Peds Final Practice Questions

A couple has just learned that their son will be born with Down's syndrome. The nurse shows a lack of understanding when making which of the following statements? a) "I will alert your entire family about this so you don't have to." b) "We have counseling services available, and I recommend them to everyone facing these circumstances." c) "I will support you in any decision that you make." d) "I will give you as much information as I can about this condition."

"I will alert your entire family about this so you don't have to." Correct Explanation: It is necessary to maintain confidentiality at all times, which prevents healthcare providers from alerting family members about any inherited characteristic unless the family member has given consent for the information to be revealed.

Which statement by the parent of a 12-month-old child diagnosed with Down syndrome shows the need for further education? a) "Thyroid testing is needed every year." b) "I will need to delay any further immunizations." c) "In a couple of years, my child will need an x-ray of the neck." d) "I will watch closely for development of respiratory infection."

"I will need to delay any further immunizations." Correct Explanation: Down syndrome children are at higher risk for infection because of a lowered immune system. Delaying immunizations may expose the child to illnesses that could have been prevented. Down syndrome children are at greater risk for developing thyroid disorders, 1st and 2nd vertebrae disorders, and respiratory infections.

A parent asks why a physical therapist is needed for the 6-month-old child diagnosed with Down syndrome. What is the best response by the nurse? a) "To optimize the child's development and functioning" b) "The earlier the intervention, the more likely we are to cure the problem." c) "To prevent contractures" d) "To ensure that the child meets all developmental milestones on time"

"To optimize the child's development and functioning" Correct Explanation: Interventional therapy is started early to promote the child's development and optimize functioning. The Down syndrome child usually meets developmental milestones at a slower pace. There is no cure for genetic disorders. Range-of-motion activities can prevent contractures; Down syndrome does not require physical therapy.

A nurse is teaching about autosomal dominant and recessive genetics. Which statement by the nurse is accurate? a) "Two abnormal genes, one from each parent, are required to produce the phenotype in an autosomal recessive disorder." b) "An autosomal dominant disorder is classified as X-linked." c) "One abnormal autosomal recessive gene is needed for outward presentation of the disorder." d) "An autosomal dominant disorder has a lower risk of phenotyping than an autosomal recessive disorder."

"Two abnormal genes, one from each parent, are required to produce the phenotype in an autosomal recessive disorder." Correct Explanation: An autosomal recessive disorder requires two abnormal genes to outwardly express the disorder. Recessive disorders have a lower risk of phenotyping than dominant disorders. X-linked and autosomal disorders are two different classifications.

The nurse recognizes that which individual or couple would most benefit from obtaining genetic counseling? a) 30-year-old female with a normal alpha-fetoprotein screening b) 23-year-old female, 25-year-old-male, both with family history of sickle cell disorder c) 25-year-old female, 40-year-old male, both with no significant past medical history d) 32-year-old female, 25-year-old male with one pregnancy loss

23-year-old female, 25-year-old-male, both with family history of sickle cell disorder Correct Explanation: A family history of sickle cell disorder increases the risk of passing the disorder to offspring; genetic counseling would benefit this couple most. The usual standard for counseling for pregnancy loss is two or more, not a single loss. A normal alpha-fetoprotein screening is not a criterion for genetic counseling. All ages listed here do not exceed the criterion for advanced maternal or paternal age.

You prepare a couple to have a karyotype performed. Which of the following describes a karyotype? a) The gene carried on the X or Y chromosome b) A visual presentation of the chromosome pattern of an individual c) The dominant gene that will exert influence over a correspondingly located recessive gene d) A blood test that will reveal an individual's homozygous tendencies

A visual presentation of the chromosome pattern of an individual Correct Explanation: A karyotype is a photograph of a person's chromosomes aligned in order.

When assessing newborns for chromosomal disorders, which assessment would be most suggestive of a problem? a) Low-set ears b) Bowed legs c) Short neck d) Slanting of the palpebral fissure

Low-set ears Correct Explanation: A number of common chromosomal disorders, such as trisomies, include low-set ears.

A pregnant client has heard about Down syndrome and wants to know about the risk factors associated with it. Which of the following would the nurse include as a risk factor? a) Advanced maternal age b) Recurrent miscarriages c) Advanced paternal age d) Family history of condition

Advanced maternal age Correct Explanation: Advanced maternal age is one the most important factors that increases the risk of an infant being born with Down syndrome. Down syndrome is not associated with advanced paternal age, recurrent miscarriages, or family history of Down syndrome.

Origin: Chapter 3, 31 The nurse is assessing the developmental milestones of an infant. The infant was born 8 weeks ago and was 4 weeks premature. The nurse anticipates that the infant will be meeting milestones for what age of child? Record your answer in weeks.

Ans: 4 Feedback: To determine adjusted age, subtract the number of weeks that the infant was premature (4 weeks) from the infant's chronological age (8 weeks).

7. The nurse is preparing a teaching plan for the family and their 6-year-old son who has just been diagnosed with diabetes mellitus. Which of the following would the nurse identify as the initial goal for the teaching plan? A) Developing management and decision-making skills B) Educating the parents about diabetes mellitus type 1 C) Developing a nutritionally sound, 30-day meal plan D) Promoting independence with self-administration of insulin

Ans: A Feedback: Developing basic management and decision-making skills related to the diabetes is the initial goal of the teaching plan for this child and family. The nurse would have provided a basic description of the disorder after it was diagnosed. Development of a detailed monthly meal plan would come later, perhaps after consulting with a nutritionist. It is too soon to expect the boy to administer his own insulin.

18. A child with diabetes insipidus is being treated with vasopressin. The nurse would assess the child closely for signs and symptoms of which of the following? A) Syndrome of inappropriate antidiuretic hormone (SIADH) B) Thyroid storm C) Cushing syndrome D) Vitamin D toxicity

Ans: A Feedback: SIADH, although rare in children, is a potential complication of excessive administration of vasopressin. Thyroid storm may result from over administration of levothyroxine (thyroid hormone replacement). Cushing syndrome is associated with corticosteroid use. Vitamin D toxicity may result from the use of vitamin D as treatment of hypoparathyroidism.

Origin: Chapter 13, 11 The nurse is preparing to administer insulin to a diabetic child. Which would be the recommended route for this administration? A) Subcutaneous B) Intradermal C) Intramuscular D) Oral

Ans: A Feedback: Subcutaneous (SQ) administration distributes medication into the fatty layers of the body. It is used primarily for insulin administration, heparin, and certain immunizations, such as MMR. Intradermal administration is used primarily for tuberculosis screening and allergy testing. Intramuscular administration is used to administer certain medications, such as many immunizations. Insulin is not administered orally.

3. The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. Which of the following would the nurse most likely identify as the priority nursing diagnosis? A) Deficient fluid volume related to dehydration B) Excess fluid volume related to edema C) Deficient knowledge related to fluid intake regimen D) Imbalanced nutrition, more than body requirements related to excess weight

Ans: A Feedback: The priority nursing diagnosis most likely would be deficient fluid volume related to dehydration, due to a deficiency in the secretion of antidiuretic hormone (ADH). Excess fluid would result from a disorder that leads to water retention, such as syndrome of inappropriate antidiuretic hormone (SIADH). Deficient knowledge related to fluid intake regimen is a nursing diagnosis for this child, but a secondary one. Imbalanced nutrition, more than body requirements related to excess weight would be inappropriate for this child since he probably has lost weight secondary to the fluid loss.

Origin: Chapter 3, 2 The nurse is teaching a new mother about the drastic growth and developmental changes her infant will experience in the first year of life. Which statement describes a developmental milestone occurring in infancy? A) By 6 months of age the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth. B) Most infants triple their birthweight by 4 to 6 months of age and quadruple their birthweight by the time they are 1 year old. C) The head circumference increases rapidly during the first 6 months: the average increase is about 1 inch per month. D) The heart triples in size over the first year of life; the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old.

Ans: A Feedback: By 6 months of age the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth. Most infants double their birthweight by 4 to 6 months of age and triple their birthweight by the time they are 1 year old. The head circumference increases rapidly during the first 6 months: the average increase is about 0.6 inch (1.5 cm) per month. The heart doubles in size over the first year of life. As the cardiovascular system matures, the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old.

Origin: Chapter 3, 6 A new mother expresses concern to the nurse that her baby is crying and grunting when passing stool. What is the nurse's best response to this observation? A) 'This is normal behavior for infants unless the stool passed is hard and dry.' B) 'This is normal behavior for infants due to the immaturity of the gastrointestinal system.' C) 'This indicates a blockage in the intestine and must be reported to the physician.' D) 'This is normal behavior for infants unless the stool passed is black or green.'

Ans: A Feedback: Due to the immaturity of the gastrointestinal system, newborns and young infants often grunt, strain, or cry while attempting to have a bowel movement. This is not of concern unless the stool is hard and dry. Stool color and texture may change depending on the foods that the infant is ingesting. Iron supplements may cause the stool to appear black or very dark green.

Origin: Chapter 8, 7 The nurse uses family-centered care to care for children in a pediatric office. Upon what concept is family-centered care based? A) The family is the constant in the child's life and the primary source of strength. B) The care provider is the constant in the child's life and the primary source of strength. C) The child must be prepared to be his or her own source of strength during times of crisis. D) The wishes of the family should direct the nursing care plan for the child.

Ans: A Feedback: Family-centered care involves a partnership between the child, family, and health care providers in planning, providing, and evaluating care. Family-centered care enhances parents' and caregivers' confidence in their own skills and also prepares children and young adults for assuming responsibility for their own health care needs. It is based on the concept that the family is the constant in the child's life and the primary source of strength and support for the child.

Origin: Chapter 11, 10 The mother of a hospitalized child reports that her daughter, who is having some difficulty eating, just had a 4-ounce cup of ice chips. The nurse documents this on the child's intake flow sheet as how much? A) 2 ounces B) 4 ounces C) 6 ounces D) 8 ounces

Ans: A Feedback: Ice chips are included as fluid intake, and the amount is approximately equivalent to half the same amount of water. Therefore, the nurse would document this fluid intake as 2 ounces.

Origin: Chapter 13, 8 The nurse is administering a crushed tablet to an 18-month-old infant. What is a recommended guideline for this intervention? A) Mix the crushed tablet with a small amount of applesauce. B) Place the crushed tablet in the infant's formula. C) Mix the crushed tablet with the infant's cereal. D) Crushed tablets should only be mixed with water.

Ans: A Feedback: If a tablet or capsule is the only oral form available for children younger than 6 years, it needs to be crushed or opened and mixed with a pleasant-tasting liquid or a small amount (generally no more than a tablespoon) of a nonessential food such as applesauce. The crushed tablet or inside of a capsule may taste bitter, so it should never be mixed with formula or other essential foods. Otherwise, the child may associate the bitter taste with the food and later refuse to eat it.

Origin: Chapter 4, 10 After teaching a group of parents about language development in toddlers, what if stated by a member of the group indicates successful teaching? A) "When my 3-year-old asks 'why?' all the time, this is completely normal." B) "A 15-month-old should be able to point to his eyes when asked to do so." C) "At age 2 years, my son should be able to understand things like under or on." D) "An 18-month-old would most likely use words and gestures to communicate."

Ans: A Feedback: Language development occurs rapidly in a toddler. By age 3 years, the child asks "why?" Pointing to named body parts is characteristic of a 2-year-old. Understanding concepts such as on, under, or in is typical of a 3-year-old. A 1-year-old would communicate with words and gestures.

Origin: Chapter 3, 19 The nurse in a community clinic is caring for a 6-month-old boy and his mother. Which intervention is priority to promote adequate growth? A) Monitoring the child's weight and height B) Encouraging a more frequent feeding schedule C) Assessing the child's current feeding pattern D) Recommending higher-calorie solid foods

Ans: A Feedback: Monitoring the child's weight and height is the priority intervention to promote adequate growth. Encouraging a more frequent feeding schedule, assessing the child's current feeding pattern, and recommending higher-calorie solid foods are interventions when the nursing diagnosis is that nutrition level does not meet body requirements.

Origin: Chapter 4, 9 The nurse is interviewing a 3-year-old girl who tells the nurse: 'Want go potty.' The parents tell the nurse that their daughter often speaks in this type of broken speech. What would be the nurse's appropriate response to this concern? A) 'This is a normal, common speech pattern in the 3-year-old and is called telegraphic speech.' B) 'This is considered a developmental delay in the 3-year-old and we should consult a speech therapist.' C) 'This is a condition known as echolalia and can be corrected if you work with your daughter on language skills.' D) 'This is a condition known as stuttering and it is a normal pattern of speech development in the toddler.'

Ans: A Feedback: Telegraphic speech is common in the 3-year-old. Telegraphic speech refers to speech that contains only the essential words to get the point across, much like a telegram. In telegraphic speech the nouns and verbs are present and are verbalized in the appropriate order. Echolalia (repetition of words and phrases without understanding) normally occurs in toddlers younger than 30 months of age. "Why" and "what" questions dominate the older toddler's language. Stuttering usually has its onset at between 2 and 4 years of age. It occurs more often in boys than in girls. About 75% of all cases of stuttering resolve within 1 to 2 years after they start.

Origin: Chapter 3, 20 The nurse is caring for a 7-month-old girl during a well-child visit. Which intervention is most appropriate for this child? A) Discussing the type of sippy cup to use B) Advising about increased caloric needs C) Explaining how to prepare table meats D) Describing the tongue extrusion reflex

Ans: A Feedback: The cup may be introduced at 6 to 8 months of age. Old-fashioned sippy cups are preferred compared to the new style. The nurse would not advise about increased caloric needs as caloric needs drop at this age. Transition to table meat will not take place until age 10 to 12 months. Tongue extrusion reflex has disappeared at age 4 to 6 months.

Origin: Chapter 3, 18 The nurse is providing anticipatory guidance to the mother of a 9-month-old girl during a well-baby visit. Which topic would be most appropriate? A) Advising how to create a toddler-safe home B) Warning about small objects left on the floor C) Cautioning about putting the baby in a walker D) Telling about safety procedures during baths

Ans: A Feedback: The most appropriate topic for this mother would be advising her on how to create a toddler-safe home. The child will very soon be pulling herself up to standing and cruising the house. This will give her access to areas yet unexplored. Warning about small objects left on the floor, telling about safety procedures during baths, and cautioning about using baby walkers would no longer be anticipatory guidance as the child has passed these stages.

Origin: Chapter 1, 17 The nurse is caring for a 14-year-old boy with a growth hormone deficiency. Which action best reflects using the nursing process to provide quality care to children and their families? A) Reviewing the effectiveness of interventions B) Questioning the facility standards for care C) Earning continuing education credits D) Ensuring reasonable costs for care provided

Ans: A Feedback: The nursing process is used to care for the child and family during health promotion, maintenance, restoration, and rehabilitation. It is a problem-solving method based on the scientific method that allows nursing care to be planned and implemented in a thorough, organized manner to ensure quality and consistency of care. The nursing process is applicable to all health care settings and consists of five steps: assessment, nursing diagnosis, outcome identification and planning, implementation, and outcome evaluation. Reviewing the effectiveness of interventions is related to outcome evaluation in the nursing process. Even though the three remaining answer options are valuable in ensuring quality of care in health care facilities, they do not involve the direct care of the child and family using the nursing process.

Origin: Chapter 8, 12 The nurse is implementing care for a hospitalized toddler. What communication technique would the nurse use with the child to reflect the child's developmental level? A) Allow the child extra time to complete thoughts. B) Communicate solely through play. C) Provide simple but honest and straightforward responses. D) Remain nonjudgmental to avoid alienation.

Ans: A Feedback: When working with toddlers and preschoolers, the nurse should allow them time to complete their thoughts. Though language acquisition at this age is exponential, it often takes longer for the young child to find the right words, particularly in response to a query. Infants communicate nonverbally and often through play. School-age children need simple but honest and straightforward responses, and nurses should be nonjudgmental with adolescents to avoid alienating them and to keep lines of communication open.

Origin: Chapter 14, 2 The nurse is managing children who have chronic diseases in a neighborhood clinic. What are some examples of chronic conditions? Select all that apply. A) Diabetes mellitus B) Myocardial infarction C) Rheumatoid arthritis D) Compound fracture E) Acute asthma F) Bronchopneumonia

Ans: A, C, E Feedback: Chronic pain is defined as pain that continues past the expected point of healing for injured tissue. Diabetes, arthritis, and asthma are examples of chronic pain. Acute pain is defined as pain that is associated with a rapid onset of varying intensity. It usually indicates tissue damage and resolves with healing of the injury. Examples include heart attack, fractures, and bronchopneumonia.

Origin: Chapter 1, 11 The nurse is caring for a 10-year-old boy with a neuroblastoma. Which activities best describe the role of the nurse as a care coordinator, collaborator, and consultant? Select all that apply. A) Collaborating with the family throughout the care path B) Advancing the interests of children and their families by knowing their needs C) Informing children and families of their rights and options D) Coordinating care provided by the interdisciplinary team E) Ensuring that the child's and family's needs are met through activities such as support groups F) Providing appropriate client education based on the child's developmental level

Ans: A, D, E Feedback: The pediatric nurse serves as a collaborator, care coordinator, and consultant. Collaborating with the interdisciplinary health care team, the pediatric nurse integrates the child's and family's needs into a coordinated plan of care. In the role of consultant, the pediatric nurse ensures that the child's and family's needs are met through such activities as support group facilitation or working with the school nurse to plan the child's care. In the role as a child and family advocate, the nurse safeguards and advances the interests of children and their families by knowing their needs and resources, informing them of their rights and options, and assisting them to make informed decisions. In the role of educator, the nurse instructs and counsels children and their families about all aspects of health and illness. In this role the pediatric nurse also ensures that communication with the child and family is based on the child's age and developmental level.

Origin: Chapter 3, 8 The nurse caring for newborns knows that infants exhibit phenomenal increases in their gross motor skills over the first 12 months of life. Which statements accurately describe the typical infant's achievement of these milestones? Select all answers that apply. A) At 1 month the infant lifts and turns the head to the side in the prone position. B) At 2 months the infant rolls from supine to prone to back again. C) At 6 months the infant pulls to stand up. D) At 7 months the infant sits alone with some use of hands for support. E) At 9 months the infant crawls with the abdomen off the floor. F) At 12 months the infant walks independently.

Ans: A, D, E, F Feedback: At 1 month the infant lifts and turns the head to the side in the prone position. At 7 months the infant sits alone with some use of hands for support. At 9 months the infant crawls with the abdomen off the floor. At 12 months the infant walks independently. At 4 months the infant lifts the head and looks around. At 10 months the infant pulls to stand up.

9. The nurse is conducting a physical examination of a child with suspected developmental dysplasia of the hip. Which of the following findings would help confirm this diagnosis? A) Abduction occurs to 75 degrees and adduction to within 30 degrees (with stable pelvis). B) A distinct "clunk" is heard with Barlow and Ortolani maneuvers. C) A high-pitched "click" is heard with hip flexion or extension. D) The thigh and gluteal folds are symmetric.

Ans: B Feedback: A distinct "clunk" while performing Barlow and Ortolani maneuvers is caused as the femoral head dislocates or reduces back in to the acetabulum. A higher-pitched "click" may occur with flexion or extension of the hip. This is a benign, adventitious sound that should not be confused with a true "clunk" when assessing for developmental dysplasia of the hip. Abduction to 75 degrees, adduction within 30 degrees, and symmetric thigh and gluteal folds are normal findings.

22. A 5-year-old child with type 1 diabetes is brought to the clinic by his mother for a follow-up visit after having his hemoglobin A1C level drawn. Which result would indicate to the nurse that the child is achieving long-term glucose control? A) 9.0% B) 8.2% C) 7.3% D) 6.9%

Ans: B Feedback: For a child 6 years of age and younger, the target HbA1C level should be less than 8.5% but greater than 7.5%. For children between the ages of 6 to 12 years, the target HbA1C level is less than 8%. For children and adolescents between 13 to 19 years of age, the target HbA1C level would be less than 7.5%.

17. A child is diagnosed with hyperthyroidism. Which agent would the nurse expect the physician to prescribe? A) Mineralocorticoid B) Methimazole C) Levothyroxine D) Dexamethasone

Ans: B Feedback: Methimazole is an antithyroid drug that is used to treat hyperthyroidism. Mineralocorticoid (Florinef) is used to treat adrenal insufficiency. Levothyroxine is used to treat hypothyroidism. Dexamethasone is used to treat congenital adrenal hyperplasia.

Origin: Chapter 4, 23 When instructing the parents of a toddler about appropriate nutrition, what would the nurse recommend? A) About 12 to 16 ounces of fruit juice per day B) Approximately 16 to 24 ounces of milk per day C) Fat intake of 30% to 40% of total calories D) An average of 10 to 12 grams of fiber per day

Ans: B Feedback: Milk intake should be limited to 16 to 24 ounces per day, with fruit juice limited to 4 to 6 ounces per day. A toddler's total fat intake should be 20% to 30% of total calories. The daily recommended fiber intake is 19 grams.

13. A child with diabetes reports that he is feeling a little shaky. Further assessment reveals that the child is coherent but with some slight tremors and sweating. A fingerstick blood glucose level is 70 mg/dL. Which of the following would the nurse do next? A) Administer a sliding-scale dose of insulin B) Give 10 to 15 grams of a simple carbohydrate C) Offer a complex carbohydrate snack D) Administer glucagon intramuscularly

Ans: B Feedback: The child is experiencing hypoglycemia as evidenced by the assessment findings and blood glucose level. Since the child is coherent, offering the child 10 to 15 grams of a simple carbohydrate would be appropriate. Insulin is not used because the child is hypoglycemic. A complex carbohydrate snack would be used after offering the simple carbohydrate to maintain the glucose level. Intramuscular glucagons would be used if the child was not coherent.

Origin: Chapter 13, 17 The nurse is caring for children who are receiving IV therapy in the hospital setting. For which children would a central venous device be indicated? A) A child who is receiving an IV push B) A child who is receiving chemotherapy for leukemia C) A child who is receiving IV fluids for dehydration D) A child who is receiving a one-time dose of a medication

Ans: B Feedback: Although central venous access devices can be used short term, the majority are used for moderate- to long-term therapy, such as chemotherapy. Central venous access devices are indicated when the child lacks suitable peripheral access, requires IV fluid or medication for more than 3 to 5 days, or is to receive specific treatments, such as the administration of highly concentrated solutions or irritating drugs that require rapid dilution. Peripheral IV devices are used for most other IV therapies.

Origin: Chapter 11, 22 When preparing to apply a restraint to a child, what would be most important for the nurse to do? A) Expect to keep the restraint on for at least 8 hours. B) Explain that safety, not punishment, is the reason for the restraint. C) Plan to use a square knot to secure the restraint to the side rails. D) Use a limb restraint rather than a jacket restraint for most issues.

Ans: B Feedback: Before applying a restraint, the nurse needs to explain the reason for the restraint to the child, emphasizing that the restraint is for safety, not to punish the child. The least restrictive type of restraint should be used, and it should be applied for the shortest time necessary. A clove-hitch knot is used to secure the restraint with ties to the bed or crib frame, not the side rails.

Origin: Chapter 4, 29 The nurse is assessing a 2-year-old boy who has missed some developmental milestones. Which finding will point to the cause of motor skill delays? A) The mother is suffering from depression. B) The child is homeless and has no toys. C) The mother describes an inadequate diet. D) The child is unperturbed by a loud noise.

Ans: B Feedback: Children develop through play, so a child without any toys may have trouble developing the motor skills appropriate to his age. Maternal depression is a risk factor for poor cognitive development. Inadequate diet will cause growth deficiencies. A child who does not respond to a loud noise probably has hearing loss, which will lead to a language deficit.

Origin: Chapter 4, 5 The nurse is observing a 24-month-old boy in a day care center. Which finding suggests delayed motor development? A) The child has trouble undressing himself. B) The child is unable to push a toy lawnmower. C) The child is unable to unscrew a jar lid. D) The child falls when he bends over.

Ans: B Feedback: Children with normal motor development are able to push toys with wheels at 24 months of age. He won't be ready to undress himself, unscrew a jar lid, or bend over without falling until about 36 months of age.

Origin: Chapter 8, 23 The nurse has completed diabetic education regarding insulin administration to a 14-year-old child newly diagnosed with diabetes and his family. The nurses knows the teaching was effective if the client and family: A) can list appropriate sites for insulin administration. B) have demonstrated correct insulin administration over the past several days. C) indicate that they understand proper nutrition for a person with diabetes. D) state that they understand hypoglycemic reaction signs and symptoms.

Ans: B Feedback: Demonstration is the best way to determine if teaching was effective in any situation. Listing, identifying, and stating understanding of a concept are desirable, but these behaviors are not the best way to determine understanding.

Origin: Chapter 1, 18 The nurse is caring for a newborn infant who has Down syndrome. Which nursing action reflects the nurse's use of the ethical principle of nonmaleficence? A) The nurse speaks truthfully to the parents regarding their child's prognosis. B) The nurse provides safe, competent nursing care to avoid harming the infant. C) The nurse involves the parents in making health care decisions for their child. D) The nurse fairly allocates resources for caring for newborns in a facility.

Ans: B Feedback: Ethics includes the basic principles of autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity. Nonmaleficence means avoiding causing harm, intentionally or unintentionally. One example is providing safe, competent nursing care. Speaking truthfully to the parents is an example of veracity. Generally, parents have the autonomy to make health care decisions for their child. Justice refers to acting fairly, and also involves allocating resources fairly.

Origin: Chapter 3, 23 The nurse is educating a first-time mother who has a 1-week-old boy. Which is the most accurate anticipatory guidance? A) Describing the effect of neonatal teeth on breastfeeding B) Explaining that the stomach holds less than 1 ounce C) Informing that fontanels will close by 6 months D) Telling that the step reflex persists until the child walks

Ans: B Feedback: Explaining that the child's stomach holds less than 1 ounce gives the mother a reason for frequent, small feedings and is the most helpful and accurate anticipatory guidance. Telling that the step reflex persists until the child walks and informing that fontanels will close by 6 months are inaccurate. The step reflex disappears at about 2 months and fontanels close between 12 and 18 months. Neonatal teeth are highly unusual and need no explanation unless they occur.

Origin: Chapter 3, 17 The nurse is providing anticipatory guidance to a mother of a 5-month-old boy about introducing solid foods. Which statement by the mother indicates that effective teaching has occurred? A) "I'll start with baby oatmeal cereal mixed with low-fat milk." B) "The cereal should be a fairly thin consistency at first." C) "I can puree the meat that we are eating to give to my baby." D) "Once he gets used to the cereal, then we'll try giving him a cup."

Ans: B Feedback: Iron-fortified rice cereal mixed with a small amount of formula or breast milk to a fairly thin consistency is typically the first solid food used. As the infant gets older, a thicker consistency is appropriate. Strained, pureed, or mashed meats may be introduced at 10 to 12 months of age. A cup is typically introduced at 6 to 8 months of age regardless of what or how much solid food is being consumed.

Origin: Chapter 3, 28 At which age would the nurse expect to find the beginning of object permanence? A) 1 month B) 6 months C) 9 months D) 12 months

Ans: B Feedback: Object permanence begins to develop between 4 and 7 months of age and is solidified by approximately age 8 months. By age 12 months, the infant knows he or she is separate from the parent or caregiver.

Origin: Chapter 3, 10 The nurse is assessing a 4-month-old boy during a scheduled visit. Which findings might suggest a developmental problem? A) The child does not babble. B) The child does not vocally respond to voices. C) The child never squeals or yells. D) The child does not say dada or mama.

Ans: B Feedback: The fact that the child does not vocally respond to voices might suggest a developmental problem. At 4 to 5 months of age most children are making simple vowel sounds, laughing aloud, doing raspberries, and vocalizing in response to voices. The child is too young to babble, squeal, yell, or say dada or mama.

Origin: Chapter 13, 5 The nurse is providing teaching for the mother of an infant who receives all of his nutrition through a tube. The nurse is reviewing interventions to promote growth and development. Which response from the mother indicates a need for further teaching? A) "I will give him a pacifier during feeding time." B) "We need to keep feeding time very quiet." C) "We need to make sure he doesn't lose the desire to eat by mouth." D) "Sucking produces saliva, which aids in digestion."

Ans: B Feedback: The nurse needs to emphasize that it is important to talk, play music, cuddle, and rock the infant to promote a normalized feeding time. The other statements are correct.

Origin: Chapter 11, 21 The nurse is caring for an immunosuppressed 3-year-old girl and is providing teaching to the mother about proper oral hygiene. Which response from the mother indicates a need for further teaching? A) "I really need to carefully check for skin breakdown." B) "I must really scrub her teeth and gums well." C) "I must use a soft toothbrush." D) "I can use a soft gauze sponge to care for her gums."

Ans: B Feedback: The nurse should caution the mother that overly vigorous brushing should be avoided as it can injure or irritate the gums. The other statements are recommended guidelines for care.

Origin: Chapter 13, 7 The nurse is preparing to administer a medication to a 5-year-old who weighs 35 pounds. The prescribed single dose is 1 to 2 mg/kg/day. Which is the appropriate dose range for this child? A) 8 to 16 mg B) 16 to 32 mg C) 35 to 70 mg D) 70 to 140 mg

Ans: B Feedback: The nurse should convert the child's weight in pounds to kilograms by dividing the child's weight in pounds by 2.2. (35 pounds divided by 2.2 = 16 kg). The nurse would then multiply the child's weight in kilograms by 1 mg for the low end (16 kg × 1 mg = 16 mg) and then by 2 mg for the high end (16 kg × 2 mg = 32 mg).

Origin: Chapter 13, 16 The nurse is preparing to administer an intramuscular injection to an 8-month-old infant. Which site would the nurse select? A) Rectus femoris B) Vastus lateralis C) Dorsogluteal muscle D) Deltoid

Ans: B Feedback: The preferred injection site in infants is the vastus lateralis muscle. An alternative site is the rectus femoris. The dorsogluteal site is not used in children until the child has been walking for at least 1 year. The deltoid muscle is used as a site in children after the age of 4 or 5 years.

Origin: Chapter 3, 9 The nurse is teaching a new mother about the development of sensory skills in her newborn. What would alert the mother to a sensory deficit in her child? A) The newborn's eyes wander and occasionally are crossed. B) The newborn does not respond to a loud noise. C) The newborn's eyes focus on near objects. D) The newborn becomes more alert with stroking when drowsy.

Ans: B Feedback: Though hearing should be fully developed at birth, the other senses continue to develop as the infant matures. The newborn should respond to noises. Sight, smell, taste, and touch all continue to develop after birth. The newborn's eyes wander and occasionally cross, and the newborn is nearsighted, preferring to view objects at a distance of 8 to 15 inches. Holding, stroking, rocking, and cuddling calm infants when they are upset and make them more alert when they are drowsy.

21. A group of students are reviewing information about the various types of insulin used to treat type 1 diabetes. The students demonstrate understanding of the information when they identify which insulin listed below as having the longest duration? A) Lispro B) Regular C) NPH D) Glargine

Ans: D Feedback: Of the insulins listed, glargine (Lantus) has the longest duration of action, that is, 12 to 24 hours. Lispro lasts approximately 3 to 5 hours; regular lasts 5 to 8 hours; and NPH lasts approximately 10 to 16 hours.

23. A nurse is providing instructions to the parents of a 3-month-old with developmental dysplasia of the hip who is being treated with a Pavlik harness. Which statement by the parents demonstrates understanding of the instructions? Select all answers that apply. A) "We need to adjust the straps so that they are snug but not too tight." B) "We should change her diaper without taking her out of the harness." C) "We need to check the area behind her knees for redness and irritation." D) "We need to send the harness to the dry cleaners to have it cleaned." E) "We need to call the doctor if she is not able to actively kick her legs."

Ans: B, C, E Feedback: Instructions related to use of a Pavlik harness include changing the child's diaper while in the harness; checking the areas behind the knees and diaper area for redness, irritation, or breakdown; and calling the doctor if the child is unable to actively kick her legs. The straps are not to be adjusted without checking with the physician or nurse practitioner first. The harness can be washed with mild detergent by hand and air dried. A hair dryer can be used to dry the harness but only if the air fluffing setting is used.

Origin: Chapter 4, 21 The nurse is helping parents prepare a healthy meal plan for their toddler. Which guidelines for promoting nutrition should be followed when planning meals? Select all that apply. A) The child younger than 2 years of age should have his or her fat intake restricted. B) Extending breastfeeding into toddlerhood is believed to be beneficial to the child. C) Weaning from the bottle should occur by 6 to 12 months of age. D) Adequate calcium intake and appropriate exercise lay the foundation for proper bone mineralization. E) The toddler requires an average intake of 500 mg calcium per day. F) Toddlers tend to have the highest daily iron intake of any age group.

Ans: B, D, E Feedback: Extending breastfeeding into toddlerhood is believed to be beneficial to the child as it is known to help prevent obesity. Adequate calcium intake and appropriate exercise lay the foundation for proper bone mineralization. The toddler requires an average intake of 500 mg calcium per day. The child younger than 2 years of age should not have his or her fat intake restricted, but this does not mean that unhealthy foods such as sweets should be eaten liberally. Weaning from the bottle should occur by 12 to 15 months of age. Prolonged bottle-feeding is associated with the development of dental caries. It is important for toddlers to consume adequate amounts of iron since they tend to have the lowest daily iron intake of any age group.

14. A child with growth hormone deficiency is receiving growth hormone. Which of the following would the nurse interpret as indicating effectiveness of this therapy? A) Rapid weight gain B) Complaints of headaches C) Height increase of 4 inches D) Growth plate closure

Ans: C Feedback: Effectiveness of growth hormone therapy is indicated by at least a 3- to 5-inch increase in linear growth in the first year of treatment. Rapid weight gain and headaches are adverse reactions of this therapy. The drug is stopped when the epiphyseal growth plates close.

10. The nurse is preparing a teaching plan for a 10-year-old girl with hyperthyroidism. Which of the following would the nurse include in the plan? A) Describing surgery to remove an anterior pituitary tumor B) Teaching her parents to give injections of growth hormone C) Explaining about the radioactive iodine procedure D) Showing her parents how to give DDAVP intranasally

Ans: C Feedback: Explaining about the radioactive iodine procedure would be part of the teaching plan for a child with hyperthyroidism because this is a less invasive type of therapy for the disorder. Describing surgery to remove an anterior pituitary tumor would be included for a child with hyperpituitarism. Teaching a parent to give injections of growth hormone would be appropriate for a child with a growth hormone deficiency. Showing parents how to give DDAVP intranasally is appropriate for a child with diabetes insipidus

24. The nurse is administering 10 units of NPH insulin to a child at 8 a.m. The nurse would expect this insulin to begin acting at which time? A) By 8:15 a.m. B) Between 8:30 and 9 a.m. C) Between 9 and 11 a.m. D) Around 12 noon

Ans: C Feedback: NPH insulin has an onset of action of 1 to 3 hours, so the drug would begin to act between 9 and 11 a.m. A rapid-acting insulin would begin to act by 8:15 a.m.; regular insulin would begin to act between 8:30 and 9 a.m. No type of insulin would begin acting around 12 noon.

15. Which exercise would the nurse suggest as most helpful to maintain mobility in a child with juvenile idiopathic arthritis? A) Jogging every other day B) Using a treadmill C) Swimming D) Playing basketball

Ans: C Feedback: Swimming is a particularly useful exercise to maintain joint mobility without placing pressure on the joints. Jogging, using a treadmill, and playing basketball would place pressure on the joints of the lower extremities.

16. A group of nursing students are reviewing information about the endocrine system in infants and children. The students demonstrate understanding of the information when they state which of the following? A) Endocrine glands begin developing in the third trimester of gestation. B) At birth, the endocrine glands are completely functional. C) Infants have difficulty balancing glucose and electrolytes. D) A child's endocrine system has little effect on growth and development.

Ans: C Feedback: Typically, most endocrine glands begin to develop during the first trimester of gestation, but their development is incomplete at birth. Thus, complete hormonal control is lacking during the early years of life, and the infant cannot appropriately balance fluid concentration, electrolytes, amino acids, glucose, and trace substances

9. The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. Which of the following would the nurse correlate with disorder? A) The parents report that their child had "a cold or flu" recently. B) Blood pressure is decreased when checking vital signs. C) The parents report that their son "can't drink enough water." D) Auscultation reveals Kussmaul breathing.

Ans: C Feedback: Unquenchable thirst (polydipsia) is a common finding associated with diabetes mellitus, type 1 and 2. However, reports of flu-like illness and Kussmaul breathing are more commonly associated with type 1 diabetes. Blood pressure is normal with type 1 diabetes and elevated with type 2 diabetes.

Origin: Chapter 4, 7 The pediatric nurse is planning quiet activities for hospitalized 18-month-old. What would be an appropriate activity for this age group? A) Painting by number B) Putting shapes into appropriate holes C) Stacking blocks D) Using crayons to color in a coloring book

Ans: C Feedback: At 18 months the child can stack four blocks. The 24-month-old can paint (but not by number), scribble, and color, and put round pegs into holes.

Origin: Chapter 3, 21 The nurse is assessing a 12-month-old boy with an English-speaking father and a Spanish-speaking mother. The boy does not say mama or dada yet. What is the priority intervention? A) Performing a developmental evaluation of the child B) Encouraging the parents to speak English to the child C) Asking the mother if the child uses Spanish words D) Referring the child to a developmental specialist

Ans: C Feedback: Infants in bilingual families may use some words from each language. Therefore, the priority intervention in this situation would be to ask the mother if the child uses Spanish words. There is not enough evidence to warrant performing a developmental evaluation or referring the child to a developmental specialist. Encouraging the parents to speak English to the child is unnecessary if the child is progressing with Spanish first.

Origin: Chapter 13, 10 The nurse is administering immunizations to children in a neighborhood clinic. What is the most frequent route of administration? A) Oral B) Intradermal C) Intramuscular D) Topical

Ans: C Feedback: Intramuscular (IM) administration delivers medication to the muscle. In children, this method of medication administration is used infrequently because it is painful and children often lack adequate muscle mass for medication absorption. However, IM administration is used to administer certain medications, such as many immunizations.

Origin: Chapter 4, 14 The nurse is assessing a 3-year-old boy's development during a well-child visit. Which response by the child indicates the need for further assessment? A) He says a swear word when he hurts himself playing. B) He says "pew" when his sister has soiled her diaper. C) He laughs when his brother cries getting vaccinated. D) He constantly asks "why?" whenever he is told a fact.

Ans: C Feedback: Laughing when his brother cries when being vaccinated indicates that the child hasn't yet developed a sense of empathy or that there may be psychosocial issues, such as sibling rivalry, that should be assessed. The child may repeat a word even if it is out of context. This is called echolalia. Older toddlers have a well-developed sense of smell and will comment if they don't like a smell. The incessant "why" is very common to toddlers' speech.

Origin: Chapter 11, 4 The nurse is caring for a 4-year-old girl who has been hospitalized for over a week with severe burns. Which would be a priority intervention to help satisfy this preschool child's basic needs? A) Encourage friends to visit as often as possible. B) Suggest that a family member be present with her 24 hours a day. C) Explain necessary procedures in simple language that she will understand. D) Allow her to make choices about her meals and activities as much as permitted.

Ans: C Feedback: Preschoolers fear mutilation and are afraid of intrusive procedures since they do not understand the body's integrity. They interpret words literally and have an active imagination; therefore, procedures should be demonstrated and/or explained in simple terms. Adolescents typically do not experience separation anxiety from being away from their parents; instead, their anxiety comes from being separated from friends, and therefore encouraging friends to visit is a priority intervention. Toddlers are especially susceptible to separation anxiety and would benefit from a family member being present as much as possible. School-age children are accustomed to controlling self-care and typically are highly social; they would benefit from being involved in choices about meals and activities.

Origin: Chapter 4, 1 The nurse is performing a physical assessment of a 3-year-old girl. What finding would be a concern for the nurse? A) The toddler gained 4 pounds in weight since last year. B) The toddler gained 3 inches in height since last year. C) The toddler's anterior fontanel is not fully closed. D) The circumference of the child's head increased 1 inch since last year.

Ans: C Feedback: The anterior fontanel should be closed by the time the child is 18-months old. The average toddler weight gain is 3 to 5 pounds per year. Length/height increases by an average of 3 inches per year. Head circumference increases about 1 inch from when the child is between 1 and 2 years of age, then increases an average of a half-inch per year until age 5.

Origin: Chapter 3, 1 The nurse is examining a 10-month-old boy who was born 10 weeks early. Which finding is cause for concern? A) The child has doubled his birth weight. B) The child exhibits plantar grasp reflex. C) The child's head circumference is 19.5 inches. D) No primary teeth have erupted yet.

Ans: C Feedback: The child's head size is large for his adjusted age (7.5 months), which would be cause for concern. Birth weight doubles by about 4 months of age. Plantar grasp reflex does not disappear until 9 months adjusted age. Primary teeth may not erupt until 8 months adjusted age.

Origin: Chapter 13, 6 The nurse is preparing to administer oral ampicillin to a child who weighs 40 kg. The safe dose for children is 50 to 100 mg/kg/day divided in doses administered every 6 hours. What would be the low single safe dose and high single safe dose per day for this child? A) 50 to 100 mg per dose B) 100 to 500 mg per dose C) 500 to 1,000 mg per dose D) 1,000 to 5,000 mg per dose

Ans: C Feedback: To calculate the dosage, the nurse would set up a proportion to calculate the low dose as follows: 50 mg/1 kg = x mg/40 kg; solve for x by cross-multiplying: 1 × x = 50 × 40; x = 2,000 mg divided by 4 doses per day = 500 mg. Then calculate the high safe dose range using the following proportion: 100 mg/1 kg = x mg/40 kg; solve for x by cross-multiplying: 1 × x = 100 × 40; x = 4,000 mg divided by 4 doses per day = 1,000 mg.

Origin: Chapter 8, 11 The nurse is teaching the student nurse how to communicate effectively with children. Which method would the nurse recommend? A) Position self above the child's level to denote authority. B) If possible, communicate with the child apart from the parent. C) Direct questions and explanations to the child. D) Use the medical terms for body parts and medical care.

Ans: C Feedback: To communicate effectively with children, the nurse should direct questions and explanations to the child; position self at the child's level; allow the child to remain near the parent if needed, so the child can remain comfortable and relaxed; and use the child's or family's terms for body parts and medical care when possible.

Origin: Chapter 4, 6 What activity would the nurse expect to find in an 18-month-old? A) Standing on tiptoes B) Pedaling a tricycle C) Climbing stairs with assistance D) Carrying a large toy while walking

Ans: C Feedback: Toddlers continue to progress with motor skills. An 18-month-old should be able to climb stairs with assistance. A 24-month-old should be able to stand on his or her tiptoes and carry a large toy while walking. A 36-month-old would be able to pedal a tricycle.

Origin: Chapter 13, 28 The nurse is monitoring the output for a 10-year-old child. The medical record indicates the child weighs 78 pounds. How much urine can be anticipated for this child for a 12-hour period? A) 300 to 1200 mL B) 360 to 900 mL C) 420 to 840 mL D) 600 to 1200 mL

Ans: C Feedback: Urinary output for a child will vary. As a general rule, output anticipated will be approximately 1.0 to 2.0 mL/kg/hour for children and adolescents. In a child who weighs 78 pounds, this will calculate as follows: 1. 78 pounds = 35kg 2. 1 mL X 35kg = 35 mL/hr and 2 mL X 35 = 70 mL/hr 3. 35 mL X 12 hours = 420 mL 4. 70 mL X 12 hours = 840 mL

16. A child is diagnosed with juvenile idiopathic arthritis and is receiving several different medications listed in the medication administration record. Which agent would the nurse identify as being used to prevent disease progression? A) Aspirin B) Prednisone C) Ibuprofen D) Methotrexate

Ans: D Feedback: Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, are necessary to prevent disease progression. Other agents, such as aspirin and ibuprofen, are helpful with pain relief. Prednisone helps for relief of inflammation.

26. A nurse is preparing a presentation for a group of parents with children diagnosed with diabetes type 1. The children are all adolescents. Which of the following issues would the nurse need to address? Select all that apply. A) Self-monitoring of blood glucose levels B) Feelings of being different C) Deficient decision-making skills D) Body image conflicts E) Struggle for independence

Ans: C, D, E Feedback: Adolescents are undergoing rapid physical, emotional, and cognitive growth. Working toward a separate identity from parents and the demands of diabetic care can hinder this. This struggle for independence can lead to nonadherence of the diabetic care regimen. Conflicts develop with self-management, body image, and peer group acceptance. Teens may acquire the skills to perform tasks related to diabetic care but may lack decision-making skills needed to adjust treatment plan. Teens do not always foresee the consequences of their activities. Self-monitoring of blood glucose levels and feelings of being different are issues common to school-age children.

25. The nurse suspects that a 4-year-old with type 1 diabetes is experiencing hypoglycemia based on which of the following? Select all that apply. A) Blurred vision B) Dry, flushed skin C) Diaphoresis D) Slurred speech E) Fruity breath odor F) Tachycardia

Ans: C, D, F Feedback: Manifestations of hypoglycemia include behavioral changes, confusion, slurred speech, belligerence, diaphoresis, tremors, palpitation, and tachycardia. Blurred vision; dry, flushed skin; and fruity breath odor suggest hyperglycemia.

23. The parents of a 7-year-old girl with type 1 diabetes has been recording her blood glucose measurements before meals and at bedtime for the past 4 days; they are as follows: Monday Tuesday Wednesday Thursday B: 120 mg/dL 135 mg/dL 124 mg/dL 200 mg/dL L: 110 mg/dL 120 mg/dL 140 mg/dL 220 mg/dL D: 90 mg/dL 140 mg/dL 130 mg/dL 200 mg/dL Bed: 110 mg/dL 110 mg/dL 160 mg/dL 240 mg/dL The parents bring the child in for a follow-up visit and show the nurse the results. Based on the results, the nurse would need to obtain additional information from the parents and child about which day? A) Monday B) Tuesday C) Wednesday D) Thursday

Ans: D Feedback: Blood glucose levels for a child who is 7 years of age should range from 90 to 180 mg/dL before meals and from 100 to 180 mg/dL before bedtime. On Thursday, the results for each testing were above normal. Therefore, the nurse needs to gather additional information about this day.

11. Which of the following would the nurse expect to assess in a child with hypothyroidism? A) Nervousness B) Heat intolerance C) Smooth velvety skin D) Weight gain

Ans: D Feedback: Hypothyroidism is manifested by weight gain, fatigue, cold intolerance, and dry skin. Nervousness, heat intolerance, and smooth velvety skin are associated with hyperthyroidism.

Origin: Chapter 2, 3 The nurse is caring for a 2-year-old girl who is wheezing and has difficulty breathing. Which interview question would provide the most useful information related to the symptoms of the child? A) Inquiring about child safety in the home B) Asking about the temperament of the child C) Asking about the child's diet D) Asking the parents if they smoke in the home

Ans: D Feedback: Asking the parents if they smoke in the home would provide the most useful information related to the health condition of the child. If they smoke, the nurse could explain that they are affecting their child's health and urge them to stop for her sake. Asking about the temperament of the child and inquiring about home safety or diet would not reveal any useful information related to the respiratory alteration.

Origin: Chapter 3, 22 A 6-month-old girl weighs 14.7 pounds during a scheduled check-up. Her birth weight was 8 pounds. What is the priority nursing intervention? A) Talking about solid food consumption B) Discouraging daily fruit juice intake C) Increasing the number of breastfeedings D) Discussing the child's feeding patterns

Ans: D Feedback: Assessing the current feeding pattern and daily intake is the priority intervention. Talking about solid food consumption may not be appropriate for this child yet. Discouraging daily fruit juice intake or increasing the number of breastfeedings may not be necessary until the situation is assessed.

Origin: Chapter 4, 28 The nurse is teaching the parents of a 2-year-old girl how to deal with common toddler situations. Which is the best advice? A) Discipline the child for regressive behavior. B) Scold the child for public thumb sucking. C) Tell the older sibling to not act like a baby. D) Have the child help clean up a bowel accident.

Ans: D Feedback: Having the child help clean up a bowel accident is the best advice. Toddlers should never be punished for bowel or bladder "accidents," but gently reminded about toileting. Regressive behavior is best ignored, while appropriate behavior should be praised. Telling the older sibling to not act like a baby is a negative approach. It would be better to have the child be mother's helper. Calmly telling the child that thumb sucking is something that is done at home is better than scolding the child.

Origin: Chapter 4, 17 The nurse is developing a teaching plan for toddler safety to present at a parenting seminar. Which safety intervention should the nurse address? A) Encourage parents to enroll toddlers in swimming classes to avoid the need for constant supervision around water. B) Advise parents to keep pot handles on stoves turned outward to avoid accidental burns. C) Encourage parents to smoke only in designated rooms in the house or outside the house. D) Advise parents to use a forward-facing car seat with harness straps and a clip, placed in the backseat of the car.

Ans: D Feedback: Safety is of prime concern throughout the toddler period. The safest place for the toddler to ride is in the back seat of the car. Parents should use the appropriate size and style of car seat for the child's weight and age as required by the state. At a minimum, all children over 20 pounds and up to 40 pounds should be in a forward-facing car seat with harness straps and a clip. Parents who want to enroll a toddler in a swimming class should be aware that a water safety skills class would be most appropriate. However, even toddlers who have completed a swimming program still need constant supervision in the water. Pot handles on stoves should be turned inward to avoid accidental burn. Nurses should counsel parents to stop smoking (optimal), but if they continue smoking never to smoke inside the home or car with children present.

Origin: Chapter 4, 30 The nurse emphasizes that a toddler younger than the age of 18 months should never be spanked primarily for which reason? A) Spanking in a child this age predisposes the child to a pro-violence attitude. B) The child will become resentful and angry, leading to more outbursts. C) Spanking demonstrates a poor model for problem-solving skills. D) There is an increased risk for physical injury in this age group.

Ans: D Feedback: Spanking should never be used with toddlers younger than 18 months of age because there is an increased possibility of physical injury. Although spanking or other forms of corporal punishment lead to a pro-violence attitude, create resentment and anger in the child, and are a poor model for learning effective problem-solving skills, the risk of physical injury in this age group is paramount.

Origin: Chapter 4, 8 The nurse is performing a cognitive assessment of a 2-year-old. Which behavior would alert the nurse to a developmental delay in this area? A) The child cannot say name, age, and gender. B) The child cannot follow a series of two independent commands. C) The child has a vocabulary of 40 to 50 words. D) The child does not point to named body parts.

Ans: D Feedback: The 2-year-old can point to named body parts and has a vocabulary of 40 to 50 words. At 30 months old a child can follow a series of two independent commands and at 3-years old a child can say name, age, and gender.

Origin: Chapter 13, 18 The nurse is determining the amount of IV fluids to administer in a 24-hour period to a child who weighs 40 kg. How many milliliters should the nurse administer? A) 1,000 mL B) 1,500 mL C) 1,750 mL D) 1,900 mL

Ans: D Feedback: Typically, the amount of fluid to be administered in a day (24 hours) is determined by the child's weight (in kg) using the following formula: 100 mL per kg of body weight for the first 10 kg (1,000) 50 mL per kg of body weight for the next 10 kg (500) 20 mL per kg of body weight for the remainder of body weight in kg (400).

Origin: Chapter 4, 15 The nurse is designing a nursing care plan for a toddler with lymphoma, who is hospitalized for treatment. What is a priority intervention that the nurse should include in this child's nursing plan? A) Limiting visitors to scheduled visiting hours B) Planning physical therapy for the child C) Introducing the toddler to other toddlers in the unit D) Monitoring the toddler for developmental delays

Ans: D Feedback: When the toddler is hospitalized, growth and development may be altered. The toddler's primary task is establishing autonomy, and the toddler's focus is mobility and language development. The nurse caring for the hospitalized toddler must use knowledge of normal growth and development to be successful in interactions with the toddler, promote continued development, and recognize delays. Parents should be encouraged to stay with the toddler to avoid separation anxiety. Planning activities and socialization of the toddler is important, but the priority intervention is monitoring for, and addressing, developmental delays that may occur in the hospital.

Origin: Chapter 4, 22 The nurse is choosing foods for a toddler's diet that are high in vitamin A. What foods could be added to the menu? Select all that apply. A) Applesauce B) Avocados C) Broccoli D) Sweet potatoes E) Spinach F) Carrots

Ans: D, E, F Feedback: Foods that are high in vitamin A include apricots, cantaloupe, carrots, mangos, spinach and dark greens, and sweet potatoes. Applesauce is high in fiber, and avocados and broccoli are high in folate.

Origin: Chapter 11, 18 The nurse is ordered to apply restraints to a toddler who keeps pulling at the tubes in his arm. Which criteria must occur to ensure proper use of these restraints? Select all answers that apply. A) The nurse must check the restraints every 15 minutes while they are in place. B) Secure the restraints with ties to the side rails, not the bed or crib frame. C) Assess the temperature of the affected extremities, pulses, and capillary refill every 15 minutes after placement. D) Use a clove-hitch type of knot to secure the restraints with ties. E) Remove the restraint every 2 hours to allow for range of motion and repositioning. F) Encourage parent participation, providing continuous explanations about the reasons and time frame for restraints.

Ans: D, E, F Feedback: The nurse should use a clove-hitch type of knot to secure the restraints with ties, remove the restraint every 2 hours to allow for range of motion and repositioning, and encourage parent participation, providing continuous explanations about the reasons and time frame for the restraints. The nurse must check restraints 15 minutes following initial placement and then every hour for proper placement and secure the restraints with ties to the bed or crib frame, not the side rails. The nurse should also assess the temperature of the affected extremities, pulses, and capillary refill, initially after 15 minutes and then every hour after placement.

A pregnant woman has a child at home who has been diagnosed with neurofibromatosis She asks the nurse what she should look for in the new baby that would indicate that it also has neurofibromatosis. What sign should the nurse instruct the woman to look for in the new baby? a) Projectile vomiting b) Café-au-lait spots c) Xanthoma d) Increased urination

Café-au-lait spots Correct Explanation: Physical assessment may provide clues that a particular genetic condition is present in a person and family. Family history assessment may offer initial guidance regarding the particular area for physical assessment. For example, a family history of neurofibromatosis type 1, an inherited condition involving tumors of the central nervous system, would prompt the nurse to carry out a detailed assessment of closely related family members. Skin findings such as café-au-lait spots, axillary freckling, or tumors of the skin (neurofibromas) would warrant referral for further evaluation, including genetic evaluation and counseling. A family history of familial hypercholesterolemia would alert the nurse to assess family members for symptoms of hyperlipidemias (xanthomas, corneal arcus, abdominal pain of unexplained origin). As another example, increased urination could indicate type 1 diabetes. Projectile vomiting is indicative of pyloric stensosis.

Which type of genetic test would be used to detect the possibility of Down syndrome? a) Complete blood count (CBC) b) DNA analysis c) Hemoglobin electrophoresis d) Chromosomal analysis

Chromosomal analysis Correct Explanation: Chromosomal analysis is part of the genetic testing for Down syndrome. DNA analysis may be used in the detection of Huntington disease. Hemoglobin electrophoresis may be used in genetic testing for sickle cell anemia. A complete blood count (CBC) may be used as part of testing for a thalassemia

You care for a child with Down syndrome (trisomy 21). This is an example of which type of inheritance? a) Mendelian dominant b) Phase 2 atrophy c) Chromosome nondisjunction d) Mendelian recessive

Chromosome nondisjunction Correct Explanation: Down syndrome occurs when an ovum or sperm cell does not divide evenly, permitting an extra 21st chromosome to cross to a new cell.

Nondisjunction of a chromosome results in which of the following diagnoses? a) Duchenne muscular dystrophy b) Down syndrome c) Marfan syndrome d) Huntingon disease

Down syndrome Correct Explanation: When a pair of chromosomes fails to separate completely (nondisjunction) the resulting sperm or oocyte contains two copies of a particular chromosome. Nondisjunction can result in a fertilized egg having trisomy 21 or Down syndrome. Huntington disease is one example of a germ-line mutation. Duchenne muscular dystrophy, an inherited form of muscular dystrophy, is an example of a genetic disease caused by structural gene mutations. Marfan syndrome is a genetic condition that may occur in a single family member as a result of spontaneous mutation.

A pregnant woman undergoes maternal serum alpha-fetoprotein (MSAFP) testing at 16 to 18 weeks' gestation. Which of the following would the nurse suspect if the woman's level is decreased? a) Cardiac defects b) Open neural tube defect c) Down syndrome d) Sickle-cell anemia

Down syndrome Explanation: Decreased levels might indicate Down syndrome or trisomy 18. Sickle cell anemia may be identified by chorionic villus sampling. MSAFP levels would be increased with cardiac defects, such as tetralogy of Fallot. A triple marker test would be used to determine an open neural tube defect.

The nurse is caring for a 1-year-old boy with Down syndrome. Which of the following would the nurse be least likely to include in the child's plan of care? a) Promoting annual vision and hearing tests b) Describing the importance of a high-fiber diet c) Explaining developmental milestones to parents d) Educating parents about how to deal with seizures

Educating parents about how to deal with seizures Correct Explanation: It is unlikely that the parents will need to know how to deal with seizures. It will be helpful to provide parents with growth and developmental milestones that are unique to children with Down syndrome. More than 60% of children with Down syndrome have hearing loss, so promoting annual vision and hearing tests is the priority intervention. Special diets are usually not necessary; however, a balanced, high-fiber diet and exercise are important because constipation is frequently a problem.

A client who is 37 years of age presents to the health care clinic for her first prenatal check up. Due to her advanced age, the nurse should prepare to talk with the client about her increased risk for what complication? a) Incompetent cervix b) Genetic disorders c) Gestational diabetes d) Preterm labor

Genetic disorders Correct Explanation: Women over the age of 35 are at increased risk of having a fetus with an abnormal karyotype or other genetic disorders. Gestational diabetes, an incompetent cervix, and preterm labor are risks for any pregnant woman.

An 18-year-old male patient is diagnosed with Klinefelter syndrome. What signs and symptoms are consistent with this diagnosis? a) Hypergonadism and decreased pubic hair b) Hypogonadism and gynecomastia c) Long torso and decreased facial hair d) Enlaged testes and tall stature

Hypogonadism and gynecomastia Correct Explanation: Klinefelter syndrome affects males, causing only testosterone deficiency. Males may develop female-like characteristics such as gynecomastia and may experience hypogonadism. Decreased pubic and facial hair, along with tall stature, are characteristic of the disorder. The corresponding signs and symptoms listed in the other answer selections are not signs and symptoms of the disorder.

A couple wants to start a family. They are concerned that their child will be at risk for cystic fibrosis because they each have a cousin with cystic fibrosis. They are seeing a nurse practitioner for preconceptual counseling. What would the nurse practitioner tell them about cystic fibrosis? a) It is an X-linked inherited disorder b) It is an autosomal dominant disorder c) It is an autosomal recessive disorder d) It is passed by mitochondrial inheritance

It is an autosomal recessive disorder Correct Explanation: Cystic fibrosis is autosomal recessive. Nurses also consider other issues when assessing the risk for genetic conditions in couples and families. For example, when obtaining a preconception or prenatal family history, the nurse asks if the prospective parents have common ancestors. This is important to know because people who are related have more genes in common than those who are unrelated, thus increasing their chance for having children with autosomal recessive inherited condition such as cystic fibrosis. Mitochondrial inheritance occurs with defects in energy conversion and affects the nervous system, kidney, muscle, and liver. X-linked inheritance, which has been inherited from a mutant allele of the mother, affects males. Autosomal dominant is an X-linked dominant genetic disease

Which statement about nondisjunction of a chromosome is true? a) Only the X chromosomes are affected. b) Only 4% of Down syndrome cases are attributed to this defect. c) It may result from genomic imprinting. d) It is failure of the chromosomal pair to separate.

It is failure of the chromosomal pair to separate. Correct Explanation: Nondisjunction simply means failure to separate. Nondisjunction can happen at any chromosome and is attributed to 95% of Down syndrome cases. Genomic imprinting is a different genetic disorder that is not related to nondisjunctioning.

The nurse is performing an assessment of a 6-year-old girl with Turner syndrome. Which of the following would the nurse most likely assess? a) Pectus carinatum b) Enlarged thyroid gland c) Short stature and slow growth d) Short, stubby trident hands

Short stature and slow growth Correct Explanation: Short stature and slow growth are frequently the first indication of Turner syndrome. While children with Turner syndrome are more prone to thyroid problems, these problems are not as likely to occur as in other symptoms. Pectus carinatum is typical of children with Marfan syndrome. Short, stubby trident hands are typical of achondroplasia.

An African American couple presents for a genetic counseling appointment. They are pregnant and are concerned about their child. What would a patient of African American heritage have genetic carrier testing for? a) Sickle cell anemia b) Asthma c) Rubella d) Meckel's diverticulum

Sickle cell anemia Correct Explanation: Assessing ancestry and ethnicity is important to help identify individuals and groups who could benefit from genetic testing for carrier identification, such as African Americans routinely offered testing for sickle cell anemia. The other answers are incorrect because they are not identified with the African American race

A woman with both heart disease and osteoarthritis has come to the genetics clinic for genetic screening. What would the nurse know about these two diseases? a) They are direct result of the patient's lifestyle b) They are multifactorial c) They do not have a genetic basis d) They are caused by a single gene

They are multifactorial Correct Explanation: Genomic or multifactorial influences involve interactions among several genes (gene-gene interactions) and between genes and the environment (gene-environment interactions), as well as the individual's lifestyle.

A gene that is expressed when paired with another gene for the same trait is called a) recessive. b) dominant. c) heterozygous. d) homozygous.

dominant. Correct Explanation: A dominant gene is one that will be expressed when paired with a like gene.

When an infant is born with a genetic disorder, it is appropriate to advise the parents that a) experiences the mother had during pregnancy are probably not related. b) not all genetic disorders are inherited. c) the disorder has probably occurred in the family before. d) it is likely that the mother drank alcohol during early cell division.

experiences the mother had during pregnancy are probably not related. Explanation: As genetic disorders occur at the moment of conception, events during pregnancy occur after the problem is already present.

A nursing student correctly identifies that a person's outward appearance or expression of genes is referred to as which of the following? a) allele b) genome c) phenotype d) genotype

phenotype Correct Explanation: Alleles are two like genes. Phenotype refers to a person's outward appearance or the expression of genes. Genotype refers to his or her actual gene composition. Genome is the complete set of genes present in a person.

Girls with Turner Syndrome will usually exhibit a) short stature b) progressive dementia c) chorealike movements d) painful joints

short stature Correct Explanation: Girls with Turner syndrome usually have a single X chromosome, causing them to have short stature and infertility. Persons with sickle cell anemia have painful joints. Color blindness occurs in persons diagnosed with Huntington disease and they may exhibit chorealike movements. Progressive dementia occurs in early-onset familial Alzheimer's disease.