Exam 4 Peds

The mother of an infant born prematurely at 32 weeks expresses the desire to breastfeed her child. The nurse correctly responds with which statement when the mother asks how long she should breastfeed her baby? 1. "Until the child begins solid foods." 2. "Many breastfeed for 2 years." 3. "It is recommended that mothers of preterm infants breastfeed at least a month." 4. "Breast milk should be the only food for the first 6 months."

"Breast milk should be the only food for the first 6 months." 4. Breast milk should be the only food for the first 6 months, and should continue until 12 months even after solid foods are introduced.

An adolescent client diagnosed with panic disorder is prescribed paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI). The client tells the nurse she often takes diet pills because she is trying to lose weight. Which response by the nurse is the most appropriate? 1. "You can continue with the paroxetine (Paxil) and the diet pills." 2. "It is important to stop both the paroxetine (Paxil) and the diet pills." 3. "Discontinue using the diet pills while taking the paroxetine (Paxil)." 4. "You should discuss the safety of these two medications pills with a pharmacist."

"Discontinue using the diet pills while taking the paroxetine (Paxil)." 3. Serotonin syndrome, the serious and life-threatening side effect of SSRIs, can develop when the drug is taken with diet pills, St. John's wort, other antidepressants, alcohol, or LSD. In this case, the diet pills should be discontinued in order to avoid serotonin syndrome. The Paxil should not be discontinued, and waiting to discuss the use of diet pills with a pharmacist would not be an appropriate option.

The parents of a client recently diagnosed with Down syndrome relate to the nurse that they "feel guilty about causing the condition." Which response by the nurse is the most appropriate? 1. "Down syndrome is a condition caused by an extra chromosome; the cause of it is unknown." 2. "Down syndrome is a condition that is genetically transmitted from both the father and the mother." 3. "Down syndrome is a condition that is carried on the X chromosome, so it came from the mother." 4. "Down syndrome is caused by birth trauma, not by genetics."

"Down syndrome is a condition caused by an extra chromosome; the cause of it is unknown." Answer: 1 Explanation: 1. The therapeutic and accurate response is that Down syndrome is a condition caused by an extra chromosome, but we don't know why it occurs. The other responses are nontherapeutic or inaccurate.

Parents of a child who experienced a moderately severe allergic reaction after eating peanuts ask the nurse what they can do to help if it happens again. Which response by the nurse is the most appropriate? 1. "If it happens again, I will teach you what to do." 2. "You should have an antihistamine like Benadryl with you at all times." 3. "We can start a desensitization process to take the allergy away." 4. "I will teach you how to use an Epi-Pen."

"I will teach you how to use an Epi-Pen." 4. An Epi-Pen is the appropriate treatment if this reaction occurs again. Benadryl is fine, but most likely is not strong enough in light of the serious reaction the child had. Desensitization is not the appropriate instruction at this time. Telling the parents that they will be taught if it happens again is brushing off the seriousness of the situation.

The nurse is providing nutritional guidance to the parents of a toddler. Which comment by the parent would prompt the nurse to provide additional education? 1. "I should not give my child raw oysters." 2. "It is safe to leave my meat red in the center as long as there are no juices running." 3. "We always wash our hands well before any food preparation." 4. "We use separate utensils for preparing raw meat and preparing fruits, vegetables, and other foods."

"It is safe to leave my meat red in the center as long as there are no juices running." 2. Meats should be cooked thoroughly before eating. Meat that is red in the center, with or without running juices, is insufficiently cooked and increases the risk of food-borne illness. Washing hands and using separate utensils help to prevent infection with food-borne pathogens. Raw oysters should be avoided.

An HIV-positive mother states she is relieved after the birth of her child to hear that the child is HIV-negative. Which response by the nurse is the most appropriate? 1. "Symptoms could still appear over the next 2 years." 2. "You took good care of yourself, so your child did not get HIV." 3. "We will assess for signs of pneumonia to be sure." 4. "The test will be repeated in 1 week to verify the negative status."

"Symptoms could still appear over the next 2 years." Answer: 1 Explanation: 1. Symptoms of HIV could still manifest within the first 2 years. An infant is retested 1 to 2 months after the initial negative result. The HIV-positive mother can infect the newborn regardless of how well she takes care of herself once she is HIV-positive. There is no reason to assess for signs of pneumonia if the newborn is HIV-negative.

A pediatric client diagnosed with Turner syndrome tells the nurse, "I feel different from my peers." Which response by the nurse is the most appropriate? 1. "Tell me more about the feelings you are experiencing." 2. "These feelings are not unusual and should pass soon." 3. "You'll start to grow soon, so don't worry." 4. "You seem to be upset about your disease."

"Tell me more about the feelings you are experiencing." Answer: 1 Explanation: 1. The lack of growth and sexual development associated with Turner syndrome presents problems with psychosocial development. Self-image, self-consciousness, and self- esteem are affected by the girl's perception of her body and how she differs from peers. The nurse should encourage more expression of the girl's feelings. Responding that the feelings will pass, that she'll start to grow, or that she is upset about the disease would not be therapeutic.

The nurse completes postoperative discharge teaching to the parents of a child who had a tonsillectomy. Which statement by the parents indicates correct understanding of the teaching session? 1. "We will call the physician for any indication of ear pain." 2. "We will plan on administering acetaminophen (Tylenol) for pain." 3. "We will be sure to give our child adequate amounts of citrus juices." 4. "We will keep our child on bed rest for 10 days after the surgery."

"We will plan on administering acetaminophen (Tylenol) for pain." 2. Acetaminophen (Tylenol) is recommended for pain after a tonsillectomy. Citrus juices should be avoided for the first week because highly acidic foods and beverages can cause irritation. Ear pain 4 to 8 days after a tonsillectomy may be experienced and does not indicate an ear infection. Children do not need to be confined to bed. They can return to school in 10 days.

The nurse is instructing a parent of a newborn on the foods that are to be started based on age. The nurse instructs the parent that the first food given to a newborn is rice cereal. What statement by the parent suggests appropriate understanding of the next food that can be introduced? 1. "Chicken can be given next." 2. "Eggs can be given next." 3. "Fruits should be given next." 4. "Whole milk should be started."

"fruits should be given next" 3. Chicken is not given until 8 to 10 months, eggs are not given until 12 months, whole milk is given at 12 months. Fruits are given after rice cereal.

John is a 4-month old who is admitted for acute dehydration. Wt is 7.9kg. He has been bottle fed with a history of poor feeding x 4 days. Order is written for a bolus of NS 123ml IV over 30mins. What rate will be appropriate to set the pump to deliver the bolus?

- 123ml/30min x 60 min/1hr = 246ml/hr

Alexis says that her daughter misbehaves and does not focus at home and fears she will eventually have trouble in school although currently, she is passing all classes with no complaints from the teachers. The ADHD parent and teacher Vanderbilt screening tools are completed, and the parents screening is positive for ADHD symptoms, but two of her teacher's results were negative for ADHD. What is your best response to the results?

- Does not meet the DS5-M criteria

Which of the following could be diagnostic of Type one diabetes?

- Fasting Glucose > 110

A nurse is providing education to parents whose children have been diagnosed with Type I diabetes Mellitus. Which of the following parental statements indicate that further teaching is required?

- Parents of a two-year-old: we will have her prick her finger.

Which of the following are important nursing interventions to implement when a child is hospitalized with a life threatening illness?

- Provide informative and frequent updates about the child's health

Childhood depression is a significant concern and is on the rise. The nurse will alert the provider if she notes which of the following about her patient during a routine physical?

- She reports frequent use of illicit drugs

Which of the following are appropriate tasks for the school nurse?

- Work with the Parent/Teacher Association to organize health fairs - Communicate with the child's primary care provider about their chronic illness management - Perform a comprehensive physical

Jared now has his prescription for a ten-day course of Amoxicillin to treat his strep pharyngitis. He understands his diagnosis but asks, when can I go back to school?

- You should no longer have a sore throat or fever and take a full day's course of antibiotics

The nurse is providing discharge teaching to a school-age client who was recently diagnosed with a latex allergy. Which product will the nurse educate the client and family to avoid? 1. Plastic bottles 2. Footballs 3. Chewing gum 4. Paper bags

. Chewing gum 3. When a child is diagnosed with a latex allergy, it is essential for the nurse to educate both the child and the family regarding sources of latex within the home and the community. The child and family should be educated to avoid chewing gum as it contains latex. The other items do not contain latex and do not pose a risk for this child in the community.

The number of serious injuries in children has doubled in the past year. Based on this information, which is the most appropriate community nursing diagnosis? 1. Noncompliance Related to Inappropriate Use of Child Safety Seats 2. Risk for Injury Related to Inadequate Use of Bicycle Helmets 3. Altered Family Processes Related to Hospitalization of an Injured Child 4. Knowledge Deficit Related to Injury Prevention in Children

. Knowledge Deficit Related to Injury Prevention in Children 4. All of these diagnoses might be appropriate in specific situations, but Knowledge Deficit Related to Injury Prevention in Children is the only one that is general to the problem as a whole and is therefore the most appropriate community nursing diagnosis.

Parents of a child in the pediatric intensive care unit (PICU) have been experiencing shock and disbelief regarding their situation. Which statement by the parents indicates they are moving forward into the next stage of coping? 1. "Why not me instead of my child?" 2. "It is hard for me to have others take care of my child." 3. "I feel like life is suspended in time." 4. "I am glad I can help with his care."

1. "Why not me instead of my child?" Explanation: 1. The parents initially enter the stage of shock and disbelief. Asking "Why not me instead of my child?" shows they are moving into the next stage, which is anger and disbelief. Having feelings about others caring for their child is the third stage of deprivation and loss. The feeling of being suspended in time is the fourth stage, which is anticipatory guidance.

The nurse is providing care to an adolescent client who is dying. Which assessment findings indicate the client is experiencing a decrease in peripheral circulation? Select all that apply. 1. Cool skin 2. Mottled appearance 3. Cheyne-Stokes respirations 4. Increased agitation5. Increased urine output

1. Cool skin 2. Mottled appearance A client who is experiencing decreased peripheral circulation will have cool, mottled skin. While Cheyne-Stokes respirations may indicate death is approaching, this is not indicative of a decrease in peripheral circulation. Increased agitation indicates decreased perfusion to the brain. A client will not experience increased urine output near the end life. 2. A client who is experiencing decreased peripheral circulation will have cool, mottled skin. While Cheyne-Stokes respirations may indicate death is approaching, this is not indicative of a decrease in peripheral circulation. Increased agitation indicates decreased perfusion to the brain. A client will not experience increased urine output near the end life.

The nurse is assessing an adolescent and notes signs and symptoms of anorexia nervosa. Which signs and symptoms led the nurse to believe the adolescent has this condition? Select all that apply. 1. Extreme weight loss 2. Depression 3. Irregular menses 4. Sedentary lifestyle 5. Bradycardia

1. Extreme weight loss 2. Depression 3. Irregular menses 5. Bradycardia 1. Extreme weight loss is a sign and symptom of anorexia nervosa. 2. Depression is a sign and symptom of anorexia nervosa. 3. Irregular menses is a sign and symptom of anorexia nervosa. 5. Bradycardia is a sign and symptom of anorexia nervosa.

A young school-age child is in the pediatric intensive-care unit (PICU) with a fractured femur and head trauma. The child was not wearing a helmet while riding his new bicycle on the highway and collided with a car. Which nursing diagnoses may be appropriate for this family? Select all that apply. 1. Guilt Related to Lack of Child Supervision and Safety Precautions 2. Family Coping: Compromised, Related to the Critical Injury of the Child 3. Parental Role Conflict Related to Child's Injuries and PICU Policies 4. Knowledge Deficit Related to Home Care of Fractured Femur 5. Anger Related to Feelings of Helplessness

1. Guilt Related to Lack of Child Supervision and Safety Precautions 2. Family Coping: Compromised, Related to the Critical Injury of the Child 3. Parental Role Conflict Related to Child's Injuries and PICU Policies 5. Anger Related to Feelings of Helplessness

The nurse is providing education to a group of student nurses regarding disorders of the endocrine system that can cause short stature. Which disorders will the nurse include in the educational session? Select all that apply. 1. Hypothyroidism 2. Turner syndrome 3. Type 1 diabetes mellitus 4. Diabetes insipidus 5. Cushing syndrome

1. Hypothyroidism 2. Turner syndrome Cushing syndrome Answer: 1, 2, 5 Explanation: 1. There are many disorders of the endocrine system that can cause short stature including hypothyroidism, Turner syndrome, and Cushing syndrome. Type 1 diabetes mellitus and diabetes insipidus are not endocrine disorders that cause short stature. 2. There are many disorders of the endocrine system that can cause short stature including hypothyroidism, Turner syndrome, and Cushing syndrome. Type 1 diabetes mellitus and diabetes insipidus are not endocrine disorders that cause short stature. 5. There are many disorders of the endocrine system that can cause short stature including hypothyroidism, Turner syndrome, and Cushing syndrome. Type 1 diabetes mellitus and diabetes insipidus are not endocrine disorders that cause short stature.

Which teaching tips should be included when instructing parents on hydrocortisone administration?Select all that apply. 1. Maintain prescribed administration times. 2. Never discontinue medication abruptly. 3. Injections might be necessary when unable to take by mouth. 4. Lower doses are needed during illness. 5. Keep an emergency kit with the child at all times.

1. Maintain prescribed administration times. 2. Never discontinue medication abruptly. 3. Injections might be necessary when unable to take by mouth. 5. Keep an emergency kit with the child at all times. Answer: 1, 2, 3, 5 Explanation: 1. Maintaining prescribed administration times is important, as they follow the normal body release of cortisol. Abruptly discontinuing a steroid is not recommended. Giving injections when unable to take by mouth and during emergencies is important to maintain cortisol levels. Higher, not lower, doses are needed during illness. 2. Maintaining prescribed administration times is important, as they follow the normal body release of cortisol. Abruptly discontinuing a steroid is not recommended. Giving injections when unable to take by mouth and during emergencies is important to maintain cortisol levels. Higher, not lower, doses are needed during illness. 3. Maintaining prescribed administration times is important, as they follow the normal body release of cortisol. Abruptly discontinuing a steroid is not recommended. Giving injections when unable to take by mouth and during emergencies is important to maintain cortisol levels. Higher, not lower, doses are needed during illness. 5. Maintaining prescribed administration times is important, as they follow the normal body release of cortisol. Abruptly discontinuing a steroid is not recommended. Giving injections when unable to take by mouth and during emergencies is important to maintain cortisol levels. Higher, not lower, doses are needed during illness.

A toddler-age client is in end-stage renal failure. Which nursing intervention will assist this child most? 1. Maintain the child's normal routines .2. Explain body changes that will take place. 3. Encourage friends to visit. 4. Allow the child to talk about the illness.

1. Maintain the child's normal routines A toddler has no real concept of death, but does sense changes in routine and parent behavior. Maintaining normal routines is the best intervention to assist this child. A toddler will not understand the body changes; this approach would be more appropriate for a school-age child. Encouraging friends to visit and allowing the child to talk about the illness are more appropriate for older children.

The emergency-room nurse receives a preschool-age child who was hit by a car. Which nursing interventions are a priority for this child? Select all that apply. 1. Performing a rapid head-to-toe assessment 2. Recording the parents' insurance information 3. Assessing airway, breathing, and circulation 4. Asking the parents about organ donation 5. Asking the parents if anyone witnessed the accident

1. Performing a rapid head-to-toe assessment 3. Assessing airway, breathing, and circulation Explanation: 1. Assessing airway, breathing, and circulation and performing a rapid head-to-toe assessment are the priority nursing interventions. Asking the parents about organ donation is insensitive until the extent of the child's injuries is known. Recording insurance information is necessary but should never come before lifesaving assessment and intervention. Detailed information about the accident is helpful in determining the child's point of impact with the car and mechanism of injury, but this is not the initial priority. 3. Assessing airway, breathing, and circulation and performing a rapid head-to-toe assessment are the priority nursing interventions. Asking the parents about organ donation is insensitive until the extent of the child's injuries is known. Recording insurance information is necessary but should never come before lifesaving assessment and intervention. Detailed information about the accident is helpful in determining the child's point of impact with the car and mechanism of injury, but this is not the initial priority.

The nurse manager is assisting the organization to open a healthcare center. What items must the manager include in pediatric inventory? Select all that apply. 1. Preprinted drug dosage chart 2. Oxygen face masks 3. Pediatric chairs and litters 4. Length-based resuscitation tape 5. Oral and NG airways and laryngoscope blades

1. Preprinted drug dosage chart 2. Oxygen face masks 4. Length-based resuscitation tape 5. Oral and NG airways and laryngoscope blades Answer: 1, 2, 4, 5 1. Essential equipment: child/neonate sized, proper weight dosage medications, smaller bags of IV fluids and special IV tubing, pediatric external defibrillator, pediatric oxygen masks/oral/NG airways and laryngoscope blades, length based resuscitation tapes and preprinted dosage chart to quickly identify equipment sizes and drug dosages by the length or weight of the child, essential emergency pediatric drugs and equipment. 2. Essential equipment: be child/neonate sized, proper weight dosage medications, smaller bags of IV fluids and special IV tubing, pediatric external defibrillator, pediatric oxygen masks/oral/NG airways and laryngoscope blades, length based resuscitation tapes and preprinted dosage chart to quickly identify equipment sizes and drug dosages by the length or weight of the child, essential emergency pediatric drugs and equipment. 4. Essential equipment: child/neonate sized, proper weight dosage medications, smaller bags of IV fluids and special IV tubing, pediatric external defibrillator, pediatric oxygen masks/oral/NG airways and laryngoscope blades, length based resuscitation tapes and preprinted dosage chart to quickly identify equipment sizes and drug dosages by the length or weight of the child, essential emergency pediatric drugs and equipment.5. Essential equipment: child/neonate sized, proper weight dosage medications, smaller bags of IV fluids and special IV tubing, pediatric external defibrillator, pediatric oxygen masks/oral/NG airways and laryngoscope blades, length based resuscitation tapes and preprinted dosage chart to quickly identify equipment sizes and drug dosages by the length or weight of the child, essential emergency pediatric drugs and equipment.

A preschool-age child has just had a moderate reaction to latex. When teaching the parents about latex allergy, the nurse should inform the parents of what common household items that contain latex?Select all that apply. 1. Rubber bands 2. Sneakers 3. Toothbrushes 4. Big Wheel® tricycle 5. Water toys

1. Rubber bands 2. Sneakers 3. Toothbrushes 5.water toys Answer: 1, 2, 3, 5 Explanation: 1. Rubber bands, sneakers, toothbrushes, and water toys are household items that might contain latex. A Big Wheel® tricycle is plastic and does not contain latex. 2. Rubber bands, sneakers, toothbrushes, and water toys are household items that might contain latex. A Big Wheel® tricycle is plastic and does not contain latex.3. Rubber bands, sneakers, toothbrushes, and water toys are household items that might contain latex. A Big Wheel® tricycle is plastic and does not contain latex. 5. Rubber bands, sneakers, toothbrushes, and water toys are household items that might contain latex. A Big Wheel® tricycle is plastic and does not contain latex.

A novice nurse in the newborn intensive care unit (NICU) has just performed postmortem care on a premature infant who passed away. The novice nurse asks to be excused near the end of the shift. Which interventions can be implemented to support this nurse? Select all that apply. 1. Schedule additional education on bereavement care 2. Ask a seasoned nurse to talk with the novice nurse 3. Tell the nurse it is OK to grieve with the family 4. Recommend that the nurse transfer to another unit 5. Assign the nurse to stable clients only

1. Schedule additional education on bereavement care 2. Ask a seasoned nurse to talk with the novice nurse 3. Tell the nurse it is OK to grieve with the family

A 2-year-old child is seen in the clinic with swelling in the eyelid, mattering and difficulty opening the eye in the morning, the healthcare provider is ordering an antibiotic for bacterial conjunctivitis. What organisms could be causing this infection?Select all that apply. 1. Staphylococcus aureus 2. Pneumococcal pneumoniae 3. Haemophilus influenza 4. Streptococcus pneumoniae 5. Moraxella catarrhalis

1. Staphylococcus aureus 3. Haemophilus influenza 4. Streptococcus pneumoniae 5. Moraxella catarrhalis Answer: 1, 3, 4, 5 Explanation: 1. Common infectious organisms in bacterial conjunctivitis include: S. aureus, H. influenza, S. pneumonia, and M. catarrhalis. 3. This is a common cause of bacterial conjunctivitis. 4. Common infectious organisms in bacterial conjunctivitis include: S. aureus, H. influenza, S. pneumonia, and M. catarrhalis. 5. Common infectious organisms in bacterial conjunctivitis include: S. aureus, H. influenza, S. pneumonia, and M. catarrhalis.

A child with the diagnosis of Wiskott-Aldrich syndrome has been ordered an IV infusion of gamma globulin. The child weighs 20 pounds. The healthcare provider orders: gamma globulin 2 g/kg IV over 12 hours.Calculate how many grams of gamma globulin will be given IV.

18g

A 22-month-old child is seen in the office for reoccurring otitis media. The child weighs 25 pounds. The healthcare provider orders:Amoxicillin 45 mg/kg/day by mouth in divided doses every 12 hours.Medication on hand: Amoxicillin 125 mg/5 mL Calculate how many mL/dose of amoxicillin will be given by mouth.

10.2 or 10ml/dose

A school-aged child is admitted with pneumococcal meningitis. The child weighs 44 pounds. The physician orders: ceftriaxone (Rocephin) 50 mg/kg/dose IV every 12 hours three times and then every 24 hours.Calculate how many mg/dose of ceftriaxone the child will receive and then calculate mL/hr to infuse via pump. Supply on hand is: a premix of ceftriaxone 1 g/50 mL, administer over 30 minutes.

1000mg/dose or 100ml/hr

John is a 4month old infant who is admitted to the hospital for acute dehydration. Wt is 6.3kg. He has been bottle fed with a history of poor feeding x 4 days. The order is written for a bolus of NS 125ml IV over 30mins. What rate will you set the pump to deliver the bolus as ordered. -

125ml/30 x 60ml/1hr =250ml/hr

A child with human immunodeficiency virus is started on sulfamethoxazole and trimethoprim (Bactrim) for Pneumocystis carinii pneumonia (PCP) prophylaxis. The recommended dose is based on the trimethoprim (TMP) component and is 15 to 20 mg TMP/kg/day in divided doses every 6 to 8 hours. The child weighs 6.8 kg. The highest dose of TMP the child can receive a day is ________. Round your answer to the nearest whole number.

136

A child is admitted to the neonatal intensive care unit (NICU). The parents are concerned because they cannot stay for long hours to visit. Which statement made by the nurse is most appropriate? 1. "One of you might take a leave of absence to be here more." 2. "Parents often feel this way; would you be interested in talking with others who have experienced having a child in the NICU?" 3. "Perhaps the grandparents can make the visits for you." 4. "Why can't you visit after work every day?"

2. "Parents often feel this way; would you be interested in talking with others who have experienced having a child in the NICU?" 2. "Parents often feel this way; would you be interested in talking with others who have experienced having a child in the NICU?" is therapeutic; it focuses on feelings and offers support to the parents. The other options do not focus on how the parents feel and attempt to solve the issue rather than allow for the parents to deal with their feelings and form solutions.

A nurse is conducting developmental assessments on several children in the day-care setting. Which child(ren) does the nurse identify as having development delays? Select all that apply. 1. An 18-month-old toddler who is unable to phrase sentences 2. A 5-year-old who is unable to button his shirt 3. A 6-year-old who is unable to sit still for a short story 4. A 2-year-old who is unable to cut with scissors5. A 2-year-old who cannot recite her phone number

2. A 5-year-old who is unable to button his shirt 3. A 6-year-old who is unable to sit still for a short story Answer: 2, 3 2. A developmental milestone that can indicate learning disability is a kindergartener's being unable to button his shirt. Inability to phrase sentences is considered a delay if not done by 2-1/2 years, inability to sit still for a short story is considered a delay if the child is 3 to 5 years old, and being unable to cut with scissors indicates a delay if not done by kindergarten age. Reciting the phone number is not appropriate for a 2-year-old. 3. A developmental milestone that can indicate learning disability is a kindergartener's being unable to button his shirt. Inability to phrase sentences is considered a delay if not done by 2-1/2 years, inability to sit still for a short story is considered a delay if the child is 3 to 5 years old, and being unable to cut with scissors indicates a delay if not done by kindergarten age. Reciting the phone number is not appropriate for a 2-year-old.

A 2-month-old infant with bronchopulmonary dysplasia (BPD) is being prepared for discharge from the neonatal intensive-care unit (NICU). The infant will continue to receive oxygen via nasal cannula at home. Prior to discharge, the home-health nurse assesses the home. Which finding poses the greatest risk to this infant? 1. Small toys strewn on the floor 2. A woodstove used for heating 3. A sibling who has an ear infection 4. Paint peeling on the walls

2. A woodstove used for heating 2. Assessment of the home environment is essential prior to discharge of a medically fragile infant. The use of a woodstove poses great risk to the infant who already has fragile lungs. Oxygen and woodstove heat will produce a flammable reaction. Small toy pieces and paint peeling from the wall will pose a choking risk to the older infant who is crawling. Ear infections are not contagious.

17) Which intervention is considered supportive care for a family whose infant has died from sudden infant death syndrome (SIDS)? 1. Interviewing parents to determine the cause of the SIDS incident 2. Allowing parents to hold, touch, and rock the infant 3. Sheltering parents from the grief by not giving them any personal items of the infant, such as footprints 4. Advising parents that an autopsy is not necessary

2. Allowing parents to hold, touch, and rock the infant 2. The parents should be allowed to hold, touch, and rock the infant, giving them a chance to say good-bye to their baby. The other options are nontherapeutic. The death of an infant without a known medical condition is an indication for an autopsy.

4) The nurse is providing care for several pediatric clients. Which client would require an Individualized Health Plan (IHP) prior to returning to school? 1. A school-age client who has recently developed a penicillin allergy 2. An adolescent client newly diagnosed with insulin-dependent diabetes mellitus 3. A school-age client who has been treated for head lice 4. An adolescent client who has missed two weeks of school due to mononucleosis

2. An adolescent client newly diagnosed with insulin-dependent diabetes mellitus Answer 2. An IHP that ensures appropriate management of the child's healthcare needs must be developed for a child newly diagnosed with a chronic illness such as diabetes. A child who is allergic to penicillin will not receive this medication any longer and therefore should not encounter any problems related to it at school. A child who has been treated for head lice can return to school and does not need an IHP. While a child who has missed two weeks of school will need to make arrangements for makeup work, an IHP is not needed.

An adolescent client diagnosed with attention deficit hyperactivity disorder (ADHD) is interested in playing the drums in the school band. Which action by the nurse is the most appropriate? 1. Recommend the child take private lessons and not join the band. 2. Encourage the child to join the band. 3. Consult with the healthcare provider about allowing participation in band activities. 4. Discourage the child from playing in the band.

2. Encourage the child to join the band. 2. A child with ADHD may lack connectedness with other children. Participation in a school activity where the rules of working with others can be learned should be encouraged.

Which nursing interventions would be best for the nursing diagnosis of Powerlessness Related to Relinquishing Control to the Healthcare Team? Select all that apply. 1. Provide a primary nursing care model. 2. Prepare the child in advance for procedures. 3. Provide optimal pain relief. 4. Explain procedures in developmentally appropriate terms. 5. Incorporate home rituals when possible.

2. Prepare the child in advance for procedures. 4. Explain procedures in developmentally appropriate terms. 5. Incorporate home rituals when possible.

3) The community-health nurse is planning an education session for recently hired teachers at a child-care center. Which item is priority for the community-health nurse to include in the educational session? 1. The schedule for immunizations 2. Principles of infection control 3. How to interpret healthcare records 4. How to take a temperature

2. Principles of infection control Answer 2: While all of the information is nice to know, it is most essential that teachers know principles of infection control to decrease the spread of germs that can cause disease in young children.

A school-age child is being assessed for syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should watch the child for which symptoms? Select all that apply. 1. Polyphagia 2. Retention of fluid 3. Hypernatremia 4. Hyponatremia 5. Hyperglycemia

2. Retention of fluid 3. Hypernatremia Answer: 2, 3 2. ADH helps the body retain fluid. Serum osmolality is increased (greater than 300 mOsm/kg) and urine osmolality is decreased (less than 300 mOsm/kg). Urine specific gravity is decreased (less than 1.005) and serum sodium is elevated.3. ADH helps the body retain fluid. Serum osmolality is increased (greater than 300 mOsm/kg) and urine osmolality is decreased (less than 300 mOsm/kg). Urine specific gravity is decreased (less than 1.005) and serum sodium is elevated.

The nurse is caring for the adolescent with systemic lupus erythematosus (SLE). What nursing diagnoses would the nurse address? Select all that apply. 1. Activity intolerance 2. Risk for impaired skin integrity 3. Body image disturbed 4. Ineffective breathing pattern 5. Risk for infection

2. Risk for impaired skin integrity 3. Body image disturbed risk for infection Answer: 2, 3, 5 2. Nursing diagnoses that may apply to the adolescent with SLE are: risk for impaired skin integrity, risk for activity intolerance, disturbed body image, risk for infection, acute pain, and ineffective family therapeutic regimen management. 3. Nursing diagnoses that may apply to the adolescent with SLE are: risk for impaired skin integrity, risk for activity intolerance, disturbed body image, risk for infection, acute pain, and ineffective family therapeutic regimen management. 5. Nursing diagnoses that may apply to the adolescent with SLE are: risk for impaired skin integrity, risk for activity intolerance, disturbed body image, risk for infection, acute pain, and ineffective family therapeutic regimen management.

An adolescent client has a stiff neck, a headache, a fever of 103 degrees Fahrenheit, and purpuric lesions noted on the legs. Although the adolescent's physical needs take priority at the present time, the nurse can expect which to be the most significant psychological stressor for this adolescent? 1. Separation from parents and home 2. Separation from friends and permanent changes in appearance 3. Fear of painful procedures and bodily mutilation 4. Fear of getting behind in schoolwork

2. Separation from friends and permanent changes in appearance Adolescents are developing their identity and rely most on their friends. They are concerned about their appearance and how they look compared to their peers. Separation from parents and home is the main psychological stressor for infants and toddlers. Preschool-age children fear pain and bodily mutilation. School-age children are developing a sense of industry and fear getting behind in schoolwork.

The nurse is caring for a pediatric client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) disorder. Which interventions should the nurse implement for this child? Select all that apply. 1. Encouragement of fluids 2. Strict intake and output 3. Administration of ordered diuretics 4. Specific gravity of urine 5. Weight only on admission but not daily

2. Strict intake and output 3. Administration of ordered diuretics 4. Specific gravity of urine Answer: 2, 3, 4 2. SIADH results from an excessive amount of serum antidiuretic hormone, causing water intoxication and hyponatremia. Intake and output should be monitored strictly. Diuretics such as furosemide (Lasix) are administered to eliminate excess body fluid, and urine specific gravity is monitored. Fluids are restricted to prevent further hemodilution. Daily weights should be obtained to monitor fluid balance. 3. SIADH results from an excessive amount of serum antidiuretic hormone, causing water intoxication and hyponatremia. Intake and output should be monitored strictly. Diuretics such as furosemide (Lasix) are administered to eliminate excess body fluid, and urine specific gravity is monitored. Fluids are restricted to prevent further hemodilution. Daily weights should be obtained to monitor fluid balance.4. SIADH results from an excessive amount of serum antidiuretic hormone, causing water intoxication and hyponatremia. Intake and output should be monitored strictly. Diuretics such as furosemide (Lasix) are administered to eliminate excess body fluid, and urine specific gravity is monitored. Fluids are restricted to prevent further hemodilution. Daily weights should be obtained to monitor fluid balance.

A pediatric client is seen in the clinic with a possible diagnosis of type 2 diabetes. The mother asks what the healthcare provider uses to make the diagnosis. The nurse explains that type 2 diabetes is suspected if the child has obesity, acanthosis nigricans, and two non-fasting blood-glucose levels above which level? 1. 120 2. 80 3. 200 4. 50

200 3. Blood-glucose levels at or above 200 mg/dL without fasting is diagnostic of type 2 diabetes.

The nurse is caring for four clients. Which client has the highest risk of developing retinopathy of prematurity? 1. 30-week-gestation infant who was in an Oxy-Hood for 12 hours and weighed 1800 g. 2. 32-week-gestation infant who needed no oxygen and weighed 1850 g. 3. 28-week-gestation infant who has been on long-term oxygen and weighed 1400 g. 4. 28-week-gestation infant who was on short-term oxygen and weighed 1420 g.

28-week-gestation infant who has been on long-term oxygen and weighed 1400 g. 3. The 28-week-gestation infant on oxygen weighing 1400 g has the highest risk of retinopathy of prematurity because of gestational age (28 weeks or less), weight (less than 1500 g), and oxygen therapy. The other neonates have fewer risk factors.

Which client in the pediatric intensive care unit (PICU) would most benefit from palliative care? 1. A child with end-stage leukemia 2. A child with a broken arm after a motor vehicle accident 3. A child with burn injuries to the legs 4. A child with recurrent asthma

3. A child with burn injuries to the legs 3. A child with burn injuries to the legs will benefit most from palliative care to help control pain, anxiety, sleep disturbances, and so on. The child with end-stage leukemia will benefit from hospice care. The child with a broken arm or recurrent asthma will not need palliative care.

A school-age child with congenital heart block codes in the emergency department (ED). The parents witness this and stare at the resuscitation scene unfolding before them. Which nursing intervention is most appropriate in this situation? 1. Ask the parents to leave until the child has stabilized. 2. Ask the parents to call the family to come into watch the resuscitation. 3. Ask the parents to sit near the child's face and hold her hand. 4. Ask the parents to stand at the foot of the cart to watch.

3. Ask the parents to sit near the child's face and hold her hand. 3. Parents should be helped to support their child through emergency procedures, if they are able. Parents should never be asked to take part in emergency efforts unless absolutely necessary. Merely watching the resuscitation serves no purpose for the child. If the parents interfere with resuscitation efforts or they are unable to tolerate the situation, they can be asked to leave later.

The nurse is assessing a 14-year-old and notes signs and symptoms of bulimia nervosa. Which assessments led the nurse to this conclusion? Select all that apply. 1. Pale skin 2. Dry, splitting hair 3. Erosion of tooth enamel 4. Calluses on back of hand 5. Gum recession

3. Erosion of tooth enamel 4. Calluses on back of hand 5. Gum recession 3. Erosion of tooth enamel is a sign and symptom of bulimia nervosa. 4. Calluses on back of hand is a sign and symptom of bulimia nervosa. 5. Gum recession is a sign and symptom of bulimia nervosa.

The nurse is providing care to a school-age client and family. The family, which consists of two parents and 4 children, live in a one-bedroom apartment. The father recently lost his job and the mother stays at home with the children. Which community resources would most benefit this family? Select all that apply. 1. Play groups 2. Parenting programs 3. Social services programs 4. Job skills training 5. Respite care

3. Social services programs 4. Job skills training Answer: 3, 4 3. This family is currently living in a one-bedroom apartment and the sole income earner recently lost his job. This family would most benefit from social services programs for monetary assistance and job skills training which would allow the parents to learn a trade and become employed. Play groups, parenting programs, and respite care are not applicable to this family's situation.4. This family is currently living in a one-bedroom apartment and the sole income earner recently lost his job. This family would most benefit from social services programs for monetary assistance and job skills training which would allow the parents to learn a trade and become employed. Play groups, parenting programs, and respite care are not applicable to this family's situation.

The nurse is planning care for a school-age client, who is diagnosed with bipolar disorder and is having suicidal ideations. Which nursing diagnosis is the priority for this client? 1. Powerlessness Related to Mood Instability 2. Social Isolation Related to Disorder 3. Risk for Injury Related to Suicidal Ideas 4. Impaired Social Interaction NURS

3. The priority for a child with bipolar disorder and suicidal ideas is safety. Risk for Injury would be the nursing diagnosis that would address safety for the child. The other diagnoses have a lower priority.

The nurse must prepare parents to see their adolescent daughter in the pediatric intensive-care unit (PICU). The child arrived by life flight after experiencing multiple traumas in a car accident involving a suspected drunk driver. At this time, which statement by the nurse to the family is the most appropriate? 1. "Don't worry; everything will be okay. We will take excellent care of your child." 2. "You should press charges against the drunk driver." 3. "Your child's leg was crushed and may have to be amputated." 4. "Your child's condition is very critical; her face is swollen, and she may not look like herself."

4. "Your child's condition is very critical; her face is swollen, and she may not look like herself." 4. The priority is to prepare the parents for the child's changed appearance. The nurse must not offer false reassurance nor project future stressful events. Truthful statements about the child's condition can be introduced after the parents have seen the child and grasped the situation. The nurse supports the family but remains nonjudgmental about accident details.Page Ref: 267-268

A school bus carrying children in grades K-12 crashed into a ravine. The critically injured children were transported by ambulance and admitted to the pediatric intensive-care unit (PICU). The nurse is concerned about calming the frightened children. Which nursing intervention is most appropriate to achieve the goal of calming the frightened children? 1. Tell the children that the physicians are competent. 2. Assure the children that the nurses are caring. 3. Explain that the PICU equipment is state of the art. 4. Call the children's parents to come into the PICU.

4. Call the children's parents to come into the PICU. 4. A sense of physical and psychological security is best achieved by the presence of parents. Children at all developmental levels look first to their parents or whoever acts as their parents for safety and security. Healthcare providers, no matter how competent or caring, cannot substitute for parents. Children often neither recognize nor care about state-of-the-art equipment.Page Ref: 263

Siblings of a client in pediatric intensive care unit (PICU) are preparing to visit their brother, who was hit by a car while riding his bike. Which intervention by the nurse will assist the siblings in preparing for the visit? 1. Spend time developing a relationship with the siblings. 2. Have the parents go with the siblings when they visit. 3. Encourage the siblings to talk to a social worker before seeing their brother. 4. Explain what the siblings will hear and see when they visit.

4. Explain what the siblings will hear and see when they visit. 4. Explaining what the siblings will hear and see when they visit will best prepare them for the visit with their brother. The other responses are good ways to help alleviate stress but won't help prepare the siblings for the visit.

An adolescent with cystic fibrosis is intubated with an endotracheal tube. Which nursing diagnosis is most appropriate for this adolescent? 1. Potential for Imbalanced Nutrition, More Than Body Requirements Related to Inactivity 2. Anxiety Related to Leaving Chores Undone at Home 3. Potential for Fear of Future Pain Related to Medical Procedures 4. Powerlessness (Moderate) Related to Inability to Speak to or Communicate with Friends

4. Powerlessness (Moderate) Related to Inability to Speak to or Communicate with Friends 4. The adolescent values communication with peers and may feel frustrated that he cannot speak to them while intubated. The adolescent is present-oriented and is unlikely to worry about household chores or future unknown procedures. The adolescent with cystic fibrosis is likely to be underweight and is unlikely to take in more calories than needed while intubated.

The nurse is planning a class for school-age children on prevention of obesity through exercise. It is important to encourage the children to exercise a minimum of how many minutes a day to meet current recommendations? 1. 20 minutes 2. 30 minutes 3. 60 minutes 4. 90 minutes

60 minutes 3. The current recommendation is 60 minutes of exercise daily.

A nurse is calculating the maximum recommended dose that a school-age client diagnosed with depression can receive for sertraline (Zoloft). The recommended pediatric dose for sertraline (Zoloft) is 1.5 to 3 mg/kg/day. If the child weighs 31 kg, the maximum recommended dose for this child would be ________ mg. Round answer to the nearest whole number.

93

The community-health nurse visits the child-care center. Which finding indicates the need for staff education? 1. A group of 2-year-olds are eating a snack of Cheerios. 2. Several 4-year-olds are outside playing on a slide. 3. An 18-month-old is pushing a toy truck. 4. A 2-month-old is sleeping in a crib on his stomach.

A 2-month-old is sleeping in a crib on his stomach. Answer: 4Explanation To decrease the incidence of sudden infant death syndrome (SIDS), infants should be placed on their backs to sleep. All of the other examples are developmentally appropriate activities for the specified age group.

The nurse suspects that an infant has a visual disorder caused by abnormal musculature. Which test will the nurse perform to detect this disorder? 1. A cover/uncover test 2. An ophthalmologic exam 3. A vision-acuity exam 4. A pupil-reaction-to-light test

A cover/uncover test Answer: 1 Explanation: 1. The cover/uncover test can detect abnormal musculature of the eye that can lead to asymmetric eye movement. An ophthalmologic eye exam allows the practitioner to view the internal structures of the eye, not abnormal musculature. A vision acuity test is used to test for myopia. A pupil-reaction-to-light test evaluates neurological status.

A nurse is caring for four pediatric clients in the hospital. Which client should the nurse refer for play therapy? 1. An adolescent with asthma 2. A preschool-age child with a fractured femur 3. A school-age child having an appendectomy 4. An infant with sepsis

A preschool-age child with a fractured femur 2. Play therapy is often used with preschool and school-age children who are experiencing anxiety, stress, and other specific nonpsychotic mental disorders. In this case, the child who experiences a condition that requires longer hospitalization and recovery, such as a fracture of the femur, should be referred for play therapy. The adolescent with asthma, the school-age child having an appendectomy, and the infant with sepsis do not have as high a need for play therapy as the preschool child with a broken bone.

A child who is dependent on a ventilator is being discharged from the hospital. Prior to discharge, the home-health nurse discusses development of an emergency plan of care with the family. Which is the most essential part of the plan? 1. Acquisition of a backup generator 2. Designation of an emergency shelter site 3. Provision for an alternate heating source if power is lost 4. Notifying the power company that the child is on life support

Acquisition of a backup generator Answer: 1 Explanation: 1. Prior to discharge to home, it is essential that the family acquire a generator so that the child's life support will continue to function effectively should power be lost. While all other actions are very important, it is most essential that the ventilator has power to continue to function at all times.

An infant is diagnosed with acute otitis media. Which intervention is most appropriate for the nurse to teach the infant's parents? 1. Keep the baby in a flat lying position during sleep. 2. Administer acetaminophen (Tylenol) to relieve discomfort. 3. Administer a decongestant. 4. Place baby to sleep with a pacifier.

Administer acetaminophen (Tylenol) to relieve discomfort. 2. 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. A flat lying position may exacerbate the discomfort. Elevating the head slightly is recommended. Decongestants are not recommended for treatment of acute otitis media. Placing infants to sleep with a pacifier may increase the incidence of otitis media.

6) The telephone triage nurse receives a call from a parent who states that her 18-month-old is making a crowing sound when he breathes and is hard to wake up. Which action by the nurse is the most appropriate? 1. Obtain the history of the illness from the parent. 2. Advise the parent to hang up and call 9-1-1. 3. Make an appointment for the child to see the healthcare provider. 4. Reassure the parent and provide instructions on home care for the child.

Advise the parent to hang up and call 9-1-1. 2. The nurse should immediately recognize the symptoms of severe upper respiratory distress and advise the parent to call 9-1-1. Crowing is heard when there is severe narrowing of the airway. The other actions would be appropriate in nonemergency situations.

The nurse is teaching the parent of a type 1 diabetic preschool-age client about management of the disease. Which teaching point is appropriate for the nurse to include in this session? 1. Allowing the client to administer all the insulin injections 2. Allowing the client to choose which finger to stick for glucose testing 3. Allowing the client to draw up the insulin dose 4. Allowing the client to test blood glucose

Allowing the client to choose which finger to stick for glucose testing 2. The preschool-age client's need for autonomy and control can be met by allowing the client to pick which finger to stick for glucose testing. Administering the insulin, drawing up the dose, and testing blood glucose should not be done by the client until he or she is middle-school age or older.

A nurse is assessing infants for visually related developmental milestones. Which infant is showing a delay in meeting an expected milestone? 1. A 4-month-old who has a social smile 2. An 8-month-old who has just begun to inspect her own hand 3. A 12-month-old who stacks blocks 4. A 7-month-old who picks up a raisin by raking

An 8-month-old who has just begun to inspect her own hand 2. An 8-month-old who has just begun to inspect her own hand is delayed. The infant usually inspects her own hand beginning at 3 months. A 4-month-old with a social smile, a 12-month-old who stacks blocks, and a 7-month-old who picks up a raisin by raking are all showing appropriate visually related milestones.

A school-age client, recently diagnosed with asthma, also has a peanut allergy. The nurse instructs the family to not only avoid peanuts but also to carefully check food label ingredients for peanut products and to make sure dishes and utensils are adequately washed prior to food preparation. The mother asks why this is specific for her child. Based on the client's history, the nurse knows that this client is at an increased risk for which complication? 1. Urticaria 2. Diarrhea 3. Anaphylaxis 4. Headache

Anaphylaxis 3. Children with food allergies may experience all of the above reactions to a particular food, but the child who also has asthma is most at risk for death secondary to anaphylaxis caused by a food allergy.

The nurse is administering a dose of rapid-acting insulin at 0800 to an insulin-dependent pediatric client. Based on when the insulin peaks, when will the client be at greatest risk for a hypoglycemic episode? 1. At about noon 2. Between bedtime and breakfast the next morning 3. Between lunch and dinner 4. Around 0930

Around 0930 4. Rapid-acting insulin peaks 30-90 minutes after administration. An injection given at 0800 would peak around 0930.

Match the classifications of bipolar disorder with their description. A. Bipolar I B. Bipolar II C. Cyclothymic disorder D. Bipolar not otherwise specified 1.Manifests as multiple mild manic and depressive episodes. 2. At least one episode of mild to moderate mania and one of depression. 3. Includes a severe manic episode that requires hospitalization or causes functional impairment in life. 4. Rapid mood fluctuations, mania without depressive episodes, or chronic depression with hypomania episodes.

Answer: 1/C, 2/B, 3/A, 4/D

The nurse is conducting a nutritional assessment for a toddler client who is diagnosed with failure to thrive (FTT). Which parameters will the nurse include in the assessment process for this toddler and family? Select all that apply. 1. Height 2. Weight 3. Hemoglobin and hematocrit 4. Twenty-four-hour food diary 5. Maternal dietary intake during pregnancy

Answer: 1, 2, 3, 4 1. Height 2. Weight 3. Hemoglobin and hematocrit 4. Twenty-four-hour food diary

Parents of a child who will begin enteral feedings ask the nurse what advantage this type of feeding has over other methods. Which responses by the nurse are the most appropriate?Select all that apply. 1. "Enteral feeding is the closest to natural feeding methods." 2. "The child must be able to absorb nutrients." 3. "Enteral feeding is complex to administer." 4. "Enteral feeding requires a central venous catheter." 5. "Enteral feeding has a high success rate."

Answer: 1, 2, 5 1. "Enteral feeding is the closest to natural feeding methods." 2. "The child must be able to absorb nutrients." 5. "Enteral feeding has a high success rate."

Match the child's concept of death with their behavioral response. A. Infant B. Toddler C. Preschool-age child D. School-age child E. Adolescent 1. Understands difference between temporary separation and death. 2. Senses emotions of caregivers and altered routines. 3. Capable of understanding death, recognizes all people and self will die. 4. No understanding of true concept of death. 5. Believes death is temporary and the person will return.

Answer: 1/D, 2/A, 3/E, 4/B, 5/C

The parents of a toddler are concerned about their child's finicky eating habits. While counseling the parents, which statements by the nurse are the most appropriate? Select all that apply. 1. "The child is experiencing physiologic anorexia, which is normal for this age group." 2. "A general guideline for food quantity at a meal is one-quarter cup of each food per year of age." 3. "It is more appropriate to assess a toddler's nutritional demands over a 1-week period rather than a 24-hour one." 4. "Nutritious foods should be made available at all times of the day so that she is able to 'graze' whenever she is hungry." 5. "The toddler should drink 16 to 24 ounces of milk daily."

Answer: 1, 3, 5 1. "The child is experiencing physiologic anorexia, which is normal for this age group." 3. "It is more appropriate to assess a toddler's nutritional demands over a 1-week period rather than a 24-hour one." 5. "The toddler should drink 16 to 24 ounces of milk daily."

A 15-year-old female is brought to the hospital by her friends after she fainted at the movies. Her friends told the nurse that she had been sad, withdrawn and this is why they asked her to go to the movies. The girl became "excited and energetic" at the movies and then fainted.The physician ordered: Lithium, clonazepam and doxepin. One order is Lithium 300 mg PO tid Medication on hand: Lithium 150 mg/capsule. Calculate how many capsules of lithium will be given by mouth.

Answer: 2 capsules

An adolescent is admitted to the intensive care unit (ICU) with diabetic ketoacidosis. The client weighs 115 pounds.The healthcare provider orders: Regular insulin 0.15 units/kg bolus via IVF, then regular insulin 0.1 units/kg/hr in 0.9 percent NSS Medication on hand: 250 mL 0.9 percent NSS with 250 units of regular insulin.Calculate the mL/hr for the continuous infusion of regular insulin at 0.1 unit/kg/hr in 0.9 percent NSS.

Answer: 7.4 mL/hr

A child with a profound intellectual disability is admitted to the hospital for an appendectomy. Which IQ does the nurse anticipate to see documented when reviewing this child's medical record? 1. Between 50 and 70 2. Below 20 3. Between 35 and 50 4. Between 20 and 35

Below 20 2. "Profound" intellectual disability is described as an intelligence quotient (IQ) below 20. "Mild" intellectual disability is described as an IQ between 50 and 70, "moderate" intellectual disability is an IQ between 35 and 50, and "severe" intellectual disability is an IQ between 20 and 35.

A nurse is administering an intramuscular vaccination to an infant diagnosed with Wiskott- Aldrich syndrome (WAS). Which reaction is the infant more at risk for due to the diagnosis of W AS? 1. Pain at injection site 2. Bleeding at injection site 3. Redness and swelling at injection site 4. Mild rash at injection site

Bleeding at injection site 2. Wiskott-Aldrich syndrome is characterized by thrombocytopenia, with bleeding tendencies appearing during the neonatal period. The syndrome would not put the child at higher risk for pain, redness, swelling, or rash at the injection site.

During a well-child physical, an adolescent female has a normal history and physical except for an excessive amount of tooth enamel erosion, a greater-than-normal number of filled cavities, and calluses on the back of her hand. Her body mass index is in the 50th to 75th percentile for her age. Which disorder is the nurse concerned about based on the assessment findings? 1. Anorexia nervosa 2. Kwashiorkor 3. Bulimia nervosa 4. Marasmus.

Bulimia nervosa 3. The erosion of tooth enamel, dental caries, and calluses on the back of her hand all most likely are due to frequent vomiting of gastric acids, which is common with bulimia nervosa as part of a binge-purge cycle. Anorexia nervosa is an eating disorder where adolescents literally starve themselves to prevent weight gain; they also exercise excessively and use laxatives and diuretics to lose weight. Anorexia usually manifests as extreme weight loss and an obsession with food. Kwashiorkor is a protein deficiency, usually from malnutrition, that manifests as generalized edema. Marasmus is a lack of energy-producing calories that can be seen in anorexia, and this causes emaciation, decreased energy levels, and retarded development.

The mother of a toddler is concerned because her child does not seem interested in eating. The child is drinking 5 to 6 cups of whole milk per day and one cup of fruit juice. When the weight- to-height percentile is calculated, the child is in the 90th to 95th percentile. What is the best advice the nurse can provide to the mother? 1. Eliminate the fruit juice from the child's diet. 2. Offer healthy snacks, presented in a creative manner, and let the child choose what he wants to eat without pressure from the parents. 3. Change from whole milk to 2 percent milk and decrease milk consumption to three to four cups per day and the fruit juice to a half cup per day, offering water if the child is still thirsty in between. 4. Make sure that the child is getting adequate opportunities for exercise, as this will increase his appetite and help lower the child's weight-to-height percentile.

Change from whole milk to 2 percent milk and decrease milk consumption to three to four cups per day and the fruit juice to a half cup per day, offering water if the child is still thirsty in between. 3. Toddlers require a maximum of about 1 L of milk per day. This toddler is consuming most of his or her calories from the milk and thus is not hungry. The high fat content of the milk and the high sugar content of the fruit juice are also contributing to the child's higher weight-to-height percentile. Decreasing the amount and fat content of the milk and decreasing the intake of fruit juice will decrease calories and thus make the child hungry for other foods. The other advice is also appropriate but did not address the problem of excessive milk consumption.

A child is diagnosed with group A beta-hemolytic streptococcus (GABHS) infection of the throat. Which item will the nurse include in the teaching plan for the parents? 1. Complete the entire course of antibiotics. 2. Keep the child NPO (nothing by mouth). 3. Continue normal activities. 4. Do not allow the child to gargle with saltwater.

Complete the entire course of antibiotics. Answer: 1 Explanation: 1. It is important for parents to complete the entire course of antibiotics for GABHS infections. Nothing-by-mouth, or NPO, status is not recommended because the child needs to stay hydrated. The child should rest, and use of warm saltwater gargles is recommended.

The family of a preschool-age client diagnosed with an intellectual disability is expressing difficulty with managing the care needs of the child. Which nursing diagnosis is most appropriate for this situation? 1. Hopelessness Related to Terminal Condition of the Child 2. Compromised Family Coping Related to the Child's Developmental Variations 3. Family Processes Dysfunctional, Related to a Child with Intellectual Disability 4. Impaired Parenting Related to Poor Parenting Skills

Compromised Family Coping Related to the Child's Developmental Variations 2. The family is compromised but not dysfunctional. Hopelessness and impaired parenting are not appropriate in the given situation.

While teaching the parents of a newborn about infant care and feeding, which instruction by the nurse is the most appropriate? 1. Delay supplemental foods until the infant is 4 to 6 months old. 2. Delay supplemental foods until the infant reaches 15 pounds or greater. 3. Begin diluted fruit juice at 2 months of age, but wait 3 to 5 days before trying a new food. 4. Add rice cereal to the nighttime feeding if the infant is having difficulty sleeping after 2 months of age.

Delay supplemental foods until the infant is 4 to 6 months old. Answer: 1 Explanation: 1. Four to six months is the optimal age to begin supplemental feedings because earlier feeding of nonformula foods is not needed by the infant and does not promote sleep. Earlier feeding of nonformula foods, regardless of the infant's weight, is more likely to cause the development of food allergies. Also, early feeding is not well tolerated by infants because the necessary tongue control is not well developed and they lack the digestive enzymes to take in and metabolize many food products.

A nurse is caring for a visually impaired 20-month-old who has not begun to walk. Which nursing diagnosis is the most appropriate for this client? 1. Delayed growth and development 2. Impaired physical mobility 3. Self-care deficit 4. Impaired home maintenance

Delayed growth and development Answer: 1 Explanation: 1. A 20-month-old child who is not walking is delayed in growth and development. The child's mobility is not due to a physiological problem, so impaired mobility is not appropriate. Self-care deficit does not apply to this age of child. There is not enough data to determine if home maintenance is impaired.

Some nursing students are discussing job options. One of the student states that a position as a school nurse sounds interesting. What is an important role of the school nurse? 1. Screening for congenital heart disease 2. Prescribing antibiotics for streptococcal pharyngitis 3. Developing a plan for emergency care of injured children 4. Diagnosing an ear infection

Developing a plan for emergency care of injured children 3. Screening of students for certain conditions; educating students, teachers, and staff; and developing emergency plans are all roles of the school nurse. Diagnosing acute illness and prescribing medication for a new illness are beyond the scope of practice for the school nurse unless the nurse is licensed as an advance-practice nurse.

A school-age client is prescribed Adderall (amphetamine mixed salts) for attention deficit hyperactivity disorder (ADHD). At which time is it most appropriate for the nurse to teach the parents to administer this medication? 1. At bedtime 2. Before lunch 3. With the evening meal 4. Early in the morning

Early in the morning 4. A side effect of Adderall can be insomnia. Administering the medication early in the day can help alleviate the effect of insomnia.

The nurse teaches parents how to care for their child who has tympanostomy tubes inserted. Which actions by the parents indicate appropriate understanding of the teaching session? Select all that apply. 1. Encouraging the child to drink generous amounts of fluids 2. Administering a decongestant for 1 to 2 weeks following surgery 3. Restricting the child to quiet activities after surgery 4. Limiting diet to soft, bland foods 5. Avoiding getting water in ears during bath time

Encouraging the child to drink generous amounts of fluids Restricting the child to quiet activities after surgery Avoiding getting water in ears during bath time Answer: 1, 3, 5 Explanation: 1. The correct responses include encouraging the child to drink generous amount of water, restricting the child to quiet activities after surgery, and avoiding water in the child's ears at bath time. Incorrect responses include administering a decongestant for 1 to 2 weeks following surgery and limiting diet to soft, bland foods-decongestants are not needed after surgery, and a regular diet should be resumed. 3. The correct responses include encouraging the child to drink generous amount of water, restricting the child to quiet activities after surgery, and avoiding water in the child's ears at bath time. Incorrect responses include administering a decongestant for 1 to 2 weeks following surgery and limiting diet to soft, bland foods-decongestants are not needed after surgery, and a regular diet should be resumed. 5. The correct responses include encouraging the child to drink generous amount of water, restricting the child to quiet activities after surgery, and avoiding water in the child's ears at bath time. Incorrect responses include administering a decongestant for 1 to 2 weeks following surgery and limiting diet to soft, bland foods-decongestants are not needed after surgery, and a regular diet should be resumed.

The parents of a toddler-age child who sustained severe head trauma from falling out a second-story window are arguing in the pediatric intensive-care unit (PICU) and blaming each other for the child's accident. Which nursing diagnosis is most appropriate for this family? 1. Parental Role Conflict Related to Protecting the Child 2. Hopelessness Related to the Child's Deteriorating Condition 3. Anxiety Related to the Critical-Care-Unit Environment 4. Family Coping: Compromised, Related to the Child's Critical Injury

Family Coping: Compromised, Related to the Child's Critical Injury 4. The parents are displaying ineffective coping behaviors as a family. Parental role conflict does not refer to the parents' argument in the PICU, but means a parent is conflicted or confused about some aspect of the parental role. Each parent may be experiencing hopelessness, frustration, and anxiety, but they are not coping well as a family unit.

The nurse is providing care to a pediatric client recently diagnosed with celiac disease. Which food choice indicates appropriate understanding of the material presented? 1. Pizza with milk 2. Spaghetti and meat sauce with juice 3. Hot dog on a bun with a shake 4. Fruit plate with Gatorade

Fruit plate with Gatorade A child with celiac disease needs a gluten-free diet. Included on the list are fruits, meats, rice, and vegetables, including corn. Excluded are bread, cake, doughnuts, cookies, crackers, and many processed foods that may contain hidden gluten. Therefore, the child would be allowed to have the fruit plate with Gatorade.

A nurse is planning preoperative teaching for a school-age client scheduled to have a tonsillectomy. The client has a history of attention deficit hyperactivity disorder (ADHD). Which intervention will the nurse include in the plan of care? 1. Give instructions verbally and use a picture pamphlet, repeating points more than once. 2. Ask other children who have had this procedure to talk to the child. 3. Allow the child to lead the session to gain a sense of control. 4. Play a television show in the background.

Give instructions verbally and use a picture pamphlet, repeating points more than once. Answer: 1 Explanation: 1. A teaching session for a child with ADHD should foster attention. Giving instructions verbally and in written form, repeating points, will improve learning for a child with ADHD. The environment needs to be quiet, with minimal distractions. A child who has difficulty concentrating should not lead the session even though the child needs to feel in control. Talking to other children who have had this procedure may not foster understanding, because this child has ADHD. Distractions such as noise from a television should be minimized.

The nurse educator is teaching a group of nursing students about the endocrine system. Which statements are appropriate for the educator to include in the teaching session?Select all that apply. 1. Gonadotropin-releasing hormone stimulates the anterior pituitary to produce LH and FSH. 2. Growth hormone regulates linear bone growth and growth of all tissues. 3. Antidiuretic hormone regulates urine concentration by the kidneys. 4. Thyroid hormone regulates serum calcium levels and phosphorus excretion. 5. Parathyroid hormone regulates metabolism of cells and body heat production.

Gonadotropin-releasing hormone stimulates the anterior pituitary to produce LH and FSH. 2. Growth hormone regulates linear bone growth and growth of all tissues. 3. Antidiuretic hormone regulates urine concentration by the kidneys. Answer: 1, 2, 3 Explanation: 1. All statements are correct except the statements regarding the thyroid hormone and the parathyroid hormone. The thyroid hormone regulates metabolism of the cells and body heat production, not the parathyroid hormone. The parathyroid hormone regulates serum calcium levels and phosphorus excretion. 2. All statements are correct except the statements regarding the thyroid hormone and the parathyroid hormone. The thyroid hormone regulates metabolism of the cells and body heat production, not the parathyroid hormone. The parathyroid hormone regulates serum calcium levels and phosphorus excretion. 3. All statements are correct except the statements regarding the thyroid hormone and the parathyroid hormone. The thyroid hormone regulates metabolism of the cells and body heat production, not the parathyroid hormone. The parathyroid hormone regulates serum calcium levels and phosphorus excretion.

5) The school nurse is preparing a plan of care specific to several children in the school who have asthma. What is the initial action on the plan of care? 1. Call 911 to request emergency medical assistance. 2. Call the child's parents to come and pick up the child. 3. Have the child use his or her metered-dose inhaler. 4. Have the child lie down to see if the symptoms subside.

Have the child use his or her metered-dose inhaler. 3. A child with a history of asthma may have episodes of wheezing that can be controlled by prompt use of the child's rescue inhaler. An inhaler should be readily available in the school setting for a child previously diagnosed with asthma. This should be tried first. Emergency personnel should be notified if the inhaler does not provide relief and the child is in respiratory distress. Parents may be notified if the child does not feel well, but this is not the initial action. Having the child lie down will likely worsen his condition.

The nurse is teaching a group of new mothers about the benefits of immunizations. The nurse will expect that the immunizing against which of the following can in some cases prevent the life threatening condition epiglottis?

Hib

A school-age client diagnosed with diabetes insipidus (DI) is admitted to the pediatric unit. Which laboratory value does the nurse anticipate for this client based on the diagnosis? 1. Hyperglycemia 2. Hypernatremia 3. Hypercalcemia 4. Hypoglycemia

Hypernatremia Answer: 2 2. In all forms of diabetes insipidus, serum sodium can increase to pathologic levels, so hypernatremia can occur and should be treated. The glucose level is not affected, so hypoglycemia or hyperglycemia is not caused by the diabetes insipidus. Hypercalcemia (high calcium) does not occur with this endocrine disorder.

The nurse is providing education to a pediatric client diagnosed with diabetes. The client will be playing soccer over the summer. Which change in the client's management will the nurse explore during this education session? 1. Increased food intake 2. Decreased food intake 3. Increased need for insulin 4. Decreased risk of insulin reaction

Increased food intake Explanation: 1. Increased physical activity requires adequate caloric intake to prevent hypoglycemia, so food intake should be increased. Increased activity would not require decreased food intake, and it would not result in a decreased risk of insulin reaction. Exercise causes the insulin to be used more efficiently, so increased insulin would not be needed.

A child comes to the clinic for an assessment 20 days post-bone marrow transplant. Which system should receive the highest priority during the nursing assessment? 1. Integumentary 2. Gastrointestinal 3. Respiratory 4. Cardiovascular

Integumentary Answer: 1 Explanation: 1. The skin is most commonly affected in graft-versus-host disease after a transplant. A pruritic, macular papular rash and a blistering, burning sensation can occur. The other systems are important to assess, but are not the highest priority.

An adolescent client has a long leg cast secondary to a fractured femur. Which action by the nurse would effectively facilitate the adolescent's return to school? 1. Meet with teachers and administrators at the school to make sure entrances and classrooms are wheelchair accessible. 2. Develop an individualized health plan (IHP) that focuses on long-term needs of the adolescent. 3. Prior to the student's return to school, meet with all of the other students to emphasize the special needs of the injured teen. 4. Meet with parents of the injured student to encourage homebound schooling until a short leg cast is applied.

Meet with teachers and administrators at the school to make sure entrances and classrooms are wheelchair accessible. Answer: 1 Explanation: 1. An adolescent with a long leg cast secondary to a fractured femur will be dependent on a wheelchair for mobility. It is essential that the environment be wheelchair accessible prior to the adolescent's return to school. While an IHP might be developed, short- term needs would be the focus. It is not necessary to meet all of the students to discuss the adolescent's needs. There is no reason to encourage the adolescent to stay at home for schooling if he is ready to return.

A pediatric client is admitted to the hospital unconscious. The client has a history of type 1 diabetes, and according to the client's mother, has been to two birthday parties in the last few days and has resisted taking the prescribed insulin. At school the client had two more pieces of birthday cake and some ice cream at a class birthday party. What is the likely reason for this client's unconscious state? 1. Metabolic alkalosis 2. Metabolic ketoacidosis 3. Insulin shock 4. Insulin reaction

Metabolic ketoacidosis 2. Metabolic acidosis or ketoacidosis could have occurred because of the excessive intake of sugar with no additional insulin. The body burns fat and protein stores for energy when no insulin is available to metabolize glucose. Altered consciousness occurs as symptoms progress. Metabolic alkalosis, insulin shock, or insulin reaction would not be happening in this case.

The nurse is caring for an adolescent client diagnosed with rheumatoid arthritis. Which nonpharmacological measure to reduce joint pain is most appropriate for the nurse to recommend to this client? 1. Moist heat 2. Elevation of extremity 3. Massage 4. Immobilization

Moist heat Answer: 1 Explanation: 1. Moist heat can promote relief of pain and decrease joint stiffness. Elevation of extremity would not have an effect on reducing pain in rheumatoid arthritis. Massage of extremities should be avoided because of a potential risk for emboli. Immobilization can lead to contractures, and range of motion to the involved joint should be maintained.

A child with human immunodeficiency virus (HIV) also has oral candidiasis. Which type of mouth care solution will the nurse teach the child to use? 1. Normal saline 2. Listerine 3. Scope 4. Viscous lidocaine

Normal saline Answer: 1 Explanation: 1. The mouth care should be with a non-alcohol base. Normal saline can keep the child's lips and mouth moist. Listerine and Scope are commercial mouth rinses that can have an alcohol base and cause drying of the membranes. Viscous lidocaine causes numbing and could depress the gag reflex in a younger child.

A nurse is conducting a daily weight on a pediatric client diagnosed with diabetes insipidus and notes the child has lost 2 pounds in 24 hours. Which action by the nurse is the most appropriate? 1. Continue to monitor the child. 2. Notify the healthcare provider regarding the weight loss. 3. Chart the weight and report the loss to the next shift. 4. Do nothing more than chart the weight, as this would be a normal finding.

Notify the healthcare provider regarding the weight loss. 2. With diabetes insipidus, the child may have severe fluid-volume deficit. A weight loss of 2 pounds indicates a loss of 1 liter of fluid, so the healthcare provider should be notified and fluids replaced either orally or intravenously. This is a significant loss in a 24-hour period, so continuing to monitor, charting the weight and reporting to the next shift, and doing nothing would prolong treatment.

The nurse is conducting a health history for a school-age client. The parents of the client tell the nurse that their child has the following behaviors: excessive handwashing, counting objects, and hoarding substances. Based on these assessment findings, which diagnosis does the nurse anticipate for this client? 1. Depression 2. Separation anxiety disorder 3. Obsessive-compulsive disorder 4. Bipolar disorder

Obsessive-compulsive disorder 3. Common behaviors of obsessive-compulsive disorder (OCD) are excessive handwashing, counting objects, and hoarding substances. These practices may take up one or more hours each day.

A nurse is concerned about the safety of a suicidal adolescent client and wants to be prepared for the use of physical restraints, if necessary. Which action by the nurse is the most appropriate in this situation? 1. Obtain a healthcare provider's order, and follow the institution's policy for use of restraints. 2. Apply the restraints, and then obtain a healthcare provider's order later. 3. Apply the restraints if parental permission is obtained. 4. Ask for the child's permission before applying the restraints.

Obtain a healthcare provider's order, and follow the institution's policy for use of restraints. Answer: 1 Explanation: 1. Restraints are used only when ordered by the physician and interdisciplinary team caring for the child. Physical restraint is only a short-term approach to provide immediate safety if necessary. It would not be appropriate to apply the restraints, and then obtain a healthcare provider's order. Even if permission is given by the parent and/or child, a healthcare provider's order still needs to be obtained.

While teaching a health promotion class to a group of parents of children in a Head Start class, which information should the nurse include to help decrease the risk of dental caries? 1. Delay introducing cow's milk until at least 1 year of age. 2. Offer drinking cups only at meal and snack times. 3. Encourage use of homemade baby food without preservatives. 4. Offer juices diluted 50 percent with water.

Offer drinking cups only at meal and snack times. 2. Offering drinking cups only at meal and snack times encourages drinking when thirsty rather than carrying a cup around. This reduces the risk of dental caries. Delaying the introduction of cow's milk, making homemade baby food, or diluting juice does not decrease dental caries.

A school-age client diagnosed with autism is admitted to the hospital because of recent vomiting and diarrhea. Which intervention by the nurse is most appropriate upon admission? 1. Take the child on a quick tour of the whole unit. 2. Take the child to the playroom immediately for arts and crafts. 3. Orient the child to the hospital room with minimal distractions. 4. Admit the child to a four-bed unit with small children.

Orient the child to the hospital room with minimal distractions. 3. Autistic children interpret and respond to the environment differently from other individuals. The child needs to be oriented to new settings and adjusts best to a quiet, controlled environment. A hospital room with only one other child is best.

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

Orienting the child to where furniture is placed in the room 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 client with a visual impairment. Policies, handling equipment, and tours can be done at a later time.

6) The nurse is teaching the parents of a 4-month-old infant about good feeding habits. The nurse emphasizes the importance of holding the baby during feeding and not letting the infant go to sleep with the bottle. Which disorder is associated with propped feedings and going to sleep with the bottle? 1. Otitis media 2. Aspiration 3. Malocclusion problems 4. Sleeping disorders

Otitis Media Answer: 1 Explanation: 1. It has been shown in numerous studies that allowing an infant to fall asleep with a bottle in his or her mouth causes pooling of the formula in the mouth, which increases the risk of both dental caries and otitis media. There has been limited data to date showing a positive correlation between bottle propping and increased risk of aspiration, malocclusions, and sleeping disorders.

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

Parenteral acyclovir (Zovirax) and vidarabine (VIRA-A) ophthalmic ointment 4. Neonatal herpes simplex virus is treated vigorously with parenteral acyclovir for 14 days or longer and topical ophthalmic medication (trifluridine, iododeoxyuridine, or vidarabine). Fluoroquinolone eye drops are used to treat bacterial eye infections. Intravenous penicillin treats selected bacterial infections. Oral erythromycin is used to treat chlamydial eye infections.Page Ref: 442

The pediatric nurse answers a call from a parent about the five-year-old child's swollen eyelid. She states, "Her right eyelid is swollen shut, it hurts her when I touch it and she says it really hurts when she tries to move her eye from side to side. What illness does the nurse expect?

Periorbital cellulitis

The nurse is providing care to a school-age client with a documented immunodeficiency who is admitted to the general pediatric unit for intravenous medication administration. Which interventions are appropriate for this client? Select all that apply. 1. Institute droplet precautions. 2. Place in a positive-pressure room. 3. Avoid live vaccines. 4. Perform frequent handwashing. 5. Recommend fresh fruits brought in by the family

Place in a positive-pressure room. 3. Avoid live vaccines. 4. Perform frequent handwashing. Answer: 2, 3, 4 2. Pediatric clients with documented immunodeficiency require specific interventions to decrease their risk for developing infections while in the hospital environment. Appropriate interventions for this client include a positive-pressure room, avoiding live vaccines, and meticulous handwashing from staff and visitors. This client would require standard precautions, not droplet precautions. Because of the risk of infection with fresh fruit, the family would not be allowed to bring this to the client during their hospital stay. 3. Pediatric clients with documented immunodeficiency require specific interventions to decrease their risk for developing infections while in the hospital environment. Appropriate interventions for this client include a positive-pressure room, avoiding live vaccines, and meticulous handwashing from staff and visitors. This client would require standard precautions, not droplet precautions. Because of the risk of infection with fresh fruit, the family would not be allowed to bring this to the client during their hospital stay.4. Pediatric clients with documented immunodeficiency require specific interventions to decrease their risk for developing infections while in the hospital environment. Appropriate interventions for this client include a positive-pressure room, avoiding live vaccines, and meticulous handwashing from staff and visitors. This client would require standard precautions, not droplet precautions. Because of the risk of infection with fresh fruit, the family would not be allowed to bring this to the client during their hospital stay.

During an admission assessment, the nurse notes that the child has impaired oral mucous membranes. Which intervention is most appropriate for the nurse to implement for this child? 1. Administering topical analgesics 2. Promoting an adequate intake of nutrients 3. Administering antibiotics as ordered 4. Using lemon and glycerin for oral hygiene

Promoting an adequate intake of nutrients 2. Adequate intake of fluids and nutrients promotes the intactness of the oral mucosal membrane tissue, which is the desired outcome for an impaired oral mucous membrane problem. Lemon and glycerin may dry the oral mucous membrane, which is not desirable. Administration of antibiotics or topical analgesics are medical interventions that might be performed but do not ensure that impaired tissue will be resolved.

A nurse is planning to teach school-age children about the common cold. Which information should the nurse include in the teaching session? 1. Vaccinations can prevent contraction of a nasopharyngitis virus. 2. Antibiotics will eliminate the nasopharyngitis virus. 3. Proper handwashing can prevent the spread of the infection. 4. Aspirin should be taken for alleviation of fever if the "common cold" is contracted.

Proper handwashing can prevent the spread of the infection. 3. Proper handwashing should be taught to school-age children to reduce the spread of the "common cold" virus. No vaccine can prevent the common cold. Antibiotics are not used to treat viral infections. Aspirin should not be taken for fever because of its association with Reye syndrome.

The nurse is planning care for pediatric clients who have diagnoses that impact the endocrine system. Which changes occurring during the school-age and adolescence have a direct impact on the endocrine system? Select all that apply. 1. Puberty 2. Adrenarche 3. Menarche 4. Sexual exploration 5. Risk-taking behavior

Puberty 2. Adrenarche 3. Menarche Answer: 1, 2, 3 Explanation: 1. Puberty, adrenarche, and menarche are all changes that occur during the school age and adolescence that have a direct impact on the endocrine system. Sexual exploration and risk-taking behaviors do not have a direct impact on the endocrine system. 2. Puberty, adrenarche, and menarche are all changes that occur during the school age and adolescence that have a direct impact on the endocrine system. Sexual exploration and risk- taking behaviors do not have a direct impact on the endocrine system. 3. Puberty, adrenarche, and menarche are all changes that occur during the school age and adolescence that have a direct impact on the endocrine system. Sexual exploration and risk- taking behaviors do not have a direct impact on the endocrine system.

A child is prescribed Didanosine (Videx), a nucleoside reverse transcriptase inhibitor, for human immunodeficiency virus (HIV). Which lab value will the nurse monitor closely for this child? 1. Potassium 2. Sodium 3. RBC count 4. Glucose

RBC count 3. Didanosine (Videx) causes bone-marrow suppression with resulting anemia. RBC counts are monitored at least monthly for changes. Potassium and sodium are electrolytes, and glucose is a laboratory test for checking diabetes. Didanosine (Videx) does not affect these values.

Twelve-year-old Peggy presents to the clinic complaining of recurrent epistaxis. Her last episode was yesterday, but she has missed 5 days of school lately due to the spontaneous episodes. Which of the following statements demonstrate an adequate understanding of the presenting problem?

Remember to squeeze the nares for 2-3 minutes during the next episode.

A school-age client is evaluated for depression. Which assessment tool does the nurse anticipate will be used by the psychologist? 1. Denver Developmental Screening tool 2. Revised Children's Manifest Anxiety Scale 3. Parent Developmental Questionnaire 4. Disruptive Behavior Disorder Scale

Revised Children's Manifest Anxiety Scale 2. The Revised Children's Manifest Anxiety Scale is a tool used to assess for depression. The Denver Developmental Screening tool and the Parent Developmental Questionnaire are tools used to assess development. The Disruptive Behavior Disorder Scale is used to assess for autism

A nurse is planning care for a pediatric client diagnosed with adrenal insufficiency (Addison disease). Which nursing diagnosis is the priority for this client? 1. Risk for Deficient Fluid Volume 2. Risk for Injury Secondary to Hypertension 3. Acute Pain 4. Imbalanced Nutrition: More than Body Requirements

Risk for Deficient Fluid Volume Answer: 1 Explanation: 1. Adrenal insufficiency can cause fluid deficit. The goal of care is to maintain fluid and electrolyte balance while normal levels of corticosteroids and mineral corticoids are established. Therefore, Acute Pain and Imbalanced Nutrition: More than Body Requirements are not priority nursing diagnoses. A symptom of adrenal insufficiency is hypotension, not hypertension.

The nurse is planning care for a pediatric client diagnosed with adrenal hyperplasia. Which nursing diagnosis is most appropriate for this client? 1. Impaired Social Interaction Related to Unnatural Facial Features 2. Nutrition: Less than Body Requirements due to Nausea and Vomiting 3. Depression Related to Inability to Take in Oral Fluids 4. Risk for Deficient Fluid Volume Related to Failure of Regulatory Mechanisms

Risk for Deficient Fluid Volume Related to Failure of Regulatory Mechanisms 4. Adrenal hyperplasia alters the regulatory mechanisms, creating a fluid volume deficit. There is no major nutritional deficit, social interaction, or depression related directly to the diagnosis of adrenal hyperplasia.

A nurse is planning care for a child with human immunodeficiency virus (HIV). Which nursing diagnosis is the highest priority for this child? 1. Risk for Infection 2. Risk for Fluid-Volume Deficit 3. Ineffective Thermoregulation 4. Ineffective Tissue Perfusion, Peripheral

Risk for Infection Answer: 1 Explanation: 1. A child with HIV is at risk for a myriad of bacterial, viral, fungal, and opportunistic infections because of the effect of the virus on the immune system. Risk for Fluid- Volume Deficit, Ineffective Thermoregulation, and Ineffective Tissue Perfusion, Peripheral would not be priority problems with this disease process.

Which would be an acceptable community-health diagnosis? 1. Risk for Injury Related to Lack of Safe Bicycle Paths in High-Traffic Areas 2. Ineffective Family Coping Related to Lack of Time Together 3. Alterations in Nutrition Related to Use of Fast Food Restaurants 4. Ineffective Communication Related to Lack of Community Newsletter

Risk for Injury Related to Lack of Safe Bicycle Paths in High-Traffic Areas Answer: 1 Explanation: 1. The lack of safe bicycle paths in high-traffic areas is a community hazard affecting a large population of people. Ineffective family coping is appropriate for one family; alterations in nutrition and ineffective communication are not appropriate for the community as a whole.

The nurse can instruct parents to expect children in which age group to begin to assume more independent responsibility for their own management of a chronic condition, such as blood glucose monitoring, insulin administration, intermittent self-catheterization, and appropriate inhaler use.

School age

The school nurse plans, develops, manages, and evaluates healthcare services to all children while they are in the educational setting. With which healthcare providers will the nurse be collaborating?Select all that apply. 1. School physician 2. Teachers 3. Cafeteria staff 4. Primary physician 5. Bus driver

School physician primary physician Answer: 1, 4 Explanation: 1. Partnering with the school physician consultant to discuss and update standing orders for the care of children; these standing orders usually address urgent and emergency care potentially needed by students. 4. Communicating with the child's primary healthcare provider or pediatric specialist about a child's specific health condition that needs to be effectively managed in the school setting.

A nurse begins an infusion of intravenous immune globulin (IVIG) to a child who has combined immunodeficiency disease. Which assessment finding indicates that the nurse should stop the infusion? 1. A mild headache 2. Clear yellow urine 3. Severe shaking, chills, and fever 4. Complaints of being "thirsty"

Severe shaking, chills, and fever 3. Hypersensitivity reaction can be seen with IVIG. The infusion should be started slowly and increased if there is no reaction. Shaking, chills, and fever can indicate a reaction. A mild headache is an adverse side effect of IVIG but not a severe reaction. Thirst is not an indication of a reaction. Voiding clear yellow urine is a normal finding.

The nurse is providing care to an adolescent client diagnosed with systemic lupus erythematosus (SLE). Which action by the client indicates acceptance of body changes associated with SLE? 1. She refuses to attend school. 2. She doesn't want to attend any social functions. 3. She discusses the body changes with a peer. 4. She discusses the body changes with healthcare personnel only.

She discusses the body changes with a peer. 3. Peer interaction is important to the teen. Being able to discuss the changes to her body with a peer indicates acceptance of the change in body image. Discussing changes only with healthcare personnel does not indicate the teen has adjusted to body-image changes. Refusing to go to school or not going to social functions indicates nonacceptance of the changes to body image.

Which aspect of an Emergency Medical Services (EMS) system is most indicative that EMS providers are prepared to provide emergency care to children? 1. Placement of small stretchers in emergency vehicles 2. Lists of hospitals in the area that treat children 3. Staff education related to assessment and treatment of children of all ages 4. Pediatric-sized equipment and supplies

Staff education related to assessment and treatment of children of all ages 3. While size-appropriate equipment and lists of hospitals that treat children are essential parts of an EMS system, the aspect that is most indicative that EMS providers are actually prepared to take care of children is evidence of education related to assessment and emergency treatment.

During a 4-month-old's well-child check, the nurse discusses introduction of solid foods into the infant's diet and concerns for foods commonly associated with food allergies. Due to allergies, which foods will the nurse instruction the parents to avoid until after 1 year of age? 1. Strawberries, eggs, and wheat 2. Peas, tomatoes, and spinach 3. Carrots, beets, and spinach 4. Squash, pork, and tomatoes

Strawberries, eggs, and wheat Answer: 1 Explanation: 1. Strawberries, eggs, and wheat, along with corn, fish, and nut products, are all foods that have commonly been associated with food allergies. Carrots, beets, and spinach contain nitrates and should not be given before the age of 4 months. Squash, peas, and tomatoes are acceptable to try after an infant is 4 to 6 months old but should be given one at a time and 3 to 5 days after starting a new food. Pork can be tried after the infant is 8 to 10 months old, as meats are harder to digest and have a high protein load.

A school-age child diagnosed with rheumatoid arthritis asks the nurse to recommend an exercise activity. Which activity is most appropriate for this child? 1. Softball 2. Football 3. Swimming 4. Basketball

Swimming 3. Swimming helps to exercise all of the extremities without putting undue stress on joints. Softball, football, and basketball could exacerbate joint discomfort.

An adolescent client diagnosed with Graves' disease is admitted to the hospital. Which clinical manifestations would the nurse expect on assessment? 1. Weight gain, hirsutism, and muscle weakness 2. Dehydration, metabolic acidosis, and hypertension 3. Tachycardia, fatigue, and heat intolerance 4. Hyperglycemia, ketonuria, and glucosuria

Tachycardia, fatigue, and heat intolerance 3. Graves' disease occurs when thyroid hormone levels are increased, resulting in excessive levels of circulating thyroid hormones. Clinical manifestations include tachycardia, fatigue, and heat intolerance. Weight gain, hirsutism, and muscle weakness are signs of Cushing syndrome. Dehydration, metabolic acidosis, and hypertension are signs of congenital adrenal hyperplasia. Hyperglycemia, ketonuria, and glucosuria are signs of diabetes.

A young school-age client who has had a tracheostomy for several years is scheduled to begin school in the fall. The teacher is concerned about this child's being in her class and consults the school nurse. Which action by the nurse is the most appropriate? 1. Make arrangements for the child to go to a special school. 2. Ask the parents of the child to provide a caregiver during school hours. 3. Recommend that the child be home schooled. 4. Teach the teacher how to care for the child in the classroom.

Teach the teacher how to care for the child in the classroom. 4. Section 504 of the Rehabilitation Act of 1973 guarantees access for children with disabilities to federally funded programs, including public schools. The child may need little extra attention while in the school setting, since he has had the tracheostomy for several years. The teacher should be taught how to care for the child if needed and the signs of distress. If needed, a health aide may be assigned to the child, but this is not the responsibility of the parents.

Which of the following Type One Diabetic children is at the highest risk for developing a hypoglycemic episode?

Teen with sedentary lifestyle

Celiac disease presents many challenges for a family. What should the nurse emphasize when educating the parents of a newly diagnosed child? 1. Ice cream is a safe dessert on a gluten-free diet. 2. The child's weight and height should reach normal levels in about 1 year. 3. Processed foods are usually gluten-free. 4. Insurance pays only a small amount of the cost of celiac diets.

The child's weight and height should reach normal levels in about 1 year. 2. Ice cream and many processed foods contain gluten. Payment by insurance is dependent on the plan the family has. Once on a gluten-free diet, the child's height and weight will reach normal range in about 1 year.

What must a home-health nurse realize prior to accepting an assignment? 1. All decisions will be made by the healthcare provider. 2. The family will adapt their lifestyle to the needs of the nurse. 3. Independent decisions regarding emergency care of the child will be made by the nurse. 4. The family is in charge.

The family is in charge. 4. The home-health nurse must realize that the family is in charge. The nurse must be flexible and adaptable to the lifestyle of the family. The family must provide informed consent for emergency care.

The nurse is planning care for an adolescent client with a newly diagnosed intellectual disability following a traumatic brain injury. Which expected outcomes are appropriate for this client?Select all that apply. 1. The family understands the adolescent's diagnosis. 2. The family understands the specific physical and developmental needs of the adolescent. 3. The adolescent develops self-care skills appropriate to his or her developmental level. 4. The adolescent's family is able to access the necessary community and educational resources. 5. The family's ability to cope with changing needs of the adolescent.

The family understands the adolescent's diagnosis. 2. The family understands the specific physical and developmental needs of the adolescent. 3. The adolescent develops self-care skills appropriate to his or her developmental level. 4. The adolescent's family is able to access the necessary community and educational resources. Answer: 1, 2, 3, 4 Explanation: 1. All statements are appropriate outcomes for the adolescent and the family except the statement regarding the family's ability to cope with the changing needs of the adolescent. This is an evaluation statement. 2. All statements are appropriate outcomes for the adolescent and the family except the statement regarding the family's ability to cope with the changing needs of the adolescent. This is an evaluation statement. 3. All statements are appropriate outcomes for the adolescent and the family except the statement regarding the family's ability to cope with the changing needs of the adolescent. This is an evaluation statement. 4. All statements are appropriate outcomes for the adolescent and the family except the statement regarding the family's ability to cope with the changing needs of the adolescent. This is an evaluation statement.

A pediatric client is diagnosed with type 1 diabetes. The nurse teaches the client the difference between insulin shock and diabetic hyperglycemia. The nurse evaluates that the client understands the teaching when the client states which characteristics of diabetic hyperglycemia? 1. Tremors and lethargy 2. Hunger and hypertension 3. Thirst and flushed skin 4. Shakiness and pallor

Thirst and flushed skin 3. Thirst and flushed skin are characteristic of diabetic hyperglycemia. Tremors, lethargy, hunger, shakiness, and pallor are characteristic of hypoglycemia. Hypertension is not a sign associated with hyperglycemia or hypoglycemia.

A parent of a newborn asks the nurse why a heel stick is being done on the baby to test for phenylketonuria (PKU). Which response by the nurse is the most appropriate? 1. "This screening is required and detection can be done before symptoms develop." 2. "The infant has high-risk characteristics." 3. "Because the infant was born by cesarean, this test is necessary." 4. "Because the infant was born by vaginal delivery, this test is recommended."

This screening is required and detection can be done before symptoms develop." Answer: 1 Explanation: 1. Screening for phenylketonuria is required by law in every state. It is not done according to high-risk characteristics or type of delivery.

A school-age child has epistaxis. Which intervention by the school nurse is the most appropriate? 1. Tilting the child's head forward, squeezing the nares below the nasal bone, and applying ice to the nose 2. Tilting the child's head back, squeezing the bridge of the nose, and applying a warm, moist pack to the nose 3. Lying the child down and applying no pressure, ice, or warm pack 4. Immediately packing the nares with a cotton ball soaked with Neo-Synephrine

Tilting the child's head forward, squeezing the nares below the nasal bone, and applying ice to the nose Answer: 1 Explanation: 1. 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. Tilting the child's head back may cause the blood to trickle down the throat. Warmth can cause an increase in bleeding because of vasodilation. Lying the child down without application of pressure to the nares may not stop the bleeding. A cotton ball soaked with Neo-Synephrine would only be used if the bleeding does not stop with pressure and ice.

A child is on a ventilator in the pediatric intensive care unit (PICU). Which nursing intervention would best meet the psychosocial needs of this child? 1. Allow the parents to remain at the bedside. 2. Touch and talk to the child often. 3. Provide the child with a blanket from home. 4. Provide consistent caregivers.

Touch and talk to the child often. 2. Touch and verbal exchanges will aid in psychosocial support. The other responses provide a sense of security.

Which action by the nurse can assist a child who has a mild hearing loss and reads lips to adapt to hospitalization? 1. Speaking directly to the parents for communication 2. Speaking in a loud voice while facing the child 3. Using a picture board as the main means of communication 4. Touching the child lightly before speaking

Touching the child lightly before speaking 4. 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. Speaking to the parents only does not help the child with the hospitalization. Speaking in a loud voice may not promote hearing in the child, and a picture board, while useful, should not be the primary means of communication for a child who reads lips.

The nurse is providing care to a preschool-age client who is diagnosed with acquired immune deficiency syndrome (AIDS). In planning the client's care, which vaccine is inappropriate for the client to receive? 1. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) 2. Haemophilus influenzae type B (HIB conjugate vaccine) 3. Varicella vaccine 4. Hepatitis B vaccine (Hep B)

Varicella vaccine 3. A child with an immune disorder should not be immunized with a live varicella vaccine because of the risk of contracting the disease. DTaP, HIB, and hepatitis B vaccinations are not live vaccines and should be given on schedule.

A nurse is talking to the mother of an exclusively breastfed African American 3-month-old infant who was born in late fall. Which supplement will the nurse recommend for this infant? 1. Iron 2. Vitamin D 3. Fluoride 4. Calcium

Vitamin D 2. An infant's iron stores are usually adequate until about 4 to 6 months of age. The infant should be receiving sufficient amounts of calcium from breast milk, and fluoride supplementation, if needed, does not begin until the child is approximately 6 months old. This infant will have limited exposure to sunlight and thus vitamin D because of the infant's dark skin and decreased sun exposure in the fall and winter months.

The child who had a tonsillectomy earlier today is now awake and tolerating fluids. The child asks for something to eat. Which food choice is most appropriate for this client? 1. Orange slices 2. Lemonade 3. Grapefruit juice 4. Applesauce

applesauce 4. Soft foods such as applesauce can be added as tolerated to a diet following a tonsillectomy. Citric juices or citric fruits should be avoided because they may cause a burning sensation in the throat.

A school-age client is admitted to the pediatric intensive care unit (PICU) in critical condition after a motor vehicle accident. Which intervention should be implemented at this time? 1. Maintain consistent caregivers. 2. Turn the lights off at night. 3. Keep alarm levels low. 4. Consult the hospital play therapist.

maintain consistent caregivers Answer: 1 Explanation: 1. The intensive care environment is fast-paced, overwhelming, and frightening. Maintaining consistent caregivers is invaluable in developing a familiar and trusting relationship with the child. Turning off the lights in an intensive care environment is not feasible. Keeping alarm levels low could increase risk of injury if an alarm is not heard by staff. Consulting the play therapist is not appropriate at this time.

A 10 yr old child is taking Adderall for ADHD. The physician has instructed the family to administer the medication every morning and afternoon. The mother reports the plan to the school nurse, but she refuses to administer the medication. What further instruction should the nurse give?

please bring signed medication administration form