PEDS FINAL EXAM - Ch. 1, 5, 9, 10, 11, 12, 13, 29, 30

An infant is having an anaphylactic reaction, and the nurse is preparing to administer epinephrine 0.001 mg/kg. The child weighs 22 pounds. What is the epinephrine dose the nurse should administer? (Record your answer using two decimal places.)

ANS: 0.01 Convert the 22 pounds to kilograms by dividing 22 by 2.2 = 10. Multiply the 10 by 0.001 mg of epinephrine = 0.01 mg as the dose to be given.

The clinic nurse is reviewing hemoglobin A1c levels on several children with type 1 diabetes. Hemoglobin A1c levels of less than _____% is a goal for children with type 1 diabetes. (Record your answer in a whole number.)

ANS: 7 The measurement of glycosylated hemoglobin (hemoglobin A1c) levels is a satisfactory method for assessing control of the diabetes. As red blood cells circulate in the bloodstream, glucose molecules gradually attach to the hemoglobin A molecules and remain there for the lifetime of the red blood cell, approximately 120 days. The attachment is not reversible, therefore, this glycosylated hemoglobin reflects the average blood glucose levels over the previous 2 to 3 months. The test is a satisfactory method for assessing control, detecting incorrect testing, monitoring the effectiveness of changes in treatment, defining patients' goals, and detecting nonadherence. Hemoglobin A1c levels of less than 7% are a well-established goal at most care centers.

ESSAY 1. Place in order the expected sequence of fine motor developmental milestones for an infant beginning with the first milestone achieved and ending with the last milestone achieved. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d, e). a. Voluntary palmar grasp b. Reflex palmar grasp c. Puts objects into a container d. Neat pincer grasp e. Builds a tower of two blocks, but fails

ANS: b, a, d, c, e Grasping occurs during the first 2 to 3 months as a reflex and gradually becomes voluntary. By 5 months, infants are able to voluntarily grasp objects. Gradually, the palmar grasp (using the whole hand) is replaced by a pincer grasp (using the thumb and index finger). By 8 to 10 months of age, infants use a crude pincer grasp, and by 11 months, they have progressed to a neat pincer grasp. By 11 months, they put objects into containers and like to remove them. By age 1 year, infants try to build towers of two blocks but fail.

A school nurse observes a child, with a peanut allergy, in obvious distress, wheezing and cyanotic, after ingestion of some trail mix containing peanuts. Place the interventions the nurse should implement in order of the highest priority to the lowest priority. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d). a. Call Jason's parents and notify them of the situation. b. Call Jason's family practitioner to obtain further orders for medication. c. Promptly administer an intramuscular dose of epinephrine. d. Call 911 and wait for the emergency response personnel to arrive.

ANS: c, d, b, a The nurse should first administer epinephrine IM to a child with a food allergy who is in obvious distress, wheezing, and cyanotic. 911 should be called after the epinephrine is administered. The physician should be contacted for further orders and, last, the parents notified of the situation.

A nurse is caring for a 5-year-old child with a major burn. The health care provider has written a prescription to notify the health care provider if urine output falls to or below 2 ml/kg/hr. The child weighs 55 lb. The nurse should notify the health care provider if the milliliters of urine output is at or below _____ for an hour. (Record your answer in a whole number.)

ANS: 50 The primary emphasis during the emergent phase is the treatment of burn shock and the management of pulmonary status. Monitoring vital signs, output, fluid infusion, and respiratory parameters are ongoing activities in the hours immediately after injury. IV infusion is begun immediately and is regulated to maintain a urinary output of at least 1 to 2 ml/kg in children weighing less than 30 kg (66 pounds). To calculate the child's weight in kilograms, the weight in pounds is divided by 2.2. That number is then multiplied by 2 to get the amount expected for a 1-hour period. 55/2.2 = 25 kg. 25 kg × 2 ml = 50 ml per hour.

The recommendation for calcium for children 1 to 3 years of age is _____ milligrams. (Record your answer in a whole number.)

ANS: 500 While limiting fat consumption, it is important to ensure diets contain adequate nutrients such as calcium. The recommendation for daily calcium intake for children 1 to 3 years of age is 500 mg, and the recommendation for children 4 to 8 years of age is 800 mg.

A goiter is an enlargement or hypertrophy of which gland? a. Thyroid b. Adrenal c. Anterior pituitary d. Posterior pituitary

ANS: A A goiter is an enlargement or hypertrophy of the thyroid gland. Goiter is not associated with the adrenal, anterior pituitary, or posterior pituitary organs.

The nurse is taking care of a 7-year-old child with a skin rash called a papule. Which clinical finding should the nurse expect to assess with this type of skin rash? a. A lesion that is elevated, palpable, firm and circumscribed, less than 1 cm in diameter b. A lesion that is elevated, flat-topped, firm, rough and superficial, greater than 1 cm in diameter c. An elevated lesion, firm, circumscribed, palpable, 1 to 2 cm in diameter d. An elevated lesion, circumscribed, filled with serous fluid, less than 1 cm in diameter

ANS: A A papule is elevated, palpable, firm, circumscribed, less than 1 cm in diameter, and brown, red, pink, tan, or bluish red. A plaque is an elevated, flat-topped, firm, rough, superficial papule greater than 1 cm in diameter. It may be coalesced papules. A nodule is elevated, 1 to 2 cm in diameter, firm, circumscribed, palpable, and deeper in the dermis than a papule. A vesicle is elevated, circumscribed, superficial, less than 1 cm in diameter, and filled with serous fluid.

A nurse is admitting a toddler to the hospital. The toddler is with both parents and is currently sitting comfortably on a parent's lap. The parents state they will need to leave for a brief period. Which type of nursing diagnosis should the nurse formulate for this child? a. Risk for anxiety b. Anxiety c. Readiness for enhanced coping d. Ineffective coping

ANS: A A potential problem is categorized as a risk. The toddler has a risk to become anxious when the parents leave. Nursing interventions will be geared toward reducing the risk. The child is not showing current anxiety or ineffective coping. The child is not at a point for readiness for enhanced coping, especially because the parents will be leaving.

1.Which is defined as a vaguely outlined area of edematous tissue situated over the portion of the scalp that presents in a vertex delivery? a.Caput succedaneum b.Hydrocephalus c.Cephalhematoma d.Subdural hematoma

ANS: A A vaguely outlined area of edematous tissue situated over the portion of the scalp that presents in a vertex delivery is the definition of a caput succedaneum. The swelling consists of serum and/or blood accumulated in the tissues above the bone, and it may extend beyond the bone margin. Hydrocephalus is caused by an imbalance in production and absorption of cerebrospinal fluid. When production exceeds absorption, fluid accumulates within the ventricular system, causing dilation of the ventricles. A cephalhematoma has sharply demarcated boundaries that do not extend beyond the limits of the (bone) suture line. A subdural hematoma is located between the dura and the cerebrum. It would not be visible on the scalp.

Preschoolers' fears can best be dealt with by which intervention? a. Actively involving them in finding practical methods to deal with the frightening experience b. Forcing them to confront the frightening object or experience in the presence of their parents c. Using logical persuasion to explain away their fears and help them recognize how unrealistic the fears are d. Ridiculing their fears so that they understand that there is no need to be afraid

ANS: A Actively involving them in finding practical methods to deal with the frightening experience is the best way to deal with fears. Forcing a child to confront fears may make the child more afraid. Preconceptual thought prevents logical understanding. Ridiculing fears does not make them go away.

The nurse is implementing care for a school-age child admitted to the pediatric intensive care in diabetic ketoacidosis (DKA). Which prescribed intervention should the nurse implement first? a. Begin 0.9% saline solution intravenously as prescribed. b. Administer regular insulin intravenously as prescribed. c. Place child on a cardiac monitor. d. Place child on a pulse oximetry monitor.

ANS: A All patients with DKA experience dehydration (10% of total body weight in severe ketoacidosis) because of the osmotic diuresis, accompanied by depletion of electrolytes, sodium, potassium, chloride, phosphate, and magnesium. The initial hydrating solution is 0.9% saline solution. Insulin therapy should be started after the initial rehydration bolus because serum glucose levels fall rapidly after volume expansion. The child should be placed on the cardiac and pulse oximetry monitor after the rehydrating solution has been initiated.

Which is most suggestive that a nurse has a nontherapeutic relationship with a patient and family? a. Staff is concerned about the nurse's actions with the patient and family. b. Staff assignments allow the nurse to care for same patient and family over an extended time. c. Nurse is able to withdraw emotionally when emotional overload occurs but still remains committed. d. Nurse uses teaching skills to instruct patient and family rather than doing everything for them.

ANS: A An important clue to a nontherapeutic staff-patient relationship is concern of other staff members. Allowing the nurse to care for the same patient over time would be therapeutic for the patient and family. Nurses who are able to somewhat withdraw emotionally can protect themselves while providing therapeutic care. Nurses using teaching skills to instruct patient and family will assist in transitioning the child and family to self-care.

Steven, 16 months old, falls down a few stairs. He gets up and "scolds" the stairs as if they caused him to fall. This is an example of which of the following? a. Animism b. Ritualism c. Irreversibility d. Delayed cognitive development

ANS: A Animism is the attribution of lifelike qualities to inanimate objects. By scolding the stairs, the toddler is attributing human characteristics to them. Ritualism is the need to maintain the sameness and reliability. It provides a sense of comfort to the toddler. Irreversibility is the inability to reverse or undo actions initiated physically. Steven is acting in an age-appropriate manner.

18. Which is an appropriate play activity for a 7-month-old infant to encourage visual stimulation? a. Playing peek-a-boo b. Playing pat-a-cake c. Imitating animal sounds d. Showing how to clap hands

ANS: A Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation. Pat-a-cake and showing how to clap hands will help with kinetic stimulation. Imitating animal sounds will help with auditory stimulation.

The management of a child who has just been stung by a bee or wasp should include the application of: a. cool compresses. b. warm compresses. c. antibiotic cream. d. corticosteroid cream.

ANS: A Bee or wasp stings are initially treated by carefully removing stinger, cleansing with soap and water, applying cool compresses, and using common household agents such as lemon juice or a paste made with aspirin and baking soda. Warm compresses are avoided. Antibiotic cream is unnecessary unless a secondary infection occurs. Corticosteroid cream is not part of the initial therapy. If a severe reaction occurs, systemic corticosteroids may be indicated.

30. The parents of a 4-month-old infant tell the nurse that they are getting a microwave oven and will be able to heat the baby's formula faster. What should the nurse recommend? a. Never heat a bottle in a microwave oven. b. Heat only 10 ounces or more. c. Always leave bottle top uncovered to allow heat to escape. d. Shake bottle vigorously for at least 30 seconds after heating.

ANS: A Bottles cannot be heated safely in microwave ovens even if safe guidelines are followed and regardless of the amount to be heated due to uneven heating and possible burns.

37. Which figure depicts an expected developmental milestone for a 7-month-old infant?

ANS: A By 6 to 7 months of age, infants are able to bear all their weight on their legs with assistance. Infants can stand holding on to furniture at 9 months. While standing, the infant takes a deliberate step at 10 months. Crawling (propelling forward with the belly on the floor) progresses to creeping on hands and knees (with the belly off of the floor) by 9 months.

14. The nurse is interviewing the father of a 10-month-old infant. She is playing on the floor when she notices an electric outlet and reaches up to touch it. Her father says "no" firmly and removes her from near the outlet. The nurse should use this opportunity to teach the father that the infant: a. is old enough to understand the word "no." b. is too young to understand the word "no." c. should already know that electric outlets are dangerous. d. will learn safety issues better if she is spanked.

ANS: A By age 10 months, children are able to associate meaning with words. The father is using both verbal and physical cues to alert the child to dangerous situations. The child should be old enough to understand the word "no." The 10-month-old is too young to understand the purpose of an electric outlet. The father is using both verbal and physical cues to teach safety measures. Physical discipline should be avoided.

7. In terms of fine motor development, what should the infant of 7 months be able to do? a. Transfer objects from one hand to the other and bang cubes on a table. b. Use thumb and index finger in crude pincer grasp and release an object at will. c. Hold a crayon between the fingers and make a mark on paper. d. Release cubes into a cup and build a tower of two blocks.

ANS: A By age 7 months, infants can transfer objects from one hand to the other, crossing the midline, and bang objects on a hard surface. The crude pincer grasp is apparent at about age 9 months, and releasing an object at will is seen around 8 months. The child can scribble spontaneously at age 15 months. At age 12 months, the child can release cubes into a cup and build a small tower.

Which is an effective strategy to reduce the stress of burn dressing procedures? a. Give child as many choices as possible. b. Reassure child that dressing changes are not painful. c. Explain to child why analgesics cannot be used. d. Encourage child to master stress with controlled passivity.

ANS: A Children who understand the procedure and have some perceived control demonstrate less maladaptive behavior. They respond well to participating in decisions and should be given as many choices as possible. The dressing change procedure is painful and stressful. Misinformation should not be given to the child. Analgesia and sedation can and should be used. Encouraging the child to master stress with controlled passivity is not a positive coping strategy.

A parent of an infant with colic tells the nurse, "All this baby does is scream at me, it is a constant worry." The nurse's best action is: a. encourage parent to verbalize feelings. b. encourage parent not to worry so much. c. assess parent for other signs of inadequate parenting. d. reassure parent that colic rarely lasts past age 9 months.

ANS: A Colic is multifactorial, and no single treatment is effective for all infants. The parent is verbalizing concern and worry. The nurse should allow the parent to put these feelings into words. An empathic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parent's anxieties. The nurse should reassure the parent that he or she is not doing anything wrong. Colic is multifactorial. The infant with colic is experiencing spasmodic pain that is manifested by loud crying, in some cases up to 3 hours each day. Telling the parent that it will eventually go away does not help him or her through the current situation.

18. The nurse is caring for a 3-week-old preterm newborn born at 29 weeks of gestation. While taking vital signs and changing the newborn's diaper, the nurse observes the newborn's color is pink but slightly mottled, arms and legs are limp and extended, hiccups are present, and heart rate is regular and rapid. The nurse should recognize these behaviors as manifestations of: a.stress. b.subtle seizures. c.preterm behavior. d.onset of respiratory distress.

ANS: A Color pink but slightly mottled, arms and legs limp and extended, hiccups, respiratory pauses and gasping, and an irregular, rapid heart rate are signs of stress or fatigue in a newborn. Neonatal seizures usually have some type of repetitive movement from twitching to rhythmic jerking movements. The behavior of a preterm newborn may be inactive and listless. Respiratory distress is exhibited by retractions and nasal flaring.

Which is the leading cause of death in infants younger than 1 year? a. Congenital anomalies b. Sudden infant death syndrome c. Respiratory distress syndrome d. Bacterial sepsis of the newborn

ANS: A Congenital anomalies account for 20.1% of deaths in infants younger than 1 year. Sudden infant death syndrome accounts for 8.2% of deaths in this age group. Respiratory distress syndrome accounts for 3.4% of deaths in this age group. Infections specific to the perinatal period account for 2.7% of deaths in this age group.

Which accurately describes the speech of the preschool child? a. Dysfluency in speech patterns is normal. b. Sentence structure and grammatic usage are limited. c. By age 5 years, child can be expected to have a vocabulary of about 1000 words. d. Rate of vocabulary acquisition keeps pace with the degree of comprehension of speech.

ANS: A Dysfluency includes stuttering and stammering, a normal characteristic of language development. Children speak in sentences of three or four words at age 3 to 4 years and eight words by age 5 years. At 5 years, children have a vocabulary of 2100 words. Children often gain vocabulary beyond degree of comprehension

The most fatal type of burn in the toddler age group is: a. flame burn from playing with matches. b. scald burn from high-temperature tap water. c. hot object burn from cigarettes or irons. d. electric burn from electric outlets.

ANS: A Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age group. High-temperature tap water, hot objects, and electrical outlets are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use.

41. The nurse is planning care for a newborn receiving IV calcium gluconate for treatment of hypocalcemia. Which intervention is the most appropriate during the acute phase? a. Allow newborn to sleep with pacifier to decrease stimuli. b. Keep newborn awake to monitor central nervous system changes. c. Encourage parents to hold and feed newborn to facilitate attachment during illness. d. Awaken newborn periodically to assess level of consciousness.

ANS: A For newborns with hypocalcemia, the nurse should manipulate the environment to reduce stimuli that might precipitate a seizure or tremors. A quiet, nonstimulating environment should be maintained for the newborn until calcium levels are normalized. Care should be provided without sudden jarring. Parents can be involved in observations and care when the child is awake.

23. The nurse is guiding parents in selecting a daycare facility for their infant. Which is especially important to consider when making the selection? a. Health practices of facility b. Structured learning environment c. Socioeconomic status of children d. Cultural similarities of children

ANS: A Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when hand washing and other hygienic measures are not adhered to. A structured learning environment is not suitable for this age child. The socioeconomic status of children should have little effect on the choice of facility. Cultural similarities of children may be important to the families, but the health care practices of the facility are more important.

35. Hemolytic disease is suspected in a mother's second newborn. Which factor is important in understanding how this could develop? a. The mother's first child was Rh positive. b. The mother is Rh positive. c. Both parents have type O blood. d. RhIG (RhoGAM) was given to the mother during her first pregnancy.

ANS: A Hemolytic disease of the newborn results from an abnormally rapid rate of red blood cell (RBC) destruction. The major causes of this are Rh and maternal-fetal ABO incompatibility. If an Rh-negative mother has previously been exposed to Rh-positive blood through pregnancy or blood transfusion, antibodies to this blood group antigen may develop so that she is isoimmunized. With further exposure to Rh, the maternal antibodies will agglutinate with the red cells of the fetus who has the antigen and destroy the cells. Hemolytic disease is also caused by ABO incompatibilities. Blood type is the important consideration. If both parents are type O blood, ABO incompatibility would not be a possibility. The mother should have received Rho(D) immune globulin to prevent antibody development after the first pregnancy.

6. A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. The nurse should interpret this as: a. normal development. b. significant developmental lag. c. slightly delayed development due to prematurity. d. suggestive of a neurologic disorder such as cerebral palsy.

ANS: A Holding a rattle but not voluntarily grasping it is indicative of normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. The infant is expected to be able to perform this task by age 3 months. If the child's age is corrected because of being 2 weeks preterm, the child is at the midpoint of the range for this developmental task and the behavior is age appropriate. No evidence of neurologic dysfunction is present.

The nurse is caring for a 5-year-old child with impetigo contagiosa. The parents ask the nurse what will happen to their child's skin after the infection has subsided and healed. Which answer should the nurse give? a. There will be no scarring. b. There may be some pigmented spots. c. It is likely there will be some slightly depressed scars. d. There will be some atrophic white scars.

ANS: A Impetigo contagiosa tends to heal without scarring unless a secondary infection occurs.

15. A 4-month-old was born at 35 weeks of gestation. She seems to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was term. The nurse should explain that: a. infants' temperaments are part of their unique characteristics. b. infants become less difficult if they are not kept on scheduled feedings and structured routines. c. the infant's behavior is suggestive of failure to bond completely with her parents. d. the infant's difficult temperament is the result of painful experiences in the neonatal period.

ANS: A Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant's unique temperament. Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. The infant's temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to the infant's temperament.

A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered? a. At bedtime b. After meals c. Before meals d. On arising in the morning

ANS: A Injections are best given at bedtime to more closely approximate the physiologic release of GH. After or before meals and on arising in the morning do not mimic the physiologic release of the hormone.

Which is the leading cause of death during the toddler period? a. Injuries b. Infectious diseases c. Congenital disorders d. Childhood diseases

ANS: A Injuries are the single most common cause of death in children ages 1 through 4 years. This represents the highest rate of death from injuries of any childhood age group except adolescence. Infectious diseases and childhood diseases are less common causes of deaths in this age group. Congenital disorders are the second leading cause of death in this age group.

When is isotretinoin (Accutane) indicated for the treatment of acne during adolescence? a. The acne has not responded to other treatments. b. The adolescent is or may become pregnant. c. The adolescent is unable to give up foods causing acne. d. Frequent washing with antibacterial soap has been unsuccessful.

ANS: A Isotretinoin is reserved for severe cystic acne that has not responded to other treatments. Isotretinoin has teratogenic effects and should never be used when there is a possibility of pregnancy. No correlation exists between foods and acne. Antibacterial soaps are ineffective. Frequent washing with antibacterial soap is not a recommended therapy for acne.

Which is usually the only symptom of pediculosis capitis (head lice)? a. Itching b. Vesicles c. Scalp rash d. Localized inflammatory response

ANS: A Itching is generally the only manifestation of pediculosis capitis (head lice). Diagnosis is made by observation of the white eggs (nits) on the hair shaft. Vesicles, scalp rash, and localized inflammatory response are not symptoms of head lice.

The nurse is conducting a staff in-service on appearance of childhood skin conditions. Lymphangitis ("streaking") is frequently seen in which condition? a. Cellulitis b. Folliculitis c. Impetigo contagiosa d. Staphylococcal scalded skin

ANS: A Lymphangitis is frequently seen in cellulitis. If it is present, hospitalization is usually required for parenteral antibiotics. Lymphangitis is not associated with folliculitis, impetigo, or staphylococcal scalded skin.

A nurse is preparing to administer an oral iron supplement to a hospitalized infant. Which should not be given simultaneously with the iron supplement? a. Milk b. Multivitamin c. Fruit juice d. Meat, fish, poultry

ANS: A Many foods interfere with iron absorption and should be avoided when the iron is consumed. These foods include phosphates found in milk, phytates found in cereals, and oxalates found in many vegetables. Multivitamins may contain iron, no contraindication exists to taking the two together. Vitamin C-containing juices enhance the absorption of iron. Meat, fish, and poultry do not have an effect on absorption.

A nurse is preparing to accompany a medical mission's team to a third world country. Marasmus is seen frequently in children 6 months to 2 years in this country. Which symptoms should the nurse expect for this condition? a. Loose, wrinkled skin b. Edematous skin c. Depigmentation of the skin d. Dermatoses

ANS: A Marasmus is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears to be very old, with loose and wrinkled skin, unlike the child with kwashiorkor, who appears more rounded from the edema. Fat metabolism is less impaired than in kwashiorkor, thus, deficiency of fat-soluble vitamins is usually minimal or absent. In general, the clinical manifestations of marasmus are similar to those seen in kwashiorkor with the following exceptions: With marasmus, there is no edema from hypoalbuminemia or sodium retention, which contributes to a severely emaciated appearance, no dermatoses caused by vitamin deficiencies, little or no depigmentation of hair or skin, moderately normal fat metabolism and lipid absorption, and a smaller head size and slower recovery after treatment.

Parents tell the nurse that their toddler daughter eats little at mealtime, only sits at the table with the family briefly, and wants snacks "all the time." Which intervention should the nurse recommend? a. Give her nutritious snacks. b. Offer rewards for eating at mealtimes. c. Avoid snacks so she is hungry at mealtimes. d. Explain to her in a firm manner what is expected of her.

ANS: A Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirement associated with the slower growth rate. Parents should help the child develop healthy eating habits. The toddler is often unable to sit through a meal. Frequent nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should be not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat nonnutritious foods in response.

A nurse is planning a class on accident prevention for parents of toddlers. Which safety topic is the priority for this class? a. Appropriate use of car seat restraints b. Safety crossing the street c. Helmet use when riding a bicycle d. Poison control numbers

ANS: A Motor vehicle accidents (MVAs) continue to be the most common cause of death in children older than 1 year, therefore the priority topic is appropriate use of car seat restraints. Safety crossing the street and bicycle helmet use are topics that should be included for preschool parents but are not priorities for parents of toddlers. Information about poison control is important for parents of toddlers and would be a safety topic to include but is not the priority over appropriate use of car seat restraints.

Which is probably the single most important influence on growth at all stages of development? a. Nutrition b. Heredity c. Culture d. Environment

ANS: A Nutrition is the single most important influence on growth. Dietary factors regulate growth at all stages of development, and their effects are exerted in numerous and complex ways. Adequate nutrition is closely related to good health throughout life. Heredity, culture, and environment contribute to the child's growth and development. However, good nutrition is essential throughout the life span for optimal health.

The nurse is observing parents playing with their 10-month-old child. Which should the nurse recognize as evidence that the child is developing object permanence? a. Looks for the toy that parents hide under the blanket b. Returns the blocks to the same spot on the table c. Recognizes that a ball of clay is the same when flattened out d. Bangs two cubes held in her hands

ANS: A Object permanence is the realization that items that leave the visual field still exist. When the infant searches for the toy under the blanket, it is an indication that object permanence has developed. Returning the blocks to the same spot on the table is not an example of object permanence. Recognizing that a ball of clay is the same when flattened out is an example of conservation, which occurs during the concrete operations stage from 7 to 11 years. Banging two cubes together is a simple repetitive activity characteristic of developing a sense of cause and effect.

Clinical manifestations of failure to thrive caused by behavioral problems resulting in inadequate intake of calories include: a. avoidance of eye contact. b. an associated malabsorption defect. c. weight that falls below the 15th percentile. d. normal achievement of developmental landmarks.

ANS: A One of the clinical manifestations of nonorganic failure to thrive is the child's avoidance of eye contact with the health professional. A malabsorption defect would result in a physiologic problem, not behavioral. Weight (but not height) below the 5th percentile is indicative of failure to thrive. Developmental delays, including social, motor, adaptive, and language, exist.

46. A premature newborn requires oxygen and mechanical ventilation. Which complications should the nurse assess for? a. Bronchopulmonary dysplasia, pneumothorax b. Anemia, necrotizing enterocolitis c. Cerebral palsy, persistent patent ductus d. Congestive heart failure, cerebral edema

ANS: A Oxygen therapy, although lifesaving, is not without hazards. The positive pressure created by mechanical ventilation creates an increase in the number of ruptured alveoli and subsequent pneumothorax and bronchopulmonary dysplasia. Anemia, necrotizing enterocolitis, cerebral palsy, persistent patent ductus, congestive heart failure, and cerebral edema are complications not primarily due to oxygen therapy and mechanical ventilation.

20. A preterm newborn, after spending 8 weeks in the NICU, is being discharged. The parents of the newborn express apprehension and worry that the newborn may still be in danger. The nurse should recognize that this is: a.normal. b.a reason to postpone discharge. c.suggestive of maladaptation. d.suggestive of inadequate bonding.

ANS: A Parents become apprehensive and excited as the time for discharge approaches. They have many concerns and insecurities regarding the care of their newborn. A major concern is that they may be unable to recognize signs of illness or distress in their newborn. Preparation for discharge should begin early and include helping the parent acquire the skills necessary for care. Apprehension and worry are normal adaptive responses. The NICU nurses should facilitate discharge by involving parents in care as soon as possible.

A child with extensive burns requires débridement. The nurse should anticipate which priority goal related to this procedure? a. Reduce pain. b. Prevent bleeding. c. Maintain airway. d. Restore fluid balance.

ANS: A Partial-thickness burns require débridement of devitalized tissue to promote healing. The procedure is painful and requires analgesia and sedation before the procedure. Preventing bleeding, maintaining the airway, and restoring fluid balance are not goals associated with débridement.

44. The nurse is caring for a preterm newborn who requires mechanical ventilation for the treatment of respiratory distress syndrome. The nurse should recognize that, because of the mechanical ventilation, there is an increased risk of: a. alveolar rupture. b. meconium aspiration. c. transient tachypnea. d. retractions and nasal flaring.

ANS: A Positive pressure introduced by mechanical apparatus has created an increase in the incidence of ruptured alveoli and subsequent pneumothorax and bronchopulmonary dysplasia. Meconium aspiration is not associated with mechanical ventilation. Tachypnea may be an indication of a pneumothorax, but it would not be transient. Retractions and nasal flaring are indications of the use of accessory muscles when the newborn cannot obtain sufficient oxygen. The use of mechanical ventilation bypasses the newborn's need to use these muscles.

To prevent plagiocephaly, the nurse should teach parents to: a. place infant prone for 30 to 60 minutes per day. b. buy a soft mattress. c. allow infant to nap in the car safety seat. d. have infant sleep with the parents.

ANS: A Prevention of positional plagiocephaly may begin shortly after birth by implementing prone positioning or "tummy time" for approximately 30 to 60 minutes per day when the infant is awake. Soft mattresses or sleeping with parents (co-sleeping) are not recommended because they put the infant at a higher risk for a sudden infant death incident. To prevent plagiocephaly, prolonged placement in car safety seats should be avoided.

A child experiences frostbite of the fingers after prolonged exposure to the cold. Which intervention should the nurse implement first? a. Rapid rewarming of the fingers by placing in warm water b. Placing the hand in cool water c. Slow rewarming by wrapping in warm cloth d. Using an ice pack to keep cold until medical intervention is possible

ANS: A Rapid rewarming is accomplished by immersing the part in well-agitated water at 37.8° to 42.2° C (100° to 108° F). The frostbitten area should be rewarmed as soon as possible to avoid further tissue damage. Rapid rewarming results in less tissue necrosis than slow thawing.

37. To prevent Rh isoimmunization, RhIG (RhoGAM) is administered to all: a. Rh-negative women who deliver an Rh-positive newborn. b. Rh-positive women who deliver an Rh-negative newborn. c. Rh-negative newborns whose mothers are Rh positive. d. Rh-positive fathers before conception of second newborn when first newborn was Rh positive.

ANS: A Rh IG human gamma globulin concentrate of anti-D is administered to all unsensitized Rh-negative women after delivery or abortion of an Rh-positive newborn or fetus. Administering RhIG to an individual who is Rh positive will result in agglutination of red cells and hemolysis. It will not alter the person's genetic makeup. The anti-D antibody contained in RhIG will have no effect on Rh-negative newborns because the D antibody is not present.

Which refers to those times in an individual's life when he or she is more susceptible to positive or negative influences? a. Sensitive period b. Sequential period c. Terminal points d. Differentiation points

ANS: A Sensitive periods are limited times during the process of growth when the organism will interact with a particular environment in a specific manner. These times make the organism more susceptible to positive or negative influences. The sequential period, terminal points, and differentiation points are developmental times that do not make the organism more susceptible to environmental interaction.

45. The nurse is caring for a newborn with respiratory distress syndrome. The newborn has an endotracheal tube. Which statement describes nursing considerations related to suctioning? a. Suctioning should not be carried out routinely. b. Newborn should be in Trendelenburg position for suctioning. c. Routine suctioning, usually every 15 minutes, is necessary. d. Frequent suctioning is necessary to maintain patency of bronchi.

ANS: A Suctioning is not an innocuous procedure and can cause bronchospasm, bradycardia, hypoxia, and increased ICP. It should never be carried out routinely. The Trendelenburg position should be avoided. This position can contribute to increased ICP and reduced lung capacity from gravity pushing organs against diaphragm. Routine suctioning is avoided because of the potential complications of bronchospasm, bradycardia, hypoxia, and increased ICP.

Parents are concerned that their child is showing aggressive behaviors. Which suggestion should the nurse make to the parents? a. Supervise television viewing. b. Ignore the behavior. c. Punish the child for the behavior. d. Accept the behavior if the child is male.

ANS: A Television is also a significant source for modeling at this impressionable age. Research indicates there is a direct correlation between media exposure, both violent and educational media, and preschoolers exhibiting physical and relational aggression (Ostrov, Gentile, and Crick, 2006). Therefore, parents should be encouraged to supervise television viewing. The behavior should not be ignored because it can escalate to hyperaggression. The child should not be punished because it may reinforce the behavior if the child is seeking attention. For example, children who are ignored by a parent until they hit a sibling or the parent learn that this act garners attention. The behavior should not be accepted from a male child, this is using a "double standard" and aggression should not be equated with masculinity.

16. Which information could be given to the parents of a 12-month-old child regarding appropriate play activities? a. Give large push-pull toys for kinetic stimulation. b. Place cradle gym across crib to facilitate fine motor skills. c. Provide child with finger-paints to enhance fine motor skills. d. Provide stick horse to develop gross motor coordination.

ANS: A The 12-month-old child is able to pull to standing and walk holding on or independently. Appropriate toys for a child this age include large pull toys for kinesthetic stimulation. A cradle gym should not be placed across the crib. Finger-paints are appropriate for older children. A 12-month-old child does not have the stability to use a stick horse.

The parents of a 2-year-old tell the nurse that they are concerned because the toddler has started to use "baby talk" since the arrival of their new baby. The nurse should recommend which intervention? a. Ignore the "baby talk." b. Explain to the toddler that "baby talk" is for babies. c. Tell the toddler frequently, "You are a big kid now." d. Encourage the toddler to practice more advanced patterns of speech.

ANS: A The baby talk is a sign of regression in the toddler. It should be ignored, while praising the child for developmentally appropriate behaviors. Regression is children's way of expressing stress. The parents should not introduce new expectations and allow the child to master the developmental tasks without criticism.

4. A nurse is assessing a 6-month-old infant. The nurse recognizes the posterior fontanel usually closes at which age? a. 6 to 8 weeks b. 10 to 12 weeks c. 4 to 6 months d. 8 to 10 months

ANS: A The bones surrounding the posterior fontanel fuse and close by age 6 to 8 weeks, 10 to 12 weeks, 4 to 6 months, and 8 to 10 months are too late. The posterior fontanel is usually closed by age 8 weeks.

Which technique is best for dealing with the negativism of the toddler? a. Offer the child choices. b. Remain serious and intent. c. Provide few or no choices for child. d. Quietly and calmly ask the child to comply.

ANS: A The child should have few opportunities to respond in a negative manner. Questions and requests should provide choices. This allows the child to be in control and reduces opportunities for negativism. The child will continue trying to assert control. The toddler is too young for verbal explanations. The negativism is the child testing limits. These should be clearly defined by structured choices.

A nurse is assessing a child with kwashiorkor disease. Which assessment findings should the nurse expect? a. Thin wasted extremities with a prominent abdomen b. Constipation c. Elevated hemoglobin d. High levels of protein

ANS: A The child with kwashiorkor has thin, wasted extremities and a prominent abdomen from edema (ascites). Diarrhea (persistent diarrhea malnutrition syndrome) not constipation commonly occurs from a lowered resistance to infection and further complicates the electrolyte imbalance. Anemia and protein deficiency is a common finding in malnourished children with kwashiorkor.

53. The nurse is caring for a newborn whose mother is diabetic. Which clinical manifestations should the nurse expect to see? a. Hypoglycemic, large for gestational age b. Hyperglycemic, large for gestational age c. Hypoglycemic, small for gestational age d. Hyperglycemic, small for gestational age

ANS: A The clinical manifestations of a newborn born to a mother with diabetes include being large for gestational age, being plump and full-faced, having abundant vernix caseosa, being listless and lethargic, and having hypoglycemia. These manifestations appear a short time after birth. The newborn is hypoglycemic from increased fetal production of insulin and large for gestational age.

19. Which would be the best play activity for a 6-month-old infant to provide tactile stimulation? a. Allow to splash in bath. b. Give various colored blocks. c. Play music box, tapes, or CDs. d. Use infant swing or stroller.

ANS: A The feel of the water while the infant is splashing will provide tactile stimulation. Various colored blocks would provide visual stimulation for a 4- to 6-month-old infant. Music box, tapes, and CDs provide auditory stimulation. Swings and strollers provide kinesthetic stimulation.

14. Which is the most appropriate nursing action when intermittently gavage-feeding a preterm newborn? a.Allow formula to flow by gravity. b.Insert tube through nares rather than mouth. c.Avoid letting newborn suck on tube. d.Apply steady pressure to syringe to deliver formula to stomach in a timely manner.

ANS: A The formula is allowed to flow by gravity. The length of time to complete the feeding will vary. Preferably, the tube is inserted through the mouth. Newborns are obligatory nose breathers, and the presence of the tube in the nose irritates the nasal mucosa. Passage of the tube through the mouth allows the nurse to observe and evaluate the sucking response. The feeding should not be done under pressure. This procedure is not used as a timesaver for the nurse.

The most immediate threat to life in children with thermal injuries is: a. shock. b. anemia. c. local infection. d. systemic sepsis.

ANS: A The immediate threat to life in children with thermal injuries is airway compromise and profound shock. Anemia is not of immediate concern. During the healing phase, local infection or sepsis are the primary complications. Respiratory problems, primarily airway compromise, are the primary complications during the acute stage of burn injury.

Which is an important nursing consideration when caring for an infant with failure to thrive? a. Establish a structured routine and follow it consistently. b. Maintain a nondistracting environment by not speaking to child during feeding. c. Place child in an infant seat during feedings to prevent overstimulation. d. Limit sensory stimulation and play activities to alleviate fatigue.

ANS: A The infant with failure to thrive should have a structured routine that is followed consistently. Disruptions in other activities of daily living can have a great impact on feeding behaviors. Bathing, sleeping, dressing, playing, and feeding are structured. The nurse should talk to the child by giving directions about eating. This will help the child maintain focus. Young children should be held while being fed, and older children can sit at a feeding table. The child should be fed in the same manner at each meal. The child can engage in sensory and play activities at times other than mealtime.

25. The nurse notices that a 10-month-old infant being seen in the clinic is wearing expensive, inflexible, high-top shoes. The nurse should explain that: a. soft and flexible shoes are generally better. b. high-top shoes are necessary for support. c. inflexible shoes are necessary to prevent in-toeing and out-toeing. d. this type of shoe will encourage the infant to walk sooner.

ANS: A The main purpose of the shoe is protection. Soft, well-constructed, athletic-type shoes are best for infants and children. High-top shoes are not necessary for support but may help to keep the child's foot in the shoe. Inflexible shoes can delay walking and can aggravate in-toeing and out-toeing and impede development of the supportive foot muscles.

The parent of a 16-month-old toddler asks, "What is the best way to keep our son from getting into our medicines at home?" The nurse's best advice is: a. "All medicines should be locked securely away." b. "The medicines should be placed in high cabinets." c. "The child just needs to be taught not to touch medicines." d. "Medicines should not be kept in the homes of small children."

ANS: A The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe. Toddlers can climb by using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize as dangerous all the different forms of medications that may be available in the home. It is not feasible to not keep medicines in the homes of small children. Many parents require medications for chronic illnesses. Parents must be taught safe storage for their home and when they visit other homes.

48. Which is the most common cause of anemia in preterm newborns? a. Frequent blood sampling b. Respiratory distress syndrome c. Meconium aspiration syndrome d. Persistent pulmonary hypertension

ANS: A The most common cause of anemia in preterm newborns is frequent blood-sample withdrawal and inadequate erythropoiesis in acutely ill newborns. Microsamples should be used for blood tests, and the amount of blood drawn should be monitored. Respiratory distress syndrome, meconium aspiration syndrome, and persistent pulmonary hypertension are not causes of anemia. They may require frequent blood sampling, which will contribute to the problem of decreased erythropoiesis and anemia.

A nurse places some x-ray contrast the toddler is to drink in a small cup instead of a large cup. Which concept of a toddler's preoperational thinking is the nurse using? a. Inability to conserve b. Magical thinking c. Centration d. Irreversibility

ANS: A The nurse is using the toddler's inability to conserve. This is when the toddler is unable to understand the idea that a mass can be changed in size, shape, volume, or length without losing or adding to the original mass. Instead, toddlers judge what they see by the immediate perceptual clues given to them. A small glass means less amount of contrast. Magical thinking is believing that thoughts are all-powerful and can cause events. Centration is focusing on one aspect rather than considering all possible alternatives. Irreversibility is the inability to undo or reverse the actions initiated, such as being unable to stop doing an action when told.

An infant gains head control before sitting unassisted. The nurse recognizes that this is which type of development? a. Cephalocaudal b. Proximodistal c. Mass to specific d. Sequential

ANS: A The pattern of development that is head-to-tail, or cephalocaudal, direction is described by an infant's ability to gain head control before sitting unassisted. The head end of the organism develops first and is large and complex, whereas the lower end is smaller and simpler, and development takes place at a later time. Proximodistal, or near to far, is another pattern of development. Limb buds develop before fingers and toes. Postnatally, the child has control of the shoulder before achieving mastery of the hands. Mass to specific is not a specific pattern of development. In all dimensions of growth, a definite, sequential pattern is followed.

42. Which is the central factor responsible for respiratory distress syndrome? a. Deficient surfactant production b. Overproduction of surfactant c. Overdeveloped alveoli d. Absence of alveoli

ANS: A The successful adaptation to extrauterine breathing requires numerous factors, which most term newborns successfully accomplish. Preterm newborns with respiratory distress are not able to adjust. The most likely central cause is the abnormal development of the surfactant system. The deficient production of surfactant results in unequal inflation of alveoli on inspiration and the collapse of the alveoli on end expiration. The number and state of development of the alveoli is not a central factor in respiratory distress syndrome. The instability of the alveoli related to the lack of surfactant is the causative issue.

Hydrotherapy is required to treat a child with extensive partial-thickness burn wounds. Which is the primary purpose of hydrotherapy? a. Débride the wounds. b. Increase peripheral blood flow. c. Provide pain relief. d. Destroy bacteria on the skin.

ANS: A The water acts to loosen and remove sloughing tissue, exudate, and topical medications. Increasing peripheral blood flow, providing pain relief, and destroying bacteria on the skin may be secondary benefits to hydrotherapy, but the primary purpose is for débridement.

3. The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. The nurse should interpret this as a(n): a. normal finding. b. finding requiring a referral. c. abnormal finding. d. normal finding, but requires rechecking in 1 month.

ANS: A This is a normal finding. The anterior fontanel closes between ages 12 and 18 months. No further intervention is required.

63. Which is an important nursing consideration in the care of the newborn with PKU? a. Suggest ways to make formula more palatable. b. Teach proper administration of phenylalanine hydroxylase. c. Encourage the breastfeeding mother to adhere to low-phenylalanine diet. d. Give reassurance that dietary restrictions are a temporary inconvenience.

ANS: A To achieve optimal metabolic control, a restricted phenylalanine diet will probably be required for virtually all individuals with classic PKU throughout life. The nurse and nutritionist should work with families to make the formula more palatable for the newborn. Phenylalanine hydroxylase is not effective because it cannot act within the cell where phenylalanine is metabolized. Partial breastfeeding may be possible, but only with extremely careful monitoring of the newborn's blood levels. According to the latest research, lifelong dietary restriction may be necessary.

A parent of an 18-month-old boy tells the nurse that he says "no" to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurse's best interpretation of this behavior is included in which statement? a. This is normal behavior for his age. b. This is unusual behavior for his age. c. He is not effectively coping with stress. d. He is showing he needs more attention.

ANS: A Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and the use of the word "no." Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old. Having a rapid mood swing is an expected behavior for a toddler.

Cow's milk allergy (CMA) is diagnosed in a 6-month-old infant. Which should the nurse recommend as a substitute formula? a. Nutramigen b. Goat's milk c. Similac d. Enfamil

ANS: A Treatment of CMA is elimination of cow's milk-based formula and all other dairy products. For infants fed cow's milk formula, this primarily involves changing the formula to a casein hydrolysate milk formula (Pregestimil, Nutramigen, or Alimentum). Goat's milk (raw) is not an acceptable substitute because it cross-reacts with cow's milk protein, is deficient in folic acid, has a high sodium and protein content, and is unsuitable as the only source of calories

The nurse is caring for a school-age child with a tinea capitis (ringworm) infection. The nurse should expect that therapeutic management for this child includes: a. administering oral griseofulvin. b. administering topical or oral antibiotics. c. applying topical sulfonamides. d. applying Burow solution compresses to affected area.

ANS: A Treatment with the antifungal agent griseofulvin is part of the treatment for the fungal disease ringworm. Oral griseofulvin therapy frequently continues for weeks or months. Antibiotics, sulfonamides, and Burow solution are not effective in fungal infections.

Which is a useful skill that the nurse should expect a 5-year-old child to be able to master? a. Tie shoelaces. b. Use knife to cut meat. c. Hammer a nail. d. Make change out of a quarter.

ANS: A Tying shoelaces is a fine motor task of 5-year-olds. Using a knife to cut meat is a fine motor task of a 7-year-old. Hammering a nail and making change out of a quarter are fine motor and cognitive tasks of an 8- to 9-year-old

29. The newborn with severe jaundice is at risk for developing: a. encephalopathy. b. bullous impetigo. c. respiratory distress. d. blood incompatibility.

ANS: A Unconjugated bilirubin, which can cross the blood-brain barrier, is highly toxic to neurons. A newborn with severe jaundice is at risk for developing kernicterus or bilirubin encephalopathy. Encephalopathy is a highly infectious bacterial infection of the skin. It has no relation to severe jaundice and is the most likely complication of severe jaundice. A blood incompatibility may be the causative factor for the severe jaundice.

Recent studies indicate that a deficiency of which vitamin correlates with increased morbidity and mortality in children with measles? a. A b. C c. Niacin d. Folic acid

ANS: A Vitamin A deficiency is correlated with increased morbidity and mortality in children with measles. This vitamin deficiency also is associated with complications from diarrhea, and infections are often increased in infants and children with vitamin A deficiency. No correlation exists between vitamins C, niacin, or folic acid and measles.

32. A blood sample for measurement of bilirubin is required from a newborn receiving phototherapy. In what environment should this blood sample be drawn? a. While phototherapy lights are turned off b. While newborn remains under phototherapy lights c. When newborn is covered with a blanket d. When newborn has been off phototherapy for 30 to 60 minutes

ANS: A When blood is drawn, phototherapy lights are turned off, and the blood is transported in a covered tube to avoid a false reading as a result of bilirubin destruction in the test tube. The lights will cause a degradation of the bilirubin in the sample, resulting in a falsely lowered result. The newborn does not need to be covered with a blanket. The phototherapy lights must be off. There is no reason to delay obtaining the blood sample. It can be drawn as soon as the lights are turned off.

2. In terms of gross motor development, which should the nurse expect a 5-month-old infant to do? (Select all that apply.) a. Roll from abdomen to back. b. Put feet in mouth when supine. c. Roll from back to abdomen. d. Sit erect without support. e. Move from prone to sitting position. f. Adjust posture to reach an object.

ANS: A, B Rolling from abdomen and to back and placing the feet in the mouth when supine are developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen usually occurs at 6 months old. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position. The 8-month-old infant adjusts posture to reach an object.

Which toys should a nurse provide to promote imaginative play for a 3-year-old hospitalized child? (Select all that apply.) a. Plastic telephone b. Hand puppets c. Jigsaw puzzle (100 pieces) d. Farm animals and equipment e. Jump rope

ANS: A, B, D To promote imaginative play for a 3-year-old child, the nurse should provide: dress-up clothes, dolls, housekeeping toys, dollhouses, play-store toys, telephones, farm animals and equipment, village sets, trains, trucks, cars, planes, hand puppets, or medical kits. A 100-piece jigsaw puzzle and a jump rope would be appropriate for a young, school-age child but not a 3-year-old child.

MULTIPLE RESPONSE 1. The nurse is teaching parents about appropriate pacifier selection. Which characteristics should the pacifier have? (Select all that apply.) a. Easily grasped handle b. One-piece construction c. Ribbon or string to secure to clothing d. Soft, pliable material e. Sturdy, flexible material

ANS: A, B, E A good pacifier should be easily grasped by the infant. One-piece construction is necessary to avoid having the nipple and guard separate. The material should be sturdy and flexible. If the pacifier is too pliable, it may be aspirated. No ribbon or string should be attached. This poses additional risks.

What factors indicate parents should seek genetic counseling for their child? (Select all that apply.) a. Abnormal newborn screen b. Family history of a hereditary disease c. History of hypertension in the family d. Severe colic as an infant e. Metabolic disorder

ANS: A, B, E Factors that are indicative parents should seek genetic counseling for their child include an abnormal newborn screen, family history of a hereditary disease, and a metabolic disorder. A history of hypertension or severe colic as an infant is not an indicator of a genetic disease.

7. A nurse is assessing a premature newborn. Which assessment findings are consistent with prematurity? (Select all that apply.) a. Abundant lanugo over the body b. Ear cartilage soft and pliable c. Flexed body posture d. Deep creases on the sole of the foot e. Skin is bright pink, smooth, and shiny.

ANS: A, B, E The premature newborn has fine lanugo hair that is abundant over the body. The ear cartilage is soft and pliable, and the soles and palms have minimal creases, resulting in a smooth appearance. The premature newborn's skin is bright pink (often translucent, depending on the degree of immaturity), smooth, and shiny, with small blood vessels clearly visible underneath the thin epidermis. In contrast to full-term infants' overall attitude of flexion and continuous activity, preterm infants may be inactive and listless. The extremities maintain an attitude of extension and remain in any position in which they are placed.

Which should the nurse include when teaching parents about preventing childhood burn injuries? (Select all that apply.) a. Keep hot liquids out of reach. b. Baby-proof electrical outlets. c. Turn water heater thermostats to a maximum of 150° F. d. Heat infant formula in the microwave. e. Test water temperature before placing your child in the tub bath.

ANS: A, B, E To prevent burns hot liquids should be kept out of reach, tablecloths and dangling appliance cords are often pulled by toddlers, who spill hot grease and liquids on themselves. Electrical cords and outlets represent a potential risk to small children, who may chew on accessible cords and insert objects into outlets. The Consumer Product Safety Commission recommends a reduction of water heater thermostats to a maximum of 48.9° C (120° F). The increased use of microwave ovens has resulted in burn injuries from the extremely hot internal temperatures generated in heated items. Baby formula, jelly-filled pastries, and hot liquids and dishes may result in cutaneous scalds or the ingestion of overheated liquids. Water should always be tested before a child is placed in the tub or shower.

6. A nurse is admitting a premature newborn to the NICU. Which interventions should the nurse implement to prevent retinopathy? (Select all that apply.) a. Place on pulse oximetry. b. Decrease exposure to bright, direct lighting. c. Place on a cardiac monitor. d. Cover eyes with an eye shield at night. e. Use supplemental oxygen only when needed.

ANS: A, B, E To prevent retinopathy, the nurse should provide preventive care by closely monitoring blood oxygen levels, responding promptly to saturation alarms, and preventing fluctuations in blood oxygen levels. Pulse oximetry is recommended to monitor the infant's oxygenation status during resuscitation and to prevent excessive use of oxygen in both term and preterm infants. Decrease exposure to bright, direct lighting, although exposure to bright light has not been proven to contribute to retinopathy of prematurity, such exposure is undesirable from a neurobehavioral developmental perspective. Use supplemental oxygen judiciously and monitor oxygen blood levels carefully, prevent wide fluctuations in oxygen blood levels (hyperoxia and hypoxia). Placing the newborn on a cardiac monitor will not prevent retinopathy. Covering the eyes with eye shields is not a preventive measure for retinopathy.

Play serves many purposes. In teaching parents about appropriate activities, the nurse should inform them that play serves which of the following function? (Select all that apply.) a. Intellectual development b. Physical development c. Socialization d. Creativity e. Temperament development

ANS: A, C, D A common statement is that play is the work of childhood. Intellectual development is enhanced through the manipulation and exploration of objects. Socialization is encouraged by interpersonal activities and learning of social roles. In addition, creativity is developed through the experimentation characteristic of imaginative play. Physical development depends on many factors, play is not one of them. Temperament refers to behavioral tendencies that are observable from the time of birth. The actual behaviors, but not the child's temperament attributes, may be modified through play.

Which gross motor milestones should the nurse assess in an 18-month-old child? (Select all that apply.) a. Jumps in place with both feet b. Takes a few steps on tiptoe c. Throws ball overhand without falling d. Pulls and pushes toys e. Stands on one foot momentarily

ANS: A, C, D An 18-month-old child can jump in place with both feet, throw a ball overhand without falling, and pull and push toys. Taking a few steps on tiptoe and standing on one foot momentarily is not acquired until 30 months of age.

MULTIPLE RESPONSE 1. The nurse needs to obtain blood for ongoing assessment of a high-risk newborn's progress. Which tests should the nurse monitor? (Select all that apply.) a. Blood glucose b. Complete blood count (CBC) c. Calcium d. Serum electrolytes e. Neonatal prothrombin time (PTT)

ANS: A, C, D The most common blood tests done on high-risk newborns are blood glucose, bilirubin, calcium, hematocrit, serum electrolytes, and blood gases. Hematocrits rather than CBCs are performed. This will monitor the red cell volume. Neonatal prothrombin time (PTT) is not a test.

5. A nurse is preparing to administer immunizations to a 6-month-old infant. Which interventions should the nurse implement to minimize local reaction and reduce pain? (Select all that apply.) a. Select a needle of adequate length (1 inch). b. Inject into the deltoid muscle. c. Apply a vapocoolant spray directly to the skin, 15 seconds before administration. d. Apply a topical anesthetic LMX4 (4% lidocaine) 10 minutes before administration.

ANS: A, C, D To minimize local reaction and reduce pain when administering an immunization, select a needle of adequate length (25 mm [1 inch] in infants) to deposit the antigen deep in the muscle mass. Apply a vapocoolant spray (e.g., ethyl chloride or Fluori-Methane) directly to the skin or to a cotton ball, which is placed on the skin for 15 seconds immediately before the injection. Inject into the vastus lateralis or ventrogluteal muscle, the deltoid may be used in children 18 months of age and older. Apply the topical anesthetic LMX4 (4% lidocaine) to the injection site 30 minutes before the injection. Ten minutes does not allow the anesthetic to be effective.

Which interventions should the nurse implement when caring for a family of a sudden infant death syndrome (SIDS) infant? (Select all that apply.) a. Allow parents to say goodbye to their infant. b. Once parents leave the hospital, no further follow-up is required. c. Arrange for someone to take the parents home from the hospital. d. Avoid requesting an autopsy of the deceased infant. e. Conduct a debriefing session with the parents before they leave the hospital.

ANS: A, C, E An important aspect of compassionate care for parents experiencing a SIDS incident is allowing them to say good-bye to their infant. These are the parents' last moments with their infant, and they should be as quiet, meaningful, peaceful, and undisturbed as possible. Because the parents leave the hospital without their infant, it is helpful to accompany them to the car or arrange for someone else to take them home. A debriefing session may help health care workers who dealt with the family and deceased infant to cope with emotions that are often engendered when a SIDS victim is brought into the acute care facility. An autopsy may clear up possible misconceptions regarding the death. When the parents return home, a competent, qualified professional should visit them after the death as soon as possible.

3. A nurse is teaching a parent about administration of iron supplements to a 7-month-old infant. Which should the nurse include in the teaching session? (Select all that apply.) a. Administer the iron supplement with a dropper toward the side and to the back of the mouth b. Administer the iron supplement with feedings. c. Your infant's stools may look tarry green. d. Your infant may have some diarrhea initially. e. Follow the iron supplement with 4 ounces of juice.

ANS: A, C, E Liquid iron supplements may stain the teeth, therefore, administer them with a dropper toward the back of the mouth (side). Ideally, iron supplements should be administered between meals for greater absorption. Avoid administration of liquid iron supplements with whole cow's milk or milk products because they bind free iron and prevent absorption. Educate parents that iron supplements will turn stools black or tarry green. Iron supplements may cause transient constipation, not diarrhea. In older children, follow liquid iron supplement with a citrus fruit or juice drink (no more than 3 to 4 oz).

Where do the lesions of atopic dermatitis (eczema) most commonly occur in the infant? (Select all that apply.) a. Cheeks b. Buttocks c. Extensor surfaces of arms and legs d. Back e. Trunk f. Scalp

ANS: A, C, E, F The lesions of atopic dermatitis are generalized in the infant. They are most commonly on the cheeks, scalp, trunk, and extensor surfaces of the extremities. The buttocks and back are not common locations for the lesions of atopic dermatitis in infants.

A nurse is planning interventions for a toddler with juvenile hypothyroidism. Which interventions should the nurse plan to implement for this child? (Select all that apply.) a. Moisturizer for dry skin b. Antidiarrheal medications c. Medications to help with insomnia d. Implementation of thyroxine therapy

ANS: A, D The presenting symptoms of juvenile hypothyroidism are myxedematous skin changes (dry skin, puffiness around the eyes, sparse hair), constipation, lethargy, and mental decline. The nurse should plan interventions for the dry skin and for the implementation of thyroxine therapy. The child is prone to constipation and sleepiness so antidiarrheal medication and medications to help with insomnia would not be appropriate.

The nurse should expect to assess which clinical manifestations in an adolescent with Cushing syndrome? (Select all that apply.) a. Hyperglycemia b. Hyperkalemia c. Hypotension d. Cushingoid features e. Susceptibility to infections

ANS: A, D, E In Cushing syndrome, physiologic disturbances seen are Cushingoid features hyperglycemia, susceptibility to infection, hypertension, and hypokalemia.

4. A nurse is planning care for a premature newborn. Which interventions should the nurse implement for skin care? (Select all that apply.) a. Use cleaning agents with neutral pH. b. Rub skin during drying. c. Use adhesive remover solvent when removing tape. d. Avoid removing adhesives for at least 24 hours. e. Consider pectin barriers beneath adhesives.

ANS: A, D, E The skin care for a premature newborn should include use of pH-neutral cleanser or soaps no more than two or three times a week. Adhesives should not be removed for at least 24 hours after application. Pectin barriers should be used beneath adhesives to protect skin. Avoid rubbing skin during bathing or drying. Do not use adhesive remover, solvents, or bonding agents. Adhesive removal can be facilitated using water, mineral oil, or petrolatum.

A nurse is preparing to administer a Denver II. Which is a correct statement about the Denver II? (Select all that apply.) a. All items intersected by the age line should be administered. b. There is no correction for a child born prematurely. c. The tool is an intelligence test. d. Toddlers and preschoolers should be prepared by presenting the test as a game. e. Presentation of the toys from the kit should be done one at a time.

ANS: A, D, E To identify "cautions," all items intersected by the age line are administered. Toddlers and preschoolers should be tested by presenting the Denver II as a game. Because children are easily distracted, perform each item quickly and present only one toy from the kit at a time. Before beginning the screening, ask whether the child was born preterm and correctly calculate the adjusted age. Up to 24 months of age, allowances are made for preterm infants by subtracting the number of weeks of missed gestation from their present age and testing them at the adjusted age. Explain to the parents and child, if appropriate, that the screenings are not intelligence tests but rather are a method of showing what the child can do at a particular age.

The community health nurse is teaching parents about prevention of the spread and reoccurrence of pediculosis (head lice). Which should the nurse include in the teaching session? (Select all that apply.) a. Dryclean nonwashable items. b. Spray the environment with an insecticide. c. Seal nonwashable items in a plastic bag for 5 days. d. Boil combs and brushes for 10 minutes. e. Discourage sharing of personal items.

ANS: A, D, E To prevent the spread and reoccurrence of pediculosis the nurse should teach the parents to: dryclean nonwashable items, boil combs and brushes for 10 minutes or soak for 1 hour in a pediculicide, and discourage the sharing of personal items, such as combs, hats, scarves and other headgear. Spraying with insecticide is not recommended because of the danger to children and animals. Nonwashable items should be sealed for 14 days in a plastic bag.

Nursing care of a child diagnosed with a syndrome of inappropriate ADH should include which of the following? (Select all that apply.) a. Weigh daily b. Encourage fluids c. Turn frequently d. Maintain nothing by mouth (NPO) e. Restrict fluids

ANS: A, E Increased secretion of ADH causes the kidney to reabsorb water, which increases fluid volume and decreases serum osmolarity with a progressive reduction in sodium concentration. The immediate management of the child is to restrict fluids. The child should also be weighed at the same time each day. Encouraging fluids will worsen the child's condition. Turning frequently is not an appropriate intervention unless the child is unresponsive. Fluids, not food, should be restricted.

The nurse is caring for a hospitalized 4-year-old boy. His parents tell the nurse that they will be back to visit at 6 PM. When the child asks the nurse when his parents are coming, the nurse's best response is a. "They will be here soon." b. "They will come after dinner." c. "Let me show you on the clock when 6 PM is." d. "I will tell you every time I see you how much longer it will be."

ANS: B A 4-year-old child understands time in relation to events such as meals. Children perceive "soon" as a very short time. The nurse may lose the child's trust if his parents do not return in the time he perceives as "soon." Children cannot read or use a clock for practical purposes until age 7 years. I will tell you every time I see you how much longer it will be assumes the child understands the concepts of hours and minutes, which are not developed until age 5 or 6 years.

2.Which finding on a newborn assessment should the nurse recognize as suggestive of a clavicle fracture? a.Negative scarf sign b.Asymmetric Moro reflex c.Swelling of fingers on affected side d.Paralysis of affected extremity and muscles

ANS: B A newborn with a broken clavicle may have no symptoms. The Moro reflex, which results in sudden extension and abduction of the extremities followed by flexion and adduction of the extremities, will most likely be asymmetric. The scarf sign that is used to determine gestational age should not be performed if a broken clavicle is suspected. Swelling of fingers on affected side and paralysis of affected extremity and muscles are not indicative of a fractured clavicle.

The parent of a 4-year-old boy tells the nurse that the child believes that monsters and boogeymen are in his bedroom at night. The nurse's best suggestion for coping with this problem is to: a. let the child sleep with his parents. b. keep a night-light on in the child's bedroom. c. help the child understand that these fears are illogical. d. tell the child frequently that monsters and boogeymen do not exist.

ANS: B A night-light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with parents will not get rid of the fears. A 4-year-old child is in the preconceptual age and cannot understand logical thought.

9. Which term refers to a newborn born before completion of week 37 of gestation, regardless of birth weight? a.Postterm b.Premature c.Low birth weight d.Small for gestational age

ANS: B A premature newborn is any child born before 37 weeks of gestation, regardless of birth weight. A postterm or postmature newborn is any child born after 42 weeks of gestational age, regardless of birth weight. A low-birth-weight newborn is a child whose birth weight is less than 2500 g, regardless of gestational age. A small-for-gestational-age (or small-for-date) newborn is any child whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on intrauterine growth curves.

Chronic adrenocortical insufficiency is also referred to as: a. Graves disease. b. Addison disease. c. Cushing syndrome. d. Hashimoto disease.

ANS: B Addison disease is chronic adrenocortical insufficiency. Graves and Hashimoto diseases involve the thyroid gland. Cushing syndrome is a result of excessive circulation of free cortisol.

20. At what age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: B At age 2 months, the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. The 3-month-old can recognize familiar faces. At age 4 months, the infant can enjoy social interactions.

Which is descriptive of a toddler's cognitive development at age 20 months? a. Searches for an object only if he or she sees it being hidden b. Realizes that "out of sight" is not out of reach c. Puts objects into a container but cannot take them out d. Understands the passage of time, such as "just a minute" and "in an hour"

ANS: B At this age, the child is in the final sensorimotor stage. Children will now search for an object in several potential places, even though they saw only the original hiding place. Children have a more developed sense of objective permanence. They will search for objects even if they have not seen them hidden. When a child puts objects into a container but cannot take them out, this is indicative of tertiary circular reactions. An embryonic sense of time exists, although the children may behave appropriately to time-oriented phrases, their sense of timing is exaggerated.

A mother reports that her 6-year-old child is highly active, irritable, and irregular in habits and that the child adapts slowly to new routines, people, or situations. The nurse should chart this type of temperament as: a. easy. b. difficult. c. slow-to-warm. d. fast-to-warm.

ANS: B Being highly active, irritable, irregular in habits, and adapting slowly to new routines, people, or situations is a description of difficult children, which compose about 10% of the population. Negative withdrawal responses are typical of this type of child, who requires a more structured environment. Mood expressions are usually intense and primarily negative. These children exhibit frequent periods of crying and often violent tantrums. Easy children are even tempered, regular, and predictable in their habits. They are open and adaptable to change. Approximately 40% of children fit this description. Slow-to-warm-up children typically react negatively and with mild intensity to new stimuli and adapt slowly with repeated contact. Approximately 10% of children fit this description. "Fast-to-warm-up" is not one of the categories identified.

A nurse makes the decision to apply a topical anesthetic to a child's skin before drawing blood. Which ethical principle is the nurse demonstrating? a. Autonomy b. Beneficence c. Justice d. Truthfulness

ANS: B Beneficence is the obligation to promote the patient's well-being. Applying a topical anesthetic before drawing blood promotes reducing the discomfort of the venipuncture. Autonomy is the patient's right to be self-governing. Justice is the concept of fairness. Truthfulness is the concept of honesty.

2. The nurse is assessing a 6-month-old healthy infant who weighed 7 pounds at birth. The nurse should expect the infant to now weigh approximately how many pounds? a. 10 b. 15 c. 20 d. 25

ANS: B Birth weight doubles at about age 5 to 6 months. At 6 months, a child who weighed 7 pounds at birth would weigh approximately 15 pounds, 10 pounds is too little. The infant would have gone from the 50th percentile at birth to below the 5th percentile, 20 to 25 pounds is too much. The infant would have tripled the birth weight at 6 months.

The nurse is examining 12-month-old Amy, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions that cross the inguinal folds. This is most likely caused by: a. impetigo. b. Candida albicans. c. urine and feces. d. infrequent diapering.

ANS: B C. albicans infection produces perianal inflammation and a maculopapular rash with satellite lesions that may cross the inguinal folds. Impetigo is a bacterial infection that spreads peripherally in sharply marginated, irregular outlines. Eruptions involving the skin in contact with the diaper, but sparing the folds, are likely to be caused by chemical irritation, especially urine and feces.

Which is most descriptive of clinical reasoning? a. A simple developmental process b. Purposeful and goal-directed c. Based on deliberate and irrational thought d. Assists individuals in guessing what is most appropriate

ANS: B Clinical reasoning is a complex, developmental process based on rational and deliberate thought. Clinical reasoning is not a developmental process. Clinical reasoning is based on rational and deliberate thought. Clinical reasoning is not a guessing process.

A school nurse notes that school-age children generally obey the rules at school. The nurse recognizes that the children are displaying which stage of moral development? a. Preconventional b. Conventional c. Post-conventional d. Undifferentiated

ANS: B Conventional stage of moral development is described as obeying the rules, doing one's duty, showing respect for authority, and maintaining the social order. This stage is characteristic of school-age children's behavior. The preconventional stage is characteristic of the toddler and preschool age. At this stage, the child has no concept of the basic moral order that supports being good or bad. The post-conventional level is characteristic of an adolescent and occurs at the formal stage of operation. Undifferentiated describes an infant's understanding of moral development.

A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of: a. vitamin D. b. cortisone. c. stool softeners. d. calcium carbonate.

ANS: B Cortisone is administered to suppress the abnormally high secretions of adrenocorticotropic hormone (ACTH). This in turn inhibits the secretion of adrenocorticosteroid, which stems the progressive virilization. Vitamin D, stool softeners, and calcium carbonate have no role in the therapy of adrenogenital hyperplasia.

Which should the nurse expect for a toddler's language development at age 18 months? a. Vocabulary of 25 words b. Increasing level of comprehension c. Use of holophrases d. Approximately one third of speech understandable

ANS: B During the second year of life, level of comprehension and understanding of speech increases and is far greater than the child's vocabulary. This is also true for bilingual children, who are able to achieve this linguistic milestone in both languages. The 18-month-old child has a vocabulary of 10 or more words. At this age, the child does not use the one-word sentences that are characteristic of the 1-year-old child. The child has a limited vocabulary of single words that are comprehensible.

4.A mother is upset because her newborn has erythema toxicum neonatorum. The nurse should reassure her that this is: a.easily treated. b.benign and transient. c.usually not contagious. d.usually not disfiguring.

ANS: B Erythema toxicum neonatorum, or newborn rash, is a benign, self-limiting eruption of unknown cause that usually appears within the first 2 days of life. The rash usually lasts about 5 to 7 days. No treatment is indicated. Erythema toxicum neonatorum is not contagious. Successive crops of lesions heal without pigmentation

A child is admitted with extensive burns. The nurse notes that there are burns on the child's lips and singed nasal hairs. The nurse should suspect that the child has a(n): a. chemical burn. b. inhalation injury. c. electrical burn. d. hot-water scald.

ANS: B Evidence of an inhalation injury is burns of the face and lips, singed nasal hairs, and laryngeal edema. Clinical manifestation may be delayed for up to 24 hours. Chemical burns, electrical burns, and those associated with hot-water scalds would not cause singed nasal hair.

An adolescent is being seen in the clinic for evaluation of acromegaly. The nurse understands that which occurs with acromegaly? a. There is a lack of growth hormone (GH) being produced. b. There is excess growth hormone (GH) after closure of the epiphyseal plates. c. There is an excess of growth hormone (GH) before the closure of the epiphyseal plates. d. There is a lack of thyroid hormone being produced.

ANS: B Excess GH after closure of the epiphyseal plates results in acromegaly. A lack of growth hormone results in delayed growth or even dwarfism. Gigantism occurs when there is hypersecretion of GH before the closure of the epiphyseal plates. Cretinism is associated with hypothyroidism.

Exophthalmos (protruding eyeballs) may occur in children with: a. hypothyroidism. b. hyperthyroidism. c. hypoparathyroidism. d. hyperparathyroidism.

ANS: B Exophthalmos is a clinical manifestation of hyperthyroidism. Hypothyroidism, hypoparathyroidism, and hyperparathyroidism are not associated with exophthalmos.

The most effective way to clean a toddler's teeth is for the: a. child to brush regularly with a toothpaste of his or her choice. b. parent to stabilize the chin with one hand and brush with the other. c. parent to brush the mandibular occlusive surfaces, leaving the rest for the child. d. parent to brush the front labial surfaces, leaving the rest for the child.

ANS: B For young children, the most effective cleaning of teeth is by the parents. Different positions can be used if the child's back is to the adult. The adult should use one hand to stabilize the chin and the other to brush the child's teeth. The child can participate in brushing, but for a thorough cleaning, adult intervention is necessary.

Which is an important consideration for the nurse when changing dressings and applying topical medication to a child's abdomen and leg burns? a. Apply topical medication with clean hands. b. Wash hands and forearms before and after dressing change. c. If dressings adhere to the wound, soak in hot water before removal. d. Apply dressing so that movement is limited during the healing process.

ANS: B Frequent hand and forearm washing is the single most important element of the infection-control program. Topical medications should be applied with a tongue blade or gloved hand. Dressings that have adhered to the wound can be removed with tepid water or normal saline. Dressings are applied with sufficient tension to remain in place but not so tightly as to impair circulation or limit motion.

39. Which is the primary treatment for hypoglycemia in newborns with feeding intolerance? a. Oral glucose feedings b. Intravenous (IV) infusion of glucose c. Short-term insulin therapy d. Feedings (formula or breast milk) at least every 2 hours

ANS: B IV infusions of glucose are indicated when the glucose level is very low and when feedings are not tolerated. Early feedings in the normoglycemic newborn are preventive. When the newborn is unable to tolerate feedings or the blood glucose level has become extremely low, then IV infusions are indicated. Insulin administration will further depress the blood glucose level. Feedings can be preventive. The child may not be able to tolerate this frequency.

A nurse, instructing parents of a hospitalized preschool child, explains that which is descriptive of the preschooler's understanding of time? a. Has no understanding of time b. Associates time with events c. Can tell time on a clock d. Uses terms like "yesterday" appropriately

ANS: B In a preschooler's understanding, time has a relation with events such as "We'll go outside after lunch." Preschoolers develop an abstract sense of time at age 3 years. Children can tell time on a clock at age 7 years. Children do not fully understand use of time-oriented words until age 6 years.

36. When should the nurse expect jaundice to be present in a newborn with hemolytic disease? a. At birth b. During first 24 hours after birth c. 24 to 48 hours after birth d. 48 to 72 hours after birth

ANS: B In hemolytic disease of the newborn, jaundice is usually evident within the first 24 hours of life. Newborns with hemolytic disease are usually not jaundiced at birth, although some degree of hepatosplenomegaly, pallor, and hypovolemic shock may occur when the most severe form, hydrops fetalis, is present, 24 to 72 hours is too late for hemolytic disease of the newborn. Jaundice at these ages is most likely due to physiologic or early-onset breastfeeding jaundice.

A toddler sustains a minor burn on the hand from hot coffee. Which is the first action the nurse should recommend in treating this burn? a. Apply ice to burned area. b. Hold burned area under cool running water. c. Break any blisters with a sterile needle. d. Cleanse wound with soap and warm water.

ANS: B In minor burns, the best method to stop the burning process is to hold the burned area under cool running water. Ice is not recommended. Removal of blisters is not generally accepted therapy unless the injury is from a chemical substance. Cooling is necessary to stop the burning process.

A 12-year-old child enjoys collecting stamps, playing soccer, and participating in Boy Scout activities. The nurse recognizes that the child is displaying which developmental task? a. Identity b. Industry c. Integrity d. Intimacy

ANS: B Industry is engaging in tasks that can be carried through to completion, learning to compete and cooperate with others, and learning rules. Industry is the developmental task characteristic of the school-age child. Identity is the developmental task of adolescence. Integrity and intimacy are not developmental tasks of childhood.

Kimberly's parents have been using a rearward-facing, convertible car seat since she was born. Most car seats can be safely switched to the forward-facing position when the child reaches which age? a. 1 b. 2 c. 3 d. 4

ANS: B It is now recommended that all infants and toddlers ride in rear-facing car safety seats until they reach the age of 2 years or height recommended by the car seat manufacturer. Children 2 years old and older who have outgrown the rear-facing height or weight limit for their car safety seat should use a forward-facing car safety seat with a harness up to the maximum height or weight recommended by the manufacturer. One year is too young to switch to a forward-facing position.

17. The nurse is discussing development and play activities with the parent of a 2-month-old. Recommendations should include giving a first rattle at about which age? a. 2 months b. 4 months c. 7 months d. 9 months

ANS: B It is recommended that a brightly colored toy or rattle be given to the child at age 4 months. Grasping has begun as a deliberate act, and the infant grasps, holds, and begins shaking to hear a noise, 2 months is too young. The infant still has primarily reflex grips, 7 to 9 months is too old for the first rattle. The child should be given toys that provide for further exploration.

The nurse should implement which prescribed treatment for a child with warts? a. Vaccination b. Local destruction c. Corticosteroids d. Specific antibiotic therapy

ANS: B Local destructive therapy individualized according to location, type, and number—including surgical removal, electrocautery, curettage, cryotherapy, caustic solutions, x-ray treatment, and laser therapies—is used. Vaccination is prophylaxis for warts and is not a treatment. Corticosteroids and specific antibiotic therapy are not effective in the treatment of warts.

Which describes marasmus? a. Deficiency of protein with an adequate supply of calories b. Not confined to geographic areas where food supplies are inadequate c. Syndrome that results solely from vitamin deficiencies d. Characterized by thin, wasted extremities and a prominent abdomen resulting from edema (ascites)

ANS: B Marasmus is a syndrome of emotional and physical deprivation. It is not confined to geographic areas were food supplies are inadequate. Marasmus is a deficiency of both protein and calories. It is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears very old, with flabby and wrinkled skin.

54. The nurse is caring for a newborn who was born 24 hours ago to a mother who received no prenatal care. The newborn is a poor feeder but sucks avidly on his hands. Clinical manifestations also include loose stools, tachycardia, fever, projectile vomiting, sneezing, and generalized sweating. Which should the nurse suspect? a. Seizure disorder b. Narcotic withdrawal c. Placental insufficiency d. Meconium aspiration syndrome

ANS: B Newborns exposed to drugs in utero usually show no untoward effects until 12 to 24 hours for heroin or much longer for methadone. The newborn usually has nonspecific signs that may coexist with other conditions such as hypocalcemia and hypoglycemia. In addition, these newborns may have loose stools, tachycardia, fever, projectile vomiting, sneezing, and generalized sweating, which is uncommon in newborns. Loose stools, tachycardia, fever, projectile vomiting, sneezing, and generalized sweating are manifestations not descriptive of seizure activity. Placental insufficiency usually results in a child who is small for gestational age. Meconium aspiration syndrome usually has manifestations of respiratory distress.

51. Newborns are highly susceptible to infection as a result of: a. excessive levels of immunoglobulin A (IgA) and immunoglobulin M (IgM). b. diminished nonspecific and specific immunity. c. increased humoral immunity. d. overwhelming anti-inflammatory response.

ANS: B Newborns have diminished inflammatory (nonspecific) and humoral (specific) immunity. They are unable to mount a local inflammatory reaction at the portal of entry to signal infection, and the resulting symptoms are vague and nonspecific, delaying diagnosis and treatment. Newborns have diminished or absent IgA and IgM. Humoral and anti-inflammatory immune responses are diminished in newborns.

29. Which information should the nurse give a mother regarding the introduction of solid foods during infancy? a. Solid foods should not be introduced until 8 to 10 months, when the extrusion reflex begins to disappear. b. Foods should be introduced one at a time, at intervals of 4 to 7 days. c. Solid foods can be mixed in a bottle to make the transition easier for the infant. d. Fruits and vegetables should be introduced into the diet first.

ANS: B One food item is introduced at intervals of 4 to 7 days to allow the identification of food allergies. Solid foods can be introduced earlier. The extrusion reflex usually disappears by age 6 months. Mixing solid foods in a bottle has no effect on the transition to solid food. Iron-fortified cereal should be the first solid food introduced into the infant's diet.

60. Phenylketonuria (PKU) is a genetic disease that results in the body's inability to correctly metabolize: a. glucose. b. phenylalanine. c. phenylketones. d. thyroxine.

ANS: B PKU is an inborn error of metabolism caused by a deficiency or absence of the enzyme needed to metabolize the essential amino acid phenylalanine. Phenylalanine hydroxylase is missing in PKU. Individuals with this disorder can metabolize glucose. Phenylketones are metabolites of phenylalanine, excreted in the urine. Thyroxine is one of the principal hormones secreted by the thyroid gland.

The nurse should teach parents of a preschool child with type 1 diabetes that which can raise the blood glucose level? a. Exercise b. Steroids c. Decreased food intake d. Lantus insulin

ANS: B Parents should understand how to adjust food, activity, and insulin at the time of illness or when the child is treated for an illness with a medication known to raise the blood glucose level (e.g., steroids). Exercise, insulin, and decreased food intake can cause hypoglycemia.

28. What is the best age for solid food to be introduced into the infant's diet? a. 2 to 3 months b. 4 to 6 months c. When birth weight has tripled d. When tooth eruption has started

ANS: B Physiologically and developmentally, the 4- to 6-month-old infant is in a transition period. The extrusion reflex has disappeared, and swallowing is a more coordinated process. In addition, the gastrointestinal tract has matured sufficiently to handle more complex nutrients and is less sensitive to potentially allergenic food. Infants of this age will try to help during feeding, 2 to 3 months is too young. The extrusion reflex is strong, and the child will push food out with the tongue. No research indicates that the addition of solid food to a bottle has any benefit. Infant birth weight doubles at 1 year. Solid foods can be started earlier. Tooth eruption can facilitate biting and chewing, most infant foods do not require this ability.

Two toddlers are playing in a sandbox when one child suddenly grabs a toy from the other child. Which is the best interpretation of this behavior? a. This is typical behavior because toddlers are aggressive. b. This is typical behavior because toddlers are egocentric. c. Toddlers should know that sharing toys is expected of them. d. Toddlers should have the cognitive ability to know right from wrong.

ANS: B Play develops from the solitary play of infancy to the parallel play of toddlers. The toddler plays alongside other children, not with them. This typical behavior of the toddler is not intentionally aggressive. Shared play is not within their cognitive development. Toddlers do not conceptualize shared play. Because the toddler cannot view the situation from the perspective of the other child, it is okay to take the toy. Therefore, no right or wrong is associated with taking a toy.

Which play item should the nurse bring from the playroom to a hospitalized toddler in isolation? a. Small plastic Lego b. Set of large plastic building blocks c. Brightly colored balloon d. Coloring book and crayons

ANS: B Play objects for toddlers must still be chosen with an awareness of danger from small parts. Large, sturdy toys without sharp edges or removable parts are safest. Large plastic blocks are appropriate for a toddler in isolation. Small plastic toys such as Lego can cause choking or can be aspirated. Balloons can cause significant harm if swallowed or aspirated. Coloring book and crayons would be too advanced for a toddler.

The nurse observes some children in the playroom. Which play situation exhibits the characteristics of parallel play? a. Kimberly and Amanda sharing clay to each make things b. Brian playing with his truck next to Kristina playing with her truck c. Adam playing a board game with Kyle, Steven, and Erich d. Danielle playing with a music box on her mother's lap

ANS: B Playing with trucks next to each other but not together is an example of parallel play. Both children are engaged in similar activities in proximity to each other, however, they are each engaged in their own play. Sharing clay to make things is characteristic of associative play. Friends playing a board game together is characteristic of cooperative play. A child playing with something by herself on her mother's lap is an example of solitary play.

The nurse is preparing an in-service education to staff about atraumatic care for pediatric patients. Which intervention should the nurse include? a. Prepare the child for separation from parents during hospitalization by reviewing a video. b. Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal. c. Help the child accept the loss of control associated with hospitalization. d. Help the child accept pain that is connected with a treatment or procedure.

ANS: B Preparing the child for any unfamiliar treatments, controlling pain, allowing privacy, providing play activities for expression of fear and aggression, providing choices, and respecting cultural differences are components of atraumatic care. In the provision of atraumatic care, the separation of child from parents during hospitalization is minimized. The nurse should promote a sense of control for the child. Preventing and minimizing bodily injury and pain are major components of atraumatic care.

A 4-year-old child is hospitalized with a serious bacterial infection. The child tells the nurse that he is sick because he was "bad." Which is the nurse's best interpretation of this comment? a. Sign of stress b. Common at this age c. Suggestive of maladaptation d. Suggestive of excessive discipline at home

ANS: B Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think they are directly responsible for events, making them feel guilty for things outside their control. Children of this age show stress by regressing developmentally or acting out. Maladaptation is unlikely. Telling the nurse that he is sick because he was "bad" does not imply excessive discipline at home.

3.The parents of a newborn ask the nurse what caused the baby's facial nerve paralysis. The nurse's response is based on knowledge that this is caused by a(n): a.genetic defect. b.birth injury. c.spinal cord injury. d.inborn error of metabolism.

ANS: B Pressure on the facial nerve during delivery may result in injury to cranial nerve VII, which can occur with birth injury. A genetic defect, spinal cord injury, or inborn error of metabolism would not cause facial paralysis.

26. Which statement best describes the clinical manifestations of the preterm newborn? a. Head is proportionately small in relation to the body. b. Sucking reflex is absent, weak, or ineffectual. c. Thermostability is well established. d. Extremities remain in attitude of flexion.

ANS: B Reflex activity is only partially developed. Sucking is absent, weak, or ineffectual. The preterm newborn's head is proportionately larger than the body. Thermoregulation is poorly developed, and the preterm newborn needs a neutral thermal environment to be provided. The preterm newborn may be listless and inactive compared with the overall attitude of flexion and activity of a full-term newborn.

Which is an appropriate recommendation for preventing tooth decay in young children? a. Substitute raisins for candy. b. Substitute sugarless gum for regular gum. c. Use honey or molasses instead of refined sugar. d. When sweets are to be eaten, select a time not during meals.

ANS: B Regular gum has high sugar content. When the child chews gum, the sugar is in prolonged contact with the teeth. Sugarless gum is less cariogenic than regular gum. Raisins, honey, and molasses are highly cariogenic and should be avoided. Sweets should be consumed with meals so that the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth.

Tinea capitis (ringworm), frequently found in schoolchildren, is caused by a(n): a. virus. b. fungus. c. allergic reaction. d. bacterial infection.

ANS: B Ringworm is caused by a group of closely related filamentous fungi that invade primarily the stratum corneum, hair, and nails. They are superficial infections that live on, not in, the skin. Virus and bacterial infection are not the causative organisms for ringworm. Ringworm is not an allergic response.

Rocky Mountain spotted fever is caused by the bite of a: a. flea. b. tick. c. mosquito. d. mouse or rat.

ANS: B Rocky Mountain spotted fever is caused by a tick. The tick must attach and feed for at least 1 to 2 hours to transmit the disease. The usual habitat of the tick is in heavily wooded areas. Fleas, mosquitoes, and mice or rats do not transmit Rocky Mountain spotted fever.

The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. Which should be included in the teaching plan for daily injections? a. The parents do not need to learn the procedure. b. He is old enough to give most of his own injections. c. Self-injections will be possible when he is closer to adolescence. d. He can learn about self-injections when he is able to reach all injection sites.

ANS: B School-age children are able to give their own injections. Parents should participate in learning and giving the insulin injections. He is already old enough to administer his own insulin. The child is able to use thighs, abdomen, part of the hip, and arm. Assistance can be obtained if other sites are used.

The nurse is teaching a class on preventing diaper rash in newborns to a group of new parents. Which statement made by a parent indicates a correct understanding of the teaching? a. "I should cleanse my infant's skin with a commercial diaper wipe every time I change the diaper." b. "If my infant's buttocks become slightly red, I will expose the skin to air." c. "I should wash my infant's buttocks with soap before applying a thin layer of oil." d. "I will apply baby oil and powder to the creases in my infant's buttocks."

ANS: B Slightly irritated skin can be exposed to air, not heat, to dry completely. Overwashing or cleansing the skin every diaper change with commercial wipes should be avoided. The skin should be thoroughly dried after washing. Application of oil does not create an effective barrier. Baby powder should not be used because of the danger of aspiration.

The parents of a neonate with adrenogenital hyperplasia tell the nurse that they are afraid to have any more children. The nurse should explain which statement about adrenogenital hyperplasia? a. It is not hereditary. b. Genetic counseling is indicated. c. It can be prevented during pregnancy. d. All future children will have the disorder.

ANS: B Some forms of adrenogenital hyperplasia are hereditary and should be referred for genetic counseling. Affected offspring should also be referred for genetic counseling. There is an autosomal recessive form of adrenogenital hyperplasia. A prenatal treatment with glucocorticoids can be offered to the mother during pregnancy to avoid the sex ambiguity, but it does not affect the presence of the disease. If it is the heritable form, for each pregnancy, a 25% risk occurs that the child will be affected.

A nurse is teaching parents about language development for preschool children. Which dysfunctional speech pattern is a normal characteristic the parents might expect? a. Lisp b. Stammering c. Echolalia d. Repetition without meaning

ANS: B Stammering and stuttering are normal dysfluency patterns in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers' language

22. A parent asks the nurse "when will my infant start to teethe?" The nurse responds that the earliest age at which an infant begins teething with eruption of lower central incisors is _____ months. a. 4 b. 6 c. 8 d. 12

ANS: B Teething usually begins at age 6 months with the eruption of the lower central incisors, 4 months is too early for teething. By age 8 months, the infant has the upper and lower central incisors. At age 12 months, the infant has six to eight deciduous teeth.

15. A healthy, stable, preterm newborn will soon be discharged. The nurse should recommend which position for sleep? a.Prone b.Supine c.Side lying d.Position of comfort

ANS: B The American Academy of Pediatrics recommends that healthy newborns be placed to sleep in a supine position. Other positions are associated with sudden infant death syndrome. The prone position can be used for supervised play.

Which statement is true about the basal metabolic rate (BMR) in children? a. It is reduced by fever. b. It is slightly higher in boys than in girls at all ages. c. It increases with age of child. d. It decreases as proportion of surface area to body mass increases.

ANS: B The BMR is the rate of metabolism when the body is at rest. At all ages, the rate is slightly higher in boys than in girls. The rate is increased by fever. The BMR is highest in infancy and then closely relates to the proportion of surface area to body mass. As the child grows, the proportion decreases progressively to maturity.

33. The nurse is preparing a parent of a newborn for home phototherapy. Which statement made by the parent would indicate a need for further teaching? a. "I should change the baby's position many times during the day." b. "I can dress the baby in lightweight clothing while under phototherapy." c. "I should be sure that the baby's eyelids are closed before applying patches." d. "I can take the patches off the baby during feedings and other caregiving activities."

ANS: B The baby should be placed nude under the lights. The newborn should be repositioned frequently to expose all body surfaces to the lights. The newborn's eyelids must be closed before the patches are applied because the corneas may become excoriated if in contact with the dressing. The eye patches should be removed so the newborn can have visual and sensory stimulation.

Which factor most impacts the type of injury a child is susceptible to, according to the child's age? a. Physical health of the child b. Developmental level of the child c. Educational level of the child d. Number of responsible adults in the home

ANS: B The child's developmental stage determines the type of injury that is likely to occur. The child's physical health may facilitate the child's recovery from an injury but does not impact the type of injury. Educational level is related to developmental level, but it is not as important as the child's developmental level in determining the type of injury. The number of responsible adults in the home may affect the number of unintentional injuries, but the type of injury is related to the child's developmental stage.

A nurse is reviewing the laboratory results on a school-age child with hypoparathyroidism. Which results are consistent with this condition? a. Decreased serum phosphorus b. Decreased serum calcium c. Increased serum glucose d. Decreased serum cortisol level

ANS: B The diagnosis of hypoparathyroidism is made on the basis of clinical manifestations associated with decreased serum calcium and increased serum phosphorus. A decreased serum phosphorus would be seen in hyperparathyroidism, elevated glucose in diabetes, and a decreased serum cortisol level in adrenocortical insufficiency (Addison disease).

A nasal spray of desmopressin acetate (DDAVP) is used to treat which disorder? a. Hypopituitarism b. Diabetes insipidus c. Acute adrenocortical insufficiency d. Syndrome of inappropriate antidiuretic hormone

ANS: B The drug of choice for the treatment of diabetes insipidus is DDAVP, which is a synthetic analogue of vasopressin. DDAVP is not used to treat hypopituitarism, acute adrenocortical insufficiency, or syndrome of inappropriate antidiuretic hormone.

What should the nurse consider when discussing language development with parents of toddlers? a. Sentences by toddlers include adverbs and adjectives. b. The toddler expresses himself or herself with verbs or combination words. c. The toddler uses simple sentences. d. Pronouns are used frequently by the toddler.

ANS: B The first parts of speech used are nouns, sometimes verbs (e.g., "go"), and combination words (e.g., "bye-bye"). Responses are usually structurally incomplete during the toddler period. The preschool child begins to use adjectives and adverbs to qualify nouns followed by adverbs to qualify nouns and verbs. Pronouns are not added until the later preschool years. By the time children enter school, they are able to use simple, structurally complete sentences that average five to seven words.

Parents of an 8-year-old child ask the nurse how many inches their child should grow each year. The nurse bases the answer on the knowledge that after age 7 years, school-age children usually grow what number of inches per year? a. 1 b. 2 c. 3 d. 4

ANS: B The growth velocity after age 7 years is approximately 5 cm (2 inches) per year. One inch is too small an amount. Three and 4 inches are greater than the average yearly growth after age 7 years.

16. Which intervention should the nurse implement to maintain the skin integrity of the premature newborn? a.Cleanse skin with a gentle alkaline-based soap and water. b.Cleanse skin with a neutral pH solution only when necessary. c.Thoroughly rinse skin with plain water after bathing in a mild hexachlorophene solution. d.Avoid cleaning skin.

ANS: B The premature newborn should be given baths no more than two or three times per week with a neutral pH solution. The eyes, oral and diaper areas, and pressure points should be cleansed daily. Alkaline-based soaps might destroy the acid mantle of the skin. They should not be used. The increased permeability of the skin facilitates absorption of the chemical ingredients. The newborn's skin must be cleaned to remove stool and urine, which are irritating to the skin.

The nurse is conducting a staff in-service on childhood endocrine disorders. Diabetes insipidus is a disorder of: a. anterior pituitary. b. posterior pituitary. c. adrenal cortex. d. adrenal medulla.

ANS: B The principal disorder of posterior pituitary hypofunction is diabetes insipidus. The anterior pituitary produces hormones such as GH, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The adrenal cortex produces aldosterone, sex hormones, and glucocorticoids. The adrenal medulla produces catecholamines.

36. The clinic is lending a federally approved car seat to an infant's family. The nurse should explain that the safest place to put the car seat is: a. front facing in back seat. b. rear facing in back seat. c. front facing in front seat with airbag on passenger side. d. rear facing in front seat if an air bag is on the passenger side.

ANS: B The rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck. The middle of the back seat is the safest position for the child. The infant must be rear facing to protect the head and neck in the event of an accident. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat.

Parents tell the nurse that they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. Which is the most appropriate recommendation the nurse should make? a. Punish children so this behavior stops. b. Neither condone nor condemn the curiosity. c. Allow children unrestricted permission to satisfy this curiosity. d. Get counseling for this unusual and dangerous behavior.

ANS: B Three-year-olds become aware of anatomic differences and are concerned about how the other "works." Such exploration should not be condoned or condemned. Children should not be punished for this normal exploration. Encouraging the children to ask questions of the parents and redirecting their activity are more appropriate than giving permission. Exploration is age-appropriate and not dangerous behavior

A nurse is teaching parents about prevention and treatment of colic. Which should the nurse include in the teaching plan? a. Avoid use of pacifiers. b. Eliminate all second-hand smoke contact. c. Lay infant flat after feeding. d. Avoid swaddling the infant.

ANS: B To prevent and treat colic, teach parents that if household members smoke, avoid smoking near infant, preferably confine smoking activity to outside of home. A pacifier can be introduced for added sucking. The infant should be swaddled tightly with a soft, stretchy blanket and placed in an upright seat after feedings.

Parents are asking the clinic nurse about an appropriate toy for their toddler. Which response by the nurse is appropriate? a. "Your child would enjoy playing a board game." b. "A toy your child can push or pull would help develop muscles." c. "An action figure toy would be a good choice." d. "A 25-piece puzzle would help your child develop recognition of shapes."

ANS: B Toys should be appropriate for the child's age. A toddler would benefit from a toy he or she could push or pull. The child is too young for a board game, action figure, or 25-piece puzzle.

A visitor arrives at a daycare center during lunch time. The preschool children think that every time they have lunch a visitor will arrive. Which preoperational characteristic is being displayed? a. Egocentrism b. Transductive reasoning c. Intuitive reasoning d. Conservation

ANS: B Transductive reasoning is when two events occur together, they cause each other. The expectation that every time lunch is served a visitor will arrive is descriptive of transductive reasoning. Egocentrism is the inability to see things from any perspective than their own. Intuitive reasoning (e.g., the stars have to go to bed just as they do) is predominantly egocentric thought. Conservation (able to realize that physical factors such as volume, weight, and number remain the same even though outward appearances are changed) does not occur until school age.

Parents express concern that their pubertal daughter is taller than the boys in her class. The nurse should respond with which statement regarding how the onset of pubertal growth spurt compares in girls and boys? a. It occurs earlier in boys. b. It occurs earlier in girls. c. It is about the same in both boys and girls. d. In both boys and girls, the pubertal growth spurt depends on growth in infancy.

ANS: B Usually, the pubertal growth spurt begins earlier in girls. It typically occurs between the ages of 10 and 14 years for girls and 11 and 16 years for boys. The average earliest age at onset is 1 year earlier for girls. There does not appear to be a relation to growth during infancy.

Which statement is correct about toilet training? a. Bladder training is usually accomplished before bowel training? b. Wanting to please the parent helps motivate the child to use the toilet. c. Watching older siblings use the toilet confuses the child. d. Children must be forced to sit on the toilet when first learning

ANS: B Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please parent by holding on rather than pleasing self by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

Biologic dressings are applied to a child with partial-thickness burns of both legs. Which nursing intervention should be implemented? a. Observing wounds for bleeding b. Observing wounds for signs of infection c. Monitoring closely for signs of shock d. Splinting legs to prevent movement

ANS: B When applied early to a superficial partial-thickness injury, biologic dressings stimulate epithelial growth and hasten wound healing. If the dressing covers areas of heavy microbial contamination, infection occurs beneath the dressing. In the case of partial-thickness burns, such infection may convert the wound to a full-thickness injury. Infection is the primary concern when biologic dressings are used.

38. The nurse is caring for a newborn receiving an exchange transfusion for hemolytic disease. Assessment of the newborn reveals slight respiratory distress and tachycardia. Which should the nurse's first action be? a. Notify practitioner. b. Stop the transfusion. c. Administer calcium gluconate. d. Monitor vital signs electronically.

ANS: B When signs of cardiac or respiratory problems occur, the procedure is stopped, and the newborn's cardiorespiratory status is allowed to stabilize. The practitioner is usually performing the exchange transfusion with the nurse's assistance. The procedure must be stopped so the newborn can stabilize. Respiratory distress and tachycardia are signs of cardiorespiratory problems, not hypocalcemia. Calcium gluconate is not indicated. The vital signs should be monitored electronically throughout the entire procedure.

8. A nurse is reviewing acid-base laboratory data on a newborn admitted to the NICU for meconium aspiration. Which laboratory values should the nurse report to the physician? (Select all that apply.) a. pH: 7.35 b. PCO2 : 49 c. HCO3-: 30 d. PaO2: 96

ANS: B, C Normal values of pH for a newborn are: Birth: 7.11-7.36 1 day: 7.29-7.45 Child: 7.35-7.45. Normal values of PCO2 are: Newborn: 27-40 mm Hg Infant: 27-41 mm Hg Girls: 32-45 mm Hg Boys: 35-48 mm Hg. Normal values for HCO3- are: Infant: 21-28 mEq/ml Thereafter: 22-26 mEq/ml. The PaO2 is within normal limits for a newborn. Therefore, the nurse should report the PCO2 of 49 and the HCO3- of 30.

Which are characteristic of physical development of a 30-month-old child? (Select all that apply.) a. Birth weight has doubled. b. Primary dentition is complete. c. Sphincter control is achieved. d. Anterior fontanel is open. e. Length from birth is doubled. f. Left or right handedness is established.

ANS: B, C Usually by age 30 months, the primary dentition of 20 teeth is completed, and the child has sphincter control in preparation for bowel and bladder control. Birth weight doubles at approximately ages 5 to 6 months. The anterior fontanel closes at age 12 to 18 months. Birth length is doubled around age 4. Left or right handedness is not established until about age 5.

An infant has been diagnosed with cow's milk allergy. What are the clinical manifestations the nurse expects to assess? (Select all that apply.) a. Pink mucous membranes b. Vomiting c. Rhinitis d. Abdominal pain e. Moist skin

ANS: B, C, D An infant with cow's milk allergy will possibly have vomiting, rhinitis, and abdominal pain. The mucous membranes may be pale due to anemia from blood lost in the GI tract, and the skin will be itchy with the possibility of atopic dermatitis.

Which behaviors by the nurse indicate a therapeutic relationship with children and families? (Select all that apply.) a. Spending off-duty time with children and families b. Asking questions if families are not participating in the care c. Clarifying information for families d. Buying toys for a hospitalized child e. Learning about the family's religious preferences

ANS: B, C, E Asking questions if families are not participating in the care, clarifying information for families, and learning about the family's religious preferences are positive actions and foster therapeutic relationships with children and families. Spending off-duty time with children and families and buying toys for a hospitalized child are negative actions and indicate overinvolvement with children and families, which is nontherapeutic.

A nurse is conducting education classes for parents of infants. The nurse plans to discuss sudden infant death syndrome (SIDS). Which risk factors should the nurse include as increasing an infant's risk of a sudden infant death syndrome incident? (Select all that apply.) a. Breastfeeding b. Low Apgar scores c. Male sex d. Birth weight in the 50th or higher percentile e. Recent viral illness

ANS: B, C, E Certain groups of infants are at increased risk for SIDS: low birth weight, low Apgar scores, recent viral illness, and male sex. Breastfed infants and infants of average or above average weight are not at higher risk for SIDS.

5. A nurse is assessing a premature newborn for the possibility of necrotizing enterocolitis (NEC). Which assessment findings should the nurse expect to find if NEC is confirmed? (Select all that apply.) a. Minimal gastric residual b. Abdominal distention c. Apnea d. Urinary output at 2 ml/kg/hr e. Unstable temperature

ANS: B, C, E The nurse should observe for indications of early development of NEC by checking the appearance of the abdomen for distention (measuring abdominal girth, measuring residual gastric contents before feedings, and listening for bowel sounds) and performing all routine assessments for high-risk neonates. The premature newborn may have apnea and unstable temperature if NEC is developing. The urinary output will be decreased and will be below the expected 2 ml/kg/hr.

Which should the nurse teach to parents of toddlers about accidental poison prevention? (Select all that apply.) a. Keep toxic substances in the garage. b. Discard empty poison containers. c. Know the number of the nearest poison control center. d. Remove colorful labels from containers of toxic substances. e. Caution child against eating nonedible items, such as plants.

ANS: B, C, E To prevent accidental poisoning, parents should be taught to promptly discard empty poison containers, know the number of the nearest poison control center and to caution the child against eating nonedible items, such as plants. Parents should place all potentially toxic agents, including cosmetics, personal care items, cleaning products, pesticides, and medications in a locked cabinet, not in the garage. Parents should be taught to never remove labels from containers of toxic substances.

4. A nurse is preparing to administer routine immunizations to a 4-month-old infant. The infant is currently up to date on all previously recommended immunizations. Which immunizations will the nurse prepare to administer? (Select all that apply.) a. Measles, mumps, and rubella (MMR) b. Rotavirus (RV) c. Diphtheria, tetanus, pertussis (DTaP) d. Varicella e. Haemophilus influenzae type b (HIB) f. Inactivated poliovirus (IPV)

ANS: B, C, E, F Recommended immunization schedule for a 4-month-old, up to date on immunizations, would be to administer the rotavirus (RV), diphtheria, tetanus, pertussis (DTaP), Haemophilus influenza type b (HIB), and inactivated poliovirus (IPV) vaccinations. The measles, mumps, and rubella (MMR) and varicella would not be administered until the child is at least 1 year of age.

6. A nurse is teaching a parent about introduction of solid foods into an infant's diet. Which should the nurse include in the teaching session? (Select all that apply.) a. Solid food introduction can be started at 2 months of age. b. Rice cereal is introduced first. c. Begin the introduction of solid foods by mixing with formula in the bottle. d. Introduce egg white in small quantities (1 tsp) toward the end of the first year. e. Introduce one food at a time, usually at interval of 4 to 7 days.

ANS: B, D, E Rice cereal, because of its low allergenic potential, is the first solid food introduced to an infant at 4 to 6 months of age. Introduce one food at a time, usually at intervals of 4 to 7 days, to identify food allergies. Introduce egg white in small quantities (1 tsp) toward the end of the first year to detect an allergy. Solid food introduction should be started at 4 to 6 months of age. Never introduce foods by mixing them with the formula in a bottle.

The nurse is talking to a parent of an infant with severe atopic dermatitis (eczema). Which response(s) should the nurse reinforce with the parent? (Select all that apply.) a. "You can use warm wet compresses to relieve discomfort." b. "You will need to keep your infant's skin well hydrated by using a mild soap in the bath." c. "You should bathe your baby in a bubble bath two times a day." d. "You will need to prevent your baby from scratching the area by using a mild antihistamine." e. "You can try a fabric softener in the laundry to avoid rough cloth." f. "You should apply an emollient to the skin immediately after a bath."

ANS: B, D, F The eczematous lesions of atopic dermatitis are intensely pruritic. Scratching can lead to new lesions and secondary infection, an antihistamine can be used. Keeping the skin hydrated is a goal of treating atopic dermatitis. Applying an emollient immediately after a bath helps to trap moisture and prevent moisture loss. Cool wet compresses should be used for relief. Bubble baths and harsh soaps should be avoided, as is bathing excessively, since this leads to drying. Fabric softener should be avoided because of the irritant effects of some of its components.

In terms of language and cognitive development, a 4-year-old child would be expected to have which traits? (Select all that apply.) a. Think in abstract terms. b. Follow directional commands. c. Understand conservation of matter. d. Use sentences of eight words. e. Tell exaggerated stories. f. Comprehend another person's perspective.

ANS: B, E Children ages 3 to 4 years can give and follow simple commands and tell exaggerated stories. Children cannot think abstractly at age 4 years. Conservation of matter is a developmental task of the school-age child. Five-year-old children use sentences with eight words with all parts of speech. A 4-year-old child cannot comprehend another's perspective

After the introduction of the Back to Sleep campaign in 1992, an increased incidence has been noted of which of the following pediatric disorders? (Select all that apply.) a. SIDS b. Torticollis c. Failure to thrive d. Apnea of infancy e. Plagiocephaly

ANS: B, E Plagiocephaly is a misshapen head caused by the prolonged pressure on one side of the skull. If that side becomes misshapen, facial asymmetry may result. The sternocleidomastoid muscle may tighten on the affected side, causing torticollis. SIDS has decreased by more than 40% with the introduction of the Back to Sleep campaign. Apnea of infancy and failure to thrive are unrelated to the Back to Sleep campaign.

The nurse is taking care of a 2-year-old child with a macule skin lesion. Which clinical finding should the nurse expect to assess with this type of lesion? a. Flat, nonpalpable, and irregularly shaped lesion that is greater than 1 cm in diameter b. Heaped-up keratinized cells, flaky exfoliation, irregular, thick or thin, dry or oily, varied in size c. Flat, brown mole less than 1 cm in diameter d. Elevated, flat-topped, firm, rough, superficial papule greater than 1 cm in diameter

ANS: C A macule is flat, nonpalpable, circumscribed, less than 1 cm in diameter, and brown, red, purple, white, or tan. A patch is a flat, nonpalpable, and irregularly shaped macule that is greater than 1 cm in diameter. Scale is heaped-up keratinized cells, flaky exfoliation, irregular, thick or thin, dry or oily, varied in size, and silver white or tan. A plaque is an elevated, flat-topped, firm, rough, superficial papule greater than 1 cm in diameter. It may be coalesced papules.

Which nursing consideration is important when caring for a child with impetigo contagiosa? a. Apply topical corticosteroids to decrease inflammation. b. Carefully remove dressings so as not to dislodge undermined skin, crusts, and debris. c. Carefully wash hands and maintain cleanliness when caring for an infected child. d. Examine child under a Wood lamp for possible spread of lesions.

ANS: C A major nursing consideration related to bacterial skin infections, such as impetigo contagiosa, is to prevent the spread of the infection and complications. This is done by thorough hand washing before and after contact with the affected child. Corticosteroids are not indicated in bacterial infections. Dressings are usually not indicated. The undermined skin, crusts, and debris are carefully removed after softening with moist compresses. A Wood lamp is used to detect fluorescent materials in the skin and hair. It is used in certain disease states, such as tinea capitis.

23. The nurse is planning care for a low-birth-weight newborn. Which is an appropriate nursing intervention to promote adequate oxygenation? a.Place in Trendelenburg position periodically. b.Suction at least every 2 to 3 hours. c.Maintain neutral thermal environment. d.Hyperextend neck with nose pointing to ceiling.

ANS: C A neutral thermal environment is one that permits the newborn to maintain a normal core temperature with minimal oxygen consumption and caloric expenditure. The Trendelenburg position should be avoided. This position can contribute to increased intracranial pressure (ICP) and reduced lung capacity from gravity pushing organs against diaphragm. Suctioning should be done only as necessary. Routine suctioning may cause bronchospasm, bradycardia due to vagal nerve stimulation, hypoxia, and increased ICP. Neck hyperextension is avoided because it reduces diameter of trachea.

Which best describes a full-thickness (third-degree) burn? a. Erythema and pain b. Skin showing erythema followed by blister formation c. Destruction of all layers of skin evident with extension into subcutaneous tissue d. Destruction injury involving underlying structures such as muscle, fascia, and bone

ANS: C A third-degree, or full-thickness, burn is a serious injury that involves the entire epidermis and dermis and extends into the subcutaneous tissues. Erythema and pain are characteristic of a first-degree, or superficial, burn. Erythema with blister formation is characteristic of a second-degree, or partial-thickness, burn. A fourth-degree burn is a full-thickness burn that also involves underlying structures such as muscle, fascia, and bone.

56. Which genetic term refers to the transfer of all or part of a chromosome to a different chromosome after chromosome breakage? a. Trisomy b. Monosomy c. Translocation d. Nondisjunction

ANS: C A translocation occurs when a part of a chromosome breaks off and attaches to another chromosome. When this occurs in the germ cells, the translocation can be transmitted to the next generation. Trisomy is the condition in which three of a specific chromosome are found rather than the usual two. Monosomy is the condition in which one of a specific chromosome is noted rather than the usual two. The term is not used for males when the normal complement of sex chromosomes (one X and one Y) is present. Nondisjunction is the failure of a chromosome to separate during cell division. Of the resultant daughter cells, one will be trisomic and one will be monosomic.

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge? a. Treatment is most successful if it is started during adolescence. b. Treatment is considered successful if children attain full stature by adulthood. c. Replacement therapy requires daily subcutaneous injections. d. Replacement therapy will be required throughout the child's lifetime.

ANS: C Additional support is required for children who require hormone replacement therapy, such as preparation for daily subcutaneous injections and education for self-management during the school-age years. Young children, obese children, and those who are severely GH deficient have the best response to therapy. When therapy is successful, children can attain their actual or near-final adult height at a slower rate than their peers. Replacement therapy is not needed after attaining final height. They are no longer GH deficient.

To help the adolescent deal with diabetes, the nurse must consider which characteristic of adolescence? a. Desire to be unique b. Preoccupation with the future c. Need to be perfect and similar to peers d. Need to make peers aware of the seriousness of hypoglycemic reactions

ANS: C Adolescence is a time when the individual wants to be perfect and similar to peers. Having diabetes makes adolescents different from their peers. Adolescents do not wish to be unique, they desire to fit in with the peer group and are usually not future oriented. Forcing peer awareness of the seriousness of hypoglycemic reactions would further alienate the adolescent with diabetes. The peer group would focus on the differences.

31. A nurse is assessing for jaundice in a dark-skinned newborn. Where is the best place to assess for jaundice in this newborn? a. Buttocks b. Tip of nose and sclera c. Sclera, conjunctiva, and oral mucosa d. Palms of hands and soles of feet

ANS: C Assessing for jaundice is part of the routine physical assessment in newborns. In dark-skinned newborns, the sclera, conjunctiva, and oral mucosa are the best place to observe jaundice because of the lack of skin pigmentation in these areas. The skin pigmentation in the buttocks, tip of nose and sclera, and palms of hands and soles of feet can mask the appearance of jaundice.

Which play is most typical of the preschool period? a. Solitary b. Parallel c. Associative d. Team

ANS: C Associative play is group play in similar or identical activities but without rigid organization or rules. Solitary play is that of infants. Parallel play is that of toddlers. School-age children play in teams

The child of 15 to 30 months is likely to be struggling with which developmental task? a. Trust b. Initiative c. Autonomy d. Intimacy

ANS: C Autonomy vs shame and doubt is the developmental task of toddlers. Trust vs mistrust is the developmental stage of infancy. Initiative vs guilt is the developmental stage of early childhood. Intimacy and solidarity vs isolation is the developmental stage of early adulthood.

A nurse is assessing a preschool-age child and notes the child exhibits magical thinking. According to Piaget, which describes magical thinking? a. Events have cause and effect. b. God is like an imaginary friend. c. Thoughts are all-powerful. d. If the skin is broken, the child's insides will come out.

ANS: C Because of their egocentrism and transductive reasoning, preschoolers believe that thoughts are all-powerful. Cause-and-effect implies logical thought, not magical thinking. Thinking God is like an imaginary friend is an example of concrete thinking in a preschooler's spiritual development. Thinking that if the skin is broken, the child's insides will come out is an example of concrete thinking in development of body image.

13. A parent asks the nurse "at what age do most infants begin to fear strangers?" The nurse should give which response? a. 2 months b. 4 months c. 6 months d. 12 months

ANS: C Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and unfamiliar people. At 2 months, infants are just beginning to respond differentially to the mother. At age 4 months, the infant is beginning the process of separation-individuation when the infant begins to recognize self and mother as separate beings. Twelve months is too late and requires referral for evaluation if the child does not fear strangers at this age.

A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on which knowledge? a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children are better able to manage the diabetes. d. Parents are better able to manage the disease.

ANS: C Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood glucose results. Blood glucose monitoring is more expensive but provides improved management. It is as accurate as equivalent testing done in laboratories. The ability to self-test allows the child to balance diet, exercise, and insulin. The parents are partners in the process, but the child should be taught how to manage the disease.

28. When should the nurse expect breastfeeding-associated jaundice to first appear in a normal newborn? a. 0 to 12 hours b. 12 to 24 hours c. 2 to 4 days d. 4 to 5 days

ANS: C Breastfeeding-associated jaundice is caused by decreased milk intake related to decreased caloric and fluid intake by the newborn before the mother's milk is well established. Fasting is associated with decreased hepatic clearance of bilirubin, 0 to 24 hours is too soon. Jaundice within the first 24 hours is associated with hemolytic disease of the newborn, 4 to 5 days is too late. Jaundice at this time may be due to breast-milk jaundice.

In the clinic waiting room, a nurse observes a parent showing an 18-month-old child how to make a tower out of blocks. The nurse should recognize in this situation that: a. blocks at this age are used primarily for throwing. b. toddlers are too young to imitate the behavior of others. c. toddlers are capable of building a tower of blocks. d. toddlers are too young to build a tower of blocks.

ANS: C Building with blocks is a good parent-child interaction. The 18-month-old child is capable of building a tower of three or four blocks. The ability to build towers of blocks usually begins at age 15 months. With ongoing development, the child is able to build taller towers. The 18-month-old child imitates others around him or her.

Developmentally, most children at age 12 months: a. use a spoon adeptly. b. relinquish the bottle voluntarily. c. eat the same food as the rest of the family. d. reject all solid food in preference to the bottle.

ANS: C By age 12 months, most children are eating the same food that is prepared for the rest of the family. Using a spoon usually is not mastered until age 18 months. The parents should be engaged in weaning a child from a bottle if that is the source of liquid. Toddlers should be encouraged to drink from a cup at the first birthday and be weaned from the bottle totally by 14 months. The child should be weaned from a milk- or formula-based diet to a balanced diet that includes iron-rich sources of food.

Parent guidelines for relieving colic in an infant include: a. avoiding touching abdomen. b. avoiding using a pacifier. c. changing infant's position frequently. d. placing infant where family cannot hear the crying.

ANS: C Changing the infant's position frequently may be beneficial. The parent can walk holding the child face down and with the child's chest across the parent's arm. The parent's hand can support the child's abdomen, applying gentle pressure. Gently massaging the abdomen is effective in some children. Pacifiers can be used for meeting additional sucking needs. The child should not be placed where monitoring cannot be done. The child can be placed in the crib and allowed to cry. Periodically, the child should be picked up and comforted.

The nurse is teaching the parents of a child who is receiving methimazole (Tapazole) for the treatment of hyperthyroidism (Graves disease). Which statement made by the parent indicates a correct understanding of the teaching? a. "I would expect my child to gain weight while taking this medication." b. "I would expect my child to experience episodes of ear pain while taking this medication." c. "If my child develops a sore throat and fever, I should contact the physician immediately." d. "If my child develops the stomach flu, my child will need to be hospitalized."

ANS: C Children being treated with Tapazole must be carefully monitored for the side effects of the medication. Parents must be alerted that sore throat and fever accompany the grave complication of leukopenia. These symptoms should be immediately reported. Weight gain, episodes of ear pain, and concern for hospitalization with the stomach flu are not concerns related to taking Tapazole.

30. Early clinical manifestations of bilirubin encephalopathy in the newborn include: a. mental retardation. b. absence of stooling. c. lethargy or irritability. d. increased or decreased temperature.

ANS: C Clinical manifestations of bilirubin encephalopathy are those of nervous system depression or excitation. Prodromal symptoms consist of decreased activity, lethargy, irritability, hypotonia, and seizures. Newborns who survive may have evidence of mental retardation. Absence of stooling and increased/decreased temperature are not manifestations of bilirubin encephalopathy.

50. Several types of seizures can occur in the newborn. Which is characteristic of clonic seizures? a. Apnea b. Tremors c. Rhythmic jerking movements d. Extensions of all four limbs

ANS: C Clonic seizures are characterized by slow rhythmic jerking movements that occur approximately 1 to 3 per second. Apnea is a common manifestation of subtle seizures. Tremors are not characteristic of seizure activity. They may be indicative of hypoglycemia or hypocalcemia. A clonic seizure would have extension and contraction of the extremities, not just extension.

49. A newborn is diagnosed with retinopathy of prematurity. The nurse should know that: a. blindness cannot be prevented. b. no treatment is currently available. c. cryotherapy and laser therapy are effective treatments. d. long-term administration of oxygen will be necessary.

ANS: C Cryotherapy and laser photocoagulation therapy can be used to minimize the vascular proliferation process that causes the retinal damage. Blindness can be prevented with early recognition and treatment. Cryotherapy and laser therapy can be used to stop the process. Surgical intervention can be used to repair a detached retina if necessary. Long-term administration of oxygen is one of the causes. Oxygen should be used judiciously.

Which is one of the first signs of overwhelming sepsis in a child with burn injuries? a. Seizures b. Bradycardia c. Disorientation d. Decreased blood pressure

ANS: C Disorientation in the burn patient is one of the first signs of overwhelming sepsis and may indicate inadequate hydration. Seizures, bradycardia, and decreased blood pressure are not initial manifestations of overwhelming sepsis.

The nurse is admitting a toddler with the diagnosis of juvenile hypothyroidism. Which is a common clinical manifestation of this disorder? a. Insomnia b. Diarrhea c. Dry skin d. Accelerated growth

ANS: C Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism are usually sleepy. Constipation is associated with hypothyroidism. Decelerated growth is common in juvenile hypothyroidism.

An infant has been pronounced dead from sudden infant death syndrome (SIDS) in the emergency department. Which is an appropriate question to ask the parents? a. "Did you hear the infant cry out?" b. "Why didn't you check on the infant earlier?" c. "What time did you find the infant?" d. "Was the head buried in a blanket?"

ANS: C During a SIDS incident, if the infant is not pronounced dead at the scene, he or she may be transported to the emergency department to be pronounced dead by a physician. While they are in the emergency department, the parents are asked only factual questions, such as when they found the infant, how he or she looked, and whom they called for help. The nurse avoids any remarks that may suggest responsibility, such as "Why didn't you go in earlier?" "Didn't you hear the infant cry out?" "Was the head buried in a blanket?"

A father tells the nurse that his child is "filling up the house with collections" like seashells, bottle caps, baseball cards, and pennies. The nurse should recognize that the child is developing: a. object permanence. b. preoperational thinking. c. concrete operational thinking. d. ability to use abstract symbols.

ANS: C During concrete operations, children develop logical thought processes. They are able to classify, sort, order, and otherwise organize facts about the world. This ability fosters the child's ability to create collections. Object permanence is the realization that items that leave the visual field still exist. This is a task of infancy and does not contribute to collections. Preoperational thinking is concrete and tangible. Children in this age group cannot reason beyond the observable, and they lack the ability to make deductions or generalizations. Collections are not typical for this developmental level. The ability to use abstract symbols is a characteristic of formal operations, which develops during adolescence. These children can develop and test hypotheses.

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

ANS: C During the concrete operations stage of development, which occurs approximately between ages 7 and 11 years, increasingly logical and coherent thought processes occur. This is characterized by the child's ability to classify, sort, order, and organize facts to use in problem solving. The progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage of development. The inability to put oneself in another's place is characteristic of the preoperational stage of development. The ability to think in abstract terms and draw logical conclusions is characteristic of the formal operations stage of development.

12. A nurse is conducting a teaching session for parents of infants. The nurse explains that which behavior indicates that an infant has developed object permanence? a. Recognizes familiar face, such as mother b. Recognizes familiar object, such as bottle c. Actively searches for a hidden object d. Secures objects by pulling on a string

ANS: C During the first 6 months of life, infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows an object exists even when it is not visible. Between ages 8 and 12 weeks, infants begin to respond differentially to the mother. They cry, smile, vocalize, and show distinct preference for the mother. This preference is one of the stages that influences the attachment process but is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object permanence. The ability to understand cause and effect is part of secondary schemata development.

Although a 14-month-old girl received a shock from an electric outlet recently, her parent finds her about to place a paper clip in another outlet. Which is the best interpretation of this behavior? a. Her cognitive development is delayed. b. This is typical behavior because toddlers are not very developed. c. This is typical behavior because of the inability to transfer knowledge to new situations. d. This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

ANS: C During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. Her cognitive development is appropriate for her age. Trying to put things into an outlet is typical behavior for a toddler. Only some awareness exists of a causal relation between events.

During the preschool period, injury prevention efforts should emphasize: a. constant vigilance and protection. b. punishment for unsafe behaviors. c. education for safety and potential hazards. d. limitation of physical activities.

ANS: C Education for safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Constant vigilance and protection is not practical at this age because preschoolers are becoming more independent. Punishment may make children scared of trying new things. Limitation of physical activities is not appropriate

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. Which should the nurse explain about exercise in type 1 diabetes? a. Exercise will increase blood glucose. b. Exercise should be restricted. c. Extra snacks are needed before exercise. d. Extra insulin is required during exercise.

ANS: C Exercise lowers blood glucose levels, which can be compensated for by extra snacks. Exercise lowers blood glucose and is encouraged and not restricted, unless indicated by other health conditions. Extra insulin is contraindicated because exercise decreases blood glucose levels.

Rickets is caused by a deficiency in: a. vitamin A. b. vitamin C. c. vitamin D and calcium. d. folic acid and iron.

ANS: C Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent the development of rickets. No correlation exists between vitamins A, C, folic acid, or iron and rickets.

Fentanyl and midazolam (Versed) are given before débridement of a child's burn wounds. Which is the rationale for administration of these medications? a. Promote healing. b. Prevent infection. c. Provide pain relief. d. Limit amount of débridement that will be necessary.

ANS: C Fentanyl and midazolam provide excellent intravenous sedation and analgesia to control procedural pain in children with burns. These drugs are for sedation and pain control, not healing, preventing infection, or limiting the amount of débridement.

Which leading cause of death topic should the nurse emphasize to a group of African-American boys ranging in ages 15 to 19 years? a. Suicide b. Cancer c. Firearm homicide d. Occupational injuries

ANS: C Firearm homicide is the second overall cause of death in this age group and the leading cause of death in African-American males. Suicide is the third-leading cause of death in this population. Cancer, although a major health problem, is the fourth-leading cause of death in this age group. Occupational injuries do not contribute to a significant death rate for this age group.

32. The parent of a 2-week-old infant, exclusively breastfed, asks the nurse if fluoride supplements are needed. The nurse's best response should be: a. "She needs to begin taking them now." b. "They are not needed if you drink fluoridated water." c. "She may need to begin taking them at age 4 months." d. "She can have infant cereal mixed with fluoridated water instead of supplements."

ANS: C Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 4 months if the child is not drinking adequate amounts of fluoridated water. The amount of water that is ingested and the amount of fluoride in the water are taken into account when supplementation is being considered.

27. A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse should recommend that the infant be given: a. skim milk. b. whole cow's milk. c. commercial iron-fortified formula. d. commercial formula without iron.

ANS: C For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, then iron-fortified commercial formula should be used. Cow's milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age, the iron-fortified formula will help prevent the development of iron-deficiency anemia.

1. A nurse is assessing a 12-month-old infant. Which statement best describes the infant's physical development a nurse should expect to find? a. Anterior fontanel closes by age 6 to 10 months. b. Binocularity is well established by age 8 months. c. Birth weight doubles by age 5 months and triples by age 1 year. d. Maternal iron stores persist during the first 12 months of life.

ANS: C Growth is very rapid during the first year of life. The birth weight has approximately doubled by age 5 to 6 months and triples by age 1 year. The anterior fontanel closes at age 12 to 18 months. Binocularity is not established until age 15 months. Maternal iron stores are usually depleted by age 6 months.

11. The nurse is caring for a very low-birth-weight (VLBW) newborn with a peripheral intravenous infusion. Which statement describes nursing considerations regarding infiltration? a.Infiltration occurs infrequently because VLBW newborns are inactive. b.Continuous infusion pumps stop automatically when infiltration occurs. c.Hypertonic solutions can cause severe tissue damage if infiltration occurs. d.Infusion site should be checked for infiltration at least once per 8-hour shift.

ANS: C Hypertonic fluids can damage cells if the fluid leaks from the vein. Careful monitoring is required to prevent severe tissue damage. Infiltrations occur for many reasons, not only activity. The vein, catheter, and fluid used all contribute to the possibility of infiltration. The continuous infusion pump may alarm when the pressure increases, but this does not alert the nurse to all infiltrations. Infusion rates and sites should be checked hourly to prevent tissue damage from extravasations, fluid overload, and dehydration.

Parents report that they have been giving a multivitamin to their 1-year-old infant. The nurse counsels the parents that which vitamin can cause a toxic reaction at a low dose? a. Niacin b. B6 c. D d. C

ANS: C Hypervitaminosis of vitamin D presents the greatest problem because this fat-soluble vitamin is stored in the body. Vitamin D is the most likely of all vitamins to cause toxic reactions in relatively small overdoses. The water-soluble vitamins, primarily niacin, B6, and C, can also cause toxicity but not at the low dose that occurs with vitamin D.

24. A preterm newborn has been receiving orogastric feedings of breast milk. The nurse initiates nipple feedings, but the newborn tires easily and has weak sucking and swallowing reflexes. The most appropriate nursing intervention is to: a.encourage mother to breastfeed. b.try nipple-feeding preterm newborn formula. c.resume orogastric feedings of breast milk. d.resume orogastric feedings of formula.

ANS: C If a preterm newborn tires easily or has weak sucking when nipple feedings are initiated, the nurse should resume orogastric feedings with the milk of mother's choice. When nipple feeding is unsuccessful, it is unlikely that the newborn will be able to breastfeed. Breast milk should be continued as long as the mother desires.

In which type of play are children engaged in similar or identical activity, without organization, division of labor, or mutual goal? a. Solitary b. Parallel c. Associative d. Cooperative

ANS: C In associative play, no group goal is present. Each child acts according to his or her own wishes. Although the children may be involved in similar activities, no organization, division of labor, leadership assignment, or mutual goal exists. Solitary play describes children playing alone with toys different from those used by other children in the same area. Parallel play describes children playing independently but being among other children. Cooperative play is organized. Children play in a group with other children who play in activities for a common goal.

Parents of a toddler with hypopituitarism ask the nurse, "What can we expect with this condition?" The nurse should respond with which statement? a. Growth is normal during the first 3 years of life. b. Weight is usually more retarded than height. c. Skeletal proportions are normal for age. d. Most of these children have subnormal intelligence.

ANS: C In children with hypopituitarism, the skeletal proportions are normal. Growth is within normal limits for the first year of life. Height is usually more delayed than weight. Intelligence is not affected by hypopituitarism.

11. According to Piaget, the 6-month-old infant should be in which developmental stage? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata

ANS: C Infants are usually in the secondary circular reaction stage from ages 4 to 8 months. This stage is characterized by a continuation of the primary circular reaction for the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking. The use of reflexes is primarily during the first month of life. Primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from ages 1 to 4 months. The fourth sensorimotor stage is coordination of secondary schemata. This is a transitional stage in which increasing motor skills enable greater exploration of the environment.

By what age does birth length usually double? a. 1 year b. 2 years c. 4 years d. 6 years

ANS: C Linear growth or height occurs almost entirely as a result of skeletal growth and is considered a stable measurement of general growth. On average, most children have doubled their birth length at age 4 years. One and 2 years are too young for doubling of length. Most children will have achieved the doubling by age 4 years.

The school nurse is conducting a class for school-age children on Lyme disease. Which is characteristic of Lyme disease? a. Difficult to prevent b. Treated with oral antibiotics in stages 1, 2, and 3 c. Caused by a spirochete that enters the skin through a tick bite d. Common in geographic areas where the soil contains the mycotic spores that cause the disease

ANS: C Lyme disease is caused by Borrelia burgdorferi, a spirochete spread by ticks. The early characteristic rash is erythema migrans. Tick bites should be avoided by entering tick-infested areas with caution. Light-colored clothing should be worn to identify ticks easily. Long-sleeved shirts and long pants tucked into socks should be the attire. Early treatment of the erythema migrans (stage 1) can prevent the development of Lyme disease. Lyme disease is caused by a spirochete, not mycotic spores.

Which snack should the nurse recommend parents offer to their slightly overweight preschool child? a. Carbonated beverage b. 10% fruit juice c. Low fat chocolate milk d. Whole milk

ANS: C Milk and dairy products are excellent sources of calcium and vitamin D (fortified). Low-fat milk may be substituted, so the quantity of milk may remain the same while limiting fat intake overall. Parents should be educated regarding non-nutritious fruit drinks, which usually contain less than 10% fruit juice yet are often advertised as healthy and nutritious, sugar content is dramatically increased and often precludes an adequate intake of milk by the child. In young children, intake of carbonated beverages that are acidic or that contain high amounts of sugar is also known to contribute to dental caries. Low fat milk should be substituted for whole milk if the child is slightly overweight.

10. By which age should the nurse expect an infant to be able to pull to a standing position? a. 6 months b. 8 months c. 11 to 12 months d. 14 to 15 months

ANS: C Most infants can pull themselves to a standing position at age 9 months. Infants who are not able to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip. At 6 months, infants have just obtained coordination of arms and legs. By age 8 months, infants can bear full weight on their legs. Any infant who cannot pull to a standing position by age 1 year should be referred for further evaluation.

Which is the leading cause of death from unintentional injuries for females ranging in age from 1 to 14? a. Mechanical suffocation b. Drowning c. Motor-vehicle-related fatalities d. Fire- and burn-related fatalities

ANS: C Motor-vehicle-related fatalities are the leading cause of death for females ranging in age from 1 to 14, either as passengers or as pedestrians. Mechanical suffocation is fourth or fifth, depending on the age. Drowning is the second- or third-leading cause of death, depending on the age. Fire- and burn-related fatalities are the second-leading cause of death.

34. The nurse is caring for a newborn with hyperbilirubinemia who is receiving phototherapy. Which is an appropriate nursing intervention for this newborn? a. Apply lotion as prescribed to moisturize skin. b. Maintain nothing-by-mouth (NPO) status to prevent nausea and vomiting. c. Monitor temperature to prevent hypothermia or hyperthermia. d. Keep eye patches on for at least 8 to 12 of every 24 hours.

ANS: C Newborns who are receiving phototherapy are at risk for thermoregulation issues. The nurse must monitor the newborn's temperature closely to rapidly detect either hypothermia or hyperthermia. Lotions are not used. They may predispose the newborn to increased tanning or "frying" effect. Newborns receiving phototherapy require additional fluid to compensate for increased fluid losses caused by the lights. The eye patches must be in place whenever the child is under the phototherapy lights.

Imaginary playmates are beneficial to the preschool child because they: a. take the place of social interactions. b. take the place of pets and other toys. c. become friends in times of loneliness. d. accomplish what the child has already successfully accomplished.

ANS: C One purpose of an imaginary friend is to be a friend in time of loneliness. Imaginary friends do not take the place of social interaction, but may encourage conversation. Imaginary friends do not take the place of pets or toys. Imaginary friends accomplish what the child is still attempting.

The nurse is taking care of a 7-year-old child with herpes simplex virus (type 1 or 2). Which prescribed medication should the nurse expect to be included in the treatment plan? a. Corticosteroids b. Oral griseofulvin c. Oral antiviral agent d. Topical and/or systemic antibiotic

ANS: C Oral antiviral agents are effective for viral infections such as herpes simplex. Corticosteroids are not effective for viral infections. Griseofulvin is an antifungal agent and not effective for viral infections. Antibiotics are not effective in viral diseases.

5. What is oral candidiasis (thrush) in the newborn? a.Bacterial infection that is life threatening in the neonatal period b.Bacterial infection of mucous membranes that responds readily to treatment c.Yeastlike fungal infection of mucous membranes that is relatively common d.Benign disorder that is transmitted from mother to newborn during the birth process only

ANS: C Oral candidiasis, characterized by white adherent patches on the tongue, palate, and inner aspects of the cheeks, is not uncommon in newborns. Candida albicans is the usual causative organism. Oral candidiasis is usually a benign disorder in the newborn, often confined to the oral and diaper regions. It is caused by a yeastlike organism and is treated with good hygiene, application of a fungicide, and correction of any underlying disorder. Thrush can be transmitted in several ways, including by maternal transmission during delivery, person-to-person transmission, and contaminated bottles, hands, or other objects.

Parents need further teaching about the use of car safety seats if they make which statement? a. "Even if our toddler helps buckle the straps, we will double-check the fastenings." b. "We won't start the car until everyone is properly restrained." c. "We won't need to use the car seat on short trips to the store." d. "We will anchor the car seat to the car's anchoring system."

ANS: C Parents need to be taught to always use the restraint even for short trips. Further teaching is needed if they make this statement. Parents have understood the teaching if they encourage the child to help attach buckles, straps, and shields but always double-check fastenings, do not start the car until everyone is properly restrained, and anchor the car safety seat securely to the car's anchoring system and apply the harness snugly to the child.

27. Physiologic jaundice in a newborn can be caused by: a. fetal-maternal blood incompatibility. b. destruction of red blood cells as a result of antibody reaction. c. liver's inability to bind bilirubin adequately for excretion. d. immature kidneys' inability to hydrolyze and excrete bilirubin.

ANS: C Physiologic jaundice is caused by the immature hepatic function of the newborn's liver coupled with the increased load from red blood cell hemolysis. The excess bilirubin from the destroyed red blood cells cannot be excreted from the body. The fetal-maternal blood incompatibility and the associated red cell destruction by antibodies are the causes of hemolytic disease of the newborn. The kidneys are not involved in the excretion of bilirubin.

A 4-year-old child tells the nurse that she does not want another blood sample drawn because "I need all my insides, and I don't want anyone taking them out." Which is the nurse's best interpretation of this? a. Child is being overly dramatic. b. Child has a disturbed body image. c. Preschoolers have poorly defined body boundaries. d. Preschoolers normally have a good understanding of their bodies.

ANS: C Preschoolers have little understanding of body boundaries, which leads to fears of mutilation. The child is not capable of being dramatic at 4 years of age. She truly has fear. Body image is just developing in the school-age child. Preschoolers do not have good understanding of their bodies.

A child steps on a nail and sustains a puncture wound of the foot. Which is the most appropriate method for cleansing this wound? a. Wash wound thoroughly with chlorhexidine. b. Wash wound thoroughly with povidone-iodine. c. Soak foot in warm water and soap. d. Soak foot in solution of 50% hydrogen peroxide and 50% water.

ANS: C Puncture wounds should be cleansed by soaking the foot in warm water and soap. Chlorhexidine, hydrogen peroxide, and povidone-iodine should not be used because they have a cytotoxic effect on healthy cells and minimal effect on controlling infection.

The nurse is taking care of a child with scabies. Which primary clinical manifestation should the nurse expect to assess with this disease? a. Edema b. Redness c. Pruritus d. Maceration

ANS: C Scabies is caused by the scabies mite. The inflammatory response and intense itching occur after the host has become sensitized to the mite. This occurs approximately 30 to 60 days after initial contact. Edema, redness, and maceration are not observed in scabies.

8. At what age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 10 months

ANS: C Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months, an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months, the infant can maneuver from a prone to a sitting position.

A nurse is counseling an adolescent, in her second month of pregnancy, about the risk of teratogens. The adolescent has understood the teaching if she makes which statement? a. "I will be able to continue taking isotretinoin (Accutane) for my acne." b. "I can continue to clean my cat's litter box." c. "I should avoid any alcoholic beverages." d. "I will ask my physician to adjust my phenytoin (Dilantin) dosage."

ANS: C Teratogens are agents that cause birth defects when present in the prenatal period. Avoidance of alcoholic beverages is recommended to prevent fetal alcohol syndrome. Isotretinoin (Accutane) and phenytoin (Dilantin) have been shown to have teratogenic effects and should not be taken during pregnancy. Cytomegalovirus, an infection agent and a teratogen, can be transmitted through cat feces, and cleaning the litter box during pregnancy should be avoided.

26. The nurse should teach parents that which age is safe to give infants whole milk instead of commercial infant formula? a. 6 months b. 9 months c. 12 months d. 18 months

ANS: C The American Academy of Pediatrics does not recommend the use of cow's milk for children younger than 12 months. At 6 and 9 months, the infant should be receiving commercial infant formula or breast milk. At age 18 months, milk and formula are supplemented with solid foods, water, and some fruit juices.

61. The commonly used Guthrie blood test is performed on newborns to diagnose: a. Down syndrome. b. isoimmunization. c. PKU. d. congenital hypothyroidism (CH).

ANS: C The Guthrie blood test is an assay commonly used to diagnosis PKU. The test should be performed after the newborn has received postnatal feedings. Down syndrome is diagnosed through chromosomal analysis. Isoimmunization is detected by analysis of blood for unexpected antibodies. CH is diagnosed by analysis of a filter paper blood spot for thyroxine (T4).

21. At what age does an infant start to recognize familiar faces and objects, such as a feeding bottle? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: C The child can recognize familiar objects at approximately age 3 months. For the first 2 months of life, infants watch and observe their surroundings. The 4-month-old infant is able to anticipate feeding after seeing the bottle.

Nursing care of the infant with atopic dermatitis focuses on: a. feeding a variety of foods. b. keeping lesions dry. c. preventing infection. d. using fabric softener to avoid rough cloth.

ANS: C The eczematous lesions of atopic dermatitis are intensely pruritic. Scratching can lead to new lesions and secondary infection. The infant's nails should be kept short and clean and have no sharp edges. In periods of irritability, these children tend to have a decreased appetite. The restriction of hyperallergenic foods, such as milk, dairy products, peanuts, and eggs, may make adequate nutrition a challenge with these children. Wet soaks and compresses are used to keep the lesions moist and minimize the pruritus. Fabric softener should be avoided because of the irritant effects of some of its components.

Herpes zoster is caused by the varicella virus and has an affinity for: a. sympathetic nerve fibers. b. parasympathetic nerve fibers. c. posterior root ganglia and posterior horn of the spinal cord. d. lateral and dorsal columns of the spinal cord.

ANS: C The herpes zoster virus has an affinity for posterior root ganglia, the posterior horn of the spinal cord, and skin. The zoster virus does not involve sympathetic or parasympathetic nerve fibers and the lateral and dorsal columns of the spinal cord.

Which is characteristic of the immune-mediated type 1 diabetes mellitus? a. Ketoacidosis is infrequent. b. Onset is gradual. c. Age at onset is usually younger than 20 years. d. Oral agents are often effective for treatment.

ANS: C The immune-mediated type 1 diabetes mellitus typically has its onset in children or young adults. Infrequent ketoacidosis, gradual onset, and effectiveness of oral agents for treatment are more consistent with type 2 diabetes.

6. Nursing care of the newborn with oral candidiasis (thrush) includes: a.avoiding use of pacifier. b.removing characteristic white patches with a soft cloth. c.continuing medication for a prescribed number of days. d.applying medication to oral mucosa, being careful that none is ingested.

ANS: C The medication must be continued for the prescribed number of days. To prevent relapse, therapy should continue for at least 2 days after the lesions disappear. Pacifiers can be used. The pacifier should be replaced with a new one or boiled for 20 minutes once daily. One of the characteristics of thrush is that the white patches cannot be removed. The medication is applied to the oral mucosa and then swallowed to treat Candida organisms in the gastrointestinal tract.

Tretinoin (Retin-A) is a topical agent commonly used to treat acne. Nursing considerations with this drug should include: a. teaching to avoid use of sunscreen agents. b. applying generously to the skin. c. explaining that medication should not be applied until at least 20 to 30 minutes after washing. d. explaining that erythema and peeling are indications of toxicity.

ANS: C The medication should not be applied for at least 20 to 30 minutes after washing to decrease the burning sensation. The avoidance of sun and the use of sunscreen agents must be emphasized because sun exposure can result in severe sunburn. The agent should be applied sparingly to the skin. Erythema and peeling are common local manifestations.

A child has a postoperative appendectomy incision covered by a dressing. The nurse has just completed a prescribed dressing change for this child. Which description is an accurate documentation of this procedure? a. Dressing change to appendectomy incision completed, child tolerated procedure well, parent present b. No complications noted during dressing change to appendectomy incision c. Appendectomy incision non-reddened, sutures intact, no drainage noted on old dressing, new dressing applied, procedure tolerated well by child d. No changes to appendectomy incisional area, dressing changed, child complained of pain during procedure, new dressing clean, dry and intact

ANS: C The nurse should document assessments and reassessments. Appearance of the incision described in objective terms should be included during a dressing change. The nurse should document patient's response and the outcomes of the care provided. In this example, these include drainage on the old dressing, the application of the new dressing, and the child's response. The other statements partially fulfill the requirements of documenting assessments and reassessments, patient's response, and outcome, but do not include all three.

Which action by the nurse demonstrates use of evidence-based practice (EBP)? a. Gathering equipment for a procedure b. Documenting changes in a patient's status c. Questioning the use of daily central line dressing changes d. Clarifying a physician's prescription for morphine

ANS: C The nurse who questions the daily central line dressing change is ascertaining whether clinical interventions result in positive outcomes for patients. This demonstrates evidence-based practice (EBP), which implies questioning why something is effective and whether a better approach exists. Gathering equipment for a procedure and documenting changes in a patient's status are practices that follow established guidelines. Clarifying a physician's prescription for morphine constitutes safe nursing care.

A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. Which is the most appropriate recommendation? a. Punish the child. b. Leave the child alone until the tantrum is over. c. Remain close by the child but without eye contact. d. Explain to child that this is wrong.

ANS: C The parent should be told that the best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common in toddlers as the child becomes more independent and overwhelmed by increasingly complex tasks. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The parent's presence is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over.

An infant experienced an apparent life-threatening event (ALTE) and is being placed on home apnea monitoring. Parents have understood the instructions for use of a home apnea monitor when they state: a. "We can adjust the monitor to eliminate false alarms." b. "We should sleep in the same bed as our monitored infant." c. "We will check the monitor several times a day to be sure the alarm is working." d. "We will place the monitor in the crib with our infant."

ANS: C The parents should check the monitor several times a day to be sure the alarm is working and that it can be heard from room to room. The parents should not adjust the monitor to eliminate false alarms. Adjustments could compromise the monitor's effectiveness. The monitor should be placed on a firm surface away from the crib and drapes. The parents should not sleep in the same bed as the monitored infant.

A nurse on a pediatric unit is practicing family-centered care. Which is most descriptive of the care the nurse is delivering? a. Taking over total care of the child to reduce stress on the family b. Encouraging family dependence on health care systems c. Recognizing that the family is the constant in a child's life d. Excluding families from the decision-making process

ANS: C The three key components of family-centered care are respect, collaboration, and support. Family-centered care recognizes the family as the constant in the child's life. Taking over total care does not include the family in the process and may increase stress instead of reducing stress. The family should be enabled and empowered to work with the health care system. The family is expected to be part of the decision-making process.

Nitrous oxide is being administered to a child with extensive burn injuries. Which is the purpose of this medication? a. Promote healing. b. Prevent infection. c. Provide anesthesia. d. Improve urinary output.

ANS: C The use of short-acting anesthetic agents, such as propofol and nitrous oxide, has proven beneficial in eliminating procedural pain. Nitrous oxide is an anesthetic agent.

A father calls the clinic nurse because his 2-year-old child was bitten by a black widow spider. The nurse should advise which to the father? a. Apply warm compresses. b. Carefully scrape off stinger. c. Take child to emergency department. d. Apply a thin layer of corticosteroid cream.

ANS: C The venom of the black widow spider has a neurotoxic effect. The father should take the child to the emergency department for treatment with antivenin and muscle relaxants as needed. Warm compresses increase the circulation to the area and facilitate the spread of the venom. The black widow spider does not have a stinger. Corticosteroid cream will have no effect on the venom.

8. The parents of a newborn with a strawberry hemangioma ask the nurse what the treatment will be. The nurse's response should be based on knowledge that: a.excision of the lesion will be necessary. b.injections of prednisone into the lesion will reduce it. c.no treatment is usually necessary because of the high rate of spontaneous involution. d.pulsed dye laser treatments will be necessary immediately to prevent permanent disability.

ANS: C There is a high rate of spontaneous resolution, so treatment is usually not indicated for hemangiomas. Surgical removal would not be indicated. If steroids are indicated, then systemic prednisone is administered for 2 to 3 weeks. The pulse dye laser is used in the uncommon situation of potential visual or respiratory impairment.

40. Which is the most appropriate nursing intervention for the newborn who is jittery and twitching and has a high-pitched cry? a. Monitor blood pressure closely. b. Obtain urine sample to detect glycosuria. c. Obtain serum glucose and serum calcium levels. d. Administer oral glucose or, if newborn refuses to suck, IV dextrose.

ANS: C These are signs and symptoms of hypocalcemia and hypoglycemia. A blood test is useful to determine the treatment. Laboratory analysis for calcium and blood glucose should be the priority intervention. Monitoring vital signs is important, but recognition of the possible hypocalcemia and hypoglycemia is imperative. A finding of glycosuria would not facilitate the diagnosis of hypoglycemia. A determination must be made between the hypocalcemia and hypoglycemia before treatment can be initiated.

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by the: a. thyroid gland. b. parathyroid glands. c. adrenal cortex. d. anterior pituitary.

ANS: C These hormones are secreted by the adrenal cortex. The thyroid gland produces thyroid hormone and thyrocalcitonin. The parathyroid gland produces parathyroid hormone. The anterior pituitary produces hormones such as GH, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone.

A school nurse assesses a case of tinea capitis (ringworm) on a 6-year-old child. Which figure depicts the characteristic lesion of tinea capitis? (I'm guessing these are pictures but didn't show up on the document but the explanation is on the other side - which may or may not help)

ANS: C Tinea capitis is characterized by lesions in the scalp configured of scaly, circumscribed patches or patchy, scaling areas of alopecia. Generally the lesions are asymptomatic but a severe, deep inflammatory reaction may occur that manifests as boggy, encrusted lesions (kerions). Impetigo contagiosa is depicted in the figure showing the vesicular lesion around the nares area that has become vesicular. The lesions rupture easily, leaving superficial, moist erosions that tend to spread peripherally in sharply marginated irregular outlines. The exudate dries to form heavy, honey-colored crusts. The figure depicting inflammation on the cheek is cellulitis. Inflammation of skin and subcutaneous tissues is characterized by intense redness, swelling, and firm infiltration. Cellulitis may progress to abscess formation. The figure depicting "streaked blisters" surrounding one large blister is characteristic of contact dermatitis from poison ivy contact.

What should the nurse suggest to the parents of an infant who has a prolonged need for middle-of-the-night feedings? a. Decrease daytime feedings. b. Allow child to go to sleep with a bottle. c. Offer last feeding as late as possible at night. d. Put infant to bed after asleep from rocking.

ANS: C To manage an infant who has a prolonged need for middle-of-the-night feedings parents should be taught to offer last feeding as late as possible at night. Parent should increase daytime feeding intervals to 4 hours or more (may need to be done gradually), offer no bottles in bed, put to bed awake and when child is crying, check at progressively longer intervals each night, reassure child but do not hold, rock, take to parent's bed, or give bottle or pacifier.

Which is the major cause of death for children older than 1 year? a. Cancer b. Heart disease c. Unintentional injuries d. Congenital anomalies

ANS: C Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence. Congenital anomalies are the leading cause of death in those younger than 1 year. Cancer ranks either second or fourth, depending on the age group, and heart disease ranks fifth in the majority of the age groups.

A mother calls the emergency department nurse because her child was stung by a scorpion. The nurse should recommend: a. administering an antihistamine. b. cleansing area with soap and water. c. keeping the child quiet and coming to the emergency department. d. removing the stinger and applying cool compresses.

ANS: C Venomous species of scorpions inject venom that contains hemolysins, endotheliolysins, and neurotoxins. The absorption of the venom is delayed by keeping the child quiet and the involved area in a dependent position. Antihistamines are not effective against scorpion venom. The wound will have intense local pain. Transport to the emergency department is indicated.

A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which sign of vitamin D toxicity? a. Headache and seizures b. Physical restlessness and voracious appetite without weight gain c. Weakness and lassitude d. Anorexia and insomnia

ANS: C Vitamin D toxicity can be a serious consequence of therapy. Parents are advised to watch for signs, including weakness, fatigue, lassitude, headache, nausea, vomiting, and diarrhea. Renal impairment is manifested through polyuria, polydipsia, and nocturia. Headaches may be a sign of vitamin D toxicity, but seizures are not. Physical restlessness and a voracious appetite with weight loss are manifestations of hyperthyroidism. Anorexia and insomnia are not characteristic of vitamin D toxicity.

17. Which is an important nursing action related to the use of tape and/or adhesives on premature newborns? a.Avoid using tape and adhesives until skin is more mature. b.Use solvents to remove tape and adhesives instead of pulling on skin. c.Remove adhesives with warm water or mineral oil. d.Use scissors carefully to remove tape instead of pulling tape off.

ANS: C Warm water, mineral oil, or petrolatum can be used to facilitate the removal of adhesive. In the premature newborn, often it is impossible to avoid using adhesives and tape. The smallest amount of adhesive necessary should be used. Solvents should be avoided because they tend to dry and burn the delicate skin. Scissors should not be used to remove dressings or tape from the extremities of very small and immature newborns because it is easy to snip off tiny extremities or nick loosely attached skin.

A nurse is teaching a parent of an infant about treatment of seborrhea dermatitis (cradle cap). Which should the nurse include in the instructions? a. Shampoo every three days with a mild soap. b. The hair should be shampooed with a medicated shampoo. c. Shampoo every day with an antiseborrheic shampoo. d. The loosened crusts should not be removed with a fine-toothed comb.

ANS: C When seborrheic lesions are present, the treatment is directed at removing the crusts. Parents are taught the appropriate procedure to clean the scalp. Shampooing should be done daily with a mild soap or commercial baby shampoo, medicated shampoos are not necessary, but an antiseborrheic shampoo containing sulfur and salicylic acid may be used. Shampoo is applied to the scalp and allowed to remain on the scalp until the crusts soften. Then the scalp is thoroughly rinsed. A fine-tooth comb or a soft facial brush helps remove the loosened crusts from the strands of hair after shampooing.

Which explains physiologically the edema formation that occurs with burns? a. Vasoconstriction b. Decreased capillary permeability c. Increased capillary permeability d. Decreased hydrostatic pressure within capillaries

ANS: C With a major burn, an increase in capillary permeability occurs, allowing plasma proteins, fluids, and electrolytes to be lost. Maximal edema in a small wound occurs about 8 to 12 hours after injury. In larger injuries, the maximal edema may not occur until 18 to 24 hours. Vasoconstriction, decreased capillary permeability, and decreased hydrostatic pressure within capillaries are not physiologic mechanisms for edema formation in burn patients.

A nurse is planning care for a school-age child with type 1 diabetes. Which insulin preparations are rapid and short acting? (Select all that apply.) a. Novolin N b. Lantus c. NovoLog d. Novolin R

ANS: C, D Rapid-acting insulin (e.g., NovoLog) reaches the blood within 15 minutes after injection. The insulin peaks 30 to 90 minutes later and may last as long as 5 hours. Short-acting (regular) insulin (e.g., Novolin R) usually reaches the blood within 30 minutes after injection. The insulin peaks 2 to 4 hours later and stays in the blood for about 4 to 8 hours. Intermediate-acting insulins (e.g., Novolin N) reach the blood 2 to 6 hours after injection. The insulins peak 4 to 14 hours later and stay in the blood for about 14 to 20 hours. Long-acting insulin (e.g., Lantus) takes 6 to 14 hours to start working. It has no peak or a very small peak 10 to 16 hours after injection. The insulin stays in the blood between 20 and 24 hours.

The nurse is caring for a school-age child with hyperthyroidism (Graves disease). Which clinical manifestations should the nurse monitor that may indicate a thyroid storm? (Select all that apply.) a. Constipation b. Hypotension c. Hyperthermia d. Tachycardia e. Vomiting

ANS: C, D, E A child with a thyroid storm will have severe irritability and restlessness, vomiting, diarrhea, hyperthermia, hypertension, severe tachycardia, and prostration.

An important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS) is to: a. explain how SIDS could have been predicted and prevented. b. interview parents in depth concerning the circumstances surrounding the child's death. c. discourage parents from making a last visit with the infant. d. make a follow-up home visit to parents as soon as possible after the child's death.

ANS: D A competent, qualified professional should visit the family at home as soon as possible after the death and provide the family with printed information about SIDS. An explanation of how SIDS could have been predicted and prevented is inappropriate. SIDS cannot be prevented or predicted. Discussions about the cause will only increase parental guilt. The parents should be asked only factual questions to determine the cause of death. Parents should be allowed and encouraged to make a last visit with their child.

10. Which refers to a newborn whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on intrauterine growth charts? a.Postterm b.Postmature c.Low birth weight d.Small for gestational age

ANS: D A small-for-gestational-age (or small-for-date) newborn is any child whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on intrauterine growth curves. A postterm or postmature newborn is any child born after 42 weeks of gestational age, regardless of birth weight. A low-birth-weight newborn is a child whose birth weight is less than 2500 g, regardless of gestational age.

The nurse is guiding parents in selecting a daycare facility for their child. Which is especially important to consider when making the selection? a. Structured learning environment b. Socioeconomic status of children c. Cultural similarities of children d. Teachers knowledgeable about development

ANS: D A teacher knowledgeable about development will structure activities for learning. A structured learning environment is not necessary at this age. Socioeconomic status is not the most important factor in selecting a preschool. Preschool is about expanding experiences with others, so cultural similarities are not necessary

The nurse is teaching nursing students about childhood skin lesions. Which is an elevated, circumscribed skin lesion that is less than 1 cm in diameter and filled with serous fluid? a. Cyst b. Papule c. Pustule d. Vesicle

ANS: D A vesicle is elevated, circumscribed, superficial, less than 1 cm in diameter, and filled with serous fluid. A cyst is elevated, circumscribed, palpable, encapsulated, and filled with liquid or semisolid material. A papule is elevated, palpable, firm, circumscribed, less than 1 cm in diameter, and brown, red, pink, tan, or bluish red. A pustule is elevated, superficial, and similar to a vesicle but filled with purulent fluid.

A nurse is conducting parenting classes for parents of children ranging in ages 2 to 7 years. The parents understand the term egocentrism when they indicate it means: a. selfishness. b. self-centeredness. c. preferring to play alone. d. unable to put self in another's place.

ANS: D According to Piaget, children ages 2 to 7 years are in the preoperational stage of development. Children interpret objects and events not in terms of their general properties but in terms of their relationships or their use to them. This egocentrism does not allow children of this age to put themselves in another's place. Selfishness, self-centeredness, and preferring to play alone do not describe the concept of egocentricity.

A nurse is planning a teaching session for parents of preschool children. Which statement explains why the nurse should include information about morbidity and mortality? a. Life-span statistics are included in the data. b. It explains effectiveness of treatment. c. Cost-effective treatment is detailed for the general population. d. High-risk age groups for certain disorders or hazards are identified.

ANS: D Analysis of morbidity and mortality data provides the parents with information about which groups of individuals are at risk for which health problems. Life-span statistics is a part of the mortality data. Treatment modalities and cost are not included in morbidity and mortality data.

At what age should the nurse expect a child to give both first and last names when asked? a. 15 months b. 18 months c. 24 months d. 30 months

ANS: D At 30 months, the child is able to give both first and last names and refer to self with an appropriate pronoun. At 15 and 18 months, the child is too young to give his or her own name. At 24 months, the child is able to give first name and refer to self by that name.

By which age should the nurse expect that most children could obey prepositional phrases such as "under," "on top of," "beside," and "behind"? a. 18 months b. 24 months c. 3 years d. 4 years

ANS: D At 4 years, children can understand directional phrases. Children at 18 months, 24 months, and 3 years are too young.

A 13-year-old girl asks the nurse how much taller she will get. She has been growing about 2 inches per year but grew 4 inches this past year. Menarche recently occurred. The nurse should base her response on which statement? a. Growth cannot be predicted. b. Pubertal growth spurt lasts about 1 year. c. Mature height is achieved when menarche occurs. d. Approximately 95% of mature height is achieved when menarche occurs.

ANS: D At the time of the beginning of menstruation or the skeletal age of 13 years, most girls have grown to about 95% of their adult height. They may have some additional growth (5%) until the epiphyseal plates are closed. Although growth cannot be definitively predicted, on average, 95% of adult height has been reached with the onset of menstruation. Pubertal growth spurt lasts about 1 year does not address the girl's question. Young women usually will grow approximately 5% more after the onset of menstruation.

Atopic dermatitis (eczema) in the infant is: a. easily cured. b. worse in humid climates. c. associated with upper respiratory tract infections. d. associated with allergy with a hereditary tendency.

ANS: D Atopic dermatitis is a type of pruritic eczema that usually begins during infancy and is associated with allergy with a hereditary tendency. Atopic dermatitis can be controlled but not cured. Manifestations of the disease are worse when environmental humidity is lower. Atopic dermatitis is not associated with respiratory tract infections.

Which characteristic best describes the language of a 3-year-old child? a. Asks meanings of words b. Follows directional commands c. Describes an object according to its composition d. Talks incessantly regardless of whether anyone is listening

ANS: D Because of the dramatic vocabulary increase at this age, 3-year-olds are known to talk incessantly regardless of whether anyone is listening. A 4- to 5-year-old asks lots of questions and can follow simple directional commands. A 6-year-old can describe an object according to its composition.

12. The nurse is caring for a high-risk newborn with an umbilical catheter in a radiant warmer. The nurse notes blanching of the feet. Which is the most appropriate nursing action? a.Elevate feet 15 degrees. b.Place socks on newborn. c.Wrap feet loosely in prewarmed blanket. d.Report findings immediately to the practitioner.

ANS: D Blanching of the feet, in a newborn with an umbilical catheter, is an indication of vasospasm. Vasoconstriction of the peripheral vessels, triggered by the vasospasm, can seriously impair circulation. It is an emergency situation and must be reported immediately.

A clinic nurse is planning a teaching session about childhood obesity prevention for parents of school-age children. The nurse should include which associated risk of obesity in the teaching plan? a. Type I diabetes b. Respiratory disease c. Celiac disease d. Type II diabetes

ANS: D Childhood obesity has been associated with the rise of type II diabetes in children. Type I diabetes is not associated with obesity and has a genetic component. Respiratory disease is not associated with obesity, and celiac disease is the inability to metabolize gluten in foods and is not associated with obesity.

31. Parents tell the nurse that their 1-year-old son often sleeps with them. They seem unconcerned about this. The nurse's response should be based on which statement? a. Children should not sleep with their parents. b. Separation from parents should be completed by this age. c. Daytime attention should be increased. d. This is a common and accepted practice, especially in some cultural groups.

ANS: D Co-sleeping, or sharing the family bed, in which the parents allow the children to sleep with them, is a common and accepted practice in many cultures. Parents should evaluate the options available and avoid conditions that place the infant at risk. Population-based studies are currently under way, no evidence at this time supports or condemns the practice for safety reasons. Co-sleeping is a cultural practice. One year is the age at which children are just beginning to individuate. Increased daytime activity may help decrease sleep problems in general, but co-sleeping is a culturally determined phenomenon.

Hyperglycemia associated with diabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than _____ mg/dl. a. 100 b. 120 c. 180 d. 200

ANS: D Diabetic ketoacidosis is a state of relative insulin insufficiency and may include the presence of hyperglycemia, a blood glucose level greater than or equal to 200 mg/dl. The values 100 mg/dl, 120 mg/dl, and 180 mg/dl are too low for the definition of ketoacidosis.

43. A preterm newborn of 36 weeks of gestation is admitted to the NICU. Approximately 2 hours after birth, the newborn begins having difficulty breathing, with grunting, tachypnea, and nasal flaring. Which is important for the nurse to recognize? a. This is a normal finding. b. This is not significant unless cyanosis is present. c. Improvement should occur within 24 hours. d. Further evaluation is needed.

ANS: D Difficulty breathing, with grunting, tachypnea, and nasal flaring are clinical manifestations of respiratory distress syndrome and require further evaluation. This is not a normal finding and requires further evaluation. Cyanosis may be present, but these are significant findings indicative of respiratory distress without cyanosis. The child's condition will most likely worsen for approximately 48 hours without intervention. Improvement may begin at 72 hours.

After the acute stage and during the healing process, the primary complication from burn injury is: a. asphyxia. b. shock. c. renal shutdown. d. infection.

ANS: D During the healing phase, local infection and sepsis are the primary complications. Renal shutdown is not a complication of the burn injury, but may be a result of the profound shock.

57. Trisomy 13, trisomy 18, and trisomy 21 have which in common? a. Viability is rare. b. They are considered deletion syndromes. c. Diagnosis is difficult, time-consuming, and expensive. d. Diagnosis can be made early, based on physical characteristics.

ANS: D Each of these disorders, trisomy 13, 18, and 21, has unique physical characteristics. A presumptive diagnosis can often be made soon after birth and later confirmed by chromosomal analysis. Children with trisomy 13 and 18 usually have short life expectancies. Trisomy 21 has a variable life expectancy, with 80% of individuals living to age 30 years. Trisomy 13, trisomy 18, and trisomy 21 are not deletion syndromes.

59. Which is an important nursing consideration in preventing the complications of congenital hypothyroidism (CH)? a. Assess for family history of CH. b. Assess mother for signs of hypothyroidism. c. Be certain appropriate screening is done prenatally. d. Be certain appropriate screening is done on newborn.

ANS: D Early diagnosis and treatment are essential to prevent the complications of CH. Neonatal screening is mandatory in all 50 United States and territories and is usually obtained in the first 24 to 48 hours of birth. A number of different etiologies exist for CH, family history will identify a small percentage only. The screening can be done postnatally on blood obtained via heel stick.

The nurse is caring for a preschool child with suspected diabetes insipidus. Which clinical manifestation should the nurse expect to observe? a. Oliguria b. Glycosuria c. Nausea and vomiting d. Polyuria and polydipsia

ANS: D Excessive urination accompanied by insatiable thirst is the primary clinical manifestation of diabetes. These symptoms may be so severe that the child does little other than drink and urinate. Oliguria is decreased urine production and is not associated with diabetes insipidus. Glycosuria is associated with diabetes mellitus. Nausea and vomiting are associated with inappropriate antidiuretic hormone (ADH) secretion.

The nurse recommends to parents that peanuts are not a good snack food for toddlers. The nurse's rationale for this action is that they: a. are low in nutritive value. b. are high in sodium. c. cannot be entirely digested. d. can be easily aspirated.

ANS: D Foreign-body aspiration is common during the second year of life. Although they chew well, this age child may have difficulty with large pieces of food, such as meat and whole hot dogs, and with hard foods, such as nuts or dried beans. Peanuts have many beneficial nutrients, but should be avoided because of the risk of aspiration in this age group. The sodium level may be a concern, but the risk of aspiration is more important. Many foods pass through the gastrointestinal tract incompletely undigested. This is not necessarily detrimental to the child.

62. The screening test for PKU is most reliable if the blood sample is: a. from cord blood. b. taken 14 days after birth. c. taken before oral feedings are initiated. d. fresh blood from the heel.

ANS: D Fresh heel-stick blood is the preferred source for the test. Fresh heel-stick blood, not cord blood, must be used. The test must be performed soon after birth so that a low-phenylalanine diet can be instituted if required. The newborn should ingest breast milk or formula before the test is performed.

Which is considered a cardinal sign of diabetes mellitus? a. Nausea b. Seizures c. Impaired vision d. Frequent urination

ANS: D Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia. Nausea and seizures are not clinical manifestations of diabetes mellitus. Impaired vision is a long-term complication of the disease.

35. The parents of a 12-month-old child ask the nurse whether the child can eat hot dogs. The nurse's reply should be based on which statement? a. Child is too young to digest hot dogs. b. Child is too young to eat hot dogs safely. c. Hot dogs must be sliced into sections to prevent aspiration. d. Hot dogs must be cut into small, irregular pieces to prevent aspiration.

ANS: D Hot dogs are of a consistency, diameter, and round shape that may cause complete obstruction of the child's airway. If given to young children, the hot dog should be cut into small irregular pieces rather than served whole or in slices. The child's digestive system is mature enough to digest hot dogs. To eat the hot dog safely, the child should be sitting down, and the hot dog should be appropriately cut.

The nurse should expect to assess which causative agent in a child with warts? a. Bacteria b. Fungus c. Parasite d. Virus

ANS: D Human warts are caused by the human papillomavirus. Infection with bacteria, fungus, and parasites does not result in warts.

Which is an appropriate action when an infant becomes apneic? a. Shake vigorously. b. Roll head side to side. c. Hold by feet upside down with head supported. d. Gently stimulate trunk by patting or rubbing.

ANS: D If the infant is apneic, the infant's trunk should be gently stimulated by patting or rubbing. If the infant is prone, turn onto the back. The infant should not be shaken vigorously, the head rolled side to side, or held by the feet upside down with the head supported. These can cause injury.

The psychosocial developmental tasks of toddlerhood include which characteristic? a. Development of a conscience b. Recognition of sex differences c. Ability to get along with age-mates d. Ability to delay gratification

ANS: D If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that the toddler is concerned with is the ability to delay gratification. Development of a conscience occurs during the preschool years. The recognition of sex differences occurs during the preschool years. The ability to get along with age-mates develops during the preschool and school-age years.

An infant who weighs 7 pounds at birth would be expected to weigh how many pounds at age 1 year? a. 14 b. 16 c. 18 d. 21

ANS: D In general, birth weight triples by the end of the first year of life. For an infant who was 7 pounds at birth, 21 pounds would be the anticipated weight at the first birthday, 14, 16, or 18 pounds is below what would be expected for an infant with a birth weight of 7 pounds.

An adolescent girl is cooking on a gas stove when her bathrobe catches fire. Her father smothers the flames with a rug and calls an ambulance. She has sustained major burns over much of her body. Which is important in her immediate care? a. Wrap her in a blanket until help arrives. b. Encourage her to drink clear liquids. c. Place her in a tub of cool water. d. Remove her burned clothing and jewelry.

ANS: D In major burns, burned clothing should be removed to avoid further damage from smoldering fabric and hot beads of melted synthetic materials. Jewelry is also removed to eliminate the transfer of heat from the metal and constriction resulting from edema formation. The burns should be covered, not wrapped with a clean cloth. A blanket can be used initially to stop the burning process. Fluids should not be given by mouth to avoid aspiration and water intoxication. The child should be kept warm. Placing her in a tub of cool water will exacerbate heat loss.

A young child has sustained a minor burn to the foot. Which is recommended for treatment of a minor burn? a. Apply ice to foot. b. Apply cortisone ointment. c. Apply an occlusive dressing. d. Cleanse the wound with a mild soap and tepid water.

ANS: D In minor burns, the best method of treatment is to cleanse the wound with a mild soap and tepid water. Ice is not recommended. Most practitioners favor covering the wound with an antimicrobial ointment (not cortisone) to reduce the risk of infection and to provide some form of pain relief. The dressing is not occlusive but consists of nonadherent fine-mesh gauze placed over the ointment and a light wrap of gauze dressing that avoids interference with movement. This helps keep the wound clean and protects it from trauma.

A school-age child falls on the playground and has a small laceration on the forearm. The school nurse should do which to cleanse the wound? a. Slowly pour hydrogen peroxide over wound. b. Soak arm in warm water and soap for at least 30 minutes. c. Gently cleanse with sterile pad and a nonstinging povidone-iodine solution. d. Wash wound gently with mild soap and water for several minutes.

ANS: D Lacerations should be washed gently with mild soap and water or normal saline. A sterile pad is not necessary, and hydrogen peroxide and povidone-iodine should not be used because they have a cytotoxic effect on healthy cells and minimal effect on controlling infection. Soaking the arm will not effectively clean the wound.

A nurse has completed a teaching session for adolescents regarding lymphoid tissue growth. Which statement, by the adolescents, indicates understanding of the teaching? a. The tissue reaches adult size by age 1 year. b. The tissue quits growing by 6 years of age. c. The tissue is poorly developed at birth. d. The tissue is twice the adult size by ages 10 to 12 years.

ANS: D Lymphoid tissue continues growing until it reaches maximal development at ages 10 to 12 years, which is twice its adult size. A rapid decline in size occurs until it reaches adult size by the end of adolescence. The tissue reaches adult size at 6 years of age but continues to grow. The tissue is well developed at birth.

47. Meconium aspiration syndrome is caused by: a. hypoglycemia. b. carbon dioxide retention. c. bowel obstruction with meconium. d. aspiration of meconium in utero or at birth.

ANS: D Meconium aspiration syndrome is caused by the aspiration of amniotic fluid containing meconium into the fetal or newborn trachea in utero or at first breath. Hypoglycemia and carbon dioxide retention are not related to meconium aspiration. Bowel obstruction with meconium may be an indication of cystic fibrosis or Hirschsprung disease, not meconium aspiration.

Although infants may be allergic to a variety of foods, the most common allergens are: a. fruit and eggs. b. fruit, vegetables, and wheat. c. cow's milk and green vegetables. d. eggs, cow's milk, and wheat.

ANS: D Milk products, eggs, and wheat are three of the most common food allergens. Ingestion of these products can cause sensitization and, with subsequent exposure, an allergic reaction. Eggs are a common allergen, but fruit is not. Wheat is a common allergen, but fruit and vegetables are not. Cow's milk is a common allergen, but green vegetables are not.

21. The nurse is planning care for a family expecting their newborn to die. The nurse's interventions should be based on which statement? a.Tangible remembrances of the newborn (e.g., lock of hair, picture) prolong grief. b.Photographs of newborns should not be taken after the death has occurred. c.Funerals are not recommended because mother is still recovering from childbirth. d.Parents should be encouraged to name their newborn if they have not done so already.

ANS: D Naming the deceased newborn is an important step in the grieving process. It gives the parents a tangible person for whom to grieve, which is a key component of the grieving process. Tangible remembrances and photographs can make the newborn seem more real to the parents. Many NICUs will make bereavement memory packets, which may include a lock of hair, handprint, footprints, bedside name card, and other individualized objects. Families need to be informed of their options. The ritual of a funeral provides an opportunity for the parents to be supported by relatives and friends.

19. When is the best time for the neonatal intensive care unit (NICU) nurse to initiate an individualized stimulation program for the preterm newborn? a.As soon as possible after newborn is born b.As soon as parent is available to provide stimulation c.When newborn is over 38 weeks of gestation d.When developmental organization and stability are sufficient

ANS: D Newborn stimulation is essential for growth and development. The appropriate time for the introduction of an individualized program is when developmental organization and stability are achieved at approximately 34 and 36 weeks of gestation. The newborn needs to be developmentally ready for a stimulation program. The newborn must be assessed to determine the readiness and appropriateness of the stimulation program. The program should be designed and implemented by the nursing staff. The family can be involved, as the nurses help teach the parents to be responsive to the child's cues, but the stimulation should not depend on the family's availability. An individualized stimulation program should be started when the child is developmentally ready.

58. Which is characteristic of newborns whose mothers smoked during pregnancy? a. Large for gestational age b. Preterm, but size appropriate for gestational age c. Growth retardation in weight only d. Growth retardation in weight, length, and head circumference

ANS: D Newborns born to mothers who smoke had growth failure in weight, length, and chest circumference when compared with newborns of mothers who did not smoke. A dose-effect relation exists. Newborns have significant growth failure, which is related to the number of cigarettes smoked.

Which clinical manifestation may occur in the child who is receiving too much methimazole (Tapazole) for the treatment of hyperthyroidism (Graves disease)? a. Seizures b. Enlargement of all lymph glands c. Pancreatitis or cholecystitis d. Lethargy and somnolence

ANS: D Parents should be aware of the signs of hypothyroidism that can occur from overdosage of the drug. The most common manifestations are lethargy and somnolence. Seizures and pancreatitis are not associated with the administration of Tapazole. Enlargement of the salivary and cervical lymph glands occurs.

The nurse is teaching parents of toddlers about animal safety. Which should be included in the teaching session? a. Petting dogs in the neighborhood should be encouraged to prevent fear of dogs. b. The toddler is safe to approach an animal if the animal is chained. c. It is permissible for your toddler to feed treats to a dog. d. Teach your toddler not to disturb an animal that is eating.

ANS: D Parents should be taught that toddlers should not disturb an animal that is eating, sleeping or caring for young puppies or kittens. The child should avoid all strange animals and not be encouraged to pet dogs in the neighborhood. The child should never approach a strange dog that is confined or restrained. The inexperienced child should not feed a dog (if the child pulls back when the animal moves to take the food, this can frighten and startle the animal).

Parents tell the nurse that their child keeps scratching the areas where he has poison ivy. The nurse's response should be based on which knowledge? a. Poison ivy does not itch and needs further investigation. b. Scratching the lesions will not cause a problem. c. Scratching the lesions will cause the poison ivy to spread. d. Scratching the lesions may cause them to become secondarily infected.

ANS: D Poison ivy is a contact dermatitis that results from exposure to the oil urushiol in the plant. Every effort is made to prevent the child from scratching because the lesions can become secondarily infected. The poison ivy produces localized, streaked or spotty, oozing, and painful impetiginous lesions. Itching is a common response. Scratching the lesions can result in secondary infections. The lesions do not spread by contact with the blister serum or by scratching.

Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Moist skin b. Weight gain c. Fluid overload d. Poor wound healing

ANS: D Poor wound healing may be present in an individual with type 1 diabetes mellitus. Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus.

A child will start treatment for precocious puberty. The nurse recognizes that this will involve the injection of which synthetic medication? a. Thyrotropin b. Gonadotropins c. Somatotropic hormone d. Luteinizing hormone-releasing hormone

ANS: D Precocious puberty of central origin is treated with monthly subcutaneous injections of luteinizing hormone-releasing hormone. Thyrotropin, gonadotropins, and somatotropic hormone are not the appropriate therapies for precocious puberty.

According to Kohlberg, children develop moral reasoning as they mature. Which statement is most characteristic of a preschooler's stage of moral development? a. Obeying the rules of correct behavior is important. b. Showing respect for authority is important behavior. c. Behavior that pleases others is considered good. d. Actions are determined as good or bad in terms of their consequences.

ANS: D Preschoolers are most likely to exhibit characteristics of Kohlberg's preconventional level of moral development. During this stage, they are culturally oriented to labels of good or bad, right or wrong. Children integrate these concepts based on the physical or pleasurable consequences of their actions. Obeying the rules of correct behavior, showing respect for authority, and engaging in behavior that pleases others are characteristics of Kohlberg's conventional level of moral development.

Which prescribed treatment should the nurse plan to implement for a child with psoriasis? a. Antihistamines b. Oral antibiotics c. Topical application of calamine lotion d. Tar and exposure to sunlight and ultraviolet light

ANS: D Psoriasis is treated with tar preparations and exposure to ultraviolet B light or natural sunlight. Antihistamines, oral antibiotics, and topical application of calamine lotion are not effective in psoriasis.

13. The mother of a preterm newborn asks the nurse when she can start breastfeeding. The nurse should explain that breastfeeding can be initiated when her newborn: a.achieves a weight of at least 3 pounds. b.indicates an interest in breastfeeding. c.does not require supplemental oxygen. d.has adequate sucking and swallowing reflexes.

ANS: D Research supports that human milk is the best source of nutrition for term and preterm newborns. Preterm newborns should be breastfed as soon as they have adequate sucking and swallowing reflexes and no other complications such as respiratory complications or concurrent illnesses. Weight is not an issue. Interest in breastfeeding can be evaluated by having nonnutritive sucking at the breast during skin-to-skin kangaroo care so the mother and child may become accustomed to each other. Supplemental oxygen can be provided during breastfeeding by using a nasal cannula.

A nurse is planning play activities for school-age children. Which type of a play activity should the nurse plan? a. Solitary b. Parallel c. Associative d. Cooperative

ANS: D School-age children engage in cooperative play where it is organized and interactive. Playing a game is a good example of cooperative play. Solitary play is appropriate for infants, parallel play is an activity appropriate for toddlers, and associative play is an activity appropriate for preschool-age children.

Which following function of play is a major component of play at all ages? a. Creativity b. Socialization c. Intellectual development d. Sensorimotor activity

ANS: D Sensorimotor activity is a major component of play at all ages. Active play is essential for muscle development and allows the release of surplus energy. Through sensorimotor play, children explore their physical world by using tactile, auditory, visual, and kinesthetic stimulation. Creativity, socialization, and intellectual development are each functions of play that are major components at different ages.

34. A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. The nurse should explain that: a. this cannot be prevented. b. infants do not feel pain as adults do. c. this is not a good reason for refusing immunizations. d. a topical anesthetic, EMLA, can be applied before injections are given.

ANS: D Several topical anesthetic agents can be used to minimize the discomfort associated with immunization injections. These include EMLA (eutectic mixture of local anesthetic) and vapor coolant sprays. Pain associated with many procedures can be prevented and minimized by using the principles of atraumatic care. With preparation, the injection site can be properly anesthetized to decrease the amount of pain felt by the infant. Infants have the neural pathways to feel pain. Numerous research studies have indicated that infants perceive and react to pain in the same manner as do children and adults. The mother should be allowed to discuss her concerns and the alternatives available. This is part of the informed consent process.

24. Austin, age 6 months, has six teeth. The nurse should recognize that this is: a. normal tooth eruption. b. delayed tooth eruption. c. unusual and dangerous. d. earlier-than-normal tooth eruption.

ANS: D Six months is earlier than expected. Most infants at age 6 months have two teeth. Although unusual, it is not dangerous.

The nurse is caring for an 8-year-old child with type 1 diabetes. The nurse should teach the child to monitor for which manifestation of hypoglycemia? a. Lethargy b. Thirst c. Nausea and vomiting d. Shaky feeling and dizziness

ANS: D Some of the clinical manifestations of hypoglycemia include shaky feelings, dizziness, difficulty concentrating, speaking, focusing, or coordinating, sweating, and pallor. Lethargy, thirst, and nausea and vomiting are manifestations of hyperglycemia.

7. Which is a bright red, rubbery nodule with a rough surface and a well-defined margin that may be present at birth? a.Port-wine stain b.Juvenile melanoma c.Cavernous hemangioma d.Strawberry hemangioma

ANS: D Strawberry hemangiomas or capillary hemangiomas are benign cutaneous tumors that involve capillaries only. They are bright red, rubbery nodules with rough surfaces and well-defined margin. They may or may not be apparent at birth but enlarge during the first year of life and tend to resolve spontaneously by age 2 to 3 years. Port-wine stain is a vascular stain that is a permanent lesion and is present at birth. Initially it is a pink, red, or, rarely, purple stain of the skin that is flat at birth and thickens, darkens, and proportionately enlarges as the child grows. Melanoma is not differentiated into juvenile and adult forms. A cavernous hemangioma involves deeper vessels in the dermis and has a bluish red color and poorly defined margins.

Cellulitis is often caused by: a. herpes zoster. b. Candida albicans. c. human papillomavirus. d. Streptococcus or Staphylococcus organisms.

ANS: D Streptococci, staphylococci, and Haemophilus influenzae are the organisms usually responsible for cellulitis. Herpes zoster is the virus associated with varicella and shingles. C. albicans is associated with candidiasis, or thrush. Human papillomavirus is associated with various types of human warts

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by: a. fat. b. fruit juice. c. several glasses of water. d. complex carbohydrate and protein.

ANS: D Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein. Fat, fruit juice, and several glasses of water do not provide the child with complex carbohydrate and protein necessary to stabilize the blood glucose.

A nurse is planning care for a 17-month-old child. According to Piaget, which stage should the nurse expect the child to be in cognitively? a. Trust b. Preoperational c. Secondary circular reaction d. Tertiary circular reaction

ANS: D The 17-month-old child is in the fifth stage of the sensorimotor phase, tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Trust is Erikson's first stage. Preoperational is the stage of cognitive development usually present in older toddlers and preschoolers. Secondary circular reactions last from about ages 4 to 8 months.

Which characteristic best describes the gross motor skills of a 24-month-old child? a. Skips and can hop in place on one foot b. Rides tricycle and broad jumps c. Jumps with both feet and stands on one foot momentarily d. Walks up and down stairs and runs with a wide stance

ANS: D The 24-month-old child can go up and down stairs alone with two feet on each step and runs with a wide stance. Skipping and hopping on one foot are achieved by 4-year-old children. Jumping with both feet and standing on one foot momentarily are achieved by 30-month-old children. Tricycle riding and broad jumping are achieved at age 3.

The nurse is discussing with a child and family the various sites used for insulin injections. Which site usually has the fastest rate of absorption? a. Arm b. Leg c. Buttock d. Abdomen

ANS: D The abdomen has the fastest rate of absorption but the shortest duration. The arm has a fast rate of absorption but short duration. The leg has a slow rate of absorption but a long duration. The buttock has the slowest rate of absorption and the longest duration.

33. A parent asks the nurse whether her infant is susceptible to pertussis. The nurse's response should be based on which statement concerning susceptibility to pertussis? a. Neonates will be immune the first few months. b. If the mother has had the disease, the infant will receive passive immunity. c. Children younger than 1 year seldom contract this disease. d. Most children are highly susceptible from birth.

ANS: D The acellular pertussis vaccine is recommended by the American Academy of Pediatrics beginning at age 6 weeks. Infants are at greater risk for complications of pertussis. The vaccine is not given after age 7 years, when the risks of the vaccine become greater than those of pertussis. The infant is highly susceptible to pertussis, which can be a life-threatening illness in this age group.

The parents of a newborn say that their toddler "hates the baby, he suggested that we put him in the trash can so the trash truck could take him away." Which is the nurse's best reply? a. "Let's see if we can figure out why he hates the new baby." b. "That's a strong statement to come from such a small boy." c. "Let's refer him to counseling to work this hatred out. It's not a normal response." d. "That is a normal response to the birth of a sibling. Let's look at ways to deal with this."

ANS: D The arrival of a new infant represents a crisis for even the best-prepared toddler. Toddlers have their entire schedule and routines disrupted because of the new family member. The nurse should work with parents on ways to involve the toddler in the newborn's care and to help focus attention on the toddler. The toddler does not hate the infant. This is an expected response to the changes in routines and attention that affect the toddler. The toddler can be provided with a doll to tend to the doll's needs at the same time the parent is performing similar care for the newborn.

A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is: a. a sign the child is spoiled. b. a way to exert unhealthy control. c. regression, common at this age. d. ritualism, common at this age.

ANS: D The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain sameness and reliability. It provides a sense of comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. Ritualism is not indicative of a child who has unreasonable expectations, but rather normal development. Toddlers use ritualistic behaviors to maintain necessary structure in their lives. This is not regression, which is a retreat from a present pattern of functioning.

52. Which is most descriptive of the clinical manifestations observed in neonatal sepsis? a. Seizures and sunken fontanels b. Sudden hyperthermia and profuse sweating c. Decreased urinary output and frequent stools d. Nonspecific physical signs with hypothermia

ANS: D The clinical manifestations of neonatal sepsis are usually characterized by the newborn generally "not doing well." Poor temperature control, usually with hypothermia, lethargy, poor feeding, pallor, cyanosis or mottling, and jaundice, may be evident. Seizures and sunken fontanels are not manifestations of the sepsis. Severe neurologic sequelae may occur in low-birth-weight children with sepsis. Hyperthermia is rare in neonatal sepsis. Urinary output is not affected by sepsis.

A parent of a child with major burns asks the nurse why a high-calorie and high-protein diet is prescribed. Which response should the nurse make? a. The diet promotes growth. b. The diet will improve appetite. c. The diet will diminish risks of stress-induced hyperglycemia. d. The diet will avoid protein breakdown.

ANS: D The diet must provide sufficient calories to meet the increased metabolic needs and enough protein to avoid protein breakdown. Healing, not growth is the primary consideration. Many children have poor appetites, and supplementation will be necessary. Hypoglycemia, not hyperglycemia, can occur from the stress of burn injury because the liver glycogen stores are rapidly depleted.

Trauma to which site can result in a growth problem for children's long bones? a. Matrix b. Connective tissue c. Calcified cartilage d. Epiphyseal cartilage plate

ANS: D The epiphyseal cartilage plate is the area of active growth. Bone injury at the epiphyseal plate can significantly affect subsequent growth and development. Trauma or infection can result in deformity. The matrix, connective tissue, and calcified cartilage are not areas of active growth. Trauma in these sites will not result in growth problems for the long bones.

5. The parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infant's stools. The nurse's explanation of this is based on which statement? a. Child should not be given fibrous foods until digestive tract matures at age 4 years. b. Child should not be given any solid foods until this digestive problem is resolved. c. This is abnormal and requires further investigation. d. This is normal because of the immaturity of digestive processes at this age.

ANS: D The immaturity of the digestive tract is evident in the appearance of the stools. Solid foods are passed incompletely broken down in the feces. An excess quantity of fiber predisposes the child to large, bulky stools. This is normal for the child and is a normal part of the maturational process, no further investigation is necessary.

The family of a 4-month-old infant will be vacationing at the beach. Which should the nurse teach the family about exposure of the infant to the sun? a. Use sun block on the infant's nose and ear tips. b. Use topical sunscreen product with a sun protective factor of 15. c. The infant can be exposed to the sun for 15-minute increments. d. Keep the infant in total shade at all times.

ANS: D The infant should be kept out of the sun or be physically shaded from it. Fabric with a tight weave, such as cotton, offers good protection. Infants should be covered with clothing or in the shade to prevent sun damage on the delicate skin at all times. The blocker can protect the nose and ear tips, but none of the infant's skin should be exposed. Sunscreens should not be used extensively on infants younger than 6 months.

A child's skeletal age is best determined by: a. assessment of dentition. b. assessment of height over time. c. facial bone development. d. radiographs of the hand and wrist.

ANS: D The most accurate measure of skeletal age is radiologic examinations of the growth plates. These are the epiphyseal cartilage plates. Radiographs of the hand and wrist provide the most useful screening to determine skeletal age. Age of tooth eruption has considerable variation in children. It would not be a good determinant of skeletal age. Assessment of height over time will provide a record of the child's height but not skeletal age. Facial bone development will not reflect the child's skeletal age, which is determined by radiographic assessment.

Which is now referred to as the "new morbidity"? a. Limitations in the major activities of daily living b. Unintentional injuries that cause chronic health problems c. Discoveries of new therapies to treat health problems d. Behavioral, social, and educational problems that alter health

ANS: D The new morbidity reflects the behavioral, social, and educational problems that interfere with the child's social and academic development. It is currently estimated that the incidence of these issues is from 5% to 30%. Limitations in major activities of daily living and unintentional injuries that result in chronic health problems are included in morbidity data. Discovery of new therapies would be reflected in changes in morbidity data over time

A nurse is preparing to feed a 12-month-old infant with failure to thrive. Which intervention should the nurse implement? a. Provide stimulation during feeding. b. Avoid being persistent during feeding time. c. Limit feeding time to 10 minutes. d. Maintain a face-to-face posture with the infant during feeding.

ANS: D The nurse preparing to feed an infant with failure to thrive should maintain a face-to-face posture with the infant when possible. Encourage eye contact and remain with the infant throughout the meal. Stimulation is not recommended, a quiet, unstimulating atmosphere should be maintained. Persistence during feeding may need to be implemented. Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. Although forced feeding is avoided, "strictly encouraged" feeding is essential. The length of the feeding should be established (usually 30 minutes), limiting the feeding to 10 minutes would make the infant feel rushed.

55. Which should the nurse anticipate in the newborn whose mother used cocaine during pregnancy? a. Seizures b. Hyperglycemia c. Cardiac and respiratory problems d. Neurobehavioral depression or excitability

ANS: D The nurse should anticipate neurobehavioral depression or excitability and implement care directed at the newborn's manifestations. Few or no neurologic sequelae appear in newborns born to mothers who use cocaine during pregnancy. The newborn is usually a poor feeder, so hypoglycemia would be a more likely occurrence. Cardiac and respiratory problems are usually not evident in these newborns.

A parent asks the nurse about negativism in toddlers. Which is the most appropriate recommendation? a. Punish the child. b. Provide more attention. c. Ask child not always to say "no." d. Reduce the opportunities for a "no" answer.

ANS: D The nurse should suggest to the parent that questions be phrased with realistic choices rather than yes or no answers. This provides the toddler with a sense of control and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention, the child is testing limits to gain an understanding of the world. The toddler is too young to be asked to not always say "no."

25. The parents of a newborn who has just died decide they want to hold their deceased infant. The most appropriate nursing intervention at this time is to: a. explain gently that this is no longer possible. b. encourage parents to accept the loss of their newborn. c. offer to take a photograph of their newborn because they cannot hold newborn. d. get the newborn, wrap in a blanket, and rewarm in a radiant warmer so parents can hold their deceased infant.

ANS: D The parents should be allowed to hold their newborn in the hospital setting. The newborn's body should be retrieved and rewarmed in a radiant warmer. The nurse should provide a private place where the parents can hold their child for a final time. A photograph is an excellent idea, but it does not replace the parents' need to hold the child.

A nurse observes a toddler playing with sand and water. The nurse appropriately documents this type of play as _____ play. a. skill b. dramatic c. social-affective d. sense-pleasure

ANS: D The toddler playing with sand and water is engaging in sense-pleasure play. This is characterized by nonsocial situations in which the child is stimulated by objects in the environment. Infants engage in skill play when they persistently demonstrate and exercise newly acquired abilities. Dramatic play is the predominant form of play in the preschool period. Children pretend and fantasize. Social-affective play is one of the first types of play in which infants engage. The infant responds to interactions with people.

The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their child. Which is most likely lacking in their particular diet? a. Fat b. Protein c. Vitamins C and A d. Complete protein

ANS: D The vegetarian diet can be extremely healthy, meeting the overall nutrition objectives for Healthy People. Parents should be taught about food preparation to ensure that complete proteins are available for growth. When parents use a strict vegetarian diet, likelihood exists of inadequate protein for growth and calories for energy. Fat and vitamins C and A are readily available from vegetable sources. Plant proteins are available. Foods must be combined to provide complete proteins for growth.

Which vitamin is recommended for all women of childbearing age to reduce the risk of neural tube defects such as spina bifida? a. A b. C c. Niacin d. Folic acid

ANS: D The vitamin supplement that is recommended for all women of childbearing age is a daily dose of 0.4 mg of folic acid. Folic acid taken before conception and during pregnancy can reduce the risk of neural tube defects by 70%. No correlation exists between vitamins A, C, or folic acid and neural tube defects.

9. The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurse's response should be based on knowledge that this is: a. unacceptable because of the risk of sudden infant death syndrome (SIDS). b. unacceptable because it does not encourage achievement of developmental milestones. c. acceptable to encourage fine motor development. d. acceptable to encourage head control and turning over.

ANS: D These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs and then be placed on their abdomens when awake to enhance development of milestones such as head control. The face-down position while awake and on the back for sleep are acceptable because they reduce risk of SIDS and allow achievement of developmental milestones. These position changes encourage gross motor, not fine motor, development.

In terms of fine motor development, which should the 3-year-old child be expected to do? a. Lace shoes and tie shoelaces with a bow. b. Use scissors to cut pictures, and print a few numbers. c. Draw a person with seven parts and correctly identify the parts. d. Draw a circle and name what has been drawn.

ANS: D Three-year-olds are able to accomplish this fine motor skill. Being able to lace shoes and tie shoelaces with a bow, use scissors to cut pictures, and print a few numbers, or draw a person with seven parts and correctly identify the parts are fine motor skills of 4- or 5-year-olds

Which should the nurse expect of a healthy 3-year-old child? a. Jump rope. b. Ride a two-wheel bicycle. c. Skip on alternate feet. d. Balance on one foot for a few seconds.

ANS: D Three-year-olds are able to accomplish this gross motor skill. Jumping rope, riding a two-wheel bicycle, and skipping on alternate feet are gross motor skills of 5-year-olds.

Which factor is most important in predisposing toddlers to frequent infections? a. Respirations are abdominal. b. Pulse and respiratory rates are slower than those in infancy. c. Defense mechanisms are less efficient than those during infancy. d. Toddlers have a short, straight internal ear canal and large lymph tissue.

ANS: D Toddlers continue to have the short, straight internal ear canal of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose the toddler to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy

The nurse is talking to the parents of a child with pediculosis capitis. Which should the nurse include when explaining how to manage pediculosis capitis? a. "You will need to cut the hair shorter if infestation and nits are severe." b. "You can distinguish viable from nonviable nits, and remove all viable ones." c. "You can wash all nits out of hair with a regular shampoo." d. "You will need to remove nits with an extra-fine tooth comb or tweezers."

ANS: D Treatment consists of the application of pediculicide and manual removal of nit cases. An extra-fine tooth comb facilitates manual removal. Parents should be cautioned against cutting the child's hair short, lice infest short hair as well as long. It increases the child's distress and serves as a continual reminder to peers who are prone to tease children with a different appearance. It is not possible to differentiate between viable and nonviable eggs. Regular shampoo is not effective, a pediculicide is necessary.

The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing is necessary for which? a. Glucose is needed before administration of insulin. b. Glucose is needed four times a day. c. Glycosylated hemoglobin is required. d. Ketonuria is suspected.

ANS: D Urine testing is still performed to detect evidence of ketonuria. Urine testing for glucose is no longer indicated because of the poor correlation between blood glucose levels and glycosuria. Glycosylated hemoglobin analysis is performed on a blood sample.

22. The nurse has been caring for a newborn who just died. The parents are present but say they are "afraid" to hold the dead newborn. Which is the most appropriate nursing intervention? a.Tell them there is nothing to fear. b.Insist that they hold newborn "one last time." c.Respect their wishes and release body to morgue. d.Keep newborn's body available for a few hours in case they change their minds.

ANS: D When the parents are hesitant about holding and touching their newborn, the nurse should keep the newborn's body for a few hours. Many parents change their minds after the initial shock of the newborn's death. This will provide the parents time to see and hold their newborn if they desire. Stating that there is nothing to fear minimizes the parents' feelings. The nurse should allow the family to parent their child as they wish in death, as in life. Many parents change their minds, if possible, the nurse should wrap the newborn in blankets and keep the newborn's body on the unit for a few hours.

2. Which are clinical manifestations of postmaturity in the newborn? (Select all that apply.) a. Excessive lanugo b. Increased subcutaneous fat c. Absence of scalp hair d. Parchment-like skin e. Minimal vernix caseosa f. Long fingernails

ANS: D, E, F In postmature newborns, the skin is often cracked, parchment-like, and desquamating, there is little to no vernix caseosa, and fingernails are long. Lanugo is usually absent in postmature newborns. Subcutaneous fat is usually depleted, giving the child a thin, elongated appearance. Scalp hair is usually abundant.

3. The nurse is preparing to care for a newborn receiving phototherapy. Which interventions are appropriate? (Select all that apply.) a. Avoid stimulation. b. Decrease fluid intake. c. Expose all the newborn's skin. d. Monitor skin temperature closely. e. Reposition the newborn every 2 hours. f. Cover the newborn's eyes with eye shields or patches.

ANS: D, E, F Several nursing interventions are instituted to protect the newborn during phototherapy. Temperature is closely monitored to prevent hyperthermia or hypothermia. The newborn is repositioned every 2 hours to maximize exposure to the phototherapy and to prevent skin breakdown. The infant's eyes are shielded by an opaque mask to prevent exposure to the light. The newborn is clothed in a diaper because a side effect of phototherapy includes loose, greenish stools. Other side effects include increased metabolic rate, dehydration, electrolyte disturbances, such as hypocalcemia, and priapism. Infants receiving phototherapy may require additional fluid volume to compensate for insensible and intestinal fluid loss. The infant should receive adequate stimulation, which includes feeding and touching.