Peds Exam 4 Test Bank

1. A child who weighs 37 pounds needs a dose of lidocaine prior to cardioversion for ventricular tachycardia. What dose does the nurse prepare to administer? Write your answer using a whole number. _____ mg

ANS: 17 First determine the child's weight in kg: 37/2.2 = 16.6666. Lidocaine is dosed at 1 mg/kg 16.6666 × 1 = 16.6666. Round up to the nearest whole number = 17 mg. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1107 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

6. Which clinical finding is an overt sign of retinoblastoma in children? a. Whitish reflex in the eye b. Lymphadenopathy c. Bone pain d. Change in gait

ANS: A A whitish reflex in the eye, leukocoria, is a common finding of retinoblastoma. It is an overt sign of cancer in children. Persistent lymphadenopathy is a manifestation of several forms of childhood cancers. It is a covert sign of cancer in children. Bone pain is not a sign of retinoblastoma and is considered a covert sign. A change in gait may be a sign of a brain tumor. It is considered a covert sign of cancer in children. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1166 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

13. What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia? a. Immobilization and elevation of the affected joint b. Administration of acetaminophen for pain relief c. Assessment of the child's response to hospitalization d. Assessment of the impact of hospitalization on the family system

ANS: A Although acetaminophen may help with pain associated with the treatment of hemarthrosis, it is not the priority nursing intervention. Although acetaminophen may help with pain associated with the treatment of hemarthrosis, it is not the priority nursing intervention. Assessment of a child's response to hospitalization is relevant to all hospitalized children; however, in this situation, psychosocial concerns are secondary to physiologic concerns. A priority nursing concern for this child is the management of hemarthrosis. Assessing the impact of hospitalization on the family system is relevant to all hospitalized children, but it is not the priority in this situation. PTS: 1 DIF: Cognitive Level: Application/Applying REF: pp. 1131-1132 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

14. What is the nurse's first action when planning to teach the parents of an infant with a CHD? a. Assess the parents' anxiety level and readiness to learn. b. Gather literature for the parents. c. Secure a quiet place for teaching. d. Discuss the plan with the nursing team.

ANS: A Any effort to organize the right environment, plan, or literature is of no use if the parents are not ready to learn or have high anxiety. Decreasing level of anxiety is often needed before new information can be processed. A baseline assessment of prior knowledge should be taken into consideration before developing any teaching plan. Locating a quiet place for meeting with parents is appropriate; however, an assessment should be done before any teaching is done. Discussing a teaching plan with the nursing team is appropriate after an assessment of the parents' knowledge and readiness. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1085 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

31. Which drug is an angiotensin-converting enzyme (ACE) inhibitor? a. Captopril b. Furosemide c. Spironolactone d. Chlorothiazide

ANS: A Capoten is an ACE inhibitor. Furosemide is a loop diuretic. Spironolactone blocks the action of aldosterone. Chlorothiazide is a diuretic. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1083 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

30. A beneficial effect of administering digoxin is that it a. decreases edema. b. decreases cardiac output. c. increases heart size. d. increases venous pressure.

ANS: A Digoxin improves cardiac output, which will lead to decreased edema although it is not a diuretic. It does not increase heart size or increase venous pressure. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1083 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

6. What intervention should be included in the plan of care for an infant with the nursing diagnosis of excess fluid volume related to congestive heart failure? a. Weigh the infant every day on the same scale at the same time. b. Notify the physician when weight gain exceeds more than 20 g/day. c. Put the infant in a car seat to minimize movement. d. Administer digoxin as ordered by the physician.

ANS: A Excess fluid volume may not be overtly visible. Weight changes may indicate fluid retention. Weighing the infant on the same scale at the same time each day ensures consistency. An excessive weight gain for an infant is an increase of more than 50 g/day. With fluid volume excess, skin will be edematous. The infant's position should be changed frequently to prevent undesirable pooling of fluid in certain areas. Digoxin is used in the treatment of congestive heart failure to improve cardiac function. Diuretics will help the body get rid of excess fluid. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1084 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

15. The mother of a child with hemophilia asks the nurse how long her child will need to be treated for hemophilia. What is the best response to this question? a. "Hemophilia is a lifelong blood disorder." b. "There is a 25% chance that your child will have spontaneous remission." c. "Treatment continues until after the toddler years." d. "Since your first child did not have hemophilia, treatment for this child is temporary."

ANS: A Hemophilia is a lifelong hereditary blood disorder with no cure. Treatment is life long. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1129 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

16. In teaching family members about their child's von Willebrand disease, what is the priority outcome for the child that the nurse should discuss? a. Prevention of injury b. Maintaining adequate hydration c. Compliance with chronic transfusion therapy d. Prevention of respiratory infections

ANS: A Hemorrhage as a result of injury is the child's greatest threat to life. Fluid volume status becomes a concern when hemorrhage has occurred. The treatment of von Willebrand disease is desmopressin acetate (DDAVP), which is administered intranasally or intravenously. Respiratory infections do not constitute a major threat to the child with von Willebrand disease. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1132 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

19. A child with acute myeloblastic leukemia is scheduled to have a bone marrow transplant (BMT). The donor is the child's own umbilical cord blood that had been previously harvested and banked. This type of BMT is termed a. autologous. b. allogeneic. c. syngeneic. d. stem cell.

ANS: A In an autologous transplant, the child's own marrow or previously harvested and banked cord blood is used. In an allogeneic BMT, histocompatibility has been matched with a related or an unrelated donor. In a syngeneic transplant, the child receives bone marrow from an identical twin. A stem cell transplantation uses a unique immature cell present in the peripheral circulation. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1147 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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

ANS: A In this scenario, there is a 50% risk of having a child with sickle cell disease. The sickle cell trait, not the disease itself, must be present in the parents for the child to have the disease. An autosomal recessive pattern of inheritance means that both parents must be carriers of the sickle cell trait. Sickle cell disease is known to have an autosomal recessive pattern of inheritance. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1121 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

8. When assessing the child with atopic dermatitis, the nurse should ask the parents about a history of which of the following? a. Asthma b. Nephrosis c. Lower respiratory tract infections d. Neurotoxicity

ANS: A Most children with atopic dermatitis have a family history of asthma, hay fever, or atopic dermatitis, and up to 80% of children with atopic dermatitis have asthma or allergic rhinitis. Complications of atopic dermatitis relate to the skin. The renal system is not affected by atopic dermatitis. There is no link between lower respiratory tract infections and atopic dermatitis. Atopic dermatitis does not have a relationship to neurotoxicity. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1175 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

2. An assessment of a 7-month-old infant with a hemoglobin level of 6.5 mg/dL is likely to reveal an infant who is a. lethargic, pale, and irritable. b. thin, energetic, and sleeps little. c. anorexic, vomiting, and has watery stools. d. flushed, fussy, and tired.

ANS: A Pallor, lethargy, irritability, and tachycardia are clinical manifestations of iron-deficiency anemia. A child with a hemoglobin level of 6.5 mg/dL has anemia. Typically these children will not be thin, energetic, anorexic, have GI complaints, or flushed. They may be tired, fussy, and sleep a lot. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1121 | Parents Want to Know Box OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

9. A child with pulmonary atresia exhibits cyanosis with feeding. On reviewing this child's laboratory values, the nurse is not surprised to notice which abnormality? a. Polycythemia b. Infection c. Dehydration d. Anemia

ANS: A Polycythemia is a compensatory response to chronic hypoxia. The body attempts to improve tissue oxygenation by producing additional red blood cells and thereby increases the oxygen-carrying capacity of the blood. Infection, dehydration, and anemia are not clinical consequences of cyanosis. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1088 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

16. A child had surgery for a brain tumor. Which provider orders does the nurse question? a. Place the child in the Trendelenburg position. b. Perform neurologic assessments. c. Assess dressings for drainage. d. Monitor temperature.

ANS: A The child is never placed in the Trendelenburg position because it increases intracranial pressure and the risk of bleeding. Increased intracranial pressure is a risk in the postoperative period. The nurse would assess the child's neurologic status frequently. Hemorrhage is a risk in the postoperative period. The child's dressing would be inspected frequently for bleeding. Temperature is monitored closely because the child is at risk for infection in the postoperative period. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1158 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

4. In which situation is there a risk that a newborn infant will have a congenital heart defect (CHD)? a. Trisomy 21 detected on amniocentesis b. Family history of myocardial infarction c. Father has type 1 diabetes mellitus d. Older sibling born with Turner syndrome

ANS: A The incidence of congenital heart disease is approximately 50% in children with trisomy 21 (Down syndrome). A family history of congenital heart disease, not acquired heart disease, increases the risk of giving birth to a child with CHD. Infants born to mothers who are insulin dependent have an increased risk of CHD. Infants identified as having certain genetic defects, such as Turner syndrome, have a higher incidence of CHD. A family history is not a risk factor. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1081 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

5. Before giving a dose of digoxin the nurse checked an infant's apical heart rate and it was 114 beats/minute. What should the nurse do next? a. Administer the dose as ordered. b. Hold the medication until the next dose. c. Wait and recheck the apical heart rate in 30 minutes. d. Notify the physician about the infant's heart rate.

ANS: A The infant's heart rate is above the lower limit for which the medication is held (100 beats/minute in an infant). The dose can be given. No other action is needed. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1084 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

1. The nurse notes that a child's gums bleed easily and that the child has bruising and petechiae on his extremities. What laboratory values are consistent with these symptoms? a. Platelet count of 19,000/mm3 b. Prothrombin time of 11 to 15 seconds c. Hematocrit of 34 d. Leukocyte count of 14,000/mm3

ANS: A The normal platelet count is 150,000 to 400,000/mm3. This finding is very low, indicating an increased bleeding potential. The child should be monitored closely for signs of bleeding. The prothrombin time of 11 to 15 seconds is within normal limits. The normal hematocrit is 35 to 45, and although this finding is low, it would not create the symptoms presented. This value indicates the probable presence of infection, but it is not a reflection of bleeding tendency. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1151 | p. 1144 | Box 48.1 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

1. A child has small red macules and vesicles that become pustules around the child's mouth and cheek. Older lesions are crusted and honey-colored. What should the nurse teach the parents about this condition? a. Keep the child home from school for 24 hours after starting antibiotics. b. Clean the rash vigorously with Betadine three times a day. c. Notify the physician for any itching. d. Keep the child home from school until the lesions are healed.

ANS: A This child has impetigo. To prevent the spread of impetigo to others, the child should be kept home from school for 24 hours after treatment is initiated. Good handwashing is imperative in preventing the spread of impetigo. The lesions should be washed gently with a warm soapy washcloth. Itching is common and does not necessitate medical treatment. Rather, parents should be taught to clip the child's nails to prevent maceration of the lesions. The washcloth should not be shared with other members of the family. The child may return to school 24 hours after initiation of antibiotic treatment. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1178 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

24. What should the nurse include in discharge teaching as the highest priority for the child with a cardiac dysrhythmia? a. CPR instructions b. Repeating digoxin if the child vomits c. Resting if dizziness occurs d. Checking the child's pulse after digoxin administration

ANS: A This could potentially be life-saving for the child. The parents and significant others in the child's life should have CPR training. The digoxin dose is not repeated if the child vomits. Dizziness is a symptom the child should be taught to report to adults so that the physician can be notified. It is not the priority intervention. The child's pulse should be counted before the medication is given. The dose is withheld if the pulse is below the parameters set by the physician. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1108 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

17. Which CHD results in increased pulmonary blood flow? a. Ventricular septal defect b. Coarctation of the aorta c. Tetralogy of Fallot d. Pulmonary stenosis

ANS: A Ventricular septal defect causes a left-to-right shunting of blood, thus increasing pulmonary blood flow. Coarctation of the aorta is a stenotic lesion that causes increased resistance to blood flow from the proximal to distal aorta. The defects associated with tetralogy of Fallot result in a right-to-left shunting of blood, thus decreasing pulmonary blood flow. Pulmonary stenosis causes obstruction of blood flow from the right ventricle to the pulmonary artery. Pulmonary blood flow is decreased. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1094 | Table 46.3 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

1. When an adolescent with a new diagnosis of Ewing sarcoma asks the nurse about treatment, the nurse's response is based on the knowledge that (Select all that apply.) a. this type of tumor invades the bone. b. management includes chemotherapy, surgery, and radiation. c. Ewing sarcoma is usually not responsive to either chemotherapy or radiation. d. affected bones such as ribs and proximal fibula may be removed to excise the tumor. e. is the most common bone tumor seen in children.

ANS: A, B, D Ewing sarcoma invades the bone and is found most often in the midshaft of long bones, especially the femur, vertebrae, ribs, and pelvic bones. Treatment for Ewing sarcoma begins with chemotherapy to decrease tumor bulk, followed by surgical resection of the primary tumor. Local control of the tumor can be achieved with surgery or radiation. The affected bone may be removed if it will not affect the child's functioning. Ribs and the proximal fibula are considered expendable and may be removed to excise the tumor without affecting function. Ewing sarcoma is responsive to both chemotherapy and radiation. Osteosarcoma is the most common primary bone malignancy in children. The second most common bone tumor seen in children is Ewing sarcoma. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1164 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

2. A child has a total cholesterol level of 180 mg/dL. What dietary recommendations should the nurse make to the child and the child's parents? (Select all that apply.) a. Replace whole milk with 1% milk. b. Increase servings of red meat. c. Increase servings of fish. d. Avoid excessive intake of fruit juices. e. Limit servings of whole grain.

ANS: A, C, D A low-fat diet includes using nonfat or low-fat dairy products, limiting red meat intake, and increasing intake of fish, vegetables, whole grains, and legumes. Children should avoid excessive intake of fruit juices and other sweetened drinks, sugars, and saturated fats. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1115 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

4. The nurse is caring for a child who has beta-thalassemia. What unique facial features does the nurse assess in this child? (Select all that apply.) a. Frontal bossing b. Strabismus c. Wide-set eyes d. Maxillary prominence e. Distinct overbite

ANS: A, C, D Children with undertreated beta-thalassemia have distinct facial features including frontal bossing, wide-set eyes, and maxillary prominence. They do not have strabismus or overbites. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1128 | Box 47.1 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

5. The nurse assesses the lab values of a child hospitalized with DIC. What findings are consistent for this disorder? (Select all that apply.) a. Decreased platelet count b. Increased hemoglobin c. Prolonged prothrombin time d. Elevated D-dimer e. Pancytopenia

ANS: A, C, D Laboratory findings in DIC include decreased platelet count, prolonged prothrombin time, and elevated D-dimer. Increased hemoglobin and pancytopenia are not seen. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1136 | Box 47.2 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

4. A nurse routinely administers chemotherapy to hospitalized children with cancer. What safety measures does this nurse take as a routine part of practice? (Select all that apply.) a. Calculates child's body-surface area in meters squared b. Ensures a CBC is obtained within 72 hours of starting chemotherapy c. Double checks ordered doses against established protocols d. Obtains emergency equipment e. Monitors child based on provider orders

ANS: A, C, D The nurse providing chemotherapy has many responsibilities including calculating the child's body-surface area, double checking orders against protocols, and having emergency equipment available. A CBC should be obtained within 48 hours of administering chemotherapy. The nurse should monitor the child based on the child's condition and not just follow the orders left by the provider. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1145 | Box 48.2 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

2. What should the nurse recognize as symptoms of a brain tumor in a school-age child? (Select all that apply.) a. Blurred vision b. Increased head circumference c. Vomiting when getting out of bed d. Intermittent headache e. Declining academic performance

ANS: A, C, D, E Visual changes such as nystagmus, diplopia, and strabismus are manifestations of a brain tumor. The change in position on awakening causes an increase in intracranial pressure, which is manifested as vomiting. Vomiting on awakening is considered a hallmark symptom of a brain tumor. Increased intracranial pressure resulting from a brain tumor is manifested as a headache. School-age children may exhibit declining academic performance, fatigue, personality changes, and symptoms of vague, intermittent headache. Other symptoms may include seizures or focal neurologic deficits. Manifestations of brain tumors vary with tumor location and the child's age and development. Infants with brain tumors may have increased head circumference with a bulging fontanel. School-age children have closed fontanels, and therefore their head circumferences do not increase with brain tumors. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: pp. 1155-1156 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

2. The nurse is caring for a child with iron-deficiency anemia. What should the nurse expect to find when reviewing the results of the complete blood count (CBC)? (Select all that apply.) a. Low hemoglobin levels b. Elevated red blood cell (RBC) levels c. Elevated mean cell volume (MCV) levels d. Low reticulocyte count e. Decreased MCV levels

ANS: A, D, E The results of the complete blood count in a child with iron-deficiency anemia will show low hemoglobin levels (6 to 11 g/dL) and microcytic, hypochromic RBCs; this manifests as decreased MCV and decreased mean cell hemoglobin. The reticulocyte count is usually slightly elevated or normal, and MCV levels are decreased, not increased. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1120 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

22. A child has a brain tumor. What assessment finding leads the nurse to request a physical therapy consultation? a. Dizziness b. Ataxia c. Slurred speech d. Visual changes

ANS: B A child with ataxia would benefit from a physical therapy consultation to help regain coordination. Physical therapy would not help with dizziness, slurred speech, or visual changes. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1158 | Box 48.3 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Safe and Effective Care Environment

7. Parents of a child with lice infestation should be instructed carefully in the use of antilice products because of which potential side effect? a. Nephrotoxicity b. Neurotoxicity c. Ototoxicity d. Bone marrow depression

ANS: B Because of the danger of absorption through the skin and potential for neurotoxicity, antilice treatment must be used with caution. A child with many open lesions can absorb enough to cause seizures. Antilice products are not known to be nephrotoxic or ototoxic and do not cause bone marrow depression. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1186 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

2. The nurse understands that the types of precautions needed for children receiving chemotherapy are based on which action of chemotherapeutic agents? a. Gastrointestinal upset b. Bone marrow suppression c. Decreased creatinine level d. Alopecia

ANS: B Chemotherapy agents cause bone marrow suppression, which creates the need to institute precautions related to reduced white blood cell, red blood cell, and platelet counts. These precautions focus on preventing infection and bleeding. Although gastrointestinal upset may be an adverse effect of chemotherapy, it is not caused by all chemotherapeutic agents. No special precautions are instituted for gastrointestinal upset. A decreased creatinine level is consistent with renal pathologic conditions, not chemotherapy. Not all chemotherapeutic agents cause alopecia. No precautions are taken to prevent alopecia. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1143 | p. 1145 OBJ: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment

12. What is an appropriate nursing action before surgery when caring for a child diagnosed with a Wilms' tumor? a. Limit fluid intake. b. Do not palpate the abdomen. c. Force oral fluids. d. Palpate the abdomen every 4 hours.

ANS: B Excessive manipulation of the tumor area can cause seeding of the tumor and spread of the malignant cells. Fluids are not routinely limited in a child with a Wilms' tumor. However, intake and output are important because of the kidney involvement. Fluids are not forced on a child with a Wilms' tumor. Normal intake for age is usually maintained. The abdomen of a child with a Wilms' tumor should never be palpated because of the danger of seeding the tumor and spreading malignant cells. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1165 | Nursing Quality Alert Box OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

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

ANS: B Hydration and pain management decrease the cells' oxygen demands and prevent sickling. Antibiotics may be given prophylactically. Oxygen therapy rather than nebulizer treatments is used to prevent further sickling. Although blood transfusions and increased calories may be indicated, they are not primary considerations for vaso-occlusive crisis. School work and diversion are not major considerations when the child is in a vaso-occlusive crisis. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1126 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

23. An adolescent being seen by the nurse practitioner for a sports physical is identified as having hypertension. On further testing, it is discovered the child has a cardiac abnormality. The initial treatment of secondary hypertension initially involves a. weight control and diet. b. treating the underlying disease. c. administration of digoxin. d. administration of beta-adrenergic receptor blockers.

ANS: B Identification and treatment of the underlying disease should be the first step in treating secondary hypertension. Weight control and diet are non-pharmacologic treatments for primary hypertension. Digoxin is indicated in the treatment of congestive heart failure. Beta-adrenergic receptor blockers may be indicated in the treatment of secondary hypertension, but the main focus is on identifying and treating the underlying cause. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1114 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

12. The nurse discovers a heart murmur in an infant 1 hour after birth. What does the nurse know about when fetal shunts close in the neonate? a. When the umbilical cord is cut b. Within several days of birth c. Within a month after birth d. By the end of the first year of life

ANS: B In the normal neonate, fetal shunts functionally close in response to pressure changes in the systemic and pulmonary circulations and to increased oxygen content. This process may take several days to complete. With the neonate's first breath, gas exchange is transferred from the placenta to the lungs. The separation of the fetus from the umbilical cord does not contribute to the establishment of neonatal circulation. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1079 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

17. A child with non-Hodgkin lymphoma will be starting chemotherapy. What intervention is initiated before chemotherapy to prevent tumor lysis syndrome? a. Insertion of a central venous catheter b. Intravenous (IV) hydration containing sodium bicarbonate c. Placement of an externalized ventriculoperitoneal (VP) shunt d. Administration of pneumococcal and Haemophilus influenzae type B vaccines

ANS: B Intensive hydration with an IV fluid containing bicarbonate alkalinizes the urine to help prevent the formation of uric acid crystals, which damage the kidney. A central venous catheter is placed to assist in delivering chemotherapy. An externalized VP shunt may be placed to relieve intracranial pressure caused by a brain tumor. If a splenectomy is necessary for a child with Hodgkin disease, the pneumococcal and Haemophilus influenzae vaccines are administered before the surgery. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1150 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

7. What is a priority nursing diagnosis for the 4-year-old child newly diagnosed with leukemia? a. Ineffective Breathing Pattern related to mediastinal disease b. Risk for Infection related to immunosuppressed state c. Disturbed Body Image related to alopecia d. Impaired Skin Integrity related to radiation therapy

ANS: B Leukemia is characterized by the proliferation of immature white blood cells, which lack the ability to fight infection. Ineffective Breathing Pattern applies to a child with non-Hodgkin lymphoma or any cancer involving the chest area. Disturbed Body Image relates to children taking chemotherapy or radiation therapy and does not occur for all children. It would not be the highest priority even if the child had the diagnosis. Radiation therapy is not a treatment for leukemia. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1148 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

14. While completing an assessment on a 6-month-old infant, which finding should the nurse recognize as a symptom of a brain tumor? a. Blurred vision b. Increased head circumference c. Vomiting when getting out of bed d. Headache

ANS: B Manifestations of brain tumors vary with tumor location and the child's age and development. Infants with brain tumors may be irritable or lethargic, feed poorly, and have increased head circumference with a bulging fontanel. Visual changes such as nystagmus, diplopia, and strabismus are manifestations of a brain tumor but would not be able to be verbalized by an infant. The change in position on awakening causes an increase in intra- cranial pressure, which is manifested as vomiting. Vomiting on awakening is considered a hallmark symptom of a brain tumor, but infants do not get themselves out of bed in the morning. Increased intracranial pressure resulting from a brain tumor is manifested as a headache but could not be verbalized by an infant. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1155 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

15. What is an expected physical assessment finding for an adolescent with a diagnosis of Hodgkin disease? a. Protuberant, firm abdomen b. Enlarged, painless, firm cervical lymph nodes c. Soft tissue swelling d. Soft to hard, nontender mass in pelvic area

ANS: B Painless, firm, movable adenopathy (enlarged lymph nodes) palpated in the cervical region is an expected assessment finding in Hodgkin disease. Other systemic symptoms include unexplained fevers, weight loss, and night sweats. A protuberant, firm abdomen is present in many cases of neuroblastoma. Soft tissue swelling around the affected bone is a manifestation of Ewing sarcoma. A soft to hard, nontender mass can be palpated when rhabdomyosarcoma is present. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1160 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

15. Which statement best describes patent ductus arteriosus? a. Patent ductus arteriosus involves a defect that results in a right-to-left shunting of blood in the heart. b. Patent ductus arteriosus involves a defect in which the fetal shunt between the aorta and the pulmonary artery fails to close. c. Patent ductus arteriosus is a stenotic lesion that must be surgically corrected at birth. d. Patent ductus arteriosus causes an abnormal opening between the four chambers of the heart.

ANS: B Patent ductus arteriosus is failure of the fetal shunt between the aorta and the pulmonary artery to close. Patent ductus arteriosus allows blood to flow from the high-pressure aorta to the low-pressure pulmonary artery, resulting in a left-to-right shunt. Patent ductus arteriosus is not a stenotic lesion. Patent ductus arteriosus can be closed both medically and surgically. Atrioventricular defect occurs when fetal development of the endocardial cushions is disturbed, resulting in abnormalities in the atrial and ventricular septa and the atrioventricular valves. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1093 | Table 46.3 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

20. What is the nurse's best response to parents with questions about how her child's blood disorder will be treated? a. "Your child may be able to receive home care." b. "What did the provider tell you?" c. "Blood diseases are transient, so there is no need to worry." d. "Your child will be tired for a while and then be back to normal."

ANS: B Providing the parents an opportunity to express what they were told by the physician allows the nurse to assess the parents' understanding and provide further information. Treatment depends on the child's condition and the type of blood disorder. Although it is possible that the child could be treated in the home, the child may need to be treated as an outpatient or in the hospital. It is best to first assess what the parents have been told by the physician. Minimizing the parents' concern is inappropriate. The nurse needs to assess the parents' knowledge before teaching about the disease. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1120 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Physiologic Integrity MULTIPLE RESPONSE

6. A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is known as a. aplastic anemia. b. sickle cell anemia. c. thalassemia major. d. iron-deficiency anemia.

ANS: B Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by an abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Hemophilia refers to a group of bleeding disorders in which there is deficiency of one of the factors necessary for coagulation. Iron-deficiency anemia affects size and depth of color and does not involve an abnormal hemoglobin. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1121 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

6. Which nursing assessment is applicable to the care of a child with herpetic gingivostomatitis? a. Comparison of range of motion of the extremities b. Urine output, mucous membranes, and skin turgor c. Growth pattern since birth d. Bowel elimination pattern

ANS: B The child with herpetic gingivostomatitis is at risk for deficient fluid volume. Painful lesions on the mouth make drinking unpleasant and undesirable, with subsequent dehydration becoming a real danger. An oral herpetic infection does not affect joint function. Herpetic gingivostomatitis is not a chronic disorder that would affect the child's long-term growth pattern. Although constipation could be caused by dehydration, it is more important to assess urine output, skin turgor, and mucous membranes to identify dehydration before constipation is a problem. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1185 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

21. Which strategy is appropriate when feeding the infant with congestive heart failure? a. Continue the feeding until a sufficient amount of formula is taken. b. Limit feeding time to no more than 30 minutes. c. Always bottle feed every 4 hours. d. Feed larger volumes of concentrated formula less frequently.

ANS: B The infant with congestive heart failure may tire easily, so the feeding should not continue beyond 30 minutes. If inadequate amounts of formula are taken, gavage feedings should be considered. The infant is fed smaller volumes of concentrated formula every 3 hours. PTS: 1 DIF: Cognitive Level: Application REF: p. 1085 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

33. The primary nursing intervention to prevent bacterial endocarditis is which of the following? a. Institute measures to prevent dental procedures. b. Counsel parents of high-risk children about prophylactic antibiotics. c. Observe children for complications, such as embolism and heart failure. d. Encourage restricted mobility in susceptible children.

ANS: B The objective of nursing care is to counsel the parents of high-risk children about both the need for prophylactic antibiotics for dental procedures and the necessity of maintaining excellent oral health. The child's dentist should be aware of the child's cardiac condition. Dental procedures should be done to maintain a high level of oral health. Prophylactic antibiotics are necessary. Observing children for complications should be done, but maintaining good oral health and prophylactic antibiotics is important. Restricted mobility may or may not be necessary. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1105 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

11. A child had an aortic stenosis defect surgically repaired 5 months ago. Which antibiotic prophylaxis is indicated for an upcoming tonsillectomy? a. No antibiotic prophylaxis is necessary. b. Amoxicillin is taken orally 1 hour before the procedure. c. Oral penicillin is given for 7 to 10 days before the procedure. d. Parenteral antibiotics are administered for 5 to 7 days after the procedure.

ANS: B The standard prophylactic agent is amoxicillin given orally 1 hour before the procedure. Antibiotic prophylaxis is indicated for the first 6 months after surgical repair. Antibiotic prophylaxis is not given for 7 to 10 days nor is it given parenterally. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1105 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

19. What is the appropriate priority nursing action for the infant with a CHD who has an increased respiratory rate, is sweating, and is not feeding well? a. Recheck the infant's blood pressure. b. Alert the provider. c. Withhold oral feeding. d. Increase the oxygen rate.

ANS: B These are signs of early congestive heart failure, and the provider should be notified. Rechecking the blood pressure is not necessary. Withholding the infant's feeding is an incomplete response to the problem. Increasing oxygen may alleviate symptoms, but medications such as digoxin and furosemide are necessary to improve heart function and fluid retention. Notifying the provider is the priority nursing action. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1084 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

7. The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur. What action by the nurse is most appropriate? a. Educate parents on daily low-dose aspirin regime. b. Prepare to administer indomethacin. c. Administer next dose of enalapril early. d. Position infant in the knee-chest position.

ANS: B This murmur is characteristic of a patent ductus arteriosus, which is treated medically with indomethacin. A daily low-dose aspirin is indicated for 6 months following repair of an ASD. ACE inhibitors (enalapril) are used to reduce afterload in a VSD. The knee-chest position is helpful in tet spells that occur in tetralogy of Fallot. PTS: 1 DIF: Cognitive Level: Analysis/Analyzing REF: p. 1093 | Table 46.3 OBJ: Nursing Process: Assessment !! ANS: D The classic finding in children with coarctation of the aorta is a disparity in pulses and blood pressures between the upper and lower extremities. Orthostatic hypotension is not present with coarctation of the aorta. Systolic hypertension may be detected in the upper extremities. The left arm may not accurately reflect systolic hypertension because the left subclavian artery can be involved in the coarctation. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1091 | Table 46.2 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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

ANS: B Tretinoin causes photosensitivity, and sunscreen should be applied before sun exposure. Tretinoin is a topical medication. Application is not affected by meals. If applied together, benzoyl peroxide and tretinoin have reduced effectiveness and a potentially irritant effect. Optimal results from tretinoin are not achieved for 3 to 5 months. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1189 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

1. The nurse working in the newborn nursery notices an infant who is having circumoral cyanosis. Which CHD does the nurse suspect the child may have? (Select all that apply.) a. Patent ductus arteriosus (PDA) b. Tetralogy of Fallot c. Pulmonary atresia d. Transposition of the great arteries e. Ventricular septal defect

ANS: B, C, D Tetralogy of Fallot is a cyanotic lesion with decreased pulmonary blood flow. The hypoxia results in baseline oxygen saturations as low as 75% to 85%. Even with oxygen administration, saturations do not reach the normal range. Pulmonary atresia is a cyanotic lesion with decreased pulmonary blood flow. The hypoxia results in baseline oxygen saturations as low as 75% to 85%. Even with oxygen administration, saturations do not reach the normal range. Transposition of the great arteries is a cyanotic lesion with increased pulmonary blood flow. PDA is failure of the fetal shunt between the aorta and the pulmonary artery to close. PDA is not classified as a cyanotic heart disease. Prostaglandin E1 is often given to maintain ductal patency in children with cyanotic heart diseases. VSD is the most common type of cardiac defect. The VSD is a left-to-right shunting defect; however, it may be accompanied by other defects. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: pp. 1193-1197 | Table 46.3 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

1. The nurse is caring for a child with aplastic anemia. What nursing diagnoses are appropriate? (Select all that apply.) a. Acute Pain related to vaso-occlusion b. Risk for Infection related to inadequate secondary defenses or immunosuppression c. Ineffective Protection related to thrombocytopenia d. Ineffective Tissue Perfusion related to anemia e. Ineffective Protection related to abnormal clotting

ANS: B, C, D These are appropriate nursing diagnosis for the nurse planning care for a child with aplastic anemia. Aplastic anemia is a condition in which the bone marrow ceases production of the cells it normally manufactures, resulting in pancytopenia. The child will have varying degrees of the disease depending on how low the values are for absolute neutrophil count (affecting the body's response to infection), platelet count (putting the child at risk for bleeding), and absolute reticulocyte count (causing the child to have anemia). Acute pain related to vaso-occlusion is an appropriate nursing diagnosis for sickle cell anemia for the child in vaso-occlusive crisis, but it is not applicable to a child with aplastic anemia. Ineffective protection related to abnormal clotting is an appropriate diagnosis for von Willebrand disease. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1137 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

3. A child with a brain tumor is undergoing radiation therapy. What should the nurse include in the discharge instructions to the child's parents? (Select all that apply.) a. Apply over-the-counter creams to the area daily. b. Avoid excessive skin exposure to the sun. c. Use a washcloth when cleaning the area receiving radiation. d. Plan for adequate rest periods for the child. e. A darkening of the skin receiving radiation is expected.

ANS: B, D, E Children receiving cranial radiation are particularly affected by fatigue and an increased need for sleep during and shortly after completion of the course of radiation. Skin damage can include changes in pigmentation (darkening), redness, peeling, and increased sensitivity. Extra care must be taken to avoid excessive skin exposure to heat, sunlight, friction (such as rubbing with a towel or washcloth), and creams or moisturizers. Only topical creams and moisturizers prescribed by the radiation oncologist should be applied to the radiated skin. PTS: 1 DIF: Cognitive Level: Application/Applying REF: pp. 1146-1147 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

3. Parents of a child with acute lymphoblastic leukemia (ALL) ask about their child's prognosis. The nurse should base the response on the knowledge that a. leukemia is a fatal disease, although chemotherapy provides increasingly longer periods of remission. b. research to find a cure for childhood cancers is very active. c. the majority of children go into remission and remain symptom free when treatment is completed. d. it usually takes several months of chemotherapy to achieve a remission.

ANS: C Children diagnosed with the most common form of leukemia, ALL, can almost always achieve remission, with a 5-year disease-free survival rate approaching 85%. With the majority of children surviving 5 years or longer, it is inappropriate to refer to leukemia as a fatal disease. Telling parents about current research to answer their question does not address their concern. About 95% of children achieve remission within the first month of chemotherapy. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1148 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

21. What fluid is the best choice when a child with mucositis asks for something to drink? a. Hot chocolate b. Lemonade c. Popsicle d. Orange juice

ANS: C Cool liquids are soothing, and ice pops are usually well tolerated. A hot beverage can be irritating to mouth ulcers. Citrus products may be very painful to an ulcerated mouth. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1155 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

27. The nurse is admitting a child who has been diagnosed with Kawasaki disease. What is the most serious complication for which the nurse should assess in Kawasaki disease? a. Cardiac valvular disease b. Cardiomyopathy c. Coronary aneurysm d. Rheumatic fever

ANS: C Coronary artery aneurysms are seen in 20% to 25% of children with untreated Kawasaki disease. Cardiac valvular disease can occur in rheumatic fever. Cardiomyopathies are diseases of the heart muscle, which can occur as a result of congenital heart disease, coronary artery disease, or other systemic disease. Rheumatic fever is not a complication of Kawasaki disease. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1111 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

11. A child has beta-thalassemia and is receiving deferoxamine. The parent asks what the purpose of this medication is. Which response by the nurse is best? a. "To improve the anemia" b. "To decrease liver and spleen swelling" c. "To eliminate excessive iron being stored in the organs" d. "To prepare your child for a bone marrow transplant"

ANS: C Excessive iron overload (hemosiderosis) causes organ damage. Chelation therapy with deferoxamine removes the iron stored in organs. It is not a treatment for existing conditions such as hepatosplenomegaly nor is it used prior to a bone marrow transplant. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1128 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

5. With what beverage should the parents of a child with ringworm be taught to give griseofulvin? a. Water b. A carbonated drink c. Milk d. Fruit juice

ANS: C Griseofulvin is insoluble in water. Giving the medication with a high-fat meal or milk increases absorption. Carbonated drinks do not contain fat, which aids in the absorption of griseofulvin. Fruit juice does not contain any fat; fat aids absorption of the medication. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1182 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

13. Children with non-Hodgkin lymphoma are at risk for complications resulting from tumor lysis syndrome (TLS). What findings would the nurse assess for to identify this complication early? a. Increased ALT, AST b. Change in level of consciousness c. Elevated BUN and creatinine d. Oxygen saturation of 93%

ANS: C In TLS, the tumor's intracellular contents are dumped into the child's extracellular fluid as the tumor cells are lysed in response to chemotherapy. Because of the large volume of these cells, their intracellular electrolytes overload the kidneys and, if not monitored, can cause kidney failure. Kidney failure would manifest in rising BUN and creatinine. This does not affect the liver so increased ALT and AST are not related. Changes in level of consciousness would not help identify this specific complication. An oxygen saturation of 93% is related to the lungs. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1157 | Nursing Quality Alert Box OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

12. Which statement best describes beta-thalassemia major (Cooley anemia)? a. All formed elements of the blood are depressed. b. Inadequate numbers of red blood cells are present. c. Increased incidence occurs in families of Mediterranean extraction. d. Increased incidence occurs in persons of West African descent.

ANS: C Individuals who live near the Mediterranean Sea and their descendants have the highest incidence of thalassemia. An overproduction of red cells occurs. Although numerous, the red cells are relatively unstable. Sickle cell disease is common in blacks of West African descent. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1128 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

1. What is the best response to a parent who asks the nurse whether her 5-month-old infant can have cow's milk? a. "You need to wait until she is 8 months old and eating solids well." b. "Yes, if you think that she will eat enough meat to get the iron she needs." c. "Infants younger than 12 months need iron-rich formula to get the iron they need." d. "Try it and see how she tolerates it."

ANS: C Infants younger than 12 months need iron-fortified formula or breast milk. Infants who drink cow's milk do not get adequate iron and are at risk for iron-deficiency anemia. A 5-month-old infant cannot get adequate iron without drinking an iron-fortified formula or taking an iron supplement. Counseling a parent to give a 5-month-old infant cow's milk is inappropriate. PTS: 1 DIF: Cognitive Level: Application/Applying REF: pp. 1120-1121 | p. 1122 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

18. The nurse is aware that an abdominal mass found in a 10-month-old infant corresponds with which childhood cancer? a. Osteogenic sarcoma b. Rhabdomyosarcoma c. Neuroblastoma d. Non-Hodgkin lymphoma

ANS: C Neuroblastoma is found exclusively in infants and children. In most cases of neuroblastoma, a primary abdominal mass and protuberant, firm abdomen are present. Osteogenic sarcoma is a bone tumor. Bone tumors typically affect older children. Rhabdomyosarcoma is a malignancy of muscle or striated tissue. It occurs most often in the periorbital area, in the head and neck in younger children, or in the trunk and extremities in older children. Non-Hodgkin lymphoma is a neoplasm of lymphoid cells. Painless, enlarged lymph nodes are found in the cervical or axillary region. Abdominal signs and symptoms do not include a mass. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1161 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

22. A nurse is teaching an adolescent about primary hypertension. Which statement made by the adolescent indicates an understanding of primary hypertension? a. Primary hypertension should be treated with diuretics as soon as it is detected. b. Congenital heart defects are the most common cause of primary hypertension. c. Primary hypertension may be treated with weight reduction. d. Primary hypertension is not affected by exercise.

ANS: C Primary hypertension in children may be treated with weight reduction and exercise programs. Primary hypertension is usually treated with weight reduction and exercise. If ineffective, pharmacologic intervention may be needed. An exercise program in conjunction with weight reduction can be effective in managing primary hypertension in children. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 1113 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

28. A nurse is conducting a class for nursing students about fetal circulation. Which statement is accurate about fetal circulation and should be included in the teaching session? a. Oxygen is carried to the fetus by the umbilical arteries. b. Blood from the inferior vena cava is shunted directly to the right ventricle through the foramen ovale. c. Pulmonary vascular resistance is high because the lungs are filled with fluid. d. Blood flows from the ductus arteriosus to the pulmonary artery.

ANS: C Resistance in the pulmonary circulation is very high because the lungs are collapsed and filled with fluid. Oxygen and nutrients are carried to the fetus by the umbilical vein. The inferior vena cava empties blood into the right atrium. The direction of blood flow and the pressure in the right atrium propel most of this blood through the foramen ovale into the left atrium. Most of the blood in the pulmonary artery flows though the ductus arteriosus into the descending aorta. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1079 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

29. Which defect results in increased pulmonary blood flow? a. Pulmonic stenosis b. Tricuspid atresia c. Atrial septal defect d. Transposition of the great arteries

ANS: C The atrial septal defect results in increased pulmonary blood flow. Blood flows from the left atrium (higher pressure) into the right atrium (lower pressure) and then to the lungs via the pulmonary artery. The other three diseases do not result in increased pulmonary blood flow. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1093 | Table 46.3 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

19. What is a priority intervention in planning care for the child with disseminated intravascular coagulation (DIC)? a. Hospitalization at the first sign of bleeding b. Teaching the child relaxation techniques for pain control c. Management in the intensive care unit d. Provision of adequate hydration to prevent complications

ANS: C The child with DIC is seriously ill and needs to be monitored in an intensive care unit. DIC typically develops in a child who is already hospitalized. Relaxation techniques and pain control are not high priorities for the child with DIC. Hydration is not the major concern for the child with DIC. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1136 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

20. What should the nurse teach parents about oral hygiene for the child receiving chemotherapy? a. Brush the teeth briskly to remove bacteria. b. Use a mouthwash that contains alcohol. c. Inspect the child's mouth daily for ulcers. d. Perform oral hygiene twice a day.

ANS: C The child's mouth is inspected regularly for ulcers. At the first sign of ulceration, an antifungal drug is initiated. The teeth should be brushed with a soft-bristled toothbrush. Excessive force with brushing should be avoided because delicate tissue could be broken, causing infection or bleeding. Mouthwashes containing alcohol may be drying to oral mucosa, thus breaking down the protective barrier of the skin. Oral hygiene should be performed four times a day. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1151 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

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

ANS: C The clinical features of sickle cell anemia are primarily the result of increased red blood cell destruction and obstruction caused by the sickle-shaped red blood cells. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension. When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation. Increased red blood cell destruction occurs. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1125 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

8. A nurse has taught parents about diagnostic testing for their child who is suspected of having leukemia. What test described by the parents shows good understanding of this information? a. Complete blood cell count (CBC) b. Lumbar puncture c. Bone marrow biopsy d. Computed tomography (CT) scan

ANS: C The confirming test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspiration and biopsy. A CBC may show blast cells that would raise suspicion of leukemia. It is not a confirming diagnostic study. A lumbar puncture is done to check for central nervous system involvement in the child who has been diagnosed with leukemia. A CT scan may be done to check for bone involvement in the child with leukemia. It does not confirm a diagnosis. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 1149 OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

14. What is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient d. Y-linked recessive inherited disorder in which the red blood cells become moon shaped

ANS: C The inheritance pattern in 80% of all cases of hemophilia is X-linked recessive and results in deficient amounts of blood-clotting factors. The disorder involves coagulation factors, not platelets. The disorder does not involve red cells or the Y chromosome. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1302 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

11. A child has just been diagnosed with acute lymphoblastic leukemia, and the mother is expressing guilt about not taking the child to the doctor right away. What response by the nurse is best? a. "Always call the physician when your child has a change in what is normal for him." b. "It is better to be safe than sorry." c. "It is common for parents not to notice subtle changes in their children's health." d. "I hope this delay does not affect the treatment plan."

ANS: C This statement is not only true, but it will also help minimize the mother's guilt and help establish a therapeutic relationship with the nurse. Identifying concerns and clarifying misconceptions will help families cope with the stress of chronic illness. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1151 OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

13. When assessing a child for possible congenital heart defects (CHDs), where should the nurse measure blood pressure? a. The right arm b. The left arm c. All four extremities d. Both arms while the child is crying

ANS: C When a CHD is suspected, the blood pressure should be measured in all four extremities while the child is quiet. Discrepancies between upper and lower extremities may indicate cardiac disease. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1091 | Table 46.2 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

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

ANS: C, D, E Parents should be taught to avoid cold, which can increase sickling, and extreme heat, which can cause dehydration. Adequate rest periods should be provided. Penicillin should be administered daily as ordered. The use of aspirin should be avoided; acetaminophen or ibuprofen should be used as an alternative. Fluids should be encouraged, and an increase in fluid intake is encouraged in hot weather or when there are other risks for dehydration. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1125 | Patient-Centered Teaching Box OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

3. A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery. The nurse instructs the parents to notify the physician if which conditions occur? (Select all that apply.) a. Respiratory rate of 36 at rest b. Appetite slowly increasing c. Temperature above 37.7° C (100° F) d. New, frequent coughing e. Turning blue or bluer than normal

ANS: C, D, E The parents should be instructed to notify the physician after their infant's cardiac surgery for a temperature above 37.7° C; new, frequent coughing; and any episodes of the infant turning blue or bluer than normal. A respiratory rate of 36 at rest for an infant is within normal expectations, and it is expected that the appetite will increase slowly. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1104 | Patient-Centered Teaching Box OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance COMPLETION

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

ANS: D A vaso-occlusive crisis is characterized by severe pain in the area of involvement. If it is in the extremities, painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if in the head, stroke and visual disturbances occur. Circulatory collapse results from sequestration crises. Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vaso-occlusive phenomena. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1124 |Table 47.1 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

9. A nurse has taught the parents about home care of their child who has leukemia. Which statement made by the parents indicates an understanding of this teaching? a. "We will take our child's blood pressure daily." b. "We will restrict fluids in case there is central nervous system involvement." c. "We will make sure our child gets all immunizations in a timely manner." d. "We will take our child's temperature frequently."

ANS: D An elevated temperature may be the only sign of an infection in an immunosuppressed child. Parents should be instructed to monitor their child's temperature as often as necessary. It is not necessary to monitor blood pressure daily. Fluids are never withheld as a precautionary measure. Children who are immunosuppressed should not receive live virus vaccines. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 1151 OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

4. Which of the following is an accurate description of anemia? a. Increased blood viscosity b. Depressed hematopoietic system c. Presence of abnormal hemoglobin d. Decreased oxygen-carrying capacity of blood

ANS: D Anemia is a condition in which the number of red blood cells or hemoglobin concentration is reduced below the normal values for age. This results in a decreased oxygen-carrying capacity of blood. Increased blood viscosity is usually a function of too many cells or of dehydration, not of anemia. A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition is dependent on the deceased oxygen-carrying capacity of the blood. A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition is dependent on the decreased oxygen-carrying capacity of the blood. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1118 | p. 1121 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

26. The nurse caring for a child diagnosed with acute rheumatic fever should assess the child for which of the following? a. Sore throat b. Elevated blood pressure c. Desquamation of the fingers and toes d. Tender, warm, inflamed joints

ANS: D Arthritis, characterized by tender, warm, erythematous joints, is one of the major manifestations of acute rheumatic fever in the first 1 to 2 weeks of the illness. The child may have had a sore throat previously associated with a group A beta-hemolytic streptococcal infection a few weeks earlier. A sore throat is not a manifestation of rheumatic fever. Hypertension is not associated with rheumatic fever. Desquamation of the fingers and toes is a manifestation of Kawasaki syndrome. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1109 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

25. A nurse is assigned to care for an infant with an unrepaired tetralogy of Fallot. What should the nurse do first when the baby is crying and becomes severely cyanotic? a. Place the infant in a knee-chest position. b. Administer oxygen. c. Administer morphine sulfate. d. Calm the infant.

ANS: D Calming the crying infant is the first response. An infant with unrepaired tetralogy of Fallot who is crying and agitated may eventually lose consciousness. Placing the infant in a knee-chest position will decrease venous return so that smaller amounts of highly saturated blood reach the heart. This should be done after calming the infant. Administering oxygen is indicated after placing the infant in a knee-chest position. Administering morphine sulfate calms the infant and depresses respirations. It may be indicated sometime after the infant has been calmed. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1088 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

34. A common, serious complication of rheumatic fever is a. seizures. b. cardiac dysrhythmias. c. pulmonary hypertension. d. cardiac valve damage.

ANS: D Cardiac valve damage is the most significant complication of rheumatic fever. The other three are not common complications of rheumatic fever. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1109 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

2. When taking a history on a child with a possible diagnosis of cellulitis, what should be the priority nursing assessment to help establish a diagnosis? a. Any pain the child is experiencing b. Enlarged, mobile, and nontender lymph nodes c. Child's urinalysis results d. Recent infections or signs of infection

ANS: D Cellulitis may follow an upper respiratory infection, sinusitis, otitis media, or a tooth abscess. The affected area is red, hot, tender, and indurated. Pain is important, but the history of recent infections is more relevant to the diagnosis. Lymph nodes may be enlarged (lymphadenitis), but they are not mobile and are nontender. Lymphangitis may be seen with red "streaking" of the surrounding area. An abnormal urinalysis result is not usually associated with cellulitis. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1179 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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

ANS: D Children with sickle cell disease are at high risk for pneumococcal infections and should receive long-term penicillin therapy and preventive immunizations. Sickle cell disease does not prohibit the child from outdoor play. Active and passive exercises help promote circulation. Aspirin use should be avoided. Acetaminophen or ibuprofen should be administered for fever or pain. The child needs to interact with peers to meet his or her developmental needs. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1125 | Patient-Centered Teaching Box OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

17. A child who has been in good health has a platelet count of 45,000/mm3, petechiae, and excessive bruising that covers the body. The nurse is aware that these signs are clinical manifestations of which disease? a. Erythroblastopenia b. von Willebrand disease c. Hemophilia d. Immune thrombocytopenic purpura (ITP)

ANS: D Excessive bruising and petechiae, especially involving the mucous membranes and gums in a child who is otherwise healthy, are the clinical manifestations of ITP, resulting from decreased platelets. The etiology of ITP is unknown, but it is considered to be an autoimmune process. They are not characteristic of erythroblastopenia, von Willebrand disease, or hemophilia. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1134 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

23. A child is in the hospital receiving chemotherapy, and the nurse suspects the child has an infection. What action by the nurse takes priority? a. Monitor the child's temperature. b. Assess the daily white blood cell count. c. Administer antibiotics. d. Obtain blood and urine cultures.

ANS: D For a child with a suspected infection, cultures are taken to determine the site and type of infection. Often these include blood and urine but may include sputum or wound drainage. Antibiotics are only started after cultures have been obtained. Monitoring temperature and WBCs is important, but cultures are the only way to specifically identify an organism so it can be effectively treated. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1159 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment MULTIPLE RESPONSE

18. Which statement suggests that a parent understands how to correctly administer digoxin? a. "I measure the amount I am supposed to give with a teaspoon." b. "I put the medicine in the baby's bottle." c. "When she spits up right after I give the medicine, I give her another dose." d. "I give the medicine at 8 in the morning and evening every day."

ANS: D For maximum effectiveness, the medication should be given at the same time every day. The maintenance dose is given in two divided doses daily. To ensure the correct dosage, the medication should be measured with a syringe. To prevent toxicity, the parent should not repeat the dose without contacting the child's physician. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 1083 OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

4. Hematopoietic stem cell transplantation (HSCT) is the standard treatment for a child in his or her first remission with what cancer? a. Acute lymphocytic leukemias b. Non-Hodgkin lymphoma c. Wilms' tumor d. Acute myeloblastic leukemia (AML)

ANS: D HSCT is often used interchangeably with bone marrow transplantation and is currently standard treatment for children in their first remission with AML. Transplantation is standard treatment for a specific type of ALL (Philadelphia chromosome positive). Standard treatment for non-Hodgkin lymphoma is chemotherapy. Bone marrow transplantation is used to treat non-Hodgkin lymphoma that is resistant to conventional chemotherapy and radiation. The treatment for Wilms' tumor consists of surgery and chemotherapy alone or in combination with radiation therapy. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1147 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

3. A nurse is evaluating parents' knowledge about caring for their child who has iron-deficiency anemia. Which action shows the parents need further education? a. Decreasing the infant's daily milk intake to 24 oz or less b. Giving oral iron supplements between meals with orange juice c. Including apricots, dark-green leafy vegetables, and egg yolk in the infant's diet d. Allowing the infant to drink the iron supplement from a small medicine cup

ANS: D Iron supplements should be administered through a straw or by a medicine dropper placed at the back of the mouth because iron temporarily stains the teeth. A daily milk intake in toddlers of less than 24 oz will encourage the consumption of iron-rich solid foods. Because food interferes with the absorption of iron, iron supplements are taken between meals. Administering this medication with foods rich in vitamin C facilitates absorption of iron. Apricots, dark-green leafy vegetables, and egg yolks are rich sources of iron. Other iron-rich foods include liver, dried beans, Cream of Wheat, iron-fortified cereal, and prunes. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 1118 | p. 1121 OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

4. What should the parents of an infant with thrush (oral candidiasis) be taught about medication administration? a. Give nystatin suspension with a syringe without a needle. b. Apply nystatin cream to the affected area twice a day. c. Give nystatin before the infant is fed. d. Swab nystatin suspension onto the oral mucous membranes after feedings.

ANS: D It is important to apply the nystatin suspension to the affected areas, which is best accomplished by rubbing it onto the gums and tongue, after feedings, until 3 to 4 days after symptoms have disappeared. Medication may not reach the affected areas when it is squirted into the infant's mouth. Rubbing the suspension onto the gum ensures contact with the affected areas. Nystatin cream is used for diaper rash caused by Candida. To prolong contact with the affected areas, the medication should be administered after a feeding. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1180 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

20. Nursing care for the child in congestive heart failure includes which of the following activities? a. Counting the number of saturated diapers b. Putting the infant in the Trendelenburg position c. Removing oxygen while the infant is crying d. Organizing care to provide rest periods

ANS: D Nursing care should be planned to allow for periods of undisturbed rest. Diapers must be weighed for an accurate record of output. The head of the bed should be raised to decrease the work of breathing. Oxygen should be administered during stressful periods such as when the child is crying if needed. PTS: 1 DIF: Cognitive Level: Application REF: p. 1084 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

18. What is the priority in the discharge plan for a child with immune thrombocytopenic purpura (ITP)? a. Teaching the parents to report excessive fatigue to the physician b. Monitoring the child's hemoglobin level every 2 weeks c. Providing a diet that contains iron-rich foods d. Establishing a safe, age-appropriate home environment

ANS: D Prevention of injury is a priority concern for a child with ITP. Excessive fatigue is not a significant problem for the child with ITP. ITP is associated with low platelet levels, not hemoglobin. Increasing the child's intake of iron in the diet will not correct ITP. PTS: 1 DIF: Cognitive Level: Application/Application REF: p. 1135 | Patient-Centered Teaching Box OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

16. For what reason might a newborn infant with a cardiac defect, such as coarctation of the aorta, that results in a right-to-left shunt receive prostaglandin E1? a. To decrease inflammation b. To control pain c. To decrease respirations d. To improve oxygenation

ANS: D Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus arteriosus patent. This will improve oxygenation. It is not given for inflammation, pain, or to decrease respirations. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1089 | p. 1091 | Table 46.3 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

32. What is the most common causative agent of bacterial endocarditis? a. Staphylococcus albus b. Streptococcus hemolyticus c. Staphylococcus albicans d. Streptococcus viridans

ANS: D S. viridans and S. aureus are the most common causative agents in bacterial (infective) endocarditis. The others are not common causative agents. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1104 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

10. Which statement made by a parent indicates understanding of restrictions for a child after cardiac surgery? a. "My child needs to go to bed early for a few weeks." b. "My son is really looking forward to riding his bike next week." c. "I'm so glad we can attend religious services as a family this coming Sunday." d. "I am going to keep my child out of day care for 6 weeks."

ANS: D Settings where large groups of people are present should be avoided for 4 to 6 weeks after discharge, including day care and other public places such as churches. The child should resume his regular bedtime and sleep schedule after discharge. Due to fatigue, the child may initially need some naps during the day. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 1104 | Patient-Centered Teaching Box OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

10. The nurse notes a reddened area on the forearm of a neutropenic child with leukemia. What action by the nurse is most appropriate? a. Massage the area. b. Turn the child more frequently. c. Document the finding and continue to observe the area. d. Notify the provider.

ANS: D Skin is the first line of defense against infection. Any signs of infection in a child who is immunosuppressed must be reported. When a child is neutropenic, pus may not be produced, and the only sign of infection may be redness. The area should never be massaged. The forearm is not a typical pressure area; therefore the likelihood of the redness being related to pressure is very small. The observation should be documented, but because it may be a sign of an infection and immunosuppression, the physician must also be notified. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1151 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

3. The nurse is admitting a child to the hospital for a cardiac workup. What is the first step in a cardiac assessment? a. Percussion b. Palpation c. Auscultation d. History and inspection

ANS: D The assessment should begin with the least threatening interventions—the history and inspection. Assessment progression includes inspection, auscultation, and palpation because each step includes more touching. Percussion of the chest is usually deferred. Palpation can be threatening to the child because it requires a significant amount of physical contact. For this reason it is not the initial step in a cardiac assessment. Auscultation requires touching the child and is not the initial step in a cardiac assessment. PTS: 1 DIF: Cognitive Level: Application REF: p. 1089 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

2. Which information should be included in the nurse's discharge instructions for a child who underwent a cardiac catheterization earlier in the day? a. Pressure dressing is changed daily for the first week. b. The child may soak in the tub beginning tomorrow. c. Contact sports can be resumed in 2 days. d. The child can return to school on the third day after the procedure.

ANS: D The child can generally return to school on the third day after the procedure. The day after the cardiac catheterization, the pressure dressing is removed and replaced with a Band-Aid. Bathing is limited to a shower, a sponge bath, or a brief tub bath (no soaking) for the first 1 to 3 days after the procedure. Strenuous exercise such as contact sports, swimming, or climbing trees is avoided for up to 1 week after the procedure. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1092 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

1. Which postoperative intervention should be questioned for a child after a cardiac catheterization? a. Continue intravenous (IV) fluids until the infant is tolerating oral fluids. b. Check the dressing for bleeding. c. Assess peripheral circulation on the affected extremity. d. Keep the affected leg flexed and elevated.

ANS: D The child should be positioned with the affected leg straight for 4 to 6 hours after the procedure. The other interventions are appropriate. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1092 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

5. A child with a history of fever of unknown origin, excessive bruising, lymphadenopathy, anemia, and fatigue is exhibiting symptoms most suggestive of which of the following? a. Ewing sarcoma b. Wilms' tumor c. Neuroblastoma d. Leukemia

ANS: D These symptoms reflect bone marrow failure and organ infiltration, which occur in leukemia. Symptoms of Ewing sarcoma involve pain and soft tissue swelling around the affected bone. Wilms' tumor usually manifests as an abdominal mass with abdominal pain and may include renal symptoms, such as hematuria, hypertension, and anemia. Neuroblastoma manifests primarily as an abdominal, chest, bone, or joint mass. Symptoms are dependent on the extent and involvement of the tumor. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1149 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

3. Which statement made by a parent indicates an understanding about the management of a child with cellulitis on the arm? a. "I am supposed to continue the antibiotic until the redness and swelling disappear." b. "I have been putting ice on my son's arm to relieve the swelling." c. "I should call the doctor if the redness disappears." d. "I have been putting a warm soak on my son's arm every 4 hours."

ANS: D Warm soaks applied every 4 hours while the child is awake increase circulation to the infected area, relieve pain, and promote healing. The parent should not discontinue antibiotics when signs of infection disappear. To ensure complete healing, the parent should understand that the entire course of antibiotics should be given as prescribed. A warm soak is indicated for the treatment of cellulitis. Ice will decrease circulation to the affected area and inhibit the healing process. The disappearance of redness indicates healing and is not a reason to seek medical advice. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 1179 OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

35. The nurse is caring for a child with Kawasaki disease. The child weighs 33 pounds. When initiating aspirin therapy, what dose does the nurse prepare to administer? a. 75 mg orally once a day b. 81 mg orally twice a day c. 200 mg three times a day d. 375 mg orally four times a day

ANS: D When initiating aspiring for Kawasaki disease, it is started at the anti-inflammatory dose of 80 to 100 mg/kg divided into four doses a day. This child weighs 15 kg so 100 mg × 15 kg = 1500 mg. Divided into four doses is 375 mg four times a day. 75 mg once a day is the maintenance dose used for antiplatelet aggregate purposes. 81 mg a day is the adult antiplatelet aggregate dose. PTS: 1 DIF: Cognitive Level: Analysis/Analyzing REF: p. 1111 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity MULTIPLE RESPONSE