Prep- U for Exam 2 Peds

The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTIs). The caregiver is puzzled about why her daughter has had three urinary tract infections but her son has had none. She reports that their diets and fluid intake is similar. Which statement would be accurate for the nurse to tell this mother? "Girls tend to urinate less frequently than boys, making them more susceptible to UTI's." "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." "It is unlikely that your daughter is practicing good cleaning habits after she voids." "Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C."

"A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." Many different bacteria may infect the urinary tract, and intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. The female urethra is shorter and straighter than the male urethra, so it is more easily contaminated with feces.

A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent? "Taking warm baths will help relax muscles and reduce pain." "Applying ice to the area will reduce the pain and swelling." "Elevate the legs, and use bed rest for 24 hours." "Apply ice to the injury for 60 minutes on and 60 minutes off."

"Applying ice to the area will reduce the pain and swelling."

The nurse is caring for a child recently fitted with braces on both legs due to cerebral palsy (CP). What would the nurse emphasize in the discharge teaching? "It is very important to comply with the use of this brace." "Check the skin that is covered by the braces for redness and breakdown." "Please try and follow the therapist's on and off schedule." "If the brace is painful, feel free to take it off."

"Check the skin that is covered by the braces for redness and breakdown."

A 6-year-old has had a viral infection for the past 5 days and is having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which question? "How high did his temperature rise when he was ill?" "What type of fluids did your child take when he had a fever?" "Did you give your child any acetaminophen, such as Tylenol?" "Did you use any medications, like aspirin, for the fever?"

"Did you use any medications like aspirin for the fever?" Severe and continual vomiting, changes in mental status, lethargy, and irritability are some of the signs and symptoms of Reye syndrome, which can occur as a result of ingesting aspirin or aspirin-containing products during a viral infection. Tylenol (acetaminophen) is allowed for viral infections in the school-age child. The type of fluids consumed during the illness has nothing to do with Reye syndrome. The temperature rise would be important for a much younger child because of the chance of febrile seizures, but not in this age child.

The nurse is teaching glucose monitoring and insulin administration to a child with type 1 diabetes and the parents. Which comment by a parent demonstrates a need for additional teaching? "Blood glucose level, food intake, and activity need to all be considered when calculating insulin dosage." "If our child is sick we should check blood glucose levels more often." "We should check our child's blood glucose levels before meals." "During exercise we should wait to check blood sugars until after our child completes the activity."

"During exercise we should wait to check blood sugars until after our child completes the activity." Blood glucose monitoring needs to be performed more often during prolonged exercise. Frequent glucose monitoring before, during, and after exercise is important to recognize hypoglycemia or hyperglycemia. Frequent glucose monitoring if the child is sick is also important to recognize changes in glucose levels and prevent hypoglycemia or hyperglycemia. The parents are correct that they will check their child's glucose before meals; they should also check it before bedtime snacks. Blood glucose level should never be the only factor considered when calculating insulin dosing. Food intake and recent or expected activity/exercise must be factored in.

The nurse helps position a child for a lumbar puncture. Which statement describes the correct positioning for this procedure? "For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back." "The child will be placed in the prone position with the nurse holding the child still." "The child will be held by the mother on her lap with his back toward the health care provider." "When positioning the child, the nurse needs to assist the child to a side-lying position and keep his back as flat as much as possible."

"For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back."

The nurse is collecting data from the caregivers of a child admitted with seizures. Which statement indicates the child most likely had an absence seizure? "He usually is very coordinated, but he couldn't even walk without falling." "His arms had jerking movements in his legs and face." "He was just staring into space and was totally unaware." "He kept smacking his lips and rubbing his hands."

"He was just staring into space and was totally unaware."

The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education? "I need to set an alarm to wake up and check his temperature during the night when he is sick." "I hate to think that I will need to be worried about my child having seizures for the rest of his life." "The next time he has a fever, I need to make sure I read the dosage on the acetaminophen bottle carefully." "When he gets his next set of immunizations, I need to make sure I give him some ibuprofen so he doesn't spike a fever."

"I hate to think that I will need to be worried about my child having seizures for the rest of his life."

The nurse has performed client education for a 15-year-old boy with Crohn disease and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning has occurred? "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines." "I have to be careful because I am prone to not absorbing nutrients." "It's unusual for someone my age to get Crohn disease." "I have a lot of diarrhea every day because of how my small intestine is damaged."

"I have to be careful because I am prone to not absorbing nutrients."

The nurse is providing teaching to the parents of a child recently prescribed carbamazepine for a seizure disorder. Which statement by a parent indicates successful teaching? "I will give the medication to him when I first wake him up in the morning." "I need to watch for any new bruises or bleeding and let my health care provider know about it." "This medication may cause him to have trouble sleeping. He may need something else to help him sleep." "I'm glad to know he will only need this medication for a short time to stop his seizures."

"I need to watch for any new bruises or bleeding and let my health care provider know about it." Carbamazepine is an antiseizure medication. It can cause bone marrow depression, so parents need to watch for any signs of bruising, bleed, or infection and notify their health care provider if this happens. Administer this medication with food to minimize GI upset. This medication can cause drowsiness, so do not give any sleep-inducing or other sedative type medications. Antiseizure medication does not cure seizures; it only controls the seizures. Lifelong antiseizure medication may be needed.

A nurse caring for an infant born with a cleft palate notices that the parents rarely interact with their child. The nurse overhears the mother telling her spouse that she "feels like crying" every time she looks at their infant. What would be the best response from the nurse? "Many infants are born with this condition. Your infant's palate is not nearly as bad as some cases." "Keep in mind that your infant's condition is not life-threatening and can be corrected eventually." "Your infant needs you right now. You should put your negative feelings about the condition aside for your infant's sake." "I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?"

"I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?"

The parents of a 17-year-old adolescent diagnosed with bacterial meningitis tell the nurse, "We just do not understand how this could have happened. Our adolescent has always been healthy and just received a booster vaccine last year." How should the nurse respond? "Maybe your child's immune system is not strong enough to fight off the infection, even with having received the vaccine." "Your child may have been exposed to the type of meningitis that is not covered by the vaccine received." "I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection." "Meningococcal conjugate vaccine covers only two types of bacterial meningitis."

"I understand your frustration. Unfortunately immunizations are not 100% effective in preventing the infection."

The nurse is caring for an infant recently diagnosed with oral candidiasis (thrush) who has been prescribed nystatin. Which statement by the infant's mother would suggest a need for further education? "I will make sure to clean all of her toys before I give them to her." "I will watch for diaper rash." "I will use a cotton tipped applicator to apply the medication to her mouth." "I will add the nystatin to her bottle four times per day."

"I will add the nystatin to her bottle four times per day."

The nurse is discharging a client diagnosed with bacterial vaginosis. Which statement would indicate to the nurse that the client has a correct understanding of the discharge instructions? "I do not have to worry about speeding this infection to my partner." "If I suspect anything, I will be sure to use soap and water after sex." "I will always use a condom with any further sexual encounters." "I do not need to see my health care provider for this infection."

"I will always use a condom with any further sexual encounters." Using condoms with every sexual encounter can help to prevent recurrence and the spread of disease. Bacterial vaginosis is transmittable to sexual partners, and washing in soap and water does not stop the transmission of the disease. If a client suspects an infection, he or she should see a health care provider or clinic.

The student nurse is caring for a child with the nursing diagnosis "Risk for fluid volume deficit related to inadequate oral intake." Which statement by the student would indicate a need for further education by the nursing instructor? "I will weigh her every morning at the same time." "I will teach her mother to give her small drinks frequently." "I will monitor her IV line to help maintain her fluid volume." "I will make sure there is plenty of orange juice available. It's her favorite juice."

"I will make sure there is plenty of orange juice available. It's her favorite juice." Proper interventions for children at risk for fluid volume deficit include maintaining IV line and administer IV fluid as ordered to maintain fluid volume. Offer small amounts of oral rehydration solution frequently to maintain fluid volume. Small amounts are usually well tolerated by children with diarrhea and vomiting. Avoid high-carbohydrate fluids such as Kool-Aid and fruit juice, as they are low in electrolytes, and increased simple carbohydrate consumption can decrease stool transit time. Daily weights are one of the best indicators of fluid volume status in children.

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with sickle cell disease. The nurses in the group make the following statements. Which statement is most accurate regarding this condition? "The trait or the disease is seen in one generation and skips the next generation." "The disease is most often seen in individuals of Asian decent." "Males are much more likely to have the disease than females." "If the trait is inherited from both parents the child will have the disease."

"If the trait is inherited from both parents the child will have the disease." When the trait is inherited from both parents (homozygous state), the child has sickle cell disease, and anemia develops. The trait does not skip generations. The trait occurs most commonly in black clients. Either sex can have the trait and disease.

The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate? "This is the most common facial nerve palsy." "In most cases treatment is not necessary, only observation." "Was this from pressure resulting from forceps?" "Have you seen any signs of improvement?"

"In most cases treatment is not necessary, only observation."

The parent of a 3-week-old infant brings the infant in for an evaluation. During the visit, the parent tells the nurse that the infant is spitting up after feedings. Which response by the nurse would be most appropriate? "Thicken the formula by adding rice cereal." "Infants this age commonly spit up." "Your child might have an allergy." "Do not worry; you are just feeding your infant too much."

"Infants this age commonly spit up." In infants younger than 1 month of age, the lower esophageal sphincter is not fully developed. Therefore, infants younger than 1 month of age frequently regurgitate after feedings. Many children younger than 1 year of age continue to regurgitate for several months, but this usually disappears with age. Adding rice cereal to the infant formula should only be done when medically indicated and under the recommendation of a health care provider. The parent's report is not a cause for concern, so the health care provider does not need to be notified. Additional information would be needed to determine if the infant had an allergy. Although the infant's stomach capacity is small, telling the parent not to worry does not address the parent's concern, and telling the parent that he or she is feeding the child too much implies that he or she is doing something wrong.

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals? "It is important to correct spinal curvature before it gets too bad, causing you problems." "It is important to prevent herniation of a spinal disk, which is painful." "It is important to prevent torticollis." "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms."

"It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms."

The mother of a young child who has been treated for a bacterial urinary tract infection tells the nurse her daughter has a white thick covering over her tongue. The mother states that she "has tried everything to get it off my child's tongue." How should the nurse respond? "Have you tried using a toothbrush to get it off?" "It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated." "That is a common side effect after taking an antibiotic. It will go away after the antibiotic is out of the system." "It is likely an infection was caused by the antibiotic for the urinary tract infection. I am sure a different antibiotic will help it."

"It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated." Oral candidiasis (thrush) is a fungal infection that can occur on the tongue while on an antibiotic for an unrelated bacterial infection. The antibiotic destroys normal flora, which allows the fungal infection to occur. Thrush requires an antifungal agent, such as nystatin liquid, to destroy the infection. Additional antibiotics will not help since it is a fungal infection.

A child and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true? "This will rectify itself if you follow all of the doctor's directions." "You are lucky that you did not have to learn how to give yourself a shot." "Kids can usually be managed with an oral agent, meal planning, and exercise." "A weight-loss program should be implemented and maintained."

"Kids can usually be managed with an oral agent, meal planning, and exercise." Treating type 2 diabetes in children may require insulin at the outset if the child is acidotic and acutely ill. More commonly, the child can be managed initially with oral agents, meal planning, and increasing activity. Telling the child that she is lucky she did not have to learn how to give a shot might scare her so it will inhibit her from seeking future health care. The condition will not rectify itself if all orders are followed. A weight-loss program might need to be implemented but that is not always the case

An adolescent client who has scoliosis and is wearing a Milwaukee brace tells the nurse that she is ugly and cannot wear the same clothing as her friends. Which response by the nurse best addresses this client's altered self-image? "Kids can be cruel sometimes. Has anyone told you that you look different?" "Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it." "You should not worry about what everyone else is wearing. You look fine." "Just hold your head up and be confident in how you look. Look for some after-school activities you can do wearing your brace."

"Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it."

The nurse is teaching a group of caregivers of children diagnosed with diabetes. The nurse is explaining insulin shock and the caregivers make the following statements. Which statement indicates the best understanding of a reason an insulin reaction might occur? "My child measures their own medication but sometimes doesn't administer the correct amount." "My child monitors their glucose levels to keep them from going too high." "On the weekends we encourage our child to participate in lots of sports activities and stay busy so they don't have an insulin reaction." "If my child eats as much as their older brother eats they could have an insulin reaction."

"My child measures their own medication but sometimes doesn't administer the correct amount." Insulin reaction (insulin shock, hypoglycemia) is caused by insulin overload, resulting in too-rapid metabolism of the body's glucose. This may be attributable to a change in the body's requirement, carelessness in diet (such as failure to eat proper amounts of food), an error in insulin measurement, or excessive exercise.

The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron-deficiency anemia. One of the caregivers tells the group, "I give my child ferrous sulfate." Which statement made by the caregivers is correct regarding giving ferrous sulfate? "I always give the ferrous sulfate with meals." "We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate." "When I give my son ferrous sulfate I know he also needs potassium supplements." "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C."

"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." When ferrous sulfate is administered, it should be given between meals with juice (preferably orange juice, because vitamin C aids in iron absorption). For best results, iron should not be given with meals. Ferrous sulfate can cause constipation or turn the child's stools black.

The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child is refusing fluids due to the pain and the mother is concerned about his hydration status. Which of the suggestions would be most appropriate? "Try some Anbesol or Kank-A." "Offer 'magic mouthwash' followed by a popsicle." "Offer him some orange juice." "Encourage him to have some soda."

"Offer 'magic mouthwash' followed by a popsicle." Children are more likely to cooperate with interventions if play is involved. "Magic" analgesic mouthwash followed by a popsicle is most likely to alleviate some pain and then provide hydration. Soda should be avoided because it can cause stinging and burning. Orange juice should be avoided because it can cause stinging and burning. Anbesol might be helpful but it will likely be difficult to apply. Additionally, oral analgesics are often necessary.

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching? "We need be aware of odor or drainage from the cast." "The casted arm must be kept still." "We must avoid causing depressions in the cast." "Pale, cool, or blue skin coloration is to be expected."

"Pale, cool, or blue skin coloration is to be expected."

A 13-year-old adolescent with hyperthyroidism who takes antithyroid medication has a sore throat and a fever. The parent calls the nurse and asks what to do. Which is the best response from the nurse? "Please take your child straight to the emergency department." "Give your child ibuprofen according to the instructions on the box." "Fever and sore throat may be side effects of the medication." "Offer your child at least 8 ounces of clear fluids and call back tomorrow."

"Please take your child straight to the emergency department." A side effect of antithyroid medications is leukopenia. Signs and symptoms that include fever and sore throat need to be seen immediately. These instructions should be reviewed with parents upon discharge. The question includes information about Graves disease, so ibuprofen would not be the treatment. The question centers around drug therapy, not the child's fluid status.

A 13-year-old adolescent with hyperthyroidism who takes antithyroid medication has a sore throat and a fever. The parent calls the nurse and asks what to do. Which is the best response from the nurse? "Give your child ibuprofen according to the instructions on the box." "Please take your child straight to the emergency department." "Fever and sore throat may be side effects of the medication." "Offer your child at least 8 ounces of clear fluids and call back tomorrow."

"Please take your child straight to the emergency department." A side effect of antithyroid medications is leukopenia. Signs and symptoms that include fever and sore throat need to be seen immediately. These instructions should be reviewed with parents upon discharge. The question includes information about Graves disease, so ibuprofen would not be the treatment. The question centers around drug therapy, not the child's fluid status.

A mother asks the nurse why her infant who was born at 34 weeks' gestation is being prescribed ferrous sulfate. Which response by the nurse is most appropriate? "Ferrous sulfate helps improve red blood cell formation." "Your infant may have been having excessive diarrhea." "Preterm infants are at risk for iron-deficiency anemia." "Infants with pyloric stenosis require ferrous sulfate."

"Preterm infants are at risk for iron-deficiency anemia." Infants born prematurely are at risk for iron-deficiency anemia because iron stores are built during the last few weeks of gestation. Although some infants with pyloric stenosis may require an iron supplement, such as ferrous sulfate, not all infants will. Infants with excessive diarrhea may develop iron-deficiency anemia, and ferrous sulfate helps improve red blood cell formation, but this does not explain why a preterm infant is being prescribed an iron supplement.

A school-age child is seen in the family clinic. The parents ask the nurse if their child should start taking growth hormones to help the child grow because the parents are short. What is the best response by the nurse? "Growth hormones work only if the child has short bones." "Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age." "Will your child be able to swallow oral pills every day?" "How tall would you like your child to be?"

"Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age." The nurse should educate the parents about growth hormones before asking questions. The nurse needs to explain that a diagnosis of deficiency must be documented before growth hormones can be used. Only the long bones are affected. Growth hormone is given orally, IM, and SC.

The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching? "I bought the medication to give to her when she says she is in pain." "I put her legs up on pillows when her knees start to hurt." "She has been down, but playing in soccer camp will cheer her up." "She loves popsicles, so I'll let her have them as a snack or for dessert."

"She has been down, but playing in soccer camp will cheer her up." Following a sickle cell crisis, the child should avoid extremely strenuous activities that may cause oxygen depletion. Fluids are encouraged, pain management will be needed, and the child's legs may be elevated to relieve discomfort, so these are all statements that indicate an understanding of caring for the child who has had a sickle cell crisis.

A couple is expecting a child. The fetus undergoes genetic testing and the couple discover the fetus has sickle cell disease. The couple ask the nurse how most commonly happens. Which statement is accurate for the nurse to provide? "Sickle cell diseas can be passed to the fetus in many ways. We will know more at birth." "Sickle cell disease is passed to a fetus when one of the parents has the gene." "Sickle cell disease is passed to a fetus when both parents have the gene." "Sickle cell disease occurs from a random genetic mutation."

"Sickle cell anemia is passed to a fetus when both parents have the gene."

After explaining the causes of hypothyroidism to the parents of a newly diagnosed infant, the nurse should recognize that further education is needed when the parents ask which question? "So, hypothyroidism can be only temporary, right?" "So, hypothyroidism can be treated by exposing our baby to a special light, right?" "Are you saying that hypothyroidism is caused by a problem in the way the thyroid gland develops?" "Do you mean that hypothyroidism may be caused by a problem in the way the body makes thyroxine?"

"So, hypothyroidism can be treated by exposing our baby to a special light, right?" Congenital hypothyroidism can be permanent or transient and may result from a defective thyroid gland or an enzymatic defect in thyroxine synthesis. Only the last question, which refers to phototherapy for physiologic jaundice, indicates that the parents need more information.

The parent of a 12-year-old child with Reye syndrome approaches the nurse wanting to know how this happened to the child, saying, "I never give my children aspirin!" What could the nurse say to begin educating the parent? "Sometimes it is hard to tell what products may contain aspirin." "Aspirin in combination with the virus will make the brain swell and the liver fail." "Do not worry; you are in good hands. We have it under control now." "Do you think that maybe your child took aspirin on his or her own?"

"Sometimes it is hard to tell what products may contain aspirin."

The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply. "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The only treatment for celiac disease is a strict gluten-free diet." "The entire family will need to eat a gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats." "Most children with celiac disease are diagnosed within the first year of life."

"Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The only treatment for celiac disease is a strict gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats."

The nurse is educating parents of a male infant with Chiari type II malformation. Which statement about their child's condition is most accurate? "You won't need to change diapers often." "Take your time feeding your baby." "You'll see a big difference after the surgery." "Lay him down after feeding."

"Take your time feeding your baby."

The nurse is caring for a 14-year-old client scheduled for magnetic resonance imaging (MRI). The nurse explains the test to the child and family. Which information would be most appropriate to include in the explanation? "The MRI uses radio waves and magnets to produce a computerized image of the body." "The MRI is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement." "The MRI uses sound waves to create images that visualize body structures and locate masses." "The MRI uses radiation to examine soft tissue and bony structures of the body."

"The MRI uses radio waves and magnets to produce a computerized image of the body."

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

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

A nurse is conducting a discussion group with parents of children who have genitourinary disorders. As part of the discussion, the nurse reviews the major functions of the kidneys. The nurse determines that the teaching was successful based on which statement by the group? "The kidneys help get rid of carbon dioxide from the body, so kidney problems can affect our child's breathing." "We should expect problems with too much fluid in the brain because the kidneys are not able to keep the fluid in balance." "The kidneys help control blood pressure, so our child's blood pressure needs to be checked often." "Problems with the kidneys raise the risk for infection because there is a problem with producing white blood cells."

"The kidneys help control blood pressure, so our child's blood pressure needs to be checked often."

A child who has been having seizures is admitted to the hospital for diagnostic testing. The child has had laboratory testing and an EEG, and is scheduled for a lumbar puncture. The parents voice concern to the nurse stating, "I don't understand why our child had to have a lumbar puncture since the EEG was negative." What is the best response by the nurse? "I know it must be frustrating not having a diagnosis yet, but you have to be patient. Seizure disorders are difficult to diagnose." "The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures." "A lumbar puncture is a routine test that is performed anytime someone has a seizure disorder." "Since the EEG was negative there must be some other cause for the seizures. The lumbar puncture is necessary to determine what the cause is."

"The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures."

A 1-year-old infant has just undergone surgery to correct craniosynostosis. Which comment is the best psychosocial intervention for the parents? "This only happens in 1 out of 2,000 births." "The surgery was successful. Do you have any questions?" "I will be watching hemoglobin and hematocrit closely." "I told you yesterday there would be facial swelling."

"The surgery was successful. Do you have any questions?"

The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be: "We put these on so the child will not pull the padding from under the cast." "These make a smooth edge on the cast so the skin is better protected." "These will help the cast look more attractive so the child won't feel self-conscious." "In case the child has an accident and misses the bedpan, these can be changed to keep the area dry."

"These make a smooth edge on the cast so the skin is better protected."

The nurse is caring for an infant girl in an outpatient setting. The infant has just been diagnosed with developmental dysplasia of the hip (DDH). The mother is very upset about the diagnosis and blames herself for her daughter's condition. Which response best addresses the mother's concerns? "There are simple noninvasive treatment options." "Don't worry; this is a relatively common diagnosis." "Your daughter will likely wear a Pavlik harness." "This is not your fault and we will help you with her care and treatment."

"This is not your fault and we will help you with her care and treatment."

The nurse is preparing a client for surgery and the client asks, "What does it mean when they say they are going to reduce my abdominal hernia?" Which response by the nurse is most appropriate? "The health care provider will remove about half of the herniated contents during the procedure." "If you do not understand this, I need to cancel your surgery and have the health care provider come back." "All this means is that the herniated intestines are twisted and edematous, which is why you need surgery." "This means the hernia contents will be manipulated back into your peritoneal cavity during surgery."

"This means the hernia contents will be manipulated back into your peritoneal cavity during surgery." A hernia in the abdominal region is considered reducible when its contents are easily manipulated back through the inguinal ring into the peritoneal cavity. The nurse would reinforce this education, already provided by the primary health care provider when the surgery was explained, to the client. It is not necessary to cancel surgery when the nurse can provide education to the client. Reducing does not mean the intestines are twisted and edematous. Nor does it mean half of the contents will be removed.

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

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

A 7-year-old client has been complaining of headache, coughing, and an aching chest. The care provider makes a diagnosis of a viral infection. The child's mother tells the nurse that when she first said she had a headache, the child's father gave her half of an adult aspirin. The mother has heard of Reye syndrome and asks the nurse if her child could get this. Which statement would be the best response by the nurse? "This might or might not be a problem. Watch your daughter for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome." "This is unlikely to be a problem. Half an aspirin is not enough to cause harm. Reye syndrome generally only develops from prolonged use of aspirin in connection with a virus." "This is a serious problem. Aspirin is likely to cause Reye syndrome, and she should be admitted to the hospital for observation as a precaution." "This might or might not be a problem. Watch your daughter for signs of nasal discharge, sneezing, itching of the nose, or dark circles under the eyes. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome."

"This might or might not be a problem. Watch your daughter for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome."

The nurse provides education to the parent of an infant being treated for hydrocephalus with a ventriculoperitoneal (VP) shunt. Which statement by the parent indicates the need for further instruction? "I will watch my baby for irritability and difficulty feeding." "This shunt is the only surgery my baby will need." "My baby's cerebrospinal fluid is increasing intracranial pressure." "The VP shunt will help drain fluid from my baby's brain."

"This shunt is the only surgery my baby will need."

The nurse is educating the family of a 7-year-old with epilepsy about care and safety for this child. What comment will be most valuable in helping the parent and the child cope? "If he is out of bed, the helmet's on the head." "Bike riding and swimming are just too dangerous." "You'll always need a monitor in his room." "Use this information to teach family and friends."

"Use this information to teach family and friends."

The nurse is educating the family of a 7-year-old with epilepsy about care and safety for this child. What comment will be most valuable in helping the parent and the child cope? "Use this information to teach family and friends." "If he is out of bed, the helmet's on the head." "You'll always need a monitor in his room." "Bike riding and swimming are just too dangerous."

"Use this information to teach family and friends." Families need and want information they can share with relatives, childcare providers, and teachers. Wearing a helmet and having a monitor in the room are precautions that may need to be modified as the child matures. The boy may be able to bike ride and swim with proper precautions.

A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement by the parents indicates that the teaching was successful? "We might notice some of the medication in her stool." "We should not stop this medication abruptly." "This drug helps to control the abdominal cramping." "She might lose some weight initially."

"We should not stop this medication abruptly." A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement by the parents indicates that the teaching was successful?

A child with central diabetes insipidus is prescribed desmopressin (DDAVP) intranasally. After teaching the child and parents about this medication, the nurse determines that the teaching was successful when the parents make which statements? Select all that apply. "We should squeeze the container to get the correct dose." "We should blow the liquid out of the tubing into the nose." "We'll make sure our child clears out his nose before using the medication." "We will keep the drug in the cabinet above the sink." "We can repeat the dose if he sneezes right after he takes the medication."

"We'll make sure our child clears out his nose before using the medication." "We should blow the liquid out of the tubing into the nose." "We can repeat the dose if he sneezes right after he takes the medication."

The nurse is providing education to the parents of a 3-year-old girl with hydrocephalus who has just had an external ventricular drainage system placed. Which question is best to begin the teaching session? "What questions or concerns do you have about this device?" "Do you understand why you clamp the drain before she sits up?" "Why do you always keep her head raised 30 degrees?" "What do you know about her autoregulation mechanism failing?"

"What questions or concerns do you have about this device?"

The nurse is taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question is important for the nurse to ask the parents? "Is your child taking vasopressin IM or SC?" "Does your child get upset about being taller than friends?" "How often do you test your child's blood glucose?" "What time each day does your child take his growth hormone?"

"What time each day does your child take his growth hormone?" It is important for the nurse to know the time of day that the child takes his or her growth hormone. Growth hormone is the common treatment for the child with hypopituitarism who is short, not tall, in stature. Vasopressin is the treatment for diabetes insipidus. Monitoring blood glucose is not part of the treatment for hypopituitarism.

A 13-year-old adolescent is being treated for scoliosis with a brace. During the first follow-up appointment after the brace was initiated, which statement by the adolescent indicates the need for further instruction? "When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." "I wear a t-shirt under my brace." "I check my brace daily to make sure there is no damage or change to it." "I leave my brace on for gym at school."

"When I get home from school, I look forward to taking off my brace for a few hours before I go to bed."

A nurse is educating a family about the Chvostek sign after their teen tested positive for Chvostek sign. Which statements by the caregivers shows the nurse that they understand the Chvostek sign? "The sign occurs when there is muscle pain and the muscle is stimulated." "The sign occurs because my child is having increased intracranial pressure." "The sign means my child is not getting enough vitamin D." "When I tap on my child's facial nerve, the reaction is a facial muscle spasm."

"When I tap on my child's facial nerve, the reaction is a facial muscle spasm." The Chvostek sign is a facial muscle spasm that occurs when the facial nerve is tapped. This can indicate heightened neuromuscular activity, possibly caused by hypocalcemia. Hypoparathyroidism may be suspected.

A nurse is caring for a 7-year-old child with hemophilia who requires an infusion of factor VIII. The child is fearful about the process and is resisting treatment. How should the nurse respond? "Would you like to administer the infusion?" "Please be brave; we need to stop the bleeding." "Will you help me apply this adhesive bandage?" "Would you help me dilute this and mix it up?"

"Would you help me dilute this and mix it up?"

A child is home with the caregivers following a treatment for a head injury. The caregiver should contact the care provider if the child makes which statement? "My stomach is upset. I feel like I might throw up." "I am glad that my headache is getting better." "It will be nice when you will let me take a long nap. I am sleepy." "You look funny. Well, both of you do. I see two of you."

"You look funny. Well, both of you do. I see two of you."

The nurse is explaining the procedure of bone marrow aspiration to a 6-year-old child with leukemia. What explanation would be best to give to the child? "You may feel pressure on your hip during the procedure." "The numbing medicine on your skin will keep you from having pain." "You will have to lie on your back and hold your breath." "You will need to lie still afterward to prevent a headache."

"You may feel pressure on your hip during the procedure." The bone marrow aspiration is performed on the iliac crest if the child is older and on the femur if the child is an infant. Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. A lidocaine/prilocaine cream is applied to the skin anywhere from 1 to 3 hours prior to the procedure to help numb the site where the needle will be inserted. Bone marrow aspirations and biopsies are usually performed with conscious sedation. If the child is an infant or there are special circumstances the procedure may be performed under anesthesia. The child is placed on the side for the procedure so the health care provider has better access to the iliac crest. The child will need to rest after the procedure to prevent bleeding, but is not required to lay flat on the back. Children who have had a lumbar puncture may need to lie on the back and are at risk for a headache.

A pediatric client's parent calls the nurse and states, "My child fell off the bike. My child was wearing a helmet, but did scrape the knee and it is bleeding a lot. What should I do?" Which response by the nurse is best? "Tell me if your child can move all four extremities and knows his or her name and current location." "You should apply pressure to the site and then bring your child in to be evaluated." "You need to immediately bring your child to his primary health care provider's office." "Apply ice packs to the site for 15 to 20 minutes, then elevate the extremity."

"You should apply pressure to the site and then bring your child in to be evaluated."

The nurse is caring for a 13-year-old girl with suspected autoimmune hepatitis. The girl inquires about the testing required to evaluate the condition. How should the nurse respond? "You will most likely have viral studies." "You will most likely have a blood test to check for certain antibodies." "You will most likely be tested for ammonia levels." "You will most likely have an ultrasound evaluation."

"You will most likely have a blood test to check for certain antibodies." Anti-nuclear antibodies are one of the diagnostic tests performed to diagnose autoimmune hepatitis. Ultrasound is performed to assess for liver or spleen abnormalities. Viral studies are performed to screen for viral causes of hepatitis. Ammonia levels may be ordered if hepatic encephalopathy is suspected.

The nurse is reviewing the results of a clotting study for a healthy 6-year-old. What would the nurse document as a normal prothrombin finding? 21.0 to 35.0 seconds 6.0 to 9.0 seconds 16.0 to 18.0 seconds 11.0 to 13.0 seconds

11.0 to 13.0 seconds Explanation:The nurse would identify a prothrombin time of 11.0 to 13.0 seconds as normal for a healthy child. A result of 21.0 to 35.0 seconds would be the expected range for partial thromboplastin time and activated partial thromboplastin time. Findings of 6.0 to 9.0 seconds and 16.0 to 18.0 seconds are outside the normal range.

A nurse is providing care to a child diagnosed with cerebral palsy who is experiencing painful muscle spasms. The health care provider has prescribed baclofen 40 mg/day PO in three divided doses. How many milligrams should the nurse administer in each dose? Record your answer using one decimal place.

13.3

The meningococcal vaccine should be offered to high-risk populations. If never vaccinated, who has an increased risk of becoming infected with meningococcal meningitis? Select all that apply. 18-year-old student who is preparing for college in the fall and has signed up to live in a dormitory with two other suite mates 5-year-old child who routinely travels in the summer with her parents on mission trips to Haiti 12-year-old child with asthma 8-year-old child who is in good health 9-year-old child who was diagnosed with diabetes when he was 7 years old

18-year-old student who is preparing for college in the fall and has signed up to live in a dormitory with two other suite mates • 12-year-old child with asthma • 5-year-old child who routinely travels in the summer with her parents on mission trips to Haiti • 9-year-old child who was diagnosed with diabetes mellitus when he was 7 years old

A nurse is reviewing the blood sugar test results of a child diagnosed with type 1 diabetes: Before meal: 84 mg/dL (4.66 mmol/l) 1 hour after meal: 160 mg/dL (8.88 mmol/l) 2 hours after meal: 180 mg/dL (9.99 mmol/l) Middle of the night: 92 mg/dL (5.11 mmol/l) Which result would lead the nurse to notify the health care provider? 2 hours after meal 1 hour after meal middle of the night before meal

2 hours after meal Acceptable blood glucose levels for a child 2 hours after a meal would range from 80 to 150 mg/dL (4.44 to 8.32 mmol/l). This child's level is above the range at 180 mg/dL (9.99 mmol/l). The other levels are within the acceptable ranges (before meal—70 to 110 mg/dL (3.89 to 6.11 mmol/l); 1 hour after meal—90 to 180 mg/dL (5.0 to 10.0 mmol/l); and middle of night—70 to 120 mg/dL (3.89 to 6.66 mmol/l).

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

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

The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia? An 8-year-old child who carries lunch to school A 3-month-old infant who is totally breastfed A 15-year-old adolescent who has heavy menstrual periods A 7-month-old infant who has started table food

A 15-year-old girl who has heavy menstrual periods Adolescents with heavy menstrual flows lose enough blood each month to cause iron-deficiency anemia.

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse (child mistreatment) in which situation? A 6-year-old with a greenstick fracture of the wrist, which the caregiver reports as having been caused when the child fell while ice-skating. A 9-year-old with a compound fracture of the tibia, which the caregiver reports as having been caused when the child attempted a flip on a skateboard. A 10-year-old with a simple fracture of the femur, which the caregiver reports as having been caused when the child fell down a set of stairs. A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate.

A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. Spiral fractures, which twist around the bone, are frequently associated with child abuse (child mistreatment) and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks.

A newborn was diagnosed as having hypothyroidism at birth. The parent asks the nurse how the disease could be discovered this early. Which is the nurse's best answer? Hypothyroidism is usually detected at birth by the newborn's physical appearance. The newborn is already severely impaired at birth, and this suggests the diagnosis. A simple blood test to diagnose hypothyroidism is required in most states. A newborn has a typical rash at birth that suggests the diagnosis.

A simple blood test to diagnose hypothyroidism is required in most states. With hypothyroidism there is insufficient production of the thyroid hormones required to meet the body's metabolic as well as growth and developmental needs. Without these hormones, cognitive impairment occurs. Hypothyroidism is diagnosed by a newborn screening procedure. This screening procedure is required by most states. With early diagnosis the condition can be treated by replacing the missing hormones. The later the diagnosis is made, the more irreversible cognitive impairment becomes. At birth, a newborn with hypothyroidism will be a poor feeder. Other symptoms, such as lethargy and hypotonicity, become evident after the first month of life. There are no other outward manifestations, such as rashes or appearances, that can be seen. These are not part of the condition.

The nurse is caring for a pediatric client who is scheduled for the surgical removal of a Wilms tumor. Which action is contraindicated in the client's care? Abdominal palpation Foley catheter placement Supine positioning Intravenous fluids

Abdominal palpation Abdominal palpation is contraindicated preoperatively in a client with a Wilms tumor. Cells may break loose and spread the tumor. Intravenous fluids and supine positioning are appropriate in the client's care. A Foley catheter is typically not placed.

A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform? Administer broad-spectrum antibiotics intravenously. Administer diuretics. Maintain fluid restriction to below maintenance levels. Monitor serum sodium levels.

Administer broad-spectrum antibiotics intravenously.

The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? Teaching the importance of taking water safety measures Plotting height and weight on a growth chart Assessing dietary intake by addressing "picky eating" and "food jags" Administering the measles, mumps, rubella (MMR) vaccine

Administering the measles, mumps, rubella (MMR) vaccine Live vaccines (viral or bacterial) should not be administered to an immunosuppressed child because of the risk of causing disease. The other health maintenance activities are important for the health maintenance of the toddler and should be included during the well-child visit.

Prior to discharging an infant with congenital hypothyroidism to home with the parents, what should the nurse emphasize regarding the care that this child will need going forward? Administration of vitamin C until after growth is complete Administration of levothyroxine indefinitely Vitamin K administration until school age An increased intake of calcium beginning immediately

Administration of levothyroxine indefinitely The treatment for hypothyroidism is oral administration of synthetic thyroid hormone or sodium levothyroxine. A small dose is given at first, and then the dose is gradually increased to therapeutic levels. The child needs to continue taking the synthetic thyroid hormone indefinitely to supplement that which the thyroid does not make. Vitamin K is not needed. Supplemental vitamin D, and not calcium, may be given to prevent the development of rickets when rapid bone growth begins. Supplemental vitamin C is not indicated for this disorder.

The parents of a child who was diagnosed with diabetes insipidus ask the nurse, "How does this disorder occur?" When responding to the parents, the nurse integrates knowledge that a deficiency of which hormone is involved? Growth hormone Antidiuretic hormone Thyroxine Insulin

Antidiuretic hormone Diabetes insipidus results from a deficiency in the secretion of antidiuretic hormone (ADH). This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland. Hypopituitarism or dwarfism involves a growth hormone deficiency. Diabetes mellitus involves a disruption in insulin secretion. Thyroxine is a thyroid hormone that if deficient leads to hypothyroidism.

The nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure? Antineoplastic Analgesic Antipyretic Antiemetic

Antiemetic Radiation has systemic effects. Radiation sickness that includes nausea and vomiting is the most frequently encountered systemic effect. It also occurs to some extent as a result of the release of toxic substances from destroyed tumor cells. To counteract this, a child is prescribed an antiemetic before each procedure. The child does not need an analgesic, antipyretic, or antineoplastic agent prior to receiving a radiation treatment.

A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode? Apply heat to the site of bleeding. Apply direct pressure to the area. Administer factor VIII replacement. Elevate the injured area such as a leg or arm.

Apply heat to the site of bleeding. Ice or cold compresses, not heat, would be applied to the site of bleeding. Direct pressure is applied until the bleeding stops. The injured part is elevated unless elevating would contribute to further injury. Factor VIII replacement is given to replace the missing clotting factor.

What information is most correct regarding the nervous system of the child? The child has underdeveloped fine motor skills and well-developed gross motor skills. The child has underdeveloped gross motor skills and well-developed fine motor skills. The child's nervous system is fully developed at birth. As the child grows, the gross and fine motor skills increase.

As the child grows, the gross and fine motor skills increase.

The nurse is caring for a child diagnosed with hydrocephalus following ventriculoperitoneal shunt placement. The child is currently on a ventilator. Which nursing action is priority? Measure the client's head circumference. Educate the family on the shunt. Monitor the client for signs of infection. Assess the client's respiratory status.

Assess the client's respiratory status.

A 9-year-old client who suffered a head injury has strabismus. The nurse assesses the client for intracranial pressure (ICP). Which additional intervention is most important for the nurse to perform? Place a patch over the client's affected eye. Notify the primary health care provider. Place the child on fall precaution. Assess the level of consciousness (LOC).

Assess the level of consciousness (LOC).

The nurse is providing preoperative care for a 7-year-old boy with a brain tumor, as well as his parents. Which intervention is a priority? Assessing the child's level of consciousness. Providing a tour of the intensive care unit. Having the child talk to another child who has had this surgery. Educating the child and parents about shunts.

Assessing the child's level of consciousness The priority intervention is to monitor for increases in intracranial pressure because brain tumors may block cerebral fluid flow or cause edema in the brain. A change in the level of consciousness is just one of several subtle changes that can occur indicating a change in intracranial pressure. Lower priority interventions include providing a tour of the ICU to prepare the child and parents for after the surgery, and educating the child and parents about shunts.

The nurse is caring for a pediatric client with idiopathic celiac disease. Which meal will the nurse select for this client? Meatloaf, green beans, peanut butter cookie, and fat-free milk Baked salmon, potato slices, vanilla ice cream, and apple juice Whole wheat pasta, meatballs, carrot sticks, apple, and water Ham and cheese sandwich, orange slices, chips, and whole milk

Baked salmon, potato slices, vanilla ice cream, and apple juice

A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the child's ear. This would be documented as: raccoon eyes. otorrhea. Battle sign. rhinorrhea.

Battle sign.

A group of nursing students are studying information about childhood cancers in preparation for a class examination. They are reviewing how childhood cancers differ from adult cancers. The group demonstrates understanding of the information when they identify what location as an unlikely site for childhood cancer? Bladder Brain Blood Kidney

Bladder The most common sites for childhood cancer include the blood, lymph, brain, bone, kidney, and muscle. Bladder is a common site for adult cancer.

The nurse is collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which vital sign would the nurse anticipate with this child's diagnosis? Blood pressure 136/84 Pulse oximetry 93% on room air Respirations 24 per minute Pulse rate 112 bpm

Blood pressure 136/84 Hypertension appears in 60% to 70% of clients during the first 4 or 5 days with a diagnosis of acute glomerulonephritis. The pulse of 112 would be a little high for a child this age, but not a concern with this diagnosis. The other vital signs are within normal limits for a child of this age.

What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent? Flushing of the device is not necessary. No tunneling is needed when the port is inserted. Body appearance changes very little. No special procedure is necessary for removal.

Body appearance changes very little. An implanted port has nothing extending through the skin and may be obvious only as a slight protrusion at the insertion site. Some tunneling from the port to a central vein is needed. Removal of the port requires a surgical procedure. Flushing of the port is necessary when used and on a regular basis.

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

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

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life? Cartilage Tendons Joints Ligaments

Cartilage

To detect complications as early as possible in a child with meningitis who's receiving IV fluids, monitoring for which condition should be the nurse's priority? Cerebral edema Renal failure Left-sided heart failure Cardiogenic shock

Cerebral edema

A 4-year-old child is brought to the emergency department after being in a motor vehicle accident. The child experienced head trauma in the accident. When assessing the child, which will be the first change noted in the presence of increasing intercranial pressure? reduction in heart rate decline in respiratory rate change in level of consciousness increase in heart rate

Change in level of consciousness

A child is born with clubfoot (congenital talipes equinovarus). The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg? Apply Denis Browne splints to the infant each night. Perform passive foot exercises. Check the infant's toes for coldness or blueness. Change the infant's diapers frequently.

Check the infant's toes for coldness or blueness.

A newborn is born with hypothyroidism. If it is not recognized and treated, what complication is likely? dehydration muscle spasticity blindness cognitive impairment

Cognitive impairment. Congenital hypothyroidism can lead to extreme cognitive challenge impairment if not treated.

A child is being evaluated for renal and urinary tract disease. What would the nurse expect to be ordered to evaluate the child's glomerular filtration rate? Urinalysis Computed tomography scan Creatinine clearance rate Kidneys, ureter, and bladder x-ray

Creatinine clearance rate The glomerular filtration rate is measured by creatinine clearance rate, or the amount of creatinine excreted in 24 hours as determined by a 24-hour urine sample along with a venous blood sample and compared with the urine findings. Urinalysis provides general information about kidney function. A kidneys, ureters, and bladder x-ray provides information about the size and contour of the kidneys. A computed tomography reveals the size and density of kidney structures and adequacy of urine flow.

A 7-year-old boy has experienced repeated urinary tract infections (UTIs). His older sister also experienced repeated UTIs and was diagnosed with vesicoureteral reflux, a condition that tends to appear in families. Therefore, the nurse suspects this same condition in this client. Which diagnostic tests would confirm this suspicion? Urine culture Urinalysis Cystoscopy Blood urea nitrogen test

Cystoscopy Cystoscopy, or examination of the bladder and ureter openings by direct examination with a cystoscope introduced into the bladder through the urethra, is done to evaluate for possible vesicoureteral reflux or urethral stenosis. A urine culture is used to diagnose a urinary tract infection (UTI), or the presence of bacteria in urine. Urinalysis involves use of a chemical reagent strip to detect glucose, protein, and occult blood and to measure pH, as well as use of a refractometer to measure specific gravity. A blood urea nitrogen (BUN) test measures the level of urea in blood or how well the kidneys can clear this from the bloodstream.

A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan? Decrease environmental stimulation Encourage the parents to hold the child Monitor temperature every 4 hours Take vital signs every 4 hours

Decrease environmental stimulation

A newborn is diagnosed with the salt-losing form of congenital adrenogenital hyperplasia. On what should the nurse focus when assessing this client? Bleeding tendency Dehydration Excessive cortisone secretion Hypoglycemia

Dehydration. With this form of the disorder, children are unable to produce aldosterone. This leads to the inability to retain sodium and fluid.

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

Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output. Desmopressin acetate is a synthetic antidiuretic hormone that promotes reabsorption of water by action on renal tubules; it is used to control diabetes insipidus by decreasing the amount of urine produced.

The nurse is seeing a new client in the clinic who reports polyuria and polydipsia. These conditions are indicative of which endocrine disorder? Precocious puberty Syndrome of inappropriate antidiuretic hormone (SIADH) secretion Hypopituitarism Diabetes insipidus (DI)

Diabetes insipidus (DI) The most common symptoms of central DI are polyuria (excessive urination) and polydipsia (excessive thirst). Children with DI typically excrete 4 to 15 L per day of urine despite the fluid intake. The onset of these symptoms is usually sudden and abrupt. Ask about repeated trips to the bathroom, nocturia, and enuresis. Other symptoms may include dehydration, fever, weight loss, increased irritability, vomiting, constipation, and, potentially, hypovolemic shock.

After teaching a group of students about endocrine disorders, the instructor determines that the teaching was successful when the students identify insulin deficiency, increased levels of counterregulatory hormones, and dehydration as the primary cause of which condition? glucosuria diabetic ketoacidosis ketone bodies ketonuria

Diabetic ketoacidosis Explanation:Insulin deficiency, in association with increased levels of counterregulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis, a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. Liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glucosuria is glucose that is spilled into the urine.

A child is prescribed glargine insulin. What information would the nurse include when teaching the child and parents about this insulin? Give the dose first thing in the morning. Do not mix this insulin with other insulins. Discard any opened vials after a week. Store the insulin in the refrigerator until just before giving it.

Do not mix this insulin with other insulins. Glargine is not to be mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month.

The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child? Effortless vomiting just after the child has eaten Bouts of diarrhea with failure to gain weight Severe constipation with occasional ribbon-like stools Forceful vomiting followed by the child being eager to eat again

Effortless vomiting just after the child has eaten

The school nurse cares for children with overuse injuries and refers them for treatment. Which statements accurately describe conservative interventions to prevent or care for these types of injuries? Select all that apply. Apply ice to the injured area to reduce inflammation. Avoid using NSAIDs for pain control. Have the coach monitor the treatment program for sports injuries. Encourage 1 to 2 days off per week of competitive athletics. Immobilize the muscles that are involved. Perform appropriate stretching during a 20-to 30-minute warmup.

Encourage 1 to 2 days off per week of competitive athletics.• Apply ice to the injured area to reduce inflammation.• Perform appropriate stretching during a 20-to 30-minute warmup. Conservative treatment methods for the child with an overuse injury include encouraging 1 to 2 days off per week of competitive athletics, performing appropriate stretching during a 20-to 30-minute warmup, and applying ice to the injured area to reduce the inflammation and irritation. NSAIDs (ibuprofen) are used for inflammation and pain control. The physical therapist institutes a stretching and strengthening program for the appropriate muscle groups. Parents and coaches may not understand that the level of activity that causes overuse symptoms varies from child to child. Notes or telephone conversations from the physician or nurse to the child's coach can clarify any misconceptions about what is expected during the recovery and recuperative periods

A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage bladder spasms? Allow tubes to dangle freely to encourage flow. Apply antibiotic ointment to tube site. Encourage high fluid intake. Increase low-fat foods.

Encourage high fluid intake. Prevent bladder stimulation secondary to a full rectum by completing a preoperative bowel evacuation, encouraging a high fluid intake, promoting early ambulation postoperatively, and administering a stool softener or glycerin suppository postoperatively.

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

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

The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority? Ensure neutropenic precautions are in place. Monitor daily complete blood count (CBC). Remind parents to contact the child's school. Encourage therapeutic play activities.

Ensure neutropenic precautions are in place. With stem cell transplants, children are at greatest risk for infection and sepsis. The nurse should ensure neutropenic precautions are used to reduce the change of infection. Monitoring laboratory values, reminding the parent to contact the school, and encouraging therapeutic play are important, but preventing infection in the immunocompromised child is a priority.

The nurse working on a pediatric floor understands the importance of diagnosing inborn errors of metabolism early. A child with a suspected problem must have blood urea nitrogen (BUN) and creatinine testing done. Which is the purpose of these two tests? Evaluate metabolism. Evaluate liver function. Detect changes in amino acid patterns. Evaluate renal function.

Evaluate renal function. Tests of BUN and creatinine evaluate renal function. These tests are done to rule out chronic renal failure and to monitor the effects of treatments on the renal system. Tests of ammonia and lactic acid evaluate metabolism. Tests of plasma amino acids detect changes in amino acid pattern, while a liver function panel would help evaluate hepatic function.

The pediatric nurse examines the radiographs of a client that indicate lesions on the bone. This finding is indicative of: Hodgkin disease. non-Hodgkin lymphoma. neuroblastoma. Ewing sarcoma.

Ewing sarcoma. Radiographs that show lesions on the bone may indicate tumors (e.g., Ewing sarcoma, osteosarcoma) or metastasis of tumors and warrant further investigation by bone scan, CT, or MRI. Positron emission tomography is the most effective test to diagnose Hodgkin disease, non-Hodgkin lymphoma, a neuroblastoma, bone tumors, lung and colon cancers, and brain tumors.

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

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

The nurse explains to the teenager that which alterations may occur when steroids are added to the cancer therapy regimen? Urinary incontinence Facial changes Loss of appetite Nighttime itching

Facial changes Facial changes are common and include a round face with full cheeks, often reddened, described as "moon face." Weight gain and fat pads may appear in various areas of the body. Appetite is likely to increase. Urinary incontinence and nighttime itching are not related to steroid therapy.

The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy?

Gowers Sign A sign of Duchenne muscular dystrophy (DMD) is Gowers sign, or the inability of the child to rise from the floor in the standard fashion because of weakness. Signs of hydrocephalus are not typically associated with DMD. Kyphosis and scoliosis occur more frequently than lordosis. A child with DMD has an enlarged appearance to their calf muscles due to pseudohypertrophy of the calves.

During an assessment of an adolescent child, the nurse notes that the child has a protuberant tongue, fatigued appearance, poor muscle tone, and exophthalmos. What medical diagnosis would the nurse expect the child to have? Graves disease Cushing disease syndrome of inappropriate antidiuretic hormone secretion (SIADH) diabetes

Graves disease Symptoms of Graves disease include an increased rate of growth; weight loss despite an excellent appetite; hyperactivity; warm, moist skin; tachycardia; fine tremors; an enlarged thyroid gland or goiter; and ophthalmic changes including exophthalmos. These are not symptoms of Cushing disease, diabetes, or SIADH.

The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this? Greenstick Spiral Complete Epiphyseal

Greenstick

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

Have the parent bring the child to the pediatric oncology clinic as soon as possible.

A child is diagnosed with hyperthyroidism. What finding would the nurse expect to assess? Constipation Heat intolerance Weight gain Facial edema

Heat intolerance Hyperthyroidism is manifested by heat intolerance, nervousness or anxiety, diarrhea, weight loss, and smooth velvety skin. Constipation, weight gain, and facial edema are associated with hypothyroidism

A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease? Ulcerative colitis (UC) Hirschsprung disease Short bowel syndrome (SBS) Gastroenteritis

Hirschsprung disease The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth, and has bilious vomiting or abdominal distention and feeding intolerance with bilious aspirates and vomiting. Typical signs and symptoms of gastroenteritis include diarrhea, nausea, vomiting, and abdominal pain. The characteristic GI manifestation of UC is bloody diarrhea accompanied by crampy, typically left-sided lower abdominal pain. Clinical manifestations of untreated SBS include profuse watery diarrhea, malabsorption, and failure to thrive.

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? Femur Sternum Anterior tibia Iliac crest

Iliac crest Bone marrow aspiration provides samples of bone marrow so the type and quantity of cells being produced can be determined. In children, the aspiration sites used are the iliac crests or spines (rather than the sternum, which is commonly used in adults) because performing the test at these sites is usually less frightening for children; these sites also have the largest marrow compartments during childhood. In neonates, the anterior tibia can be used as an additional site.

Which site is most frequently used to perform a bone marrow aspiration? Rib cage Humerus Iliac crest Femur

Iliac crest The preferred site for bone marrow aspiration in children is the iliac crest. The other sites are not used for a bone marrow aspiration.

The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client? Situational low self-esteem related to the use of a walker Pain related to chronic inflammation of the lower leg Deficient diversional activities related to a need for imposed activity restriction for 6 weeks Impaired physical mobility related to a cast on the leg

Impaired physical mobility related to a cast on the leg

The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time? Promoting comfort Preparing family for home care Improving hydration Maintaining skin integrity

Improving hydration Preoperatively, the highest priority for the child with pyloric stenosis is to improve nutrition and hydration. Maintaining mouth and skin integrity, and relieving family anxiety are important, but these are not the priority. The child will not likely have intense pain. Preparing the family for home care would be a postoperative goal.

A nurse is teaching about pharmacologic management to families with children who have diseases caused by inborn errors of metabolism. It is important for the nurse to include which information? In most cases, children can stop the treatment when they are doing better. In most cases, pharmacological treatment does not work. In most cases, treatment is lifelong. Pharmacological treatment replaces diet restrictions.

In most cases, treatment is lifelong. Pharmacologic dosages of vitamins and medications may be given. In most cases, such treatment is lifelong as this is an inborn error and not something that will change over the lifetime of the child. Pharmacological treatments are used to supplement a deficient product, such as a hormone, or to assist in removing any accumulated substrates. They do not replace diet restrictions. They usually prove to be beneficial and are necessary for the child's survival.

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux? A partial or complete intestinal obstruction occurs. There are recurrent paroxysmal bouts of abdominal pain. A thickened, elongated muscle causes an obstruction at the end of the stomach. In this disorder the sphincter that leads into the stomach is relaxed.

In this disorder the sphincter that leads into the stomach is relaxed. The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux?

A child with cancer has developed neutropenia and is in isolation with neutropenic precautions. What nursing assessment takes priority for this child? mucositis infection symptoms vital signs bleeding

Infection symptoms The neutrophils are the primary means of fighting bacterial infection. When the neutrophil count is very low, the child has the potential to have an overwhelming bacterial infection. The child is at the greatest risk when the neutrophil count is less than 500/µL (0.50 ×109/L). The nurse's priority would be to assess for signs and symptoms of infection. A bacterial infection can be life-threatening for this child. This child would be placed in neutropenic precautions. This is a form of isolation where the child is protected from health care workers and outside visitors. Among other precautions, no plants or raw fruits or vegetables would be allowed in the room, and the child should have no rectal examinations or medications and not experience a urinary catheterization. To prevent an infection, the nurse would administer broad spectrum antibiotics. The vital signs should be assessed every 4 hours, and alterations could indicate more problems than just infection. Mucositis occurs when there is an ulcerated oral mucosa. It should be assessed but is not the priority. Bleeding would be more related to low platelet count and not neutrophils.

The nurse is caring for a 6-year-old child who has a history of febrile seizures and is admitted with a temperature of 102.2°F (39°C). What is the nurse's highest priority? Offer age-appropriate activities. Provide family teaching related to the child's history. Institute safety precautions. Encourage the child to do his or her own self-care.

Institute safety precautions.

Which characteristic is true of cerebral palsy? It appears at birth or during the first 2 years of life. It's reversible. It results in intellectual disability. It's progressive.

It appears at birth or during the first 2 years of life.

Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism? Low T4 level and high TSH level High thyroxine (T4) level and low thyroid stimulating hormone (TSH) level Normal T4 level and low TSH level Normal TSH level and high T4 level

Low T4 level and high TSH level Screening results that show a low T4 level and a high TSH level indicate congenital hypothyroidism and the need for further tests to determine the cause of the disease.

A 10-year-old male presents with low-grade fever, nausea, and abdominal pain. The nurse examining him suspects appendicitis and checks for rebound tenderness in what quadrant? Lower left Upper left Upper right Lower right

Lower right

The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure? Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention Sudden, momentary loss of muscle tone, with a brief loss of consciousness Brief, sudden contracture of a muscle or muscle group Muscle tone maintained and child frozen in position

Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention

Any individual taking phenobarbital for a seizure disorder should be taught: never to go swimming. to avoid foods containing caffeine. never to discontinue the drug abruptly. to brush his or her teeth four times a day.

Never to discontinue the drug abruptly. Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child's dependency on the drug can result.

A 3-month-old girl is found to have an umbilical hernia at a well visit. On examination, the nurse discovers that the fascial ring through which the intestine protrudes is about 1 cm in diameter. Which statement by the nurse to the girl's father would indicate the likely intervention required to correct this condition? No intervention is needed, as the opening will most likely close spontaneously. Wrapping an elastic band around the child's waist should correct the problem. Surgery at age 1 to 2 years will likely be needed to repair the condition. Taping a silver dollar over the area will help reduce the hernia.

No intervention is needed, as the opening will most likely close spontaneously. An umbilical hernia is a protrusion of a portion of the intestine through the umbilical ring, muscle, and fascia surrounding the umbilical cord. If the fascial ring through which the intestine protrudes is less than 2 cm, closure will usually occur spontaneously after the child begins to walk so no repair of the disorder will be necessary. If the fascial ring is larger than 2 cm, ambulatory surgery for repair is generally indicated to prevent herniation and intestinal obstruction or bowel strangulation. This is usually done at 1 to 2 years of age. Some parents believe holding an umbilical hernia in place by using "belly bands" or taping a silver dollar over the area will help reduce the hernia. These actions can actually lead to bowel strangulation so should be avoided.

The nurse is assessing a 3-year-old boy whose mother reports that he is listless and has been having trouble swallowing. Which finding suggests the child may have a brain tumor? Observation reveals a cough and labored breathing. Vital signs show blood pressure measures 120/80 mm Hg. Examination shows temperature of 101.4° F (38.6°C) and headache. Observation reveals nystagmus and head tilt.

Observation reveals nystagmus and head tilt. Coupled with the mother's reports, observation of nystagmus and head tilt suggest the child may have a brain tumor. Elevated blood pressure of 120/80 mm Hg may be indicative of Wilms tumor. Fever and headaches are common symptoms of acute lymphoblastic leukemia. A cough and labored breathing points to rhabdomyosarcoma near the child's airway.

A child with a seizure disorder is being admitted to the inpatient unit. When preparing the room for the child, what should be included? Select all that apply. oxygen gauge and tubing padding for side rails suction at bedside tongue blade smelling salts

Oxygen gauge and tubing Suction at bedside Padding for side rails

A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury? Place petroleum jelly gauze on the spinal sac to keep it moist. Delay the parents from holding the newborn. Place a urine collection bag on newborn for the continuous leakage. Place the newborn in a prone or lateral position.

Place the newborn in a prone or lateral position.

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

Placing a "no abdominal palpation" sign above the child's bed

Which findings should the nurse expect to assess when completing the health history of a child admitted for possible type 2 diabetes? Select all that apply. Polydipsia Abrupt onset of symptoms Polyuria Marked weight loss Polyphagia

Polyuria Polydipsia Polyphagia Type 2 diabetes mellitus is characterized by a gradual onset and is most often associated with obesity and not marked weight loss. Type 1 diabetes is most often abrupt and associated with marked weight loss. Polyuria, polydipsia, and polyphagia are frequent assessment findings in both types of diabetes mellitus.

The nurse is caring for a 6-year-old child with acute glomerulonephritis. When reviewing the client's laboratory results, which result is most important to review with the health care provider? Negative for respiratory syncytial virus (RSV) Urine culture positive for contaminants Positive culture for group A streptococcus White blood cells: 8,000/µL (8.0 ×109/L)

Positive culture for group A streptococcus Acute glomerulonephritis may result as an autoimmune response to the invasion of group A streptococcus. This group of streptococci affect the glomeruli of the kidneys. This would be addressed by the health care provider and is the most important of the laboratory results presented. If there is an active strep infection, it would need to be treated with an antibiotic. The white blood cell count is within normal limits. It is good to be negative for respiratory syncytial virus. The urine culture would have to be redone due to contamination. It does not provide an accurate status of the child's urine.

An 8-year-old girl presents to the clinic for moodiness and irritability. The child has begun to develop breasts and pubic hair and the parents are concerned that the child is at too early an age for this to begin. The nurse knows that these symptoms may be indicative of what disorder? precocious puberty adrenal hyperplasia neurofibromatosis pseudopuberty

Precocious puberty. The prognosis for a child with precocious puberty depends on the age at diagnosis and immediate treatment. Appropriate treatment can halt, and sometimes even reverse, sexual development and can stop the rapid growth that results in severe short adult stature caused by premature closure of the epiphysis. Treatment for precocious puberty allows the child to achieve the maximum growth potential possible. Mental development in children with precocious puberty is normal, and developmental milestones are not affected; however, the behavior may change to that of a typical adolescent. Girls may have episodes of moodiness and irritability, whereas boys may become more aggressive

A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first? Prepare to administer factor replacement medication Document the presence of hemarthrosis in the client's chart Notify the client's primary health care provider Assess the client's urine and stool for blood

Prepare to administer factor replacement medication Many clients with hemophilia have repeated episodes of hemarthrosis or bleeding into the joints, and develop functional impairment of the joints, despite careful treatment. To assist in limiting impairment, the nurse would prepare to administer factor replacement medications, such as plasma, recombinant clotting factor VIII, or a clotting promotor medication. The nurse would document the finding, notify the health care provider, and assess the client for additional symptoms after limiting the amount of blood loss.

What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)? Obtain a catheterized urine specimen. Protect the abdomen from manipulation. Control acute pain. Assess for constipation.

Protect the abdomen from manipulation. Manipulation can release malignant cells into the abdominal cavity. Constipation may be a problem following surgical intervention. Pain is uncommon; obtaining a urine specimen is not a priority.

The nurse obtains a history from the parent of a child with glomerulonephritis about how the child became ill. What would the nurse expect the parent to report? Reddish-brown, smoky-colored urine Headache, loss of appetite Diuresis and pallor Loss of weight, oliguria

Reddish-brown, smoky-colored urine Acute glomerulonephritis can occur following a streptococcal infection. The immune process of the illness affects the structure of the kidney as well as the function of the kidney. Acute glomerulonephritis often presents with glomeruli bleeding. The nurse should inspect the urine with a dipstick. There will be increased protein evident. Inspect the urine for gross hematuria, which will cause the urine to appear tea colored, reddish-brown or smoky. The child may have a slight weight gain from slight edema. The blood pressure will be elevated and the child will experience a decreased urine output.

During the newborn examination, the nurse notes that an infant who is appropriate for gestational age by birth weight has a head circumference below the 10th percentile and the fontanels (fontanelles) are not palpable. What action would the nurse take? Tell the parent the infant's brain is underdeveloped. Report the findings to the pediatric health care provider. Reassess the head circumference in 24 hours. Document that the infant has microcephaly.

Report the findings to the pediatric health care provider.

Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura? Risk for altered urinary elimination related to kidney impairment Ineffective breathing pattern related to decreased white blood count Risk for infection related to abnormal immune system Risk for bleeding related to insufficient platelet formation

Risk for bleeding related to insufficient platelet formation Idiopathic thrombocytopenic purpura is the result of a decrease in the number of circulating platelets in the presence of adequate megakaryocytes, which are precursors to platelets. Because bleeding can occur with this disease process, the diagnosis most appropriate for the client at this time is risk for bleeding related to insufficient platelet formation. Reduced numbers of platelets would not increase the client's risk for infection. Reduced numbers of platelets does not increase the client's risk for renal impairment. Reduced risk of platelets will not lead to an ineffective breathing pattern.

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority? Activity intolerance Excess fluid volume Imbalanced nutrition less than body requirements Risk for infection

Risk for infection When vesicoureteral reflux is present, the primary goal is to avoid urine infection so that infected urine cannot gain access to the kidneys. Fluid volume typically is not a problem associated with VUR. Nutritional problems are not associated with VUR. Activity intolerance is not associated with VUR.

Which nursing diagnosis would be the priority when caring for a child in renal failure following a kidney transplant? Risk for infection related to immunocompromised state Constipation related to effects of administered drugs Pain related to tissue rejection Deficient fluid volume related to fluid intake restrictions postoperatively

Risk for infection related to immunocompromised state Children are administered immunosuppressants following a transplant. These drugs lower the immune system response and help prevent rejection following the transplant. As a result, this leaves them susceptible to infection. The child may have pain from the surgical procedure but it does not occur from the rejection of the organ. Constipation may occur from the opioids used for pain management but it is not the priority nursing diagnosis. The fluid volume should return to normal once the transplanted kidney is functioning properly.

The nurse is preparing a care plan for a child who has a seizure disorder. The child experiences tonic-clonic seizures. Which nursing diagnosis will the nurse identify as having the highest priority? Risk for delayed development Risk for injury Risk for self-care deficit: bathing and dressing Risk for ineffective tissue perfusion: cerebral

Risk for injury

In caring for the child with meningitis, the nurse recognizes that which nursing diagnosis would be most important to include in this child's plan of care? Delayed growth and development related to physical restrictions Ineffective airway clearance related to history of seizures Risk for acute pain related to surgical procedure Risk for injury related to seizure activity

Risk for injury related to seizure activity The child's risk for injury would be an appropriate nursing diagnosis. Surgery is not indicated for the child with meningitis, and the history of seizures does not impact the airway clearance. Growth and development issues are a concern but not likely delayed due to this diagnosis.

The nurse recognizes that what would be a likely physiologic cause for a child to have enuresis? Regression to get attention Sleeping too soundly Stress and stressful situations Sexual abuse

Sleeping too soundly Physiologic causes may include a small bladder capacity, urinary tract infection, and lack of awareness of the signal to empty the bladder because of sleeping too soundly. Psychological causes might include rigorous toilet training, resentment toward family caregivers, a desire to regress to an earlier level of development to receive more care and attention, or emotional stress and stressful situations. Enuresis can be a symptom of sexual abuse.

The nurse is examining the hands of a child with suspected iron deficiency anemia. Which finding should the nurse expect? spooning of nails capillary refill in less than 2 seconds absence of bruising pink palms and nail beds

Spooning of nails A convex shape of the fingernails termed 'spooning' can occur with iron deficiency anemia. Capillary refill in less than 2 seconds, pink palms and nail beds, and absence of bruising are normal findings.

The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion? Enlarged inguinal glands and fever Hardened and tender epididymitis with edema and erythema of scrotum Sudden onset of severe scrotal pain with significant hemorrhagic swelling Fever, scrotal swelling, and urethral discharge

Sudden onset of severe scrotal pain with significant hemorrhagic swelling Testicular torsion is characterized by a testicle that is abnormally attached to the scrotum and twisted. Signs and symptoms include sudden onset of severe scrotal pain with significant hemorrhagic swelling. Enlarged glands and fever point to infection. A hardened and tender epididymis points to epididymitis. Fever and urethral discharge suggest infection. Scrotal swelling is associated with testicular torsion, epididymitis, and hydrocele.

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

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

The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis? Loose, dark stools Strawberry-red tongue Jaundiced skin Tea-colored urine

Tea-colored urine The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis?

A 9-year-old boy is suffering from headaches but has no signs of physical or neurologic illness. Which intervention would be most appropriate? Have the child sleep without a pillow under his head. Have the parents call the doctor if the child vomits more than twice. Teach the child and his parents to keep a headache diary. Review the signs of increased intracranial pressure with parents.

Teach the child and his parents to keep a headache diary. A headache diary can help identify any triggers so that the child can avoid them. Triggers can include foods eaten, amount of sleep the night before, or activities at home or school that might be causing stress.Vomiting more than twice is an indication that the parents should notify the physician or nurse practitioner when the child has a head injury.Reviewing signs of increased intracranial pressure would be inappropriate because increased intracranial pressure is not associated with headaches.Having the child sleep without a pillow is an intervention to reduce pain from meningitis.

The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration? Blood pressure of 80/42 mm Hg Soft and flat fontanels (fontanelles) Pale and slightly dry mucosa Tenting of skin

Tenting of skin Tenting of skin is an indicator of severe dehydration. Soft and flat fontanels (fontanelles) indicate mild dehydration. Pale and slightly dry mucosa indicates mild or moderate dehydration. Blood pressure of 80/42 mm Hg is a normal finding for an infant.

An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care? The adolescent will become fatigued easily. Hypothermia is common. The adolescent's urine will be dark and infectious. The adolescent will be very irritable and perhaps require sedation.

The adolescent will become fatigued easily. Hepatitis A is transmitted via the oral-fecal route; it is water borne and often occurs in areas of poor sanitation. The adolescent with hepatitis A will exhibit flu-like symptoms, a headache, anorexia and fatigue. The urine is not infectious and fever may be present as opposed to hypothermia. Irritability is not one of the symptoms of hepatitis A. The client is usually lethargic or listless.

The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply. The outside of the boy's cast got wet and had to be dried using a hair dryer. The boy experiences mild pain when wiggling his toes. The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. The boy's toes are light blue and very swollen. New drainage is seeping out from under the cast.

The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. New drainage is seeping out from under the cast. The boy's toes are light blue and very swollen.

The nurse knows that which statement is a description of peritoneal dialysis when compared to hemodialysis: There are strict diet and fluid restrictions. The child must go into a facility to get peritoneal dialysis. The child can live a more normal lifestyle. Therapy is only 3 to 4 days per week.

The child can live a more normal lifestyle. The child can live a more normal lifestyle with peritoneal dialysis. This is a 7-day-a-week procedure, but there are less diet restrictions and more freedom with this type of procedure. Peritoneal dialysis can be performed at home.

A pediatric client is scheduled for an intravenous pyelogram (IVP) of the kidney this afternoon. Which situation would require immediate attention by the nurse? The child is diapered. The child's appetite is poor. The child does not have intravenous access. The child is unable to ambulate.

The child does not have intravenous access. An intravenous pyelogram is an X-ray study of the upper urinary tract in which a radio opaque dye is injected into a peripheral vein, requiring intravenous access. The other choices are not a priority for this client.

The nurse is caring for a child admitted with focal onset motor seizures (simple partial motor seizures). Which clinical manifestation would likely have been noted in the child with this diagnosis? The child was dizzy and had decreased coordination. The child had shaking movements on one side of the body. The child had jerking movements in the legs and facial muscles. The child was rubbing the hands and smacking the lips.

The child had shaking movements on one side of the body

A caregiver brings her 7-year-old son to the pediatrician's office, concerned about the child's bedwetting after being completely toilet trained even at night for over 2 years. The caregiver further reports that the child has wet the bed every night since returning home from a 1-week fishing trip. The child refuses to talk about the bedwetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out what possible explanation for the bedwetting? The child did not want to go on the fishing trip and is now retaliating against being made to go. The child is out of the habit of waking himself up during the night to void. The child has a urinary tract infection due to not bathing while on the fishing trip. The child has been sexually abused, maybe on the fishing trip.

The child has been sexually abused, maybe on the fishing trip. Enuresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. Enuresis in the older child may be an expression of resentment toward family caregivers or of a desire to regress to an earlier level of development to receive more care and attention. Emotional stress can be a precipitating factor. The health care team also needs to consider the possibility that enuresis can be a symptom of sexual abuse. Bruising, bleeding, or lacerations on the external genitalia, especially in the child who is extremely shy and frightened, may be a sign of child abuse (child mistreatment) and should be further explored.

The nurse is preparing a child suspected of having a thyroid disorder for a thyroid scan. What information regarding the child should the nurse alert the doctor or nuclear medicine department about? The child has had an MRI of their leg within the past 6 weeks. The child wears a medical alert bracelet for diabetes. The child is taking a vitamin supplement. The child is allergic to shellfish.

The child is allergic to shellfish Allergies to shellfish should be reported because shellfish contains iodine; the dye used for a nuclear medicine scan is iodine based and could cause an anaphylactic reaction. The other information about the child would not need to be reported to the staff

Which goal of therapy would be appropriate for a nurse to establish with a client's family and a client who has a diagnosis of enuresis? The child wakes up once during the night for a glass of water. The client wets only when involved in an activity. The parent takes the client to the bathroom at night. The client remains continent throughout the night.

The client remains continent throughout the night.

A newborn is diagnosed with hypospadias and the parents want the newborn to be circumcised. What would be the best response by the nurse? The foreskin is needed for repair. The circumcision may predispose the newborn to renal failure. Circumcision with hypospadias will cause meatal stenosis. Circumcision is usually performed after 1 year of age.

The foreskin is needed for repair. Hypospadias occurs when the meatal opening is on the ventral surface of the penis rather than at the end of the penis. The newborn with this condition is not circumcised at birth because the excess skin may be needed to reconstruct the meatus during surgical repair. Once the hypospadias is repaired, a circumcision can be performed as part of the procedure. Hypospadias repair is usually done after the newborn is 1 year or older. Meatal stenosis has to do with the urethral opening diameter, not the placement. Circumcision or hypospadias repair does not affect the functioning of the renal system so neither would predispose the newborn to renal failure.

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease (LCPD). What is the most important nursing intervention for the nurse to include in working with this child and his caregivers? The nurse should support the caregivers in restricting activity during the treatment. The nurse should help the caregivers to understand and help the child to effectively use the corrective devices. The nurse should be a contact person when the child is hospitalized. The nurse should provide information when the child or caregiver requests it.

The nurse should help the caregivers to understand and help the child to effectively use the corrective devices.

In caring for a child in traction, which intervention is the highest priority for the nurse? The nurse should monitor for decreased circulation every 4 hours. The nurse should record accurate intake and output. The nurse should provide age-appropriate activities for the child. The nurse should clean the pin sites at least once every 8 hours.

The nurse should monitor for decreased circulation every 4 hours.

The community health nurse is preparing a presentation which will illustrate the various forms of spina bifida for a health fair. Which explanation should the nurse use to explain spina bifida with meningocele? There is a bony defect that occurs without soft-tissue involvement. The spinal meninges protrude through the bony defect and form a cystic sac. There is protrusion of the spinal cord and meninges, with nerve roots embedded. There is no protrusion of the spinal cord, only soft-tissue inflammation occurs.

The spinal meninges protrude through the bony defect and form a cystic sac. When part of the spinal meninges protrudes through the bony defect and forms a cystic sac, the condition is termed spina bifida with meningocele. In spina bifida with myelomeningocele, there is a protrusion of the spinal cord and the meninges, with nerve roots embedded in the wall of the cyst. A bony defect that occurs without soft-tissue involvement is called spina bifida occulta.

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

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

A nurse is providing education to parents of a child diagnosed with vesicoureteral reflux (VUR). Which would be included in the parental education? This is typically treated with a kidney transplant. This occurs only when there is an obstruction of the ureteropelvic junction. This occurs when there is backflow of urine into the bladder and sometimes the kidneys. This is diagnosed by abdominal x-ray.

This occurs when there is backflow of urine into the bladder and sometimes the kidneys. The cause of VUR is a backflow of urine into the bladder and possibly kidneys. This disorder can occur if there is an obstruction, but this is not always the case. The way to determine if a child has VUR is typically by a VCUG diagnostic test. There are five different grades to VUR and it is treated according to the cause and degree of VUR.

A nurse is taking care of an infant with diabetes insipidus. Which assessment data are most important for the nurse to monitor while the infant has a prescription for fluid restriction? Urine output Oral mucosa Oral intake Vital signs

Urine output An infant with the diagnosis of diabetes insipidus has decreased secretion of antidiuretic hormone (ADH). The infant is at risk for dehydration so monitoring urinary output is the most important intervention. The child's oral intake has been ordered. Monitoring a child who is under fluid restriction includes assessing the oral mucosa; however, urine output is the most important assessment for this patient. Vital signs are part of a basic assessment.

A 14-year-old girl who is a vegetarian has recently developed anemia. Blood smear results show large, fragile, immature erythrocytes. She claims to take an iron supplement regularly and is surprised to learn that she is anemic, as she is otherwise healthy. As the nurse considers all of the data in the case, which anemia will the nurse discuss when collaborating with the primary healthcare provider? sickle-cell disorder iron deficiency vitamin B12 deficiency acute blood loss

Vitamin B12 deficiency Vitamin B12 is necessary for the maturation of RBCs. Pernicious anemia results from deficiency or inability to use the vitamin, resulting in RBCs that appear abnormally large and are immature megaloblasts (nucleated immature red cells). Thus, pernicious anemia is one of the megaloblastic anemias. In children, the cause is more often lack of ingestion of vitamin B12 rather than poor absorption. Adolescents may be deficient in vitamin B12 if they are ingesting a long-term, poorly formulated vegetarian diet as the vitamin is found primarily in foods of animal origin.

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

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

The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding? White cottage cheese-like discharge Thin gray vaginal discharge with fishy odor Irritation of labia and vaginal opening Foul yellow-gray discharge

White cottage cheese-like discharge White cottage cheese-like discharge indicates C. albicans. Thin gray discharge with a fishy odor points to Bordetella or Gardnerella. Foul yellow-gray discharge indicates Trichomonas vaginalis. Irritation of the labia and vaginal opening is commonly found with poor hygiene.

Which instructions should a nurse give to a client who has a history of urinary tract infections to prevent recurrence? Select all that apply. Use bubble bath to wash. Wipe from front to back. Encourage fluids throughout the day. Limit bathing to once a week. Finish all antibiotics prescribed.

Wipe from front to back. Encourage fluids throughout the day. Finish all antibiotics prescribed.

The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents? "Ice will help reduce the inflammation." "You will need to see a physical therapist for stretching and strengthening exercises." "NSAIDs can help with pain control and inflammation." "You and your coaches need to understand that you cannot play soccer for at least six weeks."

You and your coaches need to understand that you cannot play soccer for at least six weeks."

How would the nurse best describe Gowers sign to the parents of a child with muscular dystrophy? muscle twitching present during a quick stretch a transfer technique the pelvis position during gait a waddling-type gait

a transfer technique

The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100℉ (37.8℃). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have: acute glomerulonephritis. a urinary tract infection. lipoid nephrosis (idiopathic nephrotic syndrome). rheumatic fever.

acute glomerulonephritis. Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever. Presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection such as strep throat, otitis media, tonsillitis, or impetigo. Usually the presenting symptom is grossly bloody urine. Periorbital edema may accompany or precede hematuria. Fever may be 103℉ to 104℉ (39.4℃ to 40℃) at the onset, but decreases in a few days to about 100℉ (37.8℃). Slight headache and malaise are usual, and vomiting may occur.

A group of students is reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age? toddlerhood preschool age adolescence school age

adolescence

A group of nursing students are reviewing cerebral vascular disorders and risk factors in children. The students demonstrate understanding of the material when they identify which as a risk factor for hemorrhagic stroke? arteriovenous malformations (AVMs) sickle cell disease meningitis congenital heart defect

arteriovenous malformations (AVMs) Vascular malformations such as intracranial AVMs are a risk factor for hemorrhagic stroke. Sickle cell disease is a risk factor for ischemic stroke.Congenital heart defects are risk factors for ischemic stroke.Meningitis or other infection is a risk factor for ischemic stroke

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant? baclofen lorazepam botulin toxin prednisone

baclofen

The nurse assesses a child and finds that the child's pupils are pinpoint. What does this finding indicate? seizure activity intracranial mass brain stem dysfunction brain stem herniation

brain stem dysfunction

The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be: Complete Spiral Incomplete Greenstick

complete

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal? creatine kinase sodium serum potassium bilirubin

creatine kinase

The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. What activity would the nurse identify as a possible trigger? use of nonaccented soap 11 p.m. bedtime; 6:30 a.m. wake-up swimming twice a week drinking three cans of diet cola

drinking three cans of diet cola Cola contains caffeine, which is an associated trigger.Intense activity, not regular exercise, may be a trigger. Odors, such as strong perfumes, may be a trigger.Changes in sleeping patterns may be a trigger.

The nurse is assessing a 1-month-old girl who, according to the mother, doesn't eat well. Which assessment suggests the child has congenital hypothyroidism? enlarged tongue tachycardia frequent diarrhea warm, moist skin

enlarged tongue Observation of an enlarged tongue along with an enlarged posterior fontanel (fontanelle) and feeding difficulties are key findings for congenital hypothyroidism. The mother would report constipation rather than diarrhea. Auscultation would reveal bradycardia rather than tachycardia, and palpation would reveal cool, dry, and scaly skin.

The labor and delivery nurse is caring for a mother who has demonstrated polyhydramnios upon delivery. The newborn displays copious, frothy bubbles of mucus in the mouth and nose, as well as drooling. The nurse is concerned that the infant has what disorder? esophageal atresia gastroschisis hiatal hernia omphalocele

esophageal atresia Esophageal atresia refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. Polyhydramnios is often the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Omphalocele and gastroschisis are congenital anomalies of the anterior abdominal wall. Hiatal hernia involves a weakened diaphragm.

A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate? pyloric stenosis hernia esophageal atresia (EA) cleft palate

esophageal atresia (EA) A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula (TEF).

The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. What would the nurse assess? Select all that apply. eye opening motor response fontanels (fontanelles) verbal response posture

eye opening verbal response motor response

The parents of a 5-week-old infant present to urgent care because the child is "throwing up forcefully with every feeding." What other assessment(s) will the nurse complete? Select all that apply. feeding technique vomiting description and pattern mucous membranes and skin current weight and weight gain since birth family history of lactose and gluten intolerance

feeding technique vomiting description and pattern current weight and weight gain since birth mucous membranes and skin This child is showing potential symptoms of pyloric stenosis, which presents as postfeed projectile vomiting. The nurse should assess the feeding technique to determine if it is caused by excessive air intake or a lack of burping. The projectile vomiting from pyloric stenosis can lead to inadequate weight gain and dehydration, so the weight gain, skin, and mucous membranes should be assessed. These symptoms are not related to gluten or lactose intolerance. Gluten intolerance is uncommon before the introduction of solid foods and includes poor growth, bulky stools, malnutrition, distended abdomen, and anemia. Lactose intolerance symptoms include abdominal pain, poor growth, diarrhea, and frothy stools.

The nurse is caring for a 12-year-old child with Crohn disease. What assessment finding will the nurse report to the health care provider when caring for the child? no joint swelling clear lung sounds fever report of a headache

fever Crohn disease may affect any area of the digestive tract. It causes acute and chronic inflammation. It may also cause abscesses and fistulas. Inflammation and abscesses can cause fever. An increasing temperature could be the manifestation of the inflammation worsening or the development of an abscess and subsequent infection. The progression of the disease will be reported to the health care provider. A headache may accompany the fever and is a sign of generally not feeling well. It does not indicate progression of the disease, thus does not need to be reported. Clear lung sounds and no swollen joints are good signs, but they are not associated with Crohn disease.

A 4-year-old child receiving vincristine develops peripheral neuropathy. The parents report that the child continues to struggle with fine motor control and state, "He can't even hold a pencil to draw a picture." Which medication would the nurse anticipate being prescribed by the primary care provider? cisplatin gabapentin ondansetron prednisone

gabapentin Vincristine, a medication used as therapy for many childhood cancers, results in peripheral neuropathy—specific neurologic symptoms of weakness, tingling, and numbing of the extremities and sometimes the inability to walk comfortably because of a condition called foot drop. While receiving the medication, children may be unable to hold a pen or pencil or maneuver small parts of toys because their fingers are so affected. These symptoms typically subside after the medication is discontinued, but in the meantime, help the child think of tasks that can be accomplished without fine motor control. If severely impacting daily activities, additional neuroactive medications like gabapentin or aripiprazole may help with reducing neuropathic symptoms. Prednisone and cisplatin are chemotherapeutic agents, each with its own side effects and toxic effects. Ondansetron is used to relieve nausea and vomiting.

The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care? giving ferrous sulfate with orange juice between meals providing a high dose of intravenous immunoglobulin weekly packed red blood cell transfusions increasing the daily intake of fresh fruits and vegetables

giving ferrous sulfate with orange juice between meals Treatment for iron-deficiency anemia is the administration of ferrous sulfate for a 13-year-old client with a hemoglobin at 11 g/dL (110 g/L). It should be administered with orange juice, because vitamin C helps absorb iron. It should not be taken with milk. It can cause teeth staining in children and should be given with a straw. Intravenous immunoglobulin would be administered for idiopathic thrombocytopenic purpura. The client's hemoglobin level is not severe enough to warrant blood transfusions at this time. There is also no indication the child is symptomatic. Anemia is generally diagnosed for a hemoglobin less than 12 g/dL (120 g/L) in children 12 to 14 years of age. The normal level for children 12 to 18 years of age is 14 g/dL (140 g/L). While increasing fresh fruits and vegetables is good for the client's overall health, this client needs foods specifically high in iron. These include broccoli, bananas, tomatoes, spinach, liver, nuts, dates, legumes, beef, eggs, and pork.

A child has undergone a hematopoietic stem cell transplant. When assessing the child, the nurse notes the development of a maculopapular rash on the child's palms and bottoms of the feet. Which condition would the nurse suspect? veno-occlusive disease disseminated intravascular coagulation graft failure graft-versus-host disease

graft-versus-host disease Graft-versus-host disease involves the development of a maculopapular rash on the palmar and plantar surfaces of the hand and feet evolving into erythematous rash over most of body (ranging from slight redness of the skin to complete skin desquamation). Disseminated intravascular coagulation would involve signs of bleeding, including bruising, petechiae, and ecchymoses. Graft failure would be manifested by fever, infection, and a decrease in blood counts. Veno-occlusive disease would be manifested by sudden, unexpected weight gain, thrombocytopenia, jaundice, hepatomegaly, right upper quadrant pain, ascites, and encephalopathy.

The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis? abdominal pain and irritability perianal fissures and skin tags sausage-shaped mass in the upper mid abdomen hard, moveable "olive-like mass" in the upper right quadrant

hard, moveable "olive-like mass" in the upper right quadrant A hard, moveable "olive-like mass" in the right upper quadrant is the hypertrophied pylorus. A sausage-shaped mass in the upper mid abdomen is the hallmark of intussusception. Perianal fissures and skin tags are typical with Crohn disease. Abdominal pain and irritability is common with pyloric stenosis but are seen with many other conditions.

Testing is being performed to confirm the presence of Meckel diverticulum. Which findings are consistent with this condition? Select all that apply. white blood cell count 8 g/dl platelet count 200,000 hemoglobin 9.4 g/dl (94 g/L) hematocrit 37% (0.37) Stool test reveals occult blood.

hemoglobin 9.4 g/dl (94 g/L) Stool test reveals occult blood.

The nurse is reviewing the laboratory test results of a child with thalassemia. Which results would the nurse expect to find with the hemoglobin electrophoresis? Select all that apply. hemoglobin A2 hemoglobin F hemoglobin S hemoglobin A

hemoglobin A2 hemoglobin F In thalassemia, the hemoglobin electrophoresis would reveal the presence of hemoglobin F and A2 only. Hemoglobin S would be found with sickle cell disease.

Through which mechanism is Duchenne muscular dystrophy acquired? environmental toxins autoimmune factors virus heredity

heredity

The parent reports that the health care provider said that the infant had a hernia but cannot remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated? hiatal hernia inguinal hernia diaphragmatic hernia umbilical hernia

inguinal hernia An inguinal hernia occurs primarily in males and allows the intestine to slip into the inguinal canal, resulting in swelling. If the intestine becomes trapped and circulation is impaired, surgery is indicated within a short period of time. The diaphragmatic hernia has implications with the respiratory system. An umbilical hernia typically spontaneously closes by age 3. A hiatal hernia produces digestive issues.

A nursery nurse is providing care to a newborn diagnosed with an open neural tube disorder. What is the nurse's initial priority in providing care to the newborn? injury prevention infection control nutritional support fluid maintenance

injury prevention

Preterm infants have more fragile capillaries in the periventricular area than term infants. This put these infants at risk for which problem? congenital hydrocephalus moderate closed-head injury early closure of the fontanels (fontanelles) intracranial hemorrhaging

intracranial hemorrhaging

A child with cancer is dying and in hospice care. When developing the plan of care, which intervention should the nurse include as the primary focus? managing the symptoms of dyspnea delivering appropriate developmental care providing emotional support keeping the child pain-free

keeping the child pain-free

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element? cat dander latex alcohol gel peanuts

latex

Which clinical manifestation should a nurse recognize as most significant when assessing a client who is suspected of having female circumcision? menses vaginal discharge missing clitoris redness and swelling

missing clitoris Clients who are assessed with a missing clitoris should receive further workup for female circumcision. Redness, swelling, and vaginal discharge can be indicated for infection. Menses is not affected in clients with female circumcision.

The nurse caring for an infant with craniosynostosis, specifically positional plagiocephaly, should prioritize which activity? moving the infant's head every 2 hours massaging the scalp gently every 4 hours measuring the intake and output every shift giving the infant small feedings whenever he is fussy

moving the infant's head every 2 hours

Which hormones are secreted by the adrenal medulla? Select all that apply. norepinephrine aldosterone epinephrine cortisol insulin

norepinephrine epinephrine The adrenal medulla secretes epinephrine and norepinephrine; the adrenal cortex secretes aldosterone and cortisol. The pancreas secretes insulin.

To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to: notify a health care provider if the child develops an upper respiratory infection. administer an iron supplement daily. encourage the child to participate in school activities, such as long-distance running. prevent the child from drinking an excess amount of fluids per day.

notify a health care provider if the child develops an upper respiratory infection. Infections caused by the Streptococcus pneumoniae can be lethal to a child with sickle cell, because they can cause overwhelming sepsis or meningitis. By 2 months of age the child should be started on Penicillin V as prophylaxis against pneumococcal infections. The child should receive the 7 valent pneumococcal series in infancy. After 2 years of age the child should receive the 23 valent pneumococcal vaccine. He or she should also be immunized against meningitis. Participating in strenuous activities such as running and limiting the amount of fluids leads to a reduction of oxygen and dehydration. This can lead to the increased sickling of cells. The anemia of sickle cell disease is not the result of iron deficiency. It is the result of the abnormal shape of the red blood cell. Administering iron will not correct the anemia.

The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: ischemia. dehydration. respiratory distress. painless rectal bleeding.

painless rectal bleeding. With Meckel diverticulum, most symptomatic children present younger than age 2 years. Intermittent, painless rectal bleeding is the most common clinical manifestation of Meckel diverticulum. The blood is most often bright red or maroon and may be passed independent of stool due to ulceration at the junction of the ectopic tissue and the normal ileal mucosa.

The nurse is reviewing the medical record of a child diagnosed with Hodgkin lymphoma at the asymptomatic stage. Which would the nurse identify as typically the first sign reported by the child? painless, enlarged lymph node anorexia weight loss night sweats

painless, enlarged lymph node Children with Hodgkin lymphoma typically present with swollen, painless, and rubbery-feeling lymph nodes in the cervical or supraclavicular region. Depending on the extent of the disease at diagnosis, other symptoms may be present. However, this child was diagnosed in stage I (asymptomatic). If the lymph nodes of the chest are involved, the child has moved to the symptomatic stages and may experience dyspnea and cough. Chest pain may result from the pressure exerted by the enlarged nodes. General symptoms can also include fever, drenching night sweats, and weight loss.

The nurse is caring for an infant with myelomeningocele prior to having repair surgery. What nursing intervention(s) is necessary to include in this infant's plan of care? Select all that apply. keeping the skin clean and dry protecting knees and elbows from skin breakdown providing a pacifier for nonnutritive sucking using a high-calorie, concentrated formula for feeds

positioning of paralyzed legs to prevent contractures protecting knees and elbows from skin breakdown keeping the skin clean and dry

An experienced nurse is orienting a new nurse to the oncology unit. Which action by the new nurse would require intervention? washing hands well after administering chemotherapy pouring unused chemotherapy medicine into a sink drain providing information about nausea, mucositis, and susceptibility to infection wearing gloves when administering chemotherapy

pouring unused chemotherapy medicine into a sink drain The experienced nurse will need to intervene if the new nurse pours chemotherapy into a sink drain. Chemotherapy drugs should be considered hazardous substances and have special handling procedures (hospital specific protocols should be followed). When administering such agents, nurses should wear gloves and wash the hands well afterward to prevent skin exposure and absorption of the drug. It is appropriate for the nurse to teach the family about possible side effects and how to deal with them.

The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation? absence of Moro reflex absence of tonic neck reflex presence of Moro reflex presence of symmetrical spontaneous movement

presence of Moro reflex

A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? Select all that apply. prone right side lying left side lying semi-Fowler supine

prone right side lying left side lying supine Postoperatively, the nurse would position the infant in the prone or side-lying position to allow the incision to heal.

The nurse is assessing a 5-year-old child whose parent reports the child has been vomiting lately, has no appetite, and has had an extreme thirst. Laboratory work for diabetes is being completed. Which symptom would differentiate between type 1 diabetes from type 2 diabetes? recent weight loss loose stools blood pressure of 142/92 mm Hg slow healing wounds

recent weight loss Weight loss is unique to type 1 diabetes, whereas weight gain is associated with type 2. Hypertension is consistent with type 2 diabetes. Both type 1 and type 2 diabetes cause delayed wound healing. The increase in blood glucose in diabetes causes damage to the inner lining of the arteries that cause the arteries to develop plaque and harden. These damages to the blood vessels result in a decrease in the ability of oxygen-rich blood to be transported effectively to the tissues to promote wound healing. Loose stools or repeated loose stools (diarrhea) is a common side effect of the oral medication metformin, which is prescribed for clients with type 2 diabetes. Insulin, the treatment for type 1 diabetes, has constipation as one of the side effects.

A nurse is providing care to an 11-month-old infant diagnosed with intussusception. When assessing the appearance of the child's stool, the nurse expects to note which finding? clay-colored, watery stools red, currant jelly-like stool hard, formed large brown stool loose, dark green stool

red, currant jelly-like stool In approximately 70% of cases of intussusception, frank or occult blood is seen in the stool. The stool is described as having a "red currant jelly" appearance due to the blood and mucus it contains. It would not appear dark green. Clay-colored stools would reflect biliary obstruction. Hard, large stools would suggest constipation.

The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for: behavioral addiction. seizures. leg ulcers. priapism.

seizures. Repeated use of meperidine for pain management during sickle cell crisis increases the risk of seizures when used in children with sickle cell anemia. Behavioral addiction is rarely a concern in the child with sickle cell anemia if the narcotic is used for the alleviation of severe pain. Priapism is a complication of sickle cell anemia unrelated to meperidine administration. Leg ulcers are a complication of sickle cell anemia unrelated to meperidine administration.

A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as: bone that breaks into two pieces. bone buckling due to compression. significant bending without actual breaking. incomplete fracture.

significant bending without actual breaking.

Which diagnostic measure is most accurate in detecting neural tube defects? significant level of alpha-fetoprotein present in amniotic fluid flat plate of the lower abdomen after the 23rd week of gestation presence of high maternal levels of albumin after 12th week of gestation amniocentesis for lecithin-sphingomyelin (L/S) ratio

significant level of alpha-fetoprotein present in amniotic fluid

Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n): diuretic. steroid. anticonvulsant. antihistamine.

steroid.

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse? placing sterile cotton gauze squares around the ends of the pins using latex free sterile gloves unhooking a weight while providing pin care mixing hydrogen peroxide with sterile water to make half-strength hydrogen peroxide

unhooking a weight while providing pin care

The nurse is caring for a 3-year-old boy who is experiencing seizure activity. Which diagnostic test will determine the seizure area in the brain? cerebral angiography lumbar puncture computed tomography video electroencephalogram

video electroencephalogram

A nurse has just admitted a client with symptoms of vulva inflammation, pain, odor, and pruritus. Based on these findings, the nurse could conclude that this client will be diagnosed with which condition? vaginal inflammation vulvovaginitis urinary tract infection (UTI) pelvic inflammatory disease (PID)

vulvovaginitis Vulvovaginitis is diagnosed with clients experiencing vaginal or vulval inflammation, pain odor, and pruritus. Pelvic inflammatory disease and urinary tract infection are not consistent with these symptoms.

A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema? weight, daily abdominal circumference urine output, every shift amount of protein in the urine

weight, daily The classic sign of nephrotic syndrome is edema. It is usually generalized, but may be manifested as ascites or be periorbital depending on the seriousness of the disease. The easiest way to determine edema is by weighing the child. The child should be weighed on the same scale, at the same time daily, and with the same amount of clothing. The abdomen would only need to be measured if ascites was suspected or known. Measuring urine output will not determine edema, although it should be done to determine if urine is being produced in adequate amounts. Measuring the amount of protein in the urine will also not determine edema. The measurement is important to determine the progress of the disease, however.

The nurse measures the client's blood glucose level prior to breakfast. The measurement obtained is 130 mg/dl. The orders read to administer 2 units of Humalog insulin for a blood glucose of 100 to 150 mg/dl. How soon should the nurse ensure that the client eats breakfast after receiving insulin? within 60 to 90 minutes within 5 minutes within 15 to 30 minutes within 2 hours

within 15 to 30 minutes Humalog is a rapid-acting insulin. The onset of Humalog insulin is within 15 minutes and the peak level is achieved within 30 to 90 minutes; therefore, the client should eat within 15 to 30 minutes to avoid a hypoglycemic reaction.

A young female has been prescribed corticosteroids for dermatomyositis. Which statements by her mother indicate the need for further education? Select all that apply. "We are taking her to Disney in the summer." "The physician said that when it's time for her to stop taking this medication, he will gradually start reducing her dose." "She might recover completely from this condition." "I give it to her first thing in the morning before breakfast." "She's got to take this medication to help with the calcium deposits that can form."

• "I give it to her first thing in the morning before breakfast."• "We are taking her to Disney in the summer."