Peds CH 1-4, 6, 14

What description applies to fragile X syndrome? a. Chromosomal defect affecting only females b. Second most common genetic cause of cognitive impairment c. Most common cause of uninherited cognitive impairment d. Chromosomal defect that follows the pattern of X-linked recessive disorders

b. Second most common genetic cause of cognitive impairment Fragile X syndrome is the most common inherited cause of cognitive impairment and the second most common genetic cause of cognitive impairment after Down syndrome. Fragile X primarily affects males and follows the pattern of X-linked dominant inheritance with reduced penetrance.

The nurse is explaining different parenting styles to a group of parents. The nurse explains that an authoritative parenting style can lead to which child behavior? a. Shyness b. Self-reliance c. Submissiveness d. Self-consciousness

b. Self-reliance Children raised by parents with an authoritative parenting style tend to have high self-esteem and are self-reliant, assertive, inquisitive, content, and highly interactive with other children. Children raised by parents with an authoritarian parenting style tend to be sensitive, shy, self-conscious, retiring, and submissive.

A 3-month-old infant dies shortly after arrival to the emergency department. The infant has subdural and retinal hemorrhages but no external signs of trauma. What should the nurse suspect? a. Unintentional injury b. Shaken baby syndrome c. Congenital neurologic problem d. Sudden infant death syndrome (SIDS)

b. Shaken baby syndrome Shaken baby syndrome causes internal bleeding but may have no external signs. Unintentional injury would not cause these injuries. With unintentional injuries, external signs are usually present. Congenital neurologic problems would usually have signs of abnormal neurologic anatomy. SIDS does not usually have identifiable injuries.

What is the appropriate placement of a tongue blade for assessment of the mouth and throat? a. On the lower jaw b. Side of the tongue c. Against the soft palate d. Center back area of the tongue

b. Side of the tongue The side of the tongue is the correct position. It avoids the gag reflex yet allows visualization. On the lower jaw and against the soft palate are not appropriate places for the tongue blade. Placement in the center back area of the tongue elicits the gag reflex.

The nurse observes flaring of nares in a newborn. What should this be interpreted as? a. Nasal occlusion b. Sign of respiratory distress c. Snuffles of congenital syphilis d. Appropriate newborn breathing

b. Sign of respiratory distress Nasal flaring is an indication of respiratory distress. A nasal occlusion should prevent the child from breathing through the nose. Because newborns are obligatory nose breathers, this should require immediate referral. Snuffles are indicated by a thick, bloody nasal discharge without sneezing. Sneezing and thin, white mucus drainage are common in newborns and are not related to nasal flaring.

What identified characteristics occur more frequently in parents who abuse their children? (Select all that apply.) a. Older parents b. Socially isolated c. Middle class parents d. Single-parent families e. Few supportive relationships

b. Socially isolated d. Single-parent families e. Few supportive relationships Abusive families are often socially isolated and have few supportive relationships. Single-parent families are at higher risk for abuse. Younger parents more often are abusers of their children. Abusive parents have stressors such as low-income circumstances, with little education, and are not middle class parents.

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

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

In addition to injuries, what are the leading causes of death in adolescents ages 15 to 19 years? a. Suicide and cancer b. Suicide and homicide c. Drowning and cancer d. Homicide and heart disease

b. Suicide and homicide Suicide and homicide account for 16.7% of deaths in this age group. Suicide and cancer account for 10.9% of deaths, heart disease and cancer account for approximately 5.5%, and homicide and heart disease account for 10.9% of the deaths in this age group.

The clinic nurse is assessing a child with bacterial conjunctivitis (pink eye). Which assessment findings should the nurse expect? (Select all that apply.) a. Itching b. Swollen eyelids c. Inflamed conjunctiva d. Purulent eye drainage e. Crusting of eyelids in the morning

b. Swollen eyelids c. Inflamed conjunctiva d. Purulent eye drainage e. Crusting of eyelids in the morning The assessment findings in bacterial conjunctivitis include swollen eyelids, inflamed conjunctiva, purulent eye drainage, and crusting of eyelids in the morning. Itching is seen with allergic conjunctivitis but not with bacterial conjunctivitis.

What do mortality statistics describe? a. Disease occurring regularly within a geographic location b. The number of individuals who have died over a specific period c. The prevalence of specific illness in the population at a particular time d. Disease occurring in more than the number of expected cases in a community

b. The number of individuals who have died over a specific period Mortality statistics refer to the number of individuals who have died over a specific period. Morbidity statistics show the prevalence of specific illness in the population at a particular time. Data regarding disease within a geographic region, or in greater than expected numbers in a community, may be extrapolated from analyzing the morbidity statistics.

The Asian parent of a child being seen in the clinic avoids eye contact with the nurse. What is the best explanation for this considering cultural differences? a. The parent feels inferior to the nurse. b. The parent is showing respect for the nurse. c. The parent is embarrassed to seek health care. d. The parent feels responsible for her child's illness.

b. The parent is showing respect for the nurse. In some ethnic groups, eye contact is avoided. In the Vietnamese culture, an individual may not look directly into the nurse's eyes as a sign of respect. The nurse providing culturally competent care would recognize that the other answers listed are not why the parent avoids eye contact with the nurse.

A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, "I want to go back to work, but I don't want Eric to suffer because I'll have less time with him." Which is the nurse's most appropriate answer? a. "I'm sure he'll be fine if you get a good babysitter." b. "You will need to stay home until Eric starts school." c. "Let's talk about the child care options that will be best for Eric." d. "You should go back to work so Eric will get used to being with others."

c. "Let's talk about the child care options that will be best for Eric." Asking the mother about child care options is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and Eric. The other three answers are directive; they do not address the effect that her working will have on Eric.

Autism is a complex developmental disorder. The diagnostic criteria for autism include delayed or abnormal functioning in which area with onset before age 3 years? a. Parallel play b. Gross motor development c. Ability to maintain eye contact d. Growth below the fifth percentile

c. Ability to maintain eye contact One hallmark of autism spectrum disorders is the child's inability to maintain eye contact with another person. Parallel play is play typical of toddlers and is usually not affected. Social, not gross motor, development is affected by autism. Physical growth and development are not usually affected.

Which serious reaction should the nurse be alert for when administering vaccines? a. Fever b. Skin irritation c. Allergic reaction d. Pain at injection site

c. Allergic reaction Each vaccine administration carries the risk of an allergic reaction. The nurse must be prepared to intervene if the child demonstrates signs of a severe reaction. Mild febrile reactions do occur after administration. The nurse includes management of fever in the parent teaching. Local skin irritation may occur at the injection site after administration. Parents are informed that this is expected. The injection can be painful. The nurse can minimize the discomfort with topical analgesics and nonpharmacologic measures.

An infant requires surgery for repair of a cleft lip. An important priority of the preoperative nursing care is which? a. Initiating discharge teaching b. Performing baseline physical and behavioral assessment c. Observing for allergic reactions to preoperative antibiotics d. Determining whether this defect exists in other family members

b. Performing baseline physical and behavioral assessment It is essential to assess the infant before surgery to obtain a baseline. Postoperative changes can be identified and a determination can be made regarding pain or change in status. The parents are not ready for discharge teaching. Their focus is on the congenital defect and surgery. Although a remote possibility, allergic reactions rarely occur on the first dose. Determining whether this defect exists in other family members is an important part of the history but is not a priority before surgery.

Which finding in the newborn is considered abnormal? a. Nystagmus b. Profuse drooling c. Dark green or black stools d. Slight vaginal reddish discharge

b. Profuse drooling Profuse drooling and salivation are potential signs of a major abnormality. Newborns with esophageal atresia cannot swallow their oral secretions, resulting in excessive drooling. Nystagmus is an involuntary movement of the eyes. This is a common variation in newborns. Meconium, the first stool of newborns, is dark green or black. A pseudomenstruation may be present in normal newborns. This is a blood-tinged or mucoid vaginal discharge.

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

b. Refer for immediate medical evaluation. Hyperextension of the child's head with pain on flexion is indicative of meningeal irritation and needs immediate evaluation. No indication of injury is present. This situation is not descriptive of head lag.

Which is the name of the suture separating the parietal bones at the top of a newborn's head? a. Frontal b. Sagittal c. Coronal d. Occipital

b. Sagittal The sagittal suture separates the parietal bones at the top of the newborn's head. The frontal suture separates the frontal bones. The coronal suture is said to "crown the head." The lambdoid suture is at the margin of the parietal and occipital.

After the family, which has the greatest influence on providing continuity between generations? a. Race b. School c. Social class d. Government

b. School Schools convey a tremendous amount of culture from the older members to the younger members of society. They prepare children to carry out the traditional social roles that will be expected of them as adults. Race is defined as a division of humankind possessing traits that are transmissible by descent and are sufficient to characterize race as a distinct human type; although race may have an influence on childrearing practices, its role is not as significant as that of schools. Social class refers to the family's economic and educational levels. The social class of a family may change between generations. The government establishes parameters for children, including amount of schooling, but this is usually at a local level. The school culture has the most significant influence on continuity besides family.

A child receiving chemotherapy is experiencing mucositis. Which prescriptions should the nurse plan to administer for initial treatment? (Select all that apply.) a. Scope mouth rinse b. Listerine antiseptic mouth rinse c. Carafate suspension (Sucralfate) d. Nystatin oral suspension (Nystatin) e. Lidocaine viscous (Lidocaine hydrochloride solution)

c. Carafate suspension (Sucralfate) d. Nystatin oral suspension (Nystatin) e. Lidocaine viscous (Lidocaine hydrochloride solution) Initial treatment of stomatitis includes single agents (sucralfate suspension, nystatin, and viscous lidocaine). Scope and Listerine are plaque and gingivitis control mouth rinses that would have a drying effect and are not used with mucositis.

What is a significant secondary prevention nursing activity for lead poisoning? a. Chelation therapy b. Screening children for blood lead levels c. Removing lead-based paint from older homes d. Questioning parents about ethnic remedies containing lead

b. Screening children for blood lead levels Screening children for lead poisoning is an important secondary prevention activity. Screening does not prevent the initial exposure of the child to lead. It can lead to identification and treatment of children who are exposed. Chelation therapy is treatment, not prevention. Removing lead-based paints from older homes before children are affected is primary prevention. Questioning parents about ethnic remedies containing lead is part of the assessment to determine the potential source of lead.

The nurse is caring for a non-English-speaking child and family. Which should the nurse consider when using an interpreter? a. Pose several questions at a time. b. Use medical jargon when possible. c. Communicate directly with family members when asking questions. d. Carry on some communication in English with the interpreter about the family's needs.

c. Communicate directly with family members when asking questions. When using an interpreter, the nurse should communicate directly with family members when asking questions to reinforce interest in them and to observe nonverbal expressions. Questions should be posed one at a time to elicit only one answer at a time. Medical jargon should be avoided whenever possible. The nurse should avoid discussing the family's needs with the interpreter in English because some family members may understand some English.

The nurse is assessing a child with Down syndrome. The nurse recognizes that which are possible comorbidities that can occur with Down syndrome? (Select all that apply.) a. Diabetes mellitus b. Hodgkin's disease c. Congenital heart defects d. Respiratory tract infections e. Acute megakaryoblastic leukemia

c. Congenital heart defects d. Respiratory tract infections e. Acute megakaryoblastic leukemia Children with Down syndrome often have multiple comorbidities, contributing to numerous other conditions. Respiratory tract infections are prevalent; when combined with cardiac anomalies, they are the chief cause of death, particularly during the first year. The incidence of leukemia is several times more frequent than expected in the general population, and in about half of the cases, the type is acute megakaryoblastic leukemia.

What is a significant common side effect that occurs with opioid administration? a. Euphoria b. Diuresis c. Constipation d. Allergic reactions

c. Constipation Constipation is one of the most common side effects of opioid administration. Preventive strategies should be implemented to minimize this problem. Sedation is a more common result than euphoria. Urinary retention, not diuresis, may occur with opiates. Rarely, some individuals may have pruritus.

During an otoscopic examination on an infant, in which direction is the pinna pulled? a. Up and back b. Up and forward c. Down and back d. Down and forward

c. Down and back In infants and toddlers, the ear canal is curved upward. To visualize the ear canal, it is necessary to pull the pinna down and back to the 6 to 9 o'clock range to straighten the canal. In children older than age 3 years and adults, the canal curves downward and forward. The pinna is pulled up and back to the 10 o'clock position. Up and forward and down and forward are positions that do not facilitate visualization of the ear canal.

A newborn assessment shows a separated sagittal suture, oblique palpebral fissures, a depressed nasal bridge, a protruding tongue, and transverse palmar creases. These findings are most suggestive of which condition? a. Microcephaly b. Cerebral palsy c. Down syndrome d. Fragile X syndrome

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

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

c. He needs reassurance that the pet has not gone somewhere else. The preschooler can recognize that the pet has died but has difficulties with the permanence. Digging up the bird gives reassurance that the bird is still present. This is an expected response at this age. If the behavior persists, intervention may be required.

What is an important nursing consideration when a child is hospitalized for chelation therapy to treat lead poisoning? a. Maintain bed rest. b. Maintain isolation precautions. c. Keep an accurate record of intake and output. d. Institute measures to prevent skeletal fracture.

c. Keep an accurate record of intake and output. The iron chelates are excreted though the kidneys. Adequate hydration is essential. Periodic measurement of renal function is done. Bed rest is not necessary. Often the chelation therapy is done on an outpatient basis. Chelation therapy is not infectious or dangerous. Isolation is not indicated. Skeletal weakness does not result from high levels of lead.

Which is a sex chromosome abnormality that is caused by the presence of one or more additional X chromosomes in a male? a. Turner b. Triple X c. Klinefelter d. Trisomy 13

c. Klinefelter Klinefelter syndrome is characterized by one or more additional X chromosomes. These individuals are tall with male secondary sexual characteristics that may be deficient, and they may be learning disabled. An absence of an X chromosome results in Turner syndrome. Triple X and trisomy 13 are not abnormalities that involve one or more additional X chromosomes in a male (Klinefelter syndrome).

Which are components of the FLACC scale? (Select all that apply.) a. Color b. Capillary refill time c. Leg position d. Facial expression e. Activity

c. Leg position d. Facial expression e. Activity Facial expression, consolability, cry, activity, and leg position are components of the FLACC scale. Color is a component of the Apgar scoring system. Capillary refill time is a physiologic measure that is not a component of the FLACC scale.

Which term is used to describe a newborn's first stool? a. Milia b. Milk stool c. Meconium d. Transitional

c. Meconium Meconium is composed of amniotic fluid and its constituents, intestinal secretions, shed mucosal cells, and possibly blood. It is a newborn's first stool. Milia involves distended sweat glands that appear as minute vesicles, primarily on the face. Milk stool usually occurs by the fourth day. The appearance varies depending on whether the newborn is breast or formula fed. Transitional stools usually appear by the third day after the beginning of feeding. They are usually greenish brown to yellowish brown, thin, and less sticky than meconium.

The nurse understands that which occurring soon after birth can indicate cystic fibrosis? a. Murmur b. Hypoglycemia c. Meconium ileus d. Muscle weakness

c. Meconium ileus A symptom of cystic fibrosis is a meconium ileus soon after birth. A murmur can be a sign of a congenital heart disease. Hypoglycemia can be a sign of Beckwith-Wiedemann syndrome. Muscle weakness can be a sign of myotonic dystrophy.

A mother who breastfeeds her 6-week-old infant every 4 hours tells the nurse that he seems "hungry all the time." The nurse should recommend which? a. Newborn cereal b. Supplemental formula c. More frequent feedings d. No change in feedings

c. More frequent feedings Infants who are breastfed tend to be hungry every 2 to 3 hours. They should be fed frequently. Six weeks is too early to introduce newborn cereal. Supplemental formula is not indicated. Giving additional formula or water to a breastfed infant may satiate the infant and create problems with breastfeeding. The infant requires additional feedings. Four hours is too long between feedings for a breastfed infant.

Successful breastfeeding is most dependent on which? a. Birth weight of newborn b. Size of mother's breasts c. Mother's desire to breastfeed d. Family's socioeconomic level

c. Mother's desire to breastfeed The factors that contribute to successful breastfeeding are the mother's desire to breastfeed, satisfaction with breastfeeding, and available support systems. Very low-birth-weight infants may be unable to breastfeed. The mother can express milk, and it can be used for the infant. The size of mother's breasts does not affect the success of breastfeeding. The family's socioeconomic level may affect the mother's need to return to work and available support systems, but with support, the mother can be successful.

Which heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood? a. S1 and S2 b. S3 and S4 c. Murmur d. Physiologic splitting

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

Treatment for herpes simplex virus (type 1 or 2) includes which? a. Corticosteroids b. Oral griseofulvin c. Oral antiviral agent d. Topical or systemic antibiotic

c. Oral antiviral agent Oral antiviral agents are effective for viral infections such as herpes simplex. Corticosteroids, antibiotics, and griseofulvin (an antifungal agent) are not effective for viral infections.

Where is the best place to observe for the presence of petechiae in dark-skinned individuals? a. Face b. Buttocks c. Oral mucosa d. Palms and soles

c. Oral mucosa Petechiae, small distinct pinpoint hemorrhages, are difficult to see in dark-skinned individuals unless they are in the mouth or conjunctiva.

What is a major premise of family-centered care? a. The child is the focus of all interventions. b. Nurses are the authorities in the child's care. c. Parents are the experts in caring for their child. d. Decisions are made for the family to reduce stress.

c. Parents are the experts in caring for their child. As parents become increasingly responsible for their children, they are the experts. It is essential that the health care team recognize the family's expertise. In family-centered care, consistent attention is given to the effects of the child's chronic illness on all family members, not just the child. Nurses are adjuncts in the child's care. The nurse builds alliances with parents. Family members are involved in decision making about the child's physical care.

Phenylketonuria is a genetic disease that results in the body's inability to correctly metabolize which? a. Glucose b. Thyroxine c. Phenylalanine d. Phenylketones

c. Phenylalanine Phenylketonuria is an inborn error of metabolism caused by a deficiency or absence of the enzyme needed to metabolize the essential amino acid phenylalanine. Individuals with this disorder can metabolize glucose. Thyroxine is one of the principal hormones secreted by the thyroid gland. Phenylketones are metabolites of phenylalanine excreted in the urine.

Which action should the nurse implement when taking an axillary temperature? a. Take the temperature through one layer of clothing. b. Add a degree to the result when recording the temperature. c. Place the tip of the thermometer under the arm in the center of the axilla. d. Hold the child's arm away from the body while taking the temperature.

c. Place the tip of the thermometer under the arm in the center of the axilla. The thermometer tip should be placed under the arm in the center of the axilla and kept close to the skin, not clothing. The temperature should not be taken through any clothing. The child's arm should be pressed firmly against the side, not held away from the body. The temperature should be recorded without a degree added and designated as being taken by the axillary method.

A child is in the intensive care unit after a motor vehicle collision. The child has numerous fractures and is in pain that is rated 9 or 10 on a 10-point scale. In planning care, the nurse recognizes that the indicated action is which? a. Give only an opioid analgesic at this time. b. Increase dosage of analgesic until the child is adequately sedated. c. Plan a preventive schedule of pain medication around the clock. d. Give the child a clock and explain when she or he can have pain medications.

c. Plan a preventive schedule of pain medication around the clock. For severe postoperative pain, a preventive around the clock (ATC) schedule is necessary to prevent decreased plasma levels of medications. The opioid analgesic will help for the present, but it is not an effective strategy. Increasing the dosage requires an order. The nurse should give the drug on a regular schedule and evaluate the effectiveness. Using a clock is counterproductive because it focuses the child's attention on how long he or she will need to wait for pain relief.

Which should the nurse use when assessing the physical maturity of a newborn? a. Length b. Apgar score c. Posture at rest d. Chest circumference

c. Posture at rest With the newborn quiet and in a supine position, the degree of flexion in the arms and legs can be used for determination of gestational age. Length and chest circumference reflect the newborn's size and weight, which vary according to race and gender. Birth weight alone is a poor indicator of gestational age and fetal maturity. The Apgar score is an indication of the newborn's adjustment to extrauterine life.

What explanation best describes how preschoolers react to the death of a loved one? a. Grief is acute but does not last long at this age. b. Children this age are too young to have a concept of death. c. Preschoolers may feel guilty and responsible for the death. d. They express grief in the same way that the adults in the preschoolers' life are expressing grief.

c. Preschoolers may feel guilty and responsible for the death. Because of egocentricity, the preschooler may feel guilty and responsible for the death. Preschoolers may need to distance themselves from the loss. Giggling or joking and regression to earlier behaviors may help them until they incorporate the loss. The preschooler's concept of death is more a special sleep or departure.

A 7-year-old child is in the end stages of cancer. The parents ask you how they will know when death is imminent. What physical sign is indicative of approaching death? a. Hunger b. Tachycardia c. Increased thirst d. Difficulty swallowing

d. Difficulty swallowing The child begins to have difficulty swallowing as he or she approaches death. The child's appetite will decrease, and he or she will take only small bites of favorite foods or sips of fluids in the final few days. The pulse rate will slow.

The nurse suspects that a child has ingested some type of poison. What clinical manifestation would be most suggestive that the poison was a corrosive product? a. Tinnitus b. Disorientation c. Stupor, lethargy, and coma d. Edema of the lips, tongue, and pharynx

d. Edema of the lips, tongue, and pharynx Edema of the lips, tongue, and pharynx indicates a corrosive ingestion. Tinnitus is indicative of aspirin ingestion. Corrosives do not act on the central nervous system.

The nurse is teaching a class on breastfeeding to expectant parents. Which is a contraindication for breastfeeding? a. Mastitis b. Twin births c. Inverted nipples d. Maternal cancer therapy

d. Maternal cancer therapy Mothers receiving chemotherapy with antimetabolites and certain antineoplastic drugs should not breastfeed. The drugs are passed to the newborn through the breast milk. Mastitis, twin births, and inverted nipples are not contraindications.

Herpes zoster is caused by the varicella virus and has an affinity for which? a. Sympathetic nerve fibers b. Parasympathetic nerve fibers c. Lateral and dorsal columns of the spinal cord d. Posterior root ganglia and posterior horn of the spinal cord

d. Posterior root ganglia and posterior horn of the spinal cord The herpes zoster virus has an affinity for posterior root ganglia, the posterior horn of the spinal cord, and the skin. The zoster virus does not involve the nerve fibers listed.

The nurse is planning pain control for a child. Which is the advantage of administering pain medication by the intravenous (IV) bolus route? a. Less expensive than oral medications b. Produces a first-pass effect through the liver c. Does not need to be administered frequently d. Provides most rapid onset of effect, usually in about 5 minutes

d. Provides most rapid onset of effect, usually in about 5 minutes The advantage of pain medication by the IV bolus route is that it provides the most rapid onset of effect, usually in about 5 minutes. IV medications are more expensive than oral medications, and the IV route bypasses the first-pass effect through the liver. Pain control with IV bolus medication needs to be repeated hourly for continuous pain control.

Which characteristic is representative of a full-term newborn's gastrointestinal tract? a. Transit time is diminished. b. Peristaltic waves are relatively slow. c. Pancreatic amylase is overproduced. d. Stomach capacity is very limited.

d. Stomach capacity is very limited. Newborns require frequent small feedings because their stomach capacity is very limited. A newborn's colon has a relatively small volume and resulting increased bowel movements. Peristaltic waves are rapid. A deficiency of pancreatic lipase limits the absorption of fats.

What often causes cellulitis? a. Herpes zoster b. Candida albicans c. Human papillomavirus d. Streptococci or staphylococci

d. Streptococci or staphylococci Streptococci, staphylococci, and Haemophilus influenzae are the organisms usually responsible for cellulitis. Herpes zoster is the virus associated with varicella and shingles. C. albicans is associated with candidiasis, or thrush. Human papillomavirus is associated with various types of human warts.

How is family systems theory best described? a. The family is viewed as the sum of individual members. b. A change in one family member cannot create a change in other members. c. Individual family members are readily identified as the source of a problem. d. When the family system is disrupted, change can occur at any point in the system.

d. When the family system is disrupted, change can occur at any point in the system. Family systems theory describes an interactional model. Any change in one member will create change in others. Although the family is the sum of the individual members, family systems theory focuses on the number of dyad interactions that can occur. The interactions, not the individual members, are considered to be the problem.

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.

c. Orient him to his immediate surroundings. 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 using the CRIES pain assessment tool on a preterm infant in the neonatal intensive care unit. Which are the components of this tool? (Select all that apply.) a. Color b. Moro reflex c. Oxygen saturation d. Posture of arms and legs e. Sleeplessness f. Facial expression

c. Oxygen saturation e. Sleeplessness f. Facial expression Need for increased oxygen, crying, increased vital signs, expression, and sleeplessness are components of the CRIES pain assessment tool used with neonates. Color, Moro reflex, and posture of arms and legs are not components of the CRIES scale.

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.

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

Which vitamin supplementation has been found to reduce both morbidity and mortality in measles? a. A b. B1 c. C d. Zinc

a. A Evidence suggests that vitamin A supplementation reduces both morbidity and mortality in measles.

What does impetigo ordinarily results in? a. No scarring b. Pigmented spots c. Atrophic white scars d. Slightly depressed scars

a. No scarring Impetigo tends to heal without scarring unless a secondary infection occurs.

A parent asks the nurse about the "characteristics of a sleep terror." What response should the nurse give to the parent? (Select all that apply.) a. The child screams during the sleep terror. b. Return to sleep is delayed because of persistent fear. c. The night terror occurs during the second half of night. d. The child has no memory of the dream with a sleep terror. e. The child is not aware of another's presence during a sleep terror.

a. The child screams during the sleep terror. d. The child has no memory of the dream with a sleep terror. e. The child is not aware of another's presence during a sleep terror. During sleep terrors, the child screams and has no memory of the dream. The child is not aware of another's presence during a sleep terror. Return to sleep is usually rapid with a sleep terror, but it is delayed with a nightmare. The sleep terror occurs usually within 1 to 4 hours of sleep, but nightmares occur during the second half of night.

The clinic nurse is reviewing the immunization guidelines for hepatitis B. Which are true of the guidelines for this vaccine? (Select all that apply.) a. The hepatitis B vaccination series should be begun at birth. b. The adolescent not vaccinated at birth does not have a need to be vaccinated. c. Any child not vaccinated at birth should receive two doses at least 4 months apart. d. An unimmunized 10-year-old child should receive three doses administered 4 weeks apart.

a. The hepatitis B vaccination series should be begun at birth. d. An unimmunized 10-year-old child should receive three doses administered 4 weeks apart. Current immunization guidelines for hepatitis B vaccination recommend beginning the hepatitis B vaccine series at birth or, in unimmunized children, as soon as possible. Children younger than 11 years of age may be vaccinated with a three-dose series, administered 4 weeks apart. Children 11 years and older may receive the two-dose adult formulation given at least 4 months apart.

What statement is correct about young children who report sexual abuse? a. They may exhibit various behavioral manifestations. b. In more than half the cases, the child has fabricated the story. c. Their stories should not be believed unless other evidence is apparent. d. They should be able to retell the story the same way to another person.

a. They may exhibit various behavioral manifestations. Victims of sexual abuse have no typical profile. The child may exhibit various behavioral manifestations, none of which is diagnostic for sexual abuse. When children report potentially sexually abusive experiences, their reports need to be taken seriously. Other children in the household also need to be evaluated. In children who are sexually abused, it is often difficult to identify other evidence. In one study, approximately 96% of children who were sexually abused had normal genital and anal findings. The ability to retell the story is partly dependent on the child's cognitive level. Children who repeatedly tell identical stories may have been coached.

A father calls the clinic because he found his young daughter squirting Visine eyedrops into her mouth. What is the most appropriate nursing action? a. Reassure the father that Visine is harmless. b. Direct him to seek immediate medical treatment. c. Recommend inducing vomiting with ipecac. d. Advise him to dilute Visine by giving his daughter several glasses of water to drink.

b. Direct him to seek immediate medical treatment. Visine is a sympathomimetic and if ingested may cause serious consequences. Medical treatment is necessary. Inducing vomiting is no longer recommended for ingestions. Dilution will not decrease risk.

What are classified as hydrocarbon poisons? (Select all that apply.) a. Bleach b. Gasoline c. Turpentine d. Lighter fluid e. Oven cleaners

b. Gasoline c. Turpentine d. Lighter fluid Gasoline, turpentine, and lighter fluid are classified as hydrocarbon poisons. Bleach and oven cleaners are classified as corrosive poisons.

The nurse is having difficulty communicating with a hospitalized 6-year-old child. Which technique should be most helpful? a. Recommend that the child keep a diary. b. Provide supplies for the child to draw a picture. c. Suggest that the parent read fairy tales to the child. d. Ask the parent if the child is always uncommunicative.

b. Provide supplies for the child to draw a picture. Drawing is one of the most valuable forms of communication. Children's drawings tell a great deal about them because they are projections of the children's inner self. A diary should be difficult for a 6-year-old child, who is most likely learning to read. The parent reading fairy tales to the child is a passive activity involving the parent and child; it should not facilitate communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers, not always uncommunicative.

The nurse should know what about Lyme disease? a. Very difficult to prevent b. Easily treated with oral antibiotics in stages 1, 2, and 3 c. Caused by a spirochete that enters the skin through a tick bite d. Common in geographic areas where the soil contains the mycotic spores that cause the disease

c. Caused by a spirochete that enters the skin through a tick bite Lyme disease is caused by Borrelia burgdorferi, a spirochete spread by ticks. The early characteristic rash is erythema migrans. Tick bites should be avoided by entering tick-infested areas with caution. Light-colored clothing should be worn to identify ticks easily. Long-sleeve shirts and long pants tucked into socks should be the attire. Early treatment of erythema migrans (stage 1) can prevent the development of Lyme disease. Lyme disease is caused by a spirochete, not mycotic spores.

Which is the single most important factor to consider when communicating with children? a. Presence of the child's parent b. Child's physical condition c. Child's developmental level d. Child's nonverbal behaviors

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

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

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

When doing a nutritional assessment on a Hispanic family, the nurse learns that their diet consists mainly of vegetables, legumes, and starches. The nurse should recognize that this diet is which? a. Lacking in protein b. Indicating they live in poverty c. Providing sufficient amino acids d. Needing enrichment with meat and milk

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

During a routine health assessment, the nurse notes that an 8-month-old infant has a significant head lag. Which is the most appropriate action? a. Recheck head control at next visit. b. Teach the parents appropriate exercises. c. Schedule the child for further evaluation. d. Refer the child for further evaluation if the anterior fontanel is still open.

c. Schedule the child for further evaluation. Significant head lag after age 6 months strongly indicates cerebral injury and is referred for further evaluation. Head control is part of normal development. Exercises will not be effective. The lack of achievement of this developmental milestone must be evaluated.

A child with corrosive poisoning is being admitted to the emergency department. What clinical manifestation does the nurse expect to assess on this child? a. Nausea and vomiting b. Alterations in sensorium, such as lethargy c. Severe burning pain in the mouth, throat, and stomach d. Respiratory symptoms of acute pulmonary involvement

c. Severe burning pain in the mouth, throat, and stomach Severe burning pain in the mouth, throat, and stomach is a clinical manifestation of corrosive poisoning. Nausea and vomiting; alterations in sensorium, such as lethargy; and respiratory symptoms of acute pulmonary involvement are clinical manifestations of hydrocarbon poisoning.

The school reviewed the pediculosis capitis (head lice) policy and removed the "no nit" requirement. The nurse explains that now, when a child is found to have nits, the parents must do which before the child can return to school? a. No treatment is necessary with the policy change. b. Shampoo and then trim the child's hair to prevent reinfestation. c. The child can remain in school with treatment done at home. d. Treat the child with a shampoo to treat lice and comb with a fine-tooth comb every day until nits are eliminated.

c. The child can remain in school with treatment done at home. Many children have missed significant amounts of school time with "no nit" policies. The child should be appropriately treated with a pediculicide and a fine-tooth comb. The environment needs to be treated to prevent reinfestation. The treatment with the pediculicide will kill the lice and leave nit casings. Cutting the child's hair is not recommended; lice infest short hair as well as long. With a "no nit" policy, treating the child with a shampoo to treat lice and combing the hair with a fine-tooth comb every day until nits are eliminated is the correct treatment. The policy change recognizes that most nits do not become lice.

The nurse is administering the first hepatitis A vaccine to an 18-month-old child. When should the child return to the clinic for the second dose of hepatitis A vaccination? a. After 2 months b. After 3 months c. After 4 months d. After 6 months

d. After 6 months Hepatitis A vaccine is now recommended for all children beginning at age 1 year (i.e., 12 months to 23 months). The second dose in the two-dose series may be administered no sooner than 6 months after the first dose.

The nurse is describing clinical reasoning to a group of nursing students. Which is most descriptive of clinical reasoning? a. Purposeful and goal directed b. A simple developmental process c. Based on deliberate and irrational thought d. Assists individuals in guessing what is most appropriate

a. Purposeful and goal directed Clinical reasoning is a complex developmental process based on rational and deliberate thought. When thinking is clear, precise, accurate, relevant, consistent, and fair, a logical connection develops between the elements of thought and the problem at hand.

Which is the most frequently used test for measuring visual acuity? a. Snellen letter chart b. Ishihara vision test c. Allen picture card test d. Denver eye screening test

a. Snellen letter chart The Snellen letter chart, which consists of lines of letters of decreasing size, is the most frequently used test for visual acuity. The Ishihara Vision Test is used for color vision. The Allen picture card test and Denver eye screening test involve single cards for children ages 2 years and older who are unable to use the Snellen letter chart.

The clinic nurse is reviewing statistics on infant mortality for the United States versus other countries. Compared with other countries that have a population of at least 25 million, the nurse makes which determination? a. The United States is ranked last among 27 countries. b. The United States is ranked similar to 20 other developed countries. c. The United States is ranked in the middle of 20 other developed countries. d. The United States is ranked highest among 27 other industrialized countries.

a. The United States is ranked last among 27 countries. Although the death rate has decreased, the United States still ranks last in infant mortality among nations with a population of at least 25 million. The United States has the highest infant death rate of developed nations.

A father with an X-linked recessive disorder asks the nurse what the probability is that his sons will have the disorder. Which response should the nurse make? a. "Male children will be carriers." b. "All male children will be affected." c. "None of the sons will have the disorder." d. "It cannot be determined without more data."

c. "None of the sons will have the disorder." When a male has an X-linked recessive disorder, he has one copy of the allele on his X chromosome. The father passes only his Y chromosome (not the X chromosome) to his sons. Therefore, none of his sons will have the X-linked recessive gene. They will not be carriers or be affected by the disorder. No additional data are needed to answer this question.

Early diagnosis of congenital hypothyroidism (CH) and phenylketonuria (PKU) is essential to prevent which? a. Obesity b. Diabetes c. Cognitive impairment d. Respiratory distress

c. Cognitive impairment Untreated, both PKU and CH cause cognitive impairment. With newborn screening and early intervention, cognitive impairment from these two disorders can be prevented. Obesity, diabetes, and respiratory distress do not result from both CH and PKU.

What is a primary goal in caring for a child with cognitive impairment? a. Developing vocational skills b. Promoting optimum development c. Finding appropriate out-of-home care d. Helping child and family adjust to future care

b. Promoting optimum development The goal for children with cognitive impairment is the promotion of optimum social, physical, cognitive, and adaptive development as individuals within a family and community. Vocational skills are only one part of that goal. The focus must also be on the family and other aspects of development. Out-of-home care is considered part of the child's development. Optimum development includes adjustment for both the family and child.

What do inflicted immersion burns often appear as? a. Partial-thickness, asymmetrical burns b. Splash pattern burns on hands or feet c. Any splash burn with dry linear marks d. Sharply demarcated, symmetrical burns

d. Sharply demarcated, symmetrical burns Immersion burns are sharply demarcated symmetrical burns. Asymmetrical burns and splash burns are often accidental.

The nurse is preparing to perform a physical assessment on a 10-year-old girl. The nurse gives her the option of her mother staying in the room or leaving. This action should be considered which? a. Appropriate because of child's age b. Appropriate, but the mother may be uncomfortable c. Inappropriate because of child's age d. Inappropriate because child is same sex as mother

a. Appropriate because of child's age It is appropriate to give older school-age children the option of having the parent present or not. During the examination, the nurse should respect the child's need for privacy. Children who are 10 years old are minors, and parents are responsible for health care decisions. The mother of a 10-year-old child would not be uncomfortable. The child should help determine who is present during the examination.

The nurse is completing a physical and gestational age assessment on an infant who is 12 hours old. Which components are included in the gestational age assessment? (Select all that apply.) a. Arm recoil b. Popliteal angle c. Motor performance d. Primitive reflexes e. Square window f. Scarf sign

a. Arm recoil b. Popliteal angle e. Square window f. Scarf sign The components of the typical gestational age assessment include posture, square window, arm recoil, popliteal angle, scarf sign, and heel to ear. Motor performance and reflexes are parts of the behaviors in the Brazelton Neonatal Behavioral Assessment Scale.

The nurse is teaching parents about the effects of media on childhood obesity. The nurse realizes the parents understand the teaching if they make which statements? (Select all that apply.) a. "Advertising of unhealthy food can increase snacking." b. "Increased screen time may be related to unhealthy sleep." c. "There is a link between the amount of screen time and obesity." d. "Increased screen time can lead to better knowledge of nutrition." e. "Physical activity increases when children increase the amount of screen time."

a. "Advertising of unhealthy food can increase snacking." b. "Increased screen time may be related to unhealthy sleep." c. "There is a link between the amount of screen time and obesity." A number of studies have demonstrated a link between the amount of screen time and obesity. Advertising of unhealthy food to children is a long-standing marketing practice, which may increase snacking in the face of decreased activity. In addition, both increased screen time and unhealthy eating may also be related to unhealthy sleep. Increased screen time does not lead to a better knowledge of nutrition or increased physical activity.

Which is a complication that can occur after abdominal surgery if pain is not managed? a. Atelectasis b. Hypoglycemia c. Decrease in heart rate d. Increase in cardiac output

a. Atelectasis Pain associated with surgery in the abdominal region (e.g., appendectomy, cholecystectomy, splenectomy) may result in pulmonary complications. Pain leads to decreased muscle movement in the thorax and abdominal area and leads to decreased tidal volume, vital capacity, functional residual capacity, and alveolar ventilation. The patient is unable to cough and clear secretions, and the risk for complications such as pneumonia and atelectasis is high. Severe postoperative pain also results in sympathetic overactivity, which leads to increases in heart rate, peripheral resistance, blood pressure, and cardiac output. Hypoglycemia, decreases in heart rate, and increases in cardiac output are not complications of poor pain management.

The nurse is planning care for a child with chickenpox (varicella). Which prescribed supportive measures should the nurse plan to implement? (Select all that apply.) a. Administration of acyclovir (Zovirax) b. Administration of azithromycin (Zithromax) c. Administration of Vitamin A supplementation d. Administration of acetaminophen (Tylenol) for fever e. Administration of diphenhydramine (Benadryl) for itching

a. Administration of acyclovir (Zovirax) d. Administration of acetaminophen (Tylenol) for fever e. Administration of diphenhydramine (Benadryl) for itching Chickenpox is a virus, and acyclovir is ordered to lessen the symptoms. Benadryl and Tylenol are prescribed as supportive treatments. Vitamin A supplementation is used for treating rubeola. Zithromax is an antibiotic prescribed for bacterial infections such as pertussis.

Parents ask the nurse about the characteristics of autosomal recessive inheritance. Which is characteristic of autosomal recessive inheritance? a. Affected individuals have unaffected parents. b. Affected individuals have one affected parent. c. Affected parents have a 50% chance of having an affected child. d. Affected parents will have unaffected children.

a. Affected individuals have unaffected parents. Parents who are carriers of a recessive gene are asymptomatic. For a child to be affected, both parents must have a copy of the gene, which is passed to the child. Both parents are asymptomatic but can have affected children. In autosomal recessive inheritance, there is a 25% chance that each pregnancy will result in an affected child. In autosomal dominant inheritance, affected parents can have unaffected children.

A newborn has been diagnosed with congenital adrenal hyperplasia. Which assessment finding should the nurse expect? a. Ambiguous genitalia b. Prenatal growth retardation c. An abnormally large tongue d. Legs and arms significantly shorter than torso

a. Ambiguous genitalia A newborn diagnosed with congenital adrenal hyperplasia can have ambiguous genitalia or virilization of female external genitalia caused by elevated androgen levels. Prenatal growth retardation is present with Bloom syndrome. An abnormally large tongue is seen with Beckwith-Wiedemann syndrome. Legs and arms significantly shorter than torso are seen with achondroplasia.

Which should the nurse teach to parents regarding oral health of children? (Select all that apply.) a. Fluoridated water should be used. b. Early childhood caries is a preventable disease. c. Dental caries is a rare chronic disease of childhood. d. Dental hygiene should begin with the first tooth eruption. e. Childhood caries does not happen until after 2 years of age.

a. Fluoridated water should be used. b. Early childhood caries is a preventable disease. d. Dental hygiene should begin with the first tooth eruption. Oral health instructions to parents of children should include use of fluoridated water and dental hygiene beginning with the first tooth eruption. In addition, early childhood caries is a preventable disease and should be included in the teaching session. Dental caries is a common, not rare, chronic disease of childhood. Childhood caries may begin before the first birthday.

Because children younger than 5 years are egocentric, the nurse should do which when communicating with them? a. Focus communication on the child. b. Use easy analogies when possible. c. Explain experiences of others to the child. d. Assure the child that communication is private.

a. Focus communication on the child. Because children of this age are able to see things only in terms of themselves, the best approach is to focus communication directly on them. Children should be provided with information about what they can do and how they will feel. With children who are egocentric, analogies, experiences, and assurances that communication is private will not be effective because the child is not capable of understanding.

Which are signs and symptoms the nurse should assess in the newborn that can indicate an inborn error of metabolism? (Select all that apply.) a. Jaundice b. Strabismus c. Poor feeding d. Acrocyanosis e. Metabolic acidosis

a. Jaundice c. Poor feeding e. Metabolic acidosis Signs of inborn errors of metabolism include jaundice, poor feeding, and metabolic acidosis. Strabismus and acrocyanosis are normal findings in the newborn.

A child has a slight (26-40 dB) degree of hearing loss. The nurse recognizes this amount of hearing loss can have what effect? (Select all that apply.) a. No speech defects b. Difficulty hearing faint speech c. Usually is unaware of the hearing difficulty d. Can distinguish vowels but not consonants e. Unable to understand conversational speech

a. No speech defects b. Difficulty hearing faint speech c. Usually is unaware of the hearing difficulty A child with a slight degree of hearing loss has no speech defects, may have difficulty hearing faint speech, and is usually unaware of the hearing difficulty. The ability to distinguish vowels but not consonants is an effect of severe hearing loss and being unable to understand conversational speech is an effect of moderately severe hearing loss.

The nurse is planning care for an infant with candidiasis (moniliasis) diaper dermatitis. Which topical ointments may be prescribed for the patient? (Select all that apply.) a. Nystatin b. Bactroban c. Neosporin d. Miconazole e. Clotrimazole

a. Nystatin d. Miconazole e. Clotrimazole Candidiasis diaper dermatitis skin lesions are treated with topical nystatin, miconazole, and clotrimazole. Bactroban and Neosporin are used to treat bacterial dermatitides.

Which responsibilities are included in the pediatric nurse's promotion of the health and well-being of children? (Select all that apply.) a. Promoting disease prevention b. Providing financial assistance c. Providing support and counseling d. Establishing lifelong friendships e. Establishing a therapeutic relationship f. Participating in ethical decision making

a. Promoting disease prevention c. Providing support and counseling e. Establishing a therapeutic relationship f. Participating in ethical decision making The pediatric nurse's role includes promoting disease prevention, providing support and counseling, establishing a therapeutic relationship, and participating in ethical decision making; a pediatric nurse does not need to establish lifelong friendships or provide financial assistance to children and their families. Boundaries should be set and clear.

The nurse is preparing to complete documentation on a patient's chart. Which should be included in documentation of nursing care? (Select all that apply.) a. Reassessments b. Incident reports c. Initial assessments d. Nursing care provided e. Patient's response of care provided

a. Reassessments c. Initial assessments d. Nursing care provided e. Patient's response of care provided The patient's medical record should include: initial assessments, reassessments, nursing care provided, and the patient's response of care provided. Incident reports are not documented in the patient's chart.

Which describe the feelings and behaviors of early preschool children related to divorce? (Select all that apply.) a. Regressive behavior b. Fear of abandonment c. Fear regarding the future d. Blame themselves for the divorce e. Intense desire for reconciliation of parents

a. Regressive behavior b. Fear of abandonment d. Blame themselves for the divorce Feelings and behaviors of early preschool children related to divorce include regressive behavior, fear of abandonment, and blaming themselves for the divorce. Fear regarding the future and intense desire for reconciliation of parents is a reaction later school-age children have to divorce.

Which data should be included in a health history? a. Review of systems b. Physical assessment c. Growth measurements d. Record of vital signs

a. Review of systems A review of systems is done to elicit information concerning any potential health problems. This further guides the interview process. Physical assessment, growth measurements, and a record of vital signs are components of the physical examination.

The nurse is assessing heart sounds on a school-age child. Which should the nurse document as abnormal findings if found on the assessment? (Select all that apply.) a. S4 heart sound b. S3 heart sound c. Grade II murmur d. S1 louder at the apex of the heart e. S2 louder than S1 in the aortic area

a. S4 heart sound c. Grade II murmur e. S2 louder than S1 in the aortic area S4 is rarely heard as a normal heart sound; it usually indicates the need for further cardiac evaluation. A grade II murmur is not normal; it is slightly louder than grade I and is audible in all positions. S3 is normally heard in some children. Normally, S1 is louder at the apex of the heart in the mitral and tricuspid area, and S2 is louder near the base of the heart in the pulmonic and aortic area.

What are symptoms of abusive head trauma (AHT) in the more severe form that may be present? (Select all that apply.) a. Seizures b. Posturing c. Tachypnea d. Tachycardia e. Altered level of consciousness

a. Seizures b. Posturing e. Altered level of consciousness In more severe forms, presenting symptoms of abusive head trauma may include seizures, posturing, alterations in level of consciousness, apnea, bradycardia, or death.

A parent of a school-age child tells the school nurse that the parents are going through a divorce. The child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as what? a. Indicative of maladjustment b. A common reaction to divorce c. Suggestive of a lack of adequate parenting d. An unusual response that indicates a need for referral

b. A common reaction to divorce Parental divorce affects school-age children in many ways. In addition to difficulties in school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite, and sleep disorders. The child's responses are common reactions of school-age children to parental divorce.

Which term describes irregular areas of deep blue pigmentation seen predominantly in infants of African, Asian, Native American, or Hispanic descent? a. Acrocyanosis b. Mongolian spots c. Erythema toxicum d. Harlequin color change

b. Mongolian spots Mongolian spots are irregular areas of deep blue pigmentation, which are common variations found in newborns of African, Asian, Native American, or Hispanic descent. Acrocyanosis is cyanosis of the hands and feet; this is a usual finding in infants. Erythema toxicum is a pink papular rash with vesicles that may appear in 24 to 48 hours and resolve after several days. Harlequin color changes are clearly outlined areas of color change. As the infant lies on a side, the lower half of the body becomes pink, and the upper half is pale.

Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period? a. Codeine sulfate (Codeine) b. Morphine (Roxanol) c. Methadone (Dolophine) d. Meperidine (Demerol)

b. Morphine (Roxanol) The most commonly prescribed medications for PCA are morphine, hydromorphone, and fentanyl. Parenteral use of codeine is not recommended. Methadone in parenteral form is not used in a PCA but is given orally or intravenously for pain in the infant. Meperidine is not used for continuous and extended pain relief.

What is most important in the management of cellulitis? a. Burow solution compresses b. Oral or parenteral antibiotics c. Topical application of an antibiotic d. Incision and drainage of severe lesions

b. Oral or parenteral antibiotics Oral or parenteral antibiotics are indicated depending on the extent of the cellulitis. Warm water compresses may be indicated for limited cellulitis. The antibiotic needs to be administered systemically. Incision and drainage of severe lesions presents a risk of spreading infection or making the lesion worse.

The nurse is reviewing the importance of role learning for children. The nurse understands that children's roles are primarily shaped by which members? a. Peers b. Parents c. Siblings d. Grandparents

b. Parents Children's roles are shaped primarily by the parents, who apply direct or indirect pressures to induce or force children into the desired patterns of behavior or direct their efforts toward modification of the role responses of the child on a mutually acceptable basis.

In term newborns, the first meconium stool should occur no later than within how many hours after birth? a. 6 b. 8 c. 12 d. 24

d. 24 The first meconium stool should occur within the first 24 hours. It may be delayed up to 7 days in very low-birth-weight newborns.

The family and child have decided that hospice care best meets their needs during the terminal phase of illness. The nurse recognizes that the parents understand the principles of this care when they make which statement? a. "It will be good to be at home and care for our child." b. "What a relief it will be not to need any more medicines." c. "We are going to miss the support of the hospice team when our child dies." d. "We know that once hospice care starts, we will not be able to return to the hospital if the care is difficult."

a. "It will be good to be at home and care for our child." A major principle of hospice care is that the family members are the principal caregivers and are supported by a team of professionals. Pain and symptom management is a priority. The family and visiting nurses administer medications to keep the child as pain and symptom free as possible. The hospice team provides bereavement support to help the family in the postdeath adjustment. This may last for up to a year or more. If the family decides they can no longer care for the child at home, readmission to a freestanding hospice or hospital is possible.

Children as young as age 3 years can use facial scales for discrimination. What are some suggested anchor words for the preschool age group? a. "No hurt." b. "Red pain." c. "Zero hurt." d. "Least pain."

a. "No hurt." "No hurt" is a phrase that is simple, concrete, and appropriate to the preoperational stage of the child. Using color is complicated for this age group. The child needs to identify colors and pain levels and then choose an appropriate symbolic color. This is appropriate for an older child. Zero is an abstract construct not appropriate for this age group. "Least pain" is less concrete than "no hurt."

A child has been diagnosed with cat scratch disease. The nurse explains which characteristics about this disease? a. "The disease is usually a benign, self-limiting illness." b. "The animal that transmitted the disease will also be ill." c. "The disease is treated with a 5-day course of oral azithromycin." d. "Symptoms include pruritus, especially at the site of inoculation."

a. "The disease is usually a benign, self-limiting illness." The disease is usually a benign, self-limiting illness that resolves spontaneously in 4 to 6 weeks. The animals are not ill during the time they transmit the disease. Treatment is primarily supportive. Antibiotics do not shorten the duration or prevent progression to suppuration. The usual manifestation is a painless, nonpruritic erythematous papule at the site of inoculation.

The nurse is preparing an education program on hearing impairment for a group of new staff nurses. What concepts should be included? (Select all that apply.) a. A child with a slight hearing loss is usually unaware of a hearing difficulty. b. A clinical manifestation of a hearing impairment in children is avoidance of social interaction. c. A child with a severe hearing loss may hear a loud voice if nearby. d. Children with sensorineural hearing loss can benefit from the use of a hearing aid. e. A clinical manifestation of hearing impairment in an infant is lack of the startle reflex. f. Identification of a hearing loss after the first year is essential to facilitate language development in children.

a. A child with a slight hearing loss is usually unaware of a hearing difficulty. b. A clinical manifestation of a hearing impairment in children is avoidance of social interaction. c. A child with a severe hearing loss may hear a loud voice if nearby. e. A clinical manifestation of hearing impairment in an infant is lack of the startle reflex. When discussing hearing impairment in children, the nurse should include information about differences in hearing losses, such as with a slight hearing loss, the child is usually unaware of a hearing difficulty, and with a severe loss, the child may hear a loud noise if it is nearby. An infant with a hearing loss may lack the startle response, and a hearing impaired child may avoid social interaction. Children with a sensorineural hearing loss would not benefit from a hearing aid. Identification of a hearing loss is imperative in the first 3 to 6 months to facilitate language and educational development for children.

During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is which? a. A normal finding b. A sign of a possible visual defect and a need for vision screening c. An abnormal finding requiring referral to an ophthalmologist d. A sign of small hemorrhages, which usually resolve spontaneously

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

What causes warts? a. A virus b. A fungus c. A parasite d. Bacteria

a. A virus Human warts are caused by the human papillomavirus. Infection with fungus, parasites, or bacteria does not result in warts.

Turner syndrome is suspected in an adolescent girl with short stature. What causes this? a. Absence of one of the X chromosomes b. Presence of an incomplete Y chromosome c. Precocious puberty in an otherwise healthy child d. Excess production of both androgens and estrogens

a. Absence of one of the X chromosomes Turner syndrome is caused by an absence of one of the X chromosomes. Most girls who have this disorder have one X chromosome missing from all cells. No Y chromosome is present in individuals with Turner syndrome. These young women have 45 rather than 46 chromosomes.

The nurse is planning care for a patient with a different ethnic background. Which should be an appropriate goal? a. Adapt, as necessary, ethnic practices to health needs. b. Attempt, in a nonjudgmental way, to change ethnic beliefs. c. Encourage continuation of ethnic practices in the hospital setting. d. Strive to keep ethnic background from influencing health needs.

a. Adapt, as necessary, ethnic practices to health needs. Whenever possible, nurses should facilitate the integration of ethnic practices into health care provision. The ethnic background is part of the individual; it should be difficult to eliminate the influence of ethnic background. The ethnic practices need to be evaluated within the context of the health care setting to determine whether they are conflicting.

The nurse is caring for a child receiving a continuous intravenous (IV) low-dose infusion of morphine for severe postoperative pain. The nurse observes a slower respiratory rate, and the child cannot be aroused. The most appropriate management of this child is for the nurse to do which first? a. Administer naloxone (Narcan). b. Discontinue the IV infusion. c. Discontinue morphine until the child is fully awake. d. Stimulate the child by calling his or her name, shaking gently, and asking the child to breathe deeply.

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

The nurse is conducting discharge teaching to an adolescent with a methicillin-resistant staphylococcus aureus (MRSA) infection. What should the nurse include in the instructions? (Select all that apply.) a. Avoid sharing of towels and washcloths. b. Launder clothes and bedding in cold water. c. Use bleach when laundering towels and washcloths. d. Take a daily bath or shower with an antibacterial soap. e. Apply mupirocin (Bactroban) to the nares twice a day for 2 to 4 weeks.

a. Avoid sharing of towels and washcloths. d. Take a daily bath or shower with an antibacterial soap. e. Apply mupirocin (Bactroban) to the nares twice a day for 2 to 4 weeks. For MRSA infection, the adolescent should be provided with washcloths and towels separate from those of other family members. Daily bathing or showering with an antibacterial soap is also recommended. Mupirocin should be applied to the nares of those with MRSA infection twice daily for 2 to 4 weeks. Clothing should be laundered in warm to hot water, not cold, and bleach does not need to be used when laundering towels and washcloths.

The nurse is teaching parents of preschoolers about plants that are poisonous. What plant should the nurse include in the teaching session? a. Azalea b. Begonia c. Boston fern d. Asparagus fern

a. Azalea All parts of the azalea are poisonous. Begonias, Boston ferns, and asparagus ferns are nonpoisonous plants.

The nurse should suspect a hearing impairment in an infant who fails to demonstrate which behavior? a. Babbling by age 12 months b. Eye contact when being spoken to c. Startle or blink reflex to sound d. Gesturing to indicate wants after age 15 months

a. Babbling by age 12 months The absence of babbling or inflections in voice by at least age 7 months is an indication of hearing difficulties. Lack of eye contact is not indicative of a hearing loss. An infant with a hearing impairment might react to a loud noise but not respond to the spoken word. The child with hearing impairment uses gestures rather than vocalizations to express desires at this age.

The nurse is teaching parents of preschool-aged children strategies to prevent sexual abuse. What should the nurse include in the teaching session? (Select all that apply.) a. Back up a child's right to say no. b. Don't take what your child says too seriously. c. Take a second look at signals of potential danger. d. Don't be too detailed about examples of sexual assault. e. Remind children that even "nice" people sometimes do mean things.

a. Back up a child's right to say no. c. Take a second look at signals of potential danger e. Remind children that even "nice" people sometimes do mean things. To provide protection and preparation from sexual abuse, parents should back up a child's right to say no, take a second look at signals of potential danger, and remind children that even "nice" people sometimes do mean things. Parents should take what children say seriously and they should give specific definitions and examples of sexual assault.

What are classified as corrosive poisons? (Select all that apply.) a. Batteries b. Paint thinner c. Drain cleaners d. Mineral seed oil e. Mildew remover

a. Batteries c. Drain cleaners e. Mildew remover Batteries, drain cleaners, and mildew removers are classified as corrosive poisons. Paint thinner and mineral seed oil are classified as hydrocarbon poisons.

The nurse is teaching parents of preschool children consequences of inadequate sleep. What should the nurse include in the teaching session? (Select all that apply.) a. Behavior changes b. Increased appetite c. Difficulty concentrating d. Poor control of emotions e. Impaired learning ability

a. Behavior changes c. Difficulty concentrating d. Poor control of emotions e. Impaired learning ability Consequences of inadequate sleep include daytime tiredness, behavior changes, hyperactivity, difficulty concentrating, impaired learning ability, poor control of emotions and impulses, and strain on family relationships. Increased appetite is not a consequence of inadequate sleep.

Which actions by the nurse demonstrate overinvolvement with patients and their families? (Select all that apply.) a. Buying clothes for the patients b. Showing favoritism toward a patient c. Focusing on technical aspects of care d. Spending off-duty time with patients and families e. Asking questions if families are not participating in care

a. Buying clothes for the patients b. Showing favoritism toward a patient d. Spending off-duty time with patients and families Actions that show overinvolvement include buying clothes for patients, showing favoritism toward a patient, and spending off-duty time with patients and families. Focusing on technical aspects of care is an action that indicates under involvement, and asking questions if families are not participating in care indicates a positive action.

Lymphangitis (streaking) is frequently seen in what? a. Cellulitis b. Folliculitis c. Impetigo contagiosa d. Staphylococcal scalded skin

a. Cellulitis Lymphangitis is frequently seen in cellulitis. If it is present, hospitalization is usually required for parenteral antibiotics. Lymphangitis is not associated with folliculitis, impetigo, or staphylococcal scalded skin.

The nurse is talking to a group of parents of school-age children at an after-school program about childhood health problems. Which statement should the nurse include in the teaching? a. Childhood obesity is the most common nutritional problem among children. b. Immunization rates are the same among children of different races and ethnicity. c. Dental caries is not a problem commonly seen in children since the introduction of fluoridated water. d. Mental health problems are typically not seen in school-age children but may be diagnosed in adolescents.

a. Childhood obesity is the most common nutritional problem among children. When teaching parents of school-age children about childhood health problems, the nurse should include information about childhood obesity because it is the most common problem among children and is associated with type 2 diabetes. Teaching parents about ways to prevent obesity is important to include. Immunization rates differ depending on the child's race and ethnicity; dental caries continues to be a common chronic disease in childhood; and mental health problems are seen in children as young as school age, not just in adolescents.

Which is the leading cause of death in infants younger than 1 year in the United States? a. Congenital anomalies b. Sudden infant death syndrome c. Disorders related to short gestation and low birth weight d. Maternal complications specific to the perinatal period

a. Congenital anomalies Congenital anomalies account for 20.1% of deaths in infants younger than 1 year compared with sudden infant death syndrome, which accounts for 8.2%; disorders related to short gestation and unspecified low birth weight, which account for 16.5%; and maternal complications such as infections specific to the perinatal period, which account for 6.1% of deaths in infants younger than 1 year of age.

The nurse is presenting a staff development program about understanding culture in the health care encounter. Which components should the nurse include in the program? (Select all that apply.) a. Cultural humility b. Cultural research c. Cultural sensitivity d. Cultural competency

a. Cultural humility c. Cultural sensitivity d. Cultural competency There are several different ways health care providers can best attend to all the different facets that make up an individual's culture. Cultural competence tends to promote building information about a specific culture. Cultural sensitivity, a second way of understanding culture in the context of the clinical encounter, may be understood as a way of using one's knowledge, consideration, understanding, respect, and tailoring after realizing awareness of self and others and encountering a diverse group or individual. Cultural humility, the third component, is a commitment and active engagement in a lifelong process that individuals enter into for an ongoing basis with patients, communities, colleagues, and themselves. Cultural research is not a component of understanding culture in the health care encounter.

A 4-month-old infant comes to the clinic for a well-infant checkup. Immunizations she should receive are DTaP (diphtheria, tetanus, acellular pertussis) and IPV (inactivated poliovirus vaccine). She is recovering from a cold but is otherwise healthy and afebrile. Her older sister has cancer and is receiving chemotherapy. Nursing considerations should include which? a. DTaP and IPV can be safely given. b. DTaP and IPV are contraindicated because she has a cold. c. IPV is contraindicated because her sister is immunocompromised. d. DTaP and IPV are contraindicated because her sister is immunocompromised.

a. DTaP and IPV can be safely given. These immunizations can be given safely. Serious illness is a contraindication. A mild illness with or without fever is not a contraindication. These are not live vaccines, so they do not pose a risk to her sister.

The nurse is reviewing the Healthy People 2020 leading health indicators for a child health promotion program. Which are included in the leading health indicators? (Select all that apply.) a. Decrease tobacco use. b. Improve immunization rates. c. Reduce incidences of cancer. d. Increase access to health care. e. Decrease the number of eating disorders

a. Decrease tobacco use. b. Improve immunization rates. d. Increase access to health care. The Healthy People 2020 leading health indicators provide a framework for identifying essential components for child health promotion programs designed to prevent future health problems in our nation's children. Some of the leading health indicators include decreasing tobacco use, improving immunization rates, and increasing access to health care. Reducing the incidence of cancer and decreasing the number of eating disorders are not on the list as leading health indicators.

Which are included in the evaluation step of the nursing process? (Select all that apply.) a. Determination if the outcome has been met b. Ascertaining if the plan requires modification c. Establish priorities and selecting expected patient goals d. Selecting alternative interventions if the outcome has not been met e. Determining if a risk or actual dysfunctional health problem exists

a. Determination if the outcome has been met b. Ascertaining if the plan requires modification d. Selecting alternative interventions if the outcome has not been met Evaluation is the last step in the nursing process. The nurse gathers, sorts, and analyzes data to determine whether (1) the established outcome has been met, (2) the nursing interventions were appropriate, (3) the plan requires modification, or (4) other alternatives should be considered. Establishing priorities and selecting expected patient goals are done in the outcomes identification stage. Determining if a risk or actual dysfunctional health problem exists is done in the diagnosis stage of the nursing process.

Which describe the feelings and behaviors of adolescents related to divorce? (Select all that apply.) a. Disturbed concept of sexuality b. May withdraw from family and friends c. Worry about themselves, parents, or siblings d. Expression of anger, sadness, shame, or embarrassment e. Engage in fantasy to seek understanding of the divorce

a. Disturbed concept of sexuality b. May withdraw from family and friends c. Worry about themselves, parents, or siblings d. Expression of anger, sadness, shame, or embarrassment Feelings and behaviors of adolescents related to divorce include a disturbed concept of sexuality; withdrawing from family and friends; worrying about themselves, parents, and siblings; and expressions of anger, sadness, shame, and embarrassment. Engaging in fantasy to seek understanding of the divorce is a reaction by a child who has preconceptual cognitive processes, not the formal thinking processes adolescents have.

What can the nurse suggest to families to reduce blood lead levels? (Select all that apply.) a. Do not store food in open cans. b. Ensure the child eats regular meals. c. Mix formula with hot water from the tap. d. Vacuum hard-surfaced floors and window wells. e. Wash and dry the child's hands and face frequently.

a. Do not store food in open cans. b. Ensure the child eats regular meals. e. Wash and dry the child's hands and face frequently. To reduce blood lead levels, the family should ensure the child eats regular meals because more lead is absorbed on an empty stomach. The child's hands and face should be washed and dried frequently, especially before eating. Food should not be stored in open cans, particularly if cans are imported. Hot water dissolves lead more quickly than cold water and thus contains higher levels of lead. Hot water should not be used to mix formula. Hard-surfaced floors or window sills or wells should not be vacuumed because this spreads dust.

The nurse is caring for a child with suspected ingestion of some type of poison. What action should the nurse take next after initiating cardiopulmonary resuscitation (CPR)? a. Empty the mouth of pills, plants, or other material. b. Question the victim and witness. c. Place the child in a side-lying position. d. Call poison control.

a. Empty the mouth of pills, plants, or other material. Emptying the mouth of any leftover pills, plants, or other ingested material is the next step after assessment and initiation of CPR if needed. Questioning the victim and witnesses, calling poison control, and placing the child in a side-lying position are follow-up steps.

The nurse should plan which actions to facilitate lipreading for a child with a hearing impairment? (Select all that apply.) a. Face the child directly. b. Speak at eye level. c. Keep sentences short. d. Speak at a fast, even-paced rate. e. Establish eye contact and show interest.

a. Face the child directly. b. Speak at eye level. c. Keep sentences short. e. Establish eye contact and show interest. To facilitate lipreading, the nurse should plan to face the child directly, speak at eye level, keep sentences short, and establish eye contact and show interest. The nurse should plan to speak at a slow rate, not a fast one.

What is a function of brown adipose tissue (BAT) in newborns? a. Generates heat for distribution to other parts of body b. Provides ready source of calories in the newborn period c. Protects newborns from injury during the birth process d. Insulates the body against lowered environmental temperature

a. Generates heat for distribution to other parts of body Brown fat is a unique source of heat for newborns. It has a larger content of mitochondrial cytochromes and a greater capacity for heat production through intensified metabolic activity than does ordinary adipose tissue. Heat generated in brown fat is distributed to other parts of the body by the blood. It is effective only in heat production. Brown fat is located in superficial areas such as between the scapulae, around the neck, in the axillae, and behind the sternum. These areas should not protect the newborn from injury during the birth process. The newborn has a thin layer of subcutaneous fat, which does not provide for conservation of heat.

The clinic nurse is assessing an infant. What are early signs of cognitive impairment the nurse should discuss with the health care provider? (Select all that apply.) a. Head lag at 11 months of age b. No pincer grasp at 4 months of age c. Colicky incidents at 3 months of age d. Unable to speak two to three words at 24 months of age e. Unresponsiveness to the environment at 12 months of age

a. Head lag at 11 months of age d. Unable to speak two to three words at 24 months of age e. Unresponsiveness to the environment at 12 months of age Early signs of cognitive impairment include gross motor delay (head lag should be established by 6 months, and head lag still present at 11 months is a delay), language delay (normal language development is speaking two to three words by age 12 months; if unable to speak two to three words at 24 months, that is a delay), and unresponsiveness to the environment at 12 months. No pincer grasp at 4 months of age is normal (palmar grasp is the expected finding), and colicky incidents at 3 months of age is a normal finding.

Which assessments are included in the Apgar scoring system? (Select all that apply.) a. Heart rate b. Muscle tone c. Blood pressure d. Blood glucose e. Reflex irritability

a. Heart rate b. Muscle tone e. Reflex irritability The Apgar score is based on observation of heart rate, respiratory effort, muscle tone, reflex irritability, and color. Blood pressure and blood glucose are not part of the Apgar scoring system.

The inheritance of which is X-linked recessive? a. Hemophilia A b. Marfan syndrome c. Neurofibromatosis d. Fragile X syndrome

a. Hemophilia A Hemophilia A is inherited as an X-linked recessive trait. Marfan syndrome and neurofibromatosis are inherited as autosomal dominant disorders. Fragile X is inherited as an X-linked trait.

Where in the health history does a record of immunizations belong? a. History b. Present illness c. Review of systems d. Physical assessment

a. History The history contains information relating to all previous aspects of the child's health status. The immunizations are appropriately included in the history. The present illness, review of systems, and physical assessment are not appropriate places to record the immunization status.

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

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

The nurse is conducting a teaching session for parents on nutrition. Which characteristics of families should the nurse consider that can cause families to struggle in providing adequate nutrition? (Select all that apply.) a. Homelessness b. Lower income c. Migrant status d. Working parents e. Single parent status

a. Homelessness b. Lower income c. Migrant status Families that struggle with lower incomes, homelessness, and migrant status generally lack the resources to provide their children with adequate food intake, nutritious foods such as fresh fruits and vegetables, and appropriate protein intake. Working parents and single parent status do not mean the families will struggle to provide adequate nutrition.

The nurse is preparing to assess a 10-month-old infant. He is sitting on his father's lap and appears to be afraid of the nurse and of what might happen next. Which initial actions by the nurse should be most appropriate? a. Initiate a game of peek-a-boo. b. Ask the infant's father to place the infant on the examination table. c. Talk softly to the infant while taking him from his father. d. Undress the infant while he is still sitting on his father's lap.

a. Initiate a game of peek-a-boo. Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his father. As much of the assessment as possible should be done with the child on the father's lap. The nurse should have the father undress the child as needed during the examination.

The nurse is seeing an adolescent and the parents in the clinic for the first time. Which should the nurse do first? a. Introduce him- or herself. b. Make the family comfortable. c. Give assurance of privacy. d. Explain the purpose of the interview.

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

Which is usually the only symptom of pediculosis capitis (head lice)? a. Itching b. Vesicles c. Scalp rash d. Localized inflammatory response

a. Itching Itching is generally the only manifestation of pediculosis capitis (head lice). Diagnosis is made by observation of the white eggs (nits) on the hair shaft. Vesicles, scalp rash, and localized inflammatory response are not symptoms of head lice.

The nurse is performing an oral examination on a preschool child. Which strategies should the nurse use to encourage the child to open the mouth for the examination? (Select all that apply.) a. Lightly brush the palate with a cotton swab. b. Perform the examination in front of a mirror. c. Let the child examine someone else's mouth first. d. Have the child breathe deeply and hold his or her breath. e. Use a tongue blade to help the child open his or her mouth.

a. Lightly brush the palate with a cotton swab. b. Perform the examination in front of a mirror. c. Let the child examine someone else's mouth first. d. Have the child breathe deeply and hold his or her breath. To encourage a child to open the mouth for examination, the nurse can lightly brush the palate with a cotton swab, perform the examination in front of a mirror, let the child examine someone else's mouth first, and have the child breathe deeply and hold his or her breath. A tongue blade may elicit the gag reflex and should not be used.

What nursing intervention is most appropriate when providing comfort and support for a child when death is imminent? a. Limit care to essentials. b. Avoid playing music near the child. c. Whisper to the child instead of using a normal voice. d. Explain to the child the need for constant measurement of vital signs.

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

A burn patient is experiencing anxiety over dressing changes. Which prescription should the nurse expect to be ordered to control anxiety? a. Lorazepam (Ativan) b. Oxycodone (OxyContin) c. Fentanyl (Sublimaze) d. Morphine Sulfate (Morphine)

a. Lorazepam (Ativan) A benzodiazepine such as lorazepam is prescribed as an antianxiety agent. Oxycodone, fentanyl, and morphine sulfate are opioid analgesics.

The nurse is teaching nursing students about assessment clues to genetic disorders in the newborn. Which should the nurse include in the teaching session? (Select all that apply.) a. Low-set ears b. Mongolian spots c. Epicanthal folds d. Cephalohematoma e. Forehead prominence

a. Low-set ears c. Epicanthal folds e. Forehead prominence Assessment clues to genetic disorders in the newborn include low-set ears, epicanthal folds, and forehead prominence. Mongolian spots and cephalohematoma are findings in a newborn that are not indicative of a genetic disorder.

Which is most important in the immediate care of the newborn? a. Maintain a patent airway. b. Administer prophylactic eye care. c. Maintain a stable body temperature. d. Establish identification of the mother and baby

a. Maintain a patent airway. Maintaining a patent airway is the primary objective in the care of the newborn. First, the pharynx is cleared with a bulb syringe followed by the nasal passages. Administering prophylactic eye care and establishing identification of the mother and baby are important functions, but physiologic stability is the first priority in the immediate care of the newborn. Conserving the newborn's body heat and maintaining a stable body temperature are important, but a patent airway must be established first.

An 18-month-old child has been diagnosed with pediculosis capitis (head lice). Which prescription should the nurse question if ordered for the child? a. Malathion (Ovide) b. Permethrin 1% (Nix) c. Benzyl alcohol 5% lotion d. Pyrethrin with piperonyl butoxide (RID)

a. Malathion (Ovide) The nurse should question malathion for an 18-month-old child. Malathion contains flammable alcohol, must remain in contact with the scalp for 8 to 12 hours, and is not recommended for children younger than 2 years of age. The drug of choice for infants and children is permethrin 1% cream rinse (Nix) or pyrethrin with piperonyl butoxide, which kill adult lice and nits. Benzyl alcohol 5% lotion has been approved by the Food and Drug Administration for the treatment of head lice in children as young as 6 months.

A child is admitted with a suspected diagnosis of Munchausen syndrome by proxy (MSBP). What is an important consideration in the care of this child? a. Monitoring the parents whenever they are with the child b. Reassuring the parents that the cause of the disorder will be found c. Teaching the parents how to obtain necessary specimens d. Supporting the parents as they cope with diagnosis of a chronic illness

a. Monitoring the parents whenever they are with the child MSBP refers to an illness that one person fabricates or induces in another. The child must be continuously observed for development of symptoms to determine the cause. MSBP is caused by an individual harming the child for the purpose of gaining attention. Nursing staff should obtain all specimens for analyzing. This minimizes the possibility of the abuser contaminating the sample. The child must be supported through the diagnosis of MSBP. The abuser must be identified and the child protected from that individual.

The nurse is planning a teaching session to adolescents about deaths by unintentional injuries. Which should the nurse include in the session with regard to deaths caused by injuries? a. More deaths occur in males. b. More deaths occur in females. c. The pattern of deaths does not vary according to age and sex. d. The pattern of deaths does not vary widely among different ethnic groups.

a. More deaths occur in males. The majority of deaths from unintentional injuries occur in males. The pattern of death does vary greatly among different ethnic groups, and the causes of unintentional deaths vary with age and gender.

Which coanalgesics should the nurse expect to be prescribed for pruritus? (Select all that apply.) a. Naloxone (Narcan) b. Inapsine (Droperidol) c. Hydroxyzine (Atarax) d. Promethazine (Phenergan) e. Diphenhydramine (Benadryl)

a. Naloxone (Narcan) c. Hydroxyzine (Atarax) e. Diphenhydramine (Benadryl) The coanalgesics prescribed for pruritus include naloxone, hydroxyzine, and diphenhydramine. Inapsine and promethazine are administered as antiemetics.

A parent asks the nurse about the "characteristics of a nightmare." What response should the nurse give to the parent? (Select all that apply.) a. Nightmares are scary dreams. b. The child can describe the nightmare. c. The child is reassured by your presence. d. Nightmares occur usually 1 to 4 hours after falling asleep. e. Nightmares take place during non-rapid eye movement sleep

a. Nightmares are scary dreams. b. The child can describe the nightmare. c. The child is reassured by your presence. Nightmares are scary dreams, the child can describe the nightmare, and the child is reassured by a parent's presence. Sleep terrors occur usually 1 to 4 hours after falling asleep, but nightmares occur in the second half of sleep. Sleep terrors occur during non-rapid eye movement sleep, but nightmares occur during rapid eye movement sleep.

When discussing discipline with the mother of a 4-year-old child, which should the nurse include? a. Parental control should be consistent. b. Withdrawal of love and approval is effective at this age. c. Children as young as 4 years rarely need to be disciplined. d. One should expect rules to be followed rigidly and unquestioningly.

a. Parental control should be consistent. For effective discipline, parents must be consistent and must follow through with agreed-on actions. Withdrawal of love and approval is never appropriate or effective. The 4-year-old child will test limits and may misbehave. Children of this age do not respond to verbal reasoning. Realistic goals should be set for this age group. Discipline is necessary to reinforce these goals. Discipline strategies should be appropriate to the child's age and temperament and the severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old child.

A 12-year-old child has failed several courses of chemotherapy. An experimental drug is available that his parents want him to receive. He has told his parents and the oncologists that he is ready to die and does not want any more chemotherapy. The nurse recognizes what to be true? a. Parents and child both need support in the decision making. b. Twelve-year-olds are minors and cannot give consent or refuse treatments. c. The oncologists needs to make the decision because the parents and child disagree. d. The parents have the right and responsibility to make decisions for their children younger than age 18 years.

a. Parents and child both need support in the decision making. This is a family issue that requires support to help both parents and child resolve the conflict. Because the child has little chance of survival, many institutions support the child's right to refuse or assent to therapy. The institution can obtain a court order to support the child's decision if verified by the oncologists. Twelve-year-olds can give consent for therapy under certain conditions, including being an emancipated minor and receiving therapy for birth control and sexually transmitted infections. Right to self-determination is also accepted if the child is fully aware of the consequences of the actions. The practitioners cannot take the responsibility for decision making from the parent or child. Parents have the responsibility for decision making, but certain circumstances do limit their authority.

The nurse is caring for an adolescent hospitalized for asthma. The adolescent belongs to a large family. The nurse recognizes that the adolescent is likely to relate to which group? a. Peers b. Parents c. Siblings d. Teachers

a. Peers Adolescents from a large family are more peer oriented than family oriented. Adolescents in small families identify more strongly with their parents and rely more on them for advice.

The nurse is completing a respiratory assessment on a newborn. What are normal findings of the assessment the nurse should document? (Select all that apply.) a. Periodic breathing b. Respiratory rate of 40 breaths/min c. Wheezes on auscultation d. Apnea lasting 25 seconds e. Slight intercostal retractions

a. Periodic breathing b. Respiratory rate of 40 breaths/min e. Slight intercostal retractions Periodic breathing is common in full-term newborns and consists of rapid, nonlabored respirations followed by pauses of less than 20 seconds. The newborn's respiratory rate is between 30 and 60 breaths/min. The ribs are flexible, and slight intercostal retractions are normal on inspiration. Periods of apnea lasting more than 20 seconds are abnormal, and wheezes should be reported.

When assessing a family, the nurse determines that the parents exert little or no control over their children. This style of parenting is called which? a. Permissive b. Dictatorial c. Democratic d. Authoritarian

a. Permissive Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their children's actions. Dictatorial or authoritarian parents attempt to control their children's behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their children's behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect their children's individual natures.

What should nursing interventions to maintain a patent airway in a newborn include? a. Positioning the newborn supine after feedings. b. Wrapping the newborn as snugly as possible. c. Placing the newborn to sleep in the prone (on abdomen) position. d. Using a bulb syringe to suction as needed, suctioning the nose first and then the pharynx.

a. Positioning the newborn supine after feedings. Positioning the newborn supine after feedings is recommended by the American Academy of Pediatrics to prevent sudden newborn death syndrome. The child can be wrapped snugly but should be placed on the side or back. Placing a newborn to sleep in the prone (on abdomen) position is not advised because of the possible link between sleeping in the prone position and sudden newborn death syndrome. A bulb syringe should be kept by the bedside if necessary, but the pharynx should be suctioned before the nose.

The nurse understands that which gestational disorders can cause a cognitive impairment in the newborn? (Select all that apply.) a. Prematurity b. Postmaturity c. Low birth weight d. Physiological jaundice e. Large for gestational age

a. Prematurity b. Postmaturity c. Low birth weight Prematurity, postmaturity, and low birth weight can be causes of cognitive impairment in newborns. Physiological jaundice and large for gestational age are not associated causes of cognitive impairment in newborns.

The nurse is aware that which age group is at risk for childhood injury because of the cognitive characteristic of magical and egocentric thinking? a. Preschool b. Young school age c. Middle school age d. Adolescent

a. Preschool Preschool children have the cognitive characteristic of magical and egocentric thinking, meaning they are unable to comprehend danger to self or others. Young and middle school-aged children have transitional cognitive processes, and they may attempt dangerous acts without detailed planning but recognize danger to themselves or others. Adolescents have formal operational cognitive processes and are preoccupied with abstract thinking.

The nurse is planning to administer immunizations to a 6-month-old infant. Which interventions should the nurse implement to minimize local reactions from the vaccines? (Select all that apply.) a. Select a needle length of 1 inch. b. Administer in the deltoid muscle. c. Inject the vaccine into the vastus lateralis. d. Draw the vaccine up from a vial with a filter needle. e. Change the needle on the syringe after drawing up the vaccine and before injecting.

a. Select a needle length of 1 inch. c. Inject the vaccine into the vastus lateralis. To minimize local reactions from vaccines, the nurse should select a needle of adequate length (25 mm [1 inch] in infants) to deposit the antigen deep in the muscle mass and inject it into the vastus lateralis muscle. The deltoid may be used in children 18 months of age or older but not in a 6-month-old infant. A filter needle is not needed to draw the vaccine from a vial. Changing the needle on the syringe after drawing up the vaccine before injecting it has not been shown to decrease local reactions.

The parents of a 5-year-old child ask the nurse how they can minimize misbehavior. Which responses should the nurse give? (Select all that apply.) a. Set clear and reasonable goals. b. Praise your child for desirable behavior. c. Don't call attention to unacceptable behavior. d. Teach desirable behavior through your own example. e. Don't provide an opportunity for your child to have any control.

a. Set clear and reasonable goals. b. Praise your child for desirable behavior. d. Teach desirable behavior through your own example. To minimize misbehavior, parents should (1) set clear and reasonable rules and expect the same behavior regardless of the circumstances, (2) praise children for desirable behavior with attention and verbal approval, and (3) teach desirable behavior through their own example. Parents should call attention to unacceptable behavior as soon as it begins and provide children with opportunities for power and control.

The nurse understands that blocks to therapeutic communication include what? (Select all that apply.) a. Socializing b. Use of silence c. Using clichés d. Defending a situation e. Using open-ended questions

a. Socializing c. Using clichés d. Defending a situation Blocks to communication include socializing, using clichés, and defending a situation. Use of silence and using open-ended questions are therapeutic communication techniques.

The nurse is preparing to admit a 2-year-old child with rubella (German measles). Which clinical manifestations of rubella should the nurse expect to observe? (Select all that apply.) a. Sore throat b. Conjunctivitis c. Koplik spots d. Lymphadenopathy e. Discrete, pinkish red maculopapular exanthema

a. Sore throat b. Conjunctivitis d. Lymphadenopathy e. Discrete, pinkish red maculopapular exanthema The clinical manifestations of rubella include a sore throat; conjunctivitis; lymphadenopathy; and a discrete, pinkish red maculopapular exanthema. Koplik spots occur in measles but not rubella.

What technique facilitates lip reading 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.

a. Speak at an even rate. 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.

Which is a birth defect or disorder that occurs as a new case in a family and is not inherited? a. Sporadic b. Polygenic c. Monosomy d. Association

a. Sporadic Sporadic describes a birth defect previously unidentified in a family. It is not inherited. Polygenic inheritance involves the inheritance of many genes at separate loci whose combined effects produce a given phenotype. Monosomy is an abnormal number of chromosomes whereby the chromosome is represented by a single copy in a somatic cell. A nonrandom cluster of malformations without a specific cause is an association.

A breastfed infant has just been diagnosed with galactosemia. The therapeutic management of this includes which? a. Stop breastfeeding the infant. b. Add amino acids to breast milk. c. Substitute a lactose-containing formula for breast milk. d. Give the appropriate enzyme along with breast milk.

a. Stop breastfeeding the infant. The infant with galactosemia is fed a diet free of all milk and lactose-containing foods. This includes breast milk. Soy-protein formula is the formula of choice. Other strategies are being identified.

The parents of an infant plan to have him circumcised. They ask the nurse about pain associated with this procedure. The nurse's response should be based on which? a. That infants experience pain with circumcision b. That infants are too young for anesthesia or analgesia c. That infants do not experience pain with circumcision d. That infants quickly forget about the pain of circumcision

a. That infants experience pain with circumcision Circumcision is a surgical procedure. The American Academy of Pediatrics has recommended that procedural analgesia be provided when circumcision is performed. The pain infants experience with surgical procedures can be alleviated with analgesia. Infants who undergo circumcision without anesthetic agents react more intensely to immunization injections at 4 to 6 months of age compared with infants who had an anesthetic.

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

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

Children may believe that they are responsible for their parents' divorce and interpret the separation as punishment. At which age is this most likely to occur? a. 1 year b. 4 years c. 8 years d. 13 years

b. 4 years Preschool-age children are most likely to blame themselves for the divorce. A 4-year-old child will fear abandonment and express bewilderment regarding all human relationships. A 4-year-old child has magical thinking and believes his or her actions cause consequences, such as divorce. For infants, divorce may increase their irritability and interfere with the attachment process, but they are too young to feel responsibility. School-age children will have feelings of deprivation, including the loss of a parent, attention, money, and a secure future. Adolescents are able to disengage themselves from the parental conflict.

A couple expecting their first child has a positive family history for several congenital defects and disorders. The couple tells the nurse that they are opposed to abortion for religious reasons. Which should the nurse consider when counseling the couple? a. The couple should be encouraged to have recommended diagnostic testing. b. The couple needs counseling regarding advantages and disadvantages of pregnancy termination. c. Diagnostic testing is required by law in this situation. d. Diagnostic testing is of limited value if termination of pregnancy is not an option.

a. The couple should be encouraged to have recommended diagnostic testing. The benefits of prenatal diagnostic testing extend beyond decisions concerning abortion. If the child has congenital disorders, decisions can be made about fetal surgery if indicated. In addition, if the child is expected to require neonatal intensive care at birth, the mother is encouraged to deliver at a level III neonatal center. The couple is counseled about the advantages and disadvantages of prenatal diagnosis, not pregnancy termination, although the family cannot be forced to have prenatal testing. The information gives the parents time to grieve and plan for their child if congenital disorders are present. If the child is free of defects, then the parents are relieved of a major worry.

A couple has given birth to their first child, a boy with a recessive disorder. The genetic counselor tells them that the risk of recurrence is one in four. Which statement is a correct interpretation of this information? a. The risk factor remains the same for each pregnancy. b. The risk factor will change when they have a second child. c. Because the parents have one affected child, the next three children should be unaffected. d. Because the parents have one affected child, the next child is four times more likely to be affected.

a. The risk factor remains the same for each pregnancy. Each pregnancy has the same risks for an affected child. Because an odds ratio reflects the risk, this does not change over time. The statement by the genetic counselor refers to a probability. This does not change over time. The statement "Because the parents have one affected child, the next child is four times more likely to be affected" does not reflect autosomal recessive inheritance.

What describes nonpharmacologic techniques for pain management? a. They may reduce pain perception. b. They usually take too long to implement. c. They make pharmacologic strategies unnecessary. d. They trick children into believing they do not have pain.

a. They may reduce pain perception. Nonpharmacologic techniques provide coping strategies that may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. The nonpharmacologic strategy should be matched with the child's pain severity and be taught to the child before the onset of the painful experience. Tricking children into believing they do not have pain may mitigate the child's experience with mild pain, but the child will still know the discomfort was present.

An infant with an isolated cleft lip is being bottle fed. Which actions should the nurse plan to implement to assist with the feeding? (Select all that apply.) a. Use an NUK nipple. b. Use cheek support. c. Enlarge the nipple opening. d. Position the infant upright. e. Thicken the formula with rice cereal.

a. Use an NUK nipple. b. Use cheek support. d. Position the infant upright. A bottle-fed infant with an isolated cleft lip should be fed with cheek support (squeezing the cheeks together to decrease the width of the cleft), which may help the infant achieve an adequate anterior lip seal during feeding. Systems that have a wider base, such as an NUK (orthodontic) nipple or a Playtex nurser, allow the infant with a cleft lip to feed more successfully. The infant should be positioned upright with the head supported. This position helps gravity to direct the flow of liquid so that it is swallowed rather than entering into the nasal cavity. Enlarging the nipple opening would allow too much milk too fast for an infant with a cleft palate. Thickening the formula with rice cereal is done for infants with gastroesophageal reflux, not cleft lip.

The nurse is teaching parents of a preschool child strategies to implement when the child delays going to bed. What strategy should the nurse recommend? a. Use consistent bedtime rituals. b. Give in to attention-seeking behavior. c. Take the child into the parent's bed for an hour. d. Allow the child to stay up past the decided bedtime.

a. Use consistent bedtime rituals. For children who delay going to bed, a recommended approach involves a consistent bedtime ritual and emphasizing the normalcy of this type of behavior in young children. Parents should ignore attention-seeking behavior, and the child should not be taken into the parents' bed or allowed to stay up past a reasonable hour.

The nurse is preparing an airborne infection isolation room for a patient. Which communicable disease does the patient likely have? a. Varicella b. Pertussis c. Influenza d. Scarlet fever

a. Varicella An airborne infection isolation room is the isolation for persons with a suspected or confirmed airborne infectious disease transmitted by the airborne route such as measles, varicella, or tuberculosis. Pertussis, influenza, and scarlet fever require droplet transmission precautions.

What statement is most descriptive of a school-age child's reaction to death? a. Very interested in funerals and burials b. Little understanding of words such as "forever" c. Imagine the deceased person to be still alive d. Can explain death from a religious or spiritual point of view

a. Very interested in funerals and burials School-age children are interested in naturalistic and physiologic explanations of why death occurs and what happens to the body. School-age children do have an established concept of forever and have a deeper understanding of death in a concrete manner. Adolescents may explain death from a religious or spiritual point of view.

Which type of breath sound is normally heard over the entire surface of the lungs except for the upper intrascapular area and the area beneath the manubrium? a. Vesicular b. Bronchial c. Adventitious d. Bronchovesicular

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

The nurse is teaching parents about the visual ability of their newborn. Which should the nurse include in the teaching session? (Select all that apply.) a. Visual acuity is between 20/100 and 20/400. b. Tear glands do not begin to function until 8 to 12 weeks of age. c. Infants can momentarily fixate on a bright object that is within 8 inches. d. The infant demonstrates visual preferences of black-and-white contrasting patterns. e. The infant prefers bright colors (red, orange, blue) over medium colors (yellow, green, pink).

a. Visual acuity is between 20/100 and 20/400. c. Infants can momentarily fixate on a bright object that is within 8 inches. d. The infant demonstrates visual preferences of black-and-white contrasting patterns. Visual acuity is reported to be between 20/100 and 20/400, depending on the vision measurement techniques. The infant has the ability to momentarily fixate on a bright or moving object that is within 20 cm (8 inches) and in the midline of the visual field. The infant demonstrates visual preferences of black-and-white contrasting patterns. The visual preference is for medium colors (yellow, green, pink) over dim or bright colors (red, orange, blue). Tear glands begin to function until 2 to 4 weeks of age.

The nurse is caring for a patient who has chosen to breastfeed her infant. Which statement should the nurse include when teaching the mother about breastfeeding problems that may occur? a. "If you experience painful nipples, cleanse your nipples with soap two times per day and keep your nipples covered as much as possible." b. "If you experience plugged ducts, continue to breastfeed every 2 to 3 hours and alternate feeding positions." c. "If mastitis occurs, discontinue breastfeeding while taking prescribed antibiotics and apply warm compresses." d. "If engorgement occurs, use cold compresses before a feeding and wear a well-fitting bra at night."

b. "If you experience plugged ducts, continue to breastfeed every 2 to 3 hours and alternate feeding positions." If a woman experiences plugged ducts, the best interventions are to continue breastfeeding every 2 to 3 hours and alternate feeding positions while pointing the infant's chin toward the obstructed area. Other interventions include massaging breasts and applying warm compresses before feeding or pumping. If painful nipples occur, the woman should avoid soaps, oils, and lotions and air the nipples as much as possible. If mastitis occurs, the woman should continue breastfeeding to keep the breast well drained. If engorgement occurs, the woman should use a warm compress before feedings and wear a well-fitting bra 24 hours a day.

The nurse is discussing issues that are important with parents considering a cross-racial adoption. Which statement made by the parents indicates further teaching is needed? a. "We will try to preserve the adopted child's racial heritage." b. "We are glad we will be getting full medical information when we adopt our child." c. "We will make sure to have everyone realize this is our child and a member of the family." d. "We understand strangers may make thoughtless comments about our child being different from us."

b. "We are glad we will be getting full medical information when we adopt our child." In international adoptions, the medical information the parents receive may be incomplete or sketchy; weight, height, and head circumference are often the only objective information present in the child's medical record. Further teaching is needed if the parents expect full medical information. It is advised that parents who adopt children with different ethnic backgrounds do everything to preserve the adopted children's racial heritage. Strangers may make thoughtless comments and talk about the children as though they were not members of the family. It is vital that family members declare to others that this is their child and a cherished member of the family.

The clinic nurse is instructing parents about caring for a toddler with ascariasis (common roundworm). Which statement made by the parents indicates a need for further teaching? a. "We will wash our hands often, especially after diaper changes." b. "We know that roundworm can be transmitted from person to person." c. "We will be sure to continue the nitazoxanide (Alinia) orally for 3 days." d. "We will bring a stool sample to the clinic for examination in 2 weeks."

b. "We know that roundworm can be transmitted from person to person." Ascariasis (common roundworm) is transferred to the mouth by way of contaminated food, fingers, or toys. Further teaching is needed if parents state it is transmitted from person to person. Frequent handwashing, especially after diaper changes, continuing the Alinia for 3 days, and reexamining the stool in 2 weeks are appropriate actions.

The nurse is teaching the parents of a child with recurrent headaches methods to modify behavior patterns that increase the risk of headache. Which statement by the parents indicates understanding the teaching? a. "We will allow the child to miss school if a headache occurs." b. "We will respond matter-of-factly to requests for special attention." c. "We will be sure to give much attention to our child when a headache occurs." d. "We will be sure our child doesn't have to perform at a band concert if a headache occurs."

b. "We will respond matter-of-factly to requests for special attention." To modify behavior patterns that increase the risk of headache or reinforce headache activity, the nurse instructs the parents to avoid giving excessive attention to their child's headache and to respond matter-of-factly to pain behavior and requests for special attention. Parents learn to assess whether the child is avoiding school or social performance demands because of headache.

The stump of the umbilical cord usually drops off in how many days? a. 3 to 6 b. 10 to 14 c. 16 to 21 d. 24 to 28

b. 10 to 14 The average umbilical cord separates in 10 to 14 days. Three to 6 days is too soon, and 16 to 28 days is too late.

Pertussis vaccination should begin at which age? a. Birth b. 2 months c. 6 months d. 12 months

b. 2 months The acellular pertussis vaccine is recommended by the American Academy of Pediatrics beginning at age 6 weeks. Infants are at greater risk for complications of pertussis. The vaccine is not given after age 7 years, when the risks of the vaccine become greater than those of pertussis. The first dose is usually given at the 2-month well-child visit. Infants are highly susceptible to pertussis, which can be a life-threatening illness in this age group.

What is the earliest age at which a satisfactory radial pulse can be taken in children? a. 1 year b. 2 years c. 3 years d. 6 years

b. 2 years Satisfactory radial pulses can be taken in children older than 2 years. In infants and young children, the apical pulse is more reliable.

The nurse is performing an otoscopic examination on a child. Which are normal findings the nurse should expect? (Select all that apply.) a. Ashen gray areas b. A well-defined light reflex c. A small, round, concave spot near the center of the drum d. The tympanic membrane is a nontransparent grayish color e. A whitish line extending from the umbo upward to the margin of the membrane

b. A well-defined light reflex c. A small, round, concave spot near the center of the drum e. A whitish line extending from the umbo upward to the margin of the membrane Normal findings include the light reflex and bony landmarks. The light reflex is a fairly well-defined, cone-shaped reflection that normally points away from the face. The bony landmarks of the eardrum are formed by the umbo, or tip of the malleus. It appears as a small, round, opaque, concave spot near the center of the eardrum. The manubrium (long process or handle) of the malleus appears to be a whitish line extending from the umbo upward to the margin of the membrane. The tympanic membrane should be light pearly pink or gray and translucent, not nontransparent. Ashen gray areas indicate signs of scarring from a previous perforation.

The nurse is aware that skin turgor best estimates what? a. Perfusion b. Adequate hydration c. Amount of body fat d. Amount of anemia

b. Adequate hydration Skin turgor is one of the best estimates of adequate hydration and nutrition. It does not indicate amount of body fat and is not a test for anemia.

The Apgar score of an infant 5 minutes after birth is 8. Which is the nurse's best interpretation of this? a. Resuscitation is likely to be needed. b. Adjustment to extrauterine life is adequate. c. Additional scoring in 5 more minutes is needed. d. Maternal sedation or analgesia contributed to the low score.

b. Adjustment to extrauterine life is adequate. The Apgar reflects an infant's status in five areas: heart rate, respiratory effort, muscle tone, reflex irritability, and color. A score of 8 to 10 indicates an absence of difficulty adjusting to extrauterine life. Scores of 0 to 3 indicate severe distress, and scores of 4 to 7 indicate moderate difficulty. All infants are rescored at 5 minutes of life, and a score of 8 is not indicative of distress; the newborn does not have a low score. The Apgar score is not used to determine the infant's need for resuscitation at birth.

Which is characteristic of X-linked recessive inheritance? a. There are no carriers. b. Affected individuals are principally males. c. Affected individuals are principally females. d. Affected individuals will always have affected parents.

b. Affected individuals are principally males. In X-linked recessive disorders, the affected individuals are usually male. With recessive traits, usually two copies of the gene are needed to produce the effect. Because the male only has one X chromosome, the effect is visible with only one copy of the gene. Females are usually only carriers of X-linked recessive disorders. The X chromosome that does not have the recessive gene will produce the "normal" protein, so the woman will not show evidence of the disorder. The transmission is from mother to son. Usually the mother and father are unaffected.

When the nurse interviews an adolescent, which is especially important? a. Focus the discussion on the peer group. b. Allow an opportunity to express feelings. c. Use the same type of language as the adolescent. d. Emphasize that confidentiality will always be maintained.

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

Which explains the importance of detecting strabismus in young children? a. Color vision deficit may result. b. Amblyopia, a type of blindness, may result. c. Epicanthal folds may develop in the affected eye. d. Corneal light reflexes may fall symmetrically within each pupil.

b. Amblyopia, a type of blindness, may result. By the age of 3 to 4 months, infants are able to fixate on one visual field with both eyes simultaneously. In strabismus, or cross-eye, one eye deviates from the point of fixation. If misalignment is constant, the weak eye becomes "lazy," and the brain eventually suppresses the image produced from that eye. If strabismus is not detected and corrected by age 4 to 6 years, blindness from disuse, known as amblyopia, may occur. Color vision is not the only concern. Epicanthal folds are not related to amblyopia. In children with strabismus, the corneal light reflex will not be symmetric for each eye.

The clinic nurse is assessing a child with a heavy ascariasis lumbricoides (common roundworm) infection. Which assessment findings should the nurse expect? (Select all that apply.) a. Anemia b. Anorexia c. Irritability d. Intestinal colic e. Enlarged abdomen

b. Anorexia c. Irritability d. Intestinal colic e. Enlarged abdomen The assessment findings in a heavy ascariasis lumbricoides infection include anorexia, irritability, intestinal colic, and an enlarged abdomen. Anemia is seen in hookworm infections but not ascariasis.

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

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

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

b. Ask the adolescent, "Why did you come here today?" The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. Because the adolescent is the focus of the history, this is an appropriate way to determine the chief complaint. Requesting a detailed list of symptoms makes it difficult to determine the chief complaint. The parent and adolescent may be interviewed separately, but the nurse should determine the reason the adolescent is seeking attention at this time. The chief complaint is usually written in the words that the parent or adolescent uses to describe the reason for seeking help.

An adolescent patient wants to make decisions about treatment options, along with his parents. Which moral value is the nurse displaying when supporting the adolescent to make decisions? a. Justice b. Autonomy c. Beneficence d. Nonmaleficence

b. Autonomy Autonomy is the patient's right to be self-governing. The adolescent is trying to be autonomous, so the nurse is supporting this value. Justice is the concept of fairness. Beneficence is the obligation to promote the patient's well-being. Nonmaleficence is the obligation to minimize or prevent harm.

What risk factors can cause a sensorineural hearing impairment in an infant? (Select all that apply.) a. Cat scratch disease b. Bacterial meningitis c. Childhood case of measles d. Childhood case of chicken pox e. Administration of aminoglycosides for more than 5 days

b. Bacterial meningitis c. Childhood case of measles e. Administration of aminoglycosides for more than 5 days Risk criteria for sensorineural hearing impairment in infants include bacterial meningitis; a case of measles; and administration of ototoxic medications (e.g., gentamicin, tobramycin, kanamycin, streptomycin), including but not limited to the aminoglycosides, for more than 5 days. Cat scratch disease and a childhood case of chicken pox are not risk factors that can cause a sensorineural hearing impairment.

When giving instructions to a parent whose child has scabies, what should the nurse include? a. Treat all family members if symptoms develop. b. Be prepared for symptoms to last 2 to 3 weeks. c. Carefully treat only areas where there is a rash. d. Notify practitioner so an antibiotic can be prescribed.

b. Be prepared for symptoms to last 2 to 3 weeks. The mite responsible for the scabies will most likely be killed with the administration of medications. It will take 2 to 3 weeks for the stratum corneum to heal. That is when the symptoms will abate. Initiation of therapy does not wait for clinical symptom development. All individuals in close contact with the affected child need to be treated. Permethrin, a scabicide, is the preferred treatment and is applied to all skin surfaces.

Which is the most consistent and commonly used data for assessment of pain in infants? a. Self-report b. Behavioral c. Physiologic d. Parental report

b. Behavioral Behavioral assessment is useful for measuring pain in young children and preverbal children who do not have the language skills to communicate that they are in pain. Infants are not able to self-report. Physiologic measures are not able to distinguish between physical responses to pain and other forms of stress. Parental report without a structured tool may not accurately reflect the degree of discomfort.

Which type of family should the nurse recognize when a mother, her children, and a stepfather live together? a. Traditional nuclear b. Blended c. Extended d. Binuclear

b. Blended A blended family contains at least one stepparent, stepsibling, or half-sibling. A traditional nuclear family consists of a married couple and their biologic children. No other relatives or nonrelatives are present in the household. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.

Which genetic term refers to a person who possesses one copy of an affected gene and one copy of an unaffected gene and is clinically unaffected? a. Allele b. Carrier c. Pedigree d. Multifactorial

b. Carrier An individual who is a carrier is asymptomatic but possesses a genetic alteration, either in the form of a gene or chromosome change. Alleles are alternative expressions of genes at a different locus. A pedigree is a diagram that describes family relationships, gender, disease, status, or other relevant information about a family. Multifactorial describes a complex interaction of both genetic and environmental factors that produce an effect on the individual.

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

b. Child and family as the unit of care 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.

What is the most common form of child maltreatment? a. Sexual abuse b. Child neglect c. Physical abuse d. Emotional abuse

b. Child neglect Child neglect, which is characterized by the failure to provide for the child's basic needs, is the most common form of child maltreatment. Sexual abuse, physical abuse, and emotional abuse are individually not as common as neglect.

The nurse is teaching a group of new nursing graduates about identifiable qualities of strong families that help them function effectively. Which quality should be included in the teaching? a. Lack of congruence among family members b. Clear set of family values, rules, and beliefs c. Adoption of one coping strategy that always promotes positive functioning in dealing with life events d. Sense of commitment toward growth of individual family members as opposed to that of the family unit

b. Clear set of family values, rules, and beliefs A clear set of family rules, values, and beliefs that establish expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Varied coping strategies are used by strong families. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit.

Evidence-based practice (EBP), a decision-making model, is best described as which? a. Using information in textbooks to guide care b. Combining knowledge with clinical experience and intuition c. Using a professional code of ethics as a means for decision making d. Gathering all evidence that applies to the child's health and family situation

b. Combining knowledge with clinical experience and intuition EBP helps focus on measurable outcomes; the use of demonstrated, effective interventions; and questioning what is the best approach. EBP involves decision making based on data, not all evidence on a particular situation, and involves the latest available data. Nurses can use textbooks to determine areas of concern and potential involvement.

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.

b. Communicate with the child at his or her developmental level. 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.

Which actions by the nurse demonstrate clinical reasoning? (Select all that apply.) a. Basing decisions on intuition b. Considering alternative action c. Using formal and informal thinking to gather data d. Giving deliberate thought to a patient's problem e. Developing an outcome focused on optimum patient care

b. Considering alternative action c. Using formal and informal thinking to gather data d. Giving deliberate thought to a patient's problem e. Developing an outcome focused on optimum patient care Clinical reasoning is a cognitive process that uses formal and informal thinking to gather and analyze patient data, evaluate the significance of the information, and consider alternative actions. Clinical reasoning is a complex developmental process based on rational and deliberate thought and developing an outcome focused on optimum patient care. Clinical reasoning is based on the scientific method of inquiry; it is not based solely on intuition.

The nurse is preparing to admit a 1-year-old child with pertussis (whooping cough). Which clinical manifestations of pertussis should the nurse expect to observe? (Select all that apply.) a. Earache b. Coryza c. Conjunctivitis d. Low-grade fever e. Dry hacking cough

b. Coryza d. Low-grade fever e. Dry hacking cough The clinical manifestations of pertussis include coryza, a low-grade fever, and a dry hacking cough. The child does not have an earache or conjunctivitis.

The nurse discovers welts on the back of a Vietnamese child during a home health visit. The child's mother says she has rubbed the edge of a coin on her child's oiled skin. The nurse should recognize this as what? a. Child abuse b. Cultural practice to rid the body of disease c. Cultural practice to treat enuresis or temper tantrums d. Child discipline measure common in the Vietnamese culture

b. Cultural practice to rid the body of disease This is descriptive of coining. The welts are created by repeatedly rubbing a coin on the child's oiled skin. The mother is attempting to rid the child's body of disease. Coining is a cultural healing practice. Coining is not specific for enuresis or temper tantrums. This is not child abuse or discipline.

Which can be directly attributed to a single-gene disorder? (Select all that apply.) a. Cleft lip b. Cystic fibrosis c. Turner syndrome d. Klinefelter syndrome e. Neurofibromatosis

b. Cystic fibrosis e. Neurofibromatosis Cystic fibrosis is a single-gene disorder inherited as an autosomal recessive trait, and neurofibromatosis is a single-gene disorder inherited as an autosomal dominant trait. Cleft lip is classified as a multifactorial disorder in which a genetic susceptibility and appropriate environment appear to play important roles. Turner and Klinefelter syndromes are disorders of sex chromosome number.

Which family theory is described as a series of tasks for the family throughout its life span? a. Exchange theory b. Developmental theory c. Structural-functional theory d. Symbolic interactional theory

b. Developmental theory In developmental systems theory, the family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. Exchange theory assumes that humans, families, and groups seek rewarding statuses so that rewards are maximized while costs are minimized. Structural-functional theory states that the family performs at least one societal function while also meeting family needs. Symbolic interactional theory describes the family as a unit of interacting persons with each occupying a position within the family.

Which muscle is contraindicated for the administration of immunizations in infants and young children? a. Deltoid b. Dorsogluteal c. Ventrogluteal d. Anterolateral thigh

b. Dorsogluteal The dorsogluteal site is avoided in children because of the location of nerves and veins. The deltoid is recommended for 12 months and older. The ventrogluteal and anterolateral thigh sites can safely be used for the administration of vaccines to infants.

The school nurse is evaluating the number of school-age children classified as obese. The nurse recognizes that the percentile of body mass index that classifies a child as obese is greater than which? a. 50th percentile b. 75th percentile c. 80th percentile d. 95th percentile

d. 95th percentile Obesity in children and adolescents is defined as a body mass index at or greater than the 95th percentile for youth of the same age and gender.

Which situation denotes a nontherapeutic nurse-patient-family relationship? a. The nurse is planning to read a favorite fairy tale to a patient. b. During shift report, the nurse is criticizing parents for not visiting their child. c. The nurse is discussing with a fellow nurse the emotional draw to a certain patient. d. The nurse is working with a family to find ways to decrease the family's dependence on health care providers.

b. During shift report, the nurse is criticizing parents for not visiting their child. Criticizing parents for not visiting in shift report is nontherapeutic and shows an underinvolvement with the parents. Reading a fairy tale is a therapeutic and age appropriate action. Discussing feelings of an emotional draw with a fellow nurse is therapeutic and shows a willingness to understand feelings. Working with parents to decrease dependence on health care providers is therapeutic and helps to empower the family.

The nurse is preparing to admit a 5-year-old child who developed lesions of varicella (chickenpox) 3 days ago. Which clinical manifestations of varicella should the nurse expect to observe? (Select all that apply.) a. Nonpruritic rash b. Elevated temperature c. Discrete rose pink rash d. Vesicles surrounded by an erythematous base e. Centripetal rash in all three stages (papule, vesicle, and crust)

b. Elevated temperature d. Vesicles surrounded by an erythematous base e. Centripetal rash in all three stages (papule, vesicle, and crust) The clinical manifestations of varicella include elevated temperature, vesicles surrounded by an erythematous base, and a centripetal rash in all three stages (papule, vesicle, and crust). The rash is pruritic, and a discrete pink rash is seen with exanthema subitum, not varicella.

The nurse is aware that if patients' different cultures are implied to be inferior, the emotional attitude the nurse is displaying is what? a. Acculturation b. Ethnocentrism c. Cultural shock d. Cultural sensitivity

b. Ethnocentrism Ethnocentrism is the belief that one's way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of one's ethnic group are superior to those of others. Acculturation is the gradual changes that are produced in a culture by the influence of another culture that cause one or both cultures to become more similar. The minority culture is forced to learn the majority culture to survive. Cultural shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. Cultural sensitivity, a component of culturally competent care, is an awareness of cultural similarities and differences.

The nurse is evaluating research studies according to the GRADE criteria and has determined the quality of evidence on the subject is moderate. Which type of evidence does this determination indicate? a. Strong evidence from unbiased observational studies b. Evidence from randomized clinical trials showed inconsistent results c. Consistent evidence from well-performed randomized clinical trials d. Evidence for at least one critical outcome from randomized clinical trials had serious flaws

b. Evidence from randomized clinical trials showed inconsistent results Evidence from randomized clinical trials with important limitations indicates that the evidence is of moderate quality. Strong evidence from unbiased observational studies and consistent evidence from well-performed randomized clinical trials indicates high quality. Evidence for at least one critical outcome from randomized clinical trials that has serious flaws indicates low quality.

A mother has just given birth to a newborn with a cleft lip. Sensing that something is wrong, she starts to cry and asks the nurse, "What is wrong with my baby?" What is the most appropriate nursing action? a. Encourage the mother to express her feelings. b. Explain in simple language that the baby has a cleft lip. c. Provide emotional support until the practitioner can talk to the mother. d. Tell the mother a pediatrician will talk to her as soon as the baby is examined.

b. Explain in simple language that the baby has a cleft lip. It is best to explain in simple terms the nature of the defect and to reinforce and help clarify information given by the practitioner before the newborn is shown to the parents. Parents may not be ready to talk about their feelings during the first few days after birth. The nurse should provide information about the child's condition while waiting for the practitioner to speak with the family after the examination. The mother needs simple explanations of her child's condition during this period of waiting.

What should a nursing intervention to promote parent-infant attachment include? a. Encouraging parents to hold the infant frequently unless the infant is fussy b. Explaining individual differences among infants to the parents c. Delaying parent-infant interactions until the second period of reactivity d. Alleviating stress for parents by decreasing their participation in the infant's care

b. Explaining individual differences among infants to the parents Nurses can positively influence the attachment of parent and infant by recognizing and explaining individual differences to the parents. The nurse should emphasize the normalcy of these variations and demonstrate the uniqueness of each infant. The parents should be encouraged to hold the infant when he or she is fussy and learn how best to soothe their infant. The nurse should facilitate parent-infant interaction during the first period of reactivity. Decreasing the parents' participation in care interferes with parent-infant attachment.

Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? a. Interactional theory b. Family stress theory c. Erikson's psychosocial theory d. Developmental systems theory

b. Family stress theory Family stress theory explains the reaction of families to stressful events. In addition, the theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative, are cumulative and affect the family. Adaptation requires a change in family structure or interaction. Interactional theory is not a family theory. Interactions are the basis of general systems theory. Erikson's theory applies to individual growth and development, not families. Developmental systems theory is an outgrowth of Duvall's theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others.

A foster parent is talking to the nurse about the health care needs for the child who has been placed in the parent's care. Which statement best describes the health care needs of foster children? a. Foster children always come from abusive households and are emotionally fragile. b. Foster children tend to have a higher than normal incidence of acute and chronic health problems. c. Foster children are usually born prematurely and require technologically advanced health care. d. Foster children will not stay in the home for an extended period, so health care needs are not as important as emotional fulfillment.

b. Foster children tend to have a higher than normal incidence of acute and chronic health problems. Children who are placed in foster care have a higher incidence of acute and chronic health problems and may experience feelings of isolation and confusion; therefore, they should be monitored closely. Foster children do not always come from abusive households and may or may not be emotionally fragile; not all foster children are born prematurely or require technically advanced health care; and foster children may stay in the home for extended periods, so their health care needs require attention.

A cancer patient is experiencing neuropathic cancer pain. Which prescription should the nurse expect to be ordered to control anxiety? a. Lorazepam (Ativan) b. Gabapentin (Neurontin) c. Hydromorphone (Dilaudid) d. Morphine sulfate (MS Contin)

b. Gabapentin (Neurontin) Anticonvulsants (gabapentin, carbamazepine) have demonstrated effectiveness in neuropathic cancer pain. Ativan is an antianxiety agent, and Dilaudid and MS Contin are opioid analgesics.

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.

b. Help the parents deal with her anger constructively. 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.

What is a clinical manifestation of acetaminophen poisoning? a. Hyperpyrexia b. Hepatic involvement c. Severe burning pain in stomach d. Drooling and inability to clear secretions

b. Hepatic involvement Hepatic involvement is the third stage of acetaminophen poisoning. Hyperpyrexia is a severe elevation in body temperature and is not related to acetaminophen poisoning. Acetaminophen does not cause burning pain in stomach and does not pose an airway threat.

A child has been found to have a deficiency in 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. Which condition is this child at risk for? a. Increased uric acid b. Hypercholesterolemia c. Increased phenylketones d. Altered oxygen transport

b. Hypercholesterolemia HMG-CoA leads to a disruption of metabolic feedback mechanism and accumulation of end product (cholesterol) with the resulting condition of hypercholesterolemia.

The school nurse is explaining to older school children that obesity increases the risk for which disorders? (Select all that apply.) a. Asthma b. Hypertension c. Dyslipidemia d. Irritable bowel disease e. Altered glucose metabolism

b. Hypertension c. Dyslipidemia e. Altered glucose metabolism Overweight youth have increased risk for a cluster of cardiovascular factors that include hypertension, altered glucose metabolism, and dyslipidemia. Irritable bowel disease and asthma are not linked to obesity.

A woman, age 43 years, is 6 weeks pregnant. It is important that she be informed of which? a. The need for a therapeutic abortion b. Increased risk for Down syndrome c. Increased risk for Turner syndrome d. The need for an immediate amniocentesis

b. Increased risk for Down syndrome Women who are older than age 35 years at the birth of a single child or 31 years at the birth of twins are advised to have prenatal diagnosis. The risk of having a child with Down syndrome increases with maternal age. There is no indication of a need for a therapeutic abortion at this stage. Turner syndrome is not associated with advanced maternal age. Amniocentesis cannot be done at a gestational age of 6 weeks.

The nurse is interviewing a prenatal client about specific risk factors that are indications for prenatal testing. Which specific risk factors should the nurse note? (Select all that apply.) a. Previous twins b. Inherited disorder c. Previous preterm birth d. Cytomegalovirus infection e. Previous stillbirth or neonatal death

b. Inherited disorder d. Cytomegalovirus infection e. Previous stillbirth or neonatal death Specific risk factors that are indications for prenatal testing include inherited disorder, cytomegalovirus infection (teratogenic infection), and previous stillbirth or neonatal death. Previous twins or previous preterm birth are not specific risk factors that are indications for prenatal testing.

A child has been admitted to the hospital with a blood lead level of 72 mcg/dL. What treatment should the nurse anticipate? a. Referral to social services b. Initiation of chelation therapy c. Follow-up testing within 1 month d. Aggressive environmental intervention

b. Initiation of chelation therapy Severe lead toxicity (lead level ?5=70 mcg/dL) requires immediate inpatient chelation treatment. Referral to social service and follow-up in 1 month are prescribed for lead levels of 15 to 19 mcg/dL. Aggressive environmental intervention would be initiated after chelation treatments.

A child with Prader-Willi syndrome has been hospitalized. Which assessment findings does the nurse expect with this syndrome? a. Nonverbal b. Insatiable hunger c. Abnormal, puppetlike gait d. Paroxysms of inappropriate laughter

b. Insatiable hunger Prader-Willi syndrome is characterized by insatiable hunger that can lead to morbid obesity in childhood. Abnormal, puppetlike gait, paroxysms of inappropriate laughter, and nonverbal are characteristics seen in Angelman syndrome.

Which statement best represents the first stage or the first period of reactivity in the infant? a. Begins when the newborn awakes from a deep sleep b. Is an excellent time to acquaint the parents with the newborn c. Ends when the amounts of respiratory mucus have decreased d. Provides time for the mother to recover from the childbirth process

b. Is an excellent time to acquaint the parents with the newborn During the first period of reactivity, the infant is alert, cries vigorously, may suck his or her fist greedily, and appears interested in the environment. The infant's eyes are usually wide open, suggesting that this is an excellent opportunity for mother, father, and infant to see each other. The second period of reactivity begins when the infant awakes from a deep sleep and ends when the amounts of respiratory mucus have decreased. The mother should sleep and recover during the second stage, when the infant is sleeping.

The nurse is teaching parents the signs of a hearing impairment in infants. What should the nurse include as signs? (Select all that apply.) a. Lack of a fencing reflex b. Lack of a startle reflex to a loud sound c. Awakened by loud environmental noises d. Failure to localize a sound by 6 months of age e. Response to loud noises as opposed to the voice

b. Lack of a startle reflex to a loud sound d. Failure to localize a sound by 6 months of age e. Response to loud noises as opposed to the voice The fencing reflex is elicited when the infant is placed on his or her back; it does not indicate a hearing impairment. Awakening by a loud environmental noise is a normal response.

What is the primary treatment for warts? a. Vaccination b. Local destruction c. Corticosteroids d. Specific antibiotic therapy

b. Local destruction Local destructive therapy is individualized according to location, type, and number; surgical removal, electrocautery, curettage, cryotherapy, caustic solutions, x-ray treatment, and laser therapies are used. Vaccination is prophylaxis for warts, not a treatment. Corticosteroids and specific antibiotic therapy are not effective in the treatment of warts.

The nurse is assessing a neonate who was born 1 hour ago to healthy white parents in their early forties. Which finding should be most suggestive of Down syndrome? a. Hypertonia b. Low-set ears c. Micrognathia d. Long, thin fingers and toes

b. Low-set ears Children with Down syndrome have low-set ears. Infants with Down syndrome have hypotonia, not hypertonia. Micrognathia is common in trisomy 16, not Down syndrome. Children with Down syndrome have short hands with broad fingers.

The school nurse is assessing children for risk factors related to childhood injuries. Which child has the most risk factors related to childhood injury? a. Female, multiple siblings, stable home life b. Male, high activity level, stressful home life c. Male, even tempered, history of previous injuries d. Female, reacts negatively to new situations, no serious previous injuries

b. Male, high activity level, stressful home life Boys have a preponderance for injuries over girls because of a difference in behavioral characteristics, a high activity temperament is associated with risk-taking behaviors, and stress predisposes children to increased risk taking and self-destructive behaviors. Therefore, a male child with a high activity level and living in a stressful environment has the highest number of risk factors. A girl with several siblings and a stable home life is low risk. A boy with previous injuries has two risk factors, but an even temper is not a risk factor for injuries. A girl who reacts negatively to new situations but has no previous serious illnesses has only one risk factor.

The nurse is reviewing the characteristics of autosomal recessive inheritance. Which are true about these characteristics? (Select all that apply.) a. Most affected persons are males. b. Males and females are equally affected. c. All daughters of an affected male are carriers. d. Carrier parents have a 25% chance of producing an affected child. e. Carrier parents have a 50% chance of producing a carrier child in each pregnancy.

b. Males and females are equally affected. d. Carrier parents have a 25% chance of producing an affected child. e. Carrier parents have a 50% chance of producing a carrier child in each pregnancy. Characteristics of autosomal recessive inheritance include males and females are equally affected, carrier parents have a 25% chance of producing an affected child, and carrier parents have a 50% chance of producing a carrier child in each pregnancy. Most affected persons who are males and all daughters of an affected male are carriers are characteristics of X-linked recessive inheritance.

A child has been diagnosed with giardiasis. Which prescribed medication should the nurse expect to administer? a. Acyclovir (Zovirax) b. Metronidazole (Flagyl) c. Erythromycin (Pediazole) d. Azithromycin (Zithromax)

b. Metronidazole (Flagyl) Metronidazole is an antibiotic effective against anaerobic bacteria and certain parasites. It is prescribed to treat giardiasis. Zithromax is an antibiotic frequently used to treat respiratory infections. Zovirax is an antiviral medication and Pediazole is an antibiotic used to treat respiratory and skin infections.

A hospitalized school-age child with phenylketonuria (PKU) is choosing foods from the hospital's menu. Which food choice should the nurse discourage the child from choosing? a. Banana b. Milkshake c. Fruit juice d. Corn on the cob

b. Milkshake Foods with low phenylalanine levels (e.g., some vegetables [except legumes]; fruits; juices; and some cereals, breads, and starches) must be measured to provide the prescribed amount of phenylalanine. Most high-protein foods, such as meat and dairy products, are either eliminated or restricted to small amounts.

An awake, alert 4-year-old child has just arrived at the emergency department after an ingestion of aspirin at home. The practitioner has ordered activated charcoal. The nurse administers charcoal in which manner? a. Giving half of the solution and then repeating the other half in 1 hour b. Mixing with a flavorful beverage in an opaque container with a straw c. Serving it in a clear plastic cup so the child can see how much has been drunk d. Administering it through a nasogastric tube because the child will not drink it because of the taste

b. Mixing with a flavorful beverage in an opaque container with a straw Although activated charcoal can be mixed with a flavorful sugar-free beverage, it will be black and resemble mud. When it is served in an opaque container, the child will not have any preconceived ideas about its being distasteful. The ability to see the charcoal solution may affect the child's desire to drink the solution. The child should be encouraged to drink the solution all at once. The nasogastric tube would be traumatic. It should be used only in children who cannot be cooperative or those without a gag reflex.

The nurse is reviewing the characteristics of autosomal dominant inheritance. Which are true about these characteristics? (Select all that apply.) a. A carrier state exists. b. The phenotype appears in consecutive generations. c. Males and females are equally likely to be affected. d. Parents who have affected children are usually asymptomatic. e. Children of an affected parent have a 50% chance of being affected.

b. The phenotype appears in consecutive generations. c. Males and females are equally likely to be affected. e. Children of an affected parent have a 50% chance of being affected. Characteristics of autosomal dominant inheritance include the phenotype appears in consecutive generations, males and females are equally affected, and children of an affected parent have a 50% chance of being affected. A carrier state and parents who have affected children are usually asymptomatic are characteristic of autosomal recessive inheritance.

Which statement reflects accurate information about patterns of sleep and wakefulness in the newborn? a. States of sleep are independent of environmental stimuli. b. The quiet alert stage is the best stage for newborn stimulation. c. Cycles of sleep states are uniform in newborns of the same age. d. Muscle twitches and irregular breathing are common during deep sleep.

b. The quiet alert stage is the best stage for newborn stimulation. During the quiet alert stage, the newborn's eyes are wide open and bright. The newborn responds to the environment by active body movement and staring at close-range objects. Newborns' ability to control their own cycles depend on their neurobehavioral development. Each newborn has an individual cycle. Muscle twitches and irregular breathing are common during light sleep.

What is an important consideration when using the FACES pain rating scale with children? a. Children color the face with the color they choose to best describe their pain. b. The scale can be used with most children as young as 3 years. c. The scale is not appropriate for use with adolescents. d. The FACES scale is useful in pain assessment but is not as accurate as physiologic responses.

b. The scale can be used with most children as young as 3 years. The FACES scale is validated for use with children ages 3 years and older. Children point to the face that best describes their level of pain. The scale can be used through adulthood. The child's estimate of the pain should be used. The physiologic measures may not reflect more long-term pain.

The parents of a preterm infant in a neonatal intensive care unit are concerned about their infant experiencing pain from so many procedures. The nurse's response should be based on which characteristic about preterm infants' pain? a. They may react to painful stimuli but are unable to remember the pain experience. b. They perceive and react to pain in much the same manner as children and adults. c. They do not have the cortical and subcortical centers that are needed for pain perception. d. They lack neurochemical systems associated with pain transmission and modulation.

b. They perceive and react to pain in much the same manner as children and adults. Numerous research studies have indicated that preterm and newborn infants perceive and react to pain in the same manner as children and adults. Preterm infants can have significant reactions to painful stimuli. Pain can cause oxygen desaturation and global stress response. These physiologic effects must be avoided by use of appropriate analgesia. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response.

The parents of a 7-year-old boy tell the nurse that lately he has been cruel to their family pets and actually caused physical harm. The nurse's recommendation should be based on remembering what? a. This is an expected behavior at this age. b. This is a warning sign of a serious problem. c. This is harmless venting of anger and frustration. d. This is common in children who are physically abused.

b. This is a warning sign of a serious problem. Cruelty to family pets is not an expected behavior. Hurting animals can be one of the earliest symptoms of a conduct disorder. Abusing animals does not dissipate violent emotions; rather, the acts may fuel the abusive behaviors. Referral for evaluation is essential. This behavior may be seen in emotional abuse or neglect, not physical abuse

A child in the terminal stage of cancer has frequent breakthrough pain. Nonpharmacologic methods are not helpful, and the child is exceeding the maximum safe dose for opiate administration. What approach should the nurse implement? a. Add acetaminophen for the breakthrough pain. b. Titrate the opioid medications to control the child's pain as specified in the protocol. c. Notify the practitioner that immediate hospitalization is indicated for pain management. d. Help the parents and child understand that no additional medication can be given because of the risk of respiratory depression

b. Titrate the opioid medications to control the child's pain as specified in the protocol. The child on long-term opioid management can become tolerant to the drugs. Also, increasing amounts of drugs may be necessary for disease progression. It is important to recognize that there is no maximum dosage that can be given to control pain. Acetaminophen will offer little additional pain control; it is useful for mild and moderate pain. Immediate hospitalization is not necessary; increased dosages of pain medications can be administered in the home environment. The principle of double effect allows for a positive intervention—relief of pain—even if there is a foreseeable possibility that death may be hastened.

Which abnormality is a common sex chromosome defect? a. Down syndrome b. Turner syndrome c. Marfan syndrome d. Hemophilia

b. Turner syndrome Turner syndrome is caused by an absence of one of the X chromosomes. Down syndrome is caused by trisomy 21 (three copies rather than two copies of chromosome 21). Marfan syndrome is a connective tissue disorder inherited in an autosomal dominant pattern. Hemophilia is a disorder of blood coagulation inherited in an X-linked recessive pattern.

A child is admitted to the hospital with lesions on his abdomen that appear like cigarette burns. What should accurate documentation by the nurse include? a. Two unhealed lesions are on the child's abdomen. b. Two round 4-mm lesions are on the child's lower abdomen. c. Two round symmetrical lesions are on the child's lower abdomen. d. Two round lesions on the child's abdomen that appear to be cigarette burns.

b. Two round 4-mm lesions are on the child's lower abdomen. Burn documentation should include the location, pattern, demarcation lines, and presence of eschar or blisters. The option that includes the size of the lesions is the most accurate.

A bone marrow aspiration and biopsy are needed on a school-age child. The most appropriate action to provide analgesia during the procedure is which? a. Administer TAC (tetracaine, adrenalin, and cocaine) 15 minutes before the procedure. b. Use a combination of fentanyl and midazolam for conscious sedation. c. Apply EMLA (eutectic mixture of local anesthetics) 1 hour before the procedure. d. Apply a transdermal fentanyl (Duragesic) "patch" immediately before the procedure.

b. Use a combination of fentanyl and midazolam for conscious sedation. A bone marrow biopsy is a painful procedure. The combination of fentanyl and midazolam should be used to provide conscious sedation. TAC provides skin anesthesia about 15 minutes after it is applied to nonintact skin. The gel can be placed on a wound for suturing. It is not sufficient for a bone marrow biopsy. EMLA is an effective topical analgesic agent when applied to the skin 60 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. For this procedure, systemic analgesia is required. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control.

The nurse needs to take the blood pressure of a small child. Of the cuffs available, one is too large and one is too small. The best nursing action is which? a. Use the small cuff. b. Use the large cuff. c. Use either cuff using the palpation method. d. Wait to take the blood pressure until a proper cuff can be located.

b. Use the large cuff. If blood pressure measurement is indicated and the appropriate size cuff is not available, the next larger size is used. The nurse recognizes that this may be a falsely low blood pressure. Using the small cuff will give an incorrectly high reading. The palpation method will not improve the inaccuracy inherent in the cuff.

Which is considered a block to effective communication? a. Using silence b. Using clichés c. Directing the focus d. Defining the problem

b. Using clichés Using stereotyped comments or clichés can block effective communication. After the nurse uses such trite phrases, parents often do not respond. Silence can be an effective interviewing tool. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions. To be effective, the nurse must be able to direct the focus of the interview while allowing maximum freedom of expression. By using open-ended questions and guiding questions, the nurse can obtain the necessary information and maintain a relationship with the family. The nurse and parent must collaborate and define the problem that will be the focus of the nursing intervention.

The nurse is administering activated charcoal to a preschool child with acetaminophen (Tylenol) poisoning. What potential complications from the use of activated charcoal should the nurse plan to assess for? (Select all that apply.) a. Diarrhea b. Vomiting c. Fluid retention d. Intestinal obstruction

b. Vomiting d. Intestinal obstruction Potential complications from the use of activated charcoal include vomiting and possible aspiration, constipation, and intestinal obstruction. Diarrhea and fluid retention are not potential complications of activated charcoal administration.

Rectal temperatures are indicated in which situation? a. In the newborn period b. Whenever accuracy is essential c. Rectal temperatures are never indicated d. When rapid temperature changes are occurring

b. Whenever accuracy is essential Rectal temperatures are recommended when definitive measurements are necessary in infants older than age 1 month. Rectal temperatures are not done in the newborn period to avoid trauma to the rectal mucosa. Rectal temperature is an intrusive procedure that should be avoided whenever possible.

The nurse is teaching parents the signs of a hearing impairment in a child. What should the nurse include as signs? (Select all that apply.) a.Outgoing behavior b. Yelling to express pleasure c. Asking to have statements repeated d. Foot stamping for vibratory sensation e. Failure to develop intelligible speech by age 24 months

b. Yelling to express pleasure c. Asking to have statements repeated d. Foot stamping for vibratory sensation e. Failure to develop intelligible speech by age 24 months Signs of a hearing impairment in a child include yelling to express pleasure, asking to have statements repeated, foot stamping for vibratory sensation, and failure to develop intelligible speech by age 24 months. The child's behavior is shy, not outgoing.

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."

c. "Cataracts require surgery to remove the cloudy lens and replace it." 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.

The nurse is discussing parenting in reconstituted families with a new stepparent. The nurse is aware that the new stepparent understands the teaching when which statement is made? a. "I am glad there will be no disruption in my lifestyle." b. "I don't think children really want to live in a two-parent home." c. "I realize there may be power conflicts bringing two households together." d. "I understand contact between grandparents should be kept to a minimum."

c. "I realize there may be power conflicts bringing two households together." The entry of a stepparent into a ready-made family requires adjustments for all family members. Power conflicts are expected, and flexibility, mutual support, and open communication are critical in successful relationships. So the statement that power conflicts are possible means teaching was understood. Some obstacles to the role adjustments and family problem solving include disruption of previous lifestyles and interaction patterns, complexity in the formation of new ones, and lack of social supports. Most children from divorced families want to live in a two-parent home. There should be continued contact with grandparents.

The nurse is teaching parents of a child with cri du chat syndrome about this disorder. The nurse understands parents understand the teaching if they make which statement? a. "This disorder is very common." b. "This is an autosomal recessive disorder." c. "The crying pattern is abnormal and catlike." d. "The child will always have a moon-shaped face."

c. "The crying pattern is abnormal and catlike." Typical of this disease is a crying pattern that is abnormal and catlike. Cri du chat, or cat's cry, syndrome is a rare (one in 50,000 live births) chromosome deletion syndrome, not autosomal recessive, resulting from loss of the small arm of chromosome 5. In early infancy this syndrome manifests with a typical but nondistinctive facial appearance, often a "moon-shaped" face with wide-spaced eyes (hypertelorism). As the child grows, this feature is progressively diluted, and by age 2 years, the child is indistinguishable from age-matched control participants.

The nurse is teaching student nurses about newborn screening. Which statement made by the student indicates understanding of the teaching? a. "The newborn screening is not mandatory but voluntary." b. "It is acceptable to 'layer' the blood on the Guthrie paper." c. "The initial specimen should be collected as close to discharge as possible." d. "It is best to collect the specimen before the newborn takes the first feeding."

c. "The initial specimen should be collected as close to discharge as possible." Because of early discharge of newborns, recommendations for screening include collecting the initial specimen as close as possible to discharge. Newborn screening tests are mandatory in all 50 U.S. states. When collecting the specimen, avoid "layering" the blood specimen on the special Guthrie paper. Layering is placing one drop of blood on top of the other or overlapping the specimen. Best results are obtained by collecting the specimen with a pipette from the heel stick and spreading the blood uniformly over the blot paper. The screening test is most reliable if the blood sample is taken after the infant has ingested a source of protein.

The nurse is teaching parents about the types of behaviors children exhibit when living with chronic violence. Which statement made by the parents indicates further teaching is needed? a. "We should watch for aggressive play." b. "Our child may show lasting symptoms of stress." c. "We know that our child will show caring behaviors." d. "Our child may have difficulty concentrating in school."

c. "We know that our child will show caring behaviors." The statement that the child will show caring behaviors needs further teaching. Children living with chronic violence may exhibit behaviors such as difficulty concentrating in school, memory impairment, aggressive play, uncaring behaviors, and lasting symptoms of stress.

The nurse is planning to administer a nonopioid for pain relief to a child. Which timing should the nurse plan so the nonopioid takes effect? a. 15 minutes until maximum effect b. 30 minutes until maximum effect c. 1 hour until maximum effect d. 1 1/2 hours until maximum effect

c. 1 hour until maximum effect Nonsteroidal antiinflammatory drugs (NSAIDs) can provide safe and effective pain relief when dosed at appropriate levels with adequate frequency. Most NSAIDs take about 1 hour for effect, so timing is crucial.

The nurse should expect the apical heart rate of a stabilized newborn to be in which range? a. 60 to 80 beats/min b. 80 to 100 beats/min c. 120 to 140 beats/min d. 160 to 180 beats/min

c. 120 to 140 beats/min The pulse rate of the newborn varies with periods of reactivity. Usually the pulse rate is between 120 and 140 beats/min. Sixty to 100 beats/min is too slow for a newborn, and 160 to 180 beats/min is too fast for a newborn

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

c. 3 to 4 months Visual fixation and ability to follow a target should be present by ages 3 to 4 months. One to 2 months is too young for this developmental milestone. If an infant is not able to fix and follow by 6 months, further ophthalmologic evaluation is needed.

With the National Center for Health Statistics criteria, which body mass index (BMI)-for-age percentiles should indicate the patient is at risk for being overweight? a. 10th percentile b. 75th percentile c. 85th percentile d. 95th percentile

c. 85th percentile Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children who are greater than or equal to the 95th percentile are considered overweight. Children whose BMI is between the 10th and 75th percentiles are within normal limits.

At which age do most children have an adult concept of death as being inevitable, universal, and irreversible? a. 4 to 5 years b. 6 to 8 years c. 9 to 11 years d. 12 to 16 years

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

When doing the first assessment of a male newborn, the nurse notes that the scrotum is large, edematous, and pendulous. What should this be interpreted as? a. A hydrocele b. An inguinal hernia c. A normal finding d. An absence of testes

c. A normal finding A large, edematous, and pendulous scrotum in a term newborn, especially in those born in a breech position, is a normal finding. A hydrocele is fluid in the scrotum, usually unilateral, which usually resolves within a few months. An inguinal hernia may or may not be present at birth. It is more easily detected when the child is crying. The presence or absence of testes should be determined on palpation of the scrotum and inguinal canal. Absence of testes may be an indication of ambiguous genitalia.

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

c. A physical characteristic of Down syndrome 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.

The nurse is planning care for a hospitalized preschool-aged child. Which should the nurse plan to ensure atraumatic care? a. Limit explanation of procedures because the child is preschool aged. b. Ask that all family members leave the room when performing procedures. c. Allow the child to choose the type of juice to drink with the administration of oral medications. d. Explain that EMLA cream cannot be used for the morning lab draw because there is not time for it to be effective.

c. Allow the child to choose the type of juice to drink with the administration of oral medications. The overriding goal in providing atraumatic care is first, do no harm. Allowing the child a choice of juice to drink when taking oral medications provides the child with a sense of control. The preschool child should be prepared before procedures, so limiting explanations of procedures would increase anxiety. The family should be allowed to stay with the child during procedures, minimizing stress. Lidocaine/prilocaine (EMLA) cream is a topical local anesthetic. The nurse should plan to use the prescribed cream in time for morning laboratory draws to minimize pain.

What condition is defined as reduced visual acuity in one eye despite appropriate optical correction? a. Myopia b. Hyperopia c. Amblyopia d. Astigmatism

c. Amblyopia Amblyopia, or lazy eye, is reduced visual acuity in one eye. Amblyopia is usually caused by one eye not receiving sufficient stimulation. The resulting poor vision in the affected eye can be avoided with the treatment of the primary visual defect such as strabismus. Myopia, or nearsightedness, refers to the ability to see objects clearly at close range but not a distance. Hyperopia, or farsightedness, is the ability to see objects at a distance but not at close range. Astigmatism is unequal curvatures in refractive apparatus.

Chromosome analysis of the fetus is usually accomplished through the testing of which? a. Fetal serum b. Maternal urine c. Amniotic fluid d. Maternal serum

c. Amniotic fluid Amniocentesis is the most common method to retrieve fetal cells for chromosome analysis. Viable fetal cells are sloughed off into the amniotic fluid, and when a sample is taken, they can be cultured and analyzed. It is difficult to obtain a sample of the fetal blood. It is a high-risk situation for the fetus. Fetal cells are not present in the maternal urine or blood.

A child with cyanide poisoning has been admitted to the emergency department. What antidote does the nurse anticipate being prescribed for the child? a. Atropine b. Glucagon c. Amyl nitrate d. Naloxone (Narcan)

c. Amyl nitrate Amyl nitrate is the antidote for cyanide poisoning. Atropine is an antidote for organophosphate poisoning, glucagon is an antidote for a beta-blocker poisoning, and naloxone (Narcan) is an antidote for an opioid poisoning.

When auscultating an infant's lungs, the nurse detects diminished breath sounds. What should the nurse interpret this as? a. Suggestive of chronic pulmonary disease b. Suggestive of impending respiratory failure c. An abnormal finding warranting investigation d. A normal finding in infants younger than 1 year of age

c. An abnormal finding warranting investigation Absent or diminished breath sounds are always an abnormal finding. Fluid, air, or solid masses in the pleural space all interfere with the conduction of breath sounds. Further data are necessary for diagnosis of chronic pulmonary disease or impending respiratory failure. Diminished breath sounds in certain segments of the lungs can alert the nurse to pulmonary areas that may benefit from chest physiotherapy. Further evaluation is needed in all age groups.

Which ethnic group is at risk for Tay-Sachs disease? a. Black African b. Mediterranean c. Ashkenazi Jewish d. Southern and Southeast Asian

c. Ashkenazi Jewish The Ashkenazi Jewish ethnic group is at higher risk for Tay-Sachs disease. The black African, Mediterranean, and Southern and Southeast Asian ethnicities are at higher risk for sickle cell anemia disease.

The nurse observes that a new mother avoids making eye contact with her infant. What should the nurse do? a. Ask the mother why she won't look at the infant. b. Examine the infant's eyes for the ability to focus. c. Assess the mother for other attachment behaviors. d. Recognize this as a common reaction in new mothers.

c. Assess the mother for other attachment behaviors. Attachment behaviors are thought to indicate the formation of emotional bonds between the newborn and mother. A mother's failure to make eye contact with her infant may indicate difficulties with the formation of emotional bonds. The nurse should perform a more thorough assessment. Asking the mother why she will not look at the infant is a confrontational response that might put the mother in a defensive position. Infants do not have binocularity and cannot focus. Avoiding eye contact is an uncommon reaction in new mothers.

The nurse is assessing the reflexes of a newborn. Stroking the outer sole of the foot assesses which reflex? a. Grasp b. Perez c. Babinski d. Dance or step

c. Babinski This is a description of the Babinski reflex. Stroking the outer sole of the foot upward from the heel across the ball of the foot causes the big toes to dorsiflex and the other toes to hyperextend. This reflex persists until approximately age 1 year or when the newborn begins to walk. The grasp reflex is elicited by touching the palms or soles at the base of the digits. The digits will flex or grasp. The Perez reflex involves stroking the newborn's back when prone; the child flexes the extremities, elevating the head and pelvis. This disappears at ages 4 to 6 months. When the newborn is held so that the sole of the foot touches a hard surface, there is a reciprocal flexion and extension of the leg, simulating walking. This reflex disappears by ages 3 to 4 weeks.

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.

c. Behavior modification is an excellent form of discipline. 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.

Parents ask the nurse about the characteristics of autosomal dominant inheritance. Which statement is characteristic of autosomal dominant inheritance? a. Females are affected with greater frequency than males. b. Unaffected children of affected individuals will have affected children. c. Each child of a heterozygous affected parent has a 50% chance of being affected. d. Any child of two unaffected heterozygous parents has a 25% chance of being affected.

c. Each child of a heterozygous affected parent has a 50% chance of being affected. In autosomal dominant inheritance, only one copy of the mutant gene is necessary to cause the disorder. When a parent is affected, there is a 50% chance that the chromosome with the gene for the disorder will be contributed to each pregnancy. Males and females are equally affected. The disorder does not "skip" a generation. If the child is not affected, then most likely he or she is not a carrier of the gene for the disorder. In autosomal recessive inheritance, any child of two unaffected heterozygous parents has a 25% chance of being affected.

Which term best describes the sharing of common characteristics that differentiates one group from other groups in a society? a. Race b. Culture c. Ethnicity d. Superiority

c. Ethnicity Ethnicity is a classification aimed at grouping individuals who consider themselves, or are considered by others, to share common characteristics that differentiate them from the other collectivities in a society, and from which they develop their distinctive cultural behavior. Race is a term that groups together people by their outward physical appearance. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perception and judgments. Superiority is the state or quality of being superior; it does not apply to ethnicity.

Which type of family should the nurse recognize when the paternal grandmother, the parents, and two minor children live together? a. Blended b. Nuclear c. Extended d. Binuclear

c. Extended An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. A blended family contains at least one stepparent, stepsibling, or half-sibling. A nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.

The school nurse understands that children are impacted by divorce. Which has the most impact on the positive outcome of a divorce? a. Age of the child b. Gender of the child c. Family characteristics d. Ongoing family conflict

c. Family characteristics Family characteristics are more crucial to the child's well-being during a divorce than specific child characteristics, such as age or sex. High levels of ongoing family conflict are related to problems of social development, emotional stability, and cognitive skills for the child.

The nurse is planning to counsel family members as a group to assess the family's group dynamics. Which theoretic family model is the nurse using as a framework? a. Feminist theory b. Family stress theory c. Family systems theory d. Developmental theory

c. Family systems theory In family systems theory, the family is viewed as a system that continually interacts with its members and the environment. The emphasis is on the interaction between the members; a change in one family member creates a change in other members, which in turn results in a new change in the original member. Assessing the family's group dynamics is an example of using this theory as a framework. Family stress theory explains how families react to stressful events and suggests factors that promote adaptation to stress. Developmental theory addresses family change over time using Duvall's family life cycle stages based on the predictable changes in the family's structure, function, and roles, with the age of the oldest child as the marker for stage transition. Feminist theories assume that privilege and power are inequitably distributed based upon gender, race, and class.

Parents of a hospitalized toddler ask the nurse, "What is meant by family-centered care?" The nurse should respond with which statement? a. Family-centered care reduces the effect of cultural diversity on the family. b. Family-centered care encourages family dependence on the health care system. c. Family-centered care recognizes that the family is the constant in a child's life. d. Family-centered care avoids expecting families to be part of the decision-making process.

c. Family-centered care recognizes that the family is the constant in a child's life. The three key components of family-centered care are respect, collaboration, and support. Family-centered care recognizes the family as the constant in the child's life. The family should be enabled and empowered to work with the health care system and is expected to be part of the decision-making process. The nurse should also support the family's cultural diversity, not reduce its effect.

A child with diazepam (Valium) poisoning has been admitted to the emergency department. What antidote does the nurse anticipate being prescribed? a. Succimer (Chemet) b. EDTA (Versenate) c. Flumazenil (Romazicon) d. Octreotide acetate (Sandostatin)

c. Flumazenil (Romazicon) The antidote for diazepam (Valium) poisoning is flumazenil (Romazicon). Succimer (Chemet) and EDTA (Versenate) are antidotes for heavy metal poisoning. Octreotide acetate (Sandostatin) is an antidote for sulfonylurea poisoning.

A 4-month-old infant is discharged home after surgery for the repair of a cleft lip. What should instructions to the parents include? a. Provide crib toys for distraction. b. Breast- or bottle-feeding can begin immediately. c. Give pain medication to the infant to minimize crying. d. Leave the infant in the crib at all times to prevent suture strain.

c. Give pain medication to the infant to minimize crying. Pain medication and comfort measures are used to minimize infant crying. Interventions are implemented to minimize stress on the suture line. Although crib toys are important, the child should not be left in the crib for prolonged periods. Feeding begins with alternative feeding devices. Sucking puts stress on the suture line in the immediate postoperative period. The infant should not be left in the crib but should be removed for appropriate holding and stimulation.

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.

c. Provide peer experiences, such as infant stimulation and preschool programs. 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.

What is an appropriate screening test for hearing that the nurse can administer to a 5-year-old child? a. Rinne test b. Weber test c. Pure tone audiometry d. Eliciting the startle reflex

c. Pure tone audiometry Pure tone audiometry uses an audiometer that produces sounds at different volumes and pitches in the child's ears. The child is asked to respond in some way when the tone is heard in the earphone. The Rinne and Weber tests measure bone conduction of sound. Eliciting the startle reflex may be useful in infants.

The parents of a young child ask the nurse for suggestions about discipline. When discussing the use of time-outs, which should the nurse include? a. Send the child to his or her room if the child has one. b. A general rule for length of time is 1 hour per year of age. c. Select an area that is safe and nonstimulating, such as a hallway. d. If the child cries, refuses, or is more disruptive, try another approach.

c. Select an area that is safe and nonstimulating, such as a hallway. The area must be nonstimulating and safe. The child becomes bored in this environment and then changes behavior to rejoin activities. The child's room may have toys and activities that negate the effect of being separated from the family. The general rule is 1 minute per year of age. An hour per year is excessive. When the child cries, refuses, or is more disruptive, the time-out does not start; the time-out begins when the child quiets.

Children are taught the values of their culture through observation and feedback relative to their own behavior. In teaching a class on cultural competence, the nurse should be aware that which factor may be culturally determined? a. Ethnicity b. Racial variation c. Status d. Geographic boundaries

c. Status Status is culturally determined and varies according to each culture. Some cultures ascribe higher status to age or socioeconomic position. Social roles also are influenced by the culture. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. It is one component of culture. Race and culture are two distinct attributes. Whereas racial grouping describes transmissible traits, culture is determined by the pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. Cultural development may be limited by geographic boundaries, but the boundaries are not culturally determined.

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

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

Which is true regarding an infant's kidney function? a. Conservation of fluid and electrolytes occurs. b. Urine has color and odor similar to the urine of adults. c. The ability to concentrate urine is less than that of adults. d. Normally, urination does not occur until 24 hours after delivery.

c. The ability to concentrate urine is less than that of adults. At birth, all structural components are present in the renal system, but there is a functional deficiency in the kidney's ability to concentrate urine and to cope with conditions of fluid and electrolyte stress such as dehydration or a concentrated solute load. Infants' urine is colorless and odorless. The first voiding usually occurs within 24 hours of delivery. Newborns void when the bladder is stretched to 15 ml, resulting in about 20 voidings per day.

The nurse manager is compiling a report for a hospital committee on the quality of nursing-sensitive indicators for a nursing unit. Which does the nurse manager include in the report? a. The average age of the nurses on the unit b. The salary ranges for the nurses on the unit c. The education and certification of the nurses on the unit d. The number of nurses who have applied but were not hired for the unit

c. The education and certification of the nurses on the unit Nursing-sensitive indicators reflect the structure, process, and outcomes of nursing care. For example, the number of nursing staff, the skill level of the nursing staff, and the education and certification of nursing staff indicate the structure of nursing care. The average age of the nurses, salary range, and number of nurses who have applied but were not hired for the unit are not nursing-sensitive indicators.

A new mother wants to be discharged with her infant as soon as possible. Before discharge, what should the nurse be certain of? a. The infant has voided at least once. b. The infant does not spit up after feeding. c. Jaundice, if present, appeared before 24 hours. d. A follow-up appointment with the practitioner is made within 48 hours.

d. A follow-up appointment with the practitioner is made within 48 hours. The American Academy of Pediatrics recommends that newborns discharged early receive follow-up care within 48 hours in either a primary practitioner's office or the home. The child should void every 4 to 6 hours. Spitting up small amounts after feeding is normal in newborns; it should not delay discharge. Jaundice within the first 24 hours of life must be evaluated.

A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicles, and juices, are left. Which statement best explains this? a. The parent is trying to feed the child only what the child likes most. b. Hispanics believe the "evil eye" enters when a person gets cold. c. The parent is trying to restore normal balance through appropriate "hot" remedies. d. Hispanics believe an innate energy called chi is strengthened by eating soup.

c. The parent is trying to restore normal balance through appropriate "hot" remedies. In several cultures, including Filipino, Chinese, Arabic, and Hispanic, hot and cold describe certain properties completely unrelated to temperature. Respiratory conditions such as pneumonia are "cold" conditions and are treated with "hot" foods. The child may like broth but is unlikely to always prefer it to Jell-O, Popsicles, and juice. The evil eye applies to a state of imbalance of health, not curative actions. Chinese individuals, not Hispanic individuals, believe in chi as an innate energy.

A 6-year-old child has patient-controlled analgesia (PCA) for pain management after orthopedic surgery. The parents are worried that their child will be in pain. What should your explanation to the parents include? a. The child will continue to sleep and be pain free. b. Parents cannot administer additional medication with the button. c. The pump can deliver baseline and bolus dosages. d. There is a high risk of overdose, so monitoring is done every 15 minutes.

c. The pump can deliver baseline and bolus dosages. The PCA prescription can be set for a basal rate for a continuous infusion of pain medication. Additional doses can be administered by the patient, parent, or nurse as necessary. Although the goal of PCA is to have effective pain relief, a pain-free state may not be possible. With a 6-year-old child, the parents and nurse must assess the child to ensure that adequate medication is being given because the child may not understand the concept of pushing a button. Evidence-based practice suggests that effective analgesia can be obtained with the parents and nurse giving boluses as necessary. The prescription for the PCA includes how much medication can be given in a defined period. Monitoring every 1 to 2 hours for patient response is sufficient.

Why are rectal temperatures not recommended in newborns? a. They are inaccurate. b. They do not reflect core body temperature. c. They can cause perforation of rectal mucosa. d. They take too long to obtain an accurate reading.

c. They can cause perforation of rectal mucosa. Rectal temperatures are avoided in newborns. If done incorrectly, the insertion of a thermometer into the rectum can cause perforation of the mucosa. The time it takes to determine body temperature is related to the equipment used, not only the route.

Which genetic term refers to the transfer of all or part of a chromosome to a different chromosome after chromosome breakage? a. Trisomy b. Monosomy c. Translocation d. Nondisjunction

c. Translocation Translocation is the transfer of all or part of a chromosome to a different chromosome after chromosome breakage. It can be balanced, producing no phenotypic effects, or unbalanced, producing severe or lethal effects. Trisomy is an abnormal number of chromosomes caused by the presence of an extra chromosome, which is added to a given chromosome pair and results in a total of 47 chromosomes per cell. Monosomy is an abnormal number of chromosomes whereby the chromosome is represented by a single copy in a somatic cell. Nondisjunction is the failure of homologous chromosomes or chromatids to separate during mitosis or meiosis.

What is the major cause of death for children older than 1 year in the United States? a. Heart disease b. Childhood cancer c. Unintentional injuries d. Congenital anomalies

c. Unintentional injuries Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence. The leading cause of death for those younger than 1 year is congenital anomalies, and childhood cancers and heart disease cause a significantly lower percentage of deaths in children older than 1 year of age.

Which are effective auscultation techniques? (Select all that apply.) a. Ask the child to breathe shallowly. b. Apply light pressure on the chest piece. c. Use a symmetric and orderly approach. d. Place the stethoscope over one layer of clothing. e. Warm the stethoscope before placing it on the skin.

c. Use a symmetric and orderly approach. e. Warm the stethoscope before placing it on the skin. Effective auscultation techniques include using a symmetric approach and warming the stethoscope before placing it on the skin. Breath sounds are best heard if the child inspires deeply, not shallowly. Firm, not light, pressure should be used on the chest piece. The stethoscope should be placed on the skin, not over clothing.

The nurse is assessing breath sounds on a child. Which are expected auscultated breath sounds? (Select all that apply.) a. Wheezes b. Crackles c. Vesicular d. Bronchial e. Bronchovesicular

c. Vesicular d. Bronchial e. Bronchovesicular Normal breath sounds are classified as vesicular, bronchovesicular, or bronchial. Wheezes or crackles are abnormal or adventitious sounds.

The nurse is teaching a staff development program about levels of sedation in the pediatric population. Which statement by one of the participants should indicate a correct understanding of the teaching? a. "With minimal sedation, the patient's respiratory efforts are affected, and cognitive function is not impaired." b. "With general anesthesia, the patient's airway cannot be maintained, but cardiovascular function is maintained." c. "During deep sedation, the patient can be easily aroused by loud verbal commands and tactile stimulation." d. "During moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation."

d. "During moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation." When discussing levels of sedation, the participants should understand that during moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation, cognitive function is impaired, and respiratory function is adequate. In minimal sedation, the patient responds to verbal commands and may have impaired cognitive function; the respiratory and cardiovascular systems are unaffected. In deep sedation, the patient cannot be easily aroused except by painful stimuli; the airway and spontaneous ventilation may be impaired, but cardiovascular function is maintained. With general anesthesia, the patient loses consciousness and cannot be aroused with painful stimuli, the airway cannot be maintained, and ventilation is impaired; cardiovascular function may or may not be impaired.

A child has been diagnosed with scabies. Which statement by the parent indicates understanding of the nurse's teaching about scabies? a. "The itching will stop after the cream is applied." b. "We will complete extensive aggressive housecleaning." c. "We will apply the cream to only the affected areas as directed." d. "Everyone who has been in close contact with my child will need to be treated."

d. "Everyone who has been in close contact with my child will need to be treated." Because of the length of time between infestation and physical symptoms (30 to 60 days), all persons who were in close contact with the affected child need treatment. Families need to know that although the mite will be killed, the rash and the itch will not be eliminated until the stratum corneum is replaced, which takes approximately 2 to 3 weeks. Aggressive housecleaning is not necessary, but surface vacuuming of heavily used rooms by a person with crusted scabies is recommended. The prescribed cream should be thoroughly and gently massaged into all skin surfaces (not just the areas that have a rash) from the head to the soles of the feet.

Parents of a child with hemophilia A ask the nurse, "What is the deficiency with this disorder?" Which correct response should the nurse make? a. "Hemophilia A has a deficiency in red blood cells." b. "Hemophilia A has a deficiency in platelets." c. "Hemophilia A has a deficiency in factor IX." d. "Hemophilia A has a deficiency in factor VIII."

d. "Hemophilia A has a deficiency in factor VIII." Hemophilia A is deficient in factor VIII. Glucose-6-phosphate dehydrogenase (G6PD) deficiency shows low red blood cells (hemolytic anemia). Immunosuppression may be the cause of a deficient number of platelets. Hemophilia B is deficient in factor IX.

The nurse is teaching a nursing student about standard precautions. Which statement made by the student indicates a need for further teaching? a. "I will use precautions when I give an infant oral care." b. "I will use precautions when I change an infant's diaper." c. "I will use precautions when I come in contact with blood and body fluids." d. "I will use precautions when administering oral medications to a school-age child."

d. "I will use precautions when administering oral medications to a school-age child." Standard precautions involve the use of barrier protection (personal protective equipment [PPE]), such as gloves, goggles, a gown, or a mask, to prevent contamination from (1) blood; (2) all body fluids, secretions, and excretions except sweat, regardless of whether they contain visible blood; (3) nonintact skin; and (4) mucous membranes. Precautions should be taken when giving oral care, when changing diapers, and when coming in contact with blood and body fluids. Further teaching is needed if the student indicates the need to use precautions when administering an oral medication to a school-age child.

Parents of a preschool child ask the nurse, "Should we set rules for our child as part of a discipline plan?" Which is an accurate response by the nurse? a. "It is best to delay the punishment if a rule is broken." b. "The child is too young for rules. At this age, unrestricted freedom is best." c. "It is best to set the rules and reason with the child when the rules are broken." d. "Set clear and reasonable rules and expect the same behavior regardless of the circumstances."

d. "Set clear and reasonable rules and expect the same behavior regardless of the circumstances." Nurses can help parents establish realistic and concrete "rules." The clearer the limits that are set and the more consistently they are enforced, the less need there is for disciplinary action. Delaying punishment weakens its intent. Children want and need limits. Unrestricted freedom is a threat to their security and safety. Reasoning involves explaining why an act is wrong and is usually appropriate for older children, especially when moral issues are involved. However, young children cannot be expected to "see the other side" because of their egocentrism.

The nurse is teaching new parents about the benefits of breastfeeding their infant. Which statement by the parent should indicate a correct understanding of the teaching? a. "I should breastfeed my baby so that she will grow at a faster rate than a bottle-fed newborn." b. "One of the advantages of breastfeeding is that the baby will have fewer stools per day." c. "I should breastfeed my baby because breastfed babies adapt more easily to a regular schedule of feedings." d. "Some of the advantages of breastfeeding are that breast milk is economical and readily available for my baby."

d. "Some of the advantages of breastfeeding are that breast milk is economical and readily available for my baby." Some advantages of breastfeeding a newborn are that breast milk is more economical, is readily available, and is sanitary. Breastfed newborns usually grow at a satisfactory, slower rate than bottle-fed newborns, which research indicates aids in decreased obesity in children. Breastfed babies have an increased number of stools throughout a 24-hour period, and neither breastfed nor bottle-fed newborns should be placed on a regular schedule; they should be fed on demand.

Parents ask the nurse if there was something that should have been done during the pregnancy to prevent their child's cleft lip. Which statement should the nurse give as a response? a. "This is a type of deformation and can sometimes be prevented." b. "Studies show that taking folic acid during pregnancy can prevent this defect." c. "This is a genetic disorder and has a 25% chance of happening with each pregnancy." d. "The malformation occurs at approximately 5 weeks of gestation; there is no known way to prevent this."

d. "The malformation occurs at approximately 5 weeks of gestation; there is no known way to prevent this." Cleft lip, an example of a malformation, occurs at approximately 5 weeks of gestation when the developing embryo naturally has two clefts in the area. There is no known way to prevent this defect. Deformations are often caused by extrinsic mechanical forces on normally developing tissue. Club foot is an example of a deformation often caused by uterine constraint. Cleft lip is not a genetic disorder; the reasons for this occurring are still unknown. Taking folic acid during pregnancy can help to prevent neural tube disorders but not cleft lip defects.

The parents of an infant with a cleft palate ask the nurse, "What follow-up care will our infant need after the repair?" Which is an accurate response by the nurse? a. "Your infant will not need any subsequent follow-up care." b. "Your infant will only need to be evaluated by an audiologist." c. "Your infant will only need follow-up with a speech pathologist." d. "Your infant will need follow-up with audiologists and orthodontists."

d. "Your infant will need follow-up with audiologists and orthodontists." A cleft palate means that audiologists will evaluate the child's hearing throughout early childhood and work closely with otolaryngologists to determine if pressure-equalizing (PE) tubes are needed. An infant with a cleft palate will also go through multiple phases of orthodontic intervention to align the teeth and the maxillary arches. Follow-up will be needed as the child grows. Following up with only an audiologist or only a speech pathologist would not be adequate

A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. What should the nurse explain? a. This cannot be prevented. b. Infants do not feel pain as adults do. c. This is not a good reason for refusing immunizations. d. A topical anesthetic can be applied before injections are given.

d. A topical anesthetic can be applied before injections are given. To minimize the discomfort associated with intramuscular injections, a topical anesthetic agent can be used on the injection site. These include EMLA (eutectic mixture of local anesthetic) and vapor coolant sprays. Pain associated with many procedures can be prevented or minimized by using the principles of atraumatic care. Infants have neural pathways that will indicate pain. Numerous research studies have indicated that infants perceive and react to pain in the same manner as do children and adults. The mother should be allowed to discuss her concerns and the alternatives available. This is part of the informed consent process.

What factor is most important for parents implementing do not resuscitate (DNR) orders? a. Parents' beliefs about euthanasia b. Presence of other children in the home c. Experiences of the health care team with other children in this situation d. Acknowledgment by health care team that child has no realistic chance for cure

d. Acknowledgment by health care team that child has no realistic chance for cure Earlier implementation of DNR orders, use of less aggressive therapies, and greater provision of palliative care measures are associated with an honest appraisal of the child's condition. Euthanasia involves an action carried out by a person other than the patient to end the life of the patient suffering from a terminal condition. DNR orders do not involve euthanasia but give permission for health care providers to allow the child to die without intervention. Parents state that regardless of the number of children they have, the death of a child is a new experience and nothing can prepare them for it. Health professionals may base their discussions with families on prior experiences, but families base their decision on an honest appraisal of their child's condition.

At which developmental period do children have the most difficulty coping with death, particularly if it is their own? a. Toddlerhood b. Preschool c. School age d. Adolescence

d. Adolescence Adolescents, because of their mature understanding of death, remnants of guilt and shame, and issues with deviations from normal, have the most difficulty coping with death. Toddlers and preschoolers are too young to have difficulty coping with their own death. They fear separation from their parents. School-age children fear the unknown such as the consequences of the illness and the threat to their sense of security.

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.

d. Apply a Fox shield to the affected eye and any type of patch to the other eye. The nurse's role in a penetrating eye injury is to prevent further injury to the eye. A Fox shield (if available) should be applied to the injured eye and a regular eye patch to the other eye to prevent bilateral movement. 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.

An infant is being discharged at 48 hours of age. The parents ask how the infant should be bathed this first week home. Which is the best recommendation by the nurse? a. Bathe the infant daily with mild soap. b. Bathe the infant daily with an alkaline soap. c. Bathe the infant two or three times this week with mild soap. d. Bathe the infant two or three times this week with plain water.

d. Bathe the infant two or three times this week with plain water. A newborn infant's skin has a pH of approximately 5. This acidic pH has a bacteriostatic effect. The parents should be taught to use only plain warm water for the bath and to bathe the infant no more than two or three times the first 2 weeks. Soaps are alkaline. They will alter the acid mantle of the infant's skin, providing a medium for bacterial growth.

A young boy is found squirting lighter fluid into his mouth. His father calls the emergency department. The nurse taking the call should know that the primary danger is what? a. Hepatic dysfunction b. Dehydration secondary to vomiting c. Esophageal stricture and shock d. Bronchitis and chemical pneumonia

d. Bronchitis and chemical pneumonia Lighter fluid is a hydrocarbon. The immediate danger is aspiration. Acetaminophen overdose, not hydrocarbons, causes hepatic dysfunction. Dehydration is not the primary danger. Esophageal stricture is a late or chronic consequence of hydrocarbon ingestion.

An infant with respiratory syncytial virus (RSV) is being admitted to the hospital. The nurse should plan to place the infant on which precaution? a. Enteric b. Airborne c. Droplet d. Contact

d. Contact A patient with RSV is placed on contact precautions. The transmission of RSV is by contact of secretions, not by droplets or airborne. Enteric precautions are not required for RSV.

Which best describes signs and symptoms as part of a nursing diagnosis? a. Description of potential risk factors b. Identification of actual health problems c. Human response to state of illness or health d. Cues and clusters derived from patient assessment

d. Cues and clusters derived from patient assessment Signs and symptoms are the cues and clusters of defining characteristics that are derived from a patient assessment and indicate actual health problems. The first part of the nursing diagnosis is the problem statement, also known as the human response to the state of illness or health. The identification of actual health problems may be part of the medical diagnosis. The nursing diagnosis is based on the human response to these problems. The human response is therefore a component of the nursing diagnostic statement. Potential risk factors are used to identify nursing care needs to avoid the development of an actual health problem when a potential one exists.

What is most descriptive of the shape of the anterior fontanel in a newborn? a. Circle b. Square c. Triangle d. Diamond

d. Diamond The anterior fontanel is diamond shaped and measures from barely palpable to 4 to 5 cm. The shape of the posterior fontanel is a triangle. Neither of the fontanels is a circle or a square.

One of the techniques that has been especially useful for learners having cognitive impairment is called fading. What description best explains this technique? a. Positive reinforcement when tasks or behaviors are mastered b. Repeated verbal explanations until tasks are faded into the child's development c. Negative reinforcement for specific tasks or behaviors that need to be faded out d. Gradually reduces the assistance given to the child so the child becomes more independent

d. Gradually reduces the assistance given to the child so the child becomes more independent Fading is physically taking the child through each sequence of the desired activity and gradually fading out the physical assistance so the child becomes more independent. Positive reinforcement when tasks or behaviors are mastered is part of behavior modification. An essential component is ignoring undesirable behaviors. Verbal explanations are not as effective as demonstration and physical guidance. Consistent negative reinforcement is helpful, but positive reinforcement that focuses on skill attainment should be incorporated.

Superficial palpation of the abdomen is often perceived by the child as tickling. Which measure by the nurse is most likely to minimize this sensation and promote relaxation? a. Palpate another area simultaneously. b. Ask the child not to laugh or move if it tickles. c. Begin with deeper palpation and gradually progress to superficial palpation. d. Have the child "help" with palpation by placing his or her hand over the palpating hand.

d. Have the child "help" with palpation by placing his or her hand over the palpating hand. Having the child "help" with palpation by placing his or her hand over the palpating hand will help minimize the feeling of tickling and enlist the child's cooperation. Palpating another area simultaneously will create the sensation of tickling in the other area also. Asking the child not to laugh or move will bring attention to the tickling and make it more difficult for the child. Superficial palpation is done before deep palpation.

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.

d. He is demonstrating readiness and acceptance that death is near. 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.

The nurse is reviewing a client's prenatal history. Which prescribed medication does the nurse understand is not considered a teratogen and prescribed during pregnancy? a. Phenytoin (Dilantin) b. Warfarin (Coumadin) c. Isotretinoin (Accutane) d. Heparin sodium (Heparin)

d. Heparin sodium (Heparin) Teratogens, agents that cause birth defects when present in the prenatal environment, account for the majority of adverse intrauterine effects not attributable to genetic factors. Types of teratogens include drugs (phenytoin [Dilantin], warfarin [Coumadin], isotretinoin [Accutane]). Heparin is the anticoagulant used during pregnancy and is not a teratogen. It does not cross the placenta.

A child with acetylsalicylic acid (aspirin) poisoning is being admitted to the emergency department. What early clinical manifestation does the nurse expect to assess on this child? a. Hematemesis b. Hematochezia c. Hyperglycemia d. Hyperventilation

d. Hyperventilation An early clinical manifestation of acetylsalicylic acid (aspirin) poisoning is hyperventilation. Hematemesis, hematochezia, and hyperglycemia are clinical manifestations of iron poisoning.

What is probably the most important criterion on which to base the decision to report suspected child abuse? a. Inappropriate response of child b. Inappropriate parental concern for the degree of injury c. Absence of parents for questioning about child's injuries d. Incompatibility between the history and injury observed

d. Incompatibility between the history and injury observed Conflicting stories about the "accident" are the most indicative red flags of abuse. The child or caregiver may have an inappropriate response, but this is subjective. Parents should be questioned at some point during the investigation.

Examination of the abdomen is performed correctly by the nurse in which order? a. Inspection, palpation, percussion, and auscultation b. Inspection, percussion, auscultation, and palpation c. Palpation, percussion, auscultation, and inspection d. Inspection, auscultation, percussion, and palpation

d. Inspection, auscultation, percussion, and palpation The correct order of abdominal examination is inspection, auscultation, percussion, and palpation. Palpation is always performed last because it may distort the normal abdominal sounds. Auscultation is performed before percussion. The act of percussion can influence the findings on auscultation.

The nurse is assessing a child suspected of having pinworms. Which is the most common symptom the nurse expects to assess? a. Restlessness b. Distractibility c. Rectal discharge d. Intense perianal itching

d. Intense perianal itching Intense perianal itching is the principal symptom of pinworms. Restlessness and distractibility may be nonspecific symptoms. Rectal discharge is not a symptom of pinworms.

What should the nurse explain about ringworm? a. It is not contagious. b. It is a sign of uncleanliness. c. It is expected to resolve spontaneously. d. It is spread by both direct and indirect contact.

d. It is spread by both direct and indirect contact. Ringworm is spread by both direct and indirect contact. Infected children should wear protective caps at night to avoid transfer of ringworm to bedding. Ringworm is infectious. Because ringworm is easily transmitted, it is not a sign of uncleanliness. It can be transmitted by seats with head rests, gym mats, and animal-to-human transmission. The drug griseofulvin is indicated for a prolonged course, possibly several months.

The nurse should assess which age group for suicide ideation since suicide in which age group is the third leading cause of death? a. Preschoolers b. Young school age c. Middle school age d. Late school age and adolescents

d. Late school age and adolescents Suicide is the third leading cause of death in children ages 10 to 19 years; therefore, the age group should be late school age and adolescents. Suicide is not one of the leading causes of death for preschool and young or middle school-aged children.

When assessing a preschooler's chest, what should the nurse expect? a. Respiratory movements to be chiefly thoracic b. Anteroposterior diameter to be equal to the transverse diameter c. Retraction of the muscles between the ribs on respiratory movement d. Movement of the chest wall to be symmetric bilaterally and coordinated with breathing

d. Movement of the chest wall to be symmetric bilaterally and coordinated with breathing Movement of the chest wall should be symmetric bilaterally and coordinated with breathing. In children younger than 6 or 7 years, respiratory movement is principally abdominal or diaphragmatic. The anteroposterior diameter is equal to the transverse diameter during infancy. As the child grows, the chest increases in the transverse direction, so that the anteroposterior diameter is less than the lateral diameter. Retractions of the muscles between the ribs on respiratory movement are indicative of respiratory distress.

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

d. Myopia, or nearsightedness Clinical manifestations of myopia include excessive eye rubbing, head tilting, difficulty reading, headaches, and dizziness. Strabismus, astigmatism, and hyperopia have other clinical manifestations.

A child with acetaminophen (Tylenol) poisoning has been admitted to the emergency department. What antidote does the nurse anticipate being prescribed? a. Carnitine (Carnitor) b. Fomepizole (Antizol) c. Deferoxamine (Desferal) d. N-acetylcysteine (Mucomyst)

d. N-acetylcysteine (Mucomyst) The antidote for acetaminophen (Tylenol) poisoning is N-acetylcysteine (Mucomyst). Carnitine (Carnitor) is an antidote for valproic acid (Depakote), fomepizole (Antizol) is the antidote for methanol poisoning, and deferoxamine (Desferal) is the antidote for iron poisoning.

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

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

A couple asks the nurse about the optimal time for genetic counseling. They do not plan to have children for several years. When should the nurse recommend they begin genetic counseling? a. As soon as the woman suspects that she may be pregnant b. Whenever they are ready to start their family c. Now, if one of them has a family history of congenital heart disease d. Now, if they are members of a population at risk for certain diseases

d. Now, if they are members of a population at risk for certain diseases Persons who seek genetic evaluation and counseling must first be aware if there is a genetic or potential problem in their families. Genetic testing should be done now if the couple is part of a population at risk. It is not feasible at this time to test for all genetic diseases. The optimal time for genetic counseling is before pregnancy occurs. During the pregnancy, genetic counseling may be indicated if a genetic disorder is suspected. Congenital heart disease is not a single-gene disorder.

The nurse is caring for a child after a cleft palate repair who is on a clear liquid diet. Which feeding device should the nurse use to deliver the clear liquid diet? a. Straw b. Spoon c. Sippy cup d. Open cup

d. Open cup Acceptable feeding devices after a cleft palate repair include open cup for liquids, but rigid utensils such as spoons, straws, and hard-tipped sippy cups should be avoided to prevent accidental injury to the repair.

Which nonpharmacologic intervention appears to be effective in decreasing neonatal procedural pain? a. Tactile stimulation b. Commercial warm packs c. Doing procedure during infant sleep d. Oral sucrose and nonnutritive sucking

d. Oral sucrose and nonnutritive sucking Nonnutritive sucking attenuates behavioral, physiologic, and hormonal responses to pain. The addition of sucrose has been demonstrated to have calming and pain-relieving effects for neonates. Tactile stimulation has a variable effect on response to procedural pain. No evidence supports commercial warm packs as a pain control measure. With resulting increased blood flow to the area, pain may be greater. The infant should not be disturbed during the sleep cycle. It makes it more difficult for the infant to begin organization of sleep and awake cycles.

A preterm infant has just been admitted to the neonatal intensive care unit. The infant's parents ask the nurse about anesthesia and analgesia when painful procedures are necessary. What should the nurse's explanation be? a. Nerve pathways of neonates are not sufficiently myelinated to transmit painful stimuli. b. The risks accompanying anesthesia and analgesia are too great to justify any possible benefit of pain relief. c. Neonates do not possess sufficiently integrated cortical function to interpret or recall pain experiences. d. Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates.

d. Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates. Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response. The pathways are sufficiently myelinated to transmit the painful stimuli and produce the pain response. Local and systemic pharmacologic agents are available to permit anesthesia and analgesia for neonates.

The nurse is assessing a child's capillary refill time. This can be accomplished by doing what? a. Inspect the chest. b. Auscultate the heart. c. Palpate the apical pulse. d. Palpate the nail bed with pressure to produce a slight blanching.

d. Palpate the nail bed with pressure to produce a slight blanching. Capillary refill time is assessed by pressing lightly on the skin to produce blanching and then noting the amount of time it takes for the blanched area to refill. Inspecting the chest, auscultating the heart, and palpating the apical pulse will not provide an assessment of capillary refill time.

A 3-year-old child was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guideline concerning adoption should the nurse use in planning a response? a. It is best to wait until the child asks about it. b. The best time to tell the child is between the ages of 7 and 10 years. c. It is not necessary to tell a child who was adopted so young. d. Telling the child is an important aspect of their parental responsibilities.

d. Telling the child is an important aspect of their parental responsibilities. It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the child's identity. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to prevent third parties from telling the children before the parents have had the opportunity.

The nurse is preparing to administer a measles, mumps, rubella, and varicella (MMRV) vaccine. Which is a contraindication associated with administering this vaccine? a. The child has recently been exposed to an infectious disease. b. The child has symptoms of a cold but no fever. c. The child is having intermittent episodes of diarrhea. d. The child has a disorder that causes a deficient immune system.

d. The child has a disorder that causes a deficient immune system. The MMRV (measles, mumps, rubella, and varicella) vaccine is an attenuated live virus vaccine. Children with deficient immune systems should not receive the MMRV vaccine because of a lack of evidence of its safety in this population. Exposure to an infectious disease, symptoms of a cold, or intermittent episodes of diarrhea are not contraindications to receiving a live vaccine.

When only one child is abused in a family, the abuse is usually a result of what? a. The child is the firstborn. b. The child is the same gender as the abusing parent. c. The parent abuses the child to avoid showing favoritism. d. The parent is unable to deal with the child's behavioral style.

d. The parent is unable to deal with the child's behavioral style. The child unintentionally contributes to the abuse. The "fit" or compatibility between the child's temperament and the parent's ability to deal with that behavior style is an important predictor. Birth order and gender can contribute to abuse, but there is not a specific birth order or gender relationship that is indicative of abuse. Being the firstborn or the same gender as the abuser is not linked to child abuse. Avoidance of favoritism is not usually a cause of abuse.

Which is an accurate description of homosexual (or gay-lesbian) families? a. A nurturing environment is lacking. b. The children become homosexual like their parents. c. The stability needed to raise healthy children is lacking. d. The quality of parenting is equivalent to that of non-gay parents.

d. The quality of parenting is equivalent to that of non-gay parents. Although gay or lesbian families may be different from heterosexual families, the environment can be as healthy as any other. Lacking a nurturing environment and stability is reflective on the parents and family, not the type of family. There is little evidence to support that children become homosexual like their parents.

Which parameter correlates best with measurements of total muscle mass? a. Height b. Weight c. Skinfold thickness d. Upper arm circumference

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

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.

d. Use a cool-mist vaporizer to keep the mucous membranes moist and secretions liquefied. 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.

An immunocompromised child has been exposed to chickenpox. What should the nurse anticipate to be prescribed to the exposed child? a. Acyclovir (Zovirax) b. Valacyclovir (Valtrex) c. Amantadine (Symmetrel) d. Varicella-zoster immune globulin

d. Varicella-zoster immune globulin The use of varicella-zoster immune globulin or immune globulin intravenous (IGIV) is recommended for children who are immunocompromised, who have no previous history of varicella, and who are likely to contract the disease and have complications as a result. The antiviral agent acyclovir (Zovirax) or valacyclovir may be used to treat varicella infections in susceptible immunocompromised persons. It is effective in decreasing the number of lesions; shortening the duration of fever; and decreasing itching, lethargy, and anorexia. Symmetrel is an antiviral used to treat influenza.

What is the grayish white, cheeselike substance that covers the newborn's skin? a. Milia b. Meconium c. Amniotic fluid d. Vernix caseosa

d. Vernix caseosa The vernix caseosa is the grayish white, cheeselike substance that covers a newborn's skin.

Which is described as an elevated, circumscribed skin lesion that is less than 1 cm in diameter and filled with serous fluid? a. Cyst b. Papule c. Pustule d. Vesicle

d. Vesicle A vesicle is elevated, circumscribed, superficial, smaller than 1 cm in diameter, and filled with serous fluid. A cyst is elevated, circumscribed, palpable, encapsulated, and filled with liquid or semisolid material. A papule is elevated; palpable; firm; circumscribed; smaller than 1 cm in diameter; and brown, red, pink, tan, or bluish red. A pustule is elevated, superficial, and similar to a vesicle but filled with purulent fluid.