peds test 3

1. The nurse is assessing a child postcardiac catheterization. Which complication might the nurse anticipate? a. Cardiac arrhythmia b. Hypostatic pneumonia c. Congestive heart failure d. Rapidly increasing blood pressure

A

15. Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurses reply should be based on knowing that: a. The child needs opportunities to play with peers. b. The child needs to understand that peers activities are too strenuous. c. Parents can meet all the childs needs. d. Constant parental supervision is needed to avoid overexertion.

A

22. Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis? a. Oslers nodes c. Subcutaneous nodules b. Janeway lesions d. Aschoffs nodules

A

25. A major clinical manifestation of rheumatic fever is: a. Polyarthritis. b. Oslers nodes. c. Janeway spots. d. Splinter hemorrhages of distal third of nails.

A

5. Which structural defects constitute tetralogy of Fallot? a. Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy b. Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy c. Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy d. Pulmonic stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

A

8. A beneficial effect of administering digoxin (Lanoxin) is that it: a. Decreases edema. b. Decreases cardiac output. c. Increases heart size. d. Increases venous pressure.

A

9. Which drug is an angiotensin-converting enzyme (ACE) inhibitor? a. Captopril (Capoten) b. Furosemide (Lasix) c. Spironolactone (Aldactone) d. Chlorothiazide (Diuril)

A

The advantages of the ventrogluteal muscle as an injection site in young children include which of the following (Select all that apply)? a. Less painful than vastus lateralis b. Free of important nerves and vascular structures c. Cannot be used when child reaches a weight of 20 pounds d. Increased subcutaneous fat, which increases drug absorption e. Easily identified by major landmarks

A,B,E a. Less painful than vastus lateralis b. Free of important nerves and vascular structures e. Easily identified by major landmarks

A nurse is caring for a child in Droplet Precautions. Which instructions should the nurse give to the unlicensed assistive personnel caring for this child (Select all that apply)? a. Wear gloves when entering the room. b. Wear an isolation gown when entering the room. c. Place the child in a special air handling and ventilation room. d. A mask should be worn only when holding the child. e. Wash your hands upon exiting the room.

A,B,E a. Wear gloves when entering the room. b. Wear an isolation gown when entering the room. e. Wash your hands upon exiting the room.

Olivia, age 5 years, tells the nurse that she needs a Band-Aid where she had an injection. The best nursing action is to: a. Apply a Band-Aid. b. Ask her why she wants a Band-Aid. Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 616 c. Explain why a Band-Aid is not needed. d. Show her that the bleeding has already stopped.

ANS: A Children in this age-group still fear that their insides may leak out at the injection site, even if the bleeding has stopped. Provide the Band-Aid. No explanation should be required.

When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as: a. Punishment. c. An opportunity for regression. b. Threat to childs self-image. d. Loss of companionship with friends.

ANS: A If a toddler is not prepared for hospitalization, a typical preschooler fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds. Threat to childs self-image and loss of companionship with friends are reactions typical of school-age children. Regression is a response characteristic of toddlers when threatened with loss of control.

A previously potty-trained 30-month-old child has reverted to wearing diapers while hospitalized. The nurse should reassure the parents that this is normal because: a. Regression is seen during hospitalization. b. Developmental delays occur because of the hospitalization. Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 621 c. The child is experiencing urinary urgency because of hospitalization. d. The child was too young to be potty-trained.

ANS: A Regression is expected and normal for all age-groups when hospitalized. Nurses should assure the parents this is temporary and the child will return to the previously mastered developmental milestone when back home. This does not indicate a developmental delay. The child should not be experiencing urinary urgency because of hospitalization and this would not be normal. Successful potty-training can be started at 2 years of age if the child is ready.

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

ANS: A School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for experiences that are unavoidable. The nurse should refer to the child by the preferred name. Telling the child about all of the limitations of visiting does not help her adjust to the hospital. At the age of 8 years, the child and parents should be oriented to the environment.

What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Separation anxiety c. Fear of bodily injury b. Loss of control d. Fear of pain

ANS: A The major stress for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age-group.

A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, Wait a minute, and, Im not ready. The nurse should recognize that: a. This is normal behavior for a school-age child. b. This behavior is usually not seen past the preschool years. c. The child thinks the nurse is punishing her. d. The child has successfully manipulated the nurse in the past.

ANS: A This school-age child is attempting to maintain control. The nurse should provide the girl with structured choices about when the IV will be inserted. This can be characteristic behavior when an individual needs to maintain some control over a situation. The child is trying to have some control in the hospital experience.

What is an age-appropriate nursing intervention to facilitate psychologic adjustment for an adolescent expected to have a prolonged hospitalization (select all that apply)? a. Encourage parents to bring in homework and schedule study times. b. Allow the adolescent to wear street clothes. c. Involve the parents in care. Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 623 d. Follow home routines. e. Encourage parents to bring in favorite foods

ANS: A, B, E Encouraging parents to bring in homework, street clothes, and favorite foods are all developmentally appropriate approaches to facilitate adjustment and coping for an adolescent who will be experiencing prolonged hospitalization. Involving parents in care and following home routines are important interventions for the preschool child who is in the hospital. Adolescents do not need parents to assist in their care. They are used to performing independent self-care. Adolescents may want their parents to be nearby, or they may enjoy the freedom and independence from parental control and routines.

Ryan has just been unexpectedly admitted to the intensive care unit after abdominal surgery. The nursing staff has completed the admission process, and Ryans condition is beginning to stabilize. When speaking with the parents, the nurses should expect which stressors to be evident (select all that apply)? a. Unfamiliar environment b. Usual day-night routine c. Strange smells d. Provision of privacy e. Inadequate knowledge of condition and routine

ANS: A, C, E Intensive care units, especially when the family is unprepared for the admission, are a strange and unfamiliar place. There are many pieces of unfamiliar equipment, and the sights and sounds are much different from a general hospital unit. Also, with the childs condition being more precarious, it may be difficult to keep the parents updated and knowledgeable about what is happening. Lights are usually on around the clock, seriously disrupting the diurnal rhythm. There is usually little privacy available for families in intensive care units.

A child is being discharged from an ambulatory care center after an inguinal hernia repair. Which discharge interventions should the nurse implement (select all that apply)? a. Discuss dietary restrictions. b. Hold any analgesic medications until the child is home. c. Send a pain scale home with the family. Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 624 d. Suggest the parents fill the prescriptions on the way home. e. Discuss complications that may occur.

ANS: A, C, E The discharge interventions a nurse should implement when a child is being discharged from an ambulatory care center should include dietary restrictions, being very specific and giving examples of clear fluids or what is meant by a full liquid diet. The nurse should give specific information on pain control and send a pain scale home with the family. All complications that may occur after an inguinal hernia repair should be discussed with the parents. The pain medication, as prescribed, should be given before the child leaves the building, and prescriptions should be filled and given to the family before discharge.

An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler is to: a. Provide for privacy. b. Encourage parents to room in. c. Explain procedures and routines. d. Encourage contact with children the same age.

ANS: B A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room in as much as possible. Maintaining routines and ensuring privacy are helpful interventions, but they would not substitute for the parents. Contact with same-aged children would not substitute for having the parents present.

Which situation poses the greatest challenge to the nurse working with a child and family? a. Twenty-four-hour observation c. Outpatient admission b. Emergency hospitalization d. Rehabilitation admission

ANS: B Emergency hospitalization involves (1) limited time for preparation both for the child and family, (2) situations that cause fear for the family that the child may die or be permanently disabled, and (3) a high level of activity, which can foster further anxiety. Although preparation time may be limited with a 24-hour observation, this situation does not usually involve the acuteness of the situation and the high levels of anxiety associated with emergency admission. Outpatient admission generally involves preparation time for the family and child. Because of the lower level of acuteness in this setting, anxiety levels are not as high. Rehabilitation admission follows a serious illness or disease. This type of unit may resemble a home environment, which decreases the

Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her, We are sick of Mom always sitting with you in the hospital and playing with you. It isnt fair that you get everything and we have to stay with the neighbors. The nurses best assessment of this situation is that: a. The siblings are immature and probably spoiled. b. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling. c. The family has ineffective coping mechanisms to deal with chronic illness. d. The siblings need to better understand their sisters illness and needs.

ANS: B Siblings experience loneliness, fear, worry, anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child. These are not uncommon responses by normal siblings. There is no evidence that the family has maladaptive coping or that the siblings lack understanding.

A nurse in the emergency department is assessing a 5-year-old child with symptoms of pneumonia and a fever of 102 F. Which intervention can the nurse implement to promote a sense of control for the child? a. None, this is an emergency and the child should not participate in care. b. Allow the child to hold the digital thermometer while taking the childs blood pressure. c. Ask the child if it is OK to take a temperature in the ear. d. Have parents wait in the waiting room.

ANS: B The nurse should allow the child to hold the digital thermometer while taking the childs blood pressure. Unless an emergency is life threatening, children need to participate in their care to maintain a sense of control. Because emergency departments are frequently hectic, there is a tendency to rush through procedures to save time. However, the extra few minutes needed to allow children to participate may save many more minutes of useless resistance and uncooperativeness during subsequent procedures. The child may not give permission, if asked, for a procedure that is necessary to be performed. It is better to give choices such as, Which ear do you want me to do your temperature in? instead of, Can I take your temperature? Parents should remain with their child to help with decreasing the childs anxiety.

A nurse plans therapeutic play time for a hospitalized child. Which are the benefits of therapeutic play (select all that apply)? a. Serves as method to assist disturbed children b. Allows the child to express feelings c. The nurse can gain insight into the childs feelings d. The child can deal with concerns and feelings e. Gives the child a structured play environment

ANS: B, C, D Therapeutic play is an effective, nondirective modality for helping children deal with their concerns and fears, and at the same time, it often helps the nurse gain insights into childrens needs and feelings. Play and other expressive activities provide one of the best opportunities for encouraging emotional expression, including the safe release of anger and hostility. Nondirective play that allows children freedom for expression can be tremendously therapeutic. Play therapy is a structured therapy that helps disturbed children. It should not be confused with therapeutic play.

A nurse is interviewing the parents of a toddler about use of complementary or alternative medical practices. The parents share several practices they use in their household. Which should the nurse document as complementary or alternative medical practices (select all that apply)? a. Use of acetaminophen (Tylenol) for fever b. Administration of chamomile tea at bedtime c. Hypnotherapy for relief of pain d. Acupressure to relieve headaches e. Cool mist vaporizer at the bedside for stuffiness

ANS: B, C, D When conducting an assessment, the nurse should inquire about the use of complementary or alternative medical practices. Administration of chamomile tea at bedtime, hypnotherapy for relief of pain, and acupressure to relieve headaches are complementary or alternative medical practices. Using Tylenol for fever relief and a cool mist vaporizer at the bedside to reduce stuffiness are not considered complementary or alternative medical practices.

15. During the first 4 days of hospitalization, Eric, age 18 months, cried inconsolably when his parents left him, and he refused the staffs attention. Now the nurse observes that Eric appears to be settled in and unconcerned about seeing his parents. The nurse should interpret this as which of the following? a. He has successfully adjusted to the hospital environment. Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 619 b. He has transferred his trust to the nursing staff. c. He may be experiencing detachment, which is the third stage of separation anxiety. d. Because he is at home in the hospital now, seeing his mother frequently will only start the cycle again.

ANS: C Detachment is a behavioral manifestation of separation anxiety. Superficially it appears that the child has adjusted to the loss and transferred his trust to the nursing staff. Detachment is a sign of resignation, not contentment. Parents should be encouraged to be with their child. If parents restrict visits, they may begin a pattern of misunderstanding the childs cues and not meeting his needs.

What is the best action for the nurse to take when a 5-year-old child who requires another 2 days of intravenous (IV) antibiotics cries, screams, and resists having the IV restarted? a. Exit the room and leave the child alone until he stops crying. b. Tell the child big boys and girls dont cry. c. Let the child decide which color arm board to use with the IV. d. Administer a narcotic analgesic for pain to quiet the child.

ANS: C Giving the preschooler some choice and control, while maintaining boundaries of treatment, supports the childs coping skills. Leaving the child alone robs the child of support when a coping difficulty exists. Crying is a normal response to stress. The child needs time to adjust and support to cope with unfamiliar and painful procedures during hospitalization. Although administration of a topical analgesic is indicated before restarting the childs IV, a narcotic analgesic is not indicated.

The nurse is caring for an adolescent who had an external fixator placed after suffering a fracture of the wrist during a bicycle accident. Which statement by the adolescent would be expected about separation anxiety? a. I wish my parents could spend the night with me while I am in the hospital. b. I think I would like for my siblings to visit me but not my friends. c. I hope my friends dont forget about visiting me. d. I will be embarrassed if my friends come to the hospital to visit.

ANS: C Loss of peer-group contact may pose a severe emotional threat to an adolescent because of loss of group status; friends visiting is an important aspect of hospitalization for an adolescent and would be very reassuring. Adolescents may welcome the opportunity to be away from their parents. The separation from siblings may produce reactions from difficulty coping to a welcome relief.

A school-age child, admitted for intravenous antibiotic therapy for osteomyelitis, reports difficulty in going to sleep at night. Which intervention should the nurse implement to assist the child in going to sleep at bedtime? a. Request a prescription for a sleeping pill. b. Allow the child to stay up late and sleep late in the morning. c. Create a schedule similar to the one the child follows at home. d. Plan passive activities in the morning and interactive activities right before bedtime.

ANS: C Many children obtain significantly less sleep in the hospital than at home; the primary causes are a delay in sleep onset and early termination of sleep because of hospital routines. One technique that can minimize the disruption in the childs routine is establishing a daily schedule. This approach is most suitable for noncritically ill school-age and adolescent children who have mastered the concept of time. It involves scheduling the childs day to include all those activities that are important to the child and nurse, such as treatment procedures, schoolwork, exercise, television, playroom, and hobbies. The school-age child with osteomyelitis would benefit from a schedule similar to the one followed at home. Requesting a prescription for a sleeping pill would be inappropriate, and allowing the child to stay up late and sleep late would not be keeping the child in a routine followed at home. Passive activities in the morning and interactive activities at bedtime should be reversed; it would be better to keep the child active in the morning hours and plan quiet activities at bedtime.

What is the primary disadvantage associated with outpatient and day facility care? a. Increased cost b. Increased risk of infection c. Lack of physical connection to the hospital d. Longer separation of the child from family

ANS: C Outpatient and day facility care do not provide extended care; therefore, a child requiring extended care must be transferred to the hospital, causing increased stress to the child and parents. Outpatient care decreases cost and reduces the risk of infection. Outpatient care also minimizes separation of the child from family.

Emma, age 3 years, is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her a lot of new toys because she will be in the hospital. The nurses reply should be based on an understanding that: a. New toys make hospitalization easier. b. New toys are usually better than older ones for children of this age. c. At this age children often need the comfort and reassurance of familiar toys from home. d. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.

ANS: C Parents should bring favorite items from home to be with the child. Young children associate inanimate objects with significant people; they gain comfort and reassurance from these items. New toys will not serve the purpose of familiar toys and objects from home. The parents may experience some guilt as a response to the hospitalization, but there is no evidence that it is maladaptive.

A nurse is preparing to complete an admission assessment on a 2-year-old child. The child is sitting on the parents lap. Which technique should the nurse implement to complete the physical exam? a. Ask the parent to place the child in the hospital crib. b. Take the child and parent to the exam room. Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 620 c. Perform the exam while the child is on the parents lap. d. Ask the child to stand by the parent while completing the exam.

ANS: C The nurse should complete the exam while the child is on the parents lap. For young children, particularly infants and toddlers, preserving parent-child contact is the best means of decreasing the need for or stress of restraint. The entire physical examination can be done in a parents lap with the parent hugging the child for procedures such as an otoscopic examination. Placing the child in the crib, taking the child to the exam room, or asking the child to stand by the parent would separate the child from the parent and cause anxiety.

A child is playing in the playroom. The nurse needs to take a blood pressure on the child. Which is the appropriate procedure for obtaining the blood pressure? a. Take the blood pressure in the playroom. b. Ask the child to come to the exam room to obtain the blood pressure. c. Ask the child to return to his or her room for the blood pressure, then escort the child back to the playroom. d. Document that the blood pressure was not obtained because the child was in the playroom.

ANS: C The playroom is a safe haven for children, free from medical or nursing procedures. The child can be returned to his or her room for the blood pressure and then escorted back to the playroom. The exam room is reserved for painful procedures that should not be performed in the childs hospital bed. Documenting that the blood pressure was not obtained because the child was in the playroom is inappropriate.

A 14-year-old boy is being admitted to the hospital for an appendectomy. Which roommate should the nurse assign with this patient? a. A 4-year-old boy who is first day post-appendectomy surgery b. A 6-year-old boy with pneumonia c. A 15-year-old boy admitted with a vaso-occlusive sickle cell crisis d. A 12-year-old boy with cellulitis

ANS: C When a child is admitted, nurses follow several fairly universal admission procedures. The minimum considerations for room assignment are age, sex, and nature of the illness. Age-grouping is especially important for adolescents. The 14-year-old boy being admitted to the unit after appendectomy surgery should be placed with a noninfectious child of the same sex and age. The 15-year-old child with sickle cell is the best choice. The 4-year-old boy who is post-appendectomy is too young, and the child with pneumonia is too young and possibly has an infectious process. The 12-year-old boy with cellulitis is the right age, but he has an infection (cellulitis).

The nurse is doing a prehospitalization orientation for Kayla, age 7, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that Kayla will not be able to talk because of an endotracheal tube but that she will be able to talk when it is removed. This explanation is: a. Unnecessary. b. The surgeons responsibility. c. Too stressful for a young child. d. An appropriate part of the childs preparation.

ANS: D Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 617 This is a necessary part of preoperative preparation that will help reduce the anxiety associated with surgery. If the child wakes and is not prepared for the inability to speak, she will be even more anxious. It is a joint responsibility of nursing, medical staff, and child life personnel. This is a necessary component of preparation that will help reduce the anxiety associated with surgery.

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

ANS: D When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurp individual power and identity. This is especially Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 614 detrimental to school-age children, who are striving for independence and productivity and are now experiencing events that lessen their control and power. Infants, toddlers, and preschoolers, although affected by loss of power, are not as significantly affected as are school-age children.

10. The nurse is evaluating a child who is taking digoxin for her cardiac condition. The nurse is cognizant that a common sign of digoxin toxicity is: a. Seizures. b. Vomiting. c. Bradypnea. d. Tachycardia.

B

12. As part of the treatment for congestive heart failure, the child takes the diuretic furosemide. As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in: a. Chlorides. c. Sodium. b. Potassium. d. Vitamins.

B

13. An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurses first action should be to: a. Assess for neurologic defects. b. Place the child in the knee-chest position. c. Begin cardiopulmonary resuscitation. d. Prepare the family for imminent death

B

14. The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk of cerebrovascular accidents (strokes) exists. An important objective to decrease this risk is to: a. Minimize seizures. c. Promote cardiac output. b. Prevent dehydration. d. Reduce energy expenditure.

B

16. When preparing a school-age child and the family for heart surgery, the nurse should consider: a. Not showing unfamiliar equipment. b. Letting child hear the sounds of an electrocardiograph monitor. c. Avoiding mentioning postoperative discomfort and interventions. d. Explaining that an endotracheal tube will not be needed if the surgery goes well.

B

23. The primary nursing intervention necessary to prevent bacterial endocarditis is to: 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.

B

27. The leading cause of death after heart transplantation is: a. Infection. c. Cardiomyopathy. b. Rejection. d. Congestive heart failure.

B

18. An important nursing consideration when suctioning a young child who has had heart surgery is to: a. Perform suctioning at least every hour. b. Suction for no longer than 30 seconds at a time. c. Administer supplemental oxygen before and after suctioning. d. Expect symptoms of respiratory distress when suctioning.

C

19. The nurse is caring for a child after heart surgery. What should she or he do if evidence is found of cardiac tamponade? a. Increase analgesia. b. Apply warming blankets. c. Immediately report this to the physician. d. Encourage the child to cough, turn, and breathe deeply.

C

20. An important nursing consideration when chest tubes will be removed from a child is to: a. Explain that it is not painful. b. Explain that only a Band-Aid will be needed. c. Administer analgesics before the procedure. d. Expect bright red drainage for several hours after removal.

C

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

C

6. What is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures? a. Pulmonary congestions b. Congenital heart defect c. Congestive heart failure d. Systemic venous congestion

C

7. A clinical manifestation of the systemic venous congestion that can occur with congestive heart failure is: a. Tachypnea. b. Tachycardia. c. Peripheral edema. d. Pale, cool extremities.

C

11. The parents of a young child with congestive heart failure tell the nurse that they are nervous about giving digoxin. The nurses response should be based on knowing that: a. It is a safe, frequently used drug. b. It is difficult to either overmedicate or undermedicate with digoxin. c. Parents lack the expertise necessary to administer digoxin. d. Parents must learn specific, important guidelines for administration of digoxin.

D

17. Seventy-two hours after cardiac surgery, a young child has a temperature of 37.7 C (101 F). The nurse should: a. Keep the child warm with blankets. b. Apply a hypothermia blanket. c. Record the temperature on nurses notes. d. Report findings to physician.

D

2. Jos is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be: a. Directed at his parents because he is too young to understand. b. Detailed in regard to the actual procedures so he will know what to expect. c. Done several days before the procedure so that he will be prepared. d. Adapted to his level of development so that he can understand.

D

21. The most common causative agent of bacterial endocarditis is: a. Staphylococcus albus. b. Streptococcus hemolyticus. c. Staphylococcus albicans. d. Streptococcus viridans.

D

24. A common, serious complication of rheumatic fever is: a. Seizures. c. Pulmonary hypertension. b. Cardiac arrhythmias. d. Cardiac valve damage.

D

26. When discussing hyperlipidemia with a group of adolescents, the nurse should explain that high levels of what substance are thought to protect against cardiovascular disease? a. Cholesterol c. Low-density lipoproteins (LDLs) b. Triglycerides d. High-density lipoproteins (HDLs).

D

3. The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is too wet. The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to: a. Notify the physician. b. Apply a new bandage with more pressure. c. Place the child in the Trendelenburg position. d. Apply direct pressure above the catheterization site.

D

The nurse is preparing for the admission of an infant who will have several procedures performed. In which situation is informed consent required (Select all that apply)? a. Catheterized urine collection b. Intravenous (IV) line insertion c. Oxygen administration d. Lumbar puncture e. Computed tomography (CT) scan with contrast

D, E d. Lumbar puncture e. Computed tomography (CT) scan with contrast

When liquid medication is given to a crying 10-month-old infant, which approach minimizes the possibility of aspiration? a. Administering the medication with a syringe (without needle) placed along the side of the infant's tongue b. Administering the medication as rapidly as possible with the infant securely restrained c. Mixing the medication with the infant's regular formula or juice and administering by bottle d. Keeping the child upright with the nasal passages blocked for a minute after administration

a. Administering the medication with a syringe (without needle) placed along the side of the infant's tongue

Katie, 4 years old, is admitted to outpatient surgery for removal of a cyst on her foot. Her mother puts the hospital gown on her, but Katie is crying because she wants to leave on her underpants. The most appropriate nursing action is to: a. Allow her to wear her underpants. b. Discuss with her mother why this is important to Katie. c. Ask her mother to explain to her why she cannot wear them. d. Explain in a kind, matter-of-fact manner that this is hospital policy.

a. Allow her to wear her underpants.

The nurse is teaching a mother how to perform chest physiotherapy and postural drainage on her 3-year-old child, who has cystic fibrosis. To enable the mother to perform percussion, the nurse should instruct her to: a. Cover the skin with a shirt or gown before percussing. b. Strike the chest wall with a flat-hand position. c. Percuss over the entire trunk anteriorly and posteriorly. d. Percuss before positioning for postural drainage.

a. Cover the skin with a shirt or gown before percussing. For postural drainage and percussion, the child should be dressed in a light shirt to protect the skin and placed in the appropriate postural drainage positions. The chest wall is struck with a cupped-hand, not a flat-hand, position. The procedure should be done over the rib cage only. Positioning precedes the percussion.

The nurse gives an injection in a patient's room. What should the nurse do with the needle for disposal? a. Dispose of syringe and needle in a rigid, puncture-resistant container in patient's room. b. Dispose of syringe and needle in a rigid, puncture-resistant container in an area outside of patient's room. c. Cap needle immediately after giving injection and dispose of in proper container. d. Cap needle, break from syringe, and dispose of in proper container.

a. Dispose of syringe and needle in a rigid, puncture-resistant container in patient's room.

Kimberly, age 3 years, has a fever associated with a viral illness. Her mother calls the nurse, reporting a fever of 102° F even though Kimberly had acetaminophen 2 hours ago. The nurse's action should be based on knowing that: a. Fevers such as this are common with viral illnesses. b. Seizures are common in children when antipyretics are ineffective. c. Fever over 102° F indicates greater severity of illness. d. Fever over 102° F indicates a probable bacterial infection.

a. Fevers such as this are common with viral illnesses.

The nurse is preparing a 12-year-old girl for a bone marrow aspiration. She tells the nurse that she wants her mother with her "like before." The most appropriate nursing action is to: a. Grant her request. b. Explain why this is not possible. c. Identify an appropriate substitute for her mother. d. Offer to provide support to her during the procedure.

a. Grant her request. The parents' preferences for assisting, observing, or waiting outside the room should be assessed, as well as the child's preference for parental presence. The child's choice should be respected. If the mother and child are agreeable, the mother is welcome to stay. An appropriate substitute for the mother is necessary only if the mother does not wish to stay. Support is offered to the child regardless of parental presence.

When teaching a mother how to administer eyedrops, where should the nurse tell her to place them? a. In the conjunctival sac that is formed when the lower lid is pulled down b. Carefully under the upper eyelid while it is gently pulled upward c. On the sclera while the child looks to the side d. Anywhere as long as drops contact the eye's surface

a. In the conjunctival sac that is formed when the lower lid is pulled down

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

a. Prepare child for conscious sedation during the test.

A 6-year-old child is hospitalized for intravenous (IV) antibiotic therapy. He eats little on his "regular diet" trays. He tells the nurse that all he wants to eat is pizza, tacos, and ice cream. Which is the best nursing action? a. Request these favorite foods for him. b. Identify healthier food choices that he likes. c. Explain that he needs fruits and vegetables. d. Reward him with ice cream at the end of every meal that he eats.

a. Request these favorite foods for him

What is critical information for the nurse to incorporate into her care when using restraints on a child? a. Use the least restrictive type of restraint. b. Tie knots securely so they cannot be untied easily. c. Secure the ties to the mattress or side rails. d. Remove restraints every 4 hours to assess skin.

a. Use the least restrictive type of restraint.

The nurse wore gloves during a dressing change. When the gloves are removed, the nurse should: a. Wash hands thoroughly. b. Check the gloves for leaks. c. Rinse gloves in disinfectant solution. d. Apply new gloves before touching the next patient.

a. Wash hands thoroughly.

What is the most appropriate statement for the nurse to make to a 5-year-old child who is undergoing a venipuncture? a. "You must hold still or I'll have someone hold you down. This is not going to hurt." b. "This will hurt like a pinch. I'll get someone to help hold your arm still so it will be over fast and hurt less." c. "Be a big boy and hold still. This will be over in just a second." d. "I'm sending your mother out so she won't be scared. You are big, so hold still and this will be over soon."

b. "This will hurt like a pinch. I'll get someone to help hold your arm still so it will be over fast and hurt less."

. A child is receiving total parenteral nutrition (TPN; hyperalimentation). At the end of 8 hours, the nurse observes the solution and notes that 200 mL/8 hr is being infused rather than the ordered amount of 300 mL/8 hr. The nurse should adjust the rate so that how much will infuse during the next 8 hours? a. 200 Ml b. 300 mL c. 350 mL d. 400 mL

b. 300 mL

Which information should the nurse include in teaching parents how to care for a child's gastrostomy tube at home? a. Never turn the gastrostomy button. b. Clean around the insertion site daily with soap and water. c. Expect some leakage around the button. d. Remove the tube for cleaning once a week.

b. Clean around the insertion site daily with soap and water.

Using knowledge of child development, the best approach when preparing a toddler for a procedure is to: a. Avoid asking the child to make choices. b. Demonstrate the procedure on a doll. c. Plan for the teaching session to last about 20 minutes. d. Show necessary equipment without allowing child to handle it.

b. Demonstrate the procedure on a doll.

An important nursing consideration when performing a bladder catheterization on a young boy is to: a. Use clean technique, not Standard Precautions. b. Insert 2% lidocaine lubricant into the urethra. c. Lubricate catheter with water-soluble lubricant such as K-Y Jelly. d. Delay catheterization for 20 minutes while anesthetic lubricant is absorbed.

b. Insert 2% lidocaine lubricant into the urethra.

Guidelines for intramuscular administration of medication in school-age children include to: a. Inject medication as rapidly as possible. b. Insert the needle quickly, using a dartlike motion. c. Penetrate the skin immediately after cleansing the site, before skin has dried. d. Have the child stand, if possible, and if he or she is cooperative.

b. Insert the needle quickly, using a dartlike motion.

The nurse has just collected blood by venipuncture in the antecubital fossa. Which should the nurse do next? a. Keep arm extended while applying a bandage to the site. b. Keep arm extended, and apply pressure to the site for a few minutes. c. Apply a bandage to the site, and keep the arm flexed for 10 minutes. d. Apply a gauze pad or cotton ball to the site, and keep the arm flexed for several minutes.

b. Keep arm extended, and apply pressure to the site for a few minutes.

Which nursing action is the most appropriate when applying a face mask to a child for oxygen therapy? a. Set the oxygen flow rate at less than 6 L/min. b. Make sure the mask fits properly. c. Keep the child warm. d. Remove the mask for 5 minutes every hour.

b. Make sure the mask fits properly.

A venipuncture will be performed on a 7-year-old girl. She wants her mother to hold her during the procedure. The nurse should recognize that this: a. Is unsafe. b. May help the child relax. c. Is against hospital policy. d. Is unnecessary because of the child's age.

b. May help the child relax.

In preparing to give "enemas until clear" to a young child, the nurse should select: a. Tap water. b. Normal saline. c. Oil retention. d. Fleet solution.

b. Normal saline.

A 2-year-old child comes to the emergency department with dehydration and hypovolemic shock. What best explains why an intraosseous infusion is started? a. It is less painful for small children. b. Rapid venous access is not possible. c. Antibiotics must be started immediately. d. Long-term central venous access is not possible.

b. Rapid venous access is not possible. In situations in which rapid establishment of systemic access is vital and venous access is hampered, such as peripheral circulatory collapse and hypovolemic shock, intraosseous infusion provides a rapid, safe lifesaving alternative. The procedure is painful, and local anesthesia and systemic analgesia are given. Antibiotics could be given when vascular access is obtained. Long-term central venous access is time consuming, and intraosseous infusion is used in an emergency situation.

The nurse is planning how to best prepare a 4-year-old child for some diagnostic procedures. Guidelines for preparing this preschooler should include: a. Planning for a short teaching session of about 30 minutes. b. Telling the child that procedures are never a form of punishment. c. Keeping equipment out of the child's view. d. Using correct scientific and medical terminology in explanations.

b. Telling the child that procedures are never a form of punishment.

An appropriate method for administering oral medications that are bitter to an infant or small child would be to mix them with: a. A bottle of formula or milk. b. Any food the child is going to eat. c. A small amount (1 teaspoon) of a sweet-tasting substance such as jam or ice cream. d. Large amounts of water to dilute medication sufficiently.

c. A small amount (1 teaspoon) of a sweet-tasting substance such as jam or ice cream.

A critically ill child has hyperthermia. The parents ask the nurse to give an antipyretic such as acetaminophen (Tylenol). The nurse should explain that antipyretics: a. May cause malignant hyperthermia. b. May cause febrile seizures. c. Are of no value in treating hyperthermia. d. Are of limited value in treating hyperthermia.

c. Are of no value in treating hyperthermia.

Frequent urine testing for specific gravity and glucose are required on a 6-month-old infant. The most appropriate way to collect small amounts of urine for these tests is to: a. Apply a urine-collection bag to the perineal area. b. Tape a small medicine cup to the inside of the diaper. c. Aspirate urine from cotton balls inside the diaper with a syringe. d. Aspirate urine from a superabsorbent disposable diaper with a syringe.

c. Aspirate urine from cotton balls inside the diaper with a syringe.

Nursing considerations related to the administration of oxygen in an infant include to: a. Humidify the oxygen if the infant can tolerate it. b. Assess the infant to determine how much oxygen should be given. c. Ensure uninterrupted delivery of the appropriate oxygen concentration. d. Direct the oxygen flow so that it blows directly into the infant's face in a hood.

c. Ensure uninterrupted delivery of the appropriate oxygen concentration.

The nurse must suction a child with a tracheostomy. Interventions should include: a. Encouraging the child to cough to raise the secretions before suctioning. b. Selecting a catheter with a diameter three-fourths as large as the diameter of the tracheostomy tube. c. Ensuring that each pass of the suction catheter take no longer than 5 seconds. d. Allowing the child to rest after every 5 times the suction catheter is passed.

c. Ensuring that each pass of the suction catheter take no longer than 5 seconds.

In some genetically susceptible children, anesthetic agents can trigger malignant hyperthermia. The nurse should be alert in observing that, in addition to an increased temperature, an early sign of this disorder is: a. Apnea. b. Bradycardia. c. Muscle rigidity. d. Decreased blood pressure.

c. Muscle rigidity.

A nurse must do a venipuncture on a 6-year-old child. An important consideration in providing atraumatic care is to: a. Use an 18-gauge needle if possible. b. If not successful after four attempts, have another nurse try. c. Restrain the child only as needed to perform venipuncture safely. d. Show the child equipment to be used before procedure.

c. Restrain the child only as needed to perform venipuncture safely.

Tepid water or sponge baths are indicated for hyperthermia in children. The nurse should: a. Add isopropyl alcohol to the water. b. Direct a fan on the child in the bath. c. Stop the bath if the child begins to chill. d. Continue the bath for 5 minutes.

c. Stop the bath if the child begins to chill.

The emergency department nurse is cleaning multiple facial abrasions on 9-year-old Mike. His mother is present. He is crying and screaming loudly. The nurse should: a. Ask him to be quieter. b. Have his mother tell him to relax. c. Tell him it is okay to cry and scream. d. Suggest that he talk to his mother instead of crying.

c. Tell him it is okay to cry and scream.

What should the nurse consider when having consent forms signed for surgery and procedures on children? a. Only a parent or legal guardian can give consent. b. The person giving consent must be at least 18 years old. c. The risks and benefits of a procedure are part of the consent process. d. A mental age of 7 years or older is required for a consent to be considered "informed."

c. The risks and benefits of a procedure are part of the consent process. The informed consent must include the nature of the procedure, benefits and risks, and alternatives to the procedure. In special circumstances such as emancipated minors, the consent can be given by someone younger than 18 years without the parent or legal guardian. A mental age of 7 years is too young for consent to be informed.

What nursing action is appropriate for specimen collection? a. Follow sterile technique for specimen collection. b. Sterile gloves are worn if the nurse plans to touch the specimen. c. Use Standard Precautions when handling body fluids. d. Avoid wearing gloves in front of the child and family.

c. Use Standard Precautions when handling body fluids.

The nurse is caring for an unconscious child. Skin care should include: a. Avoiding use of pressure reduction on the bed. b. Massaging reddened bony prominences to prevent deep tissue damage. c. Using draw sheet to move child in bed to reduce friction and shearing injuries. d. Avoiding rinsing skin after cleansing with mild antibacterial soap to provide a protective barrier.

c. Using draw sheet to move child in bed to reduce friction and shearing injuries.

The nurse is doing a prehospitalization orientation for a 7-year-old child who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that she will not be able to talk because of an endotracheal tube but that she will be able to talk when it is removed. This explanation is: a. Unnecessary. b. The surgeon's responsibility. c. Too stressful for a young child. d. An appropriate part of the child's preparation.

d. An appropriate part of the child's preparation.

It is important to make certain that sensory connectors and oximeters are compatible since wiring that is incompatible can cause: a. Hyperthermia. b. Electrocution. c. Pressure necrosis. d. Burns under sensors.

d. Burns under sensors.

The nurse approaches a group of school-age patients to administer medication to Sam Hart. To identify the correct child, the nurse should: a. Ask the group, "Who is Sam Hart?" b. Call out to the group, "Sam Hart?" c. Ask each child, "What's your name?" d. Check the patient's identification name band.

d. Check the patient's identification name band.

An appropriate intervention to encourage food and fluid intake in a hospitalized child is to: a. Force child to eat and drink to combat caloric losses. b. Discourage participation in noneating activities until caloric intake is sufficient. c. Administer large quantities of flavored fluids at frequent intervals and during meals. d. Give high-quality foods and snacks whenever child expresses hunger.

d. Give high-quality foods and snacks whenever child expresses hunger.

When caring for a child with an intravenous infusion, the nurse should: a. Use a macrodropper to facilitate reaching the prescribed flow rate. b. Avoid restraining the child to prevent undue emotional stress. c. Change the insertion site every 24 hours. d. Observe the insertion site frequently for signs of infiltration.

d. Observe the insertion site frequently for signs of infiltration.

When administering a gavage feeding to a school-age child, the nurse should: a. Lubricate the tip of the feeding tube with Vaseline to facilitate passage. b. Check the placement of the tube by inserting 20 mL of sterile water. c. Administer feedings over 5 to 10 minutes. d. Position the child on the right side after administering the feeding.

d. Position the child on the right side after administering the feeding.

An 8-month-old infant is restrained to prevent interference with the intravenous infusion. The nurse should: a. Remove the restraints once a day to allow movement. b. Keep the restraints on constantly. c. Keep the restraints secure so the infant remains supine. d. Remove the restraints whenever possible.

d. Remove the restraints whenever possible.

Which is the preferred site for intramuscular injections in infants? a. Deltoid b. Dorsogluteal c. Rectus femoris d. Vastus lateralis

d. Vastus lateralis

The nurse must do a heel stick on an ill neonate to obtain a blood sample. Which procedure is recommended to facilitate this? a. Apply cool, moist compresses. b. Apply a tourniquet to the ankle. c. Elevate the foot for 5 minutes. d. Wrap foot in a warm washcloth.

d. Wrap foot in a warm washcloth.