EVOLVE EXAM 3 PEDS

Congenital heart defects have traditionally been divided into acyanotic or cyanotic defects. Based on the nurse's knowledge of congenital heart defects, this system in clinical practice is A. helpful, because it explains the hemodynamics involved. B. helpful, because children with cyanotic defects are easily identified. C. problematic, because cyanosis is rarely present in children. D. problematic, because children with acyanotic heart defects may develop cyanosis.

D. problematic, because children with acyanotic heart defects may develop cyanosis. This classification is problematic. Children with traditionally named acyanotic defects may become cyanotic, and children with traditionally classified cyanotic defects may be pink at times. The classification does not reflect the blood flow within the heart. Cardiac defects are best described by using the actual pathophysiologic process and mechanism. Children with cyanosis may be easily identified, but that does not help with the diagnosis. Cyanosis is present when children have defects where there is mixing of oxygenated blood with unoxygenated blood.

The school nurse is discussing prevention of acquired immunodeficiency syndrome (AIDS) with some adolescents. Which statement is appropriate to include? a. The virus is easily transmitted. b. The virus is transmitted only through blood. c. Intravenous drug users should not share needles. d. Condoms should be used if a person is sexually active and homosexual.

c. Intravenous drug users should not share needles. Human immunodeficiency virus (HIV) is spread through blood and body fluids. Intravenous needles that have been used should not be shared. They may be contaminated with the virus. The virus is not easily transmitted. It requires direct contact with blood or body fluids on a nonintact skin surface. Body fluids may also transmit the virus. Condoms should be used for both heterosexual and homosexual sex.

A child is coming to the clinic with his parents for a sports physical. Upon reviewing the patient's history, there is a notation that the child has been recently treated six months ago for immune thrombocytopenia purpura (ITP). Based on this notation, the nurse would provide this recommendation? a. The child should not play any sports or participate in any physical activity while in school. b. The child should take art classes rather than participate in sporting events. c. The child will have to repeat blood work before any determination can be made. d. The child can play non-contact sports but will have to be monitored if any bruising or bleeding should occur.

d. The child can play non-contact sports but will have to be monitored if any bruising or bleeding should occur. Contact sports should be avoided in a patient who has had prior treatment for ITP. The nature of ITP being idiopathic, it is important to protect the patient from impending trauma related to contact. However, the child as part of normal growth and development should be able to engage in non-contact sports activities. Being that the treatment was recent and that ITP is idiopathic, prospective management and monitoring should be included in the plan of care at this time.

At which age, is a strong preference exhibited for members of the same sex to engage in play activities rather than play with mixed groups? A. 7 B. 6 C. 8 D. 9

A. 7 At age 7, boys prefer to play with boys and girls prefer to play with girls. At age 6, play is considered to be more independent but showing some degree of socialization. Between the ages of 8 and 9, there is more interest in body-girl relationships and beginning to mix group play.

If a child is being treated with ACE inhibitors as part of the therapeutic regimen for heart failure, which observation is noted would alert the nurse to a potential interaction? A. Diuretic therapy with Aldactone B. Child complains of being slightly dizzy at times C. Maintaining normal urine output D. Blood pressure monitoring at lower end of normal range

A. Diuretic therapy with Aldactone The use of ACE inhibitors in combination with Aldactone, which is a potassium sparing inhibitor can lead to potential hyperkalemia. As such this type of diuretic therapy should not be used. ACE inhibitors typically are not associated with dizziness but continued monitoring for this presentation should be included. Normal urine output is a favorable sign. ACE inhibitors can cause hypotension so continued monitoring would be needed at this point.

What procedure uses high-frequency sound waves obtained by a transducer to produce an image of cardiac structures? A. Echocardiography B. Electrocardiography C. Cardiac catheterization D. Electrophysiology

A. Echocardiography Echocardiography uses high-frequency sound waves. The child must lie completely still. With the improvements in technology, a diagnosis can sometimes be made without cardiac catheterization. Electrocardiography is an electrical tracing of the depolarization of myocardial cells. Cardiac catheterization is an invasive procedure where a catheter is threaded into the heart, a contrast medium is injected, and the heart and its vessels are visualized. Electrophysiology is an invasive procedure where catheters with electrodes record the impulses of the heart directly from the conduction system.

A nurse is presenting a class on injury prevention to parents of preschoolers. Which injuries should the nurse identify as occurring in this age group? (Select all that apply.) A. Falls B. Drowning C. Poisoning D. Sports injuries E. Tricycle and bicycle accidents

A. Falls B. Drowning C. Poisoning E. Tricycle and bicycle accidents Falls occur frequently in preschoolers. Closely monitor playground activities such as climbing jungle-gym. Closely supervise around any water and ensure swimming pools are securely fenced to prevent submersion injury. Place all medications and poisons out of reach and in locked cabinets. Administer medications as a drug, not as candy. Keep poison control phone number by telephone. When riding tricycles and bicycles, children often forget not to ride in the streets. Sports injuries occur in older children.

Parents are concerned about the behavior of their preschool child as he is exhibiting aggressive behavior in interactions with other children. Which information would be relevant in determining if the behavior represents an abnormal pattern? (Select all that apply.) A. How many times this type of behavior has occurred in recent weeks? B. Does the behavior seem to be escalating? C. How long has this behavior been going on? D. Do you think that the behavior is warranted considering the situation that has occurred?

A. How many times this type of behavior has occurred in recent weeks? B. Does the behavior seem to be escalating? In terms of making an evaluation as to whether or not this aggressive behavior is a problem, the nurse would want to obtain information related to quantity, severity, distribution, onset and duration. Asking the parent if they think the behavior is justified given the situation does not address any of the aforementioned variables of concern but rather reflects a judgment value.

A child is brought into the hospital following a fire at his home. The child appears to be sleeping on the stretcher bed. No observable burn injuries are noted based on preliminary survey. However, the nurse would place a priortiy observation on the possiblity of the child having? A. Inhalation Injury B. Thermal burns C. Decreased metabolism leading to hypovolemic shock D. Chemical burns

A. Inhalation Injury Inhalation injury in the form of carbon monoxide poisoning or smoke inhalation should be considered in this situation. It is critical for the nurse to make these observations in order to prevent further complications. Thermal and chemical burns would cause evident tissue destruction which would be foun on preliminary survery. In burn states, incresaed metabolism would occur.

The school nurse is teaching a class on safety. Which activities require protective athletic gear? (Select all that apply.) A. Lacrosse B. Football C. Swimming D. Gymnastics E. Skateboarding

A. Lacrosse B. Football E. Skateboarding Any sport that involves body contact such as lacrosse, football, and skateboarding requires a child to wear protective equipment. Swimming does not involve body contact and requires no protective equipment. Gymnastics does not require protective equipment.

Examination of a child's mouth reveals that teeth do not line up properly upon attempts to have the child bite down. This finding is noted as? A. Malocclusion B. Gingivitis C. Evidence of dental caries D. Dental injury

A. Malocclusion Malocclusion occurs when upper and lower teeth do not approximate when a child bites down. Gingivitis refers to inflammation of the gums. Evidence of dental caries would refer to the presence of a cavity. Dental injury refers to evidence of chipping or dislocation as a result of trauma.

Based on the nurse's knowledge of wounds and wound healing, what are factors that can delay or cause dysfunctional wound healing? (Select all that apply.) A. Overweight B. Hypoxemia C. Hypervolemia D. Prolonged infection E. Corticosteroid therapy

A. Overweight Correct E. Corticosteroid therapy Correct Poor nutrition without proper protein and calorie intake affects healing more than being overweight itself. Corticosteroid therapy or other immunocompromising therapy prevents macrophages from migrating to the site of injury, thus suppressing epithelialization. Hypovolemia, not hypervolemia, inhibits wound healing due to low circulating blood volume and oxygenation of tissues. Hypoxemia makes tissues more susceptible to infection due to insufficient oxygenation. Prolonged infection affects the healing process and causes increased scarring.

A child has sustained an injury and lost a primary tooth. Which priority action should be taken by the nurse at this time? A. Provide comfort measures and assess for bleeding. B. Referral to the dentist for immediate consultation. C. Recover the tooth and prepare for reimplantation. D. If the tooth is dirty, rinse it off and cover in gauze until needed for reimplantation.

A. Provide comfort measures and assess for bleeding. Avulsed primary teeth are usually not reimplanted. Therefore the nurse should focus on assessment of the site and comfort measures. All of the other options would be indicated if an avulsed tooth were to be reimplanted.

The nurse is caring for a 12-year-old who sustained major burns when putting charcoal lighter on a campfire. The nurse observes that the child is "very brave" and appears to accept pain with little or no response. What is the most appropriate nursing action related to this? A. Request a psychological consultation. B. Ask the child why the child does not have pain. C. Praise the child for the ability to withstand pain. D. Encourage continued bravery as a coping strategy.

A. Request a psychological consultation A psychological consultation will assist the child in verbalizing fears. This age group is very concerned with physical appearance. The psychologist can help integrate the issues the child is facing. It is likely that the child is having pain but not acknowledging the pain. Speaking with a psychologist might assist the child in relaying his or her fears and pain. If the child is feeling pain, the nurse should not praise the child for hiding the pain. The nurse should encourage the child to speak up during painful episodes so that the pain can be managed appropriately. Bravery may not be an effective coping strategy if the child is in severe pain.

What is an early sign of congestive heart failure that the nurse should recognize? A. Tachypnea B. Bradycardia C. Inability to sweat D. Increased urinary output

A. Tachypnea Tachypnea is one of the early signs of congestive heart failure that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child may be diaphoretic if experiencing congestive heart failure. There will usually be decreased urinary output in a child experiencing congestive heart failure.

Which is descriptive of the nutritional requirements of preschool children? A. The quality of the food consumed is more important than the quantity. B. Nutritional requirements for preschoolers are different from requirements for toddlers. C. The requirement for calories per unit of body weight increases slightly during the preschool period. D. The average daily intake of preschoolers should be about 3000 calories.

A. The quality of the food consumed is more important than the quantity. It is essential that the child eat a balanced diet with essential nutrients; the amount of food is less important than the quality of the food. Requirements are similar for both toddlers and preschoolers. The caloric requirement decreases slightly for preschoolers. The average intake is about 1800 calories each day for preschoolers.

Which statement is correct about young children who report sexual abuse by one of their parents? A. They may exhibit various behavioral manifestations. B. In most cases, the child has fabricated the story. C. Their stories are not believed unless other evidence is apparent. D. They should be able to retell the story the same way to another person.

A. They may exhibit various behavioral manifestations. There is no diagnostic profile of the child who is being sexually abused. Many different behavioral manifestations may be exhibited, from outward sexual behaviors with others to withdrawal and introversion. It is never appropriate to assume that a child has fabricated the story of sexual abuse. Adults are reluctant to believe children, and sexual abuse often goes unreported. Physical examination is normal in approximately 80% of abused children. The child will usually try to protect their parents and may accept responsibility for the act.

The nurse should explain to the parents that their child is receiving furosemide (Lasix) for severe congestive heart failure because of its effects as A. a diuretic. B. a beta-blocker. C. a form of digitalis. D. an ACE inhibitor.

A. a diuretic. Furosemide is a loop diuretic used to eliminate excess water and salt to prevent the accumulation of fluid associated with congestive heart failure.

The nurse is preparing to give digoxin (Lanoxin) to a 9-month-old infant. The nurse checks the dose; 4 ml of the drug is to be drawn up. Based on the nurse's knowledge of this medication and safe pediatric dosages, the most appropriate action by the nurse is A. do not draw-up dose; suspect dosage error. B. mix dose with juice to disguise its taste. C. check heart rate; administer dose by placing it to the back and side of mouth. D. check heart rate; administer dose by letting infant suck it through a nipple.

A. do not draw-up dose; suspect dosage error. Digoxin is often prescribed in micrograms. Rarely is more than 1 ml administered to an infant. As a potentially dangerous drug, digoxin has precise administration guidelines. Some institutions require that digoxin dosages be checked with another professional before administration. The nurse has drawn up too much medication and should not give it to the child. Administration procedures as described are correct, but too much medication is prepared, so it should not be given to the child.

A parent is concerned as her 6-year-old child "cheats" when playing games with other children. The parent is concerned that this behavior will affect future behaviors as the child gets older. The nurse understands the parent's anxiety about the described behavior and provides the following assurance A. this type of behavior occurs around this age period and is due to the child B. this is a prompted behavior that occurs intermittently at this age. C. you are right to be concerned about this type of behavior. D. it is best to ignore the behavior as it will stop eventually

A. this type of behavior occurs around this age period and is due to the child Cheating as a behavior occurs primarily between the ages of 5 and 6. It is almost at times displayed as an automatic behavior as the child does not understand about winning and losing. The behavior typically goes away as the child matures. Ignoring the behavior without some direction is not advised as it is best to address the situation and help the child to begin understanding of the concept.

A finding that is consistent with prepubescence is A. variation in physical appearance between boys and girls. B. age of onset of physical signs is the same for both boys and girls. C. does not occur during the preadolescence period. D. appearance of secondary sex characteristics is the same for both boys and girls.

A. variation in physical appearance between boys and girls. During the period of prepubescence there is a variation in physical appearance between boys and girls. The age of onset of these appearances also varies with girls exhibiting changes earlier than their male counterparts. The changes occur during the preadolescence period. Secondary sex characteristics also present at different times for boys and girls.

Which action would indicate a priority for the nurse in terms of health promotion safety? A. 8-year-old child uses helmet protection while riding a bicycle. B. 4-year-old child wears protective equipment while on a skateboard. C. School-age child uses car seat restraint system. D. Protective equipment is used while the 9-year-old child is riding a scooter.

B. 4-year-old child wears protective equipment while on a skateboard. Skateboard use is not recommended for children aged 5 and younger regardless if they are wearing protective equipment. All of the other options indicate that attention has been placed on safety concerns and that the children are developmentally appropriate to handle the physical skill activity.

What is the most important nursing consideration in the management of cellulitis? A. Application of Burow solution compresses B. Administration of oral or parenteral antibiotics C. Topical application of an antibiotic D. Incision and drainage of severe lesions

B. Administration of oral or parenteral antibiotics Oral or parenteral antibiotics are indicated depending on the extent of the cellulitis. Warm water compresses may be indicated for limited cellulitis. Antibiotics need to be administered systemically (orally or parenterally), not topically. If incision and drainage are implemented, there is a risk of spreading infection or making the lesion worse.

Which statement is not accurate regarding the roles and responsibilities of a school nurse? A. They are responsible for development and implementation of plans of care for all children within the designated school. B. All school nurses are registered nurses. C. They are responsible for medical needs of the children within the designated school. D. They evaluate implementation of care delivered to children within the designated school setting.

B. All school nurses are registered nurses. Not all schools have a school nurse but may have unlicensed assistive personnel that work within the school setting that have received training to provide routine standardized care under the supervision of a school nurse. The other options are all within the roles and responsibilities of a school nurse.

Which is descriptive of the social development of school-age children? A. Identification with peers is minimal B. Children frequently have "best friends" C. Boys and girls play equally with each other D. Peer approval is not yet an influence toward conformity

B. Children frequently have "best friends" Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid. Identification with the peer group is an important milestone for the school-age child to move toward independence from families. During the school-age years, same-sex peer groups are more prevalent; therefore, there is less interaction between boys and girls. Conforming to the rules is an essential part of group membership and, therefore, an important skill for the school-age child to learn in terms of peer relationships

At what age would orthodontic treatment be considered to have the most potential for successful outcome? A. When the adolescent growth period has stopped. B. Early referral if malocclusion presents regardless of age. C. Treatment differs based on gender due to difference in growth and development. D. When all primary teeth are present.

B. Early referral if malocclusion presents regardless of age. If malocclusion is present, best practice would be to have early referral for evaluation and treatment. Orthodontic treatment should be started prior to the growth period stopping. Orthodontic treatment is based on individual presentation and not gender based variables. Orthodontic treatment is typically not started when all primary teeth are still present.

A physician suspects that a child may have congenital cardiac disease. Which noninvasive diagnostic procedure would help to confirm the possibility of heart disease? A. EKG B. Echocardiogram C. Chest x-ray D. Pulse oximetry

B. Echocardiogram An echocardiogram is the most common test used to identify either a cardiac anomaly or evidence of heart disease. EKG provides evidence of electrical system conduction. Pulse oximetry provides information relative to perfusion. And a chest x-ray focuses on lungs and airway exchange, it may not be sensitive and specific to determine cardiac pathology.

Which action would improve dental health in the school-age child? A. Limiting brushing of teeth to three times a day following meals. B. Encouraging the child to floss. C. Have the parent brush the child's teeth in order to make sure it is done properly. D. Have the child consume fruit juice rather than soda.

B. Encouraging the child to floss Flossing is a critical activity that has been shown to improve dental health. Brushing teeth following meals as well as following snacks has also been shown to improve dental health. At this age, the child should be able to brush their own teeth. Whereas soda should be avoided, the use of fruit juice may contribute to dental caries as it is considered to be a sugar source and example of a fermentable carbohydrate. Water as a drink should be promoted to improve dental health.

Which observation is associated with nightmares as opposed to sleep terrors? A. Child has no memory of the event or dream like state. B. Has a hard time returning to sleep following the event. C. Thrashing type behaviors continue when the child awakens. D. Is not comforted by traditional methods of contact

B. Has a hard time returning to sleep following the event. Nightmares are associated with difficulty returning to sleep as opposed to sleep terrors where the individual easily goes back to sleep. With the advent of a nightmare, the child has a memory of the dream like state, is comforted by traditional methods of contact and thrashing type behaviors cease upon awakening. In sleep terrors, the child has no memory of the event, continues thrashing behaviors when awaken, and is not comforted by traditional methods of contact.

A 4-year-old child is seen playing with his father while waiting in the clinic area for a well checkup visit. The nurse observing the interaction notes that this behavior as being an example of? A. Imaginative play B. Mutual play C. Dramatic play D. Avoidance play

B. Mutual play Children playing with a parent is an example of mutual play. Play can be described as being imaginative or dramatic as a characteristic but there is no specific information given that defines the type of play interaction that is occurring. The concept avoidance play does not exist as a characteristic term describing play behaviors.

Which benchmark serves as the ending period for the middle year period of development? A. Beginning school B. Onset of puberty C. Wisdom teeth appearing D. Loss of deciduous teeth

B. Onset of puberty The onset of puberty signals the end of the middle year period. Beginning school and loss of deciduous teeth are associated with the beginning of the middle year period. Appearance of wisdom teeth occurs later on in life.

When preparing parents to teach their preschool child about human sexuality, what should the nurse emphasize? A. A parent's words may have a greater influence on the child's understanding than the parent's actions. B. Parents should determine exactly what the child wants to know before answering a question about sexuality. C. Parents should avoid using correct anatomic terms because they are confusing to the preschooler. D. Parents should encourage preschoolers to satisfy their sexual curiosity by playing "doctor."

B. Parents should determine exactly what the child wants to know before answering a question about sexuality. It is important that the parent answer the question that the child is asking. Actions may have a greater influence because language is not fully developed in the preschool years. Using correct terminology lays the foundation for later discussion of human sexuality. Parents should encourage children to ask questions to provide accurate information at their cognitive level.

A child has been stung by a bee and the parents call the walk in clinic asking for instructions on what to do as they make their way to the clinic. The nurse responds by stating? A. Tell the parents to remove all of the child's clothing and apply warm water to the affected area. B. Remove the stinger from the site. C. Encourage the child to take slow deep breaths to minimize associuated anxiety that has occured due to the event. D. Have the parents offer the child water.

B. Remove the stinger from the site. First action is to remove the stinger, then cleanse the area with soap and water and apply a cool compress. There is no need to remove the child's clothing or provide fluid hydration. There is no indication tha the child is experiencing any evidence of anxiety provided by the parent's communication.

A child is brought to the emergency department after falling down the basement stairs. On assessment, what findings may cause the nurse to suspect child abuse? (Select all that apply.) A. The child's bruises are located only on the right arm and leg. B. The child is brought to the emergency department by an unrelated adult. C. The child has a history of a broken arm last year from falling off a swing. D. The child's caregiver is anxious that the child get immediate medical attention. E. The child has red, green, and yellow bruises on more than one plane of the body.

B. The child is brought to the emergency department by an unrelated adult. Correct E. The child has red, green, and yellow bruises on more than one plane of the body. Correct A child brought to a health care provider for a trauma or suspicious injury by an unrelated adult or if the primary care provider is totally unavailable is a warning sign of abuse. Varying degrees of healing of bruises in more than one plane of the body is a warning of abuse. Falling down stairs can be an unintentional injury. A child with an isolated documented injury is not a warning sign of abuse. Multiple fractures of differing ages are a warning sign of abuse. An anxious caregiver is a normal response for an injured child. A delay in seeking care is a warning sign of abuse.

A mother tells the nurse that her daughter's favorite toy is a large, empty box that contained a stove. She plays "house" in it with her toddler brother. Based on the nurse's knowledge of growth and development, the nurse recognizes that this is A. unsafe play that should be discouraged. B. creative play that should be encouraged. C. suggestive of limited family resources. D. suggestive of limited adult supervision.

B. creative play that should be encouraged. This type of play should be encouraged. After children create something new, they can then transfer it to other situations. There should be some supervision to prevent injury or accidents. As long as the play is supervised, it should be encouraged. This is not considered unsafe play. There is no indication of limited resources. There is no indication of limited adult supervision.

During the rehabilitative phase of care, pressure dressings are primarily applied to burned areas to A. relieve pain. B. decrease blood supply to scar. C. limit motion during the healing process. D. encourage healing through scar formation.

B. decrease blood supply to scar. Uniform pressure to the scar decreases the blood supply. The use of pressure garments serves to decrease the blood supply to the hypertrophic tissue. This is done to prevent scarring and contractures. The goal of the pressure dressing is to improve the appearance of scars by decreasing the blood supply to the area. Motion is encouraged because it prevents contractures. Movement should take place to the point of pain, but no further. The goal of the pressure dressing is to minimize the development of scar tissue.

After a patient returns from cardiac catheterization, the nurse notes that the pulse distal to the catheter insertion site is weaker (+1). The most appropriate nursing intervention is to A. elevate the affected extremity. B. document the findings and continue to monitor. C. notify the health care provider of the finding. D. apply warm compresses to the insertion site.

B. document the findings and continue to monitor. The pulse distal to the catheter insertion site may be weaker for the first few hours after catheterization. It should gradually increase in strength. The extremity is kept straight and immobile, but elevation is not necessary. Because a weaker pulse is an expected finding, the nurse should document it and continue to monitor it. There is no need to notify the physician. The insertion site is kept dry. Warm compresses would increase the risk of bleeding from the insertion site.

An important consideration in preventing injuries during middle childhood is that A. peer pressure is not strong enough to affect risk-taking behavior. B. most injuries occur in or near school or home. C. injuries from burns are the highest at this age because of fascination with fire. D. lack of muscular coordination and control results in an increased incidence of injuries

B. most injuries occur in or near school or home. Most children in the middle years spend the majority of their time in and around school or home; therefore, the risk for injuries is increased in and around these areas. Peer pressure as an impetus for risk-taking behavior begins in the school-age years but is more significant in adolescence. Burn injuries are higher in the toddler years, when children are curious and mobile. They may expose themselves to objects capable of burning them (e.g., hot pots of water in the kitchen). Automobile accidents, either as a pedestrian or passenger, account for the majority of severe accidents in the middle years. School-age children have more refined muscle development, which results in an overall decrease in the number of accidents. Lack of muscular coordination and control leading to injuries occurs in younger children.

In reviewing information about a school-age child, the nurse notes that the child goes to after school activities each day as the parents do not get home until considerably later in the day. Based on this description, the nurse would document A. concern for the growth and development due to lack of parental influence. B. no further action is needed. C. referral to a social worker for evaluation of the family unit. D. notation of being a latchkey child.

B. no further action is needed. Many children have working parents and do not exhibit any adverse outcomes if they attend after school activities each day following release from school. There is no need for referral to a social worker. A latchkey child by definition is one that has no parental or supervision contact following the school day and are responsible for their own care until the parent comes home. .

The best approach for effective communication with a preschooler is through A. speech. B. play. C. drawing. D. actions.

B. play. Preschoolers' most effective means of communication is through play. Play allows preschoolers to understand, adjust to, and work out life's experiences through their imagination and ability to invent and imitate. Speech is not effective, because preschoolers assume that everyone thinks as they do and that a brief explanation of their thinking makes them understood by others, which is often not true. Also, preschoolers often do not understand the meaning of words and often take statements literally. Drawing is still being developed as a fine motor skill; therefore, it is not the most effective means of communication. Actions are not an appropriate means of communication for a preschooler.

A 4½-year-old boy has been having increasingly frequent angry outbursts in preschool for approximately 8 to 10 weeks. In addition, he is aggressive toward the other children and teachers. His parents ask the nurse for advice. The most appropriate nursing intervention is to A. explain that this is normal in preschoolers, especially boys. B. refer the child for counseling. C. talk to the preschool teacher to obtain validation for the behavior the parent reports. D. encourage the parent to try more consistent and firm discipline.

B. refer the child for counseling. This is not expected behavior. The child should be referred to a competent professional to deal with his aggression so that an accurate assessment can be made and a care plan determined. Outward aggression to others is not normal behavior and should be evaluated. The validation will be helpful for the referral, but the referral is the priority action. This may be recommended by the professional once an accurate assessment is made.

Signs and symptoms that are associated with stress in a school-age child that require intervention are (Select all that apply.) A. child not wanted to go to sleep occasionally at the usual bedtime. B. reverting to a previous behavioral pattern exhibited several years ago. C. bedwetting. D. doesn't want to eat a certain food although the child has ate it before. E. doesn't want to go outside and prefers to remain in his bedroom each day after school but previously had been extremely sociable.

B. reverting to a previous behavioral pattern exhibited several years ago. C. bedwetting. E. doesn't want to go outside and prefers to remain in his bedroom each day after school but previously had been extremely sociable. Reverting to a previous behavior indicative of regression, evidence of bedwetting and change in socialization pattern as signs and symptoms of stress should be investigated as they are signal areas of concern. Occasional reluctance to go to sleep at the regularly scheduled bedtime may be an isolated event which is self-limiting. Refusal to eat a food even if the child ate the food before is not by itself indicative of a significant stress event.

Kimberly, age 4 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 most likely scenario is A. nightmares. B. sleep terrors. C. seizure activity. D. sleep apnea.

B. sleep terrors. In sleep terrors, the child is only partially aroused; therefore, she does not remember her parents' presence. A nightmare is a frightening dream followed by full awakening; therefore, the child would realize that her parents are present. The description of the child's experience does not indicate the presence of seizure activity. Sleep apnea is a cessation of breathing during sleep

A parent tells the nurse, "I am worried about my 13-year-old son. He hasn't started puberty, and my daughter did when she was 11 years of age." The most appropriate explanation by the nurse is A. "This is unusual and requires further evaluation of your son." B. "This is unusual because the onset of pubescence is usually the same in siblings." C. "This is normal because the onset of pubescence is usually earlier in girls than it is in boys." D. "This is abnormal because the onset of pubescence is usually earlier in boys than it is in girls."

C. "This is normal because the onset of pubescence is usually earlier in girls than it is in boys." Girls begin puberty on average approximately 2 years before boys. Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, no further evaluation is necessary at this time. The age of pubescence is gender related, with the average age of puberty onset being 12 years for girls and 14 years for boys. Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, her son is not having an abnormal onset of puberty.

A diagnosis of rheumatic fever is being ruled out for a child. Which lab test(s) is/are the most reliable? (Select all that apply.) A. Throat culture B. C-reactive protein (CRP) C. Antistreptolysin-O titer (ASO) titer D. Elevated white blood count (WBC) E. Erythrocyte sedimentation rate (ESR)

C. Antistreptolysin-O titer (ASO) titer The most reliable and best standardized lab for antistreptococcal antibodies is an Antistreptolysin-O (ASO) titer. A throat culture indicates a current streptococcal infection. C-reactive protein (CRP) lab test indicates inflammation. An elevated white blood count (WBC) may indicate a possible infection but does not indicate a causative agent. An erythrocyte sedimentation rate (ESR) indicates inflammation.

A 10-year-old child is riding a bicycle on the grounds of the school. Which finding if observed by the school nurse would require intervention? A. Child is seen walking the bicycle through the crosswalk. B. Child is riding close to the curb. C. Child's shoes are ill fitting. D. Child is riding single file.

C. Child's shoes are ill fitting. Shoes that are ill fitting can result in potential injury as they can get caught up in gears and affect the ability of the child to navigate. All of the other observed behaviors are consistent with safe practice.

What should the nurse include when giving parents guidelines about helping their children in school? A. Help children as much as possible with their homework. B. Punish children who fail to perform adequately. C. Communicate with teachers if there appears to be a problem. D. Accept responsibility for children's successes and failures.

C. Communicate with teachers if there appears to be a problem. Parents should communicate with teachers if there is a problem and not wait for a scheduled conference. Parent involvement is one factor in children's success in school. Children need to do their own homework. This cultivates responsibility. Discipline should be used to help children control behaviors that might be affecting school performance, but failure to perform adequately should not be punished itself. Communicating with the child is a better solution to getting to the "root" of the school performance problem. School-age children need to develop responsibility. Keeping promises and meeting deadlines lays a successful foundation for adulthood and adult responsibilities.

A middle age child understands that with regards to a mathematical equation that 7 can be composed of 4+3 as well as 2+5. Based on this finding, the nurse documents that the development level of the child reflects? A. Concrete operations B. Verification of latency period C. Conservation D. Accomplished industry versus inferiority

C. Conservation Piaget's cognitive theory development describes conservation as the ability of the child to understand that the same concept may exist as identified by a different method. Numerical relationships are understood before substance conservation. Concrete operations is the term Piaget applies to the entire stage whereby children are able to use thought processes to experience events and actions. The latency period is described by Freud as the ability of the child to go from peer relationships to heterosexual relationships. Industry versus inferiority refers to Erikson's overview of this time frame whereby children if successful master the challenges between industry and inferiority.

What is an important nursing responsibility when a dysrhythmia is suspected? A. Order an immediate electrocardiogram. B. Count the radial pulse every 1 minute for five times. C. Count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate. D. Have someone else take the radial pulse simultaneously with the apical pulse.

C. Count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate. This is the nurse's first action. If a dysrhythmia is occurring, the radial pulse rate may be lower than the apical pulse rate. This may be indicated after conferring with the practitioner. The radial pulse rate needs to be compared with the apical pulse rate. It does not need to be counted for 1 minute five times. Only one nurse is needed to carry out this action.

The school nurse is discussing dental health with some children in first grade. Which should be included? A. Teach how to floss teeth properly. B. Recommend a toothbrush with hard nylon bristles to get in between the teeth. C. Emphasize the importance of brushing before bedtime. D. Recommend nonfluoridated toothpaste.

C. Emphasize the importance of brushing before bedtime. Children should be taught to brush their teeth after meals and snacks and before bedtime to prevent dental caries. Parents should help with flossing until children develop the dexterity required, when they are in about the third grade. A toothbrush with soft nylon bristles is recommended to prevent damage to the gums. The American Dental Association recommends fluoridated toothpaste for this age-group

Which behavior is most characteristic of the concrete operations stage of cognitive development? A. Progression from reflex activity to imitative behavior B. Inability to put oneself in another's place C. Increasingly logical and coherent thought processes D. Ability to think in abstract terms and draw logical conclusions

C. Increasingly logical and coherent thought processes Increasingly logical and coherent thought processes are characteristic of concrete operations. Children in this stage are able to classify objects. Progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage, which occurs from birth to 2 years of age. Inability to put oneself in another's place is characteristic of the preoperational stage, ages 2 to 7 years. Adolescents, in the formal operations stage, have the ability to think in abstract terms and draw logical conclusions.

The nurse is giving anticipatory guidance to the parent of a 5-year-old. What is the most appropriate information to include? A. Prepare the parent for increased aggression. B. Encourage the parent to offer the child choices. C. Inform the parent that he or she can expect a more tranquil period at this age. D. Advise the parent that this is the age when stuttering may develop.

C. Inform the parent that he or she can expect a more tranquil period at this age. The end of preschool and the beginning of school age is a more tranquil period. Preparing the parent for increased aggression is anticipatory guidance for 4-year-old children. Encouraging the parent to offer the child choices is anticipatory guidance for 3-year-old children. Advising the parent that this is the age when stuttering may develop is anticipatory guidance for 3-year-old children.

Which statement by a student nurse indicates that additional instruction is needed regarding topical agents being used to treat burns? A. They eliminate bacterial growth but do not remove the bacteria from the skin B. They are not considered to be toxic substances C. They are associated with electrolyte derangement of surronding tissues D. They are able to penetrate through eschar levels to reach the wound

C. They are associated with electrolyte derangement of surrounding tissues Topical agents used in the treatment of burns should provide minimal electrolyte derangement. The other options stated are all consistent with the expceted actions of topical agents uised in the treatment of burns.

Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. Which should the nurse consider when discussing this issue with the parents? A. Changing self-esteem is difficult after about age 5 years. B. Self-esteem is the objective judgment of one's worthiness. C. Transitory periods of lowered self-esteem are expected developmentally. D. High self-esteem develops when parents show adequate love for the child.

C. Transitory periods of lowered self-esteem are expected developmentally Self-esteem changes with development. Transient declines are expected and, with positive encouragement and support, are only temporary. Self-esteem is influenced throughout adolescence. One aspect of self-esteem is a subjective judgment of one's worthiness. Self-esteem is based on several factors, including competence, sense of control, moral worth, and worthiness of love and acceptance

A parent calls the health clinic stating that her child was just exposed to poison ivy and asks what she should do to prevent further complications? A. Have the parent contact the Health Department so they will be aware of a possible outbreak of this event. B. Quarnetine the child until the rash disappears as the child is considered to be contagious. C. Wash the exposed area of contact with cold water to neutralize effects of oil exposure. D. Suggest to the parent that a tetanus booster is necessary to prevent further complications from this puncture exposure

C. Wash the exposed area of contact with cold water to neutralize effects of oil exposure. Best practice if this is a recent exposure is to wash the affected area with cold running water to minimize the effects by neutralizing the oil and possible bonding to skin areas. The Health Deparment does not have to be contacted as this is not considredd to be a public health issues. The child does not have to be quarentined as posion ivy can only be spread by direct contact of oils assocaited with the plant. Tetanus booster is not required as this is associated with contact and not puncture.

The parents of 9-year-old twins tell the nurse, "They have filled up their bedroom with collections of rocks, shells, stamps, and cars." The nurse should recognize that this behavior is characteristic of A. giftedness. B. typical "twin" behavior. C. cognitive development at this age. D. psychosocial development at this age.

C. cognitive development at this age. Classification skills are developed during the school-age years. This age-group enjoys sorting objects according to shared characteristics. Giftedness is not measured simply by a school-age child's ability to classify objects, which is an expected cognitive skill for this age-group. Giftedness signs include specific academic aptitudes, advanced memory skills, creative thinking, ability in the visual or performing arts, and psychomotor ability, either individually or in combination. The development of classification skills is characteristic of the school-age child and is not related to the behavior of twins. Psychosocial development of the school-age child is focused on accomplishment or industry, not the cognitive skills of classification that are described.

The goals of therapeutic management for congestive heart failure is to A. increase afterload and perfusion to tissues. B. decrease preload and increase afterload. C. decrease preload, afterload and increase contractility. D. decrease contractility and increase preload and afterload

C. decrease preload, afterload and increase contractility. Treatment goals for congestive heart failure are aimed at decreasing preload (volume), afterload (resistance) and increasing contractility (improving efficiency).

Nursing interventions to promote health during middle childhood should include stressing the need for increased calorie intake to meet the A. increased demands on the body. B. instructing parents to defer questions about sex until the child reaches adolescence. C. educating the child and parents about the need for effective dental hygiene because these are the years in which permanent teeth erupt. D. advising parents that the child will need decreasing amounts of rest toward the end of this period.

C. educating the child and parents about the need for effective dental hygiene because these are the years in which permanent teeth erupt. Because the permanent teeth are present, it is important for the child to learn how to care for these teeth. Caloric needs are diminished in relation to body size during the middle years; however, a balanced diet is important to prepare for the adolescent growth spurt. Parents should approach sex education with a life span approach and answer questions appropriate to the child's age. School-age children often need to be reminded to go to sleep.

The preschooler's body image has developed to include A. a well-defined body boundary. B. knowledge about his or her internal anatomy. C. fear of intrusive procedures. D. fear of looking different from his or her friends.

C. fear of intrusive procedures. Preschoolers fear that their insides will come out with intrusive procedures. Preschoolers have poorly defined body images. Preschoolers have little or no knowledge of their internal anatomy. The fear of looking different is a concept that occurs in later school-aged children and adolescents.

The two rules used to provide sensitive information to a preschooler focus on A. describing the information in a succinct way and answering any questions. B. ask the child if he/she understands what you have told them and then clarify any additional questions. C. find out what they know and think and then be honest. D. use the opportunity to provide minimal information and keep the level of interaction simple

C. find out what they know and think and then be honest. It is important to find out what they know and think before providing any information and then equally important is to be honest in your communication. The method of providing information may vary based on the type of information being provided and the level of understanding of the child

The parents of a 4½-year-old girl are worried because she has an imaginary playmate. Based on the nurse's knowledge of the preschooler, the most appropriate response is A. a psychosocial evaluation is indicated. B. an evaluation of possible parent-child conflict is indicated. C. having imaginary playmates is normal and useful at this age. D. having imaginary playmates is abnormal after age 2 years.

C. having imaginary playmates is normal and useful at this age. Imaginary playmates are a part of normal development at this age and serve many purposes, including being a friend in times of loneliness, accomplishing what the preschooler is still attempting, and experiencing what the preschooler wants to forget or remember. Because an imaginary playmate is part of normal development, a psychosocial evaluation is not warranted. Because an imaginary playmate is part of normal development, an evaluation of the parent-child relationship is not warranted. Imaginary playmates are commonly present during the preschool years; therefore, they are not abnormal after the age of 2 years.

According to Erikson, the primary psychosocial task of the preschool period is developing a sense of A. identity. B. intimacy. C. initiative. D. industry.

C. initiative. Preschoolers focus on developing initiative. The stage is known as initiative versus guilt. Identity versus role confusion is associated with adolescence. Intimacy versus isolation is associated with young adulthood. Industry versus inferiority is associated with the school-aged child.

Nursing care of the infant and child with congestive heart failure includes A. force fluids appropriate to age. B. monitor respirations during active periods. C. organize activities to allow for uninterrupted sleep. D. give larger feedings less often to conserve energy.

C. organize activities to allow for uninterrupted sleep. The child needs to be well rested before feeding. The child's needs should be met to minimize crying. The nurse must organize care to decrease energy expenditure. The child in congestive heart failure has an excess of fluid, so forcing fluids is contraindicated. Monitoring of vital signs is appropriate, but minimizing energy expenditure is a priority. The child often cannot tolerate larger feedings; small, frequent feedings should be given to the child in congestive heart failure.

Enteral feedings are ordered for a young child with burns covering 40% of the total body surface area. The nurse should know that A. oral feedings are contraindicated. B. enteral feedings must be stopped during painful procedures. C. paralytic ileus precludes use of enteral feedings. D. the feedings will be high in carbohydrate and low in protein.

C. paralytic ileus precludes use of enteral feedings. Enteral feedings can begin when the paralytic ileus resolves. Oral feedings are not contraindicated. Oral feedings are encouraged. Most children with burns are unable to consume sufficient calories by mouth, but every possible effort is made to encourage oral feeding. Enteral feedings can continue during procedures. A high-protein, high-calorie diet is recommended to compensate for the increased basal metabolic rate that occurs after a burn injury.

A young child with tetralogy of Fallot may assume a posturing position as a compensatory mechanism. The position automatically assumed by the child is A. the low Fowler position. B. the prone position. C. the supine position. D. the squatting position

D. the squatting position The squatting or knee-chest position increases the return of blood flow to the heart for oxygenation in a child with a defect that consists of decreased pulmonary blood flow. The low Fowler, prone or supine position does not offer any physiologic advantage to the child related to cardiac compensation.

During a well-child visit, the father of a 4-year-old child tells the nurse that he is not certain if his child is ready for kindergarten. The child's birthday is close to the cutoff date, and the child has not attended preschool. The most appropriate recommendation by the nurse is to A. encourage the father to have the child start kindergarten. B. recommend to the father that he postpone kindergarten and send the child to preschool. C. refer the child for developmental screening and make a recommendation based on the results. D. have the father observe a kindergarten class and then decide if his child would enjoy the experience.

C. refer the child for developmental screening and make a recommendation based on the results A developmental screening will provide the necessary information to help the family determine readiness. Encouraging the father to have the child start kindergarten does not address the father's concern about readiness and suggests that his concerns are not warranted. Recommending to the father that he postpone kindergarten and send the child to preschool assumes that the child is not ready for kindergarten, but the recommendation is not based on any data or facts. Recommending to the father that he simply place his child in preschool may lead to the child's boredom with school. Having the father observe a kindergarten class and then decide if the child would enjoy the experience will provide information about kindergarten but not about whether his child is ready to begin and thrive there.

The school nurse is seeing a child who brought poison ivy to school in a leaf collection. The child says that only hands touched it. The most appropriate nursing action is to A. apply Burow solution compresses immediately. B. soak hands in warm water. C. rinse hands in cold, running water. D. scrub hands thoroughly with antibacterial soap.

C. rinse hands in cold, running water. Washing the child's hands in cold running water is the recommended first action. Once contact has been made, it is desirable to flush the skin with cold running water within 15 minutes of exposure to neutralize the effect. Applying Burrow solution is effective for soothing the skin lesions once the dermatitis has begun. Antibacterial soap is not recommended as it removes protective skin oils, and may allow spread of contact.

The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. Based on the nurse's knowledge of this age-group, the most appropriate recommendation is A. organized sports, such as soccer, are not appropriate at this age. B. competition is detrimental to the establishment of a positive self-image. C. sports participation is encouraged if the sport is appropriate to the child's abilities. D. girls should compete only against girls because at this age boys are larger and have more muscle mass.

C. sports participation is encouraged if the sport is appropriate to the child's abilities. The parents should help the child select a sport that is suitable to her capabilities and interests. Team sports contribute to the school-age child's social, intellectual, and skill growth. Organized sports for school-age children can provide safe, appropriate activities with supportive parents and coaches. The desire to participate in competitive team sports develops out of a need for peer interaction for the school-age child. A sport should be selected that meets the child's capabilities and interests. The physical changes in boys described take place during puberty, later in the school-age years; therefore, there is no reason for boys and girls to compete separately at age 8 years.

A child is being treated for burns in the emergency room. The parents have provided information relative to the origin of the burn event but the patterns of injury are not consistent with their description. The nurse would suspect that A. the parents are too upset to provide information at this time, so additional questions can be answered later. B. the child may have not told the parents the truth about the event. C. there may be a potential for abuse and as such requires follow up. D. there is no real concern as the burn injuries are minimal and non life threatening.

C. there may be a potential for abuse and as such requires follow up. Anytime burn pattern injuries do not correlate with the provided information of the event, there is a potential for suspecting abuse. As such the nurse should be cognizant of this fact and follow up accordingly. Being upset would be a reasonable parent response but the physical evidence should coincide with the provided description. Suspecting that the child (victim) is not telling the truth would not be a concern unless additional evidence would be presented that would support that conclusion. Even if the burn injuries are not considered to be life-threatening

The primary therapy for secondary hypertension in children is A. weight reduction. B. low-salt diet. C. increased exercise and fitness. D. treatment of underlying cause.

D. treatment of underlying cause. Secondary hypertension is a result of an underlying disease process or structural abnormality. It is usually necessary to treat the problem before the hypertension will be resolved. Weight reduction and a low-salt diet are usually effective in managing essential hypertension. Increased exercise and fitness are usually effective in managing essential hypertension.

By what age would the nurse expect most children to use sentences of four or five words? A. 18 months B. 24 months C. 3 years D. 4½ years

D. 4½ years Children ages 4 to 5 years use sentences of four or five words. An 18-month-old child has a vocabulary of approximately 10 words. A 24-month-old child uses two- or three-word phrases. A 3-year-old child uses sentences of three or four complete words.

What should the nurse recognize as an early clinical sign of compensated shock in a child? A. Confusion B. Sleepiness C. Hypotension D. Apprehensiveness

D. Apprehensiveness Apprehensiveness is indicative of compensated shock. Confusion is indicative of uncompensated shock. Sleepiness is not an indication of shock. Hypotension is a symptom of irreversible shock.

A cardiac assessment is required to determine if a child's physical symptoms are related to possible heart disease. The nurse is proceeding to auscultation techniques. When observing the nursing student perform this assessment, which action would indicate that additional training was required? A. Documentation of heart sounds in reference to anatomical location. B. Determination that there is no evidence of carotid bruits. C. Calculation of heart rate. D. Ascertaining whether there is evidence of splenic enlargement.

D. Ascertaining whether there is evidence of splenic enlargement Evidence of splenic enlargement requires palpation as an assessment technique. All of the other options are in-line with auscultation techniques.

Which is characteristic of the psychosocial development of school-age children? A. A developing sense of initiative is important. B. Peer approval is not yet a motivating factor. C. Motivation comes from extrinsic rather than intrinsic sources. D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment The school-age child is eager to develop skills and participate in activities. All children are not able to do all tasks well, and the child must be prepared to accept some feelings of inferiority, as highlighted in Erikson's stage for this age-group of industry versus inferiority. Initiative versus guilt is the stage characteristic of preschoolers. Peer group formation is one of the major characteristics of school-age children. School-age children gain satisfaction from independent behaviors that are internally driven and accomplished.

An adolescent is being treated for new-onset hypertension with medication. Firs line therapy previously tried was with dietary management but the decision has now been made to start oral medications. Which complaint if provided by the patient would indicate a potential concern? A. Patient states that he is no longer losing weight after being on the medication for one week's time. B. Patient states he is maintaining his oral intake of 8 glasses of water a day. C. He is taking the medication in the evening rather than taking the medication in the morning as prescribed as he thinks that he feels better and has less side effects. D. He reports that he occasionally feels "lightheaded" when getting out of a chair during the course of the school day in some of his classes.

D. He reports that he occasionally feels "lightheaded" when getting out of a chair during the course of the school day in some of his classes. Safety aspects should be considered with use of anti-hypertensives and the possibility of orthostatic hypotension. As such the patient should be assessed for this event and prospective safety management should be instituted. Anti-hypertensive therapy is typically not associated with weight loss. Maintaining fluid hydration and the fact that the medication dosing is taken in the evening rather than the daytime to minimize size effects is showing individualization to patient's needs.

Ashley, age 4½ years, is afraid of dogs. What should the nurse recommend to her parents to help her with this fear? A. Keep her away from dogs. B. Buy her a stuffed dog toy. C. Force her to touch a dog briefly. D. Let her watch other children play with a dog.

D. Let her watch other children play with a dog. The parents should actively seek ways to deal with fear. By observing other children at play with dogs, the child can adapt. Keeping their child away from dogs avoids the object of fear rather than addressing the fear and finding solutions. Buying a child a stuffed dog toy avoids the object of fear rather than addressing the fear and finding solutions. Forcing the child to touch a dog without working up to it may increase the level of fear.

Parents of a preschooler relate that their child is having some difficulties falling asleep. This is a recent occurrence and the parents report that they have tried virtually everything to get their child to go to sleep. Based on this self-report, the nurse would advise the parents to? A. Do not feed the child 2 hours before sleep as food might be causing excess stimulation. B. Do not let the child watch any television in the evening as this may cause stimulation. C. Have the child fall asleep on the couch and then transfer the child to the bed. D. Maintaining a consistent approach to bedtime routine serves as a basis for promoting sleep patterns

D. Maintaining a consistent approach to bedtime routine serves as a basis for promoting sleep patterns Children in this age group often experience changes in their sleep patterns but consistent approaches in bedtime rituals may help to promote sleep patterns. By the parents self-report that they have "tried virtually everything" may have contributed to the child's altered sleep pattern. There is no enough information provided for the nurse to make any other of the provided options.

What is an important consideration related to childhood stress? A. Children should be protected from stress. B. Children do not have coping strategies. C. Parents cannot prepare children for stress. D. Some children are more vulnerable to stress than others.

D. Some children are more vulnerable to stress than others. Children's age, temperament, life situation, and state of health affect their vulnerability, reactions, and ability to handle stress. It is not feasible to protect children from all stress. Children can be taught coping strategies. Supportive interpersonal relationships are essential to the psychological well-being of children. Adults need to recognize signs of stress before they become overwhelming. Providing children with interpersonal security helps them develop coping strategies for dealing with stress.

What should nurses stress when counseling parents regarding the home care of the child with a cardiac defect before corrective surgery? A. The importance of reducing caloric intake to decrease cardiac demands B. The importance of relaxing discipline and limit setting to prevent crying C. The need to be extremely concerned about cyanotic spells D. The desirability of promoting normalcy within the limits of the child's condition

D. The desirability of promoting normalcy within the limits of the child's condition The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child. The child needs increased caloric intake after cardiac surgery. The child needs discipline and appropriate limit setting, as would be done with any other child his or her age. Because cyanotic spells will occur in children with some defects, the parents need to be taught how to assess for and manage them appropriately, thereby decreasing their anxiety and concern.

What is considered a mixed cardiac defect? A. Pulmonic stenosis B. Atrial septal defect C. Patent ductus arteriosus D. Transposition of the great arteries

D. Transposition of the great arteries Transposition of the great arteries allows the mixing of both oxygenated and unoxygenated blood in the heart. Pulmonic stenosis is classified as an obstructive defect. Atrial septal defect and patent ductus arteriosus are classified as defects with increased pulmonary blood flow.

The nurse is teaching a community health promotion class to parents and school-age children related to bicycle safety. Issues to cover in the sessions include A. bicycle helmets need to be worn only if the child is planning to ride in traffic. B. reflectors should be installed only on bicycles that are to be ridden at night. C. bicycles should be ridden against the traffic so that the rider can see the cars. D. bicycles should be walked through busy intersections.

D. bicycles should be walked through busy intersections. Bicycles should be walked through busy intersections to allow the child to have full view of the traffic and be able to react accordingly, with safety the number one priority. Bicycle helmets should be worn at all times to prevent head injuries. Reflectors should be installed on all bicycles, whether they are ridden during the daytime or at night only. Bicycles should always be ridden with the traffic, not against the traffic. This will assist in preventing accidents.

The school nurse is asked to speak with the parents of a 10-year-old boy who has been bullying other children. The nurse's response should be based on knowledge that A. bullying at this age is considered normal. B. children who bully others usually join gangs. C. bullying is a short-term problem that is generally outgrown by the end of the school-age years. D. bullying often manifests itself in children who are different or have poor academic or social skills.

D. bullying often manifests itself in children who are different or have poor academic or social skills. Poor relationships with peers and a lack of group identification, such as looking different or having poor academic or social skills, contribute to bullying behavior. Bullying is a maladaptive response to poor relationships with peers and lack of group identification; therefore, it is not considered normal behavior. Children who chronically bully tend to be impulsive, easily frustrated, and at increased risk for dropping out of school, but there is no direct correlation between bullies and joining gangs. Children who bully may be at risk for long-term psychological disturbances and psychiatric symptoms. Future problems for bullies may include violence, substance abuse, and criminal convictions, which often occur in adulthood

Surgical repair for patent ductus arteriosus (PDA) is done to prevent the complication of A. pulmonary infection. B. right-to-left shunt of blood. C. decreased workload on left side of heart. D. increased pulmonary vascular congestion.

D. increased pulmonary vascular congestion. A PDA allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary vascular congestion can occur. The increased pulmonary vascular congestion is the primary complication; pulmonary infection may occur, but it is not the priority complication. A PDA involves a left-to-right shunt of blood. The decreased workload on the left side of the heart is not a priority complication of a PDA.

An example of indirect bullying would be if A. telling an individual that you don't like them because you were hurt by their actions. B. raising one's hand to prevent another person from hitting you. C. taking a toy away from someone because you want it to see it. D. using social media to make offensive comments about an individual.

D. using social media to make offensive comments about an individual. Indirect bullying are actions that are taken that are meant to cause harm to an individual or group. The use of social media to make offensive comments about an individual is not the place for professing feelings. One must take into account that offensive comments by definition are offensive. Telling an individual that you don't like them as a result of their exhibited behavior is an example of direct communication. Taking a toy away from someone because you want to see it may not be the best approach but it does involve direct action.

A child with lymphoma is receiving extensive radiotherapy. What is the most common side effect of this treatment? a. Fatigue b. Seizures c. Neuropathy d. Lymphadenopathy

a. Fatigue Fatigue is the most common side effect of radiotherapy. For children, the fatigue may be distressing because they cannot keep up with their peers. Seizures are unlikely, because irradiation would not usually be cranial for lymphoma. Neuropathy is a side effect of certain chemotherapeutic agents but not of radiotherapy. Lymphadenopathy is one of the findings of lymphoma, not a side effect of radiotherapy.

What is the most appropriate action to stop an occasional episode of epistaxis? a. Have the child sit up and lean forward. b. Apply ice under the nose and above the lip. c. Have the child lie down quietly with the feet elevated. d. Apply continuous pressure to the nose with the thumb and forefinger for at least 1 minute.

a. Have the child sit up and lean forward. Sitting up and leaning forward is the position used to prevent the child from aspirating blood. Pressure, not ice, is indicated for an occasional episode of epistaxis. Lying the child down with the feet elevated can potentially lead to aspiration. Continuous pressure for 10 minutes is recommended; 1 minute would not be long enough.

What are the most common signs and symptoms of leukemia related to bone marrow involvement? a. Petechiae, infection, fatigue b. Headache, papilledema, irritability c. Muscle wasting, weight loss, fatigue d. Decreased intracranial pressure, psychosis, confusion

a. Petechiae, infection, fatigue Petechiae, infection, and fatigue are signs of infiltration of the bone marrow. Petechiae occur from a lowered platelet count, infection occurs from the depressed number of effective leukocytes, and fatigue occurs from the anemia. Headache, papilledema, irritability, muscle wasting, weight loss and fatigue are not signs of bone marrow involvement. Decreased intracranial pressure, psychosis, and confusion are not signs of bone marrow involvement.

What is the most important nursing consideration when caring for a child with sickle cell anemia? a. Teach the parents and child how to minimize crises. b. Refer the parents and child for genetic counseling. c. Help the child and family to adjust to a short-term disease. d. Observe for complications of multiple blood transfusions.

a. Teach the parents and child how to minimize crises. Children and their families need specific instructions on how to minimize crises, including preventing infections; maintaining adequate hydration; and addressing environmental concerns, such as avoidance of extreme cold. Genetic counseling is important, but teaching care for the child is a priority. Sickle cell anemia is a long-term, chronic illness. Multiple blood transfusions are an option for some children with sickle cell disease. The priority is that the child and the parents are properly prepared to manage the chronic disease.

A child is status post hematopoietic stem cell transplantation (HSCT) and is preparing for discharge home. Based on the nurse's knowledge of HSCT, which concepts are important to include in the discharge teaching plan of care? (Select all that apply.) a. Preparing the child to return to school within 6 weeks b. Keeping the child on a high-calcium diet c. Avoiding live plants and fresh vegetables d. Avoiding influenza vaccinations e. Practicing good hygiene

b. Keeping the child on a high-calcium diet Correct c. Avoiding live plants and fresh vegetables Correct e. Practicing good hygiene Correct Children should have a diet high in calcium or be placed on calcium supplements to reduce the risk of osteopenia. Live plants and fresh vegetables should be avoided because they carry bacteria. Practicing good hand hygiene is essential to prevent the spread of infection. Children cannot return to school for 6-12 months after HSCT. Either in-hospital or home schooling is required. Children and their families should be encouraged to get yearly influenza vaccination.

What is appropriate mouth care for a toddler with mucosal ulceration related to chemotherapy? a. Lemon glycerin swabs for cleansing b. Mouthwashes with normal saline c. Mouthwashes with hydrogen peroxide d. Local anesthetic such as viscous lidocaine before meals

b. Mouthwashes with normal saline Normal saline mouthwashes are the preferred mouth care for this age group. The rinse will keep the mucosal surfaces clean without adverse effects on mucosa or problems if the child swallows the rinse. Lemon glycerin swabs can irritate eroded tissue and can decay teeth. Hydrogen peroxide delays healing by breaking down protein. Viscous lidocaine is not recommended for toddlers, because it depresses the gag reflex and the child may have resultant aspiration.

Critical safety considerations that must be included if parenteral iron injections are used as part of therapy include (Select all that apply.) a. type and cross match. b. no massage following injection. c. multiple injections are preferred over intravenous route. d. no more than 1 ml should be given via injection. e. there is no need for a test dose administration if administered intravenously.

b. no massage following injection. Correct d. no more than 1 ml should be given via injection. Correct There is no need to perform a type and cross for iron replacement therapy. Administration via injection is done into a large muscle mass using Z track technique with no massage following. Preference is for intravenous route over intramuscular route if more than one injection is needed. No more than 1 ml is given via injection and a test dose is recommended if using intravenous route to high potential for allergic reaction.

The school nurse is explaining to a child's kindergarten teacher that the child is allergic to peanuts. The nurse should include information that a. the child will most likely outgrow the allergy soon. b. the child should have an injectable epinephrine cartridge available at all times. c. the child allergic to peanuts can usually have peanut butter, but not whole peanuts. d. the child usually only shows skin signs such as hives when allergic.

b. the child should have an injectable epinephrine cartridge available at all times. Exposure to peanuts can result in a severe allergic, potentially life-threatening reaction, such as anaphylaxis and shock. Immediate treatment to prevent such reactions includes the injection of epinephrine; therefore, this should be available at all times wherever the child is within the school premises. Peanut allergies may be lifelong. Children allergic to peanuts are allergic to all peanut products, whole and processed. They should have no peanut-containing products at all. The signs and symptoms of an allergic reaction to peanuts may vary from individual to individual.

The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. Which response by the nurse is most accurate? a. "SCA is not inherited." b. "All siblings will have SCA." c. "There is a 25% chance of a sibling having SCA." d. "There is a 50% chance of a sibling having SCA."

c. "There is a 25% chance of a sibling having SCA." SCA is inherited as an autosomal recessive disorder. In this inheritance pattern, there is a 25% chance that each subsequent child will have the disorder. SCA is an inherited hemoglobinopathy. In autosomal recessive disorders, there is a chance that 25% of the children

The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measures should the nurse use until factor replacement therapy can be instituted? a. Apply warm, moist compresses. b. Apply pressure for at least 1 minute. c. Elevate the area above the level of the heart. d. Begin passive range-of-motion unless the pain is severe.

c. Elevate the area above the level of the heart. The initial response should include elevation of the arm to minimize bleeding. Cold should be applied to the arm. This will aid in vasoconstriction, minimizing blood loss. Pressure is effective in small areas but would not be as effective for an extremity. Passive range-of-motion is not recommended. The child can perform active range-of-motion after the bleeding episode has resolved.

Sickle cell disease (SCD) occurs through a genetic mutation. Based on the understanding of this genetic form of transmission, the nurse understands that a. there are no carrier states associated with this disease. b. the disease is transmitted as part of a sex-linked mutation. c. SCD refers to a group of congenital disease expressions. d. it is a relatively uncommon disease as it is expressed as an autosomal recessive gene trait.

c. SCD refers to a group of congenital disease expressions. SCD refers to a group of heredity disease states in which there is variants exhibited in both heterozygous and homozygous expressions. It is expressed as an autosomal recessive trait and as such there are carrier states. It is not transmitted as a sex-linked mutation. It is one of the most common genetic disorders globally.

A child has been diagnosed with aplastic anemia and undergoing therapeutic treatment. Therapeutic therapy would focus on a. palliative treatment to maintain comfort. b. initiation of steroid therapy. c. anticipation of bone marrow transplant. d. asking parents if they want to consider organ donation.

c. anticipation of bone marrow transplant. Although a clinical diagnosis of aplastic anemia can lead to increased morbidity and mortality treatment measures focusing on immunosuppressive therapy, removal of potential exacerbating etiology, and bone marrow replacement. Palliative treatment methods may be included but they are not the mainstay of therapeutic management. Steroid therapy is not indicated as that may lead to an increased susceptibility to infection. Asking the parents about organ donation at this time may cause considerable distress and anxiety.

A child has frequent nose bleeds without warning producing varying amount of blood. Inspection of the nose area reveals irritated mucosa but no evidence of picking or trauma. The child has no history of allergic rhinitis or upper respiratory infections. Denies taking any medication, either prescribed or over the counter. Based on this information the nurse would: a. maintain wait full management as most nose bleeds originate from anterior portion of nose. b. suggest that the patient use humidification to prevent dryness of nasal passages. c. consider referral to ENT for evaluation for other comorbidities. d. increase fluid content to maintain humidification as this may be due to environmental dryness.

c. consider referral to ENT for evaluation for other comorbidities. Even though the majority of nose bleeds are considered to be from the anterior portion of the nose, the fact that the patient has frequent nose bleeds without warning in the absence of irritation or disease states alerts the nurse that there may be other underlying comorbidities such as vascular disorders, leukemia, thrombocytopenia, and clotting factor deficiencies. As such the patient should be referred for further evaluation.

A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. The nurse's first action is to a. administer 100% oxygen to relieve hypoxia. Incorrect b. administer pain medication to relieve symptoms. c. notify practitioner because chest syndrome is suspected. d. notify practitioner because child may be having a stroke.

c. notify practitioner because chest syndrome is suspected. Severe chest pain, fever, a cough, and dyspnea are the signs and symptoms of chest syndrome. The nurse must notify the practitioner immediately. Breathing 100% oxygen to relieve hypoxia may be ordered by the practitioner, but the first action is notification because these symptoms indicate a medical emergency. Pain medications may be indicated, but evaluation is necessary first. Severe chest pain, fever, cough, and dyspnea are not signs of a stroke.

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include to a. restrict oral fluids. b. institute strict isolation. c. use good hand washing technique. d. give immunizations appropriate for age.

c. use good hand washing technique. Good hand washing technique is the most effective means to prevent disease transmission in children with myelosuppression. There is no indication to reduce fluids in children with myelosuppression. Strict isolation is not necessary in children with myelosuppression. The child should not receive any live vaccines, because the immune system is not capable of responding appropriately to them.

The nurse suspects a child is having an adverse reaction to a blood transfusion. What should the nurse's first action be? a. Notify the physician. b. Take vital signs and blood pressure and compare them with baseline values. c. Dilute infusing blood with equal amounts of normal saline. d. Stop the transfusion and maintain a patent intravenous line with normal saline and new tubing.

d. Stop the transfusion and maintain a patent intravenous line with normal saline and new tubing. The priority nursing action is to stop the transfusion and maintain a patent intravenous line with normal saline and new tubing. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused into the child. The physician should be notified after the blood transfusion is stopped and normal saline is infusing. Vital signs should be assessed after the blood transfusion is stopped and normal saline is infusing. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred.

The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry black color. The nurse should explain that this is a. a symptom of iron-deficiency anemia. b. an adverse effect of the iron preparation. c. an indicator of an iron preparation overdose. d. a normally expected change due to the iron preparation.

d. a normally expected change due to the iron preparation. An adequate dosage of iron turns the stools a tarry black color. This is considered a normal abnormal effect related to iron medication. Tarry black stools are not a sign of iron-deficiency anemia nor are they an indicator of iron preparation overdose.

Therapeutic management of the patient with systemic lupus erythematosus (SLE) includes a. application of cold salts to suppress the inflammatory process. b. a high-protein, low-salt diet. c. a rigorous exercise regimen to build up muscle strength and endurance. d. administration of corticosteroids to control inflammation.

d. administration of corticosteroids to control inflammation. Corticosteroid administration is the primary mode of therapy currently for SLE. The application of cold salts will not affect the inflammatory process associated with SLE. A balanced diet without exceeding caloric expenditures is recommended. Exercise should be done in moderation.

Nursing considerations related to the administration of chemotherapeutic drugs include a. many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates. b. good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary. c. infiltration will not occur, unless superficial veins are used for the intravenous infusion. d. anaphylaxis cannot occur, because the drugs are considered toxic to normal cells.

d. anaphylaxis cannot occur, because the drugs are considered toxic to normal cells. Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and prepared to treat extravasations if necessary. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward. Infiltration and extravasations are always a risk, especially with peripheral veins. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents, including asparaginase (Elspar).

The nurse is explaining blood components to an 8-year-old child. Based on the nurse's knowledge of child development, the most appropriate description of platelets is that they a. help keep germs from causing infection. b. make up the liquid portion of blood. c. carry the oxygen you breathe from your lungs to all parts of your body. d. help your body stop bleeding by forming a clot (scab) over the hurt area.

d. help your body stop bleeding by forming a clot (scab) over the hurt area. Platelets are involved in homeostasis. White blood cells help protect the body from infection. The liquid portion of blood id known as plasma. Red blood cells are involved in oxygenation of tissues in the body.

A child with β-thalassemia is receiving numerous blood transfusions. In addition, the child is receiving deferoxamine (Desferal) therapy. The child's parents ask the nurse what deferoxamine does. The most appropriate response by the nurse is a. the medication helps to prevent blood transfusion reactions. b. the medication stimulates red blood cell production. c. the medication provides vitamin supplementation. d. the medication helps to prevent iron overload.

d. the medication helps to prevent iron overload. A side effect of hypertransfusion therapy is often iron overload. Deferoxamine is an iron-chelating drug that binds excess iron; therefore, it can be excreted by the kidneys. It does not prevent blood transfusions nor stimulate red bell production. It is not a vitamin supplement.