Final exam

If a child who eats a vegetarian diet is deficient in a vitamin, which one is it most apt to be? a. Vitamin C b. Vitamin A c. Vitamin B12 d. Vitamin K

Answer: c. Vitamin B12 is found exclusively in animal sources

11. Mindy has a history of juvenile arthritis. What is an important follow-up test for a child with pauriarticular arthritis? a. Venous blood sample for sedimentation rate b. Stool to be assessed for occult blood c. Abdominal palpation for bowel obstruction d. Eye exams to detect if uveitis is developing

Answer: d. A frequent finding with pauiarticular arthritis is inflammation of the iris or uveitis.

11. One of the first symptoms of necrotizing enterocolitis you would expect to see is a. fresh blood in stools. b. pain under the sternum. c. sweating and liver pain. d. abdominal distention.

Answer: d. Abdominal distention and tenseness of the abdomen are usually the first indications of NEC.

19. Meadow has a history of migraine headaches. A drug you would expect to see prescribed for this is a. Methotrexate. b. parathyroid hormone. c. Clindamycin (Cleocin). d. Egotamine tartrate (Cafergot).

Answer: d. Egotamine tartrate constricts cerebral blood vessels and so it relieves migraine headaches.

10. Testing cranial nerves is important after head trauma. To test the seventh cranial nerve, after Meadow regains consciousness, you would a. observe if Meadow can swallow easily. b. ask Meadow to turn her head to one side. c. test to see if Meadow has peripheral vision. d. ask Meadow to raise her eyebrows.

Answer: d. The seventh cranial nerve supplies innervation to the facial muscles; checking for symmetry such as asking her to raise her eyebrows equally assesses for this.

Therapeutic management in failure to thrive

Child needs to be removed from the parents care for eval and therapy, FTT can lead to permanent neurologic damage or leave child cognitively challenged because of protein deficits and interference with brain metabolism. Immediately placed on diet for their ideal weight. Rapid weight gain is diagnostic for non organic FTT

What information will assist the child's parents in avoiding an exacerbation by recognizing subtle signs of an asthma episode?

Keep records of peak flow readings to establish personal best. A reading that is 50-80% below personal best is a caution. Other subtle signs may be increased nonproductive cough and episodes of shortness of breath.

What instructions regarding the peak expiratory flow meter will you discuss?

Peak expiratory flow is a pulmonary function test that measures the amount of air that can be exhaled forcibly. It monitors asthma and acts as a signal of an asthma episode. To use the peak flow meter, move the pointer to zero, take a deep breath and blow out hard and fast into the meter. Repeat 3 times and record the highest value. Peak flow should be done every day and values below a child's personal best indicate that an acute episode may be imminent.

What causes DDH?

The exact cause of DDH is not known,Family history increases the risk tenfold. Prenatal conditions affecting the development of DDH, such as frank breech position and maternal hormones of relaxin and estrogen, may cause laxity of the hip joint and capsule and may lead to joint instability. Twins or large infant size are additional conditions associated with DDH.

Munchausen syndrome by proxy

This is a mental illness in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick. People with MSP assume the role of a sick person indirectly by producing or lying about illness in another person under their care, usually a child under 6 years of age. However, cases have been reported of adult victims of MSP.

Rheumatic fever

caused by untreated (group A) strep

posterior fontanelle

closes 1-2 months

ALL Acute lymphocytic Leukemia

distorted and uncontrolled proliferation of WBC. Because of the rapid proliferation of these immature/non functioning blast cells, RBC and platelets fall, and invasion of WBC begins

birth weight

doubles at 6 months and triples at 12 months

cleft lip

early repair(2-10 weeks)

immediate side effect of radiation

fatigue, anorexia, nausea, vomiting, erythema and skin tenderness

IV infusion of chemo drugs

fluid can infiltrate skin tissue and can cause extensive sloughing and damage. Discontinue IV and apply ice pack to create vasoconstriction. Dexaroxane Totec can be injected to speed absorption.

Kawasaki syndrome

lymph node and check apical pulse

management of brain tumor

radiation, chemo is limited due to blood brain barrier

cleft palate

repair later (6-18 months) will need follow up with dentist for possible realignment of teeth and hearing and speech due to eustachian tube may be changed in surgery.

1. Describe a characteristic that places young children at risk for contracting an infectious disease

• Young children are at risk of contracting an infectious disease because their immune systems are not fully functional and they have not yet developed antibodies to many agents. Therefore they cannot defend against disease as well as older children.

Explain the rationale for each of the following clinical manifestations of CF.

1. Respiratory symptoms - Increased viscosity of bronchial mucus contributin to obstruction and bacterial growth; chronic progressive pulmonary fibrosis. 2. Large bulky, frothy, foul smelling stools - Disturbed absorption of fat and protein, leading to excessive fat and protein in stool as a result of pancreatic deficiency of digestive enzymes 3. Voracious appetite - increased metabolism, may need 25-50% more calories that average. 4. Weight loss - as above. 5. Anemia & bleeding - Deficiency of Vitamin K, a fat-soluble vitamin; as above. 6. Significance of a sweat chloride test - Elevation in sweat electrolytes; CF interferes with electrolyte and fluid balances in the body. In most CF patients, sweat is up to five times saltier than normal and severe salt depletion can occur in very hot weather

What is the purpose of a spacer with the metered dose inhaler (MDI)?

A spacer deposits medication deeper into the airways and avoids large droplets of steroids on the oral mucosa, thereby minimizing the risk of oral yeast infections. A spacer is also useful for parents of infants and small children who are unable to manipulate the MDI. The spacer prevents loss of medication.

What content should the nurse emphasize in preoperative teaching for tonsillectomy directed towards the parents?

After the surgical procedure is explained by the health care provider, the nurse should reinforce the teaching about the procedure. The nurse should explain the events related to the operation, such as admission procedures and preoperative lab procedures. Teaching should be provided about preoperative medications for sedation, what will happen in the period before transport to the operating room, and what will happen when the child and the family are reunited following the procedure in the post anesthesia care area.

17. Children with Ewing's sarcoma may receive extensive radiation to the tumor site. What is a precaution you would teach them after this? a. They should not jump on their affected leg. b. They should not use vitamin A for acne therapy. c. They should markedly limit their calcium intake. d. They should use sugar substitutes instead of sugar.

Answer: a. A Ewing's sarcoma is a tumor generally located in long bones; radiation can weaken the bone and cause a pathologic fracture if the child jumps on it.

6. Meena had a cardiac catheterization to diagnose her congenital heart disease. Following cardiac catheterization, which of the following is the most important measure? a. Assessing the pressure dressing is intact b. Assuring the baby the procedure is now over c. Letting the baby adjust to room light gradually d. Letting the baby kick and exercise her legs

Answer: a. A child can lose a great deal of blood from the catheterized vein if a pressure dressing is not applied.

2. If Mindy has broken her elbow, why would casting be particularly dangerous? a. The radial artery or nerve can be compressed. b. Casts cause a "dragging" injury to the shoulder. c. Casts limit wrist motion so they can cause arthritis. d. The radius and ulna are not strong bones.

Answer: a. A concern with elbow injuries is that the radial artery or nerve is compressed from edema or pressure of the cast.

3. Missy states she is unable to remember the hockey puck hitting her. This has probably occurred because a. loss of memory is a common finding following concussion. b. she must be afraid that she will be blamed for the incident. c. Missy hopes that she will receive more sympathy this way. d. many young adolescents have poor memories for recent events.

Answer: a. A mark of concussion is that the individual has no memory of the incident.

16. Suppose Meadow is prescribed phenytoin sodium (Dilantin) for tonic-clonic seizures. An important health measure you would teach her is to a. brush her teeth well and use a water pick. b. know the drug may cause severe itchiness. c. have her hearing tested every 3 months. d. report any signs of loss of hair color.

Answer: a. A side effect of phenytoin is hyperplasia of the gumline. Good tooth brushing is necessary to prevent infectious organisms from collecting under the swollen gumline and causing tooth decay.

12. A danger sign of cancer advanced by the American Cancer Society is a. a sore that does not heal. b. hair loss by middle age. c. a feeling of "gloom and doom." d. frequent sneezing and draining nose.

Answer: a. A sore that does not heal is an important symptom of skin cancer.

8. Mark receives allopurinal in addition to chemotherapy. The purpose of allopurinal is to a. reduce uric acid load on kidneys. b. prevent nausea and vomiting c. increase red blood cell production. d. stimulate white blood cell count.

Answer: a. Allopurinal protects the kidneys from being overwhelmed by uric acid from the massive breakdown of cancerous cells.

19. If a burned child has an escharotomy, this means that a. the hard coating over the denuded area is cut away. b. necrotic tissue at the burned site is removed. e. granulation tissue is stimulated to grow rapidly. c. a protection coating is applied to the burn site.

Answer: a. An eschar is the hard leather-like covering that forms over burns. An escharotomy means the eschar is cut to prevent it from constricting circulation.

20. Therapy for Kawasaki disease for which you would expect to monitor would be a. administration of a corticosteroid. b. Long-term use of penicillin. c. an oral dopamine inhibitor. d. IM injections of a vasodilator.

Answer: a. As Kawasaki disease is thought to be an autoimmune disorder, a corticosteroid can decrease the immune response and symptoms. Aneurysms form in vessels so a vasodilator would be potentially dangerous to administer.

20. Children have kidney biopsies to diagnose kidney disease. An important nursing responsibility following a kidney biopsy is to a. keep pressure on the biopsy site to prevent bleeding. b. not allow the child to drink any water for 4 hours. c. administer an anticoagulant to prevent glomeruli clotting. d. teach the child to inspect the biopsy site for bruising.

Answer: a. As kidneys are very vascular organs, pressure to prevent bleeding is important.

19. Which of the following findings makes David's mother high risk for being an abuser? a. She was abused herself as a child. b. She is over 21 and a single parent. c. She works part time as a bus driver. d. She has only a high school education.

Answer: a. As many as 30% of children who are abused grow up to be child abusers.

6. An important assessment to make after administering the Mannitol solution would be a. blood pressure. b. urine for protein. c. pedal pulses. d. color of mucous membrane.

Answer: a. As the blood stream fills with excess fluid, blood pressure can rise rapidly until the fluid is detected and removed by the kidneys.

14. Jack's father is also concerned that Jack may be developing celiac disease because a maternal aunt has this. If Jack were developing this, you would assess the child specifically for symptoms of a. rickets. b. polycythemia. c. obesity. d. blindness.

Answer: a. Because children with celiac disease are unable to absorb fat and fat-soluble vitamin, such as vitamin D, rickets may occur.

3. If Mindy had to have Bryant's traction applied, this would mean that a. her legs would be elevated by skin traction. b. her arm would be elevated with traction applied. c. pins inserted into her torso would elevate her legs. d. traction would be applied to her torso and head.

Answer: a. Bryant's traction is a form of skin traction used to place traction on lower extremities using the child's body weight as counter traction. It is only used with infants.

10. Why cancer occurs has many theories. What is a characteristic of normal cells that is not seen in malignant cells? a. They are well differentiated. b. They arise from stem cells. c. They have nuclei and cytoplasm. d. They require protein to function.

Answer: a. Cancerous cells are undifferentiated or not well defined. Both types arise from stem cells, have normal cell components, and require protein to function.

If Joey 15-month-old were apprehensive about being examined, the best technique to use would be to a. begin the exam with him in his mother's lap. b. explain that nothing you will do will hurt him. c. ask his parent to hold him tightly for security. d. ask Joey to tell you if something scares him.

Answer: a. Children feel most comfortable with their parent so allow a child to begin an exam comfortably seated in a parent's lap.

6. The reason that extensive edema occurs in children with nephrosis is that a. they have a low serum protein level. b. their blood becomes rich in cholesterol. c. avitaminosis causes a flaccid abdomen. d. they are unable to drink adequate fluid.

Answer: a. Children lose protein in urine, depleting that in the circulatory system. This causes fluid to move via osmosis into interstitial tissue from blood vessels.

19. Kawasaki disease occurs most frequently in school-aged children. A common symptom to assess for in children with this disease is a. lack of bowel movements. b. slurred or inadequate speech. c. swelling of the parotid gland. d. bleeding gumline by the front teeth.

Answer: a. Children with Kawasaki disease may develop bowel obstruction and lack of bowel movements from swollen abdominal lymph nodes.

14. If Cary developed chronic renal failure, which type of diet would you expect to see prescribed for her? a. Low protein, low phosphate b. High protein, low calcium c. Low protein, high fat d. High carbohydrate, low fat

Answer: a. Children with chronic renal failure have difficulty excreting phosphate and the breakdown products of protein so they are generally placed on a low protein, low phosphate diet.

2. Jack was diagnosed as having pyloric stenosis. This is a. constriction of the valve between the stomach and duodenum. b. enlargement of the valve between the stomach and esophagus. c. inflammation of the duodenum from an allergy to milk. d. necrotic patches forming on the lining of the stomach.

Answer: a. Constriction of the pyloric value between the stomach and duodenum results in the inability of food to pass through the valve.

You administer a Denver Developmental II test to Joey. Which statement below would be the best introduction to this test for his mother? a. "The test will identify different development skills." b. "It will be best if you do not watch Joey during the test." c. "The test is an important screen for children's intelligence." d. "The test may be inaccurate as it is not well standardized."

Answer: a. Denver developmental tests measure developmental milestones. It is not an I.Q. test and is well standardized.

Ashley is being assessed for development. Development is defined as a. a qualitative change. b. the ability to grow taller. c. a quantitative change. d. an increase in body cells.

Answer: a. Development is an increase in the ability to complete tasks.

12. In planning care for a child with cerebral palsy, which of the following would you stress to his parents? a. Enrolling the child in a preschool program can increase his social skills. b. He will need an antiacetylcholinergic drug to decrease muscle spasms. c. Cerebral palsy is a dominantly inherited disorder so it will affect other children. d. The child will develop progressive brain cell destruction in the future.

Answer: a. Early education programs are often helpful to give the child with cerebral palsy a "head start" on schooling. The disease will not progress, although some symptoms may seem worse as the child grows older.

17. Cary has had nighttime enuresis for the last month. What is the usual therapy for nighttime enuresis (bedwetting)? a. Administration of desmopressin b. Administration of prednisone c. Increasing calcium in the diet d. Restricting all fluid during the day

Answer: a. Enuresis can be decreased by administration of desmopressin (DDAVP), a form of synthetic antidiuretic hormone.

13. Children who develop chronic renal disease often develop anemia. Anemia occurs with chronic renal disease because the a. kidneys are no longer able to produce erythropoietin. b. kidneys no longer produce aldosterone so red cells die. c. spleen is stimulated to destroy red blood cells. d. liver is no longer stimulated to produce red blood cells.

Answer: a. Erythropoietin, produced by the kidney, can no longer stimulate the production of red blood cells.

12. What is a prime nursing responsibility for a hospitalized infant with failure to thrive? a. Arrange for a primary care provider b. Expose the child to many individuals c. Limit the dietary intake to soft foods d. Do not allow the child's parents to visit

Answer: a. Failure-to-thrive infants need to establish a one-on-one relationship as an in-depth relationship has been denied them at home.

Ashley is also assessed for growth. Growth is defined as a. a quantitative change. b. an increase in skill. c. the ability to accomplish. d. the ability to learn.

Answer: a. Growth, in contrast to development, is a quantitative change or one that can be measured in centimeters or kilograms.

8. A common way to check for scoliosis in children Mindy's age is to a. ask a child to bend forward and inspect her back. b. see if a child can bend backward without pain. c. measure the distance from the child's hip to armpit. d. measure the child's height to see if it is normal for age.

Answer: a. If a child with scoliosis bends forward, the spinal curve becomes more prominent.

17. Meadow had meningitis ruled out when she was a preschooler. When caring for a child with meningitis, an important assessment would be to a. assess if the level of hearing is affected. b. inspect if the child has a "geographic" tongue. c. listen if the child can count to ten without pausing. d. assess if the parents understand the child will be sleepy.

Answer: a. If the eighth cranial nerve is affected, hearing will be impaired.

4. If a child has a series of urinary tract infections, a child may have a vesicoureteral reflux. This is a. return of urine into the ureters with bladder contraction. b. incomplete emptying of the urethra from a stenosis. c. blocking of the urethra by kidney stones, causing stasis. d. erosion of the bladder lining from acid urine and bleeds.

Answer: a. If the valve between the ureters and bladder is misplaced or inadequate, urine can reflux into the ureters when the bladder contracts to empty, causing stasis and infection of urine.

16. Twenty-four hours after a severe burn, which type of fluid movement would you anticipate? a. Edematous fluid moves into the vascular system, causing hypertension. b. Fluid flows into the circle of Willis, generally increasing blood pressure. c. Blood plasma pools in lower extremities and decreases cardiac output. d. Fluid drains from the burn to the outside surface, resulting in hypotension.

Answer: a. Immediately following a burn, fluid flows into the burned site to bring with it necessary white blood cells; at 24-hours post burn, fluid returns to the circulatory system.

The concept of permanence is developed by infants. This is the a. ability to know an object out of sight still exists. b. ability to recognize that no person can live forever. c. knowledge that some objects last for a long time. d. knowledge that cheaply built products break easily.

Answer: a. Infants learn at the end of the infant year that an object still exists even when it is out of the infant's sight.

8. All newborns should be examined for developmental hip dysplasia. To perform this assessment, you would attempt which maneuver? a. Abduct the child's hips to 180 degrees b. Observe if the child uses his legs evenly c. Observe if the infant's knee bends freely d. See if the leg extends fully without pain

Answer: a. Infants with developmental hip dysplasia cannot abduct the affected hip.

12. Jack's father was concerned that his son might have gastric reflux or a peptic ulcer. Peptic ulcers are thought to develop from a. an H. pylori bacterial infection. b. stress from psychological trauma. c. an allergy to milk or milk products. d. an irritation from a foreign body.

Answer: a. Infection by H. pylori causes irritation and ulcers to form in the stomach lining.

10. Why is iron such a dangerous drug when ingested in a poisoning? a. It leads to extreme gastric irritation and bleeding. b. It turns the skin a bronze or bright orange color. c. It lodges in the intestine and causes obstruction. d. It leads to bladder infection from bladder irritation.

Answer: a. Iron is extremely irritating to the stomach so it can cause gastric hemorrhage.

18. An infant with Hirschsprung's disease may need a daily enema to help with bowel evacuation. When giving parents instructions for this, which solution would you recommend they use? a. Isotonic saline solution b. Warmed tap water c. Tap water with baking soda added d. A concentrated glucose solution

Answer: a. It is important that an enema solution used with infants is isotonic to prevent fluid from shifting from the bowel into interstitial tissue by osmosis, causing water intoxication.

11. Which of the following is a symptom of coarctation of aorta that a school nurse might notice when the child reaches school age? a. Pain in the legs on physical exercise b. An especially short attention span c. Eating little lunch from lack of appetite d. Abdominal bloating and chronic pain

Answer: a. Lack of circulation to the lower extremities can result in leg pain the same as in adults who have peripheral vascular disease.

14. Suppose Mindy has myasthenia gravis. Which of the following findings would you expect to observe in her? a. She tends to grow tired exceptionally easy. b. She has no feeling in muscles below her waist. c. Her muscles jerk constantly when in motion. d. Her disposition is irritable and demanding.

Answer: a. Myasthenia gravis causes a fault in acetylcholine effectiveness so muscles tire easily.

11. Billy's SaO2 is 93%. His PaO2 is 75 mm Hg. You would evaluate this as a. hypoxemia with lessened oxygen saturation. b. adequate oxygenation but poor O2 saturation. c. ineffective oxygenation from a blocked airway. d. both poor oxygen saturation and hypoxia.

Answer: a. Oxygen saturation (SaO2) should be 95% to 100%; PaO2 should be 80 to 100 mm Hg.

7. Billy is diagnosed as having right lower lobe pneumonia in addition to cystic fibrosis. This is a. acute infection of the alveoli of the lung. b. infection of the major bronchi with exudate. c. a contagious disease that affects the trachea. d. alveoli coated with a fibrous membrane.

Answer: a. Pneumonia is inflammation and infection of lung alveoli. No fibrous membrane is present.

15. Which symptom from Meena's health history is a common symptom of rheumatic fever? a. Swelling and pain in her knees b. Pain and distress on urination c. Tingling of lower extremities d. Persistent nausea and vomiting

Answer: a. Polyarthritis means several joints or joints in succession are inflamed and swollen. Children may have abdominal pain from swollen lymph nodes, but nausea and vomiting would be rare.

12. Although it didn't occur, which happening at Meena's birth made her high risk for patent ductus arteriosus? a. She had difficulty beginning respirations. b. Her mother had an epidural block for labor. c. Her father worked at a sedentary desk job. d. Her mother had an infection during pregnancy.

Answer: a. Prematurity and difficulty beginning respirations are two common conditions associated with patent ductus arteriosus.

4. Which of the factors from Jack's health history is a risk factor for pyloric stenosis? a. He is a first-born, male infant. b. He lives in an urban community. c. His mother is allergic to dust. d. His father works as a chemist.

Answer: a. Pyloric stenosis tends to occur in first-born, white, male infants.

19. Both of Jack's parents had an appendectomy when they were school aged. Suppose you see a 10-year-old who has symptoms of appendicitis in an emergency room. When you telephone the resident on call, she asks you to assess for rebound tenderness and call her back. Which technique would you use to do this? a. Palpate the child's right lower quadrant, quickly release your hand, and ask him if he has increased pain. b. Palpate first the left lower quadrant, then the right, and ask the child to compare the levels of pain. c. Ask the child to use a valsalva maneuver, and note if pain is increased after the maneuver. d. Tell the child to bend forward, and ask him if he notices bounding abdominal pain afterward.

Answer: a. Rebound tenderness is diagnostic for appendicitis as the inflamed appendix registers pain when it moves from the sudden release of your hand.

You inspect Joey's fingers to see if they are "clubbed." Clubbed fingers occur in children who have a. respiratory disorders. b. enlarged livers or spleens. c. gastrointestinal disorders. d. many neurologic diseases.

Answer: a. Respiratory disorders cause lack of oxygen so extra capillaries form in finger tips, making them appear broad and "clubbed."

10. If a girl has steel rods inserted for scoliosis, you would instruct her that a. they will ultimately cause little loss of function for her. b. she must wear a full-body cast for 2 years to protect them. c. they will only be in place for 6 months or even less. d. if they rust, they must be removed to prevent iron poisoning.

Answer: a. Spinal rods ultimately cause few physical limitations. They are permanent; not removed.

19. Shelton was assessed for an imperforate anus at birth because this can accompany other congenital disorders. Following surgery for this, important information to tell axillary personnel would be that a. he should have no rectal temperatures taken following surgery. b. he needs to be constantly positioned on his back to relax his bowel. c. he will be placed in a cast to apply pressure to his abdomen. d. physical therapy will be necessary to cause bowel movements.

Answer: a. The baby will have a rectal suture line that could be injured by a hard object such as a thermometer.

16. Suppose Shelton had a Pierre Robin syndrome. Which is a potential difficulty that occurs with this disorder? a. The tongue can obstruct the airway. b. Stomach spasms can lead to aspiration. c. Infection from immune disorders occurs. d. The umbilical hernia causes obstruction.

Answer: a. The child's jaw is small so the tongue seems large and can fall backward and block the airway.

Vision, when tested by a Snellen eye chart, is recorded as two numbers such as 20/20 or 2/30. The first of these numbers represents the a. distance the child stands from the chart. b. optical depth of a normal child's eye. c. distance a child is able to see clearly. d. designated Snellen chart conversion factor.

Answer: a. The first number is the distance the child stood from the chart or 20 feet.

2. Billy aspirated a peanut when he was 3. Where on a chest sonogram would you have expected to have seen this lodged? a. In his right chest b. Behind the sternum c. In his left chest d. Just above the stomach bubble

Answer: a. The right bronchus is larger and straighter than the left so most aspirated objects lodge in the right lower lung.

To assess Joey's tympanic membrane, you would pull the pinna of his ear a. down and back. b. down and forward. c. up and back. d. up and forward.

Answer: a. To straighten the ear canal in a child under 2 years, you pull the ear pinna down and back. In older children, the movement would be up and back.

8. Although it might mean nothing, which statement by David would make you wonder if a role reversal between him and his mother has occurred? a. "Everything will be all right, Mom." b. "I can't breathe. It hurts too much." c. "I promise not to play by the stove again." d. "I want to go home. I hate it here."

Answer: a. When a child becomes the comforter rather than the parent, a role reversal has occurred.

2. Missy is diagnosed as having a coup type of concussion. This means that a. the posterior portion of her brain is injured. b. her brain is injured just beneath her forehead. c. she has diffuse injury throughout the brain. d. she has no injury because the forehead took the blow.

Answer: b. A coup injury means the brain injury is beneath the skin lesion; a contrecoup injury is at the opposite side.

To assess if a child has a strabismus, you would use a cover test. To do this, you would a. cover the child's head with a blanket and ask him to remove it. b. cover an eye and inspect for movement when the cover is removed. c. touch each of Joey's eyes with a cotton wisp to see if he winces. d. assess if Joey can look up and down and to the right and the left. .

Answer: b. A cover test detects if an eye is not well aligned by observing it after it has been temporarily covered

3. Suppose an infant with Tetralogy of Fallot turns cyanotic and short of breath. Your best action would be to a. put her head between her legs. b. place her in a knee-chest position. c. tell her to breathe into a paper bag. d. sit her upright to lower blood pressure.

Answer: b. A knee-chest position locks blood in the lower extremities, which makes it easier for the infant to oxygenate that remaining blood.

2. A review of systems in a health history is used to a. inform the parent how many body parts can become ill. b. help a parent remember any illness a child has had. c. caution the child to be more careful in handling toys. d. educate the child and parents about the chief concern.

Answer: b. A review of systems or questions about body parts and systems can stir the memory of parents and reveal illness information.

11. A child hospitalized beside Meadow has cerebral palsy. A sign of cerebral palsy that is often evident as early as 4 months is a. a tonic neck reflex. b. "scissoring" of the legs. c. a Moro reflex. d. poor articulation of words.

Answer: b. Abnormal muscle spasticity causes the legs to "scissor" or cross.

9. Missy poisoned herself by swallowing acetaminophen (Tylenol) as a 3-year-old. The antidote given for this in an emergency room is most frequently a. syrup of ipecac. b. activated charcoal. c. oral penicillin. d. a bronchial dilator.

Answer: b. Activated charcoal effectively counteracts most ingested drugs. An alternative drug would be mucomyst, a specific antidote for acetaminophen.

11. What is the usual cause of acute glomerulonephritis in children? a. An allergic response to milk products such as cheese b. An autoimmune response to a streptococcal infection c. A complication of a hepatitis (either B or A) infection d. A reaction to diphtheria-pertussis-tetanus vaccine

Answer: b. Acute glomerulonephritis in children most frequently follows a beta hemolytic group A streptococcal infection.

13. Shelton has a talipes disorder so he has a cast applied to his leg. You would advise his parents that the cast for this will extend a. to the calf of the leg. b. 1 inch above the knee. c. as far as the child's hip. d. to just above the ankle.

Answer: b. Although talipes disorders are ankle-foot deformities, the cast extends above the knee to securely anchor the foot in a new position.

16. Children with chronic renal failure are prescribed aluminum hydroxide with meals. You would explain to a child the purpose of this drug is to a. reduce kidney inflammation. b. reduce phosphate absorption. c. encourage calcium absorption. d. retain water in the GI tract.

Answer: b. Aluminum hydroxide combines with phosphate in the GI tract to reduce phosphate absorption.

18. Billy had croup (laryngotracheobronchitis) as a preschooler. Which observation would have been most important to demonstrate that his airway occlusion was occurring? a. Billy stated he was tired and wanted to sleep. b. Respiratory rate was gradually increasing. c. His cough was becoming louder and harsher. d. His nasal discharge was increasing in amount.

Answer: b. An increasing respiratory rate suggests difficulty with breathing.

20. Missy's father reported that he was bitten by a poisonous snake when he was a child. Emergency-room treatment for a venomous snake bite is to a. elevate the bitten extremity to aid venous flow. b. anticipate administering an antivenom serum. c. apply a warm pack to the bite until it "weeps." d. keep the person talking to prevent unconsciousness.

Answer: b. Antivenom serum counteracts the effect of the poison. Any action that increases blood flow (warmth, elevation, motion) is detrimental as it speeds flow of the poison through the circulatory system.

6. When changing Jack's diaper following surgery, which approach would be best to use? a. Fold diapers high so the incision line is well covered. b. Fold diapers low so the incision will not be contaminated. c. Don't use diapers; they could cause abdominal bloating. d. Use sterile diapers to prevent the child from acquiring an infection.

Answer: b. As a rule, folding diapers under the incision line will help prevent fecal contamination of the incision.

2. What is a factor in David's history that makes him high risk for abuse? a. He was named for his maternal grandfather. b. He was hospitalized at birth for prematurity. c. He is male and attends a preschool program. d. He learned to walk at 12 months of age.

Answer: b. Attachment may not occur readily if infants are separated from their parents at birth.

4. Meadow is prescribed Mannitol, IV because of her head trauma. The purpose of this drug is to a. shrink brain cells by bathing them in a hypertonic fluid. b. shift fluid from interstitial spaces into the bloodstream. c. move fluid out of brain cells into the interstitial space. d. stabilize brain cells by increasing calcium in the membrane.

Answer: b. Because Mannitol is a hypertonic solution, it causes fluid to shift by osmosis from interstitial tissue into the circulatory system, relieving cranial edema.

21. Billy has a cousin who has asthma. Is asthma mainly a problem of inspiration or exhalation? a. Inspiration because of narrowed alveoli b. Expiration because of narrowed bronchi c. Inspiration because alveoli are already full d. Expiration because rhonchi are present

Answer: b. Because bronchi are more narrow on expiration than inspiration, respiratory distress in asthma begins as expiratory distress.

3. Why is aspiration of a peanut a particular dangerous type of aspiration? a. Peanuts cause the lungs to rust b. A lipid pneumonia can develop c. Health insurance doesn't cover this d. He will develop an allergy to peanuts

Answer: b. Because peanuts are coated by oil, they cause extreme inflammation of lung tissue, which then becomes secondarily infected.

1. Meadow had a previous carpal tunnel syndrome. This is a. a tear in the transverse carpal ligament. b. compression of the median nerve. c. contraction of the carpal muscle. d. minute cracks in the distal tibia.

Answer: b. Carpal tunnel syndrome refers to compression of the median nerve caused by inflammation from repetitive movements.

15. If Jack were diagnosed with celiac disease, you would anticipate educating his father about a diet that is a. low fat and low carbohydrate. b. free of wheat and barley. c. free of most dairy foods. d. high in carbohydrate (glucose).

Answer: b. Celiac disease is an apparent allergic response to gluten, the protein portion of wheat, oats, barley, and rye.

13. Suppose you learn that Missy swallowed the overdose of acetaminophen, not at 3 years as you first learned, but a year ago when she was 13. Which would be your best action? a. Ask if Missy could have an IQ test as this suggests she is cognitively challenged. b. Be alert that poisoning in adolescents could be a suicide attempt, not an accident. c. Assess if Missy has difficulty reading small print so she could have misread the dose. d. Alert Missy that overdoses of acetaminophen can lead to osteoporosis as an adult.

Answer: b. Children above beginning school age rarely poison themselves accidentally so suicide attempts much be considered.

Which of the following is a principle of growth and development? a. All body systems should develop at the same rate. b. There is an optimal time for initiation of experiences. c. Development proceeds from specific to gross. d. Growth increases at a steady rate after the first year.

Answer: b. Children appear to have "built-in" or optimal times to achieve tasks such as walking or learning to speak. All body systems do not develop at the same rate; program is from gross to specific and is continuous but not necessarily steady.

16. If Meena has rheumatic fever, you can anticipate that she will be prescribed which medication to take for at least the next 5 years? a. A corticosteroid b. An oral penicillin c. An oral NSAID d. Acetylsalicylic acid

Answer: b. Children are prescribed oral penicillin to prevent them from contracting a streptococci infection again.

If Ashley's family is vegetarian, you would suggest that a. such a diet is not appropriate for children under 5. b. this is an adequate method of nutrition for children. c. children will need to receive protein supplements. d. such diets are not healthy for children under 3.

Answer: b. Children of all ages can thrive on a well-balanced vegetarian diet.

16. Mindy has a cousin who has muscular dystrophy. A common assessment for this disorder is a positive Gower's sign. This is a. weakened deep-tendon reflexes such as the Achilles' reflex. b. inability to rise from the floor without placing the hands on the knees. c. inability to keep the eyelids open for over 30 seconds at a time. d. exaggerated spinal reflexes on both forward and backward bending.

Answer: b. Children with muscular dystrophy "walk up" their body to rise from the floor to give themselves extra support for weakened muscles.

When doing health assessments, for which child would it be most important to do screening for color discrimination? a. A 6-year-old girl who doesn't play sports b. A 16-year-old boy who dislikes school c. A 2-year-old girl who cannot name colors d. An infant who has pale blue eyes

Answer: b. Color discrimination abnormalities (color blindness) occur most frequently in boys. Two-year-olds cannot normally name colors.

9. Suppose a child is placed on continuous ambulatory peritoneal dialysis. Which statement by her parents would best reassure you that they understand the principle of peritoneal dialysis? a. "Peritoneal dialysis is a test of kidney function." b. "The procedure clears waste products from the body." c. "She shouldn't drink any fluid while the tube is in place." d. "Her abdomen should appear sunken during the procedure."

Answer: b. Continuous ambulatory peritoneal dialysis is a method to use the peritoneal membrane as a filtering device to remove waste products from the body. The abdomen will appear protuberant during an infusion.

18. If a child with a severe burn is scheduled for debridement, this means that a. the burned tissue will be sterilized with an antibiotic. b. necrotic tissue at the burn site will be removed. c. skin is grafted from another child to the burned child. d. the bone under the burned area will be removed.

Answer: b. Debridement means that necrotic tissue will be surgically removed.

16. Jack had a loose bowel movement this morning. It is important to teach new parents that diarrhea in infants is a. not serious because of infant's high fluid content and intake. b. more serious in infants than in adults because of fluid shifts. c. not likely to cause dehydration unless it occurs more than four times. d. not apt to be serious unless it is associated with a high fever.

Answer: b. Diarrhea quickly causes dehydration in infants so, as a rule, it is more serious in infants than adults.

8. Meena was prescribed digoxin as an infant. The action of digoxin is to a. increase the heart rate and dilate blood vessels. b. slow heart rate and strengthen heart contractions. c. decrease the amount of blood filling the ventricles. d. stimulate angiotension to increase blood pressure.

Answer: b. Digoxin is a cardiac glycoside that decreases heart rate, allowing for more effective contractions.

13. Mindy wakes every morning with joint pain. To relieve this, you would advise her to a. take her NSAID immediately on arising. b. schedule time in the morning for a hot bath. c. stay in bed and rest until the pain passes. d. rub each inflamed joint with powdered aspirin.

Answer: b. Heat is an effective therapy to help reduce pain with arthritis. People should not take NSAIDs on empty stomachs to avoid stomach irritation.

17. Jack's father reports that his son was constipated until this morning. Hirschsprung's disease can be a cause of constipation in infants. This is a. a form of volvulus that leads to obstruction. b. lack of nerve endings in the sigmoid colon. c. lack of pancreatic enzymes that impair digestion. d. necrotic patches that form in the large intestine.

Answer: b. Hirschsprung's disease or aganglionic megacolon is lack of nerve endings in a small segment of the large bowel. Stool cannot pass this point so constipation occurs.

19. Following a kidney transplant, which laboratory test result would be most predictive that the new kidney is failing? a. Decrease in white blood count b. Increase in blood urea nitrogen c. Increase in reticulocyte count d. Decrease in appetite for meat

Answer: b. If nitrogen wastes cannot be excreted, they will accumulate in the blood stream, elevating the blood-urea-nitrogen level (BUN).

3. Following surgery and repair of a tracheoesophageal fistula, an infant has a gastrostomy tube inserted. Following a feeding, which intervention would you use? a. Clamp the gastrostomy tube securely. b. Leave the tube unclamped and elevated. c. Flush the tube with 100 mL tap water. d. Leave the tube unclamped and lowered afterward.

Answer: b. If the infant should become nauseated and vomit following a feeding, leaving the tube unclamped and elevated will allow the vomitus to be ejected by the tube, not past the esophageal stitches, possibly disrupting them.

5. You notice that Meadow's urine specific gravity is 1.035 and her 24-hour total is only 500 mL. You would assess this as a. fragments of broken vertebrae blocking glomeruli filtration. b. possible development of inappropriate antidiuretic hormone. c. possible development of diabetes insipidus as a result of pressure. d. to be expected because fluid is pooling in injured areas.

Answer: b. Inappropriate antidiuretic hormone secretion can occur from increased intracranial pressure, leading to a low urine output.

11. An infant with failure to thrive often shows which marked characteristic? a. Unusual torso accumulation of fat b. Staring intensely at caregivers c. Advanced psychosocial milestones d. Angry, forceful, persistent crying

Answer: b. Infants with failure to thrive stare hungrily at caregivers as if they are starved for human contact.

18. Another congenital anomaly that could have occurred to Shelton is a diaphragmatic hernia. This occurs because the a. intestine twists and obstructs the stomach. b. diaphragm allows the bowel to enter the chest. c. lungs herniate into the abdominal cavity. d. diaphragm feels stiff and noncompliant.

Answer: b. Intestine is present in the chest at birth, compromising lung function.

18. Suppose Meena develops congestive heart failure. An important nursing intervention would be to a. restrict milk or dairy-product intake. b. maintain her in a semi-Fowler's position. c. plan ways to reduce potassium intake. d. keep her lower extremities elevated.

Answer: b. Keeping the chest elevated lowers abdominal contents and allow for better heart and lung function.

The developmental task of the toddler period is to learn a sense of a. initiative. b. autonomy. c. tolerance. d. industry.

Answer: b. Learning autonomy or independence is the task of the toddler period.

24. Billy demonstrates use of a peak flow meter for you. To use this properly, he should a. inhale into it as deeply as possible and then exhale slowly. b. take a deep inhalation and exhale deeply into it. c. breathe normally into it for a count of at least ten. d. inhale deeply and hold his breath until it registers.

Answer: b. Peak flow measures the maximum amount of air that can be expelled in one breath.

When you assess Joey's heart, you notice he has physiologic splitting. This means that a. Joey's heart beat sounds far away or underwater. b. his second heart sound is split when Joey inhales. c. the first heart sound is absent when Joey talks. d. you cannot tell the first from the second sound.

Answer: b. Physiologic splitting is an extra heart sound caused by late closure of the pulmonary valve on inspiration.

8. Children with nephrosis are also prescribed prednisone. This is effective because a. prednisone stimulates secretion of aldosterone. b. nephrotic syndrome may be an autoimmune reaction. c. corticosteroids slow the renin-angiotension response. d. prednisone decreases the blood pressure by vasodilation.

Answer: b. Prednisone, a glucocorticoid, suppresses the immune response so it limits autoimmune reactions.

According to Piaget's theory of cognitive development, what age child develops magical thinking? a. Infant b. Preschooler c. Junior-high schoolers d. Adolescence

Answer: b. Preschoolers believe in "magical thinking" or what they wish will happen.

13. Meadow had a febrile seizure when she was 4. You would teach parents that to prevent a second seizure of this type, they should a. prevent the child from developing an upper respiratory infection again. b. keep her temperature from rising again by administering acetaminophen. c. administer phenobarbital if her temperature rises above 101°. d. cover her with alcohol-soaked towels if her temperature rises above 99°.

Answer: b. Preventing a sudden rise in temperature will help prevent a second seizure. Preventing all URIs is unrealistic. Alcohol soaks are too extreme.

5. When administering a drug to control nausea and vomiting with chemotherapy, it is best to a. assure the child it will be 100% effective. b. give it ½ hour before beginning chemotherapy. c. give it at the conclusion of the therapy. d. give it only if nausea and vomiting occur.

Answer: b. Preventing nausea and vomiting is more effective than giving the drug after it has already occurred. It may not be 100% effective.

13. The most frequent therapy, in addition to an antibiotic, that you would expect to see prescribed for a peptic ulcer would be a. surgery to remove the offending ulcer. b. Omeprazole (Prilosec), a proton pump inhibitor. c. Ethycrinic acid, a diuretic, to reduce acid content. d. whole milk to neutralize excessive stomach acid.

Answer: b. Proton pump inhibitors suppress gastric secretions by blocking the final step of acid production so they decrease the accompanying irritation of hydrochloric acid. Milk may actually stimulate acid production.

To interview Joey's mother about his growth and development, your best-worded question would be, a. "Joey is growing well, isn't he?" b. "What is Joey's favorite toy?" c. "Does he cough and sneeze? d. "Tell me about Joey."

Answer: b. Questions that are specific yield best results. A is a leading question; c is a compound question; d is too wide open to answer well.

5. David may have been a victim of a shaken baby syndrome. Which finding in his history best suggests this? a. Difficulty currently bending his elbow b. Retinal hemorrhages at 8 months c. History of colic for first 3 months d. Circular lesions on his posterior legs

Answer: b. Retinal hemorrhages are suggestive that an infant has been severely shaken.

17. Billy has frequent nosebleeds (epistaxis). Which intervention would be best for this? a. Elevate his head slightly and apply pressure to the forehead b. Sit him upright and apply pressure to the sides of the nose c. Turn his head to the side and press on his nasal ridge d. Keep him flat and apply pressure to the bridge of the nose

Answer: b. Sitting upright relieves intravascular pressure; applying pressure to the sides of the nose constricts blood vessels.

6. Which child below is at increased risk for slipped capital femoral epiphysis? a. A 16-year-old girl who is short for her age b. An 11-year-old boy who is becoming obese c. An 8-year-old boy who plays baseball d. A 6-year-old girl who loves to trampoline

Answer: b. Slipped capital femoral epiphysis most frequently occurs in preadolescents who are fast growing or obese.

3. Sulfisoxazole, a sulfonamide, is a common drug prescribed for urinary tract infections. An instruction you would give parents regarding this is that the a. drug will turn the child's urine green. b. child should drink a lot of water daily. c. drug will cause increased pain the first day. d. drug will cause food to taste unusually salty.

Answer: b. Sulfonimides can cause urinary crystals if the child does not drink adequate fluid during drug administration.

13. Childhood is the time to begin prevention for skin cancer. An important way to do this is to a. urge children to eat green leafy vegetables. b. teach children to avoid episodes of sunburn. c. encourage children to take daily vitamins. d. apply skin lotion before going outside.

Answer: b. Sunburn during childhood or adolescence is associated with development of skin cancer later in life. Sunscreen, not just skin lotion, is needed.

Joey has a "shotty" or pea-size swelling in one anterior cervical-chain lymph node. This finding frequently occurs in infants from a(n) a. common reaction to teething. b. recent respiratory infection. c. aftermath of birth trauma. d. allergy to milk products.

Answer: b. Swollen lymph nodes often occur from a recent respiratory infection. Teething should not cause this.

17. If Shelton had an intestinal obstruction, a finding you would expect to observe in him would be a. a sunken abdomen from loss of bowel tone. b. vomitus of yellow or blackish-green fluid. c. sleepiness from pressure on respiratory centers. d. a cheesy "curd-like" appearance to stools.

Answer: b. The abdomen would be distended; vomitus would be meconium stained because it is from the intestine.

You assess Joey for normal ear alignment. Normally the upper aspect of the ear pinna is a. slightly lower than the level of the tip of the nose. b. on a line from the inner to outer canthus of his eyes. c. opposite a line drawn from the corner of the mouth. d. opposite the lowest crease on his forehead or eyebrows.

Answer: b. The average position for the top of the ear pinna is on a line drawn from the inner to the outer canthus of the eye.

20. Reye's syndrome is a serious neurologic disorder that results in liver failure from fatty deposits. To help prevent this, you would advise Meadow to a. restrict the amount of fat she eats daily to 30% of caloric intake. b. never take acetylsalicylic acid (aspirin) for flu-like symptoms. c. avoid "binge drinking" in college to protect her liver function. d. reduce sun exposure to protect against abdominal sunburn.

Answer: b. There is a strong association between acetylsalicylic acid and Reye's syndrome.

6. An action you would want to take with a child with thrombocytopenia is to a. encourage him to play contact sports to maintain self-esteem. b. assess all body surfaces daily for easy bruising or purpura. c. be certain the child understands this lowers his immune system. d. urge the child to eat more red meat and fruits that have pits.

Answer: b. Thrombocytopenia is a deficiency of platelets leading to easy bruising. Contact sports should be discouraged to avoid this.

20. You want to explore if David's mother is a victim of intimate partner abuse. Which statement by her is a common reason that victims do not report this type of abuse? a. "We're saving money to buy a new house." b. "I don't deserve to be treated any better." c. "We're a lower-level economic family." d. "I wish I had more time to spend by myself."

Answer: b. Victims of intimate partner abuse frequently come to believe they deserve to be abused.

3. Meadow is not only unconscious but is developing increased intracranial pressure from head trauma when you first meet her. Based on this, which changes in vital signs would you expect to observe? a. Increased temperature and increased pulse rate b. Decreased respiratory rate and increased BP c. Increased pulse rate and decreased respiratory rate d. Decreased pulse rate and decreased blood pressure

Answer: b. Vital-sign changes that accompany increased cranial pressure are decreased respiratory and pulse rate and elevated temperature and blood pressure.

10. David is diagnosed as having failure to thrive. This is based on what finding in his health history? a. His mother says he is a picky eater. b. His weight is under the 5th percentile. c. He only talks in two-word sentences. d. He has had two infections in the past year.

Answer: b. When a child's weight falls below the 5th percentile, he is diagnosed as having failure to thrive.

1. Acute lymphocyctic leukemia (ALL) is the most common cancer of childhood. ALL is a(n) a. proliferation of all blood cells from cancer. b. overproduction of white blood cells. c. adenocarcinoma of the lymphatic gland. d. destruction of white blood cells by a virus invader.

Answer: b. With ALL, white blood cells, although nonfunctional, are overproduced.

5. Suppose Shelton had been born with a meningocele. Which is an important assessment finding that would help establish this was a meningocele, not a myelomeningocele? a. He has a normal tonic neck reflex. b. He voids at normally spaced intervals. c. The baby lies on his back without pain. d. He can follow a light across the midline.

Answer: b. With myelomeningocele, bladder function is spastic so it continually empties or "dribbles" urine. No newborn can follow a light across the midline. He shouldn't be laid on his back or the exposed meninges could rupture.

11. Why is lead poisoning so serious in young children? a. It causes bones to weaken and fracture frequently. b. It causes intestinal obstruction from "lead balls." c. It results in cognitive challenge from brain invasion. d. Lead deposits in the eye globe and causes blindness.

Answer: c. "Lead encephaly" is extreme irritation and destruction of brain cells caused by lead ingestion.

9. What is the usually designated level of pulse rate considered safe for administration of digoxin for a 6-month-old infant? a. 40 beats per minute b. 60 beats per minute c. 100 beats per minute d. 150 beats per minute

Answer: c. 100 beats per minute is an adequate pulse rate to use to safety administer digoxin to an infant.

8. You assess that Missy opens her eyes to speech (score 4), has a motor response to pain (score 5), and carries on a confused conversation (score 4), or has a Glasgow Coma Scale score of 13. You would rate this as a. severe trauma. b. moderate trauma. c. slight trauma. d. no discernible trauma.

Answer: c. A Glasgow Coma Scale score of 13 to 15 indicates slight trauma.

17. What is the most serious complication of rheumatic fever for which is it important to remain alert? a. Chronic headache b. Necrosis of fingertips c. Mitral stenosis d. Asthma symptoms

Answer: c. A mitral stenosis may occur from fibrous deposits on the valve.

12. Missy has a tender abdomen from abdominal trauma. To rule out bleeding, the doctor orders a paracentesis for her. This is a. intraventous therapy to increase her blood pressure. b. insertion of an endoscopy tube into her intestine. c. introduction of a catheter into her abdomen. d. a radiograph study of liver or spleen blood flow.

Answer: c. A paracentesis is a procedure to assess for blood in the abdomen by inserting a catheter into the abdomen.

7. Mindy's mother is concerned that Mindy's bone will become infected. A long-term complication of osteomyelitis or bone infection is a. permanently "soft" or easily bent bones. b. development of osteogenesis imperfecta. c. draining abscesses from the bone to the skin. d. bones turn brown so they no longer show on x-ray examination.

Answer: c. Abscesses may cause permanent draining lesions if the original infection is not completely eradicated. Osteogenesis is an inherited disorder.

10. Suppose Cary had acute glomerulonephritis. Which of the following signs would you expect her parents to report as a typical beginning sign of this? a. Headache and a macular rash b. Diuresis and marked pallor c. Dark brown to black urine d. Loss of weight and back pain

Answer: c. Acute glomerulonephritis typically presents with blood in urine manifested as dark or black urine.

Suppose you discover a preschool child has a two-line difference in vision acuity (20/20 in right eye; 20/50 in the left), what would be your best action? a. Advise his parents that this was probably caused by a birth injury b. Assure the parents many preschoolers have this much difference c. Refer the child to an ophthalmologist as this can lead to ambylopia d. Ask the child if he has noticed any difficulty reading small print

Answer: c. Amblyopia or loss of central vision can occur if there is over a two-line deviation in vision.

1. David's mother reported that he fell and burned the back of his hand when he reached across the stove to break his fall. What would make you suspect that this is abuse and not an accident? a. The mother readily recounts the history. b. Broken bones are always found with abuse. c. The history is inconsistent with the injury. d. A gas flame isn't hot enough to burn.

Answer: c. An abuse history often is inconsistent with the extent of the injury. A child reaching to break a fall would expose his palm to the flame, not the dorsal surface of his hand.

4. What is a common laboratory finding with children with cyanotic heart disease? a. Decreased platelet count b. Elevated sedimentation rate c. Elevated total red cell count d. Elevate white blood count

Answer: c. An infant develops polycythemia (elevated total red cell count) as the infant develops an increased number of red blood cells in an attempt to oxygenate body cells better.

20. Suppose a child's appendix ruptured before he could have surgery. Which position would you encourage for him postoperatively? a. Prone b. Supine c. Semi-Fowler's d. Right side

Answer: c. As a ruptured appendix spills contaminated feces into the peritoneal cavity, keeping the child's upper body elevated helps prevent any contaminated material still present after surgery from spreading to the chest cavity.

14. When Shelton returns to the clinic to have his cast changed, you notice the top of the cast is soaked with urine. Which of the following would be your best action? a. Alert the physician the parents must have been neglectful in care. b. Assess if the child could have a urinary tract or bladder infection. c. Suggest applying waterproof tape to the new cast. d. Instruct the parents that urine and plaster form a toxic compound.

Answer: c. As infant diapers become wet from urine, casts frequently also absorb some urine. Applying waterproof tape helps waterproof the cast and reduce urine odor. Urine weakens plaster casts but otherwise does no harm.

You assess a child's hearing using a Rhinne test. To do this, you would a. hold a tuning fork against the middle of the child's forehead. b. measure the distance across the room a child can hear a tuning fork. c. hold a tuning fork in back of and then in front of the ear being tested. d. press a ringing tuning fork against the child's cheek as he is speaking.

Answer: c. Because air-conducted sound is heard better than bone-conducted sound, the child will hear the turning fork when it is held in front of the ear better than when it is held against the back of the ear.

11. Following the cleft-palate repair, a continuing health problem you would want to assess for is a. visual coordination. b. loss of sense of taste. c. middle ear infection. d. loss of sense of smell.

Answer: c. Because the eustachian tubes are positioned more horizontally following surgery, there is an increased incidence of middle ear infection (otitis media) in children following a cleft-palate repair.

1. Shelton's physician was worried at his birth that Shelton might have a tracheoesophageal fistula as well as his other anomalies. Which finding during his mother's pregnancy would have been a clue that such a defect might be present? a. His mother had increased blood pressure the last 2 months. b. The alpha-fetoprotein/sphingomyelin ratio was elevated. c. His mother developed hydramnios during the pregnancy. d. The fetal heart rate showed variable decelerations during labor.

Answer: c. Because the fetus with tracheoesophageal fistula cannot swallow amniotic fluid, the amount of fluid accumulates, causing hydramnios.

20. Billy needs postural drainage four times a day. To perform this you would a. schedule it immediately after a meal so Billy has optimal energy. b. caution Billy not to cough during the procedure to avoid lung damage. c. position Billy sitting upright and use vibration to drain his upper alveoli. d. caution Billy that he is too old to be using a slantboard; at his age it is dangerous.

Answer: c. Billy should cough to clear away secretions. Scheduling the procedure after a meal could lead to vomiting with coughing. Sitting upright best drains upper lobes.

9. Children with scoliosis may have a thoracic-lumbar-sacral orthotic brace prescribed. You would instruct them regarding this to a. wash their hair often to keep pin sites free of infection. b. pad their chin to keep the brace from rubbing against it. c. wear the brace for 23 of every 24 hours. d. loosen the brace for 1 minute every hour to reduce neck pain.

Answer: c. Braces are most effective when they are worn for the majority of every day. They do not reach the neck.

7. Missy has clear fluid drainage from her nose. If this tested positive for glucose, you would assess this as a. lymphocytes collecting in the nasal sinuses. b. her cerebral perfusion pressure is elevated. c. possibly CSF from a meningeal tear. d. blood serum collecting in her nasal sinuses.

Answer: c. Cerebral spinal fluid will test positive for glucose and can drain from the nose or ear if there is a meningeal tear.

6. Suppose Billy's pH was 7.30, his PaCO2 was 52 mm Hg, and his HCO3 was 32 mEq/L. This would lead you to believe that Billy has a a. respiratory acidosis from oxygen pooling. b. respiratory alkalosis with oxygen want. c. partially compensated respiratory acidosis. d. fully compensated metabolic acidosis.

Answer: c. Children with cystic fibrosis "pocket" carbon dioxide as thick mucus traps it in alveoli, leading to respiratory acidosis.

18. Mindy's father had a clavicle fracture as a school-aged child. You would instruct a child with this type of fracture that a. no treatment is necessary to set the bone. b. he will need a full-body cast applied. c. a simple cloth splint will restrict motion. d. no therapy is necessary except for pain relief.

Answer: c. Clavicle fractures can be held in place by a simple cloth figure-of-eight splint.

2. A cause of carpal tunnel syndrome from Meadow's health history could be a. diving from a too unstable high board. b. bench pressing weights over 5 pounds. c. use of a hand brake on her handlebars. d. jogging while holding a transistor radio.

Answer: c. Constant use of a hand brake is an example of the type of repetitive movement that can cause carpal tunnel syndrome.

7. Mark is currently receiving vincristine as a chemotherapy drug. An adverse effect you would assess him for related to this is a. excess hair growth. b. a "dull" expression. c. constipation. d. increased pruritus.

Answer: c. Constipation and paresthesia (lack of feeling in extremities) are common side effects of vincristine.

23. Which statement by Billy's cousin would assure you he understands how to use Cromolyn sodium best? a. "I should take it as soon as an asthma attack starts." b. "I can't take it if I have a fever over 101°." c. "I should take it to prevent triggering an attack." d. "I should use it for only 24 hours after an attack."

Answer: c. Cromolyn sodium prevents asthma attacks. It is not effective after an acute attack begins.

Preschool girls Cary's age are prone to urinary tract infection. Such infections are usually caused by a. streptococcus spread through the blood stream. b. pneumococcal spores spread from the spleen. c. E. coli that usually ascend from the perineum. d. pneumococci metastasized from the lungs.

Answer: c. E. coli is the most common cause of urinary tract infections in children; because of a short urethra, bacteria ascend easily from the perineum in girls.

Ashley's mother has raised older children. A good principle for determining whether children are receiving healthy nutrition is a. don't follow pyramid guidelines as they do not apply to children. b. parents should include more fat than protein in meals for better growth. c. encourage children to eat a variety of foods from each food group. d. never allow children to snack between meals or they won't eat meals.

Answer: c. Eating a variety of foods supplies foods from all food groups. The pyramid guidelines do apply to children. Growing children may need to eat between meals to obtain enough protein and calories for growth.

5. To prepare a child for electromyography, you would tell her that a. magnets will register the calcium level of her muscles. b. electric discharges from her brain will be recorded. c. needles inserted into her muscles record muscle activity. d. her heart-rate pattern will be shown on a TV-like screen.

Answer: c. Electromyography records muscle activity.

9. Jack is prescribed an IV of D5W with potassium added. Before adding the potassium, which would be the most important assessment to make? a. If his head circumference is normal b. If his dressing is dry and intact c. If he is voiding at least 1 mL per hour d. If he has bowel sounds present

Answer: c. Excessive potassium can lead to heart block so it is important to be certain that a child's kidneys are functioning before administering D5W with potassium added.

6. David's mother states he has not had any immunizations because getting him dressed to take him for appointments was too difficult. Her actions can be categorized as a. physical abuse. b. Munchausen abuse. c. child neglect. d. psychological abuse.

Answer: c. Failure to obtain routine health care such as immunizations is one type of child neglect.

To assess Joey's abdomen, what would be the best technique with which to begin? a. Palpation b. Percussion c. Inspection d. Auscultation

Answer: c. Health assessment usually begins with inspection. Auscultate the abdomen before palpating or percussing or bowel sounds will be suppressed.

18. Hemolytic-uremic syndrome is a serious, even fatal, disorder that occurs in children. Which factor below would put Cary at risk for this? a. Her father works as a brick layer. b. Her father has a history of allergies. c. Her family serves roast beef rare. d. Her mother has O-negative blood.

Answer: c. Hemolytic-uremic syndrome is associated with an E. coli infection, often contracted by eating undercooked beef.

16. Billy had a tracheostomy when he was younger. Safety precautions to take with a child with a tracheotomy are a. don't let the child use a straw to drink. b. don't allow him to sleep on his back. c. inspect toys for small breakable parts. d. encourage the child to play indoors.

Answer: c. If small parts break, they could fly into the tracheotomy opening.

. Meena was born with a ventricular septal defect. A chief concern that parents of children with heart disease often report is a. infant is gaining weight rapidly. b. the baby always seems hungry. c. she seems to have trouble sucking. d. their baby's face appears pale.

Answer: c. Infants with heart disease grow short of breath so they have difficulty sucking for sustained periods.

12. Suppose Shelton had had a cleft lip as well at birth. In planning care for an infant following cleft-lip repair, you would position him a. on his abdomen with arms at sides. b. seated upright with arms raised. c. turned to one side or the other. d. Prone with arms extended over his head.

Answer: c. Inflammation can occur following surgery putting pressure on the airway and increasing airway secretions. Positioning him on his side allows secretions to drain without putting pressure on the new lip sutures.

12. The cause of juvenile arthritis is unproven but it is suspected that the cause is a(n) a. infection of the joint periosteum. b. allergy to unidentified protein. c. inflammatory autoimmune process. d. congenital destructive syndrome.

Answer: c. Juvenile arthritis is most likely an autoimmune process.

4. You notice that Mindy limps after her fall. Your best action would be to a. ignore her; children often fake limps for attention. b. worry about it later; most limps in children represent innocent findings. c. ask what hurts; limps usually reveal serious disorders. d. suggest she buy new shoes as these often cause limps.

Answer: c. Limps in children usually reflect serious pathology.

7. Children with nephrosis are prescribed ethacrynic acid, a loop diarrheic, as therapy. Which statement by her mother would assure you that her parent understands a possible complication of this medication? a. "We're careful to administer the medication just before bedtime." b. "I understand that hypertension can easily develop and cause dizziness." c. "I know she has to take a concurrent potassium supplement daily." d. "We know that the drug can cause a hearing loss from tympanic pressure."

Answer: c. Loop diuretics cause interference with potassium re-absorption so they generally require a potassium supplement. All diuretics should be taken early in the day to prevent enuresis. Hypotension from excess fluid loss could occur.

2. Mark is receiving methotrexate for chemotherapy. When taking a health history, which question (in relation to the drug) would be most important to ask? a. Are you drinking fluids that are strongly acidic? b. Do you eat solid foods before you drink fluid at meals? c. Do you take a folic acid supplement besides the drug? d. Have you completely stopped eating desserts?

Answer: c. Methotrexate is absorbed by cancer cells because it mimics folic acid. If a child takes a folic acid supplement, less methotrexate will be incorporated into cells, making the drug less effective.

7. The Munchausen by proxy syndrome refers to a a. parent who shows little interest in children. b. child who pretends to be ill when actually well. c. parent who causes a child to have disease symptoms. d. parent who does not understand normal child development.

Answer: c. Munchausen by proxy syndrome refers to a parent who causes a child to be ill so medical therapy is needed.

When Joey reaches adolescence, you would want to teach him how to do a self-testicular exam. A precaution you would include in this would be that a. examining will cause sharp pain but is important. b. he shouldn't do this more than every 3 months. c. one testis is usually slightly lower than the other. d. if he discovers a cord-like streak, this is abnormal.

Answer: c. One testis is normally slightly lower than the other. A cord-like streak is most likely the vas deferens.

17. If a child experiences a major burn, which complication would it be important to observe for? a. Rapid breathing that indicates the child is still worried b. Shivering, which could indicate skin is becoming permeable c. Abdominal pain, which could be a sign of paralytic ilius d. Stuttering when the child speaks as if still frightened

Answer: c. Paralytic ilius is a frequent complication of severe burns, resulting from the systemic shock.

8. Because of vomiting, which electrolyte is a baby with pyloric stenosis most apt to be deficient in? a. Iron b. Phosphorus c. Potassium d. Zinc

Answer: c. Potassium is excreted in exchange for H ions to help maintain acid-base balance.

14. Suppose a child has retinoblastoma. When planning long-term care for her, which teaching point below would you plan for? a. She will never be able to wear contact lenses. b. She must never take a corticosteroid in her life. c. She should know her disease may be inherited. d. She will develop retinal degeneration as she ages.

Answer: c. Retinoblastoma may be inherited as a dominant trait.

16. Children may receive radiation for cancer therapy. In relation to this, you would want to a. keep the skin site moist with magnesium sulfate cream. b. caution children not to wear wool clothing for long periods. c. encourage children to avoid purine foods such as asparagus. d. wash off skin markings immediately after each treatment.

Answer: c. Skin markings should be left in place for further treatments; no lotion should be applied to radiation sites as these could deflect the radiation rays.

. Billy had difficulty breathing at birth. Premature newborns may have difficulty with lung function because they lack surfactant. What is the role of this in lung function? a. It propels inhaled particles up the bronchi. b. It phagocizes viral invaders that enter the alveoli. c. It prevents complete collapse of alveoli on expiration. d. It allows alveoli to expand to their full limit on inspiration.

Answer: c. Surfactant, a lipid protein produced by lung cells decreases surface tension so it prevents alveoli from completely collapsing on expiration; this makes inflating alveoli easier with the next inspiration.

5. The father asks you what the usual therapy is for pyloric stenosis. Your best answer would be a. rest for the duodenum for 24 hours and supplementation by IV fluids. b. small frequent feedings administered orally or by nasogastric tube. c. surgery to free the pyloric valve and allow better passage of milk. d. surgery to remove the lower half of the stomach, which is ulcerated.

Answer: c. Surgery corrects the disorder by enlarging the size of the pyloric value. Older methods of medical therapy are rarely used today as surgery is so successful in correcting the problem.

Ashley's mother thinks her child has an easy temperament. Temperament a. is not demonstrated until age 3. b. cannot be assessed by observation. c. describes an inborn characteristic. d. is not noticeable until school age.

Answer: c. Temperament, or the characteristic way people respond to happenings, is apparently an inborn characteristic. It is noticeable at about 3 months of age and can be assessed by observation.

8. On the third day after admittance, you notice Meadow's mouth droops on the right side and she cannot close her right eye. She is diagnosed with Bell's palsy. This is involvement of which cranial nerve? a. Olfactory b. Trigeminal c. Facial d. Vagus

Answer: c. The facial nerve is involved in Bell's palsy.

When an infant searches for a piece of breakfast cereal that dropped off his highchair, he is demonstrating a. accommodation. b. assimilation. c. permanence. d. reversibility.

Answer: c. The infant searches for the cereal because he knows it still exists even though it is out of his sight.

14. Meena had a streptococcal pharyngitis 2 weeks ago. The chief danger of such an infection is that a. cervical lymph nodes can swell and obstruct or close the airway. b. the infection frequently spreads and causes a severe tooth abscess. c. rheumatic fever, an autoimmune process, may develop afterward. d. four out of five children tend to develop lung abscesses afterward.

Answer: c. The streptococci infection causes an autoimmune reaction that is rheumatic fever.

7. You take Meadow's blood pressure and it is suddenly 280/150. Your best action in response to her symptoms should be to a. elevate her legs and remove her neck brace. b. lower her head between her legs. c. elevate her head (neck brace in place). d. administer aspirin and maybe prednisone.

Answer: c. This extremely high blood pressure most likely denotes autonomic dysreflexia, a group of symptoms that occur from some irritation such as a filling bladder. Assessing if her Foley catheter is blocked would be the best first step. Next would be elevating her head to decrease cerebral pressure.

7. Vomiting is a danger because it can lead to acid-base imbalances. The most frequent imbalance caused by vomiting is a. hypocalcemia b. hypernatremia c. alkalosis. d. acidosis.

Answer: c. Vomiting leads to alkalosis as so much hydrochloric acid is ejected.

13. Billy had bronchiolitis as an infant. This is a. another name for pneumonia. b. a type of bacterial influenza. c. inflammation of the small bronchi. d. a first response to breathing room air.

Answer: c. When alveoli are infected, it is pneumonia. When small bronchi are involved, it is bronchiolitis.

1. When Jack was seen in the emergency room a week ago, he weighed 4.5 kg. Today he weighs 4.0 kg. Would you be concerned over this amount of weight loss? a. No, it is only one-half a kilogram. b. No, it is under 20% of his weight. c. Yes, it is 12% of his weight. d. Yes, but he is drinking so it is ok.

Answer: c. When an infant has a weight loss over 10%, it reflects a serious loss of fluid.

8. Billy has blood-tinged sputum. This occurs with pneumonia because a. his nose must be bleeding from coughing. b. his inflamed tonsils are irritated and bleeding. c. red blood cells have invaded his alveoli. d. lymphocytes have turned WBCs rust colored.

Answer: c. With pneumonia, red blood cells enter the alveoli and are coughed up with sputum.

10. Shelton is scheduled to have his cleft palate repaired at 2 years of age. Following surgery, you would want to encourage a high oral fluid intake. The best method of accomplishing this would be to a. teach him to use a straw so drinking is fun. b. let him feed himself small sips from a spoon. c. offer him a small glass of fluid at a time. d. encourage him to drink from a bottle and nipple.

Answer: c. You want to avoid any sharp object that could disrupt the fresh suture line on the roof of his mouth. Sucking causes unneeded stress on the suture line.

A Goodenough-Harris test is an easy one to administer with children. This is administered by a. asking a child to identify or name body parts. b. seeing if the child can repeat words after you. c. observing if a child can color between lines. d. asking a child to draw a picture of a person.

Answer: d. A Goodenough-Harris test is a simple test of I.Q. that requires a child to draw a picture of a person. The number of body parts drawn is compared to a standard scoring scale.

A child with an easy-to-care-for temperament would have which characteristic? a. High activity level; strong withdrawal b. Low persistence level; irregular rhythmicity c. Nonadaptable; positive mood quality d. Long attention span; high level of persistence

Answer: d. A child who can work at tasks for long periods is easier to care for than one with a high activity level, irregular rhythmicity, or is nonadaptable.

Children under 2 years of age generally have their head circumference measured as a routine part of health assessment. This measurement is made from a. the center of the child's forehead to the base of the occiput. b. the middle of the forehead through the parietal prominences. c. just above the level of the eyes and then just above the ears. d. above the eyebrows through the prominent part of the occiput.

Answer: d. A head circumference measuring tape should pass across the middle of the forehead and the most prominent point of the rear of the head.

15. If Meadow were having an absence seizure, your best action would be to a. ask her to hold her breath for a count of ten. b. attempt to distract her by calling her name. c. tell her to talk to keep her attention focused. d. observe her carefully but initiate no action.

Answer: d. Absence seizures are only 5 to 10 seconds long; no immediate therapy is necessary.

To assess if Joey's liver is enlarged, which technique would you use? a. Percuss the entire abdomen for a hollow sound b. Palpate the space under his heart for tenseness c. Listen to his abdomen for increased bowel sounds d. Palpate the abdomen below the right rib cage

Answer: d. An enlarged liver will be palpable below the right rib cage.

9. What is a finding usually present with Munchausen by proxy syndrome? a. The child is usually female and older than 5 years of age. b. Although the child is bleeding, he doesn't seem to have pain. c. The child never cries even though you know he is in pain. d. The child's symptoms occur when the parent is present.

Answer: d. As symptoms are caused by the parent, they are most apt to be present when the parent is present.

9. When planning care for Mark, which action would be most important/? a. Collect a urine sample daily for glucose released by destroyed cells. b. Keep his head elevated to prevent brain metastasis. c. Palpate his spleen daily to detect if necrosis is developing. d. Handle him gently because he is apt to have leg pain.

Answer: d. As white blood cells proliferate in bone marrow, they can cause pain in long bones.

10. If an infant were born with coarctation of the aorta, this produces few symptoms at first. An important finding to assess to best suggest this exists is a. excessive sleeping and crying. b. presence of a cardiac murmur. c. elevated body temperature. d. lack of both femoral pulses.

Answer: d. Because blood flow is so limited below the narrowed aorta, femoral pulses are very weak or cannot be palpated.

3. Which of the symptoms from Jack's health history is most representative of pyloric stenosis? a. Refusal to eat or drink anything b. Vomiting 2 hours after feeding c. Chronic diarrhea for 2 or more days d. Vomiting immediately after feeding

Answer: d. Because food cannot pass through the pyloric valve, it is vomited immediately after feeding.

9. Which factor from Meadow's history makes her susceptible to developing Bell's palsy? a. She bicycles for exercise. b. She takes an oral contraceptive. c. Her parents are divorced. d. She has had herpes infections.

Answer: d. Bell's palsy tends to follow herpes 1 infections.

7. Which nursing diagnosis would best apply to an infant with Tetralogy of Fallot? a. Impaired gas exchange related to a left to right septal shunt b. Impaired skin integrity related to consistent cyanosis c. Ineffective airway clearance related to a constricted aorta d. Altered tissue perfusion related to pulmonary artery stenosis

Answer: d. Blood is oxygenated appropriately in the lungs, but then tissue perfusion is in threat because blood cannot pass readily to the lungs because of the pulmonary stenosis.

15. While Missy is hospitalized, one of her sisters is badly burned. When a burn is so deep that it involves the blood vessels, which degree of burn is this? a. Null degree b. First degree c. Second degree d. Third degree

Answer: d. Burns that include the full thickness of skin including blood vessels and nerves are third degree.

5. Billy's family is planning a vacation. Which location for this would you suggest? a. Jamaica, because the beaches are so warm and sunny b. A Los Angeles beach because they are always crowded with people c. Alaska, because the cold air will be invigorating d. Ohio with its moderately warm climate

Answer: d. Children with cystic fibrosis need to be careful not to expose themselves to hot sun because they lose excess perspiration in sweat; they also need to avoid contacting upper respiratory infections from cold.

3. Cigarette burns resemble the scabs of impetigo, a streptococci infection. What is one way to differentiate between these two? a. Impetigo lesions always occur on the face. b. Cigarette burns turn green before they fade. c. Impetigo lesions occur only in summer. d. Cigarette burns heal with a circular scar.

Answer: d. Cigarette burns heal with an obvious scar where impetigo lesions do not.

20. If children do not have bladder function following a spinal cord anomaly, they are taught self-catheterization. What is the best technique to teach for this? a. The child must be certain to use sterile technique every time. b. Catheterization must be done every 2 hours around the clock. c. Children should flush catheters with alcohol after use. d. The technique can help children feel independent.

Answer: d. Clean, not sterile technique is used, catheters are rinsed with water; it is not done during the night to allow the child to sleep.

The best activity to encourage achievement of the school-aged developmental task for a child would be a. a scrapbook that will take 3 weeks to complete. b. a puppet show that will take 2 weeks to plan. c. watching her favorite program on television. d. building a model car that will take one afternoon.

Answer: d. Completing tasks allows a child to experience a sense of industry. Because of short attention spans, short, easily visible projects are best.

5. The best place to assess if cyanosis is present in children is in the a. conjunctiva of the lower eyelid. b. fingertips or toes for color. c. circumoral area by the mouth. d. tongue or buccal membrane.

Answer: d. Cyanosis may be most apparent in the mucous membrane of the mouth or lips.

4. What is a risk factor Billy has for cystic fibrosis? a. He rides a school bus every day. b. He lives in the United States. c. His family is allergy prone. d. He has an uncle with the disease.

Answer: d. Cystic fibrosis is an autosomal recessively inherited disease.

According to Erikson's theory of development, a developmental stage is a. a period that has a well-defined time limit. b. a label for expected physiologic growth changes. c. another way of describing routes to maturity. d. a time during which a critical task must be achieved.

Answer: d. Developmental stages each contain a specific task that a child must achieve to complete that stage. Time periods are variable.

17. The most frequent type of muscular dystrophy a. rarely develops until early or middle adulthood. b. affects mainly the upper extremities. c. occurs following an infection such as measles. d. is inherited as a sex-linked recessive trait.

Answer: d. Duchenne's or fascio-hypertrophic muscular dystrophy occurs as a sex-linked recessive trait.

5. Suppose Cary has extensive edema because of nephrotic syndrome. The best implementation to reduce her periorbital edema would be to a. apply cool, sterile soaks to her head. b. encourage her to eat low-protein foods. c. apply warm compresses to her eyes at bedtime. d. elevate the head of her bed while she sleeps.

Answer: d. Edema tends to be dependent so it is most evident in lower body parts. Keeping her head elevated will discourage periorbital edema.

1. Mindy is scheduled to have a fiberglass cast applied to her arm. An instruction you would give her regarding this is that a. casts take up to 24 hours to dry. b. she should ask her friends to autograph it. c. fiberglass casts can melt in the hot sun. d. confining broken bones helps them heal.

Answer: d. Fiberglass casts dry within 30 minutes; they shouldn't be autographed. They don't melt in the sun.

12. Newborns are occasionally born with hypospadias. Which doctor's order would you question when this occurs? a. Instruct the mother on breastfeeding by discharge. b. Teach the mother how to change diapers by tomorrow. c. Observe to see if the newborn voids by 24 hours. d. Prepare the infant for circumcision at 4 o'clock.

Answer: d. Hypospadias is placement of the urinary meatus along the shaft of the penis. Circumcision is contraindicated as the prepuce skin may be needed for the plastic repair to correct the hypospadias.

15. Which statement by a parent would cause you to believe a child is developing a complication of continuous cycling peritoneal dialysis? a. "Her abdomen distends following the inflow solution." b. "The return fluid has never been bloody or cloudy." c. "She feels abdominal pressure before I drain the return." d. "The return fluid is always less than the inflow amount."

Answer: d. If fluid and waste products are moving via osmosis across the peritoneum, the outflow fluid should be greater in amount than the inflow fluid.

18. While infusing an intravenous solution of a chemotherapy agent to Mark, you spill some on the floor. Your best action would be to a. wipe it up immediately before it eats through the floor tile. b. leave it on the floor for a cleaning person to take care of. c. report the spill to the FDA and ask for instructions. d. wipe up the solution using gloves to protect your hands.

Answer: d. It is wise to use hand protection such as latex gloves when handling chemotherapy agents.

13. Suppose Meena had been born with transposition of the great vessels so she was prescribed ibuprofen. The purpose of this medication is to a. increase blood pressure to reverse blood flow. b. increase the strength of atrial contractions. c. decrease and strengthen the heart rate. d. keep the ductus arteriosus from closing.

Answer: d. Keeping the ductus arteriosus patent allows for oxygenated and unoxygenated blood to mix and improve overall oxygenation.

4. Shelton was discovered at birth to have an omphalocele. An emergency measure you would have wanted to take with him in the birthing room would have been to a. place him under a radiant heart warmer to keep him warm. b. turn him on his abdomen to allow fluid to drain from his mouth. c. assess his chest to see if you hear bowel sounds in his upper chest. d. apply sterile saline gauze to the visible intestine to keep it moist.

Answer: d. Keeping the exposed peritoneal sac from drying keeps it from cracking and rupturing, allowing intestine to spill from the abdominal cavity. Lying him on his abdomen could rupture the sac. There would be no bowel sounds in his chest.

2. While waiting for a transport ambulance to take the infant with tracheoesophageal fistula to a major center, how would you position him? a. Prone with head lowered b. Supine with the bed flat c. On the right side d. In an infant seat

Answer: d. Keeping the infant positioned upright is important to prevent hydrochloric acid from the stomach entering the lungs through a fistula and causing pneumonia.

3. Mark is prescribed leucovorin (folic acid rescue) after methotrexate therapy. The purpose of this drug is to a. prevent hyperthermia from developing afterward. b. prevent the sharp headache associated with methotrexate. c. reduce the nausea and vomiting that usually occur. d. reduce the methotrexate entry into normal cells.

Answer: d. Leucovorin prevents methotrexate that was not utilized by fast-growing cancer cells from being incorporated into normal cells.

5. Missy is prescribed a solution of Mannitol IV in the emergency room. The purpose of this drug is to a. decrease blood pressure. b. increase blood glucose. c. diminish pain sensation. d. reduce intracranial pressure.

Answer: d. Mannitol is hypertonic so it causes fluid to shift from edematous tissue back into the vascular system.

6. Meadow is administered methylprednisone in the emergency room. This acts to a. stimulate new calcium deposits in vertebrae. b. prevent infection in the affected body part. c. reduce sodium accumulation and water intoxication. d. reduce inflammation to take pressure off nerves.

Answer: d. Methylprednisone, a corticosteroid, reduces inflammation so it may improve the outcome of a spinal cord injury.

9. Billy had no breath sounds in his right lower lobe. The reason this has occurred is that a. his wheezing was so loud, it blocked out other sounds. b. his chest wall is too thick at that point to hear through. c. he must have been holding his breath to that one lobe. d. the lobe is filled with so much exudate that air can't enter.

Answer: d. No breath sounds indicate no air is entering that portion of the lung; with pneumonia, air is blocked from entering by collected fluid.

6. Immediately following birth, important care you would plan for a newborn with a meningocele would be to a. wrap him snugly to keep him pleasantly warm. b. submerge him in a basin of warm iodized water. c. dry the exposed meninges to prevent infection. d. position him prone with head turned to the side.

Answer: d. Positioning the infant on his abdomen protects the meningeal sac from pressure and rupture. Drying meninges or wrapping him snugly could cause meninges to crack and rupture, releasing cerebral spinal fluid. Applying warm, but not sterile, water could introduce spinal cord infection.

19. Which measure would have been most effective to aide bronchodilation with croup? a. Urge Billy to continue to take oral fluids. b. Administer an oral corticosteroid. c. Teach Billy to take long slow breaths. d. Assist with racemic epinephrine by nebulizer.

Answer: d. Racemic epinephrine by nebulizer is the drug of choice for bronchodilation for children with laryngotracheobronchitis.

15. Suppose a child has radiation implants for retinoblastoma. Which would be the most important instruction to give her parents? a. Don't offer any red meat until the full course of therapy is over. b. Don't allow the child to wear sunglasses while implants are in place. c. Restrict fluid the child drinks to under one or two glasses per day. d. Don't cuddle the child against them until the implants are removed.

Answer: d. Radiation implants transmit radiation; holding the child close could expose the parents to a low level of this.

7. Following surgery for a meningocele, the most common complication you would observe for would be a. pain with each urination. b. irregular or absent heart rate. c. poor or lessened skin turgor. d. increased head circumference.

Answer: d. Removing the exposed meningeal sac increases CSF pressure and can cause hydrocephalus.

14. The most frequent organism that causes bronchiolitis in infants is a. streptococcus A. b. chlamydia. c. pneumococcus bacteria. d. respiratory syncytial virus.

Answer: d. Respiratory syncytial virus is a major organism that causes bronchiolitis in infants.

11. When cancer arises from skeletal muscle, it is termed a(n) a. fibrosarcoma. b. adenocarcinoma. c. carcinoma. d. rhabdomyosarcoma.

Answer: d. Rhabdomyosarcomas are cancers arising from skeletal muscle; they occur almost exclusively in children rather than adults.

15. Which of the following is the best nursing diagnosis for Shelton? a. Fear related to potential new surgery planned b. Altered airway regulation related to meningocele c. Potential for injury related to parent's home care d. Altered parenting related to child with anomalies

Answer: d. Shelton's mother states she is having difficulty accepting everything she is being asked to accept.

2. Tetralogy of Fallot is the most frequently occurring type of cyanotic heart disease. The four anomalies associated with this defect are a. atrial septal defect, pulmonary stenosis, left ventricular hypertrophy, and overriding aorta. b. ventricular septal defect, aortic stenosis, mitral stenosis, and right-sided aorta. c. mitral stenosis, right ventricular hypertrophy, pulmonary stenosis, and atrial septal defect. d. ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and overriding aorta.

Answer: d. Shunting of blood caused by the pulmonary stenosis through the septal defect leads to right ventricular hypertrophy.

14. Meadow had a tonic-clonic seizure immediately after her injury. Your best action for this type of seizure would be to a. place a hard object between her teeth to protect her tongue. b. restrain her from any movement by holding her down. c. turn her onto her back and administer immediate CPR. d. protect her from hitting her arms against any hard surface.

Answer: d. The best action for a child having a seizure would be to protect her from hurting herself. Putting something in her mouth could break a tooth. Laying her on her back could lead to aspiration.

4. Mark always becomes extremely nauseated with chemotherapy. Nausea occurs because a. chemotherapy agents turn on the vomiting center. b. tumor cells invade intestinal cells and cause nausea. c. it is a psychologic reaction to cells being destroyed. d. Stomach-lining cells are fast-growing so they are destroyed.

Answer: d. The cells lining the stomach are some of the fastest growing in the body because they are constantly being destroyed by hydrochloric acid. Nausea occurs because they incorporate chemotherapy drugs rapidly and are killed.

Psychological abuse

As with other forms of abuse, this type of abuse can have long-lasting psychological effects on the child. Psychological abuse occurs when parents belittle, threaten, reject, isolate, or exploit the child. This type of abuse may not be as obvious as physical abuse. The nurse must carefully observe the parent/child interaction as well as assess the parent/caregivers responses to questions about the child.

esophageal atresia with a tracheoesophageal fistula (incomplete formation of the esophageal lumen, causing an upper esophagus blind pouch, which doesnt connect to any other structure.

Choking and emesis with first feeding, fluids returned through mouth and nose. Excessive salivation and drooling, blowing bubbles. Cyanosis and respiratory distress. coughing. Polyhydramnios, sit upright. NG tube w/suction to clear secretions from blind pouch. NPO until esophagus is repaired. assess for respiratory distress after surgery, humidified oxygen. Keep laryngoscope and endotracheal tube at bedside.

How is DDH treated

DDH is treated by keeping the hip in abduction by way of an abduction device. For infants less than 3 months, the most common type of treatment is the use of a Pavlik harness, which is an adjustable chest halter that abducts the legs. (see page 753). Soft plastic stirrups hold the hips flexed, abducted, and externally rotated. DDH can also be treated with multiple diapers, Frejka splint, or a spica cast .If the child is older traction can be use to bring the head of the femur into the acetabulum

The parents question you about what they can expect regarding long term consequences of DDH. How should you respond?

Early detection and treatment enable the majority of children with DDH at attain normal hip function.

The birth of a child with a cleft lip and/or palate can be devastating to new parents. Describe how you would approach these parents, and outline a teaching plan for this family.

Encourage parents to hold and cuddle their infant. Focus on the entire baby not just the defect. Discuss the surgical options, show parents before & after pictures. Anticipate feedings difficulties. Attempt different feeding methods for example breast feeding, bottle feeding, Breck feeder, Haberman feeder, or plastic medicine cup.

nursing interventions for FTT

Ensure adequate nutrition/monitor I and O, assess stools for PH and glucose to be sure child is absorbing nutrients Effective nurturing from primary nurse Support and encourage parents to visit Help prevent poor parenting

You are the nurse in the emergency department. The mother of a 2-year-old with epiglottitis tells you that she has to cal her husband to come to the hospital. She saw a telephone down the hall and she informs you that she will be right back. What are your concerns? How will you respond?

Epiglottitis is a medical emergency. Laryngospasm, increased edema, and complete airway obstruction can occur rapidly if there is any manipulation or irritation of the mouth or throat. Airway obstruction can also occur as a result of anxiety or crying. For these reasons, a child with epiglottitis is kept calm and as quiet as possible. Parental presence reassures the child and decreases distress. The mother of this child should be encouraged to remain with her child and you an offer to telephone the husband. If there is a portable phone available, it can be brought to her.

S/S of Rheumatic fever

Fever, sore joints, elevated sed rate and ASO, c reactive protein, erythema( on trunk) , chorea, and carditis

Assessment for child abuse

Interview: Think "Does the injury seem consistent with the story provided by the caregivers." (i.e. It would be highly unlikely that a 6-month-old would injure themselves by pulling a pan of boiling water off of the stove.) Physical exam: Presence of wounds, abrasions that are well-defined - like those from a cigarette burn, belt, wrist restraint, human bites. Spiral fractures are frequently associated with child abuse. A thorough physical assessment as well as interviewing the parents/caregivers and child (depending on age) is essential to determine if child abuse/neglect has occurred. The nurse's priority is always the safety of the child. Child abuse can be prevented by early detection of potential abusers (see the risk factors on previous slide) and beginning interventions to teaching parents coping skills, normal growth and development, etc.

Physical examination of child with failure to thrive

Lethargy with poor muscle tone, loss of subcutaneous fat, or skin break down Lack of resistance of the examiners manipulation, unlike average infant Rocking on all fours excessively, as if seeking stimulation Greater reluctance to reach for toys or initiate human contact Diminished or nonexistent crying Staring hungrily at people who approach them, starved for human contact Little cuddling or conforming to being held Delays in sitting pull to stand, crawling, and walking due to spending so much time alone Delay or absent speech due to lack of interaction

post op after cleft lip/palate

NPO 4 hours, then introduced to plain water in small amounts. No tension on lip suture line. feed with haberman feeder. After palate, only liquids for 3-4 days, then soft diet. After feeding, offer sip of water to rinse suture line. Parent teaching includes avoid tension on suture line, no crying, specialized feedings, do not place infant on their stomach, use elbow restraints as necessary, pain medication as necessary, signs and symptoms of infection, how to clean suture line, and who to contact if there are any problems. Elevated position.

Cerebral palsy

Non-Progressive motor and posture dysfunction that occurs secondary to anoxic damage

Infants (birth - 1 year of age): Trust Vs. Mistrust

Nursing responses would include: Encouraging the parent to "room-in" with the child. Encourage the parent to bring in a familiar object (toy, blanket, etc.) Primary nursing if at all possible. Do not allow the child to cry for prolonged periods of time. Hold the baby often. Meet the baby's needs for food and hygiene

Advanced failure to thrive

Nutritional status so poor the child is near acidosis from starvation If upper resp infection develops, this could result in death from pneumonia

discharge plan for an infant who has under gone repair of a cleft lip

Parent teaching includes avoid tension on suture line, no crying, specialized feedings, do not place infant on their stomach, use elbow restraints as necessary, pain medication as necessary, signs and symptoms of infection, how to clean suture line, and who to contact if there are any problems

At risk issues for child abuse

Parents who were abused as children Parents who do not understand normal growth and development (i.e., a parent who would be upset with a 2 year old who did not make their bed in the morning. The parent has unrealistic expectations for the child's behavior given the child's age.) Parents who are socially isolated; have little or no support system Parents who abuse alcohol or drugs Children who were the result of an unplanned pregnancy. Children who are born premature. Children who are born with a birth anomaly and/or have special needs. Male infants have been found to be at higher risk for child abuse/shaken baby syndrome. Stepchildren Infants who have colic or episodes of inconsolable crying. Parents under stress.

Sibling visitation helps a hospitalized child continue to feel a part of his or her family. What considerations for safety do you have to think about when siblings are visiting a child?

Siblings should be free from communicable disease when visiting. The nurse can encourage the siblings to wash their hands when entering the child's hospital room. The nurse should also inspect the hospital room for any potential hazards for young visitors

Assessment in failure to thrive

Take detailed pregnancy history (unintended pregnancy, partner who left during pregnancy, economic catastrophe, no support system) Weigh the child and plot growth curves

What teaching needs to be completed with the parents of this newborn with DDH prior to discharge?

Teaching that should be completed with the parents of an infant who will be wearing a Pavlik harness includes proper application, the need for a sponge bath, and assessing the skin under the straps, daily for irritation or redness. A t-shirt and knee socks should be placed under the straps and changed without taking the harness off. The harness is worn 23 hours a day, and the hips and buttocks should be supported carefully when not in the harness. The nurse should also discuss the necessary modification of the car seat and strollers, and modification of positioning for nursing and eating. Parents need to ensure the child has adequate stimulation with toys and activities at appropriate eye level and should encourage activities that stimulate upper extremities.

A newborn is found to have developmental dysplasia of the hip prior to being discharged from the hospital. What assessment findings would you expect to find in this newborn?

The assessment findings in a newborn with developmental dysplasia of the hip (DDH) include a positive Ortolani or Barlow's sign. The nurse will also find limited abduction of the hips, asymmetry of the thigh folds, gluteal folds, and unequal knee and leg lengths. A wide perineum will be found in the infant with bilateral disease.

What content should the nurse emphasize in preoperative teaching directed towards the child undergoing surgery?

The child, if age and developmental level permit, should be taught similar to the parents, developmentally appropriate content to encourage cooperative behavior. Special attention should be given to explaining the sight, sounds, smells, touches, and tastes that the child will experience in the operating room and when the child wakes up from anesthesia. A tour of the day surgery area, including operating room and PACU should be provided.

Priority in failure to thrive

The nurses priority in FTT is always the physical well-being and safety of the infant. Further interventions can then be instituted based on the case of the FTT.

A 6-year-old child has cystic fibrosis (CF) and is hospitalized for an acute respiratory infection. The playroom has scheduled a puppet show and the child's mother asks you if he can get his antibiotics later so he won't miss the show what facts will you consider as you try to respond?

The treatment of pulmonary infection in children with (CF) is a priority. Pathogens are unusually difficult to clear and the risk of chronic colonization with resistant organisms increases if antibiotic therapy is not aggressive. Although life expectancy for children with CF has increased, pulmonary infections continue to pose the greatest threat to survival. In this situation, the socialization needs of a child with a chronic illness are also important. The nurse could consider having the child attend the puppet show while his antibiotics are being administered by an infusion pump. If there is sufficient time, perhaps the medication could be completed before the show. The nurse could also determine the length of the show and give the antibiotics after the show.

What specific measures could you take to promote developmental growth and encourage a sense of autonomy in a hospitalized 2-year-old?

To encourage autonomy, allow toddlers to participate in their care and make decisions to the extent possible.

How would you help to promote a sense of industry in a hospitalized 10-year-old?

To encourage industry, allow children opportunities to complete projects so they can feel success in what they can accomplish.

Common signs of shaken baby syndrome

Whiplash injury to the neck, edema to the brainstem, subdural hemorrhage, distinctive hemorrhages to the retina

Wilms tumor (nephroblastoma)

a malignant tumor that rises from the metanephric mesoderm cells of the upperpole of the kidney

long term side effects of radiation

assymetric growth of bones, easy fracturing, scoliosis, kyphosis, thyroid and pituitary gland dysfunction (growth problems) demyelination and necrosis of white matter in brain, pneumonitis, pulmonary fibrosis

ALL signs and symptoms

bone marrow over produces lymphocytes, first sign is decreased RBC signs, anemia, pallor, low grade fever, lethargy. Low thrombocyte (platelet) count leads to petechia and bleeding from oral mucus membranes, easy bruising on arms and legs. Spleen and liver enlarge, causing anorexia, vomiting, and abdominal pain. Bone and joint pain. CNS invasion leads to headache and unsteady gait.

Radiation therapy

changes DNA component of a cell nucleus so cell cannot replicate, therefor inhibits further cell division and growth. Therapy is scheduled over 1-6 weeks to include time intervals when cells will be susceptible to change

anterior fontanelle

closes 12-18 months

ALL goals

complete cure based on chemo agents. chemo program first aimed at complete remission or absence of leukemia cells, second is preventing leukemia cells from invading CNS, third administering delayed and intense therapy, fourth maintaining original remission.

chemotherapy

do not give aspirin, give tylenol or ibuprofen. Check with physician before giving vitamins. folic acid interferes with methotrexate. keep child away from infectious people. Zoster immune globulin can be given if child hasnt had varicella and is exposed to chicken pox. give soft diet and avoid acidic food with mucositis. Avoid rectal temperatures. petroleum jelly on lips.

Nursing care for the child receiving radiation therapy might include:

do not remove marks expose irradiated area to air but not heat or sunlight avoid long baths, use mild soaps/shampoo/avoid lotions soft toothbrush/keep mouth moist administer antiemetics provide high calorie/easy to swallow meals reduce fresh fruit and vegetables rich in cellulose no apple juice/contributes to diarrhea provide adequate rest/mild activity prepare child for effects-hair loss help play mind games monitor I and O/IV fluids sterile technique with port maintain skin integrity/prevent breakdown promote adequate nutrition maintain adequate hydration monitor leukocyte and platelet counts

Management of Rheumatic fever

low dose atb, penicillin 4 or 5 years, Nsaids, bed rest, steroids, digoxin, diuretics for CHF

side effects of chemo drugs

malnutrition, nausea, vomiting, hair loss (alopecia), mucositis, constipation, diarrhea, cushiod effects, and susceptibility to infection. can give zofran and atarax before chemo and at 4-8 hour intervals during chemo. side effects of zofran are dizziness, headache, pruitis, myalgia, and pain at injection site.

microcephaly

may have cognitive deficits

assessment of a brain tumor

morning headache, vision changes, vomiting, no nausea, enlarged head circumference, papilledema (swelling of optic nerve). Lethargy, projectile vomiting, and coma are late signs. tilted head, diplopia, ptosis.

physical exam of ALL

painless swelling of lymph nodes, elevated leukocytes. Platelet, RBC, and hematocrit will be low. Bone marrow aspiration at iliac crest to identify type of WBC (25% blast cells present, leukemia is diagnosed)

indomethacin

prostoglandin inhibitor, can cause reduced glomerular filtration, impaired platelet aggregation, and diminished GI and cerebral blood flow

therapeutic management of wilms

removal of tumor by nephrectomy, , important to remove tumor while it still encapsulated. followed by radiation (unless stage 1) and chemo. Chemo may be up to 15 months

decreased WBC (neutropenia) during chemo

temporary seclusion from other children, hand hygiene, free of plants/flowers, soft tooth brush, petroleum jelly to lips to avoid cracks, high calorie and high protein foods, limit fresh fruit/vegetables, no live vaccines.

assessment of wilms tumor

usually discovered early, tumor is felt as firm nontendor mass, parents report it occurs overnight. hematuria and low grade fever, anemic from blood loss erythropoetin formation. CT reveals primary, glomeration filtration rate BUN is done before surgery. Tumors metastasize rapidly. DO NOT PALPATE ABDOMEN

S/S of Kawasaki syndrome

vasculitis, high fever that does not respond well to antipyretics, reddened hands and feet, strawberry tongue, red cracked lips, swollen lymphnodes

Lauren, age 17, is admitted to your unit with infectious mononucleosis. Lauren is complaining of tiredness but her parents are encouraging her to be more active to regain her strength. What are some factors that contributed to Lauren being a susceptible host for infection?

• Adolescents and young adults are most commonly infected. • Sometimes referred to as "kissing disease"; spread by direct and indirect contact.

Adolescent (12-18 years of age): Identity vs. role confusion

• Adolescents are attempting to develop their own self-identity and separate themselves from their parents. • Nursing responses would include: When taking a health history, ask the adolescent questions instead of directing all questions to the parent. Peer interaction is very important at this age. Encourage interaction with peers if possible. This may be via the phone or computer is the teen is unable to have visitors. Respect the adolescent's privacy. Offer support and praise for decision-making.

4. The fetus of a woman who acquires rubella during the first trimester of pregnancy is at high risk for developing anomalies. List the most common fetal complications.

• Cardiac defects • Ophthalmologic disturbances (blindness, cataracts) • Mental and physical retardation • Deafness • Neurologic complications.

Measles is most common in the college age population. What symptoms would you assess for if a roommate of yours developed a rash?

• Check for lymph node enlargement • Koplik's spots are classic clinical sign

What would be your response to Lauren's parents regarding their approach to Lauren's treatment of mono?

• Child needs to be on bedrest for 7-10 days because of splenomegaly and the risk for spleen rupture.

What factors should be included in the nutritional plan of care with mono?

• Small frequent meals may be better tolerated. • Good fluid intake important.

Preschool (3-5 years of age): Initiative vs. Guilt

• The preschool child is learning how to do things. They take pride in their ability to initiate activities on their own. The preschooler's favorite word tends to be "Why?" They are developing more curiosity about the world around them and how things work. • Nursing responses would include: Allow the child to handle medical equipment such as a stethoscope or blood pressure cuff to lessen anxiety. Provide the child with brief, simple explanations. Be careful in the words that you use with a preschool child. I.e. A common phrase in the hospital setting is "I need to draw Patient A's blood." As adults, we now that "drawing blood" will be an invasive procedure. But the preschool child will assume you are literally going to "draw" blood - using a red crayon and a piece of paper!

Toddlers (1-3 years of age): Autonomy vs. Shame and Doubt

• The toddler is learning to be independent. Toddlers tend to be negative, with one of their favorite words being "NO". A close second to "NO" is "MINE". • Nursing responses would include: Offer the toddler simple choices. I.e., "Do you want to put on the red or blue shirt today?" Make sure that a choice exists. Do not ask a toddler "Do you want to take your medicine now?" because you can probably guess what the answer will be! Instead you could ask the child "Would you like a sip of juice or water after your medicine?" Toddlers also tend to be very ritualistic. In the hospital it would be important to question the parents about the child's normal routine at home, and to then try to incorporate as much of that routine as possible into the child's hospital stay. I.e., Does the child have a book read to them before nap time or bedtime?

A child's first impression of a hospital is gained on admission. What are steps to take to make admission atraumatic?

Greet the child at eye-level. Use a calm, comforting voice when speaking with the child. Introduce the child to staff members. Provide the child with a tour of the pediatric floor, including the play room. Encourage the parents to bring in a few favorite objects from home (i.e.,doll, blanket, etc.)

12. Billy has never had a pneumococcal vaccine. You would advise him that a. he doesn't need it now as he is recovering from pneumonia. b. the vaccine is contraindicated for children with cystic fibrosis. c. at 16, he is too old to be a candidate for the vaccine. d. he should receive this as soon as he recovers from his illness

. Answer: d. Billy should have the pneumococcal vaccine to help reduce the possibility that he will acquire another episode of pneumonia.

Emla cream

45 minutes to 1 hour for effectiveness, does require physician order

What physical assessments of the child getting a tonsillectomy are indicated?

A complete physical assessment is indicated for the child undergoing surgery. The nurse should make certain the child shows no current symptoms of illness. A child of this age should have the oral cavity checked for any loose teeth.

The developmental task of the preschool period is a. sense of initiate versus guilt. b. sense of trust or ability to love. c. sense of accomplishment. d. accommodation or permanence. .

Answer: a. Learning a sense of initiative is learning how to do things and is the task of the preschool child

20. To promote the oral comfort of a child receiving chemotherapy, you a. apply a local anesthetic to painful mouth lesions. b. encourage the use of fruit juices for vitamin C. c. keep the child's lips well coated with Vaseline. d. rigorously brush the child's teeth frequently.

Answer: a. Local anesthetic preparations can help relieve the pain of lesions; fruit juices are acidic and could cause pain.

If children demonstrate the ability to approach in relation to temperament, this means they a. have a long, sustained attention span. b. welcome new situations readily. c. are reluctant to meet new people. d. constantly criticize others actions.

Answer: b. Ability to approach means to meet or welcome new experiences.

10. Billy has rales in his upper left lobe. Rales indicate a. an innocent collection of normal fluid. b. fluid is present in his lung alveoli. c. he must have a postnasal discharge. d. his respiratory rate is abnormally rapid.

Answer: b. The sound of rales (crackles) is made by air passing through fluid in alveoli.

20. Which finding in Mindy's health history would cause you to believe she might be at risk for poor bone healing? a. She has been unhappy since her parents' divorce. b. She had trouble learning to read in 1st grade. c. Her mother tells you Mindy rarely drinks milk. d. Mindy takes an analgesic for juvenile arthritis.

Answer: c. Calcium is a major component of bones so an adequate amount of dietary calcium is necessary for bone healing.

22. Billy's cousin takes Cromolyn sodium (Intal) for his asthma. The purpose of this is to a. prevent serious infections. b. keep secretions moist. c. produce bronchial dilation. d. inhibit release of histamine.

Answer: d. Cromolyn sodium is a mast cell stabilizer that prevents release of histamine.

2. A prevention measure for young girls against urinary tract infections is to a. void infrequently to prevent ureter reflux. b. drink tap (chlorinated) rather than bottled water. c. eat a source of folic acid and calcium every day. d. not soak in a bathtub that has bubble bath.

Answer: d. The use of bubble bath is associated with urinary tract infections in preschool girls, probably because of irritation to the urethra.

10. Jack has a past history of necrotizing enterocolitis. This is a. a volvulus of the intestine that leads to death of tissue. b. a congenital short bowel syndrome that limits digestion. c. the lack of pancreatic enzymes so fat cannot be digested. d. necrotic patches of the intestine that interfere with absorption.

Answer: d. With NEC, portions of the bowel become necrotic, decreasing the surface for absorption and possibly leading to bowel perforation.

What are symptoms of esophageal atresia?

Choking and emesis with first feeding, fluids returned through mouth and nose. Excessive salivation and drooling, blowing bubbles. Cyanosis and respiratory distress.

How will you respond when the child's parents tell you they plan to restrict him from physical education at school in order to prevent another attack?

Exercise is recommended for children with asthma to enhance self-esteem and encourage endurance. Physical education activities that do not require prolonged endurance are usually not a problem for children with asthma. Exercise induced bronchospasm can be prevented by prophylactic treatment with inhaled cromolyn sodium (Intal) before strenuous exertion.

Failure to thrive

Failure to thrive (FTT) occurs when a child's weight falls below the 5th percentile on standard growth charts. In some cases, this can be attributed to an underlying medical/health issue (i.e. The child was born with a congenital heart anomaly, etc.). This would be referred to as organic FTT. If the child's lack of appropriate weight gain/growth cannot be attributed to physical/health issue - it would be termed inorganic FTT. The cause in this case might be related to a lack of knowledge in parenting skills. For example, the parent is mixing the powdered formula incorrectly and the formula contains less calories that needed. Or the parent does not know to wake a newborn after 4 hours to feed them. The inorganic FTT could also be related to a poor parent/child bond.

What laboratory tests can the nurse anticipate will need to be completed prior to tonsillectomy surgery?

One of the most important tests is evaluation of bleeding and clotting function. A CBC which includes platelet may be ordered. Prothrombin time (PT) and partial thromboplastin time (PTT) are commonly ordered lab tests. The child's blood chemistry may also be analyzed prior to anesthesia and the tonsillectomy.

What is the overall goal of asthma education discharge teaching?

The overall goal of asthma education is to prevent asthmatic episodes, improve respiratory capacity, and facilitate optimal psychologic and social development of the child and the family.

Physical neglect

This is also a form of child abuse. Children who are not provided with basic necessities (food, clothing, etc.) As the book mentions, this could also occur when a parent fails to provide adequate medical care for a child or does not require the child to attend school.

post op care of brain tumor

keep bed flat or slightly elevated, neuro checks

PDA

should close by few days, aprostoglandin inhibitor indomethicin is given will hear a murmur, shunts through ductus into pulmonary artery

pre op care for brain tumor

stool softener, decadron to reduce cranial edema, head shaved.

Describe in which situations you would NOT administer a scheduled immunization?

• Children who are seriously ill (The common cold is NOT a contraindication) • Children who are immunocompromised; receiving steroids; receiving chemo should not receive live virus vaccines • Previous reaction to a vaccine may require vaccine to be held.

3. Describe the contraindications and nursing considerations for measles, mumps, and rubella (MMR) vaccines.

• Contraindications to MMR: Allergy to neomycin and eggs; immunosuppresion; administration of immune serum globulin in the past 90 days; pregnancy • Nursing considerations: Determine whether child is allergic to neomycin or eggs or immunosuppressed; if so, do not give MMR. Instruct adolescents of childbearing age to avoid pregnancy for 3 months after immunization.

Pediculosis capitis is a common infection among school age children. What measures should children take to prevent the spread of this in the classroom?

• Do not share hats, combs, ponytail holders, helmets, etc. • Avoid having children's coats hanging next to each other. Lice may move from on coat to the next if coats are hanging on the same hook and touching.

2. What information must be recorded when an immunization is given?

• Lot number • Site of administration • Route of administration • Any severe reaction must be reported to the state health department.

School-Age ( 6-12 years of age): Industry vs. inferiority

• School-age children are striving to be able to be successful at completing tasks. The child develops a sense of self-worth from involvement in activities. • Nursing responses would include: Encourage the child to complete school-work while in the hospital. Encourage the child to bring favorite activities to the hospital (i.e. Gameboy, crossword puzzles, etc.) Provide the child with short projects to complete.

A 6-year-old child has experienced recurrent tonsillitis for the past year. He is scheduled for a tonsillectomy later in the day. The nurse assessing the child to obtain a database and is providing preoperative teaching and a tour of the recovery room and day surgery area to the child and the parents. What health history data is important to elicit from the family?

A complete health history should be taken, because the child will likely be undergoing general anesthesia. Information about the child's primary problem should be obtained as well as any concurrent illnesses. Information about current medications should be included. The history of the illness that preceded the need for surgery should be detailed. Past medical history, including allergies to medications, food and environment should be elicited. The child's birth history and past medical and health history should be documented. A review of body systems should be completed. The nurse should inquire about familial and hereditary diseases and any difficulties with anesthesia (such as malignant hyperthermia) should be recorded. The health status of family members, including parents, siblings, and extended family should be explored during the health history interview.

15. Billy had a tonsillectomy when he was 6. The best fluid to offer following a tonsillectomy would be a. water. b. a cola drink. c. orange juice. d. red gelatin.

Answer: a. Carbonated or acidic fluids sting; red fluids could be mistaken for blood if they are vomited.

4. Which finding in David's health history would make you suspect he might have been beaten by an electric cord? a. He has circular lesions on his legs. b. You notice small petechiae on his back. c. He states that he hates electricity. d. He won't talk about his accident.

Answer: a. Cords leave distinctive circular lesions from the curve of the cord.

15. Children with myasthenia gravis are prescribed an anticholinesterase drug. The antidote for this type of drug is a. Allopurinal. b. Atropine. c. a calcium channel blocker. d. a dopamine inhibitor.

Answer: b. Atropine counteracts the effect of anticholinesterase drugs.

9. Suppose a child was born with a meconium plug. A disease this often occurs with is a. diabetes mellitus. b. cystic fibrosis. c. liver carcinoma. d. hyperthyroidism.

Answer: b. Cystic fibrosis.

1. Missy is developing increased intracranial pressure from her head injury. A sign of this from her health history is a. temperature of 98.6°F. b. blood pressure of 135/70. c. apical pulse of 100. d. anxiety and crying.

Answer: b. Increased blood pressure is a sign of increased intracranial pressure. 135/70 is elevated for a 14-year-old.

19. An important measure to help prevent infection in a child with neutropenia from chemotherapy would be to a. not allow the child to listen to earphones. b. wash your hands well before giving care. c. keep the room warm to keep his skin dry. d. urge the child not to sleep on his stomach.

Answer: b. Placing the child in a private room helps prevent the child from contracting illnesses from other children.