Test 2 PEDS

Cristina, a mother of a 4-year-old child tells the nurse that her child is a very poor eater. What's the nurse's best recommendation for helping the mother increase her child's nutritional intake? a. Allow the child to feed herself b. Use specially designed dishes for children - for example, a plate with the child's favorite cartoon character c. Only serve the child's favorite foods d. Allow the child to eat at a small table and chair by herself

10.Answer A. The best recommendation is to allow the child to feed herself because the child's stage of development is the preschool period of initiative. Special dishes would enhance the primary recommendation. The child should be offered new foods and choices, not just served her favorite foods. Using a small table and chair would also enhance the primary recommendation.

Nurse Oliver s teaching a mother who plans to discontinue breast-feeding after 5 months. The nurse should advise her to include which foods in her infant's diet? a. Iron-rich formula and baby food b. Whole milk and baby food c. Skim milk and baby food d. Iron-rich formula only

23.Answer D. The American Academy of Pediatrics recommends that infants at age 5 months receive iron-rich formula and that they shouldn't receive solid food - even baby food - until age 6 months. The Academy doesn't recommend whole milk until age 12 months, and skim milk until after age 2 years.

Nurse Mariane is caring for an infant with spina bifida. Which technique is most important in recognizing possible hydrocephalus? a. Measuring head circumference b. Obtaining skull X-ray c. Performing a lumbar puncture d. Magnetic resonance imaging (MRI)

29.Answer A. Measuring head circumference is the most important assessment technique for recognizing possible hydrocephalus, and is a key part of routine infant screening. Skull X-rays and MRI may be used to confirm the diagnosis. A lumber puncture isn't appropriate.

An infant is hospitalized for treatment of nonorganic failure to thrive. Which nursing action is most appropriate for this infant? a. Encouraging the infant to hold a bottle b. Keeping the infant on bed rest to conserve energy c. Rotating caregivers to provide more stimulation d. Maintaining a consistent, structured environment

8.Answer D. The nurse caring for an infant with nonorganic failure to thrive should maintain a consistent, structured environment that provides interaction with the infant to promote growth and development. Encouraging the infant to hold a bottle would reinforce an uncaring feeding environment. The infant should receive social stimulation rather than be confined to bed rest. The number of caregivers should be minimized to promote consistency of care.

The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37 C (98.6 F). The nurse suspects mild croup and should recommend which of the following? a. Admit to the hospital and observe for impending epiglottitis. b. Provide fluids that the child likes and use comfort measures. c. Control fever with acetaminophen and call if cough gets worse tonight. d. Try over-the-counter cough medicine and come to the clinic tomorrow if no improvement.

ANS: B In mild croup, therapeutic interventions include adequate hydration (as long as the child can easily drink) and comfort measures to minimize distress. The child is not exhibiting signs of epiglottitis. A temperature of 37 C is within normal limits. Although a return to the clinic may be indicated, the mother is instructed to return if the child develops noisy respirations or drooling.

An 8-year-old girl is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. Which of the following will help her most in her adjustment to the hospital? a. Explain hospital schedules to her, such as mealtimes. b. Use terms such as "honey" and "dear" to show a caring attitude. c. Explain when parents can visit and why siblings cannot come to see her. d. Orient her parents, since she is too young, to her room and hospital facility.

ANS: A School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for those experiences that are unavailable. The nurse should refer to the child by the preferred name. Explaining when parents can visit and why siblings cannot come focuses on the limitations, rather than helping her adjust to the hospital. At the age of 8 years, the child should be oriented to the environment along with the parents.

The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurse's response should be based on knowledge that this is: a.acceptable to encourage head control and turning over. b.acceptable to encourage fine motor development. c.unacceptable because of the risk of sudden infant death syndrome (SIDS). d.unacceptable because it does not encourage achievement of developmental milestones.

ANS: A These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs to reduce the risk of SIDS and then be placed on their abdomens when awake to enhance achievement of milestones such as head control. These position changes encourage gross motor development, not fine motor.

The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. Which of the following statement by the parent would indicate a correct understanding of the teaching? a. "I should gently massage the skin under the straps once a day to stimulate circulation." b. "I will apply a lotion for sensitive skin under the straps after my baby has been given a bath to prevent skin irritation." c. "I should remove the harness several times a day to prevent contractures." d. "I will place the diaper over the harness, preferably using a superabsorbent disposable diaper that is relatively thin."

ANS: A To prevent skin breakdown with an infant who has developmental dysplasia of the hip and is in a Pavlik harness, the parent should gently massage the skin under the straps once a day to stimulate circulation. The parent should not apply lotions or powder, since this could irritate the skin. The parent should not remove the harness, except during a bath, and should place the diaper under the straps.

Clinical manifestations of failure to thrive (FTT) in a 13-month-old may include which of the following? a.Irregularity in activities of daily living b.Preferring solid food to milk or formula c.Weight that is at or below the 10th percentile d.Appropriate achievement of developmental landmarks

ANS: A One of the clinical manifestations of children with FTT is irregularity or low rhythmicity in activities of daily living. Children with FTT often refuse to switch from liquids to solid foods. Weight below the 5th percentile is indicative of FTT. Developmental delays, including social, motor, adaptive, and language, exist.

The nurse must assess 10-month-old Chad. He is sitting on his father's lap and appears to be afraid of the nurse and of what might happen next. Which of the following initial actions by the nurse would be most appropriate? a. Initiate a game of peek-a-boo. b. Ask father to place Chad on the examination table. c. Talk softly to Chad while taking him from his father. d. Undress Chad while he is still sitting on his father's lap.

ANS: A Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his father. As much of the assessment as possible should be done with the child on the father's lap. The nurse should have the father undress the child as needed during the examination.

A mother has just given birth to an infant with a cleft lip. Sensing that something is wrong, she starts to cry and asks the nurse, "What is wrong with my baby?" The most appropriate nursing action is to: a.encourage mother to express her feelings. b.explain in simple language that the baby has a cleft lip. c.provide emotional support until practitioner can talk to mother. d.tell mother a pediatrician will talk to her as soon as the baby is examined.

ANS: B It is best to explain in simple terms the nature of the defect and to reinforce and help clarify information given by the practitioner before the infant is shown to the parents. Parents may not be ready to talk about their feelings during the first few days after birth. The nurse should provide information about the child's condition while waiting for the practitioner to speak with the family after the examination. The mother needs simple explanations of what is wrong with her child during this period of waiting.

The nurse encourages the mother of a toddler with acute laryngotracheobronchitis to stay at the bedside as much as possible. The nurse's rationale for this action is primarily which of the following? a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease child's respiratory efforts. c. Separation from mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's respiratory efforts.

ANS: B The family's presence will decrease the child's distress. It is true that mothers of hospitalized toddlers often experience guilt and that separation from mother is a major developmental threat for toddlers, but the main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort.

The most important nursing intervention when caring for a child with myelomeningocele in the preoperative stage is which of the following? a. Take vital signs every hour. b. Place child on side to decrease pressure on the spinal sac. c. Watch for signs that might indicate developing hydrocephalus. d. Apply a heat lamp to facilitate drying and toughening of the sac.

ANS: B The spinal sac is protected from damage until surgery is performed. Early surgical closure is recommended to prevent local trauma and infection. Monitoring vital signs and watching for signs that might indicate developing hydrocephalus are important interventions, but preventing trauma to the sac is a priority. The sac is kept moist until surgical intervention is done.

The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include which of the following? a. Arm restraints, postural drainage, mouth irrigations b. Cleansing suture line, supine and side-lying position, appropriate analgesia c. Mouth irrigations, prone position, cleansing suture line d. Supine and side-lying positions, postural drainage, arm restraints

ANS: B The suture line should be cleansed gently after feeding. The child should be positioned on back, on side, or in infant seat. The child is medicated with appropriate analgesia to calm him or her. Postural drainage is not indicated. This would increase the pressure on the operative site when the child is placed in different positions. There is no reason to perform mouth irrigations, and the child should not be placed in the prone position where injury to the suture site can occur. Arm restraints are used according to local practice.

A recommendation to prevent neural tube defects (NTDs) is the supplementation of which of the following? a. Vitamin A throughout pregnancy b. Folic acid for all women of childbearing age c. Folic acid during the first and second trimesters of pregnancy d. Multivitamin preparations as soon as pregnancy is suspected

ANS: B The widespread use of folic acid among women of childbearing age has decreased the incidence NTDs. In the United States the rates of NTDs have declined from 1.3 per 1000 births in 1990 to 0.3 per 1000 after the introduction of mandatory folic acid supplementation in food in 1998. Vitamin A is not related to the prevention of NTDs. Folic acid supplementation is recommended for the preconceptual period, as well as during the pregnancy. The NTD is a failure of neural tube closure during early development, the first 3 to 5 weeks.

A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, "Wait a minute," and, "I'm not ready." The nurse should recognize that: a. IV insertions are viewed as punishment. b. this is expected behavior for a school-age child. c. protesting like this is usually not seen past the preschool years. d. the child has successfully manipulated the nurse in the past.

ANS: B This school-age child is attempting to maintain some control over the hospital experience. The nurse should provide the girl with structured choices about when the IV will be inserted. Preschoolers can view procedures as punishment; this is not typical preschool behavior.

The major cause of death for children older than 1 year is which of the following? a. Childhood cancer b. Unintentional injuries c. Heart disease d. Congenital anomalies

ANS: B Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence. The leading cause of death for those younger than 1 year is congenital anomalies, and childhood cancers and heart disease cause a significantly lower percentage of deaths in children older than 1 year of age.

At what age do most infants begin to fear strangers? a. 2 months b. 4 months c. 6 months d. 12 months

ANS: C Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to the infants' ability to discriminate between familiar and unfamiliar people. At 2 months, infants are just beginning to respond differentially to the mother. The infant at age 4 months is beginning the process of separation-individuation, which involves recognizing self and mother as separate beings. Twelve months is too late; the infant requires referral for evaluation if he or she does not fear strangers by this age.

Two hospitalized adolescents are playing pool in the activity room. Neither of them seems enthusiastic about the game. The nurse should recognize that: a. it requires too much concentration for this age-group. b. pool is an activity better suited for younger children. c. they may be enjoying themselves but have lower energy levels than healthy children. d. the adolescents' lack of enthusiasm is one of the signs of depression.

ANS: C Children who are ill and hospitalized typically have lower energy levels than healthy children. Therefore children may not appear enthusiastic about an activity even when they are enjoying it. Pool is an appropriate activity for adolescents. They have the cognitive and psychomotor skills that are necessary. If the adolescents were significantly depressed, they would be unable to engage in the game.

The nurse is assessing a child with croup in the emergency department. The child has a sore throat and is drooling. Examining the child's throat using a tongue depressor might precipitate which of the following? a. Sore throat b. Inspiratory stridor c. Complete obstruction d. Respiratory tract infection

ANS: C If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place. Sore throat and pain on swallowing are early signs of epiglottitis. Stridor is aggravated when a child with epiglottitis is supine. Epiglottitis is caused by Haemophilus influenzae in the respiratory tract.

By what age should the nurse expect that an infant will be able to pull to a standing position? a. 6 months b. 8 months c. 11 to 12 months d. 14 to 15 months

ANS: C Most infants can pull themselves to a standing position at age 9 months. Infants who are not able to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip. At 6 months the infant has just obtained coordination of arms and legs. By age 8 months infants can bear full weight on their legs.

Parents bring their 15-month-old infant to the emergency department at 3:00 AM because the toddler has a temperature of 39o C (102.2o F), is crying inconsolably, and is tugging at the ears. A diagnosis of otitis media (OM) is made. In addition to antibiotic therapy, the nurse practitioner would instruct the parents to use: a. decongestants to ease stuffy nose. b. antihistamines to help the child sleep. c. aspirin for pain and fever management. d. benzocaine ear drops for topical pain relief.

ANS: D Analgesic ear drops can provide topical relief for the intense pain of OM. Decongestants and antihistamines are not recommended in the treatment of OM. Aspirin is contraindicated in young children because of the association with Reye syndrome.

Which of the following characteristics best describes the fine motor skills of an infant at age 5 months? a. Neat pincer grasp b. Strong grasp reflex c. Builds a tower of two cubes d. Able to grasp object voluntarily

ANS: D At age 5 months the infant should be able to voluntarily grasp an object. The grasp reflex is present in the first 2 to 3 months of life. Gradually, the reflex becomes voluntary. The neat pincer grasp is not achieved until age 10 months. At age 12 months an infant will attempt to build a tower of two cubes but will most likely be unsuccessful.

The association of cleft palate with otitis media is primarily the result of which of the following? a. Coexisting defects of middle ear and eustachian tube b. Lowered resistance because of poor nutritional status c. Plugging of the eustachian tube with food particles d. Inefficient function of eustachian tubes and improper middle ear drainage

ANS: D Improper drainage of the middle ear, as a result of inefficient function of the eustachian tube, contributes to recurrent otitis media with scarring of the tympanic membrane, which leads to hearing impairment. Coexisting defects of middle ear and eustachian tube, lowered resistance because of poor nutritional status, and plugging of the eustachian tube with food particles are not associated with recurrent otitis media.

Cognitive development influences response to pain. Which age-group is most concerned with the fear of losing control during a painful experience? a. Toddler b. Preschooler c. School-age child d. Adolescent

ANS: D The adolescent views illness as physiologic (an organ malfunction) and psychophysiologic (psychologic factors that affect health). Adolescents usually approach pain with self-control. They are concerned with remaining composed and feel embarrassed and ashamed of losing control. Toddlers and preschoolers react to pain primarily as a physical, concrete experience. Preschoolers may try to escape a procedure with verbal statements such as "go away." Young school-age children may view pain as punishment for wrongdoing. This age-group fears bodily harm.

A 6-year-old child is admitted to the pediatric unit and requires bed rest. The nurse knows that having art supplies available: a. allows the child to create gifts for parents. b. provides developmentally appropriate activities. c. is essential for play therapy so that the child can work on past problems. d. lets the child express thoughts and feelings through pictures rather than words.

ANS: D The art supplies allow the child to draw images that come into the mind. This can help the child develop symbols and then verbalize reactions to illness and hospitalization. The child can make gifts and drawings for parents, but the goal is to allow expression of feelings. Although art is developmentally and situationally appropriate, the child benefits by being able to express feelings nonverbally. The art supplies are not therapeutic play, but a mechanism for expressive play. The child will not work on past problems.

The psychosexual conflicts of preschool children make them extremely vulnerable to which of the following threats? a. Loss of control b. Loss of identity c. Separation anxiety d. Bodily injury and pain

ANS: D The psychosexual conflicts of children in this age-group make them vulnerable to threats of bodily injury. Intrusive procedures, whether painful or painless, are threatening to preschoolers, whose concept of body integrity is still poorly developed. Loss of control, loss of identity, and separation anxiety are not related to psychosexual conflicts

6.The nurse notes that an infant stares at an object placed in her hand and takes it to her mouth, coos and gurgles when talked to, and sustains part of her own weight when held in a standing position. The nurse correctly interprets these findings as characteristic of an infant at which of the following ages? A. 2 months. B. 4 months. C. 7 months. D. 9 months.

Ans: B Holding the head erect when sitting, staring at an object placed in the hand, taking the object to the mouth, cooing and gurgling, and sustaining part of her body weight when in a standing position are behaviors characteristic of a 4-month old infant. A 2-month-old typically vocalizes, follows objects to the midline, and smiles. A 7-month-old typically is able to sit without support, turns toward the voice, and transfers object from hand to hand. Usually, a 9-month-old can crawl, stand while holding on, and initiate speech sounds

The nurse is assessing a six-month-old child. Which developmental skills are normal and should be expected? a. Speaks in short sentences. b. Sits alone. c. Can feed self with a spoon. d. Pulling up to a standing position.

Answer B. The child develops language skills between the ages of one and three. A six-month-old child is learning to sit alone. The child begins to use a spoon at 12-15 months of age. The baby pulls himself to a standing position about ten months of age.

While teaching a 10 year-old child about their impending heart surgery, the nurse should a. Provide a verbal explanation just prior to the surgery b. Provide the child with a booklet to read about the surgery c. Introduce the child to another child who had heart surgery three days ago d. Explain the surgery using a model of the heart

Answer D. According to Piaget, the school age child is in the concrete operations stage of cognitive development. Using something concrete, like a model will help the child understand the explanation of the heart surgery.

5.The mother of a 6-month-old states that she has started her infant on 2% milk. Which of the following would be the nurse's best response? A. "Your baby will probably be fine with this milk." B. "The baby should be switched to whole milk." C. "You need to keep the infant on formula." D. "You need to switch to formula right now."

Correct Answer: B The mother has already changed the infant from formula to cow's milk, so she probably will not change the infant back to formula. Therefore, the best the nurse can hope for is that the mother will switch to whole milk. Because cow's milk causes microscopic blood loss in the intestine, it is best for the infant to remain on formula until 1 year of age and then be switched to whole milk, which has a higher fat content than 2% milk. The fat is needed for brain growth.

When a child develops latex allergy, which of the following foods may also cause an allergic reaction? a. Yeast b. Wheat c. Peanuts d. Bananas

ANS: D There are cross-reactions between allergies to latex and to a number of foods such as bananas, avocados, kiwi, and chestnuts. Although yeast, wheat, and peanuts are potential allergens, currently they are not known to cross-react with latex allergy.

An adverse reaction that can occur 2-23 days are a vaccination has been given:

Guillain-Barre

Varicella immunization should be give at ....

12-15 months, subcutaneous

What is the earliest recognizable clinical manifestation(s) of cystic fibrosis (CF)? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

ANS: A The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools and recurrent respiratory infections are later manifestations of CF.

The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. The most appropriate way to position and feed this neonate is to place him: a. prone with head turned to side for feeding. b. on side to facilitate feeding. c. supine in infant carrier for feedings. d. supine, with defect supported with rolled blankets, and with nipple-feeding.

ANS: A The prone position with the head turned to side for feeding is the optimum position for the infant. It protects the spinal sac and allows the infant to be fed without trauma. The side-lying position is avoided preoperatively. It can place tension on the sac and affect hip dysplasia if present. The infant should not be placed in a supine position.

During the 2-month well-child check-up the nurse expects the infant to respond to sound in the following manner: a. responds to name. b. reacts to loud noise with Moro reflex. c. turns head to side when sound is at ear level. d. locates sound by turning head in a curving arc.

ANS: C At 2 months the infant should turn head to the side when a noise is made at ear level. At birth infants respond to sound with a startle or Moro reflex. An infant responds to name and locates sound by turning head in a curving arc at age 6 to 9 months.

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant: a.has a cough. b.becomes fussy. c.shows signs of an earache. d.has a fever higher than 37.5 C (99 F).

ANS: C If an infant with nasopharyngitis shows signs of an earache, it may indicate respiratory complications and possibly secondary bacterial infection. The health professional should be contacted to evaluate the infant. Cough can be a sign of nasopharyngitis. Irritability is common in an infant with a viral illness. Fever is common in viral illnesses.

Reflex stage: birth - 1 month

sucking, rooting, grasping and crying

At what age would the nurse expect an infant to be able to say "mama" and "dada" with meaning? a. 4 months b. 6 months c. 10 months d. 14 months

ANS: C Beginning at about age 10 months, the infant is able to ascribe meaning to the words "mama" and "dada." Four to 6 months is too young for this behavior to develop. At 14 months the child should be able to attach meaning to these words. By age 1 year, the child can say three to five words with meaning and understand as many as 100 words.

A spinal tap must be done on a 9-year-old boy. While he is waiting in the treatment room, the nurse observes that he seems composed. When the nurse asks him if he wants his mother to stay with him, he says, "I am fine." Which of the following is the best interpretation of this situation? a. This child is unusually brave. b. He has learned that support does not help. c. Nine-year-old boys do not usually want a parent present during the procedure. d. Children in this age-group often do not request support, even though they need and want it.

ANS: D The school-age child's visible composure, calmness, and acceptance often mask an inner longing for support. Children of this age have a more passive approach to pain and an indirect request for support. It is especially important to be aware of nonverbal cues such as facial expression, silence, or lack of activity. Usually when someone identifies the unspoken messages, the child will readily accept support.

The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their children. Which of the following is most likely lacking in their particular diet? a.Fat b.Protein c.Vitamins C and A d.Complete protein

ANS: D The vegetarian diet can be extremely healthy, meeting the overall nutrition objectives outlined in Healthy People 2010. Parents should be taught about food preparation to ensure that complete proteins are available for growth. When parents use a strict vegetarian diet, a likelihood exists of inadequate protein for growth and calories for energy. Fat and vitamins C and A are readily available from vegetable sources. Plant proteins are available. Foods must be combined to provide complete proteins for growth.

Morbidity statistics describe which of the following? a. Disease occurring regularly within a geographic location b. The number of individuals who have died over a specific period c. The prevalence of specific illness in the population at a particular time d. Disease occurring in more than the number of expected cases in a community

Morbidity statistics show the prevalence of specific illness in the population at a particular time. Data regarding disease within a geographic region, or in greater than expected numbers in a community, may be extrapolated from analysis of the morbidity statistics. Mortality statistics refer to the number of individuals who have died over a specific period.

Pertussis immunizations should be given to infants and adults. Added to _______.

tetanus

How lond do infants cry?

3 weeks: 1-1.5 hours a day 6 weeks: 2-4 hours a day decreases at 12 weeks

By 1 year, they have ___-___ words with meaning. If this is delayed a _________ _________ should be completed.

3-5; hearing screening

When should solid foods be introduced?

4-6 months of age; infant cereal at 4-18 months; iron; introduce foods at intervals of 4-7 days to allow for identification of allergies; at 1 year can eat well cooked table food

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which of the following? a.Do not use for more than 3 days. b.Keep drops to use again for nasal congestion. c.Administer drops after feedings and at bedtime. d.Give two drops every 5 minutes until nasal congestion subsides.

ANS: A Vasoconstrictive nose drops such as Neo-Synephrine should not be used for more than 3 days to avoid rebound congestion. Drops should be discarded after one illness and not used for other children because they may become contaminated with bacteria. Drops administered before feedings are more helpful. Two drops are administered to cause vasoconstriction in the anterior mucous membranes. An additional two drops are instilled 5 to 10 minutes later for the posterior mucous membranes. No further doses should be given.

The parents of a 4-month-old infant cannot visit except on weekends. Which action by the nurse indicates an understanding of the emotional needs of a young infant? a. Place her in a room away from other children. b. Assign her to the same nurse as much as possible. c. Tell the parents that frequent visiting is unnecessary. d. Assign her to different nurses so she will have varied contacts.

ANS: B The infant is developing a sense of trust. This is accomplished by the consistent, loving care of a nurturing person. If the parents are unable to visit, then the same staff nurses should be used as much as possible. Placing her in a room away from other children would isolate the child. The parents should be encouraged to visit. The nurse should describe how the staff will care for the infant in their absence.

Which of the following is an appropriate action when an infant becomes apneic? a.Shake vigorously. b.Roll head side to side. c.Gently stimulate trunk by patting or rubbing. d.Hold by feet upside down with head supported.

ANS: C If the infant is apneic, the infant's trunk should be gently stimulated by patting or rubbing. If the infant is prone, turn onto the back. Vigorous shaking, rolling of the head, and hanging the child upside down can cause injury and should not be done.

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent: a. otitis media. b. diabetes insipidus (DI). c. nephrotic syndrome. d. acute rheumatic fever.

ANS: D Group A -hemolytic streptococcal infection is a brief illness with varying symptoms. It is essential that pharyngitis caused by this organism be treated with appropriate antibiotics to avoid the sequelae of acute rheumatic fever and acute glomerulonephritis. The cause of otitis media is either viral or other bacterial organisms. DI is a disorder of the posterior pituitary. Infections such as meningitis or encephalitis, not streptococcal pharyngitis, can cause DI. Glomerulonephritis, not nephrotic syndrome, can result from acute streptococcal pharyngitis.

Secondary circular reactions: 4-8 months

shaking a rattle

What do infants trust?

their self, others, and the world; feeding, comfort, stimulation and caring needs; sense of self; physical comfort and security; feel empowered in unfamiliar and unknown situations

Development of body image: Realize that parts of their body are useful. Receive satisfaction when...

they smile and someone smiles back at them

What is the percentage range of the transmission of herpes simplex virus during delivery?

86-90% of herpes simplex virus is transmission occurs during delivery.

What kind of surgical team is involved in treating the CL or CP?

A craniofacial multidisciplinary team

What can you use that has three designated risk levels (high, intermediate, or low risk) of hour-specific total serum bilirubin values that assists in the determination of which newborns might need further evaluation before and after discharge?

A nomogram

What is hemorrhagic disease of the newborn (HDN) characterized by?

abnormally rapid destruction of red blood cells (RBC's)

The mother of a 7-month-old infant newly diagnosed with cystic fibrosis is rooming in with her infant. She is breast-feeding and provides all the care except for the medication administration. The nurse includes in the care plan: a. ensuring that the mother has time away from the infant. b. making sure the mother is providing all of the infant's care. c. determining whether other family members can provide the necessary care so the mother can rest. d. contacting the social worker because of the mother's interference with the nursing care.

ANS: A The mother needs sufficient rest and nutrition so she can be effective as a caregiver. While the infant is hospitalized, the care is the responsibility of the nursing staff. The mother should be made comfortable with the care the staff provides in her absence. The mother has a right to provide care for the infant. The nursing staff and the mother should agree on the care division.

The nurse is doing a prehospitalization orientation for a girl, age 7, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that after the surgery, the child will be in the intensive care unit. This explanation is: a. unnecessary. b. the surgeon's responsibility. c. too stressful for a young child. d. an appropriate part of the child's preparation.

ANS: D The explanation is a necessary part of preoperative preparation and will help reduce the anxiety associated with surgery. If the child wakes in the intensive care unit and is not prepared for the environment, she will be even more anxious. This is a joint responsibility of nursing, medical staff, and child life personnel.

Cystic fibrosis (CF) may affect single or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is which of the following? a. Hyperactivity of sweat glands b. Hypoactivity of autonomic nervous system c. Atrophic changes in mucosal wall of intestines d. Mechanical obstruction caused by increased viscosity of mucous gland secretions

ANS: D The mucous glands produce a thick mucoprotein that accumulates and results in dilation. Small passages in organs such as the pancreas and bronchioles become obstructed as secretions form concretions in the glands and ducts. The exocrine glands, not sweat glands, are dysfunctional. Although abnormalities in the autonomic nervous system are present, it is not hypoactive. Intestinal involvement in CF results from the thick intestinal secretions, which can lead to blockage and rectal prolapse.

What is the medical term for generalized edema?

Anasarca

When does surgical correction of the CL usually occur?

Around 2-3 months of life

When is surgical closure of a CP typically performed?

At 6-12 months before the child develops compensatory speech patterns

Where is the subgaleal compartment located?

Beneath the galea aponeurosis

Is a Erythema toxicum neonatorum (malignant/benign)?

Benign

What is the medical term for the definition listed below.... An infectious superficial skin condition most often caused by various strains of Staphylococcus aureus.

Bullous impetigo

What is the medical term for this definition? Blood vessels that rupture during labor or delivery to produce bleeding into the area between the bone and its periosteum.

Cephalhematoma

When blood vessels rupture during labor or delivery to produce bleeding into the area between the bone and its periosteum is called ....

Cephalhematoma

What is the term for the following description: when primary and secondary palatine plates fail to fuse during embryonic development.

Cleft palate (CP)

To ease pain of immunizations, be sure to use appropriate size needles. What can be given to reduce pain?

EMLA (lidocaine-prilocaine) 1 hour; Vapocoolant spray 15 seconds; Oral sucrose solution on pacifier for neonates

What is caused by damage to the upper plexus and usually results from stretching or pulling away of the shoulder from the head, ,as might occur with shoulder dystocia or with a difficult vertex or breech delivery?

Erb palsy (Erb-Duchenne paralysis)

How would you characterize Bullous impetigo?

Eruption of bullous vesicular lesions on previously untraumatized or intact skin

The medical term for a flea bite dermatitis or newborn rash is.....

Erythema toxicum neonatorum

What are the major nursing challenges with either CL or CP?

Feeding

What is the subsequent Tx post maternal RhIg administration, can have dramatic improvements on the outcome of affected fetuses?

Fetal blood transfusions or high-dose intravenous immunoglobulins

How does a brachial plexus injury result?

From forces that alter the normal position and relationship of the arm , shoulder, and neck.

What is the medical term for vascular tumors?

Hemangiomas: 1) hemangiomas of infancy 2) infantile hemangiomas

What do you use to predict new borns at risk of rapidly rising levels of bilirubin for monitoring healthy neonates at more than 35 week gestation before discharge form the hospital?

Hour-specific serum bilirubin levels

Erythroblastosis fatalis is aslo known as .....

Hydrops fetalis

What is present when the newborn's blood glucose concentration is lower than the body;s requirement for cellular energy and metabolism?

Hypoglycemia

What does the term bilirubin encephalopathy describe?

It is a term that is describes the degrees of CNS damage resulting from the deposition of unconjugated bilirubin in brain cells.

What is the term that describes the yellow staining of the brain cells that may result in bilirubin encephalopathy, as damage occurs when the serum concentration reaches toxic levels, regardless of cause?

Kernicterus

What is the less common lower plexus palsy?

Klumpke palsy

What kind of tissue is in the subgaleal compartment?

Loosely arranged connective tissue

Other common causes of injury:

MVA (backing up in driveway, 1-9 years old), falls, poisoning, burns, drowning

What should be administered in early intrauterine detection of fetal anemia by ultrasonography (serial droppler assessment of the peak velocity in the fetal middle cerebral artery).

Maternal Rh immunoglobulin (RhIg)

What is the most serious viral infection in newborns?

Neonatal herpes

How would you describe port-wine stains?

Pink, red, rarely purple that thicken and darken and proportionately enlarge as the child grows.

The Post-operative care centers on what ?

Protection of the suture line.

Piagets Cognitive Development:

Sensorimotor phase Imitation Play Affect

Three achievements of cognitive development?

Separation- separate themselves from other obejcts and other people; Object permanence by 9-10 months; use of symbols

What variety of hemangiomas is more likely to cause complications such as ulcerations and vital organ compromise and to involve developmental defects?

Spontaneous

__________ __________ is bleeding into the subgaleal compartment.

Subgaleal hemorrhage

How does subgaleal hemorrhage occur?

Subgaleal hemorrhage occurs as a result of forces that compress and then drag the head through the pelvic outlet.

What is treatment for CL or CP?

Surgery.

What is the medical term for oral candidiasis?

Thrush

What is the primary goal in Tx of hyperbilirubinemia?

To prevent bilirubin encephalopathy

What is VAERS?

Vaccine Adverse Event Reporting System - to report any adverse reactions after administration of any vaccine

What permanent lesion are present at birth and are initially flat and erythematous?

Vascular birthmarks

Can cleft palate occur in conjunction with cleft lip or as an isolated cleft?

Yes, cleft palate may occur in conjunction with cleft lip or as an isolated cleft.

When do localized superficial hemangiomas tend to manifest?

early in infancy

Caput succedaneum is a vaguely outlined area of __________ tissue situated over the portion of the scalp that presents in a vertex delivery.

edematous

Injury Prevention: Aspirtaion of foreign objects-

food (hot dogs, popcorn, candy, nuts, and grapes), baby powder

What is the medical term for the following description..... An excessive level of accumulated bilirubin in the blood

hyperbilirubinemia

What does cleft lip result from ?

incomplete fusion of the embryonic structures surrounding the primitive oral cavity

Birth injuries are usually transient, and may involve soft issue, bone, and _______ tissue.

nervous

What is the Tx of hyperbilirubinemia, and what does it consist of?

phototherapy, which consist of the application of fluorescent light to the infant's exposed skin.

The subgaleal compartment is a _______ space.

potenital

What does Klumpke palsy result from?

severe stretching of the upper extremity while the trunk is relatively less mobile

Birth injuries are usually transient, and may involve ______ tissue, bone, and nervous tissue.

soft

In regard to CP, Post-operatively the palate is protected by feeding the child with:

soft-tip sippy cups an open cup an oropharyngel syringe specialized bottles with soft tubing

Why are vascular tumors known as hemangiomas of infancy or infantile hemangiomas?

to differentiate them from other vascular tumors and malformations

Birth injuries are usually ________, and may involve soft tissue, bone, and nervous tissue.

transient

What is the most common type of hyperbilirubinemia seen in newborns?

unconjugated

Can spontaneous resolution of hemangiomas occur without therapy?

yes

The leading cause of chronic illness in children is: a. asthma. b. pertussis. c. tuberculosis. d. cystic fibrosis.

ANS: A Asthma is the most common chronic disease of childhood, the primary cause of school absences, and the third leading cause of hospitalization in children under the age of 15 years. Pertussis is not a chronic illness. Tuberculosis is not a significant factor in childhood chronic illness. Cystic fibrosis is the most common lethal genetic illness among Caucasian children.

First verbal communication =

crying

...

Answer C. The hospitalized adolescent may see each of these as a threat, but the major threat that they feel when hospitalized is the fear of altered body image, because of the emphasis on physical appearance.

Caring for the newborn with a cleft lip and palate before surgical repair includes which of the following? a. Gastrostomy feedings b. Allowing little or no sucking c. Providing satisfaction of sucking needs d. Keeping infant in near-horizontal position during feedings

ANS: C Using special or modified nipples for feeding techniques helps to meet the infant's sucking needs. Gastrostomy feedings are usually not indicated. The child requires both nutritive and nonnutritive sucking. Feeding is best accomplished with the infant's head in an upright position.

The nurse is testing an infant's visual acuity. By what age should the infant be able to fix on and follow a target? a. 1 month b. 1 to 2 months c. 3 to 4 months d. 6 months

ANS: C Visual fixation and ability to follow a target should be present by ages 3 to 4 months. One to 2 months is too young for this developmental milestone. If the infant is not able to fix and follow by 6 months, further ophthalmologic evaluation is needed.

While giving nursing care to a hospitalized adolescent, the nurse should be aware that the MAJOR threat felt by the hospitalized adolescent is a. Pain management b. Restricted physical activity c. Altered body image d. Separation from family

...

The parents of a child, age 5, who will begin school in the fall ask the nurse for anticipatory guidance. The nurse should explain that a child of this age: a. Still depends on the parents b. Rebels against scheduled activities c. Is highly sensitive to criticism d. Loves to tattle

1.Answer C. In a 6-year-old child, a precarious sense of self causes overreaction to criticism and a sense of inferiority. By age 6, most children no longer depend on the parents for daily tasks and love the routine of a schedule. Tattling is more common at age 4 to 5, by age 6, the child wants to make friends and be a friend.

A 4-year-old girl is brought to the emergency department. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should do which of the following? a. Make her lie down and rest quietly. b. Examine her oral pharynx and report to the physician. c. Auscultate her lungs and prepare for placement in a mist tent. d. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

ANS: D This child is exhibiting signs of respiratory distress and possible epiglottitis. Epiglottitis is always a medical emergency requiring antibiotics and airway support for treatment. Sitting up is the position that facilitates breathing in respiratory disease. The oral pharynx should not be visualized. If the epiglottis is inflamed, there is the potential for complete obstruction if it is irritated further. Although lung auscultation provides useful assessment information, a mist tent would not be beneficial for this child. Immediate medical evaluation and intervention are indicated.

Because of their striving for independence and productivity, which age-group of children is particularly vulnerable to events that may lessen their feeling of control and power? a. Infant b. Toddler c. Preschooler d. School-age child

ANS: D When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurp individual power and identity. This is especially detrimental to school-age children, who are striving for independence and productivity and are now experiencing events that decrease their control and power. Infants, toddlers, and preschoolers, although affected by loss of power, are not as significantly affected as school-age children.

How many teeth should infants have?

age of child in months - 6 = number of teeth they should have

Primary circular reactions: 1-4 months

crying, nipple, parents voice

Mistrust is caused by...

failure to learn delayed gratification; too much or too little frustation; ability to control their environment- parents meet needs prior to infants signals, prolonged amount of time after infants signal leads to constant frustation causing them to mistrust others

Describe the size, texture, color and any additional observations that you may see when assessing an Erythema toxicum neonatorum.

1) Size ~ 1-3 mm 2) Firm 3) pale yellow or white papules or pustules on an erythematous base 4) resembles flea bits

Vascular birthmarks can be divided into:

1) Vascular malformations 2) Vascular tumors (hemangiomas)

What is cleft lip often associated with?

1) abnormal development of the external nose 2) nasal cartilages 3) nasal septum 4) Maxillary alveolar ridges

Some experts suggest that a serum glucose below _____ mg/dl in a healthy term infant without risk factors such as ___________ or infant ______________ represents hypoglycemia.

1) below 45 mg/dl 2) small for gestational age (SGA) 3) infant of a diabetic mother (IDM)

Typically, the swelling extends beyond the ______ margins (or sutures) and may be associated with overlaying ___________ or _____________.

1) bone 2) petechiae 3) ecchymosis

Common Transient birth injuries include:

1) caput succedaneum 2) cephalhematoma 3) soft tissue brusing

The boundaries of the cephalhematoma are sharply ________ and ___ ____ extend beyond the limits of the ______.

1) demarcated (set the boundaries or limits of) 2) Do not 3) bone

What are common skin problems in infants?

1) erythema toxicum 2) candidiasis - (infection with candida, especially as causing oral or vaginal thrush) 3) Bullous impetigo - causes fluid-filled blisters — often on the trunk, arms and legs of infants and children younger than 2 years. 4) birthmarks

In the most severe form of erythroblastosis fetalis (hydrops fetalis), the progressive hemolysis causes :

1) fetal hypoxia 2) cardiac failure 3) generalized edema (anasarca) 4) Hydrops (the fetus characterized by an edema in the fetal subcutaneous tissue) 5) effusion into the pericardial, pleural , and peritoneal spaces.

In Rh incompatibility the problem occurs when the Rh-positive ___________ blood cells pass into the circulation of the Rh-negative _________ in sufficient quantities to produce anti-_____ antibodies, which in turn may enter the fetal circulation and cause fetal RBC hemolysis.

1) fetus 2) mother 3) anti-Rh antibodies

Hyperbilirubunemia may result from ?

1) increased unconjugated bilirubin 2) conjugated bilirubin

What is hyperbilirubinemia characterized by?

1) jaundice or icterus, a yellowish discoloration of the skin and other organs

Swelling during a cephalhematoma are usually __________ or _________ at birth and (increases/decreases) in size on the _______ or _______ day.

1) minimum 2) absent 3) increases 4) 2nd 5) 3rd

Long-term follow up of CP is necessary to promote ______ and prevent ___________.

1) optimal speech 2) abnormal dentition

When bleeding is due to subgaleal hemorrhage, bleeding extends beyond bone, often (anterior/posterior) of the neck, and (stops/continues) after birth.

1) posterior 2) continues

Swelling caused by caput succedaneum consist of ______ or _______ that has accumulated in the tissues above the bone.

1) serum 2) blood

Additional potential health injuries to the newborn that need careful evaluation include:

1) subgaleal hemorrhage 2) fractures clavicle 3) facial paralysis 4) brachial plexus paralysis

During an assessment, what are the signs of Erb palsy (Erb-Duchenne paralysis)?

1) the arm hangs limp alongside of the body 2) The shoulder and arm are ADDucted and INTERnally rotated 3) The elbow is extended 4) The forearm is pronated c the wrist and fingers flexed 5) Grasp reflex may be present b/c fingers and wrist movement remain normal

During an assessment, what are the signs of Klumpke palsy?

1) the hand are paralyzed with consequent wrist drop and relaxed fingers

What are the characteristics of thrush?

1)white adherent patches on the tongue, palate, and inner aspect of the cheeks.

The most common observed scalp lesion on the newborn is __________.

Caput succedaneum

Where does the Erythema toxicum neonatorum mostly commonly appear on the body?

1) Face 2) proximal extremities 3) trunk 4) Buttocks

Where are transient macular stains located?

1) Glabella (the smooth part of the forehead above and between the eyebrows) 2) Nape of the neck

How can candidiasis be acquired?

1) Maternal vaginal infection during delivery 2) Person-to-person transmission (especially from poor hand washing technique 3) Contaminated hands, bottles, nipples, or other articles.

What are the (2) most common vascular stains?

1) Port-wine stains (nevus flammeus) 2) Transient macular stains (i.e. stork bite, salmon patch)

Which of the following tests aids in the diagnosis of cystic fibrosis (CF)? a. Sweat test, stool for fat, chest x-ray films b. Sweat test, bronchoscopy, duodenal fluid analysis c. Sweat test, stool for trypsin, biopsy of intestinal mucosa d. Stool for fat, gastric contents for hydrochloride, chest x-ray films

ANS: A A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF. Bronchoscopy, duodenal fluid analysis, stool tests for trypsin, and intestinal biopsy are not helpful in diagnosing CF. Gastric contents normally contain hydrochloride; it is not diagnostic.

The medical term for the definition below is..... - Yeastlike fungus that produces yeast cells and spores.

Candidiasis

An erythema toxicum neonatorum is a self-limiting eruption and usually occurs within ____________.

The first 2 days of life

How does a glossoptosis affect the neonate? Does this occur often?

The large tongue often falls over the neonates airway, causing occlusion and respiratory distress.

What sheath forms the inner surface of the scalp and connects the frontal and occipital muscles?

The tendinous sheath

Birth injuries are usually transient, and may involve soft tissue, ______ , and nervous tissue.

bone

Can a cleft lip be (unilateral/bilateral/both)?

both

Which of the following factors will decrease iron absorption and therefore should not be given at the same time as an iron supplement? a.Milk b.Fruit juice c.Multivitamin d.Meat, fish, poultry

ANS: A Many foods interfere with iron absorption and should be avoided when the iron is consumed. These foods include phosphates found in milk, phytates found in cereals, and oxalates found in many vegetables. Vitamin C-containing juices enhance the absorption of iron. Multivitamins may contain iron; no contraindication exists to taking the two together. Meat, fish, and poultry do not affect absorption.

In addition to injuries, which of the following are leading causes of death in adolescents and young adults ages 15 to 24 years? a. Suicide, cancer b. Suicide, homicide c. Homicide, heart disease d. Drowning, cancer

ANS: B Homicide and suicide account for 16.7% of deaths in this age-group. Suicide and cancer account for 10.9% of deaths, and cancer accounts for 3.5% of the deaths in this age-group. Drowning is responsible for less than 2% of the deaths in adolescents.

An 18-month-old child is seen in the clinic with otitis media (OM). Oral amoxicillin is prescribed. Instructions to the parent should include which of the following? a. Administer all of the prescribed medication. b. Continue medication until all symptoms subside. c. Immediately stop giving medication if hearing loss develops. d. Stop giving medication and come to the clinic if fever is still present in 24 hours.

ANS: A Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria. Symptoms may subside before the full course is given. Hearing loss is a complication of OM; antibiotics should continue to be given. Medication may take 24 to 48 hours to make symptoms subside.

Because children younger than 5 years are egocentric, the nurse should do which of the following when communicating with them? a. Focus communication on the child. b. Use easy analogies when possible. c. Explain experiences of others to the child. d. Assure child that communication is private.

ANS: A Because children of this age are able to see things only in terms of themselves, the best approach is to focus communication directly on them. Children should be provided with information about what they can do and how they will feel. With children who are egocentric, analogies, experiences, and assurances that communication is private will not be effective because the child is not capable of understanding.

A child, age 4 years, tells the nurse that she "needs a Band-Aid" where she had an injection. Which of the following is the best nursing action? a. Apply a Band-Aid. b. Ask her why she wants a Band-Aid. c. Explain why a Band-Aid is not needed. d. Show her that the bleeding has already stopped.

ANS: A Children in this age-group still fear that their insides may leak out at the injection site. The nurse should be prepared to apply a small Band-Aid after the injection. No explanation should be required.

The parent of an infant with colic tells the nurse, "All this baby does is scream at me; it is a constant worry." The nurse's best action is which of the following? a.Encourage parent to verbalize feelings. b.Encourage parent not to worry so much. c.Assess parent for other signs of inadequate parenting. d.Reassure parent that colic rarely lasts past age 9 months.

ANS: A Colic is multifactorial, and no single treatment is effective for all infants. The parent is verbalizing concern and worry. The nurse should allow the parent to put these feelings into words. An empathetic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parent's anxiety. The nurse should reassure the parent that he or she is not doing anything wrong. The infant with colic is experiencing spasmodic pain that is manifested by loud crying, in some cases up to 3 hours each day. Telling the parent that it will eventually go away does not help him or her through the current situation.

Which of the following is the leading cause of death in infants younger than 1 year? a. Congenital anomalies b. Sudden infant death syndrome c. Disorders related to short gestation and low birth weight d. Maternal complications specific to the perinatal period

ANS: A Congenital anomalies account for 20.1% of deaths in infants younger than 1 year, compared with sudden infant death syndrome, which accounts for 8.2%; disorders related to short gestation and unspecified low birth weight, which account for 16.5%; and maternal complications such as infections specific to the perinatal period, which account for 6.1% of deaths in infants under 1 year of age.

When caring for a child after a tonsillectomy, the nurse should do which of the following? a. Watch for continuous swallowing. b. Encourage gargling to reduce discomfort. c. Apply warm compresses to the throat. d. Position the child on the back for sleeping.

ANS: A Continuous swallowing, especially while sleeping, is an early sign of bleeding. The child swallows the blood that is trickling from the operative site. Gargling is discouraged, since it could irritate the operative site. Ice compresses are recommended to reduce inflammation. The child should be positioned on the side or abdomen to facilitate drainage of secretion.

An infant's parents ask the nurse about preventing otitis media (OM). Which of the following should be recommended? a. Avoid tobacco smoke. b. Use nasal decongestant. c. Avoid children with OM. d. Bottle- or breast-feed in supine position.

ANS: A Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other symptoms of upper respiratory tract infection. Children should be fed in a semivertical position to prevent OM.

The nurse is checking reflexes on a 7-month-old infant. When the infant is suspended in a horizontal prone position, the head is raised and legs and spine are extended. Which reflex is this? a. Landau b. Parachute c. Body-righting d. Labyrinth-righting

ANS: A When the infant is suspended in a horizontal prone position, the head is raised and legs and spine are extended; this describes the Landau reflex. It appears at 6 to 8 months and persists until 12 to 24 months. The parachute reflex occurs when the infant is suspended in a horizontal prone position and suddenly thrust downward; the infant extends the hands and fingers forward as if to protect against falling. This appears at 7 to 9 months and lasts indefinitely. Body-righting occurs when turning hips and shoulders to one side causes all other body parts to follow. It appears at 6 months of age and persists until 24 to 36 months. The labyrinth-righting reflex appears at 2 months and is strongest at 10 months. This reflex involves holding infants in the prone or supine position. They are able to raise their heads.

The nurse's approach when introducing hospital equipment to a preschooler who seems afraid should be based on which one of the following principles? a. The child may think the equipment is alive. b. Explaining the equipment will only increase the child's fear. c. One brief explanation will be enough to reduce the child's fear. d. The child is too young to understand what the equipment does.

ANS: A Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. Simple, concrete explanations about what the equipment does and how it will feel will help alleviate the child's fear. The preschooler needs repeated explanations as reassurance.

An important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS) would be which of the following? a.Discourage parents from making a last visit with the infant. b.Make a follow-up home visit to parents as soon as possible after the child's death. c.Explain how SIDS could have been predicted and prevented. d.Interview parents in depth concerning the circumstances surrounding the child's death.

ANS: B A competent, qualified professional should visit the family at home as soon as possible after the death. Printed information about SIDS should be provided to the family. Parents should be allowed and encouraged to make a last visit with their child. SIDS cannot always be prevented or predicted, but parents can take steps to reduce the risk (such as supine sleeping, removing blankets and pillows from the crib, and not smoking). Discussions about the cause only increase parental guilt. The parents should be asked only factual questions to determine the cause of death.

You are notified that a 9-year-old boy with nephrotic syndrome is being admitted. Only semiprivate rooms are available. The best roommate would be: a. a 10-year-old girl with pneumonia. b. an 8-year-old boy with a fractured femur. c. a 10-year-old boy with a ruptured appendix. d. a 9-year-old girl with congenital heart disease.

ANS: B An 8-year-old boy with a fractured femur would be the best choice for a roommate. The boys are similar in age. The child with nephrotic syndrome most likely will be on immunosuppressive agents and susceptible to infection. The child with a fractured femur is not infectious. A girl would not be a good roommate for a school-age boy. In addition, the 10-year-old girl with pneumonia and the 10-year-old boy with a ruptured appendix have infections and could pose a risk for the child with nephrotic syndrome.

At what age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: B At age 2 months the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. The 3-month-old can recognize familiar faces. At age 4 months the infant can enjoy social interactions.

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. This medication should be administered: a. after chest physiotherapy (CPT). b. before CPT. c. after receiving 100% oxygen. d. before receiving 100% oxygen.

ANS: B Bronchodilators should be given before CPT to open bronchi and make expectoration easier. These medications are not helpful when used after CPT. Oxygen is administered only in acute episodes, with caution, because of chronic carbon dioxide retention.

What clinical manifestations suggest hydrocephalus in an infant? a. Closed fontanel, high-pitched cry b. Bulging fontanel, dilated scalp veins c. Constant low-pitched cry, restlessness d. Depressed fontanel, decreased blood pressure

ANS: B Bulging fontanels, dilated scalp veins, and separated sutures are clinical manifestations of hydrocephalus in neonates. Closed fontanel, high-pitched cry, constant low-pitched cry, restlessness, depressed fontanel, and decreased blood pressure are not clinical manifestations of hydrocephalus, but all should be referred for evaluation.

Which one of the following strategies might be recommended for an infant with failure to thrive (FTT) to increase caloric intake? a.Vary schedule for routine activities on a daily basis. b.Be persistent through 10 to 15 minutes of food refusal. c.Avoid solids until after the bottle is well accepted. d.Use developmental stimulation by a specialist during feedings.

ANS: B Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. Children with FTT need a structured routine to help establish rhythmicity in their activities of daily living. Many children with FTT are fed exclusively from a bottle. Solids should be fed first. Stimulation is reduced during the mealtime to maintain the focus on eating.

A 13-year-old child with cystic fibrosis (CF) is a frequent patient on the pediatric unit. This admission, she is sleeping during the daytime and unable to sleep at night. A beneficial strategy for this child would be to: a. administer prescribed sedative at night to aid in sleep. b. negotiate a daily schedule that incorporates hospital routine, therapy, and free time. c. have the practitioner speak with the child about the need for rest when receiving therapy for CF. d. arrange a consult with the social worker to determine whether issues at home are interfering with her care.

ANS: B Children's response to the disruption of routine during hospitalization is demonstrated in eating, sleeping, and other activities of daily living. The lack of structure is allowing the child to sleep during the day, rather than at night. Most likely the lack of schedule is the problem. The nurse and child can plan a schedule that incorporates all necessary activities, including medications, mealtimes, homework, and patient care procedures. The schedule can then be posted so the child has a ready reference. Sedatives are not usually used with children. The child has a chronic illness and most likely knows the importance of rest. The parents and child can be questioned about changes at home since the last hospitalization.

The parents of a 3-year-old admitted for recurrent diarrhea are upset that the practitioner has not told them what is going on with their child. The priority intervention for this family is to: a. answer all of the parents' questions about the child's illness. b. immediately page the practitioner to come to the unit to speak with the family. c. help the family develop a written list of specific questions to ask the practitioner. d. inform the family of the time that hospital rounds are made so that they can be present.

ANS: C Often families ask general questions of health care providers and do not receive the information they need. The nurse should determine what information the family does want and then help develop a list of questions. When the questions are written, the family can remember which questions to ask or can hand the sheet to the practitioner for answers. The nurse may have the information the parents want, but they are asking for specific information from the practitioner. Unless it is an emergency, the nurse should not place a stat page for the practitioner. Being present is not necessarily the issue, but rather the ability to get answers to specific questions.

A 4-month-old child is discharged home after surgery for the repair of a cleft lip. Instructions to the parents include: a. provide crib toys for distraction. b. breast- or bottle-feeding can begin immediately. c. give pain medication to infant to minimize crying. d. leave infant in crib at all times to prevent suture strain.

ANS: C Pain medication and comfort measures are used to minimize infant crying. Interventions are implemented to minimize stress on the suture line. Although crib toys are important, the child should not be left in the crib for prolonged periods. Feeding begins with alternative feeding devices. Sucking puts stress on the suture line in the immediate postoperative period. The infant should not be left in the crib, but should be removed for appropriate holding and stimulation.

An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires the following isolation: a. reverse isolation. b. airborne isolation. c. Contact Precautions. d. Standard Precautions.

ANS: C RSV is transmitted through droplets. In addition to Standard Precautions and hand washing, Contact Precautions are required. Caregivers must use gloves and gowns when entering the room. Care is taken not to touch their own eyes or mucous membranes with a contaminated gloved hand. Children are placed in a private room or in a room with other children with RSV infections. Reverse isolation focuses on keeping bacteria away from the infant. With RSV, other children need to be protected from exposure to the virus. The virus is not airborne.

In terms of gross motor development, what would the nurse expect an infant age 5 months to do? a. Sit erect without support. b. Roll from back to abdomen. c. Turn from abdomen to back. d. Move from prone to sitting position.

ANS: C Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen is developmentally appropriate for an infant at age 6 months. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position.

The nurse is admitting a 7-year-old child to the pediatric unit for abdominal pain. To determine what the child understands about the reason for hospitalization, the nurse should: a. find out what the parents have told the child. b. review the note from the admitting practitioner. c. ask the child why he came to the hospital today. d. question the parents about why they brought the child to the hospital.

ANS: C School-age children are able to answer questions. The only way for the nurse to know about the child's understanding of the reason for hospitalization is to ask the child directly. Finding out what the parents told the child and why they brought the child to the hospital, or reading the admitting practitioner's description of the reason for admission, will not provide information about what the child has heard and retained.

An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is which of the following? a. Ask her why she wants to know. b. Determine why she is so anxious. c. Explain in simple terms how it works. d. Tell her she will see how it works as it is used.

ANS: C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child so that the child can then observe during the procedure. A nurse should respond positively for requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. The child is not exhibiting anxiety in asking how the blood pressure apparatus works, just requesting clarification of what will occur.

During a routine health assessment the nurse notes that the 8-month-old infant has a significant head lag. Which of the following is the most appropriate action? a. Recheck head control at next visit. b. Teach parents appropriate exercises. c. Schedule child for further evaluation. d. Refer child for further evaluation if anterior fontanel is still open.

ANS: C Significant head lag after age 6 months strongly indicates cerebral injury and is referred for further evaluation. Head control is part of normal development. Exercises will not be effective. The lack of achievement of this developmental milestone must be evaluated.

At what age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 12 months

ANS: C Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months an infant can sit with support. At age 6 months the infant will maintain a sitting position if propped. By 10 months the infant can maneuver from a prone to a sitting position.

At about what age does an infant start to recognize familiar faces and objects, such as own hand? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: C The child can recognize familiar objects at approximately age 3 months. For the first 2 months of life, infants watch and observe their surroundings. The 4-month-old infant is beginning to develop hand-eye coordination.

A critical nursing responsibility in the postoperative care of the neonate includes: a. determining rectal temperature. b. suctioning every hour and as needed. c. carefully monitoring infant's weight. d. using only nonpharmacologic pain control measures.

ANS: C The infant's weight is carefully monitored and compared with the preoperative weight for changes in fluid balance. Additional changes in fluid balance can be detected through weight changes. Rectal temperatures are avoided in neonates. Axillary or skin temperatures are monitored. Suctioning is not done on a routine basis. It is done when necessary. After surgery, pharmacologic and nonpharmacologic pain control measures should be used.