Peds Exam 2 questions

Ch. 46 cancer /hematologic disorders

Ch. 46 cancer /hematologic disorders

Ch. 47 immunologic disorder

Ch. 47 immunologic disorder

Ch. 49 alterations in genetics

Ch. 49 alterations in genetics

The nurse is providing instructions to parents of a 2-year-old child with a fever. The child weighs 33 pounds. Based on the recommended dose for ibuprofen, how much would the nurse instruct the parents to give as the lowest amount per dose?

75 mg

An adolescent weighing 55 kg is admitted to the hospital experiencing a sickle cell crisis. Intravenous fluid therapy as well as increased oral fluids are ordered as part of his treatment plan. Based on the understanding of the amount of fluids needed to promote hemodilution, the nurse would expect the adolescent to receive how much total fluid in 24 hours?

8,250 mL

The nurse is assessing a child with aplastic anemia. What would the nurse expect to assess? Select all that apply. A) Ecchymoses B) Tachycardia C) Guaiac-positive stool D) Epistaxis E) Severe pain F) Warm tender joints

A) Ecchymoses B) Tachycardia C) Guaiac-positive stool D) Epistaxis Assessment findings associated with aplastic anemia include ecchymoses, epistaxis, guaiac-positive stools, and tachycardia. Severe pain and warm tender joints are most often associated with sickle cell crisis.

The nurse is caring for a child with widespread itching and has recommended bathing as a relief measure. After teaching the mother about this, which statement from the mother indicates a need for further instruction? A) "After bathing, I need to rub his skin everywhere to make sure he is completely dry." B) "I must make sure I use lukewarm water instead of hot water." C) "Oatmeal baths are helpful; we can add Aveeno skin relief bath treatment." D) "We should leave his skin moist before applying medication or moisturizer."

A) "After bathing, I need to rub his skin everywhere to make sure he is completely dry." The nurse needs to emphasize to the mother that she must only pat the child dry and not rub his skin. Rubbing can cause further itching. Additionally, the skin should be left moist prior to applying medication or moisturizer. Lukewarm water and oatmeal baths are appropriate.

The nurse is educating the parents of a 4-year-old boy with a Wilms tumor who is about to have chemotherapy prior to surgery. Which statement by the parents indicates that the nurse should review the instructions about preventing infection? A) "He takes his antibiotic twice a day." B) "We check his temperature orally." C) "We keep him away from crowds." D) "He must be clean, and his teeth brushed."

A) "He takes his antibiotic twice a day." The parents have heard the instructions for the antibiotic administration incorrectly. The trimethoprim-sulfamethoxazole should be administered twice daily for 3 consecutive days each week to prevent Pneumocystis pneumoniae. The parents understand to avoid rectal temperatures and crowds, and to maintain his hygiene meticulously.

The nurse is caring for a child with thalassemia who is receiving chelation therapy at home using a battery-operated pump. After teaching the parents about this treatment, which statement by the mother indicates a need for additional teaching? A) "I can have the nurse administer the chelation therapy if I am uncomfortable." B) "I must be very careful to strictly adhere to the chelation regimen." C) "The deferoxamine binds to the iron so it can be removed from the body." D) "The medication can be administered while my child is sleeping."

A) "I can have the nurse administer the chelation therapy if I am uncomfortable." The nurse needs to emphasize to the mother that therapy must be maintained at home to continuously decrease the iron levels in the child's body. Family members need to be taught to administer deferoxamine subcutaneously with a small battery- powered infusion pump over a several-hour period each night (usually while the child is sleeping).

The nurse is providing home care instructions for a 13-year-old girl recently diagnosed with systemic lupus erythematosus. Which response by the girl indicates a need for further teaching? A) "I need to wear sunscreen in the summer to prevent rashes." B) "I need to eat a healthy diet, exercise, and get plenty of sleep." C) "I need an eye examination every year." D) "I need to be careful when it is cold; I should always wear gloves."

A) "I need to wear sunscreen in the summer to prevent rashes." The nurse needs to emphasize that the girl should apply sunscreen every day, not just in the summer, to prevent rashes resulting from photosensitivity. A healthy diet, sleep, yearly eye examinations, and protection from cold weather are appropriate measures.

A nurse is caring for a 12-year-old girl with a severe peanut allergy. The girl's parents are upset because the school does not permit her to carry her EpiPen with her. It must remain in the school's office per school regulations. Which response by the nurse would be most appropriate? A) "She is allowed by law to carry her EpiPen with her; I will talk to school authorities." B) "Let's file an action plan and keep it in the school office in the event of anaphylaxis." C) "Make sure she wears a medical alert bracelet so that school staff know she has allergies." D) "I will be happy to train school authorities and staff to recognize anaphylaxis."

A) "She is allowed by law to carry her EpiPen with her; I will talk to school authorities."

What would the nurse expect to find in a male infant with Wiskott--Aldrich syndrome? A) Eczema B) Thrombocytosis C) Lymphadenopathy D) Pneumonia

A) Eczema Wiskott--Aldrich syndrome is manifested by eczema that usually worsens with time, petechiae, bloody diarrhea, or a bleeding episode in the first 6 months of life. Thrombocytopenia is present. Lymphadenopathy is associated with hypogammaglobulinemia. Pneumonia is associated with severe combined immune deficiency.

The nurse is administering intravenous immune globulin (IVIG). The nurse assesses vital signs and for adverse reactions every 15 minutes for the first hour of administration. After the first hour, the nurse most likely would continue to assess the child at which frequency? A) Every 30 minutes B) Every 45 minutes C) Every 60 minutes D) Every 2 hours

A) Every 30 minutes The nurse needs to continue assessments according to institutional protocol. Every 15 minutes for the first hour and every 30 minutes through the remainder of the infusion is the standard assessment.

An infant is diagnosed with a congenital cataract. What would the nurse expect to assess? A) Absent red reflex B) Rapid irregular eye movement C) Misalignment of the eyes D) Enlarged eye appearance

A) Absent red reflex Assessment findings associated with congenital cataract include a history of lack of visual awareness; clouding of the cornea, which may or may not be visible; and no red reflex. Rapid irregular eye movement would suggest nystagmus. Misalignment of the eyes would suggest strabismus. Enlarged appearance of the eye is associated with infantile glaucoma.

The mother of a school-age child brings the child to the clinic for evaluation because he is having difficulty reading. His last visual screening was normal. He also complains of headaches and dizziness. Which of the following would the nurse suspect? A) Astigmatism B) Myopia C) Hyperopia D) Nystagmus

A) Astigmatism

The nurse is caring for a 10-year-old with allergic conjunctivitis. The nurse would be alert to the child's increased risk for what issue? A) Atopic dermatitis B) Insect bite sensitivity C) Acute otitis media D) Frequent sore throats

A) Atopic dermatitis Atopic dermatitis is a risk factor specifically for allergic conjunctivitis because of repeated exposure to the particular allergens. Acute otitis media, insect bite sensitivity, and frequent sore throats can occur but are not related to the allergic conjunctivitis.

The nurse is reviewing the laboratory test results of a child who is receiving chemotherapy. To calculate the child's absolute neutrophil count, in addition to the total number of white blood cells, which results would the nurse use? Select all that apply. A) Bands B) Segs C) Eosinophils D) Basophils

A) Bands B) Segs To calculate the absolute neutrophil count, the nurse would add together the percentage of banded and segmented neutrophils and then multiply the total number of white blood cells reported on the complete blood count by the sum.

A nursing student is preparing an oral presentation about autosomal recessive inheritance. Which of the following must occur for an offspring to demonstrate signs and symptoms of the disorder with this type of inheritance? A) Both parents must be heterozygous carriers. B) One parent must have the disease. C) The mother must be a carrier. D) The father must be affected by the disease.

A) Both parents must be heterozygous carriers.

A 14-year-old boy is diagnosed with Hodgkin disease. When palpating for enlarged lymph nodes, the nurse would expect to find which nodes as most commonly enlarged? Select all that apply. A) Cervical B) Axillary C) Supraclavicular D) Occipital E) Inguinal

A) Cervical C) Supraclavicular Enlarged lymph nodes may feel rubbery and tend to occur in clusters. Although any lymph nodes may be involved, the lymph nodes most commonly affected are in the cervical and supraclavicular areas.

A nurse is developing a plan of care for a child who is admitted to the hospital for surgery. The child is visually impaired. What would be most appropriate for the nurse to include in the child's plan of care? Select all that apply. A) Explaining instructions using simple and specific terms the child understands B) Allowing the child to explore the postoperative equipment with his hands C) Touching the child on his shoulder before letting the child know someone is there D) Using the child's body parts to refer to the area where he may have postoperative pain E) Speaking to the child in a voice that is slightly louder than the usual tone of voice

A) Explaining instructions using simple and specific terms the child understands B) Allowing the child to explore the postoperative equipment with his hands D) Using the child's body parts to refer to the area where he may have postoperative pain

A group of students are preparing for a class exam on skin disorders. As part of their preparation, they are reviewing information about acne vulgaris and its association with increased sebum production. The students demonstrate understanding of the information when they identify which areas as having the highest sebaceous gland activity? Select all that apply. A) Face B) Upper chest C) Neck D) Back E) Shoulders

A) Face B) Upper chest D) Back The face, upper chest, and back are the areas of highest sebaceous activity and thus the most common areas for acne lesions to occur. The neck and shoulders are not typical areas involved with acne.

The nurse is assessing a 2-day-old newborn and suspects Down syndrome based on which of the following? Select all answers that apply. A) Flat facial profile B) Downward slant to the eyes C) Large tongue compared to mouth D) Simian crease E) Epicanthal folds F) Rigid joints

A) Flat facial profile (it only says A is correct but it's C too)

A child is diagnosed with a food allergy to milk. When teaching the parents about this allergy, what would the nurse suggest as possible substitutions for milk? Select all that apply. A) Fruit juice B) Rice milk C) Yogurt D) Nondairy creamers E) Soy milk

A) Fruit juice B) Rice milk E) Soy milk Milk can be replaced with water, fruit juice, rice milk, or soy milk. Yogurt contains milk and some nondairy products such as creamers may contain milk and should be avoided.

An infant is diagnosed with infantile glaucoma. When developing the plan of care for the infant, for what would the nurse expect to prepare the infant and family? A) Goniotomy B) Antibiotic therapy C) Contact lenses D) Patching of affected eye

A) Goniotomy

When evaluating the hemogram of an 8-month-old infant, the nurse would identify which type of hemoglobin as being the predominant type? A) Hemoglobin A B) Hemoglobin F C) Hemoglobin A2 D) Hemoglobin S

A) Hemoglobin A Three types of normal hemoglobin are present at any given time in the blood: A, F, and A2. By 6 months of age, hemoglobin A is the predominant type. Hemoglobin S is associated with sickle cell disease.

The parents bring their 4-year-old son to the emergency department. The child is receiving chemotherapy for acute lymphoblastic leukemia. The parents report that the child has become lethargic and has had significant episodes of vomiting and diarrhea. What findings would lead the nurse to suspect the child may be experiencing tumor lysis syndrome? Select all that apply. A) Hyperkalemia B) Hypophosphatemia C) Polyuria D) Hypocalcemia E) Hyperuricemia

A) Hyperkalemia D) Hypocalcemia E) Hyperuricemia Tumor lysis syndrome is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, decreased or absent urine output, and hypocalcemia.

.The nurse is developing a plan of care for a 5-year-old child with a severe hearing impairment focusing on psychosocial interventions based on assessment findings. Which behavior would the nurse have most likely assessed? A) Immature emotional behavior B) Self-stimulatory actions C) Inattention and vacant stare D) Head tilt or forward thrust

A) Immature emotional behavior Immature emotional behavior would be seen most frequently. The inability to hear impacts the socialization process and causes social problems for the child because the hearing impairment has inhibited normal development. Self-stimulatory actions, inattention, vacant stare, head tilt, or forward thrust may also cause problems with socialization, but they are typical of visually impaired children.

The nurse is caring for a school-age child with tinea capitis. The child has open lesions from the disease and has lost hair in the areas affected. Which nursing diagnoses would be a part of this client's care plan? Select all that apply. A) Impaired skin integrity B) Risk for infection C) Disturbed body image D) Bathing, self-care deficit E) Altered nutrition

A) Impaired skin integrity B) Risk for infection C) Disturbed body image Tinea is a fungal disease of the skin occurring on any part of the body, in this case the head (scalp, eyebrows, or eyelashes). Since this child has open lesions and hair loss from affected areas, there is impairment of skin integrity (which makes the areas at risk for infection). Body image is disturbed since the hair loss is visible. There is no indication of bathing deficit or altered nutrition.

While performing an assessment of a client who is immunocompromised, the nurse notes the child to have thrush in the mouth, tenderness over the spleen upon palpation, and a white blood cell count of 3,000. Which nursing diagnoses will the nurse include in the care plan of this child based on these findings? Select all that apply. A) Ineffective protection B) Risk for imbalanced nutrition, less than body requirements C) Pain D) Impaired skin integrity E) Delayed growth and development

A) Ineffective protection B) Risk for imbalanced nutrition, less than body requirements C) Pain Based on these symptoms the diagnosis of Ineffective protection is related to the decreased white blood cell count; Risk for imbalanced nutrition, less than body requirements, is related to the thrush; and Pain is related to the tenderness over the spleen and the thrush. There is no evidence to support the diagnoses of Impaired skin integrity or Delayed growth and development.

The nurse is caring for a 13-year-old boy with acute myelogenous leukemia who is experiencing feelings of powerlessness due to the effects of chemotherapy. What intervention will best help the teen's sense of control? A) Involving the boy in decisions whenever possible B) Acknowledging the boy's feelings of anger with the disease C) Providing realistic expectations of treatments and outcomes D) Recognizing abilities that are unaffected by the disease

A) Involving the boy in decisions whenever possible Involving the boy in the decision-making process will best help his sense of control. Whether he is included in important decisions about therapy or minor decisions like menus or dress, it will give him a sense of control over his situation. Acknowledging feelings of anger, recognizing his abilities, and providing realistic expectations will reduce body image disturbance and build self-esteem.

11. The nurse is planning a discussion group for parents with children who have cancer. How would the nurse describe a difference between cancer in children and adults? A) Most childhood cancers affect the tissues rather than organs. B) Childhood cancers are usually localized when found. C) Unlike adult cancers, childhood cancers are less responsive to treatment. D) The majority of childhood cancers can be prevented.

A) Most childhood cancers affect the tissues rather than organs. Childhood cancers usually affect the tissues, not the organs, as in adults. Metastasis often is present when the childhood cancer is diagnosed. Childhood cancers, unlike adult cancers, are very responsive to treatment. Unfortunately, little is known about cancer prevention in children.

A nurse is reviewing an article about genetic disorders and patterns of inheritance. The nurse demonstrates understanding of the information by identifying which of the following as an example of an autosomal dominant genetic disorder? A) Neurofibromatosis B) Cystic fibrosis C) Tay-Sachs disease D) Sickle cell disease

A) Neurofibromatosis

The nurse is developing a plan of care for a child with thalassemia. What information would the nurse expect to include? Select all that apply. A) Packed RBC transfusions B) Deferoxamine therapy C) Heparin therapy D) Opioid analgesics E) Platelet transfusions F) Intravenous immunoglobulin

A) Packed RBC transfusions B) Deferoxamine (chelation) therapy RBC transfusions and deferoxamine for chelation are used to treat thalassemia. Heparin therapy is used for treating DIC. Opioid analgesics would be used to treat severe pain associated with sickle cell crisis. Platelet transfusions and intravenous immunoglobulin would be used to treat idiopathic thrombocytopenia purpura.

A nurse is assessing a child who may have a latex allergy. The nurse asks the child about allergic reactions to certain foods. Which foods if identified by the child as experiencing an allergic reaction would help support the suspected latex allergy? Select all that apply. A) Peaches B) Plums C) Carrots D) Tomatoes E) Milk F) Lettuce

A) Peaches B) Plums C) Carrots D) Tomatoes Foods with a known cross-sensitivity to latex include pear, peach, passion fruit, plum, pineapple, kiwi, fig, grape, cherry, melon, nectarine, papaya, apple, apricot, banana, chestnut, carrot, celery, avocado, tomato, or potato. Milk and lettuce are not associated with a cross-sensitivity.

The nurse is reviewing the laboratory test results of a child who is suspected of having systemic lupus erythematosus (SLE). What would the nurse identify as supporting this diagnosis? Select all that apply. A) Positive antinuclear antibody (ANA) B) Increased C3 levels C) Thrombocytopenia D) Decreased C4 levels E) Increased hematocrit

A) Positive antinuclear antibody (ANA) C) Thrombocytopenia D) Decreased C4 levels Laboratory findings may include decreased hemoglobin and hematocrit, decreased platelet count, and low white blood cell count. Complement levels, C3 and C4, will also be decreased. Though not specific to SLE, the ANA is usually positive in children with SLE.

The nurse is caring for a child undergoing highly active antiretroviral therapy (HAART) for HIV infection. The nurse is preparing to administer the prescribed medication. In addition to the nucleoside analog reverse transcriptase inhibitors (NRTIs) and the non-nucleoside analog reverse transcriptase inhibitors (NNRTIs), the nurse is cognizant that the child will be taking which additional medication as part of the three-drug regimen? A) Protease inhibitors B) Corticosteroids C) Cytotoxic drugs D) Disease-modifying antirheumatic drugs (DMARDs)

A) Protease inhibitors The nurse understands that the child will be taking protease inhibitors as part of the three-drug regimen for HAART. Corticosteroids, cytotoxic agents, and DMARDs are typically used for the treatment of juvenile idiopathic arthritis (JIA).

The nurse is conducting a physical examination of a toddler with suspected lead poisoning. Lab results indicate blood lead level 52 mcg/dL. Which action would the nurse expect to happen next? A) Repeat testing within 2 days and prepare to begin chelation therapy as ordered. B) Repeat testing within 1 week with education to decrease lead exposure. C) Confirm with repeat testing in 1 month and referral to local health department. D) Prepare to admit child to begin chelation therapy.

A) Repeat testing within 2 days and prepare to begin chelation therapy as ordered. The recommendation for blood lead levels of 45 to 69 mcg/dL is to confirm the level with a repeat laboratory test within 2 days and educate the parents to decreased lead exposure. She should also expect to begin chelation therapy as ordered and refer the case to the local health department for investigation of home lead reduction with referrals for support services. Repeat testing in 1 week with parent education is appropriate for lead levels between 20 and 44 mcg/dL. Repeat testing in 1 month and education would be appropriate for levels between 15 and 19 mcg/dL. Preparing to admit the child to begin chelation therapy immediately would be appropriate for lead levels greater than 70 mcg/dL.

A child with hypogammaglobulinemia is to receive intravenous immunoglobulin (IVIG). What action would not be correct to take? A) Shake the vial after reconstituting it B) Premedicate the child with acetaminophen C) Obtain preinfusion vital signs D) Check serum blood urea nitrogen and creatinine levels

A) Shake the vial after reconstituting it Many IVIG products are packed as two vials, one the IVIG powder and one the sterile diluents. Once reconstituted, the IVIG should not be shaken because this leads to foaming and may cause the immunoglobulin protein to degrade. The child can be premedicated with acetaminophen or diphenhydramine. Baseline serum blood urea nitrogen and creatinine should be assessed because acute renal insufficiency may occur as a serious adverse reaction.

The mother of a 5-year-old girl brings the child to the clinic for an evaluation. The mother tells the nurse, "She seems to be so tired and irritable lately. And she looks so pale." Further assessment reveals pale conjunctiva and oral mucous membranes. The nurse suspects iron-deficiency anemia. Which additional finding would help provide additional evidence for this suspicion? A) Spooned nails B) Negative splenomegaly C) Oxygen saturation: 99% D) Bradycardia

A) Spooned nails Spooning or concave shape of the nails suggests iron-deficiency anemia. Other findings would include decreased oxygen saturation levels, tachycardia, and possible splenomegaly.

The nurse is assessing a 13-year-old girl with a family history of kidney cancer who has come to the clinic complaining of abdominal pain, nausea, and vomiting. Which finding would the nurse identify as least likely indicative of cancer in a child? A) The child reports rectal bleeding and diarrhea. B) Observation reveals an asymmetric abdomen. C) The child experiences a broken bone without trauma. D) Palpation determines an abdominal mass.

A) The child reports rectal bleeding and diarrhea. Rectal bleeding and diarrhea are symptoms of rectal cancer in adults and are not typical of children with cancer. The child reporting that a bone broke without any trauma, the nurse observing asymmetric swelling in the abdomen, or palpation revealing a mass in the abdomen are findings in children with cancer.

The nurse is providing care to a child with folliculitis. What would the nurse expect to administer? A) Topical mupirocin B) Oral cephalosporin C) Intravenous oxacillin D) Topical Eucerin cream

A) Topical mupirocin For folliculitis, topical mupirocin is indicated in conjunction with aggressive hygiene and warm compresses. Oral cephalosporins are used for nonbullous impetigo if there are numerous lesions. Intravenous oxacillin is used for severe cases of staphylococcal scalded skin syndrome. Topical Eucerin cream is used for atopic dermatitis.

The nurse is teaching the parents of a child diagnosed with iron-deficiency anemia about ways to increase their child's intake of iron. The parents demonstrate understanding of the teaching when they identify which foods as good choices for the child? Select all that apply. A) Tuna B) Salmon C) Tofu D) Cow's milk E) Dried fruits

A) Tuna B) Salmon C) Tofu E) Dried fruits Foods high in iron include red meats, tuna, salmon, eggs, tofu, enriched grains, dried beans and peas, dried fruits, leafy green vegetables, and iron-fortified breakfast cereals.

When reviewing the history of a child with suspected primary immunodeficiency, what would the nurse be least likely to find? A) Weight appropriate for height B) Antibiotic therapy for the past 3 months without effect C) Ten episodes of otitis media in the last year D) Three bouts of sinusitis within a year's time

A) Weight appropriate for height Weight appropriate for height would not be associated with primary immunodeficiency. Rather, failure to thrive is considered a warning sign. Other warning signs of primary immunodeficiency include four or more episodes of acute otitis media in 1 year; two or more episodes of severe sinusitis in 1 year; treatment with antibiotics for 2 months or longer with little effect; two or more episodes of pneumonia in 1 year; recurrent deep skin or organ abscesses; persistent oral thrush or skin candidiasis after age 1 year; history of infections that do not clear with antibiotics; two or more serious infections; and a family history of primary immunodeficiency.

A nursing student is reviewing information about primary immunodeficiencies. The student demonstrates understanding of the material by identifying which immunodeficiencies as affecting only males? Select all that apply. A) X-linked agammaglobulinemia B) Wiskott--Aldrich syndrome C) Selective IgA deficiency D) X-linked hyper-IgM syndrome E) IgG subclass deficiency F) Severe combined immune deficiency

A) X-linked agammaglobulinemia B) Wiskott--Aldrich syndrome D) X-linked hyper-IgM syndrome X-linked agammaglobulinemia, Wiskott--Aldrich syndrome, and X-linked hyper-IgM syndrome affect males only. Selective IgA deficiency, IgG subclass deficiency, and severe combined immune deficiency affect boys and girls.

A group of students is reviewing information about glucose-6-phosphate dehydrogenase (G6PD) deficiency. The students demonstrate understanding of the material what as the cause of the disorder? A) X-linked recessive inheritance B) Deficiency in clotting factors C) An excess supply of iron D) Autosomal recessive inheritance

A) X-linked recessive inheritance G6PD deficiency is an X-linked recessive disorder that affects the functioning of the red blood cells. A deficiency in clotting factors is associated with disorders such as idiopathic thrombocytopenia purpura, DIC, or hemophilia. An excess supply of iron refers to hemosiderosis, a complication of thalassemia, an autosomal recessive disorder.

An infant has been diagnosed with galactosemia and placed on a soy formula. When taking the health history, which question should the nurse ask the parent? A. "Did you receive a prescription for calcium supplements?" B. "Is your infant prescribed a daily vitamin B supplement?" C. "Have you been instructed to give your infant folic acid?" D. "Were iron supplements prescribed for your infant?"

A. "Did you receive a prescription for calcium supplements?"

An infant is brought to the clinic for a well child check-up. During the assessment the nurse palpates an enlarged liver and spleen. Based on this finding, what question is essential for the nurse to ask the parent? A. "Do you notice any unusual smell from your infant?" B. "Have you noticed if your infant's skin is yellow?" C. "Is your infant eating well? D. "Has your infant been sick recently?"

A. "Do you notice any unusual smell from your infant?"

The nurse is assessing a 8-month-old infant who has symptoms of poor feeding, a poor gag reflex, listlessness and a weak cry. What is the most important question the nurse should ask the parent about these symptoms? A. "Have you given your infant any honey?" B. "When did these symptoms begin?" C. "Has your infant had any unpasteurized milk to drink?" D. "What is the source of your family's water supply?"

A. "Have you given your infant any honey?" Infant botulism occurs when the infant ingests the spores of Clostridium botulinum. These multiply in the intestinal track and produce toxins. The disease is caused by the ingestion of spores from dust, improperly preserved home-canned foods and feeding an infant under 1 year of age raw honey. The infant has poor feeding, is listless, has a weak cry, and a has poor gag reflex--a distinguishing symptom. The nurse would ask about the water supply and unpasteurized milk if food poisonings or parasites were suspected. Asking about the date of the infant's illness is important, but this information does not take priority over the question about honey.

The parents of a 5-year-old have just found out that their child has head lice. Which statement by the parents would support the nursing diagnosis of deficient knowledge? A. "I can't believe it. We're not unclean, poor people." B. "We'll have to get that special shampoo." C. "Everybody in the house will need to be checked." D. "That explains his complaints of itching on his neck."

A. "I can't believe it. We're not unclean, poor people." Head lice is not an indication of poor hygiene or poverty. It occurs in all socioeconomic groups. Thus, the parents' statement about being unclean and poor reflects a lack of knowledge about the infection. A pediculicide is used to wash the hair to treat the infestation. Household contacts need to be examined and treated if affected. Extreme pruritus is the most common symptom, with nits or lice especially behind the ears or at the nape of the neck.

A family has been given the news that their expected child has a serious genetic condition. Which therapeutic communication technique(s) will be beneficial for the nurse to used when helping this family? Select all that apply. A. "I know you have been given a large amount of information. I am interested in what you think." B. "This has been a lot of information to take in, but if you keep a positive attitude about decisions it will be helpful." C. "I know this news has been hard. I am going to just sit with you and not talk while your begin to process your thoughts." D. "The health care provider suggested you seek genetic testing. Does this make you more upset?" E. "You have been give some sad news today. I think you should take some time before you make a final decision."

A. "I know you have been given a large amount of information. I am interested in what you think." C. "I know this news has been hard. I am going to just sit with you and not talk while your begin to process your thoughts." D. "The health care provider suggested you seek genetic testing. Does this make you more upset?"

The parents of a 7-month-old child with an infection ask the nurse about how to treat their child's fever. After providing teaching, the parents voice understanding with which statements? Select all that apply. A. "If my child's fever is under 102°F , I don't need to make an appointment with the physician." B. "Having a temperature over 38°C puts my child at risk for the infection spreading to the bloodstream." C. "I can use acetaminophen to help with the symptoms of the infection but it won't get rid of the infection." D. "Even though people get frightened, fevers are not a bad thing during an infection unless it gets too high." E. "Any fever is dangerous and can cause serious damage to brain cells if it goes on too long."

A. "If my child's fever is under 102°F , I don't need to make an appointment with the physician." C. "I can use acetaminophen to help with the symptoms of the infection but it won't get rid of the infection." D. "Even though people get frightened, fevers are not a bad thing during an infection unless it gets too high." In infants older than 3 months of age, fever less than 38.9°C (102°F) usually does not require treatment by a physician. Antipyretics, such as acetaminophen, provide symptomatic relief but do not change the course of the infection. A fever can actually enhance various components of the immune response. Infants younger than 3 months of age with a rectal temperature greater than 38°C should be seen by a physician or nurse practitioner because of increased risk of sepsis.

The child with a genetic disorder has some gross and fine motor deficits. What recommendation(s) will the nurse provide to the parents to help their child? Select all that apply. A. "Physical and occupational therapy may be a good resource for your child." B. "I can help you find adaptive toys for your child." C. "It is important to provide stimulation and interaction with your child." D. "I can refer you to a support group for parents who have a child with similar problems." E. "Praise your child's accomplishments even if they are small."

A. "Physical and occupational therapy may be a good resource for your child." B. "I can help you find adaptive toys for your child." C. "It is important to provide stimulation and interaction with your child." E. "Praise your child's accomplishments even if they are small."

The nurse is assessing a newborn in the delivery room and determines the umbilical cord has a single artery. What further assessment(s) should the nurse complete based on this finding? Select all that apply. A. Anal patency B. Cardiac murmurs C. Extra digits D. Dysmorphic facial features E. Cyanosis

A. Anal patency B. Cardiac murmurs C. Extra digits E. Cyanosis A single umbilical artery is commonly seen with Vater or Vacteral syndrome. The defects of these syndromes include vertebral defects, anal atresia, tracheoesophageal (TE) fistula or esophageal atresia, radial and renal dysplasia cardic anomalies and limb deficiencies. The nurse in the delivery room could easily assess the newborn for anal atresia by attempting to insert a rectal thermometer or gloved finger in the anus. If suspected, further testing could be done to confirm. One of the cardiac defects associated with this syndrome is Tetrology of Fallot. Because this is a defect with four components, cyanosis and a murmur could occur. Cyanosis could also occur from a TE fistula, which could cause respiratory distress. Children with this syndrome may have polydactyly of either fingers or toes. Dysmorphic facial features are not associated with this syndrome.

A child is being treated for pertussis and is prescribed azithromycin by the health care provider. Which finding is most important for the nurse to report to the health care provider before administering this drug? A. Child has had previous episodes of supraventricular tachycardia (SVT). B. Child has a potassium level of 3.7 mEq/l (3.7 mmol/l). C. Child is also prescribed a proton pump inhibitor (PPI). D. Child experienced a rash on the back taking this drug previously.

A. Child has had previous episodes of supraventricular tachycardia (SVT). Azithromycin is recommended for use to treat pertussis in infants older than 1 month of age and children. It should, however, not be used in children at risk for cardiovascular events. It may cause a potentially fatal heart rhythm, because it can lead in changes in the electrical activity of the heart. It is espeicially important in children with prolonged QT intervals. The finding of SVT should be reported to the health care provider before the administration of the drug. The potassium level is within a normal range and it has no effect on the drug. Azithromycin should not be given with any aluminum or magnesium antacids. The PPI should be safe. A rash may indicate an allergy to the drug and should be reported, but it is not the most important finding. The health care provider would make a determination for the drug administration based on risks versus benefits.

The nurse is caring for 3-day-old girl with Down syndrome whose mother had no prenatal care. What is the priority nursing diagnosis? A. Imbalanced nutrition, less than body requirements related to the effects of hypotonia B. Deficient knowledge related to the presence of a genetic disorder C. Delayed growth and development related to a cognitive impairment D. Impaired physical mobility related to poor muscle tone

A. Imbalanced nutrition, less than body requirements related to the effects of hypotonia p. 1827

A child with Apert syndrome is undergoing a craniotomy to reduce the effects of craniosynostosis. During postoperative care it is important for the nurse to include a short-term goal which meets which need? A. Management of anemia B. Prevention of straining at stool C. Increased oxygenation D. Decreasing crying

A. Management of anemia

The nurse determines that it is necessary to implement airborne precautions for children with which infection? A. Measles B. Streptococcus group A C. Rubella D. Scarlet fever

A. Measles Airborne precautions are designed to reduce the risk of infectious agents transmitted by airborne droplet nuclei or dust particles such as for children with measles, varicella, or tuberculosis. Droplet precautions would be used for children with streptococcal group A infections, rubella, and scarlet fever.

After teaching a class on the role of white blood cells in infection, the instructor determines that the teaching was successful when the class identifies which type of white blood cells as important in combating bacterial infections? A. Neutrophils B. Eosinophils C. Basophils D. Lymphocytes

A. Neutrophils Elevations in certain portions of the white blood cell count reflect different processes occurring in the body. Neutrophils function to combat bacterial infection. Eosinophils function in allergic disorders and parasitic infections. Basophils combat parasitic infections and some allergic disorders. Lymphocytes function in viral infections.

A nurse suspects that an adolescent may have community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA). What would the nurse expect to assess? Select all that apply. A. Participation in contact sport B. Recent cut on the lower leg C. History of a recent sore throat D. Raised fluctuant lesions E. Erythematous rash over the trunk and face

A. Participation in contact sport B. Recent cut on the lower leg D. Raised fluctuant lesions With CAMRSA, skin and tissue infections are common, often appearing as a bump or skin area that is red, swollen, painful, and warm to the touch. There also may be fluctuance and purulent drainage. Participation in contact sports, openings in the skin such as abrasions and cuts, contact with contaminated items and surfaces, poor hygiene, and crowded living conditions are risk factors for CAMRSA. Recent sore throat and an erythematous rash on the trunk, face, and possibly the extremities are associated with scarlet fever.

The nurse is caring for a hospitalized, 1-week-old infant who appears very ill. Which assessment finding(s) will the nurse report to the health care provider? Select all that apply. A. Petechiae B. Heart rate 100 beats/min C. Respiratory rate 60 breaths/min D. Axillary temperature 97.6°F (36.5°C) E. Characteristic of cry

A. Petechiae B. Heart rate 100 beats/min C. Respiratory rate 60 breaths/min D. Axillary temperature 97.6°F (36.5°C) E. Characteristic of cry Sepsis is suspected in any infant under 3 months of age until laboratory findings return. In an infant, the most important findings are hypothermia, bradycardia, and apnea. Tachypnea care be present in both infants and children. The nurse would be concerned with the infant's weak cry, lethargy, and an increased work of breathing such as rate, nasal flaring, grunting, and retractions. The child with sepsis generally has an elevated termperature, but hypothermia is seen in infants. The nurse should perform a good skin assessment. If petechiae are present, it is indicative of a very serious infection caused by Neisseria meningitidis.

A mother brings her 8-year-old son for evaluation because of a rash on his lower leg. Which finding would support the suspicion that the child has Lyme disease? A. Playing in the woods about a week ago B. Rash is papular and vesicular C. High fever occurring about 4 days before the rash D. Reports of extreme pruritus with visible nits

A. Playing in the woods about a week ago Lyme disease is caused by the bite of an infected tick, with a rash appearing 7 to 14 days after the tick bite. Ticks are commonly found in wooded areas. Therefore, reports of the child playing in the woods about 7 days ago would support the diagnosis of Lyme disease. A papular and vesicular rash is commonly associated with varicella (chickenpox). A high fever for 3 to 5 days before a rash suggests roseola. Extreme pruritus with visible nits would suggest pediculosis.

When providing care to a child with aplastic anemia, which nursing diagnosis would be the priority? A. Risk for injury B. Imbalanced nutrition, less than body requirements C. Ineffective tissue perfusion D. Impaired gas exchange

A. Risk for injury For the child with aplastic anemia, safety is of the utmost concern, with injury prevention essential to prevent hemorrhage. Nutrition, tissue perfusion, and gas exchange may or may not be associated with the child's condition.

A group of nursing students are reviewing information about neurocutaneous syndromes. What is an example of these disorders? A. Sturge-Weber syndrome B. Marfan syndrome C. Apert syndrome D. Achondroplasia

A. Sturge-Weber syndrome Sturge-Weber syndrome is an example of a neurocutaneous syndrome. Marfan syndrome, Apert syndrome, and achondroplasia are autosomal dominantly inherited genetic disorders.

The nurse is performing a physical examination of an 8-year-old girl who was bitten by her kitten. Which assessment would lead the nurse to suspect cat-scratch disease? A. Swollen lymph nodes B. Strawberry tongue C. Infected tonsils D. Swollen neck

A. Swollen lymph nodes Lymph nodes, especially under the arms, can become painful and swollen due to cat- scratch disease. Strawberry tongue is typical of scarlet fever. Infected tonsils and an edematous neck are symptoms of diphtheria.

The nurse is obtaining the health history for a 15-month-old boy from the parents. The child is not yet speaking. Which finding would be eliminated as a risk factor for a possible genetic disorder? A. The child is male and white. B. The grandmother and father have hearing impairments. C. The child was a breech delivery 3 weeks early. D. The mother was 37 when she became pregnant.

A. The child is male and white. Being male and white are risk factors for acute lymphoblastic leukemia, not genetic disorders. The fact that the child's grandmother and father have hearing impairments suggests a genetic disorder. The facts that the mother was 37 when she became pregnant and had a breech delivery 3 weeks early are also risk factors for genetic disorders.

On a routine pregnancy ultrasound at 18 weeks' gestation, the fetus is found to have a mildly enlarged ventricle in the brain. The pregnant client is referred for genetic testing. What testing would most likely be recommended for this client? A. Triple screen B. Amniocentesis C. Chorionic villi sampling D. Gene testing

A. Triple screen

A group of students are reviewing information about major and minor congenital disorders. The students demonstrate understanding of the information when they identify what condition as a minor disorder? A. Webbed neck B. Omphalocele C. Cutaneous hemangioma D. Facial asymmetry

A. Webbed neck A minor congenital anomaly is webbed neck. Omphalocele, cutaneous hemangioma, and facial asymmetry are considered major congenital anomalies.

What finding would lead the nurse to suspect that a child has Turner syndrome? A. Webbed neck B. Microcephaly C. Gynecomastia D. Cognitive delay

A. Webbed neck Manifestations of Turner syndrome include webbed neck, low posterior hairline, wide-spaced nipples, edema of the hands and feet, amenorrhea, and absence of secondary sex characteristics, along with short stature and slow growth

When teaching a class about trisomy 21, the instructor would identify the cause of this disorder as: A. nondisjunction. B. X-linked recessive inheritance. C. genomic imprinting. D. autosomal dominant inheritance.

A. nondisjunction. p. 1821

A pregnant woman diagnosed with syphilis comes to the clinic for a visit. The nurse discusses the risk of transmitting the infection to her newborn, explaining that this infection is transmitted to the newborn through which of the following? A) Amniotic fluid B) Placenta C) Birth canal D) Breast milk

B

A nurse is leading a discussion with a group of new mothers about newborn nutrition and its importance for growth and development. One of the mothers asks, "Doesn't the baby get iron from me before birth?" Which response by the nurse would be most appropriate? A) "You give the baby some iron, but it is not enough to sustain him after birth." B) "Because the baby grows rapidly during the first months, he uses up what you gave him." C) "The iron you give him before birth is different from what he needs once he is born." D) "If the baby didn't use up what you gave him before birth, he excretes it soon after birth."

B) "Because the baby grows rapidly during the first months, he uses up what you gave him." In the term infant, a period of physiologic anemia occurs between the age of 2 and 6 months. This is due to the fact that the infant demonstrates rapid growth and an increase in blood volume over the first several months of life, and maternally derived iron stores are depleted by age 4 to 6 months of age. Sufficient iron intake is critical for the appropriate development of hemoglobin and RBCs. Therefore, the infant must ingest adequate quantities of iron either from breast milk or from iron- fortified formula in early infancy and other food sources in later infancy.

15. What would the nurse include when teaching an adolescent about tinea pedis? A) "Keep your feet moist and open to the air as much as possible." B) "Dry the area between your toes really well." C) "Wear nylon or synthetic socks every day." D) "Go barefoot when you are in the locker room at school."

B) "Dry the area between your toes really well." Keeping the feet clean and dry is key for the child with tinea pedis. This includes rinsing the feet with water or a water/vinegar mixture and drying them well, especially between the toes. The adolescent should wear cotton socks and shoes that allow the feet to breathe. Going barefoot at home is allowed, but the adolescent should wear flip-flops around swimming pools and locker rooms.

The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is providing discharge instructions about home care and safety recommendations to the boy and his parents. Which response indicates a need for further teaching? A) "We should avoid aspirin and drugs like ibuprofen." B) "He can resume participation in football in 2 weeks." C) "Swimming would be a great activity." D) "Our son cannot take any antihistamines."

B) "He can resume participation in football in 2 weeks." The nurse must emphasize to the parents that they need to prevent trauma to their son by avoiding activities that may cause injury. Participation in contact sports like football is not recommended. Aspirin, nonsteroidal anti-inflammatory drugs, and antihistamines should be avoided because they could precipitate anemia. Swimming, a noncontact sport, is an appropriate choice.

A child is scheduled to undergo radiation therapy as part of his treatment plan for newly diagnosed cancer. After teaching the child and parents about this treatment, the nurse determines that additional teaching is needed when the parents state: A) "We should not wash off the markings on his skin." B) "He can use petroleum jelly if the skin becomes reddened." C) "He needs to use a sunscreen with an SPF of 30 or more." D) "He should not apply deodorant to the treatment site."

B) "He can use petroleum jelly if the skin becomes reddened." Aqueous creams and moisturizers may be used on the skin, but not petroleum jelly. Markings on the skin should not be removed or washed off. During and after radiation treatment, the skin will be more photosensitive so the child should use a high-SPF sunscreen of 30 or more. Deodorants and perfumed lotions should not be applied to the radiation treatment site.

The nurse is providing parental teaching about home care for an 8-year-old boy with widespread sunburn on his back and shoulders. Which response indicates a need for further teaching? A) "Cool compresses may help cool the burn." B) "He should manually peel off any flaking skin." C) "Nonsteroidal anti-inflammatory drugs like ibuprofen are helpful." D) "He should avoid hot showers or baths for a couple of days."

B) "He should manually peel off any flaking skin." If skin flaking occurs, the child should be discouraged from manually "peeling" the flaked skin as it can cause further injury. Using cool compresses, taking nonsteroidal anti-inflammatory drugs, and avoiding hot showers or baths are appropriate measures.

The nurse is providing a class for a group of childcare providers. When discussing allergic reactions, which statement by a participant indicates the need for further instruction? A) "Most allergic reactions will happen within a few minutes of eating a problematic food." B) "If a child has previously eaten a food and not had a reaction they are not 'truly' allergic to it." C) "Allergic reactions can happen hours after eating something." D) "In addition to hives some children may also have vomiting and diarrhea when having an allergic reaction to a food."

B) "If a child has previously eaten a food and not had a reaction they are not 'truly' allergic to it." Previous exposure with no incident does not mean an individual cannot develop a hypersensitivity to a food or other substance. An allergy may develop at any time. The remaining statements are correct.

The nurse is teaching a couple about X-linked disorders. They are concerned that they might pass on hemophilia to their children. Which of the following responses indicates the need for further teaching? A) "The father can't be a carrier if he doesn't have hemophilia." B) "If the father doesn't have it, then his kids won't either." C) "If the mother is a carrier, her daughter could be one too." D) "If the mother is a carrier, her sons may have hemophilia."

B) "If the father doesn't have it, then his kids won't either."

A teenage girl with psoriasis tells the nurse that she is so embarrassed by the plaque on her skin that she doesn't want to go to school. What is the best response by the nurse? A) "Have you been applying your medication and emollients to your skin as directed by your healthcare provider?" B) "It must be really difficult for you. Tell me how you are taking care of your skin on a daily basis." C) "Sunlight really helps the plaque areas heal. Maybe going to a tanning bed routinely will help." D) "You can't miss school because of your skin. Can you wear clothes that will cover the areas?"

B) "It must be really difficult for you. Tell me how you are taking care of your skin on a daily basis."

The parents of a 10-year-old girl with a refractive error ask the nurse about the possibility of laser surgery to correct the vision. Which statement by the nurse would be most appropriate? A) "As she gets older, her vision will begin to correct itself." B) "Laser surgery typically is not done until she's 18 years old." C) "She looks so cute in her glasses; why put her through surgery?" D) "She can use contact lenses soon, so surgery isn't necessary."

B) "Laser surgery typically is not done until she's 18 years old."

A child is diagnosed with bacterial conjunctivitis and is prescribed topical antibiotic therapy. The child's mother asks when he can return to school. Which response by the nurse would be most appropriate? A) "You need to wait until you finish the entire prescription of antibiotic." B) "Once the drainage is gone, he can go back to school." C) "You can send him to school this afternoon after his first dose of antibiotic." D) "He needs to be symptom-free for at least 72 hours."

B) "Once the drainage is gone, he can go back to school." For the child with bacterial conjunctivitis, the child may safely return to school or day care when the mucopurulent drainage is no longer present, usually after 24 to 48 hours of treatment with the topical antibiotic. There is no need to wait until the prescription is finished. The antibiotic is being given topically, not systemically. One dose of antibiotic is not sufficient to eradicate the infection. Typically, 24 to 48 hours of treatment is needed to stop the drainage, which, when no longer present, indicates that the child can return to school.

A 3-year-old boy has been on chemotherapy for cancer. He complains about a sore throat, is experiencing malaise, and has a temperature of 99.8°F orally. His mother calls the child's physician. What is the appropriate information for the nurse to tell his mother at this time? A) "Continue to watch the child, giving him aspirin and cool fluids for the fever." B) "Plan to bring the child into the physician's office today." C) "Monitor the temperature, but not to worry unless it gets above 104°F." D) "Keep the child warm and as comfortable as possible."

B) "Plan to bring the child into the physician's office today."

After teaching a group of new parents about their newborns' eyes and vision, which statement by the group indicates effective teaching? A) "Our newborn can see at distances of about 1 to 2 feet." B) "We won't know the baby's eye color until he's at least 6 months old." C) "A baby can easily distinguish colors, but they must be bright colors." D) "A newborn can focus with both eyes at the same time shortly after birth."

B) "We won't know the baby's eye color until he's at least 6 months old." The eye color of an infant is determined by 6 to 12 months of age. A newborn sees best at distances of about 8 to 10 inches. The optic nerve is not completely myelinated, so color discrimination is incomplete. The rectus muscles are uncoordinated at birth and mature over time, so binocular vision may be achieved by 4 months of age.

The nurse is talking to the parents of a child who has been diagnosed with severe combined immune deficiency (SCID). Which statement by the parents best indicates that they understand their child's condition? A) "He'll need to receive intravenous immunoglobulin routinely." B) "We'll need to prepare him and ourselves for a bone marrow transplant." C) "He'll need to receive several different types of antiviral medications." D) "We'll make sure that he has his EpiPen with him at all times."

B) "We'll need to prepare him and ourselves for a bone marrow transplant." SCID is a potentially fatal disorder requiring emergency intervention at the time of diagnosis. Gene therapy provides some promise for the future treatment of SCID, but until then bone marrow or stem cell transplantation is necessary. IVIG may be used to help decrease the number of infections until bone marrow or stem cell transplantation can be done. Antiviral medications are used to treat HIV infection. An EpiPen is used for anaphylaxis.

A nurse is preparing a presentation for a local parent group about burn prevention and care in children. What would the nurse be least likely to include in the presentation when describing how to care for a superficial burn? A) Using cool water over the burned area until the pain lessens B) Applying ice directly to the burned skin area C) Covering the burn with a clean, non-adhesive bandage D) Giving the child acetaminophen for pain relief

B) Applying ice directly to the burned skin area With a superficial burn, ice should not be applied to the skin. Using cool water over the burn area; covering with a clean, nonadhesive bandage; and using acetaminophen for pain relief are appropriate to include in the presentation.

A nurse is performing a primary survey on a child who has sustained partial thickness burns over his upper body areas. What action should the nurse take first? A) Inspect the child's skin color. B) Assess for a patent airway. C) Observe for symmetric breathing. D) Palpate the child's pulse.

B) Assess for a patent airway. When performing a primary survey, the nurse first assesses the child's airway for patency and then intervenes accordingly to ensure that the airway is patent. Next the nurse would evaluate the child's skin color, respiratory effort, and symmetry of breathing and breath sounds. Then the nurse would determine the pulse strength, perfusion status, and heart rate.

The mother of a 5-year-old child with eczema is getting a check-up for her child before school starts. What will the nurse do during the visit? A) Change the bandage on a cut on the child's hand. B) Assess the compliance with treatment regimens. C) Discuss systemic corticosteroid therapy. D) Assess the child's fluid volume.

B) Assess the compliance with treatment regimens. Maintaining proper therapy for eczema can be exhausting both physically and mentally. Therefore, it is essential that the nurse assess compliance and support the parents' ability to cope if necessary. Changing a bandage is not part of a health maintenance visit. Hydration is important for a child with eczema; however, fluid volume is not the focus at this visit. Systemic corticosteroid therapy is very rarely used, and the success of the current therapy needs to be assessed first.

A nurse is instituting neutropenic precautions for a child. What information would the nurse most likely include? Select all that apply. A) Placing the child in a semiprivate room B) Avoiding rectal exams, suppositories, and enemas C) Placing a mask on the child when outside the room D) Encouraging an intake of raw fruits and vegetables E) Discouraging fresh flowers in the child's room

B) Avoiding rectal exams, suppositories, and enemas C) Placing a mask on the child when outside the room E) Discouraging fresh flowers in the child's room Generally, neutropenic precautions include placing the child in a private room; avoiding rectal suppositories, enemas, and examinations; placing a mask on the child when outside the room; avoiding the intake of raw fruits and vegetables; and not permitting fresh flowers or live plants in the room.

A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, what would the nurse identify as potentially interfering with the accuracy of the results? A) Use of iron supplementation B) Blood transfusion 1 month ago C) Lack of fasting for 12 hours D) History of recent infection

B) Blood transfusion 1 month ago Blood transfusion within the previous 12 weeks may alter the results of the hemoglobin electrophoresis. Iron supplements can increase serum ferritin levels. Children should fast for 12 hours before having a specimen obtained for iron levels. A history of infection might interfere with the white blood cell count results, not hemoglobin electrophoresis.

A nurse is inspecting the skin of a child with atopic dermatitis. What would the nurse expect to observe? A) Erythematous papulovesicular rash B) Dry, red, scaly rash with lichenification C) Pustular vesicles with honey-colored exudates D) Hypopigmented oval scaly lesions

B) Dry, red, scaly rash with lichenification Atopic dermatitis or eczema is characterized by a dry, red, scaly rash with lichenification and hypertrophy. An erythematous papulovesicular rash is associated with contact dermatitis. Pustules and vesicles with honey-colored exudates suggest nonbullous impetigo. Hypopigmented oval scaly lesions are associated with tinea versicolor.

The nurse is caring for an 8-year-old girl who has been diagnosed with leukemia and will have a variety of tests, including a lumbar puncture, before beginning chemotherapy. What action would be the priority? A) Applying EMLA to the lumbar puncture site B) Educating the child and family about the testing procedures C) Administering promethazine as ordered for nausea D) Educating the family about chemotherapy and its side effects

B) Educating the child and family about the testing procedures The priority would be educating the child and family about the testing procedures, so they know what to expect and understand why the tests are being performed. Applying EMLA to the lumbar puncture site will be done prior to the procedure. The family will be educated about chemotherapy and its side effects prior to the therapy beginning, and promethazine or other antiemetics will be administered once chemotherapy has begun.

The nurse is developing a plan of care for a child who is receiving cyclophosphamide. What advice would the nurse expect to include? A) Withholding food and fluids from the child during the infusion B) Encouraging frequent voiding during and after the infusion C) Monitoring for signs of anaphylaxis during infusion D) Assessing the child for complaints of bone pain

B) Encouraging frequent voiding during and after the infusion Cyclophosphamide may cause hemorrhagic cystitis. Therefore, the nurse needs to provide adequate hydration and have the child void frequently during and after the infusion to decrease the risk of hemorrhagic cystitis. Fluids need to be encouraged, not withheld. Monitoring for anaphylaxis would be appropriate when asparaginase or etoposide is given. Bone pain is associated with the administration of filgrastim or sargramostim.

The nurse is assessing a child with suspected thalassemia. What would the nurse expect to assess? A) Dactylitis B) Frontal bossing C) Presence of clubbing D) Presence of spooning

B) Frontal bossing The nurse would expect to find skeletal deformities such as frontal or maxillary bossing. Dactylitis is associated with sickle cell anemia. Clubbing and spooning are associated with chronic decreases in oxygen supply.

An instructor is developing a plan for a class of nursing students on various skin disorders. When describing urticaria, what would the instructor include? A) It is a type IV hypersensitivity reaction. B) Histamine release leads to vasodilation. C) Wheals appear first followed by erythema. D) The nonpruritic rash blanches with pressure.

B) Histamine release leads to vasodilation. Urticaria is a type I hypersensitivity reaction caused by an immunologically mediated antigen-antibody response of histamine release from the mast cells. Vasodilation and increased vascular permeability result, leading to erythema and then wheals. The rash is pruritic and blanches with pressure.

When teaching a group of new parents about newborn care and development, which immunoglobulin would the nurse explain as being primarily responsible for the passive immunity exhibited by newborns? A) IgA B) IgG C) IgM D) IgE

B) IgG IgG is acquired transplacentally, providing the newborn with passive immunity to antigens to which the mother had developed antibodies. IgA, IgD, IgE, and IgM do not cross the placenta and require an antigenic challenge for production.

Assessment of a child leads the nurse to suspect viral conjunctivitis based on what finding? A) Mild pain B) Photophobia C) Itching D) Watery discharge

B) Photophobia Viral conjunctivitis is characterized by lymphadenopathy, photophobia, and tearing. Mild pain is associated with bacterial conjunctivitis. Itching and watery discharge are associated with allergic conjunctivitis.

The nurse is caring for a 5-year-old boy undergoing radiation treatment for a neuroblastoma. Which nursing diagnosis would be most applicable for this child? A) Activity intolerance related to anemia and weakness from medications B) Impaired skin integrity related to desquamation from cellular destruction C) Impaired oral mucosa related to the presence of oral lesions from malnutrition D) Imbalanced nutrition, less than body requirements related to nausea and vomiting

B) Impaired skin integrity related to desquamation from cellular destruction A nursing diagnosis for impaired skin integrity evidenced by desquamation of the radiation site would only be made for a child undergoing radiation therapy. Activity intolerance due to anemia and weakness, impaired oral mucosa evidenced by oral lesions, and malnutrition and anorexia due to nausea and vomiting are diagnoses that are common to both radiation and chemotherapy.

A nurse is preparing a plan of care for a child with a primary immunodeficiency. Which nursing diagnosis is the priority? A) Imbalanced nutrition, less than body requirements related to poor appetite B) Ineffective protection related to impaired humoral defenses C) Acute pain related to inflammatory processes D) Risk for delayed growth and development related to chronic illness

B) Ineffective protection related to impaired humoral defenses The child with a primary immunodeficiency lacks the necessary immune responses that provide protection from infection. Therefore, the priority nursing diagnosis would be ineffective protection. Imbalanced nutrition and risk for delayed growth and development may be appropriate, but these would not be the priority. Acute pain would be more appropriate for a child with juvenile idiopathic arthritis.

A mother brings her child to the healthcare clinic because she thinks that the child has conjunctivitis. Which assessment findings would lead the nurse to suspect bacterial conjunctivitis? Select all that apply. A) Itching of the eyes B) Inflamed conjunctiva C) Stringy discharge D) Photophobia E) Mild pain F) Tearing

B) Inflamed conjunctiva E) Mild pain Bacterial conjunctivitis is manifested by inflamed conjunctiva, a purulent or mucoid discharge, mild pain, and occasional eyelid edema. Itching and a stringy discharge suggest allergic conjunctivitis. Photophobia and tearing suggest viral conjunctivitis.

The nurse is examining a 3-year-old boy with acute otitis media who has a mild earache and a temperature of 38.5°C. Which action will be taken? A) Obtain a culture of the middle ear fluid. B) Instruct the parents to watch for worsening symptoms. C) Administer antibiotics. D) Administer antivirals.

B) Instruct the parents to watch for worsening symptoms.

A nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm3. Which medication would the nurse most likely expect to be ordered? A) Folic acid B) Intravenous immune globulin C) Dimercaprol D) Deferoxamine

B) Intravenous immune globulin Intravenous immune globulin would be used to treat idiopathic thrombocytopenic purpura. Folic acid is used to treat folic acid--deficiency anemia. Dimercaprol is used to remove lead from the soft tissue and bone to allow for excretion by the kidneys. Deferoxamine is used to treat iron toxicity.

The nurse is caring for a 15-year-old boy who has sustained burn injuries. The nurse observes the burn developing a purplish color with discharge and a foul odor. The nurse suspects which infection? A) Burn wound cellulitis B) Invasive burn cellulitis C) Burn impetigo D) Staphylococcal scalded skin syndrome

B) Invasive burn cellulitis Invasive burn cellulitis results in the burn developing a dark brown, black, or purplish color with a discharge and foul odor. In burn wound cellulitis, the area around the burn becomes increasingly red, swollen, and painful early in the course of burn management. Burn impetigo is characterized by multifocal, small, superficial abscesses. Staphylococcal scalded skin syndrome is not a burn infection; however, it is managed similarly to burns.

The nurse is preparing a presentation for a parent group about childhood cancers, focusing on brain tumors in children. What would the nurse describe as the most common type of brain tumor? A) Brain stem glioma B) Medulloblastoma C) Ependymoma D) Astrocytoma

B) Medulloblastoma Of all the types of brain tumors listed, a medulloblastoma is the most common type. It is invasive, is highly malignant, and grows rapidly.

A nurse is reviewing the medical record of a child with hearing loss and notes that the child's hearing loss is in the range 40 to 60 decibels (dB). The nurse interprets this as indicating what level of hearing loss? A) Mild loss B) Moderate loss C) Severe loss D) Profound loss

B) Moderate loss A hearing loss of 40 to 60 dB indicates a moderate loss; 20 to 40 dB indicates a mild loss; 60 to 80 dB indicates a severe loss; and greater than 80 dB indicates a profound loss.

A nurse is conducting a health history for a 1-month-old with an infectious disorder. Which segment of the health history would be most helpful for the nurse when determining if the infant developed the infection from the mother? A) Family history B) Past medical history C) Home treatments D) Present illness history

B) Past medical history

A child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the nurse would focus on which type of anemia? A) Aplastic anemia B) Pernicious anemia C) Folic acid anemia D) Sickle cell anemia

B) Pernicious anemia Monthly injections of vitamin B12 are used to treat pernicious anemia. Aplastic anemia is characterized by a decrease in all blood cells necessitating a bone marrow transplant. Folic acid--deficiency anemia is treated with dietary measures and possible folic acid supplementation. Sickle cell anemia is treated supportively with a focus on preventing sickling crisis, infection, and other complications.

What would be most appropriate to include in the plan of care for a child who has undergone surgery for removal of an astrocytoma? A) Elevating the foot of the bed B) Positioning the child on his unaffected side C) Raising the head of the bed at least 45 degrees D) Administering large volumes of intravenous fluids

B) Positioning the child on his unaffected side Postoperatively, the nurse should position the child on his unaffected side, with the head of the bed flat or at the level prescribed by the neurosurgeon. The foot of the bed is not elevated to prevent increasing intracranial pressure and contributing to bleeding. Fluids are administered carefully to avoid excess fluid intake, which would cause or worsen cerebral edema.

The nurse is evaluating the laboratory test results of a 7-year-old child with a suspected hematologic disorder. Which finding would cause the nurse to be concerned? A) WBC: 5.6 ×103/mm3 B) RBC: 2.8 × 106/mm3 C) Hemoglobin: 11.4 mg/dL D) Hematocrit: 35%

B) RBC: 2.8 × 106/mm3 The RBC listed is below the normal range for a child between the ages of 6 and 16 years (4.0 to 5.2 × 106/mm3). The WBC count, hemoglobin, and hematocrit are within acceptable parameters for a child this age.

The nurse is describing the phases of treatment to a child who was diagnosed with leukemia and his parents. How would the nurse describe the induction stage? A) Intense therapy to strengthen remission B) Rapid promotion of complete remission C) Elimination of all residual leukemic cells D) Reduction of risk for central nervous system (CNS) disease

B) Rapid promotion of complete remission Induction is done to rapidly produce a complete remission. Consolidation or intensification is the stage when remission is strengthened, and leukemic cell burden is reduced. Maintenance attempts to eliminate all residual leukemic cells, and CNS prophylaxis is the stage that attempts to reduce the development of CNS disease.

A nursing instructor is preparing a class discussion on the benefits and drawbacks associated with genetic advances and the Human Genome Project. Which of the following would the instructor address as a potential problem? A) Early detection possibilities B) Risk profiling C) Focus on causes D) Rapid diagnosis

B) Risk profiling

The mother of a 15-year-old girl has contacted the clinic to report that her daughter has burned the back of her hand with a curling iron. The child's mother reports the burn is mild but states her daughter is complaining of pain. After consulting with the healthcare provider, what instructions can the nurse anticipate will be recommended? Select all that apply. A) Apply a thin film of protective cocoa butter. B) Run cool water over the injured area. C) Apply ice for 15 to 20 minutes each hour until the pain subsides. D) Take acetaminophen using the manufacturer's guidelines. E) Apply a thin layer of petroleum jelly to the burned area.

B) Run cool water over the injured area. D) Take acetaminophen using the manufacturer's guidelines. Mild burns may be cared for at home. Cool water may be run over the injured tissue. Acetaminophen or ibuprofen may be administered for pain. Ointments and creams including butter, margarine, cocoa butter, and petroleum jelly should not be applied.

The nurse is caring for a 3-month-old with nasolacrimal duct obstruction. Which intervention would be most appropriate for the nurse to implement? A) Being careful to prevent spread of infection B) Teaching the parents how to gently massage the duct C) Applying hot, moist compresses to the affected eye D) Referring the child to an ophthalmologist

B) Teaching the parents how to gently massage the duct Massaging the nasolacrimal duct can cause it to open and drain. Teaching the parents how to do this would be part of the nurse's plan of care. Nasolacrimal duct obstruction is not infectious. Applying hot, moist compresses to the eye is an intervention for conjunctivitis. Nasolacrimal duct obstruction is often self-resolving, so there would be no need for a specialist's care.

A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. The nurse interprets this order as indicating which of the following? A) The child requires a prophylactic dose of iron. B) The child has mild to moderate iron deficiency. C) The child has severe iron deficiency. D) The child is being prepared for packed red blood cell administration.

B) The child has mild to moderate iron deficiency.

The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. What finding would suggest this child has a neuroblastoma? A) The child has a maculopapular rash on his palms. B) The parents report that their son is vomiting and not eating well. C) The parents report that their son is irritable and not gaining weight. D) Auscultation reveals wheezing with diminished lung sounds.

B) The parents report that their son is vomiting and not eating well. Along with the swollen abdomen on one side, the parents reporting that the child is vomiting and anorexic points to the possibility of a neuroblastoma. Observing a maculopapular rash on the child's palms is a sign of graft-versus-host disease. The parents reporting that the child is irritable and not gaining weight suggests a possible brain tumor as well as malabsorption problems. Auscultation revealing wheezing with diminished lung sounds would suggest other problems, not a neuroblastoma.

The nurse is caring for a child who is taking corticosteroids for systemic lupus erythematosus. The nurse closely monitors the child based on the understanding that corticosteroids exert which major action? A) They increase liver enzymes. B) They can mask signs of infection. C) They cause bone marrow suppression. D) They decrease renal function.

B) They can mask signs of infection. The nurse understands that corticosteroids may mask signs of infection. Cytotoxic drugs cause bone marrow suppression. Nonsteroidal anti-inflammatory drugs can increase liver enzymes and decrease renal function.

A nurse is preparing a class for parents of infants about managing diaper dermatitis. What advice would the nurse include in the presentation? Select all that apply. A) Applying topical nystatin to the diaper area B) Using a blow dryer on warm to dry the diaper area C) Refraining from using rubber pants over diapers D) Using scented diaper wipes to clean the area E) Washing the diaper area with an antibacterial soap

B) Using a blow dryer on warm to dry the diaper area C) Refraining from using rubber pants over diapers For diaper dermatitis, topical products such as ointments or creams containing vitamins A, D, and E; zinc oxide; or petrolatum help to provide a barrier. Nystatin is an antifungal agent used for diaper candidiasis. Using a blow dryer on warm to dry the area, avoiding the use of rubber pants, and using unscented diaper wipes or ones free of preservatives are appropriate. The area should be washed with a soft cloth, without harsh soaps.

The nurse is caring for a newborn and knows that his vision, unlike his hearing, is not fully developed. Which aspect of the child's vision would the nurse expect to be similar to his father's vision? A) Adequate color detection B) Visual acuity of 20/100 C) Nearsightedness D) Monocular vision

B) Visual acuity of 20/100 If the child's father has lost visual acuity, he and his new son could possibly have the same 20/100 vision. Poor color detection, nearsightedness, and monocular vision are characteristic of newborns and are the result of their lack of development.

A nurse is assessing the skin of a child with cellulitis. What would the nurse expect to find? A) Red, raised hair follicles B) Warmth at skin disruption site C) Papules progressing to vesicles D) Honey-colored exudate

B) Warmth at skin disruption site Cellulitis is manifested by erythema, pain, edema, and warmth at the site of skin disruption. Red and raised hair follicles would indicate folliculitis. Papules progressing to vesicles and a honey-colored exudate would suggest nonbullous impetigo.

What would the nurse include when teaching parents how to prevent otitis externa? A) Daily ear cleaning with cotton swabs B) Wearing earplugs when swimming C) Using a hair dryer on high to dry the ear canals D) Using hydrogen peroxide to dry the canal skin

B) Wearing earplugs when swimming To prevent otitis externa, the nurse would teach parents and children to wear earplugs when swimming and to avoid use of cotton swabs, headphones, and earphones. A hair dryer on a low setting can be used to dry the ear canals. A mixture of half rubbing alcohol and half vinegar can be used to dry the canal and alter the pH to discourage organism growth.

The nurse is conducting a physical examination of a 9-month-old baby with a flat, discolored area on the skin. The nurse documents this as a: A) papule. B) macule. C) vesicle. D) scale.

B) macule. A macule is a flat, discolored area on the skin. A papule is a small, raised bump on the skin. A vesicle is a fluid-filled bump on the skin. Scaling is flaking of the skin.

A group of nursing students are reviewing the various drug classes used for cancer chemotherapy. The students demonstrate an understanding of these classes when they identify which agent as an example of a nitrosourea? A) Busulfan B) Thiotepa C) Cisplatin D) Carmustine

D) Carmustine

The nurse is teaching the mother of a toddler about burn prevention. Which response by the mother indicates a need for further teaching? A. "We will leave fireworks displays to the professionals." B. "I will set our water heater at 130 degrees." C. "All sleepwear should be flame retardant." D. "The handles of pots on the stove should face inward."

B. "I will set our water heater at 130 degrees." If the temperature of the water heater is set at 130°F, a child can be burned significantly in only 30 seconds. The recommended maximal home hot water heater temperature is 120°F. Leaving fireworks to the professionals, using flame-retardant sleepwear, and turning the handles of pots on the stove inward are correct.

After teaching a mother how to remove a tick from her 6-year-old boy's arm, the nurse determines that additional teaching is needed when the mother makes what statement? A. "I'll protect my fingers with a paper towel." B. "I'll grasp the tick and pull it away quickly." C. "I should put the tick in a plastic bag in the freezer." D. "I need to grasp the tick close to the child's skin."

B. "I'll grasp the tick and pull it away quickly." Grasping the tick and pulling it away quickly would indicate the need for additional teaching. When removing a tick, the mother should use fine-tipped tweezers while protecting her fingers with a tissue, paper towel, or latex gloves. The mother should grasp the tick as close to the skin as possible and pull upward with steady, even pressure. Once removed, the mother should place the tick in a sealable plastic bag in the freezer in case the child becomes sick and identification of the tick is needed.

The nurse is teaching the parents of a 1-month-old girl with Down syndrome how to maintain good health for the child. Which instruction would the nurse be least likely to include? A. Getting cervical radiographs between 3 and 5 years of age B. Adhering to the special dietary needs of the child C. Getting an echocardiogram before 3 months of age D. Monitoring for symptoms of respiratory infection

B. Adhering to the special dietary needs of the child p. 1827

A child is diagnosed with a helminthic infection. Which treatments would the nurse expect to be prescribed? Select all that apply. A. Erythromycin B. Albendazole C. Pyrantel pamoate D. Acyclovir E. Metronidazole F. Permethrin

B. Albendazole C. Pyrantel pamoate Drugs used to treat helminthic infections include albendazole and pyrantel pamoate. Erythromycin is used to treat bacterial infections. Acyclovir is used to treat viral infections. Metronidazole is used to treat trichomoniasis. Permethrin is used to treat pediculosis.

The nurse is caring for an infant with candidal diaper rash. Which topical agent would the nurse expect the healthcare provider to order? A. Corticosteroids B. Antifungals C. Antibiotics D. Retinoids

B. Antifungals Candidal diaper rash would require a fungicide. The nurse would expect to administer topical antifungals as ordered. Corticosteroids are not typically recommended for young infants and are used for atopic dermatitis and certain types of contact dermatitis. Antibiotics would be ineffective against fungal infections. Retinoids are indicated for moderate to severe acne.

A pregnant woman is to undergo testing to evaluate for chromosomal abnormalities. Which test would the nurse expect to be done the earliest? A. Amniocentesis B. Chorionic villi sampling C. Triple screen D. Fetal nuchal translucency

B. Chorionic villi sampling Chorionic villi sampling is performed at 7 to 11 weeks' gestation. Amniocentesis usually is performed after 15 weeks' gestation. A triple screen is usually done between 16 and 19 weeks' gestation. Fetal nuchal translucency must be performed between 11 and 14 weeks.

A nursing instructor is teaching a group of students about the action of antipyretic agents in children. The instructor determines that the teaching has been successful when the students identify which action as the primary action? A. Cause vasodilation to promote heat loss B. Decrease the temperature set point C. Block release of histamine D. Promote prostaglandin production

B. Decrease the temperature set point Antipyretics act to decrease the temperature set point in children with elevated temperatures by inhibiting the production of prostaglandins, which leads to heat loss through vasodilation and sweating. Antihistamines block the release of histamine.

While hospitalized, a child develops scarlet fever. Isolation has been prescribed by the health care provider. The nurse would place this child in what type of isolation? A. Airborne B. Droplet C. Contact D. Reverse

B. Droplet Scarlet fever is produced by group A streptococcus. It is most seen in children ages 5 years to 15 years. It is spread by droplets from respiratory secretions by talking, coughing, or sneezing. These droplets can travel 3 feet (1 meter). Isolation recommendations require the use of a mask for care of the child. Airborne isolation is required for illness that also produce droplets but these are smaller, can travel further and stay suspended in air. An N95 mask and negative pressure room is required for this type of isolation. Contact isolation requires the use of gowns, masks and gloves for direct contact with an infected person. Reverse isolation occurs if the client is neutropenic.

When providing support and education to the family of a child who is diagnosed with a serious genetic abnormality, what would be the priority? A. Assisting with scheduling follow-up visits B. Establishing a trusting relationship C. Teaching the family what to expect D. Using measures to promote growth and development

B. Establishing a trusting relationship p. 1820

12. A child is receiving carboplatin as part of a chemotherapy protocol. What would be most important for the nurse to include in the child's plan of care? A. Monitoring for visual changes B. Maintaining adequate hydration C. Using prescribed eye drops to prevent conjunctivitis D. Avoiding administration with food or meals

B. Maintaining adequate hydration When carboplatin is administered, the nurse must ensure adequate hydration. Monitoring for visual changes is appropriate when giving fludarabine. Eye drops are necessary to prevent conjunctivitis when high doses of cytarabine are administered. Oral mercaptopurine should not be given with meals or food.

A group of nursing students are reviewing the six links in the chain of infection and the nursing implications for each. The students demonstrate understanding of the information when they identify which precaution as helping to break the chain of infection to the susceptible host? A. Keeping linens dry and clean B. Maintaining skin integrity C. Washing hands frequently D. Coughing into a handkerchief

B. Maintaining skin integrity Maintaining the integrity of the child's skin and mucous membranes is a precaution that will break the chain of infection at the susceptible host. Keeping linens dry and clean is a precaution to take at the reservoir link. Washing hands frequently breaks the chain at the mode of transmission. Coughing into a handkerchief is a precaution for the portal of exit.

When performing a physical examination on a small child, the nurse observes approximately 8 to 10 light-brown spots concentrated primarily on the trunk and extremities, two small lumps on the posterior trunk, and axillary freckling. What condition do these findings suggest? A. Klinefelter syndrome B. Neurofibromatosis C. Fragile X syndrome D. Sturge-Weber syndrome

B. Neurofibromatosis p. 1833

When teaching the parents of a child with phenylketonuria, the nurse would instruct them to include which food in the child's diet? A. Milk B. Oranges C. Meat D. Eggs

B. Oranges Foods that contain phenylalanine are to be avoided. These include milk, meat, and eggs. Foods such as oranges would be allowed.

A nurse is conducting a health history for a 1-month-old with an infectious disorder. Which segment of the maternal health history would be most helpful for the nurse when determining if the infant developed the infection from the mother? A. Family history B. Past medical history C. Home treatments D. Present illness history

B. Past medical history Past medical history will provide information about the mother's pregnancy and birth, giving insight into the possibility of maternal transmission of the infection. Family history would provide information about lack of immunizations or recent infectious or communicable diseases. Home treatments and present illness history would provide no information about the possibility of maternal transmission of infection.

A child is diagnosed with cri-du-chat syndrome. What findings would the nurse expect to assess? Select all that apply. A. Hypertonia B. Short stature C. Simian crease D. Wide and flat nasal bridge E. Hydrocephaly

B. Short stature C. Simian crease D. Wide and flat nasal bridge Manifestations of cri-du-chat syndrome include hypotonia, short stature, microcephaly, moon-like round face, bilateral epicanthal folds, wide and flat nasal bridge, and simian crease.

The nurse is caring for a couple who have just learned that their infant has a genetic disorder. What would be least appropriate for the nurse to do at this time? A. Actively listening to the parents' concerns B. Teaching the parents about the child's medical needs C. Providing time for the parents to ask questions D. Offering suggestions for support services

B. Teaching the parents about the child's medical needs p. 1814

The nurse is interviewing the mother of a 6-month-old being seen at a well- child visit. The mother reports she has used an over-the-counter topical ointment intended for adults on her child for a skin rash. What is the most appropriate response by the nurse? A) "This is dangerous so please do not do this again." B) "Why did you do that instead of contacting your healthcare provider?" C) "Children have thin skin and can absorb medications differently than adults." D) "How often do you use this medication?"

C) "Children have thin skin and can absorb medications differently than adults." Children have thinner skin than adults. They will absorb topical medications more rapidly than adults. Medications concentrated for adults should not be used on children. It is important to explain this to the parent. It is confrontational to tell her this is dangerous or to tell her to contact the healthcare provider. The frequency of use is information

The nurse is instructing a 7-year-old child and his parents about using his prescribed corrective lenses. What would the nurse include in these instructions? A) "Make sure to take your glasses off from time to time to allow your eyes to rest." B) "Remove your glasses with both hands and lay them with the lens upright on the surface." C) "Clean the glasses every day with a mild soap and water or commercial cleaning agent." D) "Use paper towels or tissues to dry and periodically clean the lenses."

C) "Clean the glasses every day with a mild soap and water or commercial cleaning agent." Eyeglasses should be cleaned daily with mild soap and water or a commercial cleaning agent. The glasses should be worn at all times, but when removed, they should be removed with both hands and placed on their side (not directly on the lens on any surface). A soft cloth, not paper towels, tissues, or toilet paper, should be used to clean the lenses.

A child with persistent otitis media with effusion is to undergo insertion of pressure-equalizing tubes via a myringotomy. The child is to be discharged later that day. After teaching the parents about caring for their child after discharge, which statement indicates that the teaching was successful? A) "The tubes will stay in place for about a month and then fall out on their own." B) "His chances for ear infections now have dramatically decreased." C) "He should wear earplugs when swimming in a pool or a lake." D) "We should keep the ears protected with cotton balls for the first 24 hours."

C) "He should wear earplugs when swimming in a pool or a lake."

Which of the following would be most important to include in the teaching plan for parents of a child with pinworm? A) "Seal the child's clothing in a plastic bag for at least 10 days." B) "Be sure your child wears shoes at all times." C) "Make sure the child washes his hands after using the bathroom." D) "After applying this special cream, leave it on for about 8 to 10 hours."

C) "Make sure the child washes his hands after using the bathroom."

While providing care to a 5-month-old girl whose family has a history of food allergies, the nurse instructs the parents about foods to be avoided in the first year of life. Which response by the parents indicates a need for further teaching? A) "She cannot have any cow's milk." B) "I should continue breastfeeding until at least 6 months." C) "Peanuts in any form should be avoided." D) "Any kind of fruit is acceptable."

C) "Peanuts in any form should be avoided." The nurse should caution the parents that kiwifruit should be avoided. Other foods to avoid include cow's milk, eggs, peanuts, tree nuts, sesame seeds, fish, and shellfish. Breastfeeding also is recommended for at least the first 6 months.

While obtaining a health history from a male adolescent during a well check-up, the nurse assesses his sexual behavior and risk for sexually transmitted infections. Based on the information, the nurse plans to teach the adolescent about using a condom. Which of the following would the nurse include in the teaching plan? A) "You can reuse a condom if it's within 3 hours." B) "Store your condoms in your wallet so they are ready for use." C) "Put the condom on before engaging in any genital contact." D) "Use Vaseline with a latex condom for extra lubrication."

C) "Put the condom on before engaging in any genital contact."

After teaching a class about the differences in the skin of infants and adults, the nurse determines that additional teaching is necessary when the class states: A) "An infant's skin is thinner than an adult's, so substances placed on the skin are absorbed more readily." B) "The infant's epidermis is loosely connected to the dermis, increasing the risk for breakdown." C) "The infant has a lower risk for damage from ultraviolet radiation because the skin is more pigmented." D) "An infant has less subcutaneous fat, which places the infant at a higher risk for heat loss."

C) "The infant has a lower risk for damage from ultraviolet radiation because the skin is more pigmented." Infants have less pigmentation in their skin, placing them at increased risk for skin damage from ultraviolet radiation. The infant's skin is thinner, the epidermis is loosely connected, and there is less subcutaneous fat.

A 16-year-old client has just been diagnosed with HIV. Which statement by the parent indicates understanding of the diagnosis? A) "It is important for our child to get started on drug therapy for a better chance of a cure of the infection." B) "I must be infected with HIV and passed it to our child while in the uterus for the infection to have occurred." C) "We don't want to face the fact that it is likely our child contracted HIV through sexual contact or IV drug use." D) "Infections as a result of being HIV positive are a low risk since the diagnosis came early."

C) "We don't want to face the fact that it is likely our child contracted HIV through sexual contact or IV drug use." In teenagers, HIV is primarily contracted through sexual intercourse with an infected person or sharing of needles with an infected person during IV drug use. There is no cure for HIV, infants primarily contract the virus from their mothers, and infections as a result of having HIV are not dependent on when the diagnosis occurred.

A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement indicates the need for additional teaching? A) "She needs to eat foods that are high in fiber, so she doesn't get constipated." B) "We'll try to get her to drink lots of fluids throughout the day." C) "We will place the liquid in the front of her gums, just below her teeth." D) "We need to measure the liquid carefully so that we give her the correct amount."

C) "We will place the liquid in the front of her gums, just below her teeth." When giving liquid iron supplements, the liquid should be placed behind the teeth because it can stain the teeth. Iron can lead to constipation, so increased fluid and fiber intake is appropriate. The dosage needs to be measured carefully to prevent overdosing the child, leading to iron toxicity.

A nurse is conducting a physical examination of a 5-year-old with suspected iron-deficiency anemia. How would the nurse evaluate for changes in neurologic functioning? A) "Open your mouth so I can look inside your cheeks and lips." B) "Do you have any bruises on your feet or shins?" C) "Will you show me how you walk across the room?" D) "Let me see the palms of your hands and soles of your feet."

C) "Will you show me how you walk across the room?" Neurologic effects of iron deficiency may be demonstrated when the child's ability to sit, stand, and walk are impaired. Inspecting the mouth, looking for bruises, and checking the hands and feet provide information about signs of petechiae, purpura, or pallor.

When developing the plan of care for a child with burns requiring fluid replacement therapy, what information would the nurse expect to include? A) Administration of colloid initially followed by a crystalloid B) Determination of fluid replacement based on the type of burn C) Administration of most of the volume during the first 8 hours D) Monitoring of hourly urine output to achieve less than 1 mL/kg/hr

C) Administration of most of the volume during the first 8 hours With fluid replacement therapy, most of the volume is administered during the first 8 hours. Crystalloids (such as Ringer lactate) are administered for the first 24 hours, and then colloids are used once capillary permeability is less of a concern. Fluid replacement is determined by the amount of body surface area burned. Hourly urine output is expected to be at least 1 mL/kg/hr.

The nurse is caring for a child who is having an anaphylactic reaction with bronchospasm. The nurse would expect to administer what medication for bronchospasm as ordered? A) Epinephrine B) Corticosteroid C) Albuterol D) Diphenhydramine

C) Albuterol The nurse would expect to administer bronchodilator inhalation treatment (albuterol) if bronchospasm is present. Epinephrine, diphenhydramine, and/or corticosteroids are administered to reverse the allergic process.

The nurse is preparing a class for a group of adolescents about reducing the risk of skin cancer. What information would the nurse include? A) Using a sunscreen with para-aminobenzoic acid (PABA) with an SPF of at least 10 B) Applying sunscreen at least 1 hour before going outside in the sun C) Avoiding sun exposure between the hours of 10 AM and 2 PM D) Using artificial ultraviolet (UV) tanning beds instead of sun exposure

C) Avoiding sun exposure between the hours of 10 AM and 2 PM Avoiding sun exposure between the hours of 10 AM and 2 PM is one method of reducing the risk for skin cancer. Sunscreens with an SPF of 15 or greater that are fragrance- and PABA-free should be used. Sunscreen should be applied at least 30 minutes before exposure and then reapplied at least every 2 hours while exposed. Artificial UV light, including tanning beds, should be avoided.

.The nurse is taking a health history for a 9-year-old girl. Which finding would alert the nurse to a possible risk factor specifically associated with visual impairment? A) Being born at 39 weeks' gestation B) Having several hours of homework daily C) Being of African American heritage D) Being active in sports

C) Being of African American heritage African American heritage is a risk factor specifically for visual impairment. Although family history of the disorder, genetic syndrome, and previous medication use are risk factors for visual impairment, they are also risk factors for hearing impairment.

A 4-year-old is brought to the emergency department with a burn. What would alert the nurse to the possibility of child abuse? A) Burn assessment correlates with mother's report of contact with a portable heater. B) Parents state that the injury occurred approximately 15 to 20 minutes ago. C) Clear delineations are noted between burned and non-burned skin areas. D) The burn area appears asymmetric and nonuniform.

C) Clear delineations are noted between burned and non-burned skin areas. Suggested signs of a burn resulting from possible child abuse include a uniform appearance of the burn with clear delineations of burned and nonburned areas. Abuse would also be suspected if the report of the injury was inconsistent with burn injury or there was a delay in seeking treatment. An asymmetric nonuniform burn often correlates with a splatter-type burn resulting from the child pulling a source of hot fluid onto himself or herself.

The nurse is caring for a 9-year-old boy who is having chemotherapy. The nurse is developing a teaching plan for the child and family about nutrition. What instruction would the nurse be least likely to include? A) Emphasizing the intake of grains, fruits, and vegetables B) Featuring high-fiber foods if opioid analgesics are being taken C) Concentrating on consuming primarily high-calorie shakes and puddings D) Avoiding milk products if diarrhea is a problem

C) Concentrating on consuming primarily high-calorie shakes and puddings Providing high-calorie shakes and puddings with diet restrictions can help with weight gain, if that is a problem. However, concentrating on high-calorie shakes and puddings is not a good strategy. It is best to provide a balanced diet emphasizing grains, fruits, and vegetables. If pain is being treated with opioid analgesics, featuring high-fiber foods is important to help relieve constipation. Avoiding milk products is a good idea if diarrhea is a problem because lactose can make diarrhea worse.

The school nurse is walking through the lunchroom when one of the children says she started to feel strange after trading lunches with a friend. Which assessment would be most important? A) Asking if she has a rash anywhere B) Checking if she has any nausea C) Determining if her throat itches D) Asking if she has abdominal pain

C) Determining if her throat itches Asking if the child's throat itches is most important because this aids in determining airway patency, which is always the priority. Asking about a rash, nausea, or abdominal pain can be done after the nurse is certain the child's airway is not jeopardized.

The nurse is caring for a 5-year-old girl with a disseminated medulloblastoma. What intervention would be most appropriate for this situation? A) Providing emotional support to the parents and siblings of the child B) Recommending support groups for people whose children have cancer C) Encouraging the family to cry and express feelings away from the child D) Educating the family about the disease, its treatments, and side effects

C) Encouraging the family to cry and express feelings away from the child The outcome of this highly malignant medulloblastoma is often not positive. Helping the family through anticipatory grieving by encouraging the family to cry and express feelings away from the child would be unique to this child's situation. Educating the family about the disease, its treatments, and side effects; recommending support groups; and providing emotional support to the parents and siblings would be appropriate for any child with cancer.

The nurse is reviewing the white blood cell differential of a 4-year-old girl. Which value would lead the nurse to be concerned? A) Bands: 8% B) Segs: 28% C) Eosinophils: 10% D) Basophils: 0%

C) Eosinophils: 10% For a 4-year-old, normally eosinophils range from 0% to 3%; therefore, a result of 10% would be abnormal and a cause for concern. Bands of 8%, segs of 28%, and basophils of 0% are normal values for this age.

A child diagnosed with stage IV neuroblastoma has undergone abdominal surgery to remove the tumor. He is now receiving chemotherapy. Which nursing diagnosis would be most important? A) Risk for infection related to chemotherapy B) Impaired skin integrity related to abdominal surgery C) Grieving related to advanced disease and poor prognosis D) Imbalanced nutrition related to adverse effects of chemotherapy

C) Grieving related to advanced disease and poor prognosis In stage IV neuroblastoma, there is metastasis to the bone, bone marrow, other organs, or distant lymph nodes. Additionally, the tumor was located in the abdomen, which is associated with a poor prognosis. Therefore, the most important diagnosis would be grieving. Although infection, skin integrity, and imbalanced nutrition may be relevant, they would not be the most important.

The nurse is assessing a 4-year-old boy whose mother was 40 years old when he was born. Which of the following findings suggests this child has a genetic disorder? A) Inquiry determines the child had feeding problems. B) Observation shows nasal congestion and excess mucus. C) Inspection reveals low-set ears with lobe creases. D) Auscultation reveals the presence of wheezing.

C) Inspection reveals low-set ears with lobe creases.

A child is receiving methotrexate as part of his chemotherapy protocol. The nurse would anticipate administering which agent to counteract the toxic effects of methotrexate? A) Mesna B) Cyclosporine C) Leucovorin D) Nystatin

C) Leucovorin Leucovorin is given as an antidote to methotrexate to reduce its toxic effects. Mesna is given when cyclophosphamide and ifosfamide are used to prevent hemorrhagic cystitis. Cyclosporine is an immunosuppressant used to treat graft- versus-host disease after hematopoietic stem cell transplant. Nystatin is used to treat mucositis or systemic fungal infection.

The nurse is caring for a child who has undergone stem cell transplantation for severe combined immune deficiency. What finding would the nurse interpret as indicative of graft-versus-host disease? A) Presence of wheezing B) Splenomegaly C) Maculopapular rash D) Chronic or recurrent diarrhea

C) Maculopapular rash The nurse should monitor the stem cell transplant child closely for a maculopapular rash that usually starts on the palms and soles for indication that graft-versus-host disease is developing. Wheezing and recurrent diarrhea are not typical clinical manifestations of graft-versus-host disease. Splenomegaly is associated with hypogammaglobulinemia.

A 3-year-old child has sustained severe burns and is ordered to receive 100% oxygen. What would the nurse use to administer the oxygen? A) Nasal cannula B) Venturi mask C) Non-rebreather mask D) Oxygen hood

C) Non-rebreather mask All children with severe burns should receive 100% oxygen via a nonrebreather mask or bag--valve--mask ventilation. A nasal cannula provides only low oxygen concentrations (22% to 44%); a Venturi mask provides only 24% to 50% oxygen concentrations. An oxygen hood is used for infants only.

5. A nurse is caring for a 5-year-old in Bucks traction. When conducting a skin examination for signs of pressure ulcers, the nurse pays particular attention to which area? A) Sacral area B) Hip area C) Occiput D) Upper arm

C) Occiput Common sites of pressure ulcers in hospitalized children include the occiput and toes, while children who require wheelchairs for mobility demonstrate pressure ulcers in the sacral or hip areas more frequently. The upper arm is not a common site for pressure ulcers.

.The nurse is examining a 7-year-old boy with blepharitis. What would the nurse least likely expect to assess? A) Redness B) Scaling C) Pain D) Edema

C) Pain Blepharitis has symptoms of redness, scaling, and edema, but not pain. Pain is typically associated with hordeolum.

.A nurse is examining a 7-year-old boy with hordeolum. Which would the nurse expect to find? A) Redness B) Scaling C) Pain D) Edema

C) Pain Pain is typical of hordeolum or stye. Blepharitis has symptoms of redness, scaling, and edema but not pain.

The nurse is reviewing the laboratory test results of a child diagnosed with disseminated intravascular coagulation (DIC). What would the nurse interpret as indicative of this disorder? A) Shortened prothrombin time B) Increased fibrinogen level C) Positive fibrin split products D) Increased platelets

C) Positive fibrin split products Laboratory test results associated with DIC include positive fibrin split products; prolonged prothrombin time, partial thromboplastin time, bleeding time, and thrombin time; decreased fibrinogen levels, platelets, clotting factors II, V, VIII, and X, and antithrombin III; and increased levels of fibrinolysin, fibrinopeptide A, and positive D-dimers.

The parents of a 5-year-old bring their son to the emergency department because of significant eyelid edema. The mother states, "He scratched himself near his eye a couple of days ago while playing outside in the yard." The nurse suspects periorbital cellulitis based on which finding? A) Evidence of discharge B) Reddened conjunctiva C) Purplish discoloration of eyelid D) Altered visual acuity

C) Purplish discoloration of eyelid Periorbital cellulitis is a bacterial infection of the eyelids and tissue surrounding the eye. The bacteria may gain entry into the skin via an abrasion, laceration, insect bite, foreign body, or impetiginous lesion. It may also result from a nearby bacterial infection such as sinusitis. Findings include marked eyelid edema, purplish or red color of the eyelid, clear conjunctivae, absence of discharge, and normal visual acuity.

After teaching a group of students about visual disorders, the instructor determines that the teaching was successful when the students identify what as the most common cause of visual difficulties in children? A) Astigmatism B) Strabismus C) Refractive errors D) Nystagmus

C) Refractive errors The most common cause of visual difficulties in children is refractive errors. Astigmatism, strabismus, and nystagmus are other common visual disorders in children but are less common than refractive errors.

.After teaching a group of parents about ear infections in children, which statement indicates that the teaching was successful? A) Infants with congenital deformities have an increased risk for ear infections. B) Ear infections typically increase as the child gets older. C) The shorter and wider eustachian tubes of an infant increase the risk. D) Adenoids shrink as the child grows, allowing more bacteria to enter.

C) The shorter and wider eustachian tubes of an infant increase the risk. The infant has relatively short, wide, horizontally placed eustachian tubes, allowing bacteria and viruses to gain access to the middle ear and resulting in an increased number of infections as compared to adults. Congenital deformities of the ear are associated with other body system anomalies, but not necessarily an increase in ear infections. As the child matures, the eustachian tubes assume a more slanted position, so older children and adults have fewer infections. A child's adenoids are often enlarged, leading to obstruction of the eustachian tubes and infection.

The nurse is teaching the parents of a child with a hematologic disorder about the functions of the various blood cells. The nurse determines that the teaching was successful when the parents state which blood cell as being primarily responsible for blood clotting? A) Granulocytes B) Erythrocytes C) Thrombocytes D) Leukocytes

C) Thrombocytes

Ch. 45 tissue integrity/integumentary disorder

Ch. 45 tissue integrity/integumentary disorder

The nurse is caring for a 6-year-old visually impaired boy and is about to begin the physical examination. Which intervention would be most appropriate to promote effective communication with the child? A) Show him the stethoscope. B) Describe the examination room. C) Use his name before touching him. D) Allow him to explore the exam room.

C) Use his name before touching him. When interacting with a visually impaired child, it is a good communication technique to use his name to gain his attention before touching him. Letting him listen to his heart with the stethoscope, describing the examination room, and promoting exploration by touch are sound ways to interact, but are not specific to communicating with the child at the beginning of the assessment.

After teaching a class about humoral and cellular immunity, the nurse recognizes that additional teaching is needed when the class states that: A) humoral immunity crosses the placenta. B) cellular immunity involves the T lymphocytes. C) cellular immunity recognizes antigens. D) humoral immunity does not destroy the foreign cell.

C) cellular immunity recognizes antigens. Humoral immunity recognizes antigens and cellular immunity does not. Humoral immunity crosses the placenta in the form of IgG. Cellular immunity involves the action of T lymphocytes, and humoral immunity does not destroy the foreign cell.

A child with systemic lupus erythematosus is receiving high-dose corticosteroid therapy over the long term. The nurse would instruct the parents and child to report: A) difficulty urinating. B) visual changes. C) joint pain. D) rash.

C) joint pain. Avascular necrosis (lack of blood supply to a joint, resulting in tissue damage) may occur as an adverse effect of long-term or high-dose corticosteroid use. Teach families to report new onset of joint pain, particularly with weight bearing, or limited range of motion. Complications of systemic lupus erythematosus include nephritis manifested by urinary changes and visual changes. Rash may develop secondary to photosensitivity. These are unrelated to the long-term or high-dose corticosteroid use.

A nurse is instructing a parent on how to obtain a stool culture for ova and parasites from a child with diarrhea. What would the nurse include in the teaching plan? A. "Give the child bismuth and then collect the next specimen." B. "Obtain the specimen from the toilet after the child has a bowel movement." C. "Keep the specimen from coming into contact with any urine." D. "Bring the specimen to the laboratory on the third day."

C. "Keep the specimen from coming into contact with any urine." A stool specimen for culture must be free of urine, water, and toilet paper. Therefore, the parent needs to understand how to collect the specimen so that it does not come into contact with any these. In addition, the specimen should not be retrieved out of toilet water. Mineral oil, barium, and bismuth interfere with the detection of parasites. In such cases, specimen collection should be delayed for 7 to 10 days. Once the specimen is collected, it should be brought to the laboratory immediately.

The nurse is providing education to the parents of a child diagnosed with pinworms. Which statement is most important for the nurse to include in the teaching? A. "Seal the child's clothing in a plastic bag for at least 10 days." B. "Be sure your child wears shoes at all times." C. "Make sure your child washes hands before eating." D. "After applying this special cream, leave it on for about 8 to 10 hours."

C. "Make sure your child washes hands before eating." The most effective measure to prevent pinworms or a recurrence is good hand hygiene, especially after using the bathroom and before eating. Sealing the child's clothing in a plastic bag is appropriate for pediculosis capitis. Having the child wear shoes at all times is helpful in preventing hookworm. Use of a cream that remains on for a specified time is associated with scabies.

The nurse is providing care for a 14-year-old girl with severe acne. The girl expresses sadness and distress about her appearance. Which response by the nurse would be most appropriate? A. "Are you using your medicine every day?" B. "Your condition will most likely improve in a year or two." C. "Many people feel this way; I know someone who can help." D. "If you have any scarring you can undergo dermabrasion."

C. "Many people feel this way; I know someone who can help." Depression can occur as a result of body image disturbances with severe acne. The nurse should provide emotional support to adolescents undergoing acne therapy and refer teens for counseling if necessary. Telling the girl that her condition is likely to improve in a year or two is not helpful. Asking the girl whether she uses her medicine every day or reminding her that her scars can be addressed with dermabrasion does not address her feelings of sadness and distress.

The nurse is caring for a 13-year-old girl with von Willebrand disease. After teaching the adolescent and her parents about this disorder and care, which response by the parents indicates a need for additional teaching? A. "We need to administer Stimate prior to dental work." B. "We should be aware that she may suffer from menorrhagia." C. "We should administer desmopressin as often as needed." D. "We understand that she may have frequent nosebleeds."

C. "We should administer desmopressin as often as needed." The parents need to know that desmopressin spray Stimate is used for controlling bleeding; the other brands are used for homeostasis and enuresis. Additionally, Stimate should only be used 3 days in a row as lessening of the response (tachyphylaxis) occurs with frequent use. Stimate should be used before dental work. Menorrhagia and nosebleeds may occur.

After teaching a class about inborn errors of metabolism, the instructor determines that additional teaching is needed when the class identifies what as an example of an inborn error of metabolism? A. Galactosemia B. Maple syrup urine disease C. Achondroplasia D. Tay-Sachs disease

C. Achondroplasia Achondroplasia is an autosomal dominant genetic disorder, not an inborn error of metabolism. Galactosemia, maple syrup urine disease, and Tay-Sachs are considered inborn errors of metabolism.

The nurse is developing a teaching plan for the mother of a 4-year-old girl with cold and fever. What would the nurse include in this teaching plan?A. Keeping the child covered and warm B. Calling the doctor if the child's fever lasts more than 36 hours C. Ensuring fluid intake to prevent dehydration D. Observing for changes in alertness resulting from brain damage

C. Ensuring fluid intake to prevent dehydration Teaching the mother to ensure fluid intake is important because fever can cause dehydration. The child should be dressed lightly. There is no need to call the doctor unless the child's fever lasts more than 3 to 5 days or the fever is greater than 105oF. A rapid rise to a high fever can cause a febrile convulsion, but it does not lead to brain damage.

The nurse is assessing a child with pauciarticular-type juvenile idiopathic arthritis. What would the nurse expect to assess? A. Fever B. Rash C. Eye inflammation D. Splenomegaly

C. Eye inflammation With pauciarticular juvenile idiopathic arthritis, eye inflammation may be noted. Fever, rash, and enlarged spleen would be noted with systemic juvenile idiopathic arthritis.

The nurse is caring for a 1-month-old girl with low-set ears and severe hypotonia who was diagnosed with trisomy 18. Which nursing diagnosis would the nurse identify as most likely? A. Interrupted family process related to the child's diagnosis B. Deficient knowledge deficit related to the genetic disorder C. Grieving related to the child's poor prognosis D. Ineffective coping related to stress of providing care

C. Grieving related to the child's poor prognosis Grieving related to the child's prognosis is a diagnosis specific to this child's care. The prognosis for trisomy 18 is that the child will not survive beyond the first year of life. Ineffective coping related to the stress of providing care, deficient knowledge related to the genetic disorder, and interrupted family process due to the child's diagnosis could be appropriate for any family of a child with a genetic disorder.

The nurse is caring for a neonate who is suspected of having sepsis. Which assessment findings would the nurse interpret as most indicative of sepsis? A. Rash on face B. Edematous neck C. Hypothermia D. Coughing

C. Hypothermia Hypothermia is a sign of sepsis in neonates. A rash on the face is a symptom of scarlet fever. An edematous neck is a sign of diphtheria. Paroxysmal coughing is a symptom of pertussis.

A child is diagnosed with scarlet fever. The nurse is reviewing the child's medical record, expecting which medication to be prescribed for this child? A. Ibuprofen B. Acyclovir C. Penicillin V D. Doxycycline

C. Penicillin V Penicillin V is the antibiotic of choice for the treatment of scarlet fever. Ibuprofen is used to treat fever. Acyclovir is used to treat viral infections. Doxycycline, a tetracycline, is the drug of choice for treating Rocky Mountain spotted fever.

The nurse is assessing an infant and notes that the infant's urine has a mousy or musty odor. What would the nurse suspect? A. Maple syrup urine disease B. Tyrosinemia C. Phenylketonuria D. Trimethylaminuria

C. Phenylketonuria the urine of a child with phenylketonuria has a mousy or musty odor. For the child with maple syrup urine disease, excretions have a maple syrup odor. With tyrosinemia, excretions have a cabbage-like or rancid butter odor. With trimethylaminuria, excretions smell like rotting fish.

The client has a heavily draining wound for which there is an order to change the dressing every 4 hours. The nurse becomes busy and does not change the dressing as ordered. Which link in the chain of infection has the nurse allowed to flourish? A. Susceptible host B. Portal of exit C. Reservoir D. Mode of transmission

C. Reservoir The reservoir is the area where a pathogen grows and reproduces. Leaving the dressing unchanged allows for a dark, warm, nutrient rich, and moist environment where many organisms will thrive. A susceptible host is a person who cannot fight off an infection. The portal of exit is the way a pathogen exits the host. The mode of transmission is the way the pathogen travels.

The nurse is performing a physical examination on a 9-year-old boy who has experienced a tick bite on his lower leg and is suspected of having Lyme disease. Which assessment finding would the nurse expect to find? A. Swelling in the neck B. Confusion and anxiety C. Ring-like rash on lower leg D. Hypersalivation

C. Ring-like rash on lower leg A ring-like rash at the site of the tick bite is characteristic for Lyme disease. Swelling in the neck is a symptom of mumps. Confusion, anxiety, and hypersalivation are symptoms of rabies.

When reviewing infectious diseases in the pediatric population, nursing students identify which disease as a common childhood exanthema? A. Mumps B. Rabies C. Rubella D. West Nile virus

C. Rubella Rubella is a common childhood exanthema. Mumps is a viral infection. Rabies is a zoonotic infection. West Nile virus is a vector-borne disease.

A school-aged child with an infectious disease is placed on transmission-based precautions. If the child is not dehydrated or otherwise in distress, which nursing diagnosis would be the priority? A. Impaired skin integrity related to trauma secondary to pruritus and scratching B. Fluid volume deficit related to increased metabolic demands and insensible losses C. Social isolation related to infectivity and inability to go to the playroom D. Deficient knowledge related to how infection is transmitted

C. Social isolation related to infectivity and inability to go to the playroom Children who are placed on transmission-based precautions are not allowed to leave their rooms and are not allowed to go to common areas such as the playroom or schoolroom. Thus, they are at risk for social isolation. Impaired skin integrity, fluid volume deficit, and deficient knowledge may be appropriate but would depend on the infectious disease diagnosed.

Which exercise would the nurse suggest as most helpful to maintain mobility in a child with juvenile idiopathic arthritis? A. Jogging every other day B. Using a treadmill C. Swimming D. Playing basketball

C. Swimming Swimming is a particularly useful exercise to maintain joint mobility without placing pressure on the joints. Jogging, using a treadmill, and playing basketball would place pressure on the joints of the lower extremities.

The nurse is assessing a 4-year-old client. Which finding suggests to the nurse this child may have a genetic disorder? A. Inquiry determines the child had feeding problems. B. The child weighs 40 lb (18.2 kg) and is 40 in (101.6 cm) in height. C. The child has low-set ears with lobe creases. D. The child can hop on one foot but cannot skip.

C. The child has low-set ears with lobe creases. Low-set ears are associated with numerous genetic dysmorphisms. Feeding problems could have been due to low birthweight, prematurity, or a variety of other reasons. The height and weight are average for this age. At this age, it is expected for the child to be able to hop on one foot. The child may or may not be able to skip at this age.

The mother of a 4-year-old boy has contacted the physician's office. She reports her son was exposed to someone with chickenpox. She has inquired about when her son may show if he has gotten the disease. What information should be provided? A. The illness should be seen in a week if he has been exposed. B. Symptoms of the disease should show up within 24 to 48 hours of exposure. C. The incubation period for the disease is between 10 and 21 days. D. Younger children will have longer periods of incubation.

C. The incubation period for the disease is between 10 and 21 days.

Down syndrome: what type of imaging is needed for atlantoaxial instability?

Cervical radiographs due to atlantoaxial instability p. 1828

Ch. 37 care of a child with an infection

Ch. 37 care of a child with an infection

Ch. 39 disorder of the eyes/ears

Ch. 39 disorder of the eyes/ears

A nurse develops a plan of care for a child that includes patching the eye. This plan of care would be most appropriate for which condition? A) Astigmatism B) Hyperopia C) Myopia D) Amblyopia

D) Amblyopia Eye patching is used for amblyopia or any condition that results in one eye being weaker than the other. Corrective lenses would be appropriate for astigmatism, hyperopia, and myopia.

27. The mother of a 5-year-old child with allergies to a variety of foods including eggs, milk, peanuts and shellfish, asks if her child will "always have these problems." What response by the nurse is most accurate? A) "Sadly, allergies to foods will persist." B) "Most children with allergies will outgrow them." C) "We cannot be sure at this point but most children who are allergic to peanuts will not have this allergy in adulthood." D) "In most cases allergies to peanuts and shellfish persist into adulthood but the others may diminish and disappear."

D) "In most cases allergies to peanuts and shellfish persist into adulthood but the others may diminish and disappear." Foods such as peanuts, milk, soy, shellfish, and tree nuts are common allergens. By adulthood many allergies will diminish or disappear. Allergies to shellfish, peanuts and tree nuts often persist into adulthood.

30. The nurse is caring for a child recently diagnosed with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The nurse is teaching the parents about triggers that may result in oxidative stress. Which response indicates a need for further teaching? A) "I doubt he will ever eat fava beans, but they could trigger hemolysis." B) "He must avoid exposure to naphthalene, an agent found in mothballs." C) "He must never take methylene blue for a urinary tract infection." D) "My son can never take penicillin for an infection."

D) "My son can never take penicillin for an infection." The nurse should emphasize that penicillin is not a known trigger that may result in oxidative stress and hemolysis. Fava beans, naphthalene, and methylene blue can trigger oxidative stress.

The nurse is caring for a 2-year-old boy with hemophilia. His parents are upset by the possibility that he will become infected with hepatitis or HIV from the clotting factor replacement therapy. Which response by the nurse would be most appropriate? A) "Parents commonly fear the worst; however, the factor will help your child lead a normal life." B) "There are risks with any treatment including using blood products, but these are very minor." C) "Although factor replacement is expensive, there's more financial strain from missing work if he has a bleeding episode." D) "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission."

D) "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission." The nurse needs to emphasize that since 1986, there have been no reports of virus transmission from factor infusion since the inception of heat treatment of the factor. Telling the parents that there is a minor risk does not teach. Telling the parents that factor is expensive or that it is common to worry does not teach, nor does it address their concerns.

The nurse is teaching a couple about the pros and cons of genetic testing. Which of the following statements best describes the capabilities of genetic testing? A) "Various genetic tests help the physician choose appropriate treatments." B) "Genetic testing helps couples avoid having children with fatal diseases." C) "Genetic tests identify people at high risk for preventable conditions." D) "Some genetic tests can give a probability for developing a disorder."

D) "Some genetic tests can give a probability for developing a disorder."

The nurse is instructing the parents of a school-age child with an eye disorder how to care for her eye. Which condition would the nurse explain as resolving by itself without the use of antibiotics? A) Blepharitis B) Hordeolum C) Corneal abrasion D) Chalazion

D) Chalazion Chalazion usually resolves spontaneously but may require surgical drainage. Therapeutic management of blepharitis, hordeolum, and corneal abrasion may require antibiotic ointment.

A nurse is caring for a 14-year-old girl who received an electrical burn. The nurse would anticipate preparing the girl for which diagnostic tests as ordered? A) Pulse oximetry B) Fiberoptic bronchoscopy C) Xenon ventilation-perfusion scanning D) Electrocardiographic monitoring

D) Electrocardiographic monitoring Electrocardiographic monitoring is important for the child who has suffered an electrical burn to identify possible cardiac arrhythmias, which can be noted for up to 72 hours after a burn injury. Fiberoptic bronchoscopy and xenon ventilation- perfusion scanning may be ordered to evaluate an inhalation injury, not an electrical burn. Pulse oximetry is used to evaluate pulmonary function and would not be indicated in the case of an electrical burn.

Which test result would the nurse least likely expect to find in a child diagnosed with Wilms tumor? A) Complete blood count (CBC) within normal limits B) Urinalysis positive for blood C) Mass on kidney D) Elevated homovanillic acid (HVA) with 24-hour urine collection

D) Elevated homovanillic acid (HVA) with 24-hour urine collection Levels of HVA and vanillylmandelic acid (VMA) will not be elevated with Wilms tumor; they are elevated with neuroblastoma. CBC, blood urea nitrogen (BUN), and creatinine usually are within normal limits. Urinalysis may reveal hematuria or leukocytes. Renal or abdominal ultrasound would reveal a mass on the kidney.

A 6-year-old boy has been admitted to the hospital with burns. The nurse notes carbonaceous sputum. What action would be the priority? A) Determining the burn depth B) Eliciting a description of the burn C) Estimating burn extent D) Ensuring a patent airway

D) Ensuring a patent airway Carbonaceous sputum is a sign of potential airway injury due to smoke inhalation. Therefore, the nurse should ensure a patent airway while obtaining a brief history and simultaneously evaluating the child and providing emergency care. If the burn does not pose an immediate, life-threatening risk, the nurse would obtain an in- depth history and elicit a description of the burn. Determining the burn depth and extent are part of the secondary survey.

A woman gives birth to a healthy newborn. As part of the newborn's care, the nurse instills erythromycin ophthalmic ointment as a preventive measure for which sexually transmitted infection (STI)? A) Genital herpes B) Hepatitis B C) Syphilis D) Gonorrhea

D) Gonorrhea

The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management? A) Administer a nonsteroidal anti-inflammatory drug (NSAID) as ordered. B) Use guided imagery and therapeutic touch. C) Administer meperidine as ordered. D) Initiate pain assessment with a standardized pain scale.

D) Initiate pain assessment with a standardized pain scale. The nurse should first initiate pain assessment with a standardized pain scale upon admission and provide frequent evaluations of pain. Administering NSAIDs or meperidine and the use of nonpharmacologic pain management techniques are all appropriate. However, the first action is to assess the child's pain to provide a baseline for future comparison.

A nurse is examining a child who has sustained blunt trauma to the eye area. The nurse suspects a simple contusion based on what finding? A) Pain in the eye B) Impaired visual acuity C) Blurred vision D) Intact extraocular movements

D) Intact extraocular movements A simple contusion of the eye area is manifested by bruising and edema of the lids or surrounding eye area, intact extraocular eye movement, intact visual acuity, absence of diplopia or blurred vision, pain surrounding the eye but not within the eye, and pupils that are equal, are round, and react to light and accommodation.

A child is diagnosed with juvenile idiopathic arthritis and is receiving several different medications listed in the medication administration record. Which agent would the nurse identify as being used to prevent disease progression? A) Aspirin B) Prednisone C) Ibuprofen D) Methotrexate

D) Methotrexate Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, are necessary to prevent disease progression. Other agents, such as aspirin and ibuprofen, are helpful with pain relief. Prednisone helps for relief of inflammation.

The nurse is caring for a 7-year-old girl who is undergoing a stem cell transplant. What information would the nurse include in the child's postoperative plan of care? A) Assessing for petechiae, purpura, bruising, or bleeding B) Limiting blood draws to the minimum volume required C) Administering antiemetics around the clock as ordered D) Monitoring for severe diarrhea and maculopapular rash

D) Monitoring for severe diarrhea and maculopapular rash In the posttransplant phase, monitor closely for symptoms of graft-versus-host disease (GVHD) such as severe diarrhea and maculopapular rash progressing to redness or desquamation of the skin (especially on the palms of the hands or soles of the feet). During chemotherapy in the pretransplant phase, assess for petechiae, purpura, bruising, or bleeding to prevent hemorrhage; administer antiemetics around the clock as ordered to prevent the cycle of nausea, vomiting, and anorexia; and limit blood draws to the minimum volume required to prevent anemia.

The nurse is caring for a 4-year-old boy with infectious conjunctivitis. Which intervention would be least appropriate to include in the child's plan of care? A) Rinsing the eye with cool water B) Educating the family about the disease C) Encouraging frequent hand washing D) Promoting eye safety

D) Promoting eye safety

The nurse is caring for a 3-year-old boy with amblyopia. Which intervention would be most appropriate to include in the child's plan of care? A) Rinsing the eye with cool water B) Educating the family about the disease C) Encouraging frequent hand washing D) Promoting eye safety

D) Promoting eye safety Promoting eye safety is extremely important for the child with amblyopia; if the better eye suffers a serious injury, both eyes may become blind. Rinsing the eye with cool water, educating the family about the disorder, and encouraging frequent hand washing are interventions for infectious conjunctivitis.

The nurse is preparing a presentation to a local community group about genetic disorders and the types of congenital anomalies that can occur. What would the nurse include as a major congenital anomaly? A. Overlapping digits B. Polydactyly C. Umbilical hernia D. Cleft palate

D. Cleft palate Cleft palate is considered a major congenital anomaly, one that creates a significant medical problem or requires surgical or medical management. Overlapping digits, polydactyly, and umbilical hernia are considered minor congenital anomalies because they do not cause an increase in morbidity in and of themselves.

The nurse is caring for a 16-year-old boy with acute myelogenous leukemia who is having chemotherapy and who has incomplete records for varicella zoster immunization. Which is the priority nursing diagnosis? A) Pain related to adverse effects of treatment verbalized by the child B) Nausea related to side effects of chemotherapy verbalized by the child C) Constipation related to the use of opioid analgesics for pain D) Risk for infection related to neutropenia and immunosuppression

D) Risk for infection related to neutropenia and immunosuppression The priority nursing diagnosis is risk for infection related to neutropenia and immunosuppression. The incomplete records for varicella zoster immunization can cause a problem since exposure to chickenpox could cause sepsis, so the nurse should contact the oncologist for approval to administer the vaccine. Certain vaccines are not administered when the child is immunosuppressed, so timing is crucial. Diagnoses for pain and nausea are valid for this child because he is undergoing chemotherapy, but they are not a priority. Likewise, the need for constipation management would not be necessary unless opioid use begins.

A child is diagnosed with atopic dermatitis. Which laboratory test would the nurse expect the child to undergo to provide additional evidence for this condition? A) Erythrocyte sedimentation rate B) Potassium hydroxide prep C) Wound culture D) Serum immunoglobulin E (IgE) level

D) Serum immunoglobulin E (IgE) level IgE levels are often used to evaluate for atopic dermatitis. IgE levels are elevated in this condition. Erythrocyte sedimentation rate may be used but this test is nonspecific and only indicates infection or inflammation. Potassium hydroxide prep is used to identify fungal infections. Wound culture would be done to identify a specific organism if an infection occurs with atopic dermatitis.

As part of a clinical conference with a group of nursing students, the instructor is describing the burn classification. The instructor determines that the teaching has been successful when the group identifies what as characteristic of full-thickness burns? A) Skin that is reddened, dry, and slightly swollen B) Skin appearing wet with significant pain C) Skin with blistering and swelling D) Skin that is leathery and dry with some numbness

D) Skin that is leathery and dry with some numbness Full-thickness burns may be very painful, numb, or pain-free in some areas. They appear red, edematous, leathery, dry, or waxy and may display peeling or charred skin. Superficial burns are painful, red, dry, and possibly edematous. Partial- thickness and deep partial-thickness burns are very painful and edematous and have a wet appearance or blisters.

A group of nursing students are reviewing information about humoral and cellular immunity. The students demonstrate understanding of this material when they identify what as being involved in cellular immunity? A) B cells B) Antibodies C) Antigens D) T cells

D) T cells Cellular immunity involves T cells, which do not recognize antigens. B cells, antibodies, and antigens are involved in humoral immunity.

A group of students are reviewing information about the differences in the hearing and vision capabilities of a child when compared to an adult. The students demonstrate a need for additional study when they identify what as one of the differences? A) Hearing is completely developed at the time of birth. B) Visual acuity develops from birth throughout childhood. C) Binocular vision is usually achieved by 2 months of age. D) The ability to discriminate colors is completed by birth.

D) The ability to discriminate colors is completed by birth. The optic nerve is not completely myelinated at birth, so color discrimination is incomplete. Hearing is intact at birth and visual acuity develops from birth throughout childhood. Binocular vision is achieved by 4 months of age.

While reviewing various studies about the use of antipyretics possibly prolonging illness, the nurse notes that there are benefits to their use for the child with fever. Which of the following would the nurse identify as the best explanation related to the benefit of antipyretics? A) They slow the growth of bacteria. B) They increase neutrophil production. C) They encourage T-cell proliferation. D) They help decrease fluid requirements.

D) They help decrease fluid requirements.

The nurse is counseling a couple who suspect that they could bear a child with a genetic abnormality. What would be most important for the nurse to incorporate into the plan of care when working with this family? A. Gathering information from at least three generations B. Informing the family of the need for a wide range of information C. Maintaining the confidentiality of the information D. Presenting the information in a nondirective manner

D. Presenting the information in a nondirective manner p. 1814

The nurse is caring for a newborn whose mother is HIV positive. The nurse would expect to administer a 6-week course of which medication? A) Lopinavir B) Ritonavir C) Nevirapine D) Zidovudine

D) Zidovudine Children born to HIV-positive mothers should receive a 6-week course of zidovudine therapy. Lopinavir, ritonavir, and nevirapine are medications used for treatment of HIV-1 infections as part of a three-drug regimen.

The nurse is assessing the tympanic temperature of several children. The nurse documents that the child with which temperature reading has a fever? A. 98.2° F (36.8° C) B. 99.2° F (37.3° C) C. 100° F (37.8° C) D. 100.8° F (38.2° C)

D. 100.8° F (38.2° C) A tympanic temperature greater than 100.4° F (greater than 38° C) is defined as fever. An oral temperature of 100° F (greater than 37.8° C) would identify a fever. An axillary temperature of 99° F (greater than 37.2° C) would identify a fever.

When describing Prader-Willi syndrome to a group of nursing students, the instructor would describe this condition as one affecting which chromosome? A. 4 B. 5 C. 11 D. 15

D. 15 Prader-Willi syndrome involves an abnormality on chromosome 15. Cri-du-chat involves an abnormality on chromosome 5; Wolf-Hirschhorn syndrome involves an abnormality on chromosome 4; and Beckwith-Wiedemann syndrome involves an abnormality on chromosome 11.

After teaching the parents of a child with chickenpox (varicella zoster), the nurse determines that the parents have understood the teaching when they state that their child can return to school at which time? A. After day 5 of the rash B. When the rash is completely healed C. Once the rash appears D. After the lesions have crusted

D. After the lesions have crusted Children with chickenpox (varicella zoster) can return to school once the lesions have crusted.

The nurse is preparing a plan of care for a 5-year-old boy with chickenpox. Which nursing intervention should be questioned? A. Administer antipyretics as ordered. B. Keep the child's fingernails short. C. Monitor fluid intake and output. D. Provide alcohol baths as needed.

D. Provide alcohol baths as needed. Treatments such as sponging the child with alcohol or cold water are not appropriate interventions for fever management. Rather, the nurse would use tepid sponge baths and cool compresses. Administering antipyretics, keeping the child's fingernails short, and monitoring intake and output are appropriate.

When providing guidance to the parents of a child with Down syndrome, which interaction would be most appropriate? A. Encourage the parents to home-school the child. B. Advise the parents that the child will need monthly thyroid testing. C. Instruct them on the need for yearly dental visits. D. Teach the parents about the need for a high-fiber diet.

D. Teach the parents about the need for a high-fiber diet. A high-fiber intake is important for children with Down syndrome because their lack of muscle tone may decrease peristalsis, leading to constipation.

The nurse is caring for a couple who is having a triple screen done. The nurse would least likely expect what level to be tested? A. α-Fetoprotein B. Human chorionic gonadotropin C. Unconjugated estriol D. Testosterone

D. Testosterone

The nurse is caring for a 9-year-old boy with achondroplasia. What will the nurse's assessment reveal? A. Narrow passages from the nose to the throat B. Slim stature, hypotonia, and a narrow face C. Craniosynostosis and a small nasopharynx D. Trident hand and persistent otitis media

D. Trident hand and persistent otitis media Achondroplasia results in disordered growth with an average adult height of 4 feet for males or females. Other distinguishing symptoms are a separation between the middle and ring fingers, called trident hand, and persistent otitis media and middle ear dysfunction. Narrow passages from nose to throat are a symptom of CHARGE syndrome. Slim stature, hypotonia, and a narrow face are symptoms of Marfan syndrome. Craniosynostosis and a small nasopharynx are symptoms of Apert syndrome.

The nurse is preparing to obtain a blood specimen via capillary heel puncture. Which action would be most appropriate for the nurse to do? A. Apply a cool compress for several minutes before collection. B. Elevate the extremity used after puncturing it. C. Squeeze the area to facilitate specimen collection. D. Wipe away the first drop of blood with dry gauze.

D. Wipe away the first drop of blood with dry gauze. When obtaining a blood specimen by capillary puncture, the nurse should wipe away the first drop of blood with a cotton ball or dry gauze pad and then collect the sample without squeezing the foot to prevent possible hemolysis. Prior to the puncture, the nurse can apply a commercial heel warmer or warm compress for several minutes to promote vasodilation. The extremity being used should be placed in the dependent position after puncturing the heel.

Rhabdomyosarcoma: where are 4 places this tumor may be located at?

Extremities Head Neck GU tract p. 1733

**** A 4-year-old child is being transported to the trauma center from a local community hospital for treatment of a burn injury that is estimated as covering over 40% of the body. The burns are partial- and full-thickness burns. The nurse is asked to prepare for the arrival of the child and gathers supplies anticipating that which of the following will be prescribed initially?

Foley cath

Superficial burns: what 3 things should you do?

Run cool water over burn Cover with clean, non-adhesive bandage Administer acetaminophen p. 1676