Peds Exam 2 Review

A nurse is caring for a male infant who has an epispadias. Which of the following findings should the nurse expect?

- Bladder exstrophy - Widened pubic symphysis - Urethral opening on the dorsal side of the penis

A nurse is assessing an infant who has a suspected urinary tract infection. Which of the following are expected findings?

- Irritability - Vomiting - Fever - Swelling of the face -Pallor - Fatigue

A nurse is assessing an infant who has hypertrophic pyloric stenosis. Which of the following manifestations should the nurse expect?

- Projectile Vomiting -- thickening of the pyloric sphincter results in projectile vomiting - dry mucus membranes -- unable to consume adequate food and fluid - constant hunger -- unable to consume adequate food and fluid

A nurse is caring for an infant who has obstructive uropathy. Which of the following findings should the nurse expect?

- UTI - Hydronephrosis

Which nursing suggestion is the most helpful when discussing frequent allergic rhinitis (hay fever) attacks with a 12-year-old client and parent? A. Consider identification of allergen and hyposensitization. B. Offer homeopathic suggestions on decreasing symptoms. C. Take an antihistamine before known allergen exposure. D. Avoid offending allergen if at all possible.

A. Consider identification of allergen and hyposensitization Rationale: The most helpful discussion with a client who is experiencing frequent allergic rhinitis (hay fever) attacks is identification of the allergen and then possible hyposensitization. Many individuals have allergy symptoms even when taking allergy relief medications and utilizing homeopathic remedies. Some allergies such as those to outdoor grass and pollens are difficult to avoid.

What is the most common debilitating disease of childhood among those of European descent? A. Cystic fibrosis B. Asthma C. Pneumonia D. BPD

A. Cystic fibrosis Rationale: Cystic fibrosis is the most common debilitating disease of childhood among those of European descent.

The vision impairment in which the child can see objects at close range but not at a distance is known as: A. Myopia B. Hyperopia C. Esotropia D. Exotropia

A. Myopia Rationale: Myopia is nearsightedness, which means that the child can see objects clearly at close range but not at a distance. It occurs because the light entering the eye focuses in front of the retina. Hyperopia is farsightedness. Esotropia is better known as "cross-eyed." It is a form of strabismus in which one or both eyes focus inward. Exotropia is a form of strabismus where the eyes are deviated outward.

The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child? A. Effortless vomiting just after the child has eaten B. Forceful vomiting followed by the child being eager to eat again C. Severe constipation with occasional ribbon-like stools D. Bouts of diarrhea with failure to gain weight

A. Effortless vomiting just after the child has eaten Rationale: In the child with GERD, almost immediately after feeding, the child vomits the contents of the stomach. The vomiting is effortless, not projectile in nature. The child with GERD is irritable and hungry, but may refuse to eat. Aspiration after vomiting may lead to respiratory concerns, such as apnea, wheezing, cough, and pneumonia. Failure to thrive and lack of normal weight gain occurs. Symptoms seen in the older child may include heartburn, nausea, epigastric pain, and difficulty swallowing.

What measure at home could help a child with an upper respiratory infection breathe more easily? A. Increasing room humidity B. Limiting fluid intake C. Enforcing strict bed rest D. Playing "rapid breathing" games

A. Increasing room humidity Rationale: A moist environment helps prevent respiratory secretions from drying and becoming difficult to raise.

The nurse is caring for a neonate who has undergone an intestinal pull-through procedure for an imperforate anus. Which action would be most important for the nurse to do postoperatively? A. Listening for bowel sounds B. Observing the abdominal skin C. Determining the infant's ability to suck on a pacifier D. Turning the infant every 4 hours

A. Listening for bowel sounds Rationale: Bowel sounds will allow the nurse to know how peristalsis is progressing after surgery. This will determine when the infant is able to receive nourishment other than through the intravenous route.

A 4-year-old with bronchiolitis has been admitted to the hospital with respiratory compromise. The father asks the nurse why the physician won't prescribe an antibiotic, "My child just keeps getting worse." What is the best response by the nurse? A. "Bronchiolitis is almost always caused by the respiratory syncytial virus (RSV). Unfortunately, antibiotics don't work on viruses." B. "You have a very good physician who I trust completely. I'm sure everything possible is being done for your child." C. "Oftentimes it is more beneficial to treat the symptoms of bronchiolitis rather than try to kill the bacteria with an antibiotic." D. "Your physician probably doesn't want to take a chance of your child building up an immunity to the antibiotic in case the condition worsens and more antibiotics are needed."

A. "Bronchiolitis is almost always caused by the respiratory syncytial virus (RSV). Unfortunately, antibiotics don't work on viruses." Rationale: Bronchiolitis is an acute inflammatory process of the bronchioles and small bronchi. Nearly always caused by a viral pathogen, respiratory syncytial virus (RSV) accounts for the majority of cases of bronchiolitis; therefore, antibiotic therapy is not warranted.

The nurse is caring for a 2-year-old boy with an umbilical hernia and is teaching the mother about this condition. Which response from the mother indicates a need for further teaching? A. "I can tape a quarter over the hernia to reduce it." B. "An incarcerated hernia is rare, but it can occur." C. "I need to watch for pain, tenderness, or redness." D. "My son could have some appearance-related self-esteem issues."

A. "I can tape a quarter over the hernia to reduce it." Rationale: The use of home remedies to reduce an umbilical hernia should be discouraged because of the risk of bowel strangulation. The mother needs to be aware that strangulation can occur, but it is rare with an umbilical hernia. Pain, tenderness, or redness indicates an incarcerated hernia, which although rare with umbilical hernias, can occur.

An 8-year-old client is suffering from allergic rhinitis (hay fever). Which statement will the nurse include when providing education to the client's caregiver? A. "Pollen is a cause of these symptoms. Allergy medicine may help your child." B. "Penicillin is the treatment of choice. Be sure your child takes the entire prescribed amount." C. "Your child needs to avoid peanuts until further testing is completed." D. "When bathing, your child needs to use a mild soap, free of dye and fragrance."

A. "Pollen is a cause of these symptoms. Allergy medicine may help your child." Rationale: The allergens that usually cause allergic rhinitis (hay fever) are pollens or molds rather than foods or drugs. Over-the-counter or prescription allergy medications may help provide relief for these clients when taken. Peanuts and soap are not associated with allergic rhinitis.

The parent of a child having tympanoplasty tubes placed asks, "Will my child lose hearing while the tubes are in place?" What is the nurse's best answer? A. "The tubes are inserted into a section of eardrum in which the hearing is not affected." B. "There is some risk of permanent deafness, but the benefit of decreasing the infection is worth it." C. "Your child's hearing will decrease while the tubes are in place." D. "Have you asked your child's surgeon about that?"

A. "The tubes are inserted into a section of eardrum in which the hearing is not affected." Rationale: Tymanostomy tubes help to ventilate the cavities of the middle ear and balance the pressure on each side of the tympanic membrane..Tympanoplasty tubes do not interfere with hearing because they are inserted into a portion of the tympanic membrane that is not instrumental to hearing. There is no risk of permanent deafness and hearing will be increased while the tubes are in place, not decreased.

At which age do children have a trachea 4 mm in width? A. Newborn B. Toddler C. School-aged child D. Teenager

A. Newborn Rationale: Pediatric airways are much smaller in diameter and shorter in length than in adults. A newborn trachea is 4 mm wide compared to an adult of 20 mm. Because the trachea is so narrow even small amounts of mucus or edema can cause significant resistance to airflow. The trachea continues to grow and develop as the child grows so the toddler, school age child, and adolescent would all have a trachea width larger than 4 mm.

Upon providing discharge instructions home after a tonsillectomy and adenoidectomy, which is most important? A. Note any frequent swallowing. B. Provide acetaminophen for pain. C. Stress regular fluid consumption. D. Allow the child an age-appropriate, quiet plan.

A. Note any frequent swallowing. Rationale: A complication of a tonsillectomy and adenoidectomy is bleeding. If the child is bleeding he or she must be brought to the emergency room immediately. To determine if a child is bleeding, the parents must assess for frequent swallowing. All of the other discharge instructions are appropriate, but noting any frequent swallowing is the priority.

The nurse is administering medications to a child with cystic fibrosis. Which method would the nurse most likely use to give medications to treat the pancreatic involvement seen in this disease? A. Open capsule and sprinkle on food. B. Shake inhaler and hold close to mouth. C. Draw up in syringe and administer subcutaneously. D. Pour in medication cup and have the child drink.

A. Open capsule and sprinkle on food. Rationale: For the infant and young child, they can be opened and sprinkled on foods such cereal, pudding, or applesauce. They also can be swallowed whole. They are not supplied in liquid form, so the child could not take them in a medication cup. They are not supplied for injection or inhalation, only oral use.

In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention? A. Prepare the infant for surgery. B. Medicate the infant with analgesics. C. Change the infant's diet to one that is lactose-free. D. Assist in doing a barium enema procedure on the infant.

A. Prepare the infant for surgery. Rationale: In pyloric stenosis, the thickened muscle of the pylorus causes gastric outlet obstruction. The treatment is a surgical correction called a pyloromyotomy. The condition is not painful, so no analgesics would be needed until after surgical repair. The condition is not related to lactose in the diet, so changing to lactose-free formula would not correct the condition. A barium enema would be used to diagnose intussusception.

In caring for the child with asthma, the nurse recognizes that bronchodilator medications are administered to children with asthma for which reason? A. Relief of acute symptoms B. Management of chronic pain C. To stabilize the cell membranes D. Prevention of mild symptoms

A. Relief of acute symptoms Rationale: Bronchodilators are used for quick relief of acute exacerbations of asthma symptoms. Mast cell stabilizers help to stabilize the cell membrane by preventing mast cells from releasing the chemical mediators that cause bronchospasm and mucous membrane inflammation. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma.

A group of students are reviewing the various causes of bacterial conjunctivitis in children. The students demonstrate understanding of this condition when they identify what as the most common cause? A. Staphylococcus aureus B. Streptococcus pneumoniae C. Haemophilus influenzae D. Chlamydia trachomatis

A. Staphylococcus aureus Rationale: They all cause bacterial conjunctivitis, but S. aureus is the most common bacterial cause of conjunctivitis.

The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism? A. Testis cannot be "milked" down inguinal canal B. Fluid detected in scrotal sac C. Venous varicosity detected along the spermatic cord D. Testis can briefly be brought into scrotum

A. Testis cannot be "milked" down inguinal canal Rationale: With true cryptorchidism, the retractile testis cannot be "milked" down the inguinal canal. Fluid in the scrotal sac is a hydrocele. A venous varicosity along the spermatic cord is a varicocele. Testis that can be brought into the scrotum refers to a retractile testis.

The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding? A. White cottage cheese-like discharge B. Thin gray vaginal discharge with fishy odor C. Foul yellow-gray discharge D. Irritation of labia and vaginal opening

A. White cottage cheese-like discharge Rationale: White cottage cheese-like discharge indicates C. albicans. Thin gray discharge with a fishy odor points to Bordetella or Gardnerella. Foul yellow-gray discharge indicates Trichomonas vaginalis. Irritation of the labia and vaginal opening is commonly found with poor hygiene.

A group of nursing students are reviewing information about variations in the anatomy of a child's respiratory tract structures in comparison to adults. The students demonstrate an understanding of the information when they describe the shape of the larynx in infants as: A. funnel. B. cylindrical. C. oval. D. spherical.

A. funnel. Rationale: In infants and children (younger than the age of 10 years), the cricoid cartilage is underdeveloped, resulting in laryngeal narrowing and a funnel-shaped larynx. In teenagers and adults, the larynx is cylindrical and fairly uniform in width.

The nurse identifies a nursing diagnosis of Ineffective airway clearance related to inflammation and copious thick secretions. What action is the priority? A. suctioning secretions from the airway B. administering oxygen as ordered C. monitoring oxygen saturation by pulse oximeter D. administering analgesics as ordered

A. suctioning secretions from the airway Rationale: The priority intervention is suctioning secretions to provide a patent airway.

The nurse is preparing to administer albuterol to a 14-year-old client for the first time. Prior to administration, which adverse reaction is priority for the nurse to educate the client? A. tachycardia B. hypoactivity C. bronchial muscle relaxation D. increased appetite

A. tachycardia Rationale: Adverse reactions of albuterol, a bronchodilator, include tachycardia, nervousness, tremors, hyperactivity, malaise, palpitations, increased appetite, hypokalemia, and muscle cramps. While tachycardia and increased appetite are both adverse reactions, tachycardia happens abruptly following the first dose and can be alarming for clients. It is a priority for the nurse to provide education on this over a slower, less concerning change.

The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis? A. Explosive diarrhea B. Projectile vomiting C. Severe abdominal pain D. Frequent urination

B. Projectile vomiting Rationale: During the first weeks of life, the infant with pyloric stenosis often eats well and gains weight and then starts vomiting occasionally after meals. Within a few days the vomiting increases in frequency and force, becoming projectile. The child may have constipation, and peristaltic waves may be seen in the abdomen, but the child does not appear in severe pain. Urine output is decreased and urination is infrequent.

The nurse is trying to pick a method to teach a 4-year-old with cystic fibrosis a good way to exercise her lungs. Which would be the developmentally correct strategy to help this client? A. Teach the client to jump rope. B. Teach the client to blow bubbles. C. Teach the client to ride a bike. D. Teach the client to hop on one foot.

B. Teach the client to blow bubbles. Rationale: A helpful exercise for the client would be to blow bubbles, a horn, or a pinwheel. This would help her exercise her lung capacity and is age-appropriate for early childhood. The other exercises are all normal activities for school-aged children.

A client has just been admitted to the unit with a history of recent streptococcal infection, hematuria, and proteinuria. Based on these findings, the nurse suspects which condition? A. prune belly syndrome B. acute glomerulonephritis C. acute kidney injury D. urinary tract infection

B. acute glomerulonephritis Rationale: Recent streptococcal infection, hematuria, and proteinuria are indicative of acute glomerulonephritis.

The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: A. respiratory distress. B. painless rectal bleeding. C. dehydration. D. ischemia.

B. painless rectal bleeding. Rationale: With Meckel diverticulum, most symptomatic children present younger than age 2 years. Intermittent, painless rectal bleeding is the most common clinical manifestation of Meckel diverticulum. The blood is most often bright red or maroon and may be passed independent of stool due to ulceration at the junction of the ectopic tissue and the normal ileal mucosa.

The nurse is collecting data on a 2-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question is most important for the nurse to ask? A. "How many times a day does your child urinate?" B. "How long has your child been toilet trained?" C. "Tell me about the types of stools your child has been having." D. "What foods has your child eaten during the last few days?"

C. "Tell me about the types of stools your child has been having." Rationale: For the child with gastroenteritis, the interview with the family caregiver must include specific information about the history of bowel patterns and the onset of diarrheal stools, with details on the number and type of stools per day. Recent eating patterns, determining if the child is toilet trained, and how many times a day the child urinates are important questions, but the highest priority is gathering data regarding the stools and stool pattern.

The nurse is caring for an infant recently diagnosed with oral candidiasis (thrush) who has been prescribed nystatin. Which statement by the infant's mother would suggest a need for further education? A."I will make sure to clean all of her toys before I give them to her." B. "I will watch for diaper rash." C. "I will add the nystatin to her bottle four times per day." D. "I will use a cotton tipped applicator to apply the medication to her mouth."

C. "I will add the nystatin to her bottle four times per day." Rationales: Administer nystatin suspension four times per day following feeding, not mixed in the bottle, to allow the medication to remain in contact with the lesions. In the younger infant, apply nystatin to the lesions with a cotton-tipped applicator. Infants and young children often mouth their toys, so it is important to clean them appropriately. Explain to parents of infants with oral candidiasis (thrush) the importance of reporting diaper rash because fungal infections in the diaper area often occur concomitantly with thrush and also need to be treated.

The nurse has finished teaching the parents of a 10-month-old male ways to prevent another acute otitis media (AOM) infection. Which statement by the mother indicates she has the correct understanding of the information provided? A. "I should continue to smoke in the house." B. "I should continue to breastfeed my son because it lowers the incidence of acute otitis media." C. "Immunizations will not help prevent another otitis media infection." D. "Because the infection is in my son's ear, hand washing is not important."

B. "I should continue to breastfeed my son because it lowers the incidence of acute otitis media." Rationale: Breastfed infants have a lower incidence of AOM than formula-fed infants so mothers should be encouraged to continue breastfeeding for at least 6 to 12 months.

The nurse is auscultating the lungs of a lethargic, irritable 6-year-old boy and hears wheezing. The nurse will most likely include which teaching point if the child is suspected of having asthma? A. "I'm going to have the respiratory therapist get some of the mucus from your lungs." B. "I'm going to have this hospital worker take a picture of your lungs." C. "We're going to go take a look at your lungs to see if there are any sores on them." D. "I'm going to hold your hand while the phlebotomist gets blood from your arm."

B. "I'm going to have this hospital worker take a picture of your lungs." Rationale: The nurse should teach the child using terms a 6-year-old will understand. A chest x-ray is usually ordered for the assessment of asthma to check for hyperventilation. A sputum culture is indicated for pneumonia, cystic fibrosis, and tuberculosis; fluoroscopy is used to identify masses or abscesses as with pneumonia; and the sweat chloride test is indicated for cystic fibrosis.

The nurse is preparing the room for a client admitted from the emergency department with suspected tuberculosis (TB). Which type of infection control precautions would the nurse anticipate? A. Standard precautions B. Airborne precautions C. Droplet precautions D. Contact precautions

B. Airborne precautions Rationale: Airborne precautions should be initiated for any client with suspected tuberculosis. Clients with suspected TB are placed away from other hospitalized clients in a single-occupancy room.

A nurse is caring for an infant who has a hydrocele. Which of the following actions should the nurse take? A. Prepare the child for surgery B. Explain to the parents that the issue will self-resolve C. Retract the foreskin and cleanse several times daily D. Refer the family for genetic counseling

B. Explain to the parents that the issue will self-resolve Rationale: Hydrocele is fluid in the scrotum and resolves spontaneously in the majority of cases

A nurse is caring for an infant who has just returned from PACU following cleft lip and palate repair. Which of the following actions should the nurse take? A. Remove the packing in the mouth B. Place the infant in an upright position C. Offer a pacifier with sucrose D. Assess the mouth with a tongue blade

B. Place the infant in an upright position Rationale: This will facilitate drainage and prevent aspiration

The nurse is talking with a woman in her second trimester of pregnancy who has been diagnosed with polyhydramnios. The physician has ordered an ultrasound be performed to check for the presence of esophageal atresia. Which statement by the woman indicates an understanding of the relationship between these conditions? A. "Babies with esophageal atresia produce an excessive amount of amniotic fluid." B. "Reductions in amniotic fluid are associated with the development of esophageal atresia." C. "Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup." D. "Enzymes in amniotic fluid can cause the development of esophageal atresia."

C. "Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup." Rationale: Review the maternal history for polyhydramnios. Often this is the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Esophageal atresia is an underlying cause of polyhydramnios.

The pediatric unit has multiple clients experiencing upper respiratory system complications. Which pediatric client is at the highest risk for respiratory distress? A. 3-year-old child with croup B. 11-month-old infant with nasopharyngitis C. 2-year-old child with epiglottitis D. 16-year-old adolescent with asthma

C. 2-year-old child with epiglottitis Rationale: Epiglottitis is a medical emergency due to the swelling of the epiglottis covering the larynx. This client needs frequent assessment for respiratory distress, especially since young children have smaller, more compliant airways.

The nurse is teaching a group of parents about eyes and eye concerns. The nurse tells these caregivers about a condition that occurs when unequal curvatures in the cornea bend the light rays in different directions and this causes images to be blurred. The condition the nurse is referring to is: A. Refraction B. Myopia C. Astigmatism D. Hyperopia

C. Astigmatism Rationale: Astigmatism is caused by unequal curvatures in the cornea that bend the light rays in different directions and produce a blurred image. Refraction is the way light rays bend as they pass through the lens to the retina. Myopia is nearsightedness; hyperopia is farsightedness.

An 8-year-old with cystic fibrosis has had a noted decline on the growth chart. Which nursing intervention is best for maintaining adequate nutrition? A. Provide high caloric meals to the client's liking. B. Delay pancreatic enzymes until food enters the small intestine. C. Encourage high calorie, high protein snacks. D. Limit sodium to a 2 gram sodium restricted diet

C. Encourage high calorie, high protein snacks. Rationale: The best nursing intervention is a high calorie, high protein snack. Calories can be obtained from non-nutritious foods. It is not only that the client needs calories for energy, but nutrition needs to be present. Pancreatic enzymes aid in digestion so they need to be available for foods; thus they are given prior to ingestion. Sodium is encouraged due to the high sodium loss.

A parent brings a 2-year-old child to the health clinic with reports of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and his child is enrolled in a local day care center. Based on this information, what gastrointestinal condition might the nurse suspect? A. Appendicitis B. Pancreatitis C. Gastroenteritis D. Hirschsprung disease

C. Gastroenteritis Rationale: Outbreaks of gastroenteritis routinely occur in day care centers, schools, institutions for the handicapped, and other places where overcrowding is prevalent and hygiene is inadequate. Typical signs and symptoms include diarrhea, nausea, vomiting, and abdominal pain.

The nurse is caring for a child who has conductive hearing loss. What is true regarding this type of hearing loss? A. It is generally severe and unresponsive to medical treatment. B. It is often undetected until the child goes to school. C. It is caused by chronic otitis media or another infection. D. It is caused by maternal rubella.

C. It is caused by chronic otitis media or another infection. Rationale: In conductive hearing loss, the transmission of sound through the middle ear is disrupted. Structures fail to carry sound waves to the inner ear. Fluid fills the ear so the tympanic membrane is unable to move properly. This type of impairment most often results from chronic serious otitis media or other infection.

A 6-month-old infant who was born premature is being seen for a follow-up examination. The child is to receive an intramuscular injection monthly through the winter and spring season. Which drug would the nurse expect to be ordered? A. Amantadine B. Zanamivir C. Palivizumab D. Nedocromil

C. Palivizumab Rationale: Palivizumab is a monoclonal antibody used for prevention of serious lower respiratory syncytial virus (RSV) disease. RSV bronchiolitis occurs most often in infants and toddlers, with a peak incidence around 6 months of age. Infants born prematurely are more at risk. The peak occurrence of bronchiolitis is in the winter and spring. Nedocromil decreases the frequency and intensity of allergic reactions. Amantadine is used to treat and prevent influenza A. Zanamivir is used to treat and prevent influenza A.

The nurse obtains a history from the parent of a child with glomerulonephritis about how the child became ill. What would the nurse expect the parent to report? A. Diuresis and pallor B. Headache, loss of appetite C. Reddish-brown, smoky-colored urine D. Loss of weight, oliguria

C. Reddish-brown, smoky-colored urine Rationale: The immune process of the illness affects the structure of the kidney as well as the function of the kidney. Acute glomerulonephritis often presents with glomeruli bleeding. The nurse should inspect the urine with a dipstick. There will be increased protein evident. Inspect the urine for gross hematuria, which will cause the urine to appear tea colored, reddish-brown or smoky. The child may have a slight weight gain from slight edema. The blood pressure will be elevated and the child will experience a decreased urine output.

An adolescent has hepatitis B. What would be the most important nursing action? A. Conscientious collection of stool for ova and parasites B. Strict calculation of caloric and vitamin B intake C. Strict enforcement of standard precautions D. Close observation to detect cerebral hallucinations

C. Strict enforcement of standard precautions Rationale: Hepatitis B is spread through IV drug use, sex, contaminated blood and perinatally. The treatment is rest, hydration, and nutrition. Hospitalization is required if there is vomiting, dehydration, elevated bleeding times and mental status changes. The adolescent should be taught about good hygiene, safe sex practices, careful handwashing and blood/bodily fluid contact precautions. Using standard precautions of gloves and good handwashing will help prevent spread of the disease.

The nurse is educating the parents of an infant after a circumcision. The parents demonstrate understanding when they reiterate the need to report which concerning development to the health care provider? A. There are small spots of blood on diaper. B. There is bleeding that stops without pressure. C. The infant does not urinate within 6 to 8 hours D. There is an appearance of granulation tissue.

C. The infant does not urinate within 6 to 8 hours Rationale: The parents should immediately notify the health care provider or nurse practitioner if the infant does not urinate within 6 to 8 hours after the procedure. Small spots of blood on the diaper, bleeding that stops without pressure, and granulation tissue are normal findings.

The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be: A. impaired digestive activity. B. high sodium chloride concentration in the sweat. C. chronic lack of oxygen. D. decreased respiratory capacity.

C. chronic lack of oxygen. Rationale: In the child with cystic fibrosis the development of a barrel chest and clubbing of fingers indicate chronic lack of oxygen.

A nurse is planning care of a child who has a UTI. Which of the following interventions should the nurse include? A. Administer an antidiuretic B. Restrict fluids C. Evaluate the child's self-esteem D. Encourage frequent voiding

D. Encourage frequent voiding Rationale: This assists in flushing the bacteria through the urinary system

The nurse has assessed a 6-year-old child as having respiratory distress due to swelling of the epiglottis and surrounding structures. Which signs and symptoms would support this assessment? A. The child is pale and has vomited. B. The child has pale, elevated patches on the skin. C. The child is irritable and tachycardic. D. The child is in tripod position.

D. The child is in tripod position. Rationale: Inflammation and swelling of the epiglottis and surrounding structures are common in children ages 2 to 7 years. The child will attempt to improve his/her airway by sitting forward and extending the neck forward with the jaw up, in a "sniffing position" (tripod position). Being pale, vomiting, and having elevated patches on the skin are not associated with epiglottis. Stridor, tachycardia, and the rapid onset are classical signs of epiglottitis.

A parent asks if her newborn's undescended testicles will need surgery to repair. What is the best response by the nurse? A. This problem needs to be corrected immediately in the newborn period. B. If the infant is having swelling or pain, then surgery will be performed. C. Surgery is not needed for this type of problem. D. There is a chance the testicles will descend on their own.

D. There is a chance the testicles will descend on their own. Rationale: The Association of American Physicians recommends surgery at 1 year of age if the testicles have not descended on their own. There is a chance they may descend on their own prior to 1 year of age. This problem does not cause pain or swelling.

The caregivers of an 8-year-old bring their child to the pediatrician and report that the child has not had breathing problems before, but since taking up lacrosse the child has been coughing and wheezing at the end of every practice and game. The nurse knows that because the problems seem to be directly related to exercise, it is likely that the child will be able to be treated with: A. decreased activity and increased fluids. B. corticosteroids and leukotriene inhibitors. C. removal of allergens in the home and school. D. a bronchodilator and mast cell stabilizers.

D. a bronchodilator and mast cell stabilizers. Rationale: Mast cell stabilizers are used to help decrease wheezing and exercise-induced asthma attacks. A bronchodilator often is given to open up the airways just before the mast cell stabilizer is used. Corticosteroids are anti-inflammatory drugs used to control severe or chronic cases of asthma. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma.

The nurse is educating the parents of a 4-year-old boy with strabismus. Teaching for the parents would include the: A. need for ultraviolet-protective glasses postoperatively. B. importance of completing the full course of oral antibiotics. C. possibility that multiple operations may be necessary. D. importance of patching as prescribed.

D. importance of patching as prescribed. Rationale: Teaching the parents the importance of patching the child's eye as prescribed is most important for the treatment of strabismus. The need for UV-protective glasses postoperatively is a subject for the treatment of cataracts. The possibility of multiple operations is a teaching subject for infantile glaucoma. Teaching the importance of completing the full course of oral antibiotics is appropriate to periorbital cellulitis.

A client has been admitted to the emergency department with nausea, vomiting, and severe scrotal pain. These findings indicate what condition? A. hydrocele B. varicocele C. testicular infection D. testicular torsion

D. testicular torsion Rationale:

The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis? A. "Your child will be treated with oral iron preparations to correct the anemia." B. "We will give enemas until clear and then teach you how to do these at home." C. "Your child will receive counseling so the underlying concerns will be addressed." D. "The treatment for the disorder will be a surgical procedure."

D. "The treatment for the disorder will be a surgical procedure." Rationale: reatment of congenital aganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel. Chronic anemia may be present, but iron will not correct the disorder. Enemas may be given to initially achieve bowel elimination, but they will not treat the disorder. Differentiation must be made between this condition and psychogenic megacolon because of coercive toileting or other emotional problems. The child with aganglionic megacolon does not withhold stools or defecate in inappropriate places, and no soiling occurs.

The 12-year-old child has developed a stye. Which may be included in the child's care? A. Manually express the lesion when a head forms. B. Apply petroleum jelly to reduce irritation. C. Apply cool, dry compresses to the affected area. D. Apply hot, moist compresses to the affected area.

D. Apply hot, moist compresses to the affected area. Rationale: The stye is an infection of a ciliary gland (a modified sweat gland) that enters the hair follicle at the lid margin, most commonly caused by Staphylococcus. Management of the stye includes the use of hot, moist compresses. Heat provides for vasodilation, which will be useful in the resolution of the inflammation.

The nurse is preparing a nursing care plan for a 2-year-old child with hearing impairment. Which intervention will be part of the plan? A. Assess vision to determine functional capability. B. Explain botulinum injection procedure and risks. C. Teach parents to make vinegar and alcohol eardrops. D. Assess the child's ability to convey information.

D. Assess the child's ability to convey information. Rationale: Children who are unable to hear during the first 36 months of life are unable to learn the language necessary for normal verbal communication; therefore, it will be important to assess the child's ability to convey information.

The nurse is mentoring a new graduate who is completing a respiratory assessment on a client with suspected epiglottitis. Which action by the new graduate would require clarification? A. Humidified air B. Continuous pulse oximetry C. Parenteral antibiotic administration D. Assessment of the nasopharynx

D. Assessment of the nasopharynx Rationale: Assessment of the nasopharynx, especially with a tongue blade, is contraindicated as it may initiate a gag reflex and complete obstruction may occur. The mentoring nurse would advise the nursing student to listen to the quality of the client's respiration to document status. Humidified air, continuous pulse oximetry and parenteral antibiotic administration are treatment options for the client with suspected epiglottitis.

The nurse is teaching the caregivers of a child with cystic fibrosis. What is most important for the nurse to teach this family? A. Be sure the child exercises daily. B. Watch out for signs that family members are overly stressed. C. Avoid overprotecting the child. D. Encourage everyone in the family to use good hand washing techniques.

D. Encourage everyone in the family to use good hand washing techniques. Rationale: The child with cystic fibrosis has low resistance, especially to respiratory infections. For this reason, take care to protect the child from any exposure to infectious organisms. Good hand washing techniques should be practiced by the whole family; teach the child and family the importance of this first line of defense. Practice and teach other good hygiene habits.

The nurse is performing the intake assessment of a 6-month-old in the pediatrician's office. The nurse alerts the physician that the child is showing signs of hearing loss based on what assessment findings? Select all that apply.

The parent reports that the infant does not wake up when the siblings are being loud during nap time. The infant does not turn the head when the nurse stands next to the infant and calls their name. The child is not making any babbling sounds and the parent reports the child never does. The nurse dropped a metal tray in the room and the infant did not react. Rationale: Not responding to the telephone or doorbell are signs of hearing loss for a young child; the infant isn't expected to respond to these sounds. Signs of hearing loss in the infant include: Waking only to touch, not environmental noises; does not startle to loud noises; does not turn to sound by 4 months of age; does not babble at 6 months of age; and does not progress with speech development.

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? Select all that apply.

applesauce, bananas, and skim milk No bread or wheat products!