Chapter 45 - Study Questions

399. Antibiotics are prescribed for a child with otitis media who underwent a myringotomy with insertion of tympanostomy tubes. The nurse provides discharge instructions to the parents regarding the administration of the antibiotics. Which state-ment, if made by the parents, indicates under-standing of the instructions provided? 1. "Administer the antibiotics until they are gone." 2. "Administer the antibiotics if the child has a fever." 3. "Administer the antibiotics until the child feels better." 4. "Begin to taper the antibiotics after 3 days of a full course."

1 Rationale: A myringotomy is the insertion of tympanoplasty tubes into the middle ear to promote drainage of purulent mid-dle ear fluid, equalize pressure, and keep the ear aerated. The nurse must instruct parents regarding the administration of antibiotics. Antibiotics need to be taken as prescribed, and the full course needs to be completed. Options 2, 3, and 4 are incorrect. Antibiotics are not tapered, but are administered for the full course of therapy. Test-Taking Strategy: Focus on the subject, understanding of the instructions about antibiotics. Recall that antibiotics must be taken for the full course, regardless of whether the child is feel-ing better. This will assist in directing you to the correct option. Review: Administration of antibiotics

398. The nurse is caring for a child after a tonsillectomy. The nurse monitors the child, knowing that which finding indicates the child is bleeding? 1. Frequent swallowing 2. A decreased pulse rate 3. Complaints of discomfort 4. An elevation in blood pressure

1 Rationale: A tonsillectomy is the surgical removal of the tonsils. Frequent swallowing, restlessness, a fast and thready pulse, and vomiting bright red blood are signs of bleeding. An elevated blood pressure and complaints of discomfort are not indications of bleeding. Test-Taking Strategy: Focus on the subject, a sign of bleeding, and use the concepts related to the signs of shock. These concepts should assist in eliminating options 2 and 4. From the remaining options, recalling that discomfort is expected and does not indicate bleeding will direct you to the correct option. Review: Signs of bleeding following tonsillectomy

392. After a tonsillectomy, a child begins to vomit bright red blood. The nurse should take which initial action? 1. Turn the child to the side. 2. Administer the prescribed antiemetic. 3. Notify the health care provider (HCP). 4. Maintain NPO (nothing by mouth) status.

1 Rationale: After tonsillectomy, if bleeding occurs, the nurse immediately turns the child to the side to prevent aspiration and then notifies the HCP. NPO status would be maintained, and an antiemetic may be prescribed; however, the initial nurs-ing action would be to turn the child to the side. Test-Taking Strategy: Note the strategic word, initial. Although all of the options may be appropriate to maintain physiological integrity, the initial action is to turn the child to the side to prevent aspiration. Review: Tonsillectomy

401. A child has been diagnosed with acute otitis media of the right ear. Which interventions should the nurse include in the plan of care? Select all that apply. 1. Provide a soft diet. 2. Position the child on the left side. 3. Administer an antihistamine twice daily. 4. Irrigate the right ear with normal saline every 8 hours. 5. Administer ibuprofen for fever every 4 hours as prescribed and as needed. 6. Instruct the parents about the need to admin-ister the prescribed antibiotics for the full course of therapy.

1, 5, 6 Rationale: Acute otitis media is an inflammatory disorder caused by an infection of the middle ear. The child often has fever, pain, loss of appetite, and possible ear drainage. The child also is irritable and lethargic and may roll the head or pull on or rub the affected ear. Otoscopic examination may reveal a red, opaque, bulging, and immobile tympanic membrane. Hearing loss may be noted particularly in chronic otitis media. The child's fever should be treated with ibuprofen. The child is positioned on his or her affected side to facilitate drainage. A soft diet is recommended during the acute stage to avoid pain that can occur with chewing. Antibiotics are prescribed to treat the bacterial infection and should be administered for the full prescribed course. The ear should not be irrigated with normal saline because it can exacerbate the inflammation further. Anti-histamines are not usually recommended as a part of therapy. Test-Taking Strategy: Focus on the subject, care for the child with acute otitis media, and on the child's diagnosis and note the words acute and right ear. Think about the pathophysiology associated with the disorder and the associated manifestations to select the correct options. Review: Acute otitis media

395. The nurse is reviewing the laboratory results for a child scheduled for a tonsillectomy. The nurse determines that which laboratory value is most sig-nificant to review? 1. Creatinine level 2. Prothrombin time 3. Sedimentation rate 4. Blood urea nitrogen level

2 Rationale: A tonsillectomy is the surgical removal of the ton-sils. Because the tonsillar area is so vascular, postoperative bleeding is a concern. Prothrombin time, partial thromboplas-tin time, platelet count, hemoglobin and hematocrit, white blood cell count, and urinalysis are performed preoperatively. The prothrombin time results would identify a potential for bleeding. Creatinine level, sedimentation rate, and blood urea nitrogen would not determine the potential for bleeding. Test-Taking Strategy: Note the strategic word, most. Focus on the surgical procedure and the subject of the question. The subject of the question relates to the potential for bleeding. Options 1 and 4 can be eliminated because they relate to kid-ney function. Option 3 can be eliminated because it is unrelated to the subject of the question. Review: Tonsillectomy

396. The nurse is preparing to care for a child after a ton-sillectomy. The nurse documents on the plan of care to place the child in which position? 1. Supine 2. Side-lying 3. High Fowler's 4. Trendelenburg

2 Rationale: A tonsillectomy is the surgical removal of the ton-sils. The child should be placed in a prone or side-lying posi-tion after the surgical procedure to facilitate drainage. Options 1, 3, and 4 would not achieve this goal. Test-Taking Strategy: Focus on the subject, positioning after tonsillectomy. Focus on the surgical procedure and visualize each of the positions described in the options. Keeping in mind that the goal is to facilitate drainage will direct you to the correct option. Review: Positioning guidelines following tonsillectomy

397. After a tonsillectomy, the nurse reviews the health care provider's (HCP's) postoperative prescriptions. Which prescription should the nurse question? 1. Monitor for bleeding. 2. Suction every 2 hours. 3. Give no milk or milk products. 4. Give clear, cool liquids when awake and alert.

2 Rationale: A tonsillectomy is the surgical removal of the tonsils. After tonsillectomy, suction equipment should be avail-able, but suctioning is not performed unless there is an airway obstruction because of the risk of trauma to the surgical site. Monitoring for bleeding is an important nursing interven-tion after any type of surgery. Milk and milk products are avoided initially because they coat the throat, cause the child to clear the throat, and increase the risk of bleeding. Clear, cool liquids are encouraged. Test-Taking Strategy: Focus on the subject, the prescription that the nurse questions. Option 1 can be eliminated first because this is a nursing action, not a medical prescription. From the remaining options, consider the anatomical location of the surgery. This should direct you to the correct option. Review: Postoperative care following tonsillectomy

393. The mother of a 6-year-old child arrives at a clinic because the child has been experiencing itchy, red, and swollen eyes. The nurse notes a discharge from the eyes and sends a culture to the laboratory for analysis. Chlamydial conjunctivitis is diagnosed. On the basis of this diagnosis, the nurse determines that which requires further investigation? 1. Possible trauma 2. Possible sexual abuse 3. Presence of an allergy 4. Presence of a respiratory infection

2 Rationale: Conjunctivitis is an inflammation of the conjunc-tiva. A diagnosis of chlamydial conjunctivitis in a child who is not sexually active should signal the health care provider to assess the child for possible sexual abuse. Trauma, allergy, and infection can cause conjunctivitis, but the causative organ-ism is not likely to be Chlamydia. Test-Taking Strategy: Note the age of the child and the organ-ism that is identified in the question. Also note that options 1, 3, and 4 are comparable or alike in that they can be recognized as the common causes of conjunctivitis and they relate to a physiological problem. Review: Causes of chlamydial conjunctivitis

400. The day care nurse is observing a 2-year-old child and suspects that the child may have strabismus. Which observation made by the nurse indicates the presence of this condition? 1. The child has difficulty hearing. 2. The child consistently tilts the head to see. 3. The child does not respond when spoken to. 4. The child consistently turns the head to hear.

2 Rationale: Strabismus is a condition in which the eyes are not aligned because of lack of coordination of the extraocular muscles. The nurse may suspect strabismus in a child when the child complains of frequent headaches, squints, or tilts the head to see. Other manifestations include crossed eyes, closing one eye to see, diplopia, photophobia, loss of binocular vision, or impairment of depth perception. Options 1, 3, and 4 are not indicative of this condition. Test-Taking Strategy: Eliminate options 1 and 4 first because they are comparable or alike and relate to hearing. To select from the remaining options, recall that this is a condition in which the eyes are not aligned because of lack of coordination of the extraocular muscles. Review: Strabismus

394. The nurse prepares a teaching plan for the mother of a child diagnosed with bacterial conjunctivitis. Which, if stated by the mother, indicates a need for further teaching? 1. "I need to wash my hands frequently." 2. "I need to clean the eye as prescribed." 3. "It is okay to share towels and washcloths." 4. "I need to give the eye drops as prescribed."

3 Rationale: Conjunctivitis is an inflammation of the conjunctiva. Bacterial conjunctivitis is highly contagious, and the nurse should teach infection control measures. These include good hand washing and not sharing towels and washcloths. Options 1, 2, and 4 are correct treatment measures. Test-Taking Strategy: Note the strategic words, need for further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Options 1, 2, and 4 can be eliminated by recalling that bacterial conjunctivitis is highly contagious. Review: Infection control measures for bacterial conjunctivitis

2) Which neonate requires a close nursing assessment for the development of retinopathy of prematurity (ROP)? 1. 28-weeks'-gestation infant who has been on long-term oxygen and weighed 1400 g 2. 32-weeks'-gestation infant of African heritage with a congenital heart defect who needed no oxygen and weighed 1850 g 3. 28-weeks'-gestation female infant who was on short-term oxygen, weighed 1420 g, and was treated with phototherapy 4. 36-weeks'-gestation, small-for-gestational-age infant who was in an oxyhood for 12 hours and weighed 1800 g

Answer: 1 Explanation: 1. The 28-weeks'-gestation infant on oxygen weighing 1400 g has the greatest risk of retinopathy of prematurity because of gestational age (28 weeks or less), weight (less than 1600 g), and oxygen therapy. 2. The 32-weeks'-gestation infant was not placed on oxygen, and therefore is not at risk. Risk for developing retinopathy of prematurity is lower for infants of African heritage than White infants. Congenital heart defects are not associated with ROP. 3. The 28-weeks'-gestation infant was only placed on short-term oxygen. Phototherapy is associated with hyperbilirubinemia and is not associated with ROP. 4. The 36-weeks'-gestation infant was on oxygen for a short period of time. A small-for-gestational-age baby would be more mature than an infant of the same weight but lower gestational age. Page Ref: 1120-1121 Cognitive Level: Analyzing

1) Which is the rationale for why young children are more prone to otitis media that the nurse should include in the teaching session with a parent? 1. The eustachian tube is shorter, wider, and horizontal in younger children. 2. The eustachian tube is shorter, more narrow, and horizontal in younger children. 3. The eustachian tube is longer, wider, and vertical in younger children. 4. The eustachian tube is longer, more narrow, and vertical in younger children.

Answer: 1 Explanation: 1. The eustachian tube, which connects the nasopharynx to the middle ear, is proportionately shorter, wider, and more horizontal in infants and young children than in older children or adults. This promotes an increase in the incidence of ear infections. 2. The eustachian tube, which connects the nasopharynx to the middle ear, is proportionately shorter, wider, and more horizontal in infants and younger children than in older children or adults. This promotes an increase in the incidence of ear infections. 3. The eustachian tube, which connects the nasopharynx to the middle ear, is proportionately shorter, wider, and more horizontal in infants and younger children than in older children or adults. This promotes an increase in the incidence of ear infections. 4. The eustachian tube, which connects the nasopharynx to the middle ear, is proportionately shorter, wider, and more horizontal in infants and younger children than in older children or adults. This promotes an increase in the incidence of ear infections. Page Ref: 1115 Cognitive Level: Applying

9) Which nursing action is appropriate when providing care to a child with a mild hearing loss who reads lips to enhance adaptation during hospitalization? 1. Touching the child lightly before speaking 2. Using a picture board as the main means of communication 3. Speaking in a loud voice while facing the child 4. Speaking directly to the parents for communication

Answer: 1 Explanation: 1. The nurse can facilitate hospital adaptation of a child who has a hearing loss and can lip read by obtaining the child's visual attention by lightly touching the child before communicating. 2. Picture boards, while useful, should not be the primary means of communication for a child who reads lips. 3. Speaking in a loud voice might not promote hearing in the child. 4. Speaking only to the parents does not help the child with the hospitalization. Page Ref: 1135-1136 Cognitive Level: Applying

13) Which assessment finding is considered normal for a school-age client? 1. Tonsils are large and seem to fill the throat. 2. Child is complaining of sore throat and drooling 3. White patches are observed on the tonsils. 4. Throat appears red, and child has a low-grade fever

Answer: 1 Explanation: 1. This is a normal finding as the tonsillar material grows faster than the child and reaches adult size in this age group. It is not a reason to refer the child for follow-up. 2. Both symptoms indicate pharyngitis and should be evaluated by a healthcare provider. 3. White exudate is associated with tonsillitis and requires further evaluation. 4. These symptoms suggest pharyngitis; the child should be evaluated further. Page Ref: 1116 Cognitive Level: Understanding

22) Which should the nurse include in the plan of care for a pediatric client who is diagnosed with periorbital ecchymosis? Select all that apply. 1. Apply ice to the site for 5 to 15 minutes every hour for the first 1 to 2 days. 2. Apply warm compresses beginning on day 3. 3. Apply antibiotic ointment to the conjunctiva for 7 to 10 days. 4. Apply a patch to the affected eye for 5 to 7 days. 5. Apply antibiotic drops to the conjunctiva for 7 to 10 days.

Answer: 1, 2 Explanation: 1. Ice should be applied to the injured eye for 5 to 15 minutes every hour for the first 1 to 2 days. 2. Warm compresses should be applied to the injured eye beginning on day 3. 3. Antibiotic ointment is not an appropriate intervention for an eye injury. 4. An eye patch is not needed for this eye injury; this intervention may be implemented for a pediatric client who is diagnosed with a corneal abrasion. 5. Antibiotic drops are not an appropriate intervention for an eye injury. Page Ref: 1127 Cognitive Level: Applying

21) Which visual screenings should the school nurse conduct when conducting annual assessments for school-age children? Select all that apply. 1. Light reflex assessment 2. Cover-uncover test 3. Acuity testing 4. Visualization of the tympanic membrane 5. Cranial nerve VIII testing

Answer: 1, 2, 3 Explanation: 1. An annual light reflex assessment is an appropriate visual screening for the school-age child. 2. An annual cover-uncover test is an appropriate visual screening for the school-age child. 3. An annual acuity test is an appropriate visual screening for the school-age child. 4. The tympanic membrane is an ear, not an eye, assessment. 5. Assessment of cranial nerve VIII is an appropriate hearing, not visual, assessment. Page Ref: 1124 Cognitive Level: Analyzing

20) Which common eye disorders should the nurse include in a teaching session for the parents of pediatric clients? Select all that apply. 1. Hyperopia 2. Myopia 3. Astigmatism 4. Strabismus 5. Cataracts

Answer: 1, 2, 3 Explanation: 1. Hyperopia, or farsightedness, is a common eye disorder seen in the pediatric population. 2. Myopia, or nearsightedness, is a common eye disorder seen in the pediatric population. 3. Astigmatism, or blurred vision, is a common eye disorder seen in the pediatric population. 4. Strabismus can be acquired or congenital; however, it is not considered a common eye disorder for pediatric clients. 5. Cataracts are more common in the older adult population, not the pediatric population. Page Ref: 1116-1127 Cognitive Level: Applying

14) Which topics should the nurse include in a teaching session to the parents of a 10-month-old infant who experiences frequent ear infections? Select all that apply. 1. Prohibiting tobacco smoke in the home 2. Avoiding use of a pacifier while the child is sleeping 3. Breastfeeding the infant 4. Cleaning the child's ears nightly with peroxide 5. Avoiding use of wood-burning stoves

Answer: 1, 2, 5 Explanation: 1. This has been shown to decrease the incidence of otitis media. 2. The use of a pacifier for the sleeping baby has been associated with otitis media. 3. While breastfeeding is associated with lower incidences of otitis media, this child is 10 months old. 4. Otitis media is not prevented by cleaning the ears. 5. Wood-burning stoves are associated with higher rates of otitis media. Page Ref: 1130-1132 Cognitive Level: Applying

6) A nurse is caring for a visually impaired school-age child. Which is the priority nursing intervention during the admission process to the hospital? 1. Explaining playroom policies 2. Orienting the child to where furniture is placed in the room 3. Taking the child on a tour of the unit 4. Letting the child touch equipment that will be used during the child's hospitalization

Answer: 2 Explanation: 1. Playroom policies can be covered at a later time 2. The priority intervention is to orient the child to furniture placement in the room. This is priority because it addresses basic safety for a visually impaired client. 3. Tours of the unit can be done at a later time. 4. Handling equipment that will be used during the child's hospitalization can be covered at a later time. Page Ref: 1125-1127 Cognitive Level: Analyzing

15) Which is the reason for a healthcare provider to recommend that a preschool-age male client with a documented hearing loss should attend preschool at least 2 days per week? 1. Help the child recognize his hearing deficit. 2. Increase the child's socialization skills. 3. Improve the child's immunity by increased exposure to organisms. 4. Teach other children that children are different.

Answer: 2 Explanation: 1. This would not be a goal of treatment. The child is aware of what he hears but may not be aware of what he is not hearing. 2. By increasing the interaction with other children, the hearing-impaired child will improve his socialization skills. 3. Increased exposure to organisms will occur, but this is not the goal of the recommendation. 4. The healthcare provider's concern is the well-being of this child, not the other children. Page Ref: 1126 Cognitive Level: Applying

3) Which is the priority nursing assessment for a pediatric client who is postoperative for tonsillectomy? 1. Arrhythmias 2. Dehydration 3. Increased blood sugar 4. Increased urinary output

Answer: 2 Explanation: 1. Unless the child has a heart condition prior to surgery, arrhythmias is not a possible postoperative complication 2. The child is at risk for dehydration due to deficient fluid volume related to inadequate intake after surgery. The child will anticipate having pain if she tries to swallow. 3. Increased blood sugar will result only if the child is a diabetic. 4. Increased urinary output is not an expected complication of surgery. Page Ref: 1142 Cognitive Level: Analyzing

23) Which should the nurse include in the plan of care for a pediatric client diagnosed with otitis media with effusion? Select all that apply. 1. Administration of antibiotic drops per order 2. Administration of pain relief measures 3. Assessment of hearing acuity over several months 4. Assessment of speech 5. Assessment of development

Answer: 2, 3, 4, 5 Explanation: 1. Otitis media with effusion is not caused by a bacterial infection; therefore, the administration of antibiotic drops is not included in the plan of care. 2. Measures to address comfort should be included in the child's plan of care. 3. Hearing acuity assessments should be included in the child's plan of care. 4. Speech assessment should be included in the child's plan of care. 5. Assessment of development should be included in the child's plan of care. Page Ref: 1129 Cognitive Level: Applying

19) Which parental statements indicate correct understanding of the anatomy and physiology of the infant's mouth, nose, and throat? Select all that apply. 1. "My baby will breathe through her mouth during the first 3 months of life." 2. "When my baby has a cold she may have trouble with bottle feedings." 3. "My baby's tonsils will be largest during infancy." 4. "I should expect my baby's first tooth to erupt during the first 6 months of life." 5. "I should expect my baby to lose her first tooth during the first year of life."

Answer: 2, 4 Explanation: 1. Infants are nose breathers through the first 6 months of life. This statement indicates the need for further education. 2. Infants often have difficulty with oral feedings when the nasal passage is blocked. This statement indicates correct understanding. 3. The size of the tonsils for the pediatric population varies; however, the tonsils are largest during school-age, not infancy. This statement indicates the need for further education. 4. First teeth often erupt during the first 6 months of life. This statement indicates correct understanding. 5. Children are not expected to lose teeth during infancy. This statement indicates the need for further education. Page Ref: 1114-1116 Cognitive Level: Analyzing

8) Which parental statements indicate correct understanding of the care that is needed for a pediatric client after the insertion of tympanostomy tubes? Select all that apply. 1. "It is important to limit my child's diet after surgery and only allow soft, bland foods." 2. "I should restrict my child to quiet activities after surgery." 3. "I should plan to administer a decongestant to my child for 1 to 2 weeks following surgery." 4. "It is important for my child to drink plenty of fluids after the procedure." 5. "I will remind my child to use ear plugs prior to showering and swimming."

Answer: 2, 4, 5 Explanation: 1. Limiting the diet to soft, bland foods and administering decongestants are not needed after surgery. A regular diet should be resumed. 2. The correct responses include encouraging the children to drink generous amounts of water, restricting the children to quiet activities after surgery, and avoiding water in the children's ears at bath time. 3. Incorrect responses include administering a decongestant for 1 to 2 weeks following surgery and limiting their diets to soft, bland foods. 4. The correct responses include encouraging the children to drink generous amounts of water, restricting the children to quiet activities after surgery, and avoiding water in the children's ears at bath time. 5. The correct responses include encouraging the children to drink generous amounts of water, restricting the children to quiet activities after surgery, and avoiding water in the children's ears at bath time. Page Ref: 1130 Cognitive Level: Analyzing

16) Which screening tool should the nurse use to screen a pediatric client for esotropia? 1. Examine the eye with an otoscope. 2. Check for the "red reflex" in the eyes. 3. Perform the cover-uncover test. 4. Use a tonometer to evaluate the eyes.

Answer: 3 Explanation: 1. An otoscope is used to examine the ear, not the eye. 2. The red reflex visualizes the retina and is used to identify infants with cataracts. 3. When one eye is covered while the child is looking at an object, the uncovered eye will deviate from the location; this tool is used to detect strabismus. 4. The tonometer measures intraocular pressure and is used to evaluate glaucoma. Page Ref: 1119 Cognitive Level: Applying

11) Which parental statement indicates correct understanding of discharge instructions for a pediatric client after a tonsillectomy? 1. "We will call the healthcare provider for any indication of ear pain." 2. "We will be sure to give our child adequate amounts of citrus juices." 3. "We will plan on administering acetaminophen (Tylenol) for pain." 4. "We will keep our child on bed rest for 10 days after the surgery."

Answer: 3 Explanation: 1. Ear pain 4 to 8 days after a tonsillectomy might be experienced and does not indicate an ear infection. 2. Citrus juices should be avoided for the first week because highly acidic foods and beverages can cause irritation. 3. Acetaminophen (Tylenol) is recommended for pain after a tonsillectomy. 4. Children do not need to be confined to bed. They can return to school in 10 days. Page Ref: 1142 Cognitive Level: Analyzing

10) Which is an appropriate nursing intervention for a child who experiences epistaxis? 1. Laying the child down and applying a warm pack. 2. Tilting the child's head back, squeezing the bridge of the nose, and applying a warm moist pack to the nose. 3. Tilting the child's head forward, squeezing the nares below the nasal bone, and applying ice to the nose. 4. Immediately packing the nares with a cotton ball soaked with phenylephrine (Neo-Synephrine).

Answer: 3 Explanation: 1. Laying the child down would allow the blood to drain down the throat, which could lead to aspiration. Warmth would promote the bleeding. 2. Tilting the child's head back could cause the blood to trickle down the throat. Warmth can cause an increase in bleeding because of vasodilation. 3. The correct initial treatment for a nosebleed is to tilt the head forward, squeeze the nares below the nasal bone for 10 to 15 minutes, and apply ice to the nose or back of the head. 4. A cotton ball soaked with Neo-Synephrine would only be used if the bleeding did not stop with pressure and ice. Page Ref: 1137-1138 Cognitive Level: Applying

4) A neonate is diagnosed with a herpes simplex viral infection of the eye. Which medication should the nurse prepare to administer? 1. Oral erythromycin 2. Fluoroquinolone eyedrops or ointment 3. Parenteral acyclovir (Zovirax) and vidarabine (VIRA-A) ophthalmic ointment 4. Intravenous penicillin

Answer: 3 Explanation: 1. Oral erythromycin is used to treat chlamydial eye infections. 2. Fluoroquinolone eyedrops are used to treat bacterial eye infections. 3. Neonatal herpes simplex virus is treated vigorously with parenteral acyclovir for 14 days or longer and topical ophthalmic medication (trifluridine, iododeoxyuridine, or vidarabine). 4. Intravenous penicillin treats selected bacterial infections. Page Ref: 1143 Cognitive Level: Applying

18) Which nursing actions are appropriate when providing care to a 12-year-old client who has lost several teeth as a result of a facial injury? Select all that apply. 1. Not worrying about the tooth loss, as children this age still have their "baby" teeth 2. Only handling the lost tooth by the roots and avoiding touching the crown of the tooth 3. Rinsing the lost tooth with sterile saline 4. Placing the tooth back into its socket and taking the child to an emergency dental facility 5. Keeping the tooth clean and dry during transport to an emergency dental facility

Answer: 3, 4 Explanation: 1. By 12 years of age, children have their permanent teeth. 2. First aid includes handling the tooth only by the crown and not touching the roots. 3. This is appropriate, as there is hope that the tooth can be re-implanted. 4. This is an appropriate way to manage the tooth. 5. The tooth should be kept moist. Page Ref: 1143 Cognitive Level: Applying

7) Which should the nurse include in the discharge instructions for the parents of an infant who is diagnosed with acute otitis media? 1. Keep the baby in a flat position during sleep. 2. Administer a decongestant. 3. Place the baby to sleep with a pacifier. 4. Administer acetaminophen (Tylenol) to relieve discomfort.

Answer: 4 Explanation: 1. A flat position could exacerbate the discomfort. Elevating the head slightly is recommended. 2. Decongestants are not recommended for treatment of acute otitis media. 3. Placing infants to sleep with a pacifier can increase the incidence of otitis media. 4. An infant with a bulging tympanic membrane because of acute otitis media will have pain. Parents are taught to administer acetaminophen (Tylenol) to relieve the discomfort associated with acute otitis media. Page Ref: 1129 Cognitive Level: Applying

12) Which information should the nurse include in a teaching session regarding treatment for the common cold in the pediatric population? 1. Aspirin should be taken for alleviation of fever if the common cold is contracted. 2. Antibiotics will eliminate the nasopharyngitis virus. 3. Vaccinations can prevent contraction of a nasopharyngitis virus. 4. Proper hand washing can prevent the spread of the common cold.

Answer: 4 Explanation: 1. Aspirin should not be taken for fever by children because of its association with Reye syndrome. 2. Antibiotics are not used to treat viral infections. 3. No vaccine can prevent the common cold. 4. Proper hand washing should be taught to school-age children to reduce the spread of the "common cold" virus. Page Ref: 1139 Cognitive Level: Applying

5) A nurse is caring for a visually impaired 20-month-old client who has not begun to walk. Which nursing diagnosis would be appropriate for this child? 1. Self-care Deficit 2. Impaired Physical Mobility 3. Impaired Home Maintenance 4. Delayed Development

Answer: 4 Explanation: 1. Self-care Deficit does not apply to this age of child. 2. The child's mobility is not due to a physiologic problem, so impaired mobility is not appropriate. 3. There are not enough data to determine if home maintenance is impaired. 4. A 20-month-old child who is not walking is experiencing delayed development. Toddlers generally walk by 15 months of age. Page Ref: 1122 Cognitive Level: Applying

17) Which is a priority nursing assessment the nurse includes in the plan of care for a pediatric client who has received a cochlear implant? 1. Ringing in the ears 2. Pharyngitis 3. Hearing loss 4. Bacterial meningitis

Answer: 4 Explanation: 1. This is not a common complication of a cochlear implant. 2. Pharyngitis is not associated with cochlear implants. 3. The child already has hearing loss. That is why the child receives a cochlear implant. 4. There is an increased risk of bacterial meningitis following insertion of a cochlear implant. Page Ref: 1135-1137 Cognitive Level: Analyzing