Exam 2 Peds

An adolescent weighing 55 kg is admitted to the hospital experiencing a sickle cell crisis. Intravenous fluid therapy as well as increased oral fluids are ordered as part of his treatment plan. Based on the understanding of the amount of fluids needed to promote hemodilution, the nurse would expect the adolescent to receive how much total fluid in 24 hours? __________ mL

150mg/kg/day = 8250 mL

The nurse is researching behavioral-cognitive pain relief strategies to use on a 5-year- old child with unrelieved pain. Which of the following methods might the nurse choose? Select all answers that apply. A) Relaxation B) Distraction C) Biofeedback D) Thought stopping E) Massage F) Sucking

A) Relaxation B) Distraction C) Biofeedback D) Thought stopping

The nurse is assessing the pain of a postoperative newborn. The nurse measures the infant's facial expression, body movement, sleep, verbal or vocal ability, consolability, and response to movements and touch. Which behavioral assessment tool is being used by the nurse? A) Riley Infant Pain Scale B) Pain Observation Scale for Young Children C) CRIES Scale for Neonatal Postoperative Pain Assessment D) FLACC Behavioral Scale for Postoperative Pain in Young Children

A) Riley Infant Pain Scale

When developing the plan of care for a child with cerebral palsy, which treatment would the nurse expect as least likely? A) Skeletal traction B) Physical therapy C) Orthotics D) Occupational therapy

A) Skeletal traction

A child with diabetes insipidus is being treated with vasopressin. The nurse would assess the child closely for signs and symptoms of which condition? A) Syndrome of inappropriate antidiuretic hormone (SIADH) B) Thyroid storm C) Cushing syndrome D) Vitamin D toxicity

A) Syndrome of inappropriate antidiuretic hormone (SIADH) Feedback: SIADH, although rare in children, is a potential complication of excessive administration of vasopressin. Thyroid storm may result from overadministration of levothyroxine (thyroid hormone replacement). Cushing syndrome is associated with corticosteroid use. Vitamin D toxicity may result from the use of vitamin D as treatment of hypoparathyroidism.

The nurse caring for infants in the neonatal intensive care unit (NICU) relies on the use of behavioral and physiologic indicators for determining pain. Which of the following examples are behavioral indicators? Select all answers that apply. A) The infant grimaces. B) The infant's heart rate is elevated. C) The infant flails his arms and legs. D) The infant's respiratory rate is elevated. E) The infant is crying uncontrollably. F) The infant's oxygen saturation is low.

A) The infant grimaces. C) The infant flails his arms and legs. E) The infant is crying uncontrollably.

The nurse is developing a plan of care for a child with thalassemia. Which of the following would the nurse expect to include? Select all that apply. A) Packed RBC transfusions B) Deferoxamine therapy C) Heparin therapy D) Opioid analgesics E) Platelet transfusions F) Intravenous immunoglo

A, B A) Packed RBC transfusions B) Deferoxamine therapy RBC transfusions and deferoxamine for chelation are used to treat thalassemia. Heparin therapy is used for treating DIC. Opioid analgesics would be used to treat severe pain associated with sickle cell crisis. Platelet transfusions and intravenous immunoglobulin would be used to treat idiopathic thrombocytopenia purpura.

A child with Duchenne muscular dystrophy is to receive prednisone as part of his treatment plan. After teaching the child's parents about this drug, which statement by the parents indicates the NEED for additional teaching? A) "We should give this drug before he eats anything." B) "We need to keep a close eye for possible infection." C) "The drug should not be stopped suddenly." D) "He might gain some weight with this drug."

A. We should give this drug before he eats anything

A group of students are reviewing information about glucose-6-phosphate dehydrogenase (G6PD) deficiency. The students demonstrate understanding of the material when they identify this disorder as due to which of the following? A) X-linked recessive inheritance B) Deficiency in clotting factors C) An excess supply of iron D) Autosomal recessive inheritance

A. X-linked recessive inheritance G6PD deficiency is an X-linked recessive disorder that affects the functioning of the red blood cells. A deficiency in clotting factors is associated with disorders such as idiopathic thrombocytopenia purpura, DIC, or hemophilia. An excess supply of iron refers to hemosiderosis, a complication of thalassemia, an autosomal recessive disorder

A child is diagnosed with hyperthyroidism. Which agent would the nurse expect the physician to prescribe? A) Mineralocorticoid B) Methimazole C) Levothyroxine D) Dexamethasone

B) Methimazole Feedback: Methimazole is an antithyroid drug that is used to treat hyperthyroidism. Mineralocorticoid is used to treat adrenal insufficiency. Levothyroxine is used to treat hypothyroidism. Dexamethasone is used to treat congenital adrenal hyperplasia.

A child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the nurse would focus on which type of anemia? A) Aplastic anemia B) Pernicious anemia C) Folic acid anemia D) Sickle cell anemia

B) Pernicious anemia Monthly injections of vitamin B12 are used to treat pernicious anemia. Aplastic anemia is characterized by a decrease in all blood cells necessitating a bone marrow transplant. Folic acid deficiency anemia is treated with dietary measures and possible folic acid supplementation. Sickle cell anemia is treated supportively with a focus on preventing sickling crisis, infection, and other complications.

The nurse is assessing a child with suspected thalassemia. Which of the following would the nurse expect to assess? A) Dactylitis B) Frontal bossing C) Presence of clubbing D) Presence of spooning

B. Frontal bossing The nurse would expect to find skeletal deformities such as frontal or maxillary bossing. Dactylitis is associated with sickle cell anemia. Clubbing and spooning are associated with chronic decreases in oxygen supply.

The nurse is caring for an 8-year-old boy with myasthenia gravis and is teaching his parents about the signs of cholinergic crisis. Which of the following responses by the parents indicates a NEED for further teaching? A) "Low blood pressure is a sign of crisis." B) "He might have difficulty swallowing." C) "He may start to sweat a lot." D) "More saliva in the mouth is a common sign."

B. He might have difficulty swallowing

A nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm3. Which medication would the nurse most likely expect to be ordered? A) Folic acid B) Intravenous immune globulin C) Dimercaprol D) Deferoxamine

B. Intravenous immune globulin Intravenous immune globulin would be used to treat idiopathic thrombocytopenic purpura. Folic acid is used to treat folic acid deficiency anemia. Dimercaprol is used to remove lead from the soft tissue and bone to allow for excretion by the kidneys. Deferoxamine is used to treat iron toxicity.

A nurse is caring for a 14-year-old girl following myelography. Which of the following would be the priority nursing action? A) Monitoring for a decrease in spasticity B) Observing for signs of meningeal irritation C) Assessing motor function D) Observing for mental confusion or hallucinations

B. Observing for signs of meningeal irritation Following myelography, the nurse should carefully observe for signs of meningeal irritation because of what is involved in this procedure. Monitoring for a decrease in muscle spasticity, assessing motor function, and observing for mental confusion or hallucinations is appropriate following an intrathecal test dose of baclofen.

The nurse assesses a child's level of consciousness, noting that the child falls asleep unless he is stimulated. The nurse documents this finding as: A. Confusion B. Obtunded C. Stupor D. Coma

B. Obtunded Obtunded is a state in which the child has limited responses to the environment and falls asleep unless stimulation is provided. Confusion involves disorientation; the child may be alert but responds inappropriately to questions. Stupor exists when the child responds only to vigorous stimulation. Coma is a state in which the child cannot be aroused even with painful stimuli.

The nurse is evaluating the laboratory test results of a 7-year-old child with a suspected hematologic disorder. Which finding would cause the nurse to be concerned? A) WBC: 5.6 × 103/mm3 B) RBC: 2.8 × 106/mm3 C) Hemoglobin: 11.4 mg/dL D) Hematocrit: 35%

B. RBC: 2.8 X 106/mm3 The RBC listed is below the normal range for a child between the ages of 6 and 16 years (4.0 to 5.2 X 106/mm3). The WBC count, hemoglobin, and hematocrit are within acceptable parameters for a child this age

The nurse is teaching a group of students about myelinization in a child. Which statement by the students indicates that the teaching was successful? A) Myelinization is completed by 4 years of age. B) The process occurs in a head-to-toe fashion. C) The speed of nerve impulses slows as myelinization occurs. D) Nerve impulses become less specific in focus with myelinization.

B. The process occurs in a head-to-toe fashion

During a well-child visit, the nurse assesses an infant's ability to suck on a pacifier. The nurse is assessing which cranial nerve? A. Olfactory B. Trigeminal C. Facial D. Accessory

B. Trigeminal To test the trigeminal nerve, the nurse would note the strength of the infant's suck on a pacifier, thumb, or bottle. The olfactory nerve is not assessed in infants and young children. The facial nerve is assessed by noting the symmetry of facial expressions. For the infant, this would be assessed during spontaneous crying or smiling. The accessory nerve is assessed when the infant is in the sitting position and symmetry of the head position is noted.

The nurse is caring for a 10-year-old with Duchenne muscular dystrophy. As part of the plan of care, the nurse focuses on maintaining his cardiopulmonary function. Which intervention would the nurse implement to best promote maximum chest expansion? A) Deep-breathing exercises B) Upright positioning C) Coughing D) Chest percussion

B. Upright positioning The nurse should emphasize that the child's position should be arranged to promote maximum chest expansion. This is usually in the upright position. Deep-breathing exercises are for strengthening/maintaining respiratory muscles. Coughing helps clear the airways. Chest percussion helps loosen secretions in lungs.

When providing care to a newborn infant who was born at 29 weeks' gestation, the nurse integrates knowledge of potential complications, being alert for signs and symptoms of which of the following? A. Neonatal conjunctivitis B. Facial deformities C. Intracranial hemorrhage D. Incomplete myelinization

C. Intracranial hemorrhage Premature infants have more fragile capillaries in the periventricular area than term infants, which puts them at greater risk for intracranial hemorrhage. Neonatal conjunctivitis can occur in any newborn during birth and is caused by viruses, bacteria, or chemicals. Facial deformities are typical of babies of alcoholic mothers. Incomplete myelinization is present in all newborns.

A child with spastic cerebral palsy is to receive botulin toxin. The nurse prepares the child for administration of this drug by which route? A) Oral B) Subcutaneous injection C) Intramuscular injection D) Intravenous infusion

C. Intramuscular injection

Hydrocephalus is suspected in a 4-month-old infant. Which of the following would the nurse expect to assess? A. Sunken fontanels B. Diminished reflexes C. Lower extremity spasticity D. Skull symmetry

C. Lower extremity spasticity Hydrocephalus is manifested by spasticity of lower extremities, bulging fontanels, brisk reflexes, and skull asymmetry.

The nurse is reviewing the laboratory test results of a child diagnosed with disseminated intravascular coagulation (DIC). Which of the following would the nurse interpret as indicative of this disorder? A) Shortened prothrombin time B) Increased fibrinogen level C) Positive fibrin split products D) Increased platelets

C. Positive fibrin split products Laboratory test results associated with DIC include positive fibrin split products; prolonged prothrombin time, partial thromboplastin time, bleeding time, and thrombin time; decreased fibrinogen levels, platelets, clotting factors II, V, VIII, and X, and antithrombin III; and increased levels of fibrinolysin, fibrinopeptide A, and positive D-dimers.

A nurse is teaching the parents of an infant with congenital adrenal hyperplasia about the signs and symptoms of adrenal crisis. The nurse determines that the teaching was successful when the parents correctly identify what sign of adrenal crisis? A) Bradycardia B) Constipation C) Fluid overload D) Persistent vomiting

D) Persistent vomiting Feedback: Signs and symptoms of acute adrenal crisis include persistent vomiting, dehydration, hyponatremia, hyperkalemia, hypotension, tachycardia, and shock.

The nurse has developed a plan of care for a 6-year-old with muscular dystrophy. He was recently injured when he fell out of bed at home. Which intervention would the nurse suggest to prevent further injury? A) Recommend the bed's side rails be raised throughout the day and night. B) Suggest a caregiver be present continuously to prevent falls from bed. C) Encourage a loose restraint to be used when he is in bed. D) Recommend raising the bed's side rails when a caregiver is not present.

D) Recommend raising the bed's side rails when a caregiver is not present. The nurse should recommend that side rails on the bed be elevated when a caregiver is not present. The use of restraints should be avoided if at all possible. Suggesting that a caregiver be present at all times places undue stress on the family. Close observation is more appropriate. Recommending side rails be elevated at all times may be upsetting to the child and make him feel like a "baby."

The nurse is monitoring a child who has received epidural analgesia with morphine. The nurse is careful to monitor for which of the following adverse effects of the medication? A) Epidural hematoma B) Arachnoiditis C) Spinal headache D) Respiratory depression

D) Respiratory depression

The nurse uses the FLACC behavioral scale to assess a 6-year-old's level of postoperative pain and obtains a score of 9. The nurse interprets this to indicate that the child is experiencing: A) Little to no pain B) Mild pain C) Moderate pain D) Severe pain

D) Severe pain

The nurse is using the acronym QUESTT to assess the pain of a child. Which of the following is an accurate descriptor of this process? A) Question the child's parents. B) Understand the child's pain level. C) Establish a caring relationship with the child. D) Take the cause of pain into account when intervening.

D) Take the cause of pain into account when intervening.

What finding would the nurse expect to assess in a child with hypothyroidism? A) Nervousness B) Heat intolerance C) Smooth velvety skin D) Weight gain

D) Weight gain Feedback: Hypothyroidism is manifested by weight gain, fatigue, cold intolerance, and dry skin. Nervousness, heat intolerance, and smooth velvety skin are associated with hyperthyroidism.

The nurse is caring for a child recently diagnosed with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The nurse is teaching the parents about triggers that may result in oxidative stress. Which of the following responses indicates a need for further teaching? A) "I doubt he will ever eat fava beans, but they could trigger hemolysis." B) "He must avoid exposure to naphthalene, an agent found in mothballs." C) "He must never take methylene blue for a urinary tract infection." D) "My son can never take penicillin for an infection."

D. "My son can never take penicillin for an infection." The nurse should emphasize that penicillin is not a known trigger that may result in oxidative stress and hemolysis. Fava beans, naphthalene, and methylene blue can trigger oxidative stress.

The nurse is developing a teaching plan for the parents of a child with a myelomeningocele who will require clean intermittent catheterization. Which of the following would the nurse include? A) Applying petroleum jelly to lubricate the catheter B) Cleaning the reusable catheter with peroxide after each use C) Storing the reusable cleaned catheter in a brown paper bag D) Soaking the catheter in a vinegar and water solution to sterilize

D. Soaking the catheter in a vinegar and water solution to sterilize

The nurse has developed a teaching plan for the family of a 2-year-old boy who holds his breath when he gets frustrated. Which of the following will be most important to include in this plan? A. Provide cuddle time whenever the child begins to act out B. Explain the child's behavior to the parents C. Encourage the parents to interact more with the child D. Stay close to prevent injury when he gets frustrated

D. Stay close to prevent injury when he gets frustrated Encourage the parents to maintain a safe environment when an episode is occurring, but to avoid giving extra attention to the child after the event since this could encourage repetition of the behavior. It is important for the parents to understand what is happening, but rewarding the child with cuddle time when he is misbehaving provides incorrect reinforcement of behaviors. Encouraging the parents to interact more with the child may be helpful, but the priority is safety for the child.

A 16-year-old boy complains to the school nurse of headaches and a stiff neck. Which of the following signs and symptoms would alert the nurse that the child may have bacterial meningitis? A. Fixed and dilated pupils B. Frequent urination C. Sunset eyes D. Sunlight is "too bright"

D. Sunlight is "too bright" Photophobia, or intolerance of light, is another symptom of bacterial meningitis. Fixed and dilated pupils are a symptom of head trauma and warrant prompt intervention. Frequent urination is a symptom of a type I Arnold-Chiari malformation. Sunset eyes indicate increased intracranial pressure typical of hydrocephalus.

The nurse inspects the eyes of a child and observes that the sclera is showing over the top of the iris. The nurse documents this finding as: A. Decorticate posturing B. Nystagmus C. Doll's eye D. Sunsetting

D. Sunsetting Sunsetting is when the sclera of the eyes is showing over the top of the iris. Decorticate posturing includes adduction of the arms, flexion at the elbows with the arms held over the chest, and flexion of the wrists with both hands fisted and the lower extremities adducted and extended. Nystagmus is manifested by involuntary rapid rhythmic eye movements. Doll's eye is a maneuver that tests for symmetric eye movement to the opposite side when the head is turned in the other direction.

The nurse is providing postoperative care for a 14-month-old girl who has undergone a myelomeningocele repair. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. Which response by the nurse would be most appropriate? A) "I will help you become comfortable in caring for your daughter." B) "You must learn how to care for your daughter at home." C) "You will need to learn to collaborate with all the caregivers." D) "There is a lot to learn, and you need a positive attitude."

A) "I will help you become comfortable in caring for your daughter." The nurse needs to empower families to become the experts on their child's needs and conditions via education and participation in care. The most positive approach is to let the mother know the nurse will support her and help her become an expert on her daughter's care. Telling the mother that she must learn how to care for her daughter or that she must have a positive attitude is not helpful. Telling her that she needs to collaborate with the caregivers is true, but does not address her fears.

The nurse is providing teaching to the parents of a newborn prior to a heelstick. The nurse is describing the procedure and recommending various methods for the parents to help comfort their baby. Which of the following statements by the parents indicates a need for further teaching? A) "It's better if we are not in the room for this." B) "We can use kangaroo care before and after." C) "We hope you are using a very tiny needle." D) "We can offer him nonnutritive sucking to calm him."

A) "It's better if we are not in the room for this."

A 6-year-old child has been diagnosed with growth hormone deficiency. The child's mother requests more information about this condition. Which statements should be included in the nurse's response? Select all that apply. A) "The majority of children who have this condition are born of normal weight and length." B) "There are several potential causes of this condition." C) "This condition is most likely related to dwarfism in past generations of your family." D) "Most children with this condition are nutritionally deprived." E) "Your child most likely does not eat adequate amounts of protein."

A) "The majority of children who have this condition are born of normal weight and length." B) "There are several potential causes of this condition." Feedback: Growth hormone deficiency can result from a variety of causes. These causes may include genetic mutations, tumors, infection and birth trauma. Some cases have not identifiable causes. Most children diagnosed with this condition are of normal length and weight at birth but in childhood fall behind in growth. A small proportion of children may have nutritional concerns.

For which of the following children would nonopioid analgesics be recommended? A) A child with juvenile arthritis B) A child with end-stage cancer C) A child with a broken arm D) A child with severe postoperative pain

A) A child with juvenile arthritis

Prior to administering morphine to a 10-year-old child, the nurse reviews the adverse effects of the drug. Which system is primarily affected by the drug causing most of the adverse effects? A) Central nervous system B) Peripheral nervous system C) Digestive system D) Musculoskeletal system

A) Central nervous system

The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. What is the priority nursing diagnosis? A) Deficient fluid volume related to dehydration B) Excess fluid volume related to edema C) Deficient knowledge related to fluid intake regimen D) Imbalanced nutrition, more than body requirements related to excess weight

A) Deficient fluid volume related to dehydration Feedback: The priority nursing diagnosis most likely would be deficient fluid volume related to dehydration, due to a deficiency in the secretion of antidiuretic hormone (ADH). Excess fluid would result from a disorder that leads to water retention, such as syndrome of inappropriate antidiuretic hormone (SIADH). Deficient knowledge related to fluid intake regimen is a nursing diagnosis for this child, but a secondary one. Imbalanced nutrition, more than body requirements related to excess weight would be inappropriate for this child since he probably has lost weight secondary to the fluid loss.

The nurse is preparing a teaching plan for the family and their 6-year-old son who has just been diagnosed with diabetes mellitus. What would the nurse identify as the initial goal for the teaching plan? A) Developing management and decision-making skills B) Educating the parents about diabetes mellitus type 1 C) Developing a nutritionally sound, 30-day meal plan D) Promoting independence with self-administration of insulin

A) Developing management and decision-making skills Feedback: Developing basic management and decision-making skills related to the diabetes is the initial goal of the teaching plan for this child and family. The nurse would have provided a basic description of the disorder after it was diagnosed. Development of a detailed monthly meal plan would come later, perhaps after consulting with a nutritionist. It is too soon to expect the boy to administer his own insulin.

The nurse is managing children who have chronic diseases in a neighborhood clinic. Which of the following are examples of chronic conditions? Select all answers that apply. A) Diabetes mellitus B) Myocardial infarction C) Rheumatoid arthritis D) Compound fracture E) Acute asthma F) Bronchopneumonia

A) Diabetes mellitus C) Rheumatoid arthritis E) Acute asthma

When evaluating the hemogram of an 8-month-old infant, the nurse would identify which type of hemoglobin as being the predominant type? A) Hemoglobin A B) Hemoglobin F C) Hemoglobin A2 D) Hemoglobin S

A) Hemoglobin A

The nurse is caring for a 9-year-old patient newly diagnosed with diabetes. The patient has polyuria, polydipsia, and weight loss. Which nursing diagnoses will the nurse include in the care plan? Select all that apply. A) Imbalanced nutrition: less than body requirements B) Deficient fluid volume C) Deficient knowledge regarding disease process D) Noncompliance E) Delayed growth and development

A) Imbalanced nutrition: less than body requirements B) Deficient fluid volume C) Deficient knowledge regarding disease process Feedback: Polyuria (excessive urination), polydipsia (excessive thirst), and weight loss support the diagnoses of Deficient fluid volume and Imbalanced nutrition: less than body requirements. Being newly diagnosed with the disease at the age of 9 supports the diagnosis of Deficient knowledge regarding disease process. There is no data to support Noncompliance or Delayed growth and development.

The nurse is caring for a child who is recovering from an appendectomy. Which of the following is the appropriate term for the pain this child is experiencing? A) Nociceptive pain B) Neuropathic pain C) Chronic pain D) Superficial somatic pain

A) Nociceptive pain

The nurse is assessing a child with aplastic anemia. Which of the following would the nurse expect to assess? Select all that apply. A) Ecchymoses B) Tachycardia C) Guaiac-positive stool D) Epistaxis E) Severe pain F) Warm tender joints

A, B, C, D Assessment findings associated with aplastic anemia include ecchymoses, epistaxis, guaiac-positive stools, and tachycardia. Severe pain and warm tender joints are most often associated with sickle cell crisis.

The nurse is teaching the parents of a child diagnosed with iron-deficiency anemia about ways to increase their child's intake of iron. The parents demonstrate understanding of the teaching when they identify which foods as good choices for the child? Select all that apply. A) Tuna B) Salmon C) Tofu D) Cow's milk E) Dried fruits

A, B, C, E A) Tuna B) Salmon C) Tofu E) Dried fruits Foods high in iron include red meats, tuna, salmon, eggs, tofu, enriched grains, dried beans and peas, dried fruits, leafy green vegetables, and iron-fortified breakfast cereals.

A group of students are reviewing information about head injuries in children. The students demonstrate understanding of this information when they identify which of the following as the most common type of skull fracture in children? A. Linear B. Depressed C. Diastatic D Basilar

A. Linear The most common type of skull fracture in children is a linear skull fracture, which can result from minor head injuries. Other, less common types of skull fractures in children include depressed, diastatic, and basilar.

The nurse is caring for a child with thalassemia who is receiving chelation therapy at home using a battery-operated pump. After teaching the parents about this treatment, which statement by the mother indicates a need for additional teaching? A) "I can have the nurse administer the chelation therapy if I am uncomfortable." B) "I must be very careful to strictly adhere to the chelation regimen." C) "The deferoxamine binds to the iron so it can be removed from the body." D) "The medication can be administered while my child is sleeping."

A. "I can have the nurse administer the chelation therapy if I am uncomfortable." The nurse needs to emphasize to the mother that therapy must be maintained at home to continuously decrease the iron levels in the child's body. Family members need to be taught to administer deferoxamine subcutaneously with a small battery-powered infusion pump over a several-hour period each night (usually while the child is sleeping)

A 10-month-old is brought to the emergency department by her parents after they found her face down in the bathtub. The mother said, "I just left the bathroom to answer the phone. When I came back, I found her." Which of the following assessments would be the priority? A. Airway, breathing, circulation B. LOC C. Vital signs D. Pupillary response

A. Airway, breathing, circulation With a submersion injury, hypoxia is the primary problem. Therefore, assessment of airway, breathing, and circulation are the priority assessments for which the nurse would institute resuscitative measures. Other assessments such as level of consciousness, vital signs, and papillary response would be done once the child's airway, breathing, and circulation are assessed and emergency interventions are instituted.

A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, " I had a sinus infection and sore throat a couple of days ago." The nurse suspects bacterial meningitis based on which of the following? Select all that apply. A. Complaints of stiff neck B. Photophobia C. Absent headache D. Negative Brudzinski sign E. Vomiting

A. Complaints of stiff neck B. Photophobia E. Vomiting In addition to the adolescent's complaints and history, other findings suggesting bacterial meningitis include complaints of a stiff neck, photophobia, headache, positive Brudzinski sign, and vomiting.

A 4-year-old boy has a history of seizures and has been started on a ketogenic diet. Which of the following food selections would be MOST appropriate for his lunch? A. Fried eggs, bacon, and iced tea B. A hamburger on a bun, french fries, and milk C. Spaghetti with meatballs, garlic bread, and a cola drink D. A grilled cheese sandwich, potato chips, and a milkshake

A. Fried eggs, bacon, and iced tea The ketogenic diet involves a high intake of fats, adequate protein intake, and a very low intake of carbohydrates, resulting in a state of ketosis.

The nurse is caring for a child with a spinal cord injury and providing instruction to the parents on promoting skin integrity. Which response from the mother indicates a NEED for further teaching? A) "I need to monitor his skin at least twice a week." B) "I must monitor skin affected by his adaptive equipment." C) "He must change positions frequently." D) "We must avoid harsh cleaning products."

A. I need to monitor his skin at least twice a week

The nurse is caring for a child hospitalized with Reye syndrome who is in the acute stage of the illness. The nurse would assess the child most carefully for which of the following? A. Indications of increased intracranial pressure B. An increase in blood glucose level C. A decrease in the liver enzymes D. A presence of protein in the urine

A. Indications of increased intracranial pressure Reye syndrome is characterized by brain swelling, liver failure, and death in hours if treatment is not initiated. Therefore, increased intracranial pressure could occur. Liver enzyme levels typically increase. Blood glucose levels and protein in the urine are not characteristic of this illness.

The physician has ordered rectal diazepam (Valium) for a 2-year-old boy with status epilepticus. Which of the following instructions is essential for the nurse to teach the parents? A. Monitor their child's level of sedation B. Watch for fever indicating infection C. Gradually reduce the dosage as seizures stop D. Monitor for an allergic reaction to the medication

A. Monitor their child's level of sedation Diazepam is useful for home management of prolonged seizures and requires that the parents be educated on its proper administration. Monitoring the child's level of sedation is key when giving diazepam because it slows the central nervous system. Parents need to monitor the overall health of the child, including temperature when needed, but that has nothing to do with the diazepam. When the use of an anticonvulsant is stopped, gradual reduction of the dosage is necessary to prevent seizures or status epilepticus. This is not done without a physician's order. Monitoring for allergic reactions is necessary when any medications have been prescribed, but is not specific to diazepam.

A nurse is preparing a school-aged child for a lumbar puncture. The nurse would expect to position the child in which manner? A. On her side with the head flexed forward and knees flexed to the abdomen B. Sitting upright with the head flexed forward to the chest C. Supine with arms and legs pronated and extended D. Prone with the arms flexed under the chest

A. On her side with the head flexed forward and knees flexed to the abdomen When a lumbar puncture is performed on a child, the child is placed on his or her side with the head flexed forward and knees flexed to the abdomen. An infant would be positioned sitting upright with the head flexed forward. A supine position with the arms and legs pronated and extended suggests decerebrate posturing. A prone position is not used for a lumbar puncture.

A child with increased intracranial pressure is being treated with hyperventilation. The nurse understands the need for this treatment is based on which of the following? A. PaCO2 levels decrease, causing vasoconstriction B. Drainage of cerebrospinal fluid occurs C. Activity is controlled via a stimulator D. Hyperexcitability of the nerves is reduced

A. PaCO2 levels decrease, causing vasoconstriction Hyperventilation decreases PaCO2, which results in vasoconstriction and therefore decreases intracranial pressure. A shunt would allow for drainage of cerebrospinal fluid. A vagal nerve stimulator is used to provide an appropriate dose of stimulation to manage seizure activity. Anticonvulsants decrease the hyperexcitability of nerves.

The nurse is conducting a physical examination of a toddler with suspected lead poisoning. Lab results indicate blood lead level 52 µg/dL. Which action would the nurse expect to happen next? A) Repeat testing within 2 days and prepare to begin chelation therapy as ordered B) Repeat testing within 1 week with education to decrease lead exposure C) Confirm with repeat testing in 1 month and referral to local health department D) Prepare to admit child to begin chelation therapy

A. Repeat testing within 2 days and prepare to begin chelation therapy as ordered. The recommendation for blood lead levels of 45 to 69 mcg/dL is to confirm the level with a repeat laboratory test within 2 days and educate the parents to decreased lead exposure. She should also expect to begin chelation therapy as ordered and refer the case to the local health department for investigation of home lead reduction with referrals for support services. Repeat testing in 1 week with parent education is appropriate for lead levels between 20 and 44 mcg/dL. Repeat testing in 1 month and education would be appropriate for levels between 15 and 19 mcg/dL. Preparing to admit the child to begin chelation therapy immediately would be appropriate for lead levels greater than 70 mcg/dL

When providing care to a child with aplastic anemia, which nursing diagnosis most likely would be the priority? A) Risk for injury B) Imbalanced nutrition, less than body requirements C) Ineffective tissue perfusion D) Impaired gas exchange

A. Risk for injury For the child with aplastic anemia, safety is of the utmost concern, with injury prevention essential to prevent hemorrhage. Nutrition, tissue perfusion, and gas exchange may or may not be associated with the child's condition.

The nurse is assessing the neuromusculoskeletal system of a newborn. Which of the following would the nurse identify as an abnormal finding? A) Sluggish deep tendon reflexes B) Full range of motion in extremities C) Absence of hypotonia D) Lack of purposeful muscular control

A. Sluggish deep tendon reflexes

The mother of a 5-year-old girl brings the child to the clinic for an evaluation. The mother tells the nurse, "She seems to be so tired and irritable lately. And she looks so pale." Further assessment reveals pale conjunctiva and oral mucous membranes. The nurse suspects iron-deficiency anemia. Which additional finding would help provide additional evidence for this suspicion? A) Spooned nails B) Negative splenomegaly C) Oxygen saturation: 99% D) Bradycardia

A. Spooned nails Spooning or concave shape of the nails suggests iron-deficiency anemia. Other findings would include decreased oxygen saturation levels, tachycardia, and possible splenomegaly.

A nurse is preparing a presentation for a local health fair about meningitis and has developed a display that lists the following causes: -Streptococcus group B -Haemophilus influenzae type B -Streptococcus pneumoniae -Neisseria meningitides Which of these would the nurse highlight as the most common cause of meningitis in newborns? A.Streptococcus group B B. Haemophilus influenzae type B C. Streptococcus pneumoniae D. Neisseria meningitides

A. Streptococcus group B Meningitis due to Streptococcus group B along with Escherichia coli is most common in newborns and infants. H. influenzae type B is a common cause in infants between the ages of 6 and 9 months. S. pneumoniae and N. meningitides are common causes in children older than 3 months and in adults.

After teaching the parents of a daughter with central precocious puberty about medication therapy, which statement by the parents indicates successful teaching? A) "She needs to use the nasal spray once every day." B) "She'll start puberty again when the medication stops." C) "This medication will slow down the changes but not reverse them." D) "Once therapy is done, she'll need surgery."

B) "She'll start puberty again when the medication stops." Feedback: Treatment for central precocious puberty involves administering a gonadotropin-releasing hormone (GnRH) analog. When it is stopped, puberty resumes according to the appropriate developmental stages. This analog can be given by depot injection every 3 to 4 weeks, a daily subcutaneous injection, or an intranasal spray two or three times per day. With GnRH analog treatment, secondary sexual development stabilizes or regresses. Surgery is indicated only if there is a tumor.

A 5-year-old child with type 1 diabetes is brought to the clinic by his mother for a follow-up visit after having his hemoglobin A1C level drawn. Which result would indicate to the nurse that the child is achieving long-term glucose control? A) 9.0% B) 8.2% C) 7.3% D) 6.9%

B) 8.2% Feedback: For a child 6 years of age and younger, the target HbA1C level should be less than 8.5% but greater than 7.5%. For children between the ages of 6 to 12 years, the target HbA1C level is less than 8%. For children and adolescents between 13 to 19 years of age, the target HbA1C level would be less than 7.5%.

The nurse is caring for a 2-month-old with cerebral palsy. The infant is limp and flaccid with uncontrolled, slow, worm-like, writhing, and twisting movements. Which of the following would the nurse use when documenting these observations? A) Spastic B) Athetoid C) Ataxic D) Mixed

B) Athetoid Athetoid cerebral palsy is characterized by abnormal, involuntary movement. It affects all four extremities with possible involvement of the face, neck, and tongue. The movements increase in periods of stress. Dysarthria and drooling may be present as well. Spastic cerebral palsy is characterized by poor control of posture, balance, and movement; exaggeration of deep tendon reflexes; and hypertonicity of affected extremities. Ataxic is characterized by poor coordination, unsteady gait, and wide-based gait.

The student nurse is learning about the effects of heat and cold when used in a pain management plan. Which of the following accurately describes one of these effects? A) Cold results in vasodilation. B) Cold alters capillary permeability. C) Heat results in vasoconstriction. D) Heat decreases blood flow to the area.

B) Cold alters capillary permeability.

The nurse tells a joke to a 12-year-old to distract him from a painful procedure. What pain management technique is the nurse using? A) Relaxation B) Distraction C) Imagery D) Thought stopping

B) Distraction

A child with diabetes reports that he is feeling a little shaky. Further assessment reveals that the child is coherent but with some slight tremors and sweating. A fingerstick blood glucose level is 70 mg/dL. What would the nurse do next? A) Administer a sliding-scale dose of insulin. B) Give 10 to 15 grams of a simple carbohydrate. C) Offer a complex carbohydrate snack. D) Administer glucagon intramuscularly.

B) Give 10 to 15 grams of a simple carbohydrate. Feedback: The child is experiencing hypoglycemia as evidenced by the assessment findings and blood glucose level. Since the child is coherent, offering the child 10 to 15 grams of a simple carbohydrate would be appropriate. Insulin is not used because the child is hypoglycemic. A complex carbohydrate snack would be used after offering the simple carbohydrate to maintain the glucose level. Intramuscular glucagons would be used if the child was not coherent.

A group of nursing students are reviewing the components of the endocrine system. The students demonstrate understanding of the review when they identify what as the primary function of this system? A) Regulation of water balance B) Hormonal secretion C) Cellular metabolism D) Growth stimulation

B) Hormonal secretion Feedback: The endocrine system consists of various glands, tissues, or clusters of cells that produce and release hormones. Hormones are chemical messengers that stimulate and/or regulate the actions of other tissues, organs, or endocrine glands that have specific receptors to a hormone. Along with the nervous system, the endocrine milieu influences all physiologic effects such as growth and development, metabolic processes related to fluid and electrolyte balance and energy production, sexual maturation and reproduction, and the body's response to stress. The release patterns of the hormones vary, but the level in the body is maintained within specified limits to preserve health.

The nurse is reviewing the laboratory test results of a child with Addison disease. What would the nurse expect to find? A) Hypernatremia B) Hyperkalemia C) Hyperglycemia D) Hypercalcemia

B) Hyperkalemia Feedback: With Addison disease, the child would exhibit hyperkalemia, hyponatremia, and hypoglycemia. Hypercalcemia would be associated with hyperparathyroidism.

The nurse is explaining the effects of heat application for pain relief. Which of the following would the nurse be likely to include as an effect? A) Increased blood flow to the area B) Increased pressure on nociceptive fibers C) Possible release of endogenous opioids D) Altered capillary permeability

B) Increased pressure on nociceptive fibers

The nurse is caring for an 8-year-old girl with hyperpituitarism. What ordered treatment will the nurse expect to perform? A) Give desmopressin acetate intranasally B) Inject octreotide acetate C) Give 1 mg/kg/day of methimazole D) Administer glipizide orally

B) Inject octreotide acetate Feedback: The nurse would give the child a subcutaneous injection of octreotide acetate every 12 hours as directed. Desmopressin is a synthetic antidiuretic hormone used to treat diabetes insipidus. Methimazole is an antithyroid drug used to treat hyperthyroidism. Glipizide is a hypoglycemic drug that assists insulin production in children with diabetes mellitus type 2.

The nurse is caring for an 8-year-old girl with an endocrine disorder involving the posterior pituitary gland. What care would the nurse expect to implement? A) Instructing the parents to report adverse reactions to the growth hormone treatment B) Teaching the parents how to administer the desmopressin acetate C) Informing the parents that treatment stops when puberty begins D) Educating the parents to report signs of acute adrenal crisis

B) Teaching the parents how to administer the desmopressin acetate Feedback: The nurse would teach the parents how to administer desmopressin acetate, which treats diabetes insipidus, a disorder related to the posterior pituitary gland. Instructing parents to report adverse reactions to growth hormone is an intervention for growth hormone deficiency. Informing the parents that treatment stops at the normal time of puberty is a teaching intervention for precocious puberty. Educating the parents to report signs of an acute adrenal crisis is an intervention for congenital adrenal hyperplasia. All three of these other disorders are related to the anterior pituitary.

A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. The nurse interprets this order as indicating which of the following? A) The child requires a prophylactic dose of iron. B) The child has mild to moderate iron deficiency. C) The child has severe iron deficiency. D) The child is being prepared for packed red blood cell administration.

B) The child has mild to moderate iron deficiency.

The nurse is caring for a child who is complaining of chronic pain. Which of the following is the priority nursing assessment? A) How the pain impacts the child's and family's stress level B) The pain's history, onset, intensity, duration, and location C) The child's and parents' feeling of anxiety and depression D) The child's cognitive level and emotional response

B) The pain's history, onset, intensity, duration, and location

When the nurse is assessing a child's pain, which of the following is most important? A) Obtaining a pain rating from the child with each assessment B) Using the same tool to assess the child's pain each time C) Documenting the child's pain assessment D) Asking the parents about the child's pain tolerance

B) Using the same tool to assess the child's pain each time

The community health nurse has just completed a presentation to a group of parents regarding drowning prevention. Which statements by the parents indicate understanding of the teaching? Select all that apply. A) "I am so glad our 6-year-old child had swim lessons. We really can't afford a fence around our pool." B) "Since we have a 16-year-old I am really concerned about supervision when our child is swimming in the ocean." C) "We always make sure our babysitter keeps her CPR training up to date." D) "It is scary to think that we have a pool and drowning is the second leading cause of accidental death in children." E) "We make sure to keep our bathroom door closed when our 10-month-old is walking around the house since the door handle is too high to reach."

B, C, D, E B) "Since we have a 16-year-old I am really concerned about supervision when our child is swimming in the ocean." C) "We always make sure our babysitter keeps her CPR training up to date." D) "It is scary to think that we have a pool and drowning is the second leading cause of accidental death in children." E) "We make sure to keep our bathroom door closed when our 10-month-old is walking around the house since the door handle is too high to reach." In children older than 15 years of age, most drownings occur in natural water settings, such as oceans or lakes. Most incidents of drowning are accidental and result from inadequately supervising children of any age. It is important for any caregivers of children to be current on CPR in case of any accident. Children younger than 1 year old most often drown in bathtubs, buckets, or toilets, so keeping the bathroom door closed helps decrease the risk of drowning.

A nurse is leading a discussion with a group of new mothers about newborn nutrition and its importance for growth and development. One of the mothers asks, "Doesn't the baby get iron from me before birth?" Which response by the nurse would be most appropriate? A) "You give the baby some iron, but it is not enough to sustain him after birth." B) "Because the baby grows rapidly during the first months, he uses up what you gave him." C) "The iron you give him before birth is different from what he needs once he is born." D) "If the baby didn't use up what you gave him before birth, he excretes it soon after birth."

B. "Because the baby grows rapidly during the first months, he uses up what you gave him." In the term infant, a period of physiologic anemia occurs between the age of 2 and 6 months. This is due to the fact that the infant demonstrates rapid growth and an increase in blood volume over the first several months of life, and maternally derived iron stores are depleted by age 4 to 6 months of age. Sufficient iron intake is critical for the appropriate development of hemoglobin and RBCs. Therefore, the infant must ingest adequate quantities of iron either from breast milk or from iron-fortified formula in early infancy and other food sources in later infancy.

The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is providing discharge instructions about home care and safety recommendations to the boy and his parents. Which response indicates a need for further teaching? A) "We should avoid aspirin and drugs like ibuprofen." B) "He can resume participation in football in 2 weeks." C) "Swimming would be a great activity." D) "Our son cannot take any antihistamines."

B. "He can resume participation in football in 2 weeks." The nurse must emphasize to the parents that they need to prevent trauma to their son by avoiding activities that may cause injury. Participation in contact sports like football is not recommended. Aspirin, nonsteroidal anti-inflammatory drugs, and antihistamines should be avoided because they could precipitate anemia. Swimming, a noncontact sport, is an appropriate choice.

A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, which of the following would the nurse identify as potentially interfering with the accuracy of the results? A) Use of iron supplementation B) Blood transfusion 1 month ago C) Lack of fasting for 12 hours D) History of recent infection

B. Blood transfusion 1 month ago Blood transfusion within the previous 12 weeks may alter the results of the hemoglobin electrophoresis. Iron supplements can increase serum ferritin levels. Children should fast for 12 hours before having a specimen obtained for iron levels. A history of infection might interfere with the white blood cell count results, not hemoglobin electrophoresis.

Which of the following would the nurse include in the preoperative plan of care for an infant with myelomeningocele? A) Positioning supine with a pillow under the buttocks B) Covering the sac with saline-soaked nonadhesive gauze C) Wrapping the infant snugly in a blanket D) Applying a diaper to prevent fecal soiling of the sac

B. Covering the sac with saline-soaked nonadhesive gauze

A child is brought to the emergency department after sustaining a concussion. The child is to be discharged home with his parents. Which of the following would the nurse include in the child's discharge instructions? A. Expect his headache to get worse initially and then disappear B. Wake him every 2 hours to check his movement and responses C. Call your medical provider if he vomits more than 5 times D. Any watery fluid draining from his ears is normal

B. Wake him every 2 hours to check his movement and responses The nurse should instruct the parents to wake the child every 2 hours to ensure that he moves normally and wakes enough to recognize and respond appropriately to them. The parents should be instructed to call the physician or nurse practitioner or bring the child back to the emergency department if he experiences a constant headache that gets worse, vomits more than two times, or has oozing of blood or watery fluid from his ears or nose.

The nurse knows that children have larger heads in relation to the body and a higher center of gravity. When developing a teaching plan for parents, the nurse includes information about an increased risk for which of the following problems? A. Febrile seizures B. Head trauma C. Caput succedaneum D. Posterior plagiocephaly

B.Head trauma The larger head size in relation to the body, coupled with a higher center of gravity, causes children to hit their head more readily when involved in motor vehicle accidents, bicycle accidents, and falls. Febrile seizures are not related to anatomy or physiology. Caput succedaneum is an edematous area on the scalp caused by pressure of the uterus or vagina during head-first delivery. Posterior plagiocephaly is caused by early closure of the lamboid suture.

The nurse caring for children with neuromuscular disorders knows that which of the following is. the most common movement disorder of childhood? A. Spina bifida B: Cerebral palsy C: Muscular dystrophy D. Spinal musclar atrophy

B: Cerebral palsy

A 6-year-old boy with cerebral palsy has been admitted to the hospital for some tests. His condition is stable. The boy's mother remains with her son, but she is obviously exhausted and stressed. Which response by the nurse would be most appropriate? A) "Would you like me to bring you a blanket and pillow?" B) "You are doing such a wonderful job with your son." C) "He's in good hands; consider going home to get some sleep." D) "Are you planning to spend the night or to go home?"

C) "He's in good hands; consider going home to get some sleep." Providing daily, intense care can be quite demanding and tiring. When a child with cerebral palsy is admitted to the hospital, this may serve as a time of respite for family and primary caregivers. The nurse should remind the mother that her son is in good hands and urge her to go home. Asking her whether she is planning to stay might make the mother feel obligated to stay. Asking if she wants a blanket or pillow does not encourage the mother to leave the hospital. Telling the mother she is doing a good job is nice, but does not encourage her to take a break.

The nurse is assessing a 9-year-old girl with a history of tuberculosis at age 6 years. She has been losing weight and has no appetite. The nurse suspects Addison disease based on which assessment findings? A) Arrested height and increased weight B) Thin, fragile skin and multiple bruises C) Hyperpigmentation and hypotension D) Blurred vision and enuresis

C) Hyperpigmentation and hypotension Feedback: Hyperpigmentation and hypotension would point to Addison disease. Arrested height and increased weight are typical of acquired hypothyroidism; this girl has lost weight. Thin, fragile skin and multiple bruises are indicative of Cushing syndrome. Blurred vision, headaches, and enuresis would be complaints of a child with diabetes mellitus.

A teenage girl diagnosed with polycystic ovary syndrome tells the nurse, "I refuse to take oral contraceptives since I am not sexually active." What is the best response to the girl? A) "It's important for you to take the pills even if you're not sexually active in order to prevent unwanted symptoms of the disease." B) "The doctor has prescribed these for you because it is an effective treatment method for the disease." C) "I know it's hard remembering to take those pills every day. Tell me more about what is making you not want to take the oral contraceptives." D) "Do your parents know that you are not taking the treatment medication your doctor prescribed?"

C) "I know it's hard remembering to take those pills every day. Tell me more about what is making you not want to take the oral contraceptives." Feedback: This response shows empathy to the client and encourages her to further discuss the reasons they are non-compliant with the prescribed treatment regimen. "It's important for you to take the pills even if you're not sexually active...," and "The doctor has prescribed these for you because it is an effective treatment..." are accurate statements, but they are not methods of therapeutic communication and do not lead to further discussion about the noncompliance. Asking if the parents know she isn't taking the medications leads to mistrust of the nurse.

A nurse is providing teaching to the mother of an adolescent girl about how to manage menstrual pain nonpharmacologically. Which of the following statements by the mother indicates a need for further teaching? A) "I need to help her learn techniques to distract her, card games, for example." B) "I need to be able to identify the subtle ways she shows pain." C) "I need to follow these instructions exactly for them to work properly." D) "I need to encourage her to practice and utilize these techniques."

C) "I need to follow these instructions exactly for them to work properly."

The nurse is teaching an 8-year-old child and his family how to manage cancer pain using nonpharmacologic methods. Which of the following parent statements signifies successful child teaching? A) "I will avoid using descriptive words like pinching, pulling, or heat." B) "I will not use positive reinforcement until the technique is perfected." C) "I will begin using the technique before he experiences pain." D) "I will be honest and tell him that the procedure will hurt a lot."

C) "I will begin using the technique before he experiences pain."

A child has been prescribed growth hormone. When collecting data from this patient, which report is of the greatest concern? A) "I sometimes have headaches." B) "I feel tired." C) "My hips often hurt." D) "I take this medication with food."

C) "My hips often hurt." Feedback: Limping or complaints of hip pain are of concern. This may signal issues with the epiphysis and warrants further evaluation. Headaches and fatigue are not associated with medication. Taking this medication with food is not contraindicated.

The nurse is administering pain medication for a child with continuous pain from internal injuries. Which of the following methods would be ordered to dispense the medication? A) Administer the medication PRN (as needed). B) Administer the mediation when pain has peaked. C) Administer the medication around the clock at timed intervals. D) Administer the medication when the child complains of pain.

C) Administer the medication around the clock at timed intervals.

The nurse is administering 10 units of NPH insulin to a child at 8 a.m. The nurse would expect this insulin to begin acting at which time? A) By 8:15 a.m. B) Between 8:30 and 9 a.m. C) Between 9 and 11 a.m. D) Around 12 noon

C) Between 9 and 11 a.m. NPH insulin has an onset of action of 1 to 3 hours, so the drug would begin to act between 9 and 11 a.m. A rapid-acting insulin would begin to act by 8:15 a.m.; regular insulin would begin to act between 8:30 and 9 a.m. No type of insulin would begin acting around 12 noon.

A nurse is preparing a presentation for a group of parents with children diagnosed with diabetes type 1. The children are all adolescents. What issues would the nurse need to address? Select all that apply. A) Self-monitoring of blood glucose levels B) Feelings of being different C) Deficient decision-making skills D) Body image conflicts E) Struggle for independence

C) Deficient decision-making skills D) Body image conflicts E) Struggle for independence Feedback: Adolescents are undergoing rapid physical, emotional, and cognitive growth. Working toward a separate identity from parents and the demands of diabetic care can hinder this. This struggle for independence can lead to nonadherence of the diabetic care regimen. Conflicts develop with self-management, body image, and peer group acceptance. Teens may acquire the skills to perform tasks related to diabetic care but may lack decision-making skills needed to adjust treatment plan. Teens do not always foresee the consequences of their activities. Self-monitoring of blood glucose levels and feelings of being different are issues common to school-age children.

The nurse suspects that a 4-year-old with type 1 diabetes is experiencing hypoglycemia based on what findings? Select all that apply. A) Blurred vision B) Dry, flushed skin C) Diaphoresis D) Slurred speech E) Fruity breath odor F) Tachycardia

C) Diaphoresis D) Slurred speech F) Tachycardia Feedback: Manifestations of hypoglycemia include behavioral changes, confusion, slurred speech, belligerence, diaphoresis, tremors, palpitation, and tachycardia. Blurred vision; dry, flushed skin; and fruity breath odor suggest hyperglycemia.

The nurse is preparing a teaching plan for a 10-year-old girl with hyperthyroidism. What information would the nurse include in the plan? A) Describing surgery to remove an anterior pituitary tumor B) Teaching her parents to give injections of growth hormone C) Explaining about the radioactive iodine procedure D) Showing her parents how to give DDAVP intranasally

C) Explaining about the radioactive iodine procedure Feedback: Explaining about the radioactive iodine procedure would be part of the teaching plan for a child with hyperthyroidism because this is a less invasive type of therapy for the disorder. Describing surgery to remove an anterior pituitary tumor would be included for a child with hyperpituitarism. Teaching a parent to give injections of growth hormone would be appropriate for a child with a growth hormone deficiency. Showing parents how to give DDAVP intranasally is appropriate for a child with diabetes insipidus.

A child with growth hormone deficiency is receiving growth hormone. What result would the nurse interpret as indicating effectiveness of this therapy? A) Rapid weight gain B) Complaints of headaches C) Height increase of 4 inches D) Growth plate closure

C) Height increase of 4 inches Feedback: Effectiveness of growth hormone therapy is indicated by at least a 3- to 5-inch increase in linear growth in the first year of treatment. Rapid weight gain and headaches are adverse reactions of this therapy. The drug is stopped when the epiphyseal growth plates close.

A group of nursing students are reviewing information about the endocrine system in infants and children. The students demonstrate understanding of the information when they state: A) Endocrine glands begin developing in the third trimester of gestation. B) At birth, the endocrine glands are completely functional. C) Infants have difficulty balancing glucose and electrolytes. D) A child's endocrine system has little effect on growth and development.

C) Infants have difficulty balancing glucose and electrolytes. Feedback: Typically, most endocrine glands begin to develop during the first trimester of gestation, but their development is incomplete at birth. Thus, complete hormonal control is lacking during the early years of life, and the infant cannot appropriately balance fluid concentration, electrolytes, amino acids, glucose, and trace substances.

The nurse is caring for a child who is experiencing pain related to chemotherapy treatment. Which of the following is a behavioral factor that might affect the child's pain experience? A) Knowledge of the therapy B) Fear about the outcome of therapy C) Participation in normal routine activities D) Ability to identify pain triggers

C) Participation in normal routine activities

The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What would the nurse correlate with disorder? A) The parents report that their child had "a cold or flu" recently. B) Blood pressure is decreased when checking vital signs. C) The parents report that their son "can't drink enough water." D) Auscultation reveals Kussmaul breathing.

C) The parents report that their son "can't drink enough water." Feedback: Unquenchable thirst (polydipsia) is a common finding associated with diabetes mellitus, type 1 and 2. However, reports of flu-like illness and Kussmaul breathing are more commonly associated with type 1 diabetes. Blood pressure is normal with type 1 diabetes and elevated with type 2 diabetes.

The nurse is teaching the parents of a child with a hematologic disorder about the functions of the various blood cells. The nurse determines that the teaching was successful when the parents state which blood cell as being primarily responsible for blood clotting? A) Granulocytes B) Erythrocytes C) Thrombocytes D) Leukocytes

C) Thrombocytes

The nurse is caring for a 13-year-old girl with von Willebrand disease. After teaching the adolescent and her parents about this disorder and care, which response by the parents indicates a need for additional teaching? A) "We need to administer Stimate prior to dental work." B) "We should be aware that she may suffer from menorrhagia." C) "We should administer desmopressin as often as needed." D) "We understand that she may have frequent nosebleeds."

C. "We should administer desmopressin as often as needed." The parents need to know that desmopressin spray Stimate is used for controlling bleeding; the other brands are used for homeostasis and enuresis. Additionally, Stimate should only be used 3 days in a row as lessening of the response (tachyphylaxis) occurs with frequent use. Stimate should be used before dental work. Menorrhagia and nosebleeds may occur.

A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement indicates the need for additional teaching? A) "She needs to eat foods that are high in fiber so she doesn't get constipated." B) "We'll try to get her to drink lots of fluids throughout the day." C) "We will place the liquid in the front of her gums, just below her teeth." D) "We need to measure the liquid carefully so that we give her the correct amount."

C. "We will place the liquid in the front of her gums, just below her teeth." When giving liquid iron supplements, the liquid should be placed behind the teeth because it can stain the teeth. Iron can lead to constipation, so increased fluid and fiber intake is appropriate. The dosage needs to be measured carefully to prevent overdosing the child, leading to iron toxicity.

A nurse is conducting a physical examination of a 5-year-old with suspected iron deficiency anemia. How would the nurse evaluate for changes in neurologic functioning? A) "Open your mouth so I can look inside your cheeks and lips." B) "Do you have any bruises on your feet or shins?" C) "Will you show me how you walk across the room?" D) "Let me see the palms of your hands and soles of your feet."

C. "Will you show me how you walk across the room?" Neurologic effects of iron deficiency may be demonstrated when the child's ability to sit, stand, and walk are impaired. Inspecting the mouth, looking for bruises, and checking the hands and feet provide information about signs of petechiae, purpura, or pallor.

A nurse is preparing a program for a group of parents about injury prevention. Which of the following would the nurse include as an important contributing factor for cervical spine injury in a child? A) Exposure to teratogens while in utero B) Immaturity of the central nervous system C) Increased mobility of the spine D) Incomplete myelinization

C. Increased mobility of the spine

The nurse is teaching the mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex. Which of the following responses from his mother indicates a NEED for further teaching? A) "He needs to get a medical alert identification." B) "I will need to discuss this with his caregivers." C) "A product's label indicates whether it is latex-free." D) "He must avoid all contact with latex."

C. A product's label indicates whether it is latex-free The Food and Drug Administration (FDA) requires that all medical supplies be labeled if they contain latex, but this is not the case with consumer products. The mother must be familiar with products that contain latex. The Spina Bifida Association of America maintains an updated list of latex-containing products. Getting a medical alert identification, talking with his caregivers, and avoiding all contact with latex are correct.

The nurse is reviewing the white blood cell differential of a 4-year-old girl. Which value would lead the nurse to be concerned? A) Bands: 8% B) Segs: 28% C) Eosinophils: 10% D) Basophils: 0%

C. Eosinophils: 10% For a 4-year-old, normally eosinophils range from 0% to 3%; therefore, a result of 10% would be abnormal and a cause for concern. Bands of 8%, segs of 28%, and basophils of 0% are normal values for this age.

A nurse is providing teaching to the parents of a child who has had a shunt inserted as treatment for hydrocephalus. The parents demonstrate understanding of the teaching when they state which of the following? A. Having the shunt put in decreases his risk for developmental problems B. If he doesn't get an infection in the first week, the risk is greatly reduced C. He will need more surgeries to replace the shunt as he grows D. The shunt will help to prevent any further complications from his disease

C. He will need more surgeries to replace the shunt as he grows Parents need to know that hydrocephalus is a chronic illness that requires lifelong follow-up and regular evaluations, including future surgeries as the child grows. The risk for infection is ever present, but is most common 1 to 2 months after shunt placement. The child with a shunt and hydrocephalus is at risk for potential growth and developmental disabilities as well as complications such as infection and malfunction of the shunt.

As a result of seizure activity, a computed tomography (CT) scan was performed and showed that an 18-month-old child has intracranial arteriovenous malformation. When developing the child's plan of care, the nurse would expect to implement actions to prevent which of the following? A. Drug interactions B. Developmental disabilities C. Hemorrhagic stroke D> Respiratory paralysis

C. Hemorrhagic stroke Intracranial hemorrhage or hemorrhagic stroke is a risk for children with intracranial arteriovenous malformation. Drug interactions are a risk for children who are treated with combinations of anticonvulsants for epilepsy. Children with hydrocephalus are at an increased risk for developmental disabilities. Respiratory paralysis is a risk of botulism that typically affects infants younger than 6 months of age.

The nurse is caring for an 8-year-old boy who has chronic epilepsy. Which of the following would be most important to address when teaching the child and parents about living with this condition? A. Multiple corrective surgeries to slowly remove diseased parts of his brain B. Physical, occupational, and speech therapy to maximize his potential C. Support for maintaining self-esteem because of his altered lifestyle D. Hyperventilation therapy to counteract the periods of decreased oxygenation

C. Support for maintaining self-esteem because of his altered lifestyle The effects of living with a seizure disorder can be devastating, and it is essential for the child to receive support to maintain self-esteem. While corrective surgery is possible, it would only be performed once. Physical, occupational, speech, and hyperventilation therapy are not indicated for treatment of epilepsy.

The nurse is counseling the parents of a 9-year-old boy who is receiving morphine for postoperative pain. Which of the following statements from the nurse accurately reflects the pain experience in children? A) "You can expect that your child will tell you when he is experiencing pain." B) "Your child will learn to adapt to the pain he is experiencing." C) "Your child will experience more adverse effects to narcotics than adults." D) "It is very rare that children become addicted to narcotics."

D) "It is very rare that children become addicted to narcotics."

The nurse is providing instructions to a mother on how to use thought stopping to help her child deal with anxiety and fear associated with frequent painful injections. Which of the following statements indicates the mother understands the technique? A) "We will imagine that we are on the beach in Florida." B) "We can talk about our favorite funny movie and laugh." C) "She can let her body parts go limp, working from head to toe." D) "We'll repeat 'quick stick, feel better, go home soon' several times."

D) "We'll repeat 'quick stick, feel better, go home soon' several times."

The nurse is conducting an assessment of a high school track athlete. He tells the nurse he is experiencing pain along his outer thigh. He describes it as tight, achy, and tender, particularly after he runs. The nurse understands that he is most likely experiencing what kind of pain? A) Cutaneous B) Neuropathic C) Visceral D) Deep somatic

D) Deep somatic

The nurse is caring for a 13-year-old girl with delayed puberty. Based on the nurse's knowledge of this condition, the nurse would include which nursing diagnosis in the child's plan of care? A) Disabled family coping related to the child's disorder B) Imbalanced nutrition, less than body requirements related to the child's short stature C) Noncompliance related to the need for lifelong hormone therapy D) Deficient knowledge related to the administration of estradiol

D) Deficient knowledge related to the administration of estradiol Feedback: Deficient knowledge related to the administration of estradiol is an appropriate nursing diagnosis for this child. There are oral, transdermal, topical, injectable, and vaginal preparations available. Disabled family coping due to the child's disorder and noncompliance due to long-term therapy are not likely diagnoses because of the simplicity and brevity of the treatment for this disorder. Imbalanced nutrition evidenced by short stature would be appropriate for a child with growth hormone deficiency

After teaching a class of nursing students about muscular dystrophy, the instructor determines that the teaching was successful when the students identify which type of muscular dystrophy as demonstrating an X-linked recessive pattern of inheritance? A) Limb-girdle B) Myotonic C) Distal D) Duchenne

D) Duchenne

A group of students are reviewing information about the various types of insulin used to treat type 1 diabetes. The students demonstrate understanding of the information when they identify which of these insulins as having the longest duration? A) Lispro B) Regular C) NPH D) Glargine

D) Glargine Feedback: Of the insulins listed, glargine (Lantus) has the longest duration of action, that is, 12 to 24 hours. Lispro lasts approximately 3 to 5 hours; regular lasts 5 to 8 hours; and NPH lasts approximately 10 to 16 hours.

The parents of a child with congenital adrenal hyperplasia bring the child to the emergency department for evaluation because the child has had persistent vomiting. What finding would lead the nurse to suspect that the child is experiencing an acute adrenal crisis? A) Hypernatremia B) Bradycardia C) Hypertension D) Hyperkalemia

D) Hyperkalemia Feedback: Signs and symptoms of an acute adrenal crisis include hyperkalemia, hyponatremia, tachycardia, hypotension, persistent vomiting, dehydration, and shock.

The nurse is obtaining a health history from parents whose 4-month-old boy has congenital hypothyroidism. What would the nurse most likely assess? A) The child has above-normal growth for his age. B) The child is active and playful. C) The skin is pink and healthy looking. D) It is difficult to keep the child awake.

D) It is difficult to keep the child awake. Feedback: The parents may state, during the health history, that it is difficult to keep the child awake. Physical examination would reveal that the child is below weight and height, that his skin is pale and mottled, and that he is lethargic and irritable.

Pentazocine is prescribed for a child with moderate pain. The nurse identifies this drug as an example of which type? A) Nonsteroidal anti-inflammatory drug (NSAID B) Prostaglandin inhibitor C) Opioid D) Mixed opioid agonist-antagonist

D) Mixed opioid agonist-antagonist

Which tool would be the least appropriate scale for the nurse to use when assessing a 4- year-old child's pain? A) FACES pain rating scale B) Oucher pain rating scale C) Poker chip tool D) Numeric pain intensity scale

D) Numeric pain intensity scale

The nurse is conducting a pain assessment of a 10-year-old boy who has been taking acetaminophen for chronic knee pain. The assessment indicates that the recommended dose is no longer providing adequate relief. What is the appropriate nursing action? A) Increase the dosage of the acetaminophen. B) Tell the child he is experiencing the ceiling effect. C) Use guided imagery to help his pain. D) Obtain an order for a different medication.

D) Obtain an order for a different medication.

The nurse is caring for a 2-year-old boy with hemophilia. His parents are upset by the possibility that he will become infected with hepatitis or HIV from the clotting factor replacement therapy. Which response by the nurse would be most appropriate? A) "Parents commonly fear the worst; however, the factor will help your child lead a normal life." B) "There are risks with any treatment including using blood products, but these are very minor." C) "Although factor replacement is expensive, there's more financial strain from missing work if he has a bleeding episode." D) "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission."

D. "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission." The nurse needs to emphasize that since 1986, there have been no reports of virus transmission from factor infusion since the inception of heat treatment of the factor. Telling the parents that there is a minor risk does not teach. Telling the parents that factor is expensive or that it is common to worry does not teach, nor does it address their concerns.

A nurse is talking with the parents of a child who has had a febrile seizure. The nurse would integrate an understanding of which of the following into the discussion? A. The child's risk for cognitive problems is greatly increased B. Structural damage occurs with febrile seizure C. the child's risk for epilepsy is now increased D. Febrile seizures are benign in nature

D. Febrile seizures are benign in nature Parents need reassurance that febrile seizures, although frightening, are benign in nature. Children who experience one or more febrile seizures are at no greater risk of developing epilepsy than the general population. No evidence exists that febrile seizures cause structural damage or cognitive declines.

A nurse is preparing a presentation for an expectant parent group about neural tube defects and prevention. Which of the following would the nurse emphasize? A. Smoking cessation B. Aerobic exercise C. Increased calcium intake D. Folic acid supplementation

D. Folic acid supplementation The cause of neural tube defects is unknown, but there is strong evidence to support the use of folic acid supplementation for prevention. Smoking cessation and aerobic exercise are general health recommendations unrelated to neural tube defects. Increased calcium intake is important for fetal growth and development, but it is not linked to preventing neural tube defects.

The nurse is caring for a child who has been admitted for a sickle cell crisis. Which of the following would the nurse do first to provide adequate pain management? A) Administer a nonsteroidal anti-inflammatory drug as ordered. B) Use guided imagery and therapeutic touch. C) Administer meperidine as ordered. D) Initiate pain assessment with a standardized pain scale.

D. Initiate pain assessment with a standardized pain scale. The nurse should first initiate pain assessment with a standardized pain scale upon admission and provide frequent evaluations of pain. Administering NSAIDs or meperidine and the use of nonpharmacologic pain management techniques are all appropriate. However, the first action is to assess the child's pain to provide a baseline for future comparison.

During class, a student states, "I didn't think children could have strokes. I thought this only occurred in older adults." When responding to the student, what would be most important for the instructor to integrate into the response? A) Strokes in children often have an identifiable cause. B) The signs and symptoms in children are different from an adult. C) Research has identified specific treatments for children. D) Ischemic strokes are more common than hemorrhagic strokes.

D. Ischemic strokes are more common than hemorrhagic strokes In children, ischemic strokes are more common than hemorrhagic strokes. However, the cause of the stroke in many children remains unidentified. Signs and symptoms are similar to those in adults and will vary based on age; underlying cause, if known; and location of the stroke. Historically, children have been excluded from adult stroke studies and thus, many treatments used have had to be adapted from adult studies.

A group of nursing students are reviewing information related to seizures that occur in infants and children. The students demonstrate a NEED for additional review when they identify which type as common in neonates? A. Tonic B. Focal clonic C. Multifocal clonic D. Myoclonic

D. Myoclonic Five major types of seizures have been recognized in the neonatal period: subtle, tonic, focal clonic, multifocal clonic, and myoclonic. Of these, myoclonic seizures rarely occur during the neonatal period. Subtle seizures affect preterm and full-term neonates. Tonic seizures primarily occur in preterm neonates. Focal clonic and multifocal clonic are more common in full-term neonates.

Which of the following would lead the nurse to suspect that a child is beginning to develop increased intracranial pressure? A. Bradycardia B. Cheyne-Stokes respirations C. Fixed, dilated pupils D. Projectile vomiting

D. Projectile vomiting Projectile vomiting is an early sign of increased intracranial pressure. Bradycardia, Cheyne-Stokes respirations, and fixed dilated pupils are late signs of increased intracranial pressure.

A 4-year-old boy has a febrile seizure during a well-child visit. Which of the following would be a priority? A. Hyperextending the child's head while placing him on his side B. Using a tongue blade to pry open the child's jaw C. Loosening the child's clothing to ensure a patent airway D> Protecting the child from harm during the seizure

D. Protecting the child from harm during the seizure During a seizure, the child should not be held down in a specific position. Protecting the child's head and body during the seizure is the priority. Ensuring a patent airway is an important intervention but is not accomplished by loosening the child's clothing or hyperextending his head. The child should be placed on his side and nothing should be inserted into his mouth to forcibly open the jaw.

t/f The nurse is caring for a child with diarrhea related to infectious enteritis. the nurse accurately informs the parents that most cases of diarrhea are bacterial in nature and therapeutic management is usually supportive in nature.

False

t/f The nurse is caring for a child with a hemoglobinopathy in which the RBCs do not carry the normal adult hemoglobin, but instead carry a less effective type. This condition is known as idiopathic thrombocytopenia purpura (ITP).

False

t/f the nurse teaching parents of a child with diabetes about insulin administration correctly informs them that short acting insulin has an onset within 15 minutes and lasts for 3 to 5 hours

False. Rapid-acting insulin has an onset within 15 minutes and lasts for 3 to 5 hours.Rationale: Short-acting insulin has an onset within 30 to 60 minutes and lasts for 5 to 8 hours.

The nurse is caring for a 19-month-old boy who has been admitted to the emergency department with a skull fracture. The parents state that the child fell down when running through the house and hit his head on the floor. Based on normal characteristics of skull fractures, what should be the initial focus of the assessment? A) Possible physical abuse B) Possible bone cancer C) Possible chronic neurological disease D) Possible developmental delay

Possible physical abuse Physical abuse must be investigated first because it takes a great deal of force to produce a skull fracture in infants and children younger than 2 years old. Due to the flexibility of the immature skull, it is able to withstand a great degree of deformation before a fracture will occur.

A 10-year-old boy is seen in the emergency department after falling down a flight of stairs and hitting his head. The child will be monitored overnight for complications. Which occurrence in the coming hours will warrant further assessment? A) The child reports a backache. B) The child is increasingly irritable with his mother and caregivers. C) The child refuses offers of snacks. D) The child reports his stomach is upset.

The child is increasingly irritable with his mother and caregivers. After a head injury the patient should be closely observed for neurological changes. Behavioral changes such as lethargy and irritability should be evaluated for the potential development of complications.

T/F The nurse working in the ER knows that trauma or inintentional injury is the leading cause of childhood morbidity and mortality in the united states?

True

t/f The nurse assessing pain in children is correct in stating that the school-age child is usually able to communicate the type, location, and severity of pain

True

The nurse is auscultating the bowel sounds of a 4-year old child and documents hypoactive bowel sounds. What might this finding indicate? a. obstruction b. gastroenteritis c. diarrhea d. infection

a. obstruction

The nurse observes a child for neurologic disorders. What is the earliest indicator of improvement or deterioration of neurologic status? a. Vital signs b. Level of consciousness c. Motor function d. Reflexes

b. Level of consciousness Rationale: While all the choices may indicate deterioration of neurologic status, the level of consciousness is the first indicator of improvement or deterioration in neurologic status. Consciousness consists of alertness, which is a wakeful state and includes the ability to respond to stimuli, and cognition, which includes the ability to process stimuli and demonstrate a verbal or motor response.

The nurse is percussing the abdomen of a child and notes a dull sound indicating a full bladder. At what anatomic location would this sound be heard? a. over the spleen b. at the right costal margin c. over the kidneys d. above the symphysis pubis

d. above the symphysis pubis

The nurse is assessing the pain of a 3-year-old child. Which pain assessment scale would be most appropriate? a. Visual analog scale b. visual numeric scale c. word-graphic rating scale d. faces pain rating scale

d. faces pain rating scale

The nurse is caring for a child diagnosed with type 1 diabetes. which of the following medical treatments would be appropriate for this child? a. surgery b. irradiation c. radioactive iodine d. glucose monitoring

d. glucose monitoring. Glucose monitoring is an intervention appropriate for controlling diabetes.Rationale: Surgery would be used to remove a mass from a gland and irradiation/radioactive iodine would be used to influence hormone secretion of a gland. Glucose monitoring and medical nutrition therapy are appropriate interventions for juvenile diabetes.