Poopsicle

A parent of a 7-year-old girl with a repaired ventricular septal defect (VSD) calls the cardiology clinic and reports that the child is just not herself. Her appetite is decreased, she has had intermittent fevers around 38° C (100.4° F), and now her muscles and joints ache. Based on this information, how should the nurse advise the mother? a. Immediately bring the child to the clinic for evaluation. b. Come to the clinic next week on a scheduled appointment. C. Treat the signs and symptoms with acetaminophen and fluids because it is most likely a viral illness. d. Recognize that the child is trying to manipulate the parent by complaining of vague symptoms.

A

Heart failure (HF) is a problem after the child has had a congenital heart defect repaired. The nurse knows a sign of HF is what? 2. Wheezing b. Increased blood pressure C. Increased urine output d. Decreased heart rate

A

The nurse is talking to the parent of a child with special needs. The parent has expressed worry about how to support the siblings at home. What suggestion is appropriate for the nurse to give to the parent? "You should help the siblings see the similarities and differences between themselves and your child with special needs." b. "You should explain that your child with special needs should be included in all activities that the siblings participate in even if they are reluctant." "You should give the siblings many caregiving tasks for your child with special needs so the siblings feel involved." You should intervene when there are differences between your child with special needs and the siblings."

A

What nursing intervention is most appropriate in promoting normalization in a school-age child with a chronic illness? a. Give the child as much control as possible. b. Ask the child's peer to make the child feel normal. C. Convince the child that nothing is wrong with him or her. d. Explain to parents that family rules for the child do not need to be the same as for healthy siblings.

A

When is an autopsy required? a. In the case of a suspected suicide b. When a person has a known terminal illness With a hospice patient who dies at home d. With the victim of a motor vehicle collision

A

The nurse is planning care for a 3-year-old boy who has Down syndrome and is on continuous oxygen. He recently began walking around furniture. He is spoon fed by his parents and eats some finger foods. What goal is the most appropriate to promote normal development? A. Encourage mobility. b. Encourage assistance in self-care. C. Promote oral-motor development. d. Provide opportunities for socialization.

ANS: A A major principle for developmental support in children with complex medical issues is that it should be flexible and tailored to the individual childs abilities, interests, and needs. This child is exhibiting readiness for ambulation. It is an appropriate time to provide activities that encourage mobility, for example, longer oxygen tubing. Parents should provide decreasing amounts of assistance with self-care as he is able to develop these skills. The boy is receiving oral foods and is eating finger foods. He has acquired this skill. Mobility is a new developmental task. Opportunities for socialization should be ongoing.

The parents of a child born with disabilities ask the nurse for advice about discipline. The nurse's response should be based on remembering that discipline is which? a. Essential for the child b. Not needed unless the child's behavior becomes problematic C. Best achieved with punishment for misbehavior d. Too difficult to implement with a special needs child

ANS: A Discipline is essential for the child. It provides boundaries on which she can test out her behavior and teaches her socially acceptable behaviors. The nurse should teach the parents ways to manage the childs behavior before it becomes problematic. Punishment is not effective in managing behavior.

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."

ANS: A If the testes do not descend spontaneously, orchiopexy is performed before the child's second birthday, preferably between 1 and 2 years of age. Surgical repair is done to (1) prevent damage to the undescended testicle by exposure to the higher degree of body heat in the undescended location, thus maintaining future fertility; (2) decrease the incidence of malignancy formation, which is higher in undescended testicles; (3) avoid trauma and torsion; (4) close the processus vaginalis; and (5) prevent the cosmetic and psychologic disability of an empty scrotum. Parents understand the teaching if they respond the surgery is done to prevent damage.

What manifestation observed by the nurse is suggestive of parental overprotection? a. Gives inconsistent discipline. b. Facilitates the child's responsibility for self-care of illness. C. Persuades the child to take on activities of daily living even when not able D. Encourages social and educational activities not appropriate to the child's level of capability.

ANS: A Parental overprotection is manifested when the parents fear letting the child achieve any new skill, avoid all discipline, and cater to every desire to prevent frustration. Overprotective parents do not allow the child to assume responsibility for self-care of the illness. The parents prefer to remain in the role of total caregiver. The parents do not encourage the child to participate in social and educational activities.

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

ANS: A The expected pH ranges from 4.8 to 7.8. A pH of 4.0 can be indicative of urinary tract infection or metabolic alkalosis or acidosis. Less than 1 or 2 white blood cells per milliliter is the expected range. The absence of protein is expected. The presence of protein can be indicative of glomerular disease. A specific gravity of 1.020 is within the anticipated range of 1.001 to 1.030. Specific gravity reflects level of hydration in addition to renal disorders and hormonal control such as antidiuretic hormone.

The health care provider suggests surgery be performed for ventricular septal defect to prevent what complication? a. Pulmonary hypertension b. Right-to-left shunt of blood C. Pulmonary embolism d. Left ventricular hypertrophy

ANS: A Congenital heart defects with a large left-to-right shunt (e.g., in ventricular septal defect, patent ductus arteriosus, or complete AV canal), which cause increased pulmonary blood flow, may result in pulmonary hypertension. If these defects are not repaired early, the high pulmonary flow will cause changes in the pulmonary artery vessels, and the vessels will lose their elasticity. The blood does not shunt right to left, a pulmonary embolism is not a complication of ventricular septal defect, and the left ventricle does not hypertrophy.

A 5-year-old child will be starting kindergarten next month. She has cerebral palsy, and it has been determined that she needs to be in a special education classroom. Her parents are tearful when telling the nurse about this and state that they did not realize her disability was so severe. What is the best interpretation of this situation? a. This is a sign the parents are in denial. b. This is a normal anticipated time of parental stress. C. The parents need to learn more about cerebral palsy. d. The parents' expectations are too high.

ANS: B Parenting a child with a chronic illness can be stressful. At certain anticipated times, parental stress increases. One of these identified times is when the child begins school. Nurses can help parents recognize and plan interventions to work through these stressful periods. The parents are not in denial; rather, they are responding to the childs placement in school. The parents are not exhibiting signs of a remembering deficit; this is their first interaction with the school system with this child.

What is a principle of palliative care that can be included in the care of children? a. Maintenance of curative therapy b. Child and family as the unit of care c. Exclusive focus on the spiritual issues the family faces d. Extensive use of opiates to ensure total pain control

ANS: B The principles of palliative care involve a multidisciplinary approach to the management of a terminal illness or the dying process that focuses on symptom control and support rather than on cure or life prolongation in the absence of the possibility of a cure. In pediatric palliative care, the focus of care is on the family. Palliative care requires the transition from curative to palliative care. The transition occurs when the likelihood of cure no longer exists. Spiritual issues are just one of the foci of palliative care. The multidisciplinary team focuses on physical, emotional, and social issues as well. Pain control is a priority in palliative care. The use of opiates is balanced with the side effects caused by this class of drugs.

An 8-year-old girl has been uncooperative and angry since the diagnosis of cancer was made. Her parents tell the nurse that they do not know what to do "because she is always so mad at us." What nursing action is most appropriate at this time? a. Explain to child that anger is not helpful. b. Help the parents deal with her anger constructively. C. Ask the parents to find out what she is angry about. d. Encourage the parents to ignore the anger at this time.

ANS: B To school-age children, chronic illness and dying represent a loss of control. This threat to their sense of security and ego strength can be manifested by verbal uncooperativeness. The child can be viewed as impolite, insolent, and stubborn. The best intervention is to encourage children to talk about feelings and give control where possible. Verbal explanations would not be heard by the child. The child may not be cognizant of the anger. Ignoring the anger will not help the child gain some control over the events.

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

ANS: B Urinalysis during the acute phase characteristically shows hematuria, proteinuria, and increased specific gravity. Proteinuria generally parallels the hematuria but is not usually the massive proteinuria seen in nephrotic syndrome. Gross discoloration of urine reflects its red blood cell and hemoglobin content. Microscopic examination of the sediment shows many red blood cells, leukocytes, epithelial cells, and granular and red blood cell casts. Bacteria are not seen, and urine culture results are negative.

The nurse is preparing to give digoxin (Lanoxin) to a 9-month-old infant. The nurse checks the dose and draws up 4 mL. of the drug. The most appropriate nursing action is which? Mix the dose with juice to disguise its taste. b. Do not give the dose; suspect a dosage error. C. Check the heart rate; administer digoxin if the rate is greater than 100 beats/min. d Check the heart rate; administer digoxin if the rate is greater than 80 beats/min.

ANS: B Infants rarely receive more than 1 ml (50 mcg, or 0.05 mg) of digoxin in one dose; a higher dose is an immediate warning of a dosage error. To ensure safety, compare the calculation with that of another staff member before giving digoxin.

What sign/symptom is a major clinical manifestation of rheumatic fever (RF)? a. Fever b. Polyarthritis C. Osler nodes d. Janeway spots

ANS: B Polyarthritis, which is swollen, hot, red, and painful joints, is a major clinical manifestation. The affected joints will change every 1 or 2 days. The large joints are primarily affected. Fever is considered a minor manifestation of RF. Osler nodes and Janeway spots are characteristic of bacterial endocarditis.

What preparation should the nurse consider when educating a school-age child and the family for heart surgery? a. Unfamiliar equipment should not be shown. b. Let the child hear the sounds of a cardiac monitor, including alarms. C. Explain that an endotracheal tube will not be needed if the surgery goes well. d. Discussion of postoperative discomfort and interventions is not necessary before the procedure.

ANS: B The child and family should be exposed to the sights and sounds of the intensive care unit (ICU). All positive, nonfrightening aspects of the environment are emphasized. The family and child should make the decision about a tour of the unit if it is an option. The child should be shown unfamiliar equipment and its use demonstrated on a doll. Carefully prepare the child for the postoperative experience, including intravenous lines, incision, endotracheal tube, expected discomfort, and management strategies.

The nurse notices that a child is increasingly apprehensive and has tachycardia after heart surgery. The chest tube drainage is now 8 mL/kg/hr. What should be the nurse's initial intervention? a. Apply warming blankets. b. Notify the practitioner of these findings. C. Give additional pain medication per protocol. d. Encourage child to cough, turn, and deep breathe.

ANS: B The practitioner is notified immediately. Increases of chest tube drainage to more than 3 ml/kg/hr for more than 3 consecutive hours or 5 to 10 ml/kg in any 1 hour may indicate postoperative hemorrhage. Increased chest tube drainage with apprehensiveness and tachycardia may indicate cardiac tamponade—blood or fluid in the pericardial space constricting the heart—which is a life-threatening complication. Warming blankets are not indicated at this time. Additional pain medication can be given before the practitioner drains the fluid, but the notification is the first action. Encouraging the child to cough, turn, and deep breathe should be deferred until after evaluation by the practitioner.

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.

ANS: C After repair of the bladder exstrophy, the child's bladder is allowed to increase capacity. Several surgical procedures may be necessary to create a urethral sphincter mechanism to aid in urination and ejaculation. With the lack of a urinary sphincter, toilet training is unlikely. The child cannot hold the urine in the bladder. Bladder capacity is one component of continence. A functional sphincter is also needed.

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.

ANS: C Blood pressure monitoring is essential to identify acute hypertension, which is treated aggressively. Antibiotic therapy is usually not indicated for glomerulonephritis. Hypertension, not hypotension, is a concern in glomerulonephritis. Blood pressure control is essential to prevent further renal damage. Blood pressure fluctuations do not provide information about the chronicity of the disease.

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

ANS: C Dietary phosphorus may need to be restricted by limiting protein and milk intake. Substances that bind phosphorus are given with meals to prevent its absorption, which enables a more liberal intake of phosphorus-containing protein. Protein is limited to the recommended daily allowance for the child's age. Further restriction is thought to negatively affect growth and neurodevelopment. Vitamin D therapy is administered in children with CRF to increase calcium absorption. Supplementation of vitamins A, E, and K, beyond normal dietary intake, is not advised in children with CRF. These fat-soluble vitamins can accumulate.

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)

ANS: C Girls between the ages of 2 and 6 years are considered high risk for UTIs. This child is showing signs of a UTI, including incontinence in a toilet-trained child and possible urinary frequency or urgency. A physiologic cause should be ruled out before psychosocial factors are investigated. Glomerulonephritis usually manifests with decreased urinary output and fluid retention. ADHD can contribute to urinary incontinence because the child is distracted, but the first manifestation was incontinence, not distractibility.

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.

ANS: C Peritoneal dialysis is the preferred form of dialysis for parents, infants, and children who wish to remain independent. Parents and older children can perform the treatments themselves. Protein loss is not significantly different. The dietary limitations are necessary, but they are not as stringent as those for hemodialysis. Treatments are needed more frequently but can be done at home.

The nurse observes that a seriously ill child passively accepts all painful procedures. The nurse should recognize that this is most likely an indication that the child is experiencing what emotional response? a. Hopefulness b. Chronic sorrow c. Belief that procedures are a deserved punishment d. - Understanding that procedures indicate impending death

ANS: C The nurse should be particularly alert to a child who withdraws and passively accepts all painful procedures. This child may believe that such acts are inflicted as deserved punishment for being less worthy. A child who is hopeful is mobilized into goal-directed actions. This child would actively participate in care. Chronic sorrow is the feeling of sorrow and loss that recurs in waves over time. It is usually evident in the parents, not in the child. The seriously ill child would actively participate in care. Nursing interventions should be used to minimize the pain.

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

ANS: C Urinary stasis is the single most important host factor that influences the development of UTIs. Urine is usually sterile but at body temperature provides an excellent growth medium for bacteria. Poor hygiene can be a contributing cause, especially in females because their short urethras predispose them to UTIs. Urinary stasis then provides a growth medium for the bacteria. Intermittent constipation contributes to urinary stasis. A full rectum displaces the bladder and posterior urethra in the fixed and limited space of the bony pelvis, causing obstruction, incomplete micturition, and urinary stasis. Congenital anomalies can contribute to UTIs, but urinary stasis is the primary factor in many cases.

The test that provides the most reliable evidence of recent streptococcal infection is which? a. Throat culture b. Mantoux test c. Antistreptolysin O test d. Elevation of liver enzymes

ANS: C Antistreptolysin O (ASLO) titers measure the concentration of antibodies formed in the blood against this product. Normally, the titers begin to rise about 7 days after onset of the infection and reach maximum levels in 4 to 6 weeks. Therefore, a rising titer demonstrated by at least two ASLO tests is the most reliable evidence of recent streptococcal infection.

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

ANS: C Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of blood urea nitrogen are complications of chronic renal failure.

What action by the school nurse is important in the prevention of rheumatic fever (RF)? a. Encourage routine cholesterol screenings. b. Conduct routine blood pressure screenings. C. Refer children with sore throats for throat cultures. d. Recommend salicylates instead of acetaminophen for minor discomforts.

ANS: C Nurses have a role in prevention, primarily in screening school-age children for sore throats caused by group A streptococci. They can actively participate in throat culture screening or refer children with possible streptococcal sore throats for testing. Routine cholesterol screenings and blood pressure screenings do not facilitate the recognition and treatment of group A hemolytic streptococci. Salicylates should be avoided routinely because of the risk of Reye syndrome after viral illnesses.

What child has a cyanotic congenital heart defect? An infant with patent ductus arteriosus b. A 1-year-old infant with atrial septal defect C. A 2-month-old infant with tetralogy of Fallot d A 6-month-old infant with repaired ventricular septal defect

ANS: C Tetralogy of Fallot is a cyanotic congenital heart defect. Patent ductus arteriosus, atrial septal defect, and ventricular septal defect are acyanotic congenital heart defects.

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? 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.

ANS: D Gender assignment is a complex decision-making process. Endocrine, genetic, social, psychologic, and ethical elements of sex assignment have been integrated into the process. Parent participation is included. The goal is to enable the affected child to grow into a well-adjusted, psychosocially stable person. Chromosome analysis usually takes 2 or 3 days. A physical examination reveals ambiguous genitalia, but additional testing is necessary. A "correct" gender may not be identifiable.

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.

ANS: D Hematuria is consistently present with renal trauma. It does not provide a reliable indicator of the seriousness of the renal injury. Flank pain results from bleeding around the kidney. Most injuries that cause renal trauma in children are of the nonpenetrating or blunt type and usually involve falls, athletic injuries, and motor vehicle accidents. In children, the kidneys are more mobile, and the outer borders are less protected than in adults.

Parents ask for help for their other children to cope with the changes in the family resulting from the special needs of their sibling. What strategy does the nurse recommend? a. Explain to the siblings that embarrassment is unhealthy. b. Encourage the parents not to expect siblings to help them care for the child with special needs. C. Provide information to the siblings about the child's condition only as requested. d. Invite the siblings to attend meetings to develop plans for the child with special needs.

ANS: D Siblings should be invited to attend meeting to be part of the care team for the child. They can learn about an individualized education plan and help design strategies that will work at home. Embarrassment may be associated with having a sibling with a chronic illness or disability. Parents must be able to respond in an appropriate manner without punishing the sibling. The parents may need assistance with the care of the child. Most siblings are positive about the extra responsibilities. Parents need to inform the siblings about the childs condition before a nonfamily member does so. The parents do not want the siblings to fantasize about what is wrong with the child.

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

ANS: D Symptoms of bladder obstruction include poor force of urinary stream, intermittency of voided stream, feelings of incomplete bladder emptying, and posturination dribbling. They may also include urinary frequency, nocturia, nocturnal enuresis, and urgency. Renal colic is a symptom of upper urinary tract obstruction. Children with bladder obstruction have a weak urinary stream. Urinary tract infections are not associated with bladder obstruction.

The parents of a young child with heart failure (HF) tell the nurse that they are nervous about giving digoxin. The nurse's response should be based on which knowledge? a. It is a safe, frequently used drug. b. Parents lack the expertise necessary to administer digoxin. C. It is difficult to either overmedicate or undermedicate with digoxin. d. Parents need to learn specific, important guidelines for administration of digoxin.

ANS: D Digoxin has a narrow therapeutic range. The margin of safety between therapeutic, toxic, and lethal doses is very small. Specific guidelines are available for parents to learn how to administer the drug safely and to monitor for side effects. Parents may lack the expertise to administer the drug at first, but with discharge preparation, they should be prepared to administer the drug safely.

A 6-month-old infant presents to the clinic with failure to thrive, a history of frequent respiratory infections, and increasing exhaustion during feedings. On physical examination, a systolic murmur is detected, no central cyanosis, and chest radiography reveals cardiomegaly. An echocardiogram is done that shows left-to-right shunting. This assessment data is characteristic of what? a. Tetralogy of Fallot b. Coarctation of the aorta C. Pulmonary stenosis d. Ventricular septal defect

ANS: D Heart failure is common with ventricular septal defect that causes failure to thrive, respiratory infections, and an increase in exhaustion during feedings. There is a characteristic murmur. The other defects do not have left-to-right shunting.

What nutritional component should be altered in the infant with heart failure (HF)? a. Decrease in fats b. Increase in fluids c. Decrease in protein d. Increase in calories

ANS: D Infants with HF have a greater metabolic rate because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of average infants, yet their ability to take in calories is diminished by their fatigue. The diet should include increased protein and increased fat to facilitate the child's intake of sufficient calories. Fluids must be carefully monitored because of the HF.

A 12-year-old boy is in the final phase of dying from leukemia. He tells the nurse who is giving him opiates for pain that his grandfather is waiting for him. How should the nurse interpret this situation? a. The boy is experiencing side effects of the opiates. b. The boy is making an attempt to comfort his parents. C. He is experiencing hallucinations resulting from brain anoxia. d. He is demonstrating readiness and acceptance that death is near.

ANS: D Near the time of death, many children experience visions of "angels" or people and talk with them. The children mention that they are not afraid and that someone is waiting for them. If the child has built a tolerance to the opioids, side effects are not likely. At this time, many children do begin to comfort their families and tell them that they are not afraid and are ready to die, but the visions usually precede this stage. There is no evidence of tissue hypoxia.

A 3-month-old infant has a hypercyanotic spell. What should be the nurse's first action? a. Assess for neurologic defects. b. Prepare the family for imminent death. C. Begin cardiopulmonary resuscitation. d. Place the child in the knee-chest position.

ANS: D The first action is to place the infant in the knee-chest position. Blow-by oxygen may be indicated. Neurologic defects are unlikely. Preparing the family for imminent death or beginning cardiopulmonary resuscitation should be unnecessary. The child is assessed for airway, breathing, and circulation. Often, calming the child and administering oxygen and morphine can alleviate the hypercyanotic spell.

The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood. What nursing action is most appropriate to institute initially? a. Notify the physician. b. Place the child in Trendelenburg position. C. Apply a new bandage with more pressure. d. Apply direct pressure above the catheterization site.

ANS: D When bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure on the vessel puncture. The physician can be notified, and a new bandage with more pressure can be applied after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. Trendelenburg positioning would not be a helpful intervention. It would increase the drainage from the lower extremities.

What nursing consideration is important when suctioning a young child who has had heart surgery? a. Perform suctioning at least every hour. b. Suction for no longer than 30 seconds at a time. C. Expect symptoms of respiratory distress when suctioning. d. Administer supplemental oxygen before and after suctioning.

ANS: D When suctioning is indicated, supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia. Suctioning should be done only as indicated and very carefully to avoid vagal stimulation. The child should be suctioned for no more than 5 seconds at a time. Symptoms of respiratory distress are avoided by using appropriate technique.

A 16-year-old boy with a chronic illness has recently become rebellious and is taking risks such as missing doses of his medication. What should the nurse explain to his parents? a. That he needs more discipline. b. That this is a normal part of adolescence. C. That he needs more socialization with peers. d. That this is how he is asking for more parental control.

B

A child with heart failure is on Lanoxin (digoxin). The laboratory value a nurse must closely monitor is which? Serum sodium b. Serum potassium C. d. Serum glucose Serum chloride

B

An infant has tetralogy of Fallot. In reviewing the record, what laboratory result should the nurse expect to be documented? a. Leukopenia b. Polycythemia C.Anemia d. Increased platelet level

B

An infant is diagnosed with transposition of the great vessels. Prostaglandin El is given intravenously. The parents ask how long the child will remain on the prostaglandin El. What is the appropriate response by the nurse? a. Prostaglandin El will be given intermittently until corrective surgery is performed. b. Prostaglandin El will be given continuously until corrective surgery is performed. C. Prostaglandin El will be given continuously throughout the preoperative and postoperative periods until the child is stable. d Prostaglandin El will be given intermittently throughout the preoperative and postoperative periods until the child is stable.

B

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes the potential risk of a cerebrovascular accident (stroke). What strategy is an important objective to decrease this risk? a. Minimize seizures. b. Prevent dehydration. C. Promote cardiac output. d. Reduce energy expenditure.

B

The nurse is making a home visit 48 hr after the death of an infant from sudden infant death syndrome (SIDS). What intervention is an appropriate objective for this visit? a. Give contraceptive information. b. Provide information on the grief process. c. Reassure parents that SIDS is not likely to occur again. d. Thoroughly investigate the home situation to verify SIDS as the cause of death.

B

The nurse is providing support to a family that is experiencing anticipatory grief related to their child's imminent death. What statement by the nurse is therapeutic? A. "Your other children need you to be strong." b. "You have been through a very tough time." C. "His suffering is over; you should be happy." D. "God never gives us more than we can handle.

B

The parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. How should the nurse reply to this concern? The parents should meet all the child's needs h. The child needs opportunities to play with peers C. Constant parental supervision is needed to avoid overexertion, The child needs to understand that peers activities are too strenuous

B

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

B

When communicating with dying children, what should the nurse remember? a. Adolescent children tend to be concrete thinkers. b. Games, art, and play provide a good means of expression. When children can recite facts, they understand the implications of those facts. d. If children's questions direct the conversation. the assessment will be incomplete.

B

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 Mannitol (Osmitrol) or furosemide (Lasix) (or both) d. Sodium, chloride, and potassium

C

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. Promote adherence to the antibiotic regimen.

C

In teaching the parent of à 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

Parents tell the nurse they do not want to let their school-age child know his illness is terminal. What response should the nurse make to the parents? "Have you discussed this with your health care provider? b. "I would do the same thing in your position; it is better the child doesn't know." C. "I understand you want to protect your child, but often children realize the serousness of their illness. "I praise you for that decision; it can be so difficult to be truthful about the serousness of your son's illness."

C

What medication used to treat heart failure (HF) is a diuretic? a. Captopril (Capten) b. Digoxin (Lanoxin) C. Hydrochlorothiazide(Diuril) d. Carvedilol (Coreg)

C

How might the quality of life for a terminally ill child and his family be enhanced by nurses? a. Tell the familv what is best. b. Leave the family alone to deal with their tragedy. c. Remain objective and uninvolved with family grieving d. Advocate for and implement pain and symptom relief measures.

D

Several nurses tell their nursing supervisor that they want to attend the funeral of a child for whom they had cared. They say they felt especially close to both the child and the family. The supervisor should recognize that attending the funeral serves what purpose? a. It is improper because it increases burnout. b. It is inappropriate because it is unprofessional. It is proper because families expect this expression of concern. d. It is appropriate because it can assist in the resolution of personal grief.

D

The diagnosis of hypertension depends on accurate assessment of blood pressure (BP). What is the appropriate technique to measure a child's BP? a. Assess BP while the child is standing. b. Compare left arm with left leg BP readings. C. Use a narrow cuff to ensure that the readings are correct. d. Serial measurements with child in sitting position with feet on the floor.

D

The nurse outlines short- and long-term goals for a 10-year-old child with many complex health problems. Who should agree on these goals? a. Family and nurse b. Child, family, and nurse All professionals involved d. Child, family, and all professionals involved

D

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

D

What recommendation should the nurse make to prevent urinary tract infections (UTIs) in 7-year-old child weighing 25 kg? a. Ensure clear liquid intake of 2000 mL/day. b. Ensure clear liquid intake of 2400 mL/day. c. Ensure clear liquid intake of 1200 mL/day. d. Ensure clear liquid intake of 1600 mL/day.

D

When caring for the child with Kawasaki disease, what should the nurse know to provide safe and effective care? a. Aspirin is contraindicated. b. The principal area of involvement is the joints. C. The child's fever is usually responsive to antibiotics within 48 hr. d. Therapeutic management includes administration of gamma globulin and salicylates.

D