Peds Comp Final Mckinney Chapters

19. Which statement best describes a subdural hematoma? a. Bleeding occurs between the dura and the skull. b. Bleeding occurs between the dura and the cerebrum. c. Bleeding is generally arterial, and brain compression occurs rapidly. d. The hematoma commonly occurs in the parietotemporal region.

B A subdural hematoma is bleeding that occurs between the dura and the cerebrum as a result of a rupture of cortical veins that bridge the subdural space. An epidural hemorrhage occurs between the dura and the skull, is usually arterial with rapid brain concussion, and occurs most often in the parietotemporal region. An epidural hemorrhage occurs between the dura and the skull, is usually arterial with rapid brain concussion, and occurs most often in the parietotemporal region. An epidural hemorrhage occurs between the dura and the skull, is usually arterial with rapid brain concussion, and occurs most often in the parietotemporal region.

33. What should be the nurse's first action when a child with a head injury complains of double vision and a headache, and then vomits? a. Immobilize the child's neck. b. Report this information to the physician. c. Darken the room and put a cool cloth on the child's forehead. d. Restrict the child's oral fluid intake.

B Any indication of ICP such as double vision, headache, or vomiting should be promptly reported to the physician. Stabilizing the child's neck does not address the child's symptoms. Darkening the room and giving a cool cloth are comfort measures. A fluid restriction is not needed.

35. The nurse is preparing a school-age child for computed tomography (CT scan) to assess cerebral function. Which statement should the nurse include when preparing the child? a. "Pain medication will be given." b. "The scan will not hurt." c. "You will be able to move once the equipment is in place." d. "Unfortunately no one can remain in the room with you during the test."

B For CT scans, the child must be immobilized. It is important to emphasize to the child that at no time is the procedure painful. Pain medication is not required; however, sedation is sometimes necessary. The child will not be allowed to move and will be immobilized. Someone is able to remain with the child during the procedure.

24. After a tonic-clonic seizure, it would not be unusual for a child to display a. irritability and hunger. b. lethargy and confusion. c. nausea and vomiting. d. nervousness and excitability.

B In the period after a tonic-clonic seizure, the child may be confused and lethargic. Some children may sleep for a period of time. The other manifestations are not normally seen after a seizure.

8. How much folic acid does the nurse tell female patients is recommended for women of childbearing age? a. 1.0 mg b. 0.4 mg c. 1.5 mg d. 2.0 mg

B It has been estimated that a daily intake of 0.4 mg of folic acid in women of childbearing age has contributed to a reduction in the number of children with neural tube defects. The other doses are not the recommended dose.

17. A child with a head injury sleeps unless aroused, and when aroused responds briefly before falling back to sleep. What should the nurse chart for this child's level of consciousness? a. Disoriented b. Obtunded c. Lethargic d. Stuporous

B Obtunded describes an individual who sleeps unless aroused and once aroused has limited interaction with the environment. Disoriented refers to lack of ability to recognize place or person. An individual is lethargic when he or she awakens easily but exhibits limited responsiveness. Stupor refers to requiring considerable stimulation to arouse the individual.

23. What is the most appropriate nursing action when a child is in the tonic phase of a generalized tonic-clonic seizure? a. Guide the child to the floor if standing and go for help. b. Turn the child's body on the side. c. Place a padded tongue blade between the teeth. d. Quickly slip soft restraints on the child's wrists.

B Positioning the child on his side will prevent aspiration. It is inappropriate to leave the child during the seizure. Nothing should be inserted into the child's mouth during a seizure to prevent injury to the mouth, gums, or teeth. Restraints could cause injury. Sharp objects and furniture should be moved out of the way to prevent injury.

11. What 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

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, slow writhing movements, and loss of kinesthetic sense are not manifestations of spastic cerebral palsy.

31. What is the priority nursing intervention for the child with ascending paralysis as a result of Guillain-Barré syndrome (GBS)? a. Immunosuppressive medications b. Respiratory assessment c. Passive range-of-motion exercises d. Anticoagulant therapy

B Special attention to respiratory status is needed because most deaths from GBS are attributed to respiratory failure. Respiratory support is necessary if the respiratory system becomes compromised and muscles weaken and become flaccid. Children with rapidly progressing paralysis are treated with intravenous immunoglobulins for several days. Administering this infusion is not the nursing priority. The child with GBS is at risk for complications of immobility. Performing passive range-of-motion exercises is an appropriate nursing intervention but not the priority intervention. Anticoagulant therapy may be initiated because the risk of pulmonary embolus as a result of deep vein thrombosis is always a threat. This is not the priority nursing intervention.

3. Which term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation? a. Coma b. Stupor c. Obtundation d. Persistent vegetative state

B Stupor exists when the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Coma is the state in which no motor or verbal response occurs to noxious (painful) stimuli. Obtundation describes a level of consciousness in which the child is arousable with stimulation. Persistent vegetative state describes the permanent loss of function of the cerebral cortex.

2. A 62-pound child has a spinal cord injury and has completed the bolus dose of IV steroids. The nurse is preparing to hang an IV infusion of steroids for the next 23 hours. How much medication should this child get per hour? Record your answer using 1 decimal place. Administer _______ mg/hour.

152.2 First calculate the child's weight in kilograms: 62/2.2 = 28.181818 kilograms. Next multiply the weight by the standard dose of 5.4 mg/kg/hour × 28.181818 = 152.181818. Last, round to 1 decimal place = 152.2 mg/hour.

1. A 62-pound child has a spinal cord injury and is to receive steroid therapy. How much medication does the nurse draw up for the bolus dose? Record your answer in a whole number. Administer _____ mg.

845 First calculate the child's weight in kilograms: 62/2.2 = 28.181818 kilograms. Next multiply the child's weight by the standard bolus dose: 28.181818 × 30 = 845.454545 mg. Round to the nearest whole number = 845 mg.

25. What should the nurse teach parents when the child is taking phenytoin (Dilantin) to control seizures? a. The child should use a soft toothbrush and floss the teeth after every meal. b. The child will require monitoring of renal function while taking this medication. c. Dilantin should be taken with food because it causes gastrointestinal distress. d. The medication can be stopped when the child has been seizure free for 1 month.

A A side effect of Dilantin is gingival hyperplasia. Good oral hygiene will minimize this adverse effect. The child should have liver function studies because this anticonvulsant may cause hepatic dysfunction, not renal dysfunction. Dilantin has not been found to cause gastrointestinal upset. The medication can be taken without food. Anticonvulsants should never be stopped suddenly or without consulting the physician. Such action could result in seizure activity.

14. A mother reports that her child has episodes where he appears to be staring into space. This behavior is characteristic of which type of seizure? a. Absence b. Atonic c. Tonic-clonic d. Simple partial

A Absence seizures are very brief episodes of altered awareness. The child has a blank expression. Atonic seizures cause an abrupt loss of postural tone, loss of consciousness, confusion, lethargy, and sleep. Tonic-clonic seizures involve sustained generalized muscle contractions followed by alternating contraction and relaxation of major muscle groups. There is no change in level of consciousness with simple partial seizures. Simple partial seizures consist of motor, autonomic, or sensory symptoms.

1. What is a sign of increased intracranial pressure (ICP) in a 10-year-old child? a. Headache b. Bulging fontanel c. Tachypnea d. Increase in head circumference

A Headaches are a clinical manifestation of increased ICP in children. A change in the child's normal behavior pattern may be an important early sign of increased ICP. Bulging fontanel or increased head circumference is seen in infants. A change in respiratory pattern is a late sign of increased ICP. Cheyne-Stokes respiration may be evident. This refers to a pattern of increasing rate and depth of respirations followed by a decreasing rate and depth with a pause of variable length.

12. Which finding in an analysis of cerebrospinal fluid (CSF) is consistent with a diagnosis of bacterial meningitis? a. CSF appears cloudy. b. CSF pressure is decreased. c. Few leukocytes are present. d. Glucose level is increased compared with blood.

A In acute bacterial meningitis, the CSF is cloudy to milky or yellowish in color. The CSF pressure is usually increased in acute bacterial meningitis. Many polymorphonuclear cells are present in CSF with acute bacterial meningitis. The CSF glucose level is usually decreased compared with the serum glucose level.

6. The most common problem of children born with a myelomeningocele is a. bladder incontinence. b. intellectual impairment. c. respiratory compromise. d. cranioschisis.

A Myelomeningocele is one of the most common causes of neuropathic (neurogenic) bladder dysfunction among children, leading to incontinence. 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.

28. The nurse should expect a child who has frequent tension-type headaches to describe headache pain as which of the following? a. "There is a rubber-band squeezing my head." b. "It's a throbbing pain over my left eye." c. "My headaches are worse in the morning and get better later in the day." d. "I have a stomachache and a headache at the same time."

A The child who has tension-type headaches may describe the pain as a bandlike tightness or pressure, tight neck muscles, or soreness in the scalp. A common symptom of migraines is throbbing headache pain, typically on one side of the eye. A headache that is worse in the morning and improves throughout the course of the day is typical of ICP. Abdominal pain may accompany headache pain in migraines.

10. When a 2-week-old infant is seen for irritability, poor appetite, and rapid head growth with observable distended scalp veins, the nurse recognizes these signs as indicative of which disorder? a. Hydrocephalus b. Syndrome of inappropriate antidiuretic hormone (SIADH) c. Cerebral palsy d. Reye's syndrome

A The combination of signs is strongly suggestive of hydrocephalus. SIADH would not manifest in this way. The child would have decreased urination, hypertension, weight gain, fluid retention, hyponatremia, and increased urine specific gravity. The manifestations of cerebral palsy vary but may include persistence of primitive reflexes, delayed gross motor development, and lack of progression through developmental milestones. Reye's syndrome is associated with an antecedent viral infection with symptoms of malaise, nausea, and vomiting. Progressive neurologic deterioration occurs.

2. Which information should the nurse give to a child who is to have magnetic resonance imaging (MRI) of the brain? a. "You won't be able to move your head during the procedure." b. "You will have to drink a special fluid before the test." c. "You will have to lie flat after the test is finished." d. "You will have electrodes placed on your head with glue."

A To reduce fear and enhance cooperation during the MRI, the child should be made aware that head movement will be restricted to obtain accurate information. The child does not need to drink special liquids, lie on the back afterward, or have electrodes placed.

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

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. Latex allergy is estimated to occur in 75% of this patient population. There are no non-allergenic latex products. At this time, desensitization is not an option. There are no treatment options for long-term management of allergic symptoms for latex allergy.

3. A 14-year-old is in the intensive care unit after a spinal cord injury 2 days ago. Nursing care for this child includes (Select all that apply.) a. monitoring and maintaining systemic blood pressure. b. administering corticosteroids. e. monitoring for respiratory complications.

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. Spinal cord injury is a catastrophic event. Discussion of long-term care should be delayed until the child is stable.

2. A nurse should expect which cerebral spinal fluid (CSF) laboratory results on a child diagnosed with bacterial meningitis? (Select all that apply.) a. Elevated white blood count (WBC) c. Decreased glucose d. Cloudy in color

A, C, D The CSF laboratory results for bacterial meningitis include elevated WBC counts, cloudy or milky in color, and decreased glucose. The protein is elevated and there should be no RBCs present. RBCs are present when the tap was traumatic.

1. A child weighs 30.8 pounds and is prescribed prednisolone syrup 0.5 mg/kg. The pharmacy delivers a syringe with 15 mg/5 mL. How many mL does the nurse administer? Round your answer to the nearest 10th.

ANS: 2.3333 mL or 2.3 mL First find the weight in kilograms: 30.8/2.2 = 14 kg Multiply 0.5 × 14 = 7 mg Set up equation: 15 mg 7 mg 5 mL = x mL Solve for x: 15x = (7 × 5) = 35 x = 35/15 = 2.333333 mL

In recent years the use of _____________ stem cell transplantation has become the accepted therapy for the treatment of several hematologic and oncologic disorders.

ANS: hematopoietic HSCT allows extremely high doses of chemotherapy, with or without radiation, to be given without regard for bone marrow recovery because hematopoiesis will be restored through transplantation. Stem cells are harvested from bone marrow, peripheral blood, and umbilical cord blood. HSCT is often used interchangeably with bone marrow transplantation in the clinical setting.

A less common malignancy of muscle or striated tissue is known as ______________.

ANS: rhabdomyosarcoma This sarcoma occurs periorbitally or in the head and neck of younger children and in the trunk and extremities of older children. Long-term survival rates are variable based upon the age of the child.

1. A nurse is preparing to administer naproxen to a toddler weighing 29 pounds. The pharmacy delivers a bottle containing 125 mg/5 mL. Based on knowledge of the safe dose, how much liquid does the nurse prepare to administer? Display your answer using a whole number. ______ mL

ANS: 66 mL First find the child's weight in kilograms. 29 pounds = 13.1818 kilograms. Next, take the dose (10 mg/kg) and multiply by 13.1818 = 131.81. Now, divide in half as this dose is given in two divided doses daily = 65.905 mL. Finally round to the nearest whole number = 66 mL.

21. The nurse closely monitors the temperature of a child with nephrotic syndrome. The purpose of this is to detect an early sign of which possible complication? a. Infection b. Hypertension c. Encephalopathy d. Edema

ANS: A A An exacerbation of the disease can occur after an infection. B Temperature is not an indication of hypertension or edema. C Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms. D Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms.

14. What is the nurse's first action when planning to teach the parents of an infant with a 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 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 level of anxiety is often needed before new information can be processed. B A baseline assessment of prior knowledge should be taken into consideration before developing any teaching plan. C Locating a quiet place for meeting with parents is appropriate; however, an assessment should be done before any teaching is done. D Discussing a teaching plan with the nursing team is appropriate after an assessment of the parents' knowledge and readiness.

26. A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of a. Bronchitis b. Bronchiolitis c. Viral-induced asthma d. Acute spasmodic laryngitis

ANS: A A Bronchitis is characterized by these symptoms and occurs in children older than 6 years. B Bronchiolitis is rare in children older than 2 years. C Asthma is a chronic inflammation of the airways that may be exacerbated by a virus. D Acute spasmodic laryngitis occurs in children between 3 months and 3 years.

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

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

19. A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests a. Asthma b. Pneumonia c. Bronchiolitis d. Foreign body in trachea

ANS: A A Children with asthma usually have these chronic symptoms. B Pneumonia appears with an acute onset and fever and general malaise. C Bronchiolitis is an acute condition caused by RSV. D Foreign body in the trachea will occur with an acute respiratory distress or failure and maybe stridor.

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

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

40. An infant's parents ask the nurse about preventing OM. What should be recommended? a. Avoid tobacco smoke. b. Use nasal decongestant. c. Avoid children with OM. d. Bottle feed or breastfeed in supine position.

ANS: A A Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. B Nasal decongestants are not useful in preventing OM. C Children with uncomplicated OM are not contagious unless they show other upper respiratory infection (URI) symptoms. D Children should be fed in an upright position to prevent OM.

6. What 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 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. B An excessive weight gain for an infant is an increase of more than 50 g/day. C 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. D Lanoxin is used in the treatment of congestive heart failure to improve cardiac function. Diuretics will help the body get rid of excess fluid.

6. The nurse should assess a child who has had a tonsillectomy for a. Frequent swallowing b. Inspiratory stridor c. Rhonchi d. Elevated white blood cell count

ANS: A A Frequent swallowing is indicative of postoperative bleeding. B Inspiratory stridor is characteristic of croup. C Rhonchi are lower airway sounds indicating pneumonia. D Assessment of blood cell counts is part of a preoperative workup.

15. The mother of a child with hemophilia asks the nurse how long her child will need to be treated for hemophilia. What is the best response to this question? a. "Hemophilia is a lifelong blood disorder." b. "There is a 25% chance that your child will have spontaneous remission and treatment will no longer be necessary." c. "Treatment is indicated until after your child has progressed through the toddler years." d. "It is unlikely that your child will need to be treated for his hemophilia because your first child does not have the disease."

ANS: A A Hemophilia is a lifelong hereditary blood disorder with no cure. Prevention by avoiding activities that induce bleeding and by treatment is lifelong. The management of hemophilia is highly individual and depends on the severity of the illness. B This is an untrue statement. Hemophilia is a lifelong hereditary blood disorder with no cure. Treatment is lifelong. C This is an untrue statement. Hemophilia is a lifelong hereditary blood disorder with no cure. Treatment is lifelong. D Because hemophilia has an X chromosome-linked recessive inheritance, there is a risk with each pregnancy that a child will either have the disease or be a carrier. Hemophilia is a life-long hereditary blood disorder with no cure. Treatment is lifelong.

16. In teaching family members about their child's von Willebrand disease, what is the priority outcome for the child that the nurse should discuss? a. Prevention of injury b. Maintaining adequate hydration c. Compliance with chronic transfusion therapy d. Prevention of respiratory infections

ANS: A A Hemorrhage as a result of injury is the child's greatest threat to life. B Fluid volume status becomes a concern when hemorrhage has occurred. C The treatment of von Willebrand disease is desmopressin acetate (DDAVP), which is administered intranasally or intravenously. D Respiratory infections do not constitute a major threat to the child with von Willebrand disease.

13. 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 A Immobilization and elevation of the joint will prevent further injury until bleeding is resolved. B Although acetaminophen may help with pain associated with the treatment of hemarthrosis, it is not the priority nursing intervention. C 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. D Assessing the impact of hospitalization on the family system is relevant to all hospitalized children, but it is not the priority in this situation.

5. What is true about the genetic transmission of sickle cell disease? a. Both parents must carry the sickle cell trait. b. Both parents must have sickle cell disease. c. One parent must have the sickle cell trait. d. Sickle cell disease has no known pattern of inheritance.

ANS: A A In this scenario, there is a 50% risk of having a child with sickle cell disease. B The sickle cell trait, not the disease itself, must be present in the parents for the child to have the disease. C An autosomal recessive pattern of inheritance means that both parents must be carriers of the sickle cell trait. D Sickle cell disease is known to have an autosomal recessive pattern of inheritance.

11. What sign is indicative of respiratory distress in infants? a. Nasal flaring b. Respiratory rate of 55 breaths/min c. Irregular respiratory pattern d. Abdominal breathing

ANS: A A Infants have difficulty breathing through their mouths; therefore nasal flaring is usually accompanied by extra respiratory efforts. It also allows more air to enter as the nares flare. B A respiratory rate of 55 breaths/min is a normal assessment for an infant. Tachypnea is a respiratory rate of 60 to 80 breaths/min. C Irregular respirations are normal in the infant. D Abdominal breathing is common because the diaphragm is the neonate's major breathing muscle.

16. A nurse is teaching a class on acute renal failure. The nurse relates that acute renal failure as a result of hemolytic-uremic syndrome (HUS) is classified as a. Intrarenal b. Prerenal c. Postrenal d. Chronic

ANS: A A Intrarenal acute renal failure is the result of damage to kidney tissue. Possible causes of intrarenal acute renal failure are HUS, glomerulonephritis, and pyelonephritis. B Prerenal acute renal failure is the result of decreased perfusion to the kidney. Possible causes include dehydration, septic and hemorrhagic shock, and hypotension. C Postrenal acute renal failure results from obstruction of urine outflow. Conditions causing postrenal failure include ureteropelvic obstruction, ureterovesical obstruction, or neurogenic bladder. Renal failure caused by HUS is of the acute nature. D Chronic renal failure is an irreversible loss of kidney function, which occurs over months or years.

48. The earliest clinical manifestation of biliary atresia is a. Jaundice b. Vomiting c. Hepatomegaly d. Absence of stooling

ANS: A A Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera, may be present at birth, but is usually not apparent until age 2 to 3 weeks. B Vomiting is not associated with biliary atresia. C Hepatomegaly and abdominal distention are common but occur later. D Stools are large and lighter in color than expected because of the lack of bile.

18. What is an expected outcome for the child with irritable bowel disease? a. Decreasing symptoms b. Adherence to a low-fiber diet c. Increasing milk products in the diet d. Adapting the lifestyle to the lifelong problems

ANS: A A Management of irritable bowel disease is aimed at identifying and decreasing exposure to triggers and decreasing bowel spasms, which will decrease symptoms. Management includes maintenance of a healthy, well-balanced, moderate-fiber, lower fat diet. B A moderate amount of fiber in the diet is indicated for the child with irritable bowel disease. C No modification in dairy products is necessary unless the child is lactose intolerant. D Irritable bowel syndrome is typically self-limiting and resolves by age 20 years.

2. An assessment of a 7-month-old infant with a hemoglobin level of 6.5 mg/dL is likely to reveal an infant who is a. Lethargic, pale, and irritable b. Thin, energetic, and sleeps little c. Anorexic, vomiting, and has watery stools d. Flushed, fussy, and tired

ANS: A A Pallor, lethargy, irritability, and tachycardia are clinical manifestations of iron deficiency anemia. A child with a hemoglobin level of 6.5 mg/dL has anemia. B A child with a hemoglobin level of 6.5 mg/dL has anemia. Infants with iron deficiency anemia are not typically thin and energetic but do tend to sleep a lot. C A child with a hemoglobin level of 6.5 mg/dL has anemia. Gastrointestinal symptoms are not clinical manifestations associated with iron deficiency anemia. D A child with a hemoglobin level of 6.5 mg/dL has anemia. Although the infant with iron deficiency anemia may be tired and fussy, pallor, rather than a flushed appearance, is characteristic of a low hemoglobin level.

36. An infant with imperforate anus has an anal plasty and temporary colostomy. Which statement by the infant's mother indicates that she understands how to care for the infant's colostomy at home? a. "I will call the doctor right away if my baby starts vomiting." b. "I'll call my home health nurse if the colostomy bag needs to be changed." c. "I'll call the doctor if I notice that the colostomy stoma is pink." d. "I'll have my mother help me with the care of the colostomy."

ANS: A A Parents are taught signs of strangulation; vomiting, pain, and an irreducible mass in the abdomen. The physician should be contacted immediately if strangulation is suspected. B The mother should be taught the basics of colostomy care, including how to change the appliance. C The colostomy stoma should be pink in color, not pale or discolored. D There is no evidence that her mother knows how to care for a colostomy. This also does not indicate the mother has understanding of caring for the infant's colostomy.

9. 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 b. Infection c. Dehydration d. Anemia

ANS: A 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. B Infection is not a clinical consequence of cyanosis. C 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. D Anemia may develop as a result of increased blood viscosity. Anemia is not a clinical consequence of cyanosis.

9. What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux? a. The importance of taking prophylactic antibiotics b. Suggestions for how to maintain fluid restrictions c. The use of bubble baths as an incentive to increase bath time d. The need for the child to hold urine for 6 to 8 hours

ANS: A A Prophylactic antibiotics are used to prevent urinary infection in a child with vesicoureteral reflux, although this treatment plan has become controversial. B Fluids are not restricted when a child has vesicoureteral reflux. In fact, fluid intake should be increased as a measure to prevent UTIs. C Bubble baths should be avoided to prevent urethral irritation and possible UTI. D To prevent UTIs, the child should be taught to void frequently and never resist the urge to urinate.

13. Which dietary modification is appropriate for a child with chronic renal failure? a. Decreased protein b. Decreased fat c. Increased potassium d. Increased phosphorus

ANS: A A Protein intake is restricted because of the kidney's inability to remove waste products. B A low-fat diet is not relevant to chronic renal failure. C Potassium intake may be restricted because of the kidney's inability to remove it. D Phosphorus is restricted to help prevent bone disease.

A syndrome that leads to the deposition of platelets and fibrinogen plugs in the vasculature and the simultaneous depletion of platelets and clotting factor proteins is commonly known as DIC or _____________________.

ANS: disseminated intravascular coagulation The pathophysiology of DIC is complicated and not easily understood because both extreme bleeding and clotting occur at the same time.

32. Which order should the nurse question when caring for a 5-year-old child after surgery for Hirschsprung disease? a. Monitor rectal temperature every 4 hours and report an elevation greater than 38.5° C. b. Assess stools after surgery. c. Keep the child NPO until bowel sounds return. d. Maintain IV fluids at ordered rate.

ANS: A A Rectal temperatures should not be taken after this surgery. Rectal temperatures are generally not the route of choice for children because of the route's traumatic nature. B This is an appropriate intervention postoperatively. Stools should be soft and formed. C This is an appropriate intervention postoperatively. D This is an appropriate postoperative order.

3. The nurse expects the initial plan of care for a 9-month-old child with an acute otitis media infection to include a. symptomatic treatment and observation for 48 to 72 hours after diagnosis b. an oral antibiotic, such as amoxicillin, five times a day for 7 days c. pneumococcal conjugate vaccine d. myringotomy with tympanoplasty tubes

ANS: A A Select children 6 months of age or older with acute otitis media are treated by initiating symptomatic treatment and observation for 48 to 72 hours. B Acute otitis media may be treated with a 5- to 10-day course of oral antibiotics. When treatment is indicated, amoxicillin at a divided dose of 80 to 90 mg/kg/day given either every 8 or 12 hours for 5 to 10 days may be ordered. C Pneumococcal conjugate vaccine helps to prevent ear infections but is not included in the initial plan of care for a child with acute otitis media. D Surgical intervention is considered when the child has persistent ear infection despite antibiotic therapy or with otitis media with effusion that persists for more than 3 months and is associated with hearing loss.

27. Which classification of drugs is used to relieve an acute asthma episode? a. Short-acting beta2-adrenergic agonist b. Inhaled corticosteroids c. Leukotriene blockers d. Long-acting bronchodilators

ANS: A A Short-acting beta2-adrenergic agonist is the first medication administered. Later, systemic corticosteroids decrease airway inflammation in an acute asthma attack. They are given for short courses of 5 to 7 days. B Inhaled corticosteroids are used for long-term, routine control of asthma. C Leukotriene blockers diminish the mediator action of leukotrienes and are used for long-term, routine control of asthma in children older than 12 years. D A long-acting bronchodilator would not relieve acute symptoms.

5. The father of an infant calls the nurse to his son's room because he is "making a strange noise." A diagnosis of laryngomalacia is made. What does the nurse expect to find on assessment? a. Stridor b. High-pitched cry c. Nasal congestion d. Spasmodic cough

ANS: A A Stridor is usually present at birth but may begin as late as 2 months. Symptoms increase when the infant is supine or crying. B High-pitched cries are consistent with neurologic abnormalities and are not usually respiratory in nature. C Nasal congestion is nonspecific in relation to laryngomalacia. D Spasmodic cough is associated with croup; it is not a common symptom of laryngomalacia.

28. The nurse getting an end-of-shift report on a child with status asthmaticus should question which intervention? a. Administer oxygen by nasal cannula to keep oxygen saturation at 100%. b. Assess intravenous (IV) maintenance fluids and site every hour. c. Notify physician for signs of increasing respiratory distress. d. Organize care to allow for uninterrupted rest periods.

ANS: A A Supplemental oxygen should not be administered to maintain oxygen saturation at 100%. Keeping the saturation around 95% is adequate. Administration of too much oxygen to a child may lead to respiratory depression by decreasing the stimulus to breathe, leading to carbon dioxide retention. B When the child cannot take oral fluids because of respiratory distress, IV fluids are administered. The child with a continuous IV infusion must be assessed hourly to prevent complications. C A physician should be notified of any changes indicating increasing respiratory distress. D A child in respiratory distress is easily fatigued. Nursing care should be organized so the child can get needed rest without being disturbed.

13. What food choice by the parent of a 2-year-old child with celiac disease indicates a need for further teaching? a. Oatmeal b. Rice cake c. Corn muffin d. Meat patty

ANS: A A The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Oatmeal contains gluten and is not an appropriate food selection. B Rice is an appropriate choice because it does not contain gluten. C Corn is digestible because it does not contain gluten. D Meats do not contain gluten and can be included in the diet of a child with celiac disease.

29. What is the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

ANS: A A The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. B History of malabsorption is a later sign that manifests as failure to thrive. C Foul-smelling stools are a later manifestation of CF. D Recurrent respiratory infections are a later sign of CF.

4. In which situation is there a 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 syndrome

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

5. Before giving a dose of digoxin (Lanoxin), the nurse checked an infant's apical heart rate and it was 114 bpm. What should the nurse do next? a. Administer the dose as ordered. b. Hold the medication until the next dose. c. Wait and recheck the apical heart rate in 30 minutes. d. Notify the physician about the infant's heart rate.

ANS: A A The infant's heart rate is above the lower limit for which the medication is held. The dose can be given. B A dose of Lanoxin is withheld for a heart rate less than 100 bpm in an infant. C The infant's heart rate is acceptable for administering Lanoxin. It is unnecessary to recheck the heart rate at a later time. D The infant's heart rate is acceptable. The physician should be notified for a heart rate less than 100 bpm in an infant.

21. What is the best response to parents who ask why their infant has a nasogastric tube to intermittent suction before abdominal surgery for hypertrophic pyloric stenosis? a. "The nasogastric tube decompresses the abdomen and decreases vomiting." b. "We can keep a more accurate measure of intake and output with the nasogastric tube." c. "The tube is used to decrease postoperative diarrhea." d. "Believe it or not, the nasogastric tube makes the baby more comfortable after surgery."

ANS: A A The nasogastric tube provides decompression and decreases vomiting. B A nursing responsibility when a patient has a nasogastric tube is measurement of accurate intake and output, but this is not why nasogastric tubes are inserted. C Nasogastric tube placement does not decrease diarrhea. D The presence of a nasogastric tube can be perceived as a discomfort by the patient.

47. The best chance of survival for a child with cirrhosis is a. Liver transplantation b. Treatment with corticosteroids c. Treatment with immune globulin d. Provision of nutritional support

ANS: A A The only successful treatment for end-stage liver disease and liver failure may be liver transplantation, which has improved the prognosis for many children with cirrhosis. B Liver transplantation has revolutionized the approach to cirrhosis. Liver failure and cirrhosis are indications for transplantation. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis. C Liver transplantation has revolutionized the approach to cirrhosis. Liver failure and cirrhosis are indications for transplantation. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis. D Liver transplantation has revolutionized the approach to cirrhosis. Liver failure and cirrhosis are indications for transplantation. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis.

24. What explanation should the nurse give to the parent of a child with asthma about using a peak flow meter? a. It is used to monitor the child's breathing capacity. b. It measures the child's lung volume. c. It will help the medication reach the child's airways. d. It measures the amount of air the child breathes in.

ANS: A A The peak flow meter is a device used to monitor breathing capacity in the child with asthma. B A child with asthma would have a pulmonary function test to measure lung volume. C A spacer used with a metered-dose inhaler prolongs medication transit so medication reaches the airways. D The peak flow meter measures the flow of air in a forced exhalation in liters per minute.

3. The mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about "casts" in the urine. The nurse's response is based on the knowledge that the presence of casts in the urine indicates a. Glomerular injury b. Glomerular healing c. Recent streptococcal infection d. Excessive amounts of protein in the urine

ANS: A A The presence of red blood cell casts in the urine indicates glomerular injury. B Casts in the urine are abnormal findings and are indicative of glomerular injury, not glomerular healing. C A urinalysis positive for casts does not confirm a recent streptococcal infection. D Casts in the urine are unrelated to proteinuria.

25. The primary clinical manifestations of acute renal failure are a. Oliguria and hypertension b. Hematuria and pallor c. Proteinuria and muscle cramps d. Bacteriuria and facial edema

ANS: A A The principal feature of acute renal failure is oliguria. B These are not principal features of acute renal failure. C These are not principal features of acute renal failure. D These are not principal features of acute renal failure.

30. The nurse notes on assessment that a 1-year-old child is underweight, with abdominal distention, thin legs and arms, and foul-smelling stools. The nurse suspects failure to thrive is associated with a. Celiac disease b. Intussusception c. Irritable bowel syndrome d. Imperforate anus

ANS: A A These are classic symptoms of celiac disease. B Intussusception is not associated with failure to thrive or underweight, thin legs and arms, and foul-smelling stools. Stools are like "currant jelly." C Irritable bowel syndrome is characterized by diarrhea and pain, and the child does not typically have thin legs and arms. D Imperforate anus is the incomplete development or absence of the anus in its normal position in the perineum. Symptoms are evident in early infancy.

9. A 5-year-old child is brought to the emergency department with copious drooling and a croaking sound on inspiration. Her mother states that the child is very agitated and only wants to sit upright. What should be the nurse's first action in this situation? a. Prepare intubation equipment and call the physician. b. Examine the child's oropharynx and call the physician. c. Obtain a throat culture for respiratory syncytial virus (RSV). d. Obtain vital signs and listen to breath sounds.

ANS: A A This child has symptoms of epiglottitis, is acutely ill, and requires emergency measures. B If epiglottitis is suspected, the nurse should not examine the child's throat. Inspection of the epiglottis is only done by a physician, because it could trigger airway obstruction. C A throat culture could precipitate a complete respiratory obstruction. D Vital signs can be assessed after emergency equipment is readied.

45. Bismuth subsalicylate, clarithromycin, and metronidazole are prescribed for a child with a peptic ulcer to a. Eradicate Helicobacter pylori. b. Coat gastric mucosa. c. Treat epigastric pain. d. Reduce gastric acid production.

ANS: A A This combination of drug therapy is effective in the treatment of H. pylori. B This drug combination is prescribed to eradicate the H. pylori. C This drug combination is prescribed to eradicate the H. pylori. D This drug combination is prescribed to eradicate the H. pylori.

24. What should the nurse include in discharge teaching as the highest priority for the child with a cardiac dysrhythmia? a. CPR instructions b. Repeating digoxin if the child vomits c. Resting if dizziness occurs d. Checking the child's pulse after digoxin administration

ANS: A A This could potentially be life-saving for the child. The parents and significant others in the child's life should have CPR training. B The digoxin dose is not repeated if the child vomits. C Dizziness is a symptom the child should be taught to report to adults so that the physician can be notified. It is not the priority intervention. D The child's pulse should be counted before the medication is given. The dose is withheld if the pulse is below the parameters set by the physician.

The extrusion of the bladder to the outside of the body through a developmental defect in the abdominal wall is known as bladder _________.

ANS: exstrophy The exposed bladder is covered with nonadherent plastic wrap until surgery can be done. Surgical management is completed in several stages and includes closing the abdominal defect and reconstructing the bladder and genitalia to allow the child to achieve urinary incontinence.

17. Which CHD results in increased pulmonary blood flow? a. Ventricular septal defect b. Coarctation of the aorta c. Tetralogy of Fallot d. Pulmonary stenosis

ANS: A A Ventricular septal defect causes a left-to-right shunting of blood, thus increasing pulmonary blood flow. B Coarctation of the aorta is a stenotic lesion that causes increased resistance to blood flow from the proximal to distal aorta. C The defects associated with tetralogy of Fallot result in a right-to-left shunting of blood, thus decreasing pulmonary blood flow. D Pulmonary stenosis causes obstruction of blood flow from the right ventricle to the pulmonary artery. Pulmonary blood flow is decreased.

13. Which assessment finding after tonsillectomy should be reported to the physician? a. Vomiting bright red blood b. Pain at surgical site c. Pain on swallowing d. The ability to only take small sips of liquids

ANS: A A Vomiting bright red blood and swallowing frequently are signs of bleeding postoperatively and should be reported to the physician. B It is normal for the child to have pain at the surgical site. C It is normal for the child to have pain on swallowing. D Only clear liquids are offered immediately after surgery, and small sips are preferred.

3. The nurse is caring for a neonate with a suspected tracheoesophageal fistula (TEF). Nursing care should include a. Elevating the head but give nothing by mouth b. Elevating the head for feedings c. Feeding glucose water only d. Avoiding suction unless infant is cyanotic

ANS: A A When a newborn is suspected of having TEF, the most desirable position is supine with the head elevated on an incline plane of at least 30 degrees. It is imperative that any source of aspiration be removed at once; oral feedings are withheld. B Feedings should not be given to infants suspected of having TEF. C Feedings should not be given to infants suspected of having TEF. D The oral pharynx should be kept clear of secretion by oral suctioning. This is to avoid cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx.

4. A nurse is teaching a group of parents about TEF. Which statement made by the nurse is accurate about TEF? a. This defect results from an embryonal failure of the foregut to differentiate into the trachea and esophagus. b. It is a fistula between the esophagus and stomach that results in the oral intake being refluxed and aspirated. c. An extra connection between the esophagus and trachea develops because of genetic abnormalities. d. The defect occurs in the second trimester of pregnancy.

ANS: A A When the foregut does not differentiate into the trachea and esophagus during the fourth to fifth week of gestation, a TEF occurs. B TEF is an abnormal connection between the esophagus and trachea. C There is no connection between the trachea and esophagus in normal fetal development. D This defect occurs early in pregnancy during the fourth to fifth week of gestation.

37. The nurse should teach parents of a child with cystic fibrosis to adjust enzyme dosage according to which indicator? a. Stool formation b. Vomiting c. Weight d. Urine output

ANS: A A When there is constipation, less enzyme is needed; with steatorrhea, more enzyme is needed for digestion of nutrients. B Vomiting does not affect enzyme dosaging. C The child's weight does not affect enzyme dosaging. D Urine output is not relevant to enzyme replacement.

7. Which suggestion is appropriate to teach a mother who has a preschool child who refuses to take the medications for HIV infection? a. Mix medications with chocolate syrup or pudding b. Mix the medications with milk or an essential food. c. Skip the dose of medication if the child protests too much. d. Mix the medication in a syringe, hold the child down firmly, and administer the medication.

ANS: A Adding medication to a small amount of nonessential food the child finds tasty may be helpful in gaining the child's cooperation. Doses of medication should never be skipped. Fighting with the child or using force should be avoided. A nonessential food that will make the taste of the medication more palatable for the child should be the correct action. The administration of medications for the child with HIV becomes part of the family's everyday routine for years.

18. The nurse is planning care for an adolescent with AIDS. The priority nursing goal is to a. prevent infection. b. prevent secondary cancers. c. restore immunologic defenses. d. identify sources of infection.

ANS: A As a result of the immunocompromise that is associated with HIV infection, the prevention of infection is paramount. 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 and prevent further deterioration. Case finding is not a priority nursing goal.

17. In caring for a child with an open fracture, the nurse should carefully assess for a. infection. b. osteoarthritis. c. epiphyseal disruption. d. periosteum thickening.

ANS: A Because the skin has been broken, the child is at risk for organisms to enter the wound. The incidence of osteoarthritis does not increase with an open fracture. The chance of epiphyseal disruption is not increased with an open fracture. Periosteum thickening is part of the healing process and not a complication.

25. The management of a child who has just been stung by a bee or wasp should include the application of which of the following? a. Cool compresses b. Warm compresses c. Antibiotic cream d. Corticosteroid cream

ANS: A Bee or wasp stings are initially treated by carefully removing the stinger, cleansing with soap and water, application of cool compresses or ice, and the use of common household agents such as lemon juice or a paste made with aspirin and baking soda. Warm compresses are avoided. Antibiotic cream is unnecessary unless a secondary infection occurs. Corticosteroid cream is not part of the initial therapy. If a severe reaction occurs, systemic corticosteroids may be indicated.

23. When assessing the child with osteogenesis imperfecta, the nurse should expect to observe a. discolored teeth. b. below-normal intelligence. c. increased muscle tone. 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.

A girl with possible malabsorption syndrome is undergoing diagnostic testing for the condition. She is instructed to wear a facemask in order for expelled air to be collected. This test is known as the ________ breath test.

ANS: hydrogen A carbohydrate solution is given by mouth and exhaled. Inadequately digested carbohydrate produces hydrogen when acted on by the gastrointestinal flora. The hydrogen breath test will help confirm the diagnosis of malabsorption syndrome.

33. A nurse is assessing cranial nerve VII. How does the nurse perform this assessment? a. Ask the child to smile or "show your teeth." b. Have the child shrug shoulders against resistance. c. Tell the child to squeeze your hands hard. d. Instruct the child to stick out the tongue.

ANS: A Cranial nerve VII (facial nerve) is assessed by having the child smile. Shrugging the shoulders against resistance is testing cranial nerve XI (spinal accessory nerve). Squeezing the hands assesses grip strength. The ability to stick out the tongue shows that cranial nerve XII (hypoglossal) is intact.

22. When would a child diagnosed with type 1 diabetes mellitus most likely demonstrate a decreased need for insulin? a. During the "honeymoon" phase b. During adolescence c. During growth spurts d. During minor illnesses

ANS: A During the "honeymoon" phase, which may last from a few weeks to a year or longer, the child is likely to need less insulin. Insulin requirements are generally higher during adolescence, growth spurts, and illnesses.

18. Impetigo ordinarily results in a. no scarring. b. pigmented spots. c. slightly depressed scars. d. atrophic white scars.

ANS: A Impetigo tends to heal without scarring unless a secondary infection occurs or the child picks at the lesions. Hyperpigmentation may occur but only in dark-skinned children.

4. The nursing student learns how infants acquire immunity. Which statement about this process is correct? a. The infant acquires humoral and cell-mediated immunity in response to infections and immunizations. b. The infant acquires maternal antibodies that ensure immunity up to 12 months age. c. Active immunity is acquired from the mother and lasts 6 to 7 months. d. Passive immunity develops in response to immunizations.

ANS: A Infants acquire long-term active immunity from exposure to antigens and vaccines. Immunity is acquired actively and passively. The term infant's passive immunity is acquired from the mother and begins to dissipate during the first 6 to 8 months of life. Passive immunity is acquired from the mother. Active immunity develops in response to immunizations.

27. The nurse knows that treatment of Osgood-Schlatter disease includes a. limitation of knee bending or kneeling. b. increasing range of motion (ROM) of the knee. c. encouraging flexion of the hip. d. limitation of adduction of the hip.

ANS: A Limitation of knee bending or kneeling provides pain control and allows the knees to heal. Increasing ROM of the knee increases pain and exacerbates the disease. Encouraging flexion of the hip will have no effect on the process affecting the knees. Limitation of hip adduction will not help the child with Osgood-Schlatter disease.

8. What is the primary nursing concern for a hospitalized child with HIV infection? a. Maintaining growth and development b. Eating foods that the family brings to the child c. Consideration of parental limitations and weaknesses d. Resting for 2 to 3 hours twice a day

ANS: A Maintaining growth and development is a major concern for the child with HIV infection. Frequent monitoring for failure to thrive, neurologic deterioration, or developmental delay is important for HIV-infected infants and children. Nutrition, which contributes to a child's growth, is a nursing concern; however, it is not necessary for family members to bring food to the child. Although an assessment of parental strengths and weaknesses is important, it will be imperative for health care providers to focus on the parental strengths, not weaknesses. This is not as important as the frequent assessment of the child's growth and development. Rest is a nursing concern, but it is not as high a priority as maintaining growth and development. Rest periods twice a day for 2 to 3 hours may or may not be appropriate.

8. When assessing the child with atopic dermatitis, the nurse should ask the parents about a history of which of the following? a. Asthma b. Nephrosis c. Lower respiratory tract infections d. Neurotoxicity

ANS: A Most children with atopic dermatitis have a family history of asthma, hay fever, or atopic dermatitis, and up to 80% of children with atopic dermatitis have asthma or allergic rhinitis. Complications of atopic dermatitis relate to the skin. The renal system is not affected by atopic dermatitis. There is no link between lower respiratory tract infections and atopic dermatitis. Atopic dermatitis does not have a relationship to neurotoxicity.

18. A nurse is teaching parents the difference between pediatric fractures and adult fractures. Which observation is true about pediatric fractures? a. They seldom are complete breaks. b. They are often open fractures. c. They are often at the epiphyseal plate. d. They are often the result of decreased mobility of the bones.

ANS: A Pediatric fractures seldom are complete breaks. Rather, children's bones tend to bend or buckle. Open fractures and epiphyseal plate fractures are no more common than simple fractures in children. Increased mobility of the bones prevents children from having complete fractures.

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

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. Although in the past some children became infected with HIV through blood transfusions, improved laboratory screening has significantly reduced the probability of contracting HIV from blood products. Poor hand washing is not an etiology of HIV infection.

19. What is the primary concern for a 7-year-old child with type 1 diabetes mellitus who asks his mother not to tell anyone at school that he has diabetes? a. The child's safety b. The privacy of the child c. Development of a sense of industry d. Peer group acceptance

ANS: A Safety is the primary issue. School personnel need to be aware of the signs and symptoms of hypoglycemia and hyperglycemia and the appropriate interventions. While privacy is a concern, for the child's safety, key personnel need to know about the diagnosis and what to do in an emergency. The treatment of type 1 diabetes should not interfere with the school-age child's development of a sense of industry. Peer group acceptance, along with body image, are issues for the early adolescent with type 1 diabetes. This is not of greater priority than the child's safety.

10. When changing an infant's diaper, the nurse notices small bright red papules with satellite lesions on the perineum, anterior thigh, and lower abdomen. This rash is characteristic of a. candidiasis. b. irritant contact dermatitis. c. intertrigo. d. seborrheic dermatitis.

ANS: A Small red papules with peripheral scaling in a sharply demarcated area involving the anterior thighs, lower abdomen, and perineum are characteristic of candidiasis. A shiny, parchment-like erythematous rash on the buttocks, medial thighs, mons pubis, and scrotum, but not in the folds, is suggestive of irritant contact dermatitis. Intertrigo is identified by a red macerated area of sharp demarcation in the groin folds. It can also develop in the gluteal and neck folds. Seborrheic dermatitis is recognized by salmon-colored, greasy lesions with a yellowish scale found primarily in skinfold areas or on the scalp.

29. Which statement by the mother of an adolescent being discharged after spinal fusion for severe scoliosis indicates the need for further teaching? a. "I am glad we chose surgery. Now it is all over and done." b. "I'll see you in a month; we'll be back fairly regularly." c. "I have to pick up some more T-shirts on the way home." d. "Those exercises the physical therapist showed us were not too hard."

ANS: A Spinal fusion requires long-term follow-up to assess the stability of the spinal correction. The other statements show good understanding of discharge instructions.

31. A priority nursing intervention when caring for a child in a Pavlik harness is a. skin care. b. bowel function. c. feeding patterns. d. respiratory function.

ANS: A The child in a Pavlik harness needs special attention to skin care because the infant's skin is sensitive and the harness may cause irritation. The harness should not affect normal bowel function in the infant. Families are typically instructed on techniques for holding and feeding. The harness should not affect feeding patterns in the infant. The harness should not affect normal respiratory function in the infant.

28. What is the most appropriate intervention for an adolescent with a mild scoliosis? a. Long-term monitoring b. Surgical intervention c. Bracing d. No follow-up

ANS: A The child with mild scoliosis requires long-term follow-up to determine whether the curve will progress or remain stable. Surgical intervention is not needed for mild scoliosis. Mild scoliosis is not braced if it is stable. Follow-up to monitor the curve is important until skeletal maturity has occurred.

7. A child with osteomyelitis asks the nurse, "What is a 'sed' rate?" What is the best response for the nurse? a. "It tells us how you are responding to the treatment." b. "It tells us what type of antibiotic you need." c. "It tells us whether we need to immobilize your extremity." d. "It tells us how your nerves and muscles are doing."

ANS: A The erythrocyte sedimentation rate (ESR) indicates the presence of inflammation and infectious process and is one of the best indicators of the child's response to treatment. Although the ESR indirectly identifies whether an antibiotic is needed, the organism involved dictates the type of antibiotic and the length of treatment. The ESR does not direct whether the extremity will be immobilized. An ESR rate will not evaluate neuromuscular status.

1. A nurse in a well-child clinic is teaching parents about their child's immune system. Which statement by the nurse is correct? a. The immune system distinguishes and actively protects the body's own cells from foreign substances. b. The immune system is fully developed by 1 year of age. c. The immune system protects the child against communicable diseases in the first 6 years of life. d. The immune system responds to an offending agent by producing antigens.

ANS: A The immune system responds to foreign substances, or antigens, by producing antibodies and storing information. Intact skin, mucous membranes, and processes such as coughing, sneezing, and tearing help maintain internal homeostasis. Children up to age 6 or 7 years have limited antibodies against common bacteria. The immunoglobulins reach adult levels at different ages. Immunization is the basis from which the immune system activates protection against some communicable diseases. Antibodies are produced by the immune system against invading agents, or antigens.

12. What is the major concern guiding treatment for the child with Legg-Calvé-Perthes disease? a. Avoid permanent deformity. b. Minimize pain. c. Maintain normal activities. d. Encourage new hobbies.

ANS: A The major concern related to Legg-Calvé-Perthes disease is to prevent an arthritic process resulting from the flattening of the femoral head of the femur when it protrudes outside the acetabulum. The pain associated with Legg-Calvé-Perthes disease decreases with increased rest, making activity restriction an important factor for these children. The priority concern for treatment is to prevent deformity. In Legg-Calvé-Perthes disease, the major concern is to prevent deformity through decreased activity. Prevention of deformity is the major concern for children with Legg-Calvé-Perthes disease, and rest is a mandatory treatment. Selected hobbies that do not require physical activity are encouraged.

13. The nurse observes a rash on a teen's face which is characteristic of systemic lupus erythematosus (SLE). What action by the nurse is most appropriate? a. Teach the teen about using sunscreen. b. Prepare the teen for a bone marrow biopsy. c. Educate the teen on proper use of antibiotics. d. Demonstrate how to use an Epi-pen.

ANS: A The nurse needs to provide education on managing the disease; one facet includes minimizing sun exposure so the nurse teaches the teen about the correct use of sunscreen. The teen will not have a bone marrow biopsy, need antibiotics, or have to use an Epi-pen.

18. What is the best time for the nurse to assess the peak effectiveness of subcutaneously administered regular insulin? a. Two hours after administration b. Four hours after administration c. Immediately after administration d. Thirty minutes after administration

ANS: A The peak action for regular (short-acting) insulin is 2 to 3 hours after subcutaneous administration. The other times do not correspond to the peak action time.

19. A nurse is working in an allergy clinic and has performed skin testing on an adolescent. Seventeen minutes after the procedure, the nurse note the presence of a wheal at one of the sites. What conclusion does the nurse make about this response? a. The child is allergic to that substance. b. This result is indeterminate. c. The testing should be redone in another location. d. Anaphylaxis is imminent.

ANS: A The presence of a wheal within 30 minutes of skin testing is indicative of an allergy to the substance used. The test does not need to be repeated, and anaphylaxis is not imminent.

14. 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 NSAIDs to decrease gastric irritation. d. immobilizing the painful joints, which is 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 NSAIDs. Children with arthritis can immobilize their own joints. Range-of-motion exercises are important for maintaining joint flexibility and preventing restricted movement in the affected joints.

1. A child has small red macules and vesicles that become pustules around the child's mouth and cheek. Older lesions are crusted and honey-colored. What should the nurse teach the parents about this condition? a. Keep the child home from school for 24 hours after starting antibiotics. b. Clean the rash vigorously with Betadine three times a day. c. Notify the physician for any itching. d. Keep the child home from school until the lesions are healed.

ANS: A This child has impetigo. To prevent the spread of impetigo to others, the child should be kept home from school for 24 hours after treatment is initiated. Good handwashing is imperative in preventing the spread of impetigo. The lesions should be washed gently with a warm soapy washcloth. Itching is common and does not necessitate medical treatment. Rather, parents should be taught to clip the child's nails to prevent maceration of the lesions. The washcloth should not be shared with other members of the family. The child may return to school 24 hours after initiation of antibiotic treatment.

4. A mother whose 7-year-old child has been placed in a cast for a fractured right arm reports that the child will not stop crying even after taking acetaminophen with codeine. The child also will not straighten the fingers on the right arm. What advice by the nurse is best? a. Take the child to the emergency department. b. Put ice on the injury. c. Avoid letting the child get so tired. d. Wait another hour; if the child is still crying, call back.

ANS: A Unrelieved pain and the child's inability to extend his fingers are signs of compartment syndrome, which requires immediate attention. Placing ice on the extremity is an inappropriate action for the symptoms. Telling the mother not to let her child get tired is an inappropriate response to a concern. A child who has signs and symptoms of compartment syndrome should be seen immediately. Waiting an hour could compromise the recovery of the child.

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. Wash the area with warm water and soap. b. Vigorously scrub the leg. c. Apply powder to absorb the material. d. Carefully pick the material off the leg.

ANS: A Washing with soap and warm water will remove the desquamated skin and secretions. 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.

Which clinical finding is an overt sign of retinoblastoma in children? a. Whitish reflex in the eye b. Lymphadenopathy c. Bone pain d. Change in gait

ANS: A Feedback A A whitish reflex in the eye, leukocoria, is a common finding of retinoblastoma. It is an overt sign of cancer in children. B Persistent lymphadenopathy is a manifestation of several forms of childhood cancer. It is a covert sign of cancer in children. C Bone pain is a covert symptom of cancer in children. D A change in gait may be a sign of a brain tumor. It is considered a covert sign of cancer in children.

A child with acute myeloblastic leukemia is scheduled to have a bone marrow transplant (BMT). The donor is the child's own umbilical cord blood that had been previously harvested and banked. This type of BMT is termed a. Autologous b. Allogeneic c. Syngeneic d. Stem cell

ANS: A Feedback A In an autologous transplant, the child's own marrow or previously harvested and banked cord blood is used. B In an allogeneic BMT, histocompatibility has been matched with a related or an unrelated donor. C In a syngeneic transplant, the child receives bone marrow from an identical twin. D A stem cell transplantation uses a unique immature cell present in the peripheral circulation.

Which nursing intervention should not be included in the postoperative plan of care for a child undergoing surgery for a brain tumor? a. Place the child in Trendelenburg position. b. Perform neurologic assessments. c. Assess dressings for drainage. d. Monitor temperature.

ANS: A Feedback A The child is never placed in the Trendelenburg position because it increases intracranial pressure and the risk of bleeding. B Increased intracranial pressure is a risk in the postoperative period. The nurse would assess the child's neurologic status frequently. C Hemorrhage is a risk in the postoperative period. The child's dressing would be inspected frequently for bleeding. D Temperature is monitored closely because the child is at risk for infection in the postoperative period.

The nurse notes that a child's gums bleed easily and he has bruising and petechiae on his extremities. What laboratory values are consistent with these symptoms? a. Platelet count of 19,000/mm3 b. Prothrombin time of 11 to 15 seconds c. Hematocrit of 34 d. Leukocyte count of 14,000/mm3

ANS: A Feedback A The normal platelet count is 150,000 to 400,000/mm3. This finding is very low, indicating an increased bleeding potential. The child should be monitored closely for signs of bleeding. B The prothrombin time of 11 to 15 seconds is within normal limits. C The normal hematocrit is 35 to 45 and, although this finding is low, it would not create the symptoms presented. D This value indicates the probable presence of infection, but it is not a reflection of bleeding tendency.

What information should the nurse teach families about reducing exposure to pollens and dust? Select all that apply. a. Replace wall-to-wall carpeting with wood and tile floors. b. Use an air conditioner. c. Put dust-proof covers on pillows and mattresses. d. Keep humidity in the house above 60%. e. Keep pets outside.

ANS: A, B, C Correct Carpets retain dust. To reduce exposure to dust, carpeting should be replaced with wood, tile, slate, or vinyl. These floors can be cleaned easily. For anyone with pollen allergies, it is best to keep the windows closed and to run the air conditioner. Covering mattresses and pillows with dust-proof covers will reduce exposure to dust. Incorrect A humidity level above 60% promotes dust mites. It is recommended that household humidity be kept between 40% and 50% to reduce dust mites inside the house. Keeping pets outside will help to decrease exposure to dander, but will not affect exposure to pollen and dust.

Which nursing interventions are significant for a child with cirrhosis who is at risk for bleeding? Select all that apply. a. Guaiac all stools b. Provide a safe environment c. Administer multivitamins with vitamins A, D, E, and K d. Inspect skin for pallor and cyanosis e. Monitor serum liver panels

ANS: A, B, C Correct: Identification of bleeding includes stool guaiac testing, which can detect if blood is present in the stool; protecting the child from injury by providing a safe environment; administering vitamin K to prevent bleeding episodes; and avoiding injections. Incorrect: A skin assessment would likely reveal jaundice. Pallor and cyanosis are associated with a cardiac problem. These may be late signs of a significant bleeding episode, but not significant in the prevention stage of the nursing process. Monitoring serum liver panels is important but would not provide information on coagulation status or risk factors associated with bleeding.

A nurse is planning care for an asymptomatic child with a positive tuberculin test. What should the nurse include in the plan? Select all that apply. a. Administration of daily isoniazid (INH) b. Instructing family members about administration of INH to all close contacts of the child c. Administration of the Bacillus Calmette-Guérin vaccine d. Reporting the case to the health department e. Administration of INH and rifampin (Rifadin) simultaneously

ANS: A, B, D Correct After a chest radiograph is obtained, asymptomatic children with positive tuberculin tests and no previous history of TB receive daily INH for 9 months. Asymptomatic contacts should receive INH for at least 8 to 10 weeks after contact has been broken or until a negative skin test can be confirmed (a second test is taken at least 10 weeks after the last exposure). Reporting cases of TB is required by law in all states in the United States. Incorrect Bacillus Calmette-Guérin vaccine is the only anti-TB vaccine available, but it is given only to children who have negative test results. For asymptomatic TB, only INH is administered, not both isoniazid and rifampin together. Rifampin is used if the child has resistance to isoniazid.

When an adolescent with a new diagnosis of Ewing sarcoma asks the nurse about treatment, the nurse's response is based on the knowledge that (select all that apply) a. This type of tumor invades the bone. b. Management includes chemotherapy, surgery, and radiation. c. Ewing sarcoma is usually not responsive to either chemotherapy or radiation. d. Affected bones such as ribs and proximal fibula may be removed to excise the tumor. e. Is the most common bone tumor seen in children.

ANS: A, B, D Feedback Correct: Ewing sarcoma invades the bone and is found most often in the midshaft of long bones, especially the femur, vertebrae, ribs, and pelvic bones. Treatment for Ewing sarcoma begins with chemotherapy to decrease tumor bulk, followed by surgical resection of the primary tumor. Local control of the tumor can be achieved with surgery or radiation. The affected bone may be removed if it will not affect the child's functioning. Ribs and the proximal fibula are considered expendable and may be removed to excise the tumor without affecting function. Incorrect: Ewing sarcoma is responsive to both chemotherapy and radiation. Osteosarcoma is the most common primary bone malignancy in children. The second most common bone tumor seen in children is Ewing sarcoma.

1. The mother of an HIV-positive infant who is 2 months old questions the nurse about which childhood immunizations her child will be able to receive. Which immunizations should an HIV-positive child be able to receive? (Select all that apply.) a. Hepatitis B b. DTaP c. MMR d. IPV e. HIB

ANS: A, B, D, E Routine immunizations are appropriate. The MMR vaccination is not given at 2 months of age. If it were indicated, CD4+ counts are monitored when deciding whether to provide live virus vaccines. If the child is severely immunocompromised, the MMR vaccine is not given. The varicella vaccine can be considered on the basis of the child's CD4+ counts. Only IPV should be used for HIV-infected children.

The mother of a newborn asks the nurse what causes the baby to begin to breathe after delivery. What changes in the respiratory system stimulating respirations postnatally can the nurse explain to the mother? Select all that apply. a. Low oxygen levels in the infant's blood b. Rubbing the newborn with a towel or blanket c. Surfactant, a special lubricant in the lungs d. Increased blood flow to the infant's lungs e. Cold environment in the delivery room

ANS: A, B, E Correct A postnatal change in the respiratory system is the stimulation of respiration by hypoxemia, hypercarbia, cold, tactile stimulation, and a possible decrease in the concentration of prostaglandin E2. Incorrect Surfactant in the lungs lowers surface tension and facilitates lung expansion. It does not stimulate respirations. Pulmonary blood flow increases after birth, but this does not stimulate respirations in the newborn.

1. Which nursing interventions are appropriate for a child with type 1 diabetes who is experiencing deficient fluid volume related to abnormal fluid losses through diuresis and emesis? (Select all that apply.) a. Initiate IV access. b. Begin IV fluid replacement with normal saline. c. Begin IV fluid replacement with D5 1/2NS. d. Weigh on arrival to the unit and then every other day. e. Maintain strict intake and output monitoring.

ANS: A, B, E IV access should always be obtained on a hospitalized child with dehydration and a history of type 1 diabetes. Maintaining circulation is a priority nursing intervention. If the child is vomiting and unable to maintain adequate hydration, fluid volume replacement/rehydration is needed. Normal saline is the initial IV rehydration fluid. Maintaining strict intake and output is essential in calculating rehydration status. D5 1/2NS is not the recommended fluid for rehydration of this patient. Weighing the patient on arrival is important, but following the initial weight, the child needs to be weighed more frequently than every other day. Comparison of admission weight and a weight every 8 hours provides an indication of hydration status.

2. A nurse is teaching parents about prevention of diaper dermatitis. Which should the nurse include in the teaching plan? (Select all that apply.) a. Clean the diaper area gently after every diaper change with a mild soap. b. Use a protective ointment to clean dry intact skin. c. Use a steroid cream after each diaper change. d. Use rubber or plastic pants over the diaper. e. Wash cloth diapers in hot water with a mild soap and double rinse.

ANS: A, B, E Prompt, gentle cleaning with water and mild soap (e.g., Dove, Neutrogena Baby Soap) after each voiding or defecation rids the skin of ammonia and other irritants and decreases the chance of skin breakdown and infection. A bland, protective ointment (e.g., A&D, Balmex, Desitin, zinc oxide) can be applied to clean, dry, intact skin to help prevent diaper rash. If cloth diapers are laundered at home, the parents should wash them in hot water, using a mild soap and double rinsing. Occlusion increases the risk of systemic absorption of a steroid; thus steroid creams are rarely used for diaper dermatitis because the diaper functions as an occlusive dressing. Rubber or plastic pants increase skin breakdown by holding in moisture and should be used infrequently. A steroid cream is not recommended.

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 for 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 Correct: 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. Incorrect : Children should avoid excessive intake of fruit juices and other sweetened drinks, sugars, and saturated fats.

1. A child has a cast applied to the left forearm. Which interventions should the nurse include in the home care instructions for the parents? (Select all that apply.) a. Keep small toys away from the cast. b. Use a padded ruler to scratch the skin under the cast if it itches. c. Assess the cast daily for unusual odors. d. Elevate the extremity on pillows for the first 24 to 48 hours. e. Numbness and tingling in the extremity are expected.

ANS: A, C, D Small toys should be kept away from the cast because they can become lodged inside the cast. The cast should be inspected daily for any unusual odors, which can indicate infection. The extremity should be elevated for the first 24 to 48 hours to decrease edema. Nothing should be placed inside the cast. If numbness or tingling is experienced, the physician should be notified.

2. 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 any antibiotics as prescribed. d. Notify the provider if the child develops a cough or congestion. e. Missed doses of antiretroviral medication should just be skipped.

ANS: A, C, D The parents are taught that vitamins are important, to have the child take all antibiotics (if prescribed) as ordered, and to notify the provider of coughs or congestion. The child should have yearly influenza vaccination, and if missed medication doses are noticed close to their scheduled time, they should be taken.

What should the nurse recognize as symptoms of a brain tumor in a school-age child for whom she is caring? Select all that apply. a. Blurred vision b. Increased head circumference c. Vomiting when getting out of bed d. Intermittent headache e. Declining academic performance

ANS: A, C, D, E Feedback Correct Visual changes such as nystagmus, diplopia, and strabismus are manifestations of a brain tumor. The change in position on awakening causes an increase in intracranial pressure, which is manifested as vomiting. Vomiting on awakening is considered a hallmark symptom of a brain tumor. Increased intracranial pressure resulting from a brain tumor is manifested as a headache. School-age children may exhibit declining academic performance, fatigue, personality changes, and symptoms of vague, intermittent headache. Other symptoms may include seizures or focal neurologic deficits. Incorrect Manifestations of brain tumors vary with tumor location and the child's age and development. Infants with brain tumors may have increased head circumference with a bulging fontanel. School-age children have closed fontanels and therefore their head circumferences do not increase with brain tumors.

The nurse should implement which interventions for an infant experiencing apnea? Select all that apply. a. Stimulate the infant by gently tapping the foot. b. Shake the infant vigorously. c. Have resuscitative equipment available. d. Suction the infant. e. Maintain a neutral thermal environment.

ANS: A, C, E Correct An infant with apnea should be stimulated by gently tapping the foot. Resuscitative equipment should be available and the infant should be maintained in a neutral thermal environment. Incorrect The infant should not be shaken vigorously nor suctioned.

A nurse is assessing an infant for urinary tract infection (UTI). Which assessment findings should the nurse expect? Select all that apply. a. Change in urine odor or color b. Enuresis c. Fever or hypothermia d. Voiding urgency e. Poor weight gain

ANS: A, C, E Correct The signs of a UTI in an infant include fever or hypothermia, irritability, dysuria as evidenced by crying when voiding, change in urine odor or color, poor weight gain, and feeding difficulties. Incorrect Enuresis and voiding urgency should be assessed in an older child.

Which interventions should a nurse implement when caring for a child with hepatitis? Select all that apply. a. Provide a well-balanced low-fat diet. b. Schedule playtime in the playroom with other children. c. Teach parents not to administer any over-the-counter medications. d. Arrange for home schooling because the child will not be able to return to school. e. Instruct parents on the importance of good handwashing.

ANS: A, C, E Correct: The child with hepatitis should be placed on a well-balanced low-fat diet. Parents should be taught to not give over-the-counter medications because of impaired liver function. Hand hygiene is the most important preventive measure for the spread of hepatitis. Incorrect: The child will be in contact isolation in the hospital so playtime with other hospitalized children is not scheduled. The child will be on contact isolation for a minimum of 1 week after the onset of jaundice. After that period, the child will be allowed to return to school.

1. Where do the lesions of atopic dermatitis most commonly occur in the infant? (Select all that apply.) a. Cheeks b. Buttocks c. Extensor surfaces of arms and legs d. Back e. Scalp

ANS: A, C, E The lesions of atopic dermatitis are generalized in the infant. They are most commonly on the cheeks, scalp, and extensor surfaces of the extremities. These lesions are not typically on the back or the buttocks.

2. A child is in skeletal traction. Which interventions should the nurse implement to prevent complications of immobility? (Select all that apply.) a. Reposition the child every 2 hours. b. Avoid use of an egg-crate or sheepskin mattress. c. Limit fluid intake. d. Administer stool softeners as prescribed. e. Encourage coughing and deep breathing.

ANS: A, D, E Complications of immobility can affect the skin, the gastrointestinal system, and the respiratory system. The child should be repositioned every 2 hours to prevent skin breakdown. Stool softeners should be administered to avoid constipation, and the child should cough and deep breathe to maintain respiratory function. Egg-crate or sheepskin mattresses can be useful in preventing skin breakdown, and fluids should be increased to prevent constipation, not decreased.

As a child with asthma struggles to get enough air, the respiratory rate increases (tachypnea). Tachypnea lowers the carbon dioxide levels in the blood. This is known as _____________.

ANS: hypocapnia As the child tires from the increased work of breathing, hyperventilation occurs and carbon dioxide levels increase. Increased levels of carbon dioxide in the blood (hypercapnia) during an asthma episode may be a sign of severe airway obstruction and impending respiratory failure.

The nurse is caring for a child with iron-deficiency anemia. What should the nurse expect to find when reviewing the results of the complete blood count (CBC)? Select all that apply. a. Low hemoglobin levels b. Elevated red blood cell (RBC) levels c. Elevated mean cell volume (MCV) levels d. Low reticulocyte count e. Decreased MCV levels

ANS: A, D, E Correct The results of the complete blood count in a child with iron-deficiency anemia will show low hemoglobin levels (6 to 11 g/dL) and microcytic, hypochromic RBCs; this manifests as decreased MCV and decreased mean cell hemoglobin. The reticulocyte count is usually slightly elevated or normal. Incorrect: The reticulocyte count is usually slightly elevated or normal, and mean cell volume levels are decreased, not increased.

14. Which assessment finding should the nurse expect in an infant with Hirschsprung disease? a. "Currant jelly" stools b. Constipation with passage of foul-smelling, ribbon-like stools c. Foul-smelling, fatty stools d. Diarrhea

ANS: B A "Currant jelly" stools are associated with intussusception. B Constipation results from absence of ganglion cells in the rectum and colon, and is present since the neonatal period with passage of frequent foul-smelling, ribbon-like, or pellet-like stools. C Foul-smelling, fatty stools are associated with cystic fibrosis and celiac disease. D Diarrhea is not typically associated with Hirschsprung disease but may result from impaction.

7. 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 b. Patent ductus arteriosus c. Ventricular septal defect d. Coarctation of the aorta

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

19. 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. b. Alert the physician. c. Withhold oral feeding. d. Increase the oxygen rate.

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

11. A child had an aortic stenosis defect surgically repaired 6 months ago. Which antibiotic prophylaxis is indicated for an upcoming tonsillectomy? a. No antibiotic prophylaxis is necessary. b. Amoxicillin is taken orally 1 hour before the procedure. c. Oral penicillin is given for 7 to 10 days before the procedure. d. Parenteral antibiotics are administered for 5 to 7 days after the procedure.

ANS: B A Antibiotic prophylaxis is indicated for the first 5 months after surgical repair. B The standard prophylactic agent is amoxicillin given orally 1 hour before the procedure. C Antibiotic prophylaxis is not given for this period of time. D The treatment for infective endocarditis involves parenteral antibiotics for 2 to 8 weeks.

7. What are the nursing priorities for a child with sickle cell disease in vaso-occlusive crisis? a. Administration of antibiotics and nebulizer treatments b. Hydration and pain management c. Blood transfusions and an increased calorie diet d. School work and diversion

ANS: B A Antibiotics may be given prophylactically. Oxygen therapy rather than nebulizer treatments is used to prevent further sickling. B Hydration and pain management decrease the cells' oxygen demands and prevent sickling. C Although blood transfusions and increased calories may be indicated, they are not primary considerations for vaso-occlusive crisis. D School work and diversion are not major considerations when the child is in a vaso-occlusive crisis

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

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

22. A child is admitted with acute glomerulonephritis. The nurse expects the urinalysis during this acute phase to show a. Bacteriuria and hematuria b. Hematuria and proteinuria c. Bacteriuria and increased specific gravity d. Proteinuria and decreased specific gravity

ANS: B A Bacteriuria and changes in specific gravity are not usually present during the acute phase. B Urinalysis during the acute phase characteristically shows hematuria and proteinuria. C Bacteriuria and changes in specific gravity are not usually present during the acute phase. D Bacteriuria and changes in specific gravity are not usually present during the acute phase.

25. What is the best nursing response to the parent of a child with asthma who asks if his child can still participate in sports? a. "Children with asthma are usually restricted from physical activities." b. "Children can usually play any type of sport if their asthma is well controlled." c. "Avoid swimming because breathing underwater is dangerous for people with asthma." d. "Even with good asthma control, I would advise limiting the child to one athletic activity per school year."

ANS: B A Children with asthma should not be restricted from physical activity. B Sports that do not require sustained exertion, such as gymnastics, baseball, and weight lifting, are well tolerated. Children can usually play any type of sport if their asthma is well controlled. C Swimming is recommended as the ideal sport for children with asthma because the air is humidified and exhaling underwater prolongs exhalation and increases end-expiratory pressure. D If asthma is well controlled, the child can participate in any type of sport.

20. The narrowing of preputial opening of foreskin is called a. Chordee b. Phimosis c. Epispadias d. Hypospadias

ANS: B A Chordee is the ventral curvature of the penis. B Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. C Epispadias is the meatal opening on the dorsal surface of the penis. D Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

33. The primary nursing intervention to prevent bacterial endocarditis is 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 A Dental procedures should be done to maintain a high level of oral health. Prophylactic antibiotics are necessary. 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. C Observing children for complications should be done, but maintaining good oral health and prophylactic antibiotics is important. D Encouraging restricted mobility should be done, but maintaining good oral health and prophylactic antibiotics is important.

28. Which statement is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. It is preferred means of renal replacement therapy in children. c. Children can receive kidneys only from other children. d. The decision for transplantation is difficult, since a relatively normal lifestyle is not possible.

ANS: B A It can be done in children as young as age 6 months. B Renal transplant offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease. C Both children and adults can serve as donors for renal transplant purposes. D Renal transplantation affords the child a more normal lifestyle than dependence on dialysis.

1. Which statement by a school-age girl indicates the need for further teaching about the prevention of urinary tract infections (UTIs)? a. "I always wear cotton underwear." b. "I really enjoy taking a bubble bath." c. "I go to the bathroom every 3 to 4 hours." d. "I drink four to six glasses of fluid every day."

ANS: B A It is desirable to wear cotton rather than nylon underwear. Nylon tends to hold in moisture and promote bacterial growth, whereas cotton absorbs moisture. B Bubble baths should be avoided because they tend to cause urethral irritation, which leads to UTI. C Children should be encouraged to urinate at least four times a day. D An adequate fluid intake prevents the buildup of bacteria in the bladder.

21. Which statement indicates that a parent of a toddler needs more education about preventing foreign body aspiration? a. "I keep objects with small parts out of reach." b. "My toddler loves to play with balloons." c. "I won't permit my child to have peanuts." d. "I never leave coins where my child could get them."

ANS: B A Keeping toys with small parts and other small objects out of reach can prevent foreign body aspiration. B Latex balloons account for a significant number of deaths from aspiration every year. C Peanuts are just one of the foods that pose a choking risk if given to young children. D Small objects, such as coins, need to be put out of the small child's reach.

16. Which type of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)

ANS: B A Laryngitis is a common viral illness in older children and adolescents, with hoarseness and URI symptoms. B Epiglottitis is always a medical emergency that requires antibiotics and airway support for treatment. C Spasmodic croup is treated with humidity. D LTB may progress to a medical emergency in some children.

41. The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include: a. Forcing fluids b. Monitoring pulse oximetry c. Instituting seizure precautions d. Encouraging a high-protein diet

ANS: B A Maintenance of vascular volume and hydration is important and should be done parenterally. B Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. C Seizures are not a side effect of ARDS. D Adequate nutrition is necessary, but a high-protein diet is not helpful.

28. Which assessment finding is the most significant to report to the physician for a child with cirrhosis? a. Weight loss b. Change in level of consciousness c. Skin with pruritus d. Black, foul-smelling stools

ANS: B A One complication of cirrhosis is ascites. The child needs to be assessed for increasing abdominal girth and edema. A child who is retaining fluid will not exhibit weight loss. B The child with cirrhosis must be assessed for encephalopathy, which is characterized by a change in level of consciousness. Encephalopathy can result from a buildup of ammonia in the blood from the incomplete breakdown of protein. C Biliary obstruction can lead to pruritus, which is a frequent finding. An alteration in the level of consciousness is of higher priority. D Black, tarry stools may indicate blood in the stool. This needs be reported to the physician. This is not a higher priority than a change in level of consciousness.

31. The infant with bronchopulmonary dysplasia (BPD) who has RSV bronchiolitis is a candidate for which treatment? a. Pancreatic enzymes b. Cool humidified oxygen c. Erythromycin intravenously d. Intermittent positive pressure ventilation

ANS: B A Pancreatic enzymes are used for patients with cystic fibrosis. B Humidified oxygen is delivered if the oxygen saturation level drops to less than 90%. C Antibiotics are ineffective against viral illnesses. Oxygen can be administered by hood, facemask, or nasal cannula. D Assisted ventilation is not necessary in the treatment of RSV infections.

15. Before preparing a teaching plan for the parents of an infant with ductus arteriosus, it is important that the nurse understands this condition. Which statement best describes patent ductus arteriosus? a. Patent ductus arteriosus involves a defect that results in a right-to-left shunting of blood in the heart. b. Patent ductus arteriosus involves a defect in which the fetal shunt between the aorta and the pulmonary artery fails to close. c. Patent ductus arteriosus is a stenotic lesion that must be surgically corrected at birth. d. Patent ductus arteriosus causes an abnormal opening between the four chambers of the heart.

ANS: B A Patent ductus arteriosus allows blood to flow from the high-pressure aorta to the low-pressure pulmonary artery, resulting in a left-to-right shunt. B Patent ductus arteriosus is failure of the fetal shunt between the aorta and the pulmonary artery to close. C Patent ductus arteriosus is not a stenotic lesion. Patent ductus arteriosus can be closed both medically and surgically. D Atrioventricular defect occurs when fetal development of the endocardial cushions is disturbed, resulting in abnormalities in the atrial and ventricular septa and the atrioventricular valves.

42. A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. What should the nurse suggest to minimize reflux? a. Place in Trendelenburg position after eating. b. Thicken formula with rice cereal. c. Give continuous nasogastric tube feedings. d. Give larger, less frequent feedings.

ANS: B A Placing the child in a Trendelenburg position increases the reflux. B Small frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula has been recommended. Milk thickening agents have been shown to decrease the number of episodes of vomiting and to increase the caloric density of the formula. This may benefit infants who are underweight as a result of GERD. C Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive. D Smaller, more frequent feedings are recommended in reflux.

26. What is the most important action to prevent the spread of gastroenteritis in a daycare setting? a. Administering prophylactic medications to children and staff b. Frequent handwashing c. Having parents bring food from home d. Directing the staff to wear gloves at all times

ANS: B A Prophylactic medications are not helpful in preventing gastroenteritis. B Handwashing is the most the important measure to prevent the spread of infectious diarrhea. C Bringing food from home will not prevent the spread of infectious diarrhea. D Gloves should be worn when changing diapers, soiled clothing, or linens. They do not need to be worn for interactions that do not involve contact with secretions. Handwashing after contact is indicated.

12. You are the nurse caring for a 4-year-old child who has developed acute renal failure as a result of hemolytic-uremic syndrome (HUS). Which bacterial infection was most likely the cause of HUS? a. Pseudomonas aeruginosa b. Escherichia coli c. Streptococcus pneumoniae d. Staphylococcus aureus

ANS: B A Pseudomonas aeruginosa is not associated with HUS. B Children with HUS become infected by Escherichia coli, which is usually contracted from eating improperly cooked meat or contaminated dairy products. C Streptococcus pneumoniae is not associated with HUS. D Staphylococcus aureus is not associated with HUS.

24. Which statement about Crohn disease is the most accurate? a. The signs and symptoms of Crohn disease are usually present at birth. b. Signs and symptoms of Crohn disease include abdominal pain, diarrhea, and often a palpable abdominal mass. c. Edema usually accompanies this disease. d. Symptoms of Crohn disease usually disappear by late adolescence.

ANS: B A Signs and symptoms are not usually present at birth. B Crohn disease can occur anywhere in the GI tract from the mouth to the anus and is most common in the terminal ileum. Signs and symptoms include abdominal pain, diarrhea (nonbloody), fever, palpable abdominal mass, anorexia, severe weight loss, fistulas, obstructions, and perianal and anal lesions. C Diarrhea and malabsorption from Crohn disease cause weight loss, anorexia, dehydration, and growth failure. Edema does not accompany this disease. D Crohn disease is a long-term health problem. Symptoms do not typically disappear by adolescence.

15. What is an expected outcome for the parents of a child with encopresis? a. The parents will give the child an enema daily for 3 to 4 months. b. The family will develop a plan to achieve control over incontinence. c. The parents will have the child launder soiled clothes. d. The parents will supply the child with a low-fiber diet.

ANS: B A Stool softeners or laxatives, along with dietary changes, are typically used to treat encopresis. Enemas are indicated when a fecal impaction is present. B Parents of the child with encopresis often feel guilty and believe that encopresis is willful on the part of the child. The family functions effectively by openly discussing problems and developing a plan to achieve control over incontinence. C This action is a punishment and will increase the child's shame and embarrassment. The child should not be punished for an action that is not willful. D Increasing fiber in the diet and fluid intake results in greater bulk in the stool, making it easier to pass.

11. Parents ask the nurse "when should our child's hypospadias be corrected?" The nurse responds based upon the knowledge that correction of hypospadias should be accomplished by the time the child is a. 1 month of age b. 6 to 12 months of age c. School age d. Sexually mature

ANS: B A Surgery to correct hypospadias is not performed when the infant is this young. B The correction of hypospadias should ideally be accomplished by the time the child is 6 to 12 months of age and before toilet training. C It is preferable for hypospadias to be surgically corrected before the child enters school so that the child has normal toileting behaviors in the presence of his peers. D Corrective surgery for hypospadias is done long before sexual maturity.

6. Which finding indicates that a child receiving prednisone for primary nephrotic syndrome is in remission? a. Urine is negative for casts for 5 days. b. Urine is up to a trace for protein for 5 to 7 days. c. Urine is positive for glucose for 1 week. d. Urine is up to a trace for blood for 1 week.

ANS: B A The absence of casts in the urine gives no indication about the child's response to treatment. The child with primary nephrotic syndrome is considered to be in remission when the urine is negative for protein for 5 to 7 consecutive days. B The child receiving steroids for the treatment of primary nephrotic syndrome is considered in remission when the urine is up to trace for protein for 5 to 7 days. C Remission is achieved when the urine is negative for protein for 5 to 7 consecutive days. It is not unusual for glucose to test positive if the child is taking prednisone. D The presence or absence of hematuria is not used to determine remission in primary nephrotic syndrome.

17. The nurse is teaching the parents of a child who has been diagnosed with irritable bowel syndrome about the pathophysiology associated with the symptoms their child is experiencing. Which response indicates to the nurse that her teaching has been effective? a. "My child has an absence of ganglion cells in the rectum causing alternating diarrhea and constipation." b. "The cause of my child's diarrhea and constipation is disorganized intestinal contractility." c. "My child has an intestinal obstruction; that's why he has abdominal pain." d. "My child has an intolerance to gluten, and this causes him to have abdominal pain."

ANS: B A The absence of ganglion cells in the rectum is associated with Hirschsprung disease. B Disorganized contractility and increased mucus production are precipitating factors of irritable bowel disease. C Intestinal obstruction is associated with pyloric stenosis. D Intolerance to gluten is the underlying cause of celiac disease.

8. What is an appropriate intervention for a child with nephrotic syndrome who is edematous? a. Teach the child to minimize body movements. b. Change the child's position every 2 hours. c. Avoid the use of skin lotions. d. Bathe every other day.

ANS: B A The child with edema is at risk for impaired skin integrity. It is important for the child to change position frequently to prevent skin breakdown. B Frequent position changes decrease pressure on body parts and help relieve edema in dependent areas. C Applying lotion to the skin helps to increase circulation. D Bathing daily removes irritating body secretions from the skin.

35. Which statement made by a parent indicates an understanding about the genetic transmission of cystic fibrosis (CF)? a. "Only one parent carries the cystic fibrosis gene." b. "Both parents are carriers of the cystic fibrosis gene." c. "The presence of the disease is most likely the result of a genetic mutation." d. "The mother is usually the carrier of the cystic fibrosis gene."

ANS: B A The disease will not be present if only one parent is a carrier of the cystic fibrosis gene. B Cystic fibrosis follows a pattern of autosomal recessive transmission. Both parents must be carriers of the gene for the disease to be transmitted to the child. If both parents carry the CF gene, each pregnancy has a 25% chance of producing a CF-affected child. C Cystic fibrosis is known to have a definite pattern of transmission. It is transmitted as an autosomal recessive trait. D A carrier parent can transmit the carrier gene to the child. The disease is present when the carrier gene is transmitted from both parents.

27. What is an expected outcome for a 1-month-old infant with biliary atresia? a. Correction of the defect with the Kasai procedure b. Adequate nutrition and age-appropriate growth and development c. Adherence to a salt-free diet with vitamin B12 supplementation d. Adequate protein intake

ANS: B A The goal of the Kasai procedure is to allow for adequate growth until a transplant can be done. It is not a curative procedure. B Adequate nutrition, preventing skin breakdown, adequate growth and development, and family education and support are expected outcomes in an infant with biliary atresia. C Vitamin B12 supplementation is not indicated. A salt-restricted diet is appropriate. D Protein intake may need to be restricted to avoid hepatic encephalopathy.

21. Which strategy is appropriate when feeding the infant with congestive heart failure? a. Continue the feeding until a sufficient amount of formula is taken. b. Limit feeding time to no more than 30 minutes. c. Always bottle feed every 4 hours. d. Feed larger volumes of concentrated formula less frequently.

ANS: B A The infant with congestive heart failure may tire easily. If the infant does not consume an adequate amount of formula in 30 minutes, gavage feedings should be considered. B The infant with congestive heart failure may tire easily, so the feeding should not continue beyond 30 minutes. If inadequate amounts of formula are taken, gavage feedings should be considered. C Infants with congestive heart failure may be breastfed. Feedings every 3 hours is a frequently used interval. If the infant were fed less frequently than every 3 hours, more formula would need to be consumed and would tire the infant. D The infant is fed smaller volumes of concentrated formula every 3 hours.

50. An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) and gastrostomy feedings. Nursing care should include a. Preparing family for impending death b. Teaching family signs of central venous catheter infection c. Teaching family how to calculate caloric needs d. Securing TPN and gastrostomy tubing under the diaper to lessen risk of dislodgment

ANS: B A The prognosis for patients with short bowel syndrome depends in part on the length of residual small intestine. It has improved with advances in TPN. B During TPN therapy, care must be taken to minimize the risk of complications related to the central venous access device, such as catheter infections, occlusions, or accidental removal. This is an important part of family teaching. C Although parents need to be taught about nutritional needs, the caloric needs and prescribed TPN and rate are the responsibility of the health care team. D The tubes should not be placed under the diaper due to risk of infection.

20. The nurse encourages the mother of a toddler with acute LTB to stay at the bedside as much as possible. The nurse's rationale for this action is primarily that a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease child's respiratory efforts. c. Separation from mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's respiratory efforts.

ANS: B A This is true, but not the best answer. B The family's presence will decrease the child's distress. C Although true for toddlers, the main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort. D The child should have constant monitoring by cardiorespiratory monitor and noninvasive oxygen saturation monitoring, but the parent should not play this role in the hospital.

18. Which factor predisposes the urinary tract to infection? a. Increased fluid intake b. Short urethra in young girls c. Prostatic secretions in males d. Frequent emptying of the bladder

ANS: B A This offers protective measures against UTIs. B The short urethra in females provides a ready pathway for invasions of organisms. C Prostatic secretions have antibacterial properties that inhibit bacteria. D This offers protective measures against UTIs.

1. What is the best response by the nurse to a mother asking about the cause of her infant's bilateral cleft lip? a. "Did you use alcohol during your pregnancy?" b. "Do you know of anyone in your family or the baby's father's family who was born with cleft lip or palate problems?" c. "This defect is associated with intrauterine infection during the second trimester." d. "The prevalent of cleft lip is higher in Caucasians"

ANS: B A Tobacco during pregnancy has been associated with bilateral cleft lip. B Cleft lip and palate result from embryonic failure resulting from multiple genetic and environmental factors. A genetic pattern or familial risk seems to exist. C The defect occurred at approximately 6 to 8 weeks of gestation. Second-trimester intrauterine infection is not a known cause of bilateral cleft lip. D The prevalence of cleft lip and palate is higher in Asian and Native American populations.

4. Diabetes insipidus is a disorder of the a. anterior pituitary. b. posterior pituitary. c. adrenal cortex. d. adrenal medulla.

ANS: B The principal disorder of posterior pituitary hypofunction is diabetes insipidus. ADH is produced in the hypothalamus and stored in the posterior pituitary gland. When ADH is not released appropriately by the posterior pituitary gland, DI occurs. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The adrenal cortex produces aldosterone, sex hormones, and glucocorticoids. The adrenal medulla produces catecholamines.

20. What is the nurse's best response to a parent with questions about how her child's blood disorder will be treated? a. "Your child may be able to receive home care." b. "What did the physician tell you?" c. "Blood diseases are transient, so there is no need to worry." d. "Your child will be tired for awhile and then be back to her old self."

ANS: B A Treatment depends on the child's condition and the type of blood disorder. Although it is possible that the child could be treated in the home, the child may need to be treated as an outpatient or in the hospital. It is best to first assess what the parent has been told by the physician. B Providing the parent an opportunity to express what she was told by the physician allows the nurse to assess the parent's understanding and provide further information. C Minimizing the parent's concern is inappropriate. D The nurse needs to assess the parent's knowledge before teaching about the disease.

10. What intervention can be taught to the parents of a 3-year-old child with pneumonia who is not hospitalized? a. Offer the child only cool liquids. b. Offer the child her favorite warm liquid drinks. c. Use a warm mist humidifier. d. Call the physician for a respiratory rate less than 28 breaths/min.

ANS: B A Warm liquids are preferable because they help loosen secretions. B Offering the child fluids that she likes will facilitate oral intake. Warm liquids help loosen secretions. C Cool mist humidifiers are preferred to warm mist. Warm mist is a safety concern and could cause burns if touched by the child. D Typically parents are not taught to count their children's respirations and report abnormalities to the physician. Even if this were the case, a respiratory rate of less than 28 breaths/min is normal for a 3-year-old child. The expected respiratory rate for a 3-year-old child is 20 to 30 breaths/min.

23. 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 beta-adrenergic receptor blockers

ANS: B A Weight control and diet is a non-pharmacologic treatment for primary hypertension. B Identification of the underlying disease should be the first step in treating secondary hypertension. C Digoxin is indicated in the treatment of congestive heart failure. D Beta-adrenergic receptor blockers are indicated in the treatment of primary hypertension.

7. The parent of a toddler calls the nurse, asking about croup. What is a distinguishing manifestation of spasmodic croup? a. Wheezing is heard audibly. b. It has a harsh, barky cough. c. It is bacterial in nature. d. The child has a high fever.

ANS: B A Wheezing is not a distinguishing manifestation of croup. It can accompany conditions such as asthma or bronchiolitis. B Spasmodic croup is viral in origin; is usually preceded by several days of symptoms of upper respiratory tract infection; often begins at night; and is marked by a harsh, metallic, barky cough; sore throat; inspiratory stridor; and hoarseness. C Spasmodic croup is viral in origin. D A high fever is not usually present.

12. The nurse discovers a heart murmur in an infant 1 hour after birth. She is aware that fetal shunts are closed in the neonate at what point? a. When the umbilical cord is cut b. Within several days of birth c. Within a month after birth d. By the end of the first year of life

ANS: B A With the neonate's first breath, gas exchange is transferred from the placenta to the lungs. The separation of the fetus from the umbilical cord does not contribute to the establishment of neonatal circulation. B In the normal neonate, fetal shunts functionally close in response to pressure changes in the systemic and pulmonary circulations and to increased oxygen content. This process may take several days to complete. C The fetal shunts normally close within several days of birth. D Fetal shunts normally close soon after birth but may take several days.

23. What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness? a. Give the child half his regular morning dose of insulin. b. Substitute simple carbohydrates or calorie-containing liquids for solid foods. c. Give the child plenty of unsweetened, clear liquids to prevent dehydration. d. Take the child directly to the emergency department.

ANS: B A sick-day diet of simple carbohydrates or calorie-containing liquids will maintain normal serum glucose levels and decrease the risk of hypoglycemia. The child should receive his regular dose of insulin even if he does not have an appetite. If the child is not eating as usual, he needs calories to prevent hypoglycemia. During periods of minor illness, the child with type 1 diabetes mellitus can be managed safely at home.

17. A young child with HIV is receiving several antiretroviral drugs. What is the purpose of these drugs? a. Cure the disease. b. Delay disease progression. c. Prevent the 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.

7. Parents of a child with lice infestation should be instructed carefully in the use of antilice products because of which potential side effect? a. Nephrotoxicity b. Neurotoxicity c. Ototoxicity d. Bone marrow depression

ANS: B Because of the danger of absorption through the skin and potential for neurotoxicity, antilice treatment must be used with caution. A child with many open lesions can absorb enough to cause seizures. Antilice products are not known to be nephrotoxic or ototoxic and do not cause bone marrow depression.

32. During a well-child visit, the nurse identifies that an 18-month-old infant is bowlegged. What action by the nurse is most appropriate? a. Assess the infant's diet history. b. Document the finding in the chart. c. Facilitate a referral to an orthopedist. d. Perform further assessment of the musculoskeletal system.

ANS: B Bowlegs are common in infants and toddlers. The nurse only needs to document the findings. No other actions are required.

25. Juvenile arthritis should be suspected in a child who exhibits a. frequent fractures. b. joint swelling and pain lasting longer than 6 weeks. c. increased joint mobility. d. lurching and abnormal gait with limited abduction.

ANS: B Intermittent joint pain lasting longer than 6 weeks is indicative of juvenile arthritis. Frequent fractures are indicative of osteogenesis imperfecta. Lurching to the affected side and an abnormal gait and limited abduction are associated with developmental dysplasia of the hip (DDH).

14. What is the primary nursing concern for a child having an anaphylactic reaction? a. Identifying the offending allergen b. Ineffective breathing pattern c. Increased cardiac output d. Positioning to facilitate comfort

ANS: B Laryngospasms resulting in ineffective breathing patterns is a life-threatening manifestation of anaphylaxis. The primary action is to assess airway patency, respiratory rate and effort, level of consciousness, oxygen saturation, and urine output. Determining the cause of an anaphylactic reaction is important to implement the appropriate treatment, but the primary concern is the airway. During anaphylaxis, the cardiac output is decreased. Positioning for comfort is not a primary concern during a crisis.

8. Which instruction 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. Arrange for tutoring and school work c. Instructions for a high-fiber diet d. Instructions to return the child to school as soon as possible

ANS: B Promoting optimal growth and development in the school-age child is important. It is important to continue school work and arrange for tutoring if indicated. The child with osteomyelitis is on a high-calorie, high-protein diet. A high-fiber diet may or may not be indicated. The bone must heal before the child returns to school.

15. During painful episodes of juvenile arthritis, a plan of care should include what nursing intervention? a. A weight-control diet to decrease stress on the joints b. Proper positioning of the affected joints to prevent musculoskeletal complications c. Complete bed rest to decrease stress to joints d. High-resistance exercises to maintain muscular tone in the affected joints

ANS: B Proper positioning is important to support and protect affected joints. Isometric exercises and passive range-of-motion exercises will prevent contractures and deformities. Children in pain often are anorexic and need high-calorie foods. Children with juvenile arthritis need a combination of rest and exercise. Children with juvenile arthritis need to avoid high-resistance exercises, and they benefit from low-resistance exercises, such as swimming.

23. Ringworm, frequently found in schoolchildren, is caused by a(n) a. virus. b. fungus. c. allergic reaction. d. bacterial infection.

ANS: B Ringworm is caused by a group of closely related filamentous fungi, which invade primarily the stratum corneum, hair, and nails. They are superficial infections that live on, not in, the skin. Ringworm is not caused by a virus, an allergic reactions, or a bacterial infection.

28. Rocky Mountain spotted fever is caused by the bite of a a. flea. b. tick. c. mosquito. d. mouse or rat.

ANS: B Rocky Mountain spotted fever is caused by a tick. The tick must attach and feed for at least 1 to 2 hours to transmit the disease. The usual habitat of the tick is in heavily wooded areas. The other organisms do not transmit Rocky Mountain spotted fever.

6. Which is the Centers for Disease Control and Prevention (CDC, 2009) recommendation for immunizing infants who are HIV positive? a. Follow the routine immunization schedule. b. Routine immunizations are administered; assess CD4+ counts before administering the MMR and varicella vaccinations. c. Do not give immunizations because of the infant's altered immune status. d. Eliminate the pertussis vaccination because of the risk of convulsions.

ANS: B Routine immunizations are appropriate. CD4+ cells are monitored when deciding whether to provide live virus vaccines. If the child is severely immunocompromised, the MMR vaccine is not given. The varicella vaccine can be considered on the basis of the child's CD4+ counts. Only inactivated polio virus (IPV) should be used for HIV-infected children. The pertussis vaccination is not eliminated for an infant who is HIV positive.

26. Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis? a. No urinary ketones b. Low arterial pH c. Elevated serum carbon dioxide d. Elevated serum phosphorus

ANS: B Severe insulin deficiency produces metabolic acidosis, which is indicated by a low arterial pH. Urinary ketones, often in large amounts, are present when a child is in diabetic ketoacidosis. Serum carbon dioxide is decreased in diabetic ketoacidosis. Serum phosphorus is decreased in diabetic ketoacidosis.

21. A boy who has fractured his forearm is unable to extend his fingers. The nurse knows that this a. is normal following this type of injury. b. may indicate compartment syndrome. c. may indicate fat embolism. d. may indicate damage to the epiphyseal plate.

ANS: B Swelling causes pressure to rise within the immobilizing device leading to compartment syndrome. Signs include severe pain, often unrelieved by analgesics, and neurovascular impairment. It is not uncommon in the forearm, so the inability to extend the fingers may indicate compartment syndrome. This is not normal and indicates neurovascular compromise of some type. Paresthesia or numbness or loss of feeling can indicate a serious problem and can result in paralysis. The inability to extend the fingers often indicates neurovascular compromise. Fat embolism causes respiratory distress with hypoxia and respiratory acidosis. This is not related to damage to the epiphyseal plate.

30. Which factor should the nurse include when teaching a parent about the care of a newborn in a Pavlik harness for hip dysplasia? a. The harness may be removed with every diaper change. b. The harness maintains the hips in flexion, abduction, and external rotation. c. The harness is only the first step of treatment. d. The harness is worn for 2 weeks.

ANS: B The harness is used to maintain the infant's hips in flexion and external rotation to allow the hips (femoral head and acetabulum) to mold and grow normally. The harness must be worn for 23 hours per day and should be removed only according to the physician's recommendation. Hips that remain unstable become progressively more deformed as maturity takes place. With early diagnosis and treatment, the Pavlik harness is often the only treatment necessary. The length of treatment is determined by radiographic documentation of the maturity of the hips.

16. When assessing a child for an upper extremity fracture, the nurse should know that these fractures most often result from a. automobile crashes. b. falls. c. physical abuse. d. sports injuries.

ANS: B The major cause of children's fractures is falls. Because of the protection reflexes, the outstretched arm often receives the full force of the fall. Crashes, physical abuse, and sports injuries can also occur but not as often.

A child with non-Hodgkin lymphoma will be starting chemotherapy. What intervention is initiated before chemotherapy to prevent tumor lysis syndrome? a. Insertion of a central venous catheter b. Intravenous (IV) hydration containing sodium bicarbonate c. Placement of an externalized ventriculoperitoneal (VP) shunt d. Administration of pneumococcal and Haemophilus influenzae type B vaccines

ANS: B Feedback A A central venous catheter is placed to assist in delivering chemotherapy. B Intensive hydration with an IV fluid containing bicarbonate alkalinizes the urine to help prevent the formation of uric acid crystals, which damage the kidney. C An externalized VP shunt may be placed to relieve intracranial pressure caused by a brain tumor. D If a splenectomy is necessary for a child with Hodgkin disease, the pneumococcal and Haemophilus influenzae vaccines are administered before the surgery.

What is an expected physical assessment finding for an adolescent with a diagnosis of Hodgkin disease? a. Protuberant, firm abdomen b. Enlarged, painless, firm cervical lymph nodes c. Soft tissue swelling d. Soft to hard, nontender mass in pelvic area

ANS: B Feedback A A protuberant, firm abdomen is present in many cases of neuroblastoma. B Painless, firm, movable adenopathy (enlarged lymph nodes) palpated in the cervical region is an expected assessment finding in Hodgkin disease. Other systemic symptoms include unexplained fevers, weight loss, and night sweats. C Soft tissue swelling around the affected bone is a manifestation of Ewing sarcoma. D A soft to hard, nontender mass can be palpated when rhabdomyosarcoma is present.

The nurse understands that the type of precautions needed for children receiving chemotherapy is based on which actions of chemotherapeutic agents? a. Gastrointestinal upset b. Bone marrow suppression c. Decreased creatinine level d. Alopecia

ANS: B Feedback A Although gastrointestinal upset may be an adverse effect of chemotherapy, it is not caused by all chemotherapeutic agents. No special precautions are instituted for gastrointestinal upset. B Chemotherapy agents cause bone marrow suppression, which creates the need to institute precautions related to reduced white blood cell, red blood cell, and platelet counts. These precautions focus on preventing infection and bleeding. C A decreased creatinine level is consistent with renal pathologic conditions, not chemotherapy. D Not all chemotherapeutic agents cause alopecia. No precautions are taken to prevent alopecia.

What is an appropriate nursing action before surgery when caring for a child diagnosed with a Wilms' tumor? a. Limit fluid intake. b. Do not palpate the abdomen. c. Force oral fluids. d. Palpate the abdomen every 4 hours.

ANS: B Feedback A Fluids are not routinely limited in a child with a Wilms' tumor. However, intake and output are important because of the kidney involvement. B Excessive manipulation of the tumor area can cause seeding of the tumor and spread of the malignant cells. C Fluids are not forced on a child with a Wilms' tumor. Normal intake for age is usually maintained. D The abdomen of a child with a Wilms' tumor should never be palpated because of the danger of seeding the tumor and spreading malignant cells.

What is a priority nursing diagnosis for the 4-year-old child newly diagnosed with leukemia? a. Ineffective Breathing Pattern related to mediastinal disease b. Risk for Infection related to immunosuppressed state c. Disturbed Body Image related to alopecia d. Impaired Skin Integrity related to radiation therapy

ANS: B Feedback A This nursing diagnosis applies to a child with non-Hodgkin lymphoma or any cancer involving the chest area. B Leukemia is characterized by the proliferation of immature white blood cells, which lack the ability to fight infection. C This is a nursing diagnosis related to chemotherapy, but it is not of the highest priority. Not all children have a body image disturbance as a result of alopecia, especially not preschoolers. This would be of more concern to an adolescent. D Radiation therapy is not a treatment for leukemia.

While completing an assessment on a 6-month-old infant, which finding should the nurse recognize as a symptom of a brain tumor in an infant? a. Blurred vision b. Increased head circumference c. Vomiting when getting out of bed d. Headache

ANS: B Feedback A Visual changes such as nystagmus, diplopia, and strabismus are manifestations of a brain tumor but would not be able to be verbalized by an infant. B Manifestations of brain tumors vary with tumor location and the child's age and development. Infants with brain tumors may be irritable or lethargic, feed poorly, and have increased head circumference with a bulging fontanel. C The change in position on awakening causes an increase in intracranial pressure, which is manifested as vomiting. Vomiting on awakening is considered a hallmark symptom of a brain tumor, but infants do not get themselves out of bed in the morning. D Increased intracranial pressure resulting from a brain tumor is manifested as a headache but could not be verbalized by an infant.

The nurse is caring for a child with aplastic anemia. What 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 Correct 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). Incorrect: 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 von Willebrand disease.

A nurse is planning care for a child admitted with nephrotic syndrome. Which interventions should be included in the plan of care? Select all that apply. a. Administration of antihypertensive medications b. Daily weights c. Salt-restricted diet d. Frequent position changes e. Teaching parents to expect tea-colored urine

ANS: B, C, D Correct: A child with nephrotic syndrome will need to be monitored closely for fluid excess so daily weights are important. The diet is salt restricted to prevent further retention of fluid. Because of the fluid excess, frequent position changes are required to prevent skin breakdown. Incorrect: Nephrotic syndrome does not require antihypertensive medications. These are administered for acute glomerulonephritis. Tea-colored urine is expected with acute glomerulonephritis, but not nephrotic syndrome. The urine in nephrotic syndrome is frothy indicating protein is being lost in the urine.

You are the nurse caring for a child with celiac disease. Which food choices by the child's parent indicate understanding of teaching? Select all that apply. a. Oatmeal b. Steamed rice c. Corn on the cob d. Baked chicken e. Peanut butter and jelly sandwich on wheat bread

ANS: B, C, D Correct: Rice is an appropriate choice because it does not contain gluten. Corn is digestible because it does not contain gluten. Meats do not contain gluten and can be included in the diet of a child with celiac disease. Incorrect: The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Oatmeal contains gluten and is not an appropriate food selection. Wheat bread is not appropriate.

. As a nurse working in the newborn nursery, you notice an infant who is having circumoral cyanosis. Which CHD do you suspect the child may have? Select all that apply. a. Patent ductus arteriosus (PDA) b. Tetralogy of Fallot c. Pulmonary atresia d. Transposition of the great arteries e. Ventricular septal defect

ANS: B, C, D Correct: Tetralogy of Fallot is a cyanotic lesion with decreased pulmonary blood flow. The hypoxia results in baseline oxygen saturations as low as 75% to 85%. Even with oxygen administration, saturations do not reach the normal range. Pulmonary atresia is a cyanotic lesion with decreased pulmonary blood flow. The hypoxia results in baseline oxygen saturations as low as 75% to 85%. Even with oxygen administration, saturations do not reach the normal range. Transposition of the great arteries is a cyanotic lesion with increased pulmonary blood flow. Incorrect: PDA is failure of the fetal shunt between the aorta and the pulmonary artery to close. PDA is not classified as a cyanotic heart disease. Prostaglandin E1 is often given to maintain ductal patency in children with cyanotic heart diseases. VSD is the most common type of cardiac defect. The VSD is a left-to-right shunting defect; however, it may be accompanied by other defects.

The nurse is providing home care instructions to the parents of an infant being discharged after repair of a bilateral cleft lip. Which instructions should the nurse include? Select all that apply. a. Acetaminophen (Tylenol) should not be given to your infant. b. Feed your infant in an upright position. c. Place your infant prone for a period of time each day. d. Burp your child frequently during feedings. e. Apply antibiotic ointment to the lip as prescribed.

ANS: B, D, E Correct: After cleft lip surgery the parents are taught to feed the infant in an upright position to decrease the chance of choking. The parents are taught to burp the infant frequently during feedings because excess air is often swallowed. Parents are taught to cleanse the suture line area with a cotton swab using a rolling motion and apply antibiotic ointment with the same technique. Incorrect: Tylenol is used for pain and the child should never be placed prone as this position can you damage the suture line.

A child with a brain tumor is undergoing radiation therapy. What should the nurse include in the discharge instructions to the child's parents? Select all that apply. a. Apply over-the-counter creams to the area daily. b. Avoid excessive skin exposure to the sun. c. Use a washcloth when cleaning the area receiving radiation. d. Plan for adequate rest periods for the child. e. A darkening of the skin receiving radiation is expected.

ANS: B, D, E Feedback Correct: Children receiving cranial radiation are particularly affected by fatigue and an increased need for sleep during and shortly after completion of the course of radiation. Skin damage can include changes in pigmentation (darkening), redness, peeling, and increased sensitivity. Incorrect: Extra care must be taken to avoid excessive skin exposure to heat, sunlight, friction (such as rubbing with a towel or washcloth), and creams or moisturizers. Only topical creams and moisturizers prescribed by the radiation oncologist should be applied to the radiated skin.

1. What is the best response to a parent who asks the nurse whether her 5-month-old infant can have cow's milk? a. "You need to wait until she is 8 months old and eating solids well." b. "Yes, if you think that she will eat enough meat to get the iron she needs." c. "Infants younger than 12 months need iron-rich formula to get the iron they need." d. "Try it and see how she tolerates it."

ANS: C A A 5-month-old infant cannot get adequate iron without drinking an iron-fortified formula or taking an iron supplement. B The American Academy of Pediatrics recommends beginning solid foods at 4 to 6 months of age. Meats are typically introduced in later infancy. Iron-fortified formula is still recommended. C Infants younger than 12 months need iron-fortified formula or breast milk. Infants who drink cow's milk do not get adequate iron and are at risk for iron deficiency anemia. D Counseling a parent to give a 5-month-old infant cow's milk is inappropriate.

34. What goal has the highest priority for a child with malabsorption associated with lactose intolerance? a. The child will experience no abdominal spasms. b. The child will not experience constipation associated with malabsorption syndrome. c. The child will not experience diarrhea associated with malabsorption syndrome. d. The child will receive adequate nutrition as evidenced by a weight gain of 1 kg/day.

ANS: C A A child usually has abdominal cramping pain and distention rather than spasms. B The child usually has diarrhea, not constipation. C This goal is correct for a child with malabsorption associated with lactose intolerance. D One kilogram a day is too much weight gain with no time parameters.

14. Teaching safety precautions with the administration of antihistamines is important because of what common side effect? a. Dry mouth b. Excitability c. Drowsiness d. Dry mucous membranes

ANS: C A A dry mouth is not a safety issue. B Excitability may affect rest or sleep, but drowsiness is the most important safety hazard. C Drowsiness is a safety hazard when alertness is needed, especially with a teenage driver. Nonsedating brands should be used. D Dry mucous membranes are not a safety issue.

5. What maternal assessment is related to an infant's diagnosis of TEF? a. Maternal age more than 40 years b. First term pregnancy for the mother c. Maternal history of polyhydramnios d. Complicated pregnancy

ANS: C A Advanced maternal age is not a risk factor for TEF. B The first term pregnancy is not a risk factor for an infant with TEF. C A maternal history of polyhydramnios is associated with TEF. D Complicated pregnancy is not a risk factor for TEF.

26. A father calls the clinic nurse because his 2-year-old child was bitten by a black widow spider. The nurse should advise the father to a. apply warm compresses. b. carefully scrape off the stinger. c. take the child to the emergency department. d. apply a thin layer of corticosteroid cream.

ANS: C The black widow spider has a venom that is toxic enough to be harmful. The father should take the child to the emergency department for immediate treatment. The other actions are contraindicated.

12. Which statement best describes beta-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.

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

14. Which condition is characterized by a history of bloody diarrhea, fever, abdominal pain, and low hemoglobin and platelet counts? a. Acute viral gastroenteritis b. Acute glomerulonephritis c. Hemolytic-uremic syndrome d. Acute nephrotic syndrome

ANS: C A Anemia and thrombocytopenia are not associated with acute gastroenteritis. B The symptoms described are not suggestive of acute glomerulonephritis. C Hemolytic-uremic syndrome is an acute disorder characterized by anemia, thrombocytopenia, and acute renal failure. Most affected children have a history of gastrointestinal symptoms, including bloody diarrhea. D The symptoms described are not suggestive of nephrotic syndrome.

23. What is a priority concern for a 14-year-old child with inflammatory bowel disease? a. Compliance with antidiarrheal medication therapy b. Long-term complications c. Dealing with the embarrassment and stress of diarrhea d. Home schooling

ANS: C A Antidiarrheal medications are not typically ordered for a child with inflammatory bowel disease. B Long-term complications are not a priority concern for the adolescent with inflammatory bowel disease. C Embarrassment and stress from chronic diarrhea are real concerns for the adolescent with inflammatory bowel disease. D Exacerbations may interfere with school attendance, but home schooling is not a usual consideration for the adolescent with inflammatory bowel disease.

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

ANS: C A Blood pressure measurements for upper and lower extremities are compared during an assessment for CHDs. B Discrepancies in blood pressure between the upper and lower extremities cannot be determined if blood pressure is not measured in all four extremities. 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.

27. The nurse is admitting a child who has been diagnosed with Kawasaki disease. What is the most serious complication for which the nurse should assess in Kawasaki disease? a. Cardiac valvular disease b. Cardiomyopathy c. Coronary aneurysm d. Rheumatic fever

ANS: C A Cardiac valvular disease can occur in rheumatic fever. B Cardiomyopathies are diseases of the heart muscle, which can occur as a result of congenital heart disease, coronary artery disease, or other systemic disease. C Coronary artery aneurysms are seen in 20% to 25% of children with untreated Kawasaki disease. D Rheumatic fever is not a complication of Kawasaki disease.

11. How should the nurse respond when asked by the mother of a child with beta-thalassemia why the child is receiving deferoxamine? a. "To improve the anemia." b. "To decrease liver and spleen swelling." c. "To eliminate excessive iron being stored in the organs." d. "To prepare your child for a bone marrow transplant."

ANS: C A Chronic transfusion therapy is the treatment for anemia. Deferoxamine is administered to prevent complications from repeated transfusions. B Deferoxamine is used to prevent organ damage, not as a treatment for existing conditions such as hepatosplenomegaly. C Multiple transfusions result in hemosiderosis. Deferoxamine is given to chelate iron and prevent organ damage. D Preparation for a bone marrow transplant does not include administration of deferoxamine.

25. Therapeutic management of the child with acute diarrhea and dehydration usually begins with a. Clear liquids b. Adsorbents, such as kaolin and pectin c. Oral rehydration solution (ORS) d. Antidiarrheal medications such as paregoric

ANS: C A Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. B Adsorbents are not recommended. C Orally administered rehydration solution is the first treatment for acute diarrhea. D Antidiarrheals are not recommended because they do not get rid of pathogens.

7. What is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux? a. Teach parents to position the infant on the left side. b. Reinforce the parents' knowledge of the infant's developmental needs. c. Teach the parents how to do infant cardiopulmonary resuscitation (CPR). d. Have the parents keep an accurate record of intake and output.

ANS: C A Correct positioning minimizes aspiration. The correct position for the infant is on the right side after feeding and supine for sleeping. B Knowledge of developmental needs should be included in discharge planning for all hospitalized infants, but it is not the most important in this case. C Risk of aspiration is a priority nursing diagnosis for the infant with gastroesophageal reflux. The parents must be taught infant CPR. D Keeping a record of intake and output is not a priority and may not be necessary.

19. What is a priority intervention in planning care for the child with disseminated intravascular coagulation (DIC)? a. Hospitalization at the first sign of bleeding b. Teaching the child relaxation techniques for pain control c. Management in the intensive care unit d. Provision of adequate hydration to prevent complications

ANS: C A DIC typically develops in a child who is already hospitalized. B Relaxation techniques and pain control are not high priorities for the child with DIC. C The child with DIC is seriously ill and needs to be monitored in an intensive care unit. D Hydration is not the major concern for the child with DIC.

8. Which intervention for treating croup at home should be taught to parents? a. Have a decongestant available to give the child when an attack occurs. b. Have the child sleep in a dry room. c. Take the child outside. d. Give the child an antibiotic at bedtime.

ANS: C A Decongestants are inappropriate for croup, which affects the middle airway level. B A dry environment may contribute to symptoms. C Taking the child into the cool, humid, night air may relieve mucosal swelling and improve symptoms. D Croup is caused by a virus. Antibiotic treatment is not indicated.

9. A nurse has admitted a child to the hospital with a diagnosis of "rule out" peptic ulcer disease. Which test will the nurse expect to be ordered to confirm the diagnosis of a peptic ulcer? a. A dietary history b. A positive Hematest result on a stool sample c. A fiberoptic upper endoscopy d. An abdominal ultrasound

ANS: C A Dietary history may yield information suggestive of a peptic ulcer, but the diagnosis is confirmed through endoscopy. B Blood in the stool indicates a gastrointestinal abnormality, but it does not conclusively confirm a diagnosis of peptic ulcer. C Endoscopy provides direct visualization of the stomach lining and confirms the diagnosis of peptic ulcer. D An abdominal ultrasound is used to rule out other gastrointestinal alterations such as gallstones, tumor, or mechanical obstruction.

22. What is a common trigger for asthma attacks in children? a. Febrile episodes b. Dehydration c. Exercise d. Seizures

ANS: C A Febrile episodes are consistent with other problems, for example, seizures. B Dehydration occurs as a result of diarrhea; it does not trigger asthma attacks. Viral infections are triggers for asthma. C Exercise is one of the most common triggers for asthma attacks, particularly in school-age children. D Seizures can result from a too-rapid intravenous infusion of theophylline—a therapy for asthma.

38. Which viral pathogen frequently causes acute diarrhea in young children? a. Giardia organisms b. Shigella organisms c. Rotavirus d. Salmonella organisms

ANS: C A Giardia is a bacterial pathogen that causes diarrhea. B Shigella is a bacterial pathogen that is uncommon in the United States. C Rotavirus is the most frequent viral pathogen that causes diarrhea in young children. D Salmonella is a bacterial pathogen that causes diarrhea.

38. Which finding confirms a diagnosis of cystic fibrosis? a. Chest radiograph shows alveolar hyperinflation. b. Stool analysis indicates significant amounts of fecal fat. c. Sweat chloride is greater than 60 mEq/L. d. Liver function levels are abnormal.

ANS: C A Hyperinflation is one of the first findings on a chest radiograph of a child with cystic fibrosis. It does not confirm a diagnosis. B A 72-hour fecal fat determination may be included in a diagnostic workup. Inability to secrete digestive enzymes causes steatorrhea. C The diagnosis of cystic fibrosis requires a positive sweat test. A chloride level greater than 60 mEq/L is considered diagnostic for cystic fibrosis. D Liver function tests may be part of the diagnostic workup for cystic fibrosis.

26. A major complication in a child with chronic renal failure is a. Hypokalemia b. Metabolic alkalosis c. Water and sodium retention d. Excessive excretion of blood urea nitrogen

ANS: C A Hyperkalemia is a complication of chronic renal failure. B Metabolic acidosis is a complication of chronic renal failure. C Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. D Retention of blood urea nitrogen is a complication of chronic renal failure.

2. The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding? a. Increased urine output b. Hypotension c. Tea-colored urine d. Weight gain

ANS: C A In acute poststreptococcal glomerulonephritis the urine output may be decreased. B In acute poststreptococcal glomerulonephritis blood pressure may be increased. C Acute poststreptococcal glomerulonephritis is characterized by hematuria, proteinuria, edema, and renal insufficiency. Tea-colored urine is an indication of hematuria. D Edema may be noted around the eyelids and ankles in patients with acute poststreptococcal glomerulonephritis; however, weight gain is associated with nephrotic syndrome.

36. A small child with cystic fibrosis cannot swallow pancreatic enzyme capsules. The nurse should teach parents to mix enzymes with: a. Macaroni and cheese b. Tapioca c. Applesauce d. Hot chocolate

ANS: C A Macaroni and cheese is not a good choice because enzymes are inactivated by heat and starchy foods. B Tapioca is not a good choice because enzymes are inactivated by starchy foods. C Enzymes can be mixed with a small amount of nonacidic foods. D Enzymes are less effective if mixed with foods that are hot.

12. Once an allergen is identified in a child with allergic rhinitis, the treatment of choice about which to educate the parents is a. Using appropriate medications b. Beginning desensitization injections c. Eliminating the allergen d. Removing the adenoids

ANS: C A Medications are not a first-line treatment but can be helpful in controlling allergic rhinitis. B Immunotherapy is usually the final component of controlling allergic rhinitis. C The first priority is to attempt to remove the causative agent from the child's environment. D Adenoids are tissues that can swell with constant rhinitis; however, a surgical procedure is not indicated for allergic rhinitis. Dealing with the cause is the first priority.

11. What is the major focus of the therapeutic management for a child with lactose intolerance? a. Compliance with the medication regimen. b. Providing emotional support to family members. c. Teaching dietary modifications. d. Administration of daily normal saline enemas.

ANS: C A Medications are not typically ordered in the management of lactose intolerance. B Providing emotional support to family members is not specific to this medical condition. C Simple dietary modifications are effective in management of lactose intolerance. Symptoms of lactose intolerance are usually relieved after instituting a lactose-free diet. D Diarrhea is a manifestation of lactose intolerance. Enemas are contraindicated for this alteration in bowel elimination.

31. The nurse caring for a child with suspected appendicitis should question which order from the physician? a. Keep patient NPO. b. Start IV of D5/0.45 normal saline at 60 mL/hr. c. Apply K-pad to abdomen prn for pain. d. Obtain CBC on admission to nursing unit.

ANS: C A NPO status is appropriate for the potential appendectomy patient. B An IV is appropriate both as a preoperative intervention and to compensate for the short-term NPO status. C A K-pad (moist heat device) is contraindicated for suspected appendicitis because it may contribute to the rupture of the appendix. D Because appendicitis is frequently reflected in an elevated WBC, laboratory data are needed.

23. Which child requires a Mantoux test? a. The child who has episodes of nighttime wheezing and coughing b. The child who has a history of allergic rhinitis c. The child whose baby-sitter has received a tuberculosis diagnosis d. The premature infant who is being treated for apnea of infancy

ANS: C A Nighttime wheezing and coughing are consistent with a diagnosis of asthma. B Allergic rhinitis requires an allergy workup. C The Mantoux test is the initial screening mechanism for patients exposed to tuberculosis. D This infant requires a sleep study as part of the evaluation.

23. The most appropriate nursing diagnosis for the child with acute glomerulonephritis is a. Risk for Injury related to malignant process and treatment b. Deficient Fluid Volume related to excessive losses c. Risk for Imbalanced Fluid Volume related to a decrease in plasma filtration d. Excess Fluid Volume related to fluid accumulation in tissues and third spaces

ANS: C A No malignant process is involved in acute glomerulonephritis. B Excess fluid volume is found. C Glomerulonephritis has a decreased filtration of plasma. The resulting decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. D The fluid accumulation is secondary to the decreased plasma filtration.

28. A nurse is conducting a class for nursing students about fetal circulation. Which statement is accurate about fetal circulation and should be included in the teaching session? a. Oxygen is carried to the fetus by the umbilical arteries. b. Blood from the inferior vena cava is shunted directly to the right ventricle through the foramen ovale. c. Pulmonary vascular resistance is high because the lungs are filled with fluid. d. Blood flows from the ductus arteriosus to the pulmonary artery.

ANS: C A Oxygen and nutrients are carried to the fetus by the umbilical vein. B The inferior vena cava empties blood into the right atrium. The direction of blood flow and the pressure in the right atrium propel most of this blood through the foramen ovale into the left atrium. C Resistance in the pulmonary circulation is very high because the lungs are collapsed and filled with fluid. D Most of the blood in the pulmonary artery flows though the ductus arteriosus into the descending aorta.

32. Which statement, if made by parents of a child with cystic fibrosis, indicates that they understood the nurse's teaching on pancreatic enzyme replacement? a. "Enzymes will improve my child's breathing." b. "I should give the enzymes 1 hour after meals." c. "Enzymes should be given with meals and snacks." d. "The enzymes are stopped if my child begins wheezing."

ANS: C A Pancreatic enzymes do not affect the respiratory system. B Pancreatic enzymes are taken within 30 minutes of eating all meals and snacks. Giving the medication 1 hour after meals is inappropriate and ineffective for absorption of nutrients. C Children with cystic fibrosis need to take enzymes with food for adequate absorption of nutrients. D Wheezing is not a reason to stop taking enzyme replacements.

6. What clinical manifestation should a nurse be alert for when suspecting a diagnosis of esophageal atresia? a. A radiograph in the prenatal period indicates abnormal development. b. It is visually identified at the time of delivery. c. A nasogastric tube fails to pass at birth. d. The infant has a low birth weight.

ANS: C A Prenatal radiographs do not provide a definitive diagnosis. B The defect is not externally visible. Bronchoscopy and endoscopy can be used to identify this defect. C Atresia is suspected when a nasogastric tube fails to pass 10 to 11 cm beyond the gum line. Abdominal radiographs will confirm the diagnosis. D Infants with esophageal atresia may have been born prematurely and with a low birth weight, but neither is suggestive of the presence of an esophageal atresia.

22. A nurse is teaching an adolescent about primary hypertension. Which statement made by the adolescent indicates an understanding of primary hypertension? 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 A Primary hypertension is usually treated with weight reduction and exercise. If ineffective, pharmacologic intervention may be needed. B Primary hypertension is considered to be an inherited disorder. C Primary hypertension in children may be treated with weight reduction and exercise programs. D An exercise program in conjunction with weight reduction can be effective in managing primary hypertension in children.

27. The diet of a child with chronic renal failure is usually characterized as a. High in protein b. Low in vitamin D c. Low in phosphorus d. Supplemented with vitamins A, E, and K

ANS: C A Protein should be limited in chronic renal failure to decrease intake of phosphorus. B Vitamin D therapy is administered in chronic renal failure to increase calcium absorption. C Dietary phosphorus is controlled to prevent or control the calcium/phosphorus imbalance by the reduction of protein and milk intake. D Supplementation of vitamins A, E, and K is not part of dietary management in chronic renal disease.

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

ANS: C A Pulmonic stenosis is an obstruction to blood flowing from the ventricles. B Tricuspid atresia results in decreased pulmonary blood flow. C The 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. D Transposition of the great arteries results in mixed blood flow.

22. Which description of a stool is characteristic of intussusception? a. Ribbon-like stools b. Hard stools positive for guaiac c. "Currant jelly" stools d. Loose, foul-smelling stools

ANS: C A Ribbon-like stools are characteristic of Hirschsprung disease. B With intussusception, passage of bloody mucus stools occurs. Stools will not be hard. C Pressure on the bowel from obstruction leads to passage of "currant jelly" stools. D Loose, foul-smelling stools may indicate infectious gastroenteritis.

33. Which parasite causes acute diarrhea? a. Shigella organisms b. Salmonella organisms c. Giardia lamblia d. Escherichia coli

ANS: C A Shigella is a bacterial pathogen. B Salmonella is a bacterial pathogen. C Giardiasis a parasite that represents 15% of nondysenteric illness in the United States. D E. coli is a bacterial pathogen.

8. What 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 A Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension. B When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation. 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. D Increased red blood cell destruction occurs.

4. Which statement made by a parent indicates an understanding about treatment of streptococcal pharyngitis? a. "I guess my child will need to have his tonsils removed." b. "A couple of days of rest and some ibuprofen will take care of this." c. "I should give the penicillin three times a day for 10 days." d. "I am giving my child prednisone to decrease the swelling of the tonsils."

ANS: C A Surgical removal of the tonsils is a controversial issue. It may be warranted in cases of recurrent tonsillitis. It is not indicated for the treatment of acute tonsillitis. B Comfort measures such as rest and analgesics are indicated, but these will not treat the bacterial infection. C Streptococcal pharyngitis is best treated with oral penicillin two to three times daily for 10 days. D Corticosteroids are not used in the treatment of streptococcal pharyngitis.

46. Which statement best characterizes hepatitis A? a. Incubation period is 6 weeks to 6 months. b. Principal mode of transmission is through the parenteral route. c. Onset is usually rapid and acute. d. There is a persistent carrier state.

ANS: C A The incubation period is approximately 3 weeks for hepatitis A. B The principal mode of transmission for hepatitis A is the fecal-oral route. C Hepatitis A is the most common form of acute hepatitis in most parts of the world. It is characterized by a rapid acute onset. D Hepatitis A does not have a carrier state.

8. What information should the nurse include when teaching the parents of a 5-week-old infant about pyloromyotomy? a. The infant will be in the hospital for a week. b. The surgical procedure is routine and "no big deal." c. The prognosis for complete correction with surgery is good. d. They will need to ask the physician about home care nursing.

ANS: C A The infant will remain in the hospital for a day or two postoperatively. B Although the prognosis for surgical correction is good, telling the parents that surgery is "no big deal" minimizes the infant's condition. C Pyloromyotomy is the definitive treatment for pyloric stenosis. Prognosis is good with few complications. These comments reassure parents. D Home care nursing is not necessary after a pyloromyotomy.

2. The postoperative care plan for an infant with surgical repair of a cleft lip includes a. A clear liquid diet for 72 hours b. Nasogastric feedings until the sutures are removed c. Elbow restraints to keep the infant's fingers away from the mouth d. Rinsing the mouth after every feeding

ANS: C A The infant's diet is advanced from clear liquid to soft foods within 48 hours of surgery. B After surgery, the infant can resume preoperative feeding techniques. C Keeping the infant's hands away from the incision reduces potential complications at the surgical site. D Rinsing the mouth after feeding is an inappropriate intervention. Feeding a small amount of water after feedings will help keep the mouth clean. A cleft lip repair site should be cleansed with a wet sterile cotton swab after feedings.

2. For which problem should the child with chronic otitis media with effusion be evaluated? a. Brain abscess b. Meningitis c. Hearing loss d. Perforation of the tympanic membrane

ANS: C A The infection of acute otitis media can spread to surrounding tissues, causing a brain abscess. B The infection of acute otitis media can spread to surrounding tissues, causing meningitis. C Chronic otitis media with effusion is the most common cause of hearing loss in children. D Inflammation and pressure from acute otitis media may result in perforation of the tympanic membrane.

14. What is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency is 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 A The inheritance pattern is X-linked recessive. B The disorder involves coagulation factors, not platelets. 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. D The disorder does not involve red cells or the Y chromosome.

20. What is an appropriate statement for the nurse to make to parents of a child who has had a barium enema to correct an intussusception? a. "I will call the physician when the baby passes his first stool." b. "I am going to dilate the anal sphincter with a gloved finger to help the baby pass the barium." c. "I would like you to save all the soiled diapers so I can inspect them." d. "Add cereal to the baby's formula to help him pass the barium."

ANS: C A The physician does not need to be notified when the infant passes the first stool. B Dilating the anal sphincter is not appropriate for the child after a barium enema. C The nurse needs to inspect diapers after a barium enema because it is important to document the passage of barium and note the characteristics of the stool. D After reduction, the infant is given clear liquids and the diet is gradually increased.

44. What is used to treat moderate to severe inflammatory bowel disease? a. Antacids b. Antibiotics c. Corticosteroids d. Antidiarrheal medications

ANS: C A These are not drugs of choice to treat the inflammatory process of inflammatory bowel disease. B Antibiotics may be used as adjunctive therapy to treat complications. C Corticosteroids, such as prednisone and prednisolone, are used in short bursts to suppress the inflammatory response in inflammatory bowel disease. D These are not drugs of choice to treat the inflammatory process of inflammatory bowel disease.

43. A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. The purpose of this is to a. Prevent reflux. b. Prevent hematemesis. c. Reduce gastric acid production. d. Increase gastric acid production.

ANS: C A These are not the modes of action of histamine-receptor antagonists. B These are not the modes of action of histamine-receptor antagonists. C The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and to prevent esophagitis. D These are not the modes of action of histamine-receptor antagonists.

30. What should the nurse teach a child about using an albuterol metered-dose inhaler for exercise-induced asthma? a. Take two puffs every 6 hours around the clock. b. Use the inhaler only when the child is short of breath. c. Use the inhaler 30 minutes before exercise. d. Take one to two puffs every morning upon awakening.

ANS: C A This schedule will not relieve exercise-induced asthma. B Waiting until symptoms are severe is too late to begin using a metered-dose inhaler. C The appropriate time to use an inhaled beta2-agonist or cromolyn is before an event that could trigger an attack. D This may be the child's usual schedule for medication. If exercise causes symptoms, additional medication is indicated.

5. A 4-year-old child with a long leg cast complains of "fire" in his cast. Which action by the nurse is most appropriate? a. Notify the provider on his or her next rounds. b. Note the complaint in the nurse's notes. c. Notify the provider immediately. d. Report the complaint to the next nurse on duty.

ANS: C A burning sensation under the cast is an indication of tissue ischemia. It may be an early indication of serious neurovascular compromise, such as compartment syndrome, that requires immediate attention. The child's symptom requires immediate attention. Notifying the physician on the next rounds is inappropriate. Charting the complaint in the nurse's notes is an appropriate action but not the priority. The priority action is to contact the provider. Communication across shifts is important to the continuing assessment of the child; however, this symptom requires immediate evaluation, and the provider should be contacted.

17. Which is an important nursing consideration when caring for a child with impetigo? a. Apply topical corticosteroids to decrease inflammation. b. Carefully remove dressings so as not to dislodge undermined skin, crusts, and debris. c. Carefully wash hands and maintain cleanliness when caring for an infected child. d. Examine child under a Wood lamp for possible spread of lesions.

ANS: C A major nursing consideration related to bacterial skin infections, such as impetigo, is to prevent the spread of the infection and complications. This is done by thorough handwashing before and after contact with the affected child. Corticosteroids are not indicated in bacterial infections. Dressings are usually not indicated. The undermined skin, crusts, and debris are carefully removed after softening with moist compresses. A Wood lamp is used to detect fluorescent materials in the skin and hair. It is used in certain disease states, such as tinea capitis. It is not used in impetigo.

16. What disorder is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ T cells? a. Raynaud phenomenon b. Idiopathic thrombocytopenic purpura c. Acquired immunodeficiency syndrome (AIDS) d. Severe combined immunodeficiency disease

ANS: C Acquired immunodeficiency is caused by the human immunodeficiency virus (HIV), which primarily attacks the CD4+ T cells. The other disorders are not viral in nature.

1. 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. Their 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.

17. A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on the knowledge that a. it is a less expensive method of testing. b. it is not as accurate as laboratory testing. c. children are better able to manage the diabetes. d. the parents are better able to manage the disease.

ANS: C Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood sugar results. The child learns to be in better control by utilizing blood glucose monitoring. Blood glucose monitoring may be more expensive but provides improved management. It is as accurate as equivalent testing done in laboratories. The ability to self-test allows the child to balance diet, exercise, and insuli n. The parents are partners in the process, but the child should be taught how to manage the disease.

25. Which comment by a 12-year-old child with type 1 diabetes indicates deficient knowledge? a. "I rotate my insulin injection sites every time I give myself an injection." b. "I keep records of my glucose levels and insulin sites and amounts." c. "I'll be glad when I can take a pill for my diabetes like my uncle does." d. "I keep Lifesavers in my school bag in case I have a low-sugar reaction."

ANS: C Children with type 1 diabetes will require life-long insulin therapy. Rotating sites may help with variable insulin absorption. Rotating spots within the same major site is important. Keeping records of serum glucose and insulin sites and amounts is appropriate. Prompt treatment of hypoglycemia reduces the possibility of a severe reaction. Keeping hard candy on hand is an appropriate action.

11. A 5-year-old child has acquired immunodeficiency syndrome (AIDS). What statement by the mother indicates good understanding of medications used for this condition? a. "When my child's pain increases, I double the recommended dosage of antiretroviral medication." b. "Addiction is a risk, so I only use the medication as ordered." c. "Doses of the antiretroviral medication are selected on the basis of my child's age and growth." d. "By the time my child is an adolescent she will not need her antiretroviral medications any longer."

ANS: C Doses of antiretroviral medication to treat HIV infection for infants and children are based on individualized age and growth considerations. Antiretroviral medications are not administered for pain relief. Addiction is not a realistic concern with antiretroviral medications. Antiretroviral medications are still needed during adolescence.

26. When providing education for the parents of a child with Duchenne muscular dystrophy, the nurse plans to include a. testing all female children for the disease. b. testing the father for the presence of the trait on the Y chromosome. c. genetic counseling for all female children. d. testing the parents to determine the carrier.

ANS: C Duchenne muscular dystrophy is a recessive sex-linked disease carried on the X chromosome, so only males are affected with the disease. Because it is a recessive X-linked disorder, females can only be carriers and do not have the disease. The disease is an X-linked recessive disorder and would not be found on the Y chromosome. The disease is a recessive X-linked disease and is always carried by the mother.

15. What is the drug of choice the nurse should administer in the acute treatment of anaphylaxis? a. Diphenhydramine b. Histamine inhibitor (cimetidine) c. Epinephrine d. Albuterol

ANS: C Epinephrine is the first drug of choice in immediate treatment of anaphylaxis. Treatment must be initiated immediately because it may only be a matter of minutes before shock occurs. Diphenhydramine and cimetidine may be used, but the drug of choice is epinephrine. Albuterol is not usually indicated.

20. What is the best nursing action when a child with type 1 diabetes mellitus is sweating, trembling, and pale? a. Offer the child a glass of water. b. Give the child 5 units of regular insulin subcutaneously. c. Give the child a glass of orange juice. d. Give the child glucagon subcutaneously.

ANS: C Four ounces of orange juice is an appropriate treatment for the conscious child who is exhibiting signs of hypoglycemia. This contains 15 grams of carbohydrate. A glass of water is not indicated in this situation. An easily digested carbohydrate is indicated when a child exhibits symptoms of hypoglycemia. Insulin would lower blood glucose and is contraindicated for a child with hypoglycemia. Subcutaneous injection of glucagon is used to treat hypoglycemia when the child is unconscious.

2. 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. Safety practices are important to assess as well, but the priority is checking for child abuse. Genetic factors are a rare cause of fractures.

5. With what beverage should the parents of a child with ringworm be taught to give griseofulvin? a. Water b. A carbonated drink c. Milk d. Fruit juice

ANS: C Griseofulvin is insoluble in water. Giving the medication with a high-fat meal or milk increases absorption. Carbonated drinks do not contain fat, which aids in the absorption of griseofulvin. Fruit juice does not contain any fat; fat aids absorption of the medication.

10. Children receiving long-term systemic corticosteroid therapy are most at risk for which condition? 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.

21. Which sign is the nurse most likely to assess in a child with hypoglycemia? a. Urine positive for ketones and serum glucose greater than 300 mg/dL b. Normal sensorium and serum glucose greater than 160 mg/dL c. Irritability and serum glucose less than 60 mg/dL d. Increased urination and serum glucose less than 120 mg/dL

ANS: C Irritability and serum glucose less than 60 mg/dL are manifestations of hypoglycemia. Serum glucose greater than 300 mg/dL and urine positive for ketones are indicative of diabetic ketoacidosis. Normal sensorium and serum glucose greater than 160 mg/dL are associated with hyperglycemia. Increased urination is an indicator of hyperglycemia. A serum glucose level less than 120 mg/dL is within normal limits.

11. Which factor is important to include in the teaching plan for parents of a child with Legg-Calvé-Perthes disease? a. It is an acute illness lasting 1 to 2 weeks. b. It affects primarily adolescents. c. There is a disturbance in the blood supply to the femoral epiphysis. d. It is caused by a virus.

ANS: C Legg-Calvé-Perthes disease is a self-limiting disease that affects the blood supply to the femoral epiphysis. The most serious problem associated is the risk of permanent deformity. The disease process usually lasts between 1 and 2 years and is a disorder of growth. Legg-Calvé-Perthes disease is seen in children between 2 and 12 years of age. Most cases occur between 4 and 9 years of age. The etiology is unknown.

1. New parents ask the nurse, "Why is it necessary for our baby to have the newborn blood test?" The nurse explains that the priority outcome of mandatory newborn screening for inborn errors of metabolism is a. appropriate community referral for affected infants. b. parental education about raising a special needs child. c. early identification of serious genetically transmitted metabolic diseases. d. early identification of electrolyte imbalances.

ANS: C Mandatory genetic screening allows early identification of genetically transmitted metabolic disorders. These disorders can be managed best with early diagnosis and in some cases, early treatment prevents serious physical and cognitive delays. Community referral is appropriate after a diagnosis is made. Parental education will be important, but that is not the goal of screening. Although electrolyte imbalances could occur with some of the inborn errors of metabolism, this is not the priority outcome, nor would the newborn screen detect electrolyte imbalances.

27. A mother calls the emergency department nurse because her child was stung by a scorpion. The nurse should recommend a. administering antihistamine. b. cleansing with soap and water. c. keeping child quiet and coming to emergency department. d. removing stinger and applying cool compresses.

ANS: C Most scorpions in the US are not venomous but their stings are painful and some species' stings can produce systemic manifestations so the child should be seen in the ED. The other actions are not warranted.

24. The primary clinical manifestation of scabies is a. edema. b. redness. c. pruritus. d. maceration.

ANS: C Scabies is caused by the scabies mite. The inflammatory response and intense itching occur after the host has become sensitized to the mite. This occurs approximately 30 to 60 days after initial contact. In the previously sensitized person, the response occurs within 48 hours. Edema, redness, and maceration are not seen in scabies.

13. A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, what response by the nurse is best? 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 the 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. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention.

12. Which intervention is appropriate for a child receiving high doses of steroids? a. Limit activity and receive home schooling. b. Increase the amount of carbohydrates in the diet. c. Substitute a killed virus vaccine for live virus vaccines. d. Monitor for seizure activity.

ANS: C The child on high doses of steroids should not receive live virus vaccines because of immunosuppression. Limiting activity and home schooling are not routine for a child receiving high doses of steroids. Children on high doses of steroids sometimes get carbohydrate intolerance; the diet should not contain high levels of carbohydrates. Children on steroids are not typically at risk for seizures.

6. What should the nurse include in the teaching plan for parents of a child with diabetes insipidus who is receiving DDAVP? a. Increase the dosage of DDAVP as the urine specific gravity (SG) increases. b. Give DDAVP only if urine output decreases. c. The child should have free access to water and toilet facilities at school. d. Cleanse skin before administering the transdermal patch.

ANS: C The child's teachers should be aware of the diagnosis and treatment plan, and the child should have free access to water and toilet facilities at school. DDAVP needs to be given as ordered by the physician. If the parents are monitoring urine SG at home, they would not increase the medication dose for increased SG; the physician may order an increased dosage for very dilute urine with decreased SG. DDAVP needs to be given continuously as ordered by the physician. DDAVP is typically given intranasally or by subcutaneous injection. For nocturnal enuresis, it may be given orally.

9. What should the nurse include in a teaching plan for the mother of a toddler who will be taking prednisone for several months? a. The medication should be taken between meals. b. The medication needs to be discontinued if side effects appear. c. The medication should not be stopped abruptly. d. The medication may lower blood glucose.

ANS: C The dosage must be tapered before the drug is discontinued to allow the gradual return of function in the pituitary-adrenal axis. Prednisone should be taken with food to minimize or prevent gastrointestinal bleeding. Although there are adverse effects from long-term steroid use, the medication must not be discontinued without consulting a physician. Acute adrenal insufficiency can occur if the medication is withdrawn abruptly. The dosage needs to be tapered. The medication puts the child at risk for hyperglycemia.

20. A 6-year-old patient who has been placed in skeletal traction has pain, edema, and fever. The nurse should assess which of the following? a. Neurologic status b. Range of motion of all extremities c. Warmth at site of pain d. Blood pressure

ANS: C The most serious complication of skeletal traction is osteomyelitis. Clinical manifestations include complaints of localized pain, swelling, warmth, tenderness, or unusual odor. An elevated temperature may accompany the symptoms. Assessing neurologic status is not required. Range of motion may or may not be affected with osteomyelitis, but this child is in skeletal traction so range of motion will be limited. Blood pressure is assessed with other vital signs.

22. A child has painful, fluid-filled vesicles on the upper lip. What medication does the nurse anticipate teaching parents about? a. Corticosteroids b. Oral griseofulvin c. Oral antiviral agent d. Topical antibiotic

ANS: C This child has a herpes infection. Oral antiviral agents are effective for viral infections such as herpes simplex. Corticosteroids are not effective for viral infections. Griseofulvin is an antifungal agent and not effective for viral infections. Antibiotics are not effective in viral diseases.

5. A child is hospitalized after a serious motor vehicle crash and has developed increased urination. What action by the nurse takes priority? a. Weigh the child daily. b. Monitor the child's intake and output. c. Assess the daily serum sodium level. d. Restrict dietary sodium intake.

ANS: C This child might have diabetes insipidus; being in a car crash has the potential for a head injury. That coupled with frequent urination leads the nurse to suspect DI. A high serum sodium and low urine specific gravity are hallmarks of this condition. The priority action for the nurse is to review the child's most recent serum sodium. Daily weights and I&O are also important for many children but is not as specific for this condition as assessing the sodium level. The child may or may not need a sodium restriction, but assessment comes first.

A nurse determines that parents understood the teaching from the pediatric oncologist if the parents indicate that which test confirms the diagnosis of leukemia in children? a. Complete blood cell count (CBC) b. Lumbar puncture c. Bone marrow biopsy d. Computed tomography (CT) scan

ANS: C Feedback A A CBC may show blast cells that would raise suspicion of leukemia. It is not a confirming diagnostic study. B A lumbar puncture is done to check for central nervous system involvement in the child who has been diagnosed with leukemia. C The confirming test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspiration and biopsy. D A CT scan may be done to check for bone involvement in the child with leukemia. It does not confirm a diagnosis.

What fluid is the best choice when a child with mucositis asks for something to drink? a. Hot chocolate b. Lemonade c. Popsicle d. Orange juice

ANS: C Feedback A A hot beverage can be irritating to mouth ulcers. B Citrus products may be very painful to an ulcerated mouth. C Cool liquids are soothing and ice pops are usually well tolerated. D Citrus products may be very painful to an ulcerated mouth

The nurse is aware that an abdominal mass found in a 10-month-old infant corresponds with which childhood cancer? a. Osteogenic sarcoma b. Rhabdomyosarcoma c. Neuroblastoma d. Non-Hodgkin lymphoma

ANS: C Feedback A Osteogenic sarcoma is a bone tumor. Bone tumors typically affect older children. B Rhabdomyosarcoma is a malignancy of muscle, or striated tissue. It occurs most often in the periorbital area, in the head and neck in younger children, or in the trunk and extremities in older children. C Neuroblastoma is found exclusively in infants and children. In most cases of neuroblastoma, a primary abdominal mass and protuberant, firm abdomen are present. D Non-Hodgkin lymphoma is a neoplasm of lymphoid cells. Painless, enlarged lymph nodes are found in the cervical or axillary region. Abdominal signs and symptoms do not include a mass.

Children with non-Hodgkin lymphoma are at risk for complications resulting from tumor lysis syndrome (TLS). The nurse should assess for a. Liver failure b. CNS deficit c. Kidney failure d. Respiratory distress

ANS: C Feedback A TLS is related to intracellular electrolytes overloading the kidney as a response to the rapid lysis of tumor cells. This does not affect the liver. B TLS does not affect the CNS. C In TLS, the tumor's intracellular contents are dumped into the child's extracellular fluid as the tumor cells are lysed in response to chemotherapy. Because of the large volume of these cells, their intracellular electrolytes overload the kidneys and, if not monitored, can cause kidney failure. D TLS does not affect the lungs and cause respiratory distress.

What is the nurse's best response to a mother whose child has a diagnosis of acute lymphoblastic leukemia and is expressing guilt about not having responded sooner to her boy's symptoms? a. "You should always call the physician when your child has a change in what is normal for him." b. "It is better to be safe than sorry." c. "It is not uncommon for parents not to notice subtle changes in their children's health." d. "I hope this delay does not affect the treatment plan."

ANS: C Feedback A The goal is to relieve the mother's guilt and build trust so that she can talk about her feelings. This statement will only reinforce her guilt. B This response is flippant and reinforces that the mother was negligent, which will only increase her guilt. C This statement minimizes the role the mother played in not seeking early medical attention. It also displays empathy, which helps to build trust, thereby enabling the mother to talk about her feelings. Identifying concerns and clarifying misconceptions will help families cope with the stress of chronic illness. D This statement shows a total lack of empathy and would increase the mother's feelings of guilt.

What should the nurse teach parents about oral hygiene for the child receiving chemotherapy? a. Brush the teeth briskly to remove bacteria. b. Use a mouthwash that contains alcohol. c. Inspect the child's mouth daily for ulcers. d. Perform oral hygiene twice a day.

ANS: C Feedback A The teeth should be brushed with a soft-bristled toothbrush. Excessive force with brushing should be avoided because delicate tissue could be broken, causing infection or bleeding. B Mouthwashes containing alcohol may be drying to oral mucosa, thus breaking down the protective barrier of the skin. C The child's mouth is inspected regularly for ulcers. At the first sign of ulceration, an antifungal drug is initiated. D Oral hygiene should be performed four times a day.

The nurse should base a response to a parent's question about the prognosis of acute lymphoblastic leukemia (ALL) on the knowledge that a. Leukemia is a fatal disease, although chemotherapy provides increasingly longer periods of remission. b. Research to find a cure for childhood cancers is very active. c. The majority of children go into remission and remain symptom free when treatment is completed. d. It usually takes several months of chemotherapy to achieve a remission.

ANS: C Feedback A With the majority of children surviving 5 years or longer, it is inappropriate to refer to leukemia as a fatal disease. B This statement is true, but it does not address the parent's concern. C Children diagnosed with the most common form of leukemia, ALL, can almost always achieve remission, with a 5-year disease-free survival rate approaching 85%. D About 95% of children achieve remission within the first month of chemotherapy. If a significant number of blast cells are still present in the bone marrow after a month of chemotherapy, a new and stronger regimen is begun.

3. A nurse is instructing parents on the treatment of pediculosis (head lice). Which should the nurse include in the teaching plan? (Select all that apply.) a. Bedding should be washed in warm water and dried on a low setting. b. After treating the hair and scalp with a pediculicide, shampoo the hair with regular shampoo. c. Retreat the hair and scalp with a pediculicide in 7 to 10 days. d. Items that cannot be washed should be dry cleaned or sealed in plastic bags for 2 to 3 weeks. e. Combs and brushes should be boiled in water for at least 10 minutes.

ANS: C, D, E An over-the-counter pediculicide, permethrin 1% (Nix, Elimite, Acticin), kills head lice and eggs with one application and has residual activity (i.e., it stays in the hair after treatment) for 10 days. Nix crème rinse is applied to the hair after it is washed with a conditioner-free shampoo. The product should be rinsed out after 10 minutes. The hair should not be shampooed for 24 hours after the treatment. Even though the kill rate is high and there is residual action, retreatment should occur after 7 to 10 days. Combs and brushes should be boiled or soaked in antilice shampoo or hot water (greater than 60° C [140° F]) for at least 10 minutes. Advise parents to wash clothing (especially hats and jackets), bedding, and linens in hot water and dry at a hot dryer setting.

A nurse is teaching home care instructions to parents of a child with sickle cell disease. Which instructions should the nurse include? Select all that apply. a. Limit fluid intake. b. Administer aspirin for fever. c. Administer penicillin as ordered. d. Avoid cold and extreme heat. e. Provide for adequate rest periods.

ANS: C, D, E Correct Parents should be taught to avoid cold, which can increase sickling, and extreme heat, which can cause dehydration. Adequate rest periods should be provided. Penicillin should be administered daily as ordered. Incorrect: The use of aspirin should be avoided; acetaminophen or ibuprofen should be used as an alternative. Fluids should be encouraged and an increase in fluid intake is encouraged in hot weather or when there are other risks for dehydration.

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 condition occurs? 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 Correct: The parents should be instructed to notify the physician after their infant's cardiac surgery for a temperature above 37.7° C; new, frequent coughing; and any episodes of the infant turning blue or bluer than normal. Incorrect: A respiratory rate of 36 at rest for an infant is within normal expectations, and it is expected that the appetite will increase slowly.

26. The nurse caring for a child diagnosed with acute rheumatic fever should assess the child for a. Sore throat b. Elevated blood pressure c. Desquamation of the fingers and toes d. Tender, warm, inflamed joints

ANS: D A The child may have had a sore throat previously associated with a group A beta-hemolytic streptococcal infection a few weeks earlier. A sore throat is not a manifestation of rheumatic fever. B Hypertension is not associated with rheumatic fever. C Desquamation of the fingers and toes is a manifestation of Kawasaki syndrome. D Arthritis, characterized by tender, warm, erythematous joints, is one of the major manifestations of acute rheumatic fever in the first 1 to 2 weeks of the illness.

3. What actions should the nurse perform while caring for a school-age child who sprained his ankle playing football? (Select all that apply.) a. Turn the child every 1 to 2 hours. b. Assist with range-of-motion exercises every 2 hours. c. Apply ice to the affected ankle. d. Wrap the ankle with an ACE bandage. e. Elevate the affected extremity.

ANS: C, D, E The child with a soft tissue injury in the first 6 to 12 hours is treated by controlling the swelling and reducing muscle damage. The acronym RICE summarizes the care needed: rest, ice, compression, and elevation. During the acute phase of the injury, the child is not moved frequently, and range-of-motion exercises would not be done. The child with a soft tissue injury in the first 6 to 12 hours is treated by controlling the swelling and reducing muscle damage.

10. What should the nurse teach a school-age child and his parents about the management of ulcer disease? a. Eat a bland, low-fiber diet in small, frequent meals. b. Eat three balanced meals a day with no snacking between meals. c. The child needs to eat alone to avoid stress. d. Do not give antacids 1 hour before or after antiulcer medications.

ANS: D A A bland diet is not indicated for ulcer disease. The diet should be a regular diet that is low in caffeine, and the child should eat a meal or snack every 2 to 3 hours. B The child should eat every 2 to 3 hours. C Eating alone is not indicated. D Antacids can interfere with antiulcer medication if given less than 1 hour before or after antiulcer medications.

3. What action is not appropriate for a 14-month-old child with iron deficiency anemia? a. Decreasing the infant's daily milk intake to 24 oz or less b. Giving oral iron supplements between meals with orange juice c. Including apricots, dark-green leafy vegetables, and egg yolk in the infant's diet d. Allowing the infant to drink the iron supplement from a small medicine cup

ANS: D A A daily milk intake in toddlers of less than 24 oz will encourage the consumption of iron-rich solid foods. B Because food interferes with the absorption of iron, iron supplements are taken between meals. Administering this medication with foods rich in vitamin C facilitates absorption of iron. C Apricots, dark-green leafy vegetables, and egg yolks are rich sources of iron. Other iron-rich foods include liver, dried beans, Cream of Wheat, iron-fortified cereal, and prunes. D Iron supplements should be administered through a straw or by a medicine dropper placed at the back of the mouth because iron temporarily stains the teeth.

19. An infant is born and the nurse notices that the child has herniation of abdominal viscera into the base of the umbilical cord. What will the nurse document on her or his assessment of this condition? a. Diaphragmatic hernia b. Umbilical hernia c. Gastroschisis d. Omphalocele

ANS: D A A diaphragmatic hernia is the protrusion of part of the abdominal organs through an opening in the diaphragm. B An umbilical hernia is a soft skin protrusion of abdominal stricture through the esophageal hiatus. C Gastroschisis is the protrusion of intraabdominal contents through a defect in the abdominal wall lateral to the umbilical ring. There is no peritoneal sac. D Omphalocele is the herniation of the abdominal viscera into the base of the umbilical cord.

49. Which type of hernia has an impaired blood supply to the herniated organ? a. Hiatal hernia b. Incarcerated hernia c. Omphalocele d. Strangulated hernia

ANS: D A A hiatal hernia is the intrusion of an abdominal structure, usually the stomach, through the esophageal hiatus. B An incarcerated hernia is a hernia that cannot be reduced easily. C Omphalocele is the protrusion of intraabdominal viscera into the base of the umbilical cord. The sac is covered with peritoneum and not skin. D A strangulated hernia is one in which the blood supply to the herniated organ is impaired.

7. Which statement by a parent of a child with nephrotic syndrome indicates an understanding of a no-added-salt diet? a. "I can give my child sweet pickles." b. "My child can put ketchup on his hotdog." c. "I can let my child have potato chips." d. "I do not put any salt in foods when I am cooking."

ANS: D A All types of pickles are high in sodium and should not be served to the child on a no-added-salt diet. B The child should not be allowed to eat hotdogs; they are considered a cured or processed meat and are high in sodium. C Potato chips are a high-sodium food and should not be included in the child's diet when sodium intake is restricted. D A no-added-salt diet means that no salt should be added to foods, either when cooking or before eating.

15. A child with secondary enuresis who complains of dysuria or urgency should be evaluated for which condition? a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. UTI

ANS: D A An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. B Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. C Glomerulonephritis is not a likely cause of dysuria or urgency. D Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI.

29. Which nursing diagnosis has the highest priority for the toddler with celiac disease? a. Disturbed Body Image related to chronic constipation b. Risk for Disproportionate Growth related to obesity c. Excess Fluid Volume related to celiac crisis d. Imbalanced Nutrition: Less than Body Requirements related to malabsorption

ANS: D A Body Image disturbances are not usually apparent in toddlers. This is more common in adolescents. It is not the priority nursing diagnosis. B Celiac disease causes disproportionate growth and development associated with malnutrition, not obesity. C Celiac crisis causes deficient fluid volume. D Imbalanced Nutrition: Less than Body Requirements is the highest priority nursing diagnosis because celiac disease causes gluten enteropathy, a malabsorption condition.

9. 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 Circulatory collapse results from sequestration crises. B Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vaso-occlusive phenomena. C Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vaso-occlusive phenomena. 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.

40. A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. Which statement by the parent indicates a correct understanding of the teaching? a. "I will keep my child on a clear liquid diet for the next 24 hours." b. "I should encourage my child to drink carbonated drinks but avoid food for the next 24 hours." c. "I will offer my child bananas, rice, applesauce, and toast for the next 48 hours." d. "I should have my child eat a normal diet with easily digested foods for the next 48 hours."

ANS: D A Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. B Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. C In some children, lactose intolerance will develop with diarrhea, and cow's milk should be avoided in the recovery stage. D Easily digested foods such as cereals, cooked vegetables, and meats should be provided for the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness.

20. Nursing care for the child in congestive heart failure includes a. Counting the number of saturated diapers b. Putting the infant in the Trendelenburg position c. Removing oxygen while the infant is crying d. Organizing care to provide rest periods

ANS: D A Diapers must be weighed for an accurate record of output. B The head of the bed should be raised to decrease the work of breathing. C Oxygen should be administered during stressful periods such as when the child is crying. D Nursing care should be planned to allow for periods of undisturbed rest.

10. Which intervention is appropriate when examining a male infant for cryptorchidism? a. Cooling the examiner's hands b. Taking a rectal temperature c. Eliciting the cremasteric reflex d. Warming the room

ANS: D A Examining the infant with cold hands is uncomfortable for the infant and likely to cause the infant's testes to retract into the inguinal canal. It may also cause the infant to be uncooperative during the examination. B A rectal temperature yields no information about cryptorchidism. C Testes can retract into the inguinal canal if the infant is upset or cold or if the cremasteric reflex is elicited. This can lead to an incorrect diagnosis. D For the infant's comfort, the infant should be examined in a warm room with the examiner's hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold.

18. What is the priority in the discharge plan for a child with immune thrombocytopenic purpura (ITP)? a. Teaching the parents to report excessive fatigue to the physician b. Monitoring the child's hemoglobin level every 2 weeks c. Providing a diet that contains iron-rich foods d. Establishing a safe, age-appropriate home environment

ANS: D A Excessive fatigue is not a significant problem for the child with ITP. B ITP is associated with low platelet levels. C Increasing the child's intake of iron in the diet will not correct ITP. D Prevention of injury is a priority concern for a child with ITP.

5. Which diagnostic finding is present when a child has primary nephrotic syndrome? a. Hyperalbuminemia b. Positive ASO titer c. Leukocytosis d. Proteinuria

ANS: D A Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the liver's inability to synthesize proteins to balance the loss. B ASO titer is negative in a child with primary nephrotic syndrome. C Leukocytosis is not a diagnostic finding in primary nephrotic syndrome. D Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane.

1. 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 A IV fluid administration continues until the child is taking and retaining adequate amounts of oral fluids. B The insertion site dressing should be observed frequently for bleeding. The nurse should also look under the child to check for pooled blood. C Peripheral perfusion is monitored after catheterization. Distal pulses should be palpable, although they may be weaker than in the contralateral extremity. D The child should be positioned with the affected leg straight for 4 to 6 hours after the procedure.

4. 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 A Increased blood viscosity is usually a function of too many cells or of dehydration, not of anemia. B A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition is dependent on the deceased oxygen-carrying capacity of the blood. C A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition is dependent on the decreased oxygen-carrying capacity of the blood. 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.

37. Careful handwashing before and after contact can prevent the spread of which condition in daycare and school settings? a. Irritable bowel syndrome b. Ulcerative colitis c. Hepatic cirrhosis d. Hepatitis A

ANS: D A Irritable bowel syndrome is the result of increased intestinal motility and is not contagious. B Ulcerative colitis is not infectious. C Cirrhosis is not infectious. D Hepatitis A is spread person to person, by the fecal-oral route, and through contaminated food or water. Good handwashing is critical in preventing its spread. The virus can survive on contaminated objects for weeks.

8. 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 A Orthostatic hypotension is not present with coarctation of the aorta. B Systolic hypertension may be detected in the upper extremities. C The left arm may not accurately reflect systolic hypertension because the left subclavian artery can be involved in the coarctation. 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.

3. The nurse is admitting a child to the hospital for a cardiac workup. What is the first step in a cardiac assessment? a. Percussion b. Palpation c. Auscultation d. History and inspection

ANS: D A Percussion of the chest is usually deferred. B Palpation can be threatening to the child because it requires a significant amount of physical contact. For this reason it is not the initial step in a cardiac assessment. C Auscultation requires touching the child and is not the initial step in a cardiac assessment. D The assessment should begin with the least threatening interventions—the history and inspection. Assessment progression includes inspection, auscultation, and palpation because each step includes more touching.

25. A nurse is assigned to care for an infant with an unrepaired tetralogy of Fallot. What should the nurse do first when the baby is crying and becomes severely cyanotic? a. Place the infant in a knee-chest position. b. Administer oxygen. c. Administer morphine sulfate. d. Calm the infant.

ANS: D A Placing the infant in a knee-chest position will decrease venous return so that smaller amounts of highly saturated blood reach the heart. This should be done after calming the infant. B Administering oxygen is indicated after placing the infant in a knee-chest position. C Administering morphine sulfate calms the infant. It may be indicated some time after the infant has been calmed. D Calming the crying infant is the first response. An infant with unrepaired tetralogy of Fallot who is crying and agitated may eventually lose consciousness.

41. Therapeutic management of most children with Hirschsprung disease is primarily a. Daily enemas b. Low-fiber diet c. Permanent colostomy d. Surgical removal of the affected section of the bowel

ANS: D A Preoperative management may include enemas and a low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. B Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. C The colostomy that is created in Hirschsprung disease is usually temporary. D Most children with Hirschsprung disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter.

16. 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 b. To control pain c. To decrease respirations d. To improve oxygenation

ANS: D A Prostaglandin E1 is used to maintain a patent ductus arteriosus, thus increasing pulmonary blood flow. B Prostaglandin E1 is administered to infants with a right-to-left shunt to keep the ductus arteriosus patent, thus increasing pulmonary blood flow. C Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus arteriosus patent to increase pulmonary blood flow. D Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus arteriosus patent. This will improve oxygenation.

39. A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of a. Protein intolerance b. Parasitic infection c. Fat malabsorption d. Bacterial gastroenteritis

ANS: D A Protein intolerance is suspected in the presence of eosinophils. B Parasitic infection is indicated by eosinophils. C Fat malabsorption is indicated by foul-smelling, greasy, bulky stools. D Neutrophils and red blood cells in stool indicate bacterial gastroenteritis.

17. What information should the nurse teach workers at a daycare center about RSV? a. RSV is transmitted through particles in the air. b. RSV can live on skin or paper for up to a few seconds after contact. c. RSV can survive on nonporous surfaces for about 60 minutes. d. Frequent handwashing can decrease the spread of the virus.

ANS: D A RSV infection is not airborne. It is acquired mainly through contact with contaminated surfaces. B RSV can live on skin or paper for up to 1 hour. C RSV can live on cribs and other nonporous surfaces for up to 6 hours. D Meticulous handwashing can decrease the spread of organisms.

32. What is the most common causative agent of bacterial endocarditis? a. Staphylococcus albus b. Streptococcus hemolyticus c. Staphylococcus albicans d. Streptococcus viridans

ANS: D A S. albus is not a common causative agent. B Streptococcus hemolyticus is not a common causative agent. C S. albicans is not a common causative agent. D S. viridans and S. aureus are the most common causative agents in bacterial (infective) endocarditis.

34. A common, serious complication of rheumatic fever is a. Seizures b. Cardiac dysrhythmias c. Pulmonary hypertension d. Cardiac valve damage

ANS: D A Seizures are not common complications of rheumatic fever. B Cardiac dysrhythmias are not common complications of rheumatic fever. C Pulmonary hypertension is not a common complication of rheumatic fever. D Cardiac valve damage is the most significant complication of rheumatic fever.

10. What should the discharge plan for a school-age child with sickle cell disease include? a. Restricting the child's participation in outside activities b. Administering aspirin for pain or fever c. Limiting the child's interaction with peers d. Administering penicillin daily as ordered

ANS: D A Sickle cell disease does not prohibit the child from outdoor play. Active and passive exercises help promote circulation. B Aspirin use should be avoided. Acetaminophen or ibuprofen should be administered for fever or pain. C The child needs to interact with peers to meet his developmental needs. D Children with sickle cell disease are at a high risk for pneumococcal infections and should receive long-term penicillin therapy and preventive immunizations.

34. Why do infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system? a. They have a widened, shorter airway. b. There is a defect in their sucking ability. c. The gag reflex increases mucus production. d. Mucus and edema obstruct small airways.

ANS: D A The airway in infants and young children is narrower, not wider. B Sucking is not necessarily related to problems with the airway. C The gag reflex is necessary to prevent aspiration. It does not produce mucus. D The airway in infants and young children is narrower, and respiratory distress can occur quickly because mucus and edema can cause obstruction to their small airways.

15. What is an appropriate beverage for the nurse to give to a child who had a tonsillectomy earlier in the day? a. Chocolate ice cream b. Orange juice c. Fruit punch d. Apple juice

ANS: D A The child can have full liquids on the second postoperative day. B Citrus drinks are not offered because they can irritate the throat. C Red liquids are avoided because they give the appearance of blood if vomited. D The child can have clear, cool liquids when fully awake.

10. Which statement made by a parent indicates understanding of restrictions for a child after cardiac surgery? a. "My child needs to get extra rest for a few weeks." b. "My son is really looking forward to riding his bike next week." c. "I'm so glad we can attend religious services as a family this coming Sunday." d. "I am going to keep my child out of daycare for 6 weeks."

ANS: D A The child should resume his regular bedtime and sleep schedule after discharge. B Activities during which the child could fall, such as riding a bicycle, are avoided for 4 to 6 weeks after discharge. C Large crowds of people should be avoided for 4 to 6 weeks after discharge, including public worship. D Settings where large groups of people are present should be avoided for 4 to 6 weeks after discharge, including day care.

12. The child with lactose intolerance is most at risk for which electrolyte imbalance? a. Hyperkalemia b. Hypoglycemia c. Hyperglycemia d. Hypocalcemia

ANS: D A The child with lactose intolerance is not at risk for hyperkalemia. B Lactose intolerance does not affect glucose metabolism. C Hyperglycemia does not result from ingestion of a lactose-free diet. D The child between 1 and 10 years requires a minimum of 800 mg of calcium daily. Because high-calcium dairy products containing lactose are restricted from the child's diet, alternative sources such as egg yolk, green leafy vegetables, dried beans, and cauliflower must be provided to prevent hypocalcemia.

1. A child has had cold symptoms for more than 2 weeks, a headache, nasal congestion with purulent nasal drainage, facial tenderness, and a cough that increases during sleep. The nurse recognizes that these symptoms are characteristic of which respiratory condition? a. Allergic rhinitis b. Bronchitis c. Asthma d. Sinusitis

ANS: D A The classic symptoms of allergic rhinitis are watery rhinorrhea, itchy nose, eyes, ears, and palate, and sneezing. Symptoms occur as long as the child is exposed to the allergen. B Bronchitis is characterized by a gradual onset of rhinitis and a cough that is initially nonproductive but may change to a loose cough. C The manifestations of asthma may vary, with wheezing being a classic sign. The symptoms presented in the question do not suggest asthma. D Sinusitis is characterized by signs and symptoms of a cold that do not improve after 14 days, a low-grade fever, nasal congestion and purulent nasal discharge, headache, tenderness, a feeling of fullness over the affected sinuses, halitosis, and a cough that increases when the child is lying down.

17. A child who has been in good health has a platelet count of 45,000/mm3, petechiae, and excessive bruising that covers the body. The nurse is aware that these signs are clinical manifestations of a. Erythroblastopenia b. von Willebrand disease c. Hemophilia d. Immune thrombocytopenic purpura (ITP)

ANS: D A The clinical manifestations of erythroblastopenia are pallor, lethargy, headache, fainting, and a history of upper respiratory infection. B The clinical manifestations of von Willebrand disease are bleeding from the gums or nose, prolonged bleeding from cuts, and excessive bleeding after surgery or trauma. C Bleeding is the clinical manifestation of hemophilia and results from a deficiency of normal factor activity necessary to produce blood clotting. D Excessive bruising and petechiae, especially involving the mucous membranes and gums in a child who is otherwise healthy, are the clinical manifestations of ITP, resulting from decreased platelets. The etiology of ITP is unknown, but it is considered to be an autoimmune process.

2. Which information should be included in the nurse's discharge instructions for a child who underwent a cardiac catheterization earlier in the day? a. Pressure dressing is changed daily for the first week. b. The child may soak in the tub beginning tomorrow. c. Contact sports can be resumed in 2 days. d. The child can return to school on the third day after the procedure.

ANS: D A The day after the cardiac catheterization, the pressure dressing is removed and replaced with a Band-Aid. The catheter insertion site is assessed daily for healing. Any bleeding or sign of infection, such as drainage, must be reported to the cardiologist. B Bathing is limited to a shower, a sponge bath, or a brief tub bath (no soaking) for the first 1 to 3 days after the procedure. C Strenuous exercise such as contact sports, swimming, or climbing trees is avoided for up to 1 week after the procedure. D The child can return to school on the third day after the procedure. It is important to emphasize follow-up with the cardiologist.

39. Which statement is characteristic of AOM? a. The etiology is unknown. b. Permanent hearing loss often results. c. It can be treated by intramuscular (IM) antibiotics. d. It is treated with a broad range of antibiotics.

ANS: D A The etiology of AOM may be Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, or a viral agent. Recent concerns about drug-resistant organisms have caused authorities to recommend judicious use of antibiotics and that antibiotics are not required for initial treatment. B Permanent hearing loss is not a frequent cause of properly treated AOM. C Intramuscular antibiotics are not necessary. Oral amoxicillin is the treatment of choice. D Historically AOM has been treated with a range of antibiotics, and it is the most common disorder treated with antibiotics in the ambulatory setting.

18. Which intervention is appropriate for the infant hospitalized with bronchiolitis? a. Position on the side with neck slightly flexed. b. Administer antibiotics as ordered. c. Restrict oral and parenteral fluids if tachypneic. d. Give cool, humidified oxygen.

ANS: D A The infant should be positioned with the head and chest elevated at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm. B The etiology of bronchiolitis is viral. Antibiotics are only given if there is a secondary bacterial infection. C Tachypnea increases insensible fluid loss. If the infant is tachypneic, fluids are given parenterally to prevent dehydration. D Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible fluid loss from tachypnea.

19. Hypospadias refers to a. Absence of a urethral opening b. Penis shorter than usual for age c. Urethral opening along dorsal surface of penis d. Urethral opening along ventral surface of penis

ANS: D A The urethral opening is present, but not at the glans. B Hypospadias refers to the urethral opening, not to the size of the penis. C This is known as epispadias. D Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

The care of the child with chronic renal failure is complex and requires a multidisciplinary team approach. Most of these children will ultimately require dialysis. Is this statement true or false?

ANS: T This statement is correct. Children and their families will be most successful with dialysis treatment if the method chosen fits their lifestyle. The goal is to optimize physical, social, and emotional development while addressing the complex physical requirements related to chronic renal failure.

17. A true statement describing the differences in the pediatric genitourinary system compared with the adult genitourinary system is that a. The young infant's kidneys can more effectively concentrate urine than an adult's kidneys. b. After 6 years of age, kidney function is nearly like that of an adult. c. Unlike adults, most children do not regain normal kidney function after acute renal failure. d. Young children have shorter urethras, which can predispose them to UTIs.

ANS: D A The young infant's kidneys cannot concentrate urine as efficiently as those of older children and adults because the loops of Henle are not yet long enough to reach the inner medulla, where concentration and reabsorption occur. B By 6 to 12 months of age, kidney function is nearly like that of an adult. C Unlike adults, most children with acute renal failure regain normal function. D Young children have shorter urethras, which can predispose them to UTIs.

24. The most common cause of acute renal failure in children is a. Pyelonephritis b. Tubular destruction c. Urinary tract obstruction d. Severe dehydration

ANS: D A These are not common causes of acute renal failure in children. B These are not common causes of acute renal failure in children. C Obstructive uropathy may cause acute renal failure, but it is not the most common cause. D The most common cause of acute renal failure in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume.

4. Which clinical finding warrants further intervention for the child with acute poststreptococcal glomerulonephritis? a. Weight loss to within 1 lb of the preillness weight b. Urine output of 1 mL/kg/hr c. A positive antistreptolysin O (ASO) titer d. Inspiratory crackles

ANS: D A This is an indication that the child is responding to treatment. B This is an acceptable urine output and indicates that the child is responding to treatment. C A positive ASO titer indicates the presence of antibodies to streptococcal bacteria; it is used to aid in diagnosis of acute poststreptococcal glomerulonephritis. This is an expected finding if the child has this acute illness. D Children with excess fluid volume may have pulmonary edema. Inspiratory crackles indicate fluid in the lungs. Pulmonary edema can be a life-threatening complication.

18. Which statement suggests that a parent understands how to correctly administer digoxin? a. "I measure the amount I am supposed to give with a teaspoon." b. "I put the medicine in the baby's bottle." c. "When she spits up right after I give the medicine, I give her another dose." d. "I give the medicine at 8 in the morning and evening every day."

ANS: D A To ensure the correct dosage, the medication should be measured with a syringe. B The medication should not be mixed with formula or food. It is difficult to judge whether the child received the proper dose if the medication is placed in food or formula. C To prevent toxicity, the parent should not repeat the dose without contacting the child's physician. D For maximum effectiveness, the medication should be given at the same time every day.

16. Which intervention should be included in the nurse's plan of care for a 7-year-old child with encopresis who has cleared the initial impaction? a. Have the child sit on the toilet for 30 minutes when he gets up in the morning and at bedtime. b. Increase sugar in the child's diet to promote bowel elimination. c. Use a Fleets enema daily. d. Give the child a choice of beverage to mix with a laxative.

ANS: D A To facilitate bowel elimination, the child should sit on the toilet for 5 to 10 minutes after breakfast and dinner. B Decreasing the amount of sugar in the diet will help keep stools soft. C Daily Fleets enemas can result in hypernatremia and hyperphosphatemia, and are used only during periods of fecal impaction. D Offering realistic choices is helpful in meeting the school-age child's sense of control.

35. What should the nurse stress in a teaching plan for the mother of an 11-year-old boy with ulcerative colitis? a. Preventing the spread of illness to others b. Nutritional guidance and preventing constipation c. Teaching daily use of enemas d. Coping with stress and avoiding triggers

ANS: D A Ulcerative colitis is not infectious. B Although nutritional guidance is a priority teaching focus, diarrhea is a problem with ulcerative colitis, not constipation. C This is not part of the therapeutic plan of care. D Coping with the stress of chronic illness and the clinical manifestations associated with ulcerative colitis (diarrhea, pain) are important teaching foci. Avoidance of triggers can help minimize the impact of the disease and its effect on the child.

33. Which vitamin supplements are necessary for children with cystic fibrosis? a. Vitamin C and calcium b. Vitamin B6 and B12 c. Magnesium d. Vitamins A, D, E, and K

ANS: D A Vitamin C and calcium are not fat soluble. B B6 and B12 are not fat-soluble vitamins. C Magnesium is not a vitamin. D Fat-soluble vitamins are poorly absorbed because of deficient pancreatic enzymes in children with cystic fibrosis; therefore supplements are necessary.

6. When a child with a musculoskeletal injury on the foot is assessed, what is most indicative of a fracture? a. Increased swelling after the injury is iced b. The presence of localized tenderness distal to the site c. The presence of an elevated temperature for 24 hours d. The inability of the child to bear weight

ANS: D An inability to bear weight on the affected extremity is indicative of a more serious injury. With a fracture, general manifestations include pain or tenderness at the site, immobility or decreased range of motion, deformity of the extremity, edema, and inability to bear weight. Although edema is often present with a fracture, it would be unusual for swelling to increase after application of ice, and this would not be most indicative of a fracture. Swelling after icing does not identify the degree of the injury. Localized tenderness along with limited joint mobility may indicate serious injury, but inability to bear weight on the extremity is a more reliable sign. Tenderness is not a usual complaint distal to the affected site. Elevated temperature is associated with infection but not a fracture.

16. Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Moist skin b. Weight gain c. Fluid overload d. Blurred vision

ANS: D Blurred vision is one manifestation of diabetes mellitus type 1. Other manifestations include dehydration with dry skin and weight loss, polyuria, and polyphagia.

Complementary and alternative medical therapies (CAM) are those that are scientifically proven or are not proven; however, they are deemed to be useful as an adjunct to treatment. It is not uncommon for families to try CAM without disclosing this information to the health care team. Is this statement true or false?

ANS: T Families should be asked about CAM therapies by the nurse in a nonthreatening manner. This is important information because some therapies can potentially decrease the efficacy of chemotherapy (such as folate in a child receiving methotrexate).

19. Patient and parent education for the child who has a synthetic cast should include which of the following? a. Applying a heating pad to the cast if the child has swelling in the affected extremity b. Wrapping the outer surface of the cast with an Ace bandage c. Splitting the cast if the child complains of numbness or pain d. Covering the cast with plastic and waterproof tape to keep it dry while bathing or showering

ANS: D Damp skin is more susceptible to breakdown. Cast should be kept clean and dry. To prevent swelling, elevate the extremity and apply bagged ice to the casted area. Wrapping the outer surface with an Ace bandage is not indicated. If the child complains of numbness or pain, the child should return immediately to the clinic or emergency department for an evaluation of neurovascular status.

24. Which is the nurse's best response to the parents of a 10-year-old child newly diagnosed with type 1 diabetes mellitus who are concerned about the child's continued participation in soccer? a. "Consider the swim team as an alternative to soccer." b. "Encourage intellectual activity rather than participation in sports." c. "It is okay to play sports such as soccer unless the weather is too hot." d. "Give the child an extra 15 to 30 g of carbohydrate snack before soccer practice."

ANS: D Exercise lowers blood glucose levels. A snack with 15 to 30 g of carbohydrates before exercise will decrease the risk of hypoglycemia. Soccer is an appropriate sport for a child with type 1 diabetes as long as the child prevents hypoglycemia by eating a snack. Participation in sports is not contraindicated for a child with type 1 diabetes. The child with type 1 diabetes may participate in sports activities regardless of climate.

Hematopoietic stem cell transplantation (HSCT) is the standard treatment for a child in his or her first remission with what cancer? a. ALL b. Non-Hodgkin lymphoma c. Wilms' tumor d. Acute myeloblastic leukemia (AML)

ANS: D Feedback A The standard treatment for ALL is combination chemotherapy. B Standard treatment for non-Hodgkin lymphoma is chemotherapy. Bone marrow transplantation is used to treat non-Hodgkin lymphoma that is resistant to conventional chemotherapy and radiation. C The treatment for Wilms' tumor consists of surgery and chemotherapy alone or in combination with radiation therapy. D HSCT is often used interchangeably with bone marrow transplantation and is currently standard treatment for children in their first remission with AML.

2. A nurse is teaching parents about the importance of immunizations for infants because of immaturity of the immune system. The parents demonstrate that they understand the teaching if they make which statement? a. "We plan to opt out of most childhood vaccinations." b. "There are only a few diseases that have effective immunizations." c. "Babies are born with a sophisticated immune system so they need few, if any, immunizations." d. "Newborns have a hard time fighting infection so they need vaccinations."

ANS: D Immaturity of the immune system places an infant and young child a greater risk of infection, so they need protection through a scheduled series of immunizations. Parents can opt out of many vaccinations, but the nurse should investigate why they plan to do so. Most communicable disease of childhood have immunizations.

4. What should the parents of an infant with thrush (oral candidiasis) be taught about medication administration? a. Give nystatin suspension with a syringe without a needle. b. Apply nystatin cream to the affected area twice a day. c. Give nystatin before the infant is fed. d. Swab nystatin suspension onto the oral mucous membranes after feedings.

ANS: D It is important to apply the nystatin suspension to the affected areas, which is best accomplished by rubbing it onto the gums and tongue, after feedings, until 3 to 4 days after symptoms have disappeared. Medication may not reach the affected areas when it is squirted into the infant's mouth. Rubbing the suspension onto the gum ensures contact with the affected areas. Nystatin cream is used for diaper rash caused by Candida. To prolong contact with the affected areas, the medication should be administered after a feeding.

22. Which term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine? a. Scoliosis b. Ankylosis c. Lordosis 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.

19. The pediatric nurse understands that cellulitis is most often caused by a. herpes zoster. b. Candida albicans. c. human papillomavirus. d. Streptococcus or Staphylococcus organisms.

ANS: D Streptococcus, Staphylococcus, and Haemophilus influenzae are the organisms usually responsible for cellulitis. Herpes zoster is the virus associated with varicella and shingles. Candida albicans is associated with candidiasis or thrush. Human papillomavirus is associated with various types of human warts.

30. A burned child is in the emergency department. The nurse calculates the fluid requirement for the next 24 hours to be 2700 mL. At what rate does the nurse set the pump for initially? a. 50 mL/hour b. 100 mL/hour c. 152.1 mL/hour d. 168.8 mL/hour

ANS: D The amount of fluid needed for fluid resuscitation is generally divided so that half is given in the first 8 hours. This child needs 2700 mL total; half of that volume is 1350 mL, and that volume divided by 8 is 168.75, which is rounded to 168.8 mL/hour.

3. Which organs and tissues control the two types of specific immune functions? a. The spleen and mucous membranes b. Upper and lower intestinal lymphoid tissue c. The skin and lymph nodes d. The thymus and bone marrow

ANS: D The thymus controls cell-mediated immunity (cells that mature into T lymphocytes). The bone marrow controls humoral immunity (stem cells for B lymphocytes). Both the spleen and mucous membranes are secondary organs of the immune system that act as filters to remove debris and antigens and foster contact with T lymphocytes. Gut-associated lymphoid tissue is a secondary organ of the immune system. This tissue filters antigens entering the gastrointestinal tract. The skin and lymph nodes are secondary organs of the immune system.

24. A nurse knows that which exercise is best for a child with juvenile arthritis? a. Jogging b. Tennis c. Gymnastics d. Swimming

ANS: D The warmth of the water (especially if the pool is heated), coupled with mild resistance, makes swimming the perfect medium for strengthening and range-of-motion exercises while protecting the joints. Jogging, tennis, and gymnastics jar the hip, knee, and ankle joints and can cause joint damage.

9. The nurse is assessing a 14-year-old who plays football and complains of knee pain when running and climbing stairs during football practice. The nurse should anticipate which action for this condition? a. Bedrest with range-of-motion exercises b. Prolonged IV antibiotics c. Electromyography d. NSAIDs or knee immobilizer

ANS: D This child most likely has Osgood-Schlatter disease, a self-limiting disorder that resolves with skeletal maturity. NSAIDs and possible knee immobilizers are the treatment. Bedrest with range of motion in indicated for Legg-Calvé-Perthes disease. IV antibiotics are used in osteomyelitis. Electromyography is used to diagnose muscular dystrophy.

What is the most appropriate nursing action when the nurse notes a reddened area on the forearm of a neutropenic child with leukemia? a. Massage the area. b. Turn the child more frequently. c. Document the finding and continue to observe the area. d. Notify the physician.

ANS: D Feedback A In a child with neutropenia, a reddened area may be the only sign of an infection. The area should never be massaged. B The forearm is not a typical pressure area; therefore the likelihood of the redness being related to pressure is very small. C The observation should be documented, but because it may be a sign of an infection and immunosuppression, the physician must also be notified. D Skin is the first line of defense against infection. Any signs of infection in a child who is immunosuppressed must be reported to the physician. When a child is neutropenic, pus may not be produced and the only sign of infection may be redness.

A child with a history of fever of unknown origin, excessive bruising, lymphadenopathy, anemia, and fatigue is exhibiting symptoms most suggestive of a. Ewing sarcoma b. Wilms' tumor c. Neuroblastoma d. Leukemia

ANS: D Feedback A Symptoms of Ewing sarcoma involve pain and soft tissue swelling around the affected bone. B Wilms' tumor usually manifests as an abdominal mass with abdominal pain and may include renal symptoms, such as hematuria, hypertension, and anemia. C Neuroblastoma manifests primarily as an abdominal, chest, bone, or joint mass. Symptoms are dependent on the extent and involvement of the tumor. D These symptoms reflect bone marrow failure and organ infiltration, which occur in leukemia.

Which statement, if made by a nurse to the parents of a child with leukemia, indicates an understanding of teaching related to home care associated with the disease? a. "Your son's blood pressure must be taken daily while he is on chemotherapy." b. "Limit your son's fluid intake just in case he has central nervous system involvement." c. "Your son must receive all of his immunizations in a timely manner." d. "Your son's temperature should be taken frequently."

ANS: D Feedback A The child's temperature must be taken daily because of the risk for infection, but it is not necessary to take a blood pressure daily. B Fluid is never withheld as a precaution against increased intracranial pressure. If a child had confirmed CNS involvement with increased intracranial pressure, this intervention might be more appropriate. C Children who are immunosuppressed should not receive any live virus vaccines. D An elevated temperature may be the only sign of an infection in an immunosuppressed child. Parents should be instructed to monitor their child's temperature as often as necessary.

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for what condition? Select all that apply a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. UTI e. Diabetes mellitus

ANS: D, E Correct: Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. If accompanied by excessive thirst and weight loss, these symptoms may indicate the onset of diabetes mellitus. IncorrecT: An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting.Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.

The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding, or provision of breast milk by bottle, for the first 4 to 6 months of life, preferably until the child reaches 1 year of age or beyond. This does not include infants with congenital heart disease who have difficulty maintaining breastfeeding due to poor oxygenation and fatigue. Is this statement true or false?

ANS: F The AAP states that breastfeeding should not be precluded for most high-risk neonates and infants, including those with congenital heart disease. The benefits of breastfeeding these infants includes; higher and more stable oxygen saturation measurements, improved weight gain, and shorter hospital stays.

The nurse is evaluating lab results to determine if her patient is experiencing a diagnosis of DIC. The nurse should anticipate the following results: increased red blood cell count, low platelet counts, and an increased fibrinogen level. Is this statement true or false?

ANS: F The results indicate a decreased red blood cell count, low platelets, red blood cell fragments, prolonged prothrombin time, and a decreased fibrinogen level with an increased D-dimer.

The childhood vaccine ____________________ has dramatically reduced the incidence of epiglottitis.

ANS: H. influenzae type B (HIB) vaccine The nurse should encourage parents of young children to have their children immunized against H. influenzae to decrease the risk for contracting epiglottitis. Prophylaxis with rifampin is given to underimmunized contacts or family members younger than 4 years old and to any child contact who is immune depressed.

Elevated blood pressure in the blood vessels of the lungs is a condition known as PAH or _____________________ __________________

ANS: Pulmonary hypertension Pulmonary hypertension is diagnosed when the mean arterial pressure exceeds 20 mm Hg (normal is 15 mm Hg). The most common cause of pulmonary hypertension in children is congenital heart disease.

The nurse is providing education related to "Safe Sleep" to the parents of a healthy newborn infant to help prevent sudden infant death syndrome (SIDS). The nurse instructs the parents that bed sharing is not recommended; however, they should put the infant in a safe bassinet or crib in the parent's room for sleeping. Is this statement true or false?

ANS: T The American Academy of Pediatrics (AAP) recommends the following actions to help prevent SIDS in infants: place healthy infants on their backs to sleep, use mattresses with a firm sleeping surface, avoid exposing the infant to secondhand smoke, and offer a pacifier for sleep. In addition, bed sharing is not recommended, and parents are advised to put the infant in a safe bassinet or crib in the parent's room for sleeping.

4. The Glasgow Coma Scale consists of an assessment of a. pupil reactivity and motor response. b. eye opening and verbal and motor responses. c. level of consciousness and verbal response. d. ICP and level of consciousness.

B The Glasgow Coma Scale assesses eye opening, and verbal and motor responses. Pupil reactivity is not a part of the Glasgow Coma Scale but is included in the pediatric coma scale. Level of consciousness is not a part of the Glasgow Coma Scale. Intracranial pressure and level of consciousness are not part of the Glasgow Coma Scale.

16. The nurse teaches parents to alert their health care provider about which adverse effect when a child receives valproic acid (Depakene) to control generalized seizures? a. Weight loss b. Bruising c. Anorexia d. Drowsiness

B Thrombocytopenia is an adverse effect of valproic acid. Parents should be alert for any unusual bruising or bleeding. Weight gain, not loss, is a side effect of valproic acid. Drowsiness is not a side effect of valproic acid, although it is associated with other anticonvulsant medications. Anorexia is not a side effect of valproic acid.

1. What nursing actions are indicated when the nurse is administering phenytoin (Dilantin) by the intravenous route to control seizures? (Select all that apply.) b. Occasional blood levels will be assessed. d. It must be given in normal saline. e. It must be filtered.

B, D, E The child should have serum levels drawn to monitor for optimal therapeutic levels. In addition, liver function studies should be monitored because this anticonvulsant may cause hepatic dysfunction. The IV dose must be given in normal saline, not D51/2 NS. The IV dose must be filtered. The IV dose must be given in normal saline, not D51/2 NS. Dilantin has not been found to cause gastrointestinal upset, and since it is being given by the IV route, this is not a concern. The medication can be taken without food.

36. Which neurologic diagnostic test gives a visualized horizontal and vertical cross section of the brain at any axis? a. Nuclear brain scan b. Echoencephalography c. CT scan d. MRI

C A CT scan provides a visualization of the horizontal and vertical cross sections of the brain at any axis. A nuclear brain scan uses a radioisotope that accumulates where the blood-brain barrier is defective. Echoencephalography identifies shifts in midline structures of the brain as a result of intracranial lesions. MRI permits visualization of morphologic features of target structures and permits tissue discrimination that is unavailable with any other techniques.

22. Which type of seizure involves both hemispheres of the brain? a. Focal b. Partial c. Generalized d. Acquired

C Clinical observations of generalized seizures indicate that the initial involvement is from both hemispheres. Focal seizures may arise from any area of the cerebral cortex, but the frontal, temporal, and parietal lobes are most commonly affected. Partial seizures are caused by abnormal electric discharges from epileptogenic foci limited to a circumscribed region of the cerebral cortex. A seizure disorder that is acquired is a result of a brain injury from a variety of factors; it does not specify the type of seizure.

18. Which type of fracture describes traumatic separation of cranial sutures? a. Basilar b. Linear c. Comminuted d. Depressed

C Comminuted skull fractures include fragmentation of the bone or a multiple fracture line. A basilar fracture involves the basilar portion of the frontal, ethmoid, sphenoid, temporal, or occipital bone. A linear fracture includes a straight-line fracture without dural involvement. A depressed fracture has the bone pushed inward, causing pressure on the brain.

5. Nursing care of the infant who has had a myelomeningocele repair should include a. securely fastening the diaper. b. measurement of pupil size. c. measurement of head circumference. d. administration of seizure medications.

C Head circumference measurement is essential because hydrocephalus can develop in these infants. A diaper should be placed under the infant but not fastened. Keeping the diaper open facilitates frequent cleaning and decreases the risk for skin breakdown. Pupil size measurement is usually not necessary. Seizure medications are not routinely given to infants who do not have seizures.

29. What is an appropriate nursing intervention for the child with a tension headache? a. Assess for an aura. b. Maintain complete bed rest. c. Administer mild pain medication. d. Assess for nausea and vomiting.

C Mild pain relievers like acetaminophen or ibuprofen are appropriate for the child with a tension headache. The other measures are not warranted.

15. What is the best response to a father who tells the nurse that his son "daydreams" at home and that his teacher has observed this behavior at school? a. "Your son must have an active imagination." b. "Can you tell me exactly how many times this occurs in one day?" c. "Tell me about your son's activity when you notice the daydreams." d. "He is probably overtired and needs more rest."

C The daydream episodes are suggestive of absence seizures, and data about activity associated with the daydreams should be obtained. Describing an active imagination or an overtired child does not address the symptoms of the father's concern. Determining the number of times the behavior occurs is not as helpful as information about the behavior.

21. A 5-year-old sustained a concussion after falling out of a tree. In preparation for discharge, the nurse is discussing home care with the parents. Which statement made by the parents indicates a correct understanding of the teaching? a. "I should expect my child to have a few episodes of vomiting." b. "If I notice sleep disturbances, I should contact the physician immediately." c. "I should expect my child to have some behavioral changes after the accident." d. "If I notice diplopia, I will have my child rest for 1 hour."

C The parents are advised of probable posttraumatic symptoms. These include behavioral changes and sleep disturbances. Vomiting and diplopia should be reported immediately. Sleep disturbances may occur with postconcussive syndrome, but difficulty waking the child up should be reported.

7. A 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.

C The widespread use of folic acid among women of childbearing age is expected to decrease the incidence of spina bifida significantly. Vitamin A, multivitamins, and folic acid only during specific points during the pregnancy have not been shown to prevent neural tube defects.

32. A child is brought to the emergency department in status epilepticus. Which medication should the nurse expect to be given initially in this situation? a. Clorazepate dipotassium (Tranxene) b. Fosphenytoin (Cerebyx) c. Phenobarbital d. Lorazepam (Ativan)

D Lorazepam (Ativan) or diazepam (Valium) is given intravenously to control generalized tonic-clonic status epilepticus and may also be used for seizures lasting more than 5 minutes. The other drugs are used for seizures but are not the first-line treatment for status.

34. A nurse is explaining to parents how the central nervous system of a child differs from that of an adult. Which statement accurately describes these differences? a. The infant has 150 mL of CSF compared with 50 mL in the adult. b. Papilledema is a common manifestation of ICP in the very young child. c. The brain of a term infant weighs less than half of the weight of the adult brain. d. Coordination and fine motor skills develop as myelinization of peripheral nerves progresses.

D Peripheral nerves are not completely myelinated at birth. As myelinization progresses, so does the child's coordination and fine muscle movements. An infant has about 50 mL of CSF compared with 150 mL in an adult. Papilledema rarely occurs in infancy because open fontanels and sutures can expand in the presence of ICP. The brain of the term infant is two thirds the weight of an adult's brain.

30. Which statement by an adolescent indicates an understanding about factors that can trigger migraine headaches? a. "I should avoid loud noises because this is a common migraine trigger." b. "Exercise can cause a migraine. I guess I won't have to take gym anymore." c. "I think I'll get a migraine if I go to bed at 9 PM on week nights." d. "I am learning to relax because I get headaches when I am worried about stuff."

D Stress can trigger migraines. Relaxation therapy can help the adolescent control stress and headaches. Other precipitating factors in addition to stress include poor diet, food sensitivities, and flashing lights. Visual stimuli, not auditory stimuli, are known to be a common trigger for migraines. Exercise is not a trigger for migraines. The adolescent needs regular physical exercise. Altered sleep patterns and fatigue are common triggers for migraine headaches. Going to bed at 9 PM should allow an adolescent plenty of sleep to prevent fatigue.

13. How should the nurse explain positioning for a lumbar puncture to a 5-year-old child? a. "You will be on your knees with your head down on the table." b. "You will be able to sit up with your chin against your chest." c. "You will be on your side with the head of your bed slightly raised." d. "You will lie on your side and bend your knees so that they touch your chin."

D The child should lie on her side with knees bent and chin tucked in to the knees. This position exposes the area of the back for the lumbar puncture. The other positions are not used for a lumbar puncture.

27. Which change in status should alert the nurse to increased intracranial pressure (ICP) in a child with a head injury? a. Rapid, shallow breathing b. Irregular, rapid heart rate c. Increased diastolic pressure with narrowing pulse pressure d. Confusion and altered mental status

D The child with a head injury may have confusion and altered mental status, a change in vital signs, retinal hemorrhaging, hemiparesis, and papilledema. Respiratory changes occur with ICP. One pattern that may be evident is Cheyne-Stokes respiration. This pattern of breathing is characterized by increasing rate and depth, then decreasing rate and depth, with a pause of variable length. Temperature elevation may occur in children with ICP. Changes in blood pressure occur, but the diastolic pressure does not increase, nor is there a narrowing of pulse pressure.

26. The father of a newborn infant with myelomeningocele asks about the cause of this condition. What response by the nurse is most appropriate? 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."

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 may be a genetic predisposition, but no pattern has been identified. Folic acid deficiency in the mother has been linked to neural tube defect. There is no evidence that children who have parents with spinal problems are at greater risk for neural tube defects.

20. The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. What is the most essential part of nursing assessment to detect early signs of a worsening condition? a. Posturing b. Vital signs c. Focal neurologic signs d. Level of consciousness

D The most important nursing observation is assessment of the child's level of consciousness. Alterations in consciousness appear earlier in the progression of head injury than do alterations of vital signs or focal neurologic signs. Neurologic posturing is indicative of neurologic damage. Vital signs and focal neurologic signs are later signs of progression when compared with level-of-consciousness changes. Vital signs and focal neurologic signs are later signs of progression when compared with level-of-consciousness changes.

3. 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.