PEDs Chapt 27 - 30 (Quiz) J.Erney@ LPN

A 16-year-old recently diagnosed with Marfan syndrome states, "I feel fine. Why do I need to have this testing done?" What is the best response by the nurse? a) "You want to live a long time, right?" b) "You are at risk of rupturing your aorta, and the echocardiogram will let us know if there are any problems." c) "This is routine. Nothing to worry about." d) "The lab work will let us know if you are developing diabetes as a complication."

"You are at risk of rupturing your aorta, and the echocardiogram will let us know if there are any problems." Correct Explanation: Marfan sydrome is a disorder that affects connective tissue. The aorta is susceptible to weakening because of the connective tissue disorder, leading to sudden death from aortic dissection. Diabetes is not a complication of Marfan. The other two choices offer no information and dismiss the teen's concerns.

The nurse is describing some of the developmental milestones the mother of a 3-month-old boy with Down syndrome can expect to see in her child. Which statement describes the milestones that are expected in a child with Down syndrome? a) "He will be speaking in sentences at 21 months of age." b) "Bladder training can be expected by 2.5 to 3 years of age." c) "You can expect him to eat with his hands by age 12 months." d) "He'll be crawling all over the house by 9 months of age."

"You can expect him to eat with his hands by age 12 months." Correct Explanation: Children with Down syndrome will accomplish eating with their hands by about 12 months of age. They will develop the skills of typical children, but at an older age. The child with Down syndrome will speak in sentences at 24 months rather than 21 months. Bladder training would occur by 48 months rather than 32 months. A child with Down syndrome will crawl at 11 months rather than 9 months.

The nurse recognizes that which individual or couple would most benefit from obtaining genetic counseling? a) 30-year-old female with a normal alpha-fetoprotein screening b) 23-year-old female, 25-year-old-male, both with family history of sickle cell disorder c) 25-year-old female, 40-year-old male, both with no significant past medical history d) 32-year-old female, 25-year-old male with one pregnancy loss

23-year-old female, 25-year-old-male, both with family history of sickle cell disorder Correct Explanation: A family history of sickle cell disorder increases the risk of passing the disorder to offspring; genetic counseling would benefit this couple most. The usual standard for counseling for pregnancy loss is two or more, not a single loss. A normal alpha-fetoprotein screening is not a criterion for genetic counseling. All ages listed here do not exceed the criterion for advanced maternal or paternal age.

When collecting data on a child diagnosed with diabetes mellitus, the nurse notes that the child has had weight loss and other symptoms of the disease. The nurse would anticipate which of the following findings in the child's fasting glucose levels? a) 180 mg/dL b) 120 mg/dL c) 60 mg/dL d) 240 mg/dL

240 mg/dL Correct Explanation: If the blood glucose level is elevated or ketonuria is present, a fasting blood sugar (FBS) is performed. An FBS result of 200 mg/dL or higher almost certainly is diagnostic for diabetes when other signs such as polyuria and weight loss, despite polyphagia, are present.

The physician requests the nurse to calculate the child's ANC. The complete blood count indicates that the child's "segs" are 14%, bands are 9%, and white blood cells (WBC) are 15,000. Calculate the child's absolute neutrophil count. _____ ANC

3450 Correct Explanation: Bands + segs/100) x WBC = ANC 14 + 9 = 23% = 23/100 = 0.23 0.23 x 15,000 = 3,450

A nurse is counseling a couple who have a 5-year-old daughter with Down syndrome. The nurse recognizes that their daughter's genome is represented by which of the following? a) 47XY21+ b) 46XX5p- c) 46XX d) 47XX21+

47XX21+ Correct Explanation: In Down syndrome, the person has an extra chromosome 21, so this is abbreviated as 47XX21+ (for a female) or 47XY21+ (for a male). 46XX is a normal genome for a female. The abbreviation 46XX5p- is the abbreviation for a female with 46 total chromosomes but with the short arm of chromosome 5 missing (Cri-du-chat syndrome).

A 25-year-old woman who recently underwent genetic testing has just learned that she is heterozygous dominant for Huntington disease. Her husband, however, who also underwent the testing, is free from the trait. What are the odds that the couple will have a child who will inherit the disorder? a) 25% b) 50% c) 75% d) 100%

50% Correct Explanation: If a person who is heterozygous or has a dominant illness gene opposing a recessive healthy gene mates with a person who is free of the trait, the chances are even (50%) a child born to the couple would have the disorder or would be disease and carrier free (that is, carrying no affected gene for the disorder).

When reviewing information about the incidence of the various types of childhood cancer, nursing students demonstrate understanding of the information when they identify which of the following as having the highest incidence? a) Acute lymphocytic (lymphoblastic) leukemia b) Osteogenic sarcoma c) Neuroblastoma d) Non-Hodgkin's lymphoma

Acute lymphocytic (lymphoblastic) leukemia Correct Explanation: Acute lymphocytic leukemia accounts for approximately 32% of all childhood cancers. Neuroblastomas account for 8%; non-Hodgkin's lymphoma accounts for 6%; osteogenic sarcoma accounts for 3%

The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which of the following actions would be the most appropriate for the school nurse to do? a) Request that someone call 911 b) Administer subcutaneous glucagon c) Anticipate that the child will need intravenous glucose d) Dissolve a piece of candy in the child's mouth

Administer subcutaneous glucagon Correct Explanation: If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level. This treatment prevents the long delay while waiting for a physician to administer IV glucose or for an ambulance to reach the child.

The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which of the following actions would be the most appropriate for the school nurse to do? a) Request that someone call 911 b) Administer subcutaneous glucagon c) Dissolve a piece of candy in the child's mouth d) Anticipate that the child will need intravenous glucose

Administer subcutaneous glucagon Correct Explanation: If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level. This treatment prevents the long delay while waiting for a physician to administer IV glucose or for an ambulance to reach the child.

A nurse is reviewing information about the various types of insulin that are used to treat diabetes mellitus type 1. Integrating knowledge about the duration of action, place the types below in the order from shortest to longest duration. Glargine NPH Aspart Regular

Aspart Regular NPH Glargine Explanation: Aspart has a duration of action of 3 to 5 hours; regular insulin has a duration of 5 to 8 hours; NPH has a duration of 10 to 16 hours; and glargine has a duration of 12 to 24 hours.

The physician has ordered a thyroid scan to confirm the diagnosis. Before the procedure the nurse should: a) Give the client a bolus of fluids. b) Tell the client they will be asleep. c) Assess the client for allergies. d) Insert a urinary catheter.

Assess the client for allergies. Correct Explanation: A thyroid scan uses dye, so a client should be assessed for allergies to iodine and shellfish to prevent a possible reaction. The client will not be asleep, have a catheter, or receive a bolus of fluids.

Cystic fibrosis is an example of which type of inheritance? a) Multifactorial b) Autosomal dominant c) X-linked recessive d) Autosomal recessive

Autosomal recessive Correct Explanation: Cystic fibrosis is an autosomal recessive inherited condition. Huntington disease would be an example of an autosomal dominant inherited condition. Hemophilia is an X-linked recessive inherited condition. Cleft lip is a multifactorial inherited condition.

A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. Which of the following would be most important for the nurse to include in the child's preoperative plan of care? a) Preparing the child for amputation b) Avoiding further abdominal palpation c) Administering analgesics for pain d) Performing dressing changes to the affected area

Avoiding further abdominal palpation Explanation: After the initial assessment is performed on a child with Wilms tumor, further palpation of the abdomen should be avoided because the tumor is highly vascular and soft. Therefore, excessive handling of the tumor may result in tumor seeding and metastasis. Preoperatively, the child with Wilms tumor does not have a wound; therefore, dressing changes are not necessary. Although the child may experience abdominal pain, avoiding further abdominal palpation would be the priority. Surgical removal of the tumor and affected kidney is the treatment of choice for Wilms tumor. Amputation would be more likely for a child with osteosarcoma.

What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent? a) Body appearance changes very little. b) Flushing of the device is not necessary. c) No tunneling is needed when the port is inserted. d) No special procedure is necessary for removal.

Body appearance changes very little. Correct Explanation: An implanted port has nothing extending through the skin and may be obvious only as a slight protrusion at the insertion site. Some tunneling from the port to a central vein is needed. Removal of the port requires a surgical procedure. Flushing of the port is necessary when used and on a regular basis.

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia." What will confirm this diagnosis? a) History of leukemia in twin b) Lethargy, bruising, and pallor c) Bone marrow aspiration d) Complete white blood count

Bone marrow aspiration Correct Explanation: Bone marrow aspiration and biopsy are diagnostic. An abnormal white blood count and symptoms of lethargy, bruising, and pallor only create suspicion of leukemia; a twin may or may not be affected.

A group of students are reviewing information about delayed puberty in preparation for a class discussion. The students demonstrate understanding of this condition when they describe which of the following as occurring in girls? a) Growth spurt has not begun by age 12. b) Breast development has not occurred by age 13. c) Pubic hair has not appeared by age 16. d) Menarche has not occurred by age 14.

Breast development has not occurred by age 13. Explanation: Delayed puberty is a condition of delayed secondary sexual development. In girls, it exists if the breasts have not developed by age 13, pubic hair has not appeared by age 14 or menarche has not occurred by age 16. Growth spurt is not a criterion for the disorders.

You care for a child with Down syndrome (trisomy 21). This is an example of which type of inheritance? a) Mendelian dominant b) Phase 2 atrophy c) Chromosome nondisjunction d) Mendelian recessive

Chromosome nondisjunction Correct Explanation: Down syndrome occurs when an ovum or sperm cell does not divide evenly, permitting an extra 21st chromosome to cross to a new cell.

As a nurse, you know that which of the following is caused by excessive levels of circulating cortisol: a) Cushing syndrome b) Addison disease c) Turner syndrome d) Graves disease

Cushing syndrome Correct Explanation: CS is a characteristic cluster of signs and symptoms resulting from excessive levels of circulating cortisol. Addison disease is caused by autoimmune destruction of the adrenal cortex, which results in dysfunction of steroidogenesis. Grave disease is the most common form of hyperthyroidism. Turner syndrome is deletion of the entire X chromosome.

As a nurse, you know that which of the following is caused by excessive levels of circulating cortisol: a) Cushing syndrome b) Graves disease c) Addison disease d) Turner syndrome

Cushing syndrome Correct Explanation: CS is a characteristic cluster of signs and symptoms resulting from excessive levels of circulating cortisol. Addison disease is caused by autoimmune destruction of the adrenal cortex, which results in dysfunction of steroidogenesis. Grave disease is the most common form of hyperthyroidism. Turner syndrome is deletion of the entire X chromosome.

A 15-year-old girl is brought to the clinic by her mother because the girl has been experiencing irregular and sporadic menstrual periods and excessive body hair growth. Polycystic ovary syndrome is suspected. Which additional assessment finding would help to support this suspicion? a) Body mass index as normal b) Darkened pigmentation around the neck area c) Short stature d) Decreased serum levels of free testosterone

Darkened pigmentation around the neck area Explanation: Acanthosis nigricans (darkened, thickened pigmentation, particularly around the neck or in the axillary region) is associated with polycystic ovary syndrome. Serum levels of free testosterone typically are elevated with polycystic ovary syndrome. With polycystic ovary syndrome, body mass index indicates overweight or obesity. Short stature typically is associated with growth hormone deficiency.

A pregnant woman undergoes maternal serum alpha-fetoprotein (MSAFP) testing at 16 to 18 weeks' gestation. Which of the following would the nurse suspect if the woman's level is decreased? a) Cardiac defects b) Open neural tube defect c) Down syndrome d) Sickle-cell anemia

Down syndrome Explanation: Decreased levels might indicate Down syndrome or trisomy 18. Sickle cell anemia may be identified by chorionic villus sampling. MSAFP levels would be increased with cardiac defects, such as tetralogy of Fallot. A triple marker test would be used to determine an open neural tube defect.

Children who are free of acute lymphocytic anemia for 2 years following treatment are considered cured. a) False b) True

False Correct Explanation: Children who are free of disease for 4 years are considered cured, and their maintenance therapy can then be stopped.

A 6-month-old girl is seen with retinoblastoma. When taking a health history from her father, which symptom would you expect him to report he has noticed? a) His daughter tugs and pulls at one ear. b) His daughter's eye appears to be protruding. c) He has noticed one pupil appears white. d) The infant always keeps her eyes tightly closed.

He has noticed one pupil appears white. Explanation: As the tumor grows against the retina of the eye, the red reflex is no longer visible; the pupil appears white.

A child with ALL is receiving methotrexate for therapy. Which nursing diagnosis below would best apply to him during therapy? a) Excess fluid volume related to effect of methotrexate on aldosterone secretion b) Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy c) Risk for impaired mobility related to depressant effects of methotrexate d) Risk for self-directed violence related to effect of methotrexate on central nervous system

Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy Explanation: Many chemotherapy agents cause oral ulcerations that interfere with nutrition because of pain and leave a portal of infection.

A Caucasian female client of Jewish ancestry is pregnant. The nurse is aware that the client may be a carrier for which of the following conditions? a) Tay Sachs disease b) Phenylketonuria c) Dupuytrens d) Krabbe disease

Tay Sachs disease Correct Explanation: Because the client is of Jewish ancestry, there is an increased risk of her being a carrier of the Tay Sachs disease gene. Norwegians are at a greater risk for Dupuytrens and Phenylketonuria, while Icelanders have an increased risk for Phenylketonuria.

A baby is born with what the physician believes is a diagnosis of trisomy 21. This means that the infant has three number 21 chromosomes. What factor describes this genetic change? a) The mother also has genetic mutation of chromosome 21 b) The patient has a nondisjunction occurring during meiosis c) The patient will have a single X chromosome and infertility d) During meiosis, a reduction of chromosomes resulted in 23

The patient has a nondisjunction occurring during meiosis Correct Explanation: During meiosis, a pair of chromosomes may fail to separate completely, creating a sperm or oocyte that contains either two copies or no copy of a particular chromosome. This sporadic event, called nondisjunction, can lead to trisomy. Down syndrome is an example of trisomy. The mother does not have a mutation of chromosome 21, which is indicated in the question. Also, Trisomy does not produce a single X chromosome and infertility. Genes are packaged and arranged in a linear order within chromosomes, which are located in the cell nucleus. In humans, 46 chromosomes occur in pairs in all body cells except oocytes and sperm, which contain only 23 chromosomes.

What is the main purpose of nurses having basic genetic knowledge? a) To advocate for a cure for genetic disorders b) To provide support and education to families c) To understand all genetic disorders, allowing for improved quality of life d) To ensure proper medical diagnosis

To provide support and education to families Correct Explanation: The purpose of the nurse knowing about basic genetics is that it helps her to provide support and education to families. Nurses can advocate for a cure, but this is not the main purpose of attaining basic knowledge of genetics. Providing a medical diagnosis is beyond the scope of practice for a nurse. It would be impossible for the nurse to understand all genetic disorders; it is more reasonable for the nurse to be familiar with the most common genetic disorders

A newborn is born with hypothyroidism. A complication of this disorder if it is not recognized and treated is a) cognitive impairment. b) blindness. c) dehydration. d) muscle spasticity.

cognitive impairment. Correct Explanation: Congenital hypothyroidism can lead to extreme cognitive challenge impairment if not treated.

In the salt-losing form of congenital adrenogenital hyperplasia, the most important observation you would make in a newborn would be for a) excessive cortisone secretion. b) dehydration. c) bleeding tendencies. d) hypoglycemia.

dehydration. Correct Explanation: With this form of the disorder, children are unable to produce aldosterone. This leads to the inability to retain sodium and fluid.

A gene that is expressed when paired with another gene for the same trait is called a) recessive. b) dominant. c) heterozygous. d) homozygous.

dominant. Correct Explanation: A dominant gene is one that will be expressed when paired with a like gene.

You teach a child with type 1 diabetes mellitus to administer her own insulin. She is receiving a combination of short-acting and long-acting insulin. You know that she has appropriately learned the technique when she a) wipes off the needle with an alcohol swab. b) administers the insulin intramuscularly into rotating sites. c) administers the insulin into a doll at a 30-degree angle. d) draws up the short-acting insulin into the syringe first.

draws up the short-acting insulin into the syringe first. Correct Explanation: Drawing up the short-acting insulin first prevents mixing a long-acting form into the vial of short-acting insulin. This maintains the short-acting insulin for an emergency. Insulin is given subcutaneously.

Children with ALL may need periodic lumbar punctures. You would teach the mother this is done to assess for a) early meningitis. b) leukemic cells. c) platelets. d) early development of septicemia.

leukemic cells. Correct Explanation: Leukemic cells in cerebrospinal fluid must be identified because, if present, they require additional therapy.

A nursing student correctly identifies that a person's outward appearance or expression of genes is referred to as which of the following? a) allele b) genome c) phenotype d) genotype

phenotype Correct Explanation: Alleles are two like genes. Phenotype refers to a person's outward appearance or the expression of genes. Genotype refers to his or her actual gene composition. Genome is the complete set of genes present in a person.

Rumination disorder is a poorly understood condition of young children. This refers to a) a habit of eating nonfood substances. b) rechewing undigested food. c) fear of moving objects. d) excessive worrying about friendships.

rechewing undigested food. Correct Explanation: Rumination is the rechewing of undigested food. It occurs primarily in infants.

The nursing diagnosis most applicable to a child with growth hormone deficiency would be a) risk for self-directed violence related to oversecretion of epinephrine. b) risk for situational low self-esteem related to short stature. c) ineffective tissue perfusion related to infantile blood vessels. d) impaired skin integrity related to overproduction of melanin.

risk for situational low self-esteem related to short stature. Correct Explanation: Children who are short in stature can develop low self-esteem from their altered appearance.

Girls with Turner Syndrome will usually exhibit a) short stature b) progressive dementia c) chorealike movements d) painful joints

short stature Correct Explanation: Girls with Turner syndrome usually have a single X chromosome, causing them to have short stature and infertility. Persons with sickle cell anemia have painful joints. Color blindness occurs in persons diagnosed with Huntington disease and they may exhibit chorealike movements. Progressive dementia occurs in early-onset familial Alzheimer's disease.

The child has been diagnosed with attention deficit hyperactivity disorder (ADHD) and has been prescribed methylphenidate (Ritalin). Which of the following findings are most likely adverse effects related to this type of medication? Select all that apply. a) The child complains that his head hurts at times b) The child has been more irritable since beginning methylphenidate (Ritalin) c) The child has gained weight since beginning methylphenidate (Ritalin) d) The child complains that he has developed abdominal pain e) The child's parents state that he sleeps much longer than he used to

• The child complains that his head hurts at times • The child has been more irritable since beginning methylphenidate (Ritalin) • The child complains that he has developed abdominal pain Explanation: Common side effects related to the use of psychostimulants are: headaches, irritability, and abdominal pain. Children typically exhibit a decreased appetite and may have difficulty with insomnia.

Which statement by the parent of a 12-month-old child diagnosed with Down syndrome shows the need for further education? a) "Thyroid testing is needed every year." b) "I will need to delay any further immunizations." c) "In a couple of years, my child will need an x-ray of the neck." d) "I will watch closely for development of respiratory infection."

"I will need to delay any further immunizations." Correct Explanation: Down syndrome children are at higher risk for infection because of a lowered immune system. Delaying immunizations may expose the child to illnesses that could have been prevented. Down syndrome children are at greater risk for developing thyroid disorders, 1st and 2nd vertebrae disorders, and respiratory infections.

The nurse is providing teaching about the potential side effects of lithium for the parents of a girl recently diagnosed with bipolar disorder. Which statement by the parents indicates a need for additional teaching? a) "She may notice an increase in urination" b) "If she loses weight, then we know the medication is working." c) "She will probably tell us that she is hungrier than usual." d) "Tremors and nausea are common side effects."

"If she loses weight, then we know the medication is working." Explanation: Weight gain, not weight loss, is a side effect of the drug. An increased appetite occurs with lithium. Lithium is associated with tremors and nausea. Polyuria occurs with lithium.

After explaining the causes of hypothyroidism to the parents of a newly diagnosed infant, the nurse should recognize that further education is needed when the parents ask which question? a) "So, hypothyroidism can be treated by exposing our baby to a special light, right?" b) "Are you saying that hypothyroidism is caused by a problem in the way the thyroid gland develops?" c) "So, hypothyroidism can be only temporary, right?" d) "Do you mean that hypothyroidism may be caused by a problem in the way the body makes thyroxine?"

"So, hypothyroidism can be treated by exposing our baby to a special light, right?" Explanation: Congenital hypothyroidism can be permanent or transient and may result from a defective thyroid gland or an enzymatic defect in thyroxine synthesis. Only the last question, which refers to phototherapy for physiologic jaundice, indicates that the parents need more information.

The parents of a child diagnosed with Tay-Sachs inquire about progression of the disorder. Which statement by the nurse is accurate? a) "Anticonvulstants will be given to prolong life and prevent further brain damage." b) "Lifetime steroid therapy will reverse the blindness." c) "The child will experince decreased muscular and neurologic functioning until death occurs." d) "Symptoms can be controlled by eliminating dairy products."

"The child will experince decreased muscular and neurologic functioning until death occurs." Correct Explanation: This is an irreversible progressive disorder that affects the functioning of muscles and the neurologic system. Symptoms cannot be controlled by changes in the diet, and medication therapy will not reverse symptoms nor prolong life. Medication will be used to treat symptoms and provide comfort measures.

Which statement by the nurse accurately describes the term phenotype? a) "The genetic makeup of an individual" b) "The somatic cells of an individual" c) "The individual's outward appearance" d) "Only the homozygous genes outwardly expressed"

"The individual's outward appearance" Correct Explanation: Phenotype is the outward characteristic of an individual. The genetic makeup of an individual is a genotype. A somatic cell is an individual cell that combines with others to form an organism. Phenotype can be determined by both homozygous genes and heterozygous genes.

A parent asks why a physical therapist is needed for the 6-month-old child diagnosed with Down syndrome. What is the best response by the nurse? a) "To optimize the child's development and functioning" b) "The earlier the intervention, the more likely we are to cure the problem." c) "To prevent contractures" d) "To ensure that the child meets all developmental milestones on time"

"To optimize the child's development and functioning" Correct Explanation: Interventional therapy is started early to promote the child's development and optimize functioning. The Down syndrome child usually meets developmental milestones at a slower pace. There is no cure for genetic disorders. Range-of-motion activities can prevent contractures; Down syndrome does not require physical therapy.

The mother of a 10-year-old boy with attention deficit hyperactivity disorder (ADHD) contacts the school nurse. She is upset because her son has been made to feel different by his peers because he has to visit the nurse's office for a lunch time dose of medication. The boy is threatening to stop taking his medication. How should the nurse respond? a) "You may want to talk to your physician about an extended release medication" b) "He should ignore the children, he needs this medication" c) "I can have the teacher speak with the other children" d) "Remind him that his schoolwork may deteriorate"

"You may want to talk to your physician about an extended release medication" Correct Explanation: The nurse should encourage the family to explore with their physician the option of one of the newer extended-release or once daily ADHD medications. The other statements are not helpful and do not address the mother's or boy's concerns.

When explaining the procedure of bone marrow aspiration to a child with leukemia, what would be the best explanation? a) "You will have to lie on your back and hold your breath." b) "You won't feel any pain at all, because you will be asleep." c) "You will feel pressure on your hip from the needle." d) "You will need to lie still afterward to prevent a headache."

"You will feel pressure on your hip from the needle." Correct Explanation: Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. It is usually done under local anesthesia or conscious sedation.

A woman carries a recessive gene for sickle cell anemia. If her sexual partner also has this recessive gene, the chance that her first child will develop sickle cell anemia is a) 0 in 4. b) 2 in 4. c) 1 in 4. d) 3 in 4.

1 in 4. Correct Explanation: Autosomal recessive inherited diseases occur at a 1-in-4 incidence in offspring.

The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myelogenous leukemia about the side effects of chemotherapy. For which of the following symptoms should the parents seek medical care immediately? a) Difficulty or pain when swallowing b) A temperature of 101°F (38.3° C) or greater

A temperature of 101°F (38.3° C) or greater Explanation: The parents should seek medical care immediately if the child has a temperature of 101°F (38.3° C) or greater. This is because many chemotherapeutic drugs cause bone marrow suppression; the parents must be directed to take action at the first sign of infection in order to prevent overwhelming sepsis. The appearance of earache, stiff neck, sore throat, blisters, ulcers, or rashes, or difficulty or pain when swallowing are reasons to seek medical care, but are not as grave as the risk of infection.

You prepare a couple to have a karyotype performed. Which of the following describes a karyotype? a) The gene carried on the X or Y chromosome b) A visual presentation of the chromosome pattern of an individual c) The dominant gene that will exert influence over a correspondingly located recessive gene d) A blood test that will reveal an individual's homozygous tendencies

A visual presentation of the chromosome pattern of an individual Correct Explanation: A karyotype is a photograph of a person's chromosomes aligned in order.

A nursing student is reviewing information about inheritance and genetic disorders. The student demonstrates understanding of the information by identifying which of the following as an example of a disorder involving multifactorial inheritance? a) Cystic fibrosis b) Hypophosphatemic rickets c) Hemophilia d) Cleft palate

Cleft palate Correct Explanation: Cleft palate is attributed to multifactorial inheritance. Hemophilia follows an X-linked recessive inheritance pattern. Hypophosphatemic rickets follows an X-linked dominant inheritance pattern. Cystic fibrosis follows an autosomal recessive inheritance pattern.

For which of the following clients is preimplantation genetic diagnosis (PGD) a viable option? a) Clients carrying cystic fibrosis gene b) Prevention of Pyloric stenosis c) Prevention of DiGeorge syndrome d) Client in the second week of pregnancy

Clients carrying cystic fibrosis gene Correct Explanation: Preimplantation genetic diagnosis (PGD) is a viable option for clients carrying the cystic fibrosis gene. PGD does not help prevent DiGeorge syndrome or pyloric stenosis. PGD is not a viable option for pregnant clients.

Hypothyroidism results from deficient production of thyroid hormone or a defect in the thyroid hormone receptor activity. Hypothyroidism caused during embryonic development of the gland is called: a) Autoimmune thyroiditis b) Congenital hypothyroidism c) Secondary hypothyroidism d) Acquired hypothyroidism

Congenital hypothyroidism Correct Explanation: Congenital hypothyroidism is most commonly caused by defective embryonic development of the gland. Acquired hypothyroidism usually refers to thyroid deficiency that becomes evident after a period of apparently normal thyroid function. The most common cause of acquired hypothyroidism in iodine-sufficient regions of the world is lymphocytic thyroiditis (also called Hashimoto's or autoimmune thyroiditis).

You are going in to see a new patient in the clinic and the chief complaints for the patient are polyuria and polydipsia. You know that these are indicative of which endocrine disorder? a) Hypopituitarism b) Precocious puberty c) Diabetes insipidus d) Syndrome of inappropriate antidiuretic hormone secretion

Diabetes insipidus Correct Explanation: The most common symptoms of central DI are polyuria (excessive urination) and polydipsia (excessive thirst). Children with DI typically excrete 4 to 15 L per day of urine despite the fluid intake. The onset of these symptoms is usually sudden and abrupt. Ask about repeated trips to the bathroom, nocturia, and enuresis. Other symptoms may include dehydration, fever, weight loss, increased irritability, vomiting, constipation, and, potentially, hypovolemic shock.

The nurse is caring for a child with diabetes mellitus type 1. The nurse notes that the child is drowsy, has flushed cheeks and red lips, a fruity smell to the breath, and there has been an increase in the rate and depth of the child's respirations. The nurse recognizes that these symptoms indicate the child has which of the following? a) Diabetic ketoacidosis b) Polyphagia c) Insulin reaction d) Cheyne stokes respiration

Diabetic ketoacidosis Correct Explanation: Diabetic ketoacidosis is characterized by drowsiness, dry skin, flushed cheeks and cherry-red lips, acetone breath with a fruity smell, and Kussmaul breathing (abnormal increase in the depth and rate of the respiratory movements).

Which of the following diagnoses would be most appropriate for an infant with a large retinoblastoma after surgery? a) Disturbed sensory perception related to enucleation b) Pain related to retinal removal c) Anticipatory grieving related to change in body image d) Fear related to loss of normal vision

Disturbed sensory perception related to enucleation Explanation: The primary therapy for a large retinoblastoma is removal (enucleation) of the affected eye.

Nondisjunction of a chromosome results in which of the following diagnoses? a) Duchenne muscular dystrophy b) Down syndrome c) Marfan syndrome d) Huntingon disease

Down syndrome Correct Explanation: When a pair of chromosomes fails to separate completely (nondisjunction) the resulting sperm or oocyte contains two copies of a particular chromosome. Nondisjunction can result in a fertilized egg having trisomy 21 or Down syndrome. Huntington disease is one example of a germ-line mutation. Duchenne muscular dystrophy, an inherited form of muscular dystrophy, is an example of a genetic disease caused by structural gene mutations. Marfan syndrome is a genetic condition that may occur in a single family member as a result of spontaneous mutation.

A 7-year-old child is diagnosed with a learning disability involving reading, writing, and spelling. The nurse identifies this as which of the following? a) Dyslexia b) Dyspraxia c) Dyscalculia d) Dysgraphia

Dyslexia Correct Explanation: Dyslexia is a learning disability that involves reading, writing, and spelling. Dyscalculia is a learning disability that involves mathematics and computation. Dyspraxia is a learning disability that involves problems with manual dexterity and coordination. Dysgraphia is a learning disability that involves problems producing the written word.

The nurse is caring for a 13-year-old girl with a nursing diagnosis of ineffective coping related to inability to deal with life stressors as evidenced by few or no meaningful friendships and low self-esteem. Which intervention would be the priority to promote coping skills? a) Set clear limits on behavior. b) Role model appropriate social and conversation skills. c) Encourage her to discuss her thoughts and feelings. d) Demonstrate unconditional acceptance of the child as a person.

Encourage her to discuss her thoughts and feelings. Explanation: The priority intervention is to encourage her to discuss her thoughts and feelings, as this is an initial step toward learning to deal with them appropriately. The other interventions are appropriate, but the priority intervention is to encourage discussion and obtain information from the child. This way the nurse can develop and refine the interventions based on the child's thoughts and feelings.

The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. Caring for a child that has issues with the anterior pituitary, the child has issues with which hormone? a) Oxytocin b) Antidiuretic hormone c) Vasopressin d) Growth hormone

Growth hormone Correct Explanation: Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adrenohypophysis, is made up of endocrine glandular tissue and secretes growth hormone (GH), adrenocorticotropic hormone (ACTH), TSH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. The posterior lobe is called the neurohypophysis because it is formed of neural tissue. It secretes antidiuretic hormone (ADH; vasopressin) and oxytocin. Usually, several target organs are affected when there is a disorder of the pituitary gland, especially the adrenohypophysis

An 18-year-old male patient is diagnosed with Klinefelter syndrome. What signs and symptoms are consistent with this diagnosis? a) Hypergonadism and decreased pubic hair b) Hypogonadism and gynecomastia c) Long torso and decreased facial hair d) Enlaged testes and tall stature

Hypogonadism and gynecomastia Correct Explanation: Klinefelter syndrome affects males, causing only testosterone deficiency. Males may develop female-like characteristics such as gynecomastia and may experience hypogonadism. Decreased pubic and facial hair, along with tall stature, are characteristic of the disorder. The corresponding signs and symptoms listed in the other answer selections are not signs and symptoms of the disorder.

Which statement about nondisjunction of a chromosome is true? a) Only the X chromosomes are affected. b) Only 4% of Down syndrome cases are attributed to this defect. c) It may result from genomic imprinting. d) It is failure of the chromosomal pair to separate.

It is failure of the chromosomal pair to separate. Correct Explanation: Nondisjunction simply means failure to separate. Nondisjunction can happen at any chromosome and is attributed to 95% of Down syndrome cases. Genomic imprinting is a different genetic disorder that is not related to nondisjunctioning.

Which of the following is a well-defined risk management technique that the nurse can teach children and parents to prevent cancer? a) Incorporate more preservative-free foods into the diet b) Eliminate aerosol sprays from the living area c) Avoid artificial colors, flavors, and fragrances in foods, cosmetics, and household items d) Limit sun exposure throughout childhood and adolescence

Limit sun exposure throughout childhood and adolescence Explanation: Limiting sun exposure by using shade, clothing, and sunscreen applied correctly will reduce the risk of skin cancer. Sun exposure is cumulative throughout life; the greatest exposure tends to occur in childhood and adolescence. Tanning booths should not be used. The other choices could have some merit, but none has been scientifically confirmed.

The nurse is caring for a 4-year-old boy during a growth hormone stimulation test. Which of the following is a priority task for the care of this child? a) Providing a wet washcloth to suck on b) Monitoring blood glucose levels c) Educating family about side effects d) Monitoring intake and output

Monitoring blood glucose levels Correct Explanation: Monitoring blood glucose levels during this study is the priority task along with observing for signs of hypoglycemia since insulin is given during the test to stimulate release of growth hormone. Providing a wet washcloth would be more appropriate for a child who is on therapeutic fluid restriction, such as with syndrome of inappropriate antidiuretic hormone. Monitoring intake and output would not be necessary for this test but would be appropriate for a child with diabetes insipidus. While it is important to educate the family about this test, it is not the priority task.

The nurse is caring for a child who has been hospitalized repeatedly at multiple hospitals. There is no clear medical diagnosis and the mother is threatening to leave the hospital against medical advice. The nurse suspects which of the following? a) Anxiety disorder b) Bipolar disorder c) Munchhausen syndrome by proxy d) Sexual abuse

Munchhausen syndrome by proxy Correct Explanation: Repeated hospitalizations that fail to produce a medical diagnosis, transfers to other hospitals, and discharges against medical advice are warning signs of Munchhausen syndrome by proxy.

Which intervention is best to use with the 6-year-old who has developed stomatitis as a side effect of chemotherapy? a) Limit foods to cool, clear liquids b) Use lidocaine rinses c) Have the child freely choose desired foods and beverages d) Practice frequent, gentle oral hygiene

Practice frequent, gentle oral hygiene Explanation: Frequent, gentle oral hygiene will keep the vulnerable oral mucosa clean and will prevent secondary infection. Offering only cool, clear liquids will limit nutrition. "Child freely choosing foods and beverages" gives some control to the 6-year-old but is likely to result in ingestion of foods that are irritating to the mouth, lips, and throat. Lidocaine used as a rinse can create risks for children younger than 8 years because often some is swallowed, and this inhibits the gag reflex.

A mother is telling the school nurse about her concerns regarding her 13-year-old daughter, who complains of headaches. Her grades have dropped, and she is sleeping late and going to bed early every night. The nurse advises the mother that the first priority should be which of the following: a) Schedule an immediate history and physical examination. b) Call for an appointment with a psychologist. c) Discuss the situation with her teacher. d) Ask the school psychologist to do psychometric testing.

Schedule an immediate history and physical examination. Correct Explanation: The first step is to conduct a physical examination to rule out or identify illnesses or physical problems that might cause depression. Once any physical causes have been ruled out, the healthcare team can determine the most appropriate approach to assess the girl's symptoms. (less)

The nurse working with the child diagnosed with Type 2 Diabetes Mellitus recognizes that most often the disorder can be managed by which of the following? a) Increasing protein in the diet, especially in the evening b) Decreasing amounts of daily insulin c) Conserving energy with rest periods during the day d) Taking oral hypoglycemic agents

Taking oral hypoglycemic agents Correct Explanation: If the child presents with diabetic ketoacidosis, initial treatment is insulin administration, but then oral hypoglycemic agents such as metformin are often effective for controlling blood glucose levels. Lifestyle changes such as weight loss and increased exercise are important aspects of treatment for the child.

The nurse is preparing an education plan to help the family to learn about their child's developmental disorder and its treatment. Which of the following interventions will be part of the plan? a) Linking the family to support groups b) Providing education to build social skills c) Conducting developmental assessments of the child d) Teaching how to plan schedules and routines

Teaching how to plan schedules and routines Correct Explanation: Teaching how to plan schedules and routines would be part of the education plan. Providing education to build social skills, conducting developmental assessments of the child, and linking the family to support groups are all nursing interventions for providing services to the child.

The nurse is working with a child diagnosed with encopresis. After a complete medical workup has been done, no organic cause has been found for the disorder. The nurse will anticipate that which of the following will be done next? a) The child will be placed in a foster home. b) The child will be started on methylphenidate (Ritalin). c) The child will be put on a high-calorie, high-protein diet. d) The child will be referred for counseling.

The child will be referred for counseling. Correct Explanation: If no organic causes (e.g., worms, megacolon) exist, encopresis indicates a serious emotional problem and a need for counseling for the child and the family caregivers.

Women having in vitro fertilization (IVF) can have both the egg and sperm examined for genetic disorders of single gene or chromosome concerns before implantation. a) True b) False

True

The parents of an adolescent are concerned about his mental health and have brought the adolescent into the physician's office for an evaluation. Which of the following statements by the child's parents indicates that the child may have a mental health disorder? Select all that apply. a) "He has lost 10 pounds over the last 4 months." b) "He used to be a straight-A student and now he's bringing home Cs and Ds." c) "He hangs out with the same kids he always has." d) "He still enjoys playing a lot of baseball." e) "He has started sleeping for only 3 hours each night."

• "He has lost 10 pounds over the last 4 months." • "He used to be a straight-A student and now he's bringing home Cs and Ds." • "He has started sleeping for only 3 hours each night." Correct Explanation: Altered sleep patterns, weight loss, and problems at school are commonly found in children with mental health disorders. There also may be alterations in friendships and changes in extracurricular activity participation.

A nurse is assessing a child with cancer and suspects that the child has developed sepsis based on which of the following? Select all that apply. a) Increased blood urea nitrogen (BUN) b) Hyperkalemia c) Absolute neutrophil count (ANC) less than 500 d) Respiratory alkalosis e) Thrombocytosis

• Absolute neutrophil count (ANC) less than 500 • Increased blood urea nitrogen (BUN) • Hyperkalemia Explanation: Findings associated with sepsis include ANC less than 500, increased BUN, increased potassium, decreased platelets, and metabolic acidosis.

A child is receiving chemotherapy and develops stomatitis. The nurse identifies a nursing diagnosis of impaired oral mucous membranes related to the effects of chemotherapy. Which of the following would the nurse include in the child's plan of care? Select all that apply. a) Provide various soft and bland foods to minimize further irritation. b) Have the child rinse the mouth with lukewarm water three times a day. c) Give the child acidic foods (eg, orange juice) to cleanse the mouth. d) Vigorously rub the child's gums with gauze to clean them. e) Apply a lip balm or petroleum jelly to prevent cracking.

• Provide various soft and bland foods to minimize further irritation. • Have the child rinse the mouth with lukewarm water three times a day. • Apply a lip balm or petroleum jelly to prevent cracking. Correct Explanation: For the child with stomatitis, the nurse should provide soft foods to prevent further abrasions, have the child rinse the mouth three times a day with lukewarm water to promote comfort and healing, avoid giving the child acidic foods that would further irritate the tissue, and apply a lip balm or petroleum jelly to prevent cracking of the lips. The nurse should offer a soft toothbrush to minimize discomfort.

The nurse is performing the physical examination of a child with bulimia. Which of the following would the nurse identify as supporting this disorder? Select all that apply. a) Pink moist gums b) Eroded dental enamel c) Dry sallow skin d) Bradycardia e) Split fingernails

• Split fingernails • Eroded dental enamel Explanation: The adolescent with bulimia will be of normal weight or slightly overweight. The hands will show calluses on the backs of the knuckles and split fingernails. The mouth and oropharynx will exhibit eroded dental enamel, red gums, and an inflamed throat from self-induced vomiting. Bradycardia and dry sallow skin suggest anorexia.

A child with a history of diabetes insipidus has been taking vasopressin. The parents bring the child to the clinic for an evaluation. During the visit, the parents mention that it seems like their son is hardly urinating. The nurse suspects syndrome of inappropriate antidiuretic hormone. Which of the following would the nurse expect to find to help confirm this condition? Select all that apply. a) Decreased urine osmolality b) Decreased serum sodium level c) Hypotension d) Weight loss e) Serum osmolality 300 mOsm/kg f) Urine specific gravity 1.033

• Urine specific gravity 1.033 • Decreased serum sodium level • Serum osmolality 300 mOsm/kg Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by decreased urination, hyponatremia, serum osmolality greater than 280 mOsm/kg, urine specific gravity greater than 1.030, increased urine osmolality, fluid retention, weight gain, and hypertension.

A child is prescribed glargine (Lantus) insulin. Which of the following would the nurse include when teaching the child and parents about this insulin? a) "Give the dose first thing in the morning." b) "Do not mix this insulin with other insulins." c) Discard any opened vials after a week. d) Store the insulin in the refrigerator until just before giving it.

"Do not mix this insulin with other insulins." Correct Explanation: Glargine (Lantus) is not mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month.

A woman is to undergo chorionic villus sampling as part of a risk assessment for genetic disorders. Which of the following would the nurse include when describing this test to the woman? a) "A needle will be inserted directly into your fetus's umbilical vessel to collect blood for testing." b) "An intravaginal ultrasound measures fluid in the space between the skin and spine." c) "A small piece of tissue from the fetal placenta will be removed and analyzed." d) "A small amount of amniotic fluid will be withdrawn and collected for analysis."

"A small piece of tissue from the fetal placenta will be removed and analyzed." Correct Explanation: Percutaneous umbilical cord sampling involves the insertion of a needle into the umbilical vessel. An amniocentesis involves the collection of amniotic fluid from the amniotic sac. Fetal nuchal translucency involves the use of intravaginal ultrasound to measure fluid collected in the subcutaneous space between the skin and cervical spine of the fetus. Chorionic villus sampling involves the removal of a small tissue specimen from the fetal portion of the placenta

A couple has just learned that their son will be born with Down's syndrome. The nurse shows a lack of understanding when making which of the following statements? a) "I will alert your entire family about this so you don't have to." b) "We have counseling services available, and I recommend them to everyone facing these circumstances." c) "I will support you in any decision that you make." d) "I will give you as much information as I can about this condition."

"I will alert your entire family about this so you don't have to." Correct Explanation: It is necessary to maintain confidentiality at all times, which prevents healthcare providers from alerting family members about any inherited characteristic unless the family member has given consent for the information to be revealed.

What is the best response by the nurse to the parents of a child with leukemia who express guilt because they did not take immediate action when their child seemed to develop one respiratory infection after another? a) "Young children develop minor illness easily and often. Stop being hard on yourselves." b) "Don't feel bad. Children get lots of colds." c) "Keep in mind that the signs of leukemia are often subtle and difficult to recognize." d) "You need to focus on the present treatment now and not worry about the past."

"Keep in mind that the signs of leukemia are often subtle and difficult to recognize." Correct Explanation: Pointing out that the signs and symptoms of leukemia are often difficult to recognize indicates to the parents that they were not neglectful, while also providing information about the disease. The other responses minimize the parents' feelings or tell them how they should feel and are not therapeutic.

The nurse is preparing a presentation for a local health fair on autism spectrum disorders. Which of the following would the nurse include as part of the presentation? a) Autism cannot be cured. b) Scientific evidence supports the use of complementary therapies. c) Children respond best when the environment is less structured. d) Communication therapies are of little value in treating autism.

Autism cannot be cured. Correct Explanation: There are no medications or treatment available to cure autism. Behavioral and communication therapies are very important in caring for a child with autism. Children with autism spectrum disorder respond very well to highly structured educational environments. To date, complementary and alternative medical therapies have not been scientifically proven to improve autism.

A child with a primary growth hormone deficiency is to receive biosynthetic growth hormone. The nurse would explain to the child and parents that this hormone would be given at which frequency? a) Monthly b) Weekly c) Bi-monthly d) Daily

Daily Explanation: Biosynthetic growth hormone, derived from recombinant DNA, is given by subcutaneous injection. The weekly dosage is 0.2 to 0.3 mg/kg, divided into equal doses given daily for best growth.

The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. Which of the following would lead the nurse to suspect that the cancer has infiltrated the central nervous system? a) Observing petechiae, purpura, or unusual bruising b) Child complains of facial palsy and vision problems c) Noting adventitious breath sounds during auscultation d) Palpation of abdomen reveals enlarged liver and spleen

Child complains of facial palsy and vision problems Correct Explanation: The presence of facial palsy and vision problems indicates that the central nervous system has been infiltrated by leukemia cells. The petechiae, purpura, or unusual bruising results from decreased platelet levels and may be present regardless of metastasis. Adventitious breath sounds may indicate pneumonia, and may be present whether the disease has metastasized or not. Hepatomegaly and splenomegaly result from infection, not metastasis.

A client who is 37 years of age presents to the health care clinic for her first prenatal check up. Due to her advanced age, the nurse should prepare to talk with the client about her increased risk for what complication? a) Incompetent cervix b) Genetic disorders c) Gestational diabetes d) Preterm labor

Genetic disorders Correct Explanation: Women over the age of 35 are at increased risk of having a fetus with an abnormal karyotype or other genetic disorders. Gestational diabetes, an incompetent cervix, and preterm labor are risks for any pregnant woman.

When discussing congenital adrenogenital hyperplasia with a child's parents, you would advise them that administration of which of the following drugs will probably be indicated? a) Calcium b) Hydrocortisone c) Vitamin D d) Growth hormone

Hydrocortisone Correct Explanation: The basic defect in congenital adrenogenital hyperplasia is the lack of cortisol. Administering hydrocortisone supplements this.

The child has been diagnosed with leukemia. Rank the following medications used to treat leukemia in order based on the stage of treatment. The child is receiving chemotherapy through an intrathecal catheter. The child is receiving vincristine through an intravenous line and oral steroids. The child is receiving low doses of mercaptopurine and methotrexate. The child is receiving high doses of mercaptopurine and methotrexate.

The child is receiving vincristine through an intravenous line and oral steroids. The child is receiving high doses of mercaptopurine and methotrexate. The child is receiving low doses of mercaptopurine and methotrexate. The child is receiving chemotherapy through an intrathecal catheter. Explanation: During induction, the child receives oral steroids and IV vincristine. During consolidation, the child receives high doses of methotrexate and mercaptopurine. During maintenance, the child receives low doses of methotrexate and mercaptopurine. During central nervous system prophylaxis, the child receives intrathecal chemotherapy.

A 6-year-old boy has a moon-faced, stocky appearance but with thin arms and legs. His cheeks are unusually ruddy. He is diagnosed with Cushing syndrome. The nurse knows that which of the following is the most likely cause of this condition in this child? a) Tumor of the parathyroids b) Tumor of the adrenal cortex c) Tumor of the pancreas d) Tumor of the thyroid

Tumor of the adrenal cortex Explanation: Cushing syndrome is caused by overproduction of the adrenal hormone cortisol; this usually results from increased ACTH production due to either a pituitary or adrenal cortex tumor. The peak age of occurrence is 6 or 7 years. The overproduction of cortisol results in increased glucose production; this causes fat to accumulate on the cheeks, chin, and trunk, causing a moon-faced, stocky appearance. Cortisol is catabolic, so protein wasting also occurs. This leads to muscle wasting, making the extremities appear thin in contrast to the trunk, and loss of calcium in bones (osteoporosis). Yet other effects are hyperpigmentation (the child's face to be unusually red, especially the cheeks).

A 7-year-old is diagnosed as having type 1 diabetes. One of the first symptoms usually noticed by parents when this illness develops is a) craving for sweets. b) loss of weight. c) severe itching. d) swelling of soft tissue.

loss of weight. Correct Explanation: Lack of insulin reduces the ability of body cells to use glucose; this leads to starvation of cells and loss of weight as an early symptom.

Eve, 2 years old, and her parents are at the office for a follow-up visit. She has had excessive hormone levels in her recent blood work and her parents question why this was not found sooner. What is the best response of the nurse? a) "Have there been signs and symptoms that you should have reported to the doctor?" b) "As endocrine functions become more stable throughout childhood, alterations become more apparent." c) "Endocrine disorders are hard to detect and you are lucky that we have found it when we did." d) "It takes time to determine the level of functioning of endocrine glands."

"As endocrine functions become more stable throughout childhood, alterations become more apparent." Correct Explanation: The endocrine glands are all present at birth; however, endocrine functions are immature. As these functions mature and become stabilized during the childhood years, alterations in endocrine function become more apparent. Thus, endocrine disorders may arise at any time during childhood development.

A nurse is teaching an adolescent with type 1 diabetes about the disease. Which instruction by the nurse about how to prevent hypoglycemia would be most appropriate for the adolescent? a) "Increase the insulin dosage before planned or unplanned strenuous exercise." b) "Limit participation in planned exercise activities that involve competition." c) "Carry crackers or fruit to eat before or during periods of increased activity." d) "Check your blood glucose level before exercising, and eat a protein snack if the level is elevated."

"Carry crackers or fruit to eat before or during periods of increased activity." Correct Explanation: Hypoglycemia can usually be prevented if an adolescent with diabetes eats more food before or during exercise. Because exercise with adolescents isn't commonly planned, carrying additional carbohydrate foods is a good preventive measure.

After teaching the parents of a child with Tourette syndrome about motor and vocal tics, the nurse determines that the teaching was successful when the parents state which of the following? a) "He can control the tics if he really concentrates on doing so." b) "Drugs are the primary method for controlling the symptoms." c) "Vocal tics are harder to control than the motor tics are." d) "If we get him focused on an activity, the tics will be less pronounced."

"If we get him focused on an activity, the tics will be less pronounced." Explanation: Tics become more noticeable or severe during times of stress and less pronounced when the child is focused on an activity such as watching TV, reading, or playing a video game. The tics are not under voluntary control and either type can be difficult to control. Management is highly individualized and involves psychopharmacology and behavioral therapy.

A 9-year-old child with leukemia is scheduled to undergo an allogenic hematopoietic stem cell transplant. When teaching the child and parents, which of the following would the nurse include? a) "The risk for rejection is much less with this type of transplant." b) "You'll need to have an incision in your hip area to instill the cells." c) "We'll need to have a match to a donor." d) "You won't need to receive the high doses of chemotherapy before the transplant."

"We'll need to have a match to a donor." Correct Explanation: An allogenic hematopoietic stem cell transplantation (HSCT) refers to transplantation using stem cells from another individual that are harvested from the bone marrow, peripheral blood, or umbilical cord blood. With this type of transplant, human leukocyte antibody (HLA) matching must occur. Therefore, the lesser the degree of HLA matching in the donor, the higher the risk for graft rejection and graft-versus-host disease (GVHD). Regardless of the type of transplant, a period of purging of abnormal cells in the child is necessary and accomplished through high-dose chemotherapy or irradiation. The procedure is accomplished by intravenously infusing hematopoietic stem cells into the child.

Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse? a) "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." b) "The spinal tap will help relieve pressure and headache for your child." c) "It will help rule out a second malignancy." d) "A sample of cerebrospinal fluid is needed to check for possible central nervous system infection."

"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." Correct Explanation: The cerebrospinal fluid is checked so the clinician can determine whether leukemic cells have invaded the central nervous system. It is common for a chemotherapy medication, usually methotrexate, to be administered immediately following lumbar puncture as treatment for potential infiltration. The other responses are incorrect.

You are meeting with a family that has learned that their 11-year-old daughter has some intellectual disabilities. They tell you that she is having trouble coping with different situations at school. Which of the following is the best response? a) "Coping and adaptation are often affected by intellectual disabilities." b) "Just give her some time, she will learn to adjust." c) "It takes time to learn to cope and adjust, give her some more time." d) "Maybe it would be best if she did not play with those kids at school."

"Coping and adaptation are often affected by intellectual disabilities." Correct Explanation: The child is at increased risk for adjustment disorders because the child's coping strategies are not understood or recognized and his or her range of adaptive strategies may be reduced. Coping, adaptation, and social skills development are greatly dependent on abstract thinking and the ability to generalize from one situation to another. Abstract thinking is impaired in intellectual disability. Children who have intellectual disability are often uncomfortable with unfamiliar surroundings and people. Time is needed to build relationships.

The nurse is interviewing a depressed 13-year-old girl. During the course of the interview, the girl reveals that her best friend is thinking about committing suicide. How should the nurse respond? 1) Are you the only one that knows? 2) Why do you think she wants to kill herself? 3) Do you know how she is planning to kill herself? 4) ?

"Do you know how she is planning to kill herself?" Explanation: Because the girl is depressed, the nurse suspects that the girl is indirectly talking about herself, not her best friend. When an adolescent raises the issue of suicide, it is important to find out exactly how he or she is envisioning suicide and take measures to prevent an attempted suicide. Therefore, the nurse should ask how the "friend" is contemplating suicide in order to gather this information and open a dialogue to encourage the girl to reveal she is talking about herself. The other questions would not elicit the critical information about the method of suicide.

A 15-year-old adolescent is scheduled for a pelvic ultrasound to evaluate for a possible ovarian cyst. Which instruction by the nurse would be most appropriate? a) "You need to remain very still for the entire test." b) "Limit your level of physical activity for one-half hour before the test." c) "You won't be able to drink any water before or during the test." d) "Drink plenty of fluids because you need to have a full bladder."

"Drink plenty of fluids because you need to have a full bladder." Explanation: A full bladder is needed for an ultrasound of the pelvic. The patient needs to remain still for a computed tomography or magnetic resonance imaging scan, not an ultrasound. Water is withheld during a water deprivation test used to detect diabetes insipidus. Limiting stress and physical activity for 30 minutes before the test is required for the growth hormone stimulation test.

The parent of a child diagnosed with Duchenne muscular dystrophy asks why gene therapy is not being used to treat her child. What is the best response by the nurse? a) "Clinical trials are very successful, and you should find one immediately." b) "Gene therapy remains experimental and is used only in clinical trials." c) "Genetic testing is unethical." d) "Gene therapy does not work for muscular dystrophy."

"Gene therapy remains experimental and is used only in clinical trials." Correct Explanation: Gene therapy in the United States is currently experimental and is used only in clinical trials. Clinical trials have resulted in minimal success. No documentation supports the statement that gene therapy would not work for muscular dystrophy. Genetic testing is used to diagnose illness; therefore, it is widely accepted as ethical when used to diagnose disorders. Gene therapy may be viewed by some as unethical, but the nurse should provide information in a nonjudgmental manner.

The nurse is conducting a well-child assessment of a 3-year-old. Which of the following statements by the parents would warrant further investigation? a) "He is very active and keeps very busy" b) "He spends hours repeatedly lining up his cars" c) "He would rather run around than sit on my lap and read a book" d) "He spends a lot of time playing with his little cars"

"He spends hours repeatedly lining up his cars" Correct Explanation: The nurse should pay particular attention to reports of a child spending hours in a repetitive activity, such as lining up cars rather than playing them. Most 3-year-olds are very busy and would rather play than sit on a parent's lap. The other statements are not outside the range of normal and do not warrant further investigation.

The nurse is teaching a 12-year-old girl with diabetes mellitus type 2 and her parents about dietary measures to control her glucose levels. Which comment by the child indicates a need for additional teaching? a) "I can eat two small cookies with each meal." b) "I can have an apple or orange for snacks." c) "We should give her nonfat milk to drink." d) "I will be eating more breads and cereals."

"I can eat two small cookies with each meal." Explanation: Cookies, cakes, candy, potato chips, and crackers are high in sugars and fats and should be eaten in moderation as special treats; they would not be included with each meal. An apple or orange makes a good snack. Nonfat milk is a better option than whole milk. Long-acting carbohydrates should be the largest category of foods eaten.

Which statement by an adolescent with anorexia nervosa would be most typical of an adolescent with this disorder? a) "I'd like to gain weight but just can't." b) "I'm afraid that someone is poisoning my food." c) "I'd like to grow up to be a model." d) "I feel chubby no matter what I wear."

"I feel chubby no matter what I wear." Correct Explanation: Children with eating disorders tend to think of themselves as overweight. This distorted body image leads them to diet excessively.

A young couple who underwent preconceptual genetic counseling and testing have learned that they are at high risk for having a child with Down syndrome. They have decided not to have children. Which of the following would be the most appropriate response for the nurse to give? a) "I think you made the right decision. After all, I never had children, and I'm perfectly happy." b) "I appreciate your decision, but I urge you to think through this further. Having a child, even one with Down syndrome, is so rewarding." c) "I understand. In case you would like to discuss this further with a genetic counselor, here is the contact information for the genetic counseling center." d) "I understand and support your decision. The risk is just not worth it."

"I understand. In case you would like to discuss this further with a genetic counselor, here is the contact information for the genetic counseling center." Correct Explanation: Even if a couple decides not to have more children, be certain they know genetic counseling is available for them should their decision change. It is never appropriate for a health care provider to impose his or her own values or opinions on others. Individuals with known inherited diseases in their family must face difficult decisions, such as how much genetic testing to undergo or whether to terminate a pregnancy that will result in a child with a specific genetic disease. Be certain couples have been told all the options available to them, and then leave them to think about the options and make their decision by themselves. Help them to understand nobody is judging their decision because they are the ones who must live with the decision in the years to come.

Parents tell the nurse who is admitting their infant for a well-child exam that they recently saw a "white glow" in their child's left pupil. What is the nurse's best response? a) "Has your baby been rubbing either eye?" b) "Most parents mention a red color." c) "I will report this to the pediatrician." d) "A plugged tear duct would not be unusual."

"I will report this to the pediatrician." Correct Explanation: The "white glow" may indicate retinoblastoma; immediate investigation is needed. The red reflex is indicative of eye health. Eye rubbing and a plugged tear duct are unrelated to the symptom described.

Which statement by a parent regarding mitochrondrial disorders requires further education? a) "It is passed from female to female. That's why my son cannot be affected." b) "The cells most affected are the ones that require high levels of energy." c) "My child can exhibit signs and symptoms of the disorder at any point in his life." d) "Mitochondrial disorders usually worsen over time."

"It is passed from female to female. That's why my son cannot be affected." Explanation: Mitochondrial disorders usually are inherited from the mother and affect offspring regardless of sex. Mitochondrial disorders are progressive, and onset of signs and symptoms can occur from infancy to adulthood. The disorder affects cells that require high levels of energy

Kate and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which of the following statements by the nurse is true? a) "This will rectify itself if you follow all of the doctor's directions." b) "Kids can usually be managed with an oral agent, meal planning, and exercise." c) "A weight-loss program should be implemented and maintained." d) "You are lucky that you did not have to learn how to give yourself a shot."

"Kids can usually be managed with an oral agent, meal planning, and exercise." Correct Explanation: Treating type 2 diabetes in children may require insulin at the outset if the child is acidotic and acutely ill. More commonly, the child can be managed initially with oral agents, meal planning, and increasing activity. Telling the child that she is lucky, she did not have to learn how to give a shot might scare her so it will inhibit her from seeking future healthcare. The condition will not rectify itself if all orders are followed. A weight-loss program might need to be implemented but that is not always the case.

A 10-year-old girl with ADHD has been on Ritalin for 6 months. The girl's mother calls and tells the nurse that the medication is ineffective and requests an immediate increase in the child's dosage. What should the nurse say? a) "Let me talk to the doctor about this." b) "Let's wait a few more weeks before we do anything." c) "Let's set up an appointment as soon as possible." d) "What does the teacher say?"

"Let's set up an appointment as soon as possible." Correct Explanation: The nurse plays a vital role in administering medicines and observing and reporting responses. A face-to-face appointment with the family and the doctor or advance practice mental health nurse can help uncover patient and parental factors that may be preventing success. Once it is established that the family is using the medication properly as well as instituting structure within the home, it can be determined if an increased dosage or alternate medicine would be appropriate. Deferring to the doctor will not elicit any information from the mother, and waiting will not address the current concerns. The teacher can only reveal partial information about the effectiveness of the medication, which can be reviewed once other factors have been addressed in a face-to-face visit with the family and patient.

A community health nurse is visiting her 16-year-old patient, a new mother. The nurse explains to the patient and her mother the genetic screening that is required by the state's law. The patient asks why it is important to have the testing done on the infant. What is the nurse's best response? a) "This testing is required and you will not be able to refuse it. It usually is free so there is no reason to refuse it." b) "Genetic testing is a way to determine the rate of infectious disease." c) "It is important to test newborns for PKU, congenital hypothyroidism, and galactosemia." d) "PKU, congenital hypothyroidism, and galactosemia are conditions that could result in disability or death if untreated."

"PKU, congenital hypothyroidism, and galactosemia are conditions that could result in disability or death if untreated." Correct Explanation: The first aim is to improve management, that is, identify people with treatable genetic conditions that could prove dangerous to their health if left untreated. The other answers are incorrect because genetic testing does not determine the rate of infectious disease. Answer B does not adequately explain the rationale for newborn testing. Answer D fails to inform the patient of the rationale for newborn testing.

Which statement by the nurse is most accurate when counseling a couple about transmitting Huntington's disease from father to child? a) "A daughter cannot be a carrier of the disease because it is an X-linked recessive disorder." b) "There is a 50% chance of transmission of the disorder because it is an autosomal dominant disorder." c) "You will transmit the disorder to a son because it is an X-linked dominant disorder." d) "There is a 75% chance that your offspring will express the disorder because it is an autosomal recessive disorder."

"There is a 50% chance of transmission of the disorder because it is an autosomal dominant disorder." Correct Explanation: An offspring of an autosomal dominant disorder has a 50% chance of acquiring the gene to be affected by the disorder. Huntington's is an autosomal dominant disorder. Female offspring of an X-linked recessive disorder have the possibility of being a carrier or of being afflicted with the disorder. With autosomal recessive disorders, there is only a 25% chance that the offspring will express the disorder.

A 10-year-old boy has been diagnosed with type 1 diabetes mellitus. He is curious about what the cause of his disease is and asks the nurse to explain it to him. Which of the following should the nurse say to the boy? a) "Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood." b) "Special cells in a part of your body called the pancreas cannot produce enough of a chemical called insulin, so there is too much sugar in your blood." c) "Your body does not produce enough a chemical called 'ADH,' which makes you really thirsty and have to go to the bathroom a lot." d) "A small part of your brain called the pituitary does not make enough of a chemical called growth hormone."

"Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood." Explanation: Type 1 diabetes is a disorder that involves an absolute or relative deficiency of insulin in contrast to type 2 where insulin production is only reduced. Insulin is produced by beta islet cells in the pancreas. Diabetes insipidus is caused by the pituitary gland not producing enough ADH and is characterized by extreme thirstiness and polyuria. Insufficient growth hormone is also related to dysfunction of the pituitary gland.

A nurse is caring for a 10-year-old intellectually disabled girl hospitalized for a scheduled cholecystectomy. The girl expresses fear related to her hospitalization and unfamiliar surroundings. How should the nurse respond? a) "Tell me about a typical day at home" b) "Have you talked to your parents about this?" c) "Do you want some art supplies?" d) "Don't worry, you will be going home soon"

"Tell me about a typical day at home" Correct Explanation: An IQ of 35 to 50 is classified as moderate. An IQ of 50 to 70 is classified as mild. An IQ of 20 to 35 is classified as severe, and an IQ less than 20 is considered profound

An 11-year-old boy has recently been prescribed Ritalin. The mother calls the pediatrician's office to speak with the advance practice pediatric nurse practitioner (APPNP). This mother has been extremely resistant to medication and insists that the medication is not working. How should the nurse respond? a) "Are you sure you are administering it properly?" b) "Tell me why you believe the medication is not working." c) "Do you want to increase the dosage?" d) "Do you want to try a different medication?"

"Tell me why you believe the medication is not working." Correct Explanation: Asking the mother to explain why she believes the medicine is not working will offer important insights into the mother's definition of effectiveness. It is important for both the mother and the advance practice pediatric nurse practitioner (APPNP) to develop a shared definition of effectiveness and improvement. Once this is established, the nurse can suggest the next step in the treatment plan. Asking if the mother wants to try a different medication or increase the dosage does not provide any information about the child's response to the current medication. Asking the mother whether she is administering it properly could cause her to take offense and does not provide the necessary information.

The nurse caring for a 14-year-old scheduled for magnetic resonance imaging (MRI) explains how the test works to the family. Which of the following responses accurately describes this test? a) "The MRI is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement." b) "The MRI uses radio waves and magnets to produce a computerized image of the body." c) "The MRI uses sound waves to create images that visualize body structures and locate masses." d) "The MRI uses radiation to examine soft tissue and bony structures of the body."

"The MRI uses radio waves and magnets to produce a computerized image of the body." Correct Explanation: The MRI uses radio waves and magnets to produce a computerized image of the body. The bone scan is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement. The ultrasound uses sound waves to create images that visualize body structures and locate masses. Radiography uses radiation to examine soft tissue and bony structures of the body.

The nurse is counseling a couple who are concerned that their children might inherit sickle cell disease. Which of the following responses from the couple indicate a need for further teaching? a) "The disorder can be passed on to the children only if both parents have the gene." b) "If both parents have the gene, there is a 25% chance of the children having the disorder." c) "The father cannot pass the disorder onto his son or the mother to her daughter." d) "Even if the children do not get the disease they can still be carriers of the gene."

"The father cannot pass the disorder onto his son or the mother to her daughter." Correct Explanation: The father can pass the gene to his sons and the mother can pass the gene to her daughters. Sickle cell disease is an autosomal recessive disease. This means that both parents must have the disease or be carriers of the gene in order to pass it onto their children. If the parents are both carriers, then there is a 25% chance that they will pass it onto a child. The children can be carriers even if they don't have the disease.

The nurse is working with a group of caregivers of school-age children diagnosed with attention deficit hyperactivity disorder. Which of the following statements would be most appropriate for the nurse to make to this group of caregivers? a) "These children study better with quiet background music such as the radio or a CD." b) "These children function best if given a set of instructions and then left to do the task." c) "A frequent change in routine will be helpful so the child does not get bored." d) "The medications your child is on may cause a decreased appetite."

"The medications your child is on may cause a decreased appetite." Correct Explanation: Learning situations should be structured so that the child has minimal distractions. Structured, consistent guidance from the caregivers is needed. Medication is used for some children and these medications may suppress the appetite and affect the child's growth. The child should be given only one simple instruction at a time. Limiting distractions, using consistency, and offering praise for accomplishments are invaluable.

A nurse is teaching about autosomal dominant and recessive genetics. Which statement by the nurse is accurate? a) "Two abnormal genes, one from each parent, are required to produce the phenotype in an autosomal recessive disorder." b) "An autosomal dominant disorder is classified as X-linked." c) "One abnormal autosomal recessive gene is needed for outward presentation of the disorder." d) "An autosomal dominant disorder has a lower risk of phenotyping than an autosomal recessive disorder."

"Two abnormal genes, one from each parent, are required to produce the phenotype in an autosomal recessive disorder." Correct Explanation: An autosomal recessive disorder requires two abnormal genes to outwardly express the disorder. Recessive disorders have a lower risk of phenotyping than dominant disorders. X-linked and autosomal disorders are two different classifications.

A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state which of the following? a) "We should administer the drug on an empty stomach." b) "We will need to gradually decrease the dosage." c) "We should check our son's urine for glucose." d) "He might develop a rounded face from this drug."

"We should administer the drug on an empty stomach." Correct Explanation: Corticosteroids are commonly administered with food to decrease the risk for gastrointestinal upset. Corticosteroids can disrupt glucose balance, so urine should be checked for glucose. A moon face is an adverse effect of corticosteroids. Corticosteroids need to be tapered gradually to reduce the risk of adrenal insufficiency.

An advance practice pediatric nurse practitioner (APPNP) is conducting a mental status examination with a 6-year-old girl. Which of the following questions would be most appropriate? a) "Isn't it fun to play with dolls?" b) "Why does your pink doll hit all the other dolls?" c) "What is the name of the president of the United States?" d) "Do you like the doll with pink hair the best or the doll with green hair?"

"Why does your pink doll hit all the other dolls?" Correct Explanation: The nurse is trying to elicit the fantasies and feelings underlying the child's play. Asking an open-ended question is likely to reveal this information. A 6-year-old might know the name of the president but the meaning is ambiguous. The other questions would elicit "yes" or "no" answers.

The young child has been diagnosed with a secondary growth hormone deficiency. The child weighs 58 pounds. The physician orders the child to receive 0.2 mg of growth hormone for each kilogram of body weight per week, divided into daily doses. How many milligrams of growth hormone would the child receive with each dose? Round to the thousandths place.

0.075 Explanation: The child weighs 58 pounds and 2.2 pounds = 1 kg. 58 pounds x 1 kg/2.2 pounds = 26.3636 kg of body weight. 26.3636 x 0.2 mg/1 kg = 0.5273 mg of growth hormone per week. 0.5273 mg/week x 1 week/7 days = 0.0753 mg/day.

The child has been prescribed chemotherapy. In order to properly calculate the child's dose, the nurse must first figure the child's body surface area (BSA). The child is 130 cm tall and weighs 27 kg. Calculate the child's BSA and round to the hundredths place. ______ BSA

0.99 Explanation: Square root of (height [cm] x weight [kg] divided by 3,600) = BSA. The child is 130 cm tall and weighs 27 kg: 130 x 27 = 3,510; 3,510/3,600 = 0.975; and the square root of 0.975 is 0.9874. The BSA would be 0.987, when rounded to the hundredths place = 0.99.

A woman who has a recessive gene for sickle cell anemia marries a man who also has a recessive gene for sickle cell anemia. Their first child is born with sickle cell anemia. The chance that their second child will develop this disease is a) 0 in 4. b) 3 in 4. c) 1 in 4. d) 2 in 4.

1 in 4. Explanation: Autosomal recessive inherited diseases occur at a 1-in-4 incidence in offspring. The possibility of a chance happening does not change for a second pregnancy.

The nurse is discussing the treatment for a child with attention deficit hyperactivity disorder with a group of school nurses. Which of the following would be an appropriate learning setting for a child with ADHD? a) A classroom with windows facing a playground. b) A classroom with tables and chairs rather than individual desks. c) A classroom with a plan of study that is followed each day. d) A classroom in which children self-select their activities.

A classroom with a plan of study that is followed each day. Correct Explanation: For the child with ADHD the learning situations should be structured so that the child has minimal distractions and a supportive teacher. Special arrangements can be made to provide an educational atmosphere that is supportive for the child without the need for the child to leave the classroom.

A child with ADHD is placed on methylphenidate (Ritalin) therapy. Which of the following symptoms may children on Ritalin develop? a) Anorexia b) Sleepiness c) Rapid increase in height d) Hypotension

Anorexia Correct Explanation: Ritalin typically causes a loss of appetite. Weighing the child periodically to detect whether this has led to a loss of weight is important.

The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which of the following actions would be the most appropriate for the school nurse to do? a) Request that someone call 911 b) Dissolve a piece of candy in the child's mouth c) Anticipate that the child will need intravenous glucose d) Administer subcutaneous glucagon

Administer subcutaneous glucagon Correct Explanation: If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level. This treatment prevents the long delay while waiting for a physician to administer IV glucose or for an ambulance to reach the child.

Antiemetics are ordered to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications? a) Provide the antiemetic as needed (PRN) when nausea and vomiting are reported b) Start the antiemetic on a scheduled basis when the chemotherapy begins to cause nausea c) Administer the antiemetic before starting chemotherapy d) Use the antiemetic after it is clear that nonpharmacologic methods are not effective

Administer the antiemetic before starting chemotherapy Correct Explanation: Antiemetics are most effective when given before chemotherapy begins and then on a regular schedule to prevent nausea and vomiting throughout administration of chemotherapy. Nonpharmacologic measures can be used in conjunction with antiemetics but not in place of them.

The nurse is caring for a 6-year-old boy with an abdominal neuroblastoma prior to having a magnetic resonance imaging (MRI) scan without contrast done. Which of the following interventions would the nurse expect to perform? a) Encouraging fluid intake to increase radionuclide uptake b) Administering a sedative as ordered to keep the child still c) Applying EMLA to the injection site prior to inserting the IV d) Advising the physician that the child is allergic to shellfish

Administering a sedative as ordered to keep the child still Explanation: The nurse would expect to administer a sedative as ordered to keep the child still because the machine makes a loud thumping noise that could frighten the child. The child must lie without moving while the MRI is being done. Encouraging fluid intake to increase radionuclide uptake is necessary for a bone scan. Advising the physician that the child is allergic to shellfish is an intervention for a computed tomograph (CT) scan with contrast. If the child did not have an IV prior to the MRI and contrast was going to be used, then an IV would need to be inserted for the contrast after the noncontrast MRI was finished. Applying EMLA to an injection site prior to inserting an IV would be appropriate for both the CT and bone scans.

The nurse is caring for a 14-year-old boy with hyperpituitarism. Which of the following would be the priority? a) Assessing the child's self-image due to the disorder b) Teaching the child and family about proper treatment c) Administering octreotide acetate as ordered d) Treating the child according to his chronological age

Administering octreotide acetate as ordered Explanation: Administering octreotide acetate as ordered is the priority intervention and treatment for acromegaly. Assessing the child's self-image is appropriate but would not be the priority Treating the child according to his chronological age would be appropriate but not the priority. Teaching the child and family about proper treatment is appropriate and important but not the immediate priority.

The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? a) Assessing dietary intake by addressing "picky eating" and "food jags" b) Plotting height and weight on a growth chart c) Administering the measles, mumps, rubella (MMR) vaccine d) Teaching the importance of taking water safety measures

Administering the measles, mumps, rubella (MMR) vaccine Correct Explanation: Live vaccines (viral or bacterial) should not be administered to an immune suppressed child because of the risk of causing disease. The other health maintenance activities are important for the health maintenance of the toddler and should be included during the well-child visit.

A pregnant client has heard about Down syndrome and wants to know about the risk factors associated with it. Which of the following would the nurse include as a risk factor? a) Advanced maternal age b) Recurrent miscarriages c) Advanced paternal age d) Family history of condition

Advanced maternal age Correct Explanation: Advanced maternal age is one the most important factors that increases the risk of an infant being born with Down syndrome. Down syndrome is not associated with advanced paternal age, recurrent miscarriages, or family history of Down syndrome.

The drug most commonly abused by children and adolescents is which of the following? a) Alcohol b) Marijuana c) Ecstasy d) Percocet

Alcohol Correct Explanation: Alcohol abuse occurs when a person ingests a quantity sufficient to cause intoxication. It is also the most commonly abused drug among children and adolescents.

A woman in her third trimester has just learned that her fetus has been diagnosed with cri-du-chat syndrome. The nurse recognizes that this child will likely have which of the following characteristics? a) Small and nonfunctional ovaries b) Cleft lip and palate c) Rounded soles of the feet (rocker-bottom) d) An abnormal, cat-like cry

An abnormal, cat-like cry Correct Explanation: Cri-du-chat syndrome is the result of a missing portion of chromosome 5. In addition to an abnormal cry, which sounds much more like the sound of a cat than a human infant's cry, children with cri-du-chat syndrome tend to have a small head, wide-set eyes, a downward slant to the palpebral fissure of the eye, and a recessed mandible. They are severely cognitively challenged. Rounded soles of the feet are characteristic of trisomy 18 syndrome. Cleft lip and palate are characteristic of trisomy 13 syndrome. Small and nonfunctional ovaries are characteristic of Turner syndrome.

The nurse will use a special needle to start intravenous (IV) fluids through which central venous access device? a) A peripherally inserted central catheter b) An implanted port c) A multilumen catheter d) A tunneled central catheter

An implanted port Correct Explanation: An implanted port requires a special (Huber) needle placed through the skin into the port, which is implanted surgically under the skin and over a bony prominence. The peripherally inserted central catheter (PICC) and tunneled catheters (Broviac, Hickman, Groshong) do not require a special needle for access. A multilumen catheter has more than one lumen but is not a port.

When teaching parents of a child with encopresis, which of the following would you stress? a) Not punishing the child for encopresis b) Importance of cleaning the child immediately after an accident occurs c) Need for keeping the child close to bathroom facilities at all times d) Necessity for giving 4 to 6 tablespoons of Kaopectate per day

Not punishing the child for encopresis Correct Explanation: Encopresis (inappropriate soiling of stool) is a symptom of an underlying stress or disease. The child needs therapy to determine the cause.

Which of the following conditions is a part of normal newborn screening? a) Down syndrome b) Cystic fibrosis c) Sickle cell anemia d) Phenylketonuria

Phenylketonuria Correct Explanation: Phenylketonuria is part of normal newborn screening. Prenatal screening includes Down syndrome. Preconception screening includes sickle cell anemia and cystic fibrosis.

A child receiving chemotherapy is experiencing significant reduction in red blood cells secondary to myelosuppression. Which agent would the nurse most likely expect to be ordered? a) Epoetin alfa b) Filgrastim c) Gamma interferon d) Sargramostim

Epoetin alfa Correct Explanation: Epoetin alfa is a colony-stimulating factor used to stimulate production of red blood cells. Filgrastim is a colony-stimulating factor used to stimulate production of granulocytes. Sargramostim is a colony-stimulating factor used to stimulate production of granulocytes. Gamma interferon is used to stimulate macrophage production to fight bacteria and fungus.

The parents of a child who was diagnosed with diabetes insipidus ask the nurse, "How does this disorder occur?" When responding to the parents, the nurse integrates knowledge that a deficiency of which hormone is involved? a) Insulin b) Antidiuretic hormone c) Growth hormone d) Thyroxine

Antidiuretic hormone Explanation: Diabetes insipidus results from a deficiency in the secretion of antidiuretic hormone (ADH). This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland. Hypopituitarism or dwarfism involves a growth hormone deficiency. Diabetes mellitus involves a disruption in insulin secretion. Thyroxine is a thyroid hormone that if deficient leads to hypothyroidism.

The nurse is providing preoperative care for a 7-year-old boy with a brain tumor and his parents. Which of the following is the priority intervention? a) Assessing the child's level of consciousness b) Having him talk to a child who has had this surgery c) Educating the child and parents about shunts d) Providing a tour of the intensive care unit

Assessing the child's level of consciousness Explanation: The priority intervention is to monitor for increases in intracranial pressure because brain tumors may block cerebral fluid flow or cause edema in the brain. A change in the level of consciousness is just one of several subtle changes that can occur indicating a change in intracranial pressure. Lower priority interventions include providing a tour of the ICU to prepare the child and parents for after the surgery, and educating the child and parents about shunts.

A group of nursing students are reviewing medications used to treat attention deficit/hyperactivity disorder (ADHD). The group demonstrates understanding of the information when they identify which of the following as a nonstimulant norepinephrine reuptake inhibitor? 1) Atomoxetine 2) Methylphenidate 3) Lisdexamfetamine 4) Pemoline

Atomoxetine Explanation: Atomoxetine is a nonstimulant norepinephrine reuptake inhibitor used to treat ADHD. Methylphenidate is a psychostimulant used to treat ADHD. Lisdexamfetamine is a psychostimulant used to treat ADHD. Pemoline is a psychostimulant used to treat ADHD.

A group of nursing students are studying information about childhood cancers in preparation for a class examination. They are reviewing how childhood cancers differ from adult cancers. The group demonstrates understanding of the information when they identify which of the following as an unlikely site for childhood cancer? a) Bladder b) Brain c) Blood d) Kidney

Bladder Correct Explanation: The most common sites for childhood cancer include the blood, lymph, brain, bone, kidney, and muscle. Bladder is a common site for adult cancer.

A 17-year-old is found after a high school football game wandering around. He is confused, sweaty, and pale. Which of the following tests is most likely to be performed first? a) Arterial blood gases b) Blood glucose level c) Blood cultures d) CT scan

Blood glucose level Correct Explanation: It is important to draw a blood glucose level on the child because he is exhibiting signs of hypoglycemia and he needs to be treated as soon as possible. Once the patient is stabilized, a complete health history will need to be taken to determine the extent of his illness.

The nurse is assessing an 11-year-old girl diagnosed with acute myelogenous leukemia (AML) who came to the emergency department. Which of the following would alert the nurse to the need for immediate intervention? a) CBC indicates hyperleukocytosis. b) Palpation reveals lymphadenopathy in the axillae. c) Observation discloses weight loss and muscle wasting. d) Child complains of headache and vision problems.

CBC indicates hyperleukocytosis. Explanation: About 25% of children with acute myelogenous leukemia present with blood counts greater than 100,000. This is called hyperleukocytosis, and it is a medical emergency requiring leukapheresis to decrease hyperviscosity by quickly decreasing the number of circulating blasts. Lymphadenopathy, headache, visual disturbance, weight loss, and muscle wasting are signs and symptoms common to both types of leukemia. Lymphadenopathy is a common manifestation associated with AML and does not require immediate intervention. Headache and vision problems are common manifestations associated with AML. They do not require immediate intervention. Weight loss and muscle wasting are common manifestations associated with AML. They do not require immediate intervention.

A pregnant woman has a child at home who has been diagnosed with neurofibromatosis She asks the nurse what she should look for in the new baby that would indicate that it also has neurofibromatosis. What sign should the nurse instruct the woman to look for in the new baby? a) Projectile vomiting b) Café-au-lait spots c) Xanthoma d) Increased urination

Café-au-lait spots Correct Explanation: Physical assessment may provide clues that a particular genetic condition is present in a person and family. Family history assessment may offer initial guidance regarding the particular area for physical assessment. For example, a family history of neurofibromatosis type 1, an inherited condition involving tumors of the central nervous system, would prompt the nurse to carry out a detailed assessment of closely related family members. Skin findings such as café-au-lait spots, axillary freckling, or tumors of the skin (neurofibromas) would warrant referral for further evaluation, including genetic evaluation and counseling. A family history of familial hypercholesterolemia would alert the nurse to assess family members for symptoms of hyperlipidemias (xanthomas, corneal arcus, abdominal pain of unexplained origin). As another example, increased urination could indicate type 1 diabetes. Projectile vomiting is indicative of pyloric stensosis.

A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. Which of the following would the nurse expect to be administered? a) Hydrocortisone b) Desmopressin c) Levothyroxine d) Calcium gluconate

Calcium gluconate Correct Explanation: Intravenous calcium gluconate is used to treat acute or severe tetany. Hydrocortisone is used to treat congenital adrenal hyperplasia and Addison disease. Desmopressin is used to control diabetes insipidus. Levothyroxine is a thyroid hormone replacement used to treat hypothyroidism.

How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old? a) Indicate that the more commonly used name is Hodgkin's disease b) Explain that it develops in nerves outside the brain and spinal cord c) Describe it as a bone tumor d) Call it a tumor of muscle tissue

Call it a tumor of muscle tissue Correct Explanation: A rhabdomyosarcoma is a tumor of striated muscle that most commonly develops in the head, neck, arms, and legs, as well as in the genitourinary tract, of children. The other descriptors are incorrect.

The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority? a) Calling the doctor if the child gets a sore throat b) Keeping a written copy of the treatment plan c) Writing down phone numbers and appointments d) Using acetaminophen if the child needs an analgesic

Calling the doctor if the child gets a sore throat Correct Explanation: Calling the doctor if the child gets a sore throat is the priority. Because of the child's impaired immune system, any sign of potential infection, such as sore throat, must be evaluated by a physician. Using acetaminophen if the child needs an analgesic, writing down phone numbers and appointments, and keeping a written copy of the treatment plan are important teaching points but secondary to guarding against infection.

The nurse is caring for a girl with anorexia who has been hospitalized with unstable vital signs and food refusal. The girl requires enteral nutrition. The nurse is alert for which of the complications that signal re-feeding syndrome? a) Bradycardia with ectopy b) Hypothermia and irregular pulse c) Cardiac arrhythmias, confusion, seizures d) Orthostatic hypotension

Cardiac arrhythmias, confusion, seizures Correct Explanation: The nurse should be aware that rapid nutritional replacement in the severely malnourished can lead to refeeding syndrome. Refeeding syndrome is characterized by cardiovascular, hematologic, and neurologic complications such as cardiac arrhythmias, confusion, and seizures. Orthostatic hypotension, hypertension, and irregular and decreased pulses are complications of anorexia but do not characterize refeeding syndrome.

The father of an 8-year-old boy who is receiving radiation therapy is upset that his son has to go through 6 weeks of treatments. He doesn't understand why it takes so long. In explaining the need for radiation over such a long time, which of the following should the nurse mention? a) Insurance companies typically allow only a short radiation treatment per week, to contain costs b) It is difficult to locate where the cancer cells are in the body, so the entire body must be irradiated c) Cells are only susceptible to treatment by radiation during certain phases of the cell cycle d) Radiation therapy is very weak, and therefore it takes a long time to achieve therapeutic doses

Cells are only susceptible to treatment by radiation during certain phases of the cell cycle Correct Explanation: Radiation is not effective on cells that have a low oxygen content (a proportion of cells in every tumor), nor is it effective at the time of cell division (mitosis). Therefore, radiation schedules are designed so that therapy occurs over a period of 1 to 6 weeks and includes time intervals when cells will be in a susceptible stage.

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is: a) Check vital signs b) Encourage increased fluid intake c) Measure urine output d) Weigh the client

Check vital signs Correct Explanation: The large amount of fluid loss can cause fluid and electrolyte imbalance that should be corrected; the loss of electrolytes would be reflected in vital signs. Urine output is important but not the priority. Encouraging fluids will not correct the problem and weighing the patient is not necessary at this time.

A nurse is conducting a physical examination of an adolescent girl with suspected bulimia. Which of the following assessment findings would the nurse expect to note? a) Eroded dental enamel b) Soft sparse body hair c) Dry sallow skin d) Thinning scalp hair

Eroded dental enamel Correct Explanation: The nurse should be sure to carefully assess the mouth and oropharynx for eroded dental enamel, red gums, and inflamed throat from self-induced vomiting. The other findings are typically noted with anorexia nervosa.

A nursing student compares and contrasts childhood and adult cancers. Which statement does so accurately? a) Adult cancers are more responsive to treatment than are those in children. b) Little is known regarding cancer prevention in adults, although much prevention information is available for children. c) Environmental and lifestyle influences in children are strong, unlike those in adults. d) Children's cancers, unlike those of adults, often are detected accidentally, not through screening.

Children's cancers, unlike those of adults, often are detected accidentally, not through screening. Correct Explanation: Children's cancers are often found during a routine checkup, following an injury, or when symptoms appear---not through screening procedures or other specific detection practices. A very small percentage of children may be followed closely because they are known to be at high risk genetically. Most children's cancers are highly responsive to therapy. Few prevention strategies are available for children, although many are known to be effective for adults. Several lifestyle and environmental influences regarding children's cancers are suspect, but few have been scientifically documented. The reverse is true in the adult population.

Which type of genetic test would be used to detect the possibility of Down syndrome? a) Complete blood count (CBC) b) DNA analysis c) Hemoglobin electrophoresis d) Chromosomal analysis

Chromosomal analysis Correct Explanation: Chromosomal analysis is part of the genetic testing for Down syndrome. DNA analysis may be used in the detection of Huntington disease. Hemoglobin electrophoresis may be used in genetic testing for sickle cell anemia. A complete blood count (CBC) may be used as part of testing for a thalassemia

Upon assessment, the nurse notices that the infant's ears are low-set. What is the priority action by the nurse? a) Inform the parents that low-set ears are a sign of Down syndrome b) Place the infant on a cardiac monitor c) Continue to assess the infant to look for other abnormalities d) Give a vitamin B12 injection to combat the metabolic disorder

Continue to assess the infant to look for other abnormalities Correct Explanation: Continue to assess for major and minor congenital anomalies because major anomalies may require immediate medical attention. Three or more minor anomalies increase the chance of a major anomaly. Low-set ears can be a symptom of a variety of genetic disorders. Mentioning Down syndrome without further investigation can cause undue stress in parents. The infant may not need cardiac monitoring; further assessment will provide clues. Diagnostic testing is needed to determine whether the child is afflicted with a metabolic disorder.

A woman in her first trimester of pregnancy has just been diagnosed with acquired hypothyroidism. The nurse is alarmed because she knows that this condition can lead to which of the following pregnancy complications? a) Gestational diabetes in the mother b) Spina bifida in the fetus c) Decreased cognitive development of the fetus d) Congenital heart defects in the fetus

Decreased cognitive development of the fetus Correct Explanation: If acquired hypothyroidism exists in a woman during pregnancy, her infant can be born cognitively challenged because there was not enough iodine present for fetal growth. It is important, therefore, that girls with this syndrome be identified before they reach childbearing age.

Insulin deficiency, increased levels of counterregulatory hormones, and dehydration are the primary cause of which of the following: a) Ketone bodies b) Ketonuria c) Glucosuria d) Diabetic ketoacidosis

Diabetic ketoacidosis Correct Explanation: Insulin deficiency, in association with increased levels of counterregulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis (DKA), a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. Liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glusosuria is glucose that is spilled into the urine.

A 45-year-old man has just been diagnosed with Huntington disease. He and his wife are concerned about their four children. What will the nurse explain about the children's possibility of inheriting the gene for the disease? a) Each child will have no chance of inheriting the disease b) Each child will have a 50% chance of inheriting the disease c) Each child will have a 25% chance of inheriting the disease d) Each child will have a 75% chance of inheriting the disease

Each child will have a 50% chance of inheriting the disease Correct Explanation: Huntington disease is an autosomal dominant disorder. Autosomal dominant inherited conditions affect female and male family members equally and follow a vertical pattern of inheritance in families. A person who has an autosomal dominant inherited condition carries a gene mutation for that condition on one chromosome pair. Each of that person's offspring has a 50% chance of inheriting the gene mutation for the condition and a 50% chance of inheriting the normal version of the gene. Based on this information, the choices of 25%, 75%, or no chance of inheriting the disease are incorrect.

Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism? a) Promoting bonding b) Early identification c) Encouraging fluid intake d) Allowing rooming in

Early identification Correct Explanation: The most important nursing objective is early identification of the disorder. Nurses caring for neonates must be certain that screening is performed, especially in neonates who are preterm, discharged early, or born at home. Promoting bonding, allowing rooming in, and encouraging fluid intake are all important but are less important than early identification.

The nurse is caring for a 1-year-old boy with Down syndrome. Which of the following would the nurse be least likely to include in the child's plan of care? a) Promoting annual vision and hearing tests b) Describing the importance of a high-fiber diet c) Explaining developmental milestones to parents d) Educating parents about how to deal with seizures

Educating parents about how to deal with seizures Correct Explanation: It is unlikely that the parents will need to know how to deal with seizures. It will be helpful to provide parents with growth and developmental milestones that are unique to children with Down syndrome. More than 60% of children with Down syndrome have hearing loss, so promoting annual vision and hearing tests is the priority intervention. Special diets are usually not necessary; however, a balanced, high-fiber diet and exercise are important because constipation is frequently a problem.

The nurse is collecting data from the caregiver of an 8-year-old child who recently started soiling his underwear each day rather than using the toilet to defecate. This behavior indicates a symptom of which of the following? a) Echolalia b) Encephalopathy c) Encopresis d) Enuresis

Encopresis Correct Explanation: Encopresis is chronic involuntary fecal soiling beyond the age when control is expected (about 3 years of age).

A 10-year-old girl has been referred for evaluation due to difficulties integrating with her peers at her new school. The counselor believes she is at risk for situational low self-esteem due to problematic relationships with both family members and peers. Which of the following is the best approach? a) Engage the girl in dialogue regarding feelings about self/personal appearance. b) Explore the girl's feelings about changes in her body with the onset of puberty. c) Remind her of the importance of good hygiene for better appearance. d) Introduce the concept of accepting differences to reduce conflict.

Engage the girl in dialogue regarding feelings about self/personal appearance. Correct Explanation: Engaging the child in dialogue about self and personal appearance may reveal self-perceptions and allow discussion of reality versus perception; this enables discussion of methods to address perceived weaknesses and to focus on strengths. Appearance may reflect self-perception, and a comment regarding hygiene might be poorly received. While pubertal changes can be stressful, a 10-year-old girl may not have entered puberty and the question may not be relevant. The concept of accepting differences is secondary to engaging child in dialogue about self and appearance.

A newborn girl is discovered to have congenital adrenogenital hyperplasia. When assessing her, you would expect to find which physical characteristic? a) Abnormal facial features b) Small for gestational age c) Divergent vision d) Enlarged clitoris

Enlarged clitoris Correct Explanation: Lack of production of cortisol by the adrenal gland leads to overproduction of androgen. This leads to female infants developing an enlarged clitoris.

When counseling potential parents about genetic disorders, which of the following statements would be appropriate? a) Genetic disorders primarily follow Mendelian laws of inheritance. b) Environmental influences may affect multifactorial inheritance. c) All genetic disorders involve a similar number of abnormal chromosomes. d) The absence of genetic disorders in both families eliminates the possibility of having a child with a genetic disorder.

Environmental influences may affect multifactorial inheritance. Correct Explanation: It is difficult to predict with certainty the incidence of genetic disorders because in some disorders, more than one gene is involved and environmental insults may play a role (cleft palate, for example).

The pediatric nurse examines the radiographs of a patient that show that there are lesions on the bone. This finding is indicative of: a) Neuroblastoma b) Hodgkin disease c) Ewing sarcoma d) Non-Hodgkin lymphoma

Ewing sarcoma Correct Explanation: Radiographs that show lesions on the bone may indicate tumors (e.g., Ewing sarcoma, osteosarcoma) or metastasis of tumors and warrant further investigation by bone scan, CT, or MRI. Positron emission tomography is the most effective test to diagnose Hodgkin disease, non-Hodgkin lymphoma, a neuroblastoma, bone tumors, lung and colon cancers, and brain tumors.

The nurse is preparing a plan to educate the parents of a 10-year-old boy with a learning disorder. Which of the following will be part of this plan? a) Explain the child's strengths and weaknesses. b) Encourage parents to give the child personal space. c) Tell parents to check on the child regularly. d) Have parents learn the child's facial expressions.

Explain the child's strengths and weaknesses. Correct Explanation: The nurse will explain the nature of the child's disorder but will also point out the strengths the child possesses as part of the plan. Encouraging parents to provide a personal space for the child is an intervention meant to promote autonomy and responsibility for a child with delayed growth and development. Regularly checking up on the child is a preventive measure to promote safety for a child with a developmental disorder. Learning facial expressions is important when a child has impaired communication skills.

The nurse explains to the teenager that which alterations may occur when steroids are added to the cancer therapy regimen? a) Facial changes b) Nighttime itching c) Loss of appetite d) Urinary incontinence

Facial changes Correct Explanation: Facial changes are common and include a round face with full cheeks, often reddened, described as "moon face." Weight gain and fat pads may appear in various areas of the body. Appetite is likely to increase. Urinary incontinence and nighttime itching are not related to steroid therapy.

Tay-Sachs disease is found primarily in the Asian population. a) True b) False

False Correct Explanation: Tay-Sachs disease is found primarily in the Ashkenazi Jewish population (Eastern European Jewish ancestry).

The parathyroid glands regulate serum levels of glucose in the body. a) False b) True

False Correct Explanation: The four parathyroid glands, located posterior and adjacent to the thyroid gland, regulate serum levels of calcium in the body by controlling the rate of bone metabolism.

The incidence of Down syndrome is 1:1600 in women older than 40 years of age, compared with 1:100 in women younger than 20 years. a) True b) False

False Correct Explanation: The incidence of Down syndrome is 1:100 in women older than 40 years of age, compared with 1:1600 in women younger than 20 years.

Nursing students are reviewing information about the normal cell cycle. They demonstrate understanding of this process when placing phases in the proper sequence. Place the phases in the sequence that demonstrates understanding by the nursing students. Doubling of cell size Cell at rest Gap Duplication of DNA and chromosomes Cell division Period until DNA stabilization complete

Gap Cell at rest Period until DNA stabilization complete Duplication of DNA and chromosomes Doubling of cell size Cell division Explanation: The phases of the cell cycle include G or gap phase; G0 when the cell is at rest; G1, the period until DNA stabilization is complete; S(synthesis), DNA and chromosomes duplicate or cell readies for division; G2, the cell doubles in size in preparation for dividing; and mitosis or period of cell division.

After teaching a class of students about genetics and inheritance, the instructor determines that the teaching was successful when the students identify which of the following as the basic unit of heredity? a) Allele b) Autosome c) Chromosome d) Gene

Gene Correct Explanation: A gene is the basic unit of heredity of all traits. A chromosome is a long, continuous strand of DNA that carries genetic information. An allele refers to one of two or more alternative versions of a gene at a given position on a chromosome that imparts the same characteristic of that gene. An autosome is a non-sex chromosome.

After hospital discharge, the mother of a child newly diagnosed with type 1 diabetes mellitus telephones you because her daughter is acting confused and very sleepy. Which emergency measure would you suggest the mother carry out before she brings the child to see her doctor? a) Give her a glass of orange juice. b) Give her a glass of orange juice with one unit regular insulin in it. c) Give her one unit of regular insulin. d) Give her nothing by mouth so that a blood sugar can be drawn at the doctor's office.

Give her a glass of orange juice. Correct Explanation: These are typical symptoms of hypoglycemia. Administering a form of glucose would help relieve them. Insulin cannot be absorbed when taken orally.

The nurse is caring for a 4-year-old boy following surgical removal of a stage I neuroblastoma. Which of the following interventions will be most appropriate for this child? a) Applying aloe vera lotion to irradiated areas of skin b) Giving medications as ordered via least invasive route c) Maintaining isolation as prescribed to avoid infection d) Administering antiemetics as prescribed for nausea

Giving medications as ordered via least invasive route Explanation: Giving medications as ordered using the least invasive route is a postsurgery intervention focused on providing atraumatic care and is appropriate for this child. Since the child has a stage I tumor, it can be treated by surgical removal, and does not require chemotherapy or radiation therapy. Applying aloe vera lotion is good skin care following radiation therapy. Administering antiemetics and maintaining isolation are interventions used to treat side effects of chemotherapy.

A child with Addison disease has been admitted with a history of nausea and vomiting for the past three days. The client is receiving IV glucocorticoids (e.g., Solu-Medrol). Which of the following interventions would the nurse implement? a) Daily weights b) Monitoring of sodium and potassium levels c) Glucometer readings as ordered d) Intake and output measurements

Glucometer readings as ordered Explanation: IV glucocorticoids raise the glucose levels and often require coverage with insulin. Measuring the intake and output at this time is not necessary. Sodium and potassium would be monitored when the client is receiving mineral corticoids. Daily weights are not necessary at this time.

A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is which of the following: a) Plummer disease b) Cushing disease c) Addison disease d) Graves disease

Graves disease Correct Explanation: Hyperthyroidism occurs less often in children than hypothyroidism. Graves' disease, the most common cause of hyperthyroidism in children, occurs in 1 in 5,000 children between 11 and 15 years of age. Hyperthyroidism occurs more often in females, and the peak incidence occurs during adolescence.

A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse? a) Ask whether any family members or other close associates are ill b) Tell the parent to administer acetaminophen every 4 hours until the fever dissipates c) Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order d) Have the parent bring the child to the pediatric oncology clinic as soon as possible

Have the parent bring the child to the pediatric oncology clinic as soon as possible Correct Explanation: The preschooler is considered immune suppressed following recent chemotherapy. A fever can mean sepsis, which would require immediate investigation of blood and other body fluids to identify the organism, plus prompt treatment with an IV antibiotic. This can be accomplished only by seeing the pediatric oncologist and is likely to result in hospitalization.

You care for a 12-month-old with autistic disorder. Which of the following descriptions would you expect to elicit from his mother on history-taking? a) He stares at a rotating wheel on his crib mobile. b) He already speaks in complete sentences. c) He sleeps at least 12 out of every 24 hours. d) He responds warmly to his father but not to his mother.

He stares at a rotating wheel on his crib mobile. Explanation: Children with autistic disorder seem fascinated by whirling or spinning toys or objects. They are nonverbal and have difficulty forming close relationships.

A child is diagnosed with hyperthyroidism. Which of the following would the nurse expect to assess? a) Weight gain b) Facial edema c) Constipation d) Heat intolerance

Heat intolerance Correct Explanation: Hyperthyroidism is manifested by heat intolerance, nervousness or anxiety, diarrhea, weight loss and smooth, velvety skin. Constipation, weight gain, and facial edema are associated with hypothyroidism.

You have been working with an adolescent with an eating disorder for several days. Which of the following is an indication that she is developing trust in you? a) Her saying to you that she'll follow your orders but not those of the nurse on the next shift b) Her saying to you that she trusts you more than anyone else c) Her telling you that she is now ready to eat again d) Her telling you that she is still inducing vomiting after each meal

Her telling you that she is still inducing vomiting after each meal Correct Explanation: An adolescent has to be able to trust an adult before she can share confidences.

The nurse is assessing a 16-year-old boy who has had long-term corticosteroid therapy. Which of the following findings, along with the use of the corticosteroids, would indicate Cushing disease? a) Observing delayed dentition b) History of rapid weight gain c) Observing a round, child-like face d) Observing high weight to height ratio

History of rapid weight gain Explanation: A history of rapid weight gain and long-term corticosteroid therapy suggests this child may have Cushing disease, which could be confirmed using an adrenal suppression test. A round, child-like face is common to both Cushing and growth hormone deficiency. Observing high weight to height ratio and delayed dentition are findings with growth hormone deficiency.

In teaching the parents of an infant diagnosed with diabetes insipidus, the nurse should include which treatment? a) Antihypertensive medications b) Fluid restrictions c) The need for blood products d) Hormone replacement

Hormone replacement Correct Explanation: The usual treatment for diabetes insipidus is hormone replacement with vasopressin or desmopressin acetate (DDAVP). Blood products shouldn't be needed. No problem with hypertension is associated with this condition, and fluids shouldn't be restricted.

When describing genetic disorders to a group of childbearing couples, the nurse would identify which as an example of an autosomal dominant inheritance disorder? a) Phenylketonuria b) Cystic fibrosis c) Huntington's disease d) Sickle cell disease

Huntington's disease Correct Explanation: Huntington's disease is an example of an autosomal dominant inheritance disorder. Sickle cell disease, phenylketonuria, and cystic fibrosis are examples of autosomal recessive inheritance disorders.

A 6-year-old girl visits the pediatrician with complaints of excessive thirst, frequent voiding, weakness, lethargy, and headache. The nurse suspects diabetes insipidus. Which of the following hormonal conditions is characteristic of this disease? a) Hypersecretion of somatotropin b) Hyposecretion of somatotropin c) Hyposecretion of antidiuretic hormone d) Hypersecretion of antidiuretic hormone

Hyposecretion of antidiuretic hormone Correct Explanation: Diabetes insipidus is a disease in which there is decreased release of antidiuretic hormone (ADH) by the pituitary gland. The child with diabetes insipidus experiences excessive thirst (polydipsia) that is relieved only by drinking large amounts of water; there is accompanying polyuria. Symptoms include irritability, weakness, lethargy, fever, headache, and seizures. Overproduction of antidiuretic hormone by the posterior pituitary gland results in a decrease in urine production and water intoxication and features weight gain, concentrated urine (increased specific gravity), nausea, and vomiting. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Hyposecretion of somatotropin, or growth hormone, results in undergrowth; hypersecretion results in overgrowth.

A child with ALL is beginning treatment with methotrexate in an attempt to eradicate the leukemic cells. The stage of therapy represents which of the following? a) Delayed intensive-therapy phase b) Induction phase c) Consolidation phase d) Sanctuary phase

Induction phase Correct Explanation: An induction phase is the first attempt at eradicating the leukemic cells to induce or achieve a complete remission.

Which behavior typical of children with autistic disorder requires you to maintain special care to keep them safe? a) A fascination with bright colors b) Insensitivity to pain c) Loss of hearing for high frequencies d) A craving for salt

Insensitivity to pain Correct Explanation: A number of children with autistic disorder demonstrate poor sensation of pain and, thus, bite their hands or bang their heads repeatedly.

When assessing newborns for chromosomal disorders, which assessment would be most suggestive of a problem? a) Low-set ears b) Bowed legs c) Short neck d) Slanting of the palpebral fissure

Low-set ears Correct Explanation: A number of common chromosomal disorders, such as trisomies, include low-set ears.

The nurse is teaching an 11-year-old boy and his family how to manage his diabetes. Which of the following does not focus on glucose management? a) Promoting higher levels of exercise than previously maintained b) Encouraging the child to maintain the proper injection schedule c) Instructing the child to rotate injection sites to decrease scar formation d) Teaching that 50% of daily calories should be carbohydrates

Instructing the child to rotate injection sites to decrease scar formation Explanation: Instructing child to rotate injection sites to decrease scar formation is important, but does not focus on managing glucose levels. Teaching the child and family to eat a balanced diet, encouraging the child to maintain the proper injection schedule, and promoting a higher level of exercise all focus on regulating glucose control.

In interpreting the negative feedback system that controls endocrine function, the nurse correlates how _______ secretion is decreased as blood glucose levels decrease. a) Glucagon b) Insulin c) Adrenocorticotropic hormone d) Glycogen

Insulin Correct Explanation: Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body; as a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted.

You care for a 10-year-old boy with growth hormone deficiency. Which therapy would you anticipate will be prescribed for him? a) Oral administration of somatotropin b) Short-term aldosterone provocation c) Intramuscular injections of growth hormone d) Long-term blocking of beta cells

Intramuscular injections of growth hormone Correct Explanation: Growth hormone deficiency occurs when the pituitary is unable to produce enough hormone for usual growth. Administering IM growth hormone supplements this.

A couple wants to start a family. They are concerned that their child will be at risk for cystic fibrosis because they each have a cousin with cystic fibrosis. They are seeing a nurse practitioner for preconceptual counseling. What would the nurse practitioner tell them about cystic fibrosis? a) It is an X-linked inherited disorder b) It is an autosomal dominant disorder c) It is an autosomal recessive disorder d) It is passed by mitochondrial inheritance

It is an autosomal recessive disorder Correct Explanation: Cystic fibrosis is autosomal recessive. Nurses also consider other issues when assessing the risk for genetic conditions in couples and families. For example, when obtaining a preconception or prenatal family history, the nurse asks if the prospective parents have common ancestors. This is important to know because people who are related have more genes in common than those who are unrelated, thus increasing their chance for having children with autosomal recessive inherited condition such as cystic fibrosis. Mitochondrial inheritance occurs with defects in energy conversion and affects the nervous system, kidney, muscle, and liver. X-linked inheritance, which has been inherited from a mutant allele of the mother, affects males. Autosomal dominant is an X-linked dominant genetic disease

The mother of an 8-year-old boy is concerned that her son has attention-deficit/hyperactivity disorder. She describes the symptoms he demonstrates. Which of the following behaviors should the nurse recognize as an example of impulsiveness? a) Constantly fidgeting in his chair and shaking his foot b) Repeating words or phrases spoken by others c) Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission d) Inability to answer a question posed by his teacher because he was daydreaming

Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission Correct Explanation: The disorder is characterized by three major behaviors: inattention, impulsiveness, and hyperactivity. Inattention makes children become easily distracted and often may not seem to listen or complete tasks effectively. Impulsiveness causes them to act before they think and therefore to have difficulty with such tasks as awaiting turns. With hyperactivity, children may shift excessively from one activity to another, exhibit excessive or exaggerated muscular activity, such as excessive climbing onto objects, constant fidgeting, or aimless or haphazard running. Repeating words or phrases spoken by others is echolalia and is associated with autistic spectrum disorder.

A nurse is giving instructions to the father of a boy who is receiving chemotherapy including methotrexate regarding how best to care for the boy during this period of treatment. Which of the following should she mention to him? a) Give him aspirin to help manage pain b) Give the boy folic acid supplements c) Be sure that the boy receives only live-virus vaccines d) Keep him away from people with known infections

Keep him away from people with known infections Correct Explanation: Caution parents, while children are receiving chemotherapy, not to give them aspirin for pain as, in addition to increasing the child's susceptibility to Reye syndrome, aspirin may interfere with blood coagulation, a problem that may already be present because of lowered thrombocyte levels. A parent who wants to give a child vitamins should check with the primary health care provider to be certain the vitamin preparation will not interfere with a chemotherapeutic agent. Administration of a vitamin that contains folic acid, for example, could interfere with the effectiveness of methotrexate, a folic acid antagonist. A child receiving chemotherapy is particularly susceptible to contracting an infection so should be kept away from people with known infections. Caution parents that live-virus vaccines should not be given during chemotherapy as, if the child's immune mechanism is deficient, these vaccines could cause widespread viral disease.

The nurse realizes that the chemotherapy agents and radiation that a child is receiving are likely to irritate the bladder. What are the best measures that the nurse can take to diminish this risk? a) Administer chemotherapy during sleep periods, including naps and overnight b) Keep intravenous (IV) fluids running to maintain excellent hydration and frequent voids c) Have the child wait to void until the bladder becomes full d) Promote drinking of cranberry juice, making it an attractive oral fluid option

Keep intravenous (IV) fluids running to maintain excellent hydration and frequent voids Correct Explanation: IV fluids are given before, during, and after radiation and chemotherapy drugs; bladder irritation results from the need to dilute and remove them from the body. This reduces the need for the child to drink large quantities. Administering the drug during sleep and having the child retain urine would cause irritating chemicals to be kept in contact with the bladder mucosa. No benefit is associated with providing cranberry juice.

A nurse is observing a 10-year-old boy who is in the waiting room of a pediatrician's office. Another child on the other side of the room removes the lid from a toy box, and the 10-year-old boy screams and then cries briefly. Noticing his shoe laces, he begins laughing and untying them. The nurse recognizes this behavior as an example of which of the following? a) Labile mood b) Catatonia c) Flat affect d) Echolalia

Labile mood Correct Explanation: Children with autistic spectrum disorder are said to have a labile mood (crying occurs suddenly and is followed immediately by giggling or laughing or vice versa). Echolalia (repetition of words or phrases spoken by others) and concrete interpretation are also common findings. Children with schizophrenia experience hallucinations (hear or see people or objects that other people cannot) and may display rambling or illogical speech patterns. They may not be responsive (have a flat affect), may withdraw into themselves so completely they are stuporous (catatonia) or be so extremely suspicious that others want to harm them (paranoia) it is difficult for them to function.

Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration. Humulin R Lispro Humulin N Lantus

Lispro Humulin R Humulin N Lantus Correct Explanation: Lispro is a rapid-acting insulin. Humulin R is a short-acting insulin. Humulin N is an intermediate-acting insulin. Lantus is a long-acting insulin.

Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism? a) Low T4 level and high TSH level b) Normal TSH level and high T4 level c) Normal T4 level and low TSH level d) High thyroxine (T4) level and low thyroid stimulating hormone (TSH) level

Low T4 level and high TSH level Correct Explanation: Screening results that show a low T4 level and a high TSH level indicate congenital hypothyroidism and the need for further tests to determine the cause of the disease.

The nurse is examining a child with fetal alcohol syndrome (FAS). Which of the following assessment findings would the nurse expect to note? a) Low nasal bridge with short upturned nose b) Macrocephaly c) Clubbing of fingers d) Short filtrum with thick upper lip

Low nasal bridge with short upturned nose Correct Explanation: Typical FAS facial features include a low nasal bridge with short upturned nose, flattened midface, and a long filtrum with narrow upper lip. Microcephaly rather than macrocephaly is associated with FAS. Clubbing of fingers is associated with chronic hypoxia.

A group of students are reviewing information about oral diabetic agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver? a) Glyburide b) Metformin c) Glipizide d) Nateglinide

Metformin Correct Explanation: Metformin, a biguanide reduces glucose production from the liver. Glipizide stimulates insulin secretion by increasing the response of β cells to glucose. Glyburide stimulates insulin secretion by increasing the response of β cells to glucose. Nateglinide stimulates insulin secretion by increasing the response of β cells to glucose.

The nurse is caring for a 10-year-old recently diagnosed with attention deficit/hyperactivity disorder (ADHD). The nurse would expect to provide teaching regarding which of the following medications? a) Buspirone b) Methylphenidate c) Fluoxetine d) Trazodone

Methylphenidate Correct Explanation: Methylphenidate is a psychostimulant commonly prescribed for ADHD. Trazodone is used to treat depression. Buspirone is used for anxiety. Fluoxetine is used for depression.

The nurse is performing a physical assessment of 16-year-old girl who is cognitively challenged. This client attended her local public elementary school through fifth grade and has since been enrolled at a special education school where she has received social and vocational training. She plans on getting a job in the coming month and on living independently in a few years. The nurse recognizes this client's level of cognitive challenge as which of the following? a) Moderate b) Severe c) Profound d) Mild

Mild Correct Explanation: About 85% of children who are cognitively challenged have an IQ of 50 to 70 and may be referred to as "educable" by a school system. During early years, these children learn social and communication skills and are often not too distinguishable from average infants or toddlers. They continue to learn academic skills up to about a sixth-grade level. As adults, they can usually achieve social and vocational skills adequate for minimum self-support. They're able to live independently but need guidance and assistance when faced with new situations or unusual stress.

A child with an intellectual disability is evaluated and found to have an intelligence quotient (IQ) of 65. The nurse interprets this as reflecting which category of intellectual disability? a) Mild b) Profound c) Moderate d) Severe

Mild Correct Explanation: Mild intellectual disability involves an IQ from 50 to 70. Moderate intellectual disability involves an IQ from 35 to 50. Severe intellectual disability involves an IQ from 20 to 35. A profound intellectual disability involves an IQ less than 20.

A nurse is caring for a child with intellectual disability. The medical chart indicates an IQ of 37. The nurse understands that the degree of disability is classified as which of the following? a) Mild b) Profound c) Severe d) Moderate

Moderate Correct Explanation: An IQ of 35 to 50 is classified as moderate. An IQ of 50 to 70 is classified as mild. An IQ of 20 to 35 is classified as severe, and an IQ less than 20 is considered profound.

The nurse is caring for a 6-year-old boy with non-Hodgkin lymphoma who is being treated with monoclonal antibodies. Which of the following would the nurse include in the child's plan of care? a) Monitoring for complaints of bone pain b) Assessing the child's hydration status secondary to vomiting c) Monitoring for allergic reactions or anaphylaxis d) Assessing for signs of capillary leak syndrome

Monitoring for allergic reactions or anaphylaxis Correct Explanation: The nurse would monitor for infusion-related reactions and anaphylaxis if monoclonal antibodies were administered and would have epinephrine, antihistamines, and steroids available at the bedside for treatment if a reaction occurred. Assessing the level of hydration due to vomiting would be necessary if tumor necrosis factor was administered. The flu-like symptoms produced by interferons require hydration maintenance also. Monitoring for complaints of bone pain is appropriate when administering colony-stimulating factors such as filgrastim or sargramostim. Assessing for signs of capillary leak syndrome within 2 to 12 hours of the start of treatment is necessary when interleukins are used.

The nurse is caring for a 13-year-old girl with delayed puberty. When developing the plan of care for this child, which of the following would be the priority? a) Encouraging the parents to discuss their concerns about the disorder b) Helping the child discuss her feelings about her condition c) Involving the child in her therapy to give her a sense of control d) Monitoring for therapeutic and side effects of medication

Monitoring for therapeutic and side effects of medication Explanation: The child will be receiving hormone supplementation; therefore, monitoring for therapeutic results and possible side effects of medications is key. The physiological effects of the medications take priority over the psychosocial needs of the family or the child. Encouraging the parents to discuss their concerns about the disorder, involving the child in her therapy to give her a sense of control, and helping the child discuss her feelings about her condition would also be included in the plan of care but they would be addressed later on.

An infant with craniosynostosis from Apert syndrome becomes lethargic and starts to vomit. What is the priority nursing intervention? a) Give IV dextrose b) Monitor intake and output c) Notify the doctor and prepare for surgery d) Reassess every hour and document findings

Notify the doctor and prepare for surgery Correct Explanation: The child is exhibiting signs and symptoms of increased intracranial pressure related to premature fusing of the skull joints. Surgery will be needed to relieve the pressure. IV dextrose is contraindicated with increased intracranial pressure. Waiting 1 hour to reassess may lead to brain damage and death. Monitoring intake and output is needed with a hospitalized child but is not the priority intervention based on presentation of symptoms.

The nurse is performing a physical examination on a 1-week-old girl with trisomy 13. Which of the following would the nurse expect to assess? a) Inspection reveals hypoplastic fingernails. b) Observation discloses severe hypotonia. c) Inspection shows a clenched fist with overlapping fingers. d) Observation reveals a microcephalic head.

Observation reveals a microcephalic head. Correct Explanation: Children with trisomy 13 have microcephalic heads with malformed ears and small eyes. Severe hypotonia, hypoplastic fingernails, and clenched fists with index and small fingers overlapping the middle fingers are typical symptoms of trisomy 18.

The nurse is assessing a 5-year-old boy who has had several convulsions. The nurse continues to assess the child and suspects that he may have hypoparathyroidism. Which of the following would support this suspicion? a) Observation reveals tetany. b) Slight exophthalmos is observed. c) Auscultation reveals an irregular heart rate. d) The child acts sleepy and unresponsive.

Observation reveals tetany. Explanation: Tetany occurs in children with hypoparathyroidism due to decreased serum calcium levels. Sleepiness and lack of responsiveness would suggest hyperthyroidism Exophthalmos is associated with hyperthyroidism Irregular heart rate is associated with hyperthyroidism.

A nurse teaching a couple says that when X-linked recessive inheritance is present in a family, the genogram will reveal which of the following? a) Only males in the family have the disorder. b) Sons of an affected man are also affected. c) A history of boys dying at birth for unknown reasons often exists. d) The parents of the affected man have the disorder.

Only males in the family have the disorder. Correct Explanation: When X-linked recessive inheritance is in a family, a genogram will reveal only males in the family with the disorder, a history of girls dying at birth for unknown reasons, unaffected sons of affected men, and parents of affected children not having the disorder

A female patient has the Huntington's disease gene. She and her husband want to have a child but are apprehensive about possibly transmitting the disease to their newborn child. They have strong views against abortion. They would also like to have their "own" child and would consider adopting only as a last resort. Which of the following would be most appropriate in this situation? a) Chancing the conception and birth of a child b) Using donor gametes for conception of a child c) Opting for a preimplantation genetic diagnosis d) Undergoing prenatal diagnosis with prenatal choice of continuing pregnancy

Opting for a preimplantation genetic diagnosis Correct Explanation: The most appropriate choice would be opting for a preimplantation genetic diagnosis (PGD). A PGD is a genetic evaluation of the embryo created through IVF which will reveal whether the Huntington's disease gene is present in the embryo. Undergoing prenatal diagnosis with prenatal choice of continuing pregnancy is not an option because the client and her husband are against abortion. Chancing the conception and birth of a child involves the risk of passing the gene to the newborn child. Using donor gametes may reduce the risk, but it is against the client's preferences.

The nurse is assessing a 14-year-old girl with a tumor. Which of the following findings would indicate Ewing's sarcoma? a) Child complains of persistent pain from minor ankle injury b) Palpation reveals swelling and redness on the right ribs c) Child complains of dull bone pain just below her knee d) Palpation discloses asymptomatic mass on the upper back

Palpation reveals swelling and redness on the right ribs Correct Explanation: Ewing sarcoma may result in swelling and erythema at the tumor site. Common sites are chest wall, pelvis, vertebrae, and long bone diaphyses. Dull bone pain in the proximal tibia is indicative of osteosarcoma. Persistent pain after an ankle injury is not indicative of Ewing's sarcoma. An asymptomatic mass on the upper back suggests rhabdomyosarcoma.

The nurse is caring for a 10-year-old girl with an anxiety disorder. During a physical examination, which of the following physical findings would the nurse expect to find? a) Patches of hair loss b) Watery eyes c) Dilated eyes d) Absence of nasal hair

Patches of hair loss Correct Explanation: Patches of hair loss that occur with repetitive hair twisting or pulling are associated with anxiety. Watery, dilated eyes and the absence of nasal hair are often signs of substance abuse.

Three sisters decide to have genetic testing done because their mother and their maternal grandmother died of breast cancer. Each of the sisters has the BRCA1 gene mutation. The nurse explains that just because they have the gene does not mean that they will develop breast cancer. What does the nurse explain their chances of developing breast cancer depend on? a) Susceptibility b) Their lifestyles c) Penetrance d) What other gene mutations they have

Penetrance Correct Explanation: A woman who has the BRCA1 hereditary breast cancer gene mutation has a lifetime risk of breast cancer that can be as high as 80%, not 100%. This quality, known as incomplete penetrance, indicates the probability that a given gene will produce disease. The other answers are incorrect because lifestyles, other gene mutations, and susceptibility are not the deciding factor in getting breast cancer if you have the BRCA1 gene mutation.

Which of the following signs is consistent with autistic disorder in a 2-year-old boy? a) Has below-average intellectual function b) Possesses excellent language development c) Performs repetitive activity with toys d) Shows signs of losing attained skills

Performs repetitive activity with toys Correct Explanation: The repetitive behavior pattern with the toys, along with observation of communication and social impairment, would suggest autism. Below-average intellectual function is a sign of mental retardation. Loss of attained skills is a sign of Rett syndrome, which occurs only in girls. The presence of excellent language skills suggests Asperger syndrome.

The nurse is interviewing the caregivers of a child admitted with a diagnosis of Type 1 Diabetes Mellitus. The caregiver states, "She is hungry all the time and eats everything, but she is losing weight." The caregiver's statement indicates the child most likely has which of the following? a) Pica b) Polyphagia c) Polydipsia d) Polyuria

Polyphagia Correct Explanation: Symptoms of Type 1 Diabetes Mellitus include polyphagia (increased hunger and food consumption), polyuria (dramatic increase in urinary output, probably with enuresis), and polydipsia (increased thirst), and. Pica is eating nonfood substances.

The nurse is interviewing the caregivers of a child admitted with a diagnosis of Type 1 Diabetes Mellitus. The caregiver states, "The teacher tells us that our child has to use the restroom many more times a day than other students do." The caregiver's statement indicates the child most likely has which of the following? a) Polyphagia b) Polydipsia c) Pica d) Polyuria

Polyuria Correct Explanation: Symptoms of Type 1 Diabetes Mellitus include polyuria (dramatic increase in urinary output, probably with enuresis), polydipsia (increased thirst), and polyphagia (increased hunger and food consumption). Pica is eating nonfood substances.

A nurse is assessing a child diagnosed with Sturge-Weber syndrome. Which of the following would the nurse expect to find when assessing the skin? a) Pigmented nevi b) Café-au-lait spots c) Port wine stain d) Tumors

Port wine stain Correct Explanation: Facial nevus or port wine stain is most often seen on the forehead and on one side of the face. Café-au-lait spots are commonly associated with neurofibromatosis. Tumors are associated with tuberous sclerosis and neurofibromatosis. Pigmented nevi are associated with neurofibromatosis.

Reva is an 8-year-old who is being seen today in the clinic for moodiness and irritability. She has begun to develop breasts and pubic hair and her parents are concerned that she is at too early an age for this to begin. As a nurse you know that the possible prognosis for her is: a) Pseudopuberty b) Adrenal hyperplasia c) Precocious puberty d) Neurofibromatosis

Precocious puberty Correct Explanation: The prognosis for a child with precocious puberty depends on the age at diagnosis and immediate treatment. Appropriate treatment can halt, and sometimes even reverse, sexual development and can stop the rapid growth that results in severe short adult stature caused by premature closure of the epiphysis. Treatment for precocious puberty allows the child to achieve the maximum growth potential possible. Mental development in children with precocious puberty is normal, and developmental milestones are not affected; however, the behavior may change to that of a typical adolescent. Girls may have episodes of moodiness and irritability, whereas boys may become more aggressive.

What is the priority action that the nurse should take when caring for a child newly diagnosed with Wilms' tumor (nephroblastoma)? a) Protact the abdomen from manipulation. b) Assess for constipation. c) Obtain a catheterized urine specimen. d) Control acute pain.

Protact the abdomen from manipulation. Explanation: Manipulation can release malignant cells into the abdominal cavity. Constipation may be a problem following surgical intervention. Pain is uncommon; obtaining a urine specimen is not a priority.

The nurse is caring for a 3-year-old diagnosed with diabetes mellitus. The child's eating patterns are unpredictable. One day the child will eat almost nothing, the next day the child eats everything on her tray. The nurse recognizes that which of the following types of insulin would most likely be used in treating this child? a) Regular insulin b) Rapid-acting insulin c) Intermediate-acting insulin d) Long-acting insulin

Rapid-acting insulin Explanation: The introduction of rapid-acting insulin, such as lispro or humalog, has greatly changed insulin administration in children. The onset of action of rapid-acting insulin is less than 15 mi nutes. Rapid-acting insulin can even be used after a meal in children with un predic table eating habits. Regular, intermediate, and long-acting insulin all have a longer onset, peak, and duration than rapid acting insulin, and are more difficult to regulate in the child with unpredictable eating patterns.

The nurse is caring for a child admitted to the emergency center in diabetic ketoacidosis. Which of the following clinical manifestations would the nurse most likely note in this child? a) Hyperactive and restless behavior b) Slow pulse and elevated blood pressure c) Red lips and fruity odor to breath d) Pale and moist skin

Red lips and fruity odor to breath Correct Explanation: Diabetic ketoacidosis is characterized by drowsiness, dry skin, flushed cheeks and cherry-red lips, acetone breath with a fruity smell, and Kussmaul breathing (abnormal increase in the depth and rate of the respiratory movements). Nausea and vomiting may occur. If untreated, the child lapses into coma and exhibits dehydration, electrolyte imbalance, rapid pulse, and subnormal temperature and blood pressure.

A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. Which of the following would the nurse expect to administer? a) NPH b) Regular insulin c) Detemir d) Lispro

Regular insulin Correct Explanation: Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.

A nurse is caring for a 12-year-old girl who is recovering from surgery for removal of a brain tumor. Which of the following interventions should the nurse implement to avoid increasing intracranial pressure? a) Place a sterile towel under wet dressings b) Regulate the rate of IV fluid infusions carefully c) Apply saline eye drops, as prescribed d) Sponge the client's face

Regulate the rate of IV fluid infusions carefully Correct Explanation: Be certain to regulate the rate of IV fluid infusions carefully because an increase in the infusion rate has the potential to increase intracranial pressure. The other answers refer to other interventions, unrelated to intracranial pressure.

The neonatal nurse caring for children with inborn errors of metabolism explains to the student nurse that prompt treatment is an essential intervention to successful management of the diseases. Which of the following is a recommended treatment for these conditions? a) Undergoing liver or bone marrow transplant to increase deficient enzymes b) Replacing deficient enzymes through intravenous administration c) Eliminating the deficient product from the child's diet d) Increasing substrates preceding the enzymatic block

Replacing deficient enzymes through intravenous administration Correct Explanation: Prompt treatment for metabolic disorders may include replacing deficient enzymes through intravenous administration. Other interventions are decreasing substrates preceding the enzymatic block (e.g., avoiding a particular amino acid or carbohydrate), administering a supplement of the deficient product that should have been produced, providing an enzymatic cofactor, using medications to remove accumulated substrates, undergoing liver or bone marrow transplantation to eliminate all deficient enzymes, and providing somatic gene therapy (a future option).

The nurse is performing an assessment of a 6-year-old girl with Turner syndrome. Which of the following would the nurse most likely assess? a) Pectus carinatum b) Enlarged thyroid gland c) Short stature and slow growth d) Short, stubby trident hands

Short stature and slow growth Correct Explanation: Short stature and slow growth are frequently the first indication of Turner syndrome. While children with Turner syndrome are more prone to thyroid problems, these problems are not as likely to occur as in other symptoms. Pectus carinatum is typical of children with Marfan syndrome. Short, stubby trident hands are typical of achondroplasia.

An African American couple presents for a genetic counseling appointment. They are pregnant and are concerned about their child. What would a patient of African American heritage have genetic carrier testing for? a) Sickle cell anemia b) Asthma c) Rubella d) Meckel's diverticulum

Sickle cell anemia Correct Explanation: Assessing ancestry and ethnicity is important to help identify individuals and groups who could benefit from genetic testing for carrier identification, such as African Americans routinely offered testing for sickle cell anemia. The other answers are incorrect because they are not identified with the African American race

Steve, a 15-year-old Vietnamese boy, has been referred by his homeroom teacher to the school nurse for evaluation. The teacher is concerned that Steve may be suffering from major depression. Who should be the primary source of information to investigate the concerns about Steve? a) Steve's homeroom teacher b) Steve c) Steve's parents d) Steve's school nurse

Steve Correct Explanation: Steve is the primary historian, and the nurse should first elicit his perspective on the problem to establish a therapeutic alliance. The school nurse might have some input, but his or her contact with Steve may have been minimal. Steve's parents can provide insight and assistance, but they may not be willing to do so because of cultural differences. The teacher will provide a valuable timeline and observations as the individual who referred this case; however, Steve is still the primary historian.

A nurse is teaching a child with type 1 diabetes mellitus how to self-inject insulin. Which of the following methods should she recommend to the child for regular doses? a) Subcutaneously in the outer thigh b) Intradermally in the outer arm c) Intramuscularly in the abdomen d) Intravenously in the chest

Subcutaneously in the outer thigh Correct Explanation: Insulin is always injected SC except in emergencies, when half the required dose may be given IV. SC tissue injection sites used most frequently in children include those of the upper outer arms and the outer aspects of the thighs. The abdominal SC tissue injection sites commonly used in adults can be adequate sites but most children dislike this site as abdominal skin is tender.

The nurse is conducting an examination of a boy with Tourette's syndrome. Which of the following would the nurse expect to observe? a) Sudden, rapid stereotypical sounds b) Spinning and hand flapping c) Toe walking d) Lack of eye contact

Sudden, rapid stereotypical sounds Correct Explanation: Sudden, rapid, stereotypical sounds are a hallmark fi ding with Tourette's syndrome. Toe walking and unusual behaviors such as hand-flapping and spinning are indicative of autism spectrum disorder (ASD). Lack of eye contact is associated with ASD but is also noted in children without a mental health disorder.

A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms? a) Hypersecretion of somatotropin b) Syndrome of inappropriate antidiuretic hormone c) Diabetes insipidus d) Hyposecretion of somatotropin

Syndrome of inappropriate antidiuretic hormone Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) is a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level. It can be caused by central nervous system infections such as bacterial meningitis. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Diabetes insipidus is characterized by polyuria, not decreased urine production. Hyposecretion of somatotropin, or growth hormone, results in undergrowth; hypersecretion results in overgrowth.

The nurse is caring for a 6-year-old girl with leukemia who is having an oncological emergency. Which of the following signs and symptoms would indicate hyperleukocytosis? a) Wheezing and diminished breath sounds b) Tachycardia and respiratory distress c) Respiratory distress and poor perfusion d) Bradycardia and distinct S1 and S2 sounds

Tachycardia and respiratory distress Explanation: Increased heart rate, murmur, and respiratory distress are symptoms of hyperleukocytosis (high white blood cell count) which is associated with leukemia. Increased heart rate and blood pressure are indicative of tumor lysis syndrome, which may occur with acute lymphoblastic leukemia, lymphoma, and neuroblastoma. Wheezing and diminished breath sounds are signs of superior vena cava syndrome related to non-Hodgkin's lymphoma or neuroblastoma. Respiratory distress and poor perfusion are symptoms of massive hepatomegaly which is caused by a neuroblastoma filling a large portion of the abdominal cavity.

Which of the following is an example of impaired adaptive functioning in a 9-year-old boy with a developmental disorder? a) The child cannot correctly copy a phone number. b) The child cannot correctly copy a sentence. c) The child cannot properly dress herself. d) The child's vision is fine but he is a poor reader.

The child cannot properly dress herself. Correct Explanation: A child with impaired adaptive functioning would not be able to dress himself properly, if at all. The inability to copy a phone number or sentence or to read well reflects learning disorders.

The nurse is assessing an 8-year-old boy who is performing at the second-grade level, complains of feeling tired and weak, and is only 45 inches tall. Which of the following findings would be specific to hypothyroidism? a) The child complains that the exam room is cold. b) The mother reports that the boy is always thirsty. c) The child has gained 20 pounds in the past year. d) Observation shows only two of the 6-year molars.

The child complains that the exam room is cold. Correct Explanation: Cold intolerance, manifested by the fact that the child was uncomfortably cold in the exam room, is a sign of hypothyroidism. Delayed dentition, with only two of the four 6-year molars having erupted, is typical of growth hormone deficiency. Complaints of thirst may signal diabetes or diabetes insipidus. The dramatic weight gain could be due to hypothyroidism, Cushing syndrome, or syndrome of inappropriate antidiuretic hormone.

Which of the following signs and symptoms suggest that a 5-year-old boy who does not maintain eye contact or speak may be autistic? a) The child constantly opens and closes his hands. b) The child has a long face and prominent jaw. c) The child has a slight decrease in head circumference. d) The child is highly active and inattentive.

The child constantly opens and closes his hands. Correct Explanation: Repetitive motor mannerisms such as constantly opening and closing the hands are a typical behavior pattern for autistic disorder. A high level of activity and inattentiveness are typical symptoms of mental retardation. Decrease in head circumference suggests malnutrition or decelerating brain growth. A long face and prominent jaw are symptoms of fragile X syndrome.

Which of the following signs and symptoms suggest that a 5-year-old boy who does not maintain eye contact or speak may be autistic? a) The child constantly pats his legs. b) The child has a long face and prominent jaw. c) The child has a slight decrease in head circumference. d) The child is highly active and inattentive.

The child constantly pats his legs. Correct Explanation: Repetitive motor mannerisms such as the boy constantly patting his legs are a typical behavior pattern for autistic disorder. A high level of activity and inattentiveness are typical symptoms of mental retardation. A decrease in head circumference suggests malnutrition or decelerating brain growth. A long face and prominent jaw are symptoms of fragile X syndrome.

The nurse is collecting data on an 18-month-old old child with a diagnosis of autism. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) The child smiles when the caregiver shows her a stuffed animal. b) The child does not respond or talk to the nurse when asked simple questions. c) The child cries and runs to the door when the caregiver leaves the room. d) The child sits quietly in the caregivers lap during interview.

The child does not respond or talk to the nurse when asked simple questions. Correct Explanation: Children with autism often have blank expressions and a lack of response to verbal stimulation. They do not develop a smiling response to others nor an interest in being touched or cuddled. In fact, they can react violently to attempts to hold them. They do not show the normal fear of separation from parents that most toddlers exhibit. Often they seem not to notice when family caregivers are present.

The nurse is assessing a 4-year-old girl whose mother complains that she is not eating well, is losing weight, and has started vomiting after eating. Which of the following risk factors from the health history would suggest the child may have a Wilm tumor? a) The child has Down syndrome b) The child has Schwachman syndrome c) There is a family history of neurofibromatosis d) The child has Beckwith-Wiedemann syndrome

The child has Beckwith-Wiedemann syndrome Correct Explanation: Along with the symptoms reported by the mother, the fact that the child has Beckwith-Wiedemann syndrome suggests that the child could have a Wilm tumor. Down syndrome would point to leukemia or brain tumor. Schwachman syndrome would suggest leukemia. A family history of neurofibromatosis is a risk factor for brain tumor, rhabdomyosarcoma, or acute myelogenous leukemia.

The nurse is caring for 1-month-old girl with thyrotoxicosis. Which of the following would the nurse expect to assess? a) The child is hypoactive and hypotonic. b) Skin is cool, dry, and scaly to the touch. c) Observation reveals lethargy and irritability. d) The child has a strong appetite but fails to thrive.

The child has a strong appetite but fails to thrive. Explanation: Infants with thyrotoxicosis may display hyperphagia but fail to gain weight. A combination of lethargy and irritability suggests congenital hypothyroidism. Cool, dry skin that is scaly to the touch suggests congenital hypothyroidism. Hypoactivity and hypotonicity are findings that suggest congenital hypothyroidism.

The nurse in the well-child clinic observes that a 5-year-old child in the waiting room is having trouble using a crayon to color. During the visit, the same child climbs off the table several times even after the nurse has asked him to stay on the table. Each time the nurse reminds him he says, "Oh, yeah," and happily climbs back up. The nurse suspects that which of the following applies to this child? a) The child is autistic. b) The child has failure to thrive. c) The child has attention deficit hyperactive disorder. d) The child has an addicted caregiver.

The child has attention deficit hyperactive disorder. Correct Explanation: The child with ADHD may have these characteristics: Impulsiveness, easy distractibility, frequent fidgeting or squirming, difficulty sitting still, problems following through on instructions despite being able to understand them, inattentiveness when being spoken to, frequent losing of things, going from one uncompleted activity to another, difficulty taking turns, frequent excessive talking, and engaging in dangerous activities without considering the consequences.

Which of the following characteristics are commonly noted in the child with anorexia nervosa? a) The child is impulsive and inattentive when spoken to. b) The child has rigid study skills and ritualistic behavior. c) The child is inactive and participates in sedentary activites. d) The child has trouble sitting still and is figety.

The child has rigid study skills and ritualistic behavior. Correct Explanation: Anorexic children often are described as successful students who tend to be perfectionists and are always trying to please parents, teachers, and other adults. They may make demands on themselves for cleanliness and order in their environment, or they may engage in rigid schedules for studying and other ritualistic behavior.

Which of the following would suggest that a 5-year-old boy might have a developmental disorder? a) The child has trouble with r, l, and y sounds. b) The child knows what a dog and a cat sound like. c) The child must be supervised when brushing his teeth. d) The child is not able to follow directions.

The child is not able to follow directions. Correct Explanation: A 5-year-old child should be able to follow simple directions. If he is unable to this, he has not yet achieved a developmental milestone. Brushing his teeth with supervision and knowing cat and dog sounds are normal for this age. Having trouble with r, l, and y sounds is not unusual and may continue until age 7.

The nurse is working with school-age children who are having enuresis or encopresis. Which of the following will most likely be the first step in this child's treatment? a) The child will be given a strict daily schedule. b) The child will have a complete physical exam. c) The child will be given medications. d) The child will be taken to a therapist.

The child will have a complete physical exam. Correct Explanation: The child with enuresis or encopresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. A complete physical exam and assessment is done first to rule out any physical cause.

A woman with both heart disease and osteoarthritis has come to the genetics clinic for genetic screening. What would the nurse know about these two diseases? a) They are direct result of the patient's lifestyle b) They are multifactorial c) They do not have a genetic basis d) They are caused by a single gene

They are multifactorial Correct Explanation: Genomic or multifactorial influences involve interactions among several genes (gene-gene interactions) and between genes and the environment (gene-environment interactions), as well as the individual's lifestyle.

The nurse is assessing a 6-year-old with attention deficit/hyperactivity disorder (ADHD). The nurse observes the boy making repeated clicking noises and notes he has a slight grimace. The nurse recommends the boy receive further evaluation for which of the following? a) Asperger syndrome b) Tourette syndrome c) Autism spectrum disorder d) Anxiety disorder

Tourette syndrome Correct Explanation: Repeated vocal tics such as sniffling, grunting, clicking, or word utterances are associated with Tourette syndrome. The syndrome consists of multiple motor tics and one or more motor tics occurring simultaneously at different times. ADHD and obsessive-compulsive disorder occur in 90% of children with Tourette syndrome. Vocal and motor tics are not typical indicators of Asperger syndrome, anxiety disorder, or autism spectrum disorder.

A number of inherited diseases can be detected in utero by amniocentesis. Which of the following diseases can be detected by this method? a) Diabetes mellitus b) Phenylketonuria c) Trisomy 21 d) Impetigo

Trisomy 21 Correct Explanation: Karyotyping for chromosomal defects can be carried out using amniocentesis.

The most common mixture of insulin used with children with type 1 diabetes mellitus is a combination of an intermediate-acting insulin and a regular insulin, usually in a 2:1 ratio or 0.75 units of the intermediate-acting insulin to 0.33 units regular insulin, and given in the same syringe. a) False b) True

True

As many as 50% of children with autistic spectrum disorder are also cognitively challenged. a) False b) True

True Explanation: As many as 50% of children with autistic spectrum disorder are also cognitively challenged; many have a coexistent mental health diagnoses.

To feed lunch to a child with autistic disorder, which of the following actions would be most important to take? a) Allow the child to ask questions about the procedure. b) Don't allow him to see the spoon approach his mouth. c) Use a repetitive series of movements. d) Use an authoritarian manner to gain control.

Use a repetitive series of movements. Correct Explanation: Children with autistic disorder typically enjoy repetitive movements or the same action over and over.

The nurse is observing a group of two and three year olds in a play group setting. Which of the following behaviors noted in one of the children indicates to the nurse that the child may be autistic? a) While the other children are eating a snack, the child walks around the room feeling the walls and ignores the caregiver who offers him a snack. b) A child flips the light switch off and on until the caregiver asks her to stop and join the other children in playing. c) A child playing in the kitchen area pretends to pour a glass of milk and repeats this over and over. d) After another child takes a toy, the child cries and stomps his feet.

While the other children are eating a snack, the child walks around the room feeling the walls and ignores the caregiver who offers him a snack. Explanation: autistic children become completely absorbed in strange repetitive behaviors such as spinning an object, flipping an electrical switch on and off, or walking around the room feeling the walls. If these movements are interrupted or if objects in the environment are moved, a violent temper tantrum may result. These tantrums may include self-destructive acts such as hand biting and head banging. Although infants and toddlers normally are self-centered, ritualistic, and prone to displays of temper, autistic children show these characteristics to an extreme degree coupled with an almost total lack of response to other people.

A nurse is conducting a mental status examination with a 5-year-old boy who is playing with trains and blocks of different colors. He repeats the same actions with the trains over and over again throughout the examination. Which of the following questions would be most appropriate? a) Are you having fun now? b) What year is it? c) Why does that red train keep crashing into all of the other trains? d) Do you like playing with trains and blocks?

Why does that red train keep crashing into all of the other trains? Correct Explanation: Asking about the red train is an open-ended question that could help the nurse elicit the fantasies and feelings underlying the boy's play. A 5-year-old may not know what year it is. Questions allowing yes or no answers do not open a dialogue.

A newborn was diagnosed as having hypothyroidism at birth. Her mother asks you how the disease could be discovered this early. Your best answer would be a) her child is already severely impaired at birth, and this suggests the diagnosis. b) hypothyroidism is usually detected at birth by the child's physical appearance. c) children have a typical rash at birth that suggests the diagnosis. d) a simple blood test to diagnose hypothyroidism is required in most states.

a simple blood test to diagnose hypothyroidism is required in most states. Explanation: Hypothyroidism is diagnosed by a screening procedure a few days after birth.

When discussing care of an infant with congenital hypothyroidism, you would stress that the infant will need a) administration of levothyroxine for a lifetime. b) administration of vitamin C until after growth is complete. c) vitamin K administration until school age. d) an increased intake of calcium beginning in infancy.

administration of levothyroxine for a lifetime. Correct Explanation: Hypothyroidism occurs because the thyroid is not producing adequate thyroxine. The child will need a supplemental source for a lifetime.

A child is to receive radiation therapy this morning. A drug you would expect to see prescribed for him prior to this would be an a) antineoplastic. b) analgesic. c) antipyretic. d) antiemetic.

antiemetic. Correct Explanation: Radiation therapy causes nausea because it destroys rapid-growing cells. Among these are the cells of the stomach lining, the reason that nausea occurs.

When an infant is born with a genetic disorder, it is appropriate to advise the parents that a) experiences the mother had during pregnancy are probably not related. b) not all genetic disorders are inherited. c) the disorder has probably occurred in the family before. d) it is likely that the mother drank alcohol during early cell division.

experiences the mother had during pregnancy are probably not related. Explanation: As genetic disorders occur at the moment of conception, events during pregnancy occur after the problem is already present.

A school-aged girl is diagnosed as having Cushing's syndrome from long-term therapy with oral prednisone. This means that the child a) appears pale and fatigued. b) has hypoglycemia. c) has purple striae on her abdomen. d) is excessively tall for her age.

has purple striae on her abdomen. Correct Explanation: An effect of a corticosteroid is to produce striae on the abdomen. Elevated levels of corticosteroids also cause these during pregnancy.

The child has been diagnosed with a mental health disorder and the child's parents are beginning to incorporate behavior management techniques. Which of the following statements by the child's parent indicates the need for further education? Select all that apply. a) "We're trying to make her accountable and responsible for her own behavior." b) "We tell her when she is doing something well." c) "I am quick to point out the things that she does that make me crazy." d) "I use a higher pitched voice when I communicate with her." e) "We have set some boundaries that are nonnegotiable."

• "I am quick to point out the things that she does that make me crazy." • "I use a higher pitched voice when I communicate with her." Correct Explanation: The parents should use a calm, low-pitched voice when communicating with her. They should ignore inappropriate behaviors. The parents should not argue or bargain with the child about set limits. They should praise the child for accomplishments and help the child see the importance of accountability for her own behavior.

Parents bring their daughter to the health care facility for evaluation. They report that lately the child seems rather pale and really tired. Which of the following would the nurse most likely find with further assessment if the child has acute lymphocytic leukemia? Select all that apply. a) Painless cervical lymphadenopathy b) Headache c) Low-grade fever d) Chest pain e) Bleeding from the oral mucous membranes

• Bleeding from the oral mucous membranes • Headache • Painless cervical lymphadenopathy • Low-grade fever Explanation: Assessment findings associated with acute lymphcytic leukemia include low-grade fever, lethargy, petechiae, bleeding from the oral mucous membranes, and easy bruising. As the spleen and liver begin to enlarge, abdominal pain, vomiting, and anorexia occur. Physical assessment reveals painless, generalized swelling of lymph nodes, especially the submaxillary or cervical nodes.

The nurse caring for a patient with leukemia documents the following signs that are clinical or diagnostic features of the disease (select all answers that apply): a) Lymphadenopathy b) Bruising c) Sore throat d) Increased hemoglobin e) Anorexia f) Increased platelet count

• Bruising • Anorexia • Sore throat • Lymphadenopathy Explanation: Clinical and diagnostic features of leukemia include fatigue, weakness, pallor, fever, bruising, bleeding (e.g., petechiae or purpura), weight loss, anorexia, swollen gums, sore throat, recurrent infections, flu-like symptoms, abdominal pain, nausea, vomiting, bone pain, lymphadenopathy, splenomegaly, hepatosplenomegaly, elevated leukocyte count (mm3), decreased hemoglobin (g/dL), and decreased platelets.

A child is suspected of having bipolar disorder. Which of the following would the nurse identify if the child was experiencing a manic episode? Select all that apply. a) Decreased sleep b) Pressured speech c) Loss of interest in activity d) Flamboyant behavior e) Decreased energy

• Decreased sleep • Pressured speech • Flamboyant behavior Correct Explanation: Manifestations associated with a manic episode include rapid, pressured speech; increased energy; decreased sleep; flamboyant behavior; and irritability. The child also may demonstrate an increase in risk-taking behaviors, resulting in accidents and sexual promiscuity.

The nurse is obtaining the history of an adolescent female who is suspected of having anorexia nervosa. Which of the following would the nurse expect to find? Select all that apply. a) Diarrhea b) Desire for perfectionism c) Warm hands and feet d) Syncope e) Secondary amenorrhea

• Desire for perfectionism • Syncope • Secondary amenorrhea Correct Explanation: The adolescent with anorexia may have a history of constipation, syncope, secondary amenorrhea, abdominal pain, and periodic episodes of cold hands and feet. In addition, the child's self-concept reveals multiple fears, high need for acceptance, disordered body image, and perfectionism.

The nurse identifies the nursing diagnosis of risk for infection related to chemotherapy-induced immunosuppression. Which of the following would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply. a) Encouraging frequent, thorough handwashing b) Cheering up the environment with fresh flowers and plants c) Encouraging frequent close contact with numerous visitors d) Having the child sleep in a single bed and room e) Providing a low-carbohydrate, low-protein diet

• Encouraging frequent, thorough handwashing • Having the child sleep in a single bed and room Correct Explanation: To reduce the risk of infection, the nurse should teach the child and parents about minimizing the child's exposure to potentially infectious situations. The nurse should encourage the parents to arrange for the child to sleep in a single bed and room and, if possible, avoid close contact with other family members who may be developing upper respiratory tract infections. Thorough and frequent handwashing, especially after using the bathroom and before eating, is essential. A high-calorie, high-protein diet helps to rebuild white blood cells and should be encouraged. If possible, the child's exposure to large crowds and visitors should be limited because of the increased risk of infection from these individuals. Fresh flowers and plants should be avoided because they could harbor mold spores.

The nurse is teaching a group of 13-year-old boys and girls about screening and prevention of reproductive cancers. Which of the following subjects would not be included in the nurse's teaching plan? (Select all that apply) a) Self examination is an effective screening method for testicular cancer b) Sexually transmitted disease is a risk factor for cervical cancer c) Testicular cancer is one of the most difficult cancers to cure d) Provide information regarding the benefits of receiving the HPV vaccine e) A papanicolaou (PAP) smear does not require parent consent in most states

• Self examination is an effective screening method for testicular cancer • A papanicolaou (PAP) smear does not require parent consent in most states • Sexually transmitted disease is a risk factor for cervical cancer • Provide information regarding the benefits of receiving the HPV vaccine Explanation: Answer b would not be part of the teaching plan. It would be more accurate and appropriate for the nurse to stress that testicular cancer is one of the most curable cancers if diagnosed early. Self-examination is an excellent way to screen for the disease. Girls should know that they can take responsibility for their own sexual health by getting a PAP smear. All the children should understand that early intercourse, sexually transmitted infections (STIs), and multiple sex partners are risk factors for reproductive cancer. Information should be provided so the teen girls can discuss the benefits of receiving the human papilloma virus vaccine since many cervical cancers are attributed to human papillomavirus.

The 18-month-old toddler has been brought into the pediatrician's office by his parents. Which of the following findings are warning signs that the toddler may be autistic based on what he should be able to do according to his age? Select all that apply. a) The child does not use any words b) The child cannot jump rope c) The child does not speak in short sentences d) The toddler does not exhibit attempts to communicate by pointing to objects e) The parents stated that the toddler has never "babbled"

• The child does not use any words • The toddler does not exhibit attempts to communicate by pointing to objects • The parents stated that the toddler has never "babbled" Correct Explanation: An 18-month-old toddler should have babbled by 12 months. He should be using gestures and using single words to communicate. The use of sentences to communicate and the ability to jump rope would be expected later.