Pediatric Unit IV

ADHD coexisting condition:Oppositional Defiant d/o (ODD)

-Angry and argumentative behavior (always saying -"NO!!" behavior), blaming others. -Onset between 3-19 years. -Hostile toward authority & uncooperative. -Mood lability. -Argumentative and blaming others,Tantrum (temper), --spiteful vindictive. -Angry. -Argumentative behavior. -Always saying "No!!"

what should be part of the nurse's teaching plan for a child with epilepsy being discharged with diphenylhydantoin (dilantin)?

-Brushing teeth after each meal. -dilantin can cause gingival hyperplasia -dilantin is also teratogenic

A 7-year-old is diagnosed with central precocious puberty. The child has to receivea monthly intramuscular injection of leuprolide acetate (Lupron). The child hasgreat fears of pain and needles and requires considerable stress reduction techniqueseach time an injection is due. What could the nurse suggest that might help managethe pain?1. Apply a eutectic mixture of local anesthetics (EMLA) of lidocaine and prilocaineto the site at least 60 minutes before the injection. 2. Have extra help on hand to help hold the child down. 3. Apply cold to the area prior to injection. 4. Identify a reward to bribe the child to behave during the injection.

1. EMLA cream works well for skin andcutaneous pain. Having the child assistin putting on the EMLA patch involvesthe child in the pain-relieving process.

Permanent tooth eruption is complete by what age?

12 years old

The nurse receives a call from the local Emergency Medical Services stating that anambulance is arriving with an 8-month-old with a decreased level of consciousness.When assessing the neurological status of an 8-month-old, the nurse should checkfor which of the following? 1. Clarity of speech. 2. Interaction with staff. 3. Developmental delay. 4. Ability to follow instructions

2. Interaction with staff. Assessment for alteration in developmentallyexpected behaviors, such asstranger anxiety, is helpful. Interactionwith staff is not to be expected due tostranger anxiety.

The school nurse is preparing a discussion on nutrition with the fourth-grade class.Based on the childrens' developmental level, what information should she include inher presentation? 1. A review of the number of calories that a fourth-grade child should consume in a day. 2. A review of a list of high-calorie foods that all fourth-graders should avoid. 3. A review of how to read food labels so children know which foods are good forthem. 4. A review of nutritious foods with basic scientific information about how they affect the body organs and systems.

4. A review of nutritious foods with basic scientific information about how they affect the body organs and systems.

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

4. Posturing is a reflex that often indicatesthat the child is receiving too muchstimulation.

The nurse develops the plan of care for a child at risk for tonic-clonic seizures. In the plan of care, which items need to be placed at the child's bedside? 1.emergency cart 2.tracheostomy 3.padded tongue blade 4.suctioning equipment and oxygen

4.suctioning equipment and oxygen

The nurse is caring for a child with burns in a pediatric hospital. What would be an appropriate nursing diagnosis for this client?

Acute pain related to thermal injuries and procedures Management of acute pain is crucial for the burn client

A 10-year-old has just spilled hot liquid on his arm, and a 4 inch area on his forearm is severely burned. His mother called the emergency department. What should the nurse advise the mother to do?

Apply cool water to the burned area

Which of the following activities would be most appropriate for the child with attention-deficit/hyperactivity disorder (ADHD)? A. monopoly B. volleyball C. pool D. checkers

B. volleyball

To assess the child with severe burns for adequate perfusion, the nurse monitors a. Distal pulses b. Skin turgor c. Urine output d. Mucous membranes

C Urine output reflects the adequacy of end-organ perfusion.

The nurse judges that the mother understand the term cerebral palsy when she describes it as a term applied to impaired movement resulting from which of the following?

Nonprogressive brain damage caused by injury

An adolescent complain of chest pain and goes to the school nurse. The nurse determines that the teenager has a history of asthma but has had no problems for years. Which of the following should the nurse do first?

Obtain a peak flow reading

The nurse is caring for a 7-year-old with burns. Which finding would be highly suggestive of a child abuse-induced burn?

Stocking-glove pattern on hands or feet A stocking-glove pattern on the hands or feet or a circumferential ring appearing around the extremity points to the caregiver forcefully holding the child under extremely hot water. A nonuniform pattern and splash or spattering patterns are not typical indicators of child abuse.

A 10 year old child who is 5'4 with a history of asthma uses an inhaled bronchodilator only when needed. He takes no other medication routinely. His best peak expiratory flow rate is 270 L/min. The Childs current peak flow reading is 180L/min. The nurse interprets this reading as indicating which of the following?

The child needs to start a short-acting inhaled beta2-agonist medication

A 14 year old is being screened for scoliosis. Which of the following statements about routine scoliosis screening is true?

The girl is assessed standing and bending forward

What should the nurse include when developing the teaching plan for the parents of a child with juvenile arthritis who is being treated with naproxen?

The nurse should be called before giving the child any over the counter medications

The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What would the nurse correlate with disorder?

The parents report that their son "can't drink enough water."

When the nurse applies a painful stimulus to the nailbeds of an unconscious patient, the patient responds with internal rotation, adduction, and flexion of the arms. The nurse documents this as a. decorticate posturing. b. decerebrate posturing. c. localization of pain. d. flexion withdrawal.

a. decorticate posturing.

A nurse is conducting a well-child visit with a child who is scheduled to receive the recommended immunizations for 11- to 12-year olds. Which of the following immunizations should the nurse administer? (Select all that apply.) a. trivalent inactivated influenza (tiV) B. Pneumococcal (PcV) c. meningococcal (mcV4) d. tetanus and diphtheria toxoids and pertussis (tdap) e. rotavirus (rV)

a. trivalent inactivated influenza (tiV) c. meningococcal (mcV4) d. tetanus and diphtheria toxoids and pertussis (tdap)

The physician prescribes triamcinolone (Azmacort) and salmeterol (Serevent) for a client with a history of asthma. What action should the nurse take when administering these drugs? a) Administer the triamcinolone and then administerthe salmeterol. b) Administer the salmeterol and then administer the triamcinolone. c) Allow the client to choose the order in which the drugs are administered. d) Monitor the client's theophylline level before administering the medications

b) Administer the salmeterol and then administer the triamcinolone.

The nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority? a) Avoid contact with fur-bearing animals. b) Change filters on heating and air conditioning units frequently. c) Take prescribed medications as scheduled. d) Avoid goose down pillows.

c) Take prescribed medications as scheduled.

When assessing a patient with a head injury, the nurse recognizes that the earliest indication of increased intracranial pressure (ICP) is] a. vomiting. b. headache. c. change in level of consciousness (LOC). d. sluggish pupil response to light.

c. change in level of consciousness (LOC). Rationale: LOC is the most sensitive indicator of the patient's neurologic status and possible changes in ICP. Vomiting and sluggish pupil response to light are later signs of increased ICP. A headache can be caused by compression of intracranial structures as the brain swells, but it is not unexpected after a head injury.

The nurse is teaching a 12-year-old girl with diabetes mellitus type 2 and her parents about dietary measures to control her glucose levels. Which comment by the child indicates a need for additional teaching? a) "We should give her nonfat milk to drink." b) "I will be eating more breads and cereals." c) "I can have an apple or orange for snacks." d) "I can eat two small cookies with each meal."

d) "I can eat two small cookies with each meal."

Insulin deficiency, increased levels of counter regulatory hormones, and dehydration are the primary causes of: a) ketonuria. b) diabetic ketoacidosis. c) glucosuria. d) ketone bodies.

diabetic ketoacidosis.

The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. Caring for a child that has issues with the anterior pituitary, the child has issues with which hormone?

growth hormone

a nurse is teaching a course about safety during the schoolage years to a group of parents. Which of the following information should the nurse include in the course? (Select all that apply.) a. gating stairs at the top and bottom B. Wearing helmets when riding bicycles or skateboarding c. riding safely in bed of pickup trucks d. implementing firearm safety e. Wearing seat belts

B. Wearing helmets when riding bicycles or skateboarding d. implementing firearm safety e. Wearing seat belts

A nurse who is caring for a 7-year-old is providing patient teaching to the child and caregiver. Which response by the caregiver demonstrates to the nurse that the caregiver understands the diagnosis of type 1 DM?

"Her body doesn't have any insulin."

The nurse is caring for a 2-year-old boy with a burn. What finding would warrant referral to a burn unit?

A chemical burn According to the American Burn Association, chemical burns warrant referral to a burn unit. A partial-thickness burn greater than 10% of the body surface area would warrant a referral to a burn unit. A superficial burn on the chest or hands does not warrant a referral to a burn unit. A first-degree burn would most likely be classified as a superficial burn, which would not warrant a referral to a burn unit.

When developing the teaching plan for the mother and a child with insulin-dependent diabetes about sick day management, which of the following instructions should the nurse expect to include?

Adjust insulin based on more frequent testing of blood glucose levels

A nurse is reviewing information about the various types of insulin that are used to treat diabetes mellitus type 1. Integrating knowledge about the duration of action, place these types in the order from shortest to longest duration. 1 Aspart 2 Glargine 3 Regular 4 NPH

Aspart Regular NPH Glargine

A nurse is preparing a presentation for a group of parents with children diagnosed with diabetes type 1. The children are all adolescents. What issues would the nurse address related to their developmental level?

Deficient decision-making skills Body image conflicts Struggle for independence

The nurse is assessing a child who pulled a boiling pot of soup off of the stove top. The child reports pain at a 9 on a scale of 0 to 10. The burn is red and edematous, and also shows areas of charred skin. The nurse is aware that these signs and symptoms are indicative of what kind of burn?

Full-thickness Full-thickness burns may be very painful or numb or pain-free in some areas. They appear red, edematous, leathery, dry, or waxy and may display peeling or charred skin.

The nurse is teaching a child with type 1 diabetes mellitus to administer her own insulin. The child is receiving a combination of short-acting and long-acting insulin. The nurse knows that the child has appropriately learned the technique when she: a) administers the insulin into a doll at a 30-degree angle. b) draws up the short-acting insulin into the syringe first. c) wipes off the needle with an alcohol swab. d) administers the insulin intramuscularly into rotating sites.

draws up the short-acting insulin into the syringe first.

the parents of a child with JIA call the clinic nurse because the child is experiencing painful exacerbation of the disease. the parents ask the nurse if the child can perform ROM exercises at this time. The nurse should make which response?

"have the child perform simple isometric exercises during this time"

The school nurse is called to the preschool classroom to evaluate a child. He hasbeen noted to have periods where he suddenly falls and appears to be weak for ashort time after the event. The preschool teacher asks what she should do. Select thenurse's best response. 1. "Have the parents follow up with his pediatrician as this is likely an atonic seizure." 2. "Find out if there have been any new stressors in his life, as it could beattention-seeking behavior." 3. "Have the parents follow up with his pediatrician as this is likely an absenceseizure." 4. "The preschool years are a time of rapid growth, and many children appearclumsy. It would be best to watch him, and see if it continues."

1. "Have the parents follow up with his pediatrician as this is likely an atonic seizure." An atonic seizure is characterized by aloss of muscular tone, whereby thechild may fall to the ground.

The nurse is caring for a child with head injury. Place the following assessment in order of priority.

1. Level of consciousness 2.Motor strength 3.Vital signs 4.Vomiting episodes 5.Urine output

How to use an inhaler

1. breathe out through the mouth 2.Inhale through an open mouth 3.Press the canister to release the medication 4.Hold the breathe 5-10 seconds

Initiation of which of the following immunizations is recommended prior to the adolescent entering college? 1) Diphtheria, tetanus, and acellular pertussis (DTaP). 2) Varicella. 3) Meningococcal. 4) Pneumococcal conjugate vaccine (PCV).

3) Meningococcal.

Joey, a 12 year old boy diagnosed with ADHD, is being assessed to determine appropriateness for behavioral therapy-based group treatment. The nurse should also assess for symptoms of which disorders that commonly co-occur with ADHD? (Select all that apply) A. oppositional defiant disorder (ODD) B. Narcissistic personality disorder C. Schizophrenia D. conduct disorder E. substance abuse

A. oppositional defiant disorder (ODD) D. conduct disorder E. substance abuseFeedback 1: ODD, a disorder characterized by persistent angry mood and defiant behavior beyond that expected for children of similar age and developmental level, is a common comorbidity with ADHDFeedback 4: Conduct disorder is characterized by a persistent pattern of behavior in which the rights of others and societal norms are violated. It is commonly seen as a comorbid condition with ADHDFeedback 5: Substance abuse is commonly seen as a comorbid disorder in people with ADHD, so it is essential to assess for its presence and to develop a plan of care that addresses dual diagnosis where it is relevant.

The nurse is teaching the parents of a child recently diagnosed with autism spectrum disorder​ (ASD). Which etiologies should the nurse​ include? (Select all that​ apply.) A.Neurotransmitters B.Environmental factors C.​Mercury-containing vaccinations D.Genetics E.Immunologic factors

A.Neurotransmitters B.Environmental factors D.Genetics E.Immunologic factors

Certain family dynamics often predispose adolescents to the development of conduct disorder. Which of the following patterns is thought to be a contributing factor? A. parents who are overprotective B. parents who have high expectations for their children C. Parents who consistently set limits on their children's behavior D. parents who are alcohol dependent

D. parents who are alcohol dependent

The child with ADHD has a nursing diagnosis of impaired social interaction. Which of the following nursing interventions are appropriate for this child? (Select all that apply) A. socially isolate the child when interactions with others are inappropriate B. set limits with consequences on inappropriate behaviors C. provide rewards for appropriate behaviors D. provide group situations for the child

B. set limits with consequences on inappropriate behaviors C. provide rewards for appropriate behaviors D. provide group situations for the child

Which of the following nursing diagnoses would be considered the priority in planning care for the child with ASD? A. Risk for self-mutilation evidenced by banging head against the wall B. impaired social interaction evidenced by unresponsiveness to people. C. impaired verbal communication evidenced by absence of verbal expression D. disturbed personal identity evidenced by inability to differentiate self from others.

A. Risk for self-mutilation evidenced by banging head against the wall

A client diagnosed with autism spectrum disorder was recently admitted to the hospital. This client grabs a toy and hits another child. Which is the most appropriate nursing action? A. isolate the client for 24 hours B. encourage the client to explain the hostile behavior C. assume a nonpunitive attitude and remove the client from the conflict D. call the parents for input regarding behavioral management.

C. assume a nonpunitive attitude and remove the client from the conflict The nurse must intervene, using a nonpunitive approach, to provide a safe environment by removing the client from the conflict. the client diagnosed with autism spectrum disorder cannot be expected to limit personal behavior.

A client diagnosed with ADHD is prescribed the neurotransmitter-altering drug methylphenidate (Ritalin). Another client, diagnosed with narcolepsy, also received Ritalin. Why is Ritalin given for these two opposing problems? A. ADHD responds positively to a decreased level of neurotransmitters, whereas narcolepsy responds positively to an increased level of neurotransmitters. B. Narcolepsy responds positively to a decreased level of neurotransmitters, whereas ADHD responds positively to an increased level of neurotransmitters. C. Both ADHD and narcolepsy respond positively to a decreased level of neurotransmitters D. Both ADHD and narcolepsy respond positively to an increase in levels of neurotransmitters.

D. Both ADHD and narcolepsy respond positively to an increase in levels of neurotransmitters. When given Ritaliin, clients diagnosed with either ADHD or narcolepsy will experience and increased level of neurotransmitters. However, behaviorally, their response is opposing. the client diagnosed with ADHD will experience a calming effect, whereas the client diagnosed with narcolepsy will be stimulated. Central nervous system stimulation is an expected response. The exact mechanism that produces the therapeutic effect in clients diagnosed with ADHD is unknown.

The nurse is assessing a​ 3-year-old child with autism spectrum disorder​ (ASD). In which area should the nurse expect to find​ impairments? (Select all that​ apply.) A.Ability to engage in complex thought process B.Communication C.Social adaptability D.Ability to organize responses to situations E.Social interactions

B.Communication C.Social adaptability D.Ability to organize responses to situations E.Social interactions

The nurse is planning care for a client who is diagnosed with autism spectrum disorder​ (ASD). Which goal is appropriate for the nurse to​ include? A.The client will remain free from infection. B.The client will display developmental progress. C.The client will demonstrate negative communication skills. D.The client will engage in private activities to stimulate learning.

B.The client will display developmental progress. Rationale: An appropriate goal when providing care to a client diagnosed with ASD is for the client to display developmental progress. Other appropriate goals include the client remaining free of​ injury, the client demonstrating positive communication​ skills, and the client participating in activities with family members or small groups of peers.

The nurse is caring for a child admitted with partial thickness burns. What is most characteristic of this type of burn?

Blisters appear In partial-thickness or second-degree burns, blistering usually occurs with an escape of body plasma

A client with asthma is being taught how to use a peak flow meter to monitor how well the asthma is being controlled. What should the nurse instruct the client to do? a. Perform the procedure once in the morning and once at night b. Move the trunk to an upright position and then exhale while bending over c. Inhale completely and then blow out as hard and as fast as possible through the mouthpiece d. Place the mouthpiece between the lips and in front of the teeth before starting the procedure

c. Inhale completely and then blow out as hard and as fast as possible through the mouthpiece

The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which action would be the most appropriate for the school nurse to do? a) Request that someone call 911 b) Anticipate that the child will need intravenous glucose c) Dissolve a piece of candy in the child's mouth d) Administer subcutaneous glucagon

d) Administer subcutaneous glucagon

When teaching the patient about going from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI), which statement by the patient shows the nurse that the patient needs more teaching? a. "I do not need to use the spacer like I used to." b. "I will hold my breath for 10 seconds or longer if I can." c. "I will not shake this inhaler like I did with my old inhaler." d. "I will store it in the bathroom so I will be able to clean it when I need to."

d. "I will store it in the bathroom so I will be able to clean it when I need to." Storing the dry powder inhaler (DPI) in the bathroom will expose it to moisture, which could cause clumping of the medication and an altered dose. The other statements show patient understanding.

Which of the following activities should a nurse suggest for a client diagnosed withhemophilia? Select all that apply. 1. Swimming. 2. Golf. 3. Hiking. 4. Fishing. 5. Soccer.

1. Swimming. 2. Golf. 3. Hiking. 4. Fishing.

hich of the following will be abnormal in a child with the diagnosis of hemophilia? 1. The platelet count. 2. The hemoglobin level. 3. The white blood cell count. 4. The partial thromboplastin time.

4. The partial thromboplastin time. Partial thromboplastintime is prolonged. normal value: 60-70 secs

Which resource should the nurse expect the healthcare provider to use to confirm the diagnosis of autism spectrum disorder​ (ASD)?A.Diagnostic and Statistical Manual of Mental Disorders B.The Mental Health Rights Manual C.The Autism Handbook D.Teaching Social Communication to Families with Autism

A.Diagnostic and Statistical Manual of Mental Disorders

The father of a preschool age child with a tentative diagnosis of juvenile idiopathic arthritis,formerly known as juvenile rheumatoid arthritis, ask about a test to definitively diagnose JIA. The nurses response is based on knowledge of which of the following?

No specific laboratory test is diagnostic

A nurse is assessing an eight year old with diabetes who is experiencing hyperglycemia. Which symptom indicates that the hyperglycemia requires immediate intervention? Select all that apply

Weakness thirst dizziness

Which is a potential side effect from the prolonged use of methylphenidate (Ritalin)? A. psychosis B. a decreased intelligence quotient (IQ) C. sore throat D. a decrease in rate of growth and development

D. a decrease in rate of growth and development A temporary decrease in the rate of growth and development may be a side effect of Ritalin therapy

A 5-year-old female has been diagnosed with a seizure disorder. Her teacher noticedthat she has been having episodes where she drops her pencil and simply appears tobe daydreaming. This is most likely called: 1. An absence seizure. 2. An akinetic seizure. 3. A non-epileptic seizure. 4. A simple spasm seizure.

1. An absence seizure. Absence seizures occur frequently andlast less than 30 seconds. The child experiences a brief loss of consciousnesswhere she may have a change in activity. These children rarely fall, but theymay drop an object. The condition isoften confused with daydreaming.

Which of the following groups is most commonly used for drug management of the child with ADHD? A. CNS depressants (e.g. diazepam [valium]) B. CNS stimulants (e.g. methylphenidate [Ritalin]) C. Anticonvulsants (e.g.phenytoin [Dilantin]) D. Major tranquilizers (e.g haloperidol [Haldol])

B. CNS stimulants (e.g. methylphenidate [Ritalin])

The child with autism spectrum disorder (ASD) has difficulty with trust. With this is mind, which of the following nursing actions would be most appropriate? A. encourage all staff to hold the child as often as possible, conveying trust through touch B. Assign a different staff member each day so the child will learn that everyone can be trusted C. Assign the same staff person as often as possible to promote feelings of security and trust D avoid eye contact, because this is extremely uncomfortable for the child, and may even discourage trust.

C. Assign the same staff person as often as possible to promote feelings of security and trust

The healthcare provider prescribes an intravenous solution of 5% dextrose and half normal saline with 40mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering this IV ?

Checks the amount of urine output.

A child with diabetes reports that he is feeling a little shaky. Further assessment reveals that the child is coherent but with some slight tremors and sweating. A fingerstick blood glucose level is 70 mg/dL. What would the nurse do next?

Give 10 to 15 grams of a simple carbohydrate

After hospital discharge, the mother of a child newly diagnosed with type 1 diabetes mellitus telephones you because her daughter is acting confused and very sleepy. Which emergency measure would the nurse suggest the mother carry out before she brings the child to see her doctor? a) Give her a glass of orange juice. b) Give her nothing by mouth so that a blood sugar can be drawn at the doctor's office. c) Give her a glass of orange juice with one unit regular insulin in it. d) Give her one unit of regular insulin.

a) Give her a glass of orange juice.

After discussing asthma as a chronic condition, which of the following statements by the father of a child with asthma best reflects the family's positive adjustment to this aspect of the child's disease? a) "We try to keep him happy at all costs; otherwise, he has an asthma attack." b) "We keep our child away from other children to help cut down on infections." c) "Although our child's disease is serious, we try not to let it be the focus of our family." d) "I'm afraid that when my child gets older, he won't be able to care for himself like I do."

c) "Although our child's disease is serious, we try not to let it be the focus of our family."

Kate and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true? a) "This will rectify itself if you follow all of the doctor's directions." b) "You are lucky that you did not have to learn how to give yourself a shot." c) "A weight-loss program should be implemented and maintained." d) "Kids can usually be managed with an oral agent, meal planning, and exercise."

d) "Kids can usually be managed with an oral agent, meal planning, and exercise."

The nurse is teaching an 11-year-old boy and his family how to manage his diabetes. Which instruction does not focus on glucose management? a) Promoting higher levels of exercise than previously maintained b) Teaching that 50% of daily calories should be carbohydrates c) Encouraging the child to maintain the proper injection schedule d) Instructing the child to rotate injection sites

d) Instructing the child to rotate injection sites

The nurse working with the child diagnosed with type 2 diabetes mellitus recognizes that most often the disorder can be managed by: a) Conserving energy with rest periods during the day b) Increasing protein in the diet, especially in the evening c) Decreasing amounts of daily insulin d) Taking oral hypoglycemic agents

d) Taking oral hypoglycemic agents

A nurse is working with a child who has had a bone age evaluation. Whichexplanation of the test should the nurse give? 1. "The bone age will give you a diagnosis of your child's short stature." 2. "If the bone age is delayed, the child will continue to grow taller." 3. "The x-ray of the bones is compared with that of the age-appropriate,standardized bone age." 4. "If the bone age is not delayed, no further treatment is needed."

3. The bone age is a method of evaluatingthe epiphyseal growth centers of thebone using standardized, ageappropriate tables.

6-8 years old

1. the child has boundless energy which is often channeled into sports, 2. fine motor skills become more developed as dexterity becomes more refined 3. the child can read, tell time and use simple math 4. interest in group activities heighten and the child wants to be with peers and participation in group activities such as scouts

9-12 years old

1. the child uses tools and equipment well 2. follows directions, 3. enthusiastic at work and at play 4. looks for ways to earn money 5. loves secrets and might help organize secret clubs 6. participates in cooperative play or activities that are organized with rules, play activities is mostly with same-sex groups.

Pediatric considerations in the care of a burn victim

1.Scarring is more severe in children 2.A delay in growth may occur 3.An immature immune system present risk for infection 4.The higher proportion of body fluid to mass increases risk for cardiovascular problems 5.Increased risk fr protein and calorie deficiencies d/t smalles muscle mass and less body fat

A 10-year-old boy has been diagnosed with type 1 diabetes mellitus. He is curious about what the cause of his disease is and asks the nurse to explain it to him. What should the nurse say to the boy? a) "Your body does not produce enough a chemical called 'ADH,' which makes you really thirsty and have to go to the bathroom a lot." b) "A small part of your brain called the pituitary does not make enough of a chemical called growth hormone." c) "Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood." d) "Special cells in a part of your body called the pancreas cannot produce enough of a chemical called insulin, so there is too much sugar in your blood."

"Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood."

The nurse is assigned to care for an 8 year old child with a diagnosis of a basilar skull fracture. Which prescription should the nurse clarify with HCP? 1.Suction as needed. 2.Obtain daily weight 3.provide clear liquid intake 4.maintain a patent IV line

1.Suction as needed.

The nurse is caring for a child with suspected child abuse-induced burns. Which assessment findings would support this?

A burn to the entire right hand up to 2 cm above wrist with consistent edges A stocking/glove pattern on the hands or feet (circumferential ring appearing around the extremity, resulting from a caregiver forcefully holding the child under extremely hot water) is one sign is one sign of child abuse-induced burns. Inconsistent history given by caregivers, delay in seeking treatment by caregivers and a lack of splattering of water burns are all indicators of child abuse-induced burns.

Which of the following would be most appropriate to institute went to school age child with burns becomes angry and combative when it is time to change the dressings and apply mafenide acetate?

Allow the child to assist in removing the dressings in applying the cream

A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode?

Apply heat to the site of bleeding. Ice or cold compresses, not heat, would be applied to the site of bleeding. Direct pressure is applied until the bleeding stops. The injured part is elevated unless elevating would contribute to further injury. Factor VIII replacement is given to replace the missing clotting factor

Which clinical manifestation should the nurse expect when a child with sickle cell anemiaexperiences an acute vaso-occlusive crisis? a. Circulatory collapse b. Cardiomegaly, systolic murmurs c. Hepatomegaly, intrahepatic cholestasis d. Painful swelling of hands and feet; painful joints

D Painful swelling of hands and feet; painful joints A vaso-occlusive crisis is characterized by severe pain in the area ofinvolvement. If in the extremities, painful swelling of the hands and feet is seen;if in the abdomen, severe pain resembles that of acute surgical abdomen; and ifin the head, stroke and visual disturbances occur

The nurse is teaching the parents of a child with sickled cell disease. To instruct them on how to prevent sickle cell crisis, she should include which instruction?

Drink at least 2 quarts of fluids per day

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

Encourage the child to drink fluids

When caring for a child with moderate burns from the waist down, which of the following should the nurse do when positioning the child?When caring for a child with moderate burns from the waist down, which of the following should the nurse do when positioning the child?

Ensure the application of leg splints

After teaching a group of students about hemophilia, the instructor determines that the students have understood the information when they identify hemophilia A as involving a problem with:

Factor VIIIIn hemophilia A, the problem is with factor VIII, and in hemophilia B it is factor IX. Platelets are problematic in idiopathic thrombocytopenia purpura. Plasmin is involved in the pathophysiologic events of disseminated intravascular coagulation.

In hemophilia A, the classic form, only females manifest a bleeding disorder.

False The classic form of hemophilia is caused by deficiency of the coagulation component factor VIII, the antihemophilic factor, and transmitted as a sex-linked recessive trait. In the United States, the incidence is approximately 1 in 10,000 white males. A female carrier may have slightly lowered but sufficient levels of the factor VIII component so that she does not manifest a bleeding disorder. Males with the disease also have varying levels of factor VIII; their bleeding tendency varies accordingly, from mild to severe

Which of the following tests should the nurse expect to be performed as a follow up measure to periodically assess the effectiveness of treatment for a child with insulin-dependent diabetes?

Glycosylated hemoglobin

ADHD coexisting condition: Conduct Disorder (CD). Hardest to treat and more severe. 3-5 time more common in Boys.

Hallmark: aggression toward people and animals. 30-50% also have ADHD. Much more violent.Cruelty + physical harm to people and animals. Criminal behavior. More destructive. Change into antisocial behavior.

A nurse is assessing the growth and development of a 10 year old. what is the expected of this child?

Has a strong sense of justice and fair play

When developing a teaching plan for the mother of anastigmatic child concerting measures to reduce allergic triggers, which of the following suggestions should the nurse expect to include?

Keep the humidity in the home between 50 - 60% - the child should sleep on top bunk -if carpet is present, vacuum daily

a 12 year old client with asthma is receiving IV hydrocortisone, ampicillin, and theophylline. the client vomits after breakfast and lunch and is very irritable. her heart rate is 120 bpm. The nurse should:

Hold the next dose of theophylline and inform the physician of the clients vomiting and heart rate. A toxic level of theophylline can cause vomiting, irritability, headache, and tachycardia. The therapeutic level is 10-20 mcg/ml

A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor?

Infection Factors that may precipitate a sickle cell crisis include: fever, infection, dehydration, hot or humid environment, cold air or water temperature, high altitude, or excessive physical activity. Respiratory distress and pallor are general signs and symptoms of a sickle cell crisis

The nurse assesses the family's ability to cope with the child's cerebral palsy. Which action should alert the nurse to the possibility of their inability to cope with the disease?

Limiting interaction with extended family and friends

When developing a plan of care for a child who is unconscious after a serious head injury, in which of the following position should the nurse expect to place the child?

Lying on the side with the head of bed elevated

The mother tells the nurse that her 8 year old child is continually telling jokes and riddles to the point of driving the other family member crazy. The nurse should explain this behavior is a sign of what?

Mastery of language ambiguities

A child with sickle cell disease is brought to the emergency department by his parents. He is in excruciating pain. A vaso-occlusive crisis is suspected and analgesia is prescribed. What would the nurse expect as LEAST likely to be ordered?

Meperidine Meperidine is contraindicated for ongoing pain management in a child with vaso-occlusive crisis because it increases the risk for seizures. Analgesics such as morphine, nalbuphine, or hydromorphone are commonly used.

An 8 year old child with asthma states "I want to play some sports like my friends. What can I do? The nurse responds to the child based on the understanding of which of the following?

Most children with asthma can participate in sports if the asthma is controlled.

A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who stated that the child has been complaining of abdominal pain and has been lethargic. Diabetic keto acidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of IV infusion?

Normal Saline Infusion - 0.9% or 0.45%

ADHD (attention-deficit/hyperactivity). Lack of attention. More common in boys.

Not diagnosed before age of 4. Hallmark signs: Inattention, Hyperactivity, Impulsiveness. Must be present for 6 months and present in 2 or more settings. Safety and ABC's. -highly distractible and unable to contain their responses to stimuli. Motor activity is excessive, and movements are random and impulsive)

To prevent further sickle cell crisis, you would advise the parents of a child with sickle cell anemia to:

Notify a health care provider if the child develops an upper respiratory infection. Reduction of oxygen and dehydration lead to increased sickling of cells. Early prevention of these with respiratory illness is important

when preparing the teaching plan for the mother of a child with asthma, which of the following should the nurse include as sign to alert the mother that her child is having an asthma attack?

Wheezing on expiration

The mother of a toddler with cerebral palsy comes to the clinic for developmental screening. The nurse explains that the reason these test are done is to recognize primary delays early so as to accomplish which of the following?

Prevent secondary development delays

The nurse is caring for a 3-year-old diagnosed with diabetes mellitus. The child's eating patterns are unpredictable. One day the child will eat almost nothing, the next day the child eats everything on her tray. The nurse recognizes that this type of insulin would most likely be used in treating this child? a) Intermediate-acting insulin b) Long-acting insulin c) Rapid-acting insulin d) Regular insulin

Rapid-acting insulin

Behavioral Indication of Autism spectrum disorder (ASD)

Repetitive actions and strict routines. e.g.repetitive counting

a nurse is discussing prepubescence and preadolescence with a group of parents of school-age children. Which of the following information should the nurse include in the discussion? a. initial physiologic changes appear during early childhood. B. changes in height and weight occur slowly during this period. c. growth differences between boys and girls become evident. d. Signs of sexual maturation become highly visible in boys.

c. growth differences between boys and girls become evident.

The nurse is caring for a child, weighing 100 pounds, on the burn unit who has partial-thickness burns on over 30% of the body. During the beginning shift assessment, which assessment finding is of most concern to the nurse?

Urine output of 15 mL per hour over the last 4 hours Fluid and electrolyte imbalance is a primary concern when caring for the client with burns. The urine output should be a minimum of 1 mL/kg/hour. The client weighs 45.5 kg, so output should equal approximately 45 mL/hour. Pain is a major concern, but the higher priority at this time is the decreased output. Refusal of one meal is not a higher priority. Weight gain of 0.9 kg over 2 days is not a concern at this time

The mother of an eight-year-old with diabetes tells the nurse that she does not want the school to know about her daughters condition. The nurse should reply.

What is it that concerns you about having the school know about your daughters condition?

In interpreting the negative feedback system that controls endocrine function, the nurse correlates how _______ secretion is decreased as blood glucose levels decrease. a) Insulin b) Glucagon c) Adrenocorticotropic hormone d) Glycogen

a) Insulin

A group of students are reviewing information about oral diabetic agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver? a) Metformin b) Glyburide c) Glipizide d) Nateglinide

a) Metformin

A client is admitted to the emergency department with an acute asthma attack. The physician prescribes ephedrine sulfate, 25 mg subcutaneously (S.C.). How soon should the ephedrine take effect? a) Rapidly b) In 3 minutes c) In 1 hour d) In 2 hours

a) Rapidly

A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer? a) Regular insulin b) Detemir c) Lispro d) NPH

a) Regular insulin

A nurse is teaching a child with type 1 diabetes mellitus how to self-inject insulin. Which method should she recommend to the child for regular doses? a) Subcutaneously in the outer thigh b) Intradermally in the outer arm c) Intramuscularly in the abdomen d) Intravenously in the chest

a) Subcutaneously in the outer thigh

After a school-age child with insulin-dependent diabetes mellitus attends a teaching session about nutrition, the nurse determines that the teaching has been effective when the child states which of the following? a) "If I'm not hungry for a meal, I can eat the carbohydrates for a snack later." b) "When I don't finish a meal, I must make up the carbohydrates right then." c) "When I don't finish a meal, I just need to take more insulin." d) "If I don't eat all my meal, I can make up the carbohydrates at the next meal."

b) "When I don't finish a meal, I must make up the carbohydrates right then."

In working with infants diagnosed with atopic dermatitis, the nurse anticipates that when these children are older they will likely have a tendency to have which of the following disorders? a) Hemophilia b) Asthma c) Rheumatoid arthritis d) Otitis media

b) Asthma

A patient has a systemic blood pressure (BP) of 120/60 mm Hg and an intracranial pressure of 24 mm Hg. The nurse determines that the cerebral perfusion pressure (CPP) of this patient indicates a. high blood flow to the brain. b. normal intracranial pressure (ICP). c. impaired brain blood flow. d. adequate cerebral perfusion

c. impaired brain blood flow Rationale: The patient's CPP is 56, below the normal of 70 to 100 mm Hg and approaching the level of ischemia and neuronal death. The patient has low cerebral blood flow/perfusion. Normal ICP is 0 to 15 mm Hg.

The parents of a school-age child ask the nurse what to expect from their child during this stage of development. When developing a plan of care to address this matter, the nurse should keep in mind that this child's cognitive development is characterized by:

conservation skills a child's ability to see how some items remain the same in some ways, even as you change something about them, for instance, their shape 7 conservation tasks: 1.Number 2.Length 3.Liquid 4.Mass 5.Area 6.Weight 7.Volume

Reva is an 8-year-old who is being seen today in the clinic for moodiness and irritability. She has begun to develop breasts and pubic hair and her parents are concerned that she is at too early an age for this to begin. The nurse knows that the possible prognosis is: a) precocious puberty. b) pseudopuberty. c) neurofibromatosis. d) adrenal hyperplasia.

precocious puberty. Explanation: The prognosis for a child with precocious puberty depends on the age at diagnosis and immediate treatment. Appropriate treatment can halt, and sometimes even reverse, sexual development and can stop the rapid growth that results in severe short adult stature caused by premature closure of the epiphysis. Treatment for precocious puberty allows the child to achieve the maximum growth potential possible. Mental development in children with precocious puberty is normal, and developmental milestones are not affected; however, the behavior may change to that of a typical adolescent. Girls may have episodes of moodiness and irritability, whereas boys may become more aggressive.

1. The nurse is taking care of a child with sickle cell disease. The nurse is aware thatwhich of the following problems is (are) associated with sickle cell disease? Select allthat apply .1. Polycythemia. 2. Hemarthrosis. 3. Aplastic crisis. 4. Thrombocytopenia. 5. Splenic sequestration. 6. Vaso-occlusive crisis.

1. Polycythemia. 3. Aplastic crisis. 5. Splenic sequestration. 6. Vaso-occlusive crisis.

The nurse is caring for a 6-year-old female with a skull fracture who is unconsciousand has severely increased ICP. The nurse notes the child's temperature to be 104°F(40°C). Which of the following should the nurse do first? 1. Place a cooling blanket on the child. 2. Administer Tylenol via nasogastric tube. 3. Administer Tylenol rectally. 4. Place ice packs in the child's axillary areas.

1. Place a cooling blanket on the child.

The nurse is teaching a 9-year-old girl with diabetes mellitus type 1 and her parents about blood glucose monitoring. Which comment indicates a need for additional teaching? a) "I should check my glucose more often if I'm sick." b) "I should check my glucose before meals." c) "The normal level for her is 70 to 110 mg/dL before meals." d) "The normal level for her is 100 to 180 mg/dL before bedtime."

"The normal level for her is 70 to 110 mg/dL before meals." the proper level for a 9-year-old child with type 1 diabetes is 80 to 150 mg/dL. The normal blood glucose level for a 7-year-old child with type 1 diabetes is 90 to 180 mg/dL before meals

A nurse is reinforcing the diagnosis of constitutional delay by the health provider to a 13-year-old male adolescent. Which is the best approach for this teen?

"You will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you."This diagnosis of "short stature" or constitutional delay may cause self-esteem issues with male teens. The nurse should explore the teen's feelings. Teens with a delay in puberty usually experience puberty late, so there is no need for a second opinion. Hormone therapy is not given until after age 14

The nurse is caring for a child with meningitis. The parents call for the nurse as"something is wrong." When the nurse arrives, she notes that the child is having ageneralized tonic-clonic seizure. Which of the following should the nurse do first? 1. Administer blow-by oxygen and call for additional help. 2. Reassure the parents that seizures are common in children with meningitis. 3. Call a code and ask the parents to leave the room. 4. Assess the child's temperature and blood pressure.

1. Administer blow-by oxygen and call for additional help. The child experiencing a seizureusually requires more oxygen as theseizure increases the body's metabolicrate and demand for oxygen. Theseizure may also affect the child's airway, causing the child to be hypoxic. Itis always appropriate to give the childblow-by oxygen immediately. Thenurse should remain with the childand call for additional help.

Which of the following measures should be implemented for a child with vonWillebrand disease who has a nosebleed? 1. Apply pressure to the nose for at least 10 minutes. 2. Have the child lie supine and quiet. 3. Avoid packing of the nostrils. 4. Encourage the child to swallow frequently.

1. Apply pressure to the nose for at least 10 minutes. Applying pressure to the nose maystop the bleeding. In von Willebranddisease, there is an increasedtendency to bleed from mucousmembranes, leading to nosebleedscommonly from the anterior partof the nasal septum.

The emergency room nurse is caring for an unconscious 6-year-old girl who has hada severe closed-head injury and notes the following changes in her vital signs. Herheart rate has dropped from 120 to 55, her blood pressure has increased from 110/44to 195/62, and her respirations are becoming more irregular. After calling the physician, which of the following should the nurse expect to do? 1. Call for additional help, and prepare to administer mannitol. 2. Continue to monitor the patient's vital signs, and prepare to administer a bolus ofisotonic fluids. 3. Call for additional help, and prepare to administer an antihypertensive. 4. Continue to monitor the patient, and administer supplemental oxygen

1. Call for additional help, and prepare to administer mannitol. Cushing triad is characterized by adecrease in heart rate, an increase inblood pressure, and changes in respirations. The triad is associated withseverely increased ICP. Mannitol is anosmotic diuretic that helps decreasethe increased ICP.

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

1. Many metabolic disorders are associated with hypoglycemia. The hypoglycemic child experiences a decreasedlevel of consciousness as the brain doesnot have stores of glucose .2. Trauma can lead to generalized brainswelling with resultant increased ICP. 3. Hypoxemia leads to a decreased levelof consciousness as the brain is intolerant to the lack of oxygen. 4. Dehydration can lead to inadequateperfusion to the brain, which can resultin a decreased level of consciousness. 5. Endocrine disorders often result in adecreased level of consciousness asthey can lead to hypoglycemia, which ispoorly tolerated by the brain.

the client is diagnosed with a closed head injury and is in a coma. The nurse writes the client problem as high risk for immobility complications. Which intervention would be included in the plan of care? 1. Position the client with the head of the bed elevated at intervals. 2. Performed active range of motion exercises every 4 hours. 3. Turn the client every shift and massage bony prominences. 4. Explain all procedures to the client before performing them.

1. Position the client with the head of the bed elevated at intervals. Rationale: The head of the clients bed should be elevated to help the lungs expand and prevent stasis of secretions that could lead to pneumonia, a complication of immobility.

the client diagnosed with a mild concussion is being discharged from the emergency department. which discharge instruction should the nurse teach the clients significant other? 1. awake in the client every 2 hours. 2. monitor for increased intracranial pressure. 3. observe frequently for hypervigilance. 4. offer the client food every 3 to 4 hours.

1. awake in the client every 2 hours. Rationale: Awakening the client every 2 hours allows the identification of headache, dizziness, lethargy, irritability, and anxiety, all signs a post concussion syndrome ,which would warrant a return to the emergency department.

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

2. "My child's 7-year-old brother is also at high risk for a febrile seizure." Most children over the age of 5 yearsdo not have febrile seizures.

The nurse is providing discharge instructions to the parents of a 13-year-old girl whohas been diagnosed with epilepsy. Her parents ask if there are any activities that sheshould avoid. Select the nurse's best response .1. "She should avoid swimming, even with a friend." 2. "She should avoid being in a car at night." 3. "She should avoid any strenuous activities." 4. "She should not return to school right away as her peers will likely cause her tofeel inadequate."

2. "She should avoid being in a car at night." The rhythmic reflection of other carlights can trigger a seizure in somechildren.

The nurse is working in the pediatric developmental clinic. Which of the childrenrequires continued follow-up because of behaviors suspicious of CP? cerebral palsy 1. A 1-month-old who demonstrates the startle reflex when a loud noise is heard. 2. A 6-month-old who always reaches for toys with the right hand. 3. A 14-month-old who has not begun to walk. 4. A 2-year-old who has not yet achieved bladder con

2. A 6-month-old who always reaches for toys with the right hand. the clinical characteristic of hemiplegia can be manifested by the early preference of one hand. This may be anearly sign of CP.

the nurse is caring for a client diagnosed with epidural hematoma. Which nursing interventions should the nurse implement? Select all that apply. 1. Maintain the head of the bed at 60 degrees. 2. Administer stool softeners daily. 3. Ensure that pulse oximeter reading is higher than 93 percent. 4. Perform deep Nasal suction every 2 hours. 5. Administer mild sedative.

2. Administer stool softeners daily. 3. Ensure that pulse oximeter reading is higher than 93 percent. 5. Administer mild sedative. Rationale: Stool softeners are initiated to prevent the Bell sell the maneuver which increaseS ICP. oxygen saturation higher the 93 percent ensures oxygenation of the brain tissues. decreasing oxygen levels increase cerebral edema.mild sedative will reduce the clans agitation. Strong narcotics would not be administered because they decrease the clients loc.

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

3. "My child will grow up and need to learn to do things independently."

The nurse is working in the emergency room caring for a 10-year-old who was in anMVA. The child is currently on a backboard with a cervical collar in place. The childis diagnosed with a cervical fracture. Which of the following would the nurse expectto find in the child's plan of care? 1. Remove the cervical collar, keep the backboard in place, and administer highdose methlyprednisolone. 2. Continue with all forms of spinal stabilization, and administer high-dosemethylprednisolone and ranitidine. 3. Remove the backboard and cervical collar, and prepare for halo tractionplacement. 4. Remove the cervical collar and backboard, place the child on spinal precautions,and administer high-dose methylprednisolone and ranitidine.

2. Continue with all forms of spinal stabilization, and administer high-dosemethylprednisolone and ranitidine. All forms of spinal stabilization shouldbe continued while methylprednisoloneand Zantac are administered

The nurse is caring for a 5-year-old female recently diagnosed with epilepsy. She isbeing evaluated for anticonvulsant medication therapy. The nurse knows that thechild will likely be placed on which kind of regimen? 1. Two to three oral anticonvulsant medications so that dosing can be low and sideeffects minimized. 2. One oral anticonvulsant medication to observe effectiveness and minimize sideeffects. 3. One rectal gel to be administered in the event of a seizure. 4. A combination of oral and intravenous anticonvulsant medications to ensurecompliance.

2. One oral anticonvulsant medication to observe effectiveness and minimize sideeffects. One medication is the preferred way toachieve seizure control. The child ismonitored for side effects and druglevels.

A nurse instructs the parent of a child with sickle cell anemia about factors thatmight precipitate a pain crisis in the child. Which of the following factors identifiedby the parent as being able to cause a pain crisis indicates a need for furtherinstruction? 1. Infection. 2. Overhydration. 3. Stress at school. 4. Cold environment.

2. Overhydration.

The nurse is caring for a child with sickle cell anemia who has a vaso-occlusive crisis.Which of the following interventions should improve tissue perfusion? 1. Limiting oral fluids. 2. Administering oxygen. 3. Administering antibiotics. 4. Administrating analgesics.

2. Oxygen prevents hypoxia, helping toprevent acidosis that could lead toincreased sickling

the 29-year-old client that was employed as a forklift operator sustains a traumatic brain injury secondary to a motor vehicle accident. The client is being discharged from the rehabilitation unit after 3 months and has cognitive deficits. Which goal would be more realistic for this client? 1. The client will return to work within 6 months. 2. The client is able to focus and stay on task for 10 minutes. 3. The client will be able to dress self without assistance. 4. The client will regain power and bladder control.

2. The client is able to focus and stay on task for 10 minutes. Rationale: Cognitive pertains to mental processes of comprehension, judgment, memory, and reasoning.

The nurse caring for an 8-year-old boy is trying to encourage developmental growth.What activity can the nurse provide for the child to encourage his sense of industry? 1. Allow the child to choose what time to take his medication. 2. Provide the child with the homework his teacher has sent in. 3. Allow the child to assist with his bath. 4. Allow the child to help with his dressing change.

2. The school-age child is focused on academic performance; therefore the child can achieve a sense of industry by completing his homework and staying on track with his classmates.

The nurse is monitoring a child with burns during treatment for burn shock. The nurse understands that which assessment provides the most accurate guide to determine the adequacy of fluid resuscitation? 1.Skin turgor 2.Neurological Assessment 3.Level of edema at burn site 4.Quality of peripheral pulses

2.Neurological Assessment burn injury itself should not affect sensorium so the child should be alert and oriented

An adolescent tells the school nurse that she would like to use tampons during her period. Which of the following would be most appropriate for the nurse to do? 1) Assess her usual menstrual flow pattern. 2) Determine whether she is sexually active. 3) Provide information about preventing toxic shock syndrome. 4) Refer her to a specialist in adolescent gynecology.

3) Provide information about preventing toxic shock syndrome.

Several high-school seniors are referred to the school nurse because of suspected alcohol misuse. When the nurse assesses the situation, what would be most important to determine? 1) What they know about the legal implications of drinking. 2) The type of alcohol they usually drink. 3) The reasons they choose to use alcohol. 4) When and with whom they use alcohol.

3) The reasons they choose to use alcohol.

The emergency room nurse is caring for a 5-year-old child who fell off his bike andsustained a closed-head injury. The child is currently awake and alert, but his motherstates that he "passed out" for approximately 2 minutes. The mother appears highlyanxious and is very tearful. The child was not wearing a helmet. Which of thefollowing statements is a priority for the nurse at this time? 1. "Was anyone else injured in the accident?" 2. "Tell me more about the accident." 3. "Did he vomit, have a seizure, or display any other behavior that was unusualwhen he woke up?" 4. "Why was he not wearing a helmet?"

3. "Did he vomit, have a seizure, or display any other behavior that was unusualwhen he woke up?" Asking specific questions will give thenurse the information needed to determine the level of care for the child.

The nurse is caring for a 2-year-old male in the PICU with a head injury. Thechild is comatose and unresponsive at this time. The parents ask if he needs painmedication. Select the nurse's best response. 1. "Pain medication is not necessary as he is unresponsive and cannot feel pain." 2. "Pain medication may interfere with his ability to respond and may mask anysigns of improvement." 3. "Pain medication is necessary to promote comfort." 4. "Although pain medication is necessary for comfort, we use it cautiously as itincreases the demand for oxygen."

3. "Pain medication is necessary to promote comfort." Pain medication promotes comfort andultimately decreases ICP.

The nurse is caring for a 13-month-old with meningitis. The child has experiencedincreased ICP and multiple seizures. The child's parents ask if the child is likely todevelop CP. Select the nurse's best response. 1. "When your daughter is stable, she'll undergo computed tomography andmagnetic resolution imaging. The physicians will be able to let you know ifshe has CP." 2. "Most children do not develop CP at this late age." 3. "Your child will be closely monitored after discharge, and a developmentalspecialist will be able to make the diagnosis." 4. "Most children who have had complications of meningitis develop someamount of CP."

3. "Your child will be closely monitored after discharge, and a developmentalspecialist will be able to make the diagnosis." The child will be given a chance torecover and will be monitored closelybefore a diagnosis is made

A student has an insulin-to-carbohydrate ratio of 1:10. The school nurse understandswhich of the following? 1. The student administers 10 U of regular insulin for every carbohydrateconsumed. 2. The student is trying to limit carbohydrate intake to 10 g per 24 hours. 3. The student administers 1 U of regular insulin for every 10 carbohydratesconsumed. 4. The student plans to eat 10 g of carbohydrate for every gram of fat or protein.

3. An insulin-to-carbohydrate ratio refersto the amount of insulin given pergram of carbohydrate. A ratio of 1:5means 1 U for every 5 carbohydrates.

A nurse is caring for a 5-year-old with sickle cell vaso-occlusive crisis. Which of thefollowing orders should the nurse question? Select all that apply. 1. Position the child for comfort. 2. Apply hot packs to painful areas. 3. Give Demerol 25 mg intravenously every 4 hours as needed for pain. 4. Restrict oral fluids. 5. Apply oxygen per nasal cannula to keep oxygen saturations above 94%.

3. Give Demerol 25 mg intravenously every 4 hours as needed for pain. 4. Restrict oral fluids.

Which of the following analgesics is most effective for a child with sicklecell pain crisis? 1. Demerol. 2. Aspirin. 3. Morphine. 4. Excedrin.

3. Morphine.

the client has sustained a severe closed head injury and the neurosurgeon is determining if the client is brain dead. Which data support That the client is brain dead? 1. The clients head is turned to the right, the eyes turn to the righT. 2. the EEG has identifiable waveforms. 3. There is no Eye activity when the cold caloric test is performed. 4 the client assumes decorticate posturing when painful stimuli are applied.

3. There is no Eye activity when the cold caloric test is performed. Rationale: The cold caloric test, also called the ocular vestibular test, is used to determine if the brain is intact or dead. No Eye activity indicates brain death. If the client eyes moved, that would indicate that the brainstem is intact.

The nurse is caring for a 5-year-old male with CP. His weight is in the fifthpercentile, and he has been hospitalized for aspiration pneumonia. His parents areanxious and state that they do not want a G-tube put in. Which of the followingwould be the nurse's best response? 1. "A G-tube will help your son gain weight and reduce his risk for futurehospitalizations due to pneumonia." 2. "G-tubes are very easy to care for and will make feeding time easier for yourfamily." 3. "Are you concerned that you will not be able to care for his G-tube?" 4. "Tell me your thoughts about G-tubes."

4. "Tell me your thoughts about G-tubes."

The nurse is caring for a 9-year-old female who is unconscious in the PICU. Thechild's mother has been calling her name repeatedly and gently shaking her shouldersin an attempt to wake her up. The nurse notes that the child is flexing her arms andwrists while bringing her arms closer to the midline of her body. The child's motherasks, "What is going on?" Select the nurse's best response. 1. "I think your daughter hears you, and she is attempting to reach out to you." 2. "Your child is responding to you; please continue trying to stimulate her." 3. "It appears that your child is having a seizure." 4. "Your child is demonstrating a reflex that indicates she is overwhelmed with thestimulation she is receiving."

4. "Your child is demonstrating a reflex that indicates she is overwhelmed with thestimulation she is receiving." Rationale:Posturing is a reflex that often indicatesthat the child is receiving too muchstimulation.

The nurse is caring for a 16-year-old female who remains unconscious 24 hours aftersustaining a closed-head injury in an MVA. She responds to deep painful stimulationwith decorticate posturing. The child has an intracranial monitor that shows periodicincreased ICP. All other vital signs remain stable. Select the most appropriate nursingaction. 1. Encourage the child's peers to visit and talk to the child about school and otherpertinent events. 2. Encourage the child's parents to hold her hand and speak loudly to her in anattempt to help her regain consciousness. 3. Attempt to keep a normal day/night pattern by keeping the child in a bright livelyenvironment during the day and dark quiet environment at night. 4. Attempt to keep the environment dark and quiet, and encourage minimalstimulation.

4. A dark, quiet environment and minimalstimulation will decrease oxygen consumption and ICP.

The nurse is caring for a child who has sustained a closed-head injury. The nurseknows that brain damage can be caused by which of the following factors? 1. Increased perfusion to the brain and increased metabolic needs of the brain. 2. Decreased perfusion to the brain and decreased metabolic needs of the brain. 3. Increased perfusion to the brain and decreased metabolic needs of the brain. 4. Decreased perfusion of the brain and increased metabolic needs of the brain.

4. Decreased perfusion of the brain and increased metabolic needs of the brain. Decreased perfusion of the brain andincreased metabolic needs of the brain

the client is admitted to the medical floor with a diagnosis of closed head injury. Which nursing intervention has priority? 1. Assess nurological status. 2. Monitor pulse, respiration, and blood pressure. 3. Initiate an intravenous access. 4. Maintain an adequate airway.

4. Maintain an adequate airway. airway is more important than neurocheck

A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of these findings, the nurse should take which action? 1. Administer an antiemetic. 2. Increase the intravenous fluids. 3. Place the child in a Sims's position. 4. Notify the health care provider (HCP).

4. Notify the health care provider (HCP).

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

4. This is paralysis of the facial nerve. This patient has Bell palsy, which is anidiopathic mononeuritis of CN VII (thefacial nerve) that innervates the face andmuscles of expression.

The parents of a child recently diagnosed with cerebral palsy ask the nurse about the disorder. The nurse bases the response on the understanding that cerebral palsy is which type of condition? 1.An infectious disease of the central nervous system 2.An inflammation of the brain as a result of a viral illness 3.A congenital condition that results in moderate to severe retardation 4.A chronic disability characterized by impaired muscle movement and posture

4.A chronic disability characterized by impaired muscle movement and posture

A mother arrives at the emergency department with her 5-year-old child and states that the child fell off a bunk bed. A head injury is suspected, and a nurse is monitoring the child continuously for signs of increased intracranial pressure (ICP). Which of the following is a late sign of increased ICP in this child? 1.Nausea 2.Irritability 3.Headaches 4.Bradycardia

4.Bradycardia

During the school age years, the child gains an average of _________ per year in weight and ______ per year in height.

6-8 lbs; 2 inches

Which instruction should the nurse include when teaching the parents of a​ 3-year-old child with autism spectrum disorder​ (ASD)? (Select all that​ apply.) A.Teaching problem solving regarding client issues B.Providing for play with other children of the same age C.Providing methods to decrease the incidence of head banging D.Administering stimulants to calm repetitive motions E.Establishing therapies to assist with building play skills

A,B,C,E​ Rationale: Clients with ASD have behaviors that interfere with functioning and can be harmful to​ them, such as banging their head or hitting solid objects. Provide clients who have ASD with early physical and occupational therapy that may be beneficial in developing some play and social skills. Clients with ASD may keep themselves in​ isolation, and assisting the clients to be able to be in the presence of others is a focus of treatment. The client with autism spectrum disorder may not progress to living​ independently; therefore, parents need to learn​ problem-solving skills to assist them and the client throughout life. Stimulants are a​ pharmacologic, not​ nonpharmacologic, treatment for autism spectrum disorder.

When admitting a patient with the diagnosis of asthma exacerbation, the nurse will assess for which of the following potential triggers? (Select all that apply.) A. Exercise B. Allergies C. Emotional stress D. Decreased humidity

A. Exercise B. Allergies C. Emotional stress Although the exact mechanism of asthma is unknown, there are several triggers that may precipitate an attack. These include allergens, exercise, air pollutants, respiratory infections, drug and food additives, psychologic factors, and GERD.

Because of the risks associated with administration of factor VIII concentrate, the nurse would teach the client's family to recognize and report which of the following? A.Yellowing of the skin B.Constipation C.Abdominal distention D.Puffiness around the eyes

A.Yellowing of the skin risk for hepatitis

A 7 year old child with history of asthma controlled without medication is referred to the school nurse by the teacher because of persistent coughing. Which of the following should the nurse do first ?

Call a parent to obtain more information A thorough history assessment should be obtained first

What should be included in the teaching plan for a child with type 1 diabetes mellitus who is going home on insulin therapy?

It is absolutely normal for the growing child to require an increase in insulin; this does not mean his/her condition is getting worse.

when teaching an adolescent with a seizure disorder who is receiving valproic acid (depakene), which sign or symptom should the nurse instruct the client to report to the HCP?

Jaundice depakene may cause liver toxicity

The school nurse develops a plan with an adolescent to provide relief of dysmenorrhea to aid in her development of which of the following?

Positive self-identity

The nurse is reviewing the record of a child with ICP and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse expects to note which characteristics of this type of posturing

Rigid extension and pronation of the arms and legs

The nurse talks to an adolescent about how she can tell her friends about her new diagnosis of diabetes. Which of the following behaviors by the adolescence indicate that the adolescent has responded positively to the discussion?

She introduces the nurse to her friend as "the one who taught me all about my diabetes"

A 10 year old child proudly tells the nurse that brushing and flossing her teeth is her responsibility. The nurse interprets this statement as indicating which of the following about the child?

She is most likely capable of this responsibility

What is true about the genetic transmission of sickle cell disease? a. Both parents must carry the sickle cell trait. b. Both parents must have sickle cell disease. c. One parent must have the sickle cell trait. d. Sickle cell disease has no known pattern of inheritance.

a. Both parents must carry the sickle cell trait.

What nursing assessment and care holds the highest priority in the initial care of a childwith a major burn injury? a. Establishing and maintaining the child's airway b. Establishing and maintaining intravenous access c. Inserting a catheter to monitor hourly urine output d. Inserting a nasogastric tube into the stomach to supply adequate nutrition

a. Establishing and maintaining the child's airway

a nurse is providing education about age-appropriate activities for the parents of a 6-year-old child. Which of the following activities should the nurse include in teaching? a. Jumping rope B. Playing card games c. Solving jigsaw puzzles d. Joining competitive sports

a. Jumping rope

Nonsteroidal anti-inflammatory drugs are the first choice in treating a child with juvenile arthritis. Which adverse effects should the nurse include in the teaching plan for the parents? Select all that apply

abdominal pain Blood in the stool Reduce blood clotting ability

A 7-year-old is diagnosed as having type 1 diabetes. One of the first symptoms usually noticed by parents when this illness develops is a) swelling of soft tissue. b) loss of weight. c) craving for sweets. d) severe itching.

b) loss of weight.

The nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing and breath sounds aren't audible. This change occurred because: a) the attack is over. b) the airways are so swollen that no air can get through. c) the swelling has decreased. d) crackles have replaced wheezes.

b) the airways are so swollen that no air can get through.

What should the nurse teach an adolescent who is taking tretinoin (Retin-A) to treat acne? a. The medication should be taken with meals. b. Apply sunscreen before going outdoors. c. Wash with benzoyl peroxide before application. d. The effect of the medication should be evident within 1 week.

b. Apply sunscreen before going outdoors.

The nurse should teach the client with asthma that which of the following is one of the most common precipitating factors of an acute asthma attack? a. Occupational exposure to toxins. b. Viral respiratory infections. c. Exposure to cigarette smoke. d. Exercising in cold temperatures.

b. Viral respiratory infections. ---intrinsic factor

A nurse is teaching home care instructions to parents of a child with sickle cell disease.Which instructions should the nurse include? Select all that apply. a. Limit fluid intake. b. Administer aspirin for fever. c. Administer penicillin as ordered. d. Avoid cold and extreme heat. e. Provide for adequate rest periods.

c. Administer penicillin as ordered. d. Avoid cold and extreme heat. e. Provide for adequate rest periods.

A patient admitted with a head injury has admission vital signs of temperature 98.6° F (37° C), blood pressure 128/68, pulse 110, and respirations 26. Which of these vital signs, if taken 1 hour after admission, will be of most concern to the nurse? a. Blood pressure 130/72, pulse 90, respirations 32 b. Blood pressure 148/78, pulse 112, respirations 28 c. Blood pressure 156/60, pulse 60, respirations 14 d. Blood pressure 110/70, pulse 120, respirations 30

c. Blood pressure 156/60, pulse 60, respirations 14 Rationale: Systolic hypertension with widening pulse pressure, bradycardia, and respiratory changes represent Cushing's triad and indicate that the ICP has increased and brain herniation may be imminent unless immediate action is taken to reduce ICP. The other vital signs may indicate the need for changes in treatment, but they are not indicative of an immediately life-threatening process.

The nurse is discussing a ketogenic diet with a family. The nurse knows that this dietis sometimes used with children who have had little success with anticonvulsant medication. The diet that produces anticonvulsant effects from ketosis consists of: 1. High fat and low carbohydrates. 2. High fat and high carbohydrates. 3. Low fat and low carbohydrates. 4. Low fat and high carbohydrates.

1. High fat and low carbohydrates.

The nurse has completed client teaching with a 16-year-old female who has been prescribed Accutane (isotretinoin) for cystic acne. Which statements indicate learning has occurred?

"If I am sexually active I need to let my doctor know."• "This is not a drug to be used for all forms of acne. My sister has minor acne so I told her this wasn't for her."• "It's important I get my CBC blood test when my doctor orders it." Accutane (isotretinoin) is a powerful medication used for severe forms of acne and cystic acne when other treatment methods are not effective. Sexual activity should be reported to the physician. Some physicians may order monthly pregnancy tests even if the client says she is not sexually active because of the risk of birth defects to a fetus. No matter what form of birth control is used, pregnancy is possible, so monthly pregnancy tests are still necessary. Liver function tests are important regardless of age because of the side effects of the medication. Any labs ordered, such as the CBC, by the physician to monitor the medication's side effects should be obtained

3. Which of the following factors need(s) to be included in a teaching plan for a childwith sickle cell anemia? Select all that apply. 1. The child needs to be taken to a physician when sick 2. The parent should make sure the child sleeps in an air-conditioned room. 3. Emotional stress should be avoided. 4. It is important to keep the child well hydrated. 5. It is important to make sure the child gets adequate nutrition.

1. The child needs to be taken to a physician when sick 3. Emotional stress should be avoided. 4. It is important to keep the child well hydrated. 5. It is important to make sure the child gets adequate nutrition.

A group of newly hired nurses who will be working on the pediatric unit are attending an in-service program about sickle cell disease. During the program, the nurse manager describes the steps for managing sickle cell pain. Place these steps in the sequence in which the nurse manager would describe them.

-Assess the pain. -Believe the child's report of pain. -Look for complications or cause of pain. -Give medications and use distraction. -Provide rest in a quiet area. -Administer fluids. The ABCs of managing sickle cell pain are assess the pain (use a pain assessment tool); believe the child's report of pain; complications or cause of pain (look for complications); drugs and distraction: pain medication (opiates and nonsteroidal anti-inflammatory drugs (NSAIDs), if no contraindications); use fixed dosing; give on a timed schedule; no PRN dosing for pain medications; distraction with music, TV, and relaxation techniques; environment (rest in quiet area with privacy); and fluids.

The school nurse is talking to a 14-year-old about managing type I DM. Which ofthe following statements indicates the student's understanding of the disease? 1. "It really does not matter what type of carbohydrate I eat as long as I take theright amount of insulin." 2. "I should probably have a snack right after gym class." 3. "I need to cut back on my carbohydrate intake and increase my lean proteinintake." 4. "Losing weight will probably help me decrease my need for insulin."

1. "It really does not matter what type of carbohydrate I eat as long as I take theright amount of insulin."

A nurse is caring for a child with von Willebrand disease. The nurse is aware thatwhich of the following is a (are) clinical manifestation(s) of von Willebrand disease?Select all that apply. 1. Bleeding of the mucous membranes. 2. The child bruises easily. 3. Excessive menstruation. 4. The child has frequent nosebleeds. 5. Elevated creatinine levels. 6. The child has a factor IX deficiency.

1. Bleeding of the mucous membranes. 2. The child bruises easily. 3. Excessive menstruation. 4. The child has frequent nosebleeds.

The nurse is caring for a child with sickle cell anemia who is scheduled to have anexchange transfusion. What information should the nurse teach the family? 1. The procedure is done to prevent further sickling during a vaso-occlusive crisis. 2. The procedure reduces side effects from blood transfusions. 3. The procedure is a routine treatment for sickle cell crisis. 4. Once the child's spleen is removed, it is necessary to do exchange transfusions.

1. Exchange transfusion reduces thenumber of circulating sickle cells andslows down the cycle of hypoxia,thrombosis, and tissue ischemia.

The nurse is caring for a child who is receiving a transfusion of packed red bloodcells. The nurse is aware that if the child had a hemolytic reaction to the blood, thesigns and symptoms would include which of the following? Select all that apply. 1. Fever. 2. Rash. 3. Oliguria. 4. Hypotension. 5. Chills.

1. Fever. 3. Oliguria. 4. Hypotension. -Hemolytic reactions include fever, painat insertion site, hypotension, renalfailure, tachycardia, oliguria, andshock. -Febrile reactions are fever and chills -Allergic reactions include hives, itching andrespiratory distress.

A child with hemophilia A fell and injured a knee while playing outside. The knee isswollen and painful. Which of the following measures should be taken to stop thebleeding? Select all that apply. 1. The extremity should be immobilized. 2. The extremity should be elevated. 3. Warm moist compresses should be applied to decrease pain. 4. Passive range-of-motion exercises should be administered to the extremity. 5. Factor VIII should be administered.

1. The extremity should be immobilized. 2. The extremity should be elevated. 5. Factor VIII should be administered.

The nurse is working in the emergency room when an ambulance arrives with a9-year-old male who has been having a generalized seizure for 35 minutes. Theparamedics have provided blow-by oxygen and monitored vital signs. The patientdoes not have intravenous access yet. Which of the following medications should thenurse anticipate administering first? 1. Establish an intravenous line, and administer intravenous lorazepam. 2. Administer rectal diazepam. 3. Administer an oral glucose gel to the side of the child's mouth. 4. Place a nasogastric tube, and administer oral diazepam.

2. Administer rectal diazepam. Rectal diazepam is first administeredin an attempt to stop the seizure longenough to establish an IV, and thenIV medication is administered.

A 10-year-old with severe factor VIII deficiency falls, injures an elbow, and isbrought to the ER. The nurse should prepare which of the following? 1. An injection of factor VIII. 2. An intravenous infusion of factor VIII. 3. An injection of desmopressin. 4. An intravenous infusion of platelets.

2. An intravenous infusion of factor VIII The child is treated with intravenousfactor VIII to replace the missingfactor and help stop the bleeding.

The nurse is caring for a child with sickle cell disease who is scheduled to have asplenectomy. What information should the nurse explain to the parents regarding thereason for a splenectomy? 1. To decrease potential for infection. 2. To prevent splenic sequestration. 3. To prevent sickling of red blood cells. 4. To prevent sickle cell crisis.

2. Splenic sequestration is a lifethreatening situation in childrenwith sickle cell anemia. Once a childis considered to be at high risk ofsplenic sequestration or has hadthis in the past, the spleen will beremoved.

The nurse is interviewing the parent of a 9-year-old girl. The parent expressesconcern because the daughter already has pubic hair and is starting to developbreasts. Which of the following statements would be most appropriate? 1. "Your daughter should get her period in approximately 6 months." 2. "Your daughter is developing early and should be evaluated for precociouspuberty." 3. "Your daughter is experiencing body changes that are appropriate for her age." 4. "Your daughter will need further testing to determine the underlying cause."

3. The changes described in the questionare normal for a healthy 9-year-oldfemale.

The nurse should implement which interventions for a child older than 2 years with type 1 diabetes who has a blood sugar of 60mg/dL. select all that apply: 1.Administer regular insulin 2.Encourage the child to ambulate 3.Give the child a teaspoon of honey 4.Provide electrolyte replacement therapy intravenously 5.Wait 30 mins and confirm the blood glucose reading 6.Prepare to administer glucagon subq if unconsciousness occurs.

3.Give the child a teaspoon of honey 6.Prepare to administer glucagon subq if unconsciousness occurs. *check blood glucose after 15 minutes

Which of the following measures should the nurse teach the parent of a child withhemophilia to do first if the child sustains an injury to a joint causing bleeding? 1. Give the child a dose of Tylenol. 2. Immobilize the joint, and elevate the extremity. 3. Apply heat to the area. 4. Administer factor per the home care protocol.

4. Administer factor per the home care protocol. Administration of factor should bethe first intervention if home-caretransfusions have been initiated.

What key information should be explained to the family of a 3-year-old who has shortstature and abnormal laboratory test results?1. Due to the diurnal rhythm of the body, growth hormone levels are elevatedfollowing the onset of sleep. 2. Exercise can stimulate growth hormone secretion. 3. The initial screening tests need to be repeated for accuracy. 4. Growth hormone levels in children are so low that stimulation testing mustbe done.

4. The need for additional testing requiresexplanation. The abnormal IGF-1 andinsulin-like growth factor binding protein require a definitive diagnosis whenthe levels are either abnormally high orlow. Very young children do not secreteadequate levels of growth hormone tomeasure accurately and thus requirechallenge/stimulation testing.

A student takes metformin (Glucophage) three times a day. The nurse expects thisstudent has which of the following? 1. Type I DM. 2. Gastrointestinal reflux. 3. Inflammatory bowel disease. 4. Type II DM.

4. Type II DM

The dermatologist treating a 16-year-old girl with a history of severe acne has ordered a pregnancy test so she can be started on a course of isotretinoin. The teen's caregiver has said that her daughter is a virgin and she refuses to allow her to have the required pregnancy testing. What would be the best action for the nurse to take?

Acknowledge the caregiver's discomfort about the pregnancy testing but encourage her to allow the daughter to have the testing so that she can use the medication. Isotretinoin is a pregnancy category X drug: It must not be used at all during pregnancy because of serious risk of fetal abnormalities. To rule out pregnancy, a urine test is done before beginning treatment. For the sexually active adolescent girl, an effective form of contraception must be used for a month before beginning and during isotretinoin therapy. The risk to the fetus, should pregnancy occur, should be discussed with the girl whether she is sexually active or not.

An adolescent diagnosed with ADHD is having difficulty maintaining concentration in the inpatient milieu. Which nursing intervention would help improve the client's task performance? A. mandate that the client remain in her room until all homework is complete B. remove privileges if homework is not completed with a 2 hour period C. encourage dividing tasks into smaller, attainable steps and reward successful completion D. seek a physician's order to discontinue the stimulant methylphenidate (Ritalin)

C. encourage dividing tasks into smaller, attainable steps and reward successful completion A client with a short attention span can be overwhelmed with large tasks. Rewards for task completion are more successful than punishments for task completion failure. Positive reinforcements increase self-esteem and provide incentives for future positive behaviors.

The nursing history and assessment of an adolescent with a conduct disorder might reveal all of the following behaviors except: A. manipulation of others for fulfillment of own desires B. chronic violation of rules C. feelings of guilt associated with the exploitation of others D. inability to form close peer relationships

C. feelings of guilt associated with the exploitation of others

A school age child with type 1 diabetes has soccer practice. the school nurse provides instruction regarding how to prevent hypoglycemia during practice. Which should the nurse tell the child to do ?

Eat a small box of raisins or drink a cup of orange juice before soccer practice

When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which would the nurse identify as the priority?

Risk for infection Removal of the spleen places the child at significant risk for infection. Although the child's skin integrity is disrupted due to the surgery, this is not the priority nursing diagnosis. Loss of fluids occurs during surgery and adequate hydration is important to prevent a sickle cell crisis, but this diagnosis is not the priority in the postoperative period. Although the child is at risk for delayed growth and development, the priority postoperatively is to prevent infection

The nurse is caring for a 4-year-old with sickle cell anemia. A physical finding you might expect to see in him is:

Slightly yellow sclerae. Many children with sickle cell anemia develop mild scleral yellowing from excess bilirubin from breakdown of damaged cells.

The nurse is discussing acne vulgaris with a group of adolescents. The teenagers make the following statements regarding the topic. Which statement is the most accurate regarding acne vulgaris? a) "My mom says I have acne because I eat too much chocolate." b) "My next door neighbor told me that acne was caused by a fungus." c) "There is a new immunization that you can get to keep from having acne." d) "Sometimes I get acne when I use my sister's makeup."

Sometimes I get acne when I use my sister's makeup." Correct Explanation: Irritation and irritating substances, such as vigorous scrubbing and cosmetics with a greasy base, can cause acne vulgaris. Increased hormone levels, hereditary factors, and anaerobic bacteria can cause acne vulgaris as well. Eating chocolate and fatty foods does not cause acne, but a well-balanced, nutritious diet does promote healing.

What are the nursing priorities for a child with sickle cell disease in vaso-occlusive crisis? a. Administration of antibiotics and nebulizer treatments b. Hydration and pain management c. Blood transfusions and an increased calorie diet d. School work and diversion

b. Hydration and pain management

A nurse is teaching an adolescent with type 1 diabetes about the disease. Which instruction by the nurse about how to prevent hypoglycemia would be most appropriate for the adolescent? a) "Increase the insulin dosage before planned or unplanned strenuous exercise." b) "Check your blood glucose level before exercising, and eat a protein snack if the level is elevated." c) "Carry crackers or fruit to eat before or during periods of increased activity." d) "Limit participation in planned exercise activities that involve competition."

c) "Carry crackers or fruit to eat before or during periods of increased activity."

The nurse is caring for a child with diabetes mellitus type 1. The nurse notes that the child is drowsy, has flushed cheeks and red lips, a fruity smell to the breath, and there has been an increase in the rate and depth of the child's respirations. The nurse recognizes that these symptoms indicate the child has: a) polyphagia. b) Cheyne-Stokes respirations. c) diabetic ketoacidosis. d) insulin reaction.

c) diabetic ketoacidosis.

What describes the pathologic changes of sickle cell anemia? a. Sickle-shaped cells carry excess oxygen .b. Sickle-shaped cells decrease blood viscosity. c. Increased red blood cell destruction occurs. d. Decreased red blood cell destruction occurs

c. Increased red blood cell destruction occurs. The clinical features of sickle cell anemia are primarily the result of increasedred blood cell destruction and obstruction caused by the sickle-shaped red bloodcells.

"An adolescent client with type I diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note? "a) sweating and tremors b) hunger and hypertension c) cold, clammy skin and irritability d) fruity breath and decreasing level of consciousness

d) fruity breath and decreasing level of consciousness

What should the discharge plan for a school-age child with sickle cell disease include? a. Restricting the child's participation in outside activities b. Administering aspirin for pain or fever c. Limiting the child's interaction with peers d. Administering penicillin daily as ordered

d. Administering penicillin daily as ordered Children with sickle cell disease are at a high risk for pneumococcal infectionsand should receive long-term penicillin therapy and preventive immunizations.