PEDS Exam 2

An 8-month-old is brought to the emergency department with a temperature of 104.6% F (40.3% C). He's dehydrated and has right-ankle edema. He's admitted to the pediatric inpatient unit with a diagnosis of sickle cell anemia. The infant hasn't had symptoms before this age because in the first few months of life he had: - 1 fetal hemoglobin. 2 immature liver function. 3 increased circulatory blood volume. 4 increased immunity from maternal antibodies.

fetal hemoglobin. Neonates are born with 60% to 90% fetal hemoglobin, which is gradually replaced by abnormal sickle hemoglobin when there is sickle cell anemia. Immature liver function doesn't protect the infant from sickle cell crisis. The infant's circulatory blood volume isn't increased. Increased immunity from maternal antibodies protects the infant from infectious diseases.

When caring for their infant, a parent asks you, "Is Emily in a lot of pain? How would you know since she can't really tell you?" The best answer to this question is: A. "Infants don't feel pain as we do because their pain receptors are not fully developed yet." B. "The nurses give pain medication before she really feels the pain." C. "We assess her pain using an infant pain assessment tool and give the medicine as needed." D. "Although we try to give her medicine before she feels pain, we watch her very closely and use different techniques to help relieve the pain."

"Although we try to give her medicine before she feels pain, we watch her very closely and use different techniques to help relieve the pain."

The nurse is discussing cystic fibrosis with the parents of a child newly diagnosed with CF. Which of the following statements by the parents indicates that they understand cystic fibrosis? Select one: a. "CF will affect my child until after going through puberty" b. "My child is less prone to respiratory infections" c. "My child will occasionally require chest physiotherapy" d. "CF causes thick mucous secretions in the respiratory system"

"CF causes thick mucous secretions in the respiratory system"

The nurse is teaching a staff development program about levels of sedation in the pediatric population. Which statement by one of the participants should indicate a correct understanding of the teaching? a. "With minimal sedation, the patient's respiratory efforts are affected, and cognitive function is not impaired." b. "With general anesthesia, the patient's airway cannot be maintained, but cardiovascular function is maintained." c. "During deep sedation, the patient can be easily aroused by loud verbal commands and tactile stimulation." d. "During moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation."

"During moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation." When discussing levels of sedation, the participants should understand that during moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation, cognitive function is impaired, and respiratory function is adequate. In minimal sedation, the patient responds to verbal commands and may have impaired cognitive function; the respiratory and cardiovascular systems are unaffected. In deep sedation, the patient cannot be easily aroused except by painful stimuli; the airway and spontaneous ventilation may be impaired, but cardiovascular function is maintained. With general anesthesia, the patient loses consciousness and cannot be aroused with painful stimuli, the airway cannot be maintained, and ventilation is impaired; cardiovascular function may or may not be impaired.

. The nurse is giving discharge instructions to the parents of a 5-year-old child who had a tonsillectomy 4 hours ago. What statement by the parent indicates a correct understanding of the teaching? a. "I can use an ice collar on my child for pain control along with analgesics." b. "My child should clear the throat frequently to clear the secretions." c. "I should allow my child to be as active as tolerated." d. "My child should gargle and brush teeth at least three times per day."

"I can use an ice collar on my child for pain control along with analgesics." Pain control after a tonsillectomy can be achieved with application of an ice collar and administration of analgesics. The child should avoid clearing the throat or coughing and does not need to gargle and brush teeth a certain number of times per day and should avoid vigorous gargling and toothbrushing. Also, the child's activity should be limited to decrease the potential for bleeding, at least for the first few days.

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

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

A nurse is teaching a 14-year-old about sickle cell anemia. Which statement is correct? - 1 "Physical exertion won't increase the risk of a sickle cell crisis." 2 "Increasing your fluid intake can help prevent a sickle cell crisis." 3 "Taking an extended trip to the mountains shouldn't be a problem." 4 "If you experience cold symptoms for more than a week, call your physician."

"Increasing your fluid intake can help prevent a sickle cell crisis." The easiest and best way to prevent a sickle cell crisis is to increase fluid intake to eight 8-oz (240-ml) glasses of water a day. This keeps the blood diluted and prevents hemoconcentration. Physical exertion and high altitudes can increase the likelihood of sickling. Cold symptoms should be reported to the physician right away because illness can precipitate a crisis

The nurse is discussing the treatment plan with the parents of a 4-year-old diagnosed with asthma as part of the discharge teaching. Which of the following statements by the parent would indicate the need for further teaching? Select one: a. "My child should check their peak flow once a week" b. "I should wash the spacer after each use" c. "There are different medications for acute and long-term treatment" d. "We should try to avoid things that trigger my child's asthma"

"My child should check their peak flow once a week"

Children as young as age 3 years can use facial scales for discrimination. What are some suggested anchor words for the preschool age group? a. "No hurt." b. "Red pain." c. "Zero hurt." d. "Least pain."

"No hurt." "No hurt" is a phrase that is simple, concrete, and appropriate to the preoperational stage of the child. Using color is complicated for this age group. The child needs to identify colors and pain levels and then choose an appropriate symbolic color. This is appropriate for an older child. Zero is an abstract construct not appropriate for this age group. "Least pain" is less concrete than "no hurt."

A nurse is teaching the parents of a 7-year-old boy with hemophilia A about health promotion strategies. Which statement by the boy's mother indicates a need for further teaching? - 1 "We don't give our son medications that contain aspirin." 2 "We've taught our son to check his urine for signs of bleeding." 3 "When our son falls, we elevate the injured area and apply ice for 24 hours." 4 "Our backyard is fenced in so I let my son and his friends play outside while I do the housework."

"Our backyard is fenced in so I let my son and his friends play outside while I do the housework." Outside play should be supervised, and a fence won't prevent such injuries as falls or being hit with a baseball. Restricting the use of aspirin, elevating an injured area, and checking for evidence of bleeding are all correct interventions.

The larynx of a child is narrow and funnel shaped. To prevent airway obstruction during care, the nurse would place the child in which position? Select one: a. Prone b. Side-lying with neck hyperextended c. Supine with neck flexed d. "Sniffing" position (chin up) while being held upright

"Sniffing" position (chin up) while being held upright

The nurse is teaching the parents of a child with recurrent headaches methods to modify behavior patterns that increase the risk of headache. Which statement by the parents indicates understanding the teaching? a. "We will allow the child to miss school if a headache occurs." b. "We will respond matter-of-factly to requests for special attention." c. "We will be sure to give much attention to our child when a headache occurs." d. "We will be sure our child doesn't have to perform at a band concert if a headache occurs."

"We will respond matter-of-factly to requests for special attention." To modify behavior patterns that increase the risk of headache or reinforce headache activity, the nurse instructs the parents to avoid giving excessive attention to their child's headache and to respond matter-of-factly to pain behavior and requests for special attention. Parents learn to assess whether the child is avoiding school or social performance demands because of headache.

The nurse is planning to administer a nonopioid for pain relief to a child. Which timing should the nurse plan so the nonopioid takes effect? a. 15 minutes until maximum effect b. 30 minutes until maximum effect c. 1 hour until maximum effect d. 1 1/2 hours until maximum effect

1 hour until maximum effect Nonsteroidal antiinflammatory drugs (NSAIDs) can provide safe and effective pain relief when dosed at appropriate levels with adequate frequency. Most NSAIDs take about 1 hour for effect, so timing is crucial.

A series of subdiaphragmatic abdominal thrusts (the Heimlich maneuver) is recommended for airway obstruction in children older than which age? a. 1 year b. 4 years c. 8 years d. 12 years

1 year A series of subdiaphragmatic abdominal thrusts (the Heimlich maneuver) is recommended for airway obstruction in children older than 1 year. For children younger than 1 year, back blows and chest thrusts are administered.

Complementary and alternative medicine therapies are grouped into five classes. Match the complementary or alternative therapy to its classification. a. Vitamins b. Massage c. Reiki d. Hypnosis e. Homeopathy 1. Manipulative treatment 2. Energy based 3. Alternative medical system 4. Mind-body technique 5. Biologically based

1. Massage 2. Reiki 3. Hemeopathy 4. Hyponosis 5. Vitamins

The nurse is teaching a parent of an infant to limit the amount of formula to encourage the intake of iron-rich food. What amount should the nurse teach to the parent? a. 500 ml b. 750 ml c. 1000 ml d. 1250 ml

1000 ml The nurse should teach the parent to limit the amount of formula to no more than 1 1/day to encourage intake of iron-rich solid foods.

The clinic nurse is evaluating lab results for a child. What recorded hemoglobin (Hgb) result is considered within the normal range? a. 9 g/dl b. 10 g/dl c. 11 g/dl d. 12 g/dl

12 g/dl Normal hemoglobin (Hgb) determination is 11.5 to 15.5 g/dl.

How much oxygen is contained in ambient air (room air)? a. 15% b. 21% c. 30% d. 42%

21% Room air is composed of 21% oxygen, trace amounts of carbon dioxide, and 79% nitrogen.

The clinic nurse is evaluating lab results for a child. What recorded hematocrit (Hct) result is considered within the normal range? a. 30% b. 40% c. 50% d. 60%

40% Normal hematocrit (Hct) is 35% to 45%.

What is the youngest age at which spirometry can be performed reliably in a child as a pulmonary function test? 1 2 to 3 years 2 3 to 4 years 3 5 to 6 years 4 7 to 8 years

5 to 6 years Spirometry can be performed reliably in a child of 5 or 6 years as a pulmonary function test. Ages 2 to 3 years or 3 to 4 years would be too young to be reliable. Ages 7 to 8 years would be too old.

A nurse is interpreting the results of a child's peak expiratory flow rate. Which percentage, either at this number or less than this number, is considered to be a red zone?

50 A peak expiratory flow rate of red (<50% of personal best) signals a medical alert. Severe airway narrowing may be occurring. A short-acting bronchodilator should be administered. Notify the practitioner if the peak expiratory flow rate does not return immediately and stay in yellow or green

Which of the following clients is at high risk for developmental problem? A) A preschooler with tonsillitis B) A 2 1/2 -year old boy with cystic fibrosis C) A 5-year-old with asthma on cromolyn sodium D) A toddler with acute Glomerulonephritis on antihypertensive and antibiotics

A 2 1/2 -year old boy with cystic fibrosis

A 3-year-old child woke up in the middle of the night with a croupy cough and inspiratory stridor. The parents bring the child to the emergency department, but by the time they arrive, the cough is gone, and the stridor has resolved. What can the nurse teach the parents with regard to this type of croup? a. A bath in tepid water can help resolve this type of croup. b. Tylenol can help to relieve the cough and stridor. c. A cool mist vaporizer at the bedside can help prevent this type of croup. d. Antibiotics need to be given to reduce the inflammation.

A cool mist vaporizer at the bedside can help prevent this type of croup. Acute spasmodic laryngitis (spasmodic croup, "midnight croup," or "twilight croup") is distinct from laryngitis and LTB and characterized by paroxysmal attacks of laryngeal obstruction that occur chiefly at night. The child goes to bed well or with some mild respiratory symptoms but awakens suddenly with characteristic barking; a metallic cough; hoarseness; noisy inspirations; and restlessness. However, there is no fever, and the episode subsides in a few hours. Children with spasmodic croup are managed at home. Cool mist is recommended for the child's room. A tepid water bath will not help, but steam provided by hot water may relieve the laryngeal spasm. The child will not need Tylenol, and antibiotics are not given for this type of croup.

Cystic fibrosis is caused by: A) A defective gene that causes abnormalities in the brain B) A defective gene that leads to the making of an abnormal protein C) It is not known what the cause is D) Someone who eats too much salt

A defective gene that leads to the making of an abnormal protein

Chronic otitis media with effusion (OME) differs from acute otitis media (AOM) because it is usually characterized by which signs or symptoms? a. Severe pain in the ear b. Anorexia and vomiting c. A feeling of fullness in the ear d. Fever as high as 40° C (104° F)

A feeling of fullness in the ear OME is characterized by a feeling of fullness in the ear or other nonspecific complaints. OME does not cause severe pain. This may be a sign of AOM. Vomiting, anorexia, and fever are associated with AOM.

A 1-year-old child has acute otitis media (AOM) and is being treated with oral antibiotics. What should the nurse include in the discharge teaching to the infant's parents? a. A follow-up visit should be done after all medicine has been given. b. After an episode of acute otitis media, hearing loss usually occurs. c. Tylenol should not be given because it may mask symptoms. d. The infant will probably need a myringotomy procedure and tubes.

A follow-up visit should be done after all medicine has been given. Children with AOM should be seen after antibiotic therapy is complete to evaluate the effectiveness of the treatment and to identify potential complications, such as effusion or hearing impairment. Hearing loss does not usually occur with acute otitis media. Tylenol should be given for pain, and the infant will not necessarily need a myringotomy procedure.

The nurse is caring for a 4-year-old child who is receiving 2 L of oxygen per nasal cannula. What disadvantage should the nurse consider when planning care for the child? a. The child may need to have high humidity administered with the oxygen. b. The child may not be able to eat and drink comfortably. c. A nasal cannula may cause an accumulation of moisture on the face. d. A nasal cannula may cause abdominal distention.

A nasal cannula may cause abdominal distention. All oxygen delivery systems have advantages and disadvantages. One disadvantage of a nasal cannula is possible abdominal distention and discomfort, which could lead to vomiting. The advantages include that the child is able to eat and drink more comfortably, there is no need for a high humidity environment, and there is no accumulation of moisture causing skin irritation.

What type of diet do children with cystic fibrosis require? 1 A diet low in fruits and vegetables 2 A special gluten-free, high-calorie diet 3 A low-protein, high-carbohydrate diet 4 A well-balanced high-protein, high-calorie diet

A well-balanced high-protein, high-calorie diet A well-balanced high-protein, high-calorie diet is important for a child with cystic fibrosis (CF) because of the impaired intestinal absorption that is part of the disease. Children with CF require a diet with adequate amounts of fruits and vegetables. Children with CF do not need a special gluten-free diet. Children with CF need a high-protein, not a low-protein diet.

A 5-year-old is recovering from a tonsillectomy and adenoidectomy and is being discharged home with his mother. Home care instructions should include which of the following? Select all that apply. A. Observe the child for continuous swallowing. B. Encourage the child to take sips of cool, clear liquids. C. Administer codeine elixir as necessary for throat pain. D. Observe the child for restlessness or difficulty breathing. E. Encourage the child to cough every 4 to 5 hours to prevent pneumonia. F. Administer an analgesic such as acetaminophen for pain.

A. Observe the child for continuous swallowing. B. Encourage the child to take sips of cool, clear liquids. D. Observe the child for restlessness or difficulty breathing. F. Administer an analgesic such as acetaminophen for pain.

A 5-year-old is seen in the urgent care clinic with the following history and symptoms: sudden onset of severe sore throat after going to bed, drooling and difficulty swallowing, axillary temperature of 102.2° F (39.0° C), clear breath sounds, and absence of cough. The child appears anxious and is flushed. Based on these symptoms and history, the nurse anticipates a diagnosis of: A. Group A beta hemolytic streptococcus (GABHS) pharyngitis B. Acute tracheitis C. Acute epiglottitis D. Acute laryngotracheobronchitis

Acute epiglottitis

The nurse is assessing a young child in the emergency department who drools and is agitated. The patient sounds like a frog during inhalation. Which condition should the nurse suspect in the patient? 1 Otitis media 2 Acute epiglottitis 3 Infectious mononucleosis 4 Acute streptococcal pharyngitis

Acute epiglottitis Drooling and agitation are two of the three clinical symptoms associated with acute epiglottis; absence of a spontaneous cough is the third. The patient with acute epiglottitis presents with a froglike croaking sound on inspiration, but the child is not hoarse. Otitis media is an infection of the middle ear. It is not associated with the presence of drooling and agitation, or a spontaneous cough. Infectious mononucleosis and acute streptococcal pharyngitis are associated with fever and pharyngitis, not the presence of drooling and agitation.

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent which condition? a. Otitis media b. Diabetes insipidus (DI) c. Nephrotic syndrome d. Acute rheumatic fever

Acute rheumatic fever Group A hemolytic streptococcal infection is a brief illness with varying symptoms. It is essential that pharyngitis caused by this organism be treated with appropriate antibiotics to avoid the sequelae of acute rheumatic fever and acute glomerulonephritis. The cause of otitis media is either viral or other bacterial organisms. DI is a disorder of the posterior pituitary. Infections such as meningitis or encephalitis, not streptococcal pharyngitis, can cause DI. Glomerulonephritis, not nephrotic syndrome, can result from acute streptococcal pharyngitis.

What information should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? a. Give with meals. b. Stop immediately if nausea and vomiting occur. c. Adequate dosage will turn the stools a tarry green color. d. Allow preparation to mix with saliva and bathe the teeth before swallowing.

Adequate dosage will turn the stools a tarry green color. The nurse should prepare the mother for the anticipated change in the child's stools. If the iron dose is adequate, the stools will become a tarry green color. A lack of color change may indicate insufficient iron. The iron should be given in two divided doses between meals when the presence of free hydrochloric acid is greatest. Iron is absorbed best in an acidic environment. Vomiting and diarrhea may occur with iron administration. If these occur, the iron should be given with meals, and the dosage reduced and gradually increased as the child develops tolerance. Liquid preparations of iron stain the teeth; they should be administered through a straw and the mouth rinsed after administration.

An 18-month-old child is seen in the clinic with otitis media (OM). Oral amoxicillin is prescribed. What instructions should be given to the parent? a. Administer all of the prescribed medication. b. Continue medication until all symptoms subside. c. Immediately stop giving medication if hearing loss develops. d. Stop giving medication and come to the clinic if fever is still present in 24 hours.

Administer all of the prescribed medication. Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria. Symptoms may subside before the full course is given. Hearing loss is a complication of OM; antibiotics should continue to be given. Medication may take 24 to 48 hours to make symptoms subside.

Which of the following is an important nursing consideration when chest tubes will be removed from a child? A. Explain that it is not painful. B. Administer analgesics before procedure. C. Explain that only a Band-Aid will be needed. D. Expect bright red drainage for several hours after removal.

Administer analgesics before procedure Removal of chest tubes can be an uncomfortable, frightening experience. Analgesics should be used.

The nurse is caring for a child receiving a continuous intravenous (IV) low-dose infusion of morphine for severe postoperative pain. The nurse observes a slower respiratory rate, and the child cannot be aroused. The most appropriate management of this child is for the nurse to do which first? a. Administer naloxone (Narcan). b. Discontinue the IV infusion. c. Discontinue morphine until the child is fully awake. d. Stimulate the child by calling his or her name, shaking gently, and asking the child to breathe deeply.

Administer naloxone (Narcan). The management of opioid-induced respiratory depression includes lowering the rate of infusion and stimulating the child. If the respiratory rate is depressed and the child cannot be aroused, then IV naloxone should be administered. The child will be in pain because of the reversal of the morphine. The morphine should be discontinued, but naloxone is indicated if the child is unresponsive.

The nurse is preparing to administer a unit of packed red blood cells to a hospitalized child. What is an appropriate action that applies to administering blood? a. Take the vital signs every 15 minutes while blood is infusing. b. Use blood within 1 hour of its arrival from the blood bank. c. Administer the blood with 5% glucose in a piggyback setup. d. Administer the first 50 ml of blood slowly and stay with the child.

Administer the first 50 ml of blood slowly and stay with the child. The nurse should administer the first 50 ml of blood or initial 20% of volume (whichever is smaller) slowly and stay with the child. Vitals signs should be taken 15 minutes after initiation and then every hour, not every 15 minutes. Blood should be used within 30 minutes, not 1 hour. Normal saline, not 5% glucose, should be the IV solution.

An infant has been diagnosed with staphylococcal pneumonia. Nursing care of the child with pneumonia includes which intervention? a. Administration of antibiotics b. Frequent complete assessment of the infant c. Round-the-clock administration of antitussive agents d. Strict monitoring of intake and output to avoid congestive heart failure

Administration of antibiotics Antibiotics are indicated for bacterial pneumonia. Often the child has decreased pulmonary reserve, and clustering of care is essential. The child's respiratory rate and status and general disposition are monitored closely, but frequent complete physical assessments are not indicated. Antitussive agents are used sparingly. It is desirable for the child to cough up some of the secretions. Fluids are essential to kept secretions as liquefied as possible.

What medication is considered to be the most useful in treating cardiac arrest? a. Bretylium tosylate (Bretylium) b. Xylocaine (lidocaine) c. Adrenaline (epinephrine) d. Naloxone (Narcan)

Adrenaline (epinephrine) Epinephrine is considered one of the most useful drugs in treating cardiac arrest. As an adrenergic agent, it acts on both a- and b-receptors in the heart. Epinephrine is rapidly cleared from the bloodstream. Bretylium is no longer used in pediatric cardiac arrest management. Lidocaine is used for ventricular arrhythmias only. Naloxone is useful only to reverse effects of opioids.

What test should the nurse do as a precautionary measure before doing an arterial puncture to obtain an arterial blood sample? a. Allen test b. Smith test c. Venipuncture d. Cold compress

Allen test The Allen test determines the adequacy of collateral circulation in the extremity distal to the proposed puncture site. If the child does not have satisfactory circulation when the proposed artery is occluded, that extremity is not used. The Smith test, venipuncture, and a cold compress are not done before arterial blood gas sampling.

A nurse is preparing a prescribed dosage of an inhalant medication for a child with asthma. The nurse explains to the parents and child that inhalation is a good route for medication administration because it: Select one: a. Prevents unpleasant aftertastes b. Eliminates bad breath c. Eliminates the potential of overdosing d. Allows the lungs to quickly absorb the medication

Allows the lungs to quickly absorb the medication

A nurse is giving an iron preparation to an 8-month-old. Which nursing intervention is most important? - 1 Mix the iron preparation in the infant's milk. 2 Mix the iron preparation in the infant's juice. 3 Always give the iron preparation behind the teeth. 4 Because iron is poorly absorbed, use the I.M. route.

Always give the iron preparation behind the teeth. Giving the iron preparation behind the infant's teeth by using a straw or syringe will prevent staining the teeth. Never mix iron with the infant's formula or juice because drinking the mixture will stain the infant's teeth. Iron can be absorbed through the GI tract in most infants, so I.M. injections are reserved for severe cases of iron deficiency anemia when oral iron is ineffective.

What condition is the leading cause of chronic illness in children? a. Asthma b. Pertussis c. Tuberculosis d. Cystic fibrosis

Asthma Asthma is the most common chronic disease of childhood, the primary cause of school absences, and the third leading cause of hospitalization in children younger than the age of 15 years. Pertussis is not a chronic illness. Tuberculosis is not a significant factor in childhood chronic illness. Cystic fibrosis is the most common lethal genetic illness among white children.

Respiratory failure can result from many causes. What condition is a specific primary cause of inefficient gas transfer? a. Anemia b. Pneumothorax c. Cystic fibrosis d. Laryngospasm

Anemia Respiratory failure is defined as the inability of the respiratory system to maintain adequate oxygenation of the blood. In primary inefficient gas transfer, there is insufficient alveolar ventilation. Anemia, which is characterized by low hemoglobin levels, results in an inability to adequately oxygenate the blood. Pneumothorax and cystic fibrosis are examples of restrictive lung disease. Laryngospasm is an example of obstructive lung disease.

The nurse is caring for a 12-year-old child with b-thalassemia. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Anorexia b. Unexplained fever c. Enlarged spleen or liver d. Bronzed, freckled complexion e. Precocious sexual development

Anorexia b. Unexplained fever c. Enlarged spleen or liver d. Bronzed, freckled complexion The clinical manifestations of b-thalassemia include anorexia; unexplained fever; an enlarged spleen or liver; and a bronzed, freckled complexion. There is delayed sexual maturation, not precocious.

In which condition are all the formed elements of the blood simultaneously depressed? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron deficiency anemia

Aplastic anemia Aplastic anemia refers to a bone marrow failure condition in which the formed elements of the blood are simultaneously depressed. Sickle cell anemia is a hemoglobinopathy in which normal adult hemoglobin is partly or completely replaced by abnormal sickled hemoglobin. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin chains. Iron-deficiency anemia results in a decreased amount of circulating red cells.

The mother of a three week-old infant being admitted to the pediatric unit with RSV asks the nurse why the child is being hospitalized. The nurse explains that the child requires observation for complications of RSV that infants are at risk for especially: Select one: a. Apnea b. Tachycardia c. Fever d. Wheezing

Apnea

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

Asthma Asthma may have these chronic signs and symptoms. Pneumonia appears with an acute onset, fever, and general malaise. Bronchiolitis is an acute condition caused by respiratory syncytial virus. Foreign body in the trachea occurs with acute respiratory distress or failure and maybe stridor.

What respiratory condition or disease results in both increased compliance and increased resistance? a. Asthma b. Atelectasis c. Surfactant deficiency d. Bronchopulmonary dysplasia

Asthma Compliance is a measure of the relative ease with which the chest wall expands. Resistance is determined primarily by airway size. Asthma results in increased compliance and increased resistance, both of which increase the work of breathing. Atelectasis and surfactant deficiency both decrease compliance but do not affect resistance. Bronchopulmonary dysplasia increases resistance but does not affect compliance.

What conditions weaken the defenses of the respiratory tract and predispose children to infection? 1 Allergies, renal disease, preterm birth 2 Preterm birth, bronchopulmonary dysplasia, diabetes 3 Allergies, largeness for gestational age, bronchopulmonary dysplasia 4 Asthma, history of respiratory syncytial virus infection, cystic fibrosis

Asthma, history of respiratory syncytial virus infection, cystic fibrosis Allergies, bronchopulmonary dysplasia, asthma, history of respiratory syncytial virus infection, preterm birth, cystic fibrosis, and cardiac anomalies that cause pulmonary congestion are conditions that weaken defenses of the respiratory tract and predispose children to infection. Diabetes and renal disease are not conditions that weaken the defenses of the respiratory tract.

Which is a complication that can occur after abdominal surgery if pain is not managed? a. Atelectasis b. Hypoglycemia c. Decrease in heart rate d. Increase in cardiac output

Atelectasis Pain associated with surgery in the abdominal region (e.g., appendectomy, cholecystectomy, splenectomy) may result in pulmonary complications. Pain leads to decreased muscle movement in the thorax and abdominal area and leads to decreased tidal volume, vital capacity, functional residual capacity, and alveolar ventilation. The patient is unable to cough and clear secretions, and the risk for complications such as pneumonia and atelectasis is high. Severe postoperative pain also results in sympathetic overactivity, which leads to increases in heart rate, peripheral resistance, blood pressure, and cardiac output.

What condition or disease decreases lung compliance? (Select all that apply.) a. Asthma b. Atelectasis c. Pneumothorax d. Pulmonary edema e. Lobar emphysema

Atelectasis Pneumothorax Pulmonary edema Atelectasis, pneumothorax, and pulmonary edema decrease lung compliance. Asthma and lobar emphysema increase lung compliance.

A nurse is talking to parents of a 6-month-old with beta-thalassemia major. This disorder causes anemia, an enlarged spleen, and failure to thrive. The parents ask the nurse how their child developed this disorder. The nurse proceeds to explain about hereditary transmission. What type of inheritance pattern is involved in the transmission of beta-thalassemia major? - 1 X-linked recessive 2 X-linked dominant 3 Autosomal recessive 4 Autosomal dominant

Autosomal recessive Beta-thalassemia major (insufficient hemoglobin synthesis) is an autosomal recessive disorder, which means that both parents must be carriers to produce the disorder in their child. Autosomal refers to chromosomes other than the sex chromosomes. Recessive disorders require transmission from both parents, whereas dominant disorders require an affected gene from one parent.

A 3-year-old child with a tracheostomy will soon be discharged. What recommendation should the nurse share with the family? a. Tub baths cannot be given. b. The child cannot be allowed to play outdoors. c. Avoid exposure to noxious fumes such as paint or varnish. d. Cover the tracheostomy with a plastic bib when exposed to cold air.

Avoid exposure to noxious fumes such as paint or varnish. The child with a tracheostomy should not be exposed to noxious fumes such as paint, varnish, or hair spray or to substances such as talc. The parent and child must be cautioned about safety measures around bodies of water. Baths can be taken, but parents must observe the necessary safety precautions. The child may play outdoors with a scarf or other protection that allows air through.

A toddler is diagnosed with chronic benign neutropenia. The parents are being taught about caring for their child. What information is important to include? a. Avoid large indoor crowds and people who are ill. b. Parenteral antibiotics are necessary to control disease. c. Frequent rest periods are needed during the daytime. d. List the side effects of corticosteroids used to decrease inflammation.

Avoid large indoor crowds and people who are ill The parents are taught to minimize risk of infection by avoiding crowded areas and individuals who are ill. Parents are also cautioned about when to notify their practitioner and administration of granulocyte colony-stimulating factor, if indicated. Antibiotics are not needed unless the child has an infection. The toddler does not need any additional rest as a result of the neutropenia. Corticosteroids are not indicated.

An infant's parents ask the nurse about preventing otitis media (OM). What information should be provided? a. Avoid tobacco smoke. b. Use nasal decongestants. c. Avoid children with OM. d. Bottle- or breastfeed in a supine position.

Avoid tobacco smoke. Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other symptoms of upper respiratory tract infection. Children should be fed in a semivertical position to prevent OM.

5. You are discharging a patient with hemophilia. Which of the following responses by the parents indicate an understanding of this disorder? Select all that apply. A. "My child should remain active to decrease joint problems, and most children with hemophilia can participate in the same activities as peers." B. "Care should be taken to avoid bleeding of gums, and softening the toothbrush in warm water before brushing or using a sponge-tipped disposable toothbrush may be helpful." C. "Signs of internal bleeding should be recognized, such as headache, slurred speech, loss of consciousness (from cerebral bleeding), and black, tarry stools (from gastrointestinal bleeding)." D. "If there is bleeding in a joint, elevation, ice, and rest should help and may prevent the need for factor VIII replacement." E."All of my son's teachers need to be aware of what to do if he gets a bloody nose."

B. "Care should be taken to avoid bleeding of gums, and softening the toothbrush in warm water before brushing or using a sponge-tipped disposable toothbrush may be helpful." C. "Signs of internal bleeding should be recognized, such as headache, slurred speech, loss of consciousness (from cerebral bleeding), and black, tarry stools (from gastrointestinal bleeding)." E."All of my son's teachers need to be aware of what to do if he gets a bloody nose."

A child with sickle cell anemia is admitted in a vaso-occlusive crisis. Which of the following interventions should the nurse expect to see ordered? Select all that apply. A. Cold compresses to painful joints B. IV fluids started, and oral fluids encouraged C. Meperidine ordered every 4 hours for pain D. High-calorie, high-protein diet E. Antibiotics ordered for any existing infection

B. IV fluids started, and oral fluids encouraged D. High-calorie, high-protein diet E. Antibiotics ordered for any existing infection

How can the nurse prepare a child for a painful procedure? Select all that apply. A. Be honest and use correct terms so that the child trusts the nurse. B. Involve the child in the use of distraction, such as using bubbles, music, or playing a game. C. Kindly ask parents to leave the room so they don't have to watch the painful procedure. D. Use positive self-talk such as "When I go home, I will feel better and be able to see my friends." E. Use guided imagery that involves recalling a previous pleasurable event.

B. Involve the child in the use of distraction, such as using D. Use positive self-talk such as "When I go home, I will feel better and be able to see my friends." E. Use guided imagery that involves recalling a previous pleasurable event.

When teaching a 6-year-old child with sickle cell disease and his family about pain management, which of the following should the nurse discuss? Select all that apply. A. When pain medications are used, all pain will be eliminated. B. Nonpharmacologic methods of pain relief including heat, massage, physical therapy, humor, and distraction. C. It is helpful to use a "passport card" that includes information about the diagnosis, any previous complications, and the pain regimen. D. Only the physician can decide the best course of treatment, and the other health care providers follow that plan. E. Long-term medication use considers many factors.

B. Nonpharmacologic methods of pain relief including heat, massage, physical therapy, humor, and distraction. C. It is helpful to use a "passport card" that includes information about the diagnosis, any previous complications, and the pain regimen. D. Only the physician can decide the best course of treatment, and the other health care providers follow that plan.

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

Before chest physiotherapy (CPT)

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

Before chest physiotherapy (CPT) Bronchodilators should be given before CPT to open bronchi and make expectoration easier. These medications are not helpful when used after CPT. Oxygen is administered only in acute episodes, with caution, because of chronic carbon dioxide retention.

When is bronchial (postural) drainage generally performed? a. Before meals and at bedtime b. Right before all aerosol therapy c. Immediately on arising and at bedtime d. Thirty minutes after meals and at bedtime

Before meals and at bedtime is most effective when it is performed after other respiratory therapy interventions, including bronchodilator and nebulizer treatments. Immediately on arising and at bedtime are appropriate times, but postural drainage is usually carried out at least three times each day. Thirty minutes after meals may induce vomiting.

Which is the most consistent and commonly used data for assessment of pain in infants? Select one: a. Behavioral b. Parental report c. Self-report

Behavioral

Which is the most consistent and commonly used data for assessment of pain in infants? a. Self-report b. Behavioral c. Physiologic d. Parental report

Behavioral Behavioral assessment is useful for measuring pain in young children and preverbal children who do not have the language skills to communicate that they are in pain. Infants are not able to self-report. Physiologic measures are not able to distinguish between physical responses to pain and other forms of stress. Parental report without a structured tool may not accurately reflect the degree of discomfort.

Parents bring their 15-month-old infant to the emergency department at 3:00 AM because the toddler has a temperature of 39° C (102.2° F), is crying inconsolably, and is tugging at the ears. A diagnosis of otitis media (OM) is made. In addition to antibiotic therapy, the nurse practitioner should instruct the parents to use what medication? a. Decongestants to ease stuffy nose b. Antihistamines to help the child sleep c. Aspirin for pain and fever management d. Benzocaine ear drops for topical pain relief

Benzocaine ear drops for topical pain relief Analgesic ear drops can provide topical relief for the intense pain of OM. Decongestants and antihistamines are not recommended in the treatment of OM. Aspirin is contraindicated in young children because of the association with Reye syndrome.

The nurse is preparing to admit a 7-year-old child with acute laryngotracheobronchitis (LTB). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Dysphagia b. Brassy cough c. Low-grade fever d. Toxic appearance e. Slowly progressive

Brassy cough Low-grade fever Slowly progressive Clinical manifestations of LTB include a brassy cough, low-grade fever, and slow progression. Dysphagia and a toxic appearance are characteristics of acute epiglottitis.

P: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity 31. The nurse is preparing a community outreach program about the prevention of iron-deficiency anemia in infants. What statement should the nurse include in the program? a. Whole milk can be introduced into the infant's diet in small amounts at 6 months. b. Iron supplements cannot be given until the infant is older than 1 year of age. c. Iron-fortified cereal should be introduced to the infant at 2 months of age. d. Breast milk or iron-fortified formula should be used for the first 12 months.

Breast milk or iron-fortified formula should be used for the first 12 months. Prevention, the primary goal in iron-deficiency anemia, is achieved through optimal nutrition and appropriate iron supplements. The American Academy of Pediatrics recommends feeding an infant only breast milk or iron-fortified formula for the first 12 months of life. Whole cow's milk should not be introduced until after 12 months, iron supplements can be given during the first year of life, and iron-fortified cereals should not be introduced until the infant is 4 to 6 months old.

The nurse is reviewing information on medications to be used in children with respiratory distress. The nurse notes that medication that stimulates beta2 receptors include Select one: a. Corticosteroids b. Mast cell stabilizers c. Leukotriene modifiers d. Bronchodilators

Bronchodilators

It is important to make certain that sensory connectors and oximeters are compatible because incompatible wiring can cause which condition? a. Hyperthermia b. Electrocution c. Pressure necrosis d. Burns under sensors

Burns under sensors Incompatible wiring can generate considerable heat at the tip of the sensor, resulting in partial- and full-thickness burns. Heat may be generated at the site of the sensor, but it will not result in generalized hyperthermia. Electrocution is not a possibility with oximeters. Pressure necrosis can occur from improperly applied sensors but not from incompatible wiring.

The clinic nurse is assessing an adolescent diagnosed with iron deficiency anemia. The nurse explains to the parent that iron deficiency anemia may be caused by: Select one: a. End of the growth spurt b. Excessive soft drink consumption c. Involvement in sports d. Poor eating habits

Poor eating habits

A child is admitted to the pediatric unit. The mother reports that the doctor says her son is anemic. What laboratory findings/manifestations would the nurse expect to see to confirm iron deficiency anemia? A. Cyanosis, due to inadequate oxygen saturation of existing hemoglobin B. A decreased reticulocyte count C. A total iron-binding capacity (TIBC) that is elevated above the normal range D. Decreased blood pressure changes, which are an early sign because of the compensatory mechanisms

C. A total iron-binding capacity (TIBC) that is elevated above the normal range

Which is the most accurate genetic explanation for a family with hemophilia? A. It is a Y-linked dominant disorder. B. It is equally distributed among males and females. C. It is an X-linked recessive disorder. D. It is an autosomal recessive disorder.

C. It is an X-linked recessive disorder.

A child is in uncompensated respiratory alkalosis. What should the nurse expect the arterial blood gas to be? a. CO2, 30; pH, 7.50 b. CO2, 55; pH, 7.30 c. CO2, 35; pH, 7.28 d. CO2, 54; pH, 7.35

CO2, 30; pH, 7.50 Laboratory findings in respiratory alkalosis include reduced PCO2 (<35?9?mm?9?Hg) and elevated plasma pH (>7.45).

One of the goals for children with asthma is to prevent respiratory tract infection. This is because respiratory tract infection does which of the following? Increases sensitivity to allergens Causes exercise-induced asthma Lessens effectiveness of medications Can trigger an episode or aggravate asthmatic state

Can trigger an episode or aggravate asthmatic state Viral respiratory tract infections can exacerbate asthma, especially in young children, whose airways are mechanically smaller and more reactive than those of older children. Respiratory tract infections do not affect sensitivity to allergens. Exercise precipitates exercise-induced asthma. The respiratory tract infection does not lessen the effectiveness of the medications.Level of cognitive ability: ApplicationArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Nursing Process: ImplementationREF: p. 1216

A child receiving chemotherapy is experiencing mucositis. Which prescriptions should the nurse plan to administer for initial treatment? (Select all that apply.) a. Scope mouth rinse b. Listerine antiseptic mouth rinse c. Carafate suspension (Sucralfate) d. Nystatin oral suspension (Nystatin) e. Lidocaine viscous (Lidocaine hydrochloride solution)

Carafate suspension (Sucralfate) Nystatin oral suspension (Nystatin) Lidocaine viscous (Lidocaine hydrochloride solution) Initial treatment of stomatitis includes single agents (sucralfate suspension, nystatin, and viscous lidocaine). Scope and Listerine are plaque and gingivitis control mouth rinses that would have a drying effect and are not used with mucositis.

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

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

The clinic nurse is evaluating causes for iron deficiency due to impaired iron absorption. What should the nurse recognize as causes for iron deficiency due to impaired iron absorption? (Select all that apply.) a. Gastric acidity b. Chronic diarrhea c. Lactose intolerance d. Absence of phosphates e. Inflammatory bowel disease

Chronic diarrhea Lactose intolerance Inflammatory bowel disease Causes for iron deficiency due to impaired iron absorption include chronic diarrhea, lactose intolerance, and inflammatory bowel disease. Gastric alkalinity, not acidity, and the presence, not absence, of phosphates can be causes of impaired iron absorption.

In a child with sickle cell anemia (SCA), adequate hydration is essential to minimize sickling and delay the vasoocclusion and hypoxia-ischemia cycle. What information should the nurse share with parents in a teaching plan? a. Encourage drinking. b. Keep accurate records of output. c. Check for moist mucous membranes. d. Monitor the concentration of the child's urine.

Check for moist mucous membranes. Children with SCA have impaired kidney function and cannot concentrate urine. Parents are taught signs of dehydration and ways to minimize loss of fluid to the environment. Encouraging drinking is not specific enough for parents. The nurse should give the parents and child a target fluid amount for each 24-hour period. Accurate monitoring of output may not reflect the child's fluid needs. Without the ability to concentrate urine, the child needs additional intake to compensate. Dilute urine and specific gravity are not valid signs of hydration status in children with SCA.

What consideration is most important in managing tuberculosis (TB) in children? a. Skin testing b. Chemotherapy c. Adequate rest d. Adequate hydration

Chemotherapy Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and isoniazid and rifampin given two or three times a week by direct observation therapy for the remaining 4 months. Chemotherapy is the most important intervention for TB.

What age group is most affected by bronchitis? 1 Adolescents 2 Young adults 3 School-age children 4 Children ages 4 and under

Children ages 4 and under Bronchitis is most common during the first 4 years of life. Adolescents, young adults, and school-age children are less susceptible to bronchitis than children ages 4 and under.

A 12-year-old child is in the urgent care clinic with a complaint of fever, headache, and sore throat. A diagnosis of group A beta hemolytic streptococcus (GABHS) pharyngitis is established with a rapid-strep test, and oral penicillin is prescribed. The nurse knows which of the following statements about GABHS is correct? A. Children with a GABHS infection are less likely to contract the illness again after the antibiotic regimen is completed. B. A follow-up throat culture is recommended following the completion of antibiotic therapy. C. Children with a GABHS infection are at increased risk for the development of rheumatic fever and glomerulonephritis. D. Children with a GABHS infection are at increased risk for the development of rheumatoid arthritis in adulthood.

Children with a GABHS infection are at increased risk for the development of rheumatic fever and glomerulonephritis.

The nurse is preparing a staff education program about pediatric asthma. What concepts should the nurse include when discussing the asthma severity classification system? (Select all that apply.) a. Children with mild persistent asthma have nighttime signs or symptoms less than two times a month. b. Children with moderate persistent asthma use a short-acting b-agonist more than two times per week. c. Children with severe persistent asthma have a peak expiratory flow (PEF) of 60% to 80% of predicted value. d. Children with mild persistent asthma have signs or symptoms more than two times per week. e. Children with moderate persistent asthma have some limitations with normal activity. f. Children with severe persistent asthma have frequent nighttime signs or symptoms.

Children with mild persistent asthma have signs or symptoms more than two times per week. e. Children with moderate persistent asthma have some limitations with normal activity. f. Children with severe persistent asthma have frequent nighttime signs or symptoms. Children with mild persistent asthma have signs or symptoms more than two times per week and nighttime signs or symptoms three or four times per month. Children with moderate persistent asthma have some limitations with normal activity and need to use a short-acting b-agonist for sign or symptom control daily. Children with severe persistent asthma have frequent nighttime signs or symptoms and have a PEF of less than 60%.

The nurse is administering a unit of blood to a child. What are signs and symptoms of a transfusion reaction? (Select all that apply.) a. Chills b. Shaking c. Flank pain d. Hypothermia e. Sudden severe headache

Chills Shaking Flank pain Sudden severe headache Signs and symptoms of a transfusion reaction include chills, shaking, flank pain, and sudden severe headache. Hyperthermia, not hypothermia, occurs.

An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of what complication? a. Air embolism b. Allergic reaction c. Hemolytic reaction d. Circulatory overload

Circulatory overload The signs of circulatory overload include distended neck veins, hypertension, crackles, a dry cough, cyanosis, and precordial pain. Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Urticaria, pruritus, flushing, asthmatic wheezing, and laryngeal edema are signs and symptoms of allergic reactions. Hemolytic reactions are characterized by chills, shaking, fever, pain at infusion site, nausea, vomiting, tightness in chest, flank pain, red or black urine, and progressive signs of shock and renal failure.

What statement best describes iron deficiency anemia in infants? a. It is caused by depression of the hematopoietic system. b. Diagnosis is easily made because of the infant's emaciated appearance. c. It results from a decreased intake of milk and the premature addition of solid foods. d. Clinical manifestations are related to a reduction in the amount of oxygen available to tissues.

Clinical manifestations are related to a reduction in the amount of oxygen available to tissues. In iron-deficiency anemia, the child's clinical appearance is a result of the anemia, not the underlying cause. Usually the hematopoietic system is not depressed. The bone marrow produces red blood cells that are smaller and contain less hemoglobin than normal red blood cells. Children who have iron deficiency from drinking excessive quantities of milk are usually pale and overweight. They are receiving sufficient calories but are deficient in essential nutrients. The clinical manifestations result from decreased intake of iron-fortified solid foods and an excessive intake of milk.

What statement best represents infectious mononucleosis? a. Herpes simplex type 2 is the principal cause. b. A complete blood count shows a characteristic leukopenia. c. A short course of ampicillin is used when pharyngitis is present. d. Clinical signs and symptoms and blood tests are both needed to establish the diagnosis.

Clinical signs and symptoms and blood tests are both needed to establish the diagnosis. The characteristics of the disease—malaise, sore throat, lymphadenopathy, central nervous system manifestations, and skin lesions—are similar to presenting signs and symptoms in other diseases. Hematologic analysis (heterophil antibody and monospot) can help confirm the diagnosis. However, not all young children develop the expected laboratory findings. Herpes-like Epstein-Barr virus is the principal cause. Usually, an increase in lymphocytes is observed. Penicillin, not ampicillin, is indicated. Ampicillin is linked with a discrete macular eruption in infectious mononucleosis.

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

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

What medication is contraindicated in children post tonsillectomy and adenoidectomy? a. Codeine b. Ondansetron (Zofran) b. Amoxil (amoxicillin) c. Acetaminophen (Tylenol)

Codeine Codeine is contraindicated in pediatric patients after tonsillectomy and adenoidectomy. In 2012, the Food and Drug Administration issued a Drug Safety Communication that codeine use in certain children after tonsillectomy or adenoidectomy may lead to rare but life-threatening adverse events or death. Zofran, amoxicillin, and Tylenol are not contraindicated after tonsillectomy and adenoidectomy.

The nurse is assessing a child with croup in the emergency department. The child has a sore throat and is drooling. Examining the child's throat using a tongue depressor might precipitate what condition? a. Sore throat b. Inspiratory stridor c. Complete obstruction d. Respiratory tract infection

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

Which of the following is a measure of chest wall and lung distensibility? A. Resistance B. Ventilation C. Compliance D. Alveolar surface tension

Compliance Compliance is a measure of chest wall and lung distensibility.

The nurse is reviewing opioid medications and remembers that a significant, common side effect that occurs with opioid administration is: Select one: a. Diuresis b. Allergic reaction c. Euphoria d. Constipation

Constipation

What is a significant common side effect that occurs with opioid administration? a. Euphoria b. Diuresis c. Constipation d. Allergic reactions

Constipation Constipation is one of the most common side effects of opioid administration. Preventive strategies should be implemented to minimize this problem. Sedation is a more common result than euphoria. Urinary retention, not diuresis, may occur with opiates. Rarely, some individuals may have pruritus.

An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires what type of isolation? a. Reverse isolation b. Airborne isolation c. Contact Precautions d. Standard Precautions

Contact Precautions RSV is transmitted through droplets. In addition to Standard Precautions and hand washing, Contact Precautions are required. Caregivers must use gloves and gowns when entering the room. Care is taken not to touch their own eyes or mucous membranes with a contaminated gloved hand. Children are placed in a private room or in a room with other children with RSV infections. Reverse isolation focuses on keeping bacteria away from the infant. With RSV, other children need to be protected from exposure to the virus. The virus is not airborne.

A 6-year-old child has had a tonsillectomy. The child is spitting up small amounts of dark brown blood in the immediate postoperative period. The nurse should take what action? a. Notify the health care provider. b. Continue to assess for bleeding. c. Give the child a red flavored ice pop. d. Position the child in a Trendelenburg position.

Continue to assess for bleeding. Some secretions, particularly dried blood from surgery, are common after a tonsillectomy. Inspect all secretions and vomitus for evidence of fresh bleeding (some blood-tinged mucus is expected). Dark brown (old) blood is usually present in the emesis, as well as in the nose and between the teeth. Small amounts of dark brown blood should be further monitored. A red-flavored ice pop should not be given and the Trendelenburg position is not recommended.

What oral rehydration measure must the nurse teach the parents of an infant with a respiratory tract infection? 1 Provide water at regular intervals. 2 Continue to breastfeed the infant. 3 Provide sips of low carbohydrate drink. 4 Awaken the infant to take fluids.

Continue to breastfeed the infant. Infants should continue to be breastfed because human milk provides some degree of protection from infection. Oral rehydration solutions, such as Infalyte or Pedialyte, should be considered for infants, and water or a low carbohydrate flavored drink should be considered for older children. Fluids should not be forced, and infants should not be awakened to take fluids to prevent aspiration.

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

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

What intervention is necessary when weaning a child from the ventilator? a. Light sedation before scheduled extubation b. No suctioning before scheduled extubation c. Cool mist begun immediately after extubation d. Vigorous chest physiotherapy and suctioning performed immediately after extubation

Cool mist begun immediately after extubation A cool mist or noninvasive oxygen therapy is initiated immediately after extubation. Steroids may be administered to minimize any laryngeal edema. Analgesics may be given, but sedation is not usually indicated. The child is suctioned just before extubation to ensure that the airway is clear. Chest physiotherapy and suctioning are performed before extubation.

What category of medication is the first-line therapy for inflammation in children with asthma? 1 Theophylline 2 Corticosteroids 3 Anticholinergics 4 Cromolyn sodium

Corticosteroids are the first-line therapy for inflammation in children with asthma. Theophylline is used primarily in the emergency department when the child is not responding to other therapies. Anticholinergics relieve bronchospasm. Cromolyn sodium stabilizes mast cell membranes.

The nurse is teaching a mother how to perform chest physical therapy and postural drainage on her 3-year-old child, who has cystic fibrosis. To perform percussion, the nurse should instruct her to: A. Strike the chest wall with a flat-hand position. B. Percuss before and after positioning for postural drainage. C. Percuss over the entire trunk anteriorly and posteriorly. D. Cover the skin with a shirt or gown before percussing

Cover the skin with a shirt or gown before percussing The child should wear a light shirt to protect the skin from the percussion.

What explanation provides the rationale for why iron-deficiency anemia is common during infancy? a. Cow's milk is a poor source of iron. b. Iron cannot be stored during fetal development. c. Fetal iron stores are depleted by 1 month of age. d. Dietary iron cannot be started until 12 months of age.

Cow's milk is a poor source of iron. Children between the ages of 12 and 36 months are at risk for anemia because cow's milk is a major component of their diet, and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by ages 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-fortified formula, and cereals during the first 12 months of life.

The nurse is preparing to admit a 3-year-old child with acute spasmodic laryngitis. What clinical features of hepatitis B should the nurse recognize? (Select all that apply.) a. High fever b. Croupy cough c. Tendency to recur d. Purulent secretions e. Occurs sudden, often at night

Croupy cough Tendency to recur Occurs sudden, often at night Clinical features of acute spasmodic laryngitis include a croupy cough, a tendency to recur, and occurring sudden, often at night. High fever is a feature of acute epiglottitis and purulent secretions are seen with acute tracheitis.

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

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

What physiologic defect is responsible for causing anemia? a. Increased blood viscosity b. Depressed hematopoietic system c. Presence of abnormal hemoglobin d. Decreased oxygen-carrying capacity of blood

Decreased oxygen-carrying capacity of blood Anemia is a condition in which the number of red blood cells or hemoglobin concentration is reduced below the normal values for age. This results in a decreased oxygen-carrying capacity of blood. Increased blood viscosity is usually a function of too many cells or of dehydration, not of anemia. A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition depends on the decreased oxygen-carrying capacity of the blood.

The nurse is reviewing discharge instructions with the parents of a 7 year-old child who was admitted with a vaso-occlusive crisis. The nurse explains that factors that may cause a sickle-cell crisis include: Select one or more: a. Weight gain b. Alkalosis c. Dehydration d. Hypoxia

Dehydration Hypoxia

A young child with human immunodeficiency virus (HIV) is receiving several antiretroviral drugs. What is the purpose of these drugs? a. Cure the disease. b. Delay disease progression. c. Prevent spread of infection. d. Treat Pneumocystis carinii pneumonia.

Delay disease progression. Although not a cure, these antiretroviral drugs can suppress viral replication, preventing further deterioration of the immune system, and delay disease progression. At this time, cure is not possible. Antiretroviral drugs do not prevent the spread of the disease. P. carinii prophylaxis is accomplished with antibiotics.

What endocrine disorder is commonly found in children with cystic fibrosis? 1 Addison disease 2 Diabetes mellitus 3 Cushing syndrome 4 Congenital adrenal hyperplasia

Diabetes mellitus Diabetes mellitus is more common in children with cystic fibrosis because of changes in pancreatic architecture and diminished blood supply over time. Addison disease, Cushing syndrome, and congenital adrenal hyperplasia are not commonly found in children with cystic fibrosis.

In providing nourishment for a child with cystic fibrosis (CF), what factors should the nurse keep in mind? a. Fats and proteins must be greatly curtailed. b. Most fruits and vegetables are not well tolerated. c. Diet should be high in calories, proteins, and unrestricted fats. d. Diet should be low fat but high in calories and proteins.

Diet should be high in calories, proteins, and unrestricted fats. Children with CF require a well-balanced, high-protein, high-caloric diet, with unrestricted fat (because of the impaired intestinal absorption).

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

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

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which information? a. Do not use for more than 3 days. b. Keep drops to use again for nasal congestion. c. Administer drops after feedings and at bedtime. d. Give two drops every 5 minutes until nasal congestion subsides.

Do not use for more than 3 days. Vasoconstrictive nose drops such as Neo-Synephrine should not be used for more than 3 days to avoid rebound congestion. Drops should be discarded after one illness and not used for other children because they may become contaminated with bacteria. Drops administered before feedings are more helpful. Two drops are administered to cause vasoconstriction in the anterior mucous membranes. An additional two drops are instilled 5 to 10 minutes later for the posterior mucous membranes. No further doses should be given.

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

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

The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. What statement most accurately reflects inheritance of SCA? a. SCA is not inherited. b. All siblings will have SCA. c. Each sibling has a 25% chance of having SCA. d. There is a 50% chance of siblings having SCA.

Each sibling has a 25% chance of having SCA. SCA is inherited as an autosomal recessive disorder. In this inheritance pattern, each child born to these parents has a 25% chance of having the disorder, a 25% chance of having neither SCA nor the trait, and a 50% chance of being heterozygous for SCA (sickle cell trait). SCA is an inherited hemoglobinopathy.

The school nurse is caring for a child with hemophilia who fell on his arm during recess. Which of the following supportive measures should the nurse do until factor replacement therapy can be instituted? a. Apply warm, moist compresses. b. Apply a tourniquet for at least 5 minutes. c. Elevate the arm above the level of the heart. d. Begin passive range of motion unless pain is severe.

Elevate the arm above the level of the heart. The initial response should include elevation. Cold should be applied to the arm. This will aid in vasoconstriction. Pressure is effective in small areas but would not work for an extremity. Passive range of motion is not recommended. The child can perform active range of motion after the bleeding episode has resolved.Level of cognitive ability: ApplicationArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Nursing Process: ImplementationREF: p. 1359

Chelation therapy is begun on a child with α-thalassemia major. The purpose of this therapy is to do which of the following? a. Treat the disease. b. Eliminate excess iron. c. Decrease risk of hypoxia. d. Manage nausea and vomiting.

Eliminate excess iron. Iron overload (hemosiderosis) is a complication of blood transfusions. Chelation therapy is necessary to minimize the development of hemosiderosis and hemochromatosis. Blood transfusions are the primary medical management. Chelation therapy removes iron; it does not affect the disease process.Level of cognitive ability: AnalysisArea of client needs: Physiologic Integrity/Pharmacologic and Parenteral TherapyIntegrated process: Teaching/LearningREF: p. 1341

A 3-year-old is brought to the emergency department with symptoms of stridor, fever, restlessness, and drooling. No coughing is observed. Based on these findings, the nurse should be prepared to assist with what action? a. Throat culture b. Nasal pharynx washing c. Administration of corticosteroids d. Emergency intubation

Emergency intubation Three clinical observations that are predictive of epiglottitis are absence of spontaneous cough, presence of drooling, and agitation. Nasotracheal intubation or tracheostomy is usually considered for a child with epiglottitis with severe respiratory distress. The throat should not be inspected because airway obstruction can occur, and steroids would not be done first when the child is in severe respiratory distress.

A preschool child has asthma, and a goal is to extend expiratory time and increase expiratory effectiveness. What action should the nurse implement to meet this goal? a. Encourage increased fluid intake. b. Recommend increased use of a budesonide (Pulmicort) inhaler. c. Administer an antitussive to suppress coughing. d. Encourage the child to blow a pinwheel every 6 hours while awake.

Encourage the child to blow a pinwheel every 6 hours while awake. Play techniques that can be used for younger children to extend their expiratory time and increase expiratory pressure include blowing cotton balls or a ping-pong ball on a table, blowing a pinwheel, blowing bubbles, or preventing a tissue from falling by blowing it against the wall. Increased fluids, increased use of a Pulmicort inhaler, or suppressing a cough will not increase expiratory effectiveness.

When planning care for a 4-month-old child admitted with respiratory distress caused by respiratory syncytial virus (RSV) and bronchiolitis, it is essential to include which of the following? a. Give antibiotics. b. Ensure adequate hydration. c. Administer cough syrup. d. Feed 4 oz of formula every 4 hours.

Ensure adequate hydration. When respiratory distress is present, hydration is an essential consideration. Usually infants cannot take fluids by the oral route because of the difficulty breathing. Intravenous fluid administration may be necessary. RSV is a virus, so antibiotics are not beneficial. Cough syrup is not routinely used in RSV. Although fluid and calories are important, an infant with respiratory distress is usually unable to drink this amount of fluid.Level of cognitive ability: ComprehensionArea of client needs: Physiologic Integrity/Pharmacologic and Parenteral TherapyIntegrated process: Nursing Process: PlanningREF: p. 1190

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

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

Which of the following types of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis

Epiglottitis Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and upper respiratory tract infection symptoms. Spasmodic croup is treated with humidity. Laryngotracheobronchitis may progress to a medical emergency in some children.Level of cognitive ability: ApplicationArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Nursing Process: PlanningREF: p. 1185

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

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

The nurse is reviewing factors that affect lung development. What factor delays surfactant production and maturation of alveolar cells? a. Thyroxine b. Prolactin c. Glucocorticosteroids d. Excess of endogenous insulin

Excess of endogenous insulin An excess of endogenous insulin can delay surfactant production and delays maturation of alveolar cells. Glucocorticosteroids, thyroxine, and prolactin enhance lung development.

Which of the following self-report pain rating scales can be used in children as young as 3 years of age? a. Poker Chip Tool b. Visual Analog Scale c. FACES Pain Rating Scale d. Word-Graphic Rating Scale

FACES Pain Rating Scale The Poker Chip Tool has been validated for children 4 years of age who have been determined to have the cognitive ability to identify the larger of two numbers. The Visual Analog Scale can be used for children older than 4 years of age but is most appropriate for ages 7 and older. The FACES Pain Rating Scale is for children as young as 3 years of age. The Word-Graphic Rating Scale uses descriptive words and is recommended for children 4 to 17 years of age.Level of cognitive ability: ComprehensionArea of client needs:Psychosocial Integrity/Coping and AdaptationIntegrated process: Nursing Process: AssessmentREF: p. 155

Pain scales for infants and their uses include but are not limited to: A. CRIES: Crying, Requiring increased oxygen, Inability to console, Expression, and Sleeplessness B. FLACC: child's face, legs, activity, cry, and consolability C. NCCPC: parent and health care giver questionnaire assessing acute and chronic pain D. NPASS: neonatal pain, agitation, and sedation scale for infants from 3 to 6 months

FLACC: child's face, legs, activity, cry, and consolability

Which of the following is the most consistent and commonly used indicator of pain in infants? a. Increased respirations b. Increased heart rate c. Thrashing of arms and legs d. Facial expression of discomfort

Facial expression of discomfort Facial expression has consistently been validated as an indicator of pain in infants. Behavioral pain measures are most reliable for sharp procedural pain in infants. Increased heart rate and respirations are indicative of a generalized and complex response to stress. They are not specific for pain in infants. Thrashing of arms and legs is a reliable indicator in young children, not infants.Level of cognitive ability: ComprehensionArea of client needs:Psychosocial Integrity/Coping and AdaptationIntegrated process: Nursing Process: AssessmentREF: p. 152

A 5-year-old child is admitted with bacterial pneumonia. What signs and symptoms should the nurse expect to assess with this disease process? a. Fever, cough, and chest pain b. Stridor, wheezing, and ear infection c. Nasal discharge, headache, and cough d. Pharyngitis, intermittent fever, and eye infection

Fever, cough, and chest pain Children with bacterial pneumonia usually appear ill. Symptoms include fever, malaise, rapid and shallow respirations, cough, and chest pain. Ear infection, nasal discharge, and eye infection are not symptoms of bacterial pneumonia.

The nurse is evaluating arterial blood gas results. What condition can cause an increase in HCO3? a. Renal failure b. Lactic acidosis c. Diabetic ketoacidosis d. Fluid loss from upper gastrointestinal tract

Fluid loss from upper gastrointestinal tract Fluid loss from an upper gastrointestinal tract causes an increase in HCO3. Renal failure, lactic acidosis, and diabetic ketoacidosis cause a decrease in HCO3.

A toddler has a unilateral foul-smelling nasal discharge and frequent sneezing. The nurse should suspect what condition? a. Allergies b. Acute pharyngitis c. Foreign body in the nose d. Acute nasopharyngitis

Foreign body in the nose The irritation of a foreign body in the nose produces local mucosal swelling with foul-smelling nasal discharge, local obstruction with sneezing, and mild discomfort. Allergies would produce clear bilateral nasal discharge. Nasal discharge is usually not associated with pharyngitis. Acute nasopharyngitis would have bilateral mucous discharge.

. What therapeutic intervention is most appropriate for a child with b-thalassemia major? a. Oxygen therapy b. Supplemental iron c. Adequate hydration d. Frequent blood transfusions

Frequent blood transfusions The goal of medical management is to maintain sufficient hemoglobin (>9.5 g/dl) to prevent bone marrow expansion. This is achieved through a long-term transfusion program. Oxygen therapy and adequate hydration are not beneficial in the overall management of thalassemia. The child does not require supplemental iron. Iron overload is a problem because of frequent blood transfusions, decreased production of hemoglobin, and increased absorption from the gastrointestinal tract.

A cancer patient is experiencing neuropathic cancer pain. Which prescription should the nurse expect to be ordered to control anxiety? a. Lorazepam (Ativan) b. Gabapentin (Neurontin) c. Hydromorphone (Dilaudid) d. Morphine sulfate (MS Contin)

Gabapentin (Neurontin) Anticonvulsants (gabapentin, carbamazepine) have demonstrated effectiveness in neuropathic cancer pain. Ativan is an antianxiety agent, and Dilaudid and MS Contin are opioid analgesics.

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

Give small amounts of favorite fluids frequently to prevent dehydration. Preventing dehydration by small, frequent feedings is an important intervention in a febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting. A febrile child should be dressed in light, loose clothing.Level of cognitive ability: ApplicationArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Nursing Process: InterventionREF: p. 1169

What activity should the school nurse recommend for a child with hemophilia A? (Select all that apply.) a. Golf b. Soccer c. Rugby d. Jogging e. Swimming

Golf Jogging Swimming Children and adolescents with severe hemophilia can participate in noncontact sports such as swimming, golf, walking, jogging, fishing, and bowling. Contact sports such as football, boxing, hockey, soccer, and rugby are strongly discouraged because the risk of injury outweighs the physical and psychosocial benefits of participating in these sports.

A quantitative sweat chloride test has been done on an 8-month-old child. What value should be indicative of cystic fibrosis (CF)? a. Less than 18 mEq/L b. 18 to 40 mEq/L c. 40 to 60 mEq/L d. Greater than 60 mEq/L

Greater than 60 mEq/L Normally sweat chloride content is less than 40 mEq/L, with a mean of 18 mEq/L. A chloride concentration greater than 60 mEq/L is diagnostic of CF; in infants younger than 3 months, a sweat chloride concentration greater than 40 mEq/L is highly suggestive of CF.

A child who has been receiving morphine intravenously will now start receiving it orally. The nurse should anticipate that to achieve equianalgesia (equal analgesic effect), the oral dose will be which of the following? a. Same as the intravenous dose b. Greater than the intravenous dose c. One half of the intravenous dose d. One fourth of the intravenous dose

Greater than the intravenous dose Oral morphine undergoes significant metabolism from the first-pass effect. For this reason, a higher oral dose is necessary to achieve the same effect as parenteral morphine. The same dose given orally will provide less pain relief. A dose larger than the intravenous dose must be given to achieve an equianalgesic effect. Level of cognitive ability: ComprehensionArea of client needs:Physiologic Integrity/Physiologic AdaptationIntegrated process: Nursing Process: PlanningREF: p. 187

A nurse is assessing a child and determines that the child is experiencing significant respiratory distress that requires immediate intervention based on assessment of which of the following symptoms? 1. Grunting 2. Increased alertness 3. Severe intercostal retractions 4. Diminished breath sounds 5. Capillary refill of 2 seconds Select one: a. 2 & 4 b. 1, 3 & 4 c. 1, 2 & 4 d. 5 & 3 e. 2, 3 & 5

Grunting Severe intercostal retractions Diminished breath sounds

A child is in uncompensated metabolic acidosis. What should the nurse expect the arterial blood gas to be? a. HCO3, 24; pH, 7.35 b. HCO3, 28; pH, 7.50 c. HCO3, 20; pH, 7.30 d. HCO3, 26; pH, 7.40

HCO3, 20; pH, 7.30 Laboratory findings of uncompensated metabolic acidosis include lowered plasma pH (<7.35) and diminished plasma bicarbonate concentration (normal HCO3 is 22-26).

A child is in uncompensated metabolic alkalosis. What should the nurse expect the arterial blood gas to be? a. HCO3, 24; pH, 7.35 b. HCO3, 28; pH, 7.50 c. HCO3, 20; pH, -7.30 d. HCO3, 26; pH, 7.40

HCO3, 28; pH, 7.50 Metabolic alkalosis results in an elevated plasma pH (normal pH is 7.35-7.45) that occurs when there is an excess of bicarbonate (normal HCO3 is 22-26).

A child with hemophilia A is scheduled for surgery. What precautions should the nurse institute with this child? a. Handle the child gently when transferring to a cart. b. Caution the child not to brush his teeth before surgery. c. Use tape sparingly on postoperative dressings. d. Do not administer analgesics before surgery.

Handle the child gently when transferring to a cart. The goal of prevention of bleeding episodes is directed toward decreasing the risk of injury. The child should be handled carefully when transferring to a cart. Brushing teeth, use of tape, and giving analgesics will not risk a bleeding episode.

The continuous administration of mist, or aerosolized water, for the treatment of inflammatory conditions of the airways is a common practice that functions in which manner? a. Has no proven benefit b. Decreases the viscosity of mucus c. Decreases bronchoconstriction d. Reduces the inflammation of the lower airways

Has no proven benefit Aerosol therapy or mist therapy with water is not a treatment of choice for inflammatory airway conditions. Some questionable benefit may occur in mild viral croup. The parent and child may experience a reduction in anxiety in a cool, humid environment. Upper airway secretions may be moistened; however, inhaled mist does not affect the viscosity of mucus. Humidity may worsen bronchospasm. Aerosolized medications are able to reduce inflammation of the lower airways, but water does not have this effect.

The nurse is caring for a child in respiratory distress. What is an early but less obvious sign of respiratory failure? a. Stupor b. Headache c. Bradycardia d. Somnolence

Headache An early but less obvious sign of respiratory failure is a headache. Stupor, bradycardia, and somnolence are signs of more severe hypoxia.

A child with sickle cell disease is in a vasoocclusive crisis. What nonpharmacologic pain intervention should the nurse plan? a. Exercise as a distraction b. Heat to the affected area c. Elevation of the extremity d. Cold compresses to the affected area

Heat to the affected area Frequently, heat to the affected area is soothing. Cold compresses are not applied to the area because doing so enhances vasoconstriction and occlusion. Bed rest is usually well tolerated during a crisis, although the actual rest obtained depends a great deal on pain alleviation and the use of organized schedules of nursing care. Although the objective of bed rest is to minimize oxygen consumption, some activity, particularly passive range of motion exercises, is beneficial to promote circulation. Usually the best course is to let children determine their activity tolerance. Elevating the extremity will not help in sickle cell disease.

The nurse is explaining blood components to an 8-year-old child. The nurse's best description of platelets is that they do which of the following? a. Make up the liquid portion of blood b. Help keep germs from causing infection c. Carry the oxygen you breathe from your lungs to all parts of your body d. Help your body stop bleeding by forming a clot (scab) over the hurt area

Help your body stop bleeding by forming a clot (scab) over the hurt area Platelets are involved in hemostasis. Plasma makes up the liquid portion of blood. White blood cells help keep germs from causing infection. Red blood cells carry the oxygen you breathe from your lungs to all parts of your body.Level of cognitive ability: KnowledgeArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Teaching/LearningREF: p. 1328

When reviewing sickle cell anemia, the student nurse remembers that children with sickle cell anemia are usually asymptomatic for the first 4-6 months of life due to: Select one: a. Symptoms become noticeable when the child becomes mobile b. High levels of fetal hemoglobin c. Increased production of HgS d. Children younger than 6 months are less prone to dehydration

High levels of fetal hemoglobin

A school-age child is admitted in vasoocclusive sickle cell crisis (pain episode). The child's care should include which therapeutic interventions? a. Hydration and pain management b. Oxygenation and factor VIII replacement c. Electrolyte replacement and administration of heparin d. Correction of alkalosis and reduction of energy expenditure

Hydration and pain management The management of crises includes adequate hydration, pain management, minimization of energy expenditures, electrolyte replacement, and blood component therapy if indicated. Factor VIII is not indicated in the treatment of vasoocclusive sickle cell crisis. Oxygen may prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels. Also, prolonged oxygen can reduce bone marrow activity. Heparin is not indicated in the treatment of vasoocclusive sickle cell crisis. Electrolyte replacement should accompany hydration. The acidosis will be corrected as the crisis is treated. Energy expenditure should be minimized to improve oxygen utilization. Acidosis, not alkalosis, results from hypoxia, which also promotes sickling.

What conditions can produce hyperventilation? (Select all that apply.) a. Hysteria b. Narcotics c. Atelectasis d. Salicylate intoxication e. Mechanical ventilation

Hysteria Salicylate intoxication Mechanical ventilation Hysteria, salicylate intoxication, and mechanical ventilation can produce hyperventilation. Narcotics and atelectasis produce inadequate gas exchange, not hyperventilation.

A 7-year-old with hemophilia A has been treated with factor VIII after a baseball injury to his arm. The nurse tells the parents that they can give the child which medication for pain? - 1 Aspirin 2 Indomethacin (Indocin) 3 Ibuprofen (Advil) 4 Etodolac

Ibuprofen (Advil) Ibuprofen in the form of Advil, Motrin, or Nuprin is safe to administer to children with hemophilia A. Nonsteroidal anti-inflammatory drugs, such as aspirin, indomethacin, and etodolac, shouldn't be used because they inhibit platelet function and can cause increased bleeding.

What condition is an acquired hemorrhagic disorder that is characterized by excessive destruction of platelets? a. Aplastic anemia b. Thalassemia major c. Idiopathic thrombocytopenic purpura d. Disseminated intravascular coagulation

Idiopathic thrombocytopenic purpura Idiopathic thrombocytopenic purpura is an acquired hemorrhagic disorder characterized by an excessive destruction of platelets, discolorations caused by petechiae beneath the skin, and normal bone marrow. Aplastic anemia refers to a bone marrow failure condition in which the formed elements of the blood are simultaneously depressed. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin chains. Disseminated intravascular coagulation is characterized by diffuse fibrin deposition in the microvasculature, consumption of coagulation factors, and endogenous generation of thrombin and plasma.

Which statement accurately expresses the genetic implications of cystic fibrosis (CF)? a. It is inherited as an autosomal dominant trait. b. It is a genetic defect found primarily in nonwhite population groups. c. If it is present in a child, both parents are carriers of the defective gene. d. There is a 50% chance that siblings of an affected child will also be affected.

If it is present in a child, both parents are carriers of the defective gene. CF is an autosomal recessive gene inherited from both parents. CF is inherited as an autosomal recessive, not autosomal dominant, trait. CF is found primarily in white populations. An autosomal recessive inheritance pattern means that there is a 25% chance a sibling will be infected but a 50% chance a sibling will be a carrier.Level of cognitive ability: ComprehensionArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Nursing Process: AssessmentREF: p. 1233

A 6-year-old child is diagnosed with iron deficiency anemia. Which nursing diagnosis is most appropriate? - 1 Activity intolerance 2 Imbalanced nutrition: Less than body requirements 3 Ineffective tissue perfusion (peripheral) 4 Impaired parenting

Imbalanced nutrition: Less than body requirements Iron deficiency anemia is the most common anemia of infancy and childhood, resulting from inadequate dietary intake of iron. Because this child's condition stems from nutritional deficiencies, Imbalanced nutrition: Less than body requirements is the most appropriate nursing diagnosis. Activity intolerance, Ineffective tissue perfusion (peripheral), and Impaired parenting may or may not be appropriate for this specific child, but they don't target the health care needs of a child with iron deficiency anemia as precisely

For children who do not have a matched sibling bone marrow donor, the therapeutic management of aplastic anemia includes what intervention? a. Antibiotics b. Antiretroviral drugs c. Iron supplementation d. Immunosuppressive therapy

Immunosuppressive therapy It is thought that aplastic anemia may be an autoimmune disease. Immunosuppressive therapy, including antilymphocyte globulin, antithymocyte globulin, cyclosporine, granulocyte colony-stimulating factor, and methylprednisone, has greatly improved the prognosis for patients with aplastic anemia. Antibiotics are not indicated as the management. They may be indicated for infections. Antiretroviral drugs and iron supplementation are not part of the therapy.

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

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

The clinic nurse is assessing a 1 year-old diagnosed with iron deficiency anemia. The nurse explains to the parent that iron deficiency anemia in this age group is most often caused by: Select one: a. Increased intestinal absorption b. Inadequate iron intake c. End of the growth spurt d. High formula intake

Inadequate iron intake

A child with severe anemia requires a unit of red blood cells (RBCs). The nurse explains to the child that the transfusion is necessary for which reason? Select one: a. Allow her parents to come visit her. b. Help her body stop bleeding by forming a clot (scab). c. Fight the infection that she now has d. Increase her energy so she will not be so tired.

Increase her energy so she will not be so tired.

A child with severe anemia requires a unit of red blood cells (RBCs). The nurse explains to the child that the transfusion is necessary for which reason? a. Allow her parents to come visit her. b. Fight the infection that she now has. c. Increase her energy so she will not be so tired. d. Help her body stop bleeding by forming a clot (scab).

Increase her energy so she will not be so tired. The indication for RBC transfusion is risk of cardiac decompensation. When the number of circulating RBCs is increased, tissue hypoxia decreases, cardiac function is improved, and the child will have more energy. Parental visiting is not dependent on transfusion. The decrease in tissue hypoxia will minimize the risk of infection. There is no evidence that the child is currently infected. Forming a clot is the function of platelets.

What statement best describes b-thalassemia major (Cooley anemia)? a. It is an acquired hemolytic anemia. b. Inadequate numbers of red blood cells (RBCs) are present. c. Increased incidence occurs in families of Mediterranean extraction. d. It commonly occurs in individuals from West Africa.

Increased incidence occurs in families of Mediterranean extraction. Individuals who live near the Mediterranean Sea and their descendants have the highest incidence of thalassemia. Thalassemia is inherited as an autosomal recessive disorder. An overproduction of RBCs occurs. Although numerous, the red blood cells are relatively unstable. Sickle cell disease is common in blacks of West African descent.

The clinical manifestations of sickle cell anemia (SCA) are primarily the result of which physiologic alteration? Select one: a. Greater affinity for oxygen b. Increased red blood cell (RBC) destruction c. Deficiency in coagulation d. Decreased blood viscosity

Increased red blood cell (RBC) destruction

. The clinical manifestations of sickle cell anemia (SCA) are primarily the result of which physiologic alteration? a. Decreased blood viscosity b. Deficiency in coagulation c. Increased red blood cell (RBC) destruction d. Greater affinity for oxygen

Increased red blood cell (RBC) destruction The clinical features of SCA are primarily the result of increased RBC destruction and obstruction caused by the sickle-shaped RBCs. When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation. SCA does not have a coagulation deficit. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension.

What does the nurse recognize as the primary factor responsible for multiple clinical manifestations of cystic fibrosis? 1 Hyperactivity of sweat glands 2 Atrophic changes in mucosal wall of intestines 3 Hypoactivity of the autonomic nervous system 4 Increased viscosity of mucous gland secretions

Increased viscosity of mucous gland secretions The primary factor responsible for clinical manifestations of cystic fibrosis is the mechanical obstruction caused by increased viscosity of mucous gland secretions, not hyperactivity of sweat glands, atrophic changes in intestinal mucosal wall, or hypoactivity of the autonomic nervous system.

Which of the following helps nurses understand how the respiratory tract in children is different from that in adults? A. Infants rely almost entirely on diaphragmatic-abdominal breathing. B. Smooth muscle development in the airways increases until about age 12 years. C. The configuration of the chest at birth is not as round as it becomes by adulthood. D. With age there is a decrease in both number of alveoli and branching of terminal bronchioles.

Infants rely almost entirely on diaphragmatic-abdominal breathing. The ribs of an infant articulate with the vertebrae and sternum at a more horizontal angle. This contributes to the infant using primarily diaphragmatic-abdominal breathing.

Iron overload is a side effect of chronic transfusion therapy. What treatment assists in minimizing this complication? a. Magnetic therapy b. Infusion of deferoxamine c. Hemoglobin electrophoresis d. Washing red blood cells (RBCs) to reduce iron

Infusion of deferoxamine Deferoxamine infusions in combination with vitamin C allow the iron to remain in a more chelatable form. The iron can then be excreted more easily. Use of magnets does not remove additional iron from the body. Hemoglobin electrophoresis is used to confirm the diagnosis of hemoglobinopathies; it does not affect iron overload. Washed RBCs remove white blood cells and other proteins from the unit of blood; they do not affect the iron concentration.

Care for the child with acute idiopathic thrombocytopenic purpura (ITP) includes which therapeutic intervention? a. Splenectomy b. Intravenous administration of anti-D antibody c. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) d. Helping child participate in sports

Intravenous administration of anti-D antibody Anti-D antibody causes an increase in platelet count approximately 48 hours after administration. Splenectomy is reserved for chronic severe ITP not responsive to pharmacologic management. NSAIDs are not used in ITP. Both NSAIDs and aspirin interfere with platelet aggregation. The nurse works with the child and parents to choose quiet activities while the platelet count is below 100,000/mm3.

A term infant is delivered, and before delivery, the medical team was notified that a congenital diaphragmatic hernia (CDH) was diagnosed on ultrasonography. What should be done immediately at birth if respiratory distress is noted? a. Give oxygen. b. Suction the infant. c. Intubate the infant. d. Ventilate the infant with a bag and mask.

Intubate the infant. Many infants with a CDH require immediate respiratory assistance, which includes endotracheal intubation and GI decompression with a double-lumen catheter to prevent further respiratory compromise. At birth, bag and mask ventilation is contraindicated to prevent air from entering the stomach and especially the intestines, further compromising pulmonary function. Oxygen and suctioning may be used for mild respiratory distress.

An intravenous line is needed in a school-age child. The most appropriate action to provide analgesia during this procedure is to apply a. TAC (tetracaine, epinephrine [Adrenalin], cocaine) 15 minutes before the procedure. b. a transdermal fentanyl (Duragesic) patch at the site of venipuncture. c. EMLA (eutectic mixture of local anesthetics) immediately before the procedure. d. LMX (4% liposomal lidocaine cream) 30 minutes before the procedure.

LMX (4% liposomal lidocaine cream) 30 minutes before the procedure. LMX is an effective analgesic agent when applied to the skin 30 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. TAC provides skin anesthesia about 15 minutes after application to nonintact skin. The gel can be placed on the wound for suturing. It is not useful for intact skin. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control. For maximum effectiveness, EMLA must be applied approximately 60 minutes in advance.Level of cognitive ability: AnalysisArea of client needs:Physiologic Integrity/Pharmacologic and Parenteral TherapiesIntegrated process: Nursing Process: ImplementationREF: p. 177

A child is developing respiratory failure. What are the assessment findings to indicate the signs of hypoxia are becoming severe? Select one: a. Restlessness b. Lethargy c. Tachycardia d. Tachypnea

Lethargy

A burn patient is experiencing anxiety over dressing changes. Which prescription should the nurse expect to be ordered to control anxiety? a. Lorazepam (Ativan) b. Oxycodone (OxyContin) c. Fentanyl (Sublimaze) d. Morphine Sulfate (Morphine)

Lorazepam (Ativan) A benzodiazepine such as lorazepam is prescribed as an antianxiety agent. Oxycodone, fentanyl, and morphine sulfate are opioid analgesics.

A child with cystic fibrosis is receiving recombinant human deoxyribonuclease (DNase). What statement about DNase is true? a. Given subcutaneously b. May cause voice alterations c. May cause mucus to thicken d. Not indicated for children younger than age 12 years

May cause voice alterations One of the only adverse effects of DNase is voice alterations and laryngitis. DNase is given in an aerosolized form, decreases the viscosity of mucus, and is safe for children younger than 12 years.

Cystic fibrosis (CF) may affect single or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations in CF? a. Hyperactivity of sweat glands b. Hypoactivity of autonomic nervous system c. Atrophic changes in mucosal wall of intestines d. Mechanical obstruction caused by increased viscosity of mucous gland secretions

Mechanical obstruction caused by increased viscosity of mucous gland secretions The mucous glands produce a thick mucoprotein that accumulates and results in dilation. Small passages in organs such as the pancreas and bronchioles become obstructed as secretions form concretions in the glands and ducts. The exocrine glands, not sweat glands, are dysfunctional. Although abnormalities in the autonomic nervous system are present, it is not hypoactive. Intestinal involvement in CF results from the thick intestinal secretions, which can lead to blockage and rectal prolapse.

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

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

What is the earliest postnatal manifestation of cystic fibrosis? 1 Steatorrhea 2 Azotorrhea 3 Meconium ileus 4 Pancreatic fibrosis

Meconium ileus is the most common earliest postnatal manifestation of cystic fibrosis. Steatorrhea is the term used to describe bulky stools from undigested fat; it is not the earliest postnatal manifestation of cystic fibrosis. Azotorrhea, foul-smelling stools resulting from putrefied protein, is not the earliest postnatal manifestation of cystic fibrosis. In pancreatic fibrosis, thick secretions block the ducts; this condition is not the earliest postnatal manifestation of cystic fibrosis.

What pain medication is contraindicated in children with sickle cell disease (SCD)? a. Meperidine (Demerol) b. Hydrocodone (Vicodin) c. Morphine sulfate d. Ketorolac (Toradol)

Meperidine (Demerol) Meperidine (pethidine [Demerol]) is not recommended. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. Patients with SCD are particularly at risk for normeperidine-induced seizures.

A mother states that she brought her child to the clinic because the 3-year-old girl was not keeping up with her siblings. During physical assessment, the nurse notes that the child has pale skin and conjunctiva and has muscle weakness. The hemoglobin on admission is 6.4 g/dl. After notifying the practitioner of the results, what nursing priority intervention should occur next? a. Reduce environmental stimulation to prevent seizures. b. Have the laboratory repeat the analysis with a new specimen. c. Minimize energy expenditure to decrease cardiac workload. d. Administer intravenous fluids to correct the dehydration.

Minimize energy expenditure to decrease cardiac workload. The child has a critically low hemoglobin value. The expected range is 11.5 to 15.5 g/dl. When the oxygen-carrying capacity of the blood decreases slowly, the child is able to compensate by increasing cardiac output. With the increasing workload of the heart, additional stress can lead to cardiac failure. Reduction of environmental stimulation can help minimize energy expenditure, but seizures are not a risk. A repeat hemoglobin analysis is not necessary. The child does not have evidence of dehydration. If intravenous fluids are given, they can further dilute the circulating blood volume and increase the strain on the heart.

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

Monitor arterial blood gases. Arterial blood gases are the best way to monitor CO poisoning. Pulse oximetry is contraindicated in the case of CO poisoning because the PaO2 may be normal. One hundred percent oxygen should be given as quickly as possible, not only if respiratory distress or other symptoms develop.

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. What nursing action should be included in the care of the child? a. Force fluids. b. Monitor pulse oximetry. c. Institute seizure precautions. d. Encourage a high-protein diet.

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

An appropriate nursing intervention when caring for a child with pneumonia is which of the following? a. Avoid placing child on the affected side. b. Monitor the respiratory status frequently. c. Place in a Trendelenburg position. d. Administer antitussive agents around the clock.

Monitor the respiratory status frequently. The child's respiratory rate, status, oxygenation, general disposition, and level of activity are frequently monitored. Lying on the affected side may promote comfort by splinting the chest and reducing pleural rubbing. The child should be positioned with the unaffected side up to promote maximum expansion. Children should be placed in a semierect position or position of comfort. Antitussives are usually not indicated.Level of cognitive ability: ApplicationArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Nursing Process: ImplementationREF: p. 1195

Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period? a. Codeine sulfate (Codeine) b. Morphine (Roxanol) c. Methadone (Dolophine) d. Meperidine (Demerol)

Morphine (Roxanol) The most commonly prescribed medications for PCA are morphine, hydromorphone, and fentanyl. Parenteral use of codeine is not recommended. Methadone in parenteral form is not used in a PCA but is given orally or intravenously for pain in the infant. Meperidine is not used for continuous and extended pain relief.

Which coanalgesics should the nurse expect to be prescribed for pruritus? (Select all that apply.) a. Naloxone (Narcan) b. Inapsine (Droperidol) c. Hydroxyzine (Atarax) d. Promethazine (Phenergan) e. Diphenhydramine (Benadryl)

Naloxone (Narcan) Hydroxyzine (Atarax) Diphenhydramine (Benadryl) The coanalgesics prescribed for pruritus include naloxone, hydroxyzine, and diphenhydramine. Inapsine and promethazine are administered as antiemetics. pg. 174 (204 pdf page) 10ed

A 5-month-old infant is in respiratory distress. What should the nurse expect to find? a. Nasal flaring b. Bradycardia c. Abdominal breathing d. Capillary refill of 2 seconds

Nasal flaring Nasal flaring is a sign of respiratory distress and a significant finding in an infant. The enlargement of the nostrils helps reduce nasal resistance and maintains airway patency. Nasal flaring may be intermittent or continuous and should be described as minimum or marked. The infant would have tachycardia, not bradycardia, in respiratory distress. Abdominal breathing and a capillary refill are normal findings in an infant.

A school-age child with cystic fibrosis takes four enzyme capsules with meals. The child is having four or five bowel movements per day. The nurse's action in regard to the pancreatic enzymes is based on the knowledge that the dosage is what? a. Adequate b. Adequate but should be taken between meals c. Needs to be increased to increase the number of bowel movements per day d. Needs to be increased to decrease the number of bowel movements per day

Needs to be increased to decrease the number of bowel movements per day The amount of enzyme is adjusted to achieve normal growth and a decrease in the number of stools to one or two per day.

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

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

A 5-year-old child is admitted to the hospital in a sickle cell crisis. The child has been alert and oriented but in severe pain. The nurse notes that the child is complaining of a headache and is having unilateral hemiplegia. What action should the nurse implement? a. Notify the health care provider. b. Place the child on bed rest. c. Administer a dose of hydrocodone (Vicodin). d. Start O2 per the hospital's protocol.

Notify the health care provider. Any number of neurologic symptoms can indicate a minor cerebral insult, such as headache, aphasia, weakness, convulsions, visual disturbances, or unilateral hemiplegia. Loss of vision is usually the result of progressive retinopathy and retinal detachment. The nurse should notify the health care provider.

The nurse is caring for a 1-month-old infant with respiratory syncytial virus (RSV) who is receiving 23% oxygen via a plastic hood. The child's SaO2 saturation is 88%, respiratory rate is 45 breaths/min, and pulse is 140 beats/min. Based on these assessments, what action should the nurse take? a. Withhold feedings. b. Notify the health care provider. c. Put the infant in an infant seat. d. Keep the infant in the plastic hood.

Notify the health care provider. The American Academy of Pediatrics practice parameter (2006) recommends the use of supplemental oxygen if the infant fails to maintain a consistent oxygen saturation of at least 90%. The health care provider should be notified of the saturation reading of 88%. Withholding the feedings or placing the infant in an infant seat would not increase the saturation reading. The infant should be kept in the hood, but because the saturation reading is 88%, the health care provider should be notified to obtain orders to increase the oxygen concentration.

A 4-year-old girl is brought to the emergency department. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should intervene in which manner? a. Make her lie down and rest quietly. b. Examine her oral pharynx and report to the physician. c. Auscultate her lungs and prepare for placement in a mist tent. d. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

Notify the physician immediately and be prepared to assist with a tracheostomy or intubation. This child is exhibiting signs of respiratory distress and possible epiglottitis. Epiglottitis is always a medical emergency requiring antibiotics and airway support for treatment. Sitting up is the position that facilitates breathing in respiratory disease. The oral pharynx should not be visualized. If the epiglottis is inflamed, there is the potential for complete obstruction if it is irritated further. Although lung auscultation provides useful assessment information, a mist tent would not be beneficial for this child. Immediate medical evaluation and intervention are indicated.

A child with sickle cell anemia (SCA) develops severe chest and back pain, fever, a cough, and dyspnea. What should be the first action by the nurse? a. Administer 100% oxygen to relieve hypoxia. b. Notify the practitioner because chest syndrome is suspected. c. Infuse intravenous antibiotics as soon as cultures are obtained. d. Give ordered pain medication to relieve symptoms of pain episode.

Notify the practitioner because chest syndrome is suspected. These are the symptoms of chest syndrome, which is a medical emergency. Notifying the practitioner is the priority action. Oxygen may be indicated; however, it does not reverse the sickling that has occurred. Antibiotics are not indicated initially. Pain medications may be required, but evaluation by the practitioner is the priority.

A child is in uncompensated respiratory acidosis. What should the nurse expect the arterial blood gas to be? a. O2, 95; CO2, 45; pH, 7.40 b. O2, 88; CO2, 55; pH, 7.30 c. O2, 88; CO2, 35; pH, 7.28 d. O2, 92; CO2, 54; pH, 7.35

O2, 88; CO2, 55; pH, 7.30 Respiratory acidosis results from diminished or inadequate pulmonary ventilation that causes an elevation in plasma Pco2 and thus an increased concentration of dissolved carbonic acid, which leads to elevated carbonic acid and hydrogen ion concentration. This tends to lower the pH. CO2 of 55 is elevated (normal CO2 is 35-45), and a pH of 7.30 is low (normal pH is 7.35-7.45).

An immediate intervention when an infant chokes on a piece of food would be to do which of the following? A. Administer mouth-to-mouth resuscitation. B. Open infant's mouth and perform blind finger sweep. C. Have infant lie quietly while a call is placed for emergency help. D. Position infant in a head-down, prone position, and administer five quick blows between the shoulder blades.

Position infant in a head-down, prone position, and administer five quick blows between the shoulder blades. This is the correct position and procedure for an infant who had choked on a piece of food or another object.

Which nonpharmacologic intervention appears to be effective in decreasing neonatal procedural pain? a. Tactile stimulation b. Commercial warm packs c. Doing procedure during infant sleep d. Oral sucrose and nonnutritive sucking

Oral sucrose and nonnutritive sucking Nonnutritive sucking attenuates behavioral, physiologic, and hormonal responses to pain. The addition of sucrose has been demonstrated to have calming and pain-relieving effects for neonates. Tactile stimulation has a variable effect on response to procedural pain. No evidence supports commercial warm packs as a pain control measure. With resulting increased blood flow to the area, pain may be greater. The infant should not be disturbed during the sleep cycle. It makes it more difficult for the infant to begin organization of sleep and awake cycles.

Ferrous sulfate 2 mL bid is ordered for a 2 year-old child who has iron deficiency anemia. For optimal absorption the nurse should administer the medication with which of the following? Select one: a. Tea b. Milk c. Water d. Orange juice

Orange juice

A child is diagnosed with influenza. Management includes which recommendation? a. Clear liquid diet for hydration b. Aspirin to control fever c. Oseltamivie (Tamiflu) d. Antibiotics to prevent bacterial infection

Oseltamivie (Tamiflu) Oseltamivie (Tamiflu) may reduce symptoms related to influenza A if administered within 24 to 48 hours of onset. A clear liquid diet is not necessary for influenza, but maintaining hydration is important. Aspirin is not recommended in children because of increased risk of Reye syndrome. Acetaminophen or ibuprofen is a better choice. Preventive antibiotics are not indicated for influenza unless there is evidence

A child is exhibiting signs and symptoms of hypoxemia. Which of the following would the nurse expect to administer? Select one: a. Bronchodilator via nebulizer b. Antibiotics c. Robitussin d. Oxygen

Oxygen

The nurse is using the CRIES pain assessment tool on a preterm infant in the neonatal intensive care unit. Which are the components of this tool? (Select all that apply.) a. Color b. Moro reflex c. Oxygen saturation d. Posture of arms and legs e. Sleeplessness f. Facial expression

Oxygen saturation Sleeplessness f. Facial expression Need for increased oxygen, crying, increased vital signs, expression, and sleeplessness are components of the CRIES pain assessment tool used with neonates. Color, Moro reflex, and posture of arms and legs are not components of the CRIES scale.

In the planning of care for a 2-year-old admitted with bacterial tracheitis, what are the priorities of care in the therapeutic management of this respiratory dysfunction? 1 Oxygen and rehydration 2 Antipyretics and antibiotics 3 Oxygen and mechanical ventilation 4 Oxygen therapy, antipyretics, and antibiotics

Oxygen therapy, antipyretics, and antibiotics Bacterial tracheitis is an infection of the mucosa of the upper trachea with features of both croup and epiglottitis. This disease occurs in children younger than 3 years and requires vigorous management with oxygen therapy, antipyretics, and antibiotics. Rehydration is not one of the top priorities for bacterial tracheitis. Mechanical ventilation may be required in some patients.

A child with hemophilia A will have which abnormal laboratory result? a. PT (ProTime) b. Platelet count c. Fibrinogen level d. PTT (partial thromboplastin time)

PTT (partial thromboplastin time) The basic defect of hemophilia A is a deficiency of factor VIII. The partial thromboplastin time measures abnormalities in the intrinsic pathway (abnormalities in factors I, II, V, VIII, IX, X, XII, HMK, and KAL). The prothrombin time measures abnormalities of the extrinsic pathway (abnormalities in factors I, II, V, VII, and X). Fibrinogen level is not dependent on the intrinsic pathway. Platelets are not affected with hemophilia A.

Arterial blood gases have just been drawn on a child. What should the nurse do next? a. Take the sample to the laboratory immediately. b. Pack the sample in ice and take it to the laboratory immediately. c. Place the sample in a brown bag until it can be taken to laboratory. d. Refrigerate the sample until it can be taken to the laboratory.

Pack the sample in ice and take it to the laboratory immediately. Arterial blood gases require careful handling for accurate results. Immediately after obtaining the specimen, the nurse packs it in ice to reduce cellular metabolism and takes it to the laboratory.

A preterm infant has just been admitted to the neonatal intensive care unit. The infant's parents ask the nurse about anesthesia and analgesia when painful procedures are necessary. What should the nurse's explanation be? a. Nerve pathways of neonates are not sufficiently myelinated to transmit painful stimuli. b. The risks accompanying anesthesia and analgesia are too great to justify any possible benefit of pain relief. c. Neonates do not possess sufficiently integrated cortical function to interpret or recall pain experiences. d. Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates.

Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates. Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response. The pathways are sufficiently myelinated to transmit the painful stimuli and produce the pain response. Local and systemic pharmacologic agents are available to permit anesthesia and analgesia for neonates.

What are signs and symptoms of anemia? (Select all that apply.) a. Pallor b. Fatigue c. Dilute urine d. Bradycardia e. Muscle weakness

Pallor Fatigue Muscle weakness Signs and symptoms of anemia include, pallor, fatigue, and muscle weakness. Tachycardia, not bradycardia, and dark urine, not dilute, are signs and symptoms of anemia.

Pancreatic enzymes are administered to the child with cystic fibrosis. What nursing consideration should be included in the plan of care? a. Give pancreatic enzymes between meals if at all possible. b. Do not administer pancreatic enzymes if the child is receiving antibiotics. c. Decrease the dose of pancreatic enzymes if the child is having frequent, bulky stools. d. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

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

A child is in the hospital for cystic fibrosis. What health care provider's prescription should the nurse clarify before implementing? a. Dornase alfa (Pulmozyme) nebulizer treatment bid b. Pancreatic enzymes every 6 hours c. Vitamin A, D, E, and K supplements daily d. Proventil (albuterol) nebulizer treatments tid

Pancreatic enzymes every 6 hours The principal treatment for pancreatic insufficiency that occurs in cystic fibrosis is replacement of pancreatic enzymes, which are administered with meals and snacks to ensure that digestive enzymes are mixed with food in the duodenum. The enzymes should not be given every 6 hours, so this should be clarified before implementing this prescription. Dornase alfa (Pulmozyme) is given by nebulizer to decrease the viscosity of secretions, vitamin supplements are given daily, and Proventil nebulizer treatments are given to open the bronchi for easier expectoration.

The nurse is planning home care for a 2-year-old child with a tracheostomy. What recommendation should be included? a. Sterile technique is essential in home care of the tracheostomy. b. Parents are able to change the tracheostomy tube when needed. c. Play activities must be sedentary such as listening to music and working on puzzles. d. The child must wear a plastic bib when eating or drinking to prevent aspiration into the stoma.

Parents are able to change the tracheostomy tube when needed. A plugged, clogged, or obstructed tracheostomy tube is a life-threatening circumstance. Parents are taught the signs and symptoms, how to suction, and how to change the tube. Clean technique and thorough hand washing are sufficient for suctioning, cleaning the tracheostomy site, and changing the tracheostomy tube. The child who is physically able can engage in activities appropriate to age. Young children who may spill food near the stoma should wear a fabric bib without a plastic lining or other device to prevent dribbled food and crumbs from being aspirated.

The nurse is analyzing an arterial blood gas of pH, 7.29; PCO2, 30; and HCO3, 20. What result should the nurse document for this blood gas? a. Fully compensated respiratory acidosis b. Partially compensated respiratory acidosis c. Fully compensated metabolic acidosis d. Partially compensated metabolic acidosis

Partially compensated metabolic acidosis

The nurse is analyzing an arterial blood gas of pH, 7.50; PCO2, 50; and HCO3, 29. What result should the nurse document for this blood gas? a. Fully compensated metabolic alkalosis b. Partially compensated metabolic alkalosis c. Fully compensated respiratory alkalosis d. Partially compensated respiratory alkalosis

Partially compensated metabolic alkalosis When the fundamental acid-base ratio is altered for any reason, the body attempts to correct the deviation. In a simple disturbance, a single primary factor affects one component of the acid-base pair and is usually accompanied by a compensatory or secondary change in the component that is not primarily affected. In metabolic alkalosis, the pH is high (?7?7.45), and the HCO3 is high (?7?26). When the pH is restored to normal, the disturbance is described as compensated. It is partially compensated because the pH remains abnormal, but the PCO2 is high (?7?45), indicating an attempt at compensation.

35. The nurse is analyzing an arterial blood gas of pH, 7.30; PCO2, 50; and HCO3, 29. What result should the nurse document for this blood gas? a. Fully compensated respiratory acidosis b. Partially compensated respiratory acidosis c. Fully compensated metabolic acidosis d. Partially compensated metabolic acidosis

Partially compensated respiratory acidosis When the fundamental acid-base ratio is altered for any reason, the body attempts to correct the deviation. In a simple disturbance, a single primary factor affects one component of the acid-base pair and is usually accompanied by a compensatory or secondary change in the component that is not primarily affected. In respiratory acidosis, the pH is low (?6?7.35), and the PCO2 is high (?7?45). When the pH is restored to normal, the disturbance is described as compensated. It is partially compensated because the pH remains abnormal, but the HCO3 is high (?7?26), indicating an attempt at compensation.

The nurse is analyzing an arterial blood gas of pH, 7.50; PCO2, 30; and HCO3, 20. What result should the nurse document for this blood gas? a. Fully compensated metabolic alkalosis b. Partially compensated metabolic alkalosis c. Fully compensated respiratory alkalosis d. Partially compensated respiratory alkalosis

Partially compensated respiratory alkalosis When the fundamental acid-base ratio is altered for any reason, the body attempts to correct the deviation. In a simple disturbance, a single primary factor affects one component of the acid-base pair and is usually accompanied by a compensatory or secondary change in the component that is not primarily affected. In respiratory alkalosis, the pH is high (?7?7.45), and the PCO2 is low (?6?35). When the pH is restored to normal, the disturbance is described as compensated. It is partially compensated because the pH remains abnormal, but the HCO3 is low (?6?22), indicating an attempt at compensation.

The nurse is caring for a child with hemophilia A. The child's activity is as tolerated. What activity is contraindicated for this child? a. Ambulating to the cafeteria b. Active range of motion c. Ambulating to the playroom d. Passive range of motion exercises

Passive range of motion exercises Passive range of motion exercises should never be part of an exercise regimen after an acute episode because the joint capsule could easily be stretched and bleeding could recur. Active range of motion exercises are best so that the patient can gauge his or her own pain tolerance. The child can ambulate to the playroom or the cafeteria.

Therapeutic management of a 6-year-old child with hereditary spherocytosis (HS) should include which therapeutic intervention? a. Perform a splenectomy. b. Supplement the diet with calcium. c. Institute a maintenance transfusion program. d. Increase intake of iron-rich foods such as meat.

Perform a splenectomy. Splenectomy corrects the hemolysis that occurs in HS. The splenectomy is generally reserved for children older than age 5 years with symptomatic anemia. Supplementation with calcium does not affect the HS. Additional folic acid can prevent deficiency caused by the rapid cell turnover. A maintenance transfusion program suppresses red blood cell formation. At this time, the risks of transfusion are greater than those of a splenectomy. Iron supplementation does not influence the course of HS.

The nurse must suction a 6-month-old infant with a tracheostomy. What intervention should be included? a. Encourage the child to cough to raise the secretions before suctioning. b. Perform each pass of the suction catheter for no longer than 5 seconds. c. Allow the child to rest after every five times the suction catheter is passed. d. Select a catheter with a diameter three quarters of the diameter of the tracheostomy tube.

Perform each pass of the suction catheter for no longer than 5 seconds. Suctioning should require no longer than 5 seconds per pass. Otherwise, the airway may be occluded for too long. An infant would be unable to cooperate with instructions to cough up secretions. The child is allowed to rest for 30 to 60 seconds after each aspiration to allow oxygen tension to return to normal. Then the process is repeated until the trachea is clear. The catheter should have a diameter one half the size of the tracheostomy tube. If it is too large, it might block the child's airway.

The majority of children in the United States with human immunodeficiency virus (HIV) infection acquired the disease by which means? a. Through sexual contact b. From a blood transfusion c. By using intravenous (IV) drugs d. Perinatally from their mothers

Perinatally from their mothers More than 90% of the children with HIV under 13 years who were reported to the Centers for Disease Control and Prevention acquired the infection during the perinatal period. With intervention, the number of children infected can be decreased. Sexual contact and IV drug use are the leading causes of infection in the 14- to 19-year age group. This number is less than the number of cases in the under 13-year age group. Transfusion has accounted for 3% to 6% of all pediatric acquired immunodeficiency syndrome cases to date. Before 1985 and routine screening of donated blood products, children with hemophilia were at great risk from pooled plasma products.

A child is in the intensive care unit after a motor vehicle collision. The child has numerous fractures and is in pain that is rated 9 or 10 on a 10-point scale. In planning care, the nurse recognizes that the indicated action is which? a. Give only an opioid analgesic at this time. b. Increase dosage of analgesic until the child is adequately sedated. c. Plan a preventive schedule of pain medication around the clock. d. Give the child a clock and explain when she or he can have pain medications.

Plan a preventive schedule of pain medication around the clock. For severe postoperative pain, a preventive around the clock (ATC) schedule is necessary to prevent decreased plasma levels of medications. The opioid analgesic will help for the present, but it is not an effective strategy. Increasing the dosage requires an order. The nurse should give the drug on a regular schedule and evaluate the effectiveness. Using a clock is counterproductive because it focuses the child's attention on how long he or she will need to wait for pain relief.

The nurse is caring for a school-age child with severe anemia and activity intolerance. What diversional activity should the nurse plan for this child? a. Playing a musical instrument b. Playing board or card games c. Participating in a game of table tennis d. Participating in decorating the hospital room

Playing board or card games Plan diversional activities that promote rest but prevent boredom and withdrawal. Because short attention span, irritability, and restlessness are common in anemia and increase stress demands on the body, plan appropriate activities such as playing board or card games. Playing a musical instrument, participating in a game of table tennis, or decorating the hospital room would cause undue exertion.

The parent of a child with cystic fibrosis (CF) 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 signs and symptoms are suggestive of what condition? a. Pneumothorax b. Bronchodilation c. Carbon dioxide retention d. Increased viscosity of sputum

Pneumothorax Usually the signs of pneumothorax are nonspecific. Tachypnea, tachycardia, dyspnea, pallor, and cyanosis are significant signs and symptoms and are indicative of respiratory distress caused by pneumothorax. If the bronchial tubes were dilated, the child would have decreased work of breathing and would most likely be asymptomatic. Carbon dioxide retention is a result of the chronic alveolar hypoventilation in CF. Hypoxia replaces carbon dioxide as the drive for respiration progresses. Increased viscosity would result in more difficulty clearing secretions.

The nurse recognizes that oxygen mist tents are rarely used for a child with respiratory distress. What are reasons for not using an oxygen mist tent? (Select all that apply.) a. Poor access to the child b. Cool and wet tent environment c. Oxygen levels fall when tent is entered d. Child may not tolerate it around the crib/bed e. Lower oxygen concentrations cannot be achieved

Poor access to the child Cool and wet tent environment Oxygen levels fall when tent is entered Child may not tolerate it around the crib/bed The disadvantages of using a mist tent include poor access to the child, a cool and wet tent environment, oxygen levels fall when the tent is entered, and the child may not tolerate it around the crib or bed. Lower oxygen concentrations can be achieved in the tent and is an advantage.

What nursing consideration is most important in the care of a child on a mechanical ventilator? a. Humidification is not necessary. b. Respiratory assessment is done by the ventilator. c. Positioning the child for comfort and optimum ventilation is necessary. d. Support and reassurance are not as important because the child is unconscious.

Positioning the child for comfort and optimum ventilation is necessary. The ventilator will do the work of breathing, but the nurse must position the child with attention to achieving optimum gas exchange. The reason for mechanical ventilation and the child's comfort are part of the assessment. Mechanical ventilation is usually achieved by intubation or tracheostomy. These routes bypass the humidification that occurs in the upper airway. The ventilator provides some information about the work of breathing, but patient assessment must be done by the nurse. Support and reassurance are always important for both the child and family. Opioids and anxiolytics are often used to decrease the child's anxiety. Careful assessment is indicated.

A 2-year-old client with cystic fibrosis is confined to bed and is not allowed to go to the playroom. Which of the following is an appropriate toy would the nurse select for the child: A. Puzzle B. Musical automobile C. Arranging stickers in the album D. Pounding board and hammer

Pounding board and hammer The autonomous toddler would be frustrated by being confined to be. The pounding board and hammer is developmentally appropriate and an excellent way for the toddler to release frustration.

The clinic nurse is evaluating causes for iron deficiency caused by inadequate supply of iron. What should the nurse recognize as causes for iron deficiency caused by an inadequate iron supply? (Select all that apply.) a. Prematurity b. Slow growth rate c. Excessive milk intake d. Severe iron deficiency in the mother e. Exclusive breastfeeding of infant from birth to 3 months

Prematurity Excessive milk intake Severe iron deficiency in the mother Causes for iron deficiency caused by an inadequate supply of iron include prematurity, excessive milk intake, and severe iron deficiency in the mother. Rapid growth rate, not slow, and exclusive breastfeeding of infant after 6 months, not from birth to 3 months, can be causes of inadequate supply of iron.

Home care is being considered for a young child who is ventilator-dependent. Which factor is most important in deciding whether home care is appropriate? a. Level of parents' education b. Presence of two parents in the home c. Preparation and training of family d. Family's ability to assume all health care costs

Preparation and training of family One of the essential elements is the family's training and preparation. The family must be able to demonstrate all aspects of care for the child. In many areas, it cannot be guaranteed that nursing care will be available on a continual basis, and the family will have to care for the child. The amount of formal education reached by the parents is not the important issue. The determinant is the family's ability to care adequately for the child in the home. At least two family members should learn and demonstrate all aspects of the child's care in the hospital, but it does not have to be two parents. Few families can assume all health care costs. Creative financial planning, including negotiating arrangements with the insurance company and/or public programs, may be required.

In anticipation of the admission of a child with hereditary spherocytosis (HS) who is experiencing an aplastic crisis, what action should the nurse plan? a. Secure an isolation room. b. Prepare for a transfusion of packed red blood cells. c. Anticipate preoperative preparation for a splenectomy. d. Gather equipment and medication for treatment of shock.

Prepare for a transfusion of packed red blood cells. In hereditary spherocytosis, aplastic crisis results in a sudden cessation of RBC production by the bone marrow. Hemoglobin and hematocrit values drop rapidly, which results in severe anemia. Transfusion support may be needed, and close monitoring of the child's cardiovascular status is necessary. The nurse should prepare for a transfusion of packed red blood cells initially. An isolation room is not needed, splenectomy would not be done at this time, and the child will not be in shock.

An infant with a congenital heart defect is to receive a dose of palivizumab (Synagis). What is the purpose of this? a. Prevent RSV infection. b. Prevent secondary bacterial infection. c. Decrease toxicity of antiviral agents. d. Make isolation of infant with RSV unnecessary.

Prevent RSV infection. The only product available in the United States for prevention of RSV is palivizumab, a humanized mouse monoclonal antibody, which is given once every 30 days (15 mg/kg) between November and March. It is given to high-risk infants, which includes an infant with a congenital heart defect.

A hospitalized 12-year-old is experiencing excessive bruising and oozing from a puncture site. Disseminated intravascular coagulation (DIC) is suspected. Which laboratory test results further suggest DIC? - 1 Increased platelet count 2 Increased fibrinogen level 3 Absent fibrin split products 4 Prolonged prothrombin time (PT) and partial thromboplastin time (PTT)

Prolonged prothrombin time (PT) and partial thromboplastin time (PTT) DIC is a paradoxical disorder that produces increased coagulation and a bleeding defect at the same time. Children with DIC have a prolonged PT and PTT, decreased platelet count, decreased fibrinogen levels, and elevated fibrin split product levels.

What condition precipitates polycythemia? a. Dehydration b. Severe infections c. Immunosuppression d. Prolonged tissue hypoxia

Prolonged tissue hypoxia Oxygen transport depends on both the number of circulating RBCs and the amount of normal hemoglobin in the cell. This explains why polycythemia (increase in the number of erythrocytes) occurs in conditions characterized by prolonged tissue hypoxia, such as cyanotic heart defects. Dehydration, severe infections, or immunosuppression will not precipitate polycythemia.

When preparing the teaching plan for the mother of a child with asthma, which of the following should the nurse include as signs to alert the mother that her child is having an asthma attack? Select one: a. Low grade fever b. Wheezing on expiration c. Frequent, productive cough d. Copious, thin mucus secretions

Wheezing on expiration

What rationale explains why prolonged use of oxygen should be discouraged in a child with anemia? a. Prolonged use of oxygen can decrease erythropoiesis. b. Prolonged use of oxygen can interfere with iron production. c. Prolonged use of oxygen interferes with a child's appetite. d. Prolonged use of oxygen can affect the synthesis of hemoglobin.

Prolonged use of oxygen can decrease erythropoiesis. Oxygen administration is of limited value, because each gram of hemoglobin is able to carry a limited amount of the gas. In addition, prolonged use of supplemental oxygen can decrease erythropoiesis. Prolonged use of oxygen does not interfere with iron production, a child's appetite, or affect the synthesis of hemoglobin.

The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C (98.6° F). The nurse suspects mild croup and should recommend which intervention? a. Admit to the hospital and observe for impending epiglottitis. b. Provide fluids that the child likes and use comfort measures. c. Control fever with acetaminophen and call if cough gets worse tonight. d. Try over-the-counter cough medicine and come to the clinic tomorrow if no improvement.

Provide fluids that the child likes and use comfort measures. In mild croup, therapeutic interventions include adequate hydration (as long as the child can easily drink) and comfort measures to minimize distress. The child is not exhibiting signs of epiglottitis. A temperature of 37° C is within normal limits. Although a return to the clinic may be indicated, the mother is instructed to return if the child develops noisy respirations or drooling.

The nurse is teaching the family of a child, age 8 years, with moderate hemophilia about home care. What should the nurse tell the family to do to minimize joint injury? a. Administer nonsteroidal anti-inflammatory drugs (NSAIDs). b. Administer DDAVP (synthetic vasopressin). c. Provide intravenous (IV) infusion of factor VIII concentrates. d. Encourage elevation and application of ice to the involved joint.

Provide intravenous (IV) infusion of factor VIII concentrates. Parents are taught home infusion of factor VIII concentrate. For moderate and severe hemophilia, prompt IV administration is essential to prevent joint injury. NSAIDs are effective for pain relief. They must be given with caution because they inhibit platelet aggregation. A factor VIII level of 30% is necessary to stop bleeding. DDAVP can raise the factor VIII level fourfold. Moderate hemophilia is defined by a factor VIII activity of 4.9. A fourfold increase would not meet the 30% level. Ice and elevation are important adjunctive therapy, but factor VIII is necessary.

Effective cardiopulmonary resuscitation (CPR) on a 5-year-old child should include what technique? a. Provide one breath to every five chest compressions. b. Provide two breaths to every 30 chest compressions. c. Reassess the child every 10 minutes while CPR continues. d. Evaluate the child after 50 cycles of compression and ventilation.

Provide two breaths to every 30 chest compressions Two breaths to 15 compressions is the standard for infants and children when two rescuers are present. One breath to every five chest compressions is not the appropriate ratio for CPR in this age group. Reassessment of the child should take place after 20 cycles or 1 minute.

The nurse is planning pain control for a child. Which is the advantage of administering pain medication by the intravenous (IV) bolus route? a. Less expensive than oral medications b. Produces a first-pass effect through the liver c. Does not need to be administered frequently d. Provides most rapid onset of effect, usually in about 5 minutes

Provides most rapid onset of effect, usually in about 5 minutes The advantage of pain medication by the IV bolus route is that it provides the most rapid onset of effect, usually in about 5 minutes. IV medications are more expensive than oral medications, and the IV route bypasses the first-pass effect through the liver. Pain control with IV bolus medication needs to be repeated hourly for continuous pain control.

What is the best explanation for using pulse oximetry on young children to determine oxygen saturation? a. Pulse oximetry is noninvasive. b. Pulse oximetry is better than capnography. c. Pulse oximetry is more accurate than arterial blood gases. d. Pulse oximetry provides intermittent measurements of oxygen.

Pulse oximetry is noninvasive. Pulse oximetry is a noninvasive measure of oxygen saturation of hemoglobin. Capnography measures carbon dioxide inhalation and exhalation. It does not provide information about oxygen saturation. Arterial blood gases provide additional clinical information, including pH, PCO2, bicarbonate, base excess, and PO2. An arterial puncture is required, which can be painful, and continuous monitoring cannot be done without an arterial line. Pulse oximetry can be either intermittent or continuous.

A nurse is calculating the correlation of Pao2 with Sao2 according to the oxyhemoglobin dissociation curve. What parameter should indicate that the Pao2 is less than 50 to 60 mm Hg? a. Coarse lung sounds b. Temperature of 100° F c. Respiratory rate of 58 d. Pulse oximetry reading of 90% or less

Pulse oximetry reading of 90% or less The Pao2 can be correlated with the Sao2 by means of the oxyhemoglobin dissociation curve, although changes in Pao2 do not cause identical (linear) changes in Sao2. The curve represents the relationship between Pao2(measured in the blood) and Sao2 (measured by the pulse oximeter). When the Pao2 is 60?9?mm?9?Hg, the Sao2 is 90%. The oxyhemoglobin dissociation curve does not correlate with lung sounds, temperature, or respiratory rate.

A child is admitted with acute laryngotracheobronchitis (LTB). The child will most likely be treated with which? a. Racemic epinephrine and corticosteroids b. Nebulizer treatments and oxygen c. Antibiotics and albuterol d. Chest physiotherapy and humidity

Racemic epinephrine and corticosteroids Nebulized epinephrine (racemic epinephrine) is now used in children with LTB that is not alleviated with cool mist. The beta-adrenergic effects cause mucosal vasoconstriction and subsequent decreased subglottic edema. The use of corticosteroids is beneficial because the anti-inflammatory effects decrease subglottic edema. Nebulizer treatments are not effective even though oxygen may be required. Antibiotics are not used because it is a viral infection. Chest physiotherapy would not be instituted.

The nurse stops to assist a child who has been hit by a car while riding a bicycle. Someone has activated the emergency medical system. Until paramedics arrive, the nurse should consider which of the following in caring for this child who has experienced severe trauma? A. Rapid assessment should begin with ABC status: airway, breathing, consciousness. B. Assessment should begin with area injured; assessment of other areas can wait. C. The possibility of spinal cord injury should be ruled out before transporting child to the hospital. D. Temperature maintenance is more difficult than in adults, since young children have a larger surface area related to body mass.

Rapid assessment should begin with ABC status: airway, breathing, consciousness. The first priority is always airway, breathing, and circulation.

The school nurse is discussing prevention of acquired immunodeficiency syndrome with some adolescents. Which of the following is appropriate to include? a. The virus is easily transmitted. b. It is only transmitted through blood. c. Condoms should be used if adolescents are homosexual. d. Recreational drug users should not share needles or other equipment.

Recreational drug users should not share needles or other equipment. Human immunodeficiency virus is spread through blood and body fluids. Intravenous needles that have been used should not be shared. They may be contaminated with the virus. The virus is not easily transmitted. It requires direct contact with blood or body fluids on a nonintact skin surface. Body fluids may also transmit the virus. Condoms should be used for both heterosexual and homosexual sex.Level of cognitive ability: ApplicationArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Teaching/LearningREF: p. 1371

One of the goals for children with asthma is to maintain the child's normal functioning. What principle of treatment helps to accomplish this goal? a. Limit participation in sports. b. Reduce underlying inflammation. c. Minimize use of pharmacologic agents. d. Have yearly evaluations by a health care provider.

Reduce underlying inflammation. Children with asthma are often excluded from exercise. This practice interferes with peer interaction and physical health. Most children with asthma can participate provided their asthma is under control. Inflammation is the underlying cause of the symptoms of asthma. By decreasing inflammation and reducing the symptomatic airway narrowing, health care providers can minimize exacerbations. Pharmacologic agents are used to prevent and control asthma symptoms, reduce the frequency and severity of asthma exacerbations, and reverse airflow obstruction. It is recommended that children with asthma be evaluated every 6 months.

The nurse is performing discharge teaching for the parents of an infant with an upper respiratory tract infection. Which respiratory complication should prompt the parents to notify the health care practitioner? a. Dry cough b. Waking up during naps c. Decreasing irritability with fever d. Refusal to drink and decreased urination

Refusal to drink and decreased urination The health care professional should be notified of any refusal to take oral fluids and decreased urination so that dehydration, which could further complicate respiratory problems, may be prevented. Although a dry cough does not warrant contacting a health care professional, persistent cough or exacerbating cough does. Waking up during naps does not warrant contacting the health care professional; however, restlessness and a poor sleep pattern does. Decreasing irritability with fever does not warrant contacting a health care professional; however, increasing irritability with or without fever does.

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

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

The nurse is caring for a child with a tracheostomy. What clinical manifestation should the nurse recognize as an early sign of impending respiratory distress or failure? a. Cyanosis b. Restlessness c. Audible stridor d. Crowing respirations

Restlessness Signs of hypoxemia are initially subtle. Cardinal signs of impending respiratory failure include restlessness, tachypnea, tachycardia, and diaphoresis. Cyanosis is a sign of severe hypoxia. Stridor and crowing respirations are indicative of inflammation. Sternal retractions are an early but less obvious sign.

A 17-year-old is admitted to the facility in sickle cell crisis. The nurse receives an order from the physician that she believes is in error and decides to question it. What does this order say? - 1 Restrict fluids to 800 ml/8 hours. 2 Give oxygen by face mask at 8 L/minute. 3 Type and crossmatch for 2 units of packed red blood cells (RBCs). 4 Give acetaminophen (Tylenol), 325 mg, orally every 4 to 6 hours for temperature above 101% F (38.3% C).

Restrict fluids to 800 ml/8 hours. The adolescent should be well-hydrated to allow sickled RBCs to move freely through the blood vessels. Dehydration leads to blood stasis and further sickling. Sickle cell anemia increases the risk of hypoxia, which also promotes sickling, so oxygen is warranted. Blood replacement may be ordered to treat anemia and reduce the viscosity of the sickled blood. Inflammation related to swollen and warm joints causes fever, which is commonly treated with acetaminophen.

The pediatric ICU nurse is receiving report from the ED on a 4 year-old child with splenic-sequestration. The nurse understands that splenic-sequestration: Select one: a. Requires surgery to remove the spleen b. Results in hypovolemia and shock c. Is caused by severe bleeding in the joints d. Frequently causes extreme chest pain

Results in hypovolemia and shock

During a respiratory assessment, the nurse notes a sinking in of soft tissues relative to the cartilaginous and bony thorax. What is the term for this finding? a. Grunting b. Tachypnea c. Retractions d. Nasal flaring

Retractions Retractions are defined as the sinking of soft tissue relative to the cartilaginous or bony thorax. Retractions can be extreme in severe airway obstruction as the work of breathing increases. Grunting can be a sign of pain in older children with respiratory issues. It serves to increase the end-respiratory pressure, which prolongs the period of oxygen and carbon dioxide exchange across the membrane. Tachypnea is an increase in the respiratory rate above the child's baseline. Nasal flaring, the enlargement of the nostrils, helps reduce nasal resistance and maintains airway patency.

What do the initial signs of respiratory syncytial virus (RSV) infection in an infant include? a. Rhinorrhea, wheezing, and fever b. Tachypnea, cyanosis, and apnea c. Retractions, fever, and listlessness d. Poor breath sounds and air hunger

Rhinorrhea, wheezing, and fever Symptoms such as rhinorrhea and a low-grade fever often appear first. OM and conjunctivitis may also be present. In time, a cough may develop. Wheezing is an initial sign as well. Progression of illness brings on the symptoms of tachypnea, retractions, poor breath sounds, cyanosis, air hunger, and apnea.

The nurse is caring for an intubated child on mechanical ventilation. What interventions should the nurse implement to prevent ventilator-assisted pneumonia (VAP)? (Select all that apply.) a. Routine oral hygiene b. Appropriate hand hygiene c. Limit oropharyngeal suctioning of secretions d. Elevating the head of the bed 30 to 45 degrees e. Wearing gloves to handle respiratory secretions

Routine oral hygiene Appropriate hand hygiene Limit oropharyngeal suctioning of secretions Elevating the head of the bed 30 to 45 degrees Critically ill children on mechanical ventilation are at risk for acquisition of VAP. To prevent VAP, recommendations for nurses working with mechanically ventilated patients include appropriate hand hygiene measures; wearing gloves to handle respiratory secretions or contaminated objects; elevating the head of the bed 30 to 45 degrees; and routine oral hygiene, which includes oropharyngeal suctioning of secretions.

When discussing emergency treatment of an acute, severe asthma episode with a young child and the parents, the nurse explains that the drug usually given first would be: Select one: a. Leukotriene modifiers b. Short acting B2-agonists c. Xanthine derivatives d. Mast cell stabilizers

Short acting B2-agonists

What drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a. Ephedrine b. Theophylline c. Aminophylline d. Short-acting b2-agonists

Short-acting b2-agonists Short-acting b2-agonists are the first treatment in an acute asthma exacerbation. Ephedrine and aminophylline are not helpful in acute asthma exacerbations. Theophylline is unnecessary for treating asthma exacerbations.

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant shows signs or symptoms of which condition? a. Has a cough b. Becomes fussy c. Shows signs of an earache d. Has a fever higher than 37.5° C (99° F)

Shows signs of an earache If an infant with nasopharyngitis shows signs of an earache, it may indicate respiratory complications and possibly secondary bacterial infection. The health professional should be contacted to evaluate the infant. Cough can be a sign of nasopharyngitis. Irritability is common in an infant with a viral illness. Fever is common in viral illnesses.

What condition occurs when the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron deficiency anemia

Sickle cell anemia Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Thalassemia major refers to a variety of inherited disorders characterized by deficiencies in production of certain globulin chains. Iron-deficiency anemia affects red blood cell size and depth of color but does not involve abnormal hemoglobin.

What diagnostic test for allergies involves the injection of specific allergens? a. Phadiatop b. Skin testing c. Radioallergosorbent tests (RAST) d. Blood examination for total immunoglobulin E (IgE)

Skin testing Skin testing is the most commonly used diagnostic test for allergy. A specific allergen is injected under the skin, and after a suitable time, the size of the resultant wheal is measured to determine the patient's sensitivity. Phadiatop is a screening test that uses a blood sample to assess for IgE antibodies for a group of specific allergens. RAST determines the level of specific IgE antibodies. Blood examination for total IgE would not distinguish among allergens.

Children who are taking long-term inhaled steroids should be assessed frequently for what potential complication? a. Cough b. Osteoporosis c. Slowed growth d. Cushing syndrome

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

When reviewing the pathophysiology of asthma, the RN remembers that the long-term effects of asthma include epithelial cell damage and: Select one: a. Mast cell suppression b. Airway dilation c. Smooth muscle hypertrophy d. Mucous hyposecretion

Smooth muscle hypertrophy

A child is developing respiratory failure. Signs that the hypoxia is becoming severe include: A. Tachypnea B. Tachycardia C. Somnolence D. Restlessness

Somnolence Somnolence is a late sign indicating severe hypoxia.

A 4-year-old boy needs to use a metered-dose inhaler for asthma. He cannot coordinate his breathing to use it effectively. What should the nurse suggest that he use? 1 Spacer 2 Nebulizer 3 Peak expiratory flow meter 4 Trial of chest physiotherapy

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 device for administering medications, but it cannot be used with metered-dose inhalers. Peak expiratory flow meters are used to measure pulmonary function but are not related to medication administration. Chest physiotherapy is unrelated to medication administration.

The nurse is taking care of an infant with RSV bronchiolitis. The nurse explains to the parent that the benefits and actions of the Ribavirin medication are listed below with one exception which is: Select one: a. Enhances antiviral response genes b. Stabilization of cell membranes c. It is associated with decreased length of hospital stay d. Blocks viral replication

Stabilization of cell membranes

The nurse suspects a child is having an adverse reaction to a blood transfusion. The first action by the nurse should be which of the following? a. Notify the physician. b. Take the vital signs and blood pressure and compare them with baseline levels. c. Dilute infusing blood with equal amounts of normal saline. d. Stop transfusion and maintain a patent intravenous line with normal saline and new tubing.

Stop transfusion and maintain a patent intravenous line with normal saline and new tubing. Stopping the transfusion and maintaining a patent intravenous line with normal saline and new tubing is the priority nursing action. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused. Notifying a physician and taking vital signs and blood pressure should be performed after the blood transfusion is stopped and infusion of normal saline has begun. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred.Level of cognitive ability: ComprehensionArea of client needs: Physiologic Integrity/Pharmacologic and Parenteral TherapyIntegrated process: Nursing Process: ImplementationREF: p. 1332

What tests aid in the diagnosis of cystic fibrosis (CF)? Select one: a. Sweat test, stool for fat, chest radiography b. Stool for fat, gastric contents for hydrochloride, radiography c. Sweat test, stool for trypsin, biopsy of intestinal mucosa d. Sweat test, bronchoscopy, duodenal fluid analysis

Sweat test, stool for fat, chest radiography

What tests aid in the diagnosis of cystic fibrosis (CF)? a. Sweat test, stool for fat, chest radiography b. Sweat test, bronchoscopy, duodenal fluid analysis c. Sweat test, stool for trypsin, biopsy of intestinal mucosa d. Stool for fat, gastric contents for hydrochloride, radiography

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

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

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

A 3-month-old infant is admitted to the pediatric unit for treatment of bronchiolitis. The infant's vital signs are T, 101.6° F; P, 106 beats/min apical; and R, 70 breaths/min. The infant is irritable and fussy and coughs frequently. IV fluids are given via a peripheral venipuncture. Fluids by mouth were initially contraindicated for what reason? a. Tachypnea b. Paroxysmal cough c. Irritability d. Fever

Tachypnea Fluids by mouth may be contraindicated because of tachypnea, weakness, and fatigue. Therefore, IV fluids are preferred until the acute stage of bronchiolitis has passed. Infants with bronchiolitis may have paroxysmal coughing, but fluids by mouth would not be contraindicated. Irritability or fever would not be reasons for fluids by mouth to be contraindicated.

What are common signs of a pneumothorax in a child with cystic fibrosis? 1 Cyanosis, bradycardia 2 Tachypnea, bradycardia, pallor 3 Tachypnea, tachycardia, dyspnea, cyanosis 4 Tachypnea, subtle increase in oxygen saturation

Tachypnea, tachycardia, dyspnea, cyanosis Signs of a pneumothorax in a child with cystic fibrosis include tachypnea, tachycardia, dyspnea, and cyanosis. Bradycardia is not a sign of a pneumothorax in a child with cystic fibrosis. A subtle decrease, rather than an increase, in oxygen saturation is a sign of a pneumothorax.

An important nursing consideration when caring for a child with sickle cell anemia is which of the following? a. Refer the parents and child for genetic counseling. b. Teach the parents and child how to recognize the signs and symptoms of crises. c. Help the child and family adjust to a short-term disease. d. Observe for complications of multiple blood transfusions.

Teach the parents and child how to recognize the signs and symptoms of crises. Parents need specific instructions on the need to watch for changes in the child's condition, including adequate hydration, and environmental concerns. Genetic counseling is important, but teaching care of the child is a priority. Sickle cell anemia is a long-term, chronic illness. Multiple blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is properly preparing the parents to care for them.Level of cognitive ability: AnalysisArea of client needs: Physiologic Integrity/Physiologic AdaptationIntegrated process: Teaching/LearningREF: p. 1351

The nurse assessing an adolescent complaining of a sore throat anticipates the need for antibiotic therapy as treatment because the adolescent most likely has bacterial pharyngitis. Which of the following would the nurse identify to support this determination? Select one: a. Rhinitis b. Gradual onset c. Temperature of 103 F d. WBC within normal range

Temperature of 103 F

. A child has a streptococcal throat infection and is being treated with antibiotics. What should the nurse teach the parents to prevent infection of others? a. The child can return to school immediately. b. The organism cannot be transmitted through contact. c. The child can return to school after taking antibiotics for 24 hours. d. The organism can only be transmitted if someone uses a personal item of the sick child.

The child can return to school after taking antibiotics for 24 hours. Children with streptococcal infection are noninfectious to others 24 hours after initiation of antibiotic therapy. It is generally recommended that children not return to school or daycare until they have been taking antibiotics for a full 24-hour period. The organism is spread by close contact with affected persons—direct projection of large droplets or physical transfer of respiratory secretions containing the organism.

The nurse is caring for a child on oxygen being delivered by a nasal cannula. What is the advantage of delivering oxygen in this manner? a. It can deliver mist if desired. b. It is less likely to cause abdominal distention. c. The child is able to eat and talk while getting oxygen. d. This method can deliver a higher concentration of oxygen.

The child is able to eat and talk while getting oxygen. An advantage of delivering oxygen by nasal cannula is that the child is able to eat and talk while getting oxygen. This method cannot deliver mist or higher concentrations of oxygen. A disadvantage of this method is that it may cause abdominal distention.

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

The diet should be high in calories and protein. Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Fats and proteins are a necessary part of a well-balanced diet. A well-balanced diet containing fruits and vegetables is important. Enzyme supplementation helps digest foods; other modifications are not necessary.Level of cognitive ability: ApplicationArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Nursing Process: ImplementationREF: p. 1243

Which statement by the parents does the nurse associate with cystic fibrosis in the child? a. The infant has diarrhea. b. The infant tastes "salty." c. The infant has loss of appetite. d. The infant has a flat abdomen.

The infant tastes "salty." The parents of the infant with cystic fibrosis may report that their infant tastes "salty." A positive sweat chloride test helps to evaluate the presence of cystic fibrosis in the child. The infant fails to pass stools and may have large, bulky, loose, frothy, and extremely foul-smelling stools. Meconium ileus and meconium ileus equivalent, or total or partialintestinal obstruction, can occur at any age. The child is often constipated as a result of a combination of malabsorption, either from inadequate pancreatic enzyme dosage or a failure to take the enzymes, decreased intestinal motility, and abnormally viscous intestinal secretions. Initially the infant has a voracious appetite, which is now reduced. The child has a distended abdomen due to intestinal obstruction.

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

The mother's presence will reduce anxiety and ease the child's respiratory efforts. The family's presence will decrease the child's distress. It is true that mothers of hospitalized toddlers often experience guilt and that separation from mother is a major developmental threat for toddlers, but the main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort.

The nurse is preparing to admit a 2 month-infant child with an acute respiratory infection. The nurse understands that this child is at increased risk for respiratory failure due to all of the following except: Select one: a. Younger children are at higher risk than older children b. The pharynx is larger in the infant than the adult ? c. The epiglottis is floppier in an infant compared to an adult d. The infant's airway is smaller than an adult's airway

The pharynx is larger in the infant than the adult

A 6-year-old child has patient-controlled analgesia (PCA) for pain management after orthopedic surgery. The parents are worried that their child will be in pain. What should your explanation to the parents include? a. The child will continue to sleep and be pain free. b. Parents cannot administer additional medication with the button. c. The pump can deliver baseline and bolus dosages. d. There is a high risk of overdose, so monitoring is done every 15 minutes.

The pump can deliver baseline and bolus dosages. The PCA prescription can be set for a basal rate for a continuous infusion of pain medication. Additional doses can be administered by the patient, parent, or nurse as necessary. Although the goal of PCA is to have effective pain relief, a pain-free state may not be possible. With a 6-year-old child, the parents and nurse must assess the child to ensure that adequate medication is being given because the child may not understand the concept of pushing a button. Evidence-based practice suggests that effective analgesia can be obtained with the parents and nurse giving boluses as necessary. The prescription for the PCA includes how much medication can be given in a defined period. Monitoring every 1 to 2 hours for patient response is sufficient.

What developmental factor increases the risk of infection in infants and young children? 1 The reduced exposure of infants to organisms increases their chance of infection. 2 The narrowed airways of young children mean that organisms move slowly down the respiratory tract. 3 The relatively short and open eustachian tubes of young children give pathogens easy access to the middle ear. 4 The diameter of the airways in young children is big and therefore subject to edema of the mucous membranes.

The relatively short and open eustachian tubes of young children give pathogens easy access to the middle ear. The relatively short and open eustachian tube in young children allows pathogens easy access to the middle ear. The narrowed airways in young children promote quick, not slow, movement of organisms down the respiratory tract. Increased exposure to organisms would increase the chance of infection. The diameter of the airways in young children is not big but small and therefore subject to edema of the mucous membranes.

What is an important consideration when using the FACES pain rating scale with children? a. Children color the face with the color they choose to best describe their pain. b. The scale can be used with most children as young as 3 years. c. The scale is not appropriate for use with adolescents. d. The FACES scale is useful in pain assessment but is not as accurate as physiologic responses.

The scale can be used with most children as young as 3 years. The FACES scale is validated for use with children ages 3 years and older. Children point to the face that best describes their level of pain. The scale can be used through adulthood. The child's estimate of the pain should be used. The physiologic measures may not reflect more long-term pain.

What statement is the most descriptive of asthma? a. It is inherited. b. There is heightened airway reactivity. c. There is decreased resistance in the airway. d. The single cause of asthma is an allergic hypersensitivity.

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

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

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

What describes nonpharmacologic techniques for pain management? Select one: a. They make pharmacologic strategies unnecessary. b. They trick children into believing they do not have pain. c. They may reduce pain perception. d. They usually take too long to implement.

They may reduce pain perception

What describes nonpharmacologic techniques for pain management? a. They may reduce pain perception. b. They usually take too long to implement. c. They make pharmacologic strategies unnecessary. d. They trick children into believing they do not have pain.

They may reduce pain perception. Nonpharmacologic techniques provide coping strategies that may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. The nonpharmacologic strategy should be matched with the child's pain severity and be taught to the child before the onset of the painful experience. Tricking children into believing they do not have pain may mitigate the child's experience with mild pain, but the child will still know the discomfort was present.

The parents of a preterm infant in a neonatal intensive care unit are concerned about their infant experiencing pain from so many procedures. The nurse's response should be based on which characteristic about preterm infants' pain? a. They may react to painful stimuli but are unable to remember the pain experience. b. They perceive and react to pain in much the same manner as children and adults. c. They do not have the cortical and subcortical centers that are needed for pain perception. d. They lack neurochemical systems associated with pain transmission and modulation.

They perceive and react to pain in much the same manner as children and adults. Numerous research studies have indicated that preterm and newborn infants perceive and react to pain in the same manner as children and adults. Preterm infants can have significant reactions to painful stimuli. Pain can cause oxygen desaturation and global stress response. These physiologic effects must be avoided by use of appropriate analgesia. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response.

The nurses caring for a child are concerned about the child's frequent requests for pain medication. During a team conference, a nurse suggests they consider administering a placebo instead of the usual pain medication. The decision should be based on knowledge of which of the following? a. This practice is unjustified and unethical. b. This practice is effective to determine whether a child's pain is real. c. The absence of a response to a placebo means the child's pain has an organic basis. d. A positive response to a placebo will not occur if the child's pain has an organic basis.

This practice is unjustified and unethical. Use of placebos without the patient's consent is unethical. Use of placebos does not provide information about the presence or severity of the pain. Individuals may have a positive response to a placebo despite a significant organic cause for their pain.Level of cognitive ability: AnalysisArea of client needs:Physiologic Integrity/Physiologic AdaptationIntegrated process: Nursing Process: PlanningREF: p. 175

What test measures the amount of air inhaled and exhaled during any respiratory cycle? a. Tidal volume b. Vital capacity c. Dynamic compliance d. Pulmonary resistance

Tidal volume Tidal volume is defined as the amount of air inhaled and exhaled during any respiratory cycle. When it is multiplied by the respiratory rate, the minute volume is obtained. Forced vital capacity is the maximum amount of air that can be expired after maximum inspiration. It is used to monitor individuals with obstructive airway disease. Dynamic compliance is the relationship between the change in volume and pressure difference. Pulmonary resistance measures the changes in pressure with changes in flow on inspiration and expiration.

The regulation of red blood cell (RBC) production is thought to be controlled by which physiologic factor? a. Hemoglobin b. Tissue hypoxia c. Reticulocyte count d. Number of RBCs

Tissue hypoxia Hemoglobin does not directly control RBC production. If there is insufficient hemoglobin to adequately oxygenate the tissue, then erythropoietin may be released. When tissue hypoxia occurs, the kidneys release erythropoietin into the bloodstream. This stimulates the marrow to produce new RBCs. Reticulocytes are immature RBCs. The "retic" count can be used to monitor hematopoiesis. The number of RBCs does not directly control production. In congenital cardiac disorders with mixed blood flow or decreased pulmonary blood flow, RBC production continues secondary to tissue hypoxia.

A child with asthma is having pulmonary function tests. What rationale explains the purpose of the peak expiratory flow rate? a. To assess severity of asthma b. To determine cause of asthma c. To identify "triggers" of asthma d. To confirm diagnosis of asthma

To assess severity of asthma Peak expiratory flow rate monitoring is used to monitor the child's current pulmonary function. It can be used to manage exacerbations and for daily long-term management. The cause of asthma is known. Asthma is caused by a complex interaction among inflammatory cells, mediators, and the cells and tissues present in the airways. The triggers of asthma are determined through history taking and immunologic and other testing. The diagnosis of asthma is made through clinical manifestations, history, physical examination, and laboratory testing.

The nurse recognizes that signs of respiratory distress in an infant include all of the following except: Select one: a. Tripod position b. Nasal flaring c. Grunting d. Intercostal retractions

Tripod position

A 3-year-old child is experiencing pain after a tonsillectomy. The child has not taken in any fluids and does not want to drink anything, saying, "My tummy hurts." The following health care prescriptions are available: acetaminophen (Tylenol) PO (orally) or PR (rectally) PRN, ice chips, clear liquids. What should the nurse implement to relieve the child's pain? a. Ice chips b. Tylenol PO c. Tylenol PR d. Popsicle

Tylenol PR The throat is very sore after a tonsillectomy. Most children experience moderate pain after a tonsillectomy and need pain medication at regular intervals for at least the first 24 hours. Analgesics may need to be given rectally or intravenously to avoid the oral route.

A bone marrow aspiration and biopsy are needed on a school-age child. The most appropriate action to provide analgesia during the procedure is which? a. Administer TAC (tetracaine, adrenalin, and cocaine) 15 minutes before the procedure. b. Use a combination of fentanyl and midazolam for conscious sedation. c. Apply EMLA (eutectic mixture of local anesthetics) 1 hour before the procedure. d. Apply a transdermal fentanyl (Duragesic) "patch" immediately before the procedure.

Use a combination of fentanyl and midazolam for conscious sedation. A bone marrow biopsy is a painful procedure. The combination of fentanyl and midazolam should be used to provide conscious sedation. TAC provides skin anesthesia about 15 minutes after it is applied to nonintact skin. The gel can be placed on a wound for suturing. It is not sufficient for a bone marrow biopsy. EMLA is an effective topical analgesic agent when applied to the skin 60 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. For this procedure, systemic analgesia is required. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control.

A family requires home care teaching with regard to preventative measures to use at home to avoid an asthmatic episode. What strategy should the nurse teach? a. Use a humidifier in the child's room. b. Launder bedding daily in cold water. c. Replace wood flooring with carpet. d. Use an indoor air purifier with HEPA filter.

Use an indoor air purifier with HEPA filter. Allergen control includes use of an indoor air purifier with HEPA filter. Humidity should be kept low, bedding laundered in hot water once a week, and carpet replaced with wood floors.

The nurse is teaching the mother of a child with cystic fibrosis how to do postural drainage. The nurse should tell the mother to: A. Use the heel of her hand during percussion B. Change the child's position every 20 minutes C. Do percussion after the child eats and at bedtime D. Use cupped hands during percussion

Use cupped hands during percussion The nurse or parent should use a cupped hand when performing chest percussion. Answer A is incorrect because the hand should be cupped. Answer B is incorrect because the childs position should be changed every 510 minutes and the whole session should be limited to 20 minutes. Answer D is incorrect because chest percussion should be done before meals.

A child with asthma is undergoing pulmonary function tests. What is the purpose of the peak expiratory flow rate test? 1 Used to assess the severity of asthma 2 Used to determine the cause of asthma 3 Used to identify the triggers of asthma 4 Used to confirm the diagnosis of asthma

Used to assess the severity of asthma The peak expiratory flow rate (PEFR) test is a measure of the maximal 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.

Respiratory illness in children may result in hypoxia. When providing care for children in respiratory distress, the nurse should know that which of the following would provide the best assessment of the child's oxygenation status? Select one: a. Dietary intake b. Vital signs with O2 Sat c. Urine output d. Respiratory rate

Vital signs with O2 Sat

Respiratory illness in children may result in hypoxia. When providing care for children in respiratory distress, the nurse should know that which of the following would provide the best assessment of the child's oxygenation status? Select one: a. Respiratory rate b. Urine output c. Dietary intake d. Vital signs with O2 Sat

Vital signs with O2 Sat

When caring for a child after a tonsillectomy, what intervention should the nurse do? a. Watch for continuous swallowing. b. Encourage gargling to reduce discomfort. c. Apply warm compresses to the throat. d. Position the child on the back for sleeping.

Watch for continuous swallowing. Continuous swallowing, especially while sleeping, is an early sign of bleeding. The child swallows the blood that is trickling from the operative site. Gargling is discouraged because it could irritate the operative site. Ice compresses are recommended to reduce inflammation. The child should be positioned on the side or abdomen to facilitate drainage of secretions.

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain which of the following concerning narcotic analgesics? a. They are often ordered but not usually needed. b. When they are medically indicated, children rarely become addicted. c. They are given as a last resort because of the threat of addiction. d. They are used only if other measures, such as ice packs, are ineffective.

When they are medically indicated, children rarely become addicted. Pain is the most common and debilitating symptom experienced by patients with sickle cell disease. The chronic nature of this pain can greatly affect the child's development. A multidisciplinary approach is best for its management. Patient-controlled analgesia or continuous intravenous administration is usually effective. Pharmacologic intervention is necessary for the pain of sickle cell crisis.Level of cognitive ability: AnalysisArea of client needs: Physiologic Integrity/Pharmacologic and Parenteral TherapyIntegrated process: Teaching/LearningREF: p. 1347

When administering pancrelipase to child with cystic fibrosis, nurse Faith knows they should be given: A) With meals and snacks B) After each bowel movement and after postural drainage C) On awakening, following meals, and at bedtime D) Every three hours while awake

With meals and snacks

What statement is descriptive of most cases of hemophilia? a. X-linked recessive deficiency of platelets causing prolonged bleeding b. X-linked recessive inherited disorder in which a blood clotting factor is deficient c. Autosomal dominant deficiency of a factor involved in the blood-clotting reaction d. Y-linked recessive inherited disorder in which the red blood cells become moon shaped

X-linked recessive inherited disorder in which a blood clotting factor is deficient The inheritance pattern in 80% of all the cases of hemophilia is X-linked recessive. The two most common forms of the disorder are factor VIII deficiency (hemophilia A, or classic hemophilia) and factor IX deficiency (hemophilia B, or Christmas disease). The disorder involves coagulation factors, not platelets. The disorder does not involve red blood cells or the Y chromosome.

What interventions can the nurse teach parents to do to ease respiratory efforts for a child with a mild respiratory tract infection? (Select all that apply.) a. Cool mist b. Warm mist c. Steam vaporizer d. Keep child in a flat, quiet position e. Run a shower of hot water to produce steam

a. Cool mist b. Warm mist c. Steam vaporizer e. Run a shower of hot water to produce steam Warm or cool mist is a common therapeutic measure for symptomatic relief of respiratory discomfort. The moisture soothes inflamed membranes and is beneficial when there is hoarseness or laryngeal involvement. A time-honored method of producing steam is the shower. Running a shower of hot water into the empty bathtub or open shower stall with the bathroom door closed produces a quick source of steam. Keeping a child in this environment for 10 to 15 minutes may help ease respiratory efforts. A small child can sit on the lap of a parent or other adult. The child should be quiet but upright, not flat. The use of steam vaporizers in the home is often discouraged because of the hazards related to their use and limited evidence to support their efficacy.

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

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

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

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

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

a. Notify the surgeon if the child swallows frequently. c. Place the child on the abdomen until fully wake. d. Allow the child to have diluted juice after the procedure. Frequent swallowing is a sign of bleeding in children after a tonsillectomy. The child should be placed on the abdomen or the side to facilitate drainage. The child can drink diluted juice, cool water, or popsicles after the procedure. An ice collar should be used after surgery. Frequent coughing and nose blowing should be avoided.

When discussing a 4th grade child's chronic headaches the nurse should include how chronic pain effects: Select all that apply Select one or more: a. Physical functioning b. Cognitive level c. Sleep d. School work

a. Physical functioning c. Sleep d. School work

The RN reviewing factors influencing pain in children during an in-service with new graduates would include: Select all that apply Select one or more: a. Previous pain experience b. Parental temperament c. Ethnicity d. Parental expectations

a. Previous pain experience c. Ethnicity d. Parental expectations

The nurse is completing a respiratory assessment on a newborn. What are normal findings of the assessment the nurse should document? (Select all that apply.) Select one or more: a. Respiratory rate of 40 breaths/min b. Slight intercostal retractions c. Periodic breathing d. Apnea lasting 25 seconds e. Wheezes on auscultation

a. Respiratory rate of 40 breaths/min b. Slight intercostal retractions c. Periodic breathing

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

after taking antibiotics for 24 hours. After children have taken antibiotics for 24 hours, they are no longer contagious to other children. Sore throat may persist longer than 24 hours of antibiotic therapy, but the child is no longer considered contagious. Complications may take days to weeks to develop. The time from throat culture does not affect the contagiousness of the infection. Antibiotics must be used.Level of cognitive ability: ComprehensionArea of client needs: Physiologic Integrity/Pharmacologic and Parenteral TherapyIntegrated process: Nursing Process: ImplementationREF: p. 1173

Asthma is now classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include all of the following except a. lung function. b. associated allergies. c. frequency of symptoms. d. frequency and severity of exacerbations.

associated allergies. Associated allergies are not part of the classification system used in the Guidelines for the Diagnosis and Management of Asthma. The clinical features that are assessed in the classification system are frequency of daytime and nighttime symptoms, frequency and severity of exacerbations, and lung function.Level of cognitive ability: ApplicationArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Nursing Process: ImplementationREF: p. 1216

A mother brings her 5-year old child into the clinic for evaluation. The mother says "I think he has a cold." The nurse assesses the child and suspects that the child has allergic rhinitis based on which assessment findings? 1. Repeated sneezing episodes 2. Absence of sinus pain 3. Itchy eyes 4. Bluish discoloration under the eyes 5. Purulent rhinorrhea Select one: a. 1, 3 & 4 b. 1, 2, 3 & 4 c. 3, 4 & 5 d. 2, 3 & 5 e. 1, 2, 4 & 5

b. 1, 2, 3 & 4

A child with bronchopulmonary dysplasia is being discharged. The nurse includes teaching about ways to manage the child's airway secretions. Which of the following would the nurse most likely include? 1. Oxygen therapy 2. Chest physiotherapy 3. Coughing 4. Pulse oximetry 5. Suctioning Select one: a. 2, 3 & 4 b. 2 & 5 c. 1 & 5 d. 1, 2 & 3

b. 2 & 5

A nurse is admitting an infant with asthma. What usually triggers asthma in infants? a. Medications b. A viral infection c. Exposure to cold air d. Allergy to dust or dust mites

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

Which are components of the FLACC scale? (Select all that apply.) a. Color b. Capillary refill time c. Leg position d. Facial expression e. Activity

c. Leg position d. Facial expression e. Activity Facial expression, consolability, cry, activity, and leg position are components of the FLACC scale. Color is a component of the Apgar scoring system. Capillary refill time is a physiologic measure that is not a component of the FLACC scale.

The nurse is preparing to admit a 7-year-old child with pulmonary edema. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Fever. b. Bradycardia. c. Diaphoresis. d. Pink frothy sputum. e. Respiratory crackles.

c. Diaphoresis. d. Pink frothy sputum. e. Respiratory crackles. Clinical manifestations of pulmonary edema include diaphoresis, pink frothy sputum, and respiratory crackles. Fever or bradycardia are not manifestations of pulmonary edema.

A school-age child with cancer is being prepared for a procedure. The child says, "I have had one of these. They hurt." The nurse's response should be based on knowledge that children a. often lie about experiencing pain. b. tolerate pain better than adults. c. become accustomed to painful procedures. d. commonly experience treatment-related moderate to severe pain when they have cancer.

commonly experience treatment-related moderate to severe pain when they have cancer. Pain is reported by approximately 84% of children with cancer. Of these, most report it as moderate to severe, and half report the pain as highly distressing. There are no data to support that children misrepresent pain experiences. Pain tolerance is a complex phenomenon that is not based on age. Children do not become accustomed to painful procedures.Level of cognitive ability: AnalysisArea of client needs:Physiologic Integrity/Physiologic AdaptationIntegrated process: Nursing Process: ImplementationREF: p. 187

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which intervention should be included in the child's care? (Select all that apply.) a. Place in a mist tent. b. Administer antibiotics. c. Administer cough syrup. d. Encourage the child to drink 8 ounces of formula every 4 hours. e. Cluster care to encourage adequate rest. f. Place on noninvasive oxygen monitoring.

d. Encourage the child to drink 8 ounces of formula every 4 hours. e. Cluster care to encourage adequate rest. f. Place on noninvasive oxygen monitoring. Hydration is important in children with RSV bronchiolitis to loosen secretions and prevent shock. Clustering of care promotes periods of rest. The use of noninvasive oxygen monitoring is recommended. Mist tents are no longer used. Antibiotics do not treat illnesses with viral causes. Cough syrup suppresses clearing of respiratory secretions and is not indicated for young children.

The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. What is the priority nursing intervention? Select one: a. Move the child to the nurse's office or hallway. b. Determine what the child has eaten. c. Administer diphenhydramine (Benadryl). d. Have someone call for an ambulance or paramedic rescue squad

d. Have someone call for an ambulance or paramedic rescue squad

The most profound complication of prolonged middle ear disorders is a. loss of hearing. b. failure to thrive. c. visual impairment. d. tympanic membrane rupture.

loss of hearing. Loss of hearing is the principal functional consequences of prolonged middle ear infections. Diminished hearing has an adverse effect on the development of speech, language, and cognition. During the active infection, loss of appetite typically occurs, and sucking or chewing tends to aggravate the pain. This is a short-term issue; when the otitis media resolves, the child resumes previous dietary intake. Ear infections do not have an effect on vision. Rupture of the eardrum may occur, but the loss of hearing and subsequent effect on speech are of greater concern.Level of cognitive ability: ApplicationArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Nursing Process: PlanningREF: p. 1179

The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry green color. The nurse should explain that this is a(n) a. symptom of iron deficiency anemia. b. adverse effect of the iron preparation. c. indicator of an iron preparation overdose. d. normally expected change resulting from the iron preparation.

normally expected change resulting from the iron preparation. An adequate dosage of iron turns the stools a tarry green color. Descriptions of iron-deficiency anemia, iron preparation, and iron preparation overdose are not relevant. If the stools do not become tarry green, it may be indicative of administration issues.Level of cognitive ability: AnalysisArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Teaching/LearningREF: p. 1338

Physiologic measurements in children's pain assessment are a. not useful as the sole indicator for pain. b. the best indicator of pain in children of all ages. c. of most value when children also report having pain. d. essential to determine whether a child is telling the truth about pain.

not useful as the sole indicator for pain. Physiologic manifestations of pain may vary considerably, so they do not provide a consistent measure of pain. Heart rate may increase or decrease. The same signs that may suggest fear, anxiety, or anger also indicate pain. In chronic pain, the body adapts, and these signs decrease or stabilize. Physiologic measurements are of limited value and must be viewed in the context of a pain rating scale, behavioral assessment, and parental report. When the child reports pain on an appropriate pain scale, the appropriate interventions should be used.Level of cognitive ability: ApplicationArea of client needs:Physiologic Integrity/Physiologic AdaptationIntegrated process: Nursing Process: AssessmentREF: p. 158

Skin testing for tuberculosis (TB) is recommended a. every year for all children older than 2 years. b. every year for all children older than 10 years. c. every 2 years for all children starting at age 1 year. d. periodically for children who are high-risk populations.

periodically for children who are high-risk populations. Children who are high risk for contracting the disease are monitored periodically. Annual testing is only indicated for children with human immunodeficiency virus infection and incarcerated adolescents. Testing is not necessary unless exposure is likely or an underlying medical risk factor is present.Level of cognitive ability: ComprehensionArea of client needs: Physiologic Integrity/Pharmacologic and Parenteral TherapiesIntegrated process: Nursing Process: ImplementationREF: p. 1197

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 less labored ventilation. d. soothes inflamed mucous membranes.

soothes inflamed mucous membranes. Warm or cold mist is useful to soothe the inflamed mucous membranes. Humidification is most useful when hoarseness or laryngeal involvement occurs. Normal saline nose drops should be used to liquefy secretions. The mist particles do not penetrate in sufficient amounts to accomplish this. There is no additional oxygen in the mist therapy commonly used for respiratory tract infections. The primary effect of mist is to soothe the inflamed membranes. A reduction in swelling might ease ventilatory effort, but it is not the primary purpose of the therapy.Level of cognitive ability: AnalysisArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Nursing Process: ImplementationREF: p. 1165

A 5-year-old has patient-controlled analgesia (PCA) for pain management after abdominal surgery. Your explanation to the parents should include a. the child will be pain free. b. only the child is allowed to push the button for a bolus. c. the pump allows for a continuous basal rate and delivers a constant amount of medication to control pain. d. there is a high risk of overdose, so monitoring is done every 15 minutes.

the pump allows for a continuous basal rate and delivers a constant amount of medication to control pain. The PCA prescription can be set for a basal rate for a continued infusion of pain medication to prevent pain from returning during sleep and when the patient cannot control the infusion. Although the goal of PCA is to have effective pain relief, a pain-free state may not be possible. With a child who is 5 years old, the parents and nurse must assess the child to ensure that adequate medication is being given. A child who is 5 years old may not be able to understand the concept of pushing a button. Evidence suggests that effective analgesia can be obtained with the parents and nurse giving boluses as necessary. The prescription for the PCA includes how much medication can be given in a defined period. Monitoring every 1 to 2 hours for patient response is sufficient.Level of cognitive ability: ComprehensionArea of client needs:Physiologic Integrity/Physiologic AdaptationIntegrated process: Teaching/LearningREF: p. 176

When hemoglobin falls sufficiently to produce clinical manifestations, the signs and symptoms are caused by a. phagocytosis. b. tissue hypoxia. c. pulmonary hypertension. d. depressed bone marrow.

tissue hypoxia. The signs and symptoms (e.g., weakness, fatigue, and a waxy pallor in severe anemia) are caused by tissue hypoxia. Phagocytosis is a function of white blood cells used in prevention of infection. Pulmonary hypertension is not associated with anemia. Severe anemia may contribute to cardiac compensation. Depressed bone marrow may be the cause of the low hemoglobin.Level of cognitive ability: KnowledgeArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Teaching/LearningREF: p. 1329