peds quiz 2

12. What finding would the nurse assessing the neurovascular status of a child in Russell traction report immediately? a. Skin thats warm to the touch b. Capillary refill less than 3 seconds c. Ability to wiggle toes d. Bluish coloration of skin

ANS: D Cyanosis or pallor noted in an extremity is an indication of circulatory impairment.

29. The nurse demonstrates which similarities among all traction devices? (Select all that apply.) a. Pull the limb into extension b. Decrease muscle spasm c. Reduce pain d. Align two bone fragments e. Immobilize the limb

ANS: A, B, D, E Tractions are designed to immobilize and pull limbs into extension. Traction can also align broken bones and decrease muscle spasm. Although some traction devices may relieve pain, many may actually cause pain.

31. After the 3-month-old child with respiratory syncytial virus is given a protocol of antiviral medications, the nurse explains that routine immunizations will need to be delayed for _______ months.

ANS: 9 After a protocol of antiviral medications, the routine immunizations should be delayed because the antiviral medications affect the integrity of the immunizations.

1. The nurse is teaching the parents of a young child with iron deficiency anemia about nutrition. What food would the nurse emphasize as being a rich source of iron? a. An egg white b. Cream of Wheat c. A banana d. A carrot

ANS: B Good nutritional sources of iron include boiled egg yolk, liver, green leafy vegetables, Cream of Wheat, dried fruits, beans, nuts, and whole-grain breads.

20. A pediatric patient is scheduled for a noninvasive procedure to determine if his heart is structurally normal and to localize a murmur. What diagnostic test does the nurse anticipate? a. Barium swallow b. Chest x-ray c. Electrocardiogram d. Echocardiogram

ANS: D Echocardiography is a noninvasive procedure that localizes murmurs and determines if theheart is structurally normal

9. The nurse is checking for capillary refill on a child in Bryants traction. How long does it take for the toe to regain color if adequate perfusion is assessed? a. 3 seconds b. 4 seconds c. 5 seconds d. 6 seconds

ANS: A Capillary refill in 3 seconds or less is determined to be indicative of adequate perfusion.

33. The nurse is performing a neurological assessment on a 10-month-old infant using a modified Glasgow Coma Scale. What score will the nurse give if the child is babbling? a. 1 b. 2 c. 3 d. 4

ANS: D If babbling, the 10-month-old infant receives a score of 4 for responses.

4. What is the result of a deficiency of factor IX? a. Thalassemia b. Idiopathic thrombocytopenic purpura c. Hemophilia A d. Christmas disease

ANS: DChristmas disease, or hemophilia B, is caused by the deficiency of factor IX.

32. The nurse explains that Bryants traction is reserved for children who weigh less than _____ pounds.

ANS: 30 Bryants traction is a skin traction used in the treatment of orthopedic disorders of young children who weigh less than 30 pounds. Greater weight would cause excessive counterbalance and injury to soft tissues.

24. The nurse reports which assessments that suggest a meconium ileus in a newborn? (Select all that apply.) a. Abdominal distention b. Vomiting c. Hiccoughing d. Jaundice e. Absence of stool

ANS: A, B, E Distended abdomen, vomiting, and absence of stool are the signs indicating meconium ileus in the newborn.

8. Which comment made by a parent of a 1-month-old would alert the nurse about the presence of a congenital heart defect? a. He is always hungry. b. He tires out during feedings. c. He is fussy for several hours every day. d. He sleeps all the time.

ANS: B Fatigue during feeding or activity is common to most infants with congenital cardiac problems.

36. To prevent ________________ ________________, the nurse warms the blood that is to be given as a transfusion through a central line.

ANS: cardiac arrhythmias Cold blood entering the heart via a central line can trigger an irregular heartbeat.

7. The nurse is providing instructions about how to treat a sprained ankle. What statement by the mother does the nurse recognize as indicative of a need for additional teaching? a. Apply warm compresses to the ankle for the first 24 hours. b. Put an ice pack on the ankle, alternating 30 minutes on with 30 minutes off. c. Wrap the ankle in an Ace bandage for support. d. Keep the leg elevated when sitting.

ANS: A Heat is not a treatment for soft tissue injuries. The principles of managing soft tissue injuries are rest, ice, compression, and elevation.

3. The nurse would observe a child for frequent swallowing after a tonsillectomy and adenoidectomy (T&A). What might this indicate? a. Bleeding from the surgical site b. Pain at the incision area c. Sore throat from postnasal drip d. Potential vomiting

ANS: A Hemorrhage is the most common postoperative complication. Blood trickling down the back of the childs throat could cause frequent swallowing.

25. Which nursing diagnosis would be a priority when preparing a plan of care for a child in a leg cast? a. Risk for altered peripheral tissue perfusion b. Risk for altered urine elimination c. Knowledge deficit d. Risk for infection

ANS: A Casting can lead to compromised tissue perfusion caused by increased pressure from edema or swelling pressing on the tissues. Neurovascular checks are an assessment priority.

7. What might the nurse explain as a common treatment for amblyopia? a. Patching the good eye to force the brain to use the affected eye b. Patching the affected eye to allow the refractory muscles to rest c. Using glasses that will slightly blur the image for the good eye d. Using corticosteroids to treat inflammation of the optic nerve

ANS: A Early detection and treatment are essential for the child with amblyopia. Treatment includes patching the good eye and using glasses to correct refractive errors.

2. Which assessment would lead the nurse to suspect that a newborn infant has a ventricular septal defect? a. A loud, harsh murmur with a systolic thrill b. Cyanosis when crying c. Blood pressure higher in the arms than in the legs d. A machinery-like murmur

ANS: A A loud, harsh murmur combined with a systolic thrill is characteristic of a ventricular septal defect.

12. A parent reports that her child has begun to do poorly at school and experiences episodes where he appears to be staring into space. Of which type of seizure is this behavior a characteristic? a. Absence b. Akinetic c. Myoclonic d. Complex partial

ANS: A Absence seizures are characterized by transient loss of consciousness where the child appears to stare blankly, and may last only a few seconds.

19. A 6-year-old sustained a fractured femur and was put in Russell traction 2 days ago. She screams in pain when she raises herself onto the bedpan. Which nursing diagnosis takes highest priority for this child? a. Pain resulting from tissue trauma b. High risk for impaired skin integrity resulting from immobility c. Altered growth and development related to separation from family d. Altered urinary elimination related to immobility and traction

ANS: A Although all of these nursing diagnoses are relevant to the child in traction, pain resulting from muscle spasm and tissue trauma is the highest priority.

11. What will the nurse teach the child with cystic fibrosis to take in order to facilitate digestion and absorption of nutrients? a. Pancreatic enzymes b. Water-soluble minerals c. Fat-soluble vitamins d. Salt supplements

ANS: A An oral pancreatic enzyme is given to the child with every meal and with snacks to replace the pancreatic enzymes that the childs body cannot produce.

8. What should the nurse explain to the parent of a child with exercise-induced asthma about when to inhale Cromolyn? a. Before exercise to prevent attacks b. At the initial onset of the attack c. During the attack to relieve symptoms d. As often as 4 times a day

ANS: A Anti-inflammatory inhalants are taken before exercise to prevent attacks. These drugs can do nothing for the attack in progress. They are meant to be used as prophylactic therapies.

18. Which observation may cause the nurse to consider the possibility of child abuse when a mother says that her young child fell down the basement stairs? a. Red, green, and yellow bruises on his body b. Bruises are dispersed on his head, arms, and legs c. A broken arm last year, and the child being described as accident-prone d. The mother is very anxious for her son to get medical attention

ANS: A As bruises heal, they change color in stages. Different colors of bruises indicate that injuries have not all occurred at the same time. The nurse must consider whether the bruises match the caretakers explanation of what happened.

2. Which statement by a mother may indicate a cause for her 9-month-olds iron deficiency anemia? a. Formula is so expensive. We switched to regular milk right away b. She almost never drinks water. c. She doesnt really like peaches or pears, so we stick to bananas for fruit. d. I give her a piece of bread now and then. She likes to chew on it.

ANS: A Because cows milk contains very little iron, infants should drink iron-fortified formula for the first year of life.

22. On entering the room of a child in Bucks traction, the nurse makes all of the following observations. Which observation requires a nursing intervention? a. Childs heels are placed firmly against the foot of the bed. b. Head of bed is elevated 20 degrees. c. Weights are hanging freely. d. Ropes are on pulleys.

ANS: A Bucks traction is dependent on the child as a counterweight. The heels should be elevated above the level of the foot of the bed.

13. An adolescent has just had a generalized seizure and collapsed in the school nurses office. When should the nurse should call 911? a. The seizure lasts more than 5 minutes. b. The child is sleepy and lethargic after the seizure. c. The child fell at the onset of the seizure. d. The child is confused and has slurred speech after the seizure.

ANS: A If there are multiple seizures or if seizures last more than 5 minutes, call 911 because these are indicators of possible status epilepticus, a medical emergency.

10. The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly becomes cyanotic. Which statement by the father leads the nurse to determine he understood the instructions? a. If the baby turns blue, I will hold him against my shoulder with his knees bent up toward his chest. b. If the baby turns blue, I will lay him down on a firm surface with his head lower than the rest of his body. c. If the baby turns blue, I will immediately put the baby upright in an infant seat. d. If the baby turns blue, I will put the baby in supine position with his head elevated.

ANS: A In the event of a paroxysmal hypercyanotic or tet spell, the infant should be placed in a knee-chest position.

9. The nurse is caring for a child with a diagnosis of Kawasaki disease. The childs parent asks the nurse, How does Kawasaki disease affect my childs heart and blood vessels? On what understanding is the nurses response based? a. Inflammation weakens blood vessels, leading to aneurysm. b. Increased lipid levels lead to the development of atherosclerosis. c. Untreated disease causes mitral valve stenosis. d. Altered blood flow increases cardiac workload with resulting heart failure.

ANS: A Inflammation of vessels weakens the walls of the vessels and often results in aneurysm.

18. Which assessment finding in a child with meningitis should be reported immediately? a. Irregular respirations b. Tachycardia c. Slight drop in blood pressure d. Elevated temperature

ANS: A Irregular respirations in conjunction with slowing heart rate and increasing blood pressure are reported immediately because they could indicate increased intracranial pressure.

1. What does the nurse explain that a ventricular septal defect will allow? a. Blood to shunt left to right, causing increased pulmonary flow and no cyanosis b. Blood to shunt right to left, causing decreased pulmonary flow and cyanosis c. No shunting because of high pressure in the left ventricle d. Increased pressure in the left atrium, impeding circulation of oxygenated blood in the circulating volume

ANS: A Pulmonary blood flow is increased when a ventricular septal defect exists. The blood shifts from left to right because of the higher pressure in the left ventricle. This particular shift does not cause cyanosis.

17. The nurse is caring for a toddler with acute laryngotracheobronchitis. Which assessment finding would indicate the child is experiencing increased respiratory obstruction? a. Restlessness b. Tachycardia c. Brassy cough d. Expiratory wheezing

ANS: A Restlessness is a primary sign of increased respiratory obstruction.

13. The nurse offers a variety of fluids to a 5-year-old asthmatic child to compensate for the fluid loss through dyspnea. Which fluids are most appropriate? a. Room temperature water b. Carbonated beverages c. Iced fruit juice d. Cold milk

ANS: A Room temperature fluids are the best. Carbonated and iced beverages increase spasm. Milk stimulates mucus production.

4. What is the best choice for fluid replacement that the nurse can offer a child who has just had a tonsillectomy? a. A popsicle b. Chocolate milk c. Orange juice d. Cola drink

ANS: A Small amounts of clear liquids can be offered to the child. Synthetic fruit juices are not as irritating as natural juices. A popsicle is usually well-tolerated.

7. What should the nurse closely assess in a child receiving a transfusion? a. Fever b. Lethargy c. Jaundice d. Bradycardia

ANS: A The child receiving a blood transfusion is observed for signs of a transfusion reaction including chills, itching, fever, rash, headache, and back pain.

22. The most recent blood count for a child who received chemotherapy last week shows neutropenia. What is the priority nursing diagnosis for this child? a. Risk for infection b. Risk for hemorrhage c. Altered skin integrity d. Disturbance in body image

ANS: A The child with neutropenia is at risk for infection.

26. Parents of a 10-year-old child diagnosed with an intellectual deficit are sharing multiple approaches they implement in dealing with various challenges. Which of the following a statements by the parents alerts the nurse that they need further instruction? a. We dress our son every morning for school. b. Our son participates in the Special Olympics every year. c. Our son attends play therapy at a center close to home. d. We attend a support group once a week.

ANS: A The mentally handicapped child needs to develop a sense of accomplishment. Caregivers should not take over projects because of their own need to assist or speed up the process.

19. The nurse notes that a 4-year-old childs gums bleed easily and he has bruising and petechiae on his extremities. Which lab value is consistent with these symptoms? a. Platelet count of 25,000/mm3 b. Hemoglobin level of 8 g/dL c. Hematocrit level of 36% d. Leukocyte count of 14,000/mm3

ANS: A The normal platelet count is 150,000 to 400,000/mm3. This finding is very low, indicating an increased bleeding potential.

15. What nursing action will significantly decrease the risk of serious complications for a child in Bryants traction? a. Neurovascular checks are done frequently. b. Bandages are wrapped tightly. c. The child is restrained from rolling over. d. The childs buttocks are resting on the bed.

ANS: A The nurse caring for a child in traction must be alert for Volkmanns ischemia, which occurs when circulation is obstructed.

14. What intervention is appropriate for a nurse assessing a preadolescent child for scoliosis? a. Ask the child to bend forward at the waist and observe the childs back for asymmetry. b. Observe the gait while the child is walking forward heel to toe. c. Have the child flex the knees and look for uneven knee height. d. Look at the childs shoulders and hips while fully clothed.

ANS: A The nurse looks at the back as the child bends forward for general body alignment and asymmetry.

23. What assessment(s) in a child with tetralogy of Fallot would indicate the child is experiencing a paroxysmal hypercyanotic episode? (Select all that apply.) a. Spontaneous cyanosis b. Dyspnea c. Weakness d. Dry cough e. Syncope

ANS: A, B, C, E Indicators of a paroxysmal hypercyanotic episode or a tet episode are spontaneous cyanosis, dyspnea, weakness, and syncope.

4. A father asks why his child with tetralogy of Fallot seems to favor a squatting position. What is the nurses best response? a. Squatting increases the return of venous blood back to the heart. b. Squatting decreases arterial blood flow away from the heart. c. Squatting is a common resting position when a child is tachycardic. d. Squatting increases the workload of the heart.

ANS: A The squatting position allows the child to breathe more easily because systemic venous return is increased.

17. A 6-year-old with leukemia asks, Who will take care of me in heaven? What is the best response by the nurse? a. Who do you think will take care of you? b. Your grandparents and God will take care of you. c. Your mom will know more about that than I do. d. Why are you asking me that?

ANS: A This response gives the child an opportunity to verbalize his or her feelings and concerns, whereas closed responses shut off communication. The asking of a why question is not therapeutic as it calls for justification.

5. An infant is experiencing dyspnea related to patent ductus arteriosus (PDA). What does the nurse understand regarding why dyspnea occurs? a. Blood is circulated through the lungs again, causing pulmonary circulatory congestion. b. Blood is shunted past the pulmonary circulation, causing pulmonary hypoxia. c. Blood is shunted past cardiac arteries, causing myocardial hypoxia. d. Blood is circulated through the ductus from the pulmonary artery to the aorta, bypassing the left side of the heart.

ANS: A When PDA is present, oxygenated blood recycles through the lungs, overburdening the pulmonary circulation.

5. A 2-year-old child has been diagnosed with hemophilia A. What information should the nurse include in a teaching plan about home care? a. If bleeding occurs, apply pressure, ice, elevate, and rest the extremity. b. Childrens aspirin in lowered doses may be given for joint discomfort. c. A firm, dry toothbrush should be used to clean teeth at least twice a day. d. Do not permit interactive play with other children.

ANS: A When bleeding occurs, the traditional approach is to follow RICErest, ice, compression, and elevation.

8. On admission, a child with leukemia has widespread purpura and a platelet count of 19,000/mm3. What is the priority nursing intervention? a. Assessing neurological status b. Inserting an intravenous line c. Monitoring vital signs during platelet transfusions d. Providing family education about how to prevent bleeding

ANS: A When platelets are low, the greatest danger is spontaneous intracranial bleeding. Neurological assessments are therefore a priority of care.

23. The nurse would suggest the parents of an asthmatic child to encourage participation in which sport(s)? (Select all that apply.) a. Swimming b. Gymnastics c. Baseball d. Cross-country skiing e. Distance running

ANS: A, B, C Sports that require bursts of energy rather than long-term output of energy are suitable pursuits for asthmatics. Swimming, gymnastics, and baseball fit this criterion.

29. What are the classic symptoms of thalassemia major (Cooleys anemia)? (Select all that apply.) a. Hepatomegaly b. Jaundice c. Protruding teeth d. Pathological fractures e. Renal failure

ANS: A, B, C, D All of the options are classic signs of thalassemia major except renal failure.

28. What should be included in the nursing care of a 12-year-old child receiving radiation therapy for Hodgkins disease? (Select all that apply.) a. Application of sunblock b. Appetite stimulation c. Conservation of energy d. Provision for expressions of anger e. Preparation for premature sexual development

ANS: A, B, C, D Sun block should be applied to skin after radiation to prevent burning. Low energy levels produce anorexia and anger in many young patients. Radiation delays the development of secondary sex characteristics and menses.

26. The nurse is caring for a child with a low platelet count. What skin assessments would alert the nurse to bleeding? (Select all that apply.) a. Petichiae b. Purpura c. Ecchymosis d. Hematoma e. Lymphadenopathy

ANS: A, B, C, D The reduction or destruction of platelets in the body interferes with the clotting mechanism. Skin lesions that are common to these disorders include petechiae, a bluish, nonblanching, pinpoint-sized lesion; purpura, groups of adjoining petechiae; ecchymosis, an isolated bluish lesion larger than a petechia; and hematoma, a raised ecchymosis. Lymphadenopathy is an enlargement of lymph nodes that is indicative of infection or disease.

31. The family of a child receiving chemotherapy for leukemia should be taught to focus on which aspect(s) of the childs care? (Select all that apply.) a. Using a support group b. Stimulating appetite c. Maintaining adequate hydration d. Continuing with scheduled immunizations e. Reporting exposure to infectious diseases

ANS: A, B, C, E Support groups are helpful for emotional support and realistic tips on care. The child on chemotherapy is anorexic and has no appetite. Maintenance of hydration is essential for the adequate therapeutic effect of the drugs. Because the drugs suppress the bone marrow, children are at risk for infection, and the suppression will not allow the antibody response needed for immunization.

21. How would the nurse caring for an infant with congestive heart failure (CHF) modify feeding techniques to adapt for the childs weakness and fatigue? (Select all that apply.) a. Feeding more frequently with smaller feedings b. Using a soft nipple with enlarged holes c. Holding and cuddling the child during feeding d. Substituting glucose water for formula e. Offering high-caloric formula

ANS: A, B, C, E Infants with CHF fatigue easily. Feeding can be given more frequently in smaller amounts through a soft, large-holed nipple. Formulas with a denser caloric content can be offered. The child may be encouraged to nurse if he or she is held.

22. The nurse describes the allergic salute as a cluster of what signs related to chronic allergy? (Select all that apply.) a. Mouth breathing b. Transverse nasal crease c. Dark circles under the eyes d. Productive cough e. Reddened conjunctiva

ANS: A, B, C, E The allergic salute does not include a productive cough.

25. What would the nurse teaching an asthmatic child the technique of pursed-lip breathing include? (Select all that apply.) a. Inhale deeply through nose with mouth closed. b. Make exhalation twice as long as inhalation. c. Use medicated inhaler prior to performing breathing exercise. d. Exhale through mouth as if whistling. e. Exhale forcefully.

ANS: A, B, D The technique requires that breath be inhaled through the nose and exhaled through pursed lips in a nonforceful manner. The exhalation should be twice as long as the inhalation.

32. The nurse explains that the COPP medical regimen for the treatment of Hodgkins disease uses a combination of which drugs? (Select all that apply.) a. Vincristine b. Cyclophosphamide c. Methotrexate d. Prednisone e. Procarbazine hydrochloride

ANS: A, B, D, E The COPP medical regimen includes the combination of cyclophosphamide, vincristine (Oncovin), prednisone, and procarbazine hydrochloride.

30. How has synthetic recombinant antihemophilic factor improved the management of hemophilia? (Select all that apply.) a. Eliminates the need for frequent transfusions b. Can be administered by family at home c. Prevents hemorrhage d. Reduces cost of care of the hemophiliac e. Reduces risk of HIV and hepatitis A and B transmission

ANS: A, B, D, E The drug can be given at home by the family. Because it supplies the missing factor, transfusions are not necessary and consequently the exposure to HIV and hepatitis A and B is reduced. Cost of care is greatly reduced because hospitalizations and transfusions are not as frequently required. The drug does not prevent hemorrhage; it makes hemorrhage manageable.

27. Why would the nurse urge the family of a dying 12-year-old boy to include his 8-year-old sister in care? (Select all that apply.) a. She will feel less neglected by the parents. b. She can make amends for past hostilities to her brother. c. She will feel increased helplessness. d. She can express her feelings through care. e. She can experience being supportive of her parents and brother.

ANS: A, B, D, E All options are potential benefits to including the sibling in the care of a dying child except increased helplessness. She would feel less helpless.

29. Which aspect(s) of a childs development does the nurse caution parents that hearing impairment can affect? (Select all that apply.) a. Speech clarity b. Language development c. Immunity to disease d. Personality development e. Academic achievement

ANS: A, B, D, E All the options, except immunity to disease, are areas in which a hearing impairment could interfere with normal development

25. A 16-year-old patient is diagnosed with primary hypertension. What risk factors does the nurse mention when providing education on this diagnosis to the patient and his family? (Select all that apply.) a. Heredity b. Stress c. Congenital defect d. Obesitye. Poor diet

ANS: A, B, D, E Primary, or essential, hypertension implies that no known underlying disease is present. Nevertheless, heredity, obesity, stress, and a poor diet and exercise pattern can contribute to any type of hypertension.

22. What are the four structural heart anomalies that make up the tetralogy of Fallot? (Select the four that apply.) a. Hypertrophied right ventricle b. Patent ductus arteriosus c. Ventral septal defect d. Narrowing of pulmonary artery e. Dextroposition of aorta

ANS: A, B, D, E The four anomalies that comprise tetralogy of Fallot are hypertrophied right ventricle, patent ductus arteriosus, stenosis of pulmonary artery, and dextroposition of the aorta.

32. The nurse is educating parents on prevention of eyestrain in their 5-year-old child. What information will the nurse include? (Select all that apply.) a. Encourage books with large type. b. Words in books should be closely spaced. c. Provide adequate lighting without glare. d. Be sure desks and chairs are adequate height. e. Instruct child to squint when reading.

ANS: A, C, D Children who are beginning to read need books with large type in which the letters are spaced far apart. The lighting must be adequate and without glare. Chairs and desks must be of the proper height.

30. What intervention(s) would the nurse caring for a child with infectious meningitis include? (Select all that apply.) a. Isolation precautions b. Provision of brightly lit room c. Observation for increasing intracranial pressure d. Preparation for spinal tap e. Seizure precautions

ANS: A, C, D, E All elements of nursing care listed in the options, except a brightly lit room, would be part of comprehensive care of a child with meningitis.

28. What factor(s) may trigger abuse in a parent? (Select all that apply.) a. Being abused as a child b. High self-esteem c. Substance abuse d. Overwhelming responsibility e. Knowledge deficit relative to child care

ANS: A, C, D, E All options except high self-esteem are possible triggers for a parent to become abusive.

31. What will the nurse include then documenting a grand mal seizure? (Select all that apply.) a. Presence of incontinence b. Current dose of antispasmodic medication c. Activity level prior to and following seizure d. Level of consciousness following seizure e. Length of seizure

ANS: A, C, D, E Documentation on a seizure should include LOC following episode, activity prior to and following seizure, change in color, respiration, muscle tone, and length of seizure. Reporting of medication regimen is not necessary.

27. The school nurse suspects a first grade student has sinusitis. Which symptoms might lead the nurse to this suspicion? (Select all that apply.) a. Child reports tooth pain. b. Severe wheezing is auscultated on inspiration. c. Child reports, I have had a cold for 2 weeks. d. Nurse observes periorbital swelling. e. Halitosis is present.

ANS: A, C, D, E The proximity of the sinus to the tooth roots often results in tooth pain when the sinus is infected. The maxillary and ethmoid sinuses are most often involved in childhood sinusitis. Therefore the signs and symptoms of sinusitis in children are different from those in adults, depending on the age of the child and which sinus is fully developed. An acute sinusitis is suspected when an upper respiratory infection lasts longer than 10 days, with a daytime cough. Halitosis is often present. Untreated sinusitis can lead to periorbital cellulitis. Severe wheezing is not indicative of sinusitis.

31. How does the pediatric skeletal system differ from that of the adult? (Select all that apply.) a. Lower mineral content b. More ossification c. Open epiphyses d. Less porosity e. Greater strength

ANS: A, C, E The childs skeletal system has less mineral content, greater porosity, open epiphyses, greater bone strength, and a thicker periosteum.

29. What will the nurse discourage when providing education to parents of a child with asthma? (Select all that apply.) a. Stuffed toys b. Pet ownership c. Gymnastics d. Basketball e. Cotton blankets

ANS: A, D Use of stuffed toys is discouraged due to potential allergens. Basketball might not be well tolerated because of the constant physical exertion. Certain pets are encouraged, gymnasitics is usually well tolerated, and cotton blankets are recommended for children with asthma.

24. Which congenital cardiac defect(s) cause(s) increased pulmonary blood flow? (Select all that apply.) a. Atrial septal defects (ASDs) b. Tetralogy of Fallot c. Dextroposition of aorta d. Patent ductus arteriosus e. Ventricular septal defects (VSDs)

ANS: A, D, E The congenital heart defects that cause increased pulmonary blood flow are ASDs, VSDs, and patent ductus arteriosus.

20. The nurse, caring for a child receiving chemotherapy, notes that the childs abdomen is firm and slightly distended. There is no record of a bowel movement for the last 2 days. What do these assessment findings suggest? a. Peripheral neuropathy b. Stomatitis c. Myelosuppression d. Hemorrhage

ANS: APeripheral neuropathy may be signaled by severe constipation resulting from decreased nerve sensations in the bowel.

15. A child diagnosed with epilepsy had a generalized tonic-clonic seizure that lasted 90 seconds. What would the nurse expect to assess after a generalized tonic-clonic seizure? a. Restlessness b. Sleepiness c. Nausea d. Anxiety

ANS: B Following a generalized tonic-clonic seizure, the child may have some confusion and may sleep for a time (postictal lethargy) and then return to full consciousness.

16. What would the nurse include in a teaching plan about mouth care of a child receiving chemotherapy? a. Use commercial mouthwash. b. Clean teeth with a soft toothbrush. c. Avoid use of a Water-Pik. d. Inspect the mouth weekly for ulcerations.

ANS: B A soft toothbrush reduces capillary damage and mucous membrane breakdown and prevents bleeding and infection. Commercial mouthwashes may kill oral flora that combat infection. Water-Pik is useful for toughening gums.

16. An infant is hospitalized with RSV bronchiolitis. What is the priority nursing diagnosis? a. Fatigue related to increased work of breathing b. Ineffective breathing pattern related to airway inflammation and increased secretions c. Risk for fluid volume deficit related to tachypnea and decreased oral intake d. Fear and/or anxiety related to dyspnea and hospitalization

ANS: B An ineffective breathing pattern is the priority nursing diagnosis for an infant hospitalized with RSV infection.

16. Which intervention would be helpful in relieving morning discomfort associated with juvenile rheumatoid arthritis? a. Wearing splints at night to prevent extension contractures b. Applying moist heat packs upon awakening c. Taking a warm tub bath the evening before d. Sleeping with two pillows under the head

ANS: B Application of moist heat, with a compress or by tub bath upon awakening, will help to lessen stiffness.

6. Which is the most appropriate nursing action related to the administration of digoxin (Lanoxin) to an infant? a. Counting the apical rate for 30 seconds before administering the medication b. Withholding a dose if the apical heart rate is less than 100 beats/min c. Repeating a dose if the child vomits within 30 minutes of the previous dose d. Checking respiratory rate and blood pressure before each dose

ANS: B As a rule, if the pulse rate of an infant is below 100 beats/min, the medication is withheld and the physician is notified.

6. What will the nurse teach the parents of a child with a low platelet count to avoid? a. Ibuprofen b. Aspirin c. Caffeine d. Prednisone

ANS: B Aspirin interferes with platelet function and should be avoided to prevent the risk of prolonged bleeding.

11. A child hospitalized for treatment of osteomyelitis complains that he is tired of being sick and wants to know when the antibiotic protocol will end. How long will the nurse indicate that antibiotic therapy will probably last? a. 2 weeks b. 6 weeks c. 2 months d. 3 months

ANS: B Because osteomyelitis is an infection in the bone, antibiotics are given intravenously for 4 to 6 weeks.

2. What intervention will the nurse caring for a child in Bucks skin traction implement? a. Position in high Fowlers position. b. Assist the child to be pulled up in bed. c. Keep childs heel on the bed surface. d. Maintain childs feet against the foot of the bed.

ANS: B Bucks traction is a type of skin traction that relies on the childs weight as counterbalance. The child must be kept with head elevated no more than 20 degrees and pulled up in bed, and the feet should not touch the bed surface or the foot of the bed.

9. The parents of a 3-month-old infant with cystic fibrosis (CF) want to know how their child got this disease, because no one in either of their families has CF. What is the nurses best response based on the understanding of CF? a. Only one parent carries the CF gene. b. Both parents are carriers of the CF gene. c. The inheritance pattern is multifactorial. d. The result is probably a genetic mutation.

ANS: B Cystic fibrosis is an inherited disease. Both parents must be carriers of the CF gene for the child to have the disease.

14. What is an appropriate nursing action when a child is experiencing a generalized tonic-clonic seizure? a. Guide the child to the floor if the child is standing, and then go for help. b. Move objects out of the childs immediate area. c. Stick a padded tongue blade between the childs teeth. d. Manually restrain the child.

ANS: B During a generalized tonic-clonic seizure, the immediate area is cleared to protect the child from injury.

4. The nurse is reviewing the characteristics of Ewings sarcoma. Which statement if made by the nurse indicates correct understanding of this disease? a. Amputation is the accepted treatment. b. The disease is sensitive to radiation and chemotherapy. c. Metastasis is rare. d. The disease is more prevalent among toddlers and preschoolers.

ANS: B Ewings sarcoma is sensitive to radiation therapy and chemotherapy. Amputation of the affected extremity is not recommended. This cancer occurs in school-age children and does metastasize.

13. A 13-year-old girl is diagnosed with functional scoliosis. What does the nurse explain as the cause of this spinal curvature defect? a. Juvenile rheumatoid arthritis b. Poor posture c. Heredity d. Myelomeningocele

ANS: B Functional scoliosis usually is caused by poor posture, and it is not a spinal disease.

24. The nurse is presenting information on the congentital disorder of hemophilia A. What fact will the nurse include? a. It is seen in males and females equally. b. It is transmitted by symptom-free females. c. It is a sex-linked dominant trait. d. It is a defective gene located on the Y chromosome.

ANS: B Hemophilia A affects mostly males who received the sex-linked recessive trait from a symptom-free female. The defective gene is on the X chromosome.

25. A child is diagnosed with nonparalytic strabismus. How will this disorder most likely be corrected? a. Patching the unaffected eye b. Corrective lenses c. Laser treatment d. Surgery

ANS: B In nonparalytic strabismus the refractory error is usually corrected with eyeglasses.

24. The nurse is caring for a 3-year-old with a head injury. Which assessment would lead the nurse to report the probability of increasing intracranial pressure (ICP)? a. Temperature increase from 37.2 C (99 F) to 37.7 C (100 F) b. Increase in blood pressure with an attendant decrease in pulse c. Increase in respirations d. Equilateral pupils

ANS: B Increasing blood pressure, accompanied by decreasing pulse, and accompanied by unequal pupils are indicators of ICP.

6. What assessment made by the school nurse would lead to the suspicion of strabismus? a. Reddened sclera in one eye b. Child covers one eye to read the chalkboard c. Child complains of a headache d. Copious tears while watching TV

ANS: B Indicators of strabismus include covering one eye to see, tilting the head to see, and missing objects in attempts to pick them up. Although headaches may be associated with amblyopia, this symptom is too vague to point suspicion to any disorder

10. The parent of a child with osteomyelitis asks why his child is in so much pain. What will the nurse respond causes the pain experienced with osteomyelitis? a. Pressure of inelastic bone b. Purulent drainage in the bone marrow c. The cast applied on the extremity d. Circulatory congestion of the skin

ANS: B Osteomyelitis is an infection of the bone. Inflammation produces an exudate that collects under the marrow and cortex of the bone. The vessels are compressed and thrombosis occurs, producing ischemia and pain.

11. Which statement made by a parent indicates an understanding of health maintenance of a child with sickle cell disease? a. I should give my child a daily iron supplement. b. It is important for my child to drink plenty of fluids. c. He needs to wear protective equipment if he plays contact sports. d. He shouldnt receive any immunizations until he is older.

ANS: B Prevention of dehydration, which can trigger the sickling process, is a priority goal in the care of a child with sickle cell disease.

7. A child develops carditis from rheumatic fever. Which areas of the heart are affected by carditis? a. Coronary arteries b. Heart muscle and the mitral valve c. Aortic and pulmonic valves d. Contractility of the ventricles

ANS: B The tissues that cover the heart and heart valves are affected. The heart muscle may be involved and the mitral valve is frequently involved.

20. What would the nurse consider an abnormal finding on a musculoskeletal assessment of a 4-year-old child? a. Has inward-turned knees while standing b. Walks on the toes c. Appears to have flat feet d. Swings his arms when walking

ANS: B Toe walking after 3 years of age may indicate a muscle problem.

25. A child is diagnosed with iron deficiency anemia. What will the nurse explain can occur if this disorder goes untreated? a. Hemorrhage b. Heart failure c. Infection d. Pulmonary embolism

ANS: B Untreated iron deficiency anemias progress slowly, and in severe cases the heart muscle becomes too weak to function. If this happens, heart failure follows.

3. What will the nurse administer with ferrous sulfate drops when providing them to a child on the pediatric unit? a. With milk b. With orange juice c. With water d. On a full stomach

ANS: B Vitamin C aids in the absorption of iron, whereas food and milk interfere with the absorption of iron.

1. What will the nurse tell parents of a child with a positive throat culture for group A hemolytic streptococcus that the treatment is most likely to be? a. Acetaminophen and plenty of fluids b. Oral penicillin for 10 days c. Penicillin until his sore throat is gone d. Streptococcus immunization

ANS: B When a throat culture is positive for group A beta-hemolytic streptococcus, penicillin is administered for 10 days even if symptoms are alleviated before the medication is finished.

14. Through what does the infant born with hypoplastic left heart syndrome acquire oxygenated blood? a. The patent ductus arteriosus b. A ventricular septal defect c. The closure of the foramen ovale d. An atrial septal defect

ANS: D Because the right side of the heart must take over pumping blood to both the lungs and systemic circulation, the ductus arteriosus must remain open to shunt the oxygenated blood from the lungs.

26. A toddler must maintain bed rest for the diagnosis of pneumonia. What actions will the nurse implement? (Select all that apply.) a. Maintain strict bed rest. b. Consider age. c. Assess developmental level. d. Implement light play activities. e. Provide hypnotic medication as ordered.

ANS: B, C, D Confinement to bed for a child does not always result in physical rest. In pediatrics, bed rest means providing play therapy that promotes minimal activity. The nurse should consider the age and developmental level of the child and the activity level involved in the play when designing appropriate activities and guiding parents in the home care of their child.

34. An 8-year-old near-drowning victim is rushed into the ED. What priorities of care will be implemented? (Select all that apply.) a. Parental education regarding prevention b. Respiratory support c. Cardiovascular support d. Controlled rewarming e. Adequate cerebral oxygenation

ANS: B, C, D, E Respiratory and cardiovascular support, controlled rewarming, and maintenance of adequate cerebral oxygenation are priorities of care. The parents should be offered support, explanations of the therapy, and referral to social services, religious, or community agencies for follow-up.

28. The nurse is caring for a 4-year-old child diagnosed with H. influenzae type B. Which signs and symptoms exhibited by the child would alert the nurse to suspect epiglottitis? (Select all that apply.) a. Harsh cough b. Restlessness c. Edematous epiglottis d. Child insists on lying down e. Drooling

ANS: B, C, E H. influenzae type B and most often occurs in children 3 to 6 years of age. It can occur in any season. The course is rapid and progressive. The onset of epiglottitis is abrupt, and the child presents with classic symptoms. The child insists on sitting up, leans forward with the mouth open, and drools saliva because of the difficulty in swallowing. The child appears wide-eyed, anxious, and restless, and he or she may emit a froglike croaking sound on inspiration. Cough is absent. Inspection of the throat shows an enlarged, reddened edematous epiglottis much like a beefy-red thumb. However, the examining tongue blade may trigger a laryngospasm and result in sudden respiratory arrest.

28. Which assessments would cause the pediatric nurse to suspect the probability of an ear infection in a 6- month-old child? (Select all that apply.) a. Hypersensitivity to noise b. Irritability c. Reddened ear canal d. Rolls head from side to side e. Temperature of 39.4 C (103 F)

ANS: B, D, E Infants signal ear infections by being irritable, rolling their heads from side to side, spiking a temperature, and pulling at or rubbing their ears.

12. A child has an elevated antistreptolysin O (ASO) titer. Which combination of symptoms, in conjunction with this finding, would confirm a diagnosis of rheumatic fever? a. Subcutaneous nodules and fever b. Painful, tender joints and carditis c. Erythema marginatum and arthralgia d. Chorea and elevated sedimentation rate

ANS: BThe presence of two major Jones criteria would indicate a high probability of rheumatic fever.

38. __________________ occurs when there is a change in the atmospheric pressure between the internal body systems and the surrounding environment.

ANS: Barotrauma Barotrauma occurs when there is a change in the atmospheric pressure between the internal body systems and the surrounding environment.

17. What instruction would the nurse provide to an adolescent who has been fitted with a Milwaukee brace? a. Wear the brace directly against the skin. b. Wear the brace over regular clothing. c. Wear the brace over a T-shirt 23 hours a day. d. Remove the brace before sleeping.

ANS: C A Milwaukee brace is worn approximately 23 hours a day over a T-shirt, which protects the skin.

10. What symptom leads the nurse caring for a 5-month-old with viral influenza to suspect the development of Reyes syndrome? a. Respirations drop from 18 to 14 breaths/min b. Falling asleep after feeding c. Sudden vomiting without effort d. Development of a macular rash

ANS: C A child with a viral infection is at risk for Reyes syndrome, the onset of which is effortless vomiting, lethargy, and a change in level of consciousness. A 5-month-old child who sleeps after eating is normal.

21. A child is brought to the emergency department after he fell and hit his head on the ground. Which nursing assessment suggests the child has a concussion? a. Sleepy but easily arousable b. Complaining of a stiff neck c. Cannot remember what happened to him d. Pupils react sluggishly to light

ANS: C A concussion is a temporary disturbance of the brain that is immediately followed by a period of unconsciousness. It is accompanied often by a loss of memory of the events that occurred immediately before, during, or after the injury.

8. What assessment does the school nurse recognize as the cardinal sign of a hyphema? a. Opacity of the lens b. A yellow-white reflex on the pupil c. A dark-red spot in front of the iris d. Inflamed mucous membranes of the eyelids

ANS: C A dark red spot in front of the iris is blood that has drained into the anterior chamber as the result of an injury.

5. When auscultating breath sounds of an infant with respiratory syncytial virus, which assessment would the nurse immediately report? a. Respiration rate decrease from 40 to 32 breaths/min b. Heart rate decrease from 110 to 100 beats/min c. Quiet chest from previous assessment of wheezing d. Oxygen saturation of 90%

ANS: C A quiet chest after assessment of wheezing indicates occlusion of air pathways and impending respiratory arrest. All other options are within normal range for infants undergoing oxygen administration.

24. A pediatric nurse is assisting with the care of a child diagnosed with a fractured femur. What type of fracture would be the most likely to alert the nurse to the possibility of physical abuse? a. Stress fracture b. Compound fracture c. Spiral fracture d. Greenstick fracture

ANS: C A spiral fracture of the femur is caused by a forceful twisting motion. When the history of an injury does not correlate with x-ray findings, child abuse should be suspected because spiral fractures can be the result of manual twisting of the extremity.

5. What would the nurse include when planning postoperative teaching for a child who has had a tympanostomy with insertion of tubes? a. Keeping the infant flat after feeding b. Giving over-the-counter decongestants c. Avoiding getting water in the ears d. Cleaning the ear canal with cotton-tipped applicators

ANS: C After a tympanostomy, care should be taken to avoid getting water in the ears.

15. A child with rheumatic fever begins involuntary, purposeless movements of her limbs. What does the nurse recognize that this indicates? a. Seizure activity b. Hypoxia c. Sydenhams chorea d. Decreasing level of consciousness

ANS: C As the effects of rheumatic fever affect the central nervous system, the child may develop Sydenhams chorea, manifested by involuntary, purposeless movements of the limbs.

21. The first child of a couple is being treated for bronchopulmonary dysplasia (BPD). They ask how to prevent this from happening with the child they are currently expecting. What will the nurse explain as the best way to prevent BPD? a. Maternal intake of folic acid b. Exercise c. Prevention of preterm birth d. Provision of oxygen therapy to the newborn

ANS: C Bronchopulmonary dysplasia (BPD) is a fibrosis, or thickening, of the alveolar walls and the bronchiolar epithelium. It occurs in premature infants (less than 32 weeks) who have abnormal or arrested lung development and receive ventilation and oxygen for more than 28 days to survive. Respiratory distress in the newborn is the major reason why oxygen and ventilators are used for prolonged periods. The main cause of respiratory distress in the newborn is prematurity. Therefore the prevention of preterm births is the best way to prevent BPD.

23. Approximately how old does the nurse assess a large green bruise on the thigh of a 4-year-old to be? a. 2 days b. 4 days c. 6 days d. 8 days

ANS: C Bruises heal in various stages that are indicated according to color; after 5 to 7 days bruise are green.

16. How long should a 4-year-old child recovering from rheumatic fever need to receive monthly injections of penicillin G? a. 1 year b. 2 years c. 5 years d. 10 years

ANS: C Children who recover from rheumatic fever should have a chemoprophylaxis protocol of penicillin G injections (about 200,000 units per dose) for a minimum of 5 years or up to the age of 18 to prevent further bouts of rheumatic fever.

16. What would the nurse include when creating a teaching plan that includes the long-term administration of phenytoin (Dilantin)? a. The medication should be given on an empty stomach. b. Insomnia can be a significant side effect. c. Gums should be massaged regularly to prevent hyperplasia. d. Blood pressure should be closely monitored.

ANS: C Dilantin can cause gum overgrowth, which can be minimized by regular massaging. Dilantin frequently causes drowsiness and should be given with meals at the same time each day.

27. What would the nurse include in teaching when preparing to teach parents about air travel instructions to prevent barotrauma in infants? a. Using ear plugs during takeoff b. Omitting the meal just before takeoff c. Letting the infant nurse during descent d. Applying ear drops before takeoff

ANS: C Encouraging an infant to swallow reduces the pressure in the ears during descent.

20. What will the nurse teach parents when giving instructions for acute conjunctivitis? a. Apply cool compresses to the affected eye several times a day. b. Instill topical steroid eye drops for 1 week. c. Clear drainage from the inner to the outer aspect of the eye. d. Keep the eye patched until the inflammation resolves.

ANS: C Eye secretions are always cleared from the inner canthus downward and away from the opposite eye (inner to outer direction).

5. What characteristic manifestation does the nurse caring for a child with Duchennes muscular dystrophy document? a. Ambulates by holding onto furniture b. Exhibits atrophy of the calf muscles c. Falls frequently and is clumsy d. Has delayed fine-motor development

ANS: C Frequent falling and clumsiness are clinical manifestations of Duchennes muscular dystrophy.

23. The nurse urges the mother of a 6-month-old to get her child inoculated with Haemophilus influenzae type B. What does this immunization protect against? a. Encephalitis b. Influenza c. Bacterial meningitis d. Otitis media

ANS: C H. influenzae type B and conjugated pneumococcal vaccines have decreased the incidence of bacterial meningitis.

17. What is accurate about the characteristics of high-density lipoproteins (HDLs)? a. They have high amounts of triglycerides. b. They have only small amounts of protein. c. They have little cholesterol. d. They aid in steroid production.

ANS: C HDLs have low amounts of triglycerides, large amounts of proteins, low amount of cholesterol, and are excreted via the liver. They have no role in the production of steroids.

23. What important focus of nursing care for the dying child and the family should the nurse implement? a. Nursing care should be organized to minimize contact with the child. b. Adequate oral intake is crucial to the dying child. c. Families should be made aware that hearing is the last sense to stop functioning before death. d. It is best for the family if the nursing staff provides all of the childs care.

ANS: C Hearing is intact even when there is a loss of consciousness.

19. The nurse observes a childs position is supine with his arms and legs rigidly extended and the hands pronated. How does the nurse identify this posture? a. Correct anatomical position b. Decorticate c. Decerebrate d. Opisthotonos

ANS: C In decerebrate posturing, arms are extended along the side of the body and hands are pronated. This posture indicates brainstem function only.

9. An adolescent is diagnosed with Hodgkins disease. Lymph nodes on both sides of her diaphragm have been found to be involved, including cervical and inguinal nodes. Which disease stage is this? a. I b. II c. III d. IV

ANS: C Lymph node regions on both sides of the diaphragm are consistent with a diagnosis of stage III Hodgkins disease.

1. What would the nurse include in planning teaching to parents of a child with Legg-Calv-Perthes disease about the long-term effects of this disease? a. There are no long-term effects. b. The disease is self-limited and requires no long-term treatment. c. Degenerative arthritis may develop later in life. d. There is risk of osteogenic sarcoma in adulthood.

ANS: C Marked distortion of the head of the femur may lead to an imperfect joint or to degenerative arthritis of the hip later in life.

26. A child is sent to the school nurse for assessment because she comes to school every day disheveled, unbathed, and hungry. The assessment does not indicate any bruises or marks on the body. What do these finding indicate? a. Sexual abuse b. Physical abuse c. Physical neglect d. Emotional abuse

ANS: C Physical neglect is the failure to provide for the basic physical needs of the child, including food, clothing, shelter, and basic cleanliness.

10. Which statement indicates that the childs parents understand how to perform respiratory therapy? a. We do her postural drainage before the aerosol therapy. b. We give her respiratory treatments when she is coughing a lot. c. We give the aerosol followed by postural drainage before meals. d. She needs respiratory therapy every day when she has an infection.

ANS: C Postural drainage for the child with CF is done following nebulization. Therapy is best scheduled before meals or at least 1 hour after eating to prevent vomiting

9. The nurse is planning to teach parents about prevention of Reyes syndrome. What information would the nurse include in this teaching?a. Use aspirin instead of acetaminophen for children with viral illness. b. Advise parents to have their children immunized against Reyes syndrome. c. Avoid giving salicylate-containing medications to a child who has viral symptoms. d. Get the child tested for Reyes syndrome if the child exhibits fever, vomiting, and lethargy.

ANS: C Prevention of Reyes syndrome includes educating parents not to give aspirin-containing medication to children with viral symptoms.

17. The nurse observes that the legs of a child with cerebral palsy cross involuntarily, and the child exhibitsjerky movements with his arms as he tries to eat. The nurse recognizes that he has which type of cerebral palsy? a. Athetoid b. Ataxic c. Spastic d. Mixed

ANS: C Spasticity is characterized by tension in certain muscle groups, which makes voluntary movements of muscles jerky and uncoordinated.

6. What classic sign would the nurse, auscultating the breath sounds of a child hospitalized for an acute asthma attack, expect to find? a. Fine crackles b. Coarse rhonchi c. Expiratory wheezing d. Decreased breath sounds at lung bases

ANS: C The child experiencing an acute asthma attack wheezes as air moves in and out of the narrowed airways. The expiratory wheeze is most pronounced.

2. Which initial intervention will the nurse suggest to the parents of a child experiencing laryngeal spasm? a. Take the child outside in the cool air. b. Bring the child directly to the emergency department. c. Take the child to the bathroom and turn on a hot shower. d. Have the child drink plenty of fluids.

ANS: C The child experiencing laryngeal spasm should be placed in a high-humidity environment, such as the bathroom with a hot shower running. The humidity liquefies secretions and reduces spasm.

19. The nurse is planning a hypertension-prevention program. What should be the main focus of the nurse when presenting information?a. Pharmacological treatment b. Surgical interventions available c. Patient education d. Reduction of aerobic exercise

ANS: C The main focus of a hypertension-prevention program is patient education.

12. How would the nurse advise a mother to clear the nostrils when her infant has a cold? a. Clear the nasal passages after the infant has a feeding. b. Use over-the-counter nose drops to clear passages. c. Remove nasal secretions with a bulb syringe. d. Instill saline nose drops after clearing away secretions.

ANS: C The nasal passages can be cleared by instilling a few drops of saline into the nose and then suctioning the secretions with a bulb syringe.

4. What is the best way for the nurse to communicate with a 10-year-old child who has a hearing impairment? a. Use gestures and signs as much as possible. b. Let the childs parents communicate for her. c. Face the child and speak clearly in short sentences. d. Recognize that the childs ability to communicate will be on a 6-year-old childs level.

ANS: C The nurse who faces the child and speaks clearly will help the hearing-impaired child in the hospital to develop a healthy personality.

18. The nurse is dealing with a preschool-age child with a life-threatening illness. What should the nurse remember the childs concept of death is at this age? a. That it is final b. Only a fear of separation from her parents c. That a person becomes alive again soon after death d. An understanding based on simple logic

ANS: C The preschooler views death as reversible and temporary.

2. What statement by a patients mother leads the nurse to determine she understands instructions about administering an oral antibiotic for otitis media? a. I will continue using the medication until symptoms are relieved. b. I will share the medicine with siblings if their symptoms are the same. c. I will give the medication with a glass of milk. d. I will administer prescribed doses until all the medication is used

ANS: D Antibiotic therapy for otitis media is continued until the prescribed amount has been completed, even if symptoms are alleviated.

12. A newly married couple is seeking genetic counseling because they are both carriers of the sickle cell trait. How can the nurse best explain the childrens risk of inheriting this disease? a. Every fourth child will have the disease; two others will be carriers. b. All of their children will be carriers, just as they are. c. Each child has a one in four chance of having the disease and a two in four chance of being a carrier. d. The risk levels of their children cannot be determined by this information.

ANS: C The sickle cell gene is inherited from both parents; therefore each offspring has a one in four chance of inheriting the disease.

22. A child is admitted to the hospital because she had a seizure. Her parents report that for the past few weeks she has had headaches, with vomiting, that are worse in the morning. What does the nurse suspect? a. Meningitis b. Reyes syndrome c. Brain tumor d. Encephalitis

ANS: C The signs and symptoms of a brain tumor are related to its size and location. Most tumors create increased intracranial pressure (ICP) with the hallmark symptoms of headache, vomiting, drowsiness, and seizures.

6. The nurse assessing a child with juvenile rheumatoid arthritis notes the childs right knee and ankle are swollen, warm, and tender. The child has a temperature of 38.8 C (102 F) and abdominal pain. What type of juvenile rheumatoid arthritis do these findings suggest? a. Psoriatic b. Enthesitis c. Systemic d. Acute febrile

ANS: C The systemic form of juvenile rheumatoid arthritis is associated with an elevated temperature, erythrocyte sedimentation rate (ESR), and C-reactive protein; abdominal pain; and a macular rash.

10. A 3-year-old child with sickle cell disease is admitted to the hospital in sickle cell crisis with severe abdominal pain. Which type of crisis is the child most likely experiencing? a. Aplastic b. Hyperhemolytic c. Vaso-occlusive d. Splenic sequestration

ANS: C Vaso-occlusive crisis, or painful crisis, is caused by obstruction of blood flow by sickle cells, infarctions, and some degrees of vasospasm.

33. A school-aged child is living with a chronic disease process. How would the nurse anticipate chronic illness will effect growth and development? (Select all that apply.) a. Delayed bonding with parents b. Delayed toilet training c. Impaired sense of belonging d. Decreased feelings of independence e. Impaired speech development

ANS: C, D A school-age child is in the stage of industry versus inferiority. A chronic illness might experience loss of grade level in school because of illness and inability to participate or compete can lead to sense of inferiority. Sense of independence and accomplishment can be lost. Being different from peers may impede childs sense of belonging.

30. The nurse performing a neurovascular check on a limb in traction would report and document which finding(s) as indicative of altered circulation? (Select all that apply.) a. Pulse is equal to uncasted limb. b. Patient is aware of touch and warm and cold application. c. Limb is cool to the touch. d. Capillary refill is 5 seconds. e. Distal limb can flex and extend.

ANS: C, D The limb should be warm, and capillary refill should be less than 3 seconds.

3. What will the nurse include when caring for a child in Bucks extension? a. Positioning the child with hips flexed 90 degrees at all times b. Keeping the weights in contact with the floor c. Checking for skin irritation from traction equipment d. Releasing the weights on a schedule

ANS: CThe skin exposed to frequent friction may break down.

13. A child with thalassemia major receives blood transfusions frequently. What is a complication of repeated blood transfusions? a. Hemarthrosis b. Hematuria c. Hemoptysis d. Hemosiderosis

ANS: D As a result of repeated blood transfusions, excessive deposits of iron (hemosiderosis) are stored in tissues.

14. A child has just been diagnosed with acute lymphoblastic leukemia. What is the result of an overproduction of immature white blood cells in the bone marrow? a. Decreased T-cell production b. Decreased hemoglobin c. Increased blood clotting d. Increased susceptibility to infection

ANS: D An overproduction of immature white blood cells increases the childs susceptibility to infection.

21. Why does a childs fracture heal more rapidly than the adults? a. A childs bones are less porous than adult bone. b. A childs bones are covered by a thicker periosteum. c. A childs bones are not affected by bone overgrowth. d. A childs bones have faster callus formation.

ANS: D Callus forms more rapidly in the child than the adult.

11. The parent of a 1-year-old child with tetralogy of Fallot asks the nurse, Why do my childs fingertips look like that? On what understanding does the nurse base a response? a. Clubbing occurs as a result of untreated congestive heart failure. b. Clubbing occurs as a result of a left-to-right shunting of blood. c. Clubbing occurs as a result of decreased cardiac output. d. Clubbing occurs as a result of chronic hypoxia.

ANS: D Clubbing of the fingers develops in response to chronic hypoxia.

11. What does the nurse explains to parents of a child with febrile seizures? a. They occur when the body temperature exceeds 38.3 C (101 F). b. They can be prevented by anticonvulsant medication. c. They usually lead to the development of epilepsy. d. They occur when the temperature rises quickly.

ANS: D Febrile seizures occur in response to a rapid rise in temperature, often above 38.8 C (102 F).

18. What should the school nurse recommend when encouraging a heart-healthy diet for a child with high cholesterol? a. A fat intake reduction of 5-10% of total calories b. A fat intake reduction of 10-15% of total calories c. A fat intake reduction of 15-20% of total calories d. A fat intake reduction of 25-35% of total calories

ANS: D For a child with increased cholesterol a fat reduction of 25-35% of total calories with less than 75 saturated fat and less than 200 mg of cholesterol per day is advised.

15. The child receiving a transfusion complains of back pain and itching. What is the best initial action by the nurse? a. Notify the charge nurse. b. Disconnect intravenous lines immediately. c. Give diphenhydramine (Benadryl). d. Clamp off blood and keep line open with normal saline.

ANS: D If a blood transfusion reaction occurs, the first action is to stop the blood infusion, keep the line open with normal saline, and notify the charge nurse.

18. The teaching plan for the use of a dry powder inhaler for the treatment of asthma should include the warning to rinse the mouth after inhaling the powder. What does this prevent? a. Discoloration of tooth enamel b. Halitosis c. Irritation of oral membranes d. Candidiasis

ANS: D Inhalant powders can cause candidiasis (yeast) infection of the mouth.

27. Which assessment performed by a nursing student performing a neurovascular check alerts the instructor that further education is necessary? a. Pulses b. Capillary refill c. Movement d. Pupils

ANS: D Neurovascular checks include assessment of pain, pulse, sensation, color, capillary refill, and movement. Pupils are assessed with a neurological check.

19. The nurse is caring for a 3-year-old who suffered a smoke inhalation injury. How long is this patient at the highest risk for pulmonary edema after exposure? a. 2 hours b. 4 hours c. 18 hours d. 72 hours

ANS: D Pulmonary edema appears in a child with smoke inhalation injury 6 to 72 hours after exposure.

8. How does Russell traction provide adequate skin traction? a. Subluxates the tibia b. Does not interfere with range of motion c. Prevents the knee from flexing d. Supplies continuous pull in two directions

ANS: D Russell traction is skin traction, similar to Bucks, with a sling positioned under the knee, which prevents subluxation of the tibia. Although the traction interferes with full ROM, the patient can change position without disrupting the continuous pull in two directions.

13. An infant with congestive heart failure is receiving digoxin (Lanoxin). What does the nurse recognize as a sign of digoxin toxicity? a. Restlessness b. Decreased respiratory rate c. Increased urinary output d. Vomiting

ANS: D Symptoms of digoxin toxicity include: nausea, vomiting, anorexia, irregularity in pulse rate and rhythm, and a sudden change in pulse.

15. The nurse is planning to teach parents about preventing sudden infant death syndrome (SIDS). What significant information would the nurse include? a. Wrapping the infant snugly for rest periods b. Positioning the infant prone for sleep c. Sitting the infant up in an infant seat d. Placing infants on their backs or sides for sleep

ANS: D The American Academy of Pediatrics recommends that all healthy infants be placed in the supine or side-lying position on a firm mattress to prevent SIDS.

3. What finding would the nurse expect when measuring blood pressure on all four extremities of a child with coarctation of the aorta? a. Blood pressure higher on the right side b. Blood pressure higher on the left side c. Blood pressure lower in the arms than in the legs d. Blood pressure lower in the legs than in the arms

ANS: D The characteristic symptoms of coarctation of the aorta are a marked difference in blood pressure and pulses between the upper and lower extremities. Pressure is increased proximal to the defect and decreased distal to the coarctation.

3. Which situation would cause the nurse to suspect a hearing impairment? a. 3-month-old infant with a positive Moro reflex b. 15-month-old toddler who is babbling c. 18-month-old toddler who is speaking one-syllable words d. 24-month-old toddler who communicates by pointing

ANS: D The child who is not making verbal attempts by 18 months should undergo a complete physical examination.

20. Which is the most appropriate nursing action when planning care for a child with cystic fibrosis? a. Provide chest physiotherapy before meals every day. b. Assess weight monthly. c. Administer pancrease with protein food at mealtime. d. Ensure high-protein, high-calorie diet.

ANS: D The maintenance of adequate nutrition is essential. The diet is high in protein and calories. Chest physiotherapy should be done between meals. Pancreatic enzyme powder should be given with applesauce or other nonstarch, nonfat, nonprotein food. Children with cystic fibrosis should be weighed daily.

21. The nurse finds an adolescent with Hodgkins disease crying. The adolescent says, I am so scared. What is the most appropriate nursing response to this comment? a. I understand how you must feel. b. You shouldnt feel that way. c. Is this the strongest feeling youve had today? d. Tell me whats got you scared.

ANS: D The nurse should encourage the adolescent to express her feelings and concerns.

14. The asthmatic child who has been taking theophylline complains of stomachache and tachycardia and is sweating profusely. What does the nurse recognize as the cause of these symptoms? a. Severe asthma attack b. Allergic response to theophylline c. Onset of bronchitis d. Drug toxicity

ANS: D The symptoms described are the signs of theophylline toxicity.

7. What is the best intervention for the nurse caring for a child experiencing an acute asthma attack? a. Offer plenty of fluids, particularly carbonated beverages. b. Place the child in a humidified cool mist tent with oxygen. c. Administer sedatives as ordered to decrease anxiety. d. Position the child with arms resting on the overbed table.

ANS: D This position is comfortable and allows maximum use of the accessory muscles for breathing. Sedatives would mask symptoms of increasing air hunger. Carbonated beverages are contraindicated in persons with dyspnea.

A parent comments that her infant has had several ear infections in the past few months. Why are infants more susceptible to otitis media? a. Infants are in a supine or prone position most of the time. b. Sucking on a nipple creates middle ear pressure. c. They have increased susceptibility to upper respiratory tract infections. d. The eustachian tube is short, straight, and wide.

ANS: DAn infants eustachian tubes are short, wide, and straight, allowing microorganisms easy access to the middle ear.

34. The child with Duchennes muscular dystrophy must push on his legs and walk up the leg in order to rise to a standing position. The nurse recognizes this characteristic behavior as _______________ maneuver.

ANS: Gowers Gowers maneuver is a unique way of rising from the floor by walking up the leg in order to get the upper body erect.

37. _______________________is a condition in which neck motion is limited and the cervical spine is rotated because of shortening of the sternocleidomastoid muscle.

ANS: Torticollis Torticollis (tortus, twisted, and collium, neck) is a condition in which neck motion is limited and the cervical spine is rotated because of shortening of the sternocleidomastoid muscle. It can be either congenital or acquired and can also be either acute or chronic.

30. The nurse explains that the ____________________ can sense the oxygen concentration in the blood and signal the brainstem to increase respiration.

ANS: chemoreceptors Chemoreceptors can sense the oxygen concentration of the blood and signal the brainstem to increase and deepen respirations to keep an adequate supply of oxygen in the circulating volume.

36. A nurse assessing welts on the body of a 2-year-old Vietnamese child should consider the skin lesions might be the result of the cultural practice of __________.

ANS: coining Some Vietnamese place heated coins on the body to cure disease. This practice leaves welts that are sometimes mistaken for child abuse.

35. The nurse recognizes the signs of ____________________ syndrome in a child in 90-90 traction when the toes are pale and edematous and have a very slow capillary refill.

ANS: compartment When a limb is in traction or has been cast, the caregiver must check for adequate perfusion of the limb. Compartment syndrome occurs when the attendant edema from the injury or the traction compromises the circulation. This is an emergency and must be corrected before permanent damage can occur.

35. The sign that suggests possible damage to the cortex of the brain is ____________ posturing.

ANS: decorticate Decorticate posturing is a flexor rigidity of the arms, wrists, fingers, and feet. This posture suggests injury to the brain cortex.

37. The rate of RBC production is regulated by _________________.

ANS: erythropoietin Erythropoietin is a glycoprotein hormone that controls erythropoiesis or red blood cell production.

34. The nurse shows slides of red blood cells from a child with sickle cell disease, noting that in addition to their sickle shape, the cells contain the abnormal element of ______________ _____.

ANS: hemoglobin S Hemoglobin S is the abnormal hemoglobin that makes red blood cells fragile and causes the walls of the cells to collapse, giving them the characteristic sickle shape.

37. The cranial nerve responsible for allowing an infant to suck and swallow formula from a bottle is the __________________ nerve.

ANS: hypoglossal The hypoglossal (XII) nerve allows the infant to be able to suck and swallow. It is also responsible for tongue movement.

36. The nurse records the finding of ______________ _____________ when the child with meningitis cries out in pain when his head is flexed toward his chest.

ANS: nuchal rigidity Stiffness of the neck resulting from inflamed meninges is a sign of meningitis called nuchal rigidity.

33. The nurse reminds the adolescent boy with Ewings sarcoma that he is prohibited from vigorous weight- bearing activities during treatment with radiation to reduce the risk of a(n) _______________ fracture.

ANS: pathological The bone has lost its integrity because of the cancer and radiation. Excessive or vigorous weight bearing can cause a pathological fracture of the compromised bone.

33. Place the three stages of smoke inhalation injury in the correct order (first to last). Put a comma and space between each answer choice (a, b, c, d, etc.) a. Bronchopneumonia b. Pulmonary insufficiency c. Pulmonary edema

ANS:B, C, ASmoke inhalation injury may cause carbon monoxide poisoning. Poisonous substances inhaled from burning material may also cause pathological disturbance. There are three stages of inhalation injury: 1. Pulmonary insufficiency in the first 6 hours 2. Pulmonary edema from 6 to 72 hours 3. Bronchopneumonia after 72 hours, which may cause atelectasis

38. Place the stages of dying in the usual order as detailed by Kbler-Ross (1975). Put a comma and space between each answer choice (a, b, c, d, etc.) a. Bargaining b. Acceptance c. Denial d. Anger e. Reaching out to help others f. Depression

ANS:C, D, A, F, B, E The stages of dying as detailed by Kbler-Ross (1975)denial, anger, bargaining, depression, acceptance, and reaching out to help otherscan be applied to parents and siblings as well as to the sick child. (Nurses may also respond with similar feelings.) It is important to accept and support each participant at whatever stage has been reached and to refrain from directing progress.

29. ________________________is designed to serve the metabolic needs during intrauterine life and also to permit safe transition to life outside the womb.

ANS:Fetal circulation Fetal circulation is designed to serve the metabolic needs during intrauterine life and also to permit safe transition to life outside the womb.

28. Because the diagnosis of rheumatic fever is difficult, an aid used to identify the presence of rheumatic fever is the _____________ _______________.

ANS:Jones criteria The Jones criteria identify a cluster of symptoms and divide them into major criteria and minor criteria. The formula for making the diagnosis of rheumatic fever is to identify two major criteria in the patient, or one major and two minor criteria.

31. ________________ is a systemic disease involving the joints, heart, central nervous system (CNS), skin, and subcutaneous tissues. It belongs to a group of disorders known as collagen diseases.

ANS:Rheumatic fever (RF) Rheumatic fever (RF) is a systemic disease involving the joints, heart, central nervous system (CNS), skin, and subcutaneous tissues. It belongs to a group of disorders known as collagen diseases

35. The nurse confirms that sickle cell trait can be distinguished from sickle cell disease by a lab test called ________________.

ANS:electrophoresis The hemoglobin electrophoresis is a blood test to check for different types of hemoglobin in the blood. Hemoglobin is the substance in red blood cells that carries oxygen. Electrophoresis uses an electrical current to separate normal and abnormal types of hemoglobin in the blood. Hemoglobin types have different electrical charges and move at different speeds. The amount of each hemoglobin type in the current is measured. An abnormal amount of normal hemoglobin or an abnormal type of hemoglobin in the blood may mean that a disease is present. A person with sickle cell disease has abnormal hemoglobin S cells.

30. Systemic blood pressure increases with age and is correlated with _________ and _________throughout childhood and adolescence.

ANS:height; weight Systemic blood pressure increases with age and is correlated with height and weight throughout childhood and adolescence. Significant hypertension is considered when measurements are persistently at or above the 95th percentile for the patients age and sex.

32. The nurse reviews Accolate and Zyflo, which are _______________ _______________; they are capable of blocking the inflammatory response as well as providing bronchodilation.

ANS:leukotriene modifiers The leukotriene modifiers are capable of blocking the inflammatory response and can also provide bronchodilation.

27. The nurse explains that the difference between the systolic blood pressure reading and the diastolic blood pressure reading is called the __________ ___________.

ANS:pulse pressure The pulse pressure is the difference between the diastolic pressure and the systolic pressure.

26. The nurse takes into consideration that the most common congenital heart defect is the ____________ ____________ defect.

ANS:ventricular septal VSDs are the most common congenital heart defect.