Chapter 32: Care of the Child With a Physical and Mental or Cognitive Disorder TB

46. The nurse instructs the parents of a child who has had a myringotomy to place the child in which position? a. Supine b. On the affected side c. On the unaffected side d. In a Trendelenburg's position

ANS: B Lying on the affected side facilitates ear drainage following a myringotomy.

17. What is the best time to administer pancreatic enzyme replacement? a. Before meals and snacks b. Before bedtime c. Early in the morning d. After meals and snacks

ANS: A Pancreatic enzymes are administered before meals and snacks to digest carbohydrates, fats, and proteins.

4. Autism is typically diagnosed between __ and 3 years of age.

ANS: 2 Autistic is typically diagnosed between 2 and 3 years of age

53. Which statement correctly explains the etiology of Down syndrome? a. There is an extra chromosome on the 21st pair. b. There is a missing chromosome on the 21st pair. c. There are two pairs of the 21st chromosome. d. The chromosome's 21st pair is missing.

ANS: A Down syndrome is attributed to an extra chromosome on the 21st pair

30. The nurse explains to the parents of a child with developmental hip dysplasia that the application of a Pavlik harness is necessary. In what position will the harness hold the child's femurs? a. Abduction b. Adduction c. Flexion d. Extension

ANS: A The use of the Pavlik harness maintains the hips in abduction for 4 to 6 months.

15. The nurse educates the family of a newly admitted child with cystic fibrosis that the treatment will be centered on what therapy? a. Chest physiotherapy b. Mucus-drying agents c. Prevention of diarrhea d. Insulin therapy

ANS: A Chest physiotherapy and aerosol medications are the center of treatment for cystic fibrosis.

59. The parents of a child suffering from depression ask the nurse what causes depression in children. Which answer is an appropriate response by the nurse? a. The causes of major depression are unknown. b. Major affective disorders in parents increase depression in children. c. Boys are more likely than girls to be depressed. d. The prevalence rate is higher in prepubescent children.

ANS: A The causes of depression have not been established. However, many studies have shown that children have a three times greater rate of suffering from depression if their parents have a major affective disorder.

1. When assessing the laboratory values of a child with nephrosis, the nurse anticipates which results? (Select all that apply.) a. High levels of protein in the urine b. High serum lipid levels c. Low serum protein levels d. Low hemoglobin e. High white blood cell count

ANS: A, B, C A patient with nephrotic syndrome has high levels of serum lipids, low serum protein, and albumin in urine that is dark and frothy with a high specific gravity. The hemoglobin and WBC are usually normal.

2. The nurse explains that which diagnostic studies are needed for the diagnosis of cognitive impairment? (Select all that apply.) a. Denver Developmental Screening Test b. Stanford-Binet Intelligence Scale c. Wechsler Intelligence Scale d. Miller's Analogies e. Strong Personality Assessment

ANS: A, B, C The Denver, Stanford-Binet, and Wechsler are standard intelligence tests that aid in the diagnosis of a cognitively impaired child.

9. What most influences the severity of respiratory distress syndrome (RDS)? a. Poor cough and gag reflex b. The gestational age at birth c. Administering high concentrations of oxygen d. The sex of the infant

ANS: B RDS is caused by a deficiency of surfactant and it occurs almost exclusively in preterm, low-birth weight infants

3. Parents of a 6-month-old child, who has just been diagnosed with iron deficiency anemia, ask why it was not diagnosed earlier. What would be the best response by the nurse? a. "Are you sure your child has iron deficiency anemia?" b. "This happens when the maternal stores of iron are depleted at about 6 months." c. "This anemia is caused by blood loss." d. "The child may not have had it for a long time."

ANS: B Iron deficiency anemia becomes apparent at about 6 months of age in a full-term infant, when maternal stores of iron are depleted.

57. The nurse is caring for a child who has been diagnosed as having an attention deficit hyperactivity disorder (ADHD). What is the most important intervention for the nurse? a. Have the child enrolled in a special education class. b. Allay any feelings of guilt the parents may have. c. Counsel the parents that the medications are lifelong. d. Teach the parents to set limits.

ANS: B It is most important to allay any feelings of guilt the parents may have

25. What is the hallmark sign of intussusception? a. Mucus-like stools b. Currant jelly-like stools c. Tarry, black stools d. Green, soft stools

ANS: B The hallmark sign of intussusception is currant jelly stools.

32. A newborn has talipes and is wearing casts. How often should the casts be changed? a. Daily b. Weekly c. Biweekly d. Monthly

ANS: B Treatment of talipes consists of manipulation and the application of a series of short leg casts. The foot is gently manipulated into a more normal position and then placed in a cast to maintain the correction. Casts are changed weekly to allow for further manipulation and to accommodate the rapidly growing infant.

12. What could suddenly occur in a child with acute epiglottitis? a. Increased carbon dioxide levels b. Airway obstruction c. Inability to swallow d. Bronchial collapse

ANS: B In acute epiglottitis, the infected epiglottis becomes inflamed and causes total airway obstruction. Immediate treatment of acute epiglottitis includes an artificial airway

28. When selecting patient problems for the 4-year-old child with nephrosis, what should be a priority for the nurse? a. Impaired body image b. Skin impairment c. Nutritional deficit d. Injury

ANS: B Nephrosis is a clinical state characterized by gross edema, which makes skin care a priority

41. An adolescent female asks the nurse about taking retinoic acid (Accutane). What guidance should be provided by the nurse? a. The medication should be used only for 10 weeks. b. The medication requires that sexually active females use contraception. c. The medication lowers hemoglobin very quickly. . The medication has few side effects. .

ANS: B Accutane has many side effects and can produce birth defects. Effective contraception is necessary during treatment and for 1 month after the 20 weeks it is to be taken

60. When the nurse performs the initial assessment of an adolescent with depression, what is the most important question to ask? a. "What is making you depressed?" b. "Have you ever thought about suicide?" c. "What could we do to make you happy?" d. "Would you like your friends to visit?"

ANS: B Ask direct questions about suicidal thoughts. The discovery of whether the person has an actual plan is an indicator of the seriousness of the situation.

2. What is the most common clinical manifestation of coarctation of the aorta? a. Clubbing of the digits b. Upper extremity hypertension c. Pedal edema and portal congestion d. Loud systolic ejection murmur

ANS: B Coarctation of the aorta results in hypertension in the upper extremities. The pressure in the arms is typically 20 mm Hg higher than in the legs.

40. An infant has been diagnosed with cradle cap. What is the correct intervention to treat the scalp? a. Alcohol b. Mineral oil c. Calamine d. A&D ointment

ANS: B Crusty patches can be removed with the application of mineral oil.

61. What is the most common method of attempted suicide? a. Hanging b. Drug overdose c. Gunshot d. Slashing the wrists

ANS: B Drug overdose is the most common method of attempted suicide.

43. What are early signs of varicella disease? a. High fever over 101°F (38.3°C) b. General malaise c. Increased appetite d. Crusty sores

ANS: B Early signs of varicella will develop during the prodromal period and are mainly low-grade fever, malaise, and anorexia. Lesions do not appear until later.

23. How is the infant with gastroesophageal reflux (GER) typically treated? a. By making the infant NPO b. By thickening the formula or breast milk with cereal c. By placing the infant to sleep on the side d. By switching the infant to cow's milk

ANS: B GER is treated with small feedings thickened with cereal. The infant should not be made NPO or switched to cow's milk. Infants should only be placed on the back to sleep due to the risk of SIDS.

38. Which additional congenital malformation is expected in 80% of infants with a myelomeningocele? a. Cerebral palsy b. Hydrocephalus c. Meningitis d. Neuroblastoma

ANS: B Hydrocephalus is present in 80% of infants affected by a myelomeningocele.

55. What assessment findings should lead the nurse to suspect Down syndrome in a newborn? a. Hypertonia and dark skin b. Low-set ears and a simian crease c. Inner epicanthal folds and a high, domed forehead d. Long, thin fingers and excessive hair

ANS: B Manifestations of the Down syndrome infant include low-set ears, simian crease, protruding tongue, and hypotonic extremities.

6. The parents of a child recently diagnosed with sickle cell anemia ask what can be done to avoid a sickle cell crisis. What should be included in the medical management of sickle cell crisis? a. Information for the parents including home care b. Provisions for adequate hydration and pain management c. Pain management and administration of iron supplements d. Adequate oxygenation and factor VIII

ANS: B Medical management of sickle cell crisis includes palliative analgesics, hydration, and oxygen.

52. Which is a priority nursing intervention for the cognitively impaired child? a. The family will provide good nutrition. b. The family will provide loving interactions. c. Stimulation will improve. d. There will be contact with peers.

ANS: B Nursing interventions focus on promoting optimal development and loving interactions with family.

37. The nurse is caring for a newborn with a myelomeningocele. Before surgery, what should the nursing interventions include? a. Leaving the lesion uncovered and placing the infant supine b. Covering the lesion with a sterile, saline-soaked gauze c. Applying lotion to the lesion to keep it moist d. Covering the lesion with a dry, sterile gauze

ANS: B Nursing interventions for an infant with myelomeningocele include covering the lesion with a sterile, saline-soaked gauze.

42. A new mother asks the clinic nurse if she must continue giving her baby nystatin for thrush since the white lesions on his tongue have disappeared. What response by the nurse is most appropriate? a. "No. When the lesions have gone you may stop the nystatin." b. "Yes. You should continue it for the full 7 days." c. "No. Thrush is a self-limiting disorder and nystatin is given for comfort only." d. "Yes. The medication should be refilled for a second week of therapy."

ANS: B Nystatin should be given for the full 7 days even if the lesions are no longer present.

56. Parents of a school-age child ask the nurse for suggestions in helping the child who is demonstrating school avoidance. What is an appropriate suggestion by the nurse? a. Take the child to the health care provider for testing. b. Be firm and insist the child go to school. c. Allow the child to stay home and rest. d. Consult with the teacher at school.

ANS: B Parents should be firm and insist the child go to school.

64. The nurse is recording a history for a child who has been diagnosed with recurrent abdominal pain (RAP). What is a finding that is characteristic of this disorder? a. Morning headaches b. Pain for 3 consecutive months c. Febrile episodes in the late afternoon d. Diaphoresis when attacks occur

ANS: B Recurrent abdominal pain occurring consecutively for 3 months supports a diagnosis of RAP once other causes have been ruled out.

1. The nurse uses a diagram to show that the tetralogy of Fallot involves a combination of four congenital defects. What are the defects? a. Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy b. Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy c. Aortic stenosis, atrial septal defect, overriding aorta, right ventricular hypertrophy d. Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

ANS: B Tetralogy of Fallot involves a combination of four congenital defects: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy.

63. When performing an assessment of a child with recurrent abdominal pain (RAP), the nurse recognizes the child will most likely experience what symptom? a. Increased temperature b. Constipation c. Right quadrant pain d. Exercise-associated pain

ANS: B The child may be constipated with periumbilical pain unrelated to eating, defecation, or exercise

10. A 2-year-old child with laryngotracheobronchitis (LTB) is fussy and restless in the oxygen tent. The oxygen level in the tent is 25%, and blood gases are normal. What would be the correct action by the nurse? a. Restrain the child in the tent and notify the health care provider. b. Increase the oxygen concentration in the tent. c. Take the child out of the tent and into the playroom. d. Ask the mother for help in comforting the child.

ANS: B The child with LTB should be placed in the mist tent with 30% oxygen. Restlessness is caused by poor oxygenation. The child should not be taken out of the oxygenated tent. While the mother could be asked to help comfort the child, and the health care provider may be notified, the priority is to set the oxygen at the correct level.

5. The parents of a child who has been diagnosed with sickle cell anemia ask why their child experiences pain. What is the most likely cause of the pain? a. Inflammation of the vessels b. Obstructed blood flow c. Overhydration d. Stress-related headaches

ANS: B The signs and symptoms of sickle cell anemia include the sickle-shaped cells clumping and obstructing blood flow, which causes severe tissue hypoxia and necrosis leading to pain.

29. When caring for a 7-week-old infant with hypothyroidism, the nurse explains that the prevention of what complication is dependent on the administration of oral thyroid replacement therapy and is critical for the child? a. Excessive growth b. Cognitive impairment c. Damage to the nervous system d. Damage to the urinary system

ANS: B The treatment of choice for congenital and acquired hypothyroidism is oral thyroid hormone replacement therapy. Prompt treatment is especially critical in the infant with congenital hypothyroidism to avoid permanent cognitive impairment.

8. The parents of a child with acute lymphoblastic leukemia ask about the best approach for maintaining remission of the disease. What would be the most effective therapy? a. Surgery to remove enlarged lymph nodes b. Long-term chemotherapy c. Nutritional supplements to enhance blood cell production d. Blood transfusions to replace ineffective red cells

ANS: B The treatment of choice is methotrexate, a chemotherapeutic agent, to produce remission

39. When speaking to young parents, the nurse states that lead poisoning is one of the most common preventable health problems affecting children. What condition occurs when the level of lead ingested exceeds the amount that can be absorbed by the bone? a. Malnutrition b. Anemia c. Bone pain d. Diarrhea

ANS: B When the amount of lead ingested exceeds the amount that can be absorbed by the bone, it leads to anemia.

58. Since children with attention deficit hyperactivity disorder (ADHD) take medication for long periods of time, side effects must be considered. How often should children be assessed for side effects of the drug therapy? a. Every 2 months b. Every 4 months c. Every 6 months d. Every 8 months

ANS: C Children should be checked for medication side effects every 6 months.

35. The health care provider is treating a child with meningitis with a course of antibiotic therapy. When should the nurse expect the child to be out of isolation? a. When the course of antibiotics is complete b. When a negative CNS culture is obtained c. When the antibiotics have been initiated for 24 hours d. When the child has no symptoms of the disease

ANS: C The child with bacterial meningitis is isolated for at least 24 hours until antibiotic therapy has been administered.

14. When interacting with the parents of a SIDS infant, the nurse should attempt to assist the parents with: a. encouraging the parents to have another baby b. encouraging the parents to remain stoic. c. allaying feelings of guilt and blame. d. learning how the event could have been prevented.

ANS: C As parents try to cope, they have feelings of guilt and blame

34. Which signs/symptoms would be considered classical signs of meningeal irritation? a. Positive Kernig sign, diarrhea, and headache b. Negative Brudzinski sign, positive Kernig sign, and irritability c. Positive Brudzinski sign, positive Kernig sign, and photophobia d. Negative Kernig sign, vomiting, and fever

ANS: C Classical manifestations of meningitis include positive Kernig and Brudzinski signs

47. What are the clinical manifestations of otitis media? a. Earache, wheezing, vomiting . Coughing, rhinorrhea, headache c. Fever, irritability, pulling on ear d. Wheezing, cough, drainage in ear canal

ANS: C Clinical manifestations of otitis media include fever, irritability, and pulling on the ear

51. What is the major criterion for diagnosing a child as cognitively impaired? a. An IQ of 75 or less b. Subaverage functioning c. An IQ of 70 or less d. Onset before 18

ANS: C Cognitive impairment is based upon IQs from 20 to 70.

48. The nurse instructs the mother of a child with a ventricular septal defect that she can expect the child to become cyanotic when the child does what? a. Experiences an elevation in temperature. b. Sleeps on the left side. c. Cries vigorously. d. Eats.

ANS: C Crying vigorously will increase the pressure in the right ventricle, which will allow unoxygenated blood to enter the circulating volume

27. What should the nurse caring for a 6-year-old child with acute glomerulonephritis anticipate as the most difficult part of the care to implement? a. Forced fluids b. Increased feedings c. Bed rest d. Frequent position changes

ANS: C During the acute phase of glomerulonephritis, bed rest is usually recommended. A diet of restricted fluid, sodium, potassium, and phosphate is initially required. Bed rest can be very hard to implement with an active 6-year-old child.

54. What other congenital defects are common in children with Down syndrome? a. Hypospadias b. Pyloric stenosis c. Heart defects d. Hip dysplasia

ANS: C Many children with Down syndrome have congenital heart defects.

19. What is the priority patient problem for the parents of a newborn born with cleft lip and palate? a. Parental role conflict b. Risk for delayed growth and development c. Risk for impaired attachment d. Anticipatory grieving

ANS: C Parents of a child with cleft lip and palate may have difficulty bonding with their child due to the appearance of the child. The priority patient problem is risk for impaired attachment. A goal is to promote bonding between parents and infant.

31. A teenage girl has been placed in a brace for the treatment of scoliosis, the most common skeletal deformity of adolescence. The family asks what they can do to be more supportive. What suggestion of the nurse is the most appropriate? a. Enrolling her in a health club b. Taking her to the mall in a wheelchair c. Purchasing clothes to disguise the cast d. Spending a majority of their time with her .

ANS: C The adolescent is trying to fit in with peers and has concerns about body image

50. The nurse explains that cognitive impairment is categorized by four levels that depend on the intelligence quotient (IQ). How is a child with an IQ of 45 classified? a. Within the normal low range b. Educable c. Trainable d. Severe

ANS: C The category of trainable is identified on the basis of an IQ of 35 to 55.

26. Which is a causative factor of Hirschsprung disease? a. Frequent evacuation of solids, liquid, and gases b. Excessive peristaltic movement c. The absence of parasympathetic ganglion cells in a portion of the colon d. One portion of the bowel telescoping into another

ANS: C The causative factor in Hirschsprung disease is the absence of parasympathetic ganglion cells in a portion of the colon.

49. Parents of a 5-year-old child diagnosed as cognitively impaired have come to the nurse to discuss different approaches to the ongoing care of their child. The nurse should suggest focusing on what activity? a. Acquiring job skills b. Making decisions c. Performing self-care activities d. Reading and doing simple math

ANS: C The cognitively impaired young child should be encouraged to learn simple skills for doing self-care.

20. Which is a long-term complication of cleft lip and palate? a. Cognitive impairment b. Altered growth and development c. Faulty dentition d. Physical abilities

ANS: C The older child with cleft lip and palate may experience psychological difficulties because of the cosmetic appearance of the defect, problems with impaired speech, and faulty dentition.

16. What is the main characteristic of cystic fibrosis? a. Multiple upper respiratory infections b. An underproduction of exocrine glands c. Excessive, thick mucus d. An overproduction of thin mucus

ANS: C The pathophysiology of cystic fibrosis includes excessive, thick mucus.

4. What should the therapeutic management of iron deficiency anemia include? a. Multivitamins b. Calcium c. Ferrous sulfate d. Iodine

ANS: C Therapeutic management of iron deficiency anemia is iron (ferrous sulfate) supplementation, nutritional counseling, and treatment of any underlying condition.

45. A child has developed a diaper rash, and the parents are using zinc oxide to treat it. What does the nurse suggest to aid in the removal of the zinc oxide? a. Mild soap and water b. A cotton ball c. Mineral oil d. Alcohol swabs

ANS: C To completely remove ointment, especially zinc oxide, mineral oil should be used.

33. A child with Duchenne muscular dystrophy rises from the floor by walking up the thighs with the hands. How should the nurse record this observation? a. Hand assistance b. Leg crawling c. Gowers sign d. Bright sign

ANS: C Using the hands to walk up the thighs is known as the Gowers sign.

21. How should the nurse measure urinary output for an infant with dehydration? a. Attaching a urine collecting bag b. Wringing out the diaper c. Weighing the diaper d. Inserting a catheter

ANS: C Wet diapers are weighed to assess the amount of output.

36. What are priority nursing interventions designed to do for a 4-year-old child with cerebral palsy? a. Assist with referral to specialized education. b. Support the child with independent toileting. c. Assist the child to develop effective communication. d. Encourage the child to ambulate independently.

ANS: D A child with cerebral palsy is usually in need of support with communication, locomotion, and self-help.

24. What should the nurse assess in an infant who has been diagnosed with hypertrophic pyloric stenosis? a. A history of diarrhea following each feeding b. Gastric pain evidenced by vigorous crying c. Poor appetite due to a poor sucking reflex d. An olive-shaped mass right of the midline

ANS: D Examination of the abdomen may assist in the diagnosis and reveal key signs of hypertrophic pyloric stenosis. Visible peristaltic waves that move from left to right across the epigastric region may be evident, and palpation may reveal an olive-shaped mass in this area to the right of the midline.

7. Which laboratory results should the nurse anticipate to be abnormal in a child with hemophilia? a. Prothrombin time b. Bleeding time c. Platelet count d. Partial thromboplastin time

ANS: D Expected laboratory findings for a child with hemophilia include a prolonged partial thromboplastin time. The prothrombin time, bleeding time, and platelet count are typically normal.

62. Recurrent abdominal pain (RAP) is most often seen in school-age or adolescent children. The nurse should assess closely for what potential problems? a. Physical problems b. Relational problems c. Eating disorders d. Emotional problems

ANS: D RAP is often related to emotional factors in the child.

11. The mother of a child with acute laryngotracheobronchitis (LTB) asks why her child must be kept NPO. Which responses would be the most correct? a. The epinephrine given causes nausea and vomiting. b. The child is being hydrated with IV fluids. c. The child is not hungry. d. The child's rapid respirations pose a risk for aspiration.

ANS: D Rapid respirations predispose to aspiration. The child is kept hydrated with IV fluids, but this is not the reason that the child must be kept NPO.

13. When conducting a class for parents about sudden infant death syndrome (SIDS), the nurse instructs the class that the infant should be placed in which position to sleep? a. Right side-lying b. Left side-lying c. Prone d. Supine

ANS: D The American Academy of Pediatrics recommends placing the infant on its back, or supine, to sleep.

44. The mother of a child who has been diagnosed with varicella asks the nurse when the child can return to school. When is the child no longer contagious? a. When the fever dissipates b. After the incubation period c. When the lesions have healed d. When the lesions are crusted over

ANS: D Varicella is no longer contagious when the lesions are dry.

18. Following surgical repair of a cleft palate, what should be used to prevent injury to the suture line? a. Straw b. Spoon c. Syringe d. Cup

ANS: D When feeding a child with a repaired cleft palate, the nurse should avoid utensils, straws, droppers, and syringes.

22. Following a bout of diarrhea, which foods should be offered to the school-age child? a. Apricots and peaches b. Chocolate milk c. Applesauce and milk d. Bananas and rice

ANS: D When rehydration has been completed, foods that are nonirritating to the bowel should be offered to the child. Bananas and rice would be the least irritating to the bowel, as fruits and milk could cause GI irritation.

1. When the mother of a child with gastroesophageal reflux calls the clinic nurse to report that her baby is vomiting small amounts of blood, the nurse explains that the esophagus has been irritated by gastric ________.

ANS: acid Gastric acid that has repeatedly come in contact with the esophageal mucosa will erode the mucosa, and bleeding will result

3. The nurse anticipates that the cerebrospinal fluid (CSF) taken from a child with bacterial meningitis would have a low __________ level.

ANS: glucose The glucose level in the CSF of a child with bacterial meningitis is low because the bacteria in the fluid have digested the glucose.

2. The nurse reassures the anxious mother of a child with pyloric stenosis who is to have surgery that the surgical procedure, called a __________, is quickly done and the child recovers almost immediately.

ANS: pyloromyotomy When the muscle is cut, the obstruction is immediately relieved and the child who is hungry will begin to eat and keep food down.