Unit exam #3: 45, 47, 41, 44, 48, 49

A toddler is admitted to the hospital with a possible diagnosis of tetanus. The health care provider has prescribed lorazepam (Ativan) intravenously 0.05 mg/kg/dose every 6 hours prn as a muscle relaxant. The child weighs 22 lbs. How many milligrams of Ativan should the nurse administer per dose? _____ Record your answer using one decimal place.

0.5 Find the child's weight in kilograms by dividing 22 by 2.2 = 22/2.2 = 10 kg. Multiply the 0.05-mg dose by 10 = 0.05 mg × 10 kg = 0.5 mg per dose.

The nurse in the neonatal intensive care unit is caring for an infant with myelomeningocele scheduled for surgical repair in the morning. Which early signs of infection should the nurse monitor on this infant (Select all that apply)? a. Temperature instability d. Bradycardia b. Irritability e. Hypertension c. Lethargy

A, B, C a. Temperature instability b. Irritability c. Lethargy The nurse should observe an infant with unrepaired myelomeningocele for early signs of infection, such as temperature instability (axillary), irritability, and lethargy. Bradycardia and hypertension are not early signs of infection in infants.

The nurse is conducting discharge teaching with parents of a preschool child with myelomeningocele, repaired at birth, who is being discharged from the hospital after a urinary tract infection (UTI). Which should the nurse include in the discharge instructions related to management of the child's genitourinary function (Select all that apply)? a. Continue to perform the clean intermittent catheterizations (CIC) at home. b. Administer the oxybutynin chloride (Ditropan) as prescribed. c. Reduce fluid intake in the afternoon and evening hours. d. Monitor for signs of a recurrent UTI. e. Administer furosemide (Lasix) as prescribed.

A, B, D a. Continue to perform the clean intermittent catheterizations (CIC) at home. b. Administer the oxybutynin chloride (Ditropan) as prescribed. d. Monitor for signs of a recurrent UTI. Discharge teaching to prevent renal complications in a child with myelomeningocele include: (1) regular urologic care with prompt and vigorous treatment of infections; (2) a method of regular emptying of the bladder, such as clean intermittent catheterization (CIC) taught to and performed by parents and self-catheterization taught to children; and (3) medications to improve bladder storage and continence, such as oxybutynin chloride (Ditropan) and tolterodine (Detrol). Fluids should not be limited, and Lasix is not used to improve renal function for children with myelomeningocele.

Which assessment findings should the nurse note in a school-age child with Duchenne's muscular dystrophy (DMD) (Select all that apply)? a. Lordosis b. Gower's sign c. Kyphosis d. Scoliosis e. Waddling gait

A, B, E a. Lordosis b. Gower's sign e. Waddling gait Difficulties in running, riding a bicycle, and climbing stairs are usually the first symptoms noted in DMD. Typically, affected boys have a waddling gait and lordosis, fall frequently, and develop a characteristic manner of rising from a squatting or sitting position on the floor (Gower's sign). Lordosis occurs as a result of weakened pelvic muscles, and the waddling gait is a result of weakness in the gluteus medius and maximus muscles. Kyphosis and scoliosis are not assessment findings with DMD.

A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. Which nursing care interventions are needed for this child (Select all that apply)? a. Monitoring and maintaining systemic blood pressure. b. Administering corticosteroids. c. Minimizing environmental stimuli. d. Discussing long-term care issues with the family. e. Monitoring for respiratory complications.

A, B, E a. Monitoring and maintaining systemic blood pressure. b. Administering corticosteroids. e. Monitoring for respiratory complications. Spinal cord injury patients are physiologically labile, and close monitoring of blood pressure and respirations is required. They may be unstable for the first few weeks after the injury. Corticosteroids are administered to minimize the inflammation present with the injury. Minimizing environmental stimuli and discussing long-term care issues with the family do not apply to providing care for this patient.

Which interventions should a nurse implement when caring for a child with hepatitis (Select all that apply)? a. Provide a well-balanced, low-fat diet. b. Schedule playtime in the playroom with other children c. Teach parents not to administer any over-the-counter medications. d. Arrange for home schooling because the child will not be able to return to school. e. Instruct parents on the importance of good hand washing.

A, C, E a. Provide a well-balanced, low-fat diet. c. Teach parents not to administer any over-the-counter medications. e. Instruct parents on the importance of good hand washing The child with hepatitis should be placed on a well-balanced, low-fat diet. Parents should be taught to not give over-the-counter medications because of impaired liver function. Hand hygiene is the most important preventive measure for the spread of hepatitis. The child will be in contact isolation in the hospital, so playtime with other hospitalized children is not scheduled. The child will be on contact isolation for a minimum of 1 week after the onset of jaundice. After that period, the child will be allowed to return to school.

A nurse is planning care for a school-age child with type 1 diabetes. Which insulin preparations are rapid and short acting (Select all that apply)? a. Novolin N b. Lantus c. NovoLog d. Novolin R

ANS C, D c. NovoLog d. Novolin R Rapid-acting insulin (e.g., NovoLog) reaches the blood within 15 minutes after injection. The insulin peaks 30 to 90 minutes later and may last as long as 5 hours. Short-acting (regular) insulin (e.g., Novolin R) usually reaches the blood within 30 minutes after injection. The insulin peaks 2 to 4 hours later and stays in the blood for about 4 to 8 hours. Intermediate-acting insulins (e.g., Novolin N) reach the blood 2 to 6 hours after injection. The insulins peak 4 to 14 hours later and stay in the blood for about 14 to 20 hours. Long-acting insulin (e.g., Lantus) takes 6 to 14 hours to start working. It has no peak or a very small peak 10 to 16 hours after injection. The insulin stays in the blood between 20 and 24 hours.

The clinic nurse is reviewing hemoglobin A1c levels on several children with type 1 diabetes. Hemoglobin A1c levels of less than _____ % are a goal for children with type 1 diabetes. Record your answer as a whole number.

ANS: 7 The measurement of glycosylated hemoglobin (hemoglobin A1c) levels is a satisfactory method for assessing control of type 1 diabetes. As red blood cells circulate in the bloodstream, glucose molecules gradually attach to the hemoglobin A molecules and remain there for the lifetime of the red blood cell, approximately 120 days. The attachment is not reversible; therefore, this glycosylated hemoglobin reflects the average blood glucose levels over the previous 2 to 3 months. The test is a satisfactory method for assessing control, detecting incorrect testing, monitoring the effectiveness of changes in treatment, defining patients' goals, and detecting nonadherence. Hemoglobin A1c levels of less than 7% are a well-established goal at most care centers.

A school-age child is diagnosed with systemic lupus erythematosus (SLE). The nurse should plan to implement which interventions for this child (Select all that apply)? a. Instructions to avoid exposure to sunlight b. Teaching about body changes associated with SLE c. Preparation for home schooling d. Restricted activity

ANS: A, B a. Instructions to avoid exposure to sunlight b. Teaching about body changes associated with SLE Key issues for a child with SLE include therapy compliance; body-image problems associated with rash, hair loss, and steroid therapy; school attendance; vocational activities; social relationships; sexual activity; and pregnancy. Specific instructions for avoiding exposure to the sun and ultraviolet B light, such as using sunscreens, wearing sun-resistant clothing, and altering outdoor activities, must be provided with great sensitivity to ensure compliance while minimizing the associated feeling of being different from peers. The child should continue school attendance in order to gain interaction with peers and activity should not be restricted, but promoted.

The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations should the nurse expect to observe (Select all that apply)? a. Positive Ortolani sign b. Unequal gluteal folds c. Negative Babinski's sign d. Trendelenburg's sign e. Telescoping of the affected limb f. Lordosis

ANS: A, B a. Positive Ortolani sign b. Unequal gluteal folds A positive Ortolani sign and unequal gluteal folds are clinical manifestations of developmental dysplasia of the hip seen from birth to 2 to 3 months. Negative Babinski's sign, Trendelenburg's sign, telescoping of the affected limb, and lordosis are not clinical manifestations of developmental dysplasia of the hip.

46. A nurse should expect which cerebrospinal fluid (CSF) laboratory results on a child diagnosed with bacterial meningitis (Select all that apply)? a. Elevated white blood cell (WBC) count b. Decreased protein c. Decreased glucose d. Cloudy in color e. Increase in red blood cells (RBCs)

ANS: A, C, D a. Elevated white blood cell (WBC) count c. Decreased glucose d. Cloudy in color The CSF laboratory results for bacterial meningitis include elevated WBC counts, cloudy or milky in color, and decreased glucose. The protein is elevated and there should be no RBCs present. RBCs are present when the tap was traumatic.

43. The treatment of brain tumors in children consists of which therapies (Select all that apply)? a. Surgery b. Bone marrow transplantation c. Chemotherapy d. Stem cell transplantation e. Radiation f. Myelography

ANS: A, C, E a. Surgery c. Chemotherapy e. Radiation Treatment for brain tumors in children may consist of surgery, chemotherapy, and radiotherapy alone or in combination. Bone marrow, stem cell, and myelographuy are transplantation therapies are not used to treat brain tumors in children.

The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestations would be observed (Select all that apply)? a. Vomiting b. Jaundice c. Failure to gain weight d. Swelling of the face e. Back pain f. Persistent diaper rash

ANS: A, C, F a. Vomiting c. Failure to gain weight f. Persistent diaper rash Vomiting, failure to gain weight, and persistent diaper rash are clinical manifestations observed in an infant with a urinary tract infection. Jaundice, swelling of the face, and back pain would not be observed in an infant with a urinary tract infection

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

ANS: A, D, E a. Apples d. Carrot sticks e. Strawberries Moderate sodium restriction and even fluid restriction may be instituted for children with acute glomerulonephritis. Foods with substantial amounts of potassium and sodium are generally restricted during the period of oliguria. Apples, carrot sticks, and strawberries would be items low in sodium and allowed. Bananas are high in potassium and cheese is high in sodium. Those items would be restricted.

The nurse should expect to assess which clinical manifestations in an adolescent with Cushing's syndrome (Select all that apply)? a. Hyperglycemia b. Hyperkalemia c. Hypotension d. Cushingoid features e. Susceptibility to infections

ANS: A, D, E a. Hyperglycemia d. Cushingoid features e. Susceptibility to infections In Cushing's syndrome, physiologic disturbances seen are cushingoid features, hyperglycemia, susceptibility to infection, hypertension, and hypokalemia.

36.Nursing care of a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) should include (Select all that apply): a. Weigh daily. b. Encourage fluids. c. Turn frequently. d. Maintain nothing by mouth. e. Restrict fluids.

ANS: A, E a. Weigh daily. e. Restrict fluids. Increased secretion of ADH causes the kidney to resorb water, which increases fluid volume and decreases serum osmolarity with a progressive reduction in sodium concentration. The immediate management of the child is to restrict fluids. The child should also be weighed at the same time each day. Encouraging fluids, turning frequently, and maintaining nothing by mouth are not associated with SIADH.

45. An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which interventions should be included in the child's postoperative care (Select all that apply)? a. Observe closely for signs of infection. b. Pump the shunt reservoir to maintain patency. c. Administer sedation to decrease irritability. d. Maintain Trendelenburg position to decrease pressure on the shunt. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention.

ANS: A, E, F a. Observe closely for signs of infection. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention. Infection is a major complication of ventriculoperitoneal shunts. Observation for signs of infection is a priority nursing intervention. Intake and output should be measured carefully. Abdominal distention could be a sign of peritonitis or a postoperative ileus. Pumping the shunt reservoir, administering sedation, and maintaining Trendelenburg position are not interventions associated with this condition.

Which children admitted to the pediatric unit would the nurse monitor closely for development of syndrome of inappropriate antidiuretic hormone (SIADH) (Select all that apply)? a. A newly diagnosed preschooler with type 1 diabetes b. A school-age child returning from surgery for removal of a brain tumor c. An infant with suspected meningitis d. An adolescent with blunt abdominal trauma following a car accident e. A school-age child with head trauma

ANS: B, C, E b. A school-age child returning from surgery for removal of a brain tumor c. An infant with suspected meningitis e. A school-age child with head trauma Childhood SIADH usually is caused by disorders affecting the central nervous system, such as infections (meningitis), head trauma, and brain tumors. Type 1 diabetes and blunt abdominal trauma are not likely to cause SIADH.

A clinic nurse is conducting a staff in-service for other clinic staff regarding the signs and symptoms of a rhabdomyosarcoma tumor. Which should be included in the teaching session (Select all that apply)? a. Bone fractures b. Abdominal mass c. Sore throat and ear pain d. Headache e. Ecchymosis of conjunctiva

ANS: B, C, E b. Abdominal mass c. Sore throat and ear pain e. Ecchymosis of conjunctiva The initial signs and symptoms of rhabdomyosarcoma tumors are related to the site of the tumor and compression of adjacent organs. Some tumor locations, such as the orbit, manifest early in the course of the illness. Other tumors, such as those of the retroperitoneal area, only produce symptoms when they are relatively large and compress adjacent organs. Unfortunately, many of the signs and symptoms attributable to rhabdomyosarcoma are vague and frequently suggest a common childhood illness, such as "earache" or "runny nose." An abdominal mass, sore throat and ear pain, and ecchymosis of conjunctiva are signs of a rhabdomyosarcoma tumor. Bone fractures would be seen in osteosarcoma and a headache is a sign of a brain tumor.

48. The nurse is monitoring an infant for signs of increased intracranial pressure (ICP). Which are late signs of increased ICP in an infant (Select all that apply)? a. Tachycardia b. Alteration in pupil size and reactivity c. Increased motor response d. Extension or flexion posturing e. Cheyne-Stokes respirations

ANS: B, D, E b. Alteration in pupil size and reactivity d. Extension or flexion posturing e. Cheyne-Stokes respirations Late signs of ICP in an infant or child include bradycardia, alteration in pupil size and reactivity, decreased motor response, extension or flexion posturing, and Cheyne-Stokes respirations.

A school-age child has been admitted to the hospital with an exacerbation of nephrotic syndrome. Which clinical manifestations should the nurse expect to assess (Select all that apply)? a. Weight loss b. Facial edema c. Cloudy, smoky browncolored urine d. Fatigue e. Frothy-appearing urine

ANS: B, D, E b. Facial edema d. Fatigue e. Frothy-appearing urine A child with nephrotic syndrome will present with facial edema, fatigue, and frothy-appearing urine (proteinuria). Weight gain, not loss, is expected because of the fluid retention. Cloudy, smoky browncolored urine is seen with acute glomerulonephritis but not with nephrotic syndrome because there is no gross hematuria associated with nephrotic syndrome

A child is diagnosed with hypothyroidism. The nurse should expect to assess which symptoms associated with hypothyroidism (Select all that apply)? a. Weight loss b. Fatigue c. Diarrhea d. Dry, thick skin e. Cold intolerance

ANS: B, D, E b. Fatigue d. Dry, thick skin e. Cold intolerance A child with hypothyroidism will display fatigue; dry, thick skin; and cold intolerance. Weight loss and diarrhea are signs of hyperthyroidism.

47. The nurse is caring for a neonate with suspected meningitis. Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed (Select all that apply)? a. Headache b. Photophobia c. Bulging anterior fontanel d. Weak cry e. Poor muscle tone

ANS: C, D, E c. Bulging anterior fontanel d. Weak cry e. Poor muscle tone Assessment findings in a neonate with meningitis include bulging anterior fontanel, weak cry, and poor muscle tone. Headache and photophobia are signs seen in an older child.

44. Clinical manifestations of increased intracranial pressure (ICP) in infants are (Select all that apply): a. Low-pitched cry. b. Sunken fontanel. c. Diplopia and blurred vision. d. Irritability. e. Distended scalp veins. f. Increased blood pressure.

ANS: C, D, E c. Diplopia and blurred vision. d. Irritability. e. Distended scalp veins. Diplopia and blurred vision, irritability, and distended scalp veins are signs of increased ICP in infants. Low-pitched cry, sunken fontanel, and increased blood pressure are not clinical manifestations associated with ICP in infants.

The nurse is caring for a school-age child with hyperthyroidism (Graves' disease). Which clinical manifestations should the nurse monitor that may indicate a thyroid storm (Select all that apply)? a. Constipation b. Hypotension c. Hyperthermia d. Tachycardia e. Vomiting

ANS: C, D, E c. Hyperthermia d. Tachycardia e. Vomiting A child with a thyroid storm will have severe irritability and restlessness, vomiting, diarrhea, hyperthermia, hypertension, severe tachycardia, and prostration.

The nurse is caring for a preschool child with a cast applied recently for a fractured tibia. Which assessment findings indicate possible compartment syndrome (Select all that apply)? a. Palpable distal pulse b. Capillary refill to extremity of <3 seconds c. Severe pain not relieved by analgesics d. Tingling of extremity e. Inability to move extremity

ANS: C, D, E c. Severe pain not relieved by analgesics d. Tingling of extremity e. Inability to move extremity Indications of compartment syndrome are severe pain not relieved by analgesics, tingling of extremity, and inability to move extremity. A palpable distal pulse and capillary refill to the extremity of <3 seconds are expected findings.

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for what condition (Select all that apply)? a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. Urinary tract infection (UTI) e. Diabetes mellitus

ANS: D, E d. Urinary tract infection (UTI) e. Diabetes mellitus Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. If accompanied by excessive thirst and weight loss, these symptoms may indicate the onset of diabetes mellitus. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.

Which statements regarding hepatitis B are correct (Select all that apply)? a. Hepatitis B cannot exist in a carrier state. b. Hepatitis B can be prevented by hepatitis B virus vaccine. c. Hepatitis B can be transferred to an infant of a breastfeeding mother. d. The onset of hepatitis B is insidious. e. Immunity to hepatitis B occurs after one attack.

B, C, D, E b. Hepatitis B can be prevented by hepatitis B virus vaccine. c. Hepatitis B can be transferred to an infant of a breastfeeding mother. d. The onset of hepatitis B is insidious. e. Immunity to hepatitis B occurs after one attack. The vaccine elicits the formation of an antibody to the hepatitis B surface antigen, which is protective against hepatitis B. Hepatitis B can be transferred to an infant of a breastfeeding mother, especially if the mother's nipples are cracked. The onset of hepatitis B is insidious. Immunity develops after one exposure to hepatitis B. Hepatitis B can exist in a carrier state.

A mother who intended to breastfeed has given birth to an infant with a cleft palate. Nursing interventions should include (Select all that apply): a. Giving medication to suppress lactation. b. Encouraging and helping mother to breastfeed. c. Teaching mother to feed breast milk by gavage. d. Recommending use of a breast pump to maintain lactation until infant can suck.

B, D b. Encouraging and helping mother to breastfeed. d. Recommending use of a breast pump to maintain lactation until infant can suck. The mother who wishes to breastfeed may need encouragement and support because the defect does present some logistical issues. The nipple must be positioned and stabilized well back in the infant's oral cavity so that the tongue action facilitates milk expression. The suction required to stimulate milk, absent initially, may be useful before nursing to stimulate the let-down reflex. Because breastfeeding is an option, if the mother wishes to breastfeed, medications should not be given to suppress lactation. Because breastfeeding can usually be accomplished, gavage feedings are not indicated.

The nurse is preparing to care for an infant returning from pyloromyotomy surgery. Which prescribed orders should the nurse anticipate implementing (Select all that apply)? a. Nothing by mouth for 24 hours b. Administration of analgesics for pain c. Ice bag to the incisional area d. Intravenous (IV) fluids continued until tolerating fluids by mouth e. Clear liquids as the first feeding

B, D, E b. Administration of analgesics for pain d. Intravenous (IV) fluids continued until tolerating fluids by mouth e. Clear liquids as the first feeding Feedings are usually instituted soon after a pyloromyotomy surgery, beginning with clear liquids and advancing to formula or breast milk as tolerated. IV fluids are administered until the infant is taking and retaining adequate amounts by mouth. Appropriate analgesics should be given around the clock because pain is continuous. Ice should not be applied to the incisional area as it vasoconstricts and would reduce circulation to the incisional area and impair healing.

A nurse is conducting dietary teaching on high-fiber foods for parents of a child with constipation. Which foods should the nurse include as being high in fiber (Select all that apply)? a. White rice b. Avocados c. Whole grain breads d. Bran pancakes e. Raw carrots

C, D, E c. Whole grain breads d. Bran pancakes e. Raw carrots High-fiber foods include whole grain breads, bran pancakes, and raw carrots. Unrefined (brown) rice is high in fiber but white rice is not. Raw fruits, especially those with skins or seeds, other than ripe banana or avocados are high in fiber.

34. Which information should the nurse give to a child who is to have magnetic resonance imaging (MRI) of the brain? a. "Your head will be restrained during the procedure." b. "You will have to drink a special fluid before the test." c. "You will have to lie flat after the test is finished." d. "You will have electrodes placed on your head with glue."

a. "Your head will be restrained during the procedure." To reduce fear and enhance cooperation during the MRI, the child should be made aware that the head will be restricted to obtain accurate information. Drinking fluids is usually done for neurologic procedures. A child should lie flat after a lumbar puncture, not after an MRI. Electrodes are attached to the head for an electroencephalogram.

31. Which type of seizure may be difficult to detect? a. Absence c. Simple partial b. Generalized d. Complex partial

a. Absence Absence seizures may go unrecognized because little change occurs in the child's behavior during the seizure. Generalized, simple partial, and complex partial seizures all have clinical manifestations that are observable.

An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma. The nurse's approach should include: a. Answering questions with straightforward honesty. b. Avoiding discussing the seriousness of the condition. c. Explaining that, although the amputation is difficult, it will cure the cancer. d. Assisting the adolescent in accepting the amputation as better than a long course of chemotherapy.

a. Answering questions with straightforward honesty. Honesty is essential to gain the cooperation and trust of the child. The diagnosis of cancer should not be disguised with falsehoods. The adolescent should be prepared in advance for the surgery so that there is time for reflection about the diagnosis and subsequent treatment. This allows questions to be answered. To accept the need for radical surgery, the child must be aware of the lack of alternatives for treatment. Amputation is necessary, but it will not guarantee a cure. Chemotherapy is an integral part of the therapy with surgery. The child should be informed of the need for chemotherapy and its side effects before surgery.

A young girl has just injured her ankle at school. In addition to calling the child's parents, the most appropriate immediate action by the school nurse is to: a. Apply ice. b. Observe for edema and discoloration. c. Encourage child to assume a comfortable position. d. Obtain parental permission for administration of acetaminophen or aspirin.

a. Apply ice. Soft-tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. Observing for edema and discoloration, encouraging the child to assume a comfortable position, and obtaining parental permission or administration of acetaminophen or aspirin are not immediate priorities.

A child with growth hormone (GH) deficiency is receiving GH therapy. The best time for the GH to be administered is: a. At bedtime. b. After meals. c. Before meals. d. On arising in the morning.

a. At bedtime. Injections are best given at bedtime to more closely approximate the physiologic release of GH. Before or after meals and on arising in the morning are times that do not mimic the physiologic release of the hormone.

Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include: a. Avoiding using any latex product. b. Using only nonallergenic latex products. c. Administering medication for long-term desensitization. d. Teaching the family about long-term management of asthma.

a. Avoiding using any latex product. Care must be taken that individuals who are at high risk for latex allergies do not come in direct or secondary contact with products or equipment containing latex at any time during medical treatment. There are no nonallergenic latex products. At this time desensitization is not an option. The child does not have asthma. The parents must be taught about allergy and the risk of anaphylaxis.

The nurse is implementing care for a school-age child admitted to the pediatric intensive care in diabetic ketoacidosis (DKA). Which prescribed intervention should the nurse implement first? a. Begin 0.9% saline solution intravenously as prescribed. b. Administer regular insulin intravenously as prescribed. c. Place child on a cardiac monitor. d. Place child on a pulse oximetry monitor.

a. Begin 0.9% saline solution intravenously as prescribed All patients with DKA experience dehydration (10% of total body weight in severe ketoacidosis) because of the osmotic diuresis, accompanied by depletion of electrolytes (sodium, potassium, chloride, phosphate, and magnesium). The initial hydrating solution is 0.9% saline solution. Insulin therapy should be started after the initial rehydration bolus because serum glucose levels fall rapidly after volume expansion. The child should be placed on the cardiac and pulse oximetry monitors after the rehydrating solution has been initiated.

14. An adolescent boy is brought to the emergency department after a motorcycle accident. His respirations are deep, periodic, and gasping. There are extreme fluctuations in blood pressure. Pupils are dilated and fixed. What type of head injury should the nurse suspect? a. Brainstem b. Skull fracture c. Subdural hemorrhage d. Epidural hemorrhage

a. Brainstem Signs of brainstem injury include deep, rapid, periodic or intermittent, and gasping respirations. Wide fluctuations or noticeable slowing of the pulse, widening pulse pressure, or extreme fluctuations in blood pressure are consistent with a brainstem injury. Skull fracture and subdural and epidural hemorrhages are not consistent with these signs.

33. Which clinical manifestations would suggest hydrocephalus in a neonate? a. Bulging fontanel and dilated scalp veins b. Closed fontanel and high-pitched cry c. Constant low-pitched cry and restlessness d. Depressed fontanel and decreased blood pressure

a. Bulging fontanel and dilated scalp veins Bulging fontanel, dilated scalp veins, and separated sutures are clinical manifestations of hydrocephalus in neonates. Closed fontanel and high-pitched cry, constant low-pitched cry and restlessness, and depressed fontanel and decreased blood pressure are not clinical manifestations of hydrocephalus, but all should be referred for evaluation.

Therapeutic management of nephrosis includes: a. Corticosteroids. c. Long-term diuretics. b. Antihypertensive agents. d. Increased fluids to promote diuresis

a. Corticosteroids. Corticosteroids are the first line of therapy for nephrosis. Response is usually seen within 7 to 21 days. Antihypertensive agents and long-term diuretic therapy are usually not necessary. A diet that has fluid and salt restrictions may be indicated

What is characterized by a chronic inflammatory process that may involve any part of the gastrointestinal (GI) tract from mouth to anus? a. Crohn's disease b. Meckel's diverticulum c. Ulcerative colitis d. Irritable bowel syndrome

a. Crohn's disease The chronic inflammatory process of Crohn's disease involves any part of the GI tract from the mouth to the anus but most often affects the terminal ileum. Ulcerative colitis, Meckel's diverticulum, and irritable bowel syndrome do not affect the entire GI tract.

The nurse closely monitors the temperature of a child with nephrosis. The purpose of this is to detect an early sign of: a. Infection. c. Encephalopathy. b. Hypertension. d. Edema.

a. Infection. Infection is a constant source of danger to edematous children and those receiving corticosteroid therapy. An increased temperature could be an indication of an infection, but it is not an indication of hypertension or edema. Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms.

32. An important nursing intervention when caring for a child who is experiencing a seizure is to: a. Describe and record the seizure activity observed. b. Restrain the child when seizure occurs to prevent bodily harm. c. Place a tongue blade between the teeth if they become clenched. d. Suction the child during a seizure to prevent aspiration.

a. Describe and record the seizure activity observed. When a child is having a seizure, the priority nursing care is observation of the child and seizure. The nurse then describes and records the seizure activity. The child should not be restrained, and nothing should be placed in his or her mouth. This may cause injury. To prevent aspiration, if possible, the child should be placed on his or her side, facilitating drainage.

21. Which statement best describes a neuroblastoma? a. Diagnosis is usually made after metastasis occurs. b. Early diagnosis is usually possible because of the obvious clinical manifestations. c. It is the most common brain tumor in young children. d. It is the most common benign tumor in young children.

a. Diagnosis is usually made after metastasis occurs. Neuroblastoma is a silent tumor with few symptoms. In more than 70% of cases, diagnosis is made after metastasis occurs, with the first signs caused by involvement in the nonprimary site. In only 30% of cases is diagnosis made before metastasis. Neuroblastomas are the most common malignant extracranial solid tumors in children. The majority of tumors develop in the adrenal glands or the retroperitoneal sympathetic chain. They are not benign; they metastasize.

When assessing the child with osteogenesis imperfecta, the nurse should expect to observe: a. Discolored teeth. b. Below-normal intelligence. c. Increased muscle tone. d. Above-average stature.

a. Discolored teeth. Children with osteogenesis imperfecta have incomplete development of bones, teeth, ligaments, and sclerae. Teeth are discolored because of abnormal enamel. Despite their appearance, children with osteogenesis imperfecta have normal or above-normal intelligence. The child with osteogenesis imperfecta has weak muscles and decreased muscle tone. Because of compression fractures of the spine, the child appears short.

The nurse is caring for a neonate with a suspected tracheoesophageal fistula. Nursing care should include: a. Elevating the head but giving nothing by mouth. b. Elevating the head for feedings. c. Feeding glucose water only. d. Avoiding suctioning unless the infant is cyanotic.

a. Elevating the head but giving nothing by mouth When a newborn is suspected of having tracheoesophageal fistula, the most desirable position is supine with the head elevated on an inclined plane of at least 30 degrees. It is imperative that any source of aspiration be removed at once; oral feedings are withheld. Feedings of fluids should not be given to infants suspected of having tracheoesophageal fistulas. The oral pharynx should be kept clear of secretion by oral suctioning. This is to avoid the cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx.

Bismuth subsalicylate, clarithromycin, and metronidazole are prescribed for a child with a peptic ulcer to: a. Eradicate Helicobacter pylori. b. Treat epigastric pain. c. Coat gastric mucosa. d. Reduce gastric acid production.

a. Eradicate Helicobacter pylori. This combination of drug therapy is effective in the treatment and eradication of H. pylori.

The priority nursing intervention when a child is unconscious after a fall is to: a. Establish an adequate airway. b. Perform neurologic assessment. c. Monitor intercranial pressure. d. Determine whether a neck injury is present.

a. Establish an adequate airway. Respiratory effectiveness is the primary concern in the care of the unconscious child. Establishing an adequate airway is always the first priority. A neurologic assessment and determination of neck injury are performed after breathing and circulation are stabilized. Intracranial, not intercranial, pressure is monitored if indicated after airway, breathing, and circulation are maintained.

Osteosarcoma is the most common bone cancer in children. Where are most of the primary tumor sites? a. Femur b. Humerus c. Pelvis d. Tibia

a. Femur Osteosarcoma is the most frequently encountered malignant bone cancer in children. The peak incidence is between ages 10 and 25 years. More than half occur in the femur. After the femur, most of the remaining sites are the humerus, tibia, pelvis, jaw, and phalanges.

The nurse is conducting an assessment on a school-age child with urosepsis. Which assessment finding should the nurse expect? a. Fever with a positive blood culture c. Oliguria and hypertension b. Proteinuria and edema d. Anemia and thrombocytopenia

a. Fever with a positive blood culture Symptoms of urosepsis include a febrile urinary tract infection coexisting with systemic signs of bacterial illness; blood culture reveals the presence of a urinary pathogen. Proteinuria and edema are symptoms of minimal change nephrotic syndrome. Oliguria and hypertension are symptoms of acute glomerulonephritis. Anemia and thrombocytopenia are symptoms of hemolytic uremic syndrome

Nurses must be alert for increased fluid requirements when a child has: a. Fever. b. Congestive heart failure. c. Mechanical ventilation. d. Increased intracranial pressure (ICP).

a. Fever. Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. Respiratory rate influences insensible fluid loss and should be monitored in the mechanically ventilated child. Congestive heart failure is a case of fluid overload in children. ICP does not lead to increased fluid requirements in children.

Which problem is most often associated with myelomeningocele? a. Hydrocephalus c. Biliary atresia b. Craniosynostosis d. Esophageal atresia

a. Hydrocephalus Hydrocephalus is an associated anomaly in 80% to 90% of children. Craniosynostosis is the premature closing of the cranial sutures and is not associated with myelomeningocele. Biliary and esophageal atresias are not associated with myelomeningocele.

Spastic cerebral palsy is characterized by: a. Hypertonicity and poor control of posture, balance, and coordinated motion. b. Athetosis and dystonic movements. c. Wide-based gait and poor performance of rapid, repetitive movements. d. Tremors and lack of active movement.

a. Hypertonicity and poor control of posture, balance, and coordinated motion. Hypertonicity and poor control of posture, balance, and coordinated motion are part of the classification of spastic cerebral palsy. Athetosis and dystonic movements are part of the classification of dyskinetic/athetoid cerebral palsy. Wide-based gait and poor performance of rapid, repetitive movements are part of the classification of ataxic cerebral palsy. Tremors and lack of active movement may indicate other neurologic disorders.

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child will begin with: a. Intravenous fluids. b. Oral rehydration solution (ORS). c. Clear liquids, 1 to 2 ounces at a time. d. Administration of antidiarrheal medication.

a. Intravenous fluids. Intravenous fluids are initiated in children with severe dehydration. ORS is acceptable therapy if the dehydration is not severe. Diarrhea is not managed by using clear liquids by mouth. These fluids have a high carbohydrate content, low electrolyte content, and high osmolality. Antidiarrheal medications are not recommended for the treatment of acute infectious diarrhea.

The earliest clinical manifestation of biliary atresia is: a. Jaundice. c. Hepatomegaly. b. Vomiting. d. Absence of stooling.

a. Jaundice. Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera and may be present at birth, but is usually not apparent until ages 2 to 3 weeks. Vomiting is not associated with biliary atresia. Hepatomegaly and abdominal distention are common but occur later. Stools are large and lighter in color than expected because of the lack of bile.

The best chance of survival for a child with cirrhosis is: a. Liver transplantation. b. Treatment with immune globulin. c. Treatment with corticosteroids. d. Provision of nutritional support.

a. Liver transplantation. The only successful treatment for end-stage liver disease and liver failure may be liver transplantation, which has improved the prognosis for many children with cirrhosis. Liver transplantation has revolutionized the approach to cirrhosis. Liver failure and cirrhosis are indications for transplantation. Liver transplantation reflects the failure of other medical and surgical measures, such as treatment with corticosteroids or immune globulin and nutritional support, to prevent or treat cirrhosis.

9. Which drug would be used to treat a child who has increased intracranial pressure (ICP) resulting from cerebral edema? a. Mannitol b. Epinephrine hydrochloride c. Atropine sulfate d. Sodium bicarbonate

a. Mannitol For increased ICP, mannitol, an osmotic diuretic, administered intravenously, is the drug used most frequently for rapid reduction. Epinephrine, atropine sulfate, and sodium bicarbonate are not used to decrease ICP.

15. A toddler fell out of a second-story window. She had brief loss of consciousness and vomited four times. Since admission, she has been alert and oriented. Her mother asks why a computed tomography (CT) scan is required when she "seems fine." The nurse should explain that the toddler: a. May have a brain injury. c. May start having seizures. b. Needs this because of her age. d. Probably has a skull fracture.

a. May have a brain injury. The child's history of the fall, brief loss of consciousness, and vomiting four times necessitate evaluation of a potential brain injury. The severity of a head injury may not be apparent on clinical examination but will be detectable on a CT scan. The need for the CT scan is related to the injury and symptoms, not the child's age, and is necessary to determine whether a brain injury has occurred.

26. When caring for the child with Reye's syndrome, the priority nursing intervention is to: a. Monitor intake and output. c. Observe for petechiae. b. Prevent skin breakdown. d. Do range-of-motion (ROM) exercises.

a. Monitor intake and output. Accurate and frequent monitoring of intake and output is essential for adjusting fluid volumes to prevent both dehydration and cerebral edema. Preventing skin breakdown, observing for petechiae, and doing ROM exercises are important interventions in the care of a critically ill or comatose child. Careful monitoring of intake and output is a priority.

The nurse is preparing an adolescent with scoliosis for a Luque-rod segmental spinal instrumentation procedure. Which consideration should the nurse include? a. Nasogastric intubation and urinary catheter may be required. b. Ambulation will not be allowed for up to 3 months. c. Surgery eliminates the need for casting and bracing. d. Discomfort can be controlled with nonpharmacologic methods.

a. Nasogastric intubation and urinary catheter may be required. Luque-rod segmental spinal instrumentation is a surgical procedure. Nasogastric intubation and urinary catheterization may be required. Ambulation is allowed as soon as possible. Depending on the instrumentation used, most patients walk by the second or third postoperative day. Casting and bracing are required postoperatively. The child usually has considerable pain for the first few days after surgery. Intravenous opioids should be administered on a regular basis.

The most common problem of children born with a myelomeningocele is: a. Neurogenic bladder. c. Respiratory compromise. b. Intellectual impairment. d. Cranioschisis.

a. Neurogenic bladder. Myelomeningocele is one of the most common causes of neuropathic (neurogenic) bladder dysfunction among children. Risk of intellectual impairment is minimized through early intervention and management of hydrocephalus. Respiratory compromise is not a common problem in myelomeningocele. Cranioschisis is a skull defect through which various tissues protrude. It is not associated with myelomeningocele.

A mother calls the clinic nurse about her 4-year-old son who has acute diarrhea. She has been giving him the antidiarrheal drug loperamide (Imodium A-D). The nurse's response should be based on knowledge that this drug is: a. Not indicated. b. Indicated because it slows intestinal motility. c. Indicated because it decreases diarrhea. d. Indicated because it decreases fluid and electrolyte losses.

a. Not indicated. Antidiarrheal medications are not recommended for the treatment of acute infectious diarrhea. These medications have adverse effects and toxicity, such as worsening of the diarrhea because of slowing of motility and ileus, or a decrease in diarrhea with continuing fluid losses and dehydration. Antidiarrheal medications are not recommended in infants and small children.

Four-year-old David is placed in Buck's extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. What should the nurse do first? a. Notify the practitioner of the changes noted. b. Give the child medication to relieve the pain. c. Reposition the child and notify the physician. d. Chart the observations and check the extremity again in 15 minutes.

a. Notify the practitioner of the changes noted. The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner. Pain medication should be given after the practitioner is notified. This is an emergency condition; immediate reporting is indicated. The findings should be documented with ongoing assessment.

The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. The most appropriate nursing action is to: a. Notify the practitioner. b. Measure abdominal girth. c. Auscultate for bowel sounds. d. Take vital signs, including blood pressure.

a. Notify the practitioner. Passage of a normal brown stool indicates that the intussusception has reduced itself. This is immediately reported to the practitioner, who may choose to alter the diagnostic/therapeutic plan of care.

What food choice by the parent of a 2-year-old child with celiac disease indicates a need for further teaching? a. Oatmeal c. Corn muffin b. Rice cake d. Meat patty

a. Oatmeal The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Oatmeal contains gluten and is not an appropriate food selection. Rice is an appropriate choice because it does not contain gluten. Corn is digestible because it does not contain gluten. Meats do not contain gluten and can be included in the diet of a child with celiac disease.

Which test is never performed on a child who is awake? a. Oculovestibular response b. Doll's head maneuver c. Funduscopic examination for papilledema d. Assessment of pyramidal tract lesions

a. Oculovestibular response The oculovestibular response (caloric test) involves the instillation of ice water into the ear of a comatose child. The caloric test is painful and is never performed on a child who is awake or one who has a ruptured tympanic membrane. Doll's head maneuver, funduscopic examination, and assessment of pyramidal tract lesions can be performed on children who are awake.

The primary clinical manifestations of acute renal failure are: a. Oliguria and hypertension. c. Proteinuria and muscle cramps. b. Hematuria and pallor. d. Bacteriuria and facial edema

a. Oliguria and hypertension. The principal feature of acute renal failure is oliguria. Hematuria and pallor, proteinuria and muscle cramps, and bacteriuria and facial edema are not principal features of acute renal failure

Which of the following can result from the bone demineralization associated with immobility? a. Osteoporosis b. Urinary retention c. Pooling of blood d. Susceptibility to infection

a. Osteoporosis Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi.

Which condition can result from the bone demineralization associated with immobility? a. Osteoporosis b. Urinary retention c. Pooling of blood d. Susceptibility to infection

a. Osteoporosis Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi. Urinary retention is secondary to the effect of immobilization on the urinary tract. Pooling of blood is a result of the cardiovascular effects of immobilization. Susceptibility to infection can result from the effects of immobilization on the respiratory and renal systems.

A high-fiber food that the nurse could recommend for a child with chronic constipation is: a. Popcorn. b. Muffins. c. Pancakes. d. Ripe bananas.

a. Popcorn. Popcorn is a high-fiber food. Pancakes and muffins do not have significant fiber unless made with fruit or bran. Raw fruits, especially those with skins and seeds, other than ripe bananas and avocados are high in fiber.

A young boy has just been diagnosed with pseudohypertrophic (Duchenne's) muscular dystrophy. The management plan should include: a. Recommending genetic counseling. b. Explaining that the disease is easily treated. c. Suggesting ways to limit the use of muscles. d. Assisting the family in finding a nursing facility to provide his care.

a. Recommending genetic counseling. Pseudohypertrophic (Duchenne's) muscular dystrophy is inherited as an X-linked recessive gene. Genetic counseling is recommended for parents, female siblings, maternal aunts, and their female offspring. No effective treatment exists at this time for childhood muscular dystrophy. Maintaining optimal function of all muscles for as long as possible is the primary goal. It has been found that children who remain as active as possible are able to avoid wheelchair confinement for a longer time. Assisting the family in finding a nursing facility is inappropriate at the time of diagnosis. When the child becomes increasingly incapacitated, the family may consider home-based care, a skilled nursing facility, or respite care to provide the necessary care.

An important nursing consideration in the care of a child with celiac disease is to: a. Refer to a nutritionist for detailed dietary instructions and education. b. Help the child and family understand that diet restrictions are usually only temporary. c. Teach proper hand washing and Standard Precautions to prevent disease transmission. d. Suggest ways to cope more effectively with stress to minimize symptoms.

a. Refer to a nutritionist for detailed dietary instructions and education. The main consideration is helping the child adhere to dietary management. Considerable time is spent in explaining to the child and parents the disease process, the specific role of gluten in aggravating the condition, and those foods that must be restricted. Referral to a nutritionist would help in this process. The most severe symptoms usually occur in early childhood and adult life. Dietary avoidance of gluten should be lifelong. Celiac disease is not transmissible or stress related.

Which diagnostic test allows visualization of the renal parenchyma and renal pelvis without exposure to external beam radiation or radioactive isotopes? a. Renal ultrasound c. Intravenous pyelography b. Computed tomography d. Voiding cystourethrography

a. Renal ultrasound The transmission of ultrasonic waves through the renal parenchyma allows visualization of the renal parenchyma and renal pelvis without exposure to external beam radiation or radioactive isotopes. Computed tomography uses external radiation, and sometimes contrast media are used. Intravenous pyelography uses contrast medium and external radiation for x-ray films. Contrast medium is injected into the bladder through the urethral opening for voiding cystourethrography. External radiation for x-ray films is used before, during, and after voiding.

One of the clinical manifestations of chronic renal failure is uremic frost. What best describes this term? a. Deposits of urea crystals in urine b. Deposits of urea crystals on skin c. Overexcretion of blood urea nitrogen d. Inability of body to tolerate cold temperatures

b. Deposits of urea crystals on skin Uremic frost is the deposition of urea crystals on the skin, not in the urine. The kidneys are unable to excrete blood urea nitrogen, leading to elevated levels. There is no relation between cold temperatures and uremic frost

Discharge planning for the child with juvenile arthritis includes the need for: a. Routine ophthalmologic examinations to assess for visual problems. b. A low-calorie diet to decrease or control weight in the less mobile child. c. Avoiding the use of aspirin to decrease gastric irritation. d. Immobilizing the painful joints, which are the result of the inflammatory process.

a. Routine ophthalmologic examinations to assess for visual problems. The systemic effects of juvenile arthritis can result in visual problems, making routine eye examinations important. Children with juvenile arthritis do not have problems with increased weight and often are anorexic and in need of high-calorie diets. Children with arthritis are often treated with aspirin. Children with arthritis are able to immobilize their own joints. Range-of-motion exercises are important for maintaining joint flexibility and preventing restricted movement in the affected joints.

Which term is used to describe a type of fracture that does not produce a break in the skin? a. Simple b. Compound c. Complicated d. Comminuted

a. Simple If a fracture does not produce a break in the skin, it is called a simple or closed fracture. A compound or open fracture is one with an open wound through which the bone protrudes. A complicated fracture is one in which the bone fragments damage other organs or tissues. A comminuted fracture occurs when small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue. These are rare in children.

A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What should the nurse suggest to remove this material? a. Soak in a bathtub. c. Apply powder to absorb material. b. Vigorously scrub the leg. d. Carefully pick material off of the leg.

a. Soak in a bathtub. Simple soaking in the bathtub is usually sufficient for the removal of the desquamated skin and sebaceous secretions. It may take several days to eliminate the accumulation completely. The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding. Oil or lotion, but not powder, may provide comfort for the child.

What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux? a. The importance of taking prophylactic antibiotics b. Suggestions for how to maintain fluid restrictions c. The use of bubble baths as an incentive to increase bath time d. The need for the child to hold urine for 6 to 8 hours

a. The importance of taking prophylactic antibiotics Prophylactic antibiotics are used to prevent urinary tract infections (UTIs) in a child with vesicoureteral reflux, although this treatment plan has become controversial. Fluids are not restricted when a child has vesicoureteral reflux. In fact, fluid intake should be increased as a measure to prevent UTIs. Bubble baths should be avoided to prevent urethral irritation and possible UTI. To prevent UTIs, the child should be taught to void frequently and never resist the urge to urinate

A goiter is an enlargement or hypertrophy of which gland? a. Thyroid b. Adrenal c. Anterior pituitary d. Posterior pituitary

a. Thyroid A goiter is an enlargement or hypertrophy of the thyroid gland. Goiter is not associated with the adrenals or the anterior and posterior pituitaries.

Which of the following is most descriptive of the therapeutic management of osteosarcoma? a. Treatment usually consists of surgery and chemotherapy. b. Amputation of affected extremity is rarely necessary. c. Intensive irradiation is the primary treatment. d. Bone marrow transplantation offers the best chance of long-term survival.

a. Treatment usually consists of surgery and chemotherapy. The optimal therapy for osteosarcoma is a combination of surgery and chemotherapy.

What is most descriptive of the therapeutic management of osteosarcoma? a. Treatment usually consists of surgery and chemotherapy. b. Amputation of the affected extremity is rarely necessary. c. Intensive irradiation is the primary treatment. d. Bone marrow transplantation offers the best chance of long-term survival.

a. Treatment usually consists of surgery and chemotherapy. The optimal therapy for osteosarcoma is a combination of surgery and chemotherapy. Amputation is frequently required. Intensive irradiation and bone marrow transplantation are usually not part of the therapeutic management.

When a child has chronic renal failure, the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as: a. Uremia. c. Proteinuria. b. Oliguria. d. Pyelonephritis.

a. Uremia. Uremia is the retention of nitrogenous products, producing toxic symptoms. Oliguria is diminished urine output. Proteinuria is the presence of protein, usually albumin, in the urine. Pyelonephritis is an inflammation of the kidney and renal pelvis.

What effect does immobilization have on the cardiovascular system? a. Venous stasis b. Increased vasopressor mechanism c. Normal distribution of blood volume d. Increased efficiency of orthostatic neurovascular reflexes

a. Venous stasis Because of decreased muscle contraction, the physiologic effects of immobilization include venous stasis. This can lead to pulmonary emboli or thrombi. A decreased vasopressor mechanism results in orthostatic hypotension, syncope, hypotension, decreased cerebral blood flow, and tachycardia. An altered distribution of blood volume is found, with decreased cardiac workload and exercise tolerance. Immobilization causes a decreased efficiency of orthostatic neurovascular reflexes, with an inability to adapt readily to the upright position and pooling of blood in the extremities in the upright position.

Immobilization causes which of the following effects on the cardiovascular system? a. Venous stasis b. Increased vasopressor mechanism c. Normal distribution of blood volume d. Increased efficiency of orthostatic neurovascular reflexes

a. Venous stasis The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi.

What should the nurse recommend to prevent urinary tract infections in young girls? a. Wearing cotton underpants b. Limiting bathing as much as possible c. Increasing fluids; decreasing salt intake d. Cleansing the perineum with water after voiding

a. Wearing cotton underpants Cotton underpants are preferable to nylon underpants. No evidence exists that limiting bathing, increasing fluids, decreasing salt intake, or cleansing the perineum with water decreases urinary tract infections in young girls

The nurse is preparing a school-age child for a computed tomography (CT) scan to assess cerebral function. When preparing the child for the scan, which statement should the nurse include? a. "Pain medication will be given." b. "The scan will not hurt." c. "You will be able to move once the equipment is in place." d. "Unfortunately no one can remain in the room with you during the test."

b. "The scan will not hurt." For CT scans, the child will not be allowed to move and must be immobilized. It is important to emphasize to the child that at no time is the procedure painful. Pain medication is not required; however, sedation is sometimes necessary. Someone is able to remain with the child during the procedure.

How much folic acid is recommended for women of childbearing age? a. 0.1 mg c. 1.5 mg b. 0.4 mg d. 2 mg

b. 0.4 mg It has been estimated that a daily intake of 0.4 mg of folic acid in women of childbearing age will prevent 50% to 70% of cases of neural tube defects. A dose of 0.1 mg is too low, and 1.5 mg and 2 mg are not recommended dosages of folic acid.

36. The nurse has received report on four children. Which child should the nurse assess first? a. A school-age child in a coma with stable vital signs b. A preschool child with a head injury and decreasing level of consciousness c. An adolescent admitted after a motor vehicle accident who is oriented to person and place d. A toddler in a persistent vegetative state with a low-grade fever

b. A preschool child with a head injury and decreasing level of consciousness The nurse should assess the child with a head injury and decreasing level of consciousness (LOC) first. Assessment of LOC remains the earliest indicator of improvement or deterioration in neurologic status. The next child the nurse should assess is a toddler in a persistent vegetative state with a low-grade fever. The school-age child in a coma with stable vital signs and the adolescent admitted to the hospital who is oriented to his or her surroundings would be of least worry to the nurse.

Chronic adrenocortical insufficiency is also referred to as: a. Graves' disease. b. Addison's disease. c. Cushing's syndrome. d. Hashimoto's disease.

b. Addison's disease. Addison's disease is chronic adrenocortical insufficiency. Graves' and Hashimoto's diseases involve the thyroid gland. Cushing's syndrome is a result of excessive circulation of free cortisol.

Acute diarrhea is often caused by: a. Hirschsprung's disease. c. Hypothyroidism. b. Antibiotic therapy. d. Meconium ileus.

b. Antibiotic therapy. Acute diarrhea is a sudden increase in frequency and change in consistency of stools and may be associated with antibiotic therapy. Hirschsprung's disease, hypothyroidism, and meconium ileus are usually manifested with constipation rather than diarrhea.

Which interaction is part of the discharge plan for a school-age child with osteomyelitis who is receiving home antibiotic therapy? a. Instructions for a low-calorie diet b. Arrangements for tutoring and schoolwork c. Instructions for a high-fat, low-protein diet d. Instructions for the parent to return the child to team sports immediately

b. Arrangements for tutoring and schoolwork Promoting optimal growth and development in the school-age child is important. It is important to continue schoolwork and arrange for tutoring if indicated. The child with osteomyelitis should be on a high-calorie, high-protein diet. The child with osteomyelitis may need time for the bone to heal before returning to full activities.

An appropriate nursing intervention when caring for a child in traction is to: a. Remove adhesive traction straps daily to prevent skin breakdown. b. Assess for tightness, weakness, or contractures in uninvolved joints and muscles. c. Provide active range-of-motion exercises to affected extremity 3 times a day. d. Keep child in one position to maintain good alignment.

b. Assess for tightness, weakness, or contractures in uninvolved joints and muscles. Traction places stress on the affected bone, joint, and muscles. The nurse must assess for tightness, weakness, or contractures developing in the uninvolved joints and muscles. The adhesive straps should be released/replaced only when absolutely necessary. Active, passive, or active with resistance exercises should be carried out for the unaffected extremity only. Movement is expected with children. Each time the child moves, the nurse should check to ensure that proper alignment is maintained.

The nurse is admitting a school-age child with suspected Guillain-Barré syndrome (GBS). Which nursing intervention is a priority in the care for this child? a. Monitoring intake and output c. Placing on a telemetry monitor b. Assessing respiratory efforts d. Obtaining laboratory studies

b. Assessing respiratory efforts Treatment of GBS is primarily supportive. In the acute phase, patients are hospitalized because respiratory and pharyngeal involvement may require assisted ventilation, sometimes with a temporary tracheotomy. Treatment modalities include aggressive ventilatory support in the event of respiratory compromise, administration of intravenous immunoglobulin (IVIG), and sometimes steroids; plasmapheresis and immunosuppressive drugs may also be used. Monitoring intake and output, telemetry monitoring, and obtaining laboratory studies may be part of the plan of care but are not the priority.

Calcium carbonate is given with meals to a child with chronic renal disease. The purpose of this is to: a. Prevent vomiting. b. Bind phosphorus. c. Stimulate appetite. d. Increase absorption of fat-soluble vitamins

b. Bind phosphorus. Oral calcium carbonate preparations combine with phosphorus to decrease gastrointestinal absorption and the serum levels of phosphate; serum calcium levels are increased by the calcium carbonate, and vitamin D administration is necessary to increase calcium absorption. Calcium carbonate does not prevent vomiting, stimulate appetite, or increase the absorption of fat-soluble vitamins

12. Which statement best describes a subdural hematoma? a. Bleeding occurs between the dura and the skull. b. Bleeding occurs between the dura and the cerebrum. c. Bleeding is generally arterial, and brain compression occurs rapidly. d. The hematoma commonly occurs in the parietotemporal region.

b. Bleeding occurs between the dura and the cerebrum. A subdural hematoma is bleeding that occurs between the dura and the cerebrum as a result of a rupture of cortical veins that bridge the subdural space. An epidural hemorrhage occurs between the dura and the skull, is usually arterial with rapid brain concussion, and occurs most often in the parietotemporal region.

The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include: a. Arm restraints, postural drainage, and mouth irrigations. b. Cleansing of suture line, supine and side-lying positions, and arm restraints. c. Mouth irrigations, prone position, and cleansing of suture line. d. Supine and side-lying positions, postural drainage, and arm restraints.

b. Cleansing of suture line, supine and side-lying positions, and arm restraints. The suture line should be cleansed gently after feeding. The child should be positioned on back or side or in an infant seat. Elbows are restrained to prevent the child from accessing the operative site. Postural drainage is not indicated. This would increase the pressure on the operative site when the child is placed in different positions. Mouth irrigations would not be indicated.

A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of: a. Vitamin D. b. Cortisone c. Stool softeners. d. Calcium carbonate.

b. Cortisone The most common biochemical defect with congenital adrenal hyperplasia is partial or complete 21-hydroxylase deficiency. With complete deficiency, insufficient amounts of aldosterone and cortisol are produced, so circulatory collapse occurs without immediate replacement. Vitamin D, stool softeners, and calcium carbonate have no role in the therapy of adrenogenital hyperplasia.

The nurse is caring for an infant with myelomeningocele scheduled for surgical closure in the morning. Which interventions should the nurse plan for the care of the myelomeningocele sac? a. Open to air b. Covered with a sterile, moist, nonadherent dressing c. Reinforcement of the original dressing if drainage noted d. A diaper secured over the dressing

b. Covered with a sterile, moist, nonadherent dressing Before surgical closure, the myelomeningocele is prevented from drying by the application of a sterile, moist, nonadherent dressing over the defect. The moistening solution is usually sterile normal saline. Dressings are changed frequently (every 2 to 4 hours), and the sac is closely inspected for leaks, abrasions, irritation, and any signs of infection. The sac must be carefully cleansed if it becomes soiled or contaminated. The original dressing would not be reinforced but changed as needed. A diaper is not placed over the dressing because stool contamination can occur.

Immobilization causes which of the following effects on metabolism? a. Hypocalcemia b. Decreased metabolic rate c. Positive nitrogen balance d. Increased production of stress hormones

b. Decreased metabolic rate Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake

The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complications should the nurse monitor? a. Hypocalcemia b. Decreased metabolic rate c. Positive nitrogen balance d. Increased production of stress hormones

b. Decreased metabolic rate Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake, leads to hypercalcemia, and causes a negative nitrogen balance secondary to muscle atrophy. A decreased production of stress hormones occurs with decreased physical and emotional coping capacity.

A nurse is reviewing the laboratory results on a school-age child with hypoparathyroidism. Which results are consistent with this condition? a. Decreased serum phosphorus b. Decreased serum calcium c. Increased serum glucose d. Decreased serum cortisol

b. Decreased serum calcium The diagnosis of hypoparathyroidism is made on the basis of clinical manifestations associated with decreased serum calcium and increased serum phosphorus. Decreased serum phosphorus would be seen in hyperparathyroidism, elevated glucose in diabetes, and decreased serum cortisol in adrenocortical insufficiency (Addison's disease).

An infant is brought to the emergency department with poor skin turgor, weight loss, lethargy, and tachycardia. This is suggestive of: a. Overhydration. c. Sodium excess. b. Dehydration. d. Calcium excess.

b. Dehydration. These clinical manifestations indicate dehydration. Symptoms of overhydration are edema and weight gain. Regardless of extracellular sodium levels, total body sodium is usually depleted in dehydration. Symptoms of hypocalcemia are a result of neuromuscular irritability and manifest as jitteriness, tetany, tremors, and muscle twitching.

A common clinical manifestation of juvenile hypothyroidism is: a. Insomnia. b. Diarrhea. c. Dry skin. d. Accelerated growth.

c. Dry skin. ANS: C Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism are usually sleepy. Constipation is associated with hypothyroidism. Decelerated growth is common in juvenile hypothyroidism.

17. A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The child's level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. The most appropriate nursing action is to: a. Discuss with parents the child's previous experiences with pain. b. Discuss with practitioner what analgesia can be safely administered. c. Explain that analgesia is contraindicated with a head injury. d. Explain that analgesia is unnecessary when child is not fully awake and alert.

b. Discuss with practitioner what analgesia can be safely administered. A key nursing role is to provide sedation and analgesia for the child. Consultation with the appropriate practitioner is necessary to avoid conflict between the necessity to monitor the child's neurologic status and to promote comfort and relieve anxiety. Gathering information about the child's previous experiences with pain should be obtained as part of the assessment, but because of the severity of injury, analgesia should be provided as soon as possible. Analgesia can be used safely in individuals who have sustained head injuries and can decrease anxiety and resultant increased intracranial pressure.

An advantage to using a fiberglass cast instead of a plaster cast is that a fiberglass cast: a. Is less expensive. c. Molds closely to body parts. b. Dries rapidly. d. Has a smooth exterior.

b. Dries rapidly. A synthetic casting material dries in 5 to 30 minutes as compared with a plaster cast, which takes 10 to 72 hours to dry. Synthetic casts are more expensive. Plaster casts mold closer to body parts. Synthetic casts have a rough exterior, which may scratch surfaces.

A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. Initial therapeutic approach to the mother should be to: a. Restate what the physician has told her about plastic surgery. b. Encourage her to express her feelings. c. Emphasize the normalcy of her baby and the baby's need for mothering. d. Recognize that negative feelings toward the child continue throughout childhood.

b. Encourage her to express her feelings. For parents, cleft lip and cleft palate deformities are particularly disturbing. The nurse must place emphasis not only on the infant's physical needs but also on the parents' emotional needs. The mother needs to be able to express her feelings before the acceptance of her child can occur. Although discussing plastic surgery will be addressed, it is not part of the initial therapeutic approach. As the mother expresses her feelings, the nurse's actions should convey to the parents that the infant is a precious human being. The child's normalcy is emphasized, and the mother is assisted to recognize the child's uniqueness. A focus on abnormal maternal-infant attachment would be inappropriate at this time.

18.What is the most appropriate intervention for the parents of a 6-year-old girl with precocious puberty? a. Advise the parents to consider birth control for their daughter. b. Explain the importance of having the child foster relationships with same-age peers. c. Assure the child's parents that there is no increased risk for sexual abuse because of her appearance. d. Counsel parents that there is no treatment currently available for this disorder.

b. Explain the importance of having the child foster relationships with same-age peers. Despite the child's appearance, the child needs to be treated according to her chronologic age and to interact with children in the same age-group. An expected outcome is that the child will adjust socially by exhibiting age-appropriate behaviors and social interactions. Advising the parents of a 6-year-old to put their daughter on birth control is not appropriate and will not reverse the effects of precocious puberty. Parents need to be aware that there is an increased risk of sexual abuse for a child with precocious puberty. Treatment for precocious puberty is the administration of gonadotropin-releasing hormone blocker, which slows or reverses the development of secondary sexual characteristics and slows rapid growth and bone aging.

The Glasgow Coma Scale consists of an assessment of: a. Pupil reactivity and motor response. b. Eye opening and verbal and motor responses. c. Level of consciousness and verbal response. d. Intracranial pressure (ICP) and level of consciousness.

b. Eye opening and verbal and motor responses. The Glasgow Coma Scale assesses eye opening and verbal and motor responses. Pupil reactivity is not a part of the Glasgow Coma Scale but is included in the pediatric coma scale. Level of consciousness and ICP are not part of the Glasgow Coma Scale.

Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell off of a tree. When discussing this injury with her parents, the nurse should consider which statement? a. Healing is usually delayed in this type of fracture. b. Growth can be affected by this type of fracture. c. This is an unusual fracture site in young children. d. This type of fracture is inconsistent with a fall.

b. Growth can be affected by this type of fracture. Detection of epiphyseal injuries is sometimes difficult, but fractures involving the epiphysis or epiphyseal plate present special problems in determining whether bone growth will be affected. Healing of epiphyseal injuries is usually prompt. The epiphysis is the weakest point of the long bones. This is a frequent site of damage during trauma.

The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. What should be included in the teaching plan for daily injections? a. The parents do not need to learn the procedure. b. He is old enough to give most of his own injections. c. Self-injections will be possible when he is closer to adolescence. d. He can learn about self-injections when he is able to reach all injection sites.

b. He is old enough to give most of his own injections. School-age children are able to give their own injections. Parents should participate in learning and giving the insulin injections. He is already old enough to administer his own insulin. The child is able to use thighs, abdomen, part of the hip, and arm. Assistance can be obtained if other sites are used.

A child is admitted with acute glomerulonephritis. The nurse would expect the urinalysis during this acute phase to show: a. Bacteriuria and hematuria. b. Hematuria and proteinuria. c. Bacteriuria and increased specific gravity. d. Proteinuria and decreased specific gravity.

b. Hematuria and proteinuria. Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes in specific gravity are not usually present during the acute phase

When does idiopathic scoliosis become most noticeable? a. Newborn period b. When child starts to walk c. During preadolescent growth spurt d. Adolescence

c. During preadolescent growth spurt Idiopathic scoliosis is most noticeable during the preadolescent growth spurt and is seldom apparent before age 10 years.

Which vaccine is now recommended for the immunization of all newborns? a. Hepatitis A vaccine c. Hepatitis C vaccine b. Hepatitis B vaccine d. Hepatitis A, B, and C vaccines

b. Hepatitis B vaccine Universal vaccination for hepatitis B is now recommended for all newborns. A vaccine is available for hepatitis A, but it is not yet universally recommended. No vaccine is currently available for hepatitis C. Only hepatitis B vaccine is recommended for newborns.

Exophthalmos (protruding eyeballs) may occur in children with: a. Hypothyroidism. b. Hyperthyroidism. c. Hypoparathyroidism. d. Hyperparathyroidism.

b. Hyperthyroidism. Exophthalmos is a clinical manifestation of hyperthyroidism. Hypothyroidism, hypoparathyroidism, and hyperparathyroidism are not associated with exophthalmos.

The nurse is conducting teaching for an adolescent being discharged to home after a renal transplantation. The adolescent needs further teaching if which statement is made? a. I will report any fever to my primary health care provider. b. I am glad I only have to take the immunosuppressant medication for two weeks. c. I will observe my incision for any redness or swelling. d. I wont miss doing kidney dialysis every week

b. I am glad I only have to take the immunosuppressant medication for two weeks. The immunosuppressant medications are taken indefinitely after a renal transplantation, so they should not be discontinued after 2 weeks. Reporting a fever and observing an incision for redness and swelling are accurate statements. The adolescent is correct in indicating dialysis will not need to be done after the transplantation.

Which statement is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. It is preferred means of renal replacement therapy in children. c. Children can receive kidneys only from other children. d. The decision for transplantation is difficult since a relatively normal lifestyle is not possible

b. It is preferred means of renal replacement therapy in children. Renal transplantation offers the opportunity for a relatively normal lifestyle versus dependence on dialysis and is the preferred means of renal replacement therapy in end-stage renal disease. It can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes.

Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis? a. No urinary ketones b. Low arterial pH c. Elevated serum carbon dioxide d. Elevated serum phosphorus

b. Low arterial pH Severe insulin deficiency produces metabolic acidosis, which is indicated by a low arterial pH. Urinary ketones, often in large amounts, are present when a child is in diabetic ketoacidosis. Serum carbon dioxide is decreased in diabetic ketoacidosis. Serum phosphorus is decreased in diabetic ketoacidosis.

An adolescent is in traction. The purpose of the traction is to fatigue the muscle and reduce muscle spasm so that the bones can be realigned. Nursing actions should include which of the following? a. Maintain continuous traction until muscle spasm ceases. b. Maintain continuous traction to prevent muscle from contracting. c. Release traction every hour to allow muscle to briefly regain its contractibility. d. Release traction once every 8 hours to allow muscle to briefly regain its contractibility.

b. Maintain continuous traction to prevent muscle from contracting. When the muscles are stretched, muscle spasm ceases and permits realignment of the bone ends. The continued maintenance of traction is important during this phase because releasing the traction allows the muscle's normal contracting ability to again cause of malpositioning of the bone ends.

23. The vector reservoir for agents causing viral encephalitis in the United States is: a. Tarantula spiders. c. Carnivorous wild animals. b. Mosquitoes and ticks. d. Domestic and wild animals.

b. Mosquitoes and ticks. Viral encephalitis, not attributable to a childhood viral disease, is usually transmitted by mosquitoes and ticks. The vector reservoir for most agents pathogenic for humans and detected in the United States are mosquitoes and ticks; therefore, most cases of encephalitis appear during the hot summer months. Tarantulas, carnivorous wild animals, and domestic animals are not reservoirs for the agents that cause viral encephalitis.

The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. The nurse should interpret this as: a. Eye trauma. b. Neurosurgical emergency. c. Severe brainstem damage. d. Indication of brain death.

b. Neurosurgical emergency. The sudden appearance of a fixed and dilated pupil(s) is a neurosurgical emergency. The nurse should immediately report this finding. Although a dilated pupil may be associated with eye trauma, this child has experienced a neurologic insult. Pinpoint pupils or fixed, bilateral pupils for more than 5 minutes are indicative of brainstem damage. The unilateral fixed and dilated pupil is suggestive of damage on the same side of the brain. One fixed and dilated pupil is not suggestive of brain death.

The narrowing of preputial opening of foreskin is called: a. Chordee c. Epispadias b. Phimosis d. Hypospadias

b. Phimosis Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

The narrowing of the preputial opening of the foreskin is called: a. Chordee. c. Epispadias. b. Phimosis. d. Hypospadias

b. Phimosis. Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

Diabetes insipidus is a disorder of the: a. Anterior pituitary. b. Posterior pituitary. c. Adrenal cortex. d. Adrenal medulla.

b. Posterior pituitary. The principal disorder of posterior pituitary hypofunction is diabetes insipidus. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The adrenal cortex produces aldosterone, sex hormones, and glucocorticoids. The adrenal medulla produces catecholamines.

The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. The most appropriate way to position and feed this neonate is to place him: a. Prone and tube feed. b. Prone, turn head to side, and nipple feed. c. Supine in infant carrier and nipple feed. d. Supine, with defect supported with rolled blankets, and nipple feed.

b. Prone, turn head to side, and nipple feed. In the prone position, feeding is a problem. The infant's head is turned to one side for feeding. If the child is able to nipple feed, no indication is present for tube feeding. Before surgery, the infant is kept in the prone position to minimize tension on the sac and risk of trauma.

An objective of care for the child with nephrosis is to: a. Reduce blood pressure. b. Reduce excretion of urinary protein. c. Increase excretion of urinary protein. d. Increase ability of tissues to retain fluid

b. Reduce excretion of urinary protein. The objectives of therapy for the child with nephrosis include reduction of the excretion of urinary protein, reduction of fluid retention, prevention of infection, and minimizing of complications associated with therapy. Blood pressure is usually not elevated in nephrosis. Increased excretion of urinary protein and increased ability of tissues to retain fluid are part of the disease process and must be reversed.

The diet of a child with nephrosis usually includes: a. High protein. c. Low fat. b. Salt restriction. d. High carbohydrate

b. Salt restriction. Salt is usually restricted (but not eliminated) during the edema phase. The child has very little appetite during the acute phase. Favorite foods are provided (with the exception of high-salt ones) in an attempt to provide nutritionally complete meals.

Which factor predisposes a child to urinary tract infections? a. Increased fluid intake c. Prostatic secretions in males b. Short urethra in young girls d. Frequent emptying of the bladder

b. Short urethra in young girls The short urethra in females provides a ready pathway for invasions of organisms. Increased fluid intake and frequent bladder emptying offer protective measures against urinary tract infections. Prostatic secretions have antibacterial properties that inhibit bacteria.

A school-age child with chronic renal failure is admitted to the hospital with a serum potassium level of 5.2 mEq/L. Which prescribed medication should the nurse plan to administer? a. Spironolactone (Aldactone) b. Sodium polystyrene sulfonate (Kayexalate) c. Lactulose (Cephulac) d. Calcium carbonate (Calcitab)

b. Sodium polystyrene sulfonate (Kayexalate) Normal serum potassium levels in a school-age child are 3.5 to 5 mEq/L. Sodium polystyrene sulfonate is administered to reduce serum potassium levels. Spironolactone is a potassium-sparing diuretic and should not be used if the serum potassium is elevated. Lactulose is administered to reduce ammonia levels in patients with liver disease. Calcium carbonate may be prescribed as a calcium supplement, but it will not reduce serum potassium levels.

Which term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation? a.Coma b. Stupor c. Obtundation d. Persistent vegetative state

b. Stupor Stupor exists when the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Coma is the state in which no motor or verbal response occurs to noxious (painful) stimuli. Obtundation describes a level of consciousness in which the child can be aroused with stimulation. Persistent vegetative state describes the permanent loss of function of the cerebral cortex.

What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness? a. Give the child half his regular morning dose of insulin. b. Substitute simple carbohydrates or calorie-containing liquids for solid foods. c. Give the child plenty of unsweetened, clear liquids to prevent dehydration. d. Take the child directly to the emergency department.

b. Substitute simple carbohydrates or calorie-containing liquids for solid foods. A sick-day diet of simple carbohydrates or calorie-containing liquids will maintain normal serum glucose levels and decrease the risk of hypoglycemia. The child should receive his regular dose of insulin even if he does not have an appetite. If the child is not eating as usual, he needs calories to prevent hypoglycemia. During periods of minor illness, the child with type 1 diabetes mellitus can be managed safely at home.

Which finding should cause the nurse to suspect a diagnosis of spastic cerebral palsy? a. Tremulous movements at rest and with activity b. Sudden jerking movement caused by stimuli c. Writhing, uncontrolled, involuntary movements d. Clumsy, uncoordinated movements

b. Sudden jerking movement caused by stimuli Spastic cerebral palsy, the most common type of cerebral palsy, will manifest with hypertonicity and increased deep tendon reflexes. The child's muscles are very tight and any stimuli may cause a sudden jerking movement. Tremulous movements are characteristic of rigid/tremor/atonic cerebral palsy. Slow, writhing, uncontrolled, involuntary movements occur with athetoid or dyskinetic cerebral palsy. Clumsy movements, loss of coordination, equilibrium, and kinesthetic sense occur in ataxic cerebral palsy.

An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) and gastrostomy feedings. Nursing care should include: a. Preparing the family for impending death. b. Teaching the family signs of central venous catheter infection. c. Teaching the family how to calculate caloric needs. d. Securing TPN and gastrostomy tubing under diaper to lessen risk of dislodgment.

b. Teaching the family signs of central venous catheter infection. During TPN therapy, care must be taken to minimize the risk of complications related to the central venous access device, such as catheter infections, occlusions, or accidental removal. This is an important part of family teaching. The prognosis for patients with short bowel syndrome depends in part on the length of residual small intestine. It has improved with advances in TPN. Although parents need to be taught about nutritional needs, the caloric needs and prescribed TPN and rate are the responsibility of the health care team. The tubes should not be placed under the diapers because of risk of infection.

An adolescent is being seen in the clinic for evaluation of acromegaly. The nurse understands that which occurs with acromegaly? a. There is a lack of growth hormone (GH) being produced. b. There is excess GH after closure of the epiphyseal plates. c. There is an excess of GH before the closure of the epiphyseal plates. d. There is a lack of thyroid hormone being produced.

b. There is excess GH after closure of the epiphyseal plates. Excess GH after closure of the epiphyseal plates results in acromegaly. A lack of growth hormone results in delayed growth or even dwarfism. Gigantism occurs when there is hypersecretion of GH before the closure of the epiphyseal plates. Cretinism is associated with hypothyroidism.

A 4-month-old infant has gastroesophageal reflux disease (GERD) but is thriving without other complications. What should the nurse suggest to minimize reflux? a. Place in Trendelenburg position after eating. b. Thicken formula with rice cereal. c. Give continuous nasogastric tube feedings. d. Give larger, less frequent feedings.

b. Thicken formula with rice cereal. Giving small frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula has been recommended. Milk thickening agents have been shown to decrease the number of episodes of vomiting and increase the caloric density of the formula. This may benefit infants who are underweight as a result of GERD. Placing the child in Trendelenburg position would increase the reflux. Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive. Smaller, more frequent feedings are recommended in reflux.

25. When taking the history of a child hospitalized with Reye's syndrome, the nurse should not be surprised that a week ago the child had recovered from: a. Measles. c. Meningitis. b. Varicella. d. Hepatitis.

b. Varicella. Most cases of Reye's syndrome follow a common viral illness such as varicella or influenza. Measles, meningitis, and hepatitis are not associated with Reye's syndrome.

Which description of a stool is characteristic of intussusception? a. Ribbon-like stools c. "Currant jelly" stools b. Hard stools positive for guaiac d. Loose, foul-smelling stools

c. "Currant jelly" stools Pressure on the bowel from obstruction leads to passage of "currant jelly" stools. Ribbon-like stools are characteristic of Hirschsprung's disease. With intussusception, passage of bloody mucus-coated stools occurs. Stools will not be hard. Loose, foul-smelling stools may indicate infectious gastroenteritis.

18. A 5-year-old girl sustained a concussion when she fell out of a tree. In preparation for discharge, the nurse is discussing home care with her mother. Which statement made by the mother indicates a correct understanding of the teaching? a. "I should expect my child to have a few episodes of vomiting." b "If I notice sleep disturbances, I should contact the physician immediately." c. "I should expect my child to have some behavioral changes after the accident." d. "If I notice diplopia, I will have my child rest for 1 hour."

c. "I should expect my child to have some behavioral changes after the accident." The parents are advised of probably post-traumatic symptoms that may be expected, including behavioral changes. If the child has episodes of vomiting, sleep disturbances, or diplopia, they should be immediately reported for evaluation.

The nurse is teaching the parents of a child who is receiving propylthiouracil for the treatment of hyperthyroidism (Graves' disease). Which statement made by the parent indicates a correct understanding of the teaching? a. "I would expect my child to gain weight while taking this medication." b. "I would expect my child to experience episodes of ear pain while taking this medication." c. "If my child develops a sore throat and fever, I should contact the physician immediately." d. "If my child develops the stomach flu, my child will need to be hospitalized."

c. "If my child develops a sore throat and fever, I should contact the physician immediately." Children being treated with propylthiouracil must be carefully monitored for the side effects of the drug. Parents must be alerted that sore throat and fever accompany the grave complication of leukopenia. These symptoms should be immediately reported. Weight gain, episodes of ear pain, and stomach flu are not usually associated with leukopenia.

19. A 3-year-old child is hospitalized after a near-drowning accident. The child's mother complains to the nurse, "This seems unnecessary when he is perfectly fine." The nurse's best reply is: a. "He still needs a little extra oxygen." b. "I'm sure he is fine, but the doctor wants to make sure." c. "The reason for this is that complications could still occur." d. "It is important to observe for possible central nervous system problems."

c. "The reason for this is that complications could still occur." All children who have a near-drowning experience should be admitted to the hospital for observation. Although many children do not appear to have suffered adverse effects from the event, complications such as respiratory compromise and cerebral edema may occur up to 24 hours after the incident. Stating that, "He still needs a little extra oxygen" does not respond directly to the mother's concern. Why is her child still receiving oxygen? The nurse should clarify that different complications can occur up to 24 hours later and that observations are necessary.

The primary method of treating osteomyelitis is: a. Joint replacement. b. Bracing and casting. c. Intravenous antibiotic therapy. d. Long-term corticosteroid therapy.

c. Intravenous antibiotic therapy. Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus aureus. The treatment of choice is antibiotics. Joint replacement, bracing and casting, and long-term corticosteroids are not indicated for infectious processes.

28. A child is brought to the emergency department after experiencing a seizure at school. There is no previous history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurse's best response is: a. "Epilepsy is easily treated." b "Very few children have actual epilepsy." c. "The seizure may or may not mean that your child has epilepsy." d. "Your child has had only one convulsion; it probably won't happen again."

c. "The seizure may or may not mean that your child has epilepsy." Seizures are the indispensable characteristic of epilepsy; however, not every seizure is epileptic. Epilepsy is a chronic seizure disorder with recurrent and unprovoked seizures. The treatment of epilepsy involves a thorough assessment to determine the type of seizure the child is having and the cause of events, followed by individualized therapy to allow the child to have as normal a life as possible. The nurse should not make generalized comments like "Very few children have actual epilepsy" and "Your child has had only one convulsion; it probably won't happen again" until further assessment is made.

A nurse is conducting discharge teaching for parents of an infant with osteogenesis imperfecta (OI). Further teaching is indicated if the parents make which statement? a. "We will be very careful handling the baby." b. "We will lift the baby by the buttocks when diapering." c. "We're glad there is a cure for this disorder." d. "We will schedule follow-up appointments as instructed."

c. "We're glad there is a cure for this disorder." The treatment for OI is primarily supportive. Although patients and families are optimistic about new research advances, there is no cure. The use of bisphosphonate therapy with IV pamidronate to promote increased bone density and prevent fractures has become standard therapy for many children with OI; however, long bones are weakened by prolonged treatment. Infants and children with this disorder require careful handling to prevent fractures. They must be supported when they are being turned, positioned, moved, and held. Even changing a diaper may cause a fracture in severely affected infants. These children should never be held by the ankles when being diapered but should be gently lifted by the buttocks or supported with pillows. Follow-up appointments for treatment with bisphosphonate can be expected.

For what clinical manifestation should a nurse be alert when suspecting a diagnosis of esophageal atresia? a. A radiograph in the prenatal period indicates abnormal development. b. It is visually identified at the time of delivery. c. A nasogastric tube fails to pass at birth. d. The infant has a low birth weight.

c. A nasogastric tube fails to pass at birth. Atresia is suspected when a nasogastric tube fails to pass 10 to 11 cm beyond the gum line. Abdominal radiographs will confirm the diagnosis. Prenatal radiographs do not provide a definitive diagnosis. The defect is not externally visible. Bronchoscopy and endoscopy can be used to identify this defect. Infants with esophageal atresia may have been born prematurely and with a low birth weight, but neither is suggestive of the presence of an esophageal atresia.

42. A child has been seizure-free for 2 years. A father asks the nurse how much longer the child will need to take the antiseizure medications. The nurse includes which intervention in the response? a. Medications can be discontinued at this time. b. The child will need to take the drugs for 5 years after the last seizure. c. A stepwise approach will be used to reduce the dosage gradually. d. Seizure disorders are a lifelong problem. Medications cannot be discontinued.

c. A stepwise approach will be used to reduce the dosage gradually. A predesigned protocol is used to wean a child gradually off antiseizure medications, usually when the child is seizure-free for 2 years and has a normal electroencephalogram. Medications must be gradually reduced to minimize the recurrence of seizures. Seizure medications can be safely discontinued. The risk of recurrence is greatest within the first year.

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by the: a. Thyroid gland. b. Parathyroid glands. c. Adrenal cortex. d. Anterior pituitary.

c. Adrenal cortex. These hormones are secreted by the adrenal cortex. The thyroid gland produces thyroid hormone and thyrocalcitonin. The parathyroid glands produce parathyroid hormone. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone.

What is characteristic of the immune-mediated type 1 diabetes mellitus? a. Ketoacidosis is infrequent. b. Onset is gradual. c. Age at onset is usually younger than 18 years. d. Oral agents are often effective for treatment.

c. Age at onset is usually younger than 18 years. The immune-mediated type 1 diabetes mellitus typically has its onset in children or young adults. Peak incidence is between the ages of 10 and 15 years. Infrequent ketoacidosis, gradual onset, and treatment with oral agents are more consistent with type 2 diabetes.

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

c. Antihistamines. Constipation may be associated with drugs such as antihistamines, antacids, diuretics, opioids, antiepileptics, and iron. Because this is the only known recent change in her habits, the addition of antihistamines is most likely the etiology of the diarrhea, rather than diet, allergies, or emotional factors. With a change in bowel habits, the presence and role of any recently prescribed medications should be assessed.

27. A young child's parents call the nurse after their child was bitten by a raccoon in the woods. The nurse's recommendation should be based on knowing that: a. The child should be hospitalized for close observation. b. No treatment is necessary if thorough wound cleaning is done. c. Antirabies prophylaxis must be initiated. d. Antirabies prophylaxis must be initiated if clinical manifestations appear.

c. Antirabies prophylaxis must be initiated. Current therapy for a rabid animal bite consists of a thorough cleansing of the wound and passive immunization with human rabies immune globulin (HRIG) as soon as possible. Hospitalization is not necessary. The wound cleansing, passive immunization, and immune globulin administration can be done as an outpatient. The child needs to receive both HRIG and rabies vaccine.

Manifestations of hypoglycemia include: a. Lethargy. b. Thirst. c. Nausea and vomiting. d. Shaky feeling and dizziness.

d. Shaky feeling and dizziness. Some of the clinical manifestations of hypoglycemia include shaky feelings; dizziness; difficulty concentrating, speaking, focusing, and coordinating; sweating; and pallor. Lethargy, thirst, and nausea and vomiting are manifestations of hyperglycemia.

When infants are seen for fractures, which nursing intervention is a priority? a. No intervention is necessary. It is not uncommon for infants to fracture bones. b. Assess the family's safety practices. Fractures in infants usually result from falls. c. Assess for child abuse. Fractures in infants are often nonaccidental. d. Assess for genetic factors.

c. Assess for child abuse. Fractures in infants are often nonaccidental. Fractures in infants warrant further investigation to rule out child abuse. Fractures in children younger than 1 year are unusual because of the cartilaginous quality of the skeleton; a large amount of force is necessary to fracture their bones. Infants should be cared for in a safe environment and should not be falling. Fractures in infancy are usually nonaccidental rather than related to a genetic factor.

Which statement is accurate concerning a child's musculoskeletal system and how it may be different from an adult's? a. Growth occurs in children as a result of an increase in the number of muscle fibers. b. Infants are at greater risk for fractures because their epiphyseal plates are not fused. c. Because soft tissues are resilient in children, dislocations and sprains are less common than in adults. d. Children's bones have less blood flow.

c. Because soft tissues are resilient in children, dislocations and sprains are less common than in adults. Because soft tissues are resilient in children, dislocations and sprains are less common than in adults. A child's growth occurs because of an increase in size rather than an increase in the number of the muscle fibers. Fractures in children younger than 1 year are unusual because a large amount of force is necessary to fracture their bones. A child's bones have greater blood flow than an adult's bones.

At what age is sexual development in boys and girls considered to be precocious? a. Boys, 11 years; girls, 9 years b. Boys, 12 years; girls, 10 years c. Boys, 9 years; girls, 8 years d. Boys, 10 years; girls, 9.5 years

c. Boys, 9 years; girls, 8 years Manifestations of sexual development before age 9 in boys and age 8 in girls are considered precocious and should be investigated. Boys older than 9 years of age and girls older than 8 years of age fall within the expected range of pubertal onset.

The nurse is explaining to a parent how to care for a child with vomiting associated with a viral illness. The nurse should include: a. Avoiding carbohydrate-containing liquids. b. Giving nothing by mouth for 24 hours. c. Brushing teeth or rinsing mouth after vomiting. d. Giving plain water until vomiting ceases for at least 24 hours.

c. Brushing teeth or rinsing mouth after vomiting. It is important to emphasize the need for the child to brush the teeth or rinse the mouth after vomiting to dilute the hydrochloric acid that comes in contact with the teeth. Administration of a glucose-electrolyte solution to an alert child will help restore water and electrolytes satisfactorily. It is important to include carbohydrates to spare body protein and avoid ketosis.

A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on knowing that: a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children are better able to manage the diabetes. d. The parents are better able to manage the disease.

c. Children are better able to manage the diabetes. Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood sugar results. Blood glucose monitoring is more expensive but provides improved management. It is as accurate as equivalent testing done in laboratories. The ability to self-test allows the child to balance diet, exercise, and insulin. The parents are partners in the process, but the child should be taught how to manage the disease.

Which neurologic diagnostic test gives a visualized horizontal and vertical cross section of the brain at any axis? a. Nuclear brain scan b. Echoencephalography c. Computed tomography (CT) scan d. Magnetic resonance imaging (MRI)

c. Computed tomography (CT) scan A CT scan provides visualization of the horizontal and vertical cross sections of the brain at any axis. A nuclear brain scan uses a radioisotope that accumulates where the blood-brain barrier is defective. Echoencephalography identifies shifts in midline structures of the brain as a result of intracranial lesions. MRI permits visualization of morphologic features of target structures and tissue discrimination that is unavailable with any other techniques.

What is used to treat moderate-to-severe inflammatory bowel disease? a. Antacids c. Corticosteroids b. Antibiotics d. Antidiarrheal medications

c. Corticosteroids Corticosteroids such as prednisone and prednisolone are used in short bursts to suppress the inflammatory response in inflammatory bowel disease. Antacids and antidiarrheals are not drugs of choice to treat the inflammatory process of inflammatory bowel disease. Antibiotics may be used as adjunctive therapy to treat complications.

The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate? a. pH c. Creatinine clearance b. Osmolality d. Protein level

c. Creatinine clearance The most useful clinical indication of glomerular filtration is the clearance of creatinine. It is a substance that is freely filtered by the glomerulus and secreted by the renal tubule cells. The pH and osmolality are not estimates of glomerular filtration. Although protein in the urine demonstrates abnormal glomerular permeability, it is not a measure of filtration rate.

11. Which type of fracture describes traumatic separation of cranial sutures? a. Basilar b. Compound c. Diastatic d. Depressed

c. Diastatic Diastatic skull fractures are traumatic separations of the cranial sutures. A basilar fracture involves the basilar portion of the frontal, ethmoid, sphenoid, temporal, or occipital bone. A compound fracture has the bone exposed through the skin. A depressed fracture has the bone pushed inward, causing pressure on the brain.

The nurse is admitting a toddler with the diagnosis of juvenile hypothyroidism. Which is a common clinical manifestation of this disorder? a. Insomnia b. Diarrhea c. Dry skin d. Accelerated growth

c. Dry skin Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism are usually sleepy. Constipation is associated with hypothyroidism. Decelerated growth is common in juvenile hypothyroidism.

The most appropriate nursing diagnosis for the child with acute glomerulonephritis is: a. Risk for Injury related to malignant process and treatment. b. Deficient Fluid Volume related to excessive losses. c. Excess Fluid Volume related to decreased plasma filtration. d. Excess Fluid Volume related to fluid accumulation in tissues and third spaces

c. Excess Fluid Volume related to decreased plasma filtration. Glomerulonephritis has a decreased filtration of plasma. The decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. A fluid volume excess is found. The fluid accumulation is secondary to the decreased plasma filtration, not fluid accumulation

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse should explain that: a. Exercise will increase blood glucose. b. Exercise should be restricted. c. Extra snacks are needed before exercise. d. Extra insulin is required during exercise.

c. Extra snacks are needed before exercise. Exercise lowers blood glucose levels, which can be compensated for by extra snacks. Exercise is encouraged and not restricted unless indicated by other health conditions. Extra insulin is contraindicated because exercise decreases blood glucose levels.

A current recommendation to prevent neural tube defects is the supplementation of: a. Vitamin A throughout pregnancy. b. Multivitamin preparations as soon as pregnancy is suspected. c. Folic acid for all women of childbearing age. d. Folic acid during the first and second trimesters of pregnancy.

c. Folic acid for all women of childbearing age. The widespread use of folic acid among women of childbearing age is expected to decrease the incidence of spina bifida significantly. Vitamin A and multivitamin preparations do not have a relation to the prevention of spina bifida. Folic acid supplementation is recommended for the preconceptual period and during the pregnancy. Only 42% of women actually follow these guidelines.

A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, the nurse should explain that: a. Traction is tried first. b. Surgical intervention is needed. c. Frequent, serial casting is tried first. d. Children outgrow this condition when they learn to walk.

c. Frequent, serial casting is tried first. Serial casting, the preferred treatment, is begun shortly after birth before discharge from the nursery. Successive casts allows for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention.

29. Which type of seizure involves both hemispheres of the brain? a. Focal c. Generalized b. Partial d. Acquired

c. Generalized Clinical observations of generalized seizures indicate that the initial involvement is from both hemispheres. Focal seizures may arise from any area of the cerebral cortex, but the frontal, temporal, and parietal lobes are most commonly affected. Partial seizures are caused by abnormal electrical discharges from epileptogenic foci limited to a circumscribed region of the cerebral cortex. A seizure disorder that is acquired is a result of a brain injury from a variety of factors; it does not specify the type of seizure.

A parasite that causes acute diarrhea is: a. Shigella organisms. c. Giardia lamblia. b. Salmonella organisms. d. Escherichia coli.

c. Giardia lamblia. Giardia is a parasite that represents 15% of nondysenteric illness in the United States. Shigella, Salmonella, and E. coli are bacterial pathogens.

20. The most common clinical manifestation of brain tumors in children is: a. Irritability. c. Headaches and vomiting. b. Seizures. d. Fever and poor fine motor control.

c. Headaches and vomiting. Headaches, especially on awakening, and vomiting that is not related to feeding are the most common clinical manifestations of brain tumors in children. Irritability, seizures, and fever and poor fine motor control are clinical manifestations of brain tumors, but headaches and vomiting are the most common.

A home care nurse is caring for an adolescent with a T1 spinal cord injury. The adolescent suddenly becomes flushed, hypertensive, and diaphoretic. Which intervention should the nurse perform first? a. Place the adolescent in a flat right side-lying position. b. Place a cool washcloth on the adolescent's forehead and continue to monitor the blood pressure. c. Implement a standing prescription to empty the bladder with a sterile in-and-out Foley catheter. d. Take a full set of vital signs and notify the health care provider.

c. Implement a standing prescription to empty the bladder with a sterile in-and-out Foley catheter. The adolescent is experiencing an autonomic dysreflexia episode. The paralytic nature of autonomic function is replaced by autonomic dysreflexia, especially when the lesions are above the mid-thoracic level. This autonomic phenomenon is caused by visceral distention or irritation, particularly of the bowel or bladder. Sensory impulses are triggered and travel to the cord lesion, where they are blocked, which causes activation of sympathetic reflex action with disturbed central inhibitory control. Excessive sympathetic activity is manifested by a flushing face, sweating forehead, pupillary constriction, marked hypertension, headache, and bradycardia. The precipitating stimulus may be merely a full bladder or rectum or other internal or external sensory input. It can be a catastrophic event unless the irritation is relieved. Positioning the adolescent, placing a cool washcloth on the adolescent's forehead, continuing to monitor blood pressure and vital signs, and notifying the health care provider would not reverse the sympathetic reflex situation.

Which statement is most descriptive of Meckel's diverticulum? a. It is more common in females than in males. b. It is acquired during childhood. c. Intestinal bleeding may be mild or profuse. d. Medical interventions are usually sufficient to treat the problem.

c. Intestinal bleeding may be mild or profuse. Blood stools are often a presenting sign of Meckel's diverticulum. It is associated with mild-to-profuse intestinal bleeding. It is twice as common in males as in females, and complications are more frequent in males. Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract and is present in 1% to 4% of the general population. The standard therapy is surgical removal of the diverticulum.

10. Which statement is most descriptive of a concussion? a. Petechial hemorrhages cause amnesia. b. Visible bruising and tearing of cerebral tissue occur. c. It is a transient, reversible neuronal dysfunction. d. A slight lesion develops remote from the site of trauma.

c. It is a transient, reversible neuronal dysfunction. A concussion is a transient, reversible neuronal dysfunction with instantaneous loss of awareness and responsiveness resulting from trauma to the head. Petechial hemorrhages along the superficial aspects of the brain along the point of impact are a type of contusion but are not necessarily associated with amnesia. A contusion is visible bruising and tearing of cerebral tissue. Contrecoup is a lesion that develops remote from the site of trauma as a result of an acceleration/deceleration injury.

30. The initial clinical manifestation of generalized seizures is: a. Being confused. c. Losing consciousness. b. Feeling frightened. d. Seeing flashing lights.

c. Losing consciousness. Loss of consciousness is a frequent occurrence in generalized seizures and is the initial clinical manifestation. Being confused, feeling frightened, and seeing flashing lights are clinical manifestations of a complex partial seizure.

The diet of a child with chronic renal failure is usually characterized as: a. High in protein. b. Low in vitamin D. c. Low in phosphorus. d. Supplemented with vitamins A, E, and K.

c. Low in phosphorus. Dietary phosphorus is controlled to prevent or control the calcium/phosphorus imbalance by the reduction of protein and milk intake. Protein should be limited in chronic renal failure to decrease intake of phosphorus. Vitamin D therapy is administered in chronic renal failure to increase calcium absorption. Supplementation with vitamins A, E, and K is not part of dietary management in chronic renal disease.

39. An appropriate nursing intervention when caring for an unconscious child should be to: a. Change the child's position infrequently to minimize the chance of increased intracranial pressure (ICP). b. Avoid using narcotics or sedatives to provide comfort and pain relief. c. Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. d. Give tepid sponge baths to reduce fever because antipyretics are contraindicated.

c. Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. Often comatose patients cannot cope with the quantity of fluids that they normally tolerate. Overhydration must be avoided to prevent fatal cerebral edema. The child's position should be changed frequently to avoid complications such as pneumonia and skin breakdown. Narcotics and sedatives should be used as necessary to reduce pain and discomfort, which can increase ICP. Antipyretics are the method of choice for fever reduction.

A 3-year-old child with Hirschsprung's disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child psychologically is: a. Not necessary because of child's age. b. Not necessary because the colostomy is temporary. c. Necessary because it will be an adjustment. d. Necessary because the child must deal with a negative body image.

c. Necessary because it will be an adjustment. The child's age dictates the type and extent of psychologic preparation. When a colostomy is performed, the child who is at least preschool age is told about the procedure and what to expect in concrete terms with the use of visual aids. It is necessary to prepare this age child for procedures. The preschooler is not yet concerned with body image.

To help the adolescent deal with diabetes, the nurse must consider which characteristic of adolescence? a. Desire to be unique b. Preoccupation with the future c. Need to be perfect and similar to peers d. Need to make peers aware of the seriousness of hypoglycemic reactions

c. Need to be perfect and similar to peers Adolescence is a time when the individual wants to be perfect and similar to peers. Having diabetes makes adolescents different from their peers. Adolescents do not wish to be unique; they desire to fit in with the peer group and are usually not future oriented. Forcing peer awareness of the seriousness of hypoglycemic reactions would further alienate the adolescent with diabetes. The peer group would focus on the differences.

Which term is used to describe a child's level of consciousness when the child can be aroused with stimulation? a. Stupor b. Confusion c. Obtundation d. Disorientation

c. Obtundation Obtundation describes a level of consciousness in which the child can be aroused with stimulation. Stupor is a state in which the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Confusion is impaired decision making. Disorientation is confusion regarding time and place.

Which statement best characterizes hepatitis A? a. The incubation period is 6 weeks to 6 months. b. The principal mode of transmission is through the parenteral route. c. Onset is usually rapid and acute. d. There is a persistent carrier state.

c. Onset is usually rapid and acute Hepatitis A is the most common form of acute hepatitis in most parts of the world. It is characterized by a rapid acute onset. The incubation period is approximately 3 weeks for hepatitis A. The principal mode of transmission for hepatitis A is the fecal-oral route. Hepatitis A does not have a carrier state.

Therapeutic management of the child with acute diarrhea and dehydration usually begins with: a. Clear liquids. b. Adsorbents such as kaolin and pectin. c. Oral rehydration solution (ORS). d. Antidiarrheal medications such as paregoric.

c. Oral rehydration solution (ORS). ORS is the first treatment for acute diarrhea. Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. Adsorbents are not recommended and neither are antidiarrheals because they do not get rid of pathogens.

The nurse is admitting a child with Werdnig-Hoffmann disease (spinal muscular atrophy type 1). Which signs and symptoms are associated with this disease? a. Spinal muscular atrophy b. Neural atrophy of muscles c. Progressive weakness and wasting of skeletal muscle d. Pseudohypertrophy of certain muscle groups

c. Progressive weakness and wasting of skeletal muscle Werdnig-Hoffmann disease (spinal muscular atrophy type 1) is the most common paralytic form of floppy infant syndrome (congenital hypotonia). It is characterized by progressive weakness and wasting of skeletal muscle caused by degeneration of anterior horn cells. Kugelberg-Welander syndrome is a juvenile spinal muscular atrophy with a later onset. Charcot-Marie-Tooth disease is a form of progressive neural atrophy of muscles supplied by the peroneal nerves. Progressive weakness of the distal muscles of the arms and feet is found. Duchenne's muscular dystrophy is characterized by muscles, especially in the calves, thighs, and upper arms, that become enlarged from fatty infiltration and feel unusually firm or woody on palpation. The term pseudohypertrophy is derived from this muscular enlargement.

A histamine receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with gastroesophageal reflux. The purpose of this is to: a. Prevent reflux. c. Reduce gastric acid production. b. Prevent hematemesis. d. Increase gastric acid production.

c. Reduce gastric acid production. The mechanism of action of histamine receptor antagonists is to reduce the amount of acid present in gastric contents and may prevent esophagitis. Preventing reflux and hematemesis and increasing gastric acid production are not the modes of action of histamine receptor antagonists.

During the first few days after surgery for cleft lip, which intervention should the nurse do? a. Leave infant in crib at all times to prevent suture strain. b. Keep infant heavily sedated to prevent suture strain. c. Remove restraints periodically to cuddle infant. d. Alternate position from prone to side-lying to supine.

c. Remove restraints periodically to cuddle infant. The nurse should remove restraints periodically, while supervising the infant, to allow him or her to exercise arms and to provide cuddling and tactile stimulation. The infant should not be left in the crib, but should be removed for appropriate holding and stimulation. Analgesia and sedation are administered for pain. Heavy sedation is not indicated. The child should not be placed in the prone position.

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which of the following? a. Treatment is most successful if it is started during adolescence. b. Treatment is considered successful if children attain full stature by adulthood. c. Replacement therapy requires daily subcutaneous injections. d. Replacement therapy will be required throughout the child's lifetime.

c. Replacement therapy requires daily subcutaneous injections. Additional support is required for children who require hormone replacement therapy, such as preparation for daily subcutaneous injections and education for self-management during the school-age years. Young children, obese children, and those who are severely GH deficient have the best response to therapy. When therapy is successful, children can attain their actual or near-final adult height at a slower rate than their peers. Replacement therapy is not needed after attaining final height. They are no longer GH deficient.

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. What should be included? a. Apply lotion or powder to minimize skin irritation. b. Remove the harness several times a day to prevent contractures. c. Return to the clinic every 1 to 2 weeks. d. Place a diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.

c. Return to the clinic every 1 to 2 weeks. Infants have a rapid growth pattern. The child needs to be assessed by the practitioner every 1 to 2 weeks for possible adjustments. Lotions and powders should not be used with the harness. The harness should not be removed, except as directed by the practitioner. A thin disposable diaper can be placed under the harness.

The viral pathogen that frequently causes acute diarrhea in young children is: a. Giardia organisms. c. Rotavirus. b. Shigella organisms. d. Salmonella organisms.

c. Rotavirus. Rotavirus is the most frequent viral pathogen that causes diarrhea in young children. Giardia and Salmonella are bacterial pathogens that cause diarrhea. Shigella is a bacterial pathogen that is uncommon in the United States.

Which type of traction uses skin traction on the lower leg and a padded sling under the knee? a. Dunlop c. Russell b. Bryant's d. Buck's extension

c. Russell Russell traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position. Dunlop traction is an upper extremity traction used for fractures of the humerus. Bryant's traction is skin traction with the legs flexed at a 90-degree angle at the hip. Buck's extension traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, before surgery with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease.

Which statement best describes hypopituitarism? a. Growth is normal during the first 3 years of life. b. Weight is usually more retarded than height. c. Skeletal proportions are normal for age. d. Most of these children have subnormal intelligence.

c. Skeletal proportions are normal for age. In children with hypopituitarism, the skeletal proportions are normal. Growth is within normal limits for the first year of life. Height is usually more delayed than weight. Intelligence is not affected by hypopituitarism.

40. A 10-year-old boy has been hit by a car while riding his bicycle in front of the school. The school nurse immediately assesses airway, breathing, and circulation. The next nursing action should be to: a. Place on side. c. Stabilize neck and spine. b. Take blood pressure. d. Check scalp and back for bleeding.

c. Stabilize neck and spine. After determining that the child is breathing and has adequate circulation, the next action is to stabilize the neck and spine to prevent any additional trauma. The child's position should not be changed until the neck and spine are stabilized. Blood pressure is a later assessment. Less urgent, but an important assessment, is inspection of the scalp for bleeding.

When caring for a child with probable appendicitis, the nurse should be alert to recognize that a sign of perforation is: a. Bradycardia. c. Sudden relief from pain. b. Anorexia. d. Decreased abdominal distention.

c. Sudden relief from pain. Signs of peritonitis, in addition to fever, include sudden relief from pain after perforation. Tachycardia, not bradycardia, is a manifestation of peritonitis. Anorexia is already a clinical manifestation of appendicitis. Abdominal distention usually increases in addition to an increase in pain (usually diffuse and accompanied by rigid guarding of the abdomen).

An important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA) is to: a. Apply ice packs to relieve stiffness and pain. b. Administer acetaminophen to reduce inflammation. c. Teach child and family the correct administration of medications. d. Encourage range-of-motion exercises during periods of inflammation.

c. Teach child and family the correct administration of medications. The management of JIA is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of a regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that nonsteroidal antiinflammatory drugs should not be given on an empty stomach and to be alert for signs of toxicity. Warm, moist heat is best for relieving stiffness and pain. Acetaminophen does not have antiinflammatory effects. Range-of-motion exercises should not be done during periods of inflammation.

What is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux? a. Teach parents to position the infant on the left side. b. Reinforce the parents' knowledge of the infant's developmental needs. c. Teach the parents how to do infant cardiopulmonary resuscitation (CPR). d. Have the parents keep an accurate record of intake and output.

c. Teach the parents how to do infant cardiopulmonary resuscitation (CPR). Risk of aspiration is a priority nursing diagnosis for the infant with gastroesophageal reflux. The parents must be taught infant CPR. Correct positioning minimizes the risk for aspiration. The correct position for the infant is on the right side after feeding and supine for sleeping. Knowledge of developmental needs should be included in discharge planning for all hospitalized infants, but it is not the most important in this case. Keeping a record of intake and output is not a priority and may not be necessary.

What is the major focus of the therapeutic management for a child with lactose intolerance? a. Compliance with the medication regimen b. Providing emotional support to family members c. Teaching dietary modifications d. Administration of daily normal saline enemas

c. Teaching dietary modifications Simple dietary modifications are effective in the management of lactose intolerance. Symptoms of lactose intolerance are usually relieved after instituting a lactose-free diet. Medications are not typically ordered in the management of lactose intolerance. Providing emotional support to family members is not specific to this medical condition. Diarrhea is a manifestation of lactose intolerance. Enemas are contraindicated for this alteration in bowel elimination.

The nurse is teaching parents of a child with chronic renal failure (CRF) about the use of recombinant human erythropoietin (rHuEPO) subcutaneous injections. Which statement indicates the parents have understood the teaching? a. These injections will help with the hypertension. b. Were glad the injections only need to be given once a month. c. The red blood cell count should begin to improve with these injections. d. Urine output should begin to improve with these injections

c. The red blood cell count should begin to improve with these injections. Anemia in children with CRF is related to decreased production of erythropoietin. Recombinant human erythropoietin (rHuEPO) is being offered to these children as thrice-weekly or weekly subcutaneous injections and is replacing the need for frequent blood transfusions. The parents understand the teaching if they say that the red blood cell count will begin to improve with these injections

What is the priority nursing goal for a 14-year-old with Graves' disease? a. Relieving constipation b. Allowing the adolescent to make decisions about whether or not to take medication c. Verbalizing the importance of adherence to the medication regimen d. Developing alternative educational goals

c. Verbalizing the importance of adherence to the medication regimen In order to adhere to the medication schedule, children need to understand that the medication must be taken two or three times per day. The adolescent with Graves' disease is not likely to be constipated. Adherence to the medication schedule is important to ensure optimal health and wellness. Medications should not be skipped and dose regimens should not be tapered by the child without consultation with the child's medical provider. The management of Graves' disease does not interfere with school attendance and does not require alternative educational plans.

The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis? a. Abdominal rigidity and pain on palpation b. Rounded abdomen and hypoactive bowel sounds c. Visible peristalsis and weight loss d. Distention of lower abdomen and constipation

c. Visible peristalsis and weight loss Visible gastric peristaltic waves that move from left to right across the epigastrium are observed in pyloric stenosis, as is weight loss. Abdominal rigidity and pain on palpation, and rounded abdomen and hypoactive bowel sounds, are usually not present. The upper abdomen is distended, not the lower abdomen.

A major complication in a child with chronic renal failure is: a. Hypokalemia. b. Metabolic alkalosis. c. Water and sodium retention. d. Excessive excretion of blood urea nitrogen

c. Water and sodium retention. Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of blood urea nitrogen are complications of chronic renal failure

A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which sign of vitamin D toxicity? a. Headache and seizures b. Physical restlessness and voracious appetite without weight gain c. Weakness and lassitude d. Anorexia and insomnia

c. Weakness and lassitude Vitamin D toxicity can be a serious consequence of therapy. Parents are advised to watch for signs including weakness, fatigue, lassitude, headache, nausea, vomiting, and diarrhea. Renal impairment is manifested through polyuria, polydipsia, and nocturia. Headaches may be a sign of vitamin D toxicity, but seizures are not. Physical restlessness and a voracious appetite with weight loss are manifestations of hyperthyroidism. Anorexia and insomnia are not characteristic of vitamin D toxicity.

The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching? a. You will need to decrease the number of calories in your childs diet. b. Your childs diet will need an increased amount of protein. c. You will need to avoid adding salt to your childs food. d. Your childs diet will consist of low-fat, low-carbohydrate foods

c. You will need to avoid adding salt to your childs food. For most children, a regular diet is allowed, but it should contain no added salt. The child should be offered a regular diet with favorite foods. Severe sodium restrictions are not indicated.

What would cause a nurse to suspect that an infection has developed under a cast? a. Complaint of paresthesia c. Increased respirations b. Cold toes d. "Hot spots" felt on cast surface

d. "Hot spots" felt on cast surface If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so a window can be made in the cast to observe the site. The "five Ps" of ischemia from a vascular injury include pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection. Cold toes may be indicative of too tight a cast and need further evaluation. Increased respirations may indicate a respiratory infection or pulmonary emboli. This should be reported, and the child should be evaluated.

The nurse is talking to a parent with a child who has a latex allergy. Which statement by the parent would indicate a correct understanding of the teaching? a. "My child will have an allergic reaction if he comes in contact with yeast products." b. "My child may have an upset stomach if he eats a food made with wheat or barley." c. "My child will probably develop an allergy to peanuts." d. "My child should not eat bananas or kiwis."

d. "My child should not eat bananas or kiwis." There are cross-reactions between latex allergies and a number of foods such as bananas, avocados, kiwi, and chestnuts. Although yeast products, wheat and barley, and peanuts are potential allergens, they are currently not known to cross-react with latex.

What is the most appropriate nursing response to the father of a newborn infant with myelomeningocele who asks about the cause of this condition? a. "One of the parents carries a defective gene that causes myelomeningocele." b. "A deficiency in folic acid in the father is the most likely cause." c. "Offspring of parents who have a spinal abnormality are at greater risk for myelomeningocele." d. "There may be no definitive cause identified."

d. "There may be no definitive cause identified." The etiology of most neural tube defects is unknown in most cases. There may be a genetic predisposition or a viral origin, and the disorder has been linked to maternal folic acid deficiency; however, the actual cause has not been determined. There is no evidence that children who have parents with spinal problems are at greater risk for neural tube defects.

35. How should the nurse explain positioning for a lumbar puncture to a 5-year-old child? a. "You will be on your knees with your head down on the table." b. "You will be able to sit up with your chin against your chest." c. "You will be on your side with the head of your bed slightly raised." d. "You will lie on your side and bend your knees so that they touch your chin."

d. "You will lie on your side and bend your knees so that they touch your chin." The child should lie on his or her side with knees bent and chin tucked in to the knees. This position exposes the area of the back for the lumbar puncture. The knee-chest position is not appropriate for a lumbar puncture. An infant can be placed in a sitting position with the infant facing the nurse and the head steadied against the nurse's body. A side-lying position with the head of the bed elevated is not appropriate for a lumbar puncture.

37. The nurse is performing a Glasgow Coma Scale (GCS) on a school-age child with a head injury. The child opens eyes spontaneously, obeys commands, and is oriented to person, time, and place. Which is the score the nurse should record? a. 8 c. 13 b. 11 d. 15

d. 15 The GCS consists of a three-part assessment: eye opening, verbal response, and motor response. Numeric values of 1 through 5 are assigned to the levels of response in each category. The sum of these numeric values provides an objective measure of the patient's level of consciousness (LOC). A person with an unaltered LOC would score the highest, 15. The child who opens eyes spontaneously, obeys commands, and is oriented is scored at a 15.

The nurse is discussing various sites used for insulin injections with a child and her family. Which site usually has the fastest rate of absorption? a. Arm b. Leg c. Buttock d. Abdomen

d. Abdomen The abdomen has the fastest rate of absorption but the shortest duration. The arm has a fast rate of absorption but short duration. The leg has a slow rate of absorption but a long duration. The buttock has the slowest rate of absorption and the longest duration.

Which clinical manifestation would most suggest acute appendicitis? a. Rebound tenderness b. Bright red or dark red rectal bleeding c. Abdominal pain that is relieved by eating d. Abdominal pain that is most intense at McBurney's point

d. Abdominal pain that is most intense at McBurney's point Pain is the cardinal feature. It is initially generalized and usually periumbilical. The pain localizes to the right lower quadrant at McBurney's point. Rebound tenderness is not a reliable sign and is extremely painful to the child. Abdominal pain that is relieved by eating and bright or dark red rectal bleeding are not signs of acute appendicitis.

The nurse is caring for an intubated infant with botulism in the pediatric intensive care unit. Which health care provider prescriptions should the nurse clarify with the health care provider before implementing? a. Administer 250 mg botulism immune globulin intravenously (BIG-IV) one time. b. Provide total parenteral nutrition (TPN) at 25 mL/hr intravenously. c. Titrate oxygen to keep pulse oximetry saturations greater than 92. d. Administer gentamicin sulfate (Garamycin) 10 mg per intravenous piggyback every 12 hours.

d. Administer gentamicin sulfate (Garamycin) 10 mg per intravenous piggyback every 12 hours. The nurse should clarify the administration of an aminoglycoside antibiotic. Antibiotic therapy is not part of the management of infant botulism because the botulinum toxin is an intracellular molecule, and antibiotics would not be effective; aminoglycosides in particular should not be administered because they may potentiate the blocking effects of the neurotoxin. Treatment consists of immediate administration of botulism immune globulin intravenously (BIG-IV) without delaying for laboratory diagnosis. Early administration of BIG-IV neutralizes the toxin and stops the progression of the disease. The human-derived botulism antitoxin (BIG-IV) has been evaluated and is now available nationwide for use only in infant botulism. Approximately 50% of affected infants require intubation and mechanical ventilation; therefore, respiratory support is crucial, as is nutritional support because these infants are unable to feed.

The nurse is caring for an adolescent who has just started dialysis. The child seems always angry, hostile, or depressed. The nurse should recognize that this is most likely related to: a. Neurologic manifestations that occur with dialysis. b. Physiologic manifestations of renal disease. c. Adolescents having few coping mechanisms. d. Adolescents often resenting the control and enforced dependence imposed by dialysis

d. Adolescents often resenting the control and enforced dependence imposed by dialysis Older children and adolescents need control. The necessity of dialysis forces the adolescent into a dependent relationship, which results in these behaviors. Neurologic manifestations that occur with dialysis and physiologic manifestations of renal disease are a function of the age of the child, not neurologic or physiologic manifestations of the dialysis. Adolescents do have coping mechanisms, but they need to have some control over their disease management.

Therapeutic management of a child with tetanus includes the administration of: a. Nonsteroidal antiinflammatory drugs (NSAIDs) to reduce inflammation. b. Muscle stimulants to counteract muscle weakness. c. Bronchodilators to prevent respiratory complications. d. Antibiotics to control bacterial proliferation at the site of injury.

d. Antibiotics to control bacterial proliferation at the site of injury. Antibiotics are administered to control the proliferation of the vegetative forms of the organism at the site of infection. Tetanus toxin acts at the myoneural junction to produce muscular stiffness and lowers the threshold for reflex excitability. NSAIDs are not routinely used. Sedatives or muscle relaxants are used to help reduce titanic spasm and prevent seizures. Respiratory status is carefully evaluated for any signs of distress because muscle relaxants, opioids, and sedatives that may be prescribed may cause respiratory depression. Bronchodilators would not be used unless specifically indicated.

The nurse uses the palms of the hands when handling a wet cast to: a. Assess dryness of the cast. c. Keep the patient's limb balanced. b. Facilitate easy turning. d. Avoid indenting the cast.

d. Avoid indenting the cast. Wet casts should be handled by the palms of the hands, not the fingers, to prevent creating pressure points. Assessing dryness, facilitating easy turning, or keeping the patient's limb balanced are not reasons for using the palms of the hand rather than the fingers when handling a wet cast.

24. What action may be beneficial in reducing the risk of Reye's syndrome? a. Immunization against the disease b. Medical attention for all head injuries c. Prompt treatment of bacterial meningitis d. Avoidance of aspirin and ibuprofen for children with varicella or those suspected of having influenza

d. Avoidance of aspirin and ibuprofen for children with varicella or those suspected of having influenza Although the etiology of Reye's syndrome is obscure, most cases follow a common viral illness, either varicella or influenza. A potential association exists between aspirin therapy and the development of Reye's syndrome; thus use of aspirin is avoided. No immunization currently exists for Reye's syndrome. Reye's syndrome is not correlated with head injuries or bacterial meningitis.

A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of which condition? a. Protein intolerance b. Fat malabsorption c. Parasitic infection d. Bacterial gastroenteritis

d. Bacterial gastroenteritis Neutrophils and red blood cells in stool indicate bacterial gastroenteritis. Protein intolerance is suspected in the presence of eosinophils. Parasitic infection is indicated by eosinophils. Fat malabsorption is indicated by foul-smelling, greasy, bulky stools.

Which of the following is a type of skin traction with legs in an extended position? a. Dunlop b. Bryant c. Russell d. Buck extension

d. Buck extension Buck extension traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease.

The nurse is caring for a child with acute renal failure. What clinical manifestation should he or she recognize as a sign of hyperkalemia? a. Dyspnea c. Oliguria b. Seizure d. Cardiac arrhythmia

d. Cardiac arrhythmia Hyperkalemia is the most common threat to the life of the child. Signs of hyperkalemia include electrocardiographic anomalies such as prolonged QRS complex, depressed ST segments, peaked T waves, bradycardia, or heart block. Dyspnea, seizure, and oliguria are not manifestations of hyperkalemia.

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by: a. Saturated and unsaturated fat. b. Fruit juice. c. Several glasses of water. d. Complex carbohydrate and protein.

d. Complex carbohydrate and protein. Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein. Saturated and unsaturated fat, fruit juice, and several glasses of water do not provide the child with complex carbohydrate and protein necessary to stabilize the blood sugar.

13. The nurse should recommend medical attention if a child with a slight head injury experiences: a. Sleepiness. b. Vomiting, even once. c. Headache, even if slight. d. Confusion or abnormal behavior.

d. Confusion or abnormal behavior. Medical attention should be sought if the child exhibits confusion or abnormal behavior; loses consciousness; or has amnesia, fluid leaking from the nose or ears, blurred vision, or unsteady gait. Sleepiness alone does not require evaluation. If the child is difficult to arouse from sleep, medical attention should be obtained. Vomiting more than three times requires medical attention. Severe or worsening headache or one that interferes with sleep should be evaluated.

What should the nurse stress in a teaching plan for the mother of an 11-year-old boy with ulcerative colitis? a. Preventing the spread of illness to others b. Nutritional guidance and preventing constipation c. Teaching daily use of enemas d. Coping with stress and avoiding triggers

d. Coping with stress and avoiding triggers Coping with the stress of chronic illness and the clinical manifestations associated with ulcerative colitis (diarrhea, pain) are important teaching foci. Avoidance of triggers can help minimize the impact of the disease and its effect on the child. Ulcerative colitis is not infectious. Although nutritional guidance is a priority teaching focus, diarrhea is a problem with ulcerative colitis, not constipation. Daily enemas are not part of the therapeutic plan of care.

The nurse is teaching the parents of a 7-year-old child who has just had a cast applied for a fractured arm with the wrist and elbow immobilized. Which instructions should be included in the teaching? a. Swelling of the fingers is to be expected for the next 48 hours. b. Immobilize the shoulder to decrease pain in the arm. c. Allow the affected limb to hang down for 1 hour each day. d. Elevate casted arm when resting and when sitting up.

d. Elevate casted arm when resting and when sitting up. The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return. Swelling of the fingers may indicate neurovascular damage and should be reported immediately. Permanent damage can occur within 6 to 8 hours. Joints above and below the cast on the affected extremity should be moved. The child should not engage in strenuous activity for the first few days. Rest with elevation of the extremity is encouraged.

Which symptom is considered a cardinal sign of diabetes mellitus? a. Nausea b. Seizures c. Impaired vision d. Frequent urination

d. Frequent urination Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia. Nausea and seizures are not clinical manifestations of diabetes mellitus. Impaired vision is a long-term complication of the disease.

Which intervention should be included in the nurse's plan of care for a 7-year-old child with encopresis who has cleared the initial impaction? a. Have the child sit on the toilet for 30 minutes when he gets up in the morning and at bedtime. b. Increase sugar in the child's diet to promote bowel elimination. c. Use a Fleet enema daily. d. Give the child a choice of beverage to mix with a laxative.

d. Give the child a choice of beverage to mix with a laxative. Offering realistic choices is helpful in meeting the school-age child's sense of control. To facilitate bowel elimination, the child should sit on the toilet for 5 to 10 minutes after breakfast and dinner. Decreasing the amount of sugar in the diet will help keep stools soft. Daily Fleet enemas can result in hypernatremia and hyperphosphatemia, and are used only during periods of fecal impaction.

Careful hand washing before and after contact can prevent the spread of which condition in day care and school settings? a. Irritable bowel syndrome b. Hepatic cirrhosis c. Ulcerative colitis d. Hepatitis A

d. Hepatitis A Hepatitis A is spread person to person, by the fecal-oral route, and through contaminated food or water. Good hand washing is critical in preventing its spread. The virus can survive on contaminated objects for weeks. Irritable bowel syndrome is the result of increased intestinal motility and is not contagious. Ulcerative colitis is not infectious. Cirrhosis is not infectious.

Which type of dehydration results from water loss in excess of electrolyte loss? a. Isotonic dehydration b. Hypotonic dehydration c. Isosmotic dehydration d. Hypertonic dehydration

d. Hypertonic dehydration Hypertonic dehydration results from water loss in excess of electrolyte loss. This is the most dangerous type of dehydration. It is caused by feeding children fluids with high amounts of solute. Isotonic dehydration occurs in conditions in which electrolyte and water deficits are present in balanced proportion. Isosmotic dehydration is another term for isotonic dehydration. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic.

The parents of a child with cerebral palsy ask the nurse if any drugs can decrease their child's spasticity. The nurse's response should be based on knowing that: a. Anticonvulsant medications are sometimes useful for controlling spasticity. b. Medications that would be useful in reducing spasticity are too toxic for use with children. c. Many different medications can be highly effective in controlling spasticity. d. Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available.

d. Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available. Baclofen given intrathecally is best suited for children with severe spasticity that interferes with activities of daily living and ambulation. Anticonvulsant medications are used when seizures occur in children with cerebral palsy. The intrathecal route decreases the side effects of the drugs that reduce spasticity. Few medications are presently available for the control of spasticity.

A common side effect of corticosteroid therapy is: a. Fever. c. Weight loss. b. Hypertension. d. Increased appetite

d. Increased appetite Side effects of corticosteroid therapy include an increased appetite. Fever is not a side effect of therapy. It may be an indication of infection. Hypertension is not usually associated with initial corticosteroid therapy. Weight gain, not weight loss, is associated with corticosteroid therapy.

The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing is necessary for which? a. Glucose is needed before administration of insulin. b. Glucose is needed four times a day. c. Glycosylated hemoglobin is required. d. Ketonuria is suspected.

d. Ketonuria is suspected. Urine testing is still performed to detect evidence of ketonuria. Urine testing for glucose is no longer indicated because of the poor correlation between blood glucose levels and glycosuria. Glycosylated hemoglobin analysis is performed on a blood sample.

Which term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine? a. Scoliosis b. Ankylosis c. Lordosis d. Kyphosis

d. Kyphosis Kyphosis is an abnormally increased convex angulation in the curve of the thoracic spine. Scoliosis is a complex spinal deformity usually involving lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis. Ankylosis is the immobility of a joint. Lordosis is an accentuation of the cervical or lumbar curvature beyond physiologic limits.

41. A child is unconscious after a motor vehicle accident. The watery discharge from the nose tests positive for glucose. The nurse should recognize that this suggests: a. Diabetic coma. c. Upper respiratory tract infection. b. Brainstem injury. d. Leaking of cerebrospinal fluid (CSF).

d. Leaking of cerebrospinal fluid (CSF). Watery discharge from the nose that is positive for glucose suggests leaking of CSF from a skull fracture and is not associated with diabetes or respiratory tract infection. The fluid is probably CSF from a skull fracture and does not signify whether the brainstem is involved.

Which clinical manifestation may occur in the child who is receiving too much methimazole (Tapazole) for the treatment of hyperthyroidism (Graves' disease)? a. Seizures b. Enlargement of all lymph glands c. Pancreatitis or cholecystitis d. Lethargy and somnolence

d. Lethargy and somnolence Parents should be aware of the signs of hypothyroidism that can occur from overdosage of the drug. The most common manifestations are lethargy and somnolence. Seizures and pancreatitis are not associated with the administration of Tapazole. Enlargement of the salivary and cervical lymph glands occurs.

16. The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. The most essential part of the nursing assessment to detect early signs of a worsening condition is: a. Posturing. c. Focal neurologic signs. b. Vital signs. d. Level of consciousness.

d. Level of consciousness. The most important nursing observation is assessment of the child's level of consciousness. Alterations in consciousness appear earlier in the progression of head injury than do alterations of vital signs or focal neurologic signs. Neurologic posturing indicates neurologic damage. Vital signs and focal neurologic signs are later signs of progression when compared with level-of-consciousness changes.

A child will start treatment for precocious puberty. This involves injections of synthetic: a. Thyrotropin. b. Gonadotropins. c. Somatotropic hormone. d. Luteinizing hormone-releasing hormone.

d. Luteinizing hormone-releasing hormone. Precocious puberty of central origin is treated with monthly subcutaneous injections of luteinizing hormone-releasing hormone. Thyrotropin, gonadotropin, and somatotropic hormone are not appropriate therapies for precocious puberty.

An infant with pyloric stenosis experiences excessive vomiting that can result in: a. Hyperchloremia. c. Metabolic acidosis. b. Hypernatremia. d. Metabolic alkalosis.

d. Metabolic alkalosis. Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Chloride ions and sodium are lost with vomiting. Metabolic alkalosis, not acidosis, is likely.

Which medication is usually tried first when a child is diagnosed with juvenile idiopathic arthritis (JIA)? a. Aspirin b. Corticosteroids c. Cytotoxic drugs such as methotrexate d. Nonsteroidal antiinflammatory drugs (NSAIDs)

d. Nonsteroidal antiinflammatory drugs (NSAIDs) NSAIDs are the first drugs used in JIA. Naproxen, ibuprofen, and tolmetin are approved for use in children. Aspirin, once the drug of choice, has been replaced by the NSAIDs because they have fewer side effects and easier administration schedules. Corticosteroids are used for life-threatening complications, incapacitating arthritis, and uveitis. Methotrexate is a second-line therapy for JIA.

An advantage of peritoneal dialysis is that: a. Treatments are done in hospitals. b. Protein loss is less extensive. c. Dietary limitations are not necessary. d. Parents and older children can perform treatments.

d. Parents and older children can perform treatments. Peritoneal dialysis is the preferred form of dialysis for parents, infants, and children who wish to remain independent. Parents and older children can perform the treatments themselves. Treatments can be done at home. Protein loss is not significantly different. The dietary limitations are necessary, but they are not as Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 766 stringent as those for hemodialysis

38. The nurse is caring for a child with severe head trauma after a car accident. Which is an ominous sign that often precedes death? a. Papilledema c. Doll's head maneuver b. Delirium d. Periodic and irregular breathing

d. Periodic and irregular breathing Periodic or irregular breathing is an ominous sign of brainstem (especially medullary) dysfunction that often precedes complete apnea. Papilledema is edema and inflammation of the optic nerve. It is commonly a sign of increased intracranial pressure. Delirium is a state of mental confusion and excitement marked by disorientation to time and place. The doll's head maneuver is a test for brainstem or oculomotor nerve dysfunction.

The nurse is caring for a child with suspected diabetes insipidus. Which clinical manifestation would she or he expect to observe? a. Oliguria b. Glycosuria c. Nausea and vomiting d. Polyuria and polydipsia

d. Polyuria and polydipsia Excessive urination accompanied by insatiable thirst is the primary clinical manifestation of diabetes. These symptoms may be so severe that the child does little other than drink and urinate. Oliguria is decreased urine production and is not associated with diabetes insipidus. Glycosuria is associated with diabetes mellitus. Nausea and vomiting are associated with inappropriate antidiuretic hormone secretion.

Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Moist skin b. Weight gain c. Fluid overload d. Poor wound healing

d. Poor wound healing Poor wound healing is often an early sign of type 1 diabetes mellitus. Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus.

Which diagnostic finding is present when a child has primary nephrotic syndrome? a. Hyperalbuminemia c. Leukocytosis b. Positive ASO titer d. Proteinuria

d. Proteinuria Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane. Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the livers inability to synthesize proteins to balance the loss. ASO titer is negative in a child with primary nephrotic syndrome. Leukocytosis is not a diagnostic finding in primary nephrotic syndrome

Caring for the newborn with a cleft lip and palate before surgical repair includes: a. Gastrostomy feedings. b. Keeping the infant in near-horizontal position during feedings. c. Allowing little or no sucking. d. Providing satisfaction of sucking needs.

d. Providing satisfaction of sucking needs. Using special or modified nipples for feeding techniques helps to meet the infant's sucking needs. Gastrostomy feedings are usually not indicated. Feeding is best accomplished with the infant's head in an upright position. The child requires both nutritive and nonnutritive sucking.

The most common cause of acute renal failure in children is: a. Pyelonephritis. c. Urinary tract obstruction. b. Tubular destruction. d. Severe dehydration

d. Severe dehydration The most common cause of acute renal failure in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. Pyelonephritis and tubular destruction are not common causes of acute renal failure in children. Obstructive uropathy may cause acute renal failure, but it is not the most common cause

Which type of hernia has an impaired blood supply to the herniated organ? a. Hiatal hernia b. Omphalocele c. Incarcerated hernia d. Strangulated hernia

d. Strangulated hernia A strangulated hernia is one in which the blood supply to the herniated organ is impaired. A hiatal hernia is the intrusion of an abdominal structure, usually the stomach, through the esophageal hiatus. An incarcerated hernia is a hernia that cannot be reduced easily. Omphalocele is the protrusion of intraabdominal viscera into the base of the umbilical cord. The sac is covered with peritoneum and not skin.

Therapeutic management of most children with Hirschsprung's disease is primarily: a. Daily enemas. b. Low-fiber diet. c. Permanent colostomy. d. Surgical removal of affected section of bowel.

d. Surgical removal of affected section of bowel. Most children with Hirschsprung's disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet until the child is physically ready for surgery. The colostomy that is created in Hirschsprung's disease is usually temporary.

A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations should include which action? a. Encouraging normal activity for as long as is possible b. Explaining the cause of the disease to the child and family c. Preparing the child and family for long-term, permanent disabilities d. Teaching the family the care and management of the corrective appliance

d. Teaching the family the care and management of the corrective appliance The family needs to learn the purpose, function, application, and care of the corrective device and the importance of compliance to achieve the desired outcome. The initial therapy is rest and non-weight bearing, which helps reduce inflammation and restore motion. Legg-Calvé-Perthes is a disease with an unknown etiology. A disturbance of circulation to the femoral capital epiphysis produces an ischemic aseptic necrosis of the femoral head. The disease is self-limiting, but the ultimate outcome of therapy depends on early and efficient therapy and the child's age at onset.p

Which nursing intervention is appropriate to assess for neurovascular competency in a child who fell off the monkey bars at school and hurt his arm? a. The degree of motion and ability to position the extremity. b. The length, diameter, and shape of the extremity. c. The amount of swelling noted in the extremity and pain intensity. d. The skin color, temperature, movement, sensation, and capillary refill of the extremity.

d. The skin color, temperature, movement, sensation, and capillary refill of the extremity. A neurovascular evaluation includes assessing skin color and temperature, ability to move the affected extremity, degree of sensation experienced, and speed of capillary refill in the extremity. The degree of motion in the affected extremity and ability to position the extremity are incomplete assessments of neurovascular competency. The length, diameter, and shape of the extremity are not assessment criteria in a neurovascular evaluation. Although the amount of swelling is an important factor in assessing an extremity, it is not a criterion for a neurovascular assessment.

Which clinical manifestation would be seen in a child with chronic renal failure? a. Hypotension c. Hypokalemia b. Massive hematuria d. Unpleasant uremic breath odor

d. Unpleasant uremic breath odor Children with chronic renal failure have a characteristic breath odor resulting from the retention of waste products. Hypertension may be a complication of chronic renal failure. With chronic renal failure, little or no urine output occurs. Hyperkalemia is a concern in chronic renal failure

. The nurse is assisting the pediatric provider with a newborn examination. The provider notes that the infant has hypospadias. The nurse understands that hypospadias refers to: a. Absence of a urethral opening. b. Penis shorter than usual for age. c. Urethral opening along dorsal surface of penis. d. Urethral opening along ventral surface of penis.

d. Urethral opening along ventral surface of penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present, but not at the glans. Hypospadias does not refer to the size of the penis. When the urethral opening is along the dorsal surface of the penis, it is known as epispadias.

A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurses best response should be that the: a. Blood pressure will stabilize. c. Urine will be free of protein. b. Child will have more energy. d. Urinary output will increase

d. Urinary output will increase An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output

22. The mother of a 1-month-old infant tells the nurse that she worries that her baby will get meningitis like her oldest son did when he was an infant. The nurse should base her response on knowing that: a. Meningitis rarely occurs during infancy. b. Often a genetic predisposition to meningitis is found. c. Vaccination to prevent all types of meningitis is now available. d. Vaccination to prevent Haemophilus influenzae type b meningitis has decreased the frequency of this disease in children.

d. Vaccination to prevent Haemophilus influenzae type b meningitis has decreased the frequency of this disease in children. H. influenzae type B meningitis has virtually been eradicated in areas of the world where the vaccine is administered routinely. Bacterial meningitis remains a serious illness in children. It is significant because of the residual damage caused by undiagnosed and untreated or inadequately treated cases. The leading causes of neonatal meningitis are the group B streptococci and Escherichia coli organisms. Meningitis is an extension of a variety of bacterial infections. No genetic predisposition exists. Vaccinations are not available for all of the potential causative organisms.

Which of the following is a physiologic effect of immobilization on children? a. Metabolic rate increases. b. Increased joint mobility can lead to contractures in a short time. c. Bone calcium increases, releasing excess calcium into the body (hypercalcemia). d. Venous stasis can lead to thrombi or emboli formation.

d. Venous stasis can lead to thrombi or emboli formation. The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi.

The nurse is preparing to admit a newborn with myelomeningocele to the neonatal intensive care nursery. Which describes this newborn's defect? a. Fissure in the spinal column that leaves the meninges and the spinal cord exposed b. Herniation of the brain and meninges through a defect in the skull c. Hernial protrusion of a saclike cyst of meninges with spinal fluid but no neural elements d. Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves

d. Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves A myelomeningocele is a visible defect with an external saclike protrusion, containing meninges, spinal fluid, and nerves. Rachischisis is a fissure in the spinal column that leaves the meninges and the spinal cord exposed. Encephalocele is a herniation of brain and meninges through a defect in the skull, producing a fluid-filled sac. Meningocele is a hernial protrusion of a saclike cyst of meninges with spinal fluid, but no neural elements.

A preschool child is being admitted to the hospital with dehydration and a urinary tract infection (UTI). Which urinalysis result should the nurse expect with these conditions? a. WBC <1; specific gravity 1.008 c. WBC >2; specific gravity 1.016 b. WBC <2; specific gravity 1.025 d. WBC >2; specific gravity 1.030

d. WBC >2; specific gravity 1.030 The white blood cell count (WBC) in a routine urinalysis should be <1 or 2. Over that amount indicates a urinary tract inflammatory process. The urinalysis specific gravity for children with normal fluid intake is 1.016 to 1.022. When the specific gravity is high, dehydration is indicated. A low specific gravity is seen with excessive fluid intake, distal tubular dysfunction, or insufficient antidiuretic hormone secretion

Which intervention is appropriate when examining a male infant for cryptorchidism? a. Cooling the examiners hands c. Eliciting the cremasteric reflex b. Taking a rectal temperature d. Warming the room

d. Warming the room For the infants comfort, the infant should be examined in a warm room with the examiners hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold. Examining the infant with cold hands is uncomfortable for the infant and likely to cause the infants testes to retract into the inguinal canal. It may also cause the infant to be uncooperative during the examination. A rectal temperature yields no information about cryptorchidism. Testes can retract into the inguinal canal if the cremasteric reflex is elicited. This can lead to an incorrect diagnosis