NCM 109 - Pediatric Lecture

A 9-year-old girl is admitted to the hospital with a diagnosis of idiopathic thrombocytopenic purpura. When assessing her, a finding you would expect to discover is -purple lesions on the roof of her mouth. -a hemorrhagic rash on the lower extremities. -purpural lesions on her forehead and chest. -vesicular lesions along the fifth cranial nerve.

A hemorrhagic rash on the lower extremities. Rationale: An autoimmune illness, idiopathic thrombocytopenic purpura is marked by a hemorrhagic rash on the lower extremities.

An 8-year-old girl is diagnosed as having tonic-clonic seizures. You would want to teach her parents that - their daughter should maintain an active lifestyle. -if their daughter shows symptoms of beginning a seizure, immediately give her medication. -their daughter should carry a padded tongue blade with her at all times. -their daughter should be kept quiet late in the day when she is most likely to have a seizure.

Answer: their daughter should maintain an active lifestyle. It is important for children with seizures to maintain as near normal a lifestyle as possible to maintain self-esteem and achievement. Most seizure medications must create a therapeutic level before they are effective.

A newborn was diagnosed as having hypothyroidism at birth. Her mother asks you how the disease could be discovered this early. Your best answer would be A) hypothyroidism is usually detected at birth by the child's physical appearance. B) children have a typical rash at birth that suggests the diagnosis. C) a simple blood test to diagnose hypothyroidism is required in most states. D) her child is already severely impaired at birth, and this suggests the diagnosis.

C) a simple blood test to diagnose hypothyroidism is required in most states. Rationale: Hypothyroidism is usually diagnosed by a simple blood test that measures the level of thyroid hormones in the blood. Most states in the US require that all newborns be screened for hypothyroidism using this blood test.

When discussing care of an infant with congenital hypothyroidism, you would stress that the infant will need A) administration of vitamin C until after growth is complete. B) an increased intake of calcium beginning in infancy. C) administration of levothyroxine for a lifetime. D) vitamin K administration until school age.

C) administration of levothyroxine for a lifetime. Rationale: Congenital hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormones at birth. The main treatment for congenital hypothyroidism is the lifelong administration of levothyroxine, which is a synthetic thyroid hormone that replaces the missing thyroid hormone.

When providing diaper care to an infant after pyloric stenosis surgery, which approach is indicated? -Diapers should be folded so that the incision line does not become contaminated. -Diapers should not be used. -Diapers should be folded so that the incision line is well covered to prevent infection. -Sterile diapers should be used.

Diapers should be folded so that the incision line does not become contaminated. Rationale: Folding diapers low so they do not contact the incision line can help prevent infection following surgery.

Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? -Ineffective tissue perfusion related to poor platelet formation. -Risk for infection related to abnormal immune system. -Ineffective breathing pattern related to decreased white blood count. -Risk for altered urinary elimination related to kidney impairment.

Ineffective tissue perfusion related to poor platelet formation. Rationale: Idiopathic thrombocytopenic purpura results in decreased platelets, so bleeding into tissue can occur.

An infant has surgery to relieve pyloric stenosis. Which of the following nursing diagnoses would apply in the immediate postoperative period? -Excess fluid volume related to increased fluid intake prescribed postoperatively. -Anxiety related to new feeding method used postoperatively. -Ineffective tissue perfusion related to pressure on heart chambers. -Risk for infection of incision line, related to disruption of skin barrier during surgery.

Risk for infection of incision line, related to disruption of skin barrier during surgery. Rationale: Because the incision line for pyloric stenosis surgery is near the diaper area, infection of the incision line is a possible complication following surgery.

A 6-month-old boy is diagnosed with pyloric stenosis. When you take a health history from his mother, which symptom would you expect to hear her describe? -Refusal to eat. -Chronic diarrhea. -Vomiting about 2 hours after feeding. -Vomiting immediately after feeding.

Vomiting immediately after feeding. Rationale: A narrowing of the pyloric valve leads to projectile vomiting soon after eating.

Any individual taking phenobarbital for a seizure disorder should be taught - to brush his or her teeth four times a day. - never to discontinue the drug abruptly. - never to go swimming. - to avoid foods containing caffeine.

Answer: never to discontinue the drug abruptly.

You are assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia? A) A 3-month-old boy who is totally breastfed. B) A 7-month-old boy who has started table food. C) An 8-year-old girl who carries her lunch to school. D) A 15-year-old girl who has heavy menstrual periods.

D) A 15-year-old girl who has heavy menstrual periods. Rationale: Menstrual blood loss is a common cause of iron-deficiency anemia in adolescent girls.

Which measurements would be most appropriate to determine if ascites is increasing in amount in a child with nephrotic syndrome? A) Blood pressure. B) Bowel sounds. C) Urine for protein. D) Abdominal circumference.

D) Abdominal circumference. Ascites is accumulation of fluid in the abdominal cavity. Increasing abdominal size reveals this.

A 9-month-old boy with iron-deficiency anemia is given ferrous sulfate therapy. Which of the following assessments would best help you determine that he is actually taking it daily? A) He will develop diarrhea. B) His reticulocyte count will have decreased. C) He will be less irritable than he was at his last visit. D) His stools will appear black.

D) His stools will appear black. Rationale: Ferrous sulfate therapy can cause black stools, so their presence is a reliable indicator that the medication is being taken.

When assisting a child during a tonic-clonic seizure, it would be important to: A) Place a tongue blade between the child's teeth. B) Restrain the child from all movement. C) Turn the child onto her back and observe her. D) Protect the child from hitting her arms against furniture.

D) Protect the child from hitting her arms against furniture. Rationale: It is essential to protect the child's head and body from any injury during a seizure. Placing a tongue blade or restraining the child's movement can harm the child and exacerbate the seizure.

Tetralogy of Fallot is the most frequently occurring type of congenital heart disease in children. The four anomalies associated with this defect are: A) Atrial septal defect, pulmonary stenosis, left ventricular hypertrophy, overriding aorta. B) Ventricular septal defect, aortic stenosis, mitral stenosis, right-sided aorta. C) Tricuspid stenosis, right ventricular hypertrophy, pulmonary stenosis, atrial septal defect. D) Ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, overriding aorta.

D) Ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, overriding aorta. Rationale: Tetralogy of Fallot is a congenital heart defect that includes four structural abnormalities: ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta.

When planning care for a 6-year-old boy with acute glomerulonephritis, you should be aware that glomerulonephritis usually follows an infection of what organism? A) A Beta-hemolytic Streptococcus. B) Staphylococcus viridans. C) One of the rhinoviruses. D) Group B streptococci.

A) A Beta-hemolytic Streptococcus. Acute glomerulonephritis may result as an autoimmune response to the invasion of A beta-hemolytic Streptococcus.

The nursing diagnosis most applicable to a child with growth hormone deficiency would be A) risk for situational low self-esteem related to short stature. B) ineffective tissue perfusion related to infantile blood vessels. C) impaired skin integrity related to overproduction of melanin. D) risk for self-directed violence related to oversecretion of epinephrine.

A) risk for situational low self-esteem related to short stature. Rationale: Children with growth hormone deficiency are usually shorter than their peers, which can affect their self-esteem and socialization skills. Therefore, the nursing diagnosis most applicable to a child with growth hormone deficiency is the risk for situational low self-esteem related to short stature.

When you are making plans for the discharge of a child following rheumatic fever, you anticipate that you will be giving her parents instructions to A. administer oral penicillin to the child daily. B. watch for signs of poor platelet function, such as petechiae. C. ensure that the child remains inside until surgery is scheduled. D. test the child's urine daily for protein.

A. administer oral penicillin to the child daily. Rationale: Children with rheumatic fever need to receive oral penicillin daily to prevent recurrent infections.

With the administration of oxygen, a preterm infant's Pa02 level is carefully monitored. It is important to keep this level under which value to help prevent retinopathy of prematurity? -100 mm Hg. -50 mm Hg. -40 mm Hg. -180 mm Hg.

Answer: 100 mm Hg Retinal capillaries can be damaged by excessive oxygen levels. Keeping the Pa02 level under 100 mm Hg helps prevent this

A 4-year-old girl has acute nasopharyngitis (a common cold). Which of the following measures would you want to teach her parents? -A cough that accompanies a cold should rarely be suppressed. -An antibiotic is prescribed for children under 5 years of age. -Typically the child will pull her ear when a cold is present. -Healthy children rarely have more than one cold per year.

Answer: A cough that accompanies a cold should rarely be supressed. Coughing can be therapeutic because it raises respiratory secretions and prevents them from becoming infected.

A 12-year-old girl is diagnosed with hyperthyroidism. What problem do you anticipate she may have in school? A) Inability to submit neat handwriting assignments. B) Increase in sleepiness by the end of the day. C)Non-comprehension of written material. D) Inability to fit legs under a school des

Answer: A) Inability to submit neat handwriting assignments Rationale: Children with hyperthyroidism may develop hand tremors, which leads to poor handwriting

4-year-old girl has been admitted to the hospital with a diagnosis of pneumococcal pneumonia. Her parents are extremely distraught over her condition and the fact she has not wanted to eat anything for the past 2 days. Which nursing approach would be most important to take to help alleviate the high anxiety level of these parents? -Avoid telling the parents unnecessary facts regarding her prognosis. -Allow the parents to remain with the child as much as possible. -Encourage the parents to return home and get some rest. -Tell the parents that their child is receiving the best care possible.

Answer: Allow the parents to remain with the child as much as possible Pneumonia is a frightening disease for parents because before the age of antibiotics, it was fatal to children. Encouraging them to visit and offer support can increase self-esteem and decrease anxiety.

At an amniocentesis just prior to birth, a fetus's lecithin/sphingomyelin ratio was determined to be 1:1. Based on this, she is prone to which type of respiratory problem following birth? - Wheezing from excess fluid accumulation. - Bronchial constriction from room air. - Alveolar collapse on expiration. - Inspiratory constricture from air contaminants.

Answer: Alveolar collapse on expiration. Without adequate surfactant, infants are unable to sustain respiratory function and thus develop respiratory distress syndrome with alveolar collapse on expiration.

All infants need to be observed for hypoglycemia during the newborn period. Based on the facts obtained from pregnancy histories, which infant would be most likely to develop hypoglycemia? - An infant whose labor began with ruptured membranes. - An infant who has marked acrocyanosis of his hands and feet. - An infant who had difficulty establishing respirations at birth. - An infant whose mother craved chocolate during pregnancy.

Answer: An infant who had difficulty establishing respirations at birth. Newborns use a great many calories in their effort to achieve effective respirations. Infants who had difficulty establishing respirations need to be assessed for hypoglycemia.

Which of the following measures would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis? -Assisting with racemic epinephrine nebulizer therapy. -Urging the child to continue to take oral fluids. -Teaching the child to take long, slow breaths. -Administering an oral analgesic.

Answer: Assisting with racemic epinephrine nebulizer therapy. A bronchodilator increases the lumen of airways.

A 7-year-old has been scheduled for a tonsillectomy. Which of the following would be most important to assess prior to surgery? -Specific gravity of urine. -Blood pressure both lying down and sitting up. -Pulse and respiratory rate. -Bleeding and clotting time.

Answer: Bleeding and clotting time. Because removal of tonsils leaves a large denuded area, not a simple suture line, hemorrhage following surgery can occur.

A newborn girl is discovered to have congenital adrenogenital hyperplasia. When assessing her, you would expect to find which physical characteristic? A) Small for gestational age. B) Abnormal facial features. C) Enlarged clitoris. D) Divergent vision.

Answer: C) Enlarged clitoris

You notice that a child is spitting up small amounts of blood in the immediate postoperative period after a tonsillectomy. Which of the following would be the best intervention? -Suction the back of the throat. -Notify the physician immediately. -Continue to assess for bleeding. -Encourage the child to cough.

Answer: Continue to assess for bleeding Children will have a small amount of blood mixed with saliva following a tonsillectomy. Suctioning or coughing could irritate the surgical site and cause hemorrhage.

A preterm infant has an umbilical vessel catheter inserted so that blood can be drawn readily. Which of the following would be most important to implement during this procedure? -Prevent her from crying. -Evaluate her urinary output. -Assess her cranial vascular tension. -Ensure that she is kept warm

Answer: Ensure that she is kept warm. Preterm infants must be protected from chilling during all procedures, because maintaining warmth is a major concern due to immaturity.

An 8-month-old boy is diagnosed as having cerebral palsy. Which finding would make you suspect that he has this? -He cries when held in a ventral suspension position -He holds his back very straight when in a sitting position. -He bears weight on both feet when held upright. -He has a strong Moro reflex when startled.

Answer: He has a strong Moro reflex when startled. Rationale: A Moro (startle) reflex typically fades by 5 to 6 months. Retained newborn reflexes are suggestive of cerebral palsy.

A 2-year-old boy is seen for acute laryngotracheobronchitis. Which of the following observations would lead you to suspect that airway occlusion is occurring? -His respiratory rate is gradually increasing. -He states he is tired and wants to sleep. -His cough is becoming harsher. -His nasal discharge is increasing.

Answer: His respiratory rate is gradually increasing. An increasing respiratory rate is a major sign of airway occlusion (breathing faster because less air is received with each breath).

When discussing congenital adrenogenital hyperplasia with a child's parents you would advise them that administration of which of the following drugs will probably be indicated? -Calcium. -Vitamin D. -Hydrocortisone. -Growth hormone.

Answer: Hydrocortisone

What measure at home could help a child with an upper respiratory infection breathe more easily? -Limiting fluid intake. -Playing "rapid breathing" games. -Enforcing strict bed rest. -Increasing room humidity.

Answer: Increasing room humidity. A moist environment helps prevent respiratory secretions from drying and becoming difficult to raise.

A newborn is being cared for under phototherapy lights for jaundice. Which of the following interventions would be most important? -Offering additional fluids. -Keeping head slightly elevated. -Keeping positioned on her abdomen. -Assessing temperature at least every 15 minutes.

Answer: Offering additional fluids. Newborn stools often become loose and green as excess bilirubin is evacuated. Keeping the infant well hydrated is very important.

A preterm infant is placed on ventilatory assistance for respiratory distress syndrome. In light of her lung pathology, which additional ventilatory measure would you anticipate additional planning? -Positive end-expiratory pressure to increase oxygenation. -Administration of dry oxygen to avoid over-humidification. -Administration of chilled oxygen to reduce lung spasm. -Increased inspiratory pressure; decreased expiratory pressure.

Answer: Positive end-expiratory pressure to increase oxygenation. Positive end-expiratory pressure, like expiratory grunting, prevents alveoli from fully closing on expiration and reduces the respiratory effort needed for inspiration.

A preterm infant will be hospitalized for an extended time. Assuming her condition is improving, which environment would you devise as the one most suitable for her? -Bring her open bassinet near the desk area so she sees people. -Place her Isolette near the window so she can see outside. -Keep her environment free of color to reduce eye straining. -Provide a mobile she can see no matter how she is turned.

Answer: Provide a mobile she can see no matter how she is turned. Preterm infants are able to focus at short distances before they can see well at long distances. A mobile offers short-distance stimulation.

A school-age child develops a nosebleed (epistaxis). Which of the following would you do? -Sit the child upright and apply pressure to the sides of the nose. -Elevate the head of the bed slightly and apply pressure to the forehead. -Keep the child flat and apply pressure to the bridge of the nose. -Turn the child's head to the side and press on the nasal ridge.

Answer: Sit the child upright and apply pressure to the sides of the nose. Keeping a child upright reduces pressure on cerebral vessels and aids coagulation at the site of a broken vessel.

You see a 3-year-old boy in an ambulatory setting for localized wheezing on auscultation. Which statement by his mother would be most important to report? -She gives the child hard candy as an afternoon treat. -She likes the child to play by himself for 15 minutes every afternoon. -The child was eating peanuts yesterday. -The child has two cousins who have many allergies.

Answer: The child was eating peanuts yesterday. Localized wheezing suggests only a small portion of a lung is involved, such as occurs following aspiration.

An infant is diagnosed as having cerebral palsy. When planning care, which of the following would you stress to his parents? -Their son will probably benefit from early schooling to increase his ability for self-care. -Administering an antiacetylcholinergic drug to decrease muscle spasms is crucial. -His mother should be tested during future pregnancies to predict similar involvement. -Their son's disease will cause progressive brain cell degeneration as he grows older.

Answer: Their son will probably benefit from early schooling to increase his ability for self-care. Rationale: Cerebral palsy is not a progressive disorder. It cannot be predicted by pregnancy studies. Early schooling gives the child a "head start."

A preterm infant is transferred to a distant hospital for care. When her parents visit her, which of the following would be most important for you to urge them to do? -Bring a piece of clothing for her. -Stand so the baby can see them. -Call the baby by her name. -Touch and hold her.

Answer: Touch and hold her. Preterm infants may be hospitalized for an extended time, so parents need to be encouraged to touch and interact with the infant to begin bonding.

A preterm infant of 32 weeks is being started on feeding. When planning care for her, you anticipate that the feeding used will most likely be - diluted with glucose water. - a 24 cal/oz formula or breastmilk - a 20 cal/oz formula. - an iron supplemental formula.

Answer: a 24 cal/oz formula or breastmilk. Because preterm babies continue to grow at their intrauterine rate, they need more calories per ounce than term newborns

A 6-year-old is diagnosed as having streptococcal pharyngitis. When planning care you should be aware that the chief danger of such an infection is that -lymph nodes will swell and obstruct the airway. -four out of five children develop nephrosis afterward. -the infection may spread and cause a tooth abscess. -a small proportion of children develop rheumatic fever.

Answer: a small proportion of children develop rheumatic fever. Certain strains of streptococci can cause a hypersensitivity reaction that results in either rheumatic fever or glomerulonephritis.

Wheezing in children is best heard -without a stethoscope -as the child cries -with the child supine -as the child exhales

Answer: as the child exhales Wheezing is an expiratory sound from difficulty pushing air through a narrowed airway.

In the salt-losing form of congenital adrenogenital hyperplasia, the most important observation you would make in a newborn would be for -excessive cortisone secretion. -dehydration. -hypoglycemia. -bleeding tendencies.

Answer: dehydration

A common symptom that would alert you that a preterm infant is developing respiratory distress syndrome is -inspiratory stridor. -expiratory grunting. -inspiratory "crowing." -expiratory wheezing.

Answer: expiratory grunting. Expiratory grunting is a physiologic measure to ensure alveoli do not fully close on expiration (so they require less energy expenditure to reopen).

A school-age girl is diagnosed as having Cushing's syndrome from long-term therapy with oral prednisone. This means that the child -appears pale and fatigued. -has purple striae on her abdomen. -is excessively tall for her age. -has hypoglycemia.

Answer: has purple striae on her abdomen

To relieve a child's feeling of thirst immediately after tonsillectomy, the best thing to offer would be -juice -ginger ale -milk -ice chips

Answer: ice chips Ice chips are soothing. Milk clings to the back of the throat, so it is difficult to swallow. Juice can sting a raw surgery site; ginger ale bubbles can be irritating.

To help meet the nutritional needs of a child with pneumonia, you would -encourage reducing fluid intake. -encourage intake of three large meals daily. -offer small, frequent feedings. -suggest feeding by enteral tube feedings.

Answer: offer small, frequent feedings Children with pneumonia need a high fluid intake to keep respiratory secretions moist. Eating small meals frequently prevents tiring them and putting pressure on the lungs from a distended stomach.

After tonsillectomy surgery, the preferred position of a child until fully awake is -on the side with the head elevated. -on the back with warm compresses applied to the throat. -on the abdomen with a pillow under the chest. -on the side with continuous oxygen by cannula at 30%.

Answer: on the abdomen with a pillow under the chest Lowering the child's head slightly and placing the child on the stomach allows mouth and throat secretions to flow out, avoiding possible aspiration and allowing for better assessment of bleeding from the surgery site.

A premature infant develops respiratory distress syndrome. With this condition, circulatory impairment is likely to occur because with increased lung tension, -the aorta or aortic valve strictures. -the ductus arteriosus remains open. -the pulmonary artery closes. -the foramen ovale closes prematurely.

Answer: the ductus arteriosus remains open. Excess pressure in the alveoli stimulates the ductus arteriosus to remain open, compromising efficient cardiovascular function.

A 10-year-old boy with hemophilia A slipped on the ice and bumped his knee. Which emergency measure would you teach him to do at home? A) Apply a tourniquet to decrease blood flow to the area. B) Begin an intravenous infusion of factor VIII. C) Administer an injection of factor X. D) Apply a warm compress to increase blood absorption.

B) Begin an intravenous infusion of factor VIII. Rationale: Hemophilia A is a deficiency of clotting factor VIII, so an intravenous infusion of this factor is the best emergency measure to take when bleeding occurs.

In which position would a child with nephrotic syndrome who has ascites and difficulty breathing be most comfortable sleeping? A) Supine. B) Fowler's. C) Sims'. D) Prone.

B) Fowler's. A Fowler's position (sitting upright) allows ascites fluid to settle downward and not press against the diaphragm, compromising breathing.

A boy with hemophilia A is scheduled for surgery. Which of the following precautions would you institute with him? A) Do not allow a dressing to be applied postoperatively. B) Handle him gently when transferring him to a stretcher. C) Caution him not to brush his teeth before surgery. D) Mark his chart for him to receive no analgesia.

B) Handle him gently when transferring him to a stretcher. Rationale: Gentle handling can reduce bruising. Analgesia will be needed postoperatively; IM injections are contraindicated because of potential bleeding.

An 8-month-old has a ventricular septal defect. Which nursing diagnosis below would best apply? A) Ineffective airway clearance related to altered pulmonary status. B) Ineffective tissue perfusion related to inefficiency of the heart as a pump. C) Impaired gas exchange related to a left-to-right shunt. D) Impaired skin integrity related to poor peripheral circulation.

B) Ineffective tissue perfusion related to inefficiency of the heart as a pump. Rationale: A ventricular septal defect causes blood to flow from the left ventricle to the right ventricle, resulting in decreased systemic circulation and decreased tissue perfusion.

A newborn is born with hypothyroidism. A complication of this disorder if it is not recognized and treated is A) blindness. B) muscle spasticity. C) dehydration. D) cognitive impairment.

D) cognitive impairment. Rationale: Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormones. Thyroid hormones are essential for brain development and growth. Therefore, if hypothyroidism is not recognized and treated early, it can lead to cognitive impairment.

You care for a 10-year-old boy with growth hormone deficiency. Which therapy would you anticipate will be prescribed for him? A) Short-term aldosterone provocation. B) Intramuscular injections of growth hormone. C) Oral administration of somatotropin. D) Long-term blocking of beta cells.

B) Intramuscular injections of growth hormone. Rationale: Growth hormone deficiency is a condition where the pituitary gland does not produce enough growth hormone, which results in a shorter stature. The main therapy for growth hormone deficiency is the administration of exogenous growth hormone, usually via daily intramuscular injections.

When reviewing the record of a child with tetralogy of Fallot, which of the following would you expect to discover? A) Leukopenia. B) Polycythemia. C) Increased platelet level. D) Anemia.

B) Polycythemia. Rationale: Children who cannot oxygenate red cells well often produce excess red blood cells or develop polycythemia.

A 1-year-old girl has experienced a febrile convulsion. You would teach her parents that to prevent a second convulsion, they should: A) Prevent the child from developing an upper respiratory infection. B) Prevent her temperature from going above 101°F by administering acetaminophen. C) Administer phenobarbital when the temperature is above 101°F. D) Place the child in an ice bath for a temperature above 101°F.

B) Prevent her temperature from going above 101°F by administering acetaminophen. Rationale: Febrile seizures are often due to high fever, so controlling the child's temperature is vital. Acetaminophen is effective in reducing fever and can prevent future seizures.

What would you want to teach the parents of a 3-year-old with hypospadias and a urethral urinary catheter? A) He must be reevaluated at puberty for testicular function. B) The catheter insertion site will leave only a minimal scar. C) He will always have tenderness on penile erection. D) Back-pressure from such drainage may result in nephrotic syndrome.

B) The catheter insertion site will leave only a minimal scar. A hypospadias repair should have no long-term consequences. The tube insertion site will leave only a minimal scar.

When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that A) the procedure is noninvasive and not frightening for children. B) the child will return with a bulky pressure dressing over the catheter insertion area. C) the child will require a general anesthetic and needs to be prepared for this. D) the child will have to remain NPO for 6 to 8 hours after the procedure to prevent vomiting.

B) the child will return with a bulky pressure dressing over the catheter insertion area. Rationale: Parents should be prepared for the appearance of the bulky pressure dressing after the procedure.

To assess for cyanosis in an infant with cardiovascular disease, it would be best to assess A) the child's toes for color. B) the child's tongue and buccal membrane. C) the child's lips and the circumoral area. D) the child's fingertips for color and blanching.

B) the child's tongue and buccal membrane. Rationale: The tongue and buccal membrane are the most reliable indicators of cyanosis in infants.

Which of the following nursing diagnoses would best apply to a child with rheumatic fever? A. Ineffective breathing pattern related to cardiomegaly. B. Activity intolerance related to inability of heart to sustain extra workload. C. Disturbed sleep pattern related to hyperexcitability. D. Risk for self-directed violence related to development of cerebral anoxia.

B. Activity intolerance related to inability of heart to sustain extra workload This would be the most appropriate nursing diagnosis for a child with rheumatic fever. Rheumatic fever can cause inflammation and damage to the heart valves, which can lead to decreased cardiac output and fatigue with activity. Ineffective breathing pattern, disturbed sleep pattern, and risk for self-directed violence are not typically associated with rheumatic fever.

Coarctation of the aorta demonstrates few symptoms in newborns. Which of the following is an important assessment to make on all newborns to help reveal this condition? A. Observing for excessive crying. B. Assessing for the presence of femoral pulses. C. Recording an upper extremity blood pressure. D. Auscultating for a cardiac murmur.

B. Assessing for the presence of femoral pulses. Rationale: Infants with a narrowing (coarctation) of the aorta have decreased pressure in the lower extremities or absence of femoral pulses.

When planning the care for a child with Kawasaki disease, which of the following would be most important? A. Making sure he performs postural drainage daily. B. Observing him for symptoms of bowel obstruction. C. Encouraging him to cough and deep-breathe. D. Teaching him to live with a chronic illness.

B. Observing him for symptoms of bowel obstruction. Rationale: Extreme enlargement of lymph nodes can occur with Kawasaki disease. If abdominal nodes increase in size, they can compress intestines, leading to bowel obstruction.

You would teach the mother of a boy with tetralogy of Fallot that if he suddenly becomes cyanotic and dyspneic to A) place him in a semi-Fowler's position in an infant seat. B) lie him supine with the head turned to one side. C) lie him prone, being sure he can breathe easily. D) place him in a knee-chest position.

D) place him in a knee-chest position. Rationale: The knee-chest position increases systemic vascular resistance and reduces blood flow to the lungs, which helps to improve oxygenation.

What would you expect the mother of a child with glomerulonephritis to tell you she noticed? A) Loss of weight, oliguria. B) Diuresis and pallor. C) Dark brown urine. D) Headache, loss of appetite.

C) Dark brown urine. Acute glomerulonephritis often presents with glomeruli bleeding, which is revealed as black or brown urine from old blood.

What is the best implementation to reduce periorbital edema in a 4-year-old boy with nephrotic syndrome? A) Apply cool, sterile soaks to his head. B) Encourage him to eat low-protein foods. C) Elevate the head of the bed. D) Apply warm compresses to his eyes at bedtime.

C) Elevate the head of the bed. Because edema tends to be dependent, elevating an edematous body part usually reduces swelling in that part.

A parent brings a 2-month-old who has tetralogy of Fallot for a health maintenance visit. The parent's chief concern is most apt to be that the infant: A) Is overweight. B) Coughs bloody sputum. C) Has difficulty sucking. D) Appears pale.

C) Has difficulty sucking. Rationale: Infants with tetralogy of Fallot may experience cyanotic episodes during feeding, which can make it difficult for them to eat and gain weight.

A school-age child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in his care should be given priority? A) Beginning active range-of-motion exercises. B) Seeing that he ingests a protein-rich diet. C) Maintaining a fluid intravenous line. D) Encouraging him to take deep breaths hourly.

C) Maintaining a fluid intravenous line. Rationale: Dehydration increases sickling of cells, so maintaining fluid balance is important.

You care for a 4-year-old with meningitis. A primary nursing goal would be to: A) Increase stimulation opportunities to prevent coma. B) Provide an opportunity for therapeutic play. C) Reduce the pain related to nuchal rigidity. D) Inspect the teeth for obvious caries.

C) Reduce the pain related to nuchal rigidity. Rationale: Nuchal rigidity, stiffness in the neck, is a symptom of meningitis. Reducing pain is a priority to alleviate discomfort and facilitate recovery.

At 3 years of age, a child has a cardiac catheterization. After the procedure, which of the following interventions would be most important? A) Assuring the child that the procedure is now over. B) Allowing the child to adapt to the light room gradually. C) Taking pedal pulses for the first 4 hours. D) Allowing the child to talk about the procedure.

C) Taking pedal pulses for the first 4 hours. Rationale: Insertion of a catheter into the femoral vein can cause vessel spasm, interfering with blood circulation in the leg. Assessing pedal pulses ensures circulation is adequate.

Question 19 Which measures would you teach a preschooler's mother to prevent further urinary tract infections? A) Suggest she drink less fluid daily to concentrate urine. B) Teach her to take frequent tub baths to clean her perineal area. C) Teach her to wipe her perineum front to back after voiding. D) Encourage her to be more ambulatory to increase urine output.

C) Teach her to wipe her perineum front to back after voiding. Escherichia coli can be easily spread from the rectum to the urinary meatus and cause infection if girls do not take precautions against this.

To prevent further sickle cell crisis, you would advise the parents of a child with sickle cell anemia to A) encourage the child to participate in school activities, such as long-distance running B) prevent the child from drinking an excess amount of fluids per day. C) notify a health care provider if the child develops an upper respiratory infection. D) administer an iron supplement daily.

C) notify a health care provider if the child develops an upper respiratory infection. Reduction of oxygen and dehydration lead to increased sickling of cells. Early prevention of these with respiratory illness is important.

When taking the pulse of a child with rheumatic fever, which method would be most appropriate? A. Brachial pulse for 30 seconds. B. Radial pulse for 60 seconds. C. Apical pulse for 60 seconds. D. Dorsalis pedis pulse for 60 seconds.

C. Apical pulse for 60 seconds. Rationale: The apical pulse, which is taken with a stethoscope over the apex of the heart, is the most accurate method for measuring the heart rate in a child with rheumatic fever.

You care for a 4-year-old with sickle cell anemia. A physical finding you might expect to see in him is A) depigmented areas on the abdomen. B) increased growth of long bones. C) enlarged mandibular growth. D) slightly yellow sclerae.

D) slightly yellow sclerae. Rationale: Many children with sickle cell anemia develop mild scleral yellowing from excess bilirubin from the breakdown of damaged cells.

A school-age boy has an emergency appendectomy. Which assessment would you report to his physician if noticed in the immediate postoperative period? A. Thirst. B. A feeling of "tugging" at the incision line. C. Abdominal pain. D. A rigid abdomen.

D. A rigid abdomen. Rationale: One of the first symptoms of peritonitis (infection of the peritoneal cavity) is a tense, rigid abdomen.

A preschooler has celiac disease. Her mother is preparing a gluten-free diet. By preparing which breakfast foods would you believe she understands the diet? A. Rye toast and peanut butter. B. Cheerios (oat cereal) and skim milk. C. Wheat toast and grape jelly. D. Eggs and orange juice.

D. Eggs and orange juice. Rationale: Children with celiac disease cannot digest the protein in common grains, such as wheat, rye, and oats.

How long do children with celiac disease remain on their restricted diet? A. Until early school age. B. Until age 21. C. Until symptoms fade. D. For life.

D. For life. Rationale: There is an association between the development of bowel cancer and celiac diseased in individuals not continuing to follow their grain-free diet for life.

You telephone a physician on call because a 10-year-old boy has been admitted to the emergency room with symptoms of appendicitis. She asks you to assess for rebound tenderness to help with assessment. Which of the following would be the best technique to do this? A. Tell the child to bend forward and then ask him if he notices bounding abdominal pain afterward. B. Palpate the child's left lower abdomen then the right, and ask the child to compare the levels of pain. C. Ask the child to use a Valsalva maneuver, and note if pain is increased after the maneuver. D. Palpate the child's right lower abdomen, quickly release your hand, and ask him if he has increased pain.

D. Palpate the child's right lower abdomen, quickly release your hand, and ask him if he has increased pain. Rationale: With appendicitis, there is sharp pain if the appendix is sharply jiggled, such as occurs when a hand is lifted suddenly from the abdomen.

A 4-year-old girl with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing her for this procedure, you would want to prepare her to A. Drink three glasses of water during the procedure. B. Have a local anesthetic injected prior to the procedure. C. Anticipate a headache afterward. D. Void during the procedure.

D. Void during the procedure. Rationale: A voiding cystourethrogram requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed.

When planning care for a child with idiopathic thrombocytopenic purpura, you plan to teach her -to use mainly cold water to wash. -to apply a soothing cream to lesions. -what foods are high in folic acid. -not to pick or irritate her nose.

Not to pick or irritate her nose. Rationale: Without adequate platelets, children bleed easily from lesions.