Exam 2 Combo

A nurse is caring for a child who has depression. Which of the following findings are associated with this diagnosis? (Select all that apply.)

B. CORRECT: Weight loss or gain are findings associated with depression. C. CORRECT: Low self-esteem is a finding associated with depression. D. CORRECT: Sleeping more than usual is a finding associated with depression.

The nurse is collecting a stool sample from an infant with lactose intolerance. Which fecal pH should the nurse expect as the result?

5.5. (An acidic pH (5-5.5) indicates malabsorption, which occurs with lactose intolerance. The normal pH of the stool is 7.0 to 7.5. A finding of 8 would be alkaline.)

The Hib conjugate vaccines protect an infant against which of the following diseases? (Select all that apply.)

Bacterial meningitis Correct B. Epiglottitis Correct C. Bacterial pneumonia Correct D. Septic arthritis Correct E. Sepsis Correct (Hib conjugate vaccines protect against a number of serious infections caused by Haemophilus influenza type b, especially bacterial meningitis, epiglottitis, bacterial pneumonia, septic arthritis, and sepsis)

A common characteristic of those who sexually abuse children is which of the following?

Pressure victim into secrecy . (Sex offenders may pressure the victim into secrecy, referring to the activity as a "secret between us" that other people may take away if they find out. The offender may be anyone, from a family member to a stranger at any level of society. Sex offenders are usually trusted acquaintances of the victims and victims' families. Many victims are abused many times over a long period)

If the mother of a child is hepatitis B surface antigen (HBsAg) negative, the nurse knows that the child should receive his or her first dose of the hepatitis B virus (HBV) vaccine at

birth before discharge from the hospital.(It is recommended that newborns receive the hepatitis B vaccine before hospital discharge if the mother is HBsAg negative. The second dose of the vaccine is given at the first well-child visit. The third dose of the vaccine is given at the third well-child visit. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, which include the hepatitis B virus vaccine.)

Strict isolation is required for a child who is hospitalized with

chickenpox (Chickenpox is communicable through direct contact, droplet spread, and contaminated objects. Mumps is transmitted from direct contact with the saliva of the infected person and is most communicable before the onset of swelling. The transmission and source of the viral infection exanthema subitum (roseola) is unknown. Erythema infectiosum is communicable before the onset of symptoms)

Which of the following is descriptive of a parent who is an abuser?

s likely a single parent or from a young parent family.(Younger parents and single parents are at higher risk to be abusers. Abusive families are often socially isolated and have few support systems. They often have additional stressors such as low-income circumstances and little education)

When determining the etiology of a skin problem, which of the following is essential to the diagnosis of the lesions?

Careful inspection (One of the more advantageous aspects of skin lesions is that the diagnosis is usually readily established by simple, careful inspection. Types of skin products and laundry detergents are important if the lesions appear to be a result of contact dermatitis. If a contagious origin is suspected after inspection, siblings having similar lesions would be part of the history)

A nurse is providing teaching to the parent of a child who has attention-deficit/hyperactivity disorder. The nurse should include which of the following as a characteristic of impulsivity?

B. CORRECT: Frequently interrupting is a characteristic of impulsivity.

The nurse is teaching a parent with a 2-month-old infant who has been diagnosed with colic about ways to relieve colic. Which statement by the parent indicates the need for additional teaching?

"I should let my infant cry for at least 30 minutes before I respond." (Because the infant has been diagnosed with colic, the parent should respond to the infant immediately or any type of interventions to relieve colic may not be effective. Also, the infant may develop a mistrust of the world if his or her needs are not met. The parent should swaddle the baby tightly with a soft blanket, massage the baby's abdomen, and place the infant in an upright seat after a feeding to help relieve colic.)

The nurse is teaching parents guidelines for feeding their 8-month-old infant with failure to thrive (FTT). Which statement by the parents indicates a need for further teaching?

"We will be sure to give our infant at least 8 oz of juice every day." (Juice intake in infants with FTT should be withheld until adequate weight gain has been achieved with appropriate milk sources; thereafter, no more than 4/oz day of juice should be given. Further teaching is needed if the parents indicate 8 oz of juice is allowed. For infants with FTT, 24-kcal/oz formulas may be provided to increase caloric intake. Because maladaptive feeding practices often contribute to growth failure, parents should follow specific step-by-step directions for formula preparation, as well as a written schedule of feeding times. Statements by the parents indicating they will use a 24-kcal/oz formula, follow directions for formula preparation, and feed their infant on schedule are accurate statements.)

The nurse is teaching parents about caring for their infant with seborrheic dermatitis (cradle cap). Which statement by the parents indicates understanding of the teaching?

"We will use a fine-tooth comb to help remove the loosened crusts from the strands of hair."(A fine-tooth comb or a soft facial brush helps remove the loosened crusts from the strands of hair after shampooing. This is an accurate statement. Shampoo should applied to the scalp and allowed to remain on the scalp until the crusts soften. Shampoo should not be rinsed off quickly. The crusts should be removed, and shampooing with antiseborrheic shampoo should be done daily, not every other day.)

A parent brings a 12-month-old infant into the emergency department and tells the nurse that the infant is allergic to peanuts and was accidentally given a cookie with peanuts in it. The infant is dyspneic, wheezing, and cyanotic. The health care provider has prescribed a dose of epinephrine to be administered. The infant weighs 24 lb. How many milligrams of epinephrine should be administered?

0.011 to 0.3 mg. (The correct dose of epinephrine to use in the emergency management of an anaphylactic reaction is 0.001 mg/kg up to a maximum of 0.3 mg, giving a range of 0.011 to 0.3 mg using a weight of 11 kg (24 lb).)

The hepatitis A vaccine is now recommended at which of the following ages?

1 year . (Hepatitis A has been recognized as a significant child health problem, particularly in communities with unusually high infection rates. Hepatitis A virus is spread by the fecal-oral route and from person-to-person contact, by ingestion of contaminated food or water, and rarely by blood transfusion, so the immunization is recommended at 1 year of age.)

At a well-child check-up, the nurse notes that an infant with a previous diagnosis of failure to thrive (FTT) is now steadily gaining weight. The nurse should recommend that fruit juice intake be limited to no more than how much?

4 oz/day. (Restrict juice intake in children with FTT until adequate weight gain has been achieved with appropriate milk sources; thereafter, give no more than 4 oz/day of juice.)

Which statement best describes colic?

A paroxysmal abdominal pain or cramping manifested by episodes of loud crying. (Colic is described as paroxysmal abdominal pain or cramping that is manifested by loud crying and drawing up the legs to the abdomen. Weight loss is not part of the clinical picture. There are many theories about the cause of colic. Emotional stress or tension between the parent and child is one component. This is not consistent throughout all cases. Colic is most common in infants younger than 3 months of age.)

A nurse is teaching a parent about posttraumatic stress disorder (PTSD). Which of the following should be included in the teaching? (Select all that apply.)

A. CORRECT: Children who have PTSD should be referred to psychotherapy to assist with resolution of the traumatic event. B. CORRECT: The child who is experiencing PTSD often has new phobias that can be related to the traumatic event. D. CORRECT: PTSD develops following a traumatic event such as assault, serious injury, or a life‑threatening episode.

2. A nurse is teaching a group of parents about preventing insect bites. Which of the following should the nurse include in the teaching? (Select all that apply.)

A. INCORRECT: Perfumes attract insects and should be avoided. B. CORRECT: Insects live in tall grasses; therefore, these areas should be avoided. C. INCORRECT: Bright colored clothing attracts insects and should be avoided. D. CORRECT: Insect repellent should be applied to prevent insect bites. E. CORRECT: House pets should be inspected and treated for insects to prevent exposing family members.

A nurse is assessing an infant who has scabies. Which of the following are expected findings? (Select all that apply.)

A. INCORRECT: Presence of nits on the hair shaft is a clinical manifestation of pediculosis capitis. B. CORRECT: Pencil-like marks on hands is a clinical manifestation of scabies. C. CORRECT: Blisters on the soles of the feet is a clinical manifestation of scabies. D. INCORRECT: Bluish-gray skin color is a clinical manifestation of pediculosis pubis. E. CORRECT: Pimples on the trunk is a clinical manifestation of scabies.

The change from the exclusive use of oral polio vaccine (OPV) to the exclusive use of inactivated poliovirus vaccine (IPV) related to the rare risk of vaccine-associated polio paralysis (VAPP) from OPV has resulted in which of the following?

An increased number of injections and increased cost (There is an increased number of injections and increased cost associated with IPV. The exclusive use of IPV eliminates the risk of VAPP. There is no increased antibody conversion from IPV. The same immunity is provided by both vaccines)

When applying wet compresses or dressings to the skin, the nurse should do which of the following?

Apply desired solution on cotton gauze or soft cotton cloths, such as clean handkerchiefs (The desired solution should be applied to Kerlix gauze; soft cotton cloths; or strips from cloth diapers, sheets, handkerchiefs, or pillowcase material. The moist dressing should be laid flat on the area with an attempt to avoid restriction of movement. After immersion in the solution, the dressings are wrung out to avoid dripping. The dry dressing should be removed, moistened again, and then reapplied. When the solution dries, concentrated residue is left in the dressing. The addition of fluid may result in a more concentrated soak being placed on the sensitive tissue)

What is the first step in the emergency treatment of poisoning in a child?

Assess the child (The initial step in treating a poisoning is to assess the child. Then treat immediate life-threatening conditions and initiate cardiopulmonary resuscitation if indicated. Locating the poison, preventing absorption of the poison, and terminating exposure to the toxic substance are important but none of these is the first step.)

What is most descriptive of atopic dermatitis (AD) (eczema) in an infant?

Associated with hereditary allergies. (AD is a type of pruritic eczema that usually begins during infancy and is associated with allergy with a hereditary tendency. Approximately 50% of children with AD develop asthma. AD can be controlled but not cured. Manifestations of the disease are worse when environmental humidity is lower. AD is not associated with respiratory tract infections.)

Allergy with a hereditary tendency

Atopy

The nurse is planning care for an infant with eczema. Which interventions should the nurse include in the care plan? (Select all that apply.)

Avoid giving the infant a bubble bath, Avoid overdressing the infant. (Guidelines for care of an infant with eczema include avoiding a bubble bath and harsh soaps and avoiding overdressing the infant to prevent perspiration, which can cause a flare-up. The care plan should include using a humidifier in the infant's room, topical steroids, and wet compresses on the most affected areas.)

A nurse is providing instruction to the teacher of a child who has attention-deficit/hyperactivity disorder (ADHD). Which of the following classroom strategies should be included in the teaching? (Select all that apply.)

B. CORRECT: Allowing for regular breaks will assist the client who has ADHD to focus on the required tasks. C. CORRECT: Combining verbal instruction with visual cues will assist the client who has ADHD with learning information. D. CORRECT: Providing consistent classroom rules will assist the client who has ADHD to become successful. E. CORRECT: Stimuli in the environment distract the client who has ADHD, so they should be decreased.

Which one of the following strategies might be recommended for an infant with failure to thrive (FTT) to increase caloric intake?

Be persistent through 10 to 15 minutes of food refusal. (Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. Children with FTT need a structured routine to help establish rhythmicity in their activities of daily living. Many children with FTT are fed exclusively from a bottle. Solids should be fed first. Stimulation is reduced during mealtimes to maintain the focus on eating.)

The nurse is preparing to feed a 10-month-old child diagnosed with failure to thrive (FTT). Which actions should the nurse plan to implement? (Select all that apply.)

Be persistent, Introduce new foods slowly, Maintain a calm, even temperament. (Feeding strategies for children with FTT should include persistence; introducing new foods slowly; and maintaining a calm, even temperament. The environment should be unstimulating, and a structured routine should be developed with regard to feeding, not just when the infant shows signs of hunger.)

The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists has recommended that pregnant adolescents and women who are not protected against pertussis receive the tetanus, diphtheria and pertussis (Tdap) vaccine optimally at which of the following times?

Between 27 and 36 weeks of gestation or postpartum before discharge from the hospital (The ACIP of the CDC and American College of Obstetricians and Gynecologists has recommended that pregnant adolescents and women who are not protected against pertussis receive the Tdap vaccine optimally between 27 and 36 weeks of gestation or postpartum before discharge from the hospital. The vaccine is not recommended during the first trimester. The vaccine is not recommended between 27 and 36 weeks to allot for antibody formation that will protect the mother and passive immunity to the infant.The vaccine is not recommended during the first trimester.)

A 7-year-old child has ingested a toxic dose of iron. The parent reports that the child vomited and had gastric pain an hour ago but "feels fine" now. The parent is not sure when the child ingested the iron tablets. The nurse should recommend which of the following?

Bring the child to the hospital immediately (The critical period for observation after the ingestion of iron is 30 minutes to 6 hours. The child has had gastric pain, which may be symptomatic of toxicity, and needs to be monitored and possibly receive medical intervention. Although activated charcoal may be necessary, evaluation is indicated first. The child needs to be evaluated immediately. Ipecac is not recommended after the ingestion of toxic substances)

The nurse is examining an infant, age 10 months, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions. What is the most likely cause?

Candida albicans infection. (C. albicans infection produces perianal inflammation and a maculopapular rash with satellite lesions that may cross the inguinal folds. Impetigo is a bacterial infection that spreads peripherally in sharply marginated, irregular outlines. Eruptions involving the skin in contact with the diaper but sparing the folds are likely to be caused by chemical irritation, especially urine and feces, and may be related to infrequent diapering.)

Which of the following is a characteristic of children with depression?

Change in appetite, resulting in weight loss or gain (Physiologic characteristics of children with depression include a change in appetite resulting in weight loss or gain, nonspecific complaints of not feeling well, alterations in sleeping pattern (insomnia or hypersomnia), and constipation. Children who are depressed have sad facial expressions with an absence or diminished range of affective response. Children who are depressed lack interest in doing homework or achieving in school, resulting in lower grades. These children withdraw from previously enjoyed activities and engage in solitary play or work. Schoolwork is not replaced by play)

Parent guidelines for relieving colic in an infant include which of the following?

Change the infant's position frequently. (Changing the infant's position frequently may be beneficial. The parent can walk holding the child face down and with the child's abdomen across the parent's arm. The parent's hand can support the child's abdomen, applying gentle pressure. Pacifiers can be used for meeting additional sucking needs. Gently massaging the abdomen is effective in some children. The child should not be placed where he or she cannot be monitored. The child can be placed in the crib and allowed to cry. Periodically, the child should be picked up and comforted.)

Where do eczematous lesions most commonly occur in an infant?

Cheeks and extensor surfaces of the arms and legs. (The lesions of atopic dermatitis are generalized in infants. They are most common on the cheeks, scalp, trunk, and extensor surfaces of the extremities. The abdomen and buttocks are not common sites of lesions. The back and flexor surfaces are not usually involved.)

The community health nurse is reviewing risk factors for vitamin D deficiency. Which children are at high risk for vitamin D deficiency? (Select all that apply.)

Children who are overweight or obese, Children with diets low in sources of vitamin D, Children of families who use milk products not supplemented with vitamin D. (Populations at risk for vitamin D deficiency include overweight or obese children, children with diets low in sources of vitamin D, and children of families who use milk products not supplemented with vitamin D. Children with dark, not fair, pigmentation and children who are exclusively breast fed, not bottle fed, are also at risk.)

A child has an evulsed (knocked out) tooth. The parents are reluctant to try to reimplant the tooth. What should the tooth be placed in for transport to the dentist?

Cold milk (An evulsed tooth should be placed in a suitable medium, either cold milk or saliva (under the child or parent's tongue), for transport. Cold milk is a more suitable medium than water. The tooth should be maintained in a wet environment)

An infant has been diagnosed with failure to thrive (FTT) classified according to the pathophysiology of defective utilization. The nurse understands that the reason for the FTT is most likely related to what?

Congenital infection. (FTT classified according to the pathophysiology of defective utilization is related to a genetic anomaly, congenital infection of metabolic storage disease. Cystic fibrosis would be related to the pathophysiology of inadequate absorption, hyperthyroidism would be related to the pathophysiology of increased metabolism, and breastfeeding problems are related to inadequate caloric intake.)

A nurse is teaching a group of parents about infants who have failure to thrive. Which of the following characteristics should be included in the teaching?

D. CORRECT: Infants who have failure to thrive exhibit developmental delays as a result of decreased nutritional intake needed for brain development.

Which term refers to the relative lactase deficiency observed in preterm infants of less than 34 weeks of gestation?

Developmental lactase deficiency. (Developmental lactase deficiency refers to the relative lactase deficiency observed in preterm infants of less than 34 weeks of gestation. Congenital lactase deficiency occurs soon after birth after the newborn has consumed lactose-containing milk. Primary lactase deficiency, sometimes referred to as late-onset lactase deficiency, is the most common type of lactose intolerance and is manifested usually after 4 or 5 years of age. Secondary lactase deficiency may occur secondary to damage of the intestinal lumen, which decreases or destroys the enzyme lactase.)

The nurse is administering an oral antihistamine at bedtime to a child with atopic dermatitis (eczema). Which antihistamine should the nurse expect to be prescribed at bedtime?

Diphenhydramine (Benadryl) (Oral antihistamine drugs such as hydroxyzine or diphenhydramine usually relieve moderate or severe pruritus. Nonsedating antihistamines such as cetirizine (Zyrtec), loratadine (Claritin), or fexofenadine (Allegra) may be preferred for daytime pruritus relief. Because pruritus increases at night, a mildly sedating antihistamine such as Benadryl is prescribed.)

The parent of an infant with colic tells the nurse, "All this baby does is scream at me; it is a constant worry." What is the nurse's best action?

Encourage the parent to verbalize feelings.(Colic is multifactorial, and no single treatment is effective for all infants. The parent is verbalizing concern and worry. The nurse should allow the parent to put these feelings into words. An empathetic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parent's anxiety. The nurse should reassure the parent that he or she is not doing anything wrong. The infant with colic is experiencing spasmodic pain that is manifested by loud crying, in some cases up to 3 hours each day. Telling the parent that it will eventually go away does not help him or her through the current situation.)

The nurse is teaching parents strategies to manage their child's refusal to go to sleep. Which should the nurse include in the teaching session? (Select all that apply.)

Enforce consistent limits, Use a reward system with the child, Have a consistent before bedtime routine.(Strategies to manage a child's refusal to go to sleep include enforcement of consistent limits, using a reward system, and having a consistent before bedtime routine. An evaluation of whether the hour of sleep is too early should be considered because an early bedtime could cause the child to resist sleep if not tired.)

Which of the following is an important nursing consideration when caring for an infant with failure to thrive?

Establish a structured routine, which is followed consistently.(An infant with failure to thrive should have a structured routine that is followed consistently. Disruptions in other activities of daily living can have a great impact on feeding behaviors. Bathing, sleeping, dressing, playing, and feeding are structured. The child can engage in sensory and play activities at times other than mealtimes. Young children should be held while being fed, and older children can sit at a feeding table. The child should be fed in the same manner at each meal. The nurse should talk to the child by giving directions about eating. This will help the child maintain focus.)

A new parent relates to the nurse that the family has many known food allergies. Which is considered a primary strategy for feeding the infant with many family food allergies?

Exclusive breastfeeding for 4 to 6 months. (Exclusive breastfeeding for 4 to 6 months is now considered a primary strategy for avoiding atopy in families with known food allergies; however, there is no evidence that maternal avoidance (during pregnancy or lactation) of cow's milk protein or other dietary products known to cause food allergy will prevent food allergy in children. Researchers indicate that delaying the introduction of highly allergenic foods past 4 to 6 months of age may not be as protective for food allergy as previously believed. Likewise, studies have shown that soy formula does not prevent allergic disease in infants.)

Which of the following situations places infants at risk for developing vitamin D-deficiency rickets?

Families using yogurt as primary source of milk.(Yogurt does not contain adequate amounts of vitamins A and D. Commercial formulas have recommended amounts of vitamin D. Lack of sunlight is a causative factor. Individuals who follow a lacto-ovovegetarian diet use dairy products and can obtain sufficient vitamin D.)

Rickets is caused by a deficiency in what?

Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent rickets

A young child is being treated for giardiasis. Which of the following should the nurse recommend to the child's parent?

Handwashing will be important to prevent transmission to other family members. (Proper handwashing technique is important to prevent transmission of the parasite to other family members. If a child with giardiasis is in a pool, contamination of the entire pool is a possibility. Treatment may be indicated for up to 1 month to treat parasites that have hatched since treatment began. It is imperative to promote fluid intake to prevent dehydration in the child, so withholding fluids is not an appropriate recommendation)

Specific components of food or ingredients in food that are recognized by allergen-specific immune cells eliciting an immune reaction

Food allergen

An adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food

Food allergy

A food elicits a reproducible adverse reaction but does not have an established immunologic mechanism

Food intolerance

Ringworm, frequently found in schoolchildren, is caused by which of the following?

Fungus (Ringworm is a dermatophytosis, which is an infection caused by closely related fungi. They cause superficial infections that invade the stratum corneum, hair, and nails. Viruses, allergic reactions, and bacterial infections do not cause ringworm)

Which of the following foods should the nurse recommend as a good source of potassium for a child receiving diuretics?

Grains and legumes .(One combination of foods that provides the appropriate amounts of essential amino acids is grains (cereal, rice, pasta) and legumes (beans, peas, lentils, peanuts). Grains alone do not provide the appropriate amounts of essential amino acids. Dairy products and dark green vegetables do not provide the appropriate amounts of essential amino acids.)

Which of the following food combinations will generally provide the appropriate amounts of essential amino acids for someone who is a vegetarian?

Grains and legumes.(Eating grains (cereal, rice, and pasta) and legumes (beans, peas, lentils, and peanuts) at the same meal provides the appropriate amount of essential amino acids. Grains and vegetables, legumes and vegetables, and milk products and fruit are combinations that do not provide the appropriate amounts of essential amino acids.)

Which of the following vaccinations are included in health promotion during infancy? (Select all that apply.)

Haemophilus influenzae type b (Hib), Diphtheria, tetanus, and pertussis (DTaP) Poliovirus Hepatitis B virus (HBV) (The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, which include diphtheria, tetanus, and pertussis (DTaP using acellular pertussis); poliovirus; measles, mumps, and rubella (MMR); Hib; HBV; hepatitis A virus (HAV); meningococcal; pneumococcal conjugate vaccine (PCV); and influenza (and H1N1) during infancy. There is no current vaccination to prevent the transmission of hepatitis C virus)

Which of the following is most descriptive of kwashiorkor?

Has a multifactorial etiology. (Current evidence suggests a multifactorial causation, including cultural, psychologic, and infective factors that interact to place the child at risk. Kwashiorkor appears in infants after being weaned from the breast after the birth of another child. No correlation exists between vitamin K and kwashiorkor. Protein deficiency exists in children with kwashiorkor.)

Which of the following is the causative agent for erythema infectiosum (fifth disease)?

Human parvovirus B19. (The human parvovirus B19 is the causative agent. Mumps is caused by paramyxovirus organisms. The human herpesvirus type 6 is the virus responsible for exanthema subitum (roseola). Group A α-hemolytic streptococci infection causes scarlet fever)

A mother calls the school nurse saying that her daughter has developed school phobia. She has been out of school for 3 days. The nurse's recommendations should include which of the following?

Immediately return the child to school (he primary goal is to return the child to school. Parents must be convinced gently, but firmly, that immediate return is essential and that it is their responsibility to insist on school attendance. The longer the child is permitted to stay out of school, the more difficult it will be for the child to reenter. This will only delay the return to school and inhibit the child's ability to cope. Professional counseling is recommended if the problem persists, but the child's return to school should not wait for the counseling.)

An infant has been diagnosed with failure to thrive (FTT) classified according to the pathophysiology of inadequate caloric intake. The nurse understands that the reason for the FTT is most likely related to what?

Incorrect formula preparation. (FTT classified according to the pathophysiology of inadequate caloric intake is related to incorrect formula preparation, neglect, food fads, excessive juice poverty, breastfeeding problems, behavioral problems affecting eating, parental restriction of caloric intake, or central nervous system problems affecting intake consumption. Cow's milk allergy would be related to the pathophysiology of inadequate absorption, congenital heart disease would be related to the pathophysiology of increased metabolism, and metabolic storage disease is related to defective utilization.)

The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their children. Which is most likely lacking in their particular diet?

Iron and calcium. (Deficiencies can occur when various substances in the diet interact with minerals. For example, iron, zinc, and calcium can form insoluble complexes with phytates or oxalates (substances found in plant proteins), which impair the bioavailability of the mineral. This type of interaction is important in vegetarian diets because plant foods such as soy are high in phytates. Fat and vitamins C and A are readily available from vegetable sources. Plant proteins are available)

What may a clinical manifestations of failure to thrive (FTT) in a 13-month-old include?

Irregularity in activities of daily living. (One of the clinical manifestations of children with FTT is irregularity or low rhythmicity in activities of daily living. Children with FTT often refuse to switch from liquids to solid foods. Weight below the fifth percentile is indicative of FTT. Developmental delays, including social, motor, adaptive, and language, exist.)

The nurse is discussing the management of atopic dermatitis (eczema) with a parent. What should be included?

Keep the infant's fingernails and toenails cut short and clean.(The infant's nails should be kept short and clean and have no sharp edges. Gloves or cotton socks can be placed over the child's hands and pinned to the shirt sleeves. Heat and humidity increase perspiration, which can exacerbate the eczema. The child should be dressed properly for the climate. Synthetic material (not wool) should be used for the child's clothing during cold months. Baths are given as prescribed with tepid water, and emollients such as Aquaphor, Cetaphil, and Eucerin are applied within 3 minutes. Soap (except as indicated), bubble bath oils, and powders are avoided. Fabric softener should be avoided because of the irritant effects of some of its components.)

Which of the following is the most frequent source of symptomatic lead poisoning in children?

Lead-based paint. (Lead-based paint in houses built before 1978 is the most frequent source of lead poisoning. Some folk remedies and unglazed pottery may contain lead, but they are not the most frequent source. Cigarette butts and ashes do not contain lead.)

What are risk factors for sudden infant death syndrome? (Select all that apply.)

Low Apgar scores, Recent viral illness, Native American infants. (Infant risk factors for sudden infant death syndrome include those with low Apgar scores and recent viral illness and Native American infants. Preterm, not postterm, birth and male, not female, gender are other risk factors.)

What is an important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS)?

Make a follow-up home visit to the parents as soon as possible after the child's death. (A competent, qualified professional should visit the family at home as soon as possible after the death. Printed information about SIDS should be provided to the family. Parents should be allowed and encouraged to make a last visit with their child. SIDS cannot always be prevented or predicted, but parents can take steps to reduce the risk (e.g., supine sleeping, removing blankets and pillows from the crib, and not smoking). Discussions about the cause only increase parental guilt. The parents should be asked only factual questions to determine the cause of death.)

Which of the following is descriptive of attention-deficit/hyperactivity disorder (ADHD)?

Manifestations affect every aspect of the child's life but are most obvious in the classroom. (ADHD affects every aspect of the child's life, but the disruption is most obvious in the classroom. The behaviors exhibited by the child with ADHD are not unusual aspects of behavior. The difference lies in the quality of motor activity and developmentally inappropriate inattention, impulsivity, and hyperactivity that the child displays. Some children experience decreased symptoms during late adolescence and adulthood, but a significant number carry their symptoms into adulthood. Any given child will not have every symptom of the condition. The manifestations may be numerous or few and mild or severe, and they vary with the child's developmental level.)

Which factors will decrease iron absorption and should not be given at the same time as an iron supplement?

Many foods interfere with iron absorption and should be avoided when iron is consumed. These foods include phosphates found in milk, phytates found in cereals, and oxalates found in many vegetables.

What is marasmus?

Marasmus is a syndrome of emotional and physical deprivation. It is not confined to geographic areas were food supplies are inadequate. Marasmus is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears old, with flabby and wrinkled skin. Marasmus is a deficiency of both protein and calories

A 12-month-old infant has been diagnosed with failure to thrive (FTT). Which assessment findings does the nurse expect to be documented with this infant? (Select all that apply.)

Minimal smiling, Avoidance of eye contact,Wide-eyed gaze and continual scan of the environment. (Signs and symptoms of FTT include minimal smiling, avoidance of eye contact, and a wide-eyed gaze and continual scan of the environment ("radar gaze"). There is no fear of strangers, and there are developmental delays, including social, motor, adaptive, and language.)

Which of the following factors promote(s) wound healing?

Moist, crust-free wound environment (moist, crust-free wound environment enhances the migration of epithelial cells across the wound and facilitates healing. Antiseptics, such as hydrogen peroxide and povidone-iodine, have a cytotoxic effect on healthy cells and little effect on controlling infections. )

An infant has been diagnosed with an allergy to milk. In teaching the parent how to meet the infant's nutritional needs, the nurse states that

Most children will grow out of the allergy. (Approximately 80% of children with cow's milk allergy develop tolerance by the fifth birthday. The child can have eggs. Any food that has milk as a component or filler is eliminated. These foods include processed meats, salad dressings, soups, and milk chocolate. Having the entire family follow the special diet would provide support for the child, but the nutritional needs of other family members must be addressed. Antihistamines are not used for food allergies.)

The nurse has administered a dose of epinephrine to a 12-month-old infant. For which adverse reactions of epinephrine should the nurse monitor? (Select all that apply.)

Nausea,Tremors,Irritability. (Epinephrine increases activation of the sympathetic nervous system. Adverse effects include nausea, tremors, and irritability. Tachycardia would occur, not bradycardia, and hypertension, not hypotension, would occur.)

The nurse is teaching parents about potential causes of colic in infancy. Which should the nurse include in the teaching session? (Select all that apply.)

Overeating, Parental smoking, Swallowing excessive air. (Potential causes of colic include too rapid feeding, overeating, swallowing excessive air, improper feeding technique (especially in positioning and burping), emotional stress or tension between the parent and child, parental smoking, and overstimulation.)

The nurse is teaching parents about foods that are hyperallergenic. Which foods should the nurse include? (Select all that apply.)

Peanuts, Egg noodles, Tomato juice. (Hyperallergenic foods include peanuts, egg noodles, and tomato juice. Bananas and potatoes are not hyperallergenic.)

After the introduction of the Back to Sleep campaign in 1992, an increased incidence has been noted of which pediatric issues?

Plagiocephaly. (Plagiocephaly is a misshapen head caused by the prolonged pressure on one side of the skull. If that side becomes misshapen, facial asymmetry may result. SIDS has decreased by more than 40% with the introduction of the Back to Sleep campaign. Apnea of infancy and failure to thrive are unrelated to the Back to Sleep campaign.)

A bottle-fed infant has been diagnosed with cow's milk allergy. Which formula should the nurse expect to be prescribed for the infant?

Pregestimil. (For infants with cow's milk allergy, the formula will be changed to a casein hydrolysate milk formula (Pregestimil, Nutramigen, or Alimentum) in which the protein has been broken down into its amino acids through enzymatic hydrolysis. Similac, Enfamil with iron, and Gerber Good Start are cow's milk-based formulas.)

A Boy Scout sustains frostbite to his feet while out hiking in the mountains. Before he is transported to the nearest emergency treatment center, which of the following is important in managing his care?

Prevent him from walking any farther (The feet must be protected from further injury until definitive treatment occurs. This includes keeping the child from walking. The child should be transported as quickly as possible to the nearest emergency treatment center. Injured body parts are handled gently. Recommended rewarming is by immersion in well-agitated warm water)

Nursing care of the infant with atopic dermatitis (eczema) should focus on which of the following?

Preventing infection of lesions .(The lesions of atopic dermatitis are itchy. New lesions develop when the skin is scratched. This cycle leads to the possibility of infection. Although keeping the baby content and maintaining adequate nutrition are important, decreasing the amount of scratching is a primary aim. Antibiotics are not the primary treatment of atopic dermatitis.)

An important role of the nurse in ambulatory settings and schools is the identification of communicable diseases for treatment and the prevention of spread. An important component is the recognition of which of the following aspects of the disease?

Prodromal stage (The prodromal period is the interval between the early manifestations of the disease and the time when the overt clinical syndrome is evident. Most communicable diseases are contagious during this time. Although the source and causative agent of the disease are important, recognizing the early signs can help the nurse prevent spread and refer the child for medical therapy when indicated. Constitutional symptoms occur during the active disease phase. The child has been contagious, and the time for early intervention may have passed)

The nurse understands that respiratory hygiene and cough etiquette is recommended by the Centers for Disease Control and Prevention (CDC) to prevent which of the following?

RSV, influenza, and adenovirus (The CDC (2007) recommends respiratory hygiene and etiquette to prevent the transmission of RSV, influenza, adenovirus, and other droplet-transmitted unknown viruses. HBV, HSV, and varicella are not transmitted via droplets)

Which of the following should the nurse include when explaining how to manage pediculosis capitis?

Remove nits with a fine-tooth comb or tweezers (Daily removal of nits from a child's hair with a metal nit or flea comb is an essential control measure after treatment with a pediculicide. Cutting the child's hair short does not prevent infestation. Lice will infest short hair as readily as long hair. Regular shampoo will not remove nits. Using a fine-tooth comb or tweezers is necessary to remove the nits. It is not possible to tell viable and nonviable nits apart.)

A child falls on the playground and has a small laceration on the forearm. The school nurse should do which of the following to cleanse the wound?

Rinse the wound with sterile water or saline using a syringe to generate mild pressure (Normal saline and sterile water are the only acceptable fluids for irrigation listed. The nurse should cleanse the wound with a forced stream of normal saline or water. Hydrogen peroxide, water and soap, and a povidone-iodine solution should not be used because they are toxic to the wound.)

What is an appropriate action when an infant becomes apneic?

Roll the infant's head to the side.

Matt's mother tells the nurse that he keeps scratching the areas where he has poison ivy. The nurse's response should be based on which of the following?

Scratching the lesions may cause them to become secondarily infected. (Comfort measures should be used to minimize scratching. Irritating the lesions can result in secondary infection. The contact dermatitis is in response to the oil urushiol present in the poison ivy plant. The oozing from the skin irritation does not result in the development of further lesions. Poison ivy can be extremely itchy, and comfort measures should be used.)

Initial exposure to an allergen resulting in an immune response; subsequent exposure induces a much stronger response

Sensitization

What is the most common piece of medical equipment that can transmit harmful microorganisms among patients?

Stethoscope (A stethoscope is commonly used between patients, and if not correctly disinfected, it can be a dangerous source of spreading microorganisms. Thermometers of all types have barriers to prevent this. Needles are discarded immediately after injections and never reused, so they are not a common source of transmission. Disposable gloves are not reused, so they are not a common source of transmission)

The nurse is interviewing the parents of a 4-month-old boy brought to the hospital emergency department. The infant is dead, and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. The nurse might initially suspect his death was caused by what?

Sudden infant death syndrome (SIDS). (The description of how the child was found in the crib is suggestive of SIDS. The nurse is careful to tell the parents that a diagnosis cannot be confirmed until an autopsy is performed.)

Which of the following is an important consideration when the nurse is discussing enuresis with the parents of a young child?

The child should be encouraged to take charge of treatment interventions(Because any treatment involves and requires the child's active participation, the child is in charge of the interventions, and the parents should learn to support the child rather than intervene. Enuresis is more common in boys than in girls, and it has a strong family tendency. Psychogenic factors may influence enuresis, but it is doubtful that they are causative)

A 12-month-old child presents to the clinic for a well visit after missing several appointments. The child began her immunization schedule but has missed several follow-up appointments and immunization doses. The nurse knows that the most appropriate action is what?

The child should only receive the missed doses of immunizations. (Children who began primary immunization at the recommended age but fail to receive all the doses do not need to begin the series again but instead should receive only the missed doses. The child may receive missed vaccinations on a catch-up schedule per CDC guidelines)

Which of the following is the appropriate site to administer an intramuscular (IM) vaccine to a newborn?

The vastus lateralis muscle. (If the vaccine is given intramuscularly, then it is given in the vastus lateralis in newborns or in the deltoid for older infants and children. Regardless of age, the dorsogluteal site should be avoided because it has been associated with low antibody seroconversion rates, indicating a reduced immune response, and it is no longer an acceptable evidence-based practice site for IM injections. The ventral gluteal muscle and the biceps muscle are not appropriate sites for IM injections.)

The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurse's response should be based on remembering what?

This is acceptable to encourage head control and turning over. (These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs to reduce the risk of SIDS and then be placed on their abdomens when awake to enhance achievement of milestones such as head control. These position changes encourage gross motor, not fine motor, development.)

The nurse is assessing a child with herpetic gingivostomatitis. In determining whether to wear gloves, the nurse bases the decision on which of the following?

This virus easily enters breaks in the skin(The herpes simplex virus is highly contagious and can easily enter breaks in the skin of the hands. Although the nurse can decide not to wear gloves, this is a violation of universal precautions because contact with the oral mucosa may take place. Herpetic gingivostomatitis is present in the lesions and is easily spread. )

Which of the following is an important nursing consideration when caring for a child with impetigo contagiosa?

Thoroughly wash hands and maintain cleanliness when caring for an infected child (Preventing the spread of inspection is a prime consideration when caring for children with bacterial skin infections. Thorough hand washing and cleanliness will help achieve this goal. Topical corticosteroids are contraindicated in bacterial infections. A Wood lamp is used for diagnosis of some fungal and bacterial skin infections. Dressings are not used in impetigo.)

Deficiency of which of the following vitamins correlates with increased morbidity and mortality in children with measles and increased complications from diarrhea and infections?

Vitamin A deficiency contributes to increased morbidity in measles, diarrhea, and infections. The American Academy of Pediatrics recommends that supplementation be considered in children with measles and related disorders. No correlation exists between vitamin C, niacin, and folic acid and increased morbidity and mortality with measles.

Which of the following vitamins increases the absorption of iron?

Vitamin C. (Vitamin C increases the absorption of iron for hemoglobin formation. No correlation exists between vitamins B12, D, and biotin and iron absorption.)

A 1-year-old child is on a pure vegetarian (vegan) diet. This diet requires supplementation with what?

Vitamins D and B12. (Pure vegetarian (vegan) diets eliminate any food of animal origin, including milk and eggs. These diets require supplementation with many vitamins, especially vitamin B6, vitamin B12, riboflavin, vitamin D, iron, and zinc)

Which of the following is an important nursing intervention in the care of a child with bacterial conjunctivitis?

Warm, moist compresses to remove crusts (Keeping the eye clean is a priority nursing goal for a child with bacterial conjunctivitis. The crusts are removed with a warm, moist compress, wiping the eye from the inner canthus downward and away from the opposite eye. Oral antihistamines are not indicated. Continuous compresses are not used. The warm, moist environment promotes bacterial growth. Topical corticosteroids are avoided because they reduce ocular resistance to bacteria.)

A new parent asks the nurse, "How can diaper rash be prevented?" What should the nurse recommend?

Wipe stool from the skin using water and a mild cleanser.(Change the diaper as soon as it becomes soiled. Gently wipe stool from the skin with water and mild soap. The skin should be thoroughly dried after washing. Applying oil does not create an effective barrier. Over washing the skin should be avoided, especially with perfumed soaps or commercial wipes, which may be irritating. Baby powder should not be used because of the danger of aspiration.)

Lactose intolerance is diagnosed in an 11-month-old infant. Which should the nurse recommend as a milk substitute?

Yogurt. (Yogurt contains the inactive lactase enzyme, which is activated by the temperature and pH of the duodenum. This lactase activity substitutes for the lack of endogenous lactase. Ice cream and cow's milk-based formula contain lactose, which will probably not be tolerated by the child. Fortified cereal does not have the nutritional equivalents of milk.)

Although infants may be allergic to a variety of foods, the most common allergens are

eggs, cow's milk, and peanuts. (Milk products, eggs, and peanuts are three of the most common food allergens. Ingestion of these products can cause sensitization and, with subsequent exposure, an allergic reaction. Eggs are a common allergen but not fruit or rice. Wheat is a common allergen but not fruit and vegetables. Cow's milk is a common allergen but not green vegetables)

The term used to describe an abnormal sensation such as burning or prickling is

paresthesia (An abnormal sensation such as burning or prickling describes paresthesia. Hyperesthesia is excessive sensitiveness, hypesthesia is diminished sensation, and anesthesia is absence of sensation)