Peds Exam 2 (Ch. 14, 15, 16, 17, 19, 22, 23, 24, 28, 32, 31)

A child with congestive heart failure is placed on a maintenance dosage of digoxin (Lanoxin). The dosage is 0.07 mg/kg/day, and the child's weight is 7.2 kg. The physician prescribes the digoxin to be given once a day by mouth. Each dose will be _____ milligrams. (Record your answer below using one decimal place.)

ANS: 0.5 Calculate the dosage by weight: 0.07 mg/day 7.2 kg = 0.5 mg/day.

A physician's prescription reads, "ampicillin sodium 125 mg IV every 6 hours." The medication label reads, "1 g = 7.4 ml." A nurse prepares to draw up _____ milliliters to administer one dose. (Round your answer to two decimal places.)

ANS: 0.93 Convert 1 g to milligrams. In the metric system, to convert larger to smaller, multiply by 1000 or move the decimal point three places to the right. 1 g = 1000 mg

The estimated average requirement of calcium for an adolescent is _____ milligrams. (Record your answer in a whole number.)

ANS: 1100 The EAR (estimated average requirement) for calcium in adolescents 14 to 18 years of age is 1100 mg.

Place in order the correct sequence for emergency treatment of poisoning in a child. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d). a. Locate the poison. b. Assess the child. c. Prevent absorption of poison. d. Terminate exposure to the toxic substance.

ANS: b, d, a, c The initial step in treating poisonings is to assess the child, treat immediate life-threatening conditions, and initiate cardiopulmonary resuscitation (CPR) if indicated. Terminating the exposure to the toxic substance is the second step. Locating the poison for identification is the third step. Preventing absorption of poison is the fourth step.

Place in order the sequence of maturational changes for girls. Begin with the first change seen, sequencing to the last change. Provide answer in using lowercase letters, separated by commas (e.g., a, b, c, d, e). a. Growth of pubic hair b. Rapid increase in height and weight c. Breast changes d. Menstruation e. Appearance of axillary hair

ANS: c, b, a, e, d The usual sequence of maturational changes for girls is breast changes, rapid increase in height and weight, growth of public hair, appearance of axillary hair, and then menstruation, which usually begins 2 years after the first signs.

A nurse is receiving report on a newborn admitted yesterday after a gastroschisis repair. In the report, the nurse is told the newborn has a physician's prescription for an NG tube to low intermittent suction. The reporting nurse confirms that the NG tube is to low intermittent suction and draining light green stomach contents. Upon initial assessment, the nurse notes that the newborn has pulled the NG tube out. Which is the priority action the nurse should take? a. Replace the NG tube and continue the low intermittent suction. b. Leave the NG tube out and notify the physician at the end of the shift. c. Leave the NG tube out and monitor for bowel sounds. d. Replace the NG tube, but leave to gravity drainage instead of low wall suction.

ANS: A A newborn with a gastroschisis performed the day before will require bowel decompression with an NG tube to low wall intermittent suction. The nurse's priority action is to replace the NG tube and continue with the low wall intermittent suctioning. The NG tube cannot be left out this soon after surgery. The physician's prescription was to have the NG tube to low wall intermittent suction so the tube cannot be placed to gravity drainage.

A child is being admitted to the hospital to be tested for cystic fibrosis (CF). Which tests should the nurse expect? a. Sweat chloride test, stool for fat, chest radiograph films b. Stool test for fat, gastric contents for hydrochloride, chest radiograph films c. Sweat chloride test, bronchoscopy, duodenal fluid analysis d. Sweat chloride test, stool for trypsin, biopsy of intestinal mucosa

ANS: A A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal (GI) manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF. Gastric contents contain hydrochloride normally; it is not diagnostic. Bronchoscopy and duodenal fluid are not diagnostic. Stool test for trypsin and intestinal biopsy are not helpful in diagnosing CF.

Which of the following types of seizures may be difficult to detect? a. Absence b. Generalized c. Simple partial d. Complex partial

ANS: A Absence seizures may go unrecognized because little change occurs in the child's behavior during the seizure. Generalized, simple partial, and complex partial seizures all have clinical manifestations that are observable.

When caring for the child with Reye syndrome, the priority nursing intervention should be to: a. monitor intake and output. b. prevent skin breakdown. c. observe for petechiae. d. do range-of-motion exercises.

ANS: A Accurate and frequent monitoring of intake and output is essential for adjusting fluid volumes to prevent both dehydration and cerebral edema. Preventing skin breakdown, observing for petechiae, and doing range-of-motion exercises are important interventions in the care of a critically ill or comatose child. Careful monitoring of intake and output is a priority.

When liquid medication is given to a crying 10-month-old infant, which approach minimizes the possibility of aspiration? a. Administer the medication with a syringe (without needle) placed along the side of the infant's tongue. b. Administer the medication as rapidly as possible with the infant securely restrained. c. Mix the medication with the infant's regular formula or juice and administer by bottle. d. Keep the child upright with the nasal passages blocked for a minute after administration.

ANS: A Administer the medication with a syringe without needle placed along the side of the infant's tongue. The contents are administered slowly in small amounts, allowing the child to swallow between deposits. Medications should be given slowly to avoid aspiration. The medication should be mixed with only a small amount of food or liquid. If the child does not finish drinking or eating, it is difficult to determine how much medication was consumed. Essential foods also should not be used. Holding the child's nasal passages will increase the risk of aspiration.

Which aspect of cognition develops during adolescence? a. Capability to use a future time perspective b. Ability to place things in a sensible and logical order c. Ability to see things from the point of view of another d. Progress from making judgments based on what they see to making judgments based on what they reason

ANS: A Adolescents are no longer restricted to the real and actual. They also are concerned with the possible; they think beyond the present. During concrete operations (between ages 7 and 11 years), children exhibit these characteristic thought processes.

The nurse gives an injection in a patient's room. The nurse should perform which intervention with the needle for disposal? a. Dispose of syringe and needle in a rigid, puncture-resistant container in patient's room. b. Dispose of syringe and needle in a rigid, puncture-resistant container in an area outside of patient's room. c. Cap needle immediately after giving injection and dispose of in proper container. d. Cap needle, break from syringe, and dispose of in proper container.

ANS: A All needles (uncapped and unbroken) are disposed of in a rigid, puncture-resistant container located near the site of use. Consequently, these containers should be installed in the patient's room. The uncapped needle should not be transported to an area distant from use. Needles are disposed of uncapped and unbroken.

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

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

A child has an evulsed (knocked-out) tooth. Which medium should the nurse instruct the parents to place the tooth in for transport to the dentist? a. In cold milk b. In cold water c. In warm salt water d. In a dry, clean jar

ANS: A An evulsed tooth should be placed in a suitable medium for transplant, either cold milk or saliva (under the child or parent's tongue). Cold milk is a more suitable medium for transport than cold water, warm salt water, or a dry, clean jar.

An 18-month-old child is seen in the clinic with AOM. Trimethoprim-sulfamethoxazole (Bactrim) is prescribed. Which statement made by the parent indicates a correct understanding of the instructions? a. "I should administer all the prescribed medication." b. "I should continue medication until the symptoms subside." c. "I will immediately stop giving medication if I notice a change in hearing." d. "I will stop giving medication if fever is still present in 24 hours."

ANS: A Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria. Symptoms may subside before the full course is given. Hearing loss is a complication of AOM. Antibiotics should continue to be given. Medication may take 24 to 48 hours to make symptoms subside. It should be continued.

A mother calls the clinic nurse about her 4-year-old son who has acute diarrhea. She has been giving him the antidiarrheal drug loperamide (Imodium A-D). The nurse's response should be based on knowledge that this drug is: a. not indicated. b. indicated because it slows intestinal motility. c. indicated because it decreases diarrhea. d. indicated because it decreases fluid and electrolyte losses.

ANS: A Antidiarrheal medications are not recommended for the treatment of acute infectious diarrhea. These medications have adverse effects and toxicity, such as worsening of the diarrhea because of slowing of motility and ileus, or a decrease in diarrhea with continuing fluid losses and dehydration. Antidiarrheal medications are not recommended in infants and small children.

A child is admitted to the hospital with asthma. Which assessment findings support this diagnosis? a. Nonproductive cough, wheezing b. Fever, general malaise c. Productive cough, rales d. Stridor, substernal retractions

ANS: A Asthma presents with a nonproductive cough and wheezing. Pneumonia appears with an acute onset, fever, and general malaise. A productive cough and rales would be indicative of pneumonia. Stridor and substernal retractions are indicative of croup.

A 2-year-old child is being admitted to the hospital for possible bacterial meningitis. When preparing for a lumbar puncture, the nurse's best action is to: a. prepare child for conscious sedation during the test. b. set up a tray with equipment the same size as for adults. c. reassure the parents that the test is simple, painless, and risk free. d. apply EMLA to puncture site 15 minutes before procedure.

ANS: A Because of the urgency of the child's condition, conscious sedation should be used for the procedure. Pediatric spinal trays have smaller needles than do adult trays. Reassuring the parents that the test is simple, painless, and risk free is incorrect information. A spinal tap does have associated risks, and analgesia will be given for the pain. EMLA (a eutectic mixture of anesthetics) should be applied approximately 60 minutes before the procedure. The emergency nature of the spinal tap precludes its use.

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

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

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

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

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered? a. Before chest physiotherapy (CPT) b. After CPT c. Before receiving 100% oxygen d. After receiving 100% oxygen

ANS: A Bronchodilators should be given before CPT to open bronchi and make expectoration easier. Aerosolized bronchodilator medications are not helpful when used after CPT. Oxygen administration is necessary only in acute episodes with caution because of chronic carbon dioxide retention.

Which clinical manifestations would suggest hydrocephalus in a neonate? a. Bulging fontanel and dilated scalp veins b. Closed fontanel and high-pitched cry c. Constant low-pitched cry and restlessness d. Depressed fontanel and decreased blood pressure

ANS: A Bulging fontanels, dilated scalp veins, and separated sutures are clinical manifestations of hydrocephalus in neonates. Closed fontanel and high-pitched cry, constant low-pitched cry and restlessness, and depressed fontanel and decreased blood pressure are not clinical manifestations of hydrocephalus, but all should be referred for evaluation.

The nurse is talking to the parent of a 13-month-old child. The mother states, "My child does not make noises like 'da' or 'na' like my sister's baby, who is only 9 months old." Which statement by the nurse would be most appropriate to make? a. "I am going to request a referral to a hearing specialist." b. "You should not compare your child to your sister's child." c. "I think your child is fine, but we will check again in 3 months." d. "You should ask other parents what noises their children made at this age."

ANS: A By 11 months of age a child should be making well-formed syllables such as "da" or "na" and should be referred to a specialist if not. You should not compare your child to your sister's child, I think your child is fine, but we will check again in 3 months, and You should ask other parents what noises their children made at this age are not appropriate statements to make to the parent.

Hearing is expressed in decibels (dB), or units of loudness. Which is the softest sound a normal ear can hear? a. 0 dB b. 10 dB c. 40 to 50 dB d. 100 dB

ANS: A By definition, 0 dB is the softest sound the normal ear can hear. Ten dB is the sound of the heartbeat or the rustling of leaves. 40 to 50 dB is in the range of normal conversation. The noise of a train is approximately 100 dB.

Parents of a child with cystic fibrosis ask the nurse about genetic implications of the disorder. Which statement, made by the nurse, expresses accurately the genetic implications? a. If it is present in a child, both parents are carriers of this defective gene. b. It is inherited as an autosomal dominant trait. c. It is a genetic defect found primarily in non-Caucasian population groups. d. There is a 50% chance that siblings of an affected child also will be affected.

ANS: A CF is an autosomal recessive gene inherited from both parents and is inherited as an autosomal recessive, not autosomal dominant, trait. CF is found primarily in Caucasian populations. An autosomal recessive inheritance pattern means that there is a 25% chance a sibling will be infected but a 50% chance a sibling will be a carrier.

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

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

Which describes a child who is abused by the parent(s)? a. Unintentionally contributes to the abusing situation b. Belongs to a low socioeconomic population c. Is healthier than the nonabused siblings d. Abuses siblings in the same way as child is abused by the parent(s)

ANS: A Child's temperament, position in the family, additional physical needs, activity level, or degree of sensitivity to parental needs unintentionally contribute to the abusing situation. Abuse occurs among all socioeconomic levels. Children who are ill or have additional physical needs are more likely to be abused. The abused child may not abuse siblings.

Prevention of hearing impairment in children is a major goal for the nurse. This can be achieved through which intervention? a. Being involved in immunization clinics for children b. Assessing a newborn for hearing loss c. Answering parents' questions about hearing aids d. Participating in hearing screening in the community

ANS: A Childhood immunizations can eliminate the possibility of acquired sensorineural hearing loss from rubella, mumps, or measles encephalitis. Assessing a newborn for hearing loss, answering parents' questions about hearing aids, and participating in hearing screening in the community are interventions to screen for the presence of hearing loss or deal with an identified loss, not prevention.

An 8-year-old girl tells the nurse that she has cancer because God is punishing her for "being bad." She shares her concern that if she dies, she will go to hell. The nurse should interpret this as: a. a belief common at this age. b. a belief that forms the basis for most religions. c. suggestive of excessive family pressure. d. suggestive of a failure to develop a conscience.

ANS: A Children at this age may view illness or injury as a punishment for a real or imagined misdeed. The belief in divine punishment is common for an 8-year-old child.

In providing nourishment for a child with cystic fibrosis (CF), which factor should the nurse keep in mind? a. Diet should be high in carbohydrates and protein. b. Diet should be high in easily digested carbohydrates and fats. c. Most fruits and vegetables are not well tolerated. d. Fats and proteins must be greatly curtailed.

ANS: A Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Enzyme supplementation helps digest foods; other modifications are not necessary. A well-balanced diet containing fruits and vegetables is important. Fats and proteins are a necessary part of a well-balanced diet.

Which statement is true about smoking in adolescence? a. Smoking is related to other high-risk behaviors. b. Smoking will not continue unless peer pressure continues. c. Smoking is less common when the adolescent's parent(s) smokes. d. Smoking among adolescents is becoming more prevalent.

ANS: A Cigarettes are considered a gateway drug. Teenagers who smoke are 11.4 times more likely to use an illicit drug. Teenagers begin smoking for a variety of reasons, such as imitation of adult behavior, peer pressure, imitation of behaviors portrayed in movies and advertisements, and a desire to control weight. The absence of peer pressure alone will not stop smoking. Teenagers who do not smoke usually have parents and friends who do not smoke or who oppose smoking. The percentage of young people who report current cigarette use and frequent cigarette use has declined significantly.

A nurse is interpreting the results of a tuberculin skin test (TST) on an adolescent who is HIV positive. Which induration size indicates a positive result for this child 48-72 hours after the test? a. 5 mm b. 10 mm c. 15 mm d. 20 mm

ANS: A Clinical evidence of a positive TST in children receiving immunosuppressive therapy, including immunosuppressive doses of steroids or who have immunosuppressive conditions, including HIV infection is an induration of 5 mm. Children younger than 4 years of age with: (a) other medical risk conditions, including Hodgkin disease, lymphoma, diabetes mellitus, chronic renal failure, or malnutrition; (b) born or whose parents were born in high-prevalence (TB) regions of the world; (c) frequently exposed to adults who are HIV infected, homeless, users of illicit drugs, residents of nursing homes, incarcerated or institutionalized, or migrant farm workers; and (d) who travel to high-prevalence (TB) regions of the world are positive when the induration is 10 mm. Children 4 years of age or older without any risk factors are positive when the induration is 20 mm.

A nurse is planning a teaching session for a group of adolescents. The nurse understands that by adolescence the individual is in which stage of cognitive development? a. Formal operations b. Concrete operations c. Conventional thought d. Post-conventional thought

ANS: A Cognitive thinking culminates with capacity for abstract thinking. This stage, the period of formal operations, is Piaget's fourth and last stage. Concrete operations usually occur between ages 7 and 11 years. Conventional and post-conventional thought refer to Kohlberg's stages of moral development.

A school nurse is performing hearing screening on school children. The nurse recognizes that the most common type of hearing loss resulting from interference of transmission of sound to the middle ear is characteristic of which type of hearing loss? a. Conductive b. Sensorineural c. Mixed conductive-sensorineural d. Central auditory imperceptive

ANS: A Conductive or middle-ear hearing loss is the most common type. It results from interference of transmission of sound to the middle ear, most often from recurrent otitis media. Sensorineural, mixed conductive-sensorineural, and central auditory imperceptive are less common types of hearing loss.

Which explains why cool-mist vaporizers rather than steam vaporizers are recommended in home treatment of childhood respiratory tract infections? a. They are safer. b. They are less expensive. c. Respiratory secretions are dried. d. A more comfortable environment is produced.

ANS: A Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam. The cost of cool-mist and steam vaporizers is comparable. Steam loosens secretions, not dries them. Both may promote a more comfortable environment, but cool-mist vaporizers present decreased risk for burns and growth of organisms.

A nurse is charting that a hospitalized child has labored breathing. Which describes labored breathing? a. Dyspnea b. Tachypnea c. Hypopnea d. Orthopnea

ANS: A Dyspnea is labored breathing. Tachypnea is rapid breathing. Hypopnea is breathing that is too shallow. Orthopnea is difficulty breathing except in upright position.

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

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

A nurse should suspect possible visual impairment in a child who displays which characteristic? a. Excessive rubbing of the eyes b. Rapid lateral movement of the eyes c. Delay in speech development d. Lack of interest in casual conversation with peers

ANS: A Excessive rubbing of the eyes is a clinical manifestation of visual impairment. Rapid lateral movement of the eyes, delay in speech development, and lack of interest in casual conversation with peers are not associated with visual impairment.

Which condition in a child should alert a nurse for increased fluid requirements? a. Fever b. Mechanical ventilation c. Congestive heart failure d. Increased intracranial pressure (ICP)

ANS: A Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. Respiratory rate influences insensible fluid loss and should be monitored in the mechanically ventilated child. Congestive heart failure is a case of fluid overload in children. Increased ICP does not lead to increased fluid requirements in children.

Which is the most commonly used method in completed suicides? a. Firearms b. Drug overdose c. Self-inflected laceration d. Carbon monoxide poisoning

ANS: A Firearms are the most commonly used instruments in completed suicides among both males and females. For adolescent boys, firearms are followed by hanging and overdose. For adolescent females, overdose and strangulation are the next most common means of completed suicide. The most common method of suicide attempt is overdose or ingestion of potentially toxic substances such as drugs. The second most common method of suicide attempt is self-inflicted laceration. Carbon monoxide poisoning is not one of the more frequent forms of suicide completion.

Which drug should the nurse expect to administer to a preschool child who has increased intracranial pressure (ICP) resulting from cerebral edema? a. Mannitol (Osmitrol) b. Epinephrine hydrochloride (Adrenalin) c. Atropine sulfate (Atropine) d. Sodium bicarbonate (Sodium bicarbonate)

ANS: A For increased ICP, mannitol, an osmotic diuretic, administered intravenously, is the drug used most frequently for rapid reduction. Epinephrine hydrochloride, atropine sulfate, and sodium bicarbonate are not used to decrease ICP.

The nurse is teaching a mother how to perform chest physical therapy and postural drainage on her 3-year-old child, who has cystic fibrosis. To perform percussion, the nurse should instruct her to: a. cover the skin with a shirt or gown before percussing. b. strike the chest wall with a flat-hand position. c. percuss over the entire trunk anteriorly and posteriorly. d. percuss before positioning for postural drainage.

ANS: A For postural drainage and percussion, the child should be dressed in a light shirt to protect the skin and placed in the appropriate postural drainage positions. The chest wall is struck with a cupped-hand, not a flat-hand position. The procedure should be done over the rib cage only. Positioning precedes the percussion.

A young adolescent boy tells the nurse he "feels gawky." The nurse should explain that this occurs in adolescents because of: a. growth of the extremities and neck precedes growth in other areas. b. growth is in the trunk and chest. c. the hip and chest breadth increases. d. the growth spurt occurs earlier in boys than it does in girls.

ANS: A Growth in length of the extremities and neck precedes growth in other areas, and, because these parts are the first to reach adult length, the hands and feet appear larger than normal during adolescence. Increases in hip and chest breadth take place in a few months followed several months later by an increase in shoulder width. These changes are followed by increases in length of the trunk and depth of the chest. This sequence of changes is responsible for the characteristic long-legged, gawky appearance of early adolescent children. The growth spurt occurs earlier in girls than in boys.

Which statement is correct about childhood obesity? a. Heredity is an important factor in the development of obesity. b. Childhood obesity in the United States is decreasing. c. Childhood obesity is the result of inactivity. d. Childhood obesity can be attributed to an underlying disease in most cases.

ANS: A Heredity is an important fact that contributes to obesity. Identical twins reared apart tend to resemble their biologic parents to a greater extent than their adoptive parents. It is difficult to distinguish between hereditary and environmental factors. The number of overweight children is increasing in the United States. Inactivity is related to childhood obesity, but it is not the only component. Underlying diseases such as hypothyroidism and hyperinsulinism account for only a small number of cases of childhood obesity.

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

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

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

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

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

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

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

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

A 14-year-old boy seems to be always eating, although his weight is appropriate for his height. What is the best explanation for this? a. This is normal because of increase in body mass. b. This is abnormal and suggestive of future obesity. c. His caloric intake would have to be excessive. d. He is substituting food for unfilled needs.

ANS: A In adolescence, nutritional needs are closely related to the increase in body mass. The peak requirements occur in the years of maximal growth. The caloric and protein requirements are higher than at almost any other time of life. Seemingly always eating describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern.

A nurse is conducting an in-service on asthma. Which statement is the most descriptive of bronchial asthma? a. There is heightened airway reactivity. b. There is decreased resistance in the airway. c. The single cause of asthma is an allergic hypersensitivity. d. It is inherited.

ANS: A In bronchial asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function. In bronchial asthma, there is increased resistance in the airway. There are multiple causes of asthma, including allergens, irritants, exercise, cold air, infections, medications, medical conditions, and endocrine factors. Atopy or development of an immunoglobulin E (IgE)-mediated response is inherited but is not the only cause of asthma.

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child should begin with: a. intravenous (IV) fluids. b. ORS. c. clear liquids, 1 to 2 ounces at a time. d. administration of antidiarrheal medication.

ANS: A In children with severe dehydration, IV fluids are initiated. ORS is acceptable therapy if the dehydration is not severe. Diarrhea is not managed by using clear liquids by mouth. These fluids have a high carbohydrate content, low electrolyte content, and high osmolality. Antidiarrheal medications are not recommended for the treatment of acute infectious diarrhea.

Which type of dehydration is defined as "dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion"? a. Isotonic dehydration b. Hypotonic dehydration c. Hypertonic dehydration d. All types of dehydration in infants and small children

ANS: A Isotonic dehydration is the correct term for this definition and is the most frequent form of dehydration in children. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic. Hypertonic dehydration results from water loss in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes. This definition is specific to isotonic dehydration.

Katie, 4 years old, is admitted to outpatient surgery for removal of a cyst on her foot. Her mother puts the hospital gown on her, but Katie is crying because she wants to leave on her underpants. The most appropriate nursing action is to: a. allow her to wear her underpants. b. discuss with her mother why this is important to Katie. c. ask her mother to explain to her why she cannot wear them. d. explain in a kind, matter-of-fact manner that this is hospital policy.

ANS: A It is appropriate for the child to leave her underpants on. This allows her some measure of control in this procedure, foot surgery. Further discussions may make the child more upset. Katie is too young to understand what hospital policy means.

A nurse is admitting an infant with biliary atresia. Which is the earliest clinical manifestation of biliary atresia the nurse should expect to assess? a. Jaundice b. Vomiting c. Hepatomegaly d. Absence of stooling

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

Effective lone-rescuer CPR on a 5-year-old child should include a. two breaths to every 30 chest compressions. b. two breaths to every 15 chest compressions. c. reassessment of child after 50 cycles of compression and ventilation. d. reassessment of child every 10 minutes that CPR continues.

ANS: A Lone-rescuer CPR is two breaths to 30 compressions for all ages until signs of recovery occur. Reassessment of the child should take place after 20 cycles or 1 minute.

A 6-year-old child is hospitalized for intravenous (IV) antibiotic therapy. He eats little on his "regular diet" trays. He tells the nurse that all he wants to eat is pizza, tacos, and ice cream. Which is the best nursing action? a. Request these favorite foods for him. b. Identify healthier food choices that he likes. c. Explain that he needs fruits and vegetables. d. Reward him with ice cream at end of every meal that he eats.

ANS: A Loss of appetite is a symptom common to most childhood illnesses. To encourage adequate nutrition, favorite foods should be requested for the child. These foods provide nutrition and can be supplemented with additional fruits and vegetables. Ice cream and other desserts should not be used as rewards or punishment.

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

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

A 3-year-old child has a fever associated with a viral illness. Her mother calls the nurse, reporting a fever of 102° F even though she had acetaminophen 2 hours ago. The nurse's action should be based on which statement? a. Fevers such as this are common with viral illnesses. b. Seizures are common in children when antipyretics are ineffective. c. Fever over 102° F indicates greater severity of illness. d. Fever over 102° F indicates a probable bacterial infection.

ANS: A Most fevers are of brief duration, with limited consequences, and are viral. Little evidence supports the use of antipyretic drugs to prevent febrile seizures. Neither the increase in temperature nor its response to antipyretics indicates the severity or etiology of infection.

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

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

Which term refers to the ability to see objects clearly at close range but not at a distance? a. Myopia b. Amblyopia c. Cataract d. Glaucoma

ANS: A Myopia, or nearsightedness, refers to the ability to see objects clearly at close range but not a distance. Amblyopia, or lazy eye, is reduced visual acuity in one eye. A cataract is opacity of the lens of the eye. Glaucoma is a group of eye diseases characterized by increased intraocular pressure.

The nurse is teaching the parents of a child recently diagnosed with ADHD who has been prescribed methylphenidate (Ritalin). Which should the nurse include in teaching about the side effects of methylphenidate? a. "Your child may experience a sense of nervousness." b. "You may see an increase in your child's appetite." c. "Your child may experience daytime sleepiness." d. "You may see a decrease in your child's blood pressure."

ANS: A Nervousness is one of the common side effects of Ritalin. Decreased appetite with subsequent weight loss, insomnia, and increased blood pressure are other common side effects.

The nurse is teaching nursing students about childhood nervous system tumors. Which best describes a neuroblastoma? a. Diagnosis is usually made after metastasis occurs. b. Early diagnosis is usually possible because of the obvious clinical manifestations. c. It is the most common brain tumor in young children. d. It is the most common benign tumor in young children.

ANS: A Neuroblastoma is a silent tumor with few symptoms. In more than 70% of cases, diagnosis is made after metastasis occurs, with the first signs caused by involvement in the nonprimary site. In only 30% of cases is diagnosis made before metastasis. Neuroblastomas are the most common malignant extracranial solid tumors in children. The majority of tumors develop in the adrenal glands or the retroperitoneal sympathetic chain. They are not benign but metastasize.

Which statement characterizes moral development in the older school-age child? a. They are able to judge an act by the intentions that prompted it rather than just by the consequences. b. Rules and judgments become more absolute and authoritarian. c. They view rule violations in an isolated context. d. They know the rules but cannot understand the reasons behind them.

ANS: A Older school-age children are able to judge an act by the intentions that prompted the behavior rather than just by the consequences. Rules and judgments become less absolute and authoritarian. Rule violation is likely to be viewed in relation to the total context in which it appears. The situation and the morality of the rule itself influence reactions.

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

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

The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. Which nursing action is the most appropriate? a. Notify practitioner. b. Measure abdominal girth. c. Auscultate for bowel sounds. d. Take vital signs, including blood pressure.

ANS: A Passage of a normal brown stool indicates that the intussusception has reduced itself. This is immediately reported to the practitioner, who may choose to alter the diagnostic-therapeutic care plan. The first action would be to report the normal stool to the practitioner.

Which is a high-fiber food that the nurse should recommend for a child with chronic constipation? a. Popcorn b. Pancakes c. Muffins d. Ripe bananas

ANS: A Popcorn is a high-fiber food. Pancakes and muffins do not have significant fiber unless made with fruit or bran. Raw fruits, especially those with skins and seeds, other than ripe bananas, have high fiber.

A child with autism spectrum disorder (ASD) is admitted to the hospital with pneumonia. The nurse should plan which priority intervention when caring for the child? a. Maintain a structured routine and keep stimulation to a minimum. b. Place child in a room with a roommate of the same age. c. Maintain frequent touch and eye contact with the child. d. Take the child frequently to the playroom to play with other children.

ANS: A Providing a structured routine for the child to follow is a key in the management of ASD. Decreasing stimulation by using a private room, avoiding extraneous auditory and visual distractions, and encouraging the parents to bring in possessions the child is attached to may lessen the disruptiveness of hospitalization. Because physical contact often upsets these children, minimum holding and eye contact may be necessary to avoid behavioral outbursts. Children with ASD need to be introduced slowly to new situations, with visits with staff caregivers kept short whenever possible. The playroom would be too overwhelming with new people and situations and should not be a priority of care.

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

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

Which is the priority nursing intervention for an unconscious child after a fall? a. Establish adequate airway. b. Perform neurologic assessment. c. Monitor intracranial pressure. d. Determine whether a neck injury is present.

ANS: A Respiratory effectiveness is the primary concern in the care of the unconscious child. Establishment of an adequate airway is always the first priority. A neurologic assessment and determination of whether a neck injury is present will be performed after breathing and circulation are stabilized. Intracranial, not intercranial, pressure is monitored if indicated after airway, breathing, and circulation are maintained.

An adolescent girl tells the nurse that she is very suicidal. The nurse asks her whether she has a specific plan. Asking this should be considered: a. an appropriate part of the assessment. b. not a critical part of the assessment. c. suggesting that the adolescent needs a plan. d. encouraging the adolescent to devise a plan.

ANS: A Routine health assessments of adolescents should include questions that assess the presence of suicidal ideation or intent. Questions such as, "Have you ever developed a plan to hurt yourself or kill yourself?" should be part of that assessment. Adolescents who express suicidal feelings and have a specific plan are at particular risk and require further assessment and constant monitoring. The information about having a plan is an essential part of the assessment and greatly affects the treatment plan.

Which should be the major consideration when selecting toys for a child who is cognitively impaired? a. Safety b. Age appropriateness c. Ability to provide exercise d. Ability to teach useful skills

ANS: A Safety is the primary concern in selecting recreational and exercise activities for all children. This is especially true for children who are cognitively impaired. Age appropriateness, the ability to provide exercise, and the ability to teach useful skills should all be considered in the selection of toys, but safety is of paramount importance.

Which is a common characteristic of those who sexually abuse children? a. Pressure victim into secrecy b. Are usually unemployed and unmarried c. Are unknown to victims and victims' families d. Have many victims that are each abused once only

ANS: A Sex offenders may pressure the victim into secrecy regarding the activity as a "secret between us" that other people may take away if they find out. The offender may be anyone, including family members and persons from any level of society. Sex offenders are usually trusted acquaintances of the victims and victims' families. Many victims are abused many times over a long period.

An adolescent boy is brought to the emergency department after a motorcycle accident. His respirations are deep, periodic, and gasping. There are extreme fluctuations in blood pressure. Pupils are dilated and fixed. The nurse should suspect which type of head injury? a. Brainstem b. Skull fracture c. Subdural hemorrhage d. Epidural hemorrhage

ANS: A Signs of brainstem injury include deep, rapid, periodic or intermittent, and gasping respirations. Wide fluctuations or noticeable slowing of the pulse, widening pulse pressure, or extreme fluctuations in blood pressure are consistent with a brainstem injury. Skull fracture, subdural hemorrhage, and epidural hemorrhage are not consistent with brainstem injuries.

A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her school work satisfactorily but lately has been somewhat aggressive and stubborn in the classroom. The school nurse should recognize this as: a. signs of stress. b. developmental delay. c. physical problem causing emotional stress. d. lack of adjustment to school environment.

ANS: A Signs of stress include stomach pains or headache, sleep problems, bed-wetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors. This child is exhibiting signs of stress.

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

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

Which is the most significant factor in distinguishing those who commit suicide from those who make suicidal attempts or threats? a. Social isolation b. Level of stress c. Degree of depression d. Desire to punish others

ANS: A Social isolation is a significant factor in distinguishing adolescents who will kill themselves from those who will not. It is also more characteristic of those who complete suicide than of those who make attempts or threats. Level of stress, degree of depression, and desire to punish others are contributing factors in suicide, but they are not the most significant factor in distinguishing those who complete suicide from those who attempt suicide.

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

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

Teasing can be common during the school-age years. The nurse should recognize that which applies to teasing? a. Can have a lasting effect on children b. Is not a significant threat to self-concept c. Is rarely based on anything that is concrete d. Is usually ignored by the child who is being teased

ANS: A Teasing in this age group is common and can have a long-lasting effect. Increasing awareness of differences, especially when accompanied by unkind comments and taunts from others, may make a child feel inferior and undesirable. Physical impairments such as hearing or visual defects, ears that "stick out," or birth marks assume great importance.

A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school. Breathing is not impaired, but some postictal confusion occurs. The most appropriate initial action by the school nurse is to: a. stay with child and have someone call emergency medical service (EMS). b. notify parent and regular practitioner. c. notify parent that child should go home. d. stay with child, offering calm reassurance.

ANS: A The EMS should be called to transport the child because this is the child's first seizure. Because this is the first seizure, evaluation should be performed as soon as possible. The nurse should stay with the child while someone else notifies the EMS.

The Heimlich maneuver is recommended for airway obstruction in children older than _____ year(s). a. 1 b. 4 c. 8 d. 12

ANS: A The Heimlich maneuver is recommended for airway obstruction in children older than 1 year. Younger than 1 year, back blows and chest thrusts are administered. The Heimlich maneuver can be used in children older than 1 year.

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

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

A school-age child has been admitted with an acute asthma episode. The child is receiving oxygen by nasal prongs at 2 liters. How often should the nurse plan to monitor the child's pulse oximetry status? a. Continuous b. Every 30 minutes c. Every hour d. Every 2 hours

ANS: A The child on supplemental oxygen requires intermittent or continuous oxygenation monitoring, depending on severity of respiratory compromise and initial oxygenation status. The child in status asthmaticus should be placed on continuous cardiorespiratory (including blood pressure) and pulse oximetry monitoring.

A nurse is caring for a hearing-impaired child who lip reads. The nurse should plan which intervention to facilitate lip reading? a. Speak at an even rate. b. Exaggerate pronunciation of words. c. Avoid using facial expressions. d. Repeat in exactly the same way if child does not understand.

ANS: A The child should be helped to learn and understand how to read lips by speaking at an even rate. It interferes with the child's comprehension of the spoken word to exaggerate pronunciation of words, to avoid using facial expressions, and to repeat in exactly the same way if the child does not understand.

When should children with cognitive impairment be referred for stimulation and educational programs? a. As young as possible b. As soon as they have the ability to communicate in some way c. At age 3 years, when schools are required to provide services d. At age 5 or 6 years, when schools are required to provide services

ANS: A The child's education should begin as soon as possible. Considerable evidence exists that early intervention programs for children with disabilities are valuable for cognitively impaired children. The early intervention may facilitate the child's development of communication skills. States are encouraged to provide early intervention programs from birth under Public Law 101-476, the Individuals with Disabilities Education Act.

A toddler fell out of a second-story window. She had a brief loss of consciousness and vomited four times. Since admission, she has been alert and oriented. Her mother asks why a computed tomography (CT) scan is required when she "seems fine." Which explanation should the nurse give? a. Your child may have a brain injury and the CT can rule one out. b. The CT needs to be done because of your child's age. c. Your child may start to have seizures and a baseline CT should be done. d. Your child probably has a skull fracture and the CT can confirm this diagnosis.

ANS: A The child's history of the fall, brief loss of consciousness, and vomiting four times necessitates evaluation of a potential brain injury. The severity of a head injury may not be apparent on clinical examination but will be detectable on a CT scan. The need for the CT scan is related to the injury and symptoms, not the child's age. The CT scan is necessary to determine whether a brain injury has occurred.

A nurse is admitting a child with Crohn disease. Parents ask the nurse, "How is this disease different from ulcerative colitis?" Which statement should the nurse make when answering this question? a. "With Crohn's the inflammatory process involves the whole GI tract." b. "There is no difference between the two diseases." c. "The inflammation with Crohn's is limited to the colon and rectum." d. "Ulcerative colitis is characterized by skip lesions."

ANS: A The chronic inflammatory process of Crohn disease involves any part of the GI tract from the mouth to the anus but most often affects the terminal ileum. Crohn disease involves all layers of the bowel wall in a discontinuous fashion, meaning that between areas of intact mucosa, there are areas of affected mucosa (skip lesions). The inflammation found with ulcerative colitis is limited to the colon and rectum, with the distal colon and rectum the most severely affected. Inflammation affects the mucosa and submucosa and involves continuous segments along the length of the bowel with varying degrees of ulceration, bleeding, and edema.

A sexually active female adolescent asks the nurse about the contraceptive Depo-Provera. The nurse should explain that it: a. requires injections every 3 months. b. requires daily administration of medication by mouth. c. provides long-term continuous protection, up to 5 years. d. prevents pregnancy if given within 72 hours of unprotected sex.

ANS: A The contraceptive Depo-Provera is administered by injection every 3 months. Oral contraceptives, not Depo-Provera, require daily administration of medication by mouth. Norplant, not Depo-Provera, provides long-term continuous protection for up to 5 years. Postcoital contraception, not Depo-Provera, prevents pregnancy if given within 72 hours of unprotected sex.

Bismuth subsalicylate, clarithromycin, and metronidazole are prescribed for a child with a peptic ulcer to: a. eradicate Helicobacter pylori. b. coat gastric mucosa. c. treat epigastric pain. d. reduce gastric acid production.

ANS: A The drug therapy combination of bismuth subsalicylate, clarithromycin, and metronidazole is effective in the treatment of H. pylori and is prescribed to eradicate it.

A nurse is admitting a child to the hospital with a diagnosis of giardiasis. Which medication should the nurse expect to be prescribed? a. Metronidazole (Flagyl) b. Amoxicillin clavulanate (Augmentin) c. Clarithromycin (Biaxin) d. Prednisone (Orapred)

ANS: A The drugs of choice for treatment of giardiasis are metronidazole (Flagyl), tinidazole (Tindamax), and nitazoxanide (Alinia). These are classified as antifungals. Amoxicillin and clarithromycin are antibiotics that treat bacterial infections. Prednisone is a steroid and is used as an anti-inflammatory medication.

A nurse is teaching nursing students about clinical manifestations of cystic fibrosis (CF). Which is/are the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

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

Which is described as the time interval between infection or exposure to disease and appearance of initial symptoms? a. Incubation period b. Prodromal period c. Desquamation period d. Period of communicability

ANS: A The incubation period is the interval between infection or exposure and appearance of symptoms. The prodromal period is the interval between the time when early manifestations of disease appear and the overt clinical syndrome is evident. Desquamation refers to the shedding of skin. The period of communicability is the time or times during which an infectious agent may be transferred directly or indirectly from an infected person to another person.

When teaching a mother how to administer eye drops, where should the nurse tell her to place them? a. In the conjunctival sac that is formed when the lower lid is pulled down b. Carefully under the eye lid while it is gently pulled upward c. On the sclera while the child looks to the side d. Anywhere as long as drops contact the eye's surface

ANS: A The lower lid is pulled down, forming a small conjunctival sac. The solution or ointment is applied to this area. The medication should not be administered directly on the eyeball.

Which is an important nursing consideration in the care of a child with celiac disease? a. Refer to a nutritionist for detailed dietary instructions and education. b. Help child and family understand that diet restrictions are usually only temporary. c. Teach proper hand washing and standard precautions to prevent disease transmission. d. Suggest ways to cope more effectively with stress to minimize symptoms.

ANS: A The main consideration is helping the child adhere to dietary management. Considerable time is spent explaining to the child and parents about the disease process, the specific role of gluten in aggravating the condition, and foods that must be restricted. Referral to a nutritionist would help in this process. The most severe symptoms usually occur in early childhood and adult life. Dietary avoidance of gluten should be lifelong. Celiac disease is not transmissible or stress related.

A 14-year-old boy and his parents are concerned about bilateral breast enlargement. The nurse's discussion of this should be based on which statement? a. This is usually benign and temporary. b. This is usually caused by Klinefelter syndrome. c. Administration of estrogen effectively reduces gynecomastia. d. Administration of testosterone effectively reduces gynecomastia.

ANS: A The male breast responds to hormonal changes. Some degree of bilateral or unilateral breast enlargement occurs frequently in boys during puberty. Although individuals with Klinefelter syndrome can have gynecomastia, it is not a common cause for male breast enlargement. Estrogen is not a therapy for gynecomastia. Administration of testosterone has no benefit for gynecomastia and may aggravate the condition.

The nurse is taking care of a child who is alert but showing signs of increased intracranial pressure. Which test is contraindicated in this case? a. Oculovestibular response b. Doll's head maneuver c. Funduscopic examination for papilledema d. Assessment of pyramidal tract lesions

ANS: A The oculovestibular response (caloric test) involves the instillation of ice water into the ear of a comatose child. The caloric test is painful and is never performed on an awake child or one who has a ruptured tympanic membrane. Doll's head maneuver, funduscopic examination for papilledema, and assessment of pyramidal tract lesions can be performed on awake children.

The best chance of survival for a child with cirrhosis is: a. liver transplantation. b. treatment with corticosteroids. c. treatment with immune globulin. d. provision of nutritional support.

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

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

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

The nurse is preparing a 12-year-old girl for a bone marrow aspiration. The girl tells the nurse she wants her mother with her "like before." The most appropriate nursing action is to: a. grant her request. b. explain why this is not possible. c. identify an appropriate substitute for her mother. d. offer to provide support to her during the procedure.

ANS: A The parent's preferences for assisting, observing, or waiting outside the room should be assessed, along with the child's preference for parental presence. The child's choice should be respected. If the mother and child are agreeable, then the mother is welcome to stay. An appropriate substitute for the mother is necessary only if the mother does not wish to stay. Support is offered to the child regardless of parental presence.

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

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

A mother calls the school nurse saying that her daughter has developed a school phobia. She has been out of school 3 days. The nurse's recommendations should include which intervention? a. Immediately return child to school. b. Explain to child that this is the last day she can stay home. c. Determine cause of phobia before returning child to school. d. Seek professional counseling before forcing child to return to school.

ANS: A The primary goal is to return the child to school. Parents must be convinced gently, but firmly, that immediate return is essential and that it is their responsibility to insist on school attendance. The longer the child is permitted to stay out of school, the more difficult it will be for the child to reenter. Trying to find the cause of phobia will only delay the return to school and inhibit the child's ability to cope. Professional counseling is recommended if the problem persists, but the child's return to school should not wait for the counseling.

Which is an important nursing consideration when caring for a child with herpetic gingivostomatitis (HGS)? a. Apply topical anesthetics before eating. b. Drink from a cup, not a straw. c. Wait to brush teeth until lesions are sufficiently healed. d. Explain to parents how this is sexually transmitted.

ANS: A Treatment for HGS is aimed at relief of pain. Drinking bland fluids through a straw helps avoid painful lesions. Mouth care is encouraged with a soft toothbrush. HGS is usually caused by herpes simplex virus type 1, which is not associated with sexual transmission.

A child has recurrent abdominal pain (RAP) and a dairy-free diet has been prescribed for 2 weeks. Which explanation is the reason for prescribing a dairy-free diet? a. To rule out lactose intolerance b. To rule out celiac disease c. To rule out sensitivity to high sugar content d. To rule out peptic ulcer disease

ANS: A Treatment for RAP involves providing reassurance and reducing or eliminating symptoms. Dietary modifications may include removal of dairy products to rule out lactose intolerance. Fructose is eliminated to rule out sensitivity to high sugar content and gluten is removed to rule out celiac disease. A dairy-free diet would not rule out peptic ulcer disease.

Turner syndrome is suspected in an adolescent girl with short stature. This is caused by: a. absence of one of the X chromosomes. b. presence of an incomplete Y chromosome. c. precocious puberty in an otherwise healthy child. d. excess production of both androgens and estrogens.

ANS: A Turner syndrome is caused by an absence of one of the X chromosomes. Most girls who have this disorder have one X chromosome missing from all cells. No Y chromosome is present in individuals with Turner syndrome. This young woman has 45 rather than 46 chromosomes.

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which action? a. Avoid using for more than 3 days. b. Keep drops to use again for nasal congestion. c. Administer drops until nasal congestion subsides. d. Administer drops after feedings and at bedtime.

ANS: A Vasoconstrictive nose drops such as phenylephrine (Neo-Synephrine) should not be used for more than 3 days to avoid rebound congestion. Drops should be discarded after one illness because they may become contaminated with bacteria. Vasoconstrictive nose drops can have a rebound effect after 3 days of use. Drops administered before feedings are more helpful

An important nursing intervention when caring for a child who is experiencing a seizure would be to: a. describe and record the seizure activity observed. b. restrain the child when seizure occurs to prevent bodily harm. c. place a tongue blade between the teeth if they become clenched. d. suction the child during a seizure to prevent aspiration.

ANS: A When a child is having a seizure, the priority nursing care is observation of the child and seizure. The nurse then describes and records the seizure activity. The child should not be restrained, and nothing should be placed in the child's mouth. This may cause injury. To prevent aspiration, if possible, the child should be placed on the side, facilitating drainage.

The nurse is caring for a neonate with a suspected tracheoesophageal fistula. Nursing care should include: a. elevating the head but give nothing by mouth. b. elevating the head for feedings. c. feeding glucose water only. d. avoiding suctioning unless infant is cyanotic.

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

The nurse wore gloves during a dressing change. When the gloves are removed, the nurse should: a. wash hands thoroughly. b. check the gloves for leaks. c. rinse gloves in disinfectant solution. d. apply new gloves before touching the next patient.

ANS: A When gloves are worn, the hands are washed thoroughly after removing the gloves because both latex and vinyl gloves fail to provide complete protection. Gloves should be disposed of after use. Hands should be thoroughly washed before new gloves are applied.

The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine is believed to be the drug involved. Data collection should include what information? a. Mode of administration b. Drug's actual content c. Function the drug plays in the adolescent's life d. Adolescent's level of interest in rehabilitation

ANS: A When the drug is questionable or unknown, every effort must be made to determine the type, amount of drug taken, the mode and time of administration, and factors relating to the onset of presenting symptoms. The actual content of most street drugs is highly questionable. Pharmacologic agents should be administered with caution, except for the narcotic antagonists in case of suspected opioid use. The function the drug plays in the adolescent's life and the adolescent's level of interest in rehabilitation are important considerations in the long-term management during the nonacute stage.

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

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

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

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

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

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

The nurse is evaluating the laboratory results on cerebral spinal fluid (CSF) from a 3-year-old child with bacterial meningitis. Which findings confirm bacterial meningitis? (Select all that apply.) a. Elevated white blood cell (WBC) count b. Decreased glucose c. Normal protein d. Elevated red blood cell (RBC) count

ANS: A, B The cerebrospinal fluid analysis in bacterial meningitis shows elevated WBC count, decreased glucose, and increased protein content. There should not be RBCs evident in the CSF fluid.

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

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

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

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

Which assessment findings indicate to the nurse a child has Down syndrome? (Select all that apply.) a. High arched narrow palate b. Protruding tongue c. Long, slender fingers d. Transverse palmar crease e. Hypertonic muscle tone

ANS: A, B, D The assessment findings of Down syndrome include high arched narrow palate, protruding tongue, and transverse palmar creases. The fingers are stubby and the muscle tone is hypotonic not hypertonic.

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

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

A nurse is caring for a child in droplet precautions. Which instructions should the nurse give to the unlicensed assistive personnel caring for this child? (Select all that apply.) a. Wear gloves when entering the room. b. Wear an isolation gown when entering the room. c. Place the child in a special air handling and ventilation room. d. A mask should be worn only when holding the child. e. Wash your hands upon exiting the room.

ANS: A, B, E Droplet transmission involves contact of the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person with large-particle droplets (>5 mm) containing microorganisms generated from a person who has a clinical disease or who is a carrier of the microorganism. Droplets are generated from the source person primarily during coughing, sneezing, or talking and during procedures such as suctioning and bronchoscopy. Gloves, gowns, and a mask should be worn when entering the room. Handwashing when exiting the room should be done with any patient. Because droplets do not remain suspended in the air, special air handling and ventilation are not required to prevent droplet transmission.

A nurse is teaching parents methods to reduce lead levels in their home. Which should the nurse include in the teaching? (Select all that apply.) a. Plant bushes around the outside of the house. b. Ensure your child eats frequent meals. c. Use hot water from the tap when boiling vegetables. d. Food can be stored in ceramic in the refrigerator. e. Ensure that your child's diet contains sufficient iron and calcium.

ANS: A, B, E Methods to reduce lead levels in homes include: planting bushes around the outside of the house, if soil is contaminated with lead, so children cannot play there; ensuring that children eat regular meals because more lead is absorbed on an empty stomach; and ensuring that children's diets contain sufficient iron and calcium. Cold water should only be used for drinking, cooking, and reconstituting powder infant formula. Hot water dissolves lead more quickly than cold water and thus contains higher levels of lead. Do not use pottery or ceramic ware that was inadequately fired or is meant for decorative use for food storage or service.

A nurse is planning care for a 7-year-old child hospitalized with osteomyelitis. Which activities should the nurse plan to bring from the playroom for the child? (Select all that apply.) a. Paper and some paints b. Board games c. Jack-in-the-box d. Stuffed animals e. Computer games

ANS: A, B, E School-age children become fascinated with complex board, card, or computer games that they can play alone, with a best friend, or with a group. They also enjoy sewing, cooking, carpentry, gardening, and creative activities such as painting. Jack-in-the-box and stuffed animals would be appropriate for a toddler or preschool child.

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

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

The advantages of the ventrogluteal muscle as an injection site in young children include which considerations? (Select all that apply.) a. Less painful than vastus lateralis b. Free of important nerves and vascular structures c. Cannot be used when child reaches a weight of 20 pounds d. Increased subcutaneous fat, which increases drug absorption e. Easily identified by major landmarks

ANS: A, B, E The advantages of the ventrogluteal are being less painful, free of important nerves and vascular lateralis, and is easily identified by major landmarks. The major disadvantage is lack of familiarity by health professionals and controversy over whether the site can be used before weight bearing. The use of the ventrogluteal has not been clarified. It has been used in infants, but clinical guidelines address the need for the child to be walking, thus generally being over 20 pounds. The site has less subcutaneous tissue, which facilitates intramuscular (rather than subcutaneous) deposition of the drug.

The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which action should the nurse include in the child's postoperative care plan? (Select all that apply.) a. Notify the surgeon if the child swallows frequently. b. Apply a heat collar to the child for pain relief. c. Place the child on the abdomen until fully wake. d. Allow the child to have diluted juice after the procedure. e. Encourage the child to cough frequently.

ANS: A, C, D Frequent swallowing is a sign of bleeding in children after a tonsillectomy. The child should be placed on the abdomen or the side to facilitate drainage. The child can drink diluted juice, cool water, or popsicles after the procedure. An ice collar should be used after surgery. Frequent coughing and nose blowing should be avoided.

The nurse should teach the adolescent that the long-term effects of tanning can cause which conditions? (Select all that apply.) a. Phototoxic reactions b. Increased number of moles c. Premature aging d. Striae e. Increased risk of skin cancer

ANS: A, C, E Long-term effects of tanning include premature aging of the skin, increased risk of skin cancer, and, in susceptible individuals, phototoxic reactions. There has been no correlation to an increase in moles or striae (streaks or stripes on the skin, usually on the abdomen) development.

A nurse is recommending strategies to a group of school-age children for prevention of obesity. Which should the nurse include? (Select all that apply.) a. Eat breakfast daily. b. Limit fruits and vegetables. c. Have frequent family meals with parents present. d. Eat frequently at restaurants. e. Limit television viewing to 2 hours a day.

ANS: A, C, E The nurse should counsel school-age children to eat breakfast daily, have mealtimes with family, and limit television viewing to 2 hours a day to prevent obesity. Fruits and vegetables should be consumed in the recommended quantities, and eating at restaurants should be limited.

The treatment of brain tumors in children consists of which therapies? (Select all that apply.) a. Surgery b. Bone marrow transplantation c. Chemotherapy d. Stem cell transplantation e. Radiation f. Myelography

ANS: A, C, E Treatment for brain tumors in children may consist of surgery, chemotherapy, and radiotherapy alone or in combination. Bone marrow and stem cell transplantation therapies are used for leukemia, lymphoma, and other solid tumors where myeloablative therapies are used. Myelography is a radiographic examination after an intrathecal injection of contrast medium. It is not a treatment.

An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which interventions? (Select all that apply.) a. Cluster care to conserve energy b. Round-the-clock administration of antitussive agents c. Strict intake and output to avoid congestive heart failure d. Administration of antibiotics

ANS: A, D Antibiotics are indicated for a bacterial pneumonia. Often the child will have decreased pulmonary reserve, and the clustering of care is essential. Antitussive agents are used sparingly. It is desirable for the child to cough up some of the secretions. Fluids are essential to kept secretions as liquefied as possible.

Which side effects should the nurse monitor when a child is taking an antipsychotic medication? (Select all that apply.) a. Extrapyramidal effects b. Hypertension c. Bradycardia d. Dizziness e. Seizures

ANS: A, D, E Common side effects of antipsychotic medications include dizziness, drowsiness, tachycardia, hypotension, and extrapyramidal effects, such as abnormal movements and seizures.

A 13-year-old is being seen in the clinic for a routine health check. The adolescent has not been in the clinic for 3 years but was up to date on immunizations at that time. Which immunizations should the adolescent receive? (Select all that apply.) a. DTaP (tetanus, diphtheria, acellular pertussis) b. MMR (measles, mumps, rubella) c. Hepatitis B d. Influenza e. MCV4 (meningococcal)

ANS: A, D, E The DTaP (tetanus, diphtheria, acellular pertussis) vaccine is recommended for adolescents 11 to 18 years old who have not received a tetanus booster (Td) or DTaP dose and have completed the childhood DTaP/DTP series. Meningococcal vaccine (MCV4) should be given to adolescents 11 to 12 years of age with a booster dose at age 16 years. Annual influenza vaccination with either the live attenuated influenza vaccine or trivalent influenza vaccine is recommended for all children and adolescents. The adolescent, previously up to date on vaccinations, would have received the MMR and hepatitis B as a child.

A nurse is planning preoperative care for a newborn with tracheoesophageal fistula (TEF). Which interventions should the nurse plan to implement? (Select all that apply.) a. Positioning with head elevated on a 30-degree plane b. Feedings through a gastrostomy tube c. Nasogastric tube to continuous low wall suction d. Suctioning with a Replogle tube passed orally to the end of the pouch e. Gastrostomy tube to gravity drainage

ANS: A, D, E The most desirable position for a newborn who has TEF is supine (or sometimes prone) with the head elevated on an inclined plane of at least 30 degrees. This positioning minimizes the reflux of gastric secretions at the distal esophagus into the trachea and bronchi, especially when intraabdominal pressure is elevated. It is imperative to immediately remove any secretions that can be aspirated. Until surgery, the blind pouch is kept empty by intermittent or continuous suction through an indwelling double-lumen or Replogle catheter passed orally or nasally to the end of the pouch. In some cases, a percutaneous gastrostomy tube is inserted and left open so that any air entering the stomach through the fistula can escape, thus minimizing the danger of gastric contents being regurgitated into the trachea. The gastrostomy tube is emptied by gravity drainage. Feedings through the gastrostomy tube and irrigations with fluid are contraindicated before surgery in an infant with a distal TEF. A nasogastric tube to low intermittent suctioning could not be accomplished because the esophagus ends in a blind pouch in TEF.

A nurse is instructing a nursing assistant on techniques to facilitate lip reading with a hearing-impaired child who lip reads. Which techniques should the nurse include? (Select all that apply.) a. Speak at eye level. b. Stand at a distance from the child. c. Speak words in a loud tone. d. Use facial expressions while speaking. e. Keep sentences short.

ANS: A, D, E To facilitate lip reading for a hearing-impaired child who can lip read, the speaker should be at eye level, facing the child directly or at a 45-degree angle. Facial expressions should be used to assist in conveying messages, and the sentences should be kept short. The speaker should stand close to the child, not at a distance, and using a loud tone while speaking will not facilitate lip reading.

A child who has just had definitive repair of a high rectal malformation is to be discharged. Which should the nurse address in the discharge preparation of this family? (Select all that apply.) a. Perineal and wound care b. Necessity of firm stools to keep suture line clean c. Bowel training beginning as soon as child returns home d. Reporting any changes in stooling patterns to practitioner e. Use of diet modification to prevent constipation

ANS: A, D, E Wound care instruction is necessary in a child who is being discharged after surgery. The parents are taught to notify the practitioner if any signs of an anal stricture or other complications develop. Constipation is avoided, since a firm stool will place strain on the suture line. Fiber and stool softeners are often given to keep stools soft and avoid tension on the suture line. The child needs to recover from the surgical procedure. Then bowel training may begin, depending on the child's developmental and physiologic readiness.

An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which interventions should be included in the child's postoperative care? (Select all that apply.) a. Observe closely for signs of infection. b. Pump the shunt reservoir to maintain patency. c. Administer sedation to decrease irritability. d. Maintain Trendelenburg position to decrease pressure on the shunt. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention.

ANS: A, E, F Infection is a major complication of ventriculoperitoneal shunts. Observation for signs of infection is a priority nursing intervention. Intake and output should be measured carefully. Abdominal distention could be a sign of peritonitis or a postoperative ileus. Pumping of the shunt may cause obstruction or other problems and should not be performed unless indicated by the neurosurgeon. Pain management rather than sedation should be the goal of therapy. The child is kept flat to avoid too rapid a reduction of intracranial fluid.

Autism is a complex developmental disorder. The diagnostic criteria for autism include delayed or abnormal functioning in which areas with onset before age 3 years? (Select all that apply.) a. Language as used in social communication b. Parallel play c. Gross motor development d. Growth below the 5th percentile for height and weight e. Symbolic or imaginative play f. Social interaction

ANS: A, E, F These are three of the areas in which autistic children may show delayed or abnormal functioning: language as used in social communication, symbolic or imaginative play, and social interaction. Parallel play is typical play of toddlers and is usually not affected. Gross motor development and growth below the 5th percentile for height and weight are usually not characteristic of autism.

-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. Which describes their action? a. Liquefy secretions. b. Dilate the bronchioles. c. Reduce inflammation of the lungs. d. Reduce infection.

ANS: B -Adrenergic agonists and methylxanthines work to dilate the bronchioles in acute exacerbations. These medications do not liquefy secretions or reduce infection. Corticosteroids and mast cell stabilizers reduce inflammation in the lungs.

The nurse is teaching nursing students about childhood fractures. Which describes a compound skull fracture? a. Involves the basilar portion of the occipital bone b. Bone is exposed through the skin c. Traumatic separations of the cranial sutures d. Bone is pushed inward, causing pressure on the brain

ANS: B A compound fracture has the bone exposed through the skin. A basilar fracture involves the basilar portion of the frontal, ethmoid, sphenoid, temporal, or occipital bone. Diastatic skull fractures are traumatic separations of the cranial sutures. A depressed fracture has the bone pushed inward, causing pressure on the brain.

A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The child's level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. The most appropriate nursing action is to: a. discuss with parents the child's previous experiences with pain. b. discuss with practitioner what analgesia can be safely administered. c. explain that analgesia is contraindicated with a head injury. d. explain that analgesia is unnecessary when child is not fully awake and alert.

ANS: B A key nursing role is to provide sedation and analgesia for the child. Consultation with the appropriate practitioner is necessary to avoid conflict between the necessity to monitor the child's neurologic status and the promotion of comfort and relief of anxiety. Information on the child's previous experiences with pain should be obtained as part of the assessment, but because of the severity of injury, analgesia should be provided as soon as possible. Analgesia can be safely used in individuals who have sustained head injuries and can decrease anxiety and resultant increased ICP.

A school nurse is conducting a class with adolescents on suicide. Which true statement about suicide should the nurse include in the teaching session? a. A sense of hopelessness and despair are a normal part of adolescence. b. Gay and lesbian adolescents are at a particularly high risk for suicide. c. Problem-solving skills are of limited value to the suicidal adolescent. d. Previous suicide attempts are not an indication of risk for completed suicides.

ANS: B A significant number of teenage suicides occur among homosexual youths. Gay and lesbian adolescents who live in families or communities that do not accept homosexuality are likely to suffer low self-esteem, self-loathing, depression, and hopelessness as a result of a lack of acceptance from their family or community. At-risk teenagers include those who are depressed, have poor problem-solving skills, or use drugs and alcohol. History of previous suicide attempt is a serious indicator for possible suicide completion in the future.

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

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

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

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

Which is descriptive of attention deficit hyperactivity disorder (ADHD)? a. Manifestations exhibited are so bizarre that the diagnosis is fairly easy. b. Manifestations affect every aspect of the child's life but are most obvious in the classroom. c. Learning disabilities associated with ADHD eventually disappear when adulthood is reached. d. Diagnosis of ADHD requires that all manifestations of the disorder be present.

ANS: B ADHD affects every aspect of the child's life, but the disruption is most obvious in the classroom. The behaviors exhibited by the child with ADHD are not unusual aspects of behavior. The difference lies in the quality of motor activity and developmentally inappropriate inattention, impulsivity, and hyperactivity that the child displays. Some children experience decreased symptoms during late adolescence and adulthood, but a significant number carry their symptoms into adulthood. Any given child will not have every symptom of the condition. The manifestations may be numerous or few, mild or severe, and will vary with the child's developmental level.

Parents call the clinic and report that their toddler has had acute diarrhea for 24 hours. The nurse should further ask the parents if the toddler has which associated factor that is causing the acute diarrhea? a. Celiac disease b. Antibiotic therapy c. Immunodeficiency d. Protein malnutrition

ANS: B Acute diarrhea is a sudden increase in frequency and change in consistency of stools and may be associated with antibiotic therapy. Celiac disease is a problem with gluten intolerance and may cause chronic diarrhea if not identified and managed appropriately. Immunodeficiency would occur with chronic diarrhea. Protein malnutrition or kwashiorkor causes chronic diarrhea from lowered resistance to infection.

Acyclovir (Zovirax) is given to children with chickenpox to: a. minimize scarring. b. decrease the number of lesions. c. prevent aplastic anemia. d. prevent spread of the disease.

ANS: B Acyclovir decreases the number of lesions; shortens duration of fever; and decreases itching, lethargy, and anorexia. Treating pruritus and discouraging itching minimizes scarring. Aplastic anemia is not a complication of chickenpox. Strict isolation until vesicles are dried prevents spread of disease.

A 14-year-old adolescent never had chickenpox as a child. Which should the nurse recommend? a. One dose of the varicella vaccination b. Two doses of the varicella vaccination 4 weeks apart c. One dose of the varicella immune globulin d. No vaccinations—the child is past the age to receive it

ANS: B All adolescents should also be assessed for previous history of varicella infection or vaccination. Vaccination with the varicella vaccine is recommended for those with no previous history; for those with no previous infection or history, the varicella vaccine may be given in two doses 4 or more weeks apart to adolescents 13 years or older. The varicella immune globulin is given to immunosuppressed children exposed to chickenpox to boost immunity; it is only temporary. The varicella vaccination should be given to adolescents, no matter the age, who have not had chickenpox as a child.

Parents of a child undergoing an endoscopy to rule out peptic ulcer disease (PUD) from H. pylori ask the nurse, "If H. pylori is found will my child need another endoscopy to know that it is gone?" Which is the nurse's best response? a. "Yes, the only way to know the H. pylori has been eradicated is with another endoscopy." b. "We can collect a stool sample and confirm that the H. pylori has been eradicated." c. "A blood test can be done to determine that the H. pylori is no longer present." d. "Your child will always test positive for H. pylori because after treatment it goes into remission, but can't be completely eradicated."

ANS: B An upper endoscopy is the procedure initially performed to diagnose PUD. A biopsy can determine the presence of H. pylori. Polyclonal and monoclonal stool antigen tests are an accurate, noninvasive method to confirm H. pylori has been eradicated after treatment. A blood test can identify the presence of the antigen to this organism, but because H. pylori was already present it would not be as accurate as a stool sample to determine whether it has been eradicated. H. pylori can be treated and, once the treatment is complete, the stool sample can determine that it was eradicated.

A child has been admitted to the emergency department with an acetaminophen (Tylenol) poisoning. An antidote is being prescribed by the health care provider. Which antidote should the nurse prepare to administer? a. Naloxone (Narcan) b. N-acetylcysteine (Mucomyst) c. Flumazenil (Romazicon) d. Digoxin immune Fab (Digibind)

ANS: B Antidotes available to treat toxin ingestion include N-acetylcysteine for acetaminophen poisoning, naloxone for opioid overdose, flumazenil (Romazicon) for benzodiazepines (diazepam [Valium], midazolam [Versed]) overdose, and digoxin immune Fab (Digibind) for digoxin toxicity.

The nurse has just collected blood by venipuncture in the antecubital fossa. Which should the nurse do next? a. Keep arm extended while applying a bandage to the site. b. Keep arm extended, and apply pressure to the site for a few minutes. c. Apply a bandage to the site, and keep the arm flexed for 10 minutes. d. Apply a gauze pad or cotton ball to the site, and keep the arm flexed for several minutes.

ANS: B Applying pressure to the site of venipuncture stops the bleeding and aids in coagulation. Pressure should be applied before bandage is applied.

The nurse is caring for a child with carbon monoxide poisoning associated with smoke inhalation. Which is essential in this child's care? a. Monitor pulse oximetry. b. Monitor arterial blood gases. c. Administer oxygen if respiratory distress develops. d. Administer oxygen if child's lips become bright, cherry red.

ANS: B Arterial blood gases are the best way to monitor carbon monoxide poisoning. Pulse oximetry is contraindicated in the case of carbon monoxide poisoning because the PaO2 may be normal. The child should receive 100% oxygen as quickly as possible, not only if respiratory distress or other symptoms develop.

An adolescent has been diagnosed with Chlamydia infection. Which medication should the nurse expect to be prescribed for this condition? a. Ceftriaxone (Rocephin) IM b. Azithromycin (Zithromax) PO c. Acyclovir (Zovirax) PO d. Penicillin G benzathine (Bicillin) IV

ANS: B Azithromycin is used to treat Chlamydia. The patient should be rescreened in 3 to 4 months. Ceftriaxone is used to treat gonorrhea, acyclovir is used to suppress genital herpes simplex virus, and penicillin G benzathine is used to treat syphilis.

A nurse is beginning chelation therapy on a child for lead poisoning. Which intervention should the nurse implement during the time the child is receiving chelation therapy? a. Calorie counts b. Strict intake and output c. Telemetry monitoring d. Contact isolation

ANS: B Because calcium disodium edetate (EDTA) and lead are toxic to the kidneys, a nurse should keep strict records of intake and output to monitor renal functioning. Adequate hydration is essential during therapy because the chelates are excreted via the kidneys. Calorie counts, telemetry, or contact isolation would not be nursing interventions appropriate for a child undergoing chelation therapy.

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

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

When a child with mild cognitive impairment reaches the end of adolescence, which characteristic should be expected? a. Achieves a mental age of 5 to 6 years b. Achieves a mental age of 8 to 12 years c. Unable to progress in functional reading or arithmetic d. Acquires practical skills and useful reading and arithmetic to an eighth-grade level

ANS: B By the end of adolescence, the child with mild cognitive impairment can acquire practical skills and useful reading and arithmetic to a third- to sixth-grade level. A mental age of 8 to 12 years is obtainable, and the child can be guided toward social conformity. The achievement of a mental age of 5 to 6 years and being unable to progress in functional reading or arithmetic are characteristics of children with moderate cognitive impairment. Acquiring practical skills and useful reading and arithmetic to an eighth-grade level is not descriptive of cognitive impairment.

Which is descriptive of central nervous system stimulants? a. They produce strong physical dependence. b. They can result in strong psychological dependence. c. Withdrawal symptoms are life threatening. d. Acute intoxication can lead to coma.

ANS: B Central nervous system stimulants such as amphetamines and cocaine produce a strong psychological dependence. This class of drugs does not produce strong physical dependence and can be withdrawn without much danger. Acute intoxication leads to violent, aggressive behavior or psychotic episodes characterized by paranoia, uncontrollable agitation, and restlessness.

Airborne isolation is required for a child who is hospitalized with: a. mumps. b. chickenpox. c. exanthema subitum (roseola). d. erythema infectiosum (fifth disease).

ANS: B Chickenpox is communicable through direct contact, droplet spread, and contaminated objects. Mumps is transmitted from direct contact with saliva of infected person and is most communicable before onset of swelling. The transmission and source of the viral infection exanthema subitum (roseola) is unknown. Erythema infectiosum (fifth disease) is communicable before onset of symptoms.

The nurse is teaching nursing students about normal physiologic changes in the respiratory system of toddlers. Which best describes why toddlers have fewer respiratory tract infections as they grow older? a. The amount of lymphoid tissue decreases. b. Repeated exposure to organisms causes increased immunity. c. Viral organisms are less prevalent in the population. d. Secondary infections rarely occur after viral illnesses.

ANS: B Children have increased immunity after exposure to a virus. The amount of lymphoid tissue increases as children grow older. Viral organisms are not less prevalent, but older children have the ability to resist invading organisms. Secondary infections after viral illnesses include Mycoplasma pneumoniae and group A -hemolytic streptococcal infections.

Mark, a 9-year-old with Down syndrome, is mainstreamed into a regular third-grade class for part of the school day. His mother asks the school nurse about programs, such as Cub Scouts, that he might join. The nurse's recommendation should be based on which statement? a. Programs like Cub Scouts are inappropriate for children who are mentally retarded. b. Children with Down syndrome have the same need for socialization as other children. c. Children with Down syndrome socialize better with children who have similar disabilities. d. Parents of children with Down syndrome encourage programs, such as scouting, because they deny that their children have disabilities.

ANS: B Children of all ages need peer relationships. Children with Down syndrome should have peer experiences similar to those of other children, such as group outings, Cub Scouts, and Special Olympics. Programs such as Cub Scouts can help children with cognitive impairment develop socialization skills. Although all children should have an opportunity to form a close relationship with someone of the same developmental level, it is appropriate for children with disabilities to develop relationships with children who do not have disabilities. The parents are acting as advocates for their child.

Which is an implanted ear prosthesis for children with sensorineural hearing loss? a. Hearing aid b. Cochlear implant c. Auditory implant d. Amplification device

ANS: B Cochlear implants are surgically implanted, and they provide a sensation of hearing for individuals who have severe or profound hearing loss of sensorineural origin. Hearing aids and amplification devices are external devices for enhancing hearing. Auditory implants do not exist.

The psychological effects of being obese during adolescence include: a. sexual promiscuity. b. poor body image. c. feelings of contempt for thin peers. d. accurate body image but self-deprecating attitude.

ANS: B Common emotional consequences of obesity include poor body image, low self-esteem, social isolation, and feelings of depression and isolation. Sexual promiscuity, feelings of contempt for thin peers, and accurate body image but self-deprecating attitude are not usually associated with obesity.

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

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

Parents of a child with Down syndrome ask the nurse about techniques for introducing solid food to their 8-month-old child's diet. The nurse should give the parents which priority instruction? a. It is too early to add solids; the parents should wait for 2 to 3 months. b. A small but long, straight-handled spoon should be used to push the food toward the back and side of the mouth. c. If the child thrusts the food out, the feeding should be stopped. d. Solids should be offered only three times a day.

ANS: B Down syndrome children have a protruding tongue which can interfere with feeding, especially of solid foods. Parents need to know that the tongue thrust is not an indication of refusal to feed but a physiologic response. Parents are advised to use a small but long, straight-handled spoon to push the food toward the back and side of the mouth. If food is thrust out, it should be re-fed. Six months is the time to introduce solid foods to a child, so waiting 2 to 3 months is inappropriate. Small frequent feedings should be initiated to prevent the child from tiring. Three times a day is too infrequent.

Which consideration is the most important in managing tuberculosis (TB) in children? a. Skin testing annually b. Pharmacotherapy c. Adequate nutrition d. Adequate hydration

ANS: B Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and two or three times a week for the remaining 4 months. Pharmacotherapy is the most important intervention for TB.

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

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

Which predisposes the adolescent to feel an increased need for sleep? a. An inadequate diet b. Rapid physical growth c. Decreased activity that contributes to a feeling of fatigue d. The lack of ambition typical of this age group

ANS: B During growth spurts, the need for sleep increases. Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contribute to fatigue.

Which statement best describes fear in the school-age child? a. They are increasingly fearful for body safety. b. Most of the new fears that trouble them are related to school and family. c. They should be encouraged to hide their fears to prevent ridicule by peers. d. Those who have numerous fears need continuous protective behavior by parents to eliminate these fears.

ANS: B During the school-age years, children experience a wide variety of fears, but new fears relate predominantly to school and family. During the middle-school years, children become less fearful for body safety than they were as preschoolers. Parents and other persons involved with children should discuss children's fears with them individually or as a group activity. Sometimes school-age children hide their fears to avoid being teased. Hiding their fears does not end them and may lead to phobias.

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

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

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

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

A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. Initial therapeutic approach to the mother should be: a. restating what the physician has told her about plastic surgery. b. encouraging her to express her feelings. c. emphasizing the normalcy of her baby and the baby's need for mothering. d. recognizing that negative feelings toward the child continue throughout childhood.

ANS: B For parents, cleft lip and cleft palate deformities are particularly disturbing. The nurse must place emphasize not only the infant's physical needs but also the parents' emotional needs. The mother needs to be able to express her feelings before she can accept her child. Although the nurse will restate what the physician has told the mother about plastic surgery, it is not part of the initial therapeutic approach. As the mother expresses her feelings, the nurse's actions should convey to the parents that the infant is a precious human being. The nurse emphasizes the child's normalcy and helps the mother recognize the child's uniqueness. Maternal-infant attachment was not negatively affected at age 1 year.

Which is a clinical manifestation of acetaminophen poisoning? a. Hyperpyrexia b. Hepatic involvement c. Severe burning pain in stomach d. Drooling and inability to clear secretions

ANS: B Hepatic involvement is the third stage of acetaminophen poisoning. Hyperpyrexia is a severe elevation in body temperature and is not related to acetaminophen poisoning. Acetaminophen does not cause burning pain in stomach or pose an airway threat.

Pyloric stenosis can best be described as: a. dilation of the pylorus. b. hypertrophy of the pyloric muscle. c. hypotonicity of the pyloric muscle. d. reduction of tone in the pyloric muscle.

ANS: B Hypertrophic pyloric stenosis occurs when the circumferential muscle of the pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric channel. Dilation of the pylorus, hypotonicity of the pyloric muscle, and reduction of tone in the pyloric muscle are not the definition of pyloric stenosis.

The nurse is assessing a child with acute epiglottitis. Examining the child's throat by using a tongue depressor might precipitate which symptom or condition? a. Inspiratory stridor b. Complete obstruction c. Sore throat d. Respiratory tract infection

ANS: B If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place. Stridor is aggravated when a child with epiglottitis is supine. Sore throat and pain on swallowing are early signs of epiglottitis. Epiglottitis is caused by H. influenzae in the respiratory tract.

Which position should the nurse place a 10-year-old child after a large tumor was removed through a supratentorial craniotomy? a. On the inoperative side with the bed flat b. On the inoperative side with the head of bed elevated 20 to 30 degrees c. On the operative side with the bed flat and pillows behind the head d. On the operative side with the head of bed elevated 45 degrees

ANS: B If a large tumor was removed, the child is not placed on the operative side because the brain may suddenly shift to that cavity, causing trauma to the blood vessels, linings, and the brain itself. The child with an infratentorial procedure is usually positioned on either side with the bed flat. When a supratentorial craniotomy is performed, the head of bed is elevated 20 to 30 degrees with the child on either side or on the back. In a supratentorial craniotomy, the head elevation facilitates CSF drainage and decreases excessive blood flow to the brain to prevent hemorrhage. Pillows should be placed against the child's back, not head, to maintain the desired position.

The nurse is planning to prepare a 4-year-old child for some diagnostic procedures. Guidelines for preparing this preschooler should include which action? a. Plan for a short teaching session of about 30 minutes. b. Tell the child that procedures are never a form of punishment. c. Keep equipment out of the child's view. d. Use correct scientific and medical terminology in explanations.

ANS: B Illness and hospitalization may be viewed as punishment in preschoolers. Always state directly that procedures are never a form of punishment. Teaching sessions for this age group should be 10 to 15 minutes in length. Demonstrate the use of equipment, and allow the child to play with miniature or actual equipment. Explain procedure in simple terms and how it affects the child.

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

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

Cardiopulmonary resuscitation (CPR) is begun on a toddler. Which pulse is usually palpated because it is the most central and accessible? a. Radial b. Carotid c. Femoral d. Brachial

ANS: B In a toddler, the carotid pulse is palpated. The radial pulse is not considered a central pulse. The femoral pulse is not the most central and accessible. Brachial pulse is felt in infants younger than 1 year.

The nurse is teaching a group of 10- to 12-year-old children about physical development during the school-age years. Which statement made by a participant, indicates the correct understanding of the teaching? a. "My body weight will be almost triple in the next few years." b. "I will grow an average of 2 inches per year from this point on." c. "There are not that many physical differences among school-age children." d. "I will have a gradual increase in fat, which may contribute to a heavier appearance."

ANS: B In middle childhood, growth in height and weight occurs at a slower pace. Between the ages of 6 and 12 years, children grow 2 inches per year. In middle childhood, children's weight will almost double; they gain 3 kg/year. At the end of middle childhood, girls grow taller and gain more weight than boys. Children take on a slimmer look with longer legs in middle childhood.

A 2-year-old child comes to the emergency department with dehydration and hypovolemic shock. Which best explains why an intraosseous infusion is started? a. It is less painful for small children. b. Rapid venous access is not possible. c. Antibiotics must be started immediately. d. Long-term central venous access is not possible.

ANS: B In situations in which rapid establishment of systemic access is vital and venous access is hampered, such as peripheral circulatory collapse and hypovolemic shock, intraosseous infusion provides a rapid, safe, lifesaving alternative. The procedure is painful, and local anesthetics and systemic analgesics are given. Antibiotics could be given when vascular access is obtained. Long-term central venous access is time-consuming, and intraosseous infusion is used in an emergency situation.

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

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

In preparing to give "enemas until clear" to a young child, the nurse should select which solution? a. Tap water b. Normal saline c. Oil retention d. Fleet solution

ANS: B Isotonic solutions should be used in children. Saline is the solution of choice. Plain water is not used. This is a hypotonic solution and can cause rapid fluid shift, resulting in fluid overload. Oil-retention enemas will not achieve the "until clear" result. Fleet enemas are not advised for children because of the harsh action of the ingredients. The osmotic effects of the Fleet enema can result in diarrhea, which can lead to metabolic acidosis.

Enemas are ordered to empty the bowel preoperatively for a child with Hirschsprung disease. The enema solution should be: a. tap water. b. normal saline. c. oil retention. d. phosphate preparation.

ANS: B Isotonic solutions should be used in children. Saline is the solution of choice. Plain water is not used. This is a hypotonic solution and can cause rapid fluid shift, resulting in fluid overload. Oil-retention enemas will not achieve the "until clear" result. Phosphate enemas are not advised for children because of the harsh action of the ingredients. The osmotic effects of the phosphate enema can result in diarrhea, which can lead to metabolic acidosis.

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

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

A nurse is assessing a child and notes Koplik spots. In which of these communicable diseases are Koplik spots present? a. Rubella b. Measles (rubeola) c. Chickenpox (varicella) d. Exanthema subitum (roseola)

ANS: B Koplik spots are small irregular red spots with a minute, bluish white center found on the buccal mucosa 2 days before systemic rash. Rubella occurs with rash on the face, which rapidly spreads downward. Varicella appears with highly pruritic macules, followed by papules and vesicles. Roseola is seen with rose-pink macules on the trunk, spreading to face and extremities.

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include: a. forcing fluids. b. monitoring pulse oximetry. c. instituting seizure precautions. d. encouraging a high-protein diet.

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

When taking the history of a child hospitalized with Reye syndrome, the nurse should not be surprised that a week ago the child had recovered from: a. measles. b. varicella. c. meningitis. d. hepatitis.

ANS: B Most cases of Reye syndrome follow a common viral illness such as varicella or influenza. Measles, meningitis, and hepatitis are not associated with Reye syndrome.

An adolescent has been diagnosed with lactose maldigestion intolerance. The nurse teaches the adolescent about lactose maldigestion intolerance and notes the teen needs further teaching if which statement is made? a. "I will limit my milk consumption to one to two glasses a day." b. "I should drink the milk alone and not with other foods." c. "Hard cheese, cottage cheese, or yogurt can be substituted for milk." d. "I will take a calcium supplement daily."

ANS: B Most people are able to tolerate small amounts of lactose ( 1 cup of milk per day) even in the presence of deficient lactase activity. It is recommended that individuals with lactose maldigestion who do not experience lactose intolerance symptoms continue to consume small amounts of dairy products with meals to prevent reduced bone mass density and subsequent osteoporosis. Hard cheese, cottage cheese, and yogurt are sources of lactose that may be better tolerated. A calcium supplement should be taken daily. Milk taken at meals may be better tolerated than when taken alone.

A child with cystic fibrosis (CF) is receiving recombinant human deoxyribonuclease (DNase). Which is an adverse effect of this medication? a. Mucus thickens b. Voice alters c. Tachycardia d. Jitteriness

ANS: B One of the only adverse effects of DNase is voice alterations and laryngitis. DNase decreases viscosity of mucus, is given in an aerosolized form, and is safe for children younger than 12 years. 2 agonists can cause tachycardia and jitteriness.

A nurse is conducting parenting classes for parents of adolescents. Which parenting style should the nurse recommend? a. Laissez-faire b. Authoritative c. Disciplinarian d. Confrontational

ANS: B Parents should be guided toward an authoritative style of parenting in which authority is used to guide the adolescent while allowing developmentally appropriate levels of freedom and providing clear, consistent messages regarding expectations. The authoritative style of parenting has been shown to have both immediate and long-term protective effects toward adolescent risk reduction. The laissez-faire method would not give adolescents enough structure. The disciplinarian and confrontational styles would not allow any autonomy or independence.

A teen asks a nurse, "What is physical dependence in substance abuse?" Which is the correct response by the nurse? a. Problem that occurs in conjunction with addiction b. Involuntary physiologic response to drug c. Culturally defined use of drugs for purposes other than accepted medical purposes d. Voluntary behavior based on psychosocial needs

ANS: B Physical dependence is an involuntary response to the pharmacologic characteristics of drugs such as opioids or alcohol. A person can be physically dependent on a narcotic/drug without being addicted; for example, patients who use opioids to control pain need increasing doses to achieve the same effect. Dependence is a physiologic response; it is not culturally determined or subject to voluntary control.

A school nurse observes school-age children playing at recess. Which is descriptive of the play the nurse expects to observe? a. Individuality in play is better tolerated than at earlier ages. b. Knowing the rules of a game gives an important sense of belonging. c. They like to invent games, making up the rules as they go. d. Team play helps children learn the universal importance of competition and winning.

ANS: B Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age, children begin to see the need for rules. Conformity and ritual permeate their play. Their games have fixed and unvarying rules, which may be bizarre and extraordinarily rigid. With team play, children learn about competition and the importance of winning, an attribute highly valued in the United States.

Using knowledge of child development, which is the best approach when preparing a toddler for a procedure? a. Avoid asking the child to make choices. b. Demonstrate the procedure on a doll. c. Plan for teaching session to last about 20 minutes. d. Show necessary equipment without allowing child to handle it.

ANS: B Prepare toddlers for procedures by using play. Demonstrate on a doll, but avoid the child's favorite doll because the toddler may think the doll is really "feeling" the procedure. In preparing a toddler for a procedure, allow the child to participate in care and help whenever possible. Teaching sessions for toddlers should be about 5 to 10 minutes. Use a small replica of the equipment, and allow the child to handle it.

Parents of a twelve-year-old child ask the clinic nurse, "How many hours of sleep should our child get?' The nurse should respond that 12-year-old children need how many hours of sleep at night? a. 8 b. 9 c. 10 d. 11

ANS: B School-age children usually do not require naps, but they do need to sleep approximately 11 hours at age 5 years and 9 hours at age 12 years each night.

A school nurse is performing hearing screening on school children. The nurse recognizes that distortion of sound and problems in discrimination are characteristic of which type of hearing loss? a. Conductive b. Sensorineural c. Mixed conductive-sensorineural d. Central auditory imperceptive

ANS: B Sensorineural hearing loss, also known as perceptive or nerve deafness, involves damage to the inner ear structures or the auditory nerve. It results in the distortion of sounds and problems in discrimination. Conductive hearing loss involves mainly interference with loudness of sound. Mixed conductive-sensorineural hearing loss manifests as a combination of both sensorineural and conductive loss. Central auditory imperceptive hearing loss includes all hearing losses that do not demonstrate defects in the conduction or sensory structures.

A 3-month-old infant dies shortly after arrival to the emergency department. The infant has subdural and retinal hemorrhages but no external signs of trauma. The nurse should suspect: a. unintentional injury. b. shaken-baby syndrome. c. sudden infant death syndrome (SIDS). d. congenital neurologic problem.

ANS: B Shaken-baby syndrome causes internal bleeding but may have no external signs. Unintentional injury would not cause these injuries. SIDS and congenital neurologic problems would not appear this way.

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

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

Smokeless tobacco is: a. not addicting. b. proven to be carcinogenic. c. easy to stop using. d. a safe alternative to cigarette smoking.

ANS: B Smokeless tobacco is a popular substitute for cigarettes and poses serious health hazards to children and adolescents. Smokeless tobacco is associated with cancer of the mouth and jaw. The nicotine in the smokeless tobacco is addicting, and therefore it is very difficult to quit. Because the product is addicting and can cause cancer, it is not a safe alternative to cigarette smoking.

An adolescent tells the school nurse that she is pregnant. Her last menstrual period was 4 months ago. She has not received any medical care. She smokes but denies any other substance use. The priority nursing action is to: a. notify her parents. b. refer for prenatal care. c. explain the importance of not smoking. d. discuss dietary needs for adequate fetal growth.

ANS: B Teenage girls and their unborn children are at greater risk for complications during pregnancy and delivery. With improved therapies, the mortality for teenage pregnancy is decreasing, but the morbidity is high. A pregnant teenager needs careful assessment by the nurse to determine the level of social support available to her and possibly her partner. Guidance from the adults in her life would be invaluable, but confidentiality should be maintained. Although it is important to explain the importance of not smoking and to discuss dietary needs for adequate fetal growth, because of her potential for having a high-risk pregnancy, she will need a comprehensive prenatal program to minimize maternal-fetal complications.

Several types of long-term central venous access devices are used. Which is considered an advantage of a Hickman-Broviac catheter? a. No need to keep exit site dry b. Easy to use for self-administered infusions c. Heparinized only monthly and after each infusion d. No limitations on regular physical activity, including swimming

ANS: B The Hickman-Broviac catheter has several benefits, including that it is easy to use for self-administered infusions. The exit site must be kept dry to decrease risk of infection. The Hickman-Broviac catheter requires daily heparin flushes. Water sports may be restricted because of risk of infection.

A child is receiving total parenteral nutrition (TPN; hyperalimentation). At the end of 8 hours, the nurse observes the solution and notes that 200 ml/8 hr is being infused rather than the ordered amount of 300 ml/8 hr. The nurse should adjust the rate so that how much will infuse during the next 8 hours? a. 200 ml b. 300 ml c. 350 ml d. 400 ml

ANS: B The TPN infusion rate should not be increased or decreased without the practitioner being informed because alterations in rate can cause hyperglycemia or hypoglycemia. Any changes from the prescribed flow rate may lead to hyperglycemia or hypoglycemia.

The nurse should suspect a hearing impairment in an infant who demonstrates which behavior? a. Absence of the Moro reflex b. Absence of babbling by age 7 months c. Lack of eye contact when being spoken to d. Lack of gesturing to indicate wants after age 15 months

ANS: B The absence of babbling or inflections in voice by age 7 months is an indication of hearing difficulties. The absence of the Moro reflex and eye contact when being spoken to does not indicate a hearing impairment. The child with hearing impairment uses gestures rather than vocalizations to express desires at this age.

Appropriate interventions to facilitate socialization of the cognitively impaired child include: a. providing age-appropriate toys and play activities. b. providing peer experiences, such as scouting, when older. c. avoiding exposure to strangers who may not understand cognitive development. d. emphasizing mastery of physical skills because they are delayed more often than verbal skills.

ANS: B The acquisition of social skills is a complex task. Children of all ages need peer relationships. Parents should enroll the child in preschool. When older, they should have peer experiences similar to those of other children such as group outings, Boy and Girl Scouts, and Special Olympics. It is important to provide age-appropriate toys and play activities, but peer interactions will facilitate social development. Parents should expose the child to strangers so that the child can practice social skills. Verbal skills are delayed more than physical skills.

Which is an important nursing consideration when performing a bladder catheterization on a young boy? a. Clean technique, not standard precautions, is needed. b. Insert 2% lidocaine lubricant into the urethra. c. Lubricate catheter with water-soluble lubricant such as K-Y Jelly. d. Delay catheterization for 20 minutes while anesthetic lubricant is absorbed.

ANS: B The anxiety, fear, and discomfort experienced during catheterization can be significantly decreased by preparation of the child and parents, by selection of the correct catheter, and by appropriate technique of insertion. Generous lubrication of the urethra before catheterization and use of lubricant containing 2% lidocaine may reduce or eliminate the burning and discomfort associated with this procedure. Catheterization is a sterile procedure, and standard precautions for body-substance protection should be followed. Water-soluble lubricants do not provide appropriate local anesthesia. Catheterization should be delayed 2 to 3 minutes only. This provides sufficient local anesthesia for the procedure.

A school nurse is teaching a group of preadolescent girls about puberty. Which is the mean age of menarche for girls in the United States? a. 11 1/2 years b. 12 3/4 years c. 13 1/2 years d. 14 years

ANS: B The average age of menarche is 12 years 9.5 months in North American girls, with a normal range of 10 1/2 to 15 years. Ages 11 1/2, 13 1/2, and 14 are within the normal range for menarche, but these are not the average ages.

The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. Which is appropriate to relieve the abdominal discomfort? a. Place in Trendelenburg position. b. Allow to assume position of comfort. c. Apply moist heat to the abdomen. d. Administer a saline enema to cleanse bowel.

ANS: B The child should be allowed to take a position of comfort, usually with the legs flexed. The Trendelenburg position will not help with the discomfort. In any instance in which appendicitis is a possibility, there is a danger in administering a laxative or enemas or applying heat to the area. Such measures stimulate bowel motility and increase the risk of perforation.

A 5-year-old boy is being prepared for surgery to remove a brain tumor. Nursing actions should be based on which statement? a. Removal of tumor will stop the various symptoms. b. Usually the postoperative dressing covers the entire scalp. c. He is not old enough to be concerned about his head being shaved. d. He is not old enough to understand the significance of the brain.

ANS: B The child should be told what he will look and feel like after surgery. This includes the size of the dressing. The nurse can demonstrate on a doll the expected size and shape of the dressing. Some of the symptoms may be alleviated by the removal of the tumor, but postsurgical headaches and cerebellar symptoms such as ataxia may be aggravated. Children should be prepared for the loss of their hair, and it should be removed in a sensitive, positive manner if the child is awake. Children at this age have poorly defined body boundaries and little knowledge of internal organs. Intrusive experiences are frightening, especially those that disrupt the integrity of the skin.

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

ANS: B The family's presence will decrease the child's distress. It is true that mothers of hospitalized toddlers often experience guilt but this is not the best answer. The main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort. The child should have constant monitoring by cardiorespiratory monitor and noninvasive oxygen saturation monitoring, but the parent should not play this role in the hospital.

A mother who intended to breastfeed has given birth to an infant with a cleft palate. Nursing interventions should include: a. giving medication to suppress lactation. b. encouraging and helping mother to breastfeed. c. teaching mother to feed breast milk by gavage. d. recommending use of a breast pump to maintain lactation until infant can suck.

ANS: B The mother who wishes to breastfeed may need encouragement and support because the defect does present some logistical issues. The nipple must be positioned and stabilized well back in the infant's oral cavity so that the tongue action facilitates milk expression. Because breastfeeding is an option, if the mother wishes to breastfeed, medications should not be given to suppress lactation. Because breastfeeding can usually be accomplished, gavage feedings are not indicated. The suction required to stimulate milk, absent initially, may be useful before nursing to stimulate the let-down reflex.

A venipuncture will be performed on a 7-year-old girl. She wants her mother to hold her during the procedure. The nurse should recognize that this behavior is: a. unsafe. b. helpful to relax the child. c. against hospital policy. d. unnecessary because of child's age.

ANS: B The mother's preference for assisting, observing, or waiting outside the room should be assessed along with the child's preference for parental presence. The child's choice should be respected. This will most likely help the child through the procedure. If the mother and child agree, then the mother is welcome to stay. Her familiarity with the procedure should be assessed and potential safety risks identified (mother may sit in chair). Hospital policies should be reviewed to ensure that they incorporate family-centered care. The child should determine whether parental support is necessary.

Guidelines for intramuscular administration of medication in school-age children include which action? a. Inject medication as rapidly as possible. b. Insert needle quickly, using a dartlike motion. c. Penetrate skin immediately after cleansing site, before skin has dried. d. Have child stand, if possible, and if child is cooperative.

ANS: B The needle should be inserted quickly in a dartlike motion at a 90-degree angle unless contraindicated. Inject medications slowly. Allow skin preparation to dry completely before skin is penetrated. Place child in lying or sitting position.

The nurse has received report on four children. Which child should the nurse assess first? a. A school-age child in a coma with stable vital signs b. A preschool child with a head injury and decreasing level of consciousness c. An adolescent admitted after a motor vehicle accident is oriented to person and place d. A toddler in a persistent vegetative state with a low-grade fever

ANS: B The nurse should assess the child with a head injury and decreasing level of consciousness first (LOC). Assessment of LOC remains the earliest indicator of improvement or deterioration in neurologic status. The next child the nurse should assess is a toddler in a persistent vegetative state with a low-grade fever. The school-age child in a coma with stable vital signs and the adolescent admitted to the hospital who is oriented to his surroundings would be of least worry to the nurse.

The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes which intervention? a. Apply a regular eye patch. b. Apply a Fox shield to affected eye and any type of patch to the other eye. c. Apply ice until the physician is seen. d. Irrigate eye copiously with a sterile saline solution.

ANS: B The nurse's role in a penetrating eye injury is to prevent further injury to the eye. A Fox shield (if available) should be applied to the injured eye and a regular eye patch to the other eye to prevent bilateral movement. It may cause more damage to the eye to apply a regular eye patch, apply ice until the physician is seen, or irrigate the eye copiously with a sterile saline solution.

The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. The nurse should interpret this as: a. eye trauma. b. neurosurgical emergency. c. severe brainstem damage. d. indication of brain death.

ANS: B The sudden appearance of a fixed and dilated pupil(s) is a neurosurgical emergency. The nurse should immediately report this finding. Although a dilated pupil may be associated with eye trauma, this child has experienced a neurologic insult. Pinpoint pupils or bilateral fixed pupils for more than 5 minutes are indicative of brainstem damage. The unilateral fixed and dilated pupil is suggestive of damage on the same side of the brain. One fixed and dilated pupil is not suggestive of brain death.

The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include: a. arm restraints, postural drainage, mouth irrigations. b. cleansing the suture line, supine and side-lying positions, arm restraints. c. mouth irrigations, prone position, cleansing suture line. d. supine and side-lying positions, postural drainage, arm restraints.

ANS: B The suture line should be cleansed gently after feeding. The child should be positioned on the back, on the side, or in an infant seat. Elbows are restrained to prevent the child from accessing the operative site. Postural drainage is not indicated. This would increase the pressure on the operative site when the child is placed in different positions. There is no reason to perform mouth irrigations, and the child should not be placed in the prone position where injury to the suture site can occur.

Which is the usual presenting symptom for testicular cancer? a. Hard, painful mass b. Hard, painless mass c. Epididymis easily palpated d. Scrotal swelling and pain

ANS: B The usual presenting symptom for testicular cancer is a heavy, hard, painless mass that is either smooth or nodular and palpated on the testes. A hard, painful mass, an epididymis easily palpated, and scrotal swelling and pain are not the clinical presentations of testicular cancer.

A newborn assessment shows separated sagittal suture, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. These findings are most suggestive of: a. microcephaly. b. Down syndrome. c. cerebral palsy. d. fragile X syndrome.

ANS: B These are characteristics associated with Down syndrome. The infant with microcephaly has a small head. Cerebral palsy is a diagnosis not usually made at birth. No characteristic physical signs are present. The infant with fragile X syndrome has increased head circumference; long, wide, and/or protruding ears; long, narrow face with prominent jaw; hypotonia; and high arched palate.

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

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

According to Erikson, the psychosocial task of adolescence is developing: a. intimacy. b. identity. c. initiative. d. independence.

ANS: B Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. Intimacy is the developmental stage for early adulthood. Independence is not one of Erikson's developmental stages.

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

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

Which syndrome involves a common sex chromosome defect? a. Down b. Turner c. Marfan d. Hemophilia

ANS: B Turner syndrome is caused by an absence of one of the X chromosomes. Down syndrome is caused by trisomy 21, three copies rather than two copies of chromosome 21. Marfan syndrome is a connective tissue disorder inherited in an autosomal dominant pattern. Hemophilia is a disorder of blood coagulation inherited in an X-linked recessive pattern.

Which vaccine is now recommended for the immunization of all newborns? a. Hepatitis A vaccine b. Hepatitis B vaccine c. Hepatitis C vaccine d. Hepatitis A, B, and C vaccines

ANS: B Universal vaccination for hepatitis B is now recommended for all newborns. A vaccine is available for hepatitis A, but it is not yet universally recommended. No vaccine is currently available for hepatitis C. Only hepatitis B vaccine is recommended for newborns.

The vector reservoir for agents causing viral encephalitis in the United States is: a. tarantula spiders. b. mosquitoes. c. carnivorous wild animals. d. domestic and wild animals.

ANS: B Viral encephalitis, not attributable to a childhood viral disease, is usually transmitted by mosquitoes. The vector reservoir for most agents pathogenic for humans and detected in the United States are mosquitoes and ticks; therefore, most cases of encephalitis appear during the hot summer months. Tarantula spiders, carnivorous wild animals, and domestic and wild animals are not reservoirs for the agents that cause viral encephalitis.

A nurse is admitting an infant with asthma. The nurse understands that asthma in infants is usually triggered by: a. medications. b. a viral infection. c. exposure to cold air. d. allergy to dust or dust mites.

ANS: B Viral illnesses cause inflammation that causes increased airway reactivity in asthma. Medications such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics may aggravate asthma, but not frequently in infants. Exposure to cold air may exacerbate already existing asthma. Allergy is associated with asthma, but 20% to 40% of children with asthma have no evidence of allergic disease.

When teaching injury prevention during the school-age years, what should the nurse include? a. Teach children to fear strangers. b. Teach basic rules of water safety. c. Avoid letting child cook in microwave ovens. d. Caution child against engaging in competitive sports.

ANS: B Water safety instruction is an important source of injury prevention at this age. The child should be taught to swim, select safe and supervised places to swim, swim with a companion, check for sufficient water depth before diving, and use an approved flotation device. Teach stranger safety, not fear of strangers. This includes instructing children to not go with strangers, not wear personalized clothing in public places, tell parents if anyone makes child feel uncomfortable, and say "no" in uncomfortable situations. Teach child safe cooking. Caution against engaging in hazardous sports such as those involving trampolines.

A nurse is teaching parents about caring for their child with chickenpox. The nurse should let the parents know that the child is considered to be no longer contagious when which occurs? a. When fever is absent b. When lesions are crusted c. 24 hours after lesions erupt d. 8 days after onset of illness

ANS: B When the lesions are crusted, the chickenpox is no longer contagious. This may be a week after onset of disease. Chickenpox is still contagious when child has fever. Children are contagious after lesions erupt. If lesions are crusted at 8 days, the child is no longer contagious.

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

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

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

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

A nurse teaches parents that team play is important for school-age children. Which can children develop by experiencing team play? (Select all that apply.) a. Achieve personal goals over group goals. b. Learn complex rules. c. Experience competition. d. Learn about division of labor.

ANS: B, C, D Team play helps stimulate cognitive growth because children are called on to learn many complex rules, make judgments about those rules, plan strategies, and assess the strengths and weaknesses of members of their own team and members of the opposing team. Team play can also contribute to children's social, intellectual, and skill growth. Children work hard to develop the skills needed to become team members, to improve their contribution to the group, and to anticipate the consequences of their behavior for the group. Team play teaches children to modify or exchange personal goals for goals of the group; it also teaches them that division of labor is an effective strategy for attaining a goal.

Which is true concerning hepatitis B? (Select all that apply.) a. Hepatitis B cannot exist in carrier state. b. Hepatitis B can be prevented by HBV vaccine. c. Hepatitis B can be transferred to an infant of a breastfeeding mother. d. Onset of hepatitis B is insidious. e. Principal mode of transmission for hepatitis B is fecal-oral route. f. Immunity to hepatitis B occurs after one attack.

ANS: B, C, D, F The vaccine elicits the formation of an antibody to the hepatitis B surface antigen, which is protective against hepatitis B. Hepatitis B can be transferred to an infant of a breastfeeding mother, especially if the mother's nipples are cracked. The onset of hepatitis B is insidious. Immunity develops after one exposure to hepatitis B. Hepatitis B has a carrier state. The fecal-oral route is the principal mode of transmission for hepatitis A. Hepatitis B is transmitted through the parenteral route.

A nurse is caring for a school-age child with left unilateral pneumonia and pleural effusion. A chest tube has been inserted to promote continuous closed chest drainage. Which interventions should the nurse implement when caring for this child? (Select all that apply.) a. Positioning child on the right side b. Assessing the chest tube and drainage device for correct settings c. Administering prescribed doses of analgesia d. Clamping the chest tube when child ambulates e. Monitoring for need of supplemental oxygen

ANS: B, C, E Nursing care of the child with a chest tube requires close attention to respiratory status; the chest tube and drainage device used are monitored for proper function (i.e., drainage is not impeded, vacuum setting is correct, tubing is free of kinks, dressing covering chest tube insertion site is intact, water seal is maintained, and chest tube remains in place). Movement in bed and ambulation with a chest tube are encouraged according to the child's respiratory status, but children require frequent doses of analgesia. Supplemental oxygen may be required in the acute phase of the illness and may be administered by nasal cannula, face mask, flow-by, or face tent. The child should be positioned on the left side, not the right. Lying on the affected side if the pneumonia is unilateral ("good lung up") splints the chest on that side and reduces the pleural rubbing that often causes discomfort. The chest tube should never be clamped; this can cause a pneumothorax. The chest tube should be maintained to the underwater seal at all times.

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

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

Which screening tests should the school nurse perform for the adolescent? (Select all that apply.) a. Glucose b. Vision c. Hearing d. Cholesterol e. Scoliosis

ANS: B, C, E The school nurse should perform vision, hearing, and scoliosis screening tests according to the school district's required schedule. Glucose and cholesterol screening would be performed in the medical clinic setting.

Which expected appearance will the nurse explain to parents of an infant returning from surgery after an enucleation was performed to treat retinoblastoma? (Select all that apply.) a. A lot of drainage will come from the affected socket. b. The face may be edematous or ecchymotic. c. The eyelids will be sutured shut for the first week. d. There will be an eye pad dressing taped over the surgical site. e. The implanted sphere is covered with conjunctiva and resembles the lining of the mouth.

ANS: B, D, E After enucleation surgery, the parents are prepared for the child's facial appearance. An eye patch is in place, and the child's face may be edematous or ecchymotic. Parents often fear seeing the surgical site because they imagine a cavity in the skull. A surgically implanted sphere maintains the shape of the eyeball, and the implant is covered with conjunctiva. When the eyelids are open, the exposed area resembles the mucosal lining of the mouth. The dressing, consisting of an eye pad taped over the surgical site, is changed daily. The wound itself is clean and has little or no drainage. So expecting a lot of drainage is not accurate to tell parents. The eyelids are not sutured shut after enucleation surgery.

Which strategies should the school nurse recommend implementing in the classroom for a child with attention deficit hyperactive disorder (ADHD)? (Select all that apply.) a. Schedule heavier subjects to be taught in the afternoon. b. Accompany verbal instructions by written format. c. Limit number of breaks taken during instructional periods. d. Allow more time for testing. e. Reduce homework and classroom assignments.

ANS: B, D, E Children with ADHD need an orderly, predictable, and consistent classroom environment with clear and consistent rules. Homework and classroom assignments may need to be reduced, and more time may need to be allotted for tests to allow the child to complete the task. Verbal instructions should be accompanied by visual references such as written instructions on the blackboard. Schedules may need to be arranged so that academic subjects are taught in the morning when the child is experiencing the effects of the morning dose of medication. Regular and frequent breaks in activity are helpful because sitting in one place for an extended time may be difficult.

The nurse is preparing to care for an infant returning from pyloromyotomy surgery. Which prescribed orders should the nurse anticipate implementing? (Select all that apply.) a. NPO for 24 hours b. Administration of analgesics for pain c. Ice bag to the incisional area d. IV fluids continued until tolerating PO e. Clear liquids as the first feeding

ANS: B, D, E Feedings are usually instituted soon after a pyloromyotomy surgery, beginning with clear liquids advancing to formula or breast milk as tolerated. IV fluids are administered until the infant is taking and retaining adequate amounts by mouth. Appropriate analgesics should be given around the clock because pain is continuous. Ice should not be applied to the incisional area as it vasoconstricts and would reduce circulation to the incisional area and impair healing.

The nurse is monitoring an infant for signs of increased intracranial pressure (ICP). Which are late signs of increased intracranial pressure (ICP) in an infant? (Select all that apply.) a. Tachycardia b. Alteration in pupil size and reactivity c. Increased motor response d. Extension or flexion posturing e. Cheyne-Stokes respirations

ANS: B, D, E Late signs of ICP in an infant or child include bradycardia, alteration in pupil size and reactivity, decreased motor response, extension or flexion posturing, and Cheyne-Stokes respirations.

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

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

When assessing the eyes of a neonate, the nurse observes opacity of the lens. This represents which impairment? a. Blindness b. Glaucoma c. Cataracts d. Retinoblastoma

ANS: C A cataract is opacity of the lens of the eye. The child may have visual impairment secondary to the cataract, but the opacity is a cataract. Glaucoma is increased intraocular pressure. Retinoblastoma is a tumor of the eye.

The nurse is planning care for an 8-year-old child with a concussion. Which is descriptive of a concussion? a. Petechial hemorrhages cause amnesia. b. Visible bruising and tearing of cerebral tissue occur. c. It is a transient and reversible neuronal dysfunction. d. A slight lesion develops remotely from the site of trauma.

ANS: C A concussion is a transient, reversible neuronal dysfunction with instantaneous loss of awareness and responsiveness resulting from trauma to the head. Petechial hemorrhages along the superficial aspects of the brain along the point of impact are a type of contusion, but are not necessarily associated with amnesia. A contusion is visible bruising and tearing of cerebral tissue. Contrecoup is a lesion that develops remote from the site of trauma as a result of an acceleration-deceleration injury

The nurse is caring for an unconscious child. Skin care should include which action? a. Avoid use of pressure reduction on bed. b. Massage reddened bony prominences to prevent deep tissue damage. c. Use draw sheet to move child in bed to reduce friction and shearing injuries. d. Avoid rinsing skin after cleansing with mild antibacterial soap to provide a protective barrier.

ANS: C A draw sheet should be used to move the child in the bed or onto a gurney to reduce friction and shearing injuries. Do not drag the child from under the arms. Pressure-reduction devices should be used to redistribute weight. Bony prominences should not be massaged if reddened. Deep tissue damage can occur. Pressure-reduction devices should be used instead. The skin should be cleansed with mild nonalkaline soap or soap-free cleaning agents for routine bathing.

A child has been seizure-free for 2 years. A father asks the nurse how much longer the child will need to take the antiseizure medications. The nurse includes which intervention in the response? a. Medications can be discontinued at this time. b. The child will need to take the drugs for 5 years after the last seizure. c. A step-wise approach will be used to reduce the dosage gradually. d. Seizure disorders are a lifelong problem. Medications cannot be discontinued.

ANS: C A predesigned protocol is used to wean a child gradually off antiseizure medications, usually when the child is seizure-free for 2 years and has a normal electroencephalogram (EEG). Medications must be gradually reduced to minimize the recurrence of seizures. Seizure medications can be safely discontinued. The risk of recurrence is greatest within the first year.

The single parent of a 3-year-old child who has just been diagnosed with chickenpox tells the nurse that she cannot afford to stay home with the child and miss work. The parent asks the nurse if some medication will shorten the course of the illness. Which is the most appropriate nursing intervention? a. Reassure the parent that it is not necessary to stay home with the child. b. Explain that no medication will shorten the course of the illness. c. Explain the advantages of the medication acyclovir (Zovirax) to treat chickenpox. d. Explain the advantages of the medication VCZ immune globulin (VariZIG) to treat chickenpox.

ANS: C Acyclovir is effective in treating the number of lesions; shortening the duration of fever; and decreasing itching, lethargy, and anorexia. It is important the parent stay with the child to monitor fever. Acyclovir lessens the severity of chickenpox. VariZIG is given only to high-risk children.

A nurse is caring for an adolescent hospitalized for cellulitis. The nurse notes that the adolescent experiences many "mood swings" throughout the day. The nurse interprets this behavior as: a. requiring a referral to a mental health counselor. b. requiring some further lab testing. c. normal behavior. d. related to feelings of depression.

ANS: C Adolescents vacillate in their emotional states between considerable maturity and childlike behavior. One minute they are exuberant and enthusiastic; the next minute they are depressed and withdrawn. Because of these mood swings, adolescents are frequently labeled as unstable, inconsistent, and unpredictable, but the behavior is normal. The behavior would not require a referral to a mental health counselor or further lab testing. The mood swings do not indicate depression.

The nurse is discussing sexuality with the parents of an adolescent girl with moderate cognitive impairment. Which should the nurse consider when dealing with this issue? a. Sterilization is recommended for any adolescent with cognitive impairment. b. Sexual drive and interest are limited in individuals with cognitive impairment. c. Individuals with cognitive impairment need a well-defined, concrete code of sexual conduct. d. Sexual intercourse rarely occurs unless the individual with cognitive impairment is sexually abused.

ANS: C Adolescents with moderate cognitive impairment may be easily persuaded and lack judgment. A well-defined, concrete code of conduct with specific instructions for handling certain situations should be laid out for the adolescent. Permanent contraception by sterilization presents moral and ethical issues and may have psychological effects on the adolescent. It may be prohibited in some states. The adolescent needs to have practical sexual information regarding physical development and contraception. Cognitively impaired individuals may desire to marry and have families. The adolescent needs to be protected from individuals who may make intimate advances.

It is generally recommended that a child with acute streptococcal pharyngitis can return to school: a. when sore throat is better. b. if no complications develop. c. after taking antibiotics for 24 hours. d. after taking antibiotics for 3 days.

ANS: C After children have taken antibiotics for 24 hours, they are no longer contagious to other children. Sore throat may persist longer than 24 hours after beginning antibiotic therapy, but the child is no longer considered contagious. Complications may take days to weeks to develop.

A 10-year-old boy on a bicycle has been hit by a car in front of the school. The school nurse immediately assesses airway, breathing, and circulation. The next nursing action: should be to a. place on side. b. take blood pressure. c. stabilize neck and spine. d. check scalp and back for bleeding.

ANS: C After determining that the child is breathing and has adequate circulation, the next action is to stabilize the neck and spine to prevent any additional trauma. The child's position should not be changed until the neck and spine are stabilized. Blood pressure is a later assessment. Less urgent, but an important assessment, is inspection of the scalp for bleeding.

A 3-year-old child is hospitalized after a submersion injury. The child's mother complains to the nurse, "Being at the hospital seems unnecessary when he is perfectly fine." The nurse's best reply should be: a. "He still needs a little extra oxygen." b. "I'm sure he is fine, but the doctor wants to make sure." c. "The reason for this is that complications could still occur." d. "It is important to observe for possible central nervous system problems."

ANS: C All children who have a submersion injury should be admitted to the hospital for observation. Although many children do not appear to have suffered adverse effects from the event, complications such as respiratory compromise and cerebral edema may occur 24 hours after the incident. The mother would not think the child is fine if oxygen were still required. The nurse should clarify that different complications can occur up to 24 hours later and that observations are necessary.

A child is diagnosed with influenza, probably type A disease. Management includes which recommendation? a. Clear liquid diet for hydration b. Aspirin to control fever c. Amantadine hydrochloride (Symmetrel) to reduce symptoms d. Antibiotics to prevent bacterial infection

ANS: C Amantadine hydrochloride may reduce symptoms related to influenza A if administered within 24 to 48 hours of onset. It is ineffective against type B or C. A clear liquid diet is not necessary for influenza, but maintaining hydration is important. Aspirin is not recommended in children because of increased risk of Reye syndrome. Acetaminophen or ibuprofen is a better choice. Preventive antibiotics are not indicated for influenza unless there is evidence of a secondary bacterial infection.

A parent reports to the nurse that her child has inflamed conjunctivae of both eyes with purulent drainage and crusting of the eyelids, especially on awakening. These manifestations suggest: a. viral conjunctivitis. b. allergic conjunctivitis. c. bacterial conjunctivitis. d. conjunctivitis caused by foreign body.

ANS: C Bacterial conjunctivitis has these symptoms. Viral or allergic conjunctivitis has watery drainage. Foreign body causes tearing and pain, and usually only one eye is affected.

A nurse is reviewing hormone changes that occur during adolescence. The hormone that is responsible for the growth of beard, mustache, and body hair in the male is: a. estrogen. b. pituitary. c. androgen. d. progesterone.

ANS: C Beard, mustache, and body hair on the chest, upward along the linea alba, and sometimes on other areas (e.g., back and shoulders) appears in males and is androgen dependent. Estrogen and progesterone are produced by the ovaries in the female and do not contribute to body hair appearance in the male. The pituitary hormone does not have any relationship to body hair appearance in the male.

A nurse is conducting an in-service on childhood gastrointestinal disorders. Which statement is most descriptive of Meckel diverticulum? a. It is more common in females than in males. b. It is acquired during childhood. c. Intestinal bleeding may be mild or profuse. d. Medical interventions are usually sufficient to treat the problem.

ANS: C Bloody stools are often a presenting sign of Meckel diverticulum. It is associated with mild to profuse intestinal bleeding. It is twice as common in males as in females, and complications are more frequent in males. Meckel diverticulum is the most common congenital malformation of the GI tract and is present in 1% to 4% of the general population. The standard therapy is surgical removal of the diverticulum.

Which describes moral development in younger school-age children? a. The standards of behavior now come from within themselves. b. They do not yet experience a sense of guilt when they misbehave. c. They know the rules and behaviors expected of them but do not understand the reasons behind them. d. They no longer interpret accidents and misfortunes as punishment for misdeeds.

ANS: C Children who are ages 6 and 7 years know the rules and behaviors expected of them but do not understand the reasons for these rules and behaviors. Young children do not believe that standards of behavior come from within themselves, but that rules are established and set down by others. Younger school-age children learn standards for acceptable behavior, act according to these standards, and feel guilty when they violate them. Misfortunes and accidents are viewed as punishment for bad acts.

A nurse is preparing to perform a dressing change on a 6-year-old child with mild cognitive impairment (CI) who sustained a minor burn. Which strategy should the nurse use to prepare the child for this procedure? a. Verbally explain what will be done. b. Have the child watch a video on dressing changes. c. Demonstrate a dressing change on a doll. d. Explain the importance of keeping the burn area clean.

ANS: C Children with CI have a marked deficit in their ability to discriminate between two or more stimuli because of difficulty in recognizing the relevance of specific cues. However, these children can learn to discriminate if the cues are presented in an exaggerated, concrete form and if all extraneous stimuli are eliminated. Therefore, demonstration is preferable to verbal explanation, and learning should be directed toward mastering a skill rather than understanding the scientific principles underlying a procedure. Watching a video would require the use of both visual and auditory stimulation and might produce overload in the child with mild cognitive impairment. Explaining the importance of keeping the burn area clean would be too abstract for the child.

The child with Down syndrome should be evaluated for which condition before participating in some sports? a. Hyperflexibility b. Cutis marmorata c. Atlantoaxial instability d. Speckling of iris (Brushfield spots)

ANS: C Children with Down syndrome are at risk for atlantoaxial instability. Before participating in sports that put stress on the head and neck, a radiologic examination should be done. Hyperflexibility, cutis marmorata, and speckling of iris (Brushfield spots) are characteristic of Down syndrome, but they do not affect the child's ability to participate in sports.

An infant is brought to the emergency department with dehydration. Which physical assessment finding does the nurse expect? a. Weight gain b. Bradycardia c. Poor skin turgor d. Brisk capillary refill

ANS: C Clinical manifestations of dehydration include poor skin turgor, weight loss, lethargy, and tachycardia. The infant would have prolonged capillary refill, not brisk.

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

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

When caring for a newborn with Down syndrome, the nurse should be aware that the most common congenital anomaly associated with Down syndrome is: a. hypospadias. b. pyloric stenosis. c. congenital heart disease. d. congenital hip dysplasia.

ANS: C Congenital heart malformations, primarily septal defects, are the most common congenital anomaly in Down syndrome. Hypospadias, pyloric stenosis, and congenital hip dysplasia are not frequent congenital anomalies associated with Down syndrome.

Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies that are being treated with antihistamines. The nurse should suspect that the constipation is most likely caused by: a. diet. b. allergies. c. antihistamines. d. emotional factors.

ANS: C Constipation may be associated with drugs such as antihistamines, antacids, diuretics, opioids, antiepileptics, and iron. Because this is the only known change in her habits, the addition of antihistamines is most likely the cause of the diarrhea. With a change in bowel habits, the role of any recently prescribed medications should be assessed.

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

ANS: C Corticosteroids, such as prednisone and prednisolone, are used in short bursts to suppress the inflammatory response in inflammatory bowel disease. Antacids and antidiarrheal medications are not drugs of choice in the treatment of inflammatory bowel disease. Antibiotics may be used as an adjunctive therapy to treat complications.

A young child's parents call the nurse after their child was bitten by a raccoon in the woods. The nurse's recommendation should be based on which statement? a. Child should be hospitalized for close observation. b. No treatment is necessary if thorough wound cleaning is done. c. Antirabies prophylaxis must be initiated. d. Antirabies prophylaxis must be initiated if clinical manifestations appear.

ANS: C Current therapy for a rabid animal bite consists of a thorough cleansing of the wound and passive immunization with human rabies immune globulin (HRIG) as soon as possible. Hospitalization is not necessary. The wound cleansing, passive immunization, and immune globulin administration can be done as an outpatient. The child needs to receive both HRIG and rabies vaccine.

The nurse is monitoring a 7-year-old child post-surgical resection of an infratentorial brain tumor. Which vital sign findings indicate Cushing's triad? a. Increased temperature, tachycardia, tachypnea b. Decreased temperature, bradycardia, bradypnea c. Bradycardia, hypertension, irregular respirations d. Bradycardia, hypotension, tachypnea

ANS: C Cushing's triad is a hallmark sign of increased intracranial pressure (ICP). The triad includes bradycardia, hypertension, and irregular respirations. Increased or decreased temperature is not a sign of Cushing's triad.

A child has been diagnosed with enuresis. TCA imipramine (Tofranil) has been prescribed for the child. The nurse understands that this medication is in which category? a. Antidepressant b. Antidiuretic c. Antispasmodic d. Analgesic

ANS: C Drug therapy is increasingly being prescribed to treat enuresis. Three types of drugs are used: tricyclic antidepressants (TCAs), antidiuretics, and antispasmodics. The selection depends on the interpretation of the cause. The drug used most frequently is the TCA imipramine (Tofranil), which exerts an anticholinergic action in the bladder to inhibit urination. Tofranil is in the antispasmodic category. Analgesics are not used to treat enuresis.

In some genetically susceptible children, anesthetic agents can trigger malignant hyperthermia. The nurse should be alert in observing that, in addition to an increased temperature, an early sign of this disorder is: a. apnea. b. bradycardia. c. muscle rigidity. d. decreased blood pressure.

ANS: C Early signs of malignant hyperthermia include tachycardia, increasing blood pressure, tachypnea, mottled skin, and muscle rigidity. Apnea is not a sign of malignant hyperthermia. Tachycardia, not bradycardia, is an early sign of malignant hyperthermia. Increased blood pressure, not decreased blood pressure, is characteristic of malignant hyperthermia.

Tepid water or sponge baths are indicated for hyperthermia in children. The nurse's action is to: a. add isopropyl alcohol to the water. b. direct a fan on the child in the bath. c. stop the bath if the child begins to chill. d. continue the bath for 5 minutes.

ANS: C Environmental measures such as sponge baths can be used to reduce temperature if tolerated by the child and if they do not induce shivering. Shivering is the body's way of maintaining the elevated set point. Compensatory shivering increases metabolic requirements above those already caused by the fever. Ice water and isopropyl alcohol are potentially dangerous solutions. Fans should not be used because of the risk of the child developing vasoconstriction, which defeats the purpose of the cooling measures. Little blood is carried to the skin surface, and the blood remains primarily in the viscera to become heated. The child is placed in a tub of tepid water for 20 to 30 minutes.

Which drug is considered the most useful in treating childhood cardiac arrest? a. Bretylium tosylate (Bretylium) b. Lidocaine hydrochloride (Lidocaine) c. Epinephrine hydrochloride (Adrenaline) d. Naloxone (Narcan)

ANS: C Epinephrine works on alpha and beta receptors in the heart and is the most useful drug in childhood cardiac arrest. Bretylium is no longer used in pediatric cardiac arrest management. Lidocaine is used for ventricular arrhythmias only. Naloxone is useful only to reverse effects of opioids.

Vitamin A supplementation may be recommended for the young child who has which disease? a. Mumps b. Rubella c. Measles (rubeola) d. Erythema infectiosum

ANS: C Evidence shows vitamin A decreases morbidity and mortality in measles. Mumps is treated with analgesics for pain and antipyretics for fever. Rubella is treated similarly to mumps. Erythema infectiosum is treated similarly to mumps and rubella.

A child has just been diagnosed with fragile X syndrome. The nurse recognizes that fragile X syndrome is: a. a chromosomal defect affecting females only. b. a chromosomal defect that follows the pattern of X-linked recessive disorders. c. the second most common genetic cause of mental retardation. d. the most common cause of noninherited mental retardation.

ANS: C Fragile X syndrome is the second most common cause of mental retardation after Down syndrome. Fragile X primarily affects males, follows the inheritance pattern of X-linked dominant with reduced penetrance. This is in distinct contrast to the classic X-linked recessive pattern in which all carrier females are normal, all affected males have symptoms of the disorder, and no males are carriers.

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

ANS: C G. lamblia is a parasite that represents 10% of non-dysenteric illness in the United States. Shigella, Salmonella, and E. coli are bacterial pathogens.

A nurse is teaching parents of kindergarten children general guidelines to assist their children in school. Which statement by the parents indicates they understand the teaching? a. "We will only meet with the teacher if problems occur." b. "We will discourage hobbies so our child focuses on school work." c. "We will plan a trip to the library as often as possible." d. "We will expect our child to make all As in school."

ANS: C General guidelines for parents to help their child in school include sharing an interest in reading. The library should be used frequently and books the child is reading should be discussed. Hobbies should be encouraged. The parents should not expect all As. They should focus on growth more than grades.

The most common clinical manifestation(s) of brain tumors in children is/are: a. irritability. b. seizures. c. headaches and vomiting. d. fever and poor fine motor control.

ANS: C Headaches, especially on awakening, and vomiting that is not related to feeding are the most common clinical manifestation(s) of brain tumors in children. Irritability, seizures, and fever and poor fine motor control are clinical manifestations of brain tumors, but headaches and vomiting are the most common.

The school nurse tells adolescents in the clinic that confidentiality and privacy will be maintained unless a life-threatening situation arises. This practice is: a. not appropriate in a school setting. b. never appropriate because adolescents are minors. c. important in establishing trusting relationships. d. suggestive that the nurse is meeting his or her own needs.

ANS: C Health professionals who work with adolescents should consider adolescents' increasing independence and responsibility while maintaining privacy and ensuring confidentiality. However, in some circumstances, such as self-destructive behavior or maltreatment by others, they are not able to maintain confidentiality. Confidentiality and privacy are necessary to build trust with this age group. The nurse must be aware of the limits placed on confidentiality by local jurisdiction.

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

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

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

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

Young people with anorexia nervosa are often described as being: a. independent. b. disruptive. c. conforming. d. low achieving.

ANS: C Individuals with anorexia nervosa are described as perfectionist, academically high achievers, conforming, and conscientious. "Independent," disruptive," and "low achieving" are not part of the behavioral characteristics of anorexia nervosa.

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

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

A nurse is teaching an adolescent how to use the peak expiratory flowmeter. The adolescent has understood the teaching if which statement is made? a. "I will record the average of the readings." b. "I should be sitting comfortably when I perform the readings." c. "I will record the readings at the same time every day." d. "I will repeat the routine two times."

ANS: C Instructions for use of a peak flowmeter include standing up straight before performing the reading, recording the highest of the three readings (not the average), measuring the peak expiratory flow rate (PEFR) close to the same time each day, and repeating the entire routine three times, waiting 30 seconds between each routine.

19. The nurse is explaining to a parent how to care for a school-age child with vomiting associated with a viral illness. Which action should the nurse include? a. Avoid carbohydrate-containing liquids. b. Give nothing by mouth for 24 hours. c. Brush teeth or rinse mouth after vomiting. d. Give plain water until vomiting ceases for at least 24 hours.

ANS: C It is important to emphasize the need for the child to brush the teeth or rinse the mouth after vomiting to dilute the hydrochloric acid that comes in contact with the teeth. Ad libitum administration of glucose-electrolyte solution to an alert child will help restore water and electrolytes satisfactorily. It is important to include carbohydrate to spare body protein and avoid ketosis.

Which is the most frequent source of acute childhood lead poisoning? a. Folk remedies b. Unglazed pottery c. Lead-based paint d. Cigarette butts and ashes

ANS: C Lead-based paint in houses built before 1978 is the most frequent source of lead poisoning. Some folk remedies and unglazed pottery may contain lead, but they are not the most frequent source. Cigarette butts and ashes do not contain lead.

Which is the initial clinical manifestation of generalized seizures? a. Being confused b. Feeling frightened c. Losing consciousness d. Seeing flashing lights

ANS: C Loss of consciousness is a frequent occurrence in generalized seizures and is the initial clinical manifestation. Being confused, feeling frightened, and seeing flashing lights are clinical manifestations of a complex partial seizure.

A nurse is conducting an in-service on gastrointestinal disorders. The nurse includes that melena, the passage of black, tarry stools, suggests bleeding from which area? a. Perianal or rectal area b. Hemorrhoids or anal fissures c. Upper gastrointestinal (GI) tract d. Lower GI tract

ANS: C Melena is denatured blood from the upper GI tract or bleeding from the right colon. Blood from the perianal or rectal area, hemorrhoids, or lower GI tract would be bright red.

An appropriate method for administering oral medications that are bitter to an infant or small child would be to mix them with: a. a bottle of formula or milk. b. any food the child is going to eat. c. a small amount (1 teaspoon) of a sweet-tasting substance such as jam or ice cream. d. large amounts of water to dilute medication sufficiently.

ANS: C Mix the drug with a small amount (about 1 teaspoon) of sweet-tasting substance. This will make the medication more palatable to the child. The medication should be mixed with only a small amount of food or liquid. If the child does not finish drinking or eating, it is difficult to determine how much medication was consumed. Medication should not be mixed with essential foods and milk. The child may associate the altered taste with the food and refuse to eat in the future.

A young child has an intelligence quotient (IQ) of 45. The nurse should document this finding as: a. within the lower limits of the range of normal intelligence. b. mild cognitive impairment but educable. c. moderate cognitive impairment but trainable. d. severe cognitive impairment and completely dependent on others for care.

ANS: C Moderate cognitively impairment IQs range between 35 and 55. The lower limit of normal intelligence is approximately 70. Individuals with IQs of 50 to 70 are considered to have mild cognitive impairment but educable. An IQ of 20 to 40 results in severe cognitive impairment.

A 12-year-old male has short stature because of a constitutional growth delay. The nurse should be the most concerned about which of the following? a. Proper administration of thyroid hormone b. Proper administration of human growth hormones c. Child's self-esteem and sense of competence d. Helping child understand that his height is most likely caused by chronic illness and is not his fault

ANS: C Most cases of constitutional growth delay are caused by simple constitutional delay of puberty, and the child can be assured that normal development will eventually take place. Listening to distressed adolescents and conveying interest and concern are important interventions for these children and adolescents. They should be encouraged to focus on the positives aspects of their bodies and personalities. Thyroid hormones and human growth hormones would not be beneficial in a constitutional growth delay. A constitutional growth delay is not caused by a chronic illness.

Which therapeutic management should the nurse prepare to initiate first for a child with acute diarrhea and moderate dehydration? a. Clear liquids b. Adsorbents, such as kaolin and pectin c. Oral rehydration solution (ORS) d. Antidiarrheal medications such as paregoric

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

The nurse has documented that a child's level of consciousness is obtunded. Which describes this level of consciousness? a. Slow response to vigorous and repeated stimulation b. Impaired decision making c. Arousable with stimulation d. Confusion regarding time and place

ANS: C Obtunded describes a level of consciousness in which the child is arousable with stimulation. Stupor is a state in which the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Confusion is impaired decision making. Disorientation is confusion regarding time and place.

An appropriate nursing intervention when caring for an unconscious child should be to: a. change the child's position infrequently to minimize the chance of increased ICP. b. avoid using narcotics or sedatives to provide comfort and pain relief. c. monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. d. give tepid sponge baths to reduce fever because antipyretics are contraindicated.

ANS: C Often comatose patients cannot cope with the quantity of fluids that they normally tolerate. Overhydration must be avoided to prevent fatal cerebral edema. The child's position should be changed frequently to avoid complications such as pneumonia and skin breakdown. Narcotics and sedatives should be used as necessary to reduce pain and discomfort, which can increase ICP. Antipyretics are the method of choice for fever reduction.

A nurse planning care for a school-age child should take into account that which thought process is seen at this age? a. Animism b. Magical thinking c. Ability to conserve d. Thoughts are all-powerful

ANS: C One cognitive task of school-age children is mastering the concept of conservation. At an early age (5 to 7 years), children grasp the concept of reversibility of numbers as a basis for simple mathematics problems (e.g., 2 + 4 = 6 and 6 - 4 = 2). They learn that simply altering their arrangement in space does not change certain properties of the environment, and they are able to resist perceptual cues that suggest alterations in the physical state of an object. Animism, magical thinking, and believing that thoughts are all powerful are thought processes seen in preschool children.

A group of boys ages 9 and 10 years have formed a "boys-only" club that is open to neighborhood and school friends who have skateboards. This should be interpreted as: a. behavior that encourages bullying and sexism. b. behavior that reinforces poor peer relationships. c. characteristic of social development at this age. d. characteristic of children who later are at risk for membership in gangs.

ANS: C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. A boys-only club does not have a direct correlation with later gang activity.

Which of the following terms refers to opacity of the crystalline lens that prevents light rays from entering the eye and refracting on the retina? a. Myopia b. Amblyopia c. Cataract d. Glaucoma

ANS: C Opacity of the crystalline lens that prevents light rays from entering the eye and refracting on the retina is the definition of a cataract. Myopia, or nearsightedness, refers to the ability to see objects clearly at close range but not at a distance. Amblyopia, or lazy eye, is reduced visual acuity in one eye. Glaucoma is a group of eye diseases characterized by increased intraocular pressure.

Which is an important consideration when the nurse is discussing enuresis with the parents of a young child? a. Enuresis is more common in girls than in boys. b. Enuresis is neither inherited nor has a familial tendency. c. Organic causes that may be related to enuresis should be considered first. d. Psychogenic factors that cause enuresis persist into adulthood.

ANS: C Organic causes that may be related to enuresis should be ruled out before psychogenic factors are considered. Enuresis is more common in boys than in girls and has a strong familial tendency. Psychogenic factors may influence enuresis, but it is doubtful that they are causative.

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

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

Nursing considerations related to the administration of oxygen in an infant include to: a. humidify oxygen if infant can tolerate it. b. assess infant to determine how much oxygen should be given. c. ensure uninterrupted delivery of the appropriate oxygen concentration. d. direct oxygen flow so that it blows directly into the infant's face in a hood.

ANS: C Oxygen is a prescribed medication. It is the nurse's responsibility to ensure that the ordered concentration is delivered and the effects of therapy are monitored. Oxygen is drying to the tissues. Oxygen should always be humidified when delivered to a patient. A child receiving oxygen therapy should have the oxygen saturation monitored at least as frequently as vital signs. Oxygen is a medication, and it is the responsibility of the practitioner to modify dosage as indicated. Humidified oxygen should not be blown directly into an infant's face.

A nurse is conducting a class for adolescent girls about pelvic inflammatory disease (PID). Why should the nurse emphasize the importance of preventing pelvic inflammatory disease (PID)? a. PID can be sexually transmitted. b. PID cannot be treated. c. PID can have devastating effects on the reproductive tract. d. PID can cause serious defects in future children of affected adolescents.

ANS: C PID is a major concern because of its devastating effects on the reproductive tract. Short-term complications include abscess formation in the fallopian tubes, whereas long-term complications include ectopic pregnancy, infertility, and dyspareunia. PID is an infection of the upper female genital tract, most commonly caused by sexually transmitted infections but it is not sexually transmitted to another person. PID can be treated by treating the underlying cause. There is a possibility of ectopic pregnancy but not birth defects in children.

Parents have a concern that their child is depressed. The nurse relates that which characteristic best describes children with depression? a. Increased range of affective response b. Preoccupation with need to perform well in school c. Change in appetite, resulting in weight loss or gain d. Tendency to prefer play instead of schoolwork

ANS: C Physiologic characteristics of children with depression include change in appetite resulting in weight loss or gain, nonspecific complaints of not feeling well, alterations in sleeping pattern, insomnia or hypersomnia, and constipation. Children who are depressed have sad facial expressions with absence or diminished range of affective response. These children withdraw from previously enjoyed activities and engage in solitary play or work with a lack of interest in play. A lack of interest is seen in doing homework or achieving in school, resulting in lower grades in children who are depressed.

Generally, the earliest age at which puberty begins is _____ years in girls, _____ in boys. a. 13; 13 b. 11; 11 c. 10; 12 d. 12; 10

ANS: C Puberty signals the beginning of the development of secondary sex characteristics. This begins earlier in girls than in boys. Usually a 2-year difference occurs in the age of onset. Girls and boys do not usually begin puberty at the same age. Girls generally begin puberty 2 years earlier than boys.

During the first few days after surgery for cleft lip, which intervention should the nurse do? a. Leave infant in crib at all times to prevent suture strain. b. Keep infant heavily sedated to prevent suture strain. c. Remove restraints periodically to cuddle infant. d. Alternate position from prone to side-lying to supine.

ANS: C Remove restraints periodically, while supervising the infant, to allow him or her to exercise arms and to provide cuddling and tactile stimulation. The infant should not be left in the crib, but should be removed for appropriate holding and stimulation. Analgesia and sedation are administered for pain. Heavy sedation is not indicated. The child should not be placed in the prone position.

A nurse is caring for a child in acute respiratory failure. Which blood gas analysis indicates the child is still in respiratory acidosis? a. pH 7.50, CO2 48 b. pH 7.30, CO2 30 c. pH 7.32, CO2 50 d. pH 7.48, CO2 33

ANS: C Respiratory failure is a process that involves pulmonary dysfunction generally resulting in impaired alveolar gas exchange, which can lead to hypoxemia or hypercapnia. Acidosis indicates the pH is less than 7.35 and the CO2 is greater than 45. If the pH is less than 7.35 but the CO2 is low, it is metabolic acidosis. Alkalosis is when the pH is greater than 7.45. If the pH is high and the CO2 is high, it is metabolic alkalosis. When the pH is high and the CO2 is low, it is respiratory alkalosis.

A nurse must do a venipuncture on a 6-year-old child. Which is an important consideration in providing atraumatic care? a. Use an 18-gauge needle if possible. b. If not successful after four attempts, have another nurse try. c. Restrain child only as needed to perform venipuncture safely. d. Show child equipment to be used before procedure.

ANS: C Restrain child only as needed to perform the procedure safely; use therapeutic hugging. Use the smallest gauge needle that permits free flow of blood. A two-try-only policy is desirable, in which two operators each have only two attempts. If insertion is not successful after four punctures, alternative venous access should be considered. Keep all equipment out of sight until used.

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

ANS: C Rotavirus is the most frequent viral pathogen that causes diarrhea in young children. Giardia (parasite) and Salmonella are bacterial pathogens that cause diarrhea. Shigella is a bacterial pathogen that is uncommon in the United States.

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

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

A child is brought to the emergency department after experiencing a seizure at school. There is no previous history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurse's best response is: a. "Epilepsy is easily treated." b. "Very few children have actual epilepsy." c. "The seizure may or may not mean that your child has epilepsy." d. "Your child has had only one convulsion; it probably won't happen again."

ANS: C Seizures are the indispensable characteristic of epilepsy; however, not every seizure is epileptic. Epilepsy is a chronic seizure disorder with recurrent and unprovoked seizures. The treatment of epilepsy involves a thorough assessment to determine the type of seizure the child is having and the cause, followed by individualized therapy to allow the child to have as normal a life as possible. The nurse should not make generalized comments regarding the incidence of epilepsy until further assessment is made.

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

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

When caring for a child with probable appendicitis, the nurse should be alert to recognize that which condition or symptom is a sign of perforation? a. Bradycardia b. Anorexia c. Sudden relief from pain d. Decreased abdominal distention

ANS: C Signs of peritonitis, in addition to fever, include sudden relief from pain after perforation. Tachycardia, not bradycardia, is a manifestation of peritonitis. Anorexia is already a clinical manifestation of appendicitis. Abdominal distention usually increases.

The nurse must suction a child with a tracheostomy. Interventions should include: a. encouraging child to cough to raise the secretions before suctioning. b. selecting a catheter with diameter three fourths as large as the diameter of the tracheostomy tube. c. ensuring each pass of the suction catheter should take no longer than 5 seconds. d. allowing child to rest after every five times the suction catheter is passed.

ANS: C Suctioning should require no longer than 5 seconds per pass. Otherwise, the airway may be occluded for too long. If the child is able to cough up secretions, suctioning may not be indicated. The catheter should have a diameter one half the size of the tracheostomy tube. If it is too large, it might block the child's airway. The child is allowed to rest for 30 to 60 seconds after each aspiration to allow oxygen tension to return to normal. Then the process is repeated until the trachea is clear.

Parents of two school-age children with asthma ask the nurse, "What sports can our children participate in?" The nurse should recommend which sport? a. Soccer b. Running c. Swimming d. Basketball

ANS: C Swimming is well tolerated in children with asthma because they are breathing air fully saturated with moisture and because of the type of breathing required in swimming. Exercise-induced bronchospasm is more common in sports that involve endurance, such as soccer. Prophylaxis with medications may be necessary.

Which statement regarding chlamydia infection is correct? a. Treatment of choice is oral penicillin. b. Treatment of choice is nystatin or miconazole. c. Clinical manifestations include dysuria and urethral itching in males. d. Clinical manifestations include small, painful vesicles on genital areas.

ANS: C Symptoms of chlamydia infection in males include meatal erythema, tenderness, itching, dysuria, and urethral discharge. Some infected males have no symptoms. Oral penicillin and nystatin or miconazole are not the antibiotics of choice. Small, painful vesicles on genital areas are clinical manifestations true of chlamydia infection but may also indicate herpetic lesions.

The Allen test is performed as a precautionary measure before which procedure? a. Heel stick b. Venipuncture c. Arterial puncture d. Lumbar puncture

ANS: C The Allen test assesses the circulation of the radial, ulnar, or brachial arteries before arterial puncture. The Allen test is used before arterial punctures, not heel sticks, venipunctures, or lumbar punctures.

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

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

The emergency department nurse is cleaning multiple facial abrasions on a 9-year-old child whose mother is present. The child is crying and screaming loudly. The nurse's action should be to: a. ask the child to be quieter. b. have the child's mother give instructions about relaxation. c. tell the child it is okay to cry and scream. d. remove the mother from the room.

ANS: C The child should be allowed to express feelings of anger, anxiety, fear, frustration, or any other emotion. The child needs to know it is all right to cry. There is no reason for the child to be quieter and feelings need to be able to be expressed. The mother should stay in the room to provide comfort to the child.

A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child psychologically is: a. not necessary because of child's age. b. not necessary because colostomy is temporary. c. necessary because it will be an adjustment. d. necessary because the child must deal with a negative body image.

ANS: C The child's age dictates the type and extent of psychological preparation. When a colostomy is performed, the child who is at least preschool age is told about the procedure and what to expect in concrete terms, with the use of visual aids. It is necessary to prepare a 3-year-old child for procedures. The preschooler is not yet concerned with body image.

Which observation made of the exposed abdomen is most indicative of pyloric stenosis? a. Abdominal rigidity b. Substernal retraction c. Palpable olive-like mass d. Marked distention of lower abdomen

ANS: C The diagnosis of pyloric stenosis is often made after the history and physical examination. The olive-like mass is easily palpated when the stomach is empty, the infant is quiet, and the abdominal muscles are relaxed. Abdominal rigidity and substernal retraction are usually not present. The upper abdomen, not lower abdomen, is distended.

A father calls the emergency department nurse saying that his daughter's eyes burn after getting some dishwasher detergent in them. The nurse recommends that the child be seen in the emergency department or by an ophthalmologist. The nurse also should recommend which action before the child is transported? a. Keep eyes closed. b. Apply cold compresses. c. Irrigate eyes copiously with tap water for 20 minutes. d. Prepare a normal saline solution (salt and water) and irrigate eyes for 20 minutes.

ANS: C The first action is to flush the eyes with clean tap water. This will rinse the detergent from the eyes. Keeping eyes closed and applying cold compresses may allow the detergent to do further harm to the eyes during transport. Normal saline is not necessary. The delay can allow the detergent to cause continued injury to the eyes.

It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because which disease or assessment findings may develop? a. Cough b. Osteoporosis c. Slowed growth d. Cushing syndrome

ANS: C The growth of children on long-term inhaled steroids should be assessed frequently to assess for systemic effects of these drugs. Cough is prevented by inhaled steroids. No evidence exists that inhaled steroids cause osteoporosis. Cushing syndrome is caused by long-term systemic steroids.

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

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

Which should the nurse consider when having consent forms signed for surgery and procedures on children? a. Only a parent or legal guardian can give consent. b. The person giving consent must be at least 18 years old. c. The risks and benefits of a procedure are part of the consent process. d. A mental age of 7 years or older is required for a consent to be considered "informed."

ANS: C The informed consent must include the nature of the procedure, benefits and risks, and alternatives to the procedure. In special circumstances, such as emancipated minors, the consent can be given by someone younger than 18 years without the parent or legal guardian. A mental age of 7 years is too young for consent to be informed.

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

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

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

ANS: C The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and perhaps prevent esophagitis. Preventing reflux or hematemesis and increasing gastric acid production are not the modes of action of histamine-receptor antagonists.

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

ANS: C The parents are advised of probable posttraumatic symptoms that may be expected. These include behavioral changes and sleep disturbances. If the child has these clinical signs, they should be immediately reported for evaluation. Sleep disturbances are to be expected.

Parents are concerned about the number of hours their teenage daughter spends with peers. The nurse explains that peer relationships are important during adolescence for which reason? a. Adolescents dislike their parents. b. Adolescents no longer need parental control. c. They provide adolescents with a feeling of belonging. d. They promote a sense of individuality in adolescents.

ANS: C The peer group serves as a strong support to teenagers, providing them with a sense of belonging and a sense of strength and power. During adolescence, the parent-child relationship changes from one of protection-dependency to one of mutual affection and quality. Parents continue to play an important role in the personal and health-related decisions. The peer group forms the transitional world between dependence and autonomy.

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

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

The nurse is talking with a 10-year-old boy who wears bilateral hearing aids. The left hearing aid is making an annoying whistling sound that the child cannot hear. Which is the most appropriate nursing action? a. Ignore the sound. b. Ask him to reverse the hearing aids in his ears. c. Suggest he reinsert the hearing aid. d. Suggest he raise the volume of the hearing aid.

ANS: C The whistling sound is acoustic feedback. The nurse should have the child remove the hearing aid and reinsert it, making certain no hair is caught between the ear mold and the ear canal. It would be annoying to others to ignore the sound or to suggest he raise the volume of the hearing aid. The hearing aids are molded specifically for each ear.

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

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

Frequent urine testing for specific gravity and glucose are required on a 6-month-old infant. Which is the most appropriate way to collect small amounts of urine for these tests? a. Apply a urine-collection bag to perineal area. b. Tape a small medicine cup to inside of diaper. c. Aspirate urine from cotton balls inside diaper with a syringe. d. Aspirate urine from superabsorbent disposable diaper with a syringe.

ANS: C To obtain small amounts of urine, use a syringe without a needle to aspirate urine directly from the diaper. If diapers with absorbent material are used, place a small gauze dressing or cotton balls inside the diaper to collect the urine, and aspirate the urine with a syringe. For frequent urine sampling, the collection bag would be too irritating to the child's skin. It is not feasible to tape a small medicine cup to inside of diaper; the urine will spill from the cup. Diapers with superabsorbent gels absorb the urine, so there is nothing to aspirate.

The school nurse is discussing testicular self-examination with adolescent boys. Why is this important? a. Epididymitis is common during adolescence. b. Asymptomatic sexually transmitted diseases may be present. c. Testicular tumors during adolescence are generally malignant. d. Testicular tumors, although usually benign, are common during adolescence.

ANS: C Tumors of the testes are not common, but when manifested in adolescence, they are generally malignant and demand immediate evaluation. Epididymitis is not common in adolescence. Asymptomatic sexually transmitted disease would not be evident during testicular self-examination. The focus of this examination is on testicular cancer. Testicular tumors are most commonly malignant.

A critically ill child has hyperthermia. The parents ask the nurse to give an antipyretic such as acetaminophen (Tylenol). The nurse should explain that antipyretics: a. may cause malignant hyperthermia. b. may cause febrile seizures. c. are of no value in treating hyperthermia. d. are of limited value in treating hyperthermia.

ANS: C Unlike with fever, antipyretics are of no value in hyperthermia because the set point is already normal. Cooling measures are used instead. Malignant hyperthermia is a genetic myopathy that is triggered by anesthetic agents. Antipyretic agents do not have this effect. Antipyretics do not cause seizures and are of no value in hyperthermia.

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

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

The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis? a. Abdominal rigidity and pain on palpation b. Rounded abdomen and hypoactive bowel sounds c. Visible peristalsis and weight loss d. Distention of lower abdomen and constipation

ANS: C Visible gastric peristaltic waves that move from left to right across the epigastrium and weight loss are observed in pyloric stenosis. Abdominal rigidity and pain on palpation or a rounded abdomen and hypoactive bowel sounds are usually not present. The upper abdomen, not lower abdomen, is distended.

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

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

Which of the following is the most common clinical manifestation of retinoblastoma? a. Glaucoma b. Amblyopia c. Cat's eye reflex d. Sunken eye socket

ANS: C When the eye is examined, the light will reflect off the tumor, giving the eye a whitish appearance. This is called a cat's eye reflex. A late sign of retinoblastoma is a red, painful eye with glaucoma. Amblyopia, or lazy eye, is reduced visual acuity in one eye. The eye socket is not sunken.

The nurse is caring for a neonate with suspected meningitis. Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed? (Select all that apply.) a. Headache b. Photophobia c. Bulging anterior fontanel d. Weak cry e. Poor muscle tone

ANS: C, D, E Assessment findings in a neonate with meningitis include bulging anterior fontanel, weak cry, and poor muscle tone. Headache and photophobia are signs seen in an older child.

A nurse is conducting dietary teaching on high-fiber foods for parents of a child with constipation. Which foods should the nurse include as being high in fiber? (Select all that apply.) a. White rice b. Avocados c. Whole grain breads d. Bran pancakes e. Raw carrots

ANS: C, D, E High-fiber foods include whole grain breads, bran pancakes, and raw carrots. Unrefined (brown) rice is high in fiber but not white rice. Raw fruits, especially those with skins or seeds, other than ripe banana or avocado are high in fiber.

The nurse is caring for a preschool child with a cast applied recently for a fractured tibia. Which assessment findings indicate possible compartment syndrome? (Select all that apply.) a. Palpable distal pulse b. Capillary refill to extremity less than 3 seconds c. Severe pain not relieved by analgesics d. Tingling of extremity e. Inability to move extremity

ANS: C, D, E Indications of compartment syndrome are severe pain not relieved by analgesics, tingling of extremity, and inability to move extremity. A palpable distal pulse and capillary refill to the extremity less than 3 seconds are expected findings.

The nurse is preparing to admit a newborn with myelomeningocele to the neonatal intensive care nursery. Which describes this newborn's defect? a. Fissure in the spinal column that leaves the meninges and the spinal cord exposed b. Herniation of the brain and meninges through a defect in the skull c. Hernial protrusion of a saclike cyst of meninges with spinal fluid but no neural elements d. Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves

ANS: D A myelomeningocele is a visible defect with an external saclike protrusion, containing meninges, spinal fluid, and nerves. Rachischisis is a fissure in the spinal column that leaves the meninges and the spinal cord exposed. Encephalocele is a herniation of brain and meninges through a defect in the skull, producing a fluid-filled sac. Meningocele is a hernial protrusion of a saclike cyst of meninges with spinal fluid, but no neural elements.

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

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

Cystic fibrosis (CF) is suspected in a toddler. Which test is essential in establishing this diagnosis? a. Bronchoscopy b. Serum calcium c. Urine creatinine d. Sweat chloride test

ANS: D A sweat chloride test result greater than 60 mEq/L is diagnostic of CF. Bronchoscopy, although helpful for identifying bacterial infection in children with CF, is not diagnostic. Serum calcium is normal in children with CF. Urine creatinine is not diagnostic of CF.

Acute salicylate (ASA, aspirin) poisoning results in: a. chemical pneumonitis. b. hepatic damage. c. retractions and grunting. d. disorientation and loss of consciousness.

ANS: D ASA poisoning causes disorientation and loss of consciousness. Chemical pneumonitis is caused by hydrocarbon ingestion. Hepatic damage is caused by acetaminophen overdose. ASA does not cause airway obstruction.

A young child has just arrived at the emergency department after ingestion of aspirin at home. The practitioner has ordered activated charcoal. The nurse administers charcoal in which way? a. Administer through a nasogastric tube because the child will not drink it because of the taste. b. Serve in a clear plastic cup so the child can see how much has been drunk. c. Give half of the solution, and then give the other half in 1 hour. d. Serve in an opaque container with a straw.

ANS: D Although the activated charcoal can be mixed with a flavorful beverage, it will be black and resemble mud. When it is served in an opaque container, the child does not have any preconceived ideas about its being distasteful. The nasogastric tube should be used only in children without a gag reflex. The ability to see the charcoal solution may affect the child's desire to drink it. The child should be encouraged to drink the solution all at once.

Which is beneficial in reducing the risk of Reye syndrome? a. Immunization against the disease b. Medical attention for all head injuries c. Prompt treatment of bacterial meningitis d. Avoidance of aspirin to treat fever associated with influenza

ANS: D Although the etiology of Reye syndrome is obscure, most cases follow a common viral illness, either varicella or influenza. A potential association exists between aspirin therapy and the development of Reye syndrome, so use of aspirin is avoided. No immunization currently exists for Reye syndrome. Reye syndrome is not correlated with head injuries or bacterial meningitis.

The parents of a child with cerebral palsy ask the nurse whether any drugs can decrease their child's spasticity. The nurse's response should be based on which statement? a. Anticonvulsant medications are sometimes useful for controlling spasticity. b. Medications that would be useful in reducing spasticity are too toxic for use with children. c. Many different medications can be highly effective in controlling spasticity. d. Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available.

ANS: D Baclofen, given intrathecally, is best suited for children with severe spasticity that interferes with activities of daily living and ambulation. Anticonvulsant medications are used when seizures occur in children with cerebral palsy. The intrathecal route decreases the side effects of the drugs that reduce spasticity. Few medications are currently available for the control of spasticity.

The nurse must do a heel stick on an ill neonate to obtain a blood sample. Which is recommended to facilitate this? a. Apply cool, moist compresses. b. Apply a tourniquet to ankle. c. Elevate foot for 5 minutes. d. Wrap foot in a warm washcloth.

ANS: D Before the blood sample is taken, the heel is heated with warm moist compresses for 5 to 10 minutes to dilate the blood vessels in the area. Cooling causes vasoconstriction, making blood collection more difficult. A tourniquet is used to constrict superficial veins. It will have an insignificant effect on capillaries. Elevating the foot will decrease the blood in the foot available for collection.

Which is a type of skin traction with legs in an extended position? a. Dunlop b. Bryant c. Russell d. Buck extension

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

Chelation therapy for lead poisoning is initiated when a child's blood level is _____ g/dl. a. 10 to 14 b. 15 to 19 c. 20 to 44 d. >45

ANS: D Chelation therapy is initiated if the child's blood level is greater than 45 g/dl. At 10 to 14 g/dl, the family should have lead-poisoning education and follow-up level. At 15 to 19 g/dl, the family should have lead-poisoning education and follow-up level but if it persists, initiate environmental investigation. At 20 to 44 g/dl environmental investigation and lead hazard control are necessary.

The nurse is assisting the family of a child with a history of encopresis. Which should be included in the nurse's discussion with this family? a. Instruct the parents to sit the child on the toilet at twice-daily routine intervals. b. Instruct the parents that the child will probably need to have daily enemas. c. Suggest the use of stimulant cathartics weekly. d. Reassure the family that most problems are resolved successfully, with some relapses during periods of stress.

ANS: D Children may be unaware of a prior sensation and unable to control the urge once it begins. They may be so accustomed to bowel accidents that they are unable to smell or feel it. Family counseling is directed toward reassurance that most problems resolve successfully, although relapses during periods of stress are possible. Sitting the child on the toilet is not recommended because it may intensify the parent-child conflict. Enemas may be needed for impactions, but long-term use prevents the child from assuming responsibility for defecation. Stimulant cathartics may cause cramping that can frighten child.

The school nurse is conducting a class on bicycle safety. Which statement made by a participant indicates a need for further teaching? a. "Most bicycle injuries occur from a fall off the bicycle." b. "Head injuries are the major causes of bicycle-related fatalities." c. "I should replace my helmet every 5 years." d. "I can ride double with a friend if the bicycle has an extra large seat."

ANS: D Children should not ride double. Most injuries result from falls. The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission and should replace the helmet at least every 5 years.

Which frequency is recommended for childhood skin testing for tuberculosis (TB) using the Mantoux test? a. Every year for all children older than 2 years b. Every year for all children older than 10 years c. Every 2 years for all children starting at age 1 year d. Periodically for children who reside in high-prevalence regions

ANS: D Children who reside in high-prevalence regions for TB should be tested every 2 to 3 years. Annual testing is not necessary. Testing is not necessary unless exposure is likely or an underlying medical risk factor is present.

A nurse is preparing a teaching session for parents on prevention of childhood hearing loss. The nurse should include that the most common cause of hearing impairment in children is: a. auditory nerve damage. b. congenital ear defects. c. congenital rubella. d. chronic otitis media.

ANS: D Chronic otitis media is the most common cause of hearing impairment in children. It is essential that appropriate measures be instituted to treat existing infections and prevent recurrences. Auditory nerve damage, congenital ear defects, and congenital rubella are rarer causes of hearing impairment.

A school nurse is teaching a group of preadolescent boys about puberty. By which age should concerns about pubertal delay be considered? a. 12 to 12 1/2 years b. 12 1/2 to 13 years c. 13 to 13 1/2 years d. 13 1/2 to 14 years

ANS: D Concerns about pubertal delay should be considered for boys who exhibit no enlargement of the testes or scrotal changes from 13 1/2 to 14 years. Ages 12 to 13 1/2 years is too young for initial concern.

Which is probably the most important criterion on which to base the decision to report suspected child abuse? a. Inappropriate parental concern for the degree of injury b. Absence of parents for questioning about child's injuries c. Inappropriate response of child d. Incompatibility between the history and injury observed

ANS: D Conflicting stories about the "accident" are the most indicative red flags of abuse. Inappropriate response of caregiver or child may be present, but is subjective. Parents should be questioned at some point during the investigation.

Children taking phenobarbital (phenobarbital sodium) and/or phenytoin (Dilantin) may experience a deficiency of: a. calcium. b. vitamin C. c. fat-soluble vitamins. d. vitamin D and folic acid.

ANS: D Deficiencies of vitamin D and folic acid have been reported in children taking phenobarbital and phenytoin. Calcium, vitamin C, and fat-soluble vitamin deficiencies are not associated with phenobarbital or phenytoin.

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

ANS: D Easily digested foods such as cereals, cooked vegetables, and meats should be provided for the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness. Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. The BRAT diet has little nutritional value and is high in carbohydrates.

The nurse suspects that a child has ingested some type of poison. Which clinical manifestation would be most suggestive that the poison was a corrosive product? a. Tinnitus b. Disorientation c. Stupor, lethargy, coma d. Edema of lips, tongue, pharynx

ANS: D Edema of lips, tongue, and pharynx indicates a corrosive ingestion. Tinnitus is indicative of aspirin ingestion. Corrosives do not act on the central nervous system (CNS).

Pancreatic enzymes are administered to the child with cystic fibrosis (CF). Nursing considerations should include to: a. not administer pancreatic enzymes if child is receiving antibiotics. b. decrease dose of pancreatic enzymes if child is having frequent, bulky stools. c. administer pancreatic enzymes between meals if at all possible. d. pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

ANS: D Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole. Pancreatic enzymes are not a contraindication for antibiotics. The dosage of enzymes should be increased if child is having frequent, bulky stools. Enzymes should be given just before meals and snacks.

The nurse is conducting reflex testing on infants at a well-child clinic. Which reflex finding should be reported as abnormal and considered as a possible sign of cerebral palsy? a. Tonic neck reflex at 5 months of age b. Absent Moro reflex at 8 months of age c. Moro reflex at 3 months of age d. Extensor reflex at 7 months of age

ANS: D Establishing a diagnosis of cerebral palsy (CP) may be confirmed with the persistence of primitive reflexes: (1) either the asymmetric tonic neck reflex or persistent Moro reflex (beyond 4 months of age) and (2) the crossed extensor reflex. The tonic neck reflex normally disappears between 4 and 6 months of age. The crossed extensor reflex, which normally disappears by 4 months, is elicited by applying a noxious stimulus to the sole of one foot with the knee extended. Normally, the contralateral foot responds with extensor, abduction, and then adduction movements. The possibility of CP is suggested if these reflexes occur after 4 months.

The nurse is doing a prehospitalization orientation for a 7-year-old child who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that she will not be able to talk because of an endotracheal tube but that she will be able to talk when it is removed. This explanation is: a. unnecessary. b. the surgeon's responsibility. c. too stressful for a young child. d. an appropriate part of the child's preparation.

ANS: D Explanation is a necessary part of preoperative preparation. If the child wakes and is not prepared for the inability to speak, she will be even more anxious. This is a necessary component for preparation for surgery that will help reduce the anxiety associated with surgery. It is a joint responsibility of nursing, medical staff, and child life personnel.

An adolescent girl asks the school nurse for advice because she has dysmenorrhea. She says that a friend recommended she try an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). The nurse's response should be based on which statement? a. Aspirin is the drug of choice for the treatment of dysmenorrhea. b. Over-the-counter NSAIDs are rarely strong enough to provide adequate pain relief. c. NSAIDs are effective because of their analgesic effect. d. NSAIDs are effective because they inhibit prostaglandins, leading to reduction in uterine activity.

ANS: D First-line therapy for adolescents with dysmenorrhea is NSAIDs. This group of drugs blocks the formation of prostaglandins. NSAIDs, not aspirin, are the drugs of choice in dysmenorrhea. NSAIDs are potent anti-inflammatory agents that inhibit prostaglandin. Although NSAIDs have analgesic effects, the mechanism of action in dysmenorrhea is most likely the antiprostaglandin effect.

The most common cause of death in the adolescent age group involves: a. drownings. b. firearms. c. drug overdoses. d. motor vehicles.

ANS: D Forty percent of all adolescent deaths in the United States are the result of motor vehicle accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but are not the most common cause of death.

Which is the causative agent of scarlet fever? a. Enteroviruses b. Corynebacterium organisms c. Scarlet fever virus d. Group A -hemolytic streptococci (GABHS)

ANS: D GABHS infection causes scarlet fever. Enteroviruses do not cause the same complications. Corynebacterium organisms cause diphtheria. Scarlet fever is not caused by a virus.

The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like her oldest son did when he was an infant. The nurse should base her response on which statement? a. Meningitis rarely occurs during infancy. b. Often a genetic predisposition to meningitis is found. c. Vaccination to prevent all types of meningitis is now available. d. Vaccination to prevent Haemophilus influenzae type B meningitis has decreased the frequency of this disease in children.

ANS: D H. influenzae type B meningitis has been virtually eradicated in areas of the world where the vaccine is administered routinely. Bacterial meningitis remains a serious illness in children. It is significant because of the residual damage caused by undiagnosed and untreated or inadequately treated cases. The leading causes of neonatal meningitis are the group B streptococci and Escherichia coli organisms. Meningitis is an extension of a variety of bacterial infections. No genetic predisposition exists. Vaccinations are not available for all of the potential causative organisms.

A nurse is admitting an infant with dehydration caused from water loss in excess of electrolyte loss. Which type of dehydration is this infant experiencing? a. Isotonic b. Isosmotic c. Hypotonic d. Hypertonic

ANS: D Hypertonic dehydration results from water loss in excess of electrolyte loss. This is the most dangerous type of dehydration. It is caused by feeding children fluids with high amounts of solute. Isotonic dehydration occurs in conditions in which electrolyte and water deficits are present in balanced proportion and is another term for isotonic dehydration. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic.

What is one of the major physical characteristics of the child with Down syndrome? a. Excessive height b. Spots on the palms c. Inflexibility of the joints d. Hypotonic musculature

ANS: D Hypotonic musculature is one of the major characteristics. Children with Down syndrome have short stature and a transverse palmar crease. Hyperflexibility is a characteristic of Down syndrome.

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant displays which clinical manifestation? a. Fussiness b. Coughing c. A fever over 99° F d. Signs of an earache

ANS: D If an infant with nasopharyngitis shows signs of an earache, it may mean a secondary bacterial infection is present and the infant should be referred to a practitioner for evaluation. Irritability is common in an infant with a viral illness. Cough can be a sign of nasopharyngitis. Fever is common in viral illnesses

Which should cause a nurse to suspect that an infection has developed under a cast? a. Complaint of paresthesia b. Cold toes c. Increased respirations d. "Hot spots" felt on cast surface

ANS: D If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so that a window can be made in the cast to observe the site. The five Ps of ischemia from a vascular injury are pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection. Cold toes may be indicative of too tight a cast and need further evaluation. Increased respirations may be indicative of a respiratory tract infection or pulmonary emboli. This should be reported, and child should be evaluated.

Which describes the cognitive abilities of school-age children? a. Have developed the ability to reason abstractly b. Are capable of scientific reasoning and formal logic c. Progress from making judgments based on what they reason to making judgments based on what they see d. Are able to classify, to group and sort, and to hold a concept in their minds while making decisions based on that concept

ANS: D In Piaget's stage of concrete operations, children have the ability to group and sort and make conceptual decisions. Children cannot reason abstractly and logically until late adolescence. Making judgments based on what they reason to making judgments based on what they see is not a developmental skill.

In girls, the initial indication of puberty is: a. menarche. b. growth spurt. c. growth of pubic hair. d. breast development.

ANS: D In most girls, the initial indication of puberty is the appearance of breast buds, an event known as thelarche. The usual sequence of secondary sex characteristic development in girls is breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, and abrupt deceleration of linear growth.

Which is descriptive of bulimia during adolescence? a. Strong sense of control over eating behavior b. Feelings of elation after the binge-purge cycle c. Profound lack of awareness that the eating pattern is abnormal d. Weight that can be normal, slightly above normal, or below normal

ANS: D Individuals with bulimia are of normal or more commonly slightly above normal weight. Those who also restrict their intake can become severely underweight. The adolescent has a lack of control over eating during the episode. Patients with bulimia commonly have self-deprecating thoughts and a depressed mood after binge-purge cycles; they are also aware that the eating pattern is abnormal but are unable to stop.

An infant with pyloric stenosis experiences excessive vomiting that can result in: a. hyperchloremia. b. hypernatremia. c. metabolic acidosis. d. metabolic alkalosis.

ANS: D Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Chloride ions and sodium are lost with vomiting. Metabolic alkalosis, not acidosis, is likely.

Invagination of one segment of bowel within another is called: a. atresia. b. stenosis. c. herniation. d. intussusception.

ANS: D Intussusception occurs when a proximal section of the bowel telescopes into a more distal segment, pulling the mesentery with it. The mesentery is compressed and angled, resulting in lymphatic and venous obstruction. Invagination of one segment of bowel within another is the definition of intussusception, not atresia, stenosis, or herniation.

It is important to make certain that sensory connectors and oximeters are compatible because wiring that is incompatible can cause: a. hyperthermia. b. electrocution. c. pressure necrosis. d. burns under sensors.

ANS: D It is important to make certain that sensor connectors and oximeters are compatible. Wiring that is incompatible can generate considerable heat at the tip of the sensor, causing second- and third-degree burns under the sensor. Incompatibility would cause a local irritation or burn. A low voltage is used, which should not present risk of electrocution. Pressure necrosis can occur from the sensor being attached too tightly, but this is not a problem of incompatibility.

The nurse is taking care of an adolescent diagnosed with kyphosis. Which describes this condition? a. Lateral curvature of the spine b. Immobility of the shoulder joint c. Exaggerated concave lumbar curvature of the spine d. Increased convex angulation in the curve of the thoracic spine

ANS: D Kyphosis is an abnormally increased convex angulation in the curve of the thoracic spine. Scoliosis is a complex spinal deformity usually involving lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis. Ankylosis is the immobility of a joint. Lordosis is an exaggerated concave lumbar curvature of the spine.

A parent has asked the nurse about how her child can be tested for pinworms. The nurse responds by stating that which is the most common test for diagnosing pinworms in a child? a. Lower gastrointestinal (GI) series b. Three stool specimens, at intervals of 4 days c. Observation for presence of worms after child defecates d. Laboratory examination of a fecal smear

ANS: D Laboratory examination of substances containing the worm, its larvae, or ova can identify the organism. Most are identified by examining fecal smears from the stools of persons suspected of harboring the parasite. Fresh specimens are best for revealing parasites or larvae. Lower GI series is not helpful for diagnosing enterobiasis. Stool specimens are not necessary to diagnose pinworms. Worms will not be visible after child defecates.

A young boy is found squirting lighter fluid into his mouth. His father calls the emergency department. The nurse taking the call should know that the primary danger is which result? a. Hepatic dysfunction b. Dehydration secondary to vomiting c. Esophageal stricture and shock d. Bronchitis and chemical pneumonia

ANS: D Lighter fluid is a hydrocarbon. The immediate danger is aspiration. Acetaminophen overdose, not hydrocarbons, causes hepatic dysfunction. Dehydration is not the primary danger. Esophageal stricture is a late or chronic issue of hydrocarbon ingestion.

The nurse should recommend medical attention if a child with a slight head injury experiences: a. sleepiness. b. vomiting, even once. c. headache, even if slight. d. confusion or abnormal behavior.

ANS: D Medical attention should be sought if the child exhibits confusion or abnormal behavior, loses consciousness, has amnesia, has fluid leaking from the nose or ears, complains of blurred vision, or has an unsteady gait. Sleepiness alone does not require evaluation. If the child is difficult to arouse from sleep, medical attention should be obtained. Vomiting more than three times requires medical attention. Severe or worsening headache or one that interferes with sleep should be evaluated.

Which therapeutic management treatment is implemented for children with Hirschsprung disease? a. Daily enemas b. Low-fiber diet c. Permanent colostomy d. Surgical removal of affected section of bowel

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

Which medication is usually tried first when a child is diagnosed with juvenile idiopathic arthritis (JIA)? a. Aspirin b. Corticosteroids c. Cytotoxic drugs such as methotrexate d. Nonsteroidal anti-inflammatory drugs (NSAIDs)

ANS: D NSAIDs are the first drugs used in JIA. Naproxen, ibuprofen, and tolmetin are approved for use in children. Aspirin, once the drug of choice, has been replaced by the NSAIDs because they have fewer side effects and easier administration schedules. Corticosteroids are used for life-threatening complications, incapacitating arthritis, and uveitis. Methotrexate is a second-line therapy for JIA.

A child is admitted with bacterial gastroenteritis. Which lab results of a stool specimen confirm this diagnosis? a. Eosinophils b. Occult blood c. pH less than 6 d. Neutrophils and red blood cells

ANS: D Neutrophils and red blood cells in stool indicate bacterial gastroenteritis. Protein intolerance and parasitic infections are suspected in the presence of eosinophils. Occult blood may indicate pathogens such as Shigella, Campylobacter, or hemorrhagic Escherichia coli strains. A pH of less than 6 may indicate carbohydrate malabsorption or secondary lactase insufficiency.

Chronic otitis media with effusion (OME) is differentiated from acute otitis media (AOM) because it is usually characterized by: a. a fever as high as 40° C (104° F). b. severe pain in the ear. c. nausea and vomiting. d. a feeling of fullness in the ear.

ANS: D OME is characterized by feeling of fullness in the ear or other nonspecific complaints. Fever is a sign of AOM. OME does not cause severe pain. This may be a sign of AOM. Nausea and vomiting are associated with otitis media.

Which is characteristic of dishonest behavior in children ages 8 to 10 years? a. Cheating during games is now more common. b. Lying results from the inability to distinguish between fact and fantasy. c. They may steal because their sense of property rights is limited. d. They may lie to meet expectations set by others that they have been unable to attain.

ANS: D Older school-age children may lie to meet expectations set by others to which they have been unable to measure up. Cheating usually becomes less frequent as the child matures. In this age group, children are able to distinguish between fact and fantasy. Young children may lack a sense of property rights; older children may steal to supplement an inadequate allowance, or it may be an indication of serious problems.

Which clinical manifestation would be the most suggestive of acute appendicitis? a. Rebound tenderness b. Bright red or dark red rectal bleeding c. Abdominal pain that is relieved by eating d. Abdominal pain that is most intense at McBurney point

ANS: D Pain is the cardinal feature. It is initially generalized, usually periumbilical. The pain localizes to the right lower quadrant at McBurney point. Rebound tenderness is not a reliable sign and is extremely painful to the child. Bright red or dark red rectal bleeding and abdominal pain that is relieved by eating are not signs of acute appendicitis.

Parents have understood teaching about prevention of childhood otitis media if they make which statement? a. "We will only prop the bottle during the daytime feedings." b. "Breastfeeding will be discontinued after 4 months of age." c. "We will place the child flat right after feedings." d. "We will be sure to keep immunizations up to date."

ANS: D Parents have understood the teaching about preventing childhood otitis media if they respond they will keep childhood immunizations up to date. The child should be maintained upright during feedings and after. Otitis media can be prevented by exclusively breastfeeding until at least 6 months of age. Propping bottles is discouraged to avoid pooling of milk while the child is in the supine position.

Parents ask the nurse whether it is common for their school-age child to spend a lot of time with peers. The nurse should respond, explaining that the role of the peer group in the life of school-age children provides: a. opportunity to become defiant. b. time to remain dependent on their parents for a longer time. c. time to establish a one-on-one relationship with the opposite sex. d. security as they gain independence from their parents.

ANS: D Peer-group identification is an important factor in gaining independence from parents. Children learn how to relate to people in positions of leadership and authority and how to explore ideas and the physical environment. Becoming defiant in a peer-group relationship may lead to bullying. Peer-group identification helps in gaining independence rather than remaining dependent. One-on-one opposite sex relationships do not occur until adolescence. School-age children form peer groups of the same sex.

The nurse is caring for a child with severe head trauma after a car accident. Which is an ominous sign that often precedes death? a. Papilledema b. Delirium c. Doll's head maneuver d. Periodic and irregular breathing

ANS: D Periodic or irregular breathing is an ominous sign of brainstem (especially medullary) dysfunction that often precedes complete apnea. Papilledema is edema and inflammation of optic nerve. It is commonly a sign of increased ICP. Delirium is a state of mental confusion and excitement marked by disorientation for time and place. The doll's head maneuver is a test for brainstem or oculomotor nerve dysfunction.

When administering a gavage feeding to a school-age child, the nurse should: a. lubricate the tip of the feeding tube with Vaseline to facilitate passage. b. check the placement of the tube by inserting 20 ml of sterile water. c. administer feedings over 5 to 10 minutes. d. position on right side after administering feeding.

ANS: D Position the child with the head elevated about 30 degrees and on the right side or abdomen for at least 1 hour. This is in the same manner as after any infant feeding to minimize the possibility of regurgitation and aspiration. Insert a tube that has been lubricated with sterile water or water-soluble lubricant. With a syringe, inject a small amount of air into the tube, while simultaneously listening with a stethoscope over the stomach area. Feedings should be administered via gravity flow and take from 15 to 30 minutes to complete.

Which is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature? a. Give tepid water baths to reduce fever. b. Encourage food intake to maintain caloric needs. c. Have child wear heavy clothing to prevent chilling. d. Give small amounts of favorite fluids frequently to prevent dehydration.

ANS: D Preventing dehydration by small frequent feedings is an important intervention in the febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting. The febrile child should be dressed in light, loose clothing.

Which is a common childhood communicable disease that may cause severe defects in the fetus when it occurs in its congenital form? a. Erythema infectiosum b. Roseola c. Rubeola d. Rubella

ANS: D Rubella causes teratogenic effects on the fetus. There is a low risk of fetal death to those in contact with children affected with fifth disease. Roseola and rubeola are not dangerous to the fetus.

An adolescent girl calls the nurse at the clinic because she had unprotected sex the night before and does not want to be pregnant. The nurse should explain that: a. it is too late to prevent an unwanted pregnancy. b. an abortion may be the best option if she is pregnant. c. Norplant can be administered to prevent pregnancy for up to 5 years. d. postcoital contraception is available to prevent implantation.

ANS: D Several emergency methods of contraception are available. Postcoital contraception options do exist. It is nontherapeutic to tell her it is too late or that an abortion is the best option. Norplant is not a postcoital contraceptive.

Which drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a. Ephedrine b. Theophylline c. Aminophylline d. Short-acting 2 agonists

ANS: D Short-acting 2 agonists are the first treatment in an acute asthma exacerbation. Ephedrine is not helpful in acute asthma exacerbations. Theophylline is unnecessary for treating asthma exacerbations. Aminophylline is not helpful for acute asthma exacerbation.

An appropriate intervention to encourage food and fluid intake in a hospitalized child is to: a. force child to eat and drink to combat caloric losses. b. discourage participation in noneating activities until caloric intake is sufficient. c. administer large quantities of flavored fluids at frequent intervals and during meals. d. give high-quality foods and snacks whenever child expresses hunger.

ANS: D Small, frequent meals and nutritious snacks should be provided for the child. Favorite foods such as peanut butter and jelly sandwiches, fruit yogurt, cheese, pizza, and macaroni and cheese should be available. Forcing a child to eat only meets with rebellion and reinforces the behavior as a control mechanism. Large quantities of fluid may decrease the child's hunger and further inhibit food intake.

An adolescent teen has bulimia. Which assessment finding should the nurse expect to assess? a. Diarrhea b. Amenorrhea c. Cold intolerance d. Erosion of tooth enamel

ANS: D Some of the signs of bulimia include erosion of tooth enamel, increased dental caries from vomited gastric acid, throat complaints, fluid and electrolyte disturbances, and abdominal complaints from laxative abuse. Diarrhea is not a result of the vomiting. It may occur in patients with bulimia who also abuse laxatives. Amenorrhea and cold intolerance are characteristics of anorexia nervosa, which some bulimics have. These symptoms are related to the extreme low weight.

Which symptoms should the nurse expect to observe during the physical assessment of an adolescent girl with severe weight loss and disrupted metabolism associated with anorexia nervosa? a. Dysmenorrhea and oliguria b. Tachycardia and tachypnea c. Heat intolerance and increased blood pressure d. Lowered body temperature and brittle nails

ANS: D Symptoms of anorexia nervosa include lower body temperature, severe weight loss, decreased blood pressure, dry skin, brittle nails, altered metabolic activity, and presence of lanugo hair. Amenorrhea, rather than dysmenorrhea, and cold intolerance are manifestations of anorexia nervosa. Bradycardia, rather than tachycardia, may be present.

A school nurse is teaching dental health practices to a group of sixth-grade children. How often should the nurse recommend the children brush their teeth? a. Twice a day b. Three times a day c. After meals d. After meals, snacks, and bedtime

ANS: D Teeth should be brushed after meals, after snacks, and at bedtime. Children who brush their teeth frequently and become accustomed to the feel of a clean mouth at an early age usually maintain the habit throughout life. Twice a day, three times a day or after meals would not be often enough.

Therapeutic management of a child with tetanus includes the administration of: a. nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation. b. muscle stimulants to counteract muscle weakness. c. bronchodilators to prevent respiratory complications. d. tetanus immunoglobulin therapy.

ANS: D Tetanus immunoglobulin therapy, to neutralize toxins, is the most specific therapy for tetanus. Tetanus toxin acts at the myoneural junction to produce muscular stiffness and lowers the threshold for reflex excitability. NSAIDs are not routinely used. Sedatives or muscle relaxants are used to help reduce titanic spasm and prevent seizures. Respiratory status is carefully evaluated for any signs of distress because muscle relaxants, opioids, and sedatives that may be prescribed may cause respiratory depression. Bronchodilators would not be used unless specifically indicated.

The nurse is performing a Glasgow Coma Scale on a school-age child with a head injury. The child opens eyes spontaneously, obeys commands, and is oriented to person, time, and place. Which is the score the nurse should record? a. 8 b. 11 c. 13 d. 15

ANS: D The Glasgow Coma Scale (GCS) consists of a three-part assessment: eye opening, verbal response, and motor response. Numeric values of 1 through 5 are assigned to the levels of response in each category. The sum of these numeric values provides an objective measure of the patient's level of consciousness (LOC). A person with an unaltered LOC would score the highest, 15. The child who opens eyes spontaneously, obeys commands, and is oriented is scored at a 15.

A 14-year-old male mentions that he now has to use deodorant but never had to before. The nurse's response should be based on knowledge that which occurs during puberty? a. Eccrine sweat glands in the axillae become fully functional during puberty. b. Sebaceous glands become extremely active during puberty. c. New deposits of fatty tissue insulate the body and cause increased sweat production. d. Apocrine sweat glands reach secretory capacity during puberty.

ANS: D The apocrine sweat glands, nonfunctional in children, reach secretory capacity during puberty. They secrete a thick substance as a result of emotional stimulation that, when acted on by surface bacteria, becomes highly odoriferous. They are limited in distribution and grow in conjunction with hair follicles, in the axilla, genital, anal, and other areas. Eccrine sweat glands are present almost everywhere on the skin and become fully functional and respond to emotional and thermal stimulation. Sebaceous glands become extremely active at this time, especially those on the genitalia and the "flush" areas of the body such as face, neck, shoulders, upper back, and chest. This increased activity is important in the development of acne. New deposits of fatty tissue is not the etiology of apocrine sweat gland activity.

The nurse approaches a group of school-age patients to administer medication to Sam Hart. To identify the correct child, the nurse's action is to: a. ask the group, "Who is Sam Hart?" b. call out to the group, "Sam Hart?" c. ask each child, "What's your name?" d. check the patient's identification name band.

ANS: D The child must be correctly identified before the administration of any medication. Children are not totally reliable in giving correct names on request; the identification bracelet should always be checked. Asking children or the group for names is not an acceptable way to identify a child. Older children may exchange places, give an erroneous name, or choose not to respond to their name as a joke.

Many of the physical characteristics of Down syndrome present nursing problems. Care of the child should include which intervention? a. Delay feeding solid foods until the tongue thrust has stopped. b. Modify diet as necessary to minimize the diarrhea that often occurs. c. Provide calories appropriate to child's age. d. Use a cool-mist vaporizer to keep mucous membranes moist.

ANS: D The constant stuffy nose forces the child to breathe by mouth, drying the mucous membranes and increasing the susceptibility to upper respiratory tract infections. A cool-mist vaporizer will keep the mucous membranes moist and liquefy secretions. The child has a protruding tongue, which makes feeding difficult. The parents must persist with feeding while the child continues the physiologic response of the tongue thrust. The child is predisposed to constipation. Calories should be appropriate to the child's weight and growth needs, not age.

Anorexia nervosa may best be described as: a. occurring most frequently in adolescent males. b. occurring most frequently in adolescents from lower socioeconomic groups. c. resulting from a posterior pituitary disorder. d. resulting in severe weight loss in the absence of obvious physical causes.

ANS: D The etiology of anorexia remains unclear, but a distinct psychological component is present. The diagnosis is based primarily on psychological and behavioral criteria. Females account for 90% to 95% of the cases. No relation has been identified between socioeconomic groups and anorexia. Posterior pituitary disorders are not associated with anorexia nervosa.

An adolescent asks the nurse what causes primary dysmenorrhea. The nurse's response should be based on which statement? a. It is an inherited problem. b. Excessive estrogen production causes uterine pain. c. There is no physiologic cause; it is a psychological reaction. d. There is a relation between prostaglandins and uterine contractility.

ANS: D The exact etiology of primary dysmenorrhea is debated. Overproduction of uterine prostaglandins has been implicated, as has overproduction of vasopressin. Dysmenorrhea is not known to be inherited. Excessive estrogen has not been implicated in the etiology. It has a physiologic cause. Women with dysmenorrhea have higher prostaglandin levels.

A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations should include which action? a. Encouraging normal activity for as long as is possible b. Explaining the cause of the disease to the child and family c. Preparing the child and family for long-term, permanent disabilities d. Teaching the family the care and management of the corrective appliance

ANS: D The family needs to learn the purpose, function, application, and care of the corrective device and the importance of compliance to achieve the desired outcome. The initial therapy is rest and non-weight bearing, which helps reduce inflammation and restore motion. Legg-Calvé-Perthes is a disease with an unknown etiology. A disturbance of circulation to the femoral capital epiphysis produces an ischemic aseptic necrosis of the femoral head. The disease is self-limiting, but the ultimate outcome of therapy depends on early and efficient therapy and the child's age at onset.

The mother of a toddler yells to the nurse, "Help! He is choking to death on his food." The nurse determines that lifesaving measures are necessary based on which symptom? a. Gagging b. Coughing c. Pulse over 100 beats/min d. Inability to speak

ANS: D The inability to speak is indicative of a foreign-body airway obstruction of the larynx. Abdominal thrusts are needed for treatment of the choking child. Gagging indicates irritation at the back of the throat, not obstruction. Coughing does not indicate a complete airway obstruction. Tachycardia may be present for many reasons.

The nurse is conducting teaching to parents of a 7-year-old child who fractured an arm and is being discharged with a cast. Which instruction should be included in the teaching? a. Swelling of the fingers is to be expected for the next 48 hours. b. Immobilize the shoulder to decrease pain in the arm. c. Allow the affected limb to hang down for 1 hour each day. d. Elevate casted arm when resting and when sitting up.

ANS: D The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return. Swelling of the fingers may indicate neurovascular damage and should be reported immediately. Permanent damage can occur within 6 to 8 hours. Joints above and below the cast on the affected extremity should be moved. The affected limb should not hang down for any length of time.

A mother calls the outpatient clinic requesting information on appropriate dosing for over-the-counter medications for her 13-month-old who has symptoms of an upper respiratory tract infection and fever. The box of acetaminophen says to give 120 mg q4h when needed. At his 12-month visit, the nurse practitioner prescribed 150 mg. The nurse's best response is: a. "The doses are close enough; it doesn't really matter which one is given." b. "It is not appropriate to use dosages based on age because children have a wide range of weights at different ages." c. "From your description, medications are not necessary. They should be avoided in children at this age." d. "The nurse practitioner ordered the drug based on weight, which is a more accurate way of determining a therapeutic dose."

ANS: D The method most often used to determine children's dosage is based on a specific dose per kilogram of body weight. The mother should be given correct information. For a therapeutic effect, the dosage should be based on weight, not age. Acetaminophen can be used to relieve discomfort in children at this age group.

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

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

The nurse is caring for an intubated infant with botulism in the pediatric intensive care unit. Which health care provider prescriptions should the nurse clarify with the health care provider before implementing? a. Administer 250 mg botulism immune globulin intravenously (BIG-IV) one time. b. Provide total parenteral nutrition (TPN) at 25 ml/hr intravenously. c. Titrate oxygen to keep pulse oximetry saturations greater than 92. d. Administer gentamicin sulfate (Garamycin) 10 mg per intravenous piggyback every 12 hours.

ANS: D The nurse should clarify the administration of an aminoglycoside antibiotic. Antibiotic therapy is not part of the management of infant botulism because the botulinum toxin is an intracellular molecule, and antibiotics would not be effective; aminoglycosides in particular should not be administered because they may potentiate the blocking effects of the neurotoxin. Treatment consists of immediate administration of botulism immune globulin intravenously (BIG-IV) without delaying for laboratory diagnosis. Early administration of BIG-IV neutralizes the toxin and stops the progression of the disease. The human-derived botulism antitoxin (BIG-IV) has been evaluated and is now available nationwide for use only in infant botulism. Approximately 50% of affected infants require intubation and mechanical ventilation; therefore, respiratory support is crucial, as is nutritional support because these infants are unable to feed.

An 8-month-old infant is restrained to prevent interference with the IV infusion. The nurse's action is to: a. remove the restraints once a day to allow movement. b. keep the restraints on constantly. c. keep the restraints secure so infant remains supine. d. remove restraints whenever possible.

ANS: D The nurse should remove the restraints whenever possible. When parents or staff are present, the restraints can be removed and the IV site protected. Restraints must be checked and documented every 1 to 2 hours. They should be removed for range of motion on a periodic basis. The child should not be securely restrained in the supine position because of risks of aspiration.

When caring for a child with an intravenous infusion, the nurse should: a. use a macrodropper to facilitate reaching the prescribed flow rate. b. avoid restraining the child to prevent undue emotional stress. c. change the insertion site every 24 hours. d. observe the insertion site frequently for signs of infiltration.

ANS: D The nursing responsibility for IV therapy is to calculate the amount to be infused in a given length of time; set the infusion rate; and monitor the apparatus frequently (at least every 1 to 2 hours) to make certain that the desired rate is maintained, the integrity of the system remains intact, the site remains intact (free of redness, edema, infiltration, or irritation), and the infusion does not stop. A minidropper (60 drops/ml) is the recommended IV tubing in pediatrics. The IV site should be protected. This may require soft restraints on the child. Insertion sites do not need to be changed every 24 hours unless a problem is found with the site. This exposes the child to significant trauma.

An adolescent gets hit in the eye during a fight. The school nurse, using a flashlight, notes the presence of gross hyphema (hemorrhage into anterior chamber). The nurse should: a. apply a Fox shield. b. instruct the adolescent to apply ice for 24 hours. c. have adolescent rest with eye closed and ice applied. d. notify parents that adolescent needs to see an ophthalmologist.

ANS: D The parents should be notified that the adolescent needs to see an ophthalmologist as soon as possible. Applying a Fox shield, instructing the adolescent to apply ice for 24 hours, and having the adolescent rest with eye closed and ice applied may cause further damage. Referral to an ophthalmologist is indicated.

The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complication should the nurse monitor related to the child's immobilization status? a. Metabolic rate increases b. Increased joint mobility leading to contractures c. Bone calcium increases, releasing excess calcium into the body (hypercalcemia) d. Venous stasis leading to thrombi or emboli formation

ANS: D The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. The metabolic rate decreases with immobilization. Loss of joint mobility leads to contractures. Bone demineralization with osteoporosis and hypercalcemia occur with immobilization.

Which is the preferred site for intramuscular injections in infants? a. Deltoid b. Dorsogluteal c. Rectus femoris d. Vastus lateralis

ANS: D The preferred site for infants is the vastus lateralis. The deltoid and dorsogluteal sites are used for older children and adults. The rectus femoris is not a recommended site.

Which statement is true about gonorrhea? a. It is caused by Treponema pallidum. b. Treatment is by multidose administration of penicillin. c. Treatment is by topical applications to lesions. d. Treatment of all sexual contacts is an essential part of treatment.

ANS: D The treatment plan should include finding and treating all sexual partners. Gonorrhea is caused by Neisseria gonorrhoeae. Syphilis is caused by T. pallidum. Primary treatment is with different antibiotics because of N. gonorrhoeae resistance to penicillin. Systemic therapy is necessary to treat this disease.

The nurse is talking to a parent with a child who has a latex allergy. Which statement by the parent would indicate a correct understanding of the teaching? a. "My child will have an allergic reaction if he comes in contact with yeast products." b. "My child may have an upset stomach if he eats a food made with wheat or barley." c. "My child will probably develop an allergy to peanuts." d. "My child should not eat bananas or kiwis."

ANS: D There are cross-reactions between latex allergies and a number of foods such as bananas, avocados, kiwi, and chestnuts. Children with a latex allergy will not develop allergies to other food products such as yeast, wheat, barley, or peanuts.

An adolescent boy tells the nurse that he has recently had homosexual feelings. The nurse's response should be based on knowledge that: a. this indicates the adolescent is homosexual. b. this indicates the adolescent will become homosexual as an adult. c. the adolescent should be referred for psychotherapy. d. the adolescent should be encouraged to share his feelings and experiences.

ANS: D These adolescents are at increased risk for health-damaging behaviors, not because of the sexual behavior itself, but because of society's reaction to the behavior. The nurse's first priority is to give the young man permission to discuss his feelings about this topic, knowing that the nurse will maintain confidentiality, appreciate his feelings, and remain sensitive to his need to talk about the topic. In recent studies among self-identified gay, lesbian, and bisexual adolescents, many of the adolescents report changing self-labels one or more times during their adolescence. An assessment must be made about any risks to himself or others. If these do not exist, the adolescent needs a supportive person to talk with.

The father of a 12-year-old child tells the nurse that he is concerned about his son getting "fat." His son is at the 50th percentile for height and the 75th percentile for weight on the growth chart. The most appropriate nursing action is to: a. reassure the father that his child is not fat. b. reassure the father that his child is just growing. c. suggest a low-calorie, low-fat diet. d. explain that this is typical of the growth pattern of boys at this age.

ANS: D This is a characteristic pattern of growth in preadolescent boys, where the growth in height has slowed in preparation for the pubertal growth spurt, but weight is still gained. The nurse should review this with both the father and the child and develop a plan to maintain physical exercise and a balanced diet. It is false reassurance to tell the father that his son is not fat. His weight is high for his height. The child needs to maintain his physical activity. The father is concerned, so an explanation is required. A nutritional diet with physical activity should be sufficient to maintain his balance.

Caring for the newborn with a cleft lip and palate before surgical repair includes: a. gastrostomy feedings. b. keeping infant in near-horizontal position during feedings. c. allowing little or no sucking. d. providing satisfaction of sucking needs.

ANS: D Using special or modified nipples for feeding techniques helps meet the infant's sucking needs. Gastrostomy feedings are usually not indicated. Feeding is best accomplished with the infant's head in an upright position. The child requires both nutritive and nonnutritive sucking.

Which may be given to high-risk children after exposure to chickenpox to prevent varicella? a. Acyclovir (Zovirax) b. Varicella globulin c. Diphenhydramine hydrochloride (Benadryl) d. VCZ immune globulin (VariZIG)

ANS: D VariZIG is given to high-risk children to prevent the development of chickenpox. Acyclovir decreases the severity, not the development, of chickenpox. Varicella globulin is not effective because it is not the immune globulin. Diphenhydramine may help pruritus but not the actual chickenpox.

A child is unconscious after a motor vehicle accident. The watery discharge from the nose tests positive for glucose. The nurse should recognize that this suggests: a. diabetic coma. b. brainstem injury. c. upper respiratory tract infection. d. leaking of cerebrospinal fluid (CSF).

ANS: D Watery discharge from the nose that is positive for glucose suggests leaking of CSF from a skull fracture and is not associated with diabetes or respiratory tract infection. The fluid is probably CSF from a skull fracture and does not signify whether the brainstem is involved.

The weight loss of anorexia nervosa is usually triggered by a. sexual abuse. b. school failure. c. independence from family. d. traumatic interpersonal conflict.

ANS: D Weight loss may be triggered by a typical adolescent crisis such as the onset of menstruation or a traumatic interpersonal incident; situations of severe family stress, such as parental separation or divorce; or circumstances in which the young person lacks personal control, such as being teased, changing schools, or entering college. "Sexual abuse," "school failure," and "independence from family" are not part of the behavioral characteristics of anorexia nervosa.

The nurse uses the palms of the hands when handling a wet cast for which reason? a. To assess dryness of the cast b. To facilitate easy turning c. To keep the patient's limb balanced d. To avoid indenting the cast

ANS: D Wet casts should be handled by the palms of the hands, not the fingers, to avoid creating pressure points. Assessing dryness, facilitating easy turning, and keeping the patient's limb balanced are not reasons for using the palms of the hand rather than the fingers when handling a wet cast.

The school nurse has been asked to begin teaching sex education in the fifth grade. The nurse should recognize that: a. children in fifth grade are too young for sex education. b. children should be discouraged from asking too many questions. c. correct terminology should be reserved for children who are older. d. sex can be presented as a normal part of growth and development.

ANS: D When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development. Fifth-graders are usually 10 or 11 years old. This age is not too young to speak about physiologic changes in their bodies. They should be encouraged to ask questions. Preadolescents need precise and concrete information.

Which are clinical manifestations of increased intracranial pressure (ICP) in infants? (Select all that apply.) a. Low-pitched cry b. Sunken fontanel c. Diplopia and blurred vision d. Irritability e. Distended scalp veins f. Increased blood pressure

ANS: D, E Diplopia and blurred vision, irritability, and distended scalp veins are signs of increased ICP in infants. Diplopia and blurred vision is indicative of ICP in children. A high-pitched cry and a tense or bulging fontanel are characteristics of increased ICP. Increased blood pressure, common in adults, is rarely seen in children.

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which intervention should be included in the child's care? (Select all that apply.) a. Place in a mist tent. b. Administer antibiotics. c. Administer cough syrup. d. Encourage to drink 8 ounces of formula every 4 hours. e. Cluster care to encourage adequate rest. f. Place on noninvasive oxygen monitoring.

ANS: D, E, F Hydration is important in children with RSV bronchiolitis to loosen secretions and prevent shock. Clustering of care promotes periods of rest. The use of noninvasive oxygen monitoring is recommended. Mist tents are no longer used. Antibiotics do not treat illnesses with viral causes. Cough syrup suppresses clearing of respiratory secretions and is not indicated for young children.