Pediatrics CH 41,44,45,27,46,48

7. A toddler weighing 22 lb with hemophilia A fell down several steps and sustained a knee injury. The parents have been instructed to provide the child with an infusion of factor VIII concentrate, one bag per 5 kg of body weight. How many bags of the concentrate will the parents infuse into the child? (Calculate to the nearest tenth decimal point.)

Ans: 2 bags Feedback: First, determine the child's weight in kilogram by dividing 22 lb by 2.2 = 10 kg. If the parents are to infuse one bag of concentrate for every 5 kg of body weight then divide the total body weight by 5 or 10 kg/5 = 2. The child is to receive 2 bags of factor VIII to treat this injury.

4. The nurse is evaluating the outcome of teaching for a baby born with torticollis. Which observation indicates that teaching has been successful? A) The child looks in the direction of the affected muscle. B) The child's shoulder of the affected muscle is elevated. C) The child looks in the direction opposite of the affected muscle. D) The child rolls onto the side to look from the direction opposite of the affected muscle.

Ans: A Feedback: : To relieve torticollis, parents need to begin a program of passive stretching exercises, laying the infant on a flat surface and rotating the head through a full range of motion. Parents should always encourage the infant to look in the direction of the affected muscle. They can encourage this by holding the child to feed in such a position the child must look in the desired direction. If manual stretching is begun early and performed consistently by parents, further treatment usually is not necessary. If extreme injury to the muscle occurred, torticollis can lead to the continued elevation of one shoulder. Any observations where the child is looking in the direction opposite of the affected muscle indicates that teaching has not been successful.

7. During the assessment of a preschool-age child, the nurse notes that the child's tongue is tender and there are cracks in the corners of the child's mouth. Which vitamin deficiency does the nurse suspect this child is experiencing? A) Vitamin A B) Vitamin B1 C) Vitamin C D) Vitamin D

Ans: A Feedback: A vitamin A deficiency is caused by a lack of yellow vegetables in the diet. Manifestations of this deficiency include a tender tongue and cracks at the corners of the mouth. Manifestations of a vitamin B1 deficiency include beriberi, diarrhea, and vomiting. Manifestations of a vitamin C deficiency include muscle tenderness and petechiae. Manifestations of a vitamin D deficiency include poor muscle tone, delayed tooth formation, poor bone formation, swelling of the wrists and cartilage of ribs, bowed legs, and muscle spasms.

6. A 2-month-old infant experiencing severe diarrhea is prescribed intravenous fluid replacement. Before adding potassium to this solution, which assessment should the nurse make? A) Is voiding B) Is sleeping C) Is crying with tears D) Hands are restrained

Ans: A Feedback: Although infants usually have a potassium depletion, potassium is not given until it is established the child is not in renal failure because giving potassium IV when the body has no outlet for excessive potassium can lead to excessively high potassium levels and heart block. Before this initial IV fluid is changed to a potassium solution, the nurse needs to be certain that the infant has voided, which is proof that the kidneys are functioning. The nurse does not need to ensure that the child is sleeping, crying with tears, or has the hands restrained.

2. The nurse is planning care for a school-age child diagnosed with growth hormone deficiency. Which diagnosis should the nurse select to help the patient with this health problem? 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

Ans: A Feedback: Children with short stature tend to report feeling of lower quality of life largely related to discrimination. The nurse may need to remind parents to assign duties and responsibilities to children that match their chronologic age, not their physical size, in order to promote children's feelings of maturity and self-esteem. A child that differs in any way from peers may be the victim of bullying. The nurse should alert the parent to this possibility and assess for this at well-child visits to help protect the child's quality of life. Tissue perfusion is not affected by this disorder. This disorder does not cause impaired skin integrity. There is no overproduction of epinephrine with this disorder.

8. A newborn female is discovered to have congenital adrenogenital hyperplasia. What will the nurse most likely observe when assessing this patient? A) Enlarged clitoris B) Divergent vision C) Small for gestational age D) Abnormal facial features

Ans: A Feedback: Congenital adrenal hyperplasia is a syndrome that is inherited as an autosomal recessive trait, which causes the adrenal glands to not be able to synthesize cortisol. Because the adrenal gland is unable to produce cortisol, the level of ACTH secreted by the pituitary in an attempt to stimulate the gland to increase function is increased. Although the adrenals enlarge under the effect of ACTH, they still cannot produce cortisol but rather overproduce androgen. Excessive androgen production during intrauterine life masculinizes the genital organs in a female fetus so that the clitoris is so enlarged it appears to be a penis. This disorder does not cause divergent vision. The child will not be born small for gestational age. This disorder does not cause abnormal facial features.

1. The nurse is caring for a school-age child newly diagnosed with type 1 diabetes mellitus. Which nursing action supports the 2020 National Health Goals to reduce the long-term complications from this disease process? A) Schedule the child and parents to attend diabetes education classes. B) Explain how the child's physical abilities will be affected during school. C) Recommend homeschooling so the mother can provide the needed medications. D) Discuss admission to a rehabilitation facility to learn self-care with this disease process.

Ans: A Feedback: Endocrine disorders tend to be long-term with lifetime consequences. Reducing the incidence of consequences or improving care has long-term implications. A 2020 National Health Goal related to endocrine disorders includes increasing the proportion of persons with diabetes who receive formal diabetes education. To support this goal, the nurse should schedule the child and parents to attend diabetes education classes. There are no 2020 National Health Goals to address alteration in physical abilities, homeschooling with type 1 diabetes mellitus, or the need to be admitted to a rehabilitation facility to learn self-care.

10. failure High in potassium foods that need to be restricted for kidney failure. A) Bananas, carrots, nuts, and milk B) Peaches, broccoli, and red meat C) Oranges, potatoes, wheat, and bran D) Spinach, chicken, fish, and green beans

Ans: A Feedback: Foods that are high in potassium include bananas, carrots, nuts, and milk. Broccoli, wheat, bran, chicken, fish, and green beans are not high in potassium and do not need to be restricted.

10. A newborn is diagnosed with the salt-losing form of congenital adrenogenital hyperplasia. On what should the nurse focus when assessing this patient? A) Dehydration B) Hypoglycemia C) Bleeding tendency D) Excessive cortisone secretion

Ans: A Feedback: If there is a complete blockage of cortisol formation, aldosterone production will also be deficient. Without adequate aldosterone, salt is not retained by the body, so fluid is not retained. Almost immediately after birth, affected infants begin to have vomiting, diarrhea, anorexia, loss of weight, and extreme dehydration. If these symptoms remain untreated, the extreme loss of salt and fluid can lead to collapse and death as early as 48 to 72 hours after birth. The salt-losing form must be detected before an infant reaches an irreversible point of salt depletion. This disorder does not cause hypoglycemia, excessive bleeding, or excessive cortisone secretion.

10. The nurse is assessing a school-age child with sickle-cell anemia. Which assessment finding is consistent with this patient's diagnosis? A) Slightly yellow sclera B) Enlarged mandibular growth C) Increased growth of long bones D) Depigmented areas on the abdomen

Ans: A Feedback: In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from the destruction of the sickled cells. Mandibular and long bone growth and depigmentation are not manifestations of this health problem.

13. While receiving a transfusion of packed red blood cells, a school-age child begins to experience itchy skin, hives, and wheezes. What should the nurse do first for this child? A) Stop the transfusion. B) Obtain a blood culture. C) Slow the transfusion rate. D) Provide a diuretic as prescribed.

Ans: A Feedback: Itchy skin, hives, and wheezes while receiving a blood transfusion indicate an allergic reaction to the blood proteins. The nurse should stop the infusion. This will be temporary because after the child receives oxygen and an antihistamine, the transfusion will be resumed. Blood cultures are indicated if the child experiences an increase in body temperature. Slowing the transfusion rate will not reduce the patient's symptoms. A diuretic would be indicated if the child demonstrates shortness of breath and an increased pulse rate.

15. A toddler is diagnosed with a functional heart murmur. What should the nurse explain to the child's parents about this murmur? A) This type of murmur is innocent. B) Mild activity restrictions are indicated. C) More frequent health appraisals are indicated. D) Corrective surgery may be required later in life.

Ans: A Feedback: Murmurs of no significance are termed functional, insignificant, or innocent murmurs. In discussing such murmurs with parents, the term innocent heart murmur is best to use because it most clearly describes that the sound heard is not important or is nothing to worry about. Activity restrictions, frequent health appraisals, and corrective surgery are not indicated for a functional heart murmur.

13. The nurse is evaluating teaching provided to the mother of a child with celiac disease. Which type of breakfast indicates that instruction has been effective? A) Eggs and orange juice B) Oat cereal and skim milk C) Wheat toast and grape jelly D) Rye toast and peanut butter

Ans: A Feedback: Parents need a great deal of nutritional counseling when their child is first placed on a gluten-free diet so they can recognize foods that contain gluten, which include wheat, rye, oats, and barley products. Eggs and orange juice is the only breakfast that does not contain wheat, rye, or oats. The oat cereal contains oats. Wheat toast contains wheat. Rye toast contains rye.

5. What should the nurse teach the parents of a child with tetralogy of Fallot to do if the child suddenly becomes cyanotic and dyspneic? A) Place in a knee-chest position. B) Lie prone and maintain the airway. C) Lie supine with the head turned to one side. D) Place in a semi-Fowler's position in an infant seat.

Ans: A Feedback: Parents need to try to keep hypercyanotic episodes to a minimum and learn what steps to take if one should occur. Placing the baby in a knee-chest position to trap blood in the lower extremities and keep the heart from being overwhelmed generally reduces symptoms. Lying prone, supine, or in the semi-Fowler's position will not help reduce cyanosis and dyspnea.

3. The nurse is preparing teaching materials for a family whose child is prescribed somatropin (Humatrope) for a growth hormone deficiency. What should the nurse instruct the parents about the administration of this medication? A) This medication must be given by injection. B) This medication must be given in the morning before school. C) Hip or knee pain is an expected adverse effect of this medication. D) This medication does not interact with any other types of medication.

Ans: A Feedback: Somatropin (Humatrope) is administered by injection. It is best given at hour of sleep because that is when growth hormone is released. Hip or knee pain could indicate a slipped capital epiphysis and should be reported to the health care provider. The nurse should urge the parents to inform all health care providers that the child is receiving this medication to avoid medication interactions.

11. Shortly after delivery, a newborn is diagnosed with hypocalcemia. What manifestation will the nurse assess in this patient? A) Jitteriness B) Constipation C) Excessive sleepiness D) A distended abdomen

Ans: A Feedback: The chief sign of hypocalcemia is neuromuscular irritability, referred to as latent tetany. This occurs if the blood calcium level falls below 7.5 mg/dl. The newborn will demonstrate jitteriness when handled or has been crying for an extended period. Constipation, excessive sleepiness, and a distended abdomen are not manifestations of hypocalcemia.

1. The nurse is working with a school district to ensure students do not develop food-borne illnesses. Which intervention should the nurse emphasize that supports the 2020 National Health Goals regarding food preparation? A) Refrigerate foods promptly. B) Provide fresh fruits and vegetables. C) Ensure all students are appropriately immunized. D) Examine the number of students who contract food-borne illnesses.

Ans: A Feedback: Unsafe food preparation is an area that could be reduced in incidence if people knew more about it and took active interventions to reduce its occurrence or spread. The 2020 National Health Goals addressing these include reducing infections caused by key pathogens transmitted commonly through food and increasing the proportion of consumers who follow key food safety practices of "Chill: refrigerate promptly." Nurses can help the nation achieve the goal by counseling parents about safe food preparation and serving as consultants to those responsible for food preparation.

8. The nurse is caring for a school-age child recovering from an allogeneic stem cell transplant. What should the nurse do to ensure the child does not develop an infection after the transplant? (Select all that apply.) A) Restrict all visits from other children. B) Provide sterilized age-appropriate play materials. C) Send for total body irradiation immediately after the transplant. D) Make arrangements for schoolwork to be delivered to the hospital. E) Encourage eating raw vegetables for each meal after the procedure.

Ans: A, B Feedback: To prevent the child from contracting an infection until the WBC count returns to a safe range, the child is restricted from interacting with other children either by remaining in the hospital or employing visiting restrictions at home. The nurse should provide sterilized play materials the child would enjoy as appropriate. Total body irradiation is completed before the transplant and not after. Schoolwork will not reduce the child's risk of developing an infection after the transplant. The only raw fruits that are permitted are those with thick skin such as bananas and oranges. Other raw fruits and vegetables are avoided because these foods can carry bacteria.

5. A new mother is concerned about the need to provide medication to a newborn every day for an indefinite period of time. What should the nurse encourage the mother to do to ensure medication compliance? (Select all that apply.) A) Check the expiration dates on all medications. B) Plan times for medications that fit in with the lifestyle. C) Build medication administration into the general home routine. D) Make medication administration pleasant such as including it during mealtimes. E) Schedule prescription refills at least 1 day before the current amount is used up.

Ans: A, B, C Feedback: To be successful in giving a medicine over a long time period, the mother should be urged to build administration into the family's general routine. Expiration dates for the medication should be checked. Plan the times for medication administration so that it allows for a normal lifestyle. Having to take medication during mealtimes is not pleasant and does not support a normal lifestyle. Be certain to anticipate the need to obtain prescriptions so medicine is always available.

5. A newborn is diagnosed with a meconium plug. Which interventions should the nurse prepare to provide to help resolve this health problem? (Select all that apply.) A) Administration of a barium enema B) Administration of a gastrografin enema C) Administration of 5 ml of saline enema D) Administration of 10 ml of tap water enema E) Rectal instillation of acetylcysteine (Mucomyst)

Ans: A, B, C, E Feedback: : Treatment for a meconium plug includes the administration of 5 ml saline enema, rectal instillation of acetylcysteine (Mucomyst), a gastrografin enema, and a barium enema used to diagnose the disorder. A tap water enema should never be used in newborns because it can cause water intoxication.

3. The mother of a 3-month-old infant is distraught because the child vomits after every feeding. After an assessment, the nurse determines that the infant is experiencing regurgitation and not vomiting. What did the nurse assess in the infant? (Select all that apply.) A) Slight sour smell B) Occurs after a feeding C) Accompanied by prolonged crying D) Runs out of the mouth with no force E) Volume amount similar to entire stomach contents

Ans: A, B, D Feedback: Evidence of regurgitation includes a slightly sour smell to the emesis, occurs after a feeding, and runs out of the mouth without any force. Evidence of vomiting would be infant distress by prolonged crying and a large volume similar to that of entire stomach contents.

1. The nurse has been asked to participate in a community health teaching session. Which interventions should the nurse include to help achieve the 2020 National Health Goals to reduce the incidence of anemias? (Select all that apply.) A) Explain the importance of healthy eating for adolescent participants. B) Instruct pregnant women to take iron supplementation as prescribed. C) Emphasize ways to reduce unintentional injuries at home, work, and play. D) Review foods that are rich in iron that should be a part of school-age children's diets. E) Examine strategies for elderly community members to improve the quality of life.

Ans: A, B, D Feedback: Nurses can help the nation achieve the 2020 National Health Goals to improve children's health and reduce hospitalization from anemia by educating parents about the importance of women taking an iron supplement during pregnancy, encouraging iron-rich food sources for young children, and educating adolescents about healthy diets. Prevention of unintentional injuries and improving the quality of life for the elderly are not interventions to achieve this National Health Goal.

3. The nurse is planning a program for community family members that focuses on the 2020 National Health Goals to improve cardiovascular health. Which content should the nurse include in this program? (Select all that apply.) A) Measures to reduce obesity B) Importance of daily exercise C) Starting reduced-fat diets upon birth D) Engaging in stress-reduction activities E) Following a diet that supports heart function

Ans: A, B, E Feedback: Nurses can help the nation achieve the 2020 National Health Goals by educating parents and children about the importance of reducing obesity and planning exercise and nutrition programs for sound cardiovascular health. Parents should be cautioned not to start their children on reduced-fat diets until they are 2 years old to allow for myelination of nerve cells. Stress-reduction activities are not identified as actions to achieve the 2020 National Health Goals for cardiovascular health.

14. A mother caring for a school-age child with type 1 diabetes mellitus is frantic because the child self-administered 15 units of regular insulin instead of the prescribed 5 units before breakfast this morning. What should the nurse instruct the mother to do at this time? (Select all that apply.) A) Observe for nervousness, weakness, dizziness, or sweating. B) Determine if the child is experiencing extreme hunger and thirst. C) Determine if the child is irritable or demonstrating stubbornness. D) Provide the child with a half-glass of orange juice or regular soda. E) Rub a small amount of honey on the child's gums and inside of the cheek.

Ans: A, C, D, E Feedback: Symptoms of hypoglycemia occur when the blood glucose level falls to about 60 mg/dl and results from the administration of too much insulin. Beginning symptoms include nervousness, weakness, dizziness, or sweating. In many children, the first signs of hypoglycemia are behavior problems such as stubbornness and irritability. When the signs of hypoglycemia are recognized, a child needs an immediate source of carbohydrate such as a half glass of orange juice or regular soda. If the child is comatose when first discovered or is too upset or uncooperative to take oral sugar, parents can rub glucose onto the gums or inside the cheek by using honey or other sweet substance. Extreme hunger and thirst are manifestations of hyperglycemia or an inadequate amount of insulin.

3. The nurse is evaluating the effectiveness of teaching provided to the parents of a school-age child prescribed liquid ferrous sulfate (Feosol) for iron-deficiency anemia. Which observations indicate that teaching has been effective? (Select all that apply.) A) Mother places medication in orange juice. B) Mother provides medication with a glass of milk. C) Child observed consuming fresh raw fruit and drinking water. D) Mother provides liquid-prepared medication to the child with a straw. E) Child goes to the bathroom to brush teeth immediately after taking the medication.

Ans: A, C, D, E Feedback: The liquid preparation of ferrous sulfate (Feosol) should be mixed with juice and swallowed by using a straw to avoid teeth staining. The child should thoroughly brush teeth to also prevent staining. High-fiber foods and water help reduce the risk of constipation from this medication. This medication should not be taken with milk because it will interfere with absorption.

11. An 18-month-old child is diagnosed with insufficient platelets. What should the nurse instruct the parents to reduce the risk of the child bleeding when at home? (Select all that apply.) A) Check that all toys have soft corners. B) Engage in limited amounts of rough play each day. C) Ensure mouth care is performed with a soft toothbrush. D) Do not apply Band-Aids or adhesive tape onto the skin. E) Pad the side and crib rails on the bed at home to prevent bruising.

Ans: A, C, D, E Feedback: To prevent bleeding in the child with insufficient platelets, the nurse should instruct the parents to check that all toys have soft corners so no skin scratches occur. Mouth care should only be done with a soft toothbrush so that gum excoriation does not occur. No adhesives should be applied to the skin because the skin can tear during the removal of these items. The bed and crib rails should be padded to ensure the child does not become bruised while sleeping. All rough play is to be avoided because this can lead to an accidental injury and subsequent bleeding.

9. The nurse suspects that an infant is experiencing intussusception. What did the nurse assess in this infant? (Select all that apply.) A) Crying as if in severe pain B) Pulse rate of 78 beats/min and irregular C) Sudden drawing up of the legs D) Vomit that looks like currant jelly E) Leg drawing up and crying repeats every 15 minutes

Ans: A, C, D, E Feedback: With intussusception, the infant will suddenly draw up the legs and cry as if in severe pain. After the peristaltic wave that caused the discomfort passes, the infant is symptom free but in approximately 15 minutes the same pattern repeats. After approximately 12 hours, blood can appear in the vomitus and looks like "currant jelly." A slow pulse rate is not typically assessed in an infant with intussusception.

12. The nurse is evaluating a mother's ability to catheterize her 2-year-old son. Which observations indicate that teaching has been effective? (Select all that apply.) A) Mother washes hands using warm, soapy water. B) Mother coats the tip of the catheter with petroleum jelly. C) Mother quickly removes the catheter once urine stops flowing. D) Mother inserts the catheter into the urinary meatus one half of an inch. E) Mother washes around the child's urinary meatus with warm, soapy water.

Ans: A, E Feedback: : When teaching on intermittent urinary catheterization, the nurse should instruct the mother to use warm, soapy water to wash the hands and around the child's urinary meatus. The mother should coat the tip of the catheter with a water-soluble lubricant and not petroleum jelly. The catheter should be removed gently once urine stops flowing. The catheter should be inserted approximately 3 in.

3. The nurse is planning a community health program to improve awareness of renal disease as one of the 2020 National Health Goals. What information should the nurse include in this program? (Select all that apply.) A) Instruct on organ transplantation procedures. B) Explain the importance of restricting fluids after 6 PM. C) Review recommended foods to promote renal functioning. D) Teach to limit the intake of milk and dairy products with meals. E) Remind parents to provide antibiotics for streptococcal throat infections.

Ans: A, E Feedback: Nurses can help the nation achieve the 2020 National Health Goals for renal disease by educating parents to give antibiotics conscientiously for streptococcal throat infections and being active advocates for organ transplant procedures. Restricting fluids, recommending specific foods, and limiting the intake of milk and dairy products are not interventions to support the 2020 National Health Goals for renal disease.

11. The nurse is planning care for a newborn with a cleft lip and palate scheduled for surgery in a few weeks. For which health need will the nurse focus when planning this patient's care? A) Visual stimulation B) Nutritional support C) Prevention of pneumonia D) Prevention of oral infection

Ans: B Feedback: : Before a cleft lip or palate is repaired, feeding the infant becomes a concern because the infant has difficulty maintaining suction with a bottle or breast. Nutritional support is of the highest priority at this time. Visual stimulation is not a concern for the infant with a cleft lip and palate. Prevention of pneumonia and an oral infection are more appropriate concerns after surgery has occurred.

7. An infant with hydrocephalus has a ventriculoperitoneal shunt inserted. Immediately following the procedure, which nursing action would best prevent decompression from excessive CSF flow? A) Elevating the infant's head 60 degrees B) Keeping the head of the infant level with the body C) Avoiding exercising the upper extremities during bathing D) Positioning the infant with the head dependent to the body

Ans: B Feedback: : Following the surgery for the initial shunt insertion, the infant's bed should be left flat or raised only about 10 degrees so the head remains level with the body. This is to ensure that CSF does not flow too rapidly, possibly leading to tearing of cerebral arteries or signs of too rapid decompression. The infant's head should not be raised 60 degrees. Upper extremity exercise is not contraindicated after placement of the shunt. The patient's head should not be positioned dependent to the body.

10. A newborn is scheduled for casting to correct a talipes disorder. What should the nurse instruct the parents about the height of the cast? A) To the calf B) Above the knee C) At the level of the hip D) Above the level of the waist

Ans: B Feedback: : For correction of a talipes disorder, a series of casts or braces are applied to gradually mold the foot into good alignment. Although the disorder involves the ankle, the cast or brace extends above the knee to ensure firm correction. The cast does not stop at the calf. The cast also does not extend to the hip or to the waist.

13. An infant is prescribed oxybutynin chloride (Ditropan) for neurogenic bladder. What should the nurse instruct the parents about this medication? A) This medication has no adverse effects. B) Check the child frequently for sweating. C) Schedule appointments with the health care provider when necessary. D) Provide the child with the medication when urinary output is sluggish.

Ans: B Feedback: : One adverse effect of oxybutynin chloride (Ditropan) is sweating. Sweating can cause a rise in body temperature. The parents should be encouraged to restrict the child from being exposed to high temperatures. Adverse effects of this medication include drowsiness, dizziness, blurred vision, and sweating. Appointments with the health care provider should be frequent so the effects of this medication can be evaluated. The medication should be taken as prescribed and not only when the child's urinary output is sluggish.

14. What health teaching should the nurse provide to the parents of a child recovering from surgery to repair a cleft palate? A) The child can expect to have chronic maxillary pain. B) The child may have increased episodes of otitis media. C) The child will have difficulty sensing the temperature of food. D) The child may have a poor appetite from a decreased sense of taste.

Ans: B Feedback: : Surgery to correct a cleft palate changes the contour of the palate and the slope of the eustachian tube to the middle ear. This can lead to a high incidence of middle ear infection or otitis media because organisms are able to reach this area from the oral cavity more readily than usual. The child is not expected to have chronic maxillary pain, inability to sense the temperature of food, or a poor appetite from a decreased sense of taste.

6. A school-age girl is diagnosed as having Cushing syndrome from long-term therapy with oral prednisone. What assessment finding is consistent with this patient's diagnosis and treatment? A) Child appears pale and fatigued. B) There are purple striae on the abdomen. C) The child is excessively tall for chronologic age. D) The child is demonstrating signs of hypoglycemia.

Ans: B Feedback: Cushing syndrome is caused by overproduction of the adrenal hormone cortisol. The overproduction of cortisol results in hyperpigmentation, which occurs from the melanin-stimulating properties of ACTH. Purple striae resulting from collagen deficit appear on the child's abdomen. The child will not be pale or fatigued. The child will not be excessively tall. The child will not be demonstrating signs of hypoglycemia.

10. An infant is prescribed digoxin. What should the nurse explain to the parents regarding the action of this medication? A) Increases the heart rate B) Slows and strengthens the heartbeat C) Thickens the walls of the myocardium D) Prevents subacute bacterial endocarditis

Ans: B Feedback: Digoxin, a cardiac glycoside made from digitalis, acts directly on the heart to increase the contractility of the myocardium and the force of contraction to slow the heart rate. Digoxin does not increase the heart rate, thicken the walls of the myocardium, or prevent subacute bacterial endocarditis.

6. Which health teaching concept should the nurse emphasize when instructing the parents of a child with polycythemia caused by a congenital heart disorder? A) Prepare for seizures. B) Prevent dehydration. C) Expect the skin to turn yellow. D) Encourage progressive activity.

Ans: B Feedback: Hydration must be monitored so dehydration does not occur in children with polycythemia so the polycythemia does not become so severe clotting or thrombophlebitis results. Seizures are not a threat with polycythemia. Jaundice is not associated with polycythemia. Encourage parents to observe the infant carefully when new activities are introduced so they can recognize the first signs of respiratory distress or the point at which the child is beginning to exceed exercise tolerance.

14. Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura? A) Risk for infection related to abnormal immune system B) Risk for bleeding related to insufficient platelet formation C) Risk for altered urinary elimination related to kidney impairment D) Ineffective breathing pattern related to decreased white blood count

Ans: B Feedback: Idiopathic thrombocytopenic purpura (ITP) is the result of a decrease in the number of circulating platelets in the presence of adequate megakaryocytes, which are precursors to platelets. Because bleeding can occur with this disease process, the diagnosis most appropriate for the patient at this time is risk for bleeding related to insufficient platelet formation. Reduced numbers of platelets would not increase the patient's risk for infection. Reduced numbers of platelets does not increase the patient's risk for renal impairment. Reduced risk of platelets will not lead to an ineffective breathing pattern.

4. The nurse is providing a child with oxybutynin (Ditropan) as prescribed following surgical repair of a hypospadias. What should the nurse teach the patient about the purpose of this medication? A) Acidifies urine B) Relieves bladder spasms C) Stimulates kidney function D) Prevents nausea and vomiting

Ans: B Feedback: The child may notice painful bladder spasms as long as the catheter is in place after surgical repair of a hypospadias. An anticholinergic medication, which relieves bladders spasms such as oxybutynin (Ditropan), may be prescribed for pain relief. Oxybutynin (Ditropan) does not acidify the urine, stimulate kidney function, or prevent nausea and vomiting.

11. An adolescent patient is diagnosed with hepatitis A. Which problem should the nurse consider when planning the care for this patient? A) The patient will develop hypothermia. B) The patient will become easily fatigued. C) The patient's urine will be dark and infectious. D) The patient will be very irritable and perhaps require sedation.

Ans: B Feedback: The treatment for hepatitis A is increased rest because of fatigue. Hypothermia is not associated with hepatitis A. Dark infectious urine is not associated with this disease process. The patient will not be irritable and will not need sedation.

9. A child with hypoplastic anemia develops hemosiderosis. What should the nurse prepare to instruct the parents about the treatment for this disorder? A) Need to avoid all products containing aspirin B) Need to infuse deferoxamine (Desferal) at home C) Importance of daily doses of ferrous sulfate (Feosol) D) Importance of adhering to a strict schedule of prednisone

Ans: B Feedback: Treatment of anemia is through transfusion of packed red blood cells to increase erythrocyte levels. As a result of the necessary number of transfusions, hemosiderosis or the deposition of iron in body tissue can occur. Treatment for hemosiderosis is iron chelation through the use of subcutaneous infusions of deferoxamine (Desferal). These infusions are to be given at home overnight for 5 to 6 nights per week. There is no enough information to determine if aspirin should be avoided. Ferrous sulfate (Feosol) will add more iron to the patient's body and should be avoided. Children with congenital hypoplastic anemia may receive corticosteroid therapy along with transfusions of packed RBCs to raise erythrocyte levels.

8. The parents of a child having a cardiac catheterization are waiting to see the child after the procedure. What should the nurse instruct the parents to expect when seeing the child for the first time? A) The child will be sleeping for at least 8 hours. B) A bulky pressure dressing will be present over the insertion site. C) The child will have bruising over the upper and lower extremities. D) The child will be on seizure precautions and have padded side rails.

Ans: B Feedback: When a child returns from a cardiac catheterization, a pressure dressing will be present over the catheter insertion site. This dressing is snug and will be checked to ensure that no bleeding is occurring. The child may or may not be sleepy after the procedure. The child will not have bruising over the upper and lower extremities. Seizure precautions are not necessary after a cardiac catheterization.

10. A school-aged child with Crohn's disease will receive enteral nutrition for the next 6 weeks. What should the nurse counsel the parents to do to support this child's needs? A) Provide the feeding during regular meal times. B) Encourage the child to stay with the family during routine meal times. C) Suggest the child stay in the bedroom during routine meal times with the family. D) Explain that this might be a permanent method to have nutrition going forward.

Ans: B Feedback: When nutrition is supplied by enteral solutions, the enteral infusion should be provided during the night. Removing the tube during the day can make feedings more tolerable. Meal time provides social stimulation so the parents should encourage the child to spend time with the family during routine meal times. The feedings should not be provided during regular meal times. Having the child stay in the bedroom during meal times with the family will not support the child's socialization needs. There is no way of knowing if enteral feedings will be a permanent method for this child to obtain nutrition going forward.

8. The nurse is preparing teaching for the parents of a newborn with a newly placed ventriculoperitoneal shunt. What should the nurse include in this teaching? (Select all that apply.) A) Restrict the intake of fruit, vegetables, and fluid. B) Expect to have the shunt replaced as the child grows. C) Examine the site every day for signs of swelling or redness. D) Notify the health care provider if the child develops a fever. E) Observe the child for signs of increased intracranial pressure.

Ans: B, C, D, E Feedback: : Teaching for the parents of a child with a newly placed ventriculoperitoneal shunt should include encouraging the intake of fruit, vegetables, and fluid to prevent constipation; expecting to have the shunt replaced as the child grows; examining the site every day for signs of redness or swelling; notifying the health care provider if the child develops a fever; and observing for signs of increased intracranial pressure.

14. The nurse is concerned that a school-age child receiving intranasal desmopressin acetate (DDAVP) for enuresis is experiencing an adverse effect of the medication. What did the nurse assess in this patient? (Select all that apply.) A) Thirst B) Nausea C) Flushing D) Itchy skin E) Headache

Ans: B, C, E Feedback: Adverse effects of desmopressin acetate (DDAVP) include nausea, flushing, and a headache. Thirst and itchy skin are not identified as adverse effects of this medication.

1. The nurse is caring for an infant born with a myelomeningocele. Which should the nurse assess in this patient? A) Vision B) Level of pain C) Voiding pattern D) Tonic neck reflex

Ans: C Feedback: : A myelomeningocele is the defect that is equated with "spina bifida" and is the most common birth defect affecting the central nervous system. In a meningomyelocele, the meninges protrude through the vertebrae and the spinal cord usually ends at the point of protrusion. Motor and sensory function will be decreased or absent beyond this point. The child will have loss of bowel and bladder control and urine, and stools will continually dribble because of lack of sphincter control. This defect is not known to affect vision. Assessing for pain is not a priority with this defect. This defect does not affect the neck region of the spinal cord.

3. The nurse manager at a family clinic is identifying ways to address the 2020 National Health Goals for the prevention of birth defects. Which action should the manager encourage all staff to perform when caring for pregnant patients? A) Avoid extreme physical activity and exercise. B) Monitor daily intake of calcium and dairy products. C) Stress the importance of taking prenatal folic acid as prescribed. D) Ensure adequate hydration by drinking eight glasses of water each day.

Ans: C Feedback: : Nurses can help the nation achieve the 2020 National Health Goals by urging patients to enter pregnancy with an adequate folic acid level. Extreme physical activity, exercise, calcium, and water are not identified interventions to prevent birth defects in the developing fetus.

9. The nurse is checking a newborn for the presence of Ortolani and Barlow signs. For which health problem are these assessments used? A) Club foot B) Cleft palate C) Hip dysplasia D) Tracheoesophageal fistula

Ans: C Feedback: : Ortolani and Barlow signs are used to assess for the presence of hip dysplasia. These techniques assess for hip clicking and femoral head slipping. These signs are not used to assess for club foot, cleft palate, or tracheoesophageal fistula.

2. A newborn with esophageal atresia has just returned from surgery to place a gastrostomy tube. Which nursing diagnosis will the nurse use to plan the care for this patient? A) Risk for imbalanced nutrition B) Risk for deficient fluid volume C) Risk for impaired skin integrity D) Risk for ineffective gas exchange

Ans: C Feedback: : The patient is at risk for impaired skin integrity related to gastrostomy tube insertion site. Acidic gastric secretions can leak onto the skin from the gastrostomy site, leading to skin irritation. The nurse should plan interventions to protect the skin by using a cream or commercial skin protection system or consult with a wound, ostomy, and continence therapy nurse to reduce the possibility of skin irritation and infection. With the placement of the gastrostomy tube, the patient is at less risk for imbalanced nutrition and deficient fluid volume. The gastrostomy tube will not affect the patient's gas exchange.

1. A female preschool patient with a urinary tract infection is scheduled to have a voiding cystourethrogram. What should the nurse include when teaching the patient about this procedure? A) A headache is a common occurrence after the procedure. B) A local anesthetic will be injected prior to the procedure. C) The patient will be expected to void during the procedure. D) The patient will have to drink three glasses of water during the procedure.

Ans: C Feedback: A voiding cystourethrogram is a study of the lower urinary tract and looks at the structure of the urethra and bladder and the presence of reflux into the ureters. After bladder catheterization, a radiopaque dye is injected into the bladder, and the catheter is then removed. The child is asked to void into a bedpan while serial X-ray films are taken. Being asked to void while being observed may be the most stressful part of the procedure for children because they have been taught voiding is a private act. Be sure children are told in advance that they will be asked to do this, and that it is alright if a stranger watches them. A headache is not a common occurrence after this procedure. A local anesthetic is not needed for this procedure. The patient will not be asked to drink water during the procedure.

12. The nurse is caring for a child experiencing hyperkalemia from renal failure. What should the nurse prepare to administer to this patient? A) Milk B) Fruit juice C) Glucose and insulin D) Sodium and increased fluid

Ans: C Feedback: Administration of intravenous glucose and insulin helps to remove excess potassium. The insulin helps the glucose move into the cells, and potassium moves along with it. Intravenous calcium gluconate, and not milk, can also be used to remove excess potassium. Fruit juice has no effect on potassium level and might cause it to increase. Sodium bicarbonate, and not sodium, and increased fluid also help to remove excess potassium.

15. The nurse is caring for a child recovering from a kidney transplant. Which nursing diagnosis should the nurse identify as the priority to guide the care for this patient? A) Pain related to tissue rejection B) Constipation related to effects of administered drugs C) Risk for infection related to immunocompromised state D) Deficient fluid volume related to fluid intake restrictions postoperatively

Ans: C Feedback: After renal transplantation, children are cared for in an environment that is as sterile as possible as they are placed on immunosuppressive therapy to reduce the possibility of kidney rejection. Immunosuppressive therapy increases the patient's risk of developing an infection. The priority nursing diagnosis at this time is the risk for infection. Tissue rejection would not be immediate. The patient's pain would be from the surgical site. There is no information to support that the patient's medication will cause constipation. It is unlikely that the patient will be on a fluid restriction after surgery since there is a need to evaluate the functioning of the transplanted kidney.

6. The parents of child recovering from surgery to repair vesicoureteral reflux ask the nurse if they can do anything to help with the care of their child. What should the nurse encourage the parents to do at this time? A) Help the child with a tub bath. B) Bring in games and other diversions to keep the child distracted while on bed rest. C) Assist the child out of bed while keeping the drainage bags below the level of the catheter. D) Provide hard candy to help with mouth dryness because the child will be on a fluid restriction.

Ans: C Feedback: Be sure that the child and parents understand the importance of not raising the collection system above the child's bladder level when helping the child out of bed. This helps prevent potentially contaminated urine from flowing from the tubes back into the bladder or ureters. Tub baths are contraindicated until all surgical sites have healed. The child will not be on bed rest so diversional activities are not needed. The child will not be on a fluid restriction so hard candy is not needed to help with mouth dryness.

5. The nurse instructs a school-age patient and the parents on continuous cycling peritoneal dialysis. Which statement indicates that teaching has been effective? A) "The solution should be infused cold." B) "Redness and warmth around the tube insertion site is expected." C) "We should notify the health care provider if the drainage is cloudy." D) "Weight gain and a productive cough are expected with the treatments."

Ans: C Feedback: Cloudy drainage could indicate an infection such as peritonitis and should be reported to the health care provider. The solution should be infused at body temperature. Redness and warmth around the tube insertion site could indicate an infection and should be reported to the health care provider. Weight gain and a productive cough could indicate fluid retention and should be reported to the health care provider.

12. A 14-year-old child is brought into the emergency room with manifestations consistent with a ruptured appendix. What is the first action that the nurse should take in the care of this child? A) Apply oxygen. B) Position flat in bed. C) Place in the semi-Fowler's position. D) Insert an indwelling urinary catheter.

Ans: C Feedback: If a child's appendix has already ruptured when the child is seen in the emergency department, the potential for peritonitis increases greatly. The child should be positioned in a semi-Fowler's position so that infected drainage from the cecum drains downward into the pelvis rather than upward toward the lungs. Oxygen is not indicated for this disorder. Positioning flat in bed could cause draining to move toward the lungs. An indwelling urinary catheter is not indicated for this disorder.

13. The nurse is caring for a child with chest tubes inserted after heart surgery that are attached to an underwater-seal drainage system. For which reason should the nurse prepare to clamp the chest tubes? A) The child is coughing. B) A clot obstructs the tubing. C) A tube becomes disconnected. D) Red-stained drainage appears in a tube.

Ans: C Feedback: If a tube becomes disconnected creating an air leak, clamp the tube close to the child's chest to prevent further air from entering the chest. The chest tube should not be clamped if the child is coughing, a clot is in the tubing, or red-stained drainage appears in the tube.

4. A newborn is diagnosed with coarctation of the aorta. Which assessment should the nurse make when caring for this infant? A) Observing for excessive crying B) Auscultating for a cardiac murmur C) Assessing for the presence of femoral pulses D) Recording an upper extremity blood pressure

Ans: C Feedback: If the coarctation is slight, absence of palpable femoral pulses from the decreased blood pressure in the lower body may be the only symptom seen. To help detect this, the nurse should always include evaluation of femoral pulses in all initial newborn assessments and admission inspections to newborn nurseries. Excessive crying, cardiac murmur, and blood pressure changes are not manifestations of coarctation of the aorta.

1. The nurse is caring for a newborn diagnosed with patent ductus arteriosus. Which finding will the nurse assess that is consistent with this diagnosis? A) Slow heart rate B) Expiratory grunt C) Wide pulse pressure D) Absent femoral pulses

Ans: C Feedback: On physical examination, the child with patent ductus arteriosus usually has a wide pulse pressure. The diastolic pressure is low because of the shunt or runoff of blood, which reduces resistance. Manifestations of patent ductus arteriosus do not include a slow heart rate, expiratory grunt, or absent femoral pulses.

11. The nurse is assessing the heart rate of a child with a congenital heart defect. What should the nurse document when a pulse of one strong beat and one weak beat is assessed? A) Dicrotic pulse B) Thready pulse C) Pulsus alternans D) Water hammer pulse

Ans: C Feedback: Pulsus alternans is a pulse of one strong beat and one weak beat. Dicrotic pulse is a double radial pulse for every apical beat. Thready pulse is weak and usually rapid. Water hammer pulse is very forceful and bounding with capillary pulsations apparent even in the fingernails.

12. The nurse is instructing the parents of a child with sickle-cell anemia on safety precautions. What should the nurse emphasize during this teaching? A) Suggest the child participate in sports activities without restriction. B) Treat upper respiratory infections with over-the-counter medication. C) Ensure a consistent and daily intake of adequate fluids to prevent dehydration. D) Remind to avoid immunizations to prevent the introduction of bacteria into the body.

Ans: C Feedback: Safety interventions for the child with sickle-cell anemia include ensuring an adequate daily intake of fluids to prevent dehydration. Dehydration will precipitate a crisis, which can be avoided. The child should avoid contact sports and long-distance running. Upper respiratory infections should be reported to the health care provider so appropriate treatment can be provided. Routine health care such as immunizations should be provided in order to prevent common childhood illnesses.

5. A 1-month-old infant is diagnosed with gastroesophageal reflux. Which intervention should the nurse teach the mother to help with the symptoms of this disorder? A) Hold in a horizontal position while feeding. B) Place on the back immediately after feeding. C) Feed with formula thickened with rice cereal. D) Administer prescribed medications before each feeding.

Ans: C Feedback: The traditional treatment of gastroesophageal reflux is to feed infants a formula thickened with rice cereal. The baby should be held in an upright position and then kept upright in an infant chair for 1 hour after feeding so gravity can help prevent reflux. Medication for gastroesophageal reflux is prescribed daily and not before each feeding.

2. The nurse is caring for a female preschool-age patient with a urinary tract infection. What measures should the nurse teach the mother to prevent future infections? A) Suggest the child drink less fluid daily to concentrate urine. B) Encourage the child to be more active to increase urine output. C) Teach the child to wipe the perineum front to back after voiding. D) Teach the child to take frequent tub baths to clean the perineal area.

Ans: C Feedback: Urinary tract infections occur more often in girls than boys because the urethra is shorter in girls and, because it is located close to the vagina and anus, vulvovaginitis or rectal bacteria can easily spread to the urethra. Girls should be taught early to wipe themselves from front to back after voiding and defecating to avoid contaminating the urethra. The child should be encouraged to drink more fluid to prevent concentrated urine. Activity level does not influence the development of urinary tract infections. There is a suggested correlation between the use of hot tubs and urinary tract infections in girls so use of these should be discouraged or minimized.

4. A preschool-age child has been experiencing severe vomiting for over 24 hours. The child's respiratory rate is currently 10 breaths/min. On which health problem will the nurse focus when caring for this child? A) Overhydration B) Metabolic acidosis C) Metabolic alkalosis D) Hypertonic dehydration

Ans: C Feedback: With vomiting, a great deal of hydrochloric acid is lost. When Cl- ions are lost this way, the body has to decrease the number of H+ ions present so the number of positive and negative charges remains balanced. This causes the child to develop alkalosis. The lungs attempt to conserve carbon dioxide and water by slowing respirations. Overhydration generally occurs in children who are receiving IV fluid, ingestion of large quantities of tap water, or through the use of tap water enemas. Metabolic acidosis is more closely associated with diarrhea. Hypertonic dehydration occurs when water is lost in a greater proportion than electrolytes. This might occur in a child with nausea, fever, and profuse diarrhea.

8. A school-age child is returning home after a renal biopsy. What teaching should the nurse provide to the patient and parents at this time? (Select all that apply.) A) Remove the dressing in 2 hours. B) Resume regular activity level at home. C) Drink a glass of fluid every hour while awake. D) Expect the first voided urine to be blood-tinged. E) Teach how to keep serial urine samples for 24 hours.

Ans: C, D, E Feedback: If a renal biopsy is done on an ambulatory basis, children can be discharged 2 to 4 hours after the procedure if vital signs are stable and they have voided. Encourage children to drink a glass of fluid every hour while awake during the first 24 hours to keep urine flowing freely and prevent blood from clotting in the kidney tubules and blocking urine flow. The first voiding after renal biopsy is invariably blood-tinged. Instruct parents how to keep serial urine samples, comparing each specimen with the previous one, to detect whether hematuria is becoming more or less marked. The dressing should not be disturbed. Parents should keep the child on restricted activity for 24 hours or until no more hematuria is present.

2. The nurse is caring for an infant recovering from surgery for pyloric stenosis. Which nursing diagnosis should the nurse use to guide care during the immediate postoperative period? A) Anxiety related to new feeding method used postoperatively B) Ineffective tissue perfusion related to pressure on heart chambers C) Excess fluid volume related to increased fluid intake prescribed postoperatively D) Risk for infection of incision line, related to disruption of skin barrier during surgery

Ans: D Feedback: Because the incision line for a pyloric stenosis repair is near the diaper area, the child is at risk for developing a surgical infection. The diagnosis risk for infection of incision line is the most appropriate during the immediate postoperative period. Anxiety might be appropriate after the immediate postoperative period has passed. There is no enough information to determine if the infant is being given excessive fluid or if the infant is experiencing ineffective tissue perfusion.

13. A child with chronic renal failure does not want to take the prescribed aluminum hydroxide gel because of the taste. What should the nurse tell the patient about the purpose of this medication? A) Prevents an upset stomach B) Assists with the absorption of calcium C) Assists with elimination of potassium D) Reduces absorption of phosphorus from the GI tract

Ans: D Feedback: Children with chronic renal failure are generally placed on a diet to prevent rapid urea and phosphate buildup. Children may be prescribed aluminum hydroxide gel to take with meals to bind phosphorus in the intestines and prevent absorption of phosphorus from foods. This medication is not being given to the patient to prevent an upset stomach. This medication does not assist with the absorption of calcium or the elimination of potassium.

15. The nurse is planning care for a school-age child recovering from being hit by a motor vehicle while riding a bicycle home from school. For what will the nurse assess to determine the onset of disseminated intravascular coagulation in this child? A) Blurred vision B) Nausea and vomiting C) Sudden onset of knee pain D) Bleeding from intravenous sites

Ans: D Feedback: Disseminated intravascular coagulation is an acquired disorder of blood clotting that result from excessive trauma. The child begins to develop petechiae or have uncontrolled bleeding from puncture sites from injections or intravenous therapy. Blurred vision, nausea, vomiting, and a sudden onset of knee pain are not manifestations associated with disseminated intravascular coagulation.

7. The nurse is teaching manifestations of nephrotic syndrome to the parents of a child with the disorder. What should the nurse instruct the parents to monitor to determine if edema is increasing? A) Appetite B) Breathing rate C) Tightness of shoes D) Abdominal circumference

Ans: D Feedback: Edema tends to be dependent or occur in the lower parts of the body. Parents may notice clothing no longer fits a child around the waist because edematous fluid is beginning to collect in the abdominal cavity or ascites. This is what the parents should monitor in the child. Appetite and breathing rate will be affected later after a significant amount of ascites fluid accumulates. Edema in the feet is not a typical manifestation of this disorder.

9. The parents of a child with acute glomerulonephritis ask the nurse to explain the cause of the disease. What organism should the nurse instruct the parents as being the cause for the disorder? A) Group B streptococci B) One of the rhinoviruses C) Staphylococcus viridans D) Group A beta-hemolytic streptococci

Ans: D Feedback: Glomerulonephritis usually occurs in children as an immune complex disease after infection with group A beta-hemolytic streptococci. Acute glomerulonephritis is not caused by group B streptococci, rhinoviruses, or Staphylococcus viridans.

7. The nurse instructs the parents of a child with a congenital heart disorder on the administration of digoxin at home. Which observation indicates that teaching has been effective? A) The father provides a dose of the medication after the baby spits it up. B) The father provides a dose of the medication at the conclusion of a feeding. C) The mother feels for a radial pulse before giving the baby the next scheduled dose. D) The mother provides a dose of the medication 1 hour before the next scheduled feeding.

Ans: D Feedback: Guidelines to ensure safe digoxin administration at home include providing a dose of the medication 1 hour before the next scheduled feeding. If a dose is vomited, do not repeat the dose. The medication should be given 2 hours after a feeding and not immediately after. The apical heart rate and not the radial pulse should be assessed before providing a dose of the medication.

7. The nurse is planning care for a 12-year-old child diagnosed with hyperthyroidism. Which issue should the nurse anticipate that this child will experience while attending school? A) Inability to fit legs under a school desk B) Noncomprehension of written material C) Increase in sleepiness by the end of the day D) Inability to submit neat handwriting assignments

Ans: D Feedback: Hyperthyroidism affects coordination, which can be seen in hand tremors. This will affect the patient's ability to write legibly. Hyperthyroidism does not affect height. This disease process does not affect cognition so school work will be comprehensible. Hyperthyroidism does not cause sleepiness.

2. The nurse is concerned that a school-age child has iron-deficiency anemia. What did the nurse assess in this patient? A) Shyness B) Thumb-sucking C) Asks many questions D) Craving for ice cubes

Ans: D Feedback: In school-age children, there is an association between iron-deficiency anemia and pica or the craving for ice cubes. Iron-deficiency anemia is not associated with shyness, thumb-sucking, or inquisitive behavior.

8. The nurse is advising a group of new parents on how to care for their infant at home if the baby develops mild diarrhea. Which statement indicates that teaching has been effective? A) "I should offer milk after each episode of diarrhea." B) "I should take the baby's temperature and call my physician." C) "I could give Kaopectate as long as I follow the directions on the bottle." D) "I should offer Pedialyte after 1 hour and frequently thereafter to prevent dehydration."

Ans: D Feedback: Mild diarrhea is not considered serious and at the end of approximately 1 hour, parents can begin to offer an oral rehydration solution such as Pedialyte in small amounts. Infants may develop a temporary lactase deficiency after diarrhea that leads to lactose intolerance. With this, a child cannot take formula or breast milk without new diarrhea beginning. Parents should alert their health care provider if they feel this is happening as the infant will need to be introduced to a lactose-free formula initially before being returned to the usual formula or to breast milk. An elevated temperature is seen in severe diarrhea. The parents should be cautioned to contact their health care provider prior to initiating over-the-counter drugs such as kaolin and pectin (Kaopectate) to halt diarrhea because toxic levels of these can occur quickly.

15. The nurse instructs a preadolescent child with type 1 diabetes mellitus how to self-administer an injection of short-acting and long-acting insulin. Which observation indicates to the nurse that teaching has been successful? A) Administers the insulin intramuscularly B) Wipes off the needle with an alcohol swab C) Administers the insulin at a 30-degree angle D) Draws up the short-acting insulin into the syringe first

Ans: D Feedback: Patients should be taught that when insulin is being mixed in one syringe, the regular or short-acting insulin should be drawn into the syringe first. Insulin is injected into subcutaneous tissue. The needle should not be wiped off with alcohol before injecting. Insulin should be administered at a 90-degree angle to the skin surface.

12. The nurse is caring for a 3-year-old child diagnosed with phenylketonuria. Which food should the nurse remove before providing the child with a lunch tray? A) Orange juice B) Lettuce leaves C) A sliced banana D) Chocolate pudding

Ans: D Feedback: Phenylketonuria (PKU) is a disease of metabolism, which is inherited as an autosomal recessive trait. The infant lacks the liver enzyme phenylalanine hydroxylase, which is necessary to convert phenylalanine, an essential amino acid, into tyrosine. Excessive phenylalanine levels build up in the bloodstream and tissues, causing permanent damage to brain tissue and leaving children severely cognitively challenged. Dietary restriction is the main treatment of PKU. Foods highest in phenylalanine are those that are rich in protein, such as meats, eggs, and milk. Foods low in phenylalanine include fruit juices, bananas, and lettuce. Pudding is forbidden because it is made with milk.

6. It is determined that a preschool-age child developed anemia after exposure to an insecticide. What should the nurse teach the parents before the child is discharged from the hospital? A) Schedule weekly chelating treatments. B) Provide the child with a high-protein diet. C) Schedule hospital visits to desensitize the child to the insecticide. D) Ensure that the child has no further exposure exposed to the insecticide.

Ans: D Feedback: The first step in therapy is to immediately ensure that the child is never exposed to the substance again. Chelation therapy is to remove excess iron from the blood and body. A high-protein diet is not indicated for this health problem. The child does not need weekly hospital visits for desensitization.

14. The cardiac monitor of a child recovering from heart surgery alarms, and the nurse finds the child without a heartbeat. What should the nurse do first? A) Apply oxygen. B) Establish an airway. C) Begin rescue breathing. D) Begin cardiac compressions.

Ans: D Feedback: The steps for resuscitation can be remembered as "CAB"—chest compressions, airway, and breathing—and the critical first elements of cardiopulmonary resuscitation are chest compressions and early defibrillation. Establishing an airway, rescue breathing, and the use of oxygen are performed in sequence after compressions are started.

9. A mother, distressed to learn that her school-age child is diagnosed with type 2 diabetes mellitus, asks the nurse how this could happen because no one in the family has diabetes. What should the nurse explain to the mother? A) "This is caused by the pancreas not making enough insulin." B) "This disorder usually occurs when inadequate calories are ingested on a regular basis." C) "Because this disorder is genetic, someone in the family will eventually develop the illness." D) "This disorder is associated with overweight and eating a diet high in fats and carbohydrates."

Ans: D Feedback: Type 2 diabetes is now seen in overweight adolescents and those who eat a diet high in fats and carbohydrates and do not exercise regularly. Type 2 diabetes is not caused by the pancreas not making enough insulin. This disorder is not linked to an inadequate ingestion of daily calories. This disorder may have a genetic link, but environmental factors such as obesity, diet, and exercise can influence its development.

9. The nurse is planning care for an 8-month-old infant with a ventricular septal defect. Which nursing diagnosis should the nurse use to help guide the care for this patient? A) Impaired gas exchange related to a right-to-left shunt B) Impaired skin integrity related to poor peripheral circulation C) Ineffective airway clearance related to altered pulmonary status D) Ineffective tissue perfusion related to inefficiency of the heart as a pump

Ans: D Feedback: Ventricular septal defect is the most common type of congenital cardiac disorder. With this disorder, an opening is present in the septum between the two ventricles. Blood shunts from left to right across the septum impairing the efficiency of the heart because blood that should be forced into the aorta and out to the body from contraction of the left ventricle shunts back into the pulmonary circulation, resulting in right ventricular hypertrophy and increased pressure in the pulmonary artery. This disorder does not impair gas exchange, cause impaired skin integrity, or cause ineffective airway clearance.

4. A school-age child weighing 55 lb is prescribed to receive 15 ml/kg of packed red blood cells. If the child is to receive 10 ml/kg/hr, how many hours will it take to infuse the prescribed amount of blood for this patient? (Calculate to the nearest 10th decimal point.)

Ans: 1.5 hours Feedback: The child weighs 55 lb. To determine weight in kilogram, divide 55 lb by 2.2 = 25 kg. Then multiply the weight in kg by 15 ml to determine the total amount of blood the patient is to receive or 15 ml × 25 kg = 375 ml. Then to determine the amount of blood to infuse per hour, multiply 10 ml × 25 kg = 10 × 25 = 250 ml. If the child is to receive a total of 375 ml of blood, divide 375 ml by 250 ml to determine that the prescribed amount of blood will take 1.5 hours to infuse.

13. The nurse is explaining to the parents of a school-age child with type 1 diabetes mellitus how the health care provider determines the daily insulin dose. The child is prescribed to receive 0.5 units/kg of body weight of intermediate-acting and short-acting insulin at the ratio of 2:1. Because the child weighs 66 lb, how many units of the short-acting insulin will the health care provider prescribe? (Enter numeric value only.)

Ans: 5 units Feedback: The nurse should first determine the patient's weight in kilograms by dividing 66 lb by 2.2 or 66 / 2.2 = 30 kg. Then the nurse should multiple the prescribed dose of insulin by the body weight or 0.5 × 30 = 15. Then the nurse will need to determine the amount of intermediate-acting and short-acting insulin according to the ratio of 2:1. If the patient is to receive two parts of intermediate-acting insulin to one part of short-acting insulin, the total volume of 15 units can be divided by 3. The patient should be prescribed to receive 10 units of intermediate-acting insulin and 5 units of short-acting insulin.

6. The nurse is assessing a 2-week-old infant who developed hydrocephalus. What should the nurse expect to assess in this patient? A) Excessive thirst B) A soft, fretful cry C) Hypothermia in the late afternoon D) White sclera showing above the pupils

Ans: D Feedback: : As the fluid accumulation continues in hydrocephalus, the brow bulges forward, and the eyes become "sunset eyes," which means the sclera shows above the iris because of upper lid retraction. Excessive thirst; soft, fretful cry; and hypothermia in the late afternoon are not manifestations of hydrocephalus.

12. Which action should the nurse implement for an infant who develops heart failure? A) Restricting daily milk intake B) Keeping in a supine position C) Planning ways to reduce salt intake D) Placing in a semi-Fowler's position

Ans: D Feedback: Most children with heart failure feel more comfortable in a semi-Fowler's position than in a supine position because the chest-elevated position lowers the abdominal contents, enlarging the thoracic cavity and allowing easier, more comfortable lung expansion. A child with heart failure does not need a milk restriction. The supine position will not help with lung expansion. An infant does not have a significant intake of salt.

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

Ans: D Feedback: The course of rheumatic fever is about 6 to 8 weeks. Children are maintained on bed rest only during the acute phase of illness until the pulse rate returns to normal. Because pulse rate is a valuable sign of improvement, monitoring vital signs is essential during and following the acute phase. Obtain an apical pulse for a full minute for best results. Taking it while the child is asleep as well as when the child is awake helps to measure the effect of activity on the pulse rate; another way to judge inflammation is decreasing and the child's heart action is improving. Chorea occurs in some children with rheumatic fever; however, it is not known if this manifestation will disturb the child's sleep. Children with rheumatic fever may develop congestive heart failure; however, cardiomegaly is not a long-term effect of the disease. The child is not at risk for self-directed violence because cerebral anoxia is not a manifestation of the disease.

11. The nurse is prescribed to infuse 75 ml/kg of dialysate for a child's peritoneal dialysis treatment. The child weighs 77 lb. At the conclusion of the treatment, the nurse measures 3,000 ml of dialysate outflow. How much of the outflow should the nurse document as peritoneal fluid?

Ans: 375 ml Feedback: The nurse needs to first determine the patient's weight in kilograms by dividing 77 lb by 2.2 or 77 / 2.2 = 35. Then the nurse should multiply the prescribed volume of dialysate by the patient's weight in kilograms or 75 ml × 35 = 2,625 ml. This is the volume that the nurse will provide for the dialysate inflow. Next, the nurse needs to subtract the total inflow volume from the outflow volume or 3,000 ml - 2,625 ml = 375 ml. This is the volume of peritoneal fluid that the nurse should document.

15. The nurse is caring for a baby with esophageal atresia. Which situation during the mother's pregnancy indicates that this health problem was developing? A) Hydramnios B) Oligohydramnios C) A difficult second stage of labor D) Bleeding at 32 weeks of pregnancy

Ans: A Feedback: : Esophageal atresia must be ruled out in any infant born to a woman with hydramnios or excessive amniotic fluid. Normally, a fetus swallows amniotic fluid during intrauterine life. With esophageal atresia, the fetus cannot swallow so the amount of amniotic fluid grows abnormally large, leading to hydramnios. Oligohydramnios, a difficult second stage of labor, or bleeding at 32 weeks of pregnancy does not indicate that esophageal atresia was developing during fetal development.

5. A school-age child is scheduled for a bone marrow aspiration to confirm the diagnosis of aplastic anemia. What should the nurse instruct the child about this procedure? A) Leg pain will occur after the procedure. B) It will be done under general anesthesia. C) A narrow needle is used so there is no pain. D) The patient will have to lie on the stomach for the procedure.

Ans: D Feedback: The child is to lie on prone on a hard surface for the procedure. Leg pain is not expected after the procedure. Conscious sedation and not general anesthesia is used for the procedure. This is a painful procedure, and topical anesthesia is applied in addition to conscious sedation to help reduce the pain.