Peds NCLEX Practice Questions

The nurse caring for a 6-year-old with bronchitis knows which of the following symptoms are commonly associated with this diagnosis?cough that worsens with exercisecaught that sounds like a seal barkingdry, hacking cough that worsens at nightcough spasms followed by a "whooping" sound

dry, hacking cough that worsens at night

The nurse caring for a 15-year-old with chronic bronchitis asks the client about which of the following?seasonal allergiesexercise tolerancetobacco and marijuana usetheir immunization record

tobacco and marijuana use

Match to the appropriate description: Buck's Traction Leg extended, knee flexed Russell's Traction Hips flexed 90 degrees, both legs Bryant's Traction Both legs extended

Buck's traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease. Russell's traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position. Bryant's traction is skin traction with the legs flexed at a 90-degree angle at the hip. Modified Bryant's Traction is used mainly to help reduce congenital hip dislocation. When the child is lying on his back, the traction holds the legs upright and the weight on the traction gently stretches the child's leg. This loosens the ligaments, tendons, and muscles around the child's hip.

Scott is a teenager suffering from osteomyelitis; the nurse would expect which of the following symptoms? Select all that apply. A. Fever B. Irritability C. Pallor D. Tenderness E. Swelling

Correct Answer: A, B, D, & E The symptoms for acute and chronic osteomyelitis are very similar and include fever, irritability, fatigue, nausea, tenderness, redness (not pallor in option C), and warmth in the area of the infection, swelling around the affected bone, and lost range of motion.

Which of the following should be included when developing a teaching plan to prevent urinary tract infection? Select all that apply. A. Maintaining adequate fluid intake B. Avoiding urination before and after intercourse C. Emptying bladder with urination D. Wearing underwear made of synthetic material such as nylon E. Keeping urine alkaline by avoiding acidic beverages F. Avoiding bubble baths and tight clothing

Correct Answer: A, C, & F Even with proper antibiotic treatment, most UTI symptoms can last several days. In women with recurrent UTIs, the quality of life is poor. About 25% of women experience such recurrences. Many cases of uncomplicated UTIs will resolve spontaneously, without treatment, but many patients seek therapy for symptom relief.

Nurse Jeremy is evaluating a client's fluid intake and output record. Fluid intake and urine output should relate in which way? A. Fluid intake should double the urine output. B. Fluid intake should be approximately equal to the urine output. C. Fluid intake should be half the urine output. D. Fluid intake should be inversely proportional to the urine output. Correct Answer: B. Fluid intake should be approximately equal to the urine output.

Correct Answer: A. Normally, fluid intake is approximately equal to the urine output. Any other relationship signals an abnormality. One general principle for all patient scenarios is to replace whatever fluid is being lost as accurately as possible. The strategy of managing a patient's fluid differs depending on each patient's clinical condition. If they can drink adequate fluid volumes by mouth, this should be the first choice. Some patients can tolerate other enteral options, such as feeding tubes. IV plus oral orders are effective for those unable to meet their total daily fluid requirements enterally.

In growing children, growth hormone deficiency results in short stature and very slow growth rates. Short stature may result from which of the following? A. Anterior pituitary gland hypofunction B. Posterior pituitary gland hyperfunction C. Parathyroid gland hyperfunction D. Thyroid gland hyperfunction

Correct Answer: A. Anterior pituitary gland hypofunction Short stature usually results from diminished or deficient growth hormone, which is released from the anterior pituitary gland. Growth hormone production from the anterior pituitary is regulated by the stimulatory and inhibitory control of the hypothalamus. Hypothalamus produces growth hormone-releasing hormone that stimulates the somatotrophs of the anterior pituitary to secrete growth hormone.

Parents bring their infant to the clinic, seeking treatment for vomiting and diarrhea that has lasted for 2 days. On assessment, the nurse in charge detects dry mucous membranes and lethargy. What other findings suggest a fluid volume deficit? A. A sunken fontanel B. Decreased pulse rate C. Increased blood pressure D. Low urine specific gravity

Correct Answer: A. A sunken fontanel In an infant, signs of fluid volume deficit (dehydration) include sunken fontanels, increased pulse rate, and decreased blood pressure. They occur when the body can no longer maintain sufficient intravascular fluid volume. When this happens, the kidneys conserve water to minimize fluid loss, which results in concentrated urine with high specific gravity.

A nurse is handling a child who is on furosemide (Lasix) IV infusion. The nurse instructs the mother to encourage the child to eat which of the following? A. Apricot and baked potato skin. B. Bread and butter. C. Gelatin and Cauliflower. D. Ginger ale and cereal.

Correct Answer: A. Apricot and baked potato skin. One of the side effects of taking furosemide is hypokalemia, so a supplemental food rich in potassium is encouraged. Many fresh fruits and vegetables are rich in potassium: Bananas, oranges, cantaloupe, honeydew, apricots, grapefruit (some dried fruits, such as prunes, raisins, and dates, are also high in potassium).

12-year-old Caroline has recurring nephrotic syndrome. Which of the following areas of potential disturbances should be a prime consideration when planning ongoing nursing care? A. Body image B. Sexual maturation C. Muscle coordination D. Intellectual development

Correct Answer: A. Body image Because of edema associated with nephrotic syndrome, potential self-concept, and body image disturbances related to changes in appearance and social isolation should be considered. Nephrotic syndrome is a condition that causes the kidneys to leak large amounts of protein into the urine. This can lead to a range of problems, including swelling of body tissues and a greater chance of catching infections.

Nurse Cheryl is assessing Fred, a 14-year-old boy who had scoliosis; besides checking neurologic status directly after Harrington rod instrumentation and spinal fusion, she should be regarded with which of the following factors? A. Comfort level B. Dietary tolerance C. Physical therapy needs D. Understanding of the procedure

Correct Answer: A. Comfort level Instrumentation and spinal fusion cause considerable pain. Therefore, the adolescent needs vigorous pain management, which involves assessment, administration of pain medication, and evaluation of the response. In the immediate postoperative period, the child is conscious of sensation and surroundings.

Beta-adrenergic agonists such as albuterol are given to Reggie, a child with asthma. Such drugs are administered primarily to do which of the following? A. Dilate the bronchioles B. Reduce secondary infections C. Decrease postnasal drip D. Reduce airway inflammation

Correct Answer: A. Dilate the bronchioles Beta-adrenergic agonists, such as albuterol, are highly effective bronchodilators and are used to dilate the narrow airways associated with asthma. Albuterol and levalbuterol are examples of short-acting bronchodilators. They have a quick onset of action, within 5 to 15 minutes, and a duration of action of 4 to 6 hours. Their administration is most often by nebulizer or inhaler.

Patient S is a sexually active adolescent. Which of the following instructions would be included in the preventive teaching plan about urinary tract infections? A. Drinking acidic juices B. Avoiding urinating before intercourse C. Wearing nylon underwear D. Wiping back to front

Correct Answer: A. Drinking acidic juices Drinking acidic juices, such as cranberry juice, helps keep the urine at its desired pH and reduces the chance of infection. Pure cranberry juice, cranberry extract, or cranberry supplements may help prevent repeated UTIs in women, but the benefit is small. It helps about as much as taking antibiotics to prevent another UTI.

The nurse is handling a 7-year-old child who has cystitis. Which of the following would Nurse Elena expect when assessing the child? A. Dysuria B. Costovertebral tenderness C. Flank pain D. High fever

Correct Answer: A. Dysuria Dysuria is a symptom of a lower urinary tract infection (UTI) such as cystitis. Common symptoms include frequency, dysuria, urgency, suprapubic pain, cloudy urine, hematuria, nausea, vomiting, and fever. A history is the most important tool for the diagnosis of acute uncomplicated cystitis, and it should be supported by a focused examination and urinalysis.

Nurse Kim is teaching a group of parents about otitis media. When discussing why children are predisposed to this disorder, the nurse should mention the significance of which anatomical feature? A. Eustachian tubes B. Nasopharynx C. Tympanic membrane D. External ear canal

Correct Answer: A. Eustachian tubes In a child, Eustachian tubes are short and lie in a horizontal plane, promoting entry of nasopharyngeal secretions into the tubes and thus setting the stage for otitis media. Due to the constricted anatomical space of the middle ear, the edema caused by the inflammatory process obstructs the narrowest part of the Eustachian tube leading to a decrease in ventilation.

Arvic who is diagnosed with diabetes mellitus type 1 displays symptoms of hypoglycemia. Which of the following actions should the nurse instruct the parents? A. Give the child honey (simple sugar) B. Give the child milk (complex sugar). C. Contact the healthcare provider before doing anything. D. Give the child nothing by mouth.

Correct Answer: A. Give the child honey (simple sugar). Immediate action is important. Therefore, providing little sugar temporarily corrects low serum glucose levels. Simple sugar is preferred because it is converted to glucose more quickly than complex sugar. A child with hyperglycemia needs fluid to prevent dehydration. Patients should be advised to wear a medical alert bracelet and to carry a glucose source like gel, candy, or tablets on their person in case symptoms arise.

A female child, age 2, is brought to the emergency department after ingesting an unknown number of aspirin tablets about 30 minutes earlier. On entering the examination room, the child is crying and clinging to the mother. Which data should the nurse obtain first? A. Heart rate, respiratory rate, and blood pressure B. Recent exposure to communicable diseases C. Number of immunizations received D. Height and weight

Correct Answer: A. Heart rate, respiratory rate, and blood pressure The most important data to obtain on a child's arrival in the emergency department are vital sign measurements. Salicylate toxicity is a medical emergency. Intentional ingestion or accidental overdose can cause severe metabolic derangements, making treatment difficult. In an acute salicylate overdose, the onset of symptoms will occur within 3 to 8 hours. The severity of symptoms is dependent on the amount ingested.

The nurse is evaluating a female child with acute post streptococcal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement? A. Increased urine output B. Increased appetite C. Increased energy level D. Decreased diarrhea

Correct Answer: A. Increased urine output Increased urine output, a sign of improving kidney function, typically is the first sign that a child with acute post-streptococcal glomerulonephritis (APSGN) is improving. PSGN typically presents with features of the nephritic syndrome such as hematuria, oliguria, hypertension, and edema, though it can also present with significant proteinuria.

The nurse is evaluating a female child with acute post-streptococcal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement? A. Increased urine output B. Increased appetite C. Increased energy level D. Decreased diarrhea

Correct Answer: A. Increased urine output Increased urine output, a sign of improving kidney function, typically is the first sign that a child with acute post-streptococcal glomerulonephritis (APSGN) is improving. PSGN typically presents with features of the nephritic syndrome such as hematuria, oliguria, hypertension, and edema, though it can also present with significant proteinuria.

Betty is a 9-year-old girl diagnosed with cystic fibrosis. Which of the following must the nurse keep in mind when developing a care plan for the child? A. Pulmonary secretions are abnormally thick. B. Elevated levels of potassium are found in sweat. C. CF is an autosomal dominant hereditary disorder. D. Obstruction of the endocrine glands occurs.

Correct Answer: A. Pulmonary secretions are abnormally thick. CF is identified by abnormally thick pulmonary secretions. Researchers now know that cystic fibrosis is an autosomal recessive disorder of exocrine gland function most commonly affecting persons of Northern European descent at a rate of 1 in 3500. It is a chronic disease that frequently leads to chronic sinopulmonary infections and pancreatic insufficiency. The most common cause of death is end-stage lung disease.

Alice is rushed to the emergency department during an acute, severe prolonged asthma attack and is unresponsive to usual treatment. The condition is referred to as which of the following? A. Status asthmaticus B. Reactive airway disease C. Intrinsic asthma D. Extrinsic asthma

Correct Answer: A. Status asthmaticus Status asthmaticus is an acute, prolonged, severe asthma attack that is unresponsive to usual treatment. Typically, the child requires hospitalization. One of the most common causes of emergency room visits in the United States is status asthmaticus, an acute, emergent episode of bronchial asthma that is poorly responsive to standard therapeutic measures.

Kim is using bronchodilators for asthma. The side effects of these drugs that you need to monitor this patient for include: A. tachycardia, nausea, vomiting, heart palpitations, inability to sleep, restlessness, and seizures. B. tachycardia, headache, dyspnea, temp. 101 F, and wheezing. C. blurred vision, tachycardia, hypertension, headache, insomnia, and oliguria. D. restlessness, insomnia, blurred vision, hypertension, chest pain, and muscle weakness.

Correct Answer: A. Tachycardia, nausea, vomiting, heart palpitations, inability to sleep, restlessness, and seizures. Bronchodilators can produce the side effects listed in answer choice (A) for a short time after the patient begins using them. The adverse effects of bronchodilators are due to sympathetic system activation. The most frequent and common adverse effects include trembling, nervousness, sudden, noticeable heart palpitations, and muscle cramps.

Mr. Lopez has a 7-year-old son with growth hormone (GH) deficiency. He shares to the nurse the desire of his son to play ball games. However, his wife feels the child will be in danger since he is smaller than the other children. In planning anticipatory guidance for these parents, the nurse should keep in mind which of the following? A. The child should be allowed to play because doing so can foster healthy self-esteem. B. The risk for fractures is increased because a GH deficiency results in fragile bones. C. Activity could aggravate insulin sensitivity, causing hyperglycemia. D. Activity would aggravate the child's joints, already over tasked by obesity.

Correct Answer: A. The child should be allowed to play because doing so can foster healthy self-esteem. Engaging in peer-group activities can aid foster a sense of belonging and a positive self-concept. T-ball is a good sport to choose because physical stature is not an important consideration in the ability to participate, unlike some other sports, such as basketball and football. Physical examination may not reveal any significant findings as the presentation is usually subtle.

Mrs. Johnson tells the nurse that she is very worried because her 2-year old child does not finish his meals. What should the nurse advise the mother? A. Make the child seat with the family in the dining room until he finishes his meal B. Provide quiet environment for the child before meals C. Do not give snacks to the child before meals D. Put the child on a chair and feed him

Correct Answer: Answer C. Do not give snacks to the child before meals. If the child is hungry he/she is more likely to finish his meals. Therefore, the mother should be advised not to give snacks to the child. Set times for meals and snacks and try to stick to them. A child who skips a meal finds it reassuring to know when to expect the next one. Avoid offering snacks or pacifying hungry kids with cups of milk or juice right before a meal — this can diminish their appetite and decrease their willingness to try a new food being offered.

In pediatric gastroesophageal reflux disease (GERD), the immaturity of lower esophageal sphincter function is manifested by frequent transient lower esophageal relaxations, which result in retrograde flow of gastric contents into the esophagus. Which statement about the esophagus is true? Select all that apply. A. It is a cartilaginous tube. B. It has upper and lower sphincters. C. It lies anterior to the trachea. D. It extends from the nasal cavity to the stomach. E. It is a highway for food and drinks to travel along to make it to the stomach. F. All statements describe the esophagus.

Correct Answer: B & E Upper and lower esophageal sphincters, located at the upper and lower ends of the esophagus, respectively, regulate the movement of food into and out of the esophagus. If the mouth is the gateway to the body, then the esophagus is a highway for food and drink to travel along to make it to the stomach.

Mrs. Cooper is concerned about her 4-month-old son's unusual condition; which of the following statements made by her would indicate that the child may have cerebral palsy? A. "He holds his left leg so stiff that I have a hard time putting on his diapers." B. "My baby won't lift his head up and look at me; he's so floppy." C. "My baby's left hip tilts when I pull him to standing position." D. "I'm very worried because my baby has not rolled all the way over yet."

Correct Answer: B. "My baby won't lift his head up and look at me; he's so floppy." Hypotonia or floppy infant is an early manifestation of cerebral palsy. Typically, the infant lifts his head to a 90-degree angle by age 4 months with only a partial head lag by age 2 months. Clinical signs and symptoms of cerebral palsy can include micro- or macrocephaly, excessive irritability or diminished interaction, hyper- or hypotonia, spasticity, dystonia, muscle weakness, the persistence of primitive reflexes, abnormal or absent postural reflexes, incoordination, and hyperreflexia.

The community nurse visits the home of George, a child recently diagnosed with autism. The parents express feelings of shame and guilt about having somehow caused this problem. Which statement by the nurse would best help alleviate parental guilt? A. "Autism is a rare disorder. Your other children shouldn't be affected." B. "The specific cause of autism is unknown. However, it is known to be associated with problems in the structure of and chemicals in the brain." C. "Sometimes a lack of prenatal care can be the cause of autism." D. "Although autism is genetically inherited if you didn't have testing you could not have known this would happen."

Correct Answer: B. "The specific cause of autism is unknown. However, it is known to be associated with problems in the structure of and chemicals in the brain." This statement is factual and does not cast blame on anything the parents did or did not do. The cause is still not known. The onset is variable. It develops in days to weeks, while in other cases, it develops slowly. It is not known whether epilepsy causes it, but children that have an autism spectrum disorder have an increased risk of having epilepsy.

The Andrews family has been taking good care of their youngest, Archie, who was diagnosed with asthma. Which of the following statements indicate a need for further home care teaching? A. "He should increase his fluid intake regularly to thin secretions." B. "We'll make sure that he avoids exercise to prevent attacks." C. "He is to use his bronchodilator inhaler before the steroid inhaler." D. "We need to identify what things trigger his attacks."

Correct Answer: B. "We'll make sure that he avoids exercise to prevent attacks." Additional teaching is needed if the family states that the child with asthma should avoid exercise to prevent attacks. Children with asthma should be encouraged to exercise as tolerated. Encourage the child to be active while also keeping asthma symptoms under control by following the asthma action plan. Ask a doctor which exercises, sports, and activities are safe for the child.

Sudden infant death syndrome (SIDS) is one of the most common causes of death in infants. At what age is the diagnosis of SIDS most likely? A. At 1 to 2 years of age B. At I week to 1 year of age, peaking at 2 to 4 months C. At 6 months to 1 year of age, peaking at 10 months D. At 6 to 8 weeks of age

Correct Answer: B. At I week to 1 year of age, peaking at 2 to 4 months SIDS can occur any time between 1 week and 1 year of age. The incidence peaks at 2 to 4 months of age. Sudden infant death syndrome (SIDS) is the abrupt and unexplained death of an infant less than 1-year old. Despite a thorough investigation (a careful review of clinical history, death scene investigation, and a complete autopsy), a cause for the patient's demise is not identified.

Baby Melody is a neonate who has a very-low-birth-weight. Nurse Josie carefully monitors inspiratory pressure and oxygen (O2) concentration to prevent which of the following? A. Meconium aspiration syndrome B. Bronchopulmonary dysplasia (BPD) C. Respiratory syncytial virus (RSV) D. Respiratory distress syndrome (RDS)

Correct Answer: B. Bronchopulmonary dysplasia (BPD) Close monitoring of inspiratory pressure and O2 concentration is necessary to prevent BPD, which is related to the use of high inspiratory pressures and O2 concentrations especially in very-low-birth-weight and extremely low-birth-weight neonates with lung disorders. Injury from mechanical ventilation and reactive oxygen species to premature lungs in the presence of antenatal factors predisposing the lungs to BPD form the basis of pathogenesis of BPD in preterm neonates.

Niklaus was born with hypospadias; which of the following should be avoided when a child has such condition? A. Surgery B. Circumcision C. Intravenous pyelography (IVP) D. Catheterization

Correct Answer: B. Circumcision Hypospadias refers to a condition in which the urethral opening is located below the glans penis or anywhere along the ventral surface (underside) of the penile shaft. The ventral foreskin is lacking, and the distal portion gives an appearance of a hood. Early recognition is important so that circumcision is avoided; the foreskin is used for surgical repair.

What is most likely the underlying physiology of primary enuresis? A. Psychogenic stress B. Delayed bladder maturation C. Urinary tract infection D. Vesicoureteral reflux

Correct Answer: B. Delayed bladder maturation The most likely cause of primary enuresis is delayed or incomplete maturation of the bladder. Primary enuresis is that which occurs in a child who has not been dry for at least 6 months, whereas secondary enuresis is the one that has an onset after a period of nocturnal dryness of at least 6 months.

Katie is admitted to the intensive care unit of Nurseslabs Medical Center for diabetic ketoacidosis. Which of the following is of primary importance when caring for the child? A. Giving I.V. NPH insulin in high doses B. Evaluating the child for cardiac abnormalities C. Limiting fluids to prevent aggravating cerebral edema D. Monitoring and recording the child's vital signs for hypertension

Correct Answer: B. Evaluating the child for cardiac abnormalities. As the fluid volume deficit is improved, total body potassium deficiency may occur, leaving the child vulnerable to hypokalemia and, afterward, cardiac arrest. The nurse should monitor the cardiac cycle for prolonged QT interval, low T wave, and depressed ST segment, which indicate weakened heart muscle and potential irregular heartbeat.

Will is being assessed by Nurse Lucas for possible intussusception. Which of the following would be least likely to provide valuable information? A. Abdominal palpation B. Family history C. Pain pattern D. Stool inspection

Correct Answer: B. Family history Because intussusception is not believed to have familial tendencies, obtaining a family history would provide the least amount of information. The causes of intussusception are not clearly known. About 90% of cases of intussusception in children arise from an unknown cause. They can include infections, anatomical factors, and altered motility. Option A: A sausage-shaped mass may be palpated in the right upper quadrant. Physical examination may reveal a "sausage-shaped" mass. Children may cry, draw their knees up to their chest, or experience dyspnea with paroxysms of pain. Option C: Acute, episodic abdominal pain is characteristic of intussusception. Early symptoms include periodic abdominal pain, nausea, vomiting (green from bile), pulling legs to the chest, and cramping abdominal pain. Pain is intermittent because the bowel segment transiently stops contracting. Option D: Stool inspection would reveal possible indicators of intussusception. Later signs include rectal bleeding, often with "red currant jelly" stool, and lethargy. "Currant jelly" stools, containing blood and mucus, are an indication of intussusception.

Nurse Oliver is attending to a child with Cushing's syndrome. Which of the following nursing interventions would be most necessary? A. Observing the child for signs and symptoms of metabolic acidosis B. Handling the child carefully to prevent bruising C. Monitoring vital signs for hypertension and tachycardia D. Monitoring the child for signs and symptoms of hypoglycemia

Correct Answer: B. Handling the child carefully to prevent bruising. The nurse should handle the child carefully because Cushing's syndrome causes capillary fragility, resulting in easy bruising and calcium excretion, resulting in osteoporosis. Glucocorticoids also increase catabolism of proteinaceous tissues such as collagen, causing skin atrophy fragility with striae and easy bruising.

Mrs. Lodge's child requires the use of a Pavlik harness. Which of the following would Nurse Betty do to best assess the mother's ability to care for her child? A. Demonstrate to the mother how to remove and reapply the device. B. Have the mother remove and reapply the harness before discharge. C. Have the mother verbalize the purpose of using the device. D. Request a home health care nurse visit after discharge.

Correct Answer: B. Have the mother remove and reapply the harness before discharge. Having the mother remove and reapply the harness before discharge allows the nurse to directly observe the mother's method and comfort level. It also provides time for reinstruction if needed. A successful transition also depends on whether hospitals have adequately educated patients about key elements of care such as diagnosis and follow-up plans.

Baby Ellie is diagnosed with gastroesophageal reflux (GER). Which of the following nursing diagnoses would be inappropriate? A. Risk for aspiration B. Impaired oral mucous membrane C. Deficient fluid volume D. Imbalanced nutrition: Less than body requirements

Correct Answer: B. Impaired oral mucous membrane GER is the backflow of gastric contents into the esophagus resulting from relaxation or incompetence of the lower esophageal (cardiac) sphincter. No alteration in the oral mucous membranes occurs with this disorder.

When educating parents regarding known antecedent infections in acute glomerulonephritis, which of the following should the nurse cover? A. Scabies B. Impetigo C. Herpes simplex D. Varicella

Correct Answer: B. Impetigo Impetigo, a bacterial infection of the skin, may be caused by streptococci and may precede acute glomerulonephritis. Although most streptococcal infections do not cause acute glomerulonephritis, when they do, a latent period of 10 to 14 days occurs between the infection, usually of the skin (impetigo) or upper respiratory tract, and the onset of clinical manifestations.

Martin Sanchez is a nine (9)-year-old child admitted to a psychiatric treatment unit accompanied by Mr. and Mrs. Sanchez. To establish trust and position of neutrality, which action would the nurse take? A. Encourage Mr. and Mrs. Sanchez to leave while Martin is being interviewed. B. Interview Martin with his parents together, observing their interaction. C. Provide diversion for Martin, and interview Mr. and Mrs. Sanchez alone. D. Review the clinical record prior to interviewing Mr. and Mrs. Sanchez.

Correct Answer: B. Interview Martin with his parents together, observing their interaction. It is important for the nurse to be seen as a neutral person who is interested in the family as an adaptive functioning unit. By conducting the admission interview with the parents and child together, the nurse establishes this neutral role from the beginning. Relationships with child and adolescent patients differ from those with adult patients and nurses build relationships in a different way with adults.

Dustin who was diagnosed with Hirschsprung's disease has a fever and watery explosive diarrhea. Which of the following would Nurse Joyce do first? A. Administer an antidiarrheal. B. Notify the physician immediately. C. Monitor the child every 30 minutes. D. Nothing. (These findings are common in Hirschsprung's disease.)

Correct Answer: B. Notify the physician immediately. For the child with Hirschsprung's disease, fever and explosive diarrhea indicate enterocolitis, a life-threatening situation. Therefore, the physician should be notified directly. Further important pointers in the history of patients with suspected HD include clinical features of Hirschsprung's associated enterocolitis (HAEC), multiple episodes of overflow constipation, and soft distended abdomen.

Nurse Kevin is assessing a newborn for developmental dysplasia of the hip (DDH); he would expect to assess which of the following? A. Characteristic limp B. Ortolani's sign C. Symmetrical gluteal folds D. Trendelenburg's signs

Correct Answer: B. Ortolani's sign Ortolani's sign is felt and heard when a newborn's or neonate's hip is flexed and abducted. The hip is held in the way the thumb on the inner aspect and index and ring finger on the greater trochanter. While applying anterior force on the greater trochanter, gently abduct the hip. If the hip is dislocated, one would feel a jerk or clunk. "Hip clicks" are clinically insignificant without instability.

The nurse is aware that the most common assessment finding in a child with ulcerative colitis is: A. Intense abdominal cramps B. Profuse diarrhea C. Anal fissures D. Abdominal distention

Correct Answer: B. Profuse diarrhea The most common assessment finding in a child with ulcerative colitis is profuse diarrhea. The main symptom of ulcerative colitis is bloody diarrhea, with or without mucus. Other symptoms include blood in the toilet, on toilet paper, or in the stool. Characteristically, it involves inflammation restricted to the mucosa and submucosa of the colon. Typically, the disease starts in the rectum and extends proximally in a continuous manner.

The nurse is aware that the most common assessment finding in a child with ulcerative colitis is: A. Intense abdominal cramps B. Profuse diarrhea C. Anal fissures D. Abdominal distention

Correct Answer: B. Profuse diarrhea Ulcerative colitis causes profuse diarrhea. The most common assessment finding in a child with ulcerative colitis is profuse diarrhea. The main symptom of ulcerative colitis is bloody diarrhea, with or without mucus. Other symptoms include blood in the toilet, on toilet paper, or in the stool. Characteristically, it involves inflammation restricted to the mucosa and submucosa of the colon. Typically, the disease starts in the rectum and extends proximally in a continuous manner.

Nurse Nancy is teaching Mr. and Mrs. Diaz about the early signs and symptoms of lead poisoning. Which of the following if stated by the couple would indicate the need for further understanding of the case? A. Anemia B. Seizures C. Irritability D. Anorexia

Correct Answer: B. Seizures Seizures usually are associated with encephalopathy, a late sign of lead poisoning. Typically, lead levels have already exceeded 70 mg/dl. In the appropriate clinical setting, lead encephalopathy should be considered in patients presenting with delirium, altered mental status, or seizures. As lead encephalopathy often presents with altered sensorium, obtaining a history directly from the patient can be challenging.

Which of the following parameters would Nurse Max monitor to evaluate the effectiveness of thickened feedings for an infant with gastroesophageal reflux (GER)? A. Urine B. Vomiting C. Weight D. Stools

Correct Answer: B. Vomiting Thickened feedings are used with GER to stop the vomiting. Therefore, the nurse would monitor the child's vomiting to evaluate the effectiveness of using the thickened feedings. The feeding management strategy has been shown to represent an effective approach in otherwise healthy infants with both GER and GERD. It involves modifying feeding frequency and volume, ensuring the intake of feed per kilogram of weight is appropriate. There is some evidence for the efficacy of feed thickeners on reducing visible regurgitation

Neurovascular assessment for a fracture patient includes: Select all that apply. A. Prosthesis B. Polyps C. Pain D. Pallor E. Pulselessness F. Paresthesia G. Paralysis H. Poikilothermia

Correct Answer: C, D, E, F, G, and H When damage occurs to a muscle or muscle group within the fascial compartment, the resulting swelling and bleeding can create an increased pressure that, if left untreated, can choke off circulation, eventually leading to localized cellular hypoxia and death. The six P's of compartment syndrome for warning signs to watch for are Pain, Pallor, Pulselessness, Paresthesia, Paralysis, and Poikilothermia.

Mandy, age 12, is brought to the clinic for evaluation for a suspected eating disorder. To best assess the effects of role and relationship patterns on the child's nutritional intake, the nurse should ask: A. "What activities do you engage in during the day?" B. "Do you have any allergies to foods?" C. "Do you like yourself physically?" D. "What kinds of food do you like to eat?"

Correct Answer: C. "Do you like yourself physically?" Role and relationship patterns focus on body image and the patient's relationship with others, which are commonly interrelated with food intake. Eating behaviors evolve during the first years of life; children learn what, when, and how much to eat through direct experiences with food and by observing the eating behaviors of others.

Nurse Charlotte suspects that a child, age 4, is being neglected physically. To best assess the child's nutritional status, the nurse should ask the parents which question? A. "Has your child always been so thin?" B. "Is your child a picky eater?" C. "What did your child eat for breakfast?" D. "Do you think your child eats enough?"

Correct Answer: C. "What did your child eat for breakfast?" The nurse should obtain objective information about the child's nutritional intake, such as by asking about what the child ate for a specific meal. In order to assess the adequacy of a child's nutritional intake, dietitians require detailed information about all food and drink consumed. As all children admitted to the hospital are at risk of nutritional deficit, a dietary record should be started on all in-patients, although this may subsequently be discontinued when deemed appropriate. Option A: Children should be weighed on admission to the hospital and subsequently at least once a week. The frequency of weighing requires adjustment according to clinical

Tara is an 11-year-old girl diagnosed with type 1 diabetes mellitus (DM). She asks her attending nurse why she can't take a pill rather than shots like her grandmother does. Which of the following would be the nurse's best reply? A. "If your blood glucose levels are controlled, you can switch to using pills." B. "The pills correct fat and protein metabolism, not carbohydrate metabolism." C. "Your body does not make insulin, so the insulin injections help to replace it." D. "The pills work on the adult pancreas, you can switch when you are 18."

Correct Answer: C. "Your body does not make insulin, so the insulin injections help to replace it." The child has type 1 DM, indicating a lack of functioning pancreatic beta cells and an absolute insulin deficiency. Type 1 diabetes is an autoimmune condition that leads to the destruction of pancreatic beta cells which in turn causes insufficient insulin production, resulting in hyperglycemia. Type 1 diabetes is a chronic disease requiring insulin replacement and intensive effort by the patient.

Among toddlers and children up to age five, femur fractures usually result from a low energy fall. In most cases, the orthopedic surgeon realigns the fracture using fluoroscopy or x-ray imaging as a guide and immobilizes the leg in a type of cast called a spica cast. Approximately how many weeks does it take for a fractured femur to heal in a 3-year-old? A. 1-2 weeks B. 2-4 weeks C. 3-8 weeks D. 10-12 weeks

Correct Answer: C. 3-8 weeks In most cases, three to six weeks of early healing is necessary before the child can begin walking on the injured leg. When the bone is completely healed, usually around one year after the injury occurs, the child returns to the hospital to have the nails removed. Following treatment, the orthopedic surgeon continues to monitor the patient for a period of several years to ensure that there is no limb length discrepancy.

Which of the following is the most common permanent disability in childhood? A. Scoliosis B. Muscular dystrophy C. Cerebral palsy D. Developmental dysplasia of the hip (DDH)

Correct Answer: C. Cerebral palsy Cerebral palsy is the most common permanent disability of childhood. It is a group of disabilities caused by injury or insult to the brain either before or during birth, or in early infancy. A cerebral palsy is a group of permanent disorders affecting the development of movement and causing a limitation of activity. Non-progressive disturbances that manifest in the developing fetal or infant brain lead to cerebral palsy.

Fred is a 12-year-old boy diagnosed with pneumococcal pneumonia. Which of the following would Nurse Nica expect to assess? A. Mild cough B. Slight fever C. Chest pain D. Bulging fontanel

Correct Answer: C. Chest pain Older children with pneumococcal pneumonia may complain of chest pain. Physical findings also vary from patient to patient and mainly depend on the severity of lung consolidation, the type of organism, the extent of the infection, host factors, and the existence or nonexistence of pleural effusion.

Nurse Elizabeth is administering medication via the intraosseous route to a child. Intraosseous drug administration is typically used when a child is: A. Under age 3 B. Over age 3 C. Critically ill and under age 3 D. Critically ill and over age 3

Correct Answer: C. Critically ill and under age 3 In an emergency, intraosseous drug administration is typically used when a child is critically ill and under age 3. IO access provides a means of administering medications, glucose, and fluids, as well as (potentially) a means of obtaining blood samples. Such a situation would include any resuscitation; cardiopulmonary arrest; shock, regardless of etiology; life-threatening status epilepticus; or lack of venous access resulting from burns, edema, or obesity.

Mr. and Mrs. Andrews' child was diagnosed with Duchenne's muscular dystrophy; which of the following usually is the first indication of the condition? A. Inability to suck in the newborn B. Lateness in walking in the toddler C. Difficulty running in the preschooler D. Decreasing coordination in the school-age child

Correct Answer: C. Difficulty running in the preschooler Usually, signs and symptoms of Duchenne's muscular dystrophy are not noticed until ages 3 to 5 years. Typically weakness starts with the pelvic girdle, evidenced as difficulty running in the preschooler. Duchenne's muscular dystrophy usually is not diagnosed in the infant or toddler period.

Immunization of children with Haemophilus influenzae type B (Hib) vaccine decreases the incidence of which of the following conditions? A. Bronchiolitis B. Laryngotracheobronchitis (LTB) C. Epiglottitis D. Pneumonia

Correct Answer: C. Epiglottitis Epiglottitis is a bacterial infection of the epiglottis primarily caused by Hib. Administration of the vaccine has decreased the incidence of epiglottitis. By the early 1990s, the use of the Hib conjugate vaccine caused a 99% drop in infections caused by Hib. Widespread use of the Hib vaccine has also been shown to significantly decrease rates of epiglottitis, which usually occurs in children.

Which of the following respiratory conditions is always considered a medical emergency? A. Asthma B. Cystic fibrosis (CF) C. Epiglottitis D. Laryngotracheobronchitis (LTB)

Correct Answer: C. Epiglottitis Epiglottitis, acute and severe inflammation of the epiglottis, is always considered an acute medical emergency because it can lead to acute, life-threatening airway obstruction. Epiglottitis is a life-threatening condition that causes profound swelling of the upper airways which can lead to asphyxia and respiratory arrest.

Which of the following organisms is the most common cause of urinary tract infection (UTI) in children? A. Klebsiella B. Staphylococcus C. Escherichia coli D. Pseudomonas

Correct Answer: C. Escherichia coli E. coli is the most common organism associated with the development of UTI. Escherichia coli is the most common organism in uncomplicated UTI by a large margin. Pathogenic bacteria ascend from the perineum, causing the UTI. Women have shorter urethras than men and therefore are far more susceptible to UTI. Very few uncomplicated UTIs are caused by blood-borne bacteria.

Buck's traction with a 10 lb. weight is securing a patient's leg while she is waiting for surgery to repair a hip fracture. It is important to check circulation-sensation-movement: A. Every shift B. Every day C. Every 4 hours D. Every 15 minutes

Correct Answer: C. Every 4 hours The patient can lose vascular status without the nurse being aware if left for more than 4 hours, yet checks should not be so frequent that the patient becomes anxious. Vital signs are generally checked q4h, at which time the CSM checks can easily be performed.

The nurse is drawing blood from the diabetic patient for a glycosylated hemoglobin test. She explains to the woman that the test is used to determine: A. the highest glucose level in the past week. B. her insulin level. C. glucose levels over the past several months. D. her usual fasting glucose level.

Correct Answer: C. Glucose levels over the past several months. The glycosylated hemoglobin test measures glucose levels for the previous 3 to 4 months. The hemoglobin A1c (glycated hemoglobin, glycosylated hemoglobin, HbA1c, or A1c) test is used to evaluate a person's level of glucose control. The test shows an average of the blood sugar level over the past 90 days and represents a percentage. The test can also be used to diagnose diabetes.

Mr. and Ms. Byers' child failed to pass meconium within the first 24 hours after birth; this may indicate which of the following? A. Celiac disease B. Intussusception C. Hirschsprung's disease D. Abdominal-wall defect

Correct Answer: C. Hirschsprung's disease Failure to pass meconium within the first 24 hours after birth may be a sign of Hirschsprung's disease, a congenital anomaly resulting in mechanical obstruction due to weak motility in an intestinal segment. History of the colonic obstruction, which might occur during the early neonatal period till adulthood, along with failure to pass meconium during the first 48 hours of the life, which presents in up to 90% of the affected patients, is highly compatible with the impression of HD.

The nurse is providing postoperative care for Dustin who has cleft palate (CP); she should position the child in which of the following? A. In an infant seat B. In the supine position C. In the prone position D. On his side

Correct Answer: C. In the prone position Postoperatively, children with a CP should be placed on their abdomens to facilitate drainage. A child who has had a cleft lip repair should be positioned on their side or back to keep them from rubbing their face in the bed. A child with only a cleft palate repair may sleep on their stomach. It is important to keep the stitches clean and without crusting.

Incomplete development of teeth, bones, and ligaments is the result of: A. Congenital hip dysplasia B. Duchenne's muscular dystrophy C. Osteogenesis imperfecta D. Osteomyelitis

Correct Answer: C. Osteogenesis imperfecta Osteogenesis imperfecta (OI), also known as brittle bone disease, is a group of genetic disorders that principally affect the bones. It results in bones that break quickly. The severity may be mild to severe. Other symptoms may include problems with the teeth, loose joints, a blue tinge to the whites of the eye, short height, hearing loss, and breathing problems.

The nurse is aware that the following laboratory values support a diagnosis of pyelonephritis? A. Myoglobinuria B. Ketonuria C. Pyuria D. Low white blood cell (WBC) count

Correct Answer: C. Pyuria Pyelonephritis is diagnosed by the presence of leukocytosis, hematuria, pyuria, and bacteriuria. A urinary specimen should be obtained for a urinalysis. On urinalysis, one should look for pyuria as it is the most common finding in patients with acute pyelonephritis.

Veronica's parents were told that their daughter needs ribavirin (Virazole). This drug is used to treat which of the following? A. Cystic fibrosis B. Otitis media C. Respiratory syncytial virus (RSV) D. Bronchitis

Correct Answer: C. Respiratory syncytial virus (RSV) Ribavirin is an antiviral medication used for treating RSV infection and for children with RSV who are compromised (such as children with bronchopulmonary dysplasia or heart disease). There is a single antiviral medication approved for use against RSV in the United States, ribavirin. It is a nucleoside analog with application in several RNA viruses, and it shows in vitro activity against RSV and may be administered in aerosolized form.

Baby Jonathan was born with cleft lip (CL); the nurse would be alert that which of the following will most likely be compromised? A. GI function B. Locomotion C. Sucking ability D. Respiratory status

Correct Answer: C. Sucking ability Because of the defect, the child will be unable to form a mouth adequately around the nipple, thereby requiring special devices to allow for feeding and sucking gratification. Patients with cleft lips inherently will have some degree of alveolar cleft with potential for collapse of the maxillary arch and class III malocclusion (the maxillary teeth sit posterior to the mandibular teeth). These hard and soft tissue anatomic changes translate to the various changes in appearance, speech, and swallowing/feeding seen in cleft lip patients.

Dr. Jones prescribes corticosteroids for a child with nephritic syndrome. What is the primary purpose of administering corticosteroids to this child? A. To increase blood pressure B. To reduce inflammation C. To decrease proteinuria D. To prevent infection

Correct Answer: C. To decrease proteinuria The primary purpose of administering corticosteroids to a child with nephritic syndrome is to decrease proteinuria. It helps relieve the inflammation in the kidney and promotes healing. The proteinuria usually ranges in the sub nephrotic range (less than 3.5 g/day), but it can go up to the nephrotic range. A 24-hours urinary protein assay is required if the attendant nephrotic syndrome is suspected.

Nurse Henry admits a child with suspected type 1 DM; Which of the following questions should the nurse ask the parents? A. "Does the child complain of headache?" B. "How much exercise does the child get?" C. "Has the child's number and type of bowel movements changed?" D. "Has the child experienced nocturia or bedwetting?" E. "How much candy and sweets does your child take daily?"

Correct Answer: D. "Has the child experienced nocturia or bedwetting?" Bedwetting in children who have previously stayed dry at night is often an early sign of diabetes. Type 1 diabetes is a disease when the pancreas that produces insulin and helps get sugars (glucose) into the cells does not produce insulin. As most children with type 1 diabetes are otherwise healthy, history and physical health is usually limited to the assessment of pertinent diabetes care.

Veronica is a 14-year-old girl who wears a brace for structural scoliosis; which of the following statements indicate effective use of the brace? A. "I sure am glad that I only have to wear this awful thing at night." B. "I'm really glad that I can take this thing off whenever I get tired." C. "I wonder if I can take the brace off when I go to the homecoming dance." D. "I'll look forward to taking this thing off to take my bath every day."

Correct Answer: D. "I'll look forward to taking this thing off to take my bath every day." The brace should be dropped for simply 1 hour of every 24-hour period for hygiene and skincare. It is recommended to wear the Milwaukee brace 23 hours a day. The one hour that the child spends out of the brace should be spent doing exercises. Studies have proven that this protocol is effective for the conservative treatment of adolescent idiopathic scoliosis.

The following are considered functions of the Urinary System, EXCEPT: A. Vitamin D synthesis B. Regulation of red blood cell synthesis C. Excretion D. Absorption of digested molecules E. Regulation of blood volume and pressure

Correct Answer: D. Absorption of digested molecules This is a function of the digestive system. The small molecules that result from digestion are absorbed through the walls of the intestine for use in the body. Digestion is the process of mechanically and enzymatically breaking down food into substances for absorption into the bloodstream

The nurse is giving instructions to a mother with a child receiving a liquid oral iron supplement. The nurse tells the mother to: A. Take it with meals. B. Mix it with food. C. Mix it with milk. D. Administer it using a straw.

Correct Answer: D. Administer it using a straw. An oral liquid iron supplement should be given with a straw because the medicine will stain the teeth. Mix each dose in water, fruit juice, or tomato juice. You may use a drinking tube or straw to help keep the iron supplement from getting on the teeth.

Which of the following instructions should Nurse Cheryl include in her teaching plan for the parents of Reggie with otitis media? A. Placing the child in the supine position to bottle-feed B. Giving prescribed amoxicillin (Amoxil) on an empty stomach C. Cleaning the inside of the ear canals with cotton swabs D. Avoiding contact with people who have upper respiratory tract infections

Correct Answer: D. Avoiding contact with people who have upper respiratory tract infections. Otitis media is commonly precipitated by an upper respiratory tract infection. Therefore, children prone to otitis should avoid people known to have an upper respiratory tract infection. Acute otitis media is the second most common pediatric diagnosis in the emergency department following upper respiratory infections. Although otitis media can occur at any age, it is most commonly seen between the ages of 6 to 24 months.

When a child injures the epiphyseal plate from a fracture, the damage may result in which of the following? A. Rheumatoid arthritis B. Permanent nerve damage C. Osteomyelitis D. Bone growth disruption

Correct Answer: D. Bone growth disruption The epiphyseal plate is a significant region of bone growth. Hence, any disruption may result in limb shortening. Sometimes, changes in the growth plate from the fracture can cause problems later. For example, the bone could end up a little crooked or a bit longer or shorter than expected.

Nurse Dorothy is caring for a child with Cushing's syndrome. Which of the following should she include in the plan of care? A. Increase fluids to prevent dehydration B. Encourage a diet high in carbohydrates C. Monitor weight each day and report for weight loss D. Encourage a diet high in potassium

Correct Answer: D. Encourage a diet high in potassium. The elevation of cortisol level in Cushing's disease causes a decrease in the level of potassium, a condition called hypokalemia. At high levels, cortisol stimulates the tubules that control the absorption of electrolytes in the kidneys to excrete more potassium into the urine.

Which of the following is the best method for performing a physical examination on a toddler A. From head to toe B. Distally to proximally C. From abdomen to toes, the to head D. From least to most intrusive

Correct Answer: D. From least to most intrusive When examining a toddler or any small child, the best way to perform the exam is from least to most intrusive. Stay at the child's level as much as possible. Do not tower. Examine painful areas last-get general impression of overall attitude. Be honest. If something is going to hurt, tell them that in a calm fashion.

Stefan was diagnosed with secondary vesicoureteral reflux; such condition usually results from which of the following? A. Acidic urine B. Congenital defects C. Hydronephrosis D. Infection

Correct Answer: D. Infection Infection is the most common cause of secondary vesicoureteral reflux. The possibility that UTI may cause reflux has also been investigated. Indeed, a subset of patients has been identified in whom reflux was detectable only during an episode of cystitis.

Justine is admitted to the pediatric unit due to the occurrence of diabetic ketoacidosis signaling a new diagnosis of diabetes. The diabetes team explores the cause of the episode and takes steps to prevent a recurrence. Diabetic ketoacidosis (DKA) results from an excessive accumulation of which of the following? A. Sodium bicarbonate from renal compensation B. Potassium from cell death C. Glucose from carbohydrate metabolism D. Ketone bodies from fat metabolism

Correct Answer: D. Ketone bodies from fat metabolism. Inability to use glucose causes lipolysis, fatty acid oxidation, and release of ketones, resulting in metabolic acidosis and coma. Ketones accumulate and cause metabolic acidosis. The body tries to compensate by hyperventilation to eliminate carbon dioxide. When the blood glucose is low or cannot be used due to a lack of insulin, ketones are the major source of energy for the brain. The brain does not have any fuel stores and has no other non-glucose-derived energy sources.

In children diagnosed with sickle cell disease (SCD), tissue damage results from which of the following? A. Air hunger and respiratory alkalosis due to deoxygenated red blood cells. B. Hypersensitivity of the central nervous system (CNS) due to elevated serum bilirubin levels C. A general inflammatory response due to an autoimmune reaction from hypoxia D. Local tissue damage with ischemia and necrosis due to obstructed circulation

Correct Answer: D. Local tissue damage with ischemia and necrosis due to obstructed circulation Characteristic sickle cells tend to clump, which results in weak and inadequate blood flow to the tissue, local tissue damage, and eventual ischemia and necrosis. There is increased adhesion of erythrocytes followed by the formation of heterocellular aggregates, which physically cause small vessel occlusion and resultant local hypoxia.

A child was brought to the emergency department with complaints of nausea, vomiting, fruity-scented breath. The resident on duty diagnosed the child with diabetes ketoacidosis. Which of the following should the nurse expect to administer? A. Potassium chloride IV infusion. B. Dextrose 5% IV infusion. C. Ringer's Lactate. D. Normal saline IV infusion.

Correct Answer: D. Normal saline IV infusion. The initial priority in the treatment of diabetic ketoacidosis is the restoration of extracellular fluid volume through the intravenous administration of a normal saline(0.9 percent sodium chloride) solution. Treatment for DKA begins with ABCs and fluid resuscitation. Insulin therapy, usually by continuous infusion, can begin once the patient is stabilized.

A spica cast was just put on an infant to immobilize her hips and thighs. Which of the following is the priority nursing action immediately after application? A. Keep the cast dry and clean. B. Cover the perineal area. C. Elevate the cast. D. Perform neurovascular checks.

Correct Answer: D. Perform neurovascular checks. A neurovascular assessment is always a priority in the assessment of a freshly applied cast to ensure adequate circulation and neurologic function and prevent complications or injury. Neurovascular observations should be conducted hourly for the first 24 hours then 2-4 hourly for the next 48 hours depending on the condition. Document findings on appropriate limb observation flowsheet.

Stephen was diagnosed with minimal-change nephrotic syndrome; which of the following signs and symptoms are characteristics of the said disorder? A. Hypertension, edema, hematuria B. Hypertension, edema, proteinuria C. Gross hematuria, fever, proteinuria D. Poor appetite, edema, proteinuria

Correct Answer: D. Poor appetite, edema, proteinuria Clinical manifestations of nephrotic syndrome include loss of appetite due to edema of the intestinal mucosa, proteinuria, and edema. The classic NS presentation is edema, in the early phase is located in the face in the morning on waking with puffiness of the eyelids and the impression of the folds of sheets on the skin and ankles at the end of the day.

Nurse Nancy is assessing a child with pyloric stenosis; she is likely to note which of the following? A. "Currant jelly" stools B. Regurgitation C. Steatorrhea D. Projectile vomiting

Correct Answer: D. Projectile vomiting Projectile vomiting is a key sign of pyloric stenosis. Pyloric stenosis, also known as infantile hypertrophic pyloric stenosis (IHPS), is an uncommon condition in infants characterized by abnormal thickening of the pylorus muscles in the stomach leading to gastric outlet obstruction. Clinically infants are well at birth. Then, at 3 to 6 weeks of age, the infants present with "projectile" vomiting, potentially leading to dehydration and weight loss.

You have learned that in babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. Which of the following is the most common form of DDH? A. Acetabular dysplasia B. Dislocation C. Preluxation D. Subluxation

Correct Answer: D. Subluxation DDH is a group of congenital abnormalities of the hip joints, which includes subluxation, dislocation, and preluxation. Of the types of congenital hip abnormalities, subluxation is the most common. In mild cases of DDH, the head of the femur is simply loose in the socket. During a physical examination, the bone can be moved within the socket, but it will not dislocate.

A child newly diagnosed with diabetes mellitus has been stabilized with insulin injections daily. A nurse prepares a discharge teaching plan regarding the insulin. The teaching plan should reinforce which of the following concepts? A. Always keep insulin vials refrigerated B. Increase the amount of insulin before exercise C. Ketones in the urine signify a need for less insulin D. Systematically rotate injection sites

Correct Answer: D. Systematically rotate injection sites. It is necessary to rotate injection sites because injecting in the same place much of the time can cause hard lumps or extra fat deposits to develop. Insulin delivery is by multiple daily injections (MDI) or an insulin pump to simulate endogenous insulin physiology. Multiple daily injections include basal insulin once or twice daily, and bolus insulin typically is given at meals three or more times daily and is based on carbohydrate content and current blood glucose.

A physician prescribes an IV solution of 500 ml 0.45% Saline with an incorporation of 20mEq potassium chloride for a child with dehydration. The nurse should check which of the following before administering this IV prescription? A. Blood pressure B. Height C. Weight D. Urine output

Correct Answer: D. Urine output When it comes to hypotonic dehydration, electrolyte loss exceeds water loss. The priority assessment for the nurse is to check the urinary output before the administration. Potassium chloride is contraindicated for patients with oliguria or anuria. The body becomes dehydrated when it loses more fluids than it consumes. When the body doesn't have enough fluids, it can't process potassium properly, and potassium builds up in the blood, which can lead to hyperkalemia.

A nurse prepares to administer an intramuscular injection to a 6-month-old infant. The nurse selects which site to administer the medication? A. Rectus femoris B. Dorsal gluteal C. Ventrogluteal D. Vastus lateralis

Correct Answer: D. Vastus lateralis Intramuscular injection sites are selected based on the child's age and muscle development. The vastus lateralis is the only safe muscle group to use for intramuscular injection in a 6 month-old infant. Muscle has fewer pain-sensing nerves than subcutaneous tissue and is less sensitive to irritating and viscous medications, so pain is lessened.

When administering an I.M. injection to an infant, the nurse in charge should use which site? A. Deltoid B. Dorsogluteal C. Ventrogluteal D. Vastus lateralis

Correct Answer: D. Vastus lateralis The recommended injection site for an infant is the vastus lateralis or rectus femoris muscles. Skeletal muscle can accommodate larger volumes of medication than subcutaneous tissue, and absorption is faster because muscle tissue is highly vascular. Muscle has fewer pain-sensing nerves than subcutaneous tissue and is less sensitive to irritating and viscous medications, so pain is lessened.

Steve is diagnosed with celiac disease and experiences celiac crisis secondary to upper respiratory tract infection; which of the following would the nurse expect to assess? A. Lethargy B. Weight gain C. Respiratory distress D. Watery diarrhea

Correct Answer: D. Watery diarrhea Episodes of celiac crises are precipitated by infections, ingestion of gluten, prolonged fasting, or exposure to anticholinergics. Celiac crisis is typically characterized by severe watery diarrhea. Celiac crisis is a life-threatening syndrome in which patients with celiac disease have profuse diarrhea and severe metabolic disturbances.

A 1-year-and 2-month-old child weighing 26 lb (11.8 kg) is admitted for traction to treat congenital hip dislocation. When preparing the patient's room, the nurse anticipates using which traction system? A. Bryant's traction B. Buck's extension traction C. Overhead suspension traction D. 90-90 traction

Incorrect Correct Answer: A. Bryant's traction Bryant's traction is used to treat femoral fractures of congenital hip dislocation in children under age 2 who weigh less than 30 lb (13.6 kg). In Bryant's traction, the child's body and the weights are used as tension to keep the end of the femur (the large bone that goes from the knee to the hip) in the hip socket.

A nurse is caring for a 5-year-old child who has been diagnosed with bronchiectasis. Based on the nurse's understanding of this condition, the nurse knows to expect signs and symptoms of which of the following?Chronic cough that produces green sputumWheezing and a barrel chestSharp chest pain with each breathAbsence of respiratory effort

chronic cough that produces green sputum