Pedi Module 3 Children with special needs

Chapter 47 Which clinical manifestation would most suggest acute appendicitis? Rebound tenderness Bright red or dark red rectal bleeding Abdominal pain that is relieved by eating Abdominal pain that is most intense at McBurney point

Abdominal pain that is most intense at McBurney point Pain is the cardinal feature. It is initially generalized and usually periumbilical. The pain localizes to the right lower quadrant at McBurney point. Rebound tenderness is not a reliable sign and is extremely painful to the child. Abdominal pain that is relieved by eating and is most intense at McBurney point are not signs of acute appendicitis. REF: 1399

Chapter 42 The nurse should suspect a hearing impairment in an infant who demonstrates which behavior? Absence of the Moro reflex Absence of babbling by age 7 months Lack of eye contact when being spoken to Lack of gesturing to indicate wants after age 15 months

Absence of babbling by age 7 months The absence of babbling or inflections in voice by age 7 months is an indication of hearing difficulties. Failure to develop intelligible speech would not be considered a problem by 12 months. This would be considered a problem at 24 months. The lack of a startle reflex would indicate a problem with hearing. The child with hearing impairment uses gestures rather than vocalizations to express desires at this age. REF: 1189

Chapter 42 When a child with mild cognitive impairment reaches the end of adolescence, what characteristic would be expected? Achieves a mental age of 5 to 6 years Achieves a mental age of 8 to 12 years Unable to progress in functional reading or arithmetic Acquires practical skills and useful reading and arithmetic to an eighth-grade level

Achieves a mental age of 8 to 12 years By the end of adolescence the child with mild cognitive impairment can usually acquire social and vocational skills, may need occasional guidance and support when under unusual social or economic stress, and may be able to adjust to marriage but not childrearing. Achieving a mental age of 5 to 6 years is considered a level of skill development associated with severe cognitive impairment. Being unable to progress in functional reading or math would indicate a level of skill development associated with profound cognitive impairment. Acquiring practical skills and useful reading and math to an eighth-grade level represents a level of skill development associated with moderate cognitive impairment. REF: 1179

Chapter 43 A family wants to begin oral feeding of their 4-year-old son, who is ventilator dependent and currently tube fed. They ask the home health nurse to feed him the baby food orally. The nurse recognizes a high risk of aspiration and an already compromised respiratory status. The most appropriate nursing action is to: Refuse to feed him orally because the risk is too high. Explain the risks involved and let the family decide what should be done. Feed him orally because the family has the right to make this decision for their child. Acknowledge their request, explain the risks, and explore with the family the available options.

Acknowledge their request, explain the risks, and explore with the family the available options. Parents want to be included in the decision making for their child's care. The nurse should discuss the request with the family to ensure that this is the issue of concern, and the potential options can be explored. Refusing to feed him orally does not determine why the parents wish the oral feedings to begin and does not involve them in the problem solving. The decision to begin or not to change feedings should be a collaborative one, made in consultation with the family, nurse, and appropriate member of the health care team. REF: 1210

Chapter 35 The nurse is caring for a child receiving intravenous (IV) morphine for severe postoperative pain. The nurse observes a slower respiratory rate, and the child cannot be aroused. The most appropriate management of this child is for the nurse to: Administer naloxone (Narcan). Discontinue IV infusion. Discontinue morphine until child is fully awake. Stimulate child by calling name, shaking gently, and asking to breathe deeply.

Administer naloxone (Narcan). The management of opioid-induced respiratory depression includes lowering the rate of infusion and stimulating the child. If the respiratory rate is depressed and the child cannot be aroused, IV naloxone should be administered. The child will be in pain because of the reversal of the morphine. The morphine should be discontinued, but naloxone is indicated if the child is unresponsive. REF: 948

Chapter 45 When liquid medication is given to a crying 10-month-old infant, which approach minimizes the possibility of aspiration? Administering the medication with a syringe (without needle) placed along the side of the infant's tongue Administering the medication as rapidly as possible with the infant securely restrained Mixing the medication with the infant's regular formula or juice and administer by bottle Keeping the child upright with the nasal passages blocked for a minute after administration

Administering the medication with a syringe (without needle) placed along the side of the infant's tongue Administer the medication with a syringe without needle placed alongside of the infant's tongue. The contents are administered slowly in small amounts, allowing the child to swallow between deposits. Medications should be given slowly to avoid aspiration. The medication should be mixed with only a small amount of food or liquid. If the child does not finish drinking/eating, it is difficult to determine how much medication was consumed. Essential foods also should not be used. Holding the child's nasal passages increases the risk of aspiration. REF: 1274

Chapter 41 At what developmental period do children have the most difficulty coping with death, particularly if it is their own? Toddlerhood Preschool School-age Adolescence

Adolescence Because of their mature understanding of death, remnants of guilt and shame, and issues with deviations from normal, adolescents have the most difficulty coping with death. Toddlers and preschoolers are too young to have difficulty coping with their own death. They will fear separation from parents. Children in these age groups are too young to have difficulty coping with their own death. They will fear separation from parents. School-age children will fear the unknown such as the consequences of the illness and the threat to their sense of security. REF: 1168

Chapter 46 It is generally recommended that a child with acute streptococcal pharyngitis can return to school: When the sore throat is better. If no complications develop. After taking antibiotics for 24 hours. After taking antibiotics for 3 days.

After taking antibiotics for 24 hours. After children have taken antibiotics for 24 hours, even if the sore throat persists, they are no longer contagious to other children. Complications may take days to weeks to develop.

Chapter 34 When the nurse interviews an adolescent, it is especially important to: Focus the discussion on the peer group. Allow an opportunity to express feelings. Emphasize that confidentiality will always be maintained. Use the same type of language as the adolescent.

Allow an opportunity to express feelings. Adolescents, like all children, need an opportunity to express their feelings. Often they will interject feelings into their words. The nurse must be alert to the words and feelings expressed. Although the peer group is important to this age group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently. REF: 872

Chapter 45 Katie, 4 years old, is admitted to outpatient surgery for removal of a cyst on her foot. Her mother puts the hospital gown on her, but Katie is crying because she wants to leave on her underpants. The most appropriate nursing action is to: Allow her to wear her underpants. Discuss with her mother why this is important to Katie. Ask her mother to explain to her why she cannot wear them. Explain in a kind, matter-of-fact manner that this is hospital policy.

Allow her to wear her underpants. It is appropriate for the child to leave her underpants on. This allows her some measure of control during the foot surgery. The mother should not be required to make the child more upset. Katie is too young to understand what hospital policy means. REF: 1249

Chapter 46 A child is diagnosed with influenza, probably type A disease. Management includes: Clear liquid diet for hydration. Aspirin to control fever. Amantadine hydrochloride to reduce symptoms. Antibiotics to prevent bacterial infection.

Amantadine hydrochloride to reduce symptoms. Amantadine hydrochloride may reduce symptoms related to influenza type A if administered within 24 to 48 hours of onset. It is ineffective against type B or C. A clear liquid diet is not necessary for influenza, but maintaining hydration is important. Aspirin is not recommended in children because of increased risk of Reye's syndrome. Acetaminophen or ibuprofen is a better choice. Preventive antibiotics are not indicated for influenza unless there is evidence of a secondary bacterial infection. REF: 1314

Chapter 44 The nurse is doing a prehospitalization orientation for Diana, age 7, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that she will not be able to talk because of an endotracheal tube but that she will be able to talk when it is removed. This explanation is: Unnecessary. The surgeon's responsibility. Too stressful for a young child. An appropriate part of the child's preparation.

An appropriate part of the child's preparation. This is a necessary part of preoperative preparation that will help reduce the anxiety associated with surgery. If the child wakes and is not prepared for the inability to speak, she will be even more anxious. It is a joint responsibility of nursing, medical staff, and child life personnel. This is a necessary component of preparation that will help reduce the anxiety associated with surgery. REF: 1228

Chapter 34 When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. This should be considered because these milestones are: Unnecessary information because the child is age 3 years. An important part of the family history. An important part of the child's past growth and development. An important part of the child's review of systems.

An important part of the child's past growth and development. Information about the attainment of developmental milestones is important to obtain. It provides data about the child's growth and development that should be included in the history. Developmental milestones provide important information about the child's physical, social, and neurologic health. The developmental milestones are specific to this child. If pertinent, attainment of milestones by siblings would be included in the family history. The review of systems does not include the developmental milestones. REF: 877

Chapter 47 Acute diarrhea is often caused by: Celiac disease. Antibiotic therapy. Immunodeficiency. Protein malnutrition.

Antibiotic therapy. Acute diarrhea is a sudden increase in frequency and change in consistency of stools and may be associated with antibiotic therapy. Hirschsprung's disease, hypothyroidism, and meconium ileus are usually manifested with constipation rather than diarrhea. REF: 1383

Chapter 47 Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies, which are now being successfully treated with antihistamines. The nurse should suspect that the constipation is most likely caused by: Diet. Allergies. Antihistamines. Emotional factors.

Antihistamines. Constipation may be associated with drugs such as antihistamines, antacids, diuretics, opioids, antiepileptics, and iron. Because this is the only known recent change in her habits, the addition of antihistamines is most likely the etiology of the diarrhea. With a change in bowel habits, the presence and role of any recently prescribed medications should be assessed. REF: 1389

Chapter 44 Samantha, age 5 years, tells the nurse that she "needs a Band-Aid" where she had an injection. The best nursing action is to: Apply a Band-Aid. Ask her why she wants a Band-Aid. Explain why a Band-Aid is not needed. Show her that the bleeding has already stopped.

Apply a Band-Aid. Children at this age group still fear that their insides may leak out at the injection site. Provide the Band-Aid. No explanation should be required. REF: 1231

Chapter 42 The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes: Applying a regular eye patch. Applying a Fox shield to the affected eye and any type of patch to the other eye. Applying ice until the physician is seen. Irrigating eye copiously with a sterile saline solution.

Applying a Fox shield to the affected eye and any type of patch to the other eye. The nurse's role in a penetrating eye injury is to prevent further injury to the eye. A Fox shield (if available) should be applied to the injured eye, and a regular eye patch to the other eye to prevent bilateral movement. Applying a regular eye patch or ice until the physician is seen, or irrigating the eye with a copious amount of sterile saline may cause more damage to the eye. REF: 1193

Chapter 43 One of the supervisors for a home health agency asks the nurse to give the family a survey evaluating the nurses and other service providers. The nurse should recognize this as: Inappropriate unless nurses are able to evaluate family. Appropriate to improve quality of care. Inappropriate unless nurses and other providers agree to participate. Inappropriate because family lacks knowledge necessary to evaluate professionals.

Appropriate to improve quality of care. Quality-assessment and quality-improvement activities are essential for virtually all organizations. Family involvement is essential in evaluating a home care plan and can occur on several levels. The nurse can ask the family open-ended questions at regular intervals to assess their opinion of the effectiveness of care. Families should also be given an opportunity to evaluate the individual home care nurses, the home care agency, and other service providers periodically. The nurse is the care provider. The evaluation is of the provision of care to the patient and family. The role of the nurse is not to evaluate the family. Quality-monitoring activities are required by virtually all health care agencies. During the evaluation process the family is requested to provide their perceptions of care. REF: 1212

Chapter 45 The Allen test is performed as a precautionary measure before which procedure? Heel stick Venipuncture Arterial puncture Lumbar puncture

Arterial puncture The Allen test assesses the circulation of the radial, ulnar, or brachial arteries before arterial puncture. REF: 1271

Chapter 42 When should children with cognitive impairment be referred for stimulation and educational programs? As young as possible As soon as they have the ability to communicate in some way At age 3 years, when schools are required to provide services At age 5 or 6 years, when schools are required to provide services

As young as possible The child's education should begin as soon as possible. Considerable evidence exists that early intervention programs for children with disabilities are valuable for cognitively impaired children. The early intervention may facilitate the child's development of communication skills. States are encouraged to provide early intervention programs from birth under Public Law 101-476, the Individuals with Disabilities Act. REF: 1178, 1179

Chapter 34 The nurse is taking a health history on an adolescent. What best describes how the chief complaint should be determined? Ask for detailed listing of symptoms. Ask adolescent, "Why did you come here today?" Use what adolescent says to determine, in correct medical terminology, what the problem is. Interview parent away from adolescent to determine chief complaint.

Ask adolescent, "Why did you come here today?" The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. Because the adolescent is the focus of the history, this is an appropriate way to determine the chief complaint. A listing of symptoms will make it difficult to determine the chief complaint. The adolescent should be prompted to tell which symptom caused him to seek help at this time. The chief complaint is usually written in the words that the parent or adolescent uses to describe the reason for seeking help. The parent and adolescent may be interviewed separately, but the nurse should determine the reason the adolescent is seeking attention at this time. REF: 875

Chapter 34 The nurse is taking a sexual history on an adolescent girl. The best way to determine whether she is sexually active is to: Ask her, "Are you sexually active?" Ask her, "Are you having sex with anyone?" Ask her, "Are you having sex with a boyfriend?" Ask both the girl and her parent if she is sexually active.

Ask her, "Are you having sex with anyone?" Asking the adolescent girl if she is having sex with anyone is a direct question that is well understood. The phrase sexually active is broadly defined and may not provide specific information to the nurse to provide necessary care. The word anyone is preferred to using gender-specific terms such as boyfriend or girlfriend. Because homosexual experimentation may occur, it is preferable to use gender-neutral terms. Questioning about sexual activity should occur when the adolescent is alone. REF: 878

Chapter 34 The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique might be most helpful? Suggest that the child keep a diary. Suggest that the parent read fairy tales to the child. Ask the parent if the child is always uncommunicative. Ask the child to draw a picture.

Ask the child to draw a picture. Drawing is one of the most valuable forms of communication. Children's drawings tell a great deal about them because they are projections of the child's inner self. It would be difficult for a 6-year-old child to keep a diary, since the child is most likely learning to read. Reading fairy tales to the child is a passive activity involving the parent and child. It would not facilitate communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers, not necessarily uncommunicative. REF: 874

Chapter 45 Frequent urine testing for specific gravity and glucose are required on a 6-month-old infant. The most appropriate way to collect small amounts of urine for these tests is to: Apply a urine-collection bag to perineal area. Tape a small medicine cup to the inside of the diaper. Aspirate urine from cotton balls inside the diaper with a syringe. Aspirate urine from a superabsorbent disposable diaper with a syringe.

Aspirate urine from cotton balls inside the diaper with a syringe. To obtain small amounts of urine, use a syringe without a needle to aspirate urine directly from the diaper. If diapers with absorbent material are used, place a small gauze dressing or cotton balls inside the diaper to collect the urine, and aspirate the urine with a syringe. For frequent urine sampling, the collection bag would be too irritating to the child's skin. Taping a small medicine cup to the inside of the diaper is not feasible; the urine will spill from the cup. Diapers with superabsorbent gels absorb the urine, so there is nothing to aspirate. REF: 1268

Chapter 46 A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests: Asthma. Pneumonia. Bronchiolitis. Foreign body in the trachea.

Asthma. Children with asthma usually have these chronic symptoms. Pneumonia appears with an acute onset and fever and general malaise. Bronchiolitis is an acute condition caused by respiratory syncytial virus. Foreign body in the trachea will occur with acute respiratory distress or failure and maybe stridor. REF: 1336

Chapter 44 Kimberly, age 3 years, is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her "a lot of new toys because she will be in the hospital." The nurse's reply should be based on an understanding that: New toys make hospitalization easier. New toys are usually better than older ones for children of this age. At this age children often need the comfort and reassurance of familiar toys from home. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.

At this age children often need the comfort and reassurance of familiar toys from home. Parents should bring favorite items from home to be with the child. Young children associate inanimate objects with significant people; they gain comfort and reassurance from these items. New toys will not serve the purpose of familiar toys and objects from home. The parents may experience some guilt as a response to the hospitalization, but there is no evidence that it is maladaptive. REF: 1233

Chapter 42 The child with Down syndrome should be evaluated for what characteristic before participating in some sports? Hyperflexibility Cutis marmorata Atlantoaxial instability Speckling of iris (Brushfield spots)

Atlantoaxial instability Children with Down syndrome are at risk for atlantoaxial instability. Before participating in sports that put stress on the head and neck, a radiologic examination should be done. Although hyperflexibility, cutis marmorata, and Brushfield spots are characteristics of Down syndrome, they do not affect the child's ability to participate in sports. REF: 1184

Chapter 46 An infant's parents ask the nurse about preventing otitis media (OM). What should the nurse recommend? Avoid tobacco smoke. Use nasal decongestant. Avoid children with OM. Bottle-feed or breastfeed in supine position.

Avoid tobacco smoke. Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other upper respiratory infection symptoms. Children should be fed in an upright position to prevent OM. REF: 1316

Chapter 46 Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include: Avoiding use for more than 3 days. Keeping drops to use again for nasal congestion. Administering drops until nasal congestion subsides. Administering drops after feedings and at bedtime.

Avoiding use for more than 3 days. Vasoconstrictive nose drops such as Neo-Synephrine should not be used for more than 3 days to avoid rebound congestion. Drops should be discarded after one illness because they may become contaminated with bacteria. Vasoconstrictive nose drops can have a rebound effect after 3 days of use. Drops administered before feedings are more helpful.

Chapter 47 A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of which condition? Protein intolerance Parasitic infection Fat malabsorption Bacterial gastroenteritis

Bacterial gastroenteritis Neutrophils and red blood cells in stool indicate bacterial gastroenteritis. Protein intolerance is suspected in the presence of eosinophils. Parasitic infection is indicated by eosinophils. Fat malabsorption is indicated by foul-smelling, greasy, bulky stools. REF: 1387

Chapter 41 The nurse is providing support to a family who is experiencing anticipatory grief related to their child's imminent death. An appropriate nursing intervention is to: Be available to the family. Attempt to "lighten the mood." Suggest activities to cheer up the family. Discourage crying until actual time of death.

Be available to the family. When death is imminent, care should be limited to interventions for palliative care. Music may be used to provide comfort to the child. Vital signs do not need to be measured frequently. The nurse should speak to the child in a clear distinct voice. REF: 1172

Chapter 42 Prevention of hearing impairment in children is a major goal for the nurse. This can be achieved through: Being involved in immunization clinics for children. Assessing a newborn for hearing loss. Answering parents' questions about hearing aids. Participating in hearing screening in the community.

Being involved in immunization clinics for children. Childhood immunizations can eliminate the possibility of acquired sensorineural hearing loss from rubella, mumps, or measles encephalitis. Assessing a newborn for hearing loss, answering parents' questions about hearing aids, and participating in community hearing screenings are screening interventions to identify the presence of hearing loss, not prevention. REF: 1191

Chapter 34 The nurse is interviewing the mother of an infant. She reports, "I had a difficult delivery, and my baby was born prematurely." This information should be recorded under which heading? Birth history Present illness Chief complaint Review of systems

Birth history The birth history refers to information that relates to previous aspects of the child's health, not to the current problem. The mother's difficult delivery and prematurity are important parts of the past history of an infant. The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. Unless chief complaint is directly related to the prematurity, this information is not included in the history of present illness. The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It would not include the birth information. The review of systems is a specific review of each body system. It does not include the premature birth. Sequelae such as pulmonary dysfunction would be included. REF: 876

Chapter 46 A school-age child has had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of: Bronchitis. Bronchiolitis. Viral-induced asthma. Acute spasmodic laryngitis.

Bronchitis. Bronchitis is characterized by these symptoms and occurs in children older than 6 years. Bronchiolitis is rare in children older than 2 years. Asthma is a chronic inflammation of the airways that may be exacerbated by a virus. Acute spasmodic laryngitis occurs in children between 3 months and 3 years. REF: 1321

Chapter 47 The nurse is explaining to a parent how to care for a child with vomiting associated with a viral illness. The nurse should include: Avoiding carbohydrate-containing liquids. Giving nothing by mouth for 24 hours. Brushing teeth or rinsing mouth after vomiting. Giving plain water until vomiting ceases for at least 24 hours.

Brushing teeth or rinsing mouth after vomiting. It is important to emphasize the need for the child to brush the teeth or rinse the mouth after vomiting to dilute the hydrochloric acid that comes in contact with the teeth. Administration of a glucose-electrolyte solution to an alert child will help restore water and electrolytes satisfactorily. It is important to include carbohydrates to spare body protein and avoid ketosis. REF: 1394

Chapter 45 It is important to make certain that sensory connectors and oximeters are compatible since wiring that is incompatible can cause: Hyperthermia. Electrocution. Pressure necrosis. Burns under sensors.

Burns under sensors. It is important to make certain that sensor connectors and oximeters are compatible. Wiring that is incompatible can generate considerable heat at the tip of the sensor, causing second- and third-degree burns under the sensor. Incompatibility would cause a local irritation or burn. A low voltage is used, which should not present risk of electrocution. Pressure necrosis can occur from the sensor being attached too tightly, but this is not a problem of incompatibility.

Chapter 34 Which tool measures body fat most accurately? Stadiometer Calipers Cloth tape measure Paper or metal tape measure

Calipers Calipers are used to measure skin-fold thickness, which is an indicator of body fat content. Stadiometers are used to measure height. Cloth tape measures should not be used because they can stretch. Paper or metal tape measures can be used for recumbent lengths and other body measurements that must be made. REF: 892

Chapter 46 Cardiopulmonary resuscitation is begun on a toddler. Which pulse is usually palpated because it is the most central and accessible? Radial Carotid Femoral Brachial

Carotid In a toddler the carotid pulse is palpated. The radial pulse is not considered a central pulse. The femoral pulse is not the most central and accessible. The brachial pulse is felt in infants younger than 1 year. REF: 1357

Chapter 42 Which term refers to opacity of the crystalline lens that prevents light rays from entering the eye and refracting on the retina? Myopia Amblyopia Cataract Glaucoma

Cataract A cataract refers to opacity of the crystalline lens that prevents light rays from entering the eye and refracting on the retina. Myopia or nearsightedness refers to the ability to see objects clearly at close range but not a distance Amblyopia or lazy eye is reduced visual acuity in one eye. Glaucoma is a group of eye diseases characterized by increased intraocular pressure. REF: 1192

Chapter 34 Kimberly is having a checkup before starting kindergarten. The nurse asks her to do the "finger-to-nose" test. The nurse is testing for: Deep tendon reflexes. Cerebellar function. Sensory discrimination. Ability to follow directions.

Cerebellar function. The finger-to-nose-test is an indication of cerebellar function. This test checks balance and coordination. Each deep tendon reflex is tested separately. Each sense is tested separately. Although this test enables the nurse to evaluate the child's ability to follow directions, it is used primarily for cerebellar function. REF: 923

Chapter 45 The nurse approaches a group of school-age patients to administer medication to Sam Hart. To identify the correct child, the nurse should: Ask the group, "Who is Sam Hart?" Call out to the group, "Sam Hart?" Ask each child, "What's your name?" Check the patient's identification name band.

Check the patient's identification name band. The child must be correctly identified before the administration of any medication. Children are not totally reliable in giving correct names on request; identification bracelets should always be checked. Asking the group to identify the child, calling out the child's name, and asking each child to give their name are not acceptable ways to identify a child. Older children may exchange places, give an erroneous name, or choose not to respond to their name as a form of a joke. REF: 1261

Chapter 41 Chris, age 9 years, has several physical disabilities. His father explains to the nurse that his son concentrates on what he can rather than cannot do and is as independent as possible. The nurse's best interpretation of this is: The father is experiencing denial. The father is expressing his own views. Child is using an adaptive coping style. Child is using a maladaptive coping style.

Child is using an adaptive coping style. The father is describing a well-adapted child who has learned to accept physical limitations. These children function well at home, at school, and with peers. They have an understanding of their disorder that allows them to accept their limitations, assume responsibility for care, and assist in treatment and rehabilitation. He is not denying the child's limitations. This is descriptive of an adaptive coping style.

Chapter 43 The home health nurse outlines short- and long-term goals for a 10-year-old child with many complex health problems. Who should agree on these goals? Family and nurse Child, family, and nurse All professionals involved Child, family, and all professionals involved

Child, family, and all professionals involved In the home the family is a partner in each step of the nursing process. The family priorities should guide the planning process. Both short- and long-term goals should be outlined and agreed on by the child, family, and professionals involved. Involvement of the individuals who are essential to the child's care is necessary during this very important stage. The elimination of any one of these groups can potentially create a plan of care that does not meet the needs of the child and family. REF: 1211

Chapter 42 Mark, a 9 year old with Down syndrome, is mainstreamed into a regular third grade for part of the school day. His mother asks the school nurse about programs such as Cub Scouts that he might join. The nurse's recommendation should be based on knowing that: Programs such as Cub Scouts are inappropriate for children who are cognitively impaired. Children with Down syndrome have the same need for socialization as other children. Children with Down syndrome socialize better with children who have similar disabilities. Parents of children with Down syndrome encourage programs such as scouting because they deny that their children have disabilities.

Children with Down syndrome have the same need for socialization as other children. Children of all ages need peer relationships. Children with Down syndrome should have peer experiences similar to those of other children such as group outings, Cub Scouts, and Special Olympics, which can all help children with cognitive impairment to develop socialization skills. Although all children should have an opportunity to form a close relationship with someone of the same developmental level, it is appropriate for children with disabilities to develop relationships with children who do not have disabilities. The parents are acting as advocates for their child. REF: 1182

Chapter 43 The home health nurse is caring for a child who requires complex care. The family expresses frustration related to obtaining accurate information about their child's illness and its management. The best action for the nurse is to: Determine why the family is easily frustrated. Refer the family to the child's primary care practitioner. Clarify the family's request and provide information they want. Answer only questions that are essential to the family knowledge base.

Clarify the family's request and provide information they want. The philosophic basis for family-centered practice is the recognition that the family is the constant in the child's life. It is essential and appropriate that the family have complete and accurate information about their child's illness and management. The nurse may first have to clarify what information the family feels has not been communicated. The family's frustration arises from their perception that they are not receiving information pertinent to their child's care. Referring the family to the child's PCP does not help the family. The home health nurse should have access to the necessary information. Questions about what they need and want to know concerning their child's care should be addressed. REF: 1211

Chapter 44 Matthew, age 18 months, has just been admitted with croup. His parent is tearful and tells the nurse, "This is all my fault. I should have taken him to the doctor sooner so he wouldn't have to be here." What is appropriate in the care plan for this parent who is experiencing guilt? Clarify the misconception about the illness. Explain to the parent that the illness is not serious. Encourage the parent to maintain a sense of control. Assess further why the parent has excessive guilt feelings.

Clarify the misconception about the illness. Guilt is a common response of parents when a child is hospitalized. They may blame themselves for the child's illness or for not recognizing it soon enough. The nurse should clarify the nature of the problem and reassure parents that the child is being cared for. Croup is a potentially very serious illness. The nurse should not minimize the parents' feelings. Encouraging the parent to maintain a sense of control would be difficult for the parents while their child is seriously ill. No further assessment is indicated at this time—guilt is a common response for parents. REF: 1236, 1237

Chapter 47 The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include Arm restraints, postural drainage, mouth irrigations. Cleansing suture line, supine and side-lying positions, arm restraints. Mouth irrigations, prone position, cleansing suture line. Supine and side-lying positions, postural drainage, arm restraints.

Cleansing suture line, supine and side-lying positions, arm restraints. The suture line should be cleansed gently after feeding. The child should be positioned on back or side or in infant seat. Elbows are restrained to prevent the child from accessing the operative site. Postural drainage is not indicated. This would increase the pressure on the operative site when the child is placed in different positions. Mouth irrigations would not be indicated. REF: 1414

Chapter 46 MULTIPLE RESPONSE An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes (choose all that apply): Cluster care to conserve energy. Round-the-clock administration of antitussive agents. Strict intake and output to avoid congestive heart failure. Administration of antibiotics.

Cluster care to conserve energy. Administration of antibiotics. Antibiotics are indicated for a bacterial pneumonia. Often the child will have decreased pulmonary reserve, and the clustering of care is essential. Round-the-clock antitussive agents and strict intake and output are not included in the care of the child with pneumonia. REF: 1325

Chapter 42 An implanted ear prosthesis for children with sensorineural hearing loss is a(n): Hearing aid. Cochlear implant. Auditory implant. Amplification device.

Cochlear implant. Cochlear implants are surgically implanted, and they provide a sensation of hearing for individuals who have severe or profound hearing loss of sensorineural origin. Hearing aids are external devices for enhancing hearing. An auditory implant does not exist. An amplification device is an external device for enhancing hearing. REF: 1188

Chapter 42 The most common type of hearing loss, which results from interference of transmission of sound to the middle ear, is called: Conductive. Sensorineural. Mixed conductive-sensorineural. Central auditory imperceptive.

Conductive. Conductive or middle-ear hearing loss is the most common type. It results from interference of transmission of sound to the middle ear, most often from recurrent otitis media. Sensorineural, mixed conductive-sensorineural, and central auditory imperceptive are less common types of hearing loss. REF: 1187

Chapter 42 When caring for a newborn with Down syndrome, the nurse should be aware that the most common congenital anomaly associated with Down syndrome is: Hypospadias. Pyloric stenosis. Congenital heart disease. Congenital hip dysplasia.

Congenital heart disease. Congenital heart malformations, primarily septal defects, are very common congenital anomalies in Down syndrome. Hypospadias, pyloric stenosis, and congenital hip dysplasia are not frequent congenital anomalies associated with Down syndrome. REF: 1183

Chapter 47 What is used to treat moderate-to-severe inflammatory bowel disease? Antacids Antibiotics Corticosteroids Antidiarrheal medications

Corticosteroids Corticosteroids such as prednisone and prednisolone are used in short bursts to suppress the inflammatory response in inflammatory bowel disease. Antacids and antidiarrheals are not drugs of choice to treat the inflammatory process of inflammatory bowel disease. Antibiotics may be used as adjunctive therapy to treat complications REF: 1402

Chapter 45 The nurse is teaching a mother how to perform chest physiotherapy and postural drainage on her 3-year-old child, who has cystic fibrosis. To perform percussion the nurse should instruct her to: Cover the skin with a shirt or gown before percussing. Strike the chest wall with a flat-hand position. Percuss over the entire trunk anteriorly and posteriorly. Percuss before positioning for postural drainage.

Cover the skin with a shirt or gown before percussing. For postural drainage and percussion, the child should be dressed in a light shirt to protect the skin and placed in the appropriate postural drainage positions. The chest wall is struck with a cupped-hand, not a flat-hand position. The procedure should be done over the rib cage only. Positioning precedes the percussion. REF: 1291

Chapter 47 What is characterized by a chronic inflammatory process that may involve any part of the gastrointestinal (GI) tract from mouth to anus? Crohn's disease Ulcerative colitis Meckel's diverticulum Irritable bowel syndrome

Crohn's disease The chronic inflammatory process of Crohn's disease involves any part of the GI tract from the mouth to the anus but most often affects the terminal ileum. Ulcerative colitis, Meckel's diverticulum, and irritable bowel syndrome do not affect the entire GI tract. REF: 1401

Chapter 47 An infant is brought to the emergency department with poor skin turgor, weight loss, lethargy, and tachycardia. This is suggestive of: Overhydration. Dehydration. Sodium excess. Potassium excess.

Dehydration. These clinical manifestations indicate dehydration. Symptoms of overhydration are edema and weight gain. Regardless of extracellular sodium levels, total body sodium is usually depleted in dehydration. Symptoms of hypocalcemia are a result of neuromuscular irritability and manifest as jitteriness, tetany, tremors, and muscle twitching. REF: 1382

Chapter 45 Using knowledge of child development, the best approach when preparing a toddler for a procedure is to: Avoid asking the child to make choices. Demonstrate the procedure on a doll. Plan for the teaching session to last about 20 minutes. Show necessary equipment without allowing child to handle it.

Demonstrate the procedure on a doll. Prepare toddlers for procedures by using play. Demonstrate on a doll, but avoid the child's favorite doll because the toddler may think the doll is really "feeling" the procedure. In preparing a toddler for a procedure, the child is allowed to participate in care and help whenever possible. Teaching sessions for toddlers should be about 5 to 10 minutes. Use a small replica of the equipment and allow the child to handle it. REF: 1248

Chapter 46 In providing nourishment for a child with cystic fibrosis (CF), which factor should the nurse keep in mind? Diet should be high in carbohydrates and protein. Diet should be high in easily digested carbohydrates and fats. Most fruits and vegetables are not well tolerated. Fats and proteins must be greatly curtailed.

Diet should be high in carbohydrates and protein. Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Enzyme supplementation helps digest foods; other modifications are not necessary. A well-balanced diet containing fruits and vegetables is important. Fats and proteins are a necessary part of a well-balanced diet. REF: 1349

Chapter 46 -Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. What is their action? Liquefy secretions. Dilate the bronchioles. Reduce inflammation of the lungs. Reduce infection.

Dilate the bronchioles. These medications work to dilate the bronchioles in acute exacerbations. These medications do not liquefy secretions or reduce infection. Corticosteroids and mast cell stabilizers reduce inflammation in the lungs.

Chapter 45 The nurse gives an injection in a patient's room. What should the nurse do with the needle for disposal? Dispose of syringe and needle in a rigid, puncture-resistant container in patient's room. Dispose of syringe and needle in a rigid, puncture-resistant container in an area outside of patient's room. Cap needle immediately after giving injection and dispose of in proper container. Cap needle, break from syringe, and dispose of in proper container.

Dispose of syringe and needle in a rigid, puncture-resistant container in patient's room. All needles (uncapped and unbroken) are disposed of in a rigid, puncture-resistant container located near the site of use. Consequently these containers should be installed in the patient's room. The uncapped needle should not be transported to an area distant from use.

Chapter 42 A newborn assessment shows separated sagittal suture, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. These findings are most suggestive of: Microcephaly. Down syndrome. Cerebral palsy. Fragile X syndrome.

Down syndrome. These are characteristics associated with Down syndrome. The infant with microcephaly has a small head. Cerebral palsy is a diagnosis not usually made at birth. No characteristic physical signs are present. The infant with fragile X syndrome has increased head circumference; long, wide, and/or protruding ears; long, narrow face with prominent jaw; hypotonia; and high, arched palate. REF: 1184

Chapter 47 The nurse is caring for a neonate with a suspected tracheoesophageal fistula. Nursing care should include: Elevating the head but giving nothing by mouth. Elevating the head for feedings. Feeding glucose water only. Avoiding suctioning unless the infant is cyanotic.

Elevating the head but giving nothing by mouth. When a newborn is suspected of having tracheoesophageal fistula, the most desirable position is supine with the head elevated on an incline plane of at least 30 degrees. It is imperative that any source of aspiration be removed at once; oral feedings are withheld. Feedings should not be given to infants suspected of having tracheoesophageal fistulas. The oral pharynx should be kept clear of secretion by oral suctioning. This is to avoid the cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx. REF: 1416

Chapter 47 A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. Initial therapeutic approach to the mother should be to: Restate what the physician has told her about plastic surgery. Encourage her to express her feelings. Emphasize the normalcy of her baby and the baby's need for mothering. Recognize that negative feelings toward the child continue throughout childhood.

Encourage her to express her feelings. For parents cleft lip and cleft palate deformities are particularly disturbing. The nurse must place emphasis not only on the infant's physical needs but also on the parents' emotional needs. The mother needs to be able to express her feelings before the acceptance of her child can occur. Although discussing plastic surgery will be addressed, it is not part of the initial therapeutic approach. As the mother expresses her feelings, the nurse's actions should convey to the parents that the infant is a precious human being. The child's normalcy is emphasized, and the mother is assisted to recognize the child's uniqueness. A focus on abnormal maternal-infant attachment would be inappropriate at this time. REF: 1412, 1413

Chapter 46 MULTIPLE RESPONSE The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which interventions should be included in the child's care? Choose all that apply. Place in a mist tent. Administer antibiotics. Administer cough syrup. Encourage infant to drink 8 ounces of formula every 4 hours. Cluster care to encourage adequate rest. Place on noninvasive oxygen monitoring.

Encourage infant to drink 8 ounces of formula every 4 hours. Cluster care to encourage adequate rest. Place on noninvasive oxygen monitoring. Hydration is important in children with RSV bronchiolitis to loosen secretions and prevent shock. Clustering of care promotes periods of rest. The use of noninvasive oxygen monitoring is recommended. REF: 1323, 1324

Chapter 44 An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler is to: Provide for privacy. Encourage parents to room in. Explain procedures and routines. Encourage contact with children the same age.

Encourage parents to room in. A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room in as much as possible. Maintaining routines and ensuring privacy are helpful interventions, but they would not substitute for the parents. Contact with same-aged children would not substitute for having the parents present. REF: 1228

Chapter 46 An appropriate nursing intervention when caring for a child with pneumonia is to: Encourage rest. Encourage the child to lie on the unaffected side. Administer analgesics. Place the child in the Trendelenburg position.

Encourage rest. Encouraging rest by clustering care and promoting a quiet environment is the best intervention for a child with pneumonia. Lying on the affected side may promote comfort by splinting the chest and reducing pleural rubbing. Analgesics are not indicated. Children should be placed in a semierect position or position of comfort. REF: 1325

Chapter 41 Which intervention will encourage a sense of autonomy in a toddler with disabilities? Avoiding separation from family during hospitalizations Encouraging independence in as many areas as possible Exposing child to pleasurable experiences as much as possible Helping parents learn special care needs of their child

Encouraging independence in as many areas as possible Encouraging the toddler to be independent encourages a sense of autonomy. The child can be given choices about feeding, dressing, and choice of diversional activities, which will provide a sense of control. These interventions should be practiced as part of family-centered care. They do not particularly foster autonomy. Exposing the child to pleasurable experiences, especially sensory ones, is a supportive intervention. It does not particularly support autonomy.

Chapter 45 The nurse must suction a child with a tracheostomy. Interventions should include: Encouraging the child to cough to raise the secretions before suctioning. Selecting a catheter with a diameter three fourths as large as the diameter of the tracheostomy tube. Ensuring that each pass of the suction catheter take no longer than 5 seconds. Allowing the child to rest after every five times the suction catheter is passed.

Ensuring that each pass of the suction catheter take no longer than 5 seconds. Suctioning should require not longer than 5 seconds per pass. Otherwise the airway may be occluded for too long. If the child is able to cough up secretions, suctioning may not be indicated. The catheter should have a diameter one-half the size of the tracheostomy tube. If it is too large, it might block the child's airway. The child is allowed to rest for 30 to 60 seconds after each aspiration to allow oxygen tension to return to normal. Then the process is repeated until the trachea is clear. REF: 1292

Chapter 46 Which type of croup is always considered a medical emergency? Laryngitis Epiglottitis Spasmodic croup Laryngotracheobronchitis (LTB)

Epiglottitis Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and upper respiratory infection symptoms. Spasmodic croup is treated with humidity. LTB may progress to a medical emergency in some children. REF: 1318

Chapter 46 Which drug is considered the most useful in treating cardiac arrest? Bretylium Lidocaine hydrochloride Epinephrine hydrochloride Naloxone (Narcan)

Epinephrine hydrochloride Epinephrine HCl works on - and -receptors in the heart and is the most useful drug in cardiac arrest. Bretylium is no longer used in pediatric cardiac arrest management. Lidocaine HCl is used for ventricular arrhythmias only. Naloxone is useful only to reverse effects of opioids. REF: 1359

Chapter 47 Bismuth subsalicylate, clarithromycin, and metronidazole are prescribed for a child with a peptic ulcer to: Eradicate Helicobacter pylori. Coat gastric mucosa. Treat epigastric pain. Reduce gastric acid production.

Eradicate Helicobacter pylori. This combination of drug therapy is effective in the treatment and eradication of H. pylori. REF: 1406

The parents of a child born with disabilities ask the nurse for advice about discipline. The nurse's response should be based on knowledge that discipline is: Essential for the child. Too difficult to implement with a special-needs child. Not needed unless child becomes problematic. Best achieved with punishment for misbehavior.

Essential for the child. Discipline is essential for the child. It provides boundaries within which to test their behavior and teaches them socially acceptable behaviors. The nurse should teach the parents ways to manage the child's behavior before it becomes problematic. Punishment is not effective in managing behavior.

Chapter 41 The parents of a child born with disabilities ask the nurse for advice about discipline. The nurse's response should be based on knowledge that discipline is: Essential for the child. Too difficult to implement with a special-needs child. Not needed unless child becomes problematic. Best achieved with punishment for misbehavior.

Essential for the child. Discipline is essential for the child. It provides boundaries within which to test their behavior and teaches them socially acceptable behaviors. The nurse should teach the parents ways to manage the child's behavior before it becomes problematic. Punishment is not effective in managing behavior. REF: 1162

Chapter 35 A lumbar puncture is needed on a school-age child. The most appropriate action to provide analgesia during this procedure is to apply: Tetracaine-adrenaline-cocaine (TAC) 15 minutes before procedure. Transdermal fentanyl (Duragesic) patch immediately before procedure. Eutectic mixture of local anesthetics (EMLA) 1 hour before procedure. EMLA 30 minutes before procedure.

Eutectic mixture of local anesthetics (EMLA) 1 hour before procedure. EMLA is an effective analgesic agent when applied to the skin 60 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. TAC provides skin anesthesia about 15 minutes after application to nonintact skin. The gel can be placed on the wound for suturing. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control. For maximal effectiveness EMLA must be applied approximately 60 minutes in advance. REF: 944

Chapter 42 A nurse would suspect possible visual impairment in a child who displays: Excessive rubbing of the eyes. Rapid lateral movement of the eyes. Delay in speech development. Lack of interest in casual conversation with peers.

Excessive rubbing of the eyes. Excessive rubbing of the eyes is a clinical manifestation of visual impairment. Rapid lateral movement of the eyes, delay in speech development, and lack of interest in casual conversation with peers are not associated with visual impairment. REF: 1192

Chapter 44 Natasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What will help her most in her adjustment to the hospital? Explain hospital schedules such as mealtimes. Use terms such as "honey" and "dear" to show a caring attitude. Explain when parents can visit and why siblings cannot come to see her. Orient her parents, because she is young, to her room and hospital facility.

Explain hospital schedules such as mealtimes. School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for experiences that are unavoidable. The nurse should refer to the child by the preferred name. Telling the child about all of the limitations of visiting does not help her adjust to the hospital. At the age of 8 years the child and parent should be oriented to the environment REF: 1222

Chapter 34 An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to: Ask her why she wants to know. Determine why she is so anxious. Explain in simple terms how it works. Tell her she will see how it works as it is used.

Explain in simple terms how it works. School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. A nurse should respond positively for requests for information about procedures and health information. By not responding the nurse may be limiting communication with the child. The child is not exhibiting anxiety, just requesting clarification of what will be occurring. The nurse must explain how the blood pressure cuff works so the child can then observe during the procedure. REF: 871

Chapter 41 At the time of a child's death, the nurse tells his mother, "We will miss him so much." The best interpretation of this is that the nurse is: Pretending to be experiencing grief. Expressing personal feelings of loss. Denying the mother's sense of loss. Talking when listening would be better.

Expressing personal feelings of loss. The death of a patient is one of the most stressful aspects of a critical care or oncology nurse. Nurses experience reactions similar to those of family members because of their involvement with the child and family during the illness. Nurses often have feelings of personal loss when a patient dies. The nurse is experiencing a normal grief response to the death of a patient. There is no implication that the mother's loss is minimized. The nurse is validating the worth of the child. REF: 1174

Chapter 41 TRUE/FALSE The loss of a child is often the most difficult and traumatic event that a parent will ever experience. For this reason the parents should never be approached regarding organ donation.

F Organ or tissue donation may be a meaningful act that assists parents who have lost their child. Ideally the person who knows the family best (or a transplant coordinator) is in an optimal position to discuss organ donation with the parents. This should be done in a sensitive manner that reassures the parents and provides the opportunity for them to have their questions answered.

Chapter 41 The nurse case manager is planning a care conference about a young child who has complex health care needs and will soon be discharged home. Who should the nurse invite to the conference? Family and nursing staff. Social worker, nursing staff, and primary care physician. Family and key health professionals involved in child's care. Primary care physician and key health professionals involved in child's care .

Family and key health professionals involved in child's care A multidisciplinary conference is necessary for coordination of care for children with complex health needs. The family and key health professionals who are involved in the child's care are included. The nursing staff can address the nursing care needs of the child with the family, but other involved disciplines must be included. The family must be included in the discharge conferences, which allow them to determine what education they will require and the resources needed at home. A member of the nursing staff must be included to review the nursing needs of the child. REF: 1148

Chapter 47 Nurses must be alert for increased fluid requirements when a child has: Fever. Mechanical ventilation. Congestive heart failure. Increased intracranial pressure (ICP).

Fever. Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. Respiratory rate influences insensible fluid loss and should be monitored in the mechanically ventilated child. Congestive heart failure is a case of fluid overload in children. ICP does not lead to increased fluid requirements in children. REF: 1381

Chapter 45 Kimberly, age 3 years, has a fever associated with a viral illness. Her mother calls the nurse, reporting a fever of 102° F even though she had acetaminophen 2 hours ago. The nurse's action should be based on knowing that: Fevers such as this are common with viral illnesses. Seizures are common in children when antipyretics are ineffective. Fever over 102° F indicates greater severity of illness. Fever over 102° F indicates a probable bacterial infection.

Fevers such as this are common with viral illnesses. Most fevers are of brief duration, have limited consequences, and are viral. Little evidence supports the use of antipyretic drugs to prevent febrile seizures. Neither the increase in temperature nor its response to antipyretics indicates the severity or etiology of infection. REF: 1259

Chapter 47 A parasite that causes acute diarrhea is: Shigella organisms. Salmonella organisms. Giardia lamblia. Escherichia coli.

Giardia lamblia. Giardiasis is a parasite that represents 15% of nondysenteric illness in the United States. Shigella, Salmonella, and E. coli are bacterial pathogens. REF: 1383, 1386

Chapter 45 An appropriate intervention to encourage food and fluid intake in a hospitalized child is to: Force child to eat and drink to combat caloric losses. Discourage participation in noneating activities until caloric intake is sufficient. Administer large quantities of flavored fluids at frequent intervals and during meals. Give high-quality foods and snacks whenever child expresses hunger.

Give high-quality foods and snacks whenever child expresses hunger. Small, frequent meals and nutritious snacks should be provided for the child. Favorite foods such as peanut butter and jelly sandwiches, fruit yogurt, cheese, pizza, and macaroni and cheese should be available. Forcing a child to eat only meets with rebellion and reinforces the behavior as a control mechanism. Large quantities of fluid may decrease the child's hunger and further inhibit food intake. REF: 1258

Chapter 46 When caring for an infant with an upper respiratory tract infection and elevated temperature, an appropriate nursing intervention is to: Give tepid water baths to reduce fever. Encourage food intake to maintain caloric needs. Have child wear heavy clothing to prevent chilling. Give small amounts of favorite fluids frequently to prevent dehydration.

Give small amounts of favorite fluids frequently to prevent dehydration. Preventing dehydration by small frequent feedings is an important intervention in the febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting. The febrile child should be dressed in light, loose clothing. REF: 1306

chapter 41 A common parental reaction to a child with special needs is parental overprotection. Parental behavior suggestive of this includes: Giving inconsistent discipline. Providing consistent, strict discipline. Forcing child to help self, even when not capable. Encouraging social and educational activities not appropriate to child's level of capability.

Giving inconsistent discipline. Parental overprotection is manifested by the parents' fear of letting the child achieve any new skill, avoiding all discipline, and catering to the child's every desire to prevent frustration. The overprotective parents usually do not set limits and or institute discipline, and they usually prefer to remain in the role of total caregiver. They do not allow the child to perform self-care or encourage the child to try new activities.

Chapter 45 The nurse is preparing a 12-year-old girl for a bone marrow aspiration. She tells the nurse that she wants her mother with her "like before." The most appropriate nursing action is to: Grant her request. Explain why this is not possible. Identify an appropriate substitute for her mother. Offer to provide support to her during the procedure.

Grant her request. The parents' preferences for assisting, observing, or waiting outside the room should be assessed, as well as the child's preference for parental presence. The child's choice should be respected. If the mother and child are agreeable, the mother is welcome to stay. An appropriate substitute for the mother is necessary only if the mother does not wish to stay. Support is offered to the child regardless of parental presence. REF: 1249

Chapter 41 The nurse is caring for a child who has just died. The parents ask to be left alone so that they can rock their child one more time. The nurse should: Grant their request. Assess why they feel that this is necessary. Discourage this because it will only prolong their grief. Kindly explain that they need to say good-bye to their child now and leave.

Grant their request. The parents should be allowed to remain with their child after the death. The nurse can remove all of the tubes and equipment and offer the parents the option of preparing the body. This is an important part of the grieving process and should be allowed if the parents desire it. It is important for the nurse to ascertain if the family has any special needs. REF: 1171

chapter 41 Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by: Denial. Guilt and anger. Social reintegration. Acceptance of child's limitations.

Guilt and anger. For most families the adjustment phase is accompanied by several responses that are normally part of the adjustment process. Guilt, self-accusation, bitterness, and anger are common reactions. The initial diagnosis of a chronic illness or disability often is often met with intense emotion and characterized by shock and denial. Social reintegration and acceptance of the child's limitations is the culmination of the adjustment process.

Chapter 47 MULTIPLE RESPONSE What is true concerning hepatitis B? Choose all that apply. Hepatitis B cannot exist in a carrier state. Hepatitis B can be prevented by hepatitis B virus vaccine. Hepatitis B can be transferred to an infant of a breastfeeding mother. The onset of hepatitis B is insidious. The principal mode of transmission for hepatitis B is the fecal-oral route. Immunity to hepatitis B occurs after one attack.

Hepatitis B can be prevented by hepatitis B virus vaccine. Hepatitis B can be transferred to an infant of a breastfeeding mother. The onset of hepatitis B is insidious. Immunity to hepatitis B occurs after one attack. The vaccine elicits the formation of an antibody to the hepatitis B surface antigen, which is protective against hepatitis B. Hepatitis B can be transferred to an infant of a breastfeeding mother, especially if the mother's nipples are cracked. The onset of hepatitis B is insidious. Immunity develops after one exposure to hepatitis B. These statements are not true concerning hepatitis B. REF: 1407

Chapter 47 Which type of dehydration results from water loss in excess of electrolyte loss? Isotonic dehydration Isosmotic dehydration Hypotonic dehydration Hypertonic dehydration

Hypertonic dehydration Hypertonic dehydration results from water loss in excess of electrolyte loss. This is the most dangerous type of dehydration. It is caused by feeding children fluids with high amounts of solute. Isotonic dehydration occurs in conditions in which electrolyte and water deficits are present in balanced proportion. Isosmotic dehydration is another term for isotonic dehydration. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic. REF: 1381

Chapter 46 Which statement expresses accurately the genetic implications of cystic fibrosis (CF)? If it is present in a child, both parents are carriers of this defective gene. It is inherited as an autosomal dominant trait. It is a genetic defect found primarily in non-Caucasian population groups. There is a 50% chance that siblings of an affected child also will be affected.

If it is present in a child, both parents are carriers of this defective gene. CF is an autosomal recessive gene inherited from both parents and is found primarily in Caucasian populations. An autosomal recessive inheritance pattern means that there is a 25% chance that a sibling will be infected but a 50% chance a sibling will be a carrier. REF: 1346

Chapter 45 When teaching a mother how to administer eye drops, where should the nurse tell her to place them? In the conjunctival sac that is formed when the lower lid is pulled down Carefully under the eye lid while it is gently pulled upward On the sclera while the child looks to the side Anywhere as long as drops contact the eye's surface

In the conjunctival sac that is formed when the lower lid is pulled down The lower lid is pulled down, forming a small conjunctival sac. The solution or ointment is applied to this area. The medication should not be administered directly on the eyeball. REF: 1283

Chapter 46 The mother of a toddler yells to the nurse, "Help! He is choking to death on his food." The nurse determines that lifesaving measures are necessary based on: Gagging. Coughing. Pulse over 100 beats/min. Inability to speak.

Inability to speak. The inability to speak indicates a foreign-body airway obstruction of the larynx. Abdominal thrusts are needed for treatment of the choking child. Gagging indicates irritation at the back of the throat, not obstruction. Coughing does not indicate a complete airway obstruction. Tachycardia may be present for many reasons. REF: 1330

Chapter 34 When palpating the child's cervical lymph nodes, the nurse notes that they are tender, enlarged, and warm. The best explanation for this is: Some form of cancer. Local scalp infection common in children. Infection or inflammation distal to the site. Infection or inflammation close to the site.

Infection or inflammation close to the site. Small nontender nodes are normal. Tender, enlarged, and warm lymph nodes may indicate infection or inflammation close to their location. Tender lymph nodes do not usually indicate cancer. A scalp infection usually does not cause inflamed lymph nodes. The lymph nodes close to the site of inflammation or infection would be inflamed. REF: 902

Chapter 45 An important nursing consideration when performing a bladder catheterization on a young boy is to: Use clean technique, not Standard Precautions. Insert 2% lidocaine lubricant into the urethra. Lubricate catheter with water-soluble lubricant such as K-Y Jelly. Delay catheterization for 20 minutes while anesthetic lubricant is absorbed.

Insert 2% lidocaine lubricant into the urethra. The anxiety, fear, and discomfort experienced during catheterization can be significantly decreased by preparing the child and parents, selecting the correct catheter, and using appropriate insertion technique. Generous lubrication of the urethra before catheterization and use of lubricant containing 2% lidocaine may reduce or eliminate the burning and discomfort associated with this procedure. Catheterization is a sterile procedure, and Standard Precautions for body-substance protection should be followed. Water-soluble lubricants do not provide appropriate local anesthesia. Catheterization should be delayed only 2 to 3 minutes. This provides sufficient local anesthesia for the procedure. REF: 1270

Chapter 45 Guidelines for intramuscular administration of medication in school-age children include to: Inject medication as rapidly as possible. Insert the needle quickly, using a dartlike motion. Penetrate the skin immediately after cleansing the site, before skin has dried. Have the child stand, if possible, and if he or she is cooperative.

Insert the needle quickly, using a dartlike motion. The needle should be inserted quickly in a dartlike motion at a 90-degree angle unless contraindicated. Inject medications slowly. Allow skin preparation to dry completely before skin is penetrated. Place the child in a lying or sitting position. REF: 1278

Chapter 34 Examination of the abdomen is performed correctly by the nurse in this order: Inspection, palpation, and auscultation Palpation, inspection, and auscultation Palpation, auscultation, and inspection Inspection, auscultation, and palpation

Inspection, auscultation, and palpation The correct order of abdominal examination is inspection, auscultation, and palpation. Palpation is always performed last because it may distort the normal abdominal sounds. REF: 917

Chapter 47 Which statement is most descriptive of Meckel's diverticulum? It is more common in females than in males. It is acquired during childhood. Intestinal bleeding may be mild or profuse. Medical interventions are usually sufficient to treat the problem.

Intestinal bleeding may be mild or profuse. Blood stools are often a presenting sign of Meckel's diverticulum. It is associated with mild-to-profuse intestinal bleeding. It is twice as common in males as in females, and complications are more frequent in males. Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract and is present in 1% to 4% of the general population. The standard therapy is surgical removal of the diverticulum. REF: 1400

Chapter 47 A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child will begin with: Intravenous fluids. Oral rehydration solution (ORS). Clear liquids, 1 to 2 ounces at a time. Administration of antidiarrheal medication.

Intravenous fluids. Intravenous fluids are initiated in children with severe dehydration. ORS is acceptable therapy if the dehydration is not severe. Diarrhea is not managed by using clear liquids by mouth. These fluids have a high carbohydrate content, low electrolyte content, and high osmolality. Antidiarrheal medications are not recommended for the treatment of acute infectious diarrhea. REF: 1388

Chapter 34 The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should the nurse do first? Introduce self. Make the family comfortable. Explain the purpose of the interview. Give an assurance of privacy.

Introduce self. The first thing that nurses must do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. During the initial part of the interview the nurse should include general conversation to help make the family feel at ease. Next the purpose of the interview and the nurse's role should be clarified. The interview should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality. REF: 866

Chapter 42 A father calls the emergency department nurse saying that his daughter's eyes burn after getting some dishwasher detergent in them. The nurse recommends that the child be seen in the emergency department or by an ophthalmologist. What should the nurse recommend before the child is transported? Keep the eyes closed. Apply cold compresses. Irrigate eyes copiously with tap water for 20 minutes. Prepare a normal saline solution (salt and water) and irrigate eyes for 20 minutes.

Irrigate eyes copiously with tap water for 20 minutes. The first action is to flush the eyes with clean tap water. This will rinse the detergent from the eyes. Keeping the eyes closed and applying cold compresses may allow the detergent to do further harm to the eyes during transport. Normal saline is not necessary. The delay can allow the detergent to cause continued injury to the eyes. REF: 1193

Chapter 41 What is most descriptive of a school-age child's reaction to death? Is very interested in funerals and burials Has little understanding of words such as forever Imagines the deceased person to be still alive Has an idealistic view of world and criticizes funerals as barbaric

Is very interested in funerals and burials The school-age child is very interested in post death services and may be inquisitive about what happens to the body. School-age children have an established concept of forever and have a deeper understanding of death in a concrete manner. Adolescents may respond to death in this manner. REF: 1167

Chapter 46 Which statement is characteristic of acute otitis media (AOM)? The etiology is unknown. Permanent hearing loss often results. It can be treated by intramuscular antibiotics. It is treated with a broad range of antibiotics.

It is treated with a broad range of antibiotics. Historically AOM has been treated with a range of antibiotics, and it is the most common disorder treated with antibiotics in the ambulatory setting. The etiology of AOM may be Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, or a viral agent. Recent concerns about drug-resistant organisms have caused authorities to recommend judicious use of antibiotics and that antibiotics are not required for initial treatment. Permanent hearing loss is not a frequent cause of properly treated AOM. Intramuscular antibiotics are not necessary. Oral amoxicillin is the treatment of choice. REF: 1315

Chapter 34 The nurse has a 2-year-old boy sit in "tailor" position during palpation for the testes. The rationale for this position is that: It prevents cremasteric reflex. Undescended testes can be palpated. This tests the child for an inguinal hernia. The child does not yet have a need for privacy.

It prevents cremasteric reflex. The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity. Undescended testes cannot be predictably palpated. Inguinal hernias are not detected by this method. This position is used for inhibiting the cremasteric reflex. Privacy should always be provided for children. REF: 920

Chapter 47 The earliest clinical manifestation of biliary atresia is: Jaundice. Vomiting. Hepatomegaly. Absence of stooling.

Jaundice. Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera, may be present at birth, but is usually not apparent until ages 2 to 3 weeks. Vomiting is not associated with biliary atresia. Hepatomegaly and abdominal distention are common but occur later. Stools are large and lighter in color than expected because of the lack of bile. REF: 1410

Chapter 44 Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her, "We are sick of Mom always sitting with you in the hospital and playing with you. It isn't fair that you get everything and we have to stay with the neighbors." The nurse's best assessment of this situation is that: The siblings are immature and probably spoiled. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling. The family has ineffective coping mechanisms to deal with chronic illness. The siblings need to better understand their sister's illness and needs.

Jealousy and resentment are common reactions to the illness or hospitalization of a sibling. Siblings experience loneliness, fear, worry, anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child. These are not uncommon responses by normal siblings. There is no evidence that the family has maladaptive coping REF: 1224

Chapter 35 COMPLETION Skin-to-skin holding of infants dressed only in diapers next to their mother's or father's chest is commonly known as _________________ care.

Kangaroo Infants who spent 1 to 3 hours in kangaroo care showed increased frequency in quiet sleep, longer duration of quiet sleep and decreased crying in the neonatal intensive care unit. Significant differences were found in pain responses during heel lancing between infants who were kangaroo held and those that were not. REF: 938

Chapter 47 COMPLETION A family who excludes meat from their diet but consumes dairy products would be referred to as ________________________ vegetarians.

Lacto-ovo Lacto-ovo vegetarians consume dairy products and occasionally fish. A well planned vegetarian diet is adequate for all stages of the life cycle and promotes normal growth. REF: 1365

Chapter 42 MULTIPLE RESPONSE Autism is a complex developmental disorder. The diagnostic criteria for autism include delayed or abnormal functioning in which area(s) with onset before age 3 years? Choose all that apply. Language as used in social communication Parallel play Gross motor development Growth below the 5th percentile for height and weight Symbolic or imaginative play Social interaction

Language as used in social communication Symbolic or imaginative play Social interaction Language as used in social communication, symbolic or imaginative play, and social interaction are three of the areas in which autistic children may show delayed or abnormal functioning. Parallel play, gross motor development, and growth below the 5th percentile for height and weight are not areas in which autistic children may show delayed or abnormal functioning. REF: 1200

Chapter 45 MULTIPLE RESPONSE The advantages of the ventrogluteal muscle as an injection site in young children include (choose all that apply): Less painful than vastus lateralis Free of important nerves and vascular structures Cannot be used when child reaches a weight of 20 pounds Increased subcutaneous fat, which increases drug absorption Easily identified by major landmarks

Less painful than vastus lateralis Free of important nerves and vascular structures Easily identified by major landmarks Less painful, free of important nerves and vascular structures, and easily identifiable are advantages of the ventrogluteal muscle. The major disadvantage is lack of familiarity by health professionals and controversy over whether the site can be used before weight bearing. Cannot be used when a child is 20 pounds or more and increased subcutaneous fat are not advantages of the ventrogluteal muscle as an injection site in young children. REF: 1276

Chapter 44 Four-year-old Brian appears to be upset by hospitalization. An appropriate intervention is to: Let him know that it is all right to cry. Give him time to gain control of himself. Show him how other children are cooperating. Tell him what a big boy he is to be so quiet.

Let him know that it is all right to cry. Crying is an appropriate behavior for the upset preschooler. The nurse provides support through physical presence. Giving the child time to gain control is appropriate, but the child must know that crying is acceptable. The preschooler does not engage in competitive behaviors. REF: 1221

Chapter 41 Limit care to essentials. Avoid playing music near the child. Explain to the child the need for constant measurement of vital signs. Whisper to the child instead of using normal voice.

Limit care to essentials. When death is imminent, care should be limited to interventions for palliative care. Music may be used to provide comfort for the child. Vital signs do not need to be measured frequently. The nurse should speak to the child in a clear, distinct voice. REF: 1171

Chapter 43 The home care nurse has been visiting an adolescent with recently acquired quadriplegia. The teen's mother tells the nurse, "I'm sick of providing all the care while my husband does whatever he wants, whenever he wants to do it. The initial action of the nurse is to: Refer mother for counseling. Listen and reflect mother's feelings. Ask father in private why he does not help. Suggest ways the mother can get her husband to help.

Listen and reflect mother's feelings. It is appropriate for the nurse to reflect with the mother about her feelings, exploring issues such as an additional home health aid to help care for the child and provide respite for the mother. It is inappropriate for the nurse to agree with the mother that her husband is not helping enough. It is a judgment beyond the role of the nurse and can help undermine the family relationship. Counseling is not necessary at this time. A support group for caregivers may be indicated. Privately asking the father why he doesn't help and suggesting ways the mother can get him to help are interventions based on the mother's assumption of the father's minimal contribution to the care of the child. The father may have a full-time job and other commitments. The parents need to have an involved third person help them through the negotiation of responsibilities for the loss of their normal child and new parenting responsibilities. REF: 1212, 1213

Chapter 47 The best chance of survival for a child with cirrhosis is: Liver transplantation. Treatment with corticosteroids. Treatment with immune globulin. Provision of nutritional support.

Liver transplantation. The only successful treatment for end-stage liver disease and liver failure may be liver transplantation, which has improved the prognosis for many children with cirrhosis. Liver transplantation has revolutionized the approach to cirrhosis. Liver failure and cirrhosis are indications for transplantation. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis. REF: 1410

Chapter 35 Kyle, age 6 months, is brought to the clinic. His parent says, "I think he hurts. He cries and rolls his head from side to side a lot." This most likely suggests which feature of pain? Type Severity Duration Location

Location The child is displaying a local sign of pain. Rolling the head from side to side and pulling at ears indicate pain in the ear. The child's behavior indicates the location of the pain. The behavior does not provide information about the type, severity, or duration. REF: 933

Chapter 41 Approach behaviors are coping mechanisms that result in a family's movement toward adjustment and resolution of the crisis of having a child with a chronic illness or disability. What is considered an approach behavior? Is unable to adjust to a progression of the disease or condition Anticipates future problems and seeks guidance and answers Looks for new cures without a perspective toward possible benefit Fails to recognize seriousness of child's condition despite physical evidence

Looks for new cures without a perspective toward possible benefit The parents who anticipate future problems and seek guidance and answers are demonstrating approach behaviors. They are demonstrating positive actions in caring for their child. Avoidance behaviors include being unable to adjust to a progression of the disease or condition, looking for new cures without a perspective toward possible benefit, and failing to recognize the seriousness of the child's condition despite physical evidence. These behaviors would suggest that the parents are moving away from adjustment or maladaptation in the crisis of a child with chronic illness or disability.

Chapter 46 A child with cystic fibrosis is receiving recombinant human deoxyribonuclease (rhDNase). This drug: May cause mucus to thicken. May cause voice alterations. Is given subcutaneously. Is not indicated for children younger than 12 years.

May cause voice alterations. Two of the only adverse effects of DNase are voice alterations and laryngitis. DNase decreases viscosity of mucus, is given in an aerosolized form, and is safe for children younger than 12 years of age. REF: 1349

Chapter 45 A venipuncture will be performed on a 7-year-old girl. She wants her mother to hold her during the procedure. The nurse should recognize that this: Is unsafe. May help the child relax. Is against hospital policy. Is unnecessary because of the child's age.

May help the child relax. Both the mother's preference for assisting, observing, or waiting outside the room and the child's preference for parental presence should be assessed. The child's choice should be respected. This will most likely help the child through the procedure. If the mother and child are agreeable, the mother is welcome to stay. Her familiarity with the procedure should be assessed, and potential safety risks identified (mother may sit in chair). Hospital policies should be reviewed to ensure that they incorporate family-centered care. REF: 1249

Chapter 34 When doing a nutritional assessment on an Hispanic family, the nurse learns that their diet consists mainly of vegetables, legumes, and starches. The nurse should recognize that this diet: Indicates that they live in poverty. Is lacking in protein. May provide sufficient amino acids. Should be enriched with meat and milk.

May provide sufficient amino acids. The diet that contains vegetable, legumes, and starches may provide sufficient essential amino acids, even though the actual amount of meat or dairy protein is low. Many cultures use diets that contain this combination of foods. It does not indicate poverty. Combinations of foods contain the essential amino acids necessary for growth. A dietary assessment should be done, but many vegetarian diets are sufficient for growth. REF: 883

Chapter 35 Nonpharmacologic strategies for pain management: May reduce pain perception. Make pharmacologic strategies unnecessary. Usually take too long to implement. Trick children into believing they do not have pain.

May reduce pain perception. Nonpharmacologic techniques provide coping strategies that may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. Nonpharmacologic techniques should be learned before the pain occurs. With severe pain it is best to use both pharmacologic and nonpharmacologic measures for pain control. The nonpharmacologic strategy should be matched with the child's pain severity and taught to the child before the onset of the painful experience. Some of the techniques may facilitate the child's experience with mild pain, but the child will still know that discomfort is present. REF: 935

Chapter 46 The earliest recognizable clinical manifestation(s) of cystic fibrosis (CF) is: Meconium ileus. History of poor intestinal absorption. Foul-smelling, frothy, greasy stools. Recurrent pneumonia and lung infections.

Meconium ileus. The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools and recurrent respiratory infections are later manifestations of CF. REF: 1347

Chapter 42 A young child who has an intelligence quotient (IQ) of 45 would be described as: Within the lower limits of the range of normal intelligence. Mildly cognitively impaired but educable. Moderately cognitively impaired but trainable. Severely cognitively impaired and completely dependent on others for care.

Moderately cognitively impaired but trainable. Moderately cognitively impaired IQs range from 35 to 55. The lower limit of normal intelligence is approximately 70. Individuals with IQs of 50 to 70 are considered mildly cognitively impaired but educable. An IQ of 20 to 40 results in severe cognitive impairment. REF: 1179

Chapter 46 The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke inhalation. What is essential in this child's care? Monitor pulse oximetry. Monitor arterial blood gases. Administer oxygen if respiratory distress develops. Administer oxygen if child's lips become bright, cherry red.

Monitor arterial blood gases. Arterial blood gases and COHb levels are the best way to monitor CO poisoning. PaO2 monitored with pulse oximetry may be normal in the case of CO poisoning. 100% O2 should be given as quickly as possible, not only if respiratory distress or other symptoms develop. REF: 1332, 1333

Chapter 46 The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include: Force fluids. Monitor pulse oximetry. Institute seizure precautions. Encourage a high-protein diet.

Monitor pulse oximetry. Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. Maintenance of vascular volume and hydration is important and should be done parenterally. Seizures are not a side effect of ARDS. Adequate nutrition is necessary, but a high-protein diet is not helpful. REF: 1332

Chapter 35 Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period? Codeine Morphine Methadone Meperidine

Morphine The most commonly prescribed medications for PCA are morphine, hydromorphone, and fentanyl. Parenteral use of codeine is not recommended. Methadone is not available in parenteral form in the United States. Meperidine is not used for continuous and extended pain relief. REF: 945

Chapter 34 What heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood? S1, S2 S3, S4 Murmur Physiologic splitting

Murmur Murmurs are the sounds that are produced in the heart chambers or major arteries from the back-and-forth flow of blood. S1 is the closure of the tricuspid and mitral valves, and S2 is the closure of the pulmonic and aortic valves, and both are considered normal heart sounds. S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If heard, medical evaluation is required. Physiologic splitting is the distinction of the two sounds in S2, which widens on inspiration. It is a significant normal finding. REF: 917

Chapter 45 In some genetically susceptible children anesthetic agents can trigger malignant hyperthermia. The nurse should be alert in observing that, in addition to an increased temperature, an early sign of this disorder is: Apnea. Bradycardia. Muscle rigidity. Decreased blood pressure.

Muscle rigidity. Early signs of malignant hyperthermia include tachycardia, increasing blood pressure, tachypnea, mottled skin, and muscle rigidity. Apnea is not a sign of malignant hyperthermia. Tachycardia, not bradycardia, is an early sign of malignant hyperthermia. Increased, not decreased, blood pressure is characteristic of malignant hyperthermia. REF: 1253

Chapter 42 Which term refers to the ability to see objects clearly at close range but not at a distance? Myopia Amblyopia Cataract Glaucoma

Myopia Myopia or nearsightedness refers to the ability to see objects clearly at close range but not a distance. Amblyopia or lazy eye is reduced visual acuity in one eye. A cataract is opacity of the lens of the eye. Glaucoma is a group of eye diseases characterized by increased intraocular pressure. REF: 1192

Chapter 47 A 3-year-old child with Hirschsprung's disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child psychologically is: Not necessary because of child's age. Not necessary because the colostomy is temporary. Necessary because it will be an adjustment. Necessary because the child must deal with a negative body image.

Necessary because it will be an adjustment. The child's age dictates the type and extent of psychologic preparation. When a colostomy is performed, the child who is at least preschool age is told about the procedure and what to expect in concrete terms with the use of visual aids. It is necessary to prepare this age child for procedures. The preschooler is not yet concerned with body image. REF: 1393

Chapter 34 During examination of a toddler's extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is: Abnormal and requires further investigation. Abnormal unless it occurs in conjunction with knock-knee. Normal if the condition is unilateral or asymmetric. Normal because the lower back and leg muscles are not yet well developed.

Normal because the lower back and leg muscles are not yet well developed. Lateral bowing of the tibia (bowlegged) is common in toddlers when they begin to walk, not an abnormal finding. It usually persists until all of their lower back and leg muscles are well developed. Further evaluation is needed if it persists beyond ages 2 to 3 years, especially in African-American children. REF: 921

Chapter 45 In preparing to give "enemas until clear" to a young child, the nurse should select: Tap water. Normal saline. Oil retention. Fleet solution.

Normal saline. Isotonic solutions should be used in children. Saline is the solution of choice. Plain water is not used. This is a hypotonic solution and can cause rapid fluid shift, resulting in fluid overload. Oil-retention enemas will not achieve the "until clear" result. Fleet enemas are not advised for children because of the harsh action of the ingredients. The osmotic effects of the Fleet enema can result in diarrhea, which can lead to metabolic acidosis. REF: 1299

Chapter 42 An adolescent gets hit in the eye during a fight. The school nurse, using a flashlight, notes the presence of gross hyphema (hemorrhage into anterior chamber). The nurse should: Apply a Fox shield. Instruct the adolescent to apply ice for 24 hours. Have adolescent rest with eye closed and ice applied. Notify parents that adolescent needs to see an ophthalmologist.

Notify parents that adolescent needs to see an ophthalmologist. The parents should be notified that the adolescent needs to see an ophthalmologist as soon as possible. Applying a Fox shield, instructing the adolescent to apply ice for 24 hours, and having the adolescent rest with the eye closed and ice applied may cause further damage. Referral to an ophthalmologist is indicated. REF: 1193

Chapter 47 The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. The most appropriate nursing action is to: Notify the practitioner. Measure abdominal girth. Auscultate for bowel sounds. Take vital signs, including blood pressure.

Notify the practitioner. Passage of a normal brown stool indicates that the intussusception has reduced itself. This is immediately reported to the practitioner, who may choose to alter the diagnostic/therapeutic plan of care. REF: 1421

Chapter 46 MULTIPLE RESPONSE The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which actions should the nurse include in the child's postoperative care plan? (Choose all that apply.) Notify the surgeon if the child swallows frequently. Apply a heat collar to the child for pain relief. Place the child on the abdomen until fully awake. Allow the child to have diluted juice after the procedure. Encourage the child to cough frequently.

Notify the surgeon if the child swallows frequently. Place the child on the abdomen until fully awake. Allow the child to have diluted juice after the procedure. Frequent swallowing is a sign of bleeding in children after a tonsillectomy. The child should be placed on the abdomen or the side to facilitate drainage. The child can drink diluted juice, cool water, or popsicles after the procedure. REF: 1312, 1313

Chapter 45 When caring for a child with an intravenous infusion, the nurse should: Use a macrodropper to facilitate reaching the prescribed flow rate. Avoid restraining the child to prevent undue emotional stress. Change the insertion site every 24 hours. Observe the insertion site frequently for signs of infiltration.

Observe the insertion site frequently for signs of infiltration. The nursing responsibility for intravenous therapy is to calculate the amount to be infused in a given length of time, set the infusion rate, and monitor the apparatus frequently, at least every 1 to 2 hours, to make certain that the desired rate is maintained, the integrity of the system remains intact, the site remains intact (free of redness, edema, infiltration, or irritation), and the infusion does not stop. A minidropper (60 drops per milliliter) is the recommended intravenous tubing in pediatrics. The intravenous site should be protected. This may require soft restraints on the child. Insertion sites do not need to be changed every 24 hours unless a problem is found with the site. Frequent change exposes the child to significant trauma. REF: 1288

Chapter 35 Physiologic measurements in children's pain assessment are: The best indicator of pain in children of all ages. Essential to determine whether a child is telling the truth about pain. Of most value when children also report having pain. Of limited value as sole indicator of pain.

Of limited value as sole indicator of pain. Physiologic manifestations of pain may vary considerably, not providing a consistent measure of pain. Heart rate may increase or decrease. The same signs that may suggest fear, anxiety, or anger also indicate pain. In chronic pain the body adapts, and these signs decrease or stabilize. These are of limited value and must be viewed in the context of a pain-rating scale, behavioral assessment, and parental report. When the child states that pain exists, it does. That is the truth. REF: 929, 930

Chapter 43 One nursing case manager The insurance company A panel of experts A multidisciplinary team Primary care provider

One nursing case manager Nursing case managers are ideally suited to provide the care coordination necessary. Care coordination is most effective if a single person works with the family to accomplish the many tasks and responsibilities that are necessary. The family retains the role as primary decision-maker. Most likely the insurance company will have a case manager focusing on the financial aspects of care. This does not include coordination of care to assist the family. The primary care provider will work closely with the home care agency to provide orders for necessary medication and durable medication equipment; however, they are not suited to coordinate this task.

Chapter 47 Which statement best characterizes hepatitis A? The incubation period is 6 weeks to 6 months. The principal mode of transmission is through the parenteral route. Onset is usually rapid and acute. There is a persistent carrier state.

Onset is usually rapid and acute. Hepatitis A is the most common form of acute hepatitis in most parts of the world. It is characterized by a rapid acute onset. The incubation period is approximately 3 weeks for hepatitis A. The principal mode of transmission for hepatitis A is the fecal-oral route. Hepatitis A does not have a carrier state. REF: 1407

Chapter 34 Where is the best place to observe for the presence of petechiae in dark-skinned individuals? Face Buttocks Oral mucosa Palms and soles

Oral mucosa Petechiae, small distinct pinpoint hemorrhages, are difficult to see in dark skin unless they are in the mouth or conjunctiva. REF: 901

Chapter 47 Therapeutic management of the child with acute diarrhea and dehydration usually begins with: Clear liquids. Adsorbents such as kaolin and pectin. Oral rehydration solution (ORS). Antidiarrheal medications such as paregoric.

Oral rehydration solution (ORS). ORS is the first treatment for acute diarrhea. Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. Adsorbents are not recommended and neither are antidiarrheals because they do not get rid of pathogens. REF: 1387

Chapter 34 The nurse must assess a child's capillary filling time. This can be accomplished by: Inspecting the chest. Auscultating the heart. Palpating the apical pulse. Palpating the skin to produce a slight blanching.

Palpating the skin to produce a slight blanching. Capillary filling time is assessed by pressing lightly on the skin to produce blanching and then noting the amount of time it takes for the blanched area to refill. Inspecting the chest, auscultating the heart, and palpating the apical pulse will not provide an assessment of capillary filling time. REF: 916

Chapter 46 Pancreatic enzymes are administered to the child with cystic fibrosis. Nursing considerations should include: Do not administer pancreatic enzymes if the child is receiving antibiotics. Decrease dose of pancreatic enzymes if the child is having frequent, bulky stools. Administer pancreatic enzymes between meals if at all possible. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal. Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole. Pancreatic enzymes are not a contraindication for antibiotics. The dose of enzymes should be increased if the child is having frequent, bulky stools. REF: 1349

Chapter 41 The nurse is talking with the parent of a child newly diagnosed with a chronic illness. The parent is upset and tearful. The nurse asks, "With whom do you talk when something is worrying you?" This should be interpreted as: Inappropriate, because parent is so upset. A diversion of the present crisis to similar situations with which parent has dealt. An intervention to find someone to help parent. Part of assessing parent's available support system.

Part of assessing parent's available support system. These are very important data for the nurse to obtain and an appropriate part of an accurate assessment. This question will provide information about the marital relationship (does the parent speak to the spouse?), alternate support systems, and ability to communicate. By assessing these areas, the nurse can facilitate the identification and use of community resources as needed. The nurse is obtaining information to help support the parent through the diagnosis. The parent is not in need of additional parenting help at this time.

Chapter 41 The nurse is providing support to parents at the time their child is diagnosed with chronic disabilities. The nurse notices that the parents keep asking the same questions. The nurse should: Patiently continue to answer questions. Kindly refer them to someone else to answer their questions. Recognize that some parents cannot understand explanations. Suggest that they ask their questions when they are not upset.

Patiently continue to answer questions. Diagnosis is one of the anticipated stress points for parents. The parents may not hear or remember all that is said to them. The nurse should continue to provide the kind of information that they desire. This is a particularly stressful time for the parents; the nurse can play a key role in providing necessary information. Parents should be provided with oral and written information. The nurse needs to work with the family to ensure understanding of the information. The parents require information at the time of diagnosis. Other questions will arise as they adjust to the information.

Chapter 46 Skin testing for tuberculosis (the Mantoux test) is recommended: Every year for all children older than 2 years. Every year for all children older than 10 years. Every 2 years for all children starting at age 1 year. Periodically for children who reside in high-prevalence regions.

Periodically for children who reside in high-prevalence regions. Children who reside in high prevalence regions for TB should be tested every 2 to 3 years. Annual testing is not necessary. Testing is not necessary unless exposure is likely or an underlying medical risk factor is present.

Chapter 41 Most parents of children with special needs tend to experience chronic sorrow. This is characterized by: Lack of acceptance of the child's limitation. Lack of available support to prevent sorrow. Periods of intensified sorrow when experiencing anger and guilt. Periods of intensified sorrow and loss that occur in waves over time.

Periods of intensified sorrow and loss that occur in waves over time. Chronic sorrow is manifested by feelings of sorrow and loss that recur in waves over time. The sorrow is in response to the recognition of the child's limitations. The family should be assessed in an ongoing manner to provide appropriate support as the needs of the family change. The sorrow is not preventable. The chronic sorrow occurs during the reintegration and acknowledgement stage.

Chapter 46 MATCHING The nurse enters a room and finds a 6-year-old child who is unconscious. After calling for help and before being able to use an automatic external defibrillator, what steps should the nurse take? Place in correct order. Place on a hard surface. Administer 30 chest compressions with two breaths. Feel carotid pulse while maintaining head tilt with the other hand. Use the head tilt-chin lift maneuver and check for breathing. Place heel of one hand on lower half of sternum with other hand on top. Give two rescue breaths.

Place on a hard surface. Use the head tilt-chin lift maneuver and check for breathing. Give two rescue breaths. Feel carotid pulse while maintaining head tilt with the other hand. Place heel of one hand on lower half of sternum with other hand on top. Administer 30 chest compressions with two breaths. REF: 1355, 1357

Chapter 45 MATCHING The nurse is preparing to insert a nasogastric tube into a 4-year-old child for intermittent suctioning after abdominal surgery. Place in correct sequence the steps for inserting a nasogastric tube. Lubricate the nasogastric tube with water-soluble lubricant. Tape the nasogastric tube securely to the child's face. Check the placement of the tube by aspirating stomach contents. Place the child in the supine position with head slightly hyperflexed. Insert the nasogastric tube through the nares. Measure the tube from the tip of the nose to the ear lobe to midpoint between the xiphoid process and the umbilicus.

Place the child in the supine position with head slightly hyperflexed. Measure the tube from the tip of the nose to the ear lobe to midpoint between the xiphoid process and the umbilicus. Lubricate the nasogastric tube with water-soluble lubricant. Insert the nasogastric tube through the nares. Check the placement of the tube by aspirating stomach contents. Tape the nasogastric tube securely to the child's face.

Chapter 47 A high-fiber food that the nurse could recommend for a child with chronic constipation is: Popcorn. Pancakes. Muffins. Ripe bananas.

Popcorn. Popcorn is a high-fiber food. Cake does not have significant fiber unless made with fruit or bran. Raw fruits, especially those with skins and seeds and other than ripe bananas and avocado, are high in fiber. REF: 1391

Chapter 43 Home care is being considered for a young child who is ventilator dependent. Which factor is most important in deciding whether home care is appropriate? Level of parents' education Presence of two parents in the home Preparation and training of family Family's ability to assume all health care costs

Preparation and training of family One of the essential elements is the training and preparation of the family. The family must be able to demonstrate all aspects of care for the child. In many areas it cannot be guaranteed that nursing care will be available on a continual basis, and the family will have to care for the child. The amount of formal education reached by the parents is not the important issue. The determinant is the family's ability to care adequately for the child in the home. At least two family members should learn and demonstrate all aspects of the child's care in the hospital, but it does not have to be two parents. Few families can assume all health care costs. Financial planning, including negotiating arrangements with the insurance company and/or public programs, may be required. REF: 1206

Chapter 41 Kelly, age 8 years, will soon be able to return to school after an injury that resulted in several severe, chronic disabilities. What is the most appropriate action by the school nurse? Recommending that Kelly's parents attend school at first to prevent teasing Preparing Kelly's classmates and teachers for changes they can expect Referring Kelly to a school where the children have chronic disabilities similar to hers. Discussing with Kelly and her parents the fact that her classmates will not accept her as they did before

Preparing Kelly's classmates and teachers for changes they can expect Attendance at school is an important part of normalization for Kelly. The school nurse should prepare teachers and classmates about her condition, abilities, and special needs. A visit by the parents can be helpful, but unless the classmates are prepared for the changes, it alone will not prevent teasing. Kelly's school experience should be normalized as much as possible. Children need the opportunity to interact with healthy peers and engage in activities with groups or clubs composed of similarly affected persons. Children with special needs are encouraged to maintain and reestablish relationships with peers and participate according to their capabilities.

Chapter 41 Kelly, age 8 years, will soon be able to return to school after an injury that resulted in several severe, chronic disabilities. What is the most appropriate action by the school nurse? Recommending that Kelly's parents attend school at first to prevent teasing Preparing Kelly's classmates and teachers for changes they can expect Referring Kelly to a school where the children have chronic disabilities similar to hers. Discussing with Kelly and her parents the fact that her classmates will not accept her as they did before

Preparing Kelly's classmates and teachers for changes they can expect Attendance at school is an important part of normalization for Kelly. The school nurse should prepare teachers and classmates about her condition, abilities, and special needs. A visit by the parents can be helpful, but unless the classmates are prepared for the changes, it alone will not prevent teasing. Kelly's school experience should be normalized as much as possible. Children need the opportunity to interact with healthy peers and engage in activities with groups or clubs composed of similarly affected persons. Children with special needs are encouraged to maintain and reestablish relationships with peers and participate according to their capabilities. REF: 1162, 1163

chapter 41 The feeling of guilt that the child "caused" the disability or illness is especially critical in which child? Toddler Preschooler School-age child Adolescent

Preschooler Preschoolers are most likely to be affected by feelings of guilt that they caused the illness/disability or are being punished for wrongdoings. Toddlers are focused on establishing their autonomy. The illness will foster dependency. The school-age child will have limited opportunities for achievement and may not be able to understand limitations. Adolescents are faced with the task of incorporating their disabilities into their changing self-concept.

Chapter 34 Where in the health history should the nurse describe all details related to the chief complaint? Past history Chief complaint Present illness Review of systems

Present illness The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. The focus of the present illness is on all factors relevant to the main problem, even if they have disappeared or changed during the onset, interval, and present. Past history refers to information that relates to previous aspects of the child's health, not to the current problem. The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It does not contain the narrative portion describing the onset and progression. The review of systems is a specific review of each body system REF: 876

Chapter 42 Appropriate interventions to facilitate socialization of the cognitively impaired child include to: Provide age-appropriate toys and play activities. Provide peer experiences such as scouting when older. Avoid exposure to strangers who may not understand cognitive development. Emphasize mastery of physical skills because they are delayed more often than verbal skills.

Provide peer experiences such as scouting when older. The acquisition of social skills is a complex task. Children of all ages need peer relationships. Parents should enroll the child in preschool. When older, they should have peer experiences similar to other children such as group outings, Boy and Girl Scouts, and Special Olympics. Providing age-appropriate toys and play activities is important, but peer interactions will facilitate social development. Parents should expose the child to strangers so the child can practice social skills. Verbal skills are delayed more than physical skills. REF: 1182

Chapter 47 Caring for the newborn with a cleft lip and palate before surgical repair includes: Gastrostomy feedings. Keeping the infant in near-horizontal position during feedings. Allowing little or no sucking. Providing satisfaction of sucking needs.

Providing satisfaction of sucking needs. Using special or modified nipples for feeding techniques helps to meet the infant's sucking needs. Gastrostomy feedings are usually not indicated. Feeding is best accomplished with the infant's head in an upright position. The child requires both nutritive and nonnutritive sucking. REF: 1413

Chapter 44 When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as: Punishment. Threat to child's self-image. An opportunity for regression. Loss of companionship with friends.

Punishment. If a toddler is not prepared for hospitalization, a typical preschooler fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds. Threat to child's self-image and loss of companionship with friends are reactions typical of school-age children. Regression is a response characteristic of toddlers when threatened with loss of control. REF: 1222

Chapter 45 A 2-year-old child comes to the emergency department with dehydration and hypovolemic shock. What best explains why an intraosseous infusion is started? It is less painful for small children. Rapid venous access is not possible. Antibiotics must be started immediately. Long-term central venous access is not possible.

Rapid venous access is not possible. In situations in which rapid establishment of systemic access is vital and venous access is hampered such as peripheral circulatory collapse and hypovolemic shock, intraosseous infusion provides a rapid, safe lifesaving alternative. The procedure is painful, and local anesthesia and systemic analgesia are given. Antibiotics could be given when vascular access is obtained. Long-term central venous access is time consuming, and intraosseous infusion is used in an emergency situation REF: 1286

Chapter 41 A preschooler is found digging up a pet bird that was recently buried after it died. The best explanation for this behavior is that: He has a morbid preoccupation with death. He is looking to see if a ghost took it away. The loss is not yet resolved, and professional counseling is needed. Reassurance is needed that the pet has not gone somewhere else.

Reassurance is needed that the pet has not gone somewhere else. The preschooler can recognize that the pet has died but has difficulties with the permanence. Digging up the bird gives reassurance that the bird is still present. A morbid preoccupation with death and the child looking to see if a ghost took it away are expected responses. If they persist, intervention may be required. The preschooler is seeking reassurance that the pet is present. REF: 1167

Chapter 47 A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with gastroesophageal reflux. The purpose of this is to: Prevent reflux. Prevent hematemesis. Reduce gastric acid production. Increase gastric acid production.

Reduce gastric acid production. The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and may prevent esophagitis. Preventing reflux and hematemesis, and increasing gastric acid production are not the modes of action of histamine-receptor antagonists. REF: 1395

Chapter 34 The nurse has just started assessing a young child who is febrile and appears very ill. There is hyperextension of the child's head (opisthotonos) with pain on flexion. The most appropriate action is to: Refer for immediate medical evaluation. Continue assessment to determine cause of neck pain. Ask parent when neck was injured. Record "head lag" on assessment record and continue assessment of child.

Refer for immediate medical evaluation. These symptoms indicate meningeal irritation and needs immediate evaluation. Continuing the assessment is not necessary. No indication of injury is present. This is not descriptive of head lag. REF: 903

Chapter 47 An important nursing consideration in the care of a child with celiac disease is to: Refer to a nutritionist for detailed dietary instructions and education. Help the child and family understand that diet restrictions are usually only temporary. Teach proper handwashing and Standard Precautions to prevent disease transmission. Suggest ways to cope more effectively with stress to minimize symptoms.

Refer to a nutritionist for detailed dietary instructions and education. The main consideration is helping the child adhere to dietary management. Considerable time is spent in explaining to the child and parents the disease process, the specific role of gluten in aggravating the condition, and those foods that must be restricted. Referral to a nutritionist would help in this process. The most severe symptoms usually occur in early childhood and adult life. Dietary avoidance of gluten should be lifelong. Celiac disease is not transmissible or stress related. REF: 1424

Chapter 45 An 8-month-old infant is restrained to prevent interference with the intravenous infusion. The nurse should: Remove the restraints once a day to allow movement. Keep the restraints on constantly. Keep the restraints secure so infant remains supine. Remove restraints whenever possible.

Remove restraints whenever possible. The nurse should remove the restraints whenever possible. When parents and/or staff are present, the restraints can be removed, and the intravenous site protected. Restraints must be checked and documented every 1 to 2 hours and should be removed for range of motion on a periodic basis. The child should not be securely restrained in the supine position because of risks of aspiration. REF: 1265

Chapter 46 What best describes why children have fewer respiratory tract infections as they grow older? The amount of lymphoid tissue decreases. Repeated exposure to organisms causes increased immunity. Viral organisms are less prevalent in the population. Secondary infections rarely occur after viral illnesses.

Repeated exposure to organisms causes increased immunity. Children have increased immunity after exposure to a virus. The amount of lymphoid tissue increases as children grow older. Viral organisms are not less prevalent, but older children have the ability to resist invading organisms. Secondary infections after viral illnesses include Mycoplasma pneumoniae and groups A and B streptococcal infections. REF: 1309

Chapter 45 A nurse must do a venipuncture on a 6-year-old child. An important consideration in providing atraumatic care is to: Use an 18-gauge needle if possible. If not successful after four attempts, have another nurse try. Restrain the child only as needed to perform venipuncture safely. Show the child equipment to be used before procedure.

Restrain the child only as needed to perform venipuncture safely. Restrain the child only as needed to perform the procedure safely; use therapeutic hugging. Use the smallest gauge needle that permits free flow of blood. A two-try-only policy is desirable, in which two operators each have only two attempts. If insertion is not successful after four punctures, alternative venous access should be considered. Keep all equipment out of sight until used. REF: 1272

Chapter 43 When communicating with other professionals, it is important for home care nurses to: Ask others what they want to know. Share everything known about the family. Restrict communication to clinically relevant information. Recognize that confidentiality is not possible.

Restrict communication to clinically relevant information. Through both oral and written communication, the nurse will need to share clinically relevant information with other involved health professionals. The nurse should share only clinically relevant information with other involved health professionals. The nurse must assure families that they have a right to expect confidentiality in regard to the data collected. REF: 1211

Chapter 34 MULTIPLE RESPONSE Which data would be included in a health history? Choose all that apply. Review of systems Physical assessment Sexual history Growth measurements Nutritional assessment Family medical history

Review of systems Sexual history Nutritional assessment Family medical history The review of systems, sexual history, nutritional assessment, and family medical history are part of the health history. Physical assessment and growth measurements are components of the physical examination. REF: 875

Chapter 47 The viral pathogen that frequently causes acute diarrhea in young children is: Giardia organisms. Shigella organisms. Rotavirus. Salmonella organisms.

Rotavirus. Rotavirus is the most frequent viral pathogen that causes diarrhea in young children. Giardia and Salmonella are bacterial pathogens that causes diarrhea. Shigella is a bacterial pathogen that is uncommon in the United States. REF: 1383, 1384

Chapter 42 The major consideration when selecting toys for a child who is cognitively impaired is: Safety. Age appropriateness. Ability to provide exercise. Ability to teach useful skills.

Safety. Safety is the primary concern in selecting recreational and exercise activities for all children. This is especially true for children who are cognitively impaired. Age appropriateness, the ability to provide exercise, and the ability to teach useful skills are all factors to consider in the selection of toys, but safety is of paramount importance. REF: 1181

Chapter 34 Which age group is most concerned with body integrity? Toddler Preschooler School-age child Adolescent

School-age child School-age children have a heightened concern about body integrity. They place importance and value on their bodies and are overly sensitive to anything that constitutes a threat or suggestion of injury. Body integrity is not as important a concern to children in the toddler, preschooler, and adolescent age groups. REF: 872

Chapter 44 Because of their striving for independence and productivity, which age group of children is particularly vulnerable to events that may lessen their feeling of control and power? Infants Toddlers Preschoolers School-age children

School-age children When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurps individual power and identity. This is especially detrimental to school-age children, who are striving for independence and productivity and are now experiencing events that lessen their control and power. Infants, toddlers, and preschoolers, although affected by loss of power, are not as significantly affected as are school-age children. REF: 1222

Chapter 42 Distortion of sound and problems in discrimination are characteristic of what type of hearing loss? Conductive Sensorineural Mixed conductive-sensorineural Central auditory imperceptive

Sensorineural Sensorineural hearing loss, also known as perceptive or nerve deafness, involves damage to the inner ear structures or the auditory nerve. It results in distortion of sounds and problems in discrimination. Conductive hearing loss involves mainly interference with loudness of sound. Mixed conductive-sensorineural hearing loss manifests as a combination of both sensorineural and conductive loss. The central auditory imperceptive category includes all hearing losses that do not demonstrate defects in the conduction or sensory structures. REF: 1187

Chapter 44 What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? Separation anxiety Loss of control Fear of bodily injury Fear of pain

Separation anxiety The major stress for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age group. REF: 1221

Chapter 46 The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant: Becomes fussy. Has a cough. Has a fever over 99° F. Shows signs of an earache.

Shows signs of an earache. If an infant with nasopharyngitis has a fever over 101° F, there is early evidence of respiratory complications. Irritability and a slight fever are common in an infant with a viral illness. Cough can be a sign of nasopharyngitis. REF: 1310

Chapter 34 The appropriate placement of a tongue blade for assessment of the mouth and throat is the: Center back area of tongue. Side of the tongue. Against the soft palate. On the lower jaw.

Side of the tongue. The side of the tongue is the correct position. It avoids the gag reflex yet allows visualization. Placement on the center back area of the tongue elicits the gag reflex. Against the soft palate and on the lower jaw are not appropriate places for the tongue blade. REF: 911

Chapter 46 It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because they may develop: Cough. Osteoporosis. Slowed growth. Cushing's syndrome.

Slowed growth. The growth of children on long-term inhaled steroids should be assessed frequently to assess for systemic effects of these drugs. Cough is prevented by inhaled steroids. No evidence exists that inhaled steroids cause osteoporosis. Cushing's syndrome is caused by long-term systemic steroids. REF: 1339

Chapter 34 The most frequently used test for measuring visual acuity is the: Denver Eye Screening test. Allen picture card test. Ishihara vision test. Snellen letter chart.

Snellen letter chart. The Snellen letter chart, which consists of lines of letters of decreasing size, is the most frequently used test for visual acuity. Single cards (Denver—letter E; Allen—pictures) are used for children age 2 years and older who are unable to use the Snellen letter chart. The Ishihara vision test is used for color vision. REF: 905

Chapter 42 What facilitates lip reading by the hearing-impaired child? Speaking at an even rate Exaggerating pronunciation of words Avoiding using facial expressions Repeating in exactly the same way if child does not understand

Speaking at an even rate The child should be helped to learn and understand how to read lips by speaking at an even rate. Exaggerating word pronunciation, avoiding facial expressions, and repeating words are characteristics of communication that would interfere with the child's comprehension of the spoken word. REF: 1189

Chapter 45 Tepid water or sponge baths are indicated for hyperthermia in children. The nurse should: Add isopropyl alcohol to the water. Direct a fan on the child in the bath. Stop the bath if the child begins to chill. Continue the bath for 5 minutes.

Stop the bath if the child begins to chill. Environmental measures such as sponge baths can be used to reduce temperature if tolerated by the child and if they do not induce shivering. Shivering is the body's way of maintaining the elevated set point. Compensatory shivering increases metabolic requirements above those already caused by the fever. Ice water and isopropyl alcohol are inappropriate, potentially dangerous solutions. Fans should not be used because of the risk of the child developing vasoconstriction, which defeats the purpose of the cooling measures. Little blood is carried to the skin surface, and the blood remains primarily in the viscera to become heated. The child is placed in a tub of tepid water for 20 to 30 minutes. REF: 1260

Chapter 47 Which type of hernia has an impaired blood supply to the herniated organ? Hiatal hernia Incarcerated hernia Omphalocele Strangulated hernia

Strangulated hernia A strangulated hernia is one in which the blood supply to the herniated organ is impaired. A hiatal hernia is the intrusion of an abdominal structure, usually the stomach, through the esophageal hiatus. An incarcerated hernia is a hernia that cannot be reduced easily. Omphalocele is the protrusion of intraabdominal viscera into the base of the umbilical cord. The sac is covered with peritoneum and not skin. REF: 1417

Chapter 47 When caring for a child with probable appendicitis, the nurse should be alert to recognize that a sign of perforation is: Bradycardia. Anorexia. Sudden relief from pain. Decreased abdominal distention.

Sudden relief from pain. Signs of peritonitis, in addition to fever, include sudden relief from pain after perforation. Tachycardia, not bradycardia, is a manifestation of peritonitis. Anorexia is already a clinical manifestation of appendicitis. Abdominal distention usually increases in addition to an increase in pain (usually diffuse and accompanied by rigid guarding of the abdomen). REF: 1399

Chapter 42 The nurse is talking with a 10-year-old boy who wears bilateral hearing aids. The left hearing aid is making an annoying whistling sound that the child cannot hear. The most appropriate nursing action is to: Ignore the sound. Ask him to reverse the hearing aids in his ears. Suggest that he reinsert the hearing aid. Suggest that he raise the volume of the hearing aid.

Suggest that he reinsert the hearing aid. The whistling sound is acoustic feedback. The nurse should have the child remove the hearing aid and reinsert it, making sure that no hair is caught between the ear mold and the ear canal. Ignoring the sound and suggesting that he raise the volume of the hearing aid would be annoying to others. The hearing aids are molded specifically for each ear. REF: 1188

Chapter 47 Therapeutic management of most children with Hirschsprung's disease is primarily: Daily enemas. Low-fiber diet. Permanent colostomy. Surgical removal of affected section of bowel.

Surgical removal of affected section of bowel. Most children with Hirschsprung's disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet until the child is physically ready for surgery. The colostomy that is created in Hirschsprung's disease is usually temporary. REF: 1392

Chapter 46 Cystic fibrosis (CF) is suspected in a toddler. Which test is essential in establishing this diagnosis? Bronchoscopy Serum calcium Urine creatinine Sweat chloride test

Sweat chloride test A sweat chloride test result greater than 60 mEq/L is diagnostic of CF. Although bronchoscopy is helpful for identifying bacterial infection in children with CF, it is not diagnostic. Serum calcium is normal in children with CF. Urine creatinine is not diagnostic of CF. REF: 1348

Chapter 46 A parent whose two school-age children have asthma asks the nurse in what sports, if any, they can participate. The nurse should recommend: Soccer. Running. Swimming. Basketball.

Swimming. Swimming is well tolerated in children with asthma because they are breathing air fully saturated with moisture and because of the type of breathing required in swimming. Exercise-induced bronchospasm is more common in sports that involve endurance such as soccer, running, and basketball. Prophylaxis with medications may be necessary. REF: 1340

Chapter 47 An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) and gastrostomy feedings. Nursing care should include: Preparing the family for impending death. Teaching the family signs of central venous catheter infection. Teaching the family how to calculate caloric needs. Securing TPN and gastrostomy tubing under diaper to lessen risk of dislodgment.

Teaching the family signs of central venous catheter infection. During TPN therapy care must be taken to minimize the risk of complications related to the central venous access device such as catheter infections, occlusions, or accidental removal. This is an important part of family teaching. The prognosis for patients with short bowel syndrome depends in part on the length of residual small intestine. It has improved with advances in TPN. Although parents need to be taught about nutritional needs, the caloric needs and prescribed TPN and rate are the responsibility of the health care team. The tubes should not be placed under the diapers because of risk of infection. REF: 1426

Chapter 45 The emergency department nurse is cleaning multiple facial abrasions on 9-year-old Mike. His mother is present. He is crying and screaming loudly. The nurse should: Ask him to be quieter. Have his mother tell him to relax. Tell him it is okay to cry and scream. Suggest that he talk to his mother instead of crying.

Tell him it is okay to cry and scream. The child should be allowed to express feelings of anger, anxiety, fear, frustration, or any other emotion. The child needs to know that it is all right to cry. There is no reason for him to be quieter. He is too upset and needs to be able to express his feelings. REF: 1250

Chapter 45 The nurse is planning how to prepare a 4-year-old child for some diagnostic procedures. Guidelines for preparing this preschooler should include to: Plan for a short teaching session of about 30 minutes. Tell the child that procedures are never a form of punishment. Keep equipment out of the child's view. Use correct scientific and medical terminology in explanations.

Tell the child that procedures are never a form of punishment. Illness and hospitalization may be viewed as punishment in preschoolers. Always state directly that procedures are never a form of punishment. Teaching sessions for this age group should be 10 to 15 minutes in length. Demonstrate the use of equipment and allow the child to play with miniature or actual equipment. Explain the procedure in simple terms and how it affects the child. REF: 1248

Chapter 41 A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. The nurse should explain that: This will help the child cope effectively by denial. This attitude is helpful to give parents time to cope. Terminally ill children know when they are seriously ill. Terminally ill children usually choose not to discuss the seriousness of their illness.

Terminally ill children know when they are seriously ill. The child needs honest and accurate information about the illness, treatments, and prognosis. Children, even at a young age, realize that something is seriously wrong and that it involves them. The nurse should help parents understand the importance of honesty. The child will know that something is wrong because of the increased attention of health professionals. This would interfere with denial as a form of coping. Parents may need professional support and guidance from a nurse or social worker in this process. Children will usually tell others how much information they want about their condition. REF: 1166

Chapter 34 The nurse is using the NCHS growth chart for an African-American child. The nurse should consider that: This growth chart should not be used. Growth patterns of African-American children are the same as for all other ethnic groups. A correction factor is necessary when the NCHS growth chart is used for non-Caucasian ethnic groups. The NCHS charts are accurate for U.S. African-American children.

The NCHS charts are accurate for U.S. African-American children. The NCHS growth charts can serve as reference guides for all racial or ethnic groups. U.S. African American-children were included in the sample population. The growth chart can be used with the perspective that different groups of children have varying normal distributions on the growth curves. No correction factor exists. REF: 890

Chapter 34 When introducing hospital equipment to a preschooler who seems afraid, the nurse's approach should be based on which principle? The child may think the equipment is alive. The child is too young to understand what the equipment does. Explaining the equipment will only increase the child's fear. One brief explanation is enough to reduce the child's fear.

The child may think the equipment is alive. Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. The child should be given simple concrete explanations about what the equipment does and how it will feel to the child. Simple, concrete explanations help alleviate the child's fear. The preschooler will need repeated explanations as reassurance. REF: 871

Chapter 34 What is the single most important factor to consider when communicating with children? The child's physical condition The presence or absence of the child's parent The child's developmental level The child's nonverbal behaviors

The child's developmental level The nurse must be aware of the child's developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Although the child's physical condition is a consideration, developmental level is much more important. The parents' presence is important when communicating with young children, but it may be detrimental when speaking with adolescents. Nonverbal behaviors vary in importance based on the child's developmental level. REF: 870

Chapter 34 MULTIPLE RESPONSE The nurse must check vital signs on a 2-year-old boy who is brought to the clinic for his 24-month checkup. Which criteria should the nurse use in determining the appropriate-size blood pressure cuff? Choose all that apply. The cuff is labeled "toddler." The cuff bladder width is approximately 40% of the circumference of the upper arm. The cuff bladder length covers 80% to 100% of the circumference of the upper arm. The cuff bladder covers 50% to 66% of the length of the upper arm.

The cuff bladder width is approximately 40% of the circumference of the upper arm. The cuff bladder length covers 80% to 100% of the circumference of the upper arm. Research has demonstrated that cuff selection with a bladder width that is 40% of the arm circumference will usually have a bladder length that is 80% to 100% of the upper arm circumference. This size cuff will most accurately reflect measured radial artery pressure. The name of the cuff is a representative size that may not be suitable for any individual child. Choosing a cuff by limb circumference more accurately reflects arterial pressure than choosing a cuff by length. REF: 898

Chapter 46 The nurse encourages the mother of a toddler with acute laryngotracheobronchitis to stay at the bedside as much as possible. The nurse's rationale for this action is primarily that: Mothers of hospitalized toddlers often experience guilt. The mother's presence will reduce anxiety and ease child's respiratory efforts. Separation from mother is a major developmental threat at this age. The mother can provide constant observations of the child's respiratory efforts.

The mother's presence will reduce anxiety and ease child's respiratory efforts. The family's presence will decrease the child's distress. The mother may experience guilt, but this is not the best answer. Although separation from the mother is a developmental threat for toddlers, the main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort. The child should have constant cardiorespiratory monitor and noninvasive oxygen saturation monitoring, but the parent should not play this role in the hospital. REF: 1321

Chapter 45 What should the nurse consider when having consent forms signed for surgery and procedures on children? Only a parent or legal guardian can give consent. The person giving consent must be at least 18 years old. The risks and benefits of a procedure are part of the consent process. A mental age of 7 years or older is required for a consent to be considered "informed."

The risks and benefits of a procedure are part of the consent process. The informed consent must include the nature of the procedure, benefits and risks, and alternatives to the procedure. In special circumstances such as emancipated minors, the consent can be given by someone younger than 18 years without the parent or legal guardian. A mental age of 7 years is too young for consent to be informed. REF: 1245

Chapter 42 Fragile X syndrome is: A chromosome defect affecting only females. A chromosome defect that follows the pattern of X-linked recessive disorders. The second most common genetic cause of cognitive impairment. The most common cause of noninherited cognitive impairment.

The second most common genetic cause of cognitive impairment. Fragile X syndrome is the most common inherited cause of cognitive impairment and the second most common cause of cognitive impairment after Down syndrome. Fragile X primarily affects males, follows the pattern of X-linked dominant with reduced penetrance, and is inherited. REF: 1185

Chapter 41 The nurse is talking with the parents of a child who died 6 months ago. They sometimes still "hear" the child's voice and have trouble sleeping. They describe feeling "empty" and depressed. The nurse should recognize that: These are normal grief responses. The pain of the loss is usually less by this time. These grief responses are more typical of the early stages of grief. This grieving is essential until the pain is gone and the child is gradually forgotten.

These are normal grief responses. These are normal grief responses. The process of grief work is lengthy and resolution of grief may take years, with intensification during the early years. The child will never be forgotten by the parents REF: 1172

Chapter 46 Cool-mist vaporizers rather than steam vaporizers are recommended in home treatment of respiratory tract infections because: They are safer. They are less expensive. Respiratory secretions are dried. A more comfortable environment is produced.

They are safer. Cool-mist vaporizers are safer than steam vaporizers, and limited evidence exists to show any advantages to steam. The cost of cool-mist and steam vaporizers is comparable. Steam loosens secretions, not dries them. Both may promote a more comfortable environment, but decreased risk for burns and growth of organisms exist in cool-mist vaporizers REF: 1304

Chapter 47 A 4-month-old infant has gastroesophageal reflux disease (GERD) but is thriving without other complications. What should the nurse suggest to minimize reflux? Place in Trendelenburg position after eating. Thicken formula with rice cereal. Give continuous nasogastric tube feedings. Give larger, less frequent feedings.

Thicken formula with rice cereal. Small frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula has been recommended. Milk thickening agents have been shown to decrease the number of episodes of vomiting and increase the caloric density of the formula. This may benefit infants who are underweight as a result of GERD. Placing the child in a Trendelenburg position would increase the reflux. Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive. Smaller, more frequent feedings are recommended in reflux. REF: 1395

Chapter 41 Lindsey, age 5 years, will be starting kindergarten next month. She has cerebral palsy, and it has been determined that she needs to be in a special education classroom. Her parents are tearful when telling the nurse about this and state that they did not realize that her disability was so severe. The best interpretation of this situation is that: This is a sign that parents are in denial. This is a normal anticipated time of parental stress. The parents need to learn more about cerebral palsy. The parents are used to having expectations that are too high.

This is a normal anticipated time of parental stress. Parenting a child with a chronic illness can be very stressful for parents. There are anticipated times that parental stress increases. One of these identified times is when the child begins school. Nurses can help parents recognize and plan interventions to work through these stressful periods. The parents are not in denial; they are responding to the child's placement in school. The parents are not exhibiting signs of a knowledge deficit; this is their first interaction with the school system with this child.

Chapter 44 A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, "Wait a minute," and, "I'm not ready." The nurse should recognize that: This is normal behavior for a school-age child. This behavior is usually not seen past the preschool years. The child thinks the nurse is punishing her. The child has successfully manipulated the nurse in the past.

This is normal behavior for a school-age child. This school-age child is attempting to maintain control. The nurse should provide the girl with structured choices about when the IV will be inserted. This can be characteristic behavior when an individual needs to maintain some control over a situation. The child is trying to have some control in the hospital experience. REF: 1222

Chapter 41 A 16-year-old boy with a chronic illness has recently become rebellious and is taking risks such as missing doses of his medication. The nurse should explain to his parents that: He needs more discipline. He needs more socialization with peers. This is part of normal adolescence. This is how he is asking for more parental control.

This is part of normal adolescence. Risk taking, rebelliousness, and lack of cooperation are normal parts of adolescence. If the parents increase the amount of discipline, he will most likely be more rebellious. Socialization with peers should be encouraged as a part of adolescence. It is a normal part of adolescence during which the young adult is establishing independence. REF: 1162

Chapter 44 MULTIPLE RESPONSE Ryan has just been unexpectedly admitted to the intensive care unit after abdominal surgery. The nursing staff has completed the admission process, and Ryan's condition is beginning to stabilize. When speaking with the parents, the nurses should expect which stressors to be evident? Choose all that apply. Unfamiliar environment Usual day-night routine Strange smells Provision of privacy Inadequate knowledge of condition and routine

Unfamiliar environment Strange smells Inadequate knowledge of condition and routine Intensive care units, especially when the family is unprepared for the admission, are a strange and unfamiliar place. There are many pieces of unfamiliar equipment, and the sights and sounds are much different from a general hospital unit. Also, with the child's condition being more precarious, it may be difficult to keep the parents updated and knowledgeable about what is happening. Lights are usually on around the clock, seriously disrupting the diurnal rhythm. There is usually little privacy available for families in intensive care units. REF: 1242

Which parameter correlates best with measurements of the body's total protein stores? Height Weight Skin-fold thickness Upper arm circumference

Upper arm circumference Upper arm circumference is correlated with measurements of total muscle mass. Muscle serves as the body's major protein reserve and is considered an index of the body's protein stores. Height is reflective of past nutritional status. Weight is indicative of current nutritional status. Skin-fold thickness is a measurement of the body's fat content. REF: 892

Chapter 34 An appropriate approach to performing a physical assessment on a toddler is to: Always proceed in a head-to-toe direction. Perform traumatic procedures first. Use minimal physical contact initially. Demonstrate use of equipment.

Use minimal physical contact initially. Parents can remove clothing, and the child can remain on the parent's lap. The nurse should use minimal physical contact initially to gain the child's cooperation. The head-to-toe assessment can be done in older children but usually must be adapted in younger children. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for this age group. REF: 888

Chapter 34 What action is most likely to encourage parents to talk about their feelings related to their child's illness? Be sympathetic. Use direct questions. Use open-ended questions. Avoid periods of silence.

Use open-ended questions. Closed-ended questions should be avoided when attempting to elicit parents' feelings. Open-ended questions require the parent to respond with more than a brief answer. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in the helping relationship. Direct questions may obtain limited information. In addition, the parent may consider them threatening. Silence can be an effective interviewing tool. It allows sharing of feelings in which two or more people absorb the emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions. REF: 868

Chapter 34 What is an important consideration for the nurse who is communicating with a very young child? Speak loudly, clearly, and directly. Use transition objects such as a doll. Disguise own feelings, attitudes, and anxiety. Initiate contact with child when parent is not present.

Use transition objects such as a doll. Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This facilitates communication with this age child. Speaking loudly, clearly, and directly tends to increase anxiety in very young children. The nurse must be honest with the child. Attempts at deception lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children. REF: 870

Chapter 42 Many of the physical characteristics of Down syndrome present nursing problems. Care of the child should include: Delaying feeding solid foods until the tongue thrust has stopped. Modifying diet as necessary to minimize the diarrhea that often occurs. Providing calories appropriate to the child's age. Using a cool-mist vaporizer to keep mucous membranes moist.

Using a cool-mist vaporizer to keep mucous membranes moist. The constant stuffy nose forces the child to breathe by mouth, drying the mucous membranes and increasing the susceptibility to upper respiratory infections. A cool mist vaporizer will keep the mucous membranes moist and liquefy secretions. The child has a protruding tongue, which makes feeding difficult. The parents must persist with feeding while the child continues the physiologic response of the tongue thrust. The child is predisposed to constipation. Calories should be appropriate to the child's weight and growth needs, not age. REF: 1185

Chapter 45 The nurse is caring for an unconscious child. Skin care should include: Avoiding use of pressure reduction on the bed. Massaging reddened bony prominences to prevent deep tissue damage. Using draw sheet to move child in bed to reduce friction and shearing injuries. Avoiding rinsing skin after cleansing with mild antibacterial soap to provide a protective barrier.

Using draw sheet to move child in bed to reduce friction and shearing injuries. A draw sheet should be used to move the child in the bed or onto a gurney to reduce friction and shearing injuries. Do not drag the child from under the arms. Pressure-reduction devices should be used to redistribute weight. Bony prominences should not be massaged if reddened. Deep tissue damage can occur. Pressure-reduction devices should be used instead. The skin should be cleansed with mild nonalkaline soap or soap-free cleaning agents for routine bathing. REF: 1257

Chapter 34 What type of breath sound is normally heard over the entire surface of the lungs except for the upper intrascapular area and the area beneath the manubrium? Vesicular Bronchial Adventitious Bronchovesicular

Vesicular Vesicular breath sounds are heard over the entire surface of lungs, with the exception of the upper intrascapular area and the area beneath the manubrium. Bronchial breath sounds are heard only over the trachea near the suprasternal notch. Adventitious breath sounds are not usually heard over the chest. These sounds occur in addition to normal or abnormal breath sounds. Bronchovesicular breath sounds are heard over the manubrium and in the upper intrascapular regions where trachea and bronchi bifurcate. REF: 915

Chapter 47 The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis? Abdominal rigidity and pain on palpation Rounded abdomen and hypoactive bowel sounds Visible peristalsis and weight loss Distention of lower abdomen and constipation

Visible peristalsis and weight loss Visible gastric peristaltic waves that move from left to right across the epigastrium are observed in pyloric stenosis. Abdominal rigidity and pain on palpation, and rounded abdomen and hypoactive bowel sounds are usually not present. The upper abdomen is distended, not the lower abdomen. REF: 1419

Chapter 45 The nurse wore gloves during a dressing change. When the gloves are removed, the nurse should: Wash hands thoroughly. Check the gloves for leaks. Rinse gloves in disinfectant solution. Apply new gloves before touching the next patient.

Wash hands thoroughly. When gloves are worn, the hands are washed thoroughly after removing the gloves because both latex and vinyl gloves fail to provide complete protection. Gloves should be disposed of after use and hands should be thoroughly washed again before new gloves are applied. REF: 1264

Chapter 34 What term is used to describe breath sounds that are produced as air passes through narrowed passageways? Rubs Rattles Wheezes Crackles

Wheezes Wheezes are produced as air passes through narrowed passageways. The sound is similar when the narrowing is caused by exudates, inflammation, spasm, or tumor. Rubs are the sound created by the friction of one surface rubbing over another. Pleural friction rub is caused by inflammation of the pleural space. Rattles is the term formerly used for crackles. Crackles are the sounds made when air passes through fluid or moisture. REF: 915

Chapter 42 The most common clinical manifestation of retinoblastoma is: Glaucoma. Amblyopia. White eye reflex. Sunken eye socket.

White eye reflex. When examining the eye, the light will reflect off of the tumor, giving the eye a whitish appearance. This is called white eye reflex. A late sign of retinoblastoma is a red, painful eye with glaucoma. Amblyopia or lazy eye is reduced visual acuity in one eye. The eye socket is not sunken. REF: 1197

Chapter 41 The nurse comes into the room of a child who was just diagnosed with a chronic disability. The child's parents begin to yell at the nurse about a variety of concerns. The nurse's best response is: "What is really wrong?" "Being angry is only natural." "Yelling at me will not change things." "I will come back when you settle down."

"Being angry is only natural." Parental anger after the diagnosis of a child with a chronic disability is a common response. One of the most common targets for parental anger is members of the staff. The nurse should recognize the common response of anger to the diagnosis and allow the family to ventilate. "What is really wrong?" "Yelling at me will not change things," and "I will come back when you settle down" are all possible responses, but they are not the likely reasons for this anger.

Chapter 44 The nurse is caring for an adolescent who had an external fixator placed after suffering a fracture of the wrist during a bicycle accident. Which statement by the adolescent would be expected about separation anxiety? "I wish my parents could spend the night with me while I am in the hospital." "I think I would like for my siblings to visit me but not my friends." "I hope my friends don't forget about visiting me." "I will be embarrassed if my friends come to the hospital to visit."

"I hope my friends don't forget about visiting me." Loss of peer-group contact may pose a severe emotional threat to an adolescent because of loss of group status; friends visiting are an important aspect of hospitalization for an adolescent and would be very reassuring. Adolescents may welcome the opportunity to be away from their parents. The separation from siblings may produce reactions from difficulty coping to a welcome relief. REF: 1221

Chapter 47 A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. Which statement by the parent would indicate a correct understanding of the teaching? "I will keep my child on a clear liquid diet for the next 24 hours." "I should encourage my child to drink carbonated drinks but avoid food for the next 24 hours." "I will offer my child bananas, rice, applesauce, and toast for the next 48 hours." "I should have my child eat a normal diet with easily digested foods for the next 48 hours."

"I should have my child eat a normal diet with easily digested foods for the next 48 hours." Easily digested foods such as cereals, cooked vegetables, and meats should be provided for the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness. Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. A diet of bananas, applesauce, and toast is contraindicated because it has little nutritional value (low in energy and protein), is high in carbohydrates, and is low in electrolytes. REF: 1388

Chapter 42 Hearing is expressed in decibels, or units of loudness. In decibels the softest sound a normal ear can hear is: 0. 10. 40 to 50. 100.

0. By definition, 0 decibels is the softest sound the normal ear can hear. Ten decibels is the sound of the heartbeat or the rustling of leaves. The range of normal conversation is 40 to 50 decibels. The noise of a train is approximately 100 decibels. REF: 1187

Chapter 34 By what age do the head and chest circumferences generally become equal? 1 month 6 to 9 months 1 to 2 years 2.5 to 3 years

1 to 2 years Head circumference begins larger than chest circumference. Between ages 1 and 2 years, they become approximately equal. Head circumference is larger than chest circumference at ages 1 month and 6 to 9 months. Chest circumference is larger than head circumference at age 2.5 to 3 years.

Chapter 46 The Heimlich maneuver is recommended for airway obstruction in children older than: 1 year 4 years 8 years 12 years

1 year The Heimlich maneuver is recommended for airway obstruction in children older than 1 year. In children younger than 1 year, back blows and chest thrusts are administered. REF: 1358

Chapter 34 The nurse should expect the anterior fontanel to close at age: 2 months 2 to 4 months 6 to 8 months 12 to 18 months

12 to 18 months Ages 2 through 8 months are too early. The expected closure of the anterior fontanel occurs between ages 12 and 18 months; if it closes at these earlier ages, the child should be referred for further evaluation. REF: 903

Chapter 34 The earliest age at which a satisfactory radial pulse can be taken in children is: 1 year 2 years 3 years 6 years

2 years Satisfactory radial pulses can be used in children older than 2 years. In infants and young children the apical pulse is more reliable. The radial pulse can be used for assessment at ages 3 and 6 years. REF: 893

Chapter 34 Binocularity, the ability to fixate on one visual field with both eyes simultaneously, is normally present by what age? 1 month 3 to 4 months 6 to 8 months 12 months

3 to 4 months Binocularity is usually achieved by ages 3 to 4 months. Age 1 month is too young for binocularity. If binocularity is not achieved by 6 months, the child must be observed for strabismus. REF: 904

Chapter 34 The nurse is testing an infant's visual acuity. By what age should the infant be able to fix on and follow a target? 1 month 1 to 2 months 3 to 4 months 6 months

3 to 4 months Visual fixation and following a target should be present by ages 3 to 4 months. Ages 1 to 2 months are is too young for this developmental milestone. If the infant is not able to fix and follow by 6 months of age, further ophthalmologic evaluation is needed. REF: 907

Chapter 45 A child is receiving total parenteral nutrition (TPN; hyperalimentation). At the end of 8 hours the nurse observes the solution and notes that 200 ml/8 hr is being infused rather than the ordered amount of 300 ml/8 hr. The nurse should adjust the rate so that how much will infuse during the next 8 hours? 200 ml 300 ml 350 ml 400 ml

300 ml The TPN infusion rate should not be increased or decreased without the practitioner being informed because alterations in rate can cause hyperglycemia or hypoglycemia. Any changes from the prescribed flow rate may lead to hyperglycemia or hypoglycemia. REF: 1298

Chapter 34 With the National Center for Health Statistics (NCHS) criteria, which body mass index (BMI)-for-age percentile indicates a risk for being overweight? 10th percentile 9th percentile 85th percentile 95th percentile

85th percentile Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children in the 9th and 10th percentiles are within normal limits. Children who are greater than or equal to the 95th percentile are considered overweight. REF: 890

Chapter 41 At what age do most children have an adult concept of death as being inevitable, universal, and irreversible? 4 to 5 years 6 to 8 years 9 to 11 years 12 to 16 years

9 to 11 years By age 9 or 10 years, children have an adult concept of death. They realize that it is inevitable, universal, and irreversible. Preschoolers and young school-age children are too little to have an adult concept of death. Adolescents have a mature understanding of death. REF: 1167

Chapter 46 Chronic otitis media with effusion (OME) is differentiated from acute otitis media (AOM) because it is usually characterized by: Fever as high as 40° C (104° F). Severe pain in the ear. Nausea and vomiting. A feeling of fullness in the ear.

A feeling of fullness in the ear. OME is characterized by an immobile or orange-discolored tympanic membrane and nonspecific complaints and does not cause severe pain. Fever and severe may be signs of AOM. Nausea and vomiting are associated with otitis media. REF: 1315

Chapter 34 During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is: A normal finding. An abnormal finding; child needs referral to ophthalmologist. A sign of possible visual defect; child needs vision screening. A sign of small hemorrhages, which usually resolve spontaneously.

A normal finding. A brilliant, uniform red reflex is an important normal and expected finding. It rules out many serious defects of the cornea, aqueous chamber, lens, and vitreous chamber REF: 904

Chapter 45 An appropriate method for administering oral medications that are bitter to an infant or small child would be to mix them with: A bottle of formula or milk. Any food the child is going to eat. A small amount (1 teaspoon) of a sweet-tasting substance such as jam or ice cream. Large amounts of water to dilute medication sufficiently.

A small amount (1 teaspoon) of a sweet-tasting substance such as jam or ice cream. Mix the drug with a small amount (about 1 teaspoon) of sweet-tasting substance. This will make the medication more palatable to the child. If the child does not finish drinking/eating, it is difficult to determine how much medication was consumed. Medication should not be mixed with essential foods and milk. The child may associate the altered taste with the food and refuse to eat in future. REF: 1274

Chapter 46 Asthma in infants is usually triggered by: Medications. A viral infection. Exposure to cold air. Allergy to dust or dust mites.

A viral infection. Viral illnesses cause inflammation that causes increased airway reactivity in asthma. Medications such as aspirin, nonsteroidal antiinflammatory drugs, and antibiotics may aggravate asthma, but not frequently in infants. Exposure to cold air may exacerbate already existing asthma. Allergy is associated with asthma, but 20% to 40% of children with asthma have no evidence of allergic disease. REF: 1334