Peds exam 2

A nurse determines that parents understood the teaching from the pediatric oncologist if the parents indicate that which test confirms the diagnosis of leukemia in children? a. Complete blood cell count (CBC) b. Lumbar puncture c. Bone marrow biopsy d. Computed tomography (CT) scan

ANS: C The confirming test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspiration and biopsy. A CBC may show blast cells that would raise suspicion of leukemia. It is not a confirming diagnostic study. A lumbar puncture is done to check for central nervous system involvement in the child who has been diagnosed with leukemia. A CT scan may be done to check for bone involvement in the child with leukemia. It does not confirm a diagnosis.

Which statement made by a nurse to the parents of a child with leukemia should be included in discharge instructions? a. Your sons blood pressure must be taken daily while he is on chemotherapy. b. Limit your sons fluid intake just in case he has central nervous system (CNS) involvement. c. Your son must receive all of his immunizations in a timely manner. d. Your sons temperature should be taken daily.

ANS: D An elevated temperature may be the only sign of an infection in an immunosuppressed child. Parents should be instructed to monitor their childs temperature daily because of the risk for infection, but it is not necessary to take a blood pressure daily. Fluid is never withheld as a precaution against increased intracranial pressure. If a child had confirmed CNS involvement with increased intracranial pressure, limiting fluid intake might be more appropriate. Children who are immunosuppressed should not receive any live virus vaccines.

What is the most appropriate nursing action when the nurse notes a reddened area on the forearm of a neutropenic child with leukemia? a. Massage the area. b. Turn the child more frequently. c. Document the finding and continue to observe the area. d. Notify the physician immediately.

ANS: D Any signs of infection in a child who is immunosuppressed must be reported immediately because it is considered a medical emergency. When a child is neutropenic, pus may not be produced and the only sign of infection may be redness. In a child with neutropenia, a reddened area may be the only sign of an infection. The area should never be massaged. The forearm is not a typical pressure area; therefore, the likelihood of the redness being related to pressure is very small. The observation should be documented, but because it may be a sign of an infection and immunosuppression, the physician must also be notified.

A child with a history of fever of unknown origin, excessive bruising, lymphadenopathy, and fatigue is exhibiting symptoms most suggestive of which condition? a. Ewings sarcoma b. Wilms tumor c. Neuroblastoma d. Leukemia

ANS: D Symptoms of a history of fever of unknown origin, excessive bruising, lymphadenopathy, and fatigue reflect bone marrow failure and organ infiltration, which occur in leukemia. Symptoms of Ewings sarcoma involve pain and soft tissue swelling around the affected bone. Wilms tumor usually manifests as an abdominal mass with abdominal pain and may include renal symptoms, such as hematuria, hypertension, and anemia. Neuroblastoma manifests primarily as an abdominal, chest, bone, or joint mass. Symptoms are dependent on the extent and involvement of the tumor.

The parents of a child with a malignancy disagree with each other about the treatment plan, then express frustration at the staff for not answering call lights quickly enough. Which nursing intervention will best address their needs? Ask the parents if they have anyone they can talk to about their child. Request assistance of the chaplain to help the parents come to an agreement. Offer to come to their room more often to check on their child. Accept the parents' anger and respond with empathy and acceptance.

Accept the parents' anger and respond with empathy and acceptance. Explanation: When parents are angry about a diagnosis, they may be unable to direct their anger appropriately. They may be angry with the nurse (e.g., for not answering the child's call light immediately). It can be difficult for the nurse to react to this kind of anger because it seems unjustified. The nurse's first reaction is not to be angry in response. A more therapeutic reaction is to accept the parents' explicit emotions and anger and respond with empathy and acceptance. Although the chaplain may be helpful, the question is directed toward nursing interventions. Asking them about having someone to talk to is not responding to the immediate issue, their grief and inability to cope. Offering to come by more often does not address their fears and only reinforces their frustration with the nursing staff.

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

Administering the measles, mumps, rubella (MMR) vaccine Explanation: Live vaccines (viral or bacterial) should not be administered to an immunosuppressed 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 child is scheduled for chemotherapy as treatment for leukemia. As the nurse is collaborating with another colleague, the discussion turns to the client's first phase of chemotherapy. This phase is known as: induction. sanctuary. delayed intensive therapy. maintenance.

induction. Explanation: A chemotherapy program is aimed at first achieving a complete remission or absence of leukemia cells (induction phase); second, preventing leukemia cells from invading or growing in the CNS (sanctuary or consolidation phase); third, administering delayed intensive therapy; and fourth, maintaining the original remission (maintenance phase).

The nurse is reviewing the medical record of a child diagnosed with Hodgkin lymphoma at the asymptomatic stage. Which would the nurse identify as typically the first sign reported by the child? painless, enlarged lymph node anorexia weight loss night sweats

painless, enlarged lymph node Explanation: Children with Hodgkin lymphoma typically present with swollen, painless, and rubbery-feeling lymph nodes in the cervical or supraclavicular region. Depending on the extent of the disease at diagnosis, other symptoms may be present. However, this child was diagnosed in stage I (asymptomatic). If the lymph nodes of the chest are involved, the child has moved to the symptomatic stages and may experience dyspnea and cough. Chest pain may result from the pressure exerted by the enlarged nodes. General symptoms can also include fever, drenching night sweats, and weight loss.

Based on the chart note, which therapy will the nurse plan to include in the client's care? palliation and mobility aids bracing serial casting Pavlik harness

palliation and mobility aids Explanation: The nurse should plan to include palliation and mobility aids in the child's plan of care, because these are commonly used for the treatment of osteogenesis imperfecta (OI). Bracing may be used for the treatment of other musculoskeletal disorders such as scoliosis. Serial casting may be used for the treatment of clubfoot. Pavlik harnessing is used to treat developmental dysplasia of the hip.

A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent? "Applying ice to the area will reduce the pain and swelling." "Apply ice to the injury for 60 minutes on and 60 minutes off." "Elevate the legs, and use bed rest for 24 hours." "Taking warm baths will help relax muscles and reduce pain."

"Applying ice to the area will reduce the pain and swelling." Explanation: Shin splints are a form of an overuse syndrome. These syndromes occur when there is repeated force applied to connective tissue, causing it to break down. The first line of treatment for these injuries is RICE (rest, ice, compression, elevation). Cold should be applied for 20 to 30 minutes and then removed for 60 minutes. This process is repeated until the area is numb. Cold causes vasoconstriction to reduce the pain and swelling. As part of RICE, the legs should be elevated, but there is no timeline for how long this should occur. Warm baths would cause vasodilation, further increasing the pain and swelling.

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

"As endocrine functions become more stable throughout childhood, alterations become more apparent." 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.

While the nurse is providing discharge education to the parents of an 18-month-old child, the parents express concern that their child has a musculoskeletal disorder because the child has bowed legs. How should the nurse respond? "This condition may result in knee pain." "Bowed legs are normal at this age and typically straighten on their own." "Bracing may be effective if it is initiated early." "Surgical treatment may be used to arrest the growth plates or reshape the tibia."

"Bowed legs are normal at this age and typically straighten on their own." Explanation: The nurse should respond by saying "Bowed legs are normal at this age and typically straighten on their own." The statements, "Surgical treatment may be used to arrest the growth plates or reshape the tibia," "Bracing may be effective if it is initiated early," and "This condition may result in knee pain," are all true about Blount disease; however, bowed legs are an expected finding in a child of this age and do not indicate whether or not a musculoskeletal disorder like Blount disease is present.

The nurse has completed client education with the parents of a child with a femur fracture. Which statement by a parent indicates successful education? "Since her fracture is in the central shaft of her leg, it may interfere with the growth of that leg." "Breaks that happen between the rounded end and the central shaft of the bone can cause growth issues in the future." "My child is at risk for abnormal growth of the leg because the break is in the outer layer of the bone." "Injuries that happen at the end of the bone, the epiphysis, are at a greater risk for becoming infected."

"Breaks that happen between the rounded end and the central shaft of the bone can cause growth issues in the future." Explanation: Fractures that occur in the epiphyseal plate, the area between the central shaft (diaphysis) and the rounded end portion (epiphysis), can halt growth, stimulate abnormal growth, or cause irregular or erratic growth. Fractures in the diaphysis and epiphysis will not interfere with growth. The outer layer of the bone, the periosteum, may be injured when infected, not from a fracture.

The nurse is teaching glucose monitoring and insulin administration to a child with type 1 diabetes mellitus and the parents. Which comment by a parent demonstrates a need for additional teaching? "During exercise we should wait to check blood sugars until after our child completes the activity." "If our child is sick we should check blood glucose levels more often." "We should check our child's blood glucose levels before meals." "Blood glucose level, food intake, and activity need to all be considered when calculating insulin dosage."

"During exercise we should wait to check blood sugars until after our child completes the activity." Explanation: Blood glucose monitoring needs to be performed more often during prolonged exercise. Frequent glucose monitoring before, during and after exercise is important to recognize hypoglycemia or hyperglycemia. Frequent glucose monitoring if the child is sick is also important to recognize changes in glucose levels and prevent hypoglycemia or hyperglycemia. The parents are correct that they will check their child's glucose before meals; they should also check it before bedtime snacks. Blood glucose level should never be the only factor considered when calculating insulin dosing. Food intake and recent or expected activity/exercise must be factored.

A nurse who is caring for a 7-year-old is providing client education to the child and caregiver. Which response by the caregiver demonstrates to the nurse that the caregiver understands the diagnosis of type 1 diabetes mellitus? "We will just have our child exercise and take medicine to cure this." "I will just feed my child healthy foods and sign her up for more sports." "Her body fights against the insulin." "Her body doesn't have any insulin."

"Her body doesn't have any insulin." Explanation: Type 1 diabetes mellitus (DM) is a disorder in which the child's body has a deficiency of insulin; children with type 1 DM cannot produce insulin. Type 2 DM is controlled through diet, medicine, and exercise. Type 2 DM can be prevented through diet and exercise, but type 1 DM cannot. Resistance to insulin is not the primary factor in type 1 DM.

A 10-year-old child has been diagnosed with precocious puberty. When talking with the child, what statements are appropriate? Select all that apply. "How are you doing in school?" "Do you like boys yet?" "Developing is normal but your development is happening early." "Would talking with someone about your feelings help?" "Tell me about your feelings about what is happening to your body."

"How are you doing in school?" "Developing is normal but your development is happening early." "Would talking with someone about your feelings help?" "Tell me about your feelings about what is happening to your body." Explanation: Communicate with the child on an age-appropriate level, even when physical characteristics make the child appear older. Maintain a calm, supportive atmosphere and provide for privacy during examinations. Refer the child and family for counseling as needed. Since the child may have issues with self-image and may be self-conscious, encourage her to express her feelings about the changes, and use role-playing to show the child how to handle teasing from other children. Let the child know that everyone develops sexual characteristics in time. The changes are physical and not emotional. Asking about feelings about boys is not indicated in this conversation.

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

The nurse is assessing a child for signs of an endocrine disorder. Which statement by the parent would alert the nurse to further assess the child for an endocrine disorder? "My child's skin is red after a bath or shower." "I have all of a sudden noticed my child is always thirsty...even at night." "My child tells me that his knees hurt at night, especially after running around all day." "My child says he has trouble seeing the print in the chapter books the teacher sends home."

"I have all of a sudden noticed my child is always thirsty...even at night." Explanation: Polydipsia (extreme thirst) is a sign of diabetes mellitus, an endocrine disorder. The other statements by the parent would indicate musculoskeletal, vision, or integumentary disorders. The nurse would further assess for polyuria, weight loss and polyphagia.

The health care provider has just informed the parents of a 3-year-old that their child has leukemia. The mother begins crying and tells the nurse she does not want her baby to die. What is the nurse's best response? "Don't worry, the health care provider is very good at treating leukemia." "I don't blame you for being upset; any parent would be scared too." "I know this is scary, but leukemia has a high cure rate in children these days." "You are very lucky to have caught it so early; that makes the treatments easier."

"I know this is scary, but leukemia has a high cure rate in children these days." Explanation: Because of the tremendous advances in cancer research and treatment over the past 20 years, the prognosis for children and the chances for a cure improve daily. Up to 95% of children with the most common form of leukemia, for example, can expect to be cured. Praising the health care provider is not therapeutic because it denies the mother's fears. Acknowledging her fears is therapeutic, but informing her of the high cure rate is more helpful. It is doubtful that any parent feels "lucky" when hearing a diagnosis of cancer, and hearing this will not make the treatment any easier.

A nurse is assisting the parents of a child who requires a Pavlik harness. The parents are apprehensive about how to care for their baby. The nurse should stress which teaching point? "The baby needs the harness only for 2 to 3 weeks." "It is important that the harness be worn continuously." "Let me teach you how to make appropriate adjustments to the harness." "The harness does not hurt the baby."

"It is important that the harness be worn continuously." Explanation: The baby will most likely wear the harness for 3 months. Telling the parents that the harness does not hurt the baby is appropriate, but stressing the importance of wearing the harness continuously is a higher priority to ensure proper care and effective treatment. Only the physician or nurse practitioner can make adjustments to the harness.

The nurse is caring for an 8-year-old child in traction. The client has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. The client is showing signs of regression with thumb sucking and pleas for the now tattered baby blanket. What would be the most helpful intervention? "Do you want a book to read?" "Would you like a coloring book?" "Let's ask your parents to bring your friends for a visit." "You are too big to suck your thumb."

"Let's ask your parents to bring your friends for a visit." Explanation: After 2 weeks in traction, a child can become easily bored and regress in social and personal skills. A visit from friends arranged by the child's parent or supervised by the child-life specialist would help the client adapt to the immobilized state. Telling the client that he or she is too big to suck the thumb is unhelpful. Suggesting a book or coloring book would be unhelpful at this point, as the child has likely grown tired of books and coloring after 2 weeks.

A nurse is assisting the parents of an infant who requires a Pavlik harness. The parents are apprehensive about how to care for their infant and concerned about holding and playing with the infant. How can the nurse best assist the parents? "Let's put you in touch with other families who have experienced this." "The harness does not hurt the infant." "The infant only needs the harness for 12 weeks." "Do not attempt to adjust the harness yourself."

"Let's put you in touch with other families who have experienced this." Explanation: A Pavlik harness is used to reduce and stabilize the hip by preventing hip extension and adduction and maintaining the hip in flexion and abduction. It can be very daunting for parents to care for their child in this device. There are many helpful pointers and suggestions that are available from other parents and orthopedic organizations. Referring the parents to other families who have experienced a Pavlik harness will provide assurance and likely increase compliance with the regimen. The other responses are factual but do not address the parent's concerns.

The nurse is teaching a group of caregivers of children diagnosed with diabetes mellitus. The nurse is explaining insulin shock and the caregivers make the following statements. Which statement indicates the best understanding of a reason an insulin reaction might occur? "If my child eats as much as their older brother eats they could have an insulin reaction." "My child measures their own medication but sometimes doesn't administer the correct amount." "My child monitors their glucose levels to keep them from going too high." "On the weekends we encourage our child to participate in lots of sports activities and stay busy so they don't have an insulin reaction."

"My child measures their own medication but sometimes doesn't administer the correct amount." Explanation: Insulin reaction (insulin shock, hypoglycemia) is caused by insulin overload, resulting in too-rapid metabolism of the body's glucose. This may be attributable to a change in the body's requirement, carelessness in diet (such as failure to eat proper amounts of food), an error in insulin measurement, or excessive exercise.

A child has a chronic degenerative musculoskeletal condition. The parents are having difficulty providing personal care to the child. What education will the nurse provide this family? Select all that apply. "Obtain assistive devices to help with mobility." "Have the child participate by placing hygiene products within reach." "Start care after the child has rested for optimal muscle strength." "Set a goal for the child to be able to wash the face independently." "Teach your other children to help with care such as diaper changes."

"Obtain assistive devices to help with mobility." "Have the child participate by placing hygiene products within reach." "Start care after the child has rested for optimal muscle strength." Explanation: Providing personal care to a child with a musculoskeletal chronic condition can be challenging because as the child's muscles deteriorate the more lifting and moving the caregivers will have to perform. In addition, the child grows in length and weight. Thus, as the child grows, the lifting is more challenging. The nurse should suggest assistive devices that could be helpful. The family should strive to allow the child to assist in care. This is best done when care is provided after the child rests and the products used are close to the child. Depending where the child is in the degenerative process, the goal of "independence" may not be achievable. The child's siblings may help with care, but the choices of care the siblings provide should not be actions that will affect the child's self-esteem or make the child feel more different than the siblings.

The nurse is educating the parents of a client newly diagnosed with type 1 diabetes. Which statement by the parents indicates additional teaching is needed? "When our child is sick, we may need to check glucose levels more frequently." "Our child should eat three meals and midafternoon and bedtime snacks each day." "We and our child need to learn to identify carbohydrate, protein, and fat foods." "Our child should not participate in sports or physical activity."

"Our child should not participate in sports or physical activity." Explanation: The nurse would provide additional education if the parents state the child should not participate in sports or physical activity. The child with diabetes can, and should, be physically active to maintain proper health and facilitate efficient insulin usage by the body. Glucose levels should be checked more frequently during times of sickness, as well as assessing the urine for ketones. Consistency of intake can help prevent complications and maintain near-normal blood glucose levels. The parents and child should know how to identify foods to adequately monitor the child's nutritional intake. A dietitian with expertise in diabetes education should be consulted for referral as needed.

After teaching the parents of a child with central precocious puberty about medication therapy, which statement by the parents indicates successful teaching? "Our child needs to use the nasal spray once every day." "Our child will start puberty again when the medication stops." "This medicine will reverse the symptoms and onset of puberty." "Once therapy is done, our child will need surgery."

"Our child will start puberty again when the medication stops." Explanation: Treatment for central precocious puberty involves administering a gonadotropin-releasing hormone (GnRH) analog. When it is stopped, puberty resumes according to the appropriate developmental stages. This analog can be given by depot injection every 3 to 4 weeks, a daily subcutaneous injection, or an intranasal spray two or three times per day. With GnRH analog treatment, secondary sexual development stabilizes or regresses. Surgery is indicated only if there is a tumor. The goal of the medication is to delay the progression of puberty and not to reverse it.

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching? "The casted arm must be kept still." "We must avoid causing depressions in the cast." "Pale, cool, or blue skin coloration is to be expected." "We need be aware of odor or drainage from the cast."

"Pale, cool, or blue skin coloration is to be expected." Explanation: It is very important to teach parents to identify the signs of neurovascular compromise (pale, cool, or blue skin) and tell them to notify the physician immediately. The other statements are correct

The nurse is caring for a 5-year-old child recently diagnosed with type 1 diabetes. When discussing the care and management of the disorder with the child's parents, which statement(s) indicates understanding? Select all that apply. "Regular exercise will help in the regulation of my child's blood sugar levels." "If my child's blood glucose remains stable for a few months, my child can move from injections to pills." "When my child is ill and unable to eat, we will need to hold the insulin until the child is able to tolerate fluids." "The insulin dosages will be directly associated to my child's carbohydrate ingestion." "We need to rotate insulin injection sites to prevent complications."

"Regular exercise will help in the regulation of my child's blood sugar levels." "The insulin dosages will be directly associated to my child's carbohydrate ingestion." "We need to rotate insulin injection sites to prevent complications." Explanation: When a child has type 1 diabetes, there is an absence of insulin to manage the metabolism of serum glucose. Regular exercise is helpful in the maintenance of stable serum glucose levels. Carbohydrate ingestion is linked to the amount of insulin that will be needed in the body. Carbohydrates break down and the body needs insulin to metabolize the resulting glucose. The rotation of insulin injection sites is important. Failing to rotate injection sites can cause a complication, lipohypertrophy. Type 1 diabetes means that the body does not have insulin, so injected insulin is needed to manage it. Oral medications are only an option for those having type 2 diabetes. When the child is ill, it is still important that the child with diabetes take the prescribed medications.

A school-age child is seen in the family clinic. The parents ask the nurse if their child should start taking growth hormones to help the child grow because the parents are short. What is the best response by the nurse? "Growth hormones work only if the child has short bones." "Will your child be able to swallow oral pills every day?" "Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age." "How tall would you like your child to be?"

"Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age." Explanation: The nurse should educate the parents about growth hormones before asking questions. The nurse needs to explain that a diagnosis of deficiency must be documented before growth hormones can be used. Only the long bones are affected. Growth hormone is given orally, IM, and SC.

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? "So, hypothyroidism can be only temporary, right?" "Are you saying that hypothyroidism is caused by a problem in the way the thyroid gland develops?" "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?"

"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.

A 10-year-old child has been diagnosed with type 1 diabetes mellitus. The child is curious about the cause of the disease and asks the nurse to explain it. Which explanation will the nurse provide? "Special cells in a part of your body called the pancreas cannot make a chemical called insulin, which helps control the sugar level in your blood." "The pancreas inside your belly makes enough chemical called insulin, but your body does not want to use it to keep your blood sugar level normal." "The part of your body called the pancreas is broken and produces too much chemical called glucagon, which makes you really thirsty and have to go to the bathroom a lot." "The alpha and beta cells in your pancreas are fighting against each other; that is why your blood sugar stays high and you need insulin injection."

"Special cells in a part of your body called the pancreas cannot make a chemical called insulin, which helps control the sugar level in your blood." Explanation: When providing instruction to a child, the nurse must consider the developmental age. Type 1 diabetes is a disorder that involves an absolute or relative deficiency of insulin thus the blood glucose level remains high if an appropriate amount of insulin is not administered to the client. With Type 2 diabetes, the body produces an adequate amount of insulin; however, the body is resistant to using the insulin properly to keep circulating blood glucose levels at a normal level. The rest of the statements provide incorrect information regarding the pathophysiology of type 1 diabetes.

A 6-year-old child has been diagnosed with growth hormone deficiency. The child's mother requests more information about this condition. Which statements should be included in the nurse's response? Select all that apply. "The majority of children who have this condition are born of normal weight and length." "There are several potential causes of this condition." "This condition is most likely related to dwarfism in past generations of your family." "Most children with this condition are nutritionally deprived." "Your child most likely does not eat adequate amounts of protein."

"The majority of children who have this condition are born of normal weight and length." "There are several potential causes of this condition." Explanation: Growth hormone deficiency can result from a variety of causes. These causes may include genetic mutations, tumors, infection, and birth trauma. Some cases have no identifiable causes. Most children diagnosed with this condition are of normal length and weight at birth but in childhood fall behind in growth. A small proportion of children may have nutritional concerns.

A 9-year-old was just diagnosed with type 1 diabetes. The parents state, "We hope our child won't have to take insulin injections." How should the nurse respond? "The pancreas doesn't produce insulin in Type 1 diabetes, so it is likely that insulin injections will be necessary." "It is very early in the diagnosis process. Let's wait to see if insulin will be necessary." "Sometimes oral hypoglycemic agents are all that is necessary. Hopefully that will be the case with your child." "You will have to trust whatever the doctor decides to order."

"The pancreas doesn't produce insulin in Type 1 diabetes, so it is likely that insulin injections will be necessary." Explanation: Since the diagnosis has been made for type 1 DM, insulin will be necessary. Insulin is used for DM to replace the body's natural insulin, which is necessary for proper glucose use.

A child is in treatment for cancer and has been experiencing pain. The nurse is talking with the parents about assisting with pain management using distraction. Which statement(s) indicates an understanding of the information provided? Select all that apply. "Distraction is helpful because it helps to lessen the pain." "The underlying principle of distraction is focusing on stimuli other than the pain being experienced." "Using media such as TV or movies can be a distraction technique." "Distraction has been researched to not be very effective with pain management." "Some people may find singing or counting a good form of distraction."

"The underlying principle of distraction is focusing on stimuli other than the pain being experienced." "Using media such as TV or movies can be a distraction technique." "Some people may find singing or counting a good form of distraction." Explanation: Distraction involves having the child focus on another stimulus, thereby attempting to shield him or her from pain. Distraction does not lessen the pain but it refocuses attention away from it. The techniques for distraction vary and what will work is individualized. Techniques may include watching TV or movies. Some may find singing, talking or reading helpful.

The nurse is talking with a parent of an adolescent who is newly diagnosed with type 2 diabetes mellitus and asks, "How could this happen? No one in our family has diabetes." What response would be appropriate? "This is caused by the pancreas not making enough insulin." "This disorder usually occurs when inadequate calories are ingested on a regular basis." "Because this disorder is genetic, someone in the family will eventually develop the illness." "This is caused by insulin resistance from previous pancreatic injury or generalized infection. "This is caused by insulin resistance from previous pancreatic injury or generalized infection."

"This is caused by insulin resistance from previous pancreatic injury or generalized infection." Explanation: Type 2 diabetes is now seen in overweight adolescents as well as those who eat a diet high in fats and carbohydrates and do not exercise regularly. Pancreatic malfunction is making enough insulin is not a cause of type 2 diabetes. This disorder is not linked to inadequate ingestion of daily calories. This disorder may have a genetic link, but environmental factors such as obesity, diet, and exercise can influence its development. Type 2 diabetes is a result of insulin resistance in the metabolism of glucose to maintain normal blood glucose levels, but it is not associated with infection or a previous pancreatic injury.

The nurse is providing education to a 12-year-old child with idiopathic scoliosis and the child's parents. Which statement will the nurse include in the teaching? "Avoid the side-lying position during sleep." "Limit the use of heavy shoulder bags." "Idiopathic scoliosis typically happens during infancy." "This is the most common type of scoliosis."

"This is the most common type of scoliosis." Explanation: The nurse will include the statement, "This is the most common type of scoliosis," in the teaching, because 80% of all scoliosis cases are comprised of idiopathic scoliosis. The statements, "Avoid the side-lying position during sleep" and "Limit the use of heavy shoulder bags," should not be included in the teaching, because sleeping position, and the use of heavy shoulder bags do not cause scoliosis. The statement, "Idiopathic scoliosis typically occurs during infancy," should not be included in the teaching, because idiopathic scoliosis most commonly manifests in children older than 10 years, around the time of puberty during adolescent growth spurts.

A young child has been diagnosed with Wilms tumor. The parents ask how this could have happened to their child. What is the nurse's best response? "This is usually related to a gene mutation." "It is usually associated with viral exposure." "No one knows what causes Wilms tumor." "This often occurs due to environmental factors."

"This is usually related to a gene mutation." Explanation: A number of gene mutations have been identified as associated with Wilms tumor. It does not seem to be related to viral exposure or environmental factors.

The nurse is reviewing the plan of care with the parents of a 1-year-old child undergoing the Ponseti method for the treatment of clubfoot. What statement will the nurse include in the teaching? "This method involves a cast being applied several times." "The foot will be taped into a molded plastic splint." "Daily stretching is needed." "Massaging of the foot will be performed by a physical therapist."

"This method involves a cast being applied several times." Explanation: The nurse will include the statement "This method involves a cast being applied several times," in the teaching, because this is a practice used in the Ponseti method. The statements, "Daily stretching is needed," "Massaging of the foot will be performed by a physical therapist," and "The foot will be taped into a molded plastic splint," should not be included in the teaching because these refer to the French functional physical therapy method, not the Ponseti method. The Ponseti method of clubfoot treatment is the preferred method of treatment with the highest success rate, and stretching, massaging the foot, and taping the foot into a molded splint are precluded by serial casting.

The nurse has told the 14-year-old adolescent with diabetes that the doctor would like to have a hemoglobin A1C test performed. Which comment by the client indicates that she understands what this test is for? "That is the test that I take after I have fasted for at least 8 hours." "The normal level for my hemoglobin A1C is between 60 to 100 mg/dl." "I monitor my own blood glucose every day at home. I don't see why the doctor would want this done." "This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months."

"This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months." Explanation: Hemoglobin A1C (HgbA1C) provides the physician or nurse practitioner with information regarding the long-term control of glucose levels, as it provides an average of what the blood glucose levels are over a 2 to 3 month period. No fasting is required. Desired levels for children and adolescents 13 to 19 years are less than 7.5%.

A 15-year-old girl has had type 1 diabetes since she was 2 years old. She recently began dialysis and is also struggling with exhaustion. She has been hospitalized with an infection and confides to the nurse that she feels hopeless due to her failing health. How should the nurse respond? "Would you like to help me create your daily schedule while you are here?" "After we get the infection under control, you will start feeling better." "What do you think would help you feel better or improve your situation?" "Have you talked with your parents about the things that concern you?"

"What do you think would help you feel better or improve your situation?" Explanation: It is important to ask the child how they view their situation and what might improve it. Using open-ended questions elicits the girl's thoughts and fears and helps the nurse assess the issues at hand. It can also help the nurse determine whether the girl's hopelessness is characteristic of depression. Questions that can be answered with "yes" or "no" are less effective. Assuring her that she'll feel better soon does not address her concerns.

The nurse is taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question is important for the nurse to ask the parents? "Is your child taking vasopressin IM or SC?" "What time each day does your child take his growth hormone?" "Does your child get upset about being taller than friends?" "How often do you test your child's blood glucose?"

"What time each day does your child take his growth hormone?" Explanation: It is important for the nurse to know the time of day that the child takes his or her growth hormone. Growth hormone is the common treatment for the child with hypopituitarism who is short, not tall, in stature. Vasopressin is the treatment for diabetes insipidus. Monitoring blood glucose is not part of the treatment for hypopituitarism.

A nurse is educating a family about the Chvostek sign after their teen tested positive for Chvostek sign. Which statements by the caregivers shows the nurse that they understand the Chvostek sign? "When I tap on my child's facial nerve, the reaction is a facial muscle spasm." "The sign means my child is not getting enough vitamin D." "The sign occurs because my child is having increased intracranial pressure." "The sign occurs when there is muscle pain and the muscle is stimulated."

"When I tap on my child's facial nerve, the reaction is a facial muscle spasm." Explanation: The Chvostek sign is a facial muscle spasm that occurs when the facial nerve is tapped. This can indicate heightened neuromuscular activity, possibly caused by hypocalcemia. Hypoparathyroidism may be suspected.

The nurse is speaking with the parents of a child recently diagnosed with hypothyroidism. Which statement by a parent indicates an understanding of symptoms of this disorder? "When they get my son's thyroid levels normal, he won't be so tired." "My son's nervousness may be a symptom of his hypothyroidism." "Heat intolerance is a caused by low thyroid levels." "Most people with hypothyroidism have smooth, velvety skin."

"When they get my son's thyroid levels normal, he won't be so tired." Explanation: Tiredness, fatigue, constipation, cold intolerance and weight gain are all symptoms of hypothyroidism. Nervousness, anxiety, heat intolerance, weight loss and smooth velvety skin are all symptoms of hyperthyroidism.

The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents? "NSAIDs can help with pain control and inflammation." "Ice will help reduce the inflammation." "You will need to see a physical therapist for stretching and strengthening exercises." "You and your coaches need to understand that you cannot play soccer for at least six weeks."

"You and your coaches need to understand that you cannot play soccer for at least six weeks." Explanation: A child with an overuse injury needs to avoid the causative activity for six to eight weeks. The other suggestions are also important, but the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks." In some situations, it is helpful to supply a written directive from the nurse or physician to help the parent avoid undue pressure from coaches.

A nurse in the school office is seeing a 7-year-old child with type 1 diabetes after gym class. The child is jittery and appears sweaty. Which intervention would the nurse advise the child to do? "You will need to drink this 6-ounce bottle of orange juice." "You will need to have an extra shot of regular insulin." "You will need to sit in the office and rest after gym class." "You will need to skip your next dose of insulin."

"You will need to drink this 6-ounce bottle of orange juice." Explanation: A child with type 1 diabetes who has signs of hypoglycemia can drink juice as a quick source of sugar to raise the glucose level and stop the symptoms of hypoglycemia. The child should only have one serving of juice and wait to see if the hypoglycemic signs resolve. Another dose of insulin could drop the glucose to dangerous levels. Skipping the insulin dose or sitting in the office will not resolve the symptoms or help the child.

A child and parents are being seen in the office after discharge from the hospital. The child was newly diagnosed with type 2 diabetes. When talking with the child and parents, which statement by the nurse would be most appropriate? "You are lucky that you did not have to learn how to give yourself a shot." "Young people can usually be managed with an oral agent, meal planning, and exercise." "This will rectify itself if you follow all of the doctor's directions." "A weight-loss program should be implemented and maintained.

"Young people can usually be managed with an oral agent, meal planning, and exercise." 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 health care. Additionally, insulin may be used if good control is not achieved. 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.

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 finding in the child's fasting glucose levels? 60 mg/dl 100 mg/dl 140 mg/dl 220 mg/dl

220 mg/dl Explanation: A fasting blood sugar result of 200 mg/dL or more almost certainly is diagnostic for diabetes when other signs, such as polyuria and weight loss despite polyphagia, are present.

A nurse is working with a child who has Osgood-Schlatter disease. Which client would be the most likely to develop this condition? An 11-year-old girl who is obese A 9-year-old boy who is sedentary A 15-year-old girl who dances ballet A 13-year-old boy who is on his school's cross-country team

A 13-year-old boy who is on his school's cross-country team Explanation: Osgood-Schlatter disease is the thickening and enlargement of the tibial tuberosity resulting from microtrauma, probably caused from overuse. It occurs more often in boys than girls and at preadolescence or early adolescence, probably because of rapid growth at these times.

A nurse is taking care of an infant with diabetes insipidus. Which assessment data are most important for the nurse to monitor while the infant has a prescription for fluid restriction? Vital signs Oral intake Oral mucosa Urine output

A nurse is taking care of an infant with diabetes insipidus. Which assessment data are most important for the nurse to monitor while the infant has a prescription for fluid restriction? Vital signs Oral intake Oral mucosa Urine output

What is the nurses best response to a mother whose child has a diagnosis of acute lymphoblastic leukemia and is expressing guilt about not having responded sooner to her child's symptoms? a. You should always call the physician when your child has a change in what is normal for him. b. It is better to be safe than sorry. c. It is not uncommon for parents not to notice subtle changes in their children's health. d. I hope this delay does not affect the treatment plan.

ANS: C Suggesting that noticing subtle changes in their children's health is not uncommon minimizes the role the mother played in not seeking early medical attention. It also displays empathy, which helps to build trust, thereby enabling the mother to talk about her feelings. Identifying concerns and clarifying misconceptions will help families cope with the stress of chronic illness. The goal is to relieve the mothers guilt and build trust so that she can talk about her feelings. Telling the mother that she should have called the pediatrician will only reinforce her guilt. Adages such as It is better to be safe than sorry are flippant and reinforce the belief that the mother was negligent, which will only increase her guilt. Telling the mother that you hope the delay does not affect the treatment plan shows a total lack of empathy and would increase the mothers feelings of guilt.

A nurse is assessing a child with diabetes insipidus. Which sign should the nurse expect to note? a. Weight gain b. Increased urine specific gravity c. Increased urination d. Serum sodium level of 130 mEq/L

ANS: C The deficiency of antidiuretic hormone associated with diabetes insipidus causes the body to excrete large volumes of dilute urine. Weight gain results from retention of water when there is an excessive production of antidiuretic hormone; in diabetes insipidus there is a decreased production of antidiuretic hormone. Concentrated urine is a sign of the syndrome of inappropriate antidiuretic hormone (SIADH), in which there is an excessive production of antidiuretic hormone. A deficiency of antidiuretic hormone, as with diabetes insipidus, results in an increased serum sodium concentration (greater than 145 mEq/L).

3. A child with a history of fever of unknown origin, excessive bruising, lymphadenopathy, and fatigue is exhibiting symptoms most suggestive of which condition? a. Ewings sarcoma b. Wilms tumor c. Neuroblastoma More Test Banks, Nursing Materials Visit: WWW.NURSYLAB.COM d. Leukemia

ANS: D

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

Administer subcutaneous glucagon. 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 nurse is providing acute care for an 11-year-old boy with hypoparathyroidism. Which intervention is priority? Providing administration of calcium and vitamin D. Ensuring patency of the IV site to prevent tissue damage. Monitoring fluid intake and urinary calcium output. Administering intravenous calcium gluconate as ordered.

Administering intravenous calcium gluconate as ordered. Explanation: Administering intravenous calcium gluconate, as ordered, will restore normal calcium and phosphate levels as well as relieve severe tetany. Ensuring patency of the IV site to prevent tissue damage due to extravasation or cardiac arrhythmias is an intervention for any child with an IV, and monitoring fluid intake and urinary calcium output are secondary interventions. Providing administration of calcium and vitamin D is an intervention for nonacute symptoms.

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? Antidiuretic hormone Growth hormone Insulin 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.

Diabetes insipidus is a disorder of the posterior pituitary that results in deficient secretion of which hormone? Adrenocorticotropic hormone (ACTH) Thyroid stimulating hormone (TSH) Luteinizing hormone (LH) Antidiuretic hormone (ADH)

Antidiuretic hormone (ADH) Explanation: Central diabetes insipidus (DI) is a disorder of the posterior pituitary that results from deficient secretion of ADH. ADH is responsible for the concentration of urine in the renal tubules. Without ADH there is a massive amount of water loss and an increase in serum sodium. Nephrogenic DI occurs as a genetic problem or from end-stage renal disease. It is the result of the inability of the kidney to respond to ADH and not from a pituitary gland problem. LH is produced from the anterior pituitary. In females, it stimulates ovulation and the development of the corpus luteum. TSH is secreted by the thyroid gland. ACTH is secreted by the anterior pituitary.

The nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure? Analgesic Antiemetic Antipyretic Antineoplastic

Antiemetic Explanation: Radiation has systemic effects. Radiation sickness that includes nausea and vomiting is the most frequently encountered systemic effect. It also occurs to some extent as a result of the release of toxic substances from destroyed tumor cells. To counteract this, a child is prescribed an antiemetic before each procedure. The child does not need an analgesic, antipyretic, or antineoplastic agent prior to receiving a radiation treatment.

The client is a 9-month-old whose babysitter brings her to the ER. An x-ray shows a spiral fracture of the femur. The babysitter tells the nurse that she found the infant in this condition when she showed up to watch her an hour ago. How should the nurse respond to this situation? Arrange for the parents to come in for an evaluation for possible physical abuse. Evaluate the infant for an underlying musculoskeletal disorder. Evaluate the child for a seizure disorder, as that is probably why the infant is injured. Ask the babysitter to advocate for the child and report the incident to the authorities.

Arrange for the parents to come in for an evaluation for possible physical abuse. Explanation: Any type of fracture can be the result of child abuse (child mistreatment), but spiral femur fractures, rib fractures, and humerus fractures, particularly in the child younger than 2 years of age, should always be thoroughly investigated to rule out the possibility of child abuse (child mistreatment). The parents should be contacted first, and the family should undergo an evaluation for possible physical abuse since femoral fractures in nonambulating infants, particularly spiral fractures, are believed to be highly specific for inflicted injury. If physical abuse is not found, the infant should be evaluated for an underlying musculoskeletal disorder and not a seizure disorder.

The primary health care provider has ordered a thyroid scan to confirm the diagnosis of hyperthyroidism. Which would the nurse do before the scan? Assess the client for allergies. Give the client a bolus of fluids Tell the client he or she will be asleep. Insert a urinary catheter.

Assess the client for allergies. Explanation: A thyroid scan uses a radionucleotide dye so a client should be assessed for allergies to iodine and shellfish to prevent a possible allergic reaction. The client will not be asleep. There is no need to give the child a bolus of fluid or insert a urinary catheter.

The parents of a 9-year-old girl who is dying from cancer are distraught and guilt-ridden when they find that treatment is no longer successful. What is the best way for the nurse to respond? Assure the parents that expert care of their child will continue. Tell the parents there is no more that can be done. Ask the parents if they wish to fill out a do-not-resuscitate order. Explain that it is not fair to the child to continue present treatment.

Assure the parents that expert care of their child will continue. Explanation: The nurse needs to make sure the parents know that the child is not being abandoned by the health care team. Instead, treatment is changing but not ending. It is not true there is not any more that can be done for the child. Palliative care can relieve symptoms and provide comfort even though it will not cure the disease. Waiting to inquire about a do-not-resuscitate decision until parents have some adjustment time is considerate. Claiming it is not fair to continue treatment may enhance the guilt already being expressed by the parents.

A 12-year-old female client has been diagnosed with scoliosis with a curvature of 30 degrees. What type of treatment would the nurse anticipate being started on this client? Traction Exercise Surgery Bracing

Bracing Explanation: For spinal curvatures of 25 to 40 degrees, the usual treatment is bracing. Curvatures greater than 40 degrees may be treated with traction or spinal instrumentation and fusion. Exercise may be implemented for very mild curvatures to strengthen the back muscles.

A 6-year-old child is being evaluated for growth hormone dysfunction. Which tests will be employed in the diagnostic workup? Select all that apply. complete blood count CT scan MRI pituitary function test erythrocyte sedimentation rate

CT scan MRI pituitary function test Explanation: The child will undergo laboratory tests to rule out chronic illnesses such as renal failure or liver and thyroid dysfunction. Laboratory and diagnostic tests used in children with suspected GH deficiency include CT and MRI to assess for structural abnormalities. A pituitary function test will be used to confirm a diagnosis of growth hormone dysfunction. A complete blood count and erythrocyte sedimentation rate test are not used for this purpose.

A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. What would the nurse expect to be administered? Calcium gluconate Hydrocortisone Desmopressin Levothyroxine

Calcium gluconate 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? Call it a tumor of muscle tissue Describe it as a bone tumor Explain that it develops in nerves outside the brain and spinal cord Indicate that the more commonly used name is Hodgkin lymphoma

Call it a tumor of muscle tissue 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.

A pediatric client has just been diagnosed with diabetes mellitus. What would the nurse do first? Educate the client on stress management. Regulate nutrition. Check blood glucose levels. Administer insulin.

Check blood glucose levels. Explanation: The nurse must check the insulin level before it can be administered. Once a need is established, then insulin administration becomes the priority intervention. Stress management, glucose checks, and nutritional consultation can all be implemented once therapy with insulin begins.

A 13-year-old adolescent is seen in the office and appears very anxious. For the past 2 weeks, the adolescent has had some muscle twitching; upon examination, the client is found to have a positive Chvostek sign. Which would be an appropriate explanation of a Chvostek sign? Chvostek sign is a facial muscle spasm demonstrated by tapping the facial nerve. Pain can be caused by touching the muscles. Increased intracranial pressure causes this sign. Excess intake of vitamin D can cause this sign.

Chvostek sign is a facial muscle spasm demonstrated by tapping the facial nerve. Explanation: Chvostek sign is demonstrated when skin anterior to the external ear is tapped and the facial muscles around the eye, nose, and mouth unilaterally contract. Tapping the facial nerve in the parotid gland area can indicate heightened neuromuscular activity. This test is done to check for hypocalcemia. The parathyroid glands regulate serum calcium levels and help control the rate of bone metabolism. If calcium levels fall, parathyroid hormone secretion is increased, so it is important to identify a deficiency, if present.

Which condition does the nurse anticipate when assessing a patient with tumor lysis syndrome? Hyperuricemia Hypophosphatemia Hypokalemia Hypercalcemia

Correct answer: A Rationale: Manifestations of tumor lysis syndrome include hyperphosphatemia, hyperkalemia, and hypocalcemia. These electrolyte abnormalities are often treated with diuretics such as mannitol, IV calcium supplementation, oral or rectal potassium exchange resin, and oral aluminum hydroxide. Hyperuricemia can lead to nephropathy, and hemodialysis may be required in severe cases of tumor lysis syndrome.

The nurse is performing a musculoskeletal assessment for a newborn. Which finding(s) requires further follow up by the nurse? Select all that apply. different knee heights during an Ortolani test palpable clunk noted during a Barlow test no audible click present during assessment unequal skin folds on the thighs equal, uninhibited abduction

Correct response: unequal skin folds on the thighs different knee heights during an Ortolani test palpable clunk noted during a Barlow test Explanation: Unequal skin folds on the thighs, different knee heights during an Ortolani test, and a palpable clunk noted during a Barlow test are all findings consistent with developmental dysplasia of the hip and require further follow up by the nurse. No audible click present during assessment, and equal, uninhibited abduction of both hips are expected findings and require no further follow up by the nurse.

A child is undergoing diagnostic testing for an endocrine dysfunction. The results indicate excessive levels of circulating cortisol. The nurse interprets this finding as indicating which of the following? Addison disease Graves disease Turner syndrome Cushing syndrome

Cushing syndrome Explanation: Cushing syndrome 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. Graves disease is the most common form of hyperthyroidism. Turner syndrome is deletion of the entire X chromosome.

A nurse on the pediatric floor is taking care of a 12-year-old child with diabetes insipidus (DI). Which fact would the nurse understand about this disease? DI can be managed by short-term treatment with hormone replacement medications. DI can cause anorexia if appropriate meals are not planned. DI can be managed with vasopressin given as lifelong treatment. DI requires strict fluid restrictions until it resolves.

DI can be managed with vasopressin given as lifelong treatment. Explanation: Vasopressin is the drug of choice for this lifelong disease. In DI, antidiuretic hormone is undersecreted. Use of vasopressin is long-term, not short-term, treatment. Diabetes mellitus, not diabetes insipidus, is the disorder that requires diet management. DI involves excessive urination, so fluid replacement, not fluid restriction, is needed.

A newborn is diagnosed with the salt-losing form of congenital adrenogenital hyperplasia. On what should the nurse focus when assessing this client? Dehydration Hypoglycemia Bleeding tendency Excessive cortisone secretion

Dehydration Explanation: If there is a complete blockage of cortisol formation, aldosterone production will also be deficient. Without adequate aldosterone, salt is not retained by the body, so fluid is not retained. Almost immediately after birth, affected infants begin to have vomiting, diarrhea, anorexia, loss of weight, and extreme dehydration. If these symptoms remain untreated, the extreme loss of salt and fluid can lead to collapse and death as early as 48 to 72 hours after birth. The salt-losing form must be detected before an infant reaches an irreversible point of salt depletion. This disorder does not cause hypoglycemia, excessive bleeding, or excessive cortisone secretion.

An adolescent is having an annual physical. The adolescent has a documented weight loss of 9 lb (4.08 kg). The parent states, "He eats constantly." Exam findings are normal overall, except that the child reports having trouble sleeping, and the child's eyeballs are noted to bulge slightly. Which interventions would the nurse perform based on these findings? Prepare the parent for a neurology consult. Explain why the child might need to schedule an eye exam. Discuss preparing for a thyroid function test. Explain the preparation for an 8-hour fasting blood glucose test.

Discuss preparing for a thyroid function test. Explanation: The child exhibits signs and symptoms of Graves disease (hyperthyroidism). A thyroid function test would show an elevation in T4 and T3 levels caused by overfunctioning of the thyroid. Neither a neurology consult nor an eye exam would be needed. A fasting blood glucose test is used to test for Cushing syndrome and diabetes mellitus.

A nurse is reviewing with an 8-year-old how to self-administer insulin. Which of the following is the proper injection technique for insulin injections? Place the needle with the bevel facing down before the injection. Spread the skin before the injection. Aspirate the syringe for blood return before the injection. Elevate the subcutaneous tissue before the injection.

Elevate the subcutaneous tissue before the injection. Explanation: Insulin injections are always given subcutaneously. Elevating the skin tissue prevents injection into muscles when subcutaneous injections are given. The needle bevel should face upward. The skin is spread in intramuscular, not subcutaneous, injections. It is no longer recommended to aspirate blood for subcutaneous injections.

The nurse is caring for an extremely active 13-year-old adolescent who has recently been prescribed a back brace to treat scoliosis. Which intervention will be most critical to the success of treatment? Ask for the adolescent's feelings about being in a brace. Emphasize and encourage compliance related to the use of a back brace. Teach the parents about the disease and its treatment. Show the adolescent how the brace works and when to wear it.

Emphasize and encourage compliance related to the use of a back brace. Explanation: Encouraging and emphasizing compliance with the treatment regimen will ultimately be most critical. The brace is intended to prevent the progression of the curve and must be worn 23 hours per day. Compliance with this is sometimes difficult with adolescents because peer pressure is very important as well as the need to be like all their friends. Educating the parents about scoliosis, showing the adolescent how to use the brace, and listening to the adolescent's concerns are also important. But in the end, the most important factor is that the adolescent wears the brace according to the treatment plan.

The nurse is caring for a child with a fractured femur in traction. Which action will the nurse complete while caring for this client? Have the unlicensed assistive personnel remove the weights daily and encourage the child to move around in bed. Ensure traction weights are hanging freely, not touching the bed or floor. Plan to add additional weights as the fracture heals, usually once per day. Remove traction weights once per shift for 30 minutes and then replace them.

Ensure traction weights are hanging freely, not touching the bed or floor. Explanation: Traction is used as a pulling force on an extremity or body part. For it to be effective, the weights need to hang freely at all times and the ropes need to remain in the pulley grooves. The weights are not replaced or removed during traction. The child can move all extremities except the affected one(s). The child remains in traction until healing occurs, a cast is applied, or surgical repair is performed.

he nurse is preparing a teaching plan for a 10-year-old girl with hyperthyroidism. What information would the nurse include in the plan? Describing surgery to remove an anterior pituitary tumor Teaching her parents to give injections of growth hormone Explaining about the radioactive iodine procedure Showing her parents how to give DDAVP intranasally

Explaining about the radioactive iodine procedure Explanation: Explaining about the radioactive iodine procedure would be part of the teaching plan for a child with hyperthyroidism because this is a less invasive type of therapy for the disorder. Describing surgery to remove an anterior pituitary tumor would be included for a child with hyperpituitarism. Teaching a parent to give injections of growth hormone would be appropriate for a child with a growth hormone deficiency. Showing parents how to give DDAVP intranasally is appropriate for a child with diabetes insipidus.

A child with diabetes reports that he is feeling a little shaky. Further assessment reveals that the child is coherent but with some slight tremors and sweating. A fingerstick blood glucose level is 70 mg/dl. What would the nurse do next? Administer a sliding-scale dose of insulin. Give 10 to 15 grams of a simple carbohydrate. Offer a complex carbohydrate snack. Administer glucagon intramuscularly.

Give 10 to 15 grams of a simple carbohydrate. Explanation: The child is experiencing hypoglycemia as evidenced by the assessment findings and blood glucose level. Since the child is coherent, offering the child 10 to 15 grams of a simple carbohydrate would be appropriate. Insulin is not used because the child is hypoglycemic. A complex carbohydrate snack would be used after offering the simple carbohydrate to maintain the glucose level. Intramuscular glucagons would be used if the child was not coherent.

After hospital discharge, the parent of a child newly diagnosed with type 1 diabetes mellitus telephones the nurse because the child is acting confused and very sleepy. Which emergency measure would the nurse suggest the parent carry out before bringing the child to see the health care provider? Give the child one unit of regular insulin. Give the child a glass of orange juice. Give the child nothing by mouth so that a blood sugar can be drawn at the health care provider's office. Give the child a glass of orange juice with one unit regular insulin in it.

Give the child a glass of orange juice. Explanation: The child is experiencing symptoms of hypoglycemia. Administering a form of glucose would help relieve them. This can be glucose tablets or a rapidly absorbable carbohydrate such as orange juice. This should be followed by a snack of complex carbohydrates and protein within 30 to 60 minutes. Insulin cannot be absorbed when taken orally and administering insulin would make the hypoglycemia worse. Withholding treatment waiting to get to the health care provider's office may cause the hypoglycemia to worsen and be a risk to the child's life. Children with diabetes and their parents need to be taught to recognize and treat the symptoms of hypoglycemia.

A child is brought to the clinic experiencing symptoms of nervousness, tremors, fatigue, increased heart rate and blood pressure. Based on this assessment, the nurse would suspect a diagnosis of which condition? hypertension Graves disease Cushing syndrome hypothyroidism

Graves disease Explanation: Children who develop Graves disease experience nervousness, tremors, and increased heart rate and blood pressure cause by overstimulation of the thyroid gland. Cushing syndrome, hypertension, and hypothyroidism are not associated with these symptoms.

A 12-year-old child has hyperthyroidism. The nurse understands that the most common cause of hyperthyroidism in children is: Addison disease. Cushing syndrome. Graves disease. Plummer disease.

Graves disease. Explanation: Hyperthyroidism occurs less often in children than hypothyroidism. Graves disease is the most common cause of hyperthyroidism in children. Hyperthyroidism occurs more often in females, and the peak incidence occurs during adolescence. Addison disease refers to chronic adrenocortical insufficiency. Cushing syndrome results from excessive levels of circulating cortisol. Plummer disease is a less common cause of hyperthyroidism.

When discussing congenital adrenal hyperplasia with a child's parents, the nurse would advise them that administration of which drug is anticipated? Calcium Vitamin D Hydrocortisone Growth hormone

Hydrocortisone Explanation: Congenital adrenal hyperplasia is an autosomal inherited disease. The adrenal glands produce an insufficient supply of the enzymes required for the synthesis of cortisol and aldosterone. Hydrocortisone is a corticosteroid that is used to replace the supply of cortisol. It would be administered throughout the life of the child. The other drugs are not necessary to treat this disorder.

The parents of a child with congenital adrenal hyperplasia bring the child to the emergency department for evaluation because the child has had persistent vomiting. What finding would lead the nurse to suspect that the child is experiencing an acute adrenal crisis? Hypernatremia Bradycardia Hypertension Hyperkalemia

Hyperkalemia Explanation: Signs and symptoms of an acute adrenal crisis include hyperkalemia, hyponatremia, tachycardia, hypotension, persistent vomiting, dehydration, and shock.

The nurse is caring for a 9-year-old newly diagnosed with diabetes. The child has polyuria, polydipsia, and weight loss. Which nursing diagnoses will the nurse include in the care plan? Select all that apply. Imbalanced nutrition: Less than body requirements Deficient fluid volume Deficient knowledge regarding disease process Noncompliance Delayed growth and development

Imbalanced nutrition: Less than body requirements Deficient fluid volume Deficient knowledge regarding disease process Explanation: Polyuria (excessive urination), polydipsia (excessive thirst), and weight loss support the diagnoses of Deficient fluid volume and Imbalanced nutrition: less than body requirements. Being newly diagnosed with the disease at the age of 9 supports the diagnosis of Deficient knowledge regarding disease process. There is no data to support Noncompliance or Delayed growth and development.

A preadolescent girl with scoliosis is prescribed a body brace. What should the nurse teach the child about the purpose of the brace? Corrects existing spinal curvature Prevents torticollis Improves spinal stability Prevents herniation of a spinal disk

Improves spinal stability Explanation: The goal of mechanical bracing is to maintain spinal stability and prevent further progression of the deformity until bone growth is complete. Bracing will not prevent torticollis, correct the curvature, or prevent herniation of a spinal disk.

A 12-year-old child is diagnosed with hyperthyroidism. What problem would the nurse anticipate the child may have in school? Inability to submit neat handwriting assignments Increase in sleepiness by the end of the day Noncomprehension of written material Inability to fit legs under a school desk

Inability to submit neat handwriting assignments Explanation: Children with hyperthyroidism are seen in the health care provider's office with the first reports being sleep problems, poor school performance, and distractibility. These children are easily frustrated, get overheated, and fatigued during physical education classes. The disease causes muscle weakness and the child can develop fine tremors, which leads to poor handwriting. The child tends to have an increased rate of growth but the growth is not abnormal so he or she should not have a problem placing the legs under the desk. The child is tired throughout the entire day, not just at the end of the day. The disease does not cause problems with cognitive delays so the child should not have problems with comprehension.

The nurse is caring for a 10-year-old child with growth hormone (GH) deficiency. Which therapy would you anticipate will be prescribed for the child? Short-term aldosterone provocation Injections of GH Oral administration of somatotropin Long-term blocking of beta cells

Injections of GH Explanation: Growth hormone (GH) deficiency occurs when the anterior pituitary is unable to produce enough hormone for usual growth. Somatotropin is the name of the growth hormone administered. Administering subcutaneous GH to the child helps correct this deficiency. The GH dosage is 0.2 to 0.3 mg/kg given daily. It is not administered orally. Aldosterone causes sodium to be retained and a provocation would be the administration of diuretics to reduce the sodium. Beta cells are found in the heart muscles, smooth muscles, airways, and arteries. They are also found in the pancreas to secrete insulin. None of these cell actions are related to the anterior pituitary

A boy is brought into the emergency room, and the preliminary diagnosis is acute adrenocortical insufficiency. Which of the interventions below should the nurse implement first? Insert an IV line in preparation for giving IV fluids and cortisol. Prepare the boy for admission to the pediatric intensive care unit. Lead the parents to believe that the child's recovery may be a long road. Discuss with parents that the outcome for their child could be death.

Insert an IV line in preparation for giving IV fluids and cortisol. Explanation: In acute adrenocortical insufficiency, immediate care consists of IV fluid and cortisol to restore blood pressure, blood glucose, and sodium. The child will also need to be closely monitored for vital signs and neurologic checks. Once the child is stabilized, he or she may be admitted to an intensive care unit for close monitoring. The recovery time for this crisis is rapid; if treated properly, it is likely the child will recover within 24 hours.

The nurse is assessing a school-aged child at the emergency department. The child is limping and reports pain in the hip, groin, and knee. The symptoms worsened gradually over time. The health care provider has prescribed radiologic studies to assess for slipped capital femoral epiphysis (SCFE). What action will the nurse perform first? Suggest developmentally appropriate activities that can be done while on bed rest. Prepare the child and family for surgery. Provide the child with crutches. Instruct the parents and child to take weight off the affected leg.

Instruct the parents and child to take weight off the affected leg. Explanation: The nurse should instruct the parents and child to take the weight off the affected leg first, because putting weight on the leg could result in further injury. The use of crutches in the child with slipped capital femoral epiphysis (SCFE) is controversial and varies by health care provider preference; therefore, the nurse should not provide the child with crutches first. The diagnosis of SCFE is confirmed by radiologic studies, so the nurse should not yet prepare the child and family for surgery. While the nurse should suggest developmentally appropriate activities that can be done while on bed rest, this is not the first action the nurse should perform.

Nursing students are reviewing information about childhood cancers. They demonstrate understanding of the information when they identify what as the most frequent type? Wilms tumor Leukemia Brain stem tumor Non-Hodgkin lymphoma

Leukemia Explanation: Although Wilms tumor, brain stem tumors, and non-Hodgkin lymphoma can occur in children, the most frequent type of cancer in children is leukemia.

The nurse is caring for a child who is approximately 6 hours postoperative for surgical correction of scoliosis. What will the nurse include in the plan of care? Logroll the child periodically with arms crossed. Reposition the upper body first, then the lower body. Turn the child every 3 hours. Encourage the child to sit up.

Logroll the child periodically with arms crossed. Explanation: The nurse should plan to logroll the child with arms crossed to avoid bending and twisting the spine. Repositioning the upper body first, then the lower body, will result in twisting of the spine, which should be avoided after surgical correction of scoliosis. The child should be repositioned every 2 hours, not every 3 hours. The child should be encouraged to sit up on postoperative day 1, not only 6 hours postoperative (day 0).

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

Low T4 level and high TSH level 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 caring for a child diagnosed with low functioning parathyroid. Which is a treatment goal of a child with hypoparathyroidism? Maintain the child's calcium level at a normal level with calcium replacement as prescribed. Assure the parents have a plan in place for periods of low glucose levels if noted. Provide the child and parent with a referral to a pediatric gastrointestinal specialist. Provide the parents a specific dietary plan for high-phosphorus foods to be eaten.

Maintain the child's calcium level at a normal level with calcium replacement as prescribed. Explanation: Hypoparathyroidism will manifest as a low calcium level, so the nurse would expect the provider to provide a prescription to maintain the calcium level within normal range. Glucose is not a concern with parathyroid function. A referral would be made to a pediatric endocrinologist, not a gastrointestinal specialist. Phosphorus and calcium have an inverse proportion, so the nurse would recommend a low-phosphorus diet.

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? Metformin Glipizide Glyburide Nateglinide

Metformin Explanation: Metformin, a biguanide, reduces glucose production from the liver. Glipizide, glyburide, and nateglinide all stimulate insulin secretion by increasing the response of β cells to glucose.

A child is diagnosed with hyperthyroidism. Which agent would the nurse expect the physician to prescribe? Mineralocorticoid Methimazole Levothyroxine Dexamethasone

Methimazole Explanation: Methimazole is an antithyroid drug that is used to treat hyperthyroidism. Mineralocorticoid is used to treat adrenal insufficiency. Levothyroxine is used to treat hypothyroidism. Dexamethasone is used to treat congenital adrenal hyperplasia.

A child has been diagnosed with the syndrome of inappropriate antidiuretic hormone (SIADH) and has been admitted to the hospital. Which nursing intervention is most important for this child? Monitor sodium levels. Monitor the child's weight daily. Monitor intake and output. Correct nausea and vomiting.

Monitor sodium levels. Explanation: The syndrome of inappropriate antidiuretic hormone (SIADH) occurs when ADH (vasopressin) is secreted in the presence of a low osmolality because the feedback mechanism that regulates ADH does not work. ADH continues to be released, causing water retention and decreased serum sodium. To correct the problem the child should be placed on fluid restriction and IV sodium chloride should be administered to correct hyponatremia. If the sodium levels drop, neurological signs develop (headache, altered mental status, behavior changes, seizures, and even coma). The child would need to be weighed daily and any gastrointestinal symptoms need to be corrected. Intake and output, especially the output, are important to monitor.

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

Monitoring blood glucose levels. 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 assessing a preadolescent client reporting pain and swelling just below the knee. The client states it hurts worse after running. What treatment would the nurse expect to be prescribed for this client? ice alternating with ankle and knee-strengthening exercises NSAIDs, ice, and limiting exercise alternating applications of 15 to 30 minutes of heat and ice rest, elevation of the leg, treatment of pain with acetaminophen

NSAIDs, ice, and limiting exercise Explanation: The child's symptoms suggest Osgood-Schlatter disease, which is a thickening and enlargement of the tibial tuberosity probably from overuse. Treatment includes administration of NSAIDS, ice, and limiting strenuous activity. Ankle and knee strengthening exercises, applications of ice, and use of acetaminophen is not indicated for this disorder.

The nurse meets a child with a slipped capital femoral epiphysis. In what type of child does this usually occur? Obese adolescent boys Preadolescent girls Active school-age children Tall, thin girls

Obese adolescent boys Explanation: A slipped capital epiphyseal femur injury occurs when the femoral head dislocates from the neck and the shaft of the femur at the level of the epiphyseal plate. The epiphysis slips downward and backward. This occurs in boys aged 9 to 16 years who are sedentary and overweight. It is thought that with a teenage growth spurt the femoral head weakens and is less resistant to stressors. Hormones are also thought to play a role. This problem is generally not seen in girls or children who are active.

A 7-year-old child who has type 1 diabetes mellitus is at school reporting a headache and dizziness. The school nurse notices sweat on the child's face. What should the nurse do first? Give glucagon IM Offer the child 8 ounces of juice or soda Give rapid-acting insulin Offer the child 8 ounces of water

Offer the child 8 ounces of juice or soda Explanation: These are symptoms of hypoglycemia. Glucagon is given only for severe hypoglycemia. Juice or soda is the best choice to get the child an immediate source of carbohydrates. Insulin or water would be given for hyperglycemia.

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: Polyuria Pica Polyphagia Polydipsia

Polyphagia 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). Pica is eating nonfood substances.

Which findings should the nurse expect to assess when completing the health history of a child admitted for possible type 2 diabetes? Select all that apply. Abrupt onset of symptoms Marked weight loss Polyuria Polydipsia Polyphagia

Polyuria Polydipsia Polyphagia Explanation: Type 2 diabetes mellitus is characterized by a gradual onset and is most often associated with obesity and not marked weight loss. Type 1 diabetes is most often abrupt and associated with marked weight loss. Polyuria, polydipsia, and polyphagia are frequent assessment findings in both types of diabetes mellitus.

A child underwent surgery for removal of an astrocytoma. What would be most appropriate to include in the plan of care? Elevating the foot of the bed 30 degrees Positioning the child on the unaffected side Raising the head of the bed 45 degrees Administering large volumes of intravenous fluids

Positioning the child on the unaffected side Explanation: Postoperatively, the nurse will position the child on the unaffected side, with the head of the bed flat or at the level prescribed by the neurosurgeon. The foot of the bed is not elevated to prevent increasing intracranial pressure and contributing to bleeding. Fluids are administered carefully to avoid excess fluid intake, which would cause or worsen cerebral edema.

The nurse is caring for a 10-year-old boy with hyperpituitarism due to a tumor on the anterior pituitary gland. Which would be a priority nursing action? Promoting a healthy body image Encouraging effective family coping Providing pre- and postoperative care Promoting knowledge about treatment options

Providing pre- and postoperative care Explanation: The priority intervention will be providing pre- and postoperative care. Promoting a healthy body image for the boy and encouraging effective family coping are secondary interventions appropriate after the surgery. Promoting knowledge about proper treatment options would be more of the physician's responsibility than the nurse's.

A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease? elevated lymphocytes Reed-Sternberg cells T-lymphocyte surface markers megakaryocyte cells

Reed-Sternberg cells Explanation: With Hodgkin disease, lymphocytes proliferate in the lymph glands, and special Reed-Sternberg cells (large, multinucleated cells that are probably nonfunctioning monocyte-macrophage cells) develop. Although these lymphocytes are capable of DNA synthesis and mitotic division, they are abnormal because they lack both B- and T-lymphocyte surface markers and cannot produce immunoglobulins as do usual B-lymphocytes. There will be elevated lymphocytes, but this is present in leukemias as well. T-lymphocyte surface markers are lacking in Hodgkin disease. Megakaryocyte cells are normal cells in the bone marrow and produce platelets.

A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer? Regular insulin Lispro NPH Detemir

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

The nurse is caring for a school-aged child newly diagnosed with type 1 diabetes mellitus. Which nursing action supports the 2020 National Health Goals to reduce the long-term complications from this disease process? Schedule the child and parents to attend diabetes education classes. Explain how the child's physical abilities will be affected during school. Recommend homeschooling so the mother can provide the needed medications. Discuss admission to a rehabilitation facility to learn self-care with this disease process.

Schedule the child and parents to attend diabetes education classes. Explanation: Endocrine disorders tend to be long-term with lifetime consequences. Reducing the incidence of consequences or improving care has long-term implications. A 2020 National Health Goal related to endocrine disorders includes increasing the proportion of persons with diabetes who receive formal diabetes education. To support this goal, the nurse should schedule the child and parents to attend diabetes education classes. There are no 2020 National Health Goals to address alteration in physical abilities, homeschooling with type 1 diabetes mellitus, or the need to be admitted to a rehabilitation facility to learn self-care.

The type of traction in which tape, rubber, or plastic materials are used to indirectly exert pull on a fractured bone is which type of traction? Skin traction Dunlop traction Skeletal traction Balanced suspension traction

Skin traction Explanation: Traction is used to provide immobilization to reduce or immobilize a fracture, align an injured extremity or allow the extremity to be restored to the normal length. The types of traction include skin, skeletal and suspension. The types of skin traction include Bryant, Russell, Buck, cervical and side arm 90-90. In these types of traction some type of tape, rubber, plastic or manufactured material is attached to the skin. A weight is attached via pulley which indirectly exerts pull on the musculoskeletal system. Dunlop is a form of skeletal traction. Balanced suspension uses a series of weights and pulleys to align the hip, femur or tibia.

A child is admitted to the pediatric unit with osteomyelitis. The child is to be placed on antibiotics. The nurse expects antibiotic coverage to include which of the following as the most common cause of osteomyelitis? Staphylococcus aureus streptococcus group B mycobacterium Haemophilus influenzae

Staphylococcus aureus Explanation: Staphylococcus aureus is the most common cause of osteomyelitis; therefore, the nurse would expect the antibiotics to cover that bacteria.

The nurse is caring for a child with a newly placed plaster cast who is postoperative from surgery for Blount disease. What will the nurse include in the plan of care? Teach the child and parents to cover the cast while bathing. Handle the cast carefully with the fingertips during the first 24 hours. Apply ice packs to the interior of the cast. Elevate the affected limb to the level of the diaphragm.

Teach the child and parents to cover the cast while bathing. Explanation: The nurse should teach the parents to cover the cast while bathing. The cast should be handled carefully with open palms during the first 24 hours of plaster cast placement to avoid deforming the cast. Ice packs should not be applied to the interior of the cast; nothing should be inserted into the cast. The affected limb should be elevated above the level of the heart, not to the level of the diaphragm.

The nurse is caring for a preschool-age child who is receiving palliative care for end-stage cancer. What would be the focus of age-appropriate interventions for this child? Providing unconditional love and trust. Providing a familiar and consistent routine. Teaching the child that death is not punishment. Providing specific, honest details of death.

Teaching the child that death is not punishment. Explanation: Spirituality in the preschool years focuses on the concept of right versus wrong. The 3- to 5-year-old may see death as punishment for wrongdoing, and the nurse must correct this misunderstanding. For the infant, unconditional love and trust are of utmost importance. The toddler, 1 to 3 years old, thrives on familiarity and routine; the nurse should maximize the toddler's time with parents, be consistent, provide favorite toys, and ensure physical comfort. The school-age child has a concrete understanding of death. Children who are 5 to 10 years old need specific, honest details (as desired).

The nurse is caring for an 8-year-old girl with an endocrine disorder involving the posterior pituitary gland. What care would the nurse expect to implement? Instructing the parents to report adverse reactions to the growth hormone treatment Teaching the parents how to administer the desmopressin acetate Informing the parents that treatment stops when puberty begins Educating the parents to report signs of acute adrenal crisis

Teaching the parents how to administer the desmopressin acetate Explanation: The nurse would teach the parents how to administer desmopressin acetate, which treats diabetes insipidus, a disorder related to the posterior pituitary gland. Instructing parents to report adverse reactions to growth hormone is an intervention for growth hormone deficiency. Informing the parents that treatment stops at the normal time of puberty is a teaching intervention for precocious puberty. Educating the parents to report signs of an acute adrenal crisis is an intervention for congenital adrenal hyperplasia. All three of these other disorders are related to the anterior pituitary.

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

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 is preparing a child suspected of having a thyroid disorder for a thyroid scan. What information regarding the child should the nurse alert the doctor or nuclear medicine department about? The child is allergic to shellfish. The child is taking a vitamin supplement. The child has had an MRI of their leg within the past 6 weeks. The child wears a medical alert bracelet for diabetes.

The child is allergic to shellfish. Explanation: Allergies to shellfish should be reported because shellfish contains iodine; the dye used for a nuclear medicine scan is iodine based and could cause an anaphylactic reaction. The other information about the child would not need to be reported to the staff.

The nurse is assessing an 8-year-old boy who is performing academically at a second-grade level. The mother reports that the boy states feeling weak and tired and has had a weight increase of 6 pounds (13.2 kg) in 3 months. Which additional data would fit with a possible diagnosis of hypothyroidism? The child states that the exam room is cold. Oral cavity assessment shows two of the 6-year molars. The mother reports that the boy is always thirsty. The child has a faint rash on the trunk of the body.

The child states that the exam room is cold. 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. A rash can be varied disease processes but is not characteristic in hypothyroidism.

The nurse has been teaching an adolescent about the treatment for hypothyroidism. Which outcome indicates that the teaching has been successful? The client states understanding that this is a lifetime medication. The parents recognize that thyroid medication be taken with food. The client verbalizes the requirement to restrict future athletic activities. The parents acknowledge the need for a follow-up appointment in a year.

The client states understanding that this is a lifetime medication. Explanation: Treatment for hypothyroidism is typically for life because the thyroid is no longer fully functioning. Thyroid replacement medication should be taken on an empty stomach. There is no need to restrict athletic activities, and follow-up is going to be needed more frequently than yearly at the beginning of treatment.

The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. What finding would suggest this child has a neuroblastoma? The child has a maculopapular rash on his palms. The parents report that their son is vomiting and not eating well. The parents report that their son is irritable and not gaining weight. Auscultation reveals wheezing with diminished lung sounds.

The parents report that their son is vomiting and not eating well. Explanation: Along with the swollen abdomen on one side, the parents reporting that the child is vomiting and anorexic points to the possibility of a neuroblastoma. Observing a maculopapular rash on the child's palms is a sign of graft-versus-host disease. Irritability and lack of weight gain suggest a possible brain tumor as well as malabsorption problems. Auscultation revealing wheezing with diminished lung sounds would suggest other problems, not a neuroblastoma.

A school-age child is diagnosed as having Cushing syndrome from long-term therapy with oral prednisone. What assessment finding is consistent with this child's diagnosis and treatment? Child appears pale and fatigued. There are purple striae on the abdomen. The child is excessively tall for chronologic age. The child is demonstrating signs of hypoglycemia.

There are purple striae on the abdomen. Explanation: Cushing syndrome is caused by overproduction of the adrenal hormone cortisol. The overproduction of cortisol results in hyperpigmentation, which occurs from the melanin-stimulating properties of ACTH. Purple striae resulting from collagen deficit appear on the child's abdomen. The child will not be pale or fatigued. The child will not be excessively tall. The child will not be demonstrating signs of hypoglycemia.

A nurse is conducting a physical examination on an 11-year-old boy with Legg-Calvé-Perthes disease. Which assessment finding would be expected? lordosis kyphosis loss of strength in ankle dorsiflexion Trendelenburg gait

Trendelenburg gait Explanation: The nurse would expect to note a Trendelenburg gait due to pain. Lordosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Kyphosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Loss of strength in ankle dorsiflexion is associated with some neuromuscular disorders but not this condition.

While examining a 4-year-old child, the nurse notes a decrease in hip motion that causes pain upon movement. The nurse interprets this finding as indicating Legg-Calvé-Perthes disease, a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity. True False

True Explanation: Legg-Calvé-Perthes disease is a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity. It has an incidence of 1 per 850 children in northern Europe and the United States, occurring four times more often in males.

An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have? Type 1 diabetes mellitus Gastrointestinal reflux Inflammatory bowel disorder Type 2 diabetes mellitus

Type 2 diabetes mellitus Explanation: Metformin is the common treatment to manage type 2 DM. Insulin, not oral medication, is the treatment of choice for type 1 DM. Metoclopramide is the treatment for GI reflux. Methylprednisolone is used to treat inflammatory bowel disease.

The nurse is preparing clients for diagnostic testing for cancer. Which test is used to differentiate a neuroblastoma from other tumors? Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) Urinalysis Serum chemistries Complete blood count (CBC) with differential

Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) Explanation: Neuroblastomas produce catecholamines. Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) differentiate neuroblastomas from other tumors. This exam is done by collecting a 24-hour urine specimen. Urinalysis provides general information about renal function. Serum chemistries help to evaluate the body's response to the cancer process. CBC with differential determines abnormal loss or destruction of cells that may indicate cancer or bone marrow suppression.

A mother contacts the oncology nurse concerned about the redness and tenderness of her child's skin following radiation treatments. What is the nurse's best response? Keep skin clean and dry. Cover skin with an occlusive dressing. Use mild soap and nonscented moisturizer. There is nothing that can be done to take care of this problem.

Use mild soap and nonscented moisturizer. Explanation: Skin reactions, such as erythema and tenderness, are typical local effects. Maintaining good skin hygiene and use of mild soaps or moisturizers (nonfragrant) may help preserve skin integrity. Keeping skin clean and dry is helpful, but the skin needs a mild moisturizer to preserve skin integrity. Covering with an occlusive dressing is not helpful, as the skin needs hydration. Telling the mother there is nothing that can be done is inaccurate.

What finding would the nurse expect to assess in a child with hypothyroidism? Nervousness Heat intolerance Smooth velvety skin Weight gain

Weight gain Explanation: Hypothyroidism is manifested by weight gain, fatigue, cold intolerance, and dry skin. Nervousness, heat intolerance, and smooth velvety skin are associated with hyperthyroidism.

A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus? proteinuria a fasting blood glucose less than 126 mg/dl a fasting blood glucose greater than 126 mg/dl glucose in the urine

a fasting blood glucose greater than 126 mg/dl Explanation: A fasting blood glucose greater than 126 mg/dl is diagnostic for diabetes mellitus.

Which client would be the most likely person to be diagnosed with idiopathic scoliosis that requires treatment? a school-age female a teenage male a young adolescent female a school-age male

a young adolescent female Explanation: Mild scoliosis occurs between the genders equally, but idiopathic scoliosis requiring treatment occurs 10 times more often in females than males. Usually, treatment is initiated during early adolescence, around age 11 to 14 years.

Wilms tumor is suspected in a 5-year-old child. Which action would be avoided? abdominal palpation fiber intake aspirin administration rectal suppository use

abdominal palpation Explanation: If Wilms tumor is suspected, the abdomen should not be palpated. Palpating the abdomen may cause the tumor capsule to rupture, resulting in tumor spillage. Tumor spillage can change the tumor from stage I to stage II or III, depending on the amount of spillage that occurs.

In a child with diabetes insipidus, which characteristic would most likely be present in the child's health history? delayed closure of the fontanels (fontanelles), coarse hair, and hypoglycemia in the morning gradual onset of personality changes, lethargy, and blurred vision vomiting early in the morning, headache, and decreased thirst abrupt onset of polyuria, nocturia, and polydipsia

abrupt onset of polyuria, nocturia, and polydipsia Explanation: Diabetes insipidus is characterized by deficient secretion of antidiuretic hormone leading to diuresis. Most children with this disorder experience an abrupt onset of symptoms, including polyuria, nocturia, and polydipsia. The other choices reflect symptoms of pituitary hyperfunction.

The nurse is assessing a child diagnosed with Cushing syndrome. Which signs and symptoms would the nurse likely note? Select all that apply. acne abdominal striae excessive hair growth thin face sunken abdomen

acne abdominal striae excessive hair growth Explanation: Signs and symptoms of Cushing syndrome include excessive hair growth, moon face with ruddy cheeks, dorsocervical fat pad, truncal obesity, abdominal striae, easy bruising, and poor wound healing.

After teaching a group of nursing students about chemotherapy agents used in treatment cancer, the instructor determines that the teaching was successful when the students identify cisplatin as which type of drug? alkylating agent antimetabolite antitumor antibiotic hormone

alkylating agent Explanation: Cisplatin is classified as an alkylating agent. Antimetabolites include 5-fluorouracil and gemcitabine. Antitumor antibiotics include bleomycin and dactinomycin. Hormones include dexamethasone, hydrocortisone, and prednisone.

A nurse is performing a physical assessment of the musculoskeletal system of 5-year-old Manuel. Which of the following is a recommended assessment technique appropriate for this client? assess Manuel while he sits in his parent's lap. assess Manuel's hips for any dislocations. assess range of motion (ROM) of his head to check for torticollis. palpate the arms from the shoulders to the fingers.

assess Manuel while he sits in his parent's lap. Explanation: The nurse should examine younger children while they sit on a parent's lap or move around the examination room. In the newborn, to look for congenital torticollis—a condition in which the head is tilted to one side—assess both the head for ROM and the hips for dislocation. Begin the examination at the most distal joints, that is, the fingers and work up to the shoulders, or begin with the toes, and work up to the hip joint.

An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the: back with the injured hip flexed and the uninjured one extended. stomach with both legs extended. back with hips flat on the bed. back with hips up off the bed.

back with hips up off the bed. Explanation: Bryant traction is used to reduce fractures or with developmental dysplasia of the hip (DDH) in children younger than 2 years of age. In this type of traction, both legs are extended vertically with the child's weight serving as the counterbalance. For there to be traction, the infant's hips must be off the bed. The position of having the child on the back with the hips flat is describing Buck traction. The position where the hip is flexed on the injured side and the uninjured extended is 90-90 traction. There is no traction when the child would be on the stomach.

The nurse is conducting a physical examination of a newborn with suspected osteogenesis imperfecta. Which finding is common? dimpled skin, hair in lumbar region The foot is drawn up and inward. blue sclera The sole of the foot faces backwards.

blue sclera Explanation: Blue sclera is not diagnostic of osteogenesis imperfecta, but it is a common finding. The foot drawn up and inward (talipes varus) and the sole of the foot facing backwards (talipes equinus) are associated with clubfoot (congenital talipes equinovarus). Dimpled skin and hair in the lumbar region are common findings with spina bifida occulta.

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. Which action would be the priority? checking vital signs measuring urine output encouraging increased fluid intake weighing the client

checking vital signs 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. Encouraging fluids will not correct the problem and weighing the client is not necessary at this time

A newborn is born with hypothyroidism. If it is not recognized and treated, what complication is likely? blindness muscle spasticity dehydration cognitive impairment

cognitive impairment Explanation: A newborn with congenital hypothyroidism is lethargic, hypotonic and irritable. Delayed growth is seen as well as decreased mental responsiveness. The newborn has an enlarged tongue and poor sucking ability. Without treatment with the thyroid hormone, the newborn will develop a cognitive impairment and failure to thrive. Blindness, muscle spasticity and dehydration are not symptoms or complications of the disease.

Assessment of a newborn reveals that the child has hypothyroidism. How does the nurse document this finding? congenital hypothyroidism acquired hypothyroidism secondary hypothyroidism autoimmune thyroiditis

congenital hypothyroidism 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 or autoimmune thyroiditis). Secondary hypothyroidism is a term that is not used when describing hypothyroidism.

The nurse is caring for a child who has developed thyroid storm. What intervention(s) will the nurse initiate? Select all that apply. cooling blanket continuous cardiac monitoring increase dosage of L-thyroxine sodium decrease stimulation, such as turning off lights and television decrease caloric intake by 10% to 15%

cooling blanket continuous cardiac monitoring decrease stimulation, such as turning off lights and television Explanation: Signs and symptoms related to the development of thyroid storm include fever, diaphoresis, and tachycardia. Children with thyroid storm are typically restless and irritable. Interventions include a cooling blanket, continuous cardiac monitoring and decreasing stimulation. Caloric intake may need to be increased and dosages of L-thyroxine sodium may need to be held or decreased

A child with growth hormone deficiency is prescribed growth hormone (GH) by subcutaneous injection. When teaching the child's parents about this drug, the nurse would instruct the parents to administer the drug at which frequency? daily, 6 to 7 days a week every 3 days weekly monthly

daily, 6 to 7 days a week Explanation: The parent or the child administers GH by subcutaneous injection usually 6 to 7 days per week (usually daily). It is generally given at bedtime to attempt to mimic the body's natural production and release during sleep.

The nurse is preparing a teaching plan for the family and their 6-year-old child who has just been diagnosed with diabetes mellitus. What would the nurse identify as the initial goal for the teaching plan? developing management and decision-making skills evaluating the child's literacy level and readiness to learn developing a nutritionally sound, 30-day meal plan promoting independence with self-administration of insulin

developing management and decision-making skills Explanation: Developing basic management and decision-making skills related to diabetes is the initial goal of the teaching plan for this child and family. The nurse would have provided a basic description of the disorder after it was diagnosed. Development of a detailed monthly meal plan would come later, perhaps after consulting with a nutritionist. It is too soon to expect the child to administer one's own insulin. The child may not be able to read, write, make rational decisions nor be ready to learn how to manage diabetes, but teaching to parents still needs to be completed. The child should be taught and be encouraged to participate in care at a level that he or she can understand. The primary responsibility still remains with the parents

The nurse is assessing a newborn following a cesarean birth necessitated by a breech presentation. The nurse knows that this presentation places the newborn at increased risk for: developmental dysplasia of the hip (DDH). clubfoot (congenital talipes equinovarus). osteogenesis imperfecta. genu valgum (knock-knees).

developmental dysplasia of the hip (DDH). Explanation: Developmental dysplasia of the hip has a higher incidence with breech presentation. Breech presentation does not cause clubfoot, genu valgum, or osteogenesis imperfecta.

A nurse is to see a child. Assessment reveals the chief complaints of urinating "a lot" and being "really thirsty." The nurse interprets these symptoms as being associated with which condition? syndrome of inappropriate antidiuretic hormone secretion hypopituitarism diabetes insipidus precocious puberty

diabetes insipidus Explanation: The most common symptoms of central diabetes insipidus are polyuria (excessive urination) and polydipsia (excessive thirst). Children with diabetes insipidus typically excrete 4 to 15 L/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.

Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism? early identification promoting bonding allowing rooming in encouraging fluid intake

early identification 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.

A newborn girl is discovered to have congenital adrenal hyperplasia. When assessing her, the nurse would expect to find which physical characteristic? small for gestational age abnormal facial features enlarged clitoris divergent vision

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

The nurse is assessing a 1-month-old girl who, according to the mother, doesn't eat well. Which assessment suggests the child has congenital hypothyroidism? frequent diarrhea enlarged tongue tachycardia warm, moist skin

enlarged tongue Explanation: Observation of an enlarged tongue along with an enlarged posterior fontanel (fontanelle) and feeding difficulties are key findings for congenital hypothyroidism. The mother would report constipation rather than diarrhea. Auscultation would reveal bradycardia rather than tachycardia, and palpation would reveal cool, dry, and scaly skin.

A 6-week-old infant has been diagnosed with congenital hypothyroidism. Once the level of medication has been determined, in order to maintain the proper dosing of thyroid hormone, the nurse instructs the parents to have the baby's levels tested how often during the first year? every 1 to 3 days every 1 to 3 weeks every 1 to 3 months every 3 to 6 months

every 1 to 3 months Explanation: Thyroid levels are measured at recommended intervals, such as every 2 weeks until the target range is reached on a stabilized dose of medication, then every 1 to 3 months until the child is 1 year old, every 2 to 3 months until the child is 3 years old, and becoming less frequent as the child gets older.f

The nurse is caring for a 12-year-old girl with a chronic endocrine condition that has resulted in weight gain, facial hair, and acne. During a routine examination, the girl confides that she doesn't participate in any extracurricular activities or have any social life because she is so unattractive. She feels it is pointless to get involved with anything or anyone because she is always going to be "fat and ugly." When responding to the girl, which of the following would be the priority? exploring the girl's perception of her body image and health status suggesting the girl speak to a counselor about her feelings discussing ways to highlight good feelings about herself assisting the girl with methods to enhance her physical appearance

exploring the girl's perception of her body image and health status Explanation: Obtaining information about how the child perceives herself provides a baseline from which to develop a teaching plan to address the child's inaccurate beliefs and then develop strategies to highlight good feelings. Assisting the girl with methods to enhance physical appearance is helpful after the nurse addresses the child's perceptions. Referral to a counselor might be appropriate after exploring the child's feelings.

A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client? fluid replacement weight loss polydipsia headache

fluid replacement Explanation: Children with diabetes insipidus lose tremendous amounts of fluid, so fluid replacement is the priority consideration for this client. Excessive fluid loss can lead to seizures and death. Headache and polydipsia can be relieved with fluid replacement. Children will requirement a nutritional consultation for weight loss, but it is not the main consideration.

The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. In caring for a child that has issues with the anterior pituitary, the nurse knows that this child has issues with which hormone? vasopressin antidiuretic hormone oxytocin growth hormone

growth hormone Explanation: Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adenohypophysis, 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 adenohypophysis.

A child with growth hormone deficiency is receiving growth hormone. What result would the nurse interpret as indicating effectiveness of this therapy? rapid weight gain reports of headaches height increase of 4 inches growth plate closure

height increase of 4 inches Explanation: Effectiveness of growth hormone therapy is indicated by at least a 3- to 5-inch increase in linear growth in the first year of treatment. Rapid weight gain and headaches are adverse reactions of this therapy. The drug is stopped when the epiphyseal growth plates close.

The nurse is assessing a 9-year-old girl with a history of tuberculosis at age 6 years. She has been losing weight and has no appetite. The nurse suspects Addison disease based on which assessment findings? arrested height and increased weight thin, fragile skin and multiple bruises hyperpigmentation and hypotension blurred vision and enuresis

hyperpigmentation and hypotension Explanation: Hyperpigmentation and hypotension would point to Addison disease. Arrested height and increased weight are typical of acquired hypothyroidism; this girl has lost weight. Thin, fragile skin and multiple bruises are indicative of Cushing syndrome. Blurred vision, headaches, and enuresis would be symptoms that would point to a child with diabetes.

A child is diagnosed with hypoparathyroidism. Which electrolyte imbalance would the nurse most likely expect to address? hypocalcemia hyperkalemia hyponatremia hypomagnesemia

hypocalcemia Explanation: Hypoparathyroidism results in low production of PTH, which in turn leads to hypocalcemia and hyperphosphatemia.

The nurse is preparing an educational session for adolescents to best ensure a lifelong healthy musculoskeletal system. Which teaching will be beneficial to the most attendees? importance of daily exercise adequate intake of calcium in dietary or supplement form need for at least 8 hours of sleep each night need for early diagnosis of painful joints

importance of daily exercise Explanation: Everyone benefits by understanding the need for physical activity throughout the lifespan. The nurse can help the adolescents achieve musculoskeletal health by educating them at this time on the importance of physical activity. Physical activity strengthens the bones and muscles and develops healthy habits. The other options are important but not as important. Diagnosis of painful joints allows for early diagnosis and treatment for those who may have future problems. Sleeping at least 8 hours per night provides for repair of body tissues, restores focus, and reenergizes the body. Dietary calcium intake, which is important in bone and muscle health, is not the most important information to teach to ensure a healthy musculoskeletal system.

Shortly after delivery, a newborn is diagnosed with hypocalcemia. What manifestation will the nurse assess in this client? jitteriness constipation excessive sleepiness a distended abdomen

jitteriness Explanation: The chief sign of hypocalcemia is neuromuscular irritability, referred to as latent tetany. This occurs if the blood calcium level falls below 7.5 mg/dl. The newborn will demonstrate jitteriness when handled or has been crying for an extended period. Constipation, excessive sleepiness, and a distended abdomen are not manifestations of hypocalcemia.

The nurse is preparing to administer pamidronate to a child with osteogenesis imperfecta. What intervention(s) will the nurse perform during the child's care? Select all that apply. assessing for fever and myalgia monitoring complete blood count (CBC) monitoring urinary output administering by IV every 1 to 2 months monitoring the IV site during infusion

monitoring the IV site during infusion monitoring urinary output Explanation: The nurse will monitor the IV site during the infusion, monitor urinary output, and assess for fever and myalgias for a child undergoing therapy with pamidronate for osteogenesis imperfecta. The medication should be administered every 3 to 4 months, not every 1 to 2 months. Monitoring the CBC is not required for this therapy; instead, the nurse should monitor serum electrolytes, phosphates, calcium, and magnesium.

Which hormones are secreted by the adrenal medulla? Select all that apply. aldosterone norepinephrine cortisol epinephrine insulin

norepinephrine epinephrine Explanation: The adrenal medulla secretes epinephrine and norepinephrine; the adrenal cortex secretes aldosterone and cortisol. The pancreas secretes insulin.

Fractures in children are always potentially serious injuries. Which child with a fracture would you observe most closely for complication? one who has a greenstick radial injury one who has a fractured patella one who has an ulnar fracture one who has an elbow fracture

one who has an elbow fracture Explanation: Elbow injuries are particularly dangerous because edema can interfere with blood vessels and nerves that pass beside the joint. The radius and ulna are long bones and would not be at increased risk for complications. The patella is the knee and can be maintained in a straight position for casting.

The nurse is caring for a child recently diagnosed with hypoparathyroidism disorder. Which medication would the nurse expect to be ordered? oral calcium oral corticosteroids intravenous diuretic therapy oral potassium

oral calcium Explanation: Medical management of hypoparathyroidism includes intravenous calcium gluconate for acute or severe tetany, then intramuscular or oral calcium as prescribed. IV diuretics are used in the treatment of hyperparathyroidism. Oral corticosteroids and oral potassium are not used in the treatment of hypoparathyroidism.

The nurse is assessing the neurovascular status of a client recovering from surgery for Blount disease. What will the nurse include in the assessment? Select all that apply. pulses palliation pallor pain paresthesia

pain pulses pallor paresthesia Explanation: The nurse should assess the neurovascular status of the client using the five Ps of tissue ischemia: pain, pulses, pallor, paresthesia, and paralysis. Palliation is not one of the five Ps of tissue ischemia. Palliation assessment would determine if the symptoms, primarily pain, have been reduced with treatment provided.

An 8-year-old child is seen for moodiness and irritability. The child has begun to develop breast and pubic hair and the parents are concerned that these changes are occurring at too early an age. Which would the nurse suspect? precocious puberty pseudopuberty adrenal hyperplasia neurofibromatosis

precocious puberty 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.

The nurse is assessing a 5-year-old child whose parent reports the child has been vomiting lately, has no appetite, and has had an extreme thirst. Laboratory work for diabetes mellitus is being completed. Which symptom would differentiate between type 1 diabetes mellitus from type 2 diabetes mellitus? recent weight loss blood pressure of 142/92 mm Hg slow healing wounds loose stools

recent weight loss Explanation: Weight loss is unique to type 1 diabetes mellitus, whereas weight gain is associated with type 2. Hypertension is consistent with type 2 diabetes mellitus. Both type 1 and type 2 diabetes cause delayed wound healing. The increase in blood glucose in diabetes causes damage to the inner lining of the arteries that cause the arteries to develop plaque and harden. These damages to the blood vessels result in a decrease in the ability of oxygen-rich blood to be transported effectively to the tissues to promote wound healing. Loose stools or repeated loose stools called diarrhea is a common side effect of the oral medication metformin, which is prescribed for clients with type 2 diabetes. Insulin, the treatment for type 1 diabetes, has constipation as one of the side effects.

A child is in Buck traction to correct a hip problem. When caring for this child, it is most important for the nurse to implement which intervention? remove the boot every 8 hours keep the affected leg on a pillow administer antispasmodics every 4 hours provide diversionary activities

remove the boot every 8 hours Explanation: Buck traction is a skin traction used to treat hip and knee problems. The traction is applied in a straight line with the extremity in a boot and weights attached that hang freely off the end of the bed. It is imperative the boot be removed every 8 hours for skin assessment. Due to the weight applied to the boot, skin integrity can easily become impaired. The affected leg should not be elevated on a pillow. Antispasmodics are generally prescribed, but they would be used when needed, not scheduled. Diversionary activities should be provided, but they do not take priority over skin assessment.

The nurse is caring for a 12-year-old girl with hypothyroidism. Which information should be part of the nurse's teaching plan for the child and family? how to recognize vitamin D toxicity how to maintain fluid intake regimens administering methimazole with meals reporting irritability or anxiety

reporting irritability or anxiety Explanation: Side effects of hypothyroidism are restlessness, inability to sleep, or irritability. These should be reported to the physician. Educating how to recognize vitamin D toxicity is necessary for a child with hypoparathyroidism. Teaching parents how to maintain fluid intake regimens is important for a child with diabetes insipidus. Teaching the child and parents to administer methimazole with meals is necessary for hyperthyroidism.

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

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

A nurse is assessing a child with suspected osteomyelitis. Which finding would help support this suspicion? swelling and point tenderness decreased erythrocyte sedimentation rate increased range of motion coolness of the affected site

swelling and point tenderness Explanation: Findings associated with osteomyelitis include swelling, point tenderness, warmth over the site, decreased range of motion, and an elevated sedimentation rate.

The nurse is performing a neurovascular assessment on a child in 90-90 skeletal traction. What will the nurse include in the assessment? Select all that apply. tactile sensation capillary refill skin color ability to wiggle fingers and toes ability to sit up in bed

tactile sensation ability to wiggle fingers and toes capillary refill skin color Explanation: The nurse should assess the child's tactile sensation, the ability to wiggle fingers and toes, capillary refill, and the child's skin color. The nurse should not assess the child's ability to sit up in bed; the child should remain flat in the supine position while undergoing 90-90 traction.

The nurse working with the child diagnosed with type 2 diabetes mellitus recognizes the disorder can be managed by: taking oral hypoglycemic agents. increasing carbohydrates in the diet, especially in the evening. conserving energy with rest periods during the day. decreasing amounts of daily insulin.

taking oral hypoglycemic agents. Explanation: Oral hypoglycemic agents, such as metformin, are often effective for controlling blood glucose levels in children diagnosed with type 2 diabetes mellitus. Insulin may be used for a child with type 2 diabetes if oral hypoglycemic agents alone are not effective, but "decreasing" the daily insulin would not help treat this disorder. Lifestyle changes such as increased exercise (not conserving energy by resting during the day), and limiting large amounts of carbohydrates are important aspects of treatment for the child.

The nurse is assessing a 16-year-old girl who is in the office because she has not started menstruating. Which endocrine gland is most often affected by age-related changes? parathyroid adrenal thyroid anterior pituitary

thyroid Explanation: Many menstrual problems may be symptoms of undiagnosed thyroid conditions. Girls who have either very early or very late menstruation should be evaluated for a potential thyroid problem, as thyroid problems can frequently be a cause of early or delayed puberty and menstruation. Hyperthyroidism in a teenage girl can delay the onset of puberty and onset of menstruation into the mid-teens, in some cases after the age of 15.

An adolescent wears a body brace for scoliosis. Which client education should the nurse provide? to continue with age-appropriate activities to wear the brace a maximum of 20 hours each day to stand absolutely still when not wearing the brace that secondary sex changes will stop until the brace is removed

to continue with age-appropriate activities Explanation: The treatment for scoliosis is aimed at preventing progression of the curve and decreasing the impact on the pulmonary and cardiac function. Bracing is one way to do that. The brace should be worn for 23 hours per day. Wearing a body brace should not interfere with normal activities, which are necessary to maintain adolescent self-esteem. It is extremely important that the adolescent has compliance with the brace usage. The nurse can help by teaching the adolescent ways to help peers understand the need for the brace. Sex changes continue with or without bracing.

After teaching a group of nursing students about osteogenesis imperfecta (OI), the instructor determines that the teaching was successful when the group identifies which type as the most common? type II type IV type I type III

type I Explanation: A classification system has been developed that identifies four main types of OI. Type I mid nondeforming is the most common and mildest form. Children with type I have bones that are predisposed to fractures. Other than spinal curvature, bone deformity is minimal. Type II perinatal lethal is the most severe type and is frequently lethal at or shortly after birth. Type III severely deforming and type IV moderately deforming are more serious than type I but not as lethal as type II.

Based on the chart note above, which therapy will the nurse anticipate in the plan of care for the child? pamidronate clindamycin vitamin D3 cefazolin

vitamin D3 Explanation: Based on the chart note, the nurse should anticipate therapy with vitamin D3, because the findings are consistent with rickets, a musculoskeletal disorder in which young bones fail to calcify. Vitamin D supports calcium metabolism by increasing calcium and phosphorus absorption. Cefazolin and clindamycin are antibiotics used in the treatment of infections such as osteomyelitis and would not be anticipated in the plan of care. Pamidronate would not be anticipated in the plan of care, because this is an agent used for the treatment of Blount disease, which is a disorder of the growth plate affecting the lower leg that causes inward curvature of the extremity.

The nurse is doing client teaching with a child who has been placed in a brace to treat scoliosis. Which statement made by the child indicates an understanding of the treatment? "I am so glad I can take this brace off for the school dance." Wearing this brace only during the night will not be so embarrassing." "When I start feeling tired, I can just take my brace off for a few minutes." "At least when I take a shower I have a few minutes out of this brace."

"At least when I take a shower I have a few minutes out of this brace." Explanation: The treatment for scoliosis is aimed at preventing progression of the curve and decreasing the impact on the pulmonary and cardiac function. For curves 25-40 degrees the recommended treatment is bracing. The brace must be worn 23 hours per day. The child needs to be taught that the brace must be worn at all times, during the day as well as the night. Compliance, especially with adolescents, is difficult due to peer pressure. The other issues with compliance include being hot and being uncomfortable.

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? "Most parents mention a red color." "I will report this to the pediatrician." "Has your baby been rubbing either eye?" "A plugged tear duct would not be unusual."

"I will report this to the pediatrician." 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.

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals? "It is important to prevent torticollis." "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." "It is important to correct spinal curvature before it gets too bad, causing you problems." "It is important to prevent herniation of a spinal disk, which is painful."

"It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." Explanation: It is important to have the adolescent understand the treatment and how the treatment will benefit him or her. Body bracing helps to hold the spine in alignment and prevent further curvature, decreasing the symptoms. The brace will not correct the problem. Adolescents have a hard time being compliant with the brace due to body image disturbance and peer reaction. The brace can also cause discomfort and be hot to wear. Torticollis is tightened neck muscles causing the head to tilt downward. A herniated disc is related to the disc space between the vertebrae. It has no affect on the curvature of the spine.

An adolescent client who has scoliosis and is wearing a Milwaukee brace tells the nurse that she is ugly and cannot wear the same clothing as her friends. Which response by the nurse best addresses this client's altered self-image? "Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it." "You should not worry about what everyone else is wearing. You look fine." "Just hold your head up and be confident in how you look. Look for some after-school activities you can do wearing your brace." "Kids can be cruel sometimes. Has anyone told you that you look different?"

"Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it." Explanation: A positive self-image is very important for adolescents wearing a brace. They want to look like their peers and wear the same clothing, but often that is not possible when wearing a brace. Assisting the adolescent in selecting clothing that looks stylish but still hides the brace is one of the best ways to help this client. Telling her she looks fine, to be confident, or bringing up the times she has been embarrassed does not help the client.

The nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse? "The newer braces only have to be worn while the child is asleep and don't have to be worn at school." "The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be." "Unfortunately, bracing is the only option for treating this disorder. I'm sure your child will get used to it after a few weeks." "Braces have been replaced with surgical intervention. Your child will only wear a brace for a few weeks after the surgery."

"The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be." Explanation: Bracing is the primary treatment for scoliosis. The braces used today are designed by computer-aided techniques and fit under the arms rather than extending to the neck. Braces must be worn 23 hours a day. Surgical intervention is only performed in severe cases.

The nurse is teaching the parents of a 6-year-old child prescribed vitamin D3 therapy. What will the nurse include in the teaching? "This is given to assist with building bone and keeping bone strong." "It can be taken with other supplements containing magnesium." "Take a second dose if a previous dose is missed." "Other supplements of vitamin D can be taken as desired."

"This is given to assist with building bone and keeping bone strong." Explanation: The nurse should include the statement, "This is given to assist with building bone and keeping bone strong." The statement, "It can be taken with other supplements containing magnesium," should not be included in the teaching because it is not recommended to take other products containing magnesium such as supplements and antacids. "Take a second dose if a previous dose is missed," is not a statement that should be included in the teaching, because it is not recommended to double the dose if a previous dose is missed. The nurse should not include the statement, "Other supplements of vitamin D can be taken as desired," because vitamin D is fat soluble and can build up in the body; therefore, the child should avoid other supplements containing vitamin D.

A 13-year-old adolescent is being treated for scoliosis with a brace. During the first follow-up appointment after the brace was initiated, which statement by the adolescent indicates the need for further instruction? "I check my brace daily to make sure there is no damage or change to it." "I leave my brace on for gym at school." "When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." "I wear a t-shirt under my brace." "I do exercises after school."

"When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." Explanation: Scoliosis refers to the lateral curvature of the spine. There are differing types of the condition. Mild-to-moderate curvatures can be managed by a brace. The brace is worn daily for all activities other than bathing. Clients should remove the brace for only 1 hour each day. Exceeding this time with the brace off will impair the therapeutic effects of the bracing treatment. During the time the brace is off, hygiene activities such as bathing should be done. It is important to check the brace for any damage daily to prevent injury. For comfort, a lightweight t-shirt may be worn under the brace.

Which child is at highest risk for Ewing sarcoma? 15-year-old male who reports dull bone pain just below the knee 13-year-old female who reports intermittent pain located in the pelvis 3-year-old male whose parents note a mass on the child's neck 4-year-old female whose parents note a mass on the child's abdomen

13-year-old female who reports intermittent pain located in the pelvis Explanation: Ewing sarcoma occurs most frequently in the pelvis or femur and is accompanied by a history for intermittent pain that progressively worsens, such as reported by the 13-year-old female client. Osteosarcoma occurs most frequently in adolescents and males and presents with dull bone pain that may be present for several months, eventually progressing to limp or gait changes, such as reported by the 15-year-old male client. Rhabdomyosarcoma is a soft tissue tumor most commonly located in the head and neck, genitourinary tract, and extremities. Diagnosis is usually made between 2 and 5 years of age, with the majority of all rhabdomyosarcomas diagnosed by age 10 years. The child or parent will often discover an asymptomatic mass and seek medical attention at that time. Wilms tumor most commonly occurs between the ages of 2 and 5 years. Parents typically initially observe the abdominal mass associated with Wilms tumor.

A child with acute myeloblastic leukemia is scheduled to have a bone marrow transplant (BMT). The donor is the child's own umbilical cord blood that had been previously harvested and banked. What type of BMT would this be? a. Autologous b. Allogeneic c. Syngeneic d. Stem cell

ANS: A In an autologous transplant, the child's own marrow or previously harvested and banked cord blood is used. In an allogeneic BMT, histocompatibility has been matched with a related or unrelated donor. In a syngeneic transplant, the child receives bone marrow from an identical twin. A stem cell transplantation uses a unique immature cell present in the peripheral circulation.

4. Which nursing diagnosis is a priority for the 4-year-old child newly diagnosed with leukemia? a. Ineffective breathing pattern related to mediastinal disease b. Risk for infection related to immunosuppressed state c. Disturbed body image related to alopecia d. Impaired skin integrity related to radiation therapy

ANS: B Leukemia is characterized by the proliferation of immature white blood cells, which lack the ability to fight infection. An ineffective breathing pattern related to mediastinal disease would apply to a child with non-Hodgkins lymphoma or any cancer involving the chest area. Disturbed body image related to alopecia is a nursing diagnosis related to chemotherapy, but it is not of the highest priority. Not all children have a body image disturbance as a result of alopecia, especially not preschoolers. This would be of more concern to an adolescent. Radiation therapy is not a treatment for leukemia.

The nurse should base a response to a parents question about the prognosis of acute lymphoblastic leukemia (ALL) on which information? Leukemia is a fatal disease although chemotherapy provides increasingly longer periods of a. remission b. Research to find a cure for childhood cancers is very active. The majority of children go into remission and remain symptom free when treatment is c. complete d. It usually takes several months of chemotherapy to achieve a remission.

ANS: C Children diagnosed with the most common form of leukemia, ALL, can almost always achieve remission, with a 5-year disease-free survival rate approaching 85%. With the majority of children surviving 5 years or longer, it is inappropriate to refer to leukemia as a fatal disease. Although research to find a cure for childhood cancers is very active, it does not address the parents concern. About 95% of children achieve remission within the first month of chemotherapy. If significant numbers of blast cells are still present in the bone marrow after a month of chemotherapy, a new and stronger regimen is begun.

What should the nurse teach parents about oral hygiene for the child receiving chemotherapy? a. Brush the teeth briskly to remove bacteria. b. Use a mouthwash that contains alcohol. c. Inspect the childs mouth daily for ulcers. d. Perform oral hygiene twice a day.

ANS: C The childs mouth is inspected regularly for ulcers. At the first sign of ulceration, an antifungal drug is initiated. The teeth should be brushed with a soft-bristled toothbrush. Excessive force with brushing should be avoided because delicate tissue could be broken, causing infection or bleeding. Mouthwashes containing alcohol may be drying to oral mucosa, thus breaking down the protective barrier of the skin.

When reviewing information about the incidence of the various types of childhood cancer, nursing students demonstrate understanding of the information when they identify which type as having the highest incidence? Neuroblastoma Osteogenic sarcoma Non-Hodgkin lymphoma Acute lymphoblastic leukemia (ALL)

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

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which abnormality associated with this oncologic emergency?Hypokalemia Hypouricemia Hypocalcemia Hypophosphatemia

C TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.

A patient with tumor lysis syndrome is taking allopurinol. Which laboratory value should the nurse monitor to determine the effectiveness of this medication? A. BUN B. Serum Phosphate C. Serum Potassium D. Uric Acid Levels

D. Allopurinol is used to decrease uric acid levels. BUN, Potassium and phosphate levels are increased in TLS but are not affected by allopurinol therapy

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

Children's cancers, unlike those of adults, often are detected accidentally, not through screening. 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.

The nurse is caring for a child who fractured the arm in an accident. A cast has been applied to the child's right arm. Which action(s) should the nurse implement? Select all that apply. Document any signs of pain. Check capillary refill time in the both arms. Monitor the color of the nail beds in the right hand. Wear a protective gown when moving the child's arm. Wear sterile gloves when removing or touching the cast.

Document any signs of pain. Check capillary refill time in the both arms. Monitor the color of the nail beds in the right hand. Explanation: The most important function for the nurse in caring for a child in a cast is frequent neurovascular checks. The nurse should monitor for increased pain and edema, a pale or blue color to the extremities, skin coolness, numbness or tingling, poor capillary refill, and decreased pulse strength. Increased pain, especially unrelieved with pain medications, can indicate serious complications such as compartment syndrome. Wearing a gown or sterile gloves is unnecessary as the cast is not sterile.

An adolescent receiving chemotherapy has lost all hair and is sad about self-image. Which action should the nurse take to support this adolescent and involve the client in decision making? Encourage the adolescent to select hats or wigs to fit one's personality. Refer the adolescent to a peer support group. Have a Child Life specialist work with the adolescent. Support the adolescent's choice of comfortable clothing.

Encourage the adolescent to select hats or wigs to fit one's personality. Explanation: A positive body image is important, especially to an adolescent. It is important for the nurse to acknowledge the adolescent's feelings of sadness over the body changes caused by the illness. To help the adolescent have some power over the illness, the nurse should encourage the adolescent to choose wigs, hats, or scarves that fit his or her personality or even meet a goal of doing something the adolescent would not have dared to before. This could be a wig of different hair color or a big floppy hat with sequins. Whatever the choice, this gives the adolescent a feeling of being in control of the situation and able to make the decisions. Nurses should support the adolescent's choice of clothing. Most likely the adolescent will choose clothing for comfort. Loose clothing disguises weight loss or scarring while promoting self-esteem. Referring the adolescent to a support group or the help of a Child Life specialist are good interventions. Both will help the adolescent work through the feelings of loss, but neither gives the adolescent the ability to make decisions about outward appearance.

The family of a terminally ill client is asking about the benefits of hospice care. Which statement by the nurse provides accurate information? Hospice is designed to meet the individual client's needs. Hospice uses alternative therapies to find a cure for the illness. Hospice is a separate care area located within a hospital setting. Hospice is designed to focus on supporting families of clients who are ill.

Hospice is designed to meet the individual client's needs. Explanation: The focus of hospice care is to meet the needs and wishes of the dying client. They also work closely with the caregivers to help support them, but caregivers are not the only recipient of care. Hospice care is not designed to find cures. Hospice is not a separate area in a hospital, though some hospitals do contain hospice centers.

When providing care to a dying child and his family, which would be most important? Focusing on the family as the unit of care. Teaching the family appropriate care measures. Offering the child support and encouragement. Assisting the parents in decision making.

Focusing on the family as the unit of care. Explanation: When caring for a dying child and his family, the most important aspect of care is focusing on the family as the unit of care. Teaching, offering support, and assisting in decision-making are important, but these actions must be implemented while focusing on the family as the unit of care.

A 15-year-old boy has been diagnosed with an osteogenic sarcoma of the distal femur. He also demonstrates a chronic cough, dyspnea, and chest pain, along with chronic leg pain. Based on these findings, the nurse should suspect metastasis to which body area? Lungs Heart Brain Rib cage

Lungs Explanation: Metastasis occurs early with bone tumors because of the extensive vascular system in bones. Metastasis to the lungs is very common; as many as 25% of adolescents will have lung metastasis already by the time of initial diagnosis. When this is present, the adolescent usually has noticed a chronic cough, dyspnea, and chest pain in addition to chronic leg pain. Other common sites of metastasis are brain and other bone tissue.

A 12-year-old child is suspected of having Hodgkin lymphoma. When preparing the child and family for diagnostic testing, which test would the nurse describe as being used to confirm the diagnosis? 24-hour urine test Lymph node biopsy Chest computed tomography Liver function tests

Lymph node biopsy Explanation: Hodgkin lymphoma is confirmed by biopsy of the lymph nodes. Further studies such as bone marrow analysis, liver function tests, chest and abdominal computed tomography scans, lymphangiography, and abdominal biopsy are done to classify the clinical stage of the disorder.

The child is recovering from multiple leg fractures in Buck extension traction and reports pain out of proportion to the injury. The child's parent reports that the pain is unrelieved by the opioid treatment. Which action will the nurse perform first? Notify the health care provider. Increase the elevation of the affected limb. Administer an additional dose of opioids as prescribed. Remove the limb from the traction apparatus.

Notify the health care provider. Explanation: The nurse will notify the health care provider first, because pain out of proportion to the injury which is unrelieved by opioids is often the first and cardinal sign of compartment syndrome, a medical emergency. Adjusting the position of the limb, additional opioid therapy, and removing the limb from the traction device may be performed later in the child's plan of care.

The nurse is assessing a 3-year-old boy whose mother reports that he is listless and has been having trouble swallowing. Which finding suggests the child may have a brain tumor? Observation reveals nystagmus and head tilt. Vital signs show blood pressure measures 120/80 mm Hg. Examination shows temperature of 101.4° F (38.6°C) and headache. Observation reveals a cough and labored breathing.

Observation reveals nystagmus and head tilt. Explanation: Coupled with the mother's reports, observation of nystagmus and head tilt suggest the child may have a brain tumor. Elevated blood pressure of 120/80 mm Hg may be indicative of Wilms tumor. Fever and headaches are common symptoms of acute lymphoblastic leukemia. A cough and labored breathing points to rhabdomyosarcoma near the child's airway.

A nurse is conducting an assessment of a 13-month-old infant. The parent notes that the infant cannot pull oneself into a standing position. To help determine a cause, which assessment will the nurse conduct? Elicit a Babinski sign. Perform a Weber test. Observe symmetry of gluteal skin folds. Palpate the anterior fontanel (fontanelle).

Observe symmetry of gluteal skin folds. Explanation: An infant can pull oneself to a standing position, generally by 10 months of age, and begins walking, generally by 15 months of age. If these developmental milestones are not reached, then physical and neurological symptoms should be assessed. One common physical reason for not standing or walking is developmental dysplasia of the hip. The nurse can easily assess if this is a contributing factor by observing the symmetry of the gluteal folds. If the folds are unequal, the finding should be reported to the health care provider for further evaluation. The Weber test is a test for hearing. The Babinski test determines neurological impairment and would be present until 18 months of age. Assessing the anterior fontanel (fontanelle) would determine if it is closed prematurely or bulging, which indicates a neurological disorder.

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

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. 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.

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

Protect 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 10-year-old child in traction. After performing a skin assessment, she notices that the skin over the calcaneus appears slightly red and irritated. What should be the first intervention? Gently massage his foot and heel each shift. Apply lotion to his foot and avoid friction to the area. Make sure the skin and linens are clean and dry. Reposition the child's foot on a pressure-reducing device.

Reposition the child's foot on a pressure-reducing device. Explanation: The nurse's first action is to remove continuous pressure from this area. The other actions can help decrease the potential for skin breakdown, but the pressure must be relieved first.

A 5-year-old client has been diagnosed with leukemia and is currently on chemotherapy and radiation. The child is having difficulty due to mucositis. Which is the most appropriate nursing diagnosis for this child? Pain due to neoplastic process in bone Disturbed body image related to loss of hair after chemotherapy Compromised family coping related to long-term chemotherapy regimen Risk for imbalanced nutrition, less than body requirements, related to inflammatio

Risk for imbalanced nutrition, less than body requirements, related to inflammation Explanation: Mucositis is inflammation of the oral mucosa, which puts this child at risk for risk for imbalanced nutrition. The client may have pain due to neoplastic process in the bone, but that is not mentioned in the scenario. The client may have lost hair, but that is not mentioned. The client's family coping is also not mentioned.

The nurse is assessing a 4-year-old girl whose mother reports that she is not eating well, is losing weight, and has started vomiting after eating. Which risk factor from the health history suggests the child may have a Wilms tumor? The child has Down syndrome. The child has Beckwith-Wiedemann syndrome. The child has Schwachman syndrome. There is a family history of neurofibromatosis.

The child has Beckwith-Wiedemann syndrome. 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 Wilms 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 myeloid leukemia.

A nurse is providing teaching to a child receiving chemotherapy and the parents. The nurse determines that the teaching was successful when the parents state that they will contact the primary health care provider if which occurs? The child has no appetite because of nausea. The child has increased urinary output or vomiting. The child has redness or swelling at the central venous access site. The child has a bruise on the arm.

The child has redness or swelling at the central venous access site. Explanation: The family should contact the health care provider if the child exhibits redness, swelling, or leakage at the central venous access site; or if the device has cracks, is pulled out, or does not flush. Loss of apetite, increased urinary output and vomitting, and bruising are expected adverse effects. The parent only need contact the health care provider if these effects become excessive.

The nurse is caring for 9-year-old boy undergoing chemotherapy whose complete blood count (CBC) with differential reports 7% banded and 13% segmented neutrophils with a white blood cell count of 2,540. He has an oral temperature of 38.6°C (101.5°F). Which intervention would be the priority? administering prescribed broad-spectrum IV antibiotics monitoring his vital signs every 4 hours restricting visitors with symptoms of infection assessing for signs of infection every 8 hours

administering prescribed broad-spectrum IV antibiotics Explanation: The priority intervention for this child is administering prescribed broad-spectrum IV antibiotics. His absolute neutrophil count (ANC; calculated by adding the bands and segs [21%] and then multiplying this [0.20] by the white blood cell count [2540] to yield an ANC of 508) indicates he has neutropenia and his temperature indicates he may have an infection. Monitoring vital signs, restricting visitors with symptoms of infection, and assessing for signs of infection are valid interventions related to neutropenia but are of lesser importance at this point.

A nurse is caring for a teenager who is in the end stage of cancer. Which of the following nursing interventions provides self-esteem and self-worth to the teen? listening to the adolescent's fears about death encouraging the teenager to talk about feelings allowing the teenager to completely participate in decisions answering all of the teenager's questions

allowing the teenager to completely participate in decisions Explanation: The adolescent stage of development thrives on feelings of self-worth and self-control. Allowing the adolescent to be involved in the care and decisions will increase self-esteem.

A child is to receive radiation therapy this morning. The nurse would expect to see which type of drug prescribed to this child? antiemetic antipyretic analgesic antineoplastic

antiemetic 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.

The mother of a 9-year-old boy brings the boy to the clinic for an evaluation because he has a fever. The history reveals a recent trauma to the knee. The nurse inspects the joint. Which of the following would lead the nurse to suspect osteomyelitis? Select all that apply. coolness of the area pain on palpation drainage from the area localized tenderness edema of the area

edema of the area localized tenderness pain on palpation Explanation: With osteomyelitis, physical examination of the affected area reveals localized tenderness, redness, warmth, and pain on palpation of the area. Occasionally, children have soft-tissue swelling around the area. With the involvement of lower extremities, a limp or a refusal to walk is seen in approximately half of pediatric patients.

The nurse is assessing a group of early adolescents for scoliosis. One of the teenagers asks the nurse what will be done. The nurse explains that which of the following will be included in the assessment? Select all that apply. examination of the shoulder blades for symmetry examination of leg length examination of the hips for symmetry examination of the shoulders for symmetry examination of the spine for curvature

examination of the shoulder blades for symmetry examination of the hips for symmetry examination of the shoulders for symmetry examination of the spine for curvature Explanation: Leg length is not affected by scoliosis, but may appear so because of asymmetry of hips. The other responses are part of the assessment for scoliosis.

A school nurse is teaching a group of parents about signs and symptoms of cancer in children. Which symptom is an early sign of a brain tumor? headache, vision changes, and vomiting projectile vomiting, lethargy, and coma headache, epistaxis, and dizziness nystagmus, ataxia, and seizures

headache, vision changes, and vomiting Explanation: Children with any form of brain tumor develop symptoms of increased intracranial pressure: headache, vision changes, vomiting, an enlarging head circumference, or papilledema. Lethargy, projectile vomiting, and coma are late signs. Epistaxis is not usually related to a brain tumor. A growing tumor produces specific localized signs, such as nystagmus (constant horizontal movement of the eye) or visual field defects. As tumor growth continues, symptoms of ataxia, personality change (e.g., emotional lability, irritability), and seizures may occur. These would be later symptoms.

The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding? lordosis idiopathic scoliosis sway back kyphosis

idiopathic scoliosis Explanation: Idiopathic scoliosis is an S-shaped curvature of the spine. Kyphosis is an outward curvature of the cervical spine. Lordosis is an inward curving of the lumbar spine. Sway back is another term used for lordosis.

A child with cancer has developed neutropenia and is in isolation with neutropenic precautions. What nursing assessment takes priority for this child? infection symptoms vital signs mucositis bleeding

infection symptoms Explanation: The neutrophils are the primary means of fighting bacterial infection. When the neutrophil count is very low, the child has the potential to have an overwhelming bacterial infection. The child is at the greatest risk when the neutrophil count is less than 500/µL (0.50 ×109/L). The nurse's priority would be to assess for signs and symptoms of infection. A bacterial infection can be life-threatening for this child. This child would be placed in neutropenic precautions. This is a form of isolation where the child is protected from health care workers and outside visitors. Among other precautions, no plants or raw fruits or vegetables would be allowed in the room, and the child should have no rectal examinations or medications and not experience a urinary catheterization. To prevent an infection, the nurse would administer broad spectrum antibiotics. The vital signs should be assessed every 4 hours, and alterations could indicate more problems than just infection. Mucositis occurs when there is an ulcerated oral mucosa. It should be assessed but is not the priority. Bleeding would be more related to low platelet count and not neutrophils.

The nurse is caring for a child with a broken wrist that has just been placed in a cast. The nurse would elevate the arm to: discourage infection. ensure proper bone alignment. promote healing. prevent edema.

prevent edema. Explanation: Edema tends to be dependent. Elevating the arm, therefore, would reduce swelling from the injury. Elevation of the arm would not promote healing or discourage infection. The cast will maintain proper bone alignment.

A 5-year-old child is at the pediatric clinic for a well-child visit. Which symptom alerts the health care provider that this child might have acute lymphoblastic leukemia (ALL)? joint pain and swelling anorexia and weight loss abdominal pain, nausea, and vomiting lethargy, bruises, and lymphadenopathy

lethargy, bruises, and lymphadenopathy Explanation: Although all of these symptoms could be related to leukemia, the most likely are lethargy, bruises, and lymphadenopathy. Joint pain and swelling could also be juvenile arthritis or another disorder. Anorexia and weight loss are fairly nonspecific, as is abdominal pain, nausea, and vomiting. With ALL, because the bone marrow overproduces lymphocytes and therefore is unable to continue normal production of other blood components, the first symptoms of ALL in children usually are those associated with decreased RBC production (anemia) such as pallor, low-grade fever, and lethargy. A low thrombocyte (platelet) count will lead to petechiae and bleeding from oral mucous membranes and cause easy bruising on arms and legs. As the spleen and liver begin to enlarge from infiltration of abnormal cells, abdominal pain, vomiting, and anorexia occur. As abnormal lymphocytes invade the bone periosteum, the child experiences bone and joint pain. Central nervous system (CNS) invasion leads to symptoms such as headache or unsteady gait. On physical assessment, painless, generalized swelling of lymph nodes is revealed.

Children with acute lymphoblastic leukemia (ALL) may need periodic lumbar punctures. The nurse would teach the parent that this is done to assess for: platelets. leukemic cells. early meningitis. early development of septicemia.

leukemic cells. Explanation: Acute lymphoblastic leukemia (ALL) is a rapidly progressive cancer affecting the undifferentiated or immature cells. It is the most common form of cancer in children. Throughout the course of the disease and treatment the child will be tested regularly for complete blood counts, bone marrow aspirations, lumbar punctures, and testing for renal and liver function. Lumbar punctures are performed to determine if leukemic cells have infiltrated the central nervous system. The white blood cells, temperature, and other symptoms would be indicative of meningitis and septicemia. The platelet count would be assessed for the possibility of bleeding.

The nurse is admitting an 8-year-old client diagnosed with a metastatic brain tumor. When the client's 5-year-old sibling becomes loud and distracting, the nurse identifies this behavior as: egocentric behavior. sibling jealousy. temper tantrum. normal behavior.

sibling jealousy. Explanation: The sibling is displaying jealousy and a desire for the parent's attention. Though the sibling understands there is an illness, the child still has a need for parental attention and feels angry about disruptions in the family. Toddlers experience temper tantrums and egocentric behavior, not preschoolers. Five-year-olds are able to follow directions and behave in a hospital setting.

The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myeloid leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately? earache, stiff neck, or sore throat blisters, ulcers, or a rash appear temperature of 101°F (38.3°C) or greater difficulty or pain when swallowing

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/pain when swallowing) are reasons to seek medical care, but are not as grave as the risk of infection.

A child is diagnosed with osteogenic sarcoma. The nurse is preparing a teaching plan for the child that addresses the treatment options. Which information the nurse most likely include? Select all that apply. tumor removal limb salvage amputation chemotherapy radiation therapy

tumor removal limb salvage amputation chemotherapy Explanation: After diagnosis has been confirmed, surgical intervention is a vital treatment for children with osteogenic sarcoma. Tumor removal, limb salvage procedures, and amputation are all viable surgical options. In addition, chemotherapy is also used, playing a substantial role in improving survival rates. Radiation therapy is not commonly used for osteogenic sarcoma.

The school nurse is providing information to parents of adolescents about prevention of cervical cancer. Which information is included in the teaching? Papanicolaou tests for adolescent girls abstinence from sexual intercourse vaccine against human papillomavirus (HPV) use of condoms for sexually active teens

vaccine against human papillomavirus (HPV) Explanation: Reminding parents that both boys and girls should receive the vaccine against HPV is an important preventive measure to reduce the incidence of cervical cancer. Papanicolaou tests are not recommended until age 21. Abstinence from intercourse and use of condoms will help, but do not prevent exposure through other sexual contact.

The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse? "Itching is common. It's nothing to worry about." "Blowing cool air with a fan or hair dryer may relieve the feeling." "You can put a pencil or coat hanger and scratch the area but don't let your child put anything down the cast without you there." "A small amount of lotion or baby oil can be poured in the cast to moisturize the area."

"Blowing cool air with a fan or hair dryer may relieve the feeling." Explanation: Itching is a common report, but just stating this does not address the entire situation. The suggestion of blowing cool air is the best answer. Clients should never put anything in a cast to scratch. Lotion may be applied to the skin above or below a cast but should never be poured into a cast.

A nursing student asks one of the nurses on the unit, "What exactly is palliative care?" Which response by the nurse would be most accurate? "Palliative care can coexist with other treatment that is focused on a cure, stabilization of a disease process, or prolongation of life." "Palliative care is essentially "giving up" on providing any further treatment of a client" "Palliative care focuses primarily on a cure, stabilization of a disease process, or prolongation of life." "Palliative care is provided for clients who are dying and want no other form of treatment of any kind."

"Palliative care can coexist with other treatment that is focused on a cure, stabilization of a disease process, or prolongation of life." Explanation: Palliative care can coexist with treatments that cure, prolong life, or stabilize a client's disease process. Palliative care does not involve giving up; it recognizes that not all clients will be cured and offers quality of life, not quantity. Palliative care can benefit all clients.

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

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.

A patient with metastatic breast cancer who received chemotherapy treatment 2 days ago presents back to the hospital with flank pain and oliguria. Which acute disorder does the nurse suspect the patient has? A. Disseminated Intravascular Coagulation B. Tumor lysis syndrome C. Graft vs. Host disease D. Sepsis

B. Rationale: TLS causes a build up of uric acid which inundates the kidneys causing crystals to form in the renal tubules leading to acute kidney failure which has the symptom so flank pain and oliguria. TLS is most likely to occur 48-72 hours after chemotherapy treatment and is most common in aggressive forms of cancer

The nurse is providing care to a child who is nearing death. Which of the following would be most important for the nurse to keep in mind when communicating with the child? Communication can be key in helping to meet the psychological needs of the dying child. Most dying children do not realize the extent of their sickness and need to be told. Most children who are dying do not wish or need to talk to others about it. Children will initiate a conversation on dying if they wish to speak about it.

Communication can be key in helping to meet the psychological needs of the dying child. Explanation: Communication can work out unresolved issues, discover fears, and help a child make plans. Dying children are usually aware of their illness and the fact that they are dying. Not talking about these issues actually adds to the child's burdens because he or she must then expend energy to leave this very important topic out of conversations. If their impending death is not discussed, children do not always initiate the discussion because they sense that doing so will make their parents sad.

The nurse is instructing the mother of a school-age child with a leg cast about cast care at home. What should the nurse include in this teaching? Select all that apply. Cover the cast with a plastic bag to bathe. Recommend using magic markers for autographs. Remind the mother that nothing is to be put down the cast. Encourage usual activities but restrict strenuous actions. Use the cool setting on a hair dryer to ease itchy skin.

Cover the cast with a plastic bag to bathe. Remind the mother that nothing is to be put down the cast. Use the cool setting on a hair dryer to ease itchy skin. Encourage usual activities but restrict strenuous actions. Explanation: When teaching the mother about cast care at home, the nurse should include covering the cast with a plastic bag while bathing so the cast does not get wet; not placing anything down the cast; using the cool setting on a hair dryer to ease itching; and encourage usual activities but reducing strenuous activities while the cast is in place. Magic markers should not be used for autographs because the ink can seep into the cast material.

The pediatric nurse examines the radiographs of a client that indicate lesions on the bone. This finding is indicative of: Ewing sarcoma. Hodgkin disease. non-Hodgkin lymphoma. neuroblastoma.

Ewing sarcoma. Explanation: Radiographs that show lesions on the bone may indicate tumors (e.g., Ewing sarcoma, osteosarcoma) or metastasis of tumors. Osteosarcoma is the most common type of bone malignancy in children. It occurs primarily in the long bones. Ewing sarcoma is a highly malignant bone cancer. It occurs in the pelvis, chest wall, vertebrae, and midshaft of the long bones. Neuroblastomas are seen in children younger than 5 years old and arise from immature nerve cells and the adrenal glands. Hodgkin disease develops from the immune system. Non-Hodgkin lymphoma is a blood cancer.

A client and family have just been told that the child has a malignant brain tumor that appears inoperable. Which nursing intervention would be most beneficial to this family and client? Tell them that they should try curative care first. Explain that death is possible and offer curative and palliative care together. Tell them that the future looks difficult. Inform them honestly that others have died from this same disease.

Explain that death is possible and offer curative and palliative care together. Explanation: It is difficult to ask families to abruptly switch from curative-intent therapy to comfort care. It is helpful if healthcare professionals explain early within the illness that death is possible and thus offer curative and palliative care simultaneously. The nurse should not start by saying the future looks difficult because this is not therapeutic. The family does not need to be informed at this time that many others have died. This is not compassionate or therapeutic.

A 14-year-old adolescent with Hodgkin disease is experiencing difficulty breathing and is sent for a radiograph. Which finding should the nurse expect to see on the x-ray report? Mediastinal mass Retinoblastoma Lymphadenopathy Tumor in the liver

Mediastinal mass Explanation: Difficulty breathing or respiratory distress may indicate a mediastinal mass (which may be seen on a radiograph) in the client with Hodgkin disease. Hepatomegaly or splenomegaly may occur when there is advanced disease. Lymphadenopathy is present in the cervical and supraclavicular nodes. These could be palpated and do not require an x-ray to diagnose. Presence of a white reflection in the pupil of the eye may indicate retinoblastoma.

A 14-year-old adolescent with Hodgkin disease is experiencing difficulty breathing and is sent for a radiograph. Which finding should the nurse expect to see on the x-ray report? Mediastinal mass Retinoblastoma Lymphadenopathy Tumor in the liver

Mediastinal mass Explanation: Difficulty breathing or respiratory distress may indicate a mediastinal mass (which may be seen on a radiograph) in the client with Hodgkin disease. Hepatomegaly or splenomegaly may occur when there is advanced disease. Lymphadenopathy is present in the cervical and supraclavicular nodes. These could be palpated and do not require an x-ray to diagnose. Presence of a white reflection in the pupil of the eye may indicate retinoblastoma.

The nurse is preparing to administer epoetin alpha to a child undergoing chemotherapy. What consideration(s) will the nurse take into account when administering this therapy? Select all that apply. Monitor hemoglobin levels. Administer according to the individual dosing plan. Monitor for skin rash. Monitor liver enzymes. Begin the administration 1 to 2 days before the next dose of chemotherapy.

Monitor hemoglobin levels. Administer according to the individual dosing plan. Explanation: The nurse will monitor hemoglobin levels and administer according to the individual dosing plan when administering epoetin alfa to a child undergoing chemotherapy. Monitoring for skin rash and liver enzymes, as well as administering the medication 1 to 2 days before the next dose of chemotherapy, are nursing considerations that should be taken for allopurinol, not epoetin alpha.

The pediatric nurse is explaining to a new graduate nurse the differences in planning well-child maintenance for a child with cancer. Which statement by the new nurse demonstrates understanding of the teaching? No routine live vaccines are administered while on chemotherapy. Siblings and parents should not receive nonlive vaccines. Growth may be stunted due to chemotherapy. Eliminate second-hand smoke within the home.

No routine live vaccines are administered while on chemotherapy. Explanation: Children with cancer need much of the same well-child maintenance care that all children do, with one exception. While they are undergoing chemotherapy, which causes a decreased immune response, they should not receive "routine" vaccines, especially live vaccines. The siblings in the home can receive all nonlive vaccines, and the entire family (including the child undergoing treatment) is encouraged to receive a yearly flu vaccine. Growth and development are monitored during well-child visits, but it is not necessarily true that growth and development may be stunted. It is always a good idea to eliminate second-hand smoke for all children, not just for children with cancer. Childhood cancers do not seem to be related to environmental contaminants.

Which symptom would lead the nurse to suspect that a child is developing a common side effect of vincristine? The cheeks are turning bright red. The child says the fingertips feel numb. The child says the teeth "ache." The child's hearing seems to be altered.

The child says the fingertips feel numb. Explanation: Vincristine has a number of side effects. Myelosuppression occurs,, which can cause decreased blood counts, hemorrhage, and anemia. A common side effect of vincristine is numbness and tingling in the hands and feet. Allopurinol is administered when the child is receiving vincristine, because the dying cancer cells cause increased uric acid. A side effect of the allopurinol is blistering, peeling, and red skin rash. With both of the drugs the child should be properly hydrated to prevent side effects. Toothache and hearing loss are symptoms of side effects of other chemotherapeutic agents, but not vincristine.

A 14-year-old male is brought to the ER by his parents with a suspected fracture of the arm sustained while playing soccer. An x-ray shows a comminuted fracture. Which of the following best describes this type of fracture? A line crosses the shaft at a 90º angle. There are three or more fracture fragments. There is a diagonal line across the bone. The bone is bent, but not broken.

There are three or more fracture fragments. Explanation: In a comminuted fracture there are three or more fracture fragments. With a transverse fracture, a line crosses the shaft at a 90º angle. In an oblique fracture, there is a diagonal line across the bone. With a greenstick fracture, the bone is bent, but not broken.

A nurse is caring for a terminally ill 7-year-old child who is hospitalized and is wishing to go home. What type of referral will allow the child to receive care at home? hospice care clergy/pastoral care home health care respite care

hospice care Explanation: Many children in terminal stages of disease are cared for at home with hospice care. Hospice care is supportive of both the client and family. Clergy/pastoral care assists the client and family with their spiritual needs. Hospice care is a form of home health care; however, hospice care nurses are trained in end-of-life care, which is needed for this family. Respite care provides periods of relief for families taking care of ill family members. Parents desire and are encouraged to be with their children during end-of-life care.

A child with cancer is dying and in hospice care. When developing the plan of care, which intervention should the nurse include as the primary focus? keeping the child pain-free managing the symptoms of dyspnea providing emotional support delivering appropriate developmental care

keeping the child pain-free Explanation: Children die from cancer. They may die at home or in the hospital, and hospice care can be provided in either setting. Children with terminal cancer often experience a great deal of pain, particularly when death is imminent. The primary goal of caring for a dying child is the prevention and alleviation of pain. The nurse would work with the parents to determine the pharmacologic and nonpharmacologic methods which work best. Many times, dyspnea and agitation can occur as a result of pain. These symptoms are reduced with pain management. Any care to the child, even in hospice care, should be developmentally appropriate. Emotional support is a necessity, both for the child and the parents, but pain relief is the priority.

A nurse is caring for a child with Hodgkin disease who is in the induction phase of a chemotherapy regimen. The nurse explains to the parents that the goal of this phase is to: destroy any remaining cancer cells. kill enough cancerous cells to induce remission. destroy any residual cancer cells. follow up for recurrent disease or late effects.

kill enough cancerous cells to induce remission. Explanation: During induction, the initial phase, intensive therapy is given to kill enough cancerous cells to induce a remission. In the consolidation phase, intensive therapy is given to destroy remaining cancer cells. The maintenance phase is a designated period during which treatment is continued to destroy any residual cancer cells. During the observation phase, therapy has ended and the child is followed up for recurrent disease or late effects of treatment.

The nurse is preparing a presentation for a parent group about childhood cancers, focusing on brain tumors in children younger than 14 years. Which type of tumor will the nurse include as one of the most common types in that age group? brain stem glioma medulloblastoma ependymoma pituitary

medulloblastoma Explanation: Brain tumors can occur anywhere within the brain. The most common types of tumors in children younger than 14 years old are pilocytic astrocytomas and medulloblastoma/primitive neuroectodermal tumors. In children older than 14 years, the most common types of tumors are pilocytic astrocytomas and pituitary tumors.