Peds Exam 2 20-24

Which piece of equipment is most helpful in determining airway obstruction in the client with asthma? A. A nebulizer B. An inhaler C. A peak flow meter D. An incentive spirometer

ANS: C Rationale: The peak flow meter provides the most reliable early sign of an asthma episode. Most episodes begin gradually, and a drop in peak flow can alert the client to begin medications before symptoms actually are noticeable. A nebulizer and inhaler treat symptoms. An incentive spirometer is used for lung expansion, especially after surgery.

The parents of a child with a history of seizures who has been taking phenytoin (Dilantin) ask the nurse why it's difficult to maintain therapeutic plasma levels of this medication. Which statement by the nurse would be most accurate? A: "A drop in the plasma drug level will lead to a toxic state." B: "The capacity to metabolize the drug becomes overwhelmed over time." C: "Small increments in dosage lead to sharp increases in plasma drug levels." D: "Large increments in dosage lead to a more rapid stabilizing therapeutic effect."

ANS: C Rationale: Within the therapeutic range for phenytoin, small increments in dosage produce sharp increases in plasma drug levels. The capacity of the liver to metabolize phenytoin is affected by slight changes in the dosage of the drug, not necessarily the length of time the client has been taking the drug. Large increments in dosage will greatly increase plasma levels, leading to drug toxicity

The nurse is working with a child with altered genitourinary status. The child demonstrates excess fluid volume. Which of the following would the nurse most likely do? A. Weigh the child 2 times a day on the same scale. B. Hold all medication until the fluid retention improves. C. Avoid administering IV fluids. D. Measure the amount of nitrates present in the urine.

ANS: A Rationale: A child with altered genitourinary status with excess fluid volume needs to be weighed twice daily always with the same scale, wearing the same amount of clothing at the same time each day. A weight gain of greater than 0.5 kg can indicate fluid retention. Withholding all medication and avoiding IV fluids would be inappropriate. IV fluid administration should be monitored closely and given at the prescribed rate. The nurse should also monitor laboratory values such as BUN and creatinine, urine and serum sodium, serum potassium, hemoglobin and hematocrit for changes.

The nurse is working with a child with altered genitourinary status. Which intervention would be included in the plan of care for the client with excess fluid volume? A. Weigh the child daily on the same scale. B. Hold all medication until the fluid retention is improving. C. Avoid administering IV therapies. D. Measure the amount of nitrates present in the urine.

ANS: A Rationale: A child with edema and fluid overload should be weighed daily, on the same scale, at the same time, with the same amount of clothing. This gives the most accurate picture of fluid gain or loss. The nurse also should assess the blood pressure and pulse rate regularly to determine if hypovolemia is occurring. This can occur from fluid shifts occurring if fluid is lost too quickly. Medications need to be administered, especially diuretics to help reduce the edema. The child should be on fluid restriction. This includes PO and IV. If IV fluids are necessary the volume should be calculated into the daily amount

The nurse is teaching the parent of a child with chronic renal failure on high-potassium foods that should be restricted. Which foods will the nurse include in this teaching? Select all that apply. A. Bananas, carrots, nuts, and milk B. Peaches, broccoli, and red meat C. Oranges, potatoes, wheat, and bran D. Spinach, chicken, fish, and green beans

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

An 8-year-old boy and his father visit the pediatrician's office with reports of a sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the boy's health history, the nurse learns that he had strep throat a little over a week ago. Which condition should the nurse suspect? A. Acute glomerulonephritis B. Kidney agenesis C. Polycystic kidney D. Nephrosis

ANS: A Rationale: Glomerulonephritis, inflammation of the glomeruli of the kidney, is most common in children between the ages of 5 and 10 years. The child typically has a history of a recent streptococcal respiratory infection (within 7 to 14 days). Symptoms are as described above. Kidney agenesis (absence of kidneys) and polycystic kidneys (formation of large, fluid-filled cysts in the place of normal kidney tissue) are serious congenital conditions that would likely be discovered either in utero or shortly after birth, not conditions that would appear acutely in an 8-year-old. Nephrosis is altered glomerular permeability apparently due to an autoimmune process or a T-lymphocyte dysfunction that results in fusion of the glomeruli membrane surfaces, which, in turn, leading to abnormal loss of protein in urine. The highest incidence is at 3 years of age, and it occurs more often in boys than in girls. In addition to proteinuria, a major symptom of nephrosis is edema, which is absent in this case.

A 10-year-old girl is experiencing acute renal failure due to dehydration. The nurse is preparing to administer IV fluid. Which of the following interventions should the nurse take in caring for this child? A. Administer the IV fluid slowly B. Make sure the IV fluid contains potassium C. Increase oral intake of fluid D. Provide a diet high in protein and sodium

ANS: A Rationale: If the child is dehydrated (as with diarrhea or hemorrhage), IV fluid is needed to replace plasma volume. Administer such fluid slowly, however, to avoid heart failure as extra fluid cannot be removed by the nonfunctioning kidneys. Be certain the fluid prescribed does not contain potassium until it is established kidney function is adequate; otherwise, the buildup of potassium could cause heart block. The child's diet should be low in protein, potassium, and sodium and high in carbohydrate to supply enough calories for metabolism yet limit urea production and control serum potassium levels. Oral fluid intake may be limited to prevent heart failure due to accumulating fluid that cannot be excreted.

A nurse is developing a teaching plan for the parents of an 8-year-old experiencing nocturnal enuresis. The nurse determines that additional teaching is needed when the parents identify what as an appropriate measure? A. Encouraging fluid intake after dinner B. Practicing bladder-stretching exercises C. Giving desmopressin intranasally D. Engaging the child in stress reduction measures

ANS: A Rationale: In many children, limiting fluids after dinner can be helpful for nocturnal enuresis. Bladder-stretching exercises also can be helpful. If these measures are ineffective, desmopressin may be prescribed. Stress factors may be contributing to the child's problem. Therefore, measures to address stress and promote coping would be appropriate.

A nurse is assessing a child who may have peritonitis. Which of the following would be signs of this problem? A. Increased white blood cell count of dialysate outflow B. Diarrhea C. Increased red blood cell count of dialysate outflow D. Syncope

ANS: A Rationale: Increased white blood cell count of dialysate outflow is one of the signs of peritonitis. Vomiting, fever, and abdominal pain are also signs of peritonitis.

The nurse is caring for a child diagnosed with a urinary tract infection. The caregiver asks the nurse why it is so important for the child to have so much fluid. What is the most important reason the child needs increased fluids? A. To dilute the urine and flush the bladder B. To fill the bladder so a specimen can be obtained C. To prevent the child from developing a fever D. To decrease the pain of urination

ANS: A Rationale: Increasing the child's fluid intake is necessary to help dilute the urine and flush the bladder.

The nurse is caring for a 12-year-old girl with nephrotic syndrome. The girl confides that she feels like a "freak" compared to her peers because of her weight, edema, and moon face. Which response by the nurse would be most appropriate? A. "Let's put you in touch with some other girls who are also having the same body changes." B. "Luckily, this is just a temporary, unfortunate part of your condition; you need to accept it." C. "Your real friends do not care about your appearance and just want you to get well." D. "You are beautiful in your own way; what matters is what is on the inside."

ANS: A Rationale: It is important to introduce the girl to other youngsters with chronic renal conditions so she does not feel so isolated. Adolescents need interaction with peers. Telling the girl that this is a temporary condition, her real friends don't care about her appearance, and she is beautiful in her own way dismisses the girl's concerns and does not offer solutions. Nephrotic syndrome is a chronic condition, so telling her the condition is temporary also is inaccurate.

At a well-child visit, a urine specimen is obtained from a child for testing. The nurse is reviewing the results which reveal positive leukocytes. The nurse interprets this as indicating which of the following? A. Possible urinary tract infection B. Diabetes C. Renal disease D. Bleeding

ANS: A Rationale: The evidence of leukocytes in a urine specimen suggests a possible urinary tract infection. Glucose in the urine may suggest diabetes. Elevated protein levels suggest renal disease. Elevated levels of red blood cells in the urine indicate possible calculus, trauma and renal parenchymal disease.

A child is having their urine checked for complaints of polyuria. When analyzing the results, what would positive glucose indicate? A. This may indicate a urinary tract infection. B. This determines the presence of sugar in the urine. C. This indicates renal disease. D. This determines the presence of bacteria in the urine.

ANS: B Rationale: Positive glucose determines the presence of sugar in the urine. This could signify diabetes and needs to be evaluated immediately. Positive leukocytes may indicate a urinary tract infection. The u

The nurse is assessing a child with suspected infective endocarditis. Which assessment finding would the nurse interpret as a sign of extracardiac emboli? A. Pruritus B. Roth spots C. Delayed capillary refill D. Erythema marginatum

ANS: B Rationale: Roth spots are splinter hemorrhages with pale centers on the sclerae, palate, buccal mucosa, chest, fingers, or toes, and are signs of extracardiac emboli. Delayed capillary refill time does not point to extracardiac emboli. Wheezing and pruritus are indicative of a hypersensitivity reaction. Erythema marginatum is a classic rash associated with acute rheumatic fever.

A child is diagnosed with hemolytic-uremic syndrome (HUS). Review of the child's laboratory test results would reveal which finding? A. Decreased blood urea nitrogen (BUN) and creatinine B. Decreased platelets and leukocytosis C. Hypernatremia and hypokalemia D. Respiratory acidosis and proteinuria

ANS: B Rationale: The child with HUS typically exhibits severe thrombocytopenia (decreased platelets) and leukocytosis. BUN and creatinine are elevated. Hyponatremia, hyperkalemia, metabolic acidosis, and proteinuria also may be noted.

The nurse is caring for a child who is undergoing peritoneal dialysis. Immediately after draining the dialysate, which action should the nurse should take immediately? A. Empty the old dialysate B. Weigh the old dialysate C. Weigh the new dialysate D. Start the process over with a fresh bag

ANS: B Rationale: The nurse should weigh the old dialysate to determine the amount of fluid removed from the child. The fluid must be weighed prior to emptying it. The nurse should weigh the new fluid prior to starting the next fill phase. Typically, the exchanges are 3 to 6 hours apart so the nurse would not immediately start the next fill phase.

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

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

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

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

The nurse is assessing an infant with suspected hemolytic uremic syndrome. Which characteristics of this condition should the nurse expect to assess or glean from chart review? A. Hemolytic anemia, acute renal failure, and hypotension B. Dirty green colored urine, elevated erythrocyte sedimentation, and depressed serum complement level C. Hemolytic anemia, thrombocytopenia, and acute renal failure D. Thrombocytopenia, hemolytic anemia, and nocturia several times each night

ANS: C Rationale: Hemolytic uremic syndrome is defined by all three particular features - hemolytic anemia, thrombocytopenia, and acute renal failure. Dirty green colored urine, elevated erythrocyte sedimentation, and depressed serum complement level are indicative of acute glomerulonephritis. Hypertension, not hypotension, would be seen and the child would have decreased urinary output which would not cause nocturia.

A nurse is caring for a 13-year-old boy with end-stage renal disease who is preparing to have his hemodialysis treatment in the dialysis unit. Which nursing action is appropriate? A. Administer his routine medications as scheduled B. Take his blood pressure measurement in extremity with AV fistula C. Withhold his routine medication until after dialysis is completed D. Assess the Tenckhoff catheter site

ANS: C Rationale: The nurse should withhold routine medications on the morning that hemodialysis is scheduled since they would be filtered out through the dialysis process. His medications should be administered after he returns from the dialysis unit. A Tenckhoff catheter is used for peritoneal dialysis, not hemodialysis. The nurse should avoid blood pressure measurement in the extremity with the AV fistula as it may cause occlusion.

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

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

A nurse is performing an assessment on a child. What would be indicative of a potential for a urinary tract infection? A. Washing the genital area with water daily B. Not using cleansing towelettes routinely C. Not using soap when cleaning the urethral area D. Holding urine while at school

ANS: D Rationale: UTIs are often caused by children who do not urinate frequently at school. It is important for a child to avoid using towelettes and soap in the genital area because this can increase the chance of a UTI. Washing the genital area with water daily does not increase the chance of a UTI.

During the assessment of a preschooler, the nurse notes that the child has abnormal dryness and thickening of the conjunctiva and dry and scaly skin. Which vitamin deficiency does the nurse suspect this child is experiencing? A: Vitamin A B:Vitamin B C: Vitamin D D: Vitamin E

ANS: A Rationale: A vitamin A deficiency manifests with night blindness, abnormal dryness and thickening of the conjunctiva and cornea (xerophthalmia), corneal ulcerations, dry and scaly skin, impaired immunity, infections, growth retardation. Manifestations of a vitamin B deficiency include stomatitis, glossitis, cheilosis, edema, anemia, ophthalmoplegia, tachycardia or bradycardia, peripheral neuropathy, fatigue, confusion, seizures. Manifestations of a vitamin D deficiency include rickets, short stature, bone fractures due to weakening or softening of the bones (osteomalacia), low calcium blood levels (which can also be associated with tetany and paresthesias). Manifestations of a vitamin E deficiency include paresthesias, tetany, ataxia, edema, depressed deep tendon reflexes, vision problems.

A voiding cystourethrogram (VCUG) is prescribed for a child. What education should be provided to the parents? A. The VCUG will rule out vesicoureteral reflux. B. The VCUG will detect if the infection is gone. C. The VCUG will rule out kidney stones. D. The VCUG will prevent further complications of the urinary tract infection (UTI).

ANS: A Rationale: A voiding cystogram (VCUG) is performed by having the bladder filled with a contrast medium via catheterization. Under fluoroscopy the bladder is visualized filling and emptying. A VCUG is used to rule out reflux in the urinary tract, causes of hematuria, UTI, and structural anomalies. Reflux may cause frequent infections and scarring in the urinary tract if not diagnosed and treated. A VCUG will not diagnose renal stones. Renal stones would be detected by a CT scan. A VCUG would not be performed to detect if infections of the UTI have cleared. This would be done by assessing a urinalysis.

The nurse is preparing an 18-month-old for discharge following treatment for dehydration secondary to diarrhea. What instruction would the nurse most likely include in the discharge teaching? A: "Encourage a bland diet." B: "Implement clear liquids." C: "Provide plenty of 100% fruit juice." D: "Offer flavored gelatin if hungry."

ANS: A Rationale: After rehydration is achieved, it is important to encourage the child to consume a bland diet in order to maintain energy and growth. The solid foods presented are easily digested and age appropriate. The parents should avoid prolonged used of clear liquids in the child with diarrhea because "starvation stools" might result. Fluids high in glucose such as fruit juice, gelatin, and soda may worsen diarrhea. Gelatin is high in glucose and may worsen diarrhea.

The nurse is taking a health history for a 9-year-old with conjunctivitis. Which statement by the parents leads the nurse to suspect that the child is experiencing allergic conjunctivitis? A: "He recently helped clean the basement. B: "He was exposed to several family members with an infection. C: He just recovered from an upper respiratory infection. D: We have a family history of conjunctivitis.

ANS: A Rationale: Allergic conjunctivitis may be induced by animal dander, dust mites, or some other ever-present antigen. Exposure to infective agents is related to infectious conjunctivitis. Recent upper respiratory infection and a family history of conjunctivitis are not contributing factors for allergic conjunctivitis.

The mother of a 12-year-old with Reye syndrome approaches the nurse wanting to know how this happened to her child, saying, "I never give my kids aspirin!" Which response by the nurse would be most appropriate? A: "Sometimes it's hard to tell if a product contains aspirin." B: "Do you think that maybe your child took aspirin on his own?" C: "Don't worry; you're in good hands. We have it under control now." D: "Aspirin in combination with the virus will make the brain swell and the liver fail."

ANS: A Rationale: Although warning labels are placed on containers of salicylates, salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. The parent needs to be receptive to further education. Don't state the obvious, but also don't minimize the situation. Encourage the mother to ask for information, and be sure to explain in terms she will understand.

The nurse is providing education to the parents of a female with hydrocephalus who has just had a shunt inserted. When discussing the child's condition with the parents, which of the following would be most appropriate? A: "Tell me your concerns about your child's shunt." B: "Be sure to call the doctor if she gets a persistent headache." C: "Her autoregulation mechanism to absorb spinal fluid has failed." D: "Always keep her head raised 30 degrees."

ANS: A Rationale: Always start by assessing the family's knowledge. Ask them what they feel they need to know. Knowing when to call the doctor and how to raise the child's head are important, but they might not be listening if they have another question on their minds. "Autoregulation" is too technical—base information on the parents' level of understanding.

The nurse is assessing a 7-year-old with a hearing aid. His mother says he is losing his hearing again. Which finding would the nurse identify as contributing to this current complaint? A: Overproduction of cerumen B: Soreness of the outer ear C: History of a normal term birth D: The eardrum responds to a puff of air

ANS: A Rationale: Approximately 10% of children either produce larger than normal amounts or have difficulty with cerumen removal that results in hearing impairment. Cerumen impaction can affect hearing, even with a hearing aid. Soreness of the outer ear is a sign of otitis externa. Full-term birth would not play role in continued loss of hearing. Eardrum response to a puff of air indicates the absence of fluid in the middle ear.

An 8-year-old child is being treated for tonic-clonic seizures. What should the nurse emphasize when teaching the parents about this disorder? A: The child should maintain an active lifestyle. B: Immediately provide medication if a seizure begins. C: Have the child carry a padded tongue blade with her at all times. D: Ensure quiet time late in the day, when seizure activity is most

ANS: A Rationale: As a rule, children with seizures should attend regular school and participate in physical education classes and active sports. Antiseizure medication is ineffective during a seizure because most medication needs to achieve a therapeutic level to be effective. Padded tongue blades are not used in people with a seizure disorder. There is no specific time of day when a seizure can occur.

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. What is the best response from the nurse? A. It will determine if the heart is enlarged. B. It will determine disturbances in heart conduction. C. It will show if blood is being shunted. D. This image will clarify the structures within the heart.

ANS: A Rationale: Chest x-rays are performed to see if the heart is enlarged. This will determine if the heart muscle is increasing in size. Disturbances in heart conduction are detected by an EKG. Visualizing where blood is being shunted is through the echocardiogram. The image used to clarify the structures of the heart is the MRI.

A nurse is conducting a presentation for a community parent group about respiratory conditions in children. The nurse determines that the teaching was successful when the group identifies which of the following as one of the most common conditions seen during early childhood? A. Croup B. Bronchiolitis C. Asthma D. Pneumonia

ANS: A Rationale: Croup is one of the most common acute respiratory conditions seen during early childhood (6 months to 5 years of age), with a peak in the second year of life, and the most common cause of upper airway obstruction

A nurse is caring for a 3-year-old girl with microcephaly. Which of the following actions is appropriate for the nurse to take? A:Playfully ask the child to touch her nose B: Teach the parents about ventriculoperitoneal (VP) shunts C: Prepare the child for the experience of cranial surgery D: Administer antipyretics as ordered

ANS: A Rationale: Having the child touch her nose will assist the nurse in assessing probable neurologic and cognitive deficits. A VP shunt may be necessary for hydrocephaly. Surgery is often an intervention for craniosynostosis but cannot correct microcephaly. Hyperthermia is not a complication with microcephaly.

The nurse is caring for a 2-year-old diagnosed with bacterial pneumonia. The child has been placed in a mist tent. In caring for the child, it is important for the nurse to: A. monitor the child regularly for signs of cyanosis. B. avoid contact with the mist if the nurse is a sexually active female of childbearing age. C. use contact transmission precautions. D. check for hyperthermia related to enclosure in the tent.

ANS: A Rationale: In some treatment of bacterial pneumonia a croupette or mist tent is used. Children have become cyanotic in mist tents, with subsequent arrest, due to the lack of visibility while in the tent; the child must be constantly observed. Ribavirin, an antiviral drug that may be used to treat certain children with RSV, is administered as an inhalant by hood, mask, or tent; it has a high risk for teratogenicity (causing damage to a fetus) so care must be taken when the drug is administered. In treating a client with bacterial pneumonia, the client may need to be placed on infection control precautions according to the policy of the health care facility, and the nurse should look for hyperthermia related to the infection process.

The nurse is educating parents of a male infant with Chiari type II malformation about the condition. Which of the following would be most important for the nurse to include? A: Taking time to feed the infant B: Laying the infant down after a feeding C: Being able to see major difference after surgery D: Not needing to change diapers as often

ANS: A Rationale: One of the problems associated with Chiari type II malformation is poor gag and swallowing reflexes, so the infant must be fed slowly. There is a great risk of aspiration, requiring that the child be placed in an upright position after feeding. The goal of surgery is to prevent further symptoms rather than to relieve existing ones. Infrequent urination is a problem associated with type I malformations.

The nurse is caring for a child who has been admitted with a possible diagnosis of tuberculosis. Which laboratory/diagnostic tools would most likely be used to help diagnose this child? A. Purified protein derivative test B. Sweat sodium chloride test C. Blood culture and sensitivity D. Pulmonary functions test

ANS: A Rationale: Purified protein derivative tests are used to detect TB. Sweat sodium chloride tests are used for determining the diagnosis of cystic fibrosis. Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection. Pulmonary function tests are diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs.

A 5-year-old girl who was already admitted to the hospital for an unrelated condition suddenly becomes irritable, restless and anxious. These may be early signs of respiratory distress in a child if accompanied by: A. tachypnea. B. retractions. C. cyanosis. D. clubbing of fingers

ANS: A Rationale: Restlessness, irritability, and anxiety result from difficulty in securing adequate oxygen. These might be very early signs of respiratory distress, especially if accompanied by tachypnea (an increased respiratory rate). Retractions can be a sign of airway obstruction but occur more commonly in newborns and infants than in older children. Cyanosis (a blue tinge to the skin) indicates hypoxia, which may be a sign of airway obstruction but would not be the first. Children with chronic respiratory illnesses often develop clubbing of the fingers, a change in the angle between the fingernail and nailbed because of increased capillary growth in the fingertips. Clubbing would not occur in an acute airway obstruction, as is indicated in the scenario above.

A child who is experiencing an exacerbation of asthma is brought to the emergency department by his parents. When reviewing the child's laboratory and diagnostic test results, which is consistent with the diagnosis? A. Hyperinflation of lungs on chest radiograph B. Increased peak expiratory flow rate C. Low arterial blood carbon dioxide level D. Decreased pulmonary function tests

ANS: A Rationale: The chest radiograph usually reveals hyperinflation. Peak expiratory flow rate usually is decreased during an exacerbation. With arterial blood gases, carbon dioxide retention is usually noted. Although pulmonary function tests are useful in determining the degree of disease, they are not useful during an attack.

When caring for children with respiratory issues in relationship to the anatomy and physiology of the child's respiratory system, it is important to recognize which of the following? A. The diameter of the child's trachea is about the size of the child's little finger. B. As soon as the child is born, respiratory passages needed during fetal life close. C. Full development of the lungs and respiratory organs involved does not occur until the child is an adolescent. D. The newborn uses the thoracic muscles to breathe, and as they grow they begin using the abdominal muscles to breathe.

ANS: A Rationale: The diameter of the infant's and child's trachea is about the size of the child's little finger. This small diameter makes it extremely important to be aware that something can easily lodge in this small passageway and obstruct the child's airway.

The nurse is caring for a 3-year-old girl who has just undergone a ventriculostomy. Which of the following would the nurse include in this child's plan of care to manage increased intracranial pressure (ICP)? A: Use pillows to support the child when lying on her side B: Support the parents in starting a ketogenic diet C: Pad the side rails on the bed D: Teach her to do deep breathing techniques

ANS: A Rationale: The nurse should use pillows to prevent the child from sliding down in bed and to support the head in a neutral position when the child lies on his or her side. Beginning a ketogenic diet and padding the side rails for safety are interventions for a child with seizures. A 3-year-old is not likely to understand deep breathing techniques.

A child with a suspected airway obstruction is brought to the emergency room. He produces a harsh, strident sound on inspiration (stridor). Where is the obstruction likely to be located, based on this information? A. In the larynx B. Lower trachea C. Bronchioles D. Pharynx

ANS: A Rationale: The vibrations produced as air is forced past obstructions such as mucus in the nose or pharynx, the noise produced is a snoring sound (rhonchi). If the obstruction is at the base of the tongue or in the larynx, a harsher, strident sound on inspiration (stridor) occurs. If an obstruction is in the lower trachea or bronchioles, an expiratory whistle sound (wheezing) occurs.

A panicked mother calls the health care provider's office and reports that her 5-year-old has a high fever and just had a seizure. The mother asks the nurse what she should do. Which is the nurse's best response? A: Report to the emergency room for medical evaluation B: Immerse the child in a bathtub of tepid water C: Administer oral acetaminophen per package directions D: Remove any heavy clothing and cover with a thin sheet

ANS: A Rationale: When a child has a febrile seizure associated with a high fever, it is important to seek medical evaluation. Medical evaluation will identify the source of the high fever. If the fever is viral, the child may be able to be managed at home. Advise them not to put the child in a bathtub of water to do this because it would be easy for the child to slip under water should a second seizure occur. Caution them not to apply alcohol or cold water as extreme cooling causes shock to an immature nervous system. Parents should not attempt to give oral medications such as acetaminophen, because the child will be in a drowsy, or postictal, state after the seizure and might aspirate the medicine. It is appropriate to remove heavy clothing but not the best response.

The nurse is providing education to parents of a child with a blood pressure in the 90th percentile. What would be included in the intervention strategies? A. The nurse would review the child's 24-hour diet recall. B. The child should not be allowed to participate in sports. C. Blood pressures should be measured daily. D. Beta blocker education should be given to the parents.

ANS: A Rationale: With a child in the 90th percentile for blood pressure, diet and physical activity should be the main focus. Blood pressures should be measured, but daily measurement is not necessary. Children are not routinely put on beta blockers, and the child should be allowed to participate in sports if monitored.

A 4-year-old child is scheduled for an echocardiogram. The nurse is explaining this procedure to the child's parents. Which information would the nurse likely include? Select all that apply. A. "This test uses sound waves to check the heart structures." B. "This test should not cause your child any pain." C. "This test exposes your child to radiation so we need to be careful." D. "This test checks the electrical conduction of your child's heart." "This test will require us to give your child a small amount of anesthesia."

ANS: A, B Rationale: An echocardiogram is a noninvasive ultrasound procedure used to assess heart wall thickness, size of heart chambers, motion of valves and septa, and relationship of great vessels to other cardiac structures. It should not cause any pain for the child. No sedation or anesthesia is needed for an echocardiogram. However, the child needs to lie still throughout the test. A chest x-ray or radiograph would expose the child to radiation. An electrocardiogram records the electrical activity of the heart.

A child has been admitted to the acute care facility for the management of dehydration. The nurse is preparing to administer intravenous fluid replacement to the child. Which fluids are suitable for use? Select all that apply. A: Lactated Ringer B: Normal saline C: 5% dextrose in water D: 0.45% saline E: 10% dextrose in water

ANS: A, B Rationale: Intravenous fluids can be used to treat dehydration. The fluids used need to be isotonic. Examples of isotonic fluids include normal saline and ringer lactate solution.

The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. What would the nurse expect to find? Select all that apply. A. Tiring easily when eating B. Shortness of breath when playing C. Crackles on lung auscultation D. Bradycardia E. Hypertension

ANS: A, B, C Rationale: Manifestations of heart failure include difficulty feeding or eating or becoming tired easily when feeding or eating, shortness of breath with exercise intolerance, crackles and wheezes on lung auscultation, tachycardia, and hypotension.

The nurse is caring for a child diagnosed with rheumatic fever. When addressing the child's pain, the nurse should perform which intervention(s)? Select all that apply. A. Carefully handle the child's knees, ankles, elbows and wrists when moving the child. B. Administer salicylates after meals or with milk. C. Teach the child how to use a patient-controlled analgesia system. D. Administer intravenous morphine as prescribed. E. Prioritize nonpharmacologic interventions over pharmacologic interventions.

ANS: A, B Rationale: Pain control and relief are the highest priorities for the child with rheumatic fever. Position the child to relieve joint pain. Large joints, including the knees, ankles, wrists, and elbows, are usually involved. Carefully handle the joints when moving the child to help minimize pain. Salicylates are administered in the form of aspirin to reduce fever but primarily to relieve joint inflammation and pain.They are also used as a heart protective. They are prescribed in high dosages. These are more commonly administered instead of opioids. Patient-controlled anesthesia is not typically used. Nonpharmacologic interventions can be used as an adjunct to pain medications.

The nurse is providing care to a child with a congenital heart defect. Which of the following would lead the nurse to suspect that the child is developing heart failure? Select all that apply. A. Tachycardia B. Sacral edema C. Bradypnea D. Inability to sweat E. Splenomegaly

ANS: A, B Rationale: Signs of heart failure include tachycardia, dependent edema such as in the sacral area, tachypnea, and hepatomegaly. In addition, diaphoresis, fatigue and exercise intolerance may be noted.

The nurse is assisting in the development of a plan of care for a child with asthma. In planning care, many goals would be appropriate for this child and/or family caregiver. Which two goals would be the highest priority for this child or family? A. The child will maintain a clear airway. B. The child will have adequate fluid intake. C. The child and family will connect with families living with the same diagnosis. D. The child and family will improve knowledge and understanding of varied pharmacologic options. E. The child will maintain adequate pain control.

ANS: A, B Rationale: Treatment and management of asthma centers around avoiding triggers and controlling inflammatory episodes. Keeping the airway open is always the priority (ABCs). The next physiologic need is adequate fluid intake. These are priorities over psychosocial considerations such as connecting with other families. Pain is not normally an issue. The family does not need to understand every available pharmacologic option. They need to understand the action plan for their child.

A nurse is assessing the history of a 7-year-old boy who is suspected of having a cardiovascular disorder. Which of the following findings would tend to indicate a cardiovascular disorder in this child? Select all that apply. A. Fatigues easily after a short walk home from school B. A tendency to squat C. Periorbital edema D. A lack of perspiration E. Frequent voiding F. Bouts of hyperactivity

ANS: A, B, C Rationale: A mark of older children with heart disease is that they notice easy fatigue. They often voluntarily squat, as this position traps blood in the lower extremities because of the sharp bend at the knee and hip, allowing the child to oxygenate the blood remaining in the upper body more fully and easily. Ask about perspiration as children with left-to-right cardiac shunts may perspire excessively because of sympathetic nerve stimulation. They are able to effectively produce urine only when cardiac function is adequate to perfuse kidneys. To assess kidney output, evaluate how often the child voids. Infrequent voiding could indicate lack of perfusion of the kidneys, and thus decreased heart function. Edema from retained fluid that cannot be voided is a late sign of heart disease in children. If it does occur, periorbital edema (swelling around the eyes) generally occurs first. Bouts of hyperactivity are not associated with cardiovascular disorders.

The nurse caring for a young adolescent with Crohn's disease. After teaching the adolescent and her family about this condition, the nurse determines that the teaching was successful when they identify which of the following as a possible complication? Select all that apply. A: Stricture B: Fistula C: Intra-abdominal abscess formation D: Gallstones E: Pancreatitis

ANS: A, B, C Rationale: Crohn's disease is a recurrent disease. Long-term complications may include stricture, fistula, and intra-abdominal abscess formation. Individuals with severe disease who require extensive resection of diseased bowel may be left with short bowel syndrome and long-term dependence on parenteral nutrition. Gallsto

The adolescent has been diagnosed with gastroesophageal reflux disease (GERD). Which statements by the teen indicates that adequate learning has occurred? Select all that apply. A: "This famotidine may make me tired." B: "The omeprazole could give me a headache." C: "It sounds like the physician is reluctant to give me a prokinetic because of the side effects." D: "I will probably need a laxative because of the omeprazole." E: "I should try to lie down right after I eat."

ANS: A, B, C Rationale: Famotidine may cause fatigue. Omeprazole can cause headaches. Prokinetics use may result in side effects involving the central nervous system. Omeprazole use more likely will result in diarrhea, not constipation. Children with GERD should not lie down after meals.

A child is diagnosed with short bowel syndrome. What would the nurse expect to be included in the child's plan of care? Select all that apply. A: Antibiotics B: Vitamin supplements C: Total parenteral nutrition D: Laxatives E: Immunosuppressants

ANS: A, B, C Rationale: For the child with short bowel syndrome, typically, antibiotics, vitamin and mineral supplements, antidiarrheal agents, and total parenteral nutrition are prescribed. Laxatives and immunosuppressants are not used.

The nurse caring for a neonate experiencing seizures asks the charge nurse: "How can I tell if a baby is having a seizure or is just crying for attention?" Which response would be most appropriate? Select all that apply. A: "You will not be able to stop a seizure with gentle restraint." B: "The baby experiencing a seizure will be tachycardic." C: "Stimulating the baby by singing to him will not stop a seizure." D: "There will be no changes in the baby's vital signs with a seizure" E: "The baby will become more active with sensory stimulation with a seizure." F. "The baby will stop the seizure activity when swaddled in a blanket."

ANS: A, B, C Rationale: With seizure activity, the neonate experiences tachycardia and increased blood pressure, and movements are not suppressed by general restraint and are unchanged by sensory stimuli. With nonepileptic movements, there is no change in vital signs, the movement is suppressed easily with gentle restraint, and movements are enhanced with sensory stimuli.

Which collaborative actions will the nurse perform when caring for an infant with transposition of the great arteries scheduled for surgical repair of the defect? Select all that apply. A. Provide education to the parents. B. Auscultate lung sounds frequently. C. Apply a continuous pulse oximeter. D. Keep oxygen saturation above 75%. E. Administer indomethacin intravenously.

ANS: A, B, C, D Rationale: Collaborative interventions for an infant with transposition of the great arteries include providing education to parents in preparation for their infant's surgery; assessing pulse oximetry and auscultating lung sounds frequently to monitor for signs of increased pulmonary flow; and maintaining normal oxygen saturation for transposition of the great arteries at 75% to 85%. Administering indomethacin would cause closure of the ductus arteriosus, which would prevent mixing of blood.

The nurse is providing teaching to the parents of a child whose blood pressure is in the 90th percentile. Which of the following would the nurse expect to include? Select all that apply A. Family lifestyle modification B. Sodium restriction C. Aerobic exercise D. Stress reduction E. Antihypertensive therapy.

ANS: A, B, C, D Rationale: With a child in the 90th percentile for blood pressure, lifestyle modification including diet and exercise are the main focus. These include salt restriction, aerobic exercise, and stress reduction. Antihypertensives are used if the child has symptomatic hypertension.

When caring for a child with acute bronchiolitis which nursing interventions should be included in the plan of care. Select all that apply. A. Encourage fluids B. Administer oxygen C. Place child in mist tent D. Administer antibiotics E. Follow contact precautions F. Encourage activity

ANS: A, B, C, E Rationale: The child is treated with high humidity by mist tent, rest, and increased fluids. Oxygen may be administered. Antibiotics are not prescribed because the causative organism is a virus. IV fluids often are administered to ensure an adequate intake and to permit the infant to rest. The hospitalized child is placed on contact transmission precautions to prevent the spread of infection.

The nurse is caring for a 1-day-old newborn with patent ductus arteriosus with the following vital signs: pulse 160, respirations 80, oxygen saturation 92%, retractions, and crackles noted in bilateral lungs. Which nursing actions are appropriate at this time? Select all that apply. A. Administer furosemide. B. Initiate intravenous access. C. Apply oxygen via oxyhood. D. Feed a high-calorie formula. E. Begin indomethacin infusion.

ANS: A, B, C, ERationale: When a newborn with patent ductus arteriosus shows signs of significant blood flow to lungs (retractions, crackles, tachypnea, and hypoxia), nursing actions will focus on applying oxygen to improve oxygenation and decrease work of breathing. Nursing interventions also include reducing cardiac workload and pulmonary flow by initiating intravenous access to administer a diuretic to reduce extra fluid and indomethacin to cause closure of the PDA and stop increased pulmonary blood flow. Feeding the infant is not a priority at this time as aspiration may result from the inability to coordinate sucking and swallowing with increased work of breathing.

The nurse is performing discharge teaching for a 16-year-old diagnosed with peptic ulcer disease. Which statements by the parents and client demonstrate learning has occurred? A: "I will need to make sure to take all of the antibiotic prescribed." B: "It's important to take my histamine agonist medication at the appropriate time." C: "My proton pump inhibitor should be taken when I feel discomfort." D: "The prednisone that I take for my rheumatoid arthritis may be a cause of my peptic ulcer disease." E: "My mom having peptic ulcer disease has nothing to do with my having it."

ANS: A, B, D Rationale: If Helicobacter pylori (H. pylori) was detected as a cause of the peptic ulcer disease (PUD), the client will be prescribed an antibiotic and should take all of the medication. Histamine agonists and/or proton pump inhibitors should be taken routinely as prescribed. Risk factors include a family history of PUD or other GI diseases, or chronic salicylate or prednisone use.

A parent calls the "on call" line stating that her infant has had a bark-like cough for the past three nights. The parent states no fever or cold symptoms. Which suggestions may save a trip to the emergency department? Select all that apply. A. Use a cool mist humidifier in the infant's room. B. Take the infant into a steamy bathroom. C. Provide the infant cold oral fluids. D. Use the coolness of the night air. E. Assess throat for throat obstruction.

ANS: A, B, D Rationale: The goal of the nurse is to provide suggestions which decrease the bark-like cough and relieve the bronchial constriction. Once this is accomplished, the infant can rest. Common suggestions are use of a cool mist humidifier, steamy bathroom, and coolness of the night air.Cold fluids may cause further spasm. The parent would not be instructed to assess the throat unless data suggested a problem in that location. More likely, the parent would be instructed to bring the infant to the emergency department.

A child aged 3 months has been spitting up regularly since birth and is somewhat underweight. The nurse suggests which interventions to the parents? Select all that apply. A: Thicken feedings with rice cereal. B: Feed smaller amounts more frequently. C: Feed the infant in the supine position. D: Burp well when feeding.

ANS: A, B, D Rationale: Thickened feedings are heavier than formula/breast milk, making them more difficult to spit up. The rice cereal also adds calories that this infant needs. Smaller, frequent feedings and burping well prevent distending the stomach and reduce the likelihood of reflux. The best position following feeding is upright. The supine position creates pressure on the lower esophageal sphincter, which promotes reflux.

The nurse is caring for a child with a gastrointestinal disorder and measuring intake and output. The nurse observes that the child is demonstrating symptoms of adequate hydration when she/he has which of the following? Select all that apply. A: Fontanelles with normal tension B: Adequate skin turgor C: Oral intake D: Pink and moist mucous membranes E: Loose stools

ANS: A, B, D Rationale: A child can have oral intake that is insufficient for his/her needs and still be dehydrated due to fluid losses. Loose stools lead to dehydration therefore would not be an indicator of adequate hydration. Adequate hydration in the child can be seen in fontanels having normal tension, adequate skin turgor and pink, moist mucous membranes.

A child has been admitted to the inpatient unit to rule out acute Kawasaki disease. A series of laboratory tests have been ordered. Which findings are consistent with this disease? Select all that apply. A. Reduced hemoglobin levels B. Reduced white blood cell count C. Elevated erythrocyte sedimentation rate (ESR) D. Negative C reactive protein levels E. Reduced platelet levels

ANS: A, C Rationale: Kawasaki disease is an acute systemic vasculitis occurring mostly in children 6 months to 5 years of age. It is the leading cause of acquired heart disease among children. The CBC count may reveal mild to moderate anemia, an elevated white blood cell count during the acute phase, and significant thrombocytosis (elevated platelet count [500,000 to 1 million]) in the later phase. The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) level are elevated.

A nurse suspects that a child is experiencing isotonic dehydration based on which assessment findings? Select all that apply. A: Extreme thirst B: Cool skin temperature C: Irritability D: Normal serum sodium level E: Clammy skin

ANS: B, C, D Rationale: Signs and symptoms of isotonic dehydration include mild thirst; poor skin turgor; cool, dry skin; decreased urine output; irritability; and normal serum sodium level. Extreme thirst suggests hypertonic dehydration. Cool, clammy skin suggests hypotonic dehydration.

While observing the parents of a neonate with pyloric stenosis feeding the baby, the nurse notes that the parents are becoming frustrated. The nurse identifies a nursing diagnosis of risk for impaired parenting related to frustration and difficulty feeding neonate. Which would be appropriate for the nurse to include in the plan of care? Select all that apply. A: Encouraging rooming in with the neonate B: Helping them understand their stress level contributes to the neonate's vomiting C: Assisting the parents in holding and feeding their neonate D: Pointing out positive aspects about their neonate E: Informing the parents that the condition will require them to adjust their lifestyles

ANS: A, C, D Rationale: For a nursing diagnosis of risk for impaired parented, appropriate interventions include encouraging the parents to room in with their neonate, helping them understand that the cause of the condition is a physical problem, not something they did, assisting the parents in holding and feeding their neonate, and pointing out positive aspects about their neonate.

A child is diagnosed with Kawasaki disease and is in the acute phase of the disorder. What would the nurse expect the physician to prescribe? Select all that apply. A. Intravenous immunoglobulin B. Ibuprofen C. Acetaminophen D. Aspirin E. Alprostadil

ANS: A, C, D Rationale: In the acute phase, high-dose aspirin in four divided doses daily and a single infusion of intravenous immunoglobulin are used. Acetaminophen is used to reduce fever. Nonsteroidal anti-inflammatory agents such as ibuprofen are avoided while the child is receiving aspirin therapy. Alprostadil is used to temporarily keep the ductus arteriosus patent in infants with ductal-dependent congenital heart defects.

The young child has been diagnosed with hepatitis B. Which of the following statements by the child's mother indicates that further education is required? A: "We went swimming in a local lake 2 months ago and I just knew she drank some of the lake water." B: "Could I have this virus in my body, too?" C: "The virus is the reason her skin looks a little yellowish." D: "The only way you can get this virus is from intravenous drug use." E: "Her fever and rash are probably related to this virus."

ANS: A, D Rationale: Hepatitis A virus is transmitted by contaminated food or water. Hepatitis B virus may be transmitted perinatally from mother to infant, intravenous drug use with contaminated needles, sexual contact with an infected person, and blood transfusions. The mother may have contracted the virus prior to giving birth to the child. Infection with the hepatitis B virus may result in jaundice, fever, and a rash.

The nurse is caring for a newborn with a cleft palate. Which findings in the maternal medical record are considered to be contributing factors? Select all that apply. A: Maternal tobacco use. B: Moderate maternal alcohol use prior to pregnancy. C: Maternal age less than 18 years. D: Anticonvulsant therapy used to manage a seizure disorder. E: Reports of marijuana use in early pregnancy.

ANS: A, D Rationale: Infants born with a cleft palate may have mother's with risk factors. These include maternal smoking, prenatal infection, advanced maternal age, use of anticonvulsants or steroids.

A school-age child with asthma has cromolyn sodium added to the medication regimen. What should the nurse include when teaching the child and parents about this medication? Select all that apply. A. Use this medication with a metered-dose inhaler. B. Take this medication before an inhaled bronchodilator. C. Repeat doses of this medication until symptoms subside. D. This medication is to be used for an acute asthma attack. E. Wait 1 to 2 minutes between puffs when taking this medication.

ANS: A, E Rationale: Cromolyn sodium should be used with a metered-dose inhaler, and the child should wait 1 to 2 minutes between puffs when taking this medication. This medication should be taken after a bronchodilator. Doses should not exceed the number of ordered puffs because tolerance can develop. This medication is not effective in an acute attack.

A nurse is obtaining the history from a parent of a child who experiences absence seizures. Which of the following would the nurse expect the mother to describe? A: Brief, sudden onset with muscles that become tense B: Loss of motor activity accompanied by a blank stare C: Sudden, brief jerking motions of a muscle group D: Loss of muscle tone and loss of consciousness

ANS: B Rationale: An absence seizure consists of a sudden, brief arrest of the child's motor activity accompanied by a blank stare and loss of awareness. A tonic seizure consists of a brief onset of increased tone. A myoclonic seizure is characterized by sudden, brief jerks of muscle groups. An atonic seizure involves a sudden loss of muscle tone and loss of consciousness.

A nurse manages the interdisciplinary care for an infant born with an omphalocele. What is an accurate description of the care for an omphalocele? A: At birth, protect the exposed bowel by gently manipulating it back into the abdominal cavity. B:Obtain IV access to give fluid resuscitation and correct any electrolyte abnormalities. C: Administer corticosteroids as prescribed—either oral prednisone or prednisolone or as IV methylprednisolone. D: Insert an NG tube to decompress the stomach and to prevent gastric distention.

ANS: B Rationale: For an omphalocele, protect the bowel by wrapping the exposed viscera with warm saline-soaked gauze and cover and seal with a plastic wrap or place in a "bowel bag" which will contain the defect, torso, and legs, to prevent heat and fluid loss from the exposed viscera. Obtain IV access. Give fluid resuscitation and correct any electrolyte abnormalities. Oral prednisone or prednisolone, or IV methylprednisolone, are administered for irritable bowel syndrome. An NG tube may be placed to decompress the stomach to prevent gastric distention when severe emesis is present with pancreatitis.

A school-aged girl with Crohn's disease will receive total parenteral nutrition (TPN) for the next 6 weeks. Which would best help her accept the treatment plan? A: Help her ambulate with the bottles. B: Provide some time to talk to her several times a day. C: Help her give the bottles nicknames and personalities. D: Explain that TPN substitutes for normal food.

ANS: B Rationale: Many children receiving alternative methods of feeding miss the conversation that goes with mealtime. Providing this helps them accept an alternative feeding method.

The nurse is conducting a physical examination of a child with suspected Crohn disease. Which finding would be the most suspicious of Crohn disease? A: Normal growth patterns B: Perianal skin tags or fissures C: Increased hunger D: Abdominal tenderness

ANS: B Rationale: Perianal skin tags and/or fissures are highly suspicious of Crohn disease. Poor growth pattern, hunger and abdominal tenderness are common to Crohn disease but are also seen with many other conditions. Normal growth patterns would not point to Crohn disease because of problems with absorbing nutrients.

The nurse is caring for a 2-month-old with a cleft palate. The child will undergo corrective surgery at age 3 months. The mother would like to continue breastfeeding the baby after surgery and wonders if it is possible. How should the nurse respond? A: "There is a good chance that you will be able to breastfeed almost immediately." B: "Breastfeeding is likely to be possible, but check with the surgeon." C: "After the suture line heals, breastfeeding can resume." D. "We will have to wait and see what happens after the surgery."

ANS: B Rationale: Postoperatively, some surgeons allow breastfeeding to be resumed almost immediately. However, the nurse needs to advise the mother to check with the surgeon to determine when breastfeeding can resume. Telling the mother that she has to wait until the suture line heals may be inaccurate. Telling her to wait and see does not answer her question.

The nurse is reinforcing teaching with the family caregivers of a child diagnosed with tuberculosis who is being treated with the drug rifampin. Which statement made by the caregivers indicates an understanding of this medication? A. "My son will have to take this medication the rest of his life." B. "While she is taking this medication, I won't worry if her tears look orange." C. "This medication may cause slight bleeding when she urinates." D. "He will not be able to attend school for the first few months that he is on this medication."

ANS: B Rationale: Rifampin is tolerated well by children, but causes body fluids such as urine, sweat, tears, and feces to turn orange-red. Drug therapy is continued for 9 to 18 months. After drug therapy has begun, the child or adolescent may return to school and normal activities. Although the urine may be orange-red, this does not indicate bleeding. If bleeding with urination presents, then it should be reported and followed up on.

A 4-month-old infant is seen at the ambulatory care clinic and diagnosed with nasolacrimal duct obstruction. The mother asks what can be done. What information should be included in the information provided to the parent? A: Once the child is 6 to 9 months old a specialist will be able to drain the duct. B: Most of these conditions will spontaneously resolve. C: Antiviral therapy can be prescribed to manage this condition. D: Over-the-counter drops can be used sparingly.

ANS: B Rationale: Stenosis or simple obstruction of the nasolacrimal duct is a common disorder of infancy, occurring in about 6% to 20% of newborns and infants. It is unilateral in about 65% of cases. Chronic tearing occurs and buildup in the lacrimal sac causes a mucoid or mucopurulent drainage. Over 90% of all cases resolve spontaneously by 1 year of age.

A 7-month-old is scheduled for surgical correction of strabismus. The child's mother says to the nurse, "I'm glad my child will never have to wear that patch again." Which of these responses would be most appropriate for the nurse to make? A: "Your child will never need to wear the patch again." B: "Your child will need to wear the patch for a few days to keep him/her from rubbing or putting pressure on the eye." C: "Your child will need to wear the patch for several months to keep the eye in alignment." D: "Your child will have to be in restraints for a week to keep him/her from rubbing the eye."

ANS: B Rationale: Strabismus refers to a misalignment of the eyes, if the strabismus persists past 6 months of age this warrants referral to an ophthalmologist for further evaluation. Clinical therapy involves occlusion therapy (patching of the good eye) for 1-2 hours a day to force use of the weak eye. The child may have to wear the patch intermittently, no restraints are needed if the patch

The nurse receives the shift report of multiple pediatric clients. Which pediatric client will the nurse see first? A. an infant whose parents report difficulty feeding with a temperature of 100.1°F (38°C) B. a toddler with tetralogy of Fallot squatting quietly in the corner of the room C. a child with history of hypertension and a current blood pressure of 130/90 mm Hg D. an adolescent with coarctation of the aorta with reports of coughing and coryza

ANS: B Rationale: The first child the nurse will see is the child showing signs and symptoms of decreased pulmonary blood flow and possible hypercyanotic (tet) spell, which includes a toddler with tetralogy of Fallot squatting. Squatting increases systemic vascular resistance and forces blood to flow through the narrow pulmonary valve to improve oxygenation. An infant with difficult feeding and an elevated temperature may have an infection but could be seen after addressing a potential respiratory/circulatory issue. The child with history of hypertension who has an elevated blood pressure can be seen later because this is an expected finding and not life-threatening. The adolescent with coarctation of the aorta being seen for coughing and coryza without any other signs of distress can also be seen later.

The nurse is caring for a child with history of asthma who presents to the emergency department with wheezing, tachypnea, and dyspnea. What will the nurse do first? A. Ask what may have triggered the attack. B. Place the child in high-Fowler's position. C. Assess the child's pulse oximetry reading. D. Apply oxygen via nasal cannula at 2 liters.

ANS: B Rationale: The nurse will first elevate the head of bed to improve the child's ability to breathe. Elevating the head of the bed allows the diaphragm to expand, consequently maximizing ventilation and oxygenation. After elevating the head of bed, the nurse will assess the pulse oximetry and apply oxygen if needed. After stabilizing the child, the nurse can ask what may have triggered the asthma attack.

The school nurse is educating the parents of a child with infectious conjunctivitis. Which of the following statements by the nurse would be most helpful for the parents related to prevention? A: "Use all the medication as directed." B: "Don't use anything that touches her face." C: "This could have started with a head cold." D: "Place the ointment inside the lower eyelid."

ANS: B Rationale: Warning the parents how infectious conjunctivitis is spread is most valuable for preventing infection within the family. Directing the parents to use a full course of medication is very important to help prevent a recurrence in the child but is not the most valuable for prevention. Telling of a possible cause or proper administration of medication has little preventive value.

The nurse is assessing a child with suspected rheumatic fever. What assessment findings are consistent with the disease process? Select all that apply. A. Diastolic murmur B. Involuntary limb movement C. Macular rash on trunk D. Tender swollen joints E. Nonpalpable subcutaneous nodules

ANS: B, C, D Rationale: Signs and symptoms of rheumatic fever include systolic murmur, involuntary limb movement, macular rash on the trunk, tender swollen joints, and subcutaneous nodules.

The nurse is reviewing the history of an adolescent with peptic ulcer disease. Which client activity would the nurse identify as an associated contributing factor? Select all that apply. A: Use of acetaminophen B: Ingestion of diet colas C: High coffee intake D: Cigarette smoking E:High-fat diet

ANS: B, C, D Rationale: In adolescents, associated factors include a genetic tendency, use of nonsteroidal anti-inflammatory drugs, alcohol, caffeine and cigarettes.

A nurse is developing a teaching plan for an adolescent diagnosed with gastroesophageal reflux disease. Which would the nurse include? Select all that apply. A: "Try sitting upright for an hour after eating." B: "You need to avoid acidic foods like oranges and grapefruits." C: "Eating smaller portions might be helpful." D: "You'll need to take your prescribed medications for about 6 to 8 weeks." E: "Try sleeping with your upper body elevated on a foam wedge."

ANS: B, C, E Rationale: Adolescents with gastroesophageal reflux disease should avoid lying down until 3 hours after a meal and should sleep at night with the upper body elevated on a foam wedge. Acidic foods such as citrus fruits and tomatoes should be avoided. Eating smaller portions may be helpful. Medications typically are prescribed for 6 to 8 months until esophageal healing is complete.

The nurse is caring for a pediatric client newly diagnosed with Crohn's disease. When reviewing the client's subjective and objective data, which is consistent with the diagnostic criteria? Select all that apply. A: Severe bloody diarrhea B: Significant weight loss C: Perianal lesions D: Lesions limited to the colon and rectum E: Cobblestone appearance of intestinal surface

ANS: B, C, E Rationale: With Crohn's disease, the child experiences moderate diarrhea, severe weight loss, and perianal lesions. The lesions can affect any part of the gastrointestinal tract but most commonly the terminal ileum. The wall of the colon becomes thickened and the surface is inflamed, leading to a "cobblestone" appearance of the mucosa.

Which assessment findings should the nurse expect to see in the infant diagnosed with pulmonary stenosis and heart failure? Select all that apply. A. Crackles (rales) B. Cyanosis C. Left ventricular hypertrophy D. Murmur E. Right ventricular hypertrophy

ANS: B, D, E Rationale: Patients with pulmonary stenosis have a narrowing in their pulmonary arteries, causing a decrease in blood flow to the lungs, which can cause cyanosis and the inability of the right ventricle to empty, leading to right ventricular hypertrophy. Crackles (rales) and left ventricular hypertrophy are signs of left-sided heart failure, which this patient does not have.

The nurse is teaching a 14-year-old child on the proper use of a metered-dose inhaler to control symptoms of asthma. Which teaching points should the nurse include in these instructions? Select all that apply. A. Take two puffs at a time. B. Shake the canister before using. C. Wait 5 minutes between puffs. D. Hold the breath for 5 to 10 seconds. E. Activate the inhaler while taking a deep breath.

ANS: B, D, E Rationale: The nurse should instruct the child to shake the canister, exhale deeply, activate the inhaler while inhaling, take a long slow inhalation, and then hold the breath for 5 to 10 seconds. The child should be instructed to take only one puff at a time and to wait for 1 minute between puffs.

The NICU nurse is caring for a preterm neonate with respiratory distress syndrome on mechanical ventilation. Which assessment data would alert the nurse that a pneumothorax might have developed? Select all that apply. A. Neonate's blood pressure is 80/50. B. The neonate's respiratory rate is 68. C. Oxygen saturation is 92% and heart rate is 130. D. Neonate is exhibiting nasal flaring and grunting. E. Chest radiography reveals low lung volume and a ground-glass appearance. F. The neonate's chest is asymmetrical. with decreased breath sounds on one side.

ANS: B, D, F Rationale: Signs of pneumothorax include respiratory rate of 68, nasal flaring and grunting, asymmetrical chest rise with decreased breath sounds on one side. Infants with a pneumothorax exhibit signs of respiratory distress, including tachypnea (>60 breaths/minute) and nasal flaring and grunting. On examination the chest is asymmetrical, with decreased breath sounds on the affected side. In the case of a large pneumothorax, the nurse should observe for hypotension (systolic blood pressure<30), hypoxemia (<90%), and bradycardia (<120 beats/minute) that may occur due to an increase in pressure inside the thorax, which in turn leads to decreased cardiac output. Blood pressure of 80/50 is within normal limits. Oxygen saturation of 92% and heart rate of 130 are also within normal limits. Chest radiography revealing low lung volume and a ground glass appearance are expected in newborn respiratory distress syndrome, but is not diagnostic of a pneumothorax. A chest X-ray of a pneumothorax will show a darkened area over the collapsed lung.

A 6-month-old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room? A: A room with a 12-month-old infant with a urinary tract infection B: A room with an 8-month-old infant with failure to thrive C: A private room near the nurses' station D: A two-bed room in the middle of the hall

ANS: C Rationale: A child who has the diagnosis of bacterial meningitis will need to be placed in a private room until that child has received I.V. antibiotics for 24 hours because the child is considered contagious. Additionally, bacterial meningitis can be quite serious; therefore, the child should be placed near the nurses' station for close monitoring and easier access in case of a crisis.

An otherwise healthy 18-month-old child with a history of febrile seizures is in the well-child clinic. Which statement by the father would indicate to the nurse that additional teaching should be done? A: "I have ibuprofen available in case it's needed." B: "My child will likely outgrow these seizures by age 5." C: "I always keep phenobarbital with me in case of a fever." D: "The most likely time for a seizure is when the fever is rising."

ANS: C Rationale: Anticonvulsants, such as phenobarbital, are administered to children with prolonged seizures or neurologic abnormalities. Ibuprofen, not phenobarbital, is given for fever. Febrile seizures usually occur after age 6 months and are unusual after age 5. Treatment is to decrease the temperature because seizures occur as the temperature rises.

The nurse instructs a hearing-impaired school-age child on to how self-inject a prescribed medication. Which observation indicates to the nurse that additional teaching is required? A: The child pinches the skin together before inserting the needle. B: The child injects the appropriate amount of air into the vial before withdrawing medication. C: The child places the filled syringe and uncapped needle on the bed to open the alcohol wipe. D: The child slowly pushes on the plunger to inject the medication before withdrawing the needle>

ANS: C Rationale: Children who are unable to hear may need additional time for explanations and support. By placing the syringe and uncapped needle on the bed, the child is contaminating the needle. This would indicate that additional teaching is necessary. Pinching the skin, injecting air, and slowly pushing on the plunger all indicate that teaching has been effective.

The nurse is collecting data on a 5-year-old child admitted with the diagnosis of congestive heart failure. Which clinical manifestation observed during the physical assessment would be consistent with this diagnosis? A. Jerking movements of the arms and legs B. Scissoring of the legs with toes pointed down C. Failure to gain weight D. Spooning of the finger nails

ANS: C Rationale: In infants and older children, one of the first signs of CHF is tachycardia. Other signs of CHF often seen in the older child include failure to gain weight, weakness, fatigue, restlessness, irritability, and a pale, mottled, or cyanotic color. Rapid respirations or tachypnea, dyspnea, and coughing with bloody sputum also are seen. Edema and enlargement of the liver and heart may be present. Jerking movements indicate seizure activity. Scissoring of the legs is seen in cerebral palsy, and spooning of the finger nails is seen in iron deficiency anemia.

An 18-month-old child is admitted with signs of increased intracranial pressure. What should the nurse observe when assessing this patient? A: Numbness of fingers and decreased temperature B: Increased pulse rate and decreased blood pressure C: Increased temperature and decreased respiratory rate D: Decreased level of consciousness and increased respiratory rate

ANS: C Rationale: Manifestations of increased intracranial pressure include increased body temperature and decreased respiratory rate. Pulse rate slows, and the blood pressure increases.

The nurse is caring for a child recovering from surgery to correct strabismus. Which interventions should the nurse include when planning this child's care? Select all that apply. A: Apply an eye patch. B: Maintain on bed rest for 3 days. C: Support for nausea and vomiting. D: Provide pain medication as prescribed. E: Apply antibiotic ointment as prescribed.

ANS: C, D, E Rationale: After eye surgery for strabismus, the patient may experience nausea and vomiting and pain on eye movement. The patient will also be prescribed antibiotic ointment. An eye patch is not usually required. The child will not need to be on bed rest for 3 days.

When assessing a child for the probable cause of acute bronchiolitis, the nurse focuses on which factor? A. Bacterial infections B. Environmental allergies C. Prenatal complications D. Viral infections

ANS: D Rationale: Acute bronchiolitis is caused by a viral not bacterial infection. Neither allergies nor prenatal complications contribute to the development of this disorder.

In developing a plan of care for the child diagnosed with rheumatic fever, the nursing intervention that takes highest priority for this child is to: A. position the child to relieve joint pain. B. monitor the C-reactive protein and ESR levels. C. provide age-appropriate diversional activities. D. promote rest periods and bed rest.

ANS: D Rationale: As long as the rheumatic process is active, progressive heart damage is possible. To prevent heart damage, bed rest is essential to reduce the heart's workload. Laboratory tests for ESR and C-reactive protein can be used to evaluate disease activity and guide treatment, but they do not improve the child's health itself. The child's comfort is important, so it is essential to relieve joint pain and prevent injury with padded bed rails. But these measures are less important than rest when it comes to preventing long-term complications such as residual heart disease.

The nurse is administering digoxin as ordered and the child vomits the dose. What should the nurse do next? A. Contact the physician. B. Offer a snack and administer another dose. C. Immediately administer another dose. D. Administer next dose as ordered in 12 hours.

ANS: D Rationale: Digoxin should be administered at regular intervals, every 12 hours, 1 hour before or 2 hours after feeding. If the child vomits digoxin, the nurse should not give a second dose and should wait until the next scheduled dose. It is not necessary to contact the physician.

The nurse is performing a well-child assessment on a 2-week-old infant. The nurse asks why her baby only breathes out of his nose and does not seem to mouth breathe. What information can the nurse provide to the mother? A. "Babies breathe from both their nose and mouth around 2 or 3 weeks of age." B. "Breathing from the nose only will be noted in newborns for about the first 6 weeks of life." C. "Your baby is breathing normally for his age." D. "Babies are nose breathers for about the first 4 weeks of life."

ANS: D Rationale: Newborns are obligatory nose breathers until at least 4 weeks of age. The young infant cannot automatically open his or her mouth to breathe if the nose is obstructed. The nares must be patent for breathing to be successful while feeding. Newborns breathe through their mouths only while crying.

When assessing a infant born at 32 weeks' gestation, which finding would lead the nurse to suspect to suspect that the newborn has a patent ductus arteriosus (PDA)? A. Weak, thready pulse B. Decreased pulse rate C. High diastolic arterial pressure D. Continuous murmur on auscultation

ANS: D Rationale: Presence of a continuous murmur on auscultation of the heart is indicative of patent ductus arteriosus (PDA) in preterm infants. Preterm infants are at an increased risk of developing PDA. Other assessment findings that indicate PDA include bounding pulse, increased pulse rate and low diastolic arterial pressure.

The nurse has received morning report on a group of pediatric clients. Which pediatric client will the nurse see first? A. an infant with rhinorrhea, coughing, and oxygen saturation of 92% B. a toddler with a temperature of 100.1°F (38°C), and a harsh, barking cough C. a preschool child with crackles in the right lower lobe and chest pain D. a school-age child with dysphagia, drooling, and a hoarse voice

ANS: D Rationale: The child with signs and symptoms of epiglottitis should be seen first because epiglottitis is an emergency that can quickly cause airway obstruction. A child with signs of bronchiolitis with an oxygen saturation of 92% is more stable than this child with epiglottitis. A toddler with signs of croup is more stable than this child with epiglottitis. A child with signs and symptoms of pneumonia is more stable than this child with epiglottitis.

The emergency department nurse is caring for a client with cystic fibrosis who is dyspneic and has a productive cough. Place in order the nursing interventions performed upon arrival to improve breathing. A. Notify respiratory therapy. B. Assess respiratory status. C. Obtain oxygen saturation reading. D. Place in bed in a semi-Fowler's position. E. Place on oxygen at 2 liters. F. Instruct on energy conservation measures.

ANS:B, D, C, E, A, F Rationale: The nurse assesses the respiratory status upon meeting the client. The nurse notes breathing difficulty, including purse lip breathing or use of accessory muscles, pallor, and ability to speak and breathe. Chronic signs of hypoxia such as clubbing of the fingers and a barrel chest can be noted. The client is then arranged in bed in a semi-Fowler's position with the upper half of the body elevated 90 degrees. An oxygen saturation reading is obtained, indicating status without oxygen, and the oxygen as a nursing measure is applied at a base of 2 liters due to respiratory state. Respiratory therapy is notified that a dyspneic client has arrived. Further orders for breathing treatments or chest physical therapy are made. Lastly, instruct on effective coughing techniques to remove mucus.

The nurse is teaching a group of mothers of infants about the benefits of immunization. Which immunization will the nurse teach to the mothers that can assist in preventing the life-threatening disease epiglottitis? 1. Measles, mumps, and rubella (MMR) 2. Haemophilus influenzae type B (HIB) 3. Hepatitis B 4. Polio

Answer: 2 The Haemophilus influenzae type B (HIB) immunization can assist in prevention of epiglottitis. Hepatitis B, measles, mumps, rubella, and the polio virus are not causative agents for epiglottitis.

Which nursing diagnosis is most appropriate for an infant with acute bronchiolitis due to respiratory syncytial virus (RSV)? 1. Activity Intolerance 2. Decreased Cardiac Output 3. Pain, Acute 4. Tissue Perfusion, Ineffective (peripheral)

Answer: 1 Activity intolerance is a problem because of the imbalance between oxygen supply and demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is not usually associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by this respiratory-disease process.

Following parental teaching, the nurse is evaluating the parents' understanding of environmental control for their child's asthma management. Which statement by the parents indicates appropriate understanding of the teaching? 1. "We will replace the carpet in our child's bedroom with tile." 2. "We're glad the dog can continue to sleep in our child's room." 3. "We'll be sure to use the fireplace often to keep the house warm in the winter." 4. "We'll keep the plants in our child's room dusted."

Answer: 1 Explanation: 1. Control of dust in the child's bedroom is an important aspect of environmental control for asthma management. When possible, pets and plants should not be kept in the home. Smoke from fireplaces should be eliminated.

A child is showing signs of acute respiratory distress. Which position will the nurse place this child? 1. Upright 2. Side-lying 3. Flat 4. In semi-Fowler's

Answer: 1 Explanation: 1. Upright is correct because it allows for optimal chest expansion. Side-lying, flat, and semi-Fowler's (head up slightly) do not allow for as optimal chest expansion as the upright position.

A child is prescribed rifampicin for treatment of tuberculosis. For which length of time will the nurse tell the parents that this child must remain on the medication? 1. 2 months 2. 4 months 3. 6 months 4. 8 months

Answer: 3 Explanation: 1. Active and latent TB are treated with isoniazid, rifampicin, pyrazinamide, and ethambutol. Therapy for active TB usually involves a 6-month regimen consisting of isoniazid, rifampicin, pyrazinamide, and ethambutol for the first 2 months and isoniazid and rifampicin for the remaining 4 months. Therefore, the child will remain on rifampicin for a total of 6 months.

A child is admitted to the hospital with the diagnosis of laryngotracheobronchitis (LTB). Which nursing intervention is the priority for this child? 1. Administer nebulized epinephrine and oral or IM dexamethasone. 2. Administer antibiotics and assist with possible intubation. 3. Swab the throat for a throat culture. 4. Obtain a sputum specimen.

Answer: 1 Nebulized epinephrine and dexamethasone are given for LTB. Antibiotic administration and possible intubation are associated with epiglottitis. Throat cultures are not obtained for LTB because it is viral and swabbing the throat could cause complete obstruction to occur. Sputum specimens will not assist in the diagnosis of LTB.

The nurse educator is teaching a group of nursing students how to perform a respiratory assessment for a newborn in the newborn intensive care unit (NICU) diagnosed with respiratory distress syndrome (RDS). Which normal characteristics of the newborn's respiratory system increase the risk for obstruction? Select all that apply. 1. Shorter and narrower airway 2. Higher trachea 3. Bronchial branching at different angles 4. Inadequate smooth muscle bundles 5. Diaphragmatic breather

Answer: 1, 2, 3 Explanation: 1. Normal characteristics of the pediatric respiratory system that increase the risk for obstruction include a shorter and narrower airway, a higher trachea, and a different angle for bronchial branching. Inadequate smooth muscle bundles and being diaphragmatic breathers are characteristics that do not increase the risk of obstruction.

The nurse is providing care to an infant who is diagnosed with bronchiolitis. Which breath sounds indicate the infant is experiencing respiratory distress? Select all that apply. 1. Tachypnea 2. Wheezing 3. Grunting 4. Retractions 5. Eupnea

Answer: 1, 2, 3 Explanation: 1. Wheezing and grunting are adventitious respiratory sounds that indicate respiratory distress in the neonate. Tachypnea is the term used to indicate a respiratory rate of greater than 60 breaths per minute in an infant. While this does indicate respiratory distress, tachypnea is not a type of breath sound. Retractions, or the use of accessory muscles, are indicative of respiratory distress in the neonate, but this is not a type of breath sound. Eupnea is the medical term for "normal breathing."

The nurse is assessing a school-age client who experienced blunt force trauma to the chest when an airbag deployed following a motor vehicle crash. Which areas of assessment are essential for this client? Select all that apply. 1. Monitor responsiveness and behavior. 2. Monitor SpO2. 3. Auscultate the lungs for crackles, wheezes, decreased breath sounds. 4. Document input and output. 5. Note changes in voice quality or coughing.

Answer: 1, 2, 3, 5 The areas of assessment that are essential for this client include: monitoring for responsive and behavior in order to detect hypoxia and the potential for airway obstruction; monitoring SpO2 frequently to identify changes indicating deterioration in condition; auscultating the lungs for crackles, wheezes, decreased breath sound; and noting changes in voice quality or coughing. Documenting input and output is not a priority for this client.

A 3-year-old has been diagnosed with cystic fibrosis. The guardians asked the nurse what respiratory symptoms they should expect to see. What will the nurse tell the guardians? Select all that apply. 1. Purulent nasal discharge 2. Frequent infections 3. Mottled nail beds 4. Chronic moist, productive cough 5. Increased fertility

Answer: 1, 2, 4 Explanation: 1. Respiratory symptoms the guardians will see are: nasal polyps, chronic sinusitis, frontal headaches, purulent nasal discharge, postnasal discharge, cough (chronic, moist, productive), wheezing, coarse crackles, frequent infections, shortness of breath, decreased exercise tolerance, barrel chest, and clubbing of fingers and toes.

A school nurse is planning care for a school-age child recently diagnosed with asthma. Which items will the school nurse include in the plan of care at the school? Select all that apply. 1. Maintain a log of quick-relief medication administration. 2. Call the parents if quick-relief medications work appropriately. 3. Assess for symptoms of exercise-induced bronchospasm. 4. Coordinate education of the child's teachers. 5. Conduct a support group for all children with asthma.

Answer: 1, 3, 4, 5 Explanation: 1. Appropriate interventions for the school nurse to include in the plan of care include: keeping a log of the quick-relief medications administered; assessing the child for exercise-induced bronchospasms and reporting, if needed; coordinating education of the child's teachers; and conducting a support group for all children in the school with asthma. The nurse would only call the parents if the quick-relief mediation was not effective in treating the child's symptoms.

The nurse is teaching the parents of a newly diagnosed cystic fibrosis patient how to administer the pancreatic enzymes. How often will the nurse teach the parents to administer the enzymes? 1. Two times per day 2. With meals and snacks 3. Every 6 hours around the clock 4. Four times per day

Answer: 2 Explanation: 1. Pancreatic enzymes are administered with meals and large snacks. A scheduled time would not be appropriate because the enzymes are used to assist in digestion of nutrients.

A child is admitted to the hospital with pneumonia. The child's oximetry reading is 88 percent upon admission to the pediatric floor. Which is the priority nursing intervention for this child? 1. Obtain a blood sample to send to the lab for electrolyte analysis. 2. Begin oxygen per nasal cannula. 3. Medicate for pain. 4. Begin administration of intravenous fluids.

Answer: 2 Explanation: 1. Pulse oximetry reading should be 92 or greater. Oxygen by nasal cannula should be started initially. Medicating for pain, administering IV fluids, and sending lab specimens can be done once the child's oxygenation status has been addressed.

The nurse is providing care to an infant in the emergency department. Upon assessment, the infant is noted to have to be experiencing tachypnea, wheezing, retractions, and nasal flaring. The infant is irritability and the parents state the infant has had poor fluid intake for two days. Pulse ox reading is currently at 85 percent on room air. The infant's blood gas is pending. Which diagnosis does the nurse anticipate for this infant? 1. Bronchitis 2. Bronchiolitis 3. Pneumonia 4. Active pulmonary tuberculosis

Answer: 2 Explanation: 1. The nurse anticipates the infant will be diagnosed with bronchiolitis. Symptoms of bronchiolitis include mild respiratory symptoms that progress to tachypnea, wheezing, retractions, nasal flaring, irritability, poor fluid intake, hypoxia, cyanosis, and decreased mental status. Symptoms of bronchitis include a dry hacking cough, increases in severity at night, painful chest and ribs. Symptoms of pneumonia include initial rhinitis and cough, followed by fever, crackles, wheezes, dyspnea, tachypnea, restlessness, diminished breath sounds. Symptoms of active pulmonary tuberculosis include persistent cough, decreased appetite, weight loss or failure to gain weight, low-grade fever, night sweats, chills, enlarged lymph nodes.

Parents of a child admitted with respiratory distress are concerned because the child won't lie down and wants to sit in a chair leaning forward. Which response by the nurse is the most appropriate? 1. "This helps the child feel in control of his situation." 2. "The child needs to be encouraged to lie flat in bed." 3. "This position helps keep the airway open." 4. "This confirms the child has asthma."

Answer: 3 Explanation: 1. Leaning forward helps keep the airway open. The child is not in control just because he is leaning forward. Lying flat in bed will increase the respiratory distress. This position does not confirm asthma.

A newborn is suspected of having cystic fibrosis. As the child is being prepared for transfer to a pediatric hospital, the mother asks the nurse which symptoms made the practitioner suspect cystic fibrosis. Which response by the nurse is the most appropriate? 1. Steatorrheic stools 2. Constipation 3. Meconium ileus 4. Rectal prolapse

Answer: 3 Newborns with cystic fibrosis may present in the first 48 hours with meconium ileus. Steatorrhea, constipation, and rectal prolapse may be signs of cystic fibrosis seen in an older infant or child.

The practitioner changes the medications for the child with asthma to salmeterol (Serevent). The mother asks the nurse what this drug will do. The nurse explains that salmeterol (Serevent) is used to treat asthma because the drug produces which characteristic? 1. Decreases inflammation 2. Decreases mucous production 3. Controls allergic rhinitis 4. Dilates the bronchioles

Answer: 4 Explanation: 1. Salmeterol (Serevent) is a long-acting beta2-agonist that acts by bronchodilating. Steroids are anti-inflammatory, anticholinergics decrease mucous production, and antihistamines control allergic rhinitis.

A nurse delegates the task of neonatal vital-sign assessment to a nurse technician. Which instruction will the nurse give to the technician prior to assign care? 1. Report any neonate using abdominal muscles to breathe. 2. Report any neonate with apnea for 10 seconds. 3. Count respirations for 15 seconds and multiply by 4 to get the rate for 1 minute. 4. Report any neonate with a breathing pause that lasts 20 seconds or longer.

Answer: 4 Explanation: 1. The abnormal assessment finding for vital signs that the nurse should instruct a nurse technician to report is any breathing pause by a neonate lasting longer than 20 seconds. This can indicate apnea and could lead to an apparent life-threatening event (ALTE). A breathing pause of 10 seconds or less is called periodic breathing and is a normal pattern for a neonate. Respirations should be counted for 1 minute, not 15 seconds. It is normal for neonates to use abdominal muscles for breathing.

A nurse is assessing a neonate. Which assessment finding indicates that the neonate's respiratory status is worsening? 1. Acrocyanosis 2. Arterial CO2 of 40 3. Periorbital edema 4. Grunting respirations with nasal flaring

Answer: 4 Grunting respirations with nasal flaring indicates respiratory status is becoming worse. Acrocyanosis (cyanosis of the extremities) is a normal finding in a neonate. CO2 of 40 is within a normal range. Periorbital edema does not necessarily mean deterioration in respiratory status.