peds exam 2

Mrs. Baker was instructed by the nurse on foods to encourage her child's diet concerning the latter's iron deficiency anemia. which of the following if stated by the mother would indicate the need for further instruction? A. Fish B. Lean meats C. Whole-grain breads D. Yellow vegetables

Correct Answer: D. Yellow vegetables If a parent states that she should stress the intake of yellow vegetables, she needs additional teaching because yellow vegetables are not a good source of iron. Leafy greens, especially dark ones, are among the best sources of nonheme iron. Option A: Some seafood provides heme iron. Shellfish such as oysters, clams, scallops, crabs, and shrimp are good sources. Most fish contain iron. Although canned sardines are good sources of iron, they're also high in calcium. Calcium may bind with iron and reduce its absorption. Option B: All meat and poultry contain heme iron. Red meat, lamb, and venison are the best sources. Poultry and chicken have lower amounts. Eating meat or poultry with nonheme iron foods, such as leafy greens, along with vitamin C-rich fruit can increase iron absorption. Option C: Whole-grain breads are good food source of iron and should be supported and encouraged. It may be a good idea to choose iron-fortified cereals, bread products, orange juice, rice, and pasta. Also, fermented and sprouted grains and legumes are a better choice for people with iron deficiency because sprouting and fermenting break down anti-nutrient compounds that negatively impact iron absorption.

The nurse is giving instructions to a mother with a child receiving a liquid oral iron supplement. The nurse tells the mother to: A. Take it with meals. B. Mix it with food. C. Mix it with milk. D. Administer it using a straw.

Correct Correct Answer: D. Administer it using a straw. An oral liquid iron supplement should be given with a straw because the medicine will stain the teeth. Mix each dose in water, fruit juice, or tomato juice. You may use a drinking tube or straw to help keep the iron supplement from getting on the teeth. Option A: Taking it with meals will decrease the absorption. Iron is best absorbed on an empty stomach (usually if taken 1 hour before or 2 hours after meals). Option B: Iron is best absorbed when taken on an empty stomach, with water or fruit juice (adults: full glass or 8 ounces; children: ½ glass or 4 ounces), about 1 hour before or 2 hours after meals. However, to lessen the possibility of stomach upset, iron may be taken with food or immediately after meals. Option C: Iron is not mixed with any drink. Avoid taking antacids, dairy products, tea, or coffee within 2 hours before or after this medication because they will decrease its effectiveness.

Which of the following is TRUE about sickle cell disease (SCD)? Select all that apply. A. Sickle cell anemia (SCD) is an inherited disorder of the hemoglobin in blood. B. Sickle cell anemia requires the inheritance of two sickle cell genes. C. Sickle cell trait, which is the inheritance of one sickle gene, almost never causes problems. D. Virtually all of the major symptoms of sickle cell anemia are the direct result of the abnormally-shaped sickled red blood cells obstructing the flow of blood. E. The contemporary treatment of sickle cell anemia is focused primarily toward managing the individual features of the illness as they occur.

Correct Answer: A, B, C, D, and E Sickle cell disease (SCD) refers to a group of hemoglobinopathies that include mutations in the gene encoding the beta subunit of hemoglobin. The Cooperative Study of Sickle Cell Disease (CSSCD) (between 1978-88) reported the median age of death for women and men as 42 and 48 years, respectively. Option A: Sickle cell anemia (SCD) is an inherited disorder of the hemoglobin in blood. SCA is the most common form of SCD with a lifelong affliction for hemolytic anemia requiring blood transfusions, pain crises, and organ damage. Option B: It requires the inheritance of two sickle cell genes. The sickle cell mutation occurs when negatively charged glutamine is replaced by a neutral valine at the sixth position of the beta-globin chain. The mutation is transmitted via Mendelian genetics and is inherited in an autosomal codominant fashion. Option C: Sickle cell trait, which is the inheritance of one sickle gene, almost never causes problems. A heterozygous inheritance leads to HbAS. Patients with HbAS are not considered within the spectrum of SCD as most of them never present with typical symptoms of SCA. Option D: Virtually all of the major symptoms of sickle cell anemia are the direct result of the abnormally-shaped sickled red blood cells blocking the flow of blood. SCA is characterized by two major components: Hemolysis and vaso-occlusive crises (VOC). Option E: The contemporary treatment of sickle cell anemia is focused primarily toward managing the individual features of the illness as they occur. Pain management is a critical part of SCA. It is challenging for clinicians to accurately assess a patient's needs, especially if they meet them for the first time. Patients with SCA often suffer from the stigma of requiring high doses of opioids for pain control, which leads to them being labeled as 'opioid abusers,' 'manipulators,' or even 'drug seekers.'

Which of the following should be included when developing a teaching plan to prevent urinary tract infection? Select all that apply. A. Maintaining adequate fluid intake B. Avoiding urination before and after intercourse C. Emptying bladder with urination D. Wearing underwear made of synthetic material such as nylon E. Keeping urine alkaline by avoiding acidic beverages F. Avoiding bubble baths and tight clothing

Correct Answer: A, C, & F Even with proper antibiotic treatment, most UTI symptoms can last several days. In women with recurrent UTIs, the quality of life is poor. About 25% of women experience such recurrences. Many cases of uncomplicated UTIs will resolve spontaneously, without treatment, but many patients seek therapy for symptom relief. Option A: Fluid intake helps dilute urine and minimize infection potential. Even without treatment, most UTIs will spontaneously resolve in about 20% of women; especially if increased hydration is used. The likelihood that a healthy female will develop acute pyelonephritis is very small. Option B: Void before and after intercourse (if sexually active). Sexual intercourse is a common cause of a UTI as it promotes the migration of bacteria into the bladder. Although there is no proof of prevention, women should urinate after sexual intercourse because bacteria in the bladder can increase by ten-fold after intercourse. Option C: Emptying the bladder fully with each urination prevents stasis. People who frequently void and empty the bladder tend to have a lower risk of a UTI. Frequent urination and high urinary volumes are also known to decrease the risk of UTI. Option D: Children and teens should wear cotton underwear. The majority of organisms causing a UTI are enteric coliforms that typically inhabit the periurethral vaginal introitus. These organisms ascend the urethra into the bladder and cause UTI. Option E: Keep the urine acidic. Urine is an ideal medium for bacterial growth. Factors that make it less favorable for bacterial growth include a pH less than 5, the presence of organic acids, and high levels of urea. Normal urine pH is slightly acidic, with usual values of 6.0 to 7.5, but the normal range is 4.5 to 8.0. A urine pH of 8.5 or 9.0 is often indicative of a urea-splitting organism, such as Proteus, Klebsiella, or Ureaplasma urealyticum. Option F: Bubble baths and tight clothing may act as irritants. Vigorous urine flow is helpful to prevention. Baths should be avoided in favor of showers. A gentle, liquid soap should be used in bathing (such as Ivory or Dial) or a liquid baby soap such as Johnson's baby shampoo which is very acceptable for the vagina.

What should be the initial bolus of crystalloid fluid replacement for a pediatric patient in shock? A. 20 ml/kg B. 10 ml/kg C. 30 ml/kg D. 15 ml/kg

Correct Answer: A. 20 ml/kg Fluid volume replacement must be calculated to the child's weight to avoid overhydration. Initial fluid bolus is administered at 20 ml/kg, followed by another 20 ml/kg bolus if there is no improvement in fluid status. Shock is a life-threatening manifestation of circulatory failure. Circulatory shock leads to cellular and tissue hypoxia resulting in cellular death and dysfunction of vital organs. Option B: Obtain two large-bore IVs or central line. Place the patient in the Trendelenburg position. Aggressive IV fluid resuscitation with 2 to 4 L of isotonic crystalloids. PRBC transfusion if ongoing bleeding. Appropriate medical or interventional strategies to treat the underlying etiology. Continue with isotonic crystalloids and use vasopressors if needed Option C: Immediate treatment with intravenous (IV) fluid should be initiated, followed by vasopressor therapy, if needed, to maintain tissue perfusion. Depending on the underlying etiology of shock, specific therapies might also be needed. Option D: The initial approach to management is the stabilization of the airway and breathing with oxygen and oral mechanical ventilation when needed. Peripheral IV or intraosseous infusion (IO) access should be obtained. Central venous access may be required in the setting of shock if there is difficulty securing peripheral venous access, or the patient needs prolonged vasopressor therapy or large-volume resuscitation.

Parents bring their infant to the clinic, seeking treatment for vomiting and diarrhea that has lasted for 2 days. On assessment, the nurse in charge detects dry mucous membranes and lethargy. What other findings suggest a fluid volume deficit? A. A sunken fontanel B. Decreased pulse rate C. Increased blood pressure D. Low urine specific gravity

Correct Answer: A. A sunken fontanel In an infant, signs of fluid volume deficit (dehydration) include sunken fontanels, increased pulse rate, and decreased blood pressure. They occur when the body can no longer maintain sufficient intravascular fluid volume. When this happens, the kidneys conserve water to minimize fluid loss, which results in concentrated urine with high specific gravity. Option B: Children with hypernatremia have better hemodynamics (eg, less tachycardia and better urine output) than do children with hyponatremia, in whom fluid has shifted out of the vascular space. Option C: Dehydrated children with hyponatremia may appear only mildly dehydrated but are actually closer to hypotension and cardiovascular collapse than are equally dehydrated children with elevated or normal sodium levels. Option D: Other laboratory abnormalities in dehydration include relative polycythemia resulting from hemoconcentration, elevated blood urea nitrogen (BUN), and increased urine specific gravity.

A nurse is handling a child who is on furosemide (Lasix) IV infusion. The nurse instructs the mother to encourage the child to eat which of the following? A. Apricot and baked potato skin. B. Bread and butter. C. Gelatin and Cauliflower. D. Ginger ale and cereal.

Correct Answer: A. Apricot and baked potato skin. One of the side effects of taking furosemide is hypokalemia, so a supplemental food rich in potassium is encouraged. Many fresh fruits and vegetables are rich in potassium: Bananas, oranges, cantaloupe, honeydew, apricots, grapefruit (some dried fruits, such as prunes, raisins, and dates, are also high in potassium). Option B: Bread is rich in carbohydrates and butter is sufficient in fats. Foods that have the highest concentrations of potassium include cantaloupe, watermelons, grapefruit, all dried fruit and fruit juices, avocadoes, tomatoes, potatoes (plain and sweet), Brussels sprouts, milk, yogurt, lentils, and most nuts (except peanuts). Option C: Cauliflower is a cruciferous vegetable that is naturally high in fiber and B-vitamins. It provides antioxidants and phytonutrients that can protect against cancer. It also contains fiber to enhance weight loss and digestion, choline that is essential for learning and memory, and many other important nutrients. Option D: These are low in potassium. People may think of ginger ale as another form of soda, but in fact, this beverage does have some important nutrients, including calcium, iron, copper, and magnesium, among others. It is relatively low in calories, but most manufacturers add sugar to make the drink more palatable.

12-year-old Caroline has recurring nephrotic syndrome. Which of the following areas of potential disturbances should be a prime consideration when planning ongoing nursing care? A. Body image B. Sexual maturation C. Muscle coordination D. Intellectual development

Correct Answer: A. Body image Because of edema associated with nephrotic syndrome, potential self-concept, and body image disturbances related to changes in appearance and social isolation should be considered. Nephrotic syndrome is a condition that causes the kidneys to leak large amounts of protein into the urine. This can lead to a range of problems, including swelling of body tissues and a greater chance of catching infections. Option B: Sexual maturation is not affected. Instruct parents to provide frequent oral hygiene. Oral hygiene reduces dryness of the mouth and mucous membranes. Advise them to limit fluid intake as ordered. The amount of allowed fluid intake is determined based on the child's weight, urine output, and response to treatment. Option C: Muscle coordination is not affected. Assess their knowledge of disease, signs and symptoms of relapse, dietary and activity aspects of care, medication administration and side effects, monitoring urine and vital signs. This provides information about education needs for follow-up care. Option D: Intellectual function is not affected. Offer parents and child with praise and encouragement as they acquire skills. Positive reinforcement improves willingness to learn new skills.

Patient S is a sexually active adolescent. Which of the following instructions would be included in the preventive teaching plan about urinary tract infections? A. Drinking acidic juices B. Avoiding urinating before intercourse C. Wearing nylon underwear D. Wiping back to front

Correct Answer: A. Drinking acidic juices Drinking acidic juices, such as cranberry juice, helps keep the urine at its desired pH and reduces the chance of infection. Pure cranberry juice, cranberry extract, or cranberry supplements may help prevent repeated UTIs in women, but the benefit is small. It helps about as much as taking antibiotics to prevent another UTI. Option B: Many health authorities, including the Centers for Disease Control and Prevention (CDC), recommend urinating after sex to prevent UTIs. Doing so may help flush away bacteria that are close to the urethra and prevent them from entering the urinary tract. Option C: Synthetic fabrics trap moisture and create the perfect breeding ground for infection. If the patient is prone to UTIs, she should wear loose-fitting bottoms that allow air to circulate around the vagina. At night, the patient can wear loose-fitting boxers or shorts. Option D: After urinating, tilt the body forward and, reaching between the buttocks, start wiping from the front of the vagina to the back. Doing so prevents the introduction of bacteria from the anus to the vagina.

Nurse Christine is planning a client education program for sickle cell disease (SCD) in children. Which of the following interventions would be included in the care plan? A. Health teaching to help reduce sickling crises B. Avoidance of the use of opioids C. Administration of an anticoagulant to prevent sickling D. Observation of the imposed fluid restriction

Correct Answer: A. Health teaching to help reduce sickling crisis. Prevention is one of the principal goals of therapeutic management because there is no cure for sickle cell disease. Consequently, health education to help lessen the sickling crisis is key. Early detection and rapid initiation of appropriate treatment for several acute conditions including the vaso-occlusive crisis, aplastic crisis, sequestration crisis, and hemolytic crisis is needed. These crises, if not treated early, can result in mortality. Option B: Opioids usually are required for pain control. Most guidelines recommend early initiation of parenteral opioid analgesics, usually with morphine at 0.1 mg/kg IV or subcutaneously (SC) every 20 minutes, and maintaining this analgesia with morphine at doses of 0.05 to 0.1 mg/ kg every 2 to 4 hrs (SC/IV or PO). Option C: Anticoagulants do not prevent sickling. Adjuvant therapy includes hydroxyurea, antihistamines, anxiolytics, and antiemetics. It is prudent to maintain adequate hydration and be vigilant in identifying other causes of pain that may need additional treatment. Option D: Fluids are encouraged to increase fluid volume and prevent sickling. The key is rapid hydration and pain control. In addition, oxygenation should be monitored. It is important to find and treat the trigger of the crisis to prevent a recurrent crisis.

Nurse Chole is evaluating a female child with acute post-streptococcal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement? A. Increased urine output B. Increased appetite C. Increased energy level D. Decreased diarrhea

Correct Answer: A. Increased urine output Increased urine output, a sign of improving kidney function, typically is the first sign that a child with acute post-streptococcal glomerulonephritis (APSGN) is improving. PSGN typically presents with features of the nephritic syndrome such as hematuria, oliguria, hypertension, and edema, though it can also present with significant proteinuria. Option B: Increased appetite is not specific to APSGN. Poststreptococcal glomerulonephritis (PSGN) results from a bacterial infection that causes rapid deterioration of the kidney function due to an inflammatory response following streptococcal infection. Option C: An increased energy level is not specific to APSGN. When symptomatic, PSGN typically presents with features of the nephritic syndrome such as hematuria, oliguria, hypertension, and edema. Less common presentations can mimic nephrotic syndrome with significant proteinuria. Option D: Decreased diarrhea is not specific to APSGN. The most common presenting symptom is gross hematuria as it occurs in 30 to 50% of cases with acute PSGN; patients often describe their urine as smoky, tea-colored, cola-colored, or rusty.

The nurse is evaluating a female child with acute post streptococcal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement? A. Increased urine output B. Increased appetite C. Increased energy level D. Decreased diarrhea

Correct Answer: A. Increased urine output Increased urine output, a sign of improving kidney function, typically is the first sign that a child with acute post-streptococcal glomerulonephritis (APSGN) is improving. PSGN typically presents with features of the nephritic syndrome such as hematuria, oliguria, hypertension, and edema, though it can also present with significant proteinuria. Option B: Increased appetite is not specific to APSGN. Poststreptococcal glomerulonephritis (PSGN) results from a bacterial infection that causes rapid deterioration of the kidney function due to an inflammatory response following streptococcal infection. Option C: An increased energy level is not specific to APSGN. When symptomatic, PSGN typically presents with features of the nephritic syndrome such as hematuria, oliguria, hypertension, and edema. Less common presentations can mimic nephrotic syndrome with significant proteinuria. Option D: Decreased diarrhea is not specific to APSGN. The most common presenting symptom is gross hematuria as it occurs in 30 to 50% of cases with acute PSGN; patients often describe their urine as smoky, tea-colored, cola-colored, or rusty.

Which of the following situations increase the risk of lead poisoning in children? A. playing in the park with heavy traffic and with many vehicles passing by B. playing sand in the park C. playing plastic balls with other children D. playing with stuffed toys at home

Correct Answer: A. Playing in the park with heavy traffic and with many vehicles passing by. Lead poisoning may be caused by inhalation of dust and smoke from leaded gas. It may also be caused by lead-based paint, soil, water (especially from plumbings of old houses). Approximately 535000 children between 1 and 5 years of age have an elevated blood lead concentration, defined by the Advisory Committee on Childhood Lead Poisoning Prevention of the Centers for Disease Control and Prevention (CDC) as greater than or equal to 5mcg/dL based on the 97.5 percentile of blood lead concentrations in the most recent National Health and Nutrition Examination Survey (NHANES) dataset. Option B: Several million young children in the United States live in older homes in which lead-based paint was previously used, and as this old paint ages, it peels, flakes, and crumbles into dust that settles on the interior surfaces of homes and in the soil surrounding the exterior of the home. Option C: Despite the fact that the amount of lead in paint intended for use in or on residential buildings, furniture, or children's toys in the United States has been restricted to 0.06% since 1978 and was further reduced to 0.009% in 2008, lead-based paint continues to be a major source of lead exposure in young children. Option D: Prevalence rates of children under 1 year of age with elevated blood lead concentrations are consistently lower than those in the 1 to 4 year age group, likely because lead is a cumulative toxin and because young children are more mobile and overall have more hand-to-mouth behavior compared to infants.

Mrs. Johnson tells the nurse that she is very worried because her 2-year old child does not finish his meals. What should the nurse advise the mother? A. Make the child seat with the family in the dining room until he finishes his meal B. Provide quiet environment for the child before meals C. Do not give snacks to the child before meals D. Put the child on a chair and feed him

Correct Answer: Answer C. Do not give snacks to the child before meals. If the child is hungry he/she is more likely to finish his meals. Therefore, the mother should be advised not to give snacks to the child. Set times for meals and snacks and try to stick to them. A child who skips a meal finds it reassuring to know when to expect the next one. Avoid offering snacks or pacifying hungry kids with cups of milk or juice right before a meal — this can diminish their appetite and decrease their willingness to try a new food being offered. Option A: The child is a "busy toddler." He/she will not be able to keep still for a long time. For some kids, dinner becomes a negotiation session from the very start, and parents have been using dessert as an incentive for decades. But this doesn't encourage healthy eating. Instead, it creates the impression that "treats" are more valuable than mealtime food. Option B: Be alert to what toddlers say through their actions. A child who is building a tower of crackers or dropping carrots on the floor may be telling you he or she is full. Pushing food on a child who's not hungry may dull the internal cues that help kids know when they've eaten enough. Kids can manage their hunger when they come to expect that food will be available during certain times of the day. If a child chooses not to eat anything at all, simply offer food again at the next meal or snack time. Option D: Kids should start finger feeding around 9 months of age and try using utensils by 15-18 months. Some parents think that not letting kids feed themselves is for the best, but it takes away control that rightfully belongs to kids at this age. They need to decide whether to eat, what they will eat, and how much to eat — this is how they learn to recognize the internal cues that tell them when they're hungry and when they're full. Just as important, toddlers need to learn and practice the mechanics of feeding themselves.

Archie is a child with iron deficiency anemia. He is required to receive elemental iron therapy at 6 mg/kg/day in three divided doses. He weighs 44 lbs. How many milligrams of iron should he receive per dose? A. 20 mg/dose B. 40 mg/dose C. 60 mg/dose D. 120 mg/dose

Correct Answer: B. 40 mg/dose The child weighs 44 lbs, which is equal to 20 kg (1 kg=2.2 lb;44/2.2=20kg). Elemental iron therapy is ordered at 6 mg/kg/day in three doses. Therefore, the child receives 120 mg/day (6 mg/20 kg/day=120), divided into three doses (120/3), which is equal to 40 mg/dose. Option A: There are currently two forms of low-molecular-weight iron dextran available on the market in North American. Both come as injectable solutions [intravenous (IV) or intramuscular (IM)] containing 50 mg/mL of elemental iron. The incidence of toxicity relative to high-molecular-weight preparations is lower with low-molecular-weight iron dextran. Option C: As per the manufacturer, a test dose of 25 mg (0.5 mL) followed by 1 hour of observation is necessary before administering the remainder of the calculated required dose to monitor for anaphylactoid reactions. Intramuscular injections should be administered to the upper outer quadrant of the buttock using the Z - track technique (lateral displacement of skin prior to injection). Option D: If total dose calculations exceed the daily allowance of administration, smaller incremental daily doses may be used until the patient achieves the total dose requirement. All doses require administration at a maximum rate of 50 mg (1 mL) per minute. No dosage adjustments are necessary for renal and/or hepatic impairment.

Nurse Jeremy is evaluating a client's fluid intake and output record. Fluid intake and urine output should relate in which way? A. Fluid intake should double the urine output. B. Fluid intake should be approximately equal to the urine output. C. Fluid intake should be half the urine output. D. Fluid intake should be inversely proportional to the urine output.

Correct Answer: B. Fluid intake should be approximately equal to the urine output. Normally, fluid intake is approximately equal to the urine output. Any other relationship signals an abnormality. One general principle for all patient scenarios is to replace whatever fluid is being lost as accurately as possible. The strategy of managing a patient's fluid differs depending on each patient's clinical condition. If they can drink adequate fluid volumes by mouth, this should be the first choice. Some patients can tolerate other enteral options, such as feeding tubes. IV plus oral orders are effective for those unable to meet their total daily fluid requirements enterally. Option A: Fluid intake that is double the urine output indicates fluid retention. Monitor for peripheral edema, pulmonary edema, or hepatomegaly. It is important to consider underlying cardiac dysfunction or renal failure and adjust volumes of administration accordingly. These patients might require a lower maintenance fluid rate than expected for their body weight. Option C: Fluid intake that is half the urine output indicates dehydration. A drop of at least 20 mm Hg systolic blood pressure or 10 mm Hg diastolic blood pressure within 2 to 5 minutes of quiet standing after 5 minutes of supine rest indicates orthostatic hypotension. Dehydrated or elderly patients who have lost sensitivity in their baroreceptors in their blood vessels might display these findings. Option D: Normally, fluid intake isn't inversely proportional to the urine output. One can see weight gain in states of fluid excess and weight loss in states of fluid deficit. It is also helpful to look at patient records to see any recent outpatient visits before hospitalization, which might indicate a patient's normal baseline weight.

Baby Ellie is diagnosed with gastroesophageal reflux (GER). Which of the following nursing diagnoses would be inappropriate? A. Risk for aspiration B. Impaired oral mucous membrane C. Deficient fluid volume D. Imbalanced nutrition: Less than body requirements

Correct Answer: B. Impaired oral mucous membrane GER is the backflow of gastric contents into the esophagus resulting from relaxation or incompetence of the lower esophageal (cardiac) sphincter. No alteration in the oral mucous membranes occurs with this disorder. Option A: Avoid placing the patient in a supine position, have the patient sit upright after meals. Supine position after meals can increase regurgitation of acid. Elevate HOB while in bed to prevent aspiration by preventing the gastric acid to flow back into the esophagus. Option C: Instruct the patient to avoid highly seasoned food, acidic juices, alcoholic drinks, bedtime snacks, and foods high in fat. These can reduce the lower esophageal sphincter pressure. Option D: Encourage small frequent meals of high calories and high protein foods. Small and frequent meals are easier to digest. Obtain a nutritional history. Determining the feeding habits of the client can provide a basis for establishing a nutritional plan.

When educating parents regarding known antecedent infections in acute glomerulonephritis, which of the following should the nurse cover? A. Scabies B. Impetigo C. Herpes simplex D. Varicella

Correct Answer: B. Impetigo Impetigo, a bacterial infection of the skin, may be caused by streptococci and may precede acute glomerulonephritis. Although most streptococcal infections do not cause acute glomerulonephritis, when they do, a latent period of 10 to 14 days occurs between the infection, usually of the skin (impetigo) or upper respiratory tract, and the onset of clinical manifestations. Option A: Scabies is not associated with acute glomerulonephritis. Scabies is a contagious skin condition resulting from the infestation of a mite. The Sarcoptes scabiei mite burrows within the skin and causes severe itching. This itch is relentless, especially at night. Skin-to-skin contact transmits the infectious organism therefore, family members and skin contact relationships create the highest risk. Option C: Herpes simplex is not associated with acute glomerulonephritis. Risk factors for HSV-1 infection differ depending on the type of HSV-1 infection. In the case of orolabial herpes, risk factors include any activity that exposes one to an infected patient's saliva, for example, shared drinkware or cosmetics, or mouth-to-mouth contact. Option D: Varicella is not associated with acute glomerulonephritis. Chickenpox or varicella is a contagious disease caused by the varicella-zoster virus (VZV). The virus is responsible for chickenpox (usually primary infection in non-immune hosts) and herpes zoster or shingles (following reactivation of latent infection).

Mr. and Mrs. Smith's child has hemophilia; which of the following actions would you instruct them to avoid? A. Immobilizing the joint B. Lowering the injured area C. Applying cold to the area D. Applying pressure

Correct Answer: B. Lowering the injured area With hemophilia, the injured area must be elevated, not lowered. If bleeding is in a joint (hemarthrosis), elevate and immobilize the affected limb. Repeated hemarthrosis can result in severe and crippling deformity. Option A: Immobilize the affected limb. Provide replacement therapy of deficient clotting factors. Replacement of factors is the primary treatment for bleeding. Treatment includes factor VIII, which is an essential clotting factor needed to convert prothrombin to thrombin. Option C: Apply ice packs to control bleeding. Usual sites of external bleeding may include the bleeding in the mouth from a cut, bite, or from cutting or losing a tooth; nosebleeds for no obvious reasons; heavy bleeding from a minor cut, or bleeding from a cut that resumes after stopping for a short time. Option D: Apply manual or mechanical pressure if active bleeding is noted. Apply sterile dressings to wounds, and apply pressure. Controlling bleeding is a nursing priority. Nasal packing should be avoided, because the subsequent removal of the packing may precipitate further bleeding.

Which of the following would be inappropriate when administering chemotherapy to a child? A. Monitoring the child for both general and specific adverse effects B. Observing the child for 10 minutes to note for signs of anaphylaxis C. Administering medication through a free-flowing intravenous line D. Assessing for signs of infusion infiltration and irritation

Correct Answer: B. Observing the child for 10 minutes to note for signs of anaphylaxis. When administering chemotherapy, the nurse should observe for an anaphylactic reaction for 20 minutes and stop the medication if one is suspected. Anaphylaxis is a severe allergic reaction, which can cause shock, low blood pressure, and occasionally death. Food allergies, including allergy to peanuts and tree nuts, are said to account for the majority of fatal or near-fatal anaphylactic reactions in the U.S.A. Care is taken especially when chemotherapy medications are known to be common allergic reaction producers, to premedicate to prevent or lessen the reaction. Option A: Chemotherapy is associated with both general and specific adverse effects, therefore close monitoring for them is important. A major challenge for the nurse caring for a child with fever and neutropenia is monitoring for signs of sepsis (e.g., peripheral perfusion, temperature of extremities, level of consciousness, vital signs, and pulse oximetry). Option C: Education of the family and child regarding the treatment plan or protocol (e.g., chemotherapy, radiotherapy, and/or surgery) is crucial to relieving parents' fears and anxieties. Even though the explanation of the diagnosis and treatment plan supports the hope that their child may survive cancer, the word cancer still conveys a life-threatening illness. Option D: Because most infectious origins develop from the child's own endogenous flora, the nurse should encourage the parents/child to adhere to strict handwashing practices, perform frequent mouth care, perineal hygiene, and avoid the use of rectal thermometers owing to the chance of introducing pathogens through the rectal mucosa. Protective isolation and food sterilization have little impact on decreasing infectious rates in neutropenic children.

Nurse Olenna is performing community assessment; which of the following age-groups would be inappropriate for her to monitor iron deficiency anemia? A. Toddlers B. School-age children C. Adolescents D. Pregnant women

Correct Answer: B. School-age children Periods of rapid growth predispose a person to iron deficiency anemia. Iron deficiency anemia is not prevalent in school-age children because this stage is not a period of rapid growth. Anemia among children has been conclusively seen to delay psychomotor development, poor cognitive performance, impaired immunity, and decrease working capacity. Option A: The "picky appetites" of toddlers may also predispose them to this condition. Children are at higher risk for iron deficiency because of their higher need for iron. Simply put, a diet that's poor in sources of iron can lead to iron deficiency. A diet that features an excess amount of milk, which is a poor source of iron, can place a child at risk for iron deficiency. Option C: Adolescence is characterized by rapid growth and development and iron requirements increase during this time. Adolescents with poor diet in early childhood and/or females with an early onset of menarche may be at greater risk for developing anemia due to the rapid depletion of iron stores in their bodies. Option D: Pregnancy is a period of rapid growth. Thus, individuals in these groups are more likely to experience iron deficiency anemia. Pregnancy is associated with increased iron demand, and therefore, increases the risk of iron deficiency anemia. Up to 52% of pregnant women in the developing world are affected.

Nurse Nancy is teaching Mr. and Mrs. Diaz about the early signs and symptoms of lead poisoning. Which of the following if stated by the couple would indicate the need for further understanding of the case? A. Anemia B. Seizures C. Irritability D. Anorexia

Correct Answer: B. Seizures Seizures usually are associated with encephalopathy, a late sign of lead poisoning. Typically, lead levels have already exceeded 70 mg/dl. In the appropriate clinical setting, lead encephalopathy should be considered in patients presenting with delirium, altered mental status, or seizures. As lead encephalopathy often presents with altered sensorium, obtaining a history directly from the patient can be challenging. Option A: Key features of the patient's history that should raise the index of suspicion for lead encephalopathy may include associated abdominal pain, constipation, or anemia, which are other common findings of lead intoxication. Option C: Particularly in sub-acute cases, additional history of preceding ataxia, headache, sensory or motor deficits, agitation, or irritability may be present. Finally, obtaining a detailed environmental history is important in understanding the route and magnitude of potential lead intoxication. Option D: A physical exam will primarily reveal CNS derangement. Generally speaking, patients afflicted with lead encephalopathy will appear to be globally altered. They may also exhibit signs of peripheral neuropathy on the exam, such as wrist drop and loss of 2 point discriminatio

Which of the following parameters would Nurse Max monitor to evaluate the effectiveness of thickened feedings for an infant with gastroesophageal reflux (GER)? A. Urine B. Vomiting C. Weight D. Stools

Correct Answer: B. Vomiting Thickened feedings are used with GER to stop the vomiting. Therefore, the nurse would monitor the child's vomiting to evaluate the effectiveness of using the thickened feedings. The feeding management strategy has been shown to represent an effective approach in otherwise healthy infants with both GER and GERD. It involves modifying feeding frequency and volume, ensuring the intake of feed per kilogram of weight is appropriate. There is some evidence for the efficacy of feed thickeners on reducing visible regurgitation Option A: No relationship exists between feedings and urine. Patients with GER and GERD may also benefit from changing body position, by keeping them upright or even in the prone position, especially in the postprandial period. Option C: If feedings are ineffective, this should be noted before there is any change in the child's weight. Identify the amount of weight loss needed for optimal body size and frame. Provides a basis for dietary planning. Option D: If the first-line management fails to improve symptoms, current pediatric guidelines advise for a 2-4 weeks trial with cow's milk protein-free diet, by either excluding milk from the maternal diet in breastfed infants or by using hydrolyzed formula in non-breast fed infants.

Nurse Karen is providing postoperative care for Dustin who has cleft palate (CP); she should position the child in which of the following? A. In an infant seat B. In the supine position C. In the prone position D. On his side

Correct Answer: C. In the prone position Postoperatively, children with a CP should be placed on their abdomens to facilitate drainage. A child who has had a cleft lip repair should be positioned on their side or back to keep them from rubbing their face in the bed. A child with only a cleft palate repair may sleep on their stomach. It is important to keep the stitches clean and without crusting. Option A: Using an infant seat does not facilitate drainage. It is important to keep the child from hurting the incision or putting hands or toys in their mouth. For this reason, they will wear arm restraints (NoNo's) which keep them from bending their elbows. These are also used for 10 days after surgery. Option B: If the child is placed in the supine position, aspiration is a concern. There may be some discomfort as the child swallows so they may not drink much the first evening. This is why IV fluids are continued until their drinking improves. Pain medicine will also be given to relieve distress. Option D: Side-lying does not facilitate drainage as well as the prone position. The goal after surgery is to protect the new repair and stitches. For this reason, there will be some changes in the child's feeding, positioning, and activity for a short time.

Which of the following tests is most effective in diagnosing hemophilia? A. Bleeding time B. Complete blood count (CBC) C. Partial thromboplastin time (PTT) D. Platelet count

Correct Answer: C. Partial thromboplastin time (PTT) PTT is abnormal in hemophilia. Therefore, this test will be the most helpful in diagnosing the disorder. In both hemophilia A and B, PTT will be prolonged (intrinsic pathway disruption), whereas PT and BT will be normal. The PTT could be as prolonged as 2 to 3 times the high normal range. Once PTT is found to be prolonged, it should be followed by a mixing study. Option A: Bleeding time is normal in hemophilia. Kaneshiro in 1969 confirmed that the mean bleeding time was normal in hemophilia. However, 2 of 11 patients with severe hemophilia A had prolonged baseline bleeding times of 12 and 15 min, respectively. Option B: The CBC is not affected in hemophilia. After the prenatal period, the initial laboratory work includes but is not limited to complete blood count, prothrombin time (PT), partial thromboplastin time (PTT), and bleeding time (BT). Option D: The severity of the disease correlates with remaining factor levels, although individual differences in bleeding tendency are seen despite similar factor levels. While thrombin generation is severely impaired in persons with hemophilia, primary hemostasis, i.e. platelet function has been generally considered to be normal.

Baby Jonathan was born with cleft lip (CL); Nurse Barbara would be alert that which of the following will most likely be compromised? A. GI function B. Locomotion C. Sucking ability D. Respiratory status

Correct Answer: C. Sucking ability Because of the defect, the child will be unable to form a mouth adequately around the nipple, thereby requiring special devices to allow for feeding and sucking gratification. Patients with cleft lips inherently will have some degree of alveolar cleft with potential for collapse of the maxillary arch and class III malocclusion (the maxillary teeth sit posterior to the mandibular teeth). These hard and soft tissue anatomic changes translate to the various changes in appearance, speech, and swallowing/feeding seen in cleft lip patients. Option A: GI functioning is not compromised in the child with a CL. Speech-language therapists and nutrition consults are usually required to teach parents techniques to meet the special feeding needs of these children. When patients do not meet feeding requirements for adequate nutrition, which is most common when there is a concomitant cleft palate, feeding access is sometimes required with the assistance of the pediatric surgery team. Option B: Locomotion would be a problem for older infants because of the use of restraints. Nurses who look after these infants should be fully aware of the risk of aspiration, airway obstruction, and difficulties with feeding. There is no single method of feeding that works in all children and the mother should be educated on the different techniques to help the infant latch on the nipple. In general, the recommendation is a soft nipple that may need to be angled. Option D: Respiratory status may be compromised if the child is fed improperly during the postoperative period. The mother should be taught about the potential for aspiration and choking. If the infant fails to gain weight, a visit to the pediatrician is highly recommended.

A nurse is monitoring the intake and output of an infant receiving furosemide (Lasix) IV. Which of the following methods is the most appropriate in measuring the urine output? A. Ask the mother regarding the number of diaper changes B. Compare intake with output C. Weighing the diaper D. Insert Foley catheter

Correct Answer: C. Weighing the diaper. The most appropriate method for measuring urine output of an infant is by weighing the diaper. The infant is placed on a preweighed, absorbent diaper. Urine output then is determined from the volume of urine in the bag and the increase in the weight of the diaper that has occurred between urine collections. Option A: Measuring output can also be achieved by placing a urine bag with adhesive edges on the infant, aspirating the bag, and determining the volume of urine therein. Unfortunately, urine leakage occurs around the bag. Option B: This will not provide an accurate measure of the urine output. Measure urine output in a diaper. If a child cannot use a bedpan or other measuring device for urinating, a diaper can be weighed. Zero an empty scale that uses gram measurements. Place a dry, new diaper on the scale, zero the scale again, remove the diaper and use it. Option D: Inserting a foley catheter will provide the most accurate measurement but it gives the infant the risk of urinary tract infection. To measure the wet diaper, place it on the scale that has been zeroed with that diaper, and measure the grams. Grams translate to milliliters (1 gram = 1 ml) for the I & O chart.

The following are considered functions of the Urinary System, EXCEPT: A. Vitamin D synthesis B. Regulation of red blood cell synthesis C. Excretion D. Absorption of digested molecules E. Regulation of blood volume and pressure

Correct Answer: D. Absorption of digested molecules This is a function of the digestive system. The small molecules that result from digestion are absorbed through the walls of the intestine for use in the body. Digestion is the process of mechanically and enzymatically breaking down food into substances for absorption into the bloodstream. Option A: This is a function of the urinary system. The kidneys play an important role in controlling blood levels of Ca2+ by regulating the synthesis of vitamin D. The kidneys have an important role in making vitamin D useful to the body. The kidneys convert vitamin D from supplements or the sun to the active form of vitamin D that is needed by the body. With chronic kidney disease, low vitamin D levels can be found, sometimes even severely low levels. Option B: This is a function of the urinary system. The kidneys secrete a hormone, erythropoietin, which regulates the synthesis of red blood cells in the bone marrow. The kidney produces 85 percent of circulating erythropoietin; the liver, the remainder. If you move to a higher altitude, the partial pressure of oxygen is lower, meaning there is less pressure to push oxygen across the alveolar membrane and into the red blood cell. Option C: This is a function of the urinary system. The kidneys are the major excretory organs of the body. They remove waste products, many of which are toxic, from the blood. The urinary system includes the kidneys, ureters, bladder and urethra. This system filters the blood, removing waste and excess water. This waste becomes urine. Option E: This is a function of the urinary system. The kidneys play a major role in controlling the extracellular fluid volume in the body by producing either a large volume of dilute urine or a small volume of concentrated urine. Due to osmosis, water follows where Na+ leads. Much of the water the kidneys recover from the forming urine follows the reabsorption of Na+. Antidiuretic hormone stimulation of aquaporin channels allows for regulation of water recovery in the collecting ducts. It is through these means that blood volume and osmolarity are regulated by the kidneys.

A child is diagnosed with Wilms' tumor. During assessment, the nurse in charge expects to detect: A. Gross hematuria B. Dysuria C. Nausea and vomiting D. An abdominal mass

Correct Answer: D. An abdominal mass The most common sign of Wilms' tumor is a painless, palpable abdominal mass, sometimes accompanied by an increase in abdominal girth. Wilms tumor usually presents as an asymptomatic abdominal mass in the majority of children. The mother may have discovered the mass during bathing the infant. Option A: Gross hematuria is uncommon, although microscopic hematuria may be present. Abdominal pain is the most common initial presenting symptom (30% to 40%), followed by hypertension (25%) and hematuria (12% to 25%). Option B: Dysuria is not associated with Wilms' tumor. Wilms tumor, or nephroblastoma, is the most common renal cancer in the pediatric age group. It is also the most common pediatric abdominal cancer and the fourth most common pediatric cancer overall. Option C: Nausea and vomiting are rare in children with Wilms' tumor. The cause of Wilms tumor is not precisely known, but it is believed to be due to genetic alterations that deal with the normal embryological development of the genitourinary tract.

Sickle cell disease (SCD) primarily affects: A. children of African descent and Hispanics of Caribbean ancestry. B. children of Middle-Eastern and Indian descent. C. children of Asian descent. D. both African descent and Hispanics of Caribbean ancestry and Middle-Eastern and Indian descent.

Correct Answer: D. Both African descent and Hispanics of Caribbean ancestry and Middle-Eastern and Indian descent. Sickle cell disease primarily affects children of African descent and Hispanics of Caribbean ancestry. It also occurs in children of Middle-Eastern and Indian descent. Sickle cell anemia is the most common monogenic disorder. Prevalence of the disease is high among the people of Sub-Saharan Africa, South Asia, the Middle East, and the Mediterranean. Option A: Sickle cell disease (SCD) is a multisystem disorder and the most common genetic disease in the United States, affecting 1 in 500 African Americans. About 1 in 12 African Americans carry the autosomal recessive mutation, and approximately 300,000 infants are born with sickle cell anemia annually. Option B: Sickle cell disease (SCD) affects millions of people throughout the world and is particularly common among those whose ancestors came from sub-Saharan Africa; Spanish-speaking regions in the Western Hemisphere (South America, the Caribbean, and Central America); Saudi Arabia; India; and Mediterranean countries such as Turkey, Greece, and Italy. Option C: In Europe and Africa, when there is a high frequency of the malaria parasite, there is a high frequency of the sickle-cell allele. In Asia, the frequency of the sickle cell allele is very low, regardless of the frequency of malaria parasites present.

A child with known hemophilia A was brought to the emergency room with complaints of nose bleeding and some bruises in the joints. Which of the following should the nurse anticipate to be given to the child? A. Oral iron supplement B. Cyclosporine C. Factor X Factor VIII

Correct Answer: D. Factor VIII Hemophilia A, also called factor VIII (FVIII) deficiency or classic hemophilia, is a genetic disorder caused by missing or defective factor VIII, a clotting protein. The initial treatment is the administration of factor VIII to replace the missing factor and decrease the bleeding episode. Option A: Oral iron supplement is not used in the management of hemophilia. Other pharmaceutical adjuvant therapies for hemophilia A-induced bleeding include desmopressin, tranexamic acid, epsilon aminocaproic acid, and management of factor VIII inhibitors. Option B: Cyclosporine is an immunosuppressive agent used to treat organ rejection post-transplant. It also has use in certain other autoimmune diseases, treatment of organ rejection in kidney, liver, and heart allogeneic transplants, rheumatoid arthritis when the condition has not adequately responded to methotrexate. Option C: Hemophilia, which means love (philia) of blood (hemo), is the most common severe hereditary hemorrhagic disorder. Both hemophilia A and B result from factor VIII and factor IX protein deficiency or dysfunction, respectively, and are characterized by prolonged and excessive bleeding after minor trauma or sometimes even spontaneously.

n children diagnosed with sickle cell disease (SCD), tissue damage results from which of the following? A. Air hunger and respiratory alkalosis due to deoxygenated red blood cells. B. Hypersensitivity of the central nervous system (CNS) due to elevated serum bilirubin levels C. A general inflammatory response due to an autoimmune reaction from hypoxia D. Local tissue damage with ischemia and necrosis due to obstructed circulation

Correct Answer: D. Local tissue damage with ischemia and necrosis due to obstructed circulation Characteristic sickle cells tend to clump, which results in weak and inadequate blood flow to the tissue, local tissue damage, and eventual ischemia and necrosis. There is increased adhesion of erythrocytes followed by the formation of heterocellular aggregates, which physically cause small vessel occlusion and resultant local hypoxia. Option A: Air hunger and respiratory alkalosis are not present. The most common symptoms in patients with ACS are fever, cough, chest pain, dyspnea, and lung exam may show reduced air entry, rales, and sometimes wheeze. ACS can progress rapidly to hypoxemia and respiratory failure if not treated promptly. Option B: The CNS effects result from ischemia. Management of sickle cell complications is tailored to the type of complication. VOC management consists of rapid pain assessment, early initiation of analgesic therapy, and maintaining this analgesia (consider PCA pump) and hydration until there is symptom relief. Option C: In sickle cell anemia, the damage is not due to inflammation response. Microvascular occlusion (the cardinal pathophysiologic cause of acute pain) leads to ischemia and hypoxia, followed by tissue and vascular damage and inflammation, the release of inflammatory mediators, all of which activate nociceptors.

Stephen was diagnosed with minimal-change nephrotic syndrome; which of the following signs and symptoms are characteristics of the said disorder? A. Hypertension, edema, hematuria B. Hypertension, edema, proteinuria C. Gross hematuria, fever, proteinuria D. Poor appetite, edema, proteinuria

Correct Answer: D. Poor appetite, edema, proteinuria Clinical manifestations of nephrotic syndrome include loss of appetite due to edema of the intestinal mucosa, proteinuria, and edema. The classic NS presentation is edema, in the early phase is located in the face in the morning on waking with puffiness of the eyelids and the impression of the folds of sheets on the skin and ankles at the end of the day. Option A: Proteinuria that is more than 85% albumin is selective proteinuria. Albumin has a net negative charge, and it is proposed that loss of glomerular membrane negative charges could be important in causing albuminuria. Option B: Hypertension alone or accompanied by hematuria is associated with glomerulonephritis. Moderate arterial hypertension is present in 25% of cases, and hypotension may reveal a state of effective hypovolemia. Option C: Gross hematuria is not associated with nephrotic syndrome. Fever will occur only if infection also exists. Functional renal failure is possible. Microscopic hematuria is noted in about 20% of cases, macroscopic hematuria being exceptional and having to make look for thrombosis of the renal veins.

Nurse Emma is planning a client education program for sickle cell disease (SCD); What topic should be included in the plan of care? A. Aerobic exercise to improve oxygenation B. Fluid restraint to 1 qt (1 L)/day C. A high-iron, high-protein diet D. Proper hand washing and infection avoidance

Correct Answer: D. Proper handwashing and infection avoidance Prevention of infection is vital in the prevention of sickle cell crisis. Patients with SCD are especially at risk for infections with encapsulated organisms because of their functional asplenia, as well as because of functionally immunocompromised state (increased bone marrow turnover and altered complement activation). Option A: Strenuous activities and exercises should be withdrawn to lessen the risk of increased tissue ischemia. Because acute intense exercise may alter these pathophysiological mechanisms, physical activity is usually contraindicated in patients with SCD. Option B: Proper hydration should be encouraged to prevent crises secondary to dehydration. Erythrocytes are more likely to sickle and become rigid in the presence of dehydration. This process is in large part caused by changes in cation homeostasis, specifically increased potassium and water efflux mediated by potassium-chloride cotransport and Gardos channels (calcium-dependent potassium channel). Option C: A high-iron, high-protein diet would have no impact on the disease or prevention of a crisis. Patients with sickle cell anemia have greater than average requirements for both calories and micronutrients and therefore need to eat more to avoid being deficient in immune-boosting nutrients.

A physician prescribes an IV solution of 500 ml 0.45% Saline with an incorporation of 20mEq potassium chloride for a child with dehydration. The nurse should check which of the following before administering this IV prescription? A. Blood pressure B. Height C. Weight D. Urine output

Correct Answer: D. Urine output When it comes to hypotonic dehydration, electrolyte loss exceeds water loss. The priority assessment for the nurse is to check the urinary output before the administration. Potassium chloride is contraindicated for patients with oliguria or anuria. The body becomes dehydrated when it loses more fluids than it consumes. When the body doesn't have enough fluids, it can't process potassium properly, and potassium builds up in the blood, which can lead to hyperkalemia. Option A: Many randomized trials have shown that potassium chloride supplementation lowers blood pressure. However, potassium in fruits and vegetables is not a chloride salt, but a mixture of potassium phosphate, sulfate, citrate, and many organic anions including proteins. Option B: A substantial decrease in potassium occurs over the 20-80 age range (33 % for males and 39 % for females), suggesting that two processes, dilution of body K concentration by added fat and reduction in muscle mass, are both occurring. Standard gives greater emphasis to height than to weight. Option C: There is some evidence from cross-sectional studies that potassium intake may be negatively linked to obesity. In three different reports from Korea and Japan, there appeared to be a trend for the lower prevalence of obesity or the MS with higher consumption of potassium.