Combo with "Peds Exam 3a" and 2 others

Pertussis vaccination should begin at which age? a. Birth b. 2 months c. 6 months d. 12 months

ANS: B The acellular pertussis vaccine is recommended by the American Academy of Pediatrics beginning at age 6 weeks. Infants are at greater risk for complications of pertussis. The vaccine is not given after age 7 years, when the risks of the vaccine become greater than those of pertussis. The first dose is usually given at the 2-month well-child visit. The infant is highly susceptible to pertussis, which can be a life-threatening illness in this age-group.

A child with Kawasaki disease is receiving low dose aspirin. The mother calls the clinic and states that the child has been exposed to influenza. Which recommendations should the nurse make? Select all that apply. 1. Increase fluid intake. 2. Stop the aspirin. 3. Keep the child home from school. 4. Watch for fever. 5. Weigh the child daily.

2, 4. Aspirin needs to be stopped because of its possible link to Reye syndrome. Additionally, the parents need to watch for signs and symptoms of influenza. Children with influenza frequently present with fever, cold symptoms, and gastrointestinal symptoms. Increasing the child's fluid intake and weighing the child daily are not needed at this time because the child is not ill. Keeping the child home from school is not necessary, because the child is not ill and has already been exposed.

The nurse is providing guidance strategies to a group of parents with toddlers at a community outreach program. Which of the following statements by a parent would indicate a correct understanding of the teaching? a. "I should expect my 24-month-old child to express some signs of readiness for toilet training." b. "I should be firm and structured when disciplining my 18-month-old child." c. "I should expect my 12-month-old child to start to develop a fear of darkness and to need a security blanket." d. "I should expect my 36-month-old child to understand time and proximity of events."

ANS: A A 24-month-old toddler starts to show readiness for toilet training; it is important for the parent to be aware of this and be ready to start the process. At 18 months of age, a child needs consistent but gentle discipline, since the child cannot yet understand firmness and structure with discipline. Development of fears and need for security items usually occurs at the end of the 18- to 24-month stage. A 36-month-old child does not yet understand time and proximity of events, so the parent needs to understand that the toddler cannot "hurry up or we will be late."

Which development is necessary for toilet training readiness for a 2-year-old? Select all that apply. 1. Adequate neuromuscular development for sphincter control 2. Appropriate chronological age. 3. Ability to communicate the need to use the toilet. 4. Desire to please the parents. 5. Ability to play with other 2-year-olds.

1, 3, 4. Readiness for toilet training is based on neurological, psychological, and physical developmental readiness. The nurse can introduce concepts of readiness for toilet training and encourage parents to look for adaptive and psychomotor signs such as the ability to walk well, balance, climb, sit in a chair, dress oneself, please the parent, and communicate awareness of the need to urinate or defecate. Chronological age is not an indicator for toilet training. Two-year-olds engage in parallel play, which is not an indicator of readiness for toilet training.

The parents of a preschooler ask the nurse how to handle their child's temper tantrums. Which of the following should the nurse include in the teaching plan? Select all that apply. 1. Putting the child in "time-out." 2. Telling the child to go to his bedroom. 3. Ignoring the child. 4. Putting the child to bed. 5. Spanking the child. 6. Trying to reason with the child.

1, 3. Some parents find that putting the child in time-out until control is regained is very effective. Others find that ignoring the behaviors works just as well with their child. Both suggestions are appropriate to include in the teaching plan. Sending the child to his bedroom means the child is being punished for having a tantrum. Spanking the child is never an option. Attempting to reason with a child having a temper tantrum does not work because the child is out of control. A more appropriate time to discuss it with the child is when the child regains control.

As part of the preoperative teaching for the family of a child undergoing a tetralogy of Fallot repair, the nurse tells the family upon returning to the pediatric floor that the child may: 1. Be placed on a reduced sodium diet. 2. Have an activity restriction for several days. 3. Be assigned to an isolation room. 4. Have visits limited to a select few.

1. Because of the hemodynamic changes that occur with open heart surgery repair, particularly with septal defects, transient congestive heart failure may develop. Therefore, the child's sodium intake typically is restricted to 2 to 3 g/ day. Activity restrictions are inappropriate. Typically the child is encouraged to walk the halls and unit. Risk for infection after the repair is the same as any postoperative client, therefore isolation is not necessary. The child may be placed in a room with other children who are not contagious. Visitors are not restricted unless the pediatric unit has restrictive visiting policies.

A child has had open heart surgery to repair a tetralogy of Fallot with a patch. The nurse should instruct the parents to: 1. Notify all health care providers before invasive procedures for the next 6 months. 2. Maintain adequate hydration of at least 10 glasses of water a day. 3. Provide for frequent rest periods and naps during the first 4 weeks. 4. Restrict the ingestion of bananas and citrus fruit.

1. Children who have undergone open heart surgery with a patch are at risk for infection, especially subacute bacterial endocarditis (SBE), for the first 6 months following surgery. The newest evidence-based guidelines suggest that once the patch has epithelialized, these precautions are no longer necessary. Therefore, parents are instructed about SBE precautions including the need to notify providers before invasive procedures so antibiotics can be prescribed for that time period. Having the child drink a very large amount of water may lead to fluid overload. Children gear their rest schedule to their activities making it unnecessary to schedule frequent rest periods. Bananas and citrus fruit are high in potassium, but there is no evidence provided that the child has an elevated serum potassium requiring restriction.

An 18-month-old with a congenital heart defect is to receive digoxin (Lanoxin) twice a day. The nurse should instruct the parents about which of the following? 1. Digoxin enables the heart to pump more effectively with a slower and more regular rhythm. 2. Signs of toxicity include loss of appetite, vomiting, increased pulse, and visual disturbances. 3. Digoxin is absorbed better if taken with meals. 4. If the child vomits within 15 minutes of administration, the dosage should be repeated.

1. Digoxin's effect is to slow the rate of the electrical conduction through the heart and increase the strength of the heart's contraction. Signs of toxicity include anorexia and decreased heart rate. Digoxin should be taken 1 hour before meals or 2 hours after meals in order to obtain better absorption of the drug. If the child vomits within 15 minutes of administration, the dose should not be repeated because it is not known how much of the medication has been absorbed.

To meet the developmental needs of an 8-year-old child who is confined to home with osteomyelitis, what should the nurse include in the care plan? 1. Encouraging the child to communicate with schoolmates. 2. Encouraging the parents to stay with the child. 3. Allowing siblings to visit freely throughout the day. 4. Talking to the child about his interests twice daily.

1. Encouraging contact with schoolmates allows the school-age child to maintain and develop socialization with peers, an important developmental task of this age group. Although having family visits and interacting with the child are important, they do not meet the child's developmental needs. Talking to the child about his interests is important, but encouraging contact with schoolmates is crucial to maintain and develop socialization with peers.

The parents of a child just diagnosed with juvenile idiopathic arthritis (JIA) tell the nurse that the diagnosis frightens them because they know nothing about the prognosis. What should the nurse include when teaching the parents about the disease? 1. Half of affected children recover without joint deformity. 2. Many affected children go into long remissions but have severe deformities. 3. The disease usually progresses to crippling rheumatoid arthritis. 4. Most affected children recover completely within a few years.

1. In half of the children diagnosed with JIA, recovery occurs without joint deformity. Approximately one-third of the children will continue to have the disease into adulthood, and approximately one-sixth will experience severe, crippling deformities.

Which of the following initial physical findings indicate the development of carditis in a child with rheumatic fever? 1. Heart murmur. 2. Low blood pressure. 3. Irregular pulse. 4. Anterior chest wall pain.

1. In rheumatic fever, the connective tissue of the heart becomes inflamed, leading to carditis. The most common signs of carditis are heart murmurs, tachycardia during rest, cardiac enlargement, and changes in the electrical conductivity of the heart. Heart murmurs are present in about 75% of all clients during the first week of carditis and in 85% of clients by the third week. Signs of carditis do not include hypotension or chest pain. The client may have a rapid pulse, but it is usually not irregular.

After a plaster cast has been applied to the arm of a child with a fractured right humerus, the nurse completes discharge teaching. The nurse should evaluate the teaching as successful when the mother agrees to seek medical advice if the child experiences which of the following? 1. Inability to extend the fingers on the right hand. 2. Vomiting after the cast is applied. 3. Coolness and dampness of the cast after 5 hours. 4. Fussiness with statements that the cast is heavy.

1. Inability to extend the fingers of the involved arm may indicate neurologic impairment caused by pressure on soft tissue. It is not unusual for a child to vomit after experiencing a traumatic injury It may take up to 72 hours for a plaster cast to dry. Until the cast dries, the dampness causes the sensation of coolness. The cast will seem heavy until the child adjusts to the extra weight. The child may exhibit fussiness (such as whining, crying or clinging) as a result of numerous causes, such as placement of the cast, the hospital experience, or pain. These reactions are normal and do not warrant medical advice.

The nurse assesses the family's ability to cope with the child's cerebral palsy. Which action should alert the nurse to the possibility of their inability to cope with the disease? 1. Limiting interaction with extended family and friends. 2. Learning measures to meet the child's physical needs. 3. Requesting teaching about cerebral palsy in general. 4. Not seeking financial help to pay for medical bills.

1. Limited interaction or lack of interaction with friends and family may lead the nurse to suspect a possible problem with the family's ability to cope with others' reactions and responses to a child with cerebral palsy. Learning measures to meet the child's physical needs demonstrates some understanding and acceptance of the disease. Requesting teaching about the disease suggests curiosity or a desire for understanding, thus demonstrating the family dealing with the situation. Although not seeking financial help to pay for medical bills may be problem, it does not indicate the type of response the family is having to the child's problems.

The nurse teaches the mother of a young child with Duchenne's muscular dystrophy about the disease and its management. Which of the following statements by the mother indicates successful teaching? 1. "My son will probably be unable to walk independently by the time he is 9 to 11 years old." 2. "Muscle relaxants are effective for some children; I hope they can help my son." 3. "When my son is a little older, he can have surgery to improve his ability to walk." 4. "I need to help my son be as active as possible to prevent progression of the disease."

1. Muscular dystrophy is a progressive disease. Children who are affected by this disease usually are unable to walk independently by age 9 to 11 years. There is no effective treatment for childhood muscular dystrophy. Although children who remain active are able to avoid wheelchair confinement for a longer period, activity does not prevent disease progression.

After teaching the family of a child with scoliosis who needs to wear a Boston brace, which of the following activities, if stated by the child and family as occasions appropriate for removal of the brace, indicates successful teaching? 1. When bathing, for about 1 hour per day. 2. While eating, for a total of 3 hours a day. 3. During school, for about 8 hours a day. 4. When sleeping, for a total of 10 hours a day.

1. One of the most effective spinal braces for correcting scoliosis, the Boston brace should be worn for at least 16 to 23 hours a day, except when carrying out personal hygiene measures.

When assessing a female adolescent for scoliosis, what should the nurse ask the client to do? 1. Bend forward at the waist with arms hanging freely. 2. Lie flat on the floor and extend her legs straight from the trunk. 3. Sit in a chair while lifting her feet and legs to a right angle with the trunk. 4. Stand against a wall while pressing the length of her back against the wall.

1. Scoliosis, a lateral deviation of the spine, is assessed by having the client bend forward at the waist with arms hanging freely, then looking for lateral curvature of the spine and a rib hump. The other positions will not reveal the deviation of the spine.

A child is admitted with a fracture of the femur and placed in skeletal traction. What should the nurse assess first? 1. The pull of traction on the pin. 2. The Ace bandage. 3. The pin sites for signs of infection. 4. The dressings for tightness.

1. Skeletal traction applies the pull directly to the skeletal structure by tongs, pin, or wire. The nurse should assess the pull of the traction on the pin first. This is critical to the success of the traction. Once this is assessed, then the pin sites are assessed for signs of infection. The dressings would be examined after the pull of the traction, neurovascular status, and pin sites were assessed. The Ace wrap is used to anchor skin traction nonadherent straps, not skeletal traction.

A child with newly diagnosed osteomyelitis has nausea and vomiting. The parent wishes to give the child ginger snaps to help control the nausea. The nurse should tell the parent: 1. "You can try them and see how he does." 2. "I will need to get a prescription." 3. "Your child needs medication for the vomiting." 4. "We discourage the use of home remedies in children."

1. Some clients find ginger snaps help relieve nausea. The National Center for Complimentary and Alternative Medicine has determined that ginger, in small doses such as would be found in the cookies, has few side effects. There is no reason that the parent should not try this dietary intervention; however, the nurse must monitor the client's response. If the child has a diet as tolerated prescription, there is no need for an additional prescription. Ultimately, the child may need an antiemetic medication, but dietary strategies are often successful in treating vomiting related to osteomyelitis. Making a universal statement disregarding home remedies is not a client-centered approach.

A 12-year-old with rheumatic fever has a history of long-term aspirin use. Which statement by the client indicates that the nurse should notify the health care provider? 1. "I hear ringing in my ears." 2. "I put lotion on my itchy skin." 3. "My stomach hurts after I take that medicine." 4. "These pills make me cough."

1. Tinnitus is an adverse effect of prolonged aspirin therapy and the child should be examined by a health care provider for hearing loss. Itchy skin commonly accompanies the rash associated with rheumatic fever and the nurse can encourage lotion use. The nurse teaches clients to take aspirin with food or milk to avoid abdominal discomfort. The nurse can also address the fact that coughing after ingesting aspirin can be caused by inadequate fluid intake during administration.

The nurse is measuring a child for crutches. What should the nurse consider? Select all that apply. 1. Type of gait child will be using. 2. Degree of child's elbow flexion. 3. Space above the crutch to child's axilla. 4. Weight of the child. 5. Whether child has to use the stairs.

2,3. To ensure proper fit of crutches, the child's elbow flexion should be 20 degrees, and the area above the top of the crutch to the child's axilla should be 1 to 1 1/ 2 inches. The type of gait, weight of the child, and use of stairs are not factors in the measurement.

Which procedures can the nurse working on a pediatric floor safely delegate to the licensed practical nurse (LPN)? Select all that apply. 1. Refilling a baclofen pump. 2. Administering gastrostomy tube feedings. 3. Administering gastrostomy medications. 4. Giving an IV push medication. 5. Calling the AM blood sugars to the physician.

2,3. In general, LPNs may perform skills related to feeding and administering of enteral medications. Refilling a baclofen pump constitutes administering an intrathecal medication and is beyond the scope of practice for LPNs in most states. Some states and institutions allow LPNs to give IV push medicines; however, special training is required. Communicating with the primary health care provider would require discussion of the client's assessments and evaluations, which fall under the RN scope of practice.

A child with spastic cerebral palsy is to begin botulinum toxin type A (Botox) injections. Which treatment goals should the health care team set for the child related to Botox? Select all that apply. 1. Improved nutritional status. 2. Decreased pain from spasticity. 3. Improved motor function. 4. Enhanced self-esteem. 5. Reduced caregiver strain and improved self-care. 6. Decreased speech impediments.

2,3,4,5. Botox injections can be used to improve many aspects of quality of life for the child with cerebral palsy. The injections can help decrease pain from spasticity. Injections improve motor status by reducing rigidity and allowing for more effective physical therapy to improve range of motion. Decreased spasms enhance self-esteem. Improved motor status facilitates the ability to provide some aspects of care, especially transfers. Botox does not significantly affect nutritional status or speech.

The child in a new hip spica cast seems to be adjusting to the cast, except that after each meal the child tells the nurse that the cast is too tight. Which of the following should the nurse plan to do? 1. Administer a laxative prior to each meal. 2. Offer smaller, more frequent meals. 3. Give the child a mechanical soft diet. 4. Offer the child more fruits and grains.

2. A hip spica cast encircles the abdomen. When the child eats a large meal, abdominal pressure increases, causing the cast to feel tight. Therefore, the nurse should plan to offer smaller, more frequent meals to minimize abdominal distention. If the child's appetite were decreased in conjunction with a feeling of fullness, the nurse might suspect that the child was becoming constipated and plan to use laxatives or a higher-fiber diet. A mechanical soft diet is indicated when the child has difficulty chewing food adequately. Giving the child more fruits and grains would contribute to abdominal distention and problems with the cast tightness after eating.

The mother of a child hospitalized with tetralogy of Fallot tells the nurse that the child's 3-year-old sibling has become quiet and shy and demonstrates more than a usual amount of genital curiosity since this child's hospitalization. The nurse should tell the mother: 1. "This behavior is very typical for a 3-year-old." 2. "This may be how your child expresses feeling a need for attention." 3. "This may be an indication that your child may have been sexually abused." 4. "This may be a sign of depression in your child."

2. According to Erikson, the central psychosocial task of a preschooler is to develop a sense of industry versus guilt. Any environmental situation may affect the child. In this situation the sibling is probably feeling less attention from the mother and trying to resolve the conflict in an inappropriate way. Three-year-olds are usually active and outgoing. These behaviors represent a change. Data are not sufficient to suggest the child has been exposed to a sexual experience. Symptoms of depression would include withdrawal and fatigue.

A 12-year-old is having surgery to repair a fractured left femur. As a part of the preoperative safety procedures, the nurse should ask the client to: 1. Point to the area of the fracture. 2. Mark the location of the fracture with an "x" and sign his name. 3. Confirm with his parents that they have signed the operative permit. 4. State the surgery risks as understood from the surgeon.

2. According to national client safety standards, when possible, the client should mark the surgery site and sign his name on the site. This step should be done prior to receiving preoperative medication. Pointing to the area is not sufficient identification. Because the client is a minor, the parents are responsible for signing the operative permit and accepting the surgery risks. The nurse should determine that the parents understand the surgery risks.

When developing the teaching plan for parents using the Pavlik harness with their child, what should be the nurse's initial step? 1. Assessing the parents' current coping strategies. 2. Determining the parents' knowledge about the device. 3. Providing the parents with written instructions. 4. Giving the parents a list of community resources.

2. Assessing the learner's knowledge level is the initial step in any teaching plan to promote the maximum amount of learning. This assessment also provides the nurse with a starting point for teaching. Assessing coping strategies can provide important information to the development of the teaching plan but is not the initial step. Giving parents written instructions or a list of community resources is appropriate once the parents' knowledge level has been determined and teaching has begun.

A child is to receive IV antibiotics for osteomyelitis. Before the initial dose of antibiotics can be given, the nurse confirms that a blood sample for which of the following tests has been drawn? 1. Creatinine. 2. Culture. 3. Hemoglobin. 4. White blood count.

2. Cultures are used to determine exactly what organism is causing the inflammation. From the culture, sensitivities to various antibiotics may be determined. If the antibiotics are given before obtaining the culture, the antibiotics may inhibit the growth of the organism in the culture medium. This may lead to a delay in the most appropriate treatment. Unless a child has a known renal problem, baseline creatinine levels are not typically needed. However, levels may be needed during treatment depending on the medication. A complete blood count (CBC) with hemoglobin and white blood cell count is typically prescribed for any suspected infection, but these tests do not identify the causative organism.

Which of the following outcomes indicates that the activity restriction necessary for a 7-year-old child with rheumatic fever during the acute phase has been effective? 1. Joints demonstrate absence of permanent injury. 2. The resting heart rate is between 60 and 100 bpm. 3. The child exhibits a decrease in chorea movements. 4. The subcutaneous nodules over the joints are no longer palpable.

2. During the acute phase of rheumatic fever, the heart is inflamed and every effort is made to reduce the work of the heart. Bed rest with limited activity is necessary to prevent heart failure. Therefore, the most reliable indicator that activity restriction has been effective is a resting heart rate between 60 and 100 bpm, normal for a 7-year-old child. No permanent damage to the joints occurs with rheumatic fever. The chorea movements associated with rheumatic fever are self-limited and usually disappear in 1 to 3 months. They are unrelated to activity restrictions. Subcutaneous nodules that occur over joint surfaces also resolve over time with no treatment. Therefore, they are not appropriate for evaluating the effectiveness of activity restrictions.

The nurse is discharging a baby with clubfoot who has had a cast applied. The nurse should provide additional teaching to the parents if they state: 1. "I should call if I see changes in the color of the toes under the cast." 2. "I should use a pillow to elevate my child's foot as he sleeps." 3. "My baby will need a series of casts to fix her foot." 4. "Having a cast should not prevent me from holding my baby."

2. Elevating the extremity at different points during the day is helpful to prevent edema, but pillows should not be used in the crib because they increase the risk of sudden infant death syndrome (SIDS). A change in the color of the toes is a sign of impaired circulation and requires medical evaluation. Children typically need a series of 5 to 10 casts to correct the deformity. Infants with club feet still need frequent holding like any other newborn.

A 9-year-old is given morphine for postoperative pain. As the nurse is assessing the client for pain 4 hours later, his mother leaves the room and the child begins to cry. The nurse's initial assessment of the child's pain is that he is: 1. Not in pain because the crying began after the mother leaves. 2. Less tolerant of pain because he is upset. 3. In pain because he is crying. 4. Not in pain because he was medicated 4 hours ago.

2. Emotional or physical stress lowers a person's tolerance of pain. The mother's presence may have distracted him and when she left it caused him to focus on the pain he was having. Crying does not automatically indicate pain. The nurse must further assess the client for pain. Although an analgesic was given 4 hours before, pain may be present.

When teaching the parents of a child with a ventricular septal defect who is scheduled for a cardiac catheterization, the nurse explains that this procedure involves the use of which of the following? 1. Ultra-high-frequency sound waves. 2. Catheter placed in the right femoral vein. 3. Cutdown procedure to place a catheter. 4. General anesthesia.

2. In children, cardiac catheterization usually involves a right-sided approach because septal defects permit entry into the left side of the heart. The catheter is usually inserted into the femoral vein through a percutaneous puncture. Echocardiography involves the use of ultra- high-frequency sound waves. A cutdown procedure is rarely used. The catheterization is usually performed under local, not general, anesthesia with sedation.

A 2-year-old child brought to the clinic by her parents is uncooperative when the nurse tries to look in her ears. Which of the following should the nurse try first? 1. Ask another nurse to assist. 2. Allow a parent to assist. 3. Wait until the child calms down. 4. Restrain the child's arms.

2. Parents can be asked to assist when their child becomes uncooperative during a procedure. Most commonly, the child's difficulty in cooperating is caused by fear. In most situations, the child will feel more secure with a parent present. Other methods, such as asking another nurse to assist or waiting until the child calms down, may be necessary but obtaining a parent's assistance is the recommended first action. Restraints should be used only as a last resort, after all other attempts have been made to encourage cooperation.

In planning the discharge for a newborn diagnosed with torticollis (wry neck), the nurse should: 1. Teach the parent the side effects of botulinum toxin (BOTOX). 2. Coordinate outpatient physical therapy. 3. Verify the date for corrective surgery. 4. Demonstrate the use of positioning wedges for sleep.

2. Physical therapy is the most important part of the child's plan of care. Most cases of torticollis respond to gentle stretching exercises, which the parents perform daily. Regular physical therapy is needed to monitor the infant's progress. Botox injections are not approved for children under the age of 2 and would not be an appropriate first-line treatment for an infant. Surgery is only done if physical therapy is not successful after several months. The use of wedges to position children during sleep is not recommended because they increase the risk of SIDS.

The mother of a 4-year-old expresses concern that her child may be hyperactive. She describes the child as always in motion, constantly dropping and spilling things. Which of the following actions would be appropriate at this time? 1. Determine whether there have been any changes at home. 2. Explain that this is not unusual behavior. 3. Explore the possibility that the child is being abused. 4. Suggest that the child be seen by a pediatric neurologist.

2. Preschool-age children have been described as powerhouses of gross motor activity who seem to have endless energy. A limitation of their motor ability is that in moving as quickly as they do, they are not always able to judge distances, nor are they able to estimate the amount of strength and balance needed for activities. As a result, they have frequent mishaps. This level of activity typically is not associated with changes at home. However, if the behavior intensifies, a referral to a pediatric neurologist would be appropriate. Children who have been abused usually demonstrate withdrawn behaviors, not endless energy.

The parents of a child who requires skeletal traction are unable to visit their child for more than 1 hour a day because there are five other children at home and both parents work outside of the home. The nurse recognizes expressions of guilt in both parents. To help alleviate this guilt, the nurse should make which of the following remarks? 1. "I'm sure you feel guilty about not being able to visit often." 2. "It's important that you visit even for 1 hour." 3. "Not all parents can stay all the time." 4. "Perhaps you could take turns visiting for a bit longer."

2. Stressing the importance of the parents' visiting when they can helps to alleviate the guilt they feel. It allows the parents to feel that they are doing what they can. Acknowledging the guilt gives the parents an opportunity to talk about it but does not help alleviate it. Comparing the parents with other parents does not alleviate guilt feelings. The parents need reinforcement that what they are doing is appropriate. Suggesting that the parents take turns visiting implies that they should feel guilty because they may not be doing all they could.

A 4-year-old has been scheduled for a cardiac catheterization. To help prepare the family, the nurse should: 1. Advise the family to bring the child to the hospital for a tour a week in advance. 2. Explain that the child will need a large bandage after the procedure. 3. Discourage bringing favorite toys that might become associated with pain. 4. Explain that the child may get up as soon as the vital signs are stable.

2. The catheter insertion site will be covered with a bandage. This is important for preschool children to know as they are very concerned about bodily harm. The best time to prepare a preschool child for an invasive procedure is the night before. Bringing a favorite toy to the hospital will help decrease the child's anxiety. To prevent bleeding, the child will be expected to keep the extremity straight for 4 to 6 hours after the procedure, either in bed or on the parent's lap.

After surgery to correct a tetralogy of Fallot, the child's parents express concern to the nurse that their 4-year-old child wants to be held more frequently than usual. The nurse recommends: 1. Introducing a new skill. 2. Play therapy. 3. Encouraging the behavior. 4. Having the volunteer hold the child.

2. The child is exhibiting regression. During periods of stress, children frequently revert to behaviors that were comforting in earlier developmental stages; play therapy is one way to help the child cope with the stress. Teaching a new skill most likely would add more stress. Parents should be instructed to praise positive behaviors and ignore regressive behaviors rather than calling attention to them through encouragement or discouragement. Having someone else hold the child does not encourage coping with the stress or promoting appropriate development.

The nurse is helping a family plan for the discharge of their child, who will be going home in a spica cast. Which of the following points of information should be most important for the nurse to consider? 1. The bathrooms are all on the second floor. 2. The child's bedroom is on the second floor. 3. A 16-year-old sister will care for the child during the day. 4. There are three steps up to the front door.

2. The child with a hip spica cast who is going home and has a bedroom on the second floor of the home needs to have the bed moved to an area that is more central to family life. Negotiating a flight of steps at least twice a day (on awakening in the morning and before going to bed at night) with a child in a hip spica cast would be difficult and most likely dangerous. Because the child in a hip spica cast will need to use a bedpan or urinal, the bathrooms can be on any floor. Because the family is involved in the discharge, the 16-year-old sister should be taught appropriate care along with the rest of the family. The child can be carried up and down the three steps to the house the few times necessary after discharge.

A child with spastic cerebral palsy receiving intrathecal baclofen therapy is admitted to the pediatric floor with vomiting and dehydration. The family tells the nurse that they were scheduled to refill the baclofen pump today, but had to cancel the appointment when the child became ill. The nurse should: 1. Explain that the medication should be discontinued during illness. 2. Arrange for the pump to be refilled in the hospital. 3. Reschedule the pump refill for the day of discharge. 4. Instruct caregivers to call for a refill when the low-volume alarm sounds.

2. To prevent a baclofen withdraw, pump refills are scheduled several days before anticipated low-volume alarms. The nurse should make it a high priority to have the pump refilled as soon as possible. Discontinuing baclofen suddenly can result in a high fever, muscle rigidity, change in level of consciousness, and even death. Waiting until the child leaves the hospital for a refill may lead to a low dose or withdraw. Waiting for the low-volume alarm puts the client at risk because medication and team members who can refill the pump may not be readily available under all circumstances.

When planning a 15-month-old toddler's daily diet with the parents, which of the following amounts of milk should the nurse include? 1. ½ to 1 cup. 2. 2 to 3 cups. 3. 3 to 4 cups. 4. 4 to 5 cups.

2. Toddlers around the age of 15 months need 2 to 3 cups of milk per day to supply necessary nutrients such as calcium. A daily intake of more than 3 cups of milk may interfere with the ingestion of other necessary nutrients.

An infant weighing 9 kg is in the pediatric intensive care unit following arterial switch surgery. In the past hour, the infant has had 16 mL of urine output. Which action should the nurse take? 1. Notify the primary health care provider immediately. 2. Record the urine output in the chart. 3. Administer a fluid bolus immediately. 4. Assess for other signs of hypervolemia.

2. Urine output for an infant weighing 9 kg should be 1 mL/ kg/ h. 16 mL of urine output is more than adequate for 1 hour so the nurse should record the output in the chart. There is no reason to notify the primary health care provider regarding adequate urine output. The infant has adequate output so there is no need for a fluid bolus. A fluid bolus could also cause the infant to become fluid overloaded, increasing the workload on the heart. There is no information in the question indicating that the child is hypervolemic.

When assessing a child after heart surgery to correct tetralogy of Fallot, which of the following should alert the nurse to suspect a low cardiac output? 1. Bounding pulses and mottled skin. 2. Altered level of consciousness and thready pulse. 3. Capillary refill of 2 seconds and blood pressure of 96/ 67 mm Hg. 4. Extremities warm to the touch and pale skin.

2. With a low cardiac output and subsequent poor tissue perfusion, signs and symptoms would include pale, cool extremities; cyanosis; weak, thready pulses; delayed capillary refill; and decrease in level of consciousness.

A mother of a toilet-trained 3-year-old expresses concern over her child's bed-wetting while hospitalized. The nurse should tell the mother: 1. "He was too immature to be toilet trained. In a few months he should be old enough." 2. "Children are afraid in the hospital and frequently wet their bed." 3. "It's very common for children to regress when they're in the hospital." 4. "This is normal. He probably received too much fluid the night before."

3. A child will regress to a behavior used in an earlier stage of development in order to cope with a perceived threatening situation. Readiness for toilet training should be based on neurological, physical, and psychological development, not the age of the child. Children are afraid of hospitalization but the bed-wetting is a compensatory mechanism done to regress to a previous stage of development that is more comfortable and secure for the child. Telling the mother that bed-wetting is related to fluid intake does not provide an adequate explanation for the underlying regression to an earlier stage of development.

After teaching a group of parents of preschoolers attending a well-child clinic about oral hygiene and tooth brushing, the nurse determines that the teaching has been successful when the parents state that children can begin to brush their teeth without help at which of the following ages? 1. 3 years. 2. 5 years. 3. 7 years. 4. 9 years.

3. Children younger than 7 years of age do not have the manual dexterity needed for tooth brushing. Therefore, parents need to help with this task until that time.

When assessing the development of a 15-month-old child with cerebral palsy, which of the following milestones should the nurse expect a toddler of this age to have achieved? 1. Walking up steps. 2. Using a spoon. 3. Copying a circle. 4. Putting a block in cup.

4. Delay in achieving developmental milestones is a characteristic of children with cerebral palsy. Ninety percent of 15-month-old children can put a block in a cup. Walking up steps typically is accomplished at 18 to 24 months. A child usually is able to use a spoon at 18 months. The ability to copy a circle is achieved at approximately 3 to 4 years of age.

The nurse observes as a child with Duchenne's muscular dystrophy attempts to rise from a sitting position on the floor. After attaining a kneeling position, the child "walks" his hands up his legs to stand. The nurse documents this as which of the following? 1. Galeazzi's sign. 2. Goodell's sign. 3. Goodenough's sign. 4. Gower's sign.

4. With Gower's sign, the child walks the hands up the legs in an attempt to stand, a common approach used by children with Duchenne's muscular dystrophy when rising from a sitting to a standing position. Galeazzi's sign refers to the shortening of the affected limb in congenital hip dislocation. Goodell's sign refers to the softening of the cervix, considered a sign of probable pregnancy Goodenough's sign refers to a test of mental age.

According to Piaget, magical thinking is the belief that: a. thoughts are all-powerful. b. God is an imaginary friend. c. events have cause and effect. d. if the skin is broken, the insides will come out.

ANS: A Because of their egocentrism and transductive reasoning, preschoolers believe that thoughts are all-powerful. Believing God is an imaginary friend is an example of concrete thinking in a preschooler's spiritual development. Cause-and-effect implies logical thought, not magical thinking. Believing that, if the skin is broken, the insides will come out is an example of concrete thinking in development of body image.

The nurse is caring for a child with suspected ingestion of some type of poison. Which of the following actions should the nurse take next after initiating cardiopulmonary resuscitation (CPR)? a. Empty the mouth of pills, plants, or other material. b. Question the victim and witness. c. Place child in side-lying position. d. Call poison control.

ANS: A Emptying the mouth of any leftover pills, plants, or other ingested material is the next step after assessment and initiation of CPR if needed. Questioning the victim and witnesses, calling poison control, and placing the child in a side-lying position are follow-up steps.

Seventy-two hours after cardiac surgery, a young child has a temperature of 38.4o C (101.1° F). The nurse should do which of the following? a. Report findings to practitioner. b. Apply a hypothermia blanket. c. Keep child warm with blankets. d. Record temperature on assessment flow sheet.

ANS: A In the first 24 to 48 hours after surgery, the body temperature may increase to 37.8° C (100° F) as part of the inflammatory response to tissue trauma. If the temperature is higher or fever continues after this period, it is most likely a sign of an infection, and immediate investigation is indicated. Hypothermia blanket is not indicated for this level of temperature. Blankets should be removed from the child to keep the temperature from increasing. The temperature should be recorded, but the practitioner must be notified for evaluation.

What is the leading cause of death during the toddler period? a. Injuries b. Infectious diseases c. Childhood diseases d. Congenital disorders

ANS: A Injuries are the most common cause of death in children ages 1 through 4 years. It is the highest rate of death from injuries of any childhood age-group except adolescence. Congenital disorders are the second leading cause of death in this age-group. Infectious and childhood diseases are less common causes of death in this age-group.

Parents tell the nurse that their toddler eats little at mealtime, only sits at the table with the family briefly, and wants snacks "all the time." Which of the following should the nurse recommend? a. Give her nutritious snacks. b. Offer rewards for eating at mealtimes. c. Avoid snacks so she is hungry at mealtimes. d. Explain to her in a firm manner what is expected of her.

ANS: A Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirement associated with the slower growth rate. Parents should assist the child in developing healthy eating habits. The toddler is often unable to sit through a meal. Frequent nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should be not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat nonnutritious foods in response. A toddler is not able to understand explanations of what is expected of her and comply with the expectations.

Selective cholesterol screening is recommended for children over the age of 2 years with the following risk factors: a. body mass index (BMI) = 95th percentile. b. blood pressure = 50th percentile. c. parent with a blood cholesterol level of 200 mg/dl. d. recently diagnosed cardiovascular disease in a 75-year-old grandparent.

ANS: A Obesity is an indication for cholesterol screening in children. A BMI in the 95th percentile or higher is considered obese. Children who are hypertensive meet the criteria for screening, but blood pressure in the 50th percentile is within the normal range. A parent or grandparent with a cholesterol level of 240 mg/dl or higher places the child at risk. Early cardiovascular disease in a first- or second-degree relative is a risk factor. Age 75 is not considered early.

Which of the following is descriptive of the nutritional requirements of preschool children? a. Quality of the food consumed is more important than the quantity. b. Average daily intake of preschoolers should be about 3000 calories. c. Nutritional requirements for preschoolers are very different from requirements for toddlers. d. Requirements for calories per unit of body weight increase slightly during the preschool period.

ANS: A Parents need to be reassured that the quality of food eaten is more important than the quantity. Children are able to self-regulate their intake when offered foods high in nutritional value. The average daily caloric intake should be approximately 1800 calories. Toddlers and preschoolers have similar nutritional requirements. There is an overall slight decrease in needed calories and fluids during the preschool period.

Nursing care of the child with Kawasaki disease is challenging because of: a. the child's irritability. b. predictable disease course. c. complex antibiotic therapy. d. the child's ongoing requests for food.

ANS: A Patient irritability is a hallmark of Kawasaki disease and the most challenging problem. A quiet environment is necessary to promote rest. The diagnosis is often difficult to make, and the course of the disease can be unpredictable. Intravenous gamma globulin and salicylates are the therapy of choice, not antibiotics. The child often is reluctant to eat. Soft foods and fluids should be offered to prevent dehydration.

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

ANS: A Simply soaking in the bathtub is usually sufficient for removal of the desquamated skin and sebaceous secretions. Several days may be required 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.

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

ANS: A Soft-tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. The nurse observes for the edema while placing a cold pack. The application of ice can reduce the severity of the injury. Maintaining the ankle at a position elevated above the heart is important. The nurse helps the child be comfortable with this requirement. The nurse obtains parental permission for administration of acetaminophen or aspirin after ice and rest are assured.

A student athlete was injured during a basketball game. The nurse observes significant swelling. The player states he thought he "heard a pop," that the pain is "pretty bad," and the ankle feels "as if it is coming apart." Based on this description, the nurse suspects a: a. sprain. b. fracture. c. dislocation. d. stress fracture.

ANS: A Sprains account for approximately 75% of all ankle injuries in children. A sprain results when the trauma is so severe that a ligament is either stretched or partially or completely torn by the force created as a joint is twisted or wrenched. Joint laxity is the most valid indicator of the severity of a sprain. A fracture involves the cross section of the bone. Dislocations occur when the force of stress on the ligaments disrupts the normal positioning of the bone ends or the bone ends in the socket. Stress fractures result from repeated muscular contraction and are seen most often in sports involving repetitive weight bearing such as running, gymnastics, and basketball.

Which of the following structural defects constitute tetralogy of Fallot? a. Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy b. Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy c. Aortic stenosis, ventricular septal defect, overriding aorta, left ventricular hypertrophy d. Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

ANS: A Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy.

The parents of a 2-year-old tell the nurse they are concerned because the toddler has started to use "baby talk" since the arrival of their new baby. The nurse should recommend which of the following? a. Ignore the baby talk. b. Tell the toddler frequently, "You are a big kid now." c. Explain to the toddler that baby talk is for babies. d. Encourage the toddler to practice more advanced patterns of speech.

ANS: A The baby talk is a sign of regression in the toddler. Often toddlers attempt to cope with a stressful situation by reverting to patterns of behavior that were successful in earlier stages of development. It should be ignored, while praising the child for developmentally appropriate behaviors. Regression is children's way of expressing stress. The parents should not introduce new expectations and allow the child to master the developmental tasks without criticism.

The nurse is discussing with a parent group the importance of fluoride for healthy teeth. Which of the following should the nurse recommend? a. Determine whether water supply is fluoridated. b. Use fluoridated mouth rinses in children older than 1 year. c. Give fluoride supplements to infants beginning at age 2 months. d. Brush teeth with fluoridated toothpaste unless fluoride content of water supply is adequate.

ANS: A The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride and the amount. It is difficult to teach toddlers to spit out the mouthwash. Swallowing fluoridated mouthwashes can contribute to fluorosis. Fluoride supplementation is not recommended until after age 6 months and then only if the water is not fluoridated. Fluoridated toothpaste is still indicated if the fluoride content of the water supply is adequate, but very small amounts are used.

Major goals for the therapeutic management of juvenile idiopathic arthritis (JIA) include: a. control pain; preserve joint function. b. minimize use of joint; achieve cure. c. prevent skin breakdown; relieve symptoms. d. reduce joint discomfort; regain proper alignment.

ANS: A The goals of therapy are to control pain, preserve joint range of motion and function, minimize the effects of inflammation, and promote normal growth and development. There is no cure for JIA at this time. Skin breakdown is not an issue for most children with JIA. Symptom relief and reduction in discomfort are important. Once the joints are damaged, it is often irreversible.

Which of the following is described as the time interval between infection or exposure to disease and appearance of initial symptoms? a. Incubation period b. Prodromal period c. Desquamation period d. Period of communicability

ANS: A The incubation period is the interval between infection or exposure and appearance of symptoms. The prodromal period is the interval between the appearance of early manifestations of disease and evidence of the overt clinical syndrome. Desquamation refers to the shedding of skin. The period of communicability is time or times during which an infectious agent may be transferred directly or indirectly from an infected person to another person.

The parent of 16-month-old Brian asks, "What is the best way to keep Brian from getting into our medicines at home?" The nurse should advise which of the following? a. "All medicines should be locked securely away." b. "The medicines should be placed in high cabinets." c. "Brian just needs to be taught not to touch medicines." d. "Medicines should not be kept in the homes of small children."

ANS: A The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe. Toddlers can climb using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize that all the different forms of medications in the home may be dangerous. Keeping medicines out of the homes of small children is not feasible. Many parents require medications for chronic or acute illnesses. Parents must be taught safe storage for their home and when they visit other homes.

The primary nursing intervention to prevent bacterial endocarditis is which of the following? a. Counsel parents of high-risk children. b. Institute measures to prevent dental procedures. c. Encourage restricted mobility in susceptible children. d. Observe children for complications, such as embolism and heart failure.

ANS: A The objective of nursing care is to counsel the parents of high-risk children about the need for both prophylactic antibiotics for dental procedures and maintaining excellent oral health. The child's dentist should be aware of the child's cardiac condition. Dental procedures should be done to maintain a high level of oral health. Restricted mobility in susceptible children is not indicated. Parents are taught to observe for unexplained fever, weight loss, or change in behavior.

An infant age 4 months comes to the clinic for a well-infant check-up. Immunizations she should receive are DTaP (diphtheria, tetanus, acellular pertussis) and IPV (inactivated poliovirus vaccine). She is recovering from a cold but is otherwise healthy and afebrile. Her older sister has cancer and is receiving chemotherapy. Nursing considerations include which of the following? a. DTaP and IPV can be safely given. b. DTaP and IPV are contraindicated because she has a cold. c. IPV is contraindicated because her sister is immunocompromised. d. DTaP and IPV are contraindicated because her sister is immunocompromised.

ANS: A These immunizations can be given safely. Serious illness is a contraindication. A mild illness with or without fever is not a contraindication. These are not live vaccines so they do not pose a risk to her sister.

A parent of an 18-month-old boy tells the nurse that he says "no" to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurse's best interpretation of this behavior is which of the following? a. This is normal behavior for his age. b. This is unusual behavior for his age. c. He is not effectively coping with stress. d. He is showing he needs more attention.

ANS: A Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and use of the word "no." Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old.

Which of the following statements is correct about young children who report sexual abuse? a. They may exhibit various behavioral manifestations. b. In more than half the cases the child has fabricated the story. c. Their stories should not be believed unless other evidence is apparent. d. They should be able to retell the story the same way to another person.

ANS: A Victims of sexual abuse have no typical profile. The child may exhibit various behavioral manifestations, none of which is diagnostic for sexual abuse. When children report potentially sexually abusive experiences, their reports need to be taken seriously. Other children in the household also need to be evaluated. In children who are sexually abused, it is often difficult to identify other evidence. In one study, approximately 96% of children who were sexually abused had normal genital and anal findings. The ability to retell the story is partly dependent on the child's cognitive level. Children who repeatedly tell identical stories may have been coached.

Which of the following measures is important in managing hypercalcemia in a child who is immobilized? a. Provide adequate hydration. b. Change position frequently. c. Encourage diet high in calcium. d. Provide diet high in calories for healing.

ANS: A Vigorous hydration is indicated to prevent problems with hypercalcemia. Suggested intake for an adolescent is 3000 to 4000 ml/day of fluids. Diuretics are used to promote the removal of calcium. Changing position is important for skin and respiratory concerns. Calcium in the diet is restricted when possible. A high-protein diet served as frequent snacks with favored foods is recommended. A high-calorie diet without adequate protein will not promote healing.

In teaching a 16-year-old adolescent who was recently diagnosed with systemic lupus erythematosus (SLE), which of the following statements should the nurse include? Select all that apply. a. "You should use a moisturizer with a sun protection factor (SPF) of 30." b. "You should avoid pregnancy, since this can cause a flare up." c. "You should not receive any immunizations in the future." d. "You may need to be on a low-protein, high-carbohydrate diet." e. "You should expect to lose weight while taking steroids." f. "You may need to modify your daily recreational activities."

ANS: A, B, F Teaching an adolescent with SLE should foster adaptation and self-advocacy and includes using a moisturizer with an SPF of 30, avoiding pregnancy since it can produce a flare up, and modifying recreational activities but continuing with daily exercise as an essential part of the treatment plan. The adolescent should continue to receive immunizations as scheduled, should expect to gain weight while on steroid therapy, and would not have a specialized diet.

The nurse is precepting a new graduate nurse at an ambulatory pediatric hematology/oncology clinic. Which of the following cardinal signs of cancer in children should the nurse make the new nurse aware of? Select all that apply. a. Sudden tendency to bruise easily b. Transitory, generalized pain c. Frequent headaches d. Excessive, rapid weight gain e. Gradual, steady fever f. Unexplained loss of energy

ANS: A, C, F The cardinal signs of cancer in children include a sudden tendency to bruise easily; frequent headaches, often with vomiting; and an unexplained loss of energy. Other cardinal signs include persistent, localized pain; excessive, rapid weight loss; and a prolonged, unexplained fever.

The nurse is caring for a child with a suspected diagnosis of erythema infectiosum. Which of the following clinical manifestations would the nurse expect to observe? Select all that apply. a. Slapped face appearance b. Discrete rose-pink macules c. High-pitched cough d. Koplik spots e. Maculopapular red spots

ANS: A, E Clinical manifestations associated with erythema infectiosum, or fifth disease, include a slapped face appearance and maculopapular spots. Discrete rose-pink macules are associated with exanthem subitum (roseola infantum); a high-pitched cough is associated with pertussis; and Koplik spots are a clinical manifestation of measles (rubeola).

Which of the following is a person or animal that harbors an infectious agent without apparent clinical disease and serves as a potential source of infection? a. Host b. Carrier c. Contact d. Reservoir

ANS: B A carrier harbors the infectious agent without apparent clinical disease and serves as a potential source of infection. The host is defined as a person, or other living animal, that affords subsistence to an infectious agent under natural conditions. A contact is someone who has been in contact with an infected person or animal or a contaminated environment that may provide an infectious agent. The reservoir is the environment in which an infectious agent lives and multiplies and on which it depends for survival. Humans are the most common reservoir of infections that are capable of producing disease in other humans.

The nurse is caring for a hospitalized 4-year-old boy. His parents tell the nurse they will be back to visit at 6 PM. When he asks the nurse when his parents are coming, the nurse's best response would be which of the following? a. "They will be here soon." b. "They will come after dinner." c. "Let me show you on the clock when 6 PM is." d. "I will tell you every time I see you how much longer it will be."

ANS: B A 4-year-old understands time in relation to events such as meals. Children perceive "soon" as a very short time. The nurse may lose the child's trust if his parents do not return in the time he perceives as "soon." Children cannot read or use a clock for practical purposes until age 7 years. "I will tell you every time I see you how much longer it will be" assumes the child understands the concepts of hours and minutes, which does not occur until age 5 or 6 years.

The nurse is caring for a 6-year-old child with acute lymphoblastic leukemia (ALL). The parent states, "My child has a low platelet count and we are being discharged this afternoon. What do I need to do at home?" Which of the following statements would be most appropriate for the nurse to make? a. "You should give your child aspirin instead of acetaminophen for fever or pain." b. "Your child should avoid contact sports or activities that could cause bleeding." c. "You should feed your child bland, soft, moist diet for the next week." d. "Your child should avoid large groups of people for the next week."

ANS: B A child with a low platelet count needs to avoid activities that could cause bleeding such as playing contact sports, climbing trees, using playground equipment, or bike riding. The child should be given acetaminophen, not aspirin, for fever or pain; the child does not need to be on a soft, bland diet or avoid large groups of people because of the low platelet count.

The nurse stops to assist an adolescent who has experienced severe trauma when hit by a motorcycle. The emergency medical system (EMS) has been activated. The first person who provided assistance applied a tourniquet to the child's leg because of arterial bleeding. The nurse should do which of the following related to the tourniquet? a. Loosen the tourniquet. b. Leave the tourniquet in place. c. Remove the tourniquet and apply direct pressure if bleeding is still present. d. Remove the tourniquet every 5 minutes, leaving it off for 30 seconds each time.

ANS: B A tourniquet is applied only as a last resort, and then it is left in place and not loosened until definitive treatment is available. Once the tourniquet is applied, skin and tissue necrosis occur below the site. Loosening or removing the tourniquet allows toxins from the tissue necrosis to be released into the circulation. This can induce systemic, deadly tourniquet shock.

The single parent of a child who has just been diagnosed with chickenpox tells the nurse that she cannot afford to stay home with the child and miss work. The parent asks the nurse if some medication will shorten the course of the illness. Which of the following is the most appropriate nursing intervention? a. Describe the role of varicella-zoster immune globulin to treat chickenpox. b. Discuss the risks and benefits of acyclovir to treat chickenpox. c. Explain that no medication will shorten the course of the illness. d. Reassure the parent that it is not necessary to stay home with the child.

ANS: B Acyclovir is effective in reducing the number of lesions; shortening the duration of fever; and decreasing itching, lethargy, and anorexia. Varicella-zoster immune globulin is given only to high-risk children. Acyclovir lessens the severity of chickenpox. It is important for the parent to stay with the child to monitor fever.

The middle school nurse is speaking to parents about prevention of injuries as a goal of the physical education program. This is accomplished through: a. use of protective equipment at the family's discretion. b. education of adults to recognize signs that indicate a risk for injury. c. sports medicine program to help student-athletes work through overuse injuries. d. arrangements for multiple sports to use same athletic fields to accommodate more children.

ANS: B Adults close to sports activities need to be aware of the early warning signs of fatigue, dehydration, and risk for injury. School policy should require mandatory use of protective equipment. Proper sports medicine therapy does not support "working through" overuse injuries. Too many students involved in different activities create distractions, which contribute to the child losing focus. This is a contributing factor to injury.

An awake, alert 4-year-old child has just arrived at the emergency department after an ingestion of aspirin at home. The practitioner has ordered activated charcoal. The nurse administers charcoal in the following manner: a. give half of the solution, and then repeat the other half in 1 hour. b. mix with a flavorful beverage in an opaque container with a straw. c. serve in a clear plastic cup so the child can see how much has been drunk. d. administer through a nasogastric tube, since the child will not drink it because of the taste.

ANS: B Although the activated charcoal can be mixed with a flavorful sugar-free beverage, it will be black and resemble mud. When it is served in an opaque container, the child will not have any preconceived ideas about its being distasteful. The ability to see the charcoal solution may affect the child's desire to drink the solution. The child should be encouraged to drink the solution all at once. The nasogastric tube would be traumatic. It should be used only in children who cannot be cooperative or those without a gag reflex.

A toddler's parents have been using a rear-facing convertible car seat since she was born. The seat can be safely switched to the forward-facing position when she weighs how many pounds? a. 10 b. 20 c. 30 d. 40

ANS: B Although the transition point for switching to the forward-facing position is defined by the manufacturer, it is generally at 9 kg (20 lb); 4.5 kg (10 lb) is too small to be safe. Because of the relatively large head, this size child should be in the rear-facing position. It is usually safe to put children who weigh more than 20 lb in forward-facing convertible safety seats.

An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a functional prosthetic device? a. As soon as possible after birth b. When the infant is developmentally ready to stand up c. At about ages 12 to 15 months, when most children are walking d. At about 4 years, when the healthy limb is not growing so rapidly

ANS: B An infant should be fitted with a functional prosthetic leg when the infant is developmentally ready to pull to a standing position. When the infant begins limb exploration, a soft prosthesis can be used. The child should begin using the prosthesis as part of his or her normal development. This will match the infant's motor readiness.

A cardiac defect that allows blood to shunt from the (high pressure) left side of the heart to the (lower pressure) right side can result in: a. cyanosis. b. congestive heart failure. c. decreased pulmonary blood flow. d. bounding pulses in upper extremities.

ANS: B As blood is shunted into the right side of the heart, there is increased pulmonary blood flow and the child is at high risk for congestive heart failure. Cyanosis usually occurs in defects with decreased pulmonary blood flow. Bounding upper extremity pulses are a manifestation of coarctation of the aorta.

The nurse should recognize that congestive heart failure (CHF) is which of the following? a. Disease related to cardiac defects b. Consequence of an underlying cardiac defect c. Inherited disorder associated with a variety of defects d. Result of diminished workload imposed on an abnormal myocardium

ANS: B CHF is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the body's metabolic demands. CHF is not a disease but rather a result of the inability of the heart to pump efficiently. CHF is not inherited. CHF occurs most frequently secondary to congenital heart defects in which structural abnormalities result in increased volume load or increased pressures on the ventricles.

Which of the following drugs is an angiotensin-converting enzyme (ACE) inhibitor? a. Furosemide (Lasix) b. Captopril (Capoten) c. Chlorothiazide (Diuril) d. Spironolactone (Aldactone)

ANS: B Captopril is an ACE inhibitor. Furosemide is a loop diuretic. Chlorothiazide works on the distal tubules. Spironolactone blocks the action of aldosterone and is a potassium-sparing diuretic.

Which of the following is the most common form of child maltreatment? a. Sexual abuse b. Child neglect c. Physical abuse d. Emotional abuse

ANS: B Child neglect, which is characterized by the failure to provide for the child's basic needs, is the most common form of child maltreatment. Sexual abuse, physical abuse, and emotional abuse are individually not as common as neglect.

The parents of a 7-year-old boy tell the nurse that lately he has been cruel to their family pets and actually caused physical harm. The nurse's recommendations should be based on knowledge that this is: a. expected behavior at this age. b. a warning sign of a serious problem. c. harmless venting of anger and frustration. d. common in children who are physically abused.

ANS: B Cruelty to family pets is not an expected behavior. Hurting animals can be one of the earliest symptoms of a conduct disorder. Abusing animals does not dissipate violent emotions; rather the acts may fuel the abusive behaviors. Referral for evaluation is essential. This behavior may be seen in emotional abuse or neglect, not physical abuse

The nurse is giving discharge instructions to the parent of a 6-year-old who had a cardiac catheterization 4 hours ago. Which of the following statements by the parent would indicate a correct understanding of the teaching? a. "My child should not attend school for the next 5 days." b. "I should change the bandage every day for the next 2 days." c. "My child can take a tub bath but should avoid taking a shower for the next 4 days." d. "I should expect the site to be red and swollen for the next 3 days."

ANS: B Discharge instructions for a parent of a child who recently had a cardiac catheterization should include changing the bandage every day for the next 2 days. The child should avoid strenuous exercise but can go back to school. The child should avoid a tub bath, but an older child could take a shower the first day after the catheterization. The site should not have swelling or redness; if there is, it should be reported to the health care practitioner.

Which of the following is characteristic of fractures in children? a. Fractures rarely occur at the growth plate site because it absorbs shock well. b. Rapidity of healing is inversely related to the child's age. c. Pliable bones of growing children are less porous than those of adults. d. Periosteum of a child's bone is thinner, is weaker, and has less osteogenic potential compared with the adult.

ANS: B Healing is more rapid in children. The younger the child, the more rapid the healing process. Nonunion of bone fragments is uncommon except in severe injuries. The epiphyseal plate is the weakest point of long bones and a frequent site of injury during trauma. Children's bones are more pliable and porous than those of adults. This allows them to bend, buckle, and break. The greater porosity increases the flexibility of the bone and dissipates and absorbs a significant amount of the force on impact. The adult periosteum is thinner, is weaker, and has less osteogenic potential than that of a child.

Which of the following is a clinical manifestation of acetaminophen poisoning? a. Hyperpyrexia b. Hepatic involvement c. Severe burning pain in stomach d. Drooling and inability to clear secretions

ANS: B Hepatic involvement is the third stage of acetaminophen poisoning. Hyperpyrexia is a severe elevation in body temperature and is not related to acetaminophen poisoning. Acetaminophen does not cause burning pain in stomach and does not pose an airway threat.

A 2-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which of the following? a. 60 beats/min b. 90 beats/min c. 100 beats/min d. 120 beats/min

ANS: B If a 1-minute apical pulse is less than 90 beats/min for an infant or young child, the digoxin is withheld. Sixty beats/min is the cut-off for holding the digoxin dose in an adult. One hundred to 120 beats/min is an acceptable pulse rate for the administration of digoxin.

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

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

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes the risk of cerebrovascular accidents (strokes) occurring. Which of the following is an important objective to decrease this risk? a. Minimize seizures. b. Prevent dehydration. c. Promote cardiac output. d. Reduce energy expenditure.

ANS: B In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes. Minimizing seizures, promoting cardiac output, and reducing energy expenditure will not reduce the risk of cerebrovascular accidents.

The parent of a 4-year-old boy tells the nurse that the child believes "monsters and bogeymen" are in his bedroom at night. The nurse's best suggestion for coping with this problem is which of the following? a. Let the child sleep with his parents. b. Keep a night light on in the child's bedroom. c. Help the child understand that these fears are illogical. d. Tell the child that monsters and bogeymen do not exist.

ANS: B Involve the child in problem solving. A night light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with parents will not get rid of the fears. A 4-year-old is in the preconceptual stage and cannot understand logical thought.

In terms of cognitive development, the 5-year-old child would be expected to do which of the following? a. Think abstractly. b. Use magical thinking. c. Understand conservation of matter. d. Understand another person's perspective.

ANS: B Magical thinking is believing that thoughts can cause events. An example would be that thinking of the death of a parent might cause it to happen. Abstract thought does not develop until school-age years. The concept of conservation is the cognitive task of school-age children, ages 5 to 7 years. A five-year-old child cannot understand another's perspective.

Which of the following statements is true concerning osteogenesis imperfecta (OI)? a. It is easily treated. b. It is an inherited disorder. c. Braces and exercises are of no therapeutic value. d. Later-onset disease usually runs a more difficult course.

ANS: B OI is a heterogeneous, autosomal dominant disorder characterized by fractures and bone deformity. Treatment is primarily supportive. Several investigational therapies are being evaluated. Primary goal of therapy is rehabilitation. Lightweight braces and splints help support limbs, prevent fractures, and aid in ambulation. The disease is present at birth. Prognosis is affected by the type of OI.

Which of the following is a major clinical manifestation of rheumatic fever (RF)? a. Fever b. Polyarthritis c. Osler nodes d. Janeway spots

ANS: B Polyarthritis, which is swollen, hot, red, and painful joints, is a major clinical manifestation. The affected joints will change every 1 or 2 days. Primarily the large joints are affected. Fever is considered a minor manifestation of RF. Osler nodes and Janeway spots are characteristic of bacterial endocarditis.

John is a 6-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be which of the following? a. Directed at his parents because he is too young to understand b. Adapted to his level of development so that he can understand c. Done several days before the procedure so he will be prepared d. Provide details about the actual procedures so he will know what to expect

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

A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was "bad." Which of the following is the nurse's best interpretation of this comment? a. Sign of stress b. Common at this age c. Suggestive of maladaptation d. Suggestive of excessive discipline at home

ANS: B Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think they are directly responsible for events, making them feel guilt for things outside of their control. Children of this age react to stress by regressing developmentally or acting out. Maladaptation is unlikely. This comment does not imply excessive discipline at home.

Which of the following is an appropriate recommendation in preventing tooth decay in young children? a. Substitute raisins for candy. b. Substitute sugarless gum for regular gum. c. Use honey or molasses instead of refined sugar. d. When sweets are to be eaten, select a time not during meals.

ANS: B Regular gum has high sugar content. When the child chews gum, the sugar is in prolonged contact with the teeth. Sugarless gum is less cariogenic than regular gum. Raisins, honey, and molasses are highly cariogenic and should be avoided. Sweets should be consumed with meals so that the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth.

An essential role of the school nurse regarding communicable diseases is: a. regularly screening for communicable diseases. b. notifying families about outbreaks. c. maintaining isolation procedures in the school. d. diagnosing and treating children with communicable disease.

ANS: B School nurses are responsible for warning parents about recent outbreaks of communicable diseases to prevent susceptible children's exposure to known cases. The nurse should have a high degree of suspicion for children with symptoms such as rashes and sore throats. Regular screenings would be time-consuming and would not likely identify many cases. It is not practical for certain types of isolation to be implemented in the school environment. Persons with diseases such as chickenpox that are spread through the airborne route should not be in school. The school nurse should identify likely cases and refer for diagnosis and treatment.

A significant secondary prevention nursing activity for lead poisoning is: a. chelation therapy. b. screening children for blood lead levels. c. removing lead-based paint from older homes. d. questioning parents about ethnic remedies containing lead.

ANS: B Screening children for lead poisoning is an important secondary prevention activity. Screening does not prevent the initial exposure of the child to lead. It can lead to identification and treatment of children who are exposed. Chelation therapy is treatment, not prevention. Removing lead-based paints from older homes before children are affected is primary prevention. Questioning parents about ethnic remedies containing lead is part of the assessment to determine the potential source of lead.

A 3-month-old infant dies shortly after arrival to the emergency department. The infant has subdural and retinal hemorrhages but no external signs of trauma. The nurse should suspect: a. unintentional injury. b. shaken baby syndrome. c. congenital neurologic problem. d. sudden infant death syndrome (SIDS).

ANS: B Shaken baby syndrome causes internal bleeding but may have no external signs. Unintentional injury would not cause these injuries. With unintentional injuries, external signs are usually present. Congenital neurologic problems would usually have signs of abnormal neurologic anatomy. SIDS does not usually have identifiable injuries.

The nurse is teaching the parent of a 4-year-old with a cast on the arm about care at home. Which of the following statement by the parent would indicate a correct understanding of the teaching? a. "I should have the affected limb hang in a dependent position." b. "I will use an ice pack to relieve the itching." c. "I should avoid keeping the injured arm elevated." d. "I will expect the fingers to be swollen for the next 3 days."

ANS: B Teaching the parent to use an ice pack to relieve the itching is an important aspect when planning discharge for a child with a cast. The affected limb should not be allowed to hang in a dependent position for more than 30 minutes. The affected arm should be kept elevated as much as possible. If there is swelling or redness of the fingers, the parent should notify the health care provider.

A 4-year-old is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses the skin of his right foot and sees that it is pale with an absence of pulse. What should the nurse do first? a. Reposition the child and notify practitioner. b. Notify the practitioner of the changes noted. c. Give the child medication to relieve the pain. d. Chart the observations and check the extremity again in 15 minutes.

ANS: B The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner. This is an emergency condition. Pain medication should be given after the practitioner is notified. The findings should be documented with ongoing assessment.

Which of the following should the nurse consider when preparing a school-age child and the family for heart surgery? a. Unfamiliar equipment should not be shown. b. Let child hear the sounds of a cardiac monitor, including alarms. c. Explain that an endotracheal tube will not be needed if the surgery goes well. d. Discussion of postoperative discomfort and interventions is not necessary before the procedure.

ANS: B The child and family should be exposed to the sights and sounds of the intensive care unit (ICU). All positive, nonfrightening aspects of the environment are emphasized. The family and child should make the decision about a tour of the unit if it is an option. The child should be shown unfamiliar equipment and its use demonstrated on a doll. Carefully prepare the child for the postoperative experience, including intravenous lines, incision, endotracheal tube, expected discomfort, and management strategies.

Which muscle is contraindicated for the administration of immunizations in infants and young children? a. Deltoid b. Dorsogluteal c. Ventrogluteal d. Anterolateral thigh

ANS: B The dorsogluteal site is avoided in children because of the location of nerves and veins. The deltoid is recommended for 12 months and older. Ventrogluteal and anterolateral thigh sites can safely be used for the administration of vaccines to infants.

A 7-year-old has just had a cast applied for a fractured arm with the wrist and elbow immobilized. Which of the following should be included in the home care instructions? a. No restrictions of activity are indicated. b. Elevate casted arm when both upright and resting. c. The shoulder should be kept as immobile as possible to avoid pain. d. Swelling of the fingers is to be expected. Notify a health professional if it persists more than 48 hours.

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

Ventricular septal defect has the following blood flow pattern: a. Mixed blood flow b. Increased pulmonary blood flow c. Decreased pulmonary blood flow d. Obstruction to blood flow from ventricles

ANS: B The opening in the septal wall allows for blood to flow from the higher pressure left ventricle into the lower pressure right ventricle. This left-to-right shunt creates increased pulmonary blood flow. The shunt is one way, from high pressure to lower pressure; oxygenated and unoxygenated blood do not mix. The outflow of blood from the ventricles is not affected by the septal defect.

Which of the following is the leading cause of death after heart transplantation? a. Infection b. Rejection c. Cardiomyopathy d. Congestive heart failure

ANS: B The posttransplant course is complex. The leading cause of death after cardiac transplant is rejection. Infection is a continued risk secondary to the immunosuppression necessary to prevent rejection. Cardiomyopathy is one of the indications for cardiac transplant. Congestive heart failure is not a leading cause of death.

The nurse notices that a child is increasingly apprehensive and has tachycardia after heart surgery. The chest tube drainage is now 8 ml/kg/hr. Which of the following should be the nurse's initial intervention? a. Apply warming blankets. b. Notify the practitioner of these findings. c. Give additional pain medication per protocol. d. Encourage child to cough, turn, and deep breathe.

ANS: B The practitioner is notified immediately. Increases of chest tube drainage to more than 3 ml/kg/hr for more than 3 consecutive hours or 5 to 10 ml/kg in any 1 hour may indicate postoperative hemorrhage. Increased chest tube drainage with apprehensiveness and tachycardia may indicate cardiac tamponade—blood or fluid in the pericardial space constricting the heart—which is a life-threatening complication. Warming blankets are not indicated at this time. Additional pain medication can be given before the practitioner drains the fluid, but the notification is the first action. Encouraging the child to cough, turn, and deep breathe should be deferred until after evaluation by the practitioner.

A child age 4 1/2 years sometimes wakes her parents up at night screaming, thrashing, sweating, and apparently frightened. Yet she is not aware of her parents' presence when they check on her. She lies down and sleeps without any parental intervention. This is most likely which of the following? a. Nightmare b. Sleep terror c. Sleep apnea d. Seizure activity

ANS: B This is a description of a sleep terror. The child is observed during the episode and not disturbed unless there is a possibility of injury. A child who awakes from a nightmare is distressed. She is aware of and reassured by the parent's presence. This is not the case with sleep apnea. This behavior is not indicative of seizure activity.

In terms of fine motor development, what could the 3-year-old child be expected to do? a. Tie shoelaces. b. Copy (draw) a circle. c. Use scissors or a pencil very well. d. Draw a person with seven to nine parts.

ANS: B Three-year-olds are able to accomplish this fine motor skill of copying (drawing) a circle. The ability to tie shoelaces, to use scissors or a pencil very well, and to draw a person with seven to nine parts are fine motor skills of 5-year-olds.

Parents tell the nurse they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. Which of the following is the most appropriate recommendation for the nurse to make? a. Punish children so this behavior stops. b. Neither condone nor condemn the curiosity. c. Get counseling for this unusual and dangerous behavior. d. Allow children unrestricted permission to satisfy this curiosity.

ANS: B Three-year-olds become aware of anatomic differences and are concerned about how the other sex "works." Such exploration should not be condoned or condemned. Children should not be punished for this normal exploration. This is age appropriate and not dangerous behavior. Encouraging the children to ask their parents questions and redirecting their activity is more appropriate than giving permission.

Which of the following is an important nursing consideration when caring for a child with herpetic gingivostomatitis (HGS)? a. Drink from a cup, not a straw. b. Apply topical anesthetics before eating. c. Wait to brush teeth until lesions are sufficiently healed. d. Explain to parents how this is sexually transmitted.

ANS: B Treatment for HGS is aimed at relief of pain. Topical anesthetics are useful for children who can keep 1 tsp of liquid in their mouth for 2 to 3 minutes, then expectorate. Drinking bland fluids through a straw helps avoid painful lesions. This will not help with foods. Mouth care is encouraged with a soft toothbrush. HGS is usually caused by herpes simplex virus type 1, which is not associated with sexual transmission.

A father calls the clinic because he found his young daughter squirting Visine eye drops into her mouth. Which of the following is the most appropriate nursing action? a. Reassure the father that Visine is harmless. b. Direct him to seek immediate medical treatment. c. Recommend inducing vomiting with ipecac. d. Advise him to dilute Visine by giving his daughter several glasses of water to drink.

ANS: B Visine is a sympathomimetic and if ingested may cause serious consequences. Medical treatment is necessary. Inducing vomiting is no longer recommended for ingestions. Dilution will not decrease risk.

Which of the following statements is correct about toilet training? a. Bladder training is usually accomplished before bowel training. b. Wanting to please the parent helps motivate the child to use the toilet. c. Watching older siblings use the toilet confuses the child. d. Children must be forced to sit on the toilet when first learning.

ANS: B Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please parent by holding on rather than pleasing self by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

Which of the following is a common sign of digoxin toxicity? a. Seizures b. Vomiting c. Bradypnea d. Tachycardia

ANS: B Vomiting is a common sign of digoxin toxicity and is often unrelated to feedings. Seizures are not associated with digoxin toxicity. The child will have a slower (not faster) heart rate but not a slower respiratory rate.

The recommended drink for athletes during practice and competition is: a. sports drinks to replace carbohydrates. b. cold water for gastrointestinal tract rapid absorption. c. carbonated beverages to help with acid-base balance. d. enhanced performance carbohydrate-electrolyte drinks.

ANS: B Water is recommended for most athletes, who should drink 4 to 8 oz every 15 to 20 minutes. Cold water facilitates rapid gastric emptying and intestinal absorption. Most carbohydrate sports drinks have 6% to 8% carbohydrate, which can cause gastrointestinal upset. Carbonated beverages are discouraged. There is no evidence that these drinks enhance function.

The mother of an infant tells the nurse that sometimes there is a whitish "glow" in the pupil of his eye. The nurse should suspect which of the following? a. Brain tumor b. Retinoblastoma c. Neuroblastoma d. Rhabdomyosarcoma

ANS: B When the nurse examines the eye, the light will reflect off of the tumor, giving the eye a whitish appearance. This is called a cat's eye reflex. Brain tumors are not usually visible. Neuroblastoma usually arises from the adrenal medulla and sympathetic nervous system. Most common presentation sites are in the abdomen, head, neck, or pelvis. Supraorbital ecchymosis may be present with distant metastasis. Rhabdomyosarcoma is a soft tissue tumor that derives from skeletal muscle undifferentiated cells.

The nurse is caring for a child with Kawasaki disease in the acute phase. Which of the following clinical manifestations would the nurse expect to observe? Select all that apply. a. Osler nodes b. Cervical lymphadenopathy c. Strawberry tongue d. Chorea e. Erythematous palms f. Polyarthritis

ANS: B, C, E Clinical manifestations of Kawasaki disease in the acute phase include cervical lymphadenopathy, a strawberry tongue, and erythematous palms. Osler nodes are a clinical manifestation of endocarditis. Chorea and polyarthritis are seen in rheumatic fever.

Which if the following developmental achievements are demonstrated by a 4-year-old child? Select all that apply. a. Cares for self totally b. Throws a ball overhead c. Has a vocabulary of 1500 words d. Can skip and hop on alternate feet e. Tends to be selfish and impatient f. Commonly has an imaginary playmate

ANS: B, C, E, F Developmental achievements for a 4-year-old include throwing a ball overhead, having a vocabulary of 1500 words, tending to be selfish and impatient, and perhaps having an imaginary playmate. Caring for self totally and skipping and hopping on alternate feet are achievements normally seen in the 5-year-old age-group.

During a well-child visit the father of a 4-year-old boy tells the nurse that he is not sure if his son is ready for kindergarten. The boy's birthday is close to the cut-off date, and he has not attended preschool. Which of the following is the nurse's best recommendation? a. Start kindergarten. b. Observe a kindergarten class. c. Perform developmental screening. d. Postpone kindergarten and go to preschool.

ANS: C A developmental assessment with a screening tool that addresses cognitive, social, and physical milestones can help identify children who may need further assessment. A readiness assessment involves an evaluation of skill acquisition. Stating the child should start kindergarten or go to preschool and postpone kindergarten does not address the father's concerns about readiness for school. Observation of a class will provide information about what happens during the day. The father can use this to help determine if his son is ready.

The nurse is talking to the parent of a 5-year-old child who refuses to go to sleep at night. Which of the following interventions should the nurse suggest in helping the parent to cope with this sleep disturbance? a. Establish a consistent punishment if the child does not go to bed when told. b. Allow child to fall asleep in a different room, then gently move the child to his or her bed. c. Establish limited rituals that signal readiness for bedtime. d. Allow the child to watch television until almost asleep.

ANS: C An appropriate intervention for a child who resists going to bed is to establish limited rituals such as a bath or story that signal readiness for bed and consistently follow through with the ritual. Punishing the child will not alleviate the resistance problem and may only add to the frustration. Allowing the child to fall asleep in a different room or to watch television to fall asleep is not a recommended approach to sleep resistance.

Vitamin A supplementation is recommended for the young child who has which of the following? a. Mumps b. Rubella c. Measles (rubeola) d. Erythema infectiosum

ANS: C Evidence shows vitamin A decreases morbidity and mortality in measles. Mumps is treated with analgesics for pain and antipyretics for fever. Rubella and erythema infectiosum are treated similarly to mumps.

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

ANS: C Idiopathic scoliosis is most noticeable during the preadolescent growth spurt. It is seldom apparent before age 10 years.

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

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

The nurse finds that a 6-month-old infant has an apical pulse of 166 beats/min during sleep. The nurse should do which of the following? a. Administer oxygen. b. Record data on nurses' notes. c. Report data to the practitioner. d. Place child in high Fowler position.

ANS: C One of the earliest signs of CHF is tachycardia (sleeping heart rate >160 beats/min) as a direct result of sympathetic stimulation. The practitioner needs to be notified for evaluation of possible CHF. Although oxygen or a semiupright position may be indicated, the first action is to report the data to the practitioner.

Which of the following is the primary method of treating osteomyelitis? a. Joint replacement b. Bracing and casting c. Intravenous antibiotic therapy d. Long-term corticosteroid therapy

ANS: C 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 corticosteroid therapy are not indicated for infectious processes.

The nurse uses the five Ps to assess ischemia in a child with a fracture. Which of the following findings is considered a late and ominous sign? a. Petaling b. Posturing c. Paresthesia d. Positioning

ANS: C Paresthesia distal to the injury or cast is an ominous sign that requires immediate notification of the practitioner. Permanent muscle and tissue damage can occur within 6 hours. The other signs of ischemia that need to be reported are pain, pallor, pulselessness, and paralysis. Petaling is a method of placing protective or smooth edges on a cast. Posturing is not a sign of peripheral ischemia. Finding a position of comfort can be difficult with a fracture. It would not be an ominous sign unless pain was increasing or uncontrollable.

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.

ANS: C Serial casting is begun shortly after birth before discharge from nursery. Successive casts allow 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. Serial casting is the preferred treatment. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention.

The nurse is teaching the girls' varsity sports teams about the "female athlete triad." Essential information to include is: a. they should take low to moderate calcium to avoid hypercalcemia. b. they have strong bones because of the athletic training. c. pregnancy can occur in the absence of menstruation. d. a diet high in carbohydrates accommodates increased training.

ANS: C Sexually active teenagers, regardless of menstrual status, need to consider contraceptive precautions. Increased calcium (1500 mg) is recommended for amenorrheic athletes. The decreased estrogen in girls with the female athlete triad, coupled with potentially inadequate diet, leads to osteoporosis. Diets high in protein and calories are necessary to avoid potentially long-term consequences of intensive, prolonged exercise programs in pubertal girls.

Which one of the following dysfunctional speech patterns is a normal characteristic of the language development of a preschool child? a. Lisp b. Echolalia c. Stammering d. Repetition without meaning

ANS: C Stammering and stuttering are normal dysfluency in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers' language.

A 17-month-old child would be expected to be in what stage, according to Piaget? a. Preoperations b. Concrete operations c. Tertiary circular reaction d. Secondary circular reaction

ANS: C The 17-month-old is in the fifth stage of the sensorimotor phase, tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Preoperations is the stage of cognitive development usually present in older toddlers and preschoolers. Concrete operations is the cognitive stage associated with the school-age child. Secondary circular reaction stage lasts from about ages 4 to 8 months.

The developmental task with which the child of 15 to 30 months is likely to be struggling is a sense of what? a. Trust b. Initiative c. Intimacy d. Autonomy

ANS: D Autonomy versus shame and doubt is the developmental task of toddlers. Trust versus mistrust is the developmental stage of infancy. Initiative versus guilt is the developmental stage of early childhood. Intimacy and solidarity versus isolation is the developmental stage of early adulthood.

The nurse suspects that a child has ingested some type of poison. Which of the following clinical manifestations would be most suggestive that the poison was a corrosive product? a. Tinnitus b. Disorientation c. Stupor, lethargy, coma d. Edema of lips, tongue, pharynx

ANS: D Edema of lips, tongue, and pharynx indicates a corrosive ingestion. Tinnitus is indicative of aspirin ingestion. Corrosives do not act on the central nervous system.

Which of the following types of drugs reduces hypertension by interfering with the production of angiotensin II? a. Diuretics b. Vasodilators c. Beta blockers d. Angiotensin-converting enzyme (ACE) inhibitors

ANS: D ACE inhibitors act by interfering with the production of angiotensin II, which is a potent vasoconstrictor. Diuretics lower blood pressure by increasing fluid output. Vasodilators act on the vascular smooth muscle. By causing arterial dilation, blood pressure is lowered. Beta blockers interfere with beta stimulation and depress renin output.

Acyclovir (Zovirax) is given to children with chickenpox to: a. minimize scarring. b. prevent aplastic anemia. c. prevent spread of the disease. d. decrease the number of lesions.

ANS: D Acyclovir decreases the number of lesions; shortens duration of fever; and decreases itching, lethargy, and anorexia. Treating pruritus and discouraging itching minimizes scarring. Aplastic anemia is not a complication of chickenpox. Strict isolation until vesicles are dried prevents spread of disease.

Which of the following types of play is most typical of the preschool period? a. Team b. Parallel c. Solitary d. Associative

ANS: D Associative play is group play in similar or identical activities but without rigid organization or rules. School-age children play in teams. Parallel play is that of toddlers. Solitary play is that of infants.

Which of the following characteristics best describes the language skills of a 3-year-old child? a. Asks meanings of words b. Follows directional commands c. Can describe an object according to its composition d. Talks incessantly regardless of whether anyone is listening

ANS: D Because of the dramatic vocabulary increase at this age, 3-year-olds are known to talk incessantly regardless of whether anyone is listening. A 4- to 5-year-old asks lots of questions and can follow simple directional commands. A 6-year-old can describe an object according to its composition.

During the preschool period the emphasis of injury prevention should be placed on which of the following? a. Limitation of physical activities b. Punishment for unsafe behaviors c. Constant vigilance and protection d. Teaching about safety and potential hazards

ANS: D Education about safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Limitation of physical activities is not appropriate. Punishment may make children scared of trying new things. Constant vigilance and protection is not practical at this age, since preschoolers are becoming more independent.

Probably the most important criterion on which to base the decision to report suspected child abuse is which of the following? a. Inappropriate response of child b. Inappropriate parental concern for the degree of injury c. Absence of parents for questioning about child's injuries d. Incompatibility between the history and injury observed

ANS: D Conflicting stories about the "accident" are the most indicative red flags of abuse. The child or caregiver may have an inappropriate response, but this is subjective. Parents should be questioned at some point during the investigation.

Which of the following is the causative agent of scarlet fever? a. Enteroviruses b. Corynebacterium organisms c. Scarlet fever virus d. Group A -hemolytic streptococci (GABHS)

ANS: D GABHS infection causes scarlet fever. Enteroviruses do not cause the same complications. Corynebacterium organisms cause diphtheria. Scarlet fever is not caused by a virus.

When caring for the child with Kawasaki disease, the nurse should know which of the following? a. Aspirin is contraindicated. b. Principal area of involvement is the joints. c. Child's fever is usually responsive to antibiotics within 48 hours. d. Therapeutic management includes administration of gamma globulin and salicylates.

ANS: D High-dose intravenous gamma globulin and salicylate therapy is indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness. Aspirin is part of the therapy. Mucous membranes, conjunctiva, changes in the extremities, and cardiac involvement are seen. The fever of Kawasaki disease is unresponsive to antibiotics. It is responsive to antiinflammatory doses of aspirin and antipyretics.

A 3-month-old infant has a hypercyanotic spell. The nurse's first action should be which of the following? a. Assess for neurologic defects. b. Prepare family for imminent death. c. Begin cardiopulmonary resuscitation. d. Place child in the knee-chest position.

ANS: D The first action is to place the infant in the knee-chest position. Blow-by oxygen may be indicated. Neurologic defects are unlikely. Preparing the family for imminent death or beginning cardiopulmonary resuscitation should be unnecessary. The child is assessed for airway, breathing, and circulation. Often, calming the child and administering oxygen and morphine can alleviate the hypercyanotic spell.

The most common type of burn in the toddler age-group is: a. electric burn from electrical outlets. b. flame burn from playing with matches. c. hot object burn from cigarettes or irons. d. scald burn from high-temperature tap water.

ANS: D Scald burns are the most common type of thermal injury in children, especially 1- and 2-year-olds. Temperature should be reduced on the hot water in the house and hot liquids placed out of the child's reach. Electric burns from electrical outlets and hot object burns from cigarettes or irons are both significant causes of burn injury. The child should be protected by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electrical outlets when not in use. Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age-group, but not one of the most common types of burn.

Parents are considering treatment options for their 5-year-old with Legg-Calvé-Perthes disease. Both surgical and conservative therapies are appropriate. They are able to verbalize the differences between the therapies when they state: a. "All therapies require extended periods of bed rest." b. "Conservative therapy will be required until puberty." c. "Our child cannot attend school during the treatment phase." d. "Surgical correction requires a 3- to 4-month recovery period."

ANS: D Surgical correction involves additional risks of anesthesia, infection, and possibly blood transfusion. The recovery period is only 3 to 4 months rather than the 2 to 4 years of conservative therapies. The use of non-weight bearing appliances and surgical intervention does not require prolonged bed rest. Conservative therapy is indicated for 2 to 4 years. The child is encouraged to attend school and engage in activities that can be adapted to therapeutic appliance.

Which of the following characteristics best describes the gross motor skills of a 24-month-old child? a. Skips b. Broad jumps c. Rides tricycle d. Walks up and down stairs

ANS: D The 24-month-old child can go up and down stairs alone with two feet on each step. Skipping and broad jumping are skills acquired at age 3. Tricycle riding is achieved at age 4.

Which one of the following factors is most important in predisposing toddlers to frequent infections? a. Respirations are abdominal. b. Pulse and respiratory rates in toddlers are slower than those in infancy. c. Defense mechanisms are less efficient than those during infancy. d. Toddlers have a short, straight internal ear canal and large lymph tissue.

ANS: D Toddlers continue to have the short, straight internal ear canal of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose the toddler to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy.

Discharge teaching for a 3-month-old infant with a cardiac defect who is to receive digoxin (Lanoxin) should include which of the following? Select all that apply. 1. Give the medication at regular intervals. 2. Mix the medication with a small volume of breast milk or formula. 3. Repeat the dose one time if the child vomits immediately after administration. 4. Notify the primary care provider of poor feeding or vomiting. 5. Make up any missed doses as soon as realized. 6. Notify the primary care provider if more than two consecutive doses are missed.

1, 4, 6. To achieve optimal therapeutic levels, digoxin should be given at regular intervals without variation, usually every 12 hours. Vomiting and poor feeding are signs of toxicity. If more than two consecutive doses are missed, interventions may be needed to assure therapeutic drug levels. The medication should not be mixed with any other fluid as refusal may result in inaccurate intake of the medication. Taking make-up doses, or taking the medication at times other than scheduled, may adversely affect serum levels.

While assessing a 3-year-old child who has had an injury to the leg, has pain, and refuses to walk, the nurse notes that the child's left thigh is swollen. What should the nurse do next? 1. Assess the neurologic status of the toes. 2. Determine the circulatory status of the upper thigh. 3. Obtain the child's vital signs. 4. Notify the physician immediately.

1. Because the nurse suspects a possible fracture based on the child's presentation, assessing the neurologic and circulatory status of the toes, the tissues distal to the fracture, is important. Soft tissue contusions, which accompany femur fractures, can result in severe hemorrhage into the tissue and subsequent circulatory and neurologic impairment. Once this information has been obtained, vital signs can be assessed and the nurse can notify the primary health care provider and report the findings. In fractures, circulation impairment will occur distal to the injury.

The mother of a child with Duchenne's muscular dystrophy asks about the chance that her next child will have the disease. The nurse responds based on the understanding of which of the following? 1. Sons have a 50% chance of being affected. 2. Daughters have a 1 in 4 chance of being carriers. 3. Each child has a 1 in 4 chance of developing the disease. 4. Each child has a 50% chance of being a carrier.

1. Duchenne's muscular dystrophy is an X-linked recessive disorder. The gene is transmitted through female carriers to affected sons 50% of the time. Daughters have a 50% chance of being carriers.

The nurse teaches the parents of an infant with developmental dysplasia of the hip how to handle their child in a Pavlik harness. Which of the following is most appropriate? 1. Fitting the diaper under the straps. 2. Leaving the harness off while the infant sleeps. 3. Checking for skin redness under straps every other day. 4. Putting powder on the skin under the straps every day.

1. The Pavlik harness is worn over a diaper. Knee socks are also worn to prevent the straps and foot and leg pieces from rubbing directly on the skin. For maximum results, the infant needs to wear the harness continuously. The skin should be inspected several times a day, not every other day, for signs of redness or irritation. Lotions and powders are to be avoided because they can cake and irritate the skin.

An adolescent tells the nurse that the area below his knee has been hurting for several weeks. The nurse should obtain history information about participation in which of the following? 1. Soccer. 2. Golf. 3. Diving. 4. Swimming.

1. The adolescent's problem should alert the nurse to the possibility of Osgood-Schlatter disease. This disease, found primarily in boys 10 to 15 years of age and in girls 8 to 13 years of age, occurs when the infrapatellar ligament of the quadriceps muscle is not well anchored to the tibial tubercle. Excessive activity of the quadriceps muscle results in microtrauma, which causes swelling and pain. Track, soccer, and football commonly produce this condition. Osgood-Schlatter disease is self-limited and usually responds to rest and application of ice.

A 13-year-old has been admitted with a diagnosis of rheumatic fever and is on bed rest. He has a sore throat. His joints are painful and swollen. He has a red rash on his trunk and is experiencing aimless movements of his extremities. Use the chart below to determine what the nurse should do first. 1. Report the heart rate to the primary health care provider. 2. Apply lotion to the rash. 3. Splint the joints to relieve the pain. 4. Request a prescription for medication to treat the elevated temperature.

1. The child's heart rate of 150 bpm is significantly above its rate at the time of his admission. The nurse must notify the primary health care provider. The increase in heart rate may indicate carditis, a possible complication of rheumatic fever that can cause serious and life-long effects on the heart. The primary health care provider will intervene with medication and cardiac monitoring. While lotion may soothe the itching, the most important action for the nurse is to notify the primary health care provider of the increased heart rate. Splinting will not help the inflammation that is causing the painful joints. The painful joints migrate and will subside with time. The temperature is not elevated at this time, and does not require intervention.

A 10-year-old has 5 lb of Buck's extension traction on his left leg. The nurse should assess the child for which of the following? Select all that apply. 1. Dryness of the skin, by removing the foam wraps and boot. 2. Alignment of the shoulder, hips, and knees. 3. Frayed rope near pulleys. 4. Correct amount of traction weight on fracture. 5. Pressure on the coccyx.

2,3,4,5. Buck's traction provides a skin traction that keeps the extremity in straight alignment and can be observed by noting a straight line formed between the shoulder, hips, and knees. The rope must be intact to maintain the prescribed traction from the weights. The correct amount of traction must be maintained to keep the fractured femur in correct alignment. Because the client is in a recumbent position, the nurse should also inspect the skin on the back and buttocks for integrity. The nurse should not remove the client's wraps and boot unless she has a primary health care provider's prescription to do so.

Nonsteroidal anti-inflammatory drugs are the first choice in treating a child with juvenile idiopathic arthritis. Which adverse effects should the nurse include in the teaching plan for the parents? Select all that apply. 1. Weight gain. 2. Abdominal pain. 3. Blood in the stool. 4. Folic acid deficiency. 5. Reduced blood clotting ability.

2,3,5. Adverse effects from nonsteroidal anti-inflammatory drugs include abdominal pain, blood in stool, and reduced clotting ability. Weight gain is common with corticosteroids. Folic acid deficiency is associated with methotrexate therapy.

The primary health care provider prescribes pulse assessments through the night for a 12-year-old child with rheumatic fever who has a daytime heart rate of 120. The nurse explains to the mother that this is to evaluate if the elevated heart rate is caused by: 1. The morning digitalis. 2. Normal activity during waking hours. 3. A warmer daytime environment. 4. Normal variations in day and evening hours.

2. An above-average pulse rate that is out of proportion to the degree of activity is an early sign of heart failure in a client with rheumatic fever. The sleeping pulse is used to determine whether the mild tachycardia persists during sleep (inactivity) or whether it is a result of daytime activities. The environmental temperature would need to be quite warmer before it could influence the heart rate. Digitalis lowers the heart rate, so the rate would be decreased during the daytime.

The mother of a preschooler reports that her child creates a scene every night at bedtime. The nurse and the mother decide that the best course of action would be to do which of the following? 1. Allow the child to stay up later one or two nights a week. 2. Establish a set bedtime and follow a routine. 3. Encourage active play before bedtime. 4. Give the child a cookie if bedtime is pleasant.

2. Bedtime is often a problem with preschoolers. Recommendations for reducing conflicts at bedtime include establishing a set bedtime; having a dependable routine, such as story reading; and conveying the expectation that the child will comply. Allowing the child to stay up late one or two nights interferes with establishing the needed bedtime rituals. Excitement, such as active play, just before bedtime should be avoided because it stimulates the child, making it difficult for the child to calm down and prepare for sleep. Using food such as a cookie as a reward if bedtime is pleasant should be avoided because it places too much importance on food. Other rewards, such as stickers, could be used as an alternative.

When developing the plan of care for a newly admitted 2-year-old child with the diagnosis of Kawasaki disease (KD), which of the following should be the priority? 1. Taking vital signs every 6 hours. 2. Monitoring intake and output every hour. 3. Minimizing skin discomfort. 4. Providing passive range-of-motion exercises.

2. Cardiac status must be monitored carefully in the initial phase of KD because the child is at high risk for congestive heart failure (CHF). Therefore, the nurse needs to assess the child frequently for signs of CHF, which would include respiratory distress and decreased urine output. Vital signs would be obtained more often than every 6 hours because of the risk of CHF. Although minimizing skin discomfort would be important, it does not take priority over monitoring the child's hourly intake and output. Passive range-of-motion exercises would be done if the child develops arthritis.

The nurse should teach the mother of a child who has a new cast for a fractured radius to do which of the following for the first few days at home? 1. Use a hair dryer to dry the cast more quickly. 2. Have the child refrain from strenuous activities. 3. Check movement and sensation of the child's fingers once a day. 4. Administer acetaminophen every 8 to 12 hours for discomfort.

2. For the first few days after application of a plaster or fiberglass cast, the child should not engage in strenuous activities, to minimize swelling that would cause the cast to become too tight. Use of a hair dryer to complete the drying of the cast is not encouraged because the hair dryer only dries the outside of the cast. Movement and sensation of the fingers need to be checked several times a day for the first few days. Typically, the mother would be instructed to administer acetaminophen every 4 to 6 hours, not every 8 to 12 hours, for discomfort.

The mother of a 4-year-old child with juvenile idiopathic arthritis (JIA) is worried that her child will have to stop attending preschool because of the illness. Which of the following responses by the nurse would be most appropriate? 1. "It may be difficult for your child to attend school because of the side effects of the medications he will be prescribed." 2. "Your child should be encouraged to attend school, but he'll need extra time to work out early morning stiffness." 3. "You should keep your child at home from school whenever he experiences discomfort or pain in his joints." 4. "Your child will probably need to wear splints and braces so that his joints will be supported properly."

2. Socialization is important for this preschool-age child, and activity is important to maintain function. Because children with JIA commonly experience most problems in the early morning after arising, they need more time to "warm up." Adverse effects may or may not occur. The child's normal routine needs to be maintained as much as possible. Although splints and braces may be needed, they are worn during periods of rest, not activity, to maintain function.

Which of the following should the nurse include when completing discharge instructions for the parents of a 12-month-old child diagnosed with Kawasaki disease (KD) and being discharged home? 1. Offer the child extra fluids every 2 hours for 2 weeks. 2. Take the child's temperature daily for several days. 3. Check the child's blood pressure daily until the follow-up appointment. 4. Call the primary health care provider if the irritability lasts for 2 more weeks.

2. The child's temperature should be taken daily for several days after discharge, because recurrent fever may develop. Offering the child fluids every 2 hours is not necessary. Doing so increases the child's risk for CHF. Checking the child's blood pressure at home usually is not included as part of the discharge instructions because, by the time of discharge, the child is considered stable and the risk for cardiac problems is minimal. Most children with KD recover fully. Irritability may last for 2 months after discharge.

After having a blood sample drawn, a 5-year-old child insists that the site be covered with a bandage. When the parent tries to remove the bandage before leaving the office, the child screams that all the blood will come out. The nurse encourages the parent to leave the bandage in place and tells the parent that the child: 1. Fears another procedure. 2. Does not understand body integrity. 3. Is expressing pain. 4. Is attempting to regain control.

2. The preschool-age child does not have an accurate concept of skin integrity and can view medical and surgical treatments as hostile invasions that can destroy or damage the body. The child does not understand that exsanguinations will not occur from the injection site. Here, the child is verbalizing a fear consistent with the developmental age. The child would most likely verbalize concerns of not wanting another procedure or exhibit other symptoms associated with pain if those were the underlying issues. If control was the main issue, the child would try to control more than just the bandage removal.

The mother asks the nurse about using a car seat for her toddler who is in a hip spica cast. The nurse should tell the mother: 1. "You can use a seat belt because of the spica cast." 2. "You will need a specially designed car seat for your toddler." 3. "You can still use the car seat you already have." 4. "You'll need to get a special release from the police so that a car seat won't be needed."

2. The toddler in a hip spica cast needs a specially designed car seat. The one that the mother already has will not be appropriate because of the need for the car seat to accommodate the cast and abductor bar. Legally, all children younger than 4 years of age are required to be restrained in a car seat.

The nurse is caring for a child in Bryant's traction (see figure). The nurse should: 1. Adjust the weights on the legs until the buttocks rest on the bed. 2. Provide frequent skin care. 3. Place a pillow under the buttocks. 4. Remove the elastic leg wraps every 8 hours for 10 minutes.

2. The traction is positioned correctly; the nurse should provide frequent skin care to the back and shoulder areas. The hips and buttocks should be lifted off the bed to provide counter traction; the nurse should not adjust the weights. The nurse should not place a pillow under the buttocks as this would prevent counter traction. The elastic wraps should remain on the legs unless permitted by the primary health care provider.

When assessing for pain in a toddler, which of the following methods should be the most appropriate? 1. Ask the child about the pain. 2. Observe the child for restlessness. 3. Use a numeric pain scale. 4. Assess for changes in vital signs.

2. Toddlers usually express pain through such behaviors as restlessness, facial grimaces, irritability, and crying. It is not particularly helpful to ask toddlers about pain. In most instances, they would be unable to understand or describe the nature and location of their pain because of their lack of verbal and cognitive skills. However, preschool and older children have the verbal and cognitive skills to be able to respond appropriately. Numeric pain scales are more appropriate for children who are of school age or older. Changes in vital signs do occur as a result of pain, but behavioral changes usually are noticed first.

When assessing a 2-year-old child brought by his mother to the clinic for a routine checkup, which of the following should the nurse expect the child to be able to do? 1. Ride a tricycle. 2. Tie his shoelaces. 3. Kick a ball forward. 4. Use blunt scissors.

3. A 2-year-old child usually can kick a ball forward. Riding a tricycle is characteristic of a 3-year-old child. Tying shoelaces is a behavior to be expected of a 5-year-old child. Using blunt scissors is characteristic of a 3-year-old child.

After teaching the parents of an infant with clubfoot requiring application of a plaster cast how to care for the cast, which of the following statements would indicate that the parents have understood the teaching? 1. "If the cast becomes soiled, we'll clean it with soap and water." 2. "We'll elevate the leg with the cast on pillows, so the leg is above heart level." 3. "We will check the color and temperature of the toes of the casted leg frequently." 4. "The petals on the edge of the cast can be removed after the first 24 hours."

3. A cast that is too tight can cause a tourniquet effect, compromising the neurovascular integrity of the extremity. Manifestations of neurovascular impairment include pain, edema, pulselessness, coolness, altered sensation, and inability to move the distal exposed extremity. The toes of the casted extremity should be assessed frequently to evaluate for changes in neurovascular integrity. Wetting a plaster cast with water and soap softens the plaster, which may alter the cast's effectiveness. There is no reason to elevate the casted extremities when a child with clubfoot is being treated with nonsurgical measures. The legs would be elevated if swelling were present. Petals, which are applied to cover the rough edges of the cast, are to be left in place to minimize the risk for skin irritation from the cast edges.

A mother brings her 18-month-old to the clinic because the child "eats ashes, crayons, and paper." Which of the following information about the toddler should the nurse assess first? 1. Evidence of eruption of large teeth. 2. Amount of attention from the mother. 3. Any changes in the home environment. 4. Intake of a soft, low-roughage diet.

3. A craving to eat nonfood substances is known as pica. Toddlers use oral gratification as a means to cope with anxiety. Therefore, the nurse should first assess whether the child is experiencing any change in the home environment that could cause anxiety. Teething or the eruption of large teeth and the amount of attention from the mother are unlikely causes of pica. Nutritional deficiencies, especially iron deficiency, were once thought to cause pica, but research has not substantiated this theory. A soft, low-roughage diet is an unlikely cause.

A 10-year-old with scoliosis has to wear a brace. The nurse should develop a teaching plan with the client to include which of the following instructions? 1. Wear the brace during waking hours. 2. Use lotions to relieve skin irritations. 3. Wear a form-fitting, sleeveless T-shirt under the brace. 4. Bathe the skin under the brace once per week.

3. A form-fitting, sleeveless T-shirt can be worn under the brace to prevent skin irritation and collect perspiration. Braces are worn 23 hours each day. Lotions may cause irritation and should not be used. The skin under the brace should be bathed daily to help prevent irritation from the brace. The brace can be removed for bathing so all the skin can be bathed.

An uncle is shopping for a toy to give his niece. He has no children of his own and asks his neighbor, a nurse, what would be the most appropriate toy to give a 15-month-old child. Which toy should the nurse recommend to facilitate learning and development? 1. A stuffed animal. 2. A music box. 3. A push-pull toy. 4. A nursery mobile.

3. A push-pull toy will aid in development of gross motor skills and muscle development. A stuffed animal is age appropriate for a toddler but is not the best toy to promote development. A music box is most appropriate to stimulate development for an infant. A nursery mobile is most appropriate to stimulate development for an infant.

To encourage autonomy in a 4-year-old, the nurse should instruct the mother to: 1. Discourage the child's choice of clothing. 2. Button the child's coat and blouse. 3. Praise the child's attempts to dress herself. 4. Tell the child when the combination of clothes is not appropriate.

3. At age 4, the child should be learning to dress without supervision. A child will feel more autonomous if allowed to try to take on tasks herself. Such attempts should be encouraged to increase self-esteem. Allowing choices encourages the child's capacity to control her behavior. Continued dependency may cause the child to doubt her own abilities. Telling the child that a combination of clothes is not appropriate may cause the child to doubt her abilities. Feelings of guilt can develop from not being able to accomplish what the child feels the adult expects of her.

When planning home care for the child with Legg-Calvé-Perthes disease, what should be the primary focus for family teaching? 1. Need for intake of protein-rich foods. 2. Gentle stretching exercises for both legs. 3. Management of the corrective appliance. 4. Relaxation techniques for pain control.

3. Because most of the child's care takes place at home, the primary focus of family teaching would be on the care and management of the corrective device. Devices such as an abduction brace, a leg cast, or a harness sling are used to protect the affected joint while revascularization and bone healing occur. As long as the child is eating a well-balanced diet, there is no need for an intake of protein-rich foods. The parents can encourage range of motion in the unaffected leg, but motion in the affected leg is limited until it heals. Once therapy has been initiated, pain is usually not a problem. The key is management of the corrective device.

When teaching a preschool-age child how to perform coughing and deep-breathing exercises before corrective surgery for tetralogy of Fallot, which of the following teaching and learning principles should the nurse address first? 1. Organizing information to be taught in a logical sequence. 2. Arranging to use actual equipment for demonstrations. 3. Building the teaching on the child's current level of knowledge. 4. Presenting the information in order from simplest to most complex.

3. Before developing any teaching program for a child, the nurse's first step is to assess the child to determine what is already known. Most older preschool children have some understanding of a condition present since birth. However, the child's interest will soon be lost if familiar material is repeated too often. The nurse can then organize the information in a sequence, because there are several steps to be demonstrated. These exercises do not require the use of equipment. The nurse should judge the amount and complexity of the information to be provided, based on the child's current knowledge and response to teaching.

A 2-year-old tells his mother he is afraid to go to sleep because "the monsters will get him." The nurse should tell his mother to: 1. Allow him to sleep with his parents in their bed whenever he is afraid. 2. Increase his activity before he goes to bed, so he eventually falls asleep from being tired. 3. Read a story to him before bedtime and allow him to have a cuddly animal or a blanket. 4. Allow him to stay up an hour later with the family until he falls asleep.

3. Behavior problems related to sleep and rest are common in young children. Consistent rituals around bedtime help to create an easier transition from waking to sleep. Allowing a child to sleep with his parents commonly creates more problems for the family and child and does not alleviate the problem or foster autonomy. Increasing activity before bedtime does not alleviate the separation anxiety in the toddler and causes further anxiety. Allowing him to stay up later than his normal time for bed will increase his anxiety, make it more difficult for him to fall asleep, and do nothing to lessen his fear.

The nurse caring for a 7-year-old child who has undergone a cardiac catheterization 2 hours ago finds the dressing and bed saturated with blood. The nurse should first: 1. Assess the vital signs. 2. Reinforce the dressing. 3. Apply pressure just above the catheter insertion site. 4. Notify the primary health care provider.

3. Direct pressure is the first measure that should be used to control bleeding. Taking the vital signs will not control the bleeding. This should be done while another person is being sent to notify the primary health care provider. The dressing can be reinforced after the bleeding has been contained.

The nurse in the emergency department is caring for a 3-year-old child with a fractured humerus. The child is crying and screaming, "I hate you." Which of the following would be most appropriate? 1. Tell the parents they will need to wait out in the lobby. 2. Ask the charge nurse to assign this client to another nurse. 3. Reassure the parents that this normal behavior under the circumstances. 4. Ask the parents to discipline the child so that the physician can treat her.

3. Explaining to the parents that this is a normal reaction under the circumstances is most appropriate. The child's outburst is related to the child's fears of the unknown. The child is scared and anxious and needs the parents for support. Asking the parents to wait outside would only add to the child's fear and anxiety. The reaction is normal for a child her age and does not usually call for a change in staff assignments. Asking the parents to discipline their child for her behavior is inappropriate. The nurse needs to handle the situation.

The family of a 5-year-old, only child has just moved to a rural setting. At the well-child visit, the father expresses concern that his child seems prone to minor accidents such as skinning his elbow and knees or falling off his scooter. The nurse tells the father: 1. "Only children use accidents as a way to seek parental attention." 2. "Children who live in the suburbs typically have more accidents." 3. "Children frequently have more accidents when families experience change." 4. "We see a relationship between accidents and parental education."

3. Family changes and stresses (e.g., moving, having company, taking a vacation, adding a new member) can distract parents and contribute to accidents. Only children typically receive more attention than those with siblings. Thus, the risk would be less. Families who live in the suburbs frequently are more affluent and, therefore, better able to maintain a home less conducive to accidents. A parent's formal education is unrelated to accidents.

During the initial assessment of a child admitted to the pediatric unit with osteomyelitis of the left tibia, when assessing the area over the tibia, which is an expected finding? 1. Diffuse tenderness. 2. Decreased pain. 3. Increased warmth. 4. Localized edema.

3. Findings associated with osteomyelitis commonly include pain over the area, increased warmth, localized tenderness, and diffuse swelling over the involved bone. The area over the affected bone is red.

Anticipating that a 3-year-old child in traction will have need for diversion, what should the nurse offer the child? 1. A video game. 2. Blocks. 3. Hand puppets. 4. Marbles.

3. Hand puppets would enable a 3-year-old child in traction to act out feelings within the constraints imposed by the traction. A 3-year-old needs creative play. The video game would make the child too active in bed and does not meet the child's developmental need for creative play. Blocks would be more appropriate for a younger child. Marbles are unsafe at this age because they can be swallowed.

An 8-year-old child with juvenile idiopathic arthritis (JIA) is being admitted to the hospital for evaluation of progressively increasing symptoms. The child weighs 60 lb and is 50 inches tall. The nurse is reconciling the medications the parent brought from home with the medications the physician has prescribed. (See chart.) 1. Have the family give the child cetirizine daily using the medication they have from home. 2. Explain the need to limit over-the-counter medications while in the hospital. 3. Request a cetirizine prescription from the primary care provider. 4. Contact the primary care provider to question the methotrexate.

3. If the child was taking cetirizine for allergies, the nurse should contact the primary care provider for a prescription to continue the medication in the hospital. The provider should either prescribe the medication or provide a valid reason to discontinue its use. Advising the family to take a home supply of medications increases the risk of adverse reactions because the provider would be unaware of potential medication interactions. Many allergy medications that formerly required a prescription are now available over the counter and because parents use them the nurse should be aware of the interactions and risks. The nurse does not need to question the methotrexate prescription as this medication is being added to treat the JIA.

During a developmental screening, the nurse finds that a 3-year-old child with cerebral palsy has arrested social and language development. The nurse tells the family: 1. "This is a sign the cerebral palsy is progressing." 2. "Your child has reached his maximum language abilities." 3. "I need to refer you for more developmental testing." 4. "We need to modify your therapy plan."

3. It is important to identify primary developmental delays in children with cerebral palsy and to prevent secondary and tertiary delays. The arrested development is worrisome and requires further investigation. It is possible the lack of development indicates hearing loss or may be a sign of autism. The brain damage caused by cerebral palsy is not progressive. The brain of a young child is quite plastic; assuming the child's development has peaked at age 3 would be a serious mistake. The therapy plan will need to be modified, but a better understanding of the underlying problem will lead to the greatest chance of creating a successful therapy plan.

A 16-month-old child diagnosed with Kawasaki disease (KD) is very irritable, refuses to eat, and exhibits peeling skin on the hands and feet. The nurse should do which of the following first? 1. Apply lotion to the hands and feet. 2. Offer foods the toddler likes. 3. Place the toddler in a quiet environment. 4. Encourage the parents to get some rest.

3. One of the characteristics of children with KD is irritability. They are often inconsolable. Placing the child in a quiet environment may help quiet the child and reduce the workload of the heart. Although peeling of the skin occurs with KD, the child's irritability takes priority over applying lotion to the hands and feet. Children with KD usually are not hungry and do not eat well regardless of what is served. There is no indication that the parents need rest. Additionally, in this situation, the child takes priority over the parents.

When developing the teaching plan about illness for the mother of a preschooler, which of the following should the nurse include about how a preschooler perceives illness? 1. A necessary part of life. 2. A test of self-worth. 3. A punishment for wrongdoing. 4. The will of God.

3. Preschool-age children may view illness as punishment for their fantasies. At this age children do not have the cognitive ability to separate fantasies from reality and may expect to be punished for their "evil thoughts." Viewing illness as a necessary part of life requires a higher level of cognition than preschoolers possess. This view is seen in children of middle school age and older. Perceiving illness as a test of self-worth or as the will of God is more characteristic of adults.

When developing the discharge teaching plan for the parents of a child who has undergone a cardiac catheterization for ventricular septal defect, which of the following should the nurse expect to include? 1. Restriction of the child's activities for the next 3 weeks. 2. Use of sponge baths until the stitches are rem oved. 3. Use of prophylactic antibiotics before receiving any dental work. 4. Maintenance of a pressure dressing until a return visit with the primary health care provider.

3. Prophylactic antibiotics are suggested for children with heart defects before dental work is done to reduce the risk of bacterial infection. Typically, activities are not restricted after a cardiac catheterization. A percutaneous approach is used to insert the catheter, so stitches are not necessary. Showering or bathing is allowed as usual. The pressure dressing will be removed before the child is discharged.

A 14-year-old is being screened for scoliosis. Which of the following statements about scoliosis screening is true? 1. Teenagers aged 14 to 16 should be screened yearly. 2. A shirt and shorts are worn for screening. 3. The girl is assessed standing and bending forward. 4. The girl should refrain from eating 8 hours before the examination.

3. Screening is done with the child wearing minimal clothing, standing and bending forward. The examination should be done on girls aged 10 to 12 years old, so a diagnosis can be made early and the scoliosis can be treated with exercises or bracing. Only underwear should be worn for the examination so that symmetry of the shoulders and hips can be observed. If the deviation on the scoliometer is < 20 degrees, no treatment is indicated. The child does not need to refrain from eating prior to this test.

When teaching the family of an older infant who has had a spica cast applied for developmental dysplasia of the hip, which information should the nurse include when describing the abduction stabilizer bar? 1. It can be adjusted to a position of comfort. 2. It is used to lift the child. 3. It adds strength to the cast. 4. It is necessary to turn the child.

3. The abduction bar is incorporated into the cast to increase the cast's strength and maintain the legs in alignment. The bar cannot be removed or adjusted, unless the cast is removed and a new cast is applied. The bar should never be used to lift or turn the client, because doing so may weaken the cast.

What should the nurse include when developing the teaching plan for the parents of a child with juvenile idiopathic arthritis who is being treated with naproxen (Naprosyn)? 1. Anti-inflammatory effect will occur in approximately 8 weeks. 2. Within 24 hours, the child will have anti-inflammatory relief. 3. The nurse should be called before giving the child any over-the-counter medications. 4. If a dose is forgotten or missed, that dose is not made up.

3. The first group of drugs typically prescribed is the nonsteroidal anti-inflammatory drugs, which include naproxen. Naproxen is included in only a few over-the-counter medications but aspirin is in several. The family should check with the nurse before giving any over-the-counter medications. Once therapy is started, it takes hours or days for relief from pain to occur. However, it takes 3 to 4 weeks for the anti-inflammatory effects to occur, including reduction in swelling and less pain with movement. The missed dose will need to be made up to maintain the serum level and to maintain therapeutic effectiveness of the drug.

When interacting with the mother of a child who has Duchenne's muscular dystrophy, the nurse observes behavior indicating that the mother may feel guilty about her child's condition. The nurse interprets this behavior as guilt stemming from which of the following? 1. The terminal nature of the disease. 2. The dependent behavior of the child. 3. The genetic mode of transmission. 4. The sudden onset of the disease.

3. The guilt that mothers of children with muscular dystrophy commonly experience usually results from the fact that the disease is genetic and the mother transmitted the defective gene. Although many children die from the disease, the disease is considered chronic and progressive. As the disease progresses, the child becomes more dependent. However, guilt typically stems from the knowledge that the mother transmitted the disease to her son rather than the dependency of the child. The disease onset is usually gradual, not sudden.

The mother asks the nurse whether her child with hemiparesis due to spastic cerebral palsy will be able to walk normally because he can pull himself to a standing position. Which of the following responses by the nurse would be most appropriate? 1. "Ask the doctor what he thinks at your next appointment." 2. "Maybe, maybe not. How old were you when you first walked?" 3. "It's difficult to predict, but his ability to bear weight is a positive factor." 4. "If he really wants to walk, and works hard, he probably will eventually."

3. The nurse needs to respond honestly to the mother. Most children with hemiparesis due to spastic cerebral palsy are able to walk because the motor deficit is usually greater in the upper extremity. There is no need to refer the mother to the primary health care provider. The age at which the mother walked may be important to elicit, but this does not influence when the child will walk. The will to walk is important, but without neurologic stability the child may be unable to do so.

A preschooler with a fractured femur of the left leg in traction tells the nurse that his leg hurts. It is too early for pain medication. The nurse should: 1. Place a pillow under the child's buttocks to provide support. 2. Remove the weight from the left leg. 3. Assess the feet for signs of neurovascular impairment. 4. Reposition the pulleys so the traction is looser.

3. The nurse should assess the client frequently for signs of neurovascular impairment of the feet, such as pallor, coldness, numbness, or tingling. Pillows are not placed under the buttocks because the pillows would alter the alignment of the traction. Weights provide traction and should not be removed. Pulleys help to maintain optimal alignment of the traction and therefore should be left alone. CN: Basic

The nurse is explaining the nature of the fracture to the parents of a 10-year-old who has a greenstick fracture. Which drawing should the nurse choose to explain the fracture to the parents? 1. 2. 3. 4.

3. The nurse should show the parents the figure of the greenstick fracture as noted in answer 3 in which the fracture does not completely cross through the bone. Answer A is a plastic deformation, or a bend in the bone. Answer B is a buckle. Answer D is a complete fracture.

A nurse is planning care for a 12-year-old with rheumatic fever. The nurse should teach the parents to: 1. Observe the child closely. 2. Allow the child to participate in activities that will not tire him. 3. Provide for adequate periods of rest between activities. 4. Encourage someone in the family to be with the child 24 hours a day.

3. The nurse should teach the parents to provide for sufficient periods of rest to decrease the client's cardiac workload. The client's condition does not warrant close observation unless cardiac complications develop. The child's activity level will be based on the results of the sedimentation rate, c-reactive protein, heart rate, and cardiac function. The family does not need to be with the client 24 hours a day unless carditis develops and his condition deteriorates.

The parent of a child with spastic cerebral palsy and a communication disorder tells the nurse, "He seems so restless. I think he is in pain." The nurse should: 1. Assess the child for pain using the Faces, Legs, Activity, Cry, Consolability (FLACC) scale. 2. Assess the child using the pediatric FACES scale. 3. Administer the pain medication that is prescribed to be given as needed and assess the response. 4. Notify the primary care provider of the change in behavior.

3. The parent is the child's primary care provider and may be very in tune to subtle changes in the child's behavior. If the parent thinks the child is in pain, it is very likely to be so. The nurse should administer the pain medication and evaluate if the medication affected the child's behavior. The FLACC scale may be difficult to interpret when the child has spasticity. The FACES scale requires self- report. The primary health care provider should be contacted regarding the change in behavior only if other available interventions are unsuccessful.

When developing the plan of care for a child with early Duchenne's muscular dystrophy, which of the following nursing goals is the priority? 1. Encouraging early wheelchair use. 2. Fostering social interactions. 3. Maintaining function of unaffected muscles. 4. Preventing circulatory impairment.

3. The primary nursing goal is to maintain function in unaffected muscles for as long as possible. There is no effective treatment for childhood muscular dystrophy. Children who remain active are able to forestall being confined in wheelchair. Remaining active also minimizes the risk for social isolation. Preventing rather than encouraging wheelchair use by maintaining function for as long as possible is an appropriate nursing goal. Children with muscular dystrophy become socially isolated as their condition deteriorates and they can no longer keep up with friends. Maintaining function helps prevent social isolation. Circulatory impairment is not associated with muscular dystrophy.

The nurse judges that the mother understands the term cerebral palsy when she describes it as a term applied to impaired movement resulting from which of the following? 1. Injury to the cerebrum caused by viral infection. 2. Malformed blood vessels in the ventricles caused by inheritance. 3. Nonprogressive brain damage caused by injury. 4. Inflammatory brain disease caused by metabolic imbalances.

3. The term cerebral palsy (CP) refers to a group of nonprogressive disorders of upper motor neuron impairment that result in motor dysfunction due to injury. In addition, a child may have speech or ocular difficulties, seizures, hyperactivity, or cognitive impairment. The condition of congenital malformed blood vessels in the ventricles is known as arteriovenous malformations. Viral infection and metabolic imbalances do not cause CP.

A child is being treated with vancomycin 40 mg/ kg/ day IV divided into 3 doses for osteomyelitis. The primary care provider has prescribed drug protocol management by pharmacy and a trough vancomycin level 30 minutes before the third dose scheduled for 9 am. The laboratory report returns prior to the third dose: The nurse should: 1. Administer the 9 am dose. 2. Notify the primary care provider. 3. Notify the pharmacist. 4. Draw a peak drug level.

3. The vancomycin level is not therapeutic and will need to be adjusted. Drug management by the pharmacy is prescribed. This is very frequently done in institutions with pediatric clinical pharmacists. Thus, the nurse should notify the pharmacist to adjust the dose. Giving subtherapeutic doses may prolong care. The nurse should contact the health care provider designated to address the issue. If needed, the pharmacist would notify the primary care provider. Peak levels are not prescribed on this client.

A 14-year-old has just had a plaster cast placed on his lower left leg. To provide safe cast care, the nurse should: 1. Petal the cast as soon as it is put on. 2. Keep the child in the same position for 24 hours until the cast is dry. 3. Use only the palms of the hand when handling the cast. 4. Notify the physician if the client feels heat.

3. The wet plaster cast should be handled using only the palms of the hands to prevent indentations of the cast surface. Petaling a cast should be done only when the edges of the cast are rough and are causing irritation to the client's skin. The nurse should not keep the child in the same position until the cast is dry. Doing so would prohibit proper toileting and elimination and would produce undue pressure on the coccyx. The cast typically emits heat as it dries, so notifying a primary health care provider is not necessary in this instance. If needed, a fan can be used to circulate the room air.

A nurse is making an initial visit to a family with a 3-year-old child with early Duchenne's muscular dystrophy. Which of the following findings is expected when assessing this child? 1. Contractures of the large joints. 2. Enlarged calf muscles. 3. Difficulty riding a tricycle. 4. Small, weak muscles.

3. Usually the first clinical manifestations of Duchenne's muscular dystrophy include difficulty with typical age-appropriate physical activities such as running, riding a bicycle, and climbing stairs. Contractures of the large joints typically occur much later in the disease process. Occasionally enlarged calves may be noted, but they are not typical findings in a child with Duchenne's muscular dystrophy. Muscular atrophy and development of small, weak muscles are later signs.

The parents of a neonate born with congenital clubfoot express feelings of helplessness and guilt, and are exhibiting anxiety about how the neonate will be treated. Which of the following actions by the nurse would be most appropriate initially? 1. Ask them to share these concerns with the primary care provider. 2. Arrange a meeting with other parents whose infants have had successful clubfoot treatment. 3. Discuss the problem with the parents and the current feelings that they are experiencing. 4. Suggest that they make an appointment to talk things over with a counselor.

3. When an infant is born with an unexpected anomaly, parents are faced with questions, uncertainties, and possible disappointments. They may feel inadequate, helpless, and anxious. The nurse can help the parents initially by assessing their concerns and providing appropriate information to help them clarify or resolve the immediate problems. Referring the parents to the primary health care provider is not necessary at this time. The nurse can assist the parents by listening to their concerns. Having them talk with other parents would be helpful a little bit later, once the nurse assesses their concerns and discusses the problem and the parents' current feelings. If the parents continue to have difficulties expressing and working through their feelings, referral to a counselor would be appropriate.

The father of a preschool-age child with a tentative diagnosis of juvenile idiopathic arthritis (JIA) asks about a test to definitively diagnose JIA. The nurse's response is based on knowledge of which of the following? 1. The latex fixation test is diagnostic. 2. An increased erythrocyte sedimentation rate is diagnostic. 3. A positive synovial fluid culture is diagnostic. 4. No specific laboratory test is diagnostic.

4. The nurse's response to the father is based on the knowledge that there is no definitive test for JIA. The latex fixation test, which is commonly used to diagnose arthritis in adults, is negative in 90% of children. The erythrocyte sedimentation rate may or may not be increased during active disease. This test identifies the presence of inflammation only. Synovial fluid cultures are done to rule out septic arthritis, not to diagnose JIA.

A preschool-age child with juvenile idiopathic arthritis (JIA) has become withdrawn, and the mother asks the nurse what she should do. Which of the following suggestions by the nurse would be most appropriate? 1. Introduce the child to other children her age who also have JIA. 2. Tell the mother to spend extra time with the child and less time with her other children. 3. Recommend that the mother send the child to see a counselor for therapy. 4. Encourage the mother to be supportive and understanding of the child.

4. Because the child is dealing with grief and loss associated with a chronic illness, parents need to be supportive and understanding. The child needs to feel valued and worthwhile. Introducing the child to others of the same age who also have JIA most probably would be ineffective because preschoolers are developmentally egocentric. Although the child needs to feel valued, the mother's spending more time with the child and less time with her other children is inappropriate because the child with JIA may experience secondary gain from the illness if the family interaction patterns are altered. Also, this action reinforces the child's withdrawal behavior. Psychological counseling is not needed at this time because the child's reaction is normal.

Twelve hours after cardiac surgery, the nurse is assessing a 3-year-old who weighs 15 kg. The nurse should notify the surgeon about which of the following clinical findings? 1. A urine output of 60 mL in 4 hours. 2. Strong peripheral pulses in all four extremities. 3. Fluctuations of fluid in the collection chamber of the chest drainage system. 4. Alterations in levels of consciousness.

4. Clinical signs of low cardiac output and poor tissue perfusion include pale, cool extremities, cyanosis or mottled skin, delayed capillary refill, weak, thready pulses, oliguria, and alterations in level of consciousness. An adequate urine output for a child over 1 year should be 1 mL/ kg/ h. Therefore 60 mL/ 4 h is satisfactory. Strong peripheral pulses indicate adequate cardiac output. Drainage from the chest tube should show fluctuation in the drainage compartment of the chest drainage system. The fluid level normally fluctuates as proof that the apparatus is airtight. On about the 3rd postoperative day, the fluctuation ceases indicating the lungs have fully expanded.

When teaching the child with scoliosis being treated with a Boston brace about exercises, the nurse explains that the exercises are performed primarily for which of the following purposes? 1. To decrease back muscle spasms. 2. To improve the brace's traction effect. 3. To prevent spinal contractures. 4. To strengthen the back and abdominal muscles.

4. Exercises are prescribed for the child with scoliosis wearing a Boston brace to help strengthen spinal and abdominal muscles and provide support. Typically, children wearing a Boston brace do not have muscle spasms. Performing exercises provides no effect on the brace's traction ability. Spinal contractures do not occur when a Boston brace is worn.

Which of following should the nurse perform to help alleviate a child's joint pain associated with rheumatic fever? 1. Maintaining the joints in an extended position. 2. Applying gentle traction to the child's affected joints. 3. Supporting proper alignment with rolled pillows. 4. Using a bed cradle to avoid the weight of bed linens on joints.

4. For a child with arthritis associated with rheumatic fever, the joints are usually so tender that even the weight of bed linens can cause pain. Use of a bed cradle is recommended to help remove the weight of the linens on painful joints. Joints need to be maintained in good alignment, not positioned in extension, to ensure that they remain functional. Applying gentle traction to the joints is not recommended because traction is usually used to relieve muscle spasms, not typically associated with rheumatic fever. Supporting the body in good alignment and changing the client's position are recommended, but these measures are not likely to relieve pain.

A nurse working in the nursery identifies a goal for a mother of a newborn to demonstrate positive attachment behaviors upon discharge. Which intervention would be least effective in accomplishing this goal? 1. Provide opportunities for the mother to hold and examine the newborn. 2. Engage the mother in the newborn's care. 3. Create an environment that fosters privacy for the mother and newborn. 4. Identify strategies to prevent difficulties in parenting.

4. Identifying ways to prevent difficulties in parenting would be helpful in reducing the incidence of child abuse and reducing the stress of child rearing. However, it would not help to develop positive attachment behaviors. Providing opportunities for the mother to hold and examine the newborn and help with care helps establish a positive emotional bond between the mother and newborn. Providing time for the mother to be alone with the infant further allows the mother and newborn to bond.

When observing the parent instilling prescribed ear drops prescribed twice a day for a toddler, the nurse decides that the teaching about positioning of the pinna for instillation of the drops is effective when the parent pulls the toddler's pinna in which of the following directions? 1. Up and forward. 2. Up and backward. 3. Down and forward. 4. Down and backward.

4. In a child younger than 3 years of age, the pinna is pulled back and down, because the auditory canals are almost straight in children. In an adult, the pinna is pulled up and backward because the auditory canals are directed inward, forward, and down.

A 16-month-old child is seen in the clinic for a checkup for the first time. The nurse notices that the toddler limps when walking. Which of the following would be appropriate to use when assessing this toddler for developmental dysplasia of the hip? 1. Ortolani's maneuver. 2. Barlow's maneuver. 3. Adam's position. 4. Trendelenburg's sign.

4. In a toddler, weight bearing causes the pelvis to tilt downward on the unaffected side instead of upward as it would normally. This is Trendelenburg's sign, and it indicates developmental dysplasia of the hip. Ortolani's maneuver is used during the neonatal period to assess developmental dysplasia of the hip in infants. With the infant quiet, relaxed, and lying on the back, the hips and knees are flexed at right angles. The knees are moved to abduction and pressure is exerted. If the femoral head moves forward, then it is dislocated. Barlow's maneuver is used to assess developmental dysplasia of the hip in infants. As the femur is moved into or out of the acetabulum, a "clunk" is heard, indicating dislocation. Adam's position is used to evaluate for structural scoliosis. The child bends forward with feet together and arms hanging freely or with palms together.

A child who limps and has pain has been found to have Legg-Calvé-Perthes disease. What should the nurse expect to include in the child's plan of care? 1. Initiation of pain control measures, especially at night when acute. 2. Promotion of ambulation despite child's discomfort in the affected hip. 3. Prevention of flexion in the affected hip and knee. 4. Avoidance of weight bearing on the head of the affected femur.

4. Legg-Calvé-Perthes disease, also known as coxa plana or osteochondrosis, is characterized by aseptic necrosis at the head of the femur when the blood supply to the area is interrupted. Avoidance of weight bearing is especially important to prevent the head of the femur from leaving the acetabulum, thus preventing hip dislocation. Devices such as an abduction brace, a leg cast, or a harness sling are used to protect the affected joint while revascularization and bone healing occur. Surgical procedures are used in some cases. Although pain control measures may be appropriate, pain is not necessarily more acute at night. Initial therapy involves rest and non- weight bearing to help restore motion. Preventing flexion is not necessary.

The nurse is caring for a child with osteomyelitis who will be receiving high-dose intravenous antibiotic therapy for 3 to 4 weeks. What should the nurse plan to monitor? 1. Blood glucose level. 2. Thrombin times. 3. Urine glucose level. 4. Urine specific gravity.

4. Long-term, high-dose antibiotic therapy can adversely affect renal, hepatic, and hematopoietic function. Urine specific gravity would provide valuable information about the kidneys' ability to concentrate or dilute urine, thereby suggesting renal impairment. Blood glucose levels reveal how well the client's body is using glucose. Thrombin times reveal information about the clotting mechanism. Urine glucose levels reveal information about the body's use and excretion of glucose.

Which of the following is the greatest priority for the therapeutic management of a child with congestive heart failure (CHF) caused by pulmonary stenosis? 1. Educating the family about the signs and symptoms of infection. 2. Administering enoxaparin (Lovenox) to improve left ventricular contractility. 3. Assessing heart rate and blood pressure every 2 hours. 4. Administrating furosemide (Lasix) to decrease systemic venous congestion.

4. Pulmonary stenosis can cause right-sided CHF, resulting in venous congestion. Removing accumulated fluid is a primary goal of treatment in right-sided CHF. Lasix is used to reduce venous congestion. It is important to educate the family about signs and symptoms of CHF but treating the client's CHF is the priority. Lovenox is an anticoagulant and will not help improve left ventricular contractility. It is important to assess vital signs frequently in the child with CHF but assessments do not treat the problem.

An adolescent is on the football team and practices in the morning and afternoon before school starts for the year. The temperature on the field has been high. The school nurse has been called to the practice field because the adolescent is now reporting that he has muscle cramps, nausea, and dizziness. Which of the following actions should the school nurse do first? 1. Administer cold water with ice cubes. 2. Take the adolescent's temperature. 3. Have the adolescent go to the swimming pool. 4. Move the adolescent to a cool environment.

4. The adolescent is most likely experiencing heat exhaustion or heat collapse, which are common after vigorous exercise in a hot environment. Symptoms result from loss of fluids and include nausea, vomiting, dizziness, headache, and thirst. Treatment consists of moving the adolescent to a cool environment and giving cool liquids. Cool liquids are easier to drink than cold liquids. Taking the adolescent's temperature would be appropriate once these actions have been completed. However, the adolescent's temperature is likely to be normal or only mildly elevated. The water in a swimming pool would be too cool, possibly causing the adolescent to shiver and thus raising his temperature.

A child diagnosed with tetralogy of Fallot becomes upset, crying and thrashing around when a blood specimen is obtained. The child's color becomes blue and the respiratory rate increases to 44 breaths/ min. Which of the following actions should the nurse do first? 1. Obtain a prescription for sedation for the child. 2. Assess for an irregular heart rate and rhythm. 3. Explain to the child that it will only hurt for a short time. 4. Place the child in a knee-to-chest position.

4. The child is experiencing a tet or hypoxic episode. Therefore the nurse should place the child in a knee-to-chest position. Flexing the legs reduces venous flow of blood from the lower extremities and reduces the volume of blood being shunted through the interventricular septal defect and the overriding aorta in the child with tetralogy of Fallot. As a result, the blood then entering the systemic circulation has higher oxygen content, and dyspnea is reduced. Flexing the legs also increases vascular resistance and pressure in the left ventricle. An infant often assumes a knee-to-chest position in the crib, or the mother learns to put the infant over her shoulder while holding the child in a knee-to-chest position to relieve dyspnea. If this position is ineffective, then the child may need a sedative. Once the child is in the position, the nurse may assess for an irregular heart rate and rhythm. Explaining to the child that it will only hurt for a short time does nothing to alleviate the hypoxia.

A 4-year-old male presents to the emergency room. His father tearfully reports that his son was on his shoulders in the driveway playing when he began to fall. When the child began to fall, the father grabbed him by the leg, swinging him toward the grass to avoid landing on the pavement. As the father swung his son, the child hit his head on the driveway and twisted his right leg. After a complete examination, it is determined that the child has a skull fracture and a spiral fracture of the femur. Which of the following actions should the nurse take? 1. Restrict the father's visitation. 2. Notify the police immediately. 3. Refer the father for parenting classes. 4. Record the father's story in the chart.

4. The father's story is consistent with the injuries incurred by the child; therefore, the nurse should document the cause of injury. There is no need to restrict the father's visitation because the injuries sustained by the child are consistent with the explanation given. The police only need to be notified if there is suspicion of child abuse. The injuries incurred by this child appear to be accidental. There is no need to refer the father for parenting classes. The father appears to be upset about the accident and will not likely repeat such reckless behavior. However, the nurse should educate the father regarding child safety.

At the 2-week well-child visit a parent states, "My baby seems to keep his head tilted to the right." The nurse should further assess the: 1. Fontanel. 2. Cervical vertebrae. 3. Trapezius muscle. 4. Sternocleidomastoid muscle.

4. The parent is describing symptoms consistent with torticollis, or wry neck syndrome. With this musculoskeletal disorder, the sternocleidomastoid muscle shortens causing the infant to drop the head toward the affected muscle and tilt the chin upward in the opposite direction. Frequently, a lump may be felt in the affected muscle. Palpating the fontanel is done to assess neurologic status, not musculoskeletal status. Torticollis does not involve the cervical vertebrae or trapezius muscle.

The nurse is assessing the infant shown in the figure. On observing the client from this angle, the nurse should document that this infant has which of the following? 1. Ortolani's "click." 2. Limited abduction. 3. Galeazzi's sign. 4. Asymmetric gluteal folds.

4. This infant with congenital hip dysplasia has asymmetric gluteal folds. The Ortolani "click" occurs when the nurse feels the femur sliding into the acetabulum with a "click." Limited abduction may be observed during an attempt to abduct the infant's thighs. Galeazzi's sign reveals femoral foreshortening and is observed by flexing the thighs.

The mother asks the nurse for advice about discipline for her 18-month-old. Which of the following should the nurse suggest that the mother use? 1. Structured interactions. 2. Spanking. 3. Reasoning. 4. Time-out.

4. Time-out is the most appropriate discipline for toddlers. It helps to remove them from the situation and allows them to regain control. Structuring interactions with 3-year-olds helps minimize unacceptable behavior. This approach involves setting clear and reasonable rules and calling attention to unacceptable behavior as soon as it occurs. Physical punishment, such as spanking, does cause a dramatic decrease in a behavior but has serious negative effects. However, slapping a child's hand is effective when the child refuses to listen to verbal commands. Reasoning is more appropriate for older children, such as preschoolers and those older, especially when moral issues are involved. Unfortunately, reasoning combined with scolding often takes the form of shame or criticism and children take such remarks seriously, believing that they are "bad."

A 2-year-old always puts his teddy bear at the head of his bed before he goes to sleep. The parents ask the nurse if this behavior is normal. The nurse should explain to the parents that toddlers use ritualistic patterns to: 1. Establish a sense of identity. 2. Establish control over adults in their environment. 3. Establish sequenced patterns of learning behavior. 4. Establish a sense of security.

4. Toddlers establish ritualistic patterns to feel secure, despite inconsistencies in their environment. Establishing a sense of identity is the developmental task of the adolescent. The toddler's developmental task is to use rituals and routines to help in making autonomy easier to accomplish. Ritualistic patterns do involve patterns of behavior, but they are not utilized to develop learning behaviors.

A 17-year-old is returning to the surgical unit following Luque instrumentation for scoliosis repair. In addition to the usual postoperative care, the nurse knows that initially: a. position changes are made by log rolling. b. assistance is needed to use the bathroom. c. head of bed is elevated to minimize spinal headache. d. passive range of motion is instituted to prevent neurologic injury.

ANS: A After scoliosis repair using a Luque procedure, the adolescent is turned by log rolling to prevent damage to the fusion and instrumentation. The patient is kept flat in bed for the first 12 hours and is not ambulatory until the second or third postoperative day. A urinary catheter is placed. The head of the bed is not elevated until the second postoperative day. Range-of-motion exercises are begun on the second postoperative day.

A toddler, age 16 months, falls down a few stairs. He gets up and "scolds" the stairs as if they caused him to fall. This is an example of which of the following? a. Animism b. Ritualism c. Irreversibility d. Delayed cognitive development

ANS: A Animism is the attribution of lifelike qualities to inanimate objects. By scolding the stairs, the toddler is attributing human characteristics to them. Ritualism is the need to maintain the sameness and reliability. It provides a sense of comfort to the toddler. Irreversibility is the inability to reverse or undo actions initiated physically. He is acting in an age-appropriate manner.

Which of the following defects results in obstruction to blood flow? a. Aortic stenosis b. Tricuspid atresia c. Atrial septal defect d. Transposition of the great arteries

ANS: A Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. Tricuspid atresia results in decreased pulmonary blood flow. The atrial septal defect results in increased pulmonary blood flow. Transposition of the great arteries results in mixed blood flow.

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

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

An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma. The nurse's approach should include which of the following? a. Answer questions with straightforward honesty. b. Avoid discussing the seriousness of the condition. c. Explain that, although the amputation is difficult, it will cure the cancer. d. Help the adolescent accept the amputation as better than a long course of chemotherapy.

ANS: A Honesty is essential to gain the child's cooperation and trust. The diagnosis of cancer should not be disguised with falsehoods. The adolescent should be prepared for the surgery so 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 child is admitted with a suspected diagnosis of Munchausen syndrome by proxy (MSBP). An important consideration in the care of this child is: a. monitor the parents whenever they are with the child. b. reassure parents that the cause of the disorder will be found. c. teach the parents how to obtain necessary specimens. d. support parents as they cope with diagnosis of a chronic illness.

ANS: A MSBP refers to an illness that one person fabricates or induces in another. The child must be continuously observed for development of symptoms to determine the cause. MSBP is caused by an individual harming the child for the purpose of gaining attention. Nursing staff should obtain all specimens for analysis. This minimizes the possibility of the abuser contaminating the sample. The child must be supported through the diagnosis of MSBP. The abuser must be identified and the child protected from that individual.

A boy age 4 1/2 years has been having increasingly frequent angry outbursts in preschool. He is aggressive toward the other children and the teachers. This behavior has been a problem for approximately 8 to 10 weeks. His parent asks the nurse for advice. Which of the following is the most appropriate intervention? a. Refer the child for a professional psychosocial assessment. b. Explain that this is normal in preschoolers, especially boys. c. Encourage the parent to try more consistent and firm discipline. d. Talk to the preschool teacher to obtain validation for behavior parent reports.

ANS: A The preschool years are a time when children learn socially acceptable behavior. The difference between normal and problematic behavior is not the behavior, but the severity, frequency, and duration. This child's behavior meets the definition requiring professional evaluation. Some aggressive behavior is within normal limits, but at 8 to 10 weeks this behavior has persisted too long. There is no indication that the parents are using inconsistent discipline. A part of the evaluation is to obtain validation for behavior the parent reports.

A parent of a 7-year-old girl with a repaired ventricular septal defect (VSD) calls the cardiology clinic and reports that the child is just not herself. Her appetite is decreased, she has had intermittent fevers around 38o C (100.4o F), and now her muscles and joints ache. Based on this information you advise the mother to: a. immediately bring the child to clinic for evaluation. b. come to the clinic next week on a scheduled appointment. c. treat the symptoms with acetaminophen and fluids, since it is most likely a viral illness. d. recognize that the child is trying to manipulate the parent by complaining of vague symptoms.

ANS: A These are the insidious symptoms of bacterial endocarditis. Since the child is in a high-risk group for this disorder (VSD repair), immediate evaluation and treatment are indicated to prevent cardiac damage. With appropriate antibiotic therapy, bacterial endocarditis is successfully treated in approximately 80% of the cases. The child's complaints should not be dismissed. The low-grade fever is not a symptom that the child can fabricate.

The nurse is preparing a staff education program about growth and development of an 18-month-old toddler. Which of the following characteristics should the nurse include in the staff education program? Select all that apply. a. Eats well with a spoon and cup b. Runs clumsily and can walk up stairs c. Points to common objects d. Builds a tower of three or four blocks e. Has a vocabulary of 300 words f. Dresses self in simple clothes

ANS: A, B, C, D Tasks accomplished by an 18-month-old toddler include eating well with a spoon and cup, running clumsily, walking up stairs, pointing to common objects such as shoes, and building a tower with three or four blocks. An 18-month-old toddler has a vocabulary of only 10 words, not 300. Toddlers cannot dress themselves in simple clothing until 24 months of age.

An adolescent comes to the school nurse after experiencing shin splints during a track meet. The nurse should offer reassurance that: a. shin splints are expected in runners. b. ice, rest, and nonsteroidal antiinflammatory drugs (NSAIDs) usually relieve pain. c. it is generally best to run around and "work the pain out." d. moist heat and acetaminophen are indicated for this type of injury.

ANS: B Shin splints result when the ligaments tear away from the tibial shaft and cause pain. Actions that have an antiinflammatory effect are indicated for shin splints. Ice, rest, and NSAIDs are the usual treatment. Shin splints are rarely serious, but they are not expected, and preventive measures are taken. Rest is important to heal the shin splints. Continuing to place stress on the tibia can lead to further damage.

A child with a hip spica cast is being prepared for discharge. Recognizing that caring for a child at home is complex, the nurse should include which of the following in the parents' instructions for home care? a. Turn every 8 hours. b. Specially designed car restraints are necessary. c. Diapers should be avoided to reduce soiling of the cast. d. Use abduction bar between legs to aid in turning.

ANS: B Standard seat belts and car seats may not be readily adapted for use by children in some casts. Specially designed car seats and restraints meet safety requirements. The child must have position changes much more frequently than every 8 hours. During feeding and play activities, the child should be moved for both physiologic and psychosocial benefit. Diapers and other strategies are necessary to maintain cleanliness. The abduction bar is never used as an aid for turning. Putting pressure on the bar may damage the integrity of the cast.

The parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should include which of the following? a. Parents can meet all the child's needs. b. Child needs opportunities to play with peers. c. Constant parental supervision is needed to avoid overexertion. d. Child needs to understand that peers' activities are too strenuous.

ANS: B The child needs opportunities for social development. Children are able to regulate and limit their activities based on their energy level. Parents must be encouraged to seek appropriate social activities for the child, especially before kindergarten. The child needs to have activities that foster independence.

An appropriate nursing intervention when caring for a child in traction would be which of the following? a. Removing adhesive traction straps daily to prevent skin breakdown b. Assessing for tightness, weakness, or contractures in uninvolved joints and muscles c. Providing active range-of-motion exercises to affected extremity three times a day d. Keeping child prone to maintain good alignment

ANS: B 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 or 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 infant with congestive heart failure (CHF) has a need for: a. decreased fat. b. increased fluids. c. decreased protein. d. increased calories.

ANS: D Infants with CHF have a greater metabolic rate because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of average infants, yet their ability to take in calories is diminished by their fatigue. The diet should include increased protein and increased fat to facilitate the child's intake of sufficient calories. Fluids must be carefully monitored because of the CHF.

Decreasing the demands on the heart is a priority in care for the infant with congestive heart failure (CHF). In evaluating the infant's status, which of the following is indicative of achieving this goal? a. Irritability when awake b. Capillary refill of more than 5 seconds c. Appropriate weight gain for age d. Positioned in high Fowler position to maintain oxygen saturation at 90%

ANS: C Appropriate weight gain for an infant is indicative of successful feeding and a reduction in caloric loss secondary to the CHF. Irritability is a symptom of CHF. The child also uses additional energy when irritable. Capillary refill should be brisk and within 2 to 3 seconds. The child needs to be positioned upright to maintain oxygen saturation at 90%. Positioning is helping to decrease respiratory effort, but the infant is still having difficulty with oxygenation.

A parent reports to the nurse that her child has inflamed conjunctivae of both eyes with purulent drainage and crusting of the eyelids, especially on awakening. These manifestations suggest: a. viral conjunctivitis. b. allergic conjunctivitis. c. bacterial conjunctivitis. d. conjunctivitis caused by foreign body.

ANS: C Bacterial conjunctivitis has these symptoms. Viral or allergic conjunctivitis has watery drainage. Foreign body causes tearing and pain and usually affects only one eye.

A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracolumbosacral orthotic. The patient asks how long she will have to wear the brace. The appropriate answer is: a. for as long as you have been told. b. most preadolescents use the brace for 6 months. c. until your vertebral column has reached skeletal maturity. d. it will be necessary to wear the brace for the rest of your life.

ANS: C Bracing can halt or slow the progress of most curvatures. They must be used continuously until the child reaches skeletal maturity. Telling the child "For as long as you have been told" does not answer the child's question and does not promote involvement in care. Six months is unrealistic, since skeletal maturity is not reached until adolescence. Once skeletal growth is complete, bracing is no longer effective.

Which of the following statements best describes Duchenne (pseudohypertrophic) muscular dystrophy (DMD)? a. It has an autosomal dominant inheritance pattern. b. Onset occurs in later childhood and adolescence. c. It is characterized by presence of Gower sign, waddling gait, and lordosis. d. Disease stabilizes during adolescence, allowing for life expectancy to approximately age 40 years.

ANS: C DMD is characterized by a waddling gait and lordosis. Gower sign is a characteristic way of rising from a squatting or sitting position on the floor. DMD is inherited as an X-linked recessive gene. Genetic counseling is recommended for parents, female siblings, maternal aunts, and their female offspring. Onset occurs usually between ages 3 and 5 years. DMD has a progressive and relentless loss of muscle function until death by respiratory or cardiac failure.

An appropriate nursing intervention when caring for the child with osteomyelitis is which of the following? a. Encourage frequent ambulation. b. Administer antibiotics with meals. c. Move and turn child carefully and gently to minimize pain. d. Provide active range-of-motion exercises of affected extremity.

ANS: C During the acute phase, any movement of the affected limb causes discomfort to the child. Careful positioning with the affected limb supported is necessary. Weight bearing is not permitted until healing is well under way to avoid pathologic fractures. Intravenous antibiotics are used initially. Food is not necessary with parenteral therapy. Active range of motion would be painful for the child.

Which of the following is a characteristic of a toddler's language development at age 18 months? a. Vocabulary of 25 words b. Use of holophrases c. Increasing level of comprehension d. Approximately one third of speech understandable

ANS: C During the second year of life the comprehension and understanding of speech increase to a level far greater than the child's vocabulary. This is also true for bilingual children, who are able to achieve this linguistic milestone in both languages. The 18-month-old has a vocabulary of approximately 10 words. At this age the child does not use the one-word sentences that are characteristic of 1-year-olds. The child has a very limited vocabulary of single words that are comprehensible.

Although a 14-month-old girl received a shock from an electrical outlet recently, her parent finds her about to place a paper clip in another outlet. Which of the following is the best interpretation of this behavior? a. Her cognitive development is delayed. b. This is typical behavior because toddlers are not very developed. c. This is typical behavior because of inability to transfer knowledge to new situations. d. This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

ANS: C During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. This is typical behavior for a toddler, who is only somewhat aware of a causal relation between events. Her cognitive development is appropriate for her age.

Which of the following serious reactions must the nurse be alert for when administering vaccines? a. Fever b. Skin irritation c. Allergic reaction d. Pain at injection site

ANS: C Each vaccine administration carries the risk of an allergic reaction. The nurse must be prepared to intervene if the child demonstrates signs of a severe reaction. Mild febrile reactions do occur after administration. The nurse includes management of fever in the parent teaching. Local skin irritation may occur at the injection site after administration. Parents are informed that this is expected. The injection can be painful. The nurse can minimize the discomfort with topical analgesics and nonpharmacologic measures.

The nurse is caring for a hospitalized adolescent whose femur was fractured 18 hours ago. The adolescent suddenly develops chest pain and dyspnea. The nurse should suspect which of the following? a. Sepsis b. Osteomyelitis c. Pulmonary embolism d. Acute respiratory tract infection

ANS: C Fat emboli are of greatest concern in individuals with fractures of the long bones. Fat droplets from the marrow are transferred to the general circulation where they are transported to the lung or brain. This type of embolism usually occurs within the second 12 hours after the injury. Sepsis would manifest with fever and lethargy. Osteomyelitis usually is seen with pain at the site of infection and temperature. A child with an acute respiratory tract infection would have nasal congestion, not chest pain.

The nurse at a summer camp recognizes the signs of heatstroke in an adolescent girl. Her temperature is 40° C (104° F). She is slightly confused but able to drink water. Nursing care while waiting for transport to the hospital should include which of the following? a. Administer antipyretics. b. Administer salt tablets. c. Apply towels wet with cool water. d. Sponge with solution of rubbing alcohol and water.

ANS: C Heatstroke is a failure of normal thermoregulatory mechanisms. The onset is rapid with initial symptoms of headache, weakness, and disorientation. Immediate care is relocation to a cool environment, removal of clothing, and application of cool water (wet towels or immersion). Antipyretics are not used because they are metabolized by the liver, which is already not functioning. Salt tablets are not indicated and may be harmful by increasing dehydration. Rubbing alcohol is not used.

Parents bring a 7-year-old to the clinic for evaluation of an injured wrist after a bicycle accident. The parents and child are upset, and the child will not allow an examination of the injured arm. The priority nursing intervention is: a. send the child to radiology so that an x-ray film can be taken. b. initiate an intravenous line and administer morphine for the pain. c. calmly ask the child to point to where the pain is worst and to wiggle fingers. d. have the parents hold the child so that the nurse can examine the arm thoroughly.

ANS: C Initially, assessment is the priority. Since the child is alert but upset, the nurse should work to gain the child's trust. Initial data are gained by observing the child's ability to move the fingers and to point to the pain. Other important observations at this time are pallor and paresthesias. The child needs to be sent to radiology for x-ray film, but initial assessment data need to be obtained. Sending the child to radiology will increase the child's anxiety, making the examination difficult. It is inappropriate to ask parents to restrain their child. These parents are upset about the injury. If restraint is indicated, the nurse should obtain assistance from other personnel.

A child with juvenile idiopathic arthritis (JIA) is started on a nonsteroidal antiinflammatory drug (NSAID). Nursing considerations include: a. monitor heart rate. b. administer NSAIDs between meals. c. check for abdominal pain and bloody stools. d. expect inflammation to be gone in 3 or 4 days.

ANS: C NSAIDs are the first-line drugs used in JIA. Potential side effects include gastrointestinal, renal, and hepatic side effects. The child is at risk for gastrointestinal bleeding and elevated blood pressure. The heart rate is not affected by this drug class. NSAIDs should be given with meals to minimize gastrointestinal problems. The antiinflammatory response usually takes 3 weeks before effectiveness can be evaluated.

Which of the following actions by the school nurse is important in the prevention of rheumatic fever (RF)? a. Encourage routine cholesterol screenings. b. Conduct routine blood pressure screenings. c. Refer children with sore throats for throat cultures. d. Recommend salicylates instead of acetaminophen for minor discomforts.

ANS: C Nurses have a role in prevention, primarily in screening school-age children for sore throats caused by group A streptococci. They can actively participate in throat culture screening or refer children with possible streptococcal sore throats for testing. Routine cholesterol screenings and blood pressure screenings do not facilitate the recognition and treatment of group A hemolytic streptococci. Salicylates should be avoided routinely because of the risk of Reye syndrome after viral illnesses.

A 4-year-old child tells the nurse that she doesn't want another blood sample drawn because "I need all of my insides and I don't want anyone taking them out." Which of the following is the nurse's best interpretation of this? a. Child is being overly dramatic. b. Child has a disturbed body image. c. Preschoolers have poorly defined body boundaries. d. Preschoolers normally have a good understanding of their bodies.

ANS: C Preschoolers have little understanding of body boundaries, which leads to fears of mutilation. The child is not capable of being dramatic at this age. She truly has fear. Body image is just developing in the school-age child. Preschoolers do not have good understanding of their bodies.

The nurse is concerned with the prevention of communicable disease. Primary prevention results from which of the following? a. Hand washing b. Strict isolation c. Immunizations d. Early diagnosis

ANS: C Primary prevention rests almost exclusively with immunizations. Hand washing and isolation are control measures to prevent the spread of disease. Early diagnosis assists in instituting appropriate therapy when available and in preventing spread to others.

The school nurse is concerned about an outbreak of chickenpox because two children at the school have cancer and are immunodeficient from chemotherapy. The nurse should recommend which of the following? a. No precautions necessary b. Acyclovir (Zovirax) to minimize symptoms of chickenpox c. Varicella-zoster immune globulin to prevent chickenpox d. Temporarily stopping chemotherapy to allow immune system to recover

ANS: C Varicella-zoster immune globulin is given to high-risk children to prevent the development of chickenpox. Precautions are necessary. In immunocompromised children, varicella can have significant morbidity and mortality. Acyclovir decreases the severity, not the incidence, of chickenpox. The children are already immunocompromised from the previous round of chemotherapy. Stopping the chemotherapy may allow their white and red blood cell counts to improve, but prophylaxis is necessary.

An 8-year-old child is hit by a motor vehicle in the school parking lot. The school nurse notes that the child is responding to verbal stimulation, but is not moving extremities when requested. The first action the nurse should take is to: a. wait for the child's parents to arrive. b. move the child out of the parking lot. c. have someone notify the emergency medical services (EMS) system. d. help the child stand to return to play.

ANS: C The child was involved in a motor vehicle collision and at this time is not able to move his extremities. The child needs immediate attention at a hospital for assessment of the possibility of a spinal cord injury. Since the child cannot move the extremities, the child should not be moved until the cervical and vertebral spines are stabilized. The EMS team can appropriately stabilize the spinal column for transport. Although it is important to notify the parents, the EMS system should be activated and transport arranged for serious injuries. The only indication to move the child is to prevent further trauma.

After returning from cardiac catheterization, the nurse monitors the child's vital signs. The heart rate should be counted for how many seconds? a. 15 b. 30 c. 60 d. 120

ANS: C The heart rate is counted for a full minute to determine whether arrhythmias or bradycardia is present. Fifteen to thirty seconds are too short for accurate assessment. Sixty seconds is sufficient to assess heart rate and rhythm.

Which of the following is an important nursing consideration when a child is hospitalized for chelation therapy to treat lead poisoning? a. Maintain bed rest. b. Maintain isolation precautions. c. Keep accurate record of intake and output. d. Institute measures to prevent skeletal fracture.

ANS: C The iron chelates are excreted though the kidneys. Adequate hydration is essential. Periodic measurement of renal function is done. Bed rest is not necessary. Often the chelation therapy is done on an outpatient basis. The chelation therapy is not infectious or dangerous. Isolation is not indicated. Skeletal weakness does not result from high levels lead.

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

ANS: C The management of JIA is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of 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.

Essential teaching for adolescents with systemic lupus erythematosus (SLE) include: a. high-calorie diet because of increased metabolic needs. b. home schooling to decrease risk of infections. c. protection from sun and fluorescent lights to minimize rash. d. intensive exercise regimen to build up muscle strength and endurance.

ANS: C The photosensitive rash is a major concern for individuals with SLE. Adolescents who spend time outdoors need to use sunscreens with a high SPF, hats, and clothing. Uncovered fluorescent lights can also cause a photosensitivity reaction. The diet should be sufficient in calories and nutrients for growth and development. The use of steroids can cause increased hunger, resulting in weight gain. This can present additional emotional issues for the adolescent. Normal functions should be maximized. The individual with SLE is encouraged to attend school and participate in peer activities. A balance of rest and exercise is important; excessive exercise is avoided.

Which of the following is a physiologic effect of immobilization on children? a. Metabolic rate increases. b. Venous return improves, since child is in supine position. c. Circulatory stasis can lead to thrombus and embolus formation. d. Bone calcium increases, releasing excess calcium into the body (hypercalcemia).

ANS: C The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. The metabolic rate decreases with immobilization. With the loss of muscle contraction, there is a decreased venous return to the heart. Calcium leaves the bone during immobilization, leading to bone demineralization and increasing the calcium ion concentration in the blood.

After returning from cardiac catheterization, the nurse determines that the pulse distal to the catheter insertion site is weaker. The nurse should do which of the following? a. Elevate affected extremity. b. Notify practitioner of the observation. c. Record data on assessment flow record. d. Apply warm compresses to insertion site.

ANS: C The pulse distal to the catheterization site may be weaker for the first few hours after catheterization, but should gradually increase in strength. Documentation of the finding provides a baseline. The extremity is maintained straight for 4 to 6 hours. This is an expected change. The pulse is monitored. If there are neurovascular changes in the extremity, the practitioner is notified. The site is kept dry. Warm compresses are not indicated.

A 14-year-old is admitted to the emergency department with a fracture of the right humerus epiphyseal plate through the joint surface. The nurse knows that this fracture will: a. create difficulty, since the child is left handed. b. heal slowly, since this is the weakest part of the bone. c. require different management to prevent bone growth complications. d. necessitate complete immobilization of the shoulder for 4 to 6 weeks.

ANS: C This type of fracture (Salter type III) can cause problems with growth in the affected limb. Early and complete assessment is essential to prevent angular deformities and longitudinal growth problems. The difficulty for the child does not depend on the location at the epiphyseal plate. Any fracture of the dominant arm presents obstacles for the individual. Healing is usually rapid in the epiphyseal plate area. Complete immobilization is not necessary. Often these injuries are surgically repaired with open reduction and internal fixation.

Which of the following developmental characteristics does not occur until a child reaches age 2 1/2 years? a. Birth weight has doubled. b. Anterior fontanel is open. c. Primary dentition is complete. d. Binocularity may be established.

ANS: C Usually by age 30 months the primary dentition of 20 teeth is complete. Birth weight doubles at approximately ages 5 to 6 months. The anterior fontanel closes at ages 12 to 18 months. Binocularity is established by age 15 months.

In a child suspected of having Wilms tumor an important priority is: a. intervening to minimize bleeding. b. monitoring temperature for infection. c. ensuring the abdomen is protected from palpation. d. teaching parents how to manage the parenteral nutrition.

ANS: C Wilms tumor, or nephroblastoma, is the most common malignant renal and intraabdominal tumor of childhood. The abdomen is protected and palpation is avoided. Careful handling and bathing are essential to prevent trauma to the tumor site. Before chemotherapy, the child is not myelosuppressed. Bleeding is not usually a risk. Infection is a concern after surgery and during chemotherapy, not before surgery. Parenteral therapy is not indicated before surgery.

At a seminar for parents with preschool-age children the nurse has discussed anticipatory tasks during the preschool years. Which of the following statements by a parent would indicate a correct understanding of the teaching? a. "I should be worried if my 4-year-old child has an increase in sexual curiosity, since this is a sign of sexual abuse." b. "I should expect my 5-year-old to change from a tranquil child to an aggressive child when school starts." c. "I should be concerned if my 4-year-old child starts telling exaggerated stories and has an imaginary playmate, since these could be signs of stress." d. "I should expect my 3-year-old child to have a more stable appetite and an increase in food selections."

ANS: D A 3-year-old exhibits a more stable appetite than during the toddler years and is more willing to try different foods. A 4-year-old child is imaginative and indulges in telling "tall tales" and may have an imaginary playmate; these are normal findings, not signs of stress. Also a 4-year-old has an increasing curiosity in sexuality, which is not a sign of child abuse. A 5-year-old child is usually tranquil, not aggressive like the 4-year-old child.

Which of the following terms is defined as the volume of blood ejected by the heart in 1 minute? a. Afterload b. Cardiac cycle c. Stroke volume d. Cardiac output

ANS: D Cardiac output is defined as the volume of blood ejected by the heart in 1 minute. Cardiac output = Heart rate × Stroke volume. Afterload is the resistance against which the ventricles must pump when ejecting blood (ventricular ejection). A cardiac cycle is the sequential contraction and relaxation of both the atria and ventricles. Stroke volume is the amount of blood ejected by the heart in any one contraction.

A chest x-ray examination is ordered for a child with suspected cardiac problems. The child's parent asks the nurse, "What will the x-ray show about the heart?" The nurse's response should be based on knowledge that the x-ray film will do which of the following? a. Show bones of chest but not the heart b. Evaluate the vascular anatomy outside of the heart c. Show a graphic measure of electrical activity of the heart d. Provide information on heart size and pulmonary blood flow patterns

ANS: D Chest x-ray films provide information on the size of the heart and pulmonary blood flow patterns. The bones of the chest are visible on the chest x-ray film, but the heart and blood vessels are also seen. Magnetic resonance imaging is a noninvasive technique that allows for evaluation of vascular anatomy outside of the heart. A graphic measure of electrical activity of the heart is provided by electrocardiography.

A young child is being treated for giardiasis. Which of the following should the nurse recommend to the child's parent? a. The child can swim in a pool if wearing diapers. b. Cloth diapers should be rinsed in the toilet before washing. c. The parasite is difficult to transmit, so no special precautions are indicated. d. Diapers must be changed as soon as soiled and disposed of in a closed receptacle.

ANS: D Diapers should be changed as soon as soiled and disposed of in a container that is not accessible to children. If a child with giardiasis is in a pool, contamination of the entire pool is a possibility. Disposable diapers should be used for the duration of the infection. When a cloth diaper is rinsed in the toilet, the parasite may be placed on the toilet seat or other area of the bathroom. The parasite can be transmitted to other family members. Treatment may be indicated for up to 1 month to treat parasites that have hatched since treatment began.

The parents of a young child with congestive heart failure (CHF) tell the nurse that they are nervous about giving digoxin. The nurse's response should be based on which of the following? a. It is a safe, frequently used drug. b. Parents lack the expertise necessary to administer digoxin. c. It is difficult to either overmedicate or undermedicate with digoxin. d. Parents need to learn specific, important guidelines for administration of digoxin.

ANS: D Digoxin has a narrow therapeutic range. The margin of safety between therapeutic, toxic, and lethal doses is very small. Specific guidelines are available for parents to learn how to administer the drug safely and to monitor for side effects. Parents may lack the expertise to administer the drug at first, but with discharge preparation, they should be prepared to administer the drug safely.

The psychosocial developmental tasks of toddlerhood include which of the following? a. Development of a conscience b. Recognition of sex differences c. Ability to get along with age-mates d. Ability to delay gratification

ANS: D If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that the toddler is concerned with is the ability to delay gratification. Development of a conscience and recognition of sex differences occur during the preschool years. The ability to get along with age-mates develops during the preschool and school-age years.

The physician suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent which of the following complications? a. Hypoxemia b. Right-to-left shunt of blood c. Decreased workload on left side of heart d. Pulmonary vascular congestion

ANS: D In PDA, blood flows from the higher pressure aorta into the lower pressure pulmonary vein, resulting in increased pulmonary blood flow. This creates pulmonary vascular congestion. Hypoxemia usually results from defects with mixed blood flow and decreased pulmonary blood flow. The shunt is from left to right in a PDA. The closure would stop this. There is increased workload on the left side of the heart with a PDA.

Which of the following statements is correct regarding sports injuries during adolescence? a. Conditioning does not help prevent many sports injuries. b. The increase in strength and vigor during adolescence helps prevent injuries related to fatigue. c. More injuries occur during organized athletic competition than during recreational sports participation. d. Adolescents may not possess insight and judgment to recognize when a sports activity is beyond their capabilities.

ANS: D Injuries occur when the adolescent's body is not suited to the sport or when he or she lacks the insight and judgment to recognize that an activity exceeds his or her physical abilities. More injuries occur when their muscles and body systems (respiratory and cardiovascular) are not conditioned to endure physical stress. Injuries do not occur from fatigue, but rather from overuse. All sports have the potential for injury to the participant, whether the youngster engages in serious competition or in sports for recreation. More injuries occur during recreational sports than during organized athletic competition.

A young boy is found squirting lighter fluid into his mouth. His father calls the emergency department. The nurse taking the call should know that the primary danger is which of the following? a. Hepatic dysfunction b. Dehydration secondary to vomiting c. Esophageal stricture and shock d. Bronchitis and chemical pneumonia

ANS: D Lighter fluid is a hydrocarbon. The immediate danger is aspiration. Acetaminophen overdose, not hydrocarbons, causes hepatic dysfunction. Dehydration is not the primary danger. Esophageal stricture is a late or chronic consequence of hydrocarbon ingestion.

The nurse is assessing a 20-month-old toddler during a well-child visit and notices tooth decay. The nurse should understand that early childhood caries are caused by which of the following? a. Allowing the child to eat citrus foods at bedtime b. A hereditary factor that cannot be prevented c. Poor fluoride supply in the drinking water d. Giving the child a bottle of juice or milk at naptime

ANS: D One cause of early childhood caries is allowing the child to go to sleep with a bottle of milk or juice; as the sweet liquid pools in the mouth, the teeth are bathed for several hours in this cariogenic environment. Eating citrus fruit at bedtime and poor fluoride supply in drinking water do not cause early childhood caries. The problem is not hereditary and can be prevented with proper education.

The parents of a newborn say that their toddler "hates the baby. . . . He suggested that we put him in the trash can so the trash truck could take him away." The nurse's best reply is which of the following? a. "Let's see if we can figure out why he hates the new baby." b. "That's a strong statement to come from such a small boy." c. "Let's refer him to counseling to work this hatred out. It's not a normal response." d. "That is a normal response to the birth of a sibling. Let's look at ways to deal with this."

ANS: D The arrival of a new infant represents a crisis for even the best-prepared toddler. Toddlers have their entire schedule and routines disrupted because of the new family member. The nurse should work with parents on ways to involve the toddler in the newborn's care and to help focus attention on the toddler. The toddler does not hate the infant. This is an expected, normal response to the changes in routines and attention that affect the toddler. The toddler can be provided with a doll to imitate parents' behaviors. The child can care for the doll's needs at the same time the parent is performing similar care for the newborn.

A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. Which of the following is the most appropriate recommendation? a. Punish the child. b. Explain to child that this is wrong. c. Leave the child alone until the tantrum is over. d. Remain close by the child but without eye contact.

ANS: D The best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common during this age-group as the child becomes more independent and overwhelmed by increasingly complex tasks. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The presence of the parent is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over.

A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is which of the following? a. A sign the child is spoiled b. An attempt to exert unhealthy control c. Regression, which is common at this age d. Ritualism, an expected behavior at this age

ANS: D The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain the sameness and reliability. It provides a sense of structure and comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. This does not indicate the child has unreasonable expectations, but rather is part of normal development. Ritualism is not regression, which is a retreat from a present pattern of functioning.

When only one child is abused in a family, the abuse is usually a result of which of the following? a. Child is the firstborn. b. Child is the same gender as the abusing parent. c. Parent abuses child to avoid showing favoritism. d. Parent is unable to deal with the child's behavioral style.

ANS: D The child unintentionally contributes to the abuse. The "fit" or compatibility between the child's temperament and the parent's ability to deal with that behavior style is an important predictor. Birth order and gender can contribute to abuse, although there is not a specific birth order or gender relationship that is indicative of abuse. Being the firstborn or the same gender as the abuser is not linked to child abuse. Avoidance of favoritism is not usually a cause of abuse.

The diagnosis of hypertension depends on accurate assessment of blood pressure (BP). The correct procedure is to: a. assess BP while the child is standing. b. compare left arm with left leg BP readings. c. use a narrow cuff to ensure that the readings are correct. d. measure BP with the child in the sitting position on three separate occasions.

ANS: D The diagnosis of hypertension is made after the BP is elevated on three separate occasions. Take the BP in a quiet area with the appropriate size cuff and the child sitting. Although left arm and left leg BP readings may be compared, it is not the procedure to diagnose hypertension. The appropriate size cuff is indicated. The most common cause of inaccurate readings is the use of a cuff that is too small.

A parent asks the nurse about negativism in toddlers. The most appropriate recommendation is which of the following? a. Punish the child. b. Provide more attention. c. Ask child not to always say "no." d. Reduce the opportunities for a "no" answer.

ANS: D The nurse should suggest to the parent that questions should be phrased with realistic choices rather than yes or no answers. This provides a sense of control for the toddler and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young to comply with requests not to say "no."

The nurse is teaching parents the proper use of a hip-knee-ankle-foot orthosis (HKAFO) for their 4-year-old child. The parents demonstrate basic essential knowledge by stating: a. alcohol will be used twice a day to clean the skin around the brace. b. weekly visits to the orthotist are scheduled to check screws for tightness. c. initially, a burning sensation is expected and the brace should remain in place. d. condition of the skin in contact with the brace should be checked every 4 hours.

ANS: D This type of brace has several contact points with the child's skin. To minimize the risk of skin breakdown and facilitate use of the brace, vigilant skin monitoring is necessary. Alcohol should not be used on the skin. It is drying. Parents are capable of checking and tightening the screws when necessary. If a burning sensation occurs, the brace should be removed. If several complaints of burning occur, the orthotist should be contacted.

A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. The nurse should explain that: a. this cannot be prevented. b. infants do not feel pain as adults do. c. this is not a good reason for refusing immunizations. d. a topical anesthetic, EMLA, can be applied before injections are given.

ANS: D To minimize the discomfort associated with intramuscular injections, a topical anesthetic agent can be used on the injection site. These include EMLA (eutectic mixture of local anesthetic) and vapor coolant sprays. Pain associated with many procedures can be prevented or minimized by using the principles of atraumatic care. Infants have the neural pathways that will indicate pain. Numerous research studies have indicated that infants perceive and react to pain in the same manner as do children and adults. The mother should be allowed to discuss her concerns and the alternatives available. This is part of the informed consent process.

The most common test for diagnosing pinworms in a child is which of the following? a. Lower gastrointestinal (GI) series b. Three stool specimens, at intervals of 4 days c. Observation of presence of worms after child defecates d. Tape placed in perianal area in the morning as soon as child awakens

ANS: D Transparent tape is used to collect pinworms and their eggs from the perianal area in the morning before the child defecates or bathes. Lower GI series is not helpful for diagnosing enterobiasis. Stool specimens are not necessary to diagnose pinworms. Worms will not be visible after child defecates.

The nurse is caring for an immobilized preschool child. Which of the following is helpful during this period of immobilization? a. Encourage wearing pajamas. b. Let child have few behavioral limitations. c. Keep child away from other immobilized children if possible. d. Take child for a "walk" by wagon outside the room.

ANS: D Transporting the child outside of the room by stretcher, wheelchair, or wagon increases environmental stimuli and provides social contact. Street clothes are preferred for hospitalized children. This decreases the sense of illness and disability. The child needs appropriate limits, for both adherence to the medical regimen and developmental concerns. It is not necessary to keep the child away from other immobilized children.

The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is which of the following? a. Notify the physician. b. Place child in Trendelenburg position. c. Apply a new bandage with more pressure. d. Apply direct pressure above catheterization site.

ANS: D When bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure on the vessel puncture. The physician can be notified and a new bandage with more pressure can be applied after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. Trendelenburg position would not be a helpful intervention. It would increase the drainage from the lower extremities.

Which of the following is an important nursing consideration when suctioning a young child who has had heart surgery? a. Perform suctioning at least every hour. b. Suction for no longer than 30 seconds at a time. c. Expect symptoms of respiratory distress when suctioning. d. Administer supplemental oxygen before and after suctioning.

ANS: D When suctioning is indicated, supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia. Suctioning should be done only as indicated and very carefully to avoid vagal stimulation. The child should be suctioned for no more than 5 seconds at a time. Symptoms of respiratory distress are avoided by using appropriate technique.