Peds Quiz

33. The parents of a child born with ambiguous genitalia tell the nurse that family and friends are asking what caused the baby to be this way. Tests are being done to assist in gender assignment. What should the nurse's intervention include? a. Explain the disorder so they can explain it to others. b. Help parents understand that this is a minor problem. c. Suggest that parents avoid family and friends until the gender is assigned. d. Encourage parents not to worry while the tests are being done.

A

35. Surgery is performed on a child to correct cryptorchidism. The parents understand the reason for the surgery if they tell the nurse this was done to do what? a. "Prevent damage to the undescended testicle." b. "Prevent urinary tract infections." c. "Prevent prostate cancer." d. "Prevent an inguinal hernia."

A

4. What name is given to inflammation of the bladder? a. Cystitis b. Urethritis c. Urosepsis d. Bacteriuria

A

44. The nurse is preparing to admit a child to the hospital with a diagnosis of minimal change nephrotic syndrome. The nurse understands that the peak age at onset for this disease is what? a. 2 to 3 years b. 4 to 5 years c. 6 to 7 years d. 8 to 9 years

A

What activity should the school nurse recommend for a child with hemophilia A? (Select all that apply.) a. Golf b. Soccer c. Rugby d. Jogging e. Swimming

A, D, E Children and adolescents with severe hemophilia can participate in noncontact sports such as swimming, golf, walking, jogging, fishing, and bowling. Contact sports such as football, boxing, hockey, soccer, and rugby are strongly discouraged because the risk of injury outweighs the physical and psychosocial benefits of participating in these sports.

6. The nurse is preparing to admit a 6-year-old child with irritable bowel syndrome (IBS). What clinical manifestations should the nurse expect to observe? (Select all that apply.) A. Flatulence B. Constipation C. No urge to defecate D. Absence of abdominal pain E. Feeling of incomplete evacuation of the bowel

A. Flatulence B. Constipation E. Feelings of incomplete evacuation of the bowel

19. What information should the nurse include when teaching an adolescent with Crohn disease (CD)? A. How to cope with stress and adjust to chronic illness B. Preparation for surgical treatment and cure of CD C. Nutritional guidance and prevention of constipation D. Prevention of spread of illness to others and principles of high-fiber diet

A. How to cope with stress and adjust to chronic illness.

38. The nurse is caring for an adolescent with anorexia nervosa. What pituitary dysfunction should the nurse assess for in the adolescent? A. Hypopituitarism B. Pituitary hyperfunction C. Hyperplasia of the pituitary cells D. Overproduction of the anterior pituitary hormones

A. Hypopituitarism

40. The nurse is assisting with a growth hormone stimulation test for a child with short stature. What should the nurse monitor closely on this child during the test? A. Hypotension B. Tachycardia C. Hypoglycemia D. Nausea and vomiting

A. Hypotension

3. The school nurse is teaching a group of adolescents about avoiding contaminated water during a mission trip. What should the nurse include in the teaching? (Select all that apply.) A. Ice B. Meats C. Raw vegetables D. Unpeeled fruits E. Carbonated beverages

A. Ice B. Meats C. Raw vegetables D. Unpeeled fruits

9. The nurse is planning to admit a 12-year-old with Graves disease (GD). What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.) A. Insomnia B. Irritability C. Tonic rigidity D. Hyperactivity E. Muscle cramps

A. Insomnia B. Irritability D. Hyperactivity

6. The nurse is preparing to assist with a growth hormone provocative test for a child with short stature. The nurse recognizes that which pharmacologics should be used to provoke the release of growth hormone (GH)? (Select all that apply.) A. Larodopa (levodopa) B. Clonidine (Catapres) C. Propranolol (Inderal) D. Cortisone (hydrocortisone) E. Biosynthetic growth hormone

A. Larodopa (levodopa) B. Clonidine (Catapres) C. Propranolol (Inderal)

37. The thyroid-stimulating hormone (TSH) increases secretion in response to which hormone? A. Low levels of circulating thyroid hormone B. High levels of circulating thyroid hormone C. Low levels of circulating adrenocorticotropic hormone D. High levels of circulating adrenocorticotropic hormone

A. Low levels of circulating thyroid hormone

32. A school-age child with diabetes gets 30 units of NPH insulin at 0800. According to when this insulin peaks, the child should be at greatest risk for a hypoglycemic episode between when? A. Lunch and dinner B. Breakfast and lunch C. 0830 to his midmorning snack D. Bedtime and breakfast the next morning

A. Lunch and dinner

10. The nurse is planning to admit an 8-year-old child with hypoparathyroidism. What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.) A. Muscle cramps B. Positive Chvostek sign C. Emotional lability D. Laryngeal spasms E. Short attention span

A. Muscle Cramps B. Positive Chvostek Sign D. Laryngeal Spasms

11. After surgery yesterday for gastroesophageal reflux, the nurse finds that the infant has somehow removed the nasogastric (NG) tube. What nursing action is most appropriate to perform at this time? A. Notify the practitioner. B. Insert the NG tube so feedings can be given. C. Replace the NG tube to maintain gastric decompression. D. Leave the NG tube out because it has probably been in long enough.

A. Notify the practitioner

45. A child is being admitted to the hospital with acute gastroenteritis. The health care provider prescribes an antiemetic. What antiemetic does the nurse anticipate being prescribed? A. Ondansetron (Zofran) B. Promethazine (Phenergan) C. Metoclopramide (Reglan) D. Dimenhydrinate (Dramamine)

A. Ondansetron (Zofran)

12. The nurse is preparing to admit a 7-year-old child with type 2 diabetes. What clinical features of type 2 diabetes should the nurse recognize? (Select all that apply.) A. Oral agents are effective. B. Insulin is usually needed. C. Ketoacidosis is infrequent. D. Diet only is often effective. E. Chronic complications frequently occur.

A. Oral agents are effective C. Ketoacidosis is infrequent D. Diet only is often effective

14. The nurse is preparing to admit a 7-year-old child with Crohn disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) A. Pain is common. B. Weight loss is severe. C. Rectal bleeding is common. D. Diarrhea is moderate to severe. E. Anal and perianal lesions are rare.

A. Pain is common B. Weight loss is severe D. Diarrhea is moderate to severe

13. The nurse is planning to admit a 14-year-old adolescent with hyperparathyroidism. What clinical manifestations should the nurse expect to observe in this patient? (Select all that apply.) A. Polyuria B. Diarrhea C. Hypotension D. Vague bone pain E. Paresthesia in extremities

A. Polyuria D. Vague Bone Pain E. Paresthesia in extremities

32. The nurse is caring for an infant who had surgical repair of a tracheoesophageal fistula 24 hours ago. Gastrostomy feedings have not been started. What do nursing actions related to the gastrostomy tube include? A. Keep the tube clamped. B. Suction the tube as needed. C. Leave the tube open to gravity drainage. D. Lower the tube to a point below the level of the stomach.

C. Leave the tube open to gravity drainage

4. The nurse is teaching parents about high-fiber foods that can prevent constipation. What foods should the nurse include in the teaching? (Select all that apply.) A. Oranges B. Bananas C. Lima beans D. Baked beans E. Raisin bran cereal

C. Lima beans D. Baked beans E. Raisin bran cereal

37. What should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia? A. The prognosis for full recovery is excellent. B. Death usually occurs by 6 months of age. C. Liver transplantation may be needed eventually. D. Children with surgical correction live normal lives.

C. Liver transplantation may be needed eventually

30. To help an adolescent deal with diabetes, the nurse needs to consider which characteristic of adolescence? A. Desire to be unique B. Preoccupation with the future C. Need to be perfect and similar to peers D. Awareness of peers that diabetes is a severe disease

C. Need to be perfect and similar to peers

5. Peripheral precocious puberty (PPP) differs from central precocious puberty (CPP) in which manner? A. PPP results from a central nervous system (CNS) insult. B. PPP occurs more frequently in girls. C. PPP may be viewed as a variation in sexual development. D. PPP results from hormonal stimulation of the hypothalamic gonadotropin-releasing hormone (Gn-RH).

C. PPP may be viewed as a variation in sexual development.

19. What statement is characteristic of type 1 diabetes mellitus? A. Onset is usually gradual. B. Ketoacidosis is infrequent. C. Peak age incidence is 10 to 15 years. D. Oral agents are available for treatment.

C. Peak age incidence is 10 to 15 years.

22. A school-age child with celiac disease asks for guidance about snacks that will not exacerbate the disease. What snack should the nurse suggest? A. Pizza B. Pretzels C. Popcorn D. Oatmeal cookies

C. Popcorn

9. A child has a nasogastric (NG) tube after surgery for Hirschsprung disease. What is the purpose of the NG tube? A. Prevent spread of infection. B. Monitor electrolyte balance. C. Prevent abdominal distention. D. Maintain accurate record of output.

C. Prevent abdominal distention

31. The nurse is caring for a neonate with a suspected tracheoesophageal fistula. What should nursing care include? A. Feed glucose water only. B. Elevate the patient's head for feedings. C. Raise the patient's head and give nothing by mouth. D. Avoid suctioning unless the infant is cyanotic.

C. Raise the patient's head and give nothing by mouth

9. What nursing care should be included for a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)? A. Maintain the child NPO (nothing by mouth). B. Turn the child frequently. C. Restrict fluids. D. Encourage fluids.

C. Restrict fluids.

2. What urine test result is considered abnormal? a. pH 4.0 b. WBC 1 or 2 cells/ml c. Protein level absent d. Specific gravity 1.020

A

3. What diagnostic test allows visualization of renal parenchyma and renal pelvis without exposure to external-beam radiation or radioactive isotopes? a. Renal ultrasonography b. Computed tomography c. Intravenous pyelography d. Voiding cystourethrography

A

A 5-year-old child is admitted to the hospital in a sickle cell crisis. The child has been alert and oriented but in severe pain. The nurse notes that the child is complaining of a headache and is having unilateral hemiplegia. What action should the nurse implement? a. Notify the health care provider. b. Place the child on bed rest. c. Administer a dose of hydrocodone (Vicodin). d. Start O2 per the hospital's protocol.

A Any number of neurologic symptoms can indicate a minor cerebral insult, such as headache, aphasia, weakness, convulsions, visual disturbances, or unilateral hemiplegia. Loss of vision is usually the result of progressive retinopathy and retinal detachment. The nurse should notify the health care provider.

In which condition are all the formed elements of the blood simultaneously depressed? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron deficiency anemia

A Aplastic anemia refers to a bone marrow failure condition in which the formed elements of the blood are simultaneously depressed. Sickle cell anemia is a hemoglobinopathy in which normal adult hemoglobin is partly or completely replaced by abnormal sickled hemoglobin. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin chains. Iron-deficiency anemia results in a decreased amount of circulating red cells.

The nurse is planning care for an adolescent with acquired immunodeficiency syndrome. What is the priority nursing goal? a. Prevent infection. b. Prevent secondary cancers. c. Identify source of infection. d. Restore immunologic defenses.

A As a result of the immunocompromise that is associated with human immunodeficiency virus (HIV) infection, the prevention of infection is paramount. Although certain precautions are justified in limiting exposure to infection, these must be balanced with the concern for the child's normal developmental needs. Preventing secondary cancers is not currently possible. Case finding is not a priority nursing goal in planning care for an individual. Current drug therapy is affecting the disease progression; although not a cure, these drugs can suppress viral replication, preventing further deterioration but not actually restoring immunologic defenses.

What explanation provides the rationale for why iron-deficiency anemia is common during infancy? a. Cow's milk is a poor source of iron. b. Iron cannot be stored during fetal development. c. Fetal iron stores are depleted by 1 month of age. d. Dietary iron cannot be started until 12 months of age.

A Children between the ages of 12 and 36 months are at risk for anemia because cow's milk is a major component of their diet, and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by ages 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-fortified formula, and cereals during the first 12 months of life.

What pain medication is contraindicated in children with sickle cell disease (SCD)? a. Meperidine (Demerol) b. Hydrocodone (Vicodin) c. Morphine sulfate d. Ketorolac (Toradol)

A Meperidine (pethidine [Demerol]) is not recommended. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. Patients with SCD are particularly at risk for normeperidine-induced seizures.

What rationale explains why prolonged use of oxygen should be discouraged in a child with anemia? a. Prolonged use of oxygen can decrease erythropoiesis. b. Prolonged use of oxygen can interfere with iron production. c. Prolonged use of oxygen interferes with a child's appetite. d. Prolonged use of oxygen can affect the synthesis of hemoglobin.

A Oxygen administration is of limited value, because each gram of hemoglobin is able to carry a limited amount of the gas. In addition, prolonged use of supplemental oxygen can decrease erythropoiesis. Prolonged use of oxygen does not interfere with iron production, a child's appetite, or affect the synthesis of hemoglobin.

A child with hemophilia A is scheduled for surgery. What precautions should the nurse institute with this child? a. Handle the child gently when transferring to a cart. b. Caution the child not to brush his teeth before surgery. c. Use tape sparingly on postoperative dressings. d. Do not administer analgesics before surgery.

A The goal of prevention of bleeding episodes is directed toward decreasing the risk of injury. The child should be handled carefully when transferring to a cart. Brushing teeth, use of tape, and giving analgesics will not risk a bleeding episode.

A school-age child is admitted in vasoocclusive sickle cell crisis (pain episode). The child's care should include which therapeutic interventions? a. Hydration and pain management b. Oxygenation and factor VIII replacement c. Electrolyte replacement and administration of heparin d. Correction of alkalosis and reduction of energy expenditure

A The management of crises includes adequate hydration, pain management, minimization of energy expenditures, electrolyte replacement, and blood component therapy if indicated. Factor VIII is not indicated in the treatment of vasoocclusive sickle cell crisis. Oxygen may prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels. Also, prolonged oxygen can reduce bone marrow activity. Heparin is not indicated in the treatment of vasoocclusive sickle cell crisis. Electrolyte replacement should accompany hydration. The acidosis will be corrected as the crisis is treated. Energy expenditure should be minimized to improve oxygen utilization. Acidosis, not alkalosis, results from hypoxia, which also promotes sickling.

A toddler is diagnosed with chronic benign neutropenia. The parents are being taught about caring for their child. What information is important to include? a. Avoid large indoor crowds and people who are ill. b. Parenteral antibiotics are necessary to control disease. c. Frequent rest periods are needed during the daytime. d. List the side effects of corticosteroids used to decrease inflammation.

A The parents are taught to minimize risk of infection by avoiding crowded areas and individuals who are ill. Parents are also cautioned about when to notify their practitioner and administration of granulocyte colony-stimulating factor, if indicated. Antibiotics are not needed unless the child has an infection. The toddler does not need any additional rest as a result of the neutropenia. Corticosteroids are not indicated.

The school nurse is informed that a child with human immunodeficiency virus (HIV) infection will be attending school soon. What is an important nursing intervention to include in the plan of care? a. Carefully follow universal precautions. b. Inform the parents of the other children. c. Determine how the child became infected. d. Reassure other children that they will not become infected.

A Universal precautions are necessary to prevent further transmission of the disease. Informing the parents of the other children would violate the child's right to privacy. It is not within the role of the school nurse to determine how the child became infected. Reassuring other children that they will not become infected violates the child's privacy. General health classes can discuss prevention of HIV transmission.

4. The nurse is caring for a child with acute renal failure. What laboratory findings should the nurse expect to find? (Select all that apply.) a. Hyponatremia b. Hyperkalemia c. Metabolic alkalosis d. Elevated blood urea nitrogen level e. Decreased plasma creatinine level

A B D

6. What signs and symptoms are indicative of a urinary tract disorder in the infancy period (1-24 months)? (Select all that apply.) a. Pallor b. Poor feeding c. Hypothermia d. Excessive thirst e. Frequent urination

A B D E

2. The nurse is caring for a child with a urinary tract infection who is on intravenous gentamicin (Garamycin). What interventions should the nurse plan for this child with regard to this medication? (Select all that apply.) a. Encourage fluids. b. Monitor urinary output. c. Monitor sodium serum levels. d. Monitor potassium serum levels. e. Monitor serum peak and trough levels.

A B E

3. The nurse is caring for a child with a urinary tract infection who is on trimethoprim-sulfamethoxazole (Bactrim). What side effects of this medication should the nurse teach to the parents and the child? (Select all that apply.) a. Rash b. Urticaria c. Pneumonitis d. Renal toxicity e. Photosensitivity

A B E

13. What are signs and symptoms of a possible kidney transplant rejection in a child? (Select all that apply.) a. Fever b. Hypotension c. Diminished urinary output d. Decreased serum creatinine e. Swelling and tenderness of graft area

A C E

7. What signs and symptoms are indicative of a urinary tract disorder in the childhood period (2 to 14 years)? (Select all that apply.) a. Fatigue b. Dehydration c. Hypotension d. Growth failure e. Blood in the urine

A D E

The nurse is preparing to admit a 4-year-old child with chronic benign neutropenia. What clinical features of chronic benign neutropenia should the nurse recognize? (Select all that apply.) a. Gingivitis is present. b. Anemia is not present. c. Monocytosis is present. d. It has an autosomal recessive pattern. e. Treatment is by bone marrow transplantation.

A, B, C The clinical features of chronic benign neutropenia include gingivitis, no anemia, and monocytosis. It is not inherited, and because it is benign, it does not require treatment except antibiotics as indicated.

The nurse is caring for a 12-year-old child with b-thalassemia. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Anorexia b. Unexplained fever c. Enlarged spleen or liver d. Bronzed, freckled complexion e. Precocious sexual development

A, B, C, D The clinical manifestations of b-thalassemia include anorexia; unexplained fever; an enlarged spleen or liver; and a bronzed, freckled complexion. There is delayed sexual maturation, not precocious.

The nurse is administering a unit of blood to a child. What are signs and symptoms of a transfusion reaction? (Select all that apply.) a. Chills b. Shaking c. Flank pain d. Hypothermia e. Sudden severe headache

A, B, C, E Signs and symptoms of a transfusion reaction include chills, shaking, flank pain, and sudden severe headache. Hyperthermia, not hypothermia, occurs.

What are signs and symptoms of anemia? (Select all that apply.) a. Pallor b. Fatigue c. Dilute urine d. Bradycardia e. Muscle weakness

A, B, E Signs and symptoms of anemia include, pallor, fatigue, and muscle weakness. Tachycardia, not bradycardia, and dark urine, not dilute, are signs and symptoms of anemia.

The clinic nurse is evaluating causes for iron deficiency caused by inadequate supply of iron. What should the nurse recognize as causes for iron deficiency caused by an inadequate iron supply? (Select all that apply.) a. Prematurity b. Slow growth rate c. Excessive milk intake d. Severe iron deficiency in the mother e. Exclusive breastfeeding of infant from birth to 3 months

A, C, D Causes for iron deficiency caused by an inadequate supply of iron include prematurity, excessive milk intake, and severe iron deficiency in the mother. Rapid growth rate, not slow, and exclusive breastfeeding of infant after 6 months, not from birth to 3 months, can be causes of inadequate supply of iron.

The nurse is caring for a 14-year-old child with disseminated intravascular coagulation (DIC). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Petechiae b. Chronic diarrhea c. Hepatosplenomegaly d. Bleeding from openings in the skin e. Hypotension f. Purpura

A, D, E, F Some clinical manifestations of DIC are petechiae, bleeding from openings in the skin, hypotension, and purpura. Hepatosplenomegaly and chronic diarrhea are clinical manifestations of human immunodeficiency virus (HIV) infection in children.

3. A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered? A. At bedtime B. After meals C. Before meals D. After arising in morning

A. At bedtime

5. A 2-year-old child has a chronic history of constipation and is brought to the clinic for evaluation. What should the therapeutic plan initially include? A. Bowel cleansing B. Dietary modification C. Structured toilet training D. Behavior modification

A. Bowel cleansing

44. An infant with short bowel syndrome will be on total parenteral nutrition (TPN) for an extended period of time. What should the nurse monitor the infant for ? A. Central venous catheter infection, electrolyte losses, and hyperglycemia B. Hypoglycemia, catheter migration, and weight gain C. Venous thrombosis, hyperlipidemia, and constipation D. Catheter damage, red currant jelly stools, and hypoglycemia

A. Central venous catheter infection, electrolyte losses, and hyperglycemia.

5. The nurse is teaching parents of a child with gastroesophageal reflux (GER) disease foods that can exacerbate acid reflux. What foods should be included in the teaching session? (Select all that apply.) A. Citrus B. Bananas C. Spicy foods D. Peppermint E. Whole wheat bread

A. Citrus C. Spicy foods D. Peppermint

7. The nurse is planning care for a child recently diagnosed with diabetes insipidus (DI). What intervention should be included? A. Encourage the child to wear medical identification. B. Discuss with the child and family ways to limit fluid intake. C. Teach the child and family how to do required urine testing. D. Reassure the child and family that this is usually not a chronic or life-threatening illness.

A. Encourage the child to wear medical identification.

48. What intervention is contraindicated in a suspected case of appendicitis? A. Enemas B. Palpating the abdomen C. Administration of antibiotics D. Administration of antipyretics for fever

A. Enemas

26. A 12-year-old girl is newly diagnosed with diabetes when she develops ketoacidosis. How should the nurse structure a successful education program? A. Essential information is presented initially. B. Teaching should take place in the child's semiprivate room. C. Education is focused toward the parents because the child is too young. D. All information needed for self-management of diabetes is taught at once.

A. Essential information is presented initially.

9. The nurse is preparing to admit a 10-year-old child with appendicitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) A. Fever B. Vomiting C. Tachycardia D. Flushed face E. Hyperactive bowel sounds

A. Fever B. Vomiting C. Tachycardia

25. A child with acute gastrointestinal bleeding is admitted to the hospital. The nurse observes which sign or symptom as an early manifestation of shock? A. Restlessness B. Rapid capillary refill C. Increased temperature D. Increased blood pressure

A. Restlessness

11. The nurse is preparing to admit a 6-month-old child with gastroesophageal reflux disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Spitting up b. Bilious vomiting c. Failure to thrive d. Excessive crying e. Respiratory problems

A. Spitting up C. Failure to thrive D. Excessive crying E. Respiratory problems

8. The nurse is preparing to admit a 6-year-old child with celiac disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) A. Steatorrhea B. Polycythemia C. Malnutrition D. Melena stools E. Foul-smelling stools

A. Steatorrhea C. Malnutrition E. Foul-smelling stools

1. What test is used to screen for carbohydrate malabsorption? A. Stool pH B. Urine ketones C. C urea breath test D. ELISA stool assay

A. Stool pH

6. What statement best describes Hirschsprung disease? A. The colon has an aganglionic segment. B. It results in frequent evacuation of solids, liquid, and gas. C. The neonate passes excessive amounts of meconium. D. It results in excessive peristaltic movements within the gastrointestinal tract.

A. The colon has an aganglionic segment

41. What is the purpose in using cimetidine (Tagamet) for gastroesophageal reflux? A. The medication reduces gastric acid secretion. B. The medication neutralizes the acid in the stomach. C. The medication increases the rate of gastric emptying time. D. The medication coats the lining of the stomach and esophagus.

A. The medication reduces gastric acid secretion

12. The nurse is preparing to admit a 5-year-old child with hepatitis A. What clinical features of hepatitis A should the nurse recognize? (Select all that apply.) A. The onset is rapid. B. Fever occurs early. C. There is usually a pruritic rash. D. Nausea and vomiting are common. E. The mode of transmission is primarily by the parenteral route.

A. The onset is rapid B. Fever occurs early D. Nausea and vomiting are common

11. A goiter is an enlargement or hypertrophy of which gland? A. Thyroid B. Adrenal C. Anterior pituitary D. Posterior pituitary

A. Thyroid

7. The clinic nurse is assessing a child with central precocious puberty. What conditions can cause central precocious puberty? (Select all that apply.) A. Trauma B. Neoplasms C. Radiotherapy D. Exogenous sex hormones E. Primary hypothyroidism

A. Trauma B. Neoplasms C. Radiotherapy

3. The nurse is planning to admit a 14-year-old adolescent with Cushing syndrome. What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.) A. Truncal obesity B. Decreased pubic hair C. Petechial hemorrhage D. Hyperpigmentation of elbows E. Facial plethora F. Headache and weakness

A. Truncal obesity C. Petechial hemorrhage E. Facial Plethora

1. The nurse is preparing a community outreach program for adolescents about the characteristic differences between type 1 and type 2 diabetes mellitus (DM). What concepts should the nurse include? (Select all that apply.) A. Type 1 DM has an abrupt onset. B. Type 1 DM is often controlled with oral glucose agents. C. Type 1 DM occurs primarily in whites. D. Type 2 DM always requires insulin therapy. E. Type 2 DM frequently has a familial history. F. Type 2 DM occurs in people who are overweight.

A. Type 1 DM has an abrupt onset. C. Type 1 DM occurs primarily in whites. E. Type 2 DM frequently has a familial history. F. Type 2 DM occurs in people who are overweight.

18. What form of diabetes is characterized by destruction of pancreatic beta cells, resulting in insulin deficiency? A. Type 1 diabetes B. Type 2 diabetes C. Gestational diabetes D. Maturity-onset diabetes of the young (MODY)

A. Type 1 diabetes

10. The nurse is preparing to admit a 2-month-old child with hypertrophic pyloric stenosis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) A. Weight loss B. Bilious vomiting C. Abdominal pain D. Projectile vomiting E. The infant is hungry after vomiting

A. Weight loss D. Projectile vomiting E. The infant is hungry after vomiting

35. During the summer many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise? A. ↑food intake B. ↓food intake C. ↑risk of hyperglycemia D. ↓risk of insulin reaction

A. ↑food intake

43. A child is having tests done to determine parathyroid function. The clinic nurse knows that the parathyroid hormone (PTH) regulates the homeostasis of what in the serum? A. Sodium B. Calcium C. Potassium D. Magnesium

B. Calcium

10. The nurse notes that a child has lost 3.6 kg (8 lb) after 4 days of hospitalization for acute glomerulonephritis. What is the most likely cause of this weight loss? a. Poor appetite b. Reduction of edema c. Restriction to bed rest d. Increased potassium intake

B

11. What measure of fluid balance status is most useful in a child with acute glomerulonephritis? a. Proteinuria b. Daily weight c. Specific gravity d. Intake and output

B

27. The nurse is conducting discharge teaching with the parent of a 7-year-old child with minimal change nephrotic syndrome (MCNS). What statement by the parent indicates a correct understanding of the teaching? a. "My child needs to stay home from school for at least 1 more month." b. "I should not add additional salt to any of my child's meals." c. "My child will not be able to participate in contact sports while receiving corticosteroid therapy." d. "I should measure my child's urine after each void and report the 24-hour amount to the health care provider."

B

28. What is the narrowing of preputial opening of foreskin called? a. Chordee b. Phimosis c. Epispadias d. Hypospadias

B

29. Identification and treatment of cryptorchid testes should be done by age 2 years. What is an important consideration? a. Medical therapy is not effective after this age. b. Treatment is necessary to maintain the ability to be fertile when older. c. The younger child can tolerate the extensive surgery needed. d. Sexual reassignment may be necessary if treatment is not successful.

B

41. A child is admitted with acute glomerulonephritis. What should the nurse expect the urinalysis during this acute phase to show? a. Bacteriuria and hematuria b. Hematuria and proteinuria c. Bacteriuria and increased specific gravity d. Proteinuria and decreased specific gravity

B

42. A child with acute glomerulonephritis is in the playroom and experiences blurred vision and a headache. What action should the nurse take? a. Check the urine to see if hematuria has increased. b. Obtain the child's blood pressure and notify the health care provider. c. Obtain serum electrolytes and send urinalysis to the laboratory. d. Reassure the child and encourage bed rest until the headache improves.

B

43. The nurse is preparing to admit a child to the hospital with a diagnosis of acute poststreptococcal glomerulonephritis. The nurse understands that the peak age at onset for this disease is what? a. 2 to 4 years b. 5 to 7 years c. 8 to 10 years d. 11 to 13 years

B

9. What pathologic process is believed to be responsible for the development of postinfectious glomerulonephritis? a. Infarction of renal vessels b. Immune complex formation and glomerular deposition c. Bacterial endotoxin deposition on and destruction of glomeruli d. Embolization of glomeruli by bacteria and fibrin from endocardial vegetation

B

A young child with human immunodeficiency virus (HIV) is receiving several antiretroviral drugs. What is the purpose of these drugs? a. Cure the disease. b. Delay disease progression. c. Prevent spread of infection. d. Treat Pneumocystis carinii pneumonia.

B Although not a cure, these antiretroviral drugs can suppress viral replication, preventing further deterioration of the immune system, and delay disease progression. At this time, cure is not possible. Antiretroviral drugs do not prevent the spread of the disease. P. carinii prophylaxis is accomplished with antibiotics.

Care for the child with acute idiopathic thrombocytopenic purpura (ITP) includes which therapeutic intervention? a. Splenectomy b. Intravenous administration of anti-D antibody c. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) d. Helping child participate in sports

B Anti-D antibody causes an increase in platelet count approximately 48 hours after administration. Splenectomy is reserved for chronic severe ITP not responsive to pharmacologic management. NSAIDs are not used in ITP. Both NSAIDs and aspirin interfere with platelet aggregation. The nurse works with the child and parents to choose quiet activities while the platelet count is below 100,000/mm3

Iron overload is a side effect of chronic transfusion therapy. What treatment assists in minimizing this complication? a. Magnetic therapy b. Infusion of deferoxamine c. Hemoglobin electrophoresis d. Washing red blood cells (RBCs) to reduce iron

B Deferoxamine infusions in combination with vitamin C allow the iron to remain in a more chelatable form. The iron can then be excreted more easily. Use of magnets does not remove additional iron from the body. Hemoglobin electrophoresis is used to confirm the diagnosis of hemoglobinopathies; it does not affect iron overload. Washed RBCs remove white blood cells and other proteins from the unit of blood; they do not affect the iron concentration.

A child with sickle cell disease is in a vasoocclusive crisis. What nonpharmacologic pain intervention should the nurse plan? a. Exercise as a distraction b. Heat to the affected area c. Elevation of the extremity d. Cold compresses to the affected area

B Frequently, heat to the affected area is soothing. Cold compresses are not applied to the area because doing so enhances vasoconstriction and occlusion. Bed rest is usually well tolerated during a crisis, although the actual rest obtained depends a great deal on pain alleviation and the use of organized schedules of nursing care. Although the objective of bed rest is to minimize oxygen consumption, some activity, particularly passive range of motion exercises, is beneficial to promote circulation. Usually the best course is to let children determine their activity tolerance. Elevating the extremity will not help in sickle cell disease.

Nursing strategies to improve the growth and development of the child with human immunodeficiency virus (HIV) infection should include what? a. Provide only those foods that the child feels like eating. b. Fortify foods with nutritional supplements to maximize quality of intake. c. Weigh the child and measure height and muscle mass on a daily basis. d. Provide high-fat and high-calorie meals and snacks to meet body requirements for growth.

B HIV infection often leads to marked failure to thrive and multiple nutritional deficiencies. Nutritional management may be difficult because of recurrent illness, diarrhea, and other physical problems. The nurse should implement intensive nutritional interventions if the child's growth begins to slow or weight begins to decrease. Fortifying foods with nutritional supplements will maximize quality of intake. The child does not need to be weighed daily, and high-fat meals and snacks should not be encouraged.

44. The nurse is caring for a child after a parathyroidectomy. What medication should the nurse have available if hypocalcemia occurs? A. Insulin B. Calcium gluconate C. Propylthiouracil (PTU) D. Cortisone (hydrocortisone)

B. Calcium gluconate

The regulation of red blood cell (RBC) production is thought to be controlled by which physiologic factor? a. Hemoglobin b. Tissue hypoxia c. Reticulocyte count d. Number of RBCs

B Hemoglobin does not directly control RBC production. If there is insufficient hemoglobin to adequately oxygenate the tissue, then erythropoietin may be released. When tissue hypoxia occurs, the kidneys release erythropoietin into the bloodstream. This stimulates the marrow to produce new RBCs. Reticulocytes are immature RBCs. The "retic" count can be used to monitor hematopoiesis. The number of RBCs does not directly control production. In congenital cardiac disorders with mixed blood flow or decreased pulmonary blood flow, RBC production continues secondary to tissue hypoxia.

The clinic nurse is evaluating lab results for a child. What recorded hematocrit (Hct) result is considered within the normal range? a. 30% b. 40% c. 50% d. 60%

B Normal hematocrit (Hct) is 35% to 45%.

The nurse is caring for a school-age child with severe anemia and activity intolerance. What diversional activity should the nurse plan for this child? a. Playing a musical instrument b. Playing board or card games c. Participating in a game of table tennis d. Participating in decorating the hospital room

B Plan diversional activities that promote rest but prevent boredom and withdrawal. Because short attention span, irritability, and restlessness are common in anemia and increase stress demands on the body, plan appropriate activities such as playing board or card games. Playing a musical instrument, participating in a game of table tennis, or decorating the hospital room would cause undue exertion.

What condition occurs when the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron deficiency anemia

B Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Thalassemia major refers to a variety of inherited disorders characterized by deficiencies in production of certain globulin chains. Iron-deficiency anemia affects red blood cell size and depth of color but does not involve abnormal hemoglobin.

What statement is descriptive of most cases of hemophilia? a. X-linked recessive deficiency of platelets causing prolonged bleeding b. X-linked recessive inherited disorder in which a blood clotting factor is deficient c. Autosomal dominant deficiency of a factor involved in the blood-clotting reaction d. Y-linked recessive inherited disorder in which the red blood cells become moon shaped

B The inheritance pattern in 80% of all the cases of hemophilia is X-linked recessive. The two most common forms of the disorder are factor VIII deficiency (hemophilia A, or classic hemophilia) and factor IX deficiency (hemophilia B, or Christmas disease). The disorder involves coagulation factors, not platelets. The disorder does not involve red blood cells or the Y chromosome.

A child with sickle cell anemia (SCA) develops severe chest and back pain, fever, a cough, and dyspnea. What should be the first action by the nurse? a. Administer 100% oxygen to relieve hypoxia. b. Notify the practitioner because chest syndrome is suspected. c. Infuse intravenous antibiotics as soon as cultures are obtained. d. Give ordered pain medication to relieve symptoms of pain episode.

B These are the symptoms of chest syndrome, which is a medical emergency. Notifying the practitioner is the priority action. Oxygen may be indicated; however, it does not reverse the sickling that has occurred. Antibiotics are not indicated initially. Pain medications may be required, but evaluation by the practitioner is the priority.

1. The nurse is admitting a 9-year-old child with hemolytic uremic syndrome. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Hematuria b. Anorexia c. Hypertension d. Purpura e. Proteinuria f. Periorbital edema

B C D

11. A child is hospitalized in acute renal failure and has a serum potassium greater than 7 mEq/L. What temporary measures that will produce a rapid but transient effect to reduce the potassium should the nurse expect to be prescribed? (Select all that apply.) a. Dialysis b. Calcium gluconate c. Sodium bicarbonate d. Glucose 50% and insulin e. Sodium polystyrene sulfonate (Kayexalate)

B C D

12. Parents of a child who will need hemodialysis ask the nurse, "What are the advantages of a fistula over a graft or external access device for hemodialysis?" What response should the nurse give? (Select all that apply.) a. It is ready to be used immediately. b. There are fewer complications with a fistula. c. There is less restriction of activity with a fistula. d. It produces dilation and thickening of the superficial vessels. e. The fistula does not require a needle insertion at each dialysis.

B C D

10. What dietary instructions should the nurse give to parents of a child undergoing chronic hemodialysis? (Select all that apply.) a. High protein b. Fluid restriction c. High phosphorus d. Sodium restriction e. Potassium restriction

B D E

29. What therapeutic intervention provides the best chance of survival for a child with cirrhosis? A. Nutritional support B. Liver transplantation C. Blood component therapy D. Treatment with corticosteroids

B. Liver transplantation

The nurse is preparing to admit a 1-month-old infant with severe congenital neutropenia (Kostmann disease). What clinical features of severe congenital neutropenia should the nurse recognize? (Select all that apply.) a. Anemia is present. b. Neutropenia is present. c. The illness is severe. d. It has a dominant inheritance pattern. e. There are decreased eosinophils in the bone marrow.

B, C The clinical features of severe congenital neutropenia include anemia and neutropenia, and the illness is severe. It has an autosomal recessive inheritance pattern, and there are increased, not decreased, eosinophils in the bone marrow.

The clinic nurse is evaluating causes for iron deficiency due to impaired iron absorption. What should the nurse recognize as causes for iron deficiency due to impaired iron absorption? (Select all that apply.) a. Gastric acidity b. Chronic diarrhea c. Lactose intolerance d. Absence of phosphates e. Inflammatory bowel disease

B, C, E Causes for iron deficiency due to impaired iron absorption include chronic diarrhea, lactose intolerance, and inflammatory bowel disease. Gastric alkalinity, not acidity, and the presence, not absence, of phosphates can be causes of impaired iron absorption.

11. What are characteristics of diabetic ketoacidosis? (Select all that apply.) A. Pallor B. Acidosis C. Bradypnea D. Dehydration E. Electrolyte imbalance

B. Acidosis D. Dehydration E. Electrolyte Imbalance

29. A preadolescent has maintained good glycemic control of his type 1 diabetes through the school year. During summer vacation, he has had repeated episodes of hypoglycemia. What additional teaching is needed? A. Carbohydrates in the diet need to be replaced with protein. B. Additional snacks are needed to compensate for increased activity. C. The child needs to decrease his activity level to minimize episodes of hypoglycemia. D. Insulin dosage should be increased to compensate for a change in activity level.

B. Additional snacks are needed to compensate for increased activity.

16. Glucocorticoids, mineralocorticoids, and sex steroids are secreted by which gland? A. Thyroid gland B. Adrenal cortex C. Anterior pituitary D. Parathyroid glands

B. Adrenal cortex

8. The nurse is planning to admit a 10-year-old child with syndrome of inappropriate antidiuretic hormone (SIADH). What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.) A. Polyuria B. Anorexia C. Polydipsia D. Irritability E. Stomach cramps

B. Anorexia D. Irritability E. Stomach Cramps

26. What signs or symptoms are most commonly associated with the prodromal phase of acute viral hepatitis? A. Bruising and lethargy B. Anorexia and malaise C. Fatigability and jaundice D. Dark urine and pale stools

B. Anorexia and malaise

39. A 6-month-old infant with Hirschsprung disease is scheduled for a temporary colostomy. What should postoperative teaching to the parents include? A. Dilating the stoma B. Assessing bowel function C. Limitation of physical activities D. Measures to prevent prolapse of the rectum

B. Assessing bowel function

14. The school nurse practitioner is consulted by a fifth-grade teacher about a student who has become increasingly inattentive and hyperactive in the classroom. The nurse notes that the child's weight has changed from the 50th percentile to the 30th percentile. The nurse is concerned about possible hyperthyroidism. What additional sign or symptom should the nurse anticipate? A. Skin that is cool and dry B. Blurred vision and loss of acuity C. Running and being active during recess D. Decreased appetite and food intake

B. Blurred vision and loss of acuity

8. Intranasal administration of desmopressin acetate (DDAVP) is used to treat which condition? A. Hypopituitarism B. Diabetes insipidus (DI) C. Syndrome of inappropriate antidiuretic hormone (SIADH) D. Acute adrenocortical insufficiency

B. Diabetes insipidus (DI)

4. The nurse is teaching the family of a child with type 1 diabetes about insulin. What should the nurse include in the teaching session? (Select all that apply.) A. Unopened vials are good for 60 days. B. Diabetic supplies should not be left in a hot environment. C. Insulin can be placed in the freezer if not used every day. D. After it has been opened, insulin is good for up to 28 to 30 days. E. Insulin bottles that have been opened should be stored at room temperature or refrigerated.

B. Diabetic supplies should not be left in a hot environment. D. After it has been opened, insulin is good for up to 28 to 30 days. E. Insulin bottles that have been opened should be stored at room temperature or refrigerated.

33. The nurse is teaching the parent of a preschool child how to administer the child's insulin injection. The child will be receiving 2 units of regular insulin and 12 units of NPH insulin every morning. What should the parent be taught? A. Draw the insulin in separate syringes. B. Draw the regular insulin first and then the NPH into the same syringe. C. Draw the NPH insulin first and then the regular into the same syringe. D. Check blood sugar first, and if below 120, hold the regular insulin and give the NPH

B. Draw the regular insulin first and then the NPH into the same syringe.

33. What should preoperative care of a newborn with an anorectal malformation include? A. Frequent suctioning B. Gastrointestinal decompression C. Feedings with sterile water only D. Supine position with head elevated

B. Gastrointestinal decompression

27. What immunization is recommended for all newborns? A. Hepatitis A vaccine B. Hepatitis B vaccine C. Hepatitis C vaccine D. Hepatitis A, B, and C vaccines

B. Hepatitis B vaccine

1. The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include? (Select all that apply.) A. Elevate the head of the bed in the crib to a 90-degree angle while the infant is sleeping. B. Hold the infant in the prone position after a feeding. C. Discontinue breastfeeding so that a formula and rice cereal mixture can be used. D. The infant will require the Nissen fundoplication after 1 year of age. E. Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.

B. Hold the infant in the prone position after a feeding E. Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.

12. Exophthalmos (protruding eyeballs) may occur in children with which condition? A. Hypothyroidism B. Hyperthyroidism C. Hypoparathyroidism D. Hyperparathyroidism

B. Hyperthyroidism

18. Nutritional management of the child with Crohn disease includes a diet that has which component? A. High fiber B. Increased protein C. Reduced calories D. Herbal supplements

B. Increased protein

7. The nurse is caring for a child with celiac disease. The nurse understands that what may precipitate a celiac crisis? (Select all that apply.) A. Exercise B. Infections C. Fluid overload D. Electrolyte depletion E. Emotional disturbance

B. Infections D. Electrolyte depletion E. Emotional disturbance

2. The nurse is preparing to admit a 9-year-old child with syndrome of inappropriate antidiuretic hormone (SIADH). What interventions should the nurse include in the child's care plan? (Select all that apply.) A. Provide a low-sodium, low-fat diet. B. Initiate seizure precautions. C. Weigh daily at the same time each day. D. Encourage intake of 1 l of fluid per day. E. Measure intake and output hourly.

B. Initiate seizure precautions. C. Weigh daily at the same time each day. E. Measure intake and output hourly.

16. What statement is most descriptive of Meckel diverticulum? A. It is acquired during childhood. B. Intestinal bleeding may be mild or profuse. C. It occurs more frequently in females than in males. D. Medical interventions are usually sufficient to treat the problem.

B. Intestinal bleeding may be mild or profuse

8. A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. How should the nurse prepare this child? A. It is unnecessary because of child's age. B. It is essential because it will be an adjustment. C. Preparation is not needed because the colostomy is temporary. D. Preparation is important because the child needs to deal with negative body image.

B. It is essential because it will be an adjustment

5. The nurse is caring for a child with an anterior pituitary tumor. What hormones are secreted by the anterior pituitary? (Select all that apply.) A. Oxytocin B. Luteinizing hormone C. Antidiuretic hormone D. Thyroid-stimulating hormone E. Adrenocorticotrophic hormone

B. Luteinizing Hormone D. Thyroid-Stimulating Hormone E. Adrenocorticotrophic Hormone

7. What procedure is most appropriate for assessment of an abdominal circumference related to a bowel obstruction? A. Measuring the abdomen after feedings B. Marking the point of measurement with a pen C. Measuring the circumference at the symphysis pubis D. Using a new tape measure with each assessment to ensure accuracy

B. Marking the point of measurement with a pen

2. The nurse is preparing to admit a 3-year-old child with intussusception. What clinical manifestations should the nurse expect to observe? (Select all that apply.) A. Absent bowel sounds B. Passage of red, currant jelly-like stools C. Anorexia D. Tender, distended abdomen E. Hematemesis F. Sudden acute abdominal pain

B. Passage of red, currant jelly-like stools D. Tender, distended abdomen F. Sudden acute abdominal pain

4. What is a high-fiber food that the nurse should recommend for a child with chronic constipation? A. White rice B. Popcorn C. Fruit juice D. Ripe bananas

B. Popcorn

13. The nurse is preparing to admit a 7-year-old child with hepatitis B. What clinical features of hepatitis B should the nurse recognize? (Select all that apply.) A. The onset is rapid. B. Rash is common. C. Jaundice is present D. No carrier state exists. E. The mode of transmission is principally by the parenteral route.

B. Rash is common C. Jaundice is present E. The mode of transmission is principally by the parenteral route

17. One of the major differences in clinical presentation between Crohn disease (CD) and ulcerative colitis (UC) is that UC is more likely to cause which clinical manifestation? A. Pain B. Rectal bleeding C. Perianal lesions D. Growth retardation

B. Rectal bleeding

2. A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge? A. Therapy is most successful if it is started during adolescence. B. Replacement therapy requires daily subcutaneous injections. C. Hormonal supplementation will be required throughout child's lifetime. D. Treatment is considered successful if children attain full stature by adolescence.

B. Replacement therapy requires daily subcutaneous injections.

17. Congenital adrenal hyperplasia (CAH) is suspected in a newborn because of ambiguous genitalia. The parents are appropriately upset and concerned about their child's gender. In teaching the parents about CAH, what should the nurse explain? A. Reconstructive surgery as a female is preferred. B. Sexual assignment should wait until genetic sex is determined. C. Prenatal masculinization will strongly influence the child's development. D. The child should be raised as a boy because of the presence of a penis and scrotum.

B. Sexual assignment should wait until genetic sex is determined.

23. An infant with short bowel syndrome is receiving total parenteral nutrition (TPN). The practitioner has added continuous enteral feedings through a gastrostomy tube. The nurse recognizes this as important for which reason? A. Wean the infant from TPN the next day B. Stimulate adaptation of the small intestine C. Give additional nutrients that cannot be included in the TPN D. Provide parents with hope that the child is close to discharge

B. Stimulate adaptation of the small intestine

12. An adolescent with irritable bowel syndrome comes to see the school nurse. What information should the nurse share with the adolescent? A. A low-fiber diet is required. B. Stress management may be helpful. C. Milk products are a contributing factor. D. Pantoprazole (a proton pump inhibitor) is effective in treatment.

B. Stress management may be helpful

28. The nurse is discussing home care with a mother whose 6-year-old child has hepatitis A. What information should the nurse include? A. Advise bed rest until 1 week after the icteric phase. B. Teach infection control measures to family members. C. Inform the mother that the child cannot return to school until 3 weeks after onset of jaundice. D. Reassure the mother that hepatitis A cannot be transmitted to other family members.

B. Teach infection control measures to family members

35. The parents of a newborn with an umbilical hernia ask about treatment options. The nurse's response should be based on which knowledge? A. Surgery is recommended as soon as possible. B. The defect usually resolves spontaneously by 3 to 5 years of age. C. Aggressive treatment is necessary to reduce its high mortality. D. Taping the abdomen to flatten the protrusion is sometimes helpful.

B. The defect usually resolves spontaneously by 3 to 5 years of age.

50. The nurse is evaluating the laboratory results of a stool sample. What is a normal finding? A. The laboratory reports a stool pH of 5.0. B. The laboratory reports a negative guaiac. C. The laboratory reports low levels of enzymes. D. The laboratory reports reducing substances present

B. The laboratory reports a negative guaiac

2. A toddler's mother calls the nurse because she thinks her son has swallowed a button type of battery. He has no signs of respiratory distress. The nurse's response should be based on which premise? A. An emergency laparotomy is very likely. B. The location needs to be confirmed by radiographic examination. C. Surgery will be necessary if the battery has not passed in the stool in 48 hours. D. Careful observation is essential because an ingested battery cannot be accurately detected.

B. The location needs to be confirmed by radiographic examination.

24. Melena, the passage of black, tarry stools, suggests bleeding from which source? A. The perianal or rectal area B. The upper gastrointestinal (GI) tract C. The lower GI tract D. Hemorrhoids or anal fissures

B. The upper gastrointestinal (GI) tract

15. A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which signs or symptoms of vitamin D toxicity? A. Headache and seizures B. Weakness and lassitude C. Anorexia and insomnia D. Physical restlessness, voracious appetite without weight gain

B. Weakness and lassitude

The nurse is teaching a parent of an infant to limit the amount of formula to encourage the intake of iron-rich food. What amount should the nurse teach to the parent? a. 500 ml b. 750 ml c. 1000 ml d. 1250 ml

C The nurse should teach the parent to limit the amount of formula to no more than 1 1/day to encourage intake of iron-rich solid foods.

5. What signs and symptoms are indicative of a urinary tract disorder in the neonatal period (birth to 1 month)? (Select all that apply.) a. Edema b. Bradypnea c. Frequent urination d. Poor urinary stream e. Failure to gain weight

C D E

1. Urinary tract anomalies are frequently associated with what irregularities in fetal development? a. Myelomeningocele b. Cardiovascular anomalies c. Malformed or low-set ears d. Defects in lower extremitie

C

12. The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. What knowledge should influence the nurse's reply? a. The antibiotic therapy contributes to labile blood pressure values. b. Hypotension leading to sudden shock can develop at any time. c. Acute hypertension is a concern that requires monitoring. d. Blood pressure fluctuations indicate that the condition has become chronic.

C

14. What is the primary objective of care for the child with minimal change nephrotic syndrome (MCNS)? a. Reduce blood pressure. b. Lower serum protein levels. c. Minimize excretion of urinary protein. d. Increase the ability of tissue to retain fluid.

C

15. A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. What nursing goal is appropriate for this child? a. Stimulate appetite. b. Detect evidence of edema. c. Minimize risk of infection. d. Promote adherence to the antibiotic regimen.

C

16. The nurse is teaching a child experiencing severe edema associated with minimal change nephrotic syndrome about his diet. The nurse should discuss what dietary need? a. Consuming a regular diet b. Increasing protein c. Restricting fluids d. Decreasing calories

C

19. What condition is the most common cause of acute renal failure in children? a. Pyelonephritis b. Tubular destruction c. Severe dehydration d. Upper tract obstruction

C

20. A child is admitted in acute renal failure (ARF). Therapeutic management to rapidly provoke a flow of urine includes the administration of what medication? a. Propranolol (Inderal) b. Calcium gluconate c. Mannitol (Osmitrol) or furosemide (Lasix) (or both) d. Sodium, chloride, and potassium

C

21. What major complication is associated with a child with chronic renal failure? a. Hypokalemia b. Metabolic alkalosis c. Water and sodium retention d. Excessive excretion of blood urea nitrogen

C

22. What diet is most appropriate for the child with chronic renal failure (CRF)? a. Low in protein b. Low in vitamin D c. Low in phosphorus d. Supplemented with vitamins A, E, and K

C

25. What statement is an advantage of peritoneal dialysis compared with hemodialysis? a. Protein loss is less extensive. b. Dietary limitations are not necessary. c. It is easy to learn and safe to perform. d. It is needed less frequently than hemodialysis.

C

26. What statement is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. Children can receive kidneys only from other children. c. It is the preferred means of renal replacement therapy in children. d. The decision for transplantation is difficult because a relatively normal lifestyle is not possible.

C

31. The parents of a 2-year-old boy who had a repair of exstrophy of the bladder at birth ask when they can begin toilet training their son. The nurse replies based on what knowledge? a. Most boys in the United States can be toilet trained at age 3 years. b. Training can begin when he has sufficient bladder capacity. c. Additional surgery may be necessary to achieve continence. d. They should begin now because he will require additional time.

C

36. What is an appropriate nursing intervention for a child with minimal change nephrotic syndrome (MCNS) who has scrotal edema? a. Place an ice pack on the scrotal area. b. Place the child in an upright sitting position. c. Elevate the scrotum with a rolled washcloth. d. Place a warm moist pack to the scrotal area.

C

5. The nurse is teaching a client to prevent future urinary tract infections (UTIs). What factor is most important to emphasize as the potential cause? a. Poor hygiene b. Constipation c. Urinary stasis d. Congenital anomalies

C

6. A girl, age 5 1/2 years, has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to her parent that the first action is to have the child evaluated for what condition? a. School phobia b. Glomerulonephritis c. Urinary tract infection (UTI) d. Attention deficit hyperactivity disorder (ADHD)

C

8. In teaching the parent of a newly diagnosed 2-year-old child with pyelonephritis related to vesicoureteral reflux (VUR), the nurse should include which information? a. Limit fluids to reduce reflux. b. Give cranberry juice twice a day. c. Have siblings examined for VUR. d. Surgery is indicated to reverse scarring.

C

In a child with sickle cell anemia (SCA), adequate hydration is essential to minimize sickling and delay the vasoocclusion and hypoxia-ischemia cycle. What information should the nurse share with parents in a teaching plan? a. Encourage drinking. b. Keep accurate records of output. c. Check for moist mucous membranes. d. Monitor the concentration of the child's urine.

C Children with SCA have impaired kidney function and cannot concentrate urine. Parents are taught signs of dehydration and ways to minimize loss of fluid to the environment. Encouraging drinking is not specific enough for parents. The nurse should give the parents and child a target fluid amount for each 24-hour period. Accurate monitoring of output may not reflect the child's fluid needs. Without the ability to concentrate urine, the child needs additional intake to compensate. Dilute urine and specific gravity are not valid signs of hydration status in children with SCA.

What medication is classified as an antiretroviral? a. Dapsone (Aczone) b. Pentamidine (Pentam) c. Didanosine (Videx) d. Trimethoprim-sulfamethoxazole (Bactrim)

C Classes of antiretroviral agents include nucleoside reverse transcriptase inhibitors (e.g., zidovudine, didanosine, stavudine, lamivudine, abacavir), nonnucleoside reverse transcriptase inhibitors (e.g., nevirapine, delavirdine, efavirenz), and protease inhibitors (e.g., indinavir, saquinavir, ritonavir, nelfinavir, amprenavir, lopinavir, ritonavir). Dapsone, pentamidine, and Bactrim are anti-infectives.

38. A 3-day-old infant presents with abdominal distention, is vomiting, and has not passed any meconium stools. What disease should the nurse suspect? A. Pyloric stenosis B. Intussusception C. Hirschsprung disease D. Celiac disease

C. Hirschsprung disease

What condition is an acquired hemorrhagic disorder that is characterized by excessive destruction of platelets? a. Aplastic anemia b. Thalassemia major c. Idiopathic thrombocytopenic purpura d. Disseminated intravascular coagulation

C Idiopathic thrombocytopenic purpura is an acquired hemorrhagic disorder characterized by an excessive destruction of platelets, discolorations caused by petechiae beneath the skin, and normal bone marrow. Aplastic anemia refers to a bone marrow failure condition in which the formed elements of the blood are simultaneously depressed. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin chains. Disseminated intravascular coagulation is characterized by diffuse fibrin deposition in the microvasculature, consumption of coagulation factors, and endogenous generation of thrombin and plasma.

What statement best describes b-thalassemia major (Cooley anemia)? a. It is an acquired hemolytic anemia. b. Inadequate numbers of red blood cells (RBCs) are present. c. Increased incidence occurs in families of Mediterranean extraction. d. It commonly occurs in individuals from West Africa.

C Individuals who live near the Mediterranean Sea and their descendants have the highest incidence of thalassemia. Thalassemia is inherited as an autosomal recessive disorder. An overproduction of RBCs occurs. Although numerous, the red blood cells are relatively unstable. Sickle cell disease is common in blacks of West African descent. The goal of medical management is to maintain sufficient hemoglobin (>9.5 g/dl) to prevent bone marrow expansion. This is achieved through a long-term transfusion program.

The nurse is teaching the family of a child, age 8 years, with moderate hemophilia about home care. What should the nurse tell the family to do to minimize joint injury? a. Administer nonsteroidal anti-inflammatory drugs (NSAIDs). b. Administer DDAVP (synthetic vasopressin). c. Provide intravenous (IV) infusion of factor VIII concentrates. d. Encourage elevation and application of ice to the involved joint.

C Parents are taught home infusion of factor VIII concentrate. For moderate and severe hemophilia, prompt IV administration is essential to prevent joint injury. NSAIDs are effective for pain relief. They must be given with caution because they inhibit platelet aggregation. A factor VIII level of 30% is necessary to stop bleeding. DDAVP can raise the factor VIII level fourfold. Moderate hemophilia is defined by a factor VIII activity of 4.9. A fourfold increase would not meet the 30% level. Ice and elevation are important adjunctive therapy, but factor VIII is necessary.

The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. What statement most accurately reflects inheritance of SCA? a. SCA is not inherited. b. All siblings will have SCA. c. Each sibling has a 25% chance of having SCA. d. There is a 50% chance of siblings having SCA.

C SCA is inherited as an autosomal recessive disorder. In this inheritance pattern, each child born to these parents has a 25% chance of having the disorder, a 25% chance of having neither SCA nor the trait, and a 50% chance of being heterozygous for SCA (sickle cell trait). SCA is an inherited hemoglobinopathy.

A mother states that she brought her child to the clinic because the 3-year-old girl was not keeping up with her siblings. During physical assessment, the nurse notes that the child has pale skin and conjunctiva and has muscle weakness. The hemoglobin on admission is 6.4 g/dl. After notifying the practitioner of the results, what nursing priority intervention should occur next? a. Reduce environmental stimulation to prevent seizures. b. Have the laboratory repeat the analysis with a new specimen. c. Minimize energy expenditure to decrease cardiac workload. d. Administer intravenous fluids to correct the dehydration.

C The child has a critically low hemoglobin value. The expected range is 11.5 to 15.5 g/dl. When the oxygen-carrying capacity of the blood decreases slowly, the child is able to compensate by increasing cardiac output. With the increasing workload of the heart, additional stress can lead to cardiac failure. Reduction of environmental stimulation can help minimize energy expenditure, but seizures are not a risk. A repeat hemoglobin analysis is not necessary. The child does not have evidence of dehydration. If intravenous fluids are given, they can further dilute the circulating blood volume and increase the strain on the heart.

The clinical manifestations of sickle cell anemia (SCA) are primarily the result of which physiologic alteration? a. Decreased blood viscosity b. Deficiency in coagulation c. Increased red blood cell (RBC) destruction d. Greater affinity for oxygen

C The clinical features of SCA are primarily the result of increased RBC destruction and obstruction caused by the sickle-shaped RBCs. When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation. SCA does not have a coagulation deficit. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension.

A child with severe anemia requires a unit of red blood cells (RBCs). The nurse explains to the child that the transfusion is necessary for which reason? a. Allow her parents to come visit her. b. Fight the infection that she now has. c. Increase her energy so she will not be so tired. d. Help her body stop bleeding by forming a clot (scab).

C The indication for RBC transfusion is risk of cardiac decompensation. When the number of circulating RBCs is increased, tissue hypoxia decreases, cardiac function is improved, and the child will have more energy. Parental visiting is not dependent on transfusion. The decrease in tissue hypoxia will minimize the risk of infection. There is no evidence that the child is currently infected. Forming a clot is the function of platelets.

What information should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? a. Give with meals. b. Stop immediately if nausea and vomiting occur. c. Adequate dosage will turn the stools a tarry green color. d. Allow preparation to mix with saliva and bathe the teeth before swallowing.

C The nurse should prepare the mother for the anticipated change in the child's stools. If the iron dose is adequate, the stools will become a tarry green color. A lack of color change may indicate insufficient iron. The iron should be given in two divided doses between meals when the presence of free hydrochloric acid is greatest. Iron is absorbed best in an acidic environment. Vomiting and diarrhea may occur with iron administration. If these occur, the iron should be given with meals, and the dosage reduced and gradually increased as the child develops tolerance. Liquid preparations of iron stain the teeth; they should be administered through a straw and the mouth rinsed after administration.

The nurse is teaching parents of a child being discharged from the hospital after a splenectomy about the risk of infection. What should the nurse include in the teaching session? (Select all that apply.) a. Avoid obtaining the pneumococcal vaccination for the child. b. Avoid obtaining the meningococcal vaccination for the child. c. The child should receive prophylactic penicillin for certain procedures. d. Have the child immunized with the Haemophilus influenzae type b vaccination. e. Notify the health care provider if your child develops a fever of 38.5° C (101.3° F).

C, D, E Because of the risk of life-threatening bacterial infection after splenectomy, these children are immunized with the pneumococcal, meningococcal, and H. influenzae type b vaccines before surgery and receive prophylactic penicillin for several years after splenectomy. The parents should be instructed in the importance of seeking immediate medical attention if their child develops a fever of 38.5° C (101.3° F) or higher as a common sign of infection or postsplenectomy sepsis.

22. The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. What effect does exercise have on a type 1 diabetic? A. Exercise increases blood glucose. B. Extra insulin is required during exercise. C. Additional snacks are needed before exercise. D. Excessive physical activity should be restricted.

C. Additional snacks are needed before exercise.

15. The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. What intervention is appropriate to relieve the abdominal discomfort during the evaluation? A. Place in the Trendelenburg position. B. Apply moist heat to the abdomen. C. Allow the child to assume a position of comfort. D. Administer a saline enema to cleanse the bowel.

C. Allow the child to assume a position of comfort.

24. A 20-kg (44-lb) child in ketoacidosis is admitted to the pediatric intensive care unit. What order should the nurse not implement until clarified with the physician? A. Weigh on admission and daily. B. Replace fluid volume deficit over 48 hours. C.Begin intravenous line with D5 0.45% normal saline with 20 mEq of potassium chloride. D. Give intravenous regular insulin 2 units/kg/hr after initial rehydration bolus.

C. Begin intravenous line with D5 0.45% normal saline with 20 mEq of potassium chloride.

43. The nurse is assisting a child with celiac disease to select foods from a menu. What foods should the nurse suggest? A. Hamburger on a bun B. Spaghetti with meat sauce C. Corn on the cob with butter D. Peanut butter and crackers

C. Corn on the cob with butter

36. The nurse is preparing to care for a newborn with an omphalocele. The nurse should understand that care of the infant should include what intervention? A. Initiating breast- or bottle-feedings to stabilize the blood glucose level B. Maintaining pain management with an intravenous opioid C. Covering the intact bowel with a nonadherent dressing to prevent injury D. Performing immediate surgery

C. Covering the intact bowel with a nonadherent dressing to prevent injury

49. The nurse is caring for a child with Meckel diverticulum. What type of stool does the nurse expect to observe? A. Steatorrhea B. Clay colored C. Currant jelly-like D. Loose stools with undigested food

C. Currant jelly-like

10. What is a common clinical manifestation of juvenile hypothyroidism? A. Insomnia B. Diarrhea C. Dry skin D. Rapid growth

C. Dry skin

30. The nurse observes that a newborn is having problems after birth. What should indicate a tracheoesophageal fistula? A. Jitteriness B. Meconium ileus C. Excessive frothy saliva D. Increased need for sleep

C. Excessive frothy saliva

13. A child is receiving propylthiouracil for the treatment of hyperthyroidism (Graves disease). The parents and child should be taught to recognize and report which sign or symptom immediately? A. Fatigue B. Weight loss C. Fever, sore throat D. Upper respiratory tract infection

C. Fever, sore throat

14. When caring for a child with probable appendicitis, the nurse should be alert to recognize which sign or symptom as a manifestation of perforation? A. Anorexia B. Bradycardia C. Sudden relief from pain D. Decreased abdominal distention

C. Sudden relief from pain

3. The mother of a child with cognitive impairment calls the nurse because her son has been gagging and drooling all morning. The nurse suspects foreign body ingestion. What physiologic occurrence is most likely responsible for the presenting signs? A. Gastrointestinal perforation may have occurred. B. The object may have been aspirated. C. The object may be lodged in the esophagus. D. The object may be embedded in stomach wall.

C. The object may be lodged in the esophagus.

10. A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent? A. Surgical therapy is indicated. B. Place in prone position for sleep after feeding. C. Thicken feedings and enlarge the nipple hole. D. Reduce the frequency of feeding by encouraging larger volumes of formula.

C. Thicken feedings and enlarge the nipple hole.

31. An adolescent diabetic is admitted to the emergency department for treatment of hyperglycemia and pneumonia. What are characteristics of diabetic hyperglycemia? A. Cold, clammy skin and lethargy B. Hunger and hypertension C. Thirst, being flushed, and fruity breath D. Disorientation and pallor

C. Thirst, being flushed, and fruity breath

47. An infant had a gastrostomy tube placed for feedings after a Nissen fundoplication and bolus feedings are initiated. Between feedings while the tube is clamped, the infant becomes irritable, and there is evidence of cramping. What action should the nurse implement? A. Burp the infant. B. Withhold the next feeding. C. Vent the gastrostomy tube. D. Notify the health care provider.

C. Vent the gastrostomy tube

13. What laboratory finding, in conjunction with the presenting symptoms, indicates minimal change nephrotic syndrome? a. Low specific gravity b. Decreased hemoglobin c. Normal platelet count d. Reduced serum albumin

D

17. A child is admitted for minimal change nephrotic syndrome (MCNS). The nurse recognizes that the child's prognosis is related to what factor? a. Admission blood pressure b. Creatinine clearance c. Amount of protein in urine d. Response to steroid therapy

D

18. A 12-year-old child is injured in a bicycle accident. When considering the possibility of renal trauma, the nurse should consider what factor? a. Flank pain rarely occurs in children with renal injuries. b. Few nonpenetrating injuries cause renal trauma in children. c. Kidneys are immobile, well protected, and rarely injured in children. d. The amount of hematuria is not a reliable indicator of the seriousness of renal injury.

D

23. What nursing consideration is most important when caring for a child with end-stage renal disease (ESRD)? a. Children with ESRD usually adapt well to minor inconveniences of treatment. b. Children with ESRD require extensive support until they outgrow the condition. c. Multiple stresses are placed on children with ESRD and their families until the illness is cured. d. Multiple stresses are placed on children with ESRD and their families because children's lives are maintained by drugs and artificial means.

D

24. The nurse is caring for an adolescent who has just started dialysis. The child always seems angry, hostile, or depressed. The nurse should recognize that this is most likely related to what underlying cause? a. Physiologic manifestations of renal disease b. The fact that adolescents have few coping mechanisms c. Neurologic manifestations that occur with dialysis d. Resentment of the control and enforced dependence imposed by dialysis

D

30. Congenital defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to accomplish what? a. Minimize separation anxiety. b. Prevent urinary complications. c. Increase acceptance of hospitalization. d. Promote development of normal body image.

D

32. An infant has been diagnosed with bladder obstruction. What do symptoms of this disorder include? a. Renal colic b. Strong urinary stream c. Urinary tract infections d. Posturination dribbling

D

34. Parents of a newborn with ambiguous genitalia want to know how long they will have to wait to know whether they have a boy or a girl. The nurse answers the parents based on what knowledge? a. Chromosome analysis will be complete in 7 days. b. A physical examination will be able to provide a definitive answer. c. Additional laboratory testing is necessary to assign the correct gender. d. Gender assignment involves collaboration between the parents and a multidisciplinary team.

D

37. What do the clinical manifestations of minimal change nephrotic syndrome include? a. Hematuria, bacteriuria, and weight gain b. Gross hematuria, albuminuria, and fever c. Hypertension, weight loss, and proteinuria d. Massive proteinuria, hypoalbuminemia, and edema

D

38. For minimal change nephrotic syndrome (MCNS), prednisone is effective when what occurs? a. Appetite increases and blood pressure is normal b. Urinary tract infection is gone and edema subsides c. Generalized edema subsides and blood pressure is normal d. Diuresis occurs as urinary protein excretion diminishes

D

39. A nurse is evaluating the effectiveness of teaching regarding care of a child with minimal change nephrotic syndrome (MCNS) that is in remission after administration of prednisone. The nurse realizes further teaching is required if the parents state what? a. "We will keep our child away from anyone who is ill." b. "We will be sure to administer the prednisone as ordered." c. "We will encourage our child to eat a balanced diet, but we will watch his salt intake." d. "We understand our child will not be able to attend school, so we will arrange for home schooling."

D

40. A parent asks the nurse what would be the first indication that acute glomerulonephritis was improving. What would be the nurse's best response? a. Blood pressure will stabilize. b. Your child will have more energy. c. Urine will be free of protein. d. Urine output will increase.

D

7. What recommendation should the nurse make to prevent urinary tract infections (UTIs) in young girls? a. Avoid public toilet facilities. b. Limit long baths as much as possible. c. Cleanse the perineum with water after voiding. d. Ensure clear liquid intake of 2 L/day.

D

What physiologic defect is responsible for causing anemia? a. Increased blood viscosity b. Depressed hematopoietic system c. Presence of abnormal hemoglobin d. Decreased oxygen-carrying capacity of blood

D Anemia is a condition in which the number of red blood cells or hemoglobin concentration is reduced below the normal values for age. This results in a decreased oxygen-carrying capacity of blood. Increased blood viscosity is usually a function of too many cells or of dehydration, not of anemia. A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition depends on the decreased oxygen-carrying capacity of the blood.

What statement best describes iron deficiency anemia in infants? a. It is caused by depression of the hematopoietic system. b. Diagnosis is easily made because of the infant's emaciated appearance. c. It results from a decreased intake of milk and the premature addition of solid foods. d. Clinical manifestations are related to a reduction in the amount of oxygen available to tissues.

D In iron-deficiency anemia, the child's clinical appearance is a result of the anemia, not the underlying cause. Usually the hematopoietic system is not depressed. The bone marrow produces red blood cells that are smaller and contain less hemoglobin than normal red blood cells. Children who have iron deficiency from drinking excessive quantities of milk are usually pale and overweight. They are receiving sufficient calories but are deficient in essential nutrients. The clinical manifestations result from decreased intake of iron-fortified solid foods and an excessive intake of milk.

For children who do not have a matched sibling bone marrow donor, the therapeutic management of aplastic anemia includes what intervention? a. Antibiotics b. Antiretroviral drugs c. Iron supplementation d. Immunosuppressive therapy

D It is thought that aplastic anemia may be an autoimmune disease. Immunosuppressive therapy, including antilymphocyte globulin, antithymocyte globulin, cyclosporine, granulocyte colony-stimulating factor, and methylprednisone, has greatly improved the prognosis for patients with aplastic anemia. Antibiotics are not indicated as the management. They may be indicated for infections. Antiretroviral drugs and iron supplementation are not part of the therapy.

The majority of children in the United States with human immunodeficiency virus (HIV) infection acquired the disease by which means? a. Through sexual contact b. From a blood transfusion c. By using intravenous (IV) drugs d. Perinatally from their mothers

D More than 90% of the children with HIV under 13 years who were reported to the Centers for Disease Control and Prevention acquired the infection during the perinatal period. With intervention, the number of children infected can be decreased. Sexual contact and IV drug use are the leading causes of infection in the 14- to 19-year age group. This number is less than the number of cases in the under 13-year age group. Transfusion has accounted for 3% to 6% of all pediatric acquired immunodeficiency syndrome cases to date. Before 1985 and routine screening of donated blood products, children with hemophilia were at great risk from pooled plasma products.

The clinic nurse is evaluating lab results for a child. What recorded hemoglobin (Hgb) result is considered within the normal range? a. 9 g/dl b. 10 g/dl c. 11 g/dl d. 12 g/dl

D Normal hemoglobin (Hgb) determination is 11.5 to 15.5 g/dl.

What condition precipitates polycythemia? a. Dehydration b. Severe infections c. Immunosuppression d. Prolonged tissue hypoxia

D Oxygen transport depends on both the number of circulating RBCs and the amount of normal hemoglobin in the cell. This explains why polycythemia (increase in the number of erythrocytes) occurs in conditions characterized by prolonged tissue hypoxia, such as cyanotic heart defects. Dehydration, severe infections, or immunosuppression will not precipitate polycythemia.

The nurse is caring for a child with hemophilia A. The child's activity is as tolerated. What activity is contraindicated for this child? a. Ambulating to the cafeteria b. Active range of motion c. Ambulating to the playroom d. Passive range of motion exercises

D Passive range of motion exercises should never be part of an exercise regimen after an acute episode because the joint capsule could easily be stretched and bleeding could recur. Active range of motion exercises are best so that the patient can gauge his or her own pain tolerance. The child can ambulate to the playroom or the cafeteria.

The nurse is preparing a community outreach program about the prevention of iron-deficiency anemia in infants. What statement should the nurse include in the program? a. Whole milk can be introduced into the infant's diet in small amounts at 6 months. b. Iron supplements cannot be given until the infant is older than 1 year of age. c. Iron-fortified cereal should be introduced to the infant at 2 months of age. d. Breast milk or iron-fortified formula should be used for the first 12 months.

D Prevention, the primary goal in iron-deficiency anemia, is achieved through optimal nutrition and appropriate iron supplements. The American Academy of Pediatrics recommends feeding an infant only breast milk or iron-fortified formula for the first 12 months of life. Whole cow's milk should not be introduced until after 12 months, iron supplements can be given during the first year of life, and iron-fortified cereals should not be introduced until the infant is 4 to 6 months old.

What condition is an inherited immunodeficiency disorder characterized by absence of both humoral and cell-mediated immunity? a. Fanconi syndrome b. Wiskott-Aldrich syndrome c. Acquired immunodeficiency syndrome (AIDS) d. Severe combined immunodeficiency syndrome (SCIDS)

D SCIDS is a genetic disorder that results in deficits of both humoral and cellular immunity. Fanconi syndrome is a hereditary disorder of red blood cell production. Wiskott-Aldrich syndrome is an X- linked recessive disorder with selected deficiencies of T and B lymphocytes. AIDS is not inherited.

A child with hemophilia A will have which abnormal laboratory result? a. PT (ProTime) b. Platelet count c. Fibrinogen level d. PTT (partial thromboplastin time)

D The basic defect of hemophilia A is a deficiency of factor VIII. The partial thromboplastin time measures abnormalities in the intrinsic pathway (abnormalities in factors I, II, V, VIII, IX, X, XII, HMK, and KAL). The prothrombin time measures abnormalities of the extrinsic pathway (abnormalities in factors I, II, V, VII, and X). Fibrinogen level is not dependent on the intrinsic pathway. Platelets are not affected with hemophilia A.

The nurse is preparing to administer a unit of packed red blood cells to a hospitalized child. What is an appropriate action that applies to administering blood? a. Take the vital signs every 15 minutes while blood is infusing. b. Use blood within 1 hour of its arrival from the blood bank. c. Administer the blood with 5% glucose in a piggyback setup. d. Administer the first 50 ml of blood slowly and stay with the child.

D The nurse should administer the first 50 ml of blood or initial 20% of volume (whichever is smaller) slowly and stay with the child. Vitals signs should be taken 15 minutes after initiation and then every hour, not every 15 minutes. Blood should be used within 30 minutes, not 1 hour. Normal saline, not 5% glucose, should be the IV solution.

An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of what complication? a. Air embolism b. Allergic reaction c. Hemolytic reaction d. Circulatory overload

D The signs of circulatory overload include distended neck veins, hypertension, crackles, a dry cough, cyanosis, and precordial pain. Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Urticaria, pruritus, flushing, asthmatic wheezing, and laryngeal edema are signs and symptoms of allergic reactions. Hemolytic reactions are characterized by chills, shaking, fever, pain at infusion site, nausea, vomiting, tightness in chest, flank pain, red or black urine, and progressive signs of shock and renal failure.

8. What dietary instructions should the nurse give to parents of a child in the oliguria phase of acute glomerulonephritis with edema and hypertension? (Select all that apply.) a. High fat b. Low protein c. Encouragement of fluids d. Moderate sodium restriction e. Limit foods high in potassium

D E

9. What dietary instructions should the nurse give to parents of a child with minimal change nephrotic syndrome with massive edema? (Select all that apply.) a. Soft diet b. High protein c. Fluid restricted d. No salt added at the table e. Restriction of foods high in sodium

D E

46. The nurse should instruct parents to administer a daily proton pump inhibitor to their child with gastroesophageal reflux at which time? A Bedtime B. With a meal C. Midmorning D. 30 minutes before breakfast

D. 30 minutes before breakfast

21. What blood glucose measurement is most likely associated with diabetic ketoacidosis? A. 185 mg/dl B. 220 mg/dl C. 280 mg/dl D. 330 mg/dl

D. 330 mg/dl

27. The nurse is discussing with a child and family the various sites used for insulin injections. What site usually has the fastest rate of absorption? A. Arm B.Leg C. Buttock D. Abdomen

D. Abdomen

4. What is a condition that can result if hypersecretion of growth hormone (GH) occurs after epiphyseal closure? A. Cretinism B. Dwarfism C. Gigantism D. Acromegaly

D. Acromegaly

1. Homeostasis in the body is maintained by what is collectively known as the neuroendocrine system. What is the name of the nervous system that is involved? A. Central B. Skeletal C. Peripheral D. Autonomic

D. Autonomic

34. A child who has just had definitive repair of a high rectal malformation is to be discharged. What should the nurse address in the discharge preparation of this family? A. Safe administration of daily enemas B. Necessity of firm stools to keep suture line clean C. Bowel training beginning as soon as the child returns home D. Changes in stooling patterns to report to the practitioner

D. Changes in stooling patterns to report to the practioner

13. What clinical manifestation should be the most suggestive of acute appendicitis? A. Rebound tenderness B. Bright red or dark red rectal bleeding C. Abdominal pain that is relieved by eating D. Colicky, cramping, abdominal pain around the umbilicus

D. Colicky, cramping, abdominal pain around the umbilicus.

40. An infant is born with a gastroschisis. Care preoperatively should include which priority intervention? A. Prone position B. Sterile water feedings C. Monitoring serum laboratory electrolytes D. Covering the defect with a sterile bowel bag

D. Covering the defect with a sterile bowel bag

42. The nurse is taking care of a child who had a thyroidectomy. The nurse recognizes what as a positive Chvostek sign? A. Paresthesia occurring in feet and toes B. Frequent sharp flexion of wrist and ankle joints C. Carpal spasm elicited by pressure applied to the nerves of the upper arm D. Facial muscle spasm elicited by tapping the facial nerve in the region of the parotid gland

D. Facial muscle spasm elicited by tapping the facial nerve in the region of the parotid gland

20. What clinical manifestation is considered a cardinal sign of diabetes mellitus? A. Nausea B. Seizures C. Impaired vision D. Frequent urination

D. Frequent urination

39. The clinic nurse is assessing a child with hypopituitarism. Hypopituitarism can lead to which disorder? A. Gigantism B. Hyperthyroidism C. Cushing syndrome D. Growth hormone deficiency

D. Growth hormone deficiency

41. The nurse is preparing to administer a prescribed dose of desmopressin acetate (DDAVP) intramuscularly (IM) to a child with diabetes insipidus. What action should the nurse take before drawing the medication into a syringe? A. Mix the medication with sterile water. B. Mix the medication with sterile normal saline. C. Have another nurse double-check the medication dose. D. Hold the medication under warm water for 10 to 15 minutes and then shake vigorously.

D. Hold the medication under warm water for 10 to 15 minutes and then shake vigorously.

21. What term describes invagination of one segment of bowel within another? A. Atresia B. Stenosis C. Herniation D. Intussusception

D. Intussusception

28. The nurse is teaching an adolescent about giving insulin injections. The adolescent asks if the disposable needles and syringes can be used more than once. The nurse's response should be based on which knowledge? A. It is unsafe. B. It is acceptable for up to 24 hours. C. It is acceptable for families with very limited resources. D. It is suitable for up to 3 days if stored in the refrigerator.

D. It is suitable for up to 3 days if stored in the refrigerator.

6. A child will start treatment for central precocious puberty. What synthetic hormone will be injected? A. Thyrotropin B. Gonadotropins C. Somatotropic hormone D. Luteinizing hormone-releasing hormone

D. Luteinizing hormone-releasing hormone

20. A child with pyloric stenosis is having excessive vomiting. The nurse should assess for what potential complication? A. Hyperkalemia B. Hyperchloremia C. Metabolic acidosis D. Metabolic alkalosis

D. Metabolic alkalosis

23. A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which dietary intervention? A. Sports drink and fruit B. Glucose tabs and protein C. Glass of water and crackers D. Milk and peanut butter on bread

D. Milk and peanut butter on bread

36. Prolonged steroid therapy has caused a child to have Cushing syndrome. To lessen the cushingoid effects, the steroid should be administered at which time? A. In the PM B. After lunch C. QD in the AM D. QOD in the AM

D. QOD in the AM

42. A health care provider prescribes feedings of 1 to 2 oz Pedialyte every 3 hours and to advance to 1/2 strength Similac with iron as tolerated postoperatively for an infant who had a pyloromyotomy. The nurse should decide to advance the feeding if which occurs? A. The infant's IV line has infiltrated. B. The infant has not voided since surgery. C. The infant's mother states the infant is tolerating the feeding okay. D. The infant is taking the Pedialyte without vomiting or distention.

D. The infant is taking the pedialyte without vomiting or distention

34. What statement applies to the current focus of the dietary management of children with diabetes? A. Measurement of all servings of food is vital for control. B. Daily calculate specific amounts of carbohydrates, fats, and proteins. C. The number of calories for carbohydrates remains constant on a daily basis; protein and fat calories are liberal. D. The intake ensures day-to-day consistency in total calories, protein, carbohydrates, and moderate fat while allowing for a wide variety of foods.

D. The intake ensures day-to-day consistency in total calories, protein, carbohydrates, and moderate fat while allowing for a wide variety of foods.

25. What clinical manifestation occurs with hypoglycemia? A. Lethargy B. Confusion C. Nausea and vomiting D. Weakness and dizziness

D. Weakness and dizziness