Unit 15-17 '21

An 8 year old will soon be able to return to school after an injury that resulted in several severe, chronic disabilities. What is the most appropriate action by the school nurse to help assure a smooth transition back to school? a. Recommending that the child's parents attend school at first to prevent teasing b. Preparing the child's classmates and teachers for changes they can expect c. Referring the child to a school where the children have chronic disabilities similar to hers d. Discussing with both the child and the parents the fact that classmates will not likely be as accepting as before

ANS: B Attendance at school is an important part of normalization for the child. The school nurse should prepare teachers and classmates about her condition, abilities, and special needs. A visit by the parents can be helpful, but unless the classmates are prepared for the changes, it alone will not prevent teasing. The child's school experience should be normalized as much as possible. Children need the opportunity to interact with healthy peers and engage in activities with groups or clubs composed of similarly affected persons. Children with special needs are encouraged to maintain and reestablish relationships with peers and participate according to their capabilities.

25. A child has been diagnosed with an atrioventricular canal defect (AVC). While awaiting surgical correction, which teaching takes priority? A. Care of tubes and drains postoperatively B. Feeding the child frequent, small amounts C. Monitoring weight gain and urine output D. Returning for all scheduled appointments

ANS: B Children with uncorrected AVC have shortness of breath, leading to feeding problems. The parents should be taught to feed the child small amounts frequently to limit dyspnea that may accompany feeding. The child will not go home with drains and tubes postoperatively. Monitoring weight gain and urine output is important for all children with cardiac defects. Returning for appointments is important for all children.

19. The nurse is caring for the parents of a chronically ill child, who display chronic sorrow. Which action by the nurse would be most beneficial for this family? A. Encourage the parents to use resources such as respite care. B. Help the parents establish a routine for school and bedtime. C. Offer the parents resources to deal with their grieving. D. Refer the parents to a community center for counseling.

ANS: B Chronic sorrow is manifested as periods of episodic grieving interspersed with periods of denial as a response to a chronically ill or disabled child. As the child never becomes well, the parents do not have closure for their loss of a "normal" child. A major nursing intervention the nurse can provide is to help the parents normalize as much of their daily lives as possible. One suggestion is to establish routines for daily activities, such as bedtime rituals or going-to-school routines. The other options could all be helpful but are not as comprehensive.

23. An immunocompromised child has been admitted to the hospital with Fifth's disease. Which action by the nurse is most appropriate? A. Place the child in contact precautions. B. Place the child in droplet precautions. C. Place the child in protective isolation. D. Place the child on standard precautions.

ANS: B Fifth's disease is spread through respiratory droplets, so droplet precautions are appropriate. Of course standard precautions should be used with all patients, but this is not enough in this situation. Contact and protective precautions are not needed for this disease.

2. As part of therapeutic play for the patients, the pediatric nurse reads a book about children receiving injections. For which age group is this nursing intervention most appropriate? A. Adolescents B. Preschoolers C. School-aged children D. Toddlers

ANS: B Priority nursing interventions for the preschooler include providing the child with the opportunity to express fears and frustrations. At this age, the use of storytelling and books about the illness may be helpful in providing a nonthreatening approach to the topic. Additionally, the preschooler can express concerns through dramatic play. The nurse can ask the child-life specialist for assistance with methods of expression.

8. A neutropenic child is admitted to the hospital and placed in protective isolation. Which instruction does the nurse give the family to help maintain a safe environment for the child? A. Do not let the child have chewing gum B. Flowers, plants, and produce are not allowed C. The child can only have one visitor at a time D. Toys and items from home cannot be brought in

ANS: B The neutropenic child should not have fresh flowers, plants, fruits, or vegetables because they can harbor infectious microorganisms. The other instructions are not needed.

Which statement made by the nurse would indicate a correct understanding of palliative care? a. "Palliative care serves to hasten death and make the process easier for the family." b. "Palliative care provides pain and symptom management for the child." c. "The goal of palliative care is to place the child in a hospice setting at the end of life." d. "The goal of palliative care is to act as the liaison between the family, child, and other health care professionals."

ANS: B The primary goal of palliative care is to provide pain and symptom management, not to hasten death or place the child in a hospice setting. Palliative care is provided by a multidisciplinary team whose goal it is to provide active total care for patients whose disease is no longer responding to curative treatment.

7. The pediatric nurse providing nursing care for a 12-year-old girl listens as her mother describes her family situation. She states that the patient's 10-year-old sister is asking many questions about the patient's illness. The patient's mother feels that it is best not to talk about the patient with her sister. Which response by the nurse is the most appropriate? A. "Having a child in the hospital and having another daughter at home must be challenging. Focusing on the future when your child goes home would be best." B. "It must be challenging to balance the needs of both of your children. Both children need information about her illness and hospitalization." C. "It must be difficult for you to balance everyone's needs at this time. Doing what you think is best is most important." D. "You and your husband know your children best. I am sure that you will decide the best way to handle this situation."

ANS: B The sibling may be affected in ways such as acquiring a decreased sense of self-esteem, receiving less support from parents, exhibiting mood swings, lacking an understanding about the condition, and displaying a negative attitude toward the child's condition. Priority nursing interventions include teaching the parents to maintain familiar routines as much as possible for the sibling. In addition, the nurse can help the parents include the sibling in simple care. It is also important to remind the parents that providing information about the ill child may decrease stress reactions in the sibling.

23. A nurse is teaching a class to new mothers who are also high school students. What action by the nurse is the most appropriate in order to decrease the risk of child maltreatment? A. Explain the laws regarding child abuse and neglect. B. Provide education on normal childhood development. C. Refer all the young mothers to a social service agency. D. Teach the mothers signs and symptoms of abuse.

ANS: B Young mothers (and fathers) may have unrealistic expectations for their child's behavior based on ignorance of normal growth and development. This can lead to anger, resentment, and harsh discipline, especially if the parent feels the child is acting out deliberately. Teaching normal growth and development along with age-appropriate disciplinary strategies can reduce the incidence of child maltreatment. Simply explaining laws and manifestations will not result in major decreases in child abuse. Not all young mothers need social service intervention; this can be offered based on individual and family assessments.

1. The pediatric nurse explains to a student that which actions are most important in preventing and controlling infections? (Select all that apply.) A. Administering antibiotics B. Educating the public C. Monitoring for outbreaks D. Providing immunizations E. Scheduling physical exams

ANS: B, C, D Prevention and control of infections, especially communicable diseases, centers around surveillance, public education, and immunization.

10. A child has been hospitalized with rubeola. Which actions by the nursing staff are most important? (Select all that apply.) A. Administer ordered antibiotics on time. B. Assess the child for Koplik's spots. C. Ensure the room is dark for photophobia. D. Monitor the child for febrile seizures. E. Report the disease to health authorities.

ANS: B, C, E Appropriate nursing care for the child with rubeola includes assessing the child's mouth for Koplik's spots, providing comfort for photophobia by darkening the room, and reporting the disease to authorities. Rubeola is a viral disease not treated with antibiotics. Fever is moderate and seizures are not usually seen.

A nurse is caring for a child who is near death. Which physical signs indicate the child is approaching death? (Select all that apply.) a. Body feels warm b. Tactile sensation decreasing c. Speech becomes rapid d. Change in respiratory pattern e. Difficulty swallowing

ANS: B, D, E Physical signs of approaching death include tactile sensation beginning to decrease, a change in respiratory pattern, and difficulty swallowing. Even though there is a sensation of heat, the body feels cool, not warm, and speech becomes slurred, not rapid.

6. The pediatric nurse is caring for a child who has been in a motor vehicle collision. The doctor explains to the family that there are serious physical disabilities. The father is upset and states: "I don't know how we will be able to cope. We have two other children. What can we do?" Which response by the nurse is the most appropriate? A. "Don't worry. You will be able to manage." B. "Don't worry. You will get through the crisis." C. "Many parents find the initial news overwhelming." D. "The doctor can explain it to you again."

ANS: C A chronic condition, such as a physical disability, can create a threat of the unknown, loss of control, and long-term effects yet to be discovered. The nurse can reassure the family that the initial news of a physical disability can be overwhelming. The nurse should assist the family in developing an ongoing plan of care to meet the child's physical, emotional, and spiritual needs, as well as offer ongoing support and supply resources to help ensure successful coping. Telling the parents not to worry discounts their very real fears. Having the doctor explain the situation again does nothing to provide psychosocial care to the family.

18. The parents of a chronically ill child confide in the nurse that they are increasingly frustrated with the ill child's younger sibling, who has become very negative toward the ill child and occasionally even hostile. What response by the nurse is the most appropriate? A. "She is too young to understand; you just have to wait for this phase to pass." B. "This is really common, unfortunately; the best you can do is to ignore the behavior." C. "This is a common reaction by siblings; can she help you with your other child?" D. "You need to spend more time with the younger child so she doesn't feel left out."

ANS: C A sibling of a chronically ill child may become negative toward the ill child and occasionally hostile based on the continuous attention the ill child may receive and the attention needed by the healthy child. It is common for children to act out when they are seeking attention or frustrated over a situation.

41. A nurse is concerned that a child with pulmonary hypertension (PA) is developing heart failure. Which manifestation would the nurse assess for first? A. Cough B. Dyspnea C. Extremity edema D. Tachycardia

ANS: C As the pressure in the lungs increases in the child with PA, the right ventricle hypertrophies and will eventually fail. Manifestations of right-sided failure include peripheral edema. Lung manifestations are seen in left-sided heart failure. Tachycardia is nonspecific. Although both sides of the heart can eventually fail, the first signs and symptoms will be of right-sided failure.

9. A 7-year-old child presents to the emergency department, where the parent reports a 3-week history of pale skin, extreme fatigue, and dizziness. Which laboratory value would the nurse correlate with the patient's current condition? A. Hematocrit: 33% B. Hemoglobin: 13.2 g/dL C. Red blood cell count: 2.8/mm3 D. White blood cell count: 12.3/mm3

ANS: C For a child of this age, a normal RBC count is 4-5.2/mm3. Low RBCs can lead to pallor, fatigue, headaches, and dizziness, as tissues are not being oxygenated. The other laboratory values are normal.

40. The pediatric charge nurse receives this report on an incoming admission: a 3-year-old boy with ear and jaw pain, bilateral parotid gland swelling, and mild dehydration. Which action by the charge nurse is most appropriate? A. Do not assign pregnant nursing staff. B. Inform parents that sterility is common. C. Place the child on droplet precautions. D. Place the child on airborne precautions.

ANS: C Hospitalized children who have mumps require droplet precautions. There is no danger to a fetus. Sterility is possible in male children due to orchitis, but it is rare.

4. A nurse hears that a new admission to the hospital was recently diagnosed with the most common kind of childhood cancer. Which collaborative care does the nurse prepare to provide to this patient? A. Antibiotic administration B. Bone marrow transplant C. Chemotherapy D. Liver transplant

ANS: C The most common type of childhood cancer is acute lymphocytic leukemia (ALL). First-line treatment for ALL is inducing remission with chemotherapy. Antibiotics are not used unless the child has an infection. Bone marrow transplant may be considered later in the child's course of care. A liver transplant would not be a treatment for ALL.

18. A nurse is assessing a child who presents to the pediatric clinic, where the parent reports new bruising and petechiae. What question asked by the nurse would elicit the most helpful information? A. "Do bleeding disorders run in your family?" B. "Does your child have arthritis symptoms?" C. "Has your child had a recent viral infection?" D. "Has your child been exposed to heavy metals?"

ANS: C These manifestations may be those of acute immune thrombocytopenia (ITP). This often follows a viral infection, so asking about recent infections is most appropriate. The other questions are not related to this disease.

29. A nurse is assessing a child who has a large head, an elongated face, and prominent ears. Which discharge instruction is most important? A. "Create a family pedigree so I can assess for Down syndrome." B. "Please make an appointment with a pediatric cardiologist." C. "We will call you regarding a referral for genetic testing." D. "You will need to abstain from alcohol in your next pregnancy."

ANS: C This child has manifestations of fragile X syndrome. The family needs to have genetic testing done for this inherited condition. The other instructions are not necessary.

39. A hospitalized diabetic child is sweating, nauseated, and has a headache. What action by the nurse takes priority? A. Administer sliding-scale insulin. B. Call laboratory for a stat blood sugar. C. Give the child some orange juice. D. Perform a urine ketone test.

ANS: C This child is exhibiting signs of hypoglycemia. The nurse should first treat the child instead of waiting for the laboratory to come draw blood. If the nurse has bedside glucose monitoring available, check the glucose first, then treat, but do not wait the several minutes it will take for phlebotomy. Because the child has low blood sugar, do not give insulin. Do not delay by trying to get a urine sample; also, ketones are present in hyperglycemia.

10. A child has been hospitalized with a sickle cell crisis and given morphine sulfate (Duramorph) for severe pain. On assessment 45 minutes later, the child appears to be sleeping quietly with a respiratory rate of 6 breaths/minute. What action by the nurse is most appropriate? A. Document findings and let the child sleep. B. Plan to hold the next dose of morphine. C. Prepare to administer naloxone (Narcan). D. Wake the child up to take deep breaths.

ANS: C This child's respiratory rate is dangerously low, brought on by the narcotic analgesic. The nurse should prepare to administer Narcan per protocol. Letting the child sleep could lead to respiratory arrest, although the findings and subsequent actions should be documented. The provider should be notified afterward to adjust the next dose of pain medication. The child may or may not be able to cooperate with deep breathing instructions.

14. An HIV-positive child has low titers after a measles vaccination. She has now been exposed to the disease. Which action by the nurse is most appropriate? A. Administer prophylactic antibiotics. B. Place the child in protective isolation. C. Prepare to administer immunoglobulin. D. Repeat the vaccination as soon as possible.

ANS: C When the immune-compromised child does not show an appropriate response to a vaccination, she should be treated with immunoglobulin if exposed. Repeating the vaccination will not help if the child's immune system cannot mount a response. Antibiotics are not used to treat measles. Protective isolation is not warranted.

José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be: A. directed at his parents because he is too young to understand. B. detailed in regard to the actual procedures so he will know what to expect. C. done several days before the procedure so that he will be prepared. D. adapted to his level of development so that he can understand.

ANS: D Preoperative teaching should always be directed at the child's stage of development. The caregivers also benefit from the same explanations. The parents may ask additional questions, which should be answered, but the child needs to receive the information based on developmental level. Preschoolers will not understand in-depth descriptions and should be prepared close to the time of the cardiac catheterization.

16. A child has been diagnosed with diabetes insipidus (DI). The nurse is teaching the parents and child about self-care measures. Which item does the nurse explain is the priority for the child to have at all times? A. Epinephrine injector B. Medic-Alert bracelet C. Medications D. Water bottle

ANS: D A Medic-Alert bracelet, medications, and a water bottle are all important for the child with DI to have with him or her. However, preventing dehydration takes priority, so the most important item is the water bottle or other ready access to water.

9. A teenager is hospitalized with sickle cell disease and vaso-occlusive crisis. What pain medication regimen does the nurse assist the patient with? A. Acetaminophen (children's Tylenol) B. Ketorolac (Toradol) orally C. Meperidine (Demerol), given intravenously D. PCA pump with morphine (Duramorph)

ANS: D A teenager is able to manage his or her own pain control, so a PCA pump is ideal. Morphine is often considered the drug of choice in sickle cell crises. Tylenol would be ineffective for pain this severe. Demerol is avoided due to its side effects. Toradol is a good choice; however, it is given parenterally for severe, acute pain.

12. Which health promotion measure does the nurse teach as being most important for the child with sickle cell disease? A. Adequate nutrition B. Ensured rest periods C. Plenty of fluids D. Routine vaccinations

ANS: D All options are appropriate for the child with sickle cell disease; however, vaccinations are vital to prevent sepsis and death from preventable diseases.

24. A nurse in the pediatric clinic suspects a patient is the victim of child abuse. What action takes priority? A. Ask a coworker to confirm the suspicions. B. Confront the parents with this information. C. Document the findings in the child's chart. D. Report the suspicions according to state law.

ANS: D All states have mandatory reporting laws for suspected child maltreatment. The nurse's priority action is to report the findings per state law and facility policy. The other actions are not incorrect; they just are not the priority.

23. A nurse is caring for a dying child. What intervention by the nurse would be best to promote hope and peace in the family? A. Ask the family to participate in providing physical care. B. Ensure the family members eat so they maintain their strength. C. Help the family members arrange child care for their other children. D. Tell the family members what is possible for them to do as the child dies.

ANS: D Everyone needs something to hope for, even if that hope is for a good death. Giving the family options based on what is actually possible helps them maintain some sense of control and allows them to provide caring measures they feel are important. They may or may not want to participate in providing physical care. They may or may not want other siblings present as the child dies. They may or may not want to eat at particular times.

22. A nurse is assessing families in the community for child maltreatment. Which family would the nurse identify as being at highest risk? A. Children involved in many activities B. Family with multiple children C. Older parents with only children D. Single mother living in poverty

ANS: D Identified risk factors for child maltreatment include: children with disabilities; children of very young parents; children of single mothers who live in poverty; parents who suffer from mental or chronic physical illness; parents who have rigid ideas of discipline, excessive stress, or marital conflict; parental substance abuse; and intergenerational history of abuse.

34. A parent is refusing to have a child vaccinated, preferring to have the child contract the illness and develop "natural immunity." Which response by the nurse is best? A. "I'm sure you know what is best for your baby." B. "I'll have to report you to social work." C. "That practice is dangerous and illegal." D. "These diseases have many serious consequences."

ANS: D Parents do have the right to refuse vaccinations, but the nurse has the responsibility of ensuring the parents have adequate information about the diseases and vaccinations. Informing the parent about possible consequences of contracting a disease is an important part of this job. The nurse should not just acquiesce and say the parent knows best without educating him or her. The other two options are threatening, and it is not illegal for a parent to opt out of vaccinations.

8. A 4-year-old girl diagnosed with leukemia will begin palliative care. The 6-year-old brother does not visit often. The parents worry their son will remember his sister as a "sad, thin, child in the hospital" rather than as his playful sister. Which response by the nurse is the most appropriate? A. "Your son can handle a visit to see his sister with your help because children are emotionally strong." B. "Your son needs to say good-bye to his sister prior to her death; you should bring him to visit immediately." C. "Your son will have these sad memories for the rest of his life; therefore, keeping him away is a good idea." D. "Your son needs preparation about the change in his sister's appearance, but for his own grieving process, he needs to visit her before her death."

ANS: D Parents often try to protect the dying child by limiting visitation. It is important for the nurse to communicate to the parents that visits from the sibling are important. Kübler-Ross (1983) stated that the child who has been included in the death and mourning process with the family is able to let go in a healthy way. The sibling may be able to write letters or draw pictures for the child as a way of saying good-bye. It is important that the sibling be included in the grieving process and has the opportunity to say good-bye.

35. A nurse has given an infant a vaccination. Which information is important to document specifically for this vaccination? A. Date of next regularly scheduled immunization B. Drug, dose, site of administration, infant's reaction C. Parental education provided before administration D. Vaccine information sheet given before administration

ANS: D The nurse is legally required to provide the appropriate vaccine information sheet to the parent/guardian prior to administering a vaccination. The other information is important to document too, but is not specific for vaccinations.

Which term best describes a multidisciplinary approach to the management of a terminal illness that focuses on symptom control and support? a. Dying care b. Curative care c. Restorative care d. Palliative care

ANS: D This is one of the definitions of palliative care. The goal of palliative care is the achievement of the highest possible quality of life for patients and their families. Curative care would infer providing a cure for the disease or disorder while restorative care involves measures to regain past abilities. Dying care generally refers to the care of an individual in the final stage of life.

3. During a pediatric nursing orientation session to a new unit, the child-life specialist is introduced as an important member of the heath-care team. What is an important role of the child-life specialist? A. Accompany children on their way to procedures B. Assist with family counseling regarding hospitalization C. Describe normal growth and development to families D. Provide opportunities for therapeutic play

ANS: D Whenever a child has a chronic condition, it is important to involve the child-life specialist. Because the child with a chronic condition often spends significant amounts of time in the hospital, the days can be long and boring. The child-life specialist is an expert in child development and therapeutic play and can assist in diversion activities during procedures, arrange for therapeutic play, or simply let the child take time to play.

The nurse is caring for several hospitalized children. Which patient is most likely to be experiencing Munchausen syndrome by proxy?

A school-age child admitted because of vomiting and dehydration for the sixth time this year. Frequent hospitalizations for nonspecific symptoms are a sign of Munchausen syndrome by proxy.

19. A child with chronic immune thrombocytopenia presents to the emergency department, where the parents report a 3-day history of severe headache and recent change in mental status. What diagnostic test does the nurse prepare to facilitate as the priority? A. CT of the head B. Lumbar puncture C. Platelet count D. White blood cell count

ANS: A A child with ITP is at risk for intracerebral hemorrhage, manifested by changes in level of consciousness, headaches, visual changes, ataxia, and/or slurred speech. The diagnostic test of choice is a CT scan of the head. A lumbar puncture is often used to diagnose meningitis; because this child does not have a fever, meningitis is a low probability. Platelet count and complete blood count (including WBCs) will be done, but the priority is to obtain a head CT.

25. A child has been diagnosed with a localized herpes simplex virus (HSV) type 1 infection. The nurse is educating the parents on topical acyclovir (Zovirax) ointment. Which statement by the nurse is most appropriate to include during the medication teaching session? A. "Acyclovir can shorten the outbreak." B. "If this doesn't work we can give it IV." C. "This medication will cure the infection." D. "Zovirax must be used for the child's life."

ANS: A Acyclovir and penciclovir (Danavir) can be used to shorten the duration and lessen the pain of HSV infection. It is not curative. IV medication is used for disseminated infection or in children with severe immunocompromise. The medication is used during outbreaks.

30. A child with Down's syndrome has been admitted to the hospital with a respiratory condition and is producing thick, tenacious mucus. Which nursing action is the priority? A. Ensuring a patent airway B. Involving child-life therapy C. Preventing nosocomial infection D. Relieving stress at hospitalization

ANS: A All answers are appropriate nursing interventions; however, the child with Down's syndrome has a small oral cavity and small airway, which can be easily occluded. The priority action of the nurse is to maintain the child's airway.

8. A child presents to the emergency department with sickle cell crisis. Which intervention does the nurse perform first? A. Administer oxygen. B. Assess and treat pain. C. Provide warm blankets. D. Start IV fluids.

ANS: A All interventions are appropriate for this child. However, airway and breathing come first, so the nurse administers oxygen then starts an IV.

20. The nurse is teaching the parents of a child with a severe, chronic condition ways to promote growth and development. Which suggestion by the nurse is the most appropriate? A. Allow interaction with peers, family, and community members. B. Ensure that the child is getting a nutritious diet and plenty of exercise. C. Insist that the public school include the child in all activities. D. Plot the child's growth and weight gain on growth charts monthly.

ANS: A Although chronic illness can have a negative impact on growth and development, so can the reactions of the child's parents or guardians. Although they need to maintain realistic expectations, parents should ensure that the child has the ability to develop in all areas: physical, cognitive, social, and psychological. The best way to ensure this development is to allow the child interaction with others and provide opportunities for appropriate activity. A nutritious diet is important but only considers the physical aspect of growth and development. It should not be necessary to insist that the school include the child in activities, as this is a legal requirement. Plotting growth is also important, but monitoring the situation is not the same as providing opportunities.

38. The day after attending a large birthday party for a classmate, a child breaks out in a rash characteristic of chickenpox. When counseling the parents, which information is most appropriate? A. "Inform all the parents of children at the party that your child has chickenpox." B. "This disease is spread through respiratory droplets, so don't get too close." C. "We can give your child a dose of varicella zoster immune globulin right away." D. "Your child is only contagious for 3 days after the rash first appears."

ANS: A Children with chickenpox are contagious from 1-2 days prior to the rash erupting until the time when all the lesions have crusted over, usually about 7 days. The parents of this child should inform the other parents about their children's exposure to the disease. The disease is spread via airborne and contact routes. Immune globulin can be used within 72 hours after an exposure in immunosuppressed children.

33. The pediatric nurse explains to a nursing student about the most important role the nurse has in preventing disease. What does this role include? A. Ensuring that immunizations are up to date in all children B. Facilitating research on new forms of immunizations C. Giving reminders about immunizations to parents in clinic D. Scheduling and conducting immunization clinics

ANS: A Immunizations are the cornerstone of communicable disease prevention. The most important role the nurse has related to this topic is to ensure that all children in contact with him or her have vaccinations that are up to date. The other activities can be important components of disease prevention, but are not as important.

7. The parents of an 8-year-old child with sickle cell anemia call the clinic to report that the child developed chest pain after playing soccer. What advice from the nurse is most appropriate? A. "Go to the nearest emergency department." B. "Have him rest and take Tylenol (acetaminophen)." C. "If he doesn't improve, bring him in to the clinic." D. "Try a warm pack on his chest for 10 minutes."

ANS: A In sickle cell disease, the abnormally shaped RBCs are sticky and adhere to the blood vessel walls, creating obstructions to circulation. This creates the potential for tissue ischemia and death. The child could be having a heart attack and needs immediate evaluation.

29. The parents of a child with transposition of the great vessels ask the nurse why the child looks blue. Which response by the nurse is the most appropriate? A. "Her body gets blood that doesn't have much oxygen." B. "Her lungs are underdeveloped and underperfused." C. "She is not able to regulate her temperature and is cold." D. "This is very unusual for this condition, so I'll ask the doctor."

ANS: A In this condition, the aorta arises from the right side of the body, so systemic circulation consists of oxygen-poor blood. The other answers are not appropriate.

25. A hospice nurse is working with the family of a child who has died. Which statement by the parent indicates that further action by the nurse is needed? A. "I have not been able to function at work since my son died." B. "Some days I wonder if I could have done anything differently." C. "There are times when I still get so angry that this happened." D. "You know, I have had some pretty good days recently."

ANS: A Kübler-Ross identified five stages of grief: denial and isolation, anger, bargaining, depression, and acceptance. People do not go through these stages in a linear fashion. It is important also for the nurse to understand that people will have good days and bad days, no matter what stage of grief they are in. However, in each stage, there are warning signs that indicate further action should occur. The inability to function normally is one of these warning signs, and the nurse should ensure the parent has appropriate follow-up.

24. A nurse is evaluating how well the family of a dying child understands the concept of hospice care in the home. Which statement by the family indicates the need for further instruction? A. "If she gets short of breath, I will call 911 right away." B. "It will be great that she can play with her sister at home." C. "Pain control will be very important even near death." D. "We should look into respite care so we can get a break."

ANS: A Once hospice care has been chosen, it is important to not make drastic changes in the care plan, especially as the end of life approaches. Hospice care recognizes that death is part of life and is focused on symptom control and quality of life, not cure. The parent who plans to call 911 for shortness of breath does not understand this concept, nor does he or she understand manifestations of approaching death. The other statements are compatible with hospice care in the home.

39. A child has been hospitalized with rubella. Which action by the charge nurse is most appropriate? A. Do not allow pregnant nursing staff in the room. B. Inform the parents that fresh produce is not allowed. C. Place the child on contact isolation precautions. D. Use standard precautions when caring for the child.

ANS: A The most serious consequence of rubella infection occurs prenatally; exposure in utero can lead to cognitive impairment, deafness, eye disorders, cardiac defects, and stillbirth. Pregnant staff should not enter this room. Disallowing produce is not related to this disorder. Contact precautions are not warranted; this disease is spread through the airborne route. Standard precautions are used for all patients.

Which is the most appropriate nursing intervention to promote normalization in a school-age child with a chronic illness? a. Give child as much control as possible. b. Ask child's peer to make child feel normal. c. Convince child that nothing is wrong with him or her. d. Explain to parents that family rules for the child do not need to be the same as for healthy siblings.

ANS: A The school-age child who is ill may be forced into a period of dependency. To foster normalcy, the child should be given as much control as possible. It is unrealistic to expect one individual to make the child feel normal. The child has a chronic illness. It would be unacceptable to convince the child that nothing is wrong. The family rules should be similar for each of the children in a family. Resentment and hostility can arise if different standards are applied to each child.

27. The clinic nurse is assessing a teenage girl who reports fever, chills, sore throat, and extreme fatigue during the last 2 weeks. Which focused assessment should the nurse perform? A. Assess lymph nodes. B. Collect buccal swabs. C. Obtain a urinalysis. D. Palpate the abdomen.

ANS: A This girl's age and symptoms are highly suggestive of infectious mononucleosis. The nurse should assess for swollen and tender occipital and cervical lymph nodes. The nurse should not palpate the abdomen because the spleen, if enlarged, can rupture under pressure. Buccal swabs and urinalysis are not related.

26. A parent brings her child to the pediatric clinic and reports that the child has a rash on one side of his body that reminds her of chickenpox, but is more painful. Which medication does the nurse anticipate teaching the parent about? A. Acyclovir (Zovirax) B. Azathioprine (Imuran) C. Diphenhydramine (Benadryl) D. Intravenous immune globulin (IVIG)

ANS: A This rash sounds like herpes zoster (shingles), which is treated with acyclovir. Imuran is used in autoimmune disorders. Benadryl is used for itching. IVIG is also used in immune disorders.

24. A child is being released from the hospital after surgical correction of an atrioventricular canal defect (AVC). What referral by the nurse is most appropriate? A. Down syndrome support group B. Hospice services team C. Lions eye bank D. Transplant team

ANS: A Up to 75% of cases of AVC occur in children with Down syndrome, so this is the most appropriate referral if this is the case for this child. There is no information in the stem of the question to indicate that the child is terminally ill; the Lions eye bank is unrelated to this condition, and the child is probably not a candidate for a heart transplant because these defects can be repaired surgically.

4. A student is learning about the process of hematopoiesis and how it is affected by leukemia. Which information does the student discover? (Select all that apply.) A. Blast cells multiply faster than mature cells. B. Leukemia disrupts normal hematopoiesis. C. Lymphoid cells differentiate into B and T cells. D. Myeloid cells crowd out normal cells in bone marrow. E. Pancytopenia occurs from proliferation of mast cells.

ANS: A, B, C Blast, or immature, cells have an increased rate of proliferation and multiply at the expense of normal cells. Leukemia does disrupt normal hematopoiesis (production and development of blood cells). Lymphoid cells differentiate into B and T cells. Myeloid cells differentiate into red blood cells, monocytes, granulocytes, and platelets; they do not reproduce and crowd out "normal" cells in the marrow. Pancytopenia occurs when large numbers of blast cells reproduce and crowd out normal marrow components.

4. A nurse is teaching the parents of a dying child how to recognize impending death. Which manifestations does the nurse tell the parents to expect? (Select all that apply.) A. Changes in breathing patterns B. Decreased desire to eat or drink C. Increased blood pressure D. Pale, cool skin E. Restlessness or agitation

ANS: A, B, D, E There are many manifestations of impending death, including changes in breathing patterns, decreased oral intake, pale or cool skin, and restlessness or agitation. Blood pressure will decrease.

1. The student nurse studying childhood cancers understands that neoplasms are caused by which factors? (Select all that apply.) A. Chromosomal/genetic abnormalities B. External stimuli or environment C. Maternal nutrition during gestation D. Substance abuse during pregnancy E. Viruses that alter the immune system

ANS: A, B, E Neoplasms are caused by one or a combination of the following: chromosomal or genetic abnormalities, external stimuli or the environment, and/or viruses that alter the immune system. Nutritional deficits and substance abuse by the mother can certainly lead to developmental and other health problems, but do not lead to childhood cancers.

10. A nurse is teaching a new diabetic child and family about sick-day management. What information does the nurse plan to include? (Select all that apply.) A. Check blood sugars every 4 hours. B. Hold insulin if the child is vomiting. C. Provide plenty of rest and sleep. D. Offer calorie-containing liquids. E. Try to follow the usual meal plan.

ANS: A, C, D, E Sick-day rules are important to prevent diabetic ketoacidosis (DKA). The child should take the normal dose of medication (the liver continues to produce glucose even when not eating) while trying to follow the meal plan. If solids are not tolerated, then offer liquids that contain calories. Check blood sugars every 4 hours while the child is ill, and check ketones with each instance of voiding. Be sure to notify the physician for any concerns.

2. The nurse working with pediatric oncology patients educates the patients and families regarding best long-term follow-up practices. Which recommendations does this include? (Select all that apply.) A. Continued care by an interdisciplinary team B. Height measurements until puberty is reached C. Genetic testing prior to having children D. Risk-based follow-up appointments E. Thyroid screening for 5 years after remission

ANS: A, D Best-practice recommendations for follow-up include risk-based referrals and continued involvement of an interdisciplinary team of specialists. Height measurements are important for children until their adult height is achieved. Genetic testing is only recommended for certain types of cancer. Thyroid screening is important throughout the lifetime of survivors who were treated with radiotherapy to the neck, spine, or brain.

7. A pediatric nurse is explaining child abuse and neglect to a class of nursing students. Which information does this nurse provide the students during the presentation? (Select all that apply.) A. Children with disabilities are at higher risk. B. Diagnosing physical child abuse is easy and quick. C. Each week, about 5 children die from abuse. D. Neglect is most common, but is difficult to identify. E. Unexplained, recurrent conditions may be caused by abuse.

ANS: A, D, E Children with disabilities have a higher risk of abuse than do nondisabled children. Child neglect is the most common form of child maltreatment but may be difficult to identify. One type of child maltreatment is Munchausen by proxy, in which a parent causes recurrent, unexplained conditions in the child for attention. Diagnosing child abuse may take a long time due to the thorough family and child assessments needed. In fact, more than 5 children die each day as a result of maltreatment.

Which are appropriate statements the nurse should make to parents after the death of their child? (Select all that apply.) a. "We feel so sorry that we couldn't save your child." b. "Your child isn't suffering anymore." c. "I know how you feel." d. "You're feeling all the pain of losing a child." e. "You are still young enough to have another baby."

ANS: A,D By saying, "We feel so sorry that we couldn't save your child," the nurse is expressing personal feeling of loss or frustration, which is therapeutic. Stating, "You're feeling all the pain of losing a child," focuses on a feeling, which is therapeutic. The statement, "Your child isn't suffering anymore," is a judgmental statement, which is nontherapeutic. "I know how you feel" and "You're still young enough to have another baby" are statements that give artificial consolation and are nontherapeutic