Pediatrics Test 3 (Final)

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30. A 5-year-old child is hospitalized with osteomyelitis and will be going home in the next few days on intravenous (IV) antibiotics. Which action by the nurse is the most appropriate? A. Ensure that a valid permit for a PICC line is on the chart. B. Locate a pharmacy that will supply the IV medications. C. Research the patient's insurance for home infusion coverage. D. Teach the child about a PICC line using a doll.

ANS: A A child going home on IV antibiotics will need a PICC line inserted for home infusion therapy. The nurse should ensure that a consent for this procedure is on the chart. Researching pharmacies and infusion companies can be done by the social worker. Teaching the child with a doll is appropriate, but does not take priority over legal responsibilities.

19. 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.

7. A child is hospitalized with heart failure and is receiving furosemide (Lasix). Which nursing action is the priority? A. Administer oxygen. B. Encourage rest. C. Provide meticulous skin care. D. Monitor brain natriuretic peptide.

ANS: A A child with heart failure receiving furosemide will have pulmonary congestion from fluid backup into the lungs. The nurse should provide oxygen as the priority action. The other actions are important for this child but do not take priority. Rest will help the body heal and reduce metabolic needs. Skin care is important for edematous tissues. Brain natriuretic peptide does help quantify fluid retention, but monitoring does not actively provide care for the child.

11. 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.

37. A teen has a scoliosis curve of 35°. What treatment option does the nurse prepare the child and family for? A. Bracing B. Continued screening C. Exercise therapy D. Surgical intervention

ANS: A A curve of 35°is considered mild scoliosis. Bracing is the treatment of choice at this point. Continued screening is inappropriate, as the child has scoliosis. Research has shown that exercise alone does not improve outcomes. Surgical intervention is reserved for more serious cases.

23. A nurse is caring for an 8-year-old child hospitalized 2 days after open reduction and internal fixation (ORIF) of a femur fracture sustained in a motor vehicle crash. The child is now in a long-leg cast. Which assessment finding prompts the nurse to notify the health-care provider? A. A foul odor coming from the cast B. Child eating only 20% of meals C. Old dried drainage marked on the cast D. Request for pain medicine every 4 hours

ANS: A A foul odor coming from the cast may indicate an infection at the surgical site or at the fracture site. The nurse should notify the health-care provider. Loss of appetite may be from several causes: fatigue, stress, side effect of medications, dislike of hospital food, loss of industry (child is in Erikson's stage of industry vs. inferiority), trying to regain some control, pain, or fear of pain. The nurse needs to assess this situation further to determine the cause of this issue. Old drainage would not be worrisome; if the drainage continues to increase, the nurse should notify the health-care provider. At 2 days since surgery, wanting pain medication every 4 hours is not unreasonable.

2. Which assessment would lead the nurse to suspect that a newborn infant has a ventricular septal defect? a. A loud, harsh murmur with a systolic thrill b. Cyanosis when crying c. Blood pressure higher in the arms than in the legs d. A machinery-like murmur

ANS: A A loud, harsh murmur combined with a systolic thrill is characteristic of a ventricular septal defect.

13. Meperidine (Demerol) is not recommended for children in sickle cell crisis because it: a. may induce seizures. b. is easily addictive. c. is not adequate for pain relief. d. is given by intramuscular injection.

ANS: A A metabolite of meperidine, normeperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. Patients with sickle cell disease are particularly at risk for normeperidine-induced seizures. Meperidine is no more addictive than other narcotic agents. Meperidine is adequate for pain relief. It is available for IV infusion.

42. A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention? a. Relax any eating pressures. b. Firmly insist that child eat normally. c. Begin gavage feedings to supplement diet. d. Serve foods that are either hot or cold.

ANS: A A multifaceted approach is necessary for children with severe stomatitis and anorexia. First, the parents should relax eating pressures rather than insisting the child eat normally. The nurse should suggest that the parents try soft, bland foods rather than hot or cold foods; normal saline or bicarbonate mouthwashes; and local anesthetics. The stomatitis is a temporary condition; gavage feedings are not necessary. The child can resume good food habits as soon as the condition resolves.

32. A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention? a. Relax any eating pressures. b. Firmly insist that child eat normally. c. Begin gavage feedings to supplement diet. d. Serve foods that are either hot or cold.

ANS: A A multifaceted approach is necessary for children with severe stomatitis and anorexia. First, the parents should relax eating pressures. The nurse should suggest that the parents try soft, bland foods; normal saline or bicarbonate mouthwashes; and local anesthetics. The stomatitis is a temporary condition. The child can resume good food habits as soon as the condition resolves.

13. A child is prescribed baclofen (Lioresal) via intrathecal pump to treat severe muscle spasms related to cerebral palsy. What teaching does the nurse provide the child and parents? A. Do not let this prescription run out. B. The medication may cause gingival hyperplasia. C. Periodic serum drug levels are needed. D. Watch for excessive facial hair growth.

ANS: A Abrupt discontinuation of intrathecal baclofen can cause drastic effects, such as high fever, altered mental status, and exaggerated rebound spasticity and muscle rigidity. The parents should ensure there is a supply of this drug on hand at all times to avoid these effects. Gingival hyperplasia and hirsutism are side effects of phenytoin (Dilantin). Serum drug levels are not obtained with an intrathecal medication.

45. A nurse is monitoring a child after an interventional catheterization for PDA. Before the procedure, blood pressure was 98/42 mm Hg. After the procedure, blood pressure was 98/74 mm Hg. One hour later, the blood pressure is 96/34 mm Hg. What action by the nurse is best? A. Administer epinephrine (Adrenalin). B. Contact the provider. C. Document the findings. D. Give a rapid fluid bolus.

ANS: A After an interventional PDA repair, the child's pulse pressure should be normal (<40 mm Hg). Children with PDA usually have widened pulse pressure, which is normalized with correction. If the pulse pressure widens again the provider should be notified, as this may signal device embolization or dislodgement.

22. A child is 3 hours postoperative, having had an open reduction and internal fixation (ORIF) of a type IV tibial fracture, which is now also casted. Which action by the nurse takes priority? A. Assess neurovascular status every hour. B. Change IV pain medication to oral pills. C. Provide an ice bag for 30 minutes every hour. D. Teach parents about activity restrictions.

ANS: A After surgery and/or casting, it is vital to assess neurovascular status, which is usually done with postoperative vital signs. Excessive swelling can disrupt circulation to the extremity, so the nurse assesses the child's neurovascular status frequently. Applying ice is also a good intervention, but not for more than 15 minutes at a time. When the child is tolerating oral foods and fluids, the nurse can switch to pain pills from IV narcotics. Teaching is important, but not as important as preventing injury from complications.

8. 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.

19. A 6-year-old sustained a fractured femur and was put in Russell traction 2 days ago. She screams in pain when she raises herself onto the bedpan. Which nursing diagnosis takes highest priority for this child? a. Pain resulting from tissue trauma b. High risk for impaired skin integrity resulting from immobility c. Altered growth and development related to separation from family d. Altered urinary elimination related to immobility and traction

ANS: A Although all of these nursing diagnoses are relevant to the child in traction, pain resulting from muscle spasm and tissue trauma is the highest priority.

10. A nurse is conducting a sports fitness class for volunteer coaches. Which information provided by the nurse is the most appropriate? A. "Fractures heal more quickly in children because the bones are still growing." B. "Children are prone to fractures because their bones are weaker than adults' bones." C. "Ligaments are bands of fibrous tissue that hold muscles to the bones." D. "Once a child reaches adult height, bone development eventually stops."

ANS: A Although children are more prone to fractures than adults due to continued bone growth, because their bones are still growing, fractures heal quickly. Ligaments hold two or more bones or cartilages together. Bone is a dynamic tissue and continues to be developed and reabsorbed throughout life.

32. The nurse is caring for an adolescent with osteosarcoma being admitted to undergo chemotherapy. The adolescent had a right above-the-knee amputation 2 months ago and has been experiencing "phantom limb pain." Which prescribed medication is appropriate to administer to relieve phantom limb pain? a. Amitriptyline (Elavil) b. Hydrocodone (Vicodin) c. Oxycodone (OxyContin) d. Alprazolam (Xanax)

ANS: A Amitriptyline (Elavil) has been used successfully to decrease phantom limb pain. Opioids such as Vicodin or OxyContin would not be prescribed for this pain. A benzodiazepine, Xanax, would not be prescribed for this type of pain.

1. 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.

40. What is the nurse's first action when planning to teach the parents of an infant with a congenital heart defect (CHD)? a. Assess the parents' anxiety level and readiness to learn. b. Gather literature for the parents. c. Secure a quiet place for teaching. d. Discuss the plan with the nursing team.

ANS: A Any effort to organize the right environment, plan, or literature is of no use if the parents are not ready to learn or have high anxiety. Decreasing their level of anxiety is often needed before new information can be processed. A baseline assessment of prior knowledge should be taken into consideration before developing any teaching plan. Locating a quiet place for meeting with parents is appropriate; however, an assessment should be done before any teaching is done. Discussing a teaching plan with the nursing team is appropriate after an assessment of the parents' knowledge and readiness.

15. In which condition are all the formed elements of the blood simultaneously depressed? a. Aplastic anemia c. Thalassemia major b. Sickle cell anemia d. Iron deficiency anemia

ANS: A Aplastic anemia refers to a bone marrow-failure condition in which the formed elements of the blood are simultaneously depressed. Sickle cell anemia is a hemoglobinopathy in which normal adult hemoglobin is partly or completely replaced by abnormal sickle hemoglobin. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains. Iron deficiency anemia results in a decreased amount of circulating red cells.

18. In which of the conditions are all the formed elements of the blood simultaneously depressed? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron deficiency anemia

30. The nurse is planning care for an adolescent with acquired immunodeficiency syndrome. The priority nursing goal is to: a. Prevent infection. c. Restore immunologic defenses. b. Prevent secondary cancers. d. Identify source of infection.

ANS: A As a result of the immunocompromise that is associated with human immunodeficiency virus infection, the prevention of infection is paramount. Although certain precautions are justified in limiting exposure to infection, these must be balanced with the concern for the child's normal developmental needs. Restoring immunologic defenses is not currently possible. Current drug therapy is affecting the disease progression; although not a cure, these drugs can suppress viral replication, preventing further deterioration. Case finding is not a priority nursing goal.

18. Which observation may cause the nurse to consider the possibility of child abuse when a mother says that her young child fell down the basement stairs? a. Red, green, and yellow bruises on his body b. Bruises are dispersed on his head, arms, and legs c. A broken arm last year, and the child being described as accident-prone d. The mother is very anxious for her son to get medical attention

ANS: A As bruises heal, they change color in stages. Different colors of bruises indicate that injuries have not all occurred at the same time. The nurse must consider whether the bruises match the caretaker's explanation of what happened.

1. The nurse is assessing a child post-cardiac catheterization. Which complication might the nurse anticipate? a. Cardiac arrhythmia c. Congestive heart failure b. Hypostatic pneumonia d. Rapidly increasing blood pressure

ANS: A Because a catheter is introduced into the heart, a risk exists of catheter-induced arrhythmias occurring during the procedure. These are usually transient. Hypostatic pneumonia, congestive heart failure, and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization.

2. The nurse is assessing a child after a cardiac catheterization. Which complication should the nurse be assessing for? a. Cardiac arrhythmia b. Hypostatic pneumonia c. Heart failure d. Rapidly increasing blood pressure

ANS: A Because a catheter is introduced into the heart, a risk exists of catheter-induced dysrhythmias occurring during the procedure. These are usually transient. Hypostatic pneumonia, heart failure, and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization.

2. Which statement by a mother may indicate a cause for her 9-month-old's iron deficiency anemia? a. "Formula is so expensive. We switched to regular milk right away." b. "She almost never drinks water." c. "She doesn't really like peaches or pears, so we stick to bananas for fruit." d. "I give her a piece of bread now and then. She likes to chew on it."

ANS: A Because cow's milk contains very little iron, infants should drink iron-fortified formula for the first year of life.

2. What effect does immobilization have on the cardiovascular system? a. Venous stasis b. Increased vasopressor mechanism c. Normal distribution of blood volume d. Increased efficiency of orthostatic neurovascular reflexes

ANS: A Because of decreased muscle contraction, the physiologic effects of immobilization include venous stasis. This can lead to pulmonary emboli or thrombi. A decreased vasopressor mechanism results in orthostatic hypotension, syncope, hypotension, decreased cerebral blood flow, and tachycardia. An altered distribution of blood volume is found, with decreased cardiac workload and exercise tolerance. Immobilization causes a decreased efficiency of orthostatic neurovascular reflexes, with an inability to adapt readily to the upright position and pooling of blood in the extremities in the upright position

38. The nurse is planning care for an adolescent with AIDS. Which is the priority nursing goal? a. Preventing infection b. Preventing secondary cancers c. Restoring immunologic defenses d. Identifying source of infection

ANS: A Because the child is immunocompromised in association with HIV infection, the prevention of infection is paramount. Although certain precautions are justified in limiting exposure to infection, these must be balanced with the concern for the child's normal developmental needs. Preventing secondary cancers is not currently possible. Current drug therapy is affecting the disease progression; although not a cure, these drugs can suppress viral replication, preventing further deterioration. Case finding is not a priority nursing goal.

6. 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.

3. Which condition can result from the bone demineralization associated with immobility? a. Osteoporosis c. Pooling of blood b. Urinary retention d. Susceptibility to infection

ANS: A Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi. Urinary retention is secondary to the effect of immobilization on the urinary tract. Pooling of blood is a result of the cardiovascular effects of immobilization. Susceptibility to infection can result from the effects of immobilization on the respiratory and renal systems

4. Which can result from the bone demineralization associated with immobility? a. Osteoporosis b. Urinary retention c. Pooling of blood d. Susceptibility to infection

22. On entering the room of a child in Buck's traction, the nurse makes all of the following observations. Which observation requires a nursing intervention? a. Child's heels are placed firmly against the foot of the bed. b. Head of bed is elevated 20 degrees. c. Weights are hanging freely. d. Ropes are on pulleys.

ANS: A Buck's traction is dependent on the child as a counterweight. The heels should be elevated above the level of the foot of the bed.

9. The nurse is checking for capillary refill on a child in Bryant's traction. How long does it take for the toe to regain color if adequate perfusion is assessed? a. 3 seconds b. 4 seconds c. 5 seconds d. 6 seconds

ANS: A Capillary refill in 3 seconds or less is determined to be indicative of adequate perfusion

9. Which drug is an angiotensin-converting enzyme (ACE) inhibitor? a. Captopril (Capoten) c. Spironolactone (Aldactone) b. Furosemide (Lasix) d. Chlorothiazide (Diuril)

ANS: A Capoten is an ACE inhibitor. Lasix is a loop diuretic. Aldactone blocks the action of aldosterone. Diuril works on the distal tubules.

14. A nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor. Which drug should the nurse be administering? a. Captopril (Capoten) b. Furosemide (Lasix) c. Spironolactone (Aldactone) d. Chlorothiazide (Diuril)

ANS: A Captopril is an ACE inhibitor. Furosemide is a loop diuretic. Spironolactone blocks the action of aldosterone. Chlorothiazide works on the distal tubules.

9. Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include: a. Avoiding using any latex product. b. Using only nonallergenic latex products. c. Administering medication for long-term desensitization. d. Teaching the family about long-term management of asthma.

ANS: A Care must be taken that individuals who are at high risk for latex allergies do not come in direct or secondary contact with products or equipment containing latex at any time during medical treatment. There are no nonallergenic latex products. At this time desensitization is not an option. The child does not have asthma. The parents must be taught about allergy and the risk of anaphylaxis.

10. Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include which action? a. Avoid using any latex product. b. Use only nonallergenic latex products. c. Administer medication for long-term desensitization. d. Teach family about long-term management of asthma.

ANS: A Care must be taken that individuals who are at high risk for latex allergies do not come in direct or secondary contact with products or equipment containing latex at any time during medical treatment. There are no nonallergenic latex products. At this time, desensitization is not an option. The child does not have asthma. The parents must be taught about allergy and the risk of anaphylaxis.

25. Which nursing diagnosis would be a priority when preparing a plan of care for a child in a leg cast? a. Risk for altered peripheral tissue perfusion b. Risk for altered urine elimination c. Knowledge deficit d. Risk for infection

ANS: A Casting can lead to compromised tissue perfusion caused by increased pressure from edema or swelling pressing on the tissues. Neurovascular checks are an assessment priority.

4. The nurse is teaching parents about the importance of iron in a toddler's diet. Which explains why iron deficiency anemia is common during toddlerhood? a. Milk is a poor source of iron. b. Iron cannot be stored during fetal development. c. Fetal iron stores are depleted by age 1 month. d. Dietary iron cannot be started until age 12 months

ANS: A Children between the ages of 12 and 36 months are at risk for anemia because cow's milk is a major component of their diet and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by age 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-fortified formula, and cereals during the first 12 months of life.

4. Which statement best explains why iron deficiency anemia is common during toddlerhood? a. Milk is a poor source of iron. b. Iron cannot be stored during fetal development. c. Fetal iron stores are depleted by age 1 month. d. Dietary iron cannot be started until age 12 months.

ANS: A Children between the ages of 12 and 36 months are at risk for anemia because cow's milk is a major component of their diet, and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by age 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-fortified formula, and cereals during the first 12 months of life.

21. 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.

29. When assessing the child with osteogenesis imperfecta, the nurse should expect to observe: a. Discolored teeth. c. Increased muscle tone. b. Below-normal intelligence. d. Above-average stature.

ANS: A Children with osteogenesis imperfecta have incomplete development of bones, teeth, ligaments, and sclerae. Teeth are discolored because of abnormal enamel. Despite their appearance, children with osteogenesis imperfecta have normal or above-normal intelligence. The child with osteogenesis imperfecta has weak muscles and decreased muscle tone. Because of compression fractures of the spine, the child appears short.

36. A 42-lb (19-kg) child is admitted for initial management of cardiomyopathy (CMP). The physician leaves orders for carvedilol (Coreg), 15 mg orally twice a day. What action by the nurse is most appropriate? A. Ask the provider to clarify the dose. B. Consult pharmacy about the drug choice. C. Give the medication as ordered. D. Withhold any antacids in this patient.

ANS: A Coreg is a beta blocker and is used in the treatment of CMP. The safe dose for this drug is 0.07 mg/kg, with a maximal dose of 0.5 mg/kg. The dose of 15 mg is far above the safe dose range. The nurse should consult the provider about the dose. Consulting pharmacy about the appropriateness of this drug is unnecessary. There is no contraindication to antacids.

43. A nurse is caring for a patient in Crutchfield tongs. Which assessment finding requires immediate notification to the health-care provider? A. Altered mental status B. Crusted drainage at pin sites C. Irritability and pain D. WBCs of 98,000/mm3

ANS: A Crutchfield tongs are inserted into the skull. Any alteration in mental status could signify a serious complication, such as infection or intracranial bleeding (both are rare but possible). The nurse would not need to report crusted drainage, irritability and pain, or a normal white blood cell count.

13. The nurse is preparing to administer a dose of digoxin (Lanoxin) to a child in heart failure (HF). Which is a beneficial effect of administering digoxin (Lanoxin)? a. It decreases edema. b. It decreases cardiac output. c. It increases heart size. d. It increases venous pressure.

ANS: A Digoxin has a rapid onset and is useful for increasing cardiac output, decreasing venous pressure, and, as a result, decreasing edema. Cardiac output is increased by digoxin. Heart size and venous pressure are decreased by digoxin.

8. A beneficial effect of administering digoxin (Lanoxin) is that it: a. Decreases edema. c. Increases heart size. b. Decreases cardiac output. d. Increases venous pressure.

ANS: A Digoxin has a rapid onset and is useful in increasing cardiac output, decreasing venous pressure, and as a result decreasing edema. Heart size is decreased by digoxin

16. A possible cause of acquired aplastic anemia in children is: a. Drugs. c. Deficient diet. b. Injury. d. Congenital defect.

ANS: A Drugs such as chemotherapeutic agents and several antibiotics such as chloramphenicol can cause aplastic anemia. Fanconi syndrome is a primary form of the disorder, which is congenital/present-at-birth and not acquired after birth. Injury, deficient diet, and congenital defect are not causative agents in acquired aplastic anemia.

19. A possible cause of acquired aplastic anemia in children is: a. drugs. b. injury. c. deficient diet. d. congenital defect.

ANS: A Drugs, such as chemotherapeutic agents and several antibiotics (e.g., chloramphenicol), can cause aplastic anemia. Injury, deficient diet, and congenital defect are not causative agents in acquired aplastic anemia.

33. The parents of a child recently diagnosed with Duchenne's muscular dystrophy want to know if their infant twin daughters should be tested for the disease too. Which response by the nurse is the most appropriate? A. "No, Duchenne's muscular dystrophy is a sex-linked genetic disorder rarely affecting females." B. "No, infants the age of your daughters are too young to undergo testing for Duchenne's muscular dystrophy." C. "Yes, the earlier the diagnosis of any type of muscular dystrophy is made, the better the child's quality of life." D. "Yes, females are equally likely to have Duchenne's muscular dystrophy as are boys."

ANS: A Duchenne's muscular dystrophy is a sex-linked recessive disease that usually only affects males. Females with Turner's syndrome, in which the child only inherits one X chromosome from the mother, can be affected, but females are usually carriers. The infant twin daughters do not need to be tested.

29. A child has been hospitalized with suspected osteomyelitis. The child's white blood cell count (WBC) is 22,000/mm3 and his C-reactive protein is 15 mg/dL. Which conclusion by the nurse is appropriate based on these laboratory values? A. The child has an infection somewhere. B. The child has osteomyelitis. C. The child is immunocompromised. D. These tests are not related to the condition.

ANS: A Elevations in WBCs and C-reactive protein indicate an infection is present, but are not specific for any one kind of infection.

35. Which intervention should be included in the plan of care for an infant with the nursing diagnosis of Excess Fluid Volume related to congestive heart failure? a. Weigh the infant every day on the same scale at the same time. b. Notify the physician when weight gain exceeds more than 20 g/day. c. Put the infant in a car seat to minimize movement. d. Administer digoxin (Lanoxin) as ordered by the physician.

ANS: A Excess fluid volume may not be overtly visible. Weight changes may indicate fluid retention. Weighing the infant on the same scale at the same time each day ensures consistency. An excessive weight gain for an infant is an increase of more than 50 g/day. With fluid volume excess, skin will be edematous. The infant's position should be changed frequently to prevent undesirable pooling of fluid in certain areas. Lanoxin is used in the treatment of congestive heart failure to improve cardiac function. Diuretics will help the body get rid of excess fluid.

7. The nurse is providing instructions about how to treat a sprained ankle. What statement by the mother does the nurse recognize as a. "Apply warm compresses to the ankle for the first 24 hours." b. "Put an ice pack on the ankle, alternating 30 minutes on with 30 minutes off." c. "Wrap the ankle in an Ace bandage for support." d. "Keep the leg elevated when sitting.

ANS: A Heat is not a treatment for soft tissue injuries. The principles of managing soft tissue injuries are rest, ice, compression, and elevation.indicative of a need for additional teaching?

27. An adolescent with osteosarcoma is scheduled for a leg amputation in 2 days. The nurse's approach should include which action? a. Answering questions with straightforward honesty b. Avoiding discussing the seriousness of the condition c. Explaining that, although the amputation is difficult, it will cure the cancer d. Assisting the adolescent in accepting the amputation as better than a long course of chemotherapy

ANS: A Honesty is essential to gain the child's cooperation and trust. The diagnosis of cancer should not be disguised with falsehoods. The adolescent should be prepared for the surgery so he or she has time to reflect on the diagnosis and subsequent treatment. This allows questions to be answered. To accept the need for radical surgery, the child must be aware of the lack of alternatives for treatment. Amputation is necessary, but it will not guarantee a cure. Chemotherapy is an integral part of the therapy with surgery. The child should be informed of the need for chemotherapy and its side effects before surgery.

21. An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma. The nurse's approach should include: a. Answering questions with straightforward honesty. b. Avoiding discussing the seriousness of the condition. c. Explaining that, although the amputation is difficult, it will cure the cancer. d. Assisting the adolescent in accepting the amputation as better than a long course of chemotherapy.

ANS: A Honesty is essential to gain the cooperation and trust of the child. The diagnosis of cancer should not be disguised with falsehoods. The adolescent should be prepared in advance for the surgery so that there is time for reflection about the diagnosis and subsequent treatment. This allows questions to be answered. To accept the need for radical surgery, the child must be aware of the lack of alternatives for treatment. Amputation is necessary, but it will not guarantee a cure. Chemotherapy is an integral part of the therapy with surgery. The child should be informed of the need for chemotherapy and its side effects before surgery.

4. The nurse is conducting a staff in-service on common problems associated with myelomeningocele. Which common problem is associated with this defect? a. Hydrocephalus b. Craniosynostosis c. Biliary atresia d. Esophageal atresia

ANS: A Hydrocephalus is a frequently associated anomaly in 80% to 90% of children. Craniosynostosis is the premature closing of the cranial sutures and is not associated with myelomeningocele. Biliary and esophageal atresia is not associated with myelomeningocele.

4. Which problem is most often associated with myelomeningocele? a. Hydrocephalus c. Biliary atresia b. Craniosynostosis d. Esophageal atresia

ANS: A Hydrocephalus is an associated anomaly in 80% to 90% of children. Craniosynostosis is the premature closing of the cranial sutures and is not associated with myelomeningocele. Biliary and esophageal atresias are not associated with myelomeningocele.

1. The nurse is planning a staff in-service on childhood spastic cerebral palsy. Spastic cerebral palsy is characterized by: a. hypertonicity and poor control of posture, balance, and coordinated motion. b. athetosis and dystonic movements. c. wide-based gait and poor performance of rapid, repetitive movements. d. tremors and lack of active movement.

ANS: A Hypertonicity and poor control of posture, balance, and coordinated motion are part of the classification of spastic cerebral palsy. Athetosis and dystonic movements are part of the classification of dyskinetic (athetoid) cerebral palsy. Wide-based gait and poor performance of rapid, repetitive movements are part of the classification of ataxic cerebral palsy. Tremors and lack of active movement may indicate other neurologic disorders.

1. Spastic cerebral palsy is characterized by: a. Hypertonicity and poor control of posture, balance, and coordinated motion. b. Athetosis and dystonic movements. c. Wide-based gait and poor performance of rapid, repetitive movements. d. Tremors and lack of active movement.

ANS: A Hypertonicity and poor control of posture, balance, and coordinated motion are part of the classification of spastic cerebral palsy. Athetosis and dystonic movements are part of the classification of dyskinetic/athetoid cerebral palsy. Wide-based gait and poor performance of rapid, repetitive movements are part of the classification of ataxic cerebral palsy. Tremors and lack of active movement may indicate other neurologic disorders.

5. Which term is used to describe a type of fracture that does not produce a break in the skin? a. Simple c. Complicated b. Compound d. Comminuted

ANS: A If a fracture does not produce a break in the skin, it is called a simple or closed fracture. A compound or open fracture is one with an open wound through which the bone protrudes. A complicated fracture is one in which the bone fragments damage other organs or tissues. A comminuted fracture occurs when small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue. These are rare in children.

6. Which term is used to describe a type of fracture that does not produce a break in the skin? a. Simple b. Compound c. Complicated d. Comminuted

ANS: A If a fracture does not produce a break in the skin, it is called a simple, or closed, fracture. A compound, or open, fracture is one with an open wound through which the bone protrudes. A complicated fracture is one in which the bone fragments damage other organs or tissues. A comminuted fracture occurs when small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue. These are rare in children.

30. The nurse is administering an IV chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action? a. Stop drug infusion immediately. b. Recheck rate of drug infusion. c. Observe child closely for next 10 minutes. d. Explain to child that this is an expected side effect

ANS: A If an allergic reaction is suspected, the drug should be immediately discontinued. Any drug in the line should be withdrawn, and a normal saline infusion begun to keep the line open. Rechecking the rate of drug infusion, observing the child closely for next 10 minutes, and explaining to the child that this is an expected side effect can all be done after the drug infusion is stopped and the child is evaluated.

41. The nurse is administering an intravenous chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action? a. Stop drug infusion immediately. b. Recheck rate of drug infusion. c. Observe child closely for next 10 minutes. d. Explain to child that this is an expected side effect.

35. What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia? a. Immobilization and elevation of the affected joint b. Administration of acetaminophen for pain relief c. Assessment of the child's response to hospitalization d. Assessment of the impact of hospitalization on the family system

ANS: A Immobilization and elevation of the joint will prevent further injury until bleeding is resolved. Although acetaminophen may help with pain associated with the treatment of hemarthrosis, it is not the priority nursing intervention. Assessment of a child's response to hospitalization is relevant to all hospitalized children; however, in this situation, psychosocial concerns are secondary to physiologic concerns. A priority nursing concern for this child is the management of hemarthrosis. Assessing the impact of hospitalization on the family system is relevant to all hospitalized children; however, it is not the priority in this situation.

26. A child has coarctation of the aorta (CoA). The parents report that the child is hesitant to participate in activities due to aching in his legs. Which information does the nurse provide? A. "Aching or pain is due to lower blood pressure in the legs." B. "Encourage activity so that collateral circulation develops." C. "Maybe he is getting to much blood pressure medication." D. "Your child needs to rest and limit participation in activities."

ANS: A In CoA, the blood pressure to the lower extremities is less than 10 mm Hg lower than the BP in the upper extremities. Normally, the lower extremity BP should be the same or higher. The lack of perfusion with oxygenated blood leads to pain or aching in the legs. The nurse provides accurate information about the condition. Developing collateral circulation is not a treatment methodology as you would see in peripheral arterial occlusions. The blood pressure is not lower due to medication; it is a manifestation of the condition. The child should participate as he is able and comfortable in order to maximize growth and development.

7. 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.

10. The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly becomes cyanotic. Which statement by the father leads the nurse to determine he understood the instructions? a. "If the baby turns blue, I will hold him against my shoulder with his knees bent up toward his chest." b. "If the baby turns blue, I will lay him down on a firm surface with his head lower than the rest of his body." c. "If the baby turns blue, I will immediately put the baby upright in an infant seat." d. "If the baby turns blue, I will put the baby in supine position with his head elevated."

ANS: A In the event of a paroxysmal hypercyanotic or "tet" spell, the infant should be placed in a knee-chest position.

29. The parents of a child with transposition of the great vessels ask the nurse why the child looks blue. Which response by the nurse is the most appropriate? A. "Her body gets blood that doesn't have much oxygen." B. "Her lungs are underdeveloped and underperfused." C. "She is not able to regulate her temperature and is cold." D. "This is very unusual for this condition, so I'll ask the doctor."

ANS: A In this condition, the aorta arises from the right side of the body, so systemic circulation consists of oxygen-poor blood. The other answers are not appropriate.

9. The nurse is caring for a child with a diagnosis of Kawasaki disease. The child's parent asks the nurse, "How does Kawasaki disease affect my child's heart and blood vessels?" On what understanding is the nurse's response based? a. Inflammation weakens blood vessels, leading to aneurysm. b. Increased lipid levels lead to the development of atherosclerosis. c. Untreated disease causes mitral valve stenosis. d. Altered blood flow increases cardiac workload with resulting heart failure.

ANS: A Inflammation of vessels weakens the walls of the vessels and often results in aneurysm.

23. The nurse is preparing an adolescent with scoliosis for a Luque-rod segmental spinal instrumentation procedure. Which consideration should the nurse include? a. Nasogastric intubation and urinary catheter may be required. b. Ambulation will not be allowed for up to 3 months. c. Surgery eliminates the need for casting and bracing. d. Discomfort can be controlled with nonpharmacologic methods.

ANS: A Luque-rod segmental spinal instrumentation is a surgical procedure. Nasogastric intubation and urinary catheterization may be required. Ambulation is allowed as soon as possible. Depending on the instrumentation used, most patients walk by the second or third postoperative day. Casting and bracing are required postoperatively. The child usually has considerable pain for the first few days after surgery. Intravenous opioids should be administered on a regular basis.

32. The nurse is preparing an adolescent with scoliosis for a Luque-rod segmental spinal instrumentation procedure. Which consideration should the nurse include? a. Nasogastric intubation and urinary catheter may be required. b. Ambulation will not be allowed for up to 3 months. c. Surgery eliminates the need for casting and bracing. d. Discomfort can be controlled with nonpharmacologic methods.

4. A nurse is teaching a community class on heart disease in children. Which information about prevention is most important for the nurse to share? A. Many conditions are genetic, and preventative gene therapy may become possible. B. Maintaining good control of diabetes and hypertension prevents most cases. C. Prevention is impossible because there are few known causes of heart disease. D. Taking 400 mg/day of folic acid will prevent most known cardiac diseases.

ANS: A Most cases of congenital cardiac disease have no known cause. The most accurate statement is that genetic causes of heart disease may be prevented with gene therapy in the future. Controlling chronic health conditions is important but not the most accurate answer. Prevention is not totally impossible. Folic acid is important but has the most impact on preventing neural tube defects.

3. The most common problem of children born with a myelomeningocele is: a. Neurogenic bladder. c. Respiratory compromise. b. Intellectual impairment. d. Cranioschisis.

ANS: A Myelomeningocele is one of the most common causes of neuropathic (neurogenic) bladder dysfunction among children. Risk of intellectual impairment is minimized through early intervention and management of hydrocephalus. Respiratory compromise is not a common problem in myelomeningocele. Cranioschisis is a skull defect through which various tissues protrude. It is not associated with myelomeningocele

5. The nurse is teaching a group of nursing students about newborns born with the congenital defect of myelomeningocele. Which common problem is associated with this defect? a. Neurogenic bladder b. Mental retardation c. Respiratory compromise d. Cranioschisis

ANS: A Myelomeningocele is one of the most common causes of neuropathic (neurogenic) bladder dysfunction among children. Risk of mental retardation is minimized through early intervention and management of hydrocephalus. Respiratory compromise is not a common problem in myelomeningocele. Cranioschisis is a skull defect through which various tissues protrude. It is not associated with myelomeningocele.

30. Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis? a. Osler nodes b. Janeway lesions c. Subcutaneous nodules d. Aschoff nodes

ANS: A Osler nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial endocarditis. Janeway lesions are painless hemorrhagic areas on palms and soles in bacterial endocarditis. Subcutaneous nodules are nontender swellings, located over bony prominences, commonly found in rheumatic fever. Aschoff nodules are small nodules composed of cells and leukocytes found in the interstitial tissues of the heart in rheumatic myocarditis.

22. Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis? a. Osler's nodes c. Subcutaneous nodules b. Janeway lesions d. Aschoff's nodules

ANS: A Osler's nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial endocarditis. Janeway lesions are painless hemorrhagic areas on palms and soles in bacterial endocarditis. Subcutaneous nodules are nontender swellings located over bony prominences, commonly found in rheumatic fever. Aschoff's nodules are small nodules composed of cells and leukocytes found in the interstitial tissues of the heart in rheumatic myocarditis.

17. A child who has been limping for several weeks is brought to the clinic and undergoes radiological studies. The results show osteonecrosis. Which information does the nurse plan to teach the parents about their child's condition? A. Non-weight-bearing status and mobility limitations B. Overcorrection with serial casting for 2-3 years C. Surgical correction with the Z-plasty technique D. Wearing and caring for a Browne splint

ANS: A Osteonecrosis is a cardinal sign of Legg-Calvé-Perthes disease. This disorder is frequently treated with non-weight-bearing status and bracing or casting. The other treatment modalities are used to treat clubfoot.

19. Osteosarcoma is the most common bone cancer in children. Where are most of the primary tumor sites? a. Femur c. Pelvis b. Humerus d. Tibia

ANS: A Osteosarcoma is the most frequently encountered malignant bone cancer in children. The peak incidence is between ages 10 and 25 years. More than half occur in the femur. After the femur, most of the remaining sites are the humerus, tibia, pelvis, jaw, and phalanges

25. A nurse is conducting a staff in-service on childhood cancers. Which is the primary site of osteosarcoma? a. Femur b. Humerus c. Pelvis d. Tibia

14. A parent calls the clinic to report that his child's cast seems to be looser than it was yesterday. Which instruction is most appropriate for the nurse to provide to the parent? A. "Bring your child in so we can evaluate the cast." B. "If the cast is loose, circulation won't be compromised." C. "Pad the top of the cast with a small towel so it fits." D. "This is not unusual; just keep your next appointment."

ANS: A Parents should be instructed to take their child to a health-care provider if a cast appears loose, damaged, or soft. The other answers are not appropriate.

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

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

20. The nurse, caring for a child receiving chemotherapy, notes that the child's abdomen is firm and slightly distended. There is no record of a bowel movement for the last 2 days. What do these assessment findings suggest? a. Peripheral neuropathy b. Stomatitis c. Myelosuppression d. Hemorrhage

ANS: A Peripheral neuropathy may be signaled by severe constipation resulting from decreased nerve sensations in the bowel.

10. Which information about exercise should the nurse give the parents of a child with heart failure? A. Encourage activity on the days when your child feels well. B. Exercise is not allowed in children who have heart failure. C. Physical activity often makes heart failure worse in children. D. Your child will not be able to participate in contact sports.

ANS: A Physical activity is beneficial to patients with heart failure, as it can strengthen the heart muscle, possibly preventing or reducing further exacerbations. However, when the child is not feeling well, he or she should not be pushed into vigorous activity. Even walking can be helpful. Without exercise, the symptoms will worsen. Too rigorous an activity may make symptoms worse. Participating in contact sports will probably not be allowed, but this information is too narrow in scope to be the best answer.

25. A major clinical manifestation of rheumatic fever is: a. Polyarthritis. b. Osler's nodes. c. Janeway spots. d. Splinter hemorrhages of distal third of nails.

ANS: A Polyarthritis is swollen, hot, red, and painful joints. The affected joints will change every 1 to 2 days. Primarily the large joints are affected. Osler's nodes, Janeway spots, and splinter hemorrhages are characteristic of infective endocarditis.

33. The nurse is conducting a staff in-service on childhood-acquired heart diseases. Which is a major clinical manifestation of rheumatic fever? a. Polyarthritis b. Osler nodes c. Janeway spots d. Splinter hemorrhages of distal third of nails

ANS: A Polyarthritis, which is swollen, hot, red, and painful joints, is a major clinical manifestation of rheumatic fever. The affected joints will change every 1 to 2 days. Primarily the large joints are affected. Osler nodes, Janeway spots, and splinter hemorrhages are characteristic of infective endocarditis.

11. A child has significant polycythemia. When consulting with the health-care provider, which intervention does the nurse inquire about? A. Administering anticoagulants B. Implementing a fluid restriction C. Obtaining an oxygen saturation D. Starting cardiac rehabilitation

ANS: A Polycythemia (hemoglobin >15 g/dL) predisposes a child to thrombotic events, including stroke. The nurse would ask about an anticoagulant. A fluid restriction would "thicken" the blood even further, increasing the risk of thrombotic events. The nurse should be able to obtain an oxygen saturation as an independent nursing assessment. There is not enough information about the patient to recommend cardiac rehabilitation.

38. A child with pulmonary atresia exhibits cyanosis with feeding. On reviewing this child's laboratory values, the nurse is not surprised to notice which abnormality? a. Polycythemia c. Dehydration b. Infection d. Anemia

ANS: A Polycythemia is a compensatory response to chronic hypoxia. The body attempts to improve tissue oxygenation by producing additional red blood cells and thereby increases the oxygen-carrying capacity of the blood. Infection is not a clinical consequence of cyanosis. Although dehydration can occur in cyanotic heart disease, it is not a compensatory mechanism for chronic hypoxia. It is not a clinical consequence of cyanosis. Anemia may develop as a result of increased blood viscosity. Anemia is not a clinical consequence of cyanosis

11. A young boy has just been diagnosed with pseudohypertrophic (Duchenne's) muscular dystrophy. The management plan should include: a. Recommending genetic counseling. b. Explaining that the disease is easily treated. c. Suggesting ways to limit the use of muscles. d. Assisting the family in finding a nursing facility to provide his care.

ANS: A Pseudohypertrophic (Duchenne's) muscular dystrophy is inherited as an X-linked recessive gene. Genetic counseling is recommended for parents, female siblings, maternal aunts, and their female offspring. No effective treatment exists at this time for childhood muscular dystrophy. Maintaining optimal function of all muscles for as long as possible is the primary goal. It has been found that children who remain as active as possible are able to avoid wheelchair confinement for a longer time. Assisting the family in finding a nursing facility is inappropriate at the time of diagnosis. When the child becomes increasingly incapacitated, the family may consider home-based care, a skilled nursing facility, or respite care to provide the necessary care.

13. A 4-year-old child has just been diagnosed with pseudohypertrophic (Duchenne) muscular dystrophy. The management plan should include which action? a. Recommend genetic counseling. b. Explain that the disease is easily treated. c. Suggest ways to limit use of muscles. d. Assist family in finding a nursing facility to provide his care.

ANS: A Pseudohypertrophic (Duchenne) muscular dystrophy is inherited as an X-linked recessive gene. Genetic counseling is recommended for parents, female siblings, maternal aunts, and their female offspring. No effective treatment exists at this time for childhood muscular dystrophy. Maintaining optimal function of all muscles for as long as possible is the primary goal. It has been found that children who remain as active as possible are able to avoid wheelchair confinement for a longer time. Assisting the family in finding a nursing facility to provide his care is inappropriate at the time of diagnosis. When the child becomes increasingly incapacitated, the family may consider home-based care, a skilled nursing facility, or respite care to provide the necessary care.

1. What does the nurse explain that a ventricular septal defect will allow? a. Blood to shunt left to right, causing increased pulmonary flow and no cyanosis b. Blood to shunt right to left, causing decreased pulmonary flow and cyanosis c. No shunting because of high pressure in the left ventricle d. Increased pressure in the left atrium, impeding circulation of oxygenated blood in the circulating volume

ANS: A Pulmonary blood flow is increased when a ventricular septal defect exists. The blood shifts from left to right because of the higher pressure in the left ventricle. This particular shift does not cause cyanosis.

31. An inherited immunodeficiency disorder characterized by absence of both humoral and cell-mediated immunity is: a. Severe combined immunodeficiency syndrome (SCIDS). b. Acquired immunodeficiency syndrome. c. Wiskott-Aldrich syndrome. d. Fanconi syndrome.

ANS: A Severe SCIDS is a genetic disorder that results in deficits of both humoral and cellular immunity. Acquired immunodeficiency syndrome is not inherited. Wiskott-Aldrich syndrome is an X-linked recessive disorder with selected deficiencies of T and B lymphocytes. Fanconi syndrome is a hereditary disorder of red cell production.

40. The nurse is conducting a staff in-service on inherited childhood blood disorders. Which statement describes severe combined immunodeficiency syndrome (SCIDS)? a. There is a deficit in both the humoral and cellular immunity with this disease. b. Production of red blood cells is affected with this disease. c. Adult hemoglobin is replaced by abnormal hemoglobin in this disease. d. There is a deficiency of T and B lymphocyte production with this disease.

ANS: A Severe combined immunodeficiency syndrome (SCIDS) is a genetic disorder that results in deficits of both humoral and cellular immunity. Wiskott-Aldrich is an X-linked recessive disorder with selected deficiencies of T and B lymphocytes. Fanconi syndrome is a hereditary disorder of red cell production. Sickle cell disease is characterized by the replacement of adult hemoglobin with an abnormal hemoglobin S.

10. When both parents have sickle cell trait, which is the chance their children will have sickle cell anemia? a. 25% b. 50% c. 75% d. 100%

ANS: A Sickle cell anemia is inherited in an autosomal recessive pattern. If both parents have sickle cell trait (one copy of the sickle cell gene), then for each pregnancy, a 25% chance exists that their child will be affected with sickle cell disease. With each pregnancy, a 50% chance exists that the child will have sickle cell trait. Percentages of 75% and 100% are too high for the children of parents who have sickle cell trait.

9. Parents of a child with sickle cell anemia ask the nurse, "What happens to the hemoglobin in sickle cell anemia?" Which statement by the nurse explains the disease process?" a. Normal adult hemoglobin is replaced by abnormal hemoglobin. b. There is a lack of cellular hemoglobin being produced. c. There is a deficiency in the production of globulin chains. d. The size and depth of the hemoglobin are affected.

ANS: A Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Thalassemia major refers to a variety of inherited disorders characterized by deficiencies in production of certain globulin chains. Iron deficiency anemia affects the size and depth of the color.

10. A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What should the nurse suggest to remove this material? a. Soak in a bathtub. c. Apply powder to absorb material. b. Vigorously scrub the leg. d. Carefully pick material off of the leg.

ANS: A Simple soaking in the bathtub is usually sufficient for the removal of the desquamated skin and sebaceous secretions. It may take several days to eliminate the accumulation completely. The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding. Oil or lotion, but not powder, may provide comfort for the child.

12. A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. Which should the nurse suggest to remove this material? a. Soak in a bathtub. b. Vigorously scrub leg. c. Apply powder to absorb material. d. Carefully pick material off leg.

4. A young girl has just injured her ankle at school. In addition to calling the child's parents, the most appropriate immediate action by the school nurse is to: a. Apply ice. b. Observe for edema and discoloration. c. Encourage child to assume a comfortable position. d. Obtain parental permission for administration of acetaminophen or aspirin.

ANS: A Soft-tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. Observing for edema and discoloration, encouraging the child to assume a comfortable position, and obtaining parental permission or administration of acetaminophen or aspirin are not immediate priorities.

5. A young girl has just injured her ankle at school. In addition to calling the child's parents, the most appropriate, immediate action by the school nurse is to: a. apply ice. b. observe for edema and discoloration. c. encourage child to assume a position of comfort. d. obtain parental permission for administration of acetaminophen or aspirin.

ANS: A Soft-tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. Observing for edema and discoloration, encouraging the child to assume a position of comfort, and obtaining parental permission for administration of acetaminophen or aspirin are not immediate priorities. The application of ice can reduce the severity of the injury.

5. Which structural defects constitute tetralogy of Fallot? a. Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy b. Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy c. Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy d. Pulmonic stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

ANS: A Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. There is pulmonic stenosis but not aortic stenosis in tetralogy of Fallot. Right ventricular hypertrophy, not left ventricular hypertrophy, is present in tetralogy of Fallot. There is a ventricular septal defect, not an atrial septal defect, and overriding aorta, not aortic hypertrophy, is present.

9. The nurse is conducting a staff in-service on congenital heart defects. Which structural defect constitutes tetralogy of Fallot? a. Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy b. Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy c. Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy d. Pulmonic stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

ANS: A Tetralogy of Fallot has these four characteristics: pulmonic stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. There is pulmonic stenosis but not atrial stenosis in tetralogy of Fallot. Right ventricular hypertrophy, not left ventricular hypertrophy, is present in tetralogy of Fallot. Tetralogy of Fallot has right ventricular hypertrophy, not left ventricular hypertrophy, and an atrial septal defect, not aortic hypertrophy.

16. Four-year-old David is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. Which action should the nurse take first? a. Notify the practitioner of the changes noted. b. Give the child medication to relieve the pain. c. Reposition the child and notify physician. d. Chart the observations and check the extremity again in 15 minutes.

ANS: A The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner. Pain medication should be given after the practitioner is notified. Legg-Calvé-Perthes disease is an emergency condition; immediate reporting is indicated. The findings should be documented with ongoing assessment.

12. Four-year-old David is placed in Buck's extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. What should the nurse do first? a. Notify the practitioner of the changes noted. b. Give the child medication to relieve the pain. c. Reposition the child and notify the physician. d. Chart the observations and check the extremity again in 15 minutes.

ANS: A The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner. Pain medication should be given after the practitioner is notified. This is an emergency condition; immediate reporting is indicated. The findings should be documented with ongoing assessment.

3. The most appropriate nursing diagnosis for a child with anemia is: a. Activity Intolerance related to generalized weakness. b. Decreased Cardiac Output related to abnormal hemoglobin. c. Risk for Injury related to depressed sensorium. d. Risk for Injury related to dehydration and abnormal hemoglobin.

ANS: A The basic pathology in anemia is the decreased oxygen-carrying capacity of the blood. The nurse must assess the child's activity level (response to the physiologic state). The nursing diagnosis would reflect the activity intolerance. In generalized anemia no abnormal hemoglobin may be present. Only at a level of very severe anemia does cardiac output become altered. No decreased sensorium exists until profound anemia occurs. Dehydration and abnormal hemoglobin are not usually part of anemia.

15. Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should be based on knowing that: a. The child needs opportunities to play with peers. b. The child needs to understand that peers' activities are too strenuous. c. Parents can meet all the child's needs. d. Constant parental supervision is needed to avoid overexertion.

ANS: A The child needs opportunities for social development. Children usually limit their activities if allowed to set their own pace and regulate their activities. The child will limit activities as necessary. Parents must be encouraged to seek appropriate social activities for the child, especially before kindergarten. The child needs to have activities that foster independence.

23. Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should be based on which statement? a. Child needs opportunities to play with peers. b. Child needs to understand that peers' activities are too strenuous. c. Parents can meet all of the child's needs. d. Constant parental supervision is needed to avoid overexertion.

ANS: A The child needs opportunities for social development. Children usually limit their activities if allowed to set their own pace. The child will limit activities as necessary. Parents must be encouraged to seek appropriate social activities for the child, especially before kindergarten. The child needs to have activities that foster independence. The child will be able to regulate activities.

7. What should the nurse closely assess in a child receiving a transfusion? a. Fever b. Lethargy c. Jaundice d. Bradycardia

ANS: A The child receiving a blood transfusion is observed for signs of a transfusion reaction including chills, itching, fever, rash, headache, and back pain.

22. The most recent blood count for a child who received chemotherapy last week shows neutropenia. What is the priority nursing diagnosis for this child? a. Risk for infection b. Risk for hemorrhage c. Altered skin integrity d. Disturbance in body image

ANS: A The child with neutropenia is at risk for infection.

26. A child is going home with a distractor in place after surgery to repair syndactyly. Which discharge teaching is most important? A. Clean around the pin sites twice a day with soap and water. B. Don't pull the pins; they will gradually fall out on their own. C. Perform range-of-motion exercises to the affected fingers daily. D. Turn the screw with the Allen wrench twice a day for a week.

ANS: A The distractor uses pins placed in the bone fragments that extend through the skin. The parents need to care for the pins using soap and water to clean around the exit sites. The pins need to be removed surgically; they will not fall out on their own. Because the bones are pinned, range of motion is not possible. The Allen wrench is used to turn the screw on the distractor twice a week.

34. The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement? a. Administering penicillin b. Avoiding salicylates (aspirin) c. Imposing strict bed rest for 4 to 6 weeks d. Administering corticosteroids if chorea develops

ANS: A The goal of medical management is the eradication of the hemolytic streptococci. Penicillin is the drug of choice. Salicylates can be used to control the inflammatory process, especially in the joints, and reduce the fever and discomfort. Bed rest is recommended for the acute febrile stage, but it does not need to be strict. The chorea is transient and will resolve without treatment.

49. The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement? a. Administering penicillin b. Avoiding salicylates (aspirin) c. Imposing strict bed rest for 4 to 6 weeks d. Administering corticosteroids if chorea develops

34. In which situation is there the greatest risk that a newborn infant will have a congenital heart defect (CHD)? a. Trisomy 21 detected on amniocentesis b. Family history of myocardial infarction c. Father has type 1 diabetes mellitus d. Older sibling born with Turner's syndrome

ANS: A The incidence of congenital heart disease is approximately 50% in children with trisomy 21 (Down syndrome). A family history of congenital heart disease, not acquired heart disease, increases the risk of giving birth to a child with CHD. Infants born to mothers who are insulin dependent have an increased risk of CHD. Infants identified as having certain genetic defects, such as Turner's syndrome, have a higher incidence of CHD.

46. The nurse is caring for an infant with congestive heart disease (CHD). The nurse should plan which intervention to decrease cardiac demands? a. Organize nursing activities to allow for uninterrupted sleep. b. Allow the infant to sleep through feedings during the night. c. Wait for the infant to cry to show definite signs of hunger. d. Discourage parents from rocking the infant

ANS: A The infant requires rest and conservation of energy for feeding. Every effort is made to organize nursing activities to allow for uninterrupted periods of sleep. Whenever possible, parents are encouraged to stay with their infant to provide the holding, rocking, and cuddling that help children sleep more soundly. To minimize disturbing the infant, changing bed linens and complete bathing are done only when necessary. Feeding is planned to accommodate the infant's sleep and wake patterns. The child is fed at the first sign of hunger, such as when sucking on fists, rather than waiting until he or she cries for a bottle because the stress of crying exhausts the limited energy supply. Because infants with CHD tire easily and may sleep through feedings, smaller feedings every 3 hours may be helpful.

52. The nurse is caring for an infant with congestive heart disease (CHD). The nurse should plan which intervention to decrease cardiac demands? a. Organize nursing activities to allow for uninterrupted sleep. b. Allow the infant to sleep through feedings during the night. c. Wait for the infant to cry to show definite signs of hunger. d. Discourage parents from rocking the infant

19. The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct? a. "You may need to increase the caloric density of your infant's formula." b. "You should feed your baby every 2 hours." c. "You may need to increase the amount of formula your infant eats with each feeding." d. "You should place a nasal oxygen cannula on your infant during and after each feeding."

ANS: A The metabolic rate of infants with heart failure is greater because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of the average infants, yet their ability to take in the calories is diminished by their fatigue. Infants with heart failure should be fed every 3 hours; a 2-hour schedule does not allow for enough rest, and a 4-hour schedule is too long. Fluids must be carefully monitored because of the heart failure. Infants do not require supplemental oxygen with feedings.

48. The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct? a. "You may need to increase the caloric density of your infant's formula." b. "You should feed your baby every 2 hours." c. "You may need to increase the amount of formula your infant eats with each feeding." d. "You should place a nasal oxygen cannula on your infant during and after each feeding."

5. 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.

31. The mother of a toddler reports to the nurse that the child becomes cyanotic when he cries. Which question by the nurse is most important to ask the mother? A. "Does he squat while he cries?" B. "How long does the cyanosis last?" C. "Is he growing normally?" D. "What was his birth weight?"

ANS: A The mother is describing a "tet" spell, which is a hallmark sign of tetralogy of Fallot. A child with this condition becomes cyanotic when playing or crying and draws his or her legs up or squats. By doing this, the child lowers his or her pulmonary vascular resistance and relieves the cyanosis. The other questions are important, but will not give information specific to this condition.

3. 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.

19. The nurse notes that a 4-year-old child's gums bleed easily and he has bruising and petechiae on his extremities. Which lab value is consistent with these symptoms? a. Platelet count of 25,000/mm3 b. Hemoglobin level of 8 g/dL c. Hematocrit level of 36% d. Leukocyte count of 14,000/mm3

ANS: A The normal platelet count is 150,000 to 400,000/mm3. This finding is very low, indicating an increased bleeding potential.

15. What nursing action will significantly decrease the risk of serious complications for a child in Bryant's traction? a. Neurovascular checks are done frequently. b. Bandages are wrapped tightly. c. The child is restrained from rolling over. d. The child's buttocks are resting on the bed.

ANS: A The nurse caring for a child in traction must be alert for Volkmann's ischemia, which occurs when circulation is obstructed.

14. What intervention is appropriate for a nurse assessing a preadolescent child for scoliosis? a. Ask the child to bend forward at the waist and observe the child's back for asymmetry. b. Observe the gait while the child is walking forward heel to toe. c. Have the child flex the knees and look for uneven knee height. d. Look at the child's shoulders and hips while fully clothed.

ANS: A The nurse looks at the back as the child bends forward for general body alignment and asymmetry.

20. What is most descriptive of the therapeutic management of osteosarcoma? a. Treatment usually consists of surgery and chemotherapy. b. Amputation of the affected extremity is rarely necessary. c. Intensive irradiation is the primary treatment. d. Bone marrow transplantation offers the best chance of long-term survival.

ANS: A The optimal therapy for osteosarcoma is a combination of surgery and chemotherapy. Amputation is frequently required. Intensive irradiation and bone marrow transplantation are usually not part of the therapeutic management

26. The nurse is taking care of an adolescent with osteosarcoma. The parents ask the nurse about treatment. The nurse should make which accurate response about treatment for osteosarcoma? a. Treatment usually consists of surgery and chemotherapy. b. Amputation of affected extremity is rarely necessary. c. Intensive irradiation is the primary treatment. d. Bone marrow transplantation offers the best chance of long-term survival.

ANS: A The optimal therapy for osteosarcoma is a combination of surgery and chemotherapy. Intensive irradiation and bone marrow transplantation are usually not part of the therapeutic management.

3. The nurse should monitor for which effect on the cardiovascular system when a child is immobilized? a. Venous stasis b. Increased vasopressor mechanism c. Normal distribution of blood volume d. Increased efficiency of orthostatic neurovascular reflexes

ANS: A The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. A decreased vasopressor mechanism results in orthostatic hypotension, syncope, hypotension, decreased cerebral blood flow, and tachycardia. An altered distribution of blood volume is found with decreased cardiac workload and exercise tolerance. Immobilization causes a decreased efficiency of orthostatic neurovascular reflexes with an inability to adapt readily to the upright position and with pooling of blood in the extremities in the upright position.

4. A father asks why his child with tetralogy of Fallot seems to favor a squatting position. What is the nurse's best response? a. Squatting increases the return of venous blood back to the heart. b. Squatting decreases arterial blood flow away from the heart. c. Squatting is a common resting position when a child is tachycardic. d. Squatting increases the workload of the heart.

ANS: A The squatting position allows the child to breathe more easily because systemic venous return is increased.

28. Discharge planning for the child with juvenile arthritis includes the need for: a. Routine ophthalmologic examinations to assess for visual problems. b. A low-calorie diet to decrease or control weight in the less mobile child. c. Avoiding the use of aspirin to decrease gastric irritation. d. Immobilizing the painful joints, which are the result of the inflammatory process.

ANS: A The systemic effects of juvenile arthritis can result in visual problems, making routine eye examinations important. Children with juvenile arthritis do not have problems with increased weight and often are anorexic and in need of high-calorie diets. Children with arthritis are often treated with aspirin. Children with arthritis are able to immobilize their own joints. Range-of-motion exercises are important for maintaining joint flexibility and preventing restricted movement in the affected joints.

21. A nurse is caring for a child who had an open reduction and internal fixation (ORIF) of a femur fracture 12 hours ago. The nurse finds the child pale and short of breath. What action by the nurse takes priority? A. Assess oxygen saturation while a coworker calls the physician. B. Assess and treat the child for pain or anxiety as needed. C. Raise the head of the bed to a 45°angle and reassess. D. Review the child's postoperative hemoglobin and hematocrit.

ANS: A This child appears to be experiencing a complication of fracture, which may include shock, fat embolism, deep vein thrombosis, pulmonary embolism, and infection. Shortness of breath should alert the nurse to a respiratory complication as a first priority. The nurse should have a coworker call the physician while obtaining other assessment data, including oxygen saturation, vital signs, and a respiratory assessment. Although it is possible that a postoperative hemoglobin and hematocrit are low enough that the child is experiencing shock, the priority steps in assessing and intervening are airway, breathing, and circulation (ABCs), so breathing comes before circulation. The child may have pain or anxiety, but these are not the priority. Raising the head of the bed may or may not be helpful, but the nurse first needs to assess oxygen saturation.

22. 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.

17. A 6-year-old with leukemia asks, "Who will take care of me in heaven?" What is the best response by the nurse? a. "Who do you think will take care of you?" b. "Your grandparents and God will take care of you." c. "Your mom will know more about that than I do." d. "Why are you asking me that?"

ANS: A This response gives the child an opportunity to verbalize his or her feelings and concerns, whereas closed responses shut off communication. The asking of a "why" question is not therapeutic as it calls for justification.

39. The school nurse is informed that a child with human immunodeficiency virus (HIV) will be attending school soon. Which is an important nursing intervention? a. Carefully follow universal precautions. b. Determine how the child became infected. c. Inform the parents of the other children. d. Reassure other children that they will not become infected.

ANS: A Universal precautions are necessary to prevent further transmission of the disease. It is not the role of the nurse to determine how the child became infected. Informing the parents of other children and reassuring children that they will not become infected is a violation of the child's right to privacy.

43. The school nurse is informed that a child with human immunodeficiency virus (HIV) will be attending school soon. Which is an important nursing intervention? a. Carefully follow universal precautions. b. Determine how the child became infected. c. Inform the parents of the other children. d. Reassure other children that they will not become infected.

ANS: A Universal precautions are necessary to prevent further transmission of the disease. It is not the role of the nurse to determine how the child became infected. Informing the parents of other children and reassuring other children that they will not become infected is a violation of the child's right to privacy.

24. A child is being released from the hospital after surgical correction of an atrioventricular canal defect (AVC). What referral by the nurse is most appropriate? A. Down syndrome support group B. Hospice services team C. Lions eye bank D. Transplant team

ANS: A Up to 75% of cases of AVC occur in children with Down syndrome, so this is the most appropriate referral if this is the case for this child. There is no information in the stem of the question to indicate that the child is terminally ill; the Lions eye bank is unrelated to this condition, and the child is probably not a candidate for a heart transplant because these defects can be repaired surgically.

5. An infant is experiencing dyspnea related to patent ductus arteriosus (PDA). What does the nurse understand regarding why dyspnea occurs? a. Blood is circulated through the lungs again, causing pulmonary circulatory congestion. b. Blood is shunted past the pulmonary circulation, causing pulmonary hypoxia. c. Blood is shunted past cardiac arteries, causing myocardial hypoxia. d. Blood is circulated through the ductus from the pulmonary artery to the aorta, bypassing the left side of the heart.

ANS: A When PDA is present, oxygenated blood recycles through the lungs, overburdening the pulmonary circulation.

5. A 2-year-old child has been diagnosed with hemophilia A. What information should the nurse include in a teaching plan about home care? a. If bleeding occurs, apply pressure, ice, elevate, and rest the extremity. b. Children's aspirin in lowered doses may be given for joint discomfort. c. A firm, dry toothbrush should be used to clean teeth at least twice a day. d. Do not permit interactive play with other children.

ANS: A When bleeding occurs, the traditional approach is to follow RICE—rest, ice, compression, and elevation.

8. On admission, a child with leukemia has widespread purpura and a platelet count of 19,000/mm3. What is the priority nursing intervention? a. Assessing neurological status b. Inserting an intravenous line c. Monitoring vital signs during platelet transfusions d. Providing family education about how to prevent bleeding

ANS: A When platelets are low, the greatest danger is spontaneous intracranial bleeding. Neurological assessments are therefore a priority of care.

34. The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations should the nurse expect to observe (Select all that apply)? a. Positive Ortolani sign b. Unequal gluteal folds c. Negative Babinski's sign d. Trendelenburg's sign e. Telescoping of the affected limb f. Lordosis

ANS: A, B A positive Ortolani sign and unequal gluteal folds are clinical manifestations of developmental dysplasia of the hip seen from birth to 2 to 3 months. Negative Babinski's sign, Trendelenburg's sign, telescoping of the affected limb, and lordosis are not clinical manifestations of developmental dysplasia of the hip.

1. The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Positive Ortolani click b. Unequal gluteal folds c. Negative Babinski sign d. Trendelenburg sign e. Telescoping of the affected limb f. Lordosis

ANS: A, B A positive Ortolani test and unequal gluteal folds are clinical manifestations of developmental dysplasia of the hip seen from birth to 2 to 3 months. Unequal gluteal folds, negative Babinski sign, and Trendelenburg sign are signs that appear in older infants and children. Telescoping of the affected limb and lordosis are not clinical manifestations of developmental dysplasia of the hip.

3. An adolescent with juvenile idiopathic arthritis (JIA) is prescribed abatacept (Orencia). Which should the nurse teach the adolescent regarding this medication? (Select all that apply.) a. Avoid receiving live immunizations while taking the medication. b. Before beginning this medication, a tuberculin screening test will be done. c. You will be getting a twice-a-day dose of this medication. d. This medication is taken orally.

ANS: A, B Abatacept reduces inflammation by inhibiting T cells and is given intravenously every 4 weeks. Possible side effects of biologics include an increased infection risk. Because of the infection risk, children should be evaluated for tuberculosis exposure before starting these medications. Live vaccines should be avoided while taking these agents.

4. A school-age child is diagnosed with systemic lupus erythematosus (SLE). The nurse should plan to implement which interventions for this child? (Select all that apply.) a. Instructions to avoid exposure to sunlight b. Teaching about body changes associated with SLE c. Preparation for home schooling d. Restricted activity

ANS: A, B Key issues for a child with SLE include therapy compliance; body-image problems associated with rash, hair loss, and steroid therapy; school attendance; vocational activities; social relationships; sexual activity; and pregnancy. Specific instructions for avoiding exposure to the sun and UVB light, such as using sunscreens, wearing sun-resistant clothing, and altering outdoor activities, must be provided with great sensitivity to ensure compliance while minimizing the associated feeling of being different from peers. The child should continue school attendance in order to gain interaction with peers and activity should not be restricted, but promoted.

36. A school-age child is diagnosed with systemic lupus erythematosus (SLE). The nurse should plan to implement which interventions for this child (Select all that apply)? a. Instructions to avoid exposure to sunlight b. Teaching about body changes associated with SLE c. Preparation for home schooling d. Restricted activity

ANS: A, B Key issues for a child with SLE include therapy compliance; body-image problems associated with rash, hair loss, and steroid therapy; school attendance; vocational activities; social relationships; sexual activity; and pregnancy. Specific instructions for avoiding exposure to the sun and ultraviolet B light, such as using sunscreens, wearing sun-resistant clothing, and altering outdoor activities, must be provided with great sensitivity to ensure compliance while minimizing the associated feeling of being different from peers. The child should continue school attendance in order to gain interaction with peers and activity should not be restricted, but promoted.

23. The nurse in the neonatal intensive care unit is caring for an infant with myelomeningocele scheduled for surgical repair in the morning. Which early signs of infection should the nurse monitor on this infant (Select all that apply)? a. Temperature instability d. Bradycardia b. Irritability e. Hypertension c. Lethargy

ANS: A, B, C The nurse should observe an infant with unrepaired myelomeningocele for early signs of infection, such as temperature instability (axillary), irritability, and lethargy. Bradycardia and hypertension are not early signs of infection in infants.

5. The nurse in the neonatal intensive care unit is caring for an infant with myelomeningocele scheduled for surgical repair in the morning. Which early signs of infection should the nurse monitor on this infant? (Select all that apply.) a. Temperature instability b. Irritability c. Lethargy d. Bradycardia e. Hypertension

29. What are the classic symptoms of thalassemia major (Cooley's anemia)? (Select all that apply.) a. Hepatomegaly b. Jaundice c. Protruding teeth d. Pathological fractures e. Renal failure

ANS: A, B, C, D All of the options are classic signs of thalassemia major except renal failure

6. 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.

3. A pediatric nurse palpates a 2-year-old child's liver at 4 cm below the right costal margin. Which actions by the nurse are appropriate? (Select all that apply.) A. Assess work of breathing. B. Auscultate lung sounds. C. Calculate child's intake and output. D. Determine last bowel movement. E. Listen for heart murmur.

ANS: A, B, C, D An enlarged liver in a child can be indicative of heart failure or fluid overload from congenital heart defects. Assessing for respiratory distress, listening to heart and lung sounds, and calculating I&O will all give information related to cardiac function. Bowel movements are not related.

11. The pediatric intensive care nurse assesses for the main complications following cardiac transplantation. Which complications is the nurse assessing for after cardiac transplantation? (Select all that apply.) A. Coronary artery disease B. Infection C. Post-transplant lymphoproliferative disorder D. Rejection E. Renal failure

ANS: A, B, C, D Coronary artery disease, infection, post-transplant lymphoproliferative disorder, and rejection are the main complications after cardiac transplantation. Renal failure may occur, but is not one of the major complications.

28. What should be included in the nursing care of a 12-year-old child receiving radiation therapy for Hodgkin's disease? (Select all that apply.) a. Application of sunblock b. Appetite stimulation c. Conservation of energy d. Provision for expressions of anger e. Preparation for premature sexual development

ANS: A, B, C, D Sun block should be applied to skin after radiation to prevent burning. Low energy levels produce anorexia and anger in many young patients. Radiation delays the development of secondary sex characteristics and menses.

26. The nurse is caring for a child with a low platelet count. What skin assessments would alert the nurse to bleeding? (Select all that apply.) a. Petichiae b. Purpura c. Ecchymosis d. Hematoma e. Lymphadenopathy

ANS: A, B, C, D The reduction or destruction of platelets in the body interferes with the clotting mechanism. Skin lesions that are common to these disorders include petechiae, a bluish, nonblanching, pinpoint-sized lesion; purpura, groups of adjoining petechiae; ecchymosis, an isolated bluish lesion larger than a petechia; and hematoma, a raised ecchymosis. Lymphadenopathy is an enlargement of lymph nodes that is indicative of infection or disease.

6. A 10-year-old child has had a sunken chest since birth, but has recently been noted to have activity intolerance when playing. Which diagnostic testing does the nurse teach the child and parents about? (Select all that apply.) A. Chest x-ray B. Chromosome analysis C. ECG and echocardiogram D. Pulmonary function studies E. Ultrasound of the chest

ANS: A, B, C, D This child has signs and symptoms of pectus excavatum, which manifests with a sunken chest. If the cardiac or respiratory systems are involved, the child will show exercise intolerance (changes in vital signs, changes on ECG, complaints of chest pain or shortness of breath with activity). Common diagnostic measures for this disorder include chest x-ray, chromosomal analysis or enzyme studies, ECG and/or echocardiogram, pulmonary function studies, and a stress test. Ultrasound is not used.

4. 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.

2. The faculty is discussing cardiac output with a student. Which components comprise the cardiac output? (Select all that apply.) A. Afterload B. Contractility C. Heart rate D. Hemoglobin E. Stroke volume

ANS: A, B, C, E Cardiac output is the product of stroke volume and heart rate (CO = SV ´ HR). Afterload and contractility are components of stroke volume. Hemoglobin is not related to cardiac output but does impact tissue oxygenation.

23. What assessment(s) in a child with tetralogy of Fallot would indicate the child is experiencing a paroxysmal hypercyanotic episode? (Select all that apply.) a. Spontaneous cyanosis b. Dyspnea c. Weakness d. Dry cough e. Syncope

ANS: A, B, C, E Indicators of a paroxysmal hypercyanotic episode or a "tet" episode are spontaneous cyanosis, dyspnea, weakness, and syncope.

21. How would the nurse caring for an infant with congestive heart failure (CHF) modify feeding techniques to adapt for the child's weakness and fatigue? (Select all that apply.) a. Feeding more frequently with smaller feedings b. Using a soft nipple with enlarged holes c. Holding and cuddling the child during feeding d. Substituting glucose water for formula e. Offering high-caloric formula

ANS: A, B, C, E Infants with CHF fatigue easily. Feeding can be given more frequently in smaller amounts through a soft, large-holed nipple. Formulas with a denser caloric content can be offered. The child may be encouraged to nurse if he or she is held.

2. 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.

31. The family of a child receiving chemotherapy for leukemia should be taught to focus on which aspect(s) of the child's care? (Select all that apply.) a. Using a support group b. Stimulating appetite c. Maintaining adequate hydration d. Continuing with scheduled immunizations e. Reporting exposure to infectious diseases

ANS: A, B, C, E Support groups are helpful for emotional support and realistic tips on care. The child on chemotherapy is anorexic and has no appetite. Maintenance of hydration is essential for the adequate therapeutic effect of the drugs. Because the drugs suppress the bone marrow, children are at risk for infection, and the suppression will not allow the antibody response needed for immunization.

3. The nurse is conducting discharge teaching to parents of a preschool child with myelomeningocele, repaired at birth, being discharged from the hospital after a urinary tract infection (UTI). Which should the nurse include in the discharge instructions related to management of the child's genitourinary function? (Select all that apply.) a. Continue to perform the clean intermittent catheterizations (CIC) at home. b. Administer the oxybutynin chloride (Ditropan) as prescribed. c. Reduce fluid intake in the afternoon and evening hours. d. Monitor for signs of a recurrent urinary tract infection. e. Administer furosemide (Lasix) as prescribed.

ANS: A, B, D Discharge teaching to prevent renal complications in a child with myelomeningocele include: (1) regular urologic care with prompt and vigorous treatment of infections; (2) a method of regular emptying of the bladder, such as clean intermittent catheterization (CIC) taught to and performed by parents and self-catheterization taught to children; (3) medications to improve bladder storage and continence, such as oxybutynin chloride (Ditropan) and tolterodine (Detrol). Fluids should not be limited and Lasix is not used to improve renal function for children with myelomeningocele.

22. The nurse is conducting discharge teaching with parents of a preschool child with myelomeningocele, repaired at birth, who is being discharged from the hospital after a urinary tract infection (UTI). Which should the nurse include in the discharge instructions related to management of the child's genitourinary function (Select all that apply)? a. Continue to perform the clean intermittent catheterizations (CIC) at home. b. Administer the oxybutynin chloride (Ditropan) as prescribed. c. Reduce fluid intake in the afternoon and evening hours. d. Monitor for signs of a recurrent UTI. e. Administer furosemide (Lasix) as prescribed.

ANS: A, B, D Discharge teaching to prevent renal complications in a child with myelomeningocele include: (1) regular urologic care with prompt and vigorous treatment of infections; (2) a method of regular emptying of the bladder, such as clean intermittent catheterization (CIC) taught to and performed by parents and self-catheterization taught to children; and (3) medications to improve bladder storage and continence, such as oxybutynin chloride (Ditropan) and tolterodine (Detrol). Fluids should not be limited, and Lasix is not used to improve renal function for children with myelomeningocele.

27. Why would the nurse urge the family of a dying 12-year-old boy to include his 8-year-old sister in care? (Select all that apply.) a. She will feel less neglected by the parents. b. She can make amends for past hostilities to her brother. c. She will feel increased helplessness. d. She can express her feelings through care. e. She can experience being supportive of her parents and brother

ANS: A, B, D, E All options are potential benefits to including the sibling in the care of a dying child except increased helplessness. She would feel less helpless.

3. 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.

25. A 16-year-old patient is diagnosed with primary hypertension. What risk factors does the nurse mention when providing education on this diagnosis to the patient and his family? (Select all that apply.) a. Heredity b. Stress c. Congenital defect d. Obesity e. Poor diet

ANS: A, B, D, E Primary, or essential, hypertension implies that no known underlying disease is present. Nevertheless, heredity, obesity, stress, and a poor diet and exercise pattern can contribute to any type of hypertension.

32. The nurse explains that the COPP medical regimen for the treatment of Hodgkin's disease uses a combination of which drugs? (Select all that apply.) a. Vincristine b. Cyclophosphamide c. Methotrexate d. Prednisone e. Procarbazine hydrochloride

ANS: A, B, D, E The COPP medical regimen includes the combination of cyclophosphamide, vincristine (Oncovin), prednisone, and procarbazine hydrochloride.

30. How has synthetic recombinant antihemophilic factor improved the management of hemophilia? (Select all that apply.) a. Eliminates the need for frequent transfusions b. Can be administered by family at home c. Prevents hemorrhage d. Reduces cost of care of the hemophiliac e. Reduces risk of HIV and hepatitis A and B transmission

ANS: A, B, D, E The drug can be given at home by the family. Because it supplies the missing factor, transfusions are not necessary and consequently the exposure to HIV and hepatitis A and B is reduced. Cost of care is greatly reduced because hospitalizations and transfusions are not as frequently required. The drug does not prevent hemorrhage; it makes hemorrhage manageable.

22. What are the four structural heart anomalies that make up the tetralogy of Fallot? (Select the four that apply.) a. Hypertrophied right ventricle b. Patent ductus arteriosus c. Ventral septal defect d. Narrowing of pulmonary artery e. Dextroposition of aorta

ANS: A, B, D, E The four anomalies that comprise tetralogy of Fallot are hypertrophied right ventricle, patent ductus arteriosus, stenosis of pulmonary artery, and dextroposition of the aorta.

29. The nurse demonstrates which similarities among all traction devices? (Select all that apply.) a. Pull the limb into extension b. Decrease muscle spasm c. Reduce pain d. Align two bone fragments e. Immobilize the limb

ANS: A, B, D, E Tractions are designed to immobilize and pull limbs into extension. Traction can also align broken bones and decrease muscle spasm. Although some traction devices may relieve pain, many may actually cause pain.

1. A parent asks about the process of bone growth. When explaining bone development to the parent, which substances does the nurse include in the teaching session as being necessary? (Select all that apply.) A. Calcitonin B. Calcium C. Estrogen D. Thyroid hormones E. Vitamin D

ANS: A, B, E Bone growth depends on several substances, including calcium, calcitonin, parathyroid hormone, vitamin D, and other minerals and enzymes. Estrogen and thyroid hormones are not required.

8. 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.

21. Which assessment findings should the nurse note in a school-age child with Duchenne's muscular dystrophy (DMD) (Select all that apply)? a. Lordosis b. Gower's sign c. Kyphosis d. Scoliosis e. Waddling gait

ANS: A, B, E Difficulties in running, riding a bicycle, and climbing stairs are usually the first symptoms noted in DMD. Typically, affected boys have a waddling gait and lordosis, fall frequently, and develop a characteristic manner of rising from a squatting or sitting position on the floor (Gower's sign). Lordosis occurs as a result of weakened pelvic muscles, and the waddling gait is a result of weakness in the gluteus medius and maximus muscles. Kyphosis and scoliosis are not assessment findings with DMD.

2. Which assessment findings should the nurse note in a school-age child with Duchenne muscular dystrophy (DMD)? (Select all that apply.) a. Lordosis b. Gower sign c. Kyphosis d. Scoliosis e. Waddling gait

ANS: A, B, E Difficulties in running, riding a bicycle, and climbing stairs are usually the first symptoms noted in Duchenne muscular dystrophy. Typically, affected boys have a waddling gait and lordosis, fall frequently, and develop a characteristic manner of rising from a squatting or sitting position on the floor (Gower sign). Lordosis occurs as a result of weakened pelvic muscles, and the waddling gait is a result of weakness in the gluteus medius and maximus muscles. Kyphosis and scoliosis are not assessment findings with DMD.

4. A nurse is teaching part of a babysitting class to teenagers. Which information about fractures does the nurse include in the lesson? (Select all that apply.) A. Approximately 10% to 15% of childhood injuries are fractures. B. Bicycle crashes account for many fractures . C. Girls rarely have stress fractures from sports. D. New bone growth is complete in 6 weeks. E. Some fractures can interrupt normal growth.

ANS: A, B, E Fractures are common, accounting for about 10% to 15% of childhood injuries, and often occur due to motor vehicle crashes, bicycle crashes, falls, and sporting injuries. Depending on where the fracture is, it has the potential to disrupt or halt growth in the bone. Girls are being seen with stress fractures more frequently. New bone growth takes up to 12 weeks to occur.

1. A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. Nursing care for this child includes which action(s)? (Select all that apply.) a. Monitoring and maintaining systemic blood pressure b. Administering corticosteroids c. Minimizing environmental stimuli d. Discussing long-term care issues with the family e. Monitoring for respiratory complications

ANS: A, B, E Spinal cord injury patients are physiologically labile, and close monitoring is required. They may be unstable for the first few weeks after the injury. Corticosteroids are administered to minimize the inflammation present with the injury. It is not necessary to minimize environmental stimuli for this type of injury. Discussing long-term care issues with the family is inappropriate. The family is focusing on the recovery of their child. It will not be known until the rehabilitation period how much function the child may recover.

20. A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. Which nursing care interventions are needed for this child (Select all that apply)? a. Monitoring and maintaining systemic blood pressure. b. Administering corticosteroids. c. Minimizing environmental stimuli. d. Discussing long-term care issues with the family. e. Monitoring for respiratory complications.

ANS: A, B, E Spinal cord injury patients are physiologically labile, and close monitoring of blood pressure and respirations is required. They may be unstable for the first few weeks after the injury. Corticosteroids are administered to minimize the inflammation present with the injury. Minimizing environmental stimuli and discussing long-term care issues with the family do not apply to providing care for this patient.

14. A young teen has been diagnosed with Osgood-Schlatter disease. Which information does the nurse teach the patient and family regarding this diagnosis? (Select all that apply.) A. Activity level is determined by pain. B. Apply ice to the knee after activity. C. Modified bedrest for 1 week is needed. D. Surgical correction is usually required. E. Use ibuprofen (Motrin) for pain.

ANS: A, B, E The nurse should teach that activity can be resumed when symptoms (pain) are gone. Icing the knee after activity is beneficial, as is wearing an elastic wrap or neoprene sleeve over the knee. Nonsteroidal anti-inflammatory medications such as ibuprofen are best for pain management. Bedrest and surgery are usually not required.

12. The pediatric nurse explains to the parents of a child with kyphosis that it is caused by a congenital or acquired condition. Which conditions are considered congenital causes of kyphosis? (Select all that apply.) A. Ankylosing spondylitis B. Chronic poor posture C. Osteogenesis imperfecta D. Osteomyelitis E. Rheumatoid arthritis

ANS: A, C In children, kyphosis is caused by a congenital or acquired condition. Some congenital causes of kyphosis are ankylosing spondylitis, metabolic disorders, osteogenesis imperfecta, spina bifida, Paget disease, and Scheuermann disease, which causes juvenile or adolescent kyphosis, in which the vertebrae in the thoracic region are wedge-shaped.

55. A child has a total cholesterol level of 180 mg/dL. What dietary recommendations should the nurse make to the child and the child's parents (Select all that apply)? a. Replace whole milk with 2% or 1% milk b. Increase servings of red meat c. Increase servings of fish d. Avoid excessive intake of fruit juices e. Limit servings of whole grain

ANS: A, C, D A low-fat diet includes using nonfat or low-fat dairy products, limiting red meat intake, and increasing intake of fish, vegetables, whole grains, and legumes. Children should avoid excessive intake of fruit juices and other sweetened drinks, sugars, and saturated fats.

9. Following hip surgery, a patient is placed in a spica cast. What nursing interventions are appropriate for this patient? (Select all that apply.) A. Cutting a window in the cast B. Icing the area over the incision C. Increasing fiber in the diet D. Increasing fluid intake E. Maintaining the same position

ANS: A, C, D Cast syndrome can be prevented by three nursing interventions: frequent repositioning, increasing fluids and fiber in the child's diet, and cutting a "belly hole" or a window in the cast to allow for abdominal expansion. The other two interventions do not help prevent cast syndrome.

10. A nursing faculty member is explaining the three different types of cardiomyopathy (CMP) to students. Which information does the faculty member include in this discussion? (Select all that apply.) A. Dilated CMP is often caused by infection. B. Dilated CMP is the least common form. C. Hypertrophic CMP is usually familial. D. Hypertrophic CMP involves poor filling. E. Restrictive CMP is the most common type.

ANS: A, C, D Dilated CMP is caused by toxic agents, often from infections, chemotherapy, immunological defects, or nutritional disorders. It is the most common form of CMP. Hypertrophic CMP is usually a familial disorder and involves a hyperdynamic ventricle that fills poorly because of thickening. Restrictive CMP is the least common type of CMP.

3. A nurse is teaching parents how to care for their child who is undergoing serial casting for clubfoot. Which information does the nurse provide? (Select all that apply.) A. Cast care B. Cast drying techniques C. Neurovascular assessment D. Pain management E. Wound care

ANS: A, C, D Parents need to be taught how to properly care for their child's cast. The cast is left open to air for drying, so there are no special techniques needed. Specifically, the parents should not use a hair dryer, as this may cause burns. The parents should also be taught about managing the child's pain, as stretching the muscles and ligaments will be painful. They also need instruction on performing neurovascular checks and when to call the physician. Serial casting is not a surgical procedure, so wound care instructions are not needed.

4. The nurse is preparing to give oral care to a school-age child with mucositis secondary to chemotherapy administered to treat leukemia. Which preparations should the nurse use for oral care on this child? (Select all that apply.) a. Chlorhexidine gluconate (Peridex) b. Lemon glycerin swabs c. Antifungal troches (lozenges) d. Lip balm (Aquaphor) e. Hydrogen peroxide

ANS: A, C, D Preparations that may be used to prevent or treat mucositis include chlorhexidine gluconate (Peridex) because of its dual effectiveness against candidal and bacterial infections, antifungal troches (lozenges) or mouthwash, and lip balm (e.g., Aquaphor) to keep the lips moist. Agents that should not be used include lemon glycerin swabs (irritate eroded tissue and can decay teeth), hydrogen peroxide (delays healing by breaking down protein), and milk of magnesia (dries mucosa).

50. The nurse is preparing to give oral care to a school-age child with mucositis secondary to chemotherapy administered to treat leukemia. Which preparations should the nurse use for oral care on this child (Select all that apply)? a. Chlorhexidine gluconate (Peridex) b. Lemon glycerin swabs c. Antifungal troches (lozenges) d. Lip balm (Aquaphor) e. Hydrogen peroxide

13. The pediatric nurse discusses home care with the parents of a patient who is returning home following a spinal fusion. Which teaching points will the nurse include in the discharge teaching for this patient? (Select all that apply.) A. Allow the child to return to school about 4 to 6 weeks following surgery. B. Encourage ambulation when permitted, usually 2 to 3 weeks postoperatively. C. Explain activity restrictions such as no twisting, bending, or lifting. D. Maintain a regular diet with added calcium, fiber, fluids, and vitamin C. E. Participation in contact sports such as football needs to be delayed for 1 year.

ANS: A, C, D The child may return to school about 4 to 6 weeks after surgery. Explain activity restrictions to the child and caregivers (no twisting or bending, no lifting of heavy objects, no contact or high-impact sports for 2 years). A regular diet with added calcium, fiber, vitamin C, and fluids is maintained. Ambulation is encouraged when it is permitted, usually about 5 days postoperatively. Participation in contact sports is not allowed for 2 years.

46. Which home care instructions should the nurse provide to the parents of a child with acquired immunodeficiency syndrome (AIDS) (Select all that apply)? a. Give supplemental vitamins as prescribed. b. Yearly influenza vaccination should be avoided. c. Administer trimethoprim-sulfamethoxazole (Bactrim) as prescribed. d. Notify the physician if the child develops a cough or congestion. e. Missed doses of antiretroviral medication do not need to be recorded.

ANS: A, C, D The parents should be taught that supplemental vitamins will be prescribed to aid in nutritional status. Bactrim is administered to prevent the opportunistic infection of Pneumocystis jiroveci pneumonia. The physician should be notified if the child with AIDS develops a cough and congestion. The yearly influenza vaccination is recommended, and any missed doses of antiretroviral medication need to be recorded and reported.

1. 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.

28. What factor(s) may trigger abuse in a parent? (Select all that apply.) a. Being abused as a child b. High self-esteem c. Substance abuse d. Overwhelming responsibility e. Knowledge deficit relative to child care

ANS: A, C, D, E All options except high self-esteem are possible triggers for a parent to become abusive.

8. The student studying pediatric cardiac disorders learns that which anomalies comprise the disorder tetralogy of Fallot? (Select all that apply.) A. An overriding aorta B. Atrial septal defect (ASD) C. Hypertrophic right ventricle D. Pulmonary stenosis or atresia E. Ventricular septal defect (VSD)

ANS: A, C, D, E The four defects seen in tetralogy of Fallot are VSD, an overriding aorta, pulmonary stenosis or atresia, and hypertrophic right ventricle. An ASD is not part of the condition.

31. How does the pediatric skeletal system differ from that of the adult? (Select all that apply.) a. Lower mineral content b. More ossification c. Open epiphyses d. Less porosity e. Greater strength

ANS: A, C, E The child's skeletal system has less mineral content, greater porosity, open epiphyses, greater bone strength, and a thicker periosteum.

10. The nurse is providing care to a pediatric patient who suffered an ankle sprain. Which interventions are appropriate to include in the patient's plan of care? (Select all that apply.) A. Apply an Ace wrap to apply pressure and reduce swelling of the joint. B. Apply heat to the extremity for the first 48 hours at 15-minute intervals. C. Elevate and move the affected joint to reduce swelling and stiffness. D. Immediately perform range-of-motion exercises on the extremity. E. Place ice on the injury for 15 minutes at a time for the first 1 to 2 days.

ANS: A, C, E The nurse should teach the RICE acronym: Rest the injured extremity to prevent further injury and allow the ligament to heal; ice for the first 48 hours, keeping ice packs in place for 15-minute intervals to decrease swelling; compression with an Ace wrap or some other method to apply pressure to the affected joint to help reduce swelling of the joint; and elevation and early motion of the affected joint (elevation reduces swelling; early motion of the affected joint helps maintain full range of motion).

1. The pediatric nurse explains to the student that which valves are known as semilunar valves? (Select all that apply.) A. Aortic B. Bicuspid C. Mitral D. Pulmonary E. Tricuspid

ANS: A, D The aortic and pulmonary valves are known as semilunar valves because each of their cusps looks like a half-moon. The mitral and tricuspid valves are atrioventricular valves. A bicuspid valve simply has two cusps.

7. 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.

2. The nurse is caring for a child diagnosed with clubfoot. Which assessment findings does the nurse anticipate in the affected extremity? (Select all that apply.) A. Adducted forefoot B. Dorsiflexion C. Everted heel D. Plantar flexion E. Rigidity

ANS: A, D, E Signs of clubfoot include plantar flexion, inverted heel, adducted forefoot, and rigidity to the point that the foot cannot be manipulated into a neutral position.

24. Which congenital cardiac defect(s) cause(s) increased pulmonary blood flow? (Select all that apply.) a. Atrial septal defects (ASDs) b. Tetralogy of Fallot c. Dextroposition of aorta d. Patent ductus arteriosus e. Ventricular septal defects (VSDs)

ANS: A, D, E The congenital heart defects that cause increased pulmonary blood flow are ASDs, VSDs, and patent ductus arteriosus.

17. Chelation therapy is begun on a child with b-thalassemia major. The purpose of this therapy is to: a. treat the disease. b. eliminate excess iron. c. decrease risk of hypoxia. d. manage nausea and vomiting.

ANS: B A complication of the frequent blood transfusions in thalassemia is iron overload. Chelation therapy with deferoxamine (an iron-chelating agent) is given with oral supplements of vitamin C to increase iron excretion. Chelation therapy treats the side effect of the disease management. Decreasing the risk of hypoxia and managing nausea and vomiting are not the purposes of chelation therapy.

14. Chelation therapy is begun on a child with -thalassemia major. The purpose of this therapy is to: a. Treat the disease. c. Decrease the risk of hypoxia. b. Eliminate excess iron. d. Manage nausea and vomiting.

ANS: B A complication of the frequent blood transfusions in thalassemia is iron overload. Chelation therapy with deferoxamine (an iron-chelating agent) is given with oral supplements of vitamin C to increase iron excretion. Chelation therapy treats the side effects of disease management. Decreasing the risk of hypoxia and managing nausea and vomiting are not the purposes of chelation therapy.

16. A nurse notes that a child's chart describes a heave. Which assessment should the nurse perform to correlate with this finding? A. Assess for nausea. B. Auscultate for heart sounds. C. Listen to lung sounds. D. Review the last ECG.

ANS: B A heave is an abnormal tremor that accompanies a vascular or cardiac murmur, so the nurse would listen to heart sounds. Lung sounds and ECGs are not directly related to a heave. Nausea is not related at all.

16. What would the nurse include in a teaching plan about mouth care of a child receiving chemotherapy? a. Use commercial mouthwash. b. Clean teeth with a soft toothbrush. c. Avoid use of a Water-Pik. d. Inspect the mouth weekly for ulcerations.

ANS: B A soft toothbrush reduces capillary damage and mucous membrane breakdown and prevents bleeding and infection. Commercial mouthwashes may kill oral flora that combat infection. Water-Pik is useful for toughening gums.

8. The nurse is conducting a staff in-service on casts. Which is an advantage to using a fiberglass cast instead of a plaster of Paris cast? a. Cheaper b. Dries rapidly c. Molds closely to body parts d. Smooth exterior

ANS: B A synthetic casting material dries in 5 to 30 minutes as compared with a plaster cast, which takes 10 to 72 hours to dry. Synthetic casts are more expensive and have a rough exterior, which may scratch surfaces. Plaster casts mold closer to body parts.

6. An advantage to using a fiberglass cast instead of a plaster cast is that a fiberglass cast: a. Is less expensive. c. Molds closely to body parts. b. Dries rapidly. d. Has a smooth exterior.

ANS: B A synthetic casting material dries in 5 to 30 minutes as compared with a plaster cast, which takes 10 to 72 hours to dry. Synthetic casts are more expensive. Plaster casts mold closer to body parts. Synthetic casts have a rough exterior, which may scratch surfaces.

20. A 10-year-old child is in the emergency department with a type IV femur fracture. Which intervention takes priority? A. Assessing the child for signs of maltreatment B. Ensuring that signed consent for surgery is on the chart C. Explaining the process of closed reduction with sedation D. Preparing the child for prolonged immobility in traction

ANS: B A type IV fracture must be reduced surgically. The nurse ensures that signed consent is on the chart. Fractures in a 10-year-old are not as commonly caused by child abuse as by bicycle crashes or sporting injuries, so unless other signs of maltreatment are noticed, this would not be a priority. Because the child is not having a closed reduction, explanation of this process is not needed. The child will also not be immobilized in traction for a prolonged period.

24. 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.

23. 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.

8. A new nurse is caring for a child after spinal fusion to correct scoliosis. Which action by the new nurse causes the experienced nurse to intervene? A. Assesses neurological status and vital signs every hour B. Instructs patient to turn by pulling on side rails C. Monitors chest tube for air leakage and drainage D. Promotes use of the incentive spirometer each hour

ANS: B After spinal fusion, the patient must be logrolled to turn. Logrolling involves two nurses turning the patient as one single unit so that the spine is maintained in a straight line. The other actions are appropriate.

39. At a well-child visit, the nurse notes a 4-year-old child to be in the 95th percentile for weight. Which screening measure is most important for the nurse include in this visit? A. Body mass index (BMI) B. Cholesterol panel C. Congenital heart disease D. None; child is too young

ANS: B After the age of 2 years, children who meet certain criteria should be screened for hypercholesterolemia-hyperlipidemia. Criteria include a child who is at the 85% percentile or greater for weight. A BMI can be calculated from the height and weight, but does not screen for other diseases. Congenital heart disease is not related to a heavy weight

14. A child is scheduled for open heart surgery. Which nursing action is the priority? A. Complete the preoperative checklist. B. Ensure informed consent is on the chart. C. Show the parents the intensive care unit. D. Teach the family about the surgery.

ANS: B All actions are important for the child undergoing open heart surgery. However, the priority for any surgical patient is to ensure complete informed consent is on the chart.

28. 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.

26. A young boy will receive a bone marrow transplant (BMT). This is possible because one of his older siblings is a histocompatible donor. Which is this type of BMT called? a. Syngeneic b. Allogeneic c. Monoclonal d. Autologous

ANS: B Allogeneic transplants are from another individual. Because he and his sibling are histocompatible, the BMT can be done. Syngeneic marrow is from an identical twin. There is no such thing as a monoclonal BMT. Autologous refers to the individual's own marrow.

23. A young boy will receive a bone marrow transplant (BMT). This is possible because one of his older siblings is a histocompatible donor. This type of BMT is termed: a. Syngeneic. c. Monoclonal. b. Allogeneic. d. Autologous.

ANS: B Allogeneic transplants are from another individual. Because he and his sibling are histocompatible, the bone marrow transplantation can be done. Syngeneic marrow is from an identical twin. There is no such thing as a monoclonal bone marrow transplant. Autologous refers to the individual's own marrow.

1. The pediatric nurse explains to the student nurse that alterations in musculoskeletal functioning may be related to a congenital defect or an acquired defect. Which disorder is an example of a congenital defect? A. Juvenile arthritis B. Muscular dystrophy C. Osgood-Schlatter disease D. Osteomyelitis

ANS: B Alterations in musculoskeletal functioning may be related to a congenital defect such as muscular dystrophy, clubfoot, or osteogenesis imperfecta. Other musculoskeletal alterations may be related to an acquired defect such as Legg-Calvé-Perthes disease, slipped femoral capital epiphysis, Osgood-Schlatter disease, scoliosis, sprains, strains, fractures, osteomyelitis, juvenile arthritis, or tetanus.

36. A young child with human immunodeficiency virus (HIV) is receiving several antiretroviral drugs. The purpose of these drugs is to: a. cure the disease. b. delay disease progression. c. prevent spread of disease. d. treat Pneumocystis carinii pneumonia.

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

28. A young child with human immunodeficiency virus is receiving several antiretroviral drugs. The purpose of these drugs is to: a. Cure the disease. b. Delay disease progression. c. Prevent spread of disease. d. Treat Pneumocystis jiroveci pneumonia.

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

16. Which intervention would be helpful in relieving morning discomfort associated with juvenile rheumatoid arthritis? a. Wearing splints at night to prevent extension contractures b. Applying moist heat packs upon awakening c. Taking a warm tub bath the evening before d. Sleeping with two pillows under the head

ANS: B Application of moist heat, with a compress or by tub bath upon awakening, will help to lessen stiffness.

6. Which is the most appropriate nursing action related to the administration of digoxin (Lanoxin) to an infant? a. Counting the apical rate for 30 seconds before administering the medication b. Withholding a dose if the apical heart rate is less than 100 beats/min c. Repeating a dose if the child vomits within 30 minutes of the previous dose d. Checking respiratory rate and blood pressure before each dose

ANS: B As a rule, if the pulse rate of an infant is below 100 beats/min, the medication is withheld and the physician is notified.

6. What will the nurse teach the parents of a child with a low platelet count to avoid? a. Ibuprofen b. Aspirin c. Caffeine d. Prednisone

ANS: B Aspirin interferes with platelet function and should be avoided to prevent the risk of prolonged bleeding.

11. A child hospitalized for treatment of osteomyelitis complains that he is tired of being sick and wants to know when the antibiotic protocol will end. How long will the nurse indicate that antibiotic therapy will probably last? a. 2 weeks b. 6 weeks c. 2 months d. 3 months

ANS: B Because osteomyelitis is an infection in the bone, antibiotics are given intravenously for 4 to 6 weeks.

16. The nurse is caring for an infant with myelomeningocele scheduled for surgical closure in the morning. Which interventions should the nurse plan for the care of the myelomeningocele sac? a. Open to air b. Covered with a sterile moist nonadherent dressing c. Reinforcement of the original dressing if drainage noted d. A diaper secured over the dressing

ANS: B Before surgical closure, the myelomeningocele is prevented from drying by the application of a sterile, moist, nonadherent dressing over the defect. The moistening solution is usually sterile normal saline. Dressings are changed frequently (every 2 to 4 hours), and the sac is closely inspected for leaks, abrasions, irritation, and any signs of infection. The sac must be carefully cleansed if it becomes soiled or contaminated. The original dressing would not be reinforced but changed as needed. A diaper is not placed over the dressing because stool contamination can occur.

16. The nurse is caring for an infant with myelomeningocele scheduled for surgical closure in the morning. Which interventions should the nurse plan for the care of the myelomeningocele sac? a. Open to air b. Covered with a sterile, moist, nonadherent dressing c. Reinforcement of the original dressing if drainage noted d. A diaper secured over the dressing

29. One of the most frequent causes of hypovolemic shock in children is: a. Myocardial infarction. c. Anaphylaxis. b. Blood loss. d. Congenital heart disease.

ANS: B Blood loss and extracellular fluid loss are two of the most frequent causes of hypovolemic shock in children. Myocardial infarction is rare in a child; if it occurred, the resulting shock would be cardiogenic, not hypovolemic. Anaphylaxis results in distributive shock from extreme allergy or hypersensitivity to a foreign substance. Congenital heart disease tends to contribute to hypervolemia, not hypovolemia.

39. The nurse is teaching nursing students about shock that occurs in children. One of the most frequent causes of hypovolemic shock in children is: a. sepsis. b. blood loss. c. anaphylaxis. d. congenital heart disease

ANS: B Blood loss is the most frequent cause of hypovolemic shock in children. Sepsis causes septic shock, which is overwhelming sepsis and circulating bacterial toxins. Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance. Congenital heart disease contributes to hypervolemia, not hypovolemia.

5. A school-age child is brought to the clinic by a parent who reports that the child becomes short of breath with activity. Which assessment finding would the nurse correlate with this condition? A. Bulging fontanels B. Elevated brain natriuretic peptide C. Peripheral edema D. Weight loss

ANS: B Brain natriuretic peptide (BNP) is a measure of fluid overload, often seen in heart failure. An elevation in the laboratory value indicates that the child is retaining fluids. Bulging fontanels would not be seen in this age group. Children do not have peripheral edema, as is common in adults. Weight gain, not loss, would occur with fluid retention.

2. What intervention will the nurse caring for a child in Buck's skin traction implement? a. Position in high Fowler's position. b. Assist the child to be pulled up in bed. c. Keep child's heel on the bed surface. d. Maintain child's feet against the foot of the bed.

ANS: B Buck's traction is a type of skin traction that relies on the child's weight as counterbalance. The child must be kept with head elevated no more than 20 degrees and pulled up in bed, and the feet should not touch the bed surface or the foot of the bed.

25. A child has been diagnosed with an atrioventricular canal defect (AVC). While awaiting surgical correction, which teaching takes priority? A. Care of tubes and drains postoperatively B. Feeding the child frequent, small amounts C. Monitoring weight gain and urine output D. Returning for all scheduled appointments

ANS: B Children with uncorrected AVC have shortness of breath, leading to feeding problems. The parents should be taught to feed the child small amounts frequently to limit dyspnea that may accompany feeding. The child will not go home with drains and tubes postoperatively. Monitoring weight gain and urine output is important for all children with cardiac defects. Returning for appointments is important for all children.

30. Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell off of a tree. When discussing this injury with her parents, the nurse should consider which statement? a. Healing is usually delayed in this type of fracture. b. Growth can be affected by this type of fracture. c. This is an unusual fracture site in young children. d. This type of fracture is inconsistent with a fall.

ANS: B Detection of epiphyseal injuries is sometimes difficult, but fractures involving the epiphysis or epiphyseal plate present special problems in determining whether bone growth will be affected. Healing of epiphyseal injuries is usually prompt. The epiphysis is the weakest point of the long bones. This is a frequent site of damage during trauma.

7. Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell off of a tree. When discussing this injury with her parents, the nurse should consider which statement? a. Healing is usually delayed in this type of fracture. b. Growth can be affected by this type of fracture. c. This is an unusual fracture site in young children. d. This type of fracture is inconsistent with a fall.

24. A child in traction is having muscle spasms. Which medication does the nurse prepare to administer? A. Acetaminophen (Tylenol) B. Diazepam (Valium) C. Morphine sulfate (Astromorph) D. Oxycodone (Percocet)

ANS: B Diazepam is a muscle relaxant and is used to treat muscle spasms. The other medications are for pain.

12. As part of the treatment for congestive heart failure, the child takes the diuretic furosemide. As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in: a. Chlorides. c. Sodium. b. Potassium. d. Vitamins.

ANS: B Diuretics that work on the proximal and distal renal tubules contribute to increased losses of potassium. The child's diet should be supplemented with potassium.

20. As part of the treatment for heart failure, the child takes the diuretic furosemide (Lasix). As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in: a. chlorides. b. potassium. c. sodium. d. vitamins.

ANS: B Diuretics that work on the proximal and distal renal tubules contribute to increased losses of potassium. The child's diet should be supplemented with this electrolyte. With this type of diuretic, potassium must be monitored and supplemented as needed.

30. A child has truncus arteriosus with hypotension and poor perfusion. Which medication does the nurse prepare to administer? A. Amiodarone (Cordarone) B. Clopidogrel (Plavix) C. Dopamine (Intropin) D. Isoproterenol (Isuprel)

ANS: B Drugs used in this condition include preload- and afterload-reducing agents and positive inotropes. Dopamine is a positive inotrope. The other drugs would not be appropriate.

35. A nurse is caring for a child with Duchenne's muscular dystrophy (MD). The child's creatinine kinase level has dropped by over half since it was last measured. What assessment finding correlates with these results? A. Better respiratory functioning B. Decreased muscle strength C. Improved posture and walking D. Stabilizing muscle strength

ANS: B Early in MD creatinine kinase levels are elevated. As muscle wasting occurs and muscle bulk diminishes, creatinine kinase levels will drop. A finding of decreased muscle strength correlates with the laboratory results.

4. The nurse is reviewing the characteristics of Ewing's sarcoma. Which statement if made by the nurse indicates correct understanding of this disease? a. "Amputation is the accepted treatment." b. "The disease is sensitive to radiation and chemotherapy." c. "Metastasis is rare." d. "The disease is more prevalent among toddlers and preschoolers."

ANS: B Ewing's sarcoma is sensitive to radiation therapy and chemotherapy. Amputation of the affected extremity is not recommended. This cancer occurs in school-age children and does metastasize.

8. Which comment made by a parent of a 1-month-old would alert the nurse about the presence of a congenital heart defect? a. "He is always hungry." b. "He tires out during feedings." c. "He is fussy for several hours every day." d. "He sleeps all the time.

ANS: B Fatigue during feeding or activity is common to most infants with congenital cardiac problems

2. The student nurse studying the anatomy of the musculoskeletal system understands that bones are classified by their size and shape. How does the student classify the pelvis? A. Flat bone B. Irregular bone C. Long bone D. Short bone

ANS: B Flat bones are located in the skull, scapulae, ribs, sternum, and clavicle. Long bones are found in the extremities, and include the fingers and toes. Short bones are located in the ankles and wrists. Irregular bones are the vertebrae, pelvis, and facial bones.

13. A 13-year-old girl is diagnosed with functional scoliosis. What does the nurse explain as the cause of this spinal curvature defect? a. Juvenile rheumatoid arthritis b. Poor posture c. Heredity d. Myelomeningocele

ANS: B Functional scoliosis usually is caused by poor posture, and it is not a spinal disease.

1. The nurse is teaching the parents of a young child with iron deficiency anemia about nutrition. What food would the nurse emphasize as being a rich source of iron? a. An egg white b. Cream of Wheat c. A banana d. A carrot

ANS: B Good nutritional sources of iron include boiled egg yolk, liver, green leafy vegetables, Cream of Wheat, dried fruits, beans, nuts, and whole-grain breads.

12. A nurse working in an inpatient pediatric unit cares for many children with musculoskeletal impairments. Which outcome takes priority for these children? A. Adapting to changing activity restrictions B. Continuing their growth and development C. Resuming ambulation as soon as possible D. Staying current with schoolwork with tutors

ANS: B Growth and development are dependent upon being able to interact with the environment. Any child with a musculoskeletal disorder is at risk for impaired growth and development. A priority outcome for any of these children is to maintain normal growth and development. Some children may need to adapt to changing activity restrictions. For some children, ambulation will be delayed or not possible. Staying current with education is important, but does not take priority over maintaining normal growth and development.

24. The nurse is presenting information on the congentital disorder of hemophilia A. What fact will the nurse include? a. It is seen in males and females equally. b. It is transmitted by symptom-free females. c. It is a sex-linked dominant trait. d. It is a defective gene located on the Y chromosome.

ANS: B Hemophilia A affects mostly males who received the sex-linked recessive trait from a symptom-free female. The defective gene is on the X chromosome.

44. An adolescent being seen by the nurse practitioner for a sports physical is identified as having hypertension. On further testing, it is discovered the child has a cardiac abnormality. The initial treatment of secondary hypertension initially involves: a. Weight control and diet. b. Treating the underlying disease. c. Administration of digoxin. d. Administration of -adrenergic receptor blockers.

ANS: B Identification of the underlying disease should be the first step in treating secondary hypertension. Weight control and diet are nonpharmacologic treatments for primary hypertension. Digoxin is indicated in the treatment of congestive heart failure. -Adrenergic receptor blockers are indicated in the treatment of primary hypertension.

15. An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min. a. 60 b. 70 c. 90 d. 100

ANS: B If a 1-minute apical pulse is less than 70 beats/min for an older child, the digoxin is withheld; 60 beats/min is the cut-off for holding the digoxin dose in an adult. A pulse below 90 to 110 beats/min is the determination for not giving a digoxin dose to infants and young children.

1. The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complications should the nurse monitor? a. Hypocalcemia b. Decreased metabolic rate c. Positive nitrogen balance d. Increased production of stress hormones

ANS: B Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake, leads to hypercalcemia, and causes a negative nitrogen balance secondary to muscle atrophy. A decreased production of stress hormones occurs with decreased physical and emotional coping capacity.

2. The nurse is caring for a preschool child immobilized by a spica cast. Which effect on metabolism should the nurse monitor on this child related to the immobilized status? a. Hypocalcemia b. Decreased metabolic rate c. Positive nitrogen balance d. Increased production of stress hormones

ANS: B Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake. Immobilization leads to hypercalcemia and causes a negative nitrogen balance secondary to muscle atrophy. A decreased production of stress hormones occurs with decreased physical and emotional coping capacity.

19. A child has been hospitalized with an acute-grade IV slipped femoral capital epiphysis (SFCE) and is on bedrest awaiting surgical correction. A new nurse places the following interventions on the child's care plan. Which intervention leads the experienced nurse to intervene? A. Consult child-life therapist for diversionary activities. B. Perform range-of-motion exercises to both lower extremities. C. Reinforce teaching on crutch-walking postoperatively. D. Teach child and family about non-weight-bearing status.

ANS: B In acute SFCE, range-of-motion exercises are not done to the affected extremity because they may cause further damage. The other interventions are appropriate for a child with this diagnosis.

14. The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk of cerebrovascular accidents (strokes) exists. An important objective to decrease this risk is to: a. Minimize seizures. c. Promote cardiac output. b. Prevent dehydration. d. Reduce energy expenditure.

ANS: B In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes. Minimizing seizures, promoting cardiac output, and reducing energy expenditure will not reduce the risk of cerebrovascular accidents.

22. The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk exists of cerebrovascular accidents (strokes). Which is an important objective to decrease this risk? a. Minimize seizures. b. Prevent dehydration. c. Promote cardiac output. d. Reduce energy expenditure.

7. The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. The most appropriate way to position and feed this neonate is to place him: a. Prone and tube feed. b. Prone, turn head to side, and nipple feed. c. Supine in infant carrier and nipple feed. d. Supine, with defect supported with rolled blankets, and nipple feed.

ANS: B In the prone position, feeding is a problem. The infant's head is turned to one side for feeding. If the child is able to nipple feed, no indication is present for tube feeding. Before surgery, the infant is kept in the prone position to minimize tension on the sac and risk of trauma.

8. The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. The most appropriate way to position and feed this neonate is which position? a. Prone and tube-fed b. Prone, head turned to side, and nipple-fed c. Supine in an infant carrier and nipple-fed d. Supine, with defect supported with rolled blankets, and nipple-fed

ANS: B In the prone position, feeding is a problem. The infant's head is turned to one side for feeding. If the child is able to nipple-feed, tube feeding is not needed. Before surgery, the infant is kept in the prone position to minimize tension on the sac and risk of trauma.

31. Which clinical changes occur as a result of septic shock? a. Hypothermia c. Vasoconstriction b. Increased cardiac output d. Angioneurotic edema

ANS: B Increased cardiac output, which results in warm, flushed skin, is one of the manifestations of septic shock. Fever and chills are characteristic of septic shock. Vasodilation is more common in septic shock. Angioneurotic edema occurs as a manifestation in anaphylactic shock.

42. Which occurs in septic shock? a. Hypothermia b. Increased cardiac output c. Vasoconstriction d. Angioneurotic edema

ANS: B Increased cardiac output, which results in warm, flushed skin, is one of the manifestations of septic shock. Fever and chills are characteristic of septic shock. Vasodilation is more common than vasoconstriction. Angioneurotic edema occurs as a manifestation in anaphylactic shock.

6. How much folic acid is recommended for women of childbearing age? a. 0.1 mg c. 1.5 mg b. 0.4 mg d. 2 mg

ANS: B It has been estimated that a daily intake of 0.4 mg of folic acid in women of childbearing age will prevent 50% to 70% of cases of neural tube defects. A dose of 0.1 mg is too low, and 1.5 mg and 2 mg are not recommended dosages of folic acid.

7. How much folic acid is recommended for women of childbearing age? a. 1.0 mg b. 0.4 mg c. 1.5 mg d. 2.0 mg

ANS: B It has been estimated that a daily intake of 0.4 mg of folic acid in women of childbearing age will prevent 50% to 70% of cases of neural tube defects; 1.0 mg is too low a dose; 1.5 to 2.0 mg are not the recommended dosages of folic acid.

31. A child has just been diagnosed with juvenile arthritis (JA). The parents want to know what caused this to happen. Which statement by the nurse is the most appropriate? A. "Genetic abnormalities are triggered by infection." B. "It seems to be an autoimmune disease." C. "Latent infections can recur and cause JA." D. "No one really understands how JA occurs."

ANS: B JA is an autoimmune, inflammatory process often thought to be triggered by an infection. The etiology is not genetic, caused by latent infections, or completely unknown.

29. Which is often administered to prevent or control hemorrhage in a child with cancer? a. Nitrosoureas b. Platelets c. Whole blood d. Corticosteroids

ANS: B Most bleeding episodes can be prevented or controlled with the administration of platelet concentrate or platelet-rich plasma. Nitrosoureas, whole blood, and corticosteroids would not prevent or control hemorrhage.

10. The parent of a child with osteomyelitis asks why his child is in so much pain. What will the nurse respond causes the pain experienced with osteomyelitis? a. "Pressure of inelastic bone" b. "Purulent drainage in the bone marrow" c. "The cast applied on the extremity" d. "Circulatory congestion of the skin"

ANS: B Osteomyelitis is an infection of the bone. Inflammation produces an exudate that collects under the marrow and cortex of the bone. The vessels are compressed and thrombosis occurs, producing ischemia and pain.

43. A 12-year-old child has been diagnosed with long QT syndrome. Which teaching by the nurse is most important? A. No driving until rhythm disturbances are controlled for 6 months. B. Parents and siblings of the child need to be tested for the disorder. C. The child cannot participate in any contact sports for a year. D. Watch the child for symptoms of heart failure or infection.

ANS: B Parents and siblings need to be tested for long QT syndrome as soon as possible. It is true the child has driving restrictions until the rhythm is controlled for 6 months, but for a 12-year old, this is not priority information. Sports may be curtailed until the rhythm is controlled, but there is no specific restriction that lasts for 1 year. Heart failure and infection are not related.

11. Which statement made by a parent indicates an understanding of health maintenance of a child with sickle cell disease? a. "I should give my child a daily iron supplement." b. "It is important for my child to drink plenty of fluids." c. "He needs to wear protective equipment if he plays contact sports." d. "He shouldn't receive any immunizations until he is older."

ANS: B Prevention of dehydration, which can trigger the sickling process, is a priority goal in the care of a child with sickle cell disease.

27. Which interaction is part of the discharge plan for a school-age child with osteomyelitis who is receiving home antibiotic therapy? a. Instructions for a low-calorie diet b. Arrangements for tutoring and schoolwork c. Instructions for a high-fat, low-protein diet d. Instructions for the parent to return the child to team sports immediately

ANS: B Promoting optimal growth and development in the school-age child is important. It is important to continue schoolwork and arrange for tutoring if indicated. The child with osteomyelitis should be on a high-calorie, high-protein diet. The child with osteomyelitis may need time for the bone to heal before returning to full activities.

22. A student nurse asks the faculty why a child with patent ductus arteriosus (PDA) is taking a nonsteroidal anti-inflammatory drug (NSAID). Which response by the faculty is the most appropriate? A. Decreases venous stasis, lowering risks of clotting B. Inhibits prostaglandin, which helps close the PDA C. Provides long-lasting pain and inflammation control D. Reduces swelling around the PDA, making surgery easier

ANS: B Prostaglandin helps keep the PDA open, so an NSAID that inhibits prostaglandin synthesis will help close the opening. This is especially beneficial for premature infants. It is not used for venous stasis, pain relief, or swelling.

8. A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is: a. Aplastic anemia. c. Thalassemia major. b. Sickle cell anemia. d. Iron deficiency anemia.

ANS: B Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Hemophilia refers to a group of bleeding disorders in which there is deficiency of one of the factors necessary for coagulation. Iron deficiency anemia affects size and depth of color of hemoglobin and does not involve abnormal hemoglobin

10. Which finding should cause the nurse to suspect a diagnosis of spastic cerebral palsy? a. Tremulous movements at rest and with activity b. Sudden jerking movement caused by stimuli c. Writhing, uncontrolled, involuntary movements d. Clumsy, uncoordinated movements

ANS: B Spastic cerebral palsy, the most common type of cerebral palsy, will manifest with hypertonicity and increased deep tendon reflexes. The child's muscles are very tight and any stimuli may cause a sudden jerking movement. Tremulous movements are characteristic of rigid/tremor/atonic cerebral palsy. Slow, writhing, uncontrolled, involuntary movements occur with athetoid or dyskinetic cerebral palsy. Clumsy movements, loss of coordination, equilibrium, and kinesthetic sense occur in ataxic cerebral palsy.

47. A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow? a. Atrial septal defect c. Ventricular septal defect b. Tetralogy of Fallot d. Patent ductus arteriosus

ANS: B Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis increases the pressure in the right ventricle, causing the blood to go from right to left across the interventricular septal defect. Atrial and ventricular septal defects and patent ductus arteriosus result in increased pulmonary blood flow.

10. A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow? a. Atrial septal defect b. Tetralogy of Fallot c. Ventricular septal defect d. Patent ductus arteriosus

ANS: B Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis increases the pressure in the right ventricle, causing the blood to go from right to left across the ventricular septal defect. Atrial and ventricular septal defects and patent ductus arteriosus result in increased pulmonary blood flow.

13. 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.

9. A new nurse is taking a child's blood pressure. What action would cause an experienced nurse to intervene? A. Allows the child to get familiar with equipment B. Chooses a cuff that covers 65% of the child's arm C. Has a parent stay with the child to calm him or her D. Uses an automatic cuff if the heart rate is normal

ANS: B The appropriate-sized cuff is important for accuracy. The cuff should be long enough to cover 80-100% of the child's arm. A cuff that is too small will give a falsely high reading. The other actions are appropriate.

24. Which should the nurse consider when preparing a school-age child and the family for heart surgery? a. Unfamiliar equipment should not be shown. b. Let child hear the sounds of an ECG monitor. c. Avoid mentioning postoperative discomfort and interventions. d. Explain that an endotracheal tube will not be needed if the surgery goes well.

ANS: B The child and family should be exposed to the sights and sounds of the intensive care unit (ICU). All positive, nonfrightening aspects of the environment are emphasized. The child should be shown unfamiliar equipment and its use demonstrated on a doll. Carefully prepare the child for the postoperative experience, including intravenous (IV) lines, incision, and endotracheal tube.

16. When preparing a school-age child and the family for heart surgery, the nurse should consider: a. Not showing unfamiliar equipment. b. Letting child hear the sounds of an electrocardiograph monitor. c. Avoiding mentioning postoperative discomfort and interventions. d. Explaining that an endotracheal tube will not be needed if the surgery goes well.

ANS: B The child and family should be exposed to the sights and sounds of the intensive care unit. All positive, nonfrightening aspects of the environment are emphasized. The child should be shown unfamiliar equipment, and its use should be demonstrated on a doll. Carefully prepare the child for the postoperative experience, including intravenous lines, incision, and endotracheal tube.

45. The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching? a. "I should avoid tub baths but may shower." b. "I have to stay on strict bed rest for 3 days." c. "I should remove the pressure dressing the day after the procedure." d. "I may attend school but should avoid exercise for several days."

ANS: B The child does not need to be on strict bed rest for 3 days. Showers are recommended; children should avoid a tub bath. The pressure dressing is removed the day after the catheterization and replaced by an adhesive bandage to keep the area clean. Strenuous activity must be avoided for several days, but the child can return to school.

6. The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching? a. "I should avoid tub baths but may shower." b. "I have to stay on strict bed rest for 3 days." c. "I should remove the pressure dressing the day after the procedure." d. "I may attend school but should avoid exercise for several days."

15. 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.

37. Which immunization should be given with caution to children infected with human immunodeficiency virus (HIV)? a. Influenza b. Varicella c. Pneumococcal d. Inactivated poliovirus (IPV)

ANS: B The children should be carefully evaluated before being given live viral vaccines such as varicella, measles, mumps, and rubella. The child must be immunocompetent and not have contact with other severely immunocompromised individuals. Influenza, pneumococcal, and inactivated poliovirus (IPV) are not live vaccines.

29. Which immunization should be given with caution to children infected with human immunodeficiency virus? a. Influenza c. Pneumococcus b. Varicella d. Inactivated poliovirus

ANS: B The children should be carefully evaluated before giving live viral vaccines such as varicella, measles, mumps, and rubella. The child must be immunocompetent and not have contact with other severely immunocompromised individuals. Influenza, pneumococcus, and inactivated poliovirus are not live vaccines.

36. The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur. This finding is associated with which congenital heart defect? a. Pulmonary stenosis c. Ventricular septal defect b. Patent ductus arteriosus d. Coarctation of the aorta

ANS: B The classic murmur associated with patent ductus arteriosus is a machinery-like one that can be heard throughout both systole and diastole. A systolic ejection murmur that may be accompanied by a palpable thrill is a manifestation of pulmonary stenosis. The characteristic murmur associated with ventricular septal defect is a loud, harsh, holosystolic murmur. A systolic murmur that is accompanied by an ejection click may be heard on auscultation when coarctation of the aorta is present.

20. A nurse is concerned that a child may have renal failure after open heart surgery. Which laboratory value does the nurse assess as the priority to determine the child's kidney function? A. Blood urea nitrogen (BUN) B. Serum creatinine C. Hemoglobin D. Urine pH

ANS: B The diagnostic laboratory value most specific for kidney function is the creatinine, so this is the laboratory value the nurse assesses. BUN also indicates kidney function, but alterations in BUN can be due to many causes other than kidney problems. The hemoglobin and urine pH do not give information about the function of the kidneys.

4. 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.

13. An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be to: a. Assess for neurologic defects. b. Place the child in the knee-chest position. c. Begin cardiopulmonary resuscitation. d. Prepare the family for imminent death.

ANS: B The first action is to place the infant in the knee-chest position. Blow-by oxygen may be indicated. Neurologic defects are unlikely. The child should be assessed for airway, breathing, and circulation. Often calming the child and administering oxygen and morphine can alleviate the hypercyanotic spell; cardiopulmonary resuscitation is not necessary, and death is unlikely.

21. An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be to: a. assess for neurologic defects. b. place the child in the knee-chest position. c. begin cardiopulmonary resuscitation. d. prepare family for imminent death.

ANS: B The first action is to place the infant in the knee-chest position. Blow-by oxygen may be indicated. Neurologic defects are unlikely. The child should be assessed for airway, breathing, and circulation. Often, calming the child and administering oxygen and morphine can alleviate the hypercyanotic spell.

23. A boy with leukemia screams whenever he needs to be turned or moved. Which is the most probable cause of this pain? a. Edema b. Bone involvement c. Petechial hemorrhages d. Changes within the muscles

ANS: B The invasion of the bone marrow with leukemic cells gradually causes a weakening of the bone and a tendency toward fractures. As leukemic cells invade the periosteum, increasing pressure causes severe pain. Edema, petechial hemorrhages, and changes within the muscles would not cause severe pain.

20. A boy with leukemia screams whenever he needs to be turned or moved. The most probable cause of this pain is: a. Edema. c. Petechial hemorrhages. b. Bone involvement. d. Changes within the muscles.

14. A school-age child is admitted in vasoocclusive sickle cell crisis. The child's care should include: a. correction of acidosis. b. adequate hydration and pain management. c. pain management and administration of heparin. d. adequate oxygenation and replacement of factor VIII

ANS: B The management of crises includes adequate hydration, minimization of energy expenditures, pain management, electrolyte replacement, and blood component therapy if indicated. Hydration and pain control are two of the major goals of therapy. The acidosis will be corrected as the crisis is treated. Heparin and factor VIII is not indicated in the treatment of vasoocclusive sickle cell crisis. Oxygen may prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels.

11. A school-age child is admitted in vaso-occlusive sickle cell crisis. The child's care should include: a. Correction of acidosis. b. Adequate hydration and pain management. c. Pain management and administration of heparin. d. Adequate oxygenation and replacement of factor VIII.

ANS: B The management of crises includes adequate hydration, minimizing energy expenditures, pain management, electrolyte replacement, and blood component therapy if indicated. The acidosis will be corrected as the crisis is treated. Heparin and factor VIII are not indicated in the treatment of vaso-occlusive sickle cell crisis. Oxygen may prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels

30. 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.

23. The primary nursing intervention necessary to prevent bacterial endocarditis is to: a. Institute measures to prevent dental procedures. b. Counsel parents of high risk children about prophylactic antibiotics. c. Observe children for complications such as embolism and heart failure. d. Encourage restricted mobility in susceptible children.

ANS: B The objective of nursing care is to counsel the parents of high risk children about both the need for prophylactic antibiotics for dental procedures and the necessity of maintaining excellent oral health. The child's dentist should be aware of the child's cardiac condition. Dental procedures should be done to maintain a high level of oral health. Prophylactic antibiotics are necessary. Observing for complications and encouraging restricted mobility in susceptible children should be done, but maintaining good oral health and using prophylactic antibiotics are most important.

31. The primary nursing intervention to prevent bacterial endocarditis is to: a. institute measures to prevent dental procedures. b. counsel parents of high-risk children about prophylactic antibiotics. c. observe children for complications, such as embolism and heart failure. d. encourage restricted mobility in susceptible children.

ANS: B The objective of nursing care is to counsel the parents of high-risk children about both the need for prophylactic antibiotics for dental procedures and the necessity of maintaining excellent oral health. The child's dentist should be aware of the child's cardiac condition. Dental procedures should be done to maintain a high level of oral health. Prophylactic antibiotics are necessary. Children should be observed for complications such as embolism and heart failure and restricted mobility should be encouraged in susceptible children, but maintaining good oral health and prophylactic antibiotics is important.

15. The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. Which is appropriate for the nurse to explain about narcotic analgesics? a. Are often ordered but not usually needed b. Rarely cause addiction because they are medically indicated c. Are given as a last resort because of the threat of addiction d. Are used only if other measures, such as ice packs, are ineffective

ANS: B The pain of sickle cell anemia is best treated by a multidisciplinary approach. Mild to moderate pain can be controlled by ibuprofen and acetaminophen. When narcotics are indicated, they are titrated to effect and are given around the clock. Patient-controlled analgesia reinforces the patient's role and responsibility in managing the pain and provides flexibility in dealing with pain. Few, if any, patients who receive opioids for severe pain become behaviorally addicted to the drug. Narcotics are often used because of the severe nature of the pain of vasoocclusive crisis. Ice is contraindicated because of its vasoconstrictive effects.

12. The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain that narcotic analgesics: a. Are often ordered but not usually needed. b. Rarely cause addiction because they are medically indicated. c. Are given as a last resort because of the threat of addiction. d. Are used only if other measures such as ice packs are ineffective.

ANS: B The pain of sickle cell anemia is best treated by a multidisciplinary approach. Mild-to-moderate pain can be controlled by ibuprofen and acetaminophen. When narcotics are indicated, they are titrated to effect and given around the clock. Patient-controlled analgesia reinforces the patient's role and responsibility in managing the pain and provides flexibility in dealing with pain. Few if any patients who receive opioids for severe pain become behaviorally addicted to the drug. Narcotics are often used because of the severe nature of the pain of vaso-occlusive crisis. Ice is contraindicated because of its vasoconstrictive effects.

37. Which is the leading cause of death after heart transplantation? a. Infection b. Rejection c. Cardiomyopathy d. Heart failure

ANS: B The posttransplant course is complex. The leading cause of death after cardiac transplantation is rejection. Infection is a continued risk secondary to the immunosuppression necessary to prevent rejection. Cardiomyopathy is one of the indications for cardiac transplant. Heart failure is not a leading cause of death.

27. The leading cause of death after heart transplantation is: a. Infection. c. Cardiomyopathy. b. Rejection. d. Congestive heart failure.

ANS: B The posttransplantation course is complex. The leading cause of death after cardiac transplantation is rejection. Infection is a continued risk secondary to the immunosuppression necessary to prevent rejection. Cardiomyopathy is one of the indications for cardiac transplant. Congestive heart failure is not a leading cause of death.

12. A child has an elevated antistreptolysin O (ASO) titer. Which combination of symptoms, in conjunction with this finding, would confirm a diagnosis of rheumatic fever? a. Subcutaneous nodules and fever b. Painful, tender joints and carditis c. Erythema marginatum and arthralgia d. Chorea and elevated sedimentation rate

ANS: B The presence of two major Jones criteria would indicate a high probability of rheumatic fever.

3. An adolescent patient is prescribed a brace to treat scoliosis. Which assessment finding by the nurse indicates that outcomes for a priority nursing diagnosis have been met by the patient? A. Is able to explain the rationale for the bracing B. No redness or breakdown seen under the brace C. Participates in social activities with friends D. Wears brace continuously for 20 hours each day

ANS: B The skin under the brace worn to treat scoliosis needs to be assessed for breakdown, especially when the brace is new. An important diagnosis would be risk for impaired skin integrity. Seeing no skin breakdown under the brace indicates the outcomes have been met for this goal. Being able to explain the rationale for the bracing and participating in social activities also indicate that outcomes for appropriate diagnoses have been met, but these do not take priority over a possible injury to the child. The brace needs to be worn continuously for 23 hours each day.

7. A child develops carditis from rheumatic fever. Which areas of the heart are affected by carditis? a. Coronary arteries b. Heart muscle and the mitral valve c. Aortic and pulmonic valves d. Contractility of the ventricles

ANS: B The tissues that cover the heart and heart valves are affected. The heart muscle may be involved and the mitral valve is frequently involved.

42. What is the appropriate priority nursing action for the infant with a CHD who has an increased respiratory rate, is sweating, and is not feeding well? a. Recheck the infant's blood pressure. c. Withhold oral feeding. b. Alert the physician. d. Increase the oxygen rate.

ANS: B These are signs of early congestive heart failure, and the physician should be notified. Although rechecking blood pressure may be indicated, it is not the priority action. Withholding the infant's feeding is an incomplete response to the problem. Increasing oxygen may alleviate symptoms; however, medications such as digoxin and furosemide are necessary to improve heart function and fluid retention. Notifying the physician is the priority nursing action.

21. A nurse is assessing patients for the presence of patent ductus arteriosus (PDA). Which patient should the nurse assess first? A. 1-year old, history of frequent colds B. 4-year old, blood pressure of 102/36 mm Hg C. Infant with history of poor feeding D. Toddler with murmur at right sternal border

ANS: B This child has a wide pulse pressure, which is a sign of PDA. The nurse would assess this child first. Frequent colds and poor feeding can be seen in PDA, but they are vague symptoms and could be related to a number of other conditions. The murmur of a PDA is heard best at the left subclavicular margin.

32. The pediatric nurse is caring for a child recently diagnosed with transient synovitis of the hip. Which medication order is most appropriate for this child? A. Acetaminophen (Tylenol) 10-15 mg/kg every 4 hours B. Ibuprofen (Motrin) 30-50 mg/kg/day in 3-4 divided doses C. Naproxen (Aleve) 20-30 mg/kg/dose every 4 hours D. Prednisone (Deltasone) 0.1-2 mg/kg/day in 1-4 divided doses

ANS: B This disorder is treated with NSAIDs. Acetaminophen is not an NSAID, although the dose listed is a safe dose. Prednisone is also not an NSAID, although the dose listed is a safe dose. Ibuprofen and Naproxen are both NSAIDs. The dose of ibuprofen is correct; the safe dose for naproxen is 10-15 mg/kg/dose every 12 hours.

20. What would the nurse consider an abnormal finding on a musculoskeletal assessment of a 4-year-old child? a. Has inward-turned knees while standing b. Walks on the toes c. Appears to have flat feet d. Swings his arms when walking

ANS: B Toe walking after 3 years of age may indicate a muscle problem

17. Which is an appropriate nursing intervention when caring for a child in traction? a. Remove adhesive traction straps daily to prevent skin breakdown. b. Assess for tightness, weakness, or contractures in uninvolved joints and muscles. c. Provide active range-of-motion exercises to affected extremity three times a day. d. Keep the child in one position to maintain good alignment.

ANS: B Traction places stress on the affected bone, joint, and muscles. The nurse must assess for tightness, weakness, or contractures developing in the uninvolved joints and muscles. The adhesive straps should be released or replaced only when absolutely necessary. Active, passive, or active with resistance exercises should be carried out for the unaffected extremity only. Movement is expected with children. Each time the child moves, the nurse should check to ensure that proper alignment is maintained.

13. An appropriate nursing intervention when caring for a child in traction is to: a. Remove adhesive traction straps daily to prevent skin breakdown. b. Assess for tightness, weakness, or contractures in uninvolved joints and muscles. c. Provide active range-of-motion exercises to affected extremity 3 times a day. d. Keep child in one position to maintain good alignment.

ANS: B Traction places stress on the affected bone, joint, and muscles. The nurse must assess for tightness, weakness, or contractures developing in the uninvolved joints and muscles. The adhesive straps should be released/replaced only when absolutely necessary. Active, passive, or active with resistance exercises should be carried out for the unaffected extremity only. Movement is expected with children. Each time the child moves, the nurse should check to ensure that proper alignment is maintained.

17. The nurse is admitting a school-age child with suspected Guillain-Barré syndrome (GBS). Which nursing intervention is a priority in the care for this child? a. Monitoring intake and output c. Placing on a telemetry monitor b. Assessing respiratory efforts d. Obtaining laboratory studies

ANS: B Treatment of GBS is primarily supportive. In the acute phase, patients are hospitalized because respiratory and pharyngeal involvement may require assisted ventilation, sometimes with a temporary tracheotomy. Treatment modalities include aggressive ventilatory support in the event of respiratory compromise, administration of intravenous immunoglobulin (IVIG), and sometimes steroids; plasmapheresis and immunosuppressive drugs may also be used. Monitoring intake and output, telemetry monitoring, and obtaining laboratory studies may be part of the plan of care but are not the priority.

17. The nurse is admitting a school-age child with suspected Guillain-Barré syndrome (GBS). Which is a priority in the care for this child? a. Monitoring intake and output b. Assessing respiratory efforts c. Placing on a telemetry monitor d. Obtaining laboratory studies

ANS: B Treatment of GBS is primarily supportive. In the acute phase, patients are hospitalized because respiratory and pharyngeal involvement may require assisted ventilation, sometimes with a temporary tracheotomy. Treatment modalities include aggressive ventilatory support in the event of respiratory compromise, intravenous (IV) administration of immunoglobulin (IVIG), and sometimes steroids; plasmapheresis and immunosuppressive drugs may also be used. Intake and output, telemetry monitoring and obtaining laboratory studies may be part of the plan of care but are not the priority.

25. A child is diagnosed with iron deficiency anemia. What will the nurse explain can occur if this disorder goes untreated? a. Hemorrhage b. Heart failure c. Infection d. Pulmonary embolism

ANS: B Untreated iron deficiency anemias progress slowly, and in severe cases the heart muscle becomes too weak to function. If this happens, heart failure follows.

3. What will the nurse administer with ferrous sulfate drops when providing them to a child on the pediatric unit? a. With milk b. With orange juice c. With water d. On a full stomach

ANS: B Vitamin C aids in the absorption of iron, whereas food and milk interfere with the absorption of iron.

10. The nurse is evaluating a child who is taking digoxin for her cardiac condition. The nurse is cognizant that a common sign of digoxin toxicity is: a. Seizures. c. Bradypnea. b. Vomiting. d. Tachycardia.

ANS: B Vomiting is a common sign of digoxin toxicity. Seizures are not associated with digoxin toxicity. The child will have a slower heart rate, not respiratory rate.

17. The nurse is teaching parents about signs of digoxin (Lanoxin) toxicity. Which is a common sign of digoxin toxicity? a. Seizures b. Vomiting c. Bradypnea d. Tachycardia

ANS: B Vomiting is a common sign of digoxin toxicity. Seizures are not associated with digoxin toxicity. The child will have a slower heart rate, not respiratory rate. The heart rate will be slower, not faster.

13. An adolescent with a fractured femur is in Russell's traction. Surgical intervention to correct the fracture is scheduled for the morning. Nursing actions should include which action? a. Maintaining continuous traction until 1 hour before the scheduled surgery b. Maintaining continuous traction and checking position of traction frequently c. Releasing traction every hour to perform skin care d. Releasing traction once every 8 hours to check circulation

ANS: B When the muscles are stretched, muscle spasm ceases and permits realignment of the bone ends. The continued maintenance of traction is important during this phase because releasing the traction allows the muscle's normal contracting ability to again cause malpositioning of the bone ends. Continuous traction must be maintained to keep the bone ends in satisfactory realignment. Releasing at any time, either 1 hour before surgery, once every hour for skin care, or once every 8 hours would not keep the fracture in satisfactory alignment.

4. Which should the nurse expect to find in the cerebral spinal fluid (CSF) results of a child with Guillain-Barré syndrome (GBS)? (Select all that apply.) a. Decreased protein concentration b. Normal glucose c. Fewer than 10 white blood cells (WBCs/mm3) d. Elevated red blood cell (RBC) count

ANS: B, C Diagnosis of GBS is based on clinical manifestations, CSF analysis, and EMG findings. CSF analysis reveals an abnormally elevated protein concentration, normal glucose, and fewer than 10 WBCs/mm3. CSF fluid should not contain RBCs.

4. A child has a large ventricular septal defect (VSD) with left-to-right shunting. Which information about VSDs does the faculty member explain to the nursing student? (Select all that apply.) A. The child will have obvious cyanosis. B. A harsh, pansystolic murmur is heard. C. This is the most common congenital heart defect. D. Some VSDs can close spontaneously. E. Transcatheter closure is common.

ANS: B, C, D A VSD is the most common congenital heart defect and is one of the mildest forms. The murmur of a VSD is harsh, pansystolic, and heard best at the lower left sternal border. Some VSDs can close spontaneously; those that need invasive closure must be surgically repaired. Presently, transcatheter closure is not available.

17. A child just had a long-leg cast placed after an open reduction and fixation of a femur fracture. What interventions are appropriate for the nurse to include in the child's plan of care? (Select all that apply.) A. Assess the 4 Ps every hour, with vital signs. B. Elevate the leg and apply ice for short periods. C. Ensure that the proximal edge of the cast stays clean. D. Handle the cast carefully when wet to prevent dents. E. Use a hand-held dryer to help the cast dry faster.

ANS: B, C, D Appropriate interventions for the child with a cast include assessing the 5 Ps along with vital signs, elevating and icing the leg, keeping the proximal edges clean as part of hygiene, handling the cast carefully when wet to prevent denting, and allowing the cast to air dry.

15. A child's family history includes muscular dystrophy (MD). What diagnostic testing does the nurse prepare the child and family for? (Select all that apply.) A. Blood urea nitrogen B. Creatinine kinase C. Electromyelogram D. Muscle biopsy E. Ultrasound

ANS: B, C, D Common diagnostic tests for MD include creatinine kinase, electromyelogram, and muscle biopsy. Blood urea nitrogen and ultrasound are not used.

9. A nurse is teaching a group of parents about bacterial endocarditis (BE) and follow-up care. Which parents should be instructed to obtain prophylactic antibiotics prior to dental cleaning? (Select all that apply.) A. Child after complete repair via catheter for 1 year B. Child after transplant, no residual defect, for 6 months C. Child with congenital repair with residual defect, for life D. Child with one prior episode of bacterial endocarditis E. Child with prosthetic mitral valve for the first 6 months

ANS: B, C, D Guidelines for who needs prophylaxis prior to invasive procedures were updated in 2007. They include children post-cardiac transplantation who do not have residual valve problems for 6 months post-transplant, any child with a residual defect after a surgical repair for the remainder of his or her life, and children who have already had one (or more) episode of BE. Prophylaxis after complete repairs is for 6 months. Prophylaxis after valve replacement is lifelong.

1. The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child? (Select all that apply.) a. Finger sticks for blood work instead of venipunctures b. Avoidance of IM injections c. Acetaminophen (Tylenol) for mild pain control d. Soft tooth brush for dental hygiene e. Administration of packed red blood cells

ANS: B, C, D Nurses should take special precautions when caring for a child with hemophilia to prevent the use of procedures that may cause bleeding, such as IM injections. The subcutaneous route is substituted for IM injections whenever possible. Venipunctures for blood samples are usually preferred for these children. There is usually less bleeding after the venipuncture than after finger or heel punctures. Neither aspirin nor any aspirin-containing compound should be used. Acetaminophen is a suitable aspirin substitute, especially for controlling mild pain. A soft toothbrush is recommended for dental hygiene to prevent bleeding from the gums. Packed red blood cells are not administered. The primary therapy for hemophilia is replacement of the missing clotting factor. The products available are factor VIII concentrates.

47. The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child (Select all that apply)? a. Fingersticks for blood work instead of venipunctures b. Avoidance of intramuscular (IM) injections c. Acetaminophen (Tylenol) for mild pain control d. Soft toothbrush for dental hygiene e. Administration of packed red blood cells

45. The nurse is caring for a child with aplastic anemia. Which nursing diagnoses are appropriate (Select all that apply)? a. Acute Pain related to vaso-occlusion b. Risk for Infection related to inadequate secondary defenses or immunosuppression c. Ineffective Protection related to thrombocytopenia d. Ineffective Tissue Perfusion related to anemia e. Ineffective Protection related to abnormal clotting

ANS: B, C, D These are appropriate nursing diagnosis for the nurse planning care for a child with aplastic anemia. Aplastic anemia is a condition in which the bone marrow ceases production of the cells it normally manufactures, resulting in pancytopenia. The child will have varying degrees of the disease depending on how low the values are for absolute neutrophil count (affecting the body's response to infection), platelet count (putting the child at risk for bleeding), and absolute reticulocyte count (causing the child to have anemia). Acute Pain related to vaso-occlusion is an appropriate nursing diagnosis for sickle cell anemia for the child in vaso-occlusive crisis, but it is not applicable to a child with aplastic anemia. Ineffective Protection related to abnormal clotting is an appropriate diagnosis for a child with hemophilia.

5. A nurse is teaching parents about caring for their child in a cast. Which information does the nurse provide? (Select all that apply.) A. Be sure the child does not move joints above and below the cast. B. Elevate the extremity above the heart as much as possible. C. Keep the child from playing with toys that have very small parts. D. Provide snacks high in calcium and vitamin D or provide supplements. E. Reinforce active or passive range of motion to unaffected joints.

ANS: B, C, D, E The nurse teaches parents how to care for a child in a cast, including moving the joints above and below the cast regularly, elevating the extremity above the heart as much as possible, keeping the child from putting objects down the cast (including toy parts), providing nutrition that encourages bone healing, and providing range of motion.

8. A pediatrician orders Russell traction for a 12-year-old patient with Legg-Calvé-Perthes disease. Which interventions are appropriate for the nurse to include in the care plan for this patient? (Select all that apply.) A. Bony areas are massaged frequently. B. Child is lying in a supine position. C. Hip is flexed and abducted. D. Skin is inspected every 12 hours. E. The child uses a trapeze to move.

ANS: B, C, E Russell traction is a type of skin traction used to stabilize femur fractures until a callus forms or to correct bone deformities or contractures, as in Legg-Calvé-Perthes disease. With this type of traction, the child lies supine with hip flexed, abducted, and immobile. The child can help with repositioning using a trapeze above the bed. The nurse should assess the skin more often than every 12 hours and should not massage bony prominences.

7. An 8-year-old girl has a third-degree sprain of the ankle. Based on this diagnosis, which teaching points will the nurse include in the teaching plan for this patient and family? (Select all that apply.) A. The ligament is only stretched and the affected joint is stable. B. The patient cannot bear weight or use the extremity. C. There is severe pain over the joint, making an exam difficult. D. There is full range of motion and weight bearing. E. Sprains and strains are unusual in a child this age.

ANS: B, C, E Sprains are less common in younger children than are fractures. In a third-degree sprain the injury is severe, the ligament is completely torn, and the joint is unstable. There is significant swelling and severe ecchymoses occurring within the first 30 minutes. There is also severe pain over the joint, making examination difficult. The person cannot bear weight or otherwise use the extremity.

2. A clinic nurse is conducting a staff in-service for other clinic nurses about signs and symptoms of a rhabdomyosarcoma tumor. Which should be included in the teaching session? (Select all that apply.) a. Bone fractures b. Abdominal mass c. Sore throat and ear pain d. Headache e. Ecchymosis of conjunctiva

ANS: B, C, E The initial signs and symptoms of rhabdomyosarcoma tumors are related to the site of the tumor and compression of adjacent organs. Some tumor locations, such as the orbit, manifest early in the course of the illness. Other tumors, such as those of the retroperitoneal area, only produce symptoms when they are relatively large and compress adjacent organs. Unfortunately, many of the signs and symptoms attributable to rhabdomyosarcoma are vague and frequently suggest a common childhood illness, such as "earache" or "runny nose." An abdominal mass, sore throat and ear pain, and ecchymosis of conjunctiva are signs of a rhabdomyosarcoma tumor. Bone fractures would be seen in osteosarcoma and a headache is a sign of a brain tumor.

35. A clinic nurse is conducting a staff in-service for other clinic staff regarding the signs and symptoms of a rhabdomyosarcoma tumor. Which should be included in the teaching session (Select all that apply)? a. Bone fractures b. Abdominal mass c. Sore throat and ear pain d. Headache e. Ecchymosis of conjunctiva

49. Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease (Select all that apply)? a. Limit fluids at bedtime. b. Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs. c. Give penicillin as prescribed. d. Use ice packs to decrease the discomfort of vaso-occlusive pain in the legs. e. Notify the health care provider if your child begins to develop symptoms of a cold.

ANS: B, C, E The most important issues to teach the family of a child with sickle cell anemia are to (1) seek early intervention for problems, such as a fever of 38.5° C (101.3° F) or greater; (2) give penicillin as ordered; (3) recognize signs and symptoms of splenic sequestration, as well as respiratory problems that can lead to hypoxia; and (4) treat the child normally. The nurse emphasizes the importance of adequate hydration to prevent sickling and to delay the adhesion-stasis-thrombosis-ischemia cycle. It is not sufficient to advise parents to "force fluids" or "encourage drinking." They need specific instructions on how many daily glasses or bottles of fluid are required. Many foods are also a source of fluid, particularly soups, flavored ice pops, ice cream, sherbet, gelatin, and puddings. Increased fluids combined with impaired kidney function result in the problem of enuresis. Parents who are unaware of this fact frequently use the usual measures to discourage bedwetting, such as limiting fluids at night. Enuresis is treated as a complication of the disease, such as joint pain or some other symptom, to alleviate parental pressure on the child. Ice should not be used during a vaso-occlusive pain crisis because it vasoconstricts and impairs circulation even more.

3. Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease? (Select all that apply.) a. Limit fluids at bedtime. b. Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs. c. Give penicillin as prescribed. d. Use ice packs to decrease the discomfort of vasoocclusive pain in the legs. e. Notify the health care provider if your child begins to develop symptoms of a cold.

ANS: B, C, E The most important issues to teach the family of a child with sickle cell anemia are to (1) seek early intervention for problems, such as a fever of 38.5° C (101.3° F) or greater; (2) give penicillin as ordered; (3) recognize signs and symptoms of splenic sequestration, as well as respiratory problems that can lead to hypoxia; and (4) treat the child normally. The nurse emphasizes the importance of adequate hydration to prevent sickling and to delay the adhesion-stasis-thrombosis-ischemia cycle. It is not sufficient to advise parents to "force fluids" or "encourage drinking." They need specific instructions on how many daily glasses or bottles of fluid are required. Many foods are also a source of fluid, particularly soups, flavored ice pops, ice cream, sherbet, gelatin, and puddings. Increased fluids combined with impaired kidney function result in the problem of enuresis. Parents who are unaware of this fact frequently use the usual measures to discourage bedwetting, such as limiting fluids at night. Enuresis is treated as a complication of the disease, such as joint pain or some other symptom, to alleviate parental pressure on the child. Ice should not be used during a vasoocclusive pain crisis because it vasoconstricts and impairs circulation even more.

5. The student is learning about atrioventricular canal defects (AVCs). Which information stated by the student reflects appropriate understanding of the disease process? (Select all that apply.) A. Cyanosis is the cardinal manifestation. B. It often occurs in children with Down syndrome. C. Prostaglandin is administered preoperatively. D. The tricuspid and mitral valves form one opening. E. It will usually close on its own without surgery.

ANS: B, D An AVC is formed during fetal endocardial development. The tricuspid and mitral valves come together and form one large opening, through which blood is mixed. Because the shunt is left to right, there is no cyanosis. This disorder is often seen in children with Down syndrome and must be repaired surgically for the child to live a normal life. Prostaglandin is used to maintain a patent ductus arteriosus, not for AVCs.

5. 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.

2. Parents of a school-age child with hemophilia ask the nurse, "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend? (Select all that apply.) a. Soccer b. Swimming c. Basketball d. Golf e. Bowling

ANS: B, D, E Because almost all persons with hemophilia are boys, the physical limitations in regard to active sports may be a difficult adjustment, and activity restrictions must be tempered with sensitivity to the child's emotional and physical needs. Use of protective equipment, such as padding and helmets, is particularly important, and noncontact sports, especially swimming, walking, jogging, tennis, golf, fishing, and bowling, are encouraged. Contact sport such as soccer and basketball are not recommended.

48. Parents of a school-age child with hemophilia ask the nurse, "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend (Select all that apply)? a. Soccer b. Swimming c. Basketball d. Golf e. Bowling

ANS: B, D, E Because almost all persons with hemophilia are boys, the physical limitations in regard to active sports may be a difficult adjustment, and activity restrictions must be tempered with sensitivity to the child's emotional and physical needs. Use of protective equipment, such as padding and helmets, is particularly important, and noncontact sports, especially swimming, walking, jogging, tennis, golf, fishing, and bowling, are encouraged. Contact sports such as soccer and basketball are not recommended.

17. What instruction would the nurse provide to an adolescent who has been fitted with a Milwaukee brace? a. Wear the brace directly against the skin. b. Wear the brace over regular clothing. c. Wear the brace over a T-shirt 23 hours a day. d. Remove the brace before sleeping.

ANS: C A Milwaukee brace is worn approximately 23 hours a day over a T-shirt, which protects the skin

1. A chest radiograph film is ordered for a child with suspected cardiac problems. The child's parent asks the nurse, "What will the radiograph show about the heart?" The nurse's response should be based on knowledge that the x-ray film will show: a. bones of chest but not the heart. b. measurement of electrical potential generated from heart muscle. c. permanent record of heart size and configuration. d. computerized image of heart vessels and tissues.

ANS: C A chest radiograph will provide information on the heart size and pulmonary blood-flow patterns. It will provide a baseline for future comparisons. The heart will be visible, as well as the sternum and ribs. Electrocardiography (ECG) measures the electrical potential generated from heart muscle. Echocardiography will produce a computerized image of the heart vessels and tissues by using sound waves.

15. An infant is discharged after open heart surgery. The infant is going home on oxygen and with multiple medications. Which instruction by the nurse is the priority? A. "Be sure to keep all postoperative appointments." B. "Do not allow anyone to pick up or hold the baby." C. "If your baby is irritable, check oxygen saturation." D. "Monitor the incision for redness or warmth."

ANS: C A child going home on oxygen will have an oximeter. This child's parents need to be educated on signs of heart failure (including decreased oxygenation), including irritability in a small child. They should be told to check the oxygen saturation when irritability is seen. Keeping appointments and monitoring a surgical incision are appropriate instructions for any postoperative patient. The baby can be picked up and held but must be cradled and not picked up under the arms until the sternum has healed.

44. A nurse completes the Pediatric Fall Risk Assessment on a patient who scores a 9. Which intervention by the nurse is most important to include on the care plan? A. Allow independent ambulation around the unit. B. Maintain forced bedrest with restraints if necessary. C. Provide assistance with transfers and ambulation. D. Use two individuals at all times for mobility.

ANS: C A pediatric fall risk score of 0 to 7 demonstrates low risk for falls, whereas a score of 8 to 17 indicates a high risk for falls. Because this child demonstrates a high risk for falls he or she should have assistance with transfers and walking.

6. A 15-year-old boy is brought to the emergency room by his parents following an injury to his arm that occurred during football practice. The x-ray shows a diagonal line that coils around the bone. Based on this x-ray, which type of fracture does the nurse prepare to teach the family about? A. Greenstick B. Oblique C. Spiral D. Transverse

ANS: C A spiral break is caused by a twisting force and shows a diagonal line that coils around the bone. An oblique break shows a diagonal line across the bone. A transverse break shows a line that crosses the shaft at a 90-degree angle. In a greenstick-type break, the bone is bent but not broken.

24. A pediatric nurse is assisting with the care of a child diagnosed with a fractured femur. What type of fracture would be the most likely to alert the nurse to the possibility of physical abuse? a. Stress fracture b. Compound fracture c. Spiral fracture d. Greenstick fracture

ANS: C A spiral fracture of the femur is caused by a forceful twisting motion. When the history of an injury does not correlate with x-ray findings, child abuse should be suspected because spiral fractures can be the result of manual twisting of the extremity.

35. Which is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ T cells? a. Wiskott-Aldrich syndrome b. Idiopathic thrombocytopenic purpura c. Acquired immunodeficiency syndrome (AIDS) d. Severe combined immunodeficiency disease

ANS: C AIDS is caused by the human immunodeficiency virus (HIV), which primarily attacks the CD4+ T cells. Wiskott-Aldrich syndrome, idiopathic thrombocytopenic purpura, and severe combined immunodeficiency disease are not viral illnesses.

27. Which condition is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ T-cells? a. Wiskott-Aldrich syndrome b. Idiopathic thrombocytopenic purpura (ITP) c. Acquired immunodeficiency syndrome (AIDS) d. Severe combined immunodeficiency disease

ANS: C AIDS is caused by the human immunodeficiency virus, which primarily attacks the CD4+ T-cells. Wiskott-Aldrich syndrome, ITP, and severe combined immunodeficiency disease are not viral illnesses.

28. A 10-year-old child is being discharged after surgical repair of a total anomalous pulmonary venous return defect (TAPVR). Which referral made by the nurse is most appropriate for this child? A. Hospice team B. Occupational therapy C. School nurse D. Visiting nurse

ANS: C After a TAPVR repair, most children go on to live full and normal lives. Because this child will return to school, communication with the school nurse is appropriate. Hospice, visiting nurses, and occupational therapy are not warranted.

43. A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. While an airway is being established, the nurse should prepare which medication for immediate administration? a. Diphenhydramine (Benadryl) b. Dobutamine (Dobutarex) c. Epinephrine (Adrenalin) d. Calcium chloride (calcium chloride)

ANS: C After the first priority of establishing an airway, administration of epinephrine is the drug of choice. Diphenhydramine, an antihistamine, is usually not used for severe reactions. Dobutamine and calcium chloride are not appropriate drugs for this type of reaction.

32. A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. While an airway is being established, what medication should the nurse prepare for immediate administration? a. Diphenhydramine (Benadryl) c. Epinephrine b. Dopamine d. Calcium chloride

ANS: C After the first priority of establishing an airway, epinephrine is the drug of choice. Benadryl is not a strong enough antihistamine for this severe a reaction. Dopamine and calcium chloride are not appropriate drugs for this type of reaction.

18. A child is being cared for at home with modified bed rest for Legg-Calvé-Perthes disease. Which assessment finding indicates to the home health-care nurse that outcomes for a priority diagnosis have been met? A. The child maintains grades in school via tutoring. B. The family identifies effective coping strategies. C. Full range of motion is present in all joints. D. The family identifies appropriate diversionary activities.

ANS: C All assessment findings signify positive adaptation to this disorder. However, because the child is on bedrest, the priority is to prevent complications of immobility including contractures or decreased ROM in joints.

46. A child is being discharged after a pacemaker insertion. Which teaching point by the nurse takes priority? A. Any prescribed activity restrictions B. Need for a healthy balanced diet C. Schedule for pacemaker testing D. Signs of wound site infection

ANS: C All options are important for the postoperative child who had a pacemaker insertion. However, the instruction that is specific to this operation is the schedule for follow-up pacemaker function testing, which will be lifelong.

51. A preschool child is scheduled for an echocardiogram. Parents ask the nurse whether they can hold the child during the procedure. The nurse should answer with which response? a. "You will be able to hold your child during the procedure." b. "Your child can be active during the procedure, but can't sit in your lap." c. "Your child must lie quietly; sometimes a mild sedative is administered before the procedure." d. "The procedure is invasive so your child will be restrained during the echocardiogram."

ANS: C Although an echocardiogram is noninvasive, painless, and associated with no known side effects, it can be stressful for children. The child must lie quietly in the standard echocardiographic positions; crying, nursing, being held, or sitting up often leads to diagnostic errors or omissions. Therefore, infants and young children may need a mild sedative; older children benefit from psychologic preparation for the test. The distraction of a video or movie is often helpful.

45. A preschool child is scheduled for an echocardiogram. Parents ask the nurse whether they can hold the child during the procedure. The nurse should answer with which response? a. "You will be able to hold your child during the procedure." b. "Your child can be active during the procedure, but can't sit in your lap." c. "Your child must lie quietly; sometimes a mild sedative is administered before the procedure." d. "The procedure is invasive so your child will be restrained during the echocardiogram."

ANS: C Although an echocardiogram is noninvasive, painless, and associated with no known side effects, it can be stressful for children. The child must lie quietly in the standard echocardiographic positions; crying, nursing, or sitting up often leads to diagnostic errors or omissions. Therefore, infants and young children may need a mild sedative; older children benefit from psychological preparation for the test. The distraction of a video or movie is often helpful.

38. Which child should the nurse document as being anemic? a. 7-year-old child with a hemoglobin of 11.5 g/dL b. 3-year-old child with a hemoglobin of 12 g/dL c. 14-year-old child with a hemoglobin of 10 g/dL d. 1-year-old child with a hemoglobin of 13 g/dL

ANS: C Anemia is a condition in which the number of red blood cells, or hemoglobin concentration, is reduced below the normal values for age. Anemia is defined as a hemoglobin level below 10 or 11 g/dL. The child with a hemoglobin of 10 g/dL would be considered anemic. The normal hemoglobin for a child after 2 years of age is 11.5 to 15.5 g/dL.

15. A child with rheumatic fever begins involuntary, purposeless movements of her limbs. What does the nurse recognize that this indicates? a. Seizure activity b. Hypoxia c. Sydenham's chorea d. Decreasing level of consciousness

ANS: C As the effects of rheumatic fever affect the central nervous system, the child may develop Sydenham's chorea, manifested by involuntary, purposeless movements of the limbs.

41. A nurse is concerned that a child with pulmonary hypertension (PA) is developing heart failure. Which manifestation would the nurse assess for first? A. Cough B. Dyspnea C. Extremity edema D. Tachycardia

ANS: C As the pressure in the lungs increases in the child with PA, the right ventricle hypertrophies and will eventually fail. Manifestations of right-sided failure include peripheral edema. Lung manifestations are seen in left-sided heart failure. Tachycardia is nonspecific. Although both sides of the heart can eventually fail, the first signs and symptoms will be of right-sided failure.

4. Which defect results in increased pulmonary blood flow? a. Pulmonic stenosis c. Atrial septal defect b. Tricuspid atresia d. Transposition of the great arteries

ANS: C Atrial septal defect results in increased pulmonary blood flow. Blood flows from the left atrium (higher pressure) into the right atrium (lower pressure) and then to the lungs via the pulmonary artery. Pulmonic stenosis is an obstruction to blood flowing from the ventricles. Tricuspid atresia results in decreased pulmonary blood flow. Transposition of the great arteries results in mixed blood flow.

8. Which defect results in increased pulmonary blood flow? a. Pulmonic stenosis b. Tricuspid atresia c. Atrial septal defect d. Transposition of the great arteries

24. Which statement is accurate concerning a child's musculoskeletal system and how it may be different from an adult's? a. Growth occurs in children as a result of an increase in the number of muscle fibers. b. Infants are at greater risk for fractures because their epiphyseal plates are not fused. c. Because soft tissues are resilient in children, dislocations and sprains are less common than in adults. d. Children's bones have less blood flow.

ANS: C Because soft tissues are resilient in children, dislocations and sprains are less common than in adults. A child's growth occurs because of an increase in size rather than an increase in the number of the muscle fibers. Fractures in children younger than 1 year are unusual because a large amount of force is necessary to fracture their bones. A child's bones have greater blood flow than an adult's bones.

3. The nurse is planning activity for a 4-year-old child with anemia. Which activity should the nurse plan for this child? a. Game of "hide and seek" in the children's outdoor play area b. Participation in dance activities in the playroom c. Puppet play in the child's room d. A walk down to the hospital lobby

ANS: C Because the basic pathologic process in anemia is a decrease in oxygen-carrying capacity, an important nursing responsibility is to assess the child's energy level and minimize excess demands. The child's level of tolerance for activities of daily living and play is assessed, and adjustments are made to allow as much self-care as possible without undue exertion. Puppet play in the child's room would not be overly tiring. Hide and seek, dancing, and walking to the lobby would not conserve the anemic child's energy.

39. The nurse is planning activity for a 4-year-old child with anemia. Which activity should the nurse plan for this child? a. Game of "hide and seek" in the children's outdoor play area b. Participation in dance activities in the playroom c. Puppet play in the child's room d. A walk down to the hospital lobby

43. An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which route? a. Bone grafting b. Bone marrow injection c. IV infusion d. Intra-abdominal infusion

ANS: C Bone marrow from a donor is infused intravenously, and the transfused stem cells will repopulate the marrow. Because the stem cells migrate to the recipient's marrow when given intravenously, this is the method of administration.

44. An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which route? a. Bone grafting c. Intravenous infusion b. Bone marrow injection d. Intraabdominal infusion

ANS: C Bone marrow from a donor is infused intravenously, not intraabdominally, and the transfused stem cells will repopulate the marrow. Because the stem cells migrate to the recipient's marrow when given intravenously, this method of administration is used rather than bone grafting or bone marrow injection.

23. Approximately how old does the nurse assess a large green bruise on the thigh of a 4-year-old to be? a. 2 days b. 4 days c. 6 days d. 8 days

ANS: C Bruises heal in various stages that are indicated according to color; after 5 to 7 days bruise are green.

39. An infant hospitalized with multiple fractures has just been diagnosed with osteogenesis imperfecta. The nurse finds the parents crying. Which response by the nurse is the most appropriate? A. "I know how you feel. I would be upset to find this out too." B. "There is medicine that can allow her to live a normal life." C. "Would you like me to help you with holding your baby?" D. "You are actually lucky; many of these babies die at birth."

ANS: C Causing more injury to their child is a common concern among parents of children with osteogenesis imperfecta. The nurse needs to show them how to hold, change, feed, and play with their babies. In this situation, the caring nurse offers to help the parents learn to hold their baby and offers support. The nurse should never assume to know how someone else is feeling. Medications will not help this child lead a normal life. Stating that the parents are lucky is belittling their feelings.

16. How long should a 4-year-old child recovering from rheumatic fever need to receive monthly injections of penicillin G? a. 1 year b. 2 years c. 5 years d. 10 years

ANS: C Children who recover from rheumatic fever should have a chemoprophylaxis protocol of penicillin G injections (about 200,000 units per dose) for a minimum of 5 years or up to the age of 18 to prevent further bouts of rheumatic fever.

12. A nurse notes that a child has clubbed fingernails. Which laboratory finding would the nurse correlate with this assessment? A. Hemoglobin: 16 g/dL B. PaCO2: 43 mm Hg C. PaO2: 72 mm Hg D. White blood count: 8,500 mm3

ANS: C Clubbing of the fingernails is associated with chronically low oxygenation. A PaO2 of 72 mm Hg is low. The other values are normal.

34. An 8-month-old child with congenital myotonic dystrophy has been hospitalized with a severe respiratory infection. Which action by the nurse is the most appropriate? A. Determine if the family wants aggressive ventilatory support. B. Discuss the option of lung transplantation with the family. C. Hold a family meeting to discuss palliative care measures and code status. D. Inform the family the child will be ventilator dependent as she gets older.

ANS: C Congenital myotonic dystrophy usually causes death before the age of 1 year due to the inability to maintain respirations. In this situation, the nurse should have a meeting with the family to explore a broad range of therapeutic options, including palliative care measures and code status. Just inquiring about ventilatory support is too narrow a focus. Lung transplantation is not a treatment for this disorder. Children with this disease die at a young age, and so they do not grow up dependent on ventilators.

17. 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.

8. A child hospitalized with heart failure has extremely high blood pressure. Which medication does the nurse prepare to administer? A. Digoxin (Lanoxin) B. Dobutamine (Dobutrex) C. Enalapril (Vasotec) D. Hydrochlorothiazide (Aquazide)

ANS: C Enalapril is a calcium-channel blocker that reduces systemic vascular resistance, or afterload. Digoxin and dobutamine are positive inotropic agents. Hydrochlorothiazide is a diuretic.

25. When infants are seen for fractures, which nursing intervention is a priority? a. No intervention is necessary. It is not uncommon for infants to fracture bones. b. Assess the family's safety practices. Fractures in infants usually result from falls. c. Assess for child abuse. Fractures in infants are often nonaccidental. d. Assess for genetic factors.

ANS: C Fractures in infants warrant further investigation to rule out child abuse. Fractures in children younger than 1 year are unusual because of the cartilaginous quality of the skeleton; a large amount of force is necessary to fracture their bones. Infants should be cared for in a safe environment and should not be falling. Fractures in infancy are usually nonaccidental rather than related to a genetic factor.

5. What characteristic manifestation does the nurse caring for a child with Duchenne's muscular dystrophy document? a. Ambulates by holding onto furniture b. Exhibits atrophy of the calf muscles c. Falls frequently and is clumsy d. Has delayed fine-motor development

ANS: C Frequent falling and clumsiness are clinical manifestations of Duchenne's muscular dystrophy.

6. A child hospitalized with heart failure has manifestations related to increased preload. Which drug does the nurse prepare to administer? A. Digoxin (Lanoxin) B. Dopamine (Intropin) C. Furosemide (Lasix) D. Metoprolol (Toprol)

ANS: C Furosemide is a diuretic, used to rid the body of excess fluid, and it is excess fluid that leads to increased preload. Digoxin is often used in heart failure for its positive inotropic actions. Dopamine increases contractility. Metoprolol is a beta blocker, and its major effect is blocking sympathetic nervous system activity

37. Children receiving long-term systemic corticosteroid therapy are most at risk for: a. Hypotension. b. Dilation of blood vessels in the cheeks. c. Growth delays. d. Decreased appetite and weight loss.

ANS: C Growth delay is associated with long-term steroid use. Hypertension is a clinical manifestation of long-term systemic steroid administration. Dilation of blood vessels in the cheeks is associated with an excess of topically administered steroids. Increased appetite and weight gain are clinical manifestations of excess systemic corticosteroid therapy

17. What is accurate about the characteristics of high-density lipoproteins (HDLs)? a. They have high amounts of triglycerides. b. They have only small amounts of protein. c. They have little cholesterol. d. They aid in steroid production.

ANS: C HDLs have low amounts of triglycerides, large amounts of proteins, low amount of cholesterol, and are excreted via the liver. They have no role in the production of steroids.

23. What important focus of nursing care for the dying child and the family should the nurse implement? a. Nursing care should be organized to minimize contact with the child. b. Adequate oral intake is crucial to the dying child. c. Families should be made aware that hearing is the last sense to stop functioning before death. d. It is best for the family if the nursing staff provides all of the child's care.

ANS: C Hearing is intact even when there is a loss of consciousness.

17. When does idiopathic scoliosis become most noticeable? a. Newborn period c. During preadolescent growth spurt b. When child starts to walk d. Adolescence

ANS: C Idiopathic scoliosis is most noticeable during the preadolescent growth spurt and is seldom apparent before age 10 years.

22. A school nurse is conducting a staff in-service to other school nurses on idiopathic scoliosis. During which period of child development does idiopathic scoliosis become most noticeable? a. Newborn period b. When child starts to walk c. Preadolescent growth spurt d. Adolescence

ANS: C Idiopathic scoliosis is most noticeable during the preadolescent growth spurt. Idiopathic scoliosis is seldom apparent before age 10 years. Diagnosis usually occurs during the preadolescent growth spurt.

19. The nurse is caring for a child after heart surgery. What should she or he do if evidence is found of cardiac tamponade? a. Increase analgesia. b. Apply warming blankets. c. Immediately report this to the physician. d. Encourage the child to cough, turn, and breathe deeply.

ANS: C If evidence is noted of cardiac tamponade (blood or fluid in the pericardial space constricting the heart), the physician is notified immediately of this life-threatening complication. Increasing analgesia may be done before the physician drains the fluid, but the physician must be notified. Warming blankets are not indicated at this time. Encouraging the child to cough, turn, and breathe deeply should be deferred until after the evaluation by the physician.

27. The nurse is caring for a child after heart surgery. Which should the nurse do if evidence is found of cardiac tamponade? a. Increase analgesia. b. Apply warming blankets. c. Immediately report this to physician. d. Encourage child to cough, turn, and breathe deeply.

ANS: C If evidence is noted of cardiac tamponade, which is blood or fluid in the pericardial space constricting the heart, the physician is notified immediately of this life-threatening complication. Increasing analgesia may be done before the physician drains the fluid, but the physician must be notified. Warming blankets are not indicated at this time. Encouraging the child to cough, turn, and breathe deeply should be deferred till after the evaluation by the physician.

26. Which is an important nursing consideration when suctioning a young child who has had heart surgery? a. Perform suctioning at least every hour. b. Suction for no longer than 30 seconds at a time. c. Administer supplemental oxygen before and after suctioning. d. Expect symptoms of respiratory distress when suctioning.

ANS: C If suctioning is indicated, supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia. Suctioning should be done only as indicated, not on a routine basis. The child should be suctioned for no more than 5 seconds at one time. Symptoms of respiratory distress are avoided by using appropriate technique.

18. An important nursing consideration when suctioning a young child who has had heart surgery is to: a. Perform suctioning at least every hour. b. Suction for no longer than 30 seconds at a time. c. Administer supplemental oxygen before and after suctioning. d. Expect symptoms of respiratory distress when suctioning.

16. A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min. a. 60 b. 70 c. 90 to 110 d. 110 to 120

ANS: C If the 1-minute apical pulse is below 90 to 110 beats/min, the digoxin should not be given to a 6-month-old. 60 beats/min is the cut-off for holding the digoxin dose in an adult. 70 beats/min is the determining heart rate to hold a dose of digoxin for an older child. 110 to 120 beats/min is an acceptable heart rate to administer digoxin to a 6-month-old.

5. The nurse is teaching parents of an infant about the causes of iron deficiency anemia. Which statement best describes iron deficiency anemia in infants? a. It is caused by depression of the hematopoietic system. b. It is easily diagnosed because of an infant's emaciated appearance. c. Clinical manifestations are similar regardless of the cause of the anemia. d. Clinical manifestations result from a decreased intake of milk and the premature addition of solid foods.

ANS: C In iron deficiency anemia, the child's clinical appearance is a result of the anemia, not the underlying cause. Usually the hematopoietic system is not depressed in iron deficiency anemia. The bone marrow produces red cells that are smaller and contain less hemoglobin than normal red cells. Children who are iron deficient from drinking excessive quantities of milk are usually pale and overweight. They are receiving sufficient calories, but are deficient in essential nutrients. The clinical manifestations result from decreased intake of iron-fortified solid foods and an excessive intake of milk.

31. 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.

13. Which statement best describes -thalassemia major (Cooley's anemia)? a. All formed elements of the blood are depressed. b. Inadequate numbers of red blood cells are present. c. Increased incidence occurs in families of Mediterranean extraction. d. Increased incidence occurs in persons of West African descent.

ANS: C Individuals who live near the Mediterranean Sea and their descendants have the highest incidence of thalassemia. An overproduction of red cells occurs. Although numerous, the red cells are relatively unstable. Sickle cell disease is common in blacks of West African descent.

16. Which statement best describes b-thalassemia major (Cooley anemia)? a. All formed elements of the blood are depressed. b. Inadequate numbers of red blood cells are present. c. Increased incidence occurs in families of Mediterranean extraction. d. Increased incidence occurs in persons of West African descent.

14. The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. What should be included? a. Apply lotion or powder to minimize skin irritation. b. Remove the harness several times a day to prevent contractures. c. Return to the clinic every 1 to 2 weeks. d. Place a diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.

ANS: C Infants have a rapid growth pattern. The child needs to be assessed by the practitioner every 1 to 2 weeks for possible adjustments. Lotions and powders should not be used with the harness. The harness should not be removed, except as directed by the practitioner. A thin disposable diaper can be placed under the harness

18. The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. Which should be included? a. Apply lotion or powder to minimize skin irritation. b. Remove harness several times a day to prevent contractures. c. Return to clinic every 1 to 2 weeks. d. Place diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.

6. Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include: a. Administering with meals. b. Administering between meals. c. Injecting deeply into a large muscle. d. Massaging injection site for 5 minutes after administration of drug.

ANS: C Iron dextran is a parenteral form of iron. When administered intramuscularly, it must be injected into a large muscle using the Z-track method. Iron dextran is for intramuscular or intravenous administration; it is not taken orally. The site should not be massaged to prevent leakage, potential irritation, and staining of the skin.

7. Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include to: a. administer with meals. b. administer between meals. c. inject deeply into a large muscle. d. massage injection site for 5 minutes after administration of drug.

ANS: C Iron dextran is a parenteral form of iron. When administered intramuscularly, it must be injected into a large muscle. Iron dextran is for intramuscular or intravenous (IV) administration. The site should not be massaged to prevent leakage, potential irritation, and staining of the skin.

28. Which is an important nursing consideration when chest tubes will be removed from a child? a. Explain that it is not painful. b. Explain that only a Band-Aid will be needed. c. Administer analgesics before procedure. d. Expect bright red drainage for several hours after removal.

ANS: C It is appropriate to prepare the child for the removal of chest tubes with analgesics. Short-acting medications can be used that are administered through an existing IV line. A sharp, momentary pain is felt. This should not be misrepresented to the child. A petroleum gauze, air-tight dressing will be needed, but it is not a pain-free procedure. Little or no drainage should be found on removal.

20. An important nursing consideration when chest tubes will be removed from a child is to: a. Explain that it is not painful. b. Explain that only a Band-Aid will be needed. c. Administer analgesics before the procedure. d. Expect bright red drainage for several hours after removal.

ANS: C It is appropriate to prepare the child for the removal of chest tubes with analgesics. Short-acting medications can be used that are administered through an existing intravenous line. It is not a pain-free procedure. A sharp, momentary pain is felt, and this should not be misrepresented to the child. A petroleum gauze/airtight dressing is needed. Little or no drainage should be found on removal.

22. Which is most descriptive of the pathophysiology of leukemia? a. Increased blood viscosity occurs. b. Thrombocytopenia (excessive destruction of platelets) occurs. c. Unrestricted proliferation of immature white blood cells (WBCs) occurs. d. First stage of coagulation process is abnormally stimulated.

ANS: C Leukemia is a group of malignant disorders of the bone marrow and lymphatic system. It is defined as an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body. Increased blood viscosity may occur secondary to the increased number of WBCs. Thrombocytopenia may occur secondary to the overproduction of WBCs in the bone marrow. The coagulation process is unaffected by leukemia.

19. What is most descriptive of the pathophysiology of leukemia? a. Increased blood viscosity occurs. b. Thrombocytopenia (excessive destruction of platelets) occurs. c. Unrestricted proliferation of immature white blood cells (WBCs) occurs. d. The first stage of the coagulation process is abnormally stimulated.

ANS: C Leukemia is a group of malignant disorders of the bone marrow and the lymphatic system. It is defined as an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body. Increased blood viscosity may occur secondary to the increased number of WBCs. Thrombocytopenia may occur secondary to the overproduction of WBCs in the bone marrow. The coagulation process is unaffected by leukemia.

9. An adolescent is diagnosed with Hodgkin's disease. Lymph nodes on both sides of her diaphragm have been found to be involved, including cervical and inguinal nodes. Which disease stage is this? a. I b. II c. III d. IV

ANS: C Lymph node regions on both sides of the diaphragm are consistent with a diagnosis of stage III Hodgkin's disease.

1. What would the nurse include in planning teaching to parents of a child with Legg-Calvé-Perthes disease about the long-term effects of this disease? a. There are no long-term effects. b. The disease is self-limited and requires no long-term treatment. c. Degenerative arthritis may develop later in life. d. There is risk of osteogenic sarcoma in adulthood

ANS: C Marked distortion of the head of the femur may lead to an imperfect joint or to degenerative arthritis of the hip later in life.

4. The nurse is providing care to a pediatric patient admitted for a workup of bone deformity. The latest laboratory values indicate calcium at 6.6 mg/dL and phosphorus at 2.1 mg/dL. Which condition does the nurse correlate with these values? A. Muscular dystrophy B. Osgood-Schlatter disease C. Rickets D. Scoliosis

ANS: C Normal calcium is 8.5-11 mg/dL, and normal phosphorus is 3-4.5 mg/dL. Low values for both are seen in rickets.

50. Which action by the school nurse is important in the prevention of rheumatic fever? a. Encourage routine cholesterol screenings. b. Conduct routine blood pressure screenings. c. Refer children with sore throats for throat cultures. d. Recommend salicylates instead of acetaminophen for minor discomforts.

ANS: C Nurses have a role in prevention—primarily in screening school-age children for sore throats caused by group A -hemolytic streptococci. They can achieve this by actively participating in throat culture screening or by referring children with possible streptococcal sore throats for testing. Cholesterol and blood pressure screenings do not facilitate the recognition and treatment of group A -hemolytic streptococci. Salicylates should be avoided routinely because of the risk of Reye's syndrome after viral illnesses.

35. Which action by the school nurse is important in the prevention of rheumatic fever? a. Encourage routine cholesterol screenings. b. Conduct routine blood pressure screenings. c. Refer children with sore throats for throat cultures. d. Recommend salicylates instead of acetaminophen for minor discomforts.

ANS: C Nurses have a role in prevention—primarily in screening school-age children for sore throats caused by group A b-hemolytic streptococci. They can achieve this by actively participating in throat culture screening or by referring children with possible streptococcal sore throats for testing. Cholesterol and blood pressure screenings do not facilitate the recognition and treatment of group A b-hemolytic streptococci. Salicylates should be avoided routinely because of the risk of Reye syndrome after viral illnesses.

44. Clinical manifestations of toxic shock syndrome include: a. severe hypertension. b. subnormal temperature. c. erythematous macular rash. d. papular rash over extremities.

ANS: C One of the diagnostic criteria for toxic shock syndrome is a diffuse macular erythroderma. Hypotension is one of the manifestations. Fever of 38.9° C or higher is a characteristic. Desquamation of the palms and soles of the feet occurs in about 1 to 2 weeks.

24. The nurse is taking care of a 10-year-old child who has osteomyelitis. Which treatment plan is considered the primary method of treating osteomyelitis? a. Joint replacement b. Bracing and casting c. Intravenous antibiotic therapy d. Long-term corticosteroid therapy

ANS: C Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus aureus. The treatment of choice is antibiotics. Joint replacement, bracing and casting, and long-term corticosteroid therapy are not indicated for infectious processes.

18. The primary method of treating osteomyelitis is: a. Joint replacement. c. Intravenous antibiotic therapy. b. Bracing and casting. d. Long-term corticosteroid therapy.

15. A parent calls the nursing call center stating that his child, who has a cast after surgical treatment of a clubfoot, is very fussy even after acetaminophen (Tylenol) administration and that the child's toes seem cool. What advice does the nurse give the parent? A. "Elevate the affected extremity and apply ice for 20 minutes." B. "Make four cuts to the top of the cast, each about 1 inch long." C. "Take your child to the nearest emergency department now." D. "Try giving your child a dose of ibuprofen (Pediaprofen) instead."

ANS: C Parents always need to observe for complications of casting, including neurovascular compromise. A child who is excessively fussy and whose toes are cool should be seen by a health-care provider to assess circulation and possibly modify or change the cast. The parent should be told to take the child to the nearest emergency department (ED). The other answers are inappropriate. If circulation is compromised, elevation and ice will make the problem worse. The parent should not be instructed to modify the cast. Although ibuprofen may manage the child's pain better than acetaminophen, the priority instruction is to send the parent to the ED.

44. A 3-year-old child is 4 hours post-cardiac catheterization via the right femoral artery. Which assessment finding should the nurse report to the provider? A. Crying, complaining of pain at site B. Restless, tries to get up repeatedly C. Right pedal pulse weaker than left D. Wants to be held by a parent

ANS: C Pedal pulses should be equal (or unchanged) after a cardiac catheterization. If a pedal pulse on the insertion side is weaker, arterial flow to the extremity may have been disrupted, and this should be reported. Pain is expected and is treated with acetaminophen. A 3-year-old would be expected to want to get up and not lie still and might want to be held. Sedation might be required to maintain bedrest with the affected leg kept straight.

12. Which is a clinical manifestation of the systemic venous congestion that can occur with heart failure? a. Tachypnea b. Tachycardia c. Peripheral edema d. Pale, cool extremities

ANS: C Peripheral edema, especially periorbital edema, is a clinical manifestation of systemic venous congestion. Tachypnea is a manifestation of pulmonary congestion. Tachycardia and pale, cool extremities are clinical manifestations of impaired myocardial function.

7. A clinical manifestation of the systemic venous congestion that can occur with congestive heart failure is: a. Tachypnea. c. Peripheral edema. b. Tachycardia. d. Pale, cool extremities.

26. A child is sent to the school nurse for assessment because she comes to school every day disheveled, unbathed, and hungry. The assessment does not indicate any bruises or marks on the body. What do these finding indicate? a. Sexual abuse b. Physical abuse c. Physical neglect d. Emotional abuse

ANS: C Physical neglect is the failure to provide for the basic physical needs of the child, including food, clothing, shelter, and basic cleanliness.

3. What has the greatest influence on preload? A. Blood pressure B. Contractility C. Fluid volume D. Heart rate

ANS: C Preload is equivalent to venous blood return to the atria and end diastolic volumes of the heart. This is directly influenced by fluid volume. Heart rate and contractility have some influence, but they are not the major determinants of preload. Blood pressure is not a direct influence on preload.

2. Several blood tests are ordered for a preschool child with severe anemia. The child is crying and upset because of memories of the venipuncture done at the clinic 2 days ago. The nurse should explain: a. venipuncture discomfort is very brief. b. only one venipuncture will be needed. c. topical application of local anesthetic can eliminate venipuncture pain. d. most blood tests on children require only a finger puncture because a small amount of blood is needed.

ANS: C Preschool children are concerned with both pain and the loss of blood. When preparing the child for venipuncture, the nurse will use a topical anesthetic to eliminate any pain. This is a traumatic experience for preschool children. They are concerned about their bodily integrity. A local anesthetic should be used, and a bandage should be applied to maintain bodily integrity. The nurse should not promise one attempt in case multiple attempts are required. Both finger punctures and venipunctures are traumatic for children. Both require preparation.

2. Several blood tests are ordered for a preschool child with severe anemia. She is crying and upset because she remembers the venipuncture done at the clinic 2 days ago. The nurse should explain that: a. Venipuncture discomfort is very brief. b. Only one venipuncture will be needed. c. Topical application of local anesthetic can eliminate venipuncture pain. d. Most blood tests on children require only a finger puncture because a small amount of blood is needed.

ANS: C Preschool children are very concerned about both pain and the loss of blood. When preparing the child for venipuncture, a topical anesthetic will be used to eliminate any pain. This is a very traumatic experience for preschool children. They are concerned about their bodily integrity. A local anesthetic should be used, and a bandage should be applied to maintain bodily integrity. A promise that only one venipuncture will be needed should not be made in case multiple attempts are required. Both finger punctures and venipunctures are traumatic for children. Both require preparation.

43. A nurse is teaching an adolescent about primary hypertension. The nurse knows that which of the following is correct? a. Primary hypertension should be treated with diuretics as soon as it is detected. b. Congenital heart defects are the most common cause of primary hypertension. c. Primary hypertension may be treated with weight reduction. d. Primary hypertension is not affected by exercise.

ANS: C Primary hypertension in children may be treated with weight reduction and exercise programs. If ineffective, pharmacologic intervention may be needed. Primary hypertension is considered an inherited disorder.

16. 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.

11. Which type of traction uses skin traction on the lower leg and a padded sling under the knee? a. Dunlop c. Russell b. Bryant's d. Buck's extension

ANS: C Russell traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position. Dunlop traction is an upper extremity traction used for fractures of the humerus. Bryant's traction is skin traction with the legs flexed at a 90-degree angle at the hip. Buck's extension traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, before surgery with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease.

15. Which type of traction uses skin traction on the lower leg and a padded sling under the knee? a. Dunlop b. Bryant c. Russell d. Buck extension

ANS: C Russell traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position. Dunlop traction is an upper-extremity traction used for fractures of the humerus. Bryant traction is skin traction with the legs flexed at a 90-degree angle at the hip. Buck extension traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease.

19. A neonate is born with bilateral mild talipes equinovarus (clubfoot). When the parents ask the nurse how this will be corrected, the nurse should give which explanation? a. Traction is tried first. b. Surgical intervention is needed. c. Frequent, serial casting is tried first. d. Children outgrow this condition when they learn to walk.

ANS: C Serial casting is begun shortly after birth before discharge from nursery. Successive casts allow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Serial casting is the preferred treatment. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention.

15. A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, the nurse should explain that: a. Traction is tried first. b. Surgical intervention is needed. c. Frequent, serial casting is tried first. d. Children outgrow this condition when they learn to walk.

ANS: C Serial casting, the preferred treatment, is begun shortly after birth before discharge from the nursery. Successive casts allows for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention.

17. The nurse observes that the legs of a child with cerebral palsy cross involuntarily, and the child exhibits jerky movements with his arms as he tries to eat. The nurse recognizes that he has which type of cerebral palsy? a. Athetoid b. Ataxic c. Spastic d. Mixed

ANS: C Spasticity is characterized by tension in certain muscle groups, which makes voluntary movements of muscles jerky and uncoordinated.

9. An adolescent expresses frustration over how long his football injury to a tendon is taking to heal. Which response by the nurse is the most appropriate? A. "I'll ask the doctor to check for a tendon infection." B. "Often these injuries never fully heal and return to normal." C. "Tendons have a poor blood supply, so healing is slow." D. "You have to be more compliant with immobilization."

ANS: C Tendons are fibrous connective tissues that have very little blood supply. Therefore healing from a tendon injury takes time. This is the best response; there is no indication that the teen has an infection interfering with recovery, it is inaccurate and disheartening to tell a young person that tendons may never heal, and the nurse should not assume the patient is noncompliant with immobilization.

33. 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.

19. A home care nurse is caring for an adolescent with a T1 spinal cord injury. The adolescent suddenly becomes flushed, hypertensive, and diaphoretic. Which intervention should the nurse perform first? a. Place the adolescent in a flat right side-lying position. b. Place a cool washcloth on the adolescent's forehead and continue to monitor the blood pressure. c. Implement a standing prescription to empty the bladder with a sterile in and out Foley catheter. d. Take a full set of vital signs and notify the health care provider.

ANS: C The adolescent is experiencing an autonomic dysreflexia episode. The paralytic nature of autonomic function is replaced by autonomic dysreflexia, especially when the lesions are above the mid-thoracic level. This autonomic phenomenon is caused by visceral distention or irritation, particularly of the bowel or bladder. Sensory impulses are triggered and travel to the cord lesion, where they are blocked, which causes activation of sympathetic reflex action with disturbed central inhibitory control. Excessive sympathetic activity is manifested by a flushing face, sweating forehead, pupillary constriction, marked hypertension, headache, and bradycardia. The precipitating stimulus may be merely a full bladder or rectum or other internal or external sensory input. It can be a catastrophic event unless the irritation is relieved. Placing a cool washcloth on the adolescent's forehead, continuing to monitor blood pressure and vital signs, and notifying the healthcare provider would not reverse the sympathetic reflex situation.

19. A home care nurse is caring for an adolescent with a T1 spinal cord injury. The adolescent suddenly becomes flushed, hypertensive, and diaphoretic. Which intervention should the nurse perform first? a. Place the adolescent in a flat right side-lying position. b. Place a cool washcloth on the adolescent's forehead and continue to monitor the blood pressure. c. Implement a standing prescription to empty the bladder with a sterile in-and-out Foley catheter. d. Take a full set of vital signs and notify the health care provider.

ANS: C The adolescent is experiencing an autonomic dysreflexia episode. The paralytic nature of autonomic function is replaced by autonomic dysreflexia, especially when the lesions are above the mid-thoracic level. This autonomic phenomenon is caused by visceral distention or irritation, particularly of the bowel or bladder. Sensory impulses are triggered and travel to the cord lesion, where they are blocked, which causes activation of sympathetic reflex action with disturbed central inhibitory control. Excessive sympathetic activity is manifested by a flushing face, sweating forehead, pupillary constriction, marked hypertension, headache, and bradycardia. The precipitating stimulus may be merely a full bladder or rectum or other internal or external sensory input. It can be a catastrophic event unless the irritation is relieved. Positioning the adolescent, placing a cool washcloth on the adolescent's forehead, continuing to monitor blood pressure and vital signs, and notifying the health care provider would not reverse the sympathetic reflex situation.

41. A student nurse is caring for a patient in skin traction. What action by the student causes the registered nurse to intervene? A. Assesses neurovascular status every 2-4 hours B. Ensures correct weights are hanging freely C. Positions child perpendicular to the traction D. Removes traction to assess the skin every 4 hours

ANS: C The child should be positioned directly in line with the traction. The other interventions are correct.

9. Which statement most accurately describes the pathologic changes of sickle cell anemia? a. Sickle-shaped cells carry excess oxygen. b. Sickle-shaped cells decrease blood viscosity. c. Increased red blood cell destruction occurs. d. Decreased red blood cell destruction occurs.

ANS: C The clinical features of sickle cell anemia are primarily the result of increased red blood cell destruction and obstruction caused by the sickle-shaped red blood cells. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension. When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation.

11. The nurse is conducting a staff in-service on sickle cell anemia. Which describes the pathologic changes of sickle cell anemia? a. Sickle-shaped cells carry excess oxygen. b. Sickle-shaped cells decrease blood viscosity. c. Increased red blood cell destruction occurs. d. Decreased adhesion of sickle-shaped cells occurs

6. What is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures? a. Pulmonary congestion c. Congestive heart failure b. Congenital heart defect d. Systemic venous congestion

ANS: C The definition of congestive heart failure is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the metabolic demands of the body. Pulmonary congestion is an excessive accumulation of fluid in the lungs. Congenital heart defect is a malformation of the heart present at birth. Systemic venous congestion is an excessive accumulation of fluid in the systemic vasculature.

11. Which is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures? a. Pulmonary congestion b. Congenital heart defect c. Heart failure d. Systemic venous congestion

ANS: C The definition of heart failure is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the body's metabolic demands. Pulmonary congestion is an excessive accumulation of fluid in the lungs. Congenital heart defect is a malformation of the heart present at birth. Systemic venous congestion is an excessive accumulation of fluid in the systemic vasculature.

28. A student athlete has a serious anterior cruciate ligament (ACL) tear, and her knee is swollen with excess synovial fluid. Which procedure does the nurse prepare this athlete for? A. Application of heat B. Immediate surgery C. Joint aspiration D. Knee reduction

ANS: C The health-care provider will remove excess synovial fluid via aspiration. Heat is not used for the first 24 hours. Immediate surgery may or may not be warranted. A knee reduction is performed for a dislocated knee.

12. Which clinical manifestations in an infant would be suggestive of spinal muscular atrophy (Werdnig-Hoffmann disease)? a. Hyperactive deep tendon reflexes b. Hypertonicity c. Lying in the frog position d. Motor deficits on one side of body

ANS: C The infant lies in the frog position with the legs externally rotated, abducted, and flexed at knees. The deep tendon reflexes are absent. The child has hypotonia and inactivity as the most prominent features. The motor deficits are bilateral.

17. As related to inherited disorders, which statement is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient d. Y-linked recessive inherited disorder in which the red blood cells become moon shaped

ANS: C The inheritance pattern in 80% of all of the cases of hemophilia is X-linked recessive. The two most common forms of the disorder are factor VIII deficiency (hemophilia A or classic hemophilia), and factor IX deficiency (hemophilia B or Christmas disease). The disorder involves coagulation factors, not platelets. The disorder does not involve red cells or the Y chromosome.

20. Parents of a hemophiliac child ask the nurse, "Can you describe hemophilia to us?" Which response by the nurse is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient d. Y-linked recessive inherited disorder in which the red blood cells become moon-shaped

ANS: C The inheritance pattern in 80% of all of the cases of hemophilia is X-linked recessive. The two most common forms of the disorder are factor VIII deficiency, hemophilia A or classic hemophilia; and factor IX deficiency, hemophilia B or Christmas disease. The inheritance pattern is X-linked recessive. The disorder involves coagulation factors, not platelets, and does not involve red cells or the Y chromosomes.

19. The nurse is planning a hypertension-prevention program. What should be the main focus of the nurse when presenting information? a. Pharmacological treatment b. Surgical interventions available c. Patient education d. Reduction of aerobic exercise

ANS: C The main focus of a hypertension-prevention program is patient education.

7. A pediatrician asks a patient with a knee injury to squat. Which disorder is this patient suspected of having? A. Juvenile arthritis B. Muscular dystrophy C. Osgood-Schlatter disease D. Osteomyelitis

ANS: C The major symptom of Osgood-Schlatter disease is pain below the kneecap that is aggravated by activity and relieved by rest. Symptoms resolve around the time skeletal growth ceases (about puberty). The child experiences pain when asked to squat or extend the knee against resistance. This is a good indicator of Osgood-Schlatter disease.

23. An important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA) is to: a. Apply ice packs to relieve stiffness and pain. b. Administer acetaminophen to reduce inflammation. c. Teach child and family the correct administration of medications. d. Encourage range-of-motion exercises during periods of inflammation.

ANS: C The management of JIA is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of a regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that nonsteroidal antiinflammatory drugs should not be given on an empty stomach and to be alert for signs of toxicity. Warm, moist heat is best for relieving stiffness and pain. Acetaminophen does not have antiinflammatory effects. Range-of-motion exercises should not be done during periods of inflammation.

29. The nurse is caring for a school-age child diagnosed with juvenile idiopathic arthritis (JIA). Which intervention should be a priority? a. Apply ice packs to relieve stiffness and pain. b. Administer acetaminophen to reduce inflammation. c. Teach the child and family correct administration of medications. d. Encourage range-of-motion exercises during periods of inflammation.

ANS: C The management of JIA is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that NSAIDs should not be given on an empty stomach and to be alert for signs of toxicity. Warm moist heat is best for relieving stiffness and pain. Acetaminophen does not have antiinflammatory effects. Range-of-motion exercises should not be done during periods of inflammation.

24. A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. The most appropriate nursing action to prevent or minimize these reactions with subsequent treatments is to: a. Encourage drinking large amounts of favorite fluids. b. Encourage child to take nothing by mouth (remain NPO) until nausea and vomiting subside. c. Administer an antiemetic before chemotherapy begins. d. Administer an antiemetic as soon as child has nausea.

ANS: C The most beneficial regimen to minimize nausea and vomiting associated with chemotherapy is to administer the antiemetic before the chemotherapy is begun. The goal is to prevent anticipatory symptoms. Drinking fluids will add to the discomfort of the nausea and vomiting. Encouraging the child to remain NPO will help with this episode, but the child will have the discomfort and be at risk for dehydration. Administering an antiemetic after the child has nausea does not avoid anticipatory nausea.

31. A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. Which is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments? a. Encourage drinking large amounts of favorite fluids. b. Encourage child to take nothing by mouth (remain NPO) until nausea and vomiting subside. c. Administer an antiemetic before chemotherapy begins. d. Administer an antiemetic as soon as child has nausea.

ANS: C The most beneficial regimen to minimize nausea and vomiting associated with chemotherapy is to administer the antiemetic before the chemotherapy is begun. The goal is to prevent anticipatory symptoms. Drinking fluids will add to the discomfort of the nausea and vomiting. Remaining until nausea and vomiting subside will help with this episode, but the child will have the discomfort and be at risk for dehydration. Administering an antiemetic as soon as the child has nausea does not prevent anticipatory nausea.

34. The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT) may be necessary. What should the nurse recognize as important when discussing this with the family? a. BMT should be done at time of diagnosis. b. Parents and siblings of child have a 25% chance of being a suitable donor. c. Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system. d. If BMT fails, chemotherapy or radiotherapy must be continued.

ANS: C The most successful BMTs come from suitable HLA-matched donors. The timing of a BMT depends on the disease process involved. It usually follows intensive high-dose chemotherapy and/or radiation therapy. Usually parents only share approximately 50% of the genetic material with their children. A one-in-four chance exists that two siblings will have two identical haplotypes and will be identically matched at the HLA loci. Discussing the continuation of chemotherapy or radiotherapy is not appropriate when planning the BMT. That decision will be made later.

16. A mother brings her daughter to the clinic after noticing the child's new swimsuit fits baggily on one side of her bottom and the child's right thigh looks quite odd compared to the other one. Which assessment question would provide the nurse the most important information? A. "Do her joints dislocate easily?" B. "Does she fatigue easily?" C. "Has your child been limping?" D. "When did you see her in a swimsuit last?"

ANS: C The mother seems to have noticed thigh and buttock muscle wasting, which are signs of Legg-Calvé-Perthes disease. Other signs and symptoms include hip or knee soreness or stiffness, pain that increases with activity and decreases with rest, a painful limp, joint dysfunction, and limited ROM. Asking about a limp would be the most important question, as it is specific to this disease process.

6. Which should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? a. They should be given with meals. b. They should be stopped immediately if nausea and vomiting occur. c. Adequate dosage will turn the stools a tarry green color. d. Allow preparation to mix with saliva and bathe the teeth before swallowing.

ANS: C The nurse should prepare the mother for the anticipated change in the child's stools. If the iron dose is adequate, the stools will become a tarry green color. The lack of the color change may indicate insufficient iron. The iron should be given in two divided doses between meals when the presence of free hydrochloric acid is greatest. Iron is absorbed best in an acidic environment. Vomiting and diarrhea may occur with iron administration. If these occur, the iron should be given with meals, and the dosage reduced, then gradually increased as the child develops tolerance. Liquid preparations of iron stain the teeth. They should be administered through a straw and the mouth rinsed after administration.

5. When teaching the mother of a 9-month-old infant about administering liquid iron preparations, the nurse should include that: a. They should be given with meals. b. They should be stopped immediately if nausea and vomiting occur. c. Adequate dosage will turn the stools a tarry green color. d. Preparation should be allowed to mix with saliva and bathe the teeth before swallowing.

ANS: C The nurse should prepare the mother for the anticipated change in the child's stools. If the iron dose is adequate, the stools will become a tarry green color. The lack of the color change may indicate insufficient iron. The iron should be given in two divided doses between meals, when the presence of free hydrochloric acid is greatest. Iron is absorbed best in an acidic environment. Vomiting and diarrhea may occur with iron administration. If these occur, the iron should be given with meals, and the dosage reduced and gradually increased as the child develops tolerance. Liquid preparations of iron stain the teeth. They should be administered through a straw, and the mouth rinsed after administration.

14. 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.

18. The nurse is dealing with a preschool-age child with a life-threatening illness. What should the nurse remember the child's concept of death is at this age? a. That it is final b. Only a fear of separation from her parents c. That a person becomes alive again soon after death d. An understanding based on simple logic

ANS: C The preschooler views death as reversible and temporary.

2. Which artery carries deoxygenated blood? A. Aorta B. Inferior vena cava C. Pulmonary artery D. Subclavian artery

ANS: C The pulmonary artery is the only artery in the body to carry deoxygenated blood. It is an artery because it carries blood away from the heart.

11. The student nurse studying anatomy knows that red blood cells are produced where? A. Growth plates B. Periosteum C. Red marrow D. Yellow marrow

ANS: C The red marrow produces red and white blood cells and platelets. Yellow marrow produces fat cells. The growth plates and periosteum are not involved in producing different cells.

1. Which is the average oxygen saturation of blood in the right atrium? A. 25% B. 50% C. 70% D. 98%

ANS: C The right atrium is the collecting chamber that receives blood from the entire body except for the lungs. The oxygen saturation of this blood is approximately 70%

12. A newly married couple is seeking genetic counseling because they are both carriers of the sickle cell trait. How can the nurse best explain the children's risk of inheriting this disease? a. Every fourth child will have the disease; two others will be carriers. b. All of their children will be carriers, just as they are. c. Each child has a one in four chance of having the disease and a two in four chance of being a carrier. d. The risk levels of their children cannot be determined by this information.

ANS: C The sickle cell gene is inherited from both parents; therefore each offspring has a one in four chance of inheriting the disease.

3. What will the nurse include when caring for a child in Buck's extension? a. Positioning the child with hips flexed 90 degrees at all times b. Keeping the weights in contact with the floor c. Checking for skin irritation from traction equipment d. Releasing the weights on a schedule

ANS: C The skin exposed to frequent friction may break down.

6. The nurse assessing a child with juvenile rheumatoid arthritis notes the child's right knee and ankle are swollen, warm, and tender. The child has a temperature of 38.8 ° C (102° F) and abdominal pain. What type of juvenile rheumatoid arthritis do these findings suggest? a. Psoriatic b. Enthesitis c. Systemic d. Acute febrile

ANS: C The systemic form of juvenile rheumatoid arthritis is associated with an elevated temperature, erythrocyte sedimentation rate (ESR), and C-reactive protein; abdominal pain; and a macular rash.

31. A nurse is conducting discharge teaching for parents of an infant with osteogenesis imperfecta (OI). Further teaching is indicated if the parents make which statement? a. "We will be very careful handling the baby." b. "We will lift the baby by the buttocks when diapering." c. "We're glad there is a cure for this disorder." d. "We will schedule follow-up appointments as instructed."

ANS: C The treatment for OI is primarily supportive. Although patients and families are optimistic about new research advances, there is no cure. The use of bisphosphonate therapy with IV pamidronate to promote increased bone density and prevent fractures has become standard therapy for many children with OI; however, long bones are weakened by prolonged treatment. Infants and children with this disorder require careful handling to prevent fractures. They must be supported when they are being turned, positioned, moved, and held. Even changing a diaper may cause a fracture in severely affected infants. These children should never be held by the ankles when being diapered but should be gently lifted by the buttocks or supported with pillows. Follow-up appointments for treatment with bisphosphonate can be expected.

33. A nurse is conducting discharge teaching for parents of an infant with osteogenesis imperfecta (OI). Further teaching is indicated if the parents make which statement? a. "We will be very careful handling the baby." b. "We will lift the baby by the buttocks when diapering." c. "We're glad there is a cure for this disorder." d. "We will schedule follow-up appointments as instructed."

6. The nurse is reviewing prenatal vitamin supplements with an expectant client. Which supplement should be included in the teaching? a. Vitamin A throughout pregnancy b. Multivitamin preparations as soon as pregnancy is suspected c. Folic acid for all women of childbearing age d. Folic acid during the first and second trimesters of pregnancy

ANS: C The widespread use of folic acid among women of childbearing age has decreased the incidence of spina bifida significantly. Vitamin A is not related to the prevention of spina bifida. Folic acid supplementation is recommended for the preconception period and during the pregnancy. Only 42% of women actually follow these guidelines.

5. A current recommendation to prevent neural tube defects is the supplementation of: a. Vitamin A throughout pregnancy. b. Multivitamin preparations as soon as pregnancy is suspected. c. Folic acid for all women of childbearing age. d. Folic acid during the first and second trimesters of pregnancy.

ANS: C The widespread use of folic acid among women of childbearing age is expected to decrease the incidence of spina bifida significantly. Vitamin A and multivitamin preparations do not have a relation to the prevention of spina bifida. Folic acid supplementation is recommended for the preconceptual period and during the pregnancy. Only 42% of women actually follow these guidelines.

18. 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.

40. A student nurse records a systolic blood pressure of 106 mm Hg for a 4-year-old child. Which response by the registered nurse is best? A. Ask the student if this is a normal finding. B. Have the student repeat the blood pressure. C. Refer the family to a health-care provider. D. Tell the student to document the results.

ANS: C This blood pressure is in the 95th percentile for age. For screening purposes, a blood pressure greater than 20 mm Hg above normal for the child's age is considered a red flag for hypertension, and the child should be referred to a health-care provider. The other options are all appropriate but are not as important as referring the child for further workup.

37. A nurse is assessing a school-age child admitted with new heart murmur, arthritis-type symptoms, erythema marginatum, and fever. When taking the child's history, which question is most likely to provide important information? A. "Did your child have any vaccinations recently?" B. "Has your child been exposed to contagious illnesses?" C. "Has your child had a sore throat in the last 2 to 3 weeks?" D. "Is there a family history of autoimmune disorders?"

ANS: C This child is displaying manifestations of rheumatic fever, which typically arises after an episode of acute pharyngitis. The nurse should ask about recent sore throats. The other questions are not as likely to provide vital information.

27. 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.

25. 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.

10. 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.

30. The nurse is caring for a 12-year-old child with a left leg below the knee amputation (BKA). The child had the surgery 1 week ago. Which intervention should the nurse plan to implement for this child? a. Elevate the left stump on a pillow. b. Place ice pack on the stump. c. Encourage the child to use an overhead bed trapeze when repositioning. d. Replace the ace wrap covering the stump with a gauze dressing.

ANS: C Use of the overhead bed trapeze should be encouraged to begin to build up the arm muscles necessary for walking with crutches. Stump elevation may be used during the first 24 hours, but after this time, the extremity should not be left in this position because contractures in the proximal joint will develop and seriously hamper ambulation. Ice would not be an appropriate intervention and would decrease circulation to the stump. Stump shaping is done postoperatively with special elastic bandaging using a figure-eight bandage, which applies pressure in a cone-shaped fashion. This technique decreases stump edema, controls hemorrhage, and aids in developing desired contours so the child will bear weight on the posterior aspect of the skin flap rather than on the end of the stump. This wrap should not be replaced with a gauze dressing.

10. A 3-year-old child with sickle cell disease is admitted to the hospital in sickle cell crisis with severe abdominal pain. Which type of crisis is the child most likely experiencing? a. Aplastic b. Hyperhemolytic c. Vaso-occlusive d. Splenic sequestration

ANS: C Vaso-occlusive crisis, or painful crisis, is caused by obstruction of blood flow by sickle cells, infarctions, and some degrees of vasospasm.

11. The nurse is admitting a child with Werdnig-Hoffmann disease (spinal muscular atrophy type 1). Which signs and symptoms are associated with this disease? a. Spinal muscular atrophy b. Neural atrophy of muscles c. Progressive weakness and wasting of skeletal muscle d. Pseudohypertrophy of certain muscle groups

ANS: C Werdnig-Hoffmann disease (spinal muscular atrophy type 1) is the most common paralytic form of floppy infant syndrome (congenital hypotonia). It is characterized by progressive weakness and wasting of skeletal muscle caused by degeneration of anterior horn cells. Kugelberg-Welander disease is a juvenile spinal muscular atrophy with a later onset. Charcot-Marie-Tooth disease is a form of progressive neural atrophy of muscles supplied by the peroneal nerves. Progressive weakness is found of the distal muscles of the arms and feet. Duchenne muscular dystrophy is characterized by muscles, especially in the calves, thighs, and upper arms, which become enlarged from fatty infiltration and feel unusually firm or woody on palpation. The term pseudohypertrophy is derived from this muscular enlargement.

15. The nurse is admitting a child with Werdnig-Hoffmann disease (spinal muscular atrophy type 1). Which signs and symptoms are associated with this disease? a. Spinal muscular atrophy b. Neural atrophy of muscles c. Progressive weakness and wasting of skeletal muscle d. Pseudohypertrophy of certain muscle groups

ANS: C Werdnig-Hoffmann disease (spinal muscular atrophy type 1) is the most common paralytic form of floppy infant syndrome (congenital hypotonia). It is characterized by progressive weakness and wasting of skeletal muscle caused by degeneration of anterior horn cells. Kugelberg-Welander syndrome is a juvenile spinal muscular atrophy with a later onset. Charcot-Marie-Tooth disease is a form of progressive neural atrophy of muscles supplied by the peroneal nerves. Progressive weakness of the distal muscles of the arms and feet is found. Duchenne's muscular dystrophy is characterized by muscles, especially in the calves, thighs, and upper arms, that become enlarged from fatty infiltration and feel unusually firm or woody on palpation. The term pseudohypertrophy is derived from this muscular enlargement.

39. When assessing a child for possible congenital heart defects (CHDs), where should the nurse measure blood pressure? a. The right arm c. All four extremities b. The left arm d. Both arms while the child is crying

ANS: C When a CHD is suspected, the blood pressure should be measured in all four extremities while the child is quiet. Discrepancies between upper and lower extremities may indicate cardiac disease. Blood pressure measurements for upper and lower extremities are compared during an assessment for CHDs. Blood pressure measurements when the child is crying are likely to be elevated; thus the readings will be inaccurate.

33. A school-aged child is living with a chronic disease process. How would the nurse anticipate chronic illness will effect growth and development? (Select all that apply.) a. Delayed bonding with parents b. Delayed toilet training c. Impaired sense of belonging d. Decreased feelings of independence e. Impaired speech development

ANS: C, D A school-age child is in the stage of industry versus inferiority. A chronic illness might experience loss of grade level in school because of illness and inability to participate or compete can lead to sense of inferiority. Sense of independence and accomplishment can be lost. Being different from peers may impede child's sense of belonging.

12. A child is prescribed warfarin (Coumadin). Which laboratory values does the nurse monitor? (Select all that apply.) A. Electrolytes B. Hematocrit (Hct) C. International normalized ratio (INR) D. Partial thromboplastin time (PTT) E. Prothrombin time (PT)

ANS: C, D Coumadin is monitored using the PT and INR. Electrolytes and hematocrit are important laboratory values but are not specific for this drug. The PTT is used to monitor heparin therapy.

7. An infant has critical aortic stenosis. The physician orders several medications for the infant. Which prescribed medications would the nurse question for this infant? (Select all that apply.) A. Bumetanide (Bumex) B. Diltiazem (Cardizem) C. Enoxaparin (Lovenox) D. Epinephrine (Adrenalin) E. Furosemide (Lasix)

ANS: C, D In cases of critical aortic stenosis, medications include preload- and afterload-reducing agents, including bumetanine, diltiazem, and furosemide. Enoxaparin is a low-molecular-weight heparin. Epinephrine will raise heart rate and blood pressure and would cause this child's condition to worsen.

16. An 8-year-old child is being treated for suspected tetanus. Which medications are appropriate for this child? (Select all that apply.) A. Ceftriaxone (Rocephin) B. Clindamycin (Cleocin) C. Erythromycin (Erythrocin) D. Penicillin G (Pfizerpen) E. Tetracycline (Sumycin)

ANS: C, D Penicillin G and erythromycin are appropriate choices for this child. Older children can take tetracycline once they have all their adult teeth. Ceftriaxone and clindamycin are not used.

6. An infant has been diagnosed with pulmonic stenosis. Which manifestations does the nurse document as normal findings for this condition? (Select all that apply.) A. Cough B. Dyspnea C. Enlarged liver D. Puffy eyelids E. Retractions

ANS: C, D Right-sided heart failure occurs with pulmonic stenosis. Manifestations include hepatomegaly (enlarged liver) and puffy eyelids. Cough and dyspnea are more likely due to left-sided heart failure. Retractions can occur with respiratory distress despite the cause.

30. The nurse performing a neurovascular check on a limb in traction would report and document which finding(s) as indicative of altered circulation? (Select all that apply.) a. Pulse is equal to uncasted limb. b. Patient is aware of touch and warm and cold application. c. Limb is cool to the touch. d. Capillary refill is 5 seconds. e. Distal limb can flex and extend.

ANS: C, D The limb should be warm, and capillary refill should be less than 3 seconds.

5. The nurse is caring for a preschool child with a cast applied recently for a fractured tibia. Which assessment findings indicate possible compartment syndrome? (Select all that apply.) a. Palpable distal pulse b. Capillary refill to extremity less than 3 seconds c. Severe pain not relieved by analgesics d. Tingling of extremity e. Inability to move extremity

ANS: C, D, E Indications of compartment syndrome are severe pain not relieved by analgesics, tingling of extremity, and inability to move extremity. A palpable distal pulse and capillary refill to the extremity less than 3 seconds are expected findings.

37. The nurse is caring for a preschool child with a cast applied recently for a fractured tibia. Which assessment findings indicate possible compartment syndrome (Select all that apply)? a. Palpable distal pulse b. Capillary refill to extremity of <3 seconds c. Severe pain not relieved by analgesics d. Tingling of extremity e. Inability to move extremity

57. The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include (Select all that apply)? a. Warm flushed extremities b. Weight loss c. Decreased urinary output d. Sweating (inappropriate) e. Fatigue

ANS: C, D, E The signs and symptoms of heart failure include decreased urinary output, sweating, and fatigue. Other signs include pale, cool extremities, not warm and flushed, and weight gain, not weight loss.

56. A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery. The nurse instructs the parents to notify the physician if what conditions occur (Select all that apply)? a. Respiratory rate of 36 at rest b. Appetite slowly increasing c. Temperature above 37.7° C (100° F) d. New, frequent coughing e. Turning blue or bluer than normal

ANS: C, D, E The parents should be instructed to notify the physician after their infant's cardiac surgery for a temperature above 37.7° C (100° F); new, frequent coughing; and any episodes of the infant turning blue or bluer than normal. A respiratory rate of 36 at rest for an infant is within normal expectations, and it is expected that the appetite will increase slowly.

54. Which clinical manifestations would the nurse expect to see as shock progresses in a child and becomes decompensated shock (Select all that apply)? a. Thirst and diminished urinary output b. Irritability and apprehension c. Cool extremities and decreased skin turgor d. Confusion and somnolence e. Normal blood pressure and narrowing pulse pressure f. Tachypnea and poor capillary refill time

ANS: C, D, F Cool extremities, decreased skin turgor, confusion, somnolence, tachypnea, and poor capillary refill time are beginning signs of decompensated shock

11. The pediatric nurse is caring for a patient with juvenile arthritis. The health-care provider tells the nurse the patient will be started on disease-modifying antirheumatic drugs (DMARDs). Which drugs does the nurse anticipate administering? (Select all that apply.) A. Acetaminophen (Tylenol) B. Indomethacin (Indocin) C. Infliximab (Remicade) D. Leflunomide (Arava) E. Methotrexate (Rheumatrex)

ANS: C, E DMARDs include methotrexate (Rheumatrex), cyclophosphamide (Cytoxan), sulfasalazine (Azulfidine), and infliximab (Remicade). Acetaminophen (Tylenol) has no anti-inflammatory effect and is not used to treat juvenile arthritis. Leflunomide is an immunosuppressant.

53. Nursing interventions for the child after a cardiac catheterization include which of the following (Select all that apply)? a. Allow ambulation as tolerated. b. Monitor vital signs every 2 hours. c. Assess the affected extremity for temperature and color. d. Check pulses above the catheterization site for equality and symmetry. e. Remove pressure dressing after 4 hours. f. Maintain a patent peripheral intravenous catheter until discharge.

ANS: C, F The extremity that was used for access for the cardiac catheterization must be checked for temperature and color. Coolness and blanching may indicate arterial occlusion. The child should have a patent peripheral intravenous line to ensure adequate hydration. Allowing ambulation, monitoring vital signs every 2 hours, checking pulses, and removing the pressure dressing after 4 hours are interventions that do not apply to a child after a cardiac catheterization.

1. An accurate description of anemia is: a. Increased blood viscosity. b. Depressed hematopoietic system. c. Presence of abnormal hemoglobin. d. Decreased oxygen-carrying capacity of blood.

ANS: D Anemia is a condition in which the number of red blood cells or hemoglobin concentration is reduced below the normal values for age. This results in a decreased oxygen-carrying capacity of blood. Increased blood viscosity is usually a function of too many cells or of dehydration, not of anemia. A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition depends on the deceased oxygen-carrying capacity of the blood.

27. A nurse is admitting a child scheduled for a Fontan repair. Which condition does the nurse understand the child to have? A. Aortic stenosis B. Patent ductus arteriosus C. Pulmonary regurgitation D. Tricuspid atresia

ANS: D A child scheduled for a Fontan repair has tricuspid atresia.

14. The nurse is preparing to admit a newborn with myelomeningocele to the neonatal intensive care nursery. Which describes this newborn's defect? a. Fissure in the spinal column that leaves the meninges and the spinal cord exposed b. Herniation of the brain and meninges through a defect in the skull c. Hernial protrusion of a saclike cyst of meninges with spinal fluid but no neural elements d. Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves

ANS: D A myelomeningocele is a visible defect with an external saclike protrusion, containing meninges, spinal fluid, and nerves. Rachischisis is a fissure in the spinal column that leaves the meninges and the spinal cord exposed. Encephalocele is a herniation of brain and meninges through a defect in the skull, producing a fluid-filled sac. Meningocele is a hernial protrusion of a saclike cyst of meninges with spinal fluid, but no neural elements.

3. The nurse is preparing to admit a newborn with myelomeningocele to the neonatal intensive care nursery. Which describes this newborn's defect? a. Fissure in the spinal column that leaves the meninges and the spinal cord exposed b. Herniation of the brain and meninges through a defect in the skull c. Hernial protrusion of a saclike cyst of meninges with spinal fluid but no neural elements d. Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves

26. Which nursing intervention is appropriate to assess for neurovascular competency in a child who fell off the monkey bars at school and hurt his arm? a. The degree of motion and ability to position the extremity. b. The length, diameter, and shape of the extremity. c. The amount of swelling noted in the extremity and pain intensity. d. The skin color, temperature, movement, sensation, and capillary refill of the extremity.

ANS: D A neurovascular evaluation includes assessing skin color and temperature, ability to move the affected extremity, degree of sensation experienced, and speed of capillary refill in the extremity. The degree of motion in the affected extremity and ability to position the extremity are incomplete assessments of neurovascular competency. The length, diameter, and shape of the extremity are not assessment criteria in a neurovascular evaluation. Although the amount of swelling is an important factor in assessing an extremity, it is not a criterion for a neurovascular assessment.

9. 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.

10. Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis? a. Circulatory collapse b. Cardiomegaly, systolic murmurs c. Hepatomegaly, intrahepatic cholestasis d. Painful swelling of hands and feet, painful joints

ANS: D A vaso-occlusive crisis is characterized by severe pain in the area of involvement. If in the extremities, painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if in the head, stroke and visual disturbances occur. Circulatory collapse results from sequestration crises. Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vaso-occlusive phenomena

12. Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis? a. Circulatory collapse b. Cardiomegaly, systolic murmurs c. Hepatomegaly, intrahepatic cholestasis d. Painful swelling of hands and feet; painful joints

ANS: D A vasoocclusive crisis is characterized by severe pain in the area of involvement. If in the extremities, painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if in the head, stroke and visual disturbances occur. Circulatory collapse results from sequestration crises. Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vasoocclusive phenomena.

35. A child has been admitted with Kawasaki disease and is started on aspirin and warfarin (Coumadin). For which nursing diagnosis does the nurse plan interventions as the priority? A. Acute pain related to mouth redness and cracked lips B. Altered body image related to peeling skin rash C. Altered nutrition: less than body requirements D. Risk for bleeding related to medication effects

ANS: D Actual nursing diagnoses take priority over "risk for" diagnoses when the actual diagnoses exist. There is no information in the stem to show that the child has impaired mucous membranes leading to pain, an altered body image related to rash, or altered nutrition, although all of these are possible for this child. Risk for injury is the priority because the child is taking two medications that alter coagulation, and for patient safety, this is a critical diagnosis.

36. A home health-care nurse is visiting a child with Duchenne's muscular dystrophy (MD). The child has a new cough, poor appetite, fatigue, and a reddened area on his coccyx from sitting in his wheelchair all day. What intervention by the nurse takes priority? A. Assess the child for his favorite high-protein foods. B. Develop a protocol for changing positions more often. C. Encourage the family to allow the child plenty of rest. D. Notify the health-care provider and request antibiotics.

ANS: D All actions are appropriate; however, children with MD usually die of respiratory infections, so aggressive treatment at the first sign of a respiratory infection is warranted. The nurse should notify the health-care provider and request antibiotics.

18. A child is in the pediatric intensive care unit 2 hours after a surgical repair of an atrial septal defect (ASD). Postoperative nursing actions include which of the following? A. Administer pain medication. B. Maintain venous access. C. Monitor chest tube drainage. D. The nurse will take all of these actions.

ANS: D All actions are important for the child postoperatively following an ASD repair. This child will be on a mechanical ventilator, so airway is the priority. The nurse will suction secretions as needed to maintain a patent airway.

38. A 5-year-old child is being discharged after valve replacement surgery. Which discharge information specific to this child does the nurse provide? A. "Be sure to keep all follow-up appointments." B. "Encourage your child to eat a healthy diet." C. "Monitor the chest incision for redness or heat." D. "This valve will need replacement in about 5 years."

ANS: D All options are appropriate for any child with a heart condition or after surgery. The option most specific to this child's condition is informing the parents that as the child grows, the valve will need to be replaced about once every 5 years.

12. 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.

33. The nurse is preparing a child for possible alopecia from chemotherapy. Which should be included? a. Explain to child that hair usually regrows in 1 year. b. Advise child to expose head to sunlight to minimize alopecia. c. Explain to child that wearing a hat or scarf is preferable to wearing a wig. d. Explain to child that when hair regrows, it may have a slightly different color or texture.

ANS: D Alopecia is a side effect of certain chemotherapeutic agents. When the hair regrows, it may be a different color or texture. The hair usually grows back within 3 to 6 months after cessation of treatment. The head should be protected from sunlight to avoid sunburn. Children should choose the head covering they prefer.

25. The nurse is preparing a child for possible alopecia from chemotherapy. Which suggestion should be included in the teaching? a. Explaining to the child that hair usually regrows in 1 year. b. Advising the child to expose the head to sunlight to minimize alopecia. c. Explaining to the child that wearing a hat or scarf is preferable to wearing a wig. d. Explaining to the child that, when hair regrows, it may have a slightly different color or texture.

ANS: D Alopecia is a side effect of certain chemotherapeutic agents. When the hair regrows, it may be of different color or texture. The hair usually grows back within 3 to 6 months after the cessation of treatment. The head should be protected from sunlight to avoid sunburn. Children should choose the head covering that they prefer.

32. The parents of a child born with severe hypoplastic left heart syndrome ask the nurse about treatment options. Which option is inconsistent with the nurse's knowledge about this condition? A. "Palliative or end-of-life care is one possibility." B. "She can be listed for a cardiac transplant." C. "Surgical correction involves several procedures." D. "We can give a series of dopamine (Intropin) infusions."

ANS: D Although dopamine is a positive inotrope, serial infusions are not used for this condition. The other statements relay possible treatment decision points for this child.

13. A child diagnosed with a heart murmur is scheduled for an echocardiogram. Which information about this diagnostic test does the nurse provide to the family? A. Allows visualization of the heart's electrical activity B. Gives direct pressure measurements across valves C. Provides more specific information than other tests D. Shows the location and size of a heart defect

ANS: D An echocardiogram is a noninvasive test that can show the size and location of a heart defect. An electrocardiogram (ECG) provides visualization of the heart's electrical activity. Direct pressure measurements are obtained with cardiac catheterization. More specific information can be obtained about heart defects via a magnetic resonance angiogram or computed tomographic angiogram.

14. A child has just been diagnosed with acute lymphoblastic leukemia. What is the result of an overproduction of immature white blood cells in the bone marrow? a. Decreased T-cell production b. Decreased hemoglobin c. Increased blood clotting d. Increased susceptibility to infection

ANS: D An overproduction of immature white blood cells increases the child's susceptibility to infection.

30. What type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy? a. Neurogenic shock c. Hypovolemic shock b. Cardiogenic shock d. Anaphylactic shock

ANS: D Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance. Neurogenic shock results from loss of neuronal control, such as the interruption of neuronal transmission that occurs from a spinal cord injury. Cardiogenic shock is decreased cardiac output. Hypovolemic shock is a reduction in the size of the vascular compartment, decreasing blood pressure, and low central venous pressure.

40. Which type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy? a. Neurogenic b. Cardiogenic c. Hypovolemic d. Anaphylactic

1. Which child should the nurse document as being anemic? a. 7-year-old child with a hemoglobin of 11.5 g/dl b. 3-year-old child with a hemoglobin of 12 g/dl c. 14-year-old child with a hemoglobin of 10 g/dl d. 1-year-old child with a hemoglobin of 13 g/dl

ANS: D Anemia is a condition in which the number of red blood cells, or hemoglobin concentration, is reduced below the normal values for age. Anemia is defined as a hemoglobin level below 10 or 11 g/dl. The child with a hemoglobin of 10 g/dl would be considered anemic. The normal hemoglobin for a child after 2 years of age is 11.5 to 15.5 g/dl.

2. 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.

12. Therapeutic management of a child with tetanus includes the administration of: a. Nonsteroidal antiinflammatory drugs (NSAIDs) to reduce inflammation. b. Muscle stimulants to counteract muscle weakness. c. Bronchodilators to prevent respiratory complications. d. Antibiotics to control bacterial proliferation at the site of injury.

ANS: D Antibiotics are administered to control the proliferation of the vegetative forms of the organism at the site of infection. Tetanus toxin acts at the myoneural junction to produce muscular stiffness and lowers the threshold for reflex excitability. NSAIDs are not routinely used. Sedatives or muscle relaxants are used to help reduce titanic spasm and prevent seizures. Respiratory status is carefully evaluated for any signs of distress because muscle relaxants, opioids, and sedatives that may be prescribed may cause respiratory depression. Bronchodilators would not be used unless specifically indicated.

13. A child with thalassemia major receives blood transfusions frequently. What is a complication of repeated blood transfusions? a. Hemarthrosis b. Hematuria c. Hemoptysis d. Hemosiderosis

ANS: D As a result of repeated blood transfusions, excessive deposits of iron (hemosiderosis) are stored in tissues.

34. Which is a common clinical manifestation of Hodgkin disease? a. Petechiae b. Bone and joint pain c. Painful, enlarged lymph nodes d. Enlarged, firm, nontender lymph nodes

ANS: D Asymptomatic, enlarged, cervical or supraclavicular lymphadenopathy is the most common presentation of Hodgkin disease. Petechiae are usually associated with leukemia. Bone and joint pain are not likely in Hodgkin disease. The enlarged nodes are rarely painful.

26. A common clinical manifestation of Hodgkin's disease is: a. Petechiae. b. Bone and joint pain. c. Painful, enlarged lymph nodes. d. Enlarged, firm, nontender lymph nodes.

ANS: D Asymptomatic, enlarged, cervical or supraclavicular lymphadenopathy is the most common presentation of Hodgkin's disease. Petechiae are usually associated with leukemia. Bone and joint pain are not likely in Hodgkin's disease. The enlarged nodes are rarely painful.

2. The parents of a child with cerebral palsy ask the nurse if any drugs can decrease their child's spasticity. The nurse's response should be based on knowing that: a. Anticonvulsant medications are sometimes useful for controlling spasticity. b. Medications that would be useful in reducing spasticity are too toxic for use with children. c. Many different medications can be highly effective in controlling spasticity. d. Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available.

ANS: D Baclofen given intrathecally is best suited for children with severe spasticity that interferes with activities of daily living and ambulation. Anticonvulsant medications are used when seizures occur in children with cerebral palsy. The intrathecal route decreases the side effects of the drugs that reduce spasticity. Few medications are presently available for the control of spasticity.

2. The parents of a child with cerebral palsy ask the nurse whether any drugs can decrease their child's spasticity. The nurse's response should be based on which statement? a. Anticonvulsant medications are sometimes useful for controlling spasticity. b. Medications that would be useful in reducing spasticity are too toxic for use with children. c. Many different medications can be highly effective in controlling spasticity. d. Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available.

ANS: D Baclofen, given intrathecally, is best suited for children with severe spasticity that interferes with activities of daily living and ambulation. Anticonvulsant medications are used when seizures occur in children with cerebral palsy. The intrathecal route decreases the side effects of the drugs that reduce spasticity. Few medications are currently available for the control of spasticity.

14. Through what does the infant born with hypoplastic left heart syndrome acquire oxygenated blood? a. The patent ductus arteriosus b. A ventricular septal defect c. The closure of the foramen ovale d. An atrial septal defect

ANS: D Because the right side of the heart must take over pumping blood to both the lungs and systemic circulation, the ductus arteriosus must remain open to shunt the oxygenated blood from the lungs.

7. The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breastfed infant. What should she or he suggest? a. Iron (ferrous sulfate) drops after age 1 month. b. Iron-fortified commercial formula can be used by ages 4 to 6 months. c. Iron-fortified infant cereal can be introduced at age 2 months. d. Iron-fortified infant cereal can be introduced at approximately 6 months of age.

ANS: D Breast milk supplies inadequate iron for growth and development after age 5 months. Supplementation is necessary at this time. Iron supplementation or the introduction of solid foods in a breastfed baby is not indicated. Introducing iron-fortified infant cereal at 2 months should be done only if the mother is choosing to discontinue breastfeeding

8. The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breast-fed infant. Which should be suggested? a. Iron (ferrous sulfate) drops after age 1 month b. Iron-fortified commercial formula by age 4 to 6 months c. Iron-fortified infant cereal by age 2 months d. Iron-fortified infant cereal by age 4 to 6 months

ANS: D Breast milk supplies inadequate iron for growth and development after age 5 months. Supplementation is necessary at this time. The mother can supplement the breastfeeding with iron-fortified infant cereal. Iron supplementation or the introduction of solid foods in a breast-fed baby is not indicated. Providing iron-fortified commercial formula by age 4 to 6 months should be done only if the mother is choosing to discontinue breastfeeding.

14. Which is a type of skin traction with legs in an extended position? a. Dunlop b. Bryant c. Russell d. Buck extension

ANS: D Buck extension traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease. Dunlop traction is an upper-extremity traction used for fractures of the humerus. Bryant traction is skin traction with the legs flexed at a 90-degree angle at the hip. Russell traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position.

21. Why does a child's fracture heal more rapidly than the adult's? a. A child's bones are less porous than adult bone. b. A child's bones are covered by a thicker periosteum. c. A child's bones are not affected by bone overgrowth. d. A child's bones have faster callus formation.

ANS: D Callus forms more rapidly in the child than the adult.

24. A common, serious complication of rheumatic fever is: a. Seizures. c. Pulmonary hypertension. b. Cardiac arrhythmias. d. Cardiac valve damage.

ANS: D Cardiac valve damage is the most significant complication of rheumatic fever. Seizures, cardiac arrhythmias, and pulmonary hypertension are not common complications of rheumatic fever.

32. Which is a common, serious complication of rheumatic fever? a. Seizures b. Cardiac arrhythmias c. Pulmonary hypertension d. Cardiac valve damage

ANS: D Cardiac valve damage is the most significant complication of rheumatic fever. Seizures, cardiac arrhythmias, and pulmonary hypertension are not common complications of rheumatic fever.

4. What is the result of a deficiency of factor IX? a. Thalassemia b. Idiopathic thrombocytopenic purpura c. Hemophilia A d. Christmas disease

ANS: D Christmas disease, or hemophilia B, is caused by the deficiency of factor IX.

11. The parent of a 1-year-old child with tetralogy of Fallot asks the nurse, "Why do my child's fingertips look like that?" On what understanding does the nurse base a response? a. Clubbing occurs as a result of untreated congestive heart failure. b. Clubbing occurs as a result of a left-to-right shunting of blood. c. Clubbing occurs as a result of decreased cardiac output. d. Clubbing occurs as a result of chronic hypoxia.

ANS: D Clubbing of the fingers develops in response to chronic hypoxia

17. A child has had a closure device inserted in interventional radiology for an atrial septal defect (ASD). Two hours later the child is pale, tachycardic, and hypotensive. Which action by the nurse takes priority? A. Administer a beta blocker to slow the heart rate down. B. Document findings then notify the health-care provider. C. Increase the rate of the IV fluid administration. D. Prepare the child to return to interventional radiology.

ANS: D Complications from insertion of closure devices include bleeding, cardiac tamponade, or migration of the device. The provider needs to be notified stat, and the child prepared to return to the interventional radiology suite. A beta blocker is inappropriate in this setting. The nurse should notify the provider and obtain orders prior to changing IV fluid rates. Documentation needs to be thorough, but should wait until after the provider is notified.

41. Which clinical manifestation should the nurse expect to see as shock progresses in a child and becomes decompensated shock? a. Thirst b. Irritability c. Apprehension d. Confusion and somnolence

ANS: D Confusion and somnolence are beginning signs of decompensated shock. Thirst, irritability, and apprehension are signs of compensated shock.

42. The nurse is providing care to a pediatric patient who has orders for Crutchfield tongs. Which diagnosis does the nurse anticipate prior to reviewing the patient's medical record? A. Dislocated hip B. Femur fracture C. Osteopenia D. Spinal fracture

ANS: D Crutchfield tongs are used to treat cervical or thoracic fractures.

12. What finding would the nurse assessing the neurovascular status of a child in Russell traction report immediately? a. Skin that's warm to the touch b. Capillary refill less than 3 seconds c. Ability to wiggle toes d. Bluish coloration of skin

ANS: D Cyanosis or pallor noted in an extremity is an indication of circulatory impairment.

11. The parents of a young child with congestive heart failure tell the nurse that they are "nervous" about giving digoxin. The nurse's response should be based on knowing that: a. It is a safe, frequently used drug. b. It is difficult to either overmedicate or undermedicate with digoxin. c. Parents lack the expertise necessary to administer digoxin. d. Parents must learn specific, important guidelines for administration of digoxin.

ANS: D Digoxin has a narrow therapeutic range. The margin of safety between therapeutic, toxic, and lethal doses is very small. Specific guidelines are available for parents to learn how to administer the drug safely and monitor for side effects. Digoxin is a frequently used drug, but it has a narrow therapeutic range. Very small amounts of the liquid are given to infants, which makes it easy to overmedicate or undermedicate. Parents may lack the necessary expertise to administer the drug at first, but with discharge preparation they should be prepared to administer the drug safely.

18. The parents of a young child with heart failure tell the nurse that they are "nervous" about giving digoxin (Lanoxin). The nurse's response should be based on which statement? a. It is a safe, frequently used drug. b. It is difficult to either overmedicate or undermedicate with digoxin. c. Parents lack the expertise necessary to administer digoxin. d. Parents must learn specific, important guidelines for administration of digoxin.

ANS: D Digoxin has a narrow therapeutic range. The margin of safety between therapeutic, toxic, and lethal doses is very small. Specific guidelines are available for parents to learn how to administer the drug safely and to monitor for side effects. Digoxin is a frequently used drug, but it has a narrow therapeutic range. Small amounts of the liquid are given to infants, making it easy to overmedicate or undermedicate. Parents may lack the necessary expertise to administer the drug at first, but with discharge preparation, they should be prepared to administer the drug safely.

20. A pediatric patient is scheduled for a noninvasive procedure to determine if his heart is structurally normal and to localize a murmur. What diagnostic test does the nurse anticipate? a. Barium swallow b. Chest x-ray c. Electrocardiogram d. Echocardiogram

ANS: D Echocardiography is a noninvasive procedure that localizes murmurs and determines if theheart is structurally normal.

27. Which is the most effective pain-management approach for a child who is having a bone marrow aspiration? a. Relaxation techniques b. Administration of an opioid c. EMLA cream applied over site d. Conscious or unconscious sedation

ANS: D Effective pharmacologic and nonpharmacologic measures should be used to minimize pain associated with procedures. For bone marrow aspiration, conscious or unconscious sedation should be used. Relaxation, opioids, and EMLA can be used to augment the conscious or unconscious sedation.

15. The nurse is conducting reflex testing on infants at a well-child clinic. Which reflex finding should be reported as abnormal and considered as a possible sign of cerebral palsy? a. Tonic neck reflex at 5 months of age b. Absent Moro reflex at 8 months of age c. Moro reflex at 3 months of age d. Extensor reflex at 7 months of age

ANS: D Establishing a diagnosis of cerebral palsy (CP) may be confirmed with the persistence of primitive reflexes: (1) either the asymmetric tonic neck reflex or persistent Moro reflex (beyond 4 months of age) and (2) the crossed extensor reflex. The tonic neck reflex normally disappears between 4 and 6 months of age. The crossed extensor reflex, which normally disappears by 4 months, is elicited by applying a noxious stimulus to the sole of one foot with the knee extended. Normally, the contralateral foot responds with extensor, abduction, and then adduction movements. The possibility of CP is suggested if these reflexes occur after 4 months.

18. What should the school nurse recommend when encouraging a heart-healthy diet for a child with high cholesterol? a. A fat intake reduction of 5-10% of total calories b. A fat intake reduction of 10-15% of total calories c. A fat intake reduction of 15-20% of total calories d. A fat intake reduction of 25-35% of total calories

ANS: D For a child with increased cholesterol a fat reduction of 25-35% of total calories with less than 75 saturated fat and less than 200 mg of cholesterol per day is advised.

25. A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. The purpose of this is to prevent: a. infection. b. brain tumor. c. drug side effects. d. central nervous system (CNS) disease.

ANS: D For certain children, CNS prophylactic therapy is indicated. This drug regimen is used to prevent CNS leukemia and will not prevent infection or drug side effects. If the child has a brain tumor in addition to leukemia, additional therapy would be indicated.

22. A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. The purpose of this is to prevent: a. Infection. b. Brain tumor. c. Drug side effects. d. Central nervous system (CNS) disease.

ANS: D For certain children, CNS prophylactic therapy is indicated. This drug regimen is used to prevent CNS leukemia. This regimen does not prevent infection or drug side effects. If the child has a brain tumor in addition to leukemia, additional therapy would be indicated

36. When discussing hyperlipidemia with a group of adolescents, the nurse should explain that cardiovascular disease can be prevented by high levels of: a. cholesterol. b. triglycerides. c. low-density lipoproteins (LDLs). d. high-density lipoproteins (HDLs).

ANS: D HDLs contain very low concentrations of triglycerides, relatively little cholesterol, and high levels of proteins. It is thought that HDLs protect against cardiovascular disease. Cholesterol, triglycerides, and LDLs are not protective against cardiovascular disease.

26. When discussing hyperlipidemia with a group of adolescents, the nurse should explain that high levels of what substance are thought to protect against cardiovascular disease? a. Cholesterol c. Low-density lipoproteins (LDLs) b. Triglycerides d. High-density lipoproteins (HDLs).

38. When caring for the child with Kawasaki disease, the nurse should know which information? a. A child's fever is usually responsive to antibiotics within 48 hours. b. The principal area of involvement is the joints. c. Aspirin is contraindicated. d. Therapeutic management includes administration of gamma globulin and aspirin.

ANS: D High-dose IV gamma globulin and aspirin therapy is indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness. The fever of Kawasaki disease is unresponsive to antibiotics and antipyretics. Mucous membranes, conjunctiva, changes in the extremities, and cardiac involvement are seen. Aspirin is part of the therapy.

28. When caring for the child with Kawasaki disease, the nurse should understand that: a. The child's fever is usually responsive to antibiotics within 48 hours. b. The principal area of involvement is the joints. c. Aspirin is contraindicated. d. Therapeutic management includes administration of gamma globulin and aspirin.

ANS: D High-dose intravenous gamma globulin and aspirin therapy are indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness. The fever of Kawasaki disease is unresponsive to antibiotics and antipyretics. Involvement of mucous membranes and conjunctiva, changes in the extremities, and cardiac involvement are seen.

18. An acquired hemorrhagic disorder that is characterized by excessive destruction of platelets is: a. Aplastic anemia. b. Thalassemia major. c. Disseminated intravascular coagulation. d. Idiopathic thrombocytopenic purpura.

ANS: D Idiopathic thrombocytopenic purpura is an acquired hemorrhagic disorder characterized by an excessive destruction of platelets, discolorations caused by petechiae beneath the skin, and a normal bone marrow. Aplastic anemia refers to a bone marrow failure condition in which the formed elements of the blood are simultaneously depressed. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains. Disseminated intravascular coagulation is characterized by diffuse fibrin deposition in the microvasculature, consumption of coagulation factors, and endogenous generation of thrombin and plasma.

21. The nurse is conducting a staff in-service on childhood blood disorders. Which describes the pathology of idiopathic thrombocytopenic purpura? a. Bone marrow failure in which all elements are suppressed b. Deficiency in the production rate of globin chains c. Diffuse fibrin deposition in the microvasculature d. An excessive destruction of platelets

ANS: D Idiopathic thrombocytopenic purpura is an acquired hemorrhagic disorder characterized by an excessive destruction of platelets, discolorations caused by petechiae beneath the skin, and a normal bone marrow. Aplastic anemia refers to a bone marrow-failure condition in which the formed elements of the blood are simultaneously depressed. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains. Disseminated intravascular coagulation is characterized by diffuse fibrin deposition in the microvasculature, consumption of coagulation factors, and endogenous generation of thrombin and plasma.

15. The child receiving a transfusion complains of back pain and itching. What is the best initial action by the nurse? a. Notify the charge nurse. b. Disconnect intravenous lines immediately. c. Give diphenhydramine (Benadryl). d. Clamp off blood and keep line open with normal saline.

ANS: D If a blood transfusion reaction occurs, the first action is to stop the blood infusion, keep the line open with normal saline, and notify the charge nurse.

44. The nurse is reviewing first aid with a group of school nurses. Which statement made by a participant indicates a correct understanding of the information? a. "If a child loses a tooth due to injury, I should place the tooth in warm milk." b. "If a child has recurrent abdominal pain, I should send him or her back to class until the end of the day." c. "If a child has a chemical burn to the eye, I should irrigate the eye with normal saline." d. "If a child has a nosebleed, I should have the child sit up and lean forward."

ANS: D If a child has a nosebleed, the child should lean forward, not lie down. A tooth should be placed in cold milk or saliva for transporting to a dentist. Recurrent abdominal pain is a physiologic problem and requires further evaluation. If a chemical burn occurs in the eye, the eye should be irrigated with water for 20 minutes.

5. The nurse is caring for a school-age child who has had a cardiac catheterization. The child tells the nurse that the bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to: a. notify physician. b. apply new bandage with more pressure. c. place the child in Trendelenburg position. d. apply direct pressure above catheterization site.

ANS: D If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture. Notifying a physician and applying a new bandage can be done after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. It is not a helpful intervention to place the girl in the Trendelenburg position. It would increase the drainage from the lower extremities.

3. The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to: a. Notify the physician. b. Apply a new bandage with more pressure. c. Place the child in the Trendelenburg position. d. Apply direct pressure above the catheterization site.

ANS: D If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture. Notifying the physician and applying a new bandage with more pressure can be done after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. The Trendelenburg position would not be helpful; it would increase the drainage from the lower extremities.

9. What would cause a nurse to suspect that an infection has developed under a cast? a. Complaint of paresthesia c. Increased respirations b. Cold toes d. "Hot spots" felt on cast surface

ANS: D If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so a window can be made in the cast to observe the site. The "five Ps" of ischemia from a vascular injury include pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection. Cold toes may be indicative of too tight a cast and need further evaluation. Increased respirations may indicate a respiratory infection or pulmonary emboli. This should be reported, and the child should be evaluated.

11. Which should cause a nurse to suspect that an infection has developed under a cast? a. Complaint of paresthesia b. Cold toes c. Increased respirations d. "Hot spots" felt on cast surface

ANS: D If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so that a window can be made in the cast to observe the site. The five Ps of ischemia from a vascular injury are pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection. Cold toes may be indicative of too tight a cast and need further evaluation. Increased respirations may be indicative of a respiratory tract infection or pulmonary emboli. This should be reported, and child should be evaluated.

23. The nurse is teaching the parents of a child who had a surgical correction of a congenital heart defect about subacute bacterial endocarditis (SBE). Which recommendation regarding antibiotic administration prior to dental cleanings is the most appropriate? A. All children with congenital heart defects need SBE prophylaxis. B. Chronic SBE prophylaxis is recommended for most similar children. C. Risks for SBE are very high but easily prevented with antibiotics. D. The provider must weigh the risk-to-benefit ratio for SBE prophylaxis.

ANS: D In 2007 the American Heart Association made major changes to the guidelines for prophylaxis needed for patients who have known cardiac disease. The provider needs to weigh the risk-to-benefit ratio, as prophylaxis will only prevent a few cases of SBE and the risk of antibiotic resistance is high. When used, SBE prophylaxis is usually a one-time dose. The actual risk of SBE from dental procedures is less than that from toothbrushing.

17. Seventy-two hours after cardiac surgery, a young child has a temperature of 37.7 C (101 F). The nurse should: a. Keep the child warm with blankets. b. Apply a hypothermia blanket. c. Record the temperature on nurses' notes. d. Report findings to physician.

ANS: D In the first 24 to 48 hours after surgery, the body temperature may increase to 37.7 C (100 F) as part of the inflammatory response to tissue trauma. If the temperature is higher or an elevated temperature continues after this period, it is most likely a sign of an infection and immediate investigation is indicated. Blankets should be removed from the child to keep the temperature from increasing. A hypothermia blanket is not indicated for this level of temperature. The temperature should be recorded, but the physician must be notified for evaluation.

25. Seventy-two hours after cardiac surgery, a young child has a temperature of 101° F. Which action should the nurse take? a. Keep child warm with blankets. b. Apply a hypothermia blanket. c. Record temperature on nurses' notes. d. Report findings to physician.

ANS: D In the first 24 to 48 hours after surgery, the body temperature may increase to 37.7° C (100° F) as part of the inflammatory response to tissue trauma. If the temperature is higher or continues after this period, it is most likely a sign of an infection and immediate investigation is indicated. Blankets should be removed from the child to keep the temperature from increasing. Hypothermia blanket is not indicated for this level of temperature. The temperature should be recorded, but the physician must be notified for evaluation. Suctioning should be done only as indicated, not on a routine basis. The child should be suctioned for no more than 5 seconds at one time. Symptoms of respiratory distress are avoided by using appropriate technique.

16. Which term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine? a. Scoliosis c. Lordosis b. Ankylosis d. Kyphosis

ANS: D Kyphosis is an abnormally increased convex angulation in the curve of the thoracic spine. Scoliosis is a complex spinal deformity usually involving lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis. Ankylosis is the immobility of a joint. Lordosis is an accentuation of the cervical or lumbar curvature beyond physiologic limits

21. The nurse is taking care of an adolescent diagnosed with kyphosis. Which describes this condition? a. Lateral curvature of the spine b. Immobility of the shoulder joint c. Exaggerated concave lumbar curvature of the spine d. Increased convex angulation in the curve of the thoracic spine

22. Which medication is usually tried first when a child is diagnosed with juvenile idiopathic arthritis (JIA)? a. Aspirin b. Corticosteroids c. Cytotoxic drugs such as methotrexate d. Nonsteroidal antiinflammatory drugs (NSAIDs)

ANS: D NSAIDs are the first drugs used in JIA. Naproxen, ibuprofen, and tolmetin are approved for use in children. Aspirin, once the drug of choice, has been replaced by the NSAIDs because they have fewer side effects and easier administration schedules. Corticosteroids are used for life-threatening complications, incapacitating arthritis, and uveitis. Methotrexate is a second-line therapy for JIA.

28. Which medication is usually tried first when a child is diagnosed with juvenile idiopathic arthritis (JIA)? a. Aspirin b. Corticosteroids c. Cytotoxic drugs such as methotrexate d. Nonsteroidal anti-inflammatory drugs (NSAIDs)

26. 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.

27. Which assessment performed by a nursing student performing a neurovascular check alerts the instructor that further education is necessary? a. Pulses b. Capillary refill c. Movement d. Pupils

ANS: D Neurovascular checks include assessment of pain, pulse, sensation, color, capillary refill, and movement. Pupils are assessed with a neurological check.

5. A pediatric nurse is caring for a 1-year-old child who is in a spica cast. The nurse teaches the parents that modifications need to be made for this child. Which modification does the nurse teach? A. Using a baby bath with shallow water to clean the child B. Using a car seat with sturdy sides to transport the child C. Using a sitting position on the floor to feed the child D. Using a wagon instead of a stroller to move the child

ANS: D Placing the child in the prone position on the floor makes it easier for feeding the child. Mobilizing a child in a wagon is a good modification for a stroller while the child is in the spica cast. Toddler car seats that do not have sides are also a good modification for a child in a spica cast. The parents will need to modify the bath by giving the child a sponge bath.

32. 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.

3. José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be: a. directed at his parents because he is too young to understand. b. detailed in regard to the actual procedures so he will know what to expect. c. done several days before the procedure so that he will be prepared. d. adapted to his level of development so that he can understand.

ANS: D Preoperative teaching should always be directed at the child's stage of development. The caregivers also benefit from the same explanations. The parents may ask additional questions, which should be answered, but the child needs to receive the information based on developmental level. Preschoolers will not understand in-depth descriptions and should be prepared close to the time of the cardiac catheterization.

2. José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be: a. Directed at his parents because he is too young to understand. b. Detailed in regard to the actual procedures so he will know what to expect. c. Done several days before the procedure so that he will be prepared. d. Adapted to his level of development so that he can understand.

ANS: D Preoperative teaching should always be directed at the child's stage of development. The caregivers also benefit from the same explanations. The parents may ask additional questions, which should be answered, but the child needs to receive the information based on developmental level. This age group does not understand in-depth descriptions. Preschoolers should be prepared close to the time of the cardiac catheterization.

41. For what reason might a newborn infant with a cardiac defect, such as coarctation of the aorta, that results in a right-to-left shunt receive prostaglandin E1? a. To decrease inflammation c. To decrease respirations b. To control pain d. To improve oxygenation

ANS: D Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus arteriosus patent. This will improve oxygenation and increase pulmonary blood flow.

13. A woman who wishes to become pregnant again consults with the nurse about preventing her child from being born with clubfoot. She has two other children, both treated for this disorder. Which information does the nurse provide about preventing clubfoot? A. Avoid secondhand cigarette smoke while pregnant B. Fetal positioning in utero cannot be controlled C. Getting enough folic acid early in pregnancy is advisable. D. The disorder is genetic so no prevention is available.

ANS: D Recent research shows that clubfoot is genetic, so no prevention is possible. In utero positioning can possibly influence the disorder as well. Second-hand smoke exposure is not related. Folic acid is important for preventing neural tube disorders.

8. How does Russell traction provide adequate skin traction? a. Subluxates the tibia b. Does not interfere with range of motion c. Prevents the knee from flexing d. Supplies continuous pull in two directions

ANS: D Russell traction is skin traction, similar to Buck's, with a sling positioned under the knee, which prevents subluxation of the tibia. Although the traction interferes with full ROM, the patient can change position without disrupting the continuous pull in two directions.

29. Which is the most common causative agent of bacterial endocarditis? a. Staphylococcus albus b. Streptococcus hemolyticus c. Staphylococcus albicans d. Streptococcus viridans

ANS: D S. viridans is the most common causative agent in bacterial (infective) endocarditis. Staphylococcus albus, Streptococcus hemolyticus, and Staphylococcus albicans are not common causative agents.

41. Several complications can occur when a child receives a blood transfusion. Which is an immediate sign or symptom of an air embolus? a. Chills and shaking b. Nausea and vomiting c. Irregular heart rate d. Sudden difficulty in breathing

ANS: D Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Air emboli should be avoided by carefully flushing all tubing of air before connecting to patient. Chills, shaking, nausea, and vomiting are associated with hemolytic reactions. Irregular heart rate is associated with electrolyte disturbances and hypothermia.

32. Several complications can occur when a child receives a blood transfusion. An immediate sign or symptom of an air embolus is: a. Chills and shaking. c. Irregular heart rate. b. Nausea and vomiting. d. Sudden difficulty in breathing.

ANS: D Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Air emboli should be avoided by carefully flushing all tubing of air before connecting to the patient. Chills, shaking, nausea, and vomiting are associated with hemolytic reactions. Irregular heart rate is associated with electrolyte disturbances and hypothermia.

21. The most common causative agent of bacterial endocarditis is: a. Staphylococcus albus. c. Staphylococcus albicans. b. Streptococcus hemolyticus. d. Streptococcus viridans.

ANS: D Staphylococcus viridans is the most common causative agent in bacterial (infective) endocarditis. Staphylococcus albus, Streptococcus hemolyticus, and Staphylococcus albicans are not common causative agents.

13. An infant with congestive heart failure is receiving digoxin (Lanoxin). What does the nurse recognize as a sign of digoxin toxicity? a. Restlessness b. Decreased respiratory rate c. Increased urinary output d. Vomiting

ANS: D Symptoms of digoxin toxicity include: nausea, vomiting, anorexia, irregularity in pulse rate and rhythm, and a sudden change in pulse.

14. Therapeutic management of a child with tetanus includes the administration of: a. nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation. b. muscle stimulants to counteract muscle weakness. c. bronchodilators to prevent respiratory complications. d. tetanus immunoglobulin therapy.

ANS: D Tetanus immunoglobulin therapy, to neutralize toxins, is the most specific therapy for tetanus. Tetanus toxin acts at the myoneural junction to produce muscular stiffness and lowers the threshold for reflex excitability. NSAIDs are not routinely used. Sedatives or muscle relaxants are used to help reduce titanic spasm and prevent seizures. Respiratory status is carefully evaluated for any signs of distress because muscle relaxants, opioids, and sedatives that may be prescribed may cause respiratory depression. Bronchodilators would not be used unless specifically indicated.

19. A student nurse is caring for a child several hours after open heart surgery. Which action by the student requires intervention by the registered nurse? A. Administers pain medication based on assessment of nonverbal signs of pain B. Groups nursing care tasks to allow for uninterrupted periods of rest and sleep C. Monitors hourly output from child's indwelling urinary catheter and chest tube D. Prepares to administer medication through the central venous pressure line

ANS: D The central venous pressure line is used to measure right atrial pressure. It is not used for medication administration. The RN should intervene when the student prepares to give medication through this line. The other actions are appropriate.

3. What finding would the nurse expect when measuring blood pressure on all four extremities of a child with coarctation of the aorta? a. Blood pressure higher on the right side b. Blood pressure higher on the left side c. Blood pressure lower in the arms than in the legs d. Blood pressure lower in the legs than in the arms

ANS: D The characteristic symptoms of coarctation of the aorta are a marked difference in blood pressure and pulses between the upper and lower extremities. Pressure is increased proximal to the defect and decreased distal to the coarctation.

38. A child in the intensive care unit with tetanus will be receiving a neuromuscular blocking agent. Which intervention takes priority for this child? A. Monitor urinary catheter output hourly. B. Provide stimulation from TV or radio. C. Turn patient every 2 hours. D. Provide ventilator care to prevent pneumonia.

ANS: D The child receiving a neuromuscular blocking agent is completely paralyzed and needs ventilator support. Proper care is important to prevent pneumonia. Monitoring urinary output and turning the patient are important, but do not take priority over breathing. The child needs a quiet environment free of excess stimulation.

33. Which postoperative intervention should be questioned for a child after a cardiac catheterization? a. Continue intravenous (IV) fluids until the infant is tolerating oral fluids. b. Check the dressing for bleeding. c. Assess peripheral circulation on the affected extremity. d. Keep the affected leg flexed and elevated.

ANS: D The child should be positioned with the affected leg straight for 4 to 6 hours after the procedure. IV fluid administration continues until the child is taking and retaining adequate amounts of oral fluids. The insertion site dressing should be observed frequently for bleeding. The nurse should also look under the child to check for pooled blood. Peripheral perfusion is monitored after catheterization. Distal pulses should be palpable, although they may be weaker than in the contralateral extremity.

4. Which explanation regarding cardiac catheterization is appropriate for a preschool child? a. Postural drainage will be performed every 4 to 6 hours after the test. b. It is necessary to be completely "asleep" during the test. c. The test is short, usually taking less than 1 hour. d. When the procedure is done, you will have to keep your leg straight for at least 4 hours.

ANS: D The child's leg will have to be maintained in a straight position for approximately 4 hours. Younger children can be held in the parent's lap with the leg maintained in the correct position. Postural drainage will not be performed unless the child has corresponding pulmonary problems. The child should be sedated to lie still, but being completely asleep is not necessary. The test will vary in length of time from start to finish.

37. What is an expected assessment finding in a child with coarctation of the aorta? a. Orthostatic hypotension b. Systolic hypertension in the lower extremities c. Blood pressure higher on the left side of the body d. Disparity in blood pressure between the upper and lower extremities

ANS: D The classic finding in children with coarctation of the aorta is a disparity in pulses and blood pressures between the upper and lower extremities. Orthostatic hypotension is not present with coarctation of the aorta. Systolic hypertension may be detected in the upper extremities. The left arm may not accurately reflect systolic hypertension because the left subclavian artery can be involved in the coarctation.

21. Myelosuppression associated with chemotherapeutic agents or some malignancies such as leukemia can cause bleeding tendencies because of a/an: a. Decrease in leukocytes. c. Vitamin C deficiency. b. Increase in lymphocytes. d. Decrease in blood platelets.

ANS: D The decrease in blood platelets secondary to the myelosuppression of chemotherapy can cause an increase in bleeding. The child and family should be alerted to avoid risk of injury. Decrease in leukocytes, increase in lymphocytes, and vitamin C deficiency would not affect bleeding tendencies.

24. Myelosuppression, associated with chemotherapeutic agents or some malignancies such as leukemia, can cause bleeding tendencies because of a(n): a. decrease in leukocytes. b. increase in lymphocytes. c. vitamin C deficiency. d. decrease in blood platelets.

46. Surgical closure of the ductus arteriosus would: a. Stop the loss of unoxygenated blood to the systemic circulation. b. Decrease the edema in legs and feet. c. Increase the oxygenation of blood. d. Prevent the return of oxygenated blood to the lungs.

ANS: D The ductus arteriosus allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a right-to-left shunt. If this is surgically closed, no additional oxygenated blood (from the aorta) will return to the lungs through the pulmonary artery. The aorta carries oxygenated blood to the systemic circulation. Because of the higher pressure in the aorta, blood is shunted into the pulmonary artery and the pulmonary circulation. Edema in the legs and feet is usually a sign of heart failure. This repair would not directly affect the edema. Increasing the oxygenation of blood would not interfere with the return of oxygenated blood to the lungs.

7. Surgical closure of the ductus arteriosus would: a. stop the loss of unoxygenated blood to the systemic circulation. b. decrease the edema in legs and feet. c. increase the oxygenation of blood. d. prevent the return of oxygenated blood to the lungs.

13. What is the most appropriate nursing response to the father of a newborn infant with myelomeningocele who asks about the cause of this condition? a. "One of the parents carries a defective gene that causes myelomeningocele." b. "A deficiency in folic acid in the father is the most likely cause." c. "Offspring of parents who have a spinal abnormality are at greater risk for myelomeningocele." d. "There may be no definitive cause identified."

ANS: D The etiology of most neural tube defects is unknown in most cases. There may be a genetic predisposition or a viral origin, and the disorder has been linked to maternal folic acid deficiency; however, the actual cause has not been determined. There is no evidence that children who have parents with spinal problems are at greater risk for neural tube defects.

20. A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations should include which action? a. Encouraging normal activity for as long as is possible b. Explaining the cause of the disease to the child and family c. Preparing the child and family for long-term, permanent disabilities d. Teaching the family the care and management of the corrective appliance

ANS: D The family needs to learn the purpose, function, application, and care of the corrective device and the importance of compliance to achieve the desired outcome. The initial therapy is rest and non-weight bearing, which helps reduce inflammation and restore motion. Legg-Calvé-Perthes is a disease with an unknown etiology. A disturbance of circulation to the femoral capital epiphysis produces an ischemic aseptic necrosis of the femoral head. The disease is self-limiting, but the ultimate outcome of therapy depends on early and efficient therapy and the child's age at onset.

31. A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations should include which action? a. Encouraging normal activity for as long as is possible b. Explaining the cause of the disease to the child and family c. Preparing the child and family for long-term, permanent disabilities d. Teaching the family the care and management of the corrective appliance

29. 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.

9. The nurse is conducting teaching to parents of a 7-year-old child who fractured an arm and is being discharged with a cast. Which instruction should be included in the teaching? a. Swelling of the fingers is to be expected for the next 48 hours. b. Immobilize the shoulder to decrease pain in the arm. c. Allow the affected limb to hang down for 1 hour each day. d. Elevate casted arm when resting and when sitting up.

ANS: D The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return. Swelling of the fingers may indicate neurovascular damage and should be reported immediately. Permanent damage can occur within 6 to 8 hours. Joints above and below the cast on the affected extremity should be moved. The affected limb should not hang down for any length of time.

7. The nurse is teaching the parents of a 7-year-old child who has just had a cast applied for a fractured arm with the wrist and elbow immobilized. Which instructions should be included in the teaching? a. Swelling of the fingers is to be expected for the next 48 hours. b. Immobilize the shoulder to decrease pain in the arm. c. Allow the affected limb to hang down for 1 hour each day. d. Elevate casted arm when resting and when sitting up.

ANS: D The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return. Swelling of the fingers may indicate neurovascular damage and should be reported immediately. Permanent damage can occur within 6 to 8 hours. Joints above and below the cast on the affected extremity should be moved. The child should not engage in strenuous activity for the first few days. Rest with elevation of the extremity is encouraged.

25. A 4-year-old child is recovering from a modified Nuss procedure. Which is the priority intervention by the nurse? A. Ambulating the child as soon as allowed B. Encouraging food and fluids postoperatively C. Monitoring vital signs and wound drainage D. Playing with the child using pinwheels or bubbles

ANS: D The modified Nuss procedure is an open chest reconstruction for severe cases of pectus excavatum. Preventing pneumonia is a critical nursing action. Because this child is too young to use an incentive spirometer, "playing" with him or her using bubbles, pinwheels, or paper triangles the child can blow across the table accomplishes pulmonary hygiene. The other activities are important postoperative nursing interventions, but are not specific to this operation.

18. The nurse is caring for an intubated infant with botulism in the pediatric intensive care unit. Which health care provider prescriptions should the nurse clarify with the health care provider before implementing? a. Administer 250 mg botulism immune globulin intravenously (BIG-IV) one time. b. Provide total parenteral nutrition (TPN) at 25 mL/hr intravenously. c. Titrate oxygen to keep pulse oximetry saturations greater than 92. d. Administer gentamicin sulfate (Garamycin) 10 mg per intravenous piggyback every 12 hours.

ANS: D The nurse should clarify the administration of an aminoglycoside antibiotic. Antibiotic therapy is not part of the management of infant botulism because the botulinum toxin is an intracellular molecule, and antibiotics would not be effective; aminoglycosides in particular should not be administered because they may potentiate the blocking effects of the neurotoxin. Treatment consists of immediate administration of botulism immune globulin intravenously (BIG-IV) without delaying for laboratory diagnosis. Early administration of BIG-IV neutralizes the toxin and stops the progression of the disease. The human-derived botulism antitoxin (BIG-IV) has been evaluated and is now available nationwide for use only in infant botulism. Approximately 50% of affected infants require intubation and mechanical ventilation; therefore, respiratory support is crucial, as is nutritional support because these infants are unable to feed.

18. The nurse is caring for an intubated infant with botulism in the pediatric intensive care unit. Which health care provider prescriptions should the nurse clarify with the health care provider before implementing? a. Administer 250 mg botulism immune globulin intravenously (BIG-IV) one time. b. Provide total parenteral nutrition (TPN) at 25 ml/hr intravenously. c. Titrate oxygen to keep pulse oximetry saturations greater than 92. d. Administer gentamicin sulfate (Garamycin) 10 mg per intravenous piggyback every 12 hours.

21. The nurse finds an adolescent with Hodgkin's disease crying. The adolescent says, "I am so scared." What is the most appropriate nursing response to this comment? a. "I understand how you must feel." b. "You shouldn't feel that way." c. "Is this the strongest feeling you've had today?" d. "Tell me what's got you scared."

ANS: D The nurse should encourage the adolescent to express her feelings and concerns.

1. The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complication should the nurse monitor related to the child's immobilization status? a. Metabolic rate increases b. Increased joint mobility leading to contractures c. Bone calcium increases, releasing excess calcium into the body (hypercalcemia) d. Venous stasis leading to thrombi or emboli formation

ANS: D The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. The metabolic rate decreases with immobilization. Loss of joint mobility leads to contractures. Bone demineralization with osteoporosis and hypercalcemia occur with immobilization.

34. A child has been admitted for suspected bacterial endocarditis. What action takes priority? A. Administering antibiotics B. Education on valve replacement C. Giving an antipyretic D. Obtaining blood cultures

ANS: D The priority action is to obtain blood cultures, either drawn by the nurse or laboratory. Antibiotics are not started until these are collected. If the child is febrile, an antipyretic is appropriate, but it is not the priority. Education on valve replacement is not warranted until later in the course of the disease if it is needed.

33. An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of: a. Air embolism. c. Hemolytic reaction. b. Allergic reaction. d. Circulatory overload.

ANS: D The signs of circulatory overload include distended neck veins, hypertension, crackles, dry cough, cyanosis, and precordial pain. Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Allergic reactions are manifested by urticaria, pruritus, flushing, asthmatic wheezing, and laryngeal edema. Hemolytic reactions are characterized by chills, shaking, fever, pain at infusion site, nausea, vomiting, tightness in chest, flank pain, red or black urine, and progressive signs of shock and renal failure.

42. An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of: a. air emboli. b. allergic reaction. c. hemolytic reaction. d. circulatory overload.

42. A child is suspected of having neurally mediated syncope. Which diagnostic test does the nurse prepare the child for? A. Cerebral angiogram B. Coronary angiogram C. Echocardiogram D. Tilt table test

ANS: D The tilt table test is specific for neurally mediated syncope.

40. Which immunization should not be given to a child receiving chemotherapy for cancer? a. Tetanus vaccine c. Diphtheria, pertussis, tetanus (DPT) b. Inactivated poliovirus vaccine d. Measles, rubella, mumps

ANS: D The vaccine used for measles, mumps, and rubella is a live virus and can result in an overwhelming infection. Tetanus vaccine, inactivated poliovirus vaccine, and DPT are not live virus vaccines.

28. Which immunization should not be given to a child receiving chemotherapy for cancer? a. Tetanus vaccine b. Inactivated poliovirus vaccine c. Diphtheria, pertussis, tetanus (DPT) d. Measles, rubella, mumps

ANS: D The vaccine used for measles, mumps, and rubella is a live virus and can result in an overwhelming infection. Tetanus vaccine, inactivated poliovirus vaccine, and diphtheria, pertussis, tetanus (DPT) are not live virus vaccines

8. The nurse is talking to a parent with a child who has a latex allergy. Which statement by the parent would indicate a correct understanding of the teaching? a. "My child will have an allergic reaction if he comes in contact with yeast products." b. "My child may have an upset stomach if he eats a food made with wheat or barley." c. "My child will probably develop an allergy to peanuts." d. "My child should not eat bananas or kiwis."

ANS: D There are cross-reactions between latex allergies and a number of foods such as bananas, avocados, kiwi, and chestnuts. Although yeast products, wheat and barley, and peanuts are potential allergens, they are currently not known to cross-react with latex.

9. The nurse is talking to a parent with a child who has a latex allergy. Which statement by the parent would indicate a correct understanding of the teaching? a. "My child will have an allergic reaction if he comes in contact with yeast products." b. "My child may have an upset stomach if he eats a food made with wheat or barley." c. "My child will probably develop an allergy to peanuts." d. "My child should not eat bananas or kiwis."

ANS: D There are cross-reactions between latex allergies and a number of foods such as bananas, avocados, kiwi, and chestnuts. Children with a latex allergy will not develop allergies to other food products such as yeast, wheat, barley, or peanuts.

20. 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.

33. The nurse is assigned to four patients on the pediatric progressive care unit. After receiving shift report, which patient should the nurse see first? A. Blood pressure of 88/56 mm Hg in 4-year-old child with heart failure B. Child crying inconsolably after his parents went home C. Pain 5/10 in a child 2 days after cardiac surgery D. Temperature 104.6°F (40.3°C) 3 days after dental visit

ANS: D This child likely has infective endocarditis or bacterial endocarditis. Any high fever after an invasive procedure or dental cleaning needs to be investigated for this possibility. The blood pressure of 88/56 mm Hg is at about the 50% percentile for a 4-year-old and would be considered adequate. Pain is an expected finding after surgery and needs to be treated, but not as the priority. The crying child could be comforted by a nursing assistant, child-life specialist, social worker, or even a volunteer until the nurse can see the child.

40. The parents of a 3-year old cannot understand how their child has developed osteoporosis, stating "We didn't think children could get this disease." Which assessment by the nurse is most important? A. Attainment of developmental milestones B. Dietary intake of calcium C. Height and weight D. Labor and birth history

ANS: D Very-low-birth-weight and premature infants are at risk for developing osteoporosis because bone mass is acquired during the last weeks of pregnancy. If this child were born prematurely, that could explain the osteoporosis. Attaining milestones and height and weight are not the priority (height loss is possible with multiple fractures in older children). Although teens can develop osteoporosis from dietary deficiency of calcium and vitamin D, it is highly unlikely that a 3-year-old would have osteoporosis from this situation.

10. The nurse uses the palms of the hands when handling a wet cast for which reason? a. To assess dryness of the cast b. To facilitate easy turning c. To keep the patient's limb balanced d. To avoid indenting the cast

ANS: D Wet casts should be handled by the palms of the hands, not the fingers, to avoid creating pressure points. Assessing dryness, facilitating easy turning, and keeping the patient's limb balanced are not reasons for using the palms of the hand rather than the fingers when handling a wet cast.

8. The nurse uses the palms of the hands when handling a wet cast to: a. Assess dryness of the cast. c. Keep the patient's limb balanced. b. Facilitate easy turning. d. Avoid indenting the cast.

ANS: D Wet casts should be handled by the palms of the hands, not the fingers, to prevent creating pressure points. Assessing dryness, facilitating easy turning, or keeping the patient's limb balanced are not reasons for using the palms of the hand rather than the fingers when handling a wet cast.

27. A new nurse is placing an elastic wrap on a patient with an ankle sprain. Which action by this nurse causes an experienced nurse to intervene? A. Exerts moderate pull on the wrap B. Instructs the patient on wrapping the injury C. Starts wrapping distal to the injury D. Wraps in a proximal-to-distal fashion

ANS: D When using an elastic wrap, start wrapping distal to the injury, work up over the injury, and end the wrapping proximal to the injury. The other actions are correct.

Pediatrics Test 3 (Final)

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