Peds 19,20,21,22,26 Exam

A child, age 7 years, has a fever associated with a viral illness. She is being cared for at home. What is the principal reason for treating fever in this child? a . Relief of discomfort b . Reassurance that illness is temporary c . Prevention of secondary bacterial infection d . Avoidance of life-threatening complications

ANS: A The principal reason for treating fever is the relief of discomfort. Relief measures include pharmacologic and environmental intervention. The most effective is the use of pharmacologic agents to lower the set point. Although the nurse can reassure the child that the illness is temporary, the child is often uncomfortable and irritable. Intervention helps the child and family minimize the discomfort. Most fevers result from viral, not bacterial, infections. Few life-threatening events are associated with fever. The use of antipyretics does not seem to reduce the incidence of febrile seizures.

A toddler is being sent to the operating room for surgery at 9 AM. As the nurse prepares the child, what is the priority intervention? a . Administering preoperative antibiotic b . Verifying that the child and procedure are correct c . Ensuring that the toddler has been NPO since midnight d . Informing the parents where they can wait during the procedure

ANS: B The most important intervention is to ensure that the correct child is going to the operating room for the identified procedure. It is the nurse's responsibility to verify identification of the child and what procedure is to be done. If an antibiotic is ordered, administering it is important, but correct identification is a priority. Clear liquids can be given up to 2 hr before surgery. If the child was NPO (taking nothing by mouth) since midnight, intravenous fluids should be administered. Parents should be encouraged to accompany the child to the preoperative area. Many institutions allow parents to be present during induction.

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered? a . After chest physiotherapy (CPT) b . Before chest physiotherapy (CPT) c . After receiving 100% oxygen d . Before receiving 100% oxygen

ANS: B Bronchodilators should be given before CPT to open bronchi and make expectoration easier. These medications are not helpful when used after CPT. Oxygen is administered only in acute episodes, with caution, because of chronic carbon dioxide retention.

A child with asthma is having pulmonary function tests. What rationale explains the purpose of the peak expiratory flow rate? a . To assess severity of asthma. b . To determine cause of asthma. c . To identify "triggers" of asthma. d . To confirm diagnosis of asthma.

ANS: A Peak expiratory flow rate monitoring is used to monitor the child's current pulmonary function. It can be used to manage exacerbations and for daily long-term management. The cause of asthma is known. Asthma is caused by a complex interaction among inflammatory cells, mediators, and the cells and tissues present in the airways. The triggers of asthma are determined through history taking and immunologic and other testing. The diagnosis of asthma is made through clinical manifestations, history, physical examination, and laboratory testing.

Parents of a hospitalized child often question the skill of staff. The nurse interprets this behavior by the parents as what? a . Normal b . Paranoid c . Indifferent d . Wanting attention

ANS: A Recent research has identified common themes among parents whose children were hospitalized, including feeling an overall sense of helplessness, questioning the skills of staff, accepting the reality of hospitalization, needing to have information explained in simple language, dealing with fear, coping with uncertainty, and seeking reassurance from the health care team. The behavior does not indicate the parents are paranoid, indifferent, or wanting attention.

An 8-year-old girl is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What intervention will help her most in her adjustment to the hospital? a . Explain hospital schedules to her, such as mealtimes. b . Use terms such as "honey" and "dear" to show a caring attitude. c . Explain when parents can visit and why siblings cannot come to see her. d . Orient her parents, because she is too young, to her room and hospital facility.

ANS: A School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for what to expect. The nurse should refer to the child by the preferred name. Explaining when parents can visit and why siblings cannot come focuses on the limitations rather than helping her adjust to the hospital. At the age of 8 years, the child should be oriented to the environment along with the parents.

The mother of a 7-month-old infant newly diagnosed with cystic fibrosis is rooming in with her infant. She is breastfeeding and provides all the care except for the medication administration. What should the nurse include in the plan of care? a . Ensuring that the mother has time away from the infant b . Making sure the mother is providing all of the infant's care c . Determining whether other family members can provide the necessary care so the mother can rest d . Contacting the social worker because of the mother's interference with the nursing care

ANS: A The mother needs sufficient rest and nutrition, so she can be effective as a caregiver. While the infant is hospitalized, the care is the responsibility of the nursing staff. The mother should be made comfortable with the care the staff provides in her absence. The mother has a right to provide care for the infant. The nursing staff and the mother should agree on the care division.

When a preschool-age child is hospitalized, particularly when isolation is required without adequate preparation, the nurse should recognize that the child may likely see hospitalization as what? a . Punishment b . Loss of parental love c . Threat to the child's self-image d . Loss of companionship with friends

ANS: A The rationale for preparing children for the hospital experience and related procedures is based on the principle that a fear of the unknown (fantasy) exceeds fear of the known. Preschool-age children see hospitalization as a punishment. Loss of parental love would be a toddler's reaction. Threat to the child's self-image would be a school-age child's reaction. Loss of companionship with friends would be an adolescent's reaction.

What nursing intervention is most appropriate in promoting normalization in a school-age child with a chronic illness? a . Give the child as much control as possible. b . Ask the child's peer to make the child feel normal. c . Convince the child that nothing is wrong with him or her. d . Explain to parents that family rules for the child do not need to be the same as for healthy siblings.

ANS: A The school-age child who is ill may be forced into a period of dependency. To foster normalcy, the child should be given as much control as possible. It is unrealistic for one individual to make the child feel normal. The child has a chronic illness, so it would be unacceptable to convince the child that nothing is wrong. The family rules should be similar for each of the children in a family. Resentment and hostility can arise if different standards are applied to each child.

The nurse is planning care for a 3-year-old boy who has Down syndrome and is on continuous oxygen. He recently began walking around furniture. He is spoon fed by his parents and eats some finger foods. What goal is the most appropriate to promote normal development? a . Encourage mobility. b . Encourage assistance in self-care. c . Promote oral-motor development. d . Provide opportunities for socialization.

ANS: A A major principle for developmental support in children with complex medical issues is that it should be flexible and tailored to the individual child's abilities, interests, and needs. This child is exhibiting readiness for ambulation. It is an appropriate time to provide activities that encourage mobility, for example, longer oxygen tubing. Parents should provide decreasing amounts of assistance with self-care as he is able to develop these skills. The boy is receiving oral foods and is eating finger foods. He has acquired this skill. Mobility is a new developmental task. Opportunities for socialization should be ongoing.

What tests aid in the diagnosis of cystic fibrosis (CF)? a . Sweat test, stool for fat, chest radiography b . Sweat test, bronchoscopy, duodenal fluid analysis c . Sweat test, stool for trypsin, biopsy of intestinal mucosa d . Stool for fat, gastric contents for hydrochloride, radiography

ANS: A A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF. Bronchoscopy, duodenal fluid analysis, stool tests for trypsin, and intestinal biopsy are not helpful in diagnosing CF. Gastric contents normally contain hydrochloride; it is not diagnostic.

A 1-month-old infant is admitted to the hospital. The infant's mother is 17 years old and single and lives with her parents. Who signs the informed consent for the 1-month-old infant? a . The infant's mother b . The maternal grandparents of the infant c . The paternal grandparents of the infant d . Both the infant's mother and the maternal grandparents

ANS: A An emancipated minor is one who is legally under the age of majority but is recognized as having the legal capacity of an adult under circumstances prescribed by state law, such as pregnancy, marriage, high school graduation, independent living, or military service.

An infant has been diagnosed with staphylococcal pneumonia. Nursing care of the child with pneumonia includes which intervention? a . Administration of antibiotics b . Frequent complete assessment of the infant c . Round-the-clock administration of antitussive agents d . Strict monitoring of intake and output to avoid congestive heart failure

ANS: A Antibiotics are indicated for bacterial pneumonia. Often the child has decreased pulmonary reserve, and clustering of care is essential. The child's respiratory rate and status and general disposition are monitored closely, but frequent complete physical assessments are not indicated. Antitussive agents are used sparingly. It is desirable for the child to cough up some of the secretions. Fluids are essential to kept secretions as liquefied as possible.

A child is admitted with acute laryngotracheobronchitis (LTB). The child will most likely be treated with which? a . Racemic epinephrine and corticosteroids b Nebulizer treatments and oxygen . c . Antibiotics and albuterol d . Chest physiotherapy and humidity

ANS: A Nebulized epinephrine (racemic epinephrine) is now used in children with LTB that is not alleviated with cool mist. The beta-adrenergic effects cause mucosal vasoconstriction and subsequent decreased subglottic edema. The use of corticosteroids is beneficial because the anti-inflammatory effects decrease subglottic edema. Nebulizer treatments are not effective even though oxygen may be required. Antibiotics are not used because it is a viral infection. Chest physiotherapy would not be instituted.

What manifestation observed by the nurse is suggestive of parental overprotection? a . Gives inconsistent discipline. b . Facilitates the child's responsibility for self-care of illness. c . Persuades the child to take on activities of daily living even when not able. d . Encourages social and educational activities not appropriate to the child's level of capability.

ANS: A Parental overprotection is manifested when the parents fear letting the child achieve any new skill, avoid all discipline, and cater to every desire to prevent frustration. Overprotective parents do not allow the child to assume responsibility for self-care of the illness. The parents prefer to remain in the role of total caregiver. The parents do not encourage the child to participate in social and educational activities.

The nurse is making a home visit 48 hr after the death of an infant from sudden infant death syndrome (SIDS). What intervention is an appropriate objective for this visit? a . Give contraceptive information. b . Provide information on the grief process. c . Reassure parents that SIDS is not likely to occur again. d . Thoroughly investigate the home situation to verify SIDS as the cause of death.

ANS: B A home visit after the death of an infant is an excellent time to help the parents with the grief process. The nurse can clarify misconceptions about SIDS and provide information on support services and coping issues. Giving contraceptive information is inappropriate unless requested by parents. Telling the parents that SIDS is not likely to occur again is a false reassurance to the family. Investigating the home situation to verify SIDS as the cause of death is not the nurse's role; this would have been done by legal and social services if there were a question about the infant's death.

The nurse is providing support to a family that is experiencing anticipatory grief related to their child's imminent death. What statement by the nurse is therapeutic? a . "Your other children need you to be strong." b . "You have been through a very tough time." c . "His suffering is over; you should be happy." d . "God never gives us more than we can handle."

ANS: B Acknowledging that the family has been through a very tough time validates the loss that the parents have experienced. It is nonjudgmental. After the death of a child, the parent recognizes the responsibilities to the rest of the family but needs to be able to experience the grief of the loss. Telling the parents what they should do is giving advice. The parent would not be happy that the child has died, and stating so is argumentative. The parents may be angry with God, or their religious beliefs may be unknown, so the nurse should not provide false reassurance by talking to them about God.

The nurse is notified that a 9-year-old boy with nephrotic syndrome is being admitted. Only semiprivate rooms are available. What roommate should be best to select? a . A 10-year-old girl with pneumonia b . An 8-year-old boy with a fractured femur c . A 10-year-old boy with a ruptured appendix d . A 9-year-old girl with congenital heart disease

ANS: B An 8-year-old boy with a fractured femur would be the best choice for a roommate. The boys are similar in age. The child with nephrotic syndrome most likely will be on immunosuppressive agents and susceptible to infection. The child with a fractured femur is not infectious. A girl should not be a good roommate for a school-age boy. In addition, the 10- year-old girl with pneumonia and the 10-year-old boy with a ruptured appendix have infections and could pose a risk for the child with nephrotic syndrome.

What is an advantage of the ventrogluteal muscle as an injection site in young children? a . Easily accessible from many directions b . Free of significant nerves and vascular structures c . Can be used until child reaches a weight of 9 kg (20 pounds) d . Increased subcutaneous fat, which provides sustained drug absorption

ANS: B Being free of significant nerves and vascular structure is one of the advantages of the ventrogluteal site. In addition, it is considered less painful than the vastus lateralis. The major disadvantage is lack of familiarity by health professionals and controversy over whether the site can be used before weight bearing. The vastus lateralis is a more accessible site. The ventrogluteal muscle site has safely been used from newborn through adulthood. Clinical guidelines address the need for the child to be walking. The site has less subcutaneous tissue, which facilitates intramuscular deposition of the drug rather than subcutaneous.

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. What nursing action should be included in the care of the child? a . Force fluids. b . Monitor pulse oximetry. c . Institute seizure precautions. d . Encourage a high-protein diet.

ANS: B Careful monitoring of oxygenation and cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. Maintenance of vascular volume and hydration is important and should be done parenterally. Seizures are not a side effect of ARDS. Adequate nutrition is necessary, but a high-protein diet is not helpful.

What intervention should be included in the nursing care of a child with autism spectrum disorder (ASD)? a . Assign multiple staff to care for the child. b . Communicate with the child at his or her developmental level. c . Provide a wide variety of foods for the child to try. d . Place the child in a semiprivate room with a roommate of a similar age.

ANS: B Children with ASD require individualized care. The nurse needs to communicate with the child at the child's developmental level. Consistent caregivers are essential for children with ASD. The same staff members should care for the child as much as possible. Children with ASD do not adapt to changing situations. The same foods should be provided to allow the child to adjust. A private room is desirable for children with ASD. Stimulation is minimized.

One of the goals for children with asthma is to maintain the child's normal functioning. What principle of treatment helps to accomplish this goal? a . Limit participation in sports. b . Reduce underlying inflammation. c . Minimize use of pharmacologic agents. d . Have yearly evaluations by a health care provider.

ANS: B Children with asthma are often excluded from exercise. This practice interferes with peer interaction and physical health. Most children with asthma can participate provided their asthma is under control. Inflammation is the underlying cause of the symptoms of asthma. By decreasing inflammation and reducing the symptomatic airway narrowing, health care providers can minimize exacerbations. Pharmacologic agents are used to prevent and control asthma symptoms, reduce the frequency and severity of asthma exacerbations, and reverse airflow obstruction. It is recommended that children with asthma be evaluated every 6 months.

The nurse is caring for a 1-month-old infant with respiratory syncytial virus (RSV) who is receiving 23% oxygen via a plastic hood. The child's SaO 2 saturation is 88%, respiratory rate is 45 breaths/min, and pulse is 140 beats/min. Based on these assessments, what action should the nurse take? a . Withhold feedings. b . Notify the health care provider. c . Put the infant in an infant seat. d . Keep the infant in the plastic hood.

ANS: B The American Academy of Pediatrics practice parameter (2006) recommends the use of supplemental oxygen if the infant fails to maintain a consistent oxygen saturation of at least 90%. The health care provider should be notified of the saturation reading of 88%. Withholding the feedings or placing the infant in an infant seat would not increase the saturation reading. The infant should be kept in the hood, but because the saturation reading is 88%, the health care provider should be notified to obtain orders to increase the oxygen concentration.

The nurse is preparing to administer a liquid medication by a nasogastric feeding tube. What is the first thing the nurse should do? a . Check placement of the tube. b . Check the pH of the gastric aspirate. c Flush the tube with a small amount of water. . d . Give the medication and then flush with a small amount of water.

ANS: B The most accurate way to check the position of the nasogastric tube is by checking the pH. Auscultation as a verification tool is reliable only 60% to 80% of the time and should not be used without additional methods. The tube should not be flushed or the medication administered until placement of the tube is checked.

Guidelines for intramuscular administration of medication in school-age children include what standard? a . Inject medication as rapidly as possible. b . Insert needle quickly, using a dartlike motion. c . Have the child stand if at all possible and if the child is cooperative. d . Penetrate the skin immediately after cleansing the site while the skin is moist.

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

The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes what intervention? a . Place a cool compress on eye during transport to the emergency department. b . Irrigate the eye copiously with a sterile saline solution. c . Remove the object with a lightly moistened gauze pad. d . Apply a Fox shield to the affected eye and any type of patch to the other eye.

ANS: D The nurse's role in a penetrating eye injury is to prevent further injury to the eye. A Fox shield (if available) should be applied to the injured eye and a regular eye patch to the other eye to prevent bilateral movement. Placing cool compress on the eye during transport to emergency department, irrigating eye copiously with a sterile saline solution, or removing object with a lightly moistened gauze pad may cause more damage to the eye.

A 2-week-old infant with Down syndrome is being seen in the clinic. His mother tells the nurse that he is difficult to hold, that "he's like a rag doll. He doesn't cuddle up to me like my other babies did." What is the nurse's best interpretation of this lack of clinging or molding? a . Sign of detachment and rejection b . Indicative of maternal deprivation c . A physical characteristic of Down syndrome d . Suggestive of autism associated with Down syndrome

ANS: C Infants with Down syndrome have hypotonicity of muscles and hyperextensibility of joints, which complicate positioning. The limp, flaccid extremities resemble the posture of a rag doll. Holding the infant is difficult and cumbersome, and parents may feel that they are inadequate. A lack of clinging or molding is characteristic of Down syndrome, not detachment. There is no evidence of maternal deprivation. Autism is not associated with Down syndrome, and it would not be evident at 2 weeks of age.

A term infant is delivered, and before delivery, the medical team was notified that a congenital diaphragmatic hernia (CDH) was diagnosed on ultrasonography. What should be done immediately at birth if respiratory distress is noted? a . Give oxygen. b . Suction the infant. c . Intubate the infant. d . Ventilate the infant with a bag and mask.

ANS: C Many infants with a CDH require immediate respiratory assistance, which includes endotracheal intubation and GI decompression with a double-lumen catheter to prevent further respiratory compromise. At birth, bag and mask ventilation is contraindicated to prevent air from entering the stomach and especially the intestines, further compromising pulmonary function. Oxygen and suctioning may be used for mild respiratory distress.

An appropriate method for administering oral medications that are bitter to an infant or small child should be to mix them with which? a . Bottle of formula or milk b . Any food the child is going to eat c . One teaspoon of something sweet-tasting such as jam d . Carbonated beverage, which is then poured over crushed ice

ANS: C Mix the drug with a small amount (about 1 tsp) of sweet-tasting substance. This will make the medication more palatable to the child. The medication should be mixed with only a small amount of food or liquid. If the child does not finish drinking or eating, it is difficult to determine how much medication was consumed. Medication should not be mixed with essential foods and milk. The child may associate the altered taste with the food and refuse to eat this food in the future.

The nurse is preparing a 9-year-old boy before obtaining a blood specimen by venipuncture. The child tells the nurse he does not want to lose his blood. What approach is best by the nurse? a . Explain that it will not be painful. b . Suggest to him that he not worry about losing just a little bit of blood. c . Discuss with him how his body is always in the process of making blood. d . Tell the child that he will not even need a Band-Aid afterward because it is a simple procedure.

ANS: C School-age children can understand that blood can be replaced. Explain the procedure to him using correct scientific and medical terminology. The venipuncture will be uncomfortable. It is inappropriate to tell him it will not hurt. Even though the nurse considers it a simple procedure, the boy is concerned. Telling him not to worry will not allay his fears.

A 14-year-old adolescent is hospitalized with cystic fibrosis. What nursing note entry represents best documentation of his breakfast meal? a . Tolerated breakfast well. b . Finished all of breakfast ordered. c . One pancake, eggs, and 240 mL OJ. d . No documentation is needed for this age child.

ANS: C Specific information is necessary for hospitalized children. It is essential to be able to identify caloric intake and eating patterns for assessment and intervention purposes. That he tolerated breakfast well only provides information that the child did not become ill with the meal. Even if he finished all his breakfast, an evaluation cannot be completed unless the quantity of food ordered is known. Nutritional information is essential, especially for children with chronic illnesses.

What intervention is most appropriate to facilitate social development of a child with a cognitive impairment? a . Provide age-appropriate toys and play activities. b . Avoid exposure to strangers who may not understand cognitive development. c . Provide peer experiences, such as infant stimulation and preschool programs. d . Emphasize mastery of physical skills because they are delayed more often than verbal skills.

ANS: C The acquisition of social skills is a complex task. Initially, an infant stimulation program should be used. Children of all ages need peer relationships. Parents should enroll the child in preschool. When older, they should have peer experiences similar to those of other children such as group outings, Boy and Girl Scouts, and Special Olympics. Providing age-appropriate toys and play activities is important, but peer interactions facilitate social development. Parents should expose the child to individuals who do not know the child. This enables the child to practice social skills. Verbal skills are delayed more often than physical skills.

A child has a central venous access device for intravenous (IV) fluid administration. A blood sample is needed for a complete blood count, hemogram, and electrolytes. What is the appropriate procedure to implement for this blood sample? a . Perform a new venipuncture to obtain the blood sample. b . Interrupt the IV fluid and withdraw the blood sample needed. c . Withdraw a blood sample equal to the amount of fluid in the device, discard, and then withdraw the sample needed. d . Flush the line and central venous device with saline and then aspirate the required amount of blood for the sample.

ANS: C The blood specimen obtained must reflect the appropriate hemodilution of the blood and electrolyte concentration. The nurse needs to withdraw the amount of fluid that is in the device and discard it. The next sample will come from the child's circulating blood. With a central venous device, the trauma of a separate venipuncture can be avoided. The blood sample will be diluted with either the IV fluid being administered or the saline.

What action should the school nurse take for a child who has a hematoma (black eye) with no hemorrhage into the anterior chamber? a . Apply a warm moist pack. b . Have the child keep the eyes open. c . Apply ice for the first 24 hr. d Refer to an ophthalmologist immediately.

ANS: C The care for a hematoma eye injury with no hemorrhage into the anterior chamber is to apply ice for the first 24 hr. A warm moist pack should not be applied, and the child should keep the eyes closed. Referral to an ophthalmologist is recommended if hyphema (hemorrhage into the anterior chamber) is present.

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

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

A toddler has a unilateral foul-smelling nasal discharge and frequent sneezing. The nurse should suspect what condition? a . Allergies b . Acute pharyngitis c . Foreign body in the nose d . Acute nasopharyngitis

ANS: C The irritation of a foreign body in the nose produces local mucosal swelling with foul- smelling nasal discharge, local obstruction with sneezing, and mild discomfort. Allergies would produce clear bilateral nasal discharge. Nasal discharge is usually not associated with pharyngitis. Acute nasopharyngitis would have bilateral mucous discharge.

When teaching a mother how to administer eye drops, where should the nurse tell her to place them? a . At the lacrimal duct b . On the sclera while the child looks to the outside c . In the conjunctival sac when the lower eyelid is pulled down d . Carefully under the eyelid while it is gently pulled upward

ANS: C The lower eyelid is pulled down, forming a small conjunctival sac. The solution or ointment is applied to this area. The medication should not be administered directly on the eyeball. The lacrimal duct is not the appropriate placement for the eye medication. It will drain into the nasopharynx, and the child will taste the drug.

A 6 year old is being discharged home, which is 90 miles from the hospital, after an outpatient hernia repair. In addition to explicit discharge instructions, what should the nurse provide? a . An ambulance for transport home b . Verbal information about follow-up care c . Prescribed pain medication before discharge d . Driving instructions for a route with less traffic

ANS: C The nurse should anticipate that the child will begin experiencing pain on the trip home. By providing a dose of oral analgesia, the nurse can ensure the child remains comfortable during the trip. Transport by ambulance is not indicated for a hernia repair. Discharge instructions should be written. The parents will be focusing on their child and returning home, which limits their ability to retain information. The parents should know the most expedient route home.

Frequent urine tests for specific gravity are required on a 6-month-old infant. What method is the most appropriate way to collect small amounts of urine for these tests? a . Apply a urine collection bag to the perineal area. b . Tape a small medicine cup inside of the diaper. c . Aspirate urine from cotton balls inside the diaper with a syringe without a needle. d . Use a syringe without a needle to aspirate urine from a superabsorbent disposable diaper.

ANS: C To obtain small amounts of urine, use a syringe without a needle to aspirate urine directly from the diaper. Diapers with superabsorbent gels absorb the urine; if these are used, place a small gauze dressing or cotton balls inside the diaper to collect the urine and aspirate the urine with a syringe. For frequent urine sampling, the collection bag would be too irritating to the child's skin. It is not feasible to tape a small medicine cup to the inside of the diaper; the urine will spill from the cup.

A critically ill child has hyperthermia. The parents ask the nurse to give an antipyretic such as acetaminophen. How should the nurse respond to the parents? a . Febrile seizures can result. b . Antipyretics may cause malignant hyperthermia. c . Antipyretics are of no value in treating hyperthermia. d . Liver damage may occur in critically ill children.

ANS: C Unlike with fever, antipyretics are of no value in hyperthermia because the set point is already normal. Cooling measures are used instead. Antipyretics do not cause seizures. Malignant hyperthermia is a genetic myopathy that is triggered by anesthetic agents. Antipyretic agents do not have this effect. Acetaminophen can result in liver damage if too much is given or if the liver is already compromised. Other antipyretics are available, but they are of no value in hyperthermia.

How might the quality of life for a terminally ill child and his family be enhanced by nurses? a . Tell the family what is best. b . Leave the family alone to deal with their tragedy. c . Remain objective and uninvolved with family grieving. d . Advocate for and implement pain and symptom relief measures.

ANS: D By increasing personal remembering, the nurse can advocate for and provide the best possible care for the child and family. This is supportive for the family and helps the nurse reduce the stress of caregiving. If the nurse tells the family what is best, this removes the decision making from the parents. It also increases pressure on the nurse to be the expert. The nurse is in a supportive role. The nurse should not leave the family alone to deal with their tragedy. Becoming involved is an objective, deliberate choice. Ideally, the nurse achieves detached concern, which allows sensitive, understanding care because the nurse is sufficiently detached to make objective, rational decisions.

The nurse is performing a physical assessment on a 3-year-old child. The parents state that the child excessively rubs the eyes and often tilts the head to one side. What visual impairment should the nurse suspect? a . Strabismus b . Astigmatism c . Hyperopia, or farsightedness d . Myopia, or nearsightedness

ANS: D Clinical manifestations of myopia include excessive eye rubbing, head tilting, difficulty reading, headaches, and dizziness. Strabismus, astigmatism, and hyperopia have other clinical manifestations.

The nurse needs to assess a 15-month-old child who is sitting quietly on his father's lap. What initial action by the nurse would be most appropriate? a . Ask the father to place the child on the exam table. b . Undress the child while he is still sitting on his father's lap. c . Talk softly to the child while taking him from his father. d . Begin the assessment while the child is in his father's lap.

ANS: D For young children, particularly infants and toddlers, preserving parent-child contact is a good way of decreasing stress or the need for physical restraint during an assessment. For example, much of a patient's physical examination can be done with the patient in a parent's lap with the parent providing reassuring and comforting contact. The initial action would be to begin the assessment while the child is in his father's lap.

A parent needs to leave a hospitalized toddler for a short period of time. What action should the nurse suggest to the parent to ease the separation for the toddler? a . Bring a new toy when returning. b . Leave when the child is distracted. c . Tell the child when they will return. d . Leave a favorite article from home with the child.

ANS: D If the parents cannot stay with the child, they should leave favorite articles from home with the child, such as a blanket, toy, bottle, feeding utensil, or article of clothing. Because young children associate such inanimate objects with significant people, they gain comfort and reassurance from these possessions. They make the association that if the parents left this, the parents will surely return. Bringing a new toy would not help with the separation. The parent should not leave when the child is distracted, and toddlers would not understand when the parent should return because time is not a concept they understand.

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

ANS: D In the home, the family is a partner in each step of the nursing process. The family priorities should guide the planning process. Both short- and long-term goals should be outlined and agreed on by the child, family, and professionals involved. Elimination of any one of these groups can potentially create a care plan that does not meet the needs of the child and family.

A 12-year-old boy is in the final phase of dying from leukemia. He tells the nurse who is giving him opiates for pain that his grandfather is waiting for him. How should the nurse interpret this situation? a . The boy is experiencing side effects of the opiates. b . The boy is making an attempt to comfort his parents. c . He is experiencing hallucinations resulting from brain anoxia. d . He is demonstrating readiness and acceptance that death is near.

ANS: D Near the time of death, many children experience visions of "angels" or people and talk with them. The children mention that they are not afraid and that someone is waiting for them. If the child has built a tolerance to the opioids, side effects are not likely. At this time, many children do begin to comfort their families and tell them that they are not afraid and are ready to die, but the visions usually precede this stage. There is no evidence of tissue hypoxia.

A preschool child has asthma, and a goal is to extend expiratory time and increase expiratory effectiveness. What action should the nurse implement to meet this goal? a . Encourage increased fluid intake. b . Recommend increased use of a budesonide (Pulmicort) inhaler. c . Administer an antitussive to suppress coughing. d . Encourage the child to blow a pinwheel every 6 hr while awake.

ANS: D Play techniques that can be used for younger children to extend their expiratory time and increase expiratory pressure include blowing cotton balls or a ping-pong ball on a table, blowing a pinwheel, blowing bubbles, or preventing a tissue from falling by blowing it against the wall. Increased fluids, increased use of a Pulmicort inhaler, or suppressing a cough will not increase expiratory effectiveness.

A spinal tap must be done on a 9-year-old boy. While he is waiting in the treatment room, the nurse observes that he seems composed. When the nurse asks him if he wants his mother to stay with him, he says, "I am fine." How should the nurse interpret this situation? a . This child is unusually brave. b . He has learned that support does not help. c . Nine-year-old boys do not usually want a parent present during the procedure. d . Children in this age-group often do not request support even though they need and want it.

ANS: D The school-age child's visible composure, calmness, and acceptance often mask an inner longing for support. Children of this age have a more passive approach to pain and an indirect request for support. It is especially important to be aware of nonverbal cues such as facial expression, silence, and lack of activity. Usually when someone identifies the unspoken messages, the child will readily accept support.

What is a priority intervention for an infant with a temporary colostomy for Hirschsprung disease? a . Teaching how to irrigate the colostomy b . Protecting the skin around the colostomy c . Discussing the implications of a colostomy during puberty d . Using simple, straightforward language to prepare the child

ANS: B Protection of the peristomal skin is a major priority. Well-fitting appliances and skin protectants are used. Teaching how to irrigate a colostomy is not necessary because colostomies are not irrigated in infants. The colostomy is usually reversed within 6 months to 1 year. The parents, not the infant, need to be prepared for the surgery.

A quantitative sweat chloride test has been done on an 8-month-old child. What value should be indicative of cystic fibrosis (CF)? a . Less than 18 mEq/L b . 18 to 40 mEq/L c . 40 to 60 mEq/L d . Greater than 60 mEq/L

ANS: D Normally sweat chloride content is less than 40 mEq/L, with a mean of 18 mEq/L. A chloride concentration greater than 60 mEq/L is diagnostic of CF; in infants younger than 3 months, a sweat chloride concentration greater than 40 mEq/L is highly suggestive of CF.

What drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a . Ephedrine b . Theophylline c . Aminophylline d . Short-acting 2 -agonists

ANS: D Short-acting 2 -agonists are the first treatment in an acute asthma exacerbation. Ephedrine and aminophylline are not helpful in acute asthma exacerbations. Theophylline is unnecessary for treating asthma exacerbations.

When caring for a child after a tonsillectomy, what intervention should the nurse do? a . Watch for continuous swallowing. b . Encourage gargling to reduce discomfort. c . Apply warm compresses to the throat. d . Position the child on the back for sleeping.

ANS: A Continuous swallowing, especially while sleeping, is an early sign of bleeding. The child swallows the blood that is trickling from the operative site. Gargling is discouraged because it could irritate the operative site. Ice compresses are recommended to reduce inflammation. The child should be positioned on the side or abdomen to facilitate drainage of secretions.

A 16-year-old girl comes to the pediatric clinic for information on birth control. The nurse knows that before this young woman can be examined, consent must be obtained from which source? a . Herself b . Her mother c . Court order d . Legal guardian

ANS: A Contraceptive advice is one of the conditions that is considered "medically emancipated." The adolescent is able to provide her own informed consent.

The nurse is administering an IM injection into a vastus lateralis muscle of a 6-month-old infant. What should the length of the needle and amount to be given be? a . 5/8 to 1 inch; 0.5 to 1.0 mL b . 1 inch to 1 1/2 inch; 1.0 to 2.0 mL c . 1 inch to 1 1/2 inch; 0.5 to 1.0 mL d . 5/8 to 1 inch; 0.75 to 2 mL

ANS: A The length of a needle for an infant should be 5/8 to 1 inch, and the amount of solution should not exceed 1 mL.

Parents tell the nurse they do not want to let their school-age child know his illness is terminal. What response should the nurse make to the parents? a . "Have you discussed this with your health care provider?" b . "I would do the same thing in your position; it is better the child doesn't know." c . "I understand you want to protect your child, but often children realize the seriousness of their illness." d . "I praise you for that decision; it can be so difficult to be truthful about the seriousness of your son's illness."

ANS: C Terminally ill children develop an awareness of the seriousness of their diagnosis even when protected from the truth. Acknowledging parents feelings but giving them truthful information is the appropriate response. Asking about discussing this with the health care provider is avoiding the issue. Sharing your own feelings by stating "I would do the same thing" and giving praise for the decision is nontherapeutic.

Parents bring their 15-month-old infant to the emergency department at 3:00 AM because the toddler has a temperature of 39° C (102.2° F), is crying inconsolably, and is tugging at the ears. A diagnosis of otitis media (OM) is made. In addition to antibiotic therapy, the nurse practitioner should instruct the parents to use what medication? a . Decongestants to ease stuffy nose b . Antihistamines to help the child sleep c . Aspirin for pain and fever management d . Benzocaine ear drops for topical pain relief

ANS: D Analgesic ear drops can provide topical relief for the intense pain of OM. Decongestants and antihistamines are not recommended in the treatment of OM. Aspirin is contraindicated in young children because of the association with Reye syndrome.

The nurse observes that a seriously ill child passively accepts all painful procedures. The nurse should recognize that this is most likely an indication that the child is experiencing what emotional response? a. Hopefulness . b . Chronic sorrow c . Belief that procedures are a deserved punishment d . Understanding that procedures indicate impending death

ANS: C The nurse should be particularly alert to a child who withdraws and passively accepts all painful procedures. This child may believe that such acts are inflicted as deserved punishment for being less worthy. A child who is hopeful is mobilized into goal-directed actions. This child would actively participate in care. Chronic sorrow is the feeling of sorrow and loss that recurs in waves over time. It is usually evident in the parents, not in the child. The seriously ill child would actively participate in care. Nursing interventions should be used to minimize the pain.

The nurse is teaching parents of a child with cataracts about the upcoming treatment. The nurse should give the parents what information about the treatment of cataracts? a . "The treatment may require more than one surgery." b . "It is corrected with biconcave lenses that focus rays on the retina." c . "Cataracts require surgery to remove the cloudy lens and replace it." d . "Treatment is with a corrective lenses; no surgery is necessary."

ANS: C Treatment for cataracts requires surgery to remove the cloudy lens and replace it (with an intraocular lens implant, removable contact lens, or prescription glasses). Treatment for glaucoma may require more than one surgery. Anisometropia is treated with corrective lenses. Myopia is corrected with biconcave lenses that focus rays on the retina.

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

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

The nurse is talking to the parent of a child with special needs. The parent has expressed worry about how to support the siblings at home. What suggestion is appropriate for the nurse to give to the parent? a . "You should help the siblings see the similarities and differences between themselves and your child with special needs." b . "You should explain that your child with special needs should be included in all activities that the siblings participate in even if they are reluctant." c . "You should give the siblings many caregiving tasks for your child with special needs so the siblings feel involved." d . "You should intervene when there are differences between your child with special needs and the siblings."

ANS: A Appropriate information to give to a parent who wants to support the siblings of a child with special needs includes helping the siblings see the differences and similarities between themselves and the child with special needs to promote an understanding environment. The parent should be encouraged to allow the siblings to participate in activities that do not always include the child with special needs, to limit caregiving responsibilities, and to allow the children to settle their own differences rather than step in all the time.

When is an autopsy required? a . In the case of a suspected suicide b . When a person has a known terminal illness c . With a hospice patient who dies at home d . With the victim of a motor vehicle collision

ANS: A Autopsy is usually required in cases of unexplained death, violent death, or suspected suicide. In other instances it may be optional, and parents should be informed. The cause of death is not unknown in a person with a known terminal illness, a hospice patient at home, or a victim of a motor vehicle collision. Autopsy can be requested by family, but it is not required.

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

ANS: A Discipline is essential for the child. It provides boundaries on which she can test out her behavior and teaches her socially acceptable behaviors. The nurse should teach the parents ways to manage the child's behavior before it becomes problematic. Punishment is not effective in managing behavior.

A 3-month-old infant is admitted to the pediatric unit for treatment of bronchiolitis. The infant's vital signs are T, 101.6° F; P, 106 beats/min apical; and R, 70 breaths/min. The infant is irritable and fussy and coughs frequently. IV fluids are given via a peripheral venipuncture. Fluids by mouth were initially contraindicated for what reason? a . Tachypnea b . Paroxysmal cough c . Irritability d . Fever

ANS: A Fluids by mouth may be contraindicated because of tachypnea, weakness, and fatigue. Therefore, IV fluids are preferred until the acute stage of bronchiolitis has passed. Infants with bronchiolitis may have paroxysmal coughing, but fluids by mouth would not be contraindicated. Irritability or fever would not be reasons for fluids by mouth to be contraindicated.

What technique facilitates lipreading by a hearing-impaired child? a . Speak at an even rate. b . Avoid using facial expressions. c . Exaggerate pronunciation of words. d . Repeat in exactly the same way if child does not understand.

ANS: A Help the child learn and understand how to read lips by speaking at an even rate. Avoiding using facial expressions, exaggerating pronunciation of words, and repeating in exactly the same way if the child does not understand interfere with the child's understanding of the spoken word.

The nurse is providing support to parents adapting to the hospitalization of their child to the pediatric intensive care unit. The nurse notices that the parents keep asking the same questions. What should the nurse do? a . Patiently continue to answer questions, trying different approaches. b . Kindly refer them to someone else for answering their questions. c . Recognize that some parents cannot understand explanations. d . Suggest that they ask their questions when they are not upset.

ANS: A In addition to a general pediatric unit, children may be admitted to special facilities such as an ambulatory or outpatient setting, an isolation room, or intensive care. Wherever the location, the core principles of patient and family-centered care provide a foundation for all communication and interventions with the patient, family, and health care team. The nurse should do the therapeutic action and patiently continue to answer questions, trying different approaches.

A 13-year-old child with cystic fibrosis (CF) is a frequent patient on the pediatric unit. This admission, she is sleeping during the daytime and unable to sleep at night. What should be a beneficial strategy for this child? a . Administer prescribed sedative at night to aid in sleep. b . Negotiate a daily schedule that incorporates hospital routine, therapy, and free time. c . Have the practitioner speak with the child about the need for rest when receiving therapy for CF. d . Arrange a consult with the social worker to determine whether issues at home are interfering with her care.

ANS: B Children's response to the disruption of routine during hospitalization is demonstrated in eating, sleeping, and other activities of daily living. The lack of structure is allowing the child to sleep during the day, rather than at night. Most likely the lack of schedule is the problem. The nurse and child can plan a schedule that incorporates all necessary activities, including medications, mealtimes, homework, and patient care procedures. The schedule can then be posted, so the child has a ready reference. Sedatives are not usually used with children. The child has a chronic illness and most likely knows the importance of rest. The parents and child can be questioned about changes at home since the last hospitalization.

When communicating with dying children, what should the nurse remember? a . Adolescent children tend to be concrete thinkers. b . Games, art, and play provide a good means of expression. c . When children can recite facts, they understand the implications of those facts. d . If children's questions direct the conversation, the assessment will be incomplete.

ANS: B Games, art, and play provide children a way to use their natural expressive means to stimulate dialogue. Adolescent children are abstract thinkers. Children may not understand the implication of facts just because they can recite them. The assessment is more complete when children's questions direct the conversation.

A 5-year-old child will be starting kindergarten next month. She has cerebral palsy, and it has been determined that she needs to be in a special education classroom. Her parents are tearful when telling the nurse about this and state that they did not realize her disability was so severe. What is the best interpretation of this situation? a . This is a sign the parents are in denial. b . This is a normal anticipated time of parental stress. c . The parents need to learn more about cerebral palsy. d . The parents' expectations are too high.

ANS: B Parenting a child with a chronic illness can be stressful. At certain anticipated times, parental stress increases. One of these identified times is when the child begins school. Nurses can help parents recognize and plan interventions to work through these stressful periods. The parents are not in denial; rather, they are responding to the child's placement in school. The parents are not exhibiting signs of a remembering deficit; this is their first interaction with the school system with this child.

A 16-year-old boy with a chronic illness has recently become rebellious and is taking risks such as missing doses of his medication. What should the nurse explain to his parents? a . That he needs more discipline. b . That this is a normal part of adolescence. c . That he needs more socialization with peers. d . That this is how he is asking for more parental control.

ANS: B Risk taking, rebelliousness, and lack of cooperation are normal parts of adolescence, during which young adults are establishing independence. If the parents increase the amount of discipline, he will most likely be more rebellious. More socialization with peers does not address the problem of risk-taking behavior.

The nurse is caring for a 10-year-old child during a long hospitalization. What intervention should the nurse include in the care plan to minimize loss of control and autonomy during the hospitalization? a . Allow the child to skip morning self-care activities to watch a favorite television program. b . Create a calendar with special events such as a visit from a friend to maintain a routine. c . Allow the child to sleep later in the morning and go to bed later at night to promote control. d . Create a restrictive environment so the child feels in control of sensory stimulation.

ANS: B School-age children may feel an overwhelming loss of control and autonomy during a longer hospitalization. One intervention to minimize this loss of control is to create a calendar with planned special events such as a visit from a friend. Maintaining the child's daily routine is another intervention to minimize the sense of loss of control; allowing the child to skip morning self-care activities, sleep later, or stay up later would work against this goal. Environments should be as nonrestrictive as possible to allow the child freedom to move about, thus allowing a sense of autonomy.

What is a principle of palliative care that can be included in the care of children? a . Maintenance of curative therapy b . Child and family as the unit of care c . Exclusive focus on the spiritual issues the family faces d . Extensive use of opiates to ensure total pain control

ANS: B The principles of palliative care involve a multidisciplinary approach to the management of a terminal illness or the dying process that focuses on symptom control and support rather than on cure or life prolongation in the absence of the possibility of a cure. In pediatric palliative care, the focus of care is on the family. Palliative care requires the transition from curative to palliative care. The transition occurs when the likelihood of cure no longer exists. Spiritual issues are just one of the foci of palliative care. The multidisciplinary team focuses on physical, emotional, and social issues as well. Pain control is a priority in palliative care. The use of opiates is balanced with the side effects caused by this class of drugs.

A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, "Wait a minute," and, "I'm not ready." How should the nurse interpret this behavior? a . IV insertions are viewed as punishment. b . This is expected behavior for a school-age child. c . Protesting like this is usually not seen past the preschool years. d . The child has successfully manipulated the nurse in the past.

ANS: B This school-age child is attempting to maintain some control over the hospital experience. The nurse should provide the girl with structured choices about when the IV line will be inserted. Preschoolers can view procedures as punishment; this is not typical behavior of a preschool- age child.

An 8-year-old girl has been uncooperative and angry since the diagnosis of cancer was made. Her parents tell the nurse that they do not know what to do "because she is always so mad at us." What nursing action is most appropriate at this time? a . Explain to child that anger is not helpful. b . Help the parents deal with her anger constructively. c . Ask the parents to find out what she is angry about. d . Encourage the parents to ignore the anger at this time.

ANS: B To school-age children, chronic illness and dying represent a loss of control. This threat to their sense of security and ego strength can be manifested by verbal uncooperativeness. The child can be viewed as impolite, insolent, and stubborn. The best intervention is to encourage children to talk about feelings and give control where possible. Verbal explanations would not be "heard" by the child. The child may not be cognizant of the anger. Ignoring the anger will not help the child gain some control over the events.

The nurse is assessing a child's functional self-care level for feeding, bathing and hygiene, dressing, and grooming and toileting. The child requires assistance or supervision from another person and equipment or device. What code does the nurse assign for this child? a . I b . II c . III d . IV

ANS: C A code of III indicates the child requires assistance from another person and equipment or device. A code of I indicates use of equipment or device. A code of II indicates assistance or supervision from another person. A code of IV indicates the child is totally dependent.

The practitioner has ordered a liquid oral antibiotic for a toddler with otitis media. The prescription reads 1 1/2 tsp four times per day. What should the nurse consider in teaching the mother how to give the medicine? a . A measuring spoon should be used, and the medication must be given every 6 hr. b . The mother is not able to handle this regimen. Long-acting intramuscular antibiotics should be administered. c . A hollow-handled medication spoon is advisable, and the medication should be equally spaced while the child is awake. d . A household teaspoon should be used and the medicine given when the child wakes up, around lunch time, at dinner time, and before bed.

ANS: C A hollow-handled medication spoon allows the mother to measure the correct amount of medication. The order is written for four times a day; every 6 hr dosing is not necessary. There is no indication that the mother is not able to adhere to the medication regimen. She is asking for clarification, so she can properly care for her child. Long-acting intramuscular antibiotics are not indicated. Household teaspoons vary greatly and should not be used.

The nurse is discussing sexuality with the parents of an adolescent girl who has a moderate cognitive impairment. What factor should the nurse consider when dealing with this issue? a Sterilization is recommended for any adolescent with cognitive impairment. . b . Sexual drive and interest are very limited in individuals with cognitive impairment. c . Individuals with cognitive impairment need a well-defined, concrete code of sexual conduct. d . Sexual intercourse rarely occurs unless the individual with cognitive impairment is sexually abused.

ANS: C Adolescents with moderate cognitive impairment may be easily persuaded and lack judgment. A well-defined, concrete code of conduct with specific instructions for handling certain situations should be defined for the adolescent. Permanent contraception by sterilization presents moral and ethical issues and may have psychologic effects on the adolescent. It may be prohibited in some states. The adolescent needs to have practical sexual information regarding physical development and contraception. Cognitively impaired individuals may desire to marry and have families. The adolescent needs to be protected from individuals who may make intimate advances.

A 2-year-old child is being admitted to the hospital for possible bacterial meningitis. When preparing for a lumbar puncture, what should the nurse do? a . Set up a tray with equipment the same size as for adults. b . Apply EMLA to the puncture site 15 minutes before the procedure. c . Prepare the child for conscious sedation being used for the procedure. d . Reassure the parents that the test is simple, painless, and risk free.

ANS: C Because of the urgency of the child's condition, conscious sedation should be used for the procedure. Pediatric spinal trays have smaller needles than do adult trays. EMLA should be applied approximately 60 minutes before the procedure; the emergency nature of the spinal tap precludes its use. A spinal tap is not a simple procedure and does have associated risks; analgesia will be given for the pain.

Two hospitalized adolescents are playing pool in the activity room. Neither of them seems enthusiastic about the game. How should the nurse interpret this situation? a . Playing pool requires too much concentration for this age-group. b . Pool is an activity better suited for younger children. c . The adolescents may be enjoying themselves but have lower energy levels than healthy children. d . The adolescents' lack of enthusiasm is one of the signs of depression.

ANS: C Children who are ill and hospitalized typically have lower energy levels than healthy children. Therefore, children may not appear enthusiastic about an activity even when they are enjoying it. Pool is an appropriate activity for adolescents. They have the cognitive and psychomotor skills that are necessary. If the adolescents were significantly depressed, they would be unable to engage in the game.

In providing nourishment for a child with cystic fibrosis (CF), what factors should the nurse keep in mind? a . Fats and proteins must be greatly curtailed. b . Most fruits and vegetables are not well tolerated. c . Diet should be high in calories, proteins, and unrestricted fats. d . Diet should be low fat but high in calories and proteins.

ANS: C Children with CF require a well-balanced, high-protein, high-caloric diet, with unrestricted fat (because of the impaired intestinal absorption).

The parents of a child with cognitive impairment ask the nurse for guidance with discipline. What should the nurse's recommendation be based on? a . Discipline is ineffective with cognitively impaired children. b . Cognitively impaired children do not require discipline. c . Behavior modification is an excellent form of discipline. d . Physical punishment is the most appropriate form of discipline.

ANS: C Discipline must begin early. Limit-setting measures must be clear, simple, consistent, and appropriate for the child's mental age. Behavior modification, especially reinforcement of desired behavior and use of time-out procedures, is an appropriate form of behavior control. Aversive strategies should be avoided in disciplining the child.

A 5-year-old child returns from the pediatric intensive care unit after abdominal surgery. The orders state to monitor vital signs every 2 hr. On assessment, the nurse observes that the child's heart rate is 20 beats/min less than it was preoperatively. What should be the nurse's next action? a . Follow the orders and check in 2 hr. b . Ask the parents if this is the child's usual heart rate. c . Recheck the pulse and blood pressure in 15 minutes. d . Notify the surgeon that the child is probably going into shock.

ANS: C In a 5-year-old child, this is a significant change in vital signs. The nurse should assess the child to see if his condition mirrors a drop in heart rate. The assessment and vital signs should be redone in 15 minutes to determine whether the child's condition is stable. When a disparity in vital signs or other assessment data is observed, the nurse should reassess sooner. Most parents will not know their child's heart rate. It is important to determine how the child is recovering from surgery. The nurse should collect additional information before notifying the surgeon. This includes blood pressure, respiratory rate, and pain status.

The parents of a 3 year old admitted for recurrent diarrhea are upset that the practitioner has not told them what is going on with their child. What is the priority intervention for this family? a . Answer all of the parents' questions about the child's illness. b . Immediately page the practitioner to come to the unit to speak with the family. c . Help the family develop a written list of specific questions to ask the practitioner. d . Inform the family of the time that hospital rounds are made so that they can be present.

ANS: C Often families ask general questions of health care providers and do not receive the information they need. The nurse should determine what information the family does want and then help develop a list of questions. When the questions are written, the family can remember which questions to ask or can hand the sheet to the practitioner for answers. The nurse may have the information the parents want, but they are asking for specific information from the practitioner. Unless it is an emergency, the nurse should not place a stat page for the practitioner. Being present is not necessarily the issue but rather the ability to get answers to specific questions.

The nurse is teaching feeding strategies to a parent of a 12-month-old infant with Down syndrome. What statement made by the parent indicates a need for further teaching? a . "If the food is thrust out, I will retry it." b . "I will use a small, long, straight-handled spoon." c . "I will place the food on the top of the tongue." d . "I know the tongue thrust doesn't indicate a refusal of the food."

ANS: C Parents of a child with Down syndrome need to know that the tongue thrust does not indicate refusal to feed but is a physiologic response. Parents are advised to use a small but long, straight-handled spoon to push the food toward the back and side of the mouth. If food is thrust out, it should be refed. If the parent indicates placing the food on the tongue, further teaching is needed.

Parents are being taught how to feed their infant using a newly placed gastrostomy tube (G- tube). What is essential information for the parents to receive? a . Verify placement before each feeding. b . Use a syringe with a plunger to give the infant bolus feedings. c . Position the infant on the right side during and after the feeding. d . Beefy red tissue around the G-tube site must be reported to the practitioner.

ANS: C Positioning on the right side during and after feedings helps minimize the risk of aspiration. It is not necessary to verify placement before each feeing. G-tubes are inserted into the stomach and sutured in place. If the tube is through the skin, it is in the stomach. Feedings should be given by gravity flow. The plunger may be used to initiate the feeding, but then the formula should be allowed to flow. Beefy red tissue around the G-tube site is normal granulation tissue that is expected.

An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires what type of isolation? a . Reverse isolation b . Airborne isolation c . Contact Precautions d . Standard Precautions

ANS: C RSV is transmitted through droplets. In addition to Standard Precautions and hand washing, Contact Precautions are required. Caregivers must use gloves and gowns when entering the room. Care is taken not to touch their own eyes or mucous membranes with a contaminated gloved hand. Children are placed in a private room or in a room with other children with RSV infections. Reverse isolation focuses on keeping bacteria away from the infant. With RSV, other children need to be protected from exposure to the virus. The virus is not airborne.

A 5-year-old child has bilateral eye patches in place after surgery yesterday morning. Today he can be out of bed. What nursing intervention is most important at this time? a . Speak to him when entering the room. b . Allow him to assist in feeding himself. c . Orient him to his immediate surroundings. d . Reassure him and allow his parents to stay with him.

ANS: C Safety is the priority concern. Because he can now be out of bed, it is imperative that he knows about his physical surroundings. Speaking to the child is a component of nursing care that is expected with all clients unless contraindicated. Unless additional impairments are present, his meal tray should be set up, and he should be able to feed himself. Reassuring him and allowing his parents to stay with him are essential parts of nursing care for all children.

The nurse is admitting a 7-year-old child to the pediatric unit for abdominal pain. To determine what the child understands about the reason for hospitalization, what should the nurse do? a . Find out what the parents have told the child. b . Review the note from the admitting practitioner. c . Ask the child why he came to the hospital today. d . Question the parents about why they brought the child to the hospital.

ANS: C School-age children are able to answer questions. The only way for the nurse to know about the child's understanding of the reason for hospitalization is to ask the child directly. Finding out what the parents told the child and why they brought the child to the hospital or reading the admitting practitioner's description of the reason for admission will not provide information about what the child has heard and retained.

Parents ask for help for their other children to cope with the changes in the family resulting from the special needs of their sibling. What strategy does the nurse recommend? a . Explain to the siblings that embarrassment is unhealthy. b . Encourage the parents not to expect siblings to help them care for the child with special needs. c . Provide information to the siblings about the child's condition only as requested. d . Invite the siblings to attend meetings to develop plans for the child with special

ANS: D Siblings should be invited to attend meeting to be part of the care team for the child. They can learn about an individualized education plan and help design strategies that will work at home. Embarrassment may be associated with having a sibling with a chronic illness or disability. Parents must be able to respond in an appropriate manner without punishing the sibling. The parents may need assistance with the care of the child. Most siblings are positive about the extra responsibilities. Parents need to inform the siblings about the child's condition before a non-family member does so. The parents do not want the siblings to fantasize about what is wrong with the child.

Several nurses tell their nursing supervisor that they want to attend the funeral of a child for whom they had cared. They say they felt especially close to both the child and the family. The supervisor should recognize that attending the funeral serves what purpose? a . It is improper because it increases burnout. b . It is inappropriate because it is unprofessional. c . It is proper because families expect this expression of concern. d . It is appropriate because it can assist in the resolution of personal grief.

ANS: D Some nurses find shared remembrance rituals useful in resolving grief. Attending funeral services can be a supportive act for both the family and the nurse. Burnout is a state of physical, emotional, and mental exhaustion. It results from prolonged involvement with individuals in situations that are emotionally demanding. Attending the funeral of a child can be an effective coping measure. Attending funerals does not detract from the professionalism of care. Although it is important to consider the family's expectations, the act of attending the funeral provides a sense of closure with the family and facilitates the grief process for the nurse.

A 6-year-old child is admitted to the pediatric unit and requires bed rest. Having art supplies available meets which purpose? a . Allows the child to create gifts for parents. b . Provides developmentally appropriate activities. c . Is essential for play therapy so the child can work on past problems. d . Lets the child express thoughts and feelings through pictures rather than words.

ANS: D The art supplies allow the child to draw images that come into the mind. This can help the child develop symbols and then verbalize reactions to illness and hospitalization. The child can make gifts and drawings for parents, but the goal is to allow expression of feelings. Although art is developmentally and situationally appropriate, the child benefits by being able to express feelings nonverbally. The art supplies are not therapeutic play but a mechanism for expressive play. The child will not work on past problems.

A 6-year-old child is in the hospital for status asthmaticus. Nursing care during this acute period includes which prescribed interventions? a . Prednisolone (Pediapred) PO every day, IV fluids, cromolyn (Intal) inhaler bid b . Salmeterol (Serevent) PO bid, vital signs every 4 hr, spot check pulse oximetry c . Triamcinolone (Azmacort) inhaler bid, continuous pulse oximetry, vital signs once a shift d . Methylprednisolone (Solumedrol) IV every 12 hr, continuous pulse oximetry, albuterol nebulizer treatments every 4 hr and prn

ANS: D The child in status asthmaticus should be placed on continuous cardiorespiratory (including blood pressure) and pulse oximetry monitoring. A systemic corticosteroid (oral, IV, or IM) may also be given to decrease the effects of inflammation. Inhaled aerosolized short-acting 2 - agonists are recommended for all patients. Therefore, Solumedrol per IV, continuous pulse oximetry, and albuterol nebulizer treatments are the expected prescribed treatments. Oral medications would not be used during the acute stage of status asthmaticus. Vital signs once a shift and spot pulse oximetry checks would not be often enough.

Many of the clinical features of Down syndrome present challenges to caregivers. Based on these features, what intervention should be included in the child's care? a . Delay feeding solid foods until the tongue thrust has stopped. b . Modify the diet as necessary to minimize the diarrhea that often occurs. c . Provide calories appropriate to the child's mental age. d . Use a cool-mist vaporizer to keep the mucous membranes moist and secretions liquefied.

ANS: D The constant stuffy nose forces the child to breathe by mouth, drying the mucous membranes and increasing the susceptibility to upper respiratory tract infections. A cool-mist vaporizer will keep the mucous membranes moist and liquefy secretions. Respiratory tract infections combined with cardiac anomalies are the primary cause of death in the first years. The child has a protruding tongue, which makes feeding difficult. The parents must persist with feeding while the child continues the physiologic response of the tongue thrust. The child is predisposed to constipation. Calories should be appropriate to the child's weight and growth needs, not mental age.

The nurse is doing a pre-hospitalization orientation for a girl, age 7 years, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that after the surgery, the child will be in the intensive care unit. How might the explanation by the nurse be viewed? a . Unnecessary b . The surgeon's responsibility c . Too stressful for a young child d . An appropriate part of the child's preparation

ANS: D The explanation is a necessary part of preoperative preparation and will help reduce the anxiety associated with surgery. If the child wakes in the intensive care unit and is not prepared for the environment, she will be even more anxious. This is a joint responsibility of nursing, medical staff, and child life personnel.

A 4-year-old girl is brought to the emergency department. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should intervene in which manner? a . Make her lie down and rest quietly. b Examine her oral pharynx and report to the physician. . c . Auscultate her lungs and prepare for placement in a mist tent. d . Notify the physician immediately and be prepared to assist with intubation.

ANS: D This child is exhibiting signs of respiratory distress and possible epiglottitis. Epiglottitis is always a medical emergency requiring antibiotics and airway support for treatment. Sitting up is the position that facilitates breathing in respiratory disease. The oral pharynx should not be visualized. If the epiglottis is inflamed, there is the potential for complete obstruction if it is irritated further. Although lung auscultation provides useful assessment information, a mist tent would not be beneficial for this child. Immediate medical evaluation and intervention are indicated.

The camp nurse is choosing a toy for a child with cognitive impairment to play with during swimming time. What toy should the nurse choose to encourage improvement of developmental skills? a . Dive rings b . An inner tube c . Floating ducks d . A large beach ball

ANS: D Toys are selected for their recreational and educational value. For example, a large inflatable beach ball is a good water toy; encourages interactive play; and can be used to learn motor skills such as balance, rocking, kicking, and throwing. Dive rings, an inner tube, and floating ducks are not interactive toys.