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Which can occur in untreated developmental dysplasia of the hip (DDH)? Select all that apply. 1. Duck gait. 2. Pain. 3. Osteoarthritis in adulthood. 4. Osteoporosis in adulthood. 5. Increased flexibility of the hip joint in adulthood.

1, 2, 3. Due to abnormal hip joint function, the client's gait is stiff and waddling. Due to abnormal femoral head placement, the client may experience pain and decreased flexibility in adulthood. Due to abnormal femoral head placement, the client may experience osteoarthritis in the hip joint in adulthood.

Which are the most serious complications for a child with Kawasaki disease (KD)? Select all that apply. 1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. 4. Hypocoagulability. 5. Decreased sedimentation rate. 6. Hypoplastic left heart syndrome.

1, 2, 3 Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation.

Which of the following activities should a nurse suggest for a client diagnosed with hemophilia? Select all that apply. 1. Swimming. 2. Golf. 3. Hiking. 4. Fishing. 5. Soccer.

1, 2, 3, 4. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as swimming. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as golf. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as hiking. . Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as fi shing.

The parents of a 3-year-old are concerned that the child is having "more accidents" during the day. Which questions would be appropriate for the nurse to ask to obtain more information? Select all that apply. 1. "Has there been a stressful event in the child ' s life, such as the birth of a sibling?" 2. "Has anyone else in the family had problems with accidents?" 3. "Does your child seem to be drinking more than usual?" 4. "Is your child more fussy, and does your child seem to be in pain when urinating?" 5. "Is your child having difficulties at preschool?"

1, 2, 3, 4. Stressors such as the birth of a sibling can lead to incontinence in a child who previously had bladder control. A pattern of enuresis can often be seen in families. Increased thirst and incontinence can be associated with diabetes Fussiness and incontinence can be associated with UTIs

The nurse is caring for a child with leukemia. The nurse should be aware that children being treated for leukemia may experience which of the following complications? Select all that apply. 1. Anemia. 2. Infection. 3. Bleeding tendencies. 4. Bone deformities. 5. Polycythemia.

1, 2, 3. Anemia is caused by decreased production of red blood cells. Infection risk in leukemia is secondary to the neutropenia. Bleeding tendencies are from decreased platelet production

The nurse tells the parent that other conditions can be associated with congenital clubfoot. Select all that apply. 1. Myelomeningocele. 2. Cerebral palsy. 3. Diastrophic dwarfism. 4. Breech position in utero. 5. Prematurity. 6. Fetal alcohol spectrum disorder

1, 2, 3. There is an association between myelomeningocele and congenital clubfoot. There is an association between some forms of cerebral palsy and congenital clubfoot. There is an association between diastrophic dwarfism and congenital clubfoot

What should the parent of a child with diabetes insipidus (DI) be taught about administering desmopressin acetate nasal spray? Select all that apply. 1. The use of the flexible nasal tube. 2. Nasal congestion causes this route to be ineffective. 3. The medication should be administered every 48 hours. 4. The medication should be administered every 8 to 12 hours. 5. Overmedication results in signs of SIADH. 6. Nasal sprays do not always work as well as injections

1, 2, 4, 5. Administering desmopressin acetate per nasal spray is a means of providing the necessary medication in a steady state, if it is given using the flexible nasal tube every 8 to 12 hours. This decreases nasal irritation. If the child becomes ill with rhinorrhea, the nasal spray will need to be administered via the buccal mucosa or rectum or the medication changed to tablets. Administering desmopressin acetate per nasal spray is a means of providing the necessary medication in a steady state, if it is given using the flexible nasal tube every 8 to 12 hours. Side effects of the desmopressin acetate are those of SIADH.

Which should the nurse include in the teaching plan for a child who had surgery to correct bilateral clubfeet and had the casts removed? Select all that apply. 1. "Your child will need to wear a brace on the feet 23 hours a day for 12 months." 2. "Your child should see an orthopedic surgeon regularly until the age of 18 years." 3. "Your child will not be able to participate in sports that require a lot of running." 4. "Your child may have a recurrence of clubfoot in a year or more." 5. "Most children treated for clubfeet develop feet that appear and function normally." 6. "Most children treated for clubfeet require surgery at puberty."

1, 2, 4, 5. After the final casting, bracing is required for 12 months. This decreases the likelihood of a recurrence. Because clubfoot can recur, it is important to have regular follow-up with the orthopedic surgeon until age 18 years. Even with proper bracing, there may be a recurrence. Most children treated for clubfeet develop normally appearing and functioning feet.

A 13-year-old just returned from surgery for scoliosis. Which nursing intervention is appropriate in the first 24 hours? Select all that apply. 1. Assess for pain. 2. Logroll to change positions. 3. Get the teen to the bathroom 12 to 24 hours after surgery. 4. Check neurological status. 5. Monitor blood pressure.

1, 2, 4, 5. General postoperative nursing interventions include assessing for pain. Specific to scoliosis surgery, logrolling is the means of changing positions. It is essential to check neurological status in a patient who just had scoliosis surgery. General postoperative nursing interventions include assessing vital signs.

Which of the following can be a manifestation of leukemia in a child? Select all that apply. 1. Leg pain. 2. Fever. 3. Excessive weight gain. 4. Bruising. 5. Enlarged lymph nodes.

1, 2, 4, 5. The proliferation of cells in the bone marrow can cause leg pain. Fever is a result of the neutropenia. A decrease in platelets causes the bruising. The lymph nodes are enlarged by the infiltration of leukemic cells

Tetralogy of Fallot (TOF) involves which defects? Select all that apply. 1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 3. Left ventricular hypertrophy. 4. Pulmonic stenosis (PS). 5. Pulmonic atresia. 6. Overriding aorta. 7. Patent ductus arteriosus (PDA).

1, 2, 4, 6 TOF is a congenital defect with a ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta

The mother of a child with Duchenne muscular dystrophy asks the nurse who in the family should have genetic screening. Who should the nurse say must be tested? Select all that apply. 1. Mother. 2. Sister. 3. Brother. 4. Aunts and all female cousins. 5. Uncles and all male cousins.

1, 2, 4. Genetic counseling is important in all inherited diseases. Duchenne muscular dystrophy is inherited as an X-linked recessive trait, meaning the defect is on the X chromosome. Women carry the disease, and males are affected. All female relatives should be tested. The X chromosome carries the disease, and males are affected. The sister should have genetic testing to determine whether she carries the gene and identify her risks for having male offspring with the disease. The X chromosome carries the disease and males are affected. All female relatives should be tested.

The nurse is assessing a child diagnosed with a brain tumor. Which of the following signs and symptoms should the nurse expect the child to demonstrate? Select all that apply. 1. Head tilt. 2. Vomiting. 3. Polydipsia. 4. Lethargy. 5. Increased appetite. 6. Increased pulse

1, 2, 4. Head tilt, vomiting, and lethargy are classic signs assessed in a child with a brain tumor. Clinical manifestations are the result of location and size of the tumor. Polydipsia is rare with a brain tumor. It is more often a sign of diabetes insipidus following a closed head injury. Increased appetite occurs during a growth spurt and is not necessarily a sign of a brain tumor. Increased pulse is a nonspecific sign and can occur with many illnesses, cardiac anomalies, fever, or exercise

Which of the following applies to the care of a child with a retroperitoneal rhabdomyosarcoma? Select all that apply. 1. Acute pain. 2. Risk for impaired urinary elimination. 3. Impaired gas exchange. 4. Self-care deficit. 5. Risk for constipation.

1, 2, 5. Pain occurs because of pressure on the organs in the lower abdomen. A retroperitoneal tumor affects the organs of the lower abdomen, including the bowel and bladder. Because this tumor is in the lower abdomen, it puts pressure on the bowel, causing constipation.

One nursing diagnosis for juvenile idiopathic arthritis (JIA) is impaired physical mobility. Select all that apply. 1. Give pain medication prior to ambulation. 2. Assist with range-of-motion activities. 3. Encourage the child to eat a high-fat diet. 4. Provide oxygen as necessary. 5. Use nonpharmacological methods, such as heat.

1, 2, 5. Providing pain medication prior to ambulation helps decrease pain during ambulation. Children with JIA need to do range of-motion exercises to prevent joint stiffness. Using nonpharmacological methods such as heat helps with flexibility and pain

A nurse is assessing an 8-year-old with diabetes who is experiencing hyperglycemia. Which symptom (s) indicate (s) that the hyperglycemia requires immediate intervention? Select all that apply. 1. Weakness. 2. Thirst. 3. Shakiness. 4. Hunger. 5. Headache. 6. Irritability. 7. Dizziness.

1, 2, 7. Weakness, thirst, and dizziness are symptoms related to dehydration caused by excretion of large amounts of glucose and water in the urine. The nurse should notify the physician. Shakiness, hunger, headache, and irritability are related to hypoglycemia and result from the brain and other cells being starved for nutrients.

Which of the following factors need(s) to be included in a teaching plan for a child with sickle cell disease? Select all that apply. 1. The child needs to be taken to a physician when sick. 2. The parent should make sure the child sleeps in an air-conditioned room. 3. Emotional stress should be avoided. 4. It is important to keep the child well hydrated. 5. It is important to make sure the child gets adequate nutrition.

1, 3, 4, 5. Seek medical attention for illness to prevent the child from going into a crisis Stress can cause a depressed immune system, making the child more susceptible to infection and crisis. Parents and children are advised to avoid stress. The child needs good hydration and nutrition to maintain good health. The child needs good hydration and nutrition to maintain good health.

Which would the nurse expect a child with spastic CP to demonstrate? Select all that apply. 1. Increased deep tendon reflexes. 2. Decreased muscle tone. 3. Scoliosis. 4. Contractures. 5. Scissoring. 6. Good control of posture. 7. Good fine motor skills.

1, 3, 4, 5. Children with spastic CP have increased deep tendon reflexes. Children with spastic CP have scoliosis. When children with spastic CP have quadriplegia, they can also develop contractures of the Achilles tendons, knees, and adductor muscles. Children with spastic CP have scissoring when walking.

A nurse is caring for a 15-year-old who has just been diagnosed with non-Hodgkin lymphoma. Which of the following should the nurse include in teaching the parents about this lymphoma? Select all that apply. 1. The malignancy originates in the lymphoid system. 2. The presence of Reed-Sternberg cells in the biopsy is considered diagnostic. 3. Mediastinal involvement is typical. 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation.

1, 3, 4, 5. Non-Hodgkin disease originates in the lymphoid system. Mediastinal involvement is typical. The disease is diffuse rather than nodular. Treatment includes chemotherapy and radiation

Which instruction should the nurse give the parents of an adolescent with slipped capital femoral epiphysis (SCFE)? Select all that apply. 1. Continue upper body exercises to limit loss of muscle strength. 2. Do not turn the teen in bed when complaining of pain. 3. Provide homework, computer games, and other activities to decrease boredom. 4. Do most activities of daily living for the teen. 5. Expect expressions of anger and hostility. 6. Continue setting limits on behavior.

1, 3, 5, 6 Immobilization can lead to a decrease in muscle strength. Upper body exercises should be continued soon after surgery. It is important for this client to continue as many normal activities as possible. This should include schoolwork and leisure activities. Some expressions of anger and hostility are normal, because this adolescent is losing some independence with this immobility. Continuation of setting limits on behavior is important to keep as much normality as possible.

Which factor is associated with slipped capital femoral epiphysis (SCFE)? Select all that apply. 1. Obesity. 2. Female gender. 3. Family history of SCFE. 4. Age of 5 to 9 years. 5. Pubertal hormonal changes. 6. Endocrine disorders.

1, 3, 5, 6. Obesity increases the risk of SCFE by stressing the epiphyseal plate. Risk factors include a family history of SCFE. SCFE is most common during pubertal hormonal changes. SCFE is associated with endocrine disorders such as hyperthyroidism

Prior to surgery, a nurse is positioning a neonate with a myelomeningocele. The nurse should position the neonate in which of the following ways? Select all that apply. 1. Place the neonate in a prone position. 2. Keep a diaper over the sac. 3. Allow the neonate's feet to hang over the mattress edge. 4. Use a foam pad to maintain hip adduction. 5. Use a soft pad over the mattress.

1, 3, 5. Prior to surgery, the neonate with a myelomeningocele should be placed in a prone position. The feet can hang over the edge of the mattress to prevent foot deformities. The neonate should rest on a soft surface to reduce pressure on the skin; the nurse can use a fleece pad or foam over the mattress. The meningeal sac should not be covered. The hips should be maintained in abduction using a diaper roll or small pillow

After the birth of an infant with clubfoot, the nursery nurse should do which of the following when instructing the parents? Select all that apply. 1. Speak in simple language about the defect. 2. Avoid the parents unless providing direct care so that they can grieve privately. 3. Keep the infant ' s feet covered at all times. 4. Present the infant as precious; emphasize the well-formed parts of the body. 5. Tell the parent that defects could be much worse. 6. Be prepared to answer questions multiple times

1, 4, 6. The parents will likely be shocked immediately after the birth of the child. To facilitate their understanding, the nurse should speak in simple terms. The baby should be shown to the parents as are all newborns, emphasizing the well-formed parts of the body. Information may need to be repeated as the family begins to absorb the information.

The parents of a preschooler diagnosed with muscular dystrophy are asking questions about the course of their child ' s disease. Which should the nurse tell them? Select all that apply. 1. "Muscular dystrophies usually result in progressive weakness." 2. "The weakness that your child is having will probably not increase." 3. "Your child will be able to function normally and not need any special accommodations." 4. "The extent of weakness depends on doing daily physical therapy." 5. "Your child may have pain in his legs with muscle weakness."

1, 5. Muscular dystrophies are progressive degenerative disorders. The most common is Duchenne muscular dystrophy, which is an X-linked recessive disorder The child may have pain due to loss of strength and muscle wasting

The nurse and parents are planning for the discharge of a child with leukemia who is receiving dactinomycin (actinomycin D) and vincristine (Oncovin). The nurse should teach the parents to: 1. Encourage increased fluid intake. 2. Keep the child out of the sun. 3. Monitor the child's heart rate. 4. Observe the child for drowsiness.

1. Dactinomycin and vincristine both cause nausea and vomiting. Oral fluids are encouraged, and antiemetics are given to prevent dehydration. Avoiding sun exposure is not necessary because photosensitivity is not associated with these drugs. Heart rate changes and drowsiness also are not associated with either of these two drugs

The nurse is caring for a child due for surgery on a Wilms tumor. The child's procedure will consist of which of the following? 1. Only the affected kidney will be removed. 2. Both the affected kidney and the other kidney will be removed in case of recurrence. 3. The mass will be removed from the affected kidney. 4. The mass will be removed from the affected kidney, and a biopsy of the tissue of the unaffected kidney will be done.

1. The treatment of a Wilms tumor involves removal of the affected kidney.

Which is the definition of "talipes varus"? 1. An inversion or bending inward of the foot. 2. An eversion or bending outward of the foot. 3. A high arch of the foot. 4. A turning in of the forefoot.

1. "Talipes varus" is an inversion of the entire foot.

Which gross motor skills should the nurse assess in a 3-month-old with spina bifida? 1. Head control. 2. Pincer grasp. 3. Sitting alone. 4. Rolling over.

1. A 3-month-old should have good head control

The school nurse is talking to a 14-year-old about managing type 1 diabetes mellitus. Which statement indicates the student's understanding of the disease? 1. "It really does not matter what type of carbohydrate I eat as long as I take the right amount of insulin." 2. "I should probably have a snack right after gym class." 3. "I need to cut back on my carbohydrate intake and increase my lean protein intake." 4. "Losing weight will probably help me decrease my need for insulin."

1. A carbohydrate is a carbohydrate, and insulin dosing is based on blood sugar level and carbohydrates to be eaten.

The parents of a child with occasional generalized seizures want to send the child to summer camp. The parents contact the nurse for advice on planning for the camping experience. Which of the following activities should the nurse and family decide the child should avoid? 1. Rock climbing. 2. Hiking. 3. Swimming. 4. Tennis.

1. A child who has generalized seizures should not participate in activities that are potentially hazardous. Even if accompanied by a responsible adult, the child could be seriously injured if a seizure were to occur during rock climbing. Someone also should accompany the child during activities in the water. At summer camp, hiking and swimming would occur most commonly as group activities, so someone should be with the child. Tennis would be considered an appropriate, nonhazardous activity for a child with generalized seizures.

A 2-month-old infant is brought to the emergency department after experiencing a seizure. The infant appears lethargic with very irregular respirations and periods of apnea. The parents report the baby is no longer interested in feeding and, before the seizure, rolled off the couch. What additional testing should the nurse immediately prepare for? 1. Computed tomography (CT) scan of the head and dilation of the eyes. 2. Computed tomography (CT) scan of the head and electroencephalogram (EEG). 3. X-rays of the head. 4. X-rays of all long bones.

1. A computed tomography (CT) scan of the head will reveal trauma. Dilating the eyes is performed to check for retinal hemorrhages that are seen in an infant who has experienced shaken baby syndrome (SBS)

The nurse is caring for a child with a skull fracture who is unconscious and has severely increased intracranial pressure (ICP). The nurse notes the child ' s temperature to be 104°F (40°C). Which should the nurse do first? 1. Place a cooling blanket on the child. 2. Administer acetaminophen (Tylenol) via nasogastric tube. 3. Administer acetaminophen (Tylenol) rectally. 4. Place ice packs in the child ' s axillary areas.

1. A cooling blanket will help cool the child quickly and at a controlled temperature.

Which of the following confirms a diagnosis of Hodgkin disease in a 15-year-old? 1. Reed-Sternberg cells in the lymph nodes. 2. Blast cells in the blood. 3. Lymphocytes in the bone marrow. 4. VMA in the urine.

1. A lymph node biopsy is done to confirm a histological diagnosis and staging of Hodgkin disease. The presence of ReedSternberg cells is characteristic of the disease.

Which statement by the mother of a child with Wilms' tumor tells the nurse that the mother understands what stage II tumor means? 1. "The tumor has extended beyond the kidney but was completely removed." 2. "Although the tumor was in the kidney, it has spread to the lung, liver, and bone." 3. "The tumor has extended outside the kidney to the lungs and the liver." 4. "The tumor was solely located in the kidney but it was totally removed."

1. A stage II tumor is one that extends beyond the kidney but is completely resected. The tumor staging is verified during surgery to maximize treatment protocols. The following criteria for staging are commonly used: stage I, tumor is limited to the kidney and completely resected; stage II, tumor extends beyond the kidney but is completely resected; stage III, residual nonhematogenous tumor is confined to the abdomen; stage IV, hematogenous metastasis occurs, with deposits beyond stage III (lung, bone and brain, liver); stage V, bilateral renal involvement is present at diagnosis

When explaining the plan of care to the parents of an infant with an undescended testis, the nurse should tell the parents about which of the following as a nonsurgical treatment method? 1. A trial of human chorionic gonadotrophic hormone. 2. A trial of adrenocorticotropic hormone. 3. Frequent stimulation of the cremasteric reflex. 4. Use of several warm baths each day

1. A trial of human chorionic gonadotrophin may be given to stimulate descent of the affected testis. A trial of adrenocorticotropic hormone will not cause the testis to descend. The cremasteric reflex results in the testis being drawn up, the opposite of the intended effect. Application of warmth, such as warm baths, although soothing and relaxing for the infant, would have little or no effect on stimulating the testis to descend.

A child with a seizure disorder has been having episodes during which she drops her pencil and simply appears to be daydreaming. This is most likely a/an: 1. Absence seizure. 2. Akinetic seizure. 3. Non-epileptic seizure. 4. Simple spasm seizure.

1. Absence seizures occur frequently and last less than 30 seconds. The child experiences a brief loss of consciousness during which she may have a change in activity. These children rarely fall, but they may drop an object. The condition is often confused with daydreaming

A child diagnosed with leukemia is receiving allopurinol (Zyloprim) as part of the treatment plan. The parents ask why their child is receiving this medication. What information about the medication should the nurse provide? 1. Helps reduce the uric acid level caused by cell destruction. 2. Helps make the chemotherapy more effective. 3. Helps reduce the nausea and vomiting associated with chemotherapy. 4. Helps decrease pain in the bone marrow.

1. Allopurinol (Zyloprim) reduces serum uric acid. When there is lysis of cells from chemotherapy, there will be an increase in serum uric acid.

Exposure to which illness should be a cause to discontinue therapy and substitute dipyridamole (Persantine) in a child receiving aspirin therapy for Kawasaki disease (KD)? 1. Chickenpox or influenza. 2. E. coli or Staphylococcus . 3. Candida or Streptococcus A. 4. Streptococcus A or staphylococcus

1. Both chickenpox and influenza are viral in nature, so consider stopping the aspirin because of the danger of Reye syndrome

A preschooler has been having periods during which he suddenly falls and appears to be weak for a short time after the event. The preschool teacher asks what she should do. Select the nurse ' s best response. 1. "Have the parents follow up with his health-care provider because this is likely an atonic seizure." 2. "Find out if there have been any new stressors in his life because it could be attention-seeking behavior." 3. "Have the parents follow up with his health-care provider because this is likely an absence seizure." 4. "The preschool years are a time of rapid growth, and many children appear clumsy. It would be best to watch him and see if it continues."

1. An atonic seizure is characterized by a loss of muscular tone, whereby the child may fall to the ground.

A 13-month-old is discharged following repair of his epispadias. Which statement made by the parents indicates they understand the discharge teaching? 1. "If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage." 2. "If a mucous plug forms in the urinary drainage tube, we will allow it to pass on its own because this is a sign of healing." 3. "We will make sure the dressing is loosely applied to increase the toddler's comfort." 4. "If we notice any yellow drainage, we will know that everything is healing well."

1. Any mucous plugs should be removed by irrigation to prevent blockage of the urinary drainage system.

The parents of an infant with myelomeningocele ask the nurse about their child's future mental ability. What is the nurse's best response? 1. "About one-third are mentally retarded, but it's too early to tell about your child." 2. "About two-thirds are significantly retarded, and you'll know soon if this will occur." 3. "Your child will probably be of normal intelligence since he demonstrates signs of it now." 4. "You'll need to talk with the doctor about that, but you can ask later."

1. Approximately one-third of infants diagnosed with myelomeningocele are mentally retarded, but the degree of retardation is variable and it is difficult to predict intellectual functioning in neonates. The parents are asking for an answer now and should not be told to talk with the physician later

A nasogastric tube is ordered to be inserted for a child with severe head trauma. Diagnostic testing reveals that the child has a basilar skull fracture. What should the nurse do next? 1. Ask for the order to be changed to oral gastric tube. 2. Attempt to place the tube into the duodenum. 3. Test the gastric aspirate for blood. 4. Use extra lubrication when inserting the nasogastric tube.

1. Because a basilar skull fracture can involve the frontal and ethmoid bones, inserting a nasogastric tube carries the risk of introducing the tube into the cranial cavity through the fracture. An oral gastric tube is preferred for a client with a basilar skull fracture. The tube would not be placed into the duodenum. Gastric aspirate is not routinely tested for blood unless there is an indication to suggest bleeding, such as a falling hemoglobin or visible blood in the drainage.

Which is the nurse's best response to the parents of a neonate with a meningocele who ask what can they expect? 1. "After initial surgery to close the defect, most children experience no neurological dysfunction." 2. "Surgery to close the sac will be postponed until the infant has grown and has enough skin to form a graft." 3. "After the initial surgery to close the defect, the child will likely have motor and sensory deficits." 4. "After the initial surgery to close the defect, the child will likely have future problems with urinary and bowel continence."

1. Because a meningocele does not contain any nerve endings, most children experience no neurological problems after surgical correction.

Because of the risks associated with administration of factor VIII concentrate, the nurse should teach the child's family to recognize and report which of the following? 1. Yellowing of the skin. 2. Constipation. 3. Abdominal distention. 4. Puffiness around the eyes.

1. Because factor VIII concentrate is derived from large pools of human plasma, the risk of hepatitis is always present. Clinical manifestations of hepatitis include yellowing of the skin, mucous membranes, and sclera. Use of factor VIII concentrate is not associated with constipation, abdominal distention, or puffiness around the eyes.

The nurse is caring for a 6-month-old infant diagnosed with meningitis. When the child is placed in the supine position and flexes his neck, the nurse notes he flexes his knees and hips. This is referred to as: 1. Brudzinski sign. 2. Cushing triad. 3. Kernig sign. 4. Nuchal rigidity.

1. Brudzinski sign occurs when the child responds to a flexed neck with an involuntary flexion of the hips and/or knees.

As part of the preoperative teaching for the family of a child undergoing a tetralogy of Fallot repair, the nurse tells the family upon returning to the pediatric floor that the child may: 1. Be placed on a reduced sodium diet. 2. Have an activity restriction for several days. 3. Be assigned to an isolation room. 4. Have visits limited to a select few.

1. Because of the hemodynamic changes that occur with open heart surgery repair, particularly with septal defects, transient congestive heart failure may develop. Therefore, the child's sodium intake typically is restricted to 2 to 3 g/day. Activity restrictions are inappropriate. Typically the child is encouraged to walk the halls and unit. Risk for infection after the repair is the same as any postoperative client, therefore isolation is not necessary. The child may be placed in a room with other children who are not contagious. Visitors are not restricted unless the pediatric unit has restrictive visiting policies.

A 17-year-old female with severe nodular acne is considering treatment with isotretinoin (Accutane). Prior to beginning the medication, the nurse explains that the client will be required to: 1. Enroll in a risk management plan. 2. Have proof of a mental health evaluation. 3. Begin an effective form of birth control. 4. Temporarily give up sports.

1. Because of the risk of birth defects with isotretinoin, the FDA has created a web-based risk management plan known as iPLEDGE. The program requires that all clients meet qualification criteria and monthly program requirements to obtain the medication. Currently, only providers enrolled in the iPLEDGE program can prescribe this medication and only clients who enroll in iPLEDGE can receive the drug. Providers are advised to closely monitor clients for signs of depression, but a mental health evaluation is not universally required. Women of child bearing age must use two forms of effective birth control for two months before, during, and 1 month after taking the drug. Isotretinoin may cause muscle aches and extreme exercise should be avoided, but general participation in sports should be considered on an individual basis

While assessing a 3-year-old child who has had an injury to the leg, has pain, and refuses to walk, the nurse notes that the child's left thigh is swollen. What should the nurse do next? 1. Assess the neurologic status of the toes. 2. Determine the circulatory status of the upper thigh. 3. Obtain the child's vital signs. 4. Notify the physician immediately

1. Because the nurse suspects a possible fracture based on the child's presentation, assessing the neurologic and circulatory status of the toes, the tissues distal to the fracture, is important. Soft tissue contusions, which accompany femur fractures, can result in severe hemorrhage into the tissue and subsequent circulatory and neurologic impairment. Once this information has been obtained, vital signs can be assessed and the nurse can notify the physician and report the findings. In fractures, circulation impairment will occur distal to the injury.

The nurse is caring for a child with a diagnosis of ALL who is receiving chemotherapy. The nurse notes that the child ' s platelet count is 20,000/mm 3 . Based on this laboratory finding, what information should the nurse provide to the child and parents? 1. A soft toothbrush should be used for mouth care. 2. Isolation precautions should be started immediately. 3. The child's vital signs, including blood pressure, should be monitored every 4 hours. 4. All visitors should be discouraged from coming to see the family.

1. Because the platelet count is decreased, there is a significant risk of bleeding, especially in soft tissue. The use of the soft toothbrush should help prevent bleeding of the gums

Which nursing diagnosis is most important for a child with Ewing sarcoma who will be undergoing chemotherapy? 1. Risk for fluid volume deficit. 2. Potential for chronic pain. 3. Risk for skin impairment. 4. Ineffective airway clearance.

1. Chemotherapy can cause nausea, vomiting, and possibly diarrhea, which contribute to fluid volume defi cit.

After a child undergoes nephrectomy for a Wilms' tumor, the nurse should assess the child postoperatively for which early sign of a complication? 1. Increased abdominal distention. 2. Elevated blood pressure. 3. Increased respiratory rate. 4. Increased urine output.

1. Children who have undergone abdominal surgery are at risk for intestinal obstruction from a dynamic ileus. Indications of intestinal obstruction include abdominal distention, decreased or absent bowel sounds, and vomiting. Later signs of intestinal obstruction include tachycardia, fever, hypotension, increased respirations, shock, and decreased urinary output.

A child has had open heart surgery to repair a tetralogy of Fallot with a patch. The nurse should instruct the parents to: 1. Notify all health care providers before invasive procedures for the next 6 months. 2. Maintain adequate hydration of at least 10 glasses of water a day. 3. Provide for frequent rest periods and naps during the first 4 weeks. 4. Restrict the ingestion of bananas and citrus fruit.

1. Children who have undergone open heart surgery with a patch are at risk for infection, especially subacute bacterial endocarditis (SBE), for the fi rst 6 months following surgery. The newest evidence-based guidelines suggest once the patch has epithelialized, these precautions are no longer necessary. Therefore, parents are instructed about SBE precautions including the need to notify providers before invasive procedures so antibiotics can be prescribed for that time period. Having the child drink a very large amount of water may lead to fl uid overload. Children gear their rest schedule to their activities making it unnecessary to schedule frequent rest periods. Bananas and citrus fruit are high in potassium, but there is no evidence provided that the child has an elevated serum potassium requiring restriction.

Which of the following is correct regarding prognostic factors for determining survival for a child newly diagnosed with ALL? 1. The initial white blood cell count on diagnosis. 2. The race of the child. 3. The amount of time needed to initiate treatment. 4. Children aged 12 to 15 years.

1. Children with a normal or low white blood cell count who do not have non-T, non-B acute lymphoblastic leukemia and who are CALLA-positive have a much better prognosis than those with high cell counts or other cell types

The nurse is caring for an unconscious 6-year-old who has had a severe closed-head injury and notes the following changes: Heart rate has dropped from 120 to 55, blood pressure has increased from 110/44 to 195/62, and respirations are becoming more irregular. Which should the nurse do first after calling the physician? 1. Call for additional help and prepare to administer mannitol (Osmitrol). 2. Continue to monitor the patient's vital signs and prepare to administer a bolus of isotonic fluids. 3. Call for additional help and prepare to administer an antihypertensive. 4. Continue to monitor the patient and administer supplemental oxygen.

1. Cushing triad is characterized by a decrease in heart rate, an increase in blood pressure, and changes in respirations. The triad is associated with severely increased ICP. Mannitol is an osmotic diuretic that helps decrease the increased ICP.

Which sign should lead the nurse to suspect that a child with meningitis has developed disseminated intravascular coagulation? 1. Hemorrhagic skin rash. 2. Edema. 3. Cyanosis. 4. Dyspnea on exertion

1. Disseminated intravascular coagulation is characterized by skin petechiae and a purpuric skin rash caused by spontaneous bleeding into the tissues. An abnormal coagulation phenomenon causes the condition. Heparin therapy is often used to interrupt the clotting process. Edema would suggest a fluid volume excess. Cyanosis would indicate decreased tissue oxygenation. Dyspnea on exertion would suggest respiratory problems, such as pulmonary edema. CN

The mother of a child with Duchenne's muscular dystrophy asks about the chance that her next child will have the disease. The nurse responds based on the understanding of which of the following? 1. Sons have a 50% chance of being affected. 2. Daughters have a 1 in 4 chance of being carriers. 3. Each child has a 1 in 4 chance of developing the disease. 4. Each child has a 50% chance of being a carrier

1. Duchenne's muscular dystrophy is an X-linked recessive disorder. The gene is transmitted through female carriers to affected sons 50% of the time. Daughters have a 50% chance of being carriers.

Which intervention should be included in the plan of care for a newborn with a newly repaired myelomeningocele? 1. Offer formula/breast milk every 3 hours. 2. Turn the infant back to front every 2 hours. 3. Place a wet dressing on the sac. 4. Provide pain medication every 4 hours.

1. Following surgery, a newborn may want formula/breast milk every 2 to 4 hours. Be sure to monitor intake and output

A 7-year-old is diagnosed with central precocious puberty. The child is to receive a monthly intramuscular (IM) injection of leuprolide acetate (Lupron). The child has great fear of pain and needles and requires considerable stress reduction techniques each time an injection is due. What could the nurse suggest that might help manage the pain? 1. Apply a eutectic mixture of local anesthetics (EMLA) of lidocaine and prilocaine to the site at least 60 minutes before the injection. 2. Have extra help on hand to help hold the child down. 3. Apply cold to the area prior to injection. 4. Identify a reward to bribe the child to behave during the injection.

1. EMLA cream works well for skin and cutaneous pain. Having the child assist in putting on the EMLA patch involves the child in the pain-relieving process.

The nurse is teaching an adolescent about Ewing sarcoma and indicates which as a common site? 1. Shaft. 2. Growth plate. 3. Ball of the femur. 4. Bone marrow.

1. Ewing sarcoma is a bone tumor that affects the shafts of long bones.

The mother of an infant with myelomeningocele asks if her baby is likely to have any other defects. The nurse responds based on the understanding that myelomeningocele is commonly associated with which disorder? 1. Excessive cerebrospinal fluid within the cranial cavity. 2. Abnormally small head. 3. Congenital absence of the cranial vault. 4. Overriding of the cranial sutures

1. Excessive cerebrospinal fluid in the cranial cavity, called hydrocephalus, is the most common anomaly associated with myelomeningocele. Microencephaly, an abnormally small head, is associated with maternal exposure to rubella or cytomegalovirus. Anencephaly, a congenital absence of the cranial vault, is a different type of neural tube defect. Overriding of the sutures, possibly a normal finding after a vaginal delivery, is not associated with myelomeningocele

The nurse is caring for a child with sickle cell disease who is scheduled to have an exchange transfusion. What information should the nurse teach the family? 1. The procedure is done to prevent further sickling during a vaso-occlusive crisis. 2. The procedure reduces side effects from blood transfusions. 3. The procedure is a routine treatment for sickle cell crisis. 4. Once the child ' s spleen is removed, it is not necessary to do exchange transfusions

1. Exchange transfusion reduces the number of circulating sickle cells and slows down the cycle of hypoxia, thrombosis, and tissue ischemia

A nurse is caring for a 5-year-old who has a fracture of the tibia involving the growth plate. When providing information to the parents, the nurse should indicate that: 1. This is a serious injury that could cause long-term growth issues. 2. The fracture usually heals within 6 weeks without further complications. 3. The child will never be able to play contact sports. 4. Fractures involving the growth plate require pain medication.

1. Fractures of the growth plate are serious because they can disrupt the growth process

A child who was intubated after a craniotomy now shows signs of decreased level of consciousness. The physician orders manual hyperventilation to keep the Paco2 between 25 and 29 mm Hg and the Pao2 between 80 and 100 mm Hg. The nurse interprets this order based on the understanding that this action will accomplish which of the following? 1. Decrease intracranial pressure. 2. Ensure a patent airway. 3. Lower the arousal level. 4. Produce hypoxia

1. Hypercapnia, hypoxia, and acidosis are potent cerebral vasodilating mechanisms that can cause increased intracranial pressure. Lowering the carbon dioxide level and increasing the oxygen level through hyperventilation is the most effective short-term method of reducing intracranial pressure. Although ensuring a patent airway is important, this is not accomplished by manual hyperventilation. Manual hyperventilation does not lower the arousal level; in fact, the arousal level may increase. Manual hyperventilation is used to reduce hypoxia, not produce it.

After teaching the mother of a child with severe burns about the importance of specific nutritional support in burn management, which of the following, if chosen by the mother from the child's diet menu, indicates the need for further instruction? 1. Bacon, lettuce, and tomato sandwich; milk; and celery and carrot sticks. 2. Cheeseburger, cottage cheese and pineapple salad, chocolate milk, and a brownie. 3. Chicken nuggets, orange and grapefruit sections, and a vanilla milkshake. 4. Beef, bean, and cheese burrito; a banana; fruit-flavored yogurt; and skim milk.

1. Hypoproteinemia is common after severe burns. The child's diet should be high in protein to compensate for protein loss and to promote tissue healing. The child will also require a diet that is high in calories and rich in iron. The menu of bacon, lettuce, and tomato sandwich; milk; and celery sticks is lacking in sufficient protein and calories.

The parents of a child just diagnosed with juvenile idiopathic arthritis (JIA) tell the nurse that the diagnosis frightens them because they know nothing about the prognosis. What should the nurse include when teaching the parents about the disease? 1. Half of affected children recover without joint deformity. 2. Many affected children go into long remissions but have severe deformities. 3. The disease usually progresses to crippling rheumatoid arthritis. 4. Most affected children recover completely within a few years.

1. In half of the children diagnosed with JIA, recovery occurs without joint deformity. Approximately one third of the children will continue to have the disease into adulthood, and approximately one sixth will experience severe, crippling deformities

Which child would likely have experienced a delay in the diagnosis of a brain tumor? 1. A 3-month-old, because signs and symptoms would not have been readily apparent. 2. A 5-month-old, because signs and symptoms would not have been readily suspected. 3. School-age child, because signs and symptoms could have been misinterpreted. 4. Adolescent, because signs and symptoms could have been ignored and denied.

1. In infants, signs and symptoms may not be readily apparent because the open fontanel allows for expansion

Which of the following initial physical findings indicate the development of carditis in a child with rheumatic fever? 1. Heart murmur. 2. Low blood pressure. 3. Irregular pulse. 4. Anterior chest wall pain.

1. In rheumatic fever, the connective tissue of the heart becomes inflamed, leading to carditis. The most common signs of carditis are heart murmurs, tachycardia during rest, cardiac enlargement, and changes in the electrical conductivity of the heart. Heart murmurs are present in about 75% of all clients during the first week of carditis and in 85% of clients by the third week. Signs of carditis do not include hypotension or chest pain. The client may have a rapid pulse, but it is usually not irregular.

Which would the nurse teach a patient when NSAIDs are prescribed for treating juvenile idiopathic arthritis (JIA)? 1. Take with food. 2. Take on an empty stomach. 3. Blood levels are required for drug dosages. 4. Good oral hygiene is needed.

1. NSAIDs can cause gastric bleeding with long-term use; food helps to reduce the exposure of the drug on the stomach lining

Which should be included in the plan of care for a child who has a neuroblastoma with metastasis to the bone marrow and pancytopenia? 1. Administer red blood cells. 2. Limit school attendance to less than 4 hours daily. 3. Administer warfarin (Coumadin). 4. Encourage a diet high in fresh fruits and vegetables.

1. Red blood cells will be needed to increase the red blood cell count.

After a plaster cast has been applied to the arm of a child with a fractured right humerus, the nurse completes discharge teaching. The nurse should evaluate the teaching as successful when the mother agrees to seek medical advice if the child experiences which of the following? 1. Inability to extend the fingers on the right hand. 2. Vomiting after the cast is applied. 3. Coolness and dampness of the cast after 5 hours. 4. Fussiness with complaints that the cast is heavy.

1. Inability to extend the fingers of the involved arm may indicate neurologic impairment caused by pressure on soft tissue. It is not unusual for a child to vomit after experiencing a traumatic injury. It may take up to 72 hours for a plaster cast to dry. Until the cast dries, the dampness causes the sensation of coolness. The cast will seem heavy until the child adjusts to the extra weight. The child may exhibit fussiness (such as whining, crying or clinging) as a result of numerous causes, such as placement of the cast, the hospital experience, or pain. These reactions are normal and do not warrant medical advice.

An 8-year-old child does well after infratentorial tumor removal and is transferred back to the pediatric unit. Although she had been told about having her head shaved for surgery, she is very upset. After exploring the child's feelings, which action should the nurse take? 1. Ask the child if she'd like to wear a hat. 2. Reassure the child that her hair will grow back. 3. Explain to the child's parents that her reaction is normal. 4. Suggest that the parents buy the child a wig as a surprise

1. It is not uncommon for a child to be concerned about a change in appearance when the entire head or only part of the head has been shaved. The child should be encouraged to participate in decisions about her care when possible. Asking her if she would like to wear a hat is one way to encourage this participation. Reassuring the child that her hair will grow back does not address the immediate change in appearance, and it ignores the child's current feelings. Explaining that this type of reaction is normal does not address the child's feelings. The child needs to be able to express feelings and be involved in care as much as possible. Buying the child a wig as a surprise does not address the child's feelings and does not allow her to participate in decision making. Rather, the parents should ask the child if she would like a wig and then work with the child to determine what kind of wig she would like.

The nurse assesses the family's ability to cope with the child's cerebral palsy. Which action should alert the nurse to the possibility of their inability to cope with the disease? 1. Limiting interaction with extended family and friends. 2. Learning measures to meet the child's physical needs. 3. Requesting teaching about cerebral palsy in general. 4. Not seeking financial help to pay for medical bills

1. Limited interaction or lack of interaction with friends and family may lead the nurse to suspect a possible problem with the family's ability to cope with others' reactions and responses to a child with cerebral palsy. Learning measures to meet the child's physical needs demonstrates some understanding and acceptance of the disease. Requesting teaching about the disease suggests curiosity or a desire for understanding, thus demonstrating the family dealing with the situation. Although not seeking financial help to pay for medical bills may be problem, it does not indicate the type of response the family is having to the child's problems

The parent of a teen with a diagnosis of Hodgkin disease asks what the child ' s prognosis will be with treatment. What information should the nurse give to the parent and child? 1. Clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stages of Hodgkin disease is excellent. 2. There is a considerably better prognosis if the client is diagnosed early and is less than 5 years of age. 3. The prognosis for Hodgkin disease depends on the type of chemotherapy. 4. The only way to obtain a good prognosis is by chemotherapy and bone marrow transplant.

1. Long-term survival for all stages of Hodgkin disease is excellent. Early-stage disease can have a survival rate greater than 90%, with advanced stages having rates between 65% and 75%.

A child is going to receive radiation for Ewing sarcoma. Which of the following is the best nursing intervention to prevent skin breakdown during therapy? 1. Advise the child to wear loose-fitting clothes to minimize irritation. 2. Advise the child to use emollients to prevent dry skin. 3. Apply cold packs nightly to reduce the warmth caused by the treatments. 4. Apply hydrocortisone to soothe itching from dry skin.

1. Loose clothing helps reduce irritation on the sensitive irradiated skin.

The nurse teaches the mother of a young child with Duchenne's muscular dystrophy about the disease and its management. Which of the following statements by the mother indicates successful teaching? 1. "My son will probably be unable to walk independently by the time he is 9 to 11 years old." 2. "Muscle relaxants are effective for some children; I hope they can help my son." 3. "When my son is a little older, he can have surgery to improve his ability to walk." 4. "I need to help my son be as active as possible to prevent progression of the disease."

1. Muscular dystrophy is a progressive disease. Children who are affected by this disease usually are unable to walk independently by age 9 to 11 years. There is no effective treatment for childhood muscular dystrophy. Although children who remain active are able to avoid wheelchair confinement for a longer period, activity does not prevent disease progression

After teaching the family of a child with scoliosis who needs to wear a Boston brace, which of the following activities, if stated by the child and family as occasions appropriate for removal of the brace, indicates successful teaching? 1. When bathing, for about 1 hour per day. 2. While eating, for a total of 3 hours a day. 3. During school, for about 8 hours a day. 4. When sleeping, for a total of 10 hours a day.

1. One of the most effective spinal braces for correcting scoliosis, the Boston brace should be worn for at least 16 to 23 hours a day, except when carrying out personal hygiene measures.

The parent of a 4-year-old brings the child to the clinic and tells the nurse the child ' s abdomen is distended. After a complete examination, a diagnosis of Wilms tumor is suspected. Which of the following is most important when doing a physical examination on this child? 1. Avoid palpation of the abdomen. 2. Assess the urine for the presence of blood. 3. Monitor vital signs, especially the blood pressure. 4. Obtain an accurate height and weight.

1. Palpating the abdomen of the child in whom a diagnosis of Wilms tumor is suspected should be avoided because manipulation of the abdomen may cause seeding of the tumor.

Which of the following statements made by the mother of a school-age child who has had a craniotomy for a brain tumor would warrant further exploration by the nurse? 1. "After this, I'll never let her out of my sight again." 2. "I hope that she'll be able to go back to school soon." 3. "I wonder how long it will be before she can ride her bike." 4. "Her best friend is eager to see her; I hope she won't be upset.

1. Parents of a child who has undergone neurosurgery can easily become overprotective. Yet the parents must foster independence in the convalescing child. It is important for the child to resume age appropriate activities, and parents play an important role in encouraging this. Statements about going back to school would be expected. Parents want the child to return to normal activities after a serious illness or injury as a sign that the child is doing well.

An adolescent with insulin-dependent diabetes is being taught the importance of rotating the sites of insulin injections. The nurse should judge that the teaching was successful when the adolescent identifies which of the following as a result of using the same site? 1. Destruction of the fat tissue and poor absorption. 2. Destruction of nerves and painful neuritis. 3. Destruction of the tissue and too-rapid insulin uptake. 4. Development of resistance to insulin and need for increased amounts

1. Repeated use of the same injection site can result in atrophy of the fat in the subcutaneous tissue and lead to poor insulin absorption. The neuritis that develops from diabetes is related to microvascular changes that occur. Subcutaneous tissue is not destroyed and insulin is not rapidly absorbed. Resistance to insulin is caused by an immune response to the insulin protein

The most appropriate nursing diagnosis for a child with type 1 diabetes mellitus is which of the following? 1. Risk for infection related to reduced body defenses. 2. Impaired urinary elimination (enuresis). 3. Risk for injury related to medical treatment. 4. Anticipatory grieving.

1. Risk for infection is a correct nursing diagnosis. Understanding DM is understanding the effect it has on peripheral circulation and impairment of defense mechanisms.

When assessing a female adolescent for scoliosis, what should the nurse ask the client to do? 1. Bend forward at the waist with arms hanging freely. 2. Lie fl at on the floor and extend her legs straight from the trunk. 3. Sit in a chair while lifting her feet and legs to a right angle with the trunk. 4. Stand against a wall while pressing the length of her back against the wall

1. Scoliosis, a lateral deviation of the spine, is assessed by having the client bend forward at the waist with arms hanging freely, then looking for lateral curvature of the spine and a rib hump. The other positions will not reveal the deviation of the spine.

The parents of a 12-month-old with cerebral palsy (CP) ask the nurse if they should teach their child sign language because he has not begun to vocalize. The nurse bases the response on the knowledge that sign language: 1. May be a very beneficial way to help children with CP communicate. 2. May cause confusion and further delay vocalization. 3. Is difficult to learn for most children with CP. 4. Is beneficial to learn, but it would be best to wait until the child is older.

1. Sign language may help the child with CP communicate and ultimately decrease frustration. Children with CP may have diffi culty verbalizing because of weak tongue and jaw muscles. They may be able to have suffi cient motor skills to communicate with their hands.

A child is admitted with a fracture of the femur and placed in skeletal traction. What should the nurse assess first? 1. The pull of traction on the pin. 2. The Ace bandage. 3. The pin sites for signs of infection. 4. The dressings for tightness

1. Skeletal traction applies the pull directly to the skeletal structure by tongs, pin, or wire. The nurse should assess the pull of the traction on the pin first. This is critical to the success of the traction. Once this is assessed, then the pin sites are assessed for signs of infection. The dressings would be examined after the pull of the traction, neurovascular status, and pin sites were assessed. The Ace wrap is used to anchor skin traction nonadherent straps, not skeletal traction.

A child with a repaired myelomeningocele is in the clinic for a regular examination. The child has frequent constipation and has been crying at night because of pain in the legs. After an MRI, the diagnosis of a tethered cord is made. Which should the nurse tell the parent? 1. Tethered cord is a postsurgical complication. 2. Tethered cord occurs during times of slow growth. 3. Release of the tethered cord will be necessary only once. 4. Offering laxatives and acetaminophen (Tylenol) daily will help control these problems.

1. Tethered cord is caused by scar tissue formation from the surgical repair of the myelomeningocele and may affect bowel, bladder, or lower extremity functioning. As the child grows, this will affect continence and mobility

The nurse teaches the parents of an infant with developmental dysplasia of the hip how to handle their child in a Pavlik harness. Which of the following is most appropriate? 1. Fitting the diaper under the straps. 2. Leaving the harness off while the infant sleeps. 3. Checking for skin redness under straps every other day. 4. Putting powder on the skin under the straps every day.

1. The Pavlik harness is worn over a diaper. Knee socks are also worn to prevent the straps and foot and leg pieces from rubbing directly on the skin. For maximum results, the infant needs to wear the harness continuously. The skin should be inspected several times a day, not every other day, for signs of redness or irritation. Lotions and powders are to be avoided because they can cake and irritate the skin.

An adolescent tells the nurse that the area below his knee has been hurting for several weeks. The nurse should obtain history information about participation in which of the following? 1. Soccer. 2. Golf. 3. Diving. 4. Swimming

1. The adolescent's complaint should alert the nurse to the possibility of Osgood-Schlatter disease. This disease, found primarily in boys 10 to 15 years of age and in girls 8 to 13 years of age, occurs when the infrapatellar ligament of the quadriceps muscle is not well anchored to the tibial tubercle. Excessive activity of the quadriceps muscle results in microtrauma, which causes swelling and pain. Track, soccer, and football commonly produce this condition. Osgood-Schlatter disease is self-limited and usually responds to rest and application of ice.

The nurse is teaching about congenital clubfoot in infants. The nurse evaluates the teaching as successful when the parent states that clubfoot is best treated when? 1. Immediately after diagnosis. 2. At age 4 to 6 months. 3. Prior to walking (age 9 to 12 months). 4. After walking is established (age 15 to 18 months).

1. The best outcomes for clubfoot are seen if casting begins as soon as the diagnosis is made, usually at birth.

The nurse is caring for a child being treated for ALL. Laboratory results indicate that the child has a white blood cell count of 5000/mm 3 with 5% polys and 3% bands. Which of the following analyses is most appropriate? 1. The absolute neutrophil count is 400/mm 3 , and the child is neutropenic. 2. The absolute neutrophil count is 800/mm 3 , and the child is neutropenic. 3. The absolute neutrophil count is 4000/mm 3 , and the child is not neutropenic. 4. The absolute neutrophil count is 5800/mm 3 , and the child is not neutropenic.

1. The calculated absolute neutrophil count is 400/mm 3 (0.08 × 5000), and the child is neutropenic because the count is less than 500/mm 3

A child diagnosed with meningitis is having a generalized tonic-clonic seizure. Which should the nurse do first? 1. Administer blow-by oxygen and call for additional help. 2. Reassure the parents that seizures are common in children with meningitis. 3. Call a code and ask the parents to leave the room. 4. Assess the child's temperature and blood pressure.

1. The child experiencing a seizure usually requires more oxygen because the seizure increases the body ' s metabolic rate and demand for oxygen. The seizure may also affect the child ' s airway, causing the child to be hypoxic. It is always appropriate to give the child blow-by oxygen immediately. The nurse should remain with the child and call for additional help.

The parents of a child with cerebral palsy (CP) are learning how to feed their child and avoid aspiration. The nurse would question which of the following when reviewing the teaching plan? 1. Place the food on the tip of the tongue. 2. Place the child in an upright position during feedings. 3. Feed the child soft and blended foods. 4. Feed the child slowly.

1. The food should be placed far back in the mouth to avoid tongue thrust.

The nurse tells a family of a child with cerebral palsy (CP) that since the 1960s the incidence of CP has: 1. Increased. 2. Decreased. 3. Remained the same. 4. Has decreased because of early misdiagnosis.

1. The incidence of CP has increased, partly as a result of the increased survival rate of extreme low-birth-weight and premature infants.

A 6-month-old child is discharged with a urinary stent after a procedure to repair a hypospadias. The nurse should tell the parents to: 1. Avoid tub baths until the stent is removed. 2. Measure output in the urinary bag. 3. Avoid drinking fruit juice. 4. Clean the tip of the penis 3 times a day with soap and water.

1. The parents should keep the penis as dry as possible until the stent is removed. Soaking in a tub bath is not recommended. Children this age typically go home voiding directly into a diaper. Infants may be started on juice at 6 months of age. Parents are advised to keep their child well hydrated after a hypospadius repair. Therefore, there is no reason to avoid juice. Cleaning the tip of the penis 3 times a day may cause unnecessary irritation.

When developing the plan of care for an infant diagnosed with myelomeningocele and the parents who have just been informed of the infant's diagnosis, which action should the nurse include as the priority when the parents visit the infant for the first time? 1. Emphasizing the infant's normal and positive features. 2. Encouraging the parents to discuss their fears and concerns. 3. Reinforcing the doctor's explanation of the defect. 4. Having the parents feed their infant

1. The parents should see the neonate as soon as possible, because the longer they must wait to see the neonate, the more anxiety they will feel. Because the parents are acutely aware of the deficit, the nurse should emphasize the neonate's normal and positive features during the visit. All parents, but especially those with a child who has a disability or defect, need to hear positive comments and comments that reflect how the infant is normal. Although the parents need to discuss their fears and concerns, the priority on the first visit is to emphasize the neonate's normal and positive features. Reinforcing the doctor's explanation of the defect may be necessary later. Reinforcing the explanation at this initial visit emphasizes the defect, not the child. The parents should spend time with or care for the neonate after birth because parent-infant contact is necessary for attachment. The parents cannot feed the neonate before the defect is repaired because the repair typically occurs within 24 hours. The infant will be prone in an isolette or warmed and watched closely. However, the parents can fondle and stroke the neonate.

A 12-year-old with rheumatic fever has a history of long-term aspirin use. Which statement by the client indicates that the nurse should notify the health care provider? 1. "I hear ringing in my ears." 2. "Is it alright to put lotion on my itchy skin?" 3. "My stomach hurts after I take that medicine." 4. "These pills make me cough."

1. Tinnitus is an adverse effect of prolonged aspirin therapy and the child should be examined by a health care provider for hearing loss. Itchy skin commonly accompanies the rash associated with rheumatic fever and the nurse can encourage lotion use. The nurse teaches clients to take aspirin with food or milk to avoid abdominal discomfort. The nurse can also address the fact that coughing after ingesting aspirin can be caused by inadequate fluid intake during administration.

A 12-year-old with leukemia will be taking vincristine. The nurse should encourage the child to eat what kind of diet? 1. High-residue. 2. Low-residue. 3. Low-fat. 4. High-calorie.

1. Vincristine may cause constipation, so the client should be encouraged to eat a high-residue (fiber) diet. The other diets do not help with constipation that can occur while receiving vincristine

When teaching an adolescent with facial acne about skin care, the nurse should instruct the adolescent to: 1. Wash the face twice a day with mild soap and water. 2. Remove whiteheads and comedones after washing his face with antibacterial soap. 3. Apply vitamin E ointment twice daily to the affected skin. 4. Apply tretinoin (Retin-A) daily in the morning and expose the face to the sun

1. Washing the face once or twice a day with a mild soap removes fatty acids from the skin. Acne is an inflammation of the sebaceous glands that produce sebum. Washing the face with mild soap and water keeps the sebaceous glands from becoming plugged. Excessive washing or squeezing the eruptions can cause rupture of these glands, spreading the sebum and causing further inflammation. Applying vitamin E to the lesions does not reduce the inflammation and, due to the greasiness of the preparation, may plug the ducts. Retin-A should be applied at night. Exposure to the sun can result in sunburn and an increased risk of skin cancer and should be avoided. Sunscreen with a sun protection factor of at least 15 must be applied before the client can be exposed to the sun

Aspirin has been ordered for the child with rheumatic fever (RF) in order to: 1. Keep the patent ductus arteriosus (PDA) open. 2. Reduce joint inflammation. 3. Decrease swelling of strawberry tongue. 4. Treat ventricular hypertrophy of endocarditis.

2. Joint inflammation is experienced in RF; aspirin therapy helps with inflammation and pain.

Which of the following is a reason to perform a lumbar puncture on a child with a diagnosis of leukemia? Select all that apply. 1. Rule out meningitis. 2. Assess the central nervous system for infiltration. 3. Give intrathecal chemotherapy. 4. Determine increased intracranial pressure. 5. Stage the leukemia

2, 3 A lumbar puncture is done to determine whether the cancer cells have entered the CNS, but this would not be routine unless the child was symptomatic. Chemotherapy can also be given through a lumbar puncture (spinal tap).

A toddler is being evaluated for syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should observe the child for which symptoms? Select all that apply. 1. Dehydration. 2. Fluid retention. 3. Hyponatremia. 4. Hypoglycemia. 5. Myxedema.

2, 3 ADH assists the body in retaining fluids and subsequently decreases serum osmolarity while the urine osmolarity rises. When serum sodium levels are decreased below 120 mEq/L, the child becomes symptomatic. ADH assists the body in retaining fluids and subsequently decreases serum osmolarity while the urine osmolarity rises. When serum sodium levels are decreased below 120 mEq/L, the child becomes symptomatic

The nurse receives a call from a parent of a child with leukemia in remission. The parent says the child has been exposed to chickenpox and has never had it. Which of the following responses is most appropriate for the nurse? Select all that apply. 1. "You need to monitor the child ' s temperature frequently and call back if the temperature is greater than 101°F (38.3°C)." 2. "The child has had two varicella immunizations as an infant but is no longer immune after chemotherapy." 3. "You need to bring the child to the clinic for a varicella immunoglobulin vaccine." 4. "Your child will need to be isolated for the next 2 weeks." 5. "Your child may develop chicken pox lesions about 14 to 21 days after exposure."

2, 3 Chickenpox exposure is a real concern for a child who is immunocompromised, and action needs to be taken. The child should receive varicella zoster immune globulin within 96 hours of the exposure.

Which of the following would be included in the plan of care for a hospitalized newborn following surgical repair of a myelomeningocele? Select all that apply. 1. Skull x-rays. 2. Daily head circumference measurements. 3. MRI scan. 4. Vital signs every 6 hours. 5. Holding to breastfeed.

2, 3 Daily head circumference measurements are done to assess for hydrocephalus. Diagnostic tests include MRI scan, CT scan, ultrasound, and myelography

Which is true of a Wilms tumor? Select all that apply. 1. It is also referred to as neuroblastoma. 2. It can occur at any age but is seen most often between the ages of 2 and 5 years. 3. It can occur on its own or can be associated with many congenital anomalies. 4. It is a slow-growing tumor. 5. It is associated with a poor prognosis.

2, 3 It can occur at any age but is seen most often between the ages of 2 and 5 years. It can occur on its own or can be associated with many congenital anomalies

A parent of a newborn diagnosed with myelomeningocele asks what is/are common long-term complication(s)? The nurse's best response is which of the following? Select all that apply. 1. Learning disabilities. 2. Urinary tract infections. 3. Hydrocephalus. 4. Decubitus ulcers and skin breakdown. 5. Nutrition issues. 6. Attention deficit disorders

2, 3 Urinary tract infections are the most common complication of myelomeningocele. Nearly all children with myelomeningocele have a neurogenic bladder that leads to incomplete emptying of the bladder and subsequent urinary tract infections. Frequent catheterization also increases the risk of urinary tract infection. About 90% to 95% of children with myelomeningocele experience hydrocephalus

A child with spastic cerebral palsy is to begin botulinum toxin type A (Botox) injections. Which treatment goals should the health care team set for the child related to Botox? Select all that apply. 1. Improved nutritional status. 2. Decreased pain from spasticity. 3. Improved motor function. 4. Enhanced self-esteem. 5. Reduced caregiver strain and improved selfcare. 6. Decreased speech impediments

2, 3, 4, 5. Botox injections can be used to improve many aspects of quality of life for the child with cerebral palsy. The injections can help decrease pain from spasticity. Injections improve motor status by reducing rigidity and allowing for more effective physical therapy to improve range of motion. Decreased spasms enhance self-esteem. Improved motor status facilitates the ability to provide some aspects of care, especially transfers. Botox does not significantly affect nutritional status or speech

A 10-year-old has 5 lb of Buck's extension traction on his left leg. The nurse should assess the child for which of the following? Select all that apply. 1. Dryness of the skin, by removing the foam wraps and boot. 2. Alignment of the shoulder, hips, and knees. 3. Frayed rope near pulleys. 4. Correct amount of traction weight on fracture. 5. Pressure on the coccyx.

2, 3, 4, 5. Buck's traction provides a skin traction that keeps the extremity in straight alignment and can be observed by noting a straight line formed between the shoulder, hips, and knees. The rope must be intact to maintain the ordered traction from the weights. The correct amount of traction must be maintained to keep the fractured femur in correct alignment. Because the client is in a recumbent position, the nurse should also inspect the skin on the back and buttocks for integrity. The nurse should not remove the client's wraps and boot unless she has a physician's order to do so

Parents bring a 10-month-old boy born with myelomeningocele and hydrocephalus with a ventriculoperitoneal shunt to the emergency department. His symptoms include vomiting, poor feeding, lethargy, and irritability. What interventions by the nurse are appropriate? Select all that apply. 1. Weigh the child. 2. Listen to bowel sounds. 3. Palpate the anterior fontanel. 4. Obtain vital signs. 5. Assess pitch and quality of the child's cry

2, 3, 4, 5. Common shunt complications are obstruction, infection, and disconnection of the tubing. The signs presented by the child indicate increased intracranial pressure from a shunt malformation, which could be caused by an infection, such as peritonitis or meningitis. By listening to bowel sounds, the nurse will note if peritonitis might be a possibility. Palpating the fontanel would indicate increased intracranial pressure if it were bulging and taut. Obtaining vital signs would assess for signs of infection, such as elevated temperature or, possibly, Cushing's triad (elevated blood pressure, slow pulse, and depressed respirations). A high-pitched cry is a sign of increased intracranial pressure. Weighing the child at this time would not be a priority, nor would it add to identifying the cause of the signs and symptoms.

The nurse is teaching the parents of a child with myelomeningocele how to prevent urinary tract infections. What should the care plan include for this child? Select all that apply. 1. Provide meticulous skin care. 2. Use the Crede's maneuver to empty the bladder. 3. Encourage frequent emptying of the bladder. 4. Assure adequate fluid intake. 5. Use tight-fitting diapers around the meatus

2, 3, 4. Prevention of urinary tract infections includes adequate fluid intake, urine acidification, frequent emptying of the bladder including the use of the Crede's maneuver if needed. While the nurse should keep the skin clean and dry, this will not prevent urinary tract infections. Keeping urine close to the meatus with a tight-fitting diaper would increase the risk for infection

Nonsteroidal anti-inflammatory drugs are the first choice in treating a child with juvenile idiopathic arthritis. Which adverse effects should the nurse include in the teaching plan for the parents? Select all that apply. 1. Weight gain. 2. Abdominal pain. 3. Blood in the stool. 4. Folic acid deficiency. 5. Reduced blood clotting ability.

2, 3, 5. Adverse effects from nonsteroidal anti-inflammatory drugs include abdominal pain, blood in stool, and reduced clotting ability. Weight gain is common with corticosteroids. Folic acid deficiency is associated with methotrexate therapy

The nurse is measuring a child for crutches. What should the nurse consider? Select all that apply. 1. Type of gait child will be using. 2. Degree of child's elbow flexion. 3. Space above the crutch to child's axilla. 4. Weight of the child. 5. Whether child has to use the stairs

2, 3. To ensure proper fit of crutches, the child's elbow flexion should be 20 degrees, and the area above the top of the crutch to the child's axilla should be 1 to 1½ inches. The type of gait, weight of the child, and use of stairs are not factors in the measurement.

A child with Kawasaki disease is receiving low dose aspirin. The mother calls the clinic and states that the child has been exposed to influenza. Which recommendations should the nurse make? Select all that apply. 1. Increase fluid intake. 2. Stop the aspirin. 3. Keep the child home from school. 4. Watch for fever. 5. Weigh the child daily.

2, 4. Aspirin needs to be stopped because of its possible link to Reye's syndrome. Additionally, the parents need to watch for signs and symptoms of influenza. Children with influenza frequently present with fever, cold symptoms, and gastrointestinal symptoms. Increasing the child's fluid intake and weighing the child daily are not needed at this time because the child is not ill. Keeping the child home from school is not necessary, because the child is not ill and has already been exposed.

The nurse is providing discharge teaching to the parents of a toddler who experienced a febrile seizure. The nurse knows clarification is needed when the mother says: 1. "My child will likely have another seizure." 2. "My child's 7-year-old brother is also at high risk for a febrile seizure." 3. "I'll give my child acetaminophen (Tylenol) when ill to prevent the fever from rising too high too rapidly." 4. "Most children with febrile seizures do not require seizure medicine."

2. Most children over the age of 5 years do not have febrile seizures

When interviewing the parents of a 2-yearold child, a history of which of the following illnesses should lead the nurse to suspect pneumococcal meningitis? 1. Bladder infection. 2. Middle ear infection. 3. Fractured clavicle. 4. Septic arthritis.

2. Organisms that cause bacterial meningitis, such as pneumococci or meningococci, are commonly spread in the body by vascular dissemination from a middle ear infection. The meningitis may also be a direct extension from the paranasal and mastoid sinuses. The causative organism is a pneumococcus. A chronically draining ear is also frequently found. Bladder infections commonly are caused by Escherichia coli, unrelated to the development of pneumococcal meningitis. Pneumococcal meningitis is unrelated to a fractured clavicle or to septic arthritis, which is commonly caused by Staphylococcus aureus, group A streptococci, or Haemophilus influenzae.

The nurse in a diabetic clinic sees a 10-year-old who is a new diabetic and has had trouble maintaining blood glucose levels within normal limits. The child's parent states the child has had several daytime "accidents." The nurse knows that this is referred to as which of the following? 1. Primary enuresis. 2. Secondary enuresis. 3. Diurnal enuresis. 4. Nocturnal enuresis.

2. Secondary enuresis refers to urinary incontinence in a child who previously had bladder control.

The nurse reports to the physician signs of increased intracranial pressure in an infant with a myelomeningocele who has which of the following? 1. Minimal lower extremity movement. 2. A high-pitched cry. 3. Overflow voiding only. 4. A fontanel that bulges with crying.

2. A Chiari malformation obstructs the flow of cerebral spinal fluid resulting in hydrocephalus. This is a common problem in infants with myelomeningocele and will require surgical intervention with a shunt. A high-pitched cry is one sign of increased intracranial pressure that may indicate the presence of a Chiari malformation and requires further evaluation. Minimal movement of the lower extremities is an expected finding associated with spinal cord damage. Overflow voiding comes from a neurogenic bladder, not increased intracranial pressure. It is normal for the fontanel to bulge with crying.

During the acute stage of meningitis, a 3-year-old child is restless and irritable. Which of the following would be most appropriate to institute? 1. Limiting conversation with the child. 2. Keeping extraneous noise to a minimum. 3. Allowing the child to play in the bathtub. 4. Performing treatments quickly.

2. A child in the acute stage of meningitis is irritable and hypersensitive to loud noise and light. Therefore, extraneous noise should be minimized and bright lights avoided as much as possible. There is no need to limit conversations with the child. However, the nurse should speak in a calm, gentle, reassuring voice. The child needs gentle and calm bathing. Because of the acuteness of the infection, sponge baths would be more appropriate than tub baths. Although treatments need to be completed as quickly as possible to prevent overstressing the child, they should be performed carefully and at a pace that avoids sudden movements to prevent startling the child and subsequently increasing intracranial pressure.

A child with a brain tumor is less responsive to verbal commands than he was when the nurse assessed the client the previous hour. The nurse should next: 1. Raise the head of the bed. 2. Notify the physician. 3. Administer an analgesic. 4. Obtain an oximeter reading

2. A decreasing level of consciousness, decerebrate positioning, or Cushing's triad (elevated systolic blood pressure, decreased pulse, and decreased respiratory rate) indicates that there is pressure on the brain stem and the client could require intubation and cardiac resuscitation unless the physician can order a medication or surgical procedure to reduce the intracranial pressure. Raising the head of the bed could offer some reduction in the intracranial pressure by increasing venous blood return from the head, but it is not the priority at this time. An analgesic administered at this time would mask the sign of decreasing level of consciousness and hinder assessment. An oximeter would measure the oxygen level in the blood, but not necessarily in the brain.

While assessing the penis of a child who has had surgery for repair of a hypospadias, the nurse observes the appearance of the penis. The nurse should report which aspect to the surgeon? 1. Swollen. 2. Dusky blue at the tip. 3. Somewhat misshapen. 4. Pink

2. A dusky blue color at the tip of the penis may indicate a problem with circulation, and the nurse should notify the surgeon. Following surgery, it is normal for the penis to be swollen and pink. The penis may be misshapen and is unlikely to look normal even after reconstruction.

The child in a new hip spica cast seems to be adjusting to the cast, except that after each meal the child tells the nurse that the cast is too tight. Which of the following should the nurse plan to do? 1. Administer a laxative prior to each meal. 2. Offer smaller, more frequent meals. 3. Give the child a mechanical soft diet. 4. Offer the child more fruits and grains.

2. A hip spica cast encircles the abdomen. When the child eats a large meal, abdominal pressure increases, causing the cast to feel tight. Therefore, the nurse should plan to offer smaller, more frequent meals to minimize abdominal distention. If the child's appetite were decreased in conjunction with a feeling of fullness, the nurse might suspect that the child was becoming constipated and plan to use laxatives or a higher-fiber diet. A mechanical soft diet is indicated when the child has difficulty chewing food adequately. Giving the child more fruits and grains would contribute to abdominal distention and complaints of the cast tightness after eating.

An infant is born with a sac protruding through the spine, containing cerebrospinal fluid (CSF), a portion of the meninges, and nerve roots. This condition is referred to as: 1. Meningocele. 2. Myelomeningocele. 3. Spina bifida occulta. 4. Anencephaly.

2. A myelomeningocele is a sac that contains a portion of the meninges, the CSF, and the nerve roots.

The nurse is caring for a 10-year-old with leukemia who is receiving chemotherapy. The child is on neutropenic precautions. Friends of the child come to the desk and ask for a vase for the flowers they have brought with them. Which of the following is the best response? 1. "I will get you a special vase that we use on this unit." 2. "The flowers from your garden are beautiful but should not be placed in the room at this time." 3. "As soon as I can wash a vase, I will put the flowers in it and bring it to the room." 4. "Get rid of the flowers immediately. You could harm the child."

2. A neutropenic client should not have flowers in the room because the flowers may harbor Aspergillus or Pseudomonas aeruginosa. Neutropenic children are susceptible to infection. Precautions need to be taken so that the child does not come in contact with any potential sources of infection. Fresh fruits and vegetables can also harbor molds and should be avoided. Telling the friend that the flowers are beautiful but that the child cannot have them is a tactful way not to offend the friend

The mother of a child hospitalized with tetralogy of Fallot tells the nurse that the child's 3-year-old sibling has become quiet and shy and demonstrates more than a usual amount of genital curiosity since this child's hospitalization. The nurse should tell the mother: 1. "This behavior is very typical for a 3-yearold." 2. "This may be how your child expresses feeling a need for attention." 3. "This may be an indication that your child may have been sexually abused." 4. "This may be a sign of depression in your child."

2. According to Erikson, the central psychosocial task of a preschooler is to develop a sense of industry versus guilt. Any environmental situation may affect the child. In this situation the sibling is probably feeling less attention from the mother and trying to resolve the conflict in an inappropriate way. Three-year-olds are usually active and outgoing. These behaviors represent a change. Data are not sufficient to suggest the child has been exposed to a sexual experience. Symptoms of depression would include withdrawal and fatigue.

A 12-year-old is having surgery to repair a fractured left femur. As a part of the preoperative safety procedures, the nurse should ask the client to: 1. Point to the area of the fracture. 2. Mark the location of the fracture with an "x" and sign his name. 3. Confirm with his parents that they have signed the operative permit. 4. State the surgery risks as understood from the surgeon

2. According to national client safety standards, when possible, the client should mark the surgery site and sign his name on the site. This step should be done prior to receiving preoperative medication. Pointing to the area is not sufficient identification. Because the client is a minor, the parents are responsible for signing the operative permit and accepting the surgery risks. The nurse should determine that the parents understand the surgery risks

The primary health care provider orders pulse assessments through the night for a 12-yearold child with rheumatic fever who has a daytime heart rate of 120. The nurse explains to the mother that this is to evaluate if the elevated heart rate is caused by: 1. The morning digitalis. 2. Normal activity during waking hours. 3. A warmer daytime environment. 4. Normal variations in day and evening hours.

2. An above-average pulse rate that is out of proportion to the degree of activity is an early sign of heart failure in a client with rheumatic fever. The sleeping pulse is used to determine whether the mild tachycardia persists during sleep (inactivity) or whether it is a result of daytime activities. The environmental temperature would need to be quite warmer before it could influence the heart rate. Digitalis lowers the heart rate, so the rate would be decreased during the daytime.

Before placement of a ventriculoperitoneal shunt for hydrocephalus, an infant is irritable, lethargic, and difficult to feed. To maintain the infant's nutritional status, which of the following actions would be most appropriate? 1. Feeding the infant just before doing any procedures. 2. Giving the infant small, frequent feedings. 3. Feeding the infant in a horizontal position. 4. Scheduling the feedings for every 6 hours.

2. An infant with hydrocephalus is difficult to feed because of poor sucking, lethargy, and vomiting, which are associated with increased intracranial pressure. Small, frequent feedings given at times when the infant is relaxed and calm are tolerated best. Feeding an infant before any procedure is inappropriate because the stress of the procedure may lead to vomiting. Ideally, the infant should be held in a slightly vertical position when feeding to prevent backflow of formula into the eustachian tubes and subsequent development of ear infections. Most infants are fed on demand every 3 to 4 hours.

Which child is at increased risk for cerebral palsy (CP)? 1. An infant born at 34 weeks with an Apgar score of 6 at 5 minutes. 2. A 17-day-old infant with group B Streptococcus meningitis. 3. A 24-month-old child who has experienced a febrile seizure. 4. A 5-year-old with a closed-head injury after falling off a bike.

2. Any infection of the central nervous system increases the infant ' s risk of CP.

The charge nurse on the pediatric floor has assigned a 6-year-old girl of Arab-American ethnicity with newly diagnosed type 1 diabetes and an 8-year-old girl recovering from ketoacidosis to the same semi-private room. The 6-year-old's mother is upset because the parent staying with the other child is the father. The nurse should: 1. Explain to the parents that this room arrangement facilitates teaching. 2. Reassign the children to different rooms. 3. Offer the Arab-American parent another place to sleep. 4. Refer the parent to the customer service representative.

2. Arab-Americans most frequently practice Islam. Sleeping in the same room with a person of the opposite sex most likely would be viewed as a violation of their faith. If at all possible, the charge nurse should reassign the family to a different room. While it makes sense to have two clients with similar educational needs in the same room, it is likely that the arrangement would be sufficiently distressing enough to create a learning barrier. Offering the mother another place to sleep deprives the child of her parent at night. The customer service representative would only need to be involved if it became impossible to accommodate the mother's needs.

A diagnosis of hemophilia A is confirmed in an infant. Which of the following instructions should the nurse provide the parents as the infant becomes more mobile and starts to crawl? 1. Administer one-half of a children's aspirin for a temperature higher than 101° F (38.3° C). 2. Sew thick padding into the elbows and knees of the child's clothing. 3. Check the color of the child's urine every day. 4. Expect the eruption of the primary teeth to produce moderate to severe bleeding.

2. As the hemophilic infant begins to acquire motor skills, the risk of bleeding increases because of falls and bumps. Such injuries can be minimized by padding vulnerable joints. Aspirin is contraindicated because of its antiplatelet properties, which increase the infant's risk for bleeding. Because genitourinary bleeding is not a typical problem in children with hemophilia, urine testing is not indicated. Although some bleeding may occur with tooth eruption, it does not normally cause moderate to severe bleeding episodes in children with hemophilia. CN

When developing the teaching plan for parents using the Pavlik harness with their child, what should be the nurse's initial step? 1. Assessing the parents' current coping strategies. 2. Determining the parents' knowledge about the device. 3. Providing the parents with written instructions. 4. Giving the parents a list of community resources

2. Assessing the learner's knowledge level is the initial step in any teaching plan to promote the maximum amount of learning. This assessment also provides the nurse with a starting point for teaching. Assessing coping strategies can provide important information to the development of the teaching plan but is not the initial step. Giving parents written instructions or a list of community resources is appropriate once the parents' knowledge level has been determined and teaching has begun.

What associated manifestation might the nurse occasionally find in a child diagnosed with Wilms tumor? 1. Atrial fibrillation. 2. Hypertension. 3. Endocarditis. 4. Hyperlipidemia.

2. Because Wilms tumor sits on the kidney, it can be associated with secondary hypertension. It does not affect or cause the other conditions.

After surgical repair of a myelomeningocele, which position should the nurse use to prevent musculoskeletal deformity in the infant? 1. Placing the feet in flexion. 2. Allowing the hips to be abducted. 3. Maintaining knees in the neutral position. 4. Placing the legs in adduction

2. Because of the potential for hip dislocation, the neonate's legs should be slightly abducted, hips maintained in slight to moderate abduction, and feet maintained in a neutral position. The infant's knees are flexed to help maintain the hips in abduction

Which is the most likely reason an adolescent with diabetes has problems with low self-esteem? 1. Managing diabetes decreases independence. 2. Managing diabetes complicates perceived ability to "fit in." 3. Obesity complicates perceived ability to "fit in." 4. Hormonal changes are exacerbated by fluctuations in insulin levels.

2. Because the desire to fit in is so strong in adolescence, the need to manage one's diabetes can compromise the patient's perception of ability to do so. For example, an adolescent with type 1 DM has to plan meals and snacks, test blood sugar, limit choices of when and what to eat, and always be concerned with the immediate health consequences of actions as simple as eating. The fact that these limitations can negatively affect self-esteem is an essential concept for the nurse caring for adolescents with diabetes to understand.

Which should be the priority nursing diagnosis for a 12-hour-old newborn with a myelomeningocele at L2? 1. Altered bowel elimination related to neurological deficits. 2. Potential for infection related to the physical defect. 3. Altered nutrition related to neurological deficit. 4. Disturbance in self-concept related to physical disability.

2. Because this infant has not had a repair, the sac is exposed. It could rupture, allowing organisms to enter the CSF, so this is the priority

A child with cerebral palsy (CP) has been fitted for braces and is beginning physical therapy to assist with ambulation. The parents ask why he needs the braces when he was crawling without any assistive devices. Select the nurse ' s best response. 1. "The CP has progressed, and he now needs more assistance to ambulate." 2. "As your child grows, different muscle groups may need more assistance." 3. "Most children with CP need braces to help with ambulation." 4. "We have found that when children with CP use braces, they are less likely to fall."

2. CP can manifest in different ways as the child grows. It does not progress, but its clinical manifestations may change.

When developing the plan of care for a newly admitted 2-year-old child with the diagnosis of Kawasaki disease, which of the following should be the priority? 1. Taking vital signs every 6 hours. 2. Monitoring intake and output every hour. 3. Minimizing skin discomfort. 4. Providing passive range-of-motion exercises.

2. Cardiac status must be monitored carefully in the initial phase of KD because the child is at high risk for congestive heart failure (CHF). Therefore, the nurse needs to assess the child frequently for signs of CHF, which would include respiratory distress and decreased urine output. Vital signs would be obtained more often than every 6 hours because of the risk of CHF. Although minimizing skin discomfort would be important, it is does not take priority over monitoring the child's hourly intake and output. Passive range-of-motion exercises would be done if the child develops arthritis.

A 10-year-old with leukemia is taking immunosuppressive drugs. To maintain health the nurse should instruct the child and parents to: 1. Continue with immunizations. 2. Not receive any live attenuated vaccines. 3. Receive vitamin and mineral supplements. 4. Stay away from peers.

2. Children who are immunosuppressed should not receive any live attenuated vaccines. Clients who are immunosuppressed and are given live attenuated vaccines such as measles, mumps, rubella and oral polio vaccine can develop severe forms of the diseases for which they are being immunized, which can result in death. Inactivated vaccines may be given if necessary, but the client is not able to adequately produce needed antibodies and it is recommended that immunizations be delayed for 3 months after the immunosuppressive drugs have be discontinued. Vitamin and mineral supplements are not normally given in conjunction with immunosuppressive drugs. When the client is immunosuppressed, the client should avoid only persons who have an infection.

The nurse is caring for an infant with a myelomeningocele. The parents ask the nurse why the nurse keeps measuring the baby ' s head circumference. Select the nurse ' s best response: 1. "Babies 'heads are measured to ensure growth is on track." 2. "Babies with a myelomeningocele are at risk for hydrocephalus, which shows up as an increase in head size." 3. "Because your baby has an opening on the spinal cord, your infant is at risk for meningitis, which can show up as an increase in head size." 4. "Many infants with myelomeningocele have microcephaly, which can show up as a decrease in head size."

2. Children with myelomeningocele are at increased risk for hydrocephalus, which can be manifested with an increase in head circumference.

The nurse is caring for an 8-year-old girl whose parents indicate she has developed spastic movements of her extremities and trunk, facial grimace, and speech disturbances. They state it seems worse when she is anxious and does not occur while sleeping. The nurse questions the parents about which recent illness? 1. Kawasaki disease (KD). 2. Rheumatic fever (RF). 3. Malignant hypertension. 4. Atrial fibrillation

2. Chorea can be a manifestation of RF, with a higher incidence in females

Which test provides a definitive diagnosis of aplastic anemia? 1. Complete blood count with differential. 2. Bone marrow aspiration. 3. Serum IgG levels. 4. Basic metabolic panel.

2. Definitive diagnosis is determined from bone marrow aspiration, which demonstrates the conversion of red bone marrow to yellow, fatty marrow

What should be part of the nurse's teaching plan for a child with epilepsy being discharged on a regimen of diphenylhydantoin (Dilantin)? 1. Drinking plenty of fluids. 2. Brushing teeth after each meal. 3. Having someone be with the child during waking hours. 4. Reporting signs of infection.

2. Diphenylhydantoin (Dilantin) can cause gingival hyperplasia. Children taking Dilantin should brush their teeth after every meal and at bedtime, and visit their dentist on a regular basis. Drinking plenty of fluids is not required while taking Dilantin. A child on Dilantin does not need to be observed during waking hours because the seizures should be under control. Infections do not occur with an increased incidence in clients receiving Dilantin.

Which of the following outcomes indicates that the activity restriction necessary for a 7-year-old child with rheumatic fever during the acute phase has been effective? 1. Joints demonstrate absence of permanent injury. 2. The resting heart rate is between 60 and 100 bpm. 3. The child exhibits a decrease in chorea movements. 4. The subcutaneous nodules over the joints are no longer palpable.

2. During the acute phase of rheumatic fever, the heart is inflamed and every effort is made to reduce the work of the heart. Bedrest with limited activity is necessary to prevent heart failure. Therefore, the most reliable indicator that activity restriction has been effective is a resting heart rate between 60 and 100 bpm, normal for a 7-year-old child. No permanent damage to the joints occurs with rheumatic fever. The chorea movements associated with rheumatic fever are self-limited and usually disappear in 1 to 3 months. They are unrelated to activity restrictions. Subcutaneous nodules that occur over joint surfaces also resolve over time with no treatment. Therefore, they are not appropriate for evaluating the effectiveness of activity restrictions

The nurse is discharging a baby with clubfoot who has had a cast applied. The nurse should provide additional teaching to the parents if they state: 1. "I should call if I see changes in the color of the toes under the cast." 2. "I should use a pillow to elevate my child's foot as he sleeps." 3. "My baby will need a series of casts to fix her foot." 4. "Having a cast should not prevent me from holding my baby."

2. Elevating the extremity at different points during the day is helpful to prevent edema, but pillows should not be used in the crib because they increase the risk of sudden infant death syndrome (SIDS). A change in the color of the toes is a sign of impaired circulation and requires medical evaluation. Children typically need a series of 5 to 10 casts to correct the deformity. Infants with club feet still need frequent holding like any other newborn

A 9-year-old is given morphine for postoperative pain. As the nurse is assessing the client for pain 4 hours later, his mother leaves the room and the child begins to cry. The nurse's initial assessment of the child's pain is that he is: 1. Not in pain because the crying began after the mother leaves. 2. Less tolerant of pain because he is upset. 3. In pain because he is crying. 4. Not in pain because he was medicated 4 hours ago.

2. Emotional or physical stress lowers a person's tolerance of pain. The mother's presence may have distracted him and when she left it caused him to focus on the pain he was having. Crying does not automatically indicate pain. The nurse must further assess the client for pain. Although an analgesic was given 4 hours before, pain may be present.

The nurse is inserting a nasogastric (NG) tube in a child admitted with head trauma. The nurse should explain to the parents that the NG tube will be used for what purpose? 1. Administer medications. 2. Decompress the stomach. 3. Obtain gastric specimens for analysis. 4. Provide adequate nutrition

2. For the child with serious head trauma, a nasogastric tube is inserted initially to decompress the stomach and to prevent vomiting and aspiration. Medications would be administered intravenously in the initial period. The tube will not be used to obtain gastric specimens. Nutrition is not a priority initially. Later on, the tube may be used to administer feedings.

Which of the following would be most appropriate to institute when a school-age child with burns becomes angry and combative when it is time to change the dressings and apply mafenide acetate (Sulfamylon)? 1. Ensure parental support during the dressing changes. 2. Allow the child to assist in removing the dressings and applying the cream. 3. Give the child permission to cry during the procedure. 4. Allow the child to schedule the time for dressing changes

2. Expressions of anger and combativeness are often the result of loss of control and a feeling of powerlessness. Some control over the situation is regained by allowing the child to participate in care. Although having parental support during the dressing changes may be helpful, this action does nothing to allow the child control. Giving the child permission to cry may help with verbalizing feelings, but doing so does nothing to provide the child with control over the situation. Although allowing the child to determine the time for dressing changes may provide a sense of control over the situation, doing so is inappropriate because the dressing changes need to be performed as ordered to ensure effectiveness and healing.

A 15-year-old has been admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which of the following signs and symptoms require the most immediate nursing intervention? 1. Fatigue and anorexia. 2. Fever and petechiae. 3. Swollen neck lymph glands and lethargy. 4. Enlarged liver and spleen

2. Fever and petechiae associated with acute lymphocytic leukemia indicate a suppression of normal white blood cells and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding. The nurse should initiate infection control and safety precautions to reduce these risks. Fatigue is a common symptom of leukemia due to red blood cell suppression. Although the client should be told about the need for rest and meal planning, such teaching is not the priority intervention. Swollen glands and lethargy may be uncomfortable but they do not require immediate intervention. An enlarged liver and spleen do require safety precautions that prevent injury to the abdomen; however, these precautions are not the priority

It is recommended that a child with metastatic rhabdomyosarcoma undergo a bone marrow transplant. Education regarding life-threatening side effects should include: 1. Diarrhea. 2. Fever. 3. Skin breakdown. 4. Tumor shrinkage.

2. Fever indicates infection that can be life threatening after a bone marrow transplant

Which position initially is most beneficial for an infant who has just returned from having a ventriculoperitoneal (VP) shunt placed? 1. Semi-Fowler in an infant seat. 2. Flat in the crib. 3. Trendelenburg. 4. In the crib with the head elevated to 90 degrees.

2. Flat in the crib is the position usually used initially, with the angle gradually increasing as the child tolerates.

The nurse should teach the mother of a child who has a new cast for a fractured radius to do which of the following for the first few days at home? 1. Use a hair dryer to dry the cast more quickly. 2. Have the child refrain from strenuous activities. 3. Check movement and sensation of the child's fingers once a day. 4. Administer acetaminophen every 8 to 12 hours for discomfort.

2. For the first few days after application of a plaster or fiberglass cast, the child should not engage in strenuous activities, to minimize swelling that would cause the cast to become too tight. Use of a hair dryer to complete the drying of the cast is not encouraged because the hair dryer only dries the outside of the cast. Movement and sensation of the fi ngers need to be checked several times a day for the fi rst few days. Typically, the mother would be instructed to administer acetaminophen every 4 to 6 hours, not every 8 to 12 hours, for discomfort.

The parent of a child with hemophilia is asking the nurse what caused the hemophilia. Which is the nurse's best response? 1. It is an X-linked dominant disorder. 2. It is an X-linked recessive disorder. 3. It is an autosomal dominant disorder. 4. It is an autosomal recessive disorder.

2. Hemophilia is transmitted as an X-linked recessive disorder. About 60% of children have a family history of hemophilia. The usual transmission is by a female with the trait and an unaffected male.

Which should the nurse do first when caring for an infant who just had a repair of a myelomeningocele? 1. Weigh diapers for 24-hour urine output. 2. Measure head circumference. 3. Offer clear fluids. 4. Assess for infection.

2. Hydrocephalus occurs in about 90% of infants with myelomeningocele, so measuring the head circumference daily and watching for an increase are important. Accumulation of cerebrospinal fluid can occur after closure of the sac.

The parent of a toddler newly diagnosed with CP asks the nurse what caused it. The nurse should answer with which of the following? 1. Most cases are caused by unknown prenatal factors. 2. It is commonly caused by perinatal factors. 3. The exact cause is not known. 4. The exact cause is known in every instance.

2. It is generally thought that the majority of infants with CP had an insult in utero. Some of the causes of perinatal insult include hypoxia, trauma, infections, or genetic abnormalities.

The nurse is teaching the parents of a child with sickle cell disease. To instruct them on how to prevent sickle cell crisis, she should include which instruction? 1. Restrict the child's fluid intake to less than 1 quart per day. 2. Drink at least 2 quarts of fluids per day. 3. Stay away from other teenagers. 4. Avoid physical activity.

2. Increasing fluid intake and being well hydrated will help prevent cell stasis in the small vessels. Restricting fl uids causes stasis of red blood cells and promotes obstruction and increases the chance of sickling with hypoxia and pain to the part that is involved. Clients with sickle cell disease should stay away from others who have infections. When the spleen of a client who has sickle cell disease has become fi brotic and nonfunctional, the client is more susceptible to infections. Clients with sickle cell disease should not avoid physical activity as long as the client stays well hydrated

The parent of an infant diagnosed with a neuroblastoma asks the nurse what the prognosis is. The nurse ' s best response is: 1. Excellent, because a neuroblastoma is always cured. 2. Excellent, because infants with a neuroblastoma have the best prognosis. 3. Poor, because infants with a neuroblastoma rarely survive. 4. Variable, depending on the site of origin.

2. Infants younger than 1 year have the best prognosis

Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis? 1. Maintain isolation precautions until 24 hours after receiving intravenous antibiotics. 2. Intravenous fluids at 1½ times regular maintenance. 3. Neurological checks every hour. 4. Administer acetaminophen (Tylenol) for temperatures higher than 38°C (100.4°F).

2. Intravenous fluids at 1½ times regular maintenance could cause fluid overload and lead to increased ICP.

After doing well for a period of time, a child with leukemia develops an overwhelming infection. The child's death is imminent. Which of the following statements offers the nurse the best guide in making plans to assist the parents in dealing with their child's imminent death? 1. Knowing that the prognosis is poor helps prepare relatives for the death of children. 2. Relatives are especially grieved when a child does well at first but then declines rapidly. 3. Trust in health care personnel is most often destroyed by a death that is considered untimely. 4. It is more difficult for relatives to accept the death of an older child than that of a toddler

2. It has been found that parents are more grieved when optimism is followed by defeat. The nurse should recognize this when planning various ways to help the parents of a dying child. It is not necessarily true that knowing about a poor prognosis for years helps prepare parents for a child's death. Death is still a shock when it occurs. Trust in health care personnel is not necessarily destroyed when a death is untimely if the family views the personnel as having done all that was possible. It is not more difficult for parents to accept the death of an older child than that of a younger child.

After teaching the parents of a child newly diagnosed with leukemia about the disease, which of the following descriptions given by the mother best indicates that she understands the nature of leukemia? 1. "The disease is an infection resulting in increased white blood cell production." 2. "The disease is a type of cancer characterized by an increase in immature white blood cells." 3. "The disease is an inflammation associated with enlargement of the lymph nodes." 4. "The disease is an allergic disorder involving increased circulating antibodies in the blood.

2. Leukemia is a neoplastic, or cancerous, disorder of blood-forming tissues that is characterized by a proliferation of immature white blood cells. Leukemia is not an infection, inflammation, or allergic disorder

A child with Ewing sarcoma is undergoing a limb salvage procedure. Which statement indicates the parents understand the procedure? 1. "Our child will have a bone graft to save the limb." 2. "Our child will need follow-up lengthening procedures." 3. "Our child will need shorter shirt sleeves." 4. "Our child will not need chemotherapy."

2. Limb salvage requires lengthening procedures to encourage the bone to continue to grow so that the child will not have a short limb.

An 8-year-old with type 1 diabetes mellitus is complaining of a headache and dizziness and is visibly perspiring. Which of the following should the nurse do first? 1. Administer glucagon intramuscularly. 2. Offer the child 8 oz of milk. 3. Administer rapid-acting insulin lispro (Humalog). 4. Offer the child 8 oz of water or calorie-free liquid

2. Milk is best to give for mild hypoglycemia, which would present with the symptoms described.

A child with osteosarcoma is going to receive chemotherapy before surgery. Which statement by the parents indicates they understand the side effect of neutropenia? 1. "My child will be more at risk for diarrhea." 2. "My child will be more at risk for infection." 3. "My child ' s hair will fall out." 4. "My child will need to drink more."

2. Neutropenia makes a child more at risk for infection because the immune system is compromised by the chemotherapy.

A nurse instructs the parent of a child with sickle cell disease about factors that might precipitate a pain crisis in the child. Which of the following factors identified by the parent as being able to cause a pain crisis indicates a need for further instruction? 1. Infection. 2. Overhydration. 3. Stress at school. 4. Cold environment

2. Overhydration does not cause a crisis

In planning the discharge for a newborn diagnosed with torticollis (wry neck), the nurse should: 1. Teach the parent the side effects of botulinum toxin (BOTOX). 2. Coordinate outpatient physical therapy. 3. Verify the date for corrective surgery. 4. Demonstrate the use of positioning wedges for sleep.

2. Physical therapy is the most important part of the child's plan of care. Most cases of torticollis respond to gentle stretching exercises which the parents perform daily. Regular physical therapy is needed to monitor the infant's progress. Botox injections are not approved for children under the age of 2 and would not be an appropriate first-line treatment for an infant. Surgery is only done if physical therapy is not successful after several months. The use of wedges to position children during sleep is not recommended because they increase the risk of SIDS.

When developing the preoperative teaching plan for a 14-month-old child with an undescended testis who is scheduled to have surgery, which of the following methods is appropriate? 1. Telling the child that his penis and scrotum will be "fixed." 2. Explaining to the parents how the defect will be corrected. 3. Telling the child that he will not see any incisions after surgery. 4. Using an anatomically correct doll to show the child what will be "fixed."

2. Preoperative teaching would be directed at the parents, because the child is too young to understand the teaching. Telling the child that his penis and scrotum will be "fixed," telling the child he will not see incisions after surgery, and using a doll to illustrate the surgery are appropriate interventions for a preschool-age child

2. Which medication should the nurse anticipate administering first to a child in status epilepticus? 1. Establish an intravenous line and administer intravenous lorazepam (Ativan). 2. Administer rectal diazepam (Valium). 3. Administer an oral glucose gel to the side of the child ' s mouth. 4. Administer oral diazepam (Valium).

2. Rectal diazepam (Valium) is first administered in an attempt to stop the seizure long enough to establish an IV, and then IV medication is administered.

After teaching the parents of a child with febrile seizures about methods to lower temperature other than using medication, which of the following statements indicates successful teaching? 1. "We'll add extra blankets when he complains of being cold." 2. "We'll wrap him in a blanket if he starts shivering." 3. "We'll make the bath water cold enough to make him shiver." 4. "We'll use a solution of half alcohol and half water when sponging him."

2. Shivering, the body's defense against rapid temperature decrease, results in an increase in body temperature. Therefore the parents need to take measures to stop the shivering (and the resulting increase in body temperature) by increasing the room temperature or the temperature of the child's immediate environment (such as with blankets) until the shivering stops. Then, attempts are made to lower the temperature more slowly. Shivering does not necessarily correlate with being cold. Alcohol, a toxic substance, can be absorbed through the skin. Its use is to be avoided.

The mother of a 4-year-old child with juvenile idiopathic arthritis (JIA) is worried that her child will have to stop attending preschool because of the illness. Which of the following responses by the nurse would be most appropriate? 1. "It may be difficult for your child to attend school because of the side effects of the medications he will be prescribed." 2. "Your child should be encouraged to attend school, but he'll need extra time to work out early morning stiffness." 3. "You should keep your child at home from school whenever he experiences discomfort or pain in his joints." 4. "Your child will probably need to wear splints and braces so that his joints will be supported properly."

2. Socialization is important for this preschool-age child, and activity is important to maintain function. Because children with JIA commonly experience the most problems in the early morning after arising, they need more time to "warm up." Adverse effects may or may not occur. The child's normal routine needs to be maintained as much as possible. Although splints and braces may be needed, they are worn during periods of rest, not activity, to maintain function.

The nurse is caring for a child with sickle cell disease who is scheduled to have a splenectomy. What information should the nurse explain to the parents regarding the reason for a splenectomy? 1. To decrease potential for infection. 2. To prevent splenic sequestration. 3. To prevent sickling of red blood cells. 4. To prevent sickle cell crisis.

2. Splenic sequestration is a life-threatening situation in children with sickle cell disease. Once a child is considered to be at high risk of splenic sequestration or has had this in the past, the spleen will be removed.

The parents of a child who requires skeletal traction are unable to visit their child for more than 1 hour a day because there are five other children at home and both parents work outside of the home. The nurse recognizes expressions of guilt in both parents. To help alleviate this guilt, the nurse should make which of the following remarks? 1. "I'm sure you feel guilty about not being able to visit often." 2. "It's important that you visit even for 1 hour." 3. "Not all parents can stay all the time." 4. "Perhaps you could take turns visiting for a bit longer."

2. Stressing the importance of the parents' visiting when they can helps to alleviate the guilt they feel. It allows the parents to feel that they are doing what they can. Acknowledging the guilt gives the parents an opportunity to talk about it but does not help alleviate it. Comparing the parents with other parents does not alleviate guilt feelings. The parents need reinforcement that what they are doing is appropriate. Suggesting that the parents take turns visiting implies that they should feel guilty because they may not be doing all they could

The mother tells the nurse she will be afraid to allow her child with hemophilia to participate in sports because of the danger of injury and bleeding. After explaining that physical fitness is important for children with hemophilia, which of the following activities should the nurse suggest as ideal? 1. Snow skiing. 2. Swimming. 3. Basketball. 4. Gymnastics.

2. Swimming is an ideal activity for a child with hemophilia because it is a noncontact sport. Many noncontact sports and physical activities that do not place excessive strain on joints are also appropriate. Such activities strengthen the muscles surrounding joints and help control bleeding in these areas. Noncontact sports also enhance general mental and physical well-being. Falls and subsequent injury to the child may occur with snow skiing. Basketball is a contact sport and therefore increases the child's risk for injury. Gymnastics is a very strenuous sport. Gymnasts frequently have muscle and joint injuries that result in bleeding episodes.

A student with type 1 diabetes tells the nurse she is feeling light-headed. The student's blood sugar is 60 mg/dL. Using the 15-15 rule, the nurse should: 1. Give 15 mL of juice and give another 15 mL in 15 minutes. 2. Give 15 g of carbohydrate and retest the blood sugar in 15 minutes. 3. Give 15 g of carbohydrate and 15 g of protein. 4. Give 15 oz of juice and retest in 15 minutes

2. The 15-15 rule is a general guideline for treating hypoglycemia where the client consumes 15 g of carbohydrate and repeats testing the blood sugar in 15 minutes. Fifteen grams of carbohydrate equals 60 calories and is roughly equal to ½ cup of juice or soda, 6 to 8 lifesavers, or a tablespoon of honey or sugar. The general recommendation is if the blood sugar is still low, the client may repeat the sequence. Fifteen milliliters of juice would only provide 15 calories. This would not be sufficient carbohydrates to treat the hypoglycemia. Protein does not treat insulin-related hypoglycemia; however a protein-starch snack may be offered after the blood glucose improves. Fifteen ounces of juice would be almost 4 times the recommended 4 oz of juice

The nurse is aware that cloudy cerebrospinal fluid (CSF) most likely indicates: 1. Viral meningitis. 2. Bacterial meningitis. 3. No infection, because CSF is usually cloudy. 4. Sepsis.

2. The CSF in bacterial meningitis is usually cloudy

When assessing a 2-year-old child with Wilms' tumor, the nurse should avoid 1. Measuring the child's chest circumference. 2. Palpating the child's abdomen. 3. Placing the child in an upright position. 4. Measuring the child's occipitofrontal circumference

2. The abdomen of the child with Wilms' tumor should not be palpated because of the danger of disseminating tumor cells. Techniques such as measuring the occipitofrontal circumference (which is done in children younger than 18 months of age because the anterior fontanel closes between 12 to 18 months of age), upright positioning, and measuring chest circumference are not necessarily contraindicated; however, the child with Wilms' tumor should always be handled gently and carefully

The nurse talks to an adolescent about how she can tell her friends about her new diagnosis of diabetes. Which of the following behaviors by the adolescent indicates that the adolescent has responded positively to the discussion? 1. She asks the nurse for material on diabetes for a school paper. 2. She introduces the nurse to her friends as "the one who taught me all about my diabetes." 3. She says, "I'll try to tell my friends, but they'll probably quit hanging out with me." 4. She asks her friends what they think about someone who has a lifelong illness.

2. The ability to talk about her diabetes indicates that the adolescent feels good enough about herself to share her problem with her peers. Asking for reference material does not specifically indicate that the client's self-esteem has improved or that she has accepted her diagnosis. Saying that her friends will probably desert her if she tells them about the illness indicates that the adolescent still needs to work on her self-esteem and her feelings about the disease. Asking her friends what they think of someone with a lifelong illness would not indicate that the nurse's interventions targeted toward improving self-esteem have been successful. Rather, this statement demonstrates the adolescent's uncertainty about herself.

Laboratory findings indicate that a child with leukemia is also anemic. The nurse interprets this finding as most likely resulting from which of the following? 1. Inadequate dietary folic acid intake. 2. Decreased red blood cell production. 3. Increased destruction of red blood cells by lymphocytes. 4. Progressive replacement of bone marrow with scar tissue.

2. The anemia seen in children with leukemia is caused by the bone marrow's overproduction of immature white blood cells at the expense of producing red blood cells and platelets. In this client, anemia is not caused by an inadequate intake of iron but, rather, by insufficient red blood cells. The anemia is not caused by destruction of red blood cells by lymphocytes or by the replacement of bone marrow with scar tissue.

A transfusion of packed red blood cells has been ordered for a 1-year-old with a sickle cell anemia. The infant has a 25 gauge I.V. infusing dextrose with sodium and potassium. Using the Situation, Background, Assessment, Recommendation (SBAR) method of communication, the nurse contacts the physician and recommends: 1. Starting a second I.V. with a 22 gauge catheter to infuse normal saline with the blood. 2. Using the existing I.V., but changing the fluids to normal saline for the transfusion. 3. Replacing the I.V. with a 22 gauge catheter to infuse the ordered fluids. 4. Starting a second I.V. with a 25 gauge catheter to infuse normal saline with the transfusion

2. The best evidence indicates that a catheter as small as 27 gauge may safely be used for transfusion in children, but blood must be infused with normal saline, not dextrose. A 1-year-old should be able to maintain their blood glucose for the 2 hour duration of the infusion without the need for a second I.V.

The nurse is assessing a 9-year-old child who has third-degree burns as shown below. Using the "Rule of Nines" adapted for children, the nurse estimates that the extent of burns for this child is: 1. 9%. 2. 14%. 3. 18%. 4. 24%

2. The child has burns of the entire leg. Because of the smaller size of children's legs, the estimate of 14% is used instead of 18%, which is used with adults. The arms of children are estimated at 9%, and the anterior and posterior trunk at 18% each. The head of the child is estimated at 18%, rather than the 9% used for adults.

A child with hemophilia presents with a burning sensation in the knee and reluctance to move the body part. The nurse collaborates with the care team to provide factor replacement and: 1. Administer an aspirin-containing compound. 2. Institute Rest, Ice, Compression, and Elevation (RICE). 3. Begin physical therapy with active range of motion. 4. Initiate skin traction.

2. The child is displaying symptoms of bleeding in the joint and factor replacement is indicated. The RICE method is used additionally as a supportive measure to help control the bleeding. Aspirin containing compounds contribute to bleeding and should never be used to control pain. Physical therapy is instituted after the acute bleeding to prevent further damage. Orthopedic traction is considered in some rare cases during the rehabilitation phase, but not the acute phase.

After surgery to correct a tetralogy of Fallot, the child's parents express concern to the nurse that their 4-year-old child wants to be held more frequently than usual. The nurse recommends: 1. Introducing a new skill. 2. Play therapy. 3. Encouraging the behavior. 4. Having the volunteer hold the child.

2. The child is exhibiting regression. During periods of stress, children frequently revert to behaviors that were comforting in earlier developmental stages; play therapy is one way to help the child cope with the stress. Teaching a new skill most likely would add more stress. Parents should be instructed to praise positive behaviors and ignore regressive behaviors rather than calling attention to them through encouragement or discouragement. Having someone else hold the child does not encourage coping with the stress or promoting appropriate development.

A child has been diagnosed with a midline brain tumor. In addition to showing signs of increased intracranial pressure (ICP), she has been voiding large amounts of very dilute urine. Which medication does the nurse expect to administer? 1. Mannitol (Osmitrol). 2. Vasopressin. 3. Furosemide (Lasix). 4. Dopamine (Intropin)

2. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Vasopressin is a hormone that is used to help the body retain water.

A 10-year-old with severe factor VIII deficiency falls, injures an elbow, and is brought to the ED. The nurse should prepare which of the following? 1. An IM injection of factor VIII. 2. An IV infusion of factor VIII. 3. An injection of desmopressin. 4. An IV infusion of platelets.

2. The child is treated with an IV infusion of factor VIII to replace the missing factor and help stop the bleeding.

A nurse is teaching an 8-year-old with diabetes and her parents about managing diabetes during illness. The nurse determines the parents understand the instruction when they indicate that, when the child is ill, they will provide: 1. More calories. 2. More insulin. 3. Less insulin. 4. Less protein and fat.

2. The child needs more insulin during an illness, because the cells becomes more insulin resistant during illness and need more insulin to achieve a normal blood glucose level. During an acute illness, simple carbohydrates and fluids are usually tolerated best

The nurse is helping a family plan for the discharge of their child, who will be going home in a spica cast. Which of the following points of information should be most important for the nurse to consider? 1. The bathrooms are all on the second floor. 2. The child's bedroom is on the second floor. 3. A 16-year-old sister will care for the child during the day. 4. There are three steps up to the front door.

2. The child with a hip spica cast who is going home and has a bedroom on the second floor of the home needs to have the bed moved to an area that is more central to family life. Negotiating a flight of steps at least twice a day (on awakening in the morning and before going to bed at night) with a child in a hip spica cast would be difficult and most likely dangerous. Because the child in a hip spica cast will need to use a bedpan or urinal, the bathrooms can be on any floor. Because the family is involved in the discharge, the 16-year-old sister should be taught appropriate care along with the rest of the family. The child can be carried up and down the three steps to the house the few times necessary after discharge.

Which of the following should the nurse include when completing discharge instructions for the parents of a 12-month-old child diagnosed with Kawasaki disease (KD) and being discharged to home? 1. Offer the child extra fluids every 2 hours for 2 weeks. 2. Take the child's temperature daily for several days. 3. Check the child's blood pressure daily until the follow-up appointment. 4. Call the physician if the irritability lasts for 2 more weeks.

2. The child's temperature should be taken daily for several days after discharge, because recurrent fever may develop. Offering the child fluids every 2 hours is not necessary. Doing so increases the child's risk for CHF. Checking the child's blood pressure at home usually is not included as part of the discharge instructions because, by the time of discharge, the child is considered stable and the risk for cardiac problems is minimal. Most children with KD recover fully. Irritability may last for 2 months after discharge.

Which child requires continued follow-up because of behaviors suspicious of cerebral palsy (CP)? 1. A 1-month-old who demonstrates the startle reflex when a loud noise is heard. 2. A 6-month-old who always reaches for toys with the right hand. 3. A 14-month-old who has not begun to walk. 4. A 2-year-old who has not yet achieved bladder control during waking hours.

2. The clinical characteristic of hemiplegia can be manifested by the early preference of one hand. This may be an early sign of CP.

What are the clinical manifestations of non-Hodgkin lymphoma? 1. Basically the same as those in Hodgkin disease. 2. Depends on the anatomical site and extent of involvement. 3. Nausea, vomiting, abdominal pain. 4. Behavior changes, jaundice, dry mouth.

2. The clinical manifestations include symptoms of involvement. Rarely is a single sign or symptom diagnostic. Metastasis to the bone marrow or central nervous system may produce manifestations of leukemia.

The parents of a neonate with hypospadias and chordee wish to have him circumcised. Which of the following explanations should the nurse incorporate into the discussion with the parents concerning the recommendation to delay circumcision? 1. The associated chordee is difficult to remove during circumcision. 2. The foreskin is used to repair the deformity surgically. 3. The meatus can become stenosed, leading to urinary obstruction. 4. The infant is too small to have a circumcision.

2. The condition in which the urethral opening is on the ventral side of the penis or below the glans penis is referred to as hypospadias. Chordee refers to a ventral curvature of the penis that results from a fibrous band of tissue that has replaced normal tissue. Circumcision is delayed because the foreskin, which is removed with a circumcision, often is used to reconstruct the urethra. The chordee is corrected when the hypospadias is repaired. Circumcision is performed at the same time. Urethral meatal stenosis, which can occur in circumcised infants, results from meatal ulceration, possibly leading to urinary obstruction. It is not associated with hypospadias or circumcision. The infant is not too small to have a circumcision, which is commonly performed on the fi rst or second day of life.

Over the past week, an infant with a repaired myelomeningocele has had a highpitched cry and been irritable. Length, weight, and head circumference have been at the 50th percentile. Today, length is at the 50th percentile, weight is at the 70th percentile, and head circumference is at the 90th percentile. The nurse should do which of the following? 1. Tell the parent this is normal for an infant with a repaired myelomeningocele. 2. Tell the parent this might mean the baby has increased intracranial pressure. 3. Suspect the baby's intracranial pressure is low because of a leak. 4. Refer the baby to the neurologist for follow-up care.

2. The increase in head size is one of the first signs of increased intracranial pressure; other signs include high pitched cry and irritability.

Which should the nurse tell the parent of an infant with spina bifida? 1. "Bone growth will be more than that of babies who are not sick because your baby will be less active." 2. "Physical and occupational therapy will be helpful to stimulate the senses and improve cognitive skills." 3. "Nutritional needs for your infant will be calculated based on activity level." 4. "Fine motor skills will be delayed because of the disability."

2. The increase in head size is one of the first signs of increased intracranial pressure; other signs include high pitched cry and irritability.

A parent of a child with a moderate head injury asks the nurse, "How will you know if my child is getting worse?" The nurse should tell the parents that best indicator of the child's brain function is: 1. The vital signs. 2. Level of consciousness. 3. Reactions of the pupils. 4. Motor strength

2. The level of consciousness (LOC) is the best indicator of brain function. If the child's condition deteriorates, the nurse would notice changes in LOC before any other changes and should notify the physician that these changes are occurring. Changes in vital signs and pupils typically follow changes in LOC. Motor strength is primarily assessed as a voluntary function. With changes in levels of consciousness there may be motor changes.

After teaching the parents about the urethral catheter placed after surgical repair of their son's hypospadias, the nurse determines that the teaching was successful when the mother states that the catheter in her child's penis accomplishes which of the following? 1. Decreases pain at the surgical site. 2. Keeps the new urethra from closing. 3. Measures his urine correctly. 4. Prevents bladder spasms.

2. The main purpose of the urethral catheter is to maintain patency of the reconstructed urethra. The catheter prevents the new tissue inside the urethra from healing on itself. However, the urethral catheter can cause bladder spasms. Recently, stents have been used instead of catheters. The urethral catheter will have no effect on the child's pain level. In fact, because bladder spasms are associated with its use, the child's complaints of pain may actually increase. Urine output can be measured through the suprapubic catheter because it provides an alternative route for urinary elimination, thus keeping the bladder empty and pressure-free.

A child has completed treatment for leukemia and comes to the clinic for a checkup with the parents. The parents express to the nurse that they are glad their child has been cured of cancer and is safe from getting cancer later in life. Which of the following should the nurse consider in responding? 1. Childhood cancer usually instills immunity to all other cancers. 2. Children surviving one cancer are at higher risk for a second cancer. 3. The child may have a remission of the leukemia but is immune to all other cancers. 4. As long as the child continues to take steroids, there will be no other cancers.

2. The most devastating late effect of leukemia treatment is development of secondary malignancy.

A 9-year-old is in a spica cast and complains of pain 1 hour after receiving intravenous opioid analgesia. What should the nurse do first? 1. Give more pain medication. 2. Perform a neuromuscular assessment. 3. Call the surgeon for orders. 4. Change the child's position.

2. The nurse looks for the source of the pain by performing a neuromuscular assessment

While the nurse is examining the infant for presence of testes, the father paces around the room shaking his head. Which of the following would be the most appropriate response by the nurse? 1. "I'm sure everything will work out for the best, and he'll be fine." 2. "You seem upset; please tell me how you're feeling." 3. "Don't worry; his testes will probably descend on their own." 4. "Would you like to talk with a parent of a child who has the same problem?"

2. The nurse needs more information about the father's perceptions and feelings before providing any information or taking action. Determining the exact nature of the father's concern rather than making an assumption about it is essential. Therefore, the nurse should identify what is observed and ask the father how he is feeling. Telling the father that everything will be fi ne or not to worry is inappropriate and provides false reassurance. It also devalues the father's concern. Later on it may be appropriate for the father to talk to a parent of a child with the same problem for support.

After placing an infant with myelomeningocele in an isolette shortly after birth, which indicator should the nurse use as the best way to determine the effectiveness of this intervention? 1. The partial pressure of arterial oxygen remains between 94 and 100 mm Hg. 2. The axillary temperature remains between 97° and 98° F (36.1° and 36.7° C). 3. The bilirubin level remains stable. 4. Weight increases by about 1 oz (28.35 g) per day

2. The nurse places the neonate with myelomeningocele in an isolette shortly after birth to help to maintain the infant's temperature. Because of the defect, the neonate cannot be bundled in blankets. Therefore, it may be difficult to prevent cold stress. The isolette can be maintained at higher than room temperature, helping to maintain the temperature of a neonate who cannot be dressed or bundled. Body temperature readings, not arterial oxygen levels, are the best indicator. Typically, an infant loses 5% to 10% of body weight before beginning to regain the weight.

Which of the following should the nurse expect to include in the plan of care for a child who is diagnosed with rheumatic fever and carditis and admitted to the hospital? 1. Ensuring continuous parental presence at the child's bedside. 2. Providing the child with periods of rest. 3. Encouraging participation in age-appropriate activities. 4. Advising the child to eat as much as possible

2. The nurse should encourage and plan to provide periods of rest for the child with rheumatic fever and carditis to allow the heart to rest. The parents should be made to feel that they can come and go as they need to. The child is not in critical condition, so the parents do not need to be present at the child's bedside continuously. The child should be allowed to participate in nonstrenuous activities that avoid overtaxing the heart, thus allowing the heart time to rest. There is no reason to encourage the child to eat as much as possible; in fact, overeating should be discouraged because it taxes the heart muscle

Which is the best action for the nurse to take during a child's seizure? 1. Administer the child's rescue dose of oral diazepam (Valium). 2. Loosen the child's clothing, and call for help. 3. Place a tongue blade in the child's mouth to prevent aspiration. 4. Carry the child to the infirmary to call 911 and start an intravenous line.

2. The nurse should remain with the child and observe the seizure. The child should be protected from his environment, and clothing should be loosened.

A 1-year-old child is scheduled for surgery to correct hypospadias and chordee. The nurse explains to the parents that this is the preferred time for surgical repair based on which of the following? 1. At this age, the child will experience less pain. 2. The child is too young to have developed castration anxiety. 3. The child will not remember the surgical experience. 4. The repair is easier to perform after the child is toilet trained

2. The preferred time for surgery is between the ages of 6 and 18 months, before the child develops castration and body image anxiety. Children learn early on about society's emphasis on the importance of genitals. Pain is different for each child and is not related to the preferred time for repair of the hypospadias or chordee. Although the child will probably not remember the experience, this is not the basis for having the surgery at this age. If the condition is not repaired, the child will have difficulty with toilet training because urine is not eliminated through the tip of the penis.

The mother asks the nurse about using a car seat for her toddler who is in a hip spica cast. The nurse should tell the mother: 1. "You can use a seat belt because of the spica cast." 2. "You will need a specially designed car seat for your toddler." 3. "You can still use the car seat you already have." 4. "You'll need to get a special release from the police so that a car seat won't be needed."

2. The toddler in a hip spica cast needs a specially designed car seat. The one that the mother already has will not be appropriate because of the need for the car seat to accommodate the cast and abductor bar. Legally, all children younger than 4 years of age are required to be restrained in a car seat.

When developing the plan of care for a child who is unconscious after a serious head injury, in which of the following positions should the nurse expect to place the child? 1. Prone with hips and knees slightly elevated. 2. Lying on the side, with the head of the bed elevated. 3. Lying on the back, in the Trendelenburg position. 4. In the semi-Fowler's position, with arms at the side

2. The unconscious child is positioned to prevent aspiration of saliva and minimize intracranial pressure. The head of the bed should be elevated, and the child should be in either the semiprone or the side-lying position. Lying prone with hips and knees slightly elevated increases intracranial pressure, as does lying on the back in the Trendelenburg position. The semi-Fowler's position with arms at the side is not the best choice.

When caring for a child with lymphoma, the nurse needs to be aware of which of the following? 1. The same staging system is used for lymphoma and Hodgkin disease. 2. Aggressive chemotherapy with central nervous system prophylaxis will give the child a good prognosis. 3. All children with lymphoma need a bone marrow transplant for a good prognosis. 4. Despite high-dose chemotherapy, the prognosis is very poor for most children.

2. The use of aggressive combination chemotherapy has a major impact on the survival rates for children with a diagnosis of lymphoma. Because there is usually bone marrow involvement, there is a need for central nervous system prophylaxis.

Why are chemotherapeutic agents such as methotrexate (Trexall) and cyclophosphamide (Cytoxan) sometimes used to treat juvenile idiopathic arthritis (JIA)? 1. Are effective against cancer-like JIA. 2. Suppress the immune system. 3. Are similar to NSAIDs. 4. Are absorbed into the synovial fluid.

2. These drugs affect the immune system to reduce its ability to attack itself, as in the case of JIA.

A 3-year-old child with CP is admitted for dehydration following an episode of diarrhea. The nurse ' s assessment follows: awake; pale, thin child lying in bed; multiple contractures; drooling; coughing spells noted when parent feeds. T 97.8°F (36.5°C), P 75, R 25, weight 7.2 kg, no diarrheal stool for 48 hours. Which nursing diagnosis is most important? 1. Potential for skin breakdown: lying in one position. 2. Alteration in nutrition: less than body requirements. 3. Potential for impaired social support: parent sole caretaker. 4. Alteration in elimination: diarrhea.

2. This child is severely underweight and malnourished for a 3-year-old. The coughing episodes while feeding put the child at risk for aspiration and pneumonia. A thorough history, physical examination, and a feeding study should be performed to determine whether it is even safe to feed the child orally. This is the priority nursing diagnosis for this severely underweight child. Weight is average for a 4-month-old. The coughing episodes while feeding may indicate aspiration. The parent needs help to learn how to feed so that less coughing occurs

A 15-year-old with spina bifida is seen in the clinic for a well-child checkup. The teen uses leg braces and crutches to ambulate. Which nursing diagnosis takes priority? 1. Potential for infection. 2. Alteration in mobility. 3. Alteration in elimination. 4. Potential body image disturbance.

2. This is a nursing diagnosis that affects many aspects of the teen ' s life. Mobility is important in all aspects of their lives. Braces and crutches enable him to more fully participate in activities and maintain some degree of independence.

A child with spastic cerebral palsy receiving intrathecal baclofen therapy is admitted to the pediatric fl oor with vomiting and dehydration. The family tells the nurse that they were scheduled to refi ll the baclofen pump today, but had to cancel the appointment when the child became ill. The nurse should: 1. Explain that the medication should be discontinued during illness. 2. Arrange for the pump to be refilled in the hospital. 3. Reschedule the pump refill for the day of discharge. 4. Instruct caregivers to call for a refill when the low-volume alarm sounds.

2. To prevent a baclofen withdraw, pump refills are scheduled several days before anticipated low-volume alarms. The nurse should make it a high priority to have the pump refilled as soon as possible. Discontinuing baclofen suddenly can result in a high fever, muscle rigidity, change in level of consciousness, and even death. Waiting until the child leaves the hospital for a refi ll may lead to a low dose or withdraw. Waiting for the low-volume alarm puts the client at risk because medication and team members who can refi ll the pump may not be readily available under all circumstances.

The parents of a 3-month-old ask why their baby will not have an operation to correct a ventricular septal defect (VSD). The nurse ' s best response is: 1. "It is always helpful to get a second opinion about any serious condition like this." 2. "Your baby's defect is small and will likely close on its own by 1 year of age." 3. "It is common for health-care providers to wait until an infant develops respiratory distress before they do the surgery." 4. "With a small defect like this, they wait until the child is 10 years old to do the surgery."

2. Usually a VSD will close on its own within the first year of life.

When assessing a child after heart surgery to correct tetralogy of Fallot, which of the following should alert the nurse to suspect a low cardiac output? 1. Bounding pulses and mottled skin. 2. Altered level of consciousness and thready pulse. 3. Capillary refill of 2 seconds and blood pressure of 96/67 mm Hg. 4. Extremities warm to the touch and pale skin

2. With a low cardiac output and subsequent poor tissue perfusion, signs and symptoms would include pale, cool extremities; cyanosis; weak, thready pulses; delayed capillary refi ll; and decrease in level of consciousness.

A 5-year-old child with burns on the trunk and arms has no appetite. The nurse and mother develop a plan of care to stimulate the child's appetite. Which of the following suggestions made by the mother would indicate that she needs additional teaching? 1. Deciding that she will feed the child herself. 2. Withholding dessert and treats unless meals are eaten. 3. Offering the child finger foods that the child likes. 4. Serving smaller and more frequent meals.

2. Withholding certain foods until the child complies is punitive and rarely successful. Allowing the mother to feed the child, serving smaller and more frequent meals, and offering finger foods are all acceptable interventions for a 5-year-old child. This is true whether the child is well or ill.

The family of a young child has been told the child has diabetes insipidus (DI). What information should the nurse emphasize to the family? 1. One caregiver needs to learn to give the injections of vasopressin. 2. Children should wear MedicAlert tags if they are over 5 years old. 3. Diabetes insipidus is different from diabetes mellitus. 4. Over time, the child may grow out of the need for medication

3 Explaining that DI is different from DM is crucial to the parents 'understanding of the management of the disease. DI is a rare condition that affects the posterior pituitary gland, whereas DM is a more common condition that affects the pancreas

Which of the following is the most effective treatment for pain in a child with sickle cell crisis? Select all that apply. 1. Meperidine (Demerol). 2. Aspirin. 3. Morphine. 4. Behavioral techniques. 5. Acetaminophen (Tylenol) with codeine.

3, 4, 5 Morphine is the drug of choice for a child with sickle cell crises. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine. When that is not sufficient to alleviate pain, stronger narcotics are prescribed, such as morphine. Ketorolac (Toradol) may be indicated for short-term use for moderate-severe pain. Behavioral techniques such as positive self-talk, relaxation, distraction, and guided imagery are helpful when pain is occurring. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine when pain is described as mild to moderate.

Which signs best indicate increased intracranial pressure (ICP) in an infant? Select all that apply. 1. Sunken anterior fontanel. 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite. 5. Sleeping more than usual

3, 5 A high-pitched cry is often indicative of increased ICP in infants. The infant may be sleeping more than usual because of increased ICP.

Which statement by the mother of a child with rheumatic fever (RF) shows she has good understanding of the care of her child? Select all that apply. 1. "I will apply heat to his swollen joints to promote circulation." 2. "I will have him do gentle stretching exercises to prevent contractures." 3. "I will give him his ordered anti-inflammatory medication for pain and inflammation." 4. "I will apply cold packs to his swollen joints to reduce pain." 5. "I will take my child every month to the health-care provider's office for his penicillin shot."

3, 5 Anti-inflammatory medications are the drugs of choice for treatment of RF because RF is a systemic inflammatory disease that can follow strep infections. The parent will take the child to the clinic monthly for a penicillin injection to prevent recurrent strep infections.

The nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems is (are) associated with sickle cell disease? Select all that apply. 1. Polycythemia. 2. Hemarthrosis. 3. Aplastic crisis. 4. Thrombocytopenia. 5. Vaso-occlusive crisis.

3, 5 Aplastic crisis, temporary cessation of red blood cell production, is associated with sickle cell anemia. Vaso-occlusive crisis is the most common problem in children with sickle cell disease

The nurse should tell the parents of a child with Duchenne (pseudohypertrophic) muscular dystrophy that some of the progressive complications include: Select all that apply. 1. Dry skin and hair, hirsutism, protruding tongue, and mental retardation. 2. Anorexia, gingival hyperplasia, dry skin and hair. 3. Contractures, obesity, and pulmonary infections. 4. Trembling, frequent loss of consciousness, and slurred speech. 5. Increasing difficulty swallowing and shallow breathing.

3, 5 The major complications of muscular dystrophy include contractures, disuse atrophy, infections, obesity, respiratory complications, and cardiopulmonary problems. The muscles of a child with MD tend to show increasing weakness and atrophy over time. The children are at risk for swallowing, aspiration, and pneumonia

Which should be included in teaching a family about postsurgical care for slipped capital femoral epiphysis (SCFE)? Select all that apply. 1. The client will receive help with weight-bearing ambulation 24 to 48 hours after surgery. 2. Monitoring of pain medication to prevent drug dependence. 3. Instruction on pin site care. 4. Offering low-calorie meals to encourage weight loss. 5. Correct use of crutches by the client. 6. Exercises to strengthen hip and leg muscles.

3, 5, 6. The parents will be assessing pin sites for infection and stability upon discharge. Instructions on care should be demonstrated for and then by the parents. Instruction on crutch usage will be given prior to discharge. Crutch walking will not be done during the early postoperative stage. The physical therapist will give the client exercises to strengthen the hip and leg muscle

Which would the nurse expect to assess on a 3-week-old infant with developmental dysplasia of the hip (DDH)? Select all that apply. 1. Excessive hip abduction. 2. Femoral lengthening of an affected leg. 3. Asymmetry of gluteal and thigh folds. 4. Pain when lying prone. 5. Positive Ortolani test

3, 5. In DDH, asymmetrical thigh and gluteal folds are frequently present. 5. The Ortolani maneuver moves a dislocated hip back into the socket with a distinct clunk

During a developmental screening, the nurse finds that a 3-year-old child with cerebral palsy has arrested social and language development. The nurse tells the family: 1. "This is a sign the cerebral palsy is progressing." 2. "Your child has reached his maximum language abilities." 3. "I need to refer you for more developmental testing." 4. "We need to modify your therapy plan."

3. It is important to identify primary developmental delays in children with cerebral palsy and to prevent secondary and tertiary delays. The arrested development is worrisome and requires further investigation. It is possible the lack of development indicates hearing loss or may be a sign of autism. The brain damage caused by cerebral palsy is not progressive. The brain of a young child is quite plastic; assuming the child's development has peaked at age 3 would be a serious mistake. The therapy plan will need to be modifi ed, but a better understanding of the underlying problem will lead to the greatest chance of creating a successful therapy plan

When teaching the family of an older infant who has had a hip spica cast applied for developmental dysplasia of the hip, which information should the nurse include when describing the abduction stabilizer bar? 1. It can be adjusted to a position of comfort. 2. It is used to lift the child. 3. It adds strength to the cast. 4. It is necessary to turn the child.

3. The abduction bar is incorporated into the cast to increase the cast's strength and maintain the legs in alignment. The bar cannot be removed or adjusted, unless the cast is removed and a new cast is applied. The bar should never be used to lift or turn the client, because doing so may weaken the cast.

A preschooler with a fractured femur of the left leg in traction tells the nurse that his leg hurts. It is too early for pain medication. The nurse should: 1. Place a pillow under the child's buttocks to provide support. 2. Remove the weight from the left leg. 3. Assess the feet for signs of neurovascular impairment. 4. Reposition the pulleys so the traction is looser.

3. The nurse should assess the client frequently for signs of neurovascular impairment of the feet, such as pallor, coldness, numbness, or tingling. Pillows are not placed under the buttocks because the pillows would alter the alignment of the traction. Weights provide traction and should not be removed. Pulleys help to maintain optimal alignment of the traction and therefore should be left alone.

After teaching the parents of an infant with clubfoot requiring application of a plaster cast how to care for the cast, which of the following statements would indicate that the parents have understood the teaching? 1. "If the cast becomes soiled, we'll clean it with soap and water." 2. "We'll elevate the leg with the cast on pillows, so the leg is above heart level." 3. "We will check the color and temperature of the toes of the casted leg frequently." 4. "The petals on the edge of the cast can be removed after the first 24 hours."

3. A cast that is too tight can cause a tourniquet effect, compromising the neurovascular integrity of the extremity. Manifestations of neurovascular impairment include pain, edema, pulselessness, coolness, altered sensation, and inability to move the distal exposed extremity. The toes of the casted extremity should be assessed frequently to evaluate for changes in neurovascular integrity. Wetting a plaster cast with water and soap softens the plaster, which may alter the cast's effectiveness. There is no reason to elevate the casted extremities when a child with clubfoot is being treated with nonsurgical measures. The legs would be elevated if swelling were present. Petals, which are applied to cover the rough edges of the cast, are to be left in place to minimize the risk for skin irritation from the cast edges

A 13-year-old child has seen the school nurse several times with headache, vomiting, and difficulty walking. When calling the adolescent's mother about these symptoms, what should the nurse suggest the mother do first? 1. Schedule an appointment with the eye doctor. 2. Begin psychological counseling for her adolescent. 3. Make an appointment with the adolescent's physician. 4. Meet with the adolescent's teachers to determine academic progress.

3. A child who has symptoms of vomiting, headaches, and problems walking needs to be evaluated by a health care provider to determine the cause. Unexplained headaches and vomiting along with complaints of difficulty walking (e.g., ataxia) may suggest a brain tumor. Evaluation by an eye doctor would be appropriate once a complete medical evaluation has been accomplished. Psychological counseling may be indicated for this adolescent, but only after medical evaluation to determine that she is physically healthy. Meeting with the child's teachers would be appropriate after medical evaluation.

When caring for a child with moderate burns from the waist down, which of the following should the nurse do when positioning the child? 1. Place the child in a position of comfort. 2. Allow the child to lie on the abdomen. 3. Ensure the application of leg splints. 4. Have the child flex the hips and knees.

3. A child with moderate burns is at high risk for contractures. A position of comfort would encourage contracture formation. Therefore, splints need to be applied to maintain proper positioning and joint function, thereby preventing contractures and loss of function. Allowing the child to lie on the abdomen or with hips and knees flexed often encourages contracture formation

While preparing to examine a 6-week-old infant's scrotal sac and testes for possible undescended testes, which of the following would be most important for the nurse to do? 1. Check the diaper for recent urination. 2. Give the infant a pacifier. 3. Ensure that the room is kept warm. 4. Tap lightly on the left inguinal ring.

3. A cold environment can cause the testes to retract. Cold and touch stimulate the cremasteric refl ex, which causes a normal retraction of the testes toward the body. Therefore, the nurse should warm the hands and make sure that the environment also is warm. Checking the diaper for urination provides information about the infant's voiding and urinary function, not information about the testes. Giving the infant a pacifi er may help to calm the infant and possibly make the examination easier, but the concern here is with the temperature of the environment. Tapping on the inguinal ring would not be helpful in assessing the infant.

To treat a common manifestation of Reye syndrome, which medication would the nurse expect to have readily available? 1. Furosemide (Lasix). 2. Insulin. 3. Glucose. 4. Morphine.

3. A common manifestation is hypoglycemia, which is treated with the administration of intravenous glucose.

A 10-year-old with scoliosis has to wear a brace. The nurse should develop a teaching plan with the client to include which of the following instructions? 1. Wear the brace during waking hours. 2. Use lotions to relieve skin irritations. 3. Wear a form-fitting, sleeveless T-shirt under the brace. 4. Bathe the skin under the brace once per week.

3. A form-fitting, sleeveless T-shirt can be worn under the brace to prevent skin irritation and collect perspiration. Braces are worn 23 hours each day. Lotions may cause irritation and should not be used. The skin under the brace should be bathed daily to help prevent irritation from the brace. The brace can be removed for bathing so all the skin can be bathed

The physician orders a urinalysis for a child who has undergone surgical repair of a hypospadias. Which of the following results should the nurse report to the physician? 1. Urine specific gravity of 1.017. 2. Ten red blood cells per high-powered field. 3. Twenty-five white blood cells per highpowered field. 4. Urine pH of 6.0.

3. A normal white blood cell count in a urinalysis is 1 to 2 cells/mL. A white blood cell count of 25 per high-powered fi eld indicates a urinary tract infection. A urine specific gravity of 1.017 is within the normal range of 1.002 to 1.030. After urologic surgery, it is not unusual for a small number of red blood cells to appear in the urine. The child's urine pH is within the normal range of 4.6 to 8. C

Select the best room assignment for a newly admitted child with bacterial meningitis. 1. Semiprivate room with a roommate who also has bacterial meningitis. 2. Semiprivate room with a roommate who has bacterial meningitis but has received intravenous antibiotics for more than 24 hours. 3. Private room that is dark and quiet with minimal stimulation. 4. Private room that is bright and colorful and has developmentally appropriate activities available.

3. A quiet private room with minimal stimulation is ideal because the child with meningitis should be in a quiet environment to avoid cerebral irritation

When teaching an adolescent with a seizure disorder who is receiving valproic acid (Depakene), which sign or symptom should the nurse instruct the client to report to the health care provider? 1. Three episodes of diarrhea. 2. Loss of appetite. 3. Jaundice. 4. Sore throat

3. A toxic effect of valproic acid (Depakene) is liver toxicity, which may manifest with jaundice and abdominal pain. If jaundice occurs, the client needs to notify the health care provider as soon as possible. Diarrhea and sore throat are not common side effects of this drug. Increased appetite is common with this drug.

After a child undergoes a craniotomy for an infratentorial brain tumor, the nurse should place the child in which of the following positions to prevent undue strain on the sutures? 1. Prone. 2. Semi-Fowler's. 3. Side-lying. 4. Trendelenburg

3. After surgery for an infratentorial tumor, the child is usually positioned flat on either side, with the head and neck in midline and the body slightly extended. Pillows against the back, not the head, help maintain position. Such a position helps avoid pressure on the operative site. Placing the child in a prone or semi-Fowler's position will cause pressure on the operative site. The Trendelenburg position is usually contraindicated because keeping the head below the level of the heart increases intracranial pressure as well as the risk of hemorrhage

The nurse is caring for a child receiving radiation therapy for a brain tumor. The parents ask if their child will likely have any learning disabilities. Select the nurse's best answer. 1. "All children who receive radiation have some amount of learning disability. As long as they receive extra tutoring, they usually do well in school." 2. "Because your child is so young, she will likely do well and have no problems in the future." 3. "Response varies with each child, but younger children who receive radiation tend to have some amount of learning disability later in life." 4. "Response varies with each child, but younger children who receive radiation tend to have fewer problems later in life than older children."

3. Although variable, younger children tend to experience more learning difficulties than do older children

A newborn with a repaired myelomeningocele is assessed for hydrocephalus. Which would the nurse expect in an infant with hydrocephalus? 1. Low-pitched cry and depressed fontanel. 2. Low-pitched cry and bulging fontanel. 3. Bulging fontanel and downwardly rotated eyes. 4. Depressed fontanel and upwardly rotated eyes.

3. An alteration in the circulation of the cerebrospinal fluid causes hydrocephalus. The anterior fontanel bulges because of an increase in cerebrospinal fluid, and an increase in intracranial pressure causes a high-pitched cry in infants and downward deviation of the eyes, also called sunset eyes. With sunset eyes, the sclera can be seen above the iris

The parents of a child with a serious head injury ask the nurse if the child is going to be all right. Which of the following responses by the nurse would be most appropriate? 1. "Children usually don't do very well after head injuries like this." 2. "Children usually recover rapidly from head injuries." 3. "It's hard to tell this early, but we'll keep you informed of the progress." 4. "That's something you'll have to talk to the doctor about."

3. As a rule, children demonstrate more rapid and more complete recovery from coma than do adults. However, it is extremely difficult to predict a specific outcome. Reassuring the parents that they will be kept informed helps open lines of communication and establish trust. Telling the parents that children do not do well would be extremely negative, destroying any hope that the parents might have. Telling the parents that children recover rapidly may give the parents false hopes. Telling the parents to talk to the doctor ignores the parents' concerns and interferes with trust-building

A child fell off his bike and sustained a closed-head injury. The child is currently awake and alert, but his mother states that he "passed out" for approximately 2 minutes. The mother appears highly anxious and is very tearful. The child was not wearing a helmet. Which is a priority for the triage nurse to say at this time? 1. "Was anyone else injured in the accident?" 2. "Tell me more about the accident." 3. "Did he vomit, have a seizure, or display any other behavior that was unusual when he woke up?" 4. "Why was he not wearing a helmet?"

3. Asking specific questions will give the nurse the information needed to determine the level of care for the child.

After the nurse teaches the mother of a child with atopic dermatitis how to bathe her child, which of the following statements by the mother indicates effective teaching? 1. "I let my child play in the tub for 30 minutes every night." 2. "My child loves the bubble bath I put in the tub." 3. "When my child gets out of the tub I just pat the skin dry." 4. "I make sure my child has a bath every night."

3. Atopic dermatitis is a chronic pruritic dermatitis that usually begins in infancy. Many of the children diagnosed with it have a family history of eczema, allergies, or asthma. Atopic dermatitis is best treated with hydrating the skin, controlling the pruritus, and preventing secondary infection. Patting the skin dry removes less natural skin moisturizer and thus maintains skin hydration. Water has a drying effect on the skin. Playing in the tub for 30 minutes each night would deplete the skin of its natural moisturizers, thereby leading to increased pruritus and dry skin. Bubble baths are to be avoided in children with atopic dermatitis because they may act as an irritant, possibly exacerbating the condition. Also, bubble baths deplete the skin of its natural moisturizers. The issue is not whether the child bathes every night. Rather, the goal is to decrease dryness and itching

The nurse prepares baclofen for a child with cerebral palsy (CP) who just had her hamstrings surgically released. The child ' s parents ask what the medication is for. Select the nurse's best response. 1. "It is a medication that will help decrease the pain from her surgery." 2. "It is a medication that will prevent her from having seizures." 3. "It is a medication that will help control her spasms." 4. "It is a medication that will help with bladder control."

3. Baclofen is given to help control the spasms associated with CP.

Which is an important nursing intervention for a child with a diagnosis of hyperthyroidism? 1. Encourage an increase in physical activity. 2. Do preoperative teaching for thyroidectomy. 3. Promote opportunities for periods of rest.4. Do dietary planning to increase caloric intake.

3. Because increased activity is characteristic of hyperthyroidism, providing opportunity for rest is a recommended nursing intervention.

When planning home care for the child with Legg-Calvé-Perthes disease, what should be the primary focus for family teaching? 1. Need for intake of protein-rich foods. 2. Gentle stretching exercises for both legs. 3. Management of the corrective appliance. 4. Relaxation techniques for pain control.

3. Because most of the child's care takes place at home, the primary focus of family teaching would be on the care and management of the corrective device. Devices such as an abduction brace, a leg cast, or a harness sling are used to protect the affected joint while revascularization and bone healing occur. As long as the child is eating a well-balanced diet, there is no need for an intake of protein-rich foods. The parents can encourage range of motion in the unaffected leg, but motion in the affected leg is limited until it heals. Once therapy has been initiated, pain is usually not a problem. The key is management of the corrective device.

When developing the discharge plan for a child who had a nephrectomy for a Wilms' tumor, the nurse identifies outcomes to prevent damage to the child's remaining kidney and accomplish which of the following? 1. Minimize pain. 2. Prevent dependent edema. 3. Prevent urinary tract infection. 4. Minimize sodium intake

3. Because the child has only one kidney, measures should be recommended to prevent urinary tract infection and injury to the remaining kidney. Severe pain and dependent edema are not associated with surgery for Wilms' tumor. Dietary sodium is not restricted because function in the remaining kidney is not impaired.

An adolescent with a history of surgical repair for an undescended testis comes to the clinic for a sports physical. Anticipatory guidance for the parents and adolescent should focus on which of the following as most important? 1. The adolescent's sterility. 2. The adolescent's future plans. 3. Technique for monthly testicular self examinations. 4. Need for a lot of psychological support.

3. Because the incidence of testicular cancer is increased in adulthood among children who have had undescended testes, it is extremely important to teach the adolescent how to perform the testicular self-examination monthly. The undescended testicle is removed to reduce the risk of cancer in that testicle. Removal of a testis would not necessarily make the adolescent sterile because the other testicle remains. Although discussing the adolescent's future plans is important, it is not the priority at this time. Because the adolescent has been dealing with the situation for a long time, the need for a sports physical at this time should not be a cause of emotional distress requiring a lot of psychological support.

When teaching a preschool-age child how to perform coughing and deep-breathing exercises before corrective surgery for tetralogy of Fallot, which of the following teaching and learning principles should the nurse address first? 1. Organizing information to be taught in a logical sequence. 2. Arranging to use actual equipment for demonstrations. 3. Building the teaching on the child's current level of knowledge. 4. Presenting the information in order from simplest to most complex.

3. Before developing any teaching program for a child, the nurse's first step is to assess the child to determine what is already known. Most older preschool children have some understanding of a condition present since birth. However, the child's interest will soon be lost if familiar material is repeated too often. The nurse can then organize the information in a sequence, because there are several steps to be demonstrated. These exercises do not require the use of equipment. The nurse should judge the amount and complexity of the information to be provided, based on the child's current knowledge and response to teaching.

When positioning a neonate with an unrepaired myelomeningocele, which of the following positions is most appropriate? 1. Supine with the hips at 90-degree flexion. 2. Right side-lying position with the knees flexed. 3. Prone with hips in abduction. 4. Supine in semi-Fowler's position with chest and abdomen elevated

3. Before surgery, the infant is kept flat in the prone position to decrease tension on the sac. This allows for optimal positioning of the hips, knees, and feet because orthopedic problems are common. The supine position is unacceptable because it causes pressure on the defect. Flexing the knees when side lying will increase tension on the sac, as will placing the infant in semi-Fowler's position, even though the chest and abdomen are elevated.

Which is most important to discuss with an adolescent who is going to have a leg amputation for osteosarcoma? 1. Pain. 2. Spirituality. 3. Body image. 4. Lack of coping

3. Body image is a developmental issue for adolescents and influences their acceptance of themselves and by peers.

The nurse explains to the parents of a 1-yearold child admitted to the hospital in sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following? 1. Autoimmune reaction complicated by hypoxia. 2. Lack of oxygen in the red blood cells. 3. Obstruction to circulation. 4. Elevated serum bilirubin concentration

3. Characteristic sickle cells tend to cause "log jams" in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis. The basic defect in sickle cell disease is an abnormality in the structure of the red blood cells. The erythrocytes are sickle-shaped, rough in texture, and rigid. Sickle cell disease is an inherited disease, not an autoimmune reaction. Elevated serum bilirubin concentrations are associated with jaundice, not sickle cell disease.

The parent of a 3-week-old states that the infant was recasted this morning for clubfoot and has been crying for the past hour. Which intervention should the nurse suggest the parent do first? 1. Give pain medication. 2. Reposition the infant in the crib. 3. Check the neurocirculatory status of the foot. 4. Use a cool blow-dryer to blow into the cast to control itching.

3. Checking the neurocirculatory status of the foot is the highest priority.

Family discharge teaching has been effective when the parent of a toddler diagnosed with Kawasaki disease (KD) states: 1. "The arthritis in her knees is permanent. She will need knee replacements." 2. "I will give her diphenhydramine (Benadryl) for her peeling palms and soles of her feet." 3. "I know she will be irritable for 2 months after her symptoms started." 4. "I will continue with high doses of Tylenol for her infl ammation."

3. Children can be irritable for 2 months after the symptoms of the disease start

A 12-year-old diagnosed with scoliosis is to wear a brace for 23 hours a day. What is the most likely reason the child will not wear it for that long? 1. Pain from the brace. 2. Difficulty in putting the brace on. 3. Self-consciousness about appearance. 4. Not understanding what the brace is for.

3. Children this age are very conscious of their appearance and fitting in with their peers, so they might be very resistant to wearing a brace

Which of the following statements by the mother of an infant with a repaired upper lumbar myelomeningocele indicates that she understands the nurse's teaching at the time of discharge? 1. "I can apply a heating pad to his lower back." 2. "I'll be sure to keep him away from other children." 3. "I will call the doctor if his urine has a funny smell." 4. "I will prop him on pillows to keep him from rolling over."

3. Children with a myelomeningocele are prone to urinary tract infections (UTI) and foul smelling urine is one symptom of a UTI. Because of the level of defect, the child may be insensitive to pressure or heat. Using a heating pad may lead to thermal injury because the child may not be able to sense if the pad is too hot. Keeping the child away from other children is unnecessary and can retard social development. Using pillows as props increases the risk of sudden infant death syndrome

A 12-year-old with leukemia is receiving cyclophosphamide (Cytoxan). The nurse should assess for the adverse effect of: 1. Photosensitivity. 2. Ataxia. 3. Cystitis. 4. Cardiac arrhythmias.

3. Cystitis is a potential adverse effect of cyclophosphamide. The client should be monitored for pain on urination. Photosensitivity, ataxia, and cardiac arrhythmias are not adverse effects associated with cyclophosphamide.

The nurse should instruct the family of a child with newly diagnosed hyperthyroidism to: 1. Keep their home warmer than usual. 2. Encourage plenty of outdoor activities. 3. Promote interactions with one friend instead of groups. 4. Limit bathing to prevent skin irritation.

3. Children with hyperthyroidism experience emotional labiality that may strain interpersonal relationships. Focusing on one friend is easier than adapting to group dynamics until the child's condition improves. Because of their high metabolic rate, children with hyperthyroidism complain of being too warm. Bright sunshine may be irritating because of disease-related ophthalmopathy. Sweating is common and bathing should be encouraged

A preschooler with a history of repaired lumbar myelomeningocele is in the emergency department with wheezing and skin rash. Which of the following questions should the nurse ask the mother first? 1. "Is your child taking any medications?" 2. "Who brought your child to the emergency department?" 3. "Is your child allergic to bananas or milk products?" 4. "What are you doing to treat your child's skin rash?

3. Children with myelomeningocele are at high risk for development of latex allergy because of repeated exposure to latex products during surgery and bladder catheterizations. Cross-reactions to food items such as bananas, kiwi, milk products, chestnuts, and avocados also occur. These allergic reactions vary in severity ranging from mild (such as sneezing) to severe anaphylaxis. While the child could have allergies to medications that caused the wheezing, the latex and food allergies are more common. Asking about the skin rash is not a priority when a child is wheezing. Who brought the child to the emergency department is irrelevant at this time.

The parent of a child diagnosed with Wilms tumor asks the nurse what the treatment plan will be. The nurse explains the usual protocol for this condition. Which information should the nurse give to the parent? 1. The child will have chemotherapy and, after that has been completed, radiation. 2. The child will need to have surgery to remove the tumor. 3. The child will go to surgery for removal of the tumor and the kidney and will then start chemotherapy. 4. The child will need radiation and later surgery to remove the tumor.

3. Combination therapy of surgery and chemotherapy is the primary therapeutic management. Radiation is done depending on clinical stage and histological pattern

After teaching a group of school teachers about seizures, the teachers role-play a scenario involving a child experiencing a generalized tonic-clonic seizure. Which of the following actions, when performed first, indicates that the nurse's teaching has been successful? 1. Asking the other children what happened before the seizure. 2. Moving the child to the nurse's office for privacy. 3. Removing any nearby objects that could harm the child. 4. Placing a padded tongue blade between the child's teeth

3. During a generalized tonic-clonic seizure, the first priority is to keep the child safe and protect the child by removing any nearby objects that could cause injury. Although obtaining information about events surrounding the seizure is important, this information can be obtained later, once the child's safety is ensured. During a seizure, the child should not be moved. Although providing privacy is important, the child's safety is the priority. During a seizure, nothing should be forced into the client's mouth because this can cause severe damage to the teeth and mouth

A teen is seen in clinic for a possible diagnosis of Hodgkin disease. The nurse is aware that which of the following symptoms should make the health-care provider suspect Hodgkin disease? 1. Fever, fatigue, and pain in the joints. 2. Anorexia with weight loss. 3. Enlarged, painless, and movable lymph nodes in the cervical area. 4. Enlarged liver with jaundice.

3. Enlarged, painless, and movable lymph nodes in the cervical area are the most common presenting manifestations of Hodgkin disease.

The nurse in the emergency department is caring for a 3-year-old child with a fractured humerus. The child is crying and screaming, "I hate you." Which of the following would be most appropriate? 1. Tell the parents they will need to wait out in the lobby. 2. Ask the charge nurse to assign this client to another nurse. 3. Reassure the parents that this a normal behavior under the circumstances. 4. Ask the parents to discipline the child so that the physician can treat her.

3. Explaining to the parents that this is a normal reaction under the circumstances is most appropriate. The child's outburst is related to the child's fears of the unknown. The child is scared and anxious and needs the parents for support. Asking the parents to wait outside would only add to the child's fear and anxiety. The reaction is normal for a child her age and does not usually call for a change in staff assignments. Asking the parents to discipline their child for her behavior is inappropriate. The nurse needs to handle the situation.

A child with spastic CP had an intrathecal dose of baclofen (Lioresal) in the early afternoon. What is the expected result 3½ hours post-dose that suggests the child would benefit from a baclofen pump? 1. The ability to self-feed. 2. The ability to walk with little assistance. 3. Decreased spasticity. 4. Increased spasticity.

3. If baclofen (Lioresal) were to work for this child, one could tell because spasticity would be decreased.

Which of the following is the priority nursing diagnosis during a toddler's vasoocclusive sickle cell crisis? 1. Ineffective coping related to presence of a lifethreatening disease. 2. Decreased cardiac output related to abnormal hemoglobin formation. 3. Pain related to tissue anoxia. 4. Excess fluid volume related to infection

3. For the child in sickle cell crisis, Pain is the priority nursing diagnosis because the sickled cells clump and obstruct the blood vessels, leading to occlusion and subsequent tissue ischemia. Although Ineffective coping may be important, it is not the priority. Decreased cardiac output is not a problem with this type of vasoocclusive crisis. Typically, a sickle cell crisis can be precipitated by a fluid volume deficit or dehydration.

Which of the following should be done to protect the central nervous system from the invasion of malignant cells in a child newly diagnosed with leukemia? 1. Cranial and spinal radiation. 2. Intravenous steroid therapy. 3. Intrathecal chemotherapy. 4. High-dose intravenous chemotherapy.

3. Giving chemotherapy via lumbar puncture allows the drugs to get to the brain and helps prevent metastasis of the disease.

Which action should the nurse do first when noting clear drainage on the child's dressing and bed linen after a craniotomy for a brain tumor? 1. Change the dressing. 2. Elevate the head of the bed. 3. Test the fluid for glucose. 4. Notify the physician

3. Glucose in this clear, colorless fluid indicates the presence of cerebrospinal fluid. Excessive fluid leakage should be reported to the physician. The nurse should not change the dressing of a postoperative craniotomy client unless instructed to do so by the surgeon. Ordinarily, the head of the bed would not be elevated because this would put pressure on the sutures. The nurse should notify the physician after testing the fluid for glucose.

Anticipating that a 3-year-old child in traction will have need for diversion, what should the nurse offer the child? Synthesize 1. A video game. 2. Blocks. 3. Hand puppets. 4. Marbles.

3. Hand puppets would enable a 3-year-old child in traction to act out feelings within the constraints imposed by the traction. A 3-year-old needs creative play. The video game would make the child too active in bed and does not meet the child's developmental need for creative play. Blocks would be more appropriate for a younger child. Marbles are unsafe at this age because they can be swallowed.

Which of the following medication orders to help relieve discomfort in a child with leukemia should the nurse question? 1. Acetaminophen (Tylenol). 2. Acetaminophen with codeine (Tylenol with Codeine). 3. Ibuprofen (Motrin). 4. Propoxyphene hydrochloride (Darvon).

3. Ibuprofen prolongs bleeding time and is contraindicated in clients with leukemia. Non-narcotic drugs other than ibuprofen or aspirin, such as acetaminophen (Tylenol), may be prescribed to control pain. Narcotic analgesics, such as acetaminophen with codeine or propoxyphene hydrochloride, may be required when pain is severe.

When caring for an infant who has undergone surgical repair of a myelomeningocele, which of the following should the nurse report to the surgeon? 1. Seizures and vomiting. 2. Frontal bossing and sunset eyes. 3. Increased head circumference and bulging fontanel. 4. Irritability and shrill cry.

3. In a neonate with open cranial sutures, increasing head circumference is the predominant and earliest sign of increased intracranial pressure and the nurse should report this to the surgeon. Bulging fontanels also are seen. However, some neonates may exhibit bulging fontanels without head enlargement. Seizures and vomiting are associated with hydrocephalus, but most often these are seen in an older child with closed cranial sutures. Shortly after increasing head circumference and bulging fontanels occur, other signs and symptoms, such as frontal bossing or enlargement with depressed eyes and the sunset sign (sclera visible above the iris), may develop. Although irritability is an early sign, a brief, shrill cry is a later sign of increasing intracranial pressure associated with the development of hydrocephalus

The nurse is caring for a 2-month-old infant who is at risk for cerebral palsy (CP) due to extreme low birth weight and prematurity. His parents ask why a speech therapist is involved in his care. Select the nurse ' s best response. 1. "Your baby is likely to have speech problems because of his early birth. Involving the speech therapist now will ensure vocalization at a developmentally appropriate age." 2. "The speech therapist will help with tongue and jaw movements to assist with babbling." 3. "The speech therapist will help with tongue and jaw movements to assist with feeding." 4. "Many members of the health-care team are involved in your child's care so that we will know if there are any unmet needs."

3. It is important to involve speech therapy to strengthen tongue and jaw movements to assist with feeding. The infant who is at risk for CP may have weakened and uncoordinated tongue and jaw movements

The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. Which is the nurse ' s best response? 1. "Circumcision is a fading practice and is now contraindicated in most children." 2. "Circumcision in children with hypospadias is recommended because it helps prevent infection." 3. "Circumcision is an option, but it cannot be done at this time." 4. "Circumcision can never be performed in a child with hypospadias."

3. It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may be needed for repair of the defect.

The parent of a 7-year-old voices concern over the child ' s continued bed-wetting at night. The parent, on going to bed, has tried getting the child up at 11:30 p.m., but the child still wakes up wet. Which is the nurse ' s best response about what the parent should do next? 1. "There is a medication called DDAVP that decreases the volume of the urine. The physician thinks that will work for your child." 2. "When your child wakes up wet, be very firm and indicate how displeased you are. Have your child change the sheets to see how much work is involved." 3. "Limit fluids in the evening and start a reward system in which your child can choose a reward after a certain number of dry nights." 4. "Bed-wetting alarms are readily available, and most children do very well with them."

3. Limiting the child's fluids in the evening will help decrease the nocturnal urge to void. Providing positive reinforcement and allowing the child to choose a reward will increase the child's sense of control

The physician has ordered intravenous mannitol (Osmitrol) for a child with a head injury. The best indicator that the drug has been effective is: 1. Increased urine output. 2. Improved level of consciousness. 3. Decreased intracranial pressure. 4. Decreased edema.

3. Mannitol is an osmotic diuretic used to reduce intracranial pressure. The use of the drug is controversial and should be reserved to cases which do not respond to other treatments or when brain herniation is likely. Children this sick should be on intracranial pressure (ICP) monitoring. The best indicator that the drug has produced the desired results is a reduction in the ICP. Improved levels of consciousness should follow reduced ICP. While the drug will cause increased urine output, that measurement in and of itself does not indicate successful treatment. Because the drug is being used for head injuries, not to improve urine output in acute renal failure, the child may not have visible edema

The parent of an infant with CP asks the nurse if the infant will be mentally retarded. Which is the nurse ' s best response? 1. "Children with CP have some amount of mental retardation." 2. "Approximately 20% of children with CP have normal intelligence." 3. "Many children with CP have normal intelligence." 4. "Mental retardation is expected if motor and sensory deficits are severe."

3. Many children with CP have normal intelligence.

Which medication should the nurse give to an infant diagnosed with transposition of the great vessels? 1. Ibuprofen (Motrin). 2. Betamethasone. 3. Prostaglandin E. 4. Indomethacin (Indocin).

3. Prostaglandin E inhibits closing of the PDA, which connects the aorta and pulmonary artery.

After 6 months of treatment with diet and exercise, a 12-year-old with type 2 diabetes still has a fasting blood glucose level of 140 mg/dL. The primary care provider has decided to begin metformin (Glucophage). The adolescent asks how the medication works. The nurse should tell the client that the medicine decreases the glucose production and: 1. Replaces natural insulin. 2. Helps the body make more insulin. 3. Increases insulin sensitivity. 4. Decreases carbohydrate adsorption.

3. Metformin is currently approved by the FDA to treat type 2 diabetes in children. The medication decreases glucogenesis in the liver and increases insulin sensitivity in the peripheral tissues. Only insulin can actually replace insulin. This treatment is reserved for clients with type 1 diabetes or those with type 2 who do not respond to diet, exercise, and an oral diabetic agent. Other oral medications used to treat diabetes augments insulin production or decreases carbohydrate absorption, but those medications are primarily used in adults.

Which action should the nurse take when providing postoperative nursing care to a child after insertion of a ventriculoperitoneal shunt? 1. Administer narcotics for pain control. 2. Check the urine for glucose and protein. 3. Monitoring for increased temperature. 4. Test cerebrospinal fluid leakage for protein.

3. Monitoring the temperature allows the nurse to assess for infection, the most common and most hazardous postoperative complication after ventroperitoneal shunt placement. Typically, pain after insertion of a ventriculoperitoneal shunt is mild, requiring the use of mild analgesics. Usually narcotics are not administered because they alter the level of consciousness, making assessment of cerebral function difficult. Neither proteinuria nor glycosuria is associated with shunt placement. Cerebrospinal fluid leakage commonly occurs with head injury. It is not usually associated with shunt placement

A nurse is developing a plan of care with the parents of a 6-year-old girl diagnosed with a seizure disorder. To promote growth and development, the nurse should instruct the parents that: 1. The child will need activity limitation and will be unable to perform as well as her peers. 2. There is potential for a learning disability and the child may need tutoring to reach her grade level. 3. The child will likely have normal intelligence and be able to attend regular school. 4. There will be problems associated with social stigma and parents should consider home schooling

3. Most children who develop seizures after infancy are intellectually normal. A child with a seizure disorder needs the same experiences and opportunities to develop intellectual, emotional, and social abilities as any other child. Activity limitation is not needed. Learning disabilities are not associated with seizures. The child is able to attend public school, and social stigma is a rarity.

An adolescent is to receive radioactive iodine for Graves' diseases. Which statement by the client reflects the need for more teaching? 1. "I plan to talk on Facebook since I have to keep several feet from my friends for 3 days." 2. "Taking radioactive iodine will not affect my ability to have children in the future." 3. "The advantage of radioactive iodine is that I will not need future medication for my disease." 4. "I should try to use a separate bathroom from the rest of my family for several days."

3. Most clients will need lifelong thyroid replacement after treatments with radioactive iodine. Most clients are treated as outpatients. To reduce the risk of exposure to radioactivity to others, clients are advised to avoid public places for at least 1 day and maintain a prudent distance from others for 2 to 3 days. Additionally, clients are advised to avoid close contact with pregnant women and children for 5 to 11 days. The use of radioiodine to treat Graves' disease has not been found to affect long-term fertility. Clients are taught not to share food, utensils, and towels. Use of a private bathroom is desirable. Clients are also instructed to flush the toilet more than one time after each use.

An 8-year-old with diabetes is placed on neutral protamine Hagedorn (NPH) and regular insulin before breakfast and before dinner. She will receive a snack of milk and cereal at bedtime. The snack will: 1. Help her regain lost weight. 2. Provide carbohydrates for immediate use. 3. Prevent late night hypoglycemia. 4. Help her stay on her diet.

3. NPH insulin peaks in 6 to 8 hours, which would occur during sleep. A bedtime snack is needed to prevent late night hypoglycemia. The snack is not given to help regain weight. Milk contains fat and protein which cause delayed absorption into the blood stream and maintains the blood glucose level at night when the NPH insulin will peak. The snack is not used to provide carbohydrates for immediate use because NPH insulin, unlike regular insulin, does not peak immediately. The snack has nothing to do with a diet

Where is the primary site of origin of the tumor in children who have neuroblastoma? 1. Bone. 2. Kidney. 3. Abdomen. 4. Liver.

3. Neuroblastoma tumors originate from embryonic neural crest cells that normally give rise to the adrenal medulla and the sympathetic nervous system. The majority of the tumors arise from the adrenal gland or from the retroperitoneal sympathetic chain. Therefore, the primary site is within the abdomen.

A 16-month-old child diagnosed with Kawasaki disease (KD) is very irritable, refuses to eat, and exhibits peeling skin on the hands and feet. The nurse should do which of the following first? 1. Apply lotion to the hands and feet. 2. Offer foods the toddler likes. 3. Place the toddler in a quiet environment. 4. Encourage the parents to get some rest.

3. One of the characteristics of children with KD is irritability. They are often inconsolable. Placing the child in a quiet environment may help quiet the child and reduce the workload of the heart. Although peeling of the skin occurs with KD, the child's irritability takes priority over applying lotion to the hands and feet. Children with KD usually are not hungry and do not eat well regardless of what is served. There is no indication that the parents need rest. Additionally, in this situation, the child takes priority over the parents

The nurse is examining an infant for hip placement and has abducted her flexed legs. The nurse should next: 1. Rotate the hips. 2. Extend the legs. 3. Listen for a "click." 4. Palpate the hips for a mass.

3. Ortolani's manipulation is used to detect congenital hip dysplasia. The infant is supine and a "click" is heard when flexed legs are abducted. This results from pressure causing the femoral head to slip out of the acetabulum. The other maneuvers will not determine the position of the femoral head in the acetabulum

A child in the PICU with a head injury is comatose and unresponsive. The parent asks if he needs pain medication. Select the nurse's best response. 1. "Pain medication is not necessary because he is unresponsive and cannot feel pain." 2. "Pain medication may interfere with his ability to respond and may mask any signs of improvement." 3. "Pain medication is necessary to make him comfortable." 4. "Pain medication is necessary for comfort, but we use it cautiously because it increases the demand for oxygen."

3. Pain medication promotes comfort and ultimately decreases ICP.

An adolescent girl with a seizure disorder controlled with phenytoin (Dilantin) and carbamazepine (Tegretol) asks the nurse about getting married and having children. Which of the following responses by the nurse would be most appropriate? 1. "You probably shouldn't consider having children until your seizures are cured." 2. "Your children won't necessarily have an increased risk of seizure disorder." 3. "When you decide to have children, talk to the doctor about changing your medication." 4. "Women who have seizure disorders commonly have a difficult time conceiving."

3. Phenytoin sodium (Dilantin) is a known teratogenic agent, causing numerous fetal problems. Therefore the adolescent should be advised to talk to the doctor about changing the medication. Additionally, anticonvulsant requirements usually increase during pregnancy. Seizures can be controlled but cannot be cured. There is a familial tendency for seizure disorders. Seizure disorders and infertility are not related

A preschooler with pneumonococci meningitis is receiving intravenous antibiotic therapy. When discontinuing the intravenous therapy, the nurse allows the child to apply a dressing to the area where the needle is removed. The nurse's rationale for doing so is based on the interpretation that a child in this age-group has a need to accomplish which of the following? 1. Trust those caring for her. 2. Find diversional activities. 3. Protect the image of an intact body. 4. Relieve the anxiety of separation from home.

3. Preschool-age children worry about having an intact body and become fearful of any threat to body integrity. Allowing the child to participate in required care helps protect her image of an intact body. Development of trust is the task typically associated with infancy. Additionally, allowing the child to apply a dressing over the intravenous insertion site is unrelated to the development of trust. Finding diversional activities is not a priority need for a child in this age group. Separation anxiety is more common in toddlers than in preschoolers.

Which does the nurse include in the postoperative plan of care for a child with myelomeningocele following ligament release? 1. Encourage the child to resume a regular diet, beginning slowly with bland foods that are easily digested, such as bananas. 2. Encourage the child to blow balloons to increase deep breathing and avoid postoperative pneumonia. 3. Assist the child to change positions to avoid skin breakdown. 4. Provide education on dietary requirements to prevent obesity and skin breakdown.

3. Preventing skin breakdown is important in the child with myelomeningocele because pressure points are not felt easily.

A child with Reye syndrome is described in the nurse ' s notes as follows: 1200— comatose with sluggish pupils; when stimulated, demonstrates decerebrate posturing. 1400—unchanged except that now demonstrates decorticate posturing when stimulated. The nurse concludes that the child ' s condition is: 1. Worsening and progressing to a more advanced stage of Reye syndrome. 2. Worsening, and the child may likely experience cardiac and respiratory failure. 3. Improving and progressing to a less advanced stage of Reye syndrome. 4. Improving because the child's posturing reflexes are similar

3. Progressing from decerebrate to decorticate posturing usually indicates an improvement in the child ' s condition.

Which statement by the mother of a child with rheumatic fever (RF) shows an understanding of prevention for her other children? 1. "Whenever one of them gets a sore throat, I will give that child an antibiotic." 2. "There is no treatment. It must run its course." 3. "If their culture is positive for group A Streptococcus, I will give them their antibiotic." 4. "If their culture is positive for Staphylococcus A, I will give them their antibiotic."

3. RF is caused by a streptococcal infection, not by Staphylococcus

An infant is scheduled for a hypospadias and chordee repair. The parent asks the nurse, "I understand why the hypospadias repair is necessary, but do they have to fix the chordee as well?" Which is the nurse ' s best response? 1. "I understand your concern. Parents do not want their children to undergo extra surgery." 2. "The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages." 3. "The repair is done to optimize sexual functioning when he is older." 4. "This is the best time to repair the chordee because he will be having surgery anyway."

3. Releasing the chordee surgically is necessary for future sexual function.

A 14-year-old is being screened for scoliosis. Which of the following statements about scoliosis screening is true? 1. Teenagers ages 14 to 16 should be screened yearly. 2. A shirt and shorts are worn for screening. 3. The girl is assessed standing and bending forward. 4. The girl should refrain from eating 8 hours before the examination.

3. Screening is done with the child wearing minimal clothing, standing and bending forward. The examination should be done on girls ages 10 to 12 years old so a diagnosis can be made early and the scoliosis can be treated with exercises or bracing. Only underwear should be worn for the examination so that symmetry of the shoulders and hips can be observed. If the deviation on the scoliometer is less than 20 degrees, no treatment is indicated. The child does not need to refrain from eating prior to this test

The nurse is developing a plan of care for a child recently diagnosed with cerebral palsy (CP). Which should be the nurse ' s priority goal? 1. Ensure the ingestion of sufficient calories for growth. 2. Decrease intracranial pressure. 3. Teach appropriate parenting strategies for a special-needs child. 4. Ensure that the child reaches full potential.

3. Teaching appropriate parenting strategies for a special-needs child is important and is done so that the child can maximize her personal skills and minimize her limitation

When developing the teaching plan for the mother and a child with insulin-dependent diabetes about sick-day management, which of the following instructions should the nurse include? 1. Adhere to the same schedule and type and amount of insulin. 2. Immediately call the physician for information about what to do. 3. Adjust insulin based on more frequent testing of blood glucose levels. 4. Take the child to the emergency department for immediate care.

3. Sick-day management requires more frequent monitoring of the child's blood glucose to evaluate for changes associated with a decreased intake and absorption of food, commonly associated with illness. Based on the child's glucose levels, insulin adjustments may be needed. In this case, regular insulin is used. Adhering to the same schedule, type, and amount of insulin is inappropriate because the child's ability to take in food and absorb nutrients can change rapidly. Typically, the child and parents are provided with specifi c instructions about sick-day management rules. Commonly the .physician will prescribe adjustments to insulin (e.g., on a sliding scale) based on the child's blood glucose levels. Therefore, calling the physician to report that the child is ill and ask what to do is inappropriate. However, the parents do need to notify the physician should any problems arise with management of the child's blood glucose levels. The child who can tolerate oral feedings of simple sugars can be kept at home as long as the parents monitor the child's blood glucose levels frequently for changes.

A child is diagnosed with stage IV rhabdomyosarcoma, and the parent asks what that means. The nurse provides which of the following explanations? 1. The tumor is limited to the organ site. 2. There is regional disease from the organ involved. 3. There is distant metastatic disease. 4. The disease is limited to the lymph nodes.

3. Stage IV disease means there is distant metastatic disease

Which would the nurse teach an adolescent is a complication of corticosteroids used in the treatment of juvenile idiopathic arthritis (JIA)? 1. Fat loss. 2. Adrenal stimulation. 3. Immune suppression. 4. Hypoglycemia.

3. Steroids cause immune suppression, which is the reason behind its use in JIA; it reduces the body ' s attack on itself

The nurse is explaining rhabdomyosarcoma cancer to an adolescent. From which of the following muscles does the cancer arise? 1. Skeletal. 2. Cardiac. 3. Striated. 4. Connective.

3. Striated muscle is in many organs and sites of the body, thus leading to the multiple sites of the disease.

The nurse caring for a 14-year-old girl with diabetes insipidus (DI) understands which of the following about this disorder? 1. DI is treated on a short-term basis with hormone replacement therapy. 2. DI may cause anorexia if proper meal planning is not addressed. 3. DI is treated with vasopressin on a lifelong basis. 4. DI requires strict fluid limitation until it resolves.

3. Vasopressin is the treatment of choice. It is important for patients and parents to understand that DI is a lifelong disease

The parent of a 17-year-old boy, who is hospitalized for complications related to type I diabetes, requests to review the adolescent's medical record. The client reported receiving mental health counseling during the admission history, but did not want his parent to know. The nurse, who is uncertain of how to protect the adolescent's privacy and accommodate the parent's request, should consult: 1. The unit nurse manager. 2. The primary care provider. 3. The organization's privacy officer. 4. The customer service representative.

3. The Health Insurance Portability and Accountability Act (HIPAA) specifi es that institutions designate a "privacy offi cer" who is responsible for developing and implementing privacy policies. This person or offi ce also handles HIPAA complaints. This would be the very best resource for the nurse to contact. Depending on the nurse manager's experience, he or she may or may not know the answer and may have to consult the privacy offi cer. While primary care providers would have an understanding of HIPAA, it is unlikely they understand the specifi cs of nursing policies. The customer service representatives typically address client concerns or complaints. At this time, the family has not voiced a complaint.

The nurse knows further education is needed about Reye syndrome when a mother states: 1. "I will have my children immunized against varicella and influenza." 2. "I will make sure not to give my child any products containing aspirin." 3. "I will give aspirin to my child to treat a headache." 4. "Children with Reye syndrome are admitted to the hospital."

3. The administration of aspirin or products containing aspirin has been associated with the development of Reye syndrome. A headache can be the first sign of a viral illness followed by other symptoms. It is best not to use aspirin or aspirin containing products in children.

Which would the nurse expect to find on assessment in a child with Wilms tumor? 1. Decreased blood pressure, increased temperature, and a fi rm mass located in one flank area. 2. Increased blood pressure, normal temperature, and a fi rm mass located in one flank area. 3. Increased blood pressure, normal temperature, and a fi rm mass located on one side of the midline of the abdomen. 4. Decreased blood pressure, normal temperature, and a fi rm mass located on one side or the other of the midline of the abdomen.

3. The blood pressure may be increased if there is renal damage. The mass will be located on one side or the other of the midline of the abdomen. There is no reason for the child ' s temperature to be affected.

The nurse is interviewing the parent of a 9-year-old girl. The parent expresses concern because the daughter already has pubic hair and is starting to develop breasts. Which statements would be most appropriate? 1. "Your daughter should get her period in approximately 6 months." 2. "Your daughter is developing early and should be evaluated for precocious puberty." 3. "Your daughter is experiencing body changes that are appropriate for her age." 4. "Your daughter will need further testing to determine the underlying cause." 5. "Your daughter will need sexual counseling now."

3. The changes described in the question are normal for a healthy 9-year-old female.

A hospitalized preschooler with meningitis who is to be discharged becomes angry when the discharge is delayed. Which of the following play activities would be most appropriate at this time? 1. Reading the child a story. 2. Painting with watercolors. 3. Pounding on a pegboard. 4. Stacking a tower of blocks.

3. The child is angry and needs a positive outlet for expression of feelings. An emotionally tense child with pent-up hostilities needs a physical activity that will release energy and frustration. Pounding on a pegboard offers this opportunity. Listening to a story does not allow the child to express emotions. It also places the child in a passive role and does not allow the child to deal with feelings in a healthy and positive way. Activities such as painting and stacking a tower of blocks require concentration and fi ne movements, which could add to frustration. However, if the child then knocks the tower over, doing so may help to dispel some of the anger.

A child diagnosed with Wilms' tumor undergoes successful surgery for removal of the diseased kidney. When the child returns to the room, the nurse should place the child in which position? 1. Modified Trendelenburg. 2. Sims'. 3. Semi-Fowler's. 4. Supine.

3. The child who has undergone abdominal surgery is usually placed in a semi-Fowler's position to facilitate draining of abdominal contents and promote pulmonary expansion. The modified Trendelenburg position is used for clients in shock. The Sims' position is likely to be uncomfortable for this child because of the large transabdominal incision. The supine position, without the head elevated, puts the child at increased risk for aspiration.

The parents of a child with meningitis and multiple seizures ask if the child will likely develop cerebral palsy (CP). Select the nurse's best response. 1. "When your child is stable, she'll undergo computed tomography (CT) and magnetic resolution imaging (MRI). The physicians will be able to let you know if she has CP." 2. "Most children do not develop CP at this late age." 3. "Your child will be closely monitored after discharge, and a developmental specialist will be able to make the diagnosis." 4. "Most children who have had complications following meningitis develop some amount of CP."

3. The child will be given a chance to recover and will be monitored closely before a diagnosis is made.

The parents of an 18-year-old preparing to enter college ask if their daughter should have the meningococcal (MCV4) vaccine. The nurse should tell the parents: 1. "It is only necessary to have the vaccine if your daughter will be living in a dormitory." 2. "Yes, we recommend the vaccine, but it needs to be given as a series of three injections." 3. "Let's review your records. The vaccine may have already been given a few years ago." 4. "We highly recommend this vaccine, but we will need to do a pregnancy screening fi rst."

3. The current recommendation is that the MCV4 vaccine be given at the earliest opportunity after the age of 11. Therefore, it is quite possible that the client received the vaccine at a previous visit and did not remember. On a college campus, students living in dormitories are at highest risk, but because it is difficult to target that group colleges may elect to require proof of vaccination for all incoming students. Other risk factors should also be considered, such as if the student plans to travel abroad. The vaccination is typically given as a single injection, but sometimes a second dose is recommended based on risk factors. The MCV4 is not a live vaccine. It may be given during pregnancy if the client is at risk.

A 5-year-old is admitted to the hospital with complaints of leg pain and fever. On physical examination, the child is pale and has bruising over various areas of the body. The health-care provider suspects that the child has ALL. The nurse informs the parent that the diagnosis will be confirmed by which of the following? 1. Lumbar puncture. 2. White blood cell count. 3. Bone marrow aspirate. 4. Bone scan.

3. The diagnostic test that confirms leukemia is microscopic examination of the bone marrow aspirate.

What should the nurse include when developing the teaching plan for the parents of a child with juvenile idiopathic arthritis who is being treated with naproxen (Naprosyn)? 1. Anti-inflammatory effect will occur in approximately 8 weeks. 2. Within 24 hours, the child will have antiinfl ammatory relief. 3. The nurse should be called before giving the child any over-the-counter medications. 4. If a dose is forgotten or missed, that dose is not made up.

3. The first group of drugs typically prescribed is the nonsteroidal anti-inflammatory drugs, which include naproxen. Naproxen is included in only a few over-the-counter medications but aspirin is in several. The family should check with the nurse before giving any over-the-counter medications. Once therapy is started, it takes hours or days for relief from pain to occur. However, it takes 3 to 4 weeks for the anti-inflammatory effects to occur, including reduction in swelling and less pain with movement. The missed dose will need to be made up to maintain the serum level and to maintain therapeutic effectiveness of the drug.

When interacting with the mother of a child who has Duchenne's muscular dystrophy, the nurse observes behavior indicating that the mother may feel guilty about her child's condition. The nurse interprets this behavior as guilt stemming from which of the following? 1. The terminal nature of the disease. 2. The dependent behavior of the child. 3. The genetic mode of transmission. 4. The sudden onset of the disease.

3. The guilt that mothers of children with muscular dystrophy commonly experience usually results from the fact that the disease is genetic and the mother transmitted the defective gene. Although many children die from the disease, the disease is considered chronic and progressive. As the disease progresses, the child becomes more dependent. However, guilt typically stems from the knowledge that the mother transmitted the disease to her son rather than the dependency of the child. The disease onset is usually gradual, not sudden.

The nurse is caring for a child who is receiving extensive radiation as part of the treatment for Hodgkin disease. Which intervention should be implemented? 1. Administer pain medication prior to the child ' s going to radiation therapy. 2. Assess the child for neuropathy since this is a common side effect. 3. Provide adequate rest, because the child may experience excessive malaise and lack of energy. 4. Encourage the child to eat a low-protein diet while on radiation therapy.

3. The most common side effect is extensive malaise, which may be from damage to the thyroid gland, causing hypothyroidism.

The mother asks the nurse whether her child with hemiparesis due to spastic cerebral palsy will be able to walk normally because he can pull himself to a standing position. Which of the following responses by the nurse would be most appropriate? 1. "Ask the doctor what he thinks at your next appointment." 2. "Maybe, maybe not. How old were you when you first walked?" 3. "It's difficult to predict, but his ability to bear weight is a positive factor." 4. "If he really wants to walk, and works hard, he probably will eventually."

3. The nurse needs to respond honestly to the mother. Most children with hemiparesis due to spastic cerebral palsy are able to walk because the motor deficit is usually greater in the upper extremity. There is no need to refer the mother to the physician. The age at which the mother walked may be important to elicit, but this does not influence when the child will walk. The will to walk is important, but without neurologic stability the child may be unable to do so.

A nurse is planning care for a 12-year-old with rheumatic fever. The nurse should teach the parents to: 1. Observe the child closely. 2. Allow the child to participate in activities that will not tire him. 3. Provide for adequate periods of rest between activities. 4. Encourage someone in the family to be with the child 24 hours a day.

3. The nurse should teach the parents to provide for sufficient periods of rest to decrease the client's cardiac workload. The client's condition does not warrant close observation unless cardiac complications develop. The child's activity level will be based on the results of the sedimentation rate, c-reactive protein, heart rate, and cardiac function. The family does not need to be with the client 24 hours a day unless carditis develops and his condition deteriorates.

The parent of a child with spastic cerebral palsy and a communication disorder tells the nurse, "He seems so restless. I think he is in pain." The nurse should: 1. Assess the child for pain using the Faces, Legs, Activity, Cry, Consolability (FLACC) scale. 2. Assess the child using the pediatric FACES scale. 3. Administer the pain medication which is ordered to be given as needed and assess the response. 4. Notify the primary care provider of the change in behavior.

3. The parent is the child's primary care provider and may be very in tune to subtle changes in the child's behavior. If the parent thinks the child is in pain, it is very likely to be so. The nurse should administer the pain medication and evaluate if the medication affected the child's behavior. The FLACC scale may be difficult to interpret when the child has spasticity. The FACES scale requires self report. The physician should be contacted regarding the change in behavior only if other available interventions are unsuccessful

The parent of a young child with CP brings the child to the clinic for a checkup. Which parent ' s statement indicates an understanding of the child ' s long-term needs? 1. "My child will need all my attention for the next 10 years." 2. "Once in school, my child will catch up and be like the other children." 3. "My child will grow up and need to learn to do things independently." 4. "I ' m the one who knows the most about my child and can do the most for my child."

3. The parent of a child with a disability should have the goal of assisting the child in achieving as much self-care as he is capable of, given his particular limitations

When developing the plan of care for a child with early Duchenne's muscular dystrophy, which of the following nursing goals is the priority? 1. Encouraging early wheelchair use. 2. Fostering social interactions. 3. Maintaining function of unaffected muscles. 4. Prevent circulatory impairment.

3. The primary nursing goal is to maintain function in unaffected muscles for as long as possible. There is no effective treatment for childhood muscular dystrophy. Children who remain active are able to forestall being confined in wheelchair. Remaining active also minimizes the risk for social isolation. Preventing rather than encouraging wheelchair use by maintaining function for as long as possible is an appropriate nursing goal. Children with muscular dystrophy become socially isolated as their condition deteriorates and they can no longer keep up with friends. Maintaining function helps prevent social isolation. Circulatory impairment is not associated with muscular dystrophy

The parent of a child with neuroblastoma asks the nurse what the typical signs and symptoms are at first. Select the nurse's best answer. 1. "Most children complain of abdominal fullness and difficulty urinating." 2. "Many children in the early stages of a neuroblastoma have joint pain and walk with a limp." 3. "The signs and symptoms vary depending on where the tumor is located, but typical symptoms include weight loss, abdominal distention, and fatigue." 4. "The signs and symptoms are fairly consistent regardless of the location of the tumor. They include fatigue, hunger, weight gain, and abdominal fullness."

3. The signs and symptoms vary depending on where the tumor is located, but typical symptoms include weight loss, abdominal distention, and fatigue.

The nurse is caring for an infant with myelomeningocele who is going to surgery later today for closure of the sac. Which would be a priority nursing diagnosis before surgery? 1. Alteration in parent-infant bonding. 2. Altered growth and development. 3. Risk of infection. 4. Risk for weight loss

3. The unrepaired myelomeningocele is oftentimes a thin membrane that covers the neural contents of the spine. A normal saline dressing is placed over the sac to prevent tearing. The tearing would allow the CSF to escape and microorganisms to enter. The infant is at high risk for spinal cord infections. The priority nursing diagnosis is risk of infection.

The nurse judges that the mother understands the term cerebral palsy when she describes it as a term applied to impaired movement resulting from which of the following? 1. Injury to the cerebrum caused by viral infection. 2. Malformed blood vessels in the ventricles caused by inheritance. 3. Nonprogressive brain damage caused by injury. 4. Inflammatory brain disease caused by metabolic imbalances.

3. The term cerebral palsy (CP) refers to a group of nonprogressive disorders of upper motor neuron impairment that result in motor dysfunction due to injury. In addition, a child may have speech or ocular difficulties, seizures, hyperactivity, or cognitive impairment. The condition of congenital malformed blood vessels in the ventricles is known as arteriovenous malformations. Viral infection and metabolic imbalances do not cause CP

A child diagnosed with a Wilms tumor is scheduled for an MRI scan of the lungs. The parent asks the nurse the reason for this test as a Wilms tumor involves the kidney, not the lung. Which is the nurse's best response? 1. "I ' m not sure why your child is going for this test. I will check and get back to you." 2. "It sounds like we made a mistake. I will check and get back to you." 3. "The test is done to check to see if the disease has spread to the lungs." 4. "We want to check the lungs to make sure your child is healthy enough to tolerate surgery."

3. The test is done to see if the disease has spread to the lungs.

During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which position? 1. Sitting. 2. Supine. 3. Squatting. 4. Standing.

3. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow

A 14-year-old has just had a plaster cast placed on his lower left leg. To provide safe cast care, the nurse should? 1. Petal the cast as soon as it is put on. 2. Keep the child in the same position for 24 hours until the cast is dry. 3. Use only the palms of the hand when handling the cast. 4. Notify the physician if the client complains of heat.

3. The wet plaster cast should be handled using only the palms of the hands to prevent indentations of the cast surface. Petaling a cast should be done only when the edges of the cast are rough and are causing irritation to the client's skin. The nurse should not keep the child in the same position until the cast is dry. Doing so would prohibit proper toileting and elimination and would produce undue pressure on the coccyx. The cast typically emits heat as it dries, so notifying a physician is not necessary in this instance. If needed, a fan can be used to circulate the room air

A 10-year-old has just spilled hot liquid on his arm, and a 4-inch area on his forearm is severely burned. His mother calls the emergency department. What should the nurse advise the mother to do? 1. Keep the child warm. 2. Cover the burned area with an antibiotic cream. 3. Apply cool water to the burned area. 4. Call 911 to transport the child to the hospital.

3. To prevent further injury to the skin, the mother should apply cool water to the burn site. Doing so causes vasoconstriction, retards further damage to tissues, and decreases fluid loss. Keeping the child warm promotes vasodilation, increases fluid loss, and decreases blood pressure and, thus, circulation to the area. Applying ointment to the burn is contraindicated because it does not allow healing to occur and may need to be removed in the hospital. Only a clean cloth should be used to cover the wound to prevent contamination or decrease pain or chilling. If only the arm is burned, a call to 911 for emergency care is not necessary, but the mother should seek health care services immediately.

A nurse is making an initial visit to a family with a 3-year-old child with early Duchenne's muscular dystrophy. Which of the following findings is expected when assessing this child? 1. Contractures of the large joints. 2. Enlarged calf muscles. 3. Difficulty riding a tricycle. 4. Small, weak muscles.

3. Usually the first clinical manifestations of Duchenne's muscular dystrophy include difficulty with typical age-appropriate physical activities such as running, riding a bicycle, and climbing stairs. Contractures of the large joints typically occur much later in the disease process. Occasionally enlarged calves may be noted, but they are not typical findings in a child with Duchenne's muscular dystrophy. Muscular atrophy and development of small, weak muscles are later signs

A 3-year-old child receiving chemotherapy after surgery for a Wilms' tumor has developed neutropenia. The parent is trying to encourage the child to eat by bringing extra foods to the room. Which food would not be appropriate for this child? 1. Fudge. 2. French fries. 3. Fresh strawberries. 4. A milk shake.

3. When a client receiving chemotherapy develops neutropenia, eating uncooked fruits and vegetables may pose a health risk due to possible bacterial contamination. All other foods are either cooked or pasteurized and would not produce a health risk.

When assessing an infant with an undescended testis, the nurse should be alert for which of the following? 1. Abnormal lower extremity reflexes. 2. A history of frequent emesis. 3. A bulging in the inguinal area. 4. Poor weight gain.

3. When an anomaly is found in one system, such as the genitourinary system, that system requires a more focused assessment to reveal other conditions that also may be occurring. A bulging in the inguinal area may suggest an inguinal hernia. Also, hydrocele or an upper urinary tract anomaly may occur on the same side as the undescended testis. A neuromuscular problem, not a genitourinary problem such as undescended testes, would most likely be the cause of abnormal lower extremity reflexes. A history of frequent emesis may be caused by pyloric stenosis or viral gastroenteritis. Poor weight gain might suggest a metabolic or feeding problem.

The parents of a neonate born with congenital clubfoot express feelings of helplessness and guilt, exhibiting anxiety about how the neonate will be treated. Which of the following actions by the nurse would be most appropriate initially? 1. Ask them to share these concerns with the physician. 2. Arrange a meeting with other parents whose infants have had successful clubfoot treatment. 3. Discuss the problem with the parents and the current feelings that they are experiencing. 4. Suggest that they make an appointment to talk things over with a counselor.

3. When an infant is born with an unexpected anomaly, parents are faced with questions, uncertainties, and possible disappointments. They may feel inadequate, helpless, and anxious. The nurse can help the parents initially by assessing their concerns and providing appropriate information to help them clarify or resolve the immediate problems. Referring the parents to the physician is not necessary at this time. The nurse can assist the parents by listening to their concerns. Having them talk with other parents would be helpful a little bit later, once the nurse assesses their concerns and discusses the problem and the parents' current feelings. If the parents continue to have difficulties expressing and working through their feelings, referral to a counselor would be appropriate.

When assessing the development of a 15-month-old child with cerebral palsy, which of the following milestones should the nurse expect a toddler of this age to have achieved? 1. Walking up steps. 2. Using a spoon. 3. Copying a circle. 4. Putting a block in cup

4. Delay in achieving developmental milestones is a characteristic of children with cerebral palsy. Ninety percent of 15-month-old children can put a block in a cup. Walking up steps typically is accomplished at 18 to 24 months. A child usually is able to use a spoon at 18 months. The ability to copy a circle is achieved at approximately 3 to 4 years of age

Which foods would be best for a child with Duchenne muscular dystrophy? Select all that apply. 1. High-carbohydrate, high-protein foods. 2. No special food combinations. 3. Extra protein to help strengthen muscles. 4. Low-calorie foods to prevent weight gain. 5. Thickened liquids and smaller portions that are cut up.

4, 5 As the child becomes less ambulatory, moving the child will become more of a problem. It is not good for the child to become overweight for several health reasons in addition to decreased ambulation. As the child loses muscle control, the need for thickened liquids and small, well-cut-up solids becomes essential.

Which should the nurse stress to the parents of an infant in a Pavlik harness for treatment of developmental dysplasia of the hip (DDH)? 1. Put socks on over the foot pieces of the harness to help stabilize the harness. 2. Use lotions or powder on the skin to prevent rubbing of straps. 3. Remove harness during diaper changes for ease of cleaning diaper area. 4. Check under the straps at least two to three times daily for red areas.

4. Checking under straps frequently is suggested to prevent skin breakdown

Prednisone is given to children who are being treated for leukemia. Why is this medication given as part of the treatment plan? 1. Enhances protein metabolism. 2. Enhances sodium excretion. 3. Increases absorption of the chemotherapy. 4. Destroys abnormal lymphocytes.

4. Prednisone is used in many of the treatment protocols for leukemia because there is abnormal lymphocyte production. Prednisone is thought to destroy abnormal lymphocytes.

During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to: 1. Lay the child flat to promote hemostasis. 2. Lay the child flat with legs elevated to increase blood flow to the heart. 3. Sit the child on the parent's lap, with legs dangling, to promote venous pooling. 4. Hold the child in knee-chest position to decrease venous blood return

4. The increase in the SVR would increase afterload and increase blood return to the pulmonary artery

The nurse is caring for an adolescent who remains unconscious 24 hours after sustaining a closed-head injury in a motor vehicle accident (MVA). She responds to deep, painful stimulation with decorticate posturing and has an intracranial monitor that shows periodic increased ICP. All other vital signs remain stable. Select the most appropriate nursing action. 1. Encourage the teen's peers to visit and talk to her about school and other pertinent events. 2. Encourage the teen's parents to hold her hand and speak loudly to her in an attempt to help her regain consciousness. 3. Attempt to keep a normal day/night pattern by keeping the teen in a bright, lively environment during the day and dark quiet environment at night. 4. Attempt to keep the environment dark and quiet and encourage minimal stimulation.

4. A dark, quiet environment and minimal stimulation will decrease oxygen consumption and ICP.

Which of the following measures should the nurse teach the parent of a child with hemophilia to do first if the child sustains an injury to a joint causing bleeding? 1. Give the child a dose of acetaminophen (Tylenol). 2. Immobilize the joint and elevate the extremity. 3. Apply heat to the area. 4. Administer factor per the home-care protocol.

4. Administration of factor should be the fi rst intervention if home-care transfusions have been initiated.

After teaching a child with leukemia scheduled for a bone marrow aspiration about the procedure, the nurse determines that the teaching has been successful when the child identifies which of the following as the site for the aspiration? 1. Right lateral side of the right wrist. 2. Middle of the chest. 3. Distal end of the thigh. 4. Back of the hipbone.

4. Although bone marrow specimens may be obtained from various sites, the most commonly used site in children is the posterior iliac crest, the back of the hipbone. This area is close to the body's surface but removed from vital organs. The area is large, so specimens can easily be obtained. For infants, the proximal tibia and the posterior iliac crest are used. The middle of the chest or sternum is the usual site for bone marrow aspiration in an adult. The wrist, chest, and thigh are not sites from which to obtain bone marrow specimens.

Which should the nurse prepare the parents of an infant for following surgical repair and closure of a myelomeningocele shortly after birth? The infant will: 1. Not need any long-term management and should be considered cured. 2. Not be at risk for urinary tract infections or movement problems. 3. Have continual drainage of cerebrospinal fluid, needing frequent dressing changes. 4. Need lifelong management of urinary, orthopedic, and neurological problems.

4. Although immediate surgical repair decreases infection, morbidity, and mortality rates, these children will require lifelong management of neurological, orthopedic, and elimination problems

The nurse is caring for a child with cerebral palsy (CP) whose weight is in the fifth percentile and who has been hospitalized for aspiration pneumonia. His parents are anxious and state that they do not want a G-tube placed. Which would be the nurse ' s best response? 1. "A G-tube will help your son gain weight and reduce his risk for future hospitalizations due to pneumonia." 2. "G-tubes are very easy to care for and will make feeding time easier for your family." 3. "Are you concerned that you will not be able to care for his G-tube?" 4. "Tell me your thoughts about G-tubes."

4. An open-ended question will encourage family members to share what they know and potentially clear up any misconceptions

A nurse is teaching the family of an 8-yearold boy with acute lymphocytic leukemia about appropriate activities. Which of the following activities should the nurse recommend? 1. Home schooling. 2. Restriction from participating in athletic activities. 3. Avoiding trips to the shopping mall. 4. Being treated as "normal" as much as possible

4. Any child with a chronic illness should be treated as normally as possible. Unless the child has severe bone marrow depression, he should be allowed to go to school with others and can go to the mall. If the child is in remission, athletic activities are allowed.

The nurse is admitting a child who has been diagnosed with bacterial meningitis to the pediatric unit. The nurse should implement which type of isolation? 1. Standard precautions. 2. Contact precautions. 3. Airborne precautions. 4. Droplet precautions

4. Bacterial meningitis is caused by one of three organisms, Haemophilus influenzae type b, Neisseria meningitidis, or Streptococcus pneumoniae. All three organisms may be transmitted through contact with respiratory droplets. These droplets are heavy and typically fall within 3 feet of the client. Droplet precautions require, in addition to standard precautions, that health care providers wear masks when coming into close contact with the client. Standard precautions, previously referred to as universal precautions, are general measures used for all clients. Contact precautions are used when direct or indirect contact with the client causes disease transmission. Gowns and gloves are needed but not masks. Airborne precautions differ from droplet in that the particles are smaller and may stay suspended in the air for longer periods of time. These clients require negative pressure rooms and all heath care workers must wear respirators.

An 11-year-old child has been diagnosed with Grave's disease and is to start drug therapy. Which of the following instructions should the nurse include in the teaching plan for the child's mother and teacher? 1. Continue with the same amount of schoolwork and homework. 2. Understand that mood swings are rare with this disorder. 3. Limit the amount of food that is offered to the child. 4. Provide the child with a calm, nonstimulating environment.

4. Because it takes approximately 2 weeks before the response to drug treatment occurs, much of the child's care focuses on managing the child's physical symptoms. Signs and symptoms of the disorder include inability to sit still or concentrate, increased appetite with weight loss, emotional lability, and fatigue. Nursing care is directed toward ensuring that the mother and teacher know how to handle the child, suggesting a shortened school day, a nonstimulating environment, and decreased stress and workload. The child should be encouraged to eat a well-balanced diet.

Which can elicit the Gower sign? Have the child: 1. Close the eyes and touch the nose with alternating index fingers. 2. Hop on one foot and then the other. 3. Bend from the waist to touch the toes. 4. Walk like a duck and rise from a squatting position.

4. Children with muscular dystrophy display the Gower sign, which is great difficulty rising and standing from a squatting position because of the lack of muscle strength.

A preschool-age child with juvenile idiopathic arthritis (JIA) has become withdrawn, and the mother asks the nurse what she should do. Which of the following suggestions by the nurse would be most appropriate? 1. Introduce the child to other children her age who also have JIA. 2. Tell the mother to spend extra time with the child and less time with her other children. 3. Recommend that the mother send the child to see a counselor for therapy. 4. Encourage the mother to be supportive and understanding of the child.

4. Because the child is dealing with grief and loss associated with a chronic illness, parents need to be supportive and understanding. The child needs to feel valued and worthwhile. Introducing the child to others of the same age who also have JIA most probably would be ineffective because preschoolers are developmentally egocentric. Although the child needs to feel valued, the mother's spending more time with the child and less time with her other children is inappropriate because the child with JIA may experience secondary gain from the illness if the family interaction patterns are altered. Also, this action reinforces the child's withdrawal behavior. Psychological counseling is not needed at this time because the child's reaction is normal

An 8-year-old with newly diagnosed diabetes is in the hospital for regulation of diet and medications. The child is using an exchange method for the diet. The nurse should instruct the client that the American Diabetes Association's (ADA's) exchange method for dietary regulation includes: 1. Choosing food from each exchange list. 2. Using a scale to weigh all food. 3. Selecting from lists that group food according to protein, fat, and carbohydrate content. 4. Carbohydrate counting for each meal and snack

4. Carbohydrate counting identifies the number of grams of carbohydrate to be eaten at each meal and snack. The ADA's exchange diet allows the substitution of one food for another on the same diet list. The exchange list does not require that all food is weighed. Choices are made from lists referred to as carbohydrate, meat or meat substitute, and fat. The client's prescription identifies how many items from each food group are to be consumed at each meal and snack. The exchange assumes that foods with similar nutrient content affect blood glucose levels in a similar manner.

Which of the following beverages should the nurse plan to give a child with leukemia to relieve nausea? 1. Orange juice. 2. Weak tea. 3. Plain water. 4. A carbonated beverage

4. Carbonated beverages ordinarily are the best tolerated when a child feels nauseated. Many children find cola drinks especially easy to tolerate, but noncola beverages are also recommended. Orange juice usually is not tolerated well because of its high acid content. Tea may also be too acidic and many children do not like tea. Water does not relieve nausea

A 7-year-old is tested for diabetes insipidus (DI). Twenty-four hours after his fluid restriction has begun, the nurse notes that his urine continues to be clear and pale, with a low specific gravity. Which is the most likely reason for this? 1. Twenty-four hours is too early to evaluate effects of fluid restriction. 2. The urine should be concentrated, and it is unlikely the child has DI. 3. The child may have been sneaking fluids and needs closer observation. 4. In DI, fluid restriction does not cause urine concentration.

4. Children with DI cannot concentrate urine

The parent of an infant asks the nurse what to watch for to determine whether the infant has CP. Which is the nurse ' s best response? 1. "If the infant cannot sit up without support before 8 months." 2. "If the infant demonstrates tongue thrust before 4 months." 3. "If the infant has poor head control after 2 months." 4. "If the infant has clenched fists after 3 months."

4. Clenched fists after 3 months of age may be a sign of upper motor injury and CP

A child with leukemia is receiving chemotherapy and is complaining of nausea. The nurse has been giving the scheduled antiemetic. Which of the following should the nurse do when the child is nauseated? 1. Encourage low-protein foods. 2. Encourage low-caloric foods. 3. Offer the child ' s favorite foods. 4. Offer cool, clear liquids.

4. Cool, clear liquids are better tolerated. Milk-based products cause secretions to be thick and can cause vomiting

What is the most appropriate method to use when drawing blood from a child with hemophilia? 1. Use finger punctures for lab draws. 2. Be prepared to administer platelets for prolonged bleeding. 3. Apply heat to the extremity before venipunctures. 4. Schedule all labs to be drawn at one time.

4. Coordinating labs to minimize sticks reduces trauma and the risk of bleeding. Finger sticks in general are more painful and associated with more bleeding than venipunctures. In hemophilia, platelets are typically normal. Heat would increase vasodilatation and increase bleeding.

A child is being admitted with the diagnosis of meningitis. Select the procedure the nurse should do first: 1. Administration of intravenous antibiotics. 2. Administration of maintenance intravenous fluids. 3. Placement of a Foley catheter. 4. Send the spinal fluid and blood samples to the laboratory for cultures.

4. Cultures of spinal fluid and blood should be obtained, followed by administration of intravenous antibiotics.

Brain damage in a child who sustained a closed-head injury can be caused by which factor? 1. Increased perfusion to the brain and increased metabolic needs of the brain. 2. Decreased perfusion to the brain and decreased metabolic needs of the brain. 3. Increased perfusion to the brain and decreased metabolic needs of the brain. 4. Decreased perfusion of the brain and increased metabolic needs of the brain.

4. Decreased perfusion of the brain and increased metabolic needs of the brain.

The nurse has completed discharge teaching for the family of a 10-year-old diagnosed with diabetes insipidus (DI). Which statement best demonstrates the family ' s correct understanding of DI? 1. "The disease was probably brought on by a bad diet and little exercise." 2. "Diabetes seems to run in my family, and that may be why my child has it." 3. "My child will need to check blood sugar several times a day." 4. "My child will have to use the bathroom more often than other children."

4. Despite the use of vasopressin to treat the symptoms of DI, breakthrough urination is likely.

When teaching the child with scoliosis being treated with a Boston brace about exercises, the nurse explains that the exercises are performed primarily for which of the following purposes? 1. To decrease back muscle spasms. 2. To improve the brace's traction effect. 3. To prevent spinal contractures. 4. To strengthen the back and abdominal muscles.

4. Exercises are prescribed for the child with scoliosis wearing a Boston brace to help strengthen spinal and abdominal muscles and provide support. Typically, children wearing a Boston brace do not complain of muscle spasms. Performing exercises provides no effect on the brace's traction ability. Spinal contractures do not occur when a Boston brace is worn.

Which of following should the nurse perform to help alleviate a child's joint pain associated with rheumatic fever? 1. Maintaining the joints in an extended position. 2. Applying gentle traction to the child's affected joints. 3. Supporting proper alignment with rolled pillows. 4. Using a bed cradle to avoid the weight of bed linens on joints.

4. For a child with arthritis associated with rheumatic fever, the joints are usually so tender that even the weight of bed linens can cause pain. Use of a bed cradle is recommended to help remove the weight of the linens on painful joints. Joints need to be maintained in good alignment, not positioned in extension, to ensure that they remain functional. Applying gentle traction to the joints is not recommended because traction is usually used to relieve muscle spasms, not typically associated with rheumatic fever. Supporting the body in good alignment and changing the client's position are recommended, but these measures are not likely to relieve pain

A 4-year-old child with hydrocephalus is scheduled to have a ventroperitoneal shunt in the right side of the head. When developing the child's postoperative plan of care, the nurse should place the preschooler in which of the following positions immediately after surgery? 1. On the right side, with the foot of the bed elevated. 2. On the left side, with the head of the bed elevated. 3. Prone, with the head of the bed elevated. 4. Supine, with the head of the bed fl at.

4. For at least the first 24 hours after insertion of a ventriculoperitoneal shunt, the child is positioned supine with the head of the bed flat to prevent too rapid a decrease in cerebrospinal fluid pressure. Although elevating the head increases cerebrospinal fluid drainage and reduces intracranial pressure, a rapid reduction in the size of the ventricles can cause subdural hematoma. Positioning on the operative or right side is avoided because it places pressure on the shunt valve, possibly blocking desired drainage of the cerebrospinal fluid. Elevating the foot of the bed could increase intracranial pressure. With continued increased intracranial pressure, the child would be positioned with the head of the bed elevated to allow gravity to aid drainage. The child should be kept off the nonoperative side (side opposite the shunt), or the left side, to help prevent rapid decompression leading to a cerebral hematoma.

The nurse is caring for a child who complains of constant hunger, constant thirst, frequent urination, and recent weight loss without dieting. Which can the nurse expect to be included in care for this child? 1. Limiting daily fluid intake. 2. Weight management consulting. 3. Strict intake and output monitoring. 4. Frequent blood glucose testing

4. Frequent blood glucose testing is included in the care of a child with type 1 DM. The symptoms described in the question are characteristic of a child just prior to the diagnosis of type 1 DM.

A 14-year-old girl with sickle cell disease has her fourth hospitalization for sickle cell crisis. Her family is planning a ski vacation in the mountains. What should the nurse tell the parents? 1. Encourage them to go on the trip. 2. Go on the trip, but fi nd a sitter for the 14-yearold. 3. Suggest the trip be postponed until next year. 4. Explain that the high altitude may cause a crisis

4. High altitude causes deoxygenation, which might precipitate a crisis. In clients with sickle cell anemia, cells sickle when the client experiences any situation where increased demand for oxygen is needed, such as in an infection or dehydration, or when low oxygen concentration is experienced, such as in high altitudes or deep sea diving. Crises can commonly be prevented by maintaining hydration. It would be unsafe to encourage the family, or to say nothing about taking the client to high altitude areas, but giving the parents adequate information will allow them to make an appropriate decision. Postponing the trip or leaving the child at home does not address the immediate concern for the child's health.

A nurse evaluates discharge teaching as successful when the parents of a school-age child with a ventriculoperitoneal shunt insertion identify which sign as signaling a blocked shunt? 1. Decreased urine output with stable intake. 2. Tense fontanel and increased head circumference. 3. Elevated temperature and reddened incisional site. 4. Irritability and increasing difficulty with eating

4. In a school-age child, irritability, lethargy, vomiting, difficulty with eating, and decreased level of consciousness are signs of increased intracranial pressure caused by a blocked shunt. Decreased urine output with stable fluid intake indicates fluid loss from a source other than the kidneys. A tense fontanel and increased head circumference would be signs of a blocked shunt in an infant. Elevated temperature and redness around incisions might suggest an infection

A 16-month-old child is seen in the clinic for a checkup for the first time. The nurse notices that the toddler limps when walking. Which of the following would be appropriate to use when assessing this toddler for developmental dysplasia of the hip? 1. Ortolani's maneuver. 2. Barlow's maneuver. 3. Adam's position. 4. Trendelenburg's sign.

4. In a toddler, weight bearing causes the pelvis to tilt downward on the unaffected side instead of upward as it would normally. This is Trendelenburg's sign, and it indicates developmental dysplasia of the hip. Ortolani's maneuver is used during the neonatal period to assess developmental dysplasia of the hip in infants. With the infant quiet, relaxed, and lying on the back, the hips and knees are flexed at right angles. The knees are moved to abduction and pressure is exerted. If the femoral head moves forward, then it is dislocated. Barlow's maneuver is used to assess developmental dysplasia of the hip in infants. As the femur is moved into or out of the acetabulum, a "clunk" is heard, indicating dislocation. Adam's position is used to evaluate for structural scoliosis. The child bends forward with feet together and arms hanging freely or with palms together

Which of the following statements should the nurse use to describe to the parents why their child with leukemia is at risk for infections? 1. "Play activities are too strenuous." 2. "Vitamin C intake is reduced over a period of time." 3. "The number of red blood cells is inadequate for carrying oxygen." 4. "Immature white blood cells are incapable of handling an infectious process."

4. In leukemia, the number of normal white blood cells that are capable of fighting an infection is decreased. Although there is an increased number of immature white blood cells, they are unable to combat infection. Therefore, a child with leukemia is subject to infection. The major morbidity and mortality factor associated with leukemia is infection resulting from the presence of granulocytopenia. While increased activity may cause fatigue, it does not put the child at risk for infection. Vitamin C intake should not decrease if the child has adequate dietary intake. Decreased red blood cells are not directly caused by infection.

The nurse is teaching the family about caring for their 7-year-old, who has been diagnosed with type 1 diabetes mellitus. What information should the nurse provide about this condition? 1. Best managed through diet, exercise, and oral medication. 2. Can be prevented by proper nutrition and monitoring blood glucose levels. 3. Characterized mainly by insulin resistance. 4. Characterized mainly by insulin deficiency

4. Individuals with type 1 DM do not produce insulin. If one does not produce insulin, type 1 DM is the diagnosis

Which is the nurse ' s best explanation to the parent of a toddler who asks what a greenstick fracture is? 1. It is a fracture located in the growth plate of the bone. 2. Because children ' s bones are not fully developed, any fracture in a young child is called a greenstick fracture. 3. It is a fracture in which a complete break occurs in the bone, and small pieces of bone are broken off. 4. It is a fracture that does not go all the way through the bone.

4. It is a fracture that does not go all the way through the bone.

The nurse is teaching the parent of a child newly diagnosed with juvenile idiopathic arthritis (JIA). The nurse would evaluate the teaching as successful when the parent is able to say that the disorder is caused by the: 1. Breakdown of osteoclasts in the joint space causing bone loss. 2. Loss of cartilage in the joints. 3. Buildup of calcium crystals in joint spaces. 4. Immune-stimulated inflammatory response in the joint.

4. JIA is caused by an immune response by the body on the joint spaces.

An overweight adolescent has been diagnosed with type 2 diabetes. To increase the client's self-efficacy to manage their disease, the nurse should: 1. Provide the client with a written daily food and exercise plan. 2. Discuss eliminating junk food in the home with the parents. 3. Arrange for the school nurse to weigh the child weekly. 4. Utilize a peer with type 2 diabetes to role model lifestyle changes

4. Self-efficacy, or the belief that one can act in a way to produce a desired outcome, can be promoted through the observation of role models. Peers are particularly effective role models because clients can more readily identify with them and believe they are capable of similar behaviors. Providing a written plan alone does not promote self-efficacy. Having parents eliminate junk food and having the school nurse weigh the adolescent can be part of the plan, but these actions do not empower the client

A child who limps and has pain has been found to have Legg-Calvé-Perthes disease. What should the nurse expect to include in the child's plan of care? 1. Initiation of pain control measures, especially at night when acute. 2. Promotion of ambulation despite child's discomfort in the affected hip. 3. Prevention of flexion in the affected hip and knee. 4. Avoidance of weight bearing on the head of the affected femur.

4. Legg-Calvé-Perthes disease, also known as coxa plana or osteochondrosis, is characterized by aseptic necrosis at the head of the femur when the blood supply to the area is interrupted. Avoidance of weight bearing is especially important to prevent the head of the femur from leaving the acetabulum, thus preventing hip dislocation. Devices such as an abduction brace, a leg cast, or a harness sling are used to protect the affected joint while revascularization and bone healing occur. Surgical procedures are used in some cases. Although pain control measures may be appropriate, pain is not necessarily more acute at night. Initial therapy involves rest and non-weight bearing to help restore motion. Preventing flexion is not necessary

The nurse is discharging a child who has just received chemotherapy for neuroblastoma. Which of the following statements made by the child ' s parent indicates a need for additional teaching? 1. "I will inspect the skin often for any lesions." 2. "I will do mouth care daily and monitor for any mouth sores." 3. "I will wash my hands before caring for my child." 4. "I will take a rectal temperature daily and report a temperature greater than 101°F (38.3°C) immediately to the health-care provider."

4. Monitoring the child ' s temperature and reporting it to the physician are important, but the temperature should not be taken rectally. The risk of injury to the mucous membranes is high. Rectal abscesses can occur in the damaged rectal tissue. The best method for taking the temperature is axillary, especially if the child has mouth sores

Which of the following statements obtained from the nursing history of a toddler should alert the nurse to suspect that the child has had a febrile seizure? 1. The child has had a low-grade fever for several weeks. 2. The family history is negative for convulsions. 3. The seizure resulted in respiratory arrest. 4. The seizure occurred when the child had a respiratory infection

4. Most febrile seizures occur in the presence of an upper respiratory infection, otitis media, or tonsillitis. Febrile seizures typically occur during a temperature rise rather than after prolonged fever. There appears to be increased susceptibility to febrile seizures within families. Infrequently, febrile seizures may lead to respiratory arrest.

A father brings his 4-week-old son to the clinic for a checkup, stating that he believes his son's testicle is missing. Which of the following explanations would be most appropriate? 1. "Although the testes should have descended by now, it is not a cause for worry." 2. "The testes often do not descend until age 6 months, but let's check to see whether the testes are present." 3. "The testes are present in the scrotal sac at birth, but surgery can remedy the situation." 4. "Although the testes normally descend by 1 year of age, I can understand your concern."

4. Normally the testes descend by 1 year of age; failure to do so may indicate a problem with patency or a hormonal imbalance. By age 4 weeks, descent may not have occurred. However, telling the father that lack of descent is not a cause for worry is inappropriate and uncaring. Additionally, a statement such as this may be false reassurance. By acknowledging the father's concern, the nurse indicates acceptance of his feelings. If the testes have not descended, then they will not be palpable in the scrotal sac. Surgery is not discussed until after a full assessment is completed.

When teaching parents about osteosarcoma, the nurse knows instruction has been successful when a parent says that this type of cancer is common in which age-group? 1. Infants. 2. Toddlers. 3. School-age children. 4. Adolescents.

4. Osteosarcoma is a common cancer of adolescents.

Which should be obtained to make a diagnosis of slipped capital femoral epiphysis (SCFE)? 1. A history of hip trauma. 2. A physical examination of hip, thigh, and knees. 3. A complete blood count. 4. A radiographic examination of the hip.

4. Radiographic examination is the only definitive diagnostic tool for SCFE.

The mother asks the nurse why her child's hemoglobin was normal at birth but now the child has S hemoglobin. Which of the following responses by the nurse is appropriate? 1. "The placenta bars passage of the hemoglobin S from the mother to the fetus." 2. "The red bone marrow does not begin to produce hemoglobin S until several months after birth." 3. "Antibodies transmitted from you to the fetus provide the newborn with temporary immunity." 4. "The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."

4. Sickle cell disease is an inherited disease that is present at birth. However, 60% to 80% of a newborn's hemoglobin is fetal hemoglobin, which has a structure different from that of hemoglobin S or hemoglobin A. Sickle cell symptoms usually occur about 4 months after birth, when hemoglobin S begins to replace the fetal hemoglobin. The gene for sickle cell disease is transmitted at the time of conception, not passed through the placenta. Some hemoglobin S is produced by the fetus near term. The fetus produces all its own hemoglobin from the earliest production in the first trimester. Passive immunity conferred by maternal antibodies is not related to sickle cell disease, but this transmission of antibodies is important to protect the infant from various infections during early infancy.

The nurse caring for a client with type 1 diabetes mellitus is teaching how to self administer insulin. Which is the proper injection technique? 1. Position the needle with the bevel facing downward before injection. 2. Spread the skin prior to intramuscular injection. 3. Aspirate for blood return prior to injection. 4. Elevate the subcutaneous tissue before injection.

4. Skin tissue is elevated to prevent injection into the muscle when giving a subcutaneous injection. Insulin is only given subcutaneously

Which of the following will be abnormal in a child with the diagnosis of hemophilia? 1. Platelet count. 2. Hemoglobin level. 3. White blood cell count. 4. Partial thromboplastin time (PTT).

4. The abnormal laboratory results in hemophilia are related to decreased clotting function. Partial thromboplastin time is prolonged.

An adolescent is on the football team and practices in the morning and afternoon before school starts for the year. The temperature on the fi eld has been high. The school nurse has been called to the practice field because the adolescent is now reporting that he has muscle cramps, nausea, and dizziness. Which of the following actions should the school nurse do first? 1. Administer cold water with ice cubes. 2. Take the adolescent's temperature. 3. Have the adolescent go to the swimming pool. 4. Move the adolescent to a cool environment.

4. The adolescent is most likely experiencing heat exhaustion or heat collapse, which are common after vigorous exercise in a hot environment. Symptoms result from loss of fluids and include nausea, vomiting, dizziness, headache, and thirst. Treatment consists of moving the adolescent to a cool environment and giving cool liquids. Cool liquids are easier to drink than cold liquids. Taking the adolescent's temperature would be appropriate once these actions have been completed. However, the adolescent's temperature is likely to be normal or only mildly elevated. The water in a swimming pool would be too cool, possibly causing the adolescent to shiver and thus raising his temperature.

A child diagnosed with tetralogy of Fallot becomes upset, crying and thrashing around when a blood specimen is obtained. The child's color becomes blue and the respiratory rate increases to 44 breaths/minute. Which of the following actions should the nurse do first? 1. Obtain an order for sedation for the child. 2. Assess for an irregular heart rate and rhythm. 3. Explain to the child that it will only hurt for a short time. 4. Place the child in a knee-to-chest position

4. The child is experiencing a tet or hypoxic episode. Therefore the nurse should place the child in a knee-to-chest position. Flexing the legs reduces venous fl ow of blood from the lower extremities and reduces the volume of blood being shunted through the interventricular septal defect and the overriding aorta in the child with tetralogy of Fallot. As a result, the blood then entering the systemic circulation has a higher oxygen content, and dyspnea is reduced. Flexing the legs also increases vascular resistance and pressure in the left ventricle. An infant often assumes a knee-to-chest position in the crib, or the mother learns to put the infant over her shoulder while holding the child in a knee-to-chest position to relieve dyspnea. If this position is ineffective, then the child may need a sedative. Once the child is in the position, the nurse may assess for an irregular heart rate and rhythm. Explaining to the child that it will only hurt for a short time does nothing to alleviate the hypoxia.

Which is included in the plan of care for a newborn who has a myelomeningocele? 1. Place the infant in the prone position with a sterile dry dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 2. Place the infant in the prone position with a sterile dry dressing over the defect. Begin intravenous fluids to prevent dehydration. 3. Place the infant in the prone position with a sterile moist dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 4. Place the child in the prone position with a sterile moist dressing over the defect. Begin intravenous fluids to prevent dehydration.

4. The child is placed in the prone position to avoid any pressure on the defect. A sterile moist dressing is placed over the defect to keep it as clean as possible. Intravenous fl u

The nurse is caring for a school-age child with Duchenne muscular dystrophy in the elementary school. Which would be an appropriate nursing diagnosis? 1. Anticipatory grieving. 2. Anxiety reduction. 3. Increased pain. 4. Activity intolerance.

4. The child would not be able to keep up with peers because of weakness, progressive loss of muscle fibers, and loss of muscle strength

Which priority item should be placed at the bedside of a newborn with myelomeningocele? Select all that apply. 1. A bottle of normal saline. 2. A rectal thermometer.3. Extra blankets. 4. A blood pressure cuff. 5. Latex-free gloves.

4. The child would not be able to keep up with peers because of weakness, progressive loss of muscle fibers, and loss of muscle strength 5. Latex-free clean gloves would be used for all care of this infant. A box should be kept at the infant ' s bedside. Children with spina bifida are at risk for latex allergy and should not be exposed to latex.

When developing the discharge plan for the parents of an infant who has undergone a myelomeningocele repair, what information is most important for the nurse to include? 1. A list of available hospital services. 2. Schedule for daily home health care. 3. Chaplain referral for psychological support. 4. Daily care required by the infant

4. The most important aspect of the discharge plan is to ensure that the parents understand what the daily care of their infant involves and to provide teaching related to carrying out this daily care. In addition to the routine care required by the infant, care also may include physical therapy to the lower extremities. Providing a list of available hospital services may be helpful to the parents, but it is not the most important aspect to include in the discharge plan. Usually, home health care is not needed because the parents are able to care for their child. A referral for counseling is initiated whenever the need arises, not just at discharge

When developing the teaching plan for the parents of a 12-month-old infant with hypospadias and chordee repair, which of the following should the nurse expect to include as most important? 1. Assisting the child to become familiar with his dressings so he will leave them alone. 2. Encouraging the child to ambulate as soon as possible by using a favorite push toy. 3. Forcing fl uids to at least 2,500 mL/day by offering his favorite juices. 4. Preventing the child from disrupting the catheters by using soft restraints

4. The most important consideration for a successful outcome of this surgery is maintenance of the catheters or stents. A 12-month-old infant likes to explore his environment but must be prevented from manipulating his dressings or catheters through the use of soft restraints. Allowing the infant to become familiar with the dressings will not prevent him from pulling at them. After surgery the child is allowed limited activity, possibly with sitting in the parent's lap. A 12-month-old infant may or may not be walking. If he is, most likely he will be clumsy and possibly injure himself. Although increasing fluids is important, 2,500 mL/day is an excessive amount for a 12-month-old. Fluid requirements would be 115 mL/kg

The father of a preschool-age child with a tentative diagnosis of juvenile idiopathic arthritis (JIA) asks about a test to definitively diagnose JIA. The nurse's response is based on knowledge of which of the following? 1. The latex fixation test is diagnostic. 2. An increased erythrocyte sedimentation rate is diagnostic. 3. A positive synovial fl uid culture is diagnostic. 4. No specific laboratory test is diagnostic.

4. The nurse's response to the father is based on the knowledge that there is no definitive test for JIA. The latex fixation test, which is commonly used to diagnose arthritis in adults, is negative in 90% of children. The erythrocyte sedimentation rate may or may not be increased during active disease. This test identifi es the presence of infl ammation only. Synovial fl uid cultures are done to rule out septic arthritis, not to diagnose JIA

At the 2 week well-child visit a parent states, "My baby seems to keep his head tilted to the right." The nurse should further assess the: 1. Fontanel. 2. Cervical vertebrae. 3. Trapezius muscle. 4. Sternocleidomastoid muscle

4. The parent is describing symptoms consistent with torticollis, or wry neck syndrome. With this musculoskeletal disorder, the sternoncleidomastoid muscle shortens causing the infant to drop the head toward the affected muscle and tilt the chin upward in the opposite direction. Frequently, a lump may be felt in the affected muscle. Palpating the fontanel is done to assess neurologic status, not musculoskeletal status. Torticollis does not involve the cervical vertebrae or trapezius muscle.

The nurse evaluates teaching of parents of a child newly diagnosed with CP as successful when the parents state that CP is which of the following? 1. Inability to speak and uncontrolled drooling. 2. Involuntary movements of lower extremities only. 3. Involuntary movements of upper extremities only. 4. An increase in muscle tone and deep tendon reflexes.

4. The primary disorder is of muscle tone, but there may be other neurological disorders such as seizures, vision disturbances, and impaired intelligence. Spastic CP is the most common type and is characterized by a generalized increase in muscle tone, increased deep tendon reflexes, and rigidity of the limbs on both flexion and extension.

The parent of a 3-year-old is shocked to hear the diagnosis of Wilms tumor and says, "How could I have missed a lump this big?" Which is the nurse ' s best response? 1. "Do not be hard on yourself. It's easy to overlook something that has probably been growing for months when we see our children on a regular basis." 2. "I understand you must be very upset. Your child would have had a better prognosis had you caught it earlier." 3. "It really takes a trained professional to recognize something like this." 4. "Do not blame yourself. This mass grows so fast that it was probably not noticeable a few days ago."

4. The tumor is fast-growing and could very easily not have been evident a few days earlier

A child with a ventriculoperitoneal (VP) shunt complains of headache and blurry vision and now experiences irritability and sleeping more than usual. The parents ask the nurse what they should do. Select the nurse ' s best response. 1. "Give her some acetaminophen (Tylenol), and see if her symptoms improve. If they do not improve, bring her to the health-care provider's office." 2. "It is common for girls to have these symptoms, especially prior to beginning their menstrual cycle. Give her a few days, and see if she improves." 3. "You are probably worried that she is having a problem with her shunt. This is very unlikely because it has been working well for 9 years." 4. "You should immediately take her to the emergency department because these may be symptoms of a shunt malfunction."

4. These are symptoms of a shunt malfunction and should be evaluated immediately

A child has been diagnosed with valvular disease following rheumatic fever (RF). During patient teaching, the nurse discusses the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth. The parents indicate they understand when they say: 1. "She will need to take the antibiotics until she is 18 years old." 2. "She will need to take the antibiotics for 5 years after the last attack." 3. "She will need to take the antibiotics for 10 years after the last attack." 4. "She will need to take the antibiotics for the rest of her life."

4. Valvular involvement indicates significant damage, so antibiotics would be taken for the rest of her life.

A school-age child is admitted to the hospital with the diagnosis of probable infratentorial brain tumor. During the child's admission to the pediatric unit, which action should the nurse anticipate taking first? 1. Eliminating the child's anxiety. 2. Implementing seizure precautions. 3. Introducing the child to other clients of the same age. 4. Preparing the child and parents for diagnostic procedures

4. When a brain tumor is suspected, the child and parents are likely to be very apprehensive and anxious. It is unrealistic to expect to eliminate their fears; rather, the nurse's goal is to decrease them. Preparing both the child and family during hospitalization can help them cope with some of their fears. Although the nurse may be able to decrease some of the child's anxiety, it would be impossible to eliminate it. Children with infratentorial tumors seldom have seizures, so seizure precautions are not indicated. Although introducing the child to other children is a positive action, this action would be more appropriate once the nurse has decreased some of the child's and parents' anxiety by preparing them.

The nurse observes as a child with Duchenne's muscular dystrophy attempts to rise from a sitting position on the floor. After attaining a kneeling position, the child "walks" his hands up his legs to stand. The nurse documents this as which of the following? 1. Galeazzi's sign. 2. Goodell's sign. 3. Goodenough's sign. 4. Gower's sign.

4. With Gower's sign, the child walks the hands up the legs in an attempt to stand, a common approach used by children with Duchenne's muscular dystrophy when rising from a sitting to a standing position. Galeazzi's sign refers to the shortening of the affected limb in congenital hip dislocation. Goodell's sign refers to the softening of the cervix, considered a sign of probable pregnancy. Goodenough's sign refers to a test of mental age