Maternal-Child Final (1-9, 33-39, 41-45, 55)

18. Which is the most critical element of pediatric emergency care? a. Airway management b. Prevention of neurologic impairment c. Maintaining adequate circulation d. Supporting the child's family

ANS: A Airway management is the most critical element in pediatric emergency care. The other elements are important, but airway is always the priority.

11. What part of the nursing process includes the collection of data on vital signs, allergies, sleep patterns, and feeding behaviors? a. Assessment b. Planning c. Intervention d. Evaluation

ANS: A Assessment includes gathering baseline data. Planning is based on baseline data and physical assessment. Implementation is the initiation and completion of nursing interventions. Evaluation is the last step in the nursing process and involves determining whether the goals were met.

23. A nurse is making a home visit on a new mother with an infant. What action by the mother requires the nurse to intervene? a. Cooks while holding and cuddling infant to provide comfort b. Keeps hand on infant while reaching for supplies on changing table c. Shows the nurse the water heater setting that is on 110° F (43.3° C) d. Places baby to sleep in crib with no blankets, toys, or other objects

ANS: A Burns are a leading cause of injury in children. The mother should not be holding the baby while cooking, so the nurse must intervene at this point. The other actions all provide safety.

9. Which statement indicates the nurse's lack of understanding about the use of patient-controlled analgesia (PCA) therapy? a. Children as young as 3 years old can effectively and successfully use a PCA pump. b. Two registered nurses (RNs) are required to double-check the dosage and programmed administration of opioids. c. The child should be carefully monitored for signs and symptoms of overmedication with opioids. d. Naloxone (Narcan) should be readily available.

ANS: A Children as young as 5 years old have effectively used PCA therapy. Further data are needed to evaluate the use of PCA therapy in children younger than 5 years of age. Two RNs are needed to check the amount of opioid being administered. Once the opioid infusion is hung and programmed, a second RN must double-check the process. Children receiving PCA therapy should be monitored closely to ensure effective pain control and for signs or symptoms of overmedication. Initially, vital signs should be monitored every 15 to 30 minutes and then every 2 to 4 hours. Respiratory rate should be assessed every hour. Narcan should be readily available to reverse opioid overmedication exhibited by respiratory distress.

17. Parents report their 3-year-old child appears restless at night and frequently scratches her anal area. What action by the nurse is best? a. Educate parents on the cellophane tape test. b. Review hygiene practices with the parents. c. Suggest the child sleep only in pajama tops. d. Ask parents to bring in a stool sample.

ANS: A The cellophane tape test is used to diagnose pinworms. The parents place a strip of cellophane tape on the child's anus at bedtime and brings it to the clinic for microscopic evaluation. There is no need to review hygienic practices, suggest sleeping in a pajama top only, or to bring in a stool sample.

13. What food choice by the parent of a 2-year-old child with celiac disease indicates a need for further teaching? a. Oatmeal b. Rice cake c. Corn muffin d. Meat patty

ANS: A The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Oatmeal contains gluten and is not an appropriate food selection. Rice, corn, and meat are appropriate selections.

46. Which treatment provides the best chance of survival for a child with cirrhosis? a. Liver transplantation b. Treatment with corticosteroids c. Treatment with immune globulin d. Provision of nutritional support

ANS: A The only successful treatment for end-stage liver disease and liver failure may be liver transplantation, which has improved the prognosis for many children with cirrhosis.

4. The nurse is performing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as a(n) a. normal finding—nurse should document finding in chart. b. questionable finding—infant should be rechecked in 1 month. c. abnormal finding—indicates need for immediate referral to practitioner. d. abnormal finding—indicates need for developmental assessment.

ANS: A This is a normal finding. The anterior fontanel closes between ages 12 and 18 months. The posterior fontanel closes between 2 and 3 months of age. There is no need for a recheck, a referral, or a developmental assessment.

3. Traditional ethnocultural beliefs related to the maintenance of health are likely to include which of the following? (Select all that apply.) a. Avoidance of natural events such as a solar eclipse b. Practicing silence, meditation, and prayer c. Protection of the soul by avoiding envy or jealousy d. Understanding that a hex, spell, or the evil eye may cause illness or injury e. Turning to Western medicine first before trying traditional practices

ANS: A, B, C, D Traditional ethnocultural beliefs related to health care can include avoiding some natural events; practicing silence, meditation, and prayer; protecting oneself against envy or jealousy on the part of others; and avoiding hexes, spells, and the evil eye. Usually people with these beliefs turn to their traditional practices prior to seeking Western medical care.

17. Assessment of a child with a submersion injury focuses on which system? a. Cardiovascular b. Respiratory c. Neurologic d. Gastrointestinal

ANS: B Assessment of the child with a submersion injury focuses on the respiratory system. The airway and breathing are the priorities. The other systems are of less priority than the respiratory system.

8. The step of the nursing process in which the nurse determines the appropriate interventions for the identified nursing diagnosis is called a. assessment. b. planning. c. intervention. d. evaluation.

ANS: B The third step in the nursing process involves planning care for problems that were identified during assessment. The first step of the nursing process is assessment, during which data are collected. The intervention phase is when the plan of care is carried out. The evaluation phase is determining whether the goals have been met.

5. The nurse is assessing a toddler's growth and development. Which statement does the nurse understand about language development in a toddler? a. Language development skills slow during the toddler period. b. The toddler understands more than he or she can express. c. Most of the toddler's speech is not easily understood. d. The toddler's vocabulary contains approximately 600 words.

ANS: B The toddler's ability to understand language (receptive language) exceeds the child's ability to speak it (expressive la nguage). Although language development varies in relationship to physical activity, language skills are rapidly accelerating by 15 to 24 months of age. By 2 years of age, 60% to 70% of the toddler's speech is understandable. The toddler's vocabulary contains approximately 300 or more words.

8. What is the most appropriate response for the nurse to make to the parent of a 3-year-old child found in a bed with the side rails down? a. "You must never leave the child in the room alone with the side rails down." b. "I am very concerned about your child's safety when you leave the side rails down." c. "It is hospital policy that side rails need to be up if the child is in bed." d. "When parents leave side rails down, they might be considered as uncaring."

ANS: B To express concern and then choose words that convey a policy without appearing to cast blame on improper behavior is appropriate. Framing the communication in the negative does not facilitate effective communication. Stating a policy to parents conveys the attitude that the hospital has authority over parents in matters concerning their children and may be perceived negatively. It also does not give information as to why the side rails need to be up. This statement conveys blame and judgment to the parent.

6. A nurse is planning for a sports pre-participation physical exam day. What goals for this event does the nurse set? (Select all that apply.) a. Comprehensive physical examination b. Assess general health c. Identify limiting conditions d. Provide wellness counseling e. Adhere to insurance requirements

ANS: B, C, D, E In a pre-participation sports examination, goals are to identify the teen's general health, identify any condition that would limit participation, provide wellness counseling, and ensure that participants meet insurance guidelines for participation. It is not meant to be a comprehensive physical examination.

4. A nurse is teaching a parenting group about behavior modification. What information does this nurse include in teaching? (Select all that apply.) a. Food rewards are highly motivating and as such are encouraged. b. Negative behavior from the child should be ignored by parents. c. Undesirable behavior may initially get worse if it is ignored. d. 1 minute per age is the suggested time limit for discipline. e. For younger kids, a behavior chart is a good visual cue.

ANS: B, C, E In behavior modification parents ignore "bad" behavior by the child, which initially may get worse as the child tries to recapture the attention it once brought. Younger children respond positively to charts with stickers that show good behavior. Food rewards should not be used as food is an essential necessity plus extra food may contribute to obesity. The time limit refers to the time-out method of discipline.

14. A traditional family structure in which married male and female partners and their children live as an independent unit is known as a(n) _____ family. a. extended b. binuclear c. nuclear d. blended

ANS: C A nuclear family is one in which two opposite-sex parents and their children live together. This is also known as a traditional family. Extended or multigenerational families include other blood relatives in addition to the parents. Binuclear is not a listed family type according to U.S. Census Bureau data but would include two nuclear families living together. A blended family is reconstructed after divorce and involves the merger of two families.

15. Which action by the nurse is appropriate when preparing a child for a procedure? a. Discourage the child from crying during the procedure. b. Use professional terms so the child will understand what is happening. c. Give the child choices whenever possible. d. Discourage the parents from staying in the room during the procedure.

ANS: C Allowing children to make choices gives them a sense of control. Children (and adults) should be given permission to cry. Age-appropriate language should always be used. Parents should be encouraged to stay in the room and give support to the child.

2. Family-centered maternity care developed in response to a. demands by physicians for family involvement in childbirth. b. the Sheppard-Towner Act of 1921. c. parental requests that infants be allowed to remain with them rather than in a nursery. d. changes in pharmacologic management of labor.

ANS: C As research began to identify the benefits of early extended parent-infant contact, parents began to insist that the infant remain with them. This gradually developed into the practice of rooming-in and finally to family-centered maternity care. Family-centered care was a request by parents, not physicians. The Sheppard-Towner Act of 1921 provided funds for state-managed programs for mothers and children. The changes in pharmacologic management of labor were not a factor in family-centered maternity care.

6. What clinical manifestation should a nurse be alert for when suspecting a diagnosis of esophageal atresia? a. A radiograph in the prenatal period indicates abnormal development. b. It is visually identified at the time of delivery. c. A nasogastric tube fails to pass at birth. d. The infant has a low birth weight.

ANS: C Atresia is suspected when a nasogastric tube fails to pass 10 to 11 cm beyond the gum line. Abdominal radiographs will confirm the diagnosis. Prenatal radiographs do not provide a definitive diagnosis. The defect is not externally visible. Bronchoscopy and endoscopy can be used to identify this defect. Infants with esophageal atresia may have been born prematurely and with a low birth weight, but neither is suggestive of the presence of an esophageal atresia.

8. Which action is appropriate when the nurse is assessing breath sounds of an 18-month-old crying child? a. Ask the parent to quiet the child so the nurse can listen. b. Auscultate breath sounds and chart that the child was crying. c. Let the child play with the stethoscope for distraction. d. Document that data are not available because of crying.

ANS: C Distracting the child with an interesting activity can assist the child to calm down so an accurate assessment can be made. Asking a parent to quiet the child may or may not work. Auscultating while the child is crying typically results in less than optimal data. The assessment needs to be completed so documenting that data are not available is not appropriate.

14. Teaching safety precautions with the administration of antihistamines is important because of what common side effect? a. Dry mouth b. Excitability c. Drowsiness d. Dry mucous membranes

ANS: C Drowsiness is a safety hazard when alertness is needed, especially with a teenage driver. Nonsedating brands should be used if possible. None of the other three problems is a safety issue.

35. A small child with cystic fibrosis cannot swallow pancreatic enzyme capsules. The nurse should teach parents to mix enzymes with which food? a. Macaroni and cheese b. Tapioca c. Applesauce d. Hot chocolate

ANS: C Enzymes can be mixed with a small amount of nonacidic foods. Macaroni and cheese and hot chocolate are not good choices because enzymes are inactivated by heat and starchy foods. Tapioca is also a starchy food.

33. Which parasite causes acute diarrhea? a. Shigella organisms b. Salmonella organisms c. Giardia lamblia d. Escherichia coli

ANS: C Giardiasis a parasite that represents 15% of nondysenteric illness in the United States. The other organisms are bacterial.

14. Which condition is characterized by a history of bloody diarrhea, fever, abdominal pain, and low hemoglobin and platelet counts? a. Acute viral gastroenteritis b. Acute glomerulonephritis c. Hemolytic-uremic syndrome d. Acute nephrotic syndrome

ANS: C Hemolytic-uremic syndrome is an acute disorder characterized by anemia, thrombocytopenia, and acute renal failure. Most affected children have a history of gastrointestinal symptoms, including bloody diarrhea. Anemia and thrombocytopenia are not associated with acute gastroenteritis. The symptoms described are not suggestive of acute glomerulonephritis. The symptoms described are not suggestive of nephrotic syndrome.

5. The nurse is counseling the family of a 12-month-old child who has lost his mother in a car accident. How should you explain to the father what the child's understanding of death is, related to theories of growth and development? a. Temporary b. Permanent c. Loss of caretaker d. Punishment

ANS: C Infants and toddlers view death as loss of a caretaker. The preschool-age child views death as temporary. The school-age child and adolescent understand the permanence of death. The preschool-age child facing impending death may view his or her condition as punishment for behaviors or thoughts.

8. The fastest growing group of homeless people is a. men and women preparing for retirement. b. migrant workers. c. single women and their children. d. intravenous (IV) substance abusers.

ANS: C Pregnancy and birth, especially for a teenager, are important contributing factors for becoming homeless. People preparing for retirement, migrant workers, and IV substance abusers are not among the fastest growing groups of homeless people.

22. Which description of a stool is characteristic of intussusception? a. Ribbon-like stools b. Hard stools positive for guaiac c. "Currant jelly" stools d. Loose, foul-smelling stools

ANS: C The characteristic stool of intussusception is described as "currant jelly." Ribbon-like stools are characteristic of Hi rschsprung disease. With intussusception, passage of bloody mucous stools occurs. Stools will not be hard. Loose, foul-smelling stools may indicate infectious gastroenteritis.

24. A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. What should the nurse explain to the parents? a. This will help the child cope effectively by denial. b. This attitude is helpful to give parents time to cope. c. Terminally ill children know when they are seriously ill. d. Terminally ill children usually choose not to discuss their illness.

ANS: C The child needs honest and accurate information about the illnesses, treatments, and prognosis. Children, even at a young age, realize that something is seriously wrong and that it involves them. The nurse should help parents understand the importance of honesty. The child will know that something is wrong because of the increased attention of health professionals. The focus should be on the child's needs, not the parents'. Children will usually tell others how much information they want about their condition.

22. A registered nurse is watching a student nurse give an IM injection to a 1-year-old. The student identifies the following site for the injection. What action by the registered nurse is best? a. Remind the student to don gloves. b. Hand the student an alcohol wipe. c. Ask the student to find another site. d. Assess for the correct needle length.

ANS: C The deltoid muscle (pictured) should not be used on children under 2 years of age. The other actions would be appropriate if the student did not have to find another injection site.

42. A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. What is the purpose of these drugs? a. Prevent reflux b. Prevent hematemesis c. Reduce gastric acid production d. Increase gastric acid production

ANS: C The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and to prevent esophagitis.

10. A 13-year-old adolescent is suspected to have a visual deficit and is scheduled for further evaluation. The teen asks the nurse to tell "the truth" about the tests. What is the nurse's best response? a. "Don't worry about anything. We're here to take good care of you." b. "Ask your parents. They have talked with the physicians." c. "Most of the vision tests are painless and noninvasive." d. "Trust the doctors. They know what is best for you."

ANS: C The nurse should be knowledgeable and honest in answering questions about procedures. The nurse should not belittle the teen's concerns by giving false reassurance, having the teen ask the parents for information, or telling the teen to trust the doctors.

2. What should the nurse identify as major fears in the preschool child who is hospitalized with a chronic illness? (Select all that apply.) a. Altered body image b. Separation from peer group c. Bodily injury d. Mutilation e. Being left alone

ANS: C, D, E Body injury, mutilation, and being left alone are major fears of the preschooler. Altered body image and separation from peer group are fears of the adolescent.

20. What should the nurse advise the mother of a 4-year-old child to bring with her child to the outpatient surgery center on the day of surgery? a. Snacks b. Fruit juice boxes c. All of the child's medications d. One of the child's favorite toys

ANS: D A familiar toy can be effective in decreasing a child's stress in an unfamiliar environment. The child will be NPO before surgery; therefore including snacks for the child is contraindicated. The child will be NPO before surgery. Unnecessary stress will result when the child is denied the juice. It is not necessary to bring all medications on the day of surgery. The medication the child has been receiving should have been noted during the preoperative workup. The parent should be knowledgeable of which medications the child has been taking if further information is necessary.

48. Which type of hernia has an impaired blood supply to the herniated organ? a. Hiatal hernia b. Incarcerated hernia c. Omphalocele d. Strangulated hernia

ANS: D A strangulated hernia is one in which the blood supply to the herniated organ is impaired. A hiatal hernia is the intrusion of an abdominal structure, usually the stomach, through the esophageal hiatus. An incarcerated hernia is a hernia that cannot be reduced easily. Omphalocele is the protrusion of intraabdominal viscera into the base of the umbilical cord. The sac is covered with peritoneum and not skin.

39. A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. Which statement by the parent indicates a correct understanding of the teaching? a. "I will keep my child on a clear liquid diet for the next 24 hours." b. "I should encourage my child to drink carbonated drinks but avoid food for the next 24 hours." c. "I will offer my child bananas, rice, applesauce, and toast for the next 48 hours." d. "I should have my child eat a normal diet with easily digested foods for the next 48 hours."

ANS: D Easily digested foods such as cereals, cooked vegetables, and meats should be provided for the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness. Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. The BRAT diet (bananas, rice, applesauce, and toast) is no longer recommended.

24. The most common cause of acute kidney injury in children is a. pyelonephritis. b. tubular destruction. c. urinary tract obstruction. d. severe dehydration.

ANS: D The most common cause of acute kidney injury in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. This is a prerenal cause. Pyelonephritis, tubular destruction, and urinary tract obstruction are not common causes of acute kidney injury in children.

1. What is the 24-hour maintenance fluid requirement for a child weighing 18.7 pounds?

ANS: 850 mL Calculate weight in kilograms: 18.7 pounds = 8.5 kg. The formula for calculating daily fluid requirements is 0 to 10 kg: 100 mL/kg/day; 10 to 20 kg: 1000 mL for the first 10 kg of body weight plus 50 mL/kg/day for each kilogram between 10 and 20. To determine an hourly rate, divide the total milliliters per day by 24: 8.5 kg × 100 mL = 850 mL/24 hr.

15. A pictorial tool that can assist the nurse in assessing aspects of family life related to health care is the a. genogram. b. ecomap. c. life cycle model. d. human development wheel.

ANS: A A genogram (also known as a pedigree) is a diagram that depicts the relationships and health issues of family members over generations, usually three. An ecomap is a pictorial representation of the family structures and their relationships with the external environment. The life cycle model in no way illustrates a family genogram. This model focuses on stages that a person reaches throughout his or her life. The human development wheel describes various stages of growth and development rather than a family's relationships to each other.

27. Which classification of drugs is used to relieve an acute asthma episode? a. Short-acting beta2-adrenergic agonist b. Inhaled corticosteroids c. Leukotriene blockers d. Long-acting bronchodilators

ANS: A A short-acting beta2-adrenergic agonist is the first medication administered. Later, systemic corticosteroids decrease airway inflammation in an acute asthma attack. They are given for short courses of 5 to 7 days. Inhaled corticosteroids are used for long-term, routine control of asthma. Leukotriene blockers diminish the mediator action of leukotrienes and are used for long-term, routine control of asthma in children older than 12 years. A long-acting bronchodilator would not relieve acute symptoms.

5. What is the most common mode of transmission of human immunodeficiency virus (HIV) in the pediatric population? a. Perinatal transmission b. Sexual abuse c. Blood transfusions d. Poor handwashing

ANS: A Perinatal transmission accounts for the highest percentage (91%) of HIV infections in children. Infected women can transmit the virus to their infants across the placenta during pregnancy, at delivery, and through breastfeeding. Cases of HIV infection from sexual abuse have been reported; however, perinatal transmission accounts for most pediatric HIV infections. Although in the past some children became infected with HIV through blood transfusions, improved laboratory screening has significantly reduced the probability of contracting HIV from blood products. Poor hand washing is not an etiology of HIV infection.

8. The nurse is assessing a preschool aged child during a well-child checkup. This child has gained 2 pounds in 1 year. What action by the nurse is best? a. Ask the parent to provide a 3-day diet diary. b. Assess the child's teeth and gums. c. Plot the weight gain on the growth chart. d. Instruct the parent on today's needed vaccinations.

ANS: A Preschool children gain an average of 5 pounds a year. A gain of only 2 pounds is less than half of the expected weight gain and should be investigated. The other actions are part of a well-child checkup but are not related to the lack of weight gain.

8. The nurse administering an IV piggyback medication to a preschool child should a. use a "Smart" pump if available. b. flush the IV tubing before and after the infusion with normal saline solution. c. inject the medication into the IV catheter using the port closest to the child. d. inject the medication into the IV tubing in the direction away from the child.

ANS: A Programmable infusion pumps are frequently used to facilitate safe intermittent infusion of IV medications for children via the piggyback method. Some pumps have preprogrammed drug libraries to assist in the prevention of medication errors. Administering medications via this route does not require flushing unless the medication is incompatible with the maintenance fluid. The nurse is using the IV push method when injecting medication into the IV tubing using the port closest to the child. The medication is not injected away from the child.

9. What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux? a. The importance of taking prophylactic antibiotics if prescribed b. Suggestions for how to maintain fluid restrictions c. The use of bubble baths as an incentive to increase bath time d. The need for the child to hold urine for 6 to 8 hours

ANS: A Prophylactic antibiotics are sometimes used to prevent urinary infection in a child with vesicoureteral reflux, especially if they are waiting for the results of imaging studies or have recurrent UTIs. If prescribed, the parents should be taught that the child must finish the entire course of antibiotics to prevent bacterial resistance. Fluids are not restricted when a child has vesicoureteral reflux. In fact, fluid intake should be increased as a measure to prevent UTIs. Bubble baths should be avoided to prevent urethral irritation and possible UTI. To prevent UTIs, the child should be taught to void frequently and never resist the urge to urinate.

2. Which toy is the most developmentally appropriate for an 18- to 24-month-old child? a. A push-and-pull toy b. Nesting blocks c. A bicycle with training wheels d. A computer

ANS: A Push-and-pull toys encourage large muscle activity and are appropriate for toddlers. Nesting blocks are more appropriate for a 12- to 15-month-old child. This child is too young for bicycles or computers.

32. Which order should the nurse question when caring for a 5-year-old child after surgery for Hirschsprung disease? a. Monitor rectal temperature every 4 hours. b. Assess stools after surgery. c. Keep the child NPO until bowel sounds return. d. Maintain IV fluids at ordered rate.

ANS: A Rectal temperatures should not be taken after this surgery. Rectal temperatures are generally not the route of choice for children because of the route's traumatic nature. The other interventions are all appropriate after this operation.

18. The nurse palpated the anterior fontanel of a 14-month-old infant and found that it was closed. What does this finding indicate? a. This is a normal finding. b. This finding indicates premature closure of cranial sutures. c. This is abnormal, and the child should have a developmental evaluation. d. This is an abnormal finding, and the child should have a neurologic evaluation.

ANS: A The anterior fontanel should be completely closed by 12 to 18 months of age. It does not mean premature closure or indicate a need for developmental or neurologic evaluations.

1. A nurse in a well-child clinic is teaching parents about their child's immune system. Which statement by the nurse is correct? a. The immune system distinguishes and actively protects the body's own cells from foreign substances. b. The immune system is fully developed by 1 year of age. c. The immune system protects the child against communicable diseases in the first 6 years of life. d. The immune system responds to an offending agent by producing antigens.

ANS: A The immune system responds to foreign substances, or antigens, by producing antibodies and storing information. Intact skin, mucous membranes, and processes such as coughing, sneezing, and tearing help maintain internal homeostasis. Children up to age 6 or 7 years have limited antibodies against common bacteria. The immunoglobulins reach adult levels at different ages. Immunization is the basis from which the immune system activates protection against some communicable diseases. Antibodies are produced by the immune system against invading agents, or antigens.

21. A baby is scheduled for abdominal surgery for hypertrophic pyloric stenosis and has an NG tube to intermittent suction. When the family asks why the child has the tube, what response by the nurse is best? a. "The nasogastric tube decompresses the abdomen and decreases vomiting." b. "We can keep a more accurate measure of intake and output with the tube." c. "The tube is used to decrease postoperative diarrhea." d. "The nasogastric tube makes the baby more comfortable after surgery."

ANS: A The nasogastric tube provides decompression and decreases vomiting. A nursing responsibility when a patient has a nasogastric tube is measurement of accurate intake and output, but this is not why nasogastric tubes are inserted. Nasogastric tube placement does not decrease diarrhea. The presence of a nasogastric tube can be perceived as a discomfort by the patient.

17. A child is receiving intravenous fluids. How frequently should the nurse assess and document the condition of the child's intravenous site? a. Every hour b. Every 2 hours c. Every 4 hours d. Every shift

ANS: A The nurse assesses and documents an IV site at least every hour for signs and symptoms of infiltration and phlebitis.

24. What explanation should the nurse give to the parent of a child with asthma about using a peak flow meter? a. It is used to monitor the child's breathing capacity. b. It measures the child's lung volume. c. It will help the medication reach the child's airways. d. It measures the amount of air the child breathes in.

ANS: A The peak flow meter is a device used to monitor breathing capacity in the child with asthma. A child with asthma would have a pulmonary function test to measure lung volume. A spacer used with a metered-dose inhaler prolongs medication transit so medication reaches the airways. The peak flow meter measures the flow of air in a forced exhalation in liters per minute.

19. A nurse is working in an allergy clinic and has performed skin testing on an adolescent. Seventeen minutes after the procedure, the nurse note the presence of a wheal at one of the sites. What conclusion does the nurse make about this response? a. The child is allergic to that substance. b. This result is indeterminate. c. The testing should be redone in another location. d. Anaphylaxis is imminent.

ANS: A The presence of a wheal within 30 minutes of skin testing is indicative of an allergy to the substance used. The test does not need to be repeated, and anaphylaxis is not imminent.

25. The primary clinical manifestations of acute kidney injury are which of the following? a. Oliguria and hypertension b. Hematuria and pallor c. Proteinuria and muscle cramps d. Bacteriuria and facial edema

ANS: A The principal feature of acute kidney injury is oliguria, and many children are hypertensive. Hematuria, pallor, proteinuria, cramps, bacteriuria, and edema are not principal features.

28. The nurse has a 2-year-old boy sit in a "tailor" position during palpation for the testes. What is the rationale for this position? a. It prevents cremasteric reflex. b. Undescended testes can be palpated. c. This tests the child for an inguinal hernia. d. The child does not yet have a need for privacy.

ANS: A The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity.

23. A 2-year-old child is in the playroom. The nurse observes him picking up a small toy and putting it in his mouth. The child begins to choke. He is unable to speak. Which intervention is appropriate? a. Heimlich maneuver b. Abdominal thrusts c. Five back blows d. Five chest thrusts

ANS: A To clear a foreign body from the airway, the American Heart Association recommends the Heimlich maneuver for a conscious child older than 1 year of age. Abdominal thrusts are indicated when the child is unconscious. Back blows are indicated for an infant with an obstructed airway. Chest thrusts follow back blows for the infant with an obstructed airway.

13. What is appropriate to include in the teaching plan for a family of a child with a tracheostomy? a. Suction the tracheostomy as needed. b. Apply powder around the stoma to decrease irritation. c. Limit suctioning time to 30 seconds. d. Provide showers and discourage baths.

ANS: A To maintain a patent airway in a child with a tracheostomy, assessing respiratory status and suctioning as needed using Standard Precautions is an important intervention to teach families. Talc powder should be avoided because of the risk of inhalation injury from breathing the powder particles. Catheter insertion for suctioning should be less than 5 seconds to prevent hypoxia. The family should be taught to avoid getting water in the tracheostomy during bath time. Showers should be discouraged.

12. The correct position for the postoperative child who has had a cataract removed from the right eye is the ________ position. a. supine b. prone c. knee-chest d. right lateral Sims

ANS: A To prevent edema and pressure on the operative site, the nurse should elevate the head of the bed slightly and avoid placing the child in a dependent position. The prone position is a dependent position, which is contraindicated after cataract surgery. The knee-chest position is contraindicated after cataract surgery. The right lateral Sims position increases pressure on the operative site.

1. Which demonstrates the school-age child's developing logic in the stage of concrete operations? (Select all that apply.) a. Recognizes that 1 lb of feathers is equal to 1 lb of metal b. Recognizes that he can be a son, brother, or nephew at the same time c. Understands the principles of adding, subtracting, and reversibility d. Has thinking that is characterized by egocentrism, animism, and centration e. Often solves problems with random guessing instead of logic

ANS: A, B, C The school-age child understands that the properties of objects do not change when their order, form, or appearance does. Conservation occurs in the concrete operations stage. Comprehension of class inclusion occurs as the school-age child's logic increases. The child begins to understand that a person can be in more than one class at the same time. This is characteristic of concrete thinking and logical reasoning. The school-age child is able to understand principles of adding and subtracting, as well as the process of reversibility, which occurs in the stage of concrete operations. Egocentrism, animism, and centration occur in the intuitive thought stage, as does random guessing.

2. What may cause hypovolemic shock in children? (Select all that apply.) a. Hyperthermia b. Burns c. Vomiting or diarrhea d. Hemorrhage e. Skin abscesses

ANS: A, B, C, D Hypovolemic shock is due to decreased circulating volume and can be caused by fluid loss due to hyperthermia, burns, vomiting or diarrhea, and hemorrhage. An abscess will not cause hypovolemia.

2. The nurse understands that risk factors for hearing loss include (Select all that apply.) a. structural abnormalities of the ear. b. family history of hearing loss. c. alcohol or drug use by the mother during pregnancy. d. gestational diabetes. e. trauma.

ANS: A, B, E Structural abnormalities of the ear, a family history of hearing loss, and trauma are risk factors for hearing loss. Other risk factors include persistent otitis media and developmental delay. The American Academy of Pediatrics suggests that infants who demonstrate hearing loss be eligible for early intervention and specialized hearing and language services. Prenatal alcohol or drug intake and gestational diabetes are not risk factors for hearing loss in the infant.

2. The nurse is caring for a child from a Middle Eastern family. Which interventions should the nurse include in planning care? (Select all that apply.) a. Include the father in the decision making. b. Ask for a dietary consult to maintain religious dietary practices. c. Plan for a male nurse to care for a female patient. d. Ask the housekeeping staff to interpret if needed. e. Allow time for prayer.

ANS: A, B, E The man is typically the head of the household in Muslim families. So the father should be included in all decision making. Muslims do not eat pork and do not use alcohol. Many are vegetarians. The dietitian should be consulted for dietary preferences. Compulsory prayer is practiced several times throughout the day. The family should not be interrupted during prayer, and treatments should not be scheduled during this time. Muslim women often prefer a female health care provider because of laws of modesty; therefore, the female patient should not be assigned a male nurse. A housekeeping staff member should not be asked to interpret. When interpreters are used, they should be of the same country and religion, if possible, because of regional differences and hostilities.

5. The nurse cares for many children with different types of hepatitis. What information about this disease is correct? (Select all that apply.) a. Hepatitis A can be contracted from contaminated water. b. Only a small percentage of children infected with hepatitis B fully recover. c. People infected with chronic hepatitis C are usually asymptomatic. d. Hepatitis D is the most likely to cause a fulminating illness. e. Hepatitis E is the most common type in children in the United States.

ANS: A, C, D Hepatitis A can be contracted from contaminated food or water. Hepatitis C infections usually are asymptomatic. Hepatitis D is the strain most likely to cause a fulminating illness. Most children with hepatitis B recover fully. Hepatitis E is rate in the United States.

3. A nurse is administering an opioid medication to a child. Which side effects should the nurse watch for with this classification of medication? (Select all that apply.) a. Respiratory depression b. Hepatic damage c. Constipation d. Pruritus e. Gastrointestinal bleeding

ANS: A, C, D The nurse should remember opioids can produce sedation and respiratory depression in addition to analgesia. Other adverse effects can include constipation, pruritus, nausea, vomiting, cough suppression, and urinary retention. Acetaminophen is associated with hepatic damage, and NSAIDs are associated with gastrointestinal bleeding.

1. Which should a nurse identify as common chronic illnesses of childhood? (Select all that apply.) a. Reactive airway disease (asthma) b. Respiratory syncytial virus (RSV) c. Cerebral palsy d. Diabetes mellitus e. Human immunodeficiency virus infection (HIV)

ANS: A, C, D, E A chronic illness is defined as a condition that is long term, does not spontaneously resolve, is usually without a complete cure, and affects activities of daily living. Reactive airway disease (asthma), cerebral palsy, diabetes mellitus, and HIV are all chronic illnesses that may occur during childhood. RSV is a virus that is highly contagious and causes bronchiolitis and pneumonia in children. It does not cause chronic illness.

1. A nurse has completed a teaching session for parents about "baby-proofing" the home. Which statements made by the parents indicate an understanding of the teaching? (Select all that apply.) a. "We will put plastic fillers in all electrical plugs." b. "We will place poisonous substances in a high cupboard." c. "We will place a gate at the top and bottom of stairways." d. "We will keep our household hot water heater at 130 degrees." e. "We will remove front knobs from the stove."

ANS: A, C, E By the time babies reach 6 months of age, they begin to become much more active, curious, and mobile. Putting plastic fillers on all electrical plugs can prevent an electrical shock. Putting gates at the top and bottom of stairways will prevent falls. Removing front knobs from the stove can prevent burns. Poisonous substances should be stored in a locked cabinet not in a cabinet that children can reach when they begin to climb. The household hot water heater should be turned down to 120 degrees or less.

3. Which interventions should a nurse implement when caring for a child with hepatitis? (Select all that apply.) a. Provide a well-balanced low-fat diet. b. Schedule playtime in the playroom with other children. c. Teach parents not to administer any over-the-counter medications. d. Arrange for home schooling because the child will not be able to return to school. e. Instruct parents on the importance of good handwashing.

ANS: A, C, E The child with hepatitis should be placed on a well-balanced low-fat diet. Parents should be taught to not give over-the-counter medications because of impaired liver function. Hand hygiene is the most important preventive measure for the spread of hepatitis. The child will be in contact isolation in the hospital so playtime with other hospitalized children is not scheduled. The child will be on contact isolation for a minimum of 1 week after the onset of jaundice. After that period, the child will be allowed to return to school.

4. A preschool-age child is being admitted for some diagnostic tests and possible surgery. The nurse planning care should use which phrases when explaining procedures to the child? (Select all that apply.) a. Fluids will be given through tubing connected to a tiny tube inserted into your arm. b. After surgery we will be doing dressing changes. c. You will get a shot before surgery. d. The doctor will give you medicine that will help you go into a deep sleep. e. We will take you to surgery on a bed on wheels.

ANS: A, D, E A preschool child needs simple concrete explanations that cannot be misinterpreted. An IV should be explained as fluids going into a tube connected to a small tube in your hand; anesthesia can be explained as a medicine that will help you go into a deep sleep (put to sleep should be avoided); and a stretcher can be described as riding on a bed with wheels. The term "dressing changes" is ambiguous and will not be understood by a preschooler. The term "get a shot" should not be used. A preschooler or young child is likely to misinterpret this information.

27. What is an expected outcome for a 1-month-old infant with biliary atresia? a. Correction of the defect with the Kasai procedure b. Adequate nutrition and age-appropriate growth and development c. Adherence to a salt-free diet with vitamin B12 supplementation d. Remaining compliant with a high-protein diet

ANS: B Adequate nutrition, preventing skin breakdown, adequate growth and development, and family education and support are expected outcomes in an infant with biliary atresia. The goal of the Kasai procedure is to allow for adequate growth until a transplant can be done. It is not a curative procedure. Vitamin B12 supplementation is not indicated. A salt-restricted diet is appropriate. Protein intake may need to be restricted to avoid hepatic encephalopathy.

18. Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by which response? a. Denial b. Anger c. Social reintegration d. Acceptance of child's limitations

ANS: B After the initial shock has worn off, families often respond to a chronic illness diagnosis with anger. Social reintegration and acceptance may or may not ever occur but if they do it is the culmination of the grief process.

19. Which observations made by an emergency department nurse raises the suspicion that a 3-year-old child has been maltreated? a. The parents are extremely calm in the emergency department. b. The injury is unusual for a child of that age. c. The child does not remember how he got hurt. d. The child was doing something unsafe when the injury occurred.

ANS: B An injury that is rarely found in children or is inconsistent with the age and condition of the child should raise suspicion of child maltreatment. The nurse should observe the parents' reaction to the child but must keep in mind that people behave very differently depending on culture, ethnicity, experience, and psychological makeup. The child may not remember what happened as a result of the injury itself, for example, sustaining a concussion. Also, a 3-year-old child may not be a reliable historian. The fact that the child was not supervised might be an area for health teaching. The nurse needs to gather more information to determine whether the parents have been negligent in the care of their child.

8. On the second postoperative day of an eye surgery, the child has puffy eyes, increased tearing, and fever. What is the most applicable nursing diagnosis? a. Risk for Infection related to surgical procedure b. Infection related to surgical procedure c. Disturbed Sensory Perception (Visual) related to surgical procedure d. Acute Pain related to recent surgical intervention

ANS: B Any surgical procedure leaves the patient vulnerable to infection and with a nursing diagnosis of Risk for Infection. However, this child is manifesting signs of infection, which changes the diagnosis to an actual, not risk for, diagnosis. There is no data to support disturbed sensory perception or acute pain.

14. Which action by the nurse indicates that the correct procedure has been used to measure vital signs in a toddler? a. Measuring oral temperature for 5 minutes b. Counting apical heart rate for 60 seconds c. Observing chest movement for respiratory rate d. Recording blood pressure as P/80

ANS: B Apical pulse measurement when the child is quiet for 1 full minute is the preferred method for measuring vital signs in infants and children ages 2 years and younger. A child younger than 6 years may not be able to hold a thermometer under the tongue. The respiratory rate should be auscultated on the quiet infant or young child for 1 full minute. The nurse should be able to auscultate the blood pressure of a toddler, so this would not be the correct way to document it.

2. Which STD should the nurse suspect when an adolescent girl comes to the clinic because she has a vaginal discharge that is white with a fishy smell? a. Human papillomavirus b. Bacterial vaginosis c. Trichomonas d. Chlamydia

ANS: B Bacterial vaginosis is characterized by a profuse, white, malodorous (fishy smelling) vaginal discharge that sticks to the vaginal walls. Manifestations of the human papillomavirus are anogenital warts that begin as small papules and grow into clustered lesions. Infections with Trichomonas are frequently asymptomatic. Symptoms in females may include dysuria, vaginal itching, burning, and a frothy, yellowish-green, foul-smelling discharge. Many people with chlamydial infection have few or no symptoms. Urethritis with dysuria, urinary frequency, or mucopurulent discharge may indicate chlamydial infection.

28. A nurse is providing anticipatory guidance to parents of a 2 1/2-year-old. What instruction is best to help the child's language development? a. Have the child's hearing tested at 3 years. b. Use clear speech and avoid baby talk. c. Speak with different voice inflections. d. Insist the child listen when you are talking.

ANS: B Between the ages of 2 and 4 the parents need to speak clearly with good grammar and avoid baby talk to encourage language development. Testing the child's hearing does not promote language. Speaking with different voice inflections is appropriate for children up to 2 years of age. Insisting the child listen when you are speaking is a good technique for children aged 4 to 6.

49. An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) and gastrostomy feedings. Nursing care should include a. preparing family for impending death. b. teaching family signs of central venous catheter infection. c. teaching family how to calculate caloric needs. d. securing TPN and gastrostomy tubing under the diaper to lessen risk of dislodgment.

ANS: B During TPN therapy, care must be taken to minimize the risk of complications related to the central venous access device, such as catheter infections, occlusions, or accidental removal. This is an important part of family teaching. The prognosis for patients with short bowel syndrome depends in part on the length of residual small intestine. It has improved with advances in TPN. Although parents need to be taught about nutritional needs, the caloric needs and prescribed TPN and rate are the responsibility of the health care team. The tubes should not be placed under the diaper due to risk of infection.

1. Which situation poses the greatest challenge to the nurse working with a child and family? a. Twenty-four-hour observation b. Emergency hospitalization c. Outpatient admission d. Rehabilitation admission

ANS: B Emergency hospitalization involves (1) limited time for preparation both for the child and family, (2) situations that cause fear for the family that the child may die or be permanently disabled, and (3) a high level of activity, which can foster further anxiety. Although preparation time may be limited with a 24-hour observation, this situation does not usually involve the acuteness of the situation and the high levels of anxiety associated with emergency admission. Outpatient admission generally involves preparation time for the family and child. Because of the lower level of acuteness in these settings, anxiety levels are not as high. Rehabilitation admission follows a serious illness or disease. This type of unit may resemble a home environment, which decreases the child's and family's anxiety.

16. Which type of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)

ANS: B Epiglottitis is always a medical emergency that requires antibiotics and airway support for treatment. The other illnesses are not medical emergencies although LTB can progress to emergent status in some children.

1. Which information should the nurse include when preparing a 5-year-old child for a cardiac catheterization? a. A detailed explanation of the procedure b. A description of what the child will feel and see during procedure c. An explanation about the dye that will go directly into his vein d. An assurance to the child that he and the nurse can talk about the procedure when it is over

ANS: B For a preschooler, the provision of sensory information about what to expect during the procedure will enhance the child's ability to cope with the events of the procedure and will decrease anxiety. Explaining the procedure in detail is probably more than the 5-year-old child can comprehend, and it will likely produce anxiety. Using the word "dye" with a preschooler can be frightening for the child. The child needs information before the procedure.

26. A school-aged child develops heat exhaustion at a soccer game. What action by the nurse in attendance is best? a. Call 911 immediately. b. Move the child to a cooler environment. c. Provide oxygen by face mask. d. Prepare to begin CPR.

ANS: B For simple heat exhaustion, treatment consists of moving the child to a cooler environment, apply cool, moist cloths to the skin; remove clothing or change to dry clothing; elevate legs; offer oral rehydration fluids if no altered mental status or vomiting. There is no need to call 911, provide oxygen, or prepare to begin CPR at this point.

19. What nursing action is indicated when a child receiving a unit of packed red blood cells complains of chills, headache, and nausea? a. Continue the infusion, and take the child's vital signs. b. Stop the infusion immediately, and notify the provider. c. Slow the infusion, and assess for cessation of symptoms. d. Start a dextrose solution, and stay with the child.

ANS: B If a reaction is suspected, as in this case, the transfusion is stopped immediately, and the provider is notified. The transfusion cannot continue. Dextrose solutions are never infused with blood products because the dextrose causes hemolysis, but more important, the infusion must be stopped.

7. When using the poker chip tool, it is important for the nurse to know that a. any number of chips can be used. b. only a specified number of chips can be used. c. the assessment tool is used with adolescents. d. the assessment tool is most effectively used with 2-year-old children.

ANS: B In the poker chip tool, four chips are used to represent a hurt. One chip represents a little hurt, and four chips represent the most hurt the child could have. Pain tools are valid only if used as directed. The poker chip tool uses four chips. Adolescents are able to think abstractly. They can describe, quantify, and identify intensity and feelings about pain. This scale is recommended for children ages 4 to 12. Self-report tools are effective in children older than 3 years of age, not 2 years of age.

11. Parents ask the nurse, "When should our child's hypospadias be corrected?" The nurse responds that correction of hypospadias should be accomplished by the time the child is a. 1 month of age. b. 6 to 12 months of age. c. school age. d. sexually mature.

ANS: B The correction of hypospadias should ideally be accomplished by the time the child is 6 to 12 months of age and before toilet training. One month of age is too young for this procedure. It is preferable for hypospadias to be surgically corrected before the child enters school so that the child has normal toileting behaviors in the presence of his peers. Corrective surgery for hypospadias is done long before sexual maturity.

22. At the time of a child's death, the nurse tells his mother, "We will miss him so much." The best interpretation of this is that the nurse is a. pretending to be experiencing grief. b. expressing personal feelings of loss. c. denying the mother's sense of loss. d. talking when listening would be better.

ANS: B The death of a patient is one of the most stressful experiences for a nurse. Nurses experience reactions similar to those of family members because of their involvement with the child and family during the illness. Nurses often have feelings of personal loss when a patient dies. The nurse is not pretending, denying the mother's sense of loss, or talking when listening would be better.

30. Kimberly is having a checkup before starting kindergarten. The nurse asks her to do the "finger-to-nose" test. The nurse is testing for a. deep tendon reflexes. b. cerebellar function. c. sensory discrimination. d. ability to follow directions.

ANS: B The finger-to-nose-test is an indication of cerebellar function. This test checks balance and coordination. It does not assess DTRs, sensory discrimination, or the ability to follow directions.

6. What is the maximum safe volume that a neonate can receive in an intramuscular injection? a. 0.5 mL b. 1.0 mL c. 1.5 mL d. 2 mL

ANS: B The maximum volume of medication for an intramuscular injection to a neonate is 1.0 mL.

11. Teaching parents about the use and application of an eye patch to treat strabismus should include which instruction? a. Check under the patch four times a day. b. Apply the patch directly to the face. c. Sometimes patching alone will straighten the eye. d. Negotiate the number of hours per day that the patch is to be worn.

ANS: B The patch should be securely applied to the face and should remain in place for the prescribed number of hours. There is no need to check under the patch. Patching alone will not straighten the eye. The amount of time the child wears the eye patch is not negotiable. Parents should learn strategies for dealing with resistant behaviors.

13. Which woman would be most likely to seek prenatal care? a. A 15-year-old who tells her friends, "I don't believe I'm pregnant." b. A 20-year-old who is in her first pregnancy and has access to a free prenatal clinic. c. A 28-year-old who is in her second pregnancy and abuses drugs and alcohol. d. A 30-year-old who is in her fifth pregnancy and delivered her last infant at home.

ANS: B The patient who acknowledges the pregnancy early, has access to health care, and has no reason to avoid health care is most likely to seek prenatal care. Being in denial about the pregnancy increases the risk of not seeking care. This patient is also 15, and other social factors may discourage her from seeking care as well. Women who abuse substances are less likely to receive prenatal care. Some women see pregnancy and delivery as a natural occurrence and do not seek health care.

11. A nurse is teaching parents how to care for a child's gastrostomy tube at home. What information should the nurse include? a. Bring the child to the clinic for cleaning b. Clean around the insertion site daily with soap and water. c. Expect some leakage around the button. d. Remove the tube for cleaning once a week.

ANS: B The skin around the tube insertion site should be cleaned with soap and water once or twice daily. Parents must be able to clean the site; the child is not taken to the clinic for this. Leakage around the tube should be reported to the physician. A gastrostomy tube is placed surgically. It is not removed for cleaning.

2. Which food is appropriate to mix with medication? a. Formula or milk b. Applesauce c. Baby food d. Orange juice

ANS: B To prevent the child from developing a negative association with an essential food, a nonessential food such as applesauce is best for mixing with medications. Formula, milk, baby food, and orange juice are essential foods in a child's diet. Medications may alter their flavor and cause the child to avoid them in the future.

6. A child has allergies to animal dander but is distraught at having to give away the family dog. What actions could the nurse suggest that might avoid this? (Select all that apply.) a. Choose a dander-free pet like a lizard. b. Keep the dog outside as much as possible. c. Install air cleaners in the house. d. Use dust-proof pillow covers. e. Keep the windows closed in the summer.

ANS: B, C, D Options for the child with allergies to the household pet include keeping the dog outside as much as possible, installing air cleaners, and using dust-proof pillow covers. Getting a lizard won't help because this child has a dog he or she wants to keep. Ventilating the house will also help.

3. Which strategies can a nurse teach to parents of a child experiencing uncomplicated school refusal? (Select all that apply.) a. The child should be allowed to stay home until the anxiety about going to school is resolved. b. Parents should be empathetic yet firm in their insistence that the child attend school. c. A modified school attendance may be necessary. d. Parents need to pick the child up at school whenever the child wants to come home. e. Parents need to communicate with the teachers about the situation.

ANS: B, C, E In uncomplicated cases of school refusal, the parent needs to return the child to school as soon as possible. If symptoms are severe, a limited period of part-time or modified school attendance may be necessary. For example, part of the day may be spent in the counselor's or school nurse's office, with assignments obtained from the teacher. Parents should be empathetic yet firm and consistent in their insistence that the child attend school. Parents should not pick the child up at school once the child is there or let the child stay home until this issue is resolved. The principal and teacher should be told about the situation so that they can cooperate with the treatment plan.

2. What should the nurse recognize as a possible indicator of child abuse in a 4-year-old child being treated for ear pain at the emergency department on a cold winter day? (Select all that apply.) a. The child extends his arms to be hugged by the nurse. b. The child is wearing clean, baggy shorts, sandals, and an oversized T-shirt. c. The child answers all questions in complete sentences and smiles afterward. d. The child has dirty, broken teeth. e. The child states "I'm so fat" when the nurse tells his mother he weighs 25 lb.

ANS: B, D, E These clothes are inappropriate for the weather and possibly too big. Dirty, broken teeth possibly show neglect of basic needs. Body image distortion is another possible clue to child abuse. Although it may be unusual for this child to want to be hugged by the nurse, it is not an indicator of child abuse. Answering questions using complete sentences and smiling is appropriate for a 4-year-old.

17. The nurse case manager is planning a care conference about a young child who has complex health care needs and will soon be discharged home. Who should the nurse invite to the conference? a. Family and nursing staff b. Social worker, nursing staff, and primary care physician c. Family and key health professionals involved in the child's care d. Primary care physician and key health professionals involved in the child's care

ANS: C A multidisciplinary conference is necessary for coordination of care for children with complex health needs. The family is involved as well as key health professionals who are involved in the child's care. The nursing staff can address the nursing care needs of the child with the family, but other involved disciplines must be included. The family must be included in the discharge conferences, which allow them to determine what education they will require and the resources needed at home. A member of the nursing staff must be included to review the nursing needs of the child.

22. What is a common trigger for asthma attacks in children? a. Febrile episodes b. Dehydration c. Exercise d. Seizures

ANS: C Exercise is one of the most common triggers for asthma attacks, particularly in school-age children. Febrile episode, dehydration, and seizures are not triggers.

7. What is the primary role of practicing nurses in the research process? a. Designing research studies b. Collecting data for other researchers c. Identifying researchable problems d. Seeking funding to support research studies

ANS: C Nursing generates and answers its own questions based on evidence within its unique subject area. Nurses of all educational levels are in a position to find researchable questions based on problems seen in their practice area. Designing research studies is generally left to nurses with advanced degrees. Collecting data may be part of a nurse's daily activity, but not all nurses will have this opportunity. Seeking funding goes along with designing and implementing research studies.

10. What nursing action is appropriate for specimen collection? a. Follow sterile technique for specimen collection. b. Sterile gloves are worn if the nurse plans to touch the specimen. c. Use Standard Precautions when handling body fluids. d. Avoid wearing gloves in front of the child and family.

ANS: C Standard Precautions should always be used when handling body fluids. Sterile gloves may be needed for some specimens, but Standard Precautions are important for all. The child and family should be educated in the purpose of glove use, including the fact that gloves are used with every patient, so that they will not be offended or frightened.

2. A 10-year-old patient is talking to the nurse about wanting to try contact lenses instead of wearing glasses. The child states that the other children at school call her "four-eyes." Contact lenses should be prescribed for a child who is a. at least 12 years of age. b. able to read all the written information and instructions. c. able to independently care for the lenses in a responsible manner. d. confident that she really wants contact lenses.

ANS: C The child must be able to care for the lenses independently. Serious eye damage can occur with irresponsible use of contact lenses. Chronologic age is not the major determinant. A responsible 10-year-old child might be permitted to wear contact lenses. The ability to read does not indicate understanding of the instructions. Confidence and "wanting" do not equal responsibility.

37. Which finding confirms a diagnosis of cystic fibrosis? a. Chest radiograph shows alveolar hyperinflation. b. Stool analysis indicates significant amounts of fecal fat. c. Sweat chloride is greater than 60 mEq/L. d. Liver function levels are abnormal.

ANS: C The diagnosis of cystic fibrosis requires a positive sweat test. A chloride level greater than 60 mEq/L is considered diagnostic for cystic fibrosis. Hyperinflation is one of the first findings on a chest radiograph of a child with cystic fibrosis. It does not confirm a diagnosis. A 72-hour fecal fat determination may be included in a diagnostic workup. Inability to secrete digestive enzymes causes steatorrhea. Liver function tests may be part of the diagnostic workup for cystic fibrosis.

10. Which nursing intervention is correctly written? a. Encourage turning, coughing, and deep breathing. b. Force fluids as necessary. c. Assist to ambulate for 10 minutes at 8 AM, 2 PM, and 6 PM. d. Observe interaction with infant.

ANS: C This intervention is the most specific and details what should be done, for how long, and when. The other interventions are too vague.

19. The nurse in the pediatric clinic is caring for a child and assesses this skin rash. What action by the nurse is best? a. Inform parents the child will be contagious for one week. b. Arrange for immediate hospitalization and IV antibiotics. c. Instruct parents to offer the child a soft, bland diet. d. Advise parents the child can maintain normal activities.

ANS: C This rash is characteristic of scarlet fever. The parents should provide soft, bland food. The child is not contagious 24 hours after starting antibiotics. There is no indication the child is sick enough to need hospitalization. The parents should encourage rest.

5. Which nursing action is most appropriate when treating a child who has a fever of 102.5° F (39.1° C)? a. Restrict fluid intake. b. Administer an aspirin. c. Administer acetaminophen. d. Bathe the child in tepid water.

ANS: C Treatment of a fever can include administration of an antipyretic such as acetaminophen. Dehydration can occur from insensible water loss. Offer the child fluids frequently and evaluate the need for IV therapy. Aspirin is avoided because of the potential association with Reye syndrome. A sponge or tub bath with tepid water to reduce fever can cause shivering and ultimately increase the child's temperature.

2. The appropriate tool(s) to assess pain in a 3-year-old child is the (Select all that apply.) a. Visual Analogue Scale (VAS) b. adolescent and pediatric pain tool c. Oucher tool d. poker chip tool e. FACES pain rating scale

ANS: C, E The Oucher tool and FACES tool can be used to assess pain in children 3 to 12 years of age. The VAS is indicated for use with older school-age children and adolescents. It can be used with younger school-age children, although less abstract tools are more appropriate. The poker chip tool can be used to assess pain in children 4 to 12 years of age. The adolescent and pediatric pain tool is indicated for use with children 8 to 17 years of age.

12. The child with lactose intolerance is most at risk for which imbalance? a. Hyperkalemia b. Hypoglycemia c. Hyperglycemia d. Hypocalcemia

ANS: D Because high-calcium dairy products containing lactose are restricted from the child's diet, alternative sources such as egg yolk, green leafy vegetables, dried beans, and cauliflower must be provided to prevent hypocalcemia. The child with lactose intolerance is not at risk for hyperkalemia. Lactose intolerance does not affect glucose metabolism. Hyperglycemia does not result from ingestion of a lactose-free diet.

12. The nurse is caring for a 6-year-old girl who had surgery 12 hours ago. The child tells the nurse that she does not have pain, but a few minutes later tells her parent that she does. What should the nurse consider when interpreting this? a. Truthful reporting of pain should occur by this age. b. Inconsistency in pain reporting suggests that pain is not present. c. Children use pain experiences to manipulate their parents. d. Children may be experiencing pain even though they deny it to the nurse.

ANS: D Children may deny pain to the nurse because they fear receiving an injectable analgesic or because they believe they deserve to suffer as a punishment for a misdeed. They may refuse to admit pain to a stranger but readily tell a parent. Myths about pain in children include that truthful reporting should occur at any age and inconsistencies suggest that pain is not present. Pain is whatever the experiencing person says it is, whenever the person says it exists. Pain is not questioned in an adult 12 hours after surgery.

35. What should the nurse stress in a teaching plan for the mother of an 11-year-old boy with ulcerative colitis? a. Preventing the spread of illness to others b. Nutritional guidance and preventing constipation c. Teaching daily use of enemas d. Coping with stress and avoiding triggers

ANS: D Coping with the stress of chronic illness and the clinical manifestations associated with ulcerative colitis (diarrhea, pain) are important teaching foci. Avoidance of triggers can help minimize the impact of the disease and its effect on the child. Ulcerative colitis is not infectious. Enemas are not used in this disease.

17. Which of the following is a true statement describing the differences in the pediatric genitourinary system compared with the adult genitourinary system? a. The young infant's kidneys can more effectively concentrate urine than an adult's kidneys. b. After 6 years of age, kidney function is nearly like that of an adult. c. Unlike adults, most children do not regain normal kidney function after acute renal failure. d. Young children have shorter urethras, which can predispose them to UTIs.

ANS: D Young children have shorter urethras, which can predispose them to UTIs. The young infant's kidneys cannot concentrate urine as efficiently as can those of older children and adults because the loops of Henle are not yet long enough to reach the inner medulla, where concentration and reabsorption occur. By 6 to 12 months of age, kidney function is nearly like that of an adult. Unlike adults, most children with acute renal failure regain normal function.

1. A student nurse is preparing to administer fentanyl 2-mcg/kg IV push to a child who weighs 26.4 pounds. The pharmacy delivers a vial with 50 mcg/10 mL. How much fentanyl does the student draw up?

ANS: 4.8 mL First convert weight to kg: 26.4 pounds = 12 kg Set up equation: 50 mcg = 2.4 mcg 10 mL × mL X = 4.8 mL

2. A school nurse is working with unlicensed assistive personnel (UAPs). What aspects of delegation should the nurse incorporate into his or her practice in this setting? a. The registered nurse is always responsible for assessment. b. Uncomplicated medication administration can be performed by the UAP. c. The nurse does not need to supervise UAPs in this setting. d. The nurse must work within school district policies when delegating. e. Understanding the complexity of the child's needs is a consideration when delegating.

ANS: A, B, D, E Delegation to UAPs is very common in all health care settings, including schools. When delegating to a UAP in the school setting, factors for the nurse to consider include that the RN is always responsible for assessment, supervision is necessary, the complexity of the child's needs must be considered, and policies must be followed. Medication administration by the UAP may be allowed.

2. A parent calls the emergency department (ED) reporting a front tooth completely knocked out of an adolescent's mouth while playing soccer. What information should the nurse provide? (Select all that apply.) a. Rinse the tooth in lukewarm tap water. b. Place the tooth in saline, milk, or water. c. Scrub the tooth with a disinfectant. d. Come to the ED within 1 hour. e. Prognosis is best if they are seen within 30 minutes.

ANS: A, B, E The parent should be advised to rinse the tooth in lukewarm tap water and to place it in saline, milk, or a commercial tooth preservative. Prognosis is best if the tooth can be re-implanted within 30 minutes. The tooth should not be scrubbed.

3. Which indicators of imminent death in a child should the nurse expect to assess? (Select all that apply.) a. Heart rate increases. b. Blood pressure increases. c. Respirations become rapid and shallow. d. The extremities become warm. e. Peripheral pulses become stronger.

ANS: A, C Indicators of imminent death include heart rate increasing, with a concomitant decrease in the strength and quality of peripheral pulses; respiratory effort decline, as evidenced by rapid, shallow respirations; and cool and cyanotic extremities. Increased BP, warm extremities, and strong peripheral pulses are not indicators of imminent death.

3. The nurse should implement which interventions for an infant experiencing apnea? (Select all that apply.) a. Stimulate the infant by gently tapping the foot. b. Shake the infant vigorously. c. Have resuscitative equipment available. d. Suction the infant. e. Maintain a neutral thermal environment.

ANS: A, C, E An infant with apnea should be stimulated by gently tapping the foot. Resuscitative equipment should be available, and the infant should be maintained in a neutral thermal environment. The infant should not be shaken vigorously nor suctioned.

24. Which statement about Crohn disease is the most accurate? a. The signs and symptoms of Crohn disease are usually present at birth. b. Signs and symptoms of Crohn disease include cramping, diarrhea, and weight loss. c. Edema usually accompanies this disease. d. Symptoms of Crohn disease usually disappear by late adolescence.

ANS: B Common manifestations of Crohn disease include abdominal cramping, diarrhea, and weight loss. Signs and symptoms are not usually present at birth. Edema does not accompany this disease. Symptoms do not typically disappear by adolescence.

41. A home health care nurse is doing a home assessment for a family whose child is oxygen dependent. What finding by the nurse requires intervention? a. Tanks are stored only in an upright position. b. Oxygen tank is placed 3 feet away from the heater. c. Smoking is not allowed in the house. d. Fire extinguisher expires at the end of the month.

ANS: B Oxygen tanks or sources should be at least 5 feet away from heat sources. The other findings are safe although the nurse might remind the family to replace the extinguisher prior to its expiration.

1. When assessing a child for pain, the nurse is aware that a. neonates do not feel pain. b. pain is an individualized experience. c. children do not remember pain. d. a child must cry to express pain.

ANS: B The manner and intensity of how a child expresses pain is dependent on the individual child's experiences. Neonates do express a total-body response to pain with a cry that is intense, high pitched, and harsh sounding. Children of all ages have been reported to have sleeping and eating disruptions after painful experiences. Not all children will cry to express pain.

29. An infant is born with bladder exstrophy. What action by the nurse is the priority? a. Obtain surgical consent for the corrective operation. b. Cover the exposed bladder with non-adherent plastic wrap. c. Insert an indwelling catheter to collect all the urine. d. Obtain consent for genetic testing on parents and infant.

ANS: B In bladder exstrophy, the bladder is outside the body and must be covered with a non-adherent plastic wrap until surgical correction. This is the priority action. Consent will be obtained prior to surgery. A catheter is not needed. Genetic testing is not necessarily done.

27. The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes which of the following? a. Taping the eye shut b. Patching the affected eye with any reasonable item c. Applying ice until the physician is seen d. Irrigating the eye copiously with a sterile saline solution

ANS: B The role of the nurse in a penetrating eye injury is to protect the eye from further injury. The injured eye should be patched with any reasonable material that serves the purpose. For instance, a Styrofoam cup can be used. The nurse would not tape the eye shut, apply ice, or irrigate the eye.

2. A hospitalized child has developed a methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse plans which interventions when caring for this child? (Select all that apply.) a. Airborne isolation b. Administration of vancomycin c. Contact isolation d. Administration of mupirocin ointment to the nares if colonized e. Administration of cefotaxime (Cefotetan)

ANS: B, C, D Vancomycin is used to treat MRSA along with mupirocin ointment to the nares. The patient is placed in contact isolation to prevent spread of the infection to other patients. The infection is not transmitted by the airborne route so only contact isolation is required. This infection is resistant to cephalosporins.

5. The increase in the number of overweight children in this country is addressed in Healthy People 2020. Strategies designed to approach this issue include (Select all that apply.) a. decreased calcium and iron intake. b. increased fiber and whole grain intake. c. decreased use of sugar and sodium. d. increase fruit and vegetable intake. e. decrease the use of solid fats.

ANS: B, C, D, E Along with these recommendations, children at risk for being overweight should be screened beginning at age 2 years. Children with a family history of dyslipidemia or early cardiovascular disease development, children whose body mass index percentile exceeds the definition for overweight, and children who have high blood pressure should have a fasting lipid screen. The nurse should instruct parents that calcium and iron intake should be increased as part of this strategy.

5. The student nurse learns that which factors place children at risk for malocclusion? (Select all that apply.) a. Sucking the thumb b. Mouth breathing c. Cleft palate d. Early loss of "baby" teeth e. Heredity

ANS: B, C, D, E Factors that contribute to malocclusion include mouth breathing, cleft palate, early loss of deciduous teeth, and heredity. Sucking the thumb is not a contributing factor unless it persists beyond 2 to 4 years.

4. The student nurse learns the stages of grief according to Kübler-Ross. What stages does this include? (Select all that apply.) a. Shock b. Denial c. Anger d. Bargaining e. Acceptance

ANS: B, C, D, E The stages of grief outlined by Kübler-Ross include denial, anger, bargaining, sadness or depression, and acceptance. Shock occurs during the denial stage.

1. Which interventions should the nurse plan when caring for a child with a visual impairment? (Select all that apply.) a. Touch the child upon entering the room before speaking. b. Keep items in the room in the same location. c. Describe the placement of the eating utensils on the meal tray. d. Face the child when speaking. e. Identify noises for the child.

ANS: B, C, E Keep all items in the room in the same location and order. Describing how many steps away something is and the placement of eating utensils on a tray are both useful tactics. Identify noises for the child because children who are visually impaired or blind often have difficulty establishing the source of a noise. Never touch the child without identifying yourself and explaining what you plan to do. Facing the child when speaking would help a child with a hearing impairment.

4. The nurse is providing home care instructions to the parents of an infant being discharged after repair of a bilateral cleft lip. Which instructions should the nurse include? (Select all that apply.) a. Acetaminophen (Tylenol) should not be given to your infant. b. Feed your infant in an upright position. c. Place your infant prone for a period of time each day. d. Burp your child frequently during feedings. e. Apply antibiotic ointment to the lip as prescribed.

ANS: B, D, E After cleft lip surgery the parents are taught to feed the infant in an upright position to decrease the chance of choking. The parents are taught to burp the infant frequently during feedings because excess air is often swallowed. Parents are taught to cleanse the suture line area with a cotton swab using a rolling motion and apply antibiotic ointment with the same technique. Tylenol is used for pain, and the child should never be placed prone as this position can damage the suture line.

5. The mother of an infant with multiple anomalies tells the nurse that she had a viral infection in the beginning of her pregnancy. Which viral infection is associated with fetal anomalies? a. Measles b. Roseola c. Rubella d. Herpes simplex virus (HSV)

ANS: C The rubella virus can cross the placenta and infect the fetus, causing fetal anomalies. Measles is not associated with congenital defects. Most cases of roseola occur in children 6 to 18 months old. HSV can be transmitted to the newborn infant during vaginal delivery, causing multisystem disease. It is not transmitted transplacentally to the fetus during gestation.

3. A student nurse has been studying Healthy People 2020. What information about this initiative does the student understand? (Select all that apply.) a. It is a new agenda for health care and research priorities. b. None of the priorities in this document pertains to pregnant women or children. c. Objectives are aimed at keeping people healthy with a good quality of life. d. Ensuring that 77.9% of women receive prenatal care in the first trimester is one goal. e. Increasing to 100% the proportion of people with health insurance.

ANS: C, D, E The Healthy People 2020 initiative is an update of previous versions and is the nation's blueprint for health care and research priorities. Many of its objectives pertain to pregnant women and children. The objectives include improving health and quality of life, ensuring that 77.9% of pregnant women receive prenatal care in the first trimester, and increasing the number of people with health insurance to 100%.

13. What do parents of preschool children need to understand about discipline? a. Both parents and the child should agree on the method of discipline. b. Discipline should involve some physical restriction. c. The method of discipline should be consistent with that of the child's peers. d. Discipline should include positive reinforcement of desired behaviors.

ANS: D Effective discipline strategies should involve a comprehensive approach that includes consideration of the parent-child relationship, reinforcement of desired behaviors, and consequences for negative behaviors. Discipline does not need to be agreed on by the child. Preschoolers feel secure with limits and appropriate, consistent discipline. Both parents should be in agreement so that the discipline is consistently applied. Discipline does not necessarily need to include physical restriction. Discipline doe s not need to be consistent with that of the child's peers.

1. A child weighs 30.8 pounds and is prescribed prednisolone syrup 0.5 mg/kg. The pharmacy delivers a syringe with 15 mg/5 mL. How many mL does the nurse administer? Round your answer to the nearest 10th.

ANS: 2.3333 mL or 2.3 mL First find the weight in kilograms: 30.8/2.2 = 14 kg Multiply 0.5 × 14 = 7 mg Set up equation: 15 mg 7 mg 5 mL = x mL Solve for x: 15x = (7 × 5) = 35 x = 35/15 = 2.333333 mL

2. A provider orders odansetron 0.15 mg/kg IV push for a child who weighs 15 pounds. How much medication does the nurse draw up?

ANS: 1 mL Calculate the weight in kilograms: 15/2.2 = 6.818181 Multiply by 0.15=1.0227272 Round as your final answer = 1 mL

1. A toddler's temperature is 101.5° F (38.6° C) axillary. The physician has ordered acetaminophen 10 mg/kg every 4 to 6 hours. The child weighs 22 lb. The bottle of acetaminophen available is a suspension (160 mg/5 mL).______ How much should the nurse administer? Round to the nearest milliliter.

ANS: 3 mL The first thing the nurse should do is convert the 22 lb into kilograms (10 kg). Next multiply the number of kilograms the child weighs by the dose ordered by the physician (10 mg × 10 kg = 100). Next, use the medication that is available (160 mg/5 mL) and calculate the amount for 100 mg. The answer is 3.125. The last step is to round to the nearest milliliter = 3 mL.

1. A nurse assessing a 2-month-old infant notes that the child can briefly hold the head erect when held against the shoulder. What action by the nurse is best? a. Document the findings in the child's chart. b. Notify the provider immediately. c. Conduct a lead-exposure assessment. d. Prepare the parents for genetic testing.

ANS: A A 2-month-old infant is able to briefly hold the head erect. If a parent were holding the infant against the parent's shoulder, the infant would be able to lift his or her head briefly. Since this is normal behavior, all that is required of the nurse is documentation. There is no need to notify the provider immediately, conduct a lead-exposure assessment, or prepare the parents for genetic testing.

16. A nurse is assessing a 1-year-old's food intake over the past 3 days. What information from the parent leads the nurse to provide education on nutrition? a. Child drinks 2 cups of 1% milk each day. b. Child loves to snack on fruit throughout the day. c. Child gets one 4-ounce cup of juice with breakfast. d. Parent allows child to regulate own portions at meals.

ANS: A A child this age should not be drinking low-fat milk. Snacking on fruit, 4 ounces of juice, and not forcing the child to eat everything on the plate are appropriate activity and do not require education.

19. A 5-year-old diagnosed with chlamydial conjunctivitis should be carefully assessed for which of the following? a. Sexual abuse b. Immune deficiency c. Congenital cataract d. Secondary glaucoma

ANS: A A diagnosis of chlamydial conjunctivitis in a nonsexually active child should signal the health care provider to assess the child for sexual abuse. Chlamydial infection is not related to immune deficiencies, cataracts, or glaucoma.

3. The nurse is assessing an infant's growth and development. The parents want education on how to stimulate this process. What action suggested by the nurse is inconsistent with knowledge of this topic? a. Have the family draw a three-generation family pedigree. b. Show the family how to coo and babble with their child. c. Encourage the parents to buy interactive toys for the child. d. Involve the child in activities that are outside the home.

ANS: A A family pedigree can help show relationships and health care problems but will not stimulate growth and development. Activities that are stimulating for a child include the consistent use of language by the parents, allowing play time with interactive toys (toys that make noises or do something in response to the baby's actions), and exposing the child to new sights and sounds.

9. The nurse is obtaining vital signs on a 1-year-old child. What is the most appropriate site for assessing the pulse rate? a. Apical b. Radial c. Carotid d. Femoral

ANS: A Apical pulse rates are taken in children younger than 2 years. Radial pulse rates may be taken in children older than 2 years. It is difficult to palpate the carotid pulse in an infant. The femoral pulse is palpated when comparing peripheral pulses, but it is not used to measure an infant's pulse rate.

11. What is the main purpose for using a volume-control device or an infusion pump to administer intravenous fluids to children? a. To avoid fluid overload b. To aid in measuring intake c. To administer antibiotics d. To ensure adequate intravenous fluid intake

ANS: A A volume-control device or an infusion pump allows the nurse to set a specific volume of fluid to be given in a specific period of time and decreases the risk of inadvertently administering a large amount of fluid. A pump can display IV intake, making calculation of I&O easier, but that is not its main function. Medications can be given via IV pump, but that is not its main function. The nurse is responsible for knowing a child's fluid requirements.

1. Which statement made by an adolescent girl indicates an understanding about the prevention of sexually transmitted diseases (STDs)? a. "I know the only way to prevent STDs is to not be sexually active." b. "I practice safe sex because I wash myself right after sex." c. "I won't get any kind of STD because I take the pill." d. "I only have sex if my boyfriend wears a condom."

ANS: A Abstinence is the only foolproof way to prevent an STD. STDs are transmitted through body fluids (semen, vaginal fluids, blood). Perineal hygiene will not prevent an STD. Oral contraceptives do not protect women from contracting STDs. A condom can reduce but not eliminate an individual's chance of acquiring an STD. However, the nurse should encourage condom use 100% of the time to decrease the risk.

4. Which activity does the nurse recommend to help develop fine motor skills in the school-age child? a. Drawing b. Singing c. Soccer d. Swimming

ANS: A Activities such as drawing, building models, and playing a musical instrument increase the school-age child's fine motor skills. Activities such as soccer or swimming help develop gross motor skills. Singing does not increase motor skills.

7. Which suggestion is appropriate to teach a mother who has a preschool child who refuses to take the medications for HIV infection? a. Mix medications with chocolate syrup or pudding b. Mix the medications with milk or an essential food. c. Skip the dose of medication if the child protests too much. d. Mix the medication in a syringe, hold the child down firmly, and administer the medication.

ANS: A Adding medication to a small amount of nonessential food the child finds tasty may be helpful in gaining the child's cooperation. Doses of medication should never be skipped. Fighting with the child or using force should be avoided. A nonessential food that will make the taste of the medication more palatable for the child should be the correct action. The administration of medications for the child with HIV becomes part of the family's everyday routine for years.

13. When liquid medication is given to a crying 10-month-old infant, which approach minimizes the possibility of aspiration? a. Administer the medication with a syringe (without needle) placed along the side of the infant's tongue. b. Administer the medication as rapidly as possible with the infant securely restrained. c. Mix the medication with the infant's regular formula or juice and administer by bottle. d. Keep the child upright with the nasal passages blocked for a minute after administration.

ANS: A Administer the medication with a syringe without a needle placed alongside of the infant's tongue. The contents are administered slowly in small amounts, allowing the child to swallow between deposits. Medications should be given slowly to avoid aspiration. The medication should be mixed with only a small amount of food or liquid. If the child does not finish drinking/eating, it is difficult to determine how much medication was consumed. Essential foods also should not be used. Holding the child's nasal passages will increase the risk of aspiration.

22. A patient who has a hyphema is at risk for developing which condition? a. Glaucoma b. Strabismus c. Diplopia d. Astigmatism

ANS: A After hyphema, there is a risk for the development of glaucoma. There is no connection between the other conditions and hyphema.

21. Which play activity should the nurse implement to enhance deep breathing exercises for a toddler? a. Blowing bubbles b. Throwing a Nerf ball c. Using a spirometer d. Keeping a chart of deep breathing

ANS: A Age-appropriate play for a toddler to enhance deep breathing is blowing bubbles. Throwing a Nerf ball does not enhance deep breathing. Using a spirometer and keeping a chart of deep breathing are more appropriate for a school-age child.

21. The nurse closely monitors the temperature of a child with nephrotic syndrome. The purpose of this is to detect an early sign of which possible complication? a. Infection b. Hypertension c. Encephalopathy d. Edema

ANS: A An exacerbation of the disease can occur after an infection. Temperature is not an indication of hypertension or edema. Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms. Edema does not manifest with an elevated temperature.

3. The nurse knows that physiologic changes associated with pain in the neonate include a. increased blood pressure and decreased arterial saturation. b. decreased blood pressure and increased arterial saturation. c. increased urine output and increased heart rate. d. decreased urine output and increased blood pressure.

ANS: A An increase in blood pressure and a decrease in arterial saturation can be noted when the neonate is feeling pain. Urinary output changes have not been associated with pain.

5. An infant has laryngomalacia. What assessment finding correlates with this condition? a. Stridor b. High-pitched cry c. Nasal congestion d. Spasmodic cough

ANS: A An infant with laryngomalacia has stridor. Stridor is usually present at birth but may begin as late as 2 months. Symptoms increase when the infant is supine or crying. High-pitched cries are consistent with neurologic abnormalities and are not usually respiratory in nature. Nasal congestion is nonspecific in relation to laryngomalacia. Spasmodic cough is associated with croup; it is not a common symptom of laryngomalacia.

14. What is the nurse's immediate action when a child comes to the emergency department with sweating, chills, and fang bite marks on the thigh? a. Secure antivenin therapy. b. Apply a tourniquet to the leg. c. Ambulate the child. d. Reassure the child and parent.

ANS: A Antivenin therapy is essential to the child's survival because the child is showing signs of envenomation. The use of a tourniquet is no longer recommended. When a bite or envenomation is located on an extremity, the extremity should be immobilized in a dependent position. Envenomation is a potentially life-threatening condition. False reassurance is not helpful for building a trusting relationship.

18. The nurse is planning care for an adolescent with AIDS. The priority nursing goal is to a. prevent infection. b. prevent secondary cancers. c. restore immunologic defenses. d. identify sources of infection.

ANS: A As a result of the immunocompromise that is associated with HIV infection, the prevention of infection is paramount. Preventing secondary cancers is not currently possible. Current drug therapy is affecting the disease progression; although not a cure, these drugs can suppress viral replication and prevent further deterioration. Case finding is not a priority nursing goal.

30. A parent of a child with a chronic illness is complaining about "all these care planning meetings." What response by the home health care nurse is best? a. "Our plan will change with your child's growth and development." b. "We have legal regulations and company policies to follow." c. "Do you want to change the frequency of our meetings?" d. "If you don't want to come to the meetings you don't have to."

ANS: A As the child goes through the different phases of growth and development, goals and interventions will change to meet the changing needs of the child. This may require frequent care planning meetings and plan updates. The nurse may be also following regulations, but that response does not give the parent useful information. The plan should be based on the child's needs. Asking if the parent wants to change the frequency of meetings is a yes/no question and does not explain the rationale. Of course the parent can opt out of meetings, but the plan will be substandard, and again this does not give the parent useful information.

10. Which assessment indicates to a nurse that a 2-year-old child is in need of pain medication? a. The child is lying rigidly in bed and not moving. b. The child's current vital signs are consistent with previous vital signs. c. The child becomes quiet when held and cuddled. d. The child has just returned from the recovery room.

ANS: A Behaviors such as crying; distressed facial expressions; certain motor responses, such as lying rigidly in bed and not moving; and interrupted sleep patterns are indicative of pain in children. Current vital signs that are consistent with earlier vita l signs do not suggest that the child is feeling pain. Response to comforting behaviors does not suggest the child is feeling pain. A child who is returning from the recovery room may or may not be in pain. Most times the child's pain is under adequate control at this time. The child may be fearful or having anxiety because of the strange surroundings and having just completed surgery.

5. The nurse advises the mother of a 3-month-old exclusively breastfed infant to a. start giving the infant a vitamin D supplement. b. start using an infant feeder and add rice cereal to the formula. c. start feeding the infant rice cereal with a spoon at the evening feeding. d. continue breastfeeding without any supplements.

ANS: A Breast milk does not provide an adequate amount of dietary vitamin D. Infants who are exclusively breastfed need vitamin D supplements to prevent rickets. An infant feeder is an inappropriate method of providing the infant with caloric intake. Solid foods are not recommended for a 3-month-old infant. Rice cereal and other solid foods are contraindicated in a 3-month-old infant. Solid feedings do not typically begin before 4 to 6 months of age.

10. When a child broke her favorite doll during a hospitalization, her primary nurse bought the child a new doll and gave it to her the next day. What is the best interpretation of the nurse's behavior? a. The nurse is displaying signs of overinvolvement. b. The nurse is a kind and generous person. c. The nurse feels a special closeness to the child. d. The nurse wants to make the child happy.

ANS: A Buying gifts for individual children is a warning sign of overinvolvement. Nurses are kind and generous people, but buying gifts for individual children is unprofessional. Nurses may feel closer to some patients and families. This does not make giving gifts to children or families acceptable from a professional standpoint. Replacing lost items is not the nurse's responsibility. Becoming overly involved with a child can inhibit a healthy relationship.

3. The ability to mentally understand that 1 + 3 = 4 and 4 - 1 = 3 occurs in which stage of cognitive development? a. Concrete operations b. Formal operations c. Intuitive thought d. Preoperations

ANS: A By 7 to 8 years of age, the child is able to retrace a process (reversibility) and has the skills necessary for solving mathematical problems. This stage is called concrete operations. The formal operations stage deals with abstract reasoning and does not occur until adolescence. Thinking in the intuitive stage is based on immediate perceptions. A child in this stage often solves problems by random guessing.

18. In terms of fine motor development, what should the 7-month-old infant be able to do? a. Transfer objects from one hand to the other. b. Use thumb and index finger in crude pincer grasp. c. Hold crayon and make a mark on paper. d. Release cubes into a cup.

ANS: A By age 7 months, infants can transfer objects from one hand to the other, crossing the midline. The crude pincer grasp is apparent at approximately age 9 months. The child can scribble spontaneously at age 15 months. At age 12 months, the child can release cubes into a cup.

6. Initial care of the child with a chemical burn to the eye(s) is focused on which of the following? a. Irrigation of the affected eye(s) b. Application of topical steroids c. Administration of an analgesic d. Administration of medication to constrict the pupils

ANS: A Chemical eye burns are an ocular emergency and best managed by immediate irrigation of the eye(s) with water or normal saline solution. The other actions are not part of initial care.

14. An 8-year-old girl tells the nurse that she has cancer because God is punishing her for "being bad." She shares her concern that if she dies, she will go to hell. What action by the nurse is most appropriate? a. Reassure the child that she is not being punished. b. Share concerns about development with the parents. c. Request a child-life specialist to intervene. d. Have the chaplain console the child.

ANS: A Children at this age may view illness or injury as a punishment for a real or imagined transgression. The nurse should reassure the child that she is not being punished. Since this is a common belief at this age, there are no concerns to share with parents. A child-life specialist or chaplain visit may be appropriate, but the nurse needs to respond to this statement him- or herself.

6. A parent asked, "When should I start dental care for my child?" What response by the nurse is best? a. "The recommendation is for children to have a dental examination no later than 2.5 years." b. "Children should see a dentist at least one time before kindergarten." c. "The recommendation is for children to have a dental examination before first grade." d. "A dental examination by 1 year of age is the current recommendation."

ANS: A Children should see a dentist by 1 year of age.

5. A nurse determines that a child consistently displays predictable behavior and is regular in performing daily habits. Which temperament is the child displaying? a. Easy b. Slow-to-warm-up c. Difficult d. Shy

ANS: A Children with an easy temperament are even tempered, predictable, and regular in their habits. They react positively to new stimuli. The slow-to-warm-up temperament type prefers to be inactive and moody. A high activity level and adapting slowly to new stimuli are characteristics of a difficult temperament. Shyness is a personality type and not a characteristic of temperament.

20. The nurse is presenting information on burn safety to a toddler and preschool parenting group at a local community center. To avoid the most common cause of fire death in children this age, what information does the nurse provide? a. Practice family fire drills often. b. Cover outlets with plastic covers. c. Turn the water heater temperature to 110° F (43.3° C). d. Keep children out of the kitchen when cooking.

ANS: A Children younger than 5 years are at the greatest risk for burn deaths in a house fire. They often panic and hide in closets or under beds rather than escape safely. Parents need to practice fire drills with their children to teach them what to do in the event of a house fire. Covering outlets, turning the water heater down, and keeping children out of the kitchen when cooking are more appropriate for younger children.

13. A student nurse learns that according to Piaget, the adolescent is in the fourth stage of cognitive development, or period of what? a. Formal operations b. Concrete operations c. Conventional thought d. Postconventional thought

ANS: A Cognitive thinking culminates with capacity for abstract thinking. This stage, the period of formal operations, is Piaget's fourth and last stage. Concrete operations usually develops between ages 7 and 11 years. Conventional and postconventional thought refer to Kohlberg's stages of moral development.

24. The most common type of hearing loss, which results from interference of transmission of sound to the middle ear, is called a. conductive. b. sensorineural. c. mixed conductive-sensorineural. d. central auditory imperceptive.

ANS: A Conductive or middle ear hearing loss is the most common type. It results from interference of transmission of sound to the middle ear, most often from recurrent otitis media. The other types occur much less often.

12. Which statement, made by a nursing student to the father of a 4-year-old child, warrants correction by the nurse? a. "Because the 'baby teeth' are not permanent, they are not important to the child." b. "Encourage your child to practice brushing his teeth after you have thoroughly cleaned them." c. "Your child's 'permanent teeth' will begin to come in around 6 years of age." d. "Fluoride supplements are needed if you do not have fluoridated water."

ANS: A Deciduous teeth are important because they maintain spacing and play an important role in the growth and development of the jaws and face and in speech development. Toddlers and preschoolers lack the manual dexterity to remove plaque adequately, so parents must assume this responsibility. But encouraging the child to practice will aid in increasing his or her abilities. Secondary teeth erupt at approximately 6 years of age. If the family does not have fluoridated water, the child will need fluoride treatments.

1. Which statement best describes development in infants and children? a. Development, a predictable and orderly process, occurs at varying rates within normal limits. b. Development is primarily related to the growth in the number and size of cells. c. Development occurs in a proximodistal direction with fine muscle development occurring first. d. Development is more easily and accurately measured than growth.

ANS: A Development, a continuous and orderly process, provides the basis for increases in the child's function and complexity of behavior. The increases in rate of function and complexity can vary normally within limits for each child. An increase in the number and size of cells is a definition for growth. Development proceeds in a proximodistal direction with fine muscle organization occurring as a result of large muscle organization. Development is a more complex process that is affected by many factors; therefore, it is less easily and accurately measured. Growth is a predictable process with standard measurement methods.

26. The parents of a child born with disabilities ask the nurse for advice about discipline. The nurse's response should be based on knowledge that discipline is a. essential for the child. b. too difficult to implement with special-needs child. c. not needed unless the child becomes problematic. d. best achieved with punishment for misbehavior.

ANS: A Discipline is essential for the child. It provides boundaries on which to test out their behavior and teaches them socially acceptable behaviors. All children in the family should be held to the same standards of behavior to prevent resentment. The nurse should teach the parents ways to manage the child's behavior before it becomes problematic. Punishment is not effective in managing behavior.

5. A school nurse is teaching a health class for 5th grade children. The nurse plans to include which statement to best describe growth in the early school-age period? a. Boys grow faster than girls. b. Puberty occurs earlier in boys than in girls. c. Puberty occurs at the same age for all races and ethnicities. d. It is a period of rapid physical growth.

ANS: A During the school-age developmental period, boys are approximately 1 inch taller and 2 pounds heavier than girls. Puberty occurs 1 1/2 to 2 years later in boys, which is developmentally later than puberty in girls (not unusual in 9- or 10-year-old girls). Puberty occurs approximately 1 year earlier in African-American girls than in white girls. Physical growth is slow and steady during the school-age years.

39. An infant's parents ask the nurse about preventing OM. What should be recommended? a. Avoid tobacco smoke. b. Use nasal decongestant. c. Avoid children with OM. d. Bottle feed or breastfeed in supine position.

ANS: A Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other upper respiratory infection (URI) symptoms. Children should be fed in an upright position to prevent OM.

7. The emergency department nurse notices that the mother of a young child is making a lot of phone calls and getting advice from her friends about what she should do. This behavior is an indication of a. stress. b. healthy coping skills. c. attention-getting behaviors. d. low self-esteem.

ANS: A Hyperactive behavior such as making a lot of phone calls and enlisting everyone's opinions is a sign of stress. The behavior described is not a healthy coping skill. This may be an attention-getting behavior but is more likely an indicator of stress. This mother may have low self-esteem, but the immediate provocation is stress.

5. The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is a. Erikson. b. Freud. c. Kohlberg. d. Piaget.

ANS: A Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled. Sigmund Freud proposed a psychosexual theory of development. He proposed that certain parts of the body assume psychological significance as foci of sexual energy. The foci shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of development. Lawrence Kohlberg described moral development as having three levels (preconventional, conventional, and postconventional). His theory closely parallels Piaget's.

19. The nurse is caring for a patient from a different culture and is frustrated by what appears to be a lack of cooperation on the patient's part. A colleague states that the patient is "in America and should do what everyone else does." This is an example of what trait? a. Ethnocentrism b. Cultural congruency c. Rudeness d. Ignorance

ANS: A Ethnocentrism is the belief that one's culture is superior to any others. The nurse stating that all patients should follow common American behaviors is demonstrating this behavior. This does not demonstrate cultural congruency. Although the colleague may be rude or ignorant, the more specific description of this behavior is ethnocentrism.

26. A nurse suspects possible visual impairment in a child who displays which problem? a. Excessive tearing of the eyes b. Rapid lateral movement of the eyes c. Delay in speech development d. Lack of interest in casual conversation with peers

ANS: A Excessive tearing of the eyes, especially one accompanied by pain and itching, is a clinical manifestation of potential vision problems. The other problems are not associated with visual impairment.

4. Which response by the nurse to the woman's statement, "I'm afraid to have a cesarean birth," would be the most therapeutic? a. "What concerns you most about a cesarean birth?" b. "Everything will be OK." c. "Don't worry about it. It will be over soon." d. "The doctor will be in later, and you can talk to him."

ANS: A Focusing on what the woman is saying and asking for clarification are the most therapeutic responses. Stating that "everything will be ok" or "don't worry about it" belittles the woman's feelings and might be providing false hope. Telling the patient to talk to the doctor does not allow the woman to verbalize her feelings when she desires.

1. What should the nurse use to prepare liquid medication in volumes less than 5 mL? a. Calibrated syringe b. Paper measuring cup c. Plastic measuring cup d. Household teaspoon

ANS: A For volumes of 5 mL or less, an oral syringe designed for oral medication administration only should be used. Measuring cups would be too large. A household teaspoon may or may not be accurate and the AAP recommends metric-only measuring devices.

6. The nurse should assess a child who has had a tonsillectomy for which of the following as the priority? a. Frequent swallowing b. Inspiratory stridor c. Swelling of the throat d. Abnormal lung sounds

ANS: A Frequent swallowing is indicative of postoperative bleeding. Inspiratory stridor is characteristic of croup. The nurse assesses the throat for clots or bleeding, not swelling. Lung sounds are assessed on every postoperative patient.

21. Which statement related to nursing care of the child at home is most correct? a. The technology-dependent infant can safely be cared for at home. b. Home care increases readmissions to the hospital for a child with chronic conditions. c. There is increased stress for the family when a sick child is being cared for at home. d. The family of the child with a chronic condition is likely to be separated from their support system if the child is cared for at home.

ANS: A Greater numbers of technology-dependent infants and children are now cared for at home. The numbers include those needing ventilator assistance, total parenteral nutrition, IV medications, apnea monitoring, and other device-assisted nursing care. Optimal home care can reduce the rate of readmission to the hospital for children with chronic conditions. Consumers often prefer home care because of the decreased stress on the family when the patient is able to remain at home. When the child is cared for at home the family is less likely to be separated from their support system because of the need for hospitalization.

23. The level of practice a reasonably prudent nurse provides is called a. the standard of care. b. risk management. c. a sentinel event. d. failure to rescue.

ANS: A Guidelines for standards of care are published by various professional nursing organizations. The standard of care for neonatal nurses is set by the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN). The Society of Pediatric Nurses is the primary specialty organization that sets standards for the pediatric nurse. Risk management identifies risks and establishes preventive practices, but it does not define the standard of care. Sentinel events and failure to rescue can be caused by not practicing up to standards of care, but they do not define it.

18. A nurse is interested in preventing injuries to children while they play. What action by the nurse would most likely lead to the biggest impact? a. Volunteering for an organization that gives away bicycle helmets. b. Providing education on the need for knee pads when skating. c. Teaching parents that children too big for child care seats should sit in the front seat. d. Encouraging children to play only on formal, constructed playgrounds.

ANS: A Head injuries from bicycles are a large part of serious injury to children in this age group. They need to be taught to only ride a bike while wearing a helmet. The nurse's best option is to volunteer for an organization that gives away helmets. Knee pads when skating is also a good idea, but that won't have the impact of helmets. Once a child is too big for a child care seat and the seat belt fits appropriately, the child should sit in the back seat. Playing on constructed playgrounds only will not prevent injuries and is unrealistic.

9. A nurse wants to work to increase the number of immunized children. What action by the nurse would best meet this goal? a. Present a workshop to the local home-schooling parent support group. b. Volunteer for a mass "back to school" immunization clinic. c. Prepare welcome and information packets to college freshmen. d. Work with the health department to bring immunizations to day cares.

ANS: A Home-schooled children are often overlooked when it comes to immunizations, because they are not in immunization-friendly systems such as day care, schools, and colleges where immunizations are required. The best way for the nurse to help increase the number of immunized children is to reach out to the home-schooled group.

10. What should be the emergency department nurse's next action when a 6-year-old child has a systolic blood pressure of 58 mm Hg? a. Alert the physician about the systolic blood pressure. b. Comfort the child and assess respiratory rate. c. Assess the child's responsiveness to the environment. d. Alert the physician that the child may need intravenous fluids.

ANS: A Hypotension is a late sign of shock in children. The lower limit for systolic blood pressure for a child more than 1 year old is 70 mm Hg plus two times the child's age in years. A systolic blood pressure of 58 mm Hg calls for immediate action. The nurse should be direct in relaying the child's condition to the physician. Comforting the child and assessing respiratory rate are not priorities. Assessing the child's responsiveness is included in a neurologic assessment. It does not address the systolic blood pressure of 58 mm Hg. Although this child most likely requires intravenous fluids, the physician must be apprised of the systolic blood pressure so that appropriate intervention can be initiated.

15. A 14-year-old male seems to be always eating, although his weight is appropriate for his height. The parents ask the nurse if they should be concerned about this behavior. Which response by the nurse is best? a. This is normal because of increase in body mass during this time. b. This is abnormal and suggestive of possible future obesity. c. His caloric intake would have to be excessive for him to gain weight. d. He is substituting food for unfilled needs.

ANS: A In adolescence, nutritional needs are closely related to the increase in body mass. The peak requirements occur in the years of maximal growth. The caloric and protein requirements are higher than at almost any other time of life. It is not suggestive of possible future obesity or unmet psychosocial needs. It may be true that the teen would need to eat an enormous amount of food in order to gain weight, but that does not give the parents the information they are requesting.

4. The nursing student learns how infants acquire immunity. Which statement about this process is correct? a. The infant acquires humoral and cell-mediated immunity in response to infections and immunizations. b. The infant acquires maternal antibodies that ensure immunity up to 12 months age. c. Active immunity is acquired from the mother and lasts 6 to 7 months. d. Passive immunity develops in response to immunizations.

ANS: A Infants acquire long-term active immunity from exposure to antigens and vaccines. Immunity is acquired actively and passively. The term infant's passive immunity is acquired from the mother and begins to dissipate during the first 6 to 8 months of life. Passive immunity is acquired from the mother. Active immunity develops in response to immunizations.

11. A nurse is caring for four infants. Which one should the nurse assess first? a. Nasal flaring b. Respiratory rate of 55 breaths/min c. Irregular respiratory pattern d. Abdominal breathing

ANS: A Infants have difficulty breathing through their mouths; therefore nasal flaring is usually accompanied by extra respiratory efforts. A respiratory rate of 55 breaths/min is a normal assessment for an infant. Irregular respirations are normal in the infant. Abdominal breathing is common because the diaphragm is the neonate's major breathing muscle.

16. A nurse is teaching a class on acute kidney injury. The nurse relates that acute kidney injury as a result of hemolytic-uremic syndrome (HUS) is classified as a. Intrinsic renal. b. Prerenal. c. Postrenal. d. Chronic.

ANS: A Intrinsic renal acute renal failure is the result of damage to kidney tissue. Possible causes include HUS, glomerulonephritis, and pyelonephritis. Prerenal acute renal failure is the result of decreased perfusion to the kidney. Possible causes include dehydration, septic and hemorrhagic shock, and hypotension. Postrenal acute renal failure results from obstruction of urine outflow. Conditions causing postrenal failure include ureteropelvic obstruction, ureterovesical obstruction, or neurogenic bladder. Renal failure caused by HUS is of the acute nature. Chronic renal failure is an irreversible loss of kidney function, which occurs over months or years.

1. The nurse teaches parents that the formula used to guide time-out as a disciplinary method is a. 1 minute per each year of the child's age. b. to relate the length of the time-out to the severity of the behavior. c. never to use time-out for a child younger than 4 years. d. to follow the time-out with a treat.

ANS: A It is important to structure time-out in a time frame that allows the child to understand why he or she has been removed from the environment. The current guideline is 1 minute per age in years. Relating time to a behavior is subjective and is inappropriate when the child is very young. Time-out can be used with the toddler. Negative behavior should not be reinforced with a positive action.

47. The earliest clinical manifestation of biliary atresia is a. jaundice. b. vomiting. c. hepatomegaly. d. absence of stooling.

ANS: A Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera, may be present at birth, but is usually not apparent until age 2 to 3 weeks. Vomiting is not associated with biliary atresia. Hepatomegaly and abdominal distention are common but occur later. Stools are large and lighter in color than expected because of the lack of bile.

11. A nurse is teaching parents to avoid environmental injury to their 2-year-old child. What information does the nurse include in teaching? a. Avoiding sun exposure, secondhand smoke, and lead b. Living in a middle-class neighborhood c. Avoiding smoking and alcohol intake during pregnancy d. Limiting breastfeeding to avoid toxins being passed through breast milk

ANS: A Lead can be present in the home and in toys made overseas. Environmental injury can also be the result of mercury, pesticides (flea and tick collars), radon, and exposure to the sun and secondhand smoke. It is important for the nurse to provide health teaching related to these factors. The nurse is unable to influence socioeconomic status, and the family may not want or be able to move. It is too late for the nurse to instruct the mother regarding smoking or alcohol intake during pregnancy. This should have been included in prenatal teaching. It is unlikely that a 2-year-old child will still be breastfeeding.

14. How should the nurse advise parents whose preschooler used to sleep through the night and now awakens at intervals after a short hospitalization? a. Regressive behavior after a hospitalization is normal and usually short term. b. The child is probably expressing anger. c. Egocentric behavior often manifests itself when the child is left alone to sleep. d. The child is probably feeling pain and needs further evaluation.

ANS: A Regression is manifested in a variety of ways, is normal, and usually is short term. Nighttime waking is not associated with anger. Egocentric behavior is not an explanation for nighttime waking. More information is needed before assessment of pain can be made.

8. What is the primary nursing concern for a hospitalized child with HIV infection? a. Maintaining growth and development b. Eating foods that the family brings to the child c. Consideration of parental limitations and weaknesses d. Resting for 2 to 3 hours twice a day

ANS: A Maintaining growth and development is a major concern for the child with HIV infection. Frequent monitoring for failure to thrive, neurologic deterioration, or developmental delay is important for HIV-infected infants and children. Nutrition, which contributes to a child's growth, is a nursing concern; however, it is not necessary for family members to bring food to the child. Although an assessment of parental strengths and weaknesses is important, it will be imperative for health care providers to focus on the parental strengths, not weaknesses. This is not as important as the frequent assessment of the child's growth and development. Rest is a nursing concern, but it is not as high a priority as maintaining growth and development. Rest periods twice a day for 2 to 3 hours may or may not be appropriate.

18. What is an expected outcome for the child with irritable bowel disease? a. Decreasing symptoms b. Adherence to a low-fiber diet c. Increasing milk products in the diet d. Adapting the lifestyle to the lifelong problems

ANS: A Management of irritable bowel disease is aimed at identifying and decreasing exposure to triggers and decreasing bowel spasms, which will decrease symptoms. Management includes maintenance of a healthy, well-balanced, moderate-fiber, lower fat diet. A moderate amount of fiber in the diet is indicated for the child with irritable bowel disease. No modification in dairy products is necessary unless the child is lactose intolerant. Irritable bowel syndrome is typically self-limiting and resolves by age 20 years.

17. A nurse wants to volunteer for an organization that helps prevent death in older adolescents. What action by the nurse would have the most impact? a. Volunteer for a suicide hotline. b. Teach firework safety classes. c. Work on a poison control hot line. d. Educate teens on gun safety.

ANS: A Of the four causes of death listed, suicide ranks highest, being the second most common cause of death in the 15 to 24 age group. The nurse would make the biggest impact volunteering for a suicide hotline.

14. The nurse is caring for a child receiving intravenous (IV) morphine for severe postoperative pain. The nurse observes a slower respiratory rate, and the child cannot be aroused. What action by the nurse takes priority? a. Administer naloxone (Narcan) immediately. b. Notify the provider immediately. c. Discontinue morphine until the child is fully awake. d. Stimulate the child by calling his or her name and shaking gently.

ANS: A Opioid-induced respiratory depression is managed by administering naloxone immediately and discontinuing the infusion. The nurse notifies the provider afterward. The provider may permanently discontinue the morphine or lower the dose. Since the child cannot be aroused, stimulating him or her is not appropriate.

6. What medication is the most effective choice for treating pain associated with sickle cell crisis in a newly admitted 5-year-old child? a. Morphine b. Acetaminophen c. Ibuprofen d. Midazolam

ANS: A Opioids, such as morphine, are the preferred drugs for the management of acute, severe pain, including postoperative pain, posttraumatic pain, pain from vaso-occlusive crisis, and chronic cancer pain. Acetaminophen provides only mild analgesic relief and is not appropriate for a newly admitted child with sickle cell crisis. Ibuprofen is a type of nonsteroidal anti-inflammatory drug (NSAID) that is used primarily for pain associated with inflammation. It is appropriate for mild to moderate pain but is not adequate for this patient. Midazolam (Versed) is a short-acting drug used for conscious sedation and preoperative sedation and as an induction agent for general anesthesia.

1. Which principle of teaching should the nurse use to ensure learning in a family situation? a. Motivate the family with praise and positive reinforcement. b. Present complex subject material first, while the family is alert and ready to learn. c. Families should be taught using medical jargon so they will be able to understand the technical language used by physicians. d. Learning is best accomplished using the lecture format.

ANS: A Praise and positive reinforcement are particularly important when a family is trying to master a frustrating task, such as breastfeeding. Learning is enhanced when the teaching is structured to present the simple tasks before the complex material. Even though a family may understand English fairly well, they may not understand the medical terminology or slang terms. A lively discussion stimulates more learning than a straight lecture, which tends to inhibit questions.

10. The parents of a preschool-aged child are in the clinic and report the child is seen playing with the genitals frequently. What response by the nurse is best? a. Reassure parents this is normal at this age. b. Teach parents about behavior modification. c. Refer parents and child to a psychologist. d. Ask the provider to speak to the parents.

ANS: A Preschool children are in the Phallic or Oedipal/Electra Stage of Freud's theory during which the genitals become the focus of curiosity and interest. The nurse should explain that this behavior is normal at this stage. Teaching about disciplinary techniques and referrals to psychotherapy are inappropriate. The nurse may well want the provider to speak to the parents, but the nurse is responsible for patient/parent teaching and should provide education him- or herself.

13. Which dietary modification is appropriate for a child with chronic renal failure? a. Decreased protein b. Decreased fat c. Increased potassium d. Increased phosphorus

ANS: A Protein intake is restricted or strictly regulated because of the kidney's inability to remove waste products. A low-fat diet is not relevant to chronic renal failure. Potassium intake may be restricted because of the kidney's inability to remove it. Phosphorus is restricted to help prevent bone disease.

16. Which activity should the nurse implement for the toddler hospitalized with a chronic illness to promote autonomy? a. Provide opportunities for play b. Making play dates with other toddlers in the unit c. Give the toddler art supplies d. Turn the television on to cartoons

ANS: A Providing play gives the toddler some time to work on growth and development skills and normalizes hospitalization at least for that time. Toddlers typically don't play together in groups. Art supplies may or may not be too advanced for the toddler, but in any case, this would be a form of play. Watching cartoons on television is passive and will not promote autonomy.

19. In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? a. Roll from abdomen to back. b. Roll from back to abdomen. c. Sit erect without support. d. Move from prone to sitting position.

ANS: A Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen usually occurs at 6 months old. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position.

3. The nurse expects the initial plan of care for a 9-month-old child with an acute otitis media infection to include a. symptomatic treatment and observation for 48 to 72 hours after diagnosis. b. an oral antibiotic, such as amoxicillin, five times a day for 7 days. c. pneumococcal conjugate vaccine. d. myringotomy with tympanoplasty tubes.

ANS: A Select children 6 months of age or older with acute otitis media are treated by initiating symptomatic treatment and observation for 48 to 72 hours. Acute otitis media may be treated with a 5- to 10-day course of oral antibiotics. When treatment is indicated, amoxicillin at a divided dose of 80 to 90 mg/kg/day given either every 8 or 12 hours for 5 to 10 days may be ordered. Pneumococcal conjugate vaccine helps to prevent ear infections but is not included in the initial plan of care for a child with acute otitis media. Surgical intervention is considered when the child has persistent ear infection despite antibiotic therapy or with otitis media with effusion that persists for more than 3 months and is associated with hearing loss.

16. A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her schoolwork satisfactorily, but lately she has been somewhat aggressive and stubborn in the classroom. What action by the school nurse is most appropriate? a. Assess the child for unusual stress. b. Perform a detailed physical exam. c. Call the parents in for a conference. d. Screen the child for developmental delay.

ANS: A Signs of stress include stomach pains or headache, sleep problems, bedwetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors. The nurse should assess the child for stress. The other actions are not warranted although the nurse may want to have a conference with parents after screening the child.

15. Parents tell the nurse their 5-month-old has started sitting up without support. What teaching does the nurse plan to provide the parents? a. Providing solid foods safely b. Encouraging cruising and walking c. Providing cow's milk d. Proper sock and shoe selection

ANS: A Sitting up is a sign the child is ready to begin solid foods. The nurse should teach the parents how to provide them safely and how to introduce them. The other topics are not related to sitting up.

14. A nurse is modeling play time with a 6-month-old infant. Which activity is appropriate? a. Pat-a-cake, peek-a-boo b. Ball rolling, hide-and-seek game c. Bright rattles and tactile toys d. Push-and-pull toys

ANS: A Six-month-old children enjoy playing pat-a-cake and peek-a-boo. Nine-month-old infants enjoy rolling a ball and playing hide-and-seek games. Four-month-old infants enjoy bright rattles and tactile toys. Twelve-month-old infants enjoy playing with push-and-pull toys.

22. A parent is worried that a child is not eating well. What does the nurse teach the parent to address this problem? a. Limit sports and team events that occur over the dinner hour. b. Pack a nutritious lunch to take to school every day. c. Teach about healthy snacks available at school. d. Ensure the child gets 2 cups of milk products a day.

ANS: A Sports and team schedules often disrupt mealtime, especially dinner, and families often find themselves eating fast food on the way to practices and games. The family's best option is to limit activities that occur during this time. The child may not eat a packed lunch and may choose unhealthy foods from the schools' vending machines. Children in this age group need 3 cups of milk and dairy products per day.

9. What parameter should guide the nurse when administering a subcutaneous injection to a school-age child with cellulitis? a. Do not to give injections in edematous areas. b. Attach a clean 1-inch needle to the syringe. c. The maximum volume injected into one site is 2 mL. d. Do not pinch up tissue before inserting the needle.

ANS: A Subcutaneous injections should never be given in areas of edema or infection because absorption is unreliable. A short (no more than 1/2- to 5/8-inch) needle should be used to deposit medication into subcutaneous tissue. Volumes for subcutaneous injections are small, usually averaging 0.5 mL. The skin is pinched up for a subcutaneous injection to raise the fatty tissue away from the muscle.

28. The nurse getting an end-of-shift report on a child with status asthmaticus should question which intervention? a. Administer oxygen by nasal cannula to keep oxygen saturation at 100%. b. Assess intravenous (IV) maintenance fluids and site every hour. c. Notify provider for signs of increasing respiratory distress. d. Organize care to allow for uninterrupted rest periods.

ANS: A Supplemental oxygen should not be administered to maintain oxygen saturation at 100%. Keeping the saturation around 95% is adequate. Administration of too much oxygen to a child may lead to respiratory depression by decreasing the stimulus to breathe, leading to carbon dioxide retention. When the child cannot take oral fluids because of respiratory distress, IV fluids are administered. The child with a continuous IV infusion must be assessed hourly to prevent complications. A provider should be notified of any changes indicating increasing respiratory distress. A child in respiratory distress is easily fatigued. Nursing care should be organized so the child can get needed rest without being disturbed.

19. The mother of a 5-year-old female inpatient on the pediatric unit asks the nurse if she could provide information regarding the recommended amount of television viewing time for her daughter. The nurse responds that the appropriate amount of time a child should be watching television is a. 1 to 2 hours per day. b. 2 to 3 hours per day. c. 3 to 4 hours per day. d. 4 hours or more.

ANS: A The American Academy of Pediatrics (2013) encourages parents to monitor their children's media exposure and limit their children's screen time (TV, computer, video games) to no more than 1 to 2 hours per day. The other options all contain more screen time than is recommended.

7. A nurse works for an organization that seeks to limit adolescent violence. In talking with donors, which risk factors for violence may lead to programming decisions? (Select all that apply.) a. Drug or alcohol use/abuse b. Poverty c. Hopelessness about the future d. Narcissism e. Lack of supervision

ANS: A, B, C, E Drug and alcohol use/abuse, poverty, hopelessness, and lack of supervision all are risk factors for violence. Narcissism is not.

5. A 3-year-old child cries, kicks, and clings to the father when the parents try to leave the hospital room. What is the nurse's best response to the parents about this behavior? a. "Your child is showing a normal response to the stress of hospitalization." b. "Your child is not coping effectively with hospitalization." c. "Parents should stay with children during hospitalization." d. "You can avoid this if you leave after your child falls asleep."

ANS: A The child is exhibiting a healthy attachment to the father. The child's behavior represents the protest stage of separation and does not represent maladaptive behavior. This response places undue stress and guilt on the parents. Leaving when the child is asleep will foster mistrust.

9. Which intervention is appropriate for a hospitalized child who has crops of lesions on the trunk that appear as a macular rash and vesicles? a. Place the child in strict isolation with airborne and contact precautions. b. Continue to practice Standard Precautions. c. Pregnant women should avoid contact with the child. d. Screen visitors for immunity to measles.

ANS: A The child's skin lesions are characteristic of varicella. Varicella is transmitted through direct contact, droplets, and airborne particles. In the hospital setting, children with varicella should be placed in strict isolation, and on contact and air borne precautions. The purpose is to prevent transmission of microorganisms by inhalation of small-particle droplet nuclei and to protect other patients and health care providers from acquiring this disease. Standard Precautions are not sufficient for this disease. Certain viral illnesses such as rubella and fifth disease are known to affect the fetus if the woman contracts the disease during pregnancy. This child appears to have varicella. Pregnancy is not a contraindication to caring for a child with varicella. However, all healthcare personnel should be vaccinated or show immunity to varicella. Screening visitors for immunity to measles is irrelevant. It is important to screen visitors for immunity to varicella.

29. What is the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

ANS: A The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools are a later manifestation of CF. Recurrent respiratory infections are a later sign of CF.

31. The home health care nurse is working with a family with three children, one of whom has a chronic condition. What statement by a parent indicates that goals for a primary nursing diagnosis have been met? a. "We take turns going to soccer practice with our other two kids." b. "Each sibling has one night when he or she is in charge so we can go out." c. "We are looking into local support groups for parents." d. "We can't afford home health care, so one of us will quit our job."

ANS: A The family that is demonstrating good ability to balance the needs of all family members is meeting an important goal for the diagnosis Interrupted Family Processes. The other siblings may not want to be "in charge" for an entire evening, but that does not show good balance. Looking into support groups and having to quit a job also do not demonstrate that a goal for this diagnosis is being met.

13. What is the goal of the initial intervention for a child in cardiopulmonary arrest? a. Establishing a patent airway b. Determining a pulse rate c. Removing clothing d. Reassuring the parents

ANS: A The first intervention for a child in cardiopulmonary arrest, as for an adult, is to establish a patent airway. Assessment of pulse follows establishment of a patent airway. Clothing may be removed from the upper body for chest compressions after a patent airway is established. Reassuring the parents is important, but the primary survey and associated interventions come first.

11. A nurse is teaching adolescent boys about pubertal changes. The first sign of pubertal change seen with boys is a. testicular enlargement. b. facial hair. c. scrotal enlargement. d. voice deepens.

ANS: A The first sign of pubertal changes in boys is testicular enlargement in response to testosterone secretion, which usually occurs in Tanner stage 2. Slight pubic hair is present and the smooth skin texture of the scrotum is somewhat altered. During Tanner stages 4 and 5, facial hair appears at the corners of the upper lip and chin. As testosterone secretion increases, the penis, testes, and scrotum enlarge. During Tanner stages 4 and 5, rising levels of testosterone cause the voice to deepen.

14. The parents of a chronic illness say, "Living with this disease is really hard; it's not fair." What response by the nurse is best? a. "Tell me about what is hard for you." b. "I know exactly how you must feel." c. "I know a local support group for families." d. "I am going to ask the grief counselor to meet with you."

ANS: A The first step in supporting families and helping them deal with chronic sorrow is to listen to and recognize their pain. Each individual's perception of a situation is different. A nurse can never know exactly how parents feel about having a child with a chronic illness. The family may welcome involvement in a support group or meeting with a counselor, but that should not be the first action.

21. When teaching a mother how to administer eye drops, where should the nurse tell her to place them? a. In the conjunctival sac that is formed when the lower lid is pulled down b. Carefully under the eyelid while it is gently pulled upward c. On the sclera while the child looks to the side d. Anywhere as long as drops contact the eye's surface

ANS: A The lower lid is pulled down, forming a small conjunctival sac. The drops are applied to this area. The medication should not be administered directly onto the eyeball.

21. The nurse is providing support to a family who is experiencing anticipatory grief related to their child's imminent death. An appropriate nursing intervention is to a. be available to family. b. attempt to "lighten the mood." c. not allow visitors at this time. d. discourage crying because the child can hear it.

ANS: A The most valuable nursing intervention at this time is to be available to the family. Attempting to lighten the mood or to cheer people up is inappropriate. The family's wishes determine who can visit. The nurse should never discourage the expression of emotions.

20. A child is brought to the emergency department after ingesting an acidic substance. What action by the nurse is best? a. Induce vomiting in the child. b. Give syrup of ipecac. c. Ensure a patent airway. d. Attach the child to a cardiac monitor.

ANS: C Ensuring a patent airway is always the priority. Since the child ingested an acid that causes corrosive damage, inducing vomiting (which is what syrup of ipecac does) is not advised. The child may need a cardiac monitor, but airway is the priority.

13. The nurse observes a rash on a teen's face which is characteristic of systemic lupus erythematosus (SLE). What action by the nurse is most appropriate? a. Teach the teen about using sunscreen. b. Prepare the teen for a bone marrow biopsy. c. Educate the teen on proper use of antibiotics. d. Demonstrate how to use an Epi-pen.

ANS: A The nurse needs to provide education on managing the disease; one facet includes minimizing sun exposure so the nurse teaches the teen about the correct use of sunscreen. The teen will not have a bone marrow biopsy, need antibiotics, or have to use an Epi-pen.

23. The nurse is caring for a child who has just died. The parents ask to be left alone so that they can rock their child one more time. What response by the nurse is best? a. Grant their request. b. Assess why they feel this is necessary. c. Discourage this because it will only prolong their grief. d. Kindly explain that they need to say good-bye to their child now and leave.

ANS: A The parents should be allowed to remain with their child after the death for as long as they need to. No other response is needed.

16. The nurse is preparing a 12-year-old girl for a bone marrow aspiration. She tells the nurse she wants her mother with her "like before." Which response by the nurse is most appropriate? a. Grant her request. b. Explain why this is not possible. c. Identify an appropriate substitute for her mother. d. Offer to provide support to her during the procedure.

ANS: A The parents' preferences for assisting, observing, or waiting outside the room should be assessed as well as the child's preference for parental presence. The child's choice should be respected. If the mother and child are agreeable, then the mother is welcome to stay. An appropriate substitute for the mother is necessary only if the mother does not wish to stay. Support is offered to the child regardless of parental presence.

6. Which is the most developmentally appropriate intervention when working with the hospitalized adolescent? a. Encourage peers to call and visit when the adolescent's condition allows. b. Encourage the adolescent's friends to continue with their daily activities; the adolescent has concrete thinking and will understand. c. Discourage questions and concerns about the effects of the illness on the adolescent's appearance. d. Ask the parents how the adolescent usually copes in new situations.

ANS: A The peer group is important to the adolescent's sense of belonging and identity; therefore separation from friends is a major source of anxiety for the hospitalized adolescent. Adolescents should have advanced beyond concrete thinking. In addition, hospitalized adolescents may be upset if their friends continue with daily activities without them. Communication, interacting, and meeting with friends will be important. Questions and concerns should be encouraged regarding the adolescent's appearance and the effects of illness on appearance. How the adolescent copes should be asked directly of the adolescent.

3. The mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about "casts" in the urine. The nurse explains that casts in the urine indicate a. glomerular injury. b. glomerular healing. c. recent streptococcal infection. d. excessive amounts of protein in the urine.

ANS: A The presence of red blood cell casts in the urine indicates glomerular injury. Casts in the urine are abnormal findings and are indicative of glomerular injury, not glomerular healing. A urinalysis positive for casts does not confirm a recent streptococcal infection. Casts in the urine are unrelated to proteinuria.

12. A nurse is working triage in the emergency department. A school-age child is brought in for treatment, carried by her mother. What assessment takes priority? a. Assess airway patency. b. Obtain a health history. c. Obtain a full set of vital signs. d. Evaluate for pain.

ANS: A The primary assessment consists of assessing the child's airway, breathing, circulation, level of consciousness, and exposure (ABCDEs). Airway always comes first. History, vital signs, and pain assessment are all part of the secondary survey.

2. A nurse is caring for a dying child. What action by the nurse best meets the the primary concern of the parents? a. Giving the child pain medication on a schedule b. Placing the child on fall and safety precautions c. Providing the child with favorite foods when requested d. Ensuring the child gets the minimum fluid requirement

ANS: A The primary concern of all parents of dying children is the possibility of their child feeling pain. The nurse works vigilantly to assess and treat the child's pain. The other options are also important considerations but usually not the priority concern.

24. A nurse is working with a child who has a sudden, serious illness. To best support the parents, what action by the nurse is best? a. Assess the parents' usual coping methods. b. Give them information about the unit protocols. c. Tell them to stay with the child as much as desired. d. Reassure them about how common this illness is.

ANS: A The way these parents will cope with this sudden illness is the same as how they cope with other stressors. The nurse helps the parents identify coping methods and support systems. Giving information about the unit and telling them they can stay are positive interventions but too narrow in scope to be the best answer. Reassuring them that their child's illness is common belittles their concerns.

14. A woman who delivered her baby 6 hours ago complains of headache and dizziness. The nurse administers an analgesic but does not perform any assessments. The woman then has a tonic-clonic seizure, falls out of bed, and fractures her femur. How would the actions of the nurse be interpreted in relation to standards of care? a. Negligent: the nurse failed to assess the woman for possible complications b. Negligent: because the nurse medicated the woman c. Not negligent: the woman had signed a waiver concerning the use of side rails d. Not negligent: the woman did not inform the nurse of her symptoms as soon as they occurred.

ANS: A There are four elements to malpractice, which is negligence in the performance of professional duties: duty, breach of duty, damage, and proximate cause. The nurse was negligent because she or he did not perform any assessments, which is the first step of the nursing process and is a standard of care. By not assessing the patient, the nurse did not meet established standards of care, and thus is guilty of professional negligence, or malpractice.

30. The nurse notes on assessment that a 1-year-old child is underweight, with abdominal distention, thin legs and arms, and foul-smelling stools. The nurse suspects failure to thrive is associated with a. Celiac disease b. Intussusception c. Irritable bowel syndrome d. Imperforate anus

ANS: A These are classic symptoms of celiac disease. They are not related to intussusception, irritable bowel syndrome, or an imperforate anus.

9. A 5-year-old child is brought to the emergency department with copious drooling and a croaking sound on inspiration. Her mother states that the child is very agitated and only wants to sit upright. What action by the nurse takes priority? a. Prepare intubation equipment and call the provider. b. Examine the child's oropharynx and call the provider. c. Obtain a throat culture for respiratory syncytial virus (RSV). d. Obtain vital signs and listen to breath sounds.

ANS: A This child has symptoms of epiglottitis, is acutely ill, and requires emergency measures. If epiglottitis is suspected, the nurse should not examine the child's throat. Inspection of the epiglottis is only done by a provider, because it could trigger airway obstruction. A throat culture could precipitate a complete respiratory obstruction. Vital signs can be assessed after emergency equipment is readied.

44. Bismuth subsalicylate, clarithromycin, and metronidazole are prescribed for a child with a peptic ulcer for what purpose? a. Eradicate Helicobacter pylori b. Coat gastric mucosa c. Treat epigastric pain d. Reduce gastric acid production

ANS: A This combination of drug therapy is effective in the treatment of H. pylori, the most common cause of ulcers in children.

13. What is a priority nursing diagnosis for the preschool child with chronic illness? a. Risk for delayed growth and development related to chronic illness or disability b. Chronic pain related to frequent injections and invasive procedures c. Anticipatory grieving related to impending death d. Anxiety related to frequent hospitalizations

ANS: A This is the priority nursing diagnosis that is appropriate for the majority of chronic illnesses. The child may or may not have frequent injections and invasive procedures. A chronic illness is one that does not have a cure. It does not mean the child will die prematurely. Frequent hospitalizations are not required for all chronic illnesses.

1. The nurse percussing over an empty stomach expects to hear which sound? a. Tympany b. Resonance c. Flatness d. Dullness

ANS: A Tympany is a high-pitched, loud-intensity sound heard over air-filled body parts such as the stomach and bowel. Resonance is a low-pitched, low-intensity sound elicited over hollow organs such as the lungs. Flatness is a high-pitched, soft-intensity sound elicited by percussing over solid masses such as bone or muscle. Dullness is a medium-pitched, medium-intensity sound elicited when percussing over high-density structures such as the liver.

14. The nurse should know that the results of untreated amblyopia ("lazy eye") in the child may include which of the following? a. Impaired depth perception b. Strabismus c. Color deficiency d. Ptosis

ANS: A Untreated amblyopia causes the child to lose binocular vision, which may impair depth perception. Amblyopia, or decreased vision in the deviated eye, can result from strabismus. Color deficiency is not a result of amblyopia. Ptosis, or drooping of the eyelid, is not a result of untreated amblyopia.

4. The nurse assesses a child's oculomotor, trochlear, and abducent nerves by using which technique? a. Assessing the six cardinal gazes b. Identification of common odors c. Having child bite on a tongue blade d. Ask child to shrug against resistance

ANS: A Using the six cardinal gazes the nurse assesses the oculomotor, trochlear, and abducent nerves. Odors are detected by the olfactory nerve. Biting on tongue blade assesses the trigeminal nerve. Shrugging against resistance assesses the accessory nerve.

13. Which assessment finding after tonsillectomy should be reported to the surgeon? a. Vomiting bright red blood b. Pain at surgical site c. Pain on swallowing d. The ability to only take small sips of liquids

ANS: A Vomiting bright red blood and swallowing frequently are signs of bleeding postoperatively and should be reported to the surgeon. It is normal for the child to have pain at the surgical site and pain with swallowing after tonsillectomy. Small sips of liquid are preferred.

3. The nurse is caring for a neonate with a suspected tracheoesophageal fistula (TEF). Nursing care should include which of the following? a. Elevating the head but give nothing by mouth b. Elevating the head for feedings c. Feeding glucose water only d. Avoiding suction unless infant is cyanotic

ANS: A When a newborn is suspected of having TEF, the most desirable position is supine with the head elevated on an incline plane of at least 30 degrees. It is imperative that any source of aspiration be removed at once; oral feedings are withheld. Feedings should not be given to infants suspected of having TEF. The oral pharynx should be kept clear of secretion by oral suctioning. This is to avoid cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx.

19. What is critical for the nurse to know when using restraints on a child? a. Use the least restrictive type of restraint. b. Tie knots securely so they cannot be untied easily. c. Secure the ties to the mattress or side rails. d. Remove restraints every 4 hours to assess skin integrity.

ANS: A When restraints are necessary, the nurse should institute the least restrictive type of restraint possible to meet goals. Knots must be tied so that they can be easily undone for quick access to the child. The ties are never tied to the mattress or side rails. They should be secured to a stable device, such as the bed frame. Restraints are removed every 2 hours to allow for range of motion, position changes, and assessment of skin integrity.

4. A nurse is teaching a group of parents about TEF. Which statement made by the nurse is accurate about TEF? a. This defect results from an embryonal failure of the foregut to differentiate into the trachea and esophagus. b. It is a fistula between the esophagus and stomach that results in the oral intake being refluxed and aspirated. c. An extra connection between the esophagus and trachea develops because of genetic abnormalities. d. The defect occurs in the second trimester of pregnancy.

ANS: A When the foregut does not differentiate into the trachea and esophagus during the fourth to fifth week of gestation, a TEF occurs. A TEF is an abnormal connection between the esophagus and trachea. There is no connection between the trachea and esophagus in normal fetal development. This defect occurs early in pregnancy during the fourth to fifth week of gestation.

36. The nurse should teach parents of a child with cystic fibrosis to adjust enzyme dosage according to which indicator? a. Stool formation b. Vomiting c. Weight d. Urine output

ANS: A When there is constipation, less enzyme is needed; with steatorrhea, more enzyme is needed for digestion of nutrients. Vomiting, weight, and urine output do not affect dosing.

4. A nurse uses the CRIES tool to assess pain in neonates. What categories does the nurse assess? (Select all that apply.) a. Crying b. Requires O2 c. Increased respiratory rate d. Expression e. Sleepiness

ANS: A, B CRIES stands for crying, requires O2, increased vital signs, expression, and sleeplessness.

2. What information should the nurse teach families about reducing exposure to pollens and dust? (Select all that apply.) a. Replace wall-to-wall carpeting with wood and tile floors. b. Use an air conditioner. c. Put dust-proof covers on pillows and mattresses. d. Keep humidity in the house above 60%. e. Keep pets outside.

ANS: A, B, C Carpets retain dust. To reduce exposure to dust, carpeting should be replaced with wood, tile, slate, or vinyl. These floors can be cleaned easily. For anyone with pollen allergies, it is best to keep the windows closed and to run the air conditioner. Covering mattresses and pillows with dust-proof covers will reduce exposure to dust. A humidity level above 60% promotes dust mites. It is recommended that household humidity be kept between 40% and 50% to reduce dust mites inside the house. Keeping pets outside will help to decrease exposure to dander but will not affect exposure to pollen and dust.

1. A preschooler is diagnosed with helminths. The child's mother is very upset and wants to know how her child could have contracted this illness. After obtaining a detailed history, the nurse identifies all possible transmission modes. What do they include? (Select all that apply.) a. Playing in the backyard sandbox b. Not washing hands before eating c. Placing hands in the mouth and nail biting d. Skin-to-skin contact with other children e. Scratches from a neighborhood cat

ANS: A, B, C Common helminths include roundworm, pinworm, tapeworm, and hookworm. Children are frequently infected as the result of frequent hand-mouth activity (unwashed hands, nail biting, not washing hands after using the toilet) and the likelihood of fecal contamination from sandboxes (especially if dogs and cats deposit fecal material in them). Other causes include not adequately washing fruits and vegetables before eating them and drinking contaminated water. Skin-to-skin contact with other children and scratches from a cat are not transmission modes for helminths.

2. Which nursing interventions are significant for a child with cirrhosis who is at risk for bleeding? (Select all that apply.) a. Guaiac all stools b. Provide a safe environment c. Administer vitamin K d. Inspect skin for pallor and cyanosis e. Monitor serum liver panels

ANS: A, B, C Identification of bleeding includes stool guaiac testing, which can detect if blood is present in the stool; protecting the child from injury by providing a safe environment; administering vitamin K to prevent bleeding episodes; and avoiding injections.

4. The nurse teaches parents signs that a child might be being bullied or otherwise victimized. What signs does the nurse include in this teaching? (Select all that apply.) a. Spends an inordinate amount of time in the nurse's office b. Belongings frequently go missing or are damaged. c. The child wants to be driven to school. d. School performance improves. e. The child freely talks about his day.

ANS: A, B, C Signs that may indicate a child is being bullied are similar to signs of other types of stress and include nonspecific illness or complaints, withdrawal, depression, school refusal, and decreased school performance. Children express fear of going to school or riding the school bus. Very often, children will not talk about what is happening to them. Improving school performance and talking about the day are not indications of bullying.

3. A nurse wishes to incorporate the American Nurses Association Code of Ethics for Nurses in daily practice. Which of the following actions best demonstrates successful integration of the code into daily routines? a. Strives to treat all patients equally and with caring kindness b. Calls the provider when the patient's pain is not controlled with prescribed medications c. Reads current literature related to practice area and brings ideas to unit management d. Routinely stays overtime in order to visit and bond with new families e. Decides to "play nicely" and not get involved in disputes about patient care.

ANS: A, B, C The ANAs Code of Ethics includes statements about practicing with compassion and respect for the inherent dignity, worth, and unique attributes of every person, advocating for the patient, and advancing the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. Staying overtime may contribute to burn out and does not advance the Code of Ethics. Nurses are responsible for making decisions and taking action consistent with the obligation to promote health and to provide optimal care; not getting involved in patient care disputes does not uphold this standard.

4. A 2-month-old child has not had any immunizations. Which ones should the nurse prepare to give? (Select all that apply.) a. Hib b. HepB c. MCV d. Varicella e. HPV

ANS: A, B, C, D Hib, HepB, MCV, and varicella are all appropriate vaccinations for this child. HPV is for adolescents.

7. The nurse is assessing a child for epiglottitis. What findings are consistent with this condition? (Select all that apply.) a. Drooling b. Dysphagia c. Dysphonia d. Distressed inspiratory efforts e. Decreased oxygenation

ANS: A, B, C, D The cardinal signs of epiglottitis are drooling, dysphagia, dysphonia, and distressed inspiratory efforts. While the child may develop decreased oxygenation if the airway is severely compromised, this is not a cardinal sign.

1. Today's nurse often assumes the role of teacher or educator. Which strategies would be best to use for a nurse working with a new mother? (Select all that apply.) a. Computer-based learning b. Videos c. Printed material d. Group discussion e. Lecture

ANS: A, B, C, D To be effective as a teacher, the nurse must tailor teaching to specific needs and characteristics of the patient. Computer-based learning, videos, printed material, and group discussions have all be shown to be effective teaching strategies. Lecture is probably the least effective method as it does not allow for participation.

5. The school nurse is evaluating the school's athletic programs for safety. What factors should the nurse assess? (Select all that apply.) a. Students get adequate rest periods. b. Equipment is in good condition. c. Practices are appropriate for students. d. Post-game concussion assessment if needed e. Adequate fluids are available at all times.

ANS: A, B, C, E A safe athletic program has several features including adequate rest periods, good quality equipment, appropriate practice schedules and regimes, and adequate fluids. Concussion testing if warranted, should occur immediately as the student is withdrawn from the game, and not wait until after the game is over.

1. Which play patterns does a 3-year-old child typically display? (Select all that apply.) a. Imaginary play b. Parallel play c. Cooperative play d. Structured play e. Associative play

ANS: A, B, C, E Children between ages 3 and 5 years enjoy parallel and associative play. Children learn to share and cooperate as they play in small groups. Play is often imitative, dramatic, and creative. Structured play is typical of school-age children.

4. A nurse is planning care for an asymptomatic child with a positive tuberculin test. What should the nurse include in the plan? (Select all that apply.) a. Administration of daily isoniazid (INH) b. Instructing family members about administration of INH to all close contacts of the child c. Administration of the bacillus Calmette-Guérin vaccine d. Reporting the case to the health department e. Administration of INH and rifampin (Rifadin) simultaneously

ANS: A, B, D After a chest radiograph is obtained, asymptomatic children with positive tuberculin tests and no previous history of TB receive daily INH for 9 months. Asymptomatic contacts should receive INH for at least 8 to 10 weeks after contact has been broken or until a negative skin test can be confirmed (a second test is taken at least 10 weeks after the last exposure). Reporting cases of TB is required by law in all states in the United States. Bacillus Calmette-Guérin vaccine is the only anti-TB vaccine available, but it is given only to children who have negative test results. For asymptomatic TB, only INH is administered, not both isoniazid and rifampin together. Rifampin is used if the child has resistance to isoniazid.

3. While developing a care plan for a school-age child with a visual impairment, the nurse knows that which of the following actions are important in working with this special needs child? (Select all that apply.) a. Obtain a thorough assessment of the child's self-care abilities. b. Orient the child to various sounds in the environment. c. Tell the child's parents to stay continuously with their child during hospitalization. d. Allow the child to handle equipment as procedures are explained. e. Encourage the child to use a dry erase board to write his needs.

ANS: A, B, D Conducting a thorough assessment of the child's self-care abilities, orienting the child to various sounds in the environment, and allowing the child to handle equipment are all ways to enhance communication with a visually impaired child. Mandating that the child's parents stay continuously with their child may not be possible and is not usually necessary if the school-age child is at the expected level of growth and development. Encouraging a child to write his needs on a dry erase board would be an appropriate intervention for a child who is hearing impaired, not for a child with a visual deficit.

3. The nurse is working with a child in the intensive care unit. The family is from out of town. There are two siblings, both of whom are acting out at home. What suggestions does the nurse provide the family? (Select all that apply.) a. Let the siblings call the ill child at scheduled times. b. Take photographs of the sick child to show the siblings. c. Suggest the parents take the siblings to counseling. d. Reassure the siblings that they will not get ill themselves. e. Stay at home with the siblings until their behavior improves.

ANS: A, B, D Having siblings call or visit the sick child helps them cope with the situation and can ease anxiety. If the sibling fears a similar illness, parents can reassure them this will not happen if reasonable. Going to counseling may be needed if the siblings cannot be reassured but is not the first step as this is normal behavior. The parents may become overly stressed if told to stay at home.

6. A nurse is assessing a child for toilet training readiness during a home visit. Which behaviors by the child are positive signs? (Select all that apply.) a. Removes own clothing b. Walks into bathroom on own c. Has been walking for 6 months d. Will give up toy when asked to e. Scratches as legs periodically

ANS: A, B, D Signs of readiness for toilet training include being able to remove own clothing, being willing to let go of a toy when asked, is able to sit, squat, and walk well, has been walking for 1 year, noticing if diaper is wet, pulls on diaper or exhibits other behavior indicating diaper needs to be changed, communicating the need to go to the bathroom or goes there by self and wanting to please parent by staying dry.

1. When counseling the newly pregnant woman regarding the option of using a free-standing birth center for care, the nurse should be aware that this type of care setting includes which advantages? (Select all that apply.) a. Less expensive than acute-care hospitals b. Access to follow-up care for 6 weeks postpartum c. Equipped for obstetric emergencies d. Safe, home-like births in a familiar setting e. Staffing by lay midwives.

ANS: A, B, D Women who are at low risk and desire a safe, home-like birth are very satisfied with this type of care setting. The new mother may return to the birth center for postpartum follow-up care, breastfeeding assistance, and family planning information for 6 weeks postpartum. Because birth centers do not incorporate advanced technologies into their services, costs are significantly less than those for a hospital setting. The major disadvantage of this care setting is that these facilities are not equipped to handle obstetric emergencies. Should unforeseen difficulties occur, the woman must be transported by ambulance to the nearest hospital. Birth centers are usually staffed by certified nurse-midwives (CNMs); however, in some states lay midwives may provide this service.

2. The traditional areas of school health nursing that are still prevalent in many school systems include which of the following? (Select all that apply.) a. Health screening b. Emergency care c. Intensive care d. Communicable disease management e. Health care advice

ANS: A, B, D, E Health screening such as vision, hearing, and growth checks can provide information about problems that may affect the child's ability to learn. School nurses are often the first to provide care for children experiencing an unintentional injury, either on the playground or in the school building. The nurse must assess children for illnesses that may be transmitted to other children and provide care and isolation until a parent can pick up the child from school. The school nurse can be a source of referral for families in need of health care services. Intensive care is provided in the hospital.

1. The mother of an HIV-positive infant who is 2 months old questions the nurse about which childhood immunizations her child will be able to receive. Which immunizations should an HIV-positive child be able to receive? (Select all that apply.) a. Hepatitis B b. DTaP c. MMR d. IPV e. HIB

ANS: A, B, D, E Routine immunizations are appropriate. The MMR vaccination is not given at 2 months of age. If it were indicated, CD4+ counts are monitored when deciding whether to provide live virus vaccines. If the child is severely immunocompromised, the MMR vaccine is not given. The varicella vaccine can be considered on the basis of the child's CD4+ counts. Only IPV should be used for HIV-infected children.

15. What is the drug of choice the nurse should administer in the acute treatment of anaphylaxis? a. Diphenhydramine b. Histamine inhibitor (cimetidine) c. Epinephrine d. Albuterol

ANS: C Epinephrine is the first drug of choice in immediate treatment of anaphylaxis. Treatment must be initiated immediately because it may only be a matter of minutes before shock occurs. Diphenhydramine and cimetidine may be used, but the drug of choice is epinephrine. Albuterol is not usually indicated.

3. The nurse is assessing parental knowledge of temper tantrums. Which are true statements about temper tantrums? (Select all that apply.) a. Temper tantrums are a common response to anger and frustration in toddlers. b. Temper tantrums often include screaming, kicking, throwing things, and head banging. c. Parents can effectively manage temper tantrums by giving in to the child's demands. d. Children having temper tantrums should be safely isolated and ignored. e. Parents can learn to anticipate times when tantrums are more likely to occur.

ANS: A, B, D, E Temper tantrums are a common response to anger and frustration in toddlers. They occur more often when toddlers are tired, hungry, bored, or excessively stimulated. A nap before fatigue or a snack if mealtime is delayed will be helpful in alleviating the times when tantrums are most likely to occur. Tantrums may include screaming, kicking, throwing things, biting themselves, or banging their head. Effective management of tantrums includes safely isolating and ignoring the child. The child should learn that nothing is gained by having a temper tantrum. Giving in to the child's demands only increases the behavior.

1. The nurse preparing to administer the Denver Developmental Screening Test II (DDST-II) should understand that it assesses which functional areas? (Select all that apply.) a. Personal-functional b. Fine motor c. Intelligence d. Language e. Gross motor

ANS: A, B, D, E The four functional areas assessed by this tool are personal-functional, fine motor, language, and gross motor. It is not an intelligence test.

1. What are age-appropriate nursing interventions to facilitate psychological adjustment for an adolescent expected to have a prolonged hospitalization? (Select all that apply.) a. Encourage parents to bring in homework and schedule study times. b. Allow the adolescent to wear street clothes. c. Involve the parents in care. d. Follow home routines. e. Encourage parents to bring in favorite foods.

ANS: A, B, E Completing homework during study time, allowing the teen to wear street clothes, and encouraging parents to bring favorite foods are all age appropriate. Involving parents in care and following home routines are important interventions for the preschool child who is in the hospital. Adolescents do not need parents to assist in their care. They are used to performing independent self-care. Adolescents may want their parents to be nearby, or they may enjoy the freedom and independence from parental control and routines.

1. The mother of a newborn asks the nurse what causes the baby to begin to breathe after delivery. What changes in the respiratory system stimulating respirations postnatally can the nurse explain to the mother? (Select all that apply.) a. Low oxygen levels in the infant's blood b. Rubbing the newborn with a towel or blanket c. Surfactant, a special lubricant in the lungs d. Increased blood flow to the infant's lungs e. Cold environment in the delivery room

ANS: A, B, E Hypoxemia, cold, and tactile stimulation all encourage the infant to breathe. Surfactant in the lungs lowers surface tension and facilitates lung expansion. It does not stimulate respirations. Pulmonary blood flow increases after birth, but this does not stimulate respirations in the newborn.

8. The nurse is discussing contraceptive choices with an adolescent girl who wants to become sexually active. Which factors are important to consider? (Select all that apply.) a. Motivation b. Cognitive development c. Chronological age d. Parental opinions e. Frequency of intercourse

ANS: A, B, E Motivation, cognitive development, and planned frequency of intercourse are some of the factors to consider when counseling an adolescent about birth control choices. Chronological age is not as important as developmental state. Parents generally do not need to give consent or be informed when a teen seeks contraception.

2. Which home care instructions should the nurse provide to the parents of a child with acquired immunodeficiency syndrome (AIDS)? (Select all that apply.) a. Give supplemental vitamins as prescribed. b. Yearly influenza vaccination should be avoided. c. Administer any antibiotics as prescribed. d. Notify the provider if the child develops a cough or congestion. e. Missed doses of antiretroviral medication should just be skipped.

ANS: A, C, D The parents are taught that vitamins are important, to have the child take all antibiotics (if prescribed) as ordered, and to notify the provider of coughs or congestion. The child should have yearly influenza vaccination, and if missed medication doses are noticed close to their scheduled time, they should be taken.

5. A nurse working with infants recognizes which findings as possible signs of brain dysfunction? (Select all that apply.) a. Irritability b. Nausea c. Anorexia d. Vomiting e. Fever

ANS: A, C, D, E Irritability, loss of appetite, vomiting, and fever may indicate brain dysfunction in infants. Infants cannot complain of nausea.

15. What is an appropriate beverage for the nurse to give to a child who had a tonsillectomy earlier in the day? a. Chocolate ice cream b. Orange juice c. Fruit punch d. Apple juice

ANS: D The child can have clear, cool liquids when fully awake. Ice cream is not a clear liquid, and dairy products can cause the child to clear the throat repeatedly, increasing the risk of bleeding. Citrus drinks are not offered because they can irritate the throat. Red liquids are avoided because they give the appearance of blood if vomited.

2. Which interventions should the nurse teach that are appropriate for preventing childhood obesity? (Select all that apply.) a. Establish consistent times for meals and snacks. b. Sign your child up for sports teams. c. Teach the family and child how to prepare foods in a healthy manner. d. Show the family how to read food labels. e. Limit computer and television time.

ANS: A, C, D, E Preventing obesity includes encouraging families to establish consistent times for meals and snacks, teaching them how to select and prepare healthful foods, and limiting computer and television time. Participating in sports is a great activity, but parents should not sign their kids up for teams without consulting them first.

2. Which behaviors by the nurse may indicate professional separation or underinvolvement? (Select all that apply.) a. Avoiding the child or his or her family b. Revealing personal information c. Calling in sick d. Spending less time with a particular child e. Asking to trade assignments

ANS: A, C, D, E Whether nurses become too emotionally involved or find themselves at the other end of the spectrum—being underinvolved—they lose effectiveness as objective professional resources. These are all indications of the nurse who is underinvolved in a child's care. Revealing personal information to a patient or his or her family is an indication of overinvolvement.

3. A nurse is assessing an infant for urinary tract infection (UTI). Which assessment findings should the nurse expect? (Select all that apply.) a. Change in urine odor or color b. Enuresis c. Fever or hypothermia d. Voiding urgency e. Poor weight gain

ANS: A, C, E The signs of a UTI in an infant include fever or hypothermia, irritability, dysuria as evidenced by crying when voiding, change in urine odor or color, poor weight gain, and feeding difficulties. Enuresis and voiding urgency should be assessed in an older child.

2. The nurse plans a teaching session with a toddler's parents on car safety. Which will the nurse teach? (Select all that apply.) a. Secure in a rear-facing, upright car safety seat. b. Place the car safety seat in the rear seat, behind the driver's seat. c. Harness safety straps should fit snugly. d. Place the car safety seat in the front passenger seat equipped with an airbag. e. After the age of 2 years, toddlers can be placed in a forward-facing car seat.

ANS: A, C, E Toddlers should be secured in a rear-facing, upright, approved car safety seat. Harness straps should be adjusted to provide a snug fit. After age 2, the child can sit in a forward-facing car seat. The car safety seat should be placed in the middle of the rear seat. Children younger than 13 years should not ride in a front passenger seat that is equipped with an airbag.

3. The nurse should provide which information to parents about preventing parasitic infections? (Select all that apply.) a. Perform good handwashing. b. Diaper a child when swimming. c. Avoid cleaning the bathroom facilities with bleach. d. Shoes should be worn outside. e. Fruits and vegetables should be washed before eating.

ANS: A, D, E Children are more commonly infected with parasites than adults, primarily as a result of frequent hand-to-mouth activity and the likelihood of fecal contamination. Good handwashing can prevent the transmission. Shoes should be worn when outside to prevent transmission, and fruits and vegetables should be washed before eating. The child should not swim in a pool that allows diapered children. The bathroom facilities should be cleaned with bleach to decrease the chance of transmission.

1. Which factors contribute to early adolescents engaging in risk-taking behaviors? (Select all that apply.) a. Peer pressure b. A desire to master their environment c. Trying to separate from their parents d. A belief that they are invulnerable e. Impulsivity

ANS: A, D, E Peer pressure (including impressing peers) is a factor contributing to adolescent injuries. During early to middle adolescence, children feel that they are exempt from the consequences of risk-taking behaviors; they believe that negative consequences only happen to others. Feelings of invulnerability ("It can't happen to me") are evident in adolescence. Impulsivity places adolescents in unsafe situations. Mastering the environment is the task of young school-age children. Emancipation is a major issue for the older adolescent. The process is accomplished as the teenager gains an education or vocational training.

1. Which statements about performing a pediatric physical assessment are correct for a school-age child? (Select all that apply.) a. Physical examinations proceed systematically from head to toe. b. The physical examination should be done with parents in the waiting room. c. Measurement of head circumference is obtained. d. The physical examination is done only when the child is cooperative. e. Remove clothing and have the child put on an examination gown.

ANS: A, D, E Physical assessment usually proceeds from head to toe; however, if developmental delays exist, considerations dictate that the least threatening assessments be done first to obtain accurate data. School-age children are at a developmental stage when they should be cooperative for the physical examination. Children of this age are usually modest, and an examination gown should be provided. Having parents in the examining room with adolescents is not appropriate, but it is appropriate for children of other age-groups. Parents usually are not kept in the waiting room. Measurement of head circumference is obtained on children 36 months of age or less.

3. The nurse is teaching a community group about preventing sudden infant death syndrome (SIDS). What information does the nurse provide? (Select all that apply.) a. Placing the baby supine to sleep b. Covering the baby warmly with blankets c. Have the baby sleep upright in the infant carrier d. Provide "tummy time" while awake e. Do not allow smoking in the house

ANS: A, D, E Recommendations to prevent SIDS include placing the baby supine in a crib with a well-fitting bottom sheet without covers or toys, providing tummy time during play, and avoiding exposure to environmental hazards such as smoke. The child should not be put to sleep in an infant carrier or covered warmly with blankets.

1. An emergency department nurse is making a general appearance assessment on a preschool child just admitted to the emergency department. Which general assessment findings indicate the child "looks bad"? (Select all that apply.) a. Color pale b. Capillary refill less than 2 seconds c. Unwilling to separate from parents d. Cold extremities e. Lethargic

ANS: A, D, E Signs of a child "looking bad" on a general appearance assessment include pale skin, cold extremities, and lethargy. A capillary refill of less than 2 seconds is a "good sign" as well as a child who is unwilling to separate from parents (separation anxiety, expected).

12. Which does the nurse teach as an appropriate disciplinary intervention for the school-age child? a. Time-out periods b. Consequences that are consistent with the behavior c. Physical punishment d. Lectures about inappropriate behavior

ANS: B A consequence that is related to the inappropriate behavior is the recommended discipline. Responsibility can be developed in children through the use of natural and logical consequences related to actions. Time-out periods are more appropriate for younger children. Physical intervention is an inappropriate form of discipline. It does not connect the discipline with the child's inappropriate behavior. Lengthy discussions typically are not helpful.

12. A nurse observes that parents discuss rules with their children when the children do not agree with the rules. Which style of parenting is being displayed? a. Autocratic b. Authoritative c. Permissive d. Disciplinarian

ANS: B A parent who discusses the rules with which children do not agree is using an authoritative parenting style. A parent who expects children to follow rules without questioning is using an authoritarian parenting style. A parent who does not consistently enforce rules and allows the child to decide whether he or she wishes to follow rules is using a permissive parenting style. A disciplinarian style would be similar to the authoritarian style.

12. Which nursing action is the most appropriate when applying a face mask to a child for oxygen therapy? a. The oxygen flow rate should be less than 6 L/min. b. Make sure the mask fits properly. c. Keep the child warm. d. Remove the mask for 5 minutes every hour.

ANS: B A properly fitting face mask is essential for adequate oxygen delivery. The oxygen flow rate should be greater than 6 L/min to prevent rebreathing of exhaled carbon dioxide. Oxygen delivery through a face mask does not affect body temperature. A face mask used for oxygen therapy is not routinely removed.

5. What is the appropriate nursing response to a parent who asks, "What should I do if my child cannot take a tablet?" a. "You can crush the tablet and put it in some food." b. "Find out if the medication is available in a liquid form." c. "If the child can't swallow the tablet, tell the child to chew it." d. "Let me show you how to get your child to swallow tablets."

ANS: B A tablet should not be crushed without knowing whether it will alter the absorption, effectiveness, release time, or taste. Therefore telling the parent to find out whether the medication is available in liquid form is the most appropriate response. A chewed tablet may have an offensive taste, and chewing it may alter its absorption, effectiveness, or release time. Forcing a child, or anyone, to swallow a tablet is not acceptable and may be dangerous.

9. Many adolescents decide to follow a vegetarian diet during their teen years. The nurse can advise the adolescent and his or her parents that a. this diet will not meet the nutritional requirements of growing teens. b. a vegetarian diet can be healthy for this population. c. an adolescent on a vegetarian diet is less likely to eat high-fat foods. d. a vegetarian diet requires little extra meal planning.

ANS: B A vegetarian diet is healthy for this population, and the low-fat aspect of the diet can prevent future cardiovascular problems. Several dietary organizations have suggested that a vegetarian diet, if correctly followed, is healthy for this population. As with any adolescent, nurses need to advise teens who follow a vegetarian eating plan to avoid low-nutrient, high-fat foods. The nurse can assist with planning food choices that will provide sufficient calories and necessary nutrients. The focus is on obtaining enough calories for growth and energy from a variety of fruits and vegetables, whole grains, nuts, and soymilk.

10. In which age-group does the child's active imagination during unfamiliar experiences increase the stress of hospitalization? a. Toddlers b. Preschoolers c. School-age children d. Adolescents

ANS: B Active imagination is a primary characteristic of preschoolers. A toddler's primary response to hospitalization is separation anxiety. School-age children experience stress with loss of control. Adolescents experience stress from separation from their peers.

1. Which statement by a school-age girl indicates the need for further teaching about the prevention of urinary tract infections (UTIs)? a. "I always wear cotton underwear." b. "I really enjoy taking a bubble bath." c. "I go to the bathroom every 3 to 4 hours." d. "I drink four to six glasses of fluid every day."

ANS: B Bubble baths should be avoided because they tend to cause urethral irritation, which leads to UTI. It is desirable to wear cotton rather than nylon underwear. Nylon tends to hold in moisture and promote bacterial growth, whereas cotton absorbs moisture. Children should be encouraged to urinate at least four times a day. An adequate fluid intake prevents the buildup of bacteria in the bladder.

27. A child has been brought to the emergency department with carbon monoxide poisoning. After the child is stabilized, what action by the nurse is best? a. Have all family members tested for carbon monoxide poisoning. b. Help family determine source of the carbon monoxide. c. Prepare to administer syrup of ipecac. d. Notify social services about the child's condition.

ANS: B After the child has been stabilized, the nurse should help the family brainstorm about the source of the carbon monoxide poisoning, which must be eliminated before the child goes home. The nurse may need to offer assistance to find companies that can help in this search or notify the local fire department for assistance. There is no indication that other family members need to be tested, but those who show signs of carbon monoxide poisoning should be. Syrup of ipecac is no longer used after an oral ingestion. Social services may or may not need to be notified.

7. Which child is most likely to be frightened by hospitalization? a. A 4-month-old infant admitted with a diagnosis of bronchiolitis b. A 2-year-old toddler admitted for cystic fibrosis c. A 9-year-old child hospitalized with a fractured femur d. A 15-year-old adolescent admitted for abdominal pain

ANS: B All children can be frightened by hospitalization. However, toddlers are most likely to be frightened by hospitalization because their thought processes are egocentric, magical, and illogical. They feel very threatened by unfamiliar people and strange environments. Young infants are not as likely to be as frightened as toddlers by hospitalization because they are not as aware of the environment. The 9-year-old child's cognitive ability is sufficient for the child to understand the reason for hospitalization. The 15-year-old adolescent has the cognitive ability to interpret the reason for hospitalization.

4. Which action should the nurse working in the emergency department implement in order to decrease fear in a 2-year-old child? a. Keep the child physically restrained during nursing care. b. Allow the child to hold a favorite toy or blanket. c. Direct the parents to remain outside the treatment room. d. Let the child decide whether to sit up or lie down for procedures.

ANS: B Allowing a child this age to hold a favorite toy or blanket is comforting. It may be necessary to restrain the toddler for some nursing care or procedures. Because toddlers need autonomy and do not respond well to restrictions, the nurse should remove any restriction or restraint as soon as safety permits. Parents should remain with the child as much as possible to calm and reassure her. The toddler should not be given the overwhelming choice of deciding which position she prefers. In addition, the procedure itself may dictate the child's position.

4. Which statement is the most appropriate advice to give parents of a 16-year-old who is rebellious? a. "You need to be stricter so that your teen stops trying to test the limits." b. "Try to collaborate to set limits that are perceived as being reasonable." c. "Increasing your teen's involvement with her peers will improve her behavior." d. "Allow your teenager to choose the type of discipline that is used in your home."

ANS: B Allowing teenagers to choose between realistic options and offering consistent and structured discipline typically enhances cooperation and decreases rebelliousness. Structure helps adolescents to feel more secure and assists them in the decision-making process. Setting stricter limits typically does not decrease rebelliousness or decrease testing of parental limits. Increasing peer involvement does not typically improve behavior. Allowing teenagers to choose the method of discipline is not realistic and typically does not reduce rebelliousness.

17. A young child with HIV is receiving several antiretroviral drugs. What is the purpose of these drugs? a. Cure the disease. b. Delay disease progression. c. Prevent the spread of disease. d. Treat Pneumocystis jiroveci pneumonia.

ANS: B Although not a cure, these antiviral drugs can suppress viral replication, preventing further deterioration of the immune system, and delay disease progression. At this time, cure is not possible. These drugs do not prevent the spread of the disease. Pneumocystis jiroveci prophylaxis is accomplished with antibiotics.

24. What condition does the nurse recognize as an early sign of distributive shock? a. Hypotension b. Skin warm and flushed c. Oliguria d. Cold, clammy skin

ANS: B An early sign of distributive shock is extremities that are warm to the touch. The child with distributive shock may have hypothermia or hyperthermia. Hypotension is a late sign of all types of shock. Oliguria is a manifestation of hypovolemic shock. Cold, clammy skin is a late sign of septic shock, which is a type of distributive shock.

2. Approximately how much would a newborn who weighed 7 pounds 6 ounces at birth weigh at 1 year of age? a. 14 3/4 lb b. 22 1/8 lb c. 29 1/2 lb d. Unable to estimate weigh at 1 year

ANS: B An infant triples birth weight by 1 year of age. The other calculations are incorrect.

19. The nursing student has planned teaching for a toddler parent group on poison prevention in the home. In reviewing the presentation with the nurse, what information requires the nurse to provide more instruction to the student? a. Lock all medications away securely. b. Place cleaning supplies in a top cabinet. c. Try not to let your child watch you take pills. d. Call Poison Control right away for an exposure.

ANS: B Anything potentially poisonous including things like medication, cleaning supplies, or personal care items must be stored in places completely inaccessible to children. Toddlers view climbing as a challenge, so a top cabinet is not inaccessible. The other instructions are appropriate.

29. Kelly, age 8 years, will soon be able to return to school after an injury that resulted in several severe, chronic disabilities. What action by the school nurse is most appropriate? a. Recommend that Kelly's parents attend school at first to prevent teasing. b. Prepare Kelly's classmates and teachers for changes they can expect. c. Refer Kelly to a school where the children have chronic disabilities similar to hers. d. Discuss the fact that her classmates will not accept her as they did before.

ANS: B Attendance at school is an important part of normalization for Kelly. The school nurse should prepare teachers and classmates about her condition, abilities, and special needs. A visit by the parents can be helpful, but unless the classmates are prepared for the changes, it alone will not prevent teasing. Kelly's school experience should be normalized as much as possible. Children need the opportunity to interact with healthy peers, as well as to engage in activities with groups or clubs composed of similarly affected persons. Children with special needs are encouraged to maintain and reestablish relationships with peers and to participate according to their capabilities.

9. Why is observation for 24 hours in an acute-care setting often appropriate for children? a. Longer hospital stays are more costly. b. Children become ill quickly and recover quickly. c. Children feel less separation anxiety when hospitalized for 24 hours. d. Families experience less disruption during short hospital stays.

ANS: B Children become ill quickly and recover quickly; therefore they can require acute care for a shorter period of time. A child's state of wellness, rather than cost, determines the length of stay. Separation anxiety is primarily a factor of the stage of development, not the length of hospital stay. Family disruption is a secondary outcome of a child's hospitalization; it does not determine length of stay.

25. A parent of a child with asthma asks if his child can still participate in sports. What response by the nurse is best? a. "Children with asthma are usually restricted from physical activities." b. "Children can usually play any type of sport if their asthma is well controlled." c. "Avoid swimming because exhaling underwater is dangerous for people with asthma." d. "Even with good asthma control, I would advise limiting the child to one athletic activity per school year."

ANS: B Children can usually play any type of sport if their asthma is well controlled. Children with asthma should not be restricted from physical activity. Sports participation depends on each child's response to the activity. Swimming is recommended as the ideal sport for children with asthma because the air is humidified and exhaling underwater prolongs exhalation and increases end-expiratory pressure.

4. What corresponds to a 5-year-old child's understanding of death? a. Loss of a caretaker b. Reversible and temporary c. Permanent d. Inevitable

ANS: B Children in early childhood (2 to 7 years old) view death as reversible and temporary. Loss of a caretaker corresponds to the infant/toddler understanding of death. The school-age child and adolescent understand that death is permanent. The adolescent understands death not only as permanent but also inevitable.

20. A school nurse reports to the parents that their child is complaining of frequent headaches. What suggestion does the nurse offer to the parents? a. A complete neurologic workup b. A vision screening exam c. Decreased amount of household stress d. Assessment for seasonal allergies

ANS: B Children often manifest visual problems during the school-age period. These children may squint, move closer to the television or to the front of the class if possible, or complain of headaches. The parents should obtain a visual screening exam for their child. None of the other options is needed at this point.

12. You are the nurse caring for a 4-year-old child who has developed acute renal failure as a result of hemolytic-uremic syndrome (HUS). Which bacterial infection was most likely the cause of HUS? a. Pseudomonas aeruginosa b. Escherichia coli c. Streptococcus pneumoniae d. Staphylococcus aureus

ANS: B Children with HUS become infected by Escherichia coli, which is usually contracted from eating improperly cooked meat or contaminated dairy products. Pseudomonas aeruginosa, Streptococcus pneumoniae, and Staphylococcus aureus are not associated with HUS.

6. How can chronic illness and frequent hospitalizations affect the psychosocial development of a toddler? a. They can create a distortion or differentiation of self from parent. b. They can interfere with the development of autonomy. c. They can interfere with the acquisition of language, fine motor, and self-care skills. d. They can create feelings of inadequacy.

ANS: B Chronic illness may interfere in the development of autonomy, which is the major psychosocial task of the toddler. The infant with a chronic illness may have distortion of differentiation of self from parents. Chronic illness with frequent hospitalizations can inhibit the acquisition of language, motor, and self-care skills in the preschool-age child. Feelings of inadequacy and inferiority can occur if independence is compromised by chronic illness in the school-age child.

1. What is the best response by the nurse to a mother asking about the cause of her infant's bilateral cleft lip? a. "Did you use alcohol during your pregnancy?" b. "Does anyone in your family have a cleft lip or palate?" c. "This defect is associated with intrauterine infection during the second trimester." d. "The prevalent of cleft lip is higher in Caucasians."

ANS: B Cleft lip and palate result from embryonic failure resulting from multiple genetic and environmental factors. A genetic pattern or familial risk seems to exist. Tobacco during pregnancy (not drinking) has been associated with bilateral cleft lip. The defect occurred at approximately 6 to 8 weeks of gestation. Second-trimester intrauterine infection is not a known cause of bilateral cleft lip. The prevalence of cleft lip and palate is higher in Asian and Native American populations.

6. A nurse has been teaching a parent of a toddler about effective discipline. Which statement by the parent indicates that goals for teaching have been met? a. "I always include explanations and morals when I am disciplining my toddler." b. "I always try to be immediate and consistent when disciplining the children." c. "I believe that discipline should be done by only one family member." d. "My rule of thumb is no more than one spanking a day."

ANS: B Consistent and immediate discipline for toddlers is the most effective approach. Unless disciplined immediately, the toddler will have difficulty connecting the discipline with the behavior. The toddler's cognitive level of development precludes the use of explanations and morals as a part of discipline. Discipline for the toddler should be immediate; therefore the family member caring for the child should provide discipline to the toddler when it is necessary. Discipline is required for unacceptable behavior, and the one-spanking-a-day rule contradicts the concept of a consistent response to inappropriate behavior. In addition, spanking is an inappropriate method of disciplining a child.

14. Which assessment finding should the nurse expect in an infant with Hirschsprung disease? a. "Currant jelly" stools b. Constipation with passage of foul-smelling, ribbon-like stools c. Foul-smelling, fatty stools d. Diarrhea

ANS: B Constipation results from absence of ganglion cells in the rectum and colon and is present since the neonatal period with passage of frequent foul-smelling, ribbon-like, or pellet-like stools. "Currant jelly" stools are associated with intussusception. Foul-smelling, fatty stools are associated with cystic fibrosis and celiac disease. Diarrhea is not typically associated with Hirschsprung disease but may result from impaction.

2. When pain is assessed in an infant, it is inappropriate to assess for a. facial expressions of pain. b. localization of pain. c. crying. d. thrashing of extremities.

ANS: B Infants cannot localize pain to any great extent. Frowning, grimacing, and facial flinching in an infant may indicate pain. Infants often exhibit high-pitched, tense, harsh crying to express pain. Infants may exhibit thrashing extremities in response to a painful stimulus.

3. Which statement made by a mother is consistent with a developmental delay? a. "I notice my 9-month-old infant responds consistently to his name." b. "My 12-month-old child does not get herself to a sitting position or pull to stand." c. "I am so happy when my 1 1/2-month-old infant smiles at me." d. "My 5-month-old infant is not rolling over in both directions yet."

ANS: B Critical developmental milestones for gross motor development in a 12-month-old include standing briefly without support, getting to a sitting position, and pulling to stand. If a 12-month-old child does not perform these activities, it may be indicative of a developmental delay. An infant who responds to his name at 9 months of age is demonstrating abilities to both hear and interpret sound. A social smile is present by 2 months of age. Rolling over in both directions is not a critical milestone for gross motor development until the child reaches 6 months of age.

34. Which statement made by a parent indicates an understanding about the genetic transmission of cystic fibrosis (CF)? a. "Only one parent carries the cystic fibrosis gene." b. "Both parents are carriers of the cystic fibrosis gene." c. "The presence of the disease is most likely the result of a genetic mutation." d. "The mother is usually the carrier of the cystic fibrosis gene."

ANS: B Cystic fibrosis follows a pattern of autosomal recessive transmission. Both parents must be carriers of the gene for the disease to be transmitted to the child. If both parents carry the CF gene, each pregnancy has a 25% chance of producing a CF-affected child. The disease will not be present if only one parent is a carrier of the cystic fibrosis gene. Cystic fibrosis is known to have a definite pattern of transmission. It is transmitted as an autosomal recessive trait. A carrier parent can transmit the carrier gene to the child. The disease is present when the carrier gene is transmitted from both parents.

17. A child has irritable bowel syndrome. The nurse is teaching the parents about the pathophysiology associated with the symptoms their child is experiencing. Which response indicates to the nurse that teaching has been effective? a. "My child has an absence of ganglion cells in the rectum causing alternating diarrhea and constipation." b. "The cause of my child's diarrhea and constipation is disorganized intestinal contractility." c. "My child has an intestinal obstruction; that's why he has abdominal pain." d. "My child has an intolerance to gluten, and this causes him to have abdominal pain."

ANS: B Disorganized contractility and increased mucous production are precipitating factors of irritable bowel disease. The absence of ganglion cells in the rectum is associated with Hirschsprung disease. Intestinal obstruction is associated with pyloric stenosis. Intolerance to gluten is the underlying cause of celiac disease.

2. Which behavior suggests appropriate psychosocial development in the adolescent? a. The adolescent seeks validation for socially acceptable behavior from older adults. b. The adolescent is self-absorbed and self-centered and has sudden mood swings. c. Adolescents move from peers and enjoy spending time with family members. d. Conformity with the peer group increases in late adolescence.

ANS: B During adolescence, energy is focused within. Adolescents concentrate on themselves in an effort to determine who they are or who they will be. Adolescents are likely to be impulsive and impatient. Parents often describe their teenager as being "self-centered or lazy." The peer group validates acceptable behavior during adolescence. Adolescents move from family and enjoy spending time with peers. Adolescents also spend time alone; they need this time to think and concentrate on themselves. Conformity becomes less important in late adolescence.

11. A nurse is caring for a child diagnosed with septic shock. He develops a dysrhythmia and hemodynamic instability. Endotracheal intubation is necessary. The physician feels that cardiac arrest may soon develop. What drug do you anticipate the physician will order? a. Atropine sulfate b. Epinephrine c. Sodium bicarbonate d. Inotropic agents

ANS: B Epinephrine is the drug of choice for the management of cardiac arrest, dysrhythmias, and hemodynamic instability. Atropine sulfate is used to treat symptomatic bradycardia. Sodium bicarbonate is given to treat severe acidosis associated with cardiac arrest. Inotropic agents are indicated for hypotension or poor peripheral circulation in a child.

8. A nurse uses Erikson's theory to guide nursing practice. What action by a hospitalized 4-year-old child would the nurse evaluate as developmentally appropriate? a. Dressed and fed by the parents b. Independently ask for play materials or other personal needs c. Verbalizes an understanding of the reason for the hospitalization d. Asks for a parent stay in the room at all times

ANS: B Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrates developmental appropriateness. Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior. A 4-year-old child cannot be expected to cognitively understand the reason for hospitalization. Expecting the child to verbalize an understanding for hospitalization is an inappropriate outcome. Parents staying with the child throughout a hospitalization is not a developmental outcome. Although children benefit from parental involvement, parents may not have the support structure to stay in the room with the child at all times.

22. Maternity nursing care that is based on knowledge gained through research is known as a. nurse-sensitive indicators. b. evidence-based practice. c. case management. d. outcomes management.

ANS: B Evidence-based practice is based on knowledge gained from research and clinical trials. Nurse-sensitive indicators are patient care outcomes particularly dependent on the quality and quantity of nursing care provided. Case management is a practice model that uses a systematic approach to identify specific patients, determine eligibility for care, and arrange access to services. The determination to lower health care costs while maintaining the quality of care has led to a clinical practice model known as outcomes management.

21. A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. What response by the nurse is best? a. "That's OK. formula is just as good for a 5-month-old." b. "Be sure to use an iron-fortified formula instead." c. "The baby will need immunizations earlier now." d. "Be sure to monitor how many diapers the baby wets."

ANS: B For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, then iron-fortified commercial formula should be used. There is no need to provide immunizations on a different schedule or specific reason for monitoring wet diapers.

10. What action is correct when administering ear drops to a 2-year-old child? a. Administer the ear drops straight from the refrigerator. b. Pull the pinna of the ear back and down. c. Massage the pinna after administering the medication. d. Pull the pinna of the ear back and up.

ANS: B For children younger than 3 years, the pinna, or lower lobe, of the ear should be pulled back and down to straighten the ear canal. Medication should be at room temperature because cold solutions in the ear will cause pain. The tragus, not the pinna, of the ear should be massaged to ensure that the drops reach the tympanic membrane. For children younger than 3 years, the pinna of the ear should be pulled back and down to straighten the ear canal.

8. What is an appropriate intervention for a child with nephrotic syndrome who is edematous? a. Teach the child to minimize body movements. b. Change the child's position every 2 hours. c. Avoid the use of skin lotions. d. Bathe every other day.

ANS: B Frequent position changes decrease pressure on body parts and help relieve edema in dependent areas. The child with edema is at risk for impaired skin integrity. It is important for the child to change position frequently to prevent skin breakdown. Good skin hygiene consists of daily baths to remove irritating body secretions and applying lotion.

26. What is the most important action to prevent the spread of gastroenteritis in a daycare setting? a. Administering prophylactic medications to children and staff b. Frequent hand washing c. Having parents bring food from home d. Directing the staff to wear gloves at all times

ANS: B Handwashing is the most the important measure to prevent the spread of infectious diarrhea. Prophylactic medications are not helpful in preventing gastroenteritis. Bringing food from home will not prevent the spread of infectious diarrhea. Gloves should be worn when changing diapers, soiled clothing, or linens. They do not need to be worn for interactions that do not involve contact with secretions. Handwashing after contact is indicated.

31. The nurse is caring for an infant with bronchopulmonary dysplasia (BPD) who has RSV. Which treatment measure does the nurse prepare to provide? a. Pancreatic enzymes b. Cool humidified oxygen c. Erythromycin intravenously d. Intermittent positive pressure ventilation

ANS: B Humidified oxygen is delivered if the oxygen saturation level drops to less than 90%. Pancreatic enzymes are used for patients with cystic fibrosis. Antibiotics are ineffective against viral illnesses. Assisted ventilation is not necessary in the treatment of RSV infections.

9. Parents of a 4-year-old child are concerned because the child continues to stutter. What nursing intervention is correct? a. Remind the parents that stuttering is normal in children younger than 10 years. b. Facilitate a speech evaluation performed if the stuttering continues beyond age 5 years. c. Reinforce the fact that this common speech defect requires no treatment. d. Tell the parents that speech problems are most treatable during the child's teen years.

ANS: B If stuttering persists after 5 years of age, the child should be seen by the physician and referred to a speech therapist. Stuttering is not normal after age 5 years. Early diagnosis and intervention are important to correct speech disorders.

4. The nurse is planning how to prepare a 4-year-old child for some diagnostic procedures. Guidelines for preparing this preschooler should include a. planning for a short teaching session of about 30 minutes. b. telling the child that procedures are never a form of punishment. c. keeping equipment out of the child's view. d. using correct scientific and medical terminology in explanations.

ANS: B Illness and hospitalization may be viewed as punishment in preschoolers. Always state directly that procedures are never a form of punishment. Teaching sessions for this age-group should be much shorter in length. Demonstrate the use of equipment, and allow the child to play with miniature or actual equipment. Explain the procedure in simple terms and how it affects the child.

17. The nurse inspecting the skin of a dark-skinned child notices an area that is a dusky red or violet color. This skin coloration is associated with what? a. Cyanosis b. Erythema c. Vitiligo d. Nevi

ANS: B In dark-skinned children, erythema appears as dusky red or violet skin coloration. Cyanosis in a dark-skinned child appears as a black coloration of the skin. Vitiligo refers to areas of depigmentation. Nevi are areas of increased pigmentation.

18. Parents tell the nurse that their preschool-age child seems to have an imaginary friend named Bob. Whenever their child is scolded or disciplined, the child in turn scolds Bob. What response by the nurse is most appropriate? a. Ask the child to introduce Bob when the parents are not present. b. Inform the parents that this is normal behavior in this age group. c. Suggest the parents discuss the situation with the provider. d. Refer the child for hearing and vision screening.

ANS: B In the early preschool years, boundaries between reality and fantasy blur. Children at the age may develop imaginary friends who can keep them company or take the blame when the child misbehaves. The nurse informs the parents that this is normal behavior. The child likely will not "introduce" Bob to a stranger. The nurse him- or herself needs to provide this anticipatory guidance and not just suggest the parents talk to the provider. There is no reason for sensory screening.

1. Which nursing action facilitates care being provided to a child in an emergency situation? a. Encourage the family to remain in the waiting room. b. Include parents as partners in providing care for the child. c. Always reassure the child and family. d. Give explanations using professional terminology.

ANS: B Include parents as partners in the child's treatments. Parents may need direct guidance in concrete terms to help distract the child. Allowing the parents to remain with the child may help calm the child. Telling the truth is the most important thing. False reassurance does not facilitate a trusting relationship. Professional terminology may not be understood. Speak to the child and family in language that they will understand.

4. Which factor should the nurse remember when administering topical medication to an infant as compared with an adolescent? a. Infants require a larger dosage because of a greater body surface area. b. Infants have a thinner stratum corneum that absorbs more medication. c. Infants have a smaller percentage of muscle mass. d. The skin of infants is less sensitive to allergic reactions.

ANS: B Infants and young children have a thinner outer skin layer (stratum corneum), which increases the absorption of topical medication. A similar dose of a topical medication administered to an infant compared with an adult is approximately three times greater in the infant because of the greater body surface area. The smaller muscle mass in infants affects site selection for injected medications but should not affect administration of topical medications. The young child's skin is more prone to irritation, making contact dermatitis and other allergic reactions more common.

25. The nurse should suspect a hearing impairment in an infant who demonstrates which of the following? a. Absence of intelligible speech by 12 months b. Cessation of babbling at age 7 months c. Lack of eye contact when being spoken to d. Lack of gesturing to indicate wants after age 15 months

ANS: B Infants who are deaf babble like hearing infants until approximately 5 to 6 months of age, at which time babbling is noted to cease. Failure to develop intelligible speech is not considered a problem by 12 months. This would be considered a problem at 24 months. The lack of a startle reflex indicates a problem with hearing. The child with hearing impairment uses gestures rather than vocalizations to express desires at this age.

15. What should be included in health teaching to prevent Lyme disease? a. Complete the immunization series in early infancy. b. Use insect repellant with DEET in heavily wooded areas. c. Give low-dose antibiotics to the child before exposure. d. Restrict activities that might lead to exposure for the child.

ANS: B Insect repellant with DEET can prevent insect bites. Currently there is no vaccine available for Lyme disease. Antibiotics are used to treat, not prevent, Lyme disease. Children should be allowed to maintain normal growth and development with activities such as hiking.

21. In preparing to give enemas to a 4-year-old child, what action by the nurse is best? a. Use tap water. b. Only use normal saline. c. Insert the tip of the tube at least 3 inches. d. Instill 120 to 240 mL of solution.

ANS: B Isotonic solutions should be used in children. Saline is the solution of choice. Plain water is not used. This is a hypotonic solution and can cause fluid and electrolyte disturbances. The tip of the tubing should be inserted 3 inches (7.5 cm) maximum. 240 to 360 mL is appropriate for this age group.

12. The mother of a 10-month-old infant tells the nurse that her infant "really likes cow's milk." What is the nurse's best response to this mother? a. "Milk is a nutritious choice at this time." b. "Children should not get cow's milk until 1 year of age." c. "Limit cow's milk to one bedtime bottle." d. "Mix cereal with cow's milk and feed it in a bottle."

ANS: B It is best to wait until the infant is at least 1 year old before giving him cow's milk because of the risk of allergies and intestinal problems. Cow's milk protein intolerance is the most common food allergy during infancy. Although milk is a good source of calcium and protein for children after the first year of life, it is not the best source of nutrients for children younger than 1 year old. Bedtime bottles of formula or milk are contraindicated because of their high sugar content, which leads to dental decay in primary teeth. Food and milk or formula should not be mixed in a bottle.

30. A nurse is assessing lab results on four patients in the general pediatric unit. What child should the nurse go see first? a. Urine specific gravity: 1.025 b. Urine ketones: positive in large amounts c. Serum BUN 21 mg/dL d. Serum creatinine 0.7 mg/dL

ANS: B Ketones should not be present in the urine. When found, they are indicative of starvation, diabetic ketoacidosis, fever, prolonged vomiting, anorexia, and severe diarrhea. The nurse should see this child first. The other lab values are normal.

14. What should the nurse expect to observe in the prodromal phase of rubeola? a. Macular rash on the face b. Koplik spots c. Petechiae on the soft palate d. Crops of vesicles on the trunk

ANS: B Koplik spots appear approximately 2 days before the appearance of a rash. The macular rash with rubeola appears after the prodromal stage. Petechiae on the soft palate occur with rubella. Crops of vesicles on the trunk are characteristic of varicella.

14. What is the primary nursing concern for a child having an anaphylactic reaction? a. Identifying the offending allergen b. Ineffective breathing pattern c. Increased cardiac output d. Positioning to facilitate comfort

ANS: B Laryngospasms resulting in ineffective breathing patterns is a life-threatening manifestation of anaphylaxis. The primary action is to assess airway patency, respiratory rate and effort, level of consciousness, oxygen saturation, and urine output. Determining the cause of an anaphylactic reaction is important to implement the appropriate treatment, but the primary concern is the airway. During anaphylaxis, the cardiac output is decreased. Positioning for comfort is not a primary concern during a crisis.

21. Which statement indicates that a parent of a toddler needs more education about preventing foreign body aspiration? a. "I keep objects with small parts out of reach." b. "My toddler loves to play with balloons." c. "I won't permit my child to have peanuts." d. "I never leave coins where my child could get them."

ANS: B Latex balloons account for a significant number of deaths from aspiration every year. The other statements show good understanding.

22. A parent wants to know why acetaminophen should only be given for 2 days for a fever without checking with the provider. What response by the nurse is best? a. Acetaminophen is a dangerous drug with bad side effects. b. Long-term acetaminophen use can cause liver damage. c. There may be better fever relievers you could use. d. What if there were something seriously wrong with your child?

ANS: B Long-term use of acetaminophen can lead to liver damage. It is not a particularly dangerous drug and, like all drugs, has side effects. The provider needs to see the child to determine if something is more seriously wrong, but this statement sounds like a threat. There may be other medications the parent could try, but the main concern is liver damage.

40. The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include which of the following? a. Forcing fluids b. Monitoring pulse oximetry c. Instituting seizure precautions d. Encouraging a high-protein diet

ANS: B Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. Maintenance of vascular volume and hydration is important and should be done parenterally. Seizures are not a side effect of ARDS. Adequate nutrition is necessary, but a high-protein diet is not helpful.

7. What characteristic would most likely be found in a Mexican-American family? a. Stoicism b. Close extended family c. Considering docile children weak d. Very interested in health-promoting lifestyles

ANS: B Most Mexican-American families are very close, and it is not unusual for children to be surrounded by parents, siblings, grandparents, and godparents. It is important to respect this cultural characteristic and to see it as a strength, not a weakness. Although stoicism may be present in any family, Mexican-American families tend to be more expressive. Considering docile children weak is a characteristic of Native Americans. Although everyone tends now to embrace more health-promoting lifestyles, they are more prominent in Anglo-Americans.

11. A mother of a 2-month-old infant tells the nurse, "My child doesn't sleep as much as his older brother did at the same age." What is the best response for the nurse? a. "Have you tried to feed the baby more often or play more before bedtime?" b. "Infant sleep patterns vary widely, some infants sleep only 2 to 3 hours at a time." c. "Keep a record of your baby's eating, waking, sleeping, and elimination patterns and to come back to discuss them." d. "This infant is difficult. It is important for you to identify what is bothering the baby."

ANS: B Newborn infants may sleep as much as 17 to 20 hours per day. Sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time. Infants typically do not need more caloric intake to improve sleep behaviors. Stimulating activities before bedtime may keep the baby awake. There is no need for the mother to keep behavior records. Just because an infant may not sleep as much as a sibling did does not justify labeling the child as being difficult. Identifying an infant as difficult without identifying helpful actions is not a therapeutic response for a parent concerned about sleep.

4. What myth may interfere with the treatment of pain in infants and children? a. Infants may have sleep difficulties after a painful event. b. Children and infants are more susceptible to respiratory depression from narcotics. c. Pain in children is multidimensional and subjective. d. A child's cognitive level does not influence the pain experience.

ANS: B No data are available to support the belief that infants and children are at higher risk of respiratory depression when given narcotic analgesics. This is a myth. It is true that infants may have sleep difficulties after a painful event. This is not a myth. Pain in children is multidimensional and subjective. The child's cognitive level, along with emotional factors and past experiences, does influence the perception of pain in children. This is not a myth.

19. The nurse is assessing a 4-year-old child's visual acuity. The results indicate a visual acuity of 20/40 in both eyes. The child's father asks the nurse about his son's results. Which response, if made by the nurse, is correct? a. "Your child will need a referral to the ophthalmologist before he can attend preschool next week." b. "Your child's visual acuity is normal for his age." c. "The results of this test indicate your child may be color blind." d. "Your child did not pass; he will need to see an eye doctor."

ANS: B Normal visual acuity for a 4-year-old is 20/40 to 20/50. This finding is normal. No other action is needed.

3. Which nursing intervention is an independent (nurse-driven) function of the nurse? a. Administering oral analgesics b. Teaching the woman perineal care c. Requesting diagnostic studies d. Providing wound care to a surgical incision

ANS: B Nurses are responsible for various independent functions, including teaching, counseling, and intervening in nonmedical problems. Interventions initiated by the physician and carried out by the nurse are called dependent functions. Administering oral analgesics is a dependent function; it is initiated by a physician or other provider and carried out by the nurse. Requesting diagnostic studies is a dependent function. Providing wound care is a dependent function; it is usually initiated by the physician or other provider through direct orders or protocol.

10. What intervention can be taught to the parents of a 3-year-old child with pneumonia who is not hospitalized? a. Offer the child only cool liquids. b. Offer the child favorite warm liquid drinks. c. Use a warm mist humidifier. d. Report a respiratory rate less than 28 breaths/min.

ANS: B Offering the child favorite fluids will facilitate oral intake. Warm liquids help loosen secretions. A humidifier may or may not be helpful. Typically parents are not taught to count their children's respirations and report abnormalities to the physician. Even if this were the case, a respiratory rate of less than 28 breaths/min is normal for a 3-year-old child. The expected respiratory rate for a 3-year-old child is 20 to 30 breaths/min.

19. Which question most likely elicits information about how a family is coping with a child's hospitalization? a. "Was this admission an emergency?" b. "How has your child's hospitalization affected your family?" c. "Who is taking care of your other children while you are here?" d. "Is this the child's first hospitalization?"

ANS: B Open-ended questions encourage communication. Ensuring a positive outcome from the hospital experience can be optimized by the nurse addressing the health needs of family members, as well as the needs of the child. Asking closed-ended questions inhibits communication.

19. The nurse comes into the room of a child who was just diagnosed with a chronic disability. The child's parents begin to yell at the nurse about a variety of concerns. The nurse's best response is a. "What is really wrong?" b. "Being angry is only natural." c. "Yelling at me will not change things." d. "I will come back when you settle down."

ANS: B Parental anger after the diagnosis of a child with a chronic disability is a common response. One of the most common targets for parental anger is members of the staff. The nurse should recognize the common response of anger to the diagnosis and allow the family to ventilate. The other responses do not validate the parents' feelings and concerns and may hamper a therapeutic nurse-family relationship.

4. Which family will most likely have the most difficulty coping with a seriously ill child? a. A single-parent mother who has the support of her parents and siblings b. Parents who have just moved to the area and have not yet found health care providers c. The family of a child who has had multiple hospitalizations related to asthma and has adequate relationships with the nursing staff d. A family in which there is a young child and four older married children who live in the area

ANS: B Parents in a new environment will have increased stress related to their lack of a support system. They have no previous experiences in the setting from which to draw confidence. Not only does this family not have friends or relatives to help them, they must find a provider when their child is seriously ill. Although only one parent is available, she has the support of her extended family, which will assist her in adjusting to the crisis. Because this family has had positive experiences in the past, family members can draw from those experiences and feel confident about the setting. This family has an extensive support system that will assist the parents in adjusting to the crisis.

17. The nurse wore gloves during a dressing change. When the gloves are removed, the nurse should a. wash hands thoroughly. b. check the gloves for leaks. c. use an alcohol-based hand rub. d. apply new gloves before touching the next patient.

ANS: C Evidence-based research has demonstrated that alcohol-based rubs are more effective for eliminating organisms. If the nurse's hands are clean, alcohol-based hand rubs are most appropriate. If hands are soiled, then soap and water are used. Gloves should be disposed of after use. Hands should be thoroughly cleaned before new gloves are applied.

15. What is an expected outcome for the parents of a child with encopresis? a. The parents will give the child an enema daily for 3 to 4 months. b. The family will develop a plan to achieve control over incontinence. c. The parents will have the child launder soiled clothes. d. The parents will supply the child with a low-fiber diet.

ANS: B Parents of the child with encopresis often feel guilty and believe that encopresis is willful on the part of the child. The family functions effectively by openly discussing problems and developing a plan to achieve control over incontinence. Stool softeners or laxatives, along with dietary changes, are typically used to treat encopresis. Enemas are indicated when a fecal impaction is present. This action is a punishment and will increase the child's shame and embarrassment. The child should not be punished for an action that is not willful. Increasing fiber in the diet and fluid intake results in greater bulk in the stool, making it easier to pass.

10. The intrapartum woman sees no need for a routine admission fetal monitoring strip. If she continues to refuse, what is the first action the nurse should take? a. Consult the family of the woman. b. Notify the provider of the situation. c. Document the woman's refusal in the nurse's notes. d. Make a referral to the hospital ethics committee.

ANS: B Patients must be allowed to make choices voluntarily without undue influence or coercion from others. The physician, especially if unaware of the patient's decision, should be notified immediately. Both professionals can work to ensure the mother understands the rationale for the action and the possible consequences of refusal. The woman herself is the decision maker, unless incapacitated. Documentation should occur but is not the first action. This situation does not rise to the level of an ethical issue so there is no reason to call the ethics committee.

20. The narrowing of preputial opening of foreskin is called a. chordee. b. phimosis. c. epispadias. d. hypospadias.

ANS: B Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

1. The parent of a 14-month-old child is concerned because the child's appetite has decreased. The best response for the nurse to make to the parent is, a. "It is important for your toddler to eat three meals a day and no snacks." b. "It is not unusual for toddlers to eat less due to slower growth." c. "Be sure to increase your child's milk consumption, which will improve nutrition." d. "Give your child a multivitamin daily to increase your toddler's nutrition."

ANS: B Physiologically, growth slows and appetite decreases during the toddler period. So the nurse should assure the parent that this is normal behavior. Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age-group. Milk consumption should not exceed 16 to 24 oz daily. Juice should be limited to 4 to 6 oz per day. Increasing the amount of milk will only further decrease solid food intake. Supplemental vitamins are important for all children, but they do not increase appetite.

6. A nurse wants to assess a chronically ill child's feelings regarding a lengthy hospitalization and treatments. What action by the nurse is best? a. Ask direct questions of the child as to feelings. b. Watch the child play on several occasions. c. Discuss the situation with the parents. d. Refer the child to the child life specialist for assessment.

ANS: B Play for all children is an activity woven with meaning and purpose. For chronically ill children, play can indicate their state of wellness and response to treatment. It is a way to express joy, fear, anxiety, and disappointments. The nurse can best decipher the child's emotional state by observing this activity. Children often are threatened by direct questions, especially if the questioner is not well known to the child. The nurse may want to discuss the situation with the parents or enlist the help of the child life specialist, but these will not give the nurse the rich data that can be obtained through watching the child play.

22. Which assessment finding is considered a neurologic soft sign in a 7-year-old child? a. Plantar reflex b. Poor muscle coordination c. Stereognostic function d. Graphesthesia

ANS: B Poor muscle coordination is a neurologic soft sign. The plantar reflex is a normal response. Stereognostic function refers to the ability to identify familiar objects placed in each hand. Graphesthesia is the ability to identify letters or numbers traced on the palm or back of the hand with a blunt point.

20. The feeling of guilt that the child "caused" the disability or illness is especially critical in which child? a. Toddler b. Preschooler c. School-age child d. Adolescent

ANS: B Preschoolers are most likely to be affected by feelings of guilt that they caused the illness/disability or are being punished for wrongdoings.

18. A child just returned from cataract eye surgery. What is the most significant nursing intervention to prevent increasing intraocular pressure in this child? a. Monitor for hypertension. b. Prevent coughing and vomiting. c. Lower the head of the bed slightly. d. Avoid use of steroids after the surgery.

ANS: B Preventing coughing, straining, vomiting, and touching the operative site are all measures directed toward avoiding increased intraocular pressure. Hypertension is not a symptom of increased intraocular pressure. The head of the bed should be raised slightly. Steroids, antibiotics, and mydriatics may be used after the surgery.

10. How should the nurse respond to a parent who asks, "How can I protect my baby from whooping cough?" a. "Don't worry; your baby will have maternal immunity to pertussis that will last until approximately 18 months old." b. "Make sure your child gets the pertussis vaccine." c. "See the doctor when the baby gets a respiratory infection." d. "Have your pediatrician prescribe erythromycin."

ANS: B Primary prevention of pertussis can be accomplished through administration of the pertussis vaccine. Infants do not receive maternal immunity to pertussis and are susceptible to pertussis. Pertussis is highly contagious and is associated with a high infant mortality rate. Prompt evaluation by the primary care provider for respiratory illness will not prevent pertussis. Erythromycin is used to treat pertussis. It will not prevent the disease.

16. What does the nurse learn that predisposes the adolescent to feel an increased need for sleep? a. An inadequate diet b. Rapid physical growth c. Decreased activity d. Typical lack of ambition

ANS: B Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contributes to fatigue in this population. It is not due to dietary factors, decreased activity, or lack of ambition.

28. Which statement is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. It is preferred means of renal replacement therapy in children. c. Children can receive kidneys only from other children. d. The decision is difficult, since a normal lifestyle is not possible.

ANS: B Renal transplant offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease. It can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes. Renal transplantation affords the child a more normal lifestyle than dependence on dialysis.

6. Which is the Centers for Disease Control and Prevention (CDC, 2009) recommendation for immunizing infants who are HIV positive? a. Follow the routine immunization schedule. b. Routine immunizations are administered; assess CD4+ counts before administering the MMR and varicella vaccinations. c. Do not give immunizations because of the infant's altered immune status. d. Eliminate the pertussis vaccination because of the risk of convulsions.

ANS: B Routine immunizations are appropriate. CD4+ cells are monitored when deciding whether to provide live virus vaccines. If the child is severely immunocompromised, the MMR vaccine is not given. The varicella vaccine can be considered on the basis of the child's CD4+ counts. Only inactivated polio virus (IPV) should be used for HIV-infected children. The pertussis vaccination is not eliminated for an infant who is HIV positive.

3. Based on concepts related to the normal growth and development of children, which child would have the most difficulty with separation from family during hospitalization? a. A 5-month-old infant b. A 15-month-old toddler c. A 4-year-old child d. A 7-year-old child

ANS: B Separation is the major stressor for children hospitalized between ages 6 and 30 months. Infants younger than 6 months of age will generally adapt to hospitalization if their basic needs for food, warmth, and comfort are met. Although separation anxiety occurs in hospitalized preschoolers, it is usually less obvious and less serious than that experienced by the toddler. The school-age child is accustomed to separation from parents. Although hospitalization is a stressor, the 7-year-old child will have less separation anxiety than a 15-month-old toddler.

25. A child with a serious, chronic illness is hospitalized frequently. The parents are worried about the child's growth and development. What action by the nurse is best? a. Tell parents developmental delays are likely in this case. b. Make a referral to the play therapist for therapeutic play. c. Encourage the child to perform age-appropriate activities. d. Ask the parents if they want a child psychology referral.

ANS: B Since developmental delay is a high risk in this situation, the nurse consults with the play therapist for therapeutic play interventions. Encouraging age-appropriate activities is always important but does not address this concern. The child may need a psychology referral, but that is not the first step. Telling parents that delays are likely in this case is discouraging and does not offer any positive solutions.

41. A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. What should the nurse suggest to minimize reflux? a. Place in the Trendelenburg position after eating. b. Thicken formula with rice cereal. c. Give continuous nasogastric tube feedings. d. Give larger, less frequent feedings.

ANS: B Small frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula have been recommended. Milk thickening agents have been shown to decrease the number of episodes of vomiting and to increase the caloric density of the formula. This may benefit infants who are underweight as a result of GERD. Placing the child in a Trendelenburg position increases the reflux. Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive. Smaller, more frequent feedings are recommended in reflux.

7. The parent of a toddler calls the nurse, asking about croup. What is a distinguishing manifestation of spasmodic croup? a. Wheezing is heard audibly. b. It has a harsh, barky cough. c. It is bacterial in nature. d. The child has a high fever.

ANS: B Spasmodic croup is viral in origin; is usually preceded by several days of symptoms of upper respiratory tract infection; often begins at night; and is marked by a harsh, metallic, barky cough, sore throat, inspiratory stridor, and hoarseness. Wheezing is not a distinguishing manifestation of croup. It can accompany conditions such as asthma or bronchiolitis. Spasmodic croup is viral in origin. A high fever is not usually present.

10. Which is assessed with Tanner staging? a. Hormone levels b. Secondary sex characteristics c. Growth hormone secretion d. Hyperthyroidism

ANS: B Tanner stages are used to assess staging of secondary sex characteristics at puberty. Hormone levels are assessed by their concentration in the blood. Growth hormone secretion tests are not associated with Tanner staging. Tanner stages are not associated with hyperthyroidism.

15. A nurse in the pediatric critical care unit assesses a child for pain using the COMFORT behavior scale. The child scores a 25. What action by the nurse is most appropriate? a. Ask a parent if the child is in pain. b. Medicate the patient for pain. c. Document and reassess in 4 hours. d. Notify the provider.

ANS: B The COMFORT behavior scale assesses pain behavior in 6 categories. Each category is scored on a scale of 1 to 5, with the higher numbers indicating more pain. A score of 25 indicates severe pain, and the nurse should medicate the child. Asking the parent if the child is in pain is unnecessary. Of course all actions and assessments should be documented, but the nurse needs to provide pain relief. Notifying the provider is not needed unless pain control cannot be achieved.

7. Which chart should the nurse use to assess the visual acuity of an 8-year-old child? a. Lea chart b. Snellen chart c. HOTV chart d. Tumbling E chart

ANS: B The Snellen chart is used to assess the vision of children older than 6 years of age. The Lea chart tests vision using four different symbols designed for use with preschool children. The HOTV chart tests vision by using graduated letters and is designed for use with children ages 3 to 6 years. The tumbling E chart uses the letter E in various directions and is designed for use with children ages 3 to 6 years.

11. Having explanations for all procedures and selecting their own meals from hospital menus is an important coping mechanism for which age-group? a. Toddlers b. Preschoolers c. School-age children d. Adolescents

ANS: C School-age children are developmentally ready to accept detailed explanations. School-age children can select their own menus and become actively involved in other areas of their care. Toddlers need routine and parental involvement for coping. Preschoolers need simple explanations of procedures. Detailed explanations and support of peers help adolescents cope.

11. A nurse is assessing an older school-age child recently admitted to the hospital. Which assessment does the nurse perform to determine if child is in an appropriate stage of cognitive development? a. Give the child a collection of similar objects, and ask him or her to organize them. b. Ask the child to perform a series of math problems using subtraction. c. Determine the child's vocabulary and reading comprehension. d. Find out what play activities the child enjoys engaging in.

ANS: B The ability to classify things from simple to complex and the ability to identify differences and similarities are cognitive skills of the older school-age child; this demonstrates use of classification and logical thought processes. The emergency of this ability explains why children of this age enjoy collecting things. Subtraction and addition are appropriate cognitive activities for the young school-age child. Vocabulary is not as valid an assessment of cognitive ability as is the child's ability to classify. Play activity is not as valid an assessment of cognitive function as is the child's ability to classify.

14. A student nurse is preparing to administer an Hib vaccination to an infant. What action by the student requires the registered nurse to intervene? a. Gives the vaccine information statement prior to administering the vaccine b. Wipes the dorsal gluteal area with alcohol prior to injection c. Obtains written informed consent before giving the vaccine d. Assesses the family's beliefs and values about vaccinations

ANS: B The anterolateral thigh is the preferred site for intramuscular administration of vaccines for infants. When the student prepares the wrong site, the registered nurse should intervene. Federal law requires parents be given vaccine information statements and sign informed consent prior to the nurse's administering vaccinations. The nurse should also assess the family's beliefs and values related to vaccination, which can help dispel myths and guide teaching.

18. An important nursing consideration when performing a bladder catheterization on a young child is to a. use clean technique, not Standard Precautions. b. insert 2% lidocaine lubricant into the urethra. c. lubricate catheter with water-soluble lubricant such as K-Y Jelly. d. delay catheterization for 20 minutes while anesthetic lubricant is absorbed.

ANS: B The anxiety, fear, and discomfort experienced during catheterization can be significantly decreased by preparation of the child and parents, by selection of the correct catheter, and by appropriate technique of insertion. Generous lubrication of the urethra before catheterization and use of lubricant containing 2% lidocaine may reduce or eliminate the burning and discomfort associated with this procedure. Catheterization is a sterile procedure. Water-soluble lubricants do not provide appropriate local anesthesia. Catheterization should be delayed only 2 to 3 minutes. This provides sufficient local anesthesia for the procedure.

7. A 17-year-old tells the nurse that he is not having sex because it would make his parents very angry. This response indicates that the adolescent has a developmental lag in which area? a. Cognitive development b. Moral development c. Psychosocial development d. Psychosexual development

ANS: B The appropriate moral development for a 17-year-old would include evidence that the teenager has internalized a value system and does not depend on parents to determine right and wrong behaviors. Adolescents who remain concrete thinkers may never advance beyond conformity to please others and avoid punishment. Cognitive development is related to moral development, but it is not the pivotal point in determining right and wrong behaviors. Identity formation is the psychosocial development task. Energy is focused within the adolescent, who exhibits behavior that is self-absorbed and egocentric. Although a task during adolescence is the development of a sexual identity, the teenager's dependence on the parents' sanctioning of right or wrong behavior is more appropriately related to moral development.

3. In which section of the health history should the nurse record that the parent brought the infant to the clinic today because of frequent diarrhea? a. Review of systems b. Chief complaint c. Lifestyle and life patterns d. Health history

ANS: B The chief complaint is documented using the child's or parent's words for the reason the child was brought to the health care center. The review of systems includes health functions of body systems. Lifestyle and life patterns include the child's interaction with the social, psychological, physical, and cultural environment. Health history includes birth history, growth and development, common childhood illnesses, immunizations, hospitalizations, injuries, and allergies.

17. A preschool-aged child tells the nurse "I was bad, that's why I got sick." What is the best rationale for this child's statement? a. The child has a fear that mutilation will lead to death. b. The child's imagination is very active, and he may believe the illness is a result of something he did. c. The child has a general understanding of body integrity at this age. d. The child will not have fear related to an IV catheter initiation but will have fear of an impending surgery.

ANS: B The child may believe that an illness occurred as a result of some personal deed or thought or perhaps because he touched something or someone. The child has imaginative thoughts at this stage of growth and development. Preschoolers do not have the cognitive ability to connect mutilation to death and do not have a sound understanding of body integrity. The preschooler fears all types of intrusive procedures, whether undergoing a simple procedure such as an IV start or something more invasive such as surgery.

6. Which finding indicates that a child receiving prednisone for primary nephrotic syndrome is in remission? a. Urine is negative for casts for 5 days. b. Urine has <1+ protein for 3 to 7 consecutive days. c. Urine is positive for glucose for 1 week. d. Urine is up to a trace for blood for 1 week.

ANS: B The child receiving steroids for the treatment of primary nephrotic syndrome is considered in remission when the urine has <1+ protein for 3 to 7 consecutive days. The absence of casts, presence of glucose, and presence of hematuria do not constitute remission.

28. Which assessment finding is the most significant to report to the physician for a child with cirrhosis? a. Weight loss b. Change in level of consciousness c. Skin with pruritus d. Black, foul-smelling stools

ANS: B The child with cirrhosis must be assessed for encephalopathy, which is characterized by a change in level of consciousness. Encephalopathy can result from a buildup of ammonia in the blood from the incomplete breakdown of protein. One complication of cirrhosis is ascites. The child needs to be assessed for increasing abdominal girth and edema. A child who is retaining fluid will not exhibit weight loss. Biliary obstruction can lead to pruritus, which is a frequent finding. An alteration in the level of consciousness is of higher priority. Black, tarry stools may indicate blood in the stool. This needs be reported to the physician. This is not a higher priority than a change in level of consciousness.

9. A parent calls the pediatrician's office because her 1-year-old child has a 100° F temperature. What is the most appropriate initial nursing response to make to the parent? a. "Did you feel your child's forehead?" b. "Does your child appear to be uncomfortable?" c. "Has anyone in your home been sick lately?" d. "Don't worry if the temperature is less than 101° F."

ANS: B The child's comfort is the primary concern in treating a fever in a normally healthy child. The nurse asks about the child's comfort level before giving further information. Feeling a child's forehead can give clues related to whether the child's temperature should be measured; if it has already been measured, this is unnecessary because it does not give accurate information about the child's body temperature. Asking about other ill family members is important, but not as the initial response, which should be to get more data about the child. Although the height of the temperature is not an indication of the seriousness of the child's illness, it is incorrect to tell a parent to be unconcerned about temperatures less than 101° F.

13. Which strategy is not always appropriate for pediatric physical examination? a. Take the history in a quiet, private place. b. Examine the child from head to toe. c. Exhibit sensitivity to cultural needs and differences. d. Perform frightening procedures last.

ANS: B The classic approach to physical examination is to begin at the head and proceed through the entire body to the toes. When examining a child, however, the examiner must tailor the physical assessment to the child's age and developmental level. The nurse should collect the child's health history in a quiet, private area. The nurse should always be sensitive to cultural needs and differences among children. When examining children, painful or frightening procedures should be left to the end of the examination.

20. The nurse encourages the mother of a toddler with acute LTB to stay at the bedside as much as possible. Which of the following best explains the nurse's rationale? a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease the child's respiratory efforts. c. Separation from the mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's respiratory efforts.

ANS: B The family's presence will decrease the child's distress, which in turn helps decrease respiratory efforts. Guilt is not the main rationale. Toddlers do suffer from separation anxiety, but that is not the primary reason for the mother to stay. The child should have constant monitoring by cardiorespiratory monitor and noninvasive oxygen saturation monitoring, but the parent should not play this role in the hospital.

4. A nurse is conducting a health education class for a group of school-age children. Which statement made by the nurse is correct about the body's first line of defense against infection in the innate immune system? a. Nutritional status b. Skin integrity c. Immunization status d. Proper hygiene practices

ANS: B The first lines of defense in the innate immune system are the skin and intact mucous membranes. Nutritional status is an indicator of overall health, but it is not the first line of defense in the innate immune system. Immunizations provide artificial immunity or resistance to harmful diseases. Practicing good hygiene may reduce susceptibility to disease, but it is not a component of the innate immune system.

6. What is the best response to a parent of a 2-month-old infant who asks when the infant should first receive the measles vaccine? a. "Your baby can get the measles vaccine now." b. "The first dose is given any time after the first birthday." c. "She should be vaccinated between 4 and 6 years of age." d. "This vaccine is administered when the child is 11 years old."

ANS: B The first measles, mumps, rubella (MMR) vaccine is recommended routinely at 1 year of age. The other statements are not correct.

18. What is the hourly maintenance fluid rate for an intravenous infusion in a child weighing 19.5 kg? a. 19 mL b. 61 mL c. 195 mL d. 1475 mL

ANS: B The formula for calculating daily fluid requirements is 0 to 10 kg: 100 mL/kg/day; 10 to 20 kg: 1000 mL for the first 10 kg of body weight plus 50 mL/kg/day for each kilogram between 10 and 20. To determine an hourly rate, divide the total milliliters per day by 24. Calculations: Child weighs 19.5 kg. Therefore the child requires 1000 mL; plus 50 mL × 9.5 kg = 475 mL. Next add calculated amounts: 1000 + 475 = 1475 mL, and divide by 24 hours to equal 61.45 mL per hour. This rounds down to 61 mL/hr.

3. In order to minimize the negative effects of illness and hospitalization on an infant, the nurse focuses care on which of the following? a. Bodily injury and pain b. Separation from caregivers and fear of strangers c. Loss of control and altered body image d. The unknown and being left alone

ANS: B The major fear of infants during illness and hospitalization are separation from caregivers and fear of strangers. Bodily injury and pain are fears of preschool and school-age children. Loss of control is a fear of children from the preschool period through adolescence. Altered body image applies to adolescents. Fear of the unknown and being left alone are applicable to preschoolers.

13. Which drug is usually the best choice for PCA for a child in the immediate postoperative period? a. Codeine b. Morphine c. Methadone d. Meperidine

ANS: B The most commonly prescribed medications for PCA are morphine, hydromorphone, and fentanyl. Codeine, methadone, and meperidine are not commonly used for children and are not used in PCA pumps.

14. Guidelines for intramuscular administration of medication in school-age children include a. inject medication as rapidly as possible. b. insert needle quickly, using a dart-like motion. c. penetrate skin immediately after cleansing site. d. have child stand, if possible and if child is cooperative.

ANS: B The needle should be inserted quickly in a dart-like motion at a 90-degree angle unless contraindicated. Inject medications slowly. Allow skin preparation to dry completely before skin is penetrated. Place child in lying or sitting position.

1. What is the most appropriate statement for the nurse to make to a 5-year-old child who is undergoing a venipuncture? a. "You must hold still or I'll have someone hold you down. This is not going to hurt." b. "This will hurt like a pinch. I'll get someone to help hold your arm still so it will be over fast and hurt less." c. "Be a big boy and hold still. This will be over in just a second." d. "I'm sending your mother out so she won't be scared. You are big, so hold still and this will be over soon."

ANS: B The nurse can help minimize the pain and stress of the venipuncture by having someone help the child maintain control during the procedure. Threatening the child with having someone hold him or her down is likely to produce less cooperation and frighten the child. Telling a child to be a "big boy" does not acknowledge the child's developmental stage. Parents should be allowed to stay during procedures when possible.

12. The nurse who coordinates and manages a patient's care with other members of the health care team is functioning in which role? a. Teacher b. Collaborator c. Researcher d. Advocate

ANS: B The nurse collaborates with other members of the health care team, often coordinating and managing the patient's care. Care is improved by this interdisciplinary approach as nurses work together with dietitians, social workers, physicians, and others. Education is an essential role of today's nurse. The nurse functions as a teacher during prenatal care, during maternity care, and when teaching parents of children regarding normal growth and development. Nurses contribute to their profession's knowledge base by systematically investigating theoretic for practice issues and nursing. A nursing advocate is one who speaks on behalf of another. As the health professional who is closest to the patient, the nurse is in an ideal position to humanize care and to intercede on the patient's behalf.

15. How should the nurse instruct the mother who calls the emergency department because her 9-year-old child has just fallen on his face and one of his front teeth fell out? a. Put the tooth back in the child's mouth and call the dentist right away. b. Place the tooth in milk or water and go directly to the emergency department. c. Gently place the tooth in a plastic zippered bag until she makes a dental appointment. d. Clean the tooth and call the dentist for an immediate appointment.

ANS: B The parent should be told to keep the tooth moist by placing it in a saline solution, water, milk, or a commercial tooth-preserving solution and get the child evaluated as soon as possible. The parent may replace the tooth incorrectly, so it is best not to advise the parent to do this. The tooth should be kept moist, not dry. The child should be evaluated as soon as possible. Cleaning or scrubbing the tooth could damage it. It is essential for the child to have an immediate dental evaluation.

8. In which developmental stage is the child first able to localize pain and describe both the amount and the intensity of the pain felt? a. Toddler stage b. Preschool stage c. School-age stage d. Adolescent stage

ANS: B The preschool stage is the period when the child is first able to describe the location and intensity of pain, stating, for example, "Ear hurts bad," when feeling pain. The toddler expresses pain by guarding or touching the painful area, verbalizes words that indicate discomfort such as "ouch" and "hurt," and demonstrates generalized restlessness when feeling pain. The school-age child describes both the location of the pain and its intensity. The adolescent also describes location and intensity of pain.

28. A 5 year-old child is in cardiopulmonary arrest, and the nursing staff is performing CPR. One of the nurses is doing compressions at the rate of 90 per minute. What action by the charge nurse is best? a. Take over compressions. b. Tell the nurse to speed up. c. Tell the nurse to slow down. d. Have the nurse compress more deeply.

ANS: B The rate of compressions for a child is at least 100/minute. The charge nurse tells the compressing nurse to speed up. If the compressor is fatigued, someone should take over, but that is not indicated in the question. The depth of compressions is not the issue.

18. Which factor predisposes the urinary tract to infection? a. Increased fluid intake b. Short urethra in young girls c. Prostatic secretions in males d. Frequent emptying of the bladder

ANS: B The short urethra in females provides a ready pathway for invasions of organisms. Increased fluid intake offers protective measures against UTIs. Prostatic secretions have antibacterial properties that inhibit bacteria. Frequent emptying of the bladder also offers protection against UTIs.

12. Many parents who have children diagnosed with a chronic illness experience recurrent feelings of grief, loss, and fear related to the child's condition and loss of the ideal healthy child. The nurse recognizes this process as a. anticipatory grieving. b. chronic sorrow. c. bereavement. d. illness trajectory.

ANS: B The stated recurrent feelings define chronic sorrow, which is considered a normal process involving grief that may never be resolved. Anticipatory grieving is the process of mourning, coping, interacting, planning, and psychosocial reorganization that is begun as a response to the impending loss of a loved one. Bereavement is defined as the objective condition or state of loss. Illness trajectory is defined as the impact of the disease or condition on all family members, physiologic unfolding of the disease, and work organization done by the family to cope.

10. The nurse is providing anticipatory guidance for parents of a school-age child. Which behavior does the nurse suggest to best assist the child in negotiating the developmental task of industry? a. Identifying failures immediately and asking the child's peers for feedback b. Structuring the environment so that the child can master tasks c. Completing homework for children who are having difficulty with them d. Decreasing expectations to eliminate potential failures

ANS: B The task of the caring teacher or parent is to identify areas in which a child is competent and to build on successful experiences to foster feelings of mastery and success. Structuring the environment to enhance self-confidence and to provide the opportunity to solve increasingly more complex problems will promote a sense of mastery. Asking peers for feedback reinforces the child's feelings of failure. When parents complete children's homework for them, it sends the message that they do not trust their child to do a good job. Providing assistance and suggestions and praising their best efforts are more appropriate. Decreasing expectations to eliminate failures will not promote a sense of achievement or mastery.

26. A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. What home care measure does the nurse educate parents about? a. Taking the full course of antibiotics b. Providing humidity and increased fluids c. Treating any fever with aspirin d. Isolation from family until symptoms resolve

ANS: B This child has bronchitis which is a viral illness treated symptomatically. Humidity and increased fluids provide comfort, ease symptoms, and prevent dehydration. Antibiotics are not used unless an overlying infection occurs as well. Aspirin is not given to children due to the association with Reye syndrome. The child does not need to be isolated.

17. A nurse observes that a 3-month-old infant will hold a rattle if it is put in the hands, but the baby will not voluntarily grasp it. What action by the nurse is most appropriate? a. Provide anticipatory guidance. b. Document the findings in the chart. c. Refer the family to a neurologist. d. Perform a developmental screening.

ANS: B This child is displaying normal age-appropriate behavior. The nurse should document the findings, but no other action is necessary. The nurse should always provide appropriate anticipatory guidance, but this answer is too vague to be the best response.

23. A parent brings an 18-month-old to the pediatrician for a routine well-child visit and reports the child has been babbling and cooing since 6 months of age but is not yet saying any words. Which response by the nurse is the most appropriate? a. "Don't worry, your child should catch up soon." b. "The doctor will want to refer your child to an audiologist and speech pathologist." c. "This is normal speech development for an 18-month-old child." d. "Your child has an expressive language disorder and needs further evaluation."

ANS: B This is an appropriate response. By 18 months children should be speaking in simple sentences. Adequate hearing is essential for the development of speech. Hearing and language should be tested, and a referral to an audiologist and speech pathologist is indicated. The nurse should not give false reassurance and needs to address the parent's concerns. The nurse cannot diagnose an expressive language disorder.

12. Which strategy is the best approach when initiating the physical examination of a 9-month-old male infant? a. Undress the infant and do a head-to-toe examination. b. Have the parent hold the child on his or her lap. c. Put the infant on the examination table and begin assessments at the head. d. Ask the parent to leave because the infant will be upset.

ANS: B Toddlers may be resistant and uncooperative. The nurse allows the child to remain on the parent's lap to ease anxiety. The head-to-toe approach needs to be modified for the infant. Uncomfortable procedures, such as the otoscopic examination, should be left until last. There is no reason to ask a parent to leave when an infant is being examined. Having the parent with the infant will make the experience less upsetting for the infant.

12. A student nurse learns that according to Erikson, the psychosocial task of adolescence is to develop a. intimacy. b. identity. c. initiative. d. independence.

ANS: B Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. Intimacy is the developmental stage for early adulthood. Initiative is the developmental stage for early childhood. Independence is not one of Erikson's developmental stages.

22. A child is admitted with acute glomerulonephritis. The nurse expects the urinalysis during this acute phase to show which of the following? a. Bacteriuria and hematuria b. Hematuria and proteinuria c. Bacteriuria and increased specific gravity d. Proteinuria and decreased specific gravity

ANS: B Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes is specific gravity would not be expected.

2. An important consideration for the nurse who is communicating with a 5-year-old child is to a. speak loudly, clearly, and directly. b. use picture or story books, or puppets. c. disguise own feelings, attitudes, and anxiety. d. initiate contact with child when parent is not present.

ANS: B Using objects such as a puppet or doll allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This will facilitate communication with a child of this age. Speaking in this manner will tend to increase anxiety in very young children as they may interpret this as being yelled at. The nurse must be honest with the child. Attempts at deception will lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children.

8. A preschool child in the emergency department has a respiratory rate of 10 breaths per minute. How should the nurse interpret this finding? a. The child is relaxed. b. Respiratory failure is likely. c. This child is in respiratory distress. d. The child's condition is improving.

ANS: B Very slow breathing in an ill child is an ominous sign, indicating respiratory failure. Although the respiratory rate slows when an individual is relaxed, a rate of 10 breaths per minute in an ill preschool child is not a normal finding and is cause for concern. A rapid respiratory rate indicates respiratory distress. Other signs of respiratory distress may include retractions, grunting, and nasal flaring. A respiratory rate of 10 breaths per minute is not a normal finding for a preschool child nor does it demonstrate improvement.{ 9. The nurse observes abdominal breathing in a 2-year-old child. What does this finding indicate? a. Imminent respiratory failure b. Hypoxia c. Normal respiration d. Airway obstruction{ ANS: C Young children normally exhibit abdominal breathing. When measuring respiratory rate, the nurse should observe the rise and fall of the abdomen. A very slow respiration rate is an indicator of respiratory failure. Nasal flaring with inspiration and grunting on expiration occurs when hypoxia is present. The child with an airway obstruction will use accessory muscles to breathe.

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

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

9. A nurse is caring for a child who is a Christian Scientist. What intervention should the nurse include in the care plan for this child? a. Offer iced tea to the child who is experiencing deficient fluid volume. b. Offer to inform a Christian Science practitioner of the child's admission. c. Allow parents to sign a form opting out of routine immunizations. d. Ask parents whether the child has been baptized.

ANS: B When a Christian Science believer is hospitalized, a parent or patient may request that a Christian Science practitioner be notified as opposed to the hospital-assigned clergy. Coffee and tea are declined as a drink. Christian Science believers seek exemption from immunizations but obey legal requirements. Baptism is not a ceremony for the Christian Science religion.

7. The nurse is caring for a 2-year-old child who has a history of meningitis as an infant. The child is not speaking and does not turn the head to the sound of a rattle. Which type of hearing loss in a child may have resulted from a previous infection with meningitis? a. Conductive b. Sensorineural c. Central d. Mixed

ANS: B When hearing loss is caused by malformations, auditory nerve damage, or infection, the loss is usually permanent. Damage caused by inflammation or obstruction usually causes a temporary and reversible hearing loss. A central type of hearing loss usually causes difficulties in differentiating sounds and problems with auditory memory, and it is reversible. A combination of conductive and sensorineural loss. Conductive loss is often reversible, whereas sensorineural is permanent.

2. A nurse is planning care for a child admitted with nephrotic syndrome. Which interventions should be included in the plan of care? (Select all that apply.) a. Administration of antihypertensive medications b. Daily weights c. Salt-restricted diet d. Frequent position changes e. Teaching parents to expect tea-colored urine

ANS: B, C, D A child with nephrotic syndrome will need to be monitored closely for fluid excess so daily weights are important. The diet is salt restricted to prevent further retention of fluid. Because of the fluid excess, frequent position changes are required to prevent skin breakdown. Nephrotic syndrome does not require antihypertensive medications. These are administered for acute glomerulonephritis. Tea-colored urine is expected with acute glomerulonephritis but not nephrotic syndrome. The urine in nephrotic syndrome is frothy, indicating that protein is being lost in the urine.

1. When providing anticipatory guidance to parents regarding disciplining children, the nurse teaches that behavioral consequences fall into which categories? (Select all that apply.) a. Corporal b. Natural c. Logical d. Unrelated e. Behavioral

ANS: B, C, D Natural consequences are those that occur spontaneously. For example, a child leaves a toy outside and it is lost. Logical consequences are those that are directly related to the misbehavior. If two children are fighting over a toy, the toy is removed and neither child has it. Unrelated consequences are purposely imposed; for example, the child is late for dinner so he or she is not allowed to watch television. Corporal punishment is not part of this behavioral approach and usually takes the approach of spanking the child. Corporal punishment is highly controversial and is strongly discouraged by the American Academy of Pediatrics. Behavior modification is another disciplinary technique that rewards positive behavior and ignores negative behavior.

1. The nurse has educated the parents of a child with celiac disease on diet modifications. Which food choices by the child's parents indicate understanding of teaching? (Select all that apply.) a. Oatmeal b. Steamed rice c. Corn on the cob d. Baked chicken e. Peanut butter and jelly sandwich on wheat bread

ANS: B, C, D Rice, corn, and chicken do not contain gluten and so are appropriate choices. Oatmeal and wheat bread are not.

4. The school nurse is presenting information on some risks of tattoos. What information should the nurse provide? (Select all that apply.) a. Amateur tattoos are difficult to remove. b. Tattoos pose a risk for bloodborne and skin infections. c. A tattoo may keep you from getting an MRI. d. Tattoo dyes may cause allergic reactions. e. Tattoo parlors are well regulated.

ANS: B, C, D Tattoos carry the risk for contracting bloodborne diseases such as hepatitis B and HIV. Infection, allergic reaction to the dye, scarring, or keloid formation can occur. Should an MRI ever be required, it is important to notify the health care professionals, because the dyes can contain iron and other metals. Amateur tattoos are easily removed; however, studio tattoos made with red and green dye are extremely difficult to remove. Very little regulation exists in the tattoo industry; therefore, the cleanliness of each tattoo parlor varies. Teens should be counseled to avoid making an impulsive decision to get a tattoo.

4. A nurse is planning care for a hospitalized toddler in the preoperational thinking stage. Which characteristics should the nurse expect in this stage? (Select all that apply.) a. Concrete thinking b. Egocentrism c. Animism d. Magical thought e. Ability to reason

ANS: B, C, D The characteristics of preoperational thinking that occur for the toddler include egocentrism (views everything in relation to self), animism (believes that inert objects are alive), and magical thought (believes that thinking something causes that event). Concrete thinking is seen in school-age children, and ability to reason is seen with adolescents.

5. Which vitamin supplements are necessary for children with cystic fibrosis? a. Vitamin C b. Vitamin D c. Vitamin A d. Vitamin E e. Vitamin K

ANS: B, C, D, E Fat-soluble vitamins (A, D, E, and K) are poorly absorbed because of deficient pancreatic enzymes in children with cystic fibrosis; therefore supplements are necessary. Vitamin C is not fat soluble.

2. Which interventions should the nurse plan when caring for a child with a hearing loss? (Select all that apply.) a. Speak loudly. b. Speak slowly. c. Have the child's full attention. d. Use visual aids. e. Eliminate background noise.

ANS: B, C, D, E Speak clearly and at a slightly slower speed than normal. Eliminate background noise so the child can focus on what is being said. Use visual aids to assist communication. Look directly at the child, and have the child's full attention before speaking. Do not speak loudly.

4. A school nurse is screening children for scoliosis. Which assessment findings should the nurse expect to observe for scoliosis? (Select all that apply.) a. Pain with deep palpation of the spinal column b. Unequal shoulder heights c. The trouser pant leg length appears shorter on one side d. Inability to bend at the waist e. Unequal waist angles

ANS: B, C, E The assessment findings associated with scoliosis include unequal shoulder heights, trouser pant leg length appearing shorter on one side meaning unequal leg length, and unequal waist angles. Scoliosis is a non-painful curvature of the spine so pain is not expected and the child is able to bend at the waist adequately.

3. A nurse is performing an assessment on a newborn. Which vital signs indicate a normal finding for this age-group? (Select all that apply.) a. Pulse of 80 to 125 a minute b. B/P of systolic 65 to 95 and diastolic 30 to 60 c. Temperature of 36.5° to 37.3° C (axillary) d. Temperature of 36.4° to 37° C (axillary) e. Respirations of 30 to 60 a minute

ANS: B, C, E The blood pressure, temperature, and respiratory rate are all normal for this child. The pulse of 80 to 125 and the temperature of 36.4° to 37° C (axillary) are both too low for a well newborn.

1. What nursing actions are correct when administering subcutaneously? (Select all that apply.) a. Insert the needle with the bevel up at a 15-degree angle. b. Insert the needle at a 45- to 90-degree angle. c. Insert the needle into the tissue on the upper back. d. Insert the needle into the abdominal tissue. e. Massage the injection site when the injection is complete.

ANS: B, D For this subcutaneous injection, the nurse inserts the needle at a 45- to 90-degree angle and injects into the subcutaneous abdominal tissue. A 15-degree angle and injecting into the tissue on the upper back are appropriate for intradermal injections. The nurse should not massage the site.

3. Parents of a teenager ask the nurse what signs they should look for if their child is in a gang. The nurse should include which signs when answering? (Select all that apply.) a. Plans to try out for the debate team at school b. Skipping classes to go to the mall c. Hanging out with friends they have had since childhood d. Unexplained source of money e. Fear of the police

ANS: B, D, E Signs of gang involvement include skipping classes, unexplained sources of money, and fear of the police. Associating with new friends while ignoring old friends is also a sign. A change in attitude toward participating in activities is another sign of gang involvement. Plans to become more involved in school activities and hanging around old friends are not signs.

2. The nurse who uses critical thinking understands that the steps of critical thinking include (Select all that apply.) a. therapeutic communication. b. examining biases. c. setting priorities. d. managing data. e. evaluating other factors.

ANS: B, D, E The five steps of critical thinking include recognizing assumptions, examining biases, analyzing the need for closure, managing data, and evaluating other factors such as emotions and environmental factors. Therapeutic communication is a skill that nurses must have to carry out the many roles expected in the profession; however, it is not one of the steps of critical thinking. Setting priorities is part of the planning phase of the nursing process.

2. A nurse should routinely ask a colleague to double-check a medication calculation and the actual medication before administering which medications? (Select all that apply.) a. Antibiotics b. Insulin c. Anticonvulsants d. Anticoagulants e. Narcotics/Opioids

ANS: B, D, E The nurse should ask another nurse to check the dosage calculation and the medication before administering the following: insulin, narcotics, chemotherapy, digoxin or other inotropic drugs, anticoagulants, and K+ and Ca++ salts. Institutions may require two nurses to check other medications also to prevent medication error. The nurse does not need a second check for antibiotics.

3. A preschool aged child is in the clinic for a well-child checkup. Which statement identifies an appropriate level of language development in this child? (Select all that apply.) a. Vocabulary of 300 words b. Relates elaborate tales c. Uses correct grammar in sentences d. Able to pronounce consonants clearly e. Expresses abstract thought

ANS: B,C The 4-year-old child is able to use correct grammar in sentence structure and can tell elaborate tales and stories. A vocabulary of 300 words is appropriate for a 2-year-old. The 4-year-old child typically has difficulty in pronouncing consonants. The use of language to express abstract thought is developmentally appropriate for the adolescent.

1. In planning care for a preschool-age child, the nurse knows that which open body postures encourage positive communication? (Select all that apply.) a. Leaning away from the preschooler b. Frequent eye contact c. Hands on hips d. Conversing at eye level e. Asking the parents to stay in the room

ANS: B,D Frequent eye contact and conversing at eye level are both open body postures that encourage positive communication. Leaning away from the child and placing your hands on your hips are both closed body postures that do not facilitate effective communication. Asking the parents to stay in the room while the nurse is talking to the child is helpful but is not an open body posture.

5. The nurse is performing a comprehensive physical examination on a young child in the hospital. At what age can the nurse expect a child's head and chest circumferences to be almost equal? a. Birth b. 6 months c. 1 year d. 3 years

ANS: C 6. An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to a. ask her why she wants to know. b. determine why she is so anxious. c. explain in simple terms how it works. d. tell her she will see how it works as it is used.{ ANS: C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. "Why" questions are not therapeutic, plus this question makes it sound like the nurse thinks the child does not need this information. The child is not exhibiting anxiety, just requesting clarification of what will be occurring. The nurse must explain how the blood pressure cuff works so that the child can then observe during the procedure.

31. The nurse caring for a child with suspected appendicitis should question which order from the physician? a. Keep patient NPO. b. Start IV of D5/0.45 normal saline at 60 mL/hr. c. Apply K-pad to abdomen prn for pain. d. Obtain CBC on admission to nursing unit.

ANS: C A K-pad (moist heat device) is contraindicated for suspected appendicitis because it may contribute to the rupture of the appendix. NPO status, an IV, and a CBC are all appropriate for this child.

16. Which situation reflects a potential ethical dilemma for the nurse? a. A nurse administers analgesics to a patient with cancer as often as the provider's order allows. b. A neonatal nurse provides nourishment and care to a newborn who has a defect that is incompatible with life. c. A labor nurse, whose religion opposes abortion, is asked to assist with an elective abortion. d. A postpartum nurse provides information about adoption to a new mother who feels she cannot adequately care for her infant.

ANS: C A dilemma exists in this situation because the nurse is being asked to assist with a procedure that she or he believes is morally wrong. The other situations do not contain elements of conflict for the nurse.

5. What maternal assessment is related to an infant's diagnosis of TEF? a. Maternal age more than 40 years b. First term pregnancy for the mother c. Maternal history of polyhydramnios d. Complicated pregnancy

ANS: C A maternal history of polyhydramnios is associated with TEF. Advanced maternal age, first term pregnancy, or complicated pregnancy are not related.

32. A student nurse hears two registered nurses discussing a child who has neurologic soft signs. The student asks what this means. What response by the nurse is best? a. The baby's fontanels have not yet closed. b. Tests of neurologic function are indeterminate. c. The child can't perform activities he should be able to. d. The child has a significant neurologic disorder.

ANS: C A neurologic soft sign indicates the child's inability to perform certain activities related to the child's age. They may provide subtle clues to an underlying central nervous system deficit or neurologic maturation delay. They require more evaluation. They are not related to fontanels or indeterminate findings.

14. Which step in the nursing process identifies the basis or cause of the patient's problem? a. Intervention b. Expected outcome c. Nursing diagnosis d. Evaluation

ANS: C A nursing diagnosis states the problem and its cause ("related to"). Interventions are actions taken to meet the problem. Expected outcome is a statement of how the goal will be measured. Evaluation determines whether the goal has been met.

14. A nurse is caring for a child who does not speak English. The parents are able to understand and speak only limited English. What action by the nurse is best? a. Allow the patient's 12-year-old sister to interpret. b. See if there is another family member who can interpret. c. Use a professionally trained interpreter for this family. d. Use the Internet to translate written information in the native language.

ANS: C A professional interpreter is the best option in this situation. They are trained in medical interpreting and do not allow cultural influences into their work. A child should never be asked to interpret; the child may be too young to understand sophisticated concepts involved in the discussion and the information from the patient may be misconstrued and disturbing to the child. An adult family member may have to do temporarily in an emergency, but the best option is a professional interpreter.

1. The parents of a school-age child are told that their child is diagnosed with leukemia. As the nurse caring for this child, what is the expected first response of the parents to the diagnosis of chronic illness in their child? a. Anger and resentment b. Sorrow and depression c. Shock and disbelief d. Acceptance and adjustment

ANS: C According to Kübler-Ross, denial is the initial stage of the grieving process when an individual reacts with shock and disbelief to the diagnosis of chronic illness. The other responses are also part of the grieving process although not usually the initial response.

16. What disorder is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ T cells? a. Raynaud phenomenon b. Idiopathic thrombocytopenic purpura c. Acquired immunodeficiency syndrome (AIDS) d. Severe combined immunodeficiency disease

ANS: C Acquired immunodeficiency is caused by the human immunodeficiency virus (HIV), which primarily attacks the CD4+ T cells. The other disorders are not viral in nature.

3. An effective technique for communicating with toddlers is to a. have the toddler make up a story from a picture. b. involve the toddler in dramatic play with dress-up clothing. c. use picture books. d. ask the toddler to draw pictures of his fears.

ANS: C Activities and procedures should be described as they are about to be done. Use picture books and play for demonstration. Toddlers experience the world through their senses. Most toddlers do not have the vocabulary to make up stories. Dramatic play is associated with older children. Toddlers probably are not capable of drawing or verbally articulating their fears.

2. The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding? a. Increased urine output b. Hypotension c. Tea-colored urine d. Weight gain

ANS: C Acute poststreptococcal glomerulonephritis is characterized by hematuria, proteinuria, edema, and renal insufficiency. Tea-colored urine is an indication of hematuria. In acute poststreptococcal glomerulonephritis the urine output may be decreased. In acute poststreptococcal glomerulonephritis blood pressure may be increased. Edema may be noted around the eyelids and ankles in patients with acute post streptococcal glomerulonephritis and can contribute to weight gain; however, weight gain is associated more with nephrotic syndrome.

6. Which action should the nurse incorporate into a care plan for a 14-year-old child in the emergency department? a. Limit the number of choices to be made by the adolescent. b. Insist that parents remain with the adolescent. c. Provide clear explanations, and encourage questions. d. Give rewards for cooperation with procedures.

ANS: C Adolescents are capable of abstract thinking and can understand explanations. They should be offered the opportunity to ask questions. Because adolescents are capable of abstract thinking, they should be allowed to make decisions about their care. Adolescents should have the choice of whether parents remain with them. They are very modest, and this modesty should be respected. Giving rewards such as stickers for cooperation with treatments or procedures is more appropriate for the younger child.

15. What action indicates that a school-age child is using a metered-dose inhaler correctly? a. The child uses his inhaled steroid before the bronchodilator. b. The child exhales forcefully as he squeezes the inhaler. c. The child holds his breath for 10 seconds after the first puff. d. The child waits 10 minutes before taking a second puff.

ANS: C After a puff, the child should hold his breath for about 10 seconds or until he counts slowly to 5. If one of the child's medications is an inhaled steroid, it should be administered last. The child should inhale slowly as the inhaler is squeezed or depressed. The child does not need to wait this long to take a second puff of medication. He can take a second puff after 1 to 2 minutes.

7. The parents of a newborn infant state, "We will probably not have our baby immunized because we are concerned about the risks." What is the nurse's best response? a. "It is your decision to immunize your child or not." b. "You should probably think about this decision." c. "It is far riskier to not immunize your baby." d. "This has to be reported to the health department."

ANS: C Although immunizations have been documented to have a negative effect in a small number of cases, an unimmunized infant is at greater risk for development of complications from childhood diseases than from the vaccines. Plus children who get ill from communicable diseases are a threat to those who are immunocompromised. Telling parents they should think about a decision does not give them any information to consider. Of course the parents have the final decision, but the nurse needs to educate them on the risks of that decision. The parents will not be reported to the health department.

17. When planning a parenting class, the nurse should explain that the leading cause of death in children 1 to 4 years of age in the United States is a. premature birth. b. congenital anomalies. c. accidental death. d. respiratory tract illness.

ANS: C Although the rates have dropped, unintentional injury (accidents) are still the leading cause of death for children aged 1 to 19. The other options contribute to morbidity and mortality in children but are not the leading cause.

13. Which statement about alternative and complementary therapies is true? a. Replace conventional Western modalities of treatment b. Are used by only a small number of American adults c. Allow for more patient autonomy but also may carry risks d. Focus primarily on the disease an individual is experiencing

ANS: C Being able to choose alternative and complementary health products and practices does allow for patient autonomy, but the major concern is risk as patients may not disclose their use or substances may interact with other medications the patient is taking. Alternative and complementary therapies are part of an integrative approach to health care for most people, although some may choose only these types of therapies. An increasing number of American adults are seeking alternative and complementary health care options. Alternative healing modalities offer a holistic approach to health, focusing on the whole person and not just the disease.

6. At what age is an infant first expected to locate an object hidden from view? a. 4 months of age b. 6 months of age c. 9 months of age d. 20 months of age

ANS: C By 9 months of age, an infant will actively search for an object that is out of sight. Four-month-old infants are not cognitively capable of searching out objects hidden from their view. Infants at this developmental level do not pursue hidden objects. Six-month-old infants have not developed the ability to perceive objects as permanent and do not search out objects hidden from their view. Twenty-month-old infants actively pursue objects not in their view and are capable of recalling the location of an object not in their view. They first look for hidden objects around age 9 months.

27. At what age do most children have an adult concept of death as being inevitable, universal, and irreversible? a. 4 to 5 years b. 6 to 8 years c. 9 to 11 years d. 12 to 16 years

ANS: C By age 9 or 10 years, children have an adult concept of death. They realize that it is inevitable, universal, and irreversible. Preschoolers and young school-age children are too little to have an adult concept of death. Adolescents have a mature understanding of death.

20. Which statement by a parent indicates understanding of instructions on the care of a child with conjunctivitis? a. "I should treat my other children with these eye drops to prevent spread of the disease." b. "My child must remain home from school until she has received 72 hours of antibiotic drops." c. "I should avoid touching the tip of the ointment tube to my child's eye." d. "My child may go back to wearing her contact lenses 24 hours after treatment has started."

ANS: C Care should be taken to avoid touching the tip of the ointment tube or dropper to the eye to avoid contamination of the medication. The other statements indicate a need for further instruction.

2. Which nursing diagnosis is appropriate for the 5-year-old child in isolation because of immunosuppression? a. Spiritual distress b. Social isolation c. Deficient diversional activity d. Sleep deprivation

ANS: C Children in isolation need extra attention to avoid boredom. A 5-year-old child is not developmentally advanced enough to feel spiritual distress. The main social system for a 5-year-old child is the family, who should be allowed liberal visitation. Sleep deprivation may occur during hospitalization but is not specific to isolation.

19. A parent reports getting annoyed with a 6-year-old child who seems to always get cranky and irritable when playing with friends. What suggestion by the nurse is best? a. Maybe he should not play with those friends anymore. b. The parents should monitor the children's play more closely. c. When the child gets cranky he should be told to rest. d. The parents should assess the child's diet for protein.

ANS: C Children often do not recognize that they are becoming fatigued. Six-year-olds in particular are quite bad about this. Signs of fatigue include being cranky. The parent should have the child rest at this point. Forbidding the child's friends, monitoring play more closely, and assessing the diet for protein are not needed for this problem.

7. Which comments indicate that the mother of a toddler needs further teaching about dental care? a. "We use well water so I give my toddler fluoride supplements." b. "My toddler brushes his teeth with my help." c. "My child will not need a dental checkup until his permanent teeth come in." d. "I use a small nylon bristle brush for my toddler's teeth."

ANS: C Children should first see the dentist 6 months after the first primary tooth erupts and no later than age 30 months. Toddlers need fluoride supplements when they use a water supply that is not fluoridated. Toddlers need supervision with dental care. The parent should finish brushing areas not reached by the child. A small nylon bristle brush works best for cleaning toddlers' teeth.

32. Which statement made by parents of a child with cystic fibrosis indicates that they understood the nurse's teaching on pancreatic enzyme replacement? a. "Enzymes will improve my child's breathing." b. "I should give the enzymes 1 hour after meals." c. "Enzymes should be given with meals and snacks." d. "The enzymes are stopped if my child begins wheezing."

ANS: C Children with cystic fibrosis need to take enzymes with food for adequate absorption of nutrients. Pancreatic enzymes do not affect the respiratory system. Pancreatic enzymes are taken within 30 minutes of eating all meals and snacks. Giving the medication 1 hour after meals is inappropriate and ineffective for absorption of nutrients. Wheezing is not a reason to stop taking enzyme replacements.

11. When assessing pain in any child, the nurse should consider that a. any pain assessment tool can be used to assess pain in children. b. children as young as 1 year old use words to express pain. c. the child's behavioral, physiologic, and verbal responses are valuable when assessing pain. d. pain assessment tools are minimally effective for communicating about pain.

ANS: C Children's behavioral, physiologic, and verbal responses are indicative when assessing pain. The use of pain measurement tools greatly assists in communicating about pain. The child's age is important in determining the appropriate pain assessment tool to use. Developmentally appropriate assessment tools need to be used to effectively identify and determine the level of pain felt by a child. Toddlers may use words such as "ouch" or "hurt" to identify pain, but infants and young children may not have the language or cognitive abilities to express pain. Pain assessment tools when used appropriately are successful and efficient in identifying and quantifying pain with children. Behavioral and physiologic signs and symptoms in combination with pain assessment tools are most effective in diagnosing pain levels in children.

2. For which problem should the child with chronic otitis media with effusion be evaluated? a. Brain abscess b. Meningitis c. Hearing loss d. Perforation of the tympanic membrane

ANS: C Chronic otitis media with effusion is the most common cause of hearing loss in children. The other options are all possible complications but not seen frequently.

26. A major complication in a child with chronic renal failure is a. hypokalemia. b. metabolic alkalosis. c. water and sodium retention. d. excessive excretion of blood urea nitrogen.

ANS: C Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia is a complication of chronic renal failure. Metabolic acidosis is a complication of chronic renal failure. Retention of blood urea nitrogen is a complication of chronic renal failure.

7. The maternity nurse should have a clear understanding of the correct use of a clinical pathway. One characteristic of clinical pathways is that they a. are developed and implemented by nurses. b. are used primarily in the pediatric setting. c. set specific time lines for sequencing interventions. d. are part of the nursing process.

ANS: C Clinical pathways are standardized, interdisciplinary plans of care devised for patients with a particular health problem. They are used to identify patient outcomes, specify time lines to achieve those outcomes, direct appropriate interventions and sequencing of interventions, include interventions from a variety of disciplines, promote collaboration, and involve a comprehensive approach to care. They are developed by multiple health care professionals and reflect interdisciplinary care. They can be used in multiple settings and for patients throughout the life span. They are not part of the nursing process but can be used in conjunction with the nursing process to provide care to patients.

4. According to Piaget's theory, the period of cognitive development in which the child is able to distinguish between concepts related to fact and fantasy, such as human beings are incapable of flying like birds, is the __________ period of cognitive development. a. sensorimotor b. formal operations c. concrete operations d. preoperational

ANS: C Concrete operations is the period of cognitive development in which children's thinking is shifted from egocentric to being able to see another's point of view. They develop the ability to distinguish fact from fantasy. The sensorimotor stage occurs in infancy and is a period of reflexive behavior. During this period, the infant's world becomes more permanent and organized. The stage ends with the infant demonstrating some evidence of reasoning. Formal operations is a period in development in which new ideas are created through previous thoughts. Analytic reason and abstract thought emerge in this period. The preoperational stage is a period of egocentrism in which the child's judgments are illogical and dominated by magical thinking and animism.

43. What is used to treat moderate to severe inflammatory bowel disease? a. Antacids b. Antibiotics c. Corticosteroids d. Antidiarrheal medications

ANS: C Corticosteroids, such as prednisone and prednisolone, are used in short bursts to suppress the inflammatory response in inflammatory bowel disease. Antacids and antidiarrheals are not used. Antibiotics may be used to treat complications.

11. What term should be used in the nurse's documentation to describe auscultation of breath sounds that are short, popping, and discontinuous on inspiration? a. Pleural friction rub b. Sonorous rhonchi c. Crackles d. Wheeze

ANS: C Crackles are short, popping, discontinuous sounds heard on inspiration. Sonorous rhonchi are low-pitched, moaning, musical sounds. A pleural friction rub has a grating, coarse, low-pitched sound. Wheezes are musical, high-pitched, predominant sounds heard on expiration.

2. Frequent developmental assessments are important for which reason? a. Stable developmental periods during infancy provide an opportunity to identify any delays or deficits. b. Infants need stimulation specific to the stage of development. c. Critical periods of development occur during childhood. d. Child development is unpredictable and needs monitoring.

ANS: C Critical periods are blocks of time during which children are ready to master specific developmental tasks. The earlier those delays in development are discovered and intervention initiated, the less dramatic their effect will be. Infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress. Infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage. Normal growth and development is orderly and proceeds in a predictable pattern based on each individual's abilities and potentials.

31. A nurse is assessing a 12-month-old baby. What question about growth and development is most appropriate? a. Can the baby roll over? b. Does your baby pull himself up? c. Is your baby cruising around yet? d. Will your baby sit alone?

ANS: C Cruising should occur by 12 months. Rolling over occurs by 3 to 6 months. A baby will pull herself up by around 11 months. Sitting alone occurs by 7 months.

9. A nurse has admitted a child to the hospital with a diagnosis of "rule out" peptic ulcer disease. Which test will the nurse expect to be ordered to confirm the diagnosis of a peptic ulcer? a. A dietary history b. A positive Hematest result on a stool sample c. A fiberoptic upper endoscopy d. An abdominal ultrasound

ANS: C Endoscopy provides direct visualization of the stomach lining and confirms the diagnosis of peptic ulcer. Dietary history may yield information suggestive of a peptic ulcer. Blood in the stool indicates a gastrointestinal abnormality, but it does not conclusively confirm a diagnosis of peptic ulcer. An abdominal ultrasound is used to rule out other gastrointestinal alterations such as gallstones, tumor, or mechanical obstruction.

4. The nurse teaches the parents that which of the following is the primary purpose of a transitional object? a. It helps the parents with the guilt they feel when they leave the child. b. It keeps the child quiet at bedtime. c. It is effective in decreasing anxiety in the toddler. d. It decreases negativism and tantrums in the toddler.

ANS: C Decreasing anxiety, particularly separation anxiety, is the function of a transitional object; it provides comfort to the toddler in stressful situations and helps make the transition from dependence to autonomy. Decreased parental guilt (distress) is an indirect benefit of a transitional object. A transitional object may be part of a bedtime ritual, but it may not keep the child quiet at bedtime. A transitional object does not significantly affect negativity and tantrums, but it can comfort a child after tantrums.

50. A nurse is teaching a student nurse in the pediatric clinic about vomiting in children. The nurse states that getting parents to estimate the amount a child has vomited is quite difficult. What is the best explanation for this problem? a. Parents are too upset by the vomiting to pay close attention. b. Parents don't know how to accurately estimate the amount. c. Descriptions about vomitus are vague and non-specific. d. Infants and small children often swallow the vomitus.

ANS: C Descriptive words used to describe vomitus are often vague and used inconsistently. The astute nurse uses specific questions to elicit the most accurate information. See Nursing Quality Alert Box 43-2 for examples of good questions to ask. Parents may or may not be too upset to pay attention. It is belittling to state that parents don't know how to estimate amounts. Infants and children may swallow some vomitus, but that is not the main problem.

7. How can chronic illness and frequent hospitalizations affect the psychosocial development of an adolescent? a. They can lead to feelings of inadequacy. b. They can interfere with parental attachment. c. They can block the development of identity. d. They can prevent the development of imagination.

ANS: C Development of identity is the task of the adolescent. Inadequacy and inferiority refer to the school-age period. Parental attachment is a task of the infant. Development of imagination occurs in the preschool period.

27. The diet of a child with chronic renal failure is usually characterized as a. high in protein. b. low in vitamin D. c. low in phosphorus. d. supplemented with vitamins A, E, and K.

ANS: C Dietary phosphorus is controlled to prevent or control the calcium/phosphorus imbalance by the reduction of protein and milk intake. Protein should be limited. Vitamin D is administered to children with chronic kidney failure. Supplementation of vitamins A, E, and K is not part of dietary management in chronic renal disease.

16. The teaching plan for a 7-year-old boy with color deficiency should include what instruction? a. Buy only one color of clothing to ensure the child's ability to match items himself. b. Patching the weaker eye will improve his color vision. c. Teach him an alternate way to distinguish between the colors of traffic signals. d. Botulism toxin drops must be administered every 2 months to improve color vision.

ANS: C Distinguishing colors of warning signals must be taught an alternative way to identify them. Clothes may be labeled or organized so the child can identify them. They do not have to be purchased only in one color. There is no cure for color blindness. Because the eye is not weak, patching will not correct the color deficiency. Color deficiency cannot be treated or corrected. The child can be taught adaptive measures to compensate for the condition.

11. A 5-year-old child has acquired immunodeficiency syndrome (AIDS). What statement by the mother indicates good understanding of medications used for this condition? a. "When my child's pain increases, I double the recommended dosage of antiretroviral medication." b. "Addiction is a risk, so I only use the medication as ordered." c. "Doses of the antiretroviral medication are selected on the basis of my child's age and growth." d. "By the time my child is an adolescent she will not need her antiretroviral medications any longer."

ANS: C Doses of antiretroviral medication to treat HIV infection for infants and children are based on individualized age and growth considerations. Antiretroviral medications are not administered for pain relief. Addiction is not a realistic concern with antiretroviral medications. Antiretroviral medications are still needed during adolescence.

3. The parents of a 14-year-old girl are concerned that their adolescent spends too much time looking in the mirror. Which statement is the most appropriate for the nurse to make? a. "Your teenager needs clearer and stricter limits about her behavior." b. "Your teenager needs more responsibility at home." c. "During adolescence this behavior is not unusual." d. "The behavior is abnormal and needs further investigation."

ANS: C Egocentric and narcissistic behavior, such as staring at oneself in the mirror, is normal during this period of development. The teenager is seeking a personal identity. Stricter limits are not an appropriate response for a behavior that is part of normal development. More responsibility at home is not an appropriate response for this situation. The behavior is normal and needs no further investigation.

12. Elective abortion is considered an ethical issue because a. abortion law is unclear about a woman's constitutional rights. b. the Supreme Court ruled that life begins at conception. c. a conflict exists between the rights of the woman and the rights of the fetus. d. it requires third-party consent.

ANS: C Elective abortion is an ethical dilemma because two opposing courses of action are available. The belief that induced abortion is a private choice is in conflict with the belief that elective pregnancy termination is taking a life. Abortion laws are clear concerning a woman's constitutional rights. The Supreme Court has not ruled on when life begins. Abortion does not require third-party consent.

23. What is a priority concern for a 14-year-old child with inflammatory bowel disease? a. Compliance with antidiarrheal medication therapy b. Long-term complications c. Dealing with the embarrassment and stress of diarrhea d. Home schooling due to extreme absenteeism

ANS: C Embarrassment and stress from chronic diarrhea are real concerns for the adolescent with inflammatory bowel disease. Antidiarrheal medications are not typically ordered for a child with inflammatory bowel disease. Long-term complications are not a priority concern for the adolescent with inflammatory bowel disease. Exacerbations may interfere with school attendance, but home schooling is not a usual consideration for the adolescent with inflammatory bowel disease.

8. What is an important focus of nursing care for the dying child and his or her family? a. Nursing care should be organized to minimize contact with the child. b. Adequate oral intake is crucial to the dying child. c. Families should be taught that hearing is the last sense to stop functioning before death. d. It is best for the family if nursing care takes place during periods when the child is alert.

ANS: C Families should be encouraged to talk to the child because verbal communication and physical touch are important both for the family and child. Nursing care should minimize disruptions but not contact. When a child is dying, fluids should be based on the child's requests, with a focus on comfort and preventing a dry mouth. The times when the child is alert should be devoted to family contacts.

11. What is the predominant trait of the resilient family associated with chronic illness? a. Social separation b. Family flexibility c. Family cohesiveness d. Clear family boundaries

ANS: C Family cohesiveness is the predominant trait of the resilient family. Social integration, not separation is another trait. Family flexibility and clear family boundaries are other traits of the resilient family but not the predominant one.

12. What is the best action for the nurse to take when a 5-year-old child who requires another 2 days of IV antibiotics cries, screams, and resists having the IV restarted? a. Exit the room and leave the child alone until he or she stops crying. b. Tell the child big boys and girls "don't cry." c. Let the child decide which color arm board to use with the IV. d. Administer an opioid analgesic for pain to quiet the child.

ANS: C Giving the preschooler some choice and control, while maintaining boundaries of treatment, supports the child's coping skills. Leaving the child alone robs the child of support when a coping difficulty exists. Crying is a normal response to stress. The child needs time to adjust and support to cope with unfamiliar and painful procedures during hospitalization. Although administration of a topical analgesic is indicated before restarting the child's IV, an opioid analgesic is not indicated.

23. The most appropriate nursing diagnosis for the child with acute glomerulonephritis is a. Risk for Injury related to malignant process and treatment. b. Deficient Fluid Volume related to excessive losses. c. Risk for Imbalanced Fluid Volume related to a decrease in plasma filtration. d. Excess Fluid Volume related to fluid accumulation in tissues and third spaces.

ANS: C Glomerulonephritis has a decreased filtration of plasma. The resulting decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. Excess fluid volume is found in this disease process. The fluid accumulation is related to the decreased plasma filtration.

10. Children receiving long-term systemic corticosteroid therapy are most at risk for which condition? a. Hypotension b. Dilation of blood vessels in the cheeks c. Growth delays d. Decreased appetite and weight loss

ANS: C Growth delay is associated with long-term steroid use. Hypertension is a clinical manifestation of long-term systemic steroid administration. Dilation of blood vessels in the cheeks is associated with an excess of topically administered steroids. Increased appetite and weight gain are clinical manifestations of excess systemic corticosteroid therapy.

3. Families who deal effectively with stress exhibit which behavior pattern? a. Focus on family problems b. Feel weakened by stress c. Expect that some stress is normal d. Feel guilty when stress exists

ANS: C Healthy families recognize that some stress is normal in all families. Healthy families focus on family strengths rather than on the problems and know that stress is temporary and may be positive. If families are dealing effectively with stress, then weakening of the family unit should not occur. Because some stress is normal in all families, feeling guilty is not reasonable. Guilt only immobilizes the family and does not lead to resolution of the stress.

45. Which statement best characterizes hepatitis A? a. Incubation period is 6 weeks to 6 months. b. Principal mode of transmission is through the parenteral route. c. Onset is usually rapid and acute. d. There is a persistent carrier state.

ANS: C Hepatitis A is characterized by a rapid acute onset. The incubation period is approximately 3 weeks for hepatitis A. The principal mode of transmission for hepatitis A is the fecal-oral route. Hepatitis A does not have a carrier state.

5. Which teaching guideline helps prevent eye injuries during sports and play activities? a. Restrict helmet use to those who wear eye glasses or contact lenses. b. Discourage the use of goggles with helmets so the child can see better. c. Wear eye protection when participating in high-risk sports such as paintball. d. Wear a face mask when playing any sport or playing roughly.

ANS: C High-risk sports such as paintball can cause penetrating eye injuries. Eye protection should be worn. All children who play games should be protected by the appropriate headgear. Goggles and helmets can and should be used concurrently. A face mask does not prevent damage to the child's head.

4. What is the best explanation for a 2-year-old child who is quiet and withdrawn on the fourth day of a hospital admission? a. The child is protesting her separation from her caregivers. b. The child has adjusted to the hospitalization. c. The child is experiencing the despair stage of separation. d. The child has reached the stage of detachment.

ANS: C In the despair stage of separation, the child exhibits signs of hopelessness and becomes quiet, withdrawn, and apathetic. In the protest stage, the child would be agitated, crying, resistant to caregivers, and inconsolable. Toddlers do not readily "adjust" to hospitalization and separation from caregivers. The detachment stage occurs after prolonged separation. During this phase, the child becomes interested in the environment and begins to play.

3. Which setting for childbirth allows the least amount of parent-infant contact? a. Labor/delivery/recovery/postpartum room b. Birth center c. Traditional hospital birth d. Home birth

ANS: C In the traditional hospital setting, the mother may see the infant for only short feeding periods, and the infant is cared for in a separate nursery. The labor/delivery/recovery/postpartum room setting allows increased parent-infant contact. Birth centers are set up to allow an increase in parent-infant contact. Home births allow an increase in parent-infant contact.

20. According to Piaget, the 6-month-old infant is in what stage of the sensorimotor phase? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata

ANS: C Infants are usually in the secondary circular reaction stage from age 4 months to 8 months. This stage is characterized by a continuation of the primary circular reaction because of the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking. The use of reflexes is primarily during the first month of life. Primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from age 1 month to 4 months. The fourth sensorimotor stage is coordination of secondary schemata. This is a transitional stage in which increasing motor skills enable greater exploration of the environment.

20. When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones. This should be considered a. unnecessary information, because the child is 3 years old. b. an important part of the family history. c. an important part of the child's past growth and development. d. an important part of the child's review of systems.

ANS: C Information about the attainment of developmental milestones is necessary and important to obtain. It provides data about the child's growth and development that should be included in the history. Developmental milestones provide important information about the child's physical, social, and neurologic health. The developmental milestones are specific to this child. If pertinent, attainment of milestones by siblings should be included in the family history. The review of systems does not include the developmental milestones.

16. Which therapeutic approach will best help a 7-year-old child cope with a lengthy course of intravenous antibiotic therapy? a. Arrange for the child to go to the playroom daily. b. Ask the child to draw you a picture of himself or herself. c. Allow the child to participate in injection play. d. Give the child stickers for cooperative behavior.

ANS: C Injection play is an appropriate intervention for the child who has to undergo frequent blood work, injections, intravenous therapy, or any other therapy involving syringes and needles. The hospitalized child should have opportunities to go to the playroom each day if the child's condition warrants. This free play does not have any specific therapeutic purpose. Children can express their thoughts and beliefs through drawing. Asking the child to draw a picture of himself or herself may not elicit the child's feelings about the treatment. Rewards such as stickers may enhance cooperative behavior. They will not address coping with painful treatments.

15. When is the most appropriate time to inspect the genital area during a well-child examination of a 14-year-old girl? a. It is not necessary to inspect the genital area. b. Examine the genital area first. c. After the abdominal assessment d. Do the genital inspection last.

ANS: C It is best to incorporate the genital assessment into the middle of the examination. This allows ample time for questions and discussion. If possible, proceed from the abdominal area to the genital area. A visual inspection of all areas of the body is included in a physical examination. Examination of the genital area can be embarrassing. It is not appropriate to begin the examination with this area. Assessing the genital area earlier in the examination allows more time for the adolescent to ask questions and engage in discussion.

12. A child is being discharged from the hospital on insulin. The mother is apprehensive about giving the medication. What action by the nurse is most important? a. Review the side effects of insulin with the mother. b. Have the mother verbalize that she knows the importance of follow-up care. c. Observe the mother while she administers an insulin injection. d. Help the mother devise a rotation schedule for injections.

ANS: C It is important that the nurse evaluate the mother's ability to give the insulin injection before discharge. Watching her give the injection to the child will give the nurse an opportunity to offer assistance and correct any errors. The other items are important too, but the priority would be ensuring the mother can administer the medication safely.

11. Which statement indicates that a father understands the treatment for his child who has scarlet fever? a. "I can stop the medicine when my child feels better." b. "I will apply antibiotic cream to her rash twice a day." c. "I will give the penicillin for the full 10 days." d. "My child can go back to school after 7 days of antibiotics."

ANS: C It is necessary to give the entire course of antibiotic for 10 to 14 days. Penicillin is the preferred treatment for any streptococcal infection. The bacteria will not be eradicated if a partial course of antibiotics is given. Treatment of scarlet fever does not include topical antibiotic cream. The child is no longer contagious after 24 hours of antibiotic therapy and can return to daycare or school.

2. The postoperative care plan for an infant with surgical repair of a cleft lip includes a. a clear liquid diet for 72 hours. b. nasogastric feedings until the sutures are removed. c. elbow restraints to keep the infant's fingers away from the mouth. d. rinsing the mouth after every feeding.

ANS: C Keeping the infant's hands away from the incision reduces potential complications at the surgical site. The infant's diet is advanced from clear liquid to soft foods within 48 hours of surgery. After surgery, the infant can resume preoperative feeding techniques. Rinsing the mouth after feeding is an inappropriate intervention. Feeding a small amount of water after feedings will help keep the mouth clean. A cleft lip repair site should be cleansed with a wet sterile cotton swab after feedings.

11. When meeting a toddler for the first time, the nurse initiates contact by a. calling the toddler by name and picking the toddler up. b. asking the toddler for his or her first name. c. kneeling in front of the toddler and speaking softly to the child. d. telling the toddler that you are his or her nurse today.

ANS: C More positive interactions occur when the toddler perceives the meeting in a nonthreatening way. Placing yourself at the toddler's level and speaking softly can be less threatening for the child. Picking a toddler up at an initial meeting is a threatening action and will more likely result in a negative response from the child. Toddlers are unlikely to respond to direct questions at a first meeting. Telling the toddler you are the nurse is not likely to facilitate or encourage cooperation. The toddler perceives you as a stranger and will find the action threatening.

26. What heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood? a. S1, S2 b. Snaps and clicks c. Murmur d. Physiologic splitting

ANS: C Murmurs are the sounds that are produced in the heart chambers or major arteries from the turbulence of blood flow. Murmurs create a blowing and swooshing sound. S1 and S2 are the normal heart sounds. Snaps and clicks are short, high-pitched sounds heard with valve disorders and do not vary with respirations. The physiologic splitting of S2, an audible pause between the closing of the aortic and pulmonic valves, frequently heard in children of all ages, is considered normal.

18. A nurse is floated to a different unit. The nurse does not know how to perform a treatment that has been prescribed for one of his or her assigned patients. What should the nurse's first action be? a. Delay the treatment until another nurse can do it. b. Make the child's parents aware of the situation. c. Inform the nursing supervisor of the problem. d. Arrange to have the child transferred to another unit.

ANS: C Nurses who work outside their usual areas of expertise must assess their own skills and avoid performing tasks or taking on responsibilities in areas in which they are not competent. This nurse should inform the supervisor of the situation. The nurse could endanger the child by delaying the intervention until another nurse is available. Telling the child's parents would most likely increase their anxiety and will not resolve the difficulty. Transfer to another unit delays needed treatment and would create unnecessary disruption for the child and family.

4. As a result of changes in health care delivery and funding, a current trend seen in the pediatric setting is a. increased hospitalization of children. b. decreased number of children living in poverty. c. an increase in ambulatory care. d. decreased use of managed care.

ANS: C One effect of managed care has been that pediatric health care delivery has shifted dramatically from the acute care setting to the ambulatory setting in order to provide more cost-efficient care. The number of hospital beds being used has decreased as more care is given in outpatient settings and in the home. The number of children living in poverty has increased over the past decade. One of the biggest changes in health care has been the growth of managed care.

13. A parent of a chubby 8-year-old wants to know how to keep the child from gaining more weight. What response by the nurse is best? a. Do not allow your child to snack. b. Make a school lunch every day. c. Model the behaviors you'd like to see. d. Place your child on a restricted diet.

ANS: C One good option for obesity prevention is to model the behaviors the parents want the child to emulate. The parents should set good examples with eating health and engaging in regular exercise. Snacks, if healthy, can be an important part of a nutritious day. Even if the parent makes a lunch for school each day, there is no guarantee the child will eat it. Children will likely rebel against a strict diet.

22. Home care is being considered for a young child who is ventilator dependent. Which factor is most important in deciding whether home care is appropriate? a. Level of parents' education b. Presence of two parents in the home c. Preparation and training of family d. Family's ability to assume all health care costs

ANS: C One of the essential elements is the training and preparation of the family. The family must be able to demonstrate all aspects of care for the child. In many areas, it cannot be guaranteed that nursing care will be available on a continual basis, and the family will have to care for the child. The amount of formal education reached by the parents is not the important issue. The determinant is the family's ability to care adequately for the child in the home. At least two family members should learn and demonstrate all aspects of the child's care in the hospital, but it does not have to be two parents.

15. A group of boys ages 9 and 10 years have formed a "boys-only" club that is open to neighborhood and school friends who have skateboards. This should be interpreted as a. behavior that encourages bullying and sexism. b. behavior that reinforces poor peer relationships. c. characteristic of social development of this age. d. characteristic of children who are at risk for membership in gangs.

ANS: C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. A boys-only club does not have a direct correlation with later gang activity.

7. Which is the most appropriate question to ask when interviewing an adolescent to encourage conversation? a. "Are you in school?" b. "Are you doing well in school?" c. "How is school going for you?" d. "How do your parents feel about your grades?"

ANS: C Open-ended questions encourage communication. Questions with "yes" or "no" answers do not encourage conversation. Questions that can be interpreted as judgmental do not enhance communication. Asking adolescents about their parents' feelings may block communication.

25. Therapeutic management of the child with acute diarrhea and dehydration usually begins with a. clear liquids. b. IV solutions while the child is NPO. c. oral rehydration solution (ORS). d. antidiarrheal medications.

ANS: C Orally administered rehydration solution is the first treatment for acute diarrhea. Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. The child might need an IV but would not be NPO. Antidiarrheals are not recommended because they do not get rid of pathogens.

2. What is the primary disadvantage associated with outpatient and day facility care? a. Increased cost b. Increased risk of infection c. Lack of physical connection to the hospital d. Longer separation of the child from family

ANS: C Outpatient and day facility care do not provide extended care; therefore a child requiring extended care should be transferred to the hospital, causing increased stress to the child and parents. This type of care decreases cost and infection and minimizes separation between the child and family.

10. Which is a priority in counseling parents of a 6-month-old infant? a. Increasing food intake for secondary growth spurt b. Encouraging the infant to smile c. Securing a developmentally safe environment for the infant d. Teaching strategies to teach infants to sit up

ANS: C Safety is a primary concern as an infant becomes increasingly mobile. The infant's appetite and growth velocity decrease in the second half of infancy. Although a social smile should be present by 6 months of age, encouraging this is not of higher priority than ensuring environmental safety. Unless the infant has a neuromuscular deficit, strategies for teaching a normally developing infant to sit up are not necessary.

17. The nurse is in a unique position to assess children for symptoms of neglect. Which high-risk family situation places the child at the greatest risk for being neglected? a. Marital conflict and divorce b. Adolescent parenting c. Substance abuse d. A child with special needs

ANS: C Parents who abuse drugs or alcohol may neglect their children because obtaining and using the substance(s) may have a stronger pull on the parents than the care of their children. Although divorce is traumatic to children, research has shown that living in a home filled with conflict is also detrimental. In this situation conflict may arise and young children may be unable to verbalize their distress; however, the child is not likely to be neglected. Teenage parenting often has a negative effect on the health and social outcomes of the entire family. Adolescent girls are at risk for a number of pregnancy complications, are unlikely to attain a high level of education, and are more likely to be poor. But this does not equate with a higher risk of neglect. When a child is born with a birth defect or has an illness that requires special care, the family is under additional stress. These families often suffer financial hardship as health insurance benefits quickly reach their maximum. But again, this does not lead to neglect as a frequent problem.

20. What is an appropriate statement for the nurse to make to parents of a child who has had a barium enema to correct an intussusception? a. "I will call the physician when the baby passes his first stool." b. "I am going to dilate the anal sphincter with a gloved finger to help the baby pass the barium." c. "Your baby can't have anything to eat or drink until bowel function returns." d. "Add cereal to the baby's formula to help him pass the barium."

ANS: C Post procedure, the child is kept NPO until bowel function returns. The physician does not need to be notified when the infant passes the first stool. Dilating the anal sphincter is not appropriate for the child after a barium enema.

9. A nurse wishes to work to reduce infant mortality in the United States. Which activity would this nurse most likely participate in? a. Creating pamphlets in several different languages using an interpreter. b. Assisting women to enroll in Medicaid by their third trimester. c. Volunteering to provide prenatal care at community centers. d. Working as an intake counselor at a women's shelter.

ANS: C Prenatal care is vital to reducing infant mortality and medical costs. This nurse would most likely participate in community service providing prenatal care outreach activities in community centers, particularly in low-income areas. Pamphlets in other languages, enrolling in Medicaid, and working at a women's shelter all might impact infant mortality, but the greatest effect would be from assisting women to get consistent prenatal care.

9. What is an appropriate preoperative teaching plan for a school-age child? a. Begin preoperative teaching the morning of surgery. b. Schedule a tour of the hospital a few weeks before surgery. c. Show the child books and pictures 4 days before surgery. d. Limit teaching to 5 minutes and use simple terminology.

ANS: C Preparatory material can be introduced to the school-age child several days (1 to 5) in advance of the event. Books, pictures, charts, and videos are appropriate. Preoperative teaching a few hours before surgery is more appropriate for the preschool child. Preoperative materials should be introduced 1 to 5 days in advance for school-age children. Preparation too far in advance of the procedure can be forgotten or cause undue anxiety for an extended period of time. A very short, simple explanation of the surgery is appropriate for a younger child such as a toddler.

8. What information should the nurse include when teaching the parents of a 5-week-old infant about pyloromyotomy? a. The infant will be in the hospital for a week. b. The surgical procedure is routine and "no big deal." c. The prognosis for complete correction with surgery is good. d. They will need to ask the physician about home care nursing.

ANS: C Pyloromyotomy is the definitive treatment for pyloric stenosis. Prognosis is good with few complications. These comments reassure parents. The infant will remain in the hospital for a day or two postoperatively. Although the prognosis for surgical correction is good, telling the parents that surgery is "no big deal" minimizes the infant's condition. Home care nursing is not necessary after a pyloromyotomy.

20. What is the best action for the nurse to take when giving medications to a 3-year-old child? a. Tell the child to take the medication "right now." b. Tell the child to take the medication or she will have to get a shot. c. Allow the child to choose fruit punch or apple juice when giving the medication. d. Tell the child that another child her age just took his medication like a "good girl."

ANS: C Realistic choices such as type of juice to drink with medications allow the child to feel some control. Direct confrontation typically results in a "no" response. Threatening a child with a shot is inappropriate. Comparisons are not helpful in getting a child this age to cooperate.

20. A nurse must do a venipuncture on a 6-year-old child. An important consideration in providing atraumatic care is to a. use an 18-gauge needle if possible. b. wait 10 minutes after applying EMLA cream. c. restrain child only as needed to perform venipuncture safely. d. have the parents choose the child's favorite bandage afterward.

ANS: C Restrain child only as needed to perform the procedure safely. Smaller needles are used. After applying EMLA cream, the nurse must wait a minimum of 60 minutes. Allow the child to choose a favorite bandage.

7. What is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux? a. Teach parents to position the infant on the left side. b. Reinforce the parents' knowledge of the infant's developmental needs. c. Teach the parents how to do infant cardiopulmonary resuscitation (CPR). d. Have the parents keep an accurate record of intake and output.

ANS: C Risk of aspiration is a priority nursing diagnosis for the infant with gastroesophageal reflux. The parents must be taught infant CPR. Correct positioning minimizes aspiration. The correct position for the infant is supine for sleeping unless the risk of aspiration is great. Knowledge of developmental needs should be included in discharge planning for all hospitalized infants, but it is not the most important in this case. Keeping a record of intake and output is not a priority and may not be necessary.

37. Which viral pathogen frequently causes acute diarrhea in young children? a. Giardia organisms b. Shigella organisms c. Rotavirus d. Salmonella organisms

ANS: C Rotavirus is the most frequent viral pathogen that causes diarrhea in young children. The other organisms are bacterial.

12. An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to a. ask why the child wants to know. b. determine why the child is so anxious. c. explain in simple terms how it works. d. tell the child he or she will see how it works as it is used.

ANS: C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. The nurse should respond positively for requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. The child is not exhibiting anxiety, just requesting clarification of what will be occurring. The nurse must explain how the blood pressure cuff works so that the child can then observe during the procedure.

11. What is the major focus of the therapeutic management for a child with lactose intolerance? a. Compliance with the medication regimen b. Providing emotional support to family members c. Teaching dietary modifications d. Administration of daily normal saline enemas

ANS: C Simple dietary modifications are effective in management of lactose intolerance. Symptoms of lactose intolerance are usually relieved after instituting a lactose-free diet. Medications are not typically ordered in the management of lactose intolerance. Providing emotional support to family members is not specific to this medical condition. Diarrhea is a manifestation of lactose intolerance. Enemas are contraindicated for this alteration in bowel elimination.

13. What manifestation in a 5-month-old child could indicate visual problems? a. Lack of binocularity b. Visual acuity of 20/50 c. Strabismus d. Hyperopia

ANS: C Strabismus is normal in the young infant but should not be present after 3 months of age. Binocularity, the ability to fixate on one visual field with both eyes, is not present at birth but is established by 6 months of age. Visual acuity by 4 months of age is between 20/50 and 20/80. Hyperopia, or farsightedness, is normal until about 7 years of age.

4. Which statement made by a parent indicates an understanding about treatment of streptococcal pharyngitis? a. "I guess my child will need to have his tonsils removed." b. "A couple of days of rest and some ibuprofen will take care of this." c. "I should give the penicillin three times a day for 10 days." d. "I am giving my child prednisone to decrease the swelling of the tonsils."

ANS: C Streptococcal pharyngitis is best treated with oral penicillin two to three times daily for 10 days. Surgical removal of the tonsils is a controversial issue. It may be warranted in cases of recurrent tonsillitis. It is not indicated for the treatment of acute tonsillitis. Comfort measures such as rest and analgesics are indicated, but these will not treat the bacterial infection. Corticosteroids are not used in the treatment of streptococcal pharyngitis.

5. Which statement by the nurse is most appropriate to a 15-year-old whose friend has mentioned suicide? a. "Tell your friend to come to the clinic immediately." b. "You need to gather details about your friend's suicide plan." c. "Your friend's threat needs to be taken seriously and he needs immediate help." d. "If your friend mentions suicide again get your friend some help."

ANS: C Suicide is the second most common cause of death among American adolescents and young adults aged 15 to 24. A suicide threat from an adolescent serves as a dramatic message to others and should be taken seriously. Adolescents at risk should be targeted for supportive guidance and counseling before a crisis occurs. Instructing a 15-year-old to tell a friend to come to the clinic immediately provides the teen with limited information and does not address the concern. The teen should not be responsible for getting more information from the friend. Waiting until the teen discusses suicide a second time may be too late.

8. Which intervention for treating croup at home should be taught to parents as possibly helpful? a. Have a decongestant available. b. Have the child sleep in a dry room. c. Take the child outside. d. Give the child an antibiotic at bedtime.

ANS: C Taking the child into the cool, humid, night air may relieve mucosal swelling and improve symptoms. Decongestants are inappropriate for croup, which affects the middle airway level. A dry environment may contribute to symptoms. Croup is caused by a virus. Antibiotic treatment is not indicated.

1. The nurse is explaining Tanner staging to an adolescent and mother. Which statement best describes Tanner staging? a. Predictable stages of puberty that are based on chronologic age b. Staging of puberty based on the initiation of menarche and nocturnal emissions c. Predictable stages of puberty based on primary and secondary sexual characteristics d. Staging of puberty based on the initiation of primary sexual characteristics

ANS: C Tanner sexual-maturing ratings are based on the development of stages of primary and secondary sexual characteristics. Tanner stages are not based on chronologic age. The age at which an adolescent enters puberty is variable. The puberty stage in girls begins with breast development. Puberty stage in boys begins with genital enlargement. Primary sexual characteristics are not the basis of Tanner staging.

8. Which statement is the most accurate about moral development in the 9-year-old school-age child? a. Right and wrong are based on physical consequences of behavior. b. The child obeys parents because of fear of punishment. c. The school-age child conforms to rules to please others. d. Parents are the determiners of right and wrong for the school-age child.

ANS: C The 7- to 12-year-old child bases right and wrong on a good-boy or good-girl orientation in which the child conforms to rules to please others and avoid disapproval. Children 4 to 7 years of age base right and wrong on consequences. Consequences are the most important consideration for the child between 4 and 7 years of age. Parents determine right and wrong for the child younger than 4 years of age.

23. Which child requires a Mantoux test? a. The child who has episodes of nighttime wheezing and coughing b. The child who has a history of allergic rhinitis c. The child whose babysitter has received a tuberculosis diagnosis d. The premature infant who is being treated for apnea of infancy

ANS: C The Mantoux test is the initial screening mechanism for patients exposed to tuberculosis. Nighttime wheezing and coughing are consistent with a diagnosis of asthma. Allergic rhinitis requires an allergy workup. The Mantoux test is not used to evaluate apnea.

4. Which statement by a parent about conjunctivitis indicates that further teaching is needed? a. "I'll have separate towels and washcloths for each family member." b. "I'll notify my doctor if the eye gets redder or the drainage increases." c. "When the eye drainage improves, we'll stop giving the antibiotic ointment." d. "After taking the antibiotic for 24 hours, my child can return to school."

ANS: C The antibiotic should be continued for the full prescription. Maintaining separate towels and washcloths will prevent the other family members from acquiring the infection. If the infection proliferates, the physician should be contacted. The child should be kept home from school or day care until the child receives the antibiotic for 24 hours.

30. What should the nurse teach a child about using an albuterol metered-dose inhaler for exercise-induced asthma? a. Take two puffs every 6 hours around the clock. b. Use the inhaler only when the child is short of breath. c. Use the inhaler 30 minutes before exercise. d. Take one to two puffs every morning upon awakening.

ANS: C The appropriate time to use an inhaled beta2-agonist is before an event that could trigger an attack. Taking the medication every 6 hours will not prevent the exercise-induced asthma. Waiting until symptoms are severe is too late to begin using a metered-dose inhaler. Taking puffs every morning may be the child's usual schedule for medication. If exercise causes symptoms, additional medication is indicated.

15. The parents of a newborn say that their toddler "hates the baby.... He suggested that we put him in the trash can so the trash truck could take him away." The nurse's best action is to a. assess the older child for signs of child abuse. b. refer the family for psychological counseling. c. assist the family to deal with this response. d. encourage the family to give the toddler extra attention.

ANS: C The arrival of a new infant represents a crisis for even the best prepared toddler. Toddlers have their entire schedule and routines disrupted because of the new family member. This is a normal response. The nurse should work with parents on ways to involve the toddler in the newborn's care and to help focus attention on the toddler. There is no need to assess for child abuse or to refer the family for counseling. Giving the toddler some extra attention and "special time" will probably help, but this is too narrow in scope to be the best answer. The nurse should help brainstorm several different strategies.

12. Which intervention is appropriate for a child receiving high doses of steroids? a. Limit activity and receive home schooling. b. Increase the amount of carbohydrates in the diet. c. Substitute a killed virus vaccine for live virus vaccines. d. Monitor for seizure activity.

ANS: C The child on high doses of steroids should not receive live virus vaccines because of immunosuppression. Limiting activity and home schooling are not routine for a child receiving high doses of steroids. Children on high doses of steroids sometimes get carbohydrate intolerance; the diet should not contain high levels of carbohydrates. Children on steroids are not typically at risk for seizures.

34. What goal has the highest priority for a child with malabsorption associated with lactose intolerance? a. The child will experience no abdominal spasms. b. The child will not experience constipation and malabsorption syndrome. c. The child will not experience diarrhea associated with malabsorption syndrome. d. The child will receive adequate nutrition as evidenced by a weight gain of 1 kg/week.

ANS: C The child with lactose intolerance will have diarrhea and malabsorption, so a good goal would be no longer having these manifestations. A child usually has abdominal cramping pain and distention rather than spasms. The child usually has diarrhea, not constipation. One kilogram every week may or may not be appropriate depending on the child's age and how long the goal is in place for.

16. What action is appropriate when using an EMLA cream before intravenous catheter insertion? a. Rub a liberal amount of cream into the skin thoroughly. b. Cover the skin with a gauze dressing after applying the cream. c. Leave the cream on the skin for 1 to 2 hours before the procedure. d. Use the smallest amount of cream necessary to numb the skin surface.

ANS: C The cream should be left in place for a minimum of 1 hour and no more than 2 hours. The EMLA cream should not be rubbed into the skin. After the cream is applied to the skin surface, it is covered with a transparent occlusive dressing. The nurse should use a liberal amount of EMLA cream.

9. What should the nurse include in a teaching plan for the mother of a toddler who will be taking prednisone for several months? a. The medication should be taken between meals. b. The medication needs to be discontinued if side effects appear. c. The medication should not be stopped abruptly. d. The medication may lower blood glucose.

ANS: C The dosage must be tapered before the drug is discontinued to allow the gradual return of function in the pituitary-adrenal axis. Prednisone should be taken with food to minimize or prevent gastrointestinal bleeding. Although there are adverse effects from long-term steroid use, the medication must not be discontinued without consulting a physician. Acute adrenal insufficiency can occur if the medication is withdrawn abruptly. The dosage needs to be tapered. The medication puts the child at risk for hyperglycemia.

14. In providing anticipatory guidance to parents whose child will soon be entering kindergarten, which is a critical factor to include in this teaching? a. The child needs to be able to sit still. b. The child should be able to count to 25. c. The parent should have interaction and be responsive to the child. d. The child should attend a preschool program first.

ANS: C The earliest interactions between parent and infant lay the foundation for school readiness. Probably the most important factor in the development of academic competency is the relationship between parent and child. Sitting still and counting are important skills but are not as vital as parental involvement and responsiveness. Preschool is a helpful experience but not required to enter kindergarten.

12. Once an allergen is identified in a child with allergic rhinitis, the treatment of choice the nurse educates the parents about is which of the following? a. Using appropriate medications b. Beginning desensitization injections c. Eliminating the allergen d. Removing the adenoids

ANS: C The first priority is to attempt to remove the causative agent from the child's environment. Medications are not a first-line treatment but can be helpful in controlling allergic rhinitis. Immunotherapy is usually the final component of controlling allergic rhinitis. Adenoids are tissues that can swell with constant rhinitis; however, a surgical procedure is not indicated for allergic rhinitis. Dealing with the cause is the first priority.

15. Which patient situation fails to meet the first requirement of informed consent? a. The patient does not understand the physician's explanations. b. The physician gives the patient only a partial list of possible side effects and complications. c. The patient is confused and disoriented. d. The patient signs a consent form because her husband tells her to.

ANS: C The first requirement of informed consent is that the patient must be competent to make decisions about health care. Full disclosure of information is an important element of the consent, but first the patient has to be competent to sign. Understanding is an important element of the consent, but first the patient has to be competent to sign. Voluntary consent is an important element of the consent, but first the patient has to be competent to sign.

3. What should the nurse consider when having consent forms signed for surgery and procedures on children? a. Only a parent or legal guardian can give consent. b. The person giving consent must be at least 18 years old. c. The risks and benefits of a procedure are part of the consent process. d. A mental age of 7 years or older is required for a consent to be considered "informed."

ANS: C The informed consent must include the nature of the procedure, benefits and risks, and alternatives to the procedure. In special circumstances, such as emancipated minors, the consent can be given by someone younger than 18 years without the parent or legal guardian. A mental age of 7 years is too young for consent to be informed.

18. A parent brings a child to the emergency department and reports fever, foul smell coming from the throat, and a gray covering over the tonsils. What action by the nurse takes priority? a. Place the child on a cardiac monitor. b. Attach a pulse oximeter to the child. c. Assess respiratory status immediately. d. Start an IV and draw blood cultures.

ANS: C The manifestations are characteristic of diphtheria, which can cause respiratory compromise and airway obstruction. The nurse first assesses the child's respiratory status. Putting the child on a cardiac monitor and oximeter are important interventions, but first the nurse needs to assess the respiratory system. The child will need an IV, but that can be started after the respiratory assessment.

15. Which is an appropriate nursing intervention for the hospitalized neonate? a. Assign the neonate to a room with other neonates. b. Provide play activities in the hospital room. c. Offer the neonate a pacifier between feedings. d. Request that parents bring a security object from home.

ANS: C The neonate needs opportunities for nonnutritive sucking and oral stimulation with a pacifier. The neonate is not aware of other children. The choice of roommate will not affect the neonate socially. It is important for older children to room with similar-age children. Formal play activities are not relevant for the neonate. Having parents bring a security object from home is applicable to older children.

23. A student nurse in the emergency department is preparing to obtain a throat culture on a child with suspected epiglottis secondary to a strep infection. What action by the registered nurse is best? a. Remind the student to wear personal protective equipment. b. Tell the student to get the child to say "ahhh." c. Consult with the provider prior to obtaining the culture. d. Inform the parents and child that a throat culture is needed.

ANS: C The nurse never obtains a throat culture on a child in whom epiglottitis is suspected because it may precipitate sudden airway obstruction. The nurse consults with the provider about this issue. Wearing personal protective equipment, having the child say "ahhh," and informing the child and parents of the needed culture would all be appropriate when obtaining it.

2. When addressing the questions of a newly pregnant woman, the nurse can explain that the certified nurse-midwife is qualified to perform a. regional anesthesia. b. cesarean deliveries. c. vaginal deliveries. d. internal versions.

ANS: C The nurse-midwife is qualified to deliver infants vaginally in uncomplicated pregnancies. The other procedures must be performed by a physician or other medical provider.

14. A student nurse asks the faculty why peer relationships become more important during adolescence. Which of the following is the nurse's best response? a. Adolescents dislike their parents. b. Adolescents no longer need parental control. c. They provide adolescents with a feeling of belonging. d. They promote a sense of individuality in adolescents.

ANS: C The peer group serves as a strong support to teenagers, providing them with a sense of belonging (versus individuality) and a sense of strength and power. During adolescence, the parent/child relationship changes from one of protection-dependency to one of mutual affection and quality. This does not mean teens do not like their parents who continue to play an important role in their personal and health-related decisions.

5. To evaluate the woman's learning about performing infant care, the nurse should a. demonstrate infant care procedures. b. allow the woman to verbalize the procedure. c. observe the woman as she performs the procedure. d. routinely assess the infant for cleanliness.

ANS: C The woman's ability to perform the procedure correctly under the nurse's supervision is the best method of evaluation. Demonstration is an excellent teaching method but not an evaluation method. During verbalization of the procedure, the nurse may not pick up on techniques that are incorrect. It is not the best tool for evaluation. Observing the infant for cleanliness does not ensure the proper procedure is carried out. The nurse may miss seeing unsafe techniques being used.

1. A child has had cold symptoms for more than 2 weeks, a headache, nasal congestion with purulent nasal drainage, facial tenderness, and a cough that increases during sleep. The nurse plans to teach the parents about which treatment regime? a. Antihistamine use b. Cold washcloths on the face for comfort c. Antibiotic treatment with amoxicillin d. Referral for a sinuplasty

ANS: C These manifestations are those of a sinus infection. The parents need to be taught about antibiotic use. A common antibiotic used for sinusitis is amoxicillin. Antihistamines are not recommended because they dry up secretions, making them more difficult to remove. Warm wet washcloths can be used for comfort. A sinuplasty may be needed if the child does not improve or if sinus infections are recurrent or frequent.

7. Which action is appropriate to promote a toddler's nutrition during hospitalization? a. Allow the child to walk around during meals. b. Require the child to empty his or her plate. c. Ask the child's parents to bring a cup and utensils from home. d. Select new foods for the child from the menu.

ANS: C Using familiar items during mealtimes increases the toddler's sense of security and control and may encourage eating. For safety reasons, "roaming" while eating should not be permitted. The child should be seated during meals. Toddlers often use food as a source of control. Forcing a toddler to eat only increases the child's sense of powerlessness. Toddlers also experience food jags, a normal phenomenon when they will only eat certain foods. Hospitalization is a stressful experience for the toddler. It is not the time to introduce the child to new foods.

6. The parent of a child who has had numerous hospitalizations asks the nurse for advice because the child has been having behavior problems at home and in school. In discussing effective discipline, what is an essential component? a. All children display some degree of acting out, and this behavior is normal. b. The child is manipulative and should have firmer limits set on her behavior. c. Positive reinforcement and encouragement should be used to promote cooperation and the desired behaviors. d. Underlying reasons for rules should be given, and the child should be allowed to decide which rules should be followed.

ANS: C Using positive reinforcement and encouragement to promote cooperation and desired behaviors is one of the three essential components of effective discipline. Behavior problems should not be disregarded as normal. It would be incorrect to assume the child is being manipulative and should have firmer limits set on her behaviors. Providing the underlying reasons for rules and giving the child a choice concerning which rules to follow constitute a component of permissive parenting and are not considered an essential component of effective discipline.

8. While reviewing the dietary-intake documentation of a 7-year-old Asian patient with a fractured femur, the nurse notes that the patient consistently refuses to eat the food on his tray. What assumption is most likely accurate? a. The child is a picky eater. b. The child needs less food because of bed rest. c. The child may have culturally related food preferences. d. The child is probably eating between meals and spoiling his appetite.

ANS: C When cultural differences are noted, food preferences should always be obtained. A child will often refuse to eat unfamiliar foods. Although the child may be a picky eater, the key point is that there are cultural differences that need to be considered. The foods he is being served may seem strange to a child. Nutrition plays an important role in healing. Although the energy the child expends has decreased while on bed rest, he or she has increased needs for good nutrition. Although the nurse should determine whether the child is eating food the family has brought from home, the more important point is to determine whether there are culturally related food preferences.

15. A nurse is planning to teach about injury prevention to a group of parents. What action by the nurse would best ensure a successful event? a. Have handouts listing community resources. b. Provide free safety gear like bike helmets. c. Group parents by child's developmental stage. d. Present the material in an interactive way.

ANS: C When providing anticipatory guidance to prevent injury, the most important thing for the nurse to know and understand is developmental levels of the children involved. Grouping parents by their child's developmental level allows the nurse to know this information about the group and to provide teaching specific to the group. The other options will help but are not as important as tailoring teaching to the specific needs of the children.

22. A child is brought to the emergency department. When he is called to triage, which vital sign should be measured first? a. Temperature b. Heart rate c. Respiratory rate d. Blood pressure

ANS: C When taking children's vital signs, the nurse observes the respiratory rate first. Temperature and blood pressure should be measured after respiratory and heart rate because it can be upsetting for children. Heart rate is measured after respiratory rate.

21. Discharge planning for an 8-year-old child with a patched eye after a large corneal abrasion should include which instruction? a. Removing the patch after 8 hours for instillation of antibiotic ointment b. Gently massaging the affected eye to prevent edema c. Keeping the patch in place for 24 hours d. Returning after 7 days of patching for reassessment

ANS: C With severe abrasions, the eye should be patched and left undisturbed for 24 hours. After 24 hours, treatment with antibiotic ointment is started. Massaging the affected eye will increase the size of the abrasion and should be avoided. The child should also be taught not to rub the affected eye. The child should return in 24 hours for reassessment if the eye is patched.

10. To resolve family conflict, it is necessary to have open communication, accurate perception of the problem, and a(n) a. intact family structure. b. arbitrator. c. willingness to consider the view of others. d. balance in personality types.

ANS: C Without constructive efforts to resolve the conflict, such as the willingness of the members of a group to consider the views of others, conflict resolution cannot take place. The structure of a family may affect family dynamics, but it is still possible to resolve conflict without an intact family structure if all of the ingredients of conflict resolution are present. Conflicts can be resolved without the assistance of an arbitrator. Most families have diverse personality types among their members. This diversity may make conflict resolution more difficult but should not impede it as long as the ingredients of conflict resolution are present.

1. Which medications are the most effective choices for treating pain associated with inflammation in children? (Select all that apply.) a. Morphine b. Acetaminophen c. Ibuprofen d. Ketorolac e. Aspirin

ANS: C, D Ibuprofen, naproxen/naproxen sodium, and ketorolac are all types of NSAIDs, which are used primarily for pain associated with inflammation. Opioids, such as morphine, are the preferred drugs for the management of acute, severe pain, including postoperative pain, posttraumatic pain, pain from vaso-occlusive crisis, and chronic cancer pain. Acetaminophen lacks the anti-inflammatory effects of NSAIDs and provides only minimal anti-inflammatory relief. Although aspirin is an anti-inflammatory medication, because of its association with Reye's syndrome, its use is not recommended in children.

25. What is the leading cause of unintentional death in children younger than 19 years of age in the United States? a. Drowning b. Airway obstruction c. Pedestrian injury d. Motor vehicle injuries

ANS: D The Centers for Disease Control and Prevention (CDC) has consistently found that motor vehicle injuries are the leading cause of unintentional death in children younger than 19 years of age in the United States. Drowning, airway obstruction, and pedestrian injury do cause death but not at the rate of motor vehicle crashes.

3. Which statement best describes how a cataract affects a child's vision? a. It increases intraocular pressure. b. It alters the ability to distinguish among colors. c. It causes double vision. d. It prevents a clear image from forming on the retina.

ANS: D A cataract is an opacity of the lens or loss of transparency of the lens. Coughing, straining, or vomiting can increase intraocular pressure postoperatively. Nystagmus and strabismus are clinical signs of a cataract. Color deficiency is not a sign. A cataract usually does not cause double vision.

7. Which statement by a parent of a child with nephrotic syndrome indicates an understanding of a no-added-salt diet? a. "I can give my child sweet pickles." b. "My child can put ketchup on his hotdog." c. "I can let my child have potato chips." d. "I do not put any salt in foods when I am cooking."

ANS: D A no-added-salt diet means that no salt should be added to foods, either when cooking or before eating. Pickles of any type, hotdogs, and potato chips are all prohibited on this diet.

3. The nurse is planning to teach parents of a 15-month-old child. Which is the priority concern the nurse should address? a. Toilet training guidelines b. Guidelines for weaning children from bottles c. Instructions on preschool readiness d. Instructions on a home safety assessment

ANS: D Accidents are the major cause of death in children, including deaths caused by ingestion of poisonous materials. Home and environmental safety assessments are priorities in this age-group because of toddlers' increased motor skills and independence, which puts them at greater risk in an unsafe environment. Although it is appropriate to give parents of a 15-month-old child toilet training guidelines, the child is not usually ready for toilet training, so it is not the priority teaching intervention . Parents of a 15-month-old child should have been advised to begin weaning from the breast or bottle at 6 to 12 months of age. Educating a parent about preschool readiness is important and can occur later in the parents' educational process. The priority teaching intervention for the parents of a 15-month-old child is the importance of a safe environment.

28. At what developmental period do children have the most difficulty coping with death, particularly if it is their own? a. Toddlerhood b. Preschool c. School-age d. Adolescence

ANS: D Adolescents, because of their mature understanding of death, remnants of guilt and shame, and issues with deviations from normal, have the most difficulty coping with death. Toddlers and preschoolers will fear separation from parents. School-age children will fear the unknown, such as the consequences of the illness and the threat to their sense of security.

11. Which statement is true about the characteristics of a healthy family? a. The parents and children have rigid assignments for all the family tasks. b. Young families assume the total responsibility for the parenting tasks, refusing any assistance. c. The family is overwhelmed by the significant changes that occur as a result of childbirth. d. Adults agree on the majority of basic parenting principles.

ANS: D Adults in a healthy family communicate with each other so that minimal discord occurs in parenting principles, such as discipline and sleep schedules. Healthy families remain flexible in their role assignments. Members of a healthy family accept assistance without feeling guilty. Healthy families can adapt to the significant changes that are common during the months after childbirth.

2. The nurse is admitting a toddler to the pediatric infectious disease unit. What is the single most important component of the child's physical examination? a. Assessment of heart and lungs b. Measurement of height and weight c. Documentation of parental concerns d. Obtaining an accurate history

ANS: D An accurate history is most helpful in identifying problems and potential problems. Heart and lung assessment is not as important as an accurate history. A single measurement of height and weight is not as significant as determining growth over time. The child's growth pattern can be elicited from the history. Documentation of parental concerns is not as relevant to the physical examination as an accurate history in this case.

11. Which statement is true regarding the "quality assurance" or "incident" report? a. The report assures the legal department that no problem exists. b. Reports are a permanent part of the patient's chart. c. The nurse's notes should contain, "Incident report filed, and copy placed in chart." d. This report is a form of documentation of an event that may result in legal action.

ANS: D An incident report is used when something occurs that might result in legal action, such as a patient fall or medication error. It warns the legal department that there may be a problem in a particular patient's care. Incident reports are not part of the patient's chart; thus the nurses' notes should not contain any reference to them.

8. The mother of a 9-month-old infant is concerned because the infant cries when approached by an unknown shopper at the grocery store. What is the best response for the nurse to make to the mother? a. "You could consider leaving the infant with other people so he can adjust." b. "You might consider taking her to the doctor because she may be ill." c. "Have you noticed whether the baby is teething?" d. "This is a sign of stranger anxiety and demonstrates healthy attachment."

ANS: D An infant who manifests stranger anxiety is showing a normal sign of healthy attachment. This behavior peaks at 7 to 9 months and is developmentally appropriate. The mother leaving the child more often will not change this developmental response to new strangers. The child does not need to see a doctor, and teething is unrelated.

16. A nurse is teaching a parent group about dental hygiene for their babies. What information does the nurse provide? a. Babies don't need dental care until they are three. b. Start brushing teeth when all of them have come in. c. Children are ready for dental care when they can hold a toothbrush. d. Start with the first tooth using a cotton swab and water to wipe the teeth.

ANS: D An infant's teeth need to be cleaned as soon as they erupt. Cleaning the teeth with cotton swabs or a face cloth is appropriate. Waiting until all the baby teeth are in is inappropriate and prolongs cleaning until 2 years of age. Being able to hold a toothbrush is not necessary as the parents should clean the teeth.

5. Which behavior is most likely to encourage open communication? a. Avoiding eye contact b. Folding arms across chest c. Standing with head bowed d. Soft stance with arms loose at the side

ANS: D An open body stance and positioning such as loose arms at the side invite communication and interaction. Avoiding eye contact, folding the arms across the chest, and standing with the head bowed, are closed body postures and do not facilitate communication.

10. What should the nurse teach a school-age child and his parents about the management of ulcer disease? a. Eat a bland, low-fiber diet in small, frequent meals. b. Eat three balanced meals a day with no snacking between meals. c. The child needs to eat alone in a quiet spot to avoid stress. d. Do not give antacids 1 hour before or after antiulcer medications.

ANS: D Antacids can interfere with antiulcer medication if given less than 1 hour before or after antiulcer medications. A bland diet is not indicated for ulcer disease. The diet should be a regular diet that is low in caffeine, and the child should eat a meal or snack every 2 to 3 hours. The child should eat every 2 to 3 hours. Eating alone is not indicated.

7. Which statement made by a parent about intervention for a child's fever shows the need for further education? a. "I should keep her covered lightly when she has a fever." b. "I'll give her plenty of liquids to keep her hydrated." c. "I can give her acetaminophen for a fever." d. "I'll look for over-the-counter aspirin or ibuprofen."

ANS: D Aspirin products are avoided because of the possibility of development of Reye's syndrome. The parent should check labels on all over-the-counter products to be sure they do not contain aspirin. Ibuprofen is alright to give children. Dressing the child in light clothing and using lightweight covers will help reduce fever and promote the child's comfort. Adequate hydration will help maintain a normal body temperature. Acetaminophen is also recommended for fever in children.

2. The father of a child in the emergency department is yelling at the physician and nurses. Which action is contraindicated in this situation? a. Provide a nondefensive response. b. Encourage the father to talk about his feelings. c. Speak in simple, short sentences. d. Tell the father he must wait in the waiting room.

ANS: D Because a parent who is upset may be aggravated by observers, he should be directed to a quiet area. When dealing with parents who are upset, it is important not to be defensive or attempt to justify anyone's actions. Encouraging the father to talk about his feelings may assist him to acknowledge his emotions and may defuse his angry reaction. People who are upset need to be spoken to with simple words (no longer than five letters) and short sentences (no more than five words).

2. The nurse observes that when an 8-year-old enters the playroom, the child often causes disruption by taking toys from other children. The nurse's best approach for this behavior is to a. ban the child from the playroom until the child learns to control behavior. b. explain to the children in the playroom that this child is very ill and should be allowed to have the toys. c. approach the child in his or her room and ask, "Would you like it if the other children took your toys from you?" d. approach the child in his room and state, "I am concerned that you are taking the other children's toys. It upsets them and me."

ANS: D By the nurse's using "I" rather than the "you" message, the child can focus on the behavior. The child and the nurse can begin to explore why the behavior occurs. Banning the child from the playroom will not solve the problem. The problem is his behavior, not the place where he exhibits it. Illness is not a reason for a child to be undisciplined. When the child recovers, the parents will have to deal with a child who is undisciplined and unruly. Children should not be made to feel guilty and to have their self-esteem attacked.

21. A school-age child got a hand-knitted sweater from a relative as a gift. The child refuses to wear it, and it is causing a great deal of conflict in the family as the relative wants to see the child in it. What information can the nurse provide the family about this issue? a. This is a time when strict discipline is needed and should be enforced. b. It's best to choose your battles carefully or you'll fight over everything. c. Teach the child a polite way of expressing dislike for the sweater. d. Children this age find it painful to be different from their peers.

ANS: D Children at this age do find it very painful to be different in any way from their peers. The sweater may be very different from anything the peers are wearing, which makes the child reluctant to wear it. The nurse can provide this information to the family so they have information they can use in working out a solution to this problem. Strict discipline is not needed. Telling parents to choose their battles does not help them solve this situation. Children should be taught polite ways in which to express themselves, but this also does not help to solve the family conflict.

33. Why do infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system? a. They have a widened, shorter airway. b. There is a defect in their sucking ability. c. The gag reflex increases mucous production. d. Mucus and edema obstruct small airways.

ANS: D The airway in infants and young children is narrow, and respiratory distress can occur quickly because mucus and edema can cause obstruction to their small airways. Sucking is not necessarily related to problems with the airway. The gag reflex is necessary to prevent aspiration. It does not produce mucus.

4. Which clinical finding warrants further intervention for the child with acute post streptococcal glomerulonephritis? a. Weight loss to within 1 lb of the preillness weight b. Urine output of 1 mL/kg/hr c. A positive antistreptolysin O (ASO) titer d. Inspiratory crackles

ANS: D Children with excess fluid volume may have pulmonary edema. Inspiratory crackles indicate fluid in the lungs. Pulmonary edema can be a life-threatening complication. Weight loss is an indication that the child is responding to treatment. The urine output of 1 mL/kg/hr is acceptable. A positive ASO titer indicates the presence of antibodies to streptococcal bacteria; it is used to aid in diagnosis of acute post streptococcal glomerulonephritis. This is an expected finding if the child has this acute illness.

15. A child with secondary enuresis who complains of dysuria or urgency should be evaluated for which condition? a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. UTI

ANS: D Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.

13. The mother of a 10-month-old infant asks the nurse about weaning her child. What assessment by the nurse indicates the child is not ready to be weaned? a. Frequently throwing the bottle down b. Takes very little formula from bottle c. Constantly chewing on the bottle nipple d. Appears to be sucking consistently when given a bottle

ANS: D Consistent sucking is a sign that the child is not ready to be weaned. Throwing the bottle down, taking more fluids from a cup than the bottle, and chewing on the nipple all indicate readiness for weaning.

18. Which intervention is appropriate for the infant hospitalized with bronchiolitis? a. Position on the side with neck slightly flexed. b. Administer antibiotics as ordered. c. Restrict oral and parenteral fluids if tachypneic. d. Give cool, humidified oxygen.

ANS: D Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible fluid loss from tachypnea. The infant should be positioned with the head and chest elevated at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm. The etiology of bronchiolitis is viral. Antibiotics are only given if there is a secondary bacterial infection. Tachypnea increases insensible fluid loss. If the infant is tachypneic, fluids are given parenterally to prevent dehydration.{ 19. A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. What action by the nurse is most appropriate? a. Prepare to administer a bronchodilator. b. Give ordered antibiotics on time. c. Provide oxygen via face tent. d. Assess the airway for a foreign body.{ ANS: A Children with asthma usually have these chronic symptoms. The nurse will prepare to administer a bronchodilator. Antibiotics are not used in asthma unless the child also has a bacterial infection, but there is no indication that this is the case. There is also no indication the child needs oxygen at this point. These manifestations do not suggest a foreign body aspiration.

18. A3 1/2-year-old child who is toilet trained has had several "accidents" since hospital admission. What is the nurse's best action in this situation? a. Find out how long the child has been toilet trained at home. b. Encourage the parents to scold the child. c. Explain how to use a bedpan and place it close to the child. d. Follow home routines of elimination.

ANS: D Cooperation will increase and anxiety will decrease if the child's normal routine and rituals are maintained. Some regression to previous behaviors is normal during hospitalization, even when the child has been practicing the skill for some time. Hospitalization is a stressful experience. If the incontinence is caused by anxiety, scolding is not indicated and may increase the anxiety. Developmentally, the 3 1/2-year-old child cannot use a bedpan independently.

5. The nurse caring for the child in pain knows that distraction a. can give total pain relief to the child. b. is effective when the child is in severe pain. c. is the best method for pain relief. d. must be developmentally appropriate to refocus attention.

ANS: D Distraction can be very effective in helping to control pain, but it must be appropriate to the child's developmental level. Distraction can help control pain, but it is rarely able to provide total pain relief. Children in severe pain are not distractible. Children may use distraction to help control pain, but it is not the best method for pain relief.

12. What should be included in the care for a neonate who was diagnosed with pertussis? a. Monitoring hemoglobin level b. Hearing test before discharge c. Serial platelet counts d. Prophylactic antibiotics for all close contacts

ANS: D Erythromycin, azithromycin, or clarithromycin is given to all close contacts for the child diagnosed with pertussis. Pertussis does not affect the hemoglobin level. A complication of pertussis is not hearing impairment. Pertussis does not affect platelets.

14. Which assessment should the nurse perform last when examining a 5-year-old child? a. Heart b. Lungs c. Abdomen d. Throat

ANS: D Examination of the mouth and throat is considered to be more invasive than other parts of a physical examination. For preschool children, invasive procedures should be left to the end of the examination. Examination of the heart, lungs, and abdomen are seen as less threatening.

17. A 2-year-old has excessive tearing and corneal haziness. The nurse knows that these symptoms may indicate which of the following? a. Viral conjunctivitis b. Paralytic strabismus c. Congenital cataract d. Infantile glaucoma

ANS: D Excessive tearing and corneal haziness are indicative of glaucoma. Because the child is younger than 3 years of age, it would be classified as "infantile." Discharge is noted with conjunctivitis. Corneal haziness is not a symptom of conjunctivitis. Neither tearing nor corneal haziness is a symptom of paralytic strabismus. A congenital cataract will cause an opacity but not excessive tearing.

8. Which intervention helps a hospitalized toddler feel a sense of control? a. Assign the same nurses to care for the child. b. Put a cover over the child's crib. c. Require parents to stay with the child. d. Follow the child's usual routines for feeding and bedtime.

ANS: D Familiar rituals and routines are important to toddlers and give the child a sense of control. Following the child's usual routines during hospitalization minimizes feelings of loss of control. Providing consistent caregivers is most applicable for the very young child, such as the neonate and infant. Placing a cover over the child's crib may increase feelings of loss of control. Parents are encouraged, rather than expected, to stay with the child during hospitalization.

20. Family-centered care (FCC) describes safe, quality care that recognizes and adapts to both the physical and psychosocial needs of the family. Which nursing practice coincides with the principles of FCC? a. The newborn is returned to the nursery at night so that the mother can receive adequate rest before discharge. b. The father is encouraged to go home after the baby is delivered. c. All patients are routinely placed on the fetal monitor. d. The nurse's assignment includes both mom and baby and increases the nurse's responsibility for education.

ANS: D Family-centered care increases the responsibilities of nurses. In addition to the physical care provided, nurses assume a major role in teaching, counseling, and supporting families. The other options do not provide family-centered care because they increase family separation or use technology routinely, which may not be needed.

8. A parent asks the nurse how she will know whether her child has fifth disease. The nurse should advise the parent to be alert for which manifestation? a. Bull's-eye rash at the site of a tick bite b. Lesions in various stages of development on the trunk c. Maculopapular rash on the trunk that lasts for 2 days d. Bright red rash on the cheeks that looks like slapped cheeks

ANS: D Fifth disease manifests with an intense, fiery red, edematous rash on the cheeks, which gives a "slapped cheek" appearance. The bull's-eye rash at the site of a tick bite is a manifestation of Lyme disease. Varicella is manifested as lesions in various stages of development—macule, papule, then vesicle, first appearing on the trunk and scalp. Roseola manifests as a maculopapular rash on the trunk that can last for hours or up to 2 days.

7. A school nurse is conducting a class on safety for a group of school-age children. Which statement indicates that the children may need further teaching? a. "My sister and I know two different ways to get out of the house." b. "I can dial 911 if there is a fire or a burglar in the house." c. "If we have a fire, we have to meet at the neighbor's house." d. "If there is a fire I will go back for my cat Fluffy because she will be scared.

ANS: D Fire safety is important at any age, but for this age group children should know two different ways out of the house, how to call 911, and where the family will meet outside the house. Children should be taught never to return to a burning house, not even for a pet.

3. A child taking oral corticosteroids for asthma is exposed to varicella. The child has not had the varicella vaccine and has never had the disease. What intervention should be taken to prevent varicella from developing? a. No intervention is needed unless varicella develops. b. Administer the varicella vaccine as soon as possible. c. The child should begin a course of oral antibiotics. d. The child should be prescribed acyclovir.

ANS: D For children who are immunosuppressed (such as from corticosteroids), acyclovir is the treatment of choice to prevent infection. Action is needed due to the risk of serious complications. The varicella vaccine is a live virus vaccine and is contraindicated for an immunosuppressed child. An antibiotic is not effective in treating varicella zoster, which is a virus.

10. Which intervention is appropriate when examining a male infant for cryptorchidism? a. Cooling the examiner's hands b. Taking a rectal temperature c. Eliciting the cremasteric reflex d. Warming the room

ANS: D For the infant's comfort, the infant should be examined in a warm room with the examiner's hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold. A rectal temperature yields no information about cryptorchidism. Testes can retract into the inguinal canal if the infant is upset or cold or if the cremasteric reflex is elicited. This can lead to an incorrect diagnosis.

29. During examination of a toddler's extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is a. abnormal, requiring further investigation. b. abnormal unless it occurs in conjunction with knock-knee. c. normal if the condition is unilateral or asymmetric. d. normal, because the lower back and leg muscles are not yet well developed.

ANS: D Genu varum (bowlegged) is common in toddlers when they begin to walk. It usually persists until all of their lower back and leg muscles are well developed, usually by age 3.

8. What is the best response a nurse can make to a 15-year-old girl who has verbalized a desire to have a baby? a. "Have you talked with your parents about this?" b. "Do you have plans to continue school?" c. "Will you be able to support the baby?" d. "Can you tell me how your life will be if you have an infant?"

ANS: D Having the teenager describe how the infant will affect her life will allow the teen to think more realistically. Her description will allow the nurse to assess the teen's perception and reality orientation. Asking the teenager whether she has talked to her parents is not particularly helpful to the teen or the nurse and may terminate the communication. A direct question about continuing school will not facilitate communication. Open-ended questions encourage communication. Asking the teenager about how she will support the child will not facilitate communication. Open-ended questions encourage communication.

16. Which measurement is not indicated for a 4-year-old well-child examination? a. Blood pressure b. Weight c. Height d. Head circumference

ANS: D Head circumference is measured on all children from birth to 3 years. Children older than 3 years of age with questionable head size or a history of megalocephaly, hydrocephalus, or microcephaly should have their head circumference assessed at every visit. A 4-year-old without a history of these problems does not need his or her head circumference measured. Blood pressure, weight, and height measurements are taken on all children at every ambulatory visit.

9. What is the most appropriate response to a school-age child who asks if she can talk to her dying sister? a. "You need to talk loudly so she can hear you." b. "Holding her hand would be better because at this point she can't hear you." c. "Although she can't hear you, she can feel your presence so sit close to her." d. "Even though she will probably not answer you, she can still hear what you say to her."

ANS: D Hearing is the last sense to cease before death. Talking to the dying child is important both for the child and the family. The sense of hearing is intact before death and there is no need to speak loudly. The sibling should be encouraged to speak to the child, as well as hold the child's hand. The sibling should be encouraged to sit close and speak to the dying child.

18. A nurse is caring for the seriously ill child of a single parent. The parent reports being overwhelmed with the situation and not being able to make decisions. What action by the nurse is best? a. Refer the patient to the hospital's social work department. b. Call the chaplain service and ask for a chaplain visit. c. Ask the parent if any other family member can come and assist. d. Have the parent describe coping methods used for past crises.

ANS: D Helping the patient to marshal internal and external resources is vital to promoting coping. The nurse should ask about previous coping methods used and help the parent adapt them to the current situation. Referring the parent to social work does not allow the nurse to be of assistance and the parent may not want to have a visit from a clergy member. Both of those options are dismissive. Other family members may or may not be able to come to assist, but this closed-ended question will not elicit much information.

36. Careful hand washing before and after contact can prevent the spread of which condition in daycare and school settings? a. Irritable bowel syndrome b. Ulcerative colitis c. Hepatic cirrhosis d. Hepatitis A

ANS: D Hepatitis A is spread person to person, by the fecal-oral route, and through contaminated food or water. Good handwashing is critical in preventing its spread. The virus can survive on contaminated objects for weeks. The other conditions are not contagious.

38. Which statement is characteristic of acute otitis media (AOM)? a. The etiology is unknown. b. Permanent hearing loss often results. c. It can be treated by intramuscular (IM) antibiotics. d. It is treated with a broad range of antibiotics.

ANS: D Historically AOM has been treated with a range of antibiotics, and it is the most common disorder treated with antibiotics in the ambulatory setting. The etiology of AOM may be Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis or a viral agent. Recent concerns about drug-resistant organisms have caused authorities to recommend judicious use of antibiotics and that antibiotics are not required for initial treatment. Permanent hearing loss is not frequently caused by properly treated AOM. Intramuscular antibiotics are not necessary.

16. Which action is initiated when a child has been scratched by a potentially rabid animal? a. No intervention unless the child becomes symptomatic b. Administration of immune globulin around the wound c. Administration of rabies vaccine on days 3, 7, 14, and 28 d. Administration of both immune globulin and vaccine as soon as possible after exposure

ANS: D Human rabies immune globulin and the first dose of the rabies vaccine are given after exposure. Transmission of rabies can occur from bites with contaminated saliva, scratches from the claws of infected animals, airborne transmission in bat-infested caves, or in a laboratory setting. Rabies is fatal if no intervention is taken to prevent the disease. Human rabies immune globulin is infiltrated locally around the wound, and the other half of the dose is given intramuscularly. This is only part of the treatment after rabies exposure. The rabies vaccine is given within 48 hours of exposure and again on days 3, 7, 14, and 28.

19. Hypospadias refers to a. absence of a urethral opening. b. penis shorter than usual for age. c. urethral opening along dorsal surface of penis. d. urethral opening along ventral surface of penis.

ANS: D Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present in hypospadias but not at the glans. Hypospadias refers to the urethral opening, not to the size of the penis. Epispadias is where the urethral opening is along the dorsal surface of the penis.

16. A 3-year-old is brought to the emergency department by ambulance after her body was found submerged in the family pool. The child has altered mental status and shallow respirations. She did not require resuscitative interventions. Which condition should the nurse monitor for as the priority in this child? a. Neurologic status b. Hypothermia c. Hypoglycemia d. Hypoxia

ANS: D Hypoxia is responsible for the injury to organ systems during submersion injuries. Hypoxia can progress to cardiopulmonary arrest. Monitoring for hypoxia takes priority for this child over neurologic status, temperature, or glucose status.

29. Which nursing diagnosis has the highest priority for the toddler with celiac disease? a. Disturbed Body Image related to chronic constipation b. Risk for Disproportionate Growth related to obesity c. Excess Fluid Volume related to celiac crisis d. Imbalanced Nutrition: Less than Body Requirements related to malabsorption

ANS: D Imbalanced Nutrition: Less than Body Requirements is the highest priority nursing diagnosis because celiac disease causes gluten enteropathy, a malabsorption condition. A psychosocial diagnosis (Disturbed Body Image) would not take priority over a physical diagnosis. Celiac disease causes disproportionate growth and development associated with malnutrition, not obesity. Celiac crisis causes deficient fluid volume.

2. A nurse is teaching parents about the importance of immunizations for infants because of immaturity of the immune system. The parents demonstrate that they understand the teaching if they make which statement? a. "We plan to opt out of most childhood vaccinations." b. "There are only a few diseases that have effective immunizations." c. "Babies are born with a sophisticated immune system so they need few, if any, immunizations." d. "Newborns have a hard time fighting infection so they need vaccinations."

ANS: D Immaturity of the immune system places an infant and young child a greater risk of infection, so they need protection through a scheduled series of immunizations. Parents can opt out of many vaccinations, but the nurse should investigate why they plan to do so. Most communicable disease of childhood have immunizations.

18. In girls, the initial indication of puberty is a. menarche. b. growth spurt. c. growth of pubic hair. d. breast development.

ANS: D In most girls, the initial indication of puberty is the appearance of breast buds, an event known as thelarche. The usual sequence of secondary sexual characteristic development in girls is breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, and abrupt deceleration of linear growth.

23. The home health nurse outlines short- and long-term goals for a 10-year-old child with many complex health problems. Who should agree on these goals? a. Family and nurse b. Child, family, and nurse c. All professionals involved d. Child, family, and all professionals involved

ANS: D In the home, the family is a partner in each step of the nursing process. The family priorities should guide the planning process. Both short-term and long-term goals should be outlined and agreed on by the child, family, and professionals involved. Involvement of the individuals who are essential to the child's care is necessary during this very important stage. The elimination of any one of these groups can potentially create a plan of care that does not meet the needs of the child and family.

13. When counseling parents and children about the importance of increased physical activity, the nurse will emphasize which of the following? a. Anaerobic exercise should comprise a major component of the child's daily exercise. b. All children should be physically active for at least 2 hours per day. c. It is not necessary to participate in physical education classes at school if a student is taking part in other activities. d. Make exercise a fun and habitual activity.

ANS: D It is important to make exercise a fun and habitual activity. Encourage parents to investigate their community's different activity programs. This includes recreation centers, parks, and the YMCA. Aerobic exercise should comprise a major component of children's daily exercise; however, physical activity should also include muscle- and bone-strengthening activities. Children and adolescents should be physically active for at least 1 hour daily. Encourage all students to participate fully in any physical education classes.

13. What should the nurse expect to be problematic for a family whose religious affiliation is Jehovah's Witness? a. Birth control b. Autopsy c. Plasma expanders d. Blood transfusion

ANS: D Jehovah's Witnesses do not accept blood transfusions but may accept alternatives such as plasma expanders. Birth control and autopsy are also allowed.

5. Which diagnostic finding is present when a child has primary nephrotic syndrome? a. Hyperalbuminemia b. Positive ASO titer c. Leukocytosis d. Proteinuria

ANS: D Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane. Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the liver's inability to synthesize proteins to balance the loss. ASO titer is negative in a child with primary nephrotic syndrome. Leukocytosis is not a diagnostic finding in primary nephrotic syndrome.

12. Which immunizations should be used with caution in children with an allergy to eggs? a. HepB b. DTaP c. Hib d. MMR

ANS: D Live measles vaccine is produced by using chick embryo cell culture, so there is a remote possibility of anaphylactic hypersensitivity in children with egg allergies. Most reactions are actually the result of other components in the vaccine. The other vaccines are safe for children with an egg allergy.

6. The nurse is talking to a 7-year-old boy during a well-child clinic visit. The boy states "I am a Power Ranger, so don't make me angry!" What action by the nurse is best? a. Ask the child about other friends he might play with. b. Find out why the child thinks he is a Power Ranger. c. Ask the parents if he has any opposite sex friends. d. Conduct further developmental screening on the child.

ANS: D Magical thinking is developmentally appropriate for the preschooler not a 7-year-old. The nurse should assess this child's development further. Asking about other friends or special powers will not provide information related to development. A 7-year-old does not typically have opposite sex playmates.

17. What information should the nurse teach workers at a daycare center about RSV? a. RSV is transmitted through particles in the air. b. RSV can live on skin or paper for up to a few seconds after contact. c. RSV can survive on nonporous surfaces for about 60 minutes. d. Frequent hand washing can decrease the spread of the virus.

ANS: D Meticulous hand washing can decrease the spread of organisms. RSV infection is not airborne. It is acquired mainly through contact with contaminated surfaces. RSV can live on skin or paper for up to 1 hour. RSV can live on cribs and other nonporous surfaces for up to 6 hours.

6. In most states, adolescents who are not emancipated minors must have the permission of their parents before a. treatment for drug abuse. b. treatment for sexually transmitted diseases (STDs). c. accessing birth control. d. surgery.

ANS: D Minors are not considered capable of giving informed consent, so a surgical procedure would require consent of the parent or guardian. Exceptions exist for obtaining treatment for drug abuse or STDs or for getting birth control in most states.

40. Therapeutic management of most children with Hirschsprung disease is primarily a. daily enemas. b. low-fiber diet. c. permanent colostomy. d. surgical removal of the affected section of the bowel.

ANS: D Most children with Hirschsprung disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. Preoperative management may include enemas and a low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. The colostomy that is created in Hirschsprung disease is usually temporary.

1. An adolescent goes to the primary care provider complaining of difficulty with vision. When the nurse asks the adolescent to explain the visual deficits, the adolescent states, "I am having difficulty seeing distant objects; they are less clear than things that are close." What disorder does the nurse suspect the adolescent has? a. Hyphema b. Astigmatism c. Amblyopia d. Myopia

ANS: D Myopic patients have the ability to see near objects more clearly than those at a distance; it is caused by the image focusing beyond the retina. Hyphema includes hemorrhage in the anterior chamber and is not a refractive disorder. Astigmatism is caused by an abnormal curvature of the cornea or lens. Amblyopia is a problem of reduced visual acuity not correctable by refraction.

13. What is the best nursing response to the mother of a 4-year-old child who asks what she can do to help the child cope with a sibling's repeated hospitalizations? a. Recommend that the child be sent to visit the grandmother until the sibling returns home. b. Inform the parent that the child is too young to visit the hospital. c. Assume the child understands that the sibling will soon be discharged because the child asks no questions. d. Help the mother give the child a simple explanation of the treatment, and encourage the mother to have the child visit the hospitalized sibling.

ANS: D Needs of a sibling will be better met with factual information and contact with the ill child. Separation from family and home may intensify fear and anxiety. Parents are experts on their children and need to determine when their child can visit a hospital. Children may have difficulty expressing questions and fears and need the support of parents and other caregivers.

38. A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of a. protein intolerance. b. parasitic infection. c. fat malabsorption. d. bacterial gastroenteritis.

ANS: D Neutrophils and red blood cells in stool indicate bacterial gastroenteritis. This does not signify protein intolerance, a parasitic infection, or fat malabsorption.

15. Identify the most appropriate nursing response to a parent who tells the nurse, "I don't want my child to know she is dying." a. "I shall respect your decision. I won't say anything to your child." b. "Don't you think she has a right to know about her condition?" c. "Would you like me to arrange for the provider to speak with your child?" d. "I'll answer any questions she asks me as honestly as I can."

ANS: D Nurses can inform parents that they will not initiate any discussion with the child but that they intend to respond openly and honestly if and when the child initiates such a discussion. As the caregiver and advocate, the nurse should first meet the child's needs. Asking the parent if the child has the right to know is judgmental and could affect the nurse's relationship with the child's parents. Having the provider speak with the child does not address the parent's concerns or the nurse's responsibility.

16. Which intervention should be included in the nurse's plan of care for a 7-year-old child with encopresis who has cleared the initial impaction? a. Have the child sit on the toilet for 30 minutes when he gets up in the morning and at bedtime. b. Increase caffeine in the child's diet to promote bowel elimination. c. Use a Fleet enema daily. d. Give the child a choice of beverage to mix with a laxative.

ANS: D Offering realistic choices is helpful in meeting the school-age child's sense of control. To facilitate bowel elimination, the child should sit on the toilet for 5 to 10 minutes after breakfast and dinner. Caffeine to stimulate the bowels is not recommended. Daily Fleet enemas can result in hypernatremia and hyperphosphatemia and are used only during periods of fecal impaction.

19. After an infant is born the nurse notices that the child has herniation of abdominal viscera into the base of the umbilical cord. What will the nurse document about this condition? a. Diaphragmatic hernia b. Umbilical hernia c. Gastroschisis d. Omphalocele

ANS: D Omphalocele is the herniation of the abdominal viscera into the base of the umbilical cord. This does not describe a diaphragmatic hernia, umbilical hernia, or gastroschisis.

21. Which initial assessment made by the triage nurse suggests that a child requires immediate intervention? a. The child has thick yellow rhinorrhea. b. The child has a frequent nonproductive cough. c. The child's oxygen saturation is 95% by pulse oximeter. d. The child is grunting.

ANS: D One of the initial observations for triage is respiratory rate and effort. Grunting is a sign of hypoxemia and represents the body's attempt to improve oxygenation by generating positive end-expiratory pressure. Rhinorrhea, coughing, and a normal SaO2 do not need immediate intervention.

6. Which strategy is most likely to encourage a child to express feelings about the hospital experience? a. Avoiding periods of silence b. Asking yes/no questions c. Sharing personal experiences d. Using open-ended questions

ANS: D Open-ended questions encourage conversation. Periods of silence can serve to facilitate communication, but this is not the most effective means of getting the child to communicate. Yes/no questions are closed ended and do not encourage conversation. Talking about yourself shifts the focus of the conversation away from the child.

9. Which goal is most appropriate for demonstrating effective parenting? a. The parents will demonstrate correct bathing by discharge. b. The mother will make an appointment with the lactation specialist prior to discharge. c. The parents will place the baby in the proper position for sleeping and napping by 2300 on postpartum day 1. d. The parents will demonstrate effective parenting by discharge.

ANS: D Outcomes and goals are not the same. Goals are broad and not measurable and so must be linked to more measurable outcome criteria. Demonstrating effective parenting is one such goal. The other options are measurable outcome indicators that help determine if the goal has been met.

3. Which physiologic difference affects the absorption of oral medications administered to a 3-month-old infant? a. More rapid peristaltic activity b. More acidic gastric secretions c. Usually more rapid gastric emptying d. Variable pancreatic enzyme activity

ANS: D Pancreatic enzyme activity is variable in infants for the first 3 months of life as the gastrointestinal system matures. Medications that require specific enzymes for dissolution and absorption might not be digested to a form suitable for intestinal action. Infants up to 8 months of age tend to have prolonged motility. The longer the intestinal transit time, the more medication is absorbed. The gastric secretions of infants are less acidic than in older children or adults. Gastric emptying is usually slower in infants.

9. In providing anticipatory guidance to parents, which parental behavior does the nurse teach as most important in fostering moral development? a. Telling the child what is right and wrong b. Vigilantly monitoring the child and her peers c. Weekly family meetings to discuss behavior d. Living as the parents say they believe

ANS: D Parents living what they believe gives non-ambivalent messages and fosters the child's moral development and reasoning. Telling the child what is right and wrong is not effective unless the child has experienced what she hears. Parents need to live according to the values they are teaching to their children. Vigilant monitoring of the child and her peers is an inappropriate action for the parent to initiate. It does not foster moral development and reasoning in the child. Weekly family meetings to discuss behaviors may or may not be helpful in the development of moral reasoning.

3. What is an appropriate nursing intervention for a 6-month-old infant in the emergency department? a. Distract the infant with noise or bright lights. b. Avoid warming the infant. c. Remove any pacifiers from the baby. d. Encourage the parent to hold the infant.

ANS: D Parents should be encouraged to hold the infant as much as possible while in the emergency department. Having the parent hold the infant may help to calm the child. Distraction with noise or bright lights is most appropriate for a preschool-age child. In an emergency health care facility, it is important to keep infants warm. Infants use pacifiers to comfort themselves; therefore the pacifier should not be taken away.

11. What should the nurse teach a parent who is concerned about preventing sleep problems in a 2-year-old child? a. Have the child always sleep in a quiet, darkened room. b. Provide high-carbohydrate snacks before bedtime. c. Have the child's daytime caretaker eliminate naps. d. Use a nightlight in the child's room.

ANS: D The boundaries between reality and fantasy are not well defined for children of this age, so monsters and scary creatures that lurk in the preschooler's imagination become real to the child after the light is turned off. A nightlight may help ease the child's fears. A dark room may be scary to a preschooler. High-carbohydrate snacks increase energy and do not promote relaxation. Most 2-year-olds take one nap each day. Many give up the habit by age 3 years. Insufficient rest during the day can lead to irritability and difficulty sleeping at night.

25. What intervention will best help the siblings of a child with special needs? a. Explaining to the siblings that embarrassment is unhealthy b. Encouraging the parents not to expect siblings to help them care for the child with special needs c. Providing information to the siblings about the child's condition only as they request it d. Suggesting to the parents ways of maintaining the siblings' usual routine and participation in activities

ANS: D Parents should strive for integrating all family members' needs into daily activities. The nurse can help the parents problem solve and come up with ways to maintain as normal a daily routine for the siblings as possible while still meeting the needs of the child with special needs. Siblings may or may not be embarrassed by the special needs of the family member, but this statement belittles their feelings. Parents can ask the siblings if they want to help provide care and offer information but should not force the child into anything.

16. According to Friedman's classifications, providing such physical necessities as food, clothing, and shelter is the __________ family function. a. economic b. socialization c. reproductive d. health care

ANS: D Physical necessities such as food, clothing, and shelter are considered part of health care. The economic function provides resources but is not concerned with health care and other basic necessities. The socialization function teaches the child cultural values. The reproductive function is concerned with ensuring family continuity.

6. When planning care for adolescents, the nurse should a. teach parents first, and they, in turn, will teach the teenager. b. provide information for long-term health needs. c. provide explanations for treatment and procedures to the parents only. d. give information privately to adolescents on specific problems that they identify.

ANS: D Problems that teenagers identify and are interested in are typically the problems that they are the most willing to address. Confidentiality is important to adolescents. Adolescents prefer to confer privately (without parents) with the nurse and health care provider. Teenagers are socially and cognitively at the developmental stage where the health care provider can teach them. Teenagers are more interested in immediate health care needs than in long-term needs. Teenagers are at the developmental level that allows them to receive explanations about health care directly from the nurse.

25. When palpating the child's cervical lymph nodes, the nurse notes that they are tender, enlarged, and warm. What is the best explanation for this? a. Some form of cancer b. Local scalp infection common in children c. Infection or inflammation distal to the site d. Infection or inflammation close to the site

ANS: D Small nontender nodes are normal. Tender, enlarged, and warm lymph nodes may indicate infection or inflammation close to their location. They are not indicative of cancer or scalp infection.

6. What situation is most conducive to learning? a. A teacher who speaks very little Spanish is teaching a class of Latino students. b. A class is composed of students of various ages and educational backgrounds. c. An auditorium is being used as a classroom for 300 students. d. An Asian nurse provides nutritional information to a group of pregnant Asian women.

ANS: D Teaching is a vital function of the professional nurse. A patient's language and culture influence the learning process; thus a situation that is most conducive to learning is one in which the teacher has knowledge and understanding of the patient's language and cultural beliefs. The ability to understand the language in which teaching is done determines how much the patient learns. Patients for whom English is not their primary language may not understand idioms, nuances, slang terms, informal usage of words, or medical words. The teacher should be fluent in the language of the student. Developmental levels and educational levels influence how a person learns best. In order for the teacher to best present information, the class should be composed of the same levels. A large class is not conducive to learning. It does not allow for questions, and the teacher is not able to see the nonverbal cues from the students to ensure understanding.

1. Which statement made by a mother of a school-age boy indicates a need for further teaching? a. "My child is playing soccer on a team this year." b. "He is always active with his friends playing games." c. "I limit his television watching to about 2 hours a day." d. "I am glad his coach emphasizes winning and discipline in today's society."

ANS: D Team sports are important for the development of sportsmanship and teamwork and for exercise and refinement of motor skills. A coach who emphasizes winning and strict discipline is not appropriate for children in this age-group. Team sports such as soccer are appropriate for exercise and refinement of motor skills. Limiting television to 2 hours a day is an appropriate restriction. School-age children should be encouraged to participate in physical activities.

1. Which factor significantly contributed to the shift from home births to hospital births in the early 20th century? a. Puerperal sepsis was identified as a risk factor in labor and delivery. b. Forceps were developed to facilitate difficult births. c. The importance of early parental-infant contact was identified. d. Technologic developments became available to physicians.

ANS: D Technologic developments were available to physicians, not lay midwives. So in-hospital births increased in order to take advantage of these advancements. Puerperal sepsis has been a known problem for generations. In the late 19th century, Semmelweis discovered how it could be prevented with improved hygienic practices. The development of forceps is an example of a technology advance made in the early 20th century but is not the only reason birthplaces moved. Unlike home births, early hospital births hindered bonding between parents and their infants.

15. The teaching plan for the parents of a 3-year-old child with amblyopia ("lazy eye") should include what instruction? a. Apply a patch to the child's eyeglass lenses. b. Apply a patch only during waking hours. c. Apply a patch over the "bad" eye to strengthen it. d. Cover the "good" eye completely with a patch.

ANS: D The "good" eye is patched to force the child to use the "bad" eye, thus strengthening the muscles. The patch should always be applied directly to the child's face, not to eyeglasses. The patch should be left in place even when the child is sleeping. Covering the "bad" eye will not contribute to strengthening it. The "good" eye should be patched.

9. A 17-month-old child is expected to be in what stage according to Piaget? a. Trust b. Preoperations c. Secondary circular reaction d. Sensorimotor period

ANS: D The 17-month-old is in the fifth stage of the sensorimotor phase, tertiary circular reactions. Learning in this stage occurs mainly by trial and error. Trust is Erikson's first stage. Preoperation is the stage of cognitive development usually present in older toddlers and preschoolers. Secondary circular reactions last from approximately ages 4 to 8 months.

17. A father tells the nurse that his toddler wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should suggest that the family do which of the following? a. Do not take the child to restaurants until this behavior has stopped. b. Take the child but do not give in to this demand. c. Explain to the child that restaurants have their own dishes. d. Suggest the family take the dishes and use them at the restaurant.

ANS: D The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain the sameness and reliability. It provides a sense of comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. The family can take the dishes and serve the toddler's food and drink with them. Not taking the child out sometimes deprives him or her of a social experience. Not giving in sets the stage for temper tantrums. This child is too young to understand an explanation.

4. What is the most important consideration for effectively communicating with a child? a. The child's chronologic age b. The parent-child interaction c. The child's receptiveness d. The child's developmental level

ANS: D The child's developmental level is the basis for selecting the terminology and structure of the message most likely to be understood by the child. The child's age may not correspond with the child's developmental level; therefore it is not the most important consideration for communicating with children. Parent-child interaction is useful in planning communication with children, but it is not the primary factor in establishing effective communication. The child's receptiveness is a consideration in evaluating the effectiveness of communication.

27. Examination of the abdomen is performed correctly by the nurse in which order? a. Inspection, palpation, and auscultation b. Palpation, inspection, and auscultation c. Palpation, auscultation, and inspection d. Inspection, auscultation, and palpation

ANS: D The correct order of abdominal examination is inspection, auscultation, and palpation. If the nurse percusses the abdomen, that is done prior to palpation. Palpation is always last because it may distort the normal abdominal sounds.

21. Which cranial nerve is assessed when the child is asked to imitate the examiner's wrinkled frown, wrinkled forehead, smile, and raised eyebrow? a. Accessory b. Hypoglossal c. Trigeminal d. Facial

ANS: D The facial nerve is assessed as described in the question. To assess the accessory nerve, the examiner palpates and notes the strength of the trapezius and sternocleidomastoid muscles against resistance. To assess the hypoglossal nerve, the examiner asks the child to stick out the tongue. To assess the trigeminal nerve, the child is asked to identify a wisp of cotton on the face. The corneal reflex and temporal and masseter muscle strength are evaluated.

9. Which statement concerning physiologic factors is true? a. The infant has a slower metabolic rate than an adult. b. An infant has an inability to digest protein and lactase. c. Infants have a slower circulatory response than adults do. d. The infant's kidneys are less efficient in concentrating urine than an adult's kidneys.

ANS: D The infant's kidneys are not as effective at concentrating urine compared with an adult's because of immaturity of the renal system and slower glomerular filtration rates. This puts the infant at greater risk for fluid and electrolyte imbalance. Infants do not have slower metabolic rates, inabilities to digest protein and lactase, or a slower circulatory response compared to adults.

23. Which parameter correlates best with measurements of the body's total muscle mass-to-fat ratio? a. Height b. Weight c. Skinfold thickness d. Mid-arm circumference

ANS: D The mid-arm circumference reflects muscle and fat. Height, weight, and skinfold thickness do not reflect muscle and fat. 24. Which tool measures body fat most accurately? a. Measuring board b. Calipers c. Cloth tape measure d. Paper or metal tape measure{ ANS: B Calipers are used to measure skinfold thickness, which is an indicator of body fat content. A measuring board is used to determine an infant or a toddler's height. Cloth tape measures should not be used because they can stretch. Paper or metal tape measures can be used for recumbent lengths and other body measurements that must be made.

16. A parent is very frustrated by the amount of time a toddler says "no" and asks the nurse about effective strategies to manage this negativism. The most appropriate recommendation is to a. punish the child for the behavior. b. provide more attention to the child. c. ask the child to not always say "no." d. reduce the opportunities for a "no" answer.

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

2. A nurse is assessing an 8-year-old child. Which finding leads the nurse to conduct further assessment? a. Understands that his or her point of view is not the only one b. Enjoys telling riddles and silly jokes c. Demonstrates the principle of object conservation d. Engages in fantasy and magical thinking

ANS: D The preschool-age child engages in fantasy and magical thinking. The school-age child moves away from this type of thinking and becomes more skeptical and logical. Belief in Santa Claus or the Easter Bunny ends in this period of development. If the child demonstrated this type of thinking, the nurse would need to follow up with more developmental screening. School-age children enter the stage of concrete operations. They learn that their point of view is not the only one. The school-age child has a sense of humor. The child's increased language mastery and increased logic allow for appreciation of plays on words, jokes, and incongruities. The school-age child understands that properties of objects do not change when their order, form, or appearance does (object conservation).

13. An adolescent has been diagnosed with the Epstein-Barr virus. What discharge information should the nurse give to the parents? a. It is important to protect the adolescent's head during physical activities. b. The teen will feel like himself and be back to his usual routines in a week. c. Treatment of the Epstein-Barr virus is several months of prolonged bed rest. d. Fatigue may persist, so increase school activities gradually.

ANS: D The recovery period is often lengthy and fatigue may continue, necessitating a gradual return to school activities. During the acute and recovery phases, activity restrictions, which include no contact sports or roughhousing, are implemented to protect the child's enlarged spleen from rupture. The recovery process from infectious mononucleosis is a slow and gradual one. Prolonged rest (not bedrest) is indicated during the acute stage of the illness only.

3. Which organs and tissues control the two types of specific immune functions? a. The spleen and mucous membranes b. Upper and lower intestinal lymphoid tissue c. The skin and lymph nodes d. The thymus and bone marrow

ANS: D The thymus controls cell-mediated immunity (cells that mature into T lymphocytes). The bone marrow controls humoral immunity (stem cells for B lymphocytes). Both the spleen and mucous membranes are secondary organs of the immune system that act as filters to remove debris and antigens and foster contact with T lymphocytes. Gut-associated lymphoid tissue is a secondary organ of the immune system. This tissue filters antigens entering the gastrointestinal tract. The skin and lymph nodes are secondary organs of the immune system.

7. The nurse is discussing toddler development with the mother of a 2 1/2-year-old child. Which statement by the mother indicates she has an understanding of how to help her daughter succeed in a developmental task while hospitalized? a. "I always help my daughter complete tasks to help her achieve a sense of accomplishment." b. "I provide many opportunities for my daughter to play with other children her age." c. "I consistently stress the difference between right and wrong to my daughter." d. "I encourage my daughter to do things for herself when she can."

ANS: D The toddler's developmental task is to achieve autonomy. Encouraging toddlers to do things for themselves assists with this developmental task (i.e., feeding self, putting on own socks). Toddlers should be encouraged to do what they can for themselves. Toddlers participate in parallel play. They play next to rather than with age mates. Excessive stress on the differences between right and wrong can stifle autonomy in the toddler and foster shame and doubt.

7. Which muscle should the nurse select to give a 6-month-old infant an intramuscular injection? a. Deltoid b. Ventrogluteal c. Dorsogluteal d. Vastus lateralis

ANS: D The vastus lateralis is not located near any vital nerves or blood vessels. It is the best choice for intramuscular injections for children younger than 3 years of age. The deltoid muscle is not used for intramuscular injections in young children. The ventrogluteal muscle is safe for intramuscular injections for children older than 13 months. The dorsogluteal muscle does not develop until a child has been walking for at least 1 year.

10. What is the priority goal for the child with a chronic illness? a. To maintain the intactness of the family b. To eliminate all stressors c. To achieve complete wellness d. To obtain the highest level of wellness

ANS: D To obtain the highest level of health and function possible is the priority goal of nursing children with a chronic illness. Maintaining intactness of the family is a great goal, but it is for the family, not the child. Eliminating all stressors and achieving complete wellness are not realistic.

13. A positive, supportive communication technique that is effective from birth throughout adulthood is a. listening. b. physical proximity. c. environment. d. touch.

ANS: D Touch can convey warmth, comfort, reassurance, security, caring, and support. In infancy, messages of security and comfort are conveyed when they are being held. Toddlers and preschoolers find it soothing and comforting to be held and rocked. School-aged children and adolescents appreciate receiving a hug or pat on the back (with permission). Listening is an essential component of the communication process. By practicing active listening skills, nurses can be effective listeners. Listening is a component of verbal communication. Individuals have different comfort zones for physical distance. The nurse should be aware of these differences and move cautiously when meeting new children and families. It is important to create a supportive and friendly environment for children including the use of child-sized furniture, posters, developmentally appropriate toys, and art displayed at a child's eye level.

5. Which nursing action is most appropriate to assist a preschool-age child in coping with the emergency department experience? a. Explain procedures and give the child at least 1 hour to prepare. b. Remind the child that she is a big girl. c. Avoid the use of bandages. d. Use positive terms, and avoid terms such as "shot" and "cut."

ANS: D Using positive terms and avoiding words that have frightening connotations assist the child in coping. Preschool-age children should be told about procedures immediately before they are done. Allowing 1 hour of time to prepare only allows time for fantasies and increased anxiety. Children should not be shamed into cooperation. Bandages are important to preschool-age children. Children in this age-group believe that their insides can leak out and that bandages stop this from happening. Plus a fancy bandage can be used as a reward.

5. The Women, Infants, and Children (WIC) program provides a. well-child examinations for infants and children living at the poverty level. b. immunizations for high-risk infants and children. c. screening for infants with developmental disorders. d. supplemental food supplies to low-income pregnant or breastfeeding women.

ANS: D WIC is a federal program that provides supplemental food supplies to low-income women who are pregnant or breastfeeding and to their children until age 5 years. Medicaid's Early and Periodic Screening, Diagnosis, and Treatment Program provides for well-child examinations and for treatment of any medical problems diagnosed during such checkups. Children in the WIC program are often referred for immunizations, but that is not the primary focus of the program. Public Law 99-457 is part of the Individuals with Disabilities Education Act that provides financial incentives to states to establish comprehensive early intervention services for infants and toddlers with, or at risk for, developmental disabilities.

17. The school nurse has been asked to begin teaching sex education in the 5th grade. The nurse should recognize that a. children in 5th grade are too young for sex education. b. children should be discouraged from asking too many questions. c. correct terminology should be reserved for children who are older. d. sex can be presented as a normal part of growth and development.

ANS: D When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development. Fifth graders are usually 10 to 11 years old. This age is not too young to speak about physiologic changes in their bodies. The students should be encouraged to ask questions. Preadolescents need precise and concrete information.

1. A child with secondary enuresis who complains of dysuria or urgency should be evaluated for what conditions? (Select all that apply.) a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. UTI e. Diabetes mellitus

ANS: D, E Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. If accompanied by excessive thirst and weight loss, these symptoms may indicate the onset of diabetes mellitus. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.

1. The nurse is preparing for the admission of an infant who will have several procedures performed. In which situations is informed consent required? (Select all that apply.) a. Catheterized urine collection b. IV line insertion c. Oxygen administration d. Lumbar puncture e. Bone marrow aspiration

ANS: D, E Informed consent is required for invasive procedures that involve a risk to a child such as lumbar puncture and bone marrow aspiration. Informed consent is not required for procedures that are covered under the general consent to treat that is signed at admission by a parent or a guardian. These include catheterized urine collection, IV insertion, and oxygen administration.

2. An immunocompromised child is in the clinic for immunizations. Which vaccine prescriptions should the nurse question? (Select all that apply.) a. DTaP b. HepA c. IPV d. Varicella e. MMR

ANS: D,E Children who are immunologically compromised should not receive live viral vaccines. Varicella is a live vaccine and should not be given except in special circumstances. MMR is a live vaccine and should not be given to immunologically compromised children. DTaP, HepA, and IPV can be given safely.

1. The nurse is preparing new parents for discharge home with their well newborn. The nurse explains that the newborn cannot be discharged until the mandatory hearing screening is performed. Is this statement true or false?

ANS: T At the recommendation of The Joint Commission on Infant Screening, most U.S. states and Canada have implemented mandatory infant hearing screening programs. As part of this program all newborns are screened before hospital discharge.

1. Adequate hearing depends on intact auditory structures and quality of sound. Failure to hear at 40 to 69 dB would be categorized as a __________ hearing loss.

ANS: moderate Normal hearing ranges from −10 to +15 dB at a variety of frequencies. Hearing loss is categorized as follows: Moderate: failure to hear at 40 to 69 dB Severe: failure to hear at 70 to 89 dB Profound: failure to hear at more than 90 dB