Peds

A seven-year-old girl has been clinging to her mother and refusing to go to school. The child is diagnosed with separation anxiety disorder, and the treatment plan will include cognitive-behavioral therapy (CBT). The nurse would explain to the parents that CBT will include: Standard Text: Select all that apply. 1. Self-talking. 2. Relaxation. 3. Hypnosis. 4. Anti-depressant medications. 5. Recognition of feelings.

1,2,5

An 11-year-old boy with rheumatoid arthritis wants to participate in the school sports programs. The boy asks the nurse to recommend a sporting activity for him. Which activity would be the most appropriate for the nurse to recommend? 1. Baseball 2. Basketball 3. Football 4. Swimming

Rationale 4: Swimming helps to exercise all the extremities without putting undue stress on joints.

The nurse is assessing a four-year-old child with a possible alteration in mental health. Which findings indicate a need for further investigation? Standard Text: Select all that apply. 1. Fails to make eye contact 2. Flinches when touched on the arm 3. History of limited prenatal care and precipitant delivery 4. Head circumference has not changed in over one year 5. Flat facial expressions

1,2,3,5

There has been an outbreak of tinea pedis among the high school football team. The school nurse meets with the team and discusses preventative activities to reduce spread of the organism. The nurse will instruct the team members to: Standard Text: Select all that apply. 1. Wear 100% white cotton socks, changed twice a day. 2. Use talc on feet daily. 3. Use an over-the-counter corticosteroid cream to treat the area. 4. Wear foot covers such as flip flops in the locker room and shower. 5. Apply heat to the area twice a day.

1,2,4

A child had an appendectomy and was discharged home at 48 hours postoperative. A week later the child is readmitted for delayed wound healing. Which causes of delayed wound healing will the nurse review prior to assessing the child? Standard Text: Select all that apply. 1. Infection 2. Predisposing chronic condition, such as diabetes 3. Hypervolemia 4. Inadequate nutrition 5. Hypoxemia 6. Corticosteroid therapy

1,2,4,5,6

The nurse is teaching the caregiver of a child who is newly diagnosed with type 1 diabetes mellitus how to minimize pain with insulin injections. Which interventions to minimize pain will the nurse include in the teaching? Standard Text: Select all that apply. 1. Do not reuse needles. 2. Remove all bubbles from the syringe before injecting. 3. Have the child flex the muscle during injection. 4. Inject insulin when it is cold. 5. Do not change the direction of the needle during insertion or withdrawal.

1,2,5

The school nurse has noticed an increase in the number of children in the school being diagnosed with type 2 diabetes. Which changes could the nurse implement at school to help reduce students' risk for developing type 2 diabetes? Standard Text: Select all that apply. 1. Increase the amount of daily physical activity. 2. Meet with all parents and explain the risk that is associated with obesity. 3. Test each child's urine monthly. 4. Teach the parents to avoid administering aspirin to their children. 5. Work with the cafeteria to decrease the amount of fat in the foods served.

1,2,5

The nurse is providing information to a teenager newly diagnosed with diabetes and his parents. The nurse teaches them that the signs of diabetic ketoacidosis (DKA) include: Standard Text: Select all that apply. 1. Change in mental status. 2. Tachycardia. 3. Fruity breath odor. 4. Rapid, shallow respirations. 5. abdominal pain

1,3,5

While preparing for the day in the integument clinic, the nurse notices that a number of the patients being seen that day have conditions with a genetic component. Which skin conditions have a genetic or inherited component? Standard Text: Select all that apply. 1. Atopic dermatitis 2. Seborrheic dermatitis 3. Epidermolysis bullosa 4. Molluscum contagiosum 5. Psoriasis

1,3,5

The clinic nurse has completed teaching the teenager about skin care and acne prevention. Which statement by the teenager indicates the need for additional teaching? 1. "I shouldn't squeeze my blackheads or pimples." 2. "I need to watch my diet and cut out all chocolates." 3. "I should avoid applying drying materials, such as astringents, to my face" 4. "I should wash my hands frequently and avoid touching my face."

2,4

The nurse at a high school is screening students for mental health issues. The nurse would want to refer the adolescent for depression if the child shows which symptoms of depression? Standard Text: Select all that apply. 1. Agoraphobia 2. Somatic complaints 3. Focus on violence 4. Poor self-care 5. Poor school performance

3,4,5

The school nurse and teacher are working on a plan to improve the behavior and learning of a child recently diagnosed with attention deficit/hyperactivity disorder (ADHD). Which activities will the nurse suggest be included in the plan? Standard Text: Select all that apply. 1. Asking the mother to seek a prescription for methylphenidate (Ritalin) for the child 2. Placing the child's desk at the back of the room to reduce distractions 3. Developing a consistent routine for the classroom 4. Limiting the decorations in the classroom 5. Determining areas where the child performs well and using these areas to promote self-esteem

3,4,5

A nurse is performing a developmental assessment on several children in a clinic setting. Which children exhibit a delay in meeting developmental milestones? Standard Text: Select all that apply. 1. An 18-month-old toddler who is unable to speak in sentences 2. A two-year-old who is unable to cut with scissors 3. A two-year-old who cannot recite her phone number 4. A six-year-old who is unable to sit still for a short story 5. A five-year-old who is unable to button his shirt

4,5

A child is brought to the emergency department in a coma. The mother thinks the child may have ingested a poison. The nurse will assess: Standard Text: Select all that apply. 1. For burns around the mouth. 2. The child's breath. 3. The child's vomitus. 4. Hair samples. 5. Blood and urine toxicology screens.

Correct Answer: 1,2,3,5

A child is receiving chemotherapy induction for acute lymphocytic leukemia (ALL). Taking common side effects into consideration, which nursing diagnoses would be appropriate during the induction chemotherapy? Standard Text: Select all that apply. 1. Risk for injury: hemorrhagic cystitis 2. Skin integrity: impaired mucous membrane 3. Fluid and electrolyte impairment: nausea and vomiting 4. Risk for infection 5. Impaired sleep pattern 6. Diarrhea

Correct Answer: 1,2,3,6

The mother of an immunocompromised child brings her child to the clinic for a routine check-up and recommended immunizations. The mother expresses concern that her child will "catch" the disease from the vaccination. The nurse would explain that which of the following carry no risk of acquiring the infection? Standard Text: Select all that apply. 1. Toxoid 2. Killed virus vaccine 3. Live virus vaccine 4. Attenuated vaccine 5. Immunoglobulins

Correct Answer: 1,2,5

Following diagnosis of Ewing's sarcoma, the physician orders chemotherapy for the 12-year-old child. After discussion with the physician, the parents refuse a central line so the chemotherapy will be administered by peripheral line. The nurse will prevent extravasation by: Standard Text: Select all that apply. 1. Ensuring that the intravenous line is a free flowing line. 2. Administering the medication by infusion pump. 3. Checking for blood return before and during chemotherapy administration. 4. Diluting the medication with normal saline. 5. Administering the vesicant drug last.

Correct Answer: 1,3

The pediatric public health nurse visits a facility for the homeless. The nurse would evaluate the children staying at the facility for what type of medical/health issues? Standard Text: Select all that apply. 1. Dental caries 2. Infections secondary to tattoos 3. Lack of immunizations 4. Nutritional deficits 5. Munchausen syndrome by proxy

Correct Answer: 1,3,4

After a severe allergic reaction, an EpiPen is prescribed for the 10-year-old child. Instructions to be given to the child and the family would include: Standard Text: Select all that apply. 1. The child should always have the EpiPen readily available. 2. The parents should learn to administer the EpiPen as the child is too young to self-administer. 3. Once an EpiPen has been administered, there is no need for additional follow-up. 4. The EpiPen has an expiration date that should be checked regularly, and the pen should be replaced as needed. 5. The child should wear a MedicAlert bracelet.

Correct Answer: 1,4,5

Manifestations of cancer in the pediatric patient vary by type and location but typically include which of the following general manifestations? Standard Text: Select all that apply. 1. Infection 2. Weight gain 3. Polycythemia 4. Neurologic symptoms 5. Pain 6. Cachexia

Correct Answer: 1,4,5,6

A child has an anaphylactic reaction to contrast dye used in an X-ray. After the emergency is over and the child is stable in the intensive care unit, the nurse explains to the parents what happens in anaphylaxis. The nurse explains that histamine is released during an anaphylactic reaction and that the action of histamine includes: Standard Text: Select all that apply. 1. Release of IgE antibodies. 2. Smooth muscle contraction. 3. Increased capillary permeability. 4. Vasoconstriction. 5. Red cell destructions

Correct Answer: 2,3

A child is admitted to the hospital with a diagnosis of lead poisoning. The health department nurse is investigating the child's home to locate the source of the lead that the child has ingested. Which possibilities will the nurse investigate? Standard Text: Select all that apply. 1. The home's foundation for a possible radon leak 2. The home's water pipes 3. The dirt surrounding the house 4. The presence of imported toys or antique baby furniture 5. Gas stored in cans

Correct Answer: 2,3,4

The 10-year-old boy is admitted to the pediatric neurologic unit with a suspected craniopharyngioma. The nurse will assess the child with which symptoms related to this brain tumor? Standard Text: Select all that apply. 1. Evening nausea 2. Excessive urination leading to dehydration 3. Nystagmus 4. Headaches 5. Orbital ecchymosis

Correct Answer: 2,3,4

The nurse administers the flu vaccine to a school age child. After administering the vaccine, the nurse will document: Standard Text: Select all that apply. 1. The date of the last flu vaccine. 2. The site of the vaccination. 3. The lot and serial number of the vaccine. 4. The date and time of administration. 5. Who assisted in restraining the child.

Correct Answer: 2,3,4

The nurse is evaluating the immunization status of a child. The nurse recognizes that the child can acquire active immunity against a disease by: Standard Text: Select all that apply. 1. Receiving a dose of immunoglobulins. 2. Immunization with a killed virus vaccine. 3. Immunization with a toxoid. 4. Antibiotic therapy. 5. Acquiring the disease.

Correct Answer: 2,3,5

The nurse recognizes that the person guilty of child abuse may have which symptoms? 1. Physical illness 2. Alcoholism 3. Many friends and families nearby 4. Unrealistic expectations for their child 5. The abuser has no relationship to the child.

Correct Answer: 2,4

The mother tells the nurse that her maternity leave is almost over and she will be returning to work soon. She will need to place her infant in a day care, and she asks the nurse how to know which day care is best. The nurse will tell the mother to investigate day care programs that: Standard Text: Select all that apply. 1. Are close to her work in the event of an emergency 2. Require all staff have criminal background checks 3. Are attractive in appearance, with bright colors and interesting visual stimulation 4. Provide regular training of the staff and administration 5. Have policies regarding child health and emergencies, such as immunization requirements and emergency medical forms

Correct Answer: 2,4,5

There has been an outbreak of communicable diseases in the community. To reduce parental anxiety, the nurse presents information about disease at the school's Parent Teacher Association meeting. The nurse explains that children cannot acquire vector-borne diseases from other children. The nurse explains that vector-borne diseases include: Standard Text: Select all that apply. 1. Measles (Rubeola). 2. Pertussis (whooping cough). 3. Rocky Mountain Spotted Fever. 4. West Nile Virus. 5. Lyme disease.

Correct Answer: 3,4,5

A hospitalized child has been diagnosed with SIADH (syndrome of inappropriate antidiuretic hormone), a complication of his meningitis. What would the nurse expect to see on this child's lab results? 1. Hyponatremia 2. Hypocalcemia 3. Hyperglycemia 4. Hypernatremia

Hyponatremia

The nurse explains to new parents that as healthy children are exposed to more infections, they: 1. Naturally develop antibodies. 2. Are found to be healthier. 3. Will acquire terminal illnesses. 4. Will weaken their immune systems.

Rationale 1: As healthy children are exposed to more infections, they naturally develop antibodies.

The waiting room of the mental health clinic is full of children with various mental health issues. The nurse watches the children and notes that which child is displaying symptoms of autism? 1. Four-year-old girl who doesn't make eye contact with mother and resists the mother's touch 2. Three-year-old boy who joins one group of children then moves to another group of children without joining their activities 3. 18-month-old child who walks around the area using the furniture to provide balance 4. Six-year-old boy who chatters constantly to anyone who will listen

Rationale 1: Although boys are affected more often than girls, lack of eye contact and resistance to physical touch are common symptoms of autism.

An infant has a severe case of oral thrush (Candida albicans). Which is the priority nursing diagnosis for this infant? 1. Ineffective infant feeding pattern related to discomfort 2. Ineffective breathing pattern related to oral thrush 3. Activity intolerance related to oral thrush 4. Ineffective airway clearance related to mucus

Rationale 1: An infant with oral thrush might refuse to nurse or feed because of discomfort and pain. Prompt treatment is necessary so the infant can resume a normal feeding pattern.

During rounds, the interdisciplinary team is discussing the care of a child with a newly diagnosed Wilms' tumor. The nurse describes the mother as being angry and upset that they are not caring properly for her child. What behavior probably is the cause of the mother's anger? 1. The mother is beginning the stages of grief over loss of her previously well child. 2. The mother is feeling guilty for not recognizing that the child was ill. 3. The nurses are negligent in providing safe care for the child. 4. The mother does not have adequate support from Social Services.

Rationale 1: Anger is the first stage of the grief process and can be applied in this instance to the mother's loss of a normal child and potential death.

A two-year-old child with a fever is prescribed amoxicillin clavulanate 250 mg/5 ml three times daily by mouth for ten days for otitis media. To guard against antibiotic resistance, the nurse instructs the parent to: 1. Give the antibiotic for the full ten days. 2. Measure the prescribed dose in a household teaspoon. 3. Spread the dose evenly during daylight hours. 4. Stop the antibiotic when the child is afebrile.

Rationale 1: Antibiotics must be administered for the full number of days ordered to prevent mutation of resistant strains of bacteria.

A nurse is providing education to a group of young mothers. The nurse would explain that as children grow, they develop immunity through: 1. Immunization or exposure to the natural disease. 2. Acquiring diseases from family members who had the disease. 3. Acquiring diseases from other children. 4. Being born with diseases already in their systems.

Rationale 1: As children grow, they develop immunity through immunization or exposure to the natural disease. As children mature and become more active, they interact more frequently with other children and adults and increase their exposure to infectious agents.

Which should the nurse use when reconstituting vaccines? 1. The diluents provided 2. Normal saline 3. Any solution available 4. Sterile water

Rationale 1: When reconstituting vaccines, it is important to use the solution provided and follow the manufacturer's directions.

The nurse is teaching strategies to prevent insect bites and stings to the parents of a small child. Which statement made by the parents indicates a need for further teaching? 1. "If my child wears bright colors and floral prints when outdoors, she will blend in with the surroundings, and the stinging insects will not sting her." 2. "We should remove any items with standing water from our yard and surrounding area to prevent mosquito reproduction." 3. "My child can use insect repellent containing DEET of 10% or less." 4. "My child should avoid heavy colognes, perfumes, and soaps so that insects are not attracted to them."

Rationale 1: Bright-colored clothing and floral prints attract the insects. White and light-colored clothing should be worn. This statement requires clarification.

The nurse is examining a 12-month-old who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with bright red, scaly plaques and small papules. Satellite lesions are also present. This is most likely caused by which of the following? 1. Candida albicans (yeast) 2. Impetigo (staph) 3. Infrequent diapering 4. Urine and feces

Rationale 1: Candida albicans is frequently the underlying cause of severe diaper rash. When a primary or secondary infection with Candida albicans occurs, the rash has bright red, scaly plaques with sharp margins. Small papules and pustules might be seen, along with satellite lesions.

A mother of two children, an 8-year-old and a 10-year-old, tells you that her husband has recently been deployed to the Middle East. The mother is concerned about the children's constant interest in watching TV news coverage of activities in the Middle East. The most appropriate suggestion for the nurse to make to this mother would be: 1. "Spend time with your children, and take cues from them about how much they want to discuss." 2. "Allow the children to watch as much television as they want. This is how they are coping with their father's absence." 3. "The less that you discuss this, the quicker the children will adjust to their father's absence. Try to keep them busy and use distractions to keep their mind off of it." 4. "It will just take some time to adjust to their father's absence and then everything will return to normal."

Rationale 1: Children need to be able to discuss their feelings and concerns with an adult; otherwise, their emotional distress could increase.

Which would be the priority nursing diagnosis during the acute phase of burn injury for a child who has a third-degree circumferential burn of the right arm? 1. Altered tissue perfusion, risk for 2. Infection, risk for 3. Impaired physical mobility 4. Altered nutrition: less than body requirements, risk for

Rationale 1: Circumferential burns can restrict blood flow due to edema, resulting in tissue hypoxia. Altered tissue perfusion to the extremity is the greatest risk and therefore the priority diagnosis.

A five-year-old with a history of being treated for hypopituitarism comes to the physician with complaints of right hip and leg pain. The nurse understands that this symptom might be related to which medication that is used to treat hypopituitarism? 1. Daily growth hormone 2. Insulin before meals and bedtime 3. DDAVP (desmopressin acetate) at HS 4. Cortisone injections

Rationale 1: Growth hormone injections and hypopituitarism have been associated with slipped capital femoral epiphysis, which manifests with complaints of hip or knee pain.

A child has been placed on an oral corticosteroid for a rash caused by graft-versus-host disease. The nurse will monitor the child for the common side effects of corticosteroids including: 1. Hyperglycemia. 2. Hepatic toxicity. 3. Seizures. 4. Renal toxicity.

Rationale 1: Hyperglycemia is a side effect of steroid therapy.

The nurse is teaching a teenage client newly diagnosed with type 1diabetes about complications of the disease. The nurse explains that clients with type 1 diabetes can avoid lipoatrophy by: 1. Rotating injection sites. 2. Checking blood sugars at mealtime and bedtime. 3. Using a sliding scale for additional coverage. 4. Administration of insulin via insulin pump.

Rationale 1: Lipoatrophy is caused by using the same insulin injection site.

A parent of a newborn asks the nurse why young children seem to become ill so often when compared with older children and adults. Which of the following does the nurse's best response address? 1. Lower numbers of natural killer cells in younger children 2. High levels of IgA in the newborn 3. Absent lymphoid tissue in the young child 4. Underdeveloped thymus glands in the infant

Rationale 1: Newborns have lower numbers of natural killer cells than do older children and adults, decreasing their ability to respond to certain antigens.

Parents understand the teaching a nurse has done with regard to care of their child with tinea capitis (ringworm of the scalp) if they state: 1. "We will give the griseofulvin with milk or peanut butter." 2. "We're glad ringworm isn't transmitted from person to person." 3. "Once the lesion is gone, we can stop the griseofulvin." 4. "Well, at least we don't have to worry about the family cat getting the ringworm."

Rationale 1: Parents are advised to give oral griseofulvin with fatty foods such as milk or peanut butter to enhance absorption.

A child has sustained a minor burn. Which of the following should be included in increased amounts in the child's diet? 1. Protein 2. Minerals 3. Carbohydrates 4. Fats

Rationale 1: Parents should be taught that management of a minor burn requires a high-calorie, high-protein diet. This is necessary to meet the increased nutritional requirements of healing.

A parent is concerned about her eight-year-old child's recent behavior and calls the nurse for advice. According to the parent, her child is constantly crying, is not sleeping well, and has withdrawn from activities. The nurse should recognize that this behavior could be a response to: 1. Bullying. 2. Normal behavior for the age. 3. Lead poisoning. 4. Drug abuse.

Rationale 1: Physical complaints, suicidal thoughts, and other problems can result from bullying.

A hospitalized child has been diagnosed with SIADH (syndrome of inappropriate antidiuretic hormone), a complication of his meningitis. What would the nurse expect to see on this child's lab results? 1. Hyponatremia 2. Hypocalcemia 3. Hyperglycemia 4. Hypernatremia

Rationale 1: SIADH is associated with increased permeability in distal renal tubes, leading to water intoxication and low sodium.

The school nurse in the high school recognizes that teenage pregnancy is a major problem in the school. The nurse recognizes that many high school girls hide their pregnancy to prevent adults from knowing they are pregnant. Therefore, it is important that the nurse insure that all pregnant teenagers are aware of: 1. Safe haven laws. 2. Birth control available to all teenagers. 3. Domestic abuse protection. 4. The father's financial responsibility for the infant.

Rationale 1: Safe haven laws provide for unwanted babies to be left in certain locations without legal repercussions to the mother.

The school nurse is trying to prevent the spread of a flu virus through the school. Infection-control strategies that could be employed include: 1. Sanitizing toys, telephones, and doorknobs to kill pathogens. 2. Teaching parents safe food preparation and storage. 3. Withholding immunizations for children with compromised immune systems. 4. Not separating children with infections from well children.

Rationale 1: Sanitizing toys and all contact surfaces, separating children with infections, and teaching children to wash their hands all control the growth and spread of microorganisms.

The child has been admitted to the hospital unit newly diagnosed with retinoblastoma. What would the nurse expect to see when examining the child's eye? 1. A white reflex 2. Blue-tinged sclera 3. A red reflex 4. Yellow sclera

Rationale 1: The first sign of retinoblastoma is a white pupil. The red reflex is absent. This is known as leukocoria, or "cat's eye" reflex.

A nurse is providing information to a group of new mothers. The nurse would explain that newborns and young infants are more susceptible to infection because they have: 1. Low levels of antibodies. 2. High levels of maternal antibodies to diseases to which the mother has been exposed. 3. Passive transplacental immunity from maternal immunoglobulin G. 4. Been exposed to microorganisms during the birth process.

Rationale 1: The infant's immune system is not fully developed at birth, and the infant has low levels of antibodies due to lack of exposure to antigens.

The child is recovering from a bone marrow transplant. Which is the priority nursing concern in this early stage management? 1. Early recognition of symptoms of graft-versus-host disease. 2. Providing discharge instructions to the parents. 3. Avoiding latex products. 4. Monitoring the child for return of bone marrow function.

Rationale 1: The nurse should be assessing for symptoms of graft-versus-host disease so that medical treatment can begin.

The child was diagnosed with phenylketonuria shortly after birth and has been treated by the endocrine clinic for the last four years. The mother has missed the last three appointments. When the child keeps the next appointment, the mother assures the nurse that the child has followed the dietary restrictions. Which finding would make the nurse question this statement? 1. The child's body has a musty odor. 2. This child is a blue-eyed blond. 3. The child appears sleepy and uninterested in the surroundings. 4. The child has a sunburn over his entire body.

Rationale 1: The odor is caused by the excretion of phenylketone by-products through the skin and would indicate noncompliance with the dietary restrictions.

The pediatric clinic has set a goal that 95% or more of the children attending the clinic will be fully immunized. To reach this goal, clinic nurses will teach the families that: 1. The benefits of immunizations outweigh the risks of communicable diseases. 2. Immunizations should be completed by the time the child starts school. 3. Once a child receives a vaccination, that individual has lifelong immunity against that disease. 4. Vaccinations are 100% safe.

Rationale 1: The risks and benefits of vaccines far outweigh the risks from communicable diseases and resulting complications.

The nurse is preparing the hospital room for admission of a child with multiple allergies including cow's milk, peanuts, and latex. The nurse's priority responsibility in preparing for this child would include: 1. Evaluating the hospital room for equipment containing latex. 2. Ordering an EpiPen for the child. 3. Notifying dietary of the milk and peanut allergy. 4. Placing a sign on the door which identifies all allergies.

Rationale 1: This is appropriate as latex allergies can be life threatening. Many pieces of medical equipment may contain latex.

The nurse is working with the mother of a child with autism. The goal of the session is to plan strategies to increase the child's socialization. The nurse is explaining behavior modification as a treatment process. The nurse will encourage the mother to: 1. Create a reward system when the child interacts with a person. 2. Punish the child when the child's social behaviors are inappropriate. 3. Use dolls to demonstrate appropriate social interactions to the child. 4. Enroll the child in a day care to encourage interaction with other children.

Rationale 1: This is appropriate treatment involving behavior modification.

The nurse prepares a DTaP (diphtheria, tetanus toxoid, and acellular pertussis) immunization for a six-month-old infant. To administer this injection safely, the nurse chooses which of the following needles (size and length), injection type, and injection site? 1. 25-gauge, 5/8-inch needle; IM (intramuscular); anterolateral thigh 2. 25-gauge, 5/8-inch needle; ID (intradermal); deltoid 3. 22-gauge, 1/2-inch needle; IM (intramuscular); dorsogluteal 4. 25-gauge, 3/4-inch needle; SQ (subcutaneous); anterolateral thigh

Rationale 1: This vaccine is only given SQ to infants, not IM.

A nurse is applying a 5% permethrin lotion to a toddler with scabies. Which instruction describes the best way to apply this lotion? 1. Apply the lotion over the entire body from the chin down, as well as on the scalp and forehead. 2. Apply the lotion only on the areas with evidence of scabies activity. 3. Apply the lotion only to the hands. 4. Apply the lotion to the scalp only.

Rationale 1: Treatment of scabies involves application of a scabicide, such as 5% permethrin lotion, over the entire body from the chin down. The scabicide is also applied to the scalp and forehead of younger children, avoiding the rest of the face.

A high school student calls to ask the nurse for advice on how to care for a new navel piercing. How should the nurse respond? 1. "Avoid contact with another person's bodily fluids until the area is well healed." 2. "Do not move or turn the jewelry for the first three days." 3. "Apply lotion to the area, rubbing gently, to prevent skin from becoming dry and irritated." 4. "Apply warm soaks to the area for the first two days to minimize swelling."

Rationale 1: Until the piercing has healed, it is a non-intact area of skin that has potential for infection, especially from contact with bodily fluids from someone else.

A child has thrombocytopenia secondary to chemotherapy treatments. Based on this finding, what should the nurse do? 1. Avoid administering intramuscular injections (IM). 2. Monitor intake and output. 3. Use palpation as a component of assessment. 4. Avoid performing oral hygiene.

Rationale 1: When the child is thrombocytopenic (decreased platelets) from chemotherapy, the nurse should not administer IM injections because of the risk of bleeding.

After years of treatment with chemotherapy and radiation, a child with a brain tumor is shown to be refractory to treatment, and a DNR (Do Not Resuscitate) has been obtained. The mother has reached the stage of acceptance; the father is angry that the medical and nursing team has not been able to "save" his child. How would the multidisciplinary team best support this family? 1. Tell the father that he should have brought his child in earlier for treatment. 2. Continue to include the family in planning care and assure them that the child will be kept comfortable in the days to come. 3. Initiate a Social Services referral. 4. Contact the on-call chaplain for consultation with the entire family and ask him to take the father aside for additional assistance.

Rationale 2: Being informed and involved will be the best way to assist the father at this point. Families also might need repeated and ongoing reassurances throughout the death process.

The 10-year-old child is admitted to the hospital following an accident at school that resulted in a puncture wound of the abdomen. Two days after the injury, the child continues in the inflammation phase of healing. What would the nurse expect to see while changing the child's dressing and assessing the wound? 1. The wound is contracting, and the edges are growing together. 2. A blood clot has formed, sealing the wound. 3. Epithelial cells are growing into the wound. 4. The wound is pale and weepy.

Rationale 2: Clot formation to seal the wound with fibrin and trapped cells and platelets occurs during the inflammation phase of wound healing, in the first three to five days.

Based on physical findings, including a webbed neck and low hairline, the newborn female infant is suspected of having Turner's syndrome. The baby is in the newborn nursery while preparations are made for further evaluation including karyotyping. The nurse will want to monitor this baby for common associated conditions including: 1. Club foot (talipes equinovarus). 2. Congenital heart anomalies. 3. Hyperbilirubinemia due to liver abnormalities. 4. Diaphragmatic hernia.

Rationale 2: Congenital heart anomalies, including coarctation of the aorta, frequently are associated with Turner's syndrome.

When the newborn female is born with ambiguous genitalia, the follow-up investigation discovers adrenogenital syndrome (also called congenital adrenal hyperplasia). The parents question why the baby's genitalia looks more male than female. The nurse would explain that: 1. The disorder caused the infant to be a hermaphrodite with both male and female sex organs. 2. The changes in the genitalia are due to increased androgens secondary to deficient cortisol. 3. The excessive cortisol caused the enlargement of the female tissue, creating a male appearance. 4. The child has only one sex chromosome resulting in an XO configuration.

Rationale 2: Deficient cortisol causes the amount of ACTH to be high, over stimulating the adrenal production of androgens which causes the pseudo-masculinization.

A young infant is admitted to the hospital unit with physical injuries. The nurse is taking the child's history. The statement by the parent that would be most suspicious for abuse is: 1. "I was walking up the steps and slipped on the ice, falling while carrying my baby." 2. "The baby's 18-month-old brother was trying to pull the baby out of the crib and dropped the baby on the floor." 3. "I placed the baby in the infant swing. His six-year-old brother was running through the house and tripped over the swing, causing it to fall." 4. "I did not realize that my baby was able to roll over yet, and I was just gone a minute to check on dinner when the baby rolled off of the couch and onto our tile floor."

Rationale 2: Developmentally, it would be very difficult for an 18-month-old child to pull an infant out of a crib.

The nurse explains to the parents of a child with a severe burn that wearing an elastic pressure garment (Jobst stocking) during the rehabilitative stage can help prevent which complication? 1. Pain 2. Hypertrophic scarring 3. Poor circulation 4. Formation of thrombus in the burn area

Rationale 2: During the rehabilitation stage, Jobst stockings or pressure garments are used to reduce development of hypertrophic scarring and contractures.

The nurse is caring for a child who experiences an anaphylactic shock reaction. In which position will the nurse place the child? 1. In Trendelenburg position 2. Flat, with legs slightly elevated 3. In high Fowler's position 4. In reverse Trendelenburg position

Rationale 2: Flat, with legs slightly elevated, is the position that is used for a client experiencing shock. This allows for the blood pressure to be maintained during this critical time.

A nurse has begun an infusion of intravenous immunogloblin (IVIG) to a child who has combined immunodeficiency disease. In which situation should this infusion be stopped? 1. The child complains of discomfort at the IV site. 2. The child develops severe shaking, chills, and fever. 3. The child complains of thirst. 4. The child experiences a mild headache.

Rationale 2: Hypersensitivity reaction can be seen with IVIG. The infusion should be started slowly and increased if there is no reaction. Shaking, chills, and fever can indicate a reaction.

A five-year-old child is on chemotherapy for rhabdomyosarcoma. Despite antiemetics, the child complains of nausea. The mother wants the child to eat and is pushing the child to eat the food. The nurse would talk with the mother and suggest that she not push the food on the nauseated child because: 1. The child does not need to eat as he is on intravenous fluids. 2. Forcing the child to eat may lead to a food aversion for the child. 3. Vomiting can lead to damage to the stomach. 4. Pushing the child to eat leads to a psychological conflict that may turn the child away from the parent.

Rationale 2: If the child is forced to eat and then vomits, the child can develop a food aversion in which the child associates that food with vomiting.

The antiemetic drug ondansetron (Zofran) is being administered to a child receiving chemotherapy. It should be administered: 1. Only if the child experiences nausea. 2. Before chemotherapy administration, as a prophylactic measure. 3. After the chemotherapy has been administered. 4. Never; this antiemetic is not effective for controlling nausea and vomiting associated with chemotherapy.

Rationale 2: The antiemetic ondansetron (Zofran) should be administered before chemotherapy and every four hours during the administration of chemotherapy, as a prophylactic measure.

A two-month-old infant has been diagnosed with severe combined immunodeficiency disease (SCID). The physician talked with the parents about the planned treatment and prognosis for the infant. Which statement by the parents indicates the need for additional education? 1. "My child will receive intravenous immune globulins as a way to help him fight infection." 2. "Within days of receiving a stem cell transplant, my child will be cured." 3. "If my child needs a blood transfusion, it should be with irradiated blood cells." 4. "Antibiotics will be used as necessary to help my child fight infections."

Rationale 2: It takes three to four months for the transplant to begin to work. The nurse needs to clarify this information.

A premature infant is at greater risk for infection than a full-term infant because of a reduced number of which immunoglobulin? 1. IgE 2. IgG 3. IgA 4. IgM

Rationale 2: Maternal IgG crosses the placenta. Newborns' levels are similar to their mothers'. Premature infants have lower levels of IgG obtained from their mothers and are at greater risk for infection.

The mother of several children is talking with the nurse. She asks the nurse why her younger child seems to sunburn easier than her older children. The nurse would explain that the skin of younger children: 1. Is thinner than that of adolescents. 2. Has less melanin. 3. Has smaller, nonfunctional apocrine sweat glands. 4. More readily absorbs chemicals.

Rationale 2: Melanin determines skin color and serves as a shield against ultraviolet radiation, the cause of sunburns.

The hospital has instructed its nurses that they must participate in disease surveillance associated with infectious agents. The nurses are warned that which of the following disease(s) are likely to be the weapons of terrorists? 1. Rocky Mountain spotted fever and Lyme disease 2. Plague, anthrax, and smallpox 3. Rubella, mumps, and chickenpox 4. Severe acute respiratory syndrome (SARS)

Rationale 2: Plague, anthrax, and smallpox are choices of terrorists because they are highly contagious, lethal diseases that can kill large numbers of people in a relatively short time.

The nurse is teaching parents how to prevent the spread of infectious disease. Which of the following is the most important health promotion strategy for all age groups of children? 1. Keeping child free from colds 2. Proper hand hygiene 3. Keeping all toys clean and free from germs 4. Keeping child away from sick adults

Rationale 2: Proper hand hygiene is one of the most important health promotion strategies for all age groups of children as well as child care providers.

While working at a weekend "free clinic," the nurse is assessing a three-year-old when the mother of the child confides that it has been very difficult providing for her family of four children on her limited budget. She is not sure that she has enough money to buy both food for the rest of the month and the antibiotic that is needed for the child's ear infection. Which intervention by the nurse would be most beneficial for the child and this family? 1. Talking with the mother about keeping the child's ear clean by using a Q-tip 2. Putting the mother in contact with a local agency that provides food on a regular basis to needy families and helps them access other resources in the community 3. Providing the mother with samples of food and food stamps for the child 4. Giving the mother free samples of an antibiotic.

Rationale 2: Putting the mother in contact with a local agency is most likely to meet the family's basic need for food and possibly connect the mother to a resource that could supply her with the antibiotic for her child.

A child with rhabdomyosarcoma is to undergo radiation therapy after surgical removal of the tumor. The parents should be taught to: 1. Apply lotion to the area before radiation therapy. 2. Apply sunscreen to the area when the child is exposed to sunlight. 3. Remove any markings left after each radiation treatment. 4. Vigorously scrub the area when bathing the child.

Rationale 2: Radiation therapy causes the skin in that area to be sensitive. Sunscreen should be applied so that sunburns are avoided.

The nurse is teaching a class on infectious disease; the nurse understands that zoonosis is only transmitted by: 1. Person to person. 2. Animals to person. 3. Adult to child. 4. Person to insects.

Rationale 2: Some infectious diseases are transmitted by insects or animals and are not communicable from person to person.

A child is admitted for scald burns to his buttocks and thighs. According to the mother, she was preparing the child's bath and before she could test the water, the child fell in and was scalded. The nurse would suspect child abuse because: 1. The burns are uneven, with some burns deeper than others. 2. The child's hands and feet are free of burns. 3. In addition to the main burn site, there are splash burns surrounding the area. 4. The mother was home alone with the child.

Rationale 2: Someone who falls in hot water would immediately try to get out by using his hands and feet.

The home health nurse is visiting a three-month-old who has been diagnosed with congenital hypothyroidism and is taking daily thyroxine. The baby is on soy formula and is at the 50th percentile for height and weight. It is important that the mother understands that: 1. Parents may stop the thyroxine as long as the baby remains in the 50th percentile for height and weight. 2. Soy-based formula can interfere with the absorption of thyroxine. 3. Dairy-based formula is contraindicated when an infant is taking thyroxine. 4. As long as the baby is growing along the same growth curve, no interventions are necessary.

Rationale 2: Soy-based formula can interfere with the absorption of thyroxine.

The hospital has just provided its nurses with information about biologic threats and terrorism. After completing the course, a group of nurses are discussing their responsibility in relation to terrorism. The nurse who correctly understood the presentation is the one who identifies their action to be: 1. Initiating isolation precautions for a hospitalized client with methicillin-resistant staphylococcus aureus (MRSA). 2. Notifying the Centers for Disease Control and Prevention (CDC) if a large number of persons with the same life-threatening infection present to the emergency department. 3. Separating clients according to age and illness to prevent the spread of disease. 4. Disposing of blood-contaminated needles in the lead-lined container.

Rationale 2: The CDC must be contacted to investigate the source of serious infections and to determine if a terrorist threat exists.

The nurse is explaining the importance of hand washing after using the toilet to parents of young children. Which is the most important reason for this practice? 1. Children's immune systems are not fully developed. 2. Hand washing is the main way to limit the transmission of disease. 3. Not all bathrooms are clean. 4. Children do not like to have dirty hands.

Rationale 2: The fecal-oral and respiratory routes are the most common sources of transmission in children.

The nurse is teaching a child care class for mothers of young children. The nurse tells the parent that the most common mode of transmission of infectious disease is: 1. Children who are playing with the same toy. 2. Children who are coughing. 3. Children who are sitting together eating meals. 4. Children who are playing board games.

Rationale 2: The fecal-oral and respiratory routes are the most common sources of transmission in children.

A three-year-old is admitted to the hospital unit with cellulitis of the neck. The nurse will expect medical treatment to include: 1. Topical antibiotics. 2. Intravenous antibiotics. 3. Incision and drainage. 4. Intravenous corticosteroids.

Rationale 2: This infection usually requires parenteral antibiotics.

Mandatory testing in the newborn nursery determines that the infant has hypothyroidism. When discussing the treatment with the new mother, the mother states that she doesn't believe in taking medications. The nurse would explain that failure to treat the infant with the appropriate medication will result in: 1. Heart disease. 2. Mental retardation. 3. Renal failure. 4. Thyroid storm.

Rationale 2: Untreated hypothyroidism will lead to mental retardation.

The school nurse is planning a smoking prevention program for middle school students. All of the following activities will be utilized. Which is likely to be the most effective in preventing middle school children from smoking? 1. A demonstration of the pathophysiology of the effects of smoking tobacco on the body given by the school's biology teacher 2. A talk on the importance of not smoking given by a local high school basketball star 3. Colorful posters with catchy slogans displayed throughout the school 4. A pledge campaign during which students sign contracts saying that they will not use tobacco products

Rationale 2: While all of the strategies are good, the most effective would be to have a local high school basketball star come to talk to the students about the importance of not smoking because students at this age are more likely to listen to and attempt to emulate someone of their own peer group.

The nurse is planning care for a child with acquired immune deficiency syndrome (AIDS). Which vaccines should be avoided in the child with AIDS? 1. Inactivated polio vaccine (a killed virus vaccine) 2. Tetanus toxoid vaccination 3. Varicella vaccine (an attenuated virus vaccine) 4. Acellular pertussis vaccine

Rationale 3: A child with an immune disorder should not be immunized with a live varicella vaccine because of the risk of contracting the disease.

A child with autism is being admitted to the hospital with dehydration. Upon admission, the nurse should: 1. Encourage the parents to avoid bringing favorite toys from home that might be lost. 2. Take the child on a tour of the pediatric unit. 3. Assign the child to his single-bed hospital room. 4. Take the child to the playroom for arts and crafts.

Rationale 3: A single room is the best place for an autistic child if the child must be hospitalized.

A 12-year-old has been selected to be a cheerleader for her middle school. This child has been recently diagnosed with type 1 diabetes. In teaching this child's mother about care for her child, the nurse wants the mother to understand that with increased physical activity, the child will need: 1. Decreased food intake. 2. Increased doses of insulin. 3. Increased food intake. 4. Decreased doses of insulin.

Rationale 3: An increase in physical activity requires an increase in caloric intake to prevent hypoglycemia.

The nurse is assessing a child with Down syndrome. The child is at greater risk of developing which illness than children who do not have Down syndrome? 1. Rheumatic heart disease 2. Glomerulonephritis 3. Leukemia 4. Hepatitis

Rationale 3: Children with Down syndrome have a significantly higher than average risk of developing leukemia.

A nine-year-old has been diagnosed with a learning disorder that is characterized by problems with manual dexterity and coordination. The nurse teaches parents that this disorder is called: 1. Dysgraphia. 2. Dyscalculia. 3. Dyspraxia. 4. Dyslexia.

Rationale 3: Children with dyspraxia have problems with manual dexterity and coordination.

An adolescent female with untreated Graves' disease is admitted to the hospital. The nurse expects to find which signs and symptoms in this client? 1. Hyperglycemia, ketonuria, and glucosuria 2. Weight gain, hirsutism, and muscle weakness 3. Tachycardia, fatigue, and heat intolerance 4. Dehydration, metabolic acidosis, and hypertension

Rationale 3: Clinical manifestations of Graves' disease are tachycardia, fatigue, and heat intolerance, seen with hyperthyroidism.

A teenager has arrived in the emergency department (ED) with confusion. The physician suspects diabetic ketoacidosis (DKA). A stat serum glucose is done, and the result is 76l5 mg/dL. The nurse expects that this teen has which symptoms? 1. Tachycardia, dehydration, and abdominal pain 2. Sweating, photophobia, and tremors 3. Dry mucous membranes, blurred vision, and weakness 4. Dry skin, shallow rapid breathing, and dehydration

Rationale 3: Dry mucous membranes, blurred vision, and weakness are seen with hyperglycemia.

Nursing care of the child with a snake bite involves assessment of the child for initial and progressive signs of envenomation. Which is the priority nursing action at this time? 1. Measure the circumference of the extremity containing the bite every 20 to 30 minutes. 2. Assess immunization status. 3. Assess the need for emergency breathing interventions. 4. Assess neurovascular status and vital signs. 5. Assess pain and the child's response to pain medication.

Rationale 3: Emergency intervention for airway, breathing, and circulation take priority and has a high probability of occurrence.

The hospital admitting nurse is taking a history on a child's illness from the parents. The nurse concludes that the parents treated their six-year-old child appropriately for a fever related to otitis media when they report that they: 1. Put the child in a tub of cold water to reduce the fever. 2. Alternated acetaminophen with ibuprofen every two hours. 3. Offered generous amounts of fluids frequently. 4. Used aspirin every four hours to reduce the fever.

Rationale 3: The body's need for fluids increases during a febrile illness.

A concerned parent calls the school nurse because of changes in his 15-year-old's behavior. Which behaviors would the nurse identify as most likely to be abnormal and indicate possible substance abuse in an adolescent? 1. Becoming very involved with friends and in activities related to the basketball team that she is on, never seeming to be home, and, when she is home, preferring to be in her room with the door shut 2. Becoming moody, crying, and weeping one minute and then cheerful and excited the next 3. Receiving numerous detentions lately from teachers for sleeping in class 4. Buying baggy, oversized clothing at thrift shops and dyeing her hair black

Rationale 3: Even though most teens do prefer staying up late, they are not usually so tired that they fall asleep during the day, especially while engaged in classroom activities. This behavior is abnormal and could indicate involvement with substance abuse or an underlying pathology.

A mother brings her four-month-old infant in for a routine checkup and vaccinations. The mother reports that the four-month-old was exposed to a brother who has the flu. In this case, the nurse will: 1. Withhold the DTaP vaccination but give the others as scheduled. 2. Give the infant the flu vaccination but withhold the others. 3. Give the vaccinations as scheduled. 4. Withhold the vaccinations.

Rationale 3: Giving the vaccine as scheduled will keep the infant properly immunized.

The nurse is giving discharge instructions to the parents of a child whose adrenal glands have been removed due to a tumor. The nurse knows that the mother needs more instructions when the mother states: 1. "I will call the doctor if my child has restlessness and confusion." 2. "If my child has any gastric irritation, I will give him antacids." 3. "If my child has vomiting and diarrhea, I will hold his hydrocortisone." 4. "I will give my child his hydrocortisone in the morning."

Rationale 3: If the child is ill and can't take hydrocortisone by mouth, the child would need to have an injection. Failure to give hydrocortisone could lead to severe illness and cardiovascular collapse. The mother needs additional instruction.

A teenage girl has recently been diagnosed with systemic lupus erythematosus (SLE). In teaching the girl about her disease, the nurse explains that the teenager needs to avoid which typical teenage activity? 1. Receiving a manicure and a pedicure 2. Daily hair shampoos 3. Using a tanning bed 4. Attending late night parties and dances

Rationale 3: Individuals with SLE have photosensitivity, and tanning beds can lead to exacerbations as well as skin damage from sun burns.

Following an automobile accident, a teenager is left paraplegic. The child is being prepared for discharge. The nurse is reviewing instructions to avoid decubitus ulcers on the buttocks and instructs the teenager to: 1. Contract the buttock muscles five times every two hours. 2. Increase fat in the diet to provide a protective coating over the boney prominences. 3. Do wheelchair push-ups every 15 to 30 minutes. 4. Avoid use of sheepskin as it prevents air from reaching the area.

Rationale 3: Lifting the buttocks with the arms can help with blood flow to the buttocks and reduce the risk of breakdown.

The parent of a child newly diagnosed with cancer verbalizes regret to the nurse for not seeking earlier medical attention for the child's symptoms. Which response would be most therapeutic? 1. "You may feel guilty, but you should not blame yourself." 2. "Most cancers can be treated easily." 3. "Many types of cancer are difficult to diagnose and might not show early symptoms." 4. "Early diagnosis is not significant in the diagnosis and management of cancer."

Rationale 3: Many cancers do not present significant findings until late and can progress rapidly. Giving such information is a communication tool.

The nurse works in a pediatric unit. In working with a parent who is suspected of Munchausen syndrome by proxy, it is very important for the nurse to: 1. Try to keep the parent separated from the child as much as possible. 2. Explain to the child that the parent is causing the illness and that the health care team will prevent the child from being harmed 3. Carefully document parent-child interactions. 4. Confront the parent with concerns of possible abuse.

Rationale 3: Munchausen syndrome by proxy is very difficult to prove, and evidence provided by the careful documentation of the nursing staff can be very influential. Care must be taken not to make the parent suspicious and to keep the child in the hospital until enough evidence is collected.

The nurse is caring for a child just admitted with diabetic ketoacidosis (DKA). Which of the physician's orders should the nurse question? 1. Neurological checks hourly 2. Insert urinary catheter and measure output hourly. 3. NPH insulin IV at 0.1 units/kg per hour 4. Stat serum electrolytes

Rationale 3: NPH insulin is never administered IV. A short-acting insulin needs to be ordered.

An adolescent has systemic lupus erythematosus (SLE). Which action by the teen indicates acceptance of the body changes that occur because of SLE? 1. Attends school but doesn't stay for after-school activities 2. Discusses the body changes with health care personnel only 3. Discusses the body changes with her best friend 4. Only attends small parties at friends' homes

Rationale 3: Peer interaction is important to the teen. Being able to discuss the changes to her body with a peer indicates acceptance of the change in body image.

The mother of a six-year-old brings her son to the physician because his teacher thinks he might have attention deficit/hyperactivity disorder (ADHD). The nurse is interviewing the mother about the child's history. The nurse knows that which factors could be associated with ADHD? 1. Measles, mumps, and rubella vaccine 2. Advanced parental age 3. Prenatal exposure to smoke 4. Immune response

Rationale 3: Research shows that a mother's use of cigarettes during pregnancy can increase the risk for ADHD.

A mother brings her 22-month-old child to the well-child clinic for an evaluation. The mother states that this child does not seem to be developing like her sister's child of the same age. The nurse will perform which screening test that may provide information about the child's development? 1. MRI of the head 2. An EEG 3. A Denver II 4. Chromosomal study

Rationale 3: The Denver Developmental Screening Test II is a tool used by the nurse that evaluates language and development.

The nurse is preparing to administer a vaccine to a 14-month-old infant. Which finding would require that the nurse delay the vaccination until the next well-child visit? 1. The child is allergic to a substance in the vaccine. 2. The child has a low-grade fever and a runny nose. 3. The child received a dose of immune globulin two months ago. 4. The child is on antibiotics.

Rationale 3: The antibodies in the immune globulin will prevent the child from developing immunity to the vaccination. By the next well-child visit, the immune globulins will not prevent immunity from developing.

A mother brings her 11-year-old son to the pediatric clinic for investigation of stomach complaints. The mother says that for the last two months, the child has complained of abdominal pain three to four mornings per week. The mother states the child usually complains on school days and always seems to be better by afternoon. The child was able to attend a weekend Boy Scout camp without difficulty but has missed several days of school due to complaints. The nurse would suspect which mental health disorder? 1. Separation anxiety 2. Depression 3. School phobia 4. Bipolar disorder

Rationale 3: The child is using somatic complaints to avoid attending school.

The nurse knows that the mother of a six-year-old needs more teaching about her son's diagnosis of ADHD when she states: 1. "I will develop a reward system for desired behaviors." 2. "I will take my child to the physician every three months for a weight and height check." 3. "I will let him do his homework while he is watching his favorite television show." 4. "I will stick to the same routine each day after school."

Rationale 3: This child should do homework in a quiet environment, away from distractions.

After her child receives a vaccination, the mother calls the clinic to report the child's reaction to the immunization. The nurse will recommend the mother call 911 when the mother reports: 1. A few hives are noted around the injection site. 2. The child is running a slight temperature. 3. The child has swelling of the face. 4. Fever and joint pains occurring within hours of the vaccination.

Rationale 3: This could be the onset of anaphylaxis, and immediate response is essential to the survival of the child. The mother should call 911.

The ten-year-old child was diagnosed with a medulloblastoma; following surgery the child is started on chemotherapy by intrathecal injection. While preparing the family for the start of chemotherapy, the nurse will explain that intrathecal administration was chosen because: 1. It reduces side effects. 2. It does not require the child being "stuck." 3. Many chemotherapy drugs do not cross the blood-brain barrier. 4. Intrathecal administration is less expensive than intravenous administration.

Rationale 3: This is the correct rationale for the selection of intrathecal administration of chemotherapy.

The child is receiving chemotherapy for acute lymphocytic leukemia. The nurse recognizes that a potential oncological emergency for this child would be tumor lysis syndrome. For which symptoms should the nurse monitor this child? 1. Respiratory distress and cyanosis 2. Thrombocytopenia and leukocytosis 3. Oliguria and altered levels of consciousness 4. Upper-extremity edema and neck vein distension

Rationale 3: Tumor lysis causes a metabolic emergency. Because of electrolyte imbalance, the signs can be oliguria and altered levels of consciousness. Thrombocytopenia and leukocytosis occur with a hematological emergency.

A child who has not had a tetanus immunization steps on a rusty nail. The child needs immediate protection from tetanus. Which of the following should be given to the child at this time? 1. Toxoid 2. Antigen 3. Killed virus 4. Passive immunity

Rationale 4: A child who has never had a tetanus immunization needs immediate protection (passive immunity) from tetanus. Passive immunity is made up of antibodies against the organism and provides immediate protection.

The nurse is caring for a hospitalized three-year-old admitted with a history of syndrome of inappropriate antidiuretic hormone (SIADH). He has just received his breakfast tray. Which food should the nurse remove from his tray? 1. Oatmeal 2. Yogurt 3. Biscuit 4. Cantaloupe

Rationale 4: A child with SIADH is on a fluid restriction. Cantaloupe contains significant fluid volume, so it would not be a good food for this child to consume.

A child has been diagnosed with Ewing sarcoma and is being started on a chemotherapy protocol. The mother questions the nurse on why more than one drug is being used as it would seem that using fewer drugs would decrease the side effects. The best response by the nurse would include the information that: 1. The child's cancer is a severe form and needs additional drugs to remove the cancer. 2. A protocol is a proven means of treatment. 3. A protocol is used in children but not adults due to the chemotherapy's effect on growth. 4. A protocol involves a group of drugs that work in different modes and have different side effects.

Rationale 4: A combination of chemotherapy will be more effective with a lessening of the side effects.

A child has recently been diagnosed with leukemia. The child's sibling is expressing feelings of anger and guilt. This reaction by the sibling is: 1. Abnormal; the sibling should be referred to a psychologist. 2. Unexpected; the cancer is easily treated. 3. Unusual; the illness doesn't affect the sibling. 4. Normal; the sibling is affected, too, and anger and guilt are expected feelings.

Rationale 4: A diagnosis of cancer affects the whole family, and initial feelings experienced by the sibling might be anger and guilt.

The school nurse wants to protect the students from Reye disease. To this end, the nurse creates a pamphlet that advises the parents to avoid giving which medication to a sick child? 1. Antibiotics 2. Acetaminophen 3. Ibuprofen 4. Aspirin

Rationale 4: Administering aspirin to a child with a viral illness has been found to be associated with Reye Syndrome.

The nurse is monitoring the urine specific gravity and pH on a child receiving chemotherapy. The nurse will try to maintain the urine values at what levels? 1. Specific gravity 1.030 and pH 7.5 2. Specific gravity 1.005 and pH 6 3. Specific gravity 1.030 and pH 6 4. Specific gravity 1.005 and pH 7.5

Rationale 4: Because the breakdown of malignant cells releases intracellular components into the blood and electrolyte imbalance causes metabolic acidosis, the patient should remain well hydrated, with the urine specific gravity at less than 1.010 and the pH at 7 to 7

The nurse is explaining to the mother that her child with cancer will receive chemotherapy daily for one month and then no treatments for six weeks. Following the period of rest, chemotherapy will be administered again for another month. The mother asks why the child can't receive the medication for two months straight. The nurse would explain that the rest period: 1. Prevents the child from having side effects from the drugs. 2. Is due to the scheduling requirements of the infusion center. 3. Is necessary because receiving the medication for more than one month can cause heart failure. 4. Allows normal cells to repair themselves while the cancer cells die.

Rationale 4: Cancer cells have lost the ability to repair themselves, so medications allow the normal cells to repair while the cancer cells die.

A three-year-old child was born with congenital adrenal insufficiency and is being treated with oral hydrocortisone. When the child develops pneumonia and is admitted to the hospital, the nurse would expect the dose of hydrocortisone to be: 1. Stopped. 2. Reduced by 50%. 3. Continued as previously prescribed. 4. Increased.

Rationale 4: During periods of stress including illness and surgery, the dose of steroids needs to be increased.

The school nurse is conducting pediculosis capitis (head lice) checks. Which finding would indicate a "positive" head check? 1. White, flaky particles throughout the entire scalp region 2. Lesions on the scalp that extend to the hairline or neck 3. Maculopapular lesions behind the ears 4. Silver/white sacs attached to the hair shafts in the occipital area

Rationale 4: Evidence of pediculosis capitis includes silver/white sacs (nits) that are attached to the hair shafts, frequently in the occiput area.

A mother refuses to have her child immunized with the measles, mumps, and rubella (MMR) vaccine because she believes that letting her infant get these diseases will help him fight off other diseases later in life. The nurse's most appropriate response to this mother is to: 1. Tell the mother that by not immunizing her child she may be exposing pregnant women to the virus, which could cause fetal harm. 2. Honor her request because she is the parent. 3. Tell the mother that she is wrong and should have her child immunized. 4. Explain the potential complications of measles, mumps, and rubella infections.

Rationale 4: Explaining that if her child contracts measles, mumps, or rubella, he could have very serious and permanent complications from these diseases is correct; measles, mumps, and rubella all have potentially serious sequelae, such as encephalitis, brain damage, and deafness.

A parent reports that her five-year-old child, who has had all recommended immunizations, had a mild fever one week ago and now has bright red cheeks and a lacy red maculopapular rash on the trunk and arms. The nurse recognizes that this child might have: 1. Rubeola (measles). 2. German measles (rubella). 3. Chickenpox (varicella). 4. Fifth disease (erythema infectiosum).

Rationale 4: Fifth disease manifests first with a flu-like illness, followed by a red "slapped-cheek" sign. Then a lacy maculopapular erythematous rash spreads symmetrically from the trunk to the extremities, sparing the soles and palms.

A child has cancer and has been treated with chemotherapy. The most recent lab value indicates that the white blood cell count is very low. Based on this result, which would the nurse expect to administer? 1. Epoetin alfa (Epogen) 2. Ondansetron (Zofran) 3. Oprelvekin (Neumega) 4. Filgrastim (Neupogen)

Rationale 4: Filgrastim (Neupogen) increases production of neutrophils by the bone marrow.

A child weighing 18.2 kg with a history of diabetes insipidus has been admitted to the hospital. Which of the physician's orders would the nurse question? 1. Stat electrolytes 2. Urine specific gravity with each void 3. DDAVP (desmopressin) PO 4. Restrict oral fluids to 500 mL every 24 hours.

Rationale 4: Fluid replacement, not fluid restriction, is necessary for child with DI.

A child with leukemia has a granulocyte count of 250/mm3 and a platelet count 150,000/mm3. Nursing intervention would include which of the following? 1. Fluid restriction 2. Avoidance of mouth care 3. Strict isolation 4. Good hand washing

Rationale 4: Hand washing is vital for preventing the spread of infection.

The nurse is discussing the immune protection of the newborn with a pregnant woman. The nurse tells the mother that her body will provide her baby with what type of antibodies? 1. IgM 2. IgA 3. IgD 4. IgG

Rationale 4: IgG crosses the placenta and provides the newborn with passive immunity.

The toddler pulled a pot of boiling water off the stove and suffered partial and full thickness burns to the chest. EMS arrived, stabilized the child, and transported him to the hospital burn unit. The child is now in the recovery-management phase of burn treatment. Which is the most common complication seen in this period? 1. Asphyxia 2. Metabolic acidosis 3. Shock 4. Burn-wound infection

Rationale 4: Infection of the burned area is a frequent complication in the recovery-management phase. A goal of burn-wound care is protection from infection.

The nurse is caring for a child with rheumatoid arthritis. Which is an appropriate nonpharmacologic measure to reduce the joint pain associated this disease? 1. Elevation of the extremity 2. Immobilization 3. Massage 4. Application of moist heat

Rationale 4: Moist heat can promote relief of pain and decrease joint stiffness.

The nurse is planning care for a three-month-old infant with eczema. Which intervention would take top priority in this infant's care? 1. Applying antibiotics to lesions 2. Keeping the baby content 3. Maintaining adequate nutrition 4. Preventing infection of lesions

Rationale 4: Nursing care should focus on preventing infection of lesions. Due to impaired skin barrier function and cutaneous immunity, an infant with eczema is at greater risk for the development of skin infections by organisms.

The nurse works in an oncology clinic. A preschool-age child is being seen in the clinic, and the nurse anticipates a diagnosis of cancer. The nurse prepares for which of the common reactions preschool-age children have following illnesses and hospitalizations? 1. Unawareness of the illness and its severity 2. Acceptance, especially if able to discuss the disease with children their own age 3. Understanding of what cancer is and how it is treated 4. Thoughts that they caused their illness and are being punished

Rationale 4: Preschool-age children are egocentric and have magical thinking, and thus they might believe they caused their own illness.

While the nurse is taking the history of a 10-year-old child, the parents admit to owning firearms. An appropriate safety measure for the nurse to suggest would be which of the following? 1. Keeping all the guns put away and out of the child's reach 2. Taking the child to a shooting range for lessons on how to use a gun properly 3. Storing the guns and ammunition in the same place 4. Using a gun lock on all firearms in the house

Rationale 4: Statistics show that about 75% of unintentional deaths and suicides are committed with firearms found in the home. The safety measures of using a gun lock, keeping the gun and ammunition separate, and putting the guns in a locked cabinet will at least makes the guns less accessible.

The nurse is providing care to homeless teens at an outreach clinic. Which of the following is most important for the nurse to understand? 1. Teens who are homeless will get a job and somewhere to live. 2. Teens who are homeless will seek help when needed. 3. Teens who are homeless will not be fearful of authority figures. 4. Teens who are homeless are most likely to have unprotected sex.

Rationale 4: Teens who are homeless are more likely to engage in risky behaviors, such as unprotected sex with multiple partners and substance abuse. They are more likely to need emergency care, to be depressed, and to become pregnant than are other teens.

A child has been diagnosed with a Wilms' tumor and is being treated with chemotherapy. Prior to administering the chemotherapy, what will the nurse monitor to determine if the child has any capability of fighting infection? 1. Hemoglobin 2. Red blood cell count 3. Platelets 4. Absolute neutrophil count (ANC)

Rationale 4: The absolute neutrophil count uses both the segmented (mature) and bands (immature) neutrophils as a measure of the body's infection-fighting capability.

A three-year-old child is lying in a fetal position. The child has pale skin, glassy eyes, and a flat affect. The child is irritable and refuses food and fluids. The child's vital signs are temperature 40.1°C (104.2°F), pulse 120/minute, respirations 28/minute. The best, most comprehensive description of this child's condition is: 1. Tired. 2. Feverish. 3. Flushed. 4. Toxic.

Rationale 4: The child with a toxic appearance is described as one with a high temperature, lethargy, irritability, poor skin perfusion, hypoventilation or hyperventilation, and cyanosis.

The clinic nurse is checking the potency of the vaccine. Which finding may have rendered the vaccine ineffective? 1. The vaccine was frozen as labeled. 2. The vaccines have been stored in a refrigerator where the temperature has been maintained between 35° to 46° F. 3. The vaccine's expiration date expires within the next month. 4. The vaccine is stored in the door of the refrigerator.

Rationale 4: The door will not maintain the temperature of the vaccine. Vaccines should be stored in the middle of the refrigerator.

During the hospital stay in the newborn nursery, the infant is tested for galactosemia. When the test is positive, the parents are educated about treatment for galactosemia. The infant will be placed on what type of infant feeding? 1. Goat's milk formula 2. Breast milk 3. Cow's milk-based formula 4. Meat-based formula such as Nutramigen

Rationale 4: The meat-based formula does not contain galactose and is appropriate for the infant's diet.

The child is admitted to the hospital unit for injuries. The mother's boyfriend is suspected of child abuse. The nurse's primary role, in addition to reporting to the proper authorities, is: 1. Gathering information about how the injuries occurred. 2. Collecting evidence against the suspected abuser. 3. Encouraging the child to talk about his experience. 4. Protecting the child from further injury.

Rationale 4: The nurse will monitor the child while in the presence of visitors. In addition, the nurse will talk with the social worker to assist in providing for the child's safety in the future. This is a priority.

Following diagnosis of osteosarcoma, a 14-year-old girl has a below-the-knee amputation. The girl has had trouble accepting the reality of her amputation. Which behavior, when observed by the nurse, indicates she is beginning to accept the amputation? 1. The girl complains of pain in the missing leg. 2. When physical therapy comes, she is willing to have her temporary prosthetic applied and attempts crutch training. 3. Prior to visiting hours, she asks to be helped to a wheelchair with a blanket over her legs. 4. When the nurses change the dressing on the stump, she watches the dressing change.

Rationale 4: This indicates the girl is willing to look at the stump, which is a step toward acceptance.

The school nurse notices a sixth-grade girl with bald patches in her hair. The hair itself is clean and shiny. Prior to referring the girl to her healthcare provider for alopecia, the nurse would want to watch the child for signs of: 1. Lice. 2. Dietary imbalances. 3. Schizophrenia. 4. Trichotillomania.

Rationale 4: Trichotillomania is the term for a condition where children pull out their hair during periods of stress.

A seven-year-old child has been seen in the pediatric clinic three times in the last two months for complaints of abdominal pain. On each occasion, the physical exam and all ordered lab work have been normal. The most important information to assess at this time would be: 1. The child's normal eating habits. 2. Recent viral illnesses or other infectious symptoms. 3. Review of the child's immunization history. 4. Changes in school or home life.

Rationale 4: With a normal exam and lab work, there is a high probability that this child's abdominal pain is stress-related, and it is most important to identify the possible stressors in this child's life to aid in diagnosis and treatment. Asking about changes in home or school life is most likely to get to information about recent stresses in the child's life.

The nurse is planning to discharge a child newly diagnosed with HIV infection. Which discharge instruction should be included for this child and her family? 1. Eat raw fruits. 2. Avoid playing sports. 3. Restrict school attendance. 4. Cover open wounds.

Rationale 4: Wounds should be covered, and gloves should be worn when treating a child's cuts and scrapes.

During a well-child exam, the parents of a four-year-old child inform the nurse that they are thinking of buying a television for their child's bedroom and ask for advice as to whether this is appropriate. The best response from the nurse would be: 1. "It is okay for children to have a television in their room as long as you limit the amount of time they watch it to less than two hours per day." 2. "Research has shown that watching educational television shows improves a child's performance in school." 3. "Don't buy a television for your child's room; he is much too young for that." 4. "Research has shown that children with a television in their bedroom spend significantly less time playing outside than other children."

Rationale 4: Young children need to be physically active at this age. Research has shown that children with a television in their bedroom spend significantly less time playing outside than do other children, and physical inactivity in children has been linked to many chronic diseases, such as obesity and type 2 diabetes. Telling parents this is the best response because it gives the parents an evidence-based rationale for not placing a television in the child's room.