PEDS EXAM 3

A 2-year-old boy has been admitted to the hospital for anemia. His mother asks the nurse what foods to include in his diet to improve his nutritional status. Which of the following should the nurse recommend? 1. Increase the child's intake of whole cow's milk to 32 ounces a day. 2. Increase the child's intake of meats, eggs, and green vegetables. 3. Increase the child's intake of fruits, whole grains, and rice. 4. Increase the number of snacks the child eats during the day.

2. Meat, eggs, and green vegetables are excellent sources of iron.

Which medication should the nurse give to a child diagnosed with transposition of the great vessels? 1. Ibuprofen. 2. Betamethasone. 3. Prostaglandin E. 4. Indocin.

3 1. Ibuprofen blocks prostaglandins, which would speed up the closing of the PDA. 2. Betamethasone blocks prostaglandins, which would speed up the closing of the PDA. 3. Prostaglandin E inhibits closing of the PDA, which connects the aorta and pulmonary artery. 4. Indocin is used to treat osteoarthritis and gout. TEST-TAKING HINT: The test taker would know that children who have transposition of the great vessels also have another cardiac defect, and the common one is PDA.

The parents of a 7-month-old girl are attending a class on child safety. Following the class, what should the child's parents understand as one of the most common causes of injury and death for a 7-month-old child? 1. Poisoning. 2. Child abuse. 3. Aspiration. 4. Dog bites.

3. Aspiration is a common cause of injury and death among children of this age. These children often find small objects lying on the floor and place them in their mouths. Older siblings are often responsible for leaving small objects around.

A 6-month-old male is at his well-child checkup. The nurse weighs him, and his mother asks if his weight is normal for his age. The nurse's best response is: 1. "At 6 months his weight should be approximately three times his birth weight." 2. "Each child gains weight at his or her own pace." 3. "At 6 months his weight should be approximately twice his birth weight." 4. "At 6 months a child should weigh about 10 lb more than his or her birth weight."

3. Children should double their birth weight by 4 to 6 months of age.

A 12-month-old boy weighed 8 lb 2 oz at birth. Understanding developmental mile stones, what should the nurse caring for the child calculate his current weight as? 1. Approximately 16 lb 4 oz. 2. Approximately 20 lb 5 oz. 3. Approximately 24 lb 6 oz. 4. Approximately 32 lb 8 oz.

3. Children should triple their birth weight by 12 months of age.

A nursing action that promotes ideal nutrition in an infant with congestive heart failure (CHF) is: 1. Feeding formula that is supplemented with additional calories. 2. Allowing the infant to nurse at each breast for 20 minutes. 3. Providing large feedings every 5 hours. 4. Using firm nipples with small openings to slow feedings.

1 1. Formula can be supplemented with extra calories, either from a commercial supplement, such as Polycose, or from corn syrup. Calories in formula could increase from 20 kcal/oz to 30 kcal/oz or more. 2. The infant would get too tired while feeding, which increases cardiac demand. Limit breastfeeding to a half hour, or 15 minutes per side. 3. Smaller feedings more often, such as every 2 to 3 hours, would decrease cardiac demand. 4. Soft nipples that are easy for the infant to suck would make for less work getting nutrition. TEST-TAKING HINT: Allow the child to get the most nutrition most effectively.

Which physiological changes occur as a result of hypoxemia in congestive heart failure (CHF)? 1. Polycythemia and clubbing. 2. Anemia and barrel chest. 3. Increased white blood cells and low platelets. 4. Elevated erythrocyte sedimentation rate and peripheral edema.

1 1. The hypoxemia stimulates erythropoiesis, which causes polycythemia, in an attempt to increase oxygen by having more red blood cells carry oxygen. Clubbing of the fingers is a result of the polycythemia and hypoxemia. 2. Anemia and barrel chest do not occur as a result of hypoxemia. Hypoxemia stimulates the production of erythropoietin to increase the number of red blood cells to carry more oxygen. The barrel chest is the result of air trapping. 3. Increased white blood cells occur as the result of an infection, not hypoxemia. Hypoxemia does not cause a decreased number of platelets. 4. An elevated erythrocyte sedimentation rate is the result of inflammation in the body. Peripheral edema can be caused by CHF. TEST-TAKING HINT: The test taker could eliminate answers 2, 3, and 4 by knowing that they do not cause hypoxemia in CHF.

16. The nurse is caring for a child with Kawasaki disease (KD). A student nurse who is on the unit asks if there are medications to treat this disease. The nurse's response to the student nurse is: 1. Immunoglobulin G and aspirin. 2. Immunoglobulin G and ACE inhibitors. 3. Immunoglobulin E and heparin. 4. Immunoglobulin E and ibuprofen.

1 1. High-dose immunoglobulin G and salicylate therapy for inflammation are the current treatment for KD. 2. Immunoglobulin G is correct, but ACE inhibitors are incorrect for treatment. 3. Heparin may be used for the child with an aneurysm, but not immuno - globulin E. 4. Immunoglobulin E and ibuprofen are not correct. TEST-TAKING HINT: Consider antiinflammatory medications for treatment of KD.

A child diagnosed with congestive heart failure (CHF) is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 beats per minute. The nurse expects which laboratory finding? 1. Hypokalemia. 2. Hypomagnesemia. 3. Hypocalcemia. 4. Hypophosphatemia.

1 1. The rubbing of the child's eyes may mean that she is seeing halos around the lights, indicating digoxin toxicity. The HR is slow for her age and also indicates digoxin toxicity. A decrease in serum potassium because of the furosemide can increase the risk for digoxin toxicity. 2. Hypomagnesemia does not affect digoxin and is not related to the child rubbing her eyes. 3. Hypocalcemia does not affect digoxin and is not related to the child rubbing her eyes. 4. Hypophosphatemia does not affect digoxin and is not related to the child rubbing her eyes. TEST-TAKING HINT: The test taker knows that furosemide causes the loss of potassium and can cause digoxin toxicity.

Hypoxic spells in the infant with a congenital heart defect (CHD) can cause which of the following? Select all that apply. 1. Polycythemia. 2. Blood clots. 3. Cerebrovascular accident. 4. Developmental delays. 5. Viral pericarditis. 6. Brain damage. 7. Alkalosis.

1, 2, 3, 4, 6. 1. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 2. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 3. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 4. Developmental delays can be caused by multiple hospitalizations and surgeries. The child usually catches up to the appropriate level. 5. Hypoxia can increase the risk for bacterial endocarditis, not viral pericarditis. 6. Brain damage can be caused by hypoxia, blood clots, and stroke. 7. Hypoxic episodes cause acidosis, not alkalosis. TEST-TAKING HINT: Hypoxic episodes in a child with CHD ("tet spells") can cause polycythemia and strokes.

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

1, 3, 4, 5. 1. The goal of therapy with children is to prevent the sickling process. 2. A cold environment causes vasoconstriction, which needs to be prevented to get good tissue perfusion. 3. Seek medical attention for illness to prevent the child from going into a crisis. 4. The child needs good hydration and nutrition to maintain good health. 5. The child needs good hydration and nutrition to maintain good health. TEST-TAKING HINT: Focus on how to prevent a sickle cell crisis.

The following are examples of acquired heart disease. Select all that apply. 1. Infective endocarditis. 2. Hypoplastic left heart syndrome. 3. Rheumatic fever (RF). 4. Cardiomyopathy. 5. Kawasaki disease (KD). 6. Transposition of the great vessels.

1, 3, 4, 5. 1. Infective endocarditis is an example of an acquired heart problem. 2. Hypoplastic left heart syndrome is a CHD. 3. RF is an acquired heart problem. 4. Cardiomyopathy is an acquired heart problem. 5. KD is an acquired heart problem. 6. Transposition of the great vessels is a CHD. TEST-TAKING HINT: "Acquired" means occurring after birth and seen in an otherwise normal and healthy heart.

Which statement by the mother of a child with rheumatic fever (RF) shows she has an understanding of prevention for her other children? select all that apply 1. "Whenever one of them gets a sore throat, I will give that child an antibiotic." 2. "There is no treatment. It must run its course." 3. "If their culture is positive for group A streptococcus, I will give them their antibiotic." 4. "If their culture is positive for staphylococcus A, I will give them their antibiotic."

1, 3. 1. Do not use an antibiotic if the disease is not bacterial in origin. Most sore throats are viral. 2. RF is a bacterial infection caused by group A beta-hemolytic streptococcus, and the drug of choice is penicillin. 3. RF is caused by a streptococcus infection, not by staphylococcus. 4. RF is cause by a streptococcus infection, not by staphylococcus. TEST-TAKING HINT: The test taker needs to know the cause of RF and how it is treated.

Which interventions decrease cardiac demands in an infant with congestive heart failure (CHF)? Select all that apply. 1. Allow parents to hold and rock their child. 2. Feed only when the infant is crying. 3. Keep the child uncovered to promote low body temperature. 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities.

1, 4, 5, 6, 7. 1. Rocking by the parents will comfort the infant and decrease demands. 2. The infant would not be fed when crying because crying increases cardiac demands. The infant might choke if the nipple is placed in the mouth and the child inhales when trying to swallow. 3. Keep the child normothermic to reduce metabolic demands. 4. Frequent position changes will decrease the risk for infection by avoiding immobility with its potential for skin breakdown. 5. An infant sucking the fists could indicate hunger. 6. Change bed linens only when necessary to avoid disturbing the child. 7. Organize nursing activities to avoid disturbing the child. TEST-TAKING HINT: Do all that can be done to decrease demands on the child.

Tetralogy of Fallot (TOF) involves which defects? Select all that apply. 1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 3. Left ventricular hypertrophy. 4. Pulmonic stenosis (PS). 5. Pulmonic atresia. 6. Overriding aorta. 7. Patent ductus arteriosus (PDA).

1,2,4,6, TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. TAKING HINT: Tetralogy of Fallot has four defects. Pulmonary stenosis causes decreased pulmonary flow.

The nurse is performing a physical assessment on a 6-month-old baby. Which finding should the nurse understand as abnormal for this child? 1. The child's posterior fontanel is open. 2. The child's anterior fontanel is open. 3. The child has the beginning signs of tooth eruption. 4. The child is able to track and follow objects.

1. The posterior fontanel should close between 6 and 8 weeks of age.

A 3-year-old female is hospitalized for an ASD repair. Her parents have decided to go home for a few hours to spend time with her siblings. The child asks when her mommy and daddy will be back. The nurse's best response is: 1. "Your mommy and daddy will be back after your nap." 2. "Your mommy and daddy will be back at 6 p.m." 3. "Your mommy and daddy will be back later this evening." 4. "Your mommy and daddy will be back in 3 hours."

1. Preschoolers understand time in relation to events.

A 9-year-old boy has been hospitalized following a bicycle injury. What should the nurse recommend to the child's parents to prevent future injury? 1. Their son should wear safety equipment while riding bicycles. 2. Their son should read educational material on bicycle safety. 3. Their son should watch a video on bicycle safety. 4. Their son should ride his bike in the presence of adults.

1. Safety equipment is essential for bicycling, skateboarding, and participating in contact sports. Most injuries occur during the school-age years, when children are more active and participate in contact sports.

A female nurse caring for a 5-year-old boy is trying to encourage developmental growth. What can the nurse do to reinforce the child's intellectual initiative when he asks the nurse about his upcoming surgery? 1. Answer the child's questions about his upcoming surgery in simple terms. 2. Provide the child with a book that has vivid illustrations about his surgery. 3. Tell the child he should wait and ask the doctor his questions. 4. Tell the child that she will answer his questions at a later time.

1. The child is taking the initiative to ask questions, as all toddlers do, and the nurse should always answer those questions as appropriately and accurately as possible.

The parents of a 3-month-old ask why their baby will not have an operation to correct a ventricular septal defect (VSD). The nurse's best response is: 1. "It is always helpful to get a second opinion about any serious condition like this." 2. "Your baby's defect is small and will likely close on its own by 1 year of age." 3. "It is common for physicians to wait until an infant develops respiratory distress before they do the surgery." 4. "With a small defect like this, they wait until the child is 10 years old to do the surgery."

2 1. This is not a collegial response, and the nurse should explain to the parents why an operation is not necessary now. 2. Usually a VSD will close on its own within the first year of life. 3. It is not common for physicians to wait until respiratory distress develops because that puts the infant at greater risk for complications. The defect is small and will likely close on its own. 4. Small defects usually close on their own within the first year. TEST-TAKING HINT: Know the various treatments depending on size of the defect. VSD is the most common CHD.

Which of the following are stressors common to hospitalized toddlers? Select all that apply. 1. Social isolation. 2. Interrupted routine. 3. Sleep disturbances. 4. Self-concept disturbances. 5. Fear of being hurt.

2, 3, 5. 1. Social isolation is a stressor of the hospitalized teen. 2. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. 3. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. 4. Self-concept disturbance is a stressor of the hospitalized teen. 5. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. The stressors of social isolation and self-concept disturbances are stressors of the hospitalized teen.

17. The nurse is caring for a 12-month-old girl. The child's mother asks if the unit has any toys that her daughter can play with. The nurse goes to the toy area in search of a toy for the child. Which toy is the best choice for this child? 1. A doll. 2. A musical rattle. 3. A board book. 4. Colorful beads.

2. A musical rattle is the perfect toy for this child. Infants have short attention spans and enjoy auditory and visual stimulation.

17. Congenital heart defects (CHDs) are classified by which of the following? Select all that apply. 1. Cyanotic defect. 2. Acyanotic defect. 3. Defects with increased pulmonary blood flow. 4. Defects with decreased pulmonary blood flow. 5. Mixed defects. 6. Obstructive defects. 7. Pansystolic murmurs.

3, 4, 5, 6. 1. Heart defects are no longer classified as cyanotic or acyanotic. 2. Heart defects are no longer classified as cyanotic or acyanotic. 3. Heart defects are now classified as defects with increased or decreased pulmonary blood flow. 4. Heart defects are now classified as defects with increased or decreased pulmonary blood flow. 5. Heart defects are now classified as defects with increased or decreased pulmonary blood flow. 6. Heart defects are now classified as defects with increased or decreased pulmonary blood flow. 7. A murmur may be heard with a CHD, but a murmur does not classify the defect. TEST-TAKING HINT: Know the new classifications, not the older ones.

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

3, 4. 1. Medical treatment of sickle cell crises is directed toward preventing hypoxia. Tissue hypoxia is very painful, so placing the child in a position of comfort is important. 2. Hot packs help relieve pain because they cause vasodilatation, which allows increased blood flow and decreased hypoxia. 3. Tissue hypoxia is very painful. Narcotics such as morphine are usually given for pain when the child is in a crisis. Demerol should be avoided because of the risk for demerol-induced seizures. 4. The child should receive hydration because when the child is in crisis, the abnormal S-shaped red blood cells clump, causing tissue hypoxia and pain. 5. Providing oxygen when the oxygen saturation decreases helps treat the hypoxia. TEST-TAKING HINT: Focus on the pathophysiology of a vaso-occlusive crisis. Keep in mind measures that decrease tissue hypoxia.

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

3, 5, 6. 1. Polycythemia is seen in children with chronic hypoxia, such as cyanotic heart disease. 2. Hemarthrosis is commonly seen in children with hemophilia. 3. Aplastic crisis is associated with sickle cell anemia. 4. Thrombocytopenia is associated with idiopathic thrombocytopenia purpura. 5. Splenic sequestration is associated with sickle cell anemia. 6. Vaso-occlusive crisis is the most common problem in children with sickle cell disease. TEST-TAKING HINT: Review the definition of terms. That will eliminate the other choices.

The nurse caring for a 4-year-old female in the ER is about to start a peripheral IV. The nurse's best method for explaining the procedure to the child is to: 1. Show the child a pamphlet with pictures showing the IV placement procedure. 2. Have the 5-year-old patient next door tell the 4-year-old about her experience with her IV placement. 3. Show the child the IV placement equipment, and demonstrate the procedure on a doll. 4. Tell the child that if she remains still, the procedure will be over quickly.

3. A 4-year-old child understands things in very concrete and simple terms. Therefore, medical play is an excellent method for helping her understand the procedure.

An 8-year-old is NPO while he awaits surgery for central line placement later in the afternoon. The nurse is trying to engage the child in some form of activity to distract him from thinking about his upcoming surgery. Which is the best method of distraction for a child of this age in this situation? 1. Encourage the child to use the telephone to call friends. 2. Encourage the child to watch television. 3. Encourage the child to play a board game. 4. Encourage the child to read the central line pamphlet he was given.

3. A board game is the optimal choice because school-age children enjoy being engaged in an activity with others that will require some skill and challenge.

A 3-year-old female is hospitalized for a femur fracture. As her nurse, what nursing action would help foster the child's sense of autonomy? 1. Allow the child to choose what time to take her oral antibiotics. 2. Allow the child to have a doll for medical play. 3. Allow the child to administer her own dose of Keflex (cephalexin) via oral syringe. 4. Allow the child to watch age-appropriate videos.

3. Allowing toddlers to participate inactions of which they are capable is an excellent way to enhance their autonomy.

Which vaccines must be delayed for 11 months after the administration of gamma globulin? Select all that apply. 1. Diphtheria, tetanus, and pertussis. 2. Hepatitis B. 3. Inactivated polio virus. 4. Measles, mumps, and rubella. 5. Varicella.

4, 5. 1. Diphtheria, tetanus, and pertussis can be given following administration of gamma globulin. These are killed vaccines, and the only vaccines not administered would be live vaccines such as measles, mumps, rubella. 2. Hepatitis B can be administered following gamma globulin. Live vaccines are held for at least 11 months. 3. Inactivated polio virus can be given following gamma globulin administration. Live vaccines are held for 11 months. 4. The body might not produce the appropriate number of antibodies following gamma globulin infusion, so live virus vaccines should be delayed for 11 months. 5. The body might not produce the appropriate number of antibodies following gamma globulin infusion, so live virus vaccines should be delayed for 11 months. TEST-TAKING HINT: The test taker needs to know which vaccines are killed and which are live.

An 8-day old female was admitted to the hospital with vomiting and dehydration. The nurse has just obtained vital signs. The child's heart rate is 185, her respiratory rate is 44, her blood pressure is 85/52, and her temperature is 99°F (37.2° C). The child's parents ask the nurse if her vital signs are within normal limits. What is the nurse's best response to the parents? 1. "Your daughter's blood pressure is elevated, but the other vital signs are within normal limits." 2. "Your daughter's temperature is elevated, but the other vital signs are within normal limits." 3. "Your daughter's respiratory rate is elevated, but the other vital signs are within normal limits." 4. "Your daughter's heart rate is elevated, but the other vital signs are within normal limits."

4. A normal heart rate for a child from birth to 1 month is 90 to 160.

15. A child who has reddened eyes with no discharge; red, swollen, and peeling palms and soles of the feet; dry, cracked lips; and a "strawberry tongue" most likely has _____________________.

Kawasaki disease or KD. TEST-TAKING HINT: Classic signs of KD include red eyes with no discharge; dry, cracked lips; strawberry tongue; and red, swollen, and peeling palms and soles of the feet. Incidence of KD is higher in males. The strongest indicator for this disease is the hallmark strawberry tongue.

A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as _____________________.

Patent ductus arteriosus or PDA. TEST-TAKING HINT: This is a defect with increased pulmonary flow. It should close in the first few weeks of life.

A 6-month-old who has episodes of cyanosis after crying could have the congenital heart defect (CHD) of decreased pulmonary blood flow called _____________________.

Tetralogy of Fallot or TOF. "Tet" spells are characteristic of TOF. TEST-TAKING HINT: Know the congenital heart defect classifications.

Which patient could require feeding by gavage? 1. Infant with congestive heart failure (CHF). 2. Toddler with repair of transposition of the great vessels. 3. Toddler with Kawasaki disease (KD) in the acute phase. 4. School-age child with rheumatic fever (RF) and chorea.

1 1. The child may experience increased cardiac demand while feeding. Feedings by gavage eliminate that work and still provide high-calorie intake for growth. 2. Transposition of the great vessels should be repaired before the toddler years, so that child would not need to be gavage-fed. 3. A toddler with KD in the acute phase does not need to be gavage-fed. 4. An RF patient with St. Vitus' dance (chorea) does not need to be gavage-fed. Most of these children do not have CHF. TEST-TAKING HINT: The test taker should consider how gavage feedings would affect the work of the heart.

Which are the most serious complications for a child with Kawasaki disease (KD)? Select all that apply. 1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. 4. Hypocoagulability. 5. Decreased sedimentation rate. 6. Hypoplastic left heart syndrome.

1, 2, 3. 1. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 2. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 3. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 4. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 5. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 6. Hypoplastic left heart syndrome is a CHD and has no relation to KD. TEST-TAKING HINT: KD is an inflammation of small- and medium-sized blood vessels.

Which statement by the mother of an 18-month-old would lead the nurse to believe that the child should be referred for further evaluation for developmental delay? 1. "My child is able to stand but is not yet taking steps independently." 2. "My child has a vocabulary of approximately 15 words." 3. "My child is still thumb sucking." 4. "My child seems to be quite wary of strangers."

18. 1. The child should be walking independently by 15 to 18 months. Because this toddler is 18 months and not walking, a referral should be made for a developmental consult.

Which finding might delay a cardiac catheterization procedure on a 1-year-old? 1. 30th percentile for weight. 2. Severe diaper rash. 3. Allergy to soy. 4. Oxygen saturation of 91% on room air.

2 1. This may be a reason the child needs the catheterization. 2. A child with severe diaper rash has potential for infection if the interventionist makes the standard groin approach. 3. Shellfish, not soy, is an allergy concern. 4. This may be a reason the child needs the catheterization. TEST-TAKING HINT: Consider the risk for infection as a delaying factor.

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

2 1. An infection can cause a child to go into crisis. 2. Overhydration does not cause a crisis. 3. Emotional stress can cause a child to go into crisis. 4. A cold environment causes vasoconstriction, which could lead to crisis. TEST-TAKING HINT: Because sickle cell anemia may be precipitated by infection, dehydration, trauma, hypoxia or stress, use the process of elimination to determine the need for further instruction.

Aspirin has been ordered for the child with rheumatic fever (RF) in order to: 1. Keep the patent ductus arteriosus (PDA) open. 2. Reduce joint inflammation. 3. Decrease swelling of strawberry tongue. 4. Treat ventricular hypertrophy of endocarditis.

2 1. Aspirin is not used to treat this condition. A PDA does not occur with RF. 2. Joint inflammation is experienced in RF; aspirin therapy helps with inflammation and pain. 3. Strawberry tongue is manifested in KD; aspirin is not used to treat this disease. 4. Aspirin is not used to treat this condition. TEST-TAKING HINT: Know the manifestations of RF.

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

2 1. Children with sickle cell anemia need to be well hydrated to promote hemodilution. 2. Oxygen prevents hypoxia, helping to prevent acidosis that could lead to increased sickling. 3. The child may need antibiotics for infection, not for the sickle cell anemia. 4. Analgesics are used for pain control. TEST-TAKING HINT: In sickle cell anemia, the tissues need to be well oxygenated, and measures need to be taken to decrease sickling and increase tissue perfusion.

43. An 18-month-old with a myelomeningocele is undergoing a cardiac catheterization. The mother expresses concern about the use of dye in the procedure. The child does not have any allergies. In addition to the concern for an iodine allergy, what other allergy should the nurse bring to the attention of the catheterization staff? 1. Soy. 2. Latex. 3. Penicillin. 4. Dairy.

2 1. Children with spina bifida (myelomeningocele) often have a latex allergy. The catheter balloon is often made of latex, and all personnel caring for the patient should be made aware of the allergy. 2. Children with spina bifida (myelomeningocele) often have a latex allergy. The catheter balloon is often made of latex, and all personnel caring for the patient should be made aware of the allergy. 3. Children with spina bifida (myelomeningocele) often have a latex allergy. The catheter balloon is often made of latex, and all personnel caring for the patient should be made aware of the allergy. 4. Children with spina bifida (myelomeningocele) often have a latex allergy. The catheter balloon is often made of latex, and all personnel caring for the patient should be made aware of the allergy. TEST-TAKING HINT: Material that composes the balloon catheter is made of latex, which is a common allergy in a child with a myelomeningocele.

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

2 1. Factor VIII is not given intramuscularly. 2. The child is treated with intravenous factor VIII to replace the missing factor and help stop the bleeding. 3. Desmopressin is given to stimulate factor VIII production, and it is given intravenously. 4. Platelets are not affected in hemophilia. TEST-TAKING HINT: Focus on the diagnosis of hemophilia: a deficiency in factor VIII causes continued bleeding with an injury.

The nurse is caring for an 8-year-old girl whose parents indicate she has developed spastic movements of her extremities and trunk, facial grimace, and speech disturbances. They state it seems worse when she is anxious and does not occur while sleeping. The nurse questions the parents about which recent illness? 1. Kawasaki disease (KD). 2. Strep throat. 3. Malignant hypertension. 4. Atrial fibrillation.

2 1. KD does not result in this condition, called chorea or St. Vitus' dance. 2. Chorea can be a manifestation of RF, with a higher incidence in females. 3. Malignant hypertension does not result in this condition, called chorea or St. Vitus' dance. 4. Atrial fibrillation is not an illness. TEST-TAKING HINT: The test taker can eliminate answer 1 because KD can cause damage to coronary arteries.

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

2 1. The cells involved with sickle cell anemia are red blood cells, so a decrease in infection would not be correct. 2. Splenic sequestration is a life threatening situation in children with sickle cell anemia. Once a child is considered to be at high risk of splenic sequestration or has had this in the past, the spleen will be removed. 3. Removal of the spleen will not prevent sickling, as it will not change the disease condition. 4. The child will still have sickle cell disease and can still have sickle cell crises. TEST-TAKING HINT: Review splenic sequestration and when a child can go into sickle cell crisis.

What should the nurse assess prior to administering digoxin? Select all that apply. 1. Sclera. 2. Apical pulse rate. 3. Cough. 4. Liver function test.

2 1. The sclera has nothing to do with CHF. 2. The apical pulse rate is assessed because digoxin decreases the HR, and if the HR is <60, digoxin should not be administered. 3. Cough would not be assessed before administration. It is more commonly seen in patients who have been prescribed ACE inhibitors. 4. Liver function tests are not assessed before digoxin is administered. Digoxin can lower HR and cause dysrhythmias. TEST-TAKING HINT: The test taker should know that the sclera and liver function tests have nothing to do with digoxin. Cough could be associated with ACE inhibitors.

The school nurse has been following a child who comes to the office frequently for vague complaints of dizziness and headache. Today, she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. The nurse suspects she has: 1. Transposition of the great vessels. 2. Coarctation of the aorta (COA). 3. Aortic stenosis (AS). 4. Pulmonic stenosis (PS).

2 1. Transposition of the great vessels does not cause these symptoms. 2. In the older child, COA causes dizziness, headache, fainting, elevated blood pressure, and bounding radial pulses. 3. AS does not cause these symptoms. 4. PS does not cause these symptoms. TEST-TAKING HINT: The test taker should recognize that the child's BP is elevated and her pulses are bounding, which are symptoms of COA.

A child has been seen by the school nurse for dizziness since the start of the school term. It happens when standing in line for recess and homeroom. The child now reports that she would rather sit and watch her friends play hopscotch because she cannot count out loud and jump at the same time. When the nurse asks her if her chest ever hurts, she says yes. Based on this history, the nurse suspects that she has: 1. Ventricular septal defect (VSD). 2. Aortic stenosis (AS). 3. Mitral valve prolapse. 4. Tricuspid atresia.

2 1. Murmur and CHF are often found in infancy. 2. AS can progress, and the child can develop exercise intolerance that can be better when resting. 3. Mitral valve prolapse causes a murmur and palpitations, usually in adulthood. 4. Tricuspid atresia causes hypoxemia in infancy. TEST-TAKING HINT: What does each of the last words of the defects mean, and what do those cause?

Treatment for congestive heart failure (CHF) in an infant began 3 days ago and has included digoxin and furosemide. The child no longer has retractions, lungs are clear, and HR is 96 beats per minute while the child sleeps. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes the child's urine output is: 1. 0.5 cc/kg/hr. 2. 1 cc/kg/hr. 3. 30 cc/hr. 4. 1 oz/hr.

2 1. This is incorrect because 0.5 cc/kg/hr is below the normal pediatric urine output. 2. Normal pediatric urine output is 1 cc/kg/hr. 3. This is incorrect because 30 cc/hr is above the normal pediatric urine output. 4. This is incorrect because 1 oz/hr is above the normal pediatric urine output. TEST-TAKING HINT: The test taker needs to know that normal urine output for a child is 1 cc/kg/hr.

A 10-year-old has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess: 1. Pain. 2. Pulses. 3. Hemoglobin and hematocrit levels. 4. Catheterization report.

2 1. Pain needs to be assessed post procedure but is not the priority. 2. Checking for pulses, especially in the cannulated extremity, would assure perfusion to that extremity and is the priority post procedure. 3. Hemoglobin and hematocrit levels would be checked post procedure if the child had bled very much during or after the procedure. 4. The catheterization report would be of interest to know what was determined from the procedure. This would also be good to check on the patient post procedure. TEST-TAKING HINT: The test taker would know that the priority is assessing the cannulated extremity, checking for adequate perfusion.

The nurse is caring for a 6-month-old in the ER. The physician orders the nurse togive the child a dose of Rocephin IM. The 1.5-mL dose arrives from the pharmacy. The nurse must do which of the following? 1. Administer the injection in the deltoid muscle. 2. Split the dose into two injections. 3. Administer the injection in the dorsogluteal muscle. 4. Administer the dose as a single injection to the vastus lateralis muscle.

2. A nurse should not deliver more than 1 mL per IM injection to a child of 6 months.

A 3-year-old girl is attending her grandfather's funeral. Her parents have told her that her grandfather is in heaven with God. The child is taken up to the open casket with her parents. Which statement by the child describes a 3-year-old child's understanding of spirituality? 1. "Grandpa's body is here with us on Earth, and his spirit is in heaven." 2. "Grandpa is in heaven. Is this heaven?" 3. "Grandpa's spirit is no longer in his body." 4. "Grandpa won't need his body in heaven."

2. Children 3 years old are literal thinkers. The child's parents told her that Grandpa was in heaven. She sees his body, so she thinks they are all in heaven.

A 5-year-old boy has always been one of the shortest children in class since pre school. His mother tells the school nurse that her husband is 6' and she is 5'7". She is concerned about her son's height. Based on her knowledge of a child's physical growth during the school-age years, what should the nurse tell the child's mother? 1. She should expect him to grow about 3 inches every year from ages 6 to 9 years. 2. She should expect him to grow about 2 inches every year from ages 6 to 9 years. 3. She should have him seen by an endocrinologist for growth hormone injections. 4. Be sure to have her son's growth reevaluated when he is 7 years old.

2. During the school-age years, a child grows approximately 2 inches per year.

A 3-year-old boy has been hospitalized because he fell down the stairs. His mother is crying and states, "This is all my fault." Which is the nurse's best response to the child's mother? 1. "Accidents happen. You shouldn't blame yourself." 2. "Falls are one of the most common injuries for toddlers." 3. "It may be a good idea to put a baby gate on the stairs." 4. "Your son should be proficient at walking down the stairs by now."

2. Falls are one of the most common in juries, and it may make the parent feel better to know that this is common among all toddlers.

A male infant is visiting the pediatrician for his 6-month well-child checkup. His mother tells the nurse she wants to advance the infant's diet. Which statement by the infant's mother leads the nurse to believe that she needs further education about the nutritional needs of a 6-month-old? 1. "I will continue to breastfeed my son and will give him rice cereal three times a day." 2. "I will start my son on fruits and gradually introduce vegetables." 3. "I will start my son on carrots and will introduce one new vegetable every few days." 4. "I will not give my son any more than 8 ounces of baby juice per day."

2. Infants should be started on vegetables prior to fruits. The sweetness of the fruits may inhibit them from taking vegetables.

An 11-month-old girl has a diagnosis of iron-deficiency anemia. The child's mother tells the nurse that her daughter is currently taking iron and a multivitamin. Which statement made by the mother should be of concern to the nurse? 1. "I give my daughter her iron and multivitamin at the same time each morning." 2. "I give my daughter her iron and her multivitamin in her morning 6-oz bottle." 3. "I give my daughter her iron and multivitamin in a nipple before I feed her the morning bottle." 4. "I give my daughter her iron and multivitamin in oral syringes toward the back of her cheek."

2. Medications should never be mixed in a large amount of food or formula because the parent cannot be sure that the child will take the entire feeding. Formula decreases the absorption of iron.

A 5-year-old is at the pediatrician's office for his well-child checkup. The nurse will be administering three immunizations to the child. The nurse should expect which reaction from the child when she gives his immunizations? 1. The child will likely remain silent and still. 2. The child will likely cry and tell the nurse that it hurts. 3. The child will likely try to stall the nurse. 4. The child will likely remain still while telling the nurse that she is hurting him.

2. The common response of a 5-year-old is to cry and protest during an immunization.

A mother requests that her child receive the varicella vaccine at her 9-month well-child checkup. The nurse tells the mother that: 1. Children who are vaccinated will likely develop a mild case of the disease from the vaccine. 2. The nurse cannot give the vaccine. 3. The nurse will administer the vaccine after the physician examines the child. 4. The child will need a booster vaccination at 18 months of age.

2. The nurse should not give the vaccine. The varicella vaccine is not usually administered prior to 1 year of age.

Which plan would be appropriate in helping to control congestive heart failure (CHF) in an infant? 1. Promoting fluid restriction. 2. Feeding a low-salt formula. 3. Feeding in semi-Fowler position. 4. Encouraging breast milk.

3 1. The nurse would not need to restrict fluids, as the child likely would not be getting overloaded with oral fluids. 2. The infant likely will have sodium depletion because of the chronic diuretic use; the infant needs a normal source of sodium, so low-sodium formula would not be used. 3. The infant has a great deal of difficulty feeding with CHF, so even getting the maintenance fluids is a challenge. The infant is fed in the more upright position so fluid in the lungs can go to the base of the lungs, allowing better expansion. 4. Breast milk has slightly less sodium than formula, and the child needs a normal source of sodium because of the diuretic. TEST-TAKING HINT: Infants are not able to concentrate urine well and may have sodium depletion, so they need a normal source of sodium.

In which congenital heart defect (CHD) would the nurse need to take upper and lower extremity BPs? 1. Transposition of the great vessels. 2. Aortic stenosis (AS). 3. Coarctation of the aorta (COA). 4. Tetralogy of Fallot (TOF).

3 1. BPs would not need to be taken in both the upper and lower extremities in transposition of the great vessels. The aorta and pulmonary arteries are in opposite positions, which does not change the BP readings. 2. AS is a narrowing of the aortic valve, which does not affect the BP in the extremities. 3. With COA there is narrowing of the aorta, which increases pressure proximal to the defect (upper extremities) and decreases pressure distal to the defect (lower extremities). There will be high BP and strong pulses in the upper extremities and lower than-expected BP and weak pulses in the lower extremities. 4. TOF is a congenital cardiac problem with four defects that do not affect the BP in the extremities. TEST-TAKING HINT: The test taker must know the anatomy of the defects and what assessments are to be made in each one.

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

3 1. Demerol should not be used as it may potentiate seizures. 2. Aspirin should not be used in children with a viral infection because of the risk for Reye syndrome. 3. Morphine is the drug of choice for a child with sickle cell crises. Usually the child is started on oral doses of Tylenol with codeine. When that does not decrease pain, stronger narcotics are prescribed. 4. Excedrin contains aspirin. TEST-TAKING HINT: One needs to consider using narcotics when a child has sickle cell crises, as tissue hypoxia can cause severe pain.

Which statement by the mother of a child with rheumatic fever (RF) shows she has good understanding of the care of her child? 1. "I will apply heat to his swollen joints to promote circulation." 2. "I will have him do gentle stretching exercises to prevent contractures." 3. "I will give him the aspirin that is ordered for pain and inflammation." 4. "I will apply cold packs to his swollen joints to reduce pain."

3 1. During the acute phase, limit any manipulation of the joint, and avoid heat or cold. 2. During the acute phase, limit any manipulation of the joint, and avoid heat or cold. 3. Aspirin is the drug of choice for treatment of RF. 4. During the acute phase, limit any manipulation of the joint, and avoid heat or cold. TEST-TAKING HINT: The test taker should know that aspirin is the drug of choice and that manipulation of the joint should be limited during the acute phase.

Which assessment indicates that the parent of a 7-year-old is following the prescribed treatment for congestive heart failure (CHF)? 1. HR of 56 beats per minute. 2. Elevated red blood cell count. 3. 50th percentile height and weight for age. 4. Urine output of 0.5 cc/kg/hr.

3 1. HR of 56 beats per minute is likely due to digoxin toxicity. 2. Elevated count of red blood cells indicates polycythemia secondary to hypoxemia. 3. The 50th percentile height and weight for age shows good growth and development, indicating good nutrition and perfusion. 4. Urine output of 0.5 cc/kg/hr indicates that furosemide is not being given as ordered; the output is too low. TEST-TAKING HINT: The test taker should know the expected responses of medications used to treat CHF.

During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which position? 1. Sitting. 2. Supine. 3. Squatting. 4. Standing.

3 1. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow. This occurs with squatting. 2. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow. This occurs with squatting. 3. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow. 4. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow. TEST-TAKING HINT: The child self-assumes this position during the spell.

Family discharge teaching has been effective when the parent of a toddler diagnosed with Kawasaki disease (KD) states: 1. "The arthritis in her knees is permanent. She will need knee replacements." 2. "I will give her diphenhydramine (Benadryl) for her peeling palms and soles of her feet." 3. "I know she will be irritable for 2 months after her symptoms started." 4. "I will continue with high doses of Tylenol for her inflammation."

3 1. Arthritis in KD is always temporary. 2. Peeling palms and feet are painless. 3. Children can be irritable for 2 months after the symptoms of the disease start. 4. Tylenol is never given in high doses due to liver failure, and it is not an antiinflammatory. Aspirin is given in high doses for KD. TEST-TAKING HINT: The test taker must know about KD to choose the best response.

An 18-month-old male is brought to the clinic by his mother. His height is in the 50th percentile, and weight is in the 80th percentile. The child is pale. The physical examination is normal, but his hematocrit level is 20%. Which of the following questions should assist the nurse in making a diagnosis? Select all that apply. 1. "How many bowel movements a day does your child have?" 2. "How much did your baby weigh at birth?" 3. "What does your child eat every day?" 4. "Has the child been given any new medications?" 5. "How much milk does your child drink per day?"

3, 5. 1. Because the child has a low hematocrit level, the child most likely has anemia. Anemia in a child is usually of nutritional origin. Iron-deficiency anemia is the most common nutritional anemia. This is important information but not necessary to make the diagnosis of iron-deficiency anemia. 2. Knowing birth weight can help determine if the child is following his or her own curve on the growth chart. 3. A diet history is necessary to determine the nutritional status of the child and if the child is getting sufficient sources of iron. 4. Knowing if the child is taking any new medication is good but is not necessary to make the diagnosis of iron-deficiency anemia. 5. By asking how much milk the child consumes, the nurse can determine if the child is filling up on milk and then not wanting to take food. TEST-TAKING HINT: The most common anemia in children and in toddlers is iron deficiency anemia, frequently due to drinking too much milk and not eating enough iron-rich foods.

In order to prevent separation anxiety in a hospitalized toddler, which of the following should the nurse do? 1. Assume the parental role when parents are not able to be at the bedside. 2. Encourage the parents to remain at the bedside always. 3. Establish a routine that is similar to that of the child's home. 4. Rotate nursing staff so the child becomes comfortable with a variety of nurses.

3. It is very important to try to maintain a child's home routine both when parents are present and when they have to leave the hospital. This will increase the child's sense of security and decrease anxiety.

The nurse is caring for a 7-year-old female on the school-age unit. Her mother is concerned that she may have some developmental delays. Which of the following statements would indicate to the nurse that the child is not developmentally on track for her age: 1. The child is able to follow a four-to-five-step command. 2. The child started wetting the bed on this admission to the hospital. 3. The child has an imaginary friend named Kelly. 4. The child enjoys playing board games with her sister.

3. Most school-age children do not have imaginary friends. This is much more common for children of 3 and 4 years of age.

The nurse is instructing a new breastfeeding mother in the need to provide her premature infant with an adequate source of iron in her diet. Which one of the following statements reflects a need for further education of the new mother? 1. "I will use only breast milk or an iron-fortified formula as a source of milk for my baby until she is at least 12 months old." 2. "My baby will need to have iron supplements introduced when she is 4 months old." 3. "I will need to add iron supplements to my baby's diet when she is 9 months old." 4. "When my baby begins to eat solid foods, I should introduce iron-fortified cereals to her diet."

3. Premature infants have iron stores from the mother that last approximately 2 months, so it is important to introduce an iron supplement by 2 months. Full-term infants have iron stores that last approximately 4 to 6 months.

A 4-year-old is visiting the pediatrician's office for his well-child checkup. The nurse needs to take his blood pressure. Which action by the nurse is a developmentally appropriate method for eliciting the child's cooperation? 1. Have the child's parents help put on the blood pressure cuff. 2. Tell the child that if he sits still, the blood pressure machine will go quickly. 3. Ask the child if he feels a squeezing of his arm. 4. Tell the child that blood pressures do not hurt.

3. Preschool children enjoy games, and it is a good way to elicit their assistance and cooperation during a procedure.

An 8-year-old girl is at the pediatrician's office for a well-child checkup. Her mother tells the nurse that she has been having some difficulty getting her daughter to complete her chores. The child's mother asks the nurse for techniques for gaining the child's cooperation with chores. Which of the following should the nurse suggest the mother do? 1. Use "grounding" as a technique. 2. Use "time-out" as a technique. 3. Use a reward system as a technique. 4. Use spanking as a technique.

3. School-age children usually respond very well to a reward system and often enjoy the rewards so much that they will continue chores without continual reminders.

The mother of a child 2 years 6 months has arranged a play date with the neighbor and her 3-year-old daughter. During the play date the two mothers should expect that the children will do which of the following? 1. The children will share and trade their toys while playing. 2. The children will play with one another with little or no conflict. 3. The children will play alongside one another but not actively with one another. 4. The children will play with one or two items, ignoring most of the other toys.

3. Toddlers engage in parallel play. They often play alongside another child but they rarely engage in activities with the other child.

According to developmental theories, which important event does the nurse understand is essential to the development of the toddler? 1. The child learns to feed self. 2. The child develops friendships. 3. The child learns to walk. 4. The child participates in being potty-trained.

4. Developmental theorists like Erickson and Freud believe that toilet training is the essential event that must be mastered by the toddler.

Which statement by a parent of an infant with congestive heart failure (CHF) who is being sent home on digoxin indicates the need for further education? 1. "I will give the medication at regular 12-hour intervals." 2. "If he vomits, I will not give a make-up dose." 3. "If I miss a dose, I will not give an extra dose" 4. "I will mix the digoxin in some formula to make it taste better."

4 1. This is appropriate for digoxin administration. 2. This is appropriate for digoxin administration. 3. This is appropriate for digoxin administration. 4. If the medication is mixed in his formula, and he refuses to drink the entire amount, the digoxin dose will be inadequate. TEST-TAKING HINT: What if the child does not drink all the formula?

A child has been diagnosed with valvular disease following rheumatic fever (RF). During patient teaching, the nurse discusses the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth. The parents indicate they understand when they say: 1. "She will need to take the antibiotics until she is 18 years old." 2. "She will need to take the antibiotics for 5 years after the last attack." 3. "She will need to take the antibiotics for 10 years after the last attack." 4. "She will need to take the antibiotics for the rest of her life."

4 1. This could be true for a patient with a less severe form of RF. 2. This could be true for a patient with a less severe form of RF. 3. This could be true for a patient with a less severe form of RF. 4. Valvular involvement indicates significant damage, so antibiotics would be taken for the rest of her life. TEST-TAKING HINT: The test taker would know that the severity of the damage to the heart valves determines how long prophylaxis antibiotics will be administered.

During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to: 1. Lay the child flat to promote hemostasis. 2. Lay the child flat with legs elevated to increase blood flow to the heart. 3. Sit the child on the parent's lap, with legs dangling, to promote venous pooling. 4. Hold the child in knee-chest position to decrease venous blood return.

4 1. Laying the child flat would increase preload, increasing blood to the heart, therefore making respiratory distress worse. 2. Laying the child flat with legs elevated would increase preload, increasing blood to the heart, therefore making respiratory distress worse. 3. Sitting the child on the parent's lap with legs dangling might possibly help, but it would not be as effective as the kneechest position in occluding the venous return. 4. The increase in the SVR would increase afterload and increase blood return to the pulmonary artery. TEST-TAKING HINT: The test taker should choose the response that decreases the preload in this patient.

The nurse is caring for a child who has undergone a cardiac catheterization. During recovery, the nurse notices the dressing is saturated with bright red blood. The nurse's first action is to: 1. Call the interventional cardiologist. 2. Notify the cardiac catheterization laboratory that the child will be returning. 3. Apply a bulky pressure dressing over the present dressing. 4. Apply direct pressure 1 inch above the puncture site.

4 1. This is not an appropriate action. 2. This is not an appropriate action. 3. This can be done after applying direct pressure 1 inch above the puncture site. 4. Applying direct pressure 1 inch above the puncture site will localize pressure over the vessel site. TEST-TAKING HINT: Consider the risk for volume depletion.

The parents of a 2-year-old boy are concerned about his behavior. Since the child's admission to the hospital 2 days ago he has been crying much more than usual and is inconsolable much of the time. The nurse's best response to the child's parents is: 1. The child is in the detachment phase of separation anxiety, which is normal for children during hospitalization. 2. The child is in the despair stage of separation anxiety, which is normal for children during hospitalization. 3. The child is in the bargaining stage of separation anxiety, which is normal for children during hospitalization. 4. The child is in the protest stage of separation anxiety, which is normal for children during hospitalization.

4. During the protest stage of separation anxiety, children are often inconsolable, and they often cry more than they do when they are at home. These children also frequently ask to go home.

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

4. Reviewing nutritious choices keeps the lesson on a positive note, and school age children are very interested in how food affects their bodies. They are capable of understanding basic medical terminology.

An 11-year-old male is being evaluated in the ER for an inguinal hernia. Which statement accurately describes how the nurse should approach him for his physical assessment? 1. The nurse should ask the child's parents to remain in the room during the physical exam. 2. The nurse should auscultate the child's heart, lungs, and abdomen first. 3. The nurse should explain to the child that the physical exam will not hurt. 4. The nurse should explain to the child what the nurse will be doing in basic understandable terms.

4. School-age children are capable of understanding basic functions of the body and should be taught about their diagnosis in simple, basic terms.

A 2-year-old girl has just become a big sister. Her mother has been a stay-at-home mother. Based on the developmental level of a 2-year-old, which comment should the child's mother expect from her toddler about her new baby brother? 1. "Mommy, when my baby brother takes a nap, will you play with me?" 2. "Mommy, can I play with my baby brother?" 3. "Mommy, he is so cute. I love him." 4. "Mommy, it is time to put him away so we can play."

4. This is a typical statement that would be made by a toddler. Toddlers are very egocentric and do not consider the needs of the other child.

45. A 3-month-old has been diagnosed with a ventricular septal defect (VSD). The flow of blood through the heart is _____________________.

Left to right. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood. TEST-TAKING HINT: The test taker should know that the classification for this defect is left to right.

A 10-year-old child is recovering from a severe sore throat. The parent states that the child complains of chest pain. The nurse observes that the child has swollen joints, nodules on the fingers, and a rash on the chest. The likely cause is _____________________.

Rheumatic fever or RF. To make the diagnosis of RF, major and minor criteria are used. Major criteria include carditis, subcutaneous nodules, erythema marginatum, chorea, and arthritis. Minor criteria include fever and previous history of RF. TEST-TAKING HINT: It is an inflammatory disease caused by group A beta-hemolytic streptococcus.