroblastoma is not always cured and can be fatal depending on the stage at diagnosis, site of origin, and the age of the child. 2. Infants younger than 1 year have the best prognosis. 3. Infants younger than 1 year have the best prognosis. 4. Although the prognosis varies with the site of origin, infants have the most favorable outcome. TEST-TAKING HINT: The question requires the test taker to be familiar with the prognosis of neuroblastoma.

The nurse tells a family of a child with cerebral palsy (CP) that since the 1960s the incidence of CP has: 1. Increased. 2. Decreased. 3. Remained the same. 4. Has decreased because of early misdiagnosis.

1. The incidence of CP has increased, partly as a result of the increased survival rate of extreme low-birth-weight and premature infants. 2. The incidence of CP has increased since the 1960s. 3. The incidence of CP has increased since the 1960s. 4. There is no evidence to suggest that CP has been diagnosed erroneously. TEST-TAKING HINT: The test taker should consider the causes of CP and be led to answer 1 because technology has increased the survival rate of low-birth-weight and premature infants. The test taker should resist the temptation to select answer 2 because it has not decreased as have many disorders.

The nurse is caring for a child due for surgery on a Wilms tumor. The child's procedure will consist of which of the following? 1. Only the affected kidney will be removed. 2. Both the affected kidney and the other kidney will be removed in case of recurrence. 3. The mass will be removed from the affected kidney. 4. The mass will be removed from the affected kidney, and a biopsy of the tissue of the unaffected kidney will be done.

1. The treatment of a Wilms tumor involves removal of the affected kidney. 2. Removal of the unaffected kidney is not necessary and is not done. 3. The entire kidney is removed. 4. A biopsy of the tissue of the unaffected kidney is not necessary and is not obtained. TEST-TAKING HINT: The test taker should eliminate answers 3 and 4 because the entire kidney is removed, not only the mass.

Which child is at increased risk for cerebral palsy (CP)? 1. An infant born at 34 weeks with an Apgar score of 6 at 5 minutes. 2. A 17-day-old infant with group B Streptococcus meningitis. 3. A 24-month-old child who has experienced a febrile seizure. 4. A 5-year-old with a closed-head injury after falling off a bike.

1. There is an increased incidence of CP when the infant has an Apgar score of 3 or less at 5 minutes. 2. Any infection of the central nervous system increases the infant's risk of CP. 3. A febrile seizure does not increase the risk of CP. 4. Although head trauma can increase the risk of CP, the school-age child is not likely to develop CP from falling off a bike. TEST-TAKING HINT: The test taker should consider the risks for CP. Answers 3 and 4 should be eliminated because these symptoms are least likely to lead to CP.

The parent of a young child with CP brings the child to the clinic for a checkup. Which parent's statement indicates an understanding of the child's long-term needs? 1. "My child will need all my attention for the next 10 years." 2. "Once in school, my child will catch up and be like the other children." 3. "My child will grow up and need to learn to do things independently." 4. "I'm the one who knows the most about my child and can do the most for my child."

1. There is no magic age when the child with special needs becomes independent and no longer needs parental assistance. The child may need some type of assistance for the rest of his life. 2. With appropriate therapy and good parental support, the child has the potential to maximize his abilities and minimize his limitations. The parent's best approach is to help the child achieve as much independence as possible given his particular disability. 3. The parent of a child with a disability should have the goal of assisting the child in achieving as much self-care as he is capable of, given his particular limitations. 4. At times, parents have tremendous grief and need to care totally for the child. It is important for the parent to be guided in helping the child achieve his potential. TEST-TAKING HINT: The test taker must understand the goals for children with chronic illnesses or disorders. One goal is to ensure that the child be diagnosed as early as possible so that interventions can be started. Another is to help the child realize as much potential as possible.

A child with a ventriculoperitoneal (VP) shunt complains of headache and blurry vision and now experiences irritability and sleeping more than usual. The parents ask the nurse what they should do. Select the nurse's best response. 1. "Give her some acetaminophen (Tylenol), and see if her symptoms improve. If they do not improve, bring her to the health-care provider's office." 2. "It is common for girls to have these symptoms, especially prior to beginning their menstrual cycle. Give her a few days, and see if she improves." 3. "You are probably worried that she is having a problem with her shunt. This is very unlikely because it has been working well for 9 years." 4. "You should immediately take her to the emergency department because these may be symptoms of a shunt malfunction."

1. These are symptoms of a shunt malfunction and should be evaluated immediately. 2. Although these symptoms may be associated with the start of a girl's menstrual cycle, they are symptoms of a shunt malfunction and require immediate evaluation. 3. A shunt can malfunction at any point and should be evaluated when signs of increased ICP are evident. 4. These are symptoms of a shunt malfunction and should be evaluated immediately. TEST-TAKING HINT: The test taker should recognize these symptoms as signs ofa shunt malfunction and can eliminate answers 1, 2, and 3 because they do not address the situation as an emergency.

A child with a seizure disorder has been having episodes during which she drops her pencil and simply appears to be daydreaming. This is most likely a/an: 1. Absence seizure. 2. Akinetic seizure. 3. Non-epileptic seizure. 4. Simple spasm seizure.

1. Absence seizures occur frequently and last less than 30 seconds. The child experiences a brief loss of consciousness during which she may have a change in activity. These children rarely fall, but they may drop an object. The condition is often confused with daydreaming. 2. Akinetic seizures occur when the young child experiences a brief loss of consciousness and postural tone and falls to the ground. The child quickly regains consciousness. 3. A non-epileptic seizure is a seizure that occurs secondary to another disorder, such as a fever or increased ICP. 4. A simple spasm seizure is not a diagnosis TEST-TAKING HINT: "Daydreaming" is the classic description of an absence seizure.

The nurse evaluates the teaching as successful when a parent states that which of the following can cause autonomic dysreflexia? 1. Exposure to cold temperatures. 2. Distended bowel or bladder. 3. Bradycardia. 4. Headache.

1. Exposure to cold temperatures does not trigger an episode of autonomic dysreflexia. 2. Autonomic dysreflexia results from an uncontrolled, paroxysmal, continuous lower motor neuron reflex arc due to stimulation of the sympathetic nervous system. It is a response that typically results from stimulation of sensory receptors such as a full bladder or bowel. 3. Symptoms of autonomic dysreflexia are bradycardia, headache, and potentially life- threatening hypertension. 4. Symptoms of autonomic dysreflexia are bradycardia, headache, and potentially life- threatening hypertension. TEST-TAKING HINT: The test taker must know what triggers autonomic dysreflexia and what the symptoms are.

Which has the potential to alter a child's level of consciousness? Select all that apply. 1. Metabolic disorders. 2. Trauma. 3. Hypoxic episode. 4. Dehydration. 5. Endocrine disorders.

1, 2, 3, 4, 5. 1. Many metabolic disorders are associated with hypoglycemia. The hypoglycemic child experiences a decreased level of consciousness because the brain does not have stores of glucose. 2. Trauma can lead to generalized brain swelling with resultant increased ICP. 3. Hypoxemia leads to a decreased level of consciousness because the brain is intolerant to the lack of oxygen. 4. Dehydration can lead to inadequate perfusion to the brain, which can result in a decreased level of consciousness. 5. Endocrine disorders often result in a decreased level of consciousness because they can lead to hypoglycemia, which is poorly tolerated by the brain. TEST-TAKING HINT: Metabolic disorders, trauma, hypoxic episodes, dehydration, and endocrine disorders are examples of disorders that can alter a child's level of consciousness by either increasing ICP or decreasing the perfusion of blood to the brain.

The parents of a 3-year-old are concerned that the child is having "more accidents" during the day. Which questions would be appropriate for the nurse to ask to obtain more information? Select all that apply. 1. "Has there been a stressful event in the child's life, such as the birth of a sibling?" 2. "Has anyone else in the family had problems with accidents?" 3. "Does your child seem to be drinking more than usual?" 4. "Is your child more fussy, and does your child seem to be in pain when urinating?" 5. "Is your child having difficulties at preschool?"

1, 2, 3, 4. 1. Stressors such as the birth of a sibling can lead to incontinence in a child who previously had bladder control. 2. A pattern of enuresis can often be seen in families. 3. Increased thirst and incontinence can be associated with diabetes. 4. Fussiness and incontinence can be associated with UTIs. 5. Preschool-age children may have difficulties at school, but the other information would be of more help to the nurse in gathering more information on enuresis. TEST-TAKING HINT: The test taker should be able to eliminate answer 5 by knowing which are the most important questions to ask.

The mother of a child with Duchenne muscular dystrophy asks the nurse who in the family should have genetic screening. Who should the nurse say must be tested? Select all that apply. 1. Mother. 2. Sister. 3. Brother. 4. Aunts and all female cousins. 5. Uncles and all male cousins.

1, 2, 4. 1. Genetic counseling is important in all inherited diseases. Duchenne muscular dystrophy is inherited as an X-linked recessive trait, meaning the defect is on the X chromosome. Women carry the disease, and males are affected. All female relatives should be tested. 2. The X chromosome carries the disease, and males are affected. The sister should have genetic testing to determine whether she carries the gene and identify her risks for having male offspring with the disease. 3. Because the disease is carried on the X chromosome, only females need to be genetically tested. Women carry the disease, and males are affected. All female relatives should be tested unless they are symptomatic. 4. The X chromosome carries the disease and males are affected. All female relatives should be tested. 5. The X chromosome carries the disease and males are affected. All female relatives should be tested. TEST-TAKING HINT: Knowing that Duchenne muscular dystrophy is inherited as an X-linked trait excludes fathers, brothers, uncles, and male cousins as carriers.

Which would the nurse expect a child with spastic CP to demonstrate? Select all that apply. 1. Increased deep tendon reflexes. 2. Decreased muscle tone. 3. Scoliosis. 4. Contractures. 5. Scissoring. 6. Good control of posture. 7. Good fine motor skills.

1, 3, 4, 5. 1. Children with spastic CP have increased deep tendon reflexes. 2. Children with spastic CP have increased muscle tone. 3. Children with spastic CP have scoliosis. 4. When children with spastic CP have quadriplegia, they can also develop contractures of the Achilles tendons, knees, and adductor muscles. 5. Children with spastic CP have scissoring when walking. 6. Depending on the amount of body involvement, children with spastic CP may have poor control of posture. It takes a lot of muscle control to stand up straight and maintain posture in space. 7. Children with spastic quadriplegic CP may have poor fine motor skills. There are varying degrees of severity of CP depending on the amount of brain injury. TEST-TAKING HINT: The test taker must know the typical signs of CP.

Which will help a school-age child with muscular dystrophy stay active longer? Select all that apply. 1. Normal activities, such as swimming. 2. Using a treadmill every day. 3. Several periods of rest every day. 4. Using a wheelchair upon getting tired. 5. Sleeping as late as needed.

1, 3, 4. 1. Swimming is an excellent exercise that uses many muscles and helps build strength. Children who are activeare usually able to postpone use of a wheelchair. It is important to keep using muscles for as long as possible, and aerobic activity is good for a child. 2. Use of a treadmill is not fun for children or adults, so keeping the child using the treadmill might be an issue. 3. Any child with a chronic disease should be kept as active as possible for as long as possible; short rest periods built into the day are helpful in maintaining stamina. 4. Children with neuromuscular diseases oftentimes will use a wheelchair to conserve energy and increase mobility. The wheelchair acts as the child's means of getting to where they want to go as independently as possible. 5. The child should be on a regular daily schedule including the same bedtime and getting up time. Rest times should be provided during the day. TEST-TAKING HINT: Appropriate interventions for different kinds of chronically ill children can be similar, so think about what would be best for this child.

A child has a provisional diagnosis of myasthenia gravis. Which should the nurse expect in this child? Select all that apply. 1. Double vision, ptosis. 2. Tremors and seizures. 3. Coughing and choking. 4. Ascending paralysis. 5. Sensory disturbance.

1, 3. 1. Symptoms in a child with myasthenia gravis include fatigue, double vision, ptosis, and difficulty swallowing and chewing. This is an autoimmune disease triggered by a viral or bacterial infection. Antibodies attack acetylcholine receptors and block their functioning. 2. Tremors and seizures are not generally seen in myasthenia gravis. 3. Symptoms in a child with myasthenia gravis include fatigue and difficulty swallowing and chewing. 4. The paralysis tends to wax and wane but is not the result of an ascending paralysis. The paralysis is first noticed in the eye muscles and eyelids and then progresses. It is the result of the neuromuscular junction not being able to send the acetylcholine to the muscle. 5. Myasthenia gravis does not cause any sensory disturbances. TEST-TAKING HINT: The test taker must know the signs and symptoms of myasthenia gravis in children. This is an autoimmune disease triggered by a viral infection in which antibodies attack acetylcholine receptors and block their functioning.

Which should the nurse include when teaching sexuality education to an adolescent with a spinal cord injury? Select all that apply. 1. "You can enjoy a healthy sex life and most likely conceive children." 2. "You will never be able to conceive if you have no genital sensation." 3. "Development of secondary sex characteristics is delayed." 4. "A few females have regular menstrual periods after injury." 5. "You can get the same sexually transmitted infections that those without spinal cord injuries get."

1, 4, 5. 1. The reproductive system continues to function properly after a spinal cord injury. Much sexual activity and response occurs in the brain as well. 2. Conception does not depend on sensation in the genitals. 3. Secondary sex characteristics develop normally. 4. Females may have irregular periods after the injury, but most return to their normal cycles. 5. Those with spinal cord injuries can acquire sexually transmitted infections and need to use safe sex practices. TEST-TAKING HINT: Spinal cord injuries have little effect on reproduction.

Which priority item should be placed at the bedside of a newborn with myelomeningocele? Select all that apply. 1. A bottle of normal saline. 2. A rectal thermometer. 3. Extra blankets. 4. A blood pressure cuff. 5. Latex-free gloves.

1, 5. 1. Before the surgical closure of the sac, the infant is at risk for infection. A sterile dressing is placed over the sac to keep it moist and help prevent it from tearing. Because the dressings dry out at least every hour, it is important to assess them frequently and apply saline as needed. Good hand washing is also important. 2. The infant's temperature will be taken, but prevention of infection is the priority. 3. Infants with myelomeningocele intact are often naked and placed in an incubator for warmth. Temperature does need to be maintained and the infant protected from sick people. 4. Blood pressure is difficult to monitor in the newborn period, especially if the baby is lying on the abdomen. Prevention of infection is the priority. 5. Latex-free clean gloves would be used for all care of this infant. A box should be kept at the infant's bedside. Children with spina bifida are at risk for latex allergy and should not be exposed to latex. TEST-TAKING HINT: The test taker should focus on the care and potential complications of an infant with spina bifida to answer the question correctly.

Which symptoms will a child suffering from complete spinal cord injury experience? Select all that apply. 1. Loss of motor and sensory function below the level of the injury. 2. Loss of interest in normal activities. 3. Extreme pain below the level of the injury. 4. Loss of some function, with sparing of function below the level of the injury. 5. Loss of bowel and bladder control.

1, 5. 1. Children with complete spinal cord injury lose motor and sensory function below the level of the injury as a result of interruption of nerve pathways. 2. Although spinal cord-injured children may suffer depression, it is not correct to state that all of them lose interest in normal activities. 3. Pain is absent below the level of the injury because of loss of sensory function. 4. When injury is in the lumbar region (L1- L5), the child loses control and sensationof the hips, thighs, and feet. This affects all motor activities such as walking and sitting, 5. The nerves to the perineal are affected when injuries occur to the lumbar region. The child develops a neurogenic bladder and bowel. TEST-TAKING HINT: A spinal cord injury causes loss of motor and sensory function below the level of the injury.

The nurse is caring for an infant newly diagnosed with Hirschsprung disease. What does the nurse understand about this infant's condition? Select all that apply. 1. There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention. 2. There is excessive peristalsis throughout the intestine, resulting in abdominal distention. 3. There is a small-bowel obstruction, leading to ribbon-like stools. 4. There is inflammation throughout the large intestine, leading to accumulation of intestinal contents and abdominal distention. 5. There is an accumulation of bowel contents, leading to non-passage of stools.

1, 5. 1. In Hirschsprung disease, a portion of the large intestine has an area lacking in ganglion cells. This results in a lack of peristalsis as well as an accumulation of bowel contents and abdominal distention. 2. There is a lack of peristalsis at the aganglionic section of the bowel. 3. Hirschsprung disease does not include a small-bowel obstruction. 4. Hirschsprung disease does not present with inflammation throughout the large intestine. 5.There is accumulation of stool above the aganglionic bowel, which does not allow stool to pass through. TEST-TAKING HINT: The test taker should be familiar with the pathophysiology of Hirschsprung disease in order to select answers 1 and 5.

The parents of a preschooler diagnosed with muscular dystrophy are asking questions about the course of their child's disease. Which should the nurse tell them? Select all that apply. 1. "Muscular dystrophies usually result in progressive weakness." 2. "The weakness that your child is having will probably not increase." 3. "Your child will be able to function normally and not need any special accommodations." 4. "The extent of weakness depends on doing daily physical therapy." 5. "Your child may have pain in his legs with muscle weakness."

1, 5. 1. Muscular dystrophies are progressive degenerative disorders. The most common is Duchenne muscular dystrophy, which is an X-linked recessive disorder. 2. The weakness is progressive. 3. The child will require assistance, and the need for it will increase with time and age. 4. Daily therapy may be helpful in decreasing contractures, although it will not deter the disease progression. 5. The child may have pain due to loss of strength and muscle wasting. TEST-TAKING HINT: The test taker should know that muscular dystrophy is a progressive degenerative disorder.

Which should the nurse do for a 7-year-old living in a rural area who is missing school shots and who has sustained a puncture wound? 1. Administer TdaP vaccine. 2. Start the child on an antibiotic. 3. Clean the wound with hydrogen peroxide. 4. Send the child to the emergency department.

1. A 7-year-old child who is not fully immunized and has a tetanus-prone wound should receive TdaP vaccine to prevent tetanus. Tetanus-prone wounds include puncture wounds and those contaminated with dirt, feces, or soil. 2. An antibiotic probably will be started, but administering TdaP vaccine is the priority. 3. Wounds are routinely cleansed with soap and water. Hydrogen peroxide does not clean better. 4. This child can be cared for in the clinic. TEST-TAKING HINT: The test taker must know about wound care and which wounds are considered contaminated.

The nurse is doing a follow-up assessment of a 9-month-old. The infant rolls both ways, sits with some support, pushes food out of the mouth, and pushes away when held. The parent asks about the infant's development. The nurse responds by saying which of the following? 1. "Your child is developing normally." 2. "Your child needs to see the primary care provider." 3. "You need to help your child learn to sit unassisted." 4. "Push the food back when your child pushes food out."

1. A 9-month-old should be able to sit alone, crawl, pull up, not push food out of the mouth (tongue thrust), and push away when held when wanting to get down. This child is not developing normally and must see the primary care provider. 2. A 9-month-old should be able to sit alone, crawl, pull up, not push food out of the mouth (tongue thrust), and push away when held when wanting to get down. The developmental screening the child received should be followed by a complete history, physical exam, and more specific developmental testing. 3. Children with developmental delay benefit from occupational, physical, and speech therapies. The therapist can teach the parent how to work with the child to help him learn to sit independently. 4. The occupational therapist can evaluate the child's ability to suck, swallow, and chew. The therapist can also teach the parent ways to assist the child to eat "normally." TEST-TAKING HINT: The test taker must know normal developmental milestones. Rolling occurs at about 4 months, sitting alone occurs at 6 months, and pushing food out of the mouth decreases by 4 months when the tongue thrust reflex wanes.

To treat a common manifestation of Reye syndrome, which medication would the nurse expect to have readily available? 1. Furosemide (Lasix). 2. Insulin. 3. Glucose. 4. Morphine.

1. A common manifestation is increased ICP, which is treated with an osmotic diuretic. Furosemide (Lasix) is a loop diuretic. 2. A common manifestation is hypoglycemia. Insulin does not treat hypoglycemia, but decreases the blood sugar instead. 3. A common manifestation is hypoglycemia, which is treated with the administration of intravenous glucose. 4. Morphine is a narcotic used for pain relief. It should be used with caution because it can lead to respiratory depression. TEST-TAKING HINT: The test taker needs to be aware that increased ICP is a very common manifestation of Reye syndrome and should therefore eliminate any answers that do not treat increased ICP. The test taker can also eliminate answers 2 and 4 because they do not treat hypoglycemia, which is another common manifestation of Reye syndrome.

A 2-month-old infant is brought to the emergency department after experiencing a seizure. The infant appears lethargic with very irregular respirations and periods of apnea. The parents report the baby is no longer interested in feeding and, before the seizure, rolled off the couch. What additional testing should the nurse immediately prepare for? 1. Computed tomography (CT) scan of the head and dilation of the eyes. 2. Computed tomography (CT) scan of the head and electroencephalogram (EEG). 3. X-rays of the head. 4. X-rays of all long bones.

1. A computed tomography (CT) scan of the head will reveal trauma. Dilating the eyes is performed to check for retinal hemorrhages that are seen in an infant who has experienced shaken baby syndrome (SBS). 2. An EEG is not usually done as a priority test in an infant displaying symptoms of SBS. 3. X-rays of the head will show fractures, but CT and pupil examinations are the priority for this child. 4. X-rays of all long bones may be performed to rule out any old or new fractures, but CT and pupil examinations are the priority for this child. TEST-TAKING HINT: The test taker should consider child abuse (SBS), because the story does not match the injury. The pupils are always dilated to rule out SBS.

Which position initially is most beneficial for an infant who has just returned from having a ventriculoperitoneal (VP) shunt placed? 1. Semi-Fowler in an infant seat. 2. Flat in the crib. 3. Trendelenburg. 4. In the crib with the head elevated to 90 degrees.

1. A semi-Fowler position in an infant seat may allow the ventricles to drain too rapidly in the immediate postoperative period. 2. Flat in the crib is the position usually used initially, with the angle gradually increasing as the child tolerates. 3. The Trendelenburg position is not used immediately after ventriculoperitoneal shunt placement because it would increase ICP. 4. The head elevated to 90 degrees will allow the ventricle of the brain to drain too quickly. TEST-TAKING HINT: The test taker should note the word "initially" and consider why the position would be immediately beneficial. Answer 3 can be eliminated because that position could increase ICP.

The nurse is caring for a child with a skull fracture who is unconscious and has severely increased intracranial pressure (ICP). The nurse notes the child's temperature to be 104°F (40°C). Which should the nurse do first? 1. Place a cooling blanket on the child. 2. Administer acetaminophen (Tylenol) via nasogastric tube. 3. Administer acetaminophen (Tylenol) rectally. 4. Place ice packs in the child's axillary areas.

1. A cooling blanket will help cool the child quickly and at a controlled temperature. 2. Acetaminophen (Tylenol) should be administered after the cooling blanket has been applied. Tylenol is an effective medication, but a cooling blanket will begin to be effective before the medication is absorbed. 3. Acetaminophen (Tylenol) should be administered after the cooling blanket has been applied. Tylenol is an effective medication, but a cooling blanket will begin to be effective before the medication is absorbed. 4. Ice packs will cause the child to shiver, which will increase oxygen consumption and possibly increase ICP. Shivering can also cause the child to experience a rebound increase in temperature. TEST-TAKING HINT: The test taker should consider the cause of the increased temperature and how to cool the child quickly. Answer 4 should be eliminated because ice packs are no longer recommended to treat increased temperatures.

Which foods should be offered to a child with hepatitis? 1. A tuna sandwich on whole wheat bread and a cup of skim milk. 2. Clear liquids, such as broth, and Jell-O. 3. A hamburger, French fries, and a diet soda. 4. A peanut butter sandwich and a milkshake.

1. A diet that is high in protein and carbohydrates helps maintain caloric intake and protein stores while preventing muscle wasting. A low-fat diet prevents abdominal distention. 2. The child should be encouraged to consume a diet higher in protein. 3. The child should be encouraged to consume a low-fat diet. 4. The child should be encouraged to consume a low-fat diet. TEST-TAKING HINT: The child with hepatitis is usually placed on a diet that is high in both protein and carbohydrates but low in fat.

The nurse anticipates that the child who has had a kidney removed will have a high level of pain and will require invasive and noninvasive measures for pain relief. The nurse anticipates that the child will have pain because of which of the following? 1. The kidney is removed laparoscopically, and there will be residual pain from accumulated air in the abdomen. 2. There is a postoperative shift of fluids and organs in the abdominal cavity, leading to increased discomfort. 3. The chemotherapy makes the child more sensitive to pain. 4. The radiation therapy makes the child less sensitive to pain.

1. A large incision is used because the kidney is not removed laparoscopically at this time. 2. There is a postoperative shift of fluids and organs in the abdominal cavity, leading to increased discomfort. 3. The increased pain is due to shifting of fluid and organs. 4. The increased pain is due to shifting of fluid and organs. TEST-TAKING HINT: The test taker should eliminate answer 1 because the kidney is not removed laparoscopically.

The nurse is developing a plan of care for a child recently diagnosed with cerebral palsy (CP). Which should be the nurse's priority goal? 1. Ensure the ingestion of sufficient calories for growth. 2. Decrease intracranial pressure. 3. Teach appropriate parenting strategies for a special-needs child. 4. Ensure that the child reaches full potential.

1. Adequate calories are an appropriate goal, but the priority for a special-needs child is that the child develop to full potential. 2. Children with CP do not have increased intracranial pressure. 3. Teaching appropriate parenting strategies for a special-needs child is important and is done so that the child can maximize her personal skills and minimize her limitation. 4. A child with CP needs a health-care team that can aid the family in helping them grow and develop to their full potential. The priority for all children is to develop to their full potential. TEST-TAKING HINT: All of these are important goals, but determining the priority goal for a special-needs child is the key.

A child is being admitted with the diagnosis of meningitis. Select the procedure the nurse should do first: 1. Administration of intravenous antibiotics. 2. Administration of maintenance intravenous fluids. 3. Placement of a Foley catheter. 4. Send the spinal fluid and blood samples to the laboratory for cultures.

1. Administration of intravenous antibiotics should not be started until after all cultures have been obtained. 2. Administration of maintenance IV fluids can wait until after the cultures have been obtained. 3. Placement of a Foley catheter is not a priority procedure. 4. Cultures of spinal fluid and blood should be obtained, followed by administration of intravenous antibiotics. TEST-TAKING HINT: The test taker needs to think about priority of care. Answer 3 can be immediately eliminated because it is not a priority. Answer 4 should be considered a priority because antibiotics should not be started before the samples have been obtained and sent for culturing.

The clinical manifestations of minimal change nephrotic syndrome (MCNS) are due to which of the following? 1. Chemical changes in the composition of albumin. 2. Increased permeability of the glomeruli. 3. Obstruction of the capillaries of the glomeruli. 4. Loss of the kidneys' ability to excrete waste and concentrate urine.

1. Albumin does not undergo any chemical changes in MCNS. 2. Increased permeability of the glomeruli in MCNS allows large substances such as protein to pass through and be excreted in the urine. 3. Obstruction of the capillaries of the glomeruli due to the formation of antibody-antigen complexes occurs in glomerulonephritis. 4. Loss of the kidneys' ability to excrete waste and concentrate urine occurs in renal failure. TEST-TAKING HINT: The test taker should recognize the pathophysiology of MCNS.

After surviving a motor vehicle accident but enduring a spinal cord injury, an adolescent is unable to walk but can use his arms, has no bowel or bladder control, and has no sensation below the nipple line. Identify the vertebral/spinal cord area most likely injured. 1. Cervical, C1-C5. 2. Cervical, C5-C7. 3. Thoracic, T1-T4. 4. Thoracic, T5-T12. 5. Lumbar, L2-L5. 6. Sacral, S1-S5.

1. C1-C5 is too high, because the patient has the use of the arms and sensation to the nipple line. 2. C5-C7 is too high, because the patient still has the use of the arms. 3. Damage at T1-T4 manifests at or just below the nipple line. Every area below would be affected. 4. Sensation ends at the nipple line, so T5-T12 is too low. 5. L2-L5 is too low, because the patient has sensation only to the nipple line. 6. S1-S5 is too low. TEST-TAKING HINT: Deficits occur at and below the level of injury.

The parent of a 7-year-old voices concern over the child's continued bed-wetting at night. The parent, on going to bed, has tried getting the child up at 11:30 p.m., but the child still wakes up wet. Which is the nurse's best response about what the parent should do next? 1. "There is a medication called DDAVP that decreases the volume of the urine. The physician thinks that will work for your child." 2. "When your child wakes up wet, be very firm and indicate how displeased you are. Have your child change the sheets to see how much work is involved." 3. "Limit fluids in the evening and start a reward system in which your child can choose a reward after a certain number of dry nights." 4. "Bed-wetting alarms are readily available, and most children do very well with them."

1. Although DDAVP is used for enuresis, it is not the first treatment chosen. Behavior modification and positive reinforcement are usually tried first. 2. Having the child help with changing the bed is a good idea. The child should be approached in a positive manner, however, not a punitive one, so as not to threaten self-esteem. 3. Limiting the child's fluids in the evening will help decrease the nocturnal urge to void. Providing positive reinforcement and allowing the child to choose a reward will increase the child's sense of control. 4. Enuresis alarms are readily available, but behavior modification and positive reinforcement are usually tried first. TEST-TAKING HINT: The test taker can eliminate answer 2 because negative reinforcement is not recommended and is not helpful.

The parent of a child with neuroblastoma asks the nurse what the typical signs and symptoms are at first. Select the nurse's best answer. 1. "Most children complain of abdominal fullness and difficulty urinating." 2. "Many children in the early stages of a neuroblastoma have joint pain and walk with a limp." 3. "The signs and symptoms vary depending on where the tumor is located, but typical symptoms include weight loss, abdominal distention, and fatigue." 4. "The signs and symptoms are fairly consistent regardless of the location of the tumor. They include fatigue, hunger, weight gain, and abdominal fullness."

1. Although abdominal fullness is often seen, difficulty urinating is not a common symptom. 2. Bone manifestations are a sign of bone metastasis, which is not seen in the early stages of neuroblastoma. 3. The signs and symptoms vary depending on where the tumor is located, but typical symptoms include weight loss, abdominal distention, and fatigue. 4. The signs and symptoms vary according to the location of the tumor. Generally, hunger and weight gain are not seen. TEST-TAKING HINT: The test taker should eliminate answer 2 because bone metastases are a late sign, and the test taker is looking for initial signs.

A child had a tonsillectomy 6 days ago and was seen in the emergency room 4 hours ago because of postoperative hemorrhage. The parent noted that her child was "swallowing a lot and finally began vomiting large amounts of blood." The child's vital signs are as follows: T 99.5°F (37.5°C), HR 124, BP 84/48, and RR 26. The nurse knows that this child is at risk for which type of renal problem? 1. CKD due to advanced disease process. 2. Prerenal failure due to dehydration. 3. Primary kidney damage due to a lack of urine flowing through the system. 4. Postrenal failure due to a hypotensive state.

1. CKD occurs gradually. 2. Examples of causes of prerenal failure include dehydration and hemorrhage. 3. Primary kidney failure occurs when the kidney experiences a direct injury. Examples include HUS and glomerulonephritis. 4. Postrenal failure occurs when there is an obstruction to urinary flow. Hypotension does not cause postrenal failure. TEST-TAKING HINT: The test taker should eliminate answer 1 because there is no evidence of a chronic disease process.

The nurse is caring for a 1-year-old who has just been diagnosed with viral encephalitis. The parents ask if their child will be admitted to the hospital. Select the nurse's best response. 1. "Your child will likely be sent home because encephalitis is usually caused by a virus and not bacteria." 2. "Your child will likely be admitted to the pediatric floor for intravenous antibiotics and observation." 3. "Your child will likely be admitted to the PICU for close monitoring and observation." 4. "Your child will likely be sent home because she is only 1 year old. We see fewer complications and a shorter disease process in the younger child."

1. Although encephalitis is usually caused by a viral infection, the child is usually admitted for close observation. 2. Intravenous antibiotics are not given to the child with viral encephalitis. 3. The young child with encephalitis should be admitted to a PICU where close observation and monitoring are available. The child should be observed for signs of increased ICP and for cardiac and respiratory compromise. 4. The child would not be discharged because observation for complications is necessary. As a general rule, younger children tend to have more complications and require a PICU admission. TEST-TAKING HINT: The test taker should be familiar with the diagnosis and treatment of encephalitis. The test taker should not be influenced by the word "viral" but should realize that the sequelae of encephalitis require close monitoring in an ICU environment.

The nurse is caring for an infant with a myelomeningocele. The parents ask the nurse why the nurse keeps measuring the baby's head circumference. Select the nurse's best response: 1. "Babies' heads are measured to ensure growth is on track." 2. "Babies with a myelomeningocele are at risk for hydrocephalus, which shows up as an increase in head size." 3. "Because your baby has an opening on the spinal cord, your infant is at risk for meningitis, which can show up as an increase in head size." 4. "Many infants with myelomeningocele have microcephaly, which can show up as a decrease in head size."

1. Although it is important to measure the head circumference of all babies, children with myelomeningocele are at increased risk for hydrocephalus, which can be manifested with an increase in head circumference. 2. Children with myelomeningocele are at increased risk for hydrocephalus, which can be manifested with an increase in head circumference. 3. Although a defect in the spine can be a portal of entry for infection, children with myelomeningocele often have hydrocephalus as well. 4. Children with myelomeningocele are not at risk for microcephaly. TEST-TAKING HINT: The test taker should consider the diagnosis and choose a response that best fits the current diagnosis.

A child recently diagnosed with epilepsy is being evaluated for anticonvulsant medication therapy. The child will likely be placed on which type of regimen? 1. Two to three oral anticonvulsant medications so that dosing can be low and side effects minimized. 2. One oral anticonvulsant medication to observe effectiveness and minimize side effects. 3. One rectal gel to be administered in the event of a seizure. 4. A combination of oral and intravenous anticonvulsant medications to ensure compliance.

1. Although many children with epilepsy require more than one medication to achieve seizure control, it is recommended that only one medication be started at a time so that the child's reaction to the specific medication can be observed. 2. One medication is the preferred way to achieve seizure control. The child is monitored for side effects and drug levels. 3. Rectal gels are used to stop a seizure once it has begun; they are not used to prevent seizures. 4. The route of choice for the prevention of seizures is oral. There is no reason to assume that compliance will be an issue prior to beginning anticonvulsant therapy. TEST-TAKING HINT: The test taker should eliminate answer 4 because IV medications are not included in the initial home medication regimen.

The nurse is caring for an adolescent who remains unconscious 24 hours after sustaining a closed-head injury in a motor vehicle accident (MVA). She responds to deep, painful stimulation with decorticate posturing and has an intracranial monitor that shows periodic increased ICP. All other vital signs remain stable. Select the most appropriate nursing action. 1. Encourage the teen's peers to visit and talk to her about school and other pertinent events. 2. Encourage the teen's parents to hold her hand and speak loudly to her in an attempt to help her regain consciousness. 3. Attempt to keep a normal day/night pattern by keeping the teen in a bright, lively environment during the day and dark quiet environment at night. 4. Attempt to keep the environment dark and quiet and encourage minimal stimulation.

1. Although peers play an important role in the adolescent's development, this particular patient is at risk for increased ICP and should have decreased stimulation. 2. Loud talking may cause the child's ICP to increase. 3. A bright, lively environment may lead to increased ICP. 4. A dark, quiet environment and minimal stimulation will decrease oxygen consumption and ICP. TEST-TAKING HINT: The test taker should consider the causes of ICP and select answers that will not increase ICP. Answers 1, 2, and 3 cause an increase in ICP and should be eliminated.

The nurse is caring for a 1-year-old diagnosed with AKI. Edema is noted throughout the child's body, and the liver is enlarged. The child's urine output is less than 0.5 mL/kg/hr, and vital signs are as follows: HR 146, BP 176/92, and RR 42. The child is noted to have nasal flaring and retractions with inspiration. The lung sounds are coarse throughout. Despite receiving oral sodium polystyrene sulfonate (Kayexalate), the child's serum potassium continues to rise. Which treatment will provide the most benefit to the child? 1. Additional rectal sodium polystyrene sulfonate (Kayexalate). 2. Intravenous furosemide (Lasix). 3. Endotracheal intubation and ventilatory assistance. 4. Placement of a Tenckhoff catheter for peritoneal dialysis.

1. Although the child will likely receive additional sodium polystyrene sulfonate (Kayexalate), the child's condition will likely not improve without dialysis. 2. Although the child will likely receive intravenous furosemide (Lasix), the child's condition will likely not improve without dialysis. 3. Endotracheal intubation and ventilatory assistance may be required, but ultimately the child will need dialysis. 4. Placement of a Tenckhoff catheter for peritoneal dialysis is needed when the child's condition deteriorates despite medical treatment. TEST-TAKING HINT: The test taker should be led to answer 4 because dialysis is the treatment required to reverse the existing clinical manifestations.

A 6-month-old infant was just diagnosed with craniosynostosis. The infant's father asks the nurse for more information about reconstructive surgery. Select the nurse's best response. 1. "The surgery is done for cosmetic reasons and is without many complications." 2. "The surgery is important to allow the brain to grow properly. Although most children do well, serious complications can occur, so your child will be closely observed in the intensive care unit." 3. "The surgery is important to allow the brain to grow properly. Most surgeons wait until the child is 18 months old to minimize potential complications." 4. "The surgery is mainly done for cosmetic reasons, and most surgeons wait until the child is 3 years old because the head has finished growing at that time."

1. Although there is a cosmetic benefit, the surgery is done to reconstruct the skull to allow the brain to grow properly. There are potential complications associated with this surgery, such as increased ICP. 2. The surgery is done to reconstruct the skull to allow the brain to grow properly. Because there are potential complications associated with this surgery, such as increased ICP, the child is usually closely observed in the PICU. 3. The surgery is not usually postponed but instead done in early infancy. 4. The surgery is not usually postponed because it will allow for brain growth. TEST-TAKING HINT: The test taker should consider the importance of allowing room for brain growth. Answers 3 and 4 can be eliminated because the surgery is performed in early infancy.

The nurse is administering omeprazole (Prilosec) to a 3-month-old with gastroesophageal reflux (GER). The child's parents ask the nurse how the medication works. Which is the nurse's best response? 1. "Prilosec is a proton pump inhibitor that is commonly used for reflux in infants." 2. "Prilosec decreases stomach acid, so it will not be as irritating when your child spits up." 3. "Prilosec helps food move through the stomach quicker, so there will be less chance for reflux." 4. "Prilosec relaxes the pressure of the lower esophageal sphincter."

1. Although this is an accurate description of the mechanism of action, it does not tell the parents how the medication functions. 2. This accurate description gives the parents information that is clear and concise. 3. Omeprazole (Prilosec) does not increase the rate of gastric emptying. 4. Omeprazole (Prilosec) does not relax the pressure of the lower esophageal sphincter. TEST-TAKING HINT: The test taker should eliminate answers 1 and 4 because they do not communicate information in a manner that will be clear to many parents.

A newborn with a repaired myelomeningocele is assessed for hydrocephalus. Which would the nurse expect in an infant with hydrocephalus? 1. Low-pitched cry and depressed fontanel. 2. Low-pitched cry and bulging fontanel. 3. Bulging fontanel and downwardly rotated eyes. 4. Depressed fontanel and upwardly rotated eyes.

1. An alteration in the circulation of the cerebrospinal fluid causes hydrocephalus. The anterior fontanel bulges because of an increase in CSF, and an increase in intracranial pressure causes a high-pitched cry in infants and downward deviation of the eyes, also called sunset eyes. 2. An alteration in the circulation of the cerebrospinal fluid causes hydrocephalus. The anterior fontanel bulges because of an increase in cerebrospinal fluid, and an increase in intracranial pressure causes a high-pitched cry in infants and downward deviation of the eyes, also called sunset eyes. 3. An alteration in the circulation of the cerebrospinal fluid causes hydrocephalus. The anterior fontanel bulges because of an increase in cerebrospinal fluid, and an increase in intracranial pressure causes a high-pitched cry in infants and downward deviation of the eyes, also called sunset eyes. With sunset eyes, the sclera can be seen above the iris. 4. An alteration in the circulation of the cerebrospinal fluid causes hydrocephalus. The anterior fontanel bulges because of an increase in cerebrospinal fluid, and an increase in intracranial pressure causes a high-pitched cry in infants and downward deviation of the eyes, also called sunset eyes. TEST-TAKING HINT: The test taker must know the difference in clinical signs of hydrocephalus in infants and older children. Infants' heads expand, whereas older children's skulls are fixed. The anterior fontanel closes between 12 and 18 months.

A preschooler has been having periods during which he suddenly falls and appears to be weak for a short time after the event. The preschool teacher asks what she should do. Select the nurse's best response. 1. "Have the parents follow up with his health-care provider because this is likely an atonic seizure." 2. "Find out if there have been any new stressors in his life because it could be attention-seeking behavior." 3. "Have the parents follow up with his health-care provider because this is likely an absence seizure." 4. "The preschool years are a time of rapid growth, and many children appear clumsy. It would be best to watch him and see if it continues."

1. An atonic seizure is characterized by a loss of muscular tone, whereby the child may fall to the ground. 2. It is important to evaluate the child for life stressors, but suspected seizure activity needs immediate evaluation. 3. An absence seizure is characterized by a change in activity whereby the child appears to be daydreaming or staring straight ahead. The child usually continues basic simple movements but loses an awareness of surroundings. 4. The preschool years are a not a time of rapid growth. Many children in this age-group appear clumsy, but suspected seizure activity needs immediate evaluation. TEST-TAKING HINT: The test taker should recognize the description as seizure activity and, therefore, could immediately eliminate answers 3 and 4.

The nurse knows that young infants are at risk for injury from shaken baby syndrome (SBS) because: 1. The anterior fontanel is open. 2. They have insufficient musculoskeletal support and a disproportionate head-to-body ratio. 3. They have an immature vascular system with veins and arteries that are more superficial. 4. There is immature myelination of the nervous system in a young infant.

1. An open anterior fontanel allows for swelling, therefore decreasing the risk of injury. 2. Insufficient musculoskeletal support and a disproportionate head size place the infant at risk because the head cannot be supported during a shaking episode. 3. Superficial veins and arteries do not place the infant at a higher risk for injury. 4. Although the myelination is immature, the immature musculoskeletal support places the infant at risk. TEST-TAKING HINT: Answer 3 should be eliminated because superficial vessels do not lead to SBS.

The mother of a newborn relates that this is her first child; the baby seems to sleep a lot and does not cry much. Which question would the nurse ask the mother? 1. "How many ounces of formula does your baby take at each feeding?" 2. "How many bowel movements does your baby have in a day?" 3. "How much sleep do you get every night?" 4. "How long does the baby stay awake at each feeding?"

1. Babies can lose up to 10% of birth weight but should regain it by 2 weeks of age. Knowing how much the baby eats can help the nurse determine whether the infant is receiving adequate nutrition. 2. The number of bowel movements will also indicate whether the infant receives enough formula. 3. If the infant does not awaken during the night, then the mother may sleep all night. Most 2-week-olds feed every 2 to 4 hours day and night. 4. How long the infant stays awake is not the most important information. Most infants sleep about 20 hours per day. TEST-TAKING HINT: The "red flags" in this question are that the baby sleeps a lot and does not cry much, both unusual behaviors. Follow-up questions need to be asked to determine whether the infant is gaining weight as expected.

The nurse prepares baclofen for a child with cerebral palsy (CP) who just had her hamstrings surgically released. The child's parents ask what the medication is for. Select the nurse's best response. 1. "It is a medication that will help decrease the pain from her surgery." 2. "It is a medication that will prevent her from having seizures." 3. "It is a medication that will help control her spasms." 4. "It is a medication that will help with bladder control."

1. Baclofen is not given for postoperative pain control. 2. Baclofen is not given for seizures. 3. Baclofen is given to help control the spasms associated with CP. 4. Baclofen is not given for bladder control. TEST-TAKING HINT: The test taker needs to be familiar with the medication baclofen.

A child with cerebral palsy (CP) has been fitted for braces and is beginning physical therapy to assist with ambulation. The parents ask why he needs the braces when he was crawling without any assistive devices. Select the nurse's best response. 1. "The CP has progressed, and he now needs more assistance to ambulate." 2. "As your child grows, different muscle groups may need more assistance." 3. "Most children with CP need braces to help with ambulation." 4. "We have found that when children with CP use braces, they are less likely to fall."

1. CP is a nonprogressive disorder. 2. CP can manifest in different ways as the child grows. It does not progress, but its clinical manifestations may change. 3. Children with CP have different abilities and needs. CP can result in mild to severe motor deficits; therefore, one treatment regimen cannot be used or recommended for all children. 4. Although braces may assist some children with ambulation, they will not be useful in all cases. TEST-TAKING HINT: The test taker can eliminate answers 3 and 4 because generalizations cannot be made regarding CP. Each child has different abilities and disabilities.

Which is the nurse's best response to the parents of a neonate with a meningocele who ask what can they expect? 1. "After initial surgery to close the defect, most children experience no neurological dysfunction." 2. "Surgery to close the sac will be postponed until the infant has grown and has enough skin to form a graft." 3. "After the initial surgery to close the defect, the child will likely have motor and sensory deficits." 4. "After the initial surgery to close the defect, the child will likely have future problems with urinary and bowel continence."

1. Because a meningocele does not contain any nerve endings, most children experience no neurological problems after surgical correction. 2. Corrective surgery is done as soon as possible to minimize the risk of infection. 3. Because a meningocele does not contain any nerve endings, most children experience no neurological problems after surgical correction. 4. Because a meningocele does not contain any nerve endings, most children experience no neurological problems after surgical correction. TEST-TAKING HINT: The test taker should consider the risks of infection and immediately eliminate answer 2 because the surgery is not postponed but performed as soon as possible.

The nurse is caring for an infant with myelomeningocele who is going to surgery later today for closure of the sac. Which would be a priority nursing diagnosis before surgery? 1. Alteration in parent-infant bonding. 2. Altered growth and development. 3. Risk of infection. 4. Risk for weight loss.

1. Because of the infant's prolonged hospitalization, there can be alterations in parental bonding. Because the myelomeningocele is unrepaired, the major risk is infection. 2. Altered growth and development may occur, but in the preoperative period, risk of infection is the priority. The long-term diagnosis of altered growth and development will be addressed at each well-child visit. 3. The unrepaired myelomeningocele is oftentimes a thin membrane that covers the neural contents of the spine. A normal saline dressing is placed over the sac to prevent tearing. The tearing would allow the CSF to escape and microorganisms to enter. The infant is at high risk for spinal cord infections. The priority nursing diagnosis is risk of infection. 4. It is normal in the first 2 weeks of life to lose up to 10% of birth weight. In fact, this infant may lose more weight because of surgery, but the priority is risk of infection. TEST-TAKING HINT: The preoperative priority is risk of infection, especially when effort is necessary to keep a sterile saline dressing on the sac.

Which should the nurse tell the parent of an infant with spina bifida? 1. "Bone growth will be more than that of babies who are not sick because your baby will be less active." 2. "Physical and occupational therapy will be helpful to stimulate the senses and improve cognitive skills." 3. "Nutritional needs for your infant will be calculated based on activity level." 4. "Fine motor skills will be delayed because of the disability."

1. Bone growth is related to weight-bearing as well as to secretion of the growth hormone. Decreased activity usually results in less bone growth. 2. Children with decreased activity due to illness or trauma are helped by physical and occupational therapy. The varied activities stimulate the senses. 3. This is partially true. Nutritional needs in children are also calculated based on growth needs. 4. Many children with myelomeningocele have low-level defects, usually in the lumbar area, which do not affect upper body fine motor skills. TEST-TAKING HINT: The test taker should know normal growth and development patterns.

The parents of a 7-year-old tell the nurse they do not understand the difference between CKD and AKI. Which is the nurse's best response? 1. "There really is not much difference because the terms are used interchangeably." 2. "Most children experience AKI. It is highly unusual for a child to experience CKD." 3. "CKD tends to occur suddenly and is irreversible." 4. "AKI is often reversible, whereas CKD results in permanent deterioration of kidney function."

1. Both disease processes are characterized by the kidney's inability to excrete waste. CKD occurs gradually and is irreversible, whereas AKI occurs suddenly and may be reversible. 2. Children can experience CKD and AKI. 3. CKD is irreversible, and it tends to occur gradually. 4. AKI is often reversible, whereas CKD results in permanent deterioration of kidney function. TEST-TAKING HINT: The test taker should eliminate answer 1 because the terms "acute" and "chronic" are not used interchangeably.

The nurse is caring for a 6-month-old infant diagnosed with meningitis. When the child is placed in the supine position and flexes his neck, the nurse notes he flexes his knees and hips. This is referred to as: 1. Brudzinski sign. 2. Cushing triad. 3. Kernig sign. 4. Nuchal rigidity.

1. Brudzinski sign occurs when the child responds to a flexed neck with an involuntary flexion of the hips and/or knees. 2. Cushing triad is a sign of increased ICP and is manifested with an increase in systolic blood pressure, decreased heart rate, and irregular respirations. 3. Kernig sign occurs when there is resistance or pain in response to raising the child's flexed leg. 4. Nuchal rigidity occurs when there is a resistance to neck flexion. TEST-TAKING HINT: The test taker should be familiar with terms used to describe meningeal irritation.

The parent of a toddler newly diagnosed with CP asks the nurse what caused it. The nurse should answer with which of the following? 1. Most cases are caused by unknown prenatal factors. 2. It is commonly caused by perinatal factors. 3. The exact cause is not known. 4. The exact cause is known in every instance.

1. CP is defined as a non-progressive (static) injury to an infant either before birth, during birth, or after birth. Depending on the presenting symptoms and the results of diagnostic testing, the etiology of the brain injury can be fairly accurately determined. 2. It is generally thought that the majority of infants with CP had an insult in utero. Some of the causes of perinatal insult include hypoxia, trauma, infections, or genetic abnormalities. 3. With current diagnostic testing for genetic abnormalities and MRIs, the etiology of the brain insult can be more often determined. 4. Frequently, the exact cause can be determined by history and physical and diagnostic studies. TEST-TAKING HINT: The test taker must know the latest information to answer this question correctly.

The parents of a child with meningitis and multiple seizures ask if the child will likely develop cerebral palsy (CP). Select the nurse's best response. 1. "When your child is stable, she'll undergo computed tomography (CT) and magnetic resolution imaging (MRI). The physicians will be able to let you know if she has CP." 2. "Most children do not develop CP at this late age." 3. "Your child will be closely monitored after discharge, and a developmental specialist will be able to make the diagnosis." 4. "Most children who have had complications following meningitis develop some amount of CP."

1. CP is diagnosed based on clinical characteristics and developmental findings. It is not diagnosed with any type of radiological examination. 2. Although most cases of CP occur in the neonatal period, some children can develop CP at a later age. 3. The child will be given a chance to recover and will be monitored closely before a diagnosis is made. 4. Although many children develop CP after having complications of meningitis, many do not. Although the parents should not be given false hope, they should not be led to lose hope for a complete recovery. TEST-TAKING HINT: The test taker should be led to answer 3 because it explains the process and does not state that the child definitely will or will not develop CP.

The nurse evaluates teaching of parents of a child newly diagnosed with CP as successful when the parents state that CP is which of the following? 1. Inability to speak and uncontrolled drooling. 2. Involuntary movements of lower extremities only. 3. Involuntary movements of upper extremities only. 4. An increase in muscle tone and deep tendon reflexes.

1. Children may also have pseudobulbar involvement, which creates swallowing difficulties and recurrent aspiration. 2. Involuntary movements of the lower extremities would be classified as spastic diplegia. These children do have some upper motor neuron involvement but not to the same degree as the lower motor involvement. 3. Depending on the type of CP, the abnormal involuntary movements of the upper extremities indicate a more diffuse injury to the entire brain. 4. The primary disorder is of muscle tone, but there may be other neurological disorders such as seizures, vision disturbances, and impaired intelligence. Spastic CP is the most common type and is characterized by a generalized increase in muscle tone, increased deep tendon reflexes, and rigidity of the limbs on both flexion and extension. TEST-TAKING HINT: The test taker must know the definition of CP.

The nurse is providing discharge teaching to the parents of a toddler who experienced a febrile seizure. The nurse knows clarification is needed when the mother says: 1. "My child will likely have another seizure." 2. "My child's 7-year-old brother is also at high risk for a febrile seizure." 3. "I'll give my child acetaminophen (Tylenol) when ill to prevent the fever from rising too high too rapidly." 4. "Most children with febrile seizures do not require seizure medicine."

1. Children who experience a febrile seizure are likely to experience another febrile seizure. 2. Most children over the age of 5 years do not have febrile seizures. 3. Antipyretics are administered to prevent the child's temperature from rising too rapidly. 4. Most children are not prescribed anticonvulsant medication after experiencing a febrile seizure. TEST-TAKING HINT: There is an increased risk in siblings, but the 7-year-old child is above the usual age of febrile seizures.

The parent of an infant asks the nurse what to watch for to determine whether the infant has CP. Which is the nurse's best response? 1. "If the infant cannot sit up without support before 8 months." 2. "If the infant demonstrates tongue thrust before 4 months." 3. "If the infant has poor head control after 2 months." 4. "If the infant has clenched fists after 3 months."

1. Children with CP frequently have developmental delays, including not being able to sit alone by 8 months. Sitting alone usually occurs by 6 months, so 8 months would be the outer limit of normal development and cause for concern. 2. Tongue thrust is common in infants younger than 6 months, but if it goes on after 6 months it is of concern. 3. Good head control is normally attained by 3 months. 4. Clenched fists after 3 months of age may be a sign of upper motor injury and CP. TEST-TAKING HINT: The test taker must know normal developmental milestones to identify those that are abnormal.

The parent of an infant with CP asks the nurse if the infant will be mentally retarded. Which is the nurse's best response? 1. "Children with CP have some amount of mental retardation." 2. "Approximately 20% of children with CP have normal intelligence." 3. "Many children with CP have normal intelligence." 4. "Mental retardation is expected if motor and sensory deficits are severe."

1. Children with CP have a range of intellectual abilities, from being profoundly retarded to having a high intelligence quotient. Many have normal intelligence. If a child has severe speech problems, some may assume that the child's intelligence is severely affected when that may not be true. 2. Children with CP have a range of intellectual abilities, from being profoundly retarded to having a high intelligence quotient. Many have normal intelligence. If a child has severe speech problems, some may assume that the child's intelligence is severely affected when that may not be true. 3. Many children with CP have normal intelligence. 4. Children with CP have a range of intellectual abilities, from being profoundly retarded to having a high intelligence quotient. Many have normal intelligence. If a child has severe speech problems, some may assume that the child's intelligence is severely affected when that may not be true. TEST-TAKING HINT: Children with CP have a wide range of intellectual abilities.

A child with GBS has had lots of oral fluids but has not urinated for 8 hours. Which is the nurse's first action? 1. Check the child's serum blood urea nitrogen level. 2. Check the child's complete blood count. 3. Catheterize the child in and out. 4. Run water in the bathroom to stimulate urination.

1. Children with GBS frequently have urinary retention, so catheterization is necessary. Complications of GBS are usually respiratory and swallowing difficulties. Checking the serum blood urea nitrogen can be done but would take too long. Eight hours is quite a lengthy time for the child not to have voided. 2. The complete blood count does not provide helpful information about urinary retention. 3. The child must be in-and-out catheterized to avoid the possibility of developing a urinary tract infection from urine left in the bladder for too long. 4. Running water in the bathroom is a strategy used frequently to encourage patients to void. It takes time for it to work, however, and sometimes it does not have the intended results. TEST-TAKING HINT: Urinary retention occurs with GBS, and catheterization is necessary in a child who has had lots of fluids but not voided in 8 hours.

Which does the nurse include in the postoperative plan of care for a child with myelomeningocele following ligament release? 1. Encourage the child to resume a regular diet, beginning slowly with bland foods that are easily digested, such as bananas. 2. Encourage the child to blow balloons to increase deep breathing and avoid postoperative pneumonia. 3. Assist the child to change positions to avoid skin breakdown. 4. Provide education on dietary requirements to prevent obesity and skin breakdown.

1. Children with myelomeningocele are prone to latex allergies and therefore should not eat bananas. 2. Children with myelomeningocele are prone to latex allergies and therefore should not be exposed to balloons. 3. Preventing skin breakdown is important in the child with myelomeningocele because pressure points are not felt easily. 4. It is always important to provide education on dietary needs, but it is not the priority in the immediate postoperative period. TEST-TAKING HINT: The test taker should consider that children with myelomeningocele are prone to latex allergies and therefore should eliminate answers 1 and 2.

Which should the nurse prepare the parents of an infant for following surgical repair and closure of a myelomeningocele shortly after birth? The infant will: 1. Not need any long-term management and should be considered cured. 2. Not be at risk for urinary tract infections or movement problems. 3. Have continual drainage of cerebrospinal fluid, needing frequent dressing changes. 4. Need lifelong management of urinary, orthopedic, and neurological problems.

1. Children with myelomeningocele have ongoing, lifelong, complex health-care needs. 2. Children with myelomeningocele may have frequent urinary tract infections and mobility concerns. 3. The surgical closure prevents the leakage of cerebrospinal fluid; dressing changes are necessary only during the postoperative period. 4. Although immediate surgical repair decreases infection, morbidity, and mortality rates, these children will require lifelong management of neurological, orthopedic, and elimination problems. TEST-TAKING HINT: The test taker can eliminate answer 1 owing to the complexity of myelomeningocele.

Which developmental milestone should the nurse be concerned about if a 10-month-old cannot do it? 1. Crawl. 2. Cruise. 3. Walk. 4. Have a pincer grasp.

1. Most infants are able to crawl unassisted by 8 months. 2. Infants learn to cruise (walk around holding on to furniture) at about 9 to 10 months. 3. Walking occurs on average at about 12 months. 4. Pincer grasp (thumb and forefinger) occurs at about 9 to 10 months. TEST-TAKING HINT: The test taker must know developmental milestones.

The nurse is caring for a 12-year-old receiving peritoneal dialysis. The nurse notes the return to be cloudy, and the child is complaining of abdominal pain. The child's parents ask what the next step will likely be. Which is the nurse's best response? 1. "We will probably place antibiotics in the dialysis fluid before the next dwell time." 2. "Many children experience cloudy returns. We do not usually worry about it." 3. "We will probably give your child some oral antibiotics just to make sure nothing else develops." 4 "The abdominal pain is likely due to the fluid going in too slowly. We will increase the rate of administration with the next fill."

1. Cloudy returns and abdominal pain are signs of peritonitis and are usually treated with the administration of antibiotics in the dialysis fluid. 2. Cloudy returns and abdominal pain are signs of peritonitis and need to be treated. 3. Cloudy returns and abdominal pain are signs of peritonitis and are usually treated with the administration of antibiotics in the dialysis fluid. 4. Cloudy returns and abdominal pain are signs of peritonitis. In addition to peritonitis, abdominal pain can be caused by the rapid infusion of dialysis fluid. TEST-TAKING HINT: The test taker can eliminate answer 4 because pain would be increased if the rate of administration were increased.

Which is the best advice to offer the parent of a 6-month-old with Werdnig- Hoffman disease on how to treat the infant's constipation? 1. Offer extra water every day. 2. Add corn syrup to two bottles a day. 3. Give the infant a glycerine suppository today. 4. Let the infant go 3 days without a stool before intervening.

1. Constipation means hard stools and infrequent passage. Adding extra water to the diet helps make the stool softer in a child of this age. 2. It is not recommended to add corn syrup or honey to the bottle of a child younger than 12 months because of the danger of botulism. 3. It is not recommended to give an infant a glycerine suppository for hard, infrequent stools; constipation should be managed with dietary changes. 4. Regular bowel elimination minimizes abdominal pain and the typical 6-month-old has two or three soft stools a day. Adding additional water daily is the easiest first step in handling constipation. TEST-TAKING HINT: The test taker must know how to treat constipation in an infant, which is different from treating it in a child.

The nurse is caring for an unconscious 6-year-old who has had a severe closed-head injury and notes the following changes: Heart rate has dropped from 120 to 55, blood pressure has increased from 110/44 to 195/62, and respirations are becoming more irregular. Which should the nurse do first after calling the physician? 1. Call for additional help and prepare to administer mannitol (Osmitrol). 2. Continue to monitor the patient's vital signs and prepare to administer a bolus of isotonic fluids. 3. Call for additional help and prepare to administer an antihypertensive. 4. Continue to monitor the patient and administer supplemental oxygen.

1. Cushing triad is characterized by a decrease in heart rate, an increase in blood pressure, and changes in respirations. The triad is associated with severely increased ICP. Mannitol is an osmotic diuretic that helps decrease the increased ICP. 2. The child's vital signs need to be monitored, but a fluid bolus will increase the circulating volume and lead to an increase in the child's ICP. Fluid boluses are necessary in cases of shock but must be administered carefully and the child closely observed. 3. An antihypertensive will not help decrease the ICP. 4. The child will benefit from supplemental oxygen, but it will not help decrease the ICP. TEST-TAKING HINT: The test taker should recognize the signs of Cushing triad. If not recognized, the child's condition should at least be seen as deteriorating and emergent. Answers 2 and 4 can be eliminated because they are only partially correct.

A child with Reye syndrome is described in the nurse's notes as follows: 1200— comatose with sluggish pupils; when stimulated, demonstrates decerebrate posturing. 1400—unchanged except that now demonstrates decorticate posturing when stimulated. The nurse concludes that the child's condition is: 1. Worsening and progressing to a more advanced stage of Reye syndrome. 2. Worsening, and the child may likely experience cardiac and respiratory failure. 3. Improving and progressing to a less advanced stage of Reye syndrome. 4. Improving because the child's posturing reflexes are similar.

1. Decorticate posturing is seen with a less advanced stage of Reye syndrome and likely indicates that the child's condition is improving. 2. The child's condition is improving; therefore, cardiac and respiratory failure is less likely. 3. Progressing from decerebrate to decorticate posturing usually indicates an improvement in the child's condition. 4. Decorticate posturing is associated with inflammation above the brain stem, whereas decerebrate posturing is associated with inflammation in the brain stem. TEST-TAKING HINT: The test taker needs to be familiar with posturing reflexes and their significance.

A child in the PICU with a head injury is comatose and unresponsive. The parent asks if he needs pain medication. Select the nurse's best response. 1. "Pain medication is not necessary because he is unresponsive and cannot feel pain." 2. "Pain medication may interfere with his ability to respond and may mask any signs of improvement." 3. "Pain medication is necessary to make him comfortable." 4. "Pain medication is necessary for comfort, but we use it cautiously because it increases the demand for oxygen."

1. Even if the child is unresponsive, the child can still feel pain. 2. If pain medication is administered cautiously, the child can still be monitored and signs of improvement will be evident. 3. Pain medication promotes comfort and ultimately decreases ICP. 4. Pain medication decreases the demand for oxygen. TEST-TAKING HINT: The test taker needs to consider the presence and significance of pain in the unresponsive child. Answer 1 can be immediately eliminated because the unresponsive child does feel pain.

Which intervention should be included in the plan of care for a newborn with a newly repaired myelomeningocele? 1. Offer formula/breast milk every 3 hours. 2. Turn the infant back to front every 2 hours. 3. Place a wet dressing on the sac. 4. Provide pain medication every 4 hours

1. Following surgery, a newborn may want formula/breast milk every 2 to 4 hours. Be sure to monitor intake and output. 2. Following surgery, the infant should not be positioned on the back. Monitor respirations when the infant is on the abdomen. 3. Before surgery, priority care for an infant with a myelomeningocele is to protect the sac. 4. Infants with myelomeningocele do not have pain because of lack of nerve innervations below the level of the defect. TEST-TAKING HINT: Realizing the defect is on the back eliminates answer 2. After surgery, the sac is repaired, so there is no need for a wet dressing, which eliminates answer 3.

The nurse knows further education is needed about Reye syndrome when a mother states: 1. "I will have my children immunized against varicella and influenza." 2. "I will make sure not to give my child any products containing aspirin." 3. "I will give aspirin to my child to treat a headache." 4. "Children with Reye syndrome are admitted to the hospital."

1. Having a child immunized helps prevent viral illnesses from occurring, thereby decreasing the likelihood of Reye syndrome. 2. The administration of aspirin or products containing aspirin has been associated with the development of Reye syndrome. 3. The administration of aspirin or products containing aspirin has been associated with the development of Reye syndrome. A headache can be the first sign of a viral illness followed by other symptoms. It is best not to use aspirin or aspirin- containing products in children. 4. Children with Reye syndrome are always admitted to the hospital because there is a strong possibility for complications and rapid deterioration. TEST-TAKING HINT: The test taker should be aware that aspirin administration in children with viral infections has been linked to Reye syndrome.

The parent of a child diagnosed with AKI asks the nurse why peritoneal dialysis was selected instead of hemodialysis. Which is the nurse's best response? 1. "Hemodialysis is not used in the pediatric population." 2. "Peritoneal dialysis has no complications, so it is a treatment used without hesitation." 3. "Peritoneal dialysis removes fluid at a slower rate than hemodialysis, so many complications are avoided." 4. "Peritoneal dialysis is much more efficient than hemodialysis."

1. Hemodialysis is used in the pediatric population. 2. Peritoneal dialysis has many complications, such as peritonitis. 3. Peritoneal dialysis removes fluid at a slower rate that is more easily controlled than that of hemodialysis. 4. Hemodialysis is much more efficient than peritoneal dialysis. TEST-TAKING HINT: The test taker should eliminate answer 2 because very few treatments are without complications.

The diet that produces anticonvulsant effects from ketosis consists of: 1. High-fat and low-carbohydrate foods. 2. High-fat and high-carbohydrate foods. 3. Low-fat and low-carbohydrate foods. 4. Low-fat and high-carbohydrate foods.

1. High fat and low carbohydrates are the components of the ketogenic diet. 2. High fat and low carbohydrates are the components of the ketogenic diet. 3. High fat and low carbohydrates are the components of the ketogenic diet. 4. High fat and low carbohydrates are the components of the ketogenic diet. TEST-TAKING HINT: The test taker needs to be familiar with the components of a ketogenic diet.

The parents of a toddler diagnosed with Werdnig-Hoffmann disease ask the nurse what they can feed their child that would be quality food. Which would be good choices for the nurse to recommend? 1. A hot dog and chips. 2. Chicken and broccoli. 3. A banana and almonds. 4. A milkshake and a hamburger.

1. Hot dogs and chips are too high in sodium and fat. 2. Chicken is a good source of protein, and broccoli is a good choice for naturally occurring vitamins. The parent may have to chop the food up for the infant to safely eat. 3. A banana is a food toddlers usually like.A child under 5 years should not eat nuts because they are a choking hazard for a child who does not chew food well. 4. A milkshake has a high amount of fat, as does a hamburger. TEST-TAKING HINT: The test taker must know good-quality foods that should be offered to children.

Which causes the clinical manifestations of hydronephrosis? 1. A structural abnormality in the urinary system causes urine to back up and can cause pressure and cell death. 2. A structural abnormality causes urine to flow too freely through the urinary system, leading to fluid and electrolyte imbalances. 3. Decreased production of urine in one or both kidneys results in an electrolyte imbalance. 4. Urine with an abnormal electrolyte balance and concentration leads to increased blood pressure and subsequent increased glomerular filtration rate.

1. Hydronephrosis is due to a structural abnormality in the urinary system, causing urine to back up, leading to pressure and potential cell death. 2. Hydronephrosis is due to pressure created by an obstruction, causing urine to back up. There is no free flow of urine. 3. A decreased production of urine does not lead to hydronephrosis. 4. Hydronephrosis is not caused by abnormalities in the urine. TEST-TAKING HINT: This question requires familiarity with the pathophysiology of hydronephrosis.

The parents of a child hospitalized with minimal change nephrotic syndrome (MCNS) ask why the last blood test revealed elevated lipids. Which is the nurse's best response? 1. "If your child had just eaten a fatty meal, the lipids may have been falsely elevated." 2. "It's not unusual to see elevated lipids in children because of the dietary habits of today." 3. "Because your child is losing so much protein, the liver is stimulated and makes more lipids." 4. "Your child's blood is very concentrated because of the edema, so the lipids are falsely elevated."

1. In MCNS, the lipids are truly elevated. Lipoprotein production is increased because of the increased stimulation of the liver caused by hypoalbuminemia. 2. The elevated lipids are unrelated to the child's dietary habits. 3. In MCNS, the lipids are truly elevated. Lipoprotein production is increased because of the increased stimulation of the liver caused by hypoalbuminemia. 4. The lipids are not falsely elevated. TEST-TAKING HINT: The test taker can eliminate answers 1 and 2 because they do not represent changes associated with a disease process.

Which child would likely have experienced a delay in the diagnosis of a brain tumor? 1. A 3-month-old, because signs and symptoms would not have been readily apparent. 2. A 5-month-old, because signs and symptoms would not have been readily suspected. 3. School-age child, because signs and symptoms could have been misinterpreted. 4. Adolescent, because signs and symptoms could have been ignored and denied.

1. In infants, signs and symptoms may not be readily apparent because the open fontanel allows for expansion. 2. Although brain tumors are not suspected in infants, a delay in diagnosis is most likely because of the open fontanel, allowing some expansion to go unnoticed. 3. Signs and symptoms may be misinterpreted, but increased ICP will become apparent. 4. Signs and symptoms may be denied, but increased ICP will become apparent. TEST-TAKING HINT: The test taker should consider growth and development in answering this question. The anterior fontanel allows for brain expansion, therefore delaying the discovery of signs and symptoms of a brain tumor.

A child receiving peritoneal dialysis has not been having adequate volume in the return. The child is currently edematous and hypertensive. Which would the nurse anticipate the health-care provider to do? 1. Increase the glucose concentration of the dialysate. 2. Decrease the glucose concentration of the dialysate. 3. Administer antihypertensives and diuretics but not change the dialysate concentration. 4. Decrease the dwell time of the dialysate.

1. Increasing the concentration of glucose will pull more fluid into the return. 2. Decreasing the concentration of glucose will pull less fluid into the return. 3. Antihypertensives and diuretics may be administered, but changing the concentration of glucose in the dialysate will help regulate the fluid balance. 4. Increasing the dwell time would help pull more fluid into the return. Decreasing the dwell time would pull less fluid into the return. TEST-TAKING HINT: The test taker should eliminate answers 2 and 4 because they decrease the amount of return.

Which should be the priority nursing diagnosis for a 12-hour-old newborn with a myelomeningocele at L2? 1. Altered bowel elimination related to neurological deficits. 2. Potential for infection related to the physical defect. 3. Altered nutrition related to neurological deficit. 4. Disturbance in self-concept related to physical disability.

1. Infants with myelomeningocele have altered bowel elimination as a result of their defect, but this is not the priority. 2. Because this infant has not had a repair, the sac is exposed. It could rupture, allowing organisms to enter the CSF, so this is the priority. 3. These infants usually eat normally. 4. The infant is too young to have a self- concept disturbance. TEST-TAKING HINT: Before surgery, the myelomeningocele is exposed, so risk of infection is much higher.

Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis? 1. Maintain isolation precautions until 24 hours after receiving intravenous antibiotics. 2. Intravenous fluids at 1.5 times regular maintenance. 3. Neurological checks every hour. 4. Administer acetaminophen (Tylenol) for temperatures higher than 38°C (100.4°F).

1. Isolation precautions must be maintainedfor at least the first 24 hours of intravenous antibiotic therapy. 2. Intravenous fluids at 1.5 times regular maintenance could cause fluid overload and lead to increased ICP. 3. Neurological checks are usually made at least every hour. 4. Acetaminophen (Tylenol) is usually administered when the child has a fever, as increased temperature can lead to increased ICP. TEST-TAKING HINT: The test taker should consider the answers and eliminate those that may increase ICP. Intravenous fluids are often given at less than maintenance unless the child is hemodynamically unstable.

A child fell off his bike and sustained a closed-head injury. The child is currently awake and alert, but his mother states that he "passed out" for approximately 2 minutes. The mother appears highly anxious and is very tearful. The child was not wearing a helmet. Which is a priority for the triage nurse to say at this time? 1. "Was anyone else injured in the accident?" 2. "Tell me more about the accident." 3. "Did he vomit, have a seizure, or display any other behavior that was unusual when he woke up?" 4. "Why was he not wearing a helmet?"

1. It is not a priority of care to find out if anyone else was injured. 2. Although open-ended questions are important, the nurse needs specific information, and the anxious parent may need to be guided during triage assessment. 3. Asking specific questions will give the nurse the information needed to determine the level of care for the child. 4. Although it is important to provide safety education, this information should be given in a nonjudgmental manner at a point when the parent and child are less stressed. TEST-TAKING HINT: The test taker needs to consider the role of a triage nurse to obtain specific information quickly. Answer 4 can be eliminated because it implies judgment and does not help the current situation.

Which medication should the nurse anticipate administering first to a child in status epilepticus? 1. Establish an intravenous line and administer intravenous lorazepam (Ativan). 2. Administer rectal diazepam (Valium). 3. Administer an oral glucose gel to the side of the child's mouth. 4. Administer oral diazepam (Valium).

1. It is very difficult and time consuming to establish an intravenous line in a child who is experiencing a generalized seizure. Rectal diazepam (Valium) is first administered in an attempt to stop the seizure long enough to establish a line, and then medication is administered intravenously. 2. Rectal diazepam (Valium) is first administered in an attempt to stop the seizure long enough to establish an IV, and then IV medication is administered. 3. Although the child may become hypoglycemic due to increased metabolic demands, stopping the seizure with rectal diazepam (Valium) is the first priority. Medication is not placed in the mouth ofa child experiencing a generalized seizure because it increases the risk of injury and aspiration. 4. Stopping the seizure with rectal diazepam (Valium) takes priority. Nothing should be administered orally to a patient who is unconscious. TEST-TAKING HINT: The test taker needs to consider the current situation and the level of difficulty in establishing intravenous access in a child experiencing a generalized seizure.

The nurse evaluates postoperative teaching for repair of testicular torsion as successful when the parent of an adolescent says which the following? 1. "I will encourage him to rest for a few days, but he can return to football practice in a week." 2. "I will keep him in bed for 4 days and let him gradually increase his activity after that." 3. "I will seek therapy as he ages because he is now infertile." 4. "I will make sure he does testicular self-examination monthly."

1. Lifting and strenuous activity should be avoided for 2 to 4 weeks. 2. The child should not be placed on bedrest and should be encouraged to gradually increase activity while resting as necessary. 3. Most cases of testicular torsion involve only one testis, so most children do not become infertile. 4. The child and family should be taught the importance of testicular self-examination. TEST-TAKING HINT: The test taker can eliminate answer 1 because this activity could place the postoperative teen at risk for injury.

The nurse knows that teaching was successful when a parent states which of the following are early signs of muscular dystrophy? 1. Increased muscle strength. 2. Difficulty climbing stairs. 3. High fevers and tiredness. 4. Respiratory infections and obesity.

1. Muscles become enlarged from fatty infiltration, so they are not stronger. 2. Difficulty climbing stairs, running, and riding a bicycle are frequently the first symptoms of Duchenne muscular dystrophy. 3. High fevers and tiredness are not early signs of muscular dystrophy but could be later signs as complications become more common. 4. Respiratory infections and obesity are major complications as the disease progresses. TEST-TAKING HINT: Early symptoms have to do with decreased ability to perform normal developmental tasks involving muscle strength.

The nurse is caring for a newborn with esophageal atresia. When reviewing the mother's history, which would the nurse expect to find? 1. Maternal polyhydramnios. 2. Pregnancy lasting more than 38 weeks. 3. Poor nutrition during pregnancy. 4. Alcohol consumption during pregnancy.

1. Maternal polyhydramnios is present because the infant cannot swallow and absorb the amniotic fluid in utero. 2. Many mothers of infants with esophageal atresia deliver early because of the pressure of the unabsorbed amniotic fluid. 3. Although good nutrition is important in every pregnancy, there is not a direct relationship between diet and esophageal atresia. 4. Although alcohol should not be consumed in any pregnancy, there is not a direct link between alcohol and esophageal atresia. TEST-TAKING HINT: The test taker should select answer 1 because esophageal atresia prevents the fetus from ingesting amniotic fluid, leading to increased amniotic fluid in utero.

An infant is born with a sac protruding through the spine, containing cerebrospinal fluid (CSF), a portion of the meninges, and nerve roots. This condition is referred to as: 1. Meningocele. 2. Myelomeningocele. 3. Spina bifida occulta. 4. Anencephaly.

1. Meningocele is a sac that contains a portion of the meninges and cerebrospinal fluid. 2. A myelomeningocele is a sac that contains a portion of the meninges, the CSF, and the nerve roots. 3. Spina bifida occulta is the mildest form of spina bifida in which one or more vertebrae are malformed. The child usually has no symptoms, and in most cases, no one knows there is a spinal defect. 4. Anencephaly is a neural tube defect in which the bones of the skull and head do not form correctly. Infants are missing large parts of their brain and skull. TEST-TAKING HINT: The test taker would need to know the definition of myelomeningocele to answer this question.

The nurse is caring for a 3-year-old with an altered state of consciousness. The nurse determines that the child is oriented by asking the child to: 1. Name the president of the United States. 2. Identify her parents and state her own name. 3. State her full name and phone number. 4. Identify the current month but not the date.

1. Most 3-year-olds are not capable of naming the president. 2. Asking the 3-year-old to identifyher parents and state her name is a developmentally appropriate way to assess orientation. 3. Many 3-year-olds are not familiar with their phone number or may not be able to share this information during a stressful time, such as hospitalization. 4. Many 3-year-olds do not know the current month. TEST-TAKING HINT: The test taker needs to be familiar with the concept of consciousness and applying normal developmental-specific age-groups.

Which is the best action for the nurse to take during a child's seizure? 1. Administer the child's rescue dose of oral diazepam (Valium). 2. Loosen the child's clothing, and call for help. 3. Place a tongue blade in the child's mouth to prevent aspiration. 4. Carry the child to the infirmary to call 911 and start an intravenous line.

1. Nothing should be placed in the child's mouth because he is at risk for aspiration. Rescue Valium is usually administered rectally. 2. The nurse should remain with the child and observe the seizure. The child should be protected from his environment, and clothing should be loosened. 3. A tongue blade should never be placed in the child's mouth because it can cause injury or increase the risk of aspiration. 4. The nurse should remain with the child and call for help. A child can be injured if carried during a seizure. TEST-TAKING HINT: The test taker should eliminate answers 1 and 3 because nothing should ever be placed in the mouth of a child having a seizure.

An adolescent presents with sudden-onset unilateral facial weakness with drooping of one side of the mouth. The teen is unable to close the eye on the affected side, but has no other symptoms and otherwise feels well. The nurse could summarize the condition by which of the following? 1. The prognosis is poor. 2. This may be a CVA. 3. It is a fifth CN palsy. 4. This is paralysis of the facial nerve.

1. Paralysis of the facial nerve (CN VII) generally resolves within 2 to 4 weeks and has a good prognosis. Treatment is supportive. 2. It would be very unusual for a healthy adolescent to have a stroke. One would also expect other symptoms. 3. CN V (the trigeminal nerve) innervates the muscles of mastication. 4. This client has Bell's palsy, which is an idiopathic mononeuritis of CN VII (the facial nerve) that innervates the face and muscles of expression. TEST-TAKING HINT: The test taker must know CNs and their actions.

Which is included in the plan of care for a newborn who has a myelomeningocele? 1. Place the infant in the prone position with a sterile dry dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 2. Place the infant in the prone position with a sterile dry dressing over the defect. Begin intravenous fluids to prevent dehydration. 3. Place the infant in the prone position with a sterile moist dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 4. Place the child in the prone position with a sterile moist dressing over the defect. Begin intravenous fluids to prevent dehydration.

1. Placing the child in the prone position is correct. A dry dressing may adhere to the defect, causing irritation. 2. A dry dressing may adhere to the defect, causing irritation. 3. Oral gastric feedings are not usually started unless there is going to be a delay in surgery. The defect is usually corrected within 24 hours to avoid infection. 4. The child is placed in the prone position to avoid any pressure on the defect. A sterile moist dressing is placed over the defect to keep it as clean as possible. Intravenous fluids are begun to prevent dehydration. TEST-TAKING HINT: The test taker can eliminate answer 2 because a dry dressing could cause irritation and stick to the sac.

A school-age child is admitted to the unit preoperatively for bladder reconstruction. The child is latex-sensitive. Which intervention should the nurse implement? 1. Post a sign on the door and note in the chart that the child is latex-allergic. 2. Use powder-free latex gloves when giving care. 3. Keep personal items such as stuffed animals in a plastic bag to avoid latex contamination. 4. Use a disposable plastic-covered blood pressure cuff that will stay in the child's room.

1. Posting a sign on the door and charting that the child has a latex allergy is important so that others will be aware of the allergy. 2. Do not use latex gloves with a child who has a latex allergy. 3. Keeping personal items in a plastic bag does not keep latex away from the child. 4. A plastic cover for the blood pressure cuff is proper to use but is not related to the latex allergy. TEST-TAKING HINT: The test taker must know which supplies have latex and about contact allergies.

The parent of a child diagnosed with Werdnig-Hoffmann disease notes times of not being able to hear the child breathing. Which should the nurse do first? 1. Check pulse oximetry on the child. 2. Count the child's respirations. 3. Listen to the child's lung sounds. 4. Ask the parent if the child coughs at night.

1. Pulse oximetry measures the oxygen percentage in the blood. It can be assessed after the child's vital signs are determined. 2. The first intervention is to check the respiratory rate of the child to see if it is abnormal, then listen to the lung sounds, and then check pulse oximetry. 3. The first intervention is to check the respiratory rate of the child to see if it is abnormal, then listen to the lung sounds, and then check pulse oximetry. 4. The first intervention is to check the respiratory rate of the child to see if it is abnormal, then listen to the lung sounds, and then check pulse oximetry. Asking if the child coughs at night would be helpful information as well. TEST-TAKING HINT: The test taker would first count respirations to determine whether the rate is normal for a child that age. Auscultation comes next, then pulse oximetry if needed.

Which should be included in the plan of care for a child who has a neuroblastoma with metastasis to the bone marrow and pancytopenia? 1. Administer red blood cells. 2. Limit school attendance to less than 4 hours daily. 3. Administer warfarin (Coumadin). 4. Encourage a diet high in fresh fruits and vegetables.

1. Red blood cells will be needed to increase the red blood cell count. 2. The child should not be around groups of people because of the potential of exposure to infection. 3. Blood thinners are not given to the child with a decreased platelet count. 4. Fresh fruits and vegetables should be avoided because they may contain microorganisms that can lead to infection in the child with a low white blood cell count. TEST-TAKING HINT: The test taker should consider all components of pancytopenia and select the answer that will not harm the child. Answers 2 and 4 should be immediately eliminated because they both increase the risk of infection.

The parents of a child with altered consciousness ask if they can stay during the morning assessment. Select the nurse's best response. 1. "Your child is more likely to answer questions and cooperate with any procedures if you are not present." 2. "Most children feel more at ease when parents are present, so you are more than welcome to stay at the bedside." 3. "It is our policy to ask parents to leave during the first assessment of the shift." 4. "Many children fear that their parents will be disappointed if they do not do well with procedures, so we recommend that no parents be present at this time."

1. School-age children feel more comfortable when parents are present and are more likely to cooperate with a neurological assessment. 2. Parents should be encouraged to remain with their child for mutual comfort. 3. Describing a policy is not sufficient and does not give the parents enough information. 4. School-age children feel more comfortable when parents are present and are more likely to cooperate with a neurological assessment. TEST-TAKING HINT: The test taker needs to be familiar with growth and development of children and applying theories to specific clinical situations.

The nurse is caring for a child with cerebral palsy (CP) whose weight is in the fifth percentile and who has been hospitalized for aspiration pneumonia. His parents are anxious and state that they do not want a G-tube placed. Which would be the nurse's best response? 1. "A G-tube will help your son gain weight and reduce his risk for future hospitalizations due to pneumonia." 2. "G-tubes are very easy to care for and will make feeding time easier for your family." 3. "Are you concerned that you will not be able to care for his G-tube?" 4. "Tell me your thoughts about G-tubes."

1. Sharing information may not be helpful if the family is not ready to listen. 2. Sharing information may not be helpful if the family is not ready to listen. 3. The family may have other concerns that would be communicated through an open- ended question. 4. An open-ended question will encourage family members to share what they know and potentially clear up any misconceptions. TEST-TAKING HINT: The test taker should consider the principles of therapeutic communication. Answer 4 is an open- ended question that will not be perceived as judgmental and should elicit the most information.

The parents of a 12-month-old with cerebral palsy (CP) ask the nurse if they should teach their child sign language because he has not begun to vocalize. The nurse bases the response on the knowledge that sign language: 1. May be a very beneficial way to help children with CP communicate. 2. May cause confusion and further delay vocalization. 3. Is difficult to learn for most children with CP. 4. Is beneficial to learn, but it would be best to wait until the child is older.

1. Sign language may help the child with CP communicate and ultimately decrease frustration. Children with CP may have difficulty verbalizing because of weak tongue and jaw muscles. They may be able to have sufficient motor skills to communicate with their hands. 2. Sign language does not cause confusion and may help reinforce vocabulary and vocalization. 3. CP is manifested differently in all children; therefore, generalizations cannot be made. 4. The earlier sign language is taught, the more it will be beneficial. TEST-TAKING HINT: The test taker can immediately eliminate answer 3 because it makes a generalization. All forms of language are beneficial and well tolerated by children, especially young children.

Which would the nurse expect to hear the parents of an infant with an incarcerated hernia report? 1. Acute onset of pain, abdominal distention, and a mass that cannot be reduced. 2. Gradual onset of pain, abdominal distention, and a mass that cannot be reduced. 3. Acute onset of pain, abdominal distention, and a mass that is easily reduced. 4. Gradual onset of pain, abdominal distention, and a mass that is easily reduced.

1. Signs of an incarcerated hernia include an acute onset of pain, abdominal distention, and a mass that cannot be reduced. Other signs are bloody stools, edema of the scrotum, and a history of poor feeding. 2. The pain is not gradual, but rather acute, in onset. 3. The mass is not easily reduced. 4. The mass is not easily reduced, and the child experiences acute, not gradual, onset of pain. TEST-TAKING HINT: The test taker can eliminate answers 2 and 4 because the onset of pain is not gradual.

A 10-kg toddler is diagnosed with AKI, is afebrile, and has a 24-hour urine output of 110 mL. After calculating daily fluid maintenance, which would the nurse expect the toddler's daily allotment of fluids to be? 1. Sips of clear fluids and ice chips only. 2. 350 mL of oral and intravenous fluids. 3. 1000 mL of oral and intravenous fluids. 4. 2000 mL of oral and intravenous fluids.

1. Sips of clear fluids and ice chips wouldnot replace the insensible losses. All oral intake needs to be measured and accurately recorded because "sips" can be very subjective. 2. 350 mL is approximately a third ofthe daily fluid requirement and is recommended for the child in the oliguric phase of AKI. If the child were febrile, the fluid intake would be increased. 3. 1000 mL represents the daily fluid requirement in a healthy child. 4. 2000 mL is double the fluid requirement of a healthy child and is contraindicated in a child in the oliguric phase of AKI. TEST-TAKING HINT: The question specifies that the child is afebrile; therefore, the test taker can eliminate answers 3 and 4 because extra fluid is not required.

Why does spinal cord injury without radiographic abnormality sometimes occur in children? 1. Children can suffer momentary severe subluxation and trauma to the spinal cord. 2. The immature spinal column in children does not allow for quality films. 3. The hemorrhaging that occurs with injury obscures radiographic abnormalities. 4. Radiographic abnormalities are not evident because of incomplete ossification of the vertebrae.

1. Spinal cord injury without radiographic abnormality results from the spinal cord sliding between the vertebrae and then sliding back into place without injury to the bony spine. It is thought to be the result of an immature spinal column that allows for reduction after momentary subluxation. 2. On x-ray the spinal cord and body structure appear normal. The edema of the cord and resulting ischemia can cause neurological dysfunction below the level of the injury. 3. Hemorrhaging that occurs with the injury does not obscure radiographic findings. 4. The vertebrae are adequately ossified for radiographic study to reveal abnormalities. TEST-TAKING HINT: The test taker must understand the physiology of spinal cord injuries in children.

An adolescent with a T4 spinal cord injury suddenly becomes dangerously hypertensive and bradycardic. Which intervention is appropriate? 1. Call the neurosurgeon immediately, as this sounds like sudden intracranial hypertension. 2. Check to be certain that the client's bladder is not distended. 3. Administer diazoxide (Hyperstat) to treat the blood pressure. 4. Administer atropine for bradycardia.

1. Sudden hypertension and bradycardia are symptoms of autonomic dysreflexia. The nurse needs to make assessments of the fullness of the bowel and bladder, take the blood pressure, and relieve the bowel or bladder before calling the doctor. 2. The first assessment is of the bladder and bowel to check for fullness. The presence of either could trigger autonomic dysreflexia. 3. The first intervention is to assess the bladder for fullness before administering any medication. 4. The first intervention is to assess the bladder for fullness before administering any medication. TEST-TAKING HINT: The test taker must know which symptoms are suggestive of autonomic dysreflexia.

The diet for a child with CKD should be high in calories and include: 1. Low protein and all minerals and electrolytes. 2. Low protein and minerals. 3. High protein and calcium and low potassium and phosphorus. 4. High protein, phosphorus, and calcium and low potassium and sodium.

1. The child's diet should be high in calories and protein, but not all minerals and electrolytes should be high. Sodium, potassium, and phosphorus should be restricted. 2. The child with CKD needs a diet high in protein. 3. The child with CKD needs a diet high in calories, protein, and calcium and low in potassium and phosphorus. 4. Phosphorus should be restricted because the kidneys are unable to excrete phosphorus. TEST-TAKING HINT: The test taker should eliminate answer 2 because it is important for the child to have a diet high in protein.

The nurse evaluates the parents' understanding of the teaching about an inguinal hernia as successful when they say which of the following? 1. "There are no risks associated with waiting to have the hernia reduced; surgery is done for cosmetic reasons." 2. "It is normal to see the bulge in the baby's groin decrease with a bowel movement." 3. "We will wait for surgery until the baby is older because narcotics for pain control will be required for several days." 4. "It is normal for the bulge in the baby's groin to look smaller when the baby is asleep."

1. Surgery is usually done at an early age to avoid incarceration, in which the hernia causes impaired circulation to the surrounding tissue. 2. The hernia tends to look larger when the child strains or has a bowel movement because of increased intra-abdominal pressure. 3. The surgery is usually done on an outpatient basis, and narcotics are not usually needed. 4. The hernia often appears smaller when the child is asleep. TEST-TAKING HINT: The test taker can eliminate answer 1 because there are risks associated with waiting for the repair, and surgery is not done solely for cosmetic reasons.

Which activity should an adolescent just diagnosed with epilepsy avoid? 1. Swimming, even with a friend. 2. Being in a car at night. 3. Participating in any strenuous activities. 4. Returning to school right away.

1. Swimming does not need to be avoided as long as there is someone else present to call for help in the event of an emergency. 2. The rhythmic reflection of other car lights can trigger a seizure in some children. 3. There is no reason to avoid strenuous activity. 4. It is important for adolescents to be with their peers in order to reach developmental milestones. TEST-TAKING HINT: The test taker should consider the answers that can lead to a seizure. Answer 2 is the only answer that includes a common trigger.

A child with a repaired myelomeningocele is in the clinic for a regular examination. The child has frequent constipation and has been crying at night because of pain in the legs. After an MRI, the diagnosis of a tethered cord is made. Which should the nurse tell the parent? 1. Tethered cord is a postsurgical complication. 2. Tethered cord occurs during times of slow growth. 3. Release of the tethered cord will be necessary only once. 4. Offering laxatives and acetaminophen (Tylenol) daily will help control these problems.

1. Tethered cord is caused by scar tissue formation from the surgical repair of the myelomeningocele and may affect bowel, bladder, or lower extremity functioning. As the child grows, this will affect continence and mobility. 2. Tethered cord occurs during growth spurts. 3. Often the release of the tether will again become necessary. 4. Laxatives and acetaminophen are temporary remedies, and they treat only the symptoms. TEST-TAKING HINT: Tethering is caused by scar tissue from any surgical intervention and may recur as the child grows.

The nurse is aware that cloudy cerebrospinal fluid (CSF) most likely indicates: 1. Viral meningitis. 2. Bacterial meningitis. 3. No infection, because CSF is usually cloudy. 4. Sepsis.

1. The CSF in viral meningitis is usually clear. 2. The CSF in bacterial meningitis is usually cloudy. 3. The CSF in healthy children is usually clear. 4. Sepsis is an infection of the bloodstream. TEST-TAKING HINT: The test taker can eliminate answer 4 because an infection of the bloodstream would not be detected in the CSF.

After spinal cord surgery, an adolescent suddenly complains of a severe headache. Which should be the nurse's first action? 1. Check the blood pressure. 2. Check for a full bladder. 3. Ask if pain is present somewhere else. 4. Ask if other symptoms are present.

1. The autonomic nervous system responds with arteriolar vasospasm, which results in an uncontrolled increase in blood pressure. The parasympathetic nervous system (vagus nerve) sends a stimulus to the heart resulting in bradycardia and vasodilation. 2. The sympathetic nervous system responds to a full bladder or bowel resulting from an uncontrolled, paroxysmal, continuous lower motor neuron reflex arc. This response is usually from stimulation of sensory receptors (e.g., distended bladder or bowel). Because the efferent pulse cannot pass through the spinal cord, the vagus nerve is not "turned off," and profound symptomatic bradycardia may occur. 3. Pain is not usually felt below the level of the injury, and pain elsewhere does not cause a severe headache. 4. In autonomic dysreflexia, the patient does not experience other symptoms. TEST-TAKING HINT: Autonomic dysreflexia is usually caused by a full bladder or bowel.

Which would the nurse expect to find on assessment in a child with Wilms tumor? 1. Decreased blood pressure, increased temperature, and a firm mass located in one flank area. 2. Increased blood pressure, normal temperature, and a firm mass located in one flank area. 3. Increased blood pressure, normal temperature, and a firm mass located on one side of the midline of the abdomen. 4. Decreased blood pressure, normal temperature, and a firm mass located on one side or the other of the midline of the abdomen.

1. The blood pressure may be increased, not decreased, if there is renal damage. The mass will be located on one side or the other of the midline of the abdomen. There is no reason for the child's temperature to be affected. 2. The blood pressure may be increased if there is renal damage. The mass will be located on one side or the other of the midline of the abdomen. There is no reason for the child's temperature to be affected. 3. The blood pressure may be increased if there is renal damage. The mass will be located on one side or the other of the midline of the abdomen. There is no reason for the child's temperature to be affected. 4. The blood pressure may be increased, not decreased, if there is renal damage. The mass is located on one side or the other of the midline of the abdomen. There is no reason for the child's temperature to be affected. TEST-TAKING HINT: The test taker can eliminate answers 1 and 2 because the mass is felt in the abdomen, not the back.

A child involved in a motor vehicle accident (MVA) is currently on a backboard with a cervical collar in place. The child is diagnosed with a cervical fracture. Which would the nurse expect to find in the child's plan of care? 1. Remove the cervical collar, keep the backboard in place, and administer high-dose methylprednisolone (Medrol). 2. Continue with all forms of spinal stabilization and administer high-dose methylprednisolone (Medrol) and ranitidine (Zantac). 3. Remove the backboard and cervical collar and prepare for halo tractionplacement. 4. Remove the cervical collar and backboard, place the child on spinal precautions, and administer high-dose methylprednisolone (Medrol) and ranitidine (Zantac).

1. The cervical collar should not be removed. In addition to the methylprednisolone (Medrol), ranitidine (Zantac) should be administered to prevent gastric ulcer formation. 2. All forms of spinal stabilization should be continued while methylprednisolone (Medrol) and ranitidine (Zantac) are administered. 3. The backboard and cervical collar should not be removed until after the halo traction has been applied. 4. The cervical collar should not be removed. TEST-TAKING HINT: The test taker should be familiar with spinal cord injuries. The test taker should eliminate any answer stating the cervical collar be removed, such as 1, 3, and 4.

A child diagnosed with meningitis is having a generalized tonic-clonic seizure. Which should the nurse do first? 1. Administer blow-by oxygen and call for additional help. 2. Reassure the parents that seizures are common in children with meningitis. 3. Call a code and ask the parents to leave the room. 4. Assess the child's temperature and blood pressure.

1. The child experiencing a seizure usually requires more oxygen because the seizure increases the body's metabolic rate and demand for oxygen. The seizure may also affect the child's airway, causing the child to be hypoxic. It is always appropriate to give the child blow-by oxygen immediately. The nurse should remain with the child and call for additional help. 2. It is important to reassure the parents, but giving the child oxygen and calling for additional support is the priority of care. 3. It is not necessary to call a code unless the child experiences a cardiac or respiratory arrest. Research indicates that encouraging parents to remain with the child in emergency situations benefits both the child and family. 4. It is important to monitor and observe the child during a seizure, but it is very difficult to obtain a blood pressure from a seizing child. The priority of care involves administering oxygen and calling for additional help. TEST-TAKING HINT: The test taker needs to prioritize care and choose answer 1 because it will help maintain the airway. Answer 3 could immediately be eliminated because the child is having a seizure, not a cardiac arrest.

The mother of an unconscious child has been calling her name repeatedly and gently shaking her shoulders in an attempt to wake her up. The nurse notes that the child is flexing her arms and wrists while bringing her arms closer to the midline of her body. The child's mother asks, "What is going on?" Select the nurse's best response. 1. "I think your daughter hears you, and she is attempting to reach out to you." 2. "Your child is responding to you; please continue trying to stimulate her." 3. "It appears that your child is having a seizure." 4. "Your child is demonstrating a reflex that indicates she is overwhelmed with the stimulation she is receiving."

1. The child is demonstrating a reflex called posturing. The parent should not be given any false hope that the child is responding at a higher level than is truly occurring. 2. The posturing reflex often indicates irritability, and the child should not continue to receive stimulation. 3. Posturing is a reflex, not a seizure. 4. Posturing is a reflex that often indicates that the child is receiving too much stimulation. TEST-TAKING HINT: The test taker needs to be familiar with caring for the comatose child and what causes posturing.

One week after kidney transplant, a child complains about abdominal pain, and the parents note that the child has been very fussy. The nurse notes a 10% weight gain as well as elevated BUN and creatinine levels. Which of the following medications would the child most likely be taking? 1. Codeine tablets. 2. Furosemide (Lasix). 3. Polyethylene glycol 3350 (MiraLAX). 4. Corticosteroids.

1. The child is demonstrating signs of rejection. Although pain control is always important, antirejection medications are of utmost importance. 2. Furosemide (Lasix) may be given to reduce edema, but antirejection medications are the most important for this child. 3. Polyethylene glycol 3350 (MiraLAX) will help with constipation, but it will not help prevent rejection. 4. Corticosteroids are considered part of the antirejection regimen that is essential after a kidney transplant. TEST-TAKING HINT: The test taker shouldbe led to answer 4 because it is the only listed answer that is part of an antirejection regimen. Steroids can cause irritability and weight gain.

A child has been diagnosed with a midline brain tumor. In addition to showing signs of increased intracranial pressure (ICP), she has been voiding large amounts of very dilute urine. Which medication does the nurse expect to administer? 1. Mannitol (Osmitrol). 2. Vasopressin. 3. Furosemide (Lasix). 4. Dopamine (Intropin).

1. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Mannitol (Osmitrol) is an osmotic diuretic that will not treat diabetes insipidus. 2. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Vasopressin is a hormone that is used to help the body retain water. 3. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Furosemide (Lasix)is a diuretic that will not treat diabetes insipidus. 4. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Dopamine (Intropin) is a beta-adrenergic agonist that is not used to treat diabetes insipidus. TEST-TAKING HINT: The test taker shouldbe familiar with diabetes insipidus. The question describes its symptoms. Diabetes insipidus commonly occurs in children with midline brain tumors. The test taker can eliminate answers 1 and 3 because they increase diuresis, which needs to be avoided.

During hemodialysis, the nurse notes that a 10-year-old becomes confused and restless. The child complains of a headache and nausea and has generalized muscle twitching. This can be prevented by which of the following? 1. Slowing the rate of solute removal during dialysis. 2. Ensuring the patient is warm during dialysis. 3. Administering antibiotics before dialysis. 4. Obtaining an accurate weight the night before dialysis.

1. The child is experiencing signs of disequilibrium syndrome, which is caused by free water shifting from intravascular spaces and can be prevented by slowing the rate of dialysis. 2. The patient's temperature is not a causative factor in disequilibrium syndrome. 3. Antibiotics are used to prevent peritonitis, not disequilibrium syndrome. 4. The child's weight should be obtained immediately prior to dialysis. TEST-TAKING HINT: The test taker should eliminate answers 2 and 3 because they are not associated with disequilibrium syndrome.

Brain damage in a child who sustained a closed-head injury can be caused by which factor? 1. Increased perfusion to the brain and increased metabolic needs of the brain. 2. Decreased perfusion to the brain and decreased metabolic needs of the brain. 3. Increased perfusion to the brain and decreased metabolic needs of the brain. 4. Decreased perfusion of the brain and increased metabolic needs of the brain.

1. The child who has a closed-head injury has decreased perfusion to the brain and increased metabolic needs that lead to ischemia and brain damage. 2. The child who has a closed-head injury has decreased perfusion to the brain and increased metabolic needs that lead to ischemia and brain damage. 3. The child who has a closed-head injury has decreased perfusion to the brain and increased metabolic needs that lead to ischemia and brain damage. 4. Decreased perfusion of the brain and increased metabolic needs of the brain. TEST-TAKING HINT: The test taker needs to be familiar with the mechanics of a head injury.

The parents of a 12-month-old with a neurogenic bladder ask the nurse if their child will always have to be catheterized. Select the nurse's best response. 1. "Your child will never feel when her bladder is full, so she will always have to be catheterized. Because she is female, she will always need assistance." 2. "As your child ages, she will likely be able to sense when her bladder is full and will be able to empty it on her own." 3. "Although your child will not be able to feel when her bladder is full, she can learn to urinate every 4 to 6 hours and therefore not require catheterizations." 4. "Your child will never be able to completely empty her bladder spontaneously, but there are other options to traditional catheterization. An opening can be made surgically through the abdomen, allowing a catheter to be placed into the opening."

1. The child with a neurogenic bladder will never be able to spontaneously empty it completely. Most children learn to self- catheterize at a young age. 2. The child with a neurogenic bladder will never be able to spontaneously empty it completely. 3. Placing the child with a neurogenic bladder on a bladder training program is not helpful, because the child will never be able to spontaneously empty it completely. 4. A vesicostomy is an example of an option for children with myelomeningocelein which alternatives to traditional catheterizations are created. TEST-TAKING HINT: The test taker should recognize that the neurogenic bladder in a child with myelomeningocele is irreversible, and answers 2 and 3 should be eliminated.

Select the best room assignment for a newly admitted child with bacterial meningitis. 1. Semiprivate room with a roommate who also has bacterial meningitis. 2. Semiprivate room with a roommate who has bacterial meningitis but has received intravenous antibiotics for more than 24 hours. 3. Private room that is dark and quiet with minimal stimulation. 4. Private room that is bright and colorful and has developmentally appropriate activities available.

1. The child with bacterial meningitis should be placed in a private room isolated from all other patients. Bacterial meningitis is caused by many pathogens, and patients should be isolated from each other. 2. The child with bacterial meningitis should be placed in a private room isolated from all other patients. Bacterial meningitis is caused by many pathogens, and patients should be isolated from each other. 3. A quiet private room with minimal stimulation is ideal because the child with meningitis should be in a quiet environment to avoid cerebral irritation. 4. A bright room with developmental activities may cause irritation and increase ICP. TEST-TAKING HINT: The test taker should consider what contributes to cerebral irritation and should not be influenced by the developmental requirements of a healthy child.

The nurse knows that teaching has been successful when the parent of a child with muscle weakness states that the diagnostic test for muscular dystrophy is which of the following?1. Electromyelogram. 2. Nerve conduction velocity. 3. Muscle biopsy. 4. Creatine kinase level.

1. The electromyelogram is part of the diagnostic workup, but muscle biopsy results classify muscle disorders. 2. Nerve conduction velocity is part of the diagnostic workup, but muscle biopsy results classify muscle disorders. 3. Muscle biopsy confirms the type of myopathy that the patient has. 4. Creatine kinase is in muscle tissue and is found in large amounts in muscular diseases. TEST-TAKING HINT: Muscle biopsy is the definitive test for myopathies.

A child with spastic CP had an intrathecal dose of baclofen (Lioresal) in the early afternoon. What is the expected result 3.5 hours post-dose that suggests the child would benefit from a baclofen pump? 1. The ability to self-feed. 2. The ability to walk with little assistance. 3. Decreased spasticity. 4. Increased spasticity.

1. The expected benefit from intrathecal baclofen (Lioresal) is less spasticity, which allows the child to have more muscle control. This leads to more fine motor control and ambulation. The onset of action is 30 minutes, and it peaks in 6 hours. 2. The expected benefit from intrathecal baclofen (Lioresal) is less spasticity, which allows the child to have more muscle control. This leads to more fine motor control and ambulation. The onset of action is 30 minutes, and it peaks in 6 hours. 3. If baclofen (Lioresal) were to work for this child, one could tell because spasticity would be decreased. 4. Baclofen (Lioresal) should decrease, not increase, spasticity. TEST-TAKING HINT: The test taker must know the purpose of baclofen (Lioresal).

Over the past week, an infant with a repaired myelomeningocele has had a high- pitched cry and been irritable. Length, weight, and head circumference have been at the 50th percentile. Today, length is at the 50th percentile, weight is at the 70th percentile, and head circumference is at the 90th percentile. The nurse should do which of the following? 1. Tell the parent this is normal for an infant with a repaired myelomeningocele. 2. Tell the parent this might mean the baby has increased intracranial pressure. 3. Suspect the baby's intracranial pressure is low because of a leak. 4. Refer the baby to the neurologist for follow-up care.

1. The fact that the head circumference has changed so much might indicate increased intracranial pressure. 2. The increase in head size is one of the first signs of increased intracranial pressure; other signs include high- pitched cry and irritability. 3. The increase in head size is one of the first signs of increased intracranial pressure; other signs include high-pitched cry and irritability. 4. This infant should be referred to the neurosurgeon, not the neurologist, and a CT scan should be obtained to determine the cause of the increase. TEST-TAKING HINT: The test taker should know that the head size of an infant grows only 0.5 in. (1.3 cm) a month for the first6 months. Having the infants' head size cross percentiles after only 1 to 2 days is an alarming finding.

The parents of a child with cerebral palsy (CP) are learning how to feed their child and avoid aspiration. The nurse would question which of the following when reviewing the teaching plan? 1. Place the food on the tip of the tongue. 2. Place the child in an upright position during feedings. 3. Feed the child soft and blended foods. 4. Feed the child slowly.

1. The food should be placed far back in the mouth to avoid tongue thrust. 2. The child should be placed in an upright position. 3. Soft and blended foods minimize the risk of aspiration. 4. Allowing the child time to feed minimizes the risk of aspiration. TEST-TAKING HINT: The test taker should consider which methods will decrease the risk of aspiration. Answers 2, 3, and 4 all decrease the risk of choking and should be eliminated.

The nurse is planning care for a child who was recently admitted with GBS. Which is a priority nursing diagnosis?1. Risk for constipation related to immobility. 2. Chronic sorrow related to presence of chronic disability. 3. Impaired skin integrity related to infectious disease process. 4. Activity intolerance related to ineffective cardiac muscle function.

1. The goal is to prevent complications related to immobility. Efforts include maintaining skin integrity, maintaining respiratory function, and preventing contractures. Constipation is a concern, but not the primary concern. 2. Most children recover completely, so there is no chronic sorrow. 3. The goal is to prevent complications related to immobility. Efforts include maintaining skin integrity, maintaining respiratory function, and preventing contractures. 4. GBS is a disease affecting the peripheral nervous system, not the cardiac muscle. TEST-TAKING HINT: The test taker must have a basic understanding of GBS and know that it affects the peripheral nervous system.

Which should the nurse teach a group of girls and parents about the importance of preventing urinary tract infections (UTIs)? 1. Avoiding constipation has no effect on the occurrence of UTIs. 2. After urinating, always wipe from back to front to prevent fecal contamination. 3. Hygiene is an important preventive measure and can be accomplished with frequent tub baths. 4. Increasing fluids will help prevent and treat UTIs.

1. The increased pressure associated with evacuating hardened stool can result in the backflow of urine into the bladder, leading to infection. 2. To prevent infection, a female child should wipe from front to back. 3. Tub baths are not recommended because they may cause irritation of the urethra, leading to infection. 4. Increasing fluids will help flush the bladder of any organisms, encourage urination, and prevent stasis of urine. TEST-TAKING HINT: The test taker can eliminate answers 1, 2, and 3 because they do not provide accurate information.

Which best describes the electrolyte imbalance that occurs in CKD? 1. Decreased serum phosphorus and calcium levels. 2. Depletion of phosphorus and calcium stores from the bones. 3. Change in the structure of the bones, causing calcium to remain in the bones. 4. Nutritional needs are poorly met, leading to a decrease in many electrolytes such as calcium and phosphorus.

1. The kidneys are unable to excrete phosphorus, so phosphorus levels increase and calcium levels fall. 2. The calcium and phosphorus levels are drawn from the bones in response to low calcium levels. 3. The calcium is drawn from the bones in response to low serum calcium levels. 4. Although the child may not be consuming enough calcium, dietary deficiency is not the primary cause of hypocalcemia. TEST-TAKING HINT: The test taker should eliminate answer 4 because dietary imbalances are not the primary cause of hypocalcemia in renal problems.

The nurse is caring for a 2-month-old infant who is at risk for cerebral palsy (CP) due to extreme low birth weight and prematurity. His parents ask why a speech therapist is involved in his care. Select the nurse's best response. 1. "Your baby is likely to have speech problems because of his early birth. Involving the speech therapist now will ensure vocalization at a developmentally appropriate age." 2. "The speech therapist will help with tongue and jaw movements to assist with babbling." 3. "The speech therapist will help with tongue and jaw movements to assist with feeding." 4. "Many members of the health-care team are involved in your child's care so that we will know if there are any unmet needs."

1. The nurse cannot assume that the child will have speech difficulties. Speech therapy does not guarantee vocalization at a developmentally appropriate age. 2. Although speech therapy will assist with babbling at a later age, its primary purpose is to assist with feeding. 3. It is important to involve speech therapy to strengthen tongue and jaw movements to assist with feeding. The infant whois at risk for CP may have weakened and uncoordinated tongue and jaw movements. 4. Members of a multidisciplinary team become involved in a child's care based on specific needs, not hospital routine. TEST-TAKING HINT: The test taker should immediately eliminate answer 4 because it does not consider the child's individual needs.

A child diagnosed with acute kidney injury (AKI) complains of "not feeling well," having "butterflies in the chest," and arms and legs "feeling like Jell-O." The cardiac monitor shows that the QRS complex is wider than it was and that an occasional premature ventricular contraction (PVC) is seen. Which would the nurse expect to administer? 1. An isotonic saline solution with 20 mEq KCl/L. 2. Sodium bicarbonate via slow intravenous push. 3. Calcium gluconate via slow intravenous push. 4. Oral potassium supplements.

1. The patient is demonstrating signs of hyperkalemia; therefore, intravenous potassium would be contraindicated 2. Sodium bicarbonate would be administered when metabolic acidosis is present. 3. Calcium gluconate is the drug of choice for cardiac irritability secondary to hyperkalemia. 4. The patient is demonstrating signs of hyperkalemia; therefore, oral potassium supplements would be contraindicated. TEST-TAKING HINT: The test taker should eliminate answers 1 and 4 because the patient is already showing signs of increased potassium levels.

Chronic hypertension in the child who has CKD is due to which of the following? 1. Retention of sodium and water. 2. Obstruction of the urinary system. 3. Accumulation of waste products in the body. 4. Generalized metabolic alkalosis.

1. The retention of sodium and water leads to hypertension. 2. Obstruction of the urinary system can lead to renal failure but is not a direct cause of hypertension. 3. The accumulation of waste products leads to metabolic acidosis. 4. In CKD, the body experiences a state of metabolic acidosis, not alkalosis. TEST-TAKING HINT: The test taker should eliminate answer 4 because metabolic alkalosis is not associated with CKD.

Which child requires continued follow-up because of behaviors suspicious of cerebral palsy (CP)? 1. A 1-month-old who demonstrates the startle reflex when a loud noise is heard. 2. A 6-month-old who always reaches for toys with the right hand. 3. A 14-month-old who has not begun to walk. 4. A 2-year-old who has not yet achieved bladder control during waking hours.

1. The startle reflex is expected in an infant 1-month-old. 2. The clinical characteristic of hemiplegia can be manifested by the early preference of one hand. This may be an early sign of CP. 3. Although many children walk before the age of 14 months, it is not considered a motor delay not to have achieved this milestone at this point. 4. Many 2-year-olds have not achieved bladder control. TEST-TAKING HINT: The test taker should be familiar with normal developmental milestones and eliminate answers 1, 3,and 4 because they are all developmentally appropriate.

The parents of a 6-week-old male ask the nurse if there is a difference between an inguinal hernia and a hydrocele. Which is the nurse's best response? 1. "The terms are used interchangeably and mean the same thing." 2. "The symptoms are similar, but an inguinal hernia occurs when tissue protrudes into the groin, whereas a hydrocele is a fluid-filled mass in the scrotum." 3. " 'Hydrocele' is the term used when an inguinal hernia occurs in females." 4. "A hydrocele presents in a manner similar to that of an inguinal hernia but causes increased concern because it is often malignant."

1. The terms are not used interchangeably. "Inguinal hernia" refers to protrusionof abdominal tissue into the groin, and "hydrocele" refers to a fluid-filled mass in the scrotum. 2. The symptoms are similar, but an inguinal hernia occurs when tissue protrudes into the groin; a hydrocele is a fluid-filled mass in the scrotum. 3. A hydrocele does not occur in females. 4. A hydrocele is not associated with an increased risk of malignancy. TEST-TAKING HINT: This question depends on knowledge of the definitions of "inguinal hernia" and "hydrocele."

Which needs to be present to diagnose hemolytic uremic syndrome (HUS)? 1. Increased red blood cells with a low reticulocyte count, increased platelet count, and renal failure. 2. Decreased red blood cells with a high reticulocyte count, decreased platelet count, and renal failure. 3. Increased red blood cells with a high reticulocyte count, increased platelet count, and renal failure. 4. Decreased red blood cells with a low reticulocyte count, decreased platelet count, and renal failure.

1. The triad in HUS includes decreased red blood cells (with a high reticulocyte count as the body attempts to produce more red blood cells), decreased platelet count, and renal failure. 2. The triad in HUS includes decreased red blood cells (with a high reticulocyte count as the body attempts to produce more red blood cells), decreased platelet count, and renal failure. 3. The triad in HUS includes decreased red blood cells (with a high reticulocyte count as the body attempts to produce more red blood cells), decreased platelet count, and renal failure. 4. The triad in HUS includes decreased red blood cells (with a high reticulocyte count as the body attempts to produce more red blood cells), decreased platelet count, and renal failure. TEST-TAKING HINT: The test taker can eliminate answers 1 and 3 because platelets are not increased in HUS.

The parents overhear the healthcare team refer to their child's disease as in stage III. The parents ask the nurse what this means. Which is the nurse's best response? 1. "The tumor is confined to the abdomen, but it has spread to the lymph nodes or peritoneal area; the prognosis is poor." 2. "The tumor is confined to the abdomen, but it has spread to the lymph nodes or peritoneal area; the prognosis is very good." 3. "The tumor has been found in three other organs beyond the peritoneal area; the prognosis is good." 4. "The tumor has spread to other organs beyond the peritoneal area; the prognosis is poor."

1. The tumor is confined to the abdomen but has spread to the lymph nodes or peritoneal area. The prognosis is still very good. 2. The tumor is confined to the abdomen but has spread to the lymph nodes or peritoneal area. The prognosis is still very good. 3. Stage III does not indicate that the tumor has spread to three other organs. 4. The tumor has not spread to other organs beyond the peritoneal area. This would represent stage IV, but with aggressive treatment the child would still have a good prognosis. TEST-TAKING HINT: The test taker should be led to answer 2 because this represents stage III.

A renal transplantation is which of the following? 1. A curative procedure that will free the child from any more treatment modalities. 2. An ideal treatment option for families with a history of dialysis noncompliance. 3. A treatment option that will free the child from dialysis. 4. A treatment option that is very new to the pediatric population.

1. There are extensive post-transplant care requirements. 2. This treatment option is not ideal for families with a history of noncompliance because there is extensive post-transplant care associated with the receipt of a kidney. 3. Renal transplantation frees the patient from dialysis. 4. Renal transplantation is not new to the pediatric population. TEST-TAKING HINT: The test taker should eliminate answer 1 because transplantation is a treatment, not a cure.

The nurse is caring for an infant with pyloric stenosis. The parent asks if any future children will likely have pyloric stenosis. Which is the nurse's best response? 1. "You seem worried; would you like to discuss your concerns?" 2. "It is very rare for a family to have more than one child with pyloric stenosis." 3. "Pyloric stenosis can run in families. It is more common among males." 4. "Although there can be a genetic link, it is very unusual for girls to have pyloric stenosis."

1. This approach sounds like the nurse is avoiding the parent's question. It would be better to offer the information and then ask about the parent's concerns. 2. It is not at all uncommon for a family to have multiple children with pyloric stenosis. 3. Pyloric stenosis can run in families, and it is more common in males. 4. Although pyloric stenosis occurs more often in males, it can occur in females, especially in siblings of a child with pyloric stenosis. TEST-TAKING HINT: The test taker needs to be familiar with pyloric stenosis.

Parents bring their 2-month-old into the clinic with concerns that the baby seems "floppy." The parents say the baby seems to be working hard to breathe, eats very slowly, and seems to fatigue quickly. The nurse assesses intercostal retractions, although the baby is otherwise in no distress. The parents add there was a cousin whose baby had similar symptoms. The nurse would be most concerned with which possible complication? 1. Respiratory compromise. 2. Dehydration. 3. Need for emotional support for the family. 4. Feeding intolerance.

1. This baby may have Werdnig-Hoffman disease, which is characterized by progressive generalized muscle weakness that eventually leads to respiratory failure. Respiratory compromise is the most important complication. 2. There is no history of being unable to ingest oral fluids; the baby is just a slow feeder. 3. This is important, but respiratory compromise is a priority in this situation. 4. There is no indication of feeding intolerance; the baby is just a slow feeder. TEST-TAKING HINT: Consider the ABCs in this situation: airway, breathing, and cardiac status. These are priorities when caring for clients.

A 3-year-old child with CP is admitted for dehydration following an episode of diarrhea. The nurse's assessment follows: awake; pale, thin child lying in bed; multiple contractures; drooling; coughing spells noted when parent feeds. T 97.8°F (36.5°C), P 75, R 25, weight 7.2 kg, no diarrheal stool for 48 hours. Which nursing diagnosis is most important? 1. Potential for skin breakdown: lying in one position. 2. Alteration in nutrition: less than body requirements. 3. Potential for impaired social support: parent sole caretaker. 4. Alteration in elimination: diarrhea.

1. This child is definitely at risk for skin breakdown, but alteration in nutrition is the priority. The child weighs 15 pounds, which is normal for a 4-month-old. The child is severely underweight. The parent needs help to manage the coughing spells while the child is being fed. 2. This child is severely underweightand malnourished for a 3-year-old.The coughing episodes while feeding put the child at risk for aspiration and pneumonia. A thorough history, physical examination, and a feeding study should be performed to determine whether it is even safe to feed the child orally. This is the priority nursing diagnosis for this severely underweight child. Weight is average for a 4-month-old. The coughing episodes while feeding may indicate aspiration. The parent needs help to learn how to feed so that less coughing occurs. 3. The parent needs support in caring for this child, but alteration in nutrition is the priority. The child weighs 15 pounds, which is normal for a 4-month-old. The child is severely underweight, and the parent needs help to manage the coughing spells while the child is being fed. 4. The child has not had a diarrheal stool for 48 hours, so the assumption is safe that the illness is over. The child weighs 15 pounds, which is normal for a 4-month-old. The child is severely underweight, and the parent needs help to manage the coughing spells while the child is being fed. TEST-TAKING HINT: The test taker should convert the weight in kilograms to pounds to have a better understanding of it. Knowing what a 3-year-old should weigh helps with answering this question.

The nurse is caring for a school-age child with Duchenne muscular dystrophy in the elementary school. Which would be an appropriate nursing diagnosis? 1. Anticipatory grieving. 2. Anxiety reduction. 3. Increased pain. 4. Activity intolerance.

1. This diagnosis would relate to the family and not to the child. 2. This diagnosis would relate to the family and not to the child. 3. The child does not have pain with the muscular dystrophy process. 4. The child would not be able to keep up with peers because of weakness, progressive loss of muscle fibers, and loss of muscle strength. TEST-TAKING HINT: Knowing that the child has decreased strength helps to answer the question.

A 15-year-old with spina bifida is seen in the clinic for a well-child checkup. The teen uses leg braces and crutches to ambulate. Which nursing diagnosis takes priority? 1. Potential for infection. 2. Alteration in mobility. 3. Alteration in elimination. 4. Potential body image disturbance.

1. This is certainly a possibility, especially as the teen uses braces and can have some skin irritation. 2. This is a nursing diagnosis that affects many aspects of the teen's life. Mobility is important in all aspects of their lives. Braces and crutches enable him to more fully participate in activities and maintain some degree of independence. 3. Because the teen is ambulatory, the teen probably has a lower-level defect, buteven lower-level defects have some type of elimination issues. 4. As an adolescent on crutches and wearing braces, the teen would have the issue of body image disturbance, which must be addressed after alteration in mobility. TEST-TAKING HINT: The test taker must know normal development.

Which can elicit the Gower sign? Have the child: 1. Close the eyes and touch the nose with alternating index fingers. 2. Hop on one foot and then the other. 3. Bend from the waist to touch the toes. 4. Walk like a duck and rise from a squatting position.

1. This is the Romberg sign, which measures balance. 2. This test measures balance and coordination. 3. This test measures flexibility. 4. Children with muscular dystrophy display the Gower sign, which is great difficulty rising and standing from a squatting position because of the lack of muscle strength. TEST-TAKING HINT: By eliminating cerebellar activities, the test taker would know that the Gower sign assists in measuring leg strength.

Which should the nurse do first when caring for an infant who just had a repair of a myelomeningocele? 1. Weigh diapers for 24-hour urine output. 2. Measure head circumference. 3. Offer clear fluids. 4. Assess for infection.

1. Weighing diapers for 24-hour urine output totals is important, but it is not the first thing to do following surgery. 2. Hydrocephalus occurs in about 90% of infants with myelomeningocele, so measuring the head circumference daily and watching for an increase are important. Accumulation of cerebrospinal fluid can occur after closure of the sac. 3. Clear fluids are offered after the infant is fully awake and there is no vomiting. 4. Assessing for infection is important, but infection is not usually seen in the initial postoperative period. TEST-TAKING HINT: The dynamics of the cerebrospinal fluid change after closure of the sac.

The mother of an infant diagnosed with Werdnig-Hoffmann disease asks the nurse what she could have done during her pregnancy to prevent this. The nurse explains that the cause of Werdnig-Hoffmann is which of the following? 1. Unknown. 2. Restricted movement in utero. 3. Inherited as an autosomal-recessive trait. 4. Inherited as an autosomal-dominant trait.

1. Werdnig-Hoffmann disease is inherited as an autosomal-recessive trait. There is an affected gene from both mother and father passed to the baby. 2. Werdnig-Hoffmann disease is inherited as an autosomal-recessive trait. There is an affected gene from both mother and father passed to the baby. 3. Werdnig-Hoffmann disease is inherited as an autosomal-recessive trait. There is an affected gene from both mother and father passed to the baby. 4. Werdnig-Hoffmann disease is inherited as an autosomal-recessive trait. There is an affected gene from both mother and father passed to the baby. TEST-TAKING HINT: The test taker needs to know how infants get this progressive disease.

A child diagnosed with a Wilms tumor is scheduled for an MRI scan of the lungs. The parent asks the nurse the reason for this test as a Wilms tumor involves the kidney, not the lung. Which is the nurse's best response? 1. "I'm not sure why your child is going for this test. I will check and get back to you." 2. "It sounds like we made a mistake. I will check and get back to you." 3. "The test is done to check to see if the disease has spread to the lungs." 4. "We want to check the lungs to make sure your child is healthy enough to tolerate surgery."

1. When the nurse is unsure of the answer, it is best to check and get back to the parents. The nurse should be aware that tests of other organs are often performed to evaluate for the presence of metastases. 2. The test is ordered to check for metastasis to the lungs. 3. The test is done to see if the disease has spread to the lungs. 4. A chest x-ray, not a magnetic resonance image, is ordered routinely to evaluate the health of the lungs prior to surgery. TEST-TAKING HINT: The test taker should be led to answer 3 because further testing evaluates metastasis to other organs.

The parent of a 3-year-old is shocked to hear the diagnosis of Wilms tumor and says, "How could I have missed a lump this big?" Which is the nurse's best response? 1. "Do not be hard on yourself. It's easy to overlook something that has probably been growing for months when we see our children on a regular basis." 2. "I understand you must be very upset. Your child would have had a better prognosis had you caught it earlier." 3. "It really takes a trained professional to recognize something like this." 4. "Do not blame yourself. This mass grows so fast that it was probably not noticeable a few days ago."

1. Wilms tumor grows very rapidly and doubles in size in less than 2 weeks. 2. This response places blame on the parent. Wilms tumor has a very good prognosis, even when first diagnosed at a more advanced stage. 3. This response is condescending and does not acknowledge the parent as the person who knows the child best. 4. The tumor is fast-growing and could very easily not have been evident a few days earlier. TEST-TAKING HINT: The test taker can eliminate answer 2 because the nurse should never cause the parent to feel guilt and responsibility over any diagnosis.

The nurse is caring for an infant with biliary atresia. The parents ask why the child is receiving cholestyramine. Which is the nurse's best response? 1. To lower the infant's cholesterol. 2. To relieve the infant's itching. 3. To help the infant gain weight. 4. To help feedings be absorbed in a more efficient manner.

1.Although cholestyramine is used to lower cholesterol, its primary purpose in the child with biliary atresia is to relieve pruritus. 2. The primary reason cholestyramine is administered to the child with biliary atresia is to relieve pruritus. 3. Cholestyramine is not administered to help the child gain weight. 4. Cholestyramine does not assist with the absorption of feedings. TEST-TAKING HINT: The test taker needs to consider the manifestations of the disease process when considering why medications are administered. The liver is unable to eliminate bile, which leads to intense pruritus.

Causes of autonomic dysreflexia include which of the following? Select all that apply. 1. Decrease in blood pressure. 2. Abdominal distention. 3. Bladder distention. 4. Diarrhea. 5. Tight clothing. 6. Hyperthermia.

2, 3, 5. 1. A decrease in blood pressure does not contribute to autonomic dysreflexia. Increased blood pressure usually occurs with autonomic dysreflexia. 2. Autonomic dysreflexia may be caused by abdominal pressure from a fecal impaction. 3. An distended bladder is usually the precipitating factor causing an increase in abdominal pressure. 4. Fecal impaction and constipation, not diarrhea, can be causes of autonomic dysreflexia. 5. Tight clothing can increase pressure to the central core of the body. 6. Hyperthermia does not cause autonomic dysreflexia. TEST-TAKING HINT: Autonomic dysreflexia most often occurs because of an irritating stimulus within the body below the level of spinal cord injury.

Which is true of a Wilms tumor? Select all that apply. 1. It is also referred to as neuroblastoma. 2. It can occur at any age but is seen most often between the ages of 2 and 5 years. 3. It can occur on its own or can be associated with many congenital anomalies. 4. It is a slow-growing tumor. 5. It is associated with a poor prognosis.

2, 3. 1. It is referred to as a nephroblastoma, not a neuroblastoma. 2. It can occur at any age but is seen most often between the ages of 2 and 5 years. 3. It can occur on its own or can be associated with many congenital anomalies. 4. It is a tumor that grows very quickly. 5. It is associated with a very good prognosis. TEST-TAKING HINT: The test taker would have to know about Wilms tumor to answer the question.

A parent of a newborn diagnosed with myelomeningocele asks what is/are common long-term complication(s)? The nurse's best response is which of the following? Select all that apply. 1. Learning disabilities. 2. Urinary tract infections. 3. Hydrocephalus. 4. Decubitus ulcers and skin breakdown. 5. Nutrition issues. 6. Attention deficit disorders

2, 3. 1. Some children with myelomeningocele experience learning disabilities, but it is not the most common complication. 2. Urinary tract infections are the most common complication of myelomeningocele. Nearly all children with myelomeningocele have a neurogenic bladder that leads to incomplete emptying of the bladder and subsequent urinary tract infections. Frequent catheterization also increases the risk of urinary tract infection. 3. About 90% to 95% of children with myelomeningocele experience hydrocephalus. 4. Children with myelomeningocele are at risk for skin breakdown and decubitus ulcers, but they are not the most common complications. 5. Nutrition issues can occur, but are not the most common complication. 6. Attention deficit disorders can occur, but are not the most common complications. TEST-TAKING HINT: The test taker needs to be familiar with the complications of myelomeningocele. Neurogenic bladder and hydrocephalus are the most common complications, so the test taker should be led to select answers 2 and 3.

The nurse is performing an admission assessment on a 9-year-old who has just been diagnosed with systemic lupus erythematosus. Which assessment findings should the nurse expect? Select all that apply. 1. Headaches and nausea. 2. Fever, malaise, and weight loss. 3. A papular rash covering the trunk and face. 4. Abdominal pain and dysuria. 5. Joint pain, proteinuria, and lymphadenopathy.

2, 5. 1. Neuropsychiatric symptoms include difficulty concentrating in school and emotional instability. 2. Fever, malaise, and weight loss are common presenting signs. 3. A rash is common, but with lupus it is usually a "butterfly" rash across the bridge of the nose. Maculopapular rashes are common but are usually on sun-exposed areas. 4. Lupus nephritis requires urine output monitoring and is usually asymptomatic. 5. Joint pain, proteinuria, and lymphadenopathy are common presenting symptoms in children. TEST-TAKING HINT: The test taker must know the presenting signs and symptoms of systemic lupus erythematosus.

When assessing the neurological status of an 8-month-old, the nurse should check for which of the following? Select all that apply. 1. Clarity of speech. 2. Interaction with staff. 3. Vision test. 4. Romberg test. 5. Ability to roll over and sit independently.

2, 5. 1. The infant is preverbal, so assessing clarity of speech is not age-appropriate or developmentally appropriate. 2. Assessment for alteration in developmentally expected behaviors, such as stranger anxiety, is helpful. Interaction with staff is not to be expected due to stranger anxiety. 3. Vision testing is not the priority assessment. 4. An 8-month-old infant is not tested with the Romberg test. 5. Sitting and rolling over are two skills that an 8-month-old infant should be able to accomplish. TEST-TAKING HINT: The test taker must know what is appropriate infant development.

Which should the nurse expect in a 2-week-old with a brachial plexus injury? Select all that apply. 1. History of a normal vaginal delivery. 2. Small infant. 3. Absent Moro reflex on one side. 4. No sensory loss. 5. Associated clavicle fracture.

3, 4, 5. 1. A brachial plexus injury in an infant (resulting from tearing or stretching of a nerve) usually occurs with large babies and breech delivery. 2. A brachial plexus injury in an infant (resulting from tearing or stretching of a nerve) usually occurs with large babies and breech delivery. 3. The infant will have an absent Moro reflex on one side and no sensory loss. 4. The infant will have an absent Moro reflex on one side and no sensory loss. 5. The injury may be associated with a fractured clavicle. TEST-TAKING HINT: The test taker must know what a brachial plexus is and how an injury would affect it.

The nurse judges teaching as successful when the parent of a child with myasthenia gravis states which of the following? Select all that apply. 1. "My child should play on the school's basketball team." 2. "My child should meditate every day." 3. "My child should be allowed to do what other kids do." 4. "My child should be watched carefully for signs of illness." 5. "My child should sleep in my room so that I can watch him better."

3, 4. 1. Children with myasthenia gravis should not play strenuous sports. The increased stress from being in a competitive sport tends to negatively impact children, and they should learn strategies to decrease stress. 2. It is important that children with myasthenia gravis have activities they can participate in without causing stress. Activities such as board games, horseback riding, and hiking should be encouraged. Some children would benefit from meditation but may take time to appreciate the results. 3. Children with myasthenia gravis can do many things other children do. They should be advised not to play strenuous sports, and they should learn how to control stress. 4. Children are watched for signs of illness because of the exacerbation of signs of myasthenia gravis. 5. It's not recommended that children sleep in the same bedroom as their parents unless it can't be avoided. TEST-TAKING HINT: The test taker must know the physiology of the illness and consider that this is a chronic disease. The child is first a child, so he will have all the growth and development issues children without a chronic disease have.

Which should the nurse expect as an intervention in a child in the recovery phase of GBS? Select all that apply. 1. Assist with self-feeding skills. 2. Assist with grooming and dressing. 3. Arrange for in-home schooling. 4. Begin an active physical therapy program. 5. Begin active PT.

3, 5. 1. Referral to OT would have been done depending on the degree of fine motor involvement. 2. Because grooming and dressing are life skills the child may need to relearn, referral to PT would be appropriate and done earlier in the course of treatment. 3. Working with the child's teacher and the school staff to keep the child at the same pace as his classmates is crucial for the healthy recovery of the child. 4. GBS does not affect cognitive functioning. 5. Beginning active physical therapy is important for helping muscle recovery and preventing contractures. TEST-TAKING HINT: The test taker must know the normal progress of the disease, which may take weeks or months for recovery to occur. A hint is provided by the word "recovery" in the question.

Which should a nurse in the ED be prepared for in a child with a possible spinal cord injury? Select all that apply. 1. Severe pain. 2. Elevated temperature. 3. Respiratory depression. 4. Increased intracranial pressure. 5. Multiple sites of injury.

3, 5. 1. Severe pain is unlikely, but the child may have pain at the injury site. 2. An elevated temperature is not common in a spinal cord injury. In fact, most trauma patients are hypothermic in spite of high ambient temperatures. 3. A spinal cord injury can occur at any level. The higher the level of the injury, the more likely the child is to have respiratory insufficiency or failure. The nurse should be prepared to support the child's respiratory system. 4. Spinal cord injury with an open or closed head injury does not cause an increase in intracranial pressure. 5. The nurse should expect that the child may have multiple injury sites as many spinal cord injuries are the result of trauma from falls from heights, violence, or sporting injuries. A complete head- to-toe assessment of the child should be performed. TEST-TAKING HINT: The test taker must know the signs of a spinal cord injury.

Which signs best indicate increased intracranial pressure (ICP) in an infant? Select all that apply. 1. Sunken anterior fontanel. 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite. 5. Sleeping more than usual.

3, 5. 1. The anterior fontanel is usually raised and bulging in infants with increased ICP. 2. The infant is not able to comprehend blurred vision or make any statements. 3. A high-pitched cry is often indicative of increased ICP in infants. 4. The infant with increased ICP usually has a poor appetite and does not feed well. 5. The infant may be sleeping more than usual because of increased ICP. TEST-TAKING HINT: The test taker needs to be familiar with hydrocephalus and how increased ICP is manifested in infants. Answer 2 can be eliminated because an infant cannot specifically verbalize.

A 6-month-old male has been diagnosed with positional brachycephaly. The nurse is providing teaching about the use of a helmet for his therapy. Which statement indicates that the parents understand the education? Select all that apply. 1. "We will keep the helmet on him when he is awake and remove it only for bathing and sleeping." 2. "He will start wearing the helmet when he is closer to 9 months because he will be more upright and mobile." 3. "He will wear the helmet 23 hours every day." 4. "Most children need to wear the helmet for 6 to 12 months." 5. "Most children gain some improvement."

3, 5. 1. The infant needs to wear the helmet 23 hours daily. It is removed for bathing but not sleeping. 2. The helmet is most effective when the child is younger because the bones in the skull are more malleable. The child is less likely to need the helmet when upright and mobile because there is less pressure in one area. 3. The helmet is worn 23 hours every day and removed only for bathing. 4. Most children wear the helmet for 3 months. 5. Most children gain some improvement from a helmet. TEST-TAKING HINT: The test taker should recognize that the helmet is worn 23 hours daily and can eliminate answer 1.

The nurse should tell the parents of a child with Duchenne (pseudohypertrophic) muscular dystrophy that some of the progressive complications include: Select all that apply. 1. Dry skin and hair, hirsutism, protruding tongue, and mental retardation. 2. Anorexia, gingival hyperplasia, dry skin and hair. 3. Contractures, obesity, and pulmonary infections. 4. Trembling, frequent loss of consciousness, and slurred speech. 5. Increasing difficulty swallowing and shallow breathing.

3, 5. 1. These symptoms are common with Down syndrome. 2. Duchenne muscular dystrophy does not produce these symptoms. 3. The major complications of muscular dystrophy include contractures, disuse atrophy, infections, obesity, respiratory complications, and cardiopulmonary problems. 4. These symptoms are evidence of a possible head injury. 5. The muscles of a child with MD tend to show increasing weakness and atrophy over time. The children are at risk for swallowing, aspiration, and pneumonia. TEST-TAKING HINT: The test taker should be able to identify signs and symptoms attributable to the loss of muscle function.

Which should the nurse include in the plan of care to decrease symptoms of gastroesophageal reflux (GER) in a 2-month-old? Select all that apply. 1. Place the infant in an infant seat immediately after feedings. 2. Place the infant in the prone position immediately after feeding to decrease the risk of aspiration. 3. Encourage the parents not to worry because most infants outgrow GER within the first year of life. 4. Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding. 5. Suggest that the parents burp the infant after every 1-2 ounces consumed.

4, 5. 1. Placing the infant in an infant seat increases intra-abdominal pressure, putting the infant at increased risk for GER. 2. The prone position is not recommended because it may lead to sudden infant death syndrome (SIDS). 3. Although most infants outgrow GER, providing the parents with this education will not help decrease the symptoms. 4.. Keeping the infant in an upright position is the best way to decrease the symptoms of GER. The infant can also be placed in the supine position with the head of the crib elevated. A harness can be used to keep the child from sliding down. 5. Burping the infant frequently may help decrease spitting up by expelling air from the stomach more often TEST-TAKING HINT: The test taker may be led to answer 3. However, the question is looking for ways to decrease reflux. Although decreasing parental anxiety may help decrease reflux, the better answers are 4 and 5 because they are more likely to be part of an effective management plan.

The nurse is caring for a 4-month-old who has just had an isolated cleft lip repaired. Select the best position for the child in the immediate post-operative period. 1. Right side-lying. 2. Left side-lying. 3. Supine. 4. Prone.

1. The infant may rub the face on the bedding if positioned on the side. 2. The infant may rub the face on the bedding if positioned on the side. 3. The supine position is preferred because there is decreased risk of the infant rubbing the suture line. 4. The infant may rub the face on the bedding if positioned on the abdomen. TEST-TAKING HINT: The test taker should be led to answer 3 because it is the only option in which the suture line is not at increased risk for injury.

Which child may need extra fluids to prevent dehydration? Select all that apply. 1. A 7-day-old receiving phototherapy. 2. A 6-month-old with newly diagnosed pyloric stenosis. 3. A 2-year-old with pneumonia. 4. A 2-year-old with full-thickness burns to the chest, back, and abdomen. 5. A 13-year-old who has just started her menses.

1, 2, 3, 4. 1. The lights in phototherapy increase insensible fluid loss, requiring the nurse to monitor fluid status closely. 2. The infant with pyloric stenosis is likely to be dehydrated as a result of persistent vomiting. 3. A 2-year-old with pneumonia may have increased insensible fluid loss as a result of tachypnea associated with respiratory illness. The nurse needs to monitor fluid status cautiously because fluid overload can result in increased respiratory distress. 4. The child with a burn experiences extensive extracellular fluid loss and is at great risk for dehydration. The younger child is at greater risk because of greater proportionate body surface area. 5. An adolescent starting her menses is not at risk for dehydration. TEST-TAKING HINT: The test taker needs to know that an infant needing phototherapy, an infant with persistent vomiting, a child with pneumonia, and a child with burns require more fluids because of the risk of dehydration.

Which should be included in the plan of care for a 14-month-old whose cleft palate was repaired 12 hours ago? Select all that apply. 1. Allow the infant to have familiar items of comfort such as a favorite stuffed animal and a "sippy" cup. 2. Once liquids have been tolerated, encourage a bland diet such as soup, Jell-O, and saltine crackers. 3. Administer pain medication on a regular schedule, as opposed to an as-needed schedule. 4. Use a Yankauer suction catheter on the infant's mouth to decrease the risk of aspiration of oral secretions. 5. When discharged, remove elbow restraints.

1, 3. 1. The child should not be allowed to use anything that creates suction in the mouth, such as pacifiers or straws. "Sippy" cups are acceptable. 2. The child should not have anything hard in the mouth, such as crackers, cookies, or a spoon. 3. Pain medication should be administered regularly to avoid crying, which places stress on the suture line. 4. A Yankauer suction should not be used in the mouth because it creates suction and is a hard instrument that could irritate the suture line. The child should be positioned to allow secretions to drain out of the child's mouth. Suction should be used only in the event of an emergency. 5. Elbow restraints are used until the repaired palate has healed. When at home, the parents need to monitor the child closely if restraints are removed to move the arms or for bathing. TEST-TAKING HINT: The child who has had a cleft palate repair should have nothing in the mouth that could irritate the suture line. Answers 2 and 4 can be eliminated.

The parents of a child with glomerulonephritis ask how they will know their child is improving after they go home. Which are the nurse's best responses? Select all that apply. 1. "Your child's urine output will increase, and the urine will become less tea-colored." 2. "Your child will have more energy as lab tests become more normal." 3. "Your child's appetite will decrease as urine output increases." 4. "Your child's laboratory values will become more normal." 5. "Your child's weight will increase as the urine becomes less tea-colored."

1, 5. 1. When glomerulonephritis is improving, urine output increases, and the urine becomes less tea-colored. These are signs that can be monitored at home by the child's parents. 2. As glomerulonephritis improves, the child should have more energy and require less rest, but lab test values are not something that will be readily apparent to the family at home. 3. The child's appetite should increase as the condition improves. 4. Although the laboratory test values will normalize, this is not something that will be readily apparent to the family at home. 5. The child's weight will increase as the urine resumes a more normal color, indicating lab values are returning to normal and the child is better. TEST-TAKING HINT: The test taker should be led to answers 1 and 5 because the manifestations represent improvement in the disease process that can be easily recognized by the parents.

In addition to increased blood pressure, which findings would most likely be found in a child with hydronephrosis? 1. Metabolic alkalosis and positive renal ultrasound. 2. Metabolic acidosis and negative renal ultrasound. 3. Metabolic alkalosis and bacterial growth in the urine. 4. Metabolic acidosis, polydipsia, and polyuria.

1. A positive renal ultrasound would indicate a blockage, causing hydronephrosis. 2. Metabolic acidosis occurs, not alkalosis. Metabolic acidosis occurs because there is a reduction in hydrogen ion secretion from the distal nephron. A positive renal ultrasound would indicate a blockage, causing hydronephrosis. 3. Metabolic acidosis, not alkalosis, occurs because there is a reduction in hydrogen ion secretion from the distal nephron. There is bacterial growth in the urine due to the urinary stasis caused by the obstruction. 4. Metabolic acidosis is caused by a reduction in hydrogen ion secretion from the distal nephron. Polydipsia and polyuria occur as the kidney's ability to concentrate urine decreases. There is bacterial growth in the urine due to the urinary stasis caused by the obstruction. TEST-TAKING HINT: The test taker can eliminate answers 1 and 3 because hydronephrosis does not lead to metabolic alkalosis.

Which is the best way to obtain a urine sample in an 8-month-old being evaluated for a urinary tract infection (UTI)? 1. Carefully cleanse the perineum from front to back and apply a self-adhesive urine collection bag to the perineum. 2. Insert an indwelling Foley catheter, obtain the sample, and wait for results. 3. Place a sterile cotton ball in the diaper and immediately obtain the sample with a syringe after the first void. 4. Using a straight catheter, obtain the sample and immediately remove the catheter without waiting for the results of the urine sample.

1. A sample obtained from a urine bag would contain microorganisms from the skin, causing contamination of the sample. 2. There is no need to leave the catheter in because it serves as a portal for infection. 3. The cotton ball would not remain sterile and would therefore contaminate the urine sample. 4. An in-and-out catheterization is the best way to obtain a urine culture in a child who is not yet toilet-trained. TEST-TAKING HINT: The test taker can eliminate answers 1 and 3 because they both lead to a contaminated sample.

The nurse is caring for a 3-month-old being evaluated for possible Hirschsprung disease. His parents call the nurse and show her his diaper containing a large amount of mucus and bloody diarrhea. The nurse notes that the infant is irritable and his abdomen appears very distended. Which should be the nurse's next action? 1. Reassure the parents that this is an expected finding and not uncommon. 2. Call a code for a potential cardiac arrest and stay with the infant. 3. Immediately obtain all vital signs with a quick head-to-toe assessment. 4. Obtain a stool sample for occult blood.

1. All cases of bloody diarrhea need to be evaluated because this may be a sign of enterocolitis, which is a potentially fatal complication of Hirschsprung disease. 2. Although this is a potentially critical complication, calling a code is not necessary at this time because the infant is irritable and not unconscious. 3. All vital signs need to be evaluated because the child with enterocolitis can quickly progress to a state of shock.A quick head-to-toe assessment will allow the nurse to evaluate the child's circulatory system. 4. It is not a priority to test the stool for occult blood, because there is obvious blood in the sample. TEST-TAKING HINT: The test taker should select answer 3 because there is not enough information to determine the status of the child. Obtaining vital signs will help the nurse to assess the situation.

Which would the nurse expect to be included to make the diagnosis of celiac disease in a child? 1. Obtain complete blood count and serum electrolytes. 2. Obtain complete blood count and stool sample; keep child NPO. 3. Obtain stool sample and prepare child for jejunal biopsy. 4. Obtain complete blood count and serum electrolytes; monitor child's response to gluten-containing diet.

1. Although a blood count and serum electrolyte evaluation will likely be included in the child's evaluation, the diagnosis cannot be confirmed without a stool sample and jejunal biopsy. 2. The child is not usually kept NPO but is monitored to assess the response to the gluten-free diet. 3. A stool sample for analysis of fat and a jejunal biopsy can confirm the diagnosis. 4. The child's response to a gluten-free diet is monitored. TEST-TAKING HINT: The test taker should eliminate answers 1, 2, and 4 because they do not include preparing the child for a jejunal biopsy, which is the key to a definitive diagnosis of celiac disease.

The nurse is providing discharge instructions to the parents of an infant who has had surgery to open a low imperforate anus. The nurse knows that the discharge instructions have been understood when the child's parents say: 1. "We will use an oral thermometer because we cannot use a rectal one." 2. "We will call the health-care provider if the stools change inconsistency." 3. "Our infant will never be toilet-trained." 4. "We understand that it is not unusual for our infant's urine to contain stool."

1. Although a rectal thermometer should never be used in a child with an anorectal malformation, an oral thermometer should not be used in an infant or young child. 2. A change in stool consistency is important to report because it could indicate stenosis of the rectum. 3. The child with a low anorectal malformation should be capable of achieving bowel continence. 4. Any stool in the urine should be reported because it indicates a fistula is present. TEST-TAKING HINT: The test taker should eliminate answer 3 as it contains the word "never." There are very few circumstances in health care in which "never" is the case.

The nurse is to receive a 4-year-old from the recovery room after an appendectomy. The parents have not seen the child since surgery and ask what to expect. Which is the nurse's best response? 1. "Your child will be very sleepy, have an intravenous line in the hand, and have a nasal tube to help drain the stomach. If your child needs pain medication, it will be given intravenously." 2. "Your child will be very sleepy, have an intravenous line in the hand, and have white stockings to help prevent blood clots. If your child needs pain medication, we will give it intravenously or provide a liquid to swallow." 3. "Your child will be wide awake and will have an intravenous line in the hand. If your child needs pain medication, we will give it intravenously or provide a liquid to swallow." 4. "Your child will be very sleepy and have an intravenous line in the hand. If your child needs pain medication, we will give it intravenously."

1. An NGT is not needed when an appendix has not ruptured. 2. Anti-embolic stockings are not used in children this young, who will likely be moving the lower extremities and ambulating. 3. The child in the immediate postoperative period is usually not wide awake. 4. In the immediate postoperative period, the child is usually sleepy but can be roused. The child usually has an intravenous line for hydration and pain medication. TEST-TAKING HINT: The test taker should eliminate answer 1 because NGTs are not used unless the appendix has ruptured. Answer 2 can also be eliminated because a 4-year-old who is post appendectomy is not at risk for blood clots.

A 13-month-old is discharged following repair of his epispadias. Which statement made by the parents indicates they understand the discharge teaching? 1. "If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage." 2. "If a mucous plug forms in the urinary drainage tube, we will allow it to pass on its own because this is a sign of healing." 3. "We will make sure the dressing is loosely applied to increase the toddler's comfort." 4. "If we notice any yellow drainage, we will know that everything is healing well."

1. Any mucous plugs should be removed by irrigation to prevent blockage of the urinary drainage system. 2. The mucous plug should be removed by irrigation because it could cause a blockage of the urinary drainage system. 3. The dressing is usually a compression type of dressing that helps decrease edema. 4. Foul-smelling yellow drainage is often a sign of infection that needs to be evaluated. TEST-TAKING HINT: The test taker can eliminate answers 2 and 4 because they have potential to cause injury to the child.

A child with hemolytic uremic syndrome (HUS) is very pale and lethargic. Stools have progressed from watery to bloody diarrhea. Blood work indicates low hemoglobin and hematocrit levels. The child has not had any urine output in 24 hours. The nurse expects administration of blood products and what else to be added to the plan of care? 1. Initiation of dialysis. 2. Close observation of the child's hemodynamic status. 3. Diuretic therapy to force urinary output. 4. Monitoring of urinary output.

1. Because the child is symptomatic, dialysis is the treatment of choice. 2. Because the child is symptomatic, dialysis is the treatment of choice. 3. Diuretics are given to prevent fluid overload, but they cannot cause the child in renal failure to produce urine. 4. The nurse would expect the plan to include dialysis because the child is no longer producing urine. Urinary output would still be monitored. TEST-TAKING HINT: The test taker can eliminate answer 3 because diuretics will not cause a child in renal failure to produce urine. The nurse can expect urine output (or lack thereof) to be monitored and dialysis to be started.

Which protrusion into the groin of a female most likely causes inguinal hernias? 1. Bowel. 2. Fallopian tube. 3. Large thrombus formation. 4. Muscle tissue.

1. Bowel is the most common tissue to protrude into the groin in males. 2. Fallopian tube or an ovary is the most common tissue to protrude into the groin in females. 3. Large thrombus formation does not commonly protrude into the groin. 4. Muscle tissue does not commonly protrude into the groin. TEST-TAKING HINT: The test taker should be led to answer 2 because the question specifically states that the child is a female.

A 5-year-old is discharged from the hospital following the diagnosis of hemolytic uremic syndrome (HUS). The child has been free of diarrhea for 1 week, and renal function has returned. The parent asks the nurse when the child can return to school. Which is the nurse's best response? 1. "Immediately, as your child is no longer contagious." 2. "It would be best to keep your child home for a few more weeks because the immune system is weak, and there could be a relapse of HUS." 3. "Your child will be contagious for approximately another 10 days, so it is best to not allow a return just yet." 4. "It would be best to keep your child home to monitor urinary output."

1. Children with HUS are considered contagious for up to 17 days after the resolution of diarrhea and should be placed on contact isolation. 2. Once the child recovers from HUS, there is usually no relapse. 3. Children with HUS are considered contagious for up to 17 days after the resolution of diarrhea and should be placed on contact isolation. 4. Once free of diarrhea for approximately 17 days, the child is considered not to be contagious and should be encouraged to return to developmentally appropriate activities as tolerated. TEST-TAKING HINT: The test taker can eliminate answer 1 because the child is still considered contagious.

The nurse is caring for an infant who has been diagnosed with short bowel syndrome (SBS). The parent asks how the disease will affect the child. Which is the nurse's best response? 1. "Because your child has a shorter intestine than most, your child will likely experience constipation and will need to be placed on a bowel regimen." 2. "Because your child has a shorter intestine than most, he will not be able to absorb all the nutrients and vitamins in food and will need to get nutrients in other ways." 3. "Unfortunately, most children with this diagnosis do not do very well." 4. "The prognosis and course of the disease have changed because hyperalimentation is available."

1. Children with SBS experience diarrhea, not constipation. 2. Because the intestine is used for absorption, children with SBS usually need alternative forms of nutrition such as hyperalimentation. 3. Without knowing how much intestine is involved, the nurse cannot make this assumption about prognosis and should not share this information with the infant's parents. 4. It is therapeutic to acknowledge the parents' concern. Without knowing the parents' knowledge base, this response may or may not be above the level of their comprehension. TEST-TAKING HINT: The test taker should eliminate answer 1 because it is false. Answer 3 can also be eliminated because it makes a generalization that should not be made without knowing the details of the child's diagnosis.

Which finding requires immediate attention in a child with glomerulonephritis? 1. Sleeping most of the day and being very "cranky" when awake; blood pressure is 170/90. 2. Urine output is 190 mL in an 8-hour period and is the color of Coca-Cola. 3. Complaining of a severe headache and photophobia. 4. Refusing breakfast and lunch and stating he "just is not hungry."

1. Children with glomerulonephritis usually have an elevated blood pressure and tend to rest most of the day. 2. The urine output is often decreased, and the urine is often tea-colored due to hematuria. 3. A severe headache and photophobia can be signs of encephalopathy due to hypertension, and the child needs immediate attention. 4. Anorexia is often seen with glomerulonephritis. TEST-TAKING HINT: The test taker should eliminate answers 1, 2, and 4 because they are manifestations of glomerulonephritis.

A 4-month-old is brought to the emergency department with severe dehydration. The heart rate is 198, and her blood pressure is 68/38. The infant's anterior fontanel is sunken. The nurse notes that the infant does not cry when the intravenous lineis inserted. The child's parents state that she has not "held anything down" in 18 hours. The nurse obtains a finger-stick blood sugar of 94. Which would the nurse expect to do immediately? 1. Administer a bolus of normal saline. 2. Administer a bolus of D10W. 3. Administer a bolus of normal saline with 5% dextrose added to the solution. 4. Offer the child an oral rehydrating solution such as Pedialyte.

1. Dehydration is corrected with the administration of an isotonic solution, such as normal saline or lactated Ringer solution. 2. Solutions containing dextrose should never be administered in bolus form because they may result in cerebral edema. 3. Solutions containing dextrose should never be administered in bolus form because they may result in cerebral edema. 4. Severe dehydration is not usually corrected with oral solutions; children with altered levels of consciousness should be kept NPO. TEST-TAKING HINT: The test taker should immediately eliminate answers 2 and 3 because they both suggest administering glucose in bolus form, which is always contraindicated in pediatric clients. Answer 4 should be eliminated because the infant is severely dehydrated and not responding to painful stimulation, which is suggested by the lack of a cry on intravenous insertion.

Which child can be discharged without further evaluation? 1. A 2-year-old who has had 24 hours of watery diarrhea that has changed to bloody diarrhea in the past 12 hours. 2. A 3-year-old who had a relapse of one diarrhea episode after restarting a normal diet. 3. A 6-year-old who has been having vomiting and diarrhea for 2 days and has decreased urine output. 4. A 10-year-old who has just returned from a Scout camping trip and has had several episodes of diarrhea.

1. Diarrhea containing blood needs further evaluation to determine the source of the blood, and the child's blood counts and electrolyte balance need to be tested. 2. It is common for children to have a relapse of diarrhea after resuming a regular diet. 3. Children who have had vomiting and diarrhea for more than 2 days require evaluation to determine whether IV rehydration and hospital admission are necessary. 4. Diarrhea following a camping trip needs further evaluation because it may be caused by bacteria or parasites. TEST-TAKING HINT: The test taker should eliminate answers 1 and 3 because they describe children who may have altered electrolytes and blood counts due to prolonged diarrhea.

The nurse is caring for a newborn with a cleft lip and palate. The mother states, "I will not be able to breastfeed my baby." Which is the nurse's best response? 1. "It sounds like you are feeling discouraged. Would you like to talk about it?" 2. "Sometimes breastfeeding is still an option for babies with a cleft lip and palate. Would you like more information?" 3. "Although breastfeeding is not an option, you can pump your milk and then feed it to your baby with a special nipple." 4. "We usually discourage breastfeeding babies with cleft lip and palate as it puts them at an increased risk for aspiration."

1. Encouraging parents to express their feelings is important, but it is more appropriate to give the parents information on breastfeeding. 2. Some mothers are able to breastfeed their infants who have a cleft lip and palate. The breast can help fill in the cleft and help the infant create suction. 3. Breastfeeding is sometimes an option. 4. Breastfeeding does not increase the risk of aspiration among infants with a cleft lip and palate. TEST-TAKING HINT: The test taker should be led to select answer 2 because the breast can sometimes act to fill in the cleft.

The nurse is caring for a 2-year-old child who was admitted to the pediatric unit for moderate dehydration due to vomiting and diarrhea. The child is restless with periods of irritability. The child is afebrile with a heart rate of 148 and a blood pressure of 90/42. Baseline laboratory tests reveal the following: Na 152, Cl 119, and glucose 115. The parents state that the child has not urinated in 12 hours. After establishing a saline lock, the nurse reviews the physician's orders. Which order should the nurse question? 1. Administer a saline bolus of 10 mL/kg, which may be repeated if the child does not urinate. 2. Recheck serum electrolytes in 12 hours. 3. After the saline bolus, begin maintenance fluids of D5 1⁄4 NS with 10 mEq KCl/L. 4. Give clear liquid diet as tolerated.

1. Fluid boluses of normal saline are administered according to the child's body weight. It is not unusual to have to repeat the bolus multiple times in order to see an improvement in the child's condition. 2. It is important to monitor serum electrolytes frequently in the dehydrated child. 3. Potassium is contraindicated because the child has not yet urinated. Potassium is not added to the maintenance fluid until kidney function has been verified. 4. The child with dehydration secondary to vomiting and diarrhea is placed on a clear liquid diet. TEST-TAKING HINT: Be aware of the usual ways in which dehydration is treated. Answer 3 should be selected because the description states that the child has not urinated.

Which should be included in the plan of care for a child diagnosed with hydronephrosis? 1. Intake and output as well as vital signs should be strictly monitored. 2. Fluids and sodium in the diet should be limited. 3. Steroids should be administered as ordered. 4. Limited contact with other people to avoid infection.

1. Fluid status is monitored to ensure adequate urinary output. Assessing blood pressure monitors kidney function. 2. Fluid and sodium restriction are not required in hydronephrosis. 3. Steroids are not routinely used in the treatment of hydronephrosis. 4. Limiting the child's exposure to other people does not help prevent UTIs. TEST-TAKING HINT: The test taker can eliminate answer 2 because fluids and sodium are not limited in the child's diet.

The nurse receives a call from the parent of a 10-month-old who has vomited three times in the past 8 hours. The parent describes the baby as playful and wantingto drink. The parent asks the nurse what to give the child. Select the nurse's best response. 1. "Replace the next feeding with regular water, and see if that is better tolerated." 2. "Do not allow your baby to eat any solids; give half the normal formula feeding, and see if that is better tolerated." 3. "Do not let your baby eat or drink anything for 24 hours to give the stomach a chance to rest." 4. "Give your child 1⁄2 ounce of Pedialyte every 10 minutes. If vomiting continues, wait an hour, and then repeat what you previously gave."

1. Free water should not be given because it does not contain any electrolytes and can lead to critical electrolyte imbalances. 2. Formula should be avoided, and clear liquids such as Pedialyte should be offered. 3. Twenty-four hours is too long for the infant to remain NPO. The infant needs to drink a rehydration solution such as Pedialyte in order to avoid severe dehydration. 4. Offering small amounts of clear liquids is usually well tolerated. If the child vomits, make NPO for an hour to allow the stomach to rest and then restart fluids. The child in this scenario is described as playful and therefore does not appear to be at risk for dehydration. TEST-TAKING HINT: The test taker should eliminate answers 1 and 3 because they could cause harm to the infant.

Which medication would most likely be included in the postoperative care of a child with repair of bladder exstrophy? 1. Furosemide (Lasix). 2. Mannitol. 3. Meperidine (Demerol). 4. Oxybutynin (Ditropan).

1. Furosemide (Lasix) is a loop diuretic that is not routinely used in the care of the child with a repair of bladder exstrophy. 2. Mannitol is an osmotic diuretic that is not routinely used in the care of the child with a repair of bladder exstrophy. 3. Meperidine (Demerol) is a narcotic that is not a first-line drug for pain management after a bladder reconstruction. 4. Oxybutynin (Ditropan) is used to help control bladder spasms. TEST-TAKING HINT: The test taker can eliminate answer 2 because mannitol is a diuretic that is used for central nervous system edema.

Which child does not need a urinalysis to evaluate for a urinary tract infection (UTI)? 1. A 4-month-old female presenting with a 2-day history of fussiness and poor appetite; current vital signs include axillary T 100.8°F (38.2°C), HR 120 beats per minute. 2. A 4-year-old female who states, "It hurts when I pee"; she has been urinating every 30 minutes; vital signs are within normal range. 3. An 8-year-old male presenting with a finger laceration; mother states he had surgical re-implantation of his ureters 2 years ago. 4. A 12-year-old female complaining of pain to her lower right back; she denies any burning or frequency at this time; oral temperature of 101.5°F (38.6°C).

1. Fussiness and lack of appetite can indicate a UTI. Signs of infection, such as fever and increased heart rate, should be evaluated to determine whether an infection exists. 2. Frequency and urgency are classic signs of a UTI. 3. Although this child has had a history of urinary infections, the child is currently not displaying any signs and therefore does not need a urinalysis at this time. 4. Pain to the lower right back can indicate infection of the upper urinary tract. Although the child currently denies any burning or frequency, the child currently has a fever coupled with flank pain, which needs evaluation. TEST-TAKING HINT: The test taker should be led to answer 3 because it states that the child is not currently having any manifestations of a UTI.

The nurse is caring for a 4-month-old with gastroesophageal reflux (GER). The infant is due to receive rantadine (Zantac). Based on the medication's mechanism of action, when should this medication be administered? 1. Immediately before a feeding. 2. 30 minutes after the feeding. 3. 30 minutes before the feeding. 4. At bedtime.

1. If rantadine (Zantac) is administered immediately before a feeding, the medication will not have enough time to take effect. 2. This medication should be administered prior to a feeding to be effective. 3. Rantadine (Zantac) decreases gastric acid secretion and should be administered 30 minutes before a feeding. 4. This medication should be administered prior to a feeding to be effective. TEST-TAKING HINT: The test taker needs to be familiar with the administration of rantadine (Zantac).

Which child is at risk for developing glomerulonephritis? 1. A 3-year-old who had impetigo 1 week ago. 2. A 5-year-old with a history of five UTIs in the previous year. 3. A 6-year-old with new-onset type 1 diabetes. 4. A 10-year-old recovering from viral pneumonia.

1. Impetigo is a skin infection caused by the streptococcal organism that is commonly associated with glomerulonephritis. 2. Frequent UTIs have not been associated with glomerulonephritis. 3. Type 1 diabetes is not a cause of glomerulonephritis. 4. Glomerulonephritis can be caused by a streptococcal organism, not a viral pneumonia. TEST-TAKING HINT: The test taker may be distracted by answer 4, but that choice is a viral infection so that makes it an incorrect choice.

The nurse is caring for a 7-week-old scheduled for a pyloromyotomy in 24 hours. Which would the nurse expect to find in the plan of care? 1. Keep infant NPO; begin intravenous fluids at maintenance. 2. Keep infant NPO; begin intravenous fluids at maintenance; place nasogastric tube (NGT) to low wall suction. 3. Obtain serum electrolytes; keep infant NPO; do not attempt to pass NGT due to obstruction. 4. Offer infant small frequent feedings; keep NPO 6 to 8 hours before surgery.

1. In addition to giving fluids intravenously and keeping the infant NPO, an NGT is placed to decompress the stomach. 2. In addition to giving fluids intravenously and keeping the infant NPO, an NGT is placed to decompress the stomach. 3. The pylorus is distal to the stomach, so an NGT is placed above the obstruction. 4. The infant is made NPO as soon as diagnosis is confirmed. Allowing the infant to feed perpetuates the vomiting and continued hypertrophy of the pylorus. TEST-TAKING HINT: The test taker should consider the pathophysiology of pyloric stenosis and eliminate answers 1, 3, and 4.

The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which statement by the parent would be typical for a child with this diagnosis? 1. "The baby is a very fussy eater and just does not want to eat." 2. "The baby tends to have a very forceful vomiting episode about 30 minutes after most feedings." 3. "The baby is always hungry after vomiting, so I feed her again." 4. "The baby is happy in spite of getting really upset after spitting up."

1. Infants with pyloric stenosis tend to be perpetually hungry because most of their feedings do not get absorbed. 2. Infants with pyloric stenosis vomit immediately after a feeding, especially as the pylorus becomes more hypertrophied. 3. Infants with pyloric stenosis are always hungry and often appear malnourished. 4. Most infants with pyloric stenosis are irritable because they are hungry. Parents do not usually describe the vomiting episodes as "spitting up" because infants tend to have projectile vomiting. TEST-TAKING HINT: Recall the dynamics of pyloric stenosis. Because feedings are not absorbed, the infant is irritable and hungry. The test taker can eliminate answers 1 and 4 and select answer 3.

The nurse is caring for a 5-year-old who has just returned from having an appendectomy. Which is the optimal way to manage pain? 1. Intravenous morphine as needed. 2. Liquid acetaminophen (Tylenol) with codeine as needed. 3. Morphine administered through a PCA pump. 4. Intramuscular morphine as needed.

1. Intravenous morphine given as needed may cause the child to have periods of pain when the medication has worn off. The child may also be hesitant to ask for pain medication, fearing an invasive procedure. 2. Liquid acetaminophen (Tylenol) with codeine may not offer sufficient pain control in the immediate postoperative period. 3. Morphine administered through a PCA pump offers the child control over managing pain. The PCA pump also has the benefit of offering a basal rate as well as an as-needed rate for optimal pain management. 4. The intramuscular route should be avoided if less invasive routes are available. A 5-year- old fears invasive procedures and may deny pain to avoid receiving an injection. TEST-TAKING HINT: The test taker should recall that PCA pumps are very effective, even in young children.

The nurse is caring for a 3-month-old infant who has short bowel syndrome (SBS) and has been receiving parenteral nutrition (PN). The parents ask if their child will ever be able to eat. Which is the nurse's best response? 1. "Children with SBS are never able to eat and must receive all of their nutrition in intravenous form." 2. "You will have to start feeding your child because children cannot be on PN longer than 6 months." 3. "We will start feeding your child soon so that the bowel continues to receive stimulation." 4. "Your child will start receiving tube feedings soon but will never be able to eat by mouth."

1. It is important for children with SBS to receive some feedings, either by tube or mouth, so that the intestine receives some stimulation. 2. Although PN can cause long-term challenges, there is not an absolute time limit. 3. It is important to begin feedings as soon as the bowel is healed so that it receives stimulation and does not atrophy. 4. Feedings are provided by mouth or tube based on each child's needs. TEST-TAKING HINT: The test taker could eliminate answers 1 and 4 because they contain the word "never," which is rarely used in health-care scenarios.

A parent asks the nurse how to prevent the child from having minimal change nephrotic syndrome (MCNS) again. Which is the nurse's best response? 1. "It is very rare for a child to have a relapse after having fully recovered." 2. "Unfortunately, many children have cycles of relapse, and there is very little that can be done to prevent it." 3. "Your child is much less likely to get sick again if sodium is decreased in the diet." 4. "Try to keep your child away from sick children because relapses have been associated with infectious illnesses."

1. It is not unusual for a child to experience relapses. 2. Many children do experience relapses, but exposure to infectious illnesses has been linked to relapses. 3. There is no correlation between the consumption of sodium and minimal change nephrotic syndrome. 4. Exposure to infectious illness has been linked to the relapse of minimal change nephrotic syndrome. TEST-TAKING HINT: The test taker can eliminate answers 1 and 2 because relapses are common and can be prevented.

More education about necrotizing enterocolitis (NEC) is needed in a nursing in-service when one of the participants states: 1. "Encouraging the mother to pump her milk for the feedings helps prevent NEC." 2. "Some sources state that the occurrence of NEC has increased because so many preterm infants are surviving." 3. "When signs of sepsis appear, the infant will likely deteriorate quickly." 4. "NEC occurs only in preemies and low-birth-weight infants."

1. It is thought that the breast milk contains macrophages that help fight infection, preventing NEC. 2. Because NEC is seen primarily in preterm and low-birth-weight infants, their increased survival rate has led to an increase in the occurrence of NEC. 3. The infant's condition deteriorates rapidly when sepsis occurs, so early recognition and treatment are essential. 4. Although much more common in preterm and low-birth-weight infants, NEC is also seen in term infants as well. TEST-TAKING HINT: The test taker needs to be familiar with general concepts associated with NEC. Answer 4 contains the word "only," which is an absolute value that is rarely used in health care.

The nurse is caring for a 9-month-old with diarrhea secondary to rotavirus. The child has not vomited and is mildly dehydrated. Which is likely to be included in the discharge teaching? 1. Administer loperamide (Imodium) as needed. 2. Administer bismuth subsalicylate (Kaopectate) as needed. 3. Continue breastfeeding per routine. 4. The infant may return to day care 24 hours after antibiotics have been started.

1. Loperamide (Imodium) slows intestinal motility and allows overgrowth of organisms and should therefore be avoided. 2. Bismuth subsalicylate (Kaopectate) slows intestinal motility and allows overgrowth of organisms and should therefore be avoided. 3. Breastfeeding is usually well tolerated and helps prevent death of intestinal villi and malabsorption. 4. Antibiotics are not effective in viruses. Children should not return to day care while they are still having diarrhea. TEST-TAKING HINT: The test taker can eliminate answer 4 because antibiotics are not effective with viruses such as rotavirus. Answers 1 and 2 can be eliminated because antidiarrheal agents are not recommended in the pediatric population.

The nurse is caring for a 3-year-old who had an appendectomy 2 days ago. The child has a fever of 101.8°F (38.8°C) and breath sounds are slightly diminished in the right lower lobe. Which action is most appropriate? 1. Teach the child how to use an incentive spirometer. 2. Encourage the child to blow bubbles. 3. Obtain an order for intravenous antibiotics. 4. Obtain an order for acetaminophen (Tylenol).

1. Many 3-year-olds have difficulty understanding how to use an incentive spirometer. 2. Blowing bubbles is a developmentally appropriate way to help the preschooler take deep breaths and cough. 3. In the early postoperative period, a fever is likely a respiratory issue and not a result of infection of the incision. 4. Although acetaminophen (Tylenol) may be administered, encouraging the child to breathe deeply and cough will help prevent the fever from returning. TEST-TAKING HINT: The test taker should be aware that a fever in the first few days after surgery is generally due to pulmonary complications, so answer 3 can be eliminated. Remembering the developmental needs of the child, the test taker should select answer 2.

The nurse is giving discharge instructions to the parent of a 1-month-old infant with tracheoesophageal fistula and a gastrostomy tube (GT). The nurse knows the mother understands the discharge teaching when she states: 1. "I will give my baby feedings through the GT but place liquid medications in the corner of the mouth to be absorbed." 2. "I will flush the GT with 2 ounces of water after each feeding to prevent the GT from clogging." 3. "I will clean the area around the GT every day." 4. "I will place petroleum jelly around the GT if any redness develops."

1. Medications can also be placed in the GT. 2. Two ounces of water is too much water for an infant and could cause electrolyte imbalances. The tube can be flushed with 3 to 5 mL of water to prevent clogging. 3. The area around the GT should be cleaned daily to prevent an infection. 4. If redness develops, the parents should call the physician because an infection could be present. TEST-TAKING HINT: The test taker should immediately eliminate answer 1 because medications and feedings can be placed in the GT. The test taker should know that 2 ounces of water after each feeding is a large amount (recalling that infants are typically fed at least every 4 hours).

The nurse is providing discharge teaching to the parents of an infant with an umbilical hernia. Which should be included in the plan of care? 1.If the hernia has not resolved on its own by the age of 12 months, surgery is generally recommended. 2. If the hernia appears to be more swollen or tender, seek medical care immediately. 3. To help the hernia resolve, place a pressure dressing over the area gently. 4. If the hernia is repaired surgically, there is a strong likelihood that it will return.

1. Most umbilical hernias resolve spontaneously by age 2 to 3 years. Surgery is not usually recommended until the age of 3 because the hernia may resolve before that. 2. If the hernia appears larger, swollen, or tender, the intestine may be trapped, which is a surgical emergency. 3. A pressure dressing should never be placed over the hernia because it can cause irritation and does not help the hernia resolve. 4. If the hernia is corrected surgically, the recurrence rate is low. TEST-TAKING HINT: The test taker should be led to select answer 2 because a change in the hernia indicates an incarcerated hernia, which is an emergency.

A child is diagnosed with chronic constipation that has been unresponsive to dietary and activity changes. Which pharmacological measure is most appropriate? 1. Natural supplements and herbs. 2. Stimulant laxative. 3. Osmotic agent. 4. Pharmacological measures are not used in pediatric constipation.

1. Natural supplements and herbs are not recommended because the safety and efficacy are not standardized. 2. A stimulant laxative is not the drug of choice because it may increase abdominal discomfort and may lead to dependency. 3. A stool softener (osmotic agent) is the drug of choice because it will lead to easier evacuation. 4. Although diet and activity modification are tried first, medications are sometimes needed. TEST-TAKING HINT: The test taker should eliminate answer 4 because it impliesthat medications are never given to the constipated child. In health care, there are very few cases of "never" and "always."

Which is a care priority for a newborn diagnosed with bladder exstrophy and a malformed pelvis? 1. Change the diaper frequently and assess for skin breakdown. 2. Keep the exposed bladder open in a warm and dry environment to avoid any heat loss. 3. Offer formula for infant growth and fluid management. 4. Cluster all care to allow the child to sleep, grow, and gain strength for the upcoming surgical repair.

1. Preventing infection from stool contamination and skin breakdown is the top priority of care. 2. Protect the bladder mucosa with a film wrap to keep the mucosa moist. Do not keep it open where it can be exposed to pathogens or subject to irritation from drying. 3. Infant formula would not provide enough fluid for this infant. An umbilical artery catheter would be inserted to provide fluids because of large insensible fluid losses from the exposed viscera. 4. Although the child should be encouraged to rest, it is important to change the diaper immediately to prevent fecal contamination and subsequent infection. TEST-TAKING HINT: The test taker can eliminate answers 2 and 3 because they have potential to cause harm to the infant.

The nurse in a diabetic clinic sees a 10-year-old who is a new diabetic and has had trouble maintaining blood glucose levels within normal limits. The child's parent states the child has had several daytime "accidents." The nurse knows that this is referred to as which of the following? 1. Primary enuresis. 2. Secondary enuresis. 3. Diurnal enuresis. 4. Nocturnal enuresis.

1. Primary enuresis refers to urinary incontinence in a child who has never had voluntary bladder control. 2. Secondary enuresis refers to urinary incontinence in a child who previously had bladder control. 3. Diurnal enuresis refers to daytime urinary incontinence not caused by something else. 4. Nocturnal enuresis refers to nighttime urinary incontinence. TEST-TAKING HINT: The test taker should be led to answer 2 because the enuresis is secondary to something else, in this case a disease process.

Which laboratory results besides hematuria are most consistent with hemolytic uremic syndrome (HUS)? 1. Massive proteinuria, elevated blood urea nitrogen and creatinine. 2. Mild proteinuria, decreased blood urea nitrogen and creatinine. 3. Mild proteinuria, increased blood urea nitrogen and creatinine. 4. Massive proteinuria, decreased blood urea nitrogen and creatinine.

1. Protein is not lost in massive amounts in HUS. 2. BUN and creatinine are usually increased in HUS. 3. Hematuria, mild proteinuria, and increased BUN and creatinine are all present in HUS. 4. Protein is not lost in massive amounts in HUS. TEST-TAKING HINT: The test taker can eliminate answer 4 because ketonuria is not associated with HUS.

The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. Which is the nurse's best response? 1. "Circumcision is a fading practice and is now contraindicated in most children." 2. "Circumcision in children with hypospadias is recommended because it helps prevent infection." 3. "Circumcision is an option, but it cannot be done at this time." 4. "Circumcision can never be performed in a child with hypospadias."

1. Routine circumcision is recommended by the American Academy of Pediatrics; it is not contraindicated in most children. 2. It is not recommended that circumcision of children with hypospadias be done immediately because the foreskin may be needed later for repair of the defect. 3. It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may be needed for repair of the defect. 4. Circumcision can usually be performed in the child with hypospadias when the defect is corrected. TEST-TAKING HINT: The test taker can eliminate answer 4 because "never" is infrequently the case in health care.

The parent of a newborn asks, "Will my baby spit out the formula if it is too hot or too cold?" Which is the nurse's best response? 1. "Babies have a tendency to reject hot fluids but not cold fluids, which could result in abdominal discomfort." 2. "Babies have a tendency to reject cold fluids but not hot fluids, which could result in esophageal burns." 3. "Your baby would most likely spit out formula that was too hot, but your baby could swallow some of it, which could result in a burn." 4. "Your baby is too young to be physically capable of spitting out fluids and will automatically swallow anything."

1. Swallowing is a reflex in neonates; infants younger than 6 weeks cannot voluntarily control swallowing. 2. Swallowing is a reflex in neonates; infants younger than 6 weeks cannot voluntarily control swallowing. 3. The infant is not capable of selectively rejecting fluid because swallowing is a reflex until 6 weeks. 4. Swallowing is a reflex in infants younger than 6 weeks. TEST-TAKING HINT: Swallowing is a reflex that is present until the age of 6 weeks. The test taker should eliminate answers 1, 2,and 3 because they suggest that the infant is capable of selectively rejecting fluids.

Which causes the symptoms in testicular torsion? 1. Twisting of the spermatic cord interrupts the blood supply. 2. Swelling of the scrotal sac leads to testicular displacement. 3. Unmanaged undescended testes cause testicular displacement. 4. Microthrombi formation in the vessels of the spermatic cord causes interruption of the blood supply.

1. Testicular torsion is caused by an interruption of the blood supply due to twisting of the spermatic cord. 2. Swelling of the scrotal sac occurs because of testicular torsion; it is not a cause of testicular torsion. 3. Unmanaged undescended testes may be a risk factor for but are not a cause of testicular torsion. 4. Microthrombi formation in the vessels of the spermatic cord does not occur in testicular torsion. TEST-TAKING HINT: This question depends on familiarity with the pathophysiology of testicular torsion.

Which is an accurate description of a Kasai procedure? 1. A palliative procedure in which the bile duct is attached to a loop of bowel to assist with bile drainage. 2. A curative procedure in which a connection is made between the bile duct and a loop of bowel to assist with bile drainage. 3. A curative procedure in which the bile duct is banded to prevent bile leakage. 4. A palliative procedure in which the bile duct is banded to prevent bile leakage.

1. The Kasai procedure is a palliative procedure in which the bile duct is attached to a loop of bowel to assist with bile drainage. 2. The procedure is palliative, not curative because most children require a liver transplant after a few years. 3. The Kasai procedure is not curative and does not band the bile duct. 4. The Kasai procedure is palliative but does not band the bile duct. TEST-TAKING HINT: The test taker can eliminate answers 2 and 3, because the majority of cases of biliary atresia require a liver transplant. The Kasai procedure is performed to give the child a few years to grow before requiring a transplant.

The mother of a newborn asks the nurse why the infant has to nurse so frequently. Which is the best response? 1. Formula tends to be more calorically dense, and formula-fed babies require fewer feedings than breastfed babies. 2. The newborn's stomach capacity is small, and peristalsis is slow. 3. The newborn's stomach capacity is small, and peristalsis is more rapid than in older children. 4. Breastfed babies tend to take longer to complete a feeding than formula-fed babies.

1. The caloric content of breast milk and formula tends to be similar. 2. Peristalsis in infants is greater than in older children. 3. The small-stomach capacity and rapid movement of fluid through the digestive system account for the need for small, frequent feedings. 4. Breastfed babies and formula-fed babies do not necessarily have a difference in feeding time. TEST-TAKING HINT: The test taker should eliminate answers 1 and 4 because they both form generalizations that are not supported by current literature.

The bladder capacity of a 3-year-old is approximately how much? 1. 1.5 fl. oz. 2. 3 fl. oz. 3. 4 fl. oz. 4. 5 fl. oz.

1. The capacity of the bladder in fluid ounces can be estimated by adding 2 to the child's age in years. 2. The capacity of the bladder in fluid ounces can be estimated by adding 2 to the child's age in years. 3. The capacity of the bladder in fluid ounces can be estimated by adding 2 to the child's age in years. 4. The capacity of the bladder in fluid ounces can be estimated by adding 2 to the child's age in years. TEST-TAKING HINT: The test taker can eliminate answer 1 because 1.5 fl oz represents a very small bladder capacity.

The nurse will soon receive a 4-month-old who has been diagnosed with intussusception. The infant is described as very lethargic with the following vital signs: T 101.8°F (38.7°C), HR 181, BP 68/38. The reporting nurse states the infant's abdomen is very rigid. Which is the most appropriate action for the receiving nurse? 1. Prepare to accompany the infant to a computed tomography scan to confirm the diagnosis. 2. Prepare to accompany the infant to the radiology department for a reducing enema. 3. Prepare to start a second intravenous line to administer fluids and antibiotics. 4. Prepare to get the infant ready for immediate surgical correction.

1. The child has already been diagnosed and appears to have developed peritonitis, which is a surgical emergency. 2. Although reducing enemas have a high success rate among infants with intussusception, they are contraindicated in the presence of peritonitis. 3. Although a second intravenous line may be needed, the nurse's first priority is getting the child to the operating room. 4. Intussusception with peritonitis is a surgical emergency, so preparing the infant for surgery is the nurse's top priority. TEST-TAKING HINT: The child has already been diagnosed and is displaying signs of shock and peritonitis. The nurse must act quickly and get the child the surgical attention needed to avoid disastrous consequences.

Which manifestations should the nurse expect to find in a child in the early stages of acute hepatitis? 1. Nausea, vomiting, and generalized malaise. 2. Nausea, vomiting, and pain in the left upper quadrant. 3. Generalized malaise and yellowing of the skin and sclera. 4. Yellowing of the skin and sclera without any other generalized complaints.

1. The early stage of acute hepatitis is referred to as the anicteric phase, during which the child usually complains of nausea, vomiting, and generalized malaise. 2. A tender enlarged liver is noted in the right upper quadrant. 3. The child does not appear jaundiced until the icteric phase. 4. The child does not appear jaundiced until the icteric phase. The child usually does not feel well during the early stages of acute hepatitis. TEST-TAKING HINT: The test taker needs to be familiar with the manifestations of acute hepatitis. Knowing that the early stage is referred to as the anicteric phase, answers 3 and 4 can be eliminated.

An adolescent woke up complaining of intense pain and swelling of the scrotal area and abdominal pain. He has vomited twice. Which should the nurse suggest? 1. Encourage him to drink clear liquids until the vomiting subsides; if he gets worse, bring him to the emergency room. 2. Bring him to the health-care provider's office for evaluation. 3. Take him to the emergency department immediately. 4. Encourage him to rest; apply ice to the scrotal area and go to the emergency department if the pain does not improve.

1. The child is having symptoms of testicular torsion, which is a surgical emergency and needs immediate attention. The child should not wait to go to the emergency department and should be told not to drink anything in anticipation of surgery. 2. Testicular torsion is a surgical emergency, and time should not be wasted at the health- care provider's office when the child needs surgery. 3. The child is having symptoms of testicular torsion, which is a surgical emergency and needs immediate attention. 4. The child should be brought to the emergency department immediately because testicular torsion is a surgical emergency.Ice and scrotal support can be used for relief of discomfort, but bringing the child to the emergency room is the priority. TEST-TAKING HINT: The test taker should be led to answer 3 because testicular torsion is a surgical emergency.

The nurse is caring for a 4-year-old who weighs 15 kg. At the end of a 10-hour period, the nurse notes the urine output to be 150 mL. What action does the nurse take? 1. Notifies the health-care provider because this urine output is too low. 2. Encourages the child to increase oral intake to increase urine output. 3. Records the child's urine output in the chart. 4. Administers isotonic fluid intravenously to help with rehydration.

1. The child weighs 15 kg, and the expected urine output is 0.5-1 mL/kg/hr.0.5 × 15 kg = 7.5 mL; 1 mL × 15 kg =15 mL. 7.5-15 mL/hour × 10 hours = 75-150 mL of urine for the 10-hour period. Therefore, the output is not too low. 2. The child weighs 15 kg, and the expected urine output is 0.5-1 mL/kg/hr.0.5 × 15 kg = 7.5 mL; 1 mL × 15 kg =15 mL. 7.5-15 mL/hour × 10 hours = 75-150 mL of urine for the 10-hour period. The urine output is not too low, so the nurse does not need to encourage more fluids. 3. Recording the child's urine output in the chart is the appropriate action because the urine output is within the expected range of 0.5-1 mL/kg/hr, or 75-150 mL for the 10-hour period. 4. The child weighs 15 kg and the expected urine output is 0.5-1 mL/kg/hr.0.5 × 15 kg = 7.5 mL; 1 mL × 15 kg =15 mL. 7.5-15 mL/hour × 10 hours = 75-150 mL of urine for the 10-hour period. Therefore, it is not too low. The child is hydrated. TEST-TAKING HINT: The test taker can eliminate answers 1, 2, and 4 because they address strategies for caring for a dehydrated child.

The nurse caring for a neonate with an anorectal malformation notes that the infant has not passed any stool per rectum but that the infant's urine contains meconium. The nurse can make which assumption? 1. The child likely has a low anorectal malformation. 2. The child likely has a high anorectal malformation. 3. The child will not need a colostomy. 4. This malformation will be corrected with a nonoperative rectal pull-through.

1. The child who has stool in the urine has a fistula connecting the rectum to the urinary tract, and the anorectal malformation cannot be low. 2. The presence of stool in the urine indicates that the anorectal malformation is high. 3. This child probably needs a colostomy. 4. This malformation requires surgical correction. TEST-TAKING HINT: The test taker needs to consider that stool is present in the urine, indicating a fistula is present and a more complex anorectal malformation exists, so answers 1 and 4 can be eliminated.

Which would be an appropriate activity for the nurse to recommend to the parent of a preschooler just diagnosed with acute hepatitis? 1. Climbing in a "playscape." 2. Kicking a ball. 3. Playing video games in bed. 4. Playing with puzzles in bed.

1. The child with acute hepatitis usually does not feel well, and activities should be limited to quiet, restful ones. 2. The child with acute hepatitis usually does not feel well, and activities should be limited to quiet, restful ones. 3. Video games can be played by preschoolers but are not the most appropriate choice. 4. Playing with puzzles is a developmentally appropriate activity for a preschooler on bedrest. TEST-TAKING HINT: The test taker should incorporate developmentally appropriate activities for the child in the early stages of acute hepatitis. Answers 1 and 2 can be eliminated because they are not activities that can be done while resting. Answer 4 should be selected because it is a better activity for a preschooler.

The nurse is caring for an 8-week-old male who has just been diagnosed with Hirschsprung disease. The parents ask what they should expect. Which is the nurse's best response? 1. "It is really an easy disease to manage. Most children are placed on stool softeners to help with constipation until it resolves." 2. "A permanent stool diversion, called a colostomy, will be placed by the surgeon to bypass the narrowed area." 3. "Daily bowel irrigations will help your child maintain regular bowel habits." 4. "Although your child will require surgery, there are different ways to manage the disease, depending on how much bowel is involved."

1. The constipation will not resolve with stool softeners. The affected bowel needs to be removed. 2. Most colostomies are not permanent. The large intestine is usually reattached, and the colostomy is taken down. 3. The child with Hirschsprung disease requires surgery to remove the aganglionic portion of the large intestine. 4. The aganglionic portion needs to be removed. Although most children have a temporary colostomy placed, many infants are able to bypass the colostomy and have the bowel immediately reattached. TEST-TAKING HINT: The test taker shouldbe led to answer 4 because it is the least restrictive of all answers and is the onlyone that states that the child will require surgery. Children with Hirschsprung disease are managed surgically.

A child with minimal change nephrotic syndrome (MCNS) has generalized edema. The skin appears stretched, and areas of breakdown are noted over the bony prominences. The child has been receiving furosemide (Lasix) twice daily for several days. Which does the nurse expect to be included in the treatment plan to reduce edema? 1. An increase in the amount and frequency of furosemide (Lasix). 2. Addition of a second diuretic, such as mannitol. 3. Administration of intravenous albumin. 4. Elimination of all fluids and sodium from the child's diet.

1. The dosage of the diuretic may be adjusted, but other medications such as albumin are likely to be used. 2. Mannitol is not usually used in the treatment of MCNS. 3. In cases of severe edema, albumin is used to help return the fluid to the bloodstream from the subcutaneous tissue. 4. Although sodium and fluids are restricted in the severely edematous child, they are not eliminated completely. TEST-TAKING HINT: The test taker can eliminate answer 2 because mannitol is used to treat cerebral edema.

The nurse is caring for a 5-month-old infant with a diagnosis of intussusception. The infant has periods of irritability during which the knees are brought to the chest and the infant cries, alternating with periods of lethargy. Vital signs are stable and within age-appropriate limits. The health-care provider elects to give an enema. The parents ask the purpose of the enema. Which is the nurse's most appropriate response? 1. "The enema will confirm the diagnosis. If the test result is positive, your child will need to have surgery to correct the intussusception." 2. "The enema will confirm the diagnosis. Although very unlikely, the enema may also help fix the intussusception so that your child will not immediately need surgery." 3. "The enema will help confirm the diagnosis and has a good chance of fixing the intussusception." 4. "The enema will help confirm the diagnosis and may temporarily fix the intussusception. If the bowel returns to normal, there is a strong likelihood that the intussusception will recur."

1. The enema is used for confirmation of diagnosis and reduction. In most cases of intussusception in young children, an enema is successful in reducing the intussusception. 2. In most cases of intussusception in young children, an enema is successful in reducing the intussusception. 3. In most cases of intussusception in young children, an enema is successful in reducing the intussusception. 4. There is not a high likelihood that the intussusception will recur. TEST-TAKING HINT: The test taker needs to be aware that intussusceptions in young children respond well to reduction by enema.

The nurse is caring for a 1-month-old term infant who experienced an anoxic episode at birth. The health-care team suspects that the infant is developing necrotizing enterocolitis (NEC). Which would the nurse expect to be included in the plan of care? 1. Immediately remove the feeding nasogastric tube (NGT) from the infant. 2. Obtain vital signs every 4 hours. 3. Prepare to administer antibiotics intravenously. 4. Change feedings to half-strength, administer slowly via a feeding pump.

1. The feedings should immediately should be stopped, but the NGT should be placed to allow decompression of the stomach. 2. Vital signs should be obtained more frequently than every 4 hours because the infant is at high risk for peritonitis and sepsis. 3. Intravenous antibiotics are administered to prevent or treat sepsis. 4. Feedings are stopped immediately when a suspicion of NEC is present. TEST-TAKING HINT: The test taker needs to consider the plan of care for an infant with NEC. This child is at risk for becoming critically ill, so feedings are stopped and vital signs are monitored very closely.

Which manifestation suggests that an infant is developing necrotizing enterocolitis (NEC)? 1. Absorption of bolus orogastric feedings at a faster rate than previous feedings. 2. Bloody diarrhea. 3. Increased bowel sounds. 4. Appears hungry right before a scheduled feeding.

1. The feedings tend to take longer and often do not get absorbed before the next scheduled feeding. 2. Bloody diarrhea can indicate that the infant has NEC. 3. Bowel sounds tend to decrease, not increase. 4. The infant does not appear hungry but irritable. TEST-TAKING HINT: The test taker needs to be familiar with manifestations of NEC and be led to select answer 2.

The nurse knows that Nissen fundoplication involves which of the following? 1. The fundus of the stomach is wrapped around the inferior stomach, mimicking a lower esophageal sphincter. 2. The fundus of the stomach is wrapped around the inferior esophagus, mimicking a cardiac sphincter. 3. The fundus of the stomach is wrapped around the middle portion of the stomach, decreasing the capacity of the stomach. 4. The fundus of the stomach is dilated, decreasing the likelihood of reflux.

1. The fundus is wrapped around the inferior esophagus, not the inferior stomach. 2. The Nissen fundoplication involves wrapping the fundus of the stomach around the inferior esophagus, creating a lower esophageal, or cardiac, sphincter. 3. The fundus is not wrapped around the middle portion of the stomach. There is no benefit to decreasing the stomach's capacity. 4. The fundus of the stomach is not dilated. TEST-TAKING HINT: The test taker needs to be familiar with surgical options for GER disease.

The parent of a child being evaluated for celiac disease asks the nurse why it is important to make dietary changes. Which is the nurse's best response? 1. "The body's response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems." 2. "The body's response to consumption of anything containing gluten is to create special cells called villi, which leads to more diarrhea." 3. "The body's response to gluten causes the intestine to become more porous and hang on to more of the fat-soluble vitamins, leading to vitamin toxicity." 4. "The body's response to gluten causes damage to the mucosal cells, leading to malabsorption of water and hard, constipated stools."

1. The inability to digest protein leads to an accumulation of an amino acid that is toxic to the mucosal cells and villi, leading to absorption problems. 2. Extra villi cells are not created. Instead, villi become damaged, leading to absorption problems. 3. The intestine does not become more porous. There is difficulty with absorbing vitamins, leading to deficiencies, not toxicity. 4. The child experiences diarrhea, not constipation. TEST-TAKING HINT: The test taker needs to recall the pathophysiology of celiac disease in order to select answer 1. By recalling that the child with celiac usually appears malnourished and experiences diarrhea, the test taker can eliminate answers 3 and 4.

The nurse receives a call from the mother of a 6-month-old who describes her child as alternately sleepy and fussy. She states that her infant vomited once this morning and had two episodes of diarrhea. The last episode contained mucus and a small amount of blood. She asks the nurse what she should do. Which is the nurse's best response? 1. "Your infant will need to have some tests in the emergency department to determine whether anything serious is going on." 2. "Try feeding your infant in about 30 minutes; in the event of repeat vomiting, bring the infant to the emergency department for some tests and intravenous rehydration." 3. "Many infants display these symptoms when they develop an allergy to the formula they are receiving; try switching to a soy-based formula." 4. "Do not worry about the blood and mucus in the stool; it is not unusual for infants to have blood in their stools because their intestines are more sensitive."

1. The infant is displaying signs of intussusception. This is an emergency that needs to be evaluated to prevent ischemia and perforation. 2. The mother should be told not to give the infant anything by mouth and bring the infant immediately to the emergency department. 3. Although similar symptoms may be seen among infants with allergies, a more serious illness must first be ruled out. It is uncommon to see lethargy as a response to an allergy. 4. All bloody stools should be evaluated. TEST-TAKING HINT: The child is described as lethargic and is having diarrhea and vomiting. This child needs to be seen to rule out an intussusception. At the very least, the mother should be told to bring the child to the emergency department because the described signs could also be seen in severe dehydration. The test taker should be led to select answer 1.

The nurse is caring for a newborn who has just been diagnosed with tracheoesophageal fistula and is scheduled for surgery. Which should the nurse expect to do in the preoperative period? 1. Keep the child in a monitored crib, obtain frequent vital signs, and allow the parents to visit but not hold their infant. 2. Administer intravenous fluids and antibiotics. 3. Place the infant on 100% oxygen via a non-rebreather mask. 4. Have the mother feed the infant slowly in a monitored area, stopping all feedings 4 to 6 hours before surgery.

1. The infant should be monitored, and vital signs should be obtained frequently, but the parents should be encouraged to hold their baby. 2. Intravenous fluids are administered to prevent dehydration because the infant is NPO. Intravenous antibiotics are administered to prevent pneumonia because aspiration of secretions is likely. 3. The infant should receive only the amount of oxygen needed to keep saturations above 94%. 4. As soon as the diagnosis is made, the infant is made NPO because the risk for aspiration is extremely high. TEST-TAKING HINT: Infants with tracheoesophageal fistula are at great risk for aspiration and subsequent pneumonia. With this knowledge, the test taker should eliminate answer 4 and select answer 2.

The nurse is providing discharge instructions to the parents of an infant born with bladder exstrophy who had a continent urinary reservoir placed. Which statement should be included? 1. "Allow your child to sleep on the abdomen to provide comfort during the immediate post-operative period." 2. "As your child grows, be cautious around playgrounds because the surface could be a health hazard." 3. "As your child grows, be sure to encourage many different foods because it is not likely that food allergies will develop." 4. "Encourage your child's development, by having brightly colored objects around, such as balloons."

1. The infant should not be allowed to sleep on the abdomen because the prone position has been associated with sudden infant death syndrome. 2. Many children with urological malformations are prone to latex allergies. The surfaces of playgroundsare often made of rubber, which contains latex. 3. Many children with urological malformations are prone to latex allergies. Foods such as bananas can cause a latex allergy. 3. Although children need a stimulating environment, balloons are dangerous because many contain latex and can also be a choking hazard. TEST-TAKING HINT: The test taker can eliminate answer 1 because infants should be placed to sleep on their back to prevent sudden infant death syndrome.

Which manifestation would the nurse expect to see in a 4-week-old infant with biliary atresia? 1. Abdominal distention, enlarged liver, enlarged spleen, clay-colored stool, and tea- colored urine. 2. Abdominal distention, multiple bruises, bloody stools, and hematuria. 3. Yellow sclera and skin tones, excessively oily skin, and prolonged bleeding times. 4. No manifestations until the disease has progressed to the advanced stage.

1. The infant with biliary atresia usually has an enlarged liver and spleen. The stools appear clay-colored because of the absence of bile pigments. The urine is tea-colored because of the excretion of bile salts. 2. The urine typically contains bile salts, not blood. There is usually no blood noted in the stool. 3. The skin is usually dry and itchy, not oily. 4. Manifestations of biliary atresia usually appear by 3 weeks of life. TEST-TAKING HINT: The test taker needs to be familiar with the manifestations of biliary atresia and should be led to select answer 1.

Which should be the nurse's immediate action when a newborn begins to cough and choke and becomes cyanotic while feeding? 1. Inform the health-care provider of the situation. 2. Have the mother stop feeding the infant, and observe to see if the choking episode resolves on its own. 3. Immediately determine the infant's oxygen saturation and have the mother stop feeding the infant. 4. Take the infant from the mother and administer blow-by oxygen while obtaining the infant's oxygen saturation.

1. The infant's feeding should be stopped immediately and oxygen administered. The nurse should call for help but should not leave the infant while in distress. 2. The mother should stop feeding the infant, but oxygen should be applied while the infant is cyanotic. The infant should be placed on a monitor, and vital signs should be obtained. 3. Although obtaining oxygen saturations is extremely important, the infant is visually cyanotic, so the nurse should administer oxygen as a priority. 4. The infant should be taken from the mother and placed in the crib where the nurse can assess the baby. Oxygen should be administered immediately, and vital signs should be obtained. TEST-TAKING HINT: The test taker should be led to answer 4 because the baby is cyanotic and needs oxygen.

A 4-month-old has had vomiting and diarrhea for 24 hours. The infant is fussy, and the anterior fontanel is sunken. The nurse notes the infant does not produce tears when crying. Which task will help confirm the diagnosis of dehydration? 1. Urinalysis obtained by bagged specimen. 2. Urinalysis obtained by sterile catheterization. 3. Analysis of serum electrolytes. 4. Analysis of cerebrospinal fluid.

1. The information obtained from a urinalysis of an infant is not as helpful as serum electrolytes. The infant has limited ability to concentrate urine, so the specific gravity is not usually affected. 2. The information obtained from a urinalysis of an infant is not as helpful as serum electrolytes. The infant has limited ability to concentrate urine, so the specific gravity is not usually affected. A urinalysis does not need to be obtained by catheterization. 3. The analysis of serum electrolytes offers the most information and assists with the diagnosis of dehydration. 4. Although critical in diagnosing meningitis, a lumber puncture and analysis of cerebrospinal fluid are not done to confirm dehydration. TEST-TAKING HINT: Infants have limited ability to concentrate urine, so answers 1 and 2 can be eliminated immediately.

The parents of a newborn diagnosed with a cleft lip and palate ask the nurse when their child's lip and palate will most likely be repaired. Which is the nurse's best response? 1. "The palate and the lip are usually repaired in the first few weeks of life so that the baby can grow and gain weight." 2. "The palate and the lip are usually not repaired until the baby is approximately 6 months old so that the mouth has had enough time to grow." 3. "The lip is repaired in the first few months of life, but the palate is not usually repaired until the child is 3 years old." 4. "The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old."

1. The palate is not repaired until the child is approximately 18 months old to allow for facial growth. Waiting beyond 18 months may interfere with speech. 2. The lip is usually repaired in the first few weeks of life, and the palate is usually repaired at approximately 18 months. 3. The palate is repaired earlier than 3 years so that speech development is not impaired. 4. The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old. TEST-TAKING HINT: The test taker should consider the palate's involvement in the development of speech and therefore eliminate answer 3. The palate is usually given at least a year to grow sufficiently.

The nurse is caring for a newborn with an anorectal malformation and a colostomy. The nurse knows that more education is needed when the infant's parent states which of the following? 1. "I will make sure the stoma is red." 2. "There should not be any discharge or irritation around the outside of the stoma." 3. "I will keep a bag attached to avoid the contents of the small intestine coming in contact with the baby's skin." 4. "As my baby grows, a pattern will develop over time, and there should be predictable bowel movements."

1. The stoma should be red in color, indicating good perfusion. 2. Discharge or irritation around the stoma could indicate the presence of an infection. 3. The colostomy contains stool from the large intestine; an ileostomy contains the very irritating stool from the small intestine. 4. Babies usually develop a pattern to their bowel habits as they grow. TEST-TAKING HINT: Although it is important to keep a bag attached to the colostomy, the contents are not the irritating effluent of an ileostomy.

The manifestations of hemolytic uremic syndrome (HUS) are due primarily to which event? 1. The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen, leading to anemia. 2. There is a disturbance of the glomerular basement membrane, allowing large proteins to pass through. 3. The red blood cell changes shape, causing it to obstruct microcirculation. 4. There is a depression in the production of all formed elements of the blood.

1. The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen. 2. The increased permeability of the basement membrane occurs in MCNS. 3. The red blood cell changing shape is typical of sickle cell anemia. 4. The depression of all formed elements of the blood occurs in aplastic anemia. TEST-TAKING HINT: The question requires familiarity with the pathophysiology of HUS.

A 10-year-old is being evaluated for possible appendicitis and complains of nausea and sharp abdominal pain in the right lower quadrant. An abdominal ultrasound is scheduled, and a blood count has been obtained. The child vomits, finds the pain relieved, and calls the nurse. Which should be the nurse's next action? 1. Cancel the ultrasound and obtain an order for oral ondansetron (Zofran). 2. Cancel the ultrasound and prepare to administer an intravenous bolus. 3. Prepare for the probable discharge of the patient. 4. Immediately notify the health-care provider of the child's status.

1. The ultrasound should not be canceled but obtained emergently because the child probably has a perforated appendix. The child should be NPO because surgery is imminent. 2. The ultrasound should not be canceled but obtained emergently because the child probably has a perforated appendix. 3. The child will not be discharged because he most likely has a perforated appendix. 4. The health-care provider should be notified immediately, because a sudden change or loss of pain often indicates a perforated appendix. TEST-TAKING HINT: The test taker should eliminate answers 1 and 2 because there is no reason to cancel the ultrasound. The health-care provider should always be notified of any changes in a patient's condition.

The nurse is caring for an infant diagnosed with Hirschsprung disease. The mother states she is pregnant with a boy and wants to know if her new baby will likely have the disorder. Which is the nurse's best response? 1. "Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well." 2. "There is no evidence to support a genetic link, so it is very unlikely the baby will also have it." 3. "It is rarely seen in boys, so it is not likely your new baby will have Hirschsprung disease." 4. "Hirschsprung disease is seen only in girls, so your new baby will not be at risk."

1. There is a genetic component to Hirschsprung disease, so any future siblings are also at risk. 2. There is a genetic component to Hirschsprung disease. 3. Hirschsprung disease is seen more commonly in males than females. 4. Hirschsprung disease is seen in both males and females, but is more common in males. TEST-TAKING HINT: The test taker can eliminate answers 3 and 4 because they are similar and therefore would not likely be the correct answer.

An infant is scheduled for a hypospadias and chordee repair. The parent asks the nurse, "I understand why the hypospadias repair is necessary, but do they have to fix the chordee as well?" Which is the nurse's best response? 1. "I understand your concern. Parents do not want their children to undergo extra surgery." 2. "The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages." 3. "The repair is done to optimize sexual functioning when he is older." 4. "This is the best time to repair the chordee because he will be having surgery anyway."

1. This response is empathetic. It does not, however, answer the parent's concern, whereas a simple explanation would immediately do so. 2. Although a cosmetic component exists, straightening the penis is important for future sexual function. 3. Releasing the chordee surgically is necessary for future sexual function. 4. Although the two surgeries are usually done simultaneously, each has its own importance and necessity. TEST-TAKING HINT: The test taker should be led to answer 3 because it provides the parents with a simple, accurate explanation.

The parents of a child being evaluated for appendicitis tell the nurse the health-care provider said their child has a positive Rovsing sign. They ask the nurse what this means. Which is the nurse's best response? 1. "Your child's health-care provider should answer that question." 2. "A positive Rovsing sign means the child feels pain in the right side of the abdomen when the left side is palpated." 3. "A positive Rovsing sign means pain is felt when the physician removes the hand from the abdomen." 4. "A positive Rovsing sign means pain is felt in the right lower quadrant when the child coughs."

1. This response is not helpful and dismisses the parents' concern. 2. A positive Rovsing sign occurs when the left lower quadrant is palpated and pain is felt in the right lower quadrant. 3. Pain that is felt when the hand is removed during palpation is called rebound tenderness. 4. Pain that is felt when the child coughs is called a positive cough sign. TEST-TAKING HINT: The test taker should immediately eliminate answer 1 because it is not therapeutic and is dismissive.

The parents of a 4-year-old ask the nurse how to manage their child's constipation. Select the nurse's best response. 1. "Add 2 ounces of apple or pear juice to the child's diet." 2. "Be sure your child eats a lot of fresh fruit such as apples and bananas." 3. "Encourage your child to drink more fluids." 4. "Decrease bulky foods such as whole-grain breads and brown rice."

1. Two ounces of apple juice is most likely not a sufficient quantity to alter a 4-year-old child's bowel movements. 2. Although fresh fruits help decrease constipation, bananas tend to increase constipation. 3. Increasing fluid consumption helps to decrease the hardness of the stool. 4. Whole-grain bread and brown rice are high in fiber and help decrease constipation. TEST-TAKING HINT: Answer 1 decreases constipation in an infant but not in a preschooler.

Which combination of signs is commonly associated with glomerulonephritis? 1. Massive proteinuria, hematuria, decreased urinary output, and lethargy. 2. Mild proteinuria, increased urinary output, and lethargy. 3. Mild proteinuria, hematuria, decreased urinary output, and lethargy. 4. Massive proteinuria, decreased urinary output, and hypotension.

1. Unlike nephrotic syndrome, protein is lost in mild-to-moderate amounts. 2. Urinary output is decreased in the child with glomerulonephritis. 3. Mild-to-moderate proteinuria, hematuria, decreased urinary output, and lethargy are common findings in glomerulonephritis. 4. Hypertension, not hypotension, is a common finding in glomerulonephritis. TEST-TAKING HINT: The test taker should eliminate answers 1 and 4 because glomerulonephritis does not cause massive proteinuria. Answer 2 can be eliminated because increased urine output is not associated with glomerulonephritis.

A child had a urinary tract infection (UTI) 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed normal results. The child has had no other problems until this visit when the child was diagnosed with another UTI. Which is the most appropriate plan? 1. Obtain urinalysis and urine culture. 2. Evaluate for renal failure. 3. Admit to the pediatric unit. 4. Send home on an antibiotic. 5. Schedule a VCUG.

1. Urinalysis and urine culture are routinely used to diagnose UTIs. VCUG is used to determine the extent of urinary tract involvement when a renal ultrasound shows scaring or possible reflux. If the child has a UTI related to bubble baths, constipation, or wiping back to front, a VCUG would not be ordered. 2. There are no data to suggest that renal failure should be evaluated. 3. A UTI is usually treated with oral antibiotics at home and does not routinely require admission to the hospital. 4. A second UTI requires more extensive evaluation and diagnostic testing. 5. If the child has a UTI related to bubble baths, constipation, or wiping back to front, a VCUG would not be ordered. TEST-TAKING HINT: The test taker can eliminate answer 2 because it is the only answer that does not address the UTI. Answer 1 is the best choice because it will provide more data about the cause of the child's recurrent UTIs.

The parent of a 5-year-old states that the child has been having diarrhea for 24 hours, vomited twice 2 hours ago, and now claims to be thirsty. The parent asks what to offer the child because the child is refusing Pedialyte. Which is the nurse's most appropriate response? 1. "You can offer clear diet soda such as Sprite and ginger ale." 2. "Pedialyte is really the best thing for your child, who, if thirsty enough, will eventually drink it." 3. "Pedialyte is really the best thing for your child. Allow your child some choice in the way to take it by offering small amounts in a spoon, medicine cup, or syringe." 4. "It really does not matter what your child drinks as long as it is kept down. Try offering small amounts of fluids in medicine cups."

1. When Pedialyte is not tolerated, it is usually recommended that clear sodas and juices be diluted. Diet beverages are not recommended because the sugar is needed to help the sodium be reabsorbed. 2. Pedialyte is the best choice. If the child is not encouraged to drink Pedialyte, the child may become severely dehydrated. Other ways to encourage oral rehydration need to be considered. 3. Pedialyte is the first choice, as recommended by the American Academy of Pediatrics. Offering the child appropriate choices may allow the child to feel empowered and less likely to refuse the Pedialyte. Small, frequent amounts are usually better tolerated. 4. Offering small amounts of liquids is important. The type of beverage does matter because many fluids may increase vomiting and diarrhea. TEST-TAKING HINT: The test taker should eliminate answer 2 because it offers an ultimatum to a child. The child is likely to refuse the Pedialyte, worsening the state of dehydration.

The nurse is providing discharge instructions to the parents of a child who had an appendectomy for a ruptured appendix 5 days ago. The nurse knows that further education is required when the parent states which of the following? Select all that apply. 1. "We will wait a few days before allowing our child to return to school." 2. "We will wait 2 weeks before allowing our child to return to sports." 3. "We will call the health-care provider's office if we notice any drainage around the wound." 4. "We will encourage our child to go for walks every day." 5. "We will encourage our child to eat at every meal and offer snacks."

2, 3. 1. The child should wait a few days before returning to school to avoid being easily fatigued. 2. The child should wait 6 weeks before returning to any strenuous activity. 3. Any signs of infection should be reported to the surgeon. 4. The child should be encouraged to walk every day because it will help the bowels return to normal and help the child regain stamina. 5. Encouraging the child to eat three meals per day and snacks in between is important following surgery to restore stamina and help with healing. TEST-TAKING HINT: The test taker should note that the question is asking which of the answers indicate that more education is needed. Answer 2 should be selected because 2 weeks is too early to return to strenuous sports. Answer 3 should be selected because the surgeon, not the general health-care provider, should be contacted.

Which would the nurse most likely find in the history of a child with hemolytic uremic syndrome (HUS)? Select all that apply. 1. Frequent UTIs and possible vesicoureteral reflux (VUR). 2. Vomiting and diarrhea before admission. 3. Bee sting and localized edema of the site for 3 days. 4. Previously healthy with no signs of illness. 5. Anorexia and bruising.

2, 5. 1. Frequent UTIs and VUR do not lead to HUS. 2. HUS is often preceded by diarrhea that may be caused by E. coli present in undercooked meat. 3. Insect stings are not associated with HUS. 4. HUS is usually preceded by diarrhea. 5. Anorexia and bruising (purura and/or petechiae) are common clinical manifestations. TEST-TAKING HINT: The test taker can eliminate answer 1 because there is no correlation between UTIs and HUS.