Peds Final

A 7-year-old child shows symptoms of anaphylactic shock. Which of the following would be most appropriate for the nurse to do immediately? Select all that apply. A. Administer epinephrine as ordered. B. Increase fluid intake. C. Teach the child how to use an EpiPen. D. Administer oxygen. E. Initiate intravenous access.

A,D,E

The nurse is taking a health history for a 9-year-old with conjunctivitis. Which statement by the parents leads the nurse to suspect that the child is experiencing allergic conjunctivitis? A: "He recently helped clean the basement. B: "He was exposed to several family members with an infection. C: He just recovered from an upper respiratory infection. D: We have a family history of conjunctivitis.

ANS: A Rationale: Allergic conjunctivitis may be induced by animal dander, dust mites, or some other ever-present antigen. Exposure to infective agents is related to infectious conjunctivitis. Recent upper respiratory infection and a family history of conjunctivitis are not contributing factors for allergic conjunctivitis.

A child is diagnosed with hemolytic-uremic syndrome (HUS). Review of the child's laboratory test results would reveal which finding? A. Decreased blood urea nitrogen (BUN) and creatinine B. Decreased platelets and leukocytosis C. Hypernatremia and hypokalemia D. Respiratory acidosis and proteinuria

ANS: B Rationale: The child with HUS typically exhibits severe thrombocytopenia (decreased platelets) and leukocytosis. BUN and creatinine are elevated. Hyponatremia, hyperkalemia, metabolic acidosis, and proteinuria also may be noted.

A nurse is reading a journal article about adolescents and major causes of injuries in this age group. The nurse demonstrates understanding of this information by identifying which situation as the major cause of adolescent injuries? A. Drowning B. Motor vehicle crashes C. Violence D. Suicide

B. Motor vehicle crashes

The child has been diagnosed with rickets. The child's mother is educated about the importance of providing the child with 10 micrograms (400 International Units) of an oral vitamin D supplement each day. The child's mother purchases over-the-counter vitamin D drops. The supplement is noted to contain 5 mcg of vitamin D in each 0.5 mL. How much of the supplement should the mother administer to the child each day? Record your answer using one decimal place

1

A 10-year-old boy has just arrived by ambulance at the emergency room following a motor vehicle accident, and a nurse is assessing him. Which three body systems should the nurse evaluate fist? A. Respiratory, cardiovascular, and neurologic B. Cardiovascular, gastrointestinal, and neurologic C. Respiratory, cardiovascular, and skeletal D. Neurologic, cardiovascular, and endocrine

A

A 13-year-old boy has had a near-drowning experience. The nurse notices he has labored breathing and a cough. Which of the following would be the priority? A. Administering 100% oxygen by mask B. Having the child sit up straight in a chair C. Checking his capillary refill time D. Providing sedation as ordered

A

A nurse is preparing a presentation for a parent group about media and school-aged children. Which of the following would the nurse most likely include in the presentation? Select all that apply. A. Media use is displacing other activities in a child's life. B. Children watch about 2 hours of television on average per day. C. Programs viewed often glamorize violence. D. A child's weight decreases with the number of hours spent watching television. E. Risky behaviors are often portrayed with little emphasis on consequences.

A. Media use is displacing other activities in a child's life. C. Programs viewed often glamorize violence. E. Risky behaviors are often portrayed with little emphasis on consequences.

A 12-year-old girl has recently begun menstruating and is well into puberty. She is visiting the doctor today for a routine physical examination. Which of the following findings should cause concern in the nurse? A. Vulvar irritation B. Irregular periods C. Breasts of slightly different sizes D. Supernumerary nipple

A. Vulvar irritation

The parent of a four year-old child has expressed concern that the child is wetting her bed several times each week. What should the nurse teach the parent? A. Bed wetting is not an unexpected behavior at this age B. The child's fluid intake should be limited after 3:00 p.m. C. The parents should try to dialogue with the child about possible causes and solutions D. The parents should provide incentives for keeping the bed dry

ANS: A

A child with attention deficit hyperactivity disorder (ADHD) is prescribed methylphenidate hydrochloride. What should the nurse instruct the parents regarding an adverse effect of this medication? A: Anorexia B: Sleepiness C: Garbled speech D: Rapid increase in height

ANS: A Rationale: An adverse effect of methylphenidate hydrochloride is anorexia. Sleepiness and garbled speech are not adverse effects of this medication. Children taking this medication can develop growth suppression and not accelerated growth in height.

A 3-year-old child is brought to the emergency department after swallowing batteries taken from a grandparent's hearing aids. The parents believe that two batteries were swallowed. What should the nurse explain to the parents regarding the care that the child will need at this time? A. Activated charcoal so that the child will vomit the batteries B. Preparation for an emergency endoscopy to remove the batteries C. Oxygen to ensure that the child's blood is thoroughly oxygenated D. Emergency intubation to ensure that the child has an adequate airway

B

Which nursing intervention is the priority for the immobilized child in an acute care setting? A. Ambulate the child up and down the hall twice a day. B. Offer age-appropriate toys and diversional activities. C. Take the child to the playroom at least once a day. D. Encourage active and passive range of motion exercises once a day.

B. Offer age-appropriate toys and diversional activities.

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

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

The nurse is assessing the eyes of a 6-month-old and notices that she has wide-spaced eyes and bilateral epicanthal folds. Which condition associated with these findings should also be assessed for in this child? A. Low-set, malformed ears B. Amblyopia C. Strabismus D. Ptosis

ANS: A Rationale: Hypertelorism is congenital, abnormally wide-spaced eyes. Detecting true hypertelorism in children is important, because this condition is associated with chromosomal abnormalities such as Cri-du-chat syndrome. Cri-du-chat syndrome is an abnormality on chromosome 5 and is associated with intellectual and developmental disability. Children with this syndrome also have short stature, microcephaly, a simian crease and a weak, cat-like cry during infancy. None of the other conditions is associated with hypertelorism.

A child with Addison's disease has been admitted with a history of nausea and vomiting for the past 3 days. The client is receiving IV glucocorticoids. Which intervention would the nurse implement? A. Take glucometer readings as ordered B. Measure intake and output C. Monitor sodium and potassium levels D. Weigh daily

ANS: A Rationale: IV glucocorticoids raise the glucose levels and often require coverage with insulin. Measuring the intake and output at this time is not necessary. Sodium and potassium would be monitored when the client is receiving mineralcorticoids. Daily weights are not necessary at this time.

The nurse is conducting an assessment of a 5-year-old client. During the assessment, the nurse notes that the child does not maintain eye contact or speak. The nurse suspects an autism spectrum disorder. Which additional finding would help support the nurse's suspicion? A: The child constantly opens and closes the hands. B: The child is highly active and inattentive. C: The child has a slight decrease in head circumference. D: The child has a long face and a prominent jaw.

ANS: A Rationale: Repetitive motor mannerisms such as constantly opening and closing the hands are a typical behavior pattern for autism spectrum disorder. A high level of activity and inattentiveness are typical symptoms of intellectual disability. Decrease in head circumference suggests malnutrition or decelerating brain growth. A long face and prominent jaw are symptoms of fragile X syndrome.

A child has been admitted to the acute care facility for the management of dehydration. The nurse is preparing to administer intravenous fluid replacement to the child. Which fluids are suitable for use? Select all that apply. A: Lactated Ringer B: Normal saline C: 5% dextrose in water D: 0.45% saline E: 10% dextrose in water

ANS: A, B Rationale: Intravenous fluids can be used to treat dehydration. The fluids used need to be isotonic. Examples of isotonic fluids include normal saline and ringer lactate solution.

A 9-year-old girl has just been diagnosed with graves disease. Which symptom should the nurse expect in this child? Select all that apply. A. Exophthalmos (protruding eyes) B. Moist skin C. Nervousness D. Increased basal metabolic rate E. Obesity F. Lethargy

ANS: A, B, C, D Rationale: In Graves disease, children gradually experience nervousness, tremors, loss of muscle strength, and easy fatigue. Their basal metabolic rate, blood pressure, and pulse all increase. Their skin feels moist and they perspire freely. An exophthalmos-producing pituitary substance causes the prominent-appearing eyes that accompany hyperthyroidism in some children. Obesity and lethargy are symptoms of hypothyroidism, not of Graves disease (hyperthyroidism).

The infant weighs 7 lb 4 oz (3,248 g) at birth. If the infant is following a normal pattern of growth, what would be the expected weight for this child at the age of 12 months? A. 14 lb 8 oz (6.6 kg) B. 21 lb 12 oz (9.9 kg) C. 25 lb (11.3 kg) D. 28 lb 4 oz (12.8 kg)

ANS: B Rationale: The average weight of a newborn is 7.5 lb (3400 g). The infant gains about 30 g each day. By four months of age, the infant has doubled the birthweight. By 1 year of age, the infant has tripled the birthweight and has grown 10 to 12 in (25 to 30 cm). 7.25 lb 3 = 21.75 lb or 21 lb 12 oz

Which piece of equipment is most helpful in determining airway obstruction in the client with asthma? A. A nebulizer B. An inhaler C. A peak flow meter D. An incentive spirometer

ANS: C Rationale: The peak flow meter provides the most reliable early sign of an asthma episode. Most episodes begin gradually, and a drop in peak flow can alert the client to begin medications before symptoms actually are noticeable. A nebulizer and inhaler treat symptoms. An incentive spirometer is used for lung expansion, especially after surgery.

The nurse is administering digoxin as ordered and the child vomits the dose. What should the nurse do next? A. Contact the physician. B. Offer a snack and administer another dose. C. Immediately administer another dose. D. Administer next dose as ordered in 12 hours.

ANS: D Rationale: Digoxin should be administered at regular intervals, every 12 hours, 1 hour before or 2 hours after feeding. If the child vomits digoxin, the nurse should not give a second dose and should wait until the next scheduled dose. It is not necessary to contact the physician.

A 3-year-old child is admitted to the hospital with osteomyelitis of the right femur. The nurse would expect to start an IV and antibiotic after blood is drawn for which lab test? A. Hemoglobin and hematocrit B. White blood cell count C. Culture D. Platelets

C. Culture

In the emergency room, the nurse is assessing a toddler who is currently being treated for a radius fracture and has a history of multiple fractures. The assessment reveals short stature, blue sclera, and no bruising or swelling at the fracture site. The nurse suspects: A. Child abuse. B. Attention deficit/hyperactivity disorder. C. Osteogenesis imperfecta. D. Lack of parental supervision.

C. Osteogenesis imperfecta.

The nurse receives a report from the admission department that a child with a slipped femoral epiphysis is en route to the care area. For which type of child should the nurse begin to plan care? A. Tall, thin female B. Preadolescent female C. Active school-age male D. Obese preadolescent male

D. Obese preadolescent male

During a complete physical assessment of a preteen boy, the nurse correctly recognizes which finding as being the first change of puberty? A. Increase in height B. Deepening voice C. Development of axillary hair D. Testicular enlargement

D. Testicular enlargement

A school-age child is hospitalized with a fractured left femur. The child is in balanced skeletal traction and is in pain. Orders read "Morphine 2.5 mg IV q 3 hours for severe pain." How many mL of morphine would the nurse administer if the medication on hand is morphine 8 mg/1 mL? Record your answer using two decimal places.

0.31

When describing play by the school-aged child to a group of nursing students, the instructor would emphasize the need for which of the following? A. Rules B. Recreation C. Physical activity D. Ritualism

A. Rules

The nurse is caring for a school-age child recovering from an open reduction for a fractured femur. Which assessment findings indicate that the child is developing an infection? Select all that apply. A. Lethargy B. Increased pulse rate C. Reduced pulse in the ankle D. Cyanosis of the casted foot E. Increased body temperature

A. Lethargy B. Increased pulse rate E. Increased body temperature

Parents usually ask when their child can return to school after having chickenpox. The correct answer would be: A. not until all lesions have completely faded. B. as soon as the temperature is normal. C. 10 days after the initial lesions appear. D. as soon as all lesions are crusted.

ANS: D Rationale: Chickenpox lesions are infectious until they crust.

An infant is brought to the emergency department with acetaminophen poisoning. Which medication should the nurse expect to administer to this child? A. Iron B. Deferoxamine C. Acetylcysteine D. Dexamethasone

C

A nurse is caring for a stable toddler diagnosed with accidental poisoning due to the ingestion of cleaning solution. What must be included in teaching parents about how to protect a toddler from accidental poisoning? A. Closely monitor the toddler's activity. B. Label poisonous solutions. C. Keep cleaning solutions locked up. D. Do not leave the toddler alone.

C

An anxious 12-year-old girl receives an injection from the nurse and sighs with relief when it is done. After a moment of reflection, the girl asks the nurse, "Is it hard to give someone an injection?" This girl's question is evidence that she has developed which cognitive skill? A. Decentering B. Accommodation C. Conservation D. Class inclusion

A. Decentering The ability to project one's self into other people's situations and see the world from their viewpoint rather than focusing only on their own,

A school health nurse is supporting a 15-year-old young woman with acne. What is a common myth related to acne in adolescent populations? A. Diet plays a significant role in acne production. B. Do not pick or squeeze acne lesions because it will just increase symptoms. C. Excessive face washing is not necessary to prevent lesions from forming. D. Makeup may increase lesion formation.

A. Diet plays a significant role in acne production.

A child is brought into the emergency department. After assessing a child's airway, breathing, and circulation (ABCs), which of the following would the nurse do next? A. Obtain a full set of vital signs. B. Remove the child's clothing. C. Provide pain management. D. Assess level of consciousness.

D

A child presents to the emergency department via ambulance in critical condition following a traumatic motor vehicle crash. What would the first action of the nurse be? A. Update the parent and obtain consent to treat B. Remove the child's clothing to assess for injury C. Begin circulation/cardiac assessment and count the pulse D. Assess the child's airway and manage airway patency

D

A child is exhibiting symptomatic bradycardia that has been unresponsive to ventilation and oxygenation. Which of the following would the nurse expect to be administered? A. Atropine B. Sodium bicarbonate C. Naloxone D. Calcium carbonate

A

The nurse is called into a toddler's room. The child's mother says "he's having trouble breathing." What should the nurse do first? A. Assess patency of the child's airway. B. Place the child on 100% oxygen. C. Notify the physician. D. Apply a pulse oximeter to monitor oxygen levels.

A

The nurse is caring for a 24-month-old child with a fever of 101°F. The child also exhibits a toxic appearance. Which of the following would the nurse expect to implement? A. Administering antibiotics as ordered B. Performing a complete septic work up C. Obtaining a specimen for a complete blood count D. Replacing fluid deficits orally

A

A young child is brought to the emergency department and requires advanced life support. The nurse is preparing to administer medication to maintain the child blood pressure and systemic perfusion. Which of the following might the nurse administer? A. Epinephrine B. Dopamine C. Dobutamine D. Atropine E. Glucose

A,B,C

The nurse is caring for a 5-year-old girl. During a routine wellness examination, the mother tells the nurse that the girl's father has enrolled her in a mini pom-pom cheering squad. The girl dislikes it immensely, but her father doesn't want the girl to be a "quitter." The mother asks for some guidance. How should the nurse respond? A. "Bad experiences can cause her to avoid other similar activities" B. "Tell your husband that requiring her to continue is inappropriate" C. "Your daughter may not be able to keep up with the instructions" D. "This may not suit your child's temperament or her physical abilities"

A. "Bad experiences can cause her to avoid other similar activities"

The nurse is caring for a 5-year-old child. The child's parent reports that the parent and child are constantly fighting about the child's choice of clothing. The child insists on selecting ones own clothes. The parent is tired of the power struggle and is embarrassed by the child's mismatched apparel. The parent asks for guidance. How should the nurse respond? A. "Offer two or three coordinated outfits and let the child choose." B. "Lay the clothes out in the order in which they are to be put on." C. "Only give your child clothes that are easy to put on." D. "Remind your child of the importance of dressing appropriately."

A. "Offer two or three coordinated outfits and let the child choose."

Jerry and his mother have come to the office for a routine visit. In the hall away from Jerry, his mother relates to the nurse that she is concerned because Jerry is playing games that girls play, and has noticed that when he plays any role-playing games his character is very feminine. She tells the nurse that she is worried about Jerry's sexual orientation. What is the best response to her concerns? A. "This behavior may be exploratory or reflect peer pressure, so avoid making assumptions about his sexual orientation." B. "Make sure that you do not allow him to play any of these games and be sure to get him some manly games." C. "Pay close attention to the activities that he is participating in because this has been shown to decrease these behaviors." D. "This is a concern. Examine what you are exposing him to because this could affect his behavior."

A. "This behavior may be exploratory or reflect peer pressure, so avoid making assumptions about his sexual orientation."

An male adolescent comes to the clinic for a routine health care followup accompanied by the parents. During the visit, the parents tell the nurse, "Our son just doesn't seem to listen to us anymore. It's like he's tuning us out. Is there anything we can do to get him to hear what we're saying to him?" Which suggestions would be appropriate for the nurse to offer? Select all that apply. A. "When you talk to him, speak to him face to face and be careful of your body language." B. "Don't be afraid to ask him questions about why he feels a certain way." C. "Choose words carefully to make sure that he understands you." D. "Tell him firmly that you have the answers because you are his parents." E. "Talk to you son as an equal and don't talk down to him."

A. "When you talk to him, speak to him face to face and be careful of your body language." B. "Don't be afraid to ask him questions about why he feels a certain way." C. "Choose words carefully to make sure that he understands you." E. "Talk to you son as an equal and don't talk down to him."

A 13-year-old girl has grown rapidly in height over the past 2 years and is taller than most of the boys in her class. She wonders when she will stop growing. What should the nurse tell her as a general guideline for the ages at which most girls stop growing? A. 16 to 17 years old B. 14 to 15 years old C. 18 to 19 years old D. 20 to 21 years old

A. 16 to 17 years old

7. A nurse is working with the local community on promoting physical fitness for children. The nurse encourages the community to develop programs that meet the needs of the school-aged child for physical activity, based on the understanding that this age group requires how much physical activity daily? A. 60 minutes B. 15 minutes C. 30 minutes D. 90 minutes

A. 60 minutes

A 3-year-old demonstrates lateral bowing of the tibia. Which signs would indicate that the boy's condition is Blount disease rather than the more typical developmental genu varum? A. A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray B. The medial surfaces of the knees are more than 2 in apart C. The malleoli are touching D. The condition is bilateral

A. A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray

A nurse is working with a 12-year-old girl with osteomyelitis who is recovering from surgery. What nursing interventions should be implemented? Select all that apply. A. Administration of IV antibiotics at the hospital B. Instruct the parents on how to care for an IV line at home C. Instruct the parents regarding the importance of maintaining bed rest D. Institute infection-control precautions related to drainage tubes E. Cast care of the affected limb F. Instruction to the parents regarding proper traction of the limb

A. Administration of IV antibiotics at the hospital B. Instruct the parents on how to care for an IV line at home C. Instruct the parents regarding the importance of maintaining bed rest D. Institute infection-control precautions related to drainage tubes

A 13-year-old girl tells the nurse during a gynecological visit that a friend of hers developed toxic shock syndrome from tampon use. The client says that tampons work well for her, but she wonders whether they are safe. Which of the following recommendations should the nurse give this client to help prevent toxic shock syndrome? A. Alternate use of tampons with sanitary pads B. Use the highest absorbency tampon possible C. Insert two tampons at a time D. Use feminine hygiene sprays in conjunction with tampons

A. Alternate use of tampons with sanitary pads

The nurse is caring for a child diagnosed with a sprain of the lower extremity. Which health care prescription(s) would the nurse clarify with the provider before implementing? Select all that apply. A. Apply a heating pad four times daily for 20 minutes per application B. Offer aspirin (ASA) three times daily orally to the child for pain and inflammation C. Avoid bearing weight on the affected extremity for 3 to 4 days D. Compress the site using an elastic bandage to wrap the area E. Assure the parents understand when to return and to call or follow-up with concerns

A. Apply a heating pad four times daily for 20 minutes per application B. Offer aspirin (ASA) three times daily orally to the child for pain and inflammation

The nurse is creating a care plan for a child with a leg cast. What interventions would be appropriate for the nursing diagnosis of Risk for ineffective peripheral tissue perfusion related to pressure from cast? Select all that apply. A. Assess foot and toes every 4 hours for color, warmth, and presence of pedal pulses. B. Keep leg elevated by a pillow at all times. C. Remind the parents to not allow the child to put anything in the cast. D. Assess capillary refill of toes every 4 hours. E. Educate the child's parents on use of good body mechanics when repositioning the child.

A. Assess foot and toes every 4 hours for color, warmth, and presence of pedal pulses. B. Keep leg elevated by a pillow at all times. D. Assess capillary refill of toes every 4 hours.

The student nurse is preparing a presentation on bones and bone growth. What information should the student include? Select all that apply. A. Calcium and vitamin D play important roles in bone growth and bone breakdown. B. Calcitonin plays a role in remodeling of bone. C. Adipose cell formation happens in the red bone marrow. D. Periosteum is the outer covering of the bone. E. The diaphysis is the rounded end portion of the bone.

A. Calcium and vitamin D play important roles in bone growth and bone breakdown. B. Calcitonin plays a role in remodeling of bone. D. Periosteum is the outer covering of the bone.

A nurse is carrying on a conversation with a 7-year-old girl during an office visit. Which of the following is an example of the level of language development the nurse should expect in this child? A. Difficulty understanding the concept of "half past" in reference to time B. Ability to carry on an adult conversation C. Inability to speak in full sentences D. Fascination with bathroom language

A. Difficulty understanding the concept of "half past" in reference to time

A nurse is admitting a 16-year-old male to the floor for an appendectomy. How can the nurse prepare this client for hospitalization? Select all that apply. A. Encourage him to keep his cell phone nearby to communicate with his friends. B. Interview the adolescent separately from the parent to allow expression of information that he may not be comfortable sharing in front of the parent. C. Remind him that there are strict rules regarding meal times and when lights are turned out on the floor. D. Encourage parents to do as much as possible for the client, including ADLs and meal selection. E. Provide privacy when client is changing into the hospital gown or going to the bathroom.

A. Encourage him to keep his cell phone nearby to communicate with his friends. B. Interview the adolescent separately from the parent to allow expression of information that he may not be comfortable sharing in front of the parent. E. Provide privacy when client is changing into the hospital gown or going to the bathroom.

The father of a 12-year-old girl reports his daughter does not have high self-esteem. He asks for suggestions to increase her feels of self-worth. What activities would be appropriate for the nurse to suggest? Select all that apply. A. Encourage the child to join a club at school. B. Recommend she begin to participate in after-school activities. C. Provide her with a weekly allowance. D. Allow the child to begin staying home alone after school when possible. E. Recommend the child investigate opportunities for volunteering at local charities

A. Encourage the child to join a club at school. B. Recommend she begin to participate in after-school activities. E. Recommend the child investigate opportunities for volunteering at local charities

A nurse is working with a family that has two children who were identified as overweight based on screening. Which of the following strategies would be important for the nurse to include in assisting the family? Select all that apply. A. Encouraging moderate exercise for 60 minutes/day B. Emphasizing that the family not skip meals C. Involving the entire family in the program D. Focusing on rapid weight loss regimens E. Using food as a punishment

A. Encouraging moderate exercise for 60 minutes/day B. Emphasizing that the family not skip meals C. Involving the entire family in the program

The nurse is conducting a routine physical examination of a newborn to screen for developmental DDH. The nurse correctly assesses the infant by placing the infant: A. In a prone position, noting asymmetry of the thigh or gluteal folds. B. With both legs extended and observes the hip and knee joint relationship. C. With both legs extended and observes the feet. D. In a supine position with both legs extended and observes the tibia/fibula.

A. In a prone position, noting asymmetry of the thigh or gluteal folds.

The nurse is describing the nutritional requirements of an adolescent to a local parent group. Which of the following would the nurse include as needing to be increased in the adolescent's diet? Select all that apply. A. Iron B. Folate C. Calcium D. Potassium E. Magnesium

A. Iron B. Folate C. Calcium

The parent of a teenager diagnosed with iron deficient anemia asks the nurse for help with incorporating more iron into the teens diet when packing lunches and snacks for school. Which foods would be good sources of iron that could be easily incorporated into the diet when taking lunches and snacks to school? Select all that apply. A. Peanut butter B. Eggs C. Oranges D. Strawberries E. Nuts

A. Peanut butter B. Eggs D. Strawberries E. Nuts

Linda, a 14-year-old, and her mother are in the office. As Linda goes to the bathroom, her mother stops the nurse and asks about the changes that Linda is going through. She would like to talk to her about sex and the changes but she is unsure of how to do this. As the nurse, which of the following would be appropriate for you to suggest? A. Promote open lines of communication, encourage listening, don't lecture, and share family values. B. Discuss with the adolescent the experiences that you had so that she can connect on a personal level. C. Encourage her to talk to her peers and teachers in health class about any concerns that she has. D. Do not initiate any conversation; let the teen come and seek you out for any advice and answers.

A. Promote open lines of communication, encourage listening, don't lecture, and share family values.

The nurse is reviewing the medical record for a 13-year-old child who is being seen for concerns about school attendance. The physician has noted the child has "school phobia". What behaviors may be noted in a child experiencing this phenomena? Select all that apply. A. Reports of fear when attending school B. Demonstrates negative behaviors before school C. Chronically late for school D. Reports of feeling bored at school E. Difficulty making friends

A. Reports of fear when attending school B. Demonstrates negative behaviors before school C. Chronically late for school

A nurse is preparing an in-service presentation about adolescent reproductive health for nurses who work in an adolescent health center. Which topics would the nurse plan to include in this presentation? Select all that apply. A. Safe sex B. Menstrual health C. Testicular self-examination D. Sexually transmitted infections E. Breast health

A. Safe sex B. Menstrual health C. Testicular self-examination D. Sexually transmitted infections E. Breast health

The mother of an 11-year-old child tells the nurse that her child seems to be "hungry all of the time" and seems to "never get full". The nurse suspects a physiological developmental problem. What is the rationale for the nurse suspecting a physiological developmental issue? Select all that apply. A. Stomach capacity increases, which should permit retention of food for longer periods of time B. The caloric needs of the school-age child are lower than in the earlier years of life C. School-age children typically consume less food than adolescents D. Peer pressure tends to cause the child to eat less E. The school-age child is very selective in the type of foods they prefer

A. Stomach capacity increases, which should permit retention of food for longer periods of time B. The caloric needs of the school-age child are lower than in the earlier years of life

Parents of an 8-year-old ask the nurse when they can stop using the booster seat in the car for their child. When responding to the parents, the nurse needs to keep in mind which of the following? Select all that apply. A. The child must be at least 4 ft 9 in. tall. B. It's okay to use the adult seat belt now based on his age. C. The child should be between 8 and 12 years of age. D. The child should wear the lap belt but not the shoulder belt. E. The lap belt must fit snugly over the child's stomach area.

A. The child must be at least 4 ft 9 in. tall. C. The child should be between 8 and 12 years of age.

A nurse in the clinic observes a school-age child pushing another child. The parent is watching without disciplining the child and tells the nurse, "He just does what he wants to and doesn't listen to anything I say." What can the nurse inform that parent about the development of self-confidence in the child? Select all that apply. A. The child needs consistent rules to develop self-confidence. B. The child needs to be able to do what he wants to develop self-confidence. C. The child needs positive attention to develop self-confidence. D. The child needs clear expectations to develop self-confidence. E. The child needs to make his own decisions about behavior to develop self-confidence.

A. The child needs consistent rules to develop self-confidence. C. The child needs positive attention to develop self-confidence. D. The child needs clear expectations to develop self-confidence.

The adolescent comes to the clinic seeking information about sexuality concerns. The clinic nurse assures the adolescent that confidentiality and privacy will be maintained unless a life-threatening situation occurs. Maintaining confidentiality demonstrates which nursing goal? Select all that apply. A. development of a trusting relationship B. compliance with existing laws C. inappropriate response because adolescents are minors D. an environment where adolescents can be truthful E. concern from parents who pay the office visit bill

A. development of a trusting relationship B. compliance with existing laws D. an environment where adolescents can be truthful

A father and his 4-year-old son are waiting in an exam room when the nurse enters and greets them. Which activity that the nurse observes the boy doing would best demonstrate the primary developmental task of the preschool-age child, according to Erikson? A. Opening drawers in the room, pulling out supplies, and examining them B. Singing a song he learned at preschool C. Rough-housing with his father D. Reading a book

ANS: A

A nurse is caring for a 4-year-old child that will be undergoing a procedure to remove a mass from the abdomen. In order to help the child remain calm in preparation for getting an IV catheter placed, what intervention might the nurse implement? A. Allow the child to play with a procedure doll. B. Not discuss the procedure in front of the child. C. Distract the child with games and candy. D. Take the child to the playroom for coloring.

ANS: A

A parent brings the 4-year-old child for a check-up. Which finding would concern the nurse? A. Resting pulse rate of 120 B. Ectomorphic body type C. No increase in appetite compared with that in toddler years D. Weight gain of 5 lb (2.27 kg) in the past year

ANS: A

The nurse is assessing a 5-year-old child. Which assessment finding would be documented as abnormal? A. Inability to state address. B. Inability to count to 20. C. Can recall a part of a story. D. Can explain how an item is used.

ANS: A

The nurse is teaching the preschooler's parents injury prevention. Which method would the nurse advise for the parents as the best way to enforce injury prevention? A. Repetition and reinforcement B. Safety rules C. Adequate supervision D. Constant vigilance E. Repetition, modeling, and reinforcement

ANS: A

When assessing a child and his parents during a well-child visit, the nurse determines that the child is experiencing night terrors. Which of the following would the nurse be most likely to suggest to assist the parents in dealing with this issue.? A. Allowing the episode to take its course B. Waking the child up during the episode C. Allowing the child roam about without supervision D. Talking to the child while the episode is occurring

ANS: A

While receiving a transfusion of packed red blood cells, a school-aged child begins to experience itchy skin, hives, and wheezes. What should the nurse do first for this child? A. Stop the transfusion. B. Obtain a blood culture. C. Slow the transfusion rate. D. Provide a diuretic as prescribed.

ANS: A

A father brings his 2-year-old son in for a well visit. The nurse assesses his growth since the last appointment. Which finding should concern the nurse? A. Total weight gain of 15 lb in the past year B. Increase in height of 5 inches in the past year C. Prominent abdomen D. Forward curve of the spine at the sacral area

ANS: A Rationale: A child gains only about 5 to 6 lb (2.5 kg) and 5 in (12 cm) a year during the toddler period, much less than the rate of growth during the infant year. Because the weight gain of the boy in this scenario is so much greater than normal, the nurse should be concerned that the boy is overweight or obese. All of the other findings listed are normal for a 2-year-old.

The nurse is working with a child with altered genitourinary status. The child demonstrates excess fluid volume. Which of the following would the nurse most likely do? A. Weigh the child 2 times a day on the same scale. B. Hold all medication until the fluid retention improves. C. Avoid administering IV fluids. D. Measure the amount of nitrates present in the urine.

ANS: A Rationale: A child with altered genitourinary status with excess fluid volume needs to be weighed twice daily always with the same scale, wearing the same amount of clothing at the same time each day. A weight gain of greater than 0.5 kg can indicate fluid retention. Withholding all medication and avoiding IV fluids would be inappropriate. IV fluid administration should be monitored closely and given at the prescribed rate. The nurse should also monitor laboratory values such as BUN and creatinine, urine and serum sodium, serum potassium, hemoglobin and hematocrit for changes.

The nurse is working with a child with altered genitourinary status. Which intervention would be included in the plan of care for the client with excess fluid volume? A. Weigh the child daily on the same scale. B. Hold all medication until the fluid retention is improving. C. Avoid administering IV therapies. D. Measure the amount of nitrates present in the urine.

ANS: A Rationale: A child with edema and fluid overload should be weighed daily, on the same scale, at the same time, with the same amount of clothing. This gives the most accurate picture of fluid gain or loss. The nurse also should assess the blood pressure and pulse rate regularly to determine if hypovolemia is occurring. This can occur from fluid shifts occurring if fluid is lost too quickly. Medications need to be administered, especially diuretics to help reduce the edema. The child should be on fluid restriction. This includes PO and IV. If IV fluids are necessary the volume should be calculated into the daily amount

The mother of Mary Jo, a 10-year-old who had a febrile reaction following a transfusion, asks the nurse: "Why did this happen to my child?" Which response by the nurse would be most appropriate? A. "Mary Jo's blood has developed antibodies to the white blood cells, platelets or plasma protein antigens in the donor blood." B. "Mary Jo's blood was not compatible with the blood product, causing the red blood cells to destruct." C . "The donor blood contained plasma proteins or other antigens to which Mary Joe was hypersensitive." D. "Too much of the blood product was transfused at too rapid a rate."

ANS: A Rationale: A febrile reaction is not associated with hemolysis and generally occurs when the recipient has developed antibodies to leukocyte, platelet, or plasma protein antigens in the donor blood. In a hemolytic reaction, the blood product is not compatible with the recipient's blood. An allergic reaction is a nonhemolytic reaction that occurs when the donor blood contains plasma proteins or antigens to which the recipient is hypersensitive. Signs of fluid overload would occur if the blood was infused too quickly.

After teaching a class of students about genetics and inheritance, the instructor determines that the teaching was successful when the students identify this as the basic unit of heredity. A. Gene B. Chromosome C. Allele D. Autosome

ANS: A Rationale: A gene is the basic unit of heredity of all traits. A chromosome is a long, continuous strand of DNA that carries genetic information. An allele refers to one of two or more alternative versions of a gene at a given position on a chromosome that imparts the same characteristic of that gene. An autosome is a non-sex chromosome.

After teaching a group of nursing students about developmental milestones for children, between the ages of 1 to 4 years, the instructor determines that the teaching was successful when the students identify which of the following as a gross motor developmental milestone that occurs between 2 to 3 years of age? A. Jumping in place B. Riding a tricycle C. Climbing D. Standing on one foot with help

ANS: A Rationale: A gross motor developmental milestone for a 2 to 3 year-old includes jumping in place. Riding a tricycle occurs at 3-4 years of age. Climbing occurs at occurs at 18 months to 2 years. At 12-18 months, the child can stand on one foot with help.

During the assessment of a preschooler, the nurse notes that the child has abnormal dryness and thickening of the conjunctiva and dry and scaly skin. Which vitamin deficiency does the nurse suspect this child is experiencing? A: Vitamin A B:Vitamin B C: Vitamin D D: Vitamin E

ANS: A Rationale: A vitamin A deficiency manifests with night blindness, abnormal dryness and thickening of the conjunctiva and cornea (xerophthalmia), corneal ulcerations, dry and scaly skin, impaired immunity, infections, growth retardation. Manifestations of a vitamin B deficiency include stomatitis, glossitis, cheilosis, edema, anemia, ophthalmoplegia, tachycardia or bradycardia, peripheral neuropathy, fatigue, confusion, seizures. Manifestations of a vitamin D deficiency include rickets, short stature, bone fractures due to weakening or softening of the bones (osteomalacia), low calcium blood levels (which can also be associated with tetany and paresthesias). Manifestations of a vitamin E deficiency include paresthesias, tetany, ataxia, edema, depressed deep tendon reflexes, vision problems.

A voiding cystourethrogram (VCUG) is prescribed for a child. What education should be provided to the parents? A. The VCUG will rule out vesicoureteral reflux. B. The VCUG will detect if the infection is gone. C. The VCUG will rule out kidney stones. D. The VCUG will prevent further complications of the urinary tract infection (UTI).

ANS: A Rationale: A voiding cystogram (VCUG) is performed by having the bladder filled with a contrast medium via catheterization. Under fluoroscopy the bladder is visualized filling and emptying. A VCUG is used to rule out reflux in the urinary tract, causes of hematuria, UTI, and structural anomalies. Reflux may cause frequent infections and scarring in the urinary tract if not diagnosed and treated. A VCUG will not diagnose renal stones. Renal stones would be detected by a CT scan. A VCUG would not be performed to detect if infections of the UTI have cleared. This would be done by assessing a urinalysis.

The nurse is preparing an 18-month-old for discharge following treatment for dehydration secondary to diarrhea. What instruction would the nurse most likely include in the discharge teaching? A: "Encourage a bland diet." B: "Implement clear liquids." C: "Provide plenty of 100% fruit juice." D: "Offer flavored gelatin if hungry."

ANS: A Rationale: After rehydration is achieved, it is important to encourage the child to consume a bland diet in order to maintain energy and growth. The solid foods presented are easily digested and age appropriate. The parents should avoid prolonged used of clear liquids in the child with diarrhea because "starvation stools" might result. Fluids high in glucose such as fruit juice, gelatin, and soda may worsen diarrhea. Gelatin is high in glucose and may worsen diarrhea.

A group of nursing students are reviewing information about neonatal screenings. The students demonstrate understanding of the information when the students identify which system of most consistently affected by metabolic disorders? A. Nervous system B. Cardiovascular system C. Gastrointestinal system D. Respiratory system

ANS: A Rationale: Although any system can be affected, the nervous system is most consistently affected by metabolic disorders. The physical examination should focus on evaluating neurodevelopmental functions. Abnormalities commonly revealed include impaired states of alertness and arousal, tremors, posturing, clonic jerking, tonic spasms, or seizures.

Which nursing intervention is priority when caring for a child with HIV? A. Administer prescribed medications. B. Assist the child with daily activities. C. Assess pain after invasive procedures. D. Review laboratory CD4 counts daily.

ANS: A Rationale: Although assisting with activities, assessing pain, and reviewing CD4 counts are all important, the priority when caring for a child with HIV is to administer prescribed medications. Prescribed medications prevent progressive deterioration of the immune system and provide prophylaxis against opportunistic infections.

The mother of a 12-year-old with Reye syndrome approaches the nurse wanting to know how this happened to her child, saying, "I never give my kids aspirin!" Which response by the nurse would be most appropriate? A: "Sometimes it's hard to tell if a product contains aspirin." B: "Do you think that maybe your child took aspirin on his own?" C: "Don't worry; you're in good hands. We have it under control now." D: "Aspirin in combination with the virus will make the brain swell and the liver fail."

ANS: A Rationale: Although warning labels are placed on containers of salicylates, salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. The parent needs to be receptive to further education. Don't state the obvious, but also don't minimize the situation. Encourage the mother to ask for information, and be sure to explain in terms she will understand.

The nurse is providing education to the parents of a female with hydrocephalus who has just had a shunt inserted. When discussing the child's condition with the parents, which of the following would be most appropriate? A: "Tell me your concerns about your child's shunt." B: "Be sure to call the doctor if she gets a persistent headache." C: "Her autoregulation mechanism to absorb spinal fluid has failed." D: "Always keep her head raised 30 degrees."

ANS: A Rationale: Always start by assessing the family's knowledge. Ask them what they feel they need to know. Knowing when to call the doctor and how to raise the child's head are important, but they might not be listening if they have another question on their minds. "Autoregulation" is too technical—base information on the parents' level of understanding.

A 9-year-old child with leukemia is scheduled to undergo an allogenic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include? A "We'll need to have a match to a donor." B "The risk for rejection is much less with this type of transplant." C "You won't need to receive the high doses of chemotherapy before the transplant." D "You'll need to have an incision in your hip area to instill the cells."

ANS: A Rationale: An allogenic hematopoietic stem cell transplantation (HSCT) refers to transplantation using stem cells from another individual that are harvested from the bone marrow, peripheral blood, or umbilical cord blood. With this type of transplant, human leukocyte antibody (HLA) matching must occur. Therefore, the lesser the degree of HLA matching in the donor, the higher the risk for graft rejection and graft-versus-host disease (GVHD). Regardless of the type of transplant, a period of purging of abnormal cells in the child is necessary and accomplished through high-dose chemotherapy or irradiation. The procedure is accomplished by intravenously infusing hematopoietic stem cells into the child.

The nurse is assessing an 8-week-old infant in the clinic. The parent states the infant was feeding well and gaining weight until a few weeks ago and now is noted to have lost weight and "isn't doing well" per the parent. What action would the nurse take next? A. Assess the infant further for an inborn error of metabolism B. Advise the parent to decrease the feedings daily to every 6 hours C. Suggest the child be fed in a supine position, using a car seat or carrier D. Refer the parents to a dietitian for education on increasing the child's appetite

ANS: A Rationale: An infant who was otherwise healthy begins to show signs of deterioration, the nurse would further assess for an inborn error of metabolism. A dietary consult would be needed if a diagnosis of inborn error of metabolism was confirmed to educate the family on the appropriate diet, but not specifically for increasing the child's appetite. Position changes and schedule changes will are beneficial for a child with an inborn error of metabolism.

A 7-year-old child is rushed into the emergency room after being stung by a yellow jacket. The child is nauseated and vomiting and is experiencing itching and swelling on the arm where stung. He is having trouble breathing. Which type of hypersensitivity response is the child experiencing? A. Type I: anaphylaxis B. Type II: cytotoxic response C. Type III: immune complex D. Type IV: cell-mediated hypersensitivity

ANS: A Rationale: Anaphylactic shock is an immediate, life-threatening, type I hypersensitivity reaction that occurs after exposure to an allergen in a previously sensitized child. Anaphylactic shock must be treated immediately as it can be fatal. Initially, a child may become nauseated, with vomiting and diarrhea, because of the sudden increase in gastrointestinal secretions produced by the stimulation of histamine. This is followed by urticaria (itching) and angioedema (swelling). Bronchospasm can become so severe the child becomes dyspneic, hypoxemic, and then hypoxic.

Antiemetics are ordered to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications? A Administer the antiemetic before starting chemotherapy B Provide the antiemetic as needed (PRN) when nausea and vomiting are reported C Use the antiemetic after it is clear that nonpharmacologic methods are not effective D Start the antiemetic on a scheduled basis when the chemotherapy begins to cause nausea

ANS: A Rationale: Antiemetics are most effective when given before chemotherapy begins and then on a regular schedule to prevent nausea and vomiting throughout administration of chemotherapy. Nonpharmacologic measures can be used in conjunction with antiemetics but not in place of them.

The nurse is assessing a 7-year-old with a hearing aid. His mother says he is losing his hearing again. Which finding would the nurse identify as contributing to this current complaint? A: Overproduction of cerumen B: Soreness of the outer ear C: History of a normal term birth D: The eardrum responds to a puff of air

ANS: A Rationale: Approximately 10% of children either produce larger than normal amounts or have difficulty with cerumen removal that results in hearing impairment. Cerumen impaction can affect hearing, even with a hearing aid. Soreness of the outer ear is a sign of otitis externa. Full-term birth would not play role in continued loss of hearing. Eardrum response to a puff of air indicates the absence of fluid in the middle ear.

An 8-year-old child is being treated for tonic-clonic seizures. What should the nurse emphasize when teaching the parents about this disorder? A: The child should maintain an active lifestyle. B: Immediately provide medication if a seizure begins. C: Have the child carry a padded tongue blade with her at all times. D: Ensure quiet time late in the day, when seizure activity is most

ANS: A Rationale: As a rule, children with seizures should attend regular school and participate in physical education classes and active sports. Antiseizure medication is ineffective during a seizure because most medication needs to achieve a therapeutic level to be effective. Padded tongue blades are not used in people with a seizure disorder. There is no specific time of day when a seizure can occur.

An 11-year-old boy has recently been prescribed methylphenidate. The mother calls the pediatrician's office to speak with the advanced practice pediatric nurse practitioner. This mother has been extremely resistant to medication and insists that the medication is not working. How should the nurse respond? A: "Tell me what makes you think the medication is not working" B: "Do you want to try a different medication?" C. "Are you sure you are administering it properly" D. "Do you want to increase the dosage?"

ANS: A Rationale: Asking the mother to explain why she believes the medicine is not working will offer important insights to the mother's definition of effectiveness. It is important for both the mother and the advanced practice pediatric nurse practitioner to develop a shared definition of effectiveness and improvement. Once this is established, the nurse can suggest the next step in the treatment plan. Asking if the mother wants to try a different medication or increase the dosage does not provide any information about the child's response to the current medication. Asking the mother whether she is administering it properly could cause her to take offense and does not provide the necessary information.

The nurse is reinforcing teaching with a group of caregivers related to the nutritional needs of the infant. One caregiver asks why the 6-month-old infant needs to have solid foods when breast milk is such a good source of nutrition. What would be the best response by the nurse? A. "Milk will not fully provide the child's needs for iron, which is found in solid foods." B. "By this age the child becomes interested in trying new skills." C. "The extrusion reflex must be developed and feeding solid foods will help the child to develop this reflex." D. "Breastfeeding will become painful when the child gets more teeth, so the infant needs to eat solid foods."

ANS: A Rationale: At about 4 to 6 months of age, the infant's milk consumption alone is not likely to be sufficient to meet caloric, protein, mineral, and vitamin needs. In particular, the infant's iron supply becomes low, and supplements of iron-rich foods are needed. It is also around 4 to 6 months when the infant is able to swallow solids effectively and has the necessary enzymes necessary to digest them. It is true that the child becomes interested in new skills, but this is not the primary rationale for introducing solids. Few parents will understand the "extrusion reflex" so using that term is not effective in teaching. The nurse should, however, describe the reflex to the parents. Breastfeeding does not become painful when the child develops teeth. Many mothers nurse for long after their infants develop teeth.

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent is a centrally acting skeletal muscle relaxant? A. Baclofen B. Prednisone C. Lorazepam D. Botulin toxin

ANS: A Rationale: Baclofen is a centrally acting skeletal muscle relaxant used to treat painful spasms and decrease spasticity in children with motor neuron lesions. Prednisone is a corticosteroid that is used to help slow the progression of Duchenne muscular dystrophy. Lorazepam is a benzodiazepine used for adjunctive relief of skeletal muscle spasm associated with cerebral palsy. Botulin toxin is a neurotoxin used to relieve spasticity in cerebral palsy.

The nurse is speaking with the parents of a school-aged child recently diagnosed with diabetes mellitus regarding the differences between hypoglycemia and hyperglycemia. Which statement by a parent indicates a need for further teaching? A. "If I notice changes in my son like tearfulness or irritability, his blood sugar may be high." B. "When my son's breath smells fruity, it almost always indicates high blood sugar." C. "If my son says he feels shaky, his blood sugar may be low." D. "Dry flushed skin may be a sign if high blood sugar."

ANS: A Rationale: Behavior changes such as tearfulness, irritability, confusion and slurred speech are indications of hypoglycemia, not hyperglycemia. Tremors and diaphoresis are also indications of low blood sugar. Dry flushed skin, fatigue, weakness, nausea, vomiting and fruity breath odor are all symptoms of hyperglycemia.

A 17-year-old girl has been diagnosed with bulimia nervosa. Which complication should the nurse carefully assess for in this client? A: Severe erosion of teeth B: Hypertension C: Diabetes mellitus D: Atherosclerosis

ANS: A Rationale: Bulimia refers to recurrent and episodic binge eating and purging by vomiting, accompanied by awareness that the eating pattern is abnormal yet the child is not able to stop the pattern. Adolescents with bulimia may develop severe erosion of their teeth because of the constant exposure to acidic gastrointestinal juices from vomiting. Esophageal tears may also result from forceful vomiting. Hypertension, diabetes mellitus, and atherosclerosis are not associated with bulimia nervosa.

3. The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority? A Calling the doctor if the child gets a sore throat B Keeping a written copy of the treatment plan C Writing down phone numbers and appointments D Using acetaminophen if the child needs an analgesic

ANS: A Rationale: Calling the doctor if the child gets a sore throat is the priority. Because of the child's impaired immune system, any sign of potential infection, such as sore throat, must be evaluated by a physician. Using acetaminophen if the child needs an analgesic, writing down phone numbers and appointments, and keeping a written copy of the treatment plan are important teaching points but secondary to guarding against infection.

An adolescent is recovering from surgery, radiation, and chemotherapy following a diagnosis of Ewing sarcoma. Which statement by the family indicates that reteaching is needed? A. "Our child is looking forward to playing football again." B. "We will remind our child to care for the skin following radiation." C. "Our child's friends shaved their heads in solidarity to show their support." D. "We will watch for signs of infection and report it to our health care provider."

ANS: A Rationale: Caution adolescents to continue to be careful about activities that cause stress on an extremity that has received radiation (for example, football or weight lifting) because it may not be as strong as usual afterward. The family will need reteaching because they say their child is looking forward to playing football again. Skin care, supportive friends, and reporting infections are all good foNr UhiRs SreIcoNvGer-y

Diabetes insipidus a disorder of the posterior pituitary resulting in deficient secretion of which hormone? A. Antidiuretic hormone B. Adrenocorticotropic hormone C. Thyroid stimulating hormone D. Luteinizing hormone

ANS: A Rationale: Central diabetes insipidus (DI), also called neurogenic, vasopressin-sensitive, or hypothalamic DI, is a disorder of the posterior pituitary that results from deficient secretion of ADH. Nephrogenic DI is a result of the inability of the kidney to respond to ADH.

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. What is the best response from the nurse? A. It will determine if the heart is enlarged. B. It will determine disturbances in heart conduction. C. It will show if blood is being shunted. D. This image will clarify the structures within the heart.

ANS: A Rationale: Chest x-rays are performed to see if the heart is enlarged. This will determine if the heart muscle is increasing in size. Disturbances in heart conduction are detected by an EKG. Visualizing where blood is being shunted is through the echocardiogram. The image used to clarify the structures of the heart is the MRI.

A new mother, when asked by a nurse, explains that her 4-month-old infant has been nursing regularly every 3 to 4 hours and seems satisfied. However, the mother recently introduced solid food in the form of unbuttered popcorn to the baby as a supplement, to "get her used to eating solid food." She felt that the popcorn would be safe because it is soft on the baby's gums. What should be the primary nursing diagnosis in this situation? A. Risk for aspiration related to feeding the infant an inappropriate food B. Imbalanced nutrition, less than body requirements, related to introduction of a low nutritive food C. Readiness for enhanced nutrition, related to the age of the infant D. Imbalanced nutrition, more than body requirements, related to introduction of a high-calorie food

ANS: A Rationale: Children under about 5 years should not be offered popcorn or peanuts because of the danger of aspiration. This should be the primary nursing diagnosis because aspiration is the greatest danger to the infant in this scenario. Because the infant is receiving all the nutrition she needs from breastfeeding and because unbuttered popcorn is not a high-calorie food, imbalanced nutrition is not really a concern here. There is not a strong indication at this point that the infant is ready for enhanced nutrition, as the breast milk provides all of the nutrients she needs and as she appears to be satisfied after her feedings.

The nurse is reviewing the medical record of a child with a mental health disorder and finds that the child is receiving cognitive behavioral therapy. How does the nurse interprets this information? A: Process that requires the individual to view a situation from a different perspective B: Interventions that address family dynamics and family coping C: Individual exploration of the person's conflicts and stressors D: Use of play to explore problems, issues, and conflicts

ANS: A Rationale: Cognitive behavioral therapy helps the individual reframe perceptions, change ideas about a situation, or view a situation from a different perspective. Next, the patient is helped to see the relations among his or her thoughts and beliefs and his or her emotional responses. Finally, the patient is encouraged to use problem solving to identify alternative solutions or ways of behaving. Individual therapy is an interpersonal process in which the patient and care provider together discover, explore, and resolve the patient's perceived and/or actual stressors, conflicts, behavioral responses, doubts, and anxieties. Family therapy focuses on family dynamics. Interventions may be designed to develop family-based coping strategies, such as problem solving or stress management. Play therapy involves the exploration of life's problems, developmental issues, and interpersonal conflicts.

A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug? A. That the infant's skin has greater permeability than that of an adult B. That there is less body surface area to be concerned about. C. That there is decreased absorption rates of topical drugs in infants. D. That there is a lower concentration of water in an infant's body compared with an adult.

ANS: A Rationale: Compared to adult skin, infants' skin exhibits greater permeability. This can result in increased absorption, which may result in adverse effects that usually do not occur in the adult patient. The nurse must consider this fact before administering skin ointment. Infants have greater, not lesser, body surface area. Greater body surface area plus increased permeability results in increased absorption of topical agents. Infants tend to have a higher concentration of water in their bodies than do adults.

A nurse is providing care to a child with hemophilia who is experiencing muscle and joint involvement related to the bleeding. Which would the nurse include as an adjunctive measure to control bleeding? A. Compression B. Heat C. Exercise D. Lowering extremities

ANS: A Rationale: Complications associated with bleeding most often involve joints and muscles. Adjunct measures include rest, ice, compression, and elevation (RICE). In addition corticosteroids such as prednisone may be used to reduce inflammation in the joint.

A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state: A "We should administer the drug on an empty stomach." B "We should check our son's urine for glucose." C "He might develop a rounded face from this drug." D. "We will need to gradually decrease the dosage."

ANS: A Rationale: Corticosteroids are commonly administered with food to decrease the risk for gastrointestinal upset. Corticosteroids can disrupt glucose balance, so urine should be checked for glucose. A moon face is an adverse effect of corticosteroids. Corticosteroids need to be tapered gradually to reduce the risk of adrenal insufficiency.

A nurse is conducting a presentation for a community parent group about respiratory conditions in children. The nurse determines that the teaching was successful when the group identifies which of the following as one of the most common conditions seen during early childhood? A. Croup B. Bronchiolitis C. Asthma D. Pneumonia

ANS: A Rationale: Croup is one of the most common acute respiratory conditions seen during early childhood (6 months to 5 years of age), with a peak in the second year of life, and the most common cause of upper airway obstruction

The nurse is assessing the neuromusculoskeletal system of a newborn. What is an abnormal assessment finding? A. Sluggish deep tendon reflexes B. Full range of motion in extremities C. Absence of hypotonia D. Lack of purposeful muscular control

ANS: A Rationale: Deep tendon reflexes are present at birth and are initially brisk in the newborn and progress to average over the first few months. Sluggish deep tendon reflexes indicate an abnormality. The newborn is capable of spontaneous movement but lacks purposeful control. Full range of motion is present at birth. Healthy infants and children demonstrate normal muscle tone; hypertonia or hypotonia is an abnormal finding.

The nurse is caring for a child who is scheduled for bone scan. It is suspected that the child has a growth hormone deficiency. Which finding would support this medical diagnosis? A. The bone scan would show bone age would be two or more deviations below normal. B. The bone scan would show a brain tumor. C. The bone scan would show bone age would be three or more deviations above normal. D. The bone scan would a tumor on the child's kidney.

ANS: A Rationale: Diagnostic testing used in children with suspected GH deficiency include bone age will be two or more deviations below normal. CT or MRI scans would be used to rule out tumors or structural abnormalities, not bone scans.

Which statement by the parent of a 12-month-old child diagnosed with Down syndrome shows the need for further education? A. "I will need to delay any further immunizations." B. "Thyroid testing is needed every year." C. "In a couple of years, my child will need an x-ray of the neck." D. "I will watch closely for development of respiratory infection."

ANS: A Rationale: Down syndrome children are at higher risk for infection because of a lowered immune system. Delaying immunizations may expose the child to illnesses that could have been prevented. Down syndrome children are at greater risk for developing thyroid disorders, 1st and 2nd vertebrae disorders, and respiratory infections.

A 19-year-old client with hypothyroidism asks the nurse if she will need to take thyroid medication if she becomes pregnant. The nurse integrates understanding of which of the following when responding to the client? A. Regulation of thyroid medication is more difficult because the thyroid gland increases in size during pregnancy B. There is no need to take a thyroid medication because the fetus's thyroid produces thyroid-stimulating hormone C. It is more difficult to maintain thyroid regulation during pregnancy due to the slowing of metabolism D. Fetal growth is arrested if the thyroid medications are continued during pregnancy.

ANS: A Rationale: During the pregnancy the thyroid gland triples n size which makes it more difficult to regulate thyroid medication. Thyroid function does not slow during pregnancy. The fetus might produce TSH but it does not reach the mother. Fetal growth is not arrested if medication is continued during the pregnancy.

A child receiving chemotherapy is experiencing significant reduction in red blood cells secondary to myelosuppression. Which agent would the nurse most likely expect to be ordered? A Epoetin alfa B Filgrastim C Sargramostim D Gamma interferon

ANS: A Rationale: Epoetin alfa is a colony-stimulating factor used to stimulate production of red blood cells. Filgrastim is a colony-stimulating factor used to stimulate production of granulocytes. Sargramostim is a colony-stimulating factor used to stimulate production of granulocytes. Gamma interferon is used to stimulate macrophage production to fight bacteria and fungus.

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which skin condition best describes erythema? A. Redness of the skin produced by congestion of the capillaries B. Small, circumscribed, solid elevation of the skin C. Discolored skin spot not elevated at the surface D. Small elevation of epidermis filled with a viscous fluid

ANS: A Rationale: Erythema is redness of the skin produced by congestion of the capillaries.

When describing the negative feedback system that controls endocrine function, the nurse explains that a decreased secretion of which correlates with a decrease in blood glucose levels? A. Insulin B. Glucagon C. Adrenocorticotropic hormone D. Glycogen

ANS: A Rationale: Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body. As a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted.

The nurse is teaching the parent of a child with chronic renal failure on high-potassium foods that should be restricted. Which foods will the nurse include in this teaching? Select all that apply. A. Bananas, carrots, nuts, and milk B. Peaches, broccoli, and red meat C. Oranges, potatoes, wheat, and bran D. Spinach, chicken, fish, and green beans

ANS: A Rationale: Foods that are high in potassium include bananas, carrots, nuts, and milk. Broccoli, wheat, bran, chicken, fish, and green beans are not high in potassium and do not need to be restricted.

An 8-year-old boy and his father visit the pediatrician's office with reports of a sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the boy's health history, the nurse learns that he had strep throat a little over a week ago. Which condition should the nurse suspect? A. Acute glomerulonephritis B. Kidney agenesis C. Polycystic kidney D. Nephrosis

ANS: A Rationale: Glomerulonephritis, inflammation of the glomeruli of the kidney, is most common in children between the ages of 5 and 10 years. The child typically has a history of a recent streptococcal respiratory infection (within 7 to 14 days). Symptoms are as described above. Kidney agenesis (absence of kidneys) and polycystic kidneys (formation of large, fluid-filled cysts in the place of normal kidney tissue) are serious congenital conditions that would likely be discovered either in utero or shortly after birth, not conditions that would appear acutely in an 8-year-old. Nephrosis is altered glomerular permeability apparently due to an autoimmune process or a T-lymphocyte dysfunction that results in fusion of the glomeruli membrane surfaces, which, in turn, leading to abnormal loss of protein in urine. The highest incidence is at 3 years of age, and it occurs more often in boys than in girls. In addition to proteinuria, a major symptom of nephrosis is edema, which is absent in this case.

How would the nurse best describe Gowers sign to the parents of a child with muscular dystrophy? A. A transfer technique B. A waddling-type gait C. The pelvis position during gait D. Muscle twitching present during a quick stretch

ANS: A Rationale: Gowers' sign is a description of a transfer technique present during some phases of muscular dystrophy. The child turns on the side or abdomen, extends the knees, and pushes on the torso to an upright position by walking his hands up the legs. The child's gait is unrelated to the presence of Gowers sign. Muscle twitching present after a quick stretch is described as clonus.

When teaching about Turner's syndrome, what should the nurse include? A. Timing and use of growth hormone B. Use of hormone therapy to prevent infertility C. Long-term effects of decreased intellectual ability D. Treatment for gynecomastia

ANS: A Rationale: Growth hormone is used once the child has fallen below the 5th percentile on the growth charts. Hormone therapy will be used to initiate puberty, not to prevent infertility. Gynecomastia is a common finding in children suffering from Klinefelter, not Turner's, syndrome.

A nurse is caring for a 3-year-old girl with microcephaly. Which of the following actions is appropriate for the nurse to take? A:Playfully ask the child to touch her nose B: Teach the parents about ventriculoperitoneal (VP) shunts C: Prepare the child for the experience of cranial surgery D: Administer antipyretics as ordered

ANS: A Rationale: Having the child touch her nose will assist the nurse in assessing probable neurologic and cognitive deficits. A VP shunt may be necessary for hydrocephaly. Surgery is often an intervention for craniosynostosis but cannot correct microcephaly. Hyperthermia is not a complication with microcephaly.

A 10-year-old girl is experiencing acute renal failure due to dehydration. The nurse is preparing to administer IV fluid. Which of the following interventions should the nurse take in caring for this child? A. Administer the IV fluid slowly B. Make sure the IV fluid contains potassium C. Increase oral intake of fluid D. Provide a diet high in protein and sodium

ANS: A Rationale: If the child is dehydrated (as with diarrhea or hemorrhage), IV fluid is needed to replace plasma volume. Administer such fluid slowly, however, to avoid heart failure as extra fluid cannot be removed by the nonfunctioning kidneys. Be certain the fluid prescribed does not contain potassium until it is established kidney function is adequate; otherwise, the buildup of potassium could cause heart block. The child's diet should be low in protein, potassium, and sodium and high in carbohydrate to supply enough calories for metabolism yet limit urea production and control serum potassium levels. Oral fluid intake may be limited to prevent heart failure due to accumulating fluid that cannot be excreted.

Which type of diet should be included in the plan of care for a child diagnosed with Addison disease? A. High-protein, low-carbohydrate, high-sodium diet B. High-protein, high-carbohydrate, low-sodium diet C. Low-calorie, low-carbohydrate, low-sodium diet D. Low-calorie, low-cholesterol, low-saturated fat di

ANS: A Rationale: In Addison disease, the body produces inadequate hepatic glucagons. A high-protein, low-carbohydrate, and high-sodium diet prevents fatigue, hypoglycemia, and hyponatremia. The child with Cushing syndrome needs low calories, carbohydrates, and sodium. The child with hypothyroidism needs low calories, cholesterol, and saturated fat.

A nurse is developing a teaching plan for the parents of an 8-year-old experiencing nocturnal enuresis. The nurse determines that additional teaching is needed when the parents identify what as an appropriate measure? A. Encouraging fluid intake after dinner B. Practicing bladder-stretching exercises C. Giving desmopressin intranasally D. Engaging the child in stress reduction measures

ANS: A Rationale: In many children, limiting fluids after dinner can be helpful for nocturnal enuresis. Bladder-stretching exercises also can be helpful. If these measures are ineffective, desmopressin may be prescribed. Stress factors may be contributing to the child's problem. Therefore, measures to address stress and promote coping would be appropriate.

The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis? A. Slightly yellow sclera B. Enlarged mandibular growth C. Increased growth of long bones D. Depigmented areas on the abdomen

ANS: A Rationale: In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from the destruction of the sickled cells. Mandibular and long bone growth and depigmentation are not manifestations of this health problem.

The nurse is caring for a 2-year-old diagnosed with bacterial pneumonia. The child has been placed in a mist tent. In caring for the child, it is important for the nurse to: A. monitor the child regularly for signs of cyanosis. B. avoid contact with the mist if the nurse is a sexually active female of childbearing age. C. use contact transmission precautions. D. check for hyperthermia related to enclosure in the tent.

ANS: A Rationale: In some treatment of bacterial pneumonia a croupette or mist tent is used. Children have become cyanotic in mist tents, with subsequent arrest, due to the lack of visibility while in the tent; the child must be constantly observed. Ribavirin, an antiviral drug that may be used to treat certain children with RSV, is administered as an inhalant by hood, mask, or tent; it has a high risk for teratogenicity (causing damage to a fetus) so care must be taken when the drug is administered. In treating a client with bacterial pneumonia, the client may need to be placed on infection control precautions according to the policy of the health care facility, and the nurse should look for hyperthermia related to the infection process.

A nurse is assessing a child who may have peritonitis. Which of the following would be signs of this problem? A. Increased white blood cell count of dialysate outflow B. Diarrhea C. Increased red blood cell count of dialysate outflow D. Syncope

ANS: A Rationale: Increased white blood cell count of dialysate outflow is one of the signs of peritonitis. Vomiting, fever, and abdominal pain are also signs of peritonitis.

The nurse is caring for a child diagnosed with a urinary tract infection. The caregiver asks the nurse why it is so important for the child to have so much fluid. What is the most important reason the child needs increased fluids? A. To dilute the urine and flush the bladder B. To fill the bladder so a specimen can be obtained C. To prevent the child from developing a fever D. To decrease the pain of urination

ANS: A Rationale: Increasing the child's fluid intake is necessary to help dilute the urine and flush the bladder.

Which developmental milestone would the nurse expect an 11-month-old infant to have achieved? A. Sitting independently B. Walking independently C. Building a tower of four cubes D. Turning a doorknob

ANS: A Rationale: Infants typically sit independently, without support, by age 8 months. Walking independently may be accomplished as late as age 15 months and still be within the normal range. Few infants walk independently by age 11 months. Building a tower of three or four blocks is a milestone of an 18-month-old. Turning a doorknob is a milestone of a 24-month-old.

A 15-year-old boy visits his primary care physician's office with fever, headache, and malaise, along with complaints of pain on chewing and pain in the jawline just in front of the ear lobe. The boy asks his mother to leave the exam room for a minute and then tells the nurse that he is also experiencing testicular pain and swelling. The nurse recognizes that this client most likely has which condition? A. Mumps B. Infectious mononucleosis C. Poliomyelitis D. Herpes zoster

ANS: A Rationale: Initial symptoms of mumps include fever, headache, anorexia, and malaise. Within 24 hours, pain on chewing and an "earache" occurs. When the child points to the site of the earache, however, he points to the jawline just in front of the ear lobe, the site of the parotid gland. By the next day, the gland appears swollen and feels tender; the ear becomes displaced upward and backward. Boys may also develop testicular pain and swelling (orchitis). None of the other conditions listed matches the symptoms indicated.

The nurse is preparing to post a sign above the crib of an infant with a Wilms tumor. Which statement should the nurse post immediately? A. "Do not palpate abdomen." B. "No intramuscular injections." C. "No milk or milk products allowed." D. "No blood sampling in lower extremities."

ANS: A Rationale: It is important that the child's abdomen not be palpated any more than is necessary for diagnosis because handling appears to aid metastasis. Place a sign reading "No Abdominal Palpation" over the child's crib to help prevent this. Intramuscular injections, milk products, or blood sampling in the lower extremities are not contraindicated for this health problem.

A nurse is communicating with a family about palliative care. Which of the following would be the best approach to take? A. Ask the family what they know, what they wish to know and be prepared to repeat the information you give to them several times B. Give the family as much information as possible to promote better decision-making C. Provide information during a crisis when the parent's senses are heightened and memory is improved D. Avoid pushing the family by asking too many questions.

ANS: A Rationale: It is important to ask what the family knows, what they are ready to hear, and be prepared to repeat the information over the course of time. An essential component of communication is to realize that it is a dynamic ongoing process and that too much information can be delivered at one time. It is important to ask what the family knows, what they are ready to hear, and be prepared to repeat the information over the course of time. In times of crisis or stress, concentration and understanding may be impaired due to overwhelming feelings of loss and helplessness.

A 17-year-old adolescent is found wandering around. The adolescent is confused, sweaty, and pale. Which test would the nurse expect to be performed first? A. Blood glucose level B. CT scan C. Arterial blood gases D. Blood cultures

ANS: A Rationale: It is important to draw a blood glucose level on the adolescent because the client is exhibiting signs of hypoglycemia and needs to be treated as soon as possible. Once the adolescent is stabilized,

The nurse is caring for a 12-year-old girl with nephrotic syndrome. The girl confides that she feels like a "freak" compared to her peers because of her weight, edema, and moon face. Which response by the nurse would be most appropriate? A. "Let's put you in touch with some other girls who are also having the same body changes." B. "Luckily, this is just a temporary, unfortunate part of your condition; you need to accept it." C. "Your real friends do not care about your appearance and just want you to get well." D. "You are beautiful in your own way; what matters is what is on the inside."

ANS: A Rationale: It is important to introduce the girl to other youngsters with chronic renal conditions so she does not feel so isolated. Adolescents need interaction with peers. Telling the girl that this is a temporary condition, her real friends don't care about her appearance, and she is beautiful in her own way dismisses the girl's concerns and does not offer solutions. Nephrotic syndrome is a chronic condition, so telling her the condition is temporary also is inaccurate.

1. The nurse is caring for a 1-year-old boy with Down syndrome. Which intervention would the nurse be least likely to include in the child's plan of care? A. Educating parents about how to deal with seizures B. Explaining developmental milestones to parents C. Promoting annual vision and hearing tests D. Describing the importance of a high-fiber diet

ANS: A Rationale: It is unlikely that the parents will need to know how to deal with seizures. It will be helpful to provide parents with growth and developmental milestones that are unique to children with Down syndrome. More than 60% of children with Down syndrome have hearing loss, so promoting annual vision and hearing tests is the priority intervention. Special diets are usually not necessary; however, a balanced, high-fiber diet and exercise are important because constipation is frequently a problem.

An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant? A. Inspection of the cystic sac on the child's back for leakage B. Auscultation for bowel sounds C. Listening for a shrill cry D. Careful supine positioning

ANS: A Rationale: Leakage from the cystic area indicates loss of cerebrospinal fluid (CSF) and risk of infection of the central nervous system. Prompt intervention is needed, probably surgical. Listening for bowel sounds confirms intestinal peristalsis but is not necessary with each infant contact. A shrill cry may indicate increased intracranial pressure (ICP). This is important to note yet is not as pressing as being aware of leakage. The baby would be positioned prone, not supine, to protect the sac.

Nursing students correctly label the group of cells whose job is to ingest, engulf, and neutralize pathogens as: A. macrophages. B. immunogens. C. immunoglobins. D. red blood cells.

ANS: A Rationale: Macrophages (mature white blood cells) engulf, ingest, and neutralize pathogens. Red blood cells do not fight infection. They carry hemoglobin and carry oxygen from the lungs to the tissues. In the immune response, immunoglobulins are antibodies and immunogens are antigens.

A 10-year-old who is receiving chemotherapy has received ondansetron before this therapy session. About an hour later, the child tells the nurse that his mouth feels really dry. The child has urinated several time and his skin turgor is normal. Which response by the nurse would be most appropriate? A "The drug you got to help with the nausea can cause dry mouth." B "Let me increase your intravenous fluids." C "You might be having a severe allergic reaction. Are you itchy?" D "This indicates an infection. We need to start antibiotics."

ANS: A Rationale: Ondansetron is associated with dry mouth. Increasing IV fluids may or may not be appropriate. The child is urinating and his skin turgor is normal so it doesn't appear that he is dehydrated and in need of extra fluid. A severe allergic reaction would more likely be manifested by itching, hives, and increasing respiratory distress. Dry mouth is not an indicator of infection.

The nurse is educating parents of a male infant with Chiari type II malformation about the condition. Which of the following would be most important for the nurse to include? A: Taking time to feed the infant B: Laying the infant down after a feeding C: Being able to see major difference after surgery D: Not needing to change diapers as often

ANS: A Rationale: One of the problems associated with Chiari type II malformation is poor gag and swallowing reflexes, so the infant must be fed slowly. There is a great risk of aspiration, requiring that the child be placed in an upright position after feeding. The goal of surgery is to prevent further symptoms rather than to relieve existing ones. Infrequent urination is a problem associated with type I malformations.

The nurse is caring for a child who has been admitted with a possible diagnosis of tuberculosis. Which laboratory/diagnostic tools would most likely be used to help diagnose this child? A. Purified protein derivative test B. Sweat sodium chloride test C. Blood culture and sensitivity D. Pulmonary functions test

ANS: A Rationale: Purified protein derivative tests are used to detect TB. Sweat sodium chloride tests are used for determining the diagnosis of cystic fibrosis. Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection. Pulmonary function tests are diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs.

A child is refusing to use the potty and having accidents, even though he has achieved toilet training. This is an example of which type of behavior? A. Regression B. Positive redirection C. Desensitization D. Phobia

ANS: A Rationale: Regression is a change from present behaviors to past developmental levels of behavior. Positive redirection is verbally guiding the child toward the accepted behavior. Desensitization occurs when the fear is conquered by approaching it little by little. If the fear becomes a phobia, then the health care team must be consulted.

A 5-year-old girl who was already admitted to the hospital for an unrelated condition suddenly becomes irritable, restless and anxious. These may be early signs of respiratory distress in a child if accompanied by: A. tachypnea. B. retractions. C. cyanosis. D. clubbing of fingers

ANS: A Rationale: Restlessness, irritability, and anxiety result from difficulty in securing adequate oxygen. These might be very early signs of respiratory distress, especially if accompanied by tachypnea (an increased respiratory rate). Retractions can be a sign of airway obstruction but occur more commonly in newborns and infants than in older children. Cyanosis (a blue tinge to the skin) indicates hypoxia, which may be a sign of airway obstruction but would not be the first. Children with chronic respiratory illnesses often develop clubbing of the fingers, a change in the angle between the fingernail and nailbed because of increased capillary growth in the fingertips. Clubbing would not occur in an acute airway obstruction, as is indicated in the scenario above.

The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided? A. Encourage rest and relaxation. B. Antibiotic therapy may be initiated. C. Antiviral medications can be prescribed. D. Range of motion to prevent contractures.

ANS: A Rationale: Rubella infection is usually mild and self-limited. The care given is normally supportive. Rest is encouraged. Medications administered are normally limited to anti-pyretics and analgesics. Antibiotic and antiviral therapies are not normally included in the plan of treatment. Range of motion is not needed as mobility of the client is not limited.

A newborn was screened for hereditary metabolic disorder at 8 hours old. Which action by the nurse is most appropriate? A. Instruct the parent to have another screening in 1 to 2 weeks B. No further intervention is needed C. Repeat screening in 8 hours D. If the infant is premature, screening needs to be done every 8 hours for 48 hours

ANS: A Rationale: Screening for hereditary metabolic disorders should be done after the first 24 hours of life because of the higher incidence of false-positive results. Repeating the screening in 8 hours or every 8 hours for 48 hours would yield the same increased risk for false-positives.

The nurse is caring for a 7-year-old with Guillain-Barré syndrome (GBS). Which of the following would be the most effective intervention to monitor for respiratory deterioration? A. Serial measurement of tidal volume B. Pulse oximetry C. Ineffective cough D. Diminished breath sounds

ANS: A Rationale: Serial measurement of tidal volumes may reveal respiratory deterioration in a child with GBS. Pulse oximetry gives no information regarding ventilation, only oxygen saturation. A decrease in oxygen saturation noted on pulse oximetry would be helpful for determining a change in respiratory function. However, it would not be the most effective method. Ineffective cough may indicate a change in respiratory function, but this change is nonspecific. Diminished breath sounds reveal a change in respiratory function; however, they are nonspecific.

A 9-year-old child is diagnosed with von Willebrand's Disease (vWD) with the following characteristics: decreased quantities of all sizes of von Willebrand's factor multimers and decreased activity of von Willebrand's factor. The nurse identifies this as which type of vWD as being involved? A. Type I B. Type II C. Type III D. Type IIIB

ANS: A Rationale: Signs of type I von Willebrand's disease include decreased quantities of all sizes of von Willebrand's factor multimers and decreased activity of von Willebrand's factor. Type II involves absence of intermediate-size and large von Willebrand's factor multimers, increased levels of small von Willebrand's factor multimers, and decreased activity of von Willebrand's factor; possibly disproportionate with quantity of von Willebrand's factor. Type III involves the absence (or almost absent) of all sizes of von Willebrand's factor multimers, absent or minimal activity of von Willebrand's factor, and low Factor VIII level.

The nurse is preparing teaching materials for a family whose child is prescribed somatropin for a growth hormone deficiency. What should the nurse instruct the parents about the administration of this medication? A. This medication must be given by injection. B. This medication must be given in the morning before school. C. Hip or knee pain is an expected adverse effect of this medication. D. This medication does not interact with any other types of medication.

ANS: A Rationale: Somatropin is administered by injection. It is best given at hour of sleep because that is when growth hormone is released. Hip or knee pain could indicate a slipped capital epiphysis and should be reported to the health care provider. The nurse should urge the parents to inform all health care providers that the child is receiving this medication to avoid medication interactions.

The parent of a child with mumps on one side of the face is concerned that the disease can develop on the other side in the future. How should the nurse respond to the mother about this concern? A. The child is immune to further attacks of the disease. B. It does not matter because mumps in adulthood is not serious. C. The child should receive active immunization against mumps. D. There is nothing that can be done to prevent another attack of mumps in the future.

ANS: A Rationale: Some parents worry that because their child had swelling only on one side, the child will develop mumps on the opposite side in the future. One attack of mumps gives lasting immunity, and the child will not contract the disease again. Mumps is a potentially dangerous disease and should not be minimized. The child does not need immunization against mumps.

The nurse is assessing a child with spastic cerebral palsy. What findings would the nurse expect to assess? Select all that apply. A. Exaggerated deep tendon reflexes B. Hemiplegia C. Poor control of balance D. Hypertonicity E. Drooling F. Dysarthria

ANS: A Rationale: Spastic cerebral palsy is associated with exaggerated deep tendon reflexes; poor control of posture, balance, and movement; hypertonicity of the affected extremities; and hemiplegia, quadriplegia, or diplegia, based on the limbs affected. Drooling and dysarthria are associated with athetoid cerebral palsy.

A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms? A. Syndrome of inappropriate antidiuretic hormone B. Diabetes insipidus C. Hyposecretion of somatotropin D. Hypersecretion of somatotropin

ANS: A Rationale: Syndrome of inappropriate antidiuretic hormone (SIADH) is a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level. It can be caused by central nervous system infections such as bacterial meningitis. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Diabetes insipidus is characterized by polyuria, not decreased urine production. Hyposecretion of somatotropin, or growth h

The nurse preparing a child for diagnostic testing to diagnose disseminated intravascular coagulation (DIC). Which results would the nurse identify as indicating this condition? A. Increased D-Dimer assay B. Increased antithrombin III C. Decreased fibrogen/fibrin degradation products D. Decreased fibrinopeptide A level

ANS: A Rationale: Test results indicative of DIC include: increased D-Dimer assay, decreased antithrombin III, increased fibrogen/fibrin degradation products, and increased fibrinopeptide A level.

The nurse is teaching a group of parents about head lice. Which statement is essential to include during the presentation? A. Head lice are becoming very resistant to treatment. B. Send your child to school even if you suspect head lice, but have the school nurse check the child. C. Discourage the children from going to sleepovers. D. Wash the bed linens in hot water to kill the lice.

ANS: A Rationale: The accurate advice is that head lice are becoming resistant to treatment. Children with head lice do not need to stay home, but parents should follow school policies regarding whether children are allowed in school until they are nit-free. Children should be allowed to participate in sleepovers, preferably bringing their own pillows. Head lice do not survive long once they have fallen off. Most children can be treated effectively without treating their bedding and clothing.

The nurse is assessing a 6-month-old child. The mother asks when the soft area in her child's head will go away. What is the best response by the nurse? A. "The area is called the anterior fontanel and typically closes anytime up to 18months of age." B. "Soft spots on the child's head should have closed by now." C. "The area is called a fontanel. They remain open to allow for rapid brain growth in the first months of life." D. "The soft spots may stay open until your child is two or three years old."

ANS: A Rationale: The anterior fontanel typically closes by the age of 9 to 18 months. Fontanels are soft areas on the skull that remain open in infancy to allow for rapid brain growth in the first months of life. This answer is a true statement but does not answer the mother's question.

A child who is experiencing an exacerbation of asthma is brought to the emergency department by his parents. When reviewing the child's laboratory and diagnostic test results, which is consistent with the diagnosis? A. Hyperinflation of lungs on chest radiograph B. Increased peak expiratory flow rate C. Low arterial blood carbon dioxide level D. Decreased pulmonary function tests

ANS: A Rationale: The chest radiograph usually reveals hyperinflation. Peak expiratory flow rate usually is decreased during an exacerbation. With arterial blood gases, carbon dioxide retention is usually noted. Although pulmonary function tests are useful in determining the degree of disease, they are not useful during an attack.

A nurse is administering a blood transfusion to a child. About 35 minutes after beginning the transfusion, the child develops pruritus and urticaria. Some wheezing is noted. Which action would the nurse take first? A. Discontinue the transfusion. B. Obtain a blood culture. C. Give an iron-chelating agent. D. Ask the health care provide for a prescription for a diuretic.

ANS: A Rationale: The child is experiencing a transfusion reaction; the first step with any transfusion reaction is to discontinue the transfusion. Oxygen should be given, and the nurse should anticipate the need for an antihistamine to reduce the child's symptoms. An iron-chelating agent would be given for hemosiderosis after repeated transfusions. A blood culture would be obtained if the child developed a fever.

When caring for children with respiratory issues in relationship to the anatomy and physiology of the child's respiratory system, it is important to recognize which of the following? A. The diameter of the child's trachea is about the size of the child's little finger. B. As soon as the child is born, respiratory passages needed during fetal life close. C. Full development of the lungs and respiratory organs involved does not occur until the child is an adolescent. D. The newborn uses the thoracic muscles to breathe, and as they grow they begin using the abdominal muscles to breathe.

ANS: A Rationale: The diameter of the infant's and child's trachea is about the size of the child's little finger. This small diameter makes it extremely important to be aware that something can easily lodge in this small passageway and obstruct the child's airway.

At a well-child visit, a urine specimen is obtained from a child for testing. The nurse is reviewing the results which reveal positive leukocytes. The nurse interprets this as indicating which of the following? A. Possible urinary tract infection B. Diabetes C. Renal disease D. Bleeding

ANS: A Rationale: The evidence of leukocytes in a urine specimen suggests a possible urinary tract infection. Glucose in the urine may suggest diabetes. Elevated protein levels suggest renal disease. Elevated levels of red blood cells in the urine indicate possible calculus, trauma and renal parenchymal disease.

A 10-year-old child is newly diagnosed with type 1 diabetes. The child's hemoglobin A1C level is being monitored. The nurse determines that additional intervention is needed with the child based on which result? A. 8.5% B. 6.5% C. 7.5 % D. 7.0%

ANS: A Rationale: The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%. Therefore, a result of 8.5% would indicate that additional intervention is needed to achieve the recommended goal.

A 5-month-old infant being assessed was born at 32 weeks. The nurse doing the well-child check-up should compare the baby to what norms? A. The development of a 3-month-old B. The development of a 10-week-old C. The growth of a 2-month-old D. The growth of a 5-month-old

ANS: A Rationale: The infant was born 8 weeks early. Two months are subtracted from the present age of 5 months. Both growth and development should be assessed using 3-month norms.

A client with severe chronic anemia is receiving ongoing transfusion therapy. The nurse frequently assesses the client for what major complication of this therapy? A. Toxic iron overload B. Fibrin clots C. Chronic idiopathic thrombocytic purpura D. Vaso-occlusive crisis

ANS: A Rationale: The major complication of an ongoing transfusion therapy program is the development of toxic iron overload, which leads to pathologic changes in body systems, including the hepatic, endocrine, and cardiac systems. Fibrin clots, chronic idiopathic thrombocytic purpura or vaso-o

A nurse is teaching parents of a 2-year-old child about discipline and limit setting. When describing the use of time out, the nurse would inform the parents that the maximum duration of time out should be how many minutes per each year of age? A. 1 minute B. 30 seconds C. 90 seconds D. 2 minutes

ANS: A Rationale: The maximum time-out duration should be 1 minute for each year of age, but it may be necessary to start with much shorter time-outs. The other time frames are incorrect.

The nurse is providing anticipatory guidance to the mother of a 9-month-old girl during a well-baby visit. Which topic would be most appropriate? A. Advising how to create a toddler-safe home B. Warning about small objects left on the floor C. Cautioning about putting the baby in a walker D. Instructing on safety procedures during baths

ANS: A Rationale: The most appropriate topic for this mother would be advising her on how to create a toddler-safe home. The child will very soon be pulling herself up to standing and cruising the house. This will give her access to areas yet unexplored. Warning about small objects left on the floor, telling about safety procedures during baths, and cautioning about using baby walkers would no longer be anticipatory guidance as the child has passed these stages.

Patty calls the hospital nursing hotline and asks, "My 8-week-old daughter cries 8 hours a day, and she is hard to console, is that normal?" What should the nurse's response be to this mother? A. "Let me ask you some more questions to see if there are symptoms of colic." B. "Yes, infants cry all the time at that age." C. "No, call your doctor." D. "Yes, maybe she is just tired."

ANS: A Rationale: The nurse should seek more information to assess the infant's symptoms. The symptoms suggest colic, which is characteristic of an infant who cries more than 3 hours a day and is fussy and hard to console. The other responses are non-therapeutic and do not seek further information to gather a history.

The nurse is caring for a 3-year-old girl who has just undergone a ventriculostomy. Which of the following would the nurse include in this child's plan of care to manage increased intracranial pressure (ICP)? A: Use pillows to support the child when lying on her side B: Support the parents in starting a ketogenic diet C: Pad the side rails on the bed D: Teach her to do deep breathing techniques

ANS: A Rationale: The nurse should use pillows to prevent the child from sliding down in bed and to support the head in a neutral position when the child lies on his or her side. Beginning a ketogenic diet and padding the side rails for safety are interventions for a child with seizures. A 3-year-old is not likely to understand deep breathing techniques.

The nurse is educating an 18-year-old female client with Turner syndrome. What information will the nurse include in the teaching plan? A. Resources regarding infertility and family planning B. Requirements for post secondary educational needs C. The need to eliminate amino acids from the diet D. The options for a cure as the client enters adulthood

ANS: A Rationale: The older adolescent female will need education on infertility and family planning, because most women with Turner syndrome are infertile but spontaneous pregnancy may occur. If the adolescent wishes to have children in the future, information on alternatives reproduction strategies should be introduced. There is no cure for Turner syndrome. The other responses are not specific to Turner syndrome.

The nurse is teaching the parents of a child with varicella about the disorder. The nurse determines that the teaching was successful when the parents state which of the following? A. "We will make sure to remind him not to scratch the lesions." B. "We can give him aspirin for fever." C. "We should put him in a warm bath if he is itchy." D. "We can use salt solutions to help heal his oral lesions."

ANS: A Rationale: The parents understand the teaching when they state that they will help make sure to remind him not to scratch the lesions. Acetaminophen should be administered for fever, not aspirin, due to the link with Reye's syndrome. The best treatment for skin discomfort is a cool bath with soothing colloidal oatmeal every 3 to 4 hours for the first few days. The child should avoid citrus, spicy, or salty foods.

The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system? A Child reports of facial palsy and vision problems B Observing petechiae, purpura, or unusual bruising C Noting adventitious breath sounds during auscultation D Palpation of abdomen reveals enlarged

ANS: A Rationale: The presence of facial palsy and vision problems indicates that the central nervous system has been infiltrated by leukemia cells. The petechiae, purpura, or unusual bruising results from decreased platelet levels and may be present regardless of metastasis. Adventitious breath sounds may indicate pneumonia, and may be present whether the disease has metastasized or not. Hepatomegaly and splenomegaly result from infection, not metastasis.

A 3-year-old boy has been brought to the doctor's office with symptoms of anorexia and abdominal pain. A blood test reveals a lead level of 20 g/100 mL. The child is prescribed an oral chelating agent. On discharge, the nurse should counsel the parents regarding: A. removal or covering of flaking paint on the walls of the home B. putting child safety locks on kitchen cabinets C. putting medicine away where children cannot reach it D. placing house plants out of reach of children

ANS: A Rationale: The usual sources of ingested lead are paint chips or paint dust, home-glazed pottery, or fumes from burning or swallowed batteries. A child with a blood lead level over 5 g/dL needs to be rescreened to confirm the level and then active interventions begun to prevent further lead exposure, such as removal of the child from the environment containing the lead source or removal of the source of lead from the child's environment. Removal of the lead source is not an easy task in homes because simple repainting or wallpapering does not necessarily remove the source of peeling paint adequately. After some months, the new paint will begin to peel because of the defective paint underneath. The walls must therefore be covered by paneling or dry wall or other solid protective material.

A child with a suspected airway obstruction is brought to the emergency room. He produces a harsh, strident sound on inspiration (stridor). Where is the obstruction likely to be located, based on this information? A. In the larynx B. Lower trachea C. Bronchioles D. Pharynx

ANS: A Rationale: The vibrations produced as air is forced past obstructions such as mucus in the nose or pharynx, the noise produced is a snoring sound (rhonchi). If the obstruction is at the base of the tongue or in the larynx, a harsher, strident sound on inspiration (stridor) occurs. If an obstruction is in the lower trachea or bronchioles, an expiratory whistle sound (wheezing) occurs.

The parents of an 8-month-old boy voice concern to the nurse that their child is not developing motor skills as he should. What question would be appropriate for the nurse to ask in determining if their fears are warranted? A. "Does he move a toy back and forth from one hand to the other when you give it to him?" B. "Does he place toys into a box or container and take them out?" C. "Is he able to drink with a cup by himself?" D. "Is he able to hold a pencil and scribble on paper?"

ANS: A Rationale: Transferring an object from one hand to the other is expected at 7 months of age, so this would be expected of an 8-month-old. The other options are not expected until later months, so questioning the parents about these skills would not help in determining if he was at the motor skill developmental level that should be expected.

A nurse is describing the underlying cause of trisomy 21 to a group of parents, integrating knowledge that the disorder is due to: A. nondisjunction. B. deletion. C. duplication. D. translocation.

ANS: A Rationale: Trisomy 21 is a disorder caused by nondisjunction or error in cell division. It is not due to the loss of a portion of the chromosome (deletion), an extra segment being present (duplication), or transfer of one part of the chromosome to another

A panicked mother calls the health care provider's office and reports that her 5-year-old has a high fever and just had a seizure. The mother asks the nurse what she should do. Which is the nurse's best response? A: Report to the emergency room for medical evaluation B: Immerse the child in a bathtub of tepid water C: Administer oral acetaminophen per package directions D: Remove any heavy clothing and cover with a thin sheet

ANS: A Rationale: When a child has a febrile seizure associated with a high fever, it is important to seek medical evaluation. Medical evaluation will identify the source of the high fever. If the fever is viral, the child may be able to be managed at home. Advise them not to put the child in a bathtub of water to do this because it would be easy for the child to slip under water should a second seizure occur. Caution them not to apply alcohol or cold water as extreme cooling causes shock to an immature nervous system. Parents should not attempt to give oral medications such as acetaminophen, because the child will be in a drowsy, or postictal, state after the seizure and might aspirate the medicine. It is appropriate to remove heavy clothing but not the best response.

The nurse is providing education to parents of a child with a blood pressure in the 90th percentile. What would be included in the intervention strategies? A. The nurse would review the child's 24-hour diet recall. B. The child should not be allowed to participate in sports. C. Blood pressures should be measured daily. D. Beta blocker education should be given to the parents.

ANS: A Rationale: With a child in the 90th percentile for blood pressure, diet and physical activity should be the main focus. Blood pressures should be measured, but daily measurement is not necessary. Children are not routinely put on beta blockers, and the child should be allowed to participate in sports if monitored.

Parents of a preschooler with cerebral palsy ask the nurse what the surgeon plans to implant in their child's body to control spasticity. What is the nurse's answer? A. Baclofen pump B. Vagal nerve stimulator C. Central venous catheter D. Botulinum toxin

ANS: A Rationale: A baclofen pump can be placed surgically to deliver continuous medication intrathecally. Baclofen can also be taken orally. Botulinum toxin is injected by a practitioner into specified muscle groups to reduce spasticity. A central venous catheter places medication directly into rapidly moving blood and would not be used. A vagal nerve stimulator is used to control seizures.

A 4-year-old child is scheduled for an echocardiogram. The nurse is explaining this procedure to the child's parents. Which information would the nurse likely include? Select all that apply. A. "This test uses sound waves to check the heart structures." B. "This test should not cause your child any pain." C. "This test exposes your child to radiation so we need to be careful." D. "This test checks the electrical conduction of your child's heart." "This test will require us to give your child a small amount of anesthesia."

ANS: A, B Rationale: An echocardiogram is a noninvasive ultrasound procedure used to assess heart wall thickness, size of heart chambers, motion of valves and septa, and relationship of great vessels to other cardiac structures. It should not cause any pain for the child. No sedation or anesthesia is needed for an echocardiogram. However, the child needs to lie still throughout the test. A chest x-ray or radiograph would expose the child to radiation. An electrocardiogram records the electrical activity of the heart.

The nurse is reviewing information about hemophilia with an adolescent client. The client demonstrates understanding of the information when identifying hemophilia B as a deficiency of which factor? Select all that apply. A. Christmas factor B. Factor IX C. Stuart's factor D. Antihemophilic factor E. Factor VIII

ANS: A, B Rationale: Factor IX is also known as plasma thromboplastin component or Christmas factor. Factor X is Stuart's factor. Factor VIII is antihemophilic factor and associated with hemophilia A.

The nurse is caring for a child diagnosed with rheumatic fever. When addressing the child's pain, the nurse should perform which intervention(s)? Select all that apply. A. Carefully handle the child's knees, ankles, elbows and wrists when moving the child. B. Administer salicylates after meals or with milk. C. Teach the child how to use a patient-controlled analgesia system. D. Administer intravenous morphine as prescribed. E. Prioritize nonpharmacologic interventions over pharmacologic interventions.

ANS: A, B Rationale: Pain control and relief are the highest priorities for the child with rheumatic fever. Position the child to relieve joint pain. Large joints, including the knees, ankles, wrists, and elbows, are usually involved. Carefully handle the joints when moving the child to help minimize pain. Salicylates are administered in the form of aspirin to reduce fever but primarily to relieve joint inflammation and pain.They are also used as a heart protective. They are prescribed in high dosages. These are more commonly administered instead of opioids. Patient-controlled anesthesia is not typically used. Nonpharmacologic interventions can be used as an adjunct to pain medications.

The nurse is providing care to a child with a congenital heart defect. Which of the following would lead the nurse to suspect that the child is developing heart failure? Select all that apply. A. Tachycardia B. Sacral edema C. Bradypnea D. Inability to sweat E. Splenomegaly

ANS: A, B Rationale: Signs of heart failure include tachycardia, dependent edema such as in the sacral area, tachypnea, and hepatomegaly. In addition, diaphoresis, fatigue and exercise intolerance may be noted.

The nurse identifies the nursing diagnosis of risk for infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply. A. Having the child sleep in a single bed and room B. Encouraging frequent, thorough handwashing C. Providing a low-carbohydrate, low-protein diet D. Encouraging frequent close contact with numerous visitors E. Cheering up the environment with fresh flowers and plants

ANS: A, B Rationale: To reduce the risk of infection, the nurse should teach the child and parents about minimizing the child's exposure to potentially infectious situations. The nurse should encourage the parents to arrange for the child to sleep in a single bed and room and, if possible, avoid close contact with other family members who may be developing upper respiratory tract infections. Thorough and frequent handwashing, especially after using the bathroom and before eating, is essential. A high-calorie, high-protein diet helps to rebuild white blood cells and should be encouraged. If possible, the child's exposure to large crowds and visitors should be limited because of the increased risk of infection from these individuals. Fresh flowers and plants should be avoided because they could harbor mold spores.

The nurse is assisting in the development of a plan of care for a child with asthma. In planning care, many goals would be appropriate for this child and/or family caregiver. Which two goals would be the highest priority for this child or family? A. The child will maintain a clear airway. B. The child will have adequate fluid intake. C. The child and family will connect with families living with the same diagnosis. D. The child and family will improve knowledge and understanding of varied pharmacologic options. E. The child will maintain adequate pain control.

ANS: A, B Rationale: Treatment and management of asthma centers around avoiding triggers and controlling inflammatory episodes. Keeping the airway open is always the priority (ABCs). The next physiologic need is adequate fluid intake. These are priorities over psychosocial considerations such as connecting with other families. Pain is not normally an issue. The family does not need to understand every available pharmacologic option. They need to understand the action plan for their child.

A group of nursing students are reviewing information about growth and development during infancy. The students demonstrate understanding of the information when they identify which of the following as characteristic of a 10-month-old infant? Select all that apply. A. Understands the word "no" B. Tilts head backward to see up Stands alone C. Exhibits stranger anxiety D. Waves hands

ANS: A, B, C Rationale: A 10-month-old understands the word "no," is able to tilt the head backwards to see up, and can stand alone. Stranger anxiety occurs around 6 months of age. The ability to wave the hand occurs around 7 to 9 months of age.

A nurse is assessing the history of a 7-year-old boy who is suspected of having a cardiovascular disorder. Which of the following findings would tend to indicate a cardiovascular disorder in this child? Select all that apply. A. Fatigues easily after a short walk home from school B. A tendency to squat C. Periorbital edema D. A lack of perspiration E. Frequent voiding F. Bouts of hyperactivity

ANS: A, B, C Rationale: A mark of older children with heart disease is that they notice easy fatigue. They often voluntarily squat, as this position traps blood in the lower extremities because of the sharp bend at the knee and hip, allowing the child to oxygenate the blood remaining in the upper body more fully and easily. Ask about perspiration as children with left-to-right cardiac shunts may perspire excessively because of sympathetic nerve stimulation. They are able to effectively produce urine only when cardiac function is adequate to perfuse kidneys. To assess kidney output, evaluate how often the child voids. Infrequent voiding could indicate lack of perfusion of the kidneys, and thus decreased heart function. Edema from retained fluid that cannot be voided is a late sign of heart disease in children. If it does occur, periorbital edema (swelling around the eyes) generally occurs first. Bouts of hyperactivity are not associated with cardiovascular disorders.

he nurse determines that a 20-month old is in Piaget's sensorimotor stage of cognitive development. Which actions support this assessment? Select all that apply. A. The child has an imaginary playmate B. The child has a limited concept of time. C. The child demonstrates egocentricity. D. The child understands instructions literally E. The child imitates others' behaviors at a later time

ANS: A, B, C Rationale: According to Piaget, children in the sensorimotor stage of cognitive development have a limited concept of time, have imaginary playmates, and are very egocentric. Understanding instructions literally and imitating others' behaviors at a later time reflect the perioperational stage according to Piaget.

A child is receiving antithymocyte globulin for treatment of acquired aplastic anemia. After administering the drug, assessment of which of the following would the nurse identify as a possible adverse reaction? Select all that apply. A. Fever B. Urticaria C. Dyspnea D. Constipation E. Diarrhea

ANS: A, B, C Rationale: Adverse reactions associated with antithymocyte globulin include fever, chills, rash, urticaria, pruritus, dyspnea, chest pain, nausea, vomiting, leukopenia, and thrombocytopenia. Other less frequent side effects that may occur and can be life threatening include hypotension, pulmonary edema, laryngospasm, and anaphylaxis. Serum sickness may also occur.

The nurse is assessing the parents interacting with their infant. Which of the following would indicate to the nurse that attachment is occurring? Select all that apply. A. Parents make eye-to-eye contact. B. Parents hold the baby close to the body. C. Parents talk to the baby while holding the baby D. Parents refrain from inspecting the baby's body. E. Parents avoid snuggling with the baby.

ANS: A, B, C Rationale: Attachment is the emotional bond that creates an important foundation for the relationship between the parent and the infant. Certain identifiable behaviors—eye-to-eye contact, physical contact, and communication—indicate that attachment is occurring.

The nurse caring for a young adolescent with Crohn's disease. After teaching the adolescent and her family about this condition, the nurse determines that the teaching was successful when they identify which of the following as a possible complication? Select all that apply. A: Stricture B: Fistula C: Intra-abdominal abscess formation D: Gallstones E: Pancreatitis

ANS: A, B, C Rationale: Crohn's disease is a recurrent disease. Long-term complications may include stricture, fistula, and intra-abdominal abscess formation. Individuals with severe disease who require extensive resection of diseased bowel may be left with short bowel syndrome and long-term dependence on parenteral nutrition. Gallsto

The adolescent has been diagnosed with gastroesophageal reflux disease (GERD). Which statements by the teen indicates that adequate learning has occurred? Select all that apply. A: "This famotidine may make me tired." B: "The omeprazole could give me a headache." C: "It sounds like the physician is reluctant to give me a prokinetic because of the side effects." D: "I will probably need a laxative because of the omeprazole." E: "I should try to lie down right after I eat."

ANS: A, B, C Rationale: Famotidine may cause fatigue. Omeprazole can cause headaches. Prokinetics use may result in side effects involving the central nervous system. Omeprazole use more likely will result in diarrhea, not constipation. Children with GERD should not lie down after meals.

A nurse is providing anticipatory guidance to parents of a 3-year-old about nutrition and finger foods. Which of the following would be most appropriate for the nurse to suggest? Select all that apply A. Diced fruit B. Shredded cheese C. Cereal D. Grapes E. Chunks of carrots

ANS: A, B, C Rationale: Finger foods such as diced fruit, steamed diced vegetables, shredded cheese, or cereals are ideal for the young child. Foods should be mashed or cut into small pieces to prevent choking. Even soft, small foods such as grapes could be a hazard. For example, steamed or cooked carrots and hot dogs should be cut in half lengthwise and then quartered to prevent choking.

A child is diagnosed with short bowel syndrome. What would the nurse expect to be included in the child's plan of care? Select all that apply. A: Antibiotics B: Vitamin supplements C: Total parenteral nutrition D: Laxatives E: Immunosuppressants

ANS: A, B, C Rationale: For the child with short bowel syndrome, typically, antibiotics, vitamin and mineral supplements, antidiarrheal agents, and total parenteral nutrition are prescribed. Laxatives and immunosuppressants are not used.

The nurse is caring for a teenager recently diagnosed with Addison disease. Which findings can be anticipated by the nurse? Select all that apply. A. Sodium level 128 mEq/L B. Potassium level 5.6 mEq/L C. Muscular weakness D. Rapid weight gain E. Facial acne

ANS: A, B, C Rationale: Hyponatermia, hyperkalemia and muscle weakness are all symptoms of Addison

A nurse performs a focused physical assessment for a child diagnosed with aplastic anemia. Which of the following would the nurse most likely document as a typical characteristic? Select all that apply. A. Epicanthal folds B. Small jaw C. Café-au-lait spots D. Narrow nasal base E. Large eyes

ANS: A, B, C Rationale: Manifestations of aplastic anemia include a broad nasal base, epicanthal folds, small eyes, microdontia, small jaws, and café-au-lait spots

The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. What would the nurse expect to find? Select all that apply. A. Tiring easily when eating B. Shortness of breath when playing C. Crackles on lung auscultation D. Bradycardia E. Hypertension

ANS: A, B, C Rationale: Manifestations of heart failure include difficulty feeding or eating or becoming tired easily when feeding or eating, shortness of breath with exercise intolerance, crackles and wheezes on lung auscultation, tachycardia, and hypotension.

The parents of a 2 year old are concerned because the toddler only says a few words. What strategies should the nurse suggest to the parents? Select all that apply. A. Read books aloud to the toddler. B. Name aloud the objects being played with. C. Always answer questions using correct grammar. D. Have the toddler watch educational television. E. Use pronouns when speaking. F. Use baby talk when speaking.

ANS: A, B, C Rationale: Reading aloud is an effective way to strengthen vocabulary. Also, urge parents to encourage language development by naming objects as they play with their child or when they give their toddler something. This helps children grasp the fact words are not meaningless sounds; they apply to people and objects and have uses. Always answering a child's questions is another good way to do this. Watching television promotes little learning as the activity is passive and it is difficult to discern how language caused the action. The American Academy of Pediatrics recommends television viewing should be severely limited until at least 2 years of age. Because children learn language from imitating what they hear, if they are spoken to in baby talk, their enunciation of words can be poor; if they hear examples of bad grammar, they will not use good grammar. Remind parents pronouns are difficult for children to use correctly; many children are 3 1/2 or 4 years of age before they can separate the different uses of "I," "me," "him," and "her."

A nurse is teaching the parents of a child diagnosed with attention-deficit/hyperactivity disorder about the condition. The nurse determines that the teaching was successful when the parents make which statements? Select all that apply. A: "We need to set clear limits for our child's behavior." B: "A reward system would be useful to give our child positive feedback." C: "We need to limit the number of choices our child has." D: "We need to give our child all directions at once in case the child gets distracted." E: "If the child acts out, we can explain that this is being bad."

ANS: A, B, C Rationale: The child with ADHD needs clear limits and a limited number of choices to prevent the child from becoming overwhelmed. Positive feedback is essential, such as with a reward or token system. Directions should be broken down into steps that are clear and short. Parents should avoid negative comments that label the child as bad.

After teaching the parents of a child diagnosed with sickle cell disease, the nurse determines that the teaching was successful when the parents state that they will contact the primary health care provider if the child develops which signs or symptoms? Select all that apply. A. Chest pain B. Severe dizziness C. Sudden change in vision D. Constipation E. Irritability

ANS: A, B, C Rationale: The parents should contact the primary health care provider if the child develops a fever, dizziness or severe headaches, severe stomach pain or swelling, sudden changes in vision, weakness, or loss of consciousness. There is no need to notify the primary health care provider if the child develops constipation or irritability.

The nurse is caring for a child admitted to the pediatric medical unit with chickenpox who has infected vesicles. What personal protective equipment should the nurse use when measuring the child's vital signs? A. Gloves B. Gown C. N95 respirator D. Face mask E. Eye wear

ANS: A, B, C Rationale: Transmission of chickenpox (Varicella zoster) occurs through direct contact with infected persons' nasopharyngeal secretions or via air-borne spread, to a lesser degree by contact with unscabbed lesions. Airborne and contact precautions (gloves, gown, N95 respirator) should be used with the hospitalized child for a minimum of 5 days after onset of rash and as long as vesicular lesions are present. A simple face mask is used for droplet precautions. Eye wear would only be necessary if splashing was likely.

A child comes to the clinic for evaluation of skin lesions and is diagnosed with impetigo. Which medications are potentially ordered with instructions placed on the discharge summary? Select all that apply. A. Penicillin B. Erythromycin C. Mupirocin D. Tetracycline E. Lindane

ANS: A, B, C Rationale: Treatment of impetigo includes oral administration of penicillin or erythromycin or the application of mupirocin. Tetracycline is not used. Lindane is used to treat tinea infections.

A child with sickle cell anemia comes to the emergency department for evaluation. The nurse suspects that the child is experiencing a vaso-occlusive crisis based on assessment of which signs and symptoms? Select all that apply. A. Low back pain B. Fever C. Distended abdomen D. Splenic enlargement E. Increased reticulocyte count

ANS: A, B, C Rationale: Vaso-occlusive crisis is manifested by bone pain, most commonly in the lumbosacral spine, fever, leukocytosis, distended abdomen and acute abdominal pain. Splenic enlargement and increased reticulocyte count suggest acute splenic sequestration.

The nurse caring for a neonate experiencing seizures asks the charge nurse: "How can I tell if a baby is having a seizure or is just crying for attention?" Which response would be most appropriate? Select all that apply. A: "You will not be able to stop a seizure with gentle restraint." B: "The baby experiencing a seizure will be tachycardic." C: "Stimulating the baby by singing to him will not stop a seizure." D: "There will be no changes in the baby's vital signs with a seizure" E: "The baby will become more active with sensory stimulation with a seizure." F. "The baby will stop the seizure activity when swaddled in a blanket."

ANS: A, B, C Rationale: With seizure activity, the neonate experiences tachycardia and increased blood pressure, and movements are not suppressed by general restraint and are unchanged by sensory stimuli. With nonepileptic movements, there is no change in vital signs, the movement is suppressed easily with gentle restraint, and movements are enhanced with sensory stimuli.

Which collaborative actions will the nurse perform when caring for an infant with transposition of the great arteries scheduled for surgical repair of the defect? Select all that apply. A. Provide education to the parents. B. Auscultate lung sounds frequently. C. Apply a continuous pulse oximeter. D. Keep oxygen saturation above 75%. E. Administer indomethacin intravenously.

ANS: A, B, C, D Rationale: Collaborative interventions for an infant with transposition of the great arteries include providing education to parents in preparation for their infant's surgery; assessing pulse oximetry and auscultating lung sounds frequently to monitor for signs of increased pulmonary flow; and maintaining normal oxygen saturation for transposition of the great arteries at 75% to 85%. Administering indomethacin would cause closure of the ductus arteriosus, which would prevent mixing of blood.

The nurse is performing a physical examination of a 5-year-old boy. Which documented findings would most strongly indicate maltreatment of the child? Select all that apply. A: Cuts and bruises on the hands B: Burns on the dorsal surface of the hand C. A curved laceration on the backD. Linear lesions across the chest and abdomen D. Linear lesions across the chest and abdomen E: A bruise on the child's knee D: A scab on the child's elbow

ANS: A, B, C, D Rationale: Several injuries in children clearly signal probable child maltreatment. Children who are maltreated have a higher incidence of hand injury. Children who are beaten with electrical cords, belts, or clotheslines have peculiar circular and linear lesions. Children who are beaten with a belt buckle may have additional curved lacerations from the imprint of the buckle; few other objects produce such contusions. When children burn their hand by accident, they usually burn the palm; burns from maltreatment are often on the dorsal surface. However, it is normal for preschoolers who actively play to have bruises on multiple bony spots (shin, elbows, knees, etc.).

During a routine well-child visit, the mother of a preadolescent patient asks the nurse to explain signs of sexual abuse. The mother is concerned because an older male neighbor has been making comments and overtly admiring the child when playing outdoors. What signs of sexual abuse should the nurse tell the mother to look out for? Select all that apply. A: Child reports abdominal pain. B: Child has a change in school performance. C: Child demonstrates anxiety or trouble sleeping. D: Child does not want to be left alone with a certain adult. E: Child spends a great deal of time with peer-group friends.

ANS: A, B, C, D Rationale: Signs of sexual maltreatment include vague reports of abdominal pain, a change in school performance, anxiety or trouble sleeping, and not wanting to be left alone with a certain adult. Spending time with peer-group friends is an expected preadolescent behavior and is not a sign of sexual maltreatment.

A nurse is developing a teaching plan for the parents of a child with myasthenia gravis. Which of the following would the nurse include? A. How to administer anticholinergic drugs B. Establishment of plans for rest periods C. Signs and symptoms of infection D. Stress management techniques E. Ways to increase the temperature of the child's environment

ANS: A, B, C, D Rationale: The teaching plan for a child with myasthenia gravis should include instructions about administering anticholinergic agents, usually 30 to 45 minutes before meals, on time and exactly as ordered; measures to allow for rest periods for energy conservation; signs and symptoms of infection and the need to notify the physician because infection can precipitate a myasthenic crisis; stress management techniques because stress can precipitate a myasthenic crisis; and ways to maintain the child's environmental temperature because exposure to extreme temperatures can precipitate a myasthenic crisis.

The nurse is providing teaching to the parents of a child whose blood pressure is in the 90th percentile. Which of the following would the nurse expect to include? Select all that apply A. Family lifestyle modification B. Sodium restriction C. Aerobic exercise D. Stress reduction E. Antihypertensive therapy.

ANS: A, B, C, D Rationale: With a child in the 90th percentile for blood pressure, lifestyle modification including diet and exercise are the main focus. These include salt restriction, aerobic exercise, and stress reduction. Antihypertensives are used if the child has symptomatic hypertension.

A mother of a 2-year-old asks the nurse, "What would be a good between-meal snack?" What foods would be appropriate for the nurse to suggest? Select all that apply. A. Pieces of apples B. Orange slices C. Cheese D. Cookies E. Yogurt

ANS: A, B, C, E Rationale: Good choices for between-meal snacks include fruits (e.g., pieces of apples or orange slices) and high-protein foods (e.g., cheese or pieces of chicken). Cheese as well as yogurt provide calcium. Cookies and other high-carbohydrate foods should be avoided because they promote dental caries.

When caring for a child with acute bronchiolitis which nursing interventions should be included in the plan of care. Select all that apply. A. Encourage fluids B. Administer oxygen C. Place child in mist tent D. Administer antibiotics E. Follow contact precautions F. Encourage activity

ANS: A, B, C, E Rationale: The child is treated with high humidity by mist tent, rest, and increased fluids. Oxygen may be administered. Antibiotics are not prescribed because the causative organism is a virus. IV fluids often are administered to ensure an adequate intake and to permit the infant to rest. The hospitalized child is placed on contact transmission precautions to prevent the spread of infection.

A nursing instructor teaching a class about immunity asks the students to identify the organs of the immune system. Which would the nursing instructor want them to include? (Select all that apply.) A. lymph nodes B. bone marrow C. thymus D. liver E. spleen F. tonsils

ANS: A, B, C, E, F Rationale: The organs of the immune system consist of the lymph nodes, bone marrow, thymus, spleen, and tonsils.

The nurse is caring for a 1-day-old newborn with patent ductus arteriosus with the following vital signs: pulse 160, respirations 80, oxygen saturation 92%, retractions, and crackles noted in bilateral lungs. Which nursing actions are appropriate at this time? Select all that apply. A. Administer furosemide. B. Initiate intravenous access. C. Apply oxygen via oxyhood. D. Feed a high-calorie formula. E. Begin indomethacin infusion.

ANS: A, B, C, ERationale: When a newborn with patent ductus arteriosus shows signs of significant blood flow to lungs (retractions, crackles, tachypnea, and hypoxia), nursing actions will focus on applying oxygen to improve oxygenation and decrease work of breathing. Nursing interventions also include reducing cardiac workload and pulmonary flow by initiating intravenous access to administer a diuretic to reduce extra fluid and indomethacin to cause closure of the PDA and stop increased pulmonary blood flow. Feeding the infant is not a priority at this time as aspiration may result from the inability to coordinate sucking and swallowing with increased work of breathing.

The nurse is performing discharge teaching for a 16-year-old diagnosed with peptic ulcer disease. Which statements by the parents and client demonstrate learning has occurred? A: "I will need to make sure to take all of the antibiotic prescribed." B: "It's important to take my histamine agonist medication at the appropriate time." C: "My proton pump inhibitor should be taken when I feel discomfort." D: "The prednisone that I take for my rheumatoid arthritis may be a cause of my peptic ulcer disease." E: "My mom having peptic ulcer disease has nothing to do with my having it."

ANS: A, B, D Rationale: If Helicobacter pylori (H. pylori) was detected as a cause of the peptic ulcer disease (PUD), the client will be prescribed an antibiotic and should take all of the medication. Histamine agonists and/or proton pump inhibitors should be taken routinely as prescribed. Risk factors include a family history of PUD or other GI diseases, or chronic salicylate or prednisone use.

A parent calls the "on call" line stating that her infant has had a bark-like cough for the past three nights. The parent states no fever or cold symptoms. Which suggestions may save a trip to the emergency department? Select all that apply. A. Use a cool mist humidifier in the infant's room. B. Take the infant into a steamy bathroom. C. Provide the infant cold oral fluids. D. Use the coolness of the night air. E. Assess throat for throat obstruction.

ANS: A, B, D Rationale: The goal of the nurse is to provide suggestions which decrease the bark-like cough and relieve the bronchial constriction. Once this is accomplished, the infant can rest. Common suggestions are use of a cool mist humidifier, steamy bathroom, and coolness of the night air.Cold fluids may cause further spasm. The parent would not be instructed to assess the throat unless data suggested a problem in that location. More likely, the parent would be instructed to bring the infant to the emergency department.

In providing anticipatory guidance related to choking hazards for infants, what should the nurse include in the teaching? Select all that apply. A. Propping a bottle B. Raw carrots C. Shape sorter D. Plastic bags E. Stuffed animals

ANS: A, B, D Rationale: The nurse should include teaching related to propping a bottle; foods that are choking hazards such as raw carrots, peanuts, hot dogs, and grapes; and plastic bags and balloons. Any toy or object that the infant can put in their mouth should be considered a choking hazard.

A child aged 3 months has been spitting up regularly since birth and is somewhat underweight. The nurse suggests which interventions to the parents? Select all that apply. A: Thicken feedings with rice cereal. B: Feed smaller amounts more frequently. C: Feed the infant in the supine position. D: Burp well when feeding.

ANS: A, B, D Rationale: Thickened feedings are heavier than formula/breast milk, making them more difficult to spit up. The rice cereal also adds calories that this infant needs. Smaller, frequent feedings and burping well prevent distending the stomach and reduce the likelihood of reflux. The best position following feeding is upright. The supine position creates pressure on the lower esophageal sphincter, which promotes reflux.

The nurse is caring for a child with a gastrointestinal disorder and measuring intake and output. The nurse observes that the child is demonstrating symptoms of adequate hydration when she/he has which of the following? Select all that apply. A: Fontanelles with normal tension B: Adequate skin turgor C: Oral intake D: Pink and moist mucous membranes E: Loose stools

ANS: A, B, D Rationale: A child can have oral intake that is insufficient for his/her needs and still be dehydrated due to fluid losses. Loose stools lead to dehydration therefore would not be an indicator of adequate hydration. Adequate hydration in the child can be seen in fontanels having normal tension, adequate skin turgor and pink, moist mucous membranes.

After an assessment, the nurse is concerned that a school-age child is at risk for developing a mental health disorder. Which assessment data will the nurse use to develop an appropriate plan care? Select all that apply. A: The parents recently divorced B: The father is unemployed and mother is infrequently home C: The child is learning to play the clarinet in music class in school D: The child is expected to care for younger siblings while mother sleeps E: There is history of multiple injuries obtained from a motor vehicle crash

ANS: A, B, D, E Rationale: Various factors have been associated with an increased risk for mental health disorders in children, including trauma, poverty or neglect, difficult temperament or attachment problems, medical illness, or major losses to the family such as divorce. Learning to play the clarinet in school has not been associated with an increased risk for mental health disorders in children.

During an admission assessment the nurse is discussing the developmental level of the child with the parents. Which comments by the parents demonstrate a good understanding of developmental expectations of the preschool-aged child? Select all that apply. A. "We think it is important to have play dates with our friend's preschool children." B. "Our child attends a wonderful preschool 3 times per week." C. "I am very concerned that our child is acting too much like some of the other children at our day care." D. "My parents are the only babysitters our child has ever had. I think contact with mostly adults is important for this age." E. "We have been talking about enrolling in a morning preschool program since this is our only child."

ANS: A, B, E

The home health nurse, who is visiting the home of a 4-year-old, prepares a nursing care plan with the nursing diagnosis of "At risk for injury related to the parents insufficient knowledge of safety practices for preschooler." Which nursing interventions should the nurse include in the plan of care? Select all that apply. A. Teach the parents to use a forward-facing car seat with harness and top tether. B. Teach the parents to only smoke in a vehicle with the child if a window is open. C. Teach the parents that the preschooler should use an approved bicycle helmet when riding a bicycle at any time. D. Teach the parents that they should wash the hands of the preschooler to ensure that proper hand washing has occurred. E. Teach the parents that medications can be kept in unlocked cabinets if childproof caps are used.

ANS: A, C

A child has been admitted to the inpatient unit to rule out acute Kawasaki disease. A series of laboratory tests have been ordered. Which findings are consistent with this disease? Select all that apply. A. Reduced hemoglobin levels B. Reduced white blood cell count C. Elevated erythrocyte sedimentation rate (ESR) D. Negative C reactive protein levels E. Reduced platelet levels

ANS: A, C Rationale: Kawasaki disease is an acute systemic vasculitis occurring mostly in children 6 months to 5 years of age. It is the leading cause of acquired heart disease among children. The CBC count may reveal mild to moderate anemia, an elevated white blood cell count during the acute phase, and significant thrombocytosis (elevated platelet count [500,000 to 1 million]) in the later phase. The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) level are elevated.

The nurse is caring for a child who has been hospitalized for maltreatment. When reviewing the child's records which findings may have placed the child at an increased risk for abuse? Select all that apply. A: The child's mother has a history of substance use disorder. B: Both parents work outside of the home. C: The child was born prematurely. D: The child has cerebral palsy. E: The child's father is the primary care taker.

ANS: A, C, D Rationale: Although not every child abused or child abuser will fit a profile of characteristics, many will. Child abuse occurs across all socioeconomic levels, but the findings are more prevalent in those experiencing poverty. Additional risk factors include prematurity, chronic illnesses, parental substance use disorder, cerebral palsy and cognitive impairment. Parents working outside the home and paternal caregivers are not families facing increased risk for abuse.

While observing the parents of a neonate with pyloric stenosis feeding the baby, the nurse notes that the parents are becoming frustrated. The nurse identifies a nursing diagnosis of risk for impaired parenting related to frustration and difficulty feeding neonate. Which would be appropriate for the nurse to include in the plan of care? Select all that apply. A: Encouraging rooming in with the neonate B: Helping them understand their stress level contributes to the neonate's vomiting C: Assisting the parents in holding and feeding their neonate D: Pointing out positive aspects about their neonate E: Informing the parents that the condition will require them to adjust their lifestyles

ANS: A, C, D Rationale: For a nursing diagnosis of risk for impaired parented, appropriate interventions include encouraging the parents to room in with their neonate, helping them understand that the cause of the condition is a physical problem, not something they did, assisting the parents in holding and feeding their neonate, and pointing out positive aspects about their neonate.

A child is diagnosed with Kawasaki disease and is in the acute phase of the disorder. What would the nurse expect the physician to prescribe? Select all that apply. A. Intravenous immunoglobulin B. Ibuprofen C. Acetaminophen D. Aspirin E. Alprostadil

ANS: A, C, D Rationale: In the acute phase, high-dose aspirin in four divided doses daily and a single infusion of intravenous immunoglobulin are used. Acetaminophen is used to reduce fever. Nonsteroidal anti-inflammatory agents such as ibuprofen are avoided while the child is receiving aspirin therapy. Alprostadil is used to temporarily keep the ductus arteriosus patent in infants with ductal-dependent congenital heart defects.

A nurse is teaching parents of a child with a nursing diagnosis of pain related to pruritus from skin lesions. Which of the following would the nurse include in the instructions? Select all that apply. A. "Keep the child's fingernails short." B. "Wrap your child up snugly with blankets." C. "Bathe the child in lukewarm water and baking soda." D. "Have the child press on the itching area instead of scratching it." E. "Avoid having your child wear cotton clothing."

ANS: A, C, D Rationale: Measures to reduce pruritus include keeping the child's fingernails short to prevent injury from scratching; bathing the child in lukewarm water with oatmeal or baking soda; dressing the child in loose, light cotton clothing to prevent overheating and perspiration, which can intensify the itching; having the child press on the itching area rather than scratching it; and avoiding wool, which can irritate the skin and worsen the itching.

The parents of twin 2-year-old toddlers are asking the nurse how to discipline the children. It seems they feed off one another's feelings and many times get into fights over everything. When giving advice about discipline, which statement should be shared with the parents? Select all that apply. A. The rule with time out is tell the child why they are going to time out and keep it to 1 minute per year of age. B. Warnings about going to time out should not be done. If the child breaks a rule, send them directly to time out. C. The discipline the parents choose should be consistent for every time the child breaks the same rule. D. If possible, try to praise correct behavior rather than punish wrong behavior. E. It is normal for children to hit their friends if the friend takes one of their toys, so the friend should be warned not to take toys that are being played with.

ANS: A, C, D Rationale: Parents should begin to instill some sense of discipline early in life because part of it involves setting safety limits and protecting others or property. Parents need to be consistent with their punishment. Rules are learned best if correct behavior is praised rather than wrong behavior punished. A "time-out" is a technique to help children learn that actions have consequences. To use a time-out effectively, parents first need to be certain their child understands the rule they are trying to enforce (e.g., "You can't hit people. If you hit your friend, you'll have time-out"). Parents should give one warning. If the child repeats the behavior, parents select an area that is nonstimulating, such as a corner of a room or a hallway. A guide as to how long children should remain in their time-out chair is 1 minute per year of age (e.g., a 2-year-old would stay in the corner for 2 minutes).

The parents of a preschool-aged child are investigating child care centers to enroll the child. What would the nurse review with the parents prior to them making a decision? Select all that apply. A. Ask about the child-staff ratio. B. Ask about the center's payment plan. C. Find out if parents can visit at any time. D. Find out how long the center has been in operation. E. Ask about the center's licenses and compliance with regulations.

ANS: A, C, D, E

The child has a meningocele and a neurogenic bladder. Which of the following topics should the nurse include in the teaching plan when educating the child and the child's caregivers? Select all that apply. A. How and when to administer oxybutynin chloride B. The importance of antibiotic use to prevent urinary tract infections from occurring C. How and when to perform clean intermittent urinary catheterization D. Signs and symptoms of a urinary tract infection E. Different types of surgeries used to treat this condition

ANS: A, C, D, E Rationale: Ditropan is used to increase the child's bladder capacity when they have a spastic bladder. The caregivers and the child should be taught about urinary catheterization techniques to allow the bladder to empty. The child and caregivers should be educated about the clinical manifestations associated with a urinary tract infection so that it can be treated promptly. Sometimes surgical interventions such as vesicostomy and the creation of a continent urinary reservoir are used to treat neurogenic bladders.

The young child has been diagnosed with hepatitis B. Which of the following statements by the child's mother indicates that further education is required? A: "We went swimming in a local lake 2 months ago and I just knew she drank some of the lake water." B: "Could I have this virus in my body, too?" C: "The virus is the reason her skin looks a little yellowish." D: "The only way you can get this virus is from intravenous drug use." E: "Her fever and rash are probably related to this virus."

ANS: A, D Rationale: Hepatitis A virus is transmitted by contaminated food or water. Hepatitis B virus may be transmitted perinatally from mother to infant, intravenous drug use with contaminated needles, sexual contact with an infected person, and blood transfusions. The mother may have contracted the virus prior to giving birth to the child. Infection with the hepatitis B virus may result in jaundice, fever, and a rash.

The nurse is caring for a newborn with a cleft palate. Which findings in the maternal medical record are considered to be contributing factors? Select all that apply. A: Maternal tobacco use. B: Moderate maternal alcohol use prior to pregnancy. C: Maternal age less than 18 years. D: Anticonvulsant therapy used to manage a seizure disorder. E: Reports of marijuana use in early pregnancy.

ANS: A, D Rationale: Infants born with a cleft palate may have mother's with risk factors. These include maternal smoking, prenatal infection, advanced maternal age, use of anticonvulsants or steroids.

A child is receiving a blood transfusion. Which of the following would alert the nurse that the child is experiencing a hemolytic reaction? Select all that apply. A. Urticaria B. Respiratory distress C. Diaphoresis D. Lower back pain D. Chills

ANS: A, D, E

The nurse is completing a physical assessment of a 15-month-old Which objective data would the nurse document as normal findings? Select all that apply. A. Heart rate of 100 beats per minute B. Predominance of baby fat C. Sunken abdomen D. Lordosis E. Waddling gait

ANS: A, D, E Rationale: A toddler typically has a heart rate from 90 to 110 beats per minute, evidence of decreasing body fat, a "pouchy" abdomen, lordosis, and a waddling or wide-based gait.

Which nursing diagnosis will the nurse select as appropriate for the child with atopic dermatitis? Select all that apply. A. Impaired skin integrity related to skin barrier function B. Delayed growth related to chronicity of immune disorder C. Ineffective breathing pattern related to allergic bronchospasm D. Anxiety related to continuing or uncontrolled allergic response E. Powerlessness related to difficulty determining cause of allergy

ANS: A, D, E Rationale: Atopic dermatitis (eczema) is a highly pruritic, chronic inflammatory skin disease. Nursing diagnoses should focus on impaired skin integrity, anxiety related to the allergic response, and powerlessness related to knowing cause of allergy. A nursing diagnosis of delayed growth is more appropriate for a child with HIV. A nursing diagnosis of ineffective breathing pattern is more appropriate for a child with asthma.

The nurse is reviewing the immunization schedule with the parent of a child who is HIV positive. What information should the nurse provide? Select all that apply. A: Pneumococcal vaccination can be given. B: The child should receive live vaccines only. C: The human papillomavirus vaccine should not be given. D: The varicella vaccine should not be given if the child is symptomatic. E: If the CD4 count is low, the measles, mumps, and rubella vaccine should not be given.

ANS: A, D, E Rationale: The nurse should emphasize that live vaccines should not be given to those infected with HIV. Children should receive routine immunizations according to the usual schedule with the killed virus vaccines, including pneumococcal and human papillomavirus vaccine. Symptomatic children should not receive the varicella vaccine, and those with low CD4 counts should not receive measles, mumps, and rubella vaccine.

The nurse is assessing the respiratory system of a newborn. Which anatomic differences place the infant at risk for respiratory compromise? Select all that apply. A. The nasal passages are narrower. B. The trachea and chest wall are less compliant. C. The bronchi and bronchioles are shorter and wider. D. The larynx is more funnel shaped. E. The tongue is smaller. F. There are significantly fewer alveoli.

ANS: A, D, F Rationale: In comparison with the adult, in the infant, the nasal passages are narrower, the trachea and chest wall are more compliant, the bronchi and bronchioles are shorter and narrower, the larynx is more funnel shaped, the tongue is larger, and there are significantly fewer alveoli. These anatomic differences place the infant at higher risk for respiratory compromise. The respiratory system does not reach adult levels of maturity until about 7 years of age.

A school-age child with asthma has cromolyn sodium added to the medication regimen. What should the nurse include when teaching the child and parents about this medication? Select all that apply. A. Use this medication with a metered-dose inhaler. B. Take this medication before an inhaled bronchodilator. C. Repeat doses of this medication until symptoms subside. D. This medication is to be used for an acute asthma attack. E. Wait 1 to 2 minutes between puffs when taking this medication.

ANS: A, E Rationale: Cromolyn sodium should be used with a metered-dose inhaler, and the child should wait 1 to 2 minutes between puffs when taking this medication. This medication should be taken after a bronchodilator. Doses should not exceed the number of ordered puffs because tolerance can develop. This medication is not effective in an acute attack.

A young client arrives at the clinic with a rash on the trunk and flexor surfaces of the extremities. The parent informs the nurse that the rash started a day before on the exterior surfaces of the extremities; 2 days before, the child had a really bad rash on the face. The health care provider diagnoses the child with erythema infectiosum. The nurse tells the parent that this is also known as: A. enterovirus. B. fifth disease. C. rosacea. D. pityriasis rosea.

ANS: B

The nurse is assessing a child who is experiencing acute splenic sequestration secondary to sickle cell disease. The nurse would identify which of the following as the priority? A. Pain relief B. Emergent transfusion C. Antibiotic administration D. Oxygen administration

ANS: B

What would be most effective in helping promote initiative and nutritional health for a preschooler? A. Giving the child a high carbohydrate snack after preschool B. Allowing the child to spread soft cheese on crackers C. Encouraging the child to cut up small pieces of apple for a snack D. Praising the child for cleaning his large plate of food

ANS: B

Which type of play would the nurse use to prepare a preschooler for upcoming surgery to reduce the stress of the event? A. Associative play B. Dramatic play C. Onlooker play D. Cooperative play

ANS: B

Which would be a nutritional goal for a preschool client? A. Eat everything on the plate. B. Introduce new food gradually and include variety. C. Reduce messiness and spills. D. Let the child eat only what the child wants.

ANS: B

A child receiving chemotherapy wants to have a large birthday party and invite all the classmates. When the parent asks the nurse about this, what is the nurse's best response? A. "That will be a good way to cheer your child up!" B. "It is better to avoid large groups right now." C. "What about taking your child to a movie instead?" D. "We can have the party here in the hospital play room."

ANS: B Rationale: A child receiving chemotherapy is particularly susceptible to contracting an infection and thus should be kept away from people with known infections. Therefore, having the child avoid large groups right now is best. Although it would possibly cheer up the client, it is not best for the client's health. Going to a movie would not be a good idea because it could lead to exposure to someone who is ill. A party in the hospital play room is a possibility for the children in the hospital, but it would not be possible to invite the child's entire class.

A child with a diagnosis of Down syndrome has had which of the following chromosome abnormalities occur? A. 1 copy of the chromosome 8 has occurred instead of 2 copies. B. 3 copies of trisomy 21 has occurred instead of 2 copies. C. 3 copies of trisomy 18 has occurred instead of 2 copies. D. 3 copies of trisomy 13 has occurred instead of 2 copies.

ANS: B Rationale: A child with Down syndrome has trisomy 21, which means 3 copies of chromosome 21 has occurred instead of 2 copies. If this occurs with chromosome 18, it leads to Edward's syndrome, and if it occurs with chromosome 13, it leads to Patau syndrome.

When assessing the oral cavity of a 2 1/2-year-old toddler, which finding is expected? A. 12 deciduous teeth B. 20 deciduous teeth C. 16 deciduous and 2 permanent teeth D. 6 deciduous and 12 permanent teeth

ANS: B Rationale: All 20 deciduous teeth are generally present by 2 1/2 to 3 years of age.

A nurse is obtaining the history from a parent of a child who experiences absence seizures. Which of the following would the nurse expect the mother to describe? A: Brief, sudden onset with muscles that become tense B: Loss of motor activity accompanied by a blank stare C: Sudden, brief jerking motions of a muscle group D: Loss of muscle tone and loss of consciousness

ANS: B Rationale: An absence seizure consists of a sudden, brief arrest of the child's motor activity accompanied by a blank stare and loss of awareness. A tonic seizure consists of a brief onset of increased tone. A myoclonic seizure is characterized by sudden, brief jerks of muscle groups. An atonic seizure involves a sudden loss of muscle tone and loss of consciousness.

A 6-month-old girl is seen with retinoblastoma. When taking a health history from her father, which symptom would you expect him to report he has noticed? A The infant always keeps her eyes tightly closed. B He has noticed one pupil appears white. C. His daughter tugs and pulls at one ear. D. His daughter's eye appears to be protruding.

ANS: B Rationale: As the tumor grows against the retina of the eye, the red reflex is no longer visible; the pupil appears white

The nurse is conducting a wellness examination of a 6-month-old child. The mother points out some dimpling and skin discoloration in the child's lumbosacral area. How should the nurse respond? A. "This could be an indicator of spina bifida; we need to evaluate this further." B. "This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look." C. "Dimpling, skin discoloration, and abnormal patches of hair are often indicators of spina bifida occulta." D. "This is often an indicator of spina bifida occulta as opposed to spina bifida cystica."

ANS: B Rationale: Dimpling and skin discoloration in the child's lumbosacral area can be an indication of spina bifida occulta. It would be best to respond that the dimpling and discoloration is possibly a normal variation with no problems and indicate that the doctor will want to take a closer look; this response will not alarm the parent, but it also does not ignore the findings. Spina bifida is a term that is often used to generalize all neural tube disorders that affect the spinal cord. This can be confusing and a cause of concern for parents. It is probably best to avoid the use of the term initially until a diagnosis is confirmed. Nursing care would then focus on educating the family.

A 25-year-old client wants to know if her baby boy is at risk for Down syndrome because one of her distant relatives was born with it. Which information would the nurse share with the client while counseling her about Down syndrome? A. Instances of Down syndrome in the family greatly increases the risk for the baby also having Down syndrome. B. Children with Down syndrome have extra genetic material in the 21 chromosome that occurs during development of the sperm or egg. C. Down syndrome occurs only in females, and there is no risk as the baby is male. D. Children with Down syndrome are usually born to older mothers.

ANS: B Rationale: Down syndrome occurs because of the presence of an extra chromosome in the body that is in either the sperm or the egg. Down syndrome is not genetically inherited, except in incidences of translocation which are very rare. Both males and females are equally at risk for Down syndrome. Most children with Down syndrome are born to younger mothers.

A nurse manages the interdisciplinary care for an infant born with an omphalocele. What is an accurate description of the care for an omphalocele? A: At birth, protect the exposed bowel by gently manipulating it back into the abdominal cavity. B:Obtain IV access to give fluid resuscitation and correct any electrolyte abnormalities. C: Administer corticosteroids as prescribed—either oral prednisone or prednisolone or as IV methylprednisolone. D: Insert an NG tube to decompress the stomach and to prevent gastric distention.

ANS: B Rationale: For an omphalocele, protect the bowel by wrapping the exposed viscera with warm saline-soaked gauze and cover and seal with a plastic wrap or place in a "bowel bag" which will contain the defect, torso, and legs, to prevent heat and fluid loss from the exposed viscera. Obtain IV access. Give fluid resuscitation and correct any electrolyte abnormalities. Oral prednisone or prednisolone, or IV methylprednisolone, are administered for irritable bowel syndrome. An NG tube may be placed to decompress the stomach to prevent gastric distention when severe emesis is present with pancreatitis.

The nurse has completed an education session with parents of children diagnosed with food allergies. Which statement by a parent would indicate a need for additional education? A. "I will make sure my daughter always has her EpiPen® with her all the time." B. "If we need to use the EpiPen® we will need to notify her physician's office the next business day." C. "I have found a website that makes medical alert bracelets in my daughter's favorite color." D. "The grey part of the EpiPen® should never be removed until right before we use it."V

ANS: B Rationale: If an EpiPen® is used, the child still needs immediate medical attention. EpiPens should be carried with the patient at all times. When administering an EpiPen, the grey safety cap should not be removed until immediately prior to using. Medical alert bracelets or necklaces should be worn by all children with severe allergies.

A 6-year-old is dealing with the death of a sibling. Which action should the nurse suggest to the family to best support the child with the grieving process? A. Having the child stay with a family friend instead of attending the funeral B. Assisting the child in drawing a picture to be placed in the sibling's casket C. Having the sibling stand in the receiving line with the parents at the funeral home D. Discouraging the child from interacting with family and friends while they express their sympathy

ANS: B Rationale: It is difficult for a 6-year-old child to understand the death of a sibling. Research supports having the presence of the sibling at the funeral and encouraging a token of love such as a drawing or note. Allowing the child to interact with others who provide comfort helps the child in this difficult time.

A school-aged girl with Crohn's disease will receive total parenteral nutrition (TPN) for the next 6 weeks. Which would best help her accept the treatment plan? A: Help her ambulate with the bottles. B: Provide some time to talk to her several times a day. C: Help her give the bottles nicknames and personalities. D: Explain that TPN substitutes for normal food.

ANS: B Rationale: Many children receiving alternative methods of feeding miss the conversation that goes with mealtime. Providing this helps them accept an alternative feeding method.

A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease? A. Measles B. Mumps C. Whooping cough D. Scabies

ANS: B Rationale: Mumps is an infectious disease with a primary symptom of a swollen parotid gland. It is a contagious disease spread by droplets. The child is contagious 1 to 7 days prior to the onset of the swelling and 4 to 9 days after the onset of the swelling. Pertussis is a respiratory disorder which causes severe paroxysmal coughing which produces a whooping sound. Measles is recognized by Koplick spots in the mouth and the classic maculopapular rash that starts on the head and spreads downward. Scabies is a skin condition where lice lay eggs under the skin. The rash is very puritic and is seen on the hands, feet, and folds of the skin.

A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? A. Restricting the child's visitors B. Placing a "no abdominal palpation" sign above the child's bed C. Ensuring that the child be allowed nothing by mouth D. Preparing the child for chemotherapy E. Preventing weight-bearing activities

ANS: B Rationale: Nephroblastoma (Wilms' tumor) metastasizes rapidly, so it is important that the child's abdomen not be palpated any more than necessary for diagnosis, because handling appears to aid metastasis. There is no need to restrict the child's visitors. Ensuring nothing by mouth would be appropriate prior to surgery. Preventing weight-bearing activities would be appropriate for a child with Ewing's sarcoma.

The nurse is conducting a physical examination of a child with suspected Crohn disease. Which finding would be the most suspicious of Crohn disease? A: Normal growth patterns B: Perianal skin tags or fissures C: Increased hunger D: Abdominal tenderness

ANS: B Rationale: Perianal skin tags and/or fissures are highly suspicious of Crohn disease. Poor growth pattern, hunger and abdominal tenderness are common to Crohn disease but are also seen with many other conditions. Normal growth patterns would not point to Crohn disease because of problems with absorbing nutrients.

A child is having their urine checked for complaints of polyuria. When analyzing the results, what would positive glucose indicate? A. This may indicate a urinary tract infection. B. This determines the presence of sugar in the urine. C. This indicates renal disease. D. This determines the presence of bacteria in the urine.

ANS: B Rationale: Positive glucose determines the presence of sugar in the urine. This could signify diabetes and needs to be evaluated immediately. Positive leukocytes may indicate a urinary tract infection. The u

The nurse is caring for a 2-month-old with a cleft palate. The child will undergo corrective surgery at age 3 months. The mother would like to continue breastfeeding the baby after surgery and wonders if it is possible. How should the nurse respond? A: "There is a good chance that you will be able to breastfeed almost immediately." B: "Breastfeeding is likely to be possible, but check with the surgeon." C: "After the suture line heals, breastfeeding can resume." D. "We will have to wait and see what happens after the surgery."

ANS: B Rationale: Postoperatively, some surgeons allow breastfeeding to be resumed almost immediately. However, the nurse needs to advise the mother to check with the surgeon to determine when breastfeeding can resume. Telling the mother that she has to wait until the suture line heals may be inaccurate. Telling her to wait and see does not answer her question.

The nurse is admitting a 12-month-old to the medical unit. During the admission process the parents tell the nurse that their child is very advanced because he says "ball" when he picks up a football. How should the nurse respond? A. "He really isn't any more advanced than most 12-month-old children." B. "That is great that he is recognizing objects and is able to name them. He is right on target for language skills." C. "If he were advanced in language skills he would be putting several words together to form short sentences." D. "Parents usually think their child is far more advanced than other children."

ANS: B Rationale: Recognizing the parents' excitement about their child's language skills while still letting them know that this is what the expected level is for language is a polite and accurate way to respond. The other responses do not give notice to the parents' pride and would likely make the parents feel defensive about their child's skill.

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

ANS: B Rationale: Regardless of the genetic abnormality, learning of a genetic abnormality may be shattering to the family. Therefore, the initial priority is to establish a trusting relationship. Once this is accomplished, other aspects of care, such as assisting with scheduling follow-up visits, teaching, and implementing measures to promote growth and development, can be addressed.

The nurse is reinforcing teaching with the family caregivers of a child diagnosed with tuberculosis who is being treated with the drug rifampin. Which statement made by the caregivers indicates an understanding of this medication? A. "My son will have to take this medication the rest of his life." B. "While she is taking this medication, I won't worry if her tears look orange." C. "This medication may cause slight bleeding when she urinates." D. "He will not be able to attend school for the first few months that he is on this medication."

ANS: B Rationale: Rifampin is tolerated well by children, but causes body fluids such as urine, sweat, tears, and feces to turn orange-red. Drug therapy is continued for 9 to 18 months. After drug therapy has begun, the child or adolescent may return to school and normal activities. Although the urine may be orange-red, this does not indicate bleeding. If bleeding with urination presents, then it should be reported and followed up on.

The nurse is assessing a child with suspected infective endocarditis. Which assessment finding would the nurse interpret as a sign of extracardiac emboli? A. Pruritus B. Roth spots C. Delayed capillary refill D. Erythema marginatum

ANS: B Rationale: Roth spots are splinter hemorrhages with pale centers on the sclerae, palate, buccal mucosa, chest, fingers, or toes, and are signs of extracardiac emboli. Delayed capillary refill time does not point to extracardiac emboli. Wheezing and pruritus are indicative of a hypersensitivity reaction. Erythema marginatum is a classic rash associated with acute rheumatic fever.

An adolescent client has just been diagnosed with systemic lupus erythematosus (SLE). Following client education about the disease, which statement by the client demonstrates understanding of SLE? A. "SLE is a rheumatic disease that mostly affects my joints." B. "SLE is an autoimmune disorder that I will always have, with times of flare- ups and times of minimal to no symptoms." C. "If my SLE has been found early enough in the disease process, there is a good chance that medication can cure it." D. "SLE only affects my skin. It seldom causes problems in any other organs."

ANS: B Rationale: SLE is a systemic autoimmune disease that can effect any organ system, including the skin. There is no cure for SLE, but with proper treatment and if the client cares for themselves properly, theNdiUseRaSseIcNanG-haTvEe SpeTriBoAdsNoKf.reCmOisMsion and fewer flare-ups.

A nurse is caring for an infant with spinal muscle atrophy (SMA) type 1. What will the nurse note when assessing the child? A. Spastic upper and lower extremities B. Narrow chest and protuberant abdomen C. Enlarged head with low-set ears D. Lusty cry with voracious appetite

ANS: B Rationale: SMA type 1 is also known as Werdnig-Hoffman disease and infantile SMA. It is the most severe of the three types. This disease is autosomal recessive and affects the ability of spinal nerves to communicate with muscle, eventually leading to atrophy. The infantile form progresses rapidly to early childhood death, usually from respiratory complications. The narrow chest and large abdomen are characteristic. Over time, the chest develops pectus excavatum, which restricts respiration further when combined with muscle weakness. Extremities would not be spastic but hypotonic. Head size and ear placement are normal in the infant with SMA type 1. Difficulties in sucking and swallowing are common, and a lusty cry is not found.

Which diagnostic measure is most accurate in detecting neural tube defects? A. Flat plate of the lower abdomen after the 23rd week of gestation B. Significant level of alpha-fetoprotein present in amniotic fluid C. Amniocentesis for lecithin-sphingomyelin (L/S) ratio D. Presence of high maternal levels of albumin after 12th week of gestation

ANS: B Rationale: Screening for significant levels of alpha-fetoprotein is 90% effective in detecting neural tube defects. Prenatal screening includes a combination of maternal serum and amniotic fluid levels, amniocentesis, amniography, and ultrasonography and has been relatively successful in diagnosing the defect. Flat plate X-rays of the abdomen, L/S ratio, and maternal serum albumin levels aren't diagnostic for the defect.

A 4-month-old infant is seen at the ambulatory care clinic and diagnosed with nasolacrimal duct obstruction. The mother asks what can be done. What information should be included in the information provided to the parent? A: Once the child is 6 to 9 months old a specialist will be able to drain the duct. B: Most of these conditions will spontaneously resolve. C: Antiviral therapy can be prescribed to manage this condition. D: Over-the-counter drops can be used sparingly.

ANS: B Rationale: Stenosis or simple obstruction of the nasolacrimal duct is a common disorder of infancy, occurring in about 6% to 20% of newborns and infants. It is unilateral in about 65% of cases. Chronic tearing occurs and buildup in the lacrimal sac causes a mucoid or mucopurulent drainage. Over 90% of all cases resolve spontaneously by 1 year of age.

A 7-month-old is scheduled for surgical correction of strabismus. The child's mother says to the nurse, "I'm glad my child will never have to wear that patch again." Which of these responses would be most appropriate for the nurse to make? A: "Your child will never need to wear the patch again." B: "Your child will need to wear the patch for a few days to keep him/her from rubbing or putting pressure on the eye." C: "Your child will need to wear the patch for several months to keep the eye in alignment." D: "Your child will have to be in restraints for a week to keep him/her from rubbing the eye."

ANS: B Rationale: Strabismus refers to a misalignment of the eyes, if the strabismus persists past 6 months of age this warrants referral to an ophthalmologist for further evaluation. Clinical therapy involves occlusion therapy (patching of the good eye) for 1-2 hours a day to force use of the weak eye. The child may have to wear the patch intermittently, no restraints are needed if the patch

The mother of a 3-year-old with a myelomeningocele is thinking about having another baby. The nurse should inform the woman that she should increase her intake of which acid? A. Folic acid to 0.4 mg/day B. Folic acid above 0.4 mg/day C. Ascorbic acid to 0.4 mg/day D. Ascorbic acid to 4 mg/day

ANS: B Rationale: The American Academy of Pediatrics recommends that a woman who has had a child with a neural tube defect increase her intake of folic acid to above 0.4 mg per day 1 month before becoming pregnant and continue this regimen through the first trimester. A woman who has no family history of neural tube defects should take 0.4 mg/day. All women of childbearing age should be encouraged to take a folic acid supplement because the majority of pregnancies in the United States are unplanned. Ascorbic acid hasn't been shown to have any effect on preventing neural tube defects.

The nurse receives the shift report of multiple pediatric clients. Which pediatric client will the nurse see first? A. an infant whose parents report difficulty feeding with a temperature of 100.1°F (38°C) B. a toddler with tetralogy of Fallot squatting quietly in the corner of the room C. a child with history of hypertension and a current blood pressure of 130/90 mm Hg D. an adolescent with coarctation of the aorta with reports of coughing and coryza

ANS: B Rationale: The first child the nurse will see is the child showing signs and symptoms of decreased pulmonary blood flow and possible hypercyanotic (tet) spell, which includes a toddler with tetralogy of Fallot squatting. Squatting increases systemic vascular resistance and forces blood to flow through the narrow pulmonary valve to improve oxygenation. An infant with difficult feeding and an elevated temperature may have an infection but could be seen after addressing a potential respiratory/circulatory issue. The child with history of hypertension who has an elevated blood pressure can be seen later because this is an expected finding and not life-threatening. The adolescent with coarctation of the aorta being seen for coughing and coryza without any other signs of distress can also be seen later.

The nurse caring for a toddler immediately after a fall from a grocery cart will avoid moving which body area as the child is examined? A. Lower extremities B. Head and neck C. Torso D. Clavicle

ANS: B Rationale: The head and neck should remain immobilized until cervical spine injury is ruled out. Motion in this area could damage the spinal cord. The rest of the child's body should be examined carefully so as not to aggravate an unsuspected injury. The clavicle is the bone most frequently fractured during childhood.

The nurse is caring for a newborn diagnosed with an inborn error of metabolism with several referrals ordered. What referral would the nurse place as the priority for the infant? A. Spiritual advisor B. Dietitian C. Community support group D. Genetic counseling

ANS: B Rationale: The infant born with an inborn error of metabolism will have specific dietary guidelines, and the parents need to understand the dietary restrictions soon after birth to ensure the child is not harmed. The other referrals are important and should be addressed soon after birth.

The nurse is caring for a child who is undergoing peritoneal dialysis. Immediately after draining the dialysate, which action should the nurse should take immediately? A. Empty the old dialysate B. Weigh the old dialysate C. Weigh the new dialysate D. Start the process over with a fresh bag

ANS: B Rationale: The nurse should weigh the old dialysate to determine the amount of fluid removed from the child. The fluid must be weighed prior to emptying it. The nurse should weigh the new fluid prior to starting the next fill phase. Typically, the exchanges are 3 to 6 hours apart so the nurse would not immediately start the next fill phase.

The nurse is caring for a child with history of asthma who presents to the emergency department with wheezing, tachypnea, and dyspnea. What will the nurse do first? A. Ask what may have triggered the attack. B. Place the child in high-Fowler's position. C. Assess the child's pulse oximetry reading. D. Apply oxygen via nasal cannula at 2 liters.

ANS: B Rationale: The nurse will first elevate the head of bed to improve the child's ability to breathe. Elevating the head of the bed allows the diaphragm to expand, consequently maximizing ventilation and oxygenation. After elevating the head of bed, the nurse will assess the pulse oximetry and apply oxygen if needed. After stabilizing the child, the nurse can ask what may have triggered the asthma attack.

The nurse is providing teaching about food substitutions when cooking for the child with an allergy to eggs. Which response indicates a need for further teaching? A: "I must not feed my child eggs in any form." B: "I can use the egg white when baking, but not the yolk." C: "1 tsp yeast and 1/4 cups warm water is a substitute in baked goods." D: "1.5 Tbsp each water and oil plus 1 tsp baking powder equals one egg in a recipe."

ANS: B Rationale: The parents must understand that their child cannot consume any part of an egg in any form. The other statements are accurate.

The nurse is evaluating outcomes for teaching provided to the mother of a school-age child with an itchy rash. Which outcome indicates that teaching has been effective? A. Mother applies hot compresses to itchy skin areas every few hours B. Child drinks a glass of water every 1 to 2 hours throughout the day C. Child showers in hot water and uses soap on the rash every morning D. Child wearing long denim pants and a long-sleeve shirt while playing outside

ANS: B Rationale: To relieve the itchiness of a rash, the child should be encouraged to have an adequate fluid intake to maintain good hydration because dry skin increases discomfort. Cold cloths or compresses applied to itchy areas are appropriate. Heat makes the itch worse. Baking soda should be used when bathing in lukewarm water. Hot water and harsh soap will irritate the rash. The child should be dressed in light cotton clothing so overheating and perspiration does not occur. Perspiration makes the itch worse. Denim pants and long-sleeved shirt would make the child very uncomfortable.

The school nurse is educating the parents of a child with infectious conjunctivitis. Which of the following statements by the nurse would be most helpful for the parents related to prevention? A: "Use all the medication as directed." B: "Don't use anything that touches her face." C: "This could have started with a head cold." D: "Place the ointment inside the lower eyelid."

ANS: B Rationale: Warning the parents how infectious conjunctivitis is spread is most valuable for preventing infection within the family. Directing the parents to use a full course of medication is very important to help prevent a recurrence in the child but is not the most valuable for prevention. Telling of a possible cause or proper administration of medication has little preventive value.

A young client is admitted to the hospital directly from the clinic. The physician suspects a problem with the child's immune system. What test does the nurse anticipate the physician will order for this client?A. Urine analysis B. Blood analysis C. EKG D. X-ray

ANS: B Rationale: When there is a deficiency of immunocompetent cells, an assessment will focus on analysis of blood components, particularly white blood cells.

The mother of a 1-month-old infant voices concern about her baby's respirations. She states they are rapid and irregular. Which information should the nurse provide? A. The normal respiratory rate for an infant at this age is between 20 and 30 breaths per minute. B. The respirations of a 1-month-old infant are normally irregular and periodically pause. C. An infant at this age should have regular respirations. D. The irregularity of the infant's respirations are concerning; I will notify the physician.

ANS: B Rationale: The normal respiratory rate for a 1-month-old infant is 30 to 60 breaths per minute. By 1 year of age the rate will be 20 to 30 breaths per minute. The respiratory patterns of the 1-month-old infant are irregular. There may normally be periodic pauses in the rhythm.

A nurse is assessing a 5-year-old boy and suspects that the child may have an autism spectrum disorder. Which assessments would help support the nurse's suspicions? Select all that apply. A: Inability to make eye contact B: Hypersensitivity to touch C: Lack of facial expression D: Distinct interest in others around him E: Easily distracted from playing

ANS: B, C Rationale: Symptoms associated with autism spectrum disorder include deficits in nonverbal communicative behaviors such as abnormalities in eye contact and lack of facial expression and hyper- or hyposensitivity to sensory input such as touch. In addition, children, and stereotyped or repetitive motor movement, use of object or speech.

The nurse is providing health-promotion teaching to a group of parents of preschoolers at a local daycare. What information would the nurse include in this education session? Select all that apply. A. Preschoolers are capable of taking a bath independently. B. Encourage children to select their own clothing to wear each day. C. Parents will need to supervise tooth-brushing and be responsible for flossing. D. Treat any toileting accidents in a matter-of-fact manner and assist the child in getting dry clothing. E. Preschoolers only need to wear bicycle helmets if they are going on long rides.

ANS: B, C, D

The nurse is reviewing the history of an adolescent with peptic ulcer disease. Which client activity would the nurse identify as an associated contributing factor? Select all that apply. A: Use of acetaminophen B: Ingestion of diet colas C: High coffee intake D: Cigarette smoking E:High-fat diet

ANS: B, C, D Rationale: In adolescents, associated factors include a genetic tendency, use of nonsteroidal anti-inflammatory drugs, alcohol, caffeine and cigarettes.

A nurse suspects that a child is experiencing isotonic dehydration based on which assessment findings? Select all that apply. A: Extreme thirst B: Cool skin temperature C: Irritability D: Normal serum sodium level E: Clammy skin

ANS: B, C, D Rationale: Signs and symptoms of isotonic dehydration include mild thirst; poor skin turgor; cool, dry skin; decreased urine output; irritability; and normal serum sodium level. Extreme thirst suggests hypertonic dehydration. Cool, clammy skin suggests hypotonic dehydration.

The nurse is assessing a child with suspected rheumatic fever. What assessment findings are consistent with the disease process? Select all that apply. A. Diastolic murmur B. Involuntary limb movement C. Macular rash on trunk D. Tender swollen joints E. Nonpalpable subcutaneous nodules

ANS: B, C, D Rationale: Signs and symptoms of rheumatic fever include systolic murmur, involuntary limb movement, macular rash on the trunk, tender swollen joints, and subcutaneous nodules.

The mother of a 2 year old asks the nurse, "How can I help to foster my child's language skills?" Which of the following would be most appropriate for the nurse to suggest? Select all that apply. A. Accepting the child's "no" as indicating actual refusal B. Reading to the child often C. Naming objects as they are used with the child D. Answering the child's questions in simple terms E. Supplying things to the child before he or she asks for them

ANS: B, C, D Rationale: To foster language development, parents need to know that the child's "no" does not necessarily mean that the child is refusing. The child may use the word because he or she does not understand it or is practicing a sound that has a strong effect on those around the child. Reading often, naming objects as they are used, and answering the child's questions in simple terms help to foster the understanding that words are not just meaningless sounds. Providing opportunities for the child to ask for things also helps to foster language development by encouraging the child to use language.

A child develops treatment-related thrombocytopenia. When preparing the plan of care for the child, which would the nurse include? Select all that apply. A. Allowing frequent blood-drawing procedures for laboratory testing B. Applying pressure to a puncture site for a full 5 minutes C. Limiting the use of adhesive tape on the child's skin D. Administering medications orally or intravenously E. Obtaining extra amounts of blood just in case when drawing blood

ANS: B, C, D Rationale: With thrombocytopenia, the risk for bleeding is increased. Therefore, the nurse should institute measures to reduce this risk. Measures include limiting the number of blood-drawing procedures, applying pressure to a puncture site for a full 5 minutes, limiting the use of adhesive tape on the child' skin, administering medications orally or intravenously instead of by injection, and not drawing extra amounts of blood just in case.

The child has a peanut allergy and accidentally ate food that contained peanuts. Which clinical manifestations of anaphylaxis should the nurse expect to find? Select all that apply. A: The child's pulse is 52 beats per minute. B: The child states that his tongue feels "too big" for his mouth. C: The child has developed hives on his face and trunk. D: The child states he feels like he might "throw up". E: The child states that he feels like he might faint.

ANS: B, C, D, E Rationale: The following are common signs and symptoms of anaphylaxis: tongue edema, urticaria, nausea, vomiting, and syncope. Typically, the child who has developed anaphylaxis will be tachycardic.

The nurse is preparing an educational program for members of the office staff. The topic is the warning signs of primary immunodeficiency. What information should be included? Select all apply. A. Two or more new episodes of acute otitis media in 1 year. B. Two or more episodes of severe sinusitis in 1 year. C. Failure to thrive in an infant. D. Two or more serious infections such as sepsis. E. History of infections requiring IV antibiotics to clear.

ANS: B, C, D, E Rationale: Warning signs of primary immunodeficiency include four, not two, or more new episodes of acute otitis media in 1 year. Other warning signs include failure to thrive in the infant, two or more episodes of severe sinusitis in 1 year, two or more serious infections such as sepsis and/or a history of infections requiring IV antibiotics to clear.

The nurse is instructing parents on how atopic disorders affect the child. For which disorder would the nurse provide information and counseling? Select all that apply. A. Serum sickness B. Allergic rhinitis C. Asthma D. Eczema E. Hay fever

ANS: B, C, D, E Rationale: Hay fever (or allergic rhinitis), asthma, and eczema (or atopic dermatitis) are classified as atopic disorders. Serum sickness is a type III hypersensitivity response of the body to a foreign serum antigen or drug.

A nurse is developing a teaching plan for an adolescent diagnosed with gastroesophageal reflux disease. Which would the nurse include? Select all that apply. A: "Try sitting upright for an hour after eating." B: "You need to avoid acidic foods like oranges and grapefruits." C: "Eating smaller portions might be helpful." D: "You'll need to take your prescribed medications for about 6 to 8 weeks." E: "Try sleeping with your upper body elevated on a foam wedge."

ANS: B, C, E Rationale: Adolescents with gastroesophageal reflux disease should avoid lying down until 3 hours after a meal and should sleep at night with the upper body elevated on a foam wedge. Acidic foods such as citrus fruits and tomatoes should be avoided. Eating smaller portions may be helpful. Medications typically are prescribed for 6 to 8 months until esophageal healing is complete.

The nurse is recording vital signs in the client diagnosed with complications of anorexia nervosa. Which findings are consistent with the condition? Select all that apply. A: Hyperthermia B: Orthostatic hypotension C: Weak pulse D: Hypertension E: Hypothermia

ANS: B, C, E Rationale: Anorexia nervosa is a condition most commonly seen in adolescents. In this condition the individual is obsessed with body weight. There is a noted loss of weight. The vital signs frequently display orthostatic hypotension, irregular and decreased pulse, or hypothermia.

A child is receiving chemotherapy and develops stomatitis. The nurse identifies a nursing diagnosis of impaired oral mucous membranes related to the effects of chemotherapy. What instructions would the nurse include in the child's plan of care? Select all that apply. A Vigorously rub the child's gums with gauze to clean them. B Provide various soft and bland foods to minimize further irritation. C Have the child rinse the mouth with lukewarm water three times a day. D Give the child acidic foods (e.g., orange juice) to cleanse the mouth. Apply a lip balm or petroleum jelly to prevent cracking.

ANS: B, C, E Rationale: For the child with stomatitis, the nurse should provide soft foods to prevent further abrasions, have the child rinse the mouth three times a day with lukewarm water to promote comfort and healing, avoid giving the child acidic foods that would further irritate the tissue, and apply a lip balm or petroleum jelly to prevent cracking of the lips. The nurse should offer a soft toothbrush to minimize discomfort.

The parent of a 20-month-old toddler reports the toddler has been becoming distraught when the parent leaves. The parent asks the nurse for advice about what is going on and how to best manage it. What information can be provided? Select all that apply. A. "This is actually a regression for your toddler because separation anxiety normally occurs in infancy." B. "This is a normal happening for a toddler of this age." C. "As your toddler begins to learn that you will return the toddler will become less upset." D. "Your care providers may be frightening to your toddler." E. "Establishing a routine for saying goodbye to your toddler will be helpful."

ANS: B, C, E Rationale: Separation anxiety occurs initially in infancy and then reoccurs again during the toddler stage. Separation anxiety for the toddler is normal. As the toddler begins to develop an understanding of object constancy, separation anxiety will ease. The toddler, while missing the parent, will begin to recognize that the parent will return. Establishing a routine for saying goodbye is helpful for the toddler. There is no indication that the care providers are problematic.

A 2-year-old child is shopping with her mother when she suddenly falls to the ground and begins to scream, "I want it!" over and over regarding a bag of candy. What would the nurse recommend to the mother to deal with this behavior? Select all that apply. A. Reason with the toddler and explain that the candy is not nutritious for her. B. Remain calm and ignore the tantrum. C. Do not reward the behavior by giving into the toddler's demands and buying the candy. D. Pick the toddler up and take her to the restroom for a spanking. E. Pick the toddler up and move her to a safe environment but do not give in to her desires.

ANS: B, C, E Rationale: Temper tantrums in toddlers are very common as they try to control their environment and the caregiver's environment. They become frustrated at their inability to do so or to verbalize their desires. If a toddler has a temper tantrum, the best thing for the parent to do is ignore them and protect them from harm. Parents cannot reason with a toddler—they lack the ability to understand or the desire to change their behavior. Never give in to their demands; they will only learn that if you scream loud enough, they get their way. However, spanking is not recommended. The child has just lost control and needs time to regain self-control.

The nurse is caring for a pediatric client newly diagnosed with Crohn's disease. When reviewing the client's subjective and objective data, which is consistent with the diagnostic criteria? Select all that apply. A: Severe bloody diarrhea B: Significant weight loss C: Perianal lesions D: Lesions limited to the colon and rectum E: Cobblestone appearance of intestinal surface

ANS: B, C, E Rationale: With Crohn's disease, the child experiences moderate diarrhea, severe weight loss, and perianal lesions. The lesions can affect any part of the gastrointestinal tract but most commonly the terminal ileum. The wall of the colon becomes thickened and the surface is inflamed, leading to a "cobblestone" appearance of the mucosa.

The client has been prescribed antihistamines and a round of corticosteroids to treat an allergic reaction to an unknown food source. Which statement by the client indicates he understands the allergic condition and medication regimen? A. "The antihistamine will help the nasal swelling I am having." B. "Corticosteroids help the inflammation that goes along with an allergy." C. "I can stop taking my steroids as soon as I feel better in a couple of days." D. "I may have to undergo intradermal testing to determine what I am allergic to." E. "Once we figure out what I am allergic to, it is important for me to avoid that allergen."

ANS: B, D, E Rationale: Nasal swelling is seen with allergic rhinitis, not usually with a food allergy. The antihistamine is given to block histamine that is released when exposed to an allergen. It treats a rash or a hive that may occur with a food allergy. Corticosteroids help with inflammation cause by an allergic reaction, but they should always be tapered in order to prevent acute adrenal insufficiency. Skin testing to determine the allergan, then avoidance of the allergen is advised.

Which assessment findings should the nurse expect to see in the infant diagnosed with pulmonary stenosis and heart failure? Select all that apply. A. Crackles (rales) B. Cyanosis C. Left ventricular hypertrophy D. Murmur E. Right ventricular hypertrophy

ANS: B, D, E Rationale: Patients with pulmonary stenosis have a narrowing in their pulmonary arteries, causing a decrease in blood flow to the lungs, which can cause cyanosis and the inability of the right ventricle to empty, leading to right ventricular hypertrophy. Crackles (rales) and left ventricular hypertrophy are signs of left-sided heart failure, which this patient does not have.

The nurse is teaching a 14-year-old child on the proper use of a metered-dose inhaler to control symptoms of asthma. Which teaching points should the nurse include in these instructions? Select all that apply. A. Take two puffs at a time. B. Shake the canister before using. C. Wait 5 minutes between puffs. D. Hold the breath for 5 to 10 seconds. E. Activate the inhaler while taking a deep breath.

ANS: B, D, E Rationale: The nurse should instruct the child to shake the canister, exhale deeply, activate the inhaler while inhaling, take a long slow inhalation, and then hold the breath for 5 to 10 seconds. The child should be instructed to take only one puff at a time and to wait for 1 minute between puffs.

The NICU nurse is caring for a preterm neonate with respiratory distress syndrome on mechanical ventilation. Which assessment data would alert the nurse that a pneumothorax might have developed? Select all that apply. A. Neonate's blood pressure is 80/50. B. The neonate's respiratory rate is 68. C. Oxygen saturation is 92% and heart rate is 130. D. Neonate is exhibiting nasal flaring and grunting. E. Chest radiography reveals low lung volume and a ground-glass appearance. F. The neonate's chest is asymmetrical. with decreased breath sounds on one side.

ANS: B, D, F Rationale: Signs of pneumothorax include respiratory rate of 68, nasal flaring and grunting, asymmetrical chest rise with decreased breath sounds on one side. Infants with a pneumothorax exhibit signs of respiratory distress, including tachypnea (>60 breaths/minute) and nasal flaring and grunting. On examination the chest is asymmetrical, with decreased breath sounds on the affected side. In the case of a large pneumothorax, the nurse should observe for hypotension (systolic blood pressure<30), hypoxemia (<90%), and bradycardia (<120 beats/minute) that may occur due to an increase in pressure inside the thorax, which in turn leads to decreased cardiac output. Blood pressure of 80/50 is within normal limits. Oxygen saturation of 92% and heart rate of 130 are also within normal limits. Chest radiography revealing low lung volume and a ground glass appearance are expected in newborn respiratory distress syndrome, but is not diagnostic of a pneumothorax. A chest X-ray of a pneumothorax will show a darkened area over the collapsed lung.

A child with sickle cell disease is brought to the emergency department by his parents. He is in excruciating pain. A vaso-occlusive crisis is suspected and analgesia is prescribed. Which of the following would the nurse least likely expect to be ordered? A. Morphine B. Nalbuphine C. Meperidine D. Hydromorphone

ANS: C

During a well-child checkup, the mother of a 5-year-old girl reports her daughter seems much smaller than her 2 older children did at this same age. A review of the medical record reveals that the child is 44 inches tall and weighs 42 pounds. What information should be included in the response by the nurse? A. "Your daughter is within normal limits for her weight but she is slightly shorter in stature than other children her age." B. "Your daughter is within the acceptable range for her height but she is significantly smaller in weight for her age." C. "Your daughter is slightly taller than other children her age but her weight is normal" D. "The weight of your daughter at this time is with normal limits for her age but she is moderately taller than other children her age."

ANS: C

The nurse has completed an education program on normal communication abilities in the preschool child. Which statement by a participant indicates a need for further education? A. "It is normal that my 4-year-old asks so many questions." B. "I'm glad to know that is normal that my 4-year-old cannot count to 10 yet." C. "I'm concerned that my 5-year-old can only count to 20." D. "I'm concerned that my 5-year-old cannot say his name and address."

ANS: C

The nurse is assessing a 4-year-old child. Which assessment finding would the nurse identify as being of the highest concern? A. Hops on one foot. B. Copies capital letters. C. Stands on one foot for about 3 seconds. D. Draws a person with 4 body parts.

ANS: C

A 6-month-old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room? A: A room with a 12-month-old infant with a urinary tract infection B: A room with an 8-month-old infant with failure to thrive C: A private room near the nurses' station D: A two-bed room in the middle of the hall

ANS: C Rationale: A child who has the diagnosis of bacterial meningitis will need to be placed in a private room until that child has received I.V. antibiotics for 24 hours because the child is considered contagious. Additionally, bacterial meningitis can be quite serious; therefore, the child should be placed near the nurses' station for close monitoring and easier access in case of a crisis.

A new mother reports that she is exhausted and that the little sleep she gets is determined by her baby. Which suggestion should the nurse prioritize to help the mother establish healthy sleeping patterns in her infant? A. Put the baby to bed at various times of the evening. B. Let the baby cry during the night and she will eventually fall back to sleep. C. Use the crib for sleeping only, not for play activities. D. Wake the baby from afternoon naps after 1 hour to ensure she is sleepy by nighttime.

ANS: C Rationale: A consistent bedtime routine is usually helpful in establishing healthy sleeping patterns and in preventing sleep problems. Using the crib for sleeping only helps the child associate the bed with sleep. Depriving the baby of sleep during the afternoon or evening will make the baby over-tired and less able to establish a healthy sleeping pattern. While letting a baby cry for a while is acceptable, this does not promote consistency in the baby's sleeping pattern.

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which best describes a macule? A. Redness of the skin produced by congestion of the capillaries B. Small, circumscribed, solid elevation of the skin C. Discolored skin spot not elevated at the surface D. Small elevation of epidermis filled with a viscous fluid

ANS: C Rationale: A macule is a discolored skin spot not elevated above the surface.

A female preschool patient with a urinary tract infection is scheduled to have a voiding cystourethrogram. What should the nurse include when teaching the patient about this procedure? A. A headache is a common occurrence after the procedure. B. A local anesthetic will be injected prior to the procedure. C. The patient will be expected to void during the procedure. D. The patient will have to drink three glasses of water during the procedure.

ANS: C Rationale: A voiding cystourethrogram is a study of the lower urinary tract and looks at the structure of the urethra and bladder and the presence of reflux into the ureters. After bladder catheterization, a radiopaque dye is injected into the bladder, and the catheter is then removed. The child is asked to void into a bedpan while serial X-ray films are taken. Being asked to void while being observed may be the most stressful part of the procedure for children because they have been taught voiding is a private act. Be sure children are told in advance that they will be asked to do this, and that it is alright if a stranger watches them. A headache is not a common occurrence after this procedure. A local anesthetic is not needed for this procedure. The patient will not be asked to drink water during the procedure.

The nurse takes a call from a concerned mother whose infant received routine immunizations the day before and now has a temperature of 101oF (38.3oC), is fussy and pulling at the injection site. The mother wants to know what she should do. Which is the best response from the nurse to this mother? A. "You need to bring the baby to the emergency department to be sure he is not having an allergic reaction." B. "All babies have similar reactions but you should call back if he is still fussy in 24 hours." C. "This is a common reaction. Give your child acetaminophen, cuddle him, and apply a cool compress to the injection site." D. "You can give your child ice cold fluids and cover the injection site so that he doesn't scratch the site and get it infected."

ANS: C Rationale: Adverse reactions vary with the type of immunization but usually are minor in nature. The most common adverse reaction is a low-grade fever within the first 24 to 48 hours and possibly a local reaction such as tenderness, redness, and swelling at the injection site. The child may be fussy and eat less than usual. These reactions are treated symptomatically with acetaminophen for the fever and cool compresses applied to the injection site. The child is encouraged to drink fluids but not necessarily ice cold fluids. Holding and cuddling are comforting to the child. These reactions may last longer than 24 hours and should subside. These are not signs of an allergic reaction. There is no need to cover the site.

The mother of a 3-month-old baby is concerned because the child is not able to sit independently. How should the nurse respond to this mother's concern? A. Most babies sit steadily at 3 months. B. Most babies sit steadily at 4 months. C. Most babies do not sit steadily until 8 months. D. Sitting ability and the age of first tooth eruption are correlated.

ANS: C Rationale: An 8-month-old child can sit securely without any additional support. Babies are not able to sit steadily at age 3 or 4 months. Sitting ability does not correspond with tooth eruption.

An otherwise healthy 18-month-old child with a history of febrile seizures is in the well-child clinic. Which statement by the father would indicate to the nurse that additional teaching should be done? A: "I have ibuprofen available in case it's needed." B: "My child will likely outgrow these seizures by age 5." C: "I always keep phenobarbital with me in case of a fever." D: "The most likely time for a seizure is when the fever is rising."

ANS: C Rationale: Anticonvulsants, such as phenobarbital, are administered to children with prolonged seizures or neurologic abnormalities. Ibuprofen, not phenobarbital, is given for fever. Febrile seizures usually occur after age 6 months and are unusual after age 5. Treatment is to decrease the temperature because seizures occur as the temperature rises.

A 16-year-old child suffering from alopecia related to chemotherapy treatment is refusing to let friends visit. Which action by the nurse is most appropriate? A Respect the child's wishes and document refusal B Have the parents explain the importance of letting friends visit C Provide opportunities for the child to discuss his or her body image changes D Allow friends to visit because socialization is important for adolescents

ANS: C Rationale: Being able to discuss body image changes is a pathway toward providing insight on adaptive measures to minimize the appearance of hair loss. The nurse should respect the child's wishes not to have visitors, but the nurse should recognize that this may be a result of altered body image.

A child with spastic cerebral palsy is to receive botulin toxin. The nurse prepares the child for administration of this drug by which route? A. Oral B. Subcutaneous injection C. Intramuscular injection D. Intravenous infusion

ANS: C Rationale: Botulin toxin is administered by injection into the muscle. It may cause dry mouth. It is not administered orally, by subcutaneous injection, or by intravenous infusion.

An extremely thin preadolescent is being assessed by the nurse. Which clients statement should the nurse identify as being consistent with that of a person with anorexia nervosa? A: "I'd like to grow up to be a model." B: "I'd like to gain weight but just can't." C: "I feel chubby no matter what I wear." D: "I'm afraid that someone is poisoning my food."

ANS: C Rationale: Characteristics of a child with anorexia nervosa include a severely distorted body image with an intense fear of gaining weight or becoming fat. The goal to be a model is not consistent with that of anorexia nervosa. The inability to gain weight is not a characteristic of anorexia nervosa. The fear of food being poisoned is a characteristic of paranoid behavior.

What should be included in the teaching plan for a child with type 1 diabetes mellitus who is going home on insulin therapy? A. Children show an increased need for insulin during the first months after glucose control is established. B. Once glucose control is established, there will never be a need for an increase in the amount of insulin administered. C. It is absolutely normal for the growing child to require an increase in insulin; this does not mean his/her condition is getting worse. D. All children should be on at least two types of insulin to establish glucose control.

ANS: C Rationale: Children show a decreased need for insulin shortly after glucose control has been established, which is referred to by some as the "honeymoon phase" and should be described to parents so that they do not get any false hope that the child does not need insulin. As children grow, they will require increased doses of insulin to maintain glucose control, and not all children need to receive two types of insulin. Insulin treatment should be based on each individual child.

The nurse instructs a hearing-impaired school-age child on to how self-inject a prescribed medication. Which observation indicates to the nurse that additional teaching is required? A: The child pinches the skin together before inserting the needle. B: The child injects the appropriate amount of air into the vial before withdrawing medication. C: The child places the filled syringe and uncapped needle on the bed to open the alcohol wipe. D: The child slowly pushes on the plunger to inject the medication before withdrawing the needle>

ANS: C Rationale: Children who are unable to hear may need additional time for explanations and support. By placing the syringe and uncapped needle on the bed, the child is contaminating the needle. This would indicate that additional teaching is necessary. Pinching the skin, injecting air, and slowly pushing on the plunger all indicate that teaching has been effective.

The nurse instructs a school-age patient and the parents on continuous cycling peritoneal dialysis. Which statement indicates that teaching has been effective? A. "The solution should be infused cold." B. "Redness and warmth around the tube insertion site is expected." C. "We should notify the health care provider if the drainage is cloudy." D. "Weight gain and a productive cough are expected with the treatments."

ANS: C Rationale: Cloudy drainage could indicate an infection such as peritonitis and should be reported to the health care provider. The solution should be infused at body temperature. Redness and warmth around the tube insertion site could indicate an infection and should be reported to the health care provider. Weight gain and a productive cough could indicate fluid retention and should be reported to the health care provider.

The nurse is assessing a 6-week-old infant in the clinic. Which characteristic represents normal language development for this age? A. Cooing B. Laughing out loud C. Babbling D. Producing noises when spoken to

ANS: C Rationale: Cooing begins in the first 4 weeks of life, productions of noises when spoken to and laughing out loud are seen in older infants. Infants begin to babble around 6 weeks of age.

What will be the nurse's next action after noting dimpling and a tuft of hair located in the lumbosacral area of the preschool child during the examination? A. Snip the tuft of hair off close to the skin for hygienic reasons B. Move on to other assessments without calling attention to the difference C. Record and refer the finding for follow-up to the pediatrician D. Inspect for precocious hair growth in the genital and underarm areas

ANS: C Rationale: Dimpling and hair growth may signal spina bifida occulta, which usually is benign. However, some complications can be associated, and further investigation is warranted to prevent possible damage to the spinal cord. Magnetic resonance imaging (MRI) is often the diagnostic tool used. No hygienic concerns need prevail. These findings do not suggest development of precocious puberty or any other hormonal problem. The dimpling and hair tuft must be clearly explained to the parents.

A toddler's mother reports that her child will only eat peanut butter and jelly sandwiches for several days in a row. The child will then refuse to eat them for several weeks. Which term would the nurse use to document this behavior? A. Physiologic anorexia B. Echolalia C. Food jag D. Egocentrism

ANS: C Rationale: During a food jag, the toddler may prefer only one particular food for several days, then not want it for weeks. Physiologic anorexia describes the fact that toddlers do not require as much food intake for their size as they did in infancy. Echolalia is repetition of words and phrases. Egocentrism describes the focus on self that is present in toddlers.

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

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

The nurse is providing education to a teen mother about her 20-month-old daughter's growth. The teen says her daughter seems to have such a big head. What information should the nurse include in the response? A. Some children have large heads but that does not signal a problem. B. Explain that the child looks normal. C. Share that the heads of children at this age are large in proportion to the rest of their body. D. Teach the mother that this larger head than body appearance will be this way until the child is about 6 years old.

ANS: C Rationale: Head circumference increases about 1 inch between 1 and 2 years of age, then increases an average of a half-inch per year until age 5. The anterior fontanel should be closed by the time the child is 18 months old. Head size becomes more proportional to the rest of the body near the age of 3 years.

The nurse is assessing an infant with suspected hemolytic uremic syndrome. Which characteristics of this condition should the nurse expect to assess or glean from chart review? A. Hemolytic anemia, acute renal failure, and hypotension B. Dirty green colored urine, elevated erythrocyte sedimentation, and depressed serum complement level C. Hemolytic anemia, thrombocytopenia, and acute renal failure D. Thrombocytopenia, hemolytic anemia, and nocturia several times each night

ANS: C Rationale: Hemolytic uremic syndrome is defined by all three particular features - hemolytic anemia, thrombocytopenia, and acute renal failure. Dirty green colored urine, elevated erythrocyte sedimentation, and depressed serum complement level are indicative of acute glomerulonephritis. Hypertension, not hypotension, would be seen and the child would have decreased urinary output which would not cause nocturia.

The nurse realizes that the chemotherapy agents and radiation that a child is receiving are likely to irritate the bladder. What are the best measures that the nurse can take to diminish this risk? A Administer chemotherapy during sleep periods, including naps and overnight B Have the child wait to void until the bladder becomes full C Keep intravenous (IV) fluids running to maintain excellent hydration and frequent voids D Promote drinking of cranberry juice, making it an attractive oral fluid option

ANS: C Rationale: IV fluids are given before, during, and after radiation and chemotherapy drugs; bladder irritation results from the need to dilute and remove them from the body. This reduces the need for the child to drink large quantities. Administering the drug during sleep and having the child retain urine would cause irritating chemicals to be kept in contact with the bladder mucosa. No benefit is associated with providing cranberry juice.

The nurse is collecting data on a 5-year-old child admitted with the diagnosis of congestive heart failure. Which clinical manifestation observed during the physical assessment would be consistent with this diagnosis? A. Jerking movements of the arms and legs B. Scissoring of the legs with toes pointed down C. Failure to gain weight D. Spooning of the finger nails

ANS: C Rationale: In infants and older children, one of the first signs of CHF is tachycardia. Other signs of CHF often seen in the older child include failure to gain weight, weakness, fatigue, restlessness, irritability, and a pale, mottled, or cyanotic color. Rapid respirations or tachypnea, dyspnea, and coughing with bloody sputum also are seen. Edema and enlargement of the liver and heart may be present. Jerking movements indicate seizure activity. Scissoring of the legs is seen in cerebral palsy, and spooning of the finger nails is seen in iron deficiency anemia.

An 18-month-old child is admitted with signs of increased intracranial pressure. What should the nurse observe when assessing this patient? A: Numbness of fingers and decreased temperature B: Increased pulse rate and decreased blood pressure C: Increased temperature and decreased respiratory rate D: Decreased level of consciousness and increased respiratory rate

ANS: C Rationale: Manifestations of increased intracranial pressure include increased body temperature and decreased respiratory rate. Pulse rate slows, and the blood pressure increases.

A nurse is working with a preceptor in a well-baby clinic that deals with children aged birth to 12 years old. During the routine physical assessment of a 2-year-old, the nurse identifies which finding as being abnormal for this age group? A. heart rate of 92 beats/min, regular B. respiration rate of 20 bpm, abdominal breathing noted C. blood pressure of 116/80 mm Hg D. wears diapers since not potty trained

ANS: C Rationale: Normal assessment findings of toddlers include: respirations slow slightly but continue to be mainly abdominal; heart rate slows from 110 to 90 beats/min; blood pressure increases to about 99/64 mm Hg; and not potty trained until complete myelination of the spinal cord has occurred. The only abnormal finding is an elevated blood pressure. However, this can occur if the toddler is crying or upset about the assessment.

The nurse is completing the physical assessment of a 12-year-old child who has a series of bruises in various stages of healing. When asked about the bruises the child appears frightened and offers inconsistent accounts about how the child got the bruises. The nurse suspectsabuse. Which initial action of the nurse is most appropriate? A: Take photographs of the bruises. B: Ask the child to provide a written statement of how he or she got the bruises. C: Document the bruises and any statements made by the child relating to them. D: Interview the child's parents about the origin of the bruises. E: Interview the child's parents about the origin of the bruises.

ANS: C Rationale: Nurses in each state have a legal requirement to report suspicions of child abuse or maltreatment. The nurse must document all findings. The medical record will be of importance in establishing the findings. Once the findings are documented, the nurse will need to closely follow the agency policies regarding the reporting process. The nursing supervisor will need to also be involved but that will take place after the documentation has been completed. The child cannot be photographed without appropriate approvals. The child may indeed be asked to provide a more detailed reporting of the bruising, but it is not the role of the nurse to request it. The child's parents will also become a part of the investigation but the interviewing process does not come before the documentation of the findings.

A nurse is assessing a child for the possible obsessive-compulsive disorder. Which question would be most helpful for obtaining information from the child? A. "Are you having any recurring dreams about the trauma you experienced?" B: "Has anything happened at home recently that has upset you?" C: "Is there anything that you do over and over again and can't resist doing?" D: "Do you have times when you wake up during the night without any reason?"

ANS: C Rationale: Obsessive-compulsive disorder is characterized by obsessions--unwanted, unrealistic, irrational recurring or persistent thoughts, impulses, or images beyond excessive worry and compulsions--repetitive behaviors, rituals, or mental acts. Thus, asking the child about doing anything over and over again would be more effective in obtaining additional information. Asking about recurring dreams related to a trauma might be appropriate for assessing posttraumatic stress disorder. Asking about home issues might help to shed light on possible separation anxiety. Asking about waking up at night without a reason provides information about sleep disorders.

A high-school football player has been diagnosed as having osteosarcoma of the femur. The parents are angry because they told the adolescent not to play football. Which health teaching points would the nurse include in the teaching plan for the adolescent and parents? A Osteosarcoma often follows trauma, such as a football injury. B You can expect some discoloration of the leg following chemotherapy. C Football injuries do not contribute to the development of a tumor. D Tumor growth is related to your dislike of milk.

ANS: C Rationale: Osteosarcoma is the most malignant form of bone cancer. It is caused from the embryonic mecenchymal tissue that forms in the bones. A football injury may predispose more scrutiny of a lesion but it will not be the cause of the cancer, nor will the dislike of milk. Osteosarcoma may be treated with chemotherapy and radiation. It may also involve an amputation. The parents who state they are angry at their adolescent for playing football is more likely projecting their fears of the diagnosis and the future for their adolescent.

The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way? A. Keep the mass uncovered and dry B. Prevent cold stress using an Isolette and blankets C. Cover the sac with a saline-moistened dressing D. Change position from side to side hourly

ANS: C Rationale: Protection of exposed neural tissue is of high priority. Keeping the cystic mass moist prevents damage to neural elements from drying. Blankets may cause trauma to the sac. An Isolette can be used for warmth, but much attention will have to be directed toward keeping the sac moist. Side-to-side hourly position changes increase the risk of damage to protruding nervous tissue. Unnecessary handling should be avoided.

A child with allergic rhinitis is prescribed a nasal antihistamine spray. When advising the parents about the use of the sprays, what should the nurse explain about the rebound phenomenon? A: It causes a permanent increase in nasal secretions. B: It causes reflux of gastric contents into the esophagus. C: It causes an increase in nasal secretions after an initial decrease. D: It causes a decrease in histamine release after an initial increase.

ANS: C Rationale: Review with the parents that if nasal antihistamine sprays are given for more than 3 days, a rebound effect can occur. The nasal mucosa becomes more edematous rather than less edematous, and symptoms will appear to worsen rather than improve. The rebound phenomenon does not cause a permanent increase in nasal secretions, reflux of gastric contents into the esophagus, or a decrease in histamine release after an initial increase.

The nurse is educating parents of a child admitted to the hospital with rubella (German measles). Which statement by the parents indicates the further education is needed? A. "Our child is contagious for 1 week after the rash appeared." B. "Acetaminophen or ibuprofen can be given to help with pain." C. "Antibiotics are needed to help our child recover from rubella." D. "Family members should wear a mask when coming to visit us."

ANS: C Rationale: Rubella (German measles) is caused by the rubella virus. Children will be contagious for 1 week before to approximately 1 week after the rash appears. Acetaminophen or ibuprofen can be given to help with pain or fever, and the child will be on droplet precautions (mask) while in the hospital.

The nurse is instructing the parents of a child with sickle cell anemia on safety precautions. What should the nurse emphasize during this teaching? A. Suggest the child participate in sports activities without restriction. B. Treat upper respiratory infections with over-the-counter medication. C. Ensure a consistent and daily intake of adequate fluids to prevent dehydration. D. Remind to avoid immunizations to prevent the introduction of bacteria into the body.

ANS: C Rationale: Safety interventions for the child with sickle cell anemia include ensuring an adequate daily intake of fluids to prevent dehydration. Dehydration will precipitate a crisis, which can be avoided. The child should avoid contact sports and long-distance running. Upper respiratory infections should be reported to the health care provider so appropriate treatment can be provided. Routine healthcare such as immunization action should be provided in order to prevent common childhood illnesses.

For which child's behavior should the nurse identify as being characteristic of separation anxiety disorder? A: An 8-month-old who cries when left with strangers B: A 7-year-old who withdraws from contact with all strangers C: An 8-year-old who will not stay overnight at a friend's house D: A 10-year-old who reports headaches if there is to be a test in school

ANS: C Rationale: Separation anxiety is considered a disorder when an older child shows excessive anxiety about separation or the possibility of separation from parents. They experience acute distress and perhaps frequent nightmares bout separation and, when separated, show symptoms of nausea or vomiting or crying to such a degree it prevents them from visiting at friends' houses. For an 8-month-old, crying when being left with strangers is a normal behavior. A 7-year-old who withdraws from contact with strangers might have been instructed to do this as a form of safety or might be shy. A 10-year-old who reports headaches when a test is scheduled in school is demonstrating some other type of behavior. Separation anxiety would not occur just when a test is scheduled in school.

A mother is concerned that her 2-year-old child is having seizures. He holds his breath until he passes out when he wants something his mother does not want him to have. How should the nurse respond to this mother's concern? A. Seizures rarely occur in toddlers B. With seizures, cyanosis rarely develops. C. Seizures are not provoked; temper tantrums are. D. Seizures typically occur with fever; temper tantrums do not.

ANS: C Rationale: Some children hold their breath as part of a temper tantrum until they become cyanotic. Breath holding occurs when a child is provoked; the child develops a distended chest, often has air-filled cheeks, and shows increasing distress as the body registers oxygen want. A seizure cannot be provoked. Seizures can occur in all ages. Cyanosis can occur with seizures. Seizures can occur in those with neurologic problems and not just with a fever.

A child has been prescribed Stimate (esmopressin) acetate for the treatment of diabetes insipidus. The client and the parents ask the nurse how this drug works. What is the correct response by the nurse? A. Stimate (esmopressin) acetate works on your pancreas to stimulate insulin production B. Stimate (esmopressin) acetate is a synthetic form of insulin used to lower your blood sugar C. Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that will slow down your urine output D. Stimate (esmopressin) acetate works to help your kidneys work more efficiently

ANS: C Rationale: Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that promotes reabsorption of water by action on renal tubules; it is used to control diabetes insipidus by decreasing the amount of urine produced.

The nurse is providing anticipatory guidance to a mother to help promote healthy sleep for her 3-week-old baby. Which recommended guideline might be included in the teaching plan? A. Place the baby on a soft mattress with a firm, flat pillow for the head. B. Place the head of the bed near the window to provide fresh air, weather permitting. C. Place the baby on his or her back when sleeping. D. If the baby sleeps through the night, wake him or her up for the night feeding.

ANS: C Rationale: Sudden infant death syndrome (SIDS) has been associated with prone positioning of newborns and infants, so the infant should be placed to sleep on the back. The baby should sleep on a firm mattress without pillows or comforters. The baby's bed should be placed away from air conditioner vents, open windows, and open heaters. By 4 months of age night waking may occur, but the infant should be capable of sleeping through the night and does not require a night feeding.

A 2-year-old client and the parents are at the office for a follow-up visit. The client has had excessive hormone levels in the recent blood work, and the parents question why this was not found sooner. Which response by the nurse would be most appropriate? A. "It takes time to determine the level of functioning of endocrine glands." B. "Have there been signs and symptoms that you should have reported to the doctor?" C. "As endocrine functions become more stable throughout childhood, alterations become more apparent." D. "Endocrine disorders are hard to detect and you are lucky that we have found it when we did."

ANS: C Rationale: The endocrine glands are all present at birth; however, endocrine functions are immature. As these functions mature and become stabilized during the childhood years, alterations in endocrine function become more apparent. Thus, endocrine disorders may arise at any time during childhood development.

A nurse is caring for a 13-year-old boy with end-stage renal disease who is preparing to have his hemodialysis treatment in the dialysis unit. Which nursing action is appropriate? A. Administer his routine medications as scheduled B. Take his blood pressure measurement in extremity with AV fistula C. Withhold his routine medication until after dialysis is completed D. Assess the Tenckhoff catheter site

ANS: C Rationale: The nurse should withhold routine medications on the morning that hemodialysis is scheduled since they would be filtered out through the dialysis process. His medications should be administered after he returns from the dialysis unit. A Tenckhoff catheter is used for peritoneal dialysis, not hemodialysis. The nurse should avoid blood pressure measurement in the extremity with the AV fistula as it may cause occlusion.

A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse? A Tell the parent to administer acetaminophen every 4 hours until the fever dissipates. B Ask whether any family members or other close associates are ill. C Have the parent bring the child to the pediatric oncology clinic as soon as possible. D Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order.

ANS: C Rationale: The preschooler is considered immune suppressed following recent chemotherapy. A fever can mean sepsis, which would require immediate investigation of blood and other body fluids to identify the organism, plus prompt treatment with an IV antibiotic. This can be accomplished only by seeing the pediatric oncologist and is likely to result in hospitalization.

Which of the following women has the greatest risk of having a child with Down syndrome? A. 25-year-old B. 30-year-old C. 42-year-old D. 35-year-old

ANS: C Rationale: The risk of having a Down syndrome child increase with maternal age - it is 1 in 1250 at 25 years of age, 1 in 400 at 35 years, and 1 in 100 at 45 years of age.

The nurse is caring for a female preschool-aged patient with a urinary tract infection. What measures should the nurse teach the mother to prevent future infections? A. Suggest the child drink less fluid daily to concentrate urine. B. Encourage the child to be more active to increase urine output. C. Teach the child to wipe the perineum front to back after voiding. D. Teach the child to take frequent tub baths to clean the perineal area.

ANS: C Rationale: Urinary tract infections occur more often in girls than boys because the urethra is shorter in girls and, because it is located close to the vagina and anus, vulvovaginitis or rectal bacteria can easily spread to the urethra. Girls should be taught early to wipe themselves from front to back after voiding and defecating to avoid contaminating the urethra. The child should be encouraged to drink more fluid to prevent concentrated urine. Activity level does not influence the development of urinary tract infections. There is a suggested correlation between the use of hot tubs and urinary tract infections in girls so use of these should be discouraged or minimized.

The adoptive parents of a child who is 7 years old and HIV positive are concerned about telling their child about his condition. What information can be provided by the nurse? A. The child should not have information about their health provided at this age. B. Children at this age should have full disclosure of their condition. C. When providing health information to a child of this age it should be simplistic and at the child's level of understanding. D. Once a child is apprised of their health concerns they do not normally experience any after affects.

ANS: C Rationale: When a child has a chronic condition they often realize that they have special concerns even before they are fully able to understand them. Information should be provided that is developmentally appropriate. Excessive information and details should be limited. Children who have this type of information may experience problems anger, depression and difficulty in school.

A nurse is teaching the parents of a child who has been diagnosed with spina bifida. Which statement by the nurse would be the most accurate description of spina bifida? A. "It has little influence on the intellectual and perceptual abilities of the child." B. "It's a simple neurologic defect that's completely corrected surgically within 1 to 2 days after birth." C. "Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately." D. "It's a complex neurologic disability that involves a collaborative health team effort for the entire first year of life."

ANS: C Rationale: When a spinal cord lesion exists at birth, it commonly leads to altered development or function of other areas of the CNS. Spina bifida is a complex neurologic defect that heavily impacts the physical, cognitive, and psychosocial development of the child and involves collaborative, lifelong management due to the chronicity and multiplicity of the problems involved.

The parents of a child with a history of seizures who has been taking phenytoin (Dilantin) ask the nurse why it's difficult to maintain therapeutic plasma levels of this medication. Which statement by the nurse would be most accurate? A: "A drop in the plasma drug level will lead to a toxic state." B: "The capacity to metabolize the drug becomes overwhelmed over time." C: "Small increments in dosage lead to sharp increases in plasma drug levels." D: "Large increments in dosage lead to a more rapid stabilizing therapeutic effect."

ANS: C Rationale: Within the therapeutic range for phenytoin, small increments in dosage produce sharp increases in plasma drug levels. The capacity of the liver to metabolize phenytoin is affected by slight changes in the dosage of the drug, not necessarily the length of time the client has been taking the drug. Large increments in dosage will greatly increase plasma levels, leading to drug toxicity

The nurse is caring for a pediatric client who has a compromised immune system. When reviewing laboratory results, which bone marrow component identifies a dysfunction in bone marrow production? Select all that apply. A. Macrophages B. Antigen C. T lymphocytes D. B lymphocytes E. Haptens

ANS: C, D Rationale: Bone marrow produces B lymphocytes and T lymphocytes. Macrophages are mature white blood cells involved with phagocytosis of an invading pathogen. Antigens are foreign substances capable of stimulating an immune response. Hapten formation occurs when a substance becomes antigenic when it combines with a higher weight molecule, usually a protein.

The nurse is caring for a child recovering from surgery to correct strabismus. Which interventions should the nurse include when planning this child's care? Select all that apply. A: Apply an eye patch. B: Maintain on bed rest for 3 days. C: Support for nausea and vomiting. D: Provide pain medication as prescribed. E: Apply antibiotic ointment as prescribed.

ANS: C, D, E Rationale: After eye surgery for strabismus, the patient may experience nausea and vomiting and pain on eye movement. The patient will also be prescribed antibiotic ointment. An eye patch is not usually required. The child will not need to be on bed rest for 3 days.

The nurse is examining a child with hypoparathyroidism. The nurse would expect to assess which signs and symptoms? Select all that apply. A. Capillary refill B. Polyphagia C. Chvostek D. Babinski E. Trousseau

ANS: C, E Rationale: A child with hypoparathyroidism would have a positive Chvostek or Trousseau sign, both of which indicate hypocalcemia. To test for the Chvostek sign, tap sharply over the facial nerve below the temple and anteriorly to the ear. The sign is positive when the mouth twitches (contraction of the lateral facial muscles). To check for the Trousseau sign, apply a blood pressure cuff to the child's upper arm. Inflate the cuff until the blood supply is occluded. If doing so causes carpal spasm (the fingers contract and the child is unable to open the hand), the Trousseau sign is positive. Capillary refill helps to evaluate tissue oxygenation. Polyphagia refers to excessive eating or hunger

The nurse is assessing a 3-year-old child. Which assessment finding would the nurse identify as abnormal? A. Builds a tower of 10 cubes. B. Pedals tricycle without assistance. C. Unscrews a bolt-on a toy. D. Falls when bending over to touch toes.

ANS: D

The nurse is planning care for a school-aged child recovering from being hit by a motor vehicle while riding a bicycle. For what will the nurse assess to determine the onset of disseminated intravascular coagulation in this child? A. Blurred vision B. Nausea and vomiting C. Sudden onset of knee pain D. Bleeding from intravenous sites

ANS: D

The parent of a 5-year-old child calls the doctor's office to seek advice about proper nutrition for her child. Which statement by the mother indicates that further teaching is needed? A. "I give her three meals a day and some snacks in between if she gets hungry." B. "We offer her the same foods we are eating, just in smaller portions." C. "She loves fruit, so I give her 1 cup each day." D. "Since she doesn't like vegetables, we no longer serve them to her."

ANS: D

The nurse is caring for a 12-month-old child diagnosed with an autism spectrum disorder. What information from the mother during the health history should the nurse identify as being consistent with the disorder? A: The child speaks in complete sentences. B: The child sleeps at least 12 out of every 24 hours. C: The child responds warmly to the father but not to the mother. D: The child constantly stares at a rotating wheel on the crib mobile.

ANS: D Rationale: A manifestation of an autism spectrum disorder is an abnormal response to sensory stimuli such as staring at a rotating wheel on the crib mobile. A child with an autism spectrum disorder will demonstrate repetitive words and failure to develop social relationships. The number of hours of sleep is not used to help identify an autism spectrum disorder.

The mother of a toddler is frustrated because no matter what she asks of the child, the response is "no." What can the nurse suggest to the mother to assist with this problem? A. Pretend she does not hear the child. B. Ask no further questions to the child. C. Tell the child to never to say "no" again. D. Give the child secondary, not primary, choices.

ANS: D Rationale: A toddler needs experience in making choices, and to provide the opportunity to do this, a parent could give a secondary choice. Pretending not to hear the child, asking no further questions, and telling the child to never say "no" again will not help with the toddler's obstinacy.

19. The mother of a an 8-year-old boy with mumps tells the nurse that she does not understand how her son could have gotten mumps since he was immunized according to her physician's recommendations. What is the best response by the nurse? a. "I am sure it must be frustrating. Where did you have the immunizations performed?" b. "I am wondering if your physician followed the immunization schedule correctly?" c. "Are you sure your child received an immunization for mumps?" d. "While immunizations are highly effective they aren't 100% effective at preventing infectious diseases."

ANS: D Rationale: According to the CDC (2014d), one dose of MMR prevents 78% of cases and two doses prevent approximately 88% of cases. Questioning where the immunizations were given, if the immunization was given, and if the physician followed the guidelines correctly is accusatory and unlikely to be the cause of the child contracting the infection.

When assessing a child for the probable cause of acute bronchiolitis, the nurse focuses on which factor? A. Bacterial infections B. Environmental allergies C. Prenatal complications D. Viral infections

ANS: D Rationale: Acute bronchiolitis is caused by a viral not bacterial infection. Neither allergies nor prenatal complications contribute to the development of this disorder.

A nurse is conducting a physical examination of a 12-year-old girl with suspected systemic lupus erythematosus (SLE). How would the nurse best interview the girl? A: "Do you notice any wheezing when you breathe or a runny nose?" B: "Do you have any shoulder pain or abdominal tenderness?" C: "Have you noticed any new bruising or different color patterns on your skin?" D: "Have you noticed any hair loss or redness on your face?"

ANS: D Rationale: Alopecia and the characteristic malar rash (butterfly rash) on the face are common clinical manifestations of SLE. Rhinorrhea, wheezing, and an enlarged spleen are not hallmark manifestations of SLE. Petechiae and purpura are more commonly associated with hematological disorders, not SLE.

In developing a plan of care for the child diagnosed with rheumatic fever, the nursing intervention that takes highest priority for this child is to: A. position the child to relieve joint pain. B. monitor the C-reactive protein and ESR levels. C. provide age-appropriate diversional activities. D. promote rest periods and bed rest.

ANS: D Rationale: As long as the rheumatic process is active, progressive heart damage is possible. To prevent heart damage, bed rest is essential to reduce the heart's workload. Laboratory tests for ESR and C-reactive protein can be used to evaluate disease activity and guide treatment, but they do not improve the child's health itself. The child's comfort is important, so it is essential to relieve joint pain and prevent injury with padded bed rails. But these measures are less important than rest when it comes to preventing long-term complications such as residual heart disease.

A 6-month-old girl weighs 14.7 pounds (6.7 kg) during a scheduled check-up. Her birth weight was 8 pounds (3.6 kg). What is the priority nursing intervention? A. Talking about solid food consumption B. Discouraging daily fruit juice intake C. Increasing the number of breast-feedings D. Discussing the child's feeding patterns

ANS: D Rationale: Assessing the current feeding pattern and daily intake is the priority intervention. Talking about solid food consumption may not be appropriate for this child yet. Discouraging daily fruit juice intake or increasing the number of breastfeedings may not be necessary until the situation is assessed.

Other than providing direct care to children, what is the major role of nurses in the care of nearly all children with neuromuscular disorders? A. Consoling parents B. Teaching children self-care C. Helping with specialized equipment D. Coordinating care by specialists

ANS: D Rationale: Being part of a multidisciplinary team and coordinating the care the child usually needs from a variety of specialists is an essential and major role. The other nursing activities are important as well, but many children/families require individual interventions.

The nurse is assessing a 30-month-old child during a routine well-child visit. Which statement by the parent would alert the nurse to further assess for a learning disorder? A: "My child seems to prefer playing with certain toys and will not play with other toys very much." B: "My child likes a certain type of food and does not want to try new foods very often." C: "My child gets restless when we go to a restaurant to eat and we have to wait for our food." D. "My child does not say more than one or two words and grunts to indicate needs."

ANS: D Rationale: Delayed language is often a first sign of an intellectual/learning disorder in a child. The nurse would expect the 30-month-old child to be a picky eater, prefer some toys over others and to be restless when required to sit for an extended period of time.

The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. Caring for a child who has issues with the anterior pituitary, the nurse would expect the child to have issues with which hormone? A. Vasopressin B. Antidiuretic hormone C. Oxytocin D. Growth hormone

ANS: D Rationale: Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adenohypophysis, is made up of endocrine glandular tissue and secretes growth hormone (GH), adrenocorticotropic hormone (ACTH), TSH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. The posterior lobe is called the neurohypophysis because it is formed of neural tissue. It secretes antidiuretic hormone (ADH; vasopressin) and oxytocin. Usually, several target organs are affected when there is a disorder of the pituitary gland, especially the adenohypophysis.

The nurse is educating the parents of a 6-year-old boy about his learning disorder. Which of the following facts would the nurse integrate into the discussion? A: Learning disorders indicate lower intelligence. B: Learning disorders are synonymous with learning deficits. C: The disorder requires comprehensive special education. D: The disorder is caused by a difference in brain architecture.

ANS: D Rationale: In most cases, the etiology of learning disorders is not known. However, it is believed that the brain architecture is different from that of children without a learning disorder. Children with a learning disability process information differently than children who respond to traditional teaching methods. The "wiring" or architecture of the brain differs from that of a child without a learning disorder, and the biochemical balance may differ as well. Learning disorders do not predict intelligence. They should not be considered deficits but rather different responses to information. Likewise, they can be limited to one area, allowing the child to excel in other areas.

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

ANS: D Rationale: It is essential to respect client autonomy and present information in a factual, nondirective manner. In these situations, the nurse needs to understand that the choice is the couple's to make. Gathering information for three generations obtains a broad overview of what has been seen in both sides of the family. Maintaining confidentiality of the information is as important as with any other client information gathered. Informing family of the need for information is necessary because of its personal nature.

The nurse is caring for a school-age child with varicella. What should the nurse observe about the rash that is associated with this infection? A.Dark red color B. Noticeable crusts but no pruritus C. Dark red, macular, very pruritic lesions D. Various stages of lesions present at the same time

ANS: D Rationale: Most of chickenpox lesions are found on the trunk, although the face, scalp, palate, and neck also may be involved. They appear in approximately three separate series or crops, with each new lesion moving through progressive stages. At some point, all four stages of lesions—macule, papule, vesicle, and crust—can be present. The lesions are not dark red in color. These lesions are very itchy.

The nurse is performing a well-child assessment on a 2-week-old infant. The nurse asks why her baby only breathes out of his nose and does not seem to mouth breathe. What information can the nurse provide to the mother? A. "Babies breathe from both their nose and mouth around 2 or 3 weeks of age." B. "Breathing from the nose only will be noted in newborns for about the first 6 weeks of life." C. "Your baby is breathing normally for his age." D. "Babies are nose breathers for about the first 4 weeks of life."

ANS: D Rationale: Newborns are obligatory nose breathers until at least 4 weeks of age. The young infant cannot automatically open his or her mouth to breathe if the nose is obstructed. The nares must be patent for breathing to be successful while feeding. Newborns breathe through their mouths only while crying.

When assessing a infant born at 32 weeks' gestation, which finding would lead the nurse to suspect to suspect that the newborn has a patent ductus arteriosus (PDA)? A. Weak, thready pulse B. Decreased pulse rate C. High diastolic arterial pressure D. Continuous murmur on auscultation

ANS: D Rationale: Presence of a continuous murmur on auscultation of the heart is indicative of patent ductus arteriosus (PDA) in preterm infants. Preterm infants are at an increased risk of developing PDA. Other assessment findings that indicate PDA include bounding pulse, increased pulse rate and low diastolic arterial pressure.

17. A child is admitted to the pediatric medical unit with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). Based on the typical signs and symptoms of this disorder, which nursing diagnosis will the nurse identify as relating to this client? A. Delayed growth and development B. Imbalanced nutrition: More than body requirements C. Noncompliance D. Excess fluid volume

ANS: D Rationale: Syndrome of inappropriate antidiuretic hormone (SIADH) occurs when ADH (vasopressin) is secreted in the presence of low serum osmolality because the feedback mechanism that regulates ADH does not function properly. ADH continues to be released, and this leads to water retention, decreased serum sodium due to hemodilution, and extracellular fluid volume expansion; thus, Excess fluid volume from edema is the highest priority.

The nurse is educating a parent after the birth of a newborn who is diagnosed with phenylketonuria (PKU). Which parent statement indicates teaching has been effective? A. "I will supplement my breast milk with prescribed formula." B. "Once the baby is on solid foods, the dietary restriction will be gone." C. "The concern is the baby has an excess of a liver enzyme." D. "I will not breast feed the baby since breast milk contains phenylalanine."

ANS: D Rationale: The child will be on a low phenylalanine diet, which is found in breast milk and formula. The baby has a deficiency of the liver enzyme, not an excess. The baby will transition to solid food and still have dietary restrictions.

The nurse has received morning report on a group of pediatric clients. Which pediatric client will the nurse see first? A. an infant with rhinorrhea, coughing, and oxygen saturation of 92% B. a toddler with a temperature of 100.1°F (38°C), and a harsh, barking cough C. a preschool child with crackles in the right lower lobe and chest pain D. a school-age child with dysphagia, drooling, and a hoarse voice

ANS: D Rationale: The child with signs and symptoms of epiglottitis should be seen first because epiglottitis is an emergency that can quickly cause airway obstruction. A child with signs of bronchiolitis with an oxygen saturation of 92% is more stable than this child with epiglottitis. A toddler with signs of croup is more stable than this child with epiglottitis. A child with signs and symptoms of pneumonia is more stable than this child with epiglottitis.

The nurse is providing teaching to the parents of a child with varicella. Which statement indicates that the parents have understood the instructions? A. "We should apply alcohol to the lesions every four hours." B. "If he has a fever, we can give him some aspirin." C. "The lesions should eventually form soft crusts that drain." D. "We need to make sure that he washes his hands frequently."

ANS: D Rationale: The child with varicella needs to wash his hands frequently with antibacterial soap to reduce bacterial colonization. A cool bath with soothing colloidal oatmeal may help the skin discomfort. Alcohol would be too drying to the skin. Acetaminophen, not aspirin, should be used to reduce fever. The lesions should eventually crust over. Soft crusts with drainage may suggest an infection.

The nurse is monitoring the CD4 count of an infant who has contracted HIV from the mother in utero. The nurse is concerned that treatment with antiretroviral therapy is not effective when noting which CD4 level? A. 1900/mm3 B. 1700/mm3 C. 1500/mm3 D. 1300/mm3

ANS: D Rationale: The number of CD4 T lymphocytes in the blood helps to determine the effectiveness of antiretroviral therapy. Normal is 1500/mm3 in the infant, so anything below that number may indicate that the therapy is not effective.

The parent of an infant born with trisomy 18 says to the nurse, "I am so lost...I can't even think about my baby not being healthy." How should the nurse respond? A. "I understand...we occasionally see clients with trisomy 18 and it is very sad." B. "This is a difficult time, but let's talk about the ways your baby will outgrow this." C. "I would encourage you to talk with the doctor about ways to cure this disorder." D. "This is a sad time for you. I will sit with you quietly in case you want to talk."

ANS: D Rationale: The prognosis is poor for children with trisomy 18 and therapeutic communication involves the nurse being available to offer support. The nurse shouldn't express understanding a parent's situation as each parent is unique and this response dismisses the parent's emotions. There is no cure and the child will not out grow the disorder, so the nurse shouldn't offer this as an option.

A nurse is performing an assessment on a child. What would be indicative of a potential for a urinary tract infection? A. Washing the genital area with water daily B. Not using cleansing towelettes routinely C. Not using soap when cleaning the urethral area D. Holding urine while at school

ANS: D Rationale: UTIs are often caused by children who do not urinate frequently at school. It is important for a child to avoid using towelettes and soap in the genital area because this can increase the chance of a UTI. Washing the genital area with water daily does not increase the chance of a UTI.

The nurse is caring for a child and notes periorbital edema on the left eye with urticaria. Which action by the nurse is priority? A. Administer a corticosteroid. B. Ask if the child has allergies. C. Evaluate fluid volume status. D. Assess lung sounds bilaterally.

ANS: D Rationale: When a child has signs of angioedema, the nurse's priority is to ensure the airway is patent, by assessing breathing sounds, because angioedema can cause laryngeal obstruction and asphyxiation. Evaluating fluid volume status, asking about allergies, and administering a corticosteroid are all actions that could be performed after first ensuring the child was breathing.

A nurse is teaching parents about erythema infectiosum and describing the progression of the disease from earliest to latest. Place the following manifestations in the order in which the nurse would describe them. A. Intense red rash on the face B. Rash on the flexor surfaces of extremities and trunk C. Rash on extremity extensor surfaces D. Fever and headache E. Lace-like lesion appearance

ANS: D, A, C, B, E Rationale: The first phase of the infection includes fever, headache, and malaise. A week later, a rash, which erupts in three stages, appears. The rash is intensely red and appears first on the face. The lesions are maculopapular and coalesce on the cheeks to form a "slapped face" appearance. The facial lesions fade in 1 to 120 days. A day after the facial lesions appear, a rash appears on the extensor surfaces of the extremities. One day later, the rash appears on the flexor surfaces and the trunk. These lesions last for 1 week or more. When they fade, they fade from the center outward, giving the lesions a lace-like appearance.

The nurse is comforting a family who were just informed by the health care provider that their baby will likely be born with a significant genetic abnormality. What actions by the nurse would be therapeutic? Select all that apply. A. Advise the parents to discuss their fears with only each other B. Discuss the nurse's personal beliefs regarding genetic abnormalities C. Encourage the family to ask questions after they have researched the disorder D. Refer the family to appropriate parent group or local family with similar needs E. Allow the family to discuss their emotions in an authentic and trusting environment

ANS: D, E Rationale: The nurse would encourage the family to discuss their emotions and fears in an authentic environment and in a trusting relationship as well as refer the to local parent groups or other families with a child with a similar need. The nurse would encourage family members to maintain open communication and ask questions rather than discourage this action. The nurse would avoid sharing personal beliefs, because this action is not therapeutic and may demonstrate personal biases and hinder a trusting relationship.

The mother of 2-month-old infant questions the nurse about autism. She reports a close family member has a child with this disorder and she is concerned about her child. What information can be provided to the child's mother? Select all that apply. A: "The cause of autism is largely considered to be related to immunizations administered in infancy." B: "Concerns are often noted as early as 3 to 6 months of age." C: "Once your child begins to speak it will be easier to make a determination." D: "In infancy, a lack of loving behaviors such as cuddling is concerning." E: "Infants who are on the autism spectrum may have difficulty establishing or maintaining eye contact."

ANS: D, E Rationale: The spectrum of autism disorder ranges from mild (e.g., Asperger syndrome) to severe. Autistic behaviors may be first noticed in infancy as developmental delays or between the age of 12 and 36 months when the child regresses or loses previously acquired skills. The exact etiology of autism continues to elude scientists, but it may be due to genetic makeup, brain abnormalities, altered chemistry, a virus, or toxic chemicals. Children with ASD display impaired social interactions and communication. They may fail to develop interpersonal relationships and experience social isolation.

The parents of a 1-year-old child with Down syndrome are at a follow-up clinic visit for their child. What information would the nurse review with the parents at this time? Select all that apply. A. Plan to have the child's vision and hearing tested at the age of 18 months B. The child should be consuming added calories now that he is growing more C. Dental visits should be scheduled yearly from this age to adolescence D. Cervical x-rays need to be scheduled for the next visit in 3 months E. Monitor for symptoms of respiratory infections and ear infections F. A thyroid test will be scheduled for this visit to monitor for high or low thyroid concerns

ANS: E, F Rationale: The nurse would encourage the parents to monitor the child for symptoms of respiratory and ear infections. Thyroid test should be done at 6 and 12 months of age and then yearly. The child should have routine hearing and vision testing already being completed by the age of 12 months. A regular diet is recommended for children with Down syndrome due to a risk of obesity not increased calories. Dental visits should be scheduled every 6 months. Cervical x-rays should be completed between 3 and 5 years of age.

The young child has been diagnosed with Guillain-Barré syndrome and it is progressing in a classic manner. Rank the following sequence of events in the order that they typically occur. A. The child is having difficulty producing facial expressions. B. The child states that it is difficult to move his legs. C. The child reports numbness and tingling in his toes. D. The child states that it is difficult to move his arms.

ANS:B, C, D, A Rationale: Guillain-Barré syndrome paresthesias and muscle weakness. Classically it initially affects the lower extremities and progresses in an ascending manner to upper extremities and then the facial muscles. Progression is usually complete in 2 to 4 weeks, followed by a stable period leading to the recovery phase.

The emergency department nurse is caring for a client with cystic fibrosis who is dyspneic and has a productive cough. Place in order the nursing interventions performed upon arrival to improve breathing. A. Notify respiratory therapy. B. Assess respiratory status. C. Obtain oxygen saturation reading. D. Place in bed in a semi-Fowler's position. E. Place on oxygen at 2 liters. F. Instruct on energy conservation measures.

ANS:B, D, C, E, A, F Rationale: The nurse assesses the respiratory status upon meeting the client. The nurse notes breathing difficulty, including purse lip breathing or use of accessory muscles, pallor, and ability to speak and breathe. Chronic signs of hypoxia such as clubbing of the fingers and a barrel chest can be noted. The client is then arranged in bed in a semi-Fowler's position with the upper half of the body elevated 90 degrees. An oxygen saturation reading is obtained, indicating status without oxygen, and the oxygen as a nursing measure is applied at a base of 2 liters due to respiratory state. Respiratory therapy is notified that a dyspneic client has arrived. Further orders for breathing treatments or chest physical therapy are made. Lastly, instruct on effective coughing techniques to remove mucus.

A 12-year-old boy has broken his arm and is showing signs and symptoms of shock. Which of the following would the nurse do first? A. Begin hyperventilation. B. Establish a suitable IV site. C. Provide oral analgesics as ordered. D. Draw blood for type and crossmatch.

B

A home care nurse provides health education to parents regarding the care of their toddler. Which precaution should the nurse suggest the parents take to protect the toddler from drowning? A. Instruct the toddler not to go near the pool. B. Avoid unattended baths for the toddler. C. Provide only partial baths to the toddler. D. Teach the child that water is dangerous.

B

The nurse is performing CPR on a child who is a victim of a near-drowning experience. How should the nurse open the child's airway to provide breaths? A. Head tilt-chin lift B. Jaw-thrust maneuver C. Two hands encircling method D. Tongue thrust

B

The nurse is caring for a child who is critically ill and requiring fluid resuscitation. Which intravenous fluids are appropriate for use? Select all that apply. A. 5% dextrose in water B. Normal saline C. Lactated Ringer's D. 10% dextrose in water E. 5% lactated Ringer's

B,C

An adolescent who is depressed states, "Nothing ever seems to be right in my life." Which would be the most appropriate response by the nurse? A. "Things will be better when you go off to college." B. "You are feeling sad right now. It's a hard time." C. "Try to look at the bright side of things." D. "Being a teenager is hard work."

B. "You are feeling sad right now. It's a hard time."

The nurse is assessing an infant at a well-check visit. The infant's mother states that she is worried about her child's feet because they are so flat and wide. What the appropriate response by the nurse? A. "You don't need to worry about your child's feet. They will change as your child grows." B. "Your child's feet are normal for an infant. A child's longitudinal arch will not develop until the child is walking for several months." C. "Flat feet are normal in infants. Their longitudinal arch doesn't appear until they are 3 to 5 years old." D. "When your child starts walking, encourage walking on the heels. This will help to develop the arch more so your child doesn't have a problem with flat feet as an adult."

B. "Your child's feet are normal for an infant. A child's longitudinal arch will not develop until the child is walking for several months."

A nurse is assessing, Maria, an 11-year-old female. During the assessment, the nurse notices that the girl's breasts have begun to develop. Based on an understanding of adolescent growth and development, the nurse would anticipate that Maria would most likely begin to menstruate within which time period? A. 1 year B. 2 years C. 3 years D. 4 years

B. 2 years

A nurse working at a pediatric clinic includes an adolescent history for every child aged 11 to 18 years when the child is new to the office. Which issues should the nurse address when the parents are not in the room? Select all that apply. A. Job responsibilities B. Abuse/domestic violence C. Self-image D. Sexual activities E. Adolescent's fit in the family

B. Abuse/domestic violence D. Sexual activities

When performing physical assessments of children with musculoskeletal disorders, the nurse distinguishes normal variations in children's muscles versus adult muscles. Which of the following would be most important for the nurse to keep in mind? A. The infant's muscles account for 45% of total body weight as opposed to 25% of adult body weight. B. During adolescence, muscle growth is influenced by increased production of androgenic hormones. C. The young child has rigid soft tissue, so dislocations and sprains are common occurrences. D. Rapid bone and muscle growth in adolescents increase their agility, thereby decreasing the incidence of injuries.

B. During adolescence, muscle growth is influenced by increased production of androgenic hormones.

A school-age child with a supracondylar fracture of the humerus has been placed in a partial cast with the elbow region wrapped with an elastic bandage. What should the nurse explain to the parents and child regarding the reason for this type of casting approach? A. Encourages healing B. Ensures edema does not press on the nerves C. Keeps the bones of the forearm in alignment D. Provides additional stability until the bone heals

B. Ensures edema does not press on the nerves

The mother of a school-age child is distraught because the child has been diagnosed with obesity. What actions should the nurse suggest to the mother to help the child with this problem? Select all that apply. A. Explain that obesity will lead to an early death. B. Maintain a balanced eating approach in the home. C. Purchase books explaining the latest ways to lose weight. D. Seek out a preteen weight loss group for the child to participate. E. Encourage increased activity such as walking the dog after school.

B. Maintain a balanced eating approach in the home. D. Seek out a preteen weight loss group for the child to participate. E. Encourage increased activity such as walking the dog after school.

The child has been diagnosed with slipped capital femoral epiphysis. Which of the following characteristics about the patient is risk factor associated with the development of this condition? Select all that apply. A. The child is noted to be underweight by the nurse. B. The child is 13 years old. C. The child is African American. D. The child's parents state that the child has recently experienced a "growth spurt." E. The child is mal

B. The child is 13 years old. C. The child is African American. D. The child's parents state that the child has recently experienced a "growth spurt." E. The child is mal

An adolescent comes into the emergency department with a foot wound. Upon assessment, the nurse learns that the patient is a runaway and has been living on the streets. Which is the most appropriate care for the nurse to provide to the client at this time? A. Recommend returning to live with parents. B. Treat the wound and provide wound care supplies. C. Discuss the importance of a diet high in protein and vitamin C. D. Explain how the wound needs to be flushed with water every 4 hours.

B. Treat the wound and provide wound care supplies.

A nurse is conducting a secondary assessment of a child who has experienced multiple trauma. When inspecting the child's back, which of the following would be most appropriate to do? A. Sit the child upright. B. Lift the child off the stretcher. C. Logroll the child to the side. D. Arch the child's back using two hands

C

When educating parents of preschoolers what is most important to include in your presentation? A. Use wrist guards with rollerblades. B. Teach preschoolers to tread water. C. Keep chemicals in a locked cabinet. D. Maintain strict discipline with potty training.

C

A 12-year-old child tells the school nurse, "I do not understand why my parents will not allow me to go to concerts without chaperones like some of my friends' parents. I feel like a baby compared to my friends." How will the nurse respond? A. "Your parents are right. Twelve years old is too young to be attending concerts without a chaperone." B. "I'm sure your parents are just very worried that you could get into trouble attending concerts at a young age." C. "Have you given any thought to why they don't let you go without a chaperone? Let's talk about some of the reasons they feel this way." D. "You are so young that you have plenty of time to go to concerts alone. Your parents just care about you."

C. "Have you given any thought to why they don't let you go without a chaperone? Let's talk about some of the reasons they feel this way."

The parents of a 10-year-old boy report they are having problems with their son. The child's mother reports her son is not a talented athlete but her husband continues to encourage him to play and try to excel. The child's father reports sports will help his son build character. What response by the nurse is most appropriate? A. "Encouraging involvement in sports can build valuable skills for a child." B. "Although your son is not a talented athlete, continue to encourage him to try." C. "Perhaps another pursuit would be better suited for your son." D. "It is important not to let him quit without trying."

C. "Perhaps another pursuit would be better suited for your son."

The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education? A. "This medication will help to increase bone mineral density." B. "My child's risk for fractures will hopefully be decreased as by taking this medication." C. "This medication will cure my child of this disorder." D. "This medication doesn't prevent fractures from happening."

C. "This medication will cure my child of this disorder."

The nurse is assessing a toddler. The mother states that he constantly is tripping over his own feet. What is the best response by the nurse? A. "At this age, your child is still learning how to control all of the muscles in the legs. As your child grows older, this clumsiness will get better." B. "Tripping over feet is a symptom of a severe bone disorder, metatarsus adductus. We will need to refer you to an orthopedic surgeon." C. "We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet." D. "Turning in of feet or toeing in, is common at this age. As your child keeps walking, it will correct on its own."

C. "We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet."

A nurse assesses a client who is complaining of calf pain, has a temperature of 101°F (38.3°C) and reports that his leg is very sore. X-rays do not reveal any abnormalities but the client's white count is 21,000 cells and his erythrocyte sedimentation rate is elevated. What problem do these symptoms suggest? A. Muscular dystrophy B. Legg-Calves-Perth disease C. Osteomyelitis D. Compartment syndrome

C. Osteomyelitis

When interviewed by the school nurse, a 13-year-old adolescent female states she has a boyfriend and that her parents do not talk about sex with her. She says is confused about the facts and wants to know the truth. Which approach would best address this adolescent's concerns? A. Explain that a discussion about sex is best handled by her parents and she should go home and ask them. B. Offer to provide her some brochures to help her better understand how her body works. C. Sit down with her and openly discuss her concerns and questions in an honest, straightforward manner. D. Refer the adolescent to a local health department for sexual counseling and pregnancy prevention.

C. Sit down with her and openly discuss her concerns and questions in an honest, straightforward manner.

The parents of a 10-year-old are experiencing problems with their son having fears when faced with new experiences. Which actions by the parents will be beneficial in helping the child effectively manage new experiences? Select all that apply. A. The parents should show support to the child by agreeing that these new experiences are indeed scary. B. The parents should limit exposing the child to new experiences. C. Teach the child relaxation techniques to use when feeling anxious. D. Encourage the child to use positive self-talk, such as saying, "I can do this" when faced with new experiences. E. The parents should allow the child to avoid situations when they feel anxious.

C. Teach the child relaxation techniques to use when feeling anxious. D. Encourage the child to use positive self-talk, such as saying, "I can do this" when faced with new experiences.

A group of 10-year-old girls have formed a "girls only" club. It is only open to girls who still like to play with dolls. How should this behavior be interpreted? A. poor peer relationships B. encouragement for bullying and sexism C. appropriate social development D. immaturity for this age group

C. appropriate social development

An unconscious client is brought to the emergency department after ingesting too much prescribed medication. What is the highest priority nursing intervention? A. Call family members. B. Establish IV access. C. Administer antacids. D. Establish a patent airway

D

The nurse is caring for the family of a pediatric client during resuscitative efforts of their child following an accident. Which response by the nurse would be best? A. "I know this is overwhelming, but I want you to know he will be OK." B. "How could this accident have happened with you both there?" C. "You must be so scared right now...especially since you were the one driving." D. "I am here to answer your questions and be with you during this difficult time."

D

The nurse is caring for a chronically ill adolescent client. What can the nurse do to maintain stimulation and support the client's sense of identity while hospitalized? A. Plan activities around scheduled rest periods. B. Explain food choices appropriate to the prescribed diet. C. Teach the name and indications for use of all medications. D. Encourage communicating with friends through social media.

D. Encourage communicating with friends through social media.

A 15-year-old male complains of persistent scrotal pain, edema, and nausea since being hit in the groin by a baseball 3 hours ago. Which is the priority action by the nurse? A. Applying an ice pack to alleviate the pain B. Documenting the swelling and discoloration C. Administering pain medications as ordered D. Ensuring that the teen is assessed by the physician immediately

D. Ensuring that the teen is assessed by the physician immediately

The nurse has just completed an assessment on a child who voices an interest in how things are made and who needs support when they are not successful. The child further reports he is involved in clubs and sports outside the home. The nurse is aware that this child is in which of Erikson's states of development? A. Initiative versus guilt B. Autonomy versus shame and doubt C. Trust versus mistrust D. Industry versus inferiority

D. Industry versus inferiority