Pediatrics Exam Ch. 32-35

The nurse is completing an admission assessment on a 3-year-old child. The child's Humpty Dumpty score is 15. Which action by the nurse is the most appropriate? A. Allow the child access to the play room. B. Classify the child as at high risk for falls. C. Place the child on seizure precautions. D. Put the child in isolation precautions.

ANS: B A Humpty Dumpty score of 12 or above indicates a high risk for falls. The child has been classified as at high risk for falls, and nursing care should be implemented to prevent them. Access to the play room can be accomplished with almost any child. Seizures and isolation actions are not related.

A mechanically ventilated adolescent has a RASS score of -3. The child is receiving pain medication and sedation by intravenous infusion. Which action by the nurse is the most appropriate? A. Assess the child for uncontrolled pain. B. Document findings and continue to monitor. C. Increase the fentanyl (Sublimaze) infusion. D. Suction the patient in case of tube obstruction.

ANS: B A RASS score of -3 indicates moderate sedation, which would be appropriate for a child being mechanically ventilated. The nurse should document the findings and continue to monitor. This score does not indicate agitation, so uncontrolled pain should not be an issue. The fentanyl infusion does not need adjustment. There is no indication that the child needs to be suctioned.

A nurse is preparing to administer chemotherapy to a child who has an Infuse-a-Port. Which action by the nurse is the most appropriate? A. Flush the catheter with normal saline and heparin. B. Obtain a Huber needle prior to administration. C. Unclamp the catheter prior to flushing the line. D. Wrap the catheter in gauze so it doesn't pull out.

ANS: B A centrally implanted port, such as an Infuse-a-Port, must be accessed with a Huber needle. Prior to administering medication is not the time to flush with heparin. The port is entirely indwelling, so there is no catheter to unclamp, nor will the device pull out.

A hospitalized child is receiving antithymocyte globulin (ATG) for aplastic anemia. What action by the nurse is most important? A. Assess the IV site for good blood return. B. Ensure emergency equipment is nearby. C. Obtain informed consent for each dose. D. Pad side rails and institute seizure precautions.

ANS: B ATG is made from horse or rabbit serum and can cause anaphylaxis, even after test dosing. The nurse ensures that appropriate emergency equipment is available in case of such an emergency. Assessing the IV site is also an important action, but does not take priority over being prepared for an emergency. Informed consent is not required for each dose. Seizure precautions are not needed.

An 8-year-old child had a hematopoietic stem cell transplant 10 months ago. The father brings her to the clinic, where the child reports "I just don't feel well." Dad relates that the child has been lethargic and sleeping a lot. The child's vital signs are within normal range for age. What action by the nurse is best? A. Explain that growth spurts can cause fatigue. B. Prepare the family for a "fever" workup. C. Provide reassurance to the father and child. D. Review side effects of immunosuppressants.

ANS: B After a stem cell transplant, patients are on lifelong immunosuppressant therapy. These patients may contract illnesses, especially infections, without showing the classic signs and symptoms. The nurse should assume the child has an infection and prepare the child and father for a full workup to determine the origins of the infection. Reassurance is always an important nursing intervention, but does not take priority over the child's physical health. At each clinic visit, the nurse should review the treatment regimen, including side effects of medications, but again this is not the priority. Until proven otherwise, this child is ill, and not just having a growth spurt.

A child is being mechanically ventilated and is very agitated and fighting the ventilator despite receiving fentanyl citrate (Sublimaze) and midazolam (Versed). Which action by the nurse is the most appropriate? A. Restrain the hands so child does not pull out the endotracheal tube. B. Request an order for vecuronium bromide (Norcuron). C. Slow the frequency and depth of mandatory ventilations. D. Tell the family that someone must stay at the bedside.

ANS: B After ensuring the child has adequate pain control and sedation, the next step would be to administer a neuromuscular blocking agent such as for vecuronium bromide (Norcuron). This will paralyze the child's skeletal muscles and reduce the agitation and fighting of the ventilator. Restraints may be necessary but should be used as a last resort. Changing ventilator settings is not appropriate for agitation control. Putting the responsibility of maintaining the child's airway on the family is a huge burden that may cause distress, and family members may not be able to stay at the bedside at all times.

A child is being discharged after surgical resection of a retinoblastoma with enucleation. Which discharge instruction is most important based on the diagnosis? A. Encouraging healthy eating B. Irrigation of the surgical site C. Monitoring the child's temperature D. Pain assessment and control

ANS: B After enucleation (removal of the eye), the eye socket must be irrigated and a thin layer of antibiotic ointment applied. The other options are valid for all postoperative pediatric patients.

The nurse administering a blood transfusion is aware that which of the following is the most important nursing action to prevent a transfusion reaction? A. Checking the provider's orders for transfusion B. Identifying the patient with two unique identifiers C. Monitoring vital signs per protocol D. Staying with patient for the first 15 minutes

ANS: B All actions are important when administering blood products. However, to prevent a transfusion reaction, accurate patient identification using two unique identifiers (and two nurses) is critical. The nurse should check the orders prior to proceeding. Staying with the patient and monitoring vital signs will not help prevent a reaction but will help identify one quickly.

A child has liver cancer. The most recent results for the alpha-fetoprotein level show it has been reduced by 50%. Which statement by the nurse to the parents and child is most appropriate at this time? A. "Once the level gets to normal, we can resect the tumor." B. "This shows the cancer is responding to therapy." C. "Unfortunately, the chemotherapy is not working." D. "Your child will need a liver transplant soon."

ANS: B Alpha-fetoprotein (AFP) is a protein produced by both hepatoblastomas and hepatocellular carcinomas. Falling levels of AFP indicate that treatment is working. The other responses are not correct.

A child is admitted and is scheduled to receive intravenous asparginase (Elspar). Which action by the nurse is most important when administering this medication? A. Arranging an outpatient hearing test B. Having emergency drugs on hand C. Monitoring the child's intake and output D. Providing anti-emetic drugs as needed

ANS: B Anaphylaxis is a possible side effect of this drug. Emergency medications should be readily available. Ototoxicity can be caused by carboplatin (Paraplatin). Monitoring intake and output is important for any child on IV therapy. Anti-emetic drugs are important for any child receiving chemotherapy.

A new nurse is caring for a child who has an arterial catheter in the radial artery. Which action by the new nurse causes the experienced nurse to intervene? A. Checks to see if arterial line connections are secure frequently B. Cleans the hub before giving medication through the site C. Documents arterial blood pressures and mean arterial pressure D. Monitors for blood loss at the site each time rounding is done

ANS: B Arterial lines should not be used to give medications and should be clearly labeled so that this does not happen. The other actions are appropriate.

A critically ill child on a ventilator is mildly anemic. Which action by the nurse is the most appropriate? A. Decrease the administration rate of the IV fluids. B. Draw minimal amounts of blood for laboratory tests. C. Have parents sign consent for blood transfusions. D. Monitor the child's hemoglobin levels daily.

ANS: B Critically ill children have frequent blood draws for laboratory tests. The nurse should ensure that the minimum amount of blood is collected each time. Decreasing fluid rates might concentrate the hemoglobin and raise the level, but at the risk of dehydration. A mildly anemic child would not need transfusions. Monitoring the hemoglobin daily is an essential nursing function but will not actively help the child with this condition.

A child has just had an invasive hemodynamic monitor inserted. After connecting the monitoring device to the monitor, what action should the nurse take next? A. Assess the child's postprocedural pain status. B. Document hemodynamic assessments. C. Have the parents return to the room to comfort the child. D. Perform hand hygiene and dispose of equipment.

ANS: B Immediately after connecting the monitoring device to the monitor, the nurse should begin hemodynamic assessments. If equipment needs to be "zeroed" or calibrated, this is done first. The other actions are important, but in the critically ill child, obtaining immediate and frequent readings is critical.

A pediatric intensive care nurse wants to practice in a way that helps reduce parents' stress while their child is in the unit. Which action by the nurse would be most helpful? A. Explain procedures to the parents first, then to the child. B. Include the parents in all decisions and care activities. C. Provide comprehensive discharge teaching in advance. D. Round with physicians to ensure parents' understanding.

ANS: B Incorporating a family-centered approach to care is the best way to reduce stress and anxiety in the critically ill child's family. Involving the family in all decisions and care activities (if appropriate) is one of the most powerful ways of providing family-centered care. Comprehensive discharge teaching is a good nursing intervention, but not as important as including the family. Discharge teaching also cannot be done too far in advance. Rounding with physicians to ensure understanding is a great intervention, but is not as important as inclusion. Explaining procedures to the parents first, then to the child, may or may not be appropriate.

A nurse is caring for a child who is scheduled to have intrathecal chemotherapy today. Which action by the nurse is most important when providing care to this patient and family? A. Educating family on side effects of chemotherapy B. Ensuring a signed consent is on the chart C. Providing distraction techniques during the process D. Reassuring the child the parents will be present

ANS: B Intrathecal chemotherapy (introducing chemotherapy into the subarachnoid space of the spinal cord) is an invasive procedure and requires a signed consent. Although all actions are important for this child, the priority is ensuring the consent is executed appropriately and on the chart.

A child has been cured of a retinoblastoma. When the parents ask how long monitoring for bone-related complications of radiation therapy should continue, which is the most appropriate response by the nurse? A. "After 5 years, you can stop worrying about this." B. "Cancers of the bone can occur up to 15 years later." C. "Probably all complications will occur within 3 years." D. "Radiation complications do not occur in bones."

ANS: B Osteosarcoma can occur as a consequence of radiation therapy up to 15 years later.

A nurse works on a pediatric oncology unit. After receiving report, which child should the nurse assess first? A. Having infusion of D5 NS and sodium bicarbonate B. On high-dose methotrexate (Rheumatrex), urine pH of 7.8 C. Receiving cyclophosphamide (Cytoxan), urine specific gravity of 1.008 D. 2 days post-tumor resection, complaining of pain

ANS: B Patients on high-dose methotrexate need their urine pH to be higher than 7.0. This child needs the nurse's attention first. An IV with NaHCO3 is common prior to receiving methotrexate. A urine specific gravity of ≤ 1.010 is required for children on chemotherapy. Pain would be an expected finding 2 days postoperatively, and should be treated, but not before the nurse assesses the other child.

As part of therapeutic play for the patients, the pediatric nurse reads a book about children receiving injections. For which age group is this nursing intervention most appropriate? A. Adolescents B. Preschoolers C. School-aged children D. Toddlers

ANS: B Priority nursing interventions for the preschooler include providing the child with the opportunity to express fears and frustrations. At this age, the use of storytelling and books about the illness may be helpful in providing a nonthreatening approach to the topic. Additionally, the preschooler can express concerns through dramatic play. The nurse can ask the child-life specialist for assistance with methods of expression.

The nursing manager of the pediatric intensive care unit wants to provide patients with improved sleep and rest. Which intervention would have the greatest impact on promoting rest in this environment? A. Clustering care so nursing interruptions are limited B. Decreasing the noise in the unit, especially at night C. Enforcing a 2-hour "quiet time" on each shift D. Turning off equipment alarms when children are sleeping

ANS: B Research shows that over half of all awakenings and arousals in intensive care unit patients are due to noise. To have the greatest impact on sleep and rest, the manager should work with staff to reduce the noise level on the unit, especially at night, so that normal sleep-wake cycles can be maintained as much as possible. Clustering care is a good idea to allow for some periods of uninterrupted rest and to decrease sensory overload from all sources, but may not always be practical and, even when done, will not have the same impact as overall noise reduction. A 2-hour "quiet time" may not provide all children with adequate rest and may be impossible to enforce. Turning off alarms is a dangerous practice and should not be done.

A couple who recently married and want to have children ask the nurse what the chances are that their children will inherit thalassemia from them, as they both are carriers. What information from the nurse is most accurate? A. All of your children will inherit it. B. Each child has a 25% chance of inheriting it. C. None of your children will inherit it. D. Only the boys will inherit it.

ANS: B Thalassemia is an autosomal recessive disorder. Each of their children has a 25% chance of having only normal genes, a 25% chance of inheriting both defective genes from the parents and expressing the disease, and a 50% chance of being a carrier.

A child is mechanically ventilated. Which assessment finding indicates that a priority goal is being met? A. Enteral feeding tube present B. PaCO2: 40 mm Hg C. Intact skin integrity D. Ventilator on control mode

ANS: B The PaCO2 reading is normal, indicating that goals for the diagnosis of impaired gas exchange are being met. The presence of an enteral feeding tube indicates that goals for nutrition are being met, but this is not the priority over gas exchange. Maintaining intact skin is also an important goal, but is not a priority over gas exchange. Having the ventilator on control mode shows that breathing patterns are being maintained, but this does not give any information about the clinical status of the child.

A toddler had a minor fall and now has a swollen, bruised, painful knee. What diagnostic test is most important for the nurse to educate the parents about? A. Complete blood count B. Plasma factor assay C. Plasma ferritin level D. Platelet count

ANS: B The child has manifestations consistent with hemophilia. The most important diagnostic testing for this disease is a direct assay of plasma factor activity level for hemophilia A and B. A CBC will also most certainly be done, as will a platelet count. Plasma ferritin measures iron and is not warranted.

A nurse working in pediatrics learns that the normal hemoglobin value for an infant is high at birth, then decreases by 2 months of age before increasing again as the child grows. The nurse knows the reason for this shift is which of the following? A. Hemodilution from starting oral nutrition B. Lower available oxygen while in utero C. Rapid hemoglobin destruction at birth D. Slower hemoglobin production after birth

ANS: B The fetus needs a higher hemoglobin level to compensate for the relatively low-oxygen environment of the uterus. The other answers are incorrect.

A child is receiving a blood transfusion. On assessment, the nurse finds the child short of breath, febrile, and hypotensive. After stopping the transfusion, what action by the nurse takes priority? A. Document the findings. B. Obtain oxygen saturation. C. Prepare fluid resuscitation. D. Sit the child upright in bed.

ANS: B The manifestations can be related to several different types of transfusion reactions, but hypoxia is most closely associated with transfusion-related lung injury (TRALI). The nurse obtains an oxygen saturation. Documentation must be completed, but this is not the priority. It is unknown at this time if the child needs aggressive fluid resuscitation or blood pressure support. Sitting the child upright may help breathing, but will worsen the hypotension.

A neutropenic child is admitted to the hospital and placed in protective isolation. Which instruction does the nurse give the family to help maintain a safe environment for the child? A. Do not let the child have chewing gum B. Flowers, plants, and produce are not allowed C. The child can only have one visitor at a time D. Toys and items from home cannot be brought in

ANS: B The neutropenic child should not have fresh flowers, plants, fruits, or vegetables because they can harbor infectious microorganisms. The other instructions are not needed.

A nurse notes that a patient with cystic fibrosis develops difficult breathing. The nurse calls the father to report his condition. The father, who has been continually present, cannot be there because the patient's sister has influenza and the father stayed at home to care for his daughter. In the morning, the nurse sees the patient's father and approaches him to talk. Which statement by the nurse is most appropriate at this time? A. "I feel sorry that you were not here when your son got so sick last night." B. "Please sit down. I want to update you about your son's condition." C. "Your son had a difficult night. It is too bad you were not here with him." D. "Your son might die. Come with me now and see him before it's too late."

ANS: B The nurse's response should be supportive and caring and should not make the father feel guilty for taking care of his other child. The nurse can help families meet emotional and spiritual needs by offering ongoing support and supplying resources to help ensure successful coping. The nurse caring for the family must remember that uncertainty and fear about the future is a constant worry for the parents of a chronically ill child.

The pediatric nurse providing nursing care for a 12-year-old girl listens as her mother describes her family situation. She states that the patient's 10-year-old sister is asking many questions about the patient's illness. The patient's mother feels that it is best not to talk about the patient with her sister. Which response by the nurse is the most appropriate? A. "Having a child in the hospital and having another daughter at home must be challenging. Focusing on the future when your child goes home would be best." B. "It must be challenging to balance the needs of both of your children. Both children need information about her illness and hospitalization." C. "It must be difficult for you to balance everyone's needs at this time. Doing what you think is best is most important." D. "You and your husband know your children best. I am sure that you will decide the best way to handle this situation."

ANS: B The sibling may be affected in ways such as acquiring a decreased sense of self-esteem, receiving less support from parents, exhibiting mood swings, lacking an understanding about the condition, and displaying a negative attitude toward the child's condition. Priority nursing interventions include teaching the parents to maintain familiar routines as much as possible for the sibling. In addition, the nurse can help the parents include the sibling in simple care. It is also important to remind the parents that providing information about the ill child may decrease stress reactions in the sibling.

A nurse assesses a toddler using the FLACC score. The child is kicking and crying steadily. The mother is upset, as she is unable to console the child. Which action by the nurse is most appropriate? A. Administer acetaminophen (Tylenol). B. Give a dose of morphine (Duramorph). C. Play soothing, quiet music. D. Prepare a dose of propofol (Diprovan).

ANS: B This child exhibits several behaviors seen in the severe pain category according to the FLACC score. The best medication for this level of pain is an opioid analgesic, such as morphine. Tylenol is used for mild to moderate pain. Nonpharmacological measures can be used as an adjunct, but it will not relieve this degree of pain alone. Propofol is usually used for procedures.

A parent brings a child to the clinic and reports that the child is reluctant to walk and has a new limp. The parent also reports that the child seems lethargic and tired all the time. The nurse notes that the child appears pale. Which other finding would warrant immediate notification of the health-care provider? A. Difficulty staying asleep at night B. Left-sided abdominal enlargement C. Polyphagia and polydipsia D. Swelling of the legs and feet

ANS: B This child has some manifestations of acute lymphocytic leukemia (ALL). Left-sided abdominal enlargement could be indicative of splenomegaly, which is another manifestation of this disease. The nurse should report these findings immediately. Difficulty staying asleep at night is vague and could be related to a number of causes, both physical and behavioral. Polydipsia and polyphagia are two of the three classic signs of diabetes. Swelling of the legs and feet is not a manifestation of ALL.

A child is being weaned from the ventilator. He is awake and alert but getting increasingly tired. Which action by the nurse is the most appropriate? A. Cluster nursing care so the child is able to get uninterrupted periods of rest. B. Collaborate with other health team members to slow or stop the weaning process. C. Draw a blood sample for blood gas analysis, and compare the results to the last blood gas values. D. Have all of the child's visitors leave to allow the child to take a short nap.

ANS: B Weaning from the ventilator is an individualized process that takes into account several different parameters. A child who is becoming increasingly fatigued is not tolerating the weaning. The nurse should collaborate with other members of the health-care team to adjust the weaning process. Rest is important to the critically ill child, but is not the most important action at this time. Laboratory work should be reviewed, but the results may be normal despite the child's fatigue level at this point.

A patient in the intensive care unit has a pulmonary artery catheter for hemodynamic monitoring. On assessment, the nurse finds the patient clinically unchanged from the last assessment, but the hemodynamic data are significantly changed. Which action by the nurse is the most appropriate? A. Document the findings and continue to monitor. B. Level and recalibrate the hemodynamic line. C. Notify the health-care provider of the findings. D. Review the last set of laboratory data for any changes.

ANS: B When caring for a patient with hemodynamic monitoring, the nurse must be able to "zero" and level the catheter transducers, monitor the waveforms, and interpret the data. When the data do not match the clinical picture, the nurse should check the equipment. The findings should be documented, but further action is needed. The health-care provider may or may not need to be notified, but the nurse would first check the equipment to ensure the readings were accurate. Reviewing laboratory data is another nursing responsibility, but does not directly address the issue.

A nurse is assessing patients in the pediatric intensive care unit for signs of hypoperfusion. Which assessment findings are indicative of this condition? (Select all that apply.) A. Capillary refill: 2 seconds B. Mean arterial pressure: 32 mm Hg C. Mental status: lethargic D. Pedal pulses: bounding E. Urinary output: 2 mL/kg/hour

ANS: B, C Signs of hypoperfusion include urinary output less than 1 mL/kg/hour, mean arterial pressure less than 45-50 mm Hg, decreased peripheral and pedal pulses, tachycardia, mental status changes, lethargy, delayed capillary refill, and pallor. A capillary refill of 2 seconds is normal. Mean arterial pressure of 32 mm Hg is too low and is indicative of hypoperfusion. Lethargy is a sign of hypoperfusion. Bounding pedal pulses may indicate fluid overload, and a urine output of 2 mL/kg/hour is normal.

A nurse has a RN preceptor student working on the pediatric oncology unit. When teaching the student about oncological crises, what disorders does the nurse include? (Select all that apply.) A. Inferior vena cava infarction B. Neurogenic shock C. Perirectal abscess D. Pleural effusion E. Superior vena cava syndrome

ANS: B, C, D, E There are many oncologic emergencies, including neurogenic shock (and other types of shock), perirectal abscess, pleural effusion, and superior vena cava syndrome. Inferior vena cava infarction is not on the list of emergent conditions.

A 7-year-old child is in the pediatric intensive care unit on a ventilator. Sedation is maintained with a midazolam (Versed) drip. Which items should the nurse ensure are readily available at the child's bedside? (Select all that apply.) A. Back-up ventilator B. Bag-valve mask device C. Flumazinil (Romazicon) D. Narcan (Naloxone) E. Working suction setup

ANS: B, C, E For the child on a ventilator, the nurse should have a bag-valve mask for manual ventilation and working suction. The antidote for Versed is Romazicon, which should also be available. A back-up ventilator for every ventilator in use is not only prohibitively expensive, but having the bag-valve mask allows for manual ventilation in case of ventilator failure. Narcan is not the antidote for Versed.

A child is in the pediatric intensive care unit with disseminated intravascular coagulation (DIC). What laboratory findings correlate with this condition? (Select all that apply.) A. Decreased PTT B. Increased D-dimer C. Increased fibrinogen D. Low platelet count E. Normal white blood cell count

ANS: B, D Laboratory findings consistent with DIC include prolonged PT and PTT, elevated D-dimer, low fibrinogen, and low platelet count. The WBCs are not diagnostic for DIC.

A pediatric patient is receiving asparaginase (Elspar). What manifestations would lead the nurse to determine that the child is having a possible side effect from this drug? (Select all that apply.) A. Blistering at infusion site B. Increased PT and INR C. Potassium of 2.7 mEq/L D. Seizures E. Shortness of breath

ANS: B, D Some common side effects of Elspar include seizures, hyperglycemia, nausea/vomiting, rashes, coagulation abnormalities, hepatotoxicity, pancreatitis, and anaphylaxis. Blistering is common with daunorubicin (Daunomycin). Hypokalemia is seen with carboplatin (Paraplatin). Shortness of breath could be seen with bleomycin (Blenoxane), which causes pulmonary fibrosis and pneumonitis.

A nurse is caring for several patients with acute lymphocytic leukemia (ALL). Which children does the nurse understand have the best prognosis? A. Infant B. < 10 years of age C. > 25% abnormal cells in bone marrow aspirate D. White count 4,200/mm3 E. White count 25,000/mm3

ANS: B, D The best prognosis for ALL occurs in children 2 to 9 years of age and in children whose initial white blood cell count is < 5,000/mm3. Children 10 and older and whose initial white blood cell counts are ?= 50,000/mm3 have worse prognoses. Infants have a very poor prognosis

The pediatric nurse is caring for a child who has been in a motor vehicle collision. The doctor explains to the family that there are serious physical disabilities. The father is upset and states: "I don't know how we will be able to cope. We have two other children. What can we do?" Which response by the nurse is the most appropriate? A. "Don't worry. You will be able to manage." B. "Don't worry. You will get through the crisis." C. "Many parents find the initial news overwhelming." D. "The doctor can explain it to you again."

ANS: C A chronic condition, such as a physical disability, can create a threat of the unknown, loss of control, and long-term effects yet to be discovered. The nurse can reassure the family that the initial news of a physical disability can be overwhelming. The nurse should assist the family in developing an ongoing plan of care to meet the child's physical, emotional, and spiritual needs, as well as offer ongoing support and supply resources to help ensure successful coping. Telling the parents not to worry discounts their very real fears. Having the doctor explain the situation again does nothing to provide psychosocial care to the family.

The parents of a chronically ill child confide in the nurse that they are increasingly frustrated with the ill child's younger sibling, who has become very negative toward the ill child and occasionally even hostile. What response by the nurse is the most appropriate? A. "She is too young to understand; you just have to wait for this phase to pass." B. "This is really common, unfortunately; the best you can do is to ignore the behavior." C. "This is a common reaction by siblings; can she help you with your other child?" D. "You need to spend more time with the younger child so she doesn't feel left out."

ANS: C A sibling of a chronically ill child may become negative toward the ill child and occasionally hostile based on the continuous attention the ill child may receive and the attention needed by the healthy child. It is common for children to act out when they are seeking attention or frustrated over a situation.

A child is 2 hours postoperative after a resection of a brain tumor. Which assessment by the nurse takes priority? A. Blood pressure B. Intake and output C. Neurological exam D. Temperature

ANS: C All actions are appropriate for a child postoperatively. However, the answer that is most specific to this child's procedure is the neurological exam.

A nursing faculty member explains to the class that which item is the most important for tumor cell growth? A. Age of transforming cells B. Programmed cell death C. Proximity to a capillary D. Rapidity of cell growth

ANS: C All cells, including tumor cells, need a consistent supply of oxygen and nutrients, delivered via the capillaries. Neoplastic cells must be in close enough proximity to a capillary to provide these required elements. The other factors do not have such an important role, if any, in neoplastic growth.

A nurse is caring for four patients who have Hodgkin's lymphoma. Which child should the nurse see first? A. Anorexia for a week B. Enlarged cervical lymph nodes C. Fever of 102.1°F (38.9°C) D. Mediastinal mass

ANS: C All options are possible manifestations of Hodgkin's lymphoma. However, the child with a fever may have another cause for the temperature, including infection, that needs to be ruled out. This is especially true of a child receiving chemotherapy, a standard treatment for this disorder.

A nursing student asks the faculty member to explain an oncogene. Which response by the faculty member is the most appropriate? A. A cell that changes into a malignancy after environmental stress B. Any gene found inside a solid tumor that can be removed for biopsy C. A gene in a virus that encourages malignant transformation in cells D. An inherited gene that is programmed to become a malignant cell

ANS: C An oncogene is a gene found inside a virus that has the ability to encourage a normal cell to become malignant.

An 8-year-old child has been diagnosed with a brain tumor. Based on knowledge of childhood cancers, which intervention does the nurse plan to implement when the child is admitted to the hospital? A. Aspiration precautions B. Protective isolation C. Safety precautions D. Seizure precautions

ANS: C Brain tumors in children 1 to 10 years of age are usually infratentorial and involve the brainstem and cerebellum. Manifestations of brainstem tumors result from involvement of the cranial nerves and include hemiparesis, spastic gait, and frequent stumbling and falling. The nurse implements safety precautions for this child. The other precautions may or may not be needed depending on the child's specific condition, treatment, and side effects of treatment.

A child is in the hospital receiving chemotherapy for Hodgkin's lymphoma. What action by a new nurse causes the precepting nurse to intervene? A. Assesses the need for anti-emetics prior to starting chemotherapy B. Checks the IV for blood return before giving the chemotherapy C. Double wraps the chemotherapy bags and places in the trash can D. Performs hand hygiene prior to and after caring for the patient

ANS: C Chemotherapeutic agents are considered hazardous waste and must be disposed of in specific containers, not the trash can. The other actions are appropriate.

A child in the pediatric intensive care unit is started on cortisone. When the nurse enters the room to check his blood glucose, the parents are concerned that he is now a diabetic. Which response by the nurse is the most appropriate? A. "Being critically ill can raise a patient's blood glucose." B. "I'm sorry; we should have been checking this all along." C. "Increased blood glucose can be a side effect of steroids." D. "The doctor is curious about how his glucose levels are."

ANS: C Corticosteroids have many side effects, including elevated blood glucose levels. When the child is started on them, he should have his glucose levels monitored per facility policy. Being ill can raise blood glucose levels, but this is not the specific reason this child is having them checked. The physician does want to know about the readings, but, again, this reason is not specific to this child. To apologize for not checking the glucose all along is not being truthful.

The nurse has an order for isotonic crystalloid solution to treat a child with hypoperfusion. Which solution does the nurse choose? A. Albumin B. D5W (5% dextrose in water) C. Normal saline D. Whole blood

ANS: C Crystalloids are fluids that are "crystal clear"—you can see through them. Colloids have more solvents in them. Crystalloids include most standard IV solutions. Colloids include blood products and albumen. Normal saline and lactated Ringer's solution are isotonic. D5W is physiologically hypotonic. The nurse should choose normal saline.

A child is taking desmopressin acetate (DDAVP) for von Willebrand's disease. What teaching about this medication does the nurse provide? A. Avoid products with aspirin (salicylate) in them. B. Get a new needle for each injection. C. Monitor your child's weight and report a gain. D. Use ice packs and pressure for epistaxis.

ANS: C DDAVP can cause hypervolemia and hyponatremia. The child may show a rapid weight gain, which should be reported. Avoiding aspirin and using ice packs for nosebleeds are care measures for the disease, not the medication. DDAVP is given intranasally for this condition.

A nurse is caring for a child who has acute lymphocytic leukemia and has been treated with doxorubicin (Adriamycin). Which assessment finding would the nurse report immediately? A. Loss of appetite B. Low WBC count C. Peripheral edema D. Temperature of 100.6°F (38.1°C), once

ANS: C Doxorubicin and other anthracycline drugs are known to cause heart damage. Peripheral edema may signal heart failure and should be reported right away. Loss of appetite and low WBC count are common findings for a child on chemotherapy. A single temperature of 100.6°F does not need to be reported.

A 7-year-old child presents to the emergency department, where the parent reports a 3-week history of pale skin, extreme fatigue, and dizziness. Which laboratory value would the nurse correlate with the patient's current condition? A. Hematocrit: 33% B. Hemoglobin: 13.2 g/dL C. Red blood cell count: 2.8/mm3 D. White blood cell count: 12.3/mm3

ANS: C For a child of this age, a normal RBC count is 4-5.2/mm3. Low RBCs can lead to pallor, fatigue, headaches, and dizziness, as tissues are not being oxygenated. The other laboratory values are normal.

The pediatric nurse understands that with a sudden catastrophic loss, family members can experience physical symptoms such as rapid respirations, agitation, nausea, and diarrhea. According to Epperson, which stage of grief are these individuals experiencing? A. Anger B. Denial C. High anxiety D. Remorse

ANS: C High anxiety is described by Epperson as a time of great stress, with many physical manifestations of emotional upheaval. A nursing assessment of the family member finds agitation, rapid respirations and increased heart rate, irritability, muscular tension, and fainting, along with digestive or bowel changes that may result in nausea and diarrhea.

A nursing student asks a pediatric intensive care nurse why being bed-bound for several weeks would affect a young child's growth and development. Which response by the nurse is the most appropriate? A. "A child on bedrest has depression, slowing development." B. "Bedrest causes muscle weakness that limits activity." C. "Growth and development are highly connected to activity." D. "Isolation from peers has a negative effect on growth."

ANS: C In all children, but especially younger ones, growth and development are tightly bound to activity and movement. Children who have their movement restricted for medical purposes often regress in their developmental stage. The other options are all part of this reaction, but do not explain the phenomenon as comprehensively as the correct option.

In preparing a patient to receive an autologous bone marrow transplantation, which action by the nurse is best? A. Ensure HLA typing has been done. B. Limit visitors to one per shift. C. Place the child in protective isolation. D. Teach about long-term complications.

ANS: C In preparation for a bone marrow transplant, patients are given "near lethal" doses of chemotherapy and/or radiation in order to completely destroy their own bone marrow. This child will need protective isolation. HLA typing does not need to be done, as the source of the bone marrow is the child herself. Visitors do not need to be limited so severely. Teaching about complications is important, but does not take priority over protecting the child.

The pediatric nurse is familiar with Kübler-Ross's stages of grief. Parents who are feeling guilty and try to find any cause for their child's illness or blame others for the illness are in which stage of grief? A. Acceptance B. Bargaining C. Denial D. Grief

ANS: C In the bargaining stage, it is common for the family members to ask, "What did I do to make this happen?" It is normal for the family members to bargain with either themselves or with God in hopes that the child's life will be spared. In the denial stage, the parents have feelings of numbness, disbelief, and shock. Acceptance of the child's illness and possible death means that the family or child has made an emotional adjustment to the illness.

A nurse is looking at photographs of a friend's infant. The nurse notes a whitish glow in the child's eyes, and the friend asks why the baby's eyes look so odd. Which response by the nurse is the most appropriate? A. "If his eyes look like this by 6 months, he needs to see a doctor." B. "Take him to the doctor to see what's wrong with his eyes." C. "This is called leukocoria and may signify retinoblastoma." D. "Your baby may have a brain tumor; take him to the hospital."

ANS: C Leukocoria (also known as the cat's-eye reflex) is a whitish glow in the pupil, often noticed on photographs, and is seen in children with retinoblastoma. The child needs to be seen by his health-care provider. The mother should not wait 6 months. Advising the mother to find out what's wrong with his eyes is not as accurate as explaining the manifestation. This sign is not seen in brain tumors.

A child is receiving chemotherapy. The nurse assesses the child's oral cavity and notes the following: raspy voice, thick saliva, and debris on the teeth. Which action by the nurse is the most appropriate? A. Have the child use commercial mouthwash. B. Hold the next dose of chemotherapy. C. Increase the frequency of oral care. D. Place the child on NPO status.

ANS: C Mucositis is a diffuse inflammation of the mouth and oral mucous membranes, and is common during chemotherapy. The nurse should increase the frequency of oral care in the child who is manifesting signs of this problem. Commercial mouthwash contains alcohol, which would burn the tissues. The chemotherapy would not be interrupted. The child should be encouraged to eat and drink as tolerated.

A child needs surgery to resect a tumor, but is scheduled for several weeks of radiation therapy first. The parents are frustrated and want to know why the surgery that can cure the cancer is being delayed. Which response by the nurse is the most appropriate? A. "Children who have radiation first generally do better than others." B. "If the radiation destroys the tumor, surgery will not be needed." C. "Radiation will shrink the tumor, making it easier to get all of it out." D. "The surgeons must be worried that they cannot get the whole tumor."

ANS: C Often radiation or chemotherapy is used prior to surgical resection to shrink the size of the tumor, maximizing the chances of complete removal. The other responses are not accurate.

A parent brings a 10-year-old child to the clinic, reporting that the child fell while playing and now has a limp several days later. In completing a history, which other finding would the nurse correlate more with bone cancer than a minor trauma? A. Decreased appetite for the last month B. Fatigues easily when playing outdoors C. Limping several weeks prior to the fall D. Often has unexplained extremity bruises

ANS: C Pain and swelling are the most common manifestations of osteosarcoma. Often the child has a limp. The child also may have a dull pain at the tumor site, and if it is on a leg (weight-bearing), it could easily cause a limp that has lasted for several weeks before really being noticed. The other manifestations are vague and could be related to other problems.

A nurse sees the term "proptosis" in a child's medical record. Which physical assessment does the nurse plan to incorporate into the child's exam based on this finding? A. Balance testing B. Hearing screen C. Visual acuity D. Strength testing

ANS: C Proptosis is a downward displacement of the eyeball that can affect visual acuity and is frequently seen in children with rhabdomyosarcoma. The other assessments are not related.

An adolescent has been taught to administer replacement factors for bleeding episodes related to hemophilia. What action by the teen indicates that further instruction is needed? A. Disposes of sharps in an approved container B. Reconstitutes the medication with sterile water C. Selects the appropriate needle for an IM injection D. Washes hands prior to working with the drug

ANS: C Replacement factors are given intravenously. The other actions are appropriate.

A clinic nurse notes that a child brought in for a physical has swelling and bruising around the eyes. The patient denies any trauma and the parent reports no environmental allergies. Which assessment is most important? A. Auscultate lungs bilaterally. B. Inspect skin on the back. C. Palpate abdomen and neck. D. Percuss abdomen and flank.

ANS: C Swelling and bruising around the face and eyes is often seen in children with neuroblastoma. Most commonly the tumor can be found by palpation of the abdomen or neck, where the tumor will present as a hard, painless mass that crosses the midline.

A child is on IV heparin. Which laboratory value does the nurse analyze to determine if the dose is therapeutic? A. Platelet count B. PT C. PTT D. Red blood cell count

ANS: C The PTT (or sometimes factor anti-Xa) is used to monitor heparin therapy for therapeutic benefit. The platelet count is also monitored to detect thrombocytopenia, a side effect of heparin. The PT is used to monitor warfarin (Coumadin) therapy. The RBC count is not used to determine anticoagulation benefit.

A nurse hears that a new admission to the hospital was recently diagnosed with the most common kind of childhood cancer. Which collaborative care does the nurse prepare to provide to this patient? A. Antibiotic administration B. Bone marrow transplant C. Chemotherapy D. Liver transplant

ANS: C The most common type of childhood cancer is acute lymphocytic leukemia (ALL). First-line treatment for ALL is inducing remission with chemotherapy. Antibiotics are not used unless the child has an infection. Bone marrow transplant may be considered later in the child's course of care. A liver transplant would not be a treatment for ALL.

A child has cancer, is unresponsive, and is doing poorly. Which action by the nursing student causes the faculty to intervene? A. Allows the parents to hold the child B. Places the child on NPO status C. Takes the child's rectal temperature D. Turns the child even if she moans

ANS: C The nurse avoids the rectal route for anything: temperatures, suppositories, and enemas are not allowed, as the rectal mucosa is fragile and prone to injury, which can lead to infection. The other actions are appropriate.

A child in the pediatric intensive care unit is alert and able to eat. The child's parent asks the nurse "Why do you keep feeding my child so much? I don't want her to become fat." Which response by the nurse is the most appropriate? A. "I understand your concerns and would be worried too." B. "She is undernourished and needs to gain some weight." C. "Very sick children need more nutrition for healing." D. "We are monitoring her intake and she won't get fat."

ANS: C The parent needs an objective, factual rationale for feeding the child what to the parent seems to be too much food. Critically ill children have higher metabolic rates and need more high-quality calories for healing. The nurse should not convey worry about the child's weight, nor should the nurse state that the child is malnourished unless that is the case. There is no information in the stem of the question that suggests this. Stating that the child won't get fat is playing into the parent's concern about weight without giving any objective reason for the increased intake.

An acutely ill, anemic child's peripheral blood smear shows small, dense, spherical RBCs. What action by the nurse takes priority? A. Assess and treat the child's pain adequately. B. Discuss the option of a bone marrow transplant. C. Obtain informed consent for blood transfusions. D. Prepare the family for chelation therapy.

ANS: C The peripheral blood smear indicates spherocytosis, which, when acute, is treated with transfusions. The nurse ensures informed consent is obtained and present on the chart. Assessing and treating pain is important but does not take priority. Chelation therapy is not indicated in the question. A bone marrow transplant may or may not be considered, but is not the primary need of this child.

A nurse is supervising a student working with hemodynamic monitors. Which action by the student requires the nurse to intervene? A. Adjusts the transducer each time the patient is repositioned B. Assesses all connections each time he or she is in the room C. Positions the transducer at the fifth intercostal space D. Positions the transducer in the mid-clavicular line

ANS: C The transducer must be placed level with the phlebostatic axis, and so is placed in line with the fourth intercostal space, mid-clavicular line. When the students places it in line with the fifth intercostal space, the nurse should intervene. The transducer may need to be adjusted when the patient is repositioned. All the monitoring device connections should be firmly connected and should be assessed each time the student is in the room.

A nurse is assessing a child who presents to the pediatric clinic, where the parent reports new bruising and petechiae. What question asked by the nurse would elicit the most helpful information? A. "Do bleeding disorders run in your family?" B. "Does your child have arthritis symptoms?" C. "Has your child had a recent viral infection?" D. "Has your child been exposed to heavy metals?"

ANS: C These manifestations may be those of acute immune thrombocytopenia (ITP). This often follows a viral infection, so asking about recent infections is most appropriate. The other questions are not related to this disease.

A child with pancytopenia is getting a blood transfusion and it is time to administer her IV antibiotic. The child has only one IV line. What action by the nurse is most appropriate? A. Administer the antibiotic with the blood. B. Obtain an order for an oral antibiotic. C. Start a new peripheral IV in another site. D. Stop the blood to give the antibiotic.

ANS: C This child needs two IV sites or a multi-lumen IV catheter. Ideally this would have been done prior to starting the transfusion, but at this point the best option is to start another IV to administer the antibiotic. Other than normal saline, nothing can be run with blood. If there is no way to obtain another IV site, the nurse and provider would determine which was the priority. Blood transfusions should not be interrupted due to the chance of contamination and the need for strict adherence to the timeframe in which it is administered.

A child is hospitalized with the following laboratory values: WBCs, 2,100 mm3; segs, 48%; and bands, 2%. What action by the nurse is best? A. Move the child to a laminar airflow room. B. Place the child on strict protective isolation. C. Use good hand hygiene measures consistently. D. Wear a mask when entering the child's room.

ANS: C This child's absolute neutrophil count (ANC) is 1,050 mm3, which is classified as minimal, or class 2, neutropenia. Good hand hygiene and keeping sick visitors away from the child should be sufficient. Protective isolation is usually not used until the ANC falls below 500 mm3. Laminar airflow may or may not be used; this modality is often used for patients with tuberculosis. A mask is not needed.

A child has been hospitalized with a sickle cell crisis and given morphine sulfate (Duramorph) for severe pain. On assessment 45 minutes later, the child appears to be sleeping quietly with a respiratory rate of 6 breaths/minute. What action by the nurse is most appropriate? A. Document findings and let the child sleep. B. Plan to hold the next dose of morphine. C. Prepare to administer naloxone (Narcan). D. Wake the child up to take deep breaths.

ANS: C This child's respiratory rate is dangerously low, brought on by the narcotic analgesic. The nurse should prepare to administer Narcan per protocol. Letting the child sleep could lead to respiratory arrest, although the findings and subsequent actions should be documented. The provider should be notified afterward to adjust the next dose of pain medication. The child may or may not be able to cooperate with deep breathing instructions.

A pediatric nurse advocates for the children's oncology clinic by initiating a fundraising project that will help pay for expansion of the bathrooms to accommodate wheelchairs. The nurse's motivation is in response to an awareness of which of concept? A. Chronic illnesses of the patients B. Disabilities of the patient population C. Handicaps of the patient population D. Work of the clinic nurse and other staff

ANS: C This fundraiser is designed to alleviate difficulties due to handicaps, which are limitations that prevent or interfere with a person's ability to carry out tasks or access certain aspects of the environment. A chronic illness is one that persists over time and may or may not lead to activity limitations. Disabilities refer to the limitations that prevent or interfere with a child's ability to perform daily activities. Although the work of the clinic staff may be made easier with the addition of wheelchair-accessible bathrooms, the focus is on the children who are patients there.

A nurse notes in a patient's medical record high levels of vanillymandelic acid (VMA). Based on this information, which condition does the nurse prepare to educate the patient and family about? A. Ewing's sarcoma B. Hodgkin's lymphoma C. Neuroblastoma D. Wilms' tumor

ANS: C VMA and homovanillic acid (HVA) are tests used to measure the level of catecholamine metabolites in the urine. Neuroblastomas typically secrete catecholamines, so high levels of either substance are indicative of neuroblastoma.

A nursing student is caring for a child diagnosed with Wilms' tumor. Which action by the student causes the faculty member to intervene? A. Assesses urinary output per protocol B. Involves the parents in the child's care C. Palpates the abdomen in all four quadrants D. Provides frequent nutritious snacks

ANS: C Wilms' tumor is a solid, encapsulated mass that can rupture with palpation. Once the child is diagnosed with this cancer, palpation of the child's abdomen is prohibited. The other actions are appropriate.

A child is brought to the emergency department with moderate respiratory distress. She has an oxygen saturation of 89% but is awake, alert, and responsive, and is clinging to the mother. The nurse is consulting about appropriate oxygen delivery devices and expresses concern about the patient retaining CO2. Which oxygen delivery device is the most appropriate for this child? A. Facial CPAP B. Nasal cannula C. Oxygen tent D. Venturi mask

ANS: D A Venturi mask can deliver oxygen concentrations up to 40% and is especially beneficial for the patient who potentially will retain CO2. Facial CPAP is invasive and is not warranted for a child in this degree of distress. Nasal cannulae do not have a benefit in CO2 retainers. An oxygen tent will require the child to be taken from the mother, which potentially will increase her agitation and oxygen needs.

A patient in the pediatric intensive care unit has hemodynamic monitoring. Her cardiac output is 3 L/minute. Which assessment finding is consistent with this reading? A. Capillary refill: 2 seconds B. Temperature: 103°F (39.4°C) C. Urine output: 3 mL/kg/hour D. Weak, thready pulse

ANS: D A cardiac output of 3 L/minute is low, indicating such conditions as heart failure, hypovolemia, or increased systemic vascular resistance. A weak, thready pulse would be consistent with this reading. Capillary refill of 2 seconds is normal. An increased temperature would not be related. A urine output of 3 mL/kg/hour is more than sufficient and does not indicate low cardiac output.

A child in the intensive care unit had a pulmonary artery catheter inserted 2 hours ago. The child is increasingly restless. The child's vital sign trends show a slow increase in pulse rate. Which action by the nurse is the most appropriate based on the assessment findings? A. Check to ensure the connections are secure. B. Document the findings in the patient's chart. C. Increase the frequency of hemodynamic readings. D. Notify the health-care provider immediately.

ANS: D A potential complication of inserting an invasive line for hemodynamic monitoring is vessel laceration, which can cause internal bleeding. Internal bleeding is often insidious, and changes will be noted over time, some of which can be subtle. The presence of increased agitation and pulse could indicate internal bleeding, and the nurse should notify the provider at once. The other actions are also appropriate, but do not take priority and can be done after notifying the provider.

A nurse is reviewing a patient's chart and notes that the patient has a cancerous tumor that has invaded other organs. Based on this information, at which stage is this patient's cancer classified? A. Stage O B. Stage I C. Stage III D. Stage IV

ANS: D A stage IV cancer is one that has invaded other organs. Stage 0 is early cancer, present only in the cells in which it began. Stages I-III are more extensive, with larger tumors and spread to nearby lymph nodes or adjacent organs.

A teenager is hospitalized with sickle cell disease and vaso-occlusive crisis. What pain medication regimen does the nurse assist the patient with? A. Acetaminophen (children's Tylenol) B. Ketorolac (Toradol) orally C. Meperidine (Demerol), given intravenously D. PCA pump with morphine (Duramorph)

ANS: D A teenager is able to manage his or her own pain control, so a PCA pump is ideal. Morphine is often considered the drug of choice in sickle cell crises. Tylenol would be ineffective for pain this severe. Demerol is avoided due to its side effects. Toradol is a good choice; however, it is given parenterally for severe, acute pain.

A teenager with a chronic medical condition requiring frequent hospitalizations has the nursing diagnosis of impaired self-esteem. Which action by the adolescent best indicates that outcomes for this diagnosis have been met? A. Complies politely with hospital rules and routines B. Makes choices as to when to bathe or eat meals C. States understanding of the need for hospitalization D. Uses social media sites to maintain contact with peers

ANS: D A teenager's self-esteem is closely linked to acceptance by his or her peer group. Maintaining relationships is vital for healthy adolescent development. The teen using social media when unable to spend time in person with friends shows adaptation to circumstances and a positive action to maintain normalcy. Complying with hospital rules and/or stating an understanding of the need for hospitalization do not mean that the teen's self-esteem has improved. Giving a teen choices when possible helps the teen maintain some autonomy, but making those choices is not the best indicator that outcomes for this diagnosis have been met.

A student nurse wants to provide nonpharmacological pain management interventions to a hospitalized child with cancer. Which action by the student causes the faculty member to intervene? A. Applying a moist heat pack B. Giving the child a massage C. Reading the child a story D. Using candles for aromatherapy

ANS: D Actions that have been reported by children to be effective pain control strategies are moist heat, massage, adequate rest and sleep, distraction (reading a story), and providing opportunities for social support. Open flames are prohibited in hospitals due to the risk of fire and explosion.

Which health promotion measure does the nurse teach as being most important for the child with sickle cell disease? A. Adequate nutrition B. Ensured rest periods C. Plenty of fluids D. Routine vaccinations

ANS: D All options are appropriate for the child with sickle cell disease; however, vaccinations are vital to prevent sepsis and death from preventable diseases.

A child has a radial arterial line in place. The nurse assesses the distal fingertips as cool and pale. Which action is most appropriate based on these assessment findings? A. Apply warm, moist heat. B. Disconnect the device. C. Elevate the extremity. D. Notify the provider.

ANS: D An invasive device within an artery can disrupt arterial blood flow to the distal tissues. The nurse should notify the provider so the arterial line can be moved, or possibly discontinued. Warm, moist heat will not increase perfusion that is disrupted mechanically. Elevating the extremity will decrease perfusion further. The nurse should not disconnect the device.

A child in the emergency department has just undergone emergent intubation. When listening to lungs, the nurse notes absent sounds on the left side. What action by the nurse is the most appropriate? A. Ask a more experienced provider to assess the child. B. Facilitate completion of a portable chest x-ray. C. Hyperoxygenate the patient and suction the airway. D. Reposition the endotracheal tube and reassess.

ANS: D Anatomical differences between the right and left bronchus can cause intubation of only the right main stem bronchus, leading to decreased oxygenation. If the nurse does not hear lung sounds on the left, this possibility should be considered, and the tube must be repositioned. The other actions will delay the child's receiving adequate oxygenation.

A child has mild anemia and the parent asks why this makes the child have difficulty concentrating. What response by the nurse is best? A. "All sick children have trouble concentrating." B. "Her anemia makes her too tired to think." C. "She may have another problem with her brain." D. "The brain isn't getting enough oxygen."

ANS: D Anemia leads to decreased oxygenation of body tissues, including the brain. A lowered cerebral oxygen concentration can lead to dizziness and difficulty concentrating. Stating that all sick children have this problem is inaccurate and vague. The child may be tired, but this answer is also vague and does not really address the question. Describing the possibility of another medical problem is not warranted at this time.

The pediatric nurse is caring for an adolescent with cancer. The parents are interested in exploring complementary and alternative (CAM) therapies. Which response by the nurse is the most appropriate? A. "Be careful; many CAM providers prey on desperation." B. "CAM therapies have worked well for many cancer patients." C. "These treatments only provide relief through a placebo effect." D. "Although many people like CAM, many therapies have not been researched."

ANS: D CAM therapies are used by many people and include natural products, mind-body medicine, and manipulative and body practices. One controversy surrounding CAM practices is that many of the therapies have not been researched. The nurse wishes to remain supportive of the family while giving objective information. Telling the family that many people do have success with CAM but advising them that many modalities have not been researched accomplishes both objectives. The other statements either may scare, discourage, or not provide information to the family.

A nurse is caring for a dying child. What intervention by the nurse would be best to promote hope and peace in the family? A. Ask the family to participate in providing physical care. B. Ensure the family members eat so they maintain their strength. C. Help the family members arrange child care for their other children. D. Tell the family members what is possible for them to do as the child dies.

ANS: D Everyone needs something to hope for, even if that hope is for a good death. Giving the family options based on what is actually possible helps them maintain some sense of control and allows them to provide caring measures they feel are important. They may or may not want to participate in providing physical care. They may or may not want other siblings present as the child dies. They may or may not want to eat at particular times.

A mechanically ventilated child is being assessed for extubation. Which assessment finding would cause extubation to be delayed? A. Alert and oriented with occasional confusion B. Evidence that prior pulmonary infection has resolved C. Peak inspiratory ventilator pressure of 14 cm H2O D. 3+ pitting pedal edema, 1-lb weight gain overnight

ANS: D Fluid overload puts the child at risk for developing respiratory distress, so the child with edema and weight gain should not be weaned from the ventilator at this time. The other parameters are acceptable for weaning.

A child is receiving a dose of filgrastim (Neupogen). The parent asks the nurse what this medication is for. What response by the nurse is best? A. Causes bones that don't usually make blood cells to create them B. Results in white blood cells being able to live longer C. Stimulates bone marrow to make more red blood cells D. Stimulates bone marrow to make more white blood cells

ANS: D Neupogen is a colony-stimulating factor that stimulates the bone marrow to make more white blood cells. The other answers are incorrect.

A child has a disease involving an antigen-antibody complex disorder. What treatment regimen does the nurse prepare the family for? A. Apheresis B. Erythrocytaphoresis C. Leukapheresis D. Plasmapheresis

ANS: D Plasmapheresis is used to remove plasma containing harmful substances such as cholesterol, antigen-antibody complexes, and toxins. Erythrocytaphoresis removes red blood cells. Leukapheresis removes white blood cells. Apheresis is a generic term that encompasses all types of these procedures.

An infant has been hospitalized since birth. What nursing intervention takes priority for this child? A. Keeping the parents updated every day B. Maintaining a set visiting schedule for family C. Providing a soft crib and cuddly toys D. Soothing and providing physical touch

ANS: D Priority nursing interventions for the infant with a chronic condition or undergoing a long hospitalization include measures to provide soothing and physical touch, such as cuddling, holding, using a soft voice, and rocking. Keeping parents up to date is important for any hospitalized child and is not specific to parents of this age group. Visitation should be liberal, preferably 24 hours a day. Soft mattresses and plush objects in the crib increase the risk of sudden infant death syndrome and should be avoided.

A nurse receives report on a patient in the pediatric intensive care unit and is told the patient is on a ventilator in SIMV mode. Which information is inconsistent with the nurse's knowledge of this type of ventilation? A. Breaths delivered with preset pressure B. Can be used in cases of respiratory failure C. Invasive form of ventilation that requires intubation D. Will override any spontaneous breathing

ANS: D SIMV, or synchronized intermittent mandatory ventilation, is an invasive form of ventilation requiring the patient to be intubated. SIMV delivers mandatory breaths at a preset pressure. It can augment spontaneous tidal volume or inspiratory efforts. It will synchronize with the patient's respiratory efforts, not override them.

A nursing student asks how excessive noise and sensory overload could cause feelings of panic in hospitalized children. Which response by the registered nurse is the most appropriate? A. "Children are frightened by all the activity in the intensive care unit." B. "Excessive noise irritates the inner ear, which leads to behavior changes." C. "It's just the body's natural way of dealing with unfamiliar stimuli." D. "Stimulation of the adrenal glands leads to secretion of stress hormones."

ANS: D Sensory overload and excessive noise stimulate the adrenal glands, which secrete the stress hormones epinephrine and norepinephrine, leading to activation of the fight-or-flight response. This response can lead to feelings of panic. Children may well be frightened by all the activity in the unit, but this is not the best explanation. Excessive noise may well irritate the child's ears, but this does not lead to behavior problems. Stating that this is just the body's natural way of dealing with stress does not provide any specific information.

A child has nausea after chemotherapy despite anti-emetics. However, the child complains that "my tummy is growling." Which other action should the nurse take to promote comfort for this child? A. Avoid hard, difficult-to-chew foods. B. Encourage a high fluid intake with meals. C. Offer the child hard candy to suck on. D. Provide bland items, such as plain mashed potatoes.

ANS: D Several actions can help the child with nausea: offering plain, bland foods; avoiding spicy, heavy, or fatty foods; decreasing the odor associated with foods if that bothers the child; and having the child take food separately from liquids. Liquid together with food can make the child feel full, inducing nausea. The other options are good choices for other nutritional problems.

The nursing manager is collaborating with health-care providers to determine appropriate candidates for ventilator weaning in the pediatric intensive care unit. Which child is the best candidate? A. Oxygen requirement: 60% B. Peak inspiratory pressure: 32 cm H2O C. Spontaneous tidal volume: 2 mL/kg D. Ventilator rate: 6 breaths/minute

ANS: D Signs that a child is a good candidate for ventilator weaning include oxygen requirements of less than 40%, peak inspiratory pressure of 16-25 cm H2O, spontaneously initiated breaths with tidal volume of 4-6 mL/kg, and a ventilator rate of 6-10 breaths/minute. The child whose ventilator rate is 6 breaths/minute is the best candidate of these children.

A nurse is supervising a student who is suctioning a 5-year-old patient in the pediatric intensive care unit. Which action by the student results in the nurse intervening? A. Auscultates lung sounds beforehand B. Cleanses catheter after suctioning C. Hyperoxygenates prior to suctioning D. Sets suction pressure to 150 mm Hg

ANS: D Suction pressure for a child is 110-130 mm Hg. The nurse should intervene and have the student reduce the pressure before suctioning. The other options are correct actions.

The parents of a child with cancer ask the nurse why the child is losing weight even though he is eating what he normally does. Which response by the nurse is the most appropriate? A. "Cancer consumes body tissues, causing weight loss." B. "He may be going through a growth spurt right now." C. "How do you know he is eating like he normally does?" D. "When you are sick, you need more nutrition than usual."

ANS: D The demands of illness lead to increased nutritional needs. A child with cancer needs increased nutrition. Cancer does not consume body tissues. The child may be going through a growth spurt, but this is not always the case and is not the best answer. Asking the parents how they know the child's eating habits have changed may put them on the defensive.

Family members are visiting a child who is mechanically ventilated and heavily sedated. The parents are visibly distressed. Which statement from the nurse is most appropriate? A. "Her latest arterial blood gases show compensated acidosis." B. "I'm glad you are here; let me get you some chairs to sit in." C. "She is so heavily sedated that she will not know if you are here or not." D. "You can talk to and touch your child to let her know you are here."

ANS: D The distraught parents need to feel as if they are providing some comfort to their child but may be afraid to touch or talk to her for fear of causing complications. The nurse should let them know that this is not only alright to do, it is desirable and will help the child. The nurse should certainly provide information about the child's condition, but this amount of jargon given to distressed parents is not likely to be helpful. The nurse needs to provide comfort to them and give them an active role in caring for their child by touching and talking to her. Information like this can come later (and with less jargon). Getting the parents chairs and acknowledging their importance is kind and caring, but this statement relegates them to a passive role. The nurse does not know if the child can hear or if she will or will not be comforted by her parents' touch, so the nurse should not tell the parents the child is too sedated to know if they are here.

The pediatric nurse is aware that the most common type of transfusion reaction is which of the following? A. Acute hemolytic reaction B. Allergic reaction C. Circulatory overload D. Febrile reaction

ANS: D The febrile reaction is the most common type of transfusion reaction and can occur up to 12 hours post-transfusion.

A nurse wants to participate in community service by providing education on the leading causes of death for various age groups coupled with appropriate preventative measures. When discussing deaths in teenagers, which topic does the nurse focus prevention on? A. Appropriate prenatal care B. Exposure to carcinogens C. Genetic testing D. Violence and injury prevention

ANS: D The leading causes of death in adolescents are accidents, homicide, suicide, and cancer. Preventative measures directed toward violence and injury prevention would have the greatest impact. Prenatal care and genetic testing would most affect the death rate in infants, the leading causes of which are prematurity and congenital defects. Decreasing exposure to carcinogens might have the greatest impact on school-age children, in whom the most frequent cause of death is cancer and accidents.

A child has been diagnosed with chronic myelogenous leukemia (CML). Which statement by the nurse to the parents is most appropriate? A. "Radiation therapy is the standard treatment." B. "The prognosis for this disease is extremely poor." C. "There are lots of good medications for nausea." D. "We need to test siblings for a bone marrow match."

ANS: D The preferred treatment for CML is a bone marrow or stem cell transplant from a matching sibling, which can be curative in up to 80% of patients. Radiation therapy is not used. Although there are many good medications for nausea, this statement is not the best choice, because it is not specific to this child's condition.

A child in the pediatric intensive care unit has a pulse oximeter for continuous oxygen saturation readings. Which action by the nurse is important for this patient's safety? A. Calibrate and "zero" the oximeter once per shift. B. Ensure the machine stays plugged in at all times. C. Have maintenance inspect the machine before use. D. Move the oximeter probe to a new site each day.

ANS: D The probe of a pulse oximeter uses infrared light, which can damage skin. The nurse should move the probe and inspect the skin underneath it per facility policy or at least once a day. Biomedical equipment has an inspection and maintenance schedule, and the nurse should not have to ask to have the machine inspected before use. Oximeters are not zeroed. The machine should stay plugged in whenever possible, but batteries allow for portability.

The nurse working in the pediatric intensive care unit understands that the priority for treating disseminated intravascular coagulation (DIC) is to do which of the following? A. Administer antibiotics. B. Discuss organ donation. C. Provide massive transfusions. D. Treat the underlying cause.

ANS: D There are several treatment modalities to support the patient in DIC, but because this disorder is always secondary to another problem, treating the primary medical condition is the priority. Antibiotics alone are not used in DIC. Organ donation requests are premature when looking at treatment options. Transfusions may be required.

A nurse works on the pediatric oncology floor. After receiving the handoff report, which child does the nurse assess first? A. Child on protective isolation B. 4 hours post-bone marrow biopsy C. Not eating an hour after chemotherapy D. Temperature of 101.5°F (38.5°C)

ANS: D This fever indicates a probable infection. The nurse will see this child first and provide report to the physician, if this has not already been done. This child is the sickest and should be seen first; one might be tempted to see the child in protective isolation first to avoid cross-contamination, but by following isolation precautions, this risk is minimized. Not eating after chemotherapy is not cause for concern, and the child 4 hours post-bone marrow biopsy should be stable.

The staff in the pediatric intensive care unit is preparing to intubate a 3-year-old child. To facilitate intubation by providing skeletal muscle paralysis, which drug does the nurse anticipate administering? A. Fentanyl citrate (Sublimaze) B. Lorazepam (Ativan) C. Pentobarbital sodium (Nembutol) D. Vecuronium bromide (Norcuron)

ANS: D Vecuronium bromide is a neuromuscular blocking agent that paralyzes skeletal muscles. Fentanyl is an opiate analgesic. Lorazepam is a benzodiazepam for sedation. Pentobarbital is a barbiturate, which provides sedation.

During a pediatric nursing orientation session to a new unit, the child-life specialist is introduced as an important member of the heath-care team. What is an important role of the child-life specialist? A. Accompany children on their way to procedures B. Assist with family counseling regarding hospitalization C. Describe normal growth and development to families D. Provide opportunities for therapeutic play

ANS: D Whenever a child has a chronic condition, it is important to involve the child-life specialist. Because the child with a chronic condition often spends significant amounts of time in the hospital, the days can be long and boring. The child-life specialist is an expert in child development and therapeutic play and can assist in diversion activities during procedures, arrange for therapeutic play, or simply let the child take time to play.

The nurse is caring for the parents of a chronically ill child, who display chronic sorrow. Which action by the nurse would be most beneficial for this family? A. Encourage the parents to use resources such as respite care. B. Help the parents establish a routine for school and bedtime. C. Offer the parents resources to deal with their grieving. D. Refer the parents to a community center for counseling.

Chronic sorrow is manifested as periods of episodic grieving interspersed with periods of denial as a response to a chronically ill or disabled child. As the child never becomes well, the parents do not have closure for their loss of a "normal" child. A major nursing intervention the nurse can provide is to help the parents normalize as much of their daily lives as possible. One suggestion is to establish routines for daily activities, such as bedtime rituals or going-to-school routines. The other options could all be helpful but are not as comprehensive.

A 4-year-old girl diagnosed with leukemia will begin palliative care. The 6-year-old brother does not visit often. The parents worry their son will remember his sister as a "sad, thin, child in the hospital" rather than as his playful sister. Which response by the nurse is the most appropriate? A. "Your son can handle a visit to see his sister with your help because children are emotionally strong." B. "Your son needs to say good-bye to his sister prior to her death; you should bring him to visit immediately." C. "Your son will have these sad memories for the rest of his life; therefore, keeping him away is a good idea." D. "Your son needs preparation about the change in his sister's appearance, but for his own grieving process, he needs to visit her before her death."

Parents often try to protect the dying child by limiting visitation. It is important for the nurse to communicate to the parents that visits from the sibling are important. Kübler-Ross (1983) stated that the child who has been included in the death and mourning process with the family is able to let go in a healthy way. The sibling may be able to write letters or draw pictures for the child as a way of saying good-bye. It is important that the sibling be included in the grieving process and has the opportunity to say good-bye

A child with chronic immune thrombocytopenia presents to the emergency department, where the parents report a 3-day history of severe headache and recent change in mental status. What diagnostic test does the nurse prepare to facilitate as the priority? A. CT of the head B. Lumbar puncture C. Platelet count D. White blood cell count

ANS: A A child with ITP is at risk for intracerebral hemorrhage, manifested by changes in level of consciousness, headaches, visual changes, ataxia, and/or slurred speech. The diagnostic test of choice is a CT scan of the head. A lumbar puncture is often used to diagnose meningitis; because this child does not have a fever, meningitis is a low probability. Platelet count and complete blood count (including WBCs) will be done, but the priority is to obtain a head CT.

A child with sickle cell disease is receiving hypertransfusion therapy, and the current serum ferritin level is 1,035 µg/L. What medication does the nurse prepare to administer? A. Deferoxamine (Desferal) B. Elemental iron C. Furosemide (Lasix) D. Morphine sulfate (Duramorph)

ANS: A A complication of hypertransfusion is iron overload, diagnosed with a serum ferritin level of greater than 1,000 µg/L. The treatment is chelation therapy with an agent such as deferoxamine. Iron would be contraindicated. Lasix is given for fluid overload. Morphine is given for pain.

A child presents to the emergency department with sickle cell crisis. Which intervention does the nurse perform first? A. Administer oxygen. B. Assess and treat pain. C. Provide warm blankets. D. Start IV fluids.

ANS: A All interventions are appropriate for this child. However, airway and breathing come first, so the nurse administers oxygen then starts an IV.

A nurse receives report on patients in the pediatric intensive care unit who are at risk for hypoperfusion. Which child should the nurse see first? A. Hypotensive B. Oliguric C. Tachycardic D. Weak pedal pulses

ANS: A All options are signs of hypoperfusion, but hypotension is a late and ominous sign in a child. The nurse should see this child first.

The nurse is teaching the parents of a child with a severe, chronic condition ways to promote growth and development. Which suggestion by the nurse is the most appropriate? A. Allow interaction with peers, family, and community members. B. Ensure that the child is getting a nutritious diet and plenty of exercise. C. Insist that the public school include the child in all activities. D. Plot the child's growth and weight gain on growth charts monthly.

ANS: A Although chronic illness can have a negative impact on growth and development, so can the reactions of the child's parents or guardians. Although they need to maintain realistic expectations, parents should ensure that the child has the ability to develop in all areas: physical, cognitive, social, and psychological. The best way to ensure this development is to allow the child interaction with others and provide opportunities for appropriate activity. A nutritious diet is important but only considers the physical aspect of growth and development. It should not be necessary to insist that the school include the child in activities, as this is a legal requirement. Plotting growth is also important, but monitoring the situation is not the same as providing opportunities.

A child with a severe, chronic illness is hospitalized and the staff finds it difficult to deal with the mother, who is overbearing and controlling. What action by the nursing manager would be most appropriate to help the situation? A. Ensure consistent caregiver staffing. B. Explain that the mom is trying to regain control. C. Request a social work consultation. D. Set strict limits on the mother's behavior.

ANS: A Although the mother is trying to regain some control over her child's situation, merely explaining this fact won't do much to alleviate the situation. The best outcome is a trusting relationship between caregivers and the mother. Once this is established, the nurses can work with the mother to allow her control when feasible. A social work consultation may be helpful but is not the best answer. Setting limits on the mother's behavior in the absence of a trusting relationship is likely to provoke her and make the behaviors worse.

The parents of a chronically ill 8-year-old do not want him to go outside and play or to attend his friends' birthday parties for fear he will become ill. What response by the nurse is most appropriate? A. "Can you let one or two friends come over to play?" B. "Children his age need to maintain friendships." C. "He can go outside if he wears a mask all the time." D. "You are right to be concerned that he will get sick."

ANS: A Although the parents do have to be vigilant that a chronically ill child does not acquire an acute community-based illness, maintaining peer relationships at this age is important. If the parents are unwilling to let the child attend larger gatherings or play outside, the nurse should assess if they would be willing to host smaller play dates. Information about the importance of friendships is a key aspect of working with the parents, but does not offer any solutions. The child may or may not need to wear a mask. Recognizing the parents' concerns is important, but, again, does not give them information or possible solutions.

A nursing student asks the instructor why he was marked off on his care plan when explaining a low hemoglobin level as being caused by "anemia." What response by the instructor is best? A. Anemia is a symptom, not a disease. B. Anemia only refers to a low red blood cell count. C. Hemoglobin and anemia are unrelated. D. The hemoglobin must not be too low.

ANS: A Anemia is a symptom that can be caused by many disease states. It is not a disease that explains low hemoglobin. The other answers are incorrect.

A 62-lb (28.1-kg) child has symptomatic bradycardia. Which medication does the nurse anticipate administering? A. Atropine, 0.28 mg IV push B. Atropine, 28 mg IV push C. Norepinephrine, 0.28 mg IV push D. Norepinephrine, 28 mg IV push

ANS: A Atropine is used for symptomatic bradycardia in a dose of 0.01-0.05 mg/kg, IV. This is the correct drug and dose. Norepinephrine is used to produce vasoconstriction at a dose of 0.1-1 µg/kg/minute, by IV infusion.

The nurse has educated parents on administration of iron to their child. What statement by the parents indicates a need for further instruction? A. "I will call the doctor right away if my child has black, tarry stools." B. "It is best if the iron is taken on an empty stomach or with orange juice." C. "Rinsing the mouth after taking iron will prevent staining the teeth." D. "We will have our child drink the iron preparation through a straw."

ANS: A Black, tarry stools are a common side effect of iron and the parents need not call the provider. The other statements show good understanding of iron and its administration.

The pediatric nurse attends a debriefing session following the death of a young child who was hospitalized for several months with cancer. The nurse developed a strong relationship with the child and even worked overtime to care for the child. The nurse now describes feelings of sadness, insomnia, fatigue, helplessness, and frustration. Which type of suffering is this nurse experiencing? A. Burnout B. Compassion fatigue C. Family empathy D. Moral distress

ANS: A Burnout is a state of physical, emotional, and mental exhaustion caused by long-term involvement in emotionally demanding situations. It emerges gradually and is a result of emotional exhaustion and job stress. The nurse who is experiencing a severe stress reaction like burnout can seek professional help and participate in a support group to replenish or maximize effective coping strategies.

A nurse caring for a child receiving chemotherapy notes that the child's urine specific gravity is 1.010. Which action by the nurse is the most appropriate? A. Document the findings in the child's chart. B. Increase the rate of the IV fluids per protocol. C. Notify the provider about the laboratory results. D. Prepare to administer an alkalizing agent.

ANS: A Children on chemotherapy should remain well hydrated to ensure the medications and any toxic by-products are flushed out. The urine specific gravity should remain at 1.012 or below. The nurse needs to take no further action after documenting the findings. The IV rate should be increased if the specific gravity is above that level. The provider does not need to be notified specifically about this normal finding. An alkalizing agent is not needed.

A child is suspected of having aplastic anemia. What physical assessment should the nurse perform to correlate with this condition? A. Abdominal palpation B. Lung auscultation C. Oral assessment D. Skin inspection

ANS: A Children with aplastic anemia do not have hepatosplenomegaly, so when palpating the abdomen, it feels normal. The other assessments are not as specific for findings in this disease.

The parents of an 8-year-old child with sickle cell anemia call the clinic to report that the child developed chest pain after playing soccer. What advice from the nurse is most appropriate? A. "Go to the nearest emergency department." B. "Have him rest and take Tylenol (acetaminophen)." C. "If he doesn't improve, bring him in to the clinic." D. "Try a warm pack on his chest for 10 minutes."

ANS: A In sickle cell disease, the abnormally shaped RBCs are sticky and adhere to the blood vessel walls, creating obstructions to circulation. This creates the potential for tissue ischemia and death. The child could be having a heart attack and needs immediate evaluation.

A hospice nurse is working with the family of a child who has died. Which statement by the parent indicates that further action by the nurse is needed? A. "I have not been able to function at work since my son died." B. "Some days I wonder if I could have done anything differently." C. "There are times when I still get so angry that this happened." D. "You know, I have had some pretty good days recently."

ANS: A Kübler-Ross identified five stages of grief: denial and isolation, anger, bargaining, depression, and acceptance. People do not go through these stages in a linear fashion. It is important also for the nurse to understand that people will have good days and bad days, no matter what stage of grief they are in. However, in each stage, there are warning signs that indicate further action should occur. The inability to function normally is one of these warning signs, and the nurse should ensure the parent has appropriate follow-up.

A mechanically ventilated 2-year-old child has copious oral secretions. What action by the nurse takes priority? A. Assess placement of the endotracheal tube. B. Clean and dry the skin around the mouth. C. Raise the head of the child's bed to 60°. D. Suction the oral cavity every 2 hours.

ANS: A Moisture can interfere with securing the endotracheal (ET) tube, especially if tape is used. The nurse should assess the placement of the tube and then clean and dry the skin. The oral cavity should be suctioned as often as needed. Raising the head of the bed will not decrease secretions (and may cause pooling of secretions in the child's mouth) and may lead to skin problems if the child slides down in bed frequently.

A nurse has to perform a brief procedure on a toddler. What action by the nurse is the most developmentally appropriate for this patient? A. Demonstrate the procedure on a stuffed animal. B. Offer a choice as to when the procedure is done. C. Perform the procedure with no advance explanation. D. Tell the child about other kids who had this done.

ANS: A Nurses can communicate with toddlers using toys. Demonstrating the procedure on a stuffed animal helps relieve fear. The other options are not appropriate for this age group

A nurse is evaluating how well the family of a dying child understands the concept of hospice care in the home. Which statement by the family indicates the need for further instruction? A. "If she gets short of breath, I will call 911 right away." B. "It will be great that she can play with her sister at home." C. "Pain control will be very important even near death." D. "We should look into respite care so we can get a break."

ANS: A Once hospice care has been chosen, it is important to not make drastic changes in the care plan, especially as the end of life approaches. Hospice care recognizes that death is part of life and is focused on symptom control and quality of life, not cure. The parent who plans to call 911 for shortness of breath does not understand this concept, nor does he or she understand manifestations of approaching death. The other statements are compatible with hospice care in the home.

A preschool-age child with a chronic condition is brought to the clinic for a checkup. During the visit she throws things, yells at her mother, and attempts to hit the nurse. The mother sighs and says "I'm afraid yelling at her will make her sicker." What response by the nurse is the most appropriate? A. Explain that without limits, preschoolers do not feel secure. B. Inform the mother that she needs to institute some discipline. C. Re-educate the mother on the progression of the child's illness. D. Tell the mother that yelling at the child will not make her sick.

ANS: A Preschoolers need set limits in order to feel secure in their world. This mother needs to set limits on her child's behavior, but the nurse needs to explain the reasoning behind it. Simply telling her to institute discipline will likely make the mother feel criticized. Re-educating the mother may need to occur, but is not the best response to this situation. Telling the mother that yelling will not make her daughter worse does not give the mother needed information.

The nurse has just repositioned a child who is intubated and mechanically ventilated. Which action by the nurse takes priority? A. Assess placement of the endotracheal tube. B. Document the condition of the child's skin. C. Ensure that the child cannot pull on tubing. D. Turn the ventilator alarms back on.

ANS: A Repositioning is a common cause of endotracheal tube displacement. After turning the child, the nurse should assess the tube placement as the priority. Other actions the nurse should take include documenting the condition of the child's skin and ensuring that the child cannot reach the tube or ventilator tubing and pull it out, but these do not take priority over assessing for correct tube placement. The ventilator alarms should not be turned off, even for a brief period of time.

A nurse is working with a school-age child who is dying. The child is hostile and uncooperative. Which action by the nurse is the most appropriate? A. Ask the child what she knows about what is wrong with her. B. Give the child time to herself and then return to complete tasks. C. Offer the child a reward for cooperative or pleasant behavior. D. Tell the child to cooperate with treatments in order to get better.

ANS: A School-age children often know and understand more than parents want to believe. Attempting to shield the child in this age group from the realities of his or her condition can create an atmosphere of distrust. An angry and uncooperative child often is displaying that distrust. The nurse should open up a conversation with the child and find out what she already knows (or thinks she knows) about her condition. This can help create trust. The child may need some time alone, but this by itself will not improve the situation. Rewards for good behavior may be helpful, especially if the parents use this technique at home, but, again, this is not the best answer. Simply telling the child to behave is not likely to be helpful.

A nurse is working with a student in the pediatric intensive care unit. The student reports that a 3-year-old patient looks very anxious, and the parents report that this behavior is not normal for her and she seems disoriented. Which action suggested by the registered nurse is the most appropriate? A. Assess the child for sensory overload. B. Encourage the child to take a short nap. C. Have the parents leave for a short break. D. Plan age-appropriate diversionary activities.

ANS: A Sensory overload is a common finding in the pediatric intensive care unit. Manifestations of this finding include lethargy, behavioral changes, disorientation, panic, withdrawal, hallucinations, fear, and anxiety. The student (and nurse) should assess the child for sensory overload. Regular sleep-wake cycles can help diminish stress, but a short nap would not alleviate these symptoms. Having the parents leave is not consistent with family-centered care. Diversionary activities are always appropriate for hospitalized children, but, again, will not diminish the symptoms.

A nurse is assessing an infant for the most common type of anemia worldwide. What action by the nurse is most helpful? A. Assess if formula is iron-fortified. B. Determine family history of anemia. C. Look at mucous membranes for pallor. D. Perform range of motion on the hips.

ANS: A The most common type of anemia worldwide is iron-deficiency anemia, which can be caused by ingesting non-iron-fortified formula if the child is not breastfed. This type of anemia is not genetic. Pallor, either of the skin or mucous membranes, would be seen in any type of anemia. Range of motion of the hips or shoulders is an important assessment in sickle cell disease, in which avascular necrosis can occur.

A 2-year-old child's hemoglobin is 8.2 g/dL. What action by the nurse is best? A. Ask the parents about activity level. B. Document findings in the chart. C. Notify the provider immediately. D. Schedule a re-draw of blood in 6 months.

ANS: A The normal hemoglobin for a child this age is 10.55-12.7 g/dL, so this child is somewhat anemic. The nurse should assess for other manifestations of anemia, including normal activity level. The findings should be documented, but this is not the only action that the nurse should take. The provider needs to be notified, but it does not have to be done immediately, as this is not an emergency. After a full evaluation, the provider may or may not want to repeat the laboratory work in 6 months.

A nurse is assessing a critically ill child's respiratory status. The child is grunting and has nasal flaring, but the pulse oximeter reads the child's oxygen saturation at 96%. Which nursing action is the priority in this situation? A. Conduct a thorough assessment and call the provider. B. Document the findings in the child's medical chart. C. Notify the rapid response team immediately. D. Turn up the oxygen and reassess the child in 30 minutes.

ANS: A The oxygen saturation does not correlate with the child's work of breathing. The nurse should do a more complete assessment, including vital signs, and notify the provider. Documentation should be thorough, but the nurse needs to take further action. Depending on institutional policies, notifying the rapid response team may be appropriate if the child needs further attention and the primary provider is not available. This child is too ill to just turn up the oxygen and reassess later.

A 36-lb (16.4-kg) patient in the pediatric intensive care unit is started on a propofol (Diprovan) infusion. The health-care provider orders the infusion started at 410 µg/minute. Which action by the nurse is the most appropriate? A. Administer the infusion using an infusion pump. B. Consult the pharmacist about giving this drug as an infusion. C. Ensure the appropriate antidote is available bedside. D. Notify the provider that the dose is above the safe range.

ANS: A The safe dose range for propofol is 25-50 µg/kg/minute, so this dose is acceptable. The nurse should administer the drug using an infusion pump. It is not necessary to check whether the drug is given as an infusion, nor is it necessary to notify the provider that the dose is out of range. Propofol is a short-acting drug with a limited half-life and has no antidote.

A 4-year-old child is several days postoperative after a resection of a brain tumor. The nurse finds the child irritable and lethargic, and notes that she has vomited. Which medication does the nurse anticipate administering? A. Dexamethasone (Decadron) B. Fosphenytoin (Cerebyx) C. Odansetron (Zofran) D. Phenytoin (Dilantin)

ANS: A This child has manifestations of increased intracranial pressure, a possible outcome after brain surgery. The nurse prepares to administer a corticosteroid to decrease the edema. Fosphenytoin and phenytoin are for seizures. Odansetron is for nausea.

A child has the following laboratory values: WBC, 7.2 mm3; bands, 4%; and neutrophils, 60%. Based on these values, which action by the nurse is the most appropriate? A. Continue monitoring the child for infection. B. Place the child on protective isolation. C. Obtain two sets of blood cultures. D. Restrict visitors to the child.

ANS: A This child's absolute neutrophil count is 4,608; therefore, the child is not neutropenic. The nurse should continue to monitor. The other actions are not necessary.

A school-age child is scheduled to have a bone marrow biopsy. What action by the nurse takes priority? A. Ensure informed consent is on the chart. B. Help position the child to facilitate the sample. C. Provide developmentally appropriate teaching. D. Use distraction techniques during the procedure.

ANS: A This invasive procedure requires informed consent. The nurse will also provide developmentally appropriate teaching and help position the child during the procedure, but these do not take priority over this legal requirement. For young children, sedation, not distraction, is used.

A parent confides to the nurse that a friend, who is 32, has been diagnosed with Hodgkin's disease. The parent says "I thought only children get that!" What response by the nurse is the most appropriate? A. "No, there are both young adult and older adult forms." B. "Usually people over the age of 50 do not get this." C. "Yes, only children under the age of 10 are affected." D. "You are right; your friend must have misspoken."

ANS: A Three groups are affected by Hodgkin's disease: children younger than 14, young adults 15-34 years of age, and older adults 55-74 years of age. The parent's friend could certainly be correct about the diagnosis.

Prior to administering IV chemotherapy, which action by the nurse is most important? A. Ensure the IV has a good blood return. B. Provide diversionary activities. C. Take and record a set of vital signs. D. Weigh the child.

ANS: A To prevent extravasation of IV chemotherapy it is important to make sure the line flushes easily and has a good blood return. This is a critical action to maintain patient safety. The other actions may also be utilized, but would not take priority over ensuring patient safety.

A child is hospitalized with anemia and critically low hemoglobin. The health-care provider orders a blood transfusion. The parents won't sign the consent form even though they have been told that without it, their child will die. What does the pediatric intensive care nurse understand about this situation? A. Legally permissible to give the transfusion against the parents' objections B. Legally permissible to give the transfusion after getting an emergency court order C. Not legally permissible to give the transfusion if both parents are in agreement D. Not legally permissible to give the transfusion if the parents won't sign the consent

ANS: A Under Section 24 of the Human Tissue Act 1982, a medical practitioner who gives a child a transfusion against the express wishes of the parents is not committing a criminal offense. The transfusion must be for a condition the child actually has, and it must be the case that without the transfusion the child will likely die.

A child on a ventilator suddenly desaturates. Which nursing action is the priority? A. Assess for displacement of the tube. B. Assess for obstruction of the tube. C. Ensure the ventilator is functioning properly. D. Listen to lung sounds for pneumothorax.

ANS: A When a mechanically ventilated patient suddenly desaturates (oxygen saturation drops), the nurse responds using the DOPE mnemonic (displaced tube, obstructed tube, pneumothorax, equipment problem). The most common cause is a displaced tube, so the nurse should assess this first.

A child is being admitted with an infratentorial brain tumor. Which anatomical regions of the brain does the nurse know this tumor might include? (Select all that apply.) A. Brainstem B. Cerebellum C. Cerebrum D. Frontal lobe E. Parietal lobe

ANS: A, B Brain tumors in children are classified as either supratentorial or infratentorial. Infratentorial tumors are located in the posterior third of the brain, below the tentorium, and involve the brainstem and cerebellum. The cerebrum, frontal, and parietal lobes are located in the supratentorial section of the brain, which is the anterior two-thirds of the brain structure.

A nurse is removing an arterial line from a patient's radial artery. What actions by the nurse are most appropriate after the line is removed? (Select all that apply.) A. Apply pressure for at least 5 minutes. B. Assess perfusion distal to the site. C. Monitor the patient for bleeding. D. Place a clean dressing over the site. E. Secure the insertion site with Steri-Strips.

ANS: A, B, C After removing the invasive device, pressure is held for at least 5 minutes, and up to 20 minutes, at the femoral site. Perfusion distal to the insertion site must be assessed, including for warmth, sensation, movement, color, pulse, and capillary refill time. The patient should be monitored for bleeding. The dressing should be sterile, and Steri-Strips are not routinely needed.

A student is learning about the process of hematopoiesis and how it is affected by leukemia. Which information does the student discover? (Select all that apply.) A. Blast cells multiply faster than mature cells. B. Leukemia disrupts normal hematopoiesis. C. Lymphoid cells differentiate into B and T cells. D. Myeloid cells crowd out normal cells in bone marrow. E. Pancytopenia occurs from proliferation of mast cells.

ANS: A, B, C Blast, or immature, cells have an increased rate of proliferation and multiply at the expense of normal cells. Leukemia does disrupt normal hematopoiesis (production and development of blood cells). Lymphoid cells differentiate into B and T cells. Myeloid cells differentiate into red blood cells, monocytes, granulocytes, and platelets; they do not reproduce and crowd out "normal" cells in the marrow. Pancytopenia occurs when large numbers of blast cells reproduce and crowd out normal marrow components.

A nurse is preparing to transfer a child from the intensive care unit to progressive care. The parents seem very anxious and do not want the child to transfer. Which responses by the nurse are most appropriate? (Select all that apply.) A. "I am interested in what is most stressful about moving your child." B. "Parents are always involved with their child's care in any unit." C. "The nurses will monitor your child closely as often as needed." D. "We can keep her here if you really insist on it." E. "You should be happy because your child is getting better."

ANS: A, B, C Parents are often anxious about moving their child out of the intensive care unit for many reasons. The caring nurse will ask what is most stressful so that this topic can be addressed. Assuring them that they will remain involved in their child's care is reassuring. Letting the parents know that the new staff will continue to monitor and care for the child based on his or her needs is also important. The nurse should not offer to keep a child in the intensive care unit to placate the parents, as this may not be possible in the facility. It is also not desirable to maintain a higher level of care than needed. Telling the parents how they should feel is dismissive of their concerns.

A faculty member is reviewing guidelines for blood transfusions with a student whose patient is to receive 2 units of packed red blood cells. Which of the following does the student know about transfusions? (Select all that apply.) A. Do not obtain the unit of blood more than 30 minutes before starting it. B. Obtain a baseline set of vital signs prior to starting the transfusion. C. Run the blood transfusion at a slow rate for the first 15 minutes. D. The transfusion of 1 unit of blood must be completed within 6 hours. E. Two appropriate health-care providers must check the blood at the bedside.

ANS: A, B, C, D Always check institutional policies before transfusing any type of blood product. These options are from the American Association of Blood Banks. Transfusions must be completed within 4 hours.

A registered nurse working with a student nurse explains problems that can cause ventilator alarms. Which patient problems does the nurse include? (Select all that apply.) A. Asynchronous breathing B. Biting the endotracheal tube C. Copious secretions obstructing the tube D. Coughing and gagging E. Kinking of the ventilator tubes

ANS: A, B, C, D Asynchronous breathing, biting the tube, secretions, and coughing and gagging are all patient-related problems that lead to ventilator alarms. Kinked tubing is a ventilator problem.

An experienced nurse is acting as preceptor to a new graduate and is discussing ways to develop a trusting relationship with the families of children who have chronic or terminal conditions. Which are helpful suggestions by the experienced nurse? (Select all that apply.) A. Ask if and how the parents would like to participate in care. B. Do not judge the parents' reactions to the child's condition. C. Follow the child's home routine while hospitalized, if possible. D. Treat each child as an individual and do not label the child. E. Work predominantly with the parents; they will include siblings.

ANS: A, B, C, D There are many ways for the nurse to develop a trusting relationship with the family of a child who is chronically or terminally ill. In addition to the four correct options listed above, the nurse should also remember to include the siblings of the patient whenever possible. Siblings often feel left out and isolated.

A child is hospitalized with immune thrombocytopenia (ITP). What treatment options does the nurse prepare to answer questions about? (Select all that apply.) A. Anti-D antibody (WinRho) B. IV immune gamma globulin C. Platelet transfusions D. Steroid administration E. Whole blood transfusion

ANS: A, B, C, D Treatment options for ITP include WinRho, IV immune gamma globulin (IVIG), platelet transfusion in case of a life-threatening condition, and steroids. Whole blood is not transfused. If the child experiences a severe hemolytic anemia secondary to the WinRho, packed red blood cells might be considered, but usually this is a rapidly improving condition.

A nurse is explaining the connection between family caregivers of chronically ill children and illness to a group of nursing students. What information about caregivers increases their risk of becoming ill? (Select all that apply.) A. Depression B. Financial worries C. Lack of sleep D. Over-exercising E. Poor eating habits

ANS: A, B, C, E Many caregivers describe their health as poor, and many factors may contribute to poor caregiver health. Some factors include insomnia, depression, poor eating, lack of exercise, lack of the ability to take time off for personal health issues/wellness activities, and financial burdens. All of these issues increase the chances of the family caregiver becoming ill.

A student nurse assesses a child for nonverbal signs of pain to report to the registered nurse. Which information should the student include? (Select all that apply.) A. Complaints of nausea B. Diaphoresis C. Facial grimacing D. Sleepiness E. Tachypnea

ANS: A, B, C, E Objective manifestations of pain include tachycardia, tachypnea, diaphoresis, sleep disturbances, hypertension, and nausea.

A child has mild anemia. Parents learn to assess for signs of worsening anemia, including which of the following? (Select all that apply.) A. Decreased activity B. Irritability C. Listlessness D. Pale skin E. Rapid heart rate

ANS: A, B, C, E Signs of moderate anemia include decreased activity, irritability or listlessness, tachycardia, systolic heart murmur, irritability, fatigue, delayed motor development, hepatomegaly, and congestive heart failure. Pale skin can be seen in both mild and moderate anemia.

The nurse is teaching a community group about early warning signs of cancer. Which signs does the nurse include? (Select all that apply.) A. A sore that does not heal B. Change in bowel or bladder habits C. Difficulty swallowing or indigestion D. Nagging feeling that something is wrong E. Unusual bleeding or discharge

ANS: A, B, C, E The American Cancer Society uses the acronym CAUTION to describe common warning signs of cancer: change in bowel or bladder habits; a sore that does not heal; unusual bleeding or discharge; thickening or lump in the breast, testicles, or elsewhere; indigestion or trouble swallowing; obvious change in the size, color shape, or thickness of a wart, mole, or mouth sore; and nagging cough or hoarseness.

The pediatric nurse knows that which of the following might be included in the collaborative care of children with mild to moderate anemia? (Select all that apply.) A. Administration of epopoietin alfa (Epogen) B. Blood product transfusions C. Bone marrow transplantation D. Routine laboratory analysis E. Supplements and iron-rich diet

ANS: A, B, D, E Collaborative care for the anemic child depends on the nature of the anemia, but includes colony-stimulating factors such as Epogen, transfusions, routine laboratory draws, iron supplements, and a nutritious diet rich in iron. Bone marrow transplantation is an option only for severe cases, such as aplastic anemia.

The staff nurse is educating nursing students on the long-term effects of childhood chemotherapy. Which problems does the nurse include in the educational session? (Select all that apply.) A. Cardiac dysfunction B. Hearing loss C. Increased risk of multiple-gestation pregnancies D. Learning disabilities E. Peripheral neuropathy

ANS: A, B, D, E The list of long-term effects of chemotherapy is lengthy and includes cardiac dysfunction, hearing loss, learning disabilities, and peripheral neuropathy, among others. Sterility, not an increased risk for multiple-gestation pregnancies, is also an effect.

A nurse is teaching the parents of a dying child how to recognize impending death. Which manifestations does the nurse tell the parents to expect? (Select all that apply.) A. Changes in breathing patterns B. Decreased desire to eat or drink C. Increased blood pressure D. Pale, cool skin E. Restlessness or agitation

ANS: A, B, D, E There are many manifestations of impending death, including changes in breathing patterns, decreased oral intake, pale or cool skin, and restlessness or agitation. Blood pressure will decrease.

A pediatric intensive care nurse understands that which of the following are complications of apheresis procedures? (Select all that apply.) A. Air embolism B. Bleeding C. Hypercalcemia D. Hyperthermia E. Hypotension

ANS: A, B, E Complications of apheresis procedures include air embolism, bleeding, hypocalcemia, hypothermia, hypotension, transfusion reaction, thrombosis, and infection.

The student nurse studying childhood cancers understands that neoplasms are caused by which factors? (Select all that apply.) A. Chromosomal/genetic abnormalities B. External stimuli or environment C. Maternal nutrition during gestation D. Substance abuse during pregnancy E. Viruses that alter the immune system

ANS: A, B, E Neoplasms are caused by one or a combination of the following: chromosomal or genetic abnormalities, external stimuli or the environment, and/or viruses that alter the immune system. Nutritional deficits and substance abuse by the mother can certainly lead to developmental and other health problems, but do not lead to childhood cancers.

A child is getting induction therapy for Burkitt lymphoma. The nurse finds the child lethargic and complaining of side and back pain. The child's morning laboratory results indicate a serum calcium level of 7.2 mg/dL. What actions by the nurse are the most appropriate at this time? (Select all that apply.) A. Administer a dose of pain medication. B. Assess Chvostek and Trousseau signs. C. Call the rapid response team. D. Encourage an increased oral intake. E. Prepare to administer allopurinol (Aloprim).

ANS: A, B, E This child is manifesting signs of tumor lysis syndrome. The child is at risk due to the rapid destruction of cancer cells (induction therapy) and from the child's type of cancer (Burkitt lymphoma). Lethargy, flank pain, and hypocalcemia are common findings in this condition. The nurse should administer pain medication, assess for physical manifestations of hypocalcemia (Chvostek and Trousseau signs), and prepare to administer allopurinol. Adequate hydration is important as well, but because the child is lethargic, IV fluids should be given, not oral fluids. The rapid response team is not needed at this point.

The nurse is teaching parents about the importance of good nutrition for their child who has cancer. Which components does the nurse include as important for this child's diet? (Select all that apply.) A. High calories B. High carbohydrates C. High vitamins D. Low minerals E. Low protein

ANS: A, C The child with cancer needs optimal nutrition, including a diet high in calories, fatty acids, vitamins, protein, and minerals.

A child is admitted to the pediatric intensive care unit with respiratory distress and respiratory acidosis. The child's pulse oximeter reads 98%. Which actions by the nurse are the most appropriate at this time? (Select all that apply.) A. Assess the child's most recent hemoglobin and hematocrit levels. B. Prepare for immediate intubation and mechanical ventilation. C. Request an order to use a transcutaneous carbon dioxide monitor. D. Titrate the oxygen flow rate down to prevent oxygen toxicity. E. Wait 30 minutes, then draw another sample for arterial blood gasses.

ANS: A, C This child's oxygen saturation does not correlate with respiratory distress and acidosis. Appropriate actions include assessing the child's hemoglobin and hematocrit and requesting the use of a carbon dioxide monitor. If the child is anemic, even with a saturation of 98%, the child will not have enough oxygen for tissue needs. The child may also have high levels of carbon dioxide causing or caused by the respiratory distress and acidosis, so this value should be monitored. The oximeter may not be working properly or reading accurately. Without further information, it is unknown if the child needs immediate intubation and mechanical ventilation. Titrating oxygen down in the face of respiratory distress is not warranted. Waiting 30 minutes is also not warranted, as this child is quite ill.

The nursing faculty informs a clinical group of nursing students about the detrimental effects of excessive noise exposure to patients in the pediatric intensive care unit. Which effects does the faculty member include in the discussion with the clinical group? (Select all that apply.) A. Decreased immune function B. Depressed pituitary function C. Increased gastric secretions D. Slower wound healing E. Weight loss

ANS: A, C, D Exposure to excessive noise has several detrimental physiological effects, including slower healing and recovery process, sleep disturbances, cardiovascular stimulation, increased gastric secretions, pituitary and adrenal gland stimulation, and suppression of the immune response to infection.

The nurse is explaining types of solid tumors to a group of students. Which information does the nurse include? (Select all that apply.) A. A sarcoma is found in bone or muscle. B. "Carcinoma" means any cancerous tumor. C. Epithelial cells give rise to carcinomas. D. Lymphoma might originate in the thymus. E. Pediatric and adult solid tumors are similar.

ANS: A, C, D Pediatric and adult solid tumors are very different. A sarcoma arises from connective or supporting tissues, such as bones or muscle. A carcinoma is cancer arising from glandular and/or epithelial cells. Lymphomas originate in lymphoid organs, such as the lymph nodes, spleen, and thymus.

The student studying pediatric hematological disorders learns that anemia can occur in several ways, including which of the following? (Select all that apply.) A. Acute or chronic blood loss B. Altered shape of RBCs C. Decreased RBC production D. Increased RBC destruction E. Lack of functional RBCs

ANS: A, C, D The three major causes of anemia include increased destruction of RBCs, decreased production of RBCs, and blood loss. Altered shape and function do not cause anemia.

A toddler is critically injured and admitted to the pediatric intensive care unit. The child is on a ventilator and is sedated. The parents explain that the child is normally very active, wants to do everything himself, and is very chatty. Which aspects of this situation would cause the greatest psychosocial impact on this child? (Select all that apply.) A. Activity restrictions B. Body image disturbances C. Communication barriers D. Loss of control E. Separation from peers

ANS: A, C, D Toddlers are in Erikson's stage of autonomy versus shame and doubt, and need to feel a sense of control over their physical abilities and increasing autonomy. Activity restrictions, not being able to talk while intubated, and a loss of control will all have a major impact on this child. Body image disturbances and separation from peers would have a bigger impact on an older child.

The pediatric intensive care nurse understands the effects of stress on the critically ill child. Which factors increase stress in this population? (Select all that apply.) A. Communication barriers B. Consistent sleep hours C. Lighting D. Noise E. Pain

ANS: A, C, D, E Many things can cause stress in the child admitted to the pediatric intensive care unit, including sensory overload from light, noise, and pain. Communication barriers also cause stress in these patients. Consistent sleep hours help decrease stress.

A nurse is working in the emergency department when a child who was involved in a motor vehicle crash is admitted. The child is critically injured and, despite heroic efforts, does not survive. The nurse finds the family in the waiting room and several family members are agitated and do not listen to the nurse describe the child's injuries. One family member feels faint and another has vomited. What does the nurse understand about the current situation based on Epperson's theory of grieving? (Select all that apply.) A. It is important to be patient and identify one person to communicate with. B. Most of the members are totally dysfunctional and should be sent home. C. Signs of emotional upheaval and physical symptoms are a result of great stress. D. The nurse should call security, as some family members may become violent. E. This family is reacting normally to a catastrophic loss, according to one theory.

ANS: A, C, E According to Epperson's theory of grieving, people experiencing a sudden or catastrophic loss experience the grief process differently than do others. There are six phases to this process: high anxiety, denial, anger, remorse, grief, and reconciliation. This family appears to be in the high-anxiety stage, with physical manifestations. The nurse should be patient with the family, find one person to communicate with primarily, and understand that this is a normal response to a great emotional upheaval. The family is not dysfunctional and should not be sent home. Violence is always a possibility in the emergency department, but the nurse should not assume that these family members will become violent. The family should be moved to a private waiting room if possible to avoid disrupting the rest of the department, but the nurse should act as if this behavior is understandable, not something to be controlled.

A child has been admitted with a paraspinal Ewing's sarcoma. The nursing instructor questions the student about assessing for signs of spinal cord compression. Which manifestations does this include? (Select all that apply.) A. Burning pain down the legs B. Difficulty with swallowing C. "Foot drop," causing a limp D. Respiratory depression E. Weakness in the hands

ANS: A, C, E Common manifestations of spinal cord compression include burning pain, often down the legs; foot drop causing difficulty with ambulation; and weakness in the hands. Other manifestations include numbness, cramping, and loss of sensation in the feet, and sexual dysfunction in the older patient. Swallowing problems and respiratory depression are not related.

A nurse is explaining radiation side effects to the parents of a child for whom it has been ordered. Which side effects does the nurse include in the explanation? (Select all that apply.) A. Hair loss B. Leukocytosis C. Nausea D. Polycythemia E. Skin desquamation

ANS: A, C, E Common side effects of radiation include nausea, alopecia (hair loss), fatigue and malaise, low WBC, skin desquamation, and mucous membrane inflammation and irritation. Leukocytosis (high WBC count) and polycythemia (increased RBC count) are not seen.

A student nurse is preparing to administer odansetron (Zofran) to a child receiving chemotherapy. The child weighs 44 lb (20 kg). Which actions by the student nurse require intervention by the faculty? (Select all that apply.) A. Assesses the child's pain with a pediatric scale B. Discusses side effects with the parents/child C. Draws up 300 mg for IV administration D. Prepares to administer 3 mg IV push E. Withdraws a 200-mg suppository for use

ANS: A, C, E Odansetron is an anti-emetic (not a pain medication) and can be given IV at 0.15 mg/kg, making the correct dose 3 mg. The faculty member should intervene if the student assesses pain, not nausea; draws up 300 mg; or tries to obtain a suppository for the child. Odansetron can also be given PO. Discussing side effects is a responsibility when giving medications.

The nurse caring for infants and children understands that which are the scariest aspects of being hospitalized for a 3-year-old? (Select all that apply.) A. Anxiety B. Being different from peers C. Pain D. Punishment in the form of illness E. Separation from parents

ANS: A, C, E The most frightening aspects of hospitalization for toddlers are pain, anxiety, and separation from the parents. Being different from peers is an issue for older children. Fear that illness is punishment is characteristic of the preschooler.

The nurse working with pediatric oncology patients educates the patients and families regarding best long-term follow-up practices. Which recommendations does this include? (Select all that apply.) A. Continued care by an interdisciplinary team B. Height measurements until puberty is reached C. Genetic testing prior to having children D. Risk-based follow-up appointments E. Thyroid screening for 5 years after remission

ANS: A, D Best-practice recommendations for follow-up include risk-based referrals and continued involvement of an interdisciplinary team of specialists. Height measurements are important for children until their adult height is achieved. Genetic testing is only recommended for certain types of cancer. Thyroid screening is important throughout the lifetime of survivors who were treated with radiotherapy to the neck, spine, or brain.

The pediatric nurse understands blood types. Which of the following donor/recipient matches are suitable? (Select all that apply.) A. Donor: A+ Recipient: A+ B. Donor: B+ Recipient: B- C. Donor: AB+ Recipient: Anyone D. Donor: O- Recipient: Anyone E. Donor: A- Recipient: A-, A+

ANS: A, D, E See Box 32-3 for compatibilities between blood donors and recipients.