Chapter 32 Pediatric

Which instruction would the nurse give to the parents of a 6-month-old infant with Down syndrome regarding feeding techniques and diet? Select all that apply. One, some, or all responses may be correct. A. "Provide the child with a fiber-rich diet." B. "Use a small spoon with a straight handle." C. "Stop feeding if the child spits the food out." D. "Never feed the child if the tongue protrudes out." E. "Provide the child with an adequate amount of fluids."

A. "Provide the child with a fiber-rich diet." B. "Use a small spoon with a straight handle." E. "Provide the child with an adequate amount of fluids." Rationale The nurse would instruct the parents to provide the infant with a fiber-rich diet because constipation is a symptom seen in children with Down syndrome. The protruding tongue of the infant may obstruct swallowing. Therefore, the nurse would instruct the parents to use a small spoon with a straight handle to feed the infant. An adequate amount of fluid is given to the infant to decrease the risk of constipation. Thrusting the food out of the mouth is a common observation in children with Down syndrome. The parents would be instructed to feed the infant even if the infant spits the food out of the mouth, in an effort to meet the nutritional requirements. The parents are instructed to feed the infant despite the tongue protrusion.

Which suggestion would the nurse include in the counseling session for the parents of a child with attention deficit/hyperactivity disorder (ADHD)? Select all that apply. One, some, or all responses may be correct. A. 'Supervise the child frequently." B. "Do not make a strict daily routine." C. "Check the child's adherence to medicines." D. "Encourage the use of controversial therapies." E. "Inform school officials about the medication."

A. 'Supervise the child frequently." C. "Check the child's adherence to medicines." E. "Inform school officials about the medication." Rationale The nurse would advise the parents of a child with ADHD to supervise the child more often to safeguard him or her, because the child may have antisocial behavior. The nurse would ask the parents to check the adherence of the child to the medication and any possible adverse effects. The parents should inform school officials and the child's teacher about the medication to ensure continuity of care. The nurse would teach the parents how to establish a strict daily routine. This helps the child to be organized and busy. The nurse would not encourage the use of controversial therapies for the child with ADHD, as this may be risky.

The nurse is caring for a child who has acute laryngotracheobronchitis (LTB). Which instruction does the health care provider give to the nurse during an emergency? A. Administer aerosolized epinephrine. B. Offer adequate oral fluids to the child. C. Administer betamethasone to the child. D. Give sedatives to the child to induce sleep.

A. Administer aerosolized epinephrine. Rationale LTB is managed by maintaining the patency of the airway. Therefore, the health care provider would instruct the nurse to administer aerosolized epinephrine to the child. This helps to decrease airway edema by vasoconstriction and to improve oxygenation by bronchodilation. Children with acute LTB are maintained in NPO (nothing by mouth) status because typically rapid respirations cause aspiration. Betamethasone is a corticosteroid given to pregnant women before delivery to increase the production of surfactant in the premature infant. Sedatives impair the level of consciousness and make it difficult to determine hypoxia; hence, it would be avoided in children with LTB.

Which finding indicates that a child with diabetes has ketoacidosis? Select all that apply. One, some, or all responses may be correct. A. Blood pH of 7.25 B. Presence of casts in urine C. Absence of ketones in blood D. Presence of glucose in urine E. Blood glucose level of 380 mg/dL

A. Blood pH of 7.25 D. Presence of glucose in urine E. Blood glucose level of 380 mg/dL Rationale Diabetic ketoacidosis is a condition in which the body uses ketones as an alternate form of energy in the absence of insulin. As a result, ketone bodies increase in the blood, decreasing the pH; a pH less than 7.30 indicates metabolic acidosis caused by ketones. Owing to absence of insulin, blood glucose levels increase. Blood glucose levels greater than 330 mg/dL indicate ketoacidosis. The increased glucose in the blood spills into the urine because the kidneys are unable to filter it out. As a result, the urine may contain variable amounts of glucose. Presence of casts in the urine indicates a urinary tract infection; this is unrelated to ketoacidosis. In ketoacidosis, the ketone levels of blood are increased.

Which factor might cause congenital heart birth defects? Select all that apply. One, some, or all responses may be correct. A. Diabetes mellitus B. Maternal alcoholism C. Advanced paternal age D. Maternal drug ingestion E. Chromosomal abnormalities

A. Diabetes mellitus B. Maternal alcoholism D. Maternal drug ingestion E. Chromosomal abnormalities Rationale Environmental factors such as diabetes mellitus, intrauterine rubella exposure, maternal alcoholism, maternal drug ingestion, and advanced maternal age may play a role in congenital birth defects in children. Genetic risk factors include chromosomal abnormalities, a sibling or parent with a congenital heart defect, and the presence of other noncardiac congenital anomalies. The paternal or fathers age does not play a role in this type of birth defect.

Which aspect of care would the nurse include while counseling a teenaged patient after a suicide attempt? Select all that apply. One, some, or all responses may be correct. A. Encourage the teenager to express feelings openly B. Encourage the use of deep-breathing techniques C. Ask the teenager about any previous suicidal attempts D. Ask the teenager to leave school and stay at home E. Directly check the teenager's body for signs of previous attempts

A. Encourage the teenager to express feelings openly B. Encourage the use of deep-breathing techniques C. Ask the teenager about any previous suicidal attempts Rationale Encouraging the teenager to express feelings openly helps to ventilate the repressed emotions. The nurse would teach the teenager positive coping strategies, such as deep-breathing techniques, to help reduce stress. The nurse would directly ask the teenager about any previous attempts and plans of suicide. This allows the nurse to find out the severity of the suicidal thoughts. The nurse would not ask the teenager to leave school and stay at home. Depriving the teenager of a social life could potentiate suicidal thoughts. The nurse would not directly check the child's body for any signs of previous suicidal attempts. This may make the child uncomfortable, and the child may not openly communicate with the nurse during counseling.

Which specific assessment finding would support a diagnosis of a ventricular septal defect? Select all that apply. One, some, or all responses may be correct. A. Fatigue B. Crackles C. Bradycardia D. Shortness of breath E. Clear breath sounds

A. Fatigue B. Crackles D. Shortness of breath Rationale A ventricular septal defect is an abnormal opening between the two ventricles. This defect allows oxygenated blood from the higher-pressured left ventricle to flow to the lower-pressured right ventricle, which causes the blood to become deoxygenated. Signs and symptoms of heart failure may include fatigue, crackles, and shortness of breath or air. The heart rate should increase because of the increased workload of the heart. Auscultation should reveal crackles caused by the buildup of fluid in the lungs.

Which characteristic is associated with iron-deficiency anemia? Select all that apply. One, some, or all responses may be correct. A. Fatigue B. Bradycardia C. Weight gain D. Spoon fingernails E. Pale mucous membranes

A. Fatigue D. Spoon fingernails E. Pale mucous membranes Rationale Iron-deficiency anemia is characterized by numerous signs and symptoms, depending on the severity of the anemia. Children with mild to moderate anemia may demonstrate irritability, fatigue, and decreased play activity. If the anemia is severe, the child may have tachycardia (not bradycardia), anorexia (not weight gain), pallor, concave or spoon fingernails, and pale mucous membranes.

Which cause of intestinal obstruction is the most common in a 4-year-old child? A. Intussusception B. Inguinal hernias. C. Hirschsprung disease D. Hypertrophic pyloric stenosis

A. Intussusception Rationale Intussusception is the result of one portion of the intestine telescoping into another. It occurs most commonly in a child between the ages of 3 months and 6 years. Hernia is the protrusion of organs or portions of an organ through a structural defect or weakened muscle. Hirschsprung disease is a functional intestinal obstruction and is commonly seen in children with trisomy 21. Hypertrophic pyloric stenosis is an obstruction in which the gastric outlet is mechanically blocked by a congenitally hypertrophied pyloric muscle. It is most commonly seen in infants younger than 6 months.

Which medication is most likely to be prescribed for a patient who is diagnosed with human immunodeficiency virus (HIV) infection? A. Lamivudine B. Palivizumab C. Naproxen D. Sulfasalazine.

A. Lamivudine Rationale Antiretroviral drugs such as lamivudine would be effective in treating HIV infection. Palivizumab is a monoclonal antibody used to treat respiratory syncytial virus (RSV) infection. Naproxen and sulfasalazine are the drugs used to treat juvenile idiopathic arthritis.

Which test would the nurse question being prescribed for a child suffering from meningitis who has papilledema, neurologic deficits, and a bulging fontanelle? A. Lumbar puncture B. Complete blood count C. Computed tomography scan D. Magnetic resonance imaging (MRI).

A. Lumbar puncture Rationale In a child with meningitis, the presence of papilledema, neurologic deficits, and a bulging fontanelle indicates increased intracranial pressure. Lumbar puncture is contraindicated in patients with increased intracranial pressure because it may cause herniation of the brainstem. A complete blood count is required to determine the baseline values of the blood cells. A computed tomography scan and MRI are needed to assess the level of meningeal irritation.

Which concern would be a priority for a patient with epiglottitis? A. Maintaining a patent airway B. Maintaining sterile technique C. Initiating isolation precautions D. Frequent communication with parents

A. Maintaining a patent airway Rationale Epiglottitis is a severe and potentially life-threatening bacterial infection of the epiglottis. The inflamed epiglottis becomes cherry-red and edematous, which can lead to total airway obstruction. The priority intervention for this child is maintaining his or her airway. There is no reason to use sterile technique because epiglottitis is a bacterial infection of the epiglottis. This disease process is not considered contagious, so isolation is not warranted. The health care providers should communicate frequently with the child's parents; however, that is not the priority need for a patient with epiglottitis.

Which factor might lead to a child developing attention deficit/hyperactivity disorder (ADHD)? Select all that apply. One, some, or all responses may be correct. A. Maternal cigarette smoking during pregnancy B. Maternal alcohol consumption during pregnancy C. Increased exposure to lead in early childhood D. Increased consumption of salt in the early childhood E. Increased consumption of sugar in the early childhood

A. Maternal cigarette smoking during pregnancy B. Maternal alcohol consumption during pregnancy C. Increased exposure to lead in early childhood Rationale A child is likely to develop ADHD if the mother smoked cigarettes or consumed alcohol during the pregnancy. Increased exposure to lead in early childhood may also lead to the development of ADHD in the later stages of childhood. Increased consumption of salt and sugar in early childhood is unrelated to the development of ADHD in the later stages of childhood.

Which is the primary goal for a young child with cerebral palsy? A. Minimize any limitations caused by the disease. B. Prevent the onset of any emotional disturbances. C. Eliminate any cause of the symptoms of the disease. D. Improve muscle coordination and control of extremities.

A. Minimize any limitations caused by the disease. Rationale The primary goal for a young child with cerebral palsy is to recognize early any of the child's abilities and help the child to use them to the fullest potential to promote independence. Any child will display emotional frustrations; the nurse needs to reinforce positive behaviors, not prevent bad behaviors. The cause of the disease cannot be eliminated. Part of the plan is to improve muscle control and coordination, but this is not the primary goal.

Which symptom would the nurse identify as an early indicator of respiratory distress syndrome in a newborn? Select all that apply. One, some, or all responses may be correct. A. Nasal flaring B. Apgar score of 10 C. Expiratory grunting D. Substernal retractions E. Temperature of 103°F (39.4°C) or higher

A. Nasal flaring C. Expiratory grunting D. Substernal retractions Rationale Respiratory signs and symptoms become apparent immediately after birth. These signs and symptoms include nasal flaring, expiratory grunting, and substernal retractions. An Apgar score of 10 is rarely assessed, even in a healthy newborn, because of cyanosis at birth. This particular newborn would be scored lower because of nasal flaring, retractions, and grunting. A newborn with respiratory distress will have a low body temperature.

Which sign or symptom would the nurse expect in a child with scarlet fever? Select all that apply. One, some, or all responses may be correct. A. Pharyngitis B. Koplik spots C. Peeling skin on palms D. Sandpaper-like red rash E. White strawberry tongue

A. Pharyngitis D. Sandpaper-like red rash E. White strawberry tongue Rationale Pharyngitis, a sandpaper-like red rash, and white strawberry tongue are all associated with scarlet fever. Koplik spots are associated with the disease rubeola. Peeling of the skin on the palms of the hands is associated with Kawasaki disease.

Which laboratory report would the nurse monitor in a child who is undergoing anti-D antibody therapy? A. Platelet count B. Creatinine levels C. Blood urea levels D. White blood cells (WBCs)

A. Platelet count Rationale Anti-D antibody therapy is given to children afflicted with idiopathic thrombocytopenia purpura (ITP). ITP is characterized by lowered platelet levels in the body. Anti-D antibody therapy is aimed at increasing the platelet count. Therefore, the nurse should regularly monitor the platelet level of the child affected with ITP. Creatinine and blood urea levels are monitored in children with renal dysfunction. Renally compromised children are treated with diuretics and not with anti-D antibody therapy. WBC count increases if the child has an infection; anti-D antibody therapy is not used to treat infection.

Which congenital heart defect could cause an obstruction of blood flow to the lungs? A. Pulmonary stenosis. B. Atrial septal defect (ASD) C. Ventricular septal defect (VSD) D. Transposition of the great vessels

A. Pulmonary stenosis. Rationale Defects involving decreased pulmonary blood flow result when there is some type of obstruction of blood flow to the lungs or if there is no connection between the right side of the heart and the lungs. Examples of this type of congenital heart defect are pulmonary stenosis, pulmonary atresia, and tetralogy of Fallot. Tetralogy of Fallot is included in this category because pulmonary stenosis is present. Septal defects are not caused by an obstruction. They occur because a congenital opening did not properly close at birth or shortly thereafter. In transposition of the great vessels, the pulmonary artery arises from the left ventricle and the aorta arises from the right ventricle. Venous blood returning to the right side of the heart exits through the aorta without being oxygenated, and oxygenated blood returning from the pulmonary system is returned via the pulmonary artery to the lungs.

Which sign and symptom might a child with a congenital heart disorder exhibit? Select all that apply. One, some, or all responses may be correct. A. S3 or S4 B. Rhonchi C. Cyanosis D. Bradycardia E. Cardiomegaly

A. S3 or S4 C. Cyanosis E. Cardiomegaly Rationale A child suspected of having a cardiac dysfunction may exhibit classic signs of distress, such as the presence of an S3 or S4 on auscultation, cyanosis, and an enlarged heart (cardiomegaly). Crackles or rales will probably be heard on auscultation, not rhonchi. An increased heart rate (tachycardia) will be present, not a slow heart rate (bradycardia).

Which method is most accurate for assessing urinary output in an infant? A. Weigh diaper before and after soiling B. Weigh the infant every day fully clothed C. Calculate the total dietary intake of fluids D. Calculate the amount of intravenous fluid infusing only

A. Weigh diaper before and after soiling Rationale For children who are not toilet-trained, wet diapers should be weighed to assess the amount of output. By subtracting the weight (in grams) of a dry diaper from the weight of the wet diaper, the nurse can calculate the actual fluid content of the diaper. An infant should be weighed without any clothes on. However, if a diaper is needed, a dry diaper would be weighed first, and that value would be subtracted from the total weight. Calculation of total dietary fluids consumed and total amount of intravenous fluids infused would give the nurse the total intake, not the total output.

Which method is the most useful way to measure fluid balance in a child with acute glomerulonephritis? A. Weigh the child daily. B. Perform urinalysis to check for proteinuria. C. Calculate the intake and output every shift. D. Perform urinalysis to monitor the specific gravity.

A. Weigh the child daily. Rationale A record of daily weight is the most useful means to assess fluid balance and should be kept for children treated at home or in the hospital. Proteinuria does not provide information about fluid balance. Intake and output can be useful but are not considered as accurate as daily weights. Specific gravity does not accurately reflect fluid balance in acute glomerulonephritis. If fluid is being retained, the excess fluid will not be included. Also, proteinuria and hematuria affect specific gravity.

Which sign and symptom would the child with a large patent ductus arteriosus (PDA) exhibit? Select all that apply. One, some, or all responses may be correct. A. Hunger B. Fatigue C. Growth spurts D. Heart murmur E. Bounding pulse

B. Fatigue D. Heart murmur E. Bounding pulse Rationale A child with a large PDA will often exhibit signs and symptoms of heart failure, such as poor eating, poor growth patterns, and fatigue. Other symptoms may include a machine-like murmur, a widened pulse pressure, and a bounding pulse. Hunger and growth spurts are not typically associated with a large PDA.

Which concern would be the highest priority when caring for an infant born with a cleft lip? A. Parental coping B. Nutritional intake C. Tissue or skin integrity D. Potential for aspiration

B. Nutritional intake Rationale The highest priority for a child with a cleft lip is adequate nutritional support. Before surgical repair, feedings can be difficult. Parental coping is in relation to the parents and learning how to accept the deformity and the corrective measures to take, but it would not be a priority over nutritional intake. Skin or tissue integrity is a priority after surgery and during the process of healing. The infant primarily needs nutritional support. The prevention of aspiration is a goal while obtaining adequate fluid intake.

Which feeding technique is correctfor a newborn with a cleft lip and palate? A. Feed newborn lying on back. B. Place newborn's head upright. C. Use regular nipples on bottles. D. Burp only after feeding is completed.

B. Place newborn's head upright. Rationale In a newborn with cleft lip and palate, a primary goal for nursing is to prevent aspiration. The best method for feeding is to support the infant's head in an upright position. A newborn should never be fed while lying on the back because this position increases the risk for aspiration as well as otitis media. Newborns with cleft lip and palate cannot generate enough suction to feed through a normal nipple or breast. They require special nipples (cleft palate nipples). A newborn with a cleft lip and palate should be burped frequently because these infants tend to swallow large amounts of air when feeding.

The nurse would avoid abdominal palpation on the patient who has Wilms tumor because this action could have which priority effect? A. Increase the tumor pain. B. Rupture the tumor capsule C. Increase the gastric peristalsis D. Lead to hematuria in the patient

B. Rupture the tumor capsule Rationale Wilms tumor is an abnormal growth in the kidneys manifesting as a palpable mass in the abdomen. Palpation should not be performed unnecessarily because it may cause the tumor capsule to rupture, leading to metastasis. Abdominal palpation may cause discomfort in the patient, but this is not the priority. Abdominal palpation may increase gastric peristalsis, but it is avoided to prevent metastasis of the tumor. Abdominal palpation may cause injury and result in hematuria in the patient.

Which position would the nurse recommend to a new mother to lay her infant down? A. Prone B. Supine C. Side-lying D. Head elevated

B. Supine Rationale The American Academy of Pediatrics recommends that infants be placed supine for sleeping in an effort to decrease the incidence of sudden infant death syndrome (SIDS). Sleeping in a prone position may predispose the infant to oropharyngeal obstruction or may affect ventilatory arousal. Side-lying and head-elevated positions are not recommended for preventing SIDS.

How will the nurse respond when parents ask about activities at school for a child newly diagnosed with juvenile idiopathic arthritis (JA)? A. "Provide pain medications only during school activities." B. "Do not allow your child to participate in school activities." C. "Talk with the school nurse to arrange for medications and rest periods." D. "Walk your child to all his classes to make sure other kids do not pick on him."

C. "Talk with the school nurse to arrange for medications and rest periods." Rationale JIA is a chronic disorder that affects the activities of daily living (ADLs) of a child. Allowing as much independence as possible is necessary, with the need for pain management and rest periods. JIA is a chronic disorder that affects a child's ADLs, not only school activities. Therefore, pain medication should be given when needed, not just during school activities. The child should be allowed to participate in school activities, and allowing as much independence as possible is necessary.

Four teenagers have been admitted to the floor for unsuccessful suicide attempts. Which patient statement is most concerning to the nurse? A. "I will attend counseling twice a week after I am discharged." B. "I plan to attend all of my classes at school when I return home." C. 'I am so excited that my dad is buying me a gun for my birthday next week." D. "I will talk openly with my parents and friends if I begin to feel overwhelmed."

C. 'I am so excited that my dad is buying me a gun for my birthday next week." Rationale The statement that the dad is buying the teen a gun would alarm the nurse because this patient could be planning the next suicide attempt. The fact that the teen will possess a firearm increases the chance of success the next time. The nurse would be encouraged if the patient plans to attend counseling sessions and classes at school after discharge. The nurse would also be encouraged by the statement that the patient will talk to parents and friends when beginning to feel overwhelmed. This is an excellent coping mechanism.

Which assessment finding would the nurse expect in a child with coarctation of the aorta? A. Clear lungs bilaterally to auscultation B. Apical heart rate of 60 beats/min and respiratory rate of 20 C. Blood pressure in upper extremities higher than in lower extremities D. Bounding pulses in upper extremities and thready pulses in lower extremities

C. Blood pressure in upper extremities higher than in lower extremities Rationale Coarctation of the aorta is a narrowing of the lumen of the aorta (usually at the site of the ductus arteriosus). This results in increased pressure proximal to the defect (head and upper extremities) and decreased pressure distal to the defect (body and lower extremities). Blood pressure in the arms is 20 mm Hg higher than in the legs. Children with this type of heart defect usually demonstrate heart failure symptoms, such as crackles and shortness of breath; therefore, the lungs will not be clear to auscultation. An apical heart rate of 60 and respiratory rate of 20 in a newborn are extremely abnormal but are not associated with this heart defect. Bounding pulses would be located in the lower extremities instead of in the upper extremities.

Which disability will the nurse suspect in a premature child with abnormal muscle tone? A. Meningitis B. Encephalitis C. Cerebral palsy D. Hydrocephalus

C. Cerebral palsy Rationale Abnormal muscle tone is a primary manifestation of cerebral palsy found mostly in prematurely delivered children. Cerebral palsy is screened using cranial sonography and electroencephalography. Meningitis is characterized by fever, vomiting, and seizures. Encephalitis is inflammation of the central nervous system and shows signs of fever, vomiting, and seizures. Hydrocephalus is caused by an imbalance between the production and the absorption of cerebrospinal fluid (CFS) within the ventricular system.

A pediatric patient with which condition may require a chelation therapy? A. Skin nodules B. Subluxated hip C. Lead poisoning D. Periorbital edema.

C. Lead poisoning Rationale Chelation therapy is a pharmacologic treatment provided for the child with lead poisoning. The therapy tends to bind the metal and helps in its excretion from the body. Skin nodules and periorbital edema are seen in a patient who has neuroblastoma. Subluxated hip is a clinical manifestation of spina bifida.

A newborn diagnosed with an atrial septal defect has a congenital abnormality. This defect is between which structures? A. Aorta and the liver B. Pulmonary artery and the aorta C. Left atrium and right atrium D. Left ventricle and right ventricle

C. Left atrium and right atrium Rationale An atrial septal defect is a defect that occurs between the left atrium and the right atrium. There is not a defect between the aorta and the liver. A defect occurring between the pulmonary artery and the aorta is called a patent ductus arteriosus. A defect that occurs between ventricles is known as a ventricular septal defect.

Which condition would the nurse infer from a child whose symptoms are a decreased blood supply to the femoral head, pain in the knees, and muscular atrophy in the thighs? A. Talipes equinovarus B. Suppurative arthritis C. Legg-Calvé-Perthes disease D. Duchenne's muscular dystrophy (DMD)

C. Legg-Calvé-Perthes disease Rationale Legg-Calvé-Perthes disease (coxa plana) is a disorder caused by decreased blood supply to the femoral head. Pain in the knees and muscular atrophy in the thighs of a child are the clinical manifestations of Legg-Calvé-Perthes disease. Talipes equinovarus is the most common congenital deformity of the foot and ankle, in which the child develops clubfoot. Suppurative arthritis is an infection of a joint, which possibly arises from bacteria in the blood and is unrelated to blood supply to the femoral head. DMD is a sex-linked inherited disorder with progressive skeletal muscle wasting and weakness, and it is not due to increased blood supply to the femoral head.

Which measure would the nurse take to ensure safety in a patient with acute lymphoid leukemia who has neutropenia? A. Serve small snacks or meals when the patient is hungry B. Avoid administering methotrexate intrathecally C. Monitor the patients temperature and maintain hygiene D. Avoid administering prednisone to the patient

C. Monitor the patients temperature and maintain hygiene Rationale Patients with cancer (acute lymphoid leukemia) have neutropenia or reduced WBC count. Neutropenia compromises the patient's immune system, increasing the risk of infections. Infection is manifested as increased body temperature; therefore, the nurse would monitor the patients temperature regularly. The nurse would maintain hygiene in the patients surroundings to prevent infection. Offering small and frequent meals helps patients who experience anorexia and vomiting; it is unrelated to neutropenia. Methotrexate is administered intrathecally to reduce the risk of cerebral leukemia and is not avoided if the patient is neutropenic. Prednisone is the principal drug used to treat acute lymphoid leukemia.

Which nursing intervention will the nurse include in the plan of care for a school-aged child with attention deficit/hyperactivity disorder (ADHD)? Select all that apply. One, some, or all responses may be correct. A. Instructing on the benefits of megavitamins and herbal therapies B. Encouraging the parents to enroll the child in multiple after-school activities C. Scheduling routine follow-up appointments for medication management and review D. Educating the parents on discipline, rewarding, accident prevention, and safety needs E. Explaining medications and possible side effects to the parents, the child, and educators

C. Scheduling routine follow-up appointments for medication management and review D. Educating the parents on discipline, rewarding, accident prevention, and safety needs E. Explaining medications and possible side effects to the parents, the child, and educators Rationale Educating the parents on discipline, rewarding, accident prevention, and safety needs is an important nursing intervention. Similarly, explaining medications to the child as well as the parents and educators and scheduling follow-up appointments for medication management and review are important interventions. Herbal therapies and megavitamins are controversial and may be dangerous to the child's health. Children with ADHD have a difficult time handling multiple activities, so the parents should limit the number of afterschool activities for the child.

Which treatment modality would be used for juvenile idiopathic arthritis? Select all that apply. One, some, or all responses may be correct. A. Glycosides B. Antihypertensive drugs C. Slow-acting antirheumatic drugs (SAARDs) D. Nonsteroidal antiinflammatory drugs (NSAIDs) E. Disease-modifying antirheumatic drugs (DMARDs)

C. Slow-acting antirheumatic drugs (SAARDs) D. Nonsteroidal antiinflammatory drugs (NSAIDs) E. Disease-modifying antirheumatic drugs (DMARDs) Rationale NSAIDs such as naproxen and ibuprofen are used as the first line of defense in treating juvenile arthritis. When NSAIDs no longer provide pain relief, SAARDs, such as methotrexate and hydroxychloroquine, are added. When other treatments prove no longer effective, then DMARDs, such as methotrexate and sulfasalazine, are used in conjunction with NSAIDs. Glycosides are used to treat diabetes, not arthritis. Antihypertensive medications are used to treat high blood pressure, not arthritis.

Which information would the nurse provide to the parents of a child with nephritic syndrome on prednisone? A. Teach the parents about foods that have low protein content B. Teach the parents to insist the child eat three large meals per day C. Teach the parents to minimize the child's exposure to communicable diseases D. Teach the parents about foods that are rich in sodium to be included in the child's diet

C. Teach the parents to minimize the child's exposure to communicable diseases Rationale Prednisone suppresses the immune system and may increase the risk of infection. Therefore, the parents are instructed to keep the child free from exposure to communicable diseases. Nephritic syndrome results in proteinuria. Loss of protein in the urine causes a decrease in the protein level of the blood (hypoproteinemia), so the nurse should tell the parents to provide a diet that is rich in protein to the child. The child should be offered small, frequent meals that are served in an attractive manner. The child should not be given a diet with high levels of salt and fluids because they further increase edema in the child.

At which time would the nurse instruct a mother to give an iron supplement to a 5-year-old child with iron deficiency anemia? A. At night before bed B. With meals or a snack C. With citrus juice on an empty stomach D. When the child is showing signs of fatigue

C. With citrus juice on an empty stomach Rationale The nurse would instruct the mother to give an iron supplement to her child with citrus juice on an empty stomach to enhance the absorption of the iron. The iron supplements should be given between meals, not at night before bed. The iron supplements should be taken regularly, not on an as-needed basis, and not with meals or a snack.

Which instruction would the nurse expect from the health care provider when an infant who is fed with bovines milk is fussy and has a pale tongue? A. Provide the infant with kangaroo care. B. Feed the infant with only breast milk. C. Avoid placing the infant on the pillow. D. Give iron-fortified formula to the infant.

D. Give iron-fortified formula to the infant. Rationale Bovine's milk, or cow's milk, may cause bloody stools in infants. Because of elimination of blood through the stools, the infant is likely to develop anemia. Anemic infants look pale and are fussy. The health care provider would instruct the nurse to feed iron-fortified milk to the infant to prevent anemia. Kangaroo care is given to ease the child from being fussy, but this is not related to blood iron levels in the infant. Feeding the child with only breast milk will not be sufficient, as breast milk is deficient in iron. Parents should avoid placing the infant on pillows, as this may lead to suffocation.

Which statement by the nurse explains the purpose of the hip spica cast for the child with developmental dysplasia of the hip (DDH)? A. 'It keeps the pelvis tilted in an upward position." B. "It will internally rotate the feet to maintain correct position." C. "It supports the pelvis and the spine and expedites spinal fusion." D. "It will externally rotate the feet, which keeps the femur head in the acetabulum."

D. "It will externally rotate the feet, which keeps the femur head in the acetabulum." Rationale Treatment for a child with DDH between the ages of 6 and 24 months may require manipulation of the head of the femur into the socket (acetabulum). This is accomplished by placing the child in a hip spica cast. The child's feet are externally rotated, causing the hips to rotate in, keeping the femur head in the acetabulum. The purpose of the hip spica cast is to keep the femur head in the acetabulum, not to keep the pelvis tilted upward. The hip spica cast causes external rotation of the feet, which causes the hip to rotate inward. With internal rotation of the feet, the hips would rotate outward, causing the head of the femur to become displaced. The purpose of the hip spica cast is to keep the femur head in the acetabulum, not to support the pelvis and spine or to expedite spinal fusion.

The mother of a child with cystic fibrosis asks the nurse, "Why does my daughter need pancreatic enzymes?" How will the nurse respond? A. "They increase peristalsis." B. "They increase your child's metabolism." C. "They help facilitate the movement of fluid in and out of cell membranes." D. "They are given before meals and snacks to help with digestion of fats, proteins, and carbohydrates."

D. "They are given before meals and snacks to help with digestion of fats, proteins, and carbohydrates." Rationale Cystic fibrosis causes an obstruction of the pancreatic ducts, leading to a decrease in the levels of pancreatic enzymes (lipase, amylase, and trypsin). These enzymes are needed to digest fats, proteins, and carbohydrates. Pancreatic enzymes do not increase peristalsis or the basal metabolic rate. Pancreatic enzymes do not help facilitate fluid in and out of the cell membranes.

Full-term, healthy infants should have adequate iron stores from their mothers until which age? A. 12 months B. 18 months. C. 6 to 8 months D. 4 to 6 months

D. 4 to 6 months Rationale Full-term, healthy infants have sufficient iron stores for the first 4 to 6 months of life. If an infant is breast-fed, the infant should receive adequate iron for the first 6 months of life. If an infant is not breast-fed, the infant should receive iron-fortified formulas for the first 9 to 12 months of life. Once a child has been introduced to solid food (usually around 12 months and older), the child should receive adequate iron from the diet.

Which intervention would the health care provider prescribe before delivery for the patient whose amniocentesis reveals that the fetal lungs are not developed? A. Provide ventilator support to the patient. B. Administer digoxin to the patient. C. Give aggressive intravenous (IV) fluids to the patient. D. Administer betamethasone to the patient.

D. Administer betamethasone to the patient. Rationale Amniocentesis is used to detect fetal lung maturity before delivery. Premature infants are more likely at risk of respiratory distress syndrome (RDS) because of deficiency of lung surfactant. Therefore, the health care provider would administer corticosteroids, such as betamethasone, to the patient before delivery to increase the production of surfactant in the premature infant. Ventilator support is provided for patients who have decreased respiratory rate. Digoxin is administered to treat patients with congenital heart disease. IV fluids are given to pregnant women if they have low levels of amniotic fluid before delivery.

Which complication does the nurse expect in an infant with untreated congenital hypothyroidism? A. Diabetes mellitus. B. Sickle cell anemia C. Periorbital cellulitis D. Cognitive impairment

D. Cognitive impairment Rationale If the congenital abnormality is not treated promptly, it may lead to cognitive impairment due to inadequate growth and development. Diabetes mellitus is unrelated to congenital hypothyroidism. However, it is diagnosed in obese children with a strong family history of diabetes. Sickle cell anemia is a genetic disorder characterized by sickle-shaped erythrocytes, and it is unrelated to congenital hypothyroidism. Periorbital cellulitis is a serious inflammation of the eyelids and periorbital area, and it is not related to congenital hypothyroidism.

Which diagnostic test will the nurse expect the health care provider to prescribe for a patient who has red eyes, photosensitivity, and stiff and swollen joints? A. Mantoux test B. Western blot test C. Blood gas analysis D. Erythrocyte sedimentation rate

D. Erythrocyte sedimentation rate Rationale Red eyes, photosensitivity, and stiff and swollen joints are the clinical manifestations of juvenile idiopathic arthritis (JIA). It can be diagnosed by elevated erythrocyte sedimentation rate in the patient when correlated with clinical symptoms. The Mantoux test is performed to determine the presence of tuberculosis (TB). The Western blot test is used to diagnose the presence of human immunodeficiency virus (HIV). Blood gas analysis indicates the degree of respiratory and metabolic acidosis, which is useful to detect respiratory distress syndrome (RDS).

The parent of a 7-month-old infant tells the nurse, "My child vomits shortly after eating and is losing a lot of weight." Which condition would the nurse suspect the infant may have? A. Gastroenteritis B. Intussusception C. Gastroesophageal reflux D. Hypertrophic pyloric stenosis

D. Hypertrophic pyloric stenosis Rationale Hypertrophic pyloric stenosis is characterized by projectile vomiting 30 to 60 minutes after feeding. Gastroenteritis is inflammation of the gastrointestinal tract, which results in diarrhea. Intussusception is characterized by common symptoms such as currant-jelly stools, vomiting, and diarrhea. Gastroesophageal reflux is effortless regurgitation in which the child vomits immediately after feeding. It is seen in infants under 1 year of age.

Which level of impairment would the nurse infer about a child whose intelligence quotient (1Q) level is 15? A. Mild B. Moderate C. Severe D. Profound

D. Profound Rationale Cognitive impairment in children is tested by the child's answers to arbitrarily chosen questions. An IQ of 15 is associated with profound cognitive impairment in the child. Presence of mild impairment is indicated by an 1Q level of 50 to 70. Moderate cognitive impairment is seen in children with an IQ score of 35 to 50. If the child has scored 20 to 25 as an IQ level, then the child is said to have severe cognitive impairment.

Which reason explains why the nurse would be concerned about a low potassium level in a child scheduled to receive a dose of digoxin? A. The child has a hospital-acquired infection. B. The child has developed brain deformities. C. The child requires increased digoxin dosage. D. The child is at increased risk of digoxin toxicity.

D. The child is at increased risk of digoxin toxicity. Rationale The nurse will regularly monitor potassium levels in the child who is on digoxin because low potassium levels enhance digoxin levels, consequently increasing the risk of digoxin toxicity. The child's white blood cell count would increase if he or she developed a hospital-acquired infection. Reduced potassium levels are unrelated to infection. Diagnostic techniques, such as magnetic resonance imaging (MRI), would help in detecting brain deformities in a child. The digoxin dosage is likely to be reduced in the child with a lowered potassium level.

Which characteristic is a hallmark sign of autism? A. Spinning in circles. B. Rocking back and forth for hours C. The inability to sit still for an hour D. The inability to maintain eye contact with another person

D. The inability to maintain eye contact with another person Rationale One hallmark characteristic of autism is the inability to maintain eye contact with another person. Stereotypical characteristics may include spinning in circles, rocking back and forth, and the inability to sit still. However, these symptoms are also present with other neurologic disorders.

Which finding would the nurse notice during the examination of the genital organs of a child with hypospadias? A. The testes in the patient have failed to descend into the scrotum. B. The opening of the foreskin of the penis is narrowed or stenosed. C. The urethral opening is located along the dorsal surface of the penile shaft. D. The urethral opening is located along the ventral surface of the penile shaft.

D. The urethral opening is located along the ventral surface of the penile shaft. Rationale Hypospadias is a condition in which the urethral opening is located along the ventral surface of the penile shaft. Cryptorchidism is the failure of the testes to descend into the scrotum. If the opening of the foreskin of the penis is narrowed or stenosed, the patient is said to have phimosis. In epispadias, the urethral opening is located along the dorsal surface of the penile shaft.