Exam 3

With a group of new parents, the nurse is reviewing treatment for viral illnesses such as influenza. Which statement by the parents indicates appropriate understanding of the teaching session? 1. "Some over-the-counter medications contain aspirin." 2. "Acetaminophen is good for treatment of fevers in young children." 3. "I can use ibuprofen as needed when my child has aches and pains." 4. "Aspirin is acceptable if my child does not have a virus."

1. "Some over-the-counter medications contain aspirin." Rationale 1: Reye syndrome is a serious consequence of aspirin use in children with viral illnesses. Over-the-counter medications should be checked to see whether they contain aspirin before being used. Aspirin is avoided in children. Ibuprofen and acetaminophen are acceptable to use in children.

6) The nurse has completed discharge teaching for the family of a child diagnosed with Legg-Calve-Perthes disease. Which statement by the family indicates the need for further education? 1. "We're glad this will only take about 6 weeks to correct." 2. "We understand swimming is a good sport for Legg-Calve-Perthes." 3. "We know to watch for areas on the skin the brace may rub." 4. "We understand that abduction of the affected leg is important."

1. "We're glad this will only take about 6 weeks to correct." Explanation: 1. The treatment generally takes approximately 2 years. Swimming is a good activity to increase mobility. A brace may be worn, so skin irritation should be monitored. The leg should be kept in the abducted position. page ref: 836

1) The nurse completes parent education related to treatment for a pediatric client with congenital clubfoot. Which statement by the parents indicates the need for further education? 1. "We're happy this is the only cast our baby will need." 2. "We'll watch for any swelling of the feet while the casts are on." 3. "We'll keep the casts dry." 4. "We're getting a special car seat to accommodate the casts."

1. "We're happy this is the only cast our baby will need." Explanation: 1. Serial casting is the treatment of choice for congenital clubfoot. The cast is changed every one to 2 weeks. Parents should be watching for swelling while the casts are on, keeping the casts dry, and using a car seat to accommodate the casts. page ref: 828

3) The nurse in the newborn nursery is performing the admission assessment on a neonate. Which assessment finding indicates the neonate may have congenital hip dysplasia? 1. Asymmetry of the gluteal and thigh fat folds 2. Trendelenburg sign 3. Telescoping of the affected limb 4. Lordosis

1. Asymmetry of the gluteal and thigh fat folds Explanation: 1. A sign of congenital hip dysplasia in the infant would be asymmetry of the gluteal and thigh fat folds. Trendelenburg sign and telescoping of the affected limb are signs that present in an older child with congenital hip dysplasia. Lordosis does not occur with hip dysplasia. page ref: 832

16) The pediatric nurse educator is conducting an in-service for novice nurses who will begin working on the pediatric oncology unit. The educator wants to include the common clinical manifestations of cancer. Which manifestation will the educator include in the presentation? Select all that apply. 1. Cachexia 2. Anemia 3. Gene abnormalities 4. Palpable mass 5. Chromosomal abnormalities

1. Cachexia 2. Anemia 4. Palpable mass Explanation: 1. Common clinical manifestations of childhood cancer include cachexia, anemia, and a palpable mass. Gene abnormalities and chromosomal abnormalities are common etiologies to childhood cancer, not clinical manifestations.

9) A child is diagnosed with a Wilms tumor. Which nursing action is most appropriate prior to surgery?1. Careful bathing and handling 2. Monitoring of behavioral status 3. Maintenance of strict isolation 4. Administration of packed RBCs

1. Careful bathing and handling The tumor should never be palpated; careful bathing and handling are an important nursing consideration. Palpating the tumor can cause a piece of the tumor to dislodge. The child's behavior will not be affected with a Wilms tumor. The tumor does not cause excessive lowering of WBCs or RBCs, so strict isolation or administration of packed RBCs is not usually a nursing intervention.

A school-age client sustains a basilar skull fracture. Which symptom is a priority for this nurse to assess for when providing care to this client? 1. Cerebral spinal fluid leakage from the nose or ears 2. Headache 3. Transient confusion 4. Periorbital ecchymosis

1. Cerebral spinal fluid leakage from the nose or ears Rationale 1: Cerebral spinal fluid leakage could be present from the nose or ears and, if it persists, may indicate that surgical repair will be needed. Headache, transient confusion, and periorbital ecchymosis are findings that commonly present with a basilar skull fracture but do not indicate that surgical repair will be needed.

The nurse is teaching a group of students about wound healing. Which items will the nurse include as occurring during the hemostasis and inflammation stage of wound healing? Standard Text: Select all that apply. 1. Clot formation to seal the wound 2. Production of collagen and granulation tissue 3. Scar formation and strengthening 4. Release of inflammatory mediators by platelets 5. Swelling as a result of increased capillary permeability

1. Clot formation to seal the wound 2. Production of collagen and granulation tissue 5. Swelling as a result of increased capillary permeability Rationale 1: During the hemostasis and inflammation stage of wound healing, the nurse would state that clot formation occurs to seal the wound; platelets release inflammatory mediators; and increased capillary permeability results in swelling. Scar formation and strengthening occur during maturation. Collagen and granulation tissue are produced during tissue formation.

18) A seasoned nurse is precepting a novice nurse on a pediatric oncology unit. The seasoned nurse would like to review the ongoing physiologic and psychosocial care of the children who survive cancer. Which topics will the seasoned nurse include in the discussion with the novice nurse? Select all that apply. 1. Developing other cancers 2. Recommending regular office visits 3. Encouraging school-age clients to manage their own care 4. Needing weekly laboratory tests 5. Providing educational and psychosocial support

1. Developing other cancers 2. Recommending regular office visits 5. Providing educational and psychosocial support Appropriate topics include discussing the increased risk for these children to develop other cancers; recommending regular office visits for monitoring purposes; and providing educational and psychosocial support. It would be appropriate to encourage the adolescent and young adult clients to manage their own care, not a school-age child. While these clients need regular laboratory examinations, weekly laboratory tests are not appropriate.

A lumbar puncture is performed on an infant suspected of having meningitis. Which finding does the nurse expect in the cerebral spinal fluid if the infant has meningitis? 1. Elevated white blood cell count 2. Elevated red blood cell count 3. Normal glucose 4. Decreased white blood cell count

1. Elevated white blood cell count Rationale 1: The lumbar puncture is done to obtain cerebral spinal fluid (CSF). Elevated white blood cell count is seen with bacterial meningitis. The red blood cell count is not elevated, and the glucose is decreased in meningitis.

A child sustains a traumatic brain injury and is monitored in the pediatric intensive-care unit (PICU). The nurse is using the Glasgow Coma Scale to assess the child. Which items will the nurse assess when using this tool? Standard Text: Select all that apply. 1. Eye opening 2. Verbal response 3. Motor response 4. Head circumference 5. Pulse oximetry

1. Eye opening 2. Verbal response 3. Motor response Rationale 1: The Glasgow Coma Scale for infants and children scores parameters related to eye opening, verbal response, and motor response. The maximum score is 15, indicating the highest level of neurological functioning. Head circumference and pulse oximetry are not included on the scale.

17) The parents of a child with Duchenne muscular dystrophy are in the clinic after diagnosis and ask the nurse if the family should have genetic testing completed. Who should the nurse suggest to have genetic testing? Select all that apply. 1. Female cousins 2. Aunts 3. Sisters 4. Brothers 5. Uncles and male cousins

1. Female cousins 2. Aunts 3. Sisters Explanation: 1. This is an X-linked disorder so all females in the family should be tested. page ref: 850

The nurse is teaching parents how to prevent a sickle cell crisis in the child with sickle cell disease. Which precipitating factors to a sickle cell crisis will the nurse include in the explanation?Select all that apply. 1. Fever 2. Dehydration 3. Regular exercise 4. Altitude 5. Increased fluid intake

1. Fever 2. Dehydration 4. Altitude Fever, dehydration, and altitude are precipitating factors contributing to a sickle cell crisis. Regular exercise and increased fluid intake are recommended activities for a child with sickle cell disease and will not contribute to a sickle cell crisis.

The nurse is providing care to a school-age client with neutropenia. Which clinical manifestations does the nurse anticipate when assessing this client? Select all that apply. 1. Fever 2. Fatigue 3. Tachycardia 4. Hypertension 5. Tachypnea

1. Fever 2. Fatigue 3. Tachycardia 5. Tachypnea A school-age client who is diagnosed with neutropenia, or a decrease in WBCs, will likely exhibit fever, fatigue, tachycardia, and tachypnea (as a result of congestive heart failure). The nurse would not anticipate that the client will exhibit hypertension as a result of the diagnosis.

2) A child diagnosed with cancer is prescribed chemotherapy. The latest lab value indicates the WBC count is very low. Which medication order does the nurse anticipate? 1. Filgrastim (Neupogen) 2. Ondansetron (Zofran) 3. Oprelvekin (Neumega) 4. Epoetin alfa (human recombinant erythropoietin)

1. Filgrastim (Neupogen) Explanation: 1. Filgrastim (Neupogen) increases production of neutrophils by the bone marrow. Ondansetron (Zofran) is an antiemetic, oprelvekin (Neumega) increases platelets, and epoetin alfa (human recombinant erythropoietin) stimulates RBC production.

A child who has undergone a hematopoietic stem cell transplantation (HSCT) is ready for discharge. Which items will the nurse include in the discharge teaching for this child and family? Select all that apply. 1. Recognize the signs of graft-versus-host disease. 2. Return the child to school within six weeks. 3. Practice good handwashing. 4. Avoid obtaining influenza vaccinations. 5. Avoid live plants and fresh vegetables.

1. Recognize the signs of graft-versus-host disease. 3. Practice good handwashing. 5. Avoid live plants and fresh vegetables A child who is preparing for discharge after a HSCT will require specific interventions to decrease the risk of contracting communicable illnesses. Appropriate teaching points include: recognizing the signs of graft-versus-host disease; practicing good handwashing; and avoiding live plants and fresh vegetables. The child will require home schooling for 6 to 12 months. The child and family members should be encouraged to obtain yearly influenza vaccinations.

A child recently diagnosed with aplastic anemia is being prepared for discharge. When planning support for the family, which service should the nurse plan to include in the discharge plan? 1. Referrals to support groups and social services 2. Short-term support 3. Genetic counseling 4. Nutrition counseling

1. Referrals to support groups and social services Families require support in dealing with a child who has a life-threatening disease. They should be referred to support groups for counseling, if indicated, and to social services. The support will be long term in nature. Aplastic anemia is not a genetically transmitted disease. Nutrition counseling is not a priority and may or may not be needed with aplastic anemia.

6) A child is diagnosed with thrombocytopenia secondary to chemotherapy treatments. Which action by the nurse is the most appropriate? 1. Refrain from administering any intramuscular injections (IM). 2. Perform oral hygiene. 3. Monitor intake and output. 4. Use palpation as a component of assessment.

1. Refrain from administering any intramuscular injections (IM). Explanation: 1. When the child is thrombocytopenic (decreased platelets) from chemotherapy, the nurse should not administer IM injections because of the risk of bleeding. Oral hygiene care should be done with a soft toothbrush and intake and output monitored for any abnormalities. Gentle palpation should still be included in physical assessments.

12) An adolescent client who is diagnosed with Duchenne muscular dystrophy is seen in the clinic for a routine health visit. Which nursing diagnosis is the priority for this client? 1. Risk for Impaired Mobility Related to Hypertrophy of Muscles 2. Risk for Infection Related to Altered Immune System 3. Risk for Impaired Skin Integrity Related to Paresthesia 4. Risk for Altered Comfort Related to Effects of the Illness

1. Risk for Impaired Mobility Related to Hypertrophy of Muscles Explanation: 1. Nursing care for muscular dystrophy (MD) focuses on promoting independence and mobility for this progressive, incapacitating disease. Risk for Infection, Risk for Impaired Skin Integrity, and Risk for Altered Comfort are not as high a priority as Risk for Impaired Mobility. page ref: 850-852

8) An adolescent client must wear a brace for the correction of scoliosis. Which nursing diagnosis is most appropriate for this client? 1. Risk for Impaired Skin Integrity 2. Risk for Altered Growth and Development 3. Risk for Impaired Mobility 4. Risk for Impaired Gas Exchange

1. Risk for Impaired Skin Integrity Explanation: 1. The skin should be monitored for breakdown in any area the brace may rub. The other diagnoses would not be a priority and should be corrected by the wearing of the brace. page ref: 839

The nurse is providing care to a school-age client diagnosed with idiopathic thrombocytopenic purpura (ITP). Which nursing diagnosis is the priority for this client? 1. Risk for Injury 2. Ineffective Breathing Pattern 3. Nausea 4. Fluid-Volume Deficit.

1. Risk for Injury ITP is the most common bleeding disorder in children, so risk for injury (bleeding) is the priority nursing diagnosis. The disease process does not usually cause ineffective breathing patterns, nausea, or fluid-volume deficits.

11) The nurse is providing care to a toddler client who is diagnosed with osteogenesis imperfecta. Which nursing intervention is appropriate for this client? 1. Support of the trunk and extremities when moving 2. Traction care 3. Cast care 4. Postop spinal surgery care

1. Support of the trunk and extremities when moving Explanation:1. With osteogenesis imperfecta, nursing care focuses on preventing fractures. Because the bones are fragile, the entire body must be supported when the child is moved. Traction, casts, and spinal surgery are not routinely done for osteogenesis page ref: 847-848

The nurse educator is describing the pediatric differences associated with the anatomy and physiology of the neurologic system to a group of nursing students. Which statements made by the class indicate appropriate understanding of this topic after the teaching session? Standard Text: Select all that apply. 1. The bones of the cranium are connected by connective tissue to allow for brain growth. 2. The spine of infants is excessively mobile due to immature neck muscles and incompletely developed vertebral bodies. 3. Maturation of the nerves continues until age 10. 4. Myelination is complete at birth, 5. Myelination proceeds in a cephalocaudal direction.

1. The bones of the cranium are connected by connective tissue to allow for brain growth. 2. The spine of infants is excessively mobile due to immature neck muscles and incompletely developed vertebral bodies. 5. Myelination proceeds in a cephalocaudal direction. Rationale 1: There are several pediatric differences associated with the anatomy and physiology of the neurological system and include: the bones of the cranium are connected by connective tissue to allow for brain growth; the spine of infants is excessively mobile due to immature neck muscles and incompletely developed vertebral bodies; and myelination proceeds in a cephalocaudal direction. Maturation of the nerves continues until the age of 4, not 10. Myelination is incomplete at birth.

The nurse is providing care to a pediatric client who is diagnosed with psoriasis. Which clinical manifestations does the nurse anticipate upon assessment of this client? Standard Text: Select all that apply. 1. Thick, silvery, scaly erythematous plaque 2. Pruritus 3. Dry skin, likely to crack and fissure 4. Fragile skin and blisters 5. Irregular border surrounded by normal skin

1. Thick, silvery, scaly erythematous plaque 2. Pruritus 5. Irregular border surrounded by normal skin Rationale 1: Clinical manifestations that support the diagnosis of psoriasis include thick, silvery, scaly erythematous plaque; pruritis; and irregular border surrounded by normal skin. Dry skin that is likely to crack and fissure is a clinical manifestation of atopic dermatitis. Fragile skin and blisters are clinical manifestations of epidermolysis bullosa.

A 5-year-old child is admitted to the hospital with increased intracranial pressure after a motor vehicle struck the child. The child weighs 15 kg. The neurosurgeon orders: Mannitol 0.5 g/kg/10 minutes IV first, followed by Mannitol 0.25 g/kg IV every 4 hours. Medication on hand: Mannitol 100 g/500mL D5W. Calculate how many mL/hr to set the IV pump to infuse the Mannitol ordered every 4 hours.

18.75 or 18.8 mL/hr

The nurse explains to the parents of a child with a severe burn that wearing of an elastic pressure garment (Jobst stocking) during the rehabilitative stage can help with the prevention of which complication? 1. Poor circulation 2. Hypertrophic scarring 3. Pain 4. Formation of thrombus in the burn area

2. Hypertrophic scarring Rationale 1: During the rehabilitation stage, Jobst stockings or pressure garments are used to reduce development of hypertrophic scarring and contractures.

16) The nurse is caring for the newborn with bilateral clubfoot. What nursing diagnoses would the nurse address? Select all that apply. 1. Activity intolerance 2. Impaired physical mobility 3. Risk for impaired skin integrity 4. Ineffective breathing pattern 5. Impaired parenting

2. Impaired physical mobility 3. Risk for impaired skin integrity 5. Impaired parenting Explanation: Nursing diagnoses that may apply to the newborn with bilateral clubfoot are impaired physical mobility, risk for impaired skin integrity, impaired parenting, and ineffective health maintenance. page ref: 829

The nurse is providing care for a pediatric client who has a third-degree circumferential burn of the right arm. Which nursing diagnosis is the priority for this client? 1. Risk for Infection 2. Risk for Altered Tissue Perfusion 3. Risk for Altered Nutrition: Less than Body Requirements 4. Impaired Physical Mobility

2. Risk for Altered Tissue Perfusion Rationale 1: When the burn is circumferential, blood flow can become restricted due to edema and result in tissue hypoxia; therefore, the priority diagnosis is Risk for Altered Tissue Perfusion to the Extremity. Infection, Nutrition, and Mobility would have second priority in this case.

14) A child with a brain tumor is admitted to the pediatric intensive care unit (PICU) after brain surgery to remove the tumor. Which postoperative order would the nurse question? 1. Antibiotics 2. Sodium levels every 24 hours 3. Anticonvulsants 4. Hourly intake and output

2. Sodium levels every 24 hours Explanation: 1. Antibiotics, anticonvulsants, and hourly intake and output are appropriate orders. Serum sodium levels should be done every 4 to 6 hours, not every 24 hours.

Which action by the parents demonstrates an understanding of the nurse's teaching with regard to prevention of iron-deficient anemia? 1. Feeding their infant with a formula that is not iron fortified 2. Starting iron-fortified infant cereal at 4 to 6 months of age 3. Introducing cow's milk at 6 months of age 4. Limiting vitamin C consumption after 1 year of age

2. Starting iron-fortified infant cereal at 4 to 6 months of age Starting iron-fortified infant cereal at 4 to 6 months of age is recommended for prevention of iron deficiency in children. Infants who are not breast-fed should get iron-fortified formula. Cow's milk should not be introduced until 12 months of age. Vitamin C should be started at 6 to 9 months of age and continued, because foods rich in vitamin C improve iron absorption.

A toddler-age client has a tonic-clonic seizure while in a crib in the hospital. The client's jaw is clamped. Which nursing action is the priority? 1. Place a padded tongue blade between the child's jaws. 2. Stay with the child and observe the respiratory status. 3. Prepare the suction equipment. 4. Restrain the child to prevent injury.

2. Stay with the child and observe the respiratory status. Rationale 1: During a seizure, the nurse remains with the child, watching for complications. The child's respiratory rate should be monitored. Be sure nothing is placed in the child's mouth during a seizure. Suction equipment should already be set up at the bedside before a seizure begins. The child should not be restrained during a seizure.

The nurse is providing education to the parents of a pediatric client who is diagnosed with tinea capitis (ringworm of the scalp). Which statement made the parents indicates an appropriate understanding of the teaching session? 1. "We will give the griseofulvin on an empty stomach." 2. "We're glad ringworm isn't transmitted from person to person." 3. "Once the lesion is gone, we can stop the griseofulvin." 4. "We will give the griseofulvin with milk or peanut butter."

4. "We will give the griseofulvin with milk or peanut butter." Rationale 1: Parents are advised to give oral griseofulvin with fatty foods such as milk or peanut butter to enhance absorption. The medication must be used for the entire prescribed period even if the lesions are gone. All members of the family and household pets should be assessed for fungal lesions because person-to-person transmission is common.

9) A child returns from spinal-fusion surgery. Which item is the priority assessment for this child? 1. Increased intracranial pressure 2. Seizure activity 3. Impaired pupillary response during neurological checks 4. Impaired color, sensitivity, and movement to lower extremities

4. Impaired color, sensitivity, and movement to lower extremities Explanation: When the spinal column is manipulated, there is a risk for impaired color, sensitivity, and movement to lower extremities. The other signs are neurological impairment and are not high risk with spinal surgery. page ref: 839

A nurse is caring for a child who is diagnosed with cerebral palsy. Which goal of therapy is most appropriate for the nurse to include in the plan of care? 1. Reversing the degenerative processes that have occurred 2. Curing the underlying defect causing the disorder 3. Preventing the spread to individuals in close contact with the child 4. Promoting optimum development

4. Promoting optimum development Rationale 1: Recognition of the disorder is important so that optimal development can be maintained. Cerebral palsy cannot be reversed or cured. It is not caused by a contagious process, so there is no risk of spread.

The school nurse is conducting pediculosis capitis (head lice) checks. Which findings would indicate a "positive" head check? 1. White, flaky particles throughout the entire scalp region 2. Maculopapular lesions behind the ears 3. Lesions in the scalp that extend to the hairline or neck 4. White sacs attached to the hair shafts in the occipital area

4. White sacs attached to the hair shafts in the occipital area Rationale 1: Evidence of pediculosis capitis includes white sacs (nits) that are attached to the hair shafts, frequently in the occiput area. Lesions may be present from itching, but the positive sign is evidence of nits. Lice and nits must be distinguished from dandruff, which appears as white, flaky particles.

The child has just been diagnosed with osteosarcoma, and the nurse is teaching the family regarding this type of cancer. The nurse knows that instruction has been successful when the family states that osteosarcoma is common in which age group?1. Infants 2. Toddlers 3. Preschool-age children 4. School-age children 5. Adolescents

5. Adolescents Osteosarcoma's peak incidence is during the rapid growth years, at age 13 for girls and 14 for boys.

7) A child undergoing chemotherapeutic treatment for cancer is being admitted to the hospital for fever of 102 degrees F and possible sepsis. Cultures, antibiotics, and acetaminophen (Tylenol) along with bed rest have been ordered for this child. Place the following steps in order from first to last. Response 1 Administer the antibiotics. Response 2 Administer the acetaminophen (Tylenol). Response 3 Obtain the cultures. Response 4 Ensure the child has bed rest.

Answer: 2, 3, 1, 4 1. Response 2 Administer the acetaminophen (Tylenol). 2. Response 3 Obtain the cultures. 3. Response 1 Administer the antibiotics. 4. Response 4 Ensure the child has bed rest. Explanation: Give acetaminophen (Tylenol) first to decrease discomfort and reduce fever. Obtain the cultures next because management of infections is critical, and since a child on chemotherapy has lowered immune status, unusual agents can be identified. Cultures can help identify the causative agents before treatment is started. Give the antibiotics next, as an infection can seriously impact the child who is receiving chemotherapy. Finally, provide comfort followed by bed rest to allow the child to rest.

The adolescent is admitted to the hospital in sickle cell crisis with a pain level of 10/10. The physician orders: Morphine sulfate 5 mg IV q 2 hr prn Medication on hand: morphine sulfate 10 mg/mL Calculate how many ml of morphine sulfate will be given IV.

0.5 mL

A child is diagnosed with sickle cell disease. The parents are unsure how their child contracted the disease. Which explanation by the nurse is the most appropriate? 1. "Both the mother and the father have the sickle cell trait." 2. "The mother has the trait, but the father doesn't." 3. "The father has the trait, but the mother doesn't." 4. "The mother has sickle cell disease, but the father doesn't have the disease or the trait."

1. "Both the mother and the father have the sickle cell trait." Sickle cell disease is an autosomal recessive disorder; both parents must have the trait in order for a child to have the disease.

The nurse is providing an educational session for parents with children diagnosed with iron deficiency anemia. Which statements will the nurse include educate about the normal functions of RBCs?Select all that apply. 1. "RBCs transport oxygen from the lungs to the tissue." 2. "RBCs transport carbon dioxide to the lungs." 3. "RBCs protect the body against bacterial invaders." 4. "RBCs form hemostatic plugs to stop bleeding." 5. "RBCs are responsible for psychosocial development."

1. "RBCs transport oxygen from the lungs to the tissue." 2. "RBCs transport carbon dioxide to the lungs." The normal function of RBCs includes transporting oxygen from the lungs to the tissue and transporting carbon dioxide to the lungs. WBCs protect the body against bacterial invaders. Platelets form hemostatic plugs to stop bleeding. RBCs are not directly responsible for psychosocial development.

13) The school nurse is providing care to a school-age client who experienced a sprain of the right ankle on the playground. Which intervention is appropriate for the nurse to implement for this client? 1. Apply ice to the extremity 2. Apply a warm, moist pack to the extremity 3. Perform passive range of motion to the extremity 4. Lower the extremity to below the level of the heart

1. Apply ice to the extremity Explanation:1. For the first 24 hours of a sprain, rest, ice, compression, and elevation should be used. Therefore, the nurse should apply ice to the extremity page ref: 852

The nurse is caring for a pediatric client diagnosed with eczema. Which topical medication order does the nurse anticipate for this client? 1. Corticosteroid 2. Retinoids 3. Antifungals 4. Antibacterials

1. Corticosteroid Rationale 1: Topical corticosteroids are used to reduce inflammation when the child has eczema. Topical retinoids are used for acne. Topical antifungals are used for dermatophytoses. Topical antibacterials would be used for problems such as burns.

A pediatric client is hospitalized with a severe case of impetigo contagiosa. Which antibiotic does the nurse anticipate the healthcare provider will order for this client? 1. Dicloxacillin (Pathocil) 2. Rifampin (Rifadin) 3. Sulfamethoxazole and trimethoprim (Bactrim) 4. Metronidazole (Flagyl)

1. Dicloxacillin (Pathocil) Rationale 1: A systemic antibiotic will be given for severe impetigo because it is a bacterial infection. Dicloxacillin is used in treatment of skin and soft-tissue infections. It is specific for treating staphylococcal infections. Rifampin is an antitubercular agent, sulfamethoxazole and trimethoprim are used as a prophylaxis against Pneumocystis carinii pneumonia (PCP), and metronidazole is used to treat anaerobic and protozoic infections.

The nurse is planning care for a school-age child diagnosed with bacterial meningitis. Which intervention is most appropriate? 1. Keeping environmental stimuli at a minimum 2. Avoiding giving pain medications that could dull sensorium 3. Measuring head circumference to assess developing complications 4. Having the child move the head from side to side at least every two hours

1. Keeping environmental stimuli at a minimum Rationale 1: A quiet environment should be maintained because noise can disturb a child with meningitis. Pain medications are appropriate to give and should be used when needed. Measuring head circumference would only be appropriate for a child less than 2 years. Excessive head movement should be avoided because it can increase irritation of the meninges.

17) The pediatric nurse is providing care to a school-age child receiving chemotherapy to treat cancer. Which interventions are appropriate to include in the plan of care in order to monitor for oncologic emergencies?Select all that apply. 1. Monitor complete blood count (CBC). 2. Document intake and output. 3. Observe for behavioral changes. 4. Refer for psychosocial support. 5. Implement neutropenic precautions.

1. Monitor complete blood count (CBC). 2. Document intake and output. 3. Observe for behavioral changes. Explanation: 1. Oncologic emergencies can be organized into three groups: metabolic, hematologic, and those involving space-occupying lesions. Appropriate interventions for the nurse to include in the plan of care to monitor for these emergencies include monitoring the CBC to prevent sepsis and hemorrhage; monitoring intake and output by encouraging hydration to prevent hypercalcemia and observing for signs of water intoxication; and observing for behavioral changes as space-occupying lesions may cause seizures or increased intracranial pressure. Referring for psychosocial support and implementing neutropenia precautions may be appropriate, but these interventions do not address oncologic emergencies.

The nurse is providing care for an adolescent client who is experiencing pain related to a sickle cell crisis. Which medication does the nurse prepare to administer to this client? 1. Morphine sulfate 2. Meperidine 3. Acetaminophen 4. Ibuprofen

1. Morphine sulfate The pain during a sickling crisis is severe, and morphine is needed for pain control around the clock or by patient-controlled analgesia (PCA). Meperidine is not used for pain control for clients with sickle cell pain crisis because it could cause seizures. Acetaminophen or ibuprofen is used for mild pain and would not be effective for the severe pain experienced by a child in sickle cell pain crisis

A child diagnosed with a mild traumatic brain injury is being sedated with a mild sedative so that pain and anxiety are minimized. Which nursing interventions are appropriate for this child? Standard Text: Select all that apply. 1. Place a continuous-pulse oximetry monitor on the child. 2. Place the child in a room near the nurse's station. 3. Allow for several visitors to remain at the child's bedside. 4. Use soft restraints if the child becomes confused. 5. Use sedation around the clock to decrease agitation.

1. Place a continuous-pulse oximetry monitor on the child. 2. Place the child in a room near the nurse's station. Rationale 1: When a child is sedated, respiratory status should be monitored with a pulse-oximetry machine. The child should be close to the nurse's station so that frequent monitoring can be done. Several visitors at the bedside would increase the child's anxiety. Soft restraints may increase agitation. Sedation around the clock is not recommended due to the need to evaluate the neurologic system.

7) A school health nurse is screening school-age students for scoliosis. Which assessment findings indicate the need for further evaluation for scoliosis? Select all that apply. 1. Uneven shoulders and hips 2. A one-sided rib hump 3. Prominent scapula 4. Lordosis 5. Pain

1. Uneven shoulders and hips 2. A one-sided rib hump 3. Prominent scapula Explanation: The classic signs of scoliosis include uneven shoulders and hips, a one-sided rib hump, and prominent scapula. Lordosis and pain are not present with scoliosis page ref: 838-839

The nurse is performing an admission assessment on an infant diagnosed with hydrocephalus and a malfunctioning shunt. Which assessment findings should the nurse expect? Select all that apply. 1. Vomiting 2. Fever 3. Irritability 4. Poor appetite 5. Decreased level of consciousness

1. Vomiting 2. Fever 3. Irritability 4. Poor appetite Signs of shunt malfunction in infants are nonspecific and include irritability, vomiting, poor appetite, disordered sleep, and fever. Older children with shunt malfunction may have a headache, nausea, vomiting, and decreased level of consciousness.

The nurse is teaching a group of adolescents about care for acne vulgaris. Which interventions will the nurse include in the teaching session? Standard Text: Select all that apply. 1. Wash skin with mild soap and water twice a day. 2. Use astringents and vigorous scrubbing. 3. Avoid picking or squeezing the lesions. 4. Apply tretinoin (Retin-A) liberally. 5. Avoid sun exposure if on tetracycline.

1. Wash skin with mild soap and water twice a day. 3. Avoid picking or squeezing the lesions. 5. Avoid sun exposure if on tetracycline. Rationale 1: The adolescent should be taught to wash skin with mild soap and water twice a day, to avoid picking or squeezing acne lesions, and to avoid sun exposure if on tetracycline. Using astringents and scrubbing vigorously can exacerbate acne. Tretinoin (Retin-A) should be applied sparingly (pea-size doses).

Which statement made by a parent during a well-child visit would cause the nurse to suspect the child has cerebral palsy? 1. "My 6-month-old baby is rolling from back to prone now." 2. "My 3-month-old seems to have floppy muscle tone." 3. "My 8-month-old can sit without support." 4. "My 10-month-old is not walking."

2. "My 3-month-old seems to have floppy muscle tone." Rationale 1: Children with cerebral palsy are delayed in meeting developmental milestones. The infant with hypotonia is showing a clinical manifestation of cerebral palsy. A baby rolls over from back to prone at 6 months, sits without support at 8 months, and walks at 12 months.

A school-age client experiences a near-drowning episode and is admitted to the pediatric intensive-care unit (PICU). The parents express guilt over the near drowning of their child. Which response by the nurse is most appropriate? 1. "You will need to watch the child more closely." 2. "Tell me more about your feelings related to the accident." 3. "The child will be fine, so don't worry." 4. "Why did you let the child almost drown?"

2. "Tell me more about your feelings related to the accident." Rationale 1: In near-drowning cases, the nurse should be nonjudgmental and provide a forum for parents to express guilt. Telling the parents to watch the child more closely or asking them why they let the child almost drown is judgmental. Saying the child will be fine may not be true. The nurse should reassure the parents that the child is receiving all possible medical treatment.

8) A 24-hour urine collection for vanillylmandelic acid (VMA) has been ordered on a child suspected of having neuroblastoma. When is the most appropriate time for the nurse to begin the collection? 1. At 0700 2. After the next time the child voids 3. At bedtime 4. When the order is noted

2. After the next time the child voids Explanation: 1. A 24-hour urine collection is started after the child voids. That specimen is not saved, but all subsequent specimens in that 24-hour period should be collected. It would not be an accurate collection of 24 hours of urine if the collection began at 0700, bedtime, or when the order is noted.

The nurse is examining a 12-month-old who is brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with bright red scaly plaques and small papules. Satellite lesions are also present. What is the most likely cause of this client's diaper rash? 1. Impetigo (staph) 2. Candida albicans (yeast) 3. Urine and feces 4. Infrequent diapering

2. Candida albicans (yeast) Rationale 1: Candida albicans is frequently the underlying cause of severe diaper rash. When a primary or secondary infection with Candida albicans occurs, the rash has bright red scaly plaques with sharp margins. Small papules and pustules may be seen, along with satellite lesions. Even though diaper dermatitis can be caused by impetigo, urine and feces, and infrequent diapering, the lesions and persistent characteristics are common for Candida.

5) The nurse is caring for a pediatric client in Bryant skin traction. Which nursing intervention is most appropriate for this client? 1. Remove the adhesive traction straps daily to prevent skin breakdown. 2. Check the traction frequently to ensure that proper alignment is maintained. 3. Place the child in a prone position to maintain good alignment. 4. Move the child as infrequently as possible to maintain traction.

2. Check the traction frequently to ensure that proper alignment is maintained. Explanation: The traction apparatus should be checked frequently to ensure that proper alignment is maintained. The adhesive straps should not be removed. The child should be placed in a supine position, and frequent repositioning is necessary to prevent complications of immobility. page ref: 833

2) An infant returns from surgery for correction of bilateral congenital clubfeet. The infant has bilateral long-leg casts. The toes on both feet are edematous, but there is color, sensitivity, and movement to them. Which action by the nurse is the most appropriate? 1. Call the healthcare provider to report the edema. 2. Elevate the legs on pillows. 3. Apply a warm, moist pack to the feet. 4. Encourage movement of toes.

2. Elevate the legs on pillows. Explanation: The legs should be elevated on a pillow for 24 hours to promote healing and help with venous return. Some amount of swelling can be expected, so it would not be appropriate to notify the healthcare provider, especially if the color, sensitivity, and movement remain normal to the toes. Ice should be applied, not heat. An infant would not be able to follow directions to move toes, and in this case it would not be as effective as elevating the legs on pillows. page ref: 829-830

A child is ready for discharge after surgery for a myelomeningocele repair. Before discharge, the nurse works with the parents to establish a catheterization schedule to prevent urinary tract infection. With what frequency should the nurse instruct the parents to catheterize the child? 1. Every 1-2 hours 2. Every 3-4 hours 3. Every 6-8 hours 4. Every 10-12 hours

2. Every 3-4 hours Rationale 1: To decrease the incidence of bladder or urinary tract infections, catheterization should occur every 3-4 hours.

13) A preschool-age child is brought to the clinic by the mother, who says the child has been lethargic and anorexic lately and complains of bone pain. On exam, the nurse notes petechiae, joint pain, and an enlarged liver. Which diagnosis does the nurse anticipate for this child? 1. Hodgkin disease 2. Leukemia 3. Rhabdomyosarcoma 4. Ewing sarcoma

2. Leukemia Explanation: 1. Hodgkin disease, rhabdomyosarcoma, and Ewing sarcoma are all childhood cancers, but they do not have the clinical manifestations listed. Leukemia is one of the most common childhood cancers, and has those clinical symptoms.

The nurse is caring for a child with disseminated intravascular coagulation (DIC). Which nursing intervention is a priority for this child? 1. Frequent ambulation 2. Maintenance of skin integrity 3. Monitoring of fluid restriction 4. Preparation for x-ray procedures

2. Maintenance of skin integrity Impairment of skin integrity can lead to bleeding in DIC. The child with DIC should be placed on bed rest. Fluids need to be monitored but will not be restricted, and DIC is not diagnosed with x-ray examination but by serum lab studies.

15) A child is diagnosed with rhabdomyosarcoma. Which nursing intervention is most appropriate for this child? 1. Position the child with the head elevated 2. Monitor for hematuria 3. Demonstrate the use of a conformer 4. Administer oxygen

2. Monitor for hematuria The most common area of the body affected by rhabdomyosarcoma is the bladder. The nursing intervention that is most appropriate is to monitor the child's urine for hematuria. Positioning the child with the head elevated and administering oxygen is appropriate for a child diagnosed with lymphoma. Demonstrating the use of a conformer is appropriate for a child diagnosed with retinoblastoma.

A nurse is caring for a toddler client who is diagnosed with scabies and prescribed a 5 percent permethrin lotion. How will the nurse apply this lotion when administering it to the toddler? 1. To the scalp only 2. Over the entire body from the chin down, as well as on the scalp and forehead 3. Only on the areas with evidence of scabies activity 4. Only on the hands

2. Over the entire body from the chin down, as well as on the scalp and forehead Rationale 1: Treatment of scabies involves application of a scabicide, such as 5 percent permethrin lotion, over the entire body from the chin down. The scabicide is also applied to the scalp and forehead of younger children, avoiding the rest of the face.

14) A nurse is assessing a child after an open reduction of a fractured femur. Which assessment findings would indicate that the child is experiencing compartment syndrome? Select all that apply. 1. Pink, warm extremity 2. Pain not relieved by pain medication 3. Dorsalis pedis pulse present 4. Prolonged capillary-refill time with paresthesia 5. Skin appears tense.

2. Pain not relieved by pain medication 4. Prolonged capillary-refill time with paresthesia 5. Skin appears tense. Explanation: The major serious complication post-fracture reduction is compartment syndrome. A prolonged capillary-refill time with loss of paresthesia, pain not relieved by medication, and skin that appears tense are signs of compartment syndrome. Pink, warm extremity; pain relieved by medication; and a present dorsalis pedis pulse would all be normal findings post-fracture reduction. page ref: 855-856

A child is diagnosed with epilepsy and is prescribed daily phenytoin (Dilantin). Which topic is most appropriate for the nurse to include in the discharge teaching? 1. Increasing fluid intake 2. Performing good dental hygiene 3. Decreasing intake of vitamin D 4. Taking the medication with milk

2. Performing good dental hygiene Because phenytoin (Dilantin) can cause gingival hyperplasia, good dental hygiene should be encouraged. Fluid intake does not affect the drug's effectiveness, an adequate intake of vitamin D should be encouraged, and phenytoin (Dilantin) should not be taken with dairy products.

A pediatric client sustains a minor burn. When teaching the family the treatment for this burn, the nurse would teach that the client's diet should be high in which substance? 1. Fats 2. Protein 3. Minerals 4. Carbohydrates

2. Protein Rationale 1: Parents should be taught that management of a minor burn requires a high-calorie, high-protein diet. This is necessary to meet the increased nutritional requirements of healing.

3) A preschool child is seen in the clinic, and the nurse anticipates a diagnosis of leukemia. Which reaction does the nurse anticipate this child will exhibit upon diagnosis? 1. Acceptance, especially if able to discuss the disease with children their own age 2. Thoughts that they caused their illness and are being punished 3. Understanding of what cancer is and how it is treated 4. Unawareness of the illness and its severity

2. Thoughts that they caused their illness and are being punished Preschool-age children may think they caused their illness. Adolescents find contact with others who have gone through their experience helpful. School-age children can understand a diagnosis of cancer. Infants and toddlers are unaware of the severity of the disease.

A child diagnosed with hemophilia plans on participating in a bicycling club. Which recommendation by the nurse is the most appropriate? 1. Consider a swim club instead of the bicycling club. 2. Wear kneepads, elbow pads, and a helmet while bicycling. 3. Participate only in the social activities of the club. 4. Not join the club.

2. Wear kneepads, elbow pads, and a helmet while bicycling. Children with hemophilia should be encouraged to participate in noncontact sports activities. Bicycling is an excellent option and is recommended along with swimming. The child should always use kneepads, elbow pads, and a helmet when participating in a physical sport. Participating only in the social aspects of the club would not encourage physical activity. Discouraging a child from joining a club would not foster growth and development.

The nurse is administering packed RBCs to a child with sickle cell disease (SCD). The nurse is monitoring for a transfusion reaction and knows it is most likely to occur during which time frame? 1. Six hours after the transfusion is given 2. Within the first 20 minutes of administration of the transfusion 3. At the end of the administration of the transfusion 4. Never; children with SCD do not have reactions.

2. Within the first 20 minutes of administration of the transfusion Blood reactions can occur as soon as the blood transfusion begins or within the first 20 minutes. The nurse should remain with the child for the first 20 minutes of the transfusion.

The nurse is caring for the 5-year-old just diagnosed with von Willebrand disease after a tooth extraction with increased bleeding. The family asks the nurse how the signs and symptoms of von Willebrand disease are manifested. What will the nurse tell the family? Select all that apply. 1. Decreased partial thromboplastin time 2. Factor VI deficiency 3. Frequent nosebleeds 4. Bleeding from mucous membranes 5. Frequent bruising

3. Frequent nosebleeds 4. Bleeding from mucous membranes 5. Frequent bruising Characteristic manifestations are prolonged and excessive mucocutaneous bleeding, in children this is exhibited through gingival bleeding, epistaxis, menorrhagia, bruising, and minor wounds or lacerations.

4) The nurse is teaching family members how to care for their infant in a Pavlik harness to treat congenital developmental dysplasia of the hip. Which statement will the nurse include in the teaching session? 1. "Apply lotion or powder to minimize skin irritation." 2. "Put clothing over the harness for maximum effectiveness of the device." 3. "Check at least 2 or 3 times a day for red areas under the straps." 4. "Place a diaper over the harness, preferably using a thin, superabsorbent, disposable diaper."

3. "Check at least 2 or 3 times a day for red areas under the straps." Explanation:1. The brace should be checked 2 or 3 times for red areas under the straps. Lotion or powder can contribute to skin breakdown. A light layer of clothing should be under the brace, not over. The diaper should also be under the brace page ref: 832-833

10) An adolescent is receiving methotrexate chemotherapy after undergoing limb-salvage surgery for osteogenic sarcoma. Which statement by the adolescent indicates understanding of the purpose of leucovorin therapy after the methotrexate? 1. "I'm glad I only need one dose of the leucovorin." 2. "I don't have any pain so I won't need to take the leucovorin this time." 3. "I know I will be taking the leucovorin every 6 hours for about the next 3 days." 4. "I don't have any nausea so I won't need the leucovorin."

3. "I know I will be taking the leucovorin every 6 hours for about the next 3 days." Leucovorin (citrovorum factor) is a form of folic acid that helps to protect normal cells from the destructive action of methotrexate. It is started within 24 hours of methotrexate administration and is given along with hydration therapy. Usual administration is every 6 hours for 72 hours or until serum methotrexate is at the desired level.

12) The child is admitted to the hospital after being diagnosed with retinoblastoma. Which assessment finding does the nurse anticipate for this child? 1. A red reflex 2. Yellow sclera 3. A white pupil 4. Blue-tinged sclera

3. A white pupil The first sign of retinoblastoma is a white pupil. The red reflex is absent. Yellow sclera is a sign of jaundice, not retinoblastoma. Blue-tinged sclera is a sign of osteogenesis imperfecta, not retinoblastoma.

1) A child diagnosed with a Wilms tumor is prescribed chemotherapy. Which laboratory test will the nurse monitor prior to administering the chemotherapy to determine the child's infection- fighting capability? 1. Hemoglobin 2. RBC count 3. Absolute neutrophil count (ANC) 4. Platelets

3. Absolute neutrophil count (ANC) Explanation: 1. The absolute neutrophil count uses both the segmented (mature) and bands (immature) neutrophils as a measure of the body's infection-fighting capability. RBC count, hemoglobin, and platelets cannot determine infection-fighting capabilities.

The nurse is caring for a child who is in a sickle cell crisis and has severe pain. Which nursing intervention is the most appropriate for this child? 1. Giving comfort measures, such as back rubs 2. Suggesting diversional activities, such as coloring 3. Administering pain medication 4. Preparing the child for painful procedures

3. Administering pain medication Severe pain requires administration of pain medication for pain relief. Comfort measures and diversional activities are not effective against severe pain in children. Comfort measures should be given to every child and can be used after pain medication is given. A child in severe pain is not capable of participating in or enjoying diversional activities. Preparing the child for painful procedures is not appropriate when the child is already in pain.

A school-age child with hemophilia falls on the playground and goes to the nurse's office with superficial bleeding above the knee. Which action by the nurse is the most appropriate? 1. Apply a warm, moist pack to the area. 2. Perform some passive range of motion to the affected leg. 3. Apply pressure to the area for at least 15 minutes. 4. Keep the affected extremity in a dependent position.

3. Apply pressure to the area for at least 15 minutes. If a hemophiliac child experiences a bleeding episode, superficial bleeding should be controlled by applying pressure to the area for at least 15 minutes. Ice should be applied, not heat. The extremity should be immobilized and elevated, so passive range of motion and keeping the extremity in a dependent position would not be appropriate interventions at this time.

5) The antiemetic drug ondansetron (Zofran) is administered to a child receiving chemotherapy. When should the nurse administer this medication? 1. Only if the child experiences nausea 2. After the chemotherapy has been administered 3. Before chemotherapy administration as a prophylactic measure 4. Never; this antiemetic is not effective for controlling nausea and vomiting associated with chemotherapy

3. Before chemotherapy administration as a prophylactic measure The antiemetic ondansetron (Zofran) should be administered before chemotherapy as a prophylactic measure. Giving it after the child has nausea or at the end of chemotherapy treatment does not help with preventing nausea. It is the drug of choice for controlling nausea caused by chemotherapy agents.

During the recovery-management phase of burn treatment, which is the most common complication seen in children? 1. Shock 2. Metabolic acidosis 3. Burn-wound infection 4. Asphyxia

3. Burn-wound infection Rationale 1: Infection of the burned area is a frequent complication in the recovery-management phase. A goal of burn-wound care is protection from infection.

An infant has a severe case of oral thrush (Candida albicans). Which nursing diagnosis is the priority for this infant? 1. Activity Intolerance Related to Oral Thrush 2. Ineffective Airway Clearance Related to Mucus 3. Ineffective Infant Feeding Pattern Related to Discomfort 4. Ineffective Breathing Pattern Related to Oral Thrush

3. Ineffective Infant Feeding Pattern Related to Discomfort Rationale 1: An infant with oral thrush may refuse to nurse or feed because of discomfort and pain. Prompt treatment is necessary so the infant can resume a normal feeding pattern. Activity intolerance, ineffective airway clearance, and ineffective breathing patterns are not usual associated problems.

The nurse is providing teaching to a community group regarding preventative strategies to reduce the risk of burn injury. Which topics will the nurse include in the teaching session? Standard Text: Select all that apply. 1. Avoid contact with unknown animals and wild animals. 2. Layer children's clothing for warmth. 3. Keep infants and toddlers off the lap when drinking hot beverages or eating soup. 4. Lower the temperature settings for hot water heaters. 5. Wear light-colored clothes and avoid eating sweetened foods and beverages when outside.

3. Keep infants and toddlers off the lap when drinking hot beverages or eating soup. 4. Lower the temperature settings for hot water heaters. Rationale 1: In order to decrease the risk of burn injury, the nurse would tell the group to keep infants and toddlers off the lap while drinking hot beverages or eating soup and to lower the temperature settings for the hot water heaters. Avoiding contact with unknown animals and wild animals along with wearing light-colored clothes and avoiding eating sweetened foods and beverages when outside are strategies to prevent bites and stings. Layering children's clothing for warmth is a strategy to prevent hypothermia.

Which nursing intervention is most appropriate when caring for an infant with a myelomeningocele in the preoperative stage? 1. Placing infant supine to decrease pressure on the sac 2. Appling a heat lamp to facilitate drying and toughening of the sac 3. Measuring head circumference every shift to identify developing hydrocephalus 4. Appling a diaper to prevent contamination of the sac

3. Measuring head circumference every shift to identify developing hydrocephalus Rationale 1: The infant should be monitored for developing hydrocephalus, so the head circumference should be monitored daily. The infant will be placed prone, not supine, and the defect will be protected from trauma or infection. Therefore, applying heat and a diaper around the defect would not be recommended. A sterile saline dressing may be used to cover the sac to maintain integrity.

10) A nurse notes blue sclera during a newborn assessment. Which item will the newborn require further assessment for based on this finding? 1. Marfan syndrome 2. Achondroplasia 3. Osteogenesis imperfecta 4. Muscular dystrophy

3. Osteogenesis imperfecta Explanation: Clinical manifestations of osteogenesis imperfecta include blue sclera. This is not present in Marfan syndrome, achondroplasia, or muscular dystrophy page ref: 852

The nurse is planning care for a 3-month-old infant diagnosed with eczema. Which should be the focus of the nurse's care for this infant? 1. Maintaining adequate nutrition 2. Keeping the baby content 3. Preventing infection of lesions 4. Applying antibiotics to lesions

3. Preventing infection of lesions Rationale 1: Nursing care should focus on preventing infection of lesions. Due to impaired skin-barrier function and cutaneous immunity, an infant with eczema is at greater risk for the development of skin infections by organisms. Maintaining adequate nutrition and keeping the infant content are not as high a priority. Antibiotics are not routinely applied to the lesions.

A child with myelomeningocele, corrected at birth, is now 5 years old. Which is the priority nursing diagnosis for a child with corrected spina bifida at this age? 1. Risk for Altered Nutrition 2. Risk for Impaired Tissue Perfusion—Cranial 3. Risk for Altered Urinary Elimination 4. Risk for Altered Comfort

3. Risk for Altered Urinary Elimination Rationale 1: A child with spina bifida will continue to have a risk for altered urinary elimination because the bowel and bladder sphincter controls are affected. Urinary retention is a problem, so bladder interventions are initiated early to prevent kidney damage. Risk for Altered Nutrition, Impaired Tissue Perfusion, and Altered Comfort are not problems once surgery has been performed to close the defect.

20) The nurse is teaching a 10-year-old and family about the diagnosis of Ewing sarcoma. The nurse knows that instruction has been successful when the child and family indicate which is a common site? 1. Bone marrow 2. Head 3. Shaft 4. Growth plate 5. Bursae

3. Shaft Ewing sarcoma is a malignant, tumor involving the diaphyseal (shaft) portion of the long bones. Common sites include: femur, pelvis, tibia, fibula, ribs, humerus, scapula, and clavicle.

15) A school-age client is admitted to the hospital with osteomyelitis. Which statement regarding the treatment of osteomyelitis is most appropriate for the nurse to share with the parents? 1. "Cultures should be done immediately after the first dose of antibiotic infuses." 2. "Antibiotics are ineffective against this virus." 3. "Methicillin is the antibiotic of choice." 4. "Antibiotic therapy should continue for 3 to 6 weeks."

4. "Antibiotic therapy should continue for 3 to 6 weeks." Explanation: 1. Medical management of osteomyelitis begins with intravenous administration of a broad-spectrum antibiotic. Antibiotic therapy should continue for 3 to 6 weeks. Cultures are always done before an antibiotic is started. Methicillin is not the drug of choice. page ref: 844

A nurse is conducting a postoperative assessment on an infant who has just had a ventriculoperitoneal shunt placed for hydrocephalus. Which assessment finding would indicate a malfunction in the shunt? 1. Incisional pain 2. Movement of all extremities 3. Negative Brudzinski sign 4. Bulging fontanel

4. Bulging fontanel Rationale 1: A bulging fontanel would be an abnormal finding and could indicate that the shunt is malfunctioning. Incisional pain, movement of all extremities, and negative Brudzinski sign are all normal findings after a ventriculoperitoneal shunt has been placed.

A child who has beta-thalassemia is receiving numerous blood transfusions. The child is also receiving deferoxamine (Desferal) therapy. The parents ask how the deferoxamine will help their child. Which rationale does the nurse use when responding to the parents? 1. It prevents blood transfusion reactions. 2. It stimulates RBC production. 3. It provides vitamin supplementation. 4. It prevents iron overload.

4. It prevents iron overload. Iron overload can be a side effect of a hypertransfusion therapy. Deferoxamine (Desferal) is an iron-chelating drug, which binds excess iron so it can be excreted by the kidneys. It does not prevent blood-transfusion reactions, stimulate RBC production, or provide vitamin supplementation.

The nurse is evaluating the activity tolerance of a 9-month-old with iron deficiency anemia. Which finding indicates that the infant is not tolerating activity? 1. Heart rate of 138 2. Increased alertness 3. Respiratory rate less than 40 with activity 4. Muscle weakness

4. Muscle Weakness Iron deficiency anemia can result in less oxygen reaching the cells and tissues, causing activity intolerance. An indication that a 9-month-old child is not tolerating activity and that iron deficiency anemia is worsening would be the presence of muscle weakness during activity. A heart rate of 138, increased alertness, and a respiratory rate of less than 40 with activity are all signs that iron deficiency anemia is resolving and activity tolerance is improving.

11) A child who is diagnosed with leukemia has a sibling who is expressing feelings of anger and guilt. How would the nurse characterize this reaction by the sibling? 1. Abnormal; the sibling should be referred to a psychologist. 2. Normal; the illness doesn't affect the sibling. 3. Unexpected; the cancer is easily treated. 4. Normal; the sibling is affected too, and anger and guilt are expected feelings.

4. Normal; the sibling is affected too, and anger and guilt are expected feelings. Explanation: 1. A diagnosis of cancer affects the whole family, and initial feelings experienced by the sibling may be anger and guilt. Seldom will the sibling be unaffected; however, the response is not abnormal.

A 2-month-old client has a candidal diaper rash. Which medication does the nurse anticipate will be prescribed for this client? 1. Bacitracin ointment 2. Hydrocortisone ointment 3. Desitin 4. Nystatin given topically and orally

4. Nystatin given topically and orally Rationale 1: Diaper candidiasis is treated with an antifungal cream (Nystatin). An oral antifungal agent may be given to clear the candidiasis from the intestines. Bacitracin is for an infection caused by staphylococcus. Mild diaper rash is treated with a barrier such as Desitin. Moderate diaper rash is treated with hydrocortisone ointment.

The charge nurse on a pediatric unit is making a room assignment for a school-age child diagnosed with sickle cell disease, who is in splenic sequestration crisis. Which room assignment is most appropriate for this client? 1. Semiprivate room 2. Reverse-isolation room 3. Contact-isolation room 4. Private room

4. Private room Splenic sequestration can be life-threatening, and there is profound anemia. The child does not need an isolation room but should not be placed in a room with any child who may have an infectious illness. The private room is appropriate for this child.

A child with meningococcemia is being admitted to the pediatric intensive-care unit. Which room assignment is the most appropriate for this child? 1. Semiprivate room 2. Private room, but not in isolation 3. Private room, in protective isolation 4. Private room, in respiratory isolation

4. Private room, in respiratory isolation Meningococcemia follows an infection with Neisseria meningitidis. N. meningitidis is transmitted through airborne droplets; thus, the child should be placed in a private room in respiratory isolation. A private room with protective isolation (child is essentially kept in a "bubble") would not be appropriate.

4) The nurse is monitoring the urine specific gravity and pH on a child receiving chemotherapy. Which urinalysis result is the goal for this child? 1. Spec gravity 1.030; pH 6 2. Spec gravity 1.030; pH 7.5 3. Spec gravity 1.005; pH 6 4. Spec gravity 1.005; pH 7.5

4. Spec gravity 1.005; pH 7.5 Because the breakdown of malignant cells releases intracellular components into the blood and electrolyte imbalance causes metabolic acidosis, the urine specific gravity should remain at less than 1.010 and the pH at 7 to 7.5. A specific gravity higher than 1.010 can mean fluid intake is not high enough, and a pH of less than 7 means acidosis.

A school-age client is transported to the emergency department by ambulance from the scene of a car accident. The client is alert and oriented × 3; pulse, respirations, and blood pressure are stable; and the neck and back are immobilized on a backboard. The nurse sees no obvious bleeding. The client states, "I can't feel or move my legs." Which injury does the nurse suspect? 1. Traumatic brain injury 2. Ruptured spleen 3. Traumatic shock 4. Spinal cord injury

4. Spinal cord injury Rationale 1: Spinal cord injury results in paralysis and anesthesia of the affected body parts below the level of the lesion. Altered levels of consciousness may indicate traumatic brain injury. The child may have a ruptured spleen, but it is not evident from the data given. Traumatic shock results in initially increasing then decreasing pulse and respirations, and falling blood pressure.

A child is prescribed cephalexin for treatment of cellulitis. The child weighs 15 kg. The pediatrician orders: cephalexin 40 mg/kg/day PO, give twice a day.Medication on hand: 250 mg/5 mLCalculate how many mLs the nurse must draw up for each dose.

Answer: 6 mL

The nurse is caring for a pediatric client who sustained a severe burn. Determine the order of what would be done for this child when the medical team arrives on the scene: Standard Text: Click on the down arrow for each response in the right column and select the correct choice from the list. Response 1. Start intravenous fluids. Response 2. Provide for relief of pain. Response 3. Establish an airway. Response 4. Place a Foley catheter.

Correct Answer: 3,1,2,4 Response 3. Establish an airway. Response 1. Start intravenous fluids. Response 2. Provide for relief of pain. Response 4. Place a Foley catheter. Rationale 1: The first step in burn care is to ensure that the child has an airway, is breathing, and has a pulse. Due to the severity of the burn, establishing IV access and starting resuscitation fluids would be next, followed by addressing the area of pain and inserting a Foley catheter.