Pedi Module 7

Initial care of the child with a chemical burn to the eye(s) is focused on which of the following? a. Irrigation of the affected eye(s) b. Application of topical steroids c. Administration of an analgesic d. Administration of medication to constrict the pupils

ANS: A Chemical eye burns are an ocular emergency and best managed by immediate irrigation of the eye(s) with water or normal saline solution. The other actions are not part of initial care.

The most common type of hearing loss, which results from interference of transmission of sound to the middle ear, is called a. conductive. b. sensorineural. c. mixed conductive-sensorineural. d. central auditory imperceptive.

ANS: A 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. The other types occur much less often.

The correct position for the postoperative child who has had a cataract removed from the right eye is the ________ position. a. supine b. prone c. knee-chest d. right lateral Sims

ANS: A To prevent edema and pressure on the operative site, the nurse should elevate the head of the bed slightly and avoid placing the child in a dependent position. The prone position is a dependent position, which is contraindicated after cataract surgery. The knee-chest position is contraindicated after cataract surgery. The right lateral Sims position increases pressure on the operative site.

A baby is born with blood type AB. The father is type A, and the mother is type B. The father asks why the baby has a blood type different from those of his parents. The nurse's answer should be based on the knowledge that a. both A and B blood types are dominant. b. the baby has a mutation of the parents' blood types. c. type A is recessive and links more easily with type B. d. types A and B are recessive when linked together.

ANS: A Types A and B are equally dominant, and the baby can thus inherit one from each parent. The infant has inherited both blood types from the parents; it is not a mutation.

The nurse should know that the results of untreated amblyopia ("lazy eye") in the child may include which of the following? a. Impaired depth perception b. Strabismus c. Color deficiency d. Ptosis

ANS: A Untreated amblyopia causes the child to lose binocular vision, which may impair depth perception. Amblyopia, or decreased vision in the deviated eye, can result from strabismus. Color deficiency is not a result of amblyopia. Ptosis, or drooping of the eyelid, is not a result of untreated amblyopia.

The nurse is assessing a 3-year-old child who has characteristics of autism. Which observed behaviors are associated with autism? (Select all that apply.) a. The child flicks the light in the examination room on and off repetitiously. b. The child has a flat affect. c. The child demonstrates imitation and gesturing skills. d. The mother reports the child has no interest in playing with other children. e. The child is able to make eye contact.

ANS: A,B,D Self-stimulation is common and usually involves repetition of a sensory stimulus. Autistic children show a fixed, unchanging response to a particular stimulus. Autistic children play alone or involve others only as mere objects. Autistic children lack imitative skills. These children lack social ability and make poor eye contact.

The nurse knows that which of the following chromosomal abnormalities are structural in nature? (Select all that apply.) a. Part of a chromosome is missing. b. The material within a chromosome is rearranged. c. One or more sets of chromosomes are added. d. An entire single chromosome is added. e. Two chromosomes adhere to each other.

ANS: A,B,E Characteristics of structural abnormalities include part of a chromosome missing or added, rearrangement of material within chromosomes, two chromosomes that adhered to each other, and fragility of a specific site on the X chromosome. The addition of a single chromosome (trisomy), the deletion of a single chromosome (monosomy), and one or more added sets of chromosomes (polyploidy) are numerical abnormalities.

A nurse is providing anticipatory guidance to parents of a 2 1/2-year-old. What instruction is best to help the child's language development? a. Have the child's hearing tested at 3 years. b. Use clear speech and avoid baby talk. c. Speak with different voice inflections. d. Insist the child listen when you are talking.

ANS: B Between the ages of 2 and 4 the parents need to speak clearly with good grammar and avoid baby talk to encourage language development. Testing the child's hearing does not promote language. Speaking with different voice inflections is appropriate for children up to 2 years of age. Insisting the child listen when you are speaking is a good technique for children aged 4 to 6.

Which statement by a school-age girl indicates the need for further teaching about the prevention of urinary tract infections (UTIs)? a. "I always wear cotton underwear." b. "I really enjoy taking a bubble bath." c. "I go to the bathroom every 3 to 4 hours." d. "I drink four to six glasses of fluid every day."

ANS: B Bubble baths should be avoided because they tend to cause urethral irritation, which leads to UTI. It is desirable to wear cotton rather than nylon underwear. Nylon tends to hold in moisture and promote bacterial growth, whereas cotton absorbs moisture. Children should be encouraged to urinate at least four times a day. An adequate fluid intake prevents the buildup of bacteria in the bladder.

You are the nurse caring for a 4-year-old child who has developed acute renal failure as a result of hemolytic-uremic syndrome (HUS). Which bacterial infection was most likely the cause of HUS? a. Pseudomonas aeruginosa b. Escherichia coli c. Streptococcus pneumoniae d. Staphylococcus aureus

ANS: B Children with HUS become infected by Escherichia coli, which is usually contracted from eating improperly cooked meat or contaminated dairy products. Pseudomonas aeruginosa, Streptococcus pneumoniae, and Staphylococcus aureus are not associated with HUS.

A child with autism is hospitalized with asthma. The nurse should plan care so that the a. parents' expectations are met. b. child's routine habits and preferences are maintained. c. child is supported through the autistic crisis. d. parents need not be at the hospital.

ANS: B Children with autism are often unable to tolerate even slight changes in routine. The child's routine habits and preferences are important to maintain. Focus of care is on the child's needs rather than on the parent's desires. Autism is a life-long condition. The presence of the parents is almost always required when an autistic child is hospitalized.

A neonate born with ambiguous genitalia is diagnosed with congenital adrenal hyperplasia. Therapeutic management includes administration of a. vitamin D. b. cortisone acetate. c. stool softeners. d. calcium carbonate.

ANS: B Cortisone acetate is the treatment for congenital adrenal hyperplasia, and treatment is lifelong. Vitamin D, stool softeners, and calcium carbonate are not used in therapy for this condition.

An infant is born with bladder exstrophy. What action by the nurse is the priority? a. Obtain surgical consent for the corrective operation. b. Cover the exposed bladder with non-adherent plastic wrap. c. Insert an indwelling catheter to collect all the urine. d. Obtain consent for genetic testing on parents and infant.

ANS: B In bladder exstrophy, the bladder is outside the body and must be covered with a non-adherent plastic wrap until surgical correction. This is the priority action. Consent will be obtained prior to surgery. A catheter is not needed. Genetic testing is not necessarily done.

The nurse should suspect a hearing impairment in an infant who demonstrates which of the following? a. Absence of intelligible speech by 12 months b. Cessation of babbling at age 7 months c. Lack of eye contact when being spoken to d. Lack of gesturing to indicate wants after age 15 months

ANS: B Infants who are deaf babble like hearing infants until approximately 5 to 6 months of age, at which time babbling is noted to cease. Failure to develop intelligible speech is not considered a problem by 12 months. This would be considered a problem at 24 months. The lack of a startle reflex indicates a problem with hearing. The child with hearing impairment uses gestures rather than vocalizations to express desires at this age.

A nurse is assessing lab results on four patients in the general pediatric unit. What child should the nurse go see first? a. Urine specific gravity: 1.025 b. Urine ketones: positive in large amounts c. Serum BUN 21 mg/dL d. Serum creatinine 0.7 mg/dL

ANS: B Ketones should not be present in the urine. When found, they are indicative of starvation, diabetic ketoacidosis, fever, prolonged vomiting, anorexia, and severe diarrhea. The nurse should see this child first. The other lab values are normal.

Which statement is true of multifactorial disorders? a. They may not be evident until later in life. b. They are usually present and detectable at birth. c. The disorders are characterized by multiple defects. d. Secondary defects are rarely associated with multifactorial disease.

ANS: B Multifactorial disorders result from an interaction between a person's genetic susceptibility and environmental conditions that favor development of the defect. They are characteristically present and detectable at birth. They are usually single isolated defects, although the primary defect may cause secondary defects. Secondary defects can occur with multifactorial disorders.

Appropriate interventions to facilitate socialization of the cognitively impaired child include a. providing age-appropriate toys and play activities. b. providing peer experiences, such as scouting, when older. c. avoiding exposure to strangers who may not understand cognitive development. d. emphasizing mastery of physical skills because they are the most delayed.

ANS: B 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. However, peer interactions will better facilitate social development. Parents should expose the child to strangers so that the child can practice social skills. Verbal skills are delayed more than physical skills.

Which finding indicates that a child receiving prednisone for primary nephrotic syndrome is in remission? a. Urine is negative for casts for 5 days. b. Urine has <1+ protein for 3 to 7 consecutive days. c. Urine is positive for glucose for 1 week. d. Urine is up to a trace for blood for 1 week.

ANS: B The child receiving steroids for the treatment of primary nephrotic syndrome is considered in remission when the urine has <1+ protein for 3 to 7 consecutive days. The absence of casts, presence of glucose, and presence of hematuria do not constitute remission.

Parents ask the nurse, "When should our child's hypospadias be corrected?" The nurse responds that correction of hypospadias should be accomplished by the time the child is a. 1 month of age. b. 6 to 12 months of age. c. school age. d. sexually mature.

ANS: B The correction of hypospadias should ideally be accomplished by the time the child is 6 to 12 months of age and before toilet training. One month of age is too young for this procedure. It is preferable for hypospadias to be surgically corrected before the child enters school so that the child has normal toileting behaviors in the presence of his peers. Corrective surgery for hypospadias is done long before sexual maturity.

A nurse is giving a parent information about autism. Which statement made by the parent indicates understanding of the teaching? a. Autism is characterized by periods of remission and exacerbation. b. The onset of autism usually occurs before 3 years of age. c. Children with autism have imitation and gesturing skills. d. Autism can be treated effectively with medication.

ANS: B The onset of autism usually occurs before 3 years of age. Autism does not have periods of remission and exacerbation. Autistic children lack imitative skills. Medications are of limited use in children with autism.

Teaching parents about the use and application of an eye patch to treat strabismus should include which instruction? a. Check under the patch four times a day. b. Apply the patch directly to the face. c. Sometimes patching alone will straighten the eye. d. Negotiate the number of hours per day that the patch is to be worn.

ANS: B The patch should be securely applied to the face and should remain in place for the prescribed number of hours. There is no need to check under the patch. Patching alone will not straighten the eye. The amount of time the child wears the eye patch is not negotiable. Parents should learn strategies for dealing with resistant behaviors.

Diabetes insipidus is a disorder of the a. anterior pituitary. b. posterior pituitary. c. adrenal cortex. d. adrenal medulla.

ANS: B The principal disorder of posterior pituitary hypofunction is diabetes insipidus. ADH is produced in the hypothalamus and stored in the posterior pituitary gland. When ADH is not released appropriately by the posterior pituitary gland, DI occurs. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The adrenal cortex produces aldosterone, sex hormones, and glucocorticoids. The adrenal medulla produces catecholamines.

The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes which of the following? a. Taping the eye shut b. Patching the affected eye with any reasonable item c. Applying ice until the physician is seen d. Irrigating the eye copiously with a sterile saline solution

ANS: B The role of the nurse in a penetrating eye injury is to protect the eye from further injury. The injured eye should be patched with any reasonable material that serves the purpose. For instance, a Styrofoam cup can be used. The nurse would not tape the eye shut, apply ice, or irrigate the eye.

Which factor predisposes the urinary tract to infection? a. Increased fluid intake b. Short urethra in young girls c. Prostatic secretions in males d. Frequent emptying of the bladder

ANS: B The short urethra in females provides a ready pathway for invasions of organisms. Increased fluid intake offers protective measures against UTIs. Prostatic secretions have antibacterial properties that inhibit bacteria. Frequent emptying of the bladder also offers protection against UTIs.

A parent whose child has been diagnosed with a cognitive deficit should be counseled that intellectual impairment a. is usually due to a genetic defect. b. may be caused by a variety of factors. c. is rarely due to first trimester events. d. is usually caused by parental intellectual impairment.

ANS: B There are a multitude of causes for intellectual impairment. In most cases, a specific cause has not been identified. Only a small percentage of children with intellectual impairment are affected by a genetic defect. One third of children with intellectual impairment are affected by first trimester events. Intellectual impairment can be transmitted to a child only if the parent has a genetic disorder.

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 a. microcephaly. b. Down syndrome. c. cerebral palsy. d. fragile X syndrome.

ANS: B 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.

A nurse is providing anticipatory guidance to parents of a child with an intellectual disability. Which safety information is correct based on the child's age? (Select all that apply.) a. Elementary age: safe use of grooming products b. High school age: safety while cooking c. Preschool age: keep hands inside car d. High school age: stranger danger e. Elementary age: water safety

ANS: B,C,E Many factors related to anticipatory guidance and safety will be similar for the cognitively impaired child as for the other children, based on the child's intellectual age. Teaching high school-age children about safety in the kitchen, preschool-age children to keep their hands inside the car, and elementary-age children water safety are appropriate areas to start with, tailored to intellectual age. Elementary-age children are too young for grooming product safety, and high school-age children are too old for stranger danger.

A child is diagnosed with hypothyroidism. The nurse should expect to assess which symptoms associated with hypothyroidism? (Select all that apply.) a. Weight loss b. Fatigue c. Diarrhea d. Dry, thick skin e. Cold intolerance

ANS: B,D,E A child with hypothyroidism will display fatigue, dry, thick skin, and cold intolerance. Weight loss and diarrhea are signs of hyperthyroidism.

What is the priority nursing goal for a 14-year-old with Graves' disease? a. Relieving constipation b. Allowing the adolescent to make decisions about whether or not to take medication c. Verbalizing the importance of adherence to the medication regimen d. Developing alternative educational goals

ANS: C A priority goal is for the adolescent to verbalize the need to remain adherent to the medication regime. The adolescent with Graves' disease is not constipated. Adherence to the medication schedule is important to ensure optimal health and wellness. Medications should not be skipped, and dose regimens should not be tapered by the child without consultation with the child's medical provider. The management of Graves' disease does not interfere with school attendance and does not require alternative educational plans.

Developmental delays, self-injury, fecal smearing, and severe temper tantrums in a preschool child are symptoms of a. Down syndrome. b. intellectual disability. c. psychosocial deprivation. d. separation anxiety.

ANS: B These are symptoms of intellectual disability. Down syndrome is often identified at birth by characteristic facial and head features, such as brachycephaly (disproportionate shortness of the head); flat profile; inner epicanthal folds; wide, flat nasal bridge; narrow, high-arched palate; protruding tongue; and small, short ears, which may be low set. Although intellectual impairment may be present, the symptoms listed are not the primary ones expected in the diagnosis of Down syndrome. Psychosocial deprivation may be a cause of mild intellectual disability. The symptoms listed are characteristic of severe intellectual disability. Symptoms of separation anxiety include protest, despair, and detachment.

The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding? a. Increased urine output b. Hypotension c. Tea-colored urine d. Weight gain

ANS: C Acute poststreptococcal glomerulonephritis is characterized by hematuria, proteinuria, edema, and renal insufficiency. Tea-colored urine is an indication of hematuria. In acute poststreptococcal glomerulonephritis the urine output may be decreased. In acute poststreptococcal glomerulonephritis blood pressure may be increased. Edema may be noted around the eyelids and ankles in patients with acute post streptococcal glomerulonephritis and can contribute to weight gain; however, weight gain is associated more with nephrotic syndrome.

A parent brings an 18-month-old to the pediatrician for a routine well-child visit and reports the child has been babbling and cooing since 6 months of age but is not yet saying any words. Which response by the nurse is the most appropriate? a. "Don't worry, your child should catch up soon." b. "The doctor will want to refer your child to an audiologist and speech pathologist." c. "This is normal speech development for an 18-month-old child." d. "Your child has an expressive language disorder and needs further evaluation."

ANS: B This is an appropriate response. By 18 months children should be speaking in simple sentences. Adequate hearing is essential for the development of speech. Hearing and language should be tested, and a referral to an audiologist and speech pathologist is indicated. The nurse should not give false reassurance and needs to address the parent's concerns. The nurse cannot diagnose an expressive language disorder.

A maternal-newborn nurse is caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis is the most essential in caring for the mother of this infant? a. Disturbed body image b. Interrupted family processes c. Anxiety d. Risk for injury

ANS: B This mother likely will experience a disruption in the family process related to the birth of a baby with an inherited disorder. Family disruption is common, and the strain of having a child with a serious birth defect may lead to divorce. Siblings may feel neglected because the child with a disorder requires more of their parents' time and attention. Women commonly experience body image disturbances in the postpartum period, but this is unrelated to giving birth to a child with Down syndrome. The mother likely will have a mix of emotions that may include anxiety, guilt, and denial, but this is not the most essential nursing diagnosis for this family. Risk for injury is not applicable.

The karyotype of a person is 47, XY, +21. This person is a a. normal male. b. male with Down syndrome. c. normal female. d. female with Turner syndrome.

ANS: B This person is male because his sex chromosomes are XY. He has one extra copy of chromosome 21 (for a total of 47 instead of 46), resulting in Down syndrome. A normal male has 46 chromosomes. A normal female has 46 chromosomes and XX for the sex chromosomes. A female with Turner syndrome has 45 chromosomes; the sex chromosomes have just one X.

A child is admitted with acute glomerulonephritis. The nurse expects the urinalysis during this acute phase to show which of the following? a. Bacteriuria and hematuria b. Hematuria and proteinuria c. Bacteriuria and increased specific gravity d. Proteinuria and decreased specific gravity

ANS: B Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes is specific gravity would not be expected.

The nurse is caring for a 2-year-old child who has a history of meningitis as an infant. The child is not speaking and does not turn the head to the sound of a rattle. Which type of hearing loss in a child may have resulted from a previous infection with meningitis? a. Conductive b. Sensorineural c. Central d. Mixed

ANS: B When hearing loss is caused by malformations, auditory nerve damage, or infection, the loss is usually permanent. Damage caused by inflammation or obstruction usually causes a temporary and reversible hearing loss. A central type of hearing loss usually causes difficulties in differentiating sounds and problems with auditory memory, and it is reversible. A combination of conductive and sensorineural loss. Conductive loss is often reversible, whereas sensorineural is permanent.

A nurse is planning care for a child admitted with nephrotic syndrome. Which interventions should be included in the plan of care? (Select all that apply.) a. Administration of antihypertensive medications b. Daily weights c. Salt-restricted diet d. Frequent position changes e. Teaching parents to expect tea-colored urine

ANS: B, C, D A child with nephrotic syndrome will need to be monitored closely for fluid excess so daily weights are important. The diet is salt restricted to prevent further retention of fluid. Because of the fluid excess, frequent position changes are required to prevent skin breakdown. Nephrotic syndrome does not require antihypertensive medications. These are administered for acute glomerulonephritis. Tea-colored urine is expected with acute glomerulonephritis but not nephrotic syndrome. The urine in nephrotic syndrome is frothy, indicating that protein is being lost in the urine.

A patient at 34 weeks of gestation has reported to the OB triage unit for assessment of oligohydramnios. The nurse assigned to care for this patient is aware that prolonged oligohydramnios may result in (Select all that apply.) a. intrauterine limb amputations. b. clubfoot. c. delayed lung development. d. other fetal abnormalities. e. fetal deformations.

ANS: B,C,D Oligohydramnios, an abnormally small volume of amniotic fluid, reduces the cushion surrounding the fetus and may result in deformations such as clubfoot. Prolonged oligohydramnios interferes with fetal lung development because it does not allow normal development of the alveoli. Oligohydramnios may not be the primary fetal problem but rather may be related to other fetal anomalies. This does not lead to intrauterine limb amputations or fetal deformations.

Which interventions should the nurse plan when caring for a child with a hearing loss? (Select all that apply.) a. Speak loudly. b. Speak slowly. c. Have the child's full attention. d. Use visual aids. e. Eliminate background noise.

ANS: B,C,D,E Speak clearly and at a slightly slower speed than normal. Eliminate background noise so the child can focus on what is being said. Use visual aids to assist communication. Look directly at the child, and have the child's full attention before speaking. Do not speak loudly

Which children admitted to the pediatric unit would the nurse monitor closely for development of SIADH? (Select all that apply.) a. A newly diagnosed preschooler with type 1 diabetes b. A school-age child returning from surgery for removal of a brain tumor c. An infant with suspected meningitis d. An adolescent with blunt abdominal trauma following a car accident e. A school-age child with head trauma

ANS: B,C,E Childhood SIADH usually is caused by disorders affecting the central nervous system, such as infections (meningitis), head trauma, and brain tumors. Diabetes and abdominal trauma do not cause SIADH.

Which interventions should the nurse plan when caring for a child with a visual impairment? (Select all that apply.) a. Touch the child upon entering the room before speaking. b. Keep items in the room in the same location. c. Describe the placement of the eating utensils on the meal tray. d. Face the child when speaking. e. Identify noises for the child.

ANS: B,C,E Keep all items in the room in the same location and order. Describing how many steps away something is and the placement of eating utensils on a tray are both useful tactics. Identify noises for the child because children who are visually impaired or blind often have difficulty establishing the source of a noise. Never touch the child without identifying yourself and explaining what you plan to do. Facing the child when speaking would help a child with a hearing impairment.

Throughout their life span, cognitively impaired children are less capable of managing environmental challenges and are at risk for a. nutritional deficits. b. visual impairments. c. physical injuries. d. psychiatric problems.

ANS: C Safety is a challenge for cognitively impaired children. Decreased capability to manage environmental challenges may lead to physical injuries. Nutritional deficits are related more to dietary habits and the caregivers' understanding of nutrition. Visual impairments are unrelated to cognitive impairment. Psychiatric problems may coexist with cognitive impairment; however, they are not environmental challenges.

What manifestation in a 5-month-old child could indicate visual problems? a. Lack of binocularity b. Visual acuity of 20/50 c. Strabismus d. Hyperopia

ANS: C Strabismus is normal in the young infant but should not be present after 3 months of age. Binocularity, the ability to fixate on one visual field with both eyes, is not present at birth but is established by 6 months of age. Visual acuity by 4 months of age is between 20/50 and 20/80. Hyperopia, or farsightedness, is normal until about 7 years of age.

Which statement by a parent about conjunctivitis indicates that further teaching is needed? a. "I'll have separate towels and washcloths for each family member." b. "I'll notify my doctor if the eye gets redder or the drainage increases." c. "When the eye drainage improves, we'll stop giving the antibiotic ointment." d. "After taking the antibiotic for 24 hours, my child can return to school."

ANS: C The antibiotic should be continued for the full prescription. Maintaining separate towels and washcloths will prevent the other family members from acquiring the infection. If the infection proliferates, the physician should be contacted. The child should be kept home from school or day care until the child receives the antibiotic for 24 hours.

A 10-year-old patient is talking to the nurse about wanting to try contact lenses instead of wearing glasses. The child states that the other children at school call her "four-eyes." Contact lenses should be prescribed for a child who is a. at least 12 years of age. b. able to read all the written information and instructions. c. able to independently care for the lenses in a responsible manner. d. confident that she really wants contact lenses.

ANS: C The child must be able to care for the lenses independently. Serious eye damage can occur with irresponsible use of contact lenses. Chronologic age is not the major determinant. A responsible 10-year-old child might be permitted to wear contact lenses. The ability to read does not indicate understanding of the instructions. Confidence and "wanting" do not equal responsibility.

A child is hospitalized after a serious motor vehicle crash and has developed increased urination. What action by the nurse takes priority? a. Weigh the child daily. b. Monitor the child's intake and output. c. Assess the daily serum sodium level. d. Restrict dietary sodium intake.

ANS: C This child might have diabetes insipidus; being in a car crash has the potential for a head injury. That coupled with frequent urination leads the nurse to suspect DI. A high serum sodium and low urine specific gravity are hallmarks of this condition. The priority action for the nurse is to review the child's most recent serum sodium. Daily weights and I&O are also important for many children but is not as specific for this condition as assessing the sodium level. The child may or may not need a sodium restriction, but assessment comes first.

Discharge planning for an 8-year-old child with a patched eye after a large corneal abrasion should include which instruction? a. Removing the patch after 8 hours for instillation of antibiotic ointment b. Gently massaging the affected eye to prevent edema c. Keeping the patch in place for 24 hours d. Returning after 7 days of patching for reassessment

ANS: C With severe abrasions, the eye should be patched and left undisturbed for 24 hours. After 24 hours, treatment with antibiotic ointment is started. Massaging the affected eye will increase the size of the abrasion and should be avoided. The child should also be taught not to rub the affected eye. The child should return in 24 hours for reassessment if the eye is patched.

Which statement best describes how a cataract affects a child's vision? a. It increases intraocular pressure. b. It alters the ability to distinguish among colors. c. It causes double vision. d. It prevents a clear image from forming on the retina

ANS: D A cataract is an opacity of the lens or loss of transparency of the lens. Coughing, straining, or vomiting can increase intraocular pressure postoperatively. Nystagmus and strabismus are clinical signs of a cataract. Color deficiency is not a sign. A cataract usually does not cause double vision.

Which statement by a parent of a child with nephrotic syndrome indicates an understanding of a no-added-salt diet? a. "I can give my child sweet pickles." b. "My child can put ketchup on his hotdog." c. "I can let my child have potato chips." d. "I do not put any salt in foods when I am cooking."

ANS: D A no-added-salt diet means that no salt should be added to foods, either when cooking or before eating. Pickles of any type, hotdogs, and potato chips are all prohibited on this diet.

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for which condition? a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. UTI

ANS: D Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.

Which statement should a nurse make when telling a couple about the prenatal diagnosis of genetic disorders? a. Diagnosis can be obtained promptly through most hospital laboratories. b. Common disorders can quickly be diagnosed through blood tests. c. A comprehensive evaluation will result in an accurate diagnosis. d. Diagnosis may be slow and could be inconclusive.

ANS: D Even the best efforts at diagnosis do not always yield the information needed to counsel patients. They may require many visits over several weeks. Some tests must be sent to a special laboratory, which requires a longer waiting period for results. There is no quick blood test available at this time to diagnose genetic disorders. Despite a comprehensive evaluation, a diagnosis may never be established.

A 2-year-old has excessive tearing and corneal haziness. The nurse knows that these symptoms may indicate which of the following? a. Viral conjunctivitis b. Paralytic strabismus c. Congenital cataract d. Infantile glaucoma

ANS: D Excessive tearing and corneal haziness are indicative of glaucoma. Because the child is younger than 3 years of age, it would be classified as "infantile." Discharge is noted with conjunctivitis. Corneal haziness is not a symptom of conjunctivitis. Neither tearing nor corneal haziness is a symptom of paralytic strabismus. A congenital cataract will cause an opacity but not excessive tearing.

Which is the nurse's best response to the parents of a 10-year-old child newly diagnosed with type 1 diabetes mellitus who are concerned about the child's continued participation in soccer? a. "Consider the swim team as an alternative to soccer." b. "Encourage intellectual activity rather than participation in sports." c. "It is okay to play sports such as soccer unless the weather is too hot." d. "Give the child an extra 15 to 30 g of carbohydrate snack before soccer practice."

ANS: D Exercise lowers blood glucose levels. A snack with 15 to 30 g of carbohydrates before exercise will decrease the risk of hypoglycemia. Soccer is an appropriate sport for a child with type 1 diabetes as long as the child prevents hypoglycemia by eating a snack. Participation in sports is not contraindicated for a child with type 1 diabetes. The child with type 1 diabetes may participate in sports activities regardless of climate.

Which intervention is appropriate when examining a male infant for cryptorchidism? a. Cooling the examiner's hands b. Taking a rectal temperature c. Eliciting the cremasteric reflex d. Warming the room

ANS: D For the infant's comfort, the infant should be examined in a warm room with the examiner's hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold. A rectal temperature yields no information about cryptorchidism. Testes can retract into the inguinal canal if the infant is upset or cold or if the cremasteric reflex is elicited. This can lead to an incorrect diagnosis.

A nurse is seeing a pregnant woman who has had genetic testing on her unborn fetus and has been given the results. The nurse notes the results confirm that the husband could not be the father. What action by the nurse is best? a. Do not discuss this information with the mother. b. Inform the mother genetic testing does not establish paternity. c. Call the husband immediately to break the news. d. Be available and offer support as the mother absorbs the news.

ANS: D Genetic testing can reveal paternity; hopefully the couple was informed that this can occur before the testing was done. The nurse should offer support to the woman as she tries to absorb the news and determine what to do next. Refusing to discuss the information may leave the woman feeling abandoned and does not address her emotional needs. The nurse should not call the husband.

Hypospadias refers to a. absence of a urethral opening. b. penis shorter than usual for age. c. urethral opening along dorsal surface of penis. d. urethral opening along ventral surface of penis.

ANS: D Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present in hypospadias but not at the glans. Hypospadias refers to the urethral opening, not to the size of the penis. Epispadias is where the urethral opening is along the dorsal surface of the penis.

Which diagnostic finding is present when a child has primary nephrotic syndrome? a. Hyperalbuminemia b. Positive ASO titer c. Leukocytosis d. Proteinuria

ANS: D Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane. Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the liver's inability to synthesize proteins to balance the loss. ASO titer is negative in a child with primary nephrotic syndrome. Leukocytosis is not a diagnostic finding in primary nephrotic syndrome.

An adolescent goes to the primary care provider complaining of difficulty with vision. When the nurse asks the adolescent to explain the visual deficits, the adolescent states, "I am having difficulty seeing distant objects; they are less clear than things that are close." What disorder does the nurse suspect the adolescent has? a. Hyphema b. Astigmatism c. Amblyopia d. Myopia

ANS: D Myopic patients have the ability to see near objects more clearly than those at a distance; it is caused by the image focusing beyond the retina. Hyphema includes hemorrhage in the anterior chamber and is not a refractive disorder. Astigmatism is caused by an abnormal curvature of the cornea or lens. Amblyopia is a problem of reduced visual acuity not correctable by refraction.

The teaching plan for the parents of a 3-year-old child with amblyopia ("lazy eye") should include what instruction? a. Apply a patch to the child's eyeglass lenses. b. Apply a patch only during waking hours. c. Apply a patch over the "bad" eye to strengthen it. d. Cover the "good" eye completely with a patch.

ANS: D The "good" eye is patched to force the child to use the "bad" eye, thus strengthening the muscles. The patch should always be applied directly to the child's face, not to eyeglasses. The patch should be left in place even when the child is sleeping. Covering the "bad" eye will not contribute to strengthening it. The "good" eye should be patched.

A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on the knowledge that a. it is a less expensive method of testing. b. it is not as accurate as laboratory testing. c. children are better able to manage the diabetes. d. the parents are better able to manage the disease.

ANS: C Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood sugar results. The child learns to be in better control by utilizing blood glucose monitoring. Blood glucose monitoring may be more expensive but provides improved management. It is as accurate as equivalent testing done in laboratories. The ability to self-test allows the child to balance diet, exercise, and insulin. The parents are partners in the process, but the child should be taught how to manage the disease.

Which statement by a parent indicates understanding of instructions on the care of a child with conjunctivitis? a. "I should treat my other children with these eye drops to prevent spread of the disease." b. "My child must remain home from school until she has received 72 hours of antibiotic drops." c. "I should avoid touching the tip of the ointment tube to my child's eye." d. "My child may go back to wearing her contact lenses 24 hours after treatment has started."

ANS: C Care should be taken to avoid touching the tip of the ointment tube or dropper to the eye to avoid contamination of the medication. The other statements indicate a need for further instruction.

The child with Down syndrome should be evaluated for which condition before participating in some sports? a. Hyperflexibility b. Cutis marmorata c. Atlantoaxial instability d. Speckling of iris (Brushfield spots)

ANS: C 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 is characteristic of Down syndrome, it does not affect the child's ability to participate in sports. Although cutis marmorata is characteristic of Down syndrome, it does not affect the child's ability to participate in sports. Although Brushfield spots are characteristic of Down syndrome, they do not affect the child's ability to participate in sports.

What should the nurse keep in mind when planning to communicate with a child who has autism? a. The child has normal verbal communication. b. Expect the child to use sign language. c. The child may exhibit monotone speech and echolalia. d. The child is not listening if she is not looking at the nurse.

ANS: C Children with autism have abnormalities in the production of speech such as a monotone voice or echolalia or inappropriate volume, pitch, rate, rhythm, or intonation. The child has impaired verbal communication and abnormalities in the production of speech. Some autistic children may use sign language, but it is not assumed. Children with autism often are reluctant to initiate direct eye contact.

Which comment by a 12-year-old child with type 1 diabetes indicates deficient knowledge? a. "I rotate my insulin injection sites every time I give myself an injection." b. "I keep records of my glucose levels and insulin sites and amounts." c. "I'll be glad when I can take a pill for my diabetes like my uncle does." d. "I keep Lifesavers in my school bag in case I have a low-sugar reaction."

ANS: C Children with type 1 diabetes will require life-long insulin therapy. Rotating sites may help with variable insulin absorption. Rotating spots within the same major site is important. Keeping records of serum glucose and insulin sites and amounts is appropriate. Prompt treatment of hypoglycemia reduces the possibility of a severe reaction. Keeping hard candy on hand is an appropriate action.

A major complication in a child with chronic renal failure is a. hypokalemia. b. metabolic alkalosis. c. water and sodium retention. d. excessive excretion of blood urea nitrogen.

ANS: C Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia is a complication of chronic renal failure. Metabolic acidosis is a complication of chronic renal failure. Retention of blood urea nitrogen is a complication of chronic renal failure.

The diet of a child with chronic renal failure is usually characterized as a. high in protein. b. low in vitamin D. c. low in phosphorus. d. supplemented with vitamins A, E, and K.

ANS: C Dietary phosphorus is controlled to prevent or control the calcium/phosphorus imbalance by the reduction of protein and milk intake. Protein should be limited. Vitamin D is administered to children with chronic kidney failure. Supplementation of vitamins A, E, and K is not part of dietary management in chronic renal disease

The teaching plan for a 7-year-old boy with color deficiency should include what instruction? a. Buy only one color of clothing to ensure the child's ability to match items himself. b. Patching the weaker eye will improve his color vision. c. Teach him an alternate way to distinguish between the colors of traffic signals. d. Botulism toxin drops must be administered every 2 months to improve color vision.

ANS: C Distinguishing colors of warning signals must be taught an alternative way to identify them. Clothes may be labeled or organized so the child can identify them. They do not have to be purchased only in one color. There is no cure for color blindness. Because the eye is not weak, patching will not correct the color deficiency. Color deficiency cannot be treated or corrected. The child can be taught adaptive measures to compensate for the condition.

A nurse is caring for a child undergoing an ACTH stimulation test. After administering the Cortrosyn according to policy, what action by the nurse takes priority? a. Obtain a set of vital signs. b. Monitor the urine output. c. Facilitate a lab draw in 30 minutes. d. Keep the child NPO.

ANS: C For the ACTH stimulation test, cortisol levels are drawn before and 30 and 60 minutes after cortisone administration. The nurses' priority is to facilitate the lab being drawn on time. Obtaining vital signs and urine output and keeping the child NPO are not related to this test.

What is the best nursing action when a child with type 1 diabetes mellitus is sweating, trembling, and pale? a. Offer the child a glass of water. b. Give the child 5 units of regular insulin subcutaneously. c. Give the child a glass of orange juice. d. Give the child glucagon subcutaneously.

ANS: C Four ounces of orange juice is an appropriate treatment for the conscious child who is exhibiting signs of hypoglycemia. This contains 15 grams of carbohydrate. A glass of water is not indicated in this situation. An easily digested carbohydrate is indicated when a child exhibits symptoms of hypoglycemia. Insulin would lower blood glucose and is contraindicated for a child with hypoglycemia. Subcutaneous injection of glucagon is used to treat hypoglycemia when the child is unconscious.

Which statement best describes fragile X syndrome? a. Chromosomal defect affecting only females. b. Chromosomal defect that follows the pattern of X-linked recessive disorders. c. It is a common genetic cause of cognitive impairment. d. Most common cause of noninherited cognitive impairment.

ANS: C 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. Fragile X follows the pattern of X-linked dominant with reduced manifestation of the syndrome in female and moderate to severe dysfunction in males. Fragile X is inherited.

The most appropriate nursing diagnosis for the child with acute glomerulonephritis is a. Risk for Injury related to malignant process and treatment. b. Deficient Fluid Volume related to excessive losses. c. Risk for Imbalanced Fluid Volume related to a decrease in plasma filtration. d. Excess Fluid Volume related to fluid accumulation in tissues and third spaces.

ANS: C Glomerulonephritis has a decreased filtration of plasma. The resulting decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. Excess fluid volume is found in this disease process. The fluid accumulation is related to the decreased plasma filtration.

Which condition is characterized by a history of bloody diarrhea, fever, abdominal pain, and low hemoglobin and platelet counts? a. Acute viral gastroenteritis b. Acute glomerulonephritis c. Hemolytic-uremic syndrome d. Acute nephrotic syndrome

ANS: C Hemolytic-uremic syndrome is an acute disorder characterized by anemia, thrombocytopenia, and acute renal failure. Most affected children have a history of gastrointestinal symptoms, including bloody diarrhea. Anemia and thrombocytopenia are not associated with acute gastroenteritis. The symptoms described are not suggestive of acute glomerulonephritis. The symptoms described are not suggestive of nephrotic syndrome.

Which teaching guideline helps prevent eye injuries during sports and play activities? a. Restrict helmet use to those who wear eye glasses or contact lenses. b. Discourage the use of goggles with helmets so the child can see better. c. Wear eye protection when participating in high-risk sports such as paintball. d. Wear a face mask when playing any sport or playing roughly.

ANS: C High-risk sports such as paintball can cause penetrating eye injuries. Eye protection should be worn. All children who play games should be protected by the appropriate headgear. Goggles and helmets can and should be used concurrently. A face mask does not prevent damage to the child's head.

How can a woman avoid exposing her fetus to teratogens? a. Update her immunizations during the first trimester of her pregnancy. b. Use saunas and hot tubs during the winter months only. c. Use only class A drugs during her pregnancy. d. Use alcoholic beverages only in the first and third trimesters of pregnancy.

ANS: C In well-controlled studies, class A drugs have no demonstrated fetal risk. Immunizations, such as rubella, are contraindicated in pregnancy. Maternal hyperthermia is an important teratogen. Alcohol is an environmental substance known to be teratogenic.

A common clinical manifestation of congenital hypothyroidism is a. insomnia. b. diarrhea. c. hoarse cry. d. jitteriness.

ANS: C Infants with congenital hypothyroidism often have a hoarse cry. They also sleep excessively, are constipated and lethargic.

Which sign is the nurse most likely to assess in a child with hypoglycemia? a. Urine positive for ketones and serum glucose greater than 300 mg/dL b. Normal sensorium and serum glucose greater than 160 mg/dL c. Irritability and serum glucose less than 60 mg/dL d. Increased urination and serum glucose less than 120 mg/dL

ANS: C Irritability and serum glucose less than 60 mg/dL are manifestations of hypoglycemia. Serum glucose greater than 300 mg/dL and urine positive for ketones are indicative of diabetic ketoacidosis. Normal sensorium and serum glucose greater than 160 mg/dL are associated with hyperglycemia. Increased urination is an indicator of hyperglycemia. A serum glucose level less than 120 mg/dL is within normal limits.

A 5-year-old diagnosed with chlamydial conjunctivitis should be carefully assessed for which of the following? a. Sexual abuse b. Immune deficiency c. Congenital cataract d. Secondary glaucoma

ANS: A A diagnosis of chlamydial conjunctivitis in a nonsexually active child should signal the health care provider to assess the child for sexual abuse. Chlamydial infection is not related to immune deficiencies, cataracts, or glaucoma.

A goiter is an enlargement or hypertrophy of which gland? a. Thyroid b. Adrenal c. Anterior pituitary d. Posterior pituitary

ANS: A A goiter is an enlargement or hypertrophy of the thyroid gland.

A patient who has a hyphema is at risk for developing which condition? a. Glaucoma b. Strabismus c. Diplopia d. Astigmatism

ANS: A After hyphema, there is a risk for the development of glaucoma. There is no connection between the other conditions and hyphema.

The nurse closely monitors the temperature of a child with nephrotic syndrome. The purpose of this is to detect an early sign of which possible complication? a. Infection b. Hypertension c. Encephalopathy d. Edema

ANS: A An exacerbation of the disease can occur after an infection. Temperature is not an indication of hypertension or edema. Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms. Edema does not manifest with an elevated temperature.

The primary clinical manifestations of acute kidney injury are which of the following? a. Oliguria and hypertension b. Hematuria and pallor c. Proteinuria and muscle cramps d. Bacteriuria and facial edema

ANS: A The principal feature of acute kidney injury is oliguria, and many children are hypertensive. Hematuria, pallor, proteinuria, cramps, bacteriuria, and edema are not principal features.

When would a child diagnosed with type 1 diabetes mellitus most likely demonstrate a decreased need for insulin? a. During the "honeymoon" phase b. During adolescence c. During growth spurts d. During minor illnesses

ANS: A During the "honeymoon" phase, which may last from a few weeks to a year or longer, the child is likely to need less insulin. Insulin requirements are generally higher during adolescence, growth spurts, and illnesses.

Both members of an expectant couple are carriers for phenylketonuria (PKU), an autosomal recessive disorder. In counseling them about the risk to their unborn child, the nurse should tell them that a. the child has a 25% chance of being affected. b. the child will be a carrier, like the parents. c. the child has a 50% chance of being affected. d. one of four of their children will be affected.

ANS: A Each child born to a couple who carries an autosomal recessive trait has a 25% chance of having the disorder, because the child receives either a normal or an abnormal gene from each parent. If one member of the couple has the autosomal recessive disorder, all of their children will be carriers. If both parents are carriers, each child has a 50% chance of being a carrier. Each child has the identical odds of being affected.

A nurse suspects possible visual impairment in a child who displays which problem? a. Excessive tearing of the eyes b. Rapid lateral movement of the eyes c. Delay in speech development d. Lack of interest in casual conversation with peers

ANS: A Excessive tearing of the eyes, especially one accompanied by pain and itching, is a clinical manifestation of potential vision problems. The other problems are not associated with visual impairment.

A child with growth hormone deficiency is receiving GH therapy. What is the best time for the GH to be administered? a. At bedtime b. After meals c. Before meals d. On arising in the morning

ANS: A Injections are best given at bedtime to more closely approximate the physiologic release of GH.

A nurse is teaching a class on acute kidney injury. The nurse relates that acute kidney injury as a result of hemolytic-uremic syndrome (HUS) is classified as a. Intrinsic renal. b. Prerenal. c. Postrenal. d. Chronic.

ANS: A Intrinsic renal acute renal failure is the result of damage to kidney tissue. Possible causes include HUS, glomerulonephritis, and pyelonephritis. Prerenal acute renal failure is the result of decreased perfusion to the kidney. Possible causes include dehydration, septic and hemorrhagic shock, and hypotension. Postrenal acute renal failure results from obstruction of urine outflow. Conditions causing postrenal failure include ureteropelvic obstruction, ureterovesical obstruction, or neurogenic bladder. Renal failure caused by HUS is of the acute nature. Chronic renal failure is an irreversible loss of kidney function, which occurs over months or years.

What information provided by the nurse would be helpful to a 15-year-old adolescent taking methimazole three times a day? a. Pill dispensers and alarms on a watch can be effective reminders to take the medication. b. She can take the medication when she is feels symptomatic. c. She can take two pills before school and one pill at dinner, which is easier to remember. d. The mother can be responsible for reminding her to take her medication.

ANS: A Methimazole is an antithyroid medication that should be taken three times a day. Reminders will facilitate taking medication as ordered. This medication needs to be taken regularly, not on an as-needed basis. The dosage cannot be combined to reduce the frequency of administration. An adolescent is old enough and mature enough to be responsible for taking medications.

A nurse is creating a pedigree for a couple whose son has Tay-Sachs disease. What information from the pedigree would the nurse most likely find? a. Parental consanguinity b. Disease has skipped a generation. c. Only men have had this disorder. d. Only women have had this disorder.

ANS: A Parental consanguinity increases the risk for autosomal recessive disorders such as Tay-Sachs disease. The pedigree would not show the disease skipping generations. Males and females are equally affected by this disorder.

People who have two copies of the same abnormal autosomal dominant gene will usually be a. more severely affected by the disorder than will people with one copy of the gene. b. infertile and unable to transmit the gene. c. carriers of the trait but not affected with the disorder. d. mildly affected with the disorder.

ANS: A People who have two copies of an abnormal gene are usually more severely affected by the disorder because they have no normal gene to maintain normal function. Infertility may or may not be caused by chromosomal defects. A carrier of a trait has one recessive gene. Those mildly affected with the disorder will have only one copy of the abnormal gene.

A woman tells the nurse at a prenatal interview that she has quit smoking, only has a glass of wine with dinner, and has cut down on coffee to four cups a day. What response by the nurse will be most helpful in promoting lifestyle changes? a. "You have made some great progress toward having a healthy baby. Let's talk about the changes you have made." b. "You need to do a lot better than that. You may still be hurting your baby right now." c. "Here are some pamphlets for you to study. They will help you find more ways to improve." d. "Those few things won't cause any trouble. Good for you."

ANS: A Praising her for making positive changes is an effective technique for motivating a patient. She still has to identify the risk factors to optimize the results so a discussion with the nurse can facilitate that. Telling her she has to do better is belittling to the patient. She will be less likely to confide in the nurse. The nurse is not acknowledging the efforts that the woman has already accomplished by simply giving her pamphlets. Those accomplishments need to be praised to motivate the woman to continue. Plus before giving written material, the nurse must assess the woman's literacy level. Alcohol and coffee consumption are still major risk factors and need to be addressed in a positive, nonjudgmental manner.

What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux? a. The importance of taking prophylactic antibiotics if prescribed b. Suggestions for how to maintain fluid restrictions c. The use of bubble baths as an incentive to increase bath time d. The need for the child to hold urine for 6 to 8 hours

ANS: A Prophylactic antibiotics are sometimes used to prevent urinary infection in a child with vesicoureteral reflux, especially if they are waiting for the results of imaging studies or have recurrent UTIs. If prescribed, the parents should be taught that the child must finish the entire course of antibiotics to prevent bacterial resistance. Fluids are not restricted when a child has vesicoureteral reflux. In fact, fluid intake should be increased as a measure to prevent UTIs. Bubble baths should be avoided to prevent urethral irritation and possible UTI. To prevent UTIs, the child should be taught to void frequently and never resist the urge to urinate.

Which dietary modification is appropriate for a child with chronic renal failure? a. Decreased protein b. Decreased fat c. Increased potassium d. Increased phosphorus

ANS: A Protein intake is restricted or strictly regulated because of the kidney's inability to remove waste products. A low-fat diet is not relevant to chronic renal failure. Potassium intake may be restricted because of the kidney's inability to remove it. Phosphorus is restricted to help prevent bone disease.

What should be the major consideration when selecting toys for a child with an intellectual or developmental disability? a. Safety b. Age appropriateness c. Ability to provide exercise d. Ability to teach useful skills

ANS: A Safety is the primary concern in selecting recreational and exercise activities for all children. This is especially true for children who are intellectually disabled. Age appropriateness should be considered in the selection of toys, but safety is of paramount importance since their intellectual age will be less than their chronological age. Ability to provide exercise and teach skills is also important but not as vital as safety.

What is the primary concern for a 7-year-old child with type 1 diabetes mellitus who asks his mother not to tell anyone at school that he has diabetes? a. The child's safety b. The privacy of the child c. Development of a sense of industry d. Peer group acceptance

ANS: A Safety is the primary issue. School personnel need to be aware of the signs and symptoms of hypoglycemia and hyperglycemia and the appropriate interventions. While privacy is a concern, for the child's safety, key personnel need to know about the diagnosis and what to do in an emergency. The treatment of type 1 diabetes should not interfere with the school-age child's development of a sense of industry. Peer group acceptance, along with body image, are issues for the early adolescent with type 1 diabetes. This is not of greater priority than the child's safety.

Parents have learned that their 6-year-old child has autism. The nurse may help the parents to cope by explaining that the child may a. have an extremely developed skill in a particular area. b. outgrow the condition by early adulthood. c. have average social skills. d. have age-appropriate language skills.

ANS: A Some children with autism have an extremely developed skill in a particular area such as mathematics or music. This information may be comforting, although the nurse should avoid giving false hope. No evidence supports that autism is outgrown. Autistic children have abnormal ways of relating to people (social skills). Speech and language skills are usually delayed in autistic children.

An infant has just been diagnosed with Tay-Sachs disease. What action by the nurse is most appropriate? a. Refer the family to a support group. b. Educate the family on bone marrow transplant. c. Teach the family how to promote growth and development. d. Obtain informed consent for laser eye surgery.

ANS: A Tay-Sachs is inevitably fatal, usually by early childhood. The family will need much emotional support, which is found in support groups where they will interact with families who are or who have been in a similar situation. Tay-Sachs is not treated with bone marrow transplant or eye surgery. Development regresses with neurologic deterioration, and the infant usually exhibits macrocephaly, seizures, blindness, and deafness

What is the best time for the nurse to assess the peak effectiveness of subcutaneously administered regular insulin? a. Two hours after administration b. Four hours after administration c. Immediately after administration d. Thirty minutes after administration

ANS: A The peak action for regular (short-acting) insulin is 2 to 3 hours after subcutaneous administration. The other times do not correspond to the peak action time.

The mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about "casts" in the urine. The nurse explains that casts in the urine indicate a. glomerular injury. b. glomerular healing. c. recent streptococcal infection. d. excessive amounts of protein in the urine.

ANS: A The presence of red blood cell casts in the urine indicates glomerular injury. Casts in the urine are abnormal findings and are indicative of glomerular injury, not glomerular healing. A urinalysis positive for casts does not confirm a recent streptococcal infection. Casts in the urine are unrelated to proteinuria.

A nurse is assessing an infant for urinary tract infection (UTI). Which assessment findings should the nurse expect? (Select all that apply.) a. Change in urine odor or color b. Enuresis c. Fever or hypothermia d. Voiding urgency e. Poor weight gain

ANS: A, C, E The signs of a UTI in an infant include fever or hypothermia, irritability, dysuria as evidenced by crying when voiding, change in urine odor or color, poor weight gain, and feeding difficulties. Enuresis and voiding urgency should be assessed in an older child

The faculty member teaches students that which of the following are examples of autosomal recessive disorders or traits? (Select all that apply.) a. Blood group O b. Tay-Sachs disease c. Huntington disease d. Neurofibromatosis e. Hemophilia A

ANS: A,B Autosomal recessive traits and disorders include blood group O, Tay-Sachs disease, and cystic fibrosis. Huntington disease and neurofibromatosis are examples of autosomal dominant disorders. Hemophilia A is an X-linked disorder.

A nurse is assessing a newborn for facial feature characteristics associated with fetal alcohol syndrome. Which characteristics should the nurse expect to assess? (Select all that apply.) a. Short palpebral fissures b. Smooth philtrum c. Low-set ears d. Inner epicanthal folds e. Thin upper lip

ANS: A,B,C,E Infants with fetal alcohol syndrome may have characteristic facial features, including short palpebral fissures, a smooth philtrum (the vertical groove in the median portion of the upper lip), low-set ears, and a thin upper lip. Low-set ears and inner epicanthal folds are associated with Down syndrome.

Which nursing interventions are appropriate for a child with type 1 diabetes who is experiencing deficient fluid volume related to abnormal fluid losses through diuresis and emesis? (Select all that apply.) a. Initiate IV access. b. Begin IV fluid replacement with normal saline. c. Begin IV fluid replacement with D5 1/2NS. d. Weigh on arrival to the unit and then every other day. e. Maintain strict intake and output monitoring.

ANS: A,B,E IV access should always be obtained on a hospitalized child with dehydration and a history of type 1 diabetes. Maintaining circulation is a priority nursing intervention. If the child is vomiting and unable to maintain adequate hydration, fluid volume replacement/rehydration is needed. Normal saline is the initial IV rehydration fluid. Maintaining strict intake and output is essential in calculating rehydration status. D5 1/2NS is not the recommended fluid for rehydration of this patient. Weighing the patient on arrival is important, but following the initial weight, the child needs to be weighed more frequently than every other day. Comparison of admission weight and a weight every 8 hours provides an indication of hydration status.

The generalist nurse working with child-bearing families understands that his or her practice related to genetics includes which of the following? (Select all that apply.) a. Identifying families at risk and providing referrals b. Interpreting genetic test results for the family c. Assessing the couple's concern about genetic alterations d. Helping create a family tree or pedigree e. Providing support in all phases of genetic counseling

ANS: A,C,D,E The nurse who works with women and families in the childbearing years is in a wonderful position to help identify families at risk and provide referrals, assess concerns, create pedigrees, and provide support. Interpreting genetic test results is provided by those who have advanced training and education in that area and would not be expected of the generalist nurse.

A nurse should plan to implement which interventions for a child admitted with inorganic failure to thrive? (Select all that apply.) a. Observation of parent-child interactions b. Assignment of different nurses to care for the child from day to day c. Use of 28-calorie-per-ounce concentrated formulas d. Administration of daily multivitamin supplements e. Role-modeling appropriate adult-child interactions

ANS: A,D,E The nurse should plan to assess parent-child interactions when a child is admitted for nonorganic failure to thrive. The observations should include how the child is held and fed, how eye contact is initiated and maintained, and the facial expressions of both the child and the caregiver during interactions. Role-modeling and teaching appropriate adult-child interactions (including holding, touching, and feeding the child) will facilitate appropriate parent-child relationships, enhance parents' confidence in caring for their child, and facilitate expression by the parents of realistic expectations based on the child's developmental needs. Daily multivitamin supplements with minerals are often prescribed to ensure that specific nutritional deficiencies do not occur in the course of rapid growth. The nursing staff assigned to care for the child should be consistent. Providing a consistent caregiver from the nursing staff increases trust and provides the child with an adult who anticipates his or her needs and who is able to role-model child care to the parent. Caloric enrichment of food is essential, and formula may be concentrated in titrated amounts up to 24 calories per ounce. Greater concentrations can lead to diarrhea and dehydration.

The nurse is working in an OB/GYN office and commonly obtains patient histories and performs initial assessments. Which woman is likely to be referred for genetic counseling after her first visit? a. A pregnant woman who will be 40 years or older when her infant is born b. A woman whose partner is 41 years of age c. A patient who carries a Y-linked disorder d. An anxious woman with a normal quadruple screening result

ANS: B A genetics referral should be made if the woman's (male) partner is over the age of 40 at conception. Other reasons for referral include pregnant women who will be 35 or older at the time of birth or abnormal quadruple (or other) screening results. Women do not carry Y chromosomes.

What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness? a. Give the child half his regular morning dose of insulin. b. Substitute simple carbohydrates or calorie-containing liquids for solid foods. c. Give the child plenty of unsweetened, clear liquids to prevent dehydration. d. Take the child directly to the emergency department.

ANS: B A sick-day diet of simple carbohydrates or calorie-containing liquids will maintain normal serum glucose levels and decrease the risk of hypoglycemia. The child should receive his regular dose of insulin even if he does not have an appetite. If the child is not eating as usual, he needs calories to prevent hypoglycemia. During periods of minor illness, the child with type 1 diabetes mellitus can be managed safely at home.

A neonate is displaying mottled skin, has a large fontanel and tongue, is lethargic, and is having difficulty feeding. The nurse recognizes that this is most suggestive of which disorder? a. Hypocalcemia b. Hypothyroidism c. Hypoglycemia d. Phenylketonuria (PKU)

ANS: B An infant with hypothyroidism may exhibit skin mottling, a large fontanel, a large tongue, hypotonia, slow reflexes, a distended abdomen, prolonged jaundice, lethargy, constipation, feeding problems, and coldness to touch. When hypocalcemia is present, neonates may display twitching, tremors, irritability, jitteriness, electrocardiographic changes, and, rarely, seizures. Hypoglycemia causes the neonate to exhibit jitteriness, poor feeding, lethargy, seizures, respiratory alterations including apnea, hypotonia, high-pitched cry, bradycardia, cyanosis, and temperature instability. Infants with PKU may initially have digestive problems with vomiting, and they may have a musty or mousy odor to the urine, infantile eczema, hypertonia, and hyperactive behavior.

On the second postoperative day of an eye surgery, the child has puffy eyes, increased tearing, and fever. What is the most applicable nursing diagnosis? a. Risk for Infection related to surgical procedure b. Infection related to surgical procedure c. Disturbed Sensory Perception (Visual) related to surgical procedure d. Acute Pain related to recent surgical intervention

ANS: B Any surgical procedure leaves the patient vulnerable to infection and with a nursing diagnosis of Risk for Infection. However, this child is manifesting signs of infection, which changes the diagnosis to an actual, not risk for, diagnosis. There is no data to support disturbed sensory perception or acute pain.

What is the most appropriate intervention for the parents of a 6-year-old child with precocious puberty? a. Advise the parents to consider birth control for their daughter. b. Explain the importance the child having relationships with same-age peers. c. Reassure parents that there are no long-term consequences. d. Counsel parents that there is no treatment currently available for this disorder.

ANS: B Despite the child's appearance, the child needs to be treated according to her chronologic age and to interact with children in the same age-group. An expected outcome is that the child will adjust socially by exhibiting age-appropriate behaviors and social interactions. Advising the parents of a 6-year-old to put their daughter on birth control is not appropriate and will not reverse the effects of precocious puberty. There may be both long-term physical and emotional consequences of this disorder. Treatment for precocious puberty is the administration of gonadotropin-releasing hormone blocker, which slows or reverses the development of secondary sexual characteristics and slows rapid growth and bone aging.

A parent asks the nurse why a developmental assessment is being conducted for a child during a routine well-child visit. The nurse answers based on the knowledge that routine developmental assessments during well-child visits are a. not necessary unless the parents request them. b. the best method for early detection of cognitive disorders. c. frightening to parents and children and should be avoided. d. valuable in measuring intelligence in children.

ANS: B Early detection of cognitive disorders can be facilitated through assessment of development at each well-child examination. Developmental assessment is a component of all well-child examinations. Developmental assessments are not as frightening when the parent and child are educated about the purpose of the assessment. Developmental assessments are not intended to measure intelligence.

Exophthalmos (protruding eyeballs) may occur in children with which condition? a. Hypothyroidism b. Hyperthyroidism c. Hypoparathyroidism d. Hyperparathyroidism

ANS: B Exophthalmos is a clinical manifestation of hyperthyroidism. It is not associated with the other conditions.

What is an appropriate intervention for a child with nephrotic syndrome who is edematous? a. Teach the child to minimize body movements. b. Change the child's position every 2 hours. c. Avoid the use of skin lotions. d. Bathe every other day.

ANS: B Frequent position changes decrease pressure on body parts and help relieve edema in dependent areas. The child with edema is at risk for impaired skin integrity. It is important for the child to change position frequently to prevent skin breakdown. Good skin hygiene consists of daily baths to remove irritating body secretions and applying lotion.

A nurse is explaining growth hormone deficiency to parents of a child admitted to rule out this problem. Which metabolic alteration that is related to growth hormone deficiency should the nurse explain to the parent? a. Hypocalcemia b. Hypoglycemia c. Diabetes insipidus d. Hyperglycemia

ANS: B Growth hormone helps maintain blood sugar at normal levels. Calcium is not affected. Diabetes insipidus is a disorder of the posterior pituitary. Growth hormone is produced by the anterior pituitary. Hyperglycemia results from an insufficiency of insulin, which is produced by the beta cells in the islets of Langerhans in the pancreas.

Parents of a 4-year-old child are concerned because the child continues to stutter. What nursing intervention is correct? a. Remind the parents that stuttering is normal in children younger than 10 years. b. Facilitate a speech evaluation performed if the stuttering continues beyond age 5 years. c. Reinforce the fact that this common speech defect requires no treatment. d. Tell the parents that speech problems are most treatable during the child's teen years.

ANS: B If stuttering persists after 5 years of age, the child should be seen by the physician and referred to a speech therapist. Stuttering is not normal after age 5 years. Early diagnosis and intervention are important to correct speech disorders.

The most appropriate nursing diagnosis for a child with a cognitive dysfunction is a. impaired social interaction. b. deficient knowledge. c. risk for injury. d. ineffective coping.

ANS: C The nurse needs to know that limited cognitive abilities to anticipate danger lead to risk for injury. Safety is a priority for all children with cognitive dysfunction. Impaired social interaction is indeed a concern for the child with a cognitive disorder but does not address the limited ability to anticipate danger. Because of the child's cognitive deficit, knowledge will not be retained and will not decrease the risk for injury. Ineffective individual coping does not address the limited ability to anticipate danger.

The narrowing of preputial opening of foreskin is called a. chordee. b. phimosis. c. epispadias. d. hypospadias.

ANS: B Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

Anticipatory guidance for the family of a preadolescent with a cognitive dysfunction should include information about a. institutional placement. b. sexual development. c. sterilization. d. appropriate clothing.

ANS: B Preadolescents who have a cognitive dysfunction may have normal sexual development without the emotional and cognitive abilities to deal with it. It is important to assist the family and child through this developmental stage. The child may or may not need institutional placement at some point. Sterilization is not an appropriate intervention when a child has a cognitive dysfunction. By the time a child reaches preadolescence, the family should have received counseling on age-appropriate clothing.

A child just returned from cataract eye surgery. What is the most significant nursing intervention to prevent increasing intraocular pressure in this child? a. Monitor for hypertension. b. Prevent coughing and vomiting. c. Lower the head of the bed slightly. d. Avoid use of steroids after the surgery.

ANS: B Preventing coughing, straining, vomiting, and touching the operative site are all measures directed toward avoiding increased intraocular pressure. Hypertension is not a symptom of increased intraocular pressure. The head of the bed should be raised slightly. Steroids, antibiotics, and mydriatics may be used after the surgery.

Which statement is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. It is preferred means of renal replacement therapy in children. c. Children can receive kidneys only from other children. d. The decision is difficult, since a normal lifestyle is not possible.

ANS: B Renal transplant offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease. It can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes. Renal transplantation affords the child a more normal lifestyle than dependence on dialysis.

Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis? a. No urinary ketones b. Low arterial pH c. Elevated serum carbon dioxide d. Elevated serum phosphorus

ANS: B Severe insulin deficiency produces metabolic acidosis, which is indicated by a low arterial pH. Urinary ketones, often in large amounts, are present when a child is in diabetic ketoacidosis. Serum carbon dioxide is decreased in diabetic ketoacidosis. Serum phosphorus is decreased in diabetic ketoacidosis.

A 13-year-old adolescent is suspected to have a visual deficit and is scheduled for further evaluation. The teen asks the nurse to tell "the truth" about the tests. What is the nurse's best response? a. "Don't worry about anything. We're here to take good care of you." b. "Ask your parents. They have talked with the physicians." c. "Most of the vision tests are painless and noninvasive." d. "Trust the doctors. They know what is best for you."

ANS: C The nurse should be knowledgeable and honest in answering questions about procedures. The nurse should not belittle the teen's concerns by giving false reassurance, having the teen ask the parents for information, or telling the teen to trust the doctors.

A couple has been counseled for genetic anomalies. They ask the nurse, "What is karyotyping?" Which of the following is the nurse's best response? a. "Karyotyping will reveal if the baby's lungs are mature." b. "Karyotyping will reveal if your baby will develop normally." c. "Karyotyping will provide information about the number and structure of the chromosomes." d. "Karyotyping will detect any physical deformities the baby has."

ANS: C Karyotyping provides genetic information, such as gender and chromosomal structure. Karyotyping is completed by photographing or using computer imaging to arrange chromosomes in pairs from largest to smallest. The karyotype can then be analyzed. Karyotyping does not determine lung maturity or if the baby is developing normally. Although karyotyping can detect genetic anomalies, not all such anomalies display obvious physical deformities. The term deformities is a nondescriptive word. Furthermore, physical anomalies may be present that are not detected by genetic studies (e.g., cardiac malformations).

New parents ask the nurse, "Why is it necessary for our baby to have the newborn blood test?" The nurse explains that the priority outcome of mandatory newborn screening for inborn errors of metabolism is a. appropriate community referral for affected infants. b. parental education about raising a special needs child. c. early identification of serious genetically transmitted metabolic diseases. d. early identification of electrolyte imbalances.

ANS: C Mandatory genetic screening allows early identification of genetically transmitted metabolic disorders. These disorders can be managed best with early diagnosis and in some cases, early treatment prevents serious physical and cognitive delays. Community referral is appropriate after a diagnosis is made. Parental education will be important, but that is not the goal of screening. Although electrolyte imbalances could occur with some of the inborn errors of metabolism, this is not the priority outcome, nor would the newborn screen detect electrolyte imbalances.

At what age is sexual development in boys and girls considered to be precocious? a. Boys, 11 years; girls, 9 years b. Boys, 12 years; girls, 10 years c. Boys, 9 years; girls, 8 years d. Boys, 10 years; girls, 9 1/2 years

ANS: C Manifestations of sexual development before age 9 in boys and age 8 in girls is considered precocious and should be investigated. The other ages fall within the expected range of pubertal onset.

In practical terms regarding genetic health care, nurses should be aware that a. genetic disorders equally affect people of all socioeconomic backgrounds, races, and ethnic groups. b. genetic health care is more concerned with populations than individuals. c. the most important related nursing function is providing emotional support to the family during counseling. d. taking genetic histories is usually only done at large universities and medical centers.

ANS: C Nurses should be prepared to help with a variety of stress reactions from a couple facing the possibility of a genetic disorder. Although anyone may have a genetic disorder, certain disorders appear more often in certain ethnic and racial groups. Genetic health care is highly individualized, because treatments are based on the phenotypic responses of the individual. Individual nurses at any facility can take a genetic history and provide basic genetic information, although larger facilities may have better support services.

What action is contraindicated when a child with Down syndrome is hospitalized? a. Determine the child's vocabulary for specific body functions. b. Assess the child's hearing and visual capabilities. c. Encourage parents to leave the child alone to encourage adaptation. d. Have meals served at the child's usual meal times.

ANS: C The child with Down syndrome needs routine schedules and consistency. Having familiar people present, especially parents, helps to decrease the child's anxiety. To communicate effectively with the child, it is important to know the child's particular vocabulary for specific body functions. Children with Down syndrome have a high incidence of hearing loss and vision problems and should have hearing and vision assessed whenever they are in a health care facility. Routine schedules and consistency are important to children.

What should the nurse include in the teaching plan for parents of a child with diabetes insipidus who is receiving DDAVP? a. Increase the dosage of DDAVP as the urine specific gravity (SG) increases. b. Give DDAVP only if urine output decreases. c. The child should have free access to water and toilet facilities at school. d. Cleanse skin before administering the transdermal patch.

ANS: C The child's teachers should be aware of the diagnosis and treatment plan, and the child should have free access to water and toilet facilities at school. DDAVP needs to be given as ordered by the physician. If the parents are monitoring urine SG at home, they would not increase the medication dose for increased SG; the physician may order an increased dosage for very dilute urine with decreased SG. DDAVP needs to be given continuously as ordered by the physician. DDAVP is typically given intranasally or by subcutaneous injection. For nocturnal enuresis, it may be given orally.

A 35-year-old woman has an amniocentesis performed to find out whether her baby has a chromosome defect. Which statement by this patient indicates that she understands her situation? a. "The doctor will tell me if I should have an abortion when the test results come back." b. "I know support groups exist for parents who have a baby with birth defects, but we have plenty of insurance to cover what we need." c. "When all the lab results come back, my husband and I will make a decision about the pregnancy." d. "My mother must not find out about all this testing. If she does, she will think I'm having an abortion."

ANS: C The final decision about genetic testing and the future of the pregnancy lies with the patient. She will involve only those people whom she chooses in her decisions. The final decision about the future of the pregnancy lies with the patient only. Support groups are extremely important for parents of a baby with a defect. Insurance will help cover expenses, but the defect also takes a toll on the emotional, physical, and social aspects of the parents' lives. The nurse should ensure the woman understands that her care is confidential.

The father of a child recently diagnosed with developmental delay is very rude and hostile toward the nurses. This father was cooperative during the child's evaluation a month ago. What is the best explanation for this change in parental behavior? a. The father is exhibiting symptoms of a psychiatric illness. b. The father may be abusing the child. c. The father is resentful of the time he is missing from work for this appointment. d. The father is experiencing a symptom of grief.

ANS: D After a child is diagnosed with a developmental delay, families typically experience a cycle of grieving that is repeated when developmental milestones are not met. One cannot determine that a parent is exhibiting symptoms of a psychiatric illness on the basis of a single situation. The scenario does not give any information to suggest child abuse. Although the father may have difficulty balancing his work schedule with medical appointments for his child, a more likely explanation for his behavior change is that he is grieving the loss of a normal child.

Which is the best setting for daytime care for a 5-year-old autistic child whose mother works? a. Private day care b. Public school c. His own home with a sitter d. A specialized program that uses behavioral methods

ANS: D Autistic children can benefit from specialized educational programs that address their special needs. Day care programs generally do not have resources to meet the needs of severely impaired children. To best meet the needs of an autistic child, the public school may refer the child to a specialized program. A sitter might not have the skills to interact with an autistic child.

Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Moist skin b. Weight gain c. Fluid overload d. Blurred vision

ANS: D Blurred vision is one manifestation of diabetes mellitus type 1. Other manifestations include dehydration with dry skin and weight loss, polyuria, and polyphagia.

Many of the physical characteristics of Down syndrome present feeding problems. Care of the infant should include a. delaying feeding solid foods until the tongue thrust has stopped. b. modifying diet as necessary to minimize the diarrhea that often occurs. c. providing calories appropriate to child's age. d. using special bottles that may assist the infant with feeding.

ANS: D Breastfeeding may not be possible if the infant's muscle tone or sucking reflex is immature. Mothers should be encouraged to pump breast milk and use special bottles for assistance with feeding. Some children with Down syndrome can breastfeed adequately. 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.

Which clinical finding warrants further intervention for the child with acute post streptococcal glomerulonephritis? a. Weight loss to within 1 lb of the preillness weight b. Urine output of 1 mL/kg/hr c. A positive antistreptolysin O (ASO) titer d. Inspiratory crackles

ANS: D Children with excess fluid volume may have pulmonary edema. Inspiratory crackles indicate fluid in the lungs. Pulmonary edema can be a life-threatening complication. Weight loss is an indication that the child is responding to treatment. The urine output of 1 mL/kg/hr is acceptable. A positive ASO titer indicates the presence of antibodies to streptococcal bacteria; it is used to aid in diagnosis of acute post streptococcal glomerulonephritis. This is an expected finding if the child has this acute illness.

The nurse is providing counseling to the mother of a child diagnosed with fragile X syndrome. She explains to the mother that fragile X syndrome is a. most commonly seen in girls. b. acquired after birth. c. usually transmitted by the male carrier. d. usually transmitted by the female carrier.

ANS: D The gene causing fragile X syndrome is transmitted by the mother. Fragile X syndrome is most common in males. Fragile X syndrome is congenital. Fragile X syndrome is not transmitted by a male carrier.

The infant with Down syndrome is closely monitored during the first year of life for what serious condition? a. Thyroid complications b. Orthopedic malformations c. Dental malformation d. Cardiac abnormalities.

ANS: D The high incidence of cardiac defects in children with Down syndrome makes assessment for signs and symptoms of these defects important during the first year. Clinicians recommend the child be monitored frequently throughout the first 12 months of life, including a full cardiac workup. Infants with Down syndrome are not known to have thyroid complications although they can manifest later. Orthopedic malformations may be present, but special attention is given to assessment for cardiac and gastrointestinal abnormalities. Dental malformations are not a major concern compared with the life-threatening complications of cardiac defects.

The most common cause of acute kidney injury in children is a. pyelonephritis. b. tubular destruction. c. urinary tract obstruction. d. severe dehydration.

ANS: D The most common cause of acute kidney injury in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. This is a prerenal cause. Pyelonephritis, tubular destruction, and urinary tract obstruction are not common causes of acute kidney injury in children.

Which question by the nurse will most likely promote sharing of sensitive information during a genetic counseling interview? a. "How many people in your family are mentally retarded or handicapped?" b. "What kinds of defects or diseases seem to run in the family?" c. "Did you know that you can always have an abortion if the fetus is abnormal?" d. "Are there any family members who have learning or developmental problems?"

ANS: D The nurse should probe gently by using lay-oriented terminology rather than direct questions or statements.

Which of the following is a true statement describing the differences in the pediatric genitourinary system compared with the adult genitourinary system? a. The young infant's kidneys can more effectively concentrate urine than an adult's kidneys. b. After 6 years of age, kidney function is nearly like that of an adult. c. Unlike adults, most children do not regain normal kidney function after acute renal failure. d. Young children have shorter urethras, which can predispose them to UTIs.

ANS: D Young children have shorter urethras, which can predispose them to UTIs. The young infant's kidneys cannot concentrate urine as efficiently as can those of older children and adults because the loops of Henle are not yet long enough to reach the inner medulla, where concentration and reabsorption occur. By 6 to 12 months of age, kidney function is nearly like that of an adult. Unlike adults, most children with acute renal failure regain normal function.

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for what conditions? (Select all that apply.) a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. UTI e. Diabetes mellitus

ANS: D, E Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. If accompanied by excessive thirst and weight loss, these symptoms may indicate the onset of diabetes mellitus. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.