Peds Final

Which is the acceptable mg/dl level, or below this level, low-density lipoprotein (LDL) cholesterol level for a child from a family with heart disease? _____ Record your answer as a whole number.

ANS: 110

51. A toddler with leukemia is on intravenous chemotherapy treatments. The toddler's lab results are white blood cell count (WBC): 1000; neutrophils: 7%; nonsegmented neutrophils (bands): 7%. What is this child's absolute neutrophil count (ANC)? _____ Record your answer as a whole number.

ANS: 140 Step 1: 7% + 7% = 14%. Step 2: 0.14 ´ 1000 = 140 ANC.

The nurse is talking to the parents of a child with pediculosis capitis. Which should the nurse include when explaining how to manage pediculosis capitis?

"You will need to remove nits with an extra-fine tooth comb or tweezers."

Abdominal thrusts (the Heimlich maneuver) are recommended for airway obstruction in children older than:

1 year

The nurse is examining 12-month-old Amy, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions that cross the inguinal folds. This is most likely caused by:

Candida albicans.

An important nursing consideration when caring for a child with impetigo contagiosa is to:

Carefully wash hands and maintain cleanliness when caring for an infected child.

Cardiopulmonary resuscitation is begun on a toddler. Which pulse is usually palpated because it is the most central and accessible?

Carotid

The nurse should understand that Lyme disease is:the mycotic spores that cause the disease.

Caused by a spirochete that enters the skin through a tick bite.

Lymphangitis ("streaking") is frequently seen in:

Cellulitis

An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of:

Circulatory overload

The management of a child who has just been stung by a bee or wasp should include the application of:

Cool compresses.

Therapeutic management of nephrosis includes:

Corticosteroids

What is used to treat moderate-to-severe inflammatory bowel disease?

Corticosteroids

Which primary treatment will the nurse implement for a child with warts?

Corticosteroids

A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. While an airway is being established, what medication should the nurse prepare for immediate administration?

Epinephrine

Which nursing intervention is the highest priority in the initial care of a child with a major burn injury?

Establishing and maintaining the child's airway

Tretinoin (Retin-A) is a topical agent commonly used to treat acne. Nursing considerations with this drug include:

Explaining that medication should not be applied until at least 20 to 30 minutes after washing.

Ringworm, frequently found in schoolchildren, is caused by:

Fungus

An effective strategy to reduce the stress of burn dressing procedures is to:

Give the child as many choices as possible.

A toddler sustains a minor burn on the hand from hot coffee. The first action in treating this burn is to:

Hold the burned area under cool running water.

Which immunization should not be given to a child receiving chemotherapy for cancer?

Measles, rubella, mumps

The nurse is teaching parents of a 3-year-old with impetigo that they can anticipate:

No scarring.

Biologic dressings are applied to a child with partial-thickness burns of both legs. Nursing actions related to this include:

Observing wounds for signs of infection.

The nurse is caring for a 7-year-old with herpes simplex virus. Which prescribed medication should the nurse expect to be included in the treatment plan?

Oral antiviral agent

Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis?

Osler's nodes

What is the most common mode of transmission of human immunodeficiency virus (HIV) in the pediatric population?

Perinatal transmission

A child with pulmonary atresia exhibits cyanosis with feeding. On reviewing this child's laboratory values, the nurse is not surprised to notice which abnormality?

Polycythemia

A high-fiber food that the nurse could recommend for a child with chronic constipation is:

Popcorn

Herpes zoster is caused by the varicella virus and has an affinity for:

Posterior root ganglia and the posterior horn of the spinal cord.

The nurse is planning care for an adolescent with acquired immunodeficiency syndrome. The priority nursing goal is to:

Prevent infection

Nursing care of the infant with atopic dermatitis focuses on:

Preventing infection.

Fentanyl and midazolam (Versed) are given before debridement of a child's burn wounds. These drugs are important to:

Provide pain relief.

The primary clinical manifestation of scabies is:

Pruritus

A child experiences frostbite of the fingers after prolonged exposure to the cold. Which intervention would the nurse implement first?

Rapid rewarming of the fingers by placing in warm water

A child with extensive burns requires debridement. The nurse should anticipate that a priority goal related to this procedure is to:

Reduce pain.

The leading cause of death after heart transplantation is:

Rejection

An adolescent girl is cooking on a gas stove when her bathrobe catches fire. Her father smothers the flames with a rug and calls an ambulance. She has sustained major burns over much of her body. What is important in her immediate care?

Remove her burned clothing and jewelry

The viral pathogen that frequently causes acute diarrhea in young children is:

Rotavirus

Matt's mother tells the nurse that he keeps scratching the areas where he has poison ivy. The nurse's response should be based on knowing that:

Scratching the lesions may cause them to become secondarily infected.

A child has had cold symptoms for more than 2 weeks, a headache, nasal congestion with purulent nasal drainage, facial tenderness, and a cough that increases during sleep. The nurse recognizes that these symptoms are characteristic of which respiratory condition?

Sinusitis

A child steps on a nail and sustains a puncture wound of the foot. The most appropriate method for cleansing this wound is to:

Soak foot in warm water and soap.

Cellulitis is often caused by:

Streptococcus or Staphylococcus organisms

Several complications can occur when a child receives a blood transfusion. An immediate sign or symptom of an air embolus is:

Sudden difficulty in breathing.

A father calls the clinic nurse because his 2-year-old child was bitten by a black widow spider. The nurse should advise the father to:

Take the child to emergency department.

Which prescribed treatment should the nurse plan to implement for a child with psoriasis?

Tar and exposure to sunlight and ultraviolet light

The nurse is teaching parents of toddlers about animal safety. Which information should be included in the teaching session?

Teach your toddler not to disturb an animal that is eating.

Rocky Mountain spotted fever is caused by the bite of a:

Tick

To best assess the child with severe burns for adequate perfusion, the nurse monitors:

Urine output.

Which immunization should be given with caution to children infected with human immunodeficiency virus?

Varicella

The nurse should expect to assess which causative agent in a child who has warts?

Virus

The nurse is evaluating a child who is taking digoxin for her cardiac condition. The nurse is cognizant that a common sign of digoxin toxicity is:

Vomiting

An important consideration for the nurse when changing dressings and applying topical medication to a child's abdomen and leg burns is to:

Wash hands and forearms before and after dressing change.

A child falls on the playground and has a small laceration on the forearm. What should the school nurse do to cleanse the wound?

Wash wound gently with mild soap and water for several minutes.

Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should be based on knowing that:

a. The child needs opportunities to play with peers.

What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux?

a. The importance of taking prophylactic antibiotics

A nurse is conducting an in-service on asthma. Which statement is the most descriptive of bronchial asthma?

a. There is heightened airway reactivity.

In which situation is there the greatest risk that a newborn infant will have a congenital heart defect (CHD)? a. Trisomy 21 dete

a. Trisomy 21 detected on amniocentesis

When a child has chronic renal failure, the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as:

a. Uremia.

The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestations would be observed (Select all that apply)?

a. Vomiting c. Failure to gain weight f. Persistent diaper rash

What should the nurse recommend to prevent urinary tract infections in young girls?

a. Wearing cotton underpants

Which intervention should be included in the plan of care for an infant with the nursing diagnosis of Excess Fluid Volume related to congestive heart failure?

a. Weigh the infant every day on the same scale at the same time.

Nursing interventions for the child after a cardiac catheterization include which of the following (Select all that apply)?

ANS: C, F c. Assess the affected extremity for temperature and color. f. Maintain a patent peripheral intravenous catheter until discharge.

Isotretinoin (Accutane) is indicated for the treatment of acne during adolescence when:

Acne has not responded to other treatments.

The nurse is caring for a school-age child with a tinea capitis (ringworm) infection. The nurse should expect that therapeutic management for this child includes:

Administering oral griseofulvin.

A young boy will receive a bone marrow transplant (BMT). This is possible because one of his older siblings is a histocompatible donor. This type of BMT is termed:

Allogeneic

A child is admitted with extensive burns. The nurse notes that there are burns on the child's lips and singed nasal hairs. The nurse should suspect that the child has:

An inhalation injury.

A high-protein diet for the child with major burns is ordered to:

Avoid protein breakdown.

The nurse encourages the mother of a toddler with acute laryngotracheobronchitis to stay at the bedside as much as possible. The nurse's rationale for this action is primarily that:

b. The mother's presence will reduce anxiety and ease the child's respiratory efforts.

A 4-month-old infant has gastroesophageal reflux disease (GERD) but is thriving without other complications. What should the nurse suggest to minimize reflux?

b. Thicken formula with rice cereal.

An adolescent being seen by the nurse practitioner for a sports physical is identified as having hypertension. On further testing, it is discovered the child has a cardiac abnormality. The initial treatment of secondary hypertension initially involves:

b. Treating the underlying disease.

Which description of a stool is characteristic of intussusception?

c. "Currant jelly" stools

The nurse is teaching parents of a child with chronic renal failure (CRF) about the use of recombinant human erythropoietin (rHuEPO) subcutaneous injections. Which statement indicates the parents have understood the teaching?

c. "The red blood cell count should begin to improve with these injections."

The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching?

c. "You will need to avoid adding salt to your child's food."

A preschool child is scheduled for an echocardiogram. Parents ask the nurse whether they can hold the child during the procedure. The nurse should answer with which response?

c. "Your child must lie quietly; sometimes a mild sedative is administered before the procedure."

Which child should the nurse document as being anemic?

c. 14-year-old child with a hemoglobin of 10 g/dL

For what clinical manifestation should a nurse be alert when suspecting a diagnosis of esophageal atresia?

c. A nasogastric tube fails to pass at birth.

Which condition is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ T-cells?

c. Acquired immunodeficiency syndrome (AIDS)

When teaching the mother of a 9-month-old infant about administering liquid iron preparations, the nurse should include that:

c. Adequate dosage will turn the stools a tarry green color.

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. The most appropriate nursing action to prevent or minimize these reactions with subsequent treatments is to:

c. Administer an antiemetic before chemotherapy begins.

An important nursing consideration when chest tubes will be removed from a child is to:

c. Administer analgesics before the procedure.

An important nursing consideration when suctioning a young child who has had heart surgery is to:

c. Administer supplemental oxygen before and after suctioning.

It is generally recommended that a child with acute streptococcal pharyngitis can return to school:

c. After taking antibiotics for 24 hours.

When assessing a child for possible congenital heart defects (CHDs), where should the nurse measure blood pressure?

c. All four extremities

A child is diagnosed with influenza, probably type A disease. Management includes:

c. Amantadine hydrochloride to reduce symptoms.

Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies, which are now being successfully treated with antihistamines. The nurse should suspect that the constipation is most likely caused by:

c. Antihistamines.

Which defect results in increased pulmonary blood flow?

c. Atrial septal defect

The nurse is explaining to a parent how to care for a child with vomiting associated with a viral illness. The nurse should include:

c. Brushing teeth or rinsing mouth after vomiting.

What is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures?

c. Congestive heart failure

Which clinical manifestations would the nurse expect to see as shock progresses in a child and becomes decompensated shock (Select all that apply)?

c. Cool extremities and decreased skin turgor d. Confusion and somnolence f. Tachypnea and poor capillary refill time

The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate?

c. Creatinine clearance

The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include (Select all that apply)?

c. Decreased urinary output d. Sweating (inappropriate) e. Fatigue

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which interventions should be included in the child's care (Select all that apply)?

c. Encourage infant to drink 8 ounces of formula every 4 hours. d. Institute cluster care to encourage adequate rest. e. Place on noninvasive oxygen monitoring.

The most appropriate nursing diagnosis for the child with acute glomerulonephritis is:

c. Excess Fluid Volume related to decreased plasma filtration.

The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT) may be necessary. What should the nurse recognize as important when discussing this with the family? continued.

c. Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.

A parasite that causes acute diarrhea is:

c. Giardia lamblia.

Children receiving long-term systemic corticosteroid therapy are most at risk for:

c. Growth delays.

The nurse is caring for a child after heart surgery. What should she or he do if evidence is found of cardiac tamponade?

c. Immediately report this to the physician.

Which statement best describes -thalassemia major (Cooley's anemia)?

c. Increased incidence occurs in families of Mediterranean extraction.

Which statement most accurately describes the pathologic changes of sickle cell anemia?

c. Increased red blood cell destruction occurs.

Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include:

c. Injecting deeply into a large muscle.

Which statement is most descriptive of Meckel's diverticulum?

c. Intestinal bleeding may be mild or profuse.

An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which route?

c. Intravenous infusion

The diet of a child with chronic renal failure is usually characterized as:

c. Low in phosphorus.

A 3-year-old child with Hirschsprung's disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child psychologically is:

c. Necessary because it will be an adjustment.

Which statement best characterizes hepatitis A?

c. Onset is usually rapid and acute.

Therapeutic management of the child with acute diarrhea and dehydration usually begins with:

c. Oral rehydration solution (ORS).

A clinical manifestation of the systemic venous congestion that can occur with congestive heart failure is:

c. Peripheral edema.

A nurse is teaching an adolescent about primary hypertension. The nurse knows that which of the following is correct?

c. Primary hypertension may be treated with weight reduction.

The nurse is planning activity for a 4-year-old child with anemia. Which activity should the nurse plan for this child?

c. Puppet play in the child's room

A histamine receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with gastroesophageal reflux. The purpose of this is to:

c. Reduce gastric acid production.

Which action by the school nurse is important in the prevention of rheumatic fever?

c. Refer children with sore throats for throat cultures.

During the first few days after surgery for cleft lip, which intervention should the nurse do?

c. Remove restraints periodically to cuddle infant.

It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because they may develop:

c. Slowed growth.

When caring for a child with probable appendicitis, the nurse should be alert to recognize that a sign of perforation is:

c. Sudden relief from pain.

A parent whose two school-age children have asthma asks the nurse in what sports, if any, they can participate. The nurse should recommend:

c. Swimming.

Which intervention for treating croup at home should be taught to parents?

c. Take the child outside.

What is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux?

c. Teach the parents how to do infant cardiopulmonary resuscitation (CPR).

What is the major focus of the therapeutic management for a child with lactose intolerance?

c. Teaching dietary modifications

A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery. The nurse instructs the parents to notify the physician if what conditions occur (Select all that apply)?

c. Temperature above 37.7° C (100° F) d. New, frequent coughing e. Turning blue or bluer than normal

Several blood tests are ordered for a preschool child with severe anemia. She is crying and upset because she remembers the venipuncture done at the clinic 2 days ago. The nurse should explain that:

c. Topical application of local anesthetic can eliminate venipuncture pain.

What is most descriptive of the pathophysiology of leukemia?

c. Unrestricted proliferation of immature white blood cells (WBCs) occurs.

The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis?

c. Visible peristalsis and weight loss

A major complication in a child with chronic renal failure is:

c. Water and sodium retention.

A nurse is conducting dietary teaching on high-fiber foods for parents of a child with constipation. Which foods should the nurse include as being high in fiber (Select all that apply)?

c. Whole grain breads d. Bran pancakes e. Raw carrots

As related to inherited disorders, which statement is descriptive of most cases of hemophilia?

c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient

An appropriate nursing intervention when caring for a child with pneumonia is to:

encourage rest

Nurses must be alert for increased fluid requirements when a child has:

fever

After the acute stage and during the healing process, the primary complication from burn injury is:

infection

What food choice by the parent of a 2-year-old child with celiac disease indicates a need for further teaching?

oatmeal

The most immediate threat to life in children with thermal injuries is:

shock

Which type of croup is always considered a medical emergency?

b. Epiglottitis

Which statement expresses accurately the genetic implications of cystic fibrosis (CF)?

a. If it is present in a child, both parents are carriers of this defective gene.

What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia?

a. Immobilization and elevation of the affected joint

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child will begin with:

a. Intravenous fluids.

Which should the nurse include when teaching parents about preventing childhood burn injuries (Select all that apply)?

a. Keep hot liquids out of reach. b. Baby-proof electrical outlets. e. Test water temperature before placing your child in the tub bath.

The best chance of survival for a child with cirrhosis is:

a. Liver transplantation.

The earliest recognizable clinical manifestation of cystic fibrosis (CF) is:

a. Meconium ileus.

Which statement best explains why iron deficiency anemia is common during toddlerhood?

a. Milk is a poor source of iron.

A mother calls the clinic nurse about her 4-year-old son who has acute diarrhea. She has been giving him the antidiarrheal drug loperamide (Imodium A-D). The nurse's response should be based on knowledge that this drug is:

a. Not indicated.

The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. The most appropriate nursing action is to:

a. Notify the practitioner.

The primary clinical manifestations of acute renal failure are:

a. Oliguria and hypertension.

The nurse is caring for an infant with congestive heart disease (CHD). The nurse should plan which intervention to decrease cardiac demands?

a. Organize nursing activities to allow for uninterrupted sleep.

A major clinical manifestation of rheumatic fever is:

a. Polyarthritis.

A preschool child is being admitted to the hospital with dehydration and a urinary tract infection (UTI). Which urinalysis result should the nurse expect with these conditions?

d. WBC >2; specific gravity 1.030

The nurse is administering an intravenous chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action?

a. Stop drug infusion immediately.

A young child with human immunodeficiency virus is receiving several antiretroviral drugs. The purpose of these drugs is to:

b. Delay disease progression.

One of the clinical manifestations of chronic renal failure is uremic frost. What best describes this term?

b. Deposits of urea crystals on skin

b-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. What is their action?

b. Dilate the bronchioles

Chelation therapy is begun on a child with -thalassemia major. The purpose of this therapy is to:

b. Eliminate excess iron

Which intervention is appropriate when examining a male infant for cryptorchidism?

d. Warming the room

A school-age child has been admitted to the hospital with an exacerbation of nephrotic syndrome. Which clinical manifestations should the nurse expect to assess (Select all that apply)?

b. Facial edema d. Fatigue e. Frothy-appearing urine

A child is admitted with acute glomerulonephritis. The nurse would expect the urinalysis during this acute phase to show:

b. Hematuria and proteinuria.

Which statements regarding hepatitis B are correct (Select all that apply)?

b. Hepatitis B can be prevented by hepatitis B virus vaccine. c. Hepatitis B can be transferred to an infant of a breastfeeding mother. d. The onset of hepatitis B is insidious. e. Immunity to hepatitis B occurs after one attack.

Which vaccine is now recommended for the immunization of all newborns?

b. Hepatitis B vaccine

Which clinical changes occur as a result of septic shock?

b. Increased cardiac output

The parent of a toddler calls the nurse, asking about croup. What is a distinguishing manifestation of spasmodic croup?

b. It has a harsh, barky cough.

Which statement is descriptive of renal transplantation in children?

b. It is preferred means of renal replacement therapy in children.

When preparing a school-age child and the family for heart surgery, the nurse should consider:

b. Letting child hear the sounds of an electrocardiograph monitor.

A child with cystic fibrosis is receiving recombinant human deoxyribonuclease (rhDNase). This drug:

b. May cause voice alterations.

The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke inhalation. What is essential in this child's care?

b. Monitor arterial blood gases.

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include:

b. Monitor pulse oximetry.

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease (Select all that apply)?

b. Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs. c. Give penicillin as prescribed. e. Notify the health care provider if your child begins to develop symptoms of a cold.

The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur. This finding is associated with which congenital heart defect?

b. Patent ductus arteriosus

Which consideration is the most important in managing tuberculosis (TB) in children?

b. Pharmacotherapy

The narrowing of preputial opening of foreskin is called:

b. Phimosis

The narrowing of the preputial opening of the foreskin is called:

b. Phimosis.

An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be to:

b. Place the child in the knee-chest position.

As part of the treatment for congestive heart failure, the child takes the diuretic furosemide. As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in:

b. Potassium.

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk of cerebrovascular accidents (strokes) exists. An important objective to decrease this risk is to:

b. Prevent dehydration.

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain that narcotic analgesics:

b. Rarely cause addiction because they are medically indicated.

An objective of care for the child with nephrosis is to:

b. Reduce excretion of urinary protein.

Which statement best describes why children have fewer respiratory tract infections as they grow older?

b. Repeated exposure to organisms causes increased immunity.

The nurse is caring for a child with aplastic anemia. Which nursing diagnoses are appropriate (Select all that apply)?

b. Risk for Infection related to inadequate secondary defenses or immunosuppression c. Ineffective Protection related to thrombocytopenia d. Ineffective Tissue Perfusion related to anemia

The diet of a child with nephrosis usually includes:

b. Salt restriction.

Which factor predisposes a child to urinary tract infections?

b. Short urethra in young girls

A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is:

b. Sickle cell anemia.

A school-age child with chronic renal failure is admitted to the hospital with a serum potassium level of 5.2 mEq/L. Which prescribed medication should the nurse plan to administer?

b. Sodium polystyrene sulfonate (Kayexalate)

Parents of a school-age child with hemophilia ask the nurse, "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend (Select all that apply)?

b. Swimming d. Golf e. Bowling

An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) and gastrostomy feedings. Nursing care should include:

b. Teaching the family signs of central venous catheter infection.

A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow?

b. Tetralogy of Fallot

What is an expected assessment finding in a child with coarctation of the aorta?

d. Disparity in blood pressure between the upper and lower extremities

A common clinical manifestation of Hodgkin's disease is:

d. Enlarged, firm, nontender lymph nodes.

Client Needs: Physiologic Integrity 25. The nurse is preparing a child for possible alopecia from chemotherapy. Which suggestion should be included in the teaching?

d. Explaining to the child that, when hair regrows, it may have a slightly different color or texture.

Which information should the nurse teach workers at a day care center about respiratory syncytial virus (RSV)?

d. Frequent hand washing can decrease the spread of the virus.

When caring for an infant with an upper respiratory tract infection and elevated temperature, an appropriate nursing intervention is to:

d. Give small amounts of favorite fluids frequently to prevent dehydration.

Which intervention should be included in the nurse's plan of care for a 7-year-old child with encopresis who has cleared the initial impaction?

d. Give the child a choice of beverage to mix with a laxative.

Careful hand washing before and after contact can prevent the spread of which condition in day care and school settings?

d. Hepatitis A

When discussing hyperlipidemia with a group of adolescents, the nurse should explain that high levels of what substance are thought to protect against cardiovascular disease?

d. High-density lipoproteins (HDLs).

Which type of dehydration results from water loss in excess of electrolyte loss?

d. Hypertonic dehydration

An acquired hemorrhagic disorder that is characterized by excessive destruction of platelets is:

d. Idiopathic thrombocytopenic purpura.

The mother of a toddler yells to the nurse, "Help! He is choking to death on his food." The nurse determines that lifesaving measures are necessary based on:

d. Inability to speak.

A common side effect of corticosteroid therapy is:

d. Increased appetite.

The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breastfed infant. What should she or he suggest?

d. Iron-fortified infant cereal can be introduced at approximately 6 months of age.

Which statement is characteristic of acute otitis media (AOM)?

d. It is treated with a broad range of antibiotics.

Which postoperative intervention should be questioned for a child after a cardiac catheterization?

d. Keep the affected leg flexed and elevated.

An infant with pyloric stenosis experiences excessive vomiting that can result in:

d. Metabolic alkalosis.

Why do infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system?

d. Mucus and edema obstruct small airways.

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis?

d. Painful swelling of hands and feet, painful joints

Pancreatic enzymes are administered to the child with cystic fibrosis. Nursing considerations should include:

d. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal

An advantage of peritoneal dialysis is that:

d. Parents and older children can perform treatments.

The parents of a young child with congestive heart failure tell the nurse that they are "nervous" about giving digoxin. The nurse's response should be based on knowing that:

d. Parents must learn specific, important guidelines for administration of digoxin.

Skin testing for tuberculosis (the Mantoux test) is recommended:

d. Periodically for children who reside in high-prevalence regions.

Surgical closure of the ductus arteriosus would:

d. Prevent the return of oxygenated blood to the lungs

Which diagnostic finding is present when a child has primary nephrotic syndrome?

d. Proteinuria

Caring for the newborn with a cleft lip and palate before surgical repair includes:

d. Providing satisfaction of sucking needs.

Seventy-two hours after cardiac surgery, a young child has a temperature of 37.7° C (101° F). The nurse should:

d. Report findings to physician.

The most common cause of acute renal failure in children is:

d. Severe dehydration.

The parent of an infant with nasopharyngitis should be instructed to notify the health care professional if the infant:

d. Shows signs of an earache.

Which type of hernia has an impaired blood supply to the herniated organ?

d. Strangulated hernia

The most common causative agent of bacterial endocarditis is:

d. Streptococcus viridans.

Therapeutic management of most children with Hirschsprung's disease is primarily:

d. Surgical removal of affected section of bowel.

Cystic fibrosis (CF) is suspected in a toddler. Which test is essential in establishing this diagnosis?

d. Sweat chloride test

When caring for the child with Kawasaki disease, the nurse should understand that:

d. Therapeutic management includes administration of gamma globulin and aspirin.

For what reason might a newborn infant with a cardiac defect, such as coarctation of the aorta, that results in a right-to-left shunt receive prostaglandin E1?

d. To improve oxygenation

Which clinical manifestation would be seen in a child with chronic renal failure?

d. Unpleasant "uremic" breath odor

The nurse is conducting an assessment on a school-age child with urosepsis. Which assessment finding should the nurse expect?

a. Fever with a positive blood culture

Which interventions should a nurse implement when caring for a child with hepatitis (Select all that apply)?

a. Provide a well-balanced, low-fat diet. c. Teach parents not to administer any over-the-counter medications. e. Instruct parents on the importance of good hand washing.

Which structural defects constitute tetralogy of Fallot?

a. Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

An important nursing consideration in the care of a child with celiac disease is to:

a. Refer to a nutritionist for detailed dietary instructions and education.

A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention?

a. Relax any eating pressures.

Which diagnostic test allows visualization of the renal parenchyma and renal pelvis without exposure to external beam radiation or radioactive isotopes?

a. Renal ultrasound

The nurse is assisting the pediatric provider with a newborn examination. The provider notes that the infant has hypospadias. The nurse understands that hypospadias refers to:

d. Urethral opening along ventral surface of penis.

Which information should the nurse teach families about reducing exposure to pollens and dust (Select all that apply)?

a. Replace wall-to-wall carpeting with wood and tile floors. b. Use an air conditioner. c. Put dust-proof covers on pillows and mattresses.

A child has a total cholesterol level of 180 mg/dL. What dietary recommendations should the nurse make to the child and the child's parents (Select all that apply)?

a. Replace whole milk with 2% or 1% milk c. Increase servings of fish d. Avoid excessive intake of fruit juices

An inherited immunodeficiency disorder characterized by absence of both humoral and cell-mediated immunity is:

a. Severe combined immunodeficiency syndrome (SCIDS).

The nurse is teaching a class on preventing diaper rash in newborns to a group of new parents. Which statement made by a parent indicates a correct understanding of the teaching?

"I will wash with a mild soap and water and dry thoroughly whenever my infant has a bowel movement."

52. The nurse has initiated a blood transfusion on a preschool child. The child begins to exhibit signs of a transfusion reaction. Place in order the interventions the nurse should implement, sequencing from the highest priority to the lowest.

B. Stop the transfusion. A. Take the vital signs. D. Maintain a patent intravenous (IV) line with normal saline. C. Notify the practitioner.

Hydrotherapy is required to treat a child with extensive partial-thickness burn wounds. Which is the primary purpose of hydrotherapy?

Debride the wounds.

Myelosuppression associated with chemotherapeutic agents or some malignancies such as leukemia can cause bleeding tendencies because of a/an:

Decrease in blood platelets.

Which of the following best describes a full-thickness (third-degree) burn?

Destruction of all layers of skin evident with extension into subcutaneous tissue

One of the first signs of overwhelming sepsis in a child with burn injuries is:

Disorientation.

An infant with an unrepaired tetralogy of Fallot defect is becoming extremely cyanotic during a routine blood draw. Which interventions should the nurse implement? Place in order from the highest-priority intervention to the lowest-priority intervention. a. Administer 100% oxygen by blow-by. b. Place infant in knee-chest position. c. Remain calm. d. Give morphine subcutaneously or by an existing intravenous line. 59. First priority 60. Second priority 61. Third priority 62. Fourth priority

Hypercyanotic spells, also referred to as blue spells or tet spells because they are often seen in infants with tetralogy of Fallot, may occur in any child whose heart defect includes obstruction to pulmonary blood flow and communication between the ventricles. The infant becomes acutely cyanotic and hyperpneic because sudden infundibular spasm decreases pulmonary blood flow and increases right-to-left shunting. Because profound hypoxemia causes cerebral hypoxia, hypercyanotic spells require prompt assessment and treatment to prevent brain damage or possibly death. The infant should first be placed in the knee-chest position to reduce blood returning to the heart. Next, 100% oxygen is given to alleviate the hypoxemia. Morphine is next administered to reduce infundibular spasms. Last, the nurse should remain calm.

Which physiologic change causes the edema formation that occurs with burns?

Increased capillary permeability

The nurse closely monitors the temperature of a child with nephrosis. The purpose of this is to detect an early sign of:

Infection

Which statement regarding atopic dermatitis (eczema) in the infant is most accurate?

It is associated with allergy with a hereditary tenden

The only symptom of pediculosis capitis (head lice) is usually:

Itching

The earliest clinical manifestation of biliary atresia is:

Jaundice

The family of a 4-month-old infant will be vacationing at the beach. The best recommendation to this family is to:

Keep the infant in total shade at all times

A mother calls the emergency department nurse because her child was stung by a scorpion. The nurse should recommend:

Keeping the child quiet and coming to emergency department.

Which home care instructions should the nurse provide to the parents of a child with acquired immunodeficiency syndrome (AIDS) (Select all that apply)?

a. Give supplemental vitamins as prescribed. c. Administer trimethoprim-sulfamethoxazole (Bactrim) as prescribed. d. Notify the physician if the child develops a cough or congestion.

An 18-month-old child is seen in the clinic with AOM. Trimethoprim-sulfamethoxazole (Bactrim) is prescribed. Which statement made by the parent indicates a correct understanding of the instructions?

a. "I should administer all the prescribed medication."

The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct?

a. "You may need to increase the caloric density of your infant's formula."

A nurse is interpreting the results of a tuberculin skin test (TST) on an adolescent who is human immunodeficiency virus (HIV) positive. Which induration size indicates a positive result for this child 48 to 72 hours after the test?

a. 5 mm

The most appropriate nursing diagnosis for a child with anemia is:

a. Activity Intolerance related to generalized weakness.

The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement?

a. Administering penicillin

In which condition are all the formed elements of the blood simultaneously depressed?

a. Aplastic anemia

A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child (Select all that apply)? a. Apples b. Bananas c. Cheese d. Carrot sticks e. Strawberries

a. Apples d. Carrot sticks e. Strawberries

What is the nurse's first action when planning to teach the parents of an infant with a congenital heart defect (CHD)?

a. Assess the parents' anxiety level and readiness to learn.

A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests:

a. Asthma.

An infant's parents ask the nurse about preventing otitis media (OM). What should the nurse recommend?

a. Avoid tobacco smoke.

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include:

a. Avoiding use for more than 3 days.

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered?

a. Before chest physiotherapy (CPT)

A school-age child has had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of:

a. Bronchitis.

Which drug is an angiotensin-converting enzyme (ACE) inhibitor?

a. Captopril (Capoten)

The nurse is assessing a child post-cardiac catheterization. Which complication might the nurse anticipate?

a. Cardiac arrhythmia

The school nurse is informed that a child with human immunodeficiency virus (HIV) will be attending school soon. Which is an important nursing intervention?

a. Carefully follow universal precautions.

Where do the lesions of atopic dermatitis most commonly occur in the infant (Select all that apply)?

a. Cheeks c. Extensor surfaces of arms and legs e. Trunk f. Scalp

The nurse is preparing to give oral care to a school-age child with mucositis secondary to chemotherapy administered to treat leukemia. Which preparations should the nurse use for oral care on this child (Select all that apply)?

a. Chlorhexidine gluconate (Peridex) c. Antifungal troches (lozenges) d. Lip balm (Aquaphor)

An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which of the following? (Select all that apply).

a. Cluster care to conserve energy d. Administration of antibiotics

What is characterized by a chronic inflammatory process that may involve any part of the gastrointestinal (GI) tract from mouth to anus?

a. Crohn's disease

A beneficial effect of administering digoxin (Lanoxin) is that it:

a. Decreases edema.

In providing nourishment for a child with cystic fibrosis (CF), which factor should the nurse keep in mind?

a. Diet should be high in carbohydrates and protein.

A possible cause of acquired aplastic anemia in children is:

a. Drugs.

The community health nurse is teaching parents about prevention of the spread and reoccurrence of pediculosis (head lice). Which should the nurse include in the teaching session (Select all that apply)?

a. Dry-clean nonwashable items. d. Boil combs and brushes for 10 minutes. e. Discourage sharing of personal items.

A nurse is charting that a hospitalized child has labored breathing. Which describes labored breathing?

a. Dyspnea

The nurse is caring for a neonate with a suspected tracheoesophageal fistula. Nursing care should include:

a. Elevating the head but giving nothing by mouth.

Bismuth subsalicylate, clarithromycin, and metronidazole are prescribed for a child with a peptic ulcer to:

a. Eradicate Helicobacter pylori.

A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. Initial therapeutic approach to the mother should be to:

b. Encourage her to express her feelings.

A mother who intended to breastfeed has given birth to an infant with a cleft palate. Nursing interventions should include (Select all that apply):

b. Encouraging and helping mother to breastfeed. d. Recommending use of a breast pump to maintain lactation until infant can suck.

The nurse is conducting teaching for an adolescent being discharged to home after a renal transplantation. The adolescent needs further teaching if which statement is made?

b. "I am glad I only have to take the immunosuppressant medication for two weeks."

The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching?

b. "I have to stay on strict bed rest for 3 days."

The nurse is speaking with the parent of an infant with severe atopic dermatitis. What information should the nurse reinforce with the parent (Select all that apply)?

b. "You will need to keep your infant's skin well hydrated by using a mild soap in the bath." d. "You will need to prevent your baby from scratching the area by using a mild antihistamine." f. "You should apply an emollient to the skin immediately after a bath."

Asthma in infants is usually triggered by:

b. A viral infection.

A school-age child is admitted in vaso-occlusive sickle cell crisis. The child's care should include:

b. Adequate hydration and pain management.

The nurse is preparing to care for an infant returning from pyloromyotomy surgery. Which prescribed orders should the nurse anticipate implementing (Select all that apply)?

b. Administration of analgesics for pain d. Intravenous (IV) fluids continued until tolerating fluids by mouth e. Clear liquids as the first feeding

What is the appropriate priority nursing action for the infant with a CHD who has an increased respiratory rate, is sweating, and is not feeding well?

b. Alert the physician.

Acute diarrhea is often caused by:

b. Antibiotic therapy.

The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child (Select all that apply)?

b. Avoidance of intramuscular (IM) injections c. Acetaminophen (Tylenol) for mild pain control d. Soft toothbrush for dental hygiene

Calcium carbonate is given with meals to a child with chronic renal disease. The purpose of this is to:

b. Bind phosphorus.

One of the most frequent causes of hypovolemic shock in children is:

b. Blood loss.

A boy with leukemia screams whenever he needs to be turned or moved. The most probable cause of this pain is:

b. Bone involvement.

The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include:

b. Cleansing of suture line, supine and side-lying positions, and arm restraints.

The nurse is assessing a child with acute epiglottitis. Examining the child's throat by using a tongue depressor might precipitate which symptom or condition?

b. Complete obstruction

The primary nursing intervention necessary to prevent bacterial endocarditis is to:

b. Counsel parents of high risk children about prophylactic antibiotics.

An infant is brought to the emergency department with poor skin turgor, weight loss, lethargy, and tachycardia. This is suggestive of:

b. Dehydration.

A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse's best response should be that the:

d. Urinary output will increase.

Which vitamin supplements are necessary for children with cystic fibrosis?

d. Vitamins A, D, E, and K

Parents have understood teaching about prevention of childhood otitis media if they make which statement?

d. "We will be sure to keep immunizations up to date."

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for what condition (Select all that apply)?

d. (UTI) e. Diabetes mellitus

Chronic otitis media with effusion (OME) is differentiated from acute otitis media (AOM) because it is usually characterized by:

d. A feeling of fullness in the ear.

Which clinical manifestation would most suggest acute appendicitis?

d. Abdominal pain that is most intense at McBurney's point

José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be:

d. Adapted to his level of development so that he can understand.

The nurse is caring for an adolescent who has just started dialysis. The child seems always angry, hostile, or depressed. The nurse should recognize that this is most likely related to:

d. Adolescents often resenting the control and enforced dependence imposed by dialysis

What type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy?

d. Anaphylactic shock

The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to:

d. Apply direct pressure above the catheterization site.

A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of which condition?

d. Bacterial gastroenteritis

The nurse is caring for a child with acute renal failure. What clinical manifestation should he or she recognize as a sign of hyperkalemia?

d. Cardiac arrhythmia

A common, serious complication of rheumatic fever is:

d. Cardiac valve damage.

A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. The purpose of this is to prevent:

d. Central nervous system (CNS) disease.

What should the nurse stress in a teaching plan for the mother of an 11-year-old boy with ulcerative colitis?

d. Coping with stress and avoiding triggers

An accurate description of anemia is:

d. Decreased oxygen-carrying capacity of blood.