pediatric final exam

A child in a classroom is disruptive with loud talking, has a short attention span, and has difficulty organizing work. Which is the most likely diagnosis for this child? 1. Enuresis. 2. Sexual abuse. 3. Learning disability. 4. Attention deficit-hyperactivity disorder.

4 question 59 comprehensive exam

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 chapter 9 question 49

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

A nurse educator is providing a teaching session for the nursing staff. Which of the following individuals is at greatest risk for developing beta-thalassemia (Cooley anemia)? 1. A child of Mediterranean descent. 2. A child of Mexican descent. 3. A child whose mother has chronic anemia. 4. A child who has a low intake of iron.

1

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

Which of the following should the nurse expect to administer to a child with ITP and a platelet count of 5000/mm3? Select all that apply. 1. Platelets. 2. Intravenous immunoglobulin. 3. Packed red blood cells (PRBCs). 4. White blood cells. 5. Prednisolone.

2, 5

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

3

The nurse expects which of the following clinical manifestations in a child diagnosed with SCID? 1. Prolonged bleeding. 2. Failure to thrive. 3. Fatigue and malaise. 4. Susceptibility to infection.

4

The nurse is caring for a child diagnosed with thalassemia major who is receiving the first chelation therapy. What information should the nurse provide to the parent regarding the therapy? Select all that apply. 1. Decreases the risk of bleeding. 2. Eliminates excess iron. 3. Prevents further sickling of the red blood cells. 4. Provides an iron supplement. 5. Hydration is necessary for the process to be effective.

2, 5

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/mm3 with 5% polys and 3% bands. Which of the following analyses is most appropriate? 1. The absolute neutrophil count is 400/mm3, and the child is neutropenic. 2. The absolute neutrophil count is 800/mm3, and the child is neutropenic. 3. The absolute neutrophil count is 4000/mm3, and the child is not neutropenic. 4. The absolute neutrophil count is 5800/mm3, and the child is not neutropenic.

1

Which of the following measures should be implemented for a child with von Willebrand disease who has a nosebleed? 1. Apply pressure to the nose for at least 10 minutes. 2. Have the child lie supine and quiet. 3. Avoid packing of the nostrils. 4. Encourage the child to swallow frequently.

1

Which intervention should be implemented after a bone marrow aspiration? 1. Ask the child to remain in a supine position. 2. Place the child in an upright position for 4 hours. 3. Keep the child nothing by mouth for 6 hours. 4. Administer analgesics as needed for pain.

4

Which of the following is the most common opportunistic infection in children infected with human immunodeficiency virus (HIV)? 1. CMV. 2. Encephalitis. 3. Meningitis. 4. Pneumocystic pneumonia.

4

Which of the following laboratory tests will be ordered to determine the presence of the human immunodeficiency virus antigen in an infant whose mother is HIV+? 1. CD4 cell count. 2. Western blot. 3. IgG levels. 4. p24 antigen assay.

4

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

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 nurse is instructing the parent of a child with HIV about immunizations. Which of the following should the nurse tell the parent? Select all that apply. 1. Hepatitis B vaccine will not be given to this child. 2. Members of the family should be cautioned not to receive the varicella vaccine. 3. The child will need to have a Western blot test done prior to all immunizations. 4. Pneumococcal and influenza vaccines are recommended. 5. Meningitis immunization.

4, 5

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 . 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

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

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

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

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

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

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.

A nurse is caring for a child with von Willebrand disease. The nurse is aware that which of the following is a clinical manifestation of von Willebrand disease? Select all that apply. 1. The child bruises easily. 2. Excessive menstruation. 3. The child has frequent nosebleeds. 4. Elevated creatinine levels. 5. Elevated blood pressure.

1, 2, 3.

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.

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

Which medication is the most effective treatment for acne? 1. Salicylic acid. 2. Benzoyl peroxide. 3. Fluconazole (Diflucan). 4. Clotrimazole (Lotrimin).

2 chapter 2 question 27

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 Chapter 9 question 21

Which of the following measures should the nurse implement to help with the nausea and vomiting caused by chemotherapy? Select all that apply. 1. Give an antiemetic 30 minutes prior to the start of therapy. 2. Continue the antiemetic as ordered until 24 hours after the chemotherapy is complete. 3. Remove food that has a lot of odor. 4. Keep the child on a nothing-by-mouth status. 5. Wait until the nausea begins to start the antiemetic.

1, 2, 3.

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. chapter 9 question 36

A child with hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. Which of the following measures should be taken to stop the bleeding? Select all that apply. 1. The extremity should be immobilized. 2. The extremity should be elevated. 3. Warm moist compresses should be applied to decrease pain. 4. Passive range-of-motion exercises should be administered to the extremity. 5. Factor VIII should be administered.

1, 2, 5.

Which of the following can lead to a possible diagnosis of human immunodeficiency virus (HIV) in a child? Select all that apply. 1. Repeated respiratory infections. 2. Intermittent diarrhea. 3. Excessive weight gain. 4. Irregular heartbeat. 5. Poor weight gain

1, 2, 5.

Which is assessed to diagnose pediculosis capitis? Select all that apply. 1. Crawling insects. 2. White flakes in the hair. 3. Nits attached close to scalp. 4. Inflammatory papules. 5. Dark brown hair.

1, 3, 4 chapter 15 question 58

The nurse is caring for a child who is receiving a transfusion of PRBCs. The nurse is aware that if the child has a hemolytic reaction to the blood, the signs and symptoms would include which of the following? Select all that apply. 1. Fever. 2. Rash. 3. Oliguria. 4. Hypotension. 5. Chills.

1, 3, 4.

Which of the following best describes the action of chemotherapeutic agents used in the treatment of cancer in children? Select all that apply. 1. Suppress the function of normal lymphocytes in the immune system. 2. Are alkylating agents and are cell-specific. 3. Cause a replication of DNA and are cell-specific. 4. Interrupt cell cycle, thereby causing cell death. 5. Prednisone is a natural hormone.

1, 4, 5

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 chickenpox lesions about 14 to 21 days after exposure."

2, 3

Which of the following describes idiopathic thrombocytopenia purpura (ITP)? Select all that apply. 1. ITP is a congenital hematological disorder. 2. ITP causes excessive destruction of platelets. 3. Children with ITP have normal bone marrow. 4. Platelets are small in ITP. 5. Purpura is observed in ITP.

2, 3, 5.

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

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

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

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.

An 18-month-old male is brought to the clinic by his mother. His height is in the 50th percentile, and his weight is in the 80th percentile. The child is pale. The physical examination is normal, but his hematocrit level is 20%. Which of the following questions should assist the nurse in making a diagnosis? Select all that apply. 1. "How many bowel movements a day does your child have?" 2. "How much did your baby weigh at birth?" 3. "What does your child eat every day?" 4. "Has the child been given any new medications?" 5. "How much milk does your child drink per day?"

3, 5.

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

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.

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.

School-age children with cancer often have a body image disturbance related to hair loss, moon face, or debilitation. Which of the following interventions is (are) most appropriate? Select all that apply. 1. Encourage them to wear a wig similar to their own hairstyle. 2. Emphasize the benefits of the therapy they are receiving. 3. Have them play only with other children with cancer. 4. Use diversional techniques to avoid discussing changes in the body because of the chemotherapy. 5. Help them find a "special friend" who understands what they are experiencing.

1, 5

Which statement is true of abused children? 1. They will tell the truth if asked about their injuries. 2. They will repeat the same story that their parents tell. 3. They usually are not noted to have any changes in behavior. 4. They will have outgoing personalities and be active in school activities.

2 chapter 4 question 59

A nurse is doing discharge education with a parent who has a child with beta- thalassemia (Cooley anemia). The nurse informs the parent that the child is at risk for which of the following conditions? 1. Hypertrophy of the thyroid. 2. Polycythemia vera. 3. Thrombocytopenia. 4. Chronic hypoxia and iron overload.

4

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

Which approach should the nurse use to gather information from a child brought to the ED for suspected child abuse? 1. Promise the child that her parents will not know what she tells the nurse. 2. Promise the child that she will not have to see the suspected abuser again. 3. Use correct anatomical terms to discuss body parts. 4. Tell the child that the abuse is not her fault and that she is a good person.

4 chapter 3 question 30

Which is the reason a student takes metformin (Glucophage) three times a day? 1. Type 1 diabetes mellitus. 2. Diabetes insipidus. 3. Inflammatory bowel disease. 4. Type 2 diabetes mellitus.

4 chapter 9 quesiton 54

Which of the following is the best method to prevent the spread of infection to an immunosuppressed child? 1. Administer antibiotics prophylactically to the child. 2. Have people wash their hands prior to contact with the child. 3. Assign the same nurses to care for the child each day. 4. Limit visitors to family members only.

2

Parents of a 2-year-old with Down syndrome are told the child should be screened for atlantoaxial instability. The nurse tells the parents that which of the following are symptoms of this instability? 1. Mental retardation. 2. Neck pain and torticollis. 3. Vision and hearing loss. 4. Early onset of puberty.

2 question 68 comprehensive exam

Which of the following would the nurse instruct the parent about treating a pediculosis infestation? 1. Apply spinosad (Natroba) to the scalp, leave it in place for 4 minutes, and then add water. 2. Apply chlorhexidine (Hibiclens) to the scalp with sterile gloves and leave on overnight. 3. Apply terbinafine (Lamisil) as a thin layer to the scalp twice a day for 5 days. 4. Apply collagenase (Santyl) to the scalp with cotton applicator, leave in place overnight, then shampoo.

1 chapter 2 question 22

Which child is at risk for developing glomerulonephritis? 1. A 3-year-old who had impetigo 1 week ago. 2. A 5-year-old with a history of five UTIs in the previous year. 3. A 6-year-old with new-onset type 1 diabetes. 4. A 10-year-old recovering from viral pneumonia.

1 chapter 8 question 7

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 childhas 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 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

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

The parent of a 2-year-old who is HIV+ questions the nurse about placing the child in day care. Which of the following is the best response? 1. The child should not go to day care until older, because there is a high risk for transmission of the disease. 2. The child can go to day care without restrictions and should be allowed to participate in all activities. 3. The child can go to day care but should avoid physical activity. 4. The child may go to day care, but the parent must inform all the parents at the day care that the child is HIV+.

2

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

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

A 6-year-old white girl comes with her mother for evaluation of her acne, breast buds, axillary hair, and body odor. What information should the nurse explain to them? 1. This is a typical age for girls to go into puberty. 2. Encourage the girl to dress and act appropriately for her chronological age. 3. She should be on birth control because she is fertile. 4. She may be short if her epiphyses close early.

2 chapter 9 question 3

A nurse is caring for an infant who is very fussy and has a diagnosis of diabetes insipidus (DI). Which parameters should the nurse monitor while the infant is on fluid restrictions? Select all that apply. 1. Oral intake. 2. Urine output. 3. Appearance of the mucous membranes. 4. Change in pulse and temperature. 5. Lethargy and pain.

2, 5 chapter 9 question 4

Which should the nurse teach the parents is one of the most common causes of injury and death for a 9-month-old infant? 1. Poisoning. 2. Child abuse. 3. Aspiration. 4. Dog bites.

3 chapter 3 question 13

Which statement would be most therapeutic to a child the nurse suspects has been abused? 1. "Who did this to you? This is not right." 2. "This is wrong that your parents did not protect you." 3. "This is not your fault; you are not to blame for this." 4. "I will not tell anyone."

3 chapter 4 question 53

Which statement most accurately describes child abuse? 1. Physical abuse and neglect, usually carried out by a known adult. 2. Intentional and unintentional physical and emotional abuse and neglect. 3. Sexual abuse of children, usually by an adult. 4. Intentional physical, emotional, and/or sexual abuse and/or neglect.

4 chapter 4 question 51

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 chapter 9 question 40

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 chapter 9 question 42

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 chapter 9 question 43

A nurse is caring for a 5-year-old with sickle cell vaso-occlusive crisis. Which of the following orders should the nurse question? Select all that apply. 1. Position the child for comfort. 2. Apply hot packs to painful areas. 3. Give meperidine (Demerol) 25 mg intravenously every 4 hours as needed for pain. 4. Restrict oral fluids. 5. Apply oxygen per nasal cannula to keep oxygen saturations above 94%.

3, 4, 5.

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

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

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 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

Which assessment of an 18-month-old with burns on his feet would cause suspicion of child abuse? 1. Splash marks on his right lower leg. 2. Burns noted on right arm. 3. Symmetrical burns on both feet. 4. Burns mainly noted on right foot.

3 chapter 4 question 55

A 13-year-old with type 2 diabetes mellitus asks the nurse, "Why do I need to have this hemoglobin A1c test?" The nurse's response is based on which of the following? 1. To determine how balanced the child's diet has been. 2. To make sure the child is not anemic. 3. To determine how controlled the child's blood sugar has been. 4. To make sure the child's blood ketone level is normal.

3 chapter 9 question 46

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 chapter 9 question 47

The most important reason health-care providers prescribe a combination of antiretroviral drugs to children with HIV is to delay: 1. Progression to AIDS. 2. Enable treatment of multiple symptoms. 3. Recurrence of symptoms. 4. Drug resistance.

4

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

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 chapter 9 question 48

A 6-month-old is prescribed 2.5% hydrocortisone for topical treatment of eczema. The nurse instructs the parent not to use the cream for more than a week. What is the primary reason for this instruction? 1. Adverse effects, such as skin atrophy and fragility, can occur with long-term treatment. 2. If after a week there is no improvement, then a stronger dose is required. 3. The drug loses its efficacy after prolonged use. 4. If no improvement is seen after a week, an antibiotic should be prescribed.

1 chapter 2 question 39

The mother of a 6-month-old states that since yesterday, the infant cries when anyone touches her arm. Which would be the priority assessment after the airway, breathing, and circulation had been assessed and found stable? 1. Ask the mother if she knows what happened. 2. Assess infant for other signs of potential physical abuse. 3. Prepare for radiological diagnostic studies. 4. Establish intravenous access and draw blood for diagnostic testing.

1 chapter 4 question 54

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 chapter 9 question 41

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 chapter 9 question 56

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

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 chapter 9 question 38

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 chapter 9 question 55

Parents confide to the nurse that their child, who is 35 months old, does not talk and spends hours sitting on the floor watching the ceiling fan go around. They are concerned their child may have autism. The nurse should ask the parents which question? 1. "Does your child have brothers or sisters?" 2. "Does your child seek you out for comfort and love?" 3. "Do you have trouble getting babysitters for your child?" 4. "Does your child receive speech therapy?"

2 question 19 comprehensive exam

Which statement by the mother would lead the nurse to suspect sexual abuse in a 4-year-old? 1. "She has just started masturbating." 2. "She has lots more temper tantrums." 3. "She now has an invisible friend." 4. "She wants to spend time with her sister."

2 question 4 chapter 57

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 chapter 9 question 50

A 12-year-old with type 2 diabetes mellitus presents with a fever and a 2-day history of vomiting. The nurse observes that the child's breath has a fruity odor and breathing is deep and rapid. Which should the nurse do first? 1. Offer the child 8 oz of clear noncaloric fluid. 2. Test the child's urine for ketones. 3. Prepare the child for an IV infusion. 4. Offer the child 25 g of carbohydrates.

3 chapter 9 question 52

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.

A child born with Down syndrome should be evaluated for which associated cardiac manifestation? 1. Congenital heart defect (CHD). 2. Systemic hypertension. 3. Hyperlipidemia. 4. Cardiomyopathy.

1 question 36 chapter 6

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.

Which would the school nurse expect in a student who has an insulin-to- carbohydrate ratio of 1 : 10? 1. The student administers 10 U of regular insulin for every gram of carbohydrate consumed. 2. The student is trying to limit carbohydrate intake to 10 g per insulin dose. 3. The student administers 1 U of regular insulin for every 10 grams of carbohydrate consumed. 4. The student plans to eat 10 g of carbohydrate for every dose of insulin.

3 chapter 9 question 53

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 chapter 9 question 9

A 13-year-old is being seen for an annual physical examination. The child has lost 10 lb despite reports of excellent appetite. Appearance is normal, except for slightly protruding eyeballs, and the parents report the child has had difficulty sleeping lately. The nurse should do which of the following? 1. Prepare the family for a neurology consult. 2. Explain the need for an ophthalmology consult. 3. Discuss the plan for thyroid function tests. 4. Explain the plan for an 8-hour fasting blood glucose test.

3 chapter 9 question 58