exam 5 practice questions
26. A nurse educator is providing a teaching session for the nursing staff. Which of the following individuals is at greatest risk for developing beta-thalassemia (Cooley anemia)? 1. A child of Mediterranean descent. 2. A child of Mexican descent. 3. A child whose mother has chronic anemia. 4. A child who has a low intake of iron.
. 1. Beta-thalassemia is an inherited recessive disorder that is found primarily in individuals of Mediterranean descent. The disease has also been reported in Asian and African populations.
16. A baby's blood type is B negative. The baby is at risk for hemolytic jaundice if the mother has which of the following blood types? 1. Type O negative. 2. Type A negative. 3. Type B positive. 4. Type AB positive
. 1. Significant ABO incompatibility can occur when the mother is type O and the baby is either type A or type B, regardless of Rh factor
24. A child with a repaired myelomeningocele is in the clinic for a regular examination. The child has frequent constipation and has been crying at night because of pain in the legs. After an MRI, the diagnosis of a tethered cord is made. Which should the nurse tell the parent? 1. Tethered cord is a postsurgical complication. 2. Tethered cord occurs during times of slow growth. 3. Release of the tethered cord will be necessary only once. 4. Offering laxatives and acetaminophen (Tylenol) daily will help control these problems.
. 1. Tethered cord is caused by scar tissue formation from the surgical repair of the myelomeningocele and may affect bowel, bladder, or lower extremity functioning. As the child grows, this will affect continence and mobility
98. A 4-day-old baby born via cesarean section is slightly jaundiced. The laboratory reports a bilirubin assessment of 6 mg/dL (102.6 μmol/L). Which of the following would the nurse expect the primary healthcare provider to order for the baby at this time? 1. To be placed under phototherapy. 2. To be discharged home with the parents. 3. To be prepared for a replacement transfusion. 4. To be fed glucose water between routine feeds.
. 1. These findings are all within normal limits.
25. A baby whose mother was addicted to heroin during pregnancy is in the NICU. Which of the following nursing actions would be appropriate for the nurse to perform? 1. Tightly swaddle the baby. 2. Place the baby prone in the crib. 3. Provide needed stimulation to the baby. 4. Feed the baby half-strength formula.
. 1. Tightly swaddling drug-dependent babies often helps to control the hyperreflexia that they may exhibit.
7. Which of the following activities should a nurse suggest for a client diagnosed with hemophilia? Select all that apply. 1. Swimming. 2. Golf. 3. Hiking. 4. Fishing. 5. Soccer.
1, 2, 3, 4 Children with hemophilia should be encouraged to take part in non-contact activities that allow for social, psychological, and physical growth, such as swimming, golf, hiking, fishing.
5. Which is the defi nition of "talipes varus"? 1. An inversion or bending inward of the foot. 2. An eversion or bending outward of the foot. 3. A high arch of the foot. 4. A turning in of the forefoot.
1. "Talipes varus" is an inversion of the entire foot
30. Which gross motor skills should the nurse assess in a 3-month-old with spina bifi da? 1. Head control. 2. Pincer grasp. 3. Sitting alone. 4. Rolling over
1. A 3-month-old should have good head control
7. When planning a rehabilitative approach for a child with osteogenesis imperfecta (OI), the nurse should prevent which of the following? Select all that apply. 1. Positional contractures and deformities. 2. Bone infection. 3. Muscle weakness. 4. Osteoporosis. 5. Misalignment of lower extremity joints.
1. A long-term goal in caring for a child with OI is to prevent contractures and deformities. 3. A long-term goal in caring for a child with OI is to prevent muscle weakness. 4. A long-term goal in caring for a child with OI is to prevent osteoporosis. 5. A long-term goal in caring for a child with OI is to prevent misalignment of lower extremity joints.
19. Which should the nurse include in the teaching plan for a child who had surgery to correct bilateral clubfeet and had the casts removed? Select all that apply. 1. "Your child will need to wear a brace on the feet 23 hours a day for 12 months." 2. "Your child should see an orthopedic surgeon regularly until the age of 18 years." 3. "Your child will not be able to participate in sports that require a lot of running." 4. "Your child may have a recurrence of clubfoot in a year or more." 5. "Most children treated for clubfeet develop feet that appear and function normally." 6. "Most children treated for clubfeet require surgery at puberty."
1. After the fi nal casting, bracing is required for 12 months. This decreases the likelihood of a recurrence. 2. Because clubfoot can recur, it is important to have regular follow-up with the orthopedic surgeon until age 18 years. 4. Even with proper bracing, there may be a recurrence. 5. Most children treated for clubfeet develop normally appearing and functioning feet.
45. Which of the following best describes the action of chemotherapeutic agents used in the treatment of cancer in children? Select all that apply. 1. Suppress the function of normal lymphocytes in the immune system. 2. Are alkylating agents and are cell-specifi c. 3. Cause a replication of DNA and are cell-specifi c. 4. Interrupt cell cycle, thereby causing cell death. 5. Prednisone is a natural hormone.
1. All chemotherapy is immunosuppressive, because most childhood cancers affect the immune system. 4. Mitotic inhibitors, such as vincristine (Oncovin), stop cell division but can also damage cells in all phases of the cell cycle. 5. The corticosteroids are natural hormones that can be used to prevent nausea and allergic reactions. They are given with other chemotherapeutic agents.
74. A neonate is being assessed for necrotizing enterocolitis (NEC). Which of the following actions by the nurse is appropriate? Select all that apply. 1. Perform hemoccult test on stools. 2. Monitor for an increase in abdominal girth. 3. Measure gastric contents before each feed. 4. Assess bowel sounds before each feed. 5. Assess for anal fissures daily.
1. Babies with NEC have blood in their stools. 2. The abdominal girth measurements of babies with NEC increase. 3. When babies have NEC, they have increasingly larger undigested gastric contents after feeds. 4. The neonates' bowel sounds are diminished with NEC.
26. A newborn in the nursery is exhibiting signs of neonatal abstinence syndrome. Which of the following signs/symptoms is the nurse seeing? Select all that apply. 1. Hyperphagia. 2. Lethargy. 3. Prolonged periods of sleep. 4. Hyporeflexia. 5. Persistent shrill cry
1. Babies with signs of neonatal abstinence syndrome repeatedly exhibit signs of hunger.
36. Which is the nurse ' s best response to the parents of a neonate with a meningocele who ask what can they expect? 1. "After initial surgery to close the defect, most children experience no neurological dysfunction." 2. "Surgery to close the sac will be postponed until the infant has grown and has enough skin to form a graft." 3. "After the initial surgery to close the defect, the child will likely have motor and sensory defi cits." 4. "After the initial surgery to close the defect, the child will likely have future problems with urinary and bowel continence."
1. Because a meningocele does not contain any nerve endings, most children experience no neurological problems after surgical correction.
31. The nurse is caring for a child with a diagnosis of ALL who is receiving chemotherapy. The nurse notes that the child ' s platelet count is 20,000/mm 3 . Based on this laboratory fi nding, what information should the nurse provide to the child and parents? 1. A soft toothbrush should be used for mouth care. 2. Isolation precautions should be started immediately. 3. The child ' s vital signs, including blood pressure, should be monitored every 4 hours. 4. All visitors should be discouraged from coming to see the family
1. Because the platelet count is decreased, there is a signifi cant risk of bleeding, especially in soft tissue. The use of the soft toothbrush should help prevent bleeding of the gums.
21. Which priority item should be placed at the bedside of a newborn with myelomeningocele? Select all that apply. 1. A bottle of normal saline. 2. A rectal thermometer. 3. Extra blankets. 4. A blood pressure cuff. 5. Latex-free gloves.
1. Before the surgical closure of the sac, the infant is at risk for infection. A sterile dressing is placed over the sac to keep it moist and help prevent it from tearing. Because the dressings dry out at least every hour, it is important to assess them frequently and apply saline as needed. Good hand washing is also important. 5. Latex-free clean gloves would be used for all care of this infant. A box should be kept at the infant ' s bedside. Children with spina bifi da are at risk for latex allergy and should not be exposed to latex.
11. The nurse is caring for a 6-month-old infant diagnosed with meningitis. When the child is placed in the supine position and fl exes his neck, the nurse notes he fl exes his knees and hips. This is referred to as: 1. Brudzinski sign. 2. Cushing triad. 3. Kernig sign. 4. Nuchal rigidity
1. Brudzinski sign occurs when the child responds to a fl exed neck with an involuntary fl exion of the hips and/or knees
43. Which would the nurse expect a child with spastic CP to demonstrate? Select all that apply. 1. Increased deep tendon refl exes. 2. Decreased muscle tone. 3. Scoliosis. 4. Contractures. 5. Scissoring. 6. Good control of posture. 7. Good fi ne motor skills.
1. Children with spastic CP have increased deep tendon refl exes. 3. Children with spastic CP have scoliosis. 4. When children with spastic CP have quadriplegia, they can also develop contractures of the Achilles tendons, knees, and adductor muscles. 5. Children with spastic CP have scissoring when walking.
3. Which can occur in untreated developmental dysplasia of the hip (DDH)? Select all that apply. 1. Duck gait. 2. Pain. 3. Osteoarthritis in adulthood. 4. Osteoporosis in adulthood. 5. Increased fl exibility of the hip joint in adulthood.
1. Due to abnormal hip joint function, the client ' s gait is stiff and waddling. 2. Due to abnormal femoral head placement, the client may experience pain and decreased fl exibility in adulthood. 3. Due to abnormal femoral head placement, the client may experience osteoarthritis in the hip joint in adulthood.
102. The nurse suspects that a newborn in the nursery has a clubbed right foot because the foot is plantar flexed as well as which of the following? 1. Right foot that will not move into alignment. 2. Positive Ortolani sign on the right. 3. Shortened right metatarsal arch. 4. Positive Babinski reflex on the right.
1. During the neonatal physical assessment, the nurse is unable to move a clubfoot into proper alignment
46. A client is delivering her baby at 42 weeks' gestation. A nurse and pediatrician are present at the birth. The amniotic fluid is green and thick. The baby fails to breathe spontaneously. Which of the following actions should the nurse take next? Select all that apply. 1. Stimulate the baby to breathe. 2. Assess neonatal heart rate. 3. Prepare to assist with intubation. 4. Place the baby in the prone position. 5. Place the baby under the overhead warmer
1. Even though meconium is present in the amniotic fluid, the baby should be stimulated to breathe. 2. The baby's heart rate is a critical piece of information. If the heart rate is below 100 bpm, positive pressure ventilation and pulse oximetry should be initiated. In addition, direct ECG assessment may be appropriate. 3. Although not universally recommended, the physician may determine that intubation is needed to remove meconium-contaminated fluid from the baby's airway and/or to provide direct ventilation. It is always best to be prepared, whether or not the intervention is done. 5. Hypothermic neonates are at high risk of morbidity and mortality. When in need of resuscitation, they should be kept warm under an overhead heat source.
19. The nurse is caring for a child with sickle cell disease who is scheduled to have an exchange transfusion. What information should the nurse teach the family? 1. The procedure is done to prevent further sickling during a vaso-occlusive crisis. 2. The procedure reduces side effects from blood transfusions. 3. The procedure is a routine treatment for sickle cell crisis. 4. Once the child ' s spleen is removed, it is not necessary to do exchange transfusions.
1. Exchange transfusion reduces the number of circulating sickle cells and slows down the cycle of hypoxia, thrombosis, and tissue ischemia.
25. Which intervention should be included in the plan of care for a newborn with a newly repaired myelomeningocele? 1. Offer formula/breast milk every 3 hours. 2. Turn the infant back to front every 2 hours. 3. Place a wet dressing on the sac. 4. Provide pain medication every 4 hours.
1. Following surgery, a newborn may want formula/breast milk every 2 to 4 hours. Be sure to monitor intake and output
29. A 13-year-old just returned from surgery for scoliosis. Which nursing intervention is appropriate in the fi rst 24 hours? Select all that apply. 1. Assess for pain. 2. Logroll to change positions. 3. Get the teen to the bathroom 12 to 24 hours after surgery. 4. Check neurological status. 5. Monitor blood pressure.
1. General postoperative nursing interventions include assessing for pain. 2. Specifi c to scoliosis surgery, logrolling is the means of changing positions. 4. It is essential to check neurological status in a patient who just had scoliosis surgery. 5. General postoperative nursing interventions include assessing vital signs.
9. The mother of a child with Duchenne muscular dystrophy asks the nurse who in the family should have genetic screening. Who should the nurse say must be tested? Select all that apply. 1. Mother. 2. Sister. 3. Brother. 4. Aunts and all female cousins. 5. Uncles and all male cousins.
1. Genetic counseling is important in all inherited diseases. Duchenne muscular dystrophy is inherited as an X-linked recessive trait, meaning the defect is on the X chromosome. Women carry the disease, and males are affected. All female relatives should be tested. 2. The X chromosome carries the disease, and males are affected. The sister should have genetic testing to determine whether she carries the gene and identify her risks for having male offspring with the disease. 4. The X chromosome carries the disease and males are affected. All female relatives should be tested.
6. A child with hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. Which of the following measures should be taken to stop the bleeding? Select all that apply. 1. The extremity should be immobilized. 2. The extremity should be elevated. 3. Warm moist compresses should be applied to decrease pain. 4. Passive range-of-motion exercises should be administered to the extremity. 5. Factor VIII should be administered.
1. Measures are needed to induce vasoconstriction and stop the bleeding, including immobilization of the extremity. 2. Measures are needed to induce vasoconstriction and stop the bleeding. Treatment should include elevating the extremity. 5. Hemophilia A is a defi ciency in factor VIII, which causes delay in clotting when there is a bleed. Giving a dose of Factor VIII concentrate will assist in the clotting process.
6. A 5-year-old has been diagnosed with pseudohypertrophic muscular dystrophy. Which nursing intervention(s) would be appropriate? Select all that apply. 1. Discuss with the parents the potential need for respiratory support. 2. Explain that this disease is easily treated with medication. 3. Suggest exercises that will limit the use of muscles and prevent fatigue. 4. Assist the parents in fi nding a nursing facility for future care. 5. Encourage the parents to contact the school to develop an IEP
1. Muscles become weaker, including those needed for respiration, and a decision will need to be made about whether respiratory support will be provided. 3. Physical therapy will be part of the treatment plan, but respiratory support is a priority. 5. Parents should be encouraged to allow the child to go to school and participate in activities as tolerated.
3. The parents of a preschooler diagnosed with muscular dystrophy are asking questions about the course of their child ' s disease. Which should the nurse tell them? Select all that apply. 1. "Muscular dystrophies usually result in progressive weakness." 2. "The weakness that your child is having will probably not increase." 3. "Your child will be able to function normally and not need any special accommodations." 4. "The extent of weakness depends on doing daily physical therapy." 5. "Your child may have pain in his legs with muscle weakness."
1. Muscular dystrophies are progressive degenerative disorders. The most common is Duchenne muscular dystrophy, which is an X-linked recessive disorder. 5. The child may have pain due to loss of strength and muscle wasting.
54. Which would the nurse teach a patient when NSAIDs are prescribed for treating juvenile idiopathic arthritis (JIA)? 1. Take with food. 2. Take on an empty stomach. 3. Blood levels are required for drug dosages. 4. Good oral hygiene is needed.
1. NSAIDs can cause gastric bleeding with long-term use; food helps to reduce the exposure of the drug on the stomach lining.
51. The parent of a 4-year-old brings the child to the clinic and tells the nurse the child ' s abdomen is distended. After a complete examination, a diagnosis of Wilms tumor is suspected. Which of the following is most important when doing a physical examination on this child? 1. Avoid palpation of the abdomen. 2. Assess the urine for the presence of blood. 3. Monitor vital signs, especially the blood pressure. 4. Obtain an accurate height and weight.
1. Palpating the abdomen of the child in whom a diagnosis of Wilms tumor is suspected should be avoided because manipulation of the abdomen may cause seeding of the tumor.
6. Which of the following actions should the nurse expect to see during a primary healthcare provider's evaluation of developmental dysplasia of the hip (DDH) in a newborn? Select all that apply. 1. Grasp the baby's legs with the thumbs on the inner thighs and forefingers on the outer thighs. 2. Gently adduct and abduct the baby's thighs. 3. Palpate the trochanter during hip rotation. 4. Place the baby in a fetal position. 5. Compare the lengths of the baby's legs.
1. Passage of stool eliminates bilirubin and prevents reabsorption of bilirubin. 2. A drop of milk in the baby's mouth indicates mother's milk is present and will likely increase. 3. A TcB measurement in the low intermediate risk is expected with this baby's risk factors.
56. One nursing diagnosis for juvenile idiopathic arthritis (JIA) is impaired physical mobility. Select all that apply. 1. Give pain medication prior to ambulation. 2. Assist with range-of-motion activities. 3. Encourage the child to eat a high-fat diet. 4. Provide oxygen as necessary. 5. Use nonpharmacological methods, such as heat.
1. Providing pain medication prior to ambulation helps decrease pain during ambulation. 2. Children with JIA need to do range of motion exercises to prevent joint stiffness. 5. Using non pharmacological methods such as heat helps with flexibility and pain.
3. Which of the following factors need(s) to be included in a teaching plan for a child with sickle cell disease? Select all that apply. 1. The child needs to be taken to a physician when sick. 2. The parent should make sure the child sleeps in an air-conditioned room. 3. Emotional stress should be avoided. 4. It is important to keep the child well hydrated. 5. It is important to make sure the child gets adequate nutrition.
1. Seek medical attention for illness to prevent the child from going into a crisis 3. Stress can cause a depressed immune system, making the child more susceptible to infection and crisis. Parents and children are advised to avoid stress. 4. The child needs good hydration and nutrition to maintain good health. 5. The child needs good hydration and nutrition to maintain good health.
51. The parents of a 12-month-old with cerebral palsy (CP) ask the nurse if they should teach their child sign language because he has not begun to vocalize. The nurse bases the response on the knowledge that sign language: 1. May be a very benefi cial way to help children with CP communicate. 2. May cause confusion and further delay vocalization. 3. Is diffi cult to learn for most children with CP. 4. Is benefi cial to learn, but it would be best to wait until the child is older
1. Sign language may help the child with CP communicate and ultimately decrease frustration. Children with CP may have diffi culty verbalizing because of weak tongue and jaw muscles. They may be able to have suffi cient motor skills to communicate with their hands.
8. Which will help a school-age child with muscular dystrophy stay active longer? Select all that apply. 1. Normal activities, such as swimming. 2. Using a treadmill every day. 3. Several periods of rest every day. 4. Using a wheelchair upon getting tired. 5. Sleeping as late as needed.
1. Swimming is an excellent exercise that uses many muscles and helps build strength. Children who are active are usually able to postpone use of a wheelchair. It is important to keep using muscles for as long as possible, and aerobic activity is good for a child. 3. Any child with a chronic disease should be kept as active as possible for as long as possible; short rest periods built into the day are helpful in maintaining stamina. 4. Children with neuromuscular diseases oftentimes will use a wheelchair to conserve energy and increase mobility. The wheelchair acts as the child ' s means of getting to where they want to go as independently as possible.
4. The nurse is teaching about congenital clubfoot in infants. The nurse evaluates the teaching as successful when the parent states that clubfoot is best treated when? 1. Immediately after diagnosis. 2. At age 4 to 6 months. 3. Prior to walking (age 9 to 12 months). 4. After walking is established (age 15 to 18 months)
1. The best outcomes for clubfoot are seen if casting begins as soon as the diagnosis is made, usually at birth.
18. A child diagnosed with meningitis is having a generalized tonic-clonic seizure. Which should the nurse do fi rst? 1. Administer blow-by oxygen and call for additional help. 2. Reassure the parents that seizures are common in children with meningitis. 3. Call a code and ask the parents to leave the room. 4. Assess the child ' s temperature and blood pressure.
1. The child experiencing a seizure usually requires more oxygen because the seizure increases the body ' s metabolic rate and demand for oxygen. The seizure may also affect the child ' s airway, causing the child to be hypoxic. It is always appropriate to give the child blow-by oxygen immediately. The nurse should remain with the child and call for additional help.
52. The parents of a child with cerebral palsy (CP) are learning how to feed their child and avoid aspiration. The nurse would question which of the following when reviewing the teaching plan? 1. Place the food on the tip of the tongue. 2. Place the child in an upright position during feedings. 3. Feed the child soft and blended foods. 4. Feed the child slowly
1. The food should be placed far back in the mouth to avoid tongue thrust
44. The nurse tells a family of a child with cerebral palsy (CP) that since the 1960s the incidence of CP has: 1. Increased. 2. Decreased. 3. Remained the same. 4. Has decreased because of early misdiagnosis
1. The incidence of CP has increased, partly as a result of the increased survival rate of extreme low-birth-weight and premature infants.
103. The parents of a baby born with bilateral club foot ask the nurse what medical care the baby will likely need. Which of the following should the nurse tell the parents? The baby will: 1. Need a series of leg casts until the correction is accomplished. 2. Have a Harrington rod inserted when the child is about 3 years old. 3. Have a Pavlik harness fitted before discharge from the nursery. 4. Need to wear braces on both legs until the child begins to walk.
1. The initial treatment plan for clubfoot (also called talipes equinovarus) usually includes a series of casts that slowly move the foot into proper alignment.
32. After the birth of an infant with clubfoot, the nursery nurse should do which of the following when instructing the parents? Select all that apply. 1. Speak in simple language about the defect. 2. Avoid the parents unless providing direct care so that they can grieve privately. 3. Keep the infant ' s feet covered at all times. 4. Present the infant as precious; emphasize the well-formed parts of the body. 5. Tell the parent that defects could be much worse. 6. Be prepared to answer questions multiple times.
1. The parents will likely be shocked immediately after the birth of the child. To facilitate their understanding, the nurse should speak in simple terms. 4. The baby should be shown to the parents as are all newborns, emphasizing the well-formed parts of the body. 6. Information may need to be repeated as the family begins to absorb the information.
6. The nurse tells the parent that other conditions can be associated with congenital clubfoot. Select all that apply. 1. Myelomeningocele. 2. Cerebral palsy. 3. Diastrophic dwarfi sm. 4. Breech position in utero. 5. Prematurity. 6. Fetal alcohol spectrum disorder
1. There is an association between myelomeningocele and congenital clubfoot. 2. There is an association between some forms of cerebral palsy and congenital clubfoot. 3. There is an association between diastrophic dwarfi sm and congenital clubfoot.
31. A 14-year-old with osteogenesis imperfecta (OI) is confi ned to a wheelchair. Which nursing interventions will promote normal development? Select all that apply. 1. Encourage participation in groups with teens who have disabilities or chronic illness. 2. Encourage decorating the wheelchair with stickers. 3. Encourage transfer of primary care to an adult provider at age 18 years. 4. Allow the teen to view the radiographs. 5. Help the teen set realistic goals for the future. 6. Discourage discussion of sexuality, because the child is not likely to date.
1. This client is trying to become more independent and trying to fi t in with the peer group. Encouraging socializing with peers who face similar challenges alleviates feelings of isolation. 2. Decorating the wheelchair encourages the client to assume independence in self-care. 4. Allowing the patient to view radiographs encourages the patient to assume self-care. 5. Helping the patient set realistic goals for the future encourages independence.
100. The nurse is caring for a baby diagnosed with developmental dysplasia of the hip (DDH). Which of the following therapeutic interventions should the nurse expect to perform? 1. Maintain the baby's legs in abduction. 2. Administer pain medication as needed. 3. Assist with bilateral leg casting. 4. Monitor pedal pulses bilaterally
1. To treat developmental dysplasia of the hip (DDH), babies' legs are maintained in a state of abduction.
97. A 2-day-old baby's blood values are: Blood type, O- (negative). Direct Coombs, negative. Hematocrit, 50%. Bilirubin, 1.5 mg/dL (25.6 μmol/L). The mother's blood type is A + (positive). What should the nurse do at this time? 1. Do nothing because the results are within normal limits. 2. Assess the baby for opisthotonic posturing. 3. Administer RhoGAM to the mother per doctor's order. 4. Call the doctor for an order to place the baby under bili-lights
1. When bilirubin levels elevate to toxic levels, babies can develop kernicterus
13. A baby with hemolytic jaundice is being treated with fluorescent phototherapy. To provide safe newborn care, which of the following actions should the nurse perform? 1. Cover the baby's eyes with eye pads. 2. Turn the lights off for 10 minutes every hour. 3. Clothe the baby in a shirt and diaper only. 4. Tightly swaddle the baby in a baby blanket
1. When phototherapy is administered, the baby's eyes must be protected from the light source
12. Which of the following measures should the nurse implement to help with the nausea and vomiting caused by chemotherapy? Select all that apply. 1. Give an antiemetic 30 minutes prior to the start of therapy. 2. Continue the antiemetic as ordered until 24 hours after the chemotherapy is complete. 3. Remove food that has a lot of odor. 4. Keep the child on a nothing-by-mouth status. 5. Wait until the nausea begins to start the antiemetic
2. A lumbar puncture is done to determine whether the cancer cells have entered the CNS, but this would not be routine unless the child was symptomatic. 3. Chemotherapy can also be given through a lumbar puncture (spinal tap).
35. An infant is born with a sac protruding through the spine, containing cerebrospinal fl uid (CSF), a portion of the meninges, and nerve roots. This condition is referred to as: 1. Meningocele. 2. Myelomeningocele. 3. Spina bifi da occulta. 4. Anencephaly.
2. A myelomeningocele is a sac that contains a portion of the meninges, the CSF, and the nerve roots.
45. Which child is at increased risk for cerebral palsy (CP)? 1. An infant born at 34 weeks with an Apgar score of 6 at 5 minutes. 2. A 17-day-old infant with group B Streptococcus meningitis. 3. A 24-month-old child who has experienced a febrile seizure. 4. A 5-year-old with a closed-head injury after falling off a bike.
2. Any infection of the central nervous system increases the infant ' s risk of CP
16. When assessing the neurological status of an 8-month-old, the nurse should check for which of the following? Select all that apply. 1. Clarity of speech. 2. Interaction with staff. 3. Vision test. 4. Romberg test. 5. Ability to roll over and sit independently.
2. Assessment for alteration in developmentally expected behaviors, such as stranger anxiety, is helpful. Interaction with staff is not to be expected due to stranger anxiety 5. Sitting and rolling over are two skills that an 8-month-old infant should be able to accomplish.
81. A baby is thought to have esophageal atresia. The nurse would expect to see which of the following signs/symptoms? Select all that apply. 1. Frequent vomiting. 2. Excessive mucus. 3. Ruddy complexion. 4. Abdominal distention. 5. Pigeon chest.
2. Babies with esophageal atresia would be expected to expel large amounts of mucus from the mouth because they can't swallow it into the stomach. 4. Abdominal distention can be seen with esophageal atresia because air enters the stomach via the trachea.
27. Which should be the priority nursing diagnosis for a 12-hour-old newborn with a myelomeningocele at L2? 1. Altered bowel elimination related to neurological deficits. 2. Potential for infection related to the physical defect. 3. Altered nutrition related to neurological deficit. 4. Disturbance in self-concept related to physical disability.
2. Because this infant has not had a repair, the sac is exposed. It could rupture, allowing organisms to enter the CSF, so this is the priority.
50. A child with cerebral palsy (CP) has been fi tted for braces and is beginning physical therapy to assist with ambulation. The parents ask why he needs the braces when he was crawling without any assistive devices. Select the nurse ' s best response. 1. "The CP has progressed, and he now needs more assistance to ambulate." 2. "As your child grows, different muscle groups may need more assistance." 3. "Most children with CP need braces to help with ambulation." 4. "We have found that when children with CP use braces, they are less likely to fall."
2. CP can manifest in different ways as the child grows. It does not progress, but its clinical manifestations may change.
28. The nurse is caring for a child diagnosed with thalassemia major who is receiving the fi rst chelation therapy. What information should the nurse provide to the parent regarding the therapy? Select all that apply. 1. Decreases the risk of bleeding. 2. Eliminates excess iron. 3. Prevents further sickling of the red blood cells. 4. Provides an iron supplement. 5. Hydration is necessary for the process to be effective.
2. Chelation therapy is used to rid the body of excess iron stores that result from frequent blood transfusions. 5. Hydration is necessary for the process to be effective.
29. Which should the nurse tell the parent of an infant with spina bifi da? 1. "Bone growth will be more than that of babies who are not sick because your baby will be less active." 2. "Physical and occupational therapy will be helpful to stimulate the senses and improve cognitive skills." 3. "Nutritional needs for your infant will be calculated based on activity level." 4. "Fine motor skills will be delayed because of the disability."
2. Children with decreased activity due to illness or trauma are helped by physical and occupational therapy. The varied activities stimulate the senses.
37. The nurse is caring for an infant with a myelomeningocele. The parents ask the nurse why the nurse keeps measuring the baby ' s head circumference. Select the nurse ' s best response: 1. "Babies 'heads are measured to ensure growth is on track." 2. "Babies with a myelomeningocele are at risk for hydrocephalus, which shows up as an increase in head size." 3. "Because your baby has an opening on the spinal cord, your infant is at risk for meningitis, which can show up as an increase in head size." 4. "Many infants with myelomeningocele have microcephaly, which can show up as a decrease in head size."
2. Children with myelomeningocele are at increased risk for hydrocephalus, which can be manifested with an increase in head circumference.
6. Which of the following would be included in the plan of care for a hospitalized newborn following surgical repair of a myelomeningocele? Select all that apply. 1. Skull x-rays. 2. Daily head circumference measurements. 3. MRI scan. 4. Vital signs every 6 hours. 5. Holding to breastfeed
2. Daily head circumference measurements are done to assess for hydrocephalus. 3. Diagnostic tests include MRI scan, CT scan, ultrasound, and myelography.
10. The nurse knows that teaching was successful when a parent states which of the following are early signs of muscular dystrophy? 1. Increased muscle strength. 2. Difficulty climbing stairs. 3. High fevers and tiredness. 4. Respiratory infections and obesity.
2. Diffi culty climbing stairs, running, and riding a bicycle are frequently the fi rst symptoms of Duchenne muscular dystrophy.
8. Which position initially is most benefi cial for an infant who has just returned from having a ventriculoperitoneal (VP) shunt placed? 1. Semi-Fowler in an infant seat. 2. Flat in the crib. 3. Trendelenburg. 4. In the crib with the head elevated to 90 degrees
2. Flat in the crib is the position usually used initially, with the angle gradually increasing as the child tolerates.
56. A baby has just been admitted into the newborn nursery. Before taking the newborn's vital signs, the nurse should warm his or her hands and the stethoscope to prevent heat loss resulting from which of the following? 1. Evaporation. 2. Conduction. 3. Radiation. 4. Convection.
2. Heat loss resulting from conduction occurs when the baby comes in contact with cold objects (hands or stethoscope).
26. Which should the nurse do first when caring for an infant who just had a repair of a myelomeningocele? 1. Weigh diapers for 24-hour urine output. 2. Measure head circumference. 3. Offer clear fluids. 4. Assess for infection.
2. Hydrocephalus occurs in about 90% of infants with myelomeningocele, so measuring the head circumference daily and watching for an increase are important. Accumulation of cerebrospinal fl uid can occur after closure of the sac.
8. Which of the following describes idiopathic thrombocytopenia purpura (ITP)? Select all that apply. 1. ITP is a congenital hematological disorder. 2. ITP causes excessive destruction of platelets. 3. Children with ITP have normal bone marrow. 4. Platelets are small in ITP. 5. Purpura is observed in ITP
2. ITP is characterized by excessive destruction of platelets. 3. The bone marrow is normal in children with ITP 5. ITP is characterized by purpura, which are areas of hemorrhage under the skin.
97. A neonate has just been born with a meningomyelocele. Which of the following risks should the nurse identify as related to this medical diagnosis? 1. Deficient fluid volume. 2. High risk for infection. 3. Ineffective breathing pattern. 4. Imbalanced nutrition: less than body requirements.
2. If the fragile sac is injured, the baby is at very high risk for infection.
13. Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis? 1. Maintain isolation precautions until 24 hours after receiving intravenous antibiotics. 2. Intravenous fl uids at 1½ times regular maintenance. 3. Neurological checks every hour. 4. Administer acetaminophen (Tylenol) for temperatures higher than 38°C (100.4°F).
2. Intravenous fl uids at 1½ times regular maintenance could cause fl uid overload and lead to increased ICP.
29. Which of the following should the nurse expect to administer to a child with ITP and a platelet count of 5000/mm 3 ? Select all that apply. 1. Platelets. 2. Intravenous immunoglobulin. 3. Packed red blood cells (PRBCs). 4. White blood cells. 5. Prednisolone.
2. Intravenous immunoglobulin is given because the cause of platelet destruction is believed to be an autoimmune response to disease-related antigens. Treatment is usually supportive. Activity is restricted at the onset because of the low platelet count and risk for injury that could cause bleeding 5. Treatment in the acute phase is often symptomatic, and prednisolone, IVIG, and anti-D antibody are often given. This tends to shorten the course because the disease tends to resolve over time. Focus on the cause of ITP and which cells are affected.
37. The parent of a toddler newly diagnosed with CP asks the nurse what caused it. The nurse should answer with which of the following? 1. Most cases are caused by unknown prenatal factors. 2. It is commonly caused by perinatal factors. 3. The exact cause is not known. 4. The exact cause is known in every instance.
2. It is generally thought that the majority of infants with CP had an insult in utero. Some of the causes of perinatal insult include hypoxia, trauma, infections, or genetic abnormalities.
84. Which of the following actions would the NICU nurse expect to perform when caring for a neonate with esophageal atresia and tracheoesophageal fistula (TEF)? 1. Position the baby flat on the left side. 2. Maintain low nasogastric suction. 3. Give small, frequent feedings. 4. Place on hypothermia blanket.
2. Low nasogastric suction is usually maintained to minimize the amount of the baby's oral secretions.
23. The nurse is providing discharge teaching to the parents of a toddler who experienced a febrile seizure. The nurse knows clarifi cation is needed when the mother says: 1. "My child will likely have another seizure." 2. "My child ' s 7-year-old brother is also at high risk for a febrile seizure." 3. "I ' ll give my child acetaminophen (Tylenol) when ill to prevent the fever from rising too high too rapidly." 4. "Most children with febrile seizures do not require seizure medicine."
2. Most children over the age of 5 years do not have febrile seizures.
38. A child with osteosarcoma is going to receive chemotherapy before surgery. Which statement by the parents indicates they understand the side effect of neutropenia? 1. "My child will be more at risk for diarrhea." 2. "My child will be more at risk for infection." 3. "My child ' s hair will fall out." 4. "My child will need to drink more."
2. Neutropenia makes a child more at risk for infection because the immune system is compromised by the chemotherapy
20. A nurse instructs the parent of a child with sickle cell disease about factors that might precipitate a pain crisis in the child. Which of the following factors identifi ed by the parent as being able to cause a pain crisis indicates a need for further instruction? 1. Infection. 2. Overhydration. 3. Stress at school. 4. Cold environment
2. Overhydration does not cause a crisis
22. Which medication should the nurse anticipate administering fi rst to a child in status epilepticus? 1. Establish an intravenous line and administer intravenous lorazepam (Ativan). 2. Administer rectal diazepam (Valium). 3. Administer an oral glucose gel to the side of the child ' s mouth. 4. Administer oral diazepam (Valium).
2. Rectal diazepam (Valium) is fi rst administered in an attempt to stop the seizure long enough to establish an IV, and then IV medication is administered.
18. An 18-hour-old baby with an elevated bilirubin level is placed under the bili lights. Which of the following is an expected nursing action in these circumstances? 1. Give the baby oral rehydration therapy in place of all feedings. 2. Rotate the baby from side to back to side to front every 2 hours. 3. Apply restraints to keep the baby under the light source. 4. Administer intravenous fluids via pump per doctor orders.
2. Rotating the baby's position maximizes the therapeutic response because the more skin surface that is exposed to the light source, the better the results are
17. The nurse is caring for a child with sickle cell disease who is scheduled to have a splenectomy. What information should the nurse explain to the parents regarding the reason for a splenectomy? 1. To decrease potential for infection. 2. To prevent splenic sequestration. 3. To prevent sickling of red blood cells. 4. To prevent sickle cell crisis.
2. Splenic sequestration is a life-threatening situation in children with sickle cell disease. Once a child is considered to be at high risk of splenic sequestration or has had this in the past, the spleen will be removed.
9. The nurse is aware that cloudy cerebrospinal fl uid (CSF) most likely indicates: 1. Viral meningitis. 2. Bacterial meningitis. 3. No infection, because CSF is usually cloudy. 4. Sepsis.
2. The CSF in bacterial meningitis is usually cloudy.
46. Which child requires continued follow-up because of behaviors suspicious of cerebral palsy (CP)? 1. A 1-month-old who demonstrates the startle refl ex when a loud noise is heard. 2. A 6-month-old who always reaches for toys with the right hand. 3. A 14-month-old who has not begun to walk. 4. A 2-year-old who has not yet achieved bladder control during waking hours.
2. The clinical characteristic of hemiplegia can be manifested by the early preference of one hand. This may be an early sign of CP.
28. Over the past week, an infant with a repaired myelomeningocele has had a highpitched cry and been irritable. Length, weight, and head circumference have been at the 50th percentile. Today, length is at the 50th percentile, weight is at the 70th percentile, and head circumference is at the 90th percentile. The nurse should do which of the following? 1. Tell the parent this is normal for an infant with a repaired myelomeningocele. 2. Tell the parent this might mean the baby has increased intracranial pressure. 3. Suspect the baby ' s intracranial pressure is low because of a leak. 4. Refer the baby to the neurologist for follow-up care.
2. The increase in head size is one of the fi rst signs of increased intracranial pressure; other signs include highpitched cry and irritability.
30. A 9-year-old is in a spica cast and complains of pain 1 hour after receiving intravenous opioid analgesia. What should the nurse do fi rst? 1. Give more pain medication. 2. Perform a neuromuscular assessment. 3. Call the surgeon for orders. 4. Change the child ' s position.
2. The nurse looks for the source of the pain by performing a neuromuscular assessment.
9. When counseling the parents of a child with osteogenesis imperfecta (OI), the nurse should include which of the following? Select all that apply. 1. Discourage future children because the condition is inherited. 2. Provide education about the child ' s physical limitations. 3. Give the parents a letter signed by the primary care provider explaining OI. 4. Provide information on contacting the Osteogenesis Imperfecta Foundation. 5. Encourage the parents to treat the child like their other children. 6. Encourage use of calcium to decrease risk of fractures.
2. The nurse should provide education about the child ' s physical limitations so that physical therapy and appropriate activity can be encouraged. 3. OI is frequently confused with child abuse. Carrying a letter stating that the child has OI and what that condition looks like can ease the stressors of an emergency department visit. 4. The Osteogenesis Imperfecta Foundation is an organization that can provide information and support for a family with a child with the condition.
55. Why are chemotherapeutic agents such as methotrexate (Trexall) and cyclophosphamide (Cytoxan) sometimes used to treat juvenile idiopathic arthritis (JIA)? 1. Are effective against cancer-like JIA. 2. Suppress the immune system. 3. Are similar to NSAIDs. 4. Are absorbed into the synovial fl uid.
2. These drugs affect the immune system to reduce its ability to attack itself, as in the case of JIA.
44. A 3-year-old child with CP is admitted for dehydration following an episode of diarrhea. The nurse ' s assessment follows: awake; pale, thin child lying in bed; multiple contractures; drooling; coughing spells noted when parent feeds. T 97.8°F (36.5°C), P 75, R 25, weight 7.2 kg, no diarrheal stool for 48 hours. Which nursing diagnosis is most important? 1. Potential for skin breakdown: lying in one position. 2. Alteration in nutrition: less than body requirements. 3. Potential for impaired social support: parent sole caretaker. 4. Alteration in elimination: diarrhea.
2. This child is severely underweight and malnourished for a 3-year-old. The coughing episodes while feeding put the child at risk for aspiration and pneumonia. A thorough history, physical examination, and a feeding study should be performed to determine whether it is even safe to feed the child orally. This is the priority nursing diagnosis for this severely underweight child. Weight is average for a 4-month-old. The coughing episodes while feeding may indicate aspiration. The parent needs help to learn how to feed so that less coughing occurs.
38. A parent of a newborn diagnosed with myelomeningocele asks what is/are common long-term complication(s)? The nurse ' s best response is which of the following? Select all that apply. 1. Learning disabilities. 2. Urinary tract infections. 3. Hydrocephalus. 4. Decubitus ulcers and skin breakdown. 5. Nutrition issues. 6. Attention defi cit disorders
2. Urinary tract infections are the most common complication of myelomeningocele. Nearly all children with myelomeningocele have a neurogenic bladder that leads to incomplete emptying of the bladder and subsequent urinary tract infections. Frequent catheterization also increases the risk of urinary tract infection. 3. About 90% to 95% of children with myelomeningocele experience hydrocephalus
88. A neonate has an elevated bilirubin and is slightly jaundiced on day 3 of life. What is the probable reason for these changes? 1. Hemolysis of neonatal red blood cells by the maternal antibodies. 2. Physiological destruction of fetal red blood cells during the extrauterine period. 3. Pathological liver function resulting from hypoxemia during the birthing process. 4. Delayed meconium excretion resulting in the production of direct bilirubin.
2. With lung oxygenation, the neonate no longer needs large numbers of red blood cells. As a result, excess red blood cells are destroyed. Jaundice often results on days 2 to 4.
23. A nurse is preparing a care plan for a 5-day-old newborn under phototherapy. Which of the following client care outcomes should be included in the nursing care plan? "During the next 24 hour period, the baby will: 1. Have at least 6 wet diapers." 2. Breastfeed 2 to 4 times." 3. Lose less than 12% of the baby's birth weight." 4. Have an apical heart rate of 160 to 170 bpm."
23. 1. Healthy, hydrated neonates saturate their diapers a minimum of 6 times in 24 hours.
2. An 18-month-old male is brought to the clinic by his mother. His height is in the 50th percentile, and his weight is in the 80th percentile. The child is pale. The physical examination is normal, but his hematocrit level is 20%. Which of the following questions should assist the nurse in making a diagnosis? Select all that apply. 1. "How many bowel movements a day does your child have?" 2. "How much did your baby weigh at birth?" 3. "What does your child eat every day?" 4. "Has the child been given any new medications?" 5. "How much milk does your child drink per day?"
3. A diet history is necessary to determine the nutritional status of the child and whether the child is getting sufficient sources of iron. 5. By asking how much milk the child consumes, the nurse can determine whether the child is fi lling up on milk and then not wanting to take food.
5. Which signs best indicate increased intracranial pressure (ICP) in an infant? Select all that apply. 1. Sunken anterior fontanel. 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite. 5. Sleeping more than usual.
3. A high-pitched cry is often indicative of increased ICP in infants. 5. The infant may be sleeping more than usual because of increased ICP.
12. Select the best room assignment for a newly admitted child with bacterial meningitis. 1. Semiprivate room with a roommate who also has bacterial meningitis. 2. Semiprivate room with a roommate who has bacterial meningitis but has received intravenous antibiotics for more than 24 hours. 3. Private room that is dark and quiet with minimal stimulation. 4. Private room that is bright and colorful and has developmentally appropriate activities available.
3. A quiet private room with minimal stimulation is ideal because the child with meningitis should be in a quiet environment to avoid cerebral irritation.
34. A newborn with a repaired myelomeningocele is assessed for hydrocephalus. Which would the nurse expect in an infant with hydrocephalus? 1. Low-pitched cry and depressed fontanel. 2. Low-pitched cry and bulging fontanel. 3. Bulging fontanel and downwardly rotated eyes. 4. Depressed fontanel and upwardly rotated eyes.
3. An alteration in the circulation of the cerebrospinal fl uid causes hydrocephalus. The anterior fontanel bulges because of an increase in cerebrospinal fl uid, and an increase in intracranial pressure causes a high-pitched cry in infants and downward deviation of the eyes, also called sunset eyes. With sunset eyes, the sclera can be seen above the iris.
1. The nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems is (are) associated with sickle cell disease? Select all that apply. 1. Polycythemia. 2. Hemarthrosis. 3. Aplastic crisis. 4. Thrombocytopenia. 5. Vaso-occlusive crisis.
3. Aplastic crisis, temporary cessation of red blood cell production, is associated with sickle cell anemia. 5. Vaso-occlusive crisis is the most common problem in children with sickle cell disease.
9. Which of the following would lead the nurse to suspect cold stress in a newborn with a temperature of 96.5° F (35.8° C)? 1. Blood glucose of 50 mg/dL (2.8 mmol/L). 2. Acrocyanosis. 3. Tachypnea. 4. Oxygen saturation of 96%
3. Babies who have cold stress will develop respiratory distress. One symptom of the distress is tachypnea.
66. A neonate has asymmetrical intrauterine growth restriction (IUGR) secondary to placental insufficiency. Which of the following signs/symptoms should the nurse expect to observe at delivery? Select all that apply. 1. Thrombocytopenia. 2. Neutropenia. 3. Polycythemia. 4. Hypoglycemia. 5. Hyperlipidemia.
3. Babies who have lived in utero with a dysfunctional placenta usually are born with polycythemia. 4. Babies who have lived in utero with a dysfunctional placenta will often demonstrate hypoglycemia after the birth.
49. The nurse prepares baclofen for a child with cerebral palsy (CP) who just had her hamstrings surgically released. The child ' s parents ask what the medication is for. Select the nurse ' s best response. 1. "It is a medication that will help decrease the pain from her surgery." 2. "It is a medication that will prevent her from having seizures." 3. "It is a medication that will help control her spasms." 4. "It is a medication that will help with bladder control."
3. Baclofen is given to help control the spasms associated with CP.
39. Which is most important to discuss with an adolescent who is going to have a leg amputation for osteosarcoma? 1. Pain. 2. Spirituality. 3. Body image. 4. Lack of coping.
3. Body image is a developmental issue for adolescents and infl uences their acceptance of themselves and by peers
18. The parent of a 3-week-old states that the infant was recasted this morning for clubfoot and has been crying for the past hour. Which intervention should the nurse suggest the parent do fi rst? 1. Give pain medication. 2. Reposition the infant in the crib. 3. Check the neurocirculatory status of the foot. 4. Use a cool blow-dryer to blow into the cast to control itching.
3. Checking the neurocirculatory status of the foot is the highest priority.
27. A 12-year-old diagnosed with scoliosis is to wear a brace for 23 hours a day. What is the most likely reason the child will not wear it for that long? 1. Pain from the brace. 2. Diffi culty in putting the brace on. 3. Self-consciousness about appearance. 4. Not understanding what the brace is for.
3. Children this age are very conscious of their appearance and fi tting in with their peers, so they might be very resistant to wearing a brace
52. The parent of a child diagnosed with Wilms tumor asks the nurse what the treatment plan will be. The nurse explains the usual protocol for this condition. Which information should the nurse give to the parent? 1. The child will have chemotherapy and, after that has been completed, radiation. 2. The child will need to have surgery to remove the tumor. 3. The child will go to surgery for removal of the tumor and the kidney and will then start chemotherapy. 4. The child will need radiation and later surgery to remove the tumor.
3. Combination therapy of surgery and chemotherapy is the primary therapeutic management. Radiation is done depending on clinical stage and histological pattern
1. Which would the nurse expect to assess on a 3-week-old infant with developmental dysplasia of the hip (DDH)? Select all that apply. 1. Excessive hip abduction. 2. Femoral lengthening of an affected leg. 3. Asymmetry of gluteal and thigh folds. 4. Pain when lying prone. 5. Positive Ortolani test.
3. In DDH, asymmetrical thigh and gluteal folds are frequently present 5. The Ortolani maneuver moves a disclocated hip back into the socket with a distinct clunk.
48. The nurse is caring for a 2-month-old infant who is at risk for cerebral palsy (CP) due to extreme low birth weight and prematurity. His parents ask why a speech therapist is involved in his care. Select the nurse ' s best response. 1. "Your baby is likely to have speech problems because of his early birth. Involving the speech therapist now will ensure vocalization at a developmentally appropriate age." 2. "The speech therapist will help with tongue and jaw movements to assist with babbling." 3. "The speech therapist will help with tongue and jaw movements to assist with feeding." 4. "Many members of the health-care team are involved in your child ' s care so that we will know if there are any unmet needs."
3. It is important to involve speech therapy to strengthen tongue and jaw movements to assist with feeding. The infant who is at risk for CP may have weakened and uncoordinated tongue and jaw movements.
96. A full-term baby's bilirubin level is 12 mg/dL (205.2 μmol/L) on day 3. Which of the following neonatal behaviors would the nurse expect to see? 1. Excessive crying. 2. Increased appetite. 3. Lethargy. 4. Hyperreflexia.
3. Lethargy is one of the most common early symptoms of hyperbilirubinemia
45. The parent of an infant with CP asks the nurse if the infant will be mentally retarded. Which is the nurse ' s best response? 1. "Children with CP have some amount of mental retardation." 2. "Approximately 20% of children with CP have normal intelligence." 3. "Many children with CP have normal intelligence." 4. "Mental retardation is expected if motor and sensory defi cits are severe."
3. Many children with CP have normal intelligence.
18. Which of the following is the most effective treatment for pain in a child with sickle cell crisis? Select all that apply. 1. Meperidine (Demerol). 2. Aspirin. 3. Morphine. 4. Behavioral techniques. 5. Acetaminophen (Tylenol) with codeine.
3. Morphine is the drug of choice for a child with sickle cell crises. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine. When that is not suffi cient to alleviate pain, stronger narcotics are prescribed, such as morphine. Ketorolac (Toradol) may be indicated for short-term use for moderate-severe pain. 4. Behavioral techniques such as positive self-talk, relaxation, distraction, and guided imagery are helpful when pain is occurring. 5. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine when pain is described as mild to moderate
12. The nurse knows that teaching has been successful when the parent of a child with muscle weakness states that the diagnostic test for muscular dystrophy is which of the following? 1. Electromyelogram. 2. Nerve conduction velocity. 3. Muscle biopsy. 4. Creatine kinase level
3. Muscle biopsy confi rms the type of myopathy that the patient has.
24. A baby in the neonatal intensive care unit (NICU) is exhibiting signs of neonatal abstinence syndrome (NAS). Which of the following medications is contraindicated for this neonate? 1. Morphine. 2. Methadone. 3. Narcan. 4. Phenobarbital.
3. Narcan is an opiate-antagonist. If it were to be given to the neonate with neonatal abstinence syndrome, the baby would go into a traumatic withdrawal.
113. A baby is born with esophageal atresia and tracheoesophageal fistula. Which of the following complications of pregnancy would the nurse expect to note in the mother's history? 1. Pre-eclampsia. 2. Idiopathic thrombocytopenia. 3. Polyhydramnios. 4. Severe iron deficiency anemia.
3. Polyhydramnios, also called hydramnios, is often seen in pregnancies complicated by a fetus with a digestive blockage.
8. Which of the following neonates is at highest risk for cold stress syndrome? 1. Infant of diabetic mother. 2. Infant with Rh incompatibility. 3. Neonate that is postdates. 4. Infant with Down's syndrome
3. Postdates babies are at high risk for cold stress syndrome because while still in utero they often metabolize the brown adipose tissue for energy when the placental function deteriorates.
7. A 1-day-old neonate at 32 weeks' gestation is being cared for in an isolette. The nurse assesses the morning axillary temperature as 96.9° F (36.1° C). Which of the following could explain this finding? 1. This is a normal temperature for a preterm neonate. 2. Axillary temperatures are not valid for preterm babies. 3. The supply of brown adipose tissue is incomplete. 4. Conduction heat loss is pronounced in the baby.
3. Preterm babies are born with an insufficient supply of brown adipose tissue that is needed for thermogenesis, or heat generation.
41. Which does the nurse include in the postoperative plan of care for a child with myelomeningocele following ligament release? 1. Encourage the child to resume a regular diet, beginning slowly with bland foods that are easily digested, such as bananas. 2. Encourage the child to blow balloons to increase deep breathing and avoid postoperative pneumonia. 3. Assist the child to change positions to avoid skin breakdown. 4. Provide education on dietary requirements to prevent obesity and skin breakdown.
3. Preventing skin breakdown is important in the child with myelomeningocele because pressure points are not felt easily.
53. Which would the nurse teach an adolescent is a complication of corticosteroids used in the treatment of juvenile idiopathic arthritis (JIA)? 1. Fat loss. 2. Adrenal stimulation. 3. Immune suppression. 4. Hypoglycemia.
3. Steroids cause immune suppression, which is the reason behind its use in JIA; it reduces the body ' s attack on itself.
35. The nurse is developing a plan of care for a child recently diagnosed with cerebral palsy (CP). Which should be the nurse ' s priority goal? 1. Ensure the ingestion of suffi cient calories for growth. 2. Decrease intracranial pressure. 3. Teach appropriate parenting strategies for a special-needs child. 4. Ensure that the child reaches full potential.
3. Teaching appropriate parenting strategies for a special-needs child is important and is done so that the child can maximize her personal skills and minimize her limitation.
47. The parents of a child with meningitis and multiple seizures ask if the child will likely develop cerebral palsy (CP). Select the nurse ' s best response. 1. "When your child is stable, she ' ll undergo computed tomography (CT) and magnetic resolution imaging (MRI). The physicians will be able to let you know if she has CP." 2. "Most children do not develop CP at this late age." 3. "Your child will be closely monitored after discharge, and a developmental specialist will be able to make the diagnosis." 4. "Most children who have had complications following meningitis develop some amount of CP."
3. The child will be given a chance to recover and will be monitored closely before a diagnosis is made
101. A baby has been diagnosed with developmental dysplasia of the hip (DDH). Which of the following findings would the nurse expect to see? 1. Pronounced hip abduction. 2. Swelling at the site. 3. Asymmetrical leg folds. 4. Weak femoral pulses.
3. The leg folds of the baby, both anteriorly and posteriorly, are frequently asymmetrical.
4. The nurse should tell the parents of a child with Duchenne (pseudohypertrophic) muscular dystrophy that some of the progressive complications include: Select all that apply. 1. Dry skin and hair, hirsutism, protruding tongue, and mental retardation. 2. Anorexia, gingival hyperplasia, dry skin and hair. 3. Contractures, obesity, and pulmonary infections. 4. Trembling, frequent loss of consciousness, and slurred speech. 5. Increasing diffi culty swallowing and shallow breathing.
3. The major complications of muscular dystrophy include contractures, disuse atrophy, infections, obesity, respiratory complications, and cardiopulmonary problems. 5. The muscles of a child with MD tend to show increasing weakness and atrophy over time. The children are at risk for swallowing, aspiration, and pneumonia.
40. The parent of a young child with CP brings the child to the clinic for a checkup. Which parent ' s statement indicates an understanding of the child ' s long-term needs? 1. "My child will need all my attention for the next 10 years." 2. "Once in school, my child will catch up and be like the other children." 3. "My child will grow up and need to learn to do things independently." 4. "I ' m the one who knows the most about my child and can do the most for my child."
3. The parent of a child with a disability should have the goal of assisting the child in achieving as much self-care as he is capable of, given his particular limitations
22. The nurse is caring for an infant with myelomeningocele who is going to surgery later today for closure of the sac. Which would be a priority nursing diagnosis before surgery? 1. Alteration in parent-infant bonding. 2. Altered growth and development. 3. Risk of infection. 4. Risk for weight loss
3. The unrepaired myelomeningocele is oftentimes a thin membrane that covers the neural contents of the spine. A normal saline dressing is placed over the sac to prevent tearing. The tearing would allow the CSF to escape and microorganisms to enter. The infant is at high risk for spinal cord infections. The priority nursing diagnosis is risk of infection.
4. A nurse is caring for a 5-year-old with sickle cell vaso-occlusive crisis. Which of the following orders should the nurse question? Select all that apply. 1. Position the child for comfort. 2. Apply hot packs to painful areas. 3. Give meperidine (Demerol) 25 mg intravenously every 4 hours as needed for pain. 4. Restrict oral fluids. 5. Apply oxygen per nasal cannula to keep oxygen saturations above 94%.
3. Tissue hypoxia is very painful. Narcotics such as morphine are usually given for pain when the child is in a crisis. Meperidine (Demerol) should be avoided because of the risk of Demerol-induced seizures. 4. The child should receive hydration because when the child is in crisis, the abnormal S-shaped red blood cells clump, causing tissue hypoxia and pain. 5. Oxygen is of little value unless the tissue is hypoxic. The objective of treatment is to minimize hypoxia
91. A baby is born with a meningomyelocele at L2. In assessing the baby, which of the following would the nurse expect to see? 1. Sensory loss in all four extremities. 2. Tuft of hair over the lumbosacral region. 3. Flaccid paralysis of the legs. 4. Positive Moro reflex
3. With a defect at L2, the nurse would expect to see paralysis of the legs.
3. Which clinical assessment of a neonate with bacterial meningitis would warrant immediate intervention? 1. Irritability. 2. Rectal temperature of 100.6°F (38.1°C). 3. Quieter than usual. 4. Respiratory rate of 24 breaths per minute.
4. A normal neonate ' s respiratory rate is 30 to 60 breaths per minute. Neonates ' respiratory systems are immature, and the rate may initially double in response to illness. If no immediate interventions are begun when there is respiratory distress, a neonate ' s respiratory rate will slow down, respiratory distress will worsen, and, eventually, respiratory arrest will occur. Neonates with sloweror faster-than-normal respiratory rates are true emergency cases; they require identifi cation of the cause of distress.
24. Which of the following measures should the nurse teach the parent of a child with hemophilia to do fi rst if the child sustains an injury to a joint causing bleeding? 1. Give the child a dose of acetaminophen (Tylenol). 2. Immobilize the joint and elevate the extremity. 3. Apply heat to the area. 4. Administer factor per the home-care protocol.
4. Administration of factor should be the fi rst intervention if home-care transfusions have been initiated.
33. Which should the nurse prepare the parents of an infant for following surgical repair and closure of a myelomeningocele shortly after birth? The infant will: 1. Not need any long-term management and should be considered cured. 2. Not be at risk for urinary tract infections or movement problems. 3. Have continual drainage of cerebrospinal fl uid, needing frequent dressing changes. 4. Need lifelong management of urinary, orthopedic, and neurological problems.
4. Although immediate surgical repair decreases infection, morbidity, and mortality rates, these children will require lifelong management of neurological, orthopedic, and elimination problems.
7. Which foods would be best for a child with Duchenne muscular dystrophy? Select all that apply. 1. High-carbohydrate, high-protein foods. 2. No special food combinations. 3. Extra protein to help strengthen muscles. 4. Low-calorie foods to prevent weight gain. 5. Thickened liquids and smaller portions that are cut up.
4. As the child becomes less ambulatory, moving the child will become more of a problem. It is not good for the child to become overweight for several health reasons in addition to decreased ambulation. 5. As the child loses muscle control, the need for thickened liquids and small, well-cut-up solids becomes essential.
2. Which should the nurse stress to the parents of an infant in a Pavlik harness for treatment of developmental dysplasia of the hip (DDH)? 1. Put socks on over the foot pieces of the harness to help stabilize the harness. 2. Use lotions or powder on the skin to prevent rubbing of straps. 3. Remove harness during diaper changes for ease of cleaning diaper area. 4. Check under the straps at least two to three times daily for red areas
4. Checking under straps frequently is suggested to prevent skin breakdown
39. The parent of an infant asks the nurse what to watch for to determine whether the infant has CP. Which is the nurse ' s best response? 1. "If the infant cannot sit up without support before 8 months." 2. "If the infant demonstrates tongue thrust before 4 months." 3. "If the infant has poor head control after 2 months." 4. "If the infant has clenched fi sts after 3 months."
4. Clenched fi sts after 3 months of age may be a sign of upper motor injury and CP.
10. A child is being admitted with the diagnosis of meningitis. Select the procedure the nurse should do fi rst: 1. Administration of intravenous antibiotics. 2. Administration of maintenance intravenous fl uids. 3. Placement of a Foley catheter. 4. Send the spinal fl uid and blood samples to the laboratory for cultures.
4. Cultures of spinal fl uid and blood should be obtained, followed by administration of intravenous antibiotics.
20. Using the Neonatal Infant Pain Scale (NIPS), a nurse is assessing the pain response of a newborn who has just had a circumcision. The nurse is assessing a change in which of the following signs/symptoms? Select all that apply. 1. Heart rate. 2. Blood pressure. 3. Temperature. 4. Facial expression. 5. Breathing pattern.
4. Facial expression is one variable that is evaluated as part of the NIPS. 5. Breathing pattern is one variable that is evaluated as part of the NIPS.
27. A nurse is doing discharge education with a parent who has a child with betathalassemia (Cooley anemia). The nurse informs the parent that the child is at risk for which of the following conditions? 1. Hypertrophy of the thyroid. 2. Polycythemia vera. 3. Thrombocytopenia. 4. Chronic hypoxia and iron overload.
4. In beta-thalassemia, there is increased destruction of red blood cells, causing anemia. This results in chronic anemia and hypoxia. The children are treated with multiple blood transfusions, which can cause iron overload and damage to major organs.
52. The nurse is teaching the parent of a child newly diagnosed with juvenile idiopathic arthritis (JIA). The nurse would evaluate the teaching as successful when the parent is able to say that the disorder is caused by the: 1. Breakdown of osteoclasts in the joint space causing bone loss. 2. Loss of cartilage in the joints. 3. Buildup of calcium crystals in joint spaces. 4. Immune-stimulated infl ammatory response in the joint.
4. JIA is caused by an immune response by the body on the joint spaces.
45. A baby at 42 weeks' gestation has been admitted to the neonatal intensive care unit. At delivery, thick green amniotic fluid was noted. Which of the following neonatal care actions by the nurse is critical at this time? 1. Bath to remove meconium-contaminated fluid from the skin. 2. Ophthalmic assessment to check for conjunctival irritation. 3. Rectal temperature to assess for septic hyperthermia. 4. Respiratory evaluation to monitor for respiratory distress.
4. Meconium aspiration syndrome (MAS) is a rare but serious complication seen in post-term neonates who are exposed to meconium-stained fluid. Respiratory distress would indicate that the baby has likely developed MAS.
37. When teaching parents about osteosarcoma, the nurse knows instruction has been successful when a parent says that this type of cancer is common in which age-group? 1. Infants. 2. Toddlers. 3. School-age children. 4. Adolescents.
4. Osteosarcoma is a common cancer of adolescents.
22. Which of the following will be abnormal in a child with the diagnosis of hemophilia? 1. Platelet count. 2. Hemoglobin level. 3. White blood cell count. 4. Partial thromboplastin time (PTT)
4. The abnormal laboratory results in hemophilia are related to decreased clotting function. Partial thromboplastin time is prolonged.
39. Which is included in the plan of care for a newborn who has a myelomeningocele? 1. Place the infant in the prone position with a sterile dry dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 2. Place the infant in the prone position with a sterile dry dressing over the defect. Begin intravenous fl uids to prevent dehydration. 3. Place the infant in the prone position with a sterile moist dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 4. Place the child in the prone position with a sterile moist dressing over the defect. Begin intravenous fl uids to prevent dehydration.
4. The child is placed in the prone position to avoid any pressure on the defect. A sterile moist dressing is placed over the defect to keep it as clean as possible. Intravenous fl uids are begun to prevent dehydration.
11. The nurse is caring for a school-age child with Duchenne muscular dystrophy in the elementary school. Which would be an appropriate nursing diagnosis? 1. Anticipatory grieving. 2. Anxiety reduction. 3. Increased pain. 4. Activity intolerance.
4. The child would not be able to keep up with peers because of weakness, progressive loss of muscle fi bers, and loss of muscle strength.
44. A baby has been admitted to the neonatal intensive care unit with a diagnosis of postmaturity. The nurse expects to find which of the following during the initial newborn assessment? 1. Abundant lanugo. 2. Flat breast tissue. 3. Prominent clitoris. 4. Wrinkled skin.
4. The post-term baby does have dry, wrinkled, and often peeling skin due to progressive placental deterioration and often reduced amounts of amniotic fluid.
36. The nurse evaluates teaching of parents of a child newly diagnosed with CP as successful when the parents state that CP is which of the following? 1. Inability to speak and uncontrolled drooling. 2. Involuntary movements of lower extremities only. 3. Involuntary movements of upper extremities only. 4. An increase in muscle tone and deep tendon refl exes.
4. The primary disorder is of muscle tone, but there may be other neurological disorders such as seizures, vision disturbances, and impaired intelligence. Spastic CP is the most common type and is characterized by a generalized increase in muscle tone, increased deep tendon refl exes, and rigidity of the limbs on both fl exion and extension
22. A neonate is under phototherapy for elevated bilirubin levels. The baby's stools are now loose and green. Which of the following actions should the nurse take at this time? 1. Discontinue the phototherapy. 2. Notify the healthcare practitioner. 3. Take the baby's temperature. 4. Assess the baby's skin integrity.
4. The stools can be very caustic to the baby's delicate skin. The nurse should cleanse the area well and inspect the skin for any sign that the skin is breaking down.
7. A child with a ventriculoperitoneal (VP) shunt complains of headache and blurry vision and now experiences irritability and sleeping more than usual. The parents ask the nurse what they should do. Select the nurse ' s best response. 1. "Give her some acetaminophen (Tylenol), and see if her symptoms improve. If they do not improve, bring her to the health-care provider ' s offi ce." 2. "It is common for girls to have these symptoms, especially prior to beginning their menstrual cycle. Give her a few days, and see if she improves." 3. "You are probably worried that she is having a problem with her shunt. This is very unlikely because it has been working well for 9 years." 4. "You should immediately take her to the emergency department because these may be symptoms of a shunt malfunction."
4. These are symptoms of a shunt malfunction and should be evaluated immediately.
17. A newborn admitted to the nursery has a positive direct Coombs test. Which of the following is an appropriate action by the nurse? 1. Monitor the baby for jitters. 2. Assess the blood glucose level. 3. Assess the rectal temperature. 4. Monitor the baby for jaundice.
4. When the neonatal bloodstream contains antibodies, hemolysis of the red blood cells occurs and jaundice develops.
29. A baby was born 24 hours ago to a mother who received no prenatal care. The infant has tremors, sneezes excessively, constantly roots on its hand to suck, and has a shrill, high-pitched cry. The baby's serum glucose levels are normal. For which of the following should the nurse request an order from the pediatrician? 1. Urine drug toxicology test. 2. Biophysical profile test. 3. Chest and abdominal ultrasound evaluations. 4. Oxygen saturation and blood gas assessments.
5. Babies with signs of neonatal abstinence syndrome often have a shrill cry that may continue for prolonged periods.
