35

9). The registered nurse (RN) teaches the parents of a hospitalized 3-month-old about separation anxiety. The practical nurse notices that the parents still seem concerned about leaving the infant while they work and so reinforces the information provided by the RN. Which statement by one of the parents indicates that the teaching has been effective?

"At this age, my baby will not cry because we are leaving." Explain: Separation or stranger anxiety occurs when the primary caregivers leave the child in the care of others who are not familiar to the child. This behavior starts around age 6 months, peaks at age 10-18 months, and can last until age 3 years. Separation anxiety produces more stress than any other factor (eg, pain, injury, change in surroundings) for children in this age range. However, this reaction is normal and resolves as the child approaches age 3 years. A 3-month-old is too young to experience separation anxiety and can be soothed by any comforting voice

2). The clinic nurse supervises a graduate nurse who is reinforcing teaching about home management to the parents of a 2-year-old with acute diarrhea. The nurse would need to intervene when the graduate nurse reinforces which instruction?

"Follow the bananas, rice, applesauce, and toast diet for the next few days." Right: 2 The BRAT (bananas, rice, applesauce, and toast) diet is not recommended as it does not provide sufficient protein or energy. Wrong: 4 (Option 4) Protecting the perineal skin from breakdown during bouts of diarrhea can be accomplished by using skin barrier creams (eg, petrolatum, zinc oxide). Educate: When a child has acute diarrhea, the priority is to monitor for dehydration. Treatment is accomplished with oral rehydration solutions and early reintroduction of the child's normal diet (usual foods).

59). A nurse is reinforcing appropriate interventions with the parent of an infant who had a febrile seizure. Which instruction is appropriate to review?

"Give acetaminophen or ibuprofen every 6-8 hours to control fever."

57). The nurse is reinforcing teaching on behavioral strategies to treat fecal incontinence due to functional constipation to the parent of a 6-year-old. Which statement by the parent indicates a need for further teaching?

"I will give my child a reward for each bowel movement made while sitting on the toilet." Educate: A reward system is a behavioral strategy used in the treatment of functional incontinence (due to constipation). The reward is given to encourage the child's involvement in the treatment to restore normal bowel function. Rewards are given for the child's effort and participation, not for having bowel movements while sitting on the toilet

65). The nurse is caring for a 7-year-old child diagnosed with nephrotic syndrome who will be discharged soon. Which statement by the parent indicates the need for reinforcement of teaching?

"I'll organize a lot of playdates to keep my child's spirits up." Educate: -Loss of immunoglobulins makes children susceptible to infection -Infection prevention (ex: limiting social interaction until the child is better)

5). The nurse is reinforcing teaching to the parents of a toddler about health promotion. Which statement by one parent requires clarification?

"If my child refuses a meal, I will wait a few minutes and try again." explanation: (Option 2) When toddlers have been physically active immediately before mealtime, they may have difficulty sitting at the table and can be disruptive. Offering a 15- to 30-minute period to calm down promotes better eating habits.

35). A school-age child is brought to the emergency department due to nausea, vomiting, and severe right lower quadrant pain. The child's white blood cell count is 17,000/mm3 (17.0 x 109/L). Which statement by the child is of most concern to the nurse?

"My belly doesn't hurt anymore."

66). The nurse is reinforcing teaching to the parent of a child diagnosed with ringworm. Which statement by the parent indicates a need for further teaching?

"My child has been infected by a worm and must be treated to rid it from the body." Missed: 3 However, it is highly contagious and spreads via contact. Management includes teaching appropriate hygiene (eg, washing hands after touching infected areas), limited contact with personal items (eg, hair brush), and treatment with the prescribed shampoos as well as topical and/or oral medications (eg, terbinafine [Lamisil], miconazole). Wrong: 1 (Option 1) Antifungal cream (terbinafine [Lamisil]) is the preferred treatment and is applied to infected areas twice a day. It may take 1-4 weeks to complete treatment depending on infection severity.

68). The nurse is reinforcing teaching for parents of a child diagnosed with fifth disease. Which statement by a parent indicates a need for further teaching?

"Our child's condition is communicable until the rash disappears." Wrong: 4 (Options 1, 3, and 4) These statements indicate that parent teaching regarding fifth disease was effective.

52). The clinic nurse is asked by the mother of a 15-month-old, "I am worried about my child's thumb sucking and its effects on tooth alignment. What should I do?" What is the nurse's best response?

"The risk for misaligned teeth occurs when thumb sucking persists after eruption of permanent teeth." Missed: 4 Rule of thumb sucking stops before the permanent teeth begin to erupt, misalignment of the teeth and malocclusion can be avoided Wrong: 3 (Options 1, 2, and 3) These options are incorrect. Use of a pacifier or thumb sucking prior to eruption of the permanent teeth does not tend to cause dental issues such as teeth misalignment or malocclusion.

46). The clinic nurse reviews teaching provided to the parent of a child being considered for growth hormone replacement therapy at home. Which statement by the parent indicates that teaching has been effective?

"Treatment will require a daily injection under my child's skin."

34). The nurse is discussing child safety with the parents of a 12-month-old who is just beginning to walk. Which statement by the parents indicates a need for further instruction?

"When we can't be watching, we put our child in a mobile child walker."

Fifth disease

("slapped face," or erythema infectiosum) is a viral illness caused by the human parvovirus and affects mainly school-age children. The virus spreads via respiratory secretions, and the period of communicability occurs before onset of symptoms. The child will have a distinctive red rash on the cheeks that gives the appearance of having been slapped. The rash spreads to the extremities and a maculopapular rash develops, which then progresses from the proximal to distal surfaces. The child may have general malaise and joint pain that are typically well controlled with nonsteroidal anti-inflammatory drugs such as ibuprofen. Affected children typically recover quickly, within 7-10 days.

Intussusception

(Option 3) A classic sign of intussusception is blood-streaked mucous stool, sometimes referred to as "currant jelly-like" stool. This is expected with intussusception. Treatment is an enema of either air or barium to unfold the intestine.

When assessing a client with symptoms suggestive of epiglottitis

(eg, acutely ill, drooling, leaning forward, dyspnea), the nurse should prepare for an emergency airway.

Congenital heart defects that cause blood to shunt from the higher pressure left side of the heart to the lower pressure right side

(eg, patent ductus arteriosus, atrial septal defect, ventricular septal defect) increase pulmonary blood flow.

Children with fifth disease are communicable only prior to onset of symptoms

(eg, rash, joint pains). The causative agent, human parvovirus, spreads via respiratory secretions. Fifth disease is self-limiting and short-lived; treatment is given to alleviate symptoms. Isolation is not usually required for a non-hospitalized child.

Pertussis

(whooping cough) is a very contagious communicable disease caused by the Bordetella pertussis bacteria. These organisms attach to the small hairs in the airway and release a toxin that causes swelling and irritation. Pertussis is spread by contact with respiratory secretions expelled through coughing and sneezing. As a result, an infected client should be placed in standard (universal) and droplet isolation precautions when hospitalized (Option 1). At first, symptoms similar to the common cold and a mild fever occur, but eventually these clients develop a characteristic violent, spasmodic cough. Coughing is so severe that the client is forced to inhale afterward, resulting in a distinctive, high-pitched "whooping" sound. Coughing episodes may continue until a thick mucus plug is expectorated and sometimes are followed by vomiting (posttussive emesis). The client should be positioned on the left side to prevent aspiration if vomiting occurs. Treatment consists of antibiotics and supportive measures. Humidified oxygen and adequate fluids will help loosen the thick mucus. Suction as needed is important in infants. Respiratory status should be monitored for obstruction (Options 2 and 3). Vaccination against whooping cough is available, but some individuals will still develop the disease, although in a milder form.

43) The nurse reinforces teaching for the parents of a 6-year-old diagnosed with nocturnal enuresis. What instructions will the nurse include? Select all that apply.

- "Attach an enuresis alarm to your child's underwear." - "Prepare a calendar with your child for logging wet and dry nights." -"Wake your child at a specified time each night to void."

21). A 1-month-old infant has received a diagnosis of phenylketonuria (PKU). Which statements about PKU are true? Select all that apply.

- A low-phenylalanine diet is required - Meat and dairy products should not be introduced to the diet - Special infant formula is required Missed: 2,4 Including synthetic proteins and special formulas (eg, Lofenalac, Phenyl-Free) in the diet (Option 4) 3.Eliminating high-protein/phenylalanine foods (eg, meats, eggs, milk) from the diet (Option 2) Wrong: 5 (Option 5) Restriction of dietary tyrosine is not necessary. Tyrosine levels in clients with PKU may be normal or slightly decreased.

31). The clinic nurse is reinforcing teaching to the parent of a child who has been diagnosed with scabies. Which instructions should the nurse include? Select all that apply.

- All persons in contact with the child need treatment -Apply permethrin to all body areas below the head - Wash the child's bedding in hot water Wrong: 4 Scabies mites do not survive away from human skin for more than 2-3 days. Therefore, disinfecting the child's clothes, linens, and stuffed animals involves placing these in a plastic bag (for a minimum of 3 days) or machine washing them in hot water and drying them on the hottest dryer cycle. Fumigation of living areas is not needed for the same reason (Options 3, 4, and 5).

10). The practical nurse is performing a physical examination with the registered nurse on a 2-year-old with cold symptoms and a fever at home of 101.7 F (38.7 C). Which interventions will enhance the child's cooperation during the examination? Select all that apply.

- Allow the child to play with the stethoscope - Begin with the child in the parent's lap - Interact with the parent in a friendly manner - Play with the child using a finger puppet

1). A 15-year-old client with type 1 diabetes mellitus is admitted to the hospital with a blood glucose of 460 mg/dL (25.6 mmol/L). Based on this information, the nurse understands that which factor is contributing to this client's noncompliant behavior?

- Client's psychosocial developmental stage Explain: Certain behaviors are common in the adolescent period, ages 11 (early adolescence) to 20 (late adolescence). Teenagers engage in risk-taking behaviors and want to be just like their peers. Adolescents with chronic disease may have difficulty managing their illness due to a false sense of security and the belief that they are invincible. Educate: Adolescence in psychosocial development is marked by risk-taking behaviors, a sense of invincibility, the need for independence, and a strong connection to peers.

23). When monitoring an infant with a left-to-right-sided heart shunt, which findings would the nurse expect during the physical assessment? Select all that apply.

- Diaphoresis during feedings - Heart murmur - Poor weight gain Missed: 5 Increased metabolic rate with poor weight gain (Option 5) Wrong: 2 (Option 2) Right-to-left congenital heart defects (eg, cyanotic defects) impede pulmonary blood flow (eg, tetralogy of Fallot, transposition of the great vessels) and cause cyanosis, which is evident shortly after birth and during periods of physical exertion.

73). The nurse is collecting data on a 2-day-old infant with suspected Hirschsprung disease. Which findings should the nurse anticipate? Select all that apply.

- Distended abdomen - Has not passed stool (meconium) - . Refuses to feed Missed: 5 Difficulty feeding Wrong: 4 (Option 4) Nonbilious vomiting is seen in conditions in which the pathology is proximal to the pylorus (eg, hypertrophic pyloric stenosis). Bilious (green) vomiting is seen in conditions in which the pathology is distal to the duodenum as the common bile duct drains at the duodenum.

71). The nurse on a pediatric unit is caring for a preschooler who exhibits separation anxiety when the parents go to work. Which interventions should the nurse implement? Select all that apply.

- Encourage the parents to leave the child's favorite stuffed animal - Establish a daily schedule similar to the child's home routine - Provide frequent opportunities for play and activity Wrong: 3 (Option 3) When the child is visibly upset, it is important to provide a calming presence and implement strategies to reduce the child's anxiety. Leaving the child alone at such times can further increase stress.

42). Which is a management concern for a male teenage client with cystic fibrosis (CF)? Select all that apply.

- Frequent respiratory infections - Infertility - Vitamin A deficiency Missed: 3, 5 Infertility - Cystic fibrosis causes congenital absence of vas deferens in male clients, resulting in low sperm levels and infertility. Female clients have thick cervical secretions that can obstruct sperm entry. , deficiency of fat-soluble vitamins, Wrong: 1,4 (Option 1) Diabetes insipidus is a disorder of the posterior pituitary gland and is an inability of the kidneys to concentrate urine. It is not related to the pathophysiology of CF. Pancreatic damage in CF will cause some clients to develop diabetes mellitus but not insipidus. Pancreatic insufficiency - mucus plugs in the pancreas obstruct the release of pancreatic enzymes, leading to malabsorption of fat-soluble vitamins (A, D, E, K). Because of malabsorption and an increased metabolic rate associated with frequent infection, children with CF have difficulty maintaining adequate weight and growth (Option 4).

12). A nurse is discussing the fine motor abilities of a 10-month-old infant with the infant's parent. Which are developmentally appropriate skills for an infant of this age? Select all that apply.

- Grasps a small doll by the arm - Transfers small objects from hand to hand - Uses a basic pincer grasp Missed: 1 7 Months, infants are able to transfer an object from one hand to the other Wrong: 4 (Options 2 and 4) By 12 months, infants may attempt to turn multiple book pages at once, and they also begin attempts to stack 2 blocks. These skills require finer muscle control than is expected of a 10-month-old.

72). The school nurse creates a cafeteria menu for a newly enrolled child with celiac disease. Which lunches would be appropriate for this child? Select all that apply.

- Grilled chicken, baked potato, and strawberry yogurt - Mexican corn tacos with ground beef and cheese - Rice noodles with chicken and broccoli Missed: 3,5 The child will need to adhere to a gluten-free diet for life. Rice, corn, and potatoes are gluten free and are allowed in the diet (Options 2, 3, and 5). Wrong: 4 (Option 4) Peanut butter and jelly on rice cakes are permitted but not the oatmeal cookie. Educate: Celiac disease is an autoimmune disorder in which an individual cannot tolerate gluten, a protein found in barley, rye, oats, and wheat (BROW). Rice, corn, and potatoes are allowed in the diet and can be used as grain substitutes. Affected individuals must adhere to a gluten-free diet for life.

14). The most recent laboratory results for a 12-month-old who is HIV-positive show a CD4 lymphocyte count of 500/mm3 and a CD4 lymphocyte percentage of 10%. The nurse anticipates administering which immunizations? Select all that apply.

- Haemophilus influenzae type b (Hib) - Hepatitis A (Hep A) - Pneumococcal conjugate vaccine (PCV) Missed: 2, 4 Wrong: 3,5 However, live vaccine preparations (eg, MMR, varicella) are contraindicated in the presence of marked immunosuppression, as determined by CD4 lymphocyte percentages and/or counts (Options 3 and 5). Educate: Routine immunization is particularly beneficial to children who are HIV-positive as they are more susceptible to preventable diseases due to a compromised immune system.

45). The practical nurse is assisting the registered nurse in creating a care plan for a 3-year-old who was admitted with suspected pertussis infection. Which interventions should be included? Select all that apply.

- Institute droplet precautions - Monitor for signs of airway obstruction - Offer small amounts of fluids frequently

30). A nurse preceptor on a pediatric unit is reviewing interventions with a student nurse who will be caring for a toddler. What are appropriate activities to minimize the effect of hospitalization on a toddler? Select all that apply.

- Integrate preferred snack foods in the day's routine - Plan quiet play prior to usual nap time - Provide 1 or 2 options when choosing toys Wrong: 4 (Option 4) This is an appropriate activity when working with school-age children after they have grasped the concept of time. Toddlers have not yet reached this level of cognition.

16). Which nursing interventions should be included in the plan of care for a newborn with suspected esophageal atresia (EA) and tracheoesophageal fistula (TEF)? Select all that apply.

- Keep the infant nothing by mouth (NPO) status -Maintain the infant supine with the head elevated 30 degrees -Place suction equipment by the infant's bed Educate: Priority nursing interventions to prevent aspiration in infants with EA/TEF include: -maintaining NPO status, -positioning the child supine -with the head elevated at least 30 degrees, -and keeping suction equipment available by the bed.

29). The practical nurse is assisting the registered nurse in creating a teaching plan for the parents of a child diagnosed with pediculosis capitis. Which instructions should be included in the teaching plan? Select all that apply.

- oak the child's comb and hair accessories in boiling water for 10 minutes - Use a nit comb daily for 2 weeks after pediculicide treatment - Vacuum the furniture, carpets, and mattresses every few days Missed: 5 However, the nits can live away from the host (eg, on hairbrushes, carpets, hats) for up to 10 days. The infestation can spread between children when they share lice-infested items. Educational objective: Pediculosis capitis (head lice) is a parasitic infestation that is seen often in school-age children. Measures to control the spread and reinfestation include using nit combs, soaking hair brushes and accessories in boiling water, and vacuuming rugs/carpets frequently.

49). The nurse is reinforcing teaching about home care management to the parents of a child diagnosed with cystic fibrosis. Which statements by a parent indicate a need for further teaching? Select all that apply.

-"Administering pancreatic enzymes every morning and evening is important." - "Bronchodilator breathing treatment should be given right after chest physiotherapy." -"We will limit the number of sports activities our child participates in." Wrong:4 A diet high in calories, fat, and protein is required to meet growth needs.

48). A nurse is reinforcing education given to the parents of a child diagnosed with chronic allergic rhinitis that is triggered by household and environmental allergens. Which statements by the parents indicate that the teaching has been effective? Select all that apply.

-"My wife plans to wipe down our child's furniture with a damp rag every other day." - "Our child needs plastic covers for the mattress and pillow." - "We will replace the carpet with hardwood floors throughout the house."

74). The nurse is reinforcing prior teaching for the parents of a child newly diagnosed with hemophilia A. Which statements by the parents indicate that teaching has been effective? Select all that apply.

-"Our child should wear a medical alert bracelet at all times." - "We should avoid giving our child over-the-counter medicine containing aspirin." -"We should encourage a noncontact sport such as swimming." Wrong: (Option 2) Dehydration is not commonly associated with hemophilia. Avoiding dehydration is important for those with sickle cell anemia.

17). The nurse is reinforcing discharge teaching for the parents of a 1-year-old with a newly diagnosed cow's milk allergy. Which nutrients normally provided by milk should be obtained from other sources? Select all that apply.

-Calcium -Vitamin D Wrong add: 3 (Option 3) Cow's milk is not a significant source of iron. Dietary sources of iron include meats and spinach.

55). The student nurse is reviewing the medical record of a 4-year-old diagnosed with failure to thrive (FTT). The nurse correctly identifies which clinical and psychosocial factors that have likely contributed to the child's condition? Select all that apply.

-Child is bottle fed 4 times a day and at bedtime -Child's parent is incarcerated for spousal abuse -Parent worries about having enough money to buy food -The children eat at various times of the day in front of the television

62). Which discharge teaching instructions should the nurse reinforce to the parents of a 2-year-old with group A streptococcal pharyngitis? Select all that apply.

-Complete all the antibiotics even if your child is feeling better -Cool liquids and soft diet are recommended -Replace your child's toothbrush 24 hours after starting antibiotics Missed: 2 Children may refuse to eat due to pain. A soft diet and cool liquids (ice chips) should be offered rather than solid foods (Option 2). Wrong: 5 (Option 5) Throat lozenges can be given to older children but are a choking hazard in younger children. Acetaminophen or ibuprofen (liquid preparations) should be given for pain.

32). Home health nurse is visiting an infant who recently had surgery to repair tetralogy of Fallot. Which findings indicative of heart failure should the parent report to the health care provider? Select all that apply.

-Cool extremities -Puffiness around the eyes - Reduction in number of wet diapers Missed: 3 These may include rapid breathing rate; rapid heart rate at rest; dyspnea; activity intolerance and fatigue (especially during feeding in infants); pale, cool extremities; weight gain; reduction in wet diapers; and puffiness around the eyes. Wrong: (Option 5) The infant would more likely have experienced weight gain due to fluid retention.

38). A nurse is performing an assessment of a 12-month-old infant. Which findings would the nurse expect? Select all that apply.

-Equal head and chest circumference -Sits from a standing position Missed: 5 12 months should be able to sit down from a standing position without assistance Wrong: 2,4 (Option 2) Tooth eruption is variable, but it starts with the lower central incisors usually between age 6-10 months. The following is a quick assessment formula to calculate the expected number of teeth during the first 24 months: Age of child (in months) - 6 = Expected number of teeth A 12-month-old should have approximately 6 teeth, and by age 30 months all primary teeth (20) should have erupted. (Option 4) At age 12 months, the infant usually attempts to place a small object such as a raisin into a narrow opening but is unsuccessful.

51). The nurse in a clinic is obtaining a developmental history of an 18-month-old during a well-child visit. Which activities should the child be expected to perform? Select all that apply.

-Goes up stairs while holding a hand -Turns 2 pages in a book at a time

3). The nurse is caring for a newborn with patent ductus arteriosus. Which assessment finding should the nurse expect?

-Loud machine-like murmur Educate: The child will be acyanotic but will have a machine-like murmur heard on both systole and diastole.

36). The nurse is monitoring a 12-month-old diagnosed with intussusception. Which findings should the nurse expect? Select all that apply.

-Palpable sausage-shaped mass in upper right quadrant -Screaming and drawing the knees up to the chest - Stool mixed with blood and mucus

12 months

-Walks first steps independently -Crawls up stairs -Uses 2 finger pincer grasp -Hits 2 objects together -Says 3-5 words -Uses non verbal gestures (ex: waving goodbye -May have separation anxiety -Searches for hidden objects

3 years

-Walks up stairs with alternating feet -Pedals a tricycle -Jumps forward -Draws a circle -Feeds self without help -Grips a crayon with fingers instead of fist -3-4 word sentences -Asks "why" questions -States own age -Begins associative play -Toilet trained, except wiping

18 months

-Walks up/ down stairs with help -Throws a ball overhand -Jumps in place -Builds 3-4 block tower -Turns 2-3 book pages -Scribbles -Uses cup and spoon -10 + word vocab -Identifies common objects Has temper tantrums -Understands ownership (mine) -Imitates others

2 years

-Walks up/down stairs alone, 1 step at a time -Runs without falling -Kicks ball -Building 6-7 block tower -Turns 1 book page -Draws a line -300 + word vocabulary -2-3 word phrases -States own name -Begins parallel play -Begins to gain independence from parents

1 gram if equal to how many mL

1

The standard vaccine schedule for a 12-month-old includes

1). Hib 2). PCV (PVC13) 3). MMR 4). Varicella 5). Hep A. HIV-positive children who are asymptomatic and not extremely immunocompromised can receive the appropriate age-specific immunizations as recommended.

The normal range for hemoglobin in a 1-month-old is

12.5-20.5 g/dL (125-205 g/L). Hemoglobin of 24.9 g/dL (249 g/L) is diagnostic of polycythemia (elevated hemoglobin levels). Polycythemia will increase blood viscosity, placing an infant at risk for stroke or thromboembolism (Option 1). prolonged hypoxia.

56). The nurse cares for an 11-lb (5-kg) infant admitted with dehydration and prepares to calculate intake and output over an 8-hour shift. Using the data in the exhibit, calculate the total output in milliliters for the 8-hour shift. Record your answer as a whole number. Click on the exhibit button for additional information. Intake and output record Emesis 120 mL Wet diaper 1 50 g Wet diaper 2 52 g Wet diaper 3 46 g *Weight of a dry diaper = 30 g

178 Explain: Urine output in diapers: Diaper 1: 50 − 30 = 20 g Diaper 2: 52 − 30 = 22 g Diaper 3: 46 − 30 = 16 g Total mg of urine: 58 g = 58 mL Total output: (Emesis) + (Urine) = 120 mL + 58 mL = 178 mL

41). Which infant is most likely to require oral iron supplementation at this time?

2-month-old born at 34 weeks gestation who is bottle-fed with breast milk Missed: 1 Premature infants require iron supplementation by age 2-3 months, which is when maternal iron stores are depleted. Appropriate sources include oral iron drops if breastfeeding or iron-fortified formula. Wrong: 4 (Option 4) Infants often begin the transition to solid foods with fortified infant cereal. Although adequate intake should be confirmed, this infant is not likely to require supplements at this time.

Epiglottitis should be considered first in a

3- to 7-year-old with acute respiratory distress, toxic appearance (eg, sitting up, leaning forward, drooling), stridor, and high-grade fever. Tachycardia and tachypnea are also present. The complications of epiglottitis are serious and include sudden airway obstruction. Epiglottitis is a pediatric emergency and should be managed with endotracheal intubation. However, intubating such clients is difficult, and as a result, preparation for possible tracheostomy is also standard.

Voluntary grasping with the palm begins around

5 months followed by the ability to transfer an object between hands by 7 months and development of a crude pincer grasp (using the thumb, index, and other fingers) around 8-10 months

27). The practical nurse is collecting data on 4 infants in the pediatric unit. Which assessment finding would the practical nurse report to the registered nurse?

6-month-old with birth weight of 7 lb 3 oz (3.3 kg) who now weighs 12 lb (5.4 kg) Missed: 3 Infants should double in birth weight by age 6 months and triple in birth weight by age 12 months. An infant who does not meet expected length or weight milestones should be reported to the registered nurse for further assessment. Fontanelles should be flat, but slight pulsation or temporary bulging of the anterior fontanelle when the infant cries, coughs, or is lying down is considered normal. Wrong: 1 (Options 1 and 2) At birth, the infant has non-ossified membranes called fontanelles; these "soft spots" lie between the bones of the cranium. The anterior and posterior fontanelles are soft, non-fused, and the most noticeable. Fontanelles should be flat, but slight pulsations visible in the anterior fontanelle are normal, as is temporary bulging when the infant cries, coughs, or is lying down. The posterior fontanelle fuses by age 2 months, and the anterior fontanelle fuses by age 18 months. Educational objective: Infants should double in birth weight by age 6 months and triple in birth weight by age 12 months. An infant who does not meet expected length or weight milestones should be reported to the registered nurse for further assessment. Fontanelles should be flat, but slight pulsation or temporary bulging of the anterior fontanelle when the infant cries, coughs, or is lying down is considered normal.

Appendicitis

A child with acute-onset right lower quadrant abdominal pain, nausea, and vomiting and a high white blood cell count likely has acute appendicitis. Appendicitis is a serious condition that usually requires emergency surgery due to the risk of appendix rupture. The pain results from swelling and inflammation of the appendix. However, once the appendix ruptures, pain is relieved only temporarily and will return with full-blown peritonitis and sepsis.

44). The nurse assesses a child with intussusception. Which assessment findings require priority intervention?

Abdominal rigidity with guarding

Patent ductus arteriosus (PDA) is an

Acyanotic congenital defect more common in premature infants. When fetal circulation changes to pulmonary circulation outside the womb, the ductus arteriosus should close spontaneously. This closure is caused by increased oxygenation after birth. If a PDA is present, blood will shunt from the aorta back to the pulmonary arteries via the opened ductus arteriosus. Many newborns are asymptomatic except for a loud, machine-like systolic and diastolic murmur. The PDA will be treated with surgical ligation or IV indomethacin to stimulate duct closure.

26). The clinic nurse cares for a 4-year-old who has been diagnosed with a pinworm infection. Which client symptom supports this diagnosis?

Anal itching that is worse at night Missed: 1 Wrong: 3 (Option 3) Poor appetite, inadequate absorption of nutrients from food, and weight loss are symptoms associated with tapeworm infection (eg, Taenia solium). Tapeworm larvae are ingested when a person eats food that is contaminated with feces or undercooked meat from an infected animal.

67). A 15-year-old parent brings a 4-month-old infant for a well-baby checkup. The parent tells the nurse that the baby cries all the time; the parent has tried everything to keep the infant quiet but nothing works. What is the priority nursing action?

Assess the infant's pattern and frequency of crying During the first 3-4 months of life, it is not unusual for an infant to cry 1-3 hours a day in response to being hungry, thirsty, tired, in pain, bored, or lonely. Educate: When a parent tells the nurse that an infant cries "all the time," the priority nursing action is to assess the pattern, quality, and frequency of the child's crying. This will help the nurse determine if the crying is normal infant behavior or a sign of a more serious condition that requires further evaluation and treatment.

22). The nurse working on a pediatric oncology unit recognizes which as a personal coping strategy for remaining effective when caring for dying children?

Attending a child's memorial service Educate: Nurses who care for dying children experience many of the same feelings that the family of the dying child does, resulting in stress that may lead to compassion fatigue. To remain effective in the caregiving role, nurses should use professional and personal support systems, share in end-of-life celebration rituals, and take time off from work when distancing is needed. The family and the nurse can gain support by remaining in contact during the grieving process

6). A nurse is talking with the parent of a 6-year-old regarding sleep and rest. Which information should be included?

Bedtime hours should be established Right: 2 Bedtimes should be established to prevent fatigue the next day. Bedtime issues are usually not a concern, although many children retain bedtime rituals such as reading or listening to music. Wrong: 4 During the school-age years (6-12), sleep needs of a child depend on health status, activity level, and age. Children in this age group need approximately 11 hours of sleep daily at age 5 and 9 hours at age 12

Early indicators of bleeding

Continuous swallowing, restlessness, and frequent coughing . To prevent hemorrhage, the client should avoid clearing the throat, blowing the nose, and coughing.

20). A child received the varicella immunization. The day after the injection, the parent calls the nurse to say that the child has discomfort, slight redness, and 2 vesicles at the injection site. Which instruction should the nurse reinforce?

Cover the vesicles with a small bandage until they are dry

common side effects of the varicella immunization

Discomfort, redness, and a few vesicles at the injection site are and do not require the attention of a healthcare provider.

Toddlers (age 1-3)

Dsplay an egocentric approach as they strive for autonomy. They attempt to control their experiences through intense emotional displays, such as temper tantrums or forceful negative responses (eg, "no!"). Hospitalization causes loss of a toddler's usual routines and rituals, often resulting in regressive behavior. The toddler may also be frequently separated from the parents, leading to separation anxiety. Nursing care activities should be similar to the toddler's home routines and include providing preferred snacks and anticipating nap time. The toddler should be given options rather than asked yes/no questions to limit any potential negative responses. It is also important to encourage participation and parental presence whenever possible.

Accidents associated with child walkers

Due to the relatively high incidence of injuries associated with child walkers, the American Academy of Pediatrics has recommended a ban on the manufacture and sale of mobile infant walkers. Accidents associated with child walkers include: •Rolling down stairs (the most common cause of injury) • Burns - children can reach high in a walker, enabling them to grab hot pot handles, reach heaters and fireplaces, or grab a hot cup of liquid off a counter or table • Drowning - a child can fall into a bathtub or pool while in a mobile walker • Poisoning - the child can reach higher objects Even if a parent is close by and watching a child in a walker, an accident may not be preventable. Children can move quickly and the parent or caregiver may not be able to respond quickly enough. Safer alternatives to mobile baby walkers include stationary walkers (no wheels) and play areas. If parents or caregivers insist on using a baby walker, they should be advised to choose one that meets the American Society for Testing and Materials safety standards. Walkers with braking mechanisms stop if at least one wheel drops off the riding surface.

53). The clinic nurse is caring for a 3-year-old client. Which task, if not observed or reported by the parents as accomplished, will cause the nurse concern?

Eats with a spoon

Parents of a child with hemophilia should

Encourage noncontact sports, avoid giving medications that inhibit platelet aggregation, know how to control bleeding when it occurs, and ensure that the child wears a MedicAlert bracelet at all times.

28). The nurse is caring for a 7-year-old with sickle cell crisis. The client is short of breath and vomiting and has severe generalized body and joint pains. Which assessment finding requires the most immediate intervention?

Enlarged spleen on palpation Missed: 2 Splenic sequestration crisis occurs when a large number of "sickled" cells get trapped in the spleen, causing splenomegaly. This is a life-threatening emergency as it can lead to severe hypovolemic (hypotensive) shock. The classic assessment finding is a rapidly enlarging spleen. Wrong: 4 (Option 4) Swelling of hands and feet (dactylitis) is another symptom of this disease due to the sickled red blood cells blocking blood flow to the hands and feet. This is often detected in babies as the first sign of the disease.

Performing a physical assessment in a toddler Nurse should

Establish a rapport with the parent and then attempt to gain the child's trust. Playing with the child and allowing the child to sit on the parent's lap can make the experience easier on the nurse, parent, and child. The nurse should always perform the least invasive procedures first, explain them in simple terms, and praise the child throughout the assessment.

18). An overweight toddler is diagnosed with iron deficiency anemia. Which is the most likely explanation for the anemia?

Excessive intake of milk Educate: Iron deficiency anemia is the most common nutritional disorder in children. Risk factors include premature birth, cow's milk before age 1 year, and excessive milk intake in toddlers. Prevention and treatment are achieved through proper nutrition (eg, meat, leafy green vegetables, fortified cereal) and supplementation. Wrong: 3 (Option 3) Gastrointestinal blood loss, which can occur if infants under age 1 year are fed cow's milk, is a potential cause of iron deficiency anemia. However, excessive milk intake is a more common cause, particularly in clients over age 1 year.

70). A 10-year-old weighs 99 lb (44.9 kg) and has a BMI of 24.8 kg/m2 (>95th percentile). The licensed practical nurse (LPN) is collaborating with the registered nurse (RN) to formulate a weight loss plan. Which is most important for the nurse to determine?

Family's readiness for change Explain: Before initiating a treatment plan for weight loss, it is most important to make certain that the child and family are ready for change. Attempting to engage the family and child in weight loss strategies and dietary changes before they are ready could easily result in frustration, treatment failure, and reluctance to try new approaches in the future.

60). The nurse is reinforcing discharge instructions to the parent of a child with Kawasaki disease. The nurse informs the parent that the presence of which symptom should be immediately reported to the health care provider?

Fever

Peritonitis

Fever abdominal rigidity guarding and rebound tenderness

64). A nurse is reinforcing discharge teaching to the parent of a child who is postoperative following a tonsillectomy. Which finding should be reported as a priority?

Frequent swallowing

39). The nurse is caring for an 11-year-old admitted for surgical treatment of a fractured femur who also has attention-deficit hyperactivity disorder, predominantly inattentive type. What is the priority nursing action?

Give the child a written schedule of daily activities Missed: 2 The most important nursing intervention in caring for a child with attention-deficit hyperactivity disorder is providing a structured, consistent, and organized environment. A written schedule of activities will remind the child what to expect at any given time. Wrong: 1 (Option 1) It is important for the child to keep up with school work to the fullest extent possible to not fall behind. Catching up will be more difficult for a child with ADHD than for a child without the diagnosis. A structured environment can help the child plan time for school work.

33). A nurse is reviewing the laboratory values of a 3-year-old with nephrotic syndrome. The nurse interprets the results to most clearly reflect which physiologic process related to nephrotic syndrome? Click on the exhibit button for additional information. Laboratory results Serum albumin 2.0 g/dL (20 g/L) Serum total cholesterol 275 mg/dL (7.1 mmol/L) Urinalysis, protein 3+

Glomerular injury Missed:1 Nephrotic syndrome is a collection of symptoms resulting from glomerular injury. The 4 characteristic manifestations are proteinuria, edema, hypoalbuminemia, and hyperlipidemia. Wrong: 3 (Option 3) Lipid levels (normal total cholesterol: <200 mg/dL [5.2 mmol/L]) can increase with nephrotic syndrome as the liver produces increased lipids and proteins to compensate for protein loss.

Celiac disease diet

Gluten free diet cannot tolerate (BROW) Barely Rye Oats Wheat

Replacement is administered via

Growth hormone replacement is an option for children who are not growing according to accepted standards. The treatment should begin as soon as delays are noted and continue until bone growth begins to cease despite replacement therapy. Replacement is administered via subcutaneous injections.

47). The nurse who is caring for a 1-month-old with Tetralogy of Fallot will report which finding to the supervising registered nurse as a priority?

Hemoglobin level of 24.9 g/dL (249 g/L) Missed: 1 Poor oxygenation can cause elevated levels of hemoglobin (polycythemia), which increase blood viscosity. Thickened serum puts infants at risk for stroke or thromboembolism. An infant with polycythemia must stay hydrated. Wrong: 3 (Option 3) Tetralogy of Fallot (TOF) is a cyanotic cardiac defect. Infants with TOF will normally maintain oxygen saturation of 65%-85% until the defect is surgically corrected.

37). The nurse reinforcing teaching to the parents of a child diagnosed with cystic fibrosis will advise the parents to choose foods that satisfy which recommended diet?

High calorie, high protein, high fat Missed: 2 Wrong: 4 (Options 1, 3, and 4) A gluten-free diet is required for clients with celiac disease who cannot tolerate barley, rye, oats, or wheat (mnemonic: BROW). Low-phosphate diets are indicated for clients with certain kidney disorders. Low-sodium diets are indicated for volume overload states (eg, heart failure, ascites) and hypertension.

Cystic fibrosis diet

High in calorie Fat Protein

40). An 8-month-old infant is scheduled for balloon angioplasty of a congenital pulmonic stenosis in the cardiac catheterization laboratory. Which finding could possibly delay the procedure and should be reported?

Infant has severe diaper rash Educate: The nurse should report severe diaper rash to the registered nurse and health care provider in an infant who has an interventional catheterization procedure planned. If the rash is near the groin area, the procedure may be delayed due to possible contamination at the insertion site.

pyloric stenosis

Infants with infantile hypertrophic pyloric stenosis often present with excessive hunger (frequent feeder), a palpable olive-shaped mass in the epigastrium to the right of the umbilicus, and projectile vomiting (can be up to 3 feet).

58). The practical nurse monitoring a 3-year-old finds dyspnea, high fever, irritability, and open-mouthed drooling with leaning forward. The parents report that the symptoms started rather abruptly. The client has not received age-appropriate vaccinations. Which set of actions should the practical nurse anticipate?

Intubation in the operating room with a prepared tracheotomy kit standing by

Intussusception

Intussusception is a common obstructive disorder in infancy that occurs when one segment of the bowel telescopes into another. The classic clinical triad is intermittent, severe, crampy abdominal pain; a palpable "sausage-shaped" mass on the right side of the abdomen; and "currant jelly" stools. Other manifestations include inconsolable crying, drawing the knees up to the chest during episodes of pain, and vomiting. The child may appear normal and comfortable between episodes.

Lead poisoning

Lead poisoning still occurs in the United States, although not as often as in previous decades. A common source of exposure is lead-based paints found in houses built before 1978, when such paint was banned. Blood lead level (BLL) screenings are recommended at ages 1 and 2, and up to age 6 if not previously tested. Because lead poisoning particularly affects the neurological system, elevated BLLs (≥5 mcg/dL [0.24 µmol/L]) are dangerous in young children due to immature development of the brain and nervous system. A mild to moderate increase in BLL can manifest with hyperactivity and impulsiveness; prolonged low-level exposure can cause developmental delays, reading difficulties, and visual-motor issues. Extremely elevated BLLs can lead to permanent cognitive impairment, seizures, blindness, or even death.

Left-to-right cardiac shunts

Left-to-right cardiac shunts (eg, patent ductus arteriosus, atrial septal defect, ventricular septal defect) result in excess blood flow to the lungs. Manifestations include heart murmur, poor weight gain, diaphoresis with exertion, and signs of heart failure.

Phenylketonuria requires

Lifetime dietary restrictions. Infants should be given special formulas (eg, Lofenalac). For children and adults, high-phenylalanine foods (eg, meats, eggs, milk) should be restricted and replaced with protein substitutes

contraindicated in the presence of marked immunosuppression,

Live vaccine preparations Example: 1). MMR 2). Varicella

Client diet with kidney disorder

Low phosphate diet

Droplet

Neisseria MENINGITIS Haemophilus influenza type B Diptheria Mumps Rubella Pertussis Strep group A (strep throat) Viral influenza PPE: -Surgical mask -Private room >as needed for procedure with risk of splash or body

33 Nephrotic syndrome

Nephrotic syndrome is a collection of symptoms resulting from various causes of glomerular injury. The 4 classic manifestations of nephrotic syndrome are as follows: •Edema - periorbital edema is usually the first sign; peripheral edema and ascites develop later due to fluid shifts • Massive proteinuria - caused by increased glomerular permeability •Hypoalbuminemia - resulting from excess protein loss in the urine Hyperlipidemia - related to increased compensatory protein and lipid production by the liver Additional symptoms include decreased urine output, fatigue, pallor, and weight gain. The most common cause of nephrotic syndrome in children is minimal change nephrotic syndrome, which is generally considered idiopathic. Less common secondary causes may be related to systemic disease or infection, such as glomerulonephritis, drug toxicity, or acquired immunodeficiency syndrome.

15). A 12-month-old is found to have a moderately elevated blood lead level. Which of the following is the most serious concern for this child?

Neurocognitive impairment Missed: 3 Lead poisoning can lead to many severe complications of the neurological system (eg, developmental delays, cognitive impairment, seizures). Elevated blood lead levels are particularly dangerous in young children due to immature development of the brain and nervous system. Wrong: 1 (Option 1) Gastrointestinal bleeding is a concern for clients with iron poisoning but has no link to lead toxicity.

4). The nurse is caring for a 2-year-old who is receiving a saline enema for treatment of intussusception. Which client finding is most important to report to the supervisory registered nurse?

Passed a normal brown stool

β-hemolytic Streptococcus is a bacterial throat infection that can cause

Pharyngitis caused by group A renal or cardiac complications if not treated. It is important to discard the child's toothbrush 24 hours after starting antibiotics, test siblings age <3 years, and complete the full course of prescribed antibiotics.

8). A child with autism spectrum disorder is being admitted to a medical-surgical unit. Which is the most appropriate nursing action?

Placing the child in a private room away from the nurses' station Right: 1 May be hyper- or hypo-sensitive to sounds, lights, movement, touch, taste, and smells. A calming environment with minimal stimulation should be provided; a private room away from the nurses' station is the best location. Wrong: 2 (Option 2) A private room is an appropriate placement; however, the noise and activity from the playroom may be distracting to the child with ASD.

Preschoolers play

Play is an integral part of a child's mastery of emotional, social, and physical development. When a child is hospitalized, play can also serve as a diversion and a way to express stress and anxiety. Preschoolers enjoy play that enables them to imitate others and be dramatic. They have rich imaginations and enjoy make-believe. Their play often centers on imitating adult behaviors by playing dress up and using housekeeping toys, telephones, medical kits, dolls, and puppets. Quiet play appropriate for the preschooler includes finger paints, crayons, illustrated books, puzzles with large pieces, and clay. Through playing with objects such as dolls or puppets, preschoolers can often process fears and anxieties that are difficult for them to express.

11). The nurse is caring for a 10-year-old diagnosed with osteomyelitis. What is the best activity the nurse can suggest to promote age-specific growth and development during hospitalization?

Provide missed schoolwork Right: 3 According to Erikson's stages of psychosocial development, school-age children deal with the conflict of industry versus inferiority. Attaining a sense of industry (competence) is the most significant developmental goal for children age 6-12. Parents should therefore be encouraged to provide a hospitalized child with missed school work on a regular basis. Wrong: 4 (Option 4) Watching television is a good diversion for all hospitalized children, but it does not promote age-specific growth and development. Educate: Learning is a priority and completing school work provides a sense of accomplishment and satisfaction -It is therefore important that parents provide hospitalized school age children with missed school work on a regular basis

50). The nurse cares for a 4-year-old who is on long-term, strict bed rest. Which toy is most appropriate to provide diversion and minimize developmental delays?

Puppets

Projectile vomiting (without blood) is seen with

Pyloric stenosis and elevated intracranial pressure.

61). The nurse on a pediatric unit is caring for a school-age child with suspected Reye syndrome. Which subjective client data is most consistent with this condition?

Recent influenza infection Missed: 3 Wrong: 4

24). The nurse just administered routine immunizations to a healthy 15-month-old. What information should the nurse reinforce with the caregivers before they leave the clinic?

Redness at the injection sites and a mild fever are common Educational objective: Common side effects of immunizations include a mild fever and soreness and redness at the injection site. Anorexia and fussiness can be present for the first 24 hours.

63). During the client interview for a developmentally normal 18-month-old, the parent expresses concern about the small amount of food the child consumes. What is the nurse's priority intervention?

Reinforce teaching about the toddler's nutritional needs Missed: 4 During toddlerhood, it is normal for a child to have a decreased appetite as the result of reduced metabolic needs. Parents should be taught to provide multiple food options, set a schedule for meals/snacks, and avoid watching TV or playing games during mealtime. Toddlers should not be forced to eat. Wrong: 1 Starting at approximately age 1 year, the very high metabolic demands of infancy slow down to keep pace with the moderate growth of toddlerhood. During this phase, toddlers are increasingly picky about their food choices and schedules. Although to the parents it may appear that the child is not consuming enough calories, intake over several days actually meets nutritional and energy needs. Parents should be educated concerning what constitutes a healthy diet for toddlers and which foods they are more likely to consume.

25). A 4-year-old admitted with Wilms tumor is scheduled for a right nephrectomy in the morning. Which nursing action is a priority pre-operatively?

Reinforcing instructions not to palpate the abdomen Educational objective: Wilms tumor is discovered when caregivers note an unusual bulging/swelling on one side of a child's abdomen. The abdomen should not be palpated once diagnosis is suspected or confirmed as this can disrupt the tumor and cause dissemination of tumor cells.

Ringworm is a

Skin infection caused by a fungus. It leads to red, scaly, blistered rings on the skin or scalp that grow outward as infection spreads. The fungus is easily spread by sharing hair care instruments and hats or via towels, linens, clothing, and sports equipment.

54). A newborn had a bowel resection with temporary colostomy for Hirschsprung disease. The practical nurse should alert the supervising registered nurse about which postoperative finding?

Stoma is gray-tinged at the edges but pink at the center on postoperative day 5

7). A 2-year-old in the emergency department is suspected of having intussusception. Which assessment finding should the nurse expect?

Stools mixed with blood and mucus Right: 3 Wrong: 4 (Option 4) Thin, ribbon-like stool is characteristic of Hirschsprung disease (congenital aganglionic megacolon). Bowel obstruction is caused by failure of the internal sphincter to relax.

13). A nurse discovers a cyanotic newborn with excessive frothy mucus in the mouth. What should be the nurse's first action?

Suction the infant's mouth Educate: The initial nursing action for a client experiencing cyanosis and excess oral secretions is oropharyngeal suctioning to ensure airway patency.

Most cases of intussusception are treated successfully without

Surgery using hydrostatic (saline) or pneumatic (air) enema. The nurse will monitor for passage of normal brown stool, indicating reduction of intussusception. If this occurs, the supervisory registered nurse should be notified immediately to modify the plan of care and stop all plans for surgery.

69). A 9-year-old has terminal cancer, but the parents do not want the child to know the prognosis. The child has been asking questions such as what dying is like and whether the child will die. Which action by the nurse is most appropriate?

Tell the parents about the child's questions Educate: The nurse's role with a dying client is to aid communication. When a dying child asks about death, the parents should know about the child's concerns and be encouraged to speak with their child about death.

19). A nurse in a clinic is talking with a parent about the onset of puberty in boys. What is the first sign of pubertal change that occurs?

Testicular enlargement explain: Testicular enlargement, including scrotal changes, is the first manifestation of puberty and sexual maturation.

Key nursing interventions to alleviate separation anxiety include

Toddlers and preschool-age children experience separation anxiety in response to the stress of illness and hospitalization. >Encouraging the presence of favorite items, establishing a daily routine, providing opportunities for play, facilitating phone calls with the parents, and providing support when the child is upset.

Reduction of intussusception is often performed with

a saline or air enema. The supervisory registered nurse should be notified if there is passage of a normal stool as this indicates reduction of intussusception. All plans for surgery should be stopped, and the plan of care should be modified.

Children with streptococcal pharyngitis may return to school or daycare when

after they have completed 24 hours of antibiotics and are afebrile.

Separation anxiety starts around

age 6 months, peaks at age 10-18 months, and can last until age 3 years. It produces more stress than any other factor (eg, pain, injury, change in surroundings) for children in this age range. However, separation anxiety is normal and resolves by age 3 years.

A negative-pressure isolation room is indicated for diseases requiring

airborne precautions (eg, measles, tuberculosis, and varicella zoster [mnemonic: airing MTV]).

A child with celiac disease cannot eat

barley, rye, oats, or wheat (mnemonic - BROW).

The colostomy stoma should be

beefy red in the immediate postoperative period. Any discoloration of the stoma could indicate decreased blood supply to the area; the nurse should notify the supervising registered nurse. By postoperative day 6, non-formed stool would be expected from the colostomy due to removal of part of the fluid-absorbing portion of the large intestine.

Bronchodilators and nebulizers are more effective when administered

before chest physiotherapy (percussion, vibration, and postural drainage) to open airways and break up loosened secretions.

What should parent do for seizure lasting more than 5 mins

call 911

Aspirin should be avoided in

children due to the risk of Reye syndrome

Clubbing of the fingertips is associated with

chronic hypoxia caused by decreased pulmonary circulation as occurs with right-to-left heart defects.

A 4-year-old can .

copy or draw a square with a pencil or crayon. Copying shapes other than a circle is a developmental expectation for a 5-year-old.

Growth hormone replacement

does not guarantee that a child will grow at a rate equal to peers. Treated children often remain shorter than their peers. Replacement therapy is not continued throughout a child's life. It is stopped when bone growth begins to cease or when the child, parents, and provider make the decision.

(Option 2) Cardiac murmur is

expected in heart defects. This is not a priority to report.

Reye syndrome in children is characterized by

fever, acute encephalopathy, and altered hepatic function. It often develops following a viral infection, especially varicella or influenza. The risk of developing Reye syndrome increases if aspirin is used to treat varicella- or influenza-associated fever; acetaminophen or ibuprofen should be given instead.

Bloody vomiting is seen with

gastric ulcers and variceal bleed.

Cystic fibrosis damage to GI and pancreas leads to

growth deficits

Croup presents with a characteristic

hacking cough, which is absent in epiglottitis.

Side Effect of varicella immunization

include -discomfort -redness -few vesicles at the injection site To reduce risk of transmission from exudate -Cover vesicles with clothing or a small bandage will reduce the risk of transmission from any exudate -Once vesicles have dried, or crusted, a dressing is no longer necessary

The most common worm infection in the United States is pinworm, which is easily spread by

inhaling or swallowing microscopic pinworm eggs, which can be found on contaminated food, drink, toys, and linens. Once eggs are ingested, they hatch in the intestines. During the night, the female pinworm lays thousands of microscopic eggs in the skinfolds around the anus, resulting in anal itching and troubled sleep. When the infected person scratches, eggs are transferred from the fingers and fingernails to other surfaces. Pinworm infection is treated with anti-parasitic medications.

The classic clinical triad of intussusception is

intermittent, severe, crampy abdominal pain; a palpable sausage-shaped mass on the right side of the abdomen; and currant jelly stools.

Sausage shaped right sided mass is commonly felt palpation in clients with

intussusception This is an expected finding for this condition

(Option 3) Tetralogy of Fallot (TOF)

is a cyanotic cardiac defect. Infants with TOF will normally maintain oxygen saturation of 65%-85% until the defect is surgically corrected.

Hemophilia

is a hereditary bleeding disorder caused by a deficiency in coagulation proteins. Treatment consists of replacing the missing clotting factor and teaching the client about injury prevention, including: Wrong: (Option 2) Dehydration is not commonly associated with hemophilia. Avoiding dehydration is important for those with sickle cell anemia.

Intussusception causes

non-projectile vomiting that is usually non-bloody, but stools mixed with mucus and blood are seen.

Children with severe immunosuppression as indicated by CD4 lymphocyte counts and/or percentages should

not receive any live vaccines, including MMR and varicella.

Bathing an infant in tepid water and placing ice bags under the arms and around the neck are

not recommended techniques as these induce shivering, increase metabolic activity, have no antiseizure effects, and cause discomfort for the child. These cooling techniques are more effective for a child experiencing hyperthermia (eg, with heat stroke).

Nocturnal enuresis,

or involuntary bed-wetting at night, is managed with a variety of nonpharmacologic measures that nurses should teach parents. These include use of positive reinforcement and bed alarms, restricting fluids after the evening meal, avoiding scolding or ridiculing, awakening the child at a specified time to void, and keeping a log of wet and dry nights.

Tonsillectomy is usually performed as an

outpatient procedure. Postoperative bleeding is an uncommon but important complication and it can last up to 2 weeks. It manifests with frequent or continuous swallowing and/or cough from the trickling blood; some clients may also develop restlessness. Discharge teaching includes: •Avoid coughing, clearing the throat, and blowing the nose to prevent hemorrhage • Limit physical activity • Milk products are discouraged due to their coating effect, which can prompt clearing of the throat • Oral mouth rinses, gargling, and vigorous tooth brushing should be avoided to prevent irritation

Infants with cyanotic cardiac defects can develop

polycythemia as a compensatory mechanism due to prolonged tissue hypoxia.

Risk factors for FTT include

poverty, lack of structured meal times, negative attitudes toward food, domestic violence, and substance abuse.

Clubbing is another manifestation of

prolonged hypoxia

Left-to-right shunting results in

pulmonary congestion, causing increased work of breathing and decreased lung compliance. Compensatory mechanisms (eg, tachycardia, diaphoresis) result from sympathetic stimulation. Clinical manifestations of acyanotic defects may include: •Tachypnea • Tachycardia, even at rest • Diaphoresis during feeding or exertion (Option 3) • Heart murmur or extra heart sounds (Option 4) • Signs of congestive heart failure • Increased metabolic rate with poor weight gain (Option 5)

Parents of an infant or child with a repaired congenital heart should be able to recognize and report signs and symptoms of heart failure to the health care provider. These may include

rapid breathing rate; rapid heart rate at rest; dyspnea; activity intolerance; pale, cool extremities; weight gain; reduction in wet diapers; and puffiness around the eyes.

Simple febrile seizure management typically involves

reassurance regarding the benign nature of most febrile seizures, and education about the risk of recurrence (around 30%) and seizure safety precautions (eg, side-lying positioning, removal from harmful environments). Parents should use antipyretics such as acetaminophen or ibuprofen to control fevers and make the child more comfortable. However, there is no evidence that antipyretics reduce the risk of future febrile seizures. After the administration of antipyretics, additional cooling methods that may be beneficial for reducing fever include applying cool, damp compresses to the forehead; increasing air circulation in the room; and wearing loose or minimal clothing to increase skin exposure to air. However, care should be taken to prevent shivering, which can further raise the metabolic rate above that caused by fever.

Children who are HIV-positive and not severely immunocompromised can

receive routine childhood immunizations.

Children who develop Reye syndrome have often had a

recent viral infection, especially varicella (chicken pox) or influenza. Clinical manifestations of Reye syndrome include fever, lethargy, acute encephalopathy, and altered hepatic function. Elevated serum ammonia levels are an expected laboratory finding. In addition, acute encephalopathy manifests with vomiting and a severely altered level of consciousness; it can rapidly progress to seizures and/or coma. The risk of developing Reye syndrome increases if aspirin is used to treat the fever associated with varicella or influenza. As a result, the use of acetaminophen or ibuprofen for fever management in children has increased significantly.

An individual with a CD4 lymphocyte percentage less than 15% is considered

severely immunocompromised

Scabies is a

skin infestation caused by the Sarcoptes scabiei mite. It spreads easily via direct person-to-person contact (eg, nursing homes, day cares, prisons). The pregnant female mite burrows into the outer skin layer (dead layer) to lay eggs and feces, leaving a superficial burrow track. Intense itching, especially at night, occurs due to the body's inflammatory response to the mite's eggs and feces. The lengthy 30- to 60-day incubation period (time frame between infestation and appearance of symptoms) makes it necessary to treat all persons who have had contact with the infested child during that time. Those age >2 months can receive one-time treatment with scabicide cream (1% permethrin is used most often), which is applied to all body areas below the head. It is important to inform the parents and child that itching will continue for several weeks even after proper treatment is given (Options 1 and 2).

Kawasaki disease (KD) is a

systemic vasculitis of childhood that presents with ≥5 days of fever, nonexudative conjunctivitis, lymphadenopathy, mucositis, hand and foot swelling, and a rash. First-line treatment consists of IV immunoglobulin and aspirin to prevent coronary artery aneurysms. When children with KD are discharged home, parents are instructed to monitor them for fever by checking the temperature (orally or rectally) every 6 hours for the first 48 hours following the last fever. Temperature should also be checked daily until the follow-up appointment. If the child develops a fever, the health care provider should be notified as this may indicate the acute phase of KD recurrence. The child may require additional treatment with IV immunoglobulin to prevent development of coronary artery aneurysms and occlusions.

Pancreatic enzymes need to be given to the child at

the beginning of all meals and snacks.

In intussusception,

the stools are mixed with blood and mucus, giving a characteristic "currant jelly" appearance. This is an expected finding. Pain in intussusception is typically intermittent, occurs every 15-20 minutes, and is accompanied by screaming and drawing up of the knees. Therefore, if a child stops crying, it may due to a short-term intermission from painful spasms rather than reduction of intussusception.

Once children with KD are discharged home, parents should be instructed to check

their temperature every 6 hours for the first 48 hours following the last fever and then daily until the follow-up visit. The health care provider should be notified if the child has fever as this may indicate a need for further treatment.

Postoperative bleeding after a tonsillectomy is

uncommon but can last up to 14 days after surgery.

A harsh systolic murmur is heard in

ventricular septal defect, an opening between the ventricles of the heart. Ventricular septal defect is an acyanotic defect.

strategies to reduce or avoid exposure to known allergens.

•Installing high-efficiency particulate air filters in the home air conditioning system • Keeping windows closed and staying indoors, particularly during times of heavy pollen • Using hypoallergenic pillow and mattress covers to prevent exposure to dust mites (Option 2) • Reducing or eliminating carpet and area rugs from the home (Option 5) • Regularly mopping hard floors and damp-dusting furniture (at least weekly) (Option 1)

Risk factors for FTT include:

•Young parent age • Unplanned or unwanted pregnancy • Lower levels of parental education • Single-parent home • Social isolation • Chronic life stresses/anxiety in the home • Disordered feeding techniques◦ Prolonged breast or bottle feeding ◦ Unstructured meal times ◦ Negative or difficult interactions at meal time ◦ Poor parental feeding skills ◦ Negative attitudes toward food - fear of obesity or an overweight child • Substance abuse • Domestic violence and/or parental history of child abuse • Poverty, food insecurity • Parents who have a negative perception of the child