Peds Exam 2 - Elsevier Practice Questions

Which is most descriptive of the spiritual development of the older adolescent? A. Beliefs become more abstract. B. Rituals and practices become increasingly important. C. Strict observance of religious customs is common. D. Emphasis is placed on external manifestations, such as whether a person goes to church.

A. Beliefs become more abstract. Because of their abstract thinking abilities, adolescents are able to interpret analogies and symbols related to their spiritual development. Rituals and practices become less important as the adolescent questions values and ideals of families. Strict observation of religious customs becomes less important as the adolescent questions values and ideals of families. Adolescents question external manifestations when not supported by adherence to supportive behaviors. The adolescent's spiritual development is more internally driven.

It is time to give a 3-year-old medication. What approach is most likely to receive a positive response from the child? A. "It's time for your medication now. Would you like water or apple juice afterward?" B. "Wouldn't you like to take your medicine now?" C. "You must take your medicine because the doctor says it will make you better." D. "See how nicely your roommate took medicine? Now take yours."

A. "It's time for your medication now. Would you like water or apple juice afterward?" This statement provides the child with a structured choice with two acceptable options, which is important for preschoolers. As a question, it allows the child the option of saying no and therefore should be avoided. The statement "you must" can elicit negative behavior from the child. The nurse is also abdicating responsibility to the physician by telling the child, "The doctor said...." Competition is not appropriate for this age group. What one child does or how one child acts should not be used to entice another child to do something, such as taking a medication.

A nurse working with adolescents is aware of common drugs of abuse. Which of the following drugs is the most common drug of abuse in the adolescent population? A. Alcohol B. Morphine C. Cocaine D. Oxycontin

A. Alcohol Alcohol is the drug most often used and abused by the adolescent population. The ease of access and the low cost make alcohol the drug of choice for many teenagers. Morphine is not the most common drug of abuse in the adolescent population. Cocaine is not the most common drug of abuse in the adolescent population. Oxycontin is not the most common drug of abuse in the adolescent population.

An adolescent is accompanied by their mother for an annual physical examination. Based on the nurse's knowledge of this age group, the nurse should avoid questions on which topics? (Select all that apply.) A. Alcohol use B. Sexual activity C. Cigarette smoking D. School performance E. Use of car seat belts

A. Alcohol use B. Sexual activity C. Cigarette smoking The nurse must maintain confidentiality, which is between the nurse and adolescent. Therefore, while the mother is in the room, the nurse should not ask personal questions. The nurse must maintain confidentiality, which is between the nurse and adolescent. Therefore, while the mother is in the room, the nurse should not ask personal questions. The nurse must maintain confidentiality, which is between the nurse and adolescent. Therefore, while the mother is in the room, the nurse should not ask personal questions. The nurse can ask general questions about academic performance without breaching confidentiality. The nurse can ask general questions about safety issues such as use of car seat belts without breaching confidentiality.

Apnea of infancy has been diagnosed in an infant scheduled for discharge with home monitoring. Part of the infant's discharge teaching plan should include? A. Cardiopulmonary resuscitation (CPR) B. Administration of intravenous (IV) fluids C. Foreign airway obstruction removal using the Heimlich maneuver D. Advice that the infant not be left with caretakers other than the parents

A. Cardiopulmonary resuscitation (CPR) CPR is essential for all parents and caregivers to know, especially when an infant has a history of apnea of infancy that is being monitored at home. Most likely, the child will not be receiving home IV therapy as part of the discharge care. The Heimlich maneuver is used to intervene when a child or an adult is experiencing a choking episode. It would not be necessary for the parents to learn the maneuver at this time. (Back slaps and chest thrusts are used on the responsive infant for choking.) The parents should arrange for other caregivers to help when possible. There is no reason that the infant cannot be left with capable and trained individuals. Anyone caring for the infant will need to be taught to use equipment and how to perform CPR.

The most appropriate question to ask a rape victim prior to the start of the physical examination is A. Has she showered or bathed since the attack? B. Does she think rape is a violent crime? C. How many items did the attacker take? D. When the attack occurred, could she have prevented it?

A. Has she showered or bathed since the attack? The nurse needs to document if the patient has bathed or showered prior to collecting evidence from the rape. Cleaning the body could remove trace body secretions, such as saliva, semen, or blood, left by the perpetrator, which would be important to collect if possible. It is not appropriate to ask the patient if she thinks rape is a violent crime. It is not a priority to ask how many items the attacker took from her. It is not appropriate to ask the patient if she could have prevented the attack.

The nurse is concerned with the prevention of communicable disease. Primary prevention results from A. Immunizations B. Early diagnosis C. Strict isolation D. Treatment of disease

A. Immunizations Communicable diseases are prevented through immunizations, which constitute primary prevention. Early diagnosis can prevent the spread of communicable disease by initiating treatment and isolation if necessary; this would be considered secondary prevention. Strict isolation would be considered part of the treatment regimen and would constitute tertiary prevention, which is the prevention of complications or sequelae. Treatment of disease would not prevent communicable disease.

How does the onset of the pubertal growth spurt compare in girls and boys? A. In girls, it occurs about 2 years before it appears in boys. B. In girls, it occurs about 3 years before it appears in boys. C. In boys, it occurs about 1 year before it appears in girls. D. It is about the same in both boys and girls.

A. In girls, it occurs about 2 years before it appears in boys. The average age of onset for puberty is 12 years in girls and 14 years in boys. Although this may be true for an individual, the average difference is approximately 2 years. Usually, girls begin puberty and their growth spurt earlier than boys.

The school nurse is teaching a class on safety. Which activities require protective athletic gear? (Select all that apply) A. Lacrosse B. Football C. Swimming D. Gymnastics E. Skateboarding

A. Lacrosse B. Football E. Skateboarding Any sport that involves body contact such as lacrosse, football, and skateboarding requires a child to wear protective equipment. Swimming does not involve body contact and requires no protective equipment. Gymnastics does not require protective equipment.

Which statement is correct about young children who report sexual abuse by one of their parents? A. They may exhibit various behavioral manifestations. B. In most cases, the child has fabricated the story. C. Their stories are not believed unless other evidence is apparent. D. They should be able to retell the story the same way to another person.

A. They may exhibit various behavioral manifestations. There is no diagnostic profile of the child who is being sexually abused. Many different behavioral manifestations may be exhibited, from outward sexual behaviors with others to withdrawal and introversion. It is never appropriate to assume that a child has fabricated the story of sexual abuse. Adults are reluctant to believe children, and sexual abuse often goes unreported. Physical examination is normal in approximately 80% of abused children. The child will usually try to protect their parents and may accept responsibility for the act.

A sexually active adolescent asks the school nurse about prevention of sexually transmitted diseases (STDs). The most appropriate recommendation by the nurse is the use of A. condoms. B. prophylactic antibiotics. C. any type of contraception method. D. withdrawal method of contraception.

A. condoms. Prophylactic antibiotics are not recommended to prevent STDs. Antibiotics are only effective against bacteria, not viruses. Condoms provide a barrier to the organisms that cause STDs. Only condoms create a physical barrier that prevents contact with the organisms that cause STDs. Only condoms create a physical barrier that prevents contact with the organisms that cause STDs.

Evidence-based research shows that the most successful strategy for preventing smoking in teenagers is A. emphasis on immediate effects of smoking. B. emphasis on long-term effects of smoking. C. large-scale public information campaigns. D. threatening the social norms of groups most likely to smoke.

A. emphasis on immediate effects of smoking. An emphasis on immediate effects of smoking has proven to be one of the most effective strategies for preventing smoking. Information focuses on tobacco smell and other aesthetic issues. Because this age-group is neither future oriented nor consequence oriented, emphasis on the long-term effects of smoking does not work as well as focusing on the immediate effects. Public campaigns can be effective when focused on the immediate effects of smoking, but they often focus on the more long-term effects of smoking. Threatening social norms in adolescents is not an effective strategy for the prevention of smoking.

A 10-year-old child requires daily medications for a chronic illness. The mother tells the nurse that she is always nagging the child to take the medicine before school. The most appropriate nursing intervention to promote the child's compliance is to A. establish a contract with the child, including rewards. B. suggest time-outs when the child forgets her medicine. C. discuss with the child's mother the damaging effects of nagging. D. ask the child to bring her medicine containers to each appointment so that the pills can be counted.

A. establish a contract with the child, including rewards. For school-age children, behavior contracting with desirable rewards is an effective method of encouraging compliance. Any forms of negative consequences, such as time-outs, should only be used if the behavioral contracting is not successful. Although nagging is not an effective strategy, the nurse needs to assist the mother in problem solving. The technique of counting pills may be tried if the contracting is not successful, but it sends a punitive signal to the child that may make the situation worse.

Girls experience an increase in weight and fat deposition during puberty. Nursing considerations related to this include A. giving reassurance that these changes are normal B. suggesting dietary measures to control weight gain C. recommending increased exercise to control weight gain D. encouraging a low-fat diet to prevent fat deposition

A. giving reassurance that these changes are normal A certain amount of fat is increased along with lean body mass to fill the characteristic contours of the child's gender. A healthy balance must be achieved between expected healthy weight gain and obesity as related to these normal and expected physical changes. This should not be done unless weight gain is excessive. Eating disorders can develop in this group, and diet management should be considered only under a health care practitioner's care. Exercise is an important component in weight management but should never be done or encouraged in increased amounts or in excess to control weight gain that occurs normally during puberty. Some fat deposition is essential for normal hormonal regulation. Menarche is delayed in girls with body fat contents that are too low; therefore, a low-fat diet is not a recommended intervention.

The nurse observes erythema, pain, and edema at a child's intravenous (IV) infusion site with streaking along the vein. The nurse's priority action is to A. immediately stop the infusion. B. check for a good blood return. C. ask another nurse to check the IV site. D. increase IV drip with normal saline for 1 minute and recheck.

A. immediately stop the infusion. Erythema, pain, and edema at an IV site describe an extravasation or infiltration. The IV must be stopped to prevent further damage to the child. Blood return suggests that the IV catheter is still in the vein, but this does not address the immediacy of the assessment findings. Reassessment of the IV site by another nurse can be done once the IV has been stopped, which is the priority based on the assessment findings. The IV infusion should not be increased. It will add additional fluid to the child's tissue and could cause further damage.

An important nursing intervention in the care of a child with bacterial conjunctivitis is A. intermittent warm, moist compresses to remove crusts on the eye area. B. oral antihistamines to minimize itching. C. continuous warm compresses to relieve discomfort. D. application of optic corticosteroids to reduce inflammation.

A. intermittent warm, moist compresses to remove crusts on the eye area. The eye should be kept clean. Intermittent warm, moist compresses can soften the crusting for easier removal, maintaining the cleanliness of the eye. Antihistamines are not usually necessary for bacterial conjunctivitis. Continuous warm compresses would promote bacterial growth. Antibiotics are the treatment of choice for bacterial infections; optic corticosteroids are not warranted.

The best explanation for using pulse oximetry on young children is that it A. is noninvasive. B. is better than capnography. C. is more accurate than arterial blood gas measurements. D. provides intermittent measurements of oxygen.

A. is noninvasive. Pulse oximetry is a noninvasive method for determining oxygen saturation. Capnography measures carbon dioxide exhalation. It does not reflect oxygen perfusion. Pulse oximetry is less invasive and easier to test than arterial blood gases. Pulse oximetry provides continuous or intermittent measurements of oxygen saturation.

While caring for hospitalized adolescents, the nurse observes that sometimes they are skeptical of their parents' religious beliefs and practices. The nurse should recognize that this is A. normal in spiritual development. B. abnormal in spiritual development. C. related to illness and occurs only at times of crisis. D. related to the parents' inability to adequately explain their beliefs and practices.

A. normal in spiritual development. The behavior described occurs in stage 4 in spiritual development. Adolescents attempt to determine which of their parents' standards and beliefs to incorporate into their own. The behavior described is not abnormal. The behavior described is not applicable only during times of crisis. The behavior described is not related to the parents' inability to explain their beliefs and practices.

An adolescent girl is brought to the hospital emergency department by her parents after being raped. The girl is calm and controlled throughout the interview and examination. The nurse should recognize that this behavior is A. one of a variety of behaviors normally seen in rape victims. B. indicative of a higher-than-usual level of maturity in the adolescent. C. suggestive that a rape has not actually occurred. D. suggestive that the adolescent had severe emotional problems before the rape occurred.

A. one of a variety of behaviors normally seen in rape victims. Rape victims display a wide range of behaviors. A controlled manner may be an attempt to maintain composure and control while hiding inner turmoil. The responses described are indicative of those often assessed in rape victims. There are no data to support that a rape has not occurred. Physical assessment will provide valuable information. There are no data to support that the adolescent had prior emotional problems.

The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of A. pneumothorax. B. bronchodilation. C. carbon dioxide retention. D. increased viscosity of sputum.

A. pneumothorax. The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. The child needs to be seen as soon as possible. Bronchodilation would not produce the described symptoms. Carbon dioxide retention would not produce the described symptoms. The increased viscosity of sputum is characteristic of cystic fibrosis. The change in respiratory status is potentially due to a pneumothorax.

An infant with a congenital heart defect is receiving palivizumab (Synagis). Based on the nurse's knowledge of medication, the purpose of this medication is to A. prevent respiratory syncytial virus (RSV) infection. B. make isolation of the infant with RSV unnecessary. C. prevent secondary bacterial infection. D. decrease toxicity of antiviral agents.

A. prevent respiratory syncytial virus (RSV) infection. Palivizumab is a monoclonal antibody specifically used in the prevention of RSV. Monthly administration is expected to prevent infection with RSV. The goal of this drug is prevention of RSV. It will not affect the need to isolate the child if RSV develops. Palivizumab is specific to RSV, not bacterial infections. Palivizumab will have no effect on antiviral agents.

A child, age 7 years, is being treated at home and has a fever associated with a viral illness. The principal reason for treating the child's fever is A. relief of discomfort. B. reassurance that illness is temporary. C. prevention of secondary bacterial infection. D. prevention of life-threatening complications.

A. relief of discomfort. The primary reason for treating a fever with pharmacologic (acetaminophen and ibuprofen) or environmental interventions is to relieve discomfort in a child with a viral illness. Fever management does not provide reassurance that the illness is temporary. Fever-reducing medications do not have antibacterial actions and may inhibit the fever-enhancing effects on the immune system. Fever-reducing medications do not prevent life-threatening complications of viral illnesses.

A 6-year-old has difficulty hearing faint or distant speech. The child's speech is normal, but the child is having problems with school performance. This hearing loss would most likely be classified as A. slight. B. severe. C. moderate. D. inattentiveness rather than hearing loss.

A. slight. The definition of a slight hearing loss includes normal speech with difficulty hearing faint and/or distant speech. With severe hearing loss, the child may hear a loud voice if nearby and may be able to identify loud environmental noises. Moderate hearing loss results in symptoms of being able to understand conversation at a distance of 3 to 5 feet. Children with difficulty hearing faint or distant speech, but who have normal speech themselves, are by definition experiencing slight hearing loss.

A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a A. spacer. B. nebulizer. C. peak expiratory flow meter. D. trial of chest physiotherapy.

A. spacer. The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a mechanism to administer medications, but it cannot be used with metered-dose inhalers. Peak expiratory flow meters measure pulmonary function but are not related to medication administration. Chest physiotherapy is unrelated to medication administration.

When caring for a child with an intravenous (IV) infusion, the most appropriate nursing interventions are to (Select all that apply.) A. use an infusion pump with a microdropper to ensure the prescribed infusion rate. B. check IV fluids and infusion rate with another licensed professional. C. avoid restraining the child to prevent undue emotional stress. D. observe the insertion site frequently for signs of infiltration. E. change the insertion site every 24 hours.

A. use an infusion pump with a microdropper to ensure the prescribed infusion rate. B. check IV fluids and infusion rate with another licensed professional. D. observe the insertion site frequently for signs of infiltration. An infusion pump with a microdropper is recommended for IV infusions in pediatrics to ensure the correct amount is infused and checked at least every 1 to 2 hours to ensure that the desired rate is infused. IV fluids and infusion rates should be checked with another licensed professional to ensure right fluids and correct infusion rate based on the pediatric age and weight. The nurse is responsible for close observation at least every 1 to 2 hours to ensure the system remains intact and infusion site remains free of redness, edema, infiltration, or irritation. Soft restraints may be required at times in pediatrics to ensure the IV site is protected. IV infusion sites do not need to be changed every 24 unless a problem is found with the site. Frequent changes expose the pediatric patient to significant trauma.

The most appropriate nursing intervention for a child following a tonsillectomy is to A. watch for continuous swallowing. B. encourage gargling to reduce discomfort. C. position the child on the back for sleeping. D. apply warm compresses to the throat.

A. watch for continuous swallowing. Frequent swallowing is the most obvious early sign of bleeding from the operative site in a child who has had a tonsillectomy. Gargling should be avoided after a tonsillectomy because of potential trauma to the suture line. The child should be positioned on the side or abdomen to facilitate drainage after a tonsillectomy. Ice collars and cold liquids are encouraged for the child who has had a tonsillectomy. Cold therapy soothes and anesthetizes the area, decreasing the pain. Heat or warmth would increase the risk of bleeding.

A nurse is assessing a patient diagnosed with attention deficit hyperactive disorder (ADHD). What behavior would the nurse anticipate the patient to demonstrate? A. Ability to complete school work during class B. Requires reminders to keep focused and on task C. Is defiant with parents and refuses to complete chores at home D. Is aggressive with peers when asked to participate in team sports

B. Requires reminders to keep focused and on task Children with ADHD are often not able to remain focused and require frequent reminders to remain focused and complete an assigned task. They generally are not able to complete work at school and require extra time to complete assignments. The ability to complete school work during class is not something the nurse would anticipate this patient to demonstrate. Defiance with parents and refusal to complete chores at home are not behaviors the nurse would anticipate this patient to demonstrate. Aggression with peers when asked to participate in team sports is not typical of ADHD behavior.

Early detection of a hearing impairment is critical because of its effect on a variety of areas of a child's life. Which one is of primary importance? A. Reading development B. Speech development C. Relationships with peers D. Performance at school

B. Speech development The ability to hear sounds is essential for the development of speech. Babies imitate the sounds they hear as they begin to form sounds and eventually words as they grow and develop. The child will have greater difficulty reading, but the primary issue is the effect of hearing impairment on speech. Relationships with peers will be affected by the child's lack of hearing. The effect will be compounded by difficulties with oral communication. Performance at school will be affected by hearing impairment, but some schools are geared to children with hearing loss, and programs in regular schools address the needs of the hearing-impaired child.

Autism is a complex developmental disorder. Diagnostic criteria for autism include delayed or abnormal functioning in which area(s) before 3 years of age? (Select all that apply.) A. Parallel play B. Social interaction C. Gross motor development D. Inability to maintain eye contact E. Language as used in social communication

B. Social interaction D. Inability to maintain eye contact E. Language as used in social communication Children diagnosed with autism show delayed or abnormal functioning in social interactions. A hallmark characteristic of autism is the child's inability to make and maintain eye contact. A characteristic of autism is the child's delay of language at an early age or the sudden deterioration in extant expressive speech. Parallel play is not an area in which autistic children may show delay. When interacting with other children in other forms of play they display functional limitations. Gross motor development is not an area in which autistic children show delayed or abnormal functioning.

Which is descriptive of the social development of school-age children? A. Identification with peers is minimal B. Children frequently have "best friends" C. Boys and girls play equally with each other D. Peer approval is not yet an influence toward conformity

B. Children frequently have "best friends" Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid. Identification with the peer group is an important milestone for the school-age child to move toward independence from families. During the school-age years, same-sex peer groups are more prevalent; therefore, there is less interaction between boys and girls. Conforming to the rules is an essential part of group membership and, therefore, an important skill for the school-age child to learn in terms of peer relationships.

What is the most important goal when caring for an individual with anorexia nervosa? A. Encourage weight gain B. Correct malnutrition C. Limit fluid intake D. Provide effective oral care

B. Correct malnutrition Correct malnutrition is the priority goal of treatment. The individual with anorexia nervosa would probably not be receptive to encouragement of weight gain because of the complex etiology of the disorder. Anorexics often have low self-esteem and have a need for control, which they meet by controlling their eating. Fluids are often restricted by the individual with anorexia. It is important to correct fluid and electrolyte imbalances if present and not restrict fluid intake. Oral and dental care is more of an issue with the bulimia nervosa patient secondary to the excessive purging or vomiting episodes.

Which statement best represents infectious mononucleosis? A. Human herpesvirus type 2 is the principal cause. B. Herpes-like Epstein-Barr virus is the principal cause. C. Diagnosis is established by a complete blood count, which reveals a characteristic leukopenia. D. Diagnosis is established by clinical manifestations because diagnostic tests cannot confirm the diagnosis.

B. Herpes-like Epstein-Barr virus is the principal cause. Herpes-like Epstein-Barr virus accounts for most cases of mononucleosis. Herpes-like Epstein-Barr virus is the principal cause of mononucleosis. A complete blood count in an adolescent with mononucleosis would indicate a lymphocytic leukocytosis with atypical lymphs, not leukopenia. The monospot test is a highly specific test for mononucleosis.

What is the causative agent for erythema infectiosum (fifth disease)? A. Paramyxovirus B. Human parvovirus B19 C. Human herpesvirus type 6 D. Group A β-hemolytic streptococcus

B. Human parvovirus B19 Human parvovirus B19 is the causative agent of fifth disease. Paramyxovirus causes mumps. Human herpesvirus types 1 and 2 are the major causes of herpetic infections in humans. Group A β-hemolytic streptococcus is the causative agent for scarlet fever.

What is described as the time interval between early manifestations of a disease and the overt clinical syndrome? A. Incubation period B. Prodromal period C. Desquamation period D. Period of communicability

B. Prodromal period The prodromal period is defined as the symptoms that occur between early manifestations of the disease and overt clinical symptoms. The incubation period is the time from exposure to the appearance of the first symptom. The desquamation period refers to the shedding of skin when applicable for a syndrome or disorder. The period of communicability describes the period when the child is infectious.

A child is brought to the emergency department after falling down the basement stairs. On assessment, what findings may cause the nurse to suspect child abuse? (Select all that apply.) A. The childs bruises are located only on the right arm and leg. B. The child is brought to the emergency department by an unrelated adult. C. The child has a history of a broken arm last year from falling off a swing. D. The childs caregiver is anxious that the child get immediate medical attention. E. The child has red, green, and yellow bruises on more than one plane of the body.

B. The child is brought to the emergency department by an unrelated adult. E. The child has red, green, and yellow bruises on more than one plane of the body. A child brought to a healthcare provider for a trauma or suspicious injury by an unrelated adult or if the primary care provider is totally unavailable is a warning sign of abuse.<br>Varying degrees of healing of bruises in more than one plane of the body is a warning of abuse.<br>Falling down stairs can be an unintentional injury.<br>A child with an isolated documented injury is not a warning sign of abuse. Multiple fractures of differing ages are a warning sign of abuse.<br>An anxious caregiver is a normal response for an injured child. A delay in seeking care is a warning sign of abuse.

The most appropriate time to perform bronchial postural drainage is A. immediately before all aerosol therapy. B. before meals and at bedtime. C. immediately on arising and at bedtime. D. thirty minutes after meals and at bedtime

B. before meals and at bedtime. The most effective time for bronchial drainage is before meals and before bedtime to prevent the interaction of excessive amounts of mucus and food intake, thereby increasing the risk of vomiting. Bronchial drainage is more effective after other respiratory therapies such as bronchodilator or nebulizer treatments. These treatments open the airways, facilitating the movement of mucus with the positioning of bronchial drainage. Bronchial drainage should be done three or four times each day to be effective. When bronchial drainage is completed after meals, it may cause the child to vomit.

The nurse is discussing health behaviors with a 14-year old who recently began smoking cigarettes. An appropriate tactic for the nurse to use when discussing this lifestyle choice is A. cigarette smoking is only "cool" in high school and is not accepted in college. B. cigarette smoking can cause permanent damage to the lungs and can cause cancer as an adult. C. cigarettes are expensive, and a 14-year-old will not be able to afford them, so he should stop smoking. D. cigarettes contain nicotine, and this will cause addiction to other drugs.

B. cigarette smoking can cause permanent damage to the lungs and can cause cancer as an adult. Cigarette smoking can cause permanent damage to the lungs and can cause cancer as an adult. At 14, the child only thinks of the present. The nurse would need to include and explain, and even use pictures to illustrate, what might happen to the body if the child continues to smoke. Saying cigarette smoking is only cool in high school and is not accepted in college is not a useful tactic the nurse should use when discussing smoking cigarettes. Suggesting that cigarettes are not affordable and the 14-year-old should therefore stop smoking is not a healthy approach to teaching adolescents to stop smoking. Cigarettes contain nicotine, and this will cause addiction to other drugs. Adolescents are not often concerned with whether cigarette smoking will lead to other addictions.

The management of adolescent obesity should include A. planning a low-calorie, low-protein diet. B. incorporating favorite foods into the diet. C. encouraging diversional activities during mealtimes. D. using nutritious foods as a method of reward.

B. incorporating favorite foods into the diet. Incorporating small amounts of the adolescent's favorite foods will increase adherence to the nutritional plan. A food plan high in nutrients with calories and fats at a healthy level is recommended. Adolescents need calories and protein in appropriate amounts to allow continued physical growth during a growth spurt and puberty. Diversional activities such as television watching may contribute to overeating and should be discouraged. Food should never be used as a reward.

An adolescent boy tells the school nurse that he is gay. The nurse's response should be based on knowledge that A. he is too young to have had enough sexual activity to determine his sexual orientation at this time. B. it is important to provide a nonthreatening environment for him to discuss his feelings. C. the nurse should feel open in discussing his or her own beliefs about homosexuality. D. homosexual adolescents do not have concerns that differ from those of heterosexual adolescents.

B. it is important to provide a nonthreatening environment for him to discuss his feelings. The nurse needs to be open and nonjudgmental in interactions with adolescents who have questions about their sexual orientation. This will allow a safe environment for the adolescents to speak and receive guidance from a health care professional as warranted. Adolescence is when sexual identity develops; therefore, questions about sexual orientation often surface at this time. The nurse's own beliefs should not bias the interaction with this student and, therefore, are irrelevant. Homosexual adolescents have different challenges to growing up and their sexual identity than heterosexual adolescents, often related to societal, cultural, religious, and spiritual influences.

An important consideration in preventing injuries during middle childhood is that A. peer pressure is not strong enough to affect risk-taking behavior. B. most injuries occur in or near school or home. C. injuries from burns are the highest at this age because of fascination with fire. D. lack of muscular coordination and control results in an increased incidence of injuries.

B. most injuries occur in or near school or home. Most children in the middle years spend the majority of their time in and around school or home; therefore, the risk for injuries is increased in and around these areas. Peer pressure as an impetus for risk-taking behavior begins in the school-age years but is more significant in adolescence. Burn injuries are higher in the toddler years, when children are curious and mobile. They may expose themselves to objects capable of burning them (e.g., hot pots of water in the kitchen). Automobile accidents, either as a pedestrian or passenger, account for the majority of severe accidents in the middle years. School-age children have more refined muscle development, which results in an overall decrease in the number of accidents. Lack of muscular coordination and control leading to injuries occurs in younger children.

When caring for the suicidal adolescent, the most important nursing intervention is A. emphasizing that a suicide attempt is an immature way of dealing with stress B. paying particular attention to children who are withdrawn and are giving away their personal belongings C. ignoring threats of suicide because they are usually bids for attention D. recognizing a suicide attempt as an impulsive act resulting from a temporary crisis

B. paying particular attention to children who are withdrawn and are giving away their personal belongings It is imperative that the nurse recognize warning signs of a potential suicide. For the depressed youngster, suicide may appear to be the only way out, and telling a child that he or she is immature in feelings or behavior will exacerbate an already crisis-laden situation. All threats of suicide must be taken seriously and should never be ignored. Even if the crisis is temporary, the child's perception may be that suicide is the only way out of it.

An immediate intervention to teach parents for when an infant chokes on a piece of food would be to A. have infant lie quietly while a call is placed for emergency help. B. position infant in a head-down, face-down position and administer five quick back slaps. C. administer mouth-to-mouth resuscitation. D. give some water by a cup to relieve the obstruction.

B. position infant in a head-down, face-down position and administer five quick back slaps. Positioning the infant head and face down while administering five quick blows between the shoulder blades is the correct initial sequence of actions for an infant with an obstructed airway. The infant needs to receive treatment immediately. Emergency help is called after attempting to remove the obstruction. Mouth-to-mouth resuscitation should not be used. This may push the object further into the child's respiratory system. If the child is obstructed, the water will not be able to pass. This will increase the risk of aspiration.

When conducting a class on sex and sexual activities with adolescents, the most appropriate approach by the nurse is to A. use dolls to teach the content. B. present normal body functions in a straightforward manner. C. refer the adolescents to their parents for sexual information. D. delay giving information about pregnancy unless the adolescents are sexually active.

B. present normal body functions in a straightforward manner. The nurse should provide accurate and complete information using correct terminology that is understandable to the adolescent. Dolls are appropriate for teaching a younger age-group of children. Using the correct terminology is more appropriate for a group of adolescents. Parents are important for conveying the morals and values surrounding sexual activities, but nurses may provide adolescents with accurate, complete information. Adolescents should have information before they become sexually active about the potential consequences of sex, including the practice of safe sex to prevent pregnancy and the transmission of sexually transmitted diseases.

The primary goal in caring for the child with cognitive impairment is to A. encourage play. B. promote optimum development. C. help families develop a care plan and have them stay with it. D. develop vocational skills.

B. promote optimum development. A comprehensive approach is desirable to establish acceptable social behavior and feelings of self-worth and promote optimum development. Providing parents guidance for the selection of developmentally appropriate activities is only one component in a comprehensive care plan. Care for the mentally retarded child is an ongoing process that changes as the child meets developmental milestones. The development of vocational skills will be addressed as the child's capabilities are developing and is one component of the comprehensive care plan.

A 16-year-old girl tells the school nurse that she has not started to menstruate. The most appropriate nursing intervention is to A. explain that this is not unusual. B. refer the adolescent for an evaluation. C. assume that the adolescent is pregnant. D. suggest the adolescent stop exercising until menarche occurs.

B. refer the adolescent for an evaluation. This meets the definition of primary amenorrhea and should be evaluated. Menstruation usually begins approximately 2 years after the beginning of secondary sex characteristics. Although pregnancy is a possibility, the nurse should not assume that the girl is pregnant until further assessment is performed. There is no indication that the adolescent is exercising excessively.

The onset of puberty in boys is characterized by A. voice changes. B. testicular enlargement. C. growth of dark pubic hair. D. increased size of the penis.

B. testicular enlargement. This is the first change that signals puberty in boys during Tanner stage 2 of sexual development. Voice changes occur between Tanner stages 3 and 4 of sexual development. Fine pubic hair may occur at the base of the penis early in puberty, but darker hair occurs during Tanner stage 3 of sexual development. The penis enlarges during Tanner stage 3 of sexual development.

The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37ºC (98.6ºF). The mother states the child is not having difficulty breathing. The nurse suspects croup and should recommend A. controlling the fever with acetaminophen (Tylenol) and call the primary care provider if the cough gets worse tonight. B. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. C. trying over-the-counter cough medicine and coming to the clinic tomorrow if there is no improvement. D. bringing the child to the hospital to be admitted and to be observed for impending epiglottitis.

B. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief because this therapy will assist in opening up the child's airways. The child does not have a temperature and, therefore, does not need management with acetaminophen. Cough suppressants are not indicated by symptom, and the American Pediatrics Association no longer recommends over-the-counter cough medicines for children under the age of 2 years. A barking cough is characteristic of laryngotracheobronchitis, not epiglottitis.

Standard precautions for infection control include A. gloves are worn anytime a patient is touched. B. needles are capped immediately after use and disposed of in a special container. C. gloves are worn to change diapers when there are loose or explosive stools. D. masks are needed only when caring for patients with airborne infections.

C. gloves are worn to change diapers when there are loose or explosive stools. Handling diapers with loose or explosive stools has the greatest risk for exposure to body substances. Gloves are not indicated, unless there is potential for contact with body substances. Needles should never be recapped. They should be immediately disposed of in a rigid, puncture-proof container. Masks are a component of transmission-based precautions, not standard precautions.

A nurse is working with teenagers and their parents in a school drug prevention program. Several of the parents ask how they can determine if their child has a problem with drugs. The most appropriate response by the nurse is A. "There is no way to know until they tell you." B. "At some point, the child will develop depression and attempt suicide; then you can put them in rehab." C. "It is common for them to withdraw and not achieve normal developmental tasks. You should then consult a professional." D. "You should make your child take a home test for drugs. You can buy those at the drug store."

C. "It is common for them to withdraw and not achieve normal developmental tasks. You should then consult a professional." Children and teenagers who begin using drugs may often stop participating in routine activities and not continue to achieve the normal milestones of the adolescent period. If the parent ever has a question, they should seek information from a health care provider. Waiting for the child to tell the parent is not a way to determine if the child has a problem with drugs. It is a very passive approach to parenting. Waiting for the child to develop depression and attempt suicide is not a preventive approach to handling drug use. Taking a home test for drugs is not a measure that should be taken unless the child has been caught engaging in drug use.

A parent tells the nurse, "I am worried about my 13-year-old son. He hasn't started puberty, and my daughter did when she was 11 years of age." The most appropriate explanation by the nurse is A. "This is unusual and requires further evaluation of your son." B. "This is unusual because the onset of pubescence is usually the same in siblings." C. "This is normal because the onset of pubescence is usually earlier in girls than it is in boys." D. "This is abnormal because the onset of pubescence is usually earlier in boys than it is in girls."

C. "This is normal because the onset of pubescence is usually earlier in girls than it is in boys." Girls begin puberty on average approximately 2 years before boys. Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, no further evaluation is necessary at this time. The age of pubescence is gender related, with the average age of puberty onset being 12 years for girls and 14 years for boys. Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, her son is not having an abnormal onset of puberty.

Because the absorption of fat-soluble vitamins is decreased in cystic fibrosis, which vitamin supplementation is necessary? A. C, D B. A, E, K C. A, D, E, K D. C, folic acid

C. A, D, E, K A, D, E, and K are the fat-soluble vitamins, which need to be supplemented in higher doses for the child with cystic fibrosis. C is not one of the fat-soluble vitamins. D also needs to be supplemented in children with cystic fibrosis. C and folic acid are not fat-soluble vitamins.

What is an important consideration for the school nurse planning a class on injury prevention for adolescents? A. Adolescents generally are not risk takers. B. Adolescents can anticipate the long-term consequences of serious injuries. C. Adolescents need to discharge energy, often at the expense of logical thinking. D. During adolescence, participation in sports should be limited to prevent permanent injuries.

C. Adolescents need to discharge energy, often at the expense of logical thinking. The physical, sensory, and psychomotor development of adolescents provides a sense of strength and confidence. There is also an increase in energy coupled with risk taking that puts them at risk, because they often ignore logical thinking. Adolescents tend to be risk takers because of their feelings of indestructibility. The feelings of indestructibility that accompany adolescence interfere with understanding the consequences of their behavior, thus increasing their potential for injuries. Sports can be a useful way to discharge energy and should not be limited. Care must be taken to avoid overuse injuries and to use appropriate protective equipment.

What is defined as reduced visual acuity in one eye despite appropriate optical correction? A. Myopia B. Hyperopia C. Amblyopia D. Astigmatism

C. Amblyopia The definition of amblyopia is the reduction of visual acuity in one eye despite appropriate optical correction. Myopia is near-sightedness, which is the ability to see objects up close but not clearly at a distance. Hyperopia is far-sightedness, which is the ability to clearly see distant objects but not close ones. Astigmatism is an alteration in vision caused by unequal curvature in the eye's refractive apparatus.

What should the nurse include when giving parents guidelines about helping their children in school? A. Help children as much as possible with their homework. B. Punish children who fail to perform adequately. C. Communicate with teachers if there appears to be a problem. D. Accept responsibility for children's successes and failures.

C. Communicate with teachers if there appears to be a problem. Parents should communicate with teachers if there is a problem and not wait for a scheduled conference. Parent involvement is one factor in children's success in school. Children need to do their own homework. This cultivates responsibility. Discipline should be used to help children control behaviors that might be affecting school performance, but failure to perform adequately should not be punished itself. Communicating with the child is a better solution to getting to the "root" of the school performance problem. School-age children need to develop responsibility. Keeping promises and meeting deadlines lays a successful foundation for adulthood and adult responsibilities.

The school nurse is discussing dental health with some children in first grade. Which should be included? A. Teach how to floss teeth properly. B. Recommend a toothbrush with hard nylon bristles to get in between the teeth. C. Emphasize the importance of brushing before bedtime. D. Recommend nonfluoridated toothpaste.

C. Emphasize the importance of brushing before bedtime. Children should be taught to brush their teeth after meals and snacks and before bedtime to prevent dental caries. Parents should help with flossing until children develop the dexterity required, when they are in about the third grade. A toothbrush with soft nylon bristles is recommended to prevent damage to the gums. The American Dental Association recommends fluoridated toothpaste for this age-group.

Which behavior is most characteristic of the concrete operations stage of cognitive development? A. Progression from reflex activity to imitative behavior B. Inability to put oneself in another's place C. Increasingly logical and coherent thought processes D. Ability to think in abstract terms and draw logical conclusions

C. Increasingly logical and coherent thought processes Increasingly logical and coherent thought processes are characteristic of concrete operations. Children in this stage are able to classify objects. Progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage, which occurs from birth to 2 years of age. Inability to put oneself in another's place is characteristic of the preoperational stage, ages 2 to 7 years. Adolescents, in the formal operations stage, have the ability to think in abstract terms and draw logical conclusions.

Which symptoms are commonly seen in a child with depression? (Select all that apply.) A. Focus on violence B. Excessive laughing C. Somatic complaints D. Increased motor activity E. Poor school performance

C. Somatic complaints E. Poor school performance Children with depression will complain of nonspecific complaints such as not feeling well. Children with depression will show a lack of interest in doing homework or achieving in school and getting lower grades than usual. Focus on violence can be associated with depression in the adolescent. A child with depression exhibits predominantly sad facial expression with absence or diminished range of affective response. Children with depression will have diminished motor activity and complain of being too tired.

The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. Based on the nurse's knowledge of this age-group, the most appropriate recommendation is A. Organized sports, such as soccer, are not appropriate at this age B. Competition is detrimental to the establishment of a positive self-image C. Sports participation is encouraged if the sport is appropriate to the child's abilities D. Girls should compete only against girls because at this age boys are larger and have more muscle mass

C. Sports participation is encouraged if the sport is appropriate to the child's abilities The parents should help the child select a sport that is suitable to her capabilities and interests. Team sports contribute to the school-age child's social, intellectual, and skill growth. Organized sports for school-age children can provide safe, appropriate activities with supportive parents and coaches. The desire to participate in competitive team sports develops out of a need for peer interaction for the school-age child. A sport should be selected that meets the child's capabilities and interests. The physical changes in boys described take place during puberty, later in the school-age years; therefore, there is no reason for boys and girls to compete separately at age 8 years.

Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. Which should the nurse consider when discussing this issue with the parents? A. Changing self-esteem is difficult after about age 5 years. B. Self-esteem is the objective judgment of one's worthiness. C. Transitory periods of lowered self-esteem are expected developmentally. D. High self-esteem develops when parents show adequate love for the child.

C. Transitory periods of lowered self-esteem are expected developmentally. Self-esteem changes with development. Transient declines are expected and, with positive encouragement and support, are only temporary. Self-esteem is influenced throughout adolescence. One aspect of self-esteem is a subjective judgment of one's worthiness. Self-esteem is based on several factors, including competence, sense of control, moral worth, and worthiness of love and acceptance.

The school nurse is concerned about an outbreak of chickenpox because two children at the school have cancer and are immunodeficient from chemotherapy. The most appropriate recommendation by the school nurse is that A. no precautions necessary. B. Acyclovir (Zovirax) should be taken to minimize the symptoms of chickenpox. C. Varicella-zoster immune globulin (VZIG) to prevent chickenpox. D. temporarily stopping chemotherapy will allow the immune system to recover.

C. Varicella-zoster immune globulin (VZIG) to prevent chickenpox. VZIG is an antibody to the virus that causes chickenpox. Administration of VZIG can prevent development of the disease in immunocompromised children secondary to chemotherapy. Chickenpox can be a life-threatening event for a child who is immunocompromised and must be addressed. Acyclovir is effective in reducing the number of lesions from chickenpox, but in immunodeficient children the disease itself should be prevented. The administration of VZIG does not place the child at any greater risk; therefore, there is no need to stop chemotherapy.

When should clear liquids be stopped before scheduled surgery? A. 2 hours before surgery B. 6 hours before surgery C. Varies according to the surgical procedure to be done D. The night before surgery, at midnight

C. Varies according to the surgical procedure to be done Each surgical procedure may have a different requirement for when nothing by mouth (NPO) status should be initiated. The nurse should follow the surgeon's or anesthesiologist's order as to when clear liquids should be stopped. Although 2 hours before surgery is a common time for stopping clear liquids to reduce the risk of pulmonary aspiration in healthy patients, the timing may vary. Therefore, it should be clarified with the surgeon or anesthesiologist. Although a 6-hour time frame is often used for stopping milk and milk products before surgery, the timing may vary. Therefore, it should be clarified with the surgeon or anesthesiologist. Stopping clear liquids by midnight may be too long a period before surgery. Therefore, the timing should be clarified with the surgeon or anesthesiologist.

A 13-year-old boy is concerned about bilateral breast enlargement. The most appropriate explanation by the nurse is based on knowing that this is A. a sign of too much body fat B. a sign of hormonal imbalance C. a normal occurrence during puberty D. an indication of precocious puberty

C. a normal occurrence during puberty Gynecomastia, or enlargement of the breast tissue, is common during midpuberty in about one third of boys. For most boys, the breast enlargement disappears within 2 years. Although overweight boys may have excess body weight in the breast area, in boys of normal body weight, gynecomastia is a normal occurrence during puberty. If gynecomastia persists beyond 2 years, then a hormonal cause may need to be investigated. Precocious puberty is the early onset of puberty, before age 9 years in boys, and is not related to the gynecomastia.

Informed consent is valid when (Select all that apply) A. universal consent is used B. it is completed only for major surgery C. a person is over the age of majority and competent D. information is provided to make an intelligent decision E. the choice exercised is free of force, fraud, duress, or coercion

C. a person is over the age of majority and competent D. information is provided to make an intelligent decision E. the choice exercised is free of force, fraud, duress, or coercion The age of majority is usually 18 years. The term competent is defined as possessing the mental capacity to make choices and understand their consequences. Enough information is provided so that the person can make an intelligent decision. The person giving consent does so voluntarily, that is, freely without coercion, any form of constraint, force, fraud, duress, or deceit. Universal consent is not sufficient. Informed consent must be obtained for each surgical or diagnostic procedure. Informed consents must be obtained for major and minor surgery, diagnostic tests, medical treatments, release of medical information, postmortem examination, removal of a child from the health care provider against medical advice, and photographs for medical, educational, or public use.

The parents of a cognitively impaired child ask the nurse for guidance with discipline. The most appropriate recommendation by the nurse is that A. discipline is ineffective with cognitively impaired children. B. discipline is not necessary for cognitively impaired children. C. behavior modification is an excellent form of discipline. D. physical punishment is the most appropriate form of discipline.

C. behavior modification is an excellent form of discipline. Positive behaviors and desirable actions should be reinforced with cognitively impaired children. Behavior modification with positive reinforcement is effective in children with cognitive impairment. Discipline is essential to assist the child in developing boundaries. Most children with cognitive impairment will not be able to understand the reason for the physical punishment, and the behavior will not change. Physical punishment is not an acceptable form of discipline.

The parents of 9-year-old twins tell the nurse, "They have filled up their bedroom with collections of rocks, shells, stamps, and cars." The nurse should recognize that this behavior is characteristic of A. giftedness. B. typical "twin" behavior. C. cognitive development at this age. D. psychosocial development at this age.

C. cognitive development at this age. Classification skills are developed during the school-age years. This age-group enjoys sorting objects according to shared characteristics. Giftedness is not measured simply by a school-age child's ability to classify objects, which is an expected cognitive skill for this age-group. Giftedness signs include specific academic aptitudes, advanced memory skills, creative thinking, ability in the visual or performing arts, and psychomotor ability, either individually or in combination. The development of classification skills is characteristic of the school-age child and is not related to the behavior of twins. Psychosocial development of the school-age child is focused on accomplishment or industry, not the cognitive skills of classification that are described.

Nursing interventions to promote health during middle childhood should include A. stressing the need for increased calorie intake to meet the increased demands on the body. B. instructing parents to defer questions about sex until the child reaches adolescence. C. educating the child and parents about the need for effective dental hygiene because these are the years in which permanent teeth erupt. D. advising parents that the child will need decreasing amounts of rest toward the end of this period.

C. educating the child and parents about the need for effective dental hygiene because these are the years in which permanent teeth erupt. Because the permanent teeth are present, it is important for the child to learn how to care for these teeth. Caloric needs are diminished in relation to body size during the middle years; however, a balanced diet is important to prepare for the adolescent growth spurt. Parents should approach sex education with a life span approach and ANS questions appropriate to the child's age. School-age children often need to be reminded to go to sleep.

Therapeutic management of an 11-year-old girl with Turner syndrome involves A. administration of thyroid and human growth hormones. B. progesterone therapy until development of secondary sex characteristics. C. estrogen therapy to promote development of secondary sex characteristics. D. estrogen therapy until menses are well established and height no longer increases.

C. estrogen therapy to promote development of secondary sex characteristics Although the response is variable, most girls with Turner syndrome will achieve some feminization with estrogen therapy. Growth hormone may be administered, but unless there is a concurrent hypothyroidism, thyroid hormone is not indicated. Progesterone does not facilitate development of secondary sex characteristics and thus is not warranted. Menses may never be established due to lack of a uterus and ovaries, and estrogen will not promote increased height.

Several types of long-term central venous access devices are used in practice. The benefit of using a long-term central venous access device such as a Port-a-Cath is that A. implanted devices are easy to use for self-administered infusions. B. implanted devices do not require piercing the skin for access. C. implanted devices do not require limiting regular physical activity, including swimming. D. implanted devices cannot dislodge, even if child "plays" with the port site.

C. implanted devices do not require limiting regular physical activity, including swimming. Because this device is totally implanted under the skin, there are no activity limitations for the child. The implantable port has to be accessed with a special needle, making it difficult to self-administer infusions. Because the implantable port is totally under the skin, a needle must be used to access the port; therefore, the skin must be pierced for access. The implantable port site is under the skin, so the child cannot play with it.

A neonate had corrective surgery 3 days ago for esophageal atresia. The nurse notices that after gastrostomy feedings, there is often a backup of feeding into the tube. The most appropriate intervention by the nurse is to A. position the child in a supine position after feedings. B. position the child on the left side after feedings. C. leave the gastrostomy tube open and suspended after feedings. D. leave the gastrostomy tube clamped after feedings.

C. leave the gastrostomy tube open and suspended after feedings. The formula is backing up into the tube because of delayed emptying. By keeping the tube open to air, it will prevent the buildup of pressure on the operative site and the subsequent backup of feeding into the tube. The child should be positioned on the right side with the head elevated approximately 30 degrees after feeding. The child should be positioned on the right side with the head elevated approximately 30 degrees after feeding. Leaving the gastrostomy tube clamped after feedings will create pressure on the operative site and increase the risk of backup of the feedings.

A 12-year-old child being seen in the clinic has not received the hepatitis B (HBV) vaccine. Based on the nurse's knowledge of vaccines, the most appropriate recommendation is A. only one dose of HBV will be needed sometime during adolescence. B. one dose of HBV is needed at age 14 years. C. the three-dose series of HBV should be started at this time. D. the three-dose series of HBV should be started at age 16 years or sooner if the adolescent becomes sexually active.

C. the three-dose series of HBV should be started at this time. Adolescents should be vaccinated against hepatitis B at this age if they have not been previously. Three doses of HBV are required to achieve immunity. The recommendation is that the HBV vaccine series be started at birth. The American Academy of Pediatrics recommends that vaccinations be completed by age 13 years.

What clinical manifestation would the nurse expect when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation? A. Barrel chest B. Wheezing C. Thermal instability D. Nasal flaring and retractions

D. Nasal flaring and retractions Nasal flaring, retractions, and grunting are signs of respiratory distress in a neonate. Barrel chest develops with chronic obstructive pulmonary disease, not with acute pneumothorax. Wheezing has a greater association with bronchopulmonary dysplasia or an obstruction in the airways than with an acute pneumothorax. An acute pneumothorax would not affect the neonate's thermal stability.

The school nurse is teaching a class on injury prevention. What should be included when discussing firearms? A. Adolescents are too young to use a gun properly for hunting. B. Gun carrying among adolescents is on the rise, primarily among inner-city youth. C. Nonpowder guns (air rifles, BB guns) are a relatively safe alternative to powder guns. D. Adolescence is the peak age for being either a victim or an offender in an injury involving a firearm.

D. Adolescence is the peak age for being either a victim or an offender in an injury involving a firearm. Gun carrying among adolescents is on the rise. The increase in gun availability is linked to increased gun injuries and deaths among children. Adolescents can be taught to safely use and store guns for hunting. Gun carrying is on the rise in adolescents and is not limited to stereotypical inner-city youth. Nonpowder guns, such as air rifles and BB guns, cause almost as many injuries as powder guns.

A child with asthma is having pulmonary function tests. What explains the purpose of the peak expiratory flow rate (PEFR)? A. Confirms the diagnosis of asthma B. Determines the cause of asthma C. Identifies the "triggers" of asthma D. Assesses the severity of asthma

D. Assesses the severity of asthma The PEFR measures the maximum amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared with the child's baseline. The diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination, not pulmonary function tests such as the PEFR. The cause of asthma is inflammation, bronchospasm, and obstruction, which are not identified by the PEFR. Some of the triggers of asthma are identified with allergy testing, not with the PEFR.

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent A. otitis media. B. diabetes insipidus. C. nephrotic syndrome. D. acute rheumatic fever.

D. acute rheumatic fever. Children with group A β-hemolytic streptococci (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis. Otitis media is not a complication of acute streptococcal pharyngitis. Diabetes insipidus is not a complication of acute streptococcal pharyngitis. Children who have had acute streptococcal pharyngitis are at risk for acute glomerulonephritis, not nephrotic syndrome.

The school nurse is asked to speak with the parents of a 10-year-old boy who has been bullying other children. The nurse's response should be based on knowledge that A. Bullying at this age is considered normal B. Children who bully others usually join gangs C. Bullying is a short-term problem that is generally outgrown by the end of the school-age years D. Bullying often manifests itself in children who are different or have poor academic or social skills

D. Bullying often manifests itself in children who are different or have poor academic or social skills Poor relationships with peers and a lack of group identification, such as looking different or having poor academic or social skills, contribute to bullying behavior. Bullying is a maladaptive response to poor relationships with peers and lack of group identification; therefore, it is not considered normal behavior. Children who chronically bully tend to be impulsive, easily frustrated, and at increased risk for dropping out of school, but there is no direct correlation between bullies and joining gangs. Children who bully may be at risk for long-term psychological disturbances and psychiatric symptoms. Future problems for bullies may include violence, substance abuse, and criminal convictions, which often occur in adulthood.

What is characteristic of children with posttraumatic stress disorder (PTSD)? A. Denial as a defense mechanism is unusual. B. Traumatic effects cannot remain indefinitely. C. Previous coping strategies and defense mechanisms are not useful. D. Children often play out the situation over and over again in an attempt to come to terms with their fear.

D. Children often play out the situation over and over again in an attempt to come to terms with their fear. This is an expected response by a child to a traumatic event. Play is often the safest means of communication for children and should be encouraged as a means of expression with a child experiencing PTSD. Denial is a defense mechanism commonly used by children and adolescents. Professional help is indicated if the stages of response are prolonged. Coping strategies and defense mechanisms that have been effective previously may be effective for PTSD.

The nurse is collecting history on a 16-year-old admitted for treatment of anorexia nervosa. The patient limits the answers to yes or no. What is the primary nursing goal for this patient at this time? A. Ask about favorite foods to provide for them to eat. B. Return to ask further questions when the patient wants to talk. C. Discuss the treatment plan and expected stay in the hospital. D. Develop a positive rapport with the patient.

D. Develop a positive rapport with the patient. The nurse would focus on development and establishing a positive rapport with the patient at the early stage. Eating disorders in children often stem from low self-esteem. Children with eating disorders may have low self-esteem and a lack of trust in others. It is important to establish a trusting relationship with the patient. Asking the patient about favorite foods is not a question that will build rapport with the patient. Returning to ask further questions when the patient wants to talk is not the primary nursing goal at this time. Discussing the treatment plan and expected stay in the hospital is not an appropriate goal because the patient is not open to discussion at this time.

The parents of a child with fragile X syndrome want to have another baby. They tell the nurse that they worry another child might be similarly affected. What is the most appropriate nursing action? A. Reassure them that the syndrome is not inherited. B. Assess for family history of the syndrome. C. Recommend that they do not have another child. D. Explain that prenatal diagnosis of the syndrome is now available.

D. Explain that prenatal diagnosis of the syndrome is now available. Fragile X syndrome can now be detected prenatally. The family should be referred for genetic counseling. Fragile X syndrome is inherited on the X chromosome. This should be done, but it does not address the parents' concern and need for genetic counseling. Nurses do not make recommendations related to whether parents should become pregnant and have other children. A referral for genetic counseling is indicated, and, based on findings, the geneticist can present family planning options, but the decision is strictly up to the family.

Which is characteristic of the psychosocial development of school-age children? A. A developing sense of initiative is important. B. Peer approval is not yet a motivating factor. C. Motivation comes from extrinsic rather than intrinsic sources. D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment. The school-age child is eager to develop skills and participate in activities. All children are not able to do all tasks well, and the child must be prepared to accept some feelings of inferiority, as highlighted in Erikson's stage for this age-group of industry versus inferiority. Initiative versus guilt is the stage characteristic of preschoolers. Peer group formation is one of the major characteristics of school-age children. School-age children gain satisfaction from independent behaviors that are internally driven and accomplished.

The nurse is teaching a class on the dangers of "huffing." What information is included as a major side effect of "huffing?" A. Cardiac arrest B. Loss of vision C. Delay of growth D. Loss of consciousness

D. Loss of consciousness Skin discoloration is not a side effect of huffing. Cardiac arrest is not typically a major side effect of huffing. Loss of consciousness and respiratory arrest are major side effects of huffing. Delay of growth is not a side effect of huffing.

Cystic fibrosis may affect one system or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations? A. Atrophic changes in the mucosal wall of the intestines B. Hypoactivity of the autonomic nervous system C. Hyperactivity of the apocrine glands D. Mechanical obstruction caused by increased viscosity of exocrine gland secretions

D. Mechanical obstruction caused by increased viscosity of exocrine gland secretions Children with cystic fibrosis have thick exocrine gland secretions. The viscous secretions obstruct small passages in organs such as the lungs and pancreas. Thick mucous secretions are the probable cause of the multiple body system involvement, not atrophic changes in the intestinal mucosal walls. There is an identified autonomic nervous system anomaly, but it is not hypoactivity. The apocrine, or sweat, glands are not hyperactive. The child loses a greater amount of salt due to abnormal chloride movement.

The nurse needs to take the blood pressure of a preschooler for the first time. What action would be best for gaining the child's cooperation? A. Take the blood pressure when a parent is there to comfort the child. B. Tell the child that this procedure will help the child to get well faster. C. Explain to the child how blood flows through the arm and why taking the blood pressure is important. D. Permit the child to handle equipment and see the dial move before putting the cuff in place.

D. Permit the child to handle equipment and see the dial move before putting the cuff in place. The best approach for a preschooler is to allow the child to play out the experience ahead of time, thereby decreasing the child's anxiety. The parent's presence will be helpful, but it will not alleviate fear of the unknown. Telling a child that the procedure will help the child to get well faster is not a true statement, and the child will not be able to understand the relationship between the blood pressure and feeling better. The explanation of how blood pressure is determined physiologically is too complex an explanation for this age group.

The nurse is doing preoperative teaching with a child and the parents. The parents say the child "is dreading the shot for before surgery." On which of the following facts should the nurse's response be based? A. Preanesthetic medication can only be given intramuscularly. B. In children, the intramuscular (IM) route is safer than the intravenous (IV) route. C. The child will have no memory of the injection because of amnesia. D. Preanesthetic medication should be "atraumatic," using oral, existing IV, or rectal routes.

D. Preanesthetic medication should be "atraumatic," using oral, existing IV, or rectal routes. The necessity of premedication is being investigated. If necessary, numerous drug regimens and routes exist; the route is not limited to the IM route. Preanesthetic medicines can be given in a variety of routes other than intramuscularly. The IV route is preferable to the IM route for premedication. The muscle may be sore after the injection. Therefore, the child may have a memory, and telling the child otherwise will create distrust between the nurse and the child or family.

What is an important consideration related to childhood stress? A. Children should be protected from stress. B. Children do not have coping strategies. C. Parents cannot prepare children for stress. D. Some children are more vulnerable to stress than others.

D. Some children are more vulnerable to stress than others. Children's age, temperament, life situation, and state of health affect their vulnerability, reactions, and ability to handle stress. It is not feasible to protect children from all stress. Children can be taught coping strategies. Supportive interpersonal relationships are essential to the psychological well-being of children. Adults need to recognize signs of stress before they become overwhelming. Providing children with interpersonal security helps them develop coping strategies for dealing with stress.

The nurse is interviewing the parents of a 4-month-old infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in the crib with a blanket over the head, lying face down in bloody fluid from the nose and mouth. The parents indicate no problems when the infant was placed in the crib asleep. Which of the following causes of death does the nurse suspect? A. Suffocation B. Child abuse C. Infantile apnea D. Sudden infant death syndrome (SIDS)

D. Sudden infant death syndrome (SIDS) Death is consistent with the appearance of SIDS. The infant is usually found in a disheveled bed; with blankets over the head; huddled into a corner and clutching the sheets; with frothy, blood-tinged fluid in the mouth and nose; and lying face down. The diaper is also usually full of stool, indicating a cataclysmic type of death. Although the child was found under the blanket, the other findings are consistent with SIDS. The findings as reported are consistent with SIDS, not child abuse. The history and physical findings are consistent with SIDS, not infantile apnea.

In planning sex education and contraceptive teaching for adolescents, what should the nurse consider? A. Most teenagers today are knowledgeable about reproductive anatomy and physiology. B. Both sexual activity and contraception require planning. C. Most teenagers who become pregnant do so as an act of hostility, especially toward the parents. D. Teenagers need contraception education in both oral and written form.

D. Teenagers need contraception education in both oral and written form. Sex education and contraceptive information need to be concrete and concise. Oral explanations with demonstrations and written explanations with diagrams should be provided. Sex education and contraceptive teaching are independent of adolescents' knowledge of reproductive anatomy and physiology. Contraception requires planning. Most adolescents are sexually active for 6 months to 1 year before seeking contraceptive information. Most adolescent sexual activity is unplanned. There are no data to support that most teenage pregnancies occur as acts of hostility toward parents.

The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. What action should the nurse take next? A. Notify the surgeon. B. Perform oral intubation. C. Try inserting a larger tracheostomy tube. D. Try inserting a smaller tracheostomy tube.

D. Try inserting a smaller tracheostomy tube. A smaller tracheostomy tube should be available at the bedside at all times. Insertion of the smaller tube will keep the stoma open until further action can be taken. Notification of the surgeon should be done after the emergent situation is handled. Oral intubation is done if a tracheostomy tube cannot be inserted. A larger tracheostomy tube would cause trauma to the trachea and, therefore, is not used.

The nurse is teaching a community health promotion class to parents and school-age children related to bicycle safety. Issues to cover in the sessions include A. bicycle helmets need to be worn only if the child is planning to ride in traffic. B. reflectors should be installed only on bicycles that are to be ridden at night. C. bicycles should be ridden against the traffic so that the rider can see the cars. D. bicycles should be walked through busy intersections.

D. bicycles should be walked through busy intersections. Bicycles should be walked through busy intersections to allow the child to have full view of the traffic and be able to react accordingly, with safety the number one priority. Bicycle helmets should be worn at all times to prevent head injuries. Reflectors should be installed on all bicycles, whether they are ridden during the daytime or at night only. Bicycles should always be ridden with the traffic, not against the traffic. This will assist in preventing accidents.

One of the goals for children with asthma is to prevent respiratory tract infection because infections A. lessen effectiveness of medications. B. encourage exercise-induced asthma. C. increase sensitivity to allergens. D. can trigger an episode or aggravate asthmatic state.

D. can trigger an episode or aggravate asthmatic state. Respiratory tract infections can trigger an asthmatic attack. An annual influenza vaccine is recommended. All respiratory equipment should be kept clean. Respiratory tract infection affects the asthma, not the medications. Exercise-induced asthma is caused by vigorous activity, not a respiratory tract infection. Sensitivity to allergens is independent of respiratory tract infection.

A 15-year-old female is in a free clinic seeking information on birth control. The girl tells the nurse that she is sexually active with multiple partners. She states that she does not want to have to remember to take a pill every day. The most appropriate birth control option for this patient is A. an intrauterine device. B. abstinence. C. diaphragm. D. condom.

D. condom. Condom use is recommended for birth control in teens who are sexually active with multiple partners. An intrauterine device is not a method of birth control that protects from sexually transmitted diseases. Abstinence is not an effective approach to birth control for a teen who is sexually active with multiple partners. A diaphragm is not a method of birth control that protects from sexually transmitted diseases.

The nurse needs to give an injection to a 4-year-old in the deltoid muscle. Based on the nurse's knowledge of preschool development, the most appropriate approach by the nurse is to A. smile while giving the injection to help the child relax. B. tell the child that you will be so quick, the injection won't even hurt. C. explain that child will experience "a little stick in the arm." D. explain with concrete terms such as "putting medicine under the skin."

D. explain with concrete terms such as "putting medicine under the skin." By using concrete terms, the nurse helps the child understand what the nurse is going to do. Facial expressions are too abstract. The young child will not correlate a smile with relaxation. Distraction techniques are more appropriate. The nurse does not know that the injection will not hurt the child. Lying or distorting the truth is never appropriate. This response will block trust, especially if the injection does hurt the child. The child may visualize an actual stick being placed in the arm. Children at this age are very literal.

The most appropriate comfort intervention for a child with itching related to chickenpox is A. encourage frequent warm baths. B. give aspirin or acetaminophen (Tylenol). C. apply thick coat of pramoxine (Caladryl) lotion over open lesions. D. give an antipruritic medication such as diphenhydramine (Benadryl). E. apply thick coat of pramoxine (Caladryl) lotion over open lesions.

D. give an antipruritic medication such as diphenhydramine (Benadryl). Antipruritic medicines such as diphenhydramine are useful for severe itching, which interferes with sleep and may contribute to secondary infection. Cool baths, not warm ones, are recommended for relief of itching secondary to chickenpox. Neither drug provides antipruritic effects, nor should aspirin ever be given to children with chickenpox, because there is an increased risk of developing Reye syndrome. Caladryl lotion, which contains diphenhydramine, should be applied sparingly, not in thick coats, over open lesions to minimize absorption.

The nurse is assessing a child with herpetic gingivostomatitis. The nurse wears gloves when examining the lesions. This nursing action is A. unnecessary because the virus is sexually transmitted. B. unnecessary because the virus is not easily spread. C. necessary only if the nurse touches his or her own mouth after touching the child's mouth. D. necessary because virus can easily enter breaks in the skin.

D. necessary because virus can easily enter breaks in the skin. HSV easily enters breaks in the skin and can cause herpetic whitlow on the fingers. Herpetic gingivostomatitis is usually caused by herpes simplex virus (HSV) 1. HSV 2 is usually transmitted through sexual activity. Gloves are always necessary because the virus is easily spread.

A 4-year-old child is brought to the emergency department. The child has a "froglike" croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. The priority action by the nurse is to A. examine the child's oropharynx and report the assessment to the healthcare provider. B. make the child lie down and rest quietly. C. auscultate the child's lungs and make preparations for placement in a mist tent. D. notify the healthcare provider immediately and be prepared to assist with a tracheostomy or intubation.

D. notify the healthcare provider immediately and be prepared to assist with a tracheostomy or intubation. Sitting upright, drooling, agitation, and a froglike cough are indicative of epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary. Examination of the oropharynx may cause total obstruction and should not be done when a child manifests signs indicating potential epiglottitis. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase the respiratory distress and anxiety. Interventions should be planned once the diagnosis of epiglottitis has been made or ruled out.

A 5-year-old has bilateral eye patches in place after surgery one day earlier. Today, the child can be out of bed. The most appropriate nursing intervention is to A. reassure the child and allow the parents to stay B. allow the child to assist in self-feeding C. speak to the child when entering the room D. orient the child to the immediate surroundings

D. orient the child to the immediate surroundings Because the child is out of bed with both eyes patched, the immediate safety concern is for the child to be familiar with his or her immediate surroundings. Reassurance of the child is essential throughout the hospitalization, as is allowing the parents to stay with their child. Orientation to the room now that the child is out of bed with both of the eyes patched is the priority at this time. The child should be allowed to self-feed with assistance as needed. The child should always be referred to by name and spoken to when entering the room.

The nurse is preparing a plan to teach a mother how to administer 1 1/2 teaspoons of medicine to her 6-month-old child. Based on the nurse's knowledge of administering pediatric medications, the nurse teaches the parent to use a A. household measuring spoon. B. regular silverware teaspoon. C. paper cup measure in 5-ml increments. D. plastic syringe (without needle) calibrated in milliliters.

D. plastic syringe (without needle) calibrated in milliliters. Plastic calibrated syringes, without a needle, offer the most accurate measurement for medication administration in the infant. The nurse should teach the mother to give the child 7.5 mL of the medication. Household measuring spoons can be used if other, more precise devices are not available, but they are not the preferred method of medication administration for an infant. Regular silverware teaspoons are not acceptable for medication administration, because household teaspoons vary greatly in size. A paper cup marked with 5-mL increments does not contain calibration for the additional 2.5 mL that is needed for this infant's required dosage, and its use would therefore limit the accuracy of the dosage.

A 2-week-old infant with Down syndrome is being seen in the clinic. The mother tells the nurse that the infant is difficult to hold. "The baby is like a rag doll and doesn't cuddle up to me like my other babies did." The nurse interprets the infant's behavior as a A. sign of maternal deprivation. B. sign of detachment and rejection. C. sign of autism associated with Down syndrome. D. result of the physical characteristics of Down syndrome.

D. result of the physical characteristics of Down syndrome. Lack of clinging (or molding) between child and mother is a result of the muscle hypotonicity and hyperextensibility of the joints associated with Down syndrome. Mothers may have difficulty with attachment to their child due to the lack of clinging or molding behavior characteristic of Down syndrome. The nurse should recommend swaddling and wrapping the baby before picking up. There is no indication of maternal deprivation. Lack of clinging or molding is not symptomatic of detachment and rejection. These physical signs are characteristic of Down syndrome. Autism is not associated with Down syndrome.

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it A. liquefies secretions. B. improves oxygenation. C. promotes ventilation. D. soothes inflamed mucous membrane.

D. soothes inflamed mucous membrane. Humidified inspired air soothes the membranes inflamed by the infection and dry air. The size of the droplets in humidified air is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation.

The diagnosis of intellectual disability is based on the presence of A. intelligence quotient (IQ) of 75 or less. B. IQ of 70 or less. C. subaverage intellectual functioning, deficits in adaptive skills, and onset at any age. D. subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age.

D. subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age. The diagnosis of intellectual disability is made with the presentation of subaverage intellectual functioning, deficits in adaptive skills, and an onset before age 18. IQ is only one component of the diagnosis of intellectual disability. IQ is only one component of the diagnosis of intellectual disability. The onset of the deficit in adaptive skills and subaverage intellectual functioning must occur before age 18 years to meet the diagnosis of intellectual disability.

The genetic testing of a child with Down syndrome showed that the disorder was caused by chromosomal translocation. The parents ask about further genetic testing. Based on the nurse's knowledge of genetics, the most appropriate recommendation is A. no further genetic testing of the family is indicated. B. the child should be retested to confirm the diagnosis of Down syndrome. C. the mother should be tested if she is over age 35. D. the parents can be tested, since it might be hereditary.

D. the parents can be tested, since it might be hereditary. The parents and any siblings should be tested. Down syndrome resulting from a translocation may be inherited. This type of chromosomal abnormality presents issues for future pregnancies. The child does not require further genetic testing, but the parents and siblings should be further evaluated with genetic testing. There is no need to retest the child at a later date, because the diagnosis has been validated with chromosomal testing. This type of chromosomal abnormality occurs in children of parents of all ages.