Ch. 1

A parent of a child recently diagnosed with attention deficit hyperactivity disorder (ADHD) asks the nurse to explain how the provider determined the diagnosis. Which statement made by the nurse correctly explains the diagnostic criteria for ADHD? A. "A pattern of attention and/or hyperactivity-impulsivity persisting for 6 months that interferes with functioning or development." B. "A pattern of attention and/or hyperactivity-impulsivity persisting for 1 year that interferes with functioning or development." C. "A pattern of inattention and/or hyperactivity-impulsivity persisting for 6 months that interferes with functioning or development." D. "A pattern of inattention and/or hyperactivity-impulsivity persisting for 3 months that interferes with functioning or development."

"A pattern of inattention and/or hyperactivity-impulsivity persisting for 6 months that interferes with functioning or development."

The nurse is educating an 11-year-old obese child and his parents about nutrition. Which statement by the child requires further follow-up by the nurse? A. "I usually eat whatever my grandma fixes for me." B. "My parents know what good food choices are for me." C. "I am ready to start making changes to what I eat while I am at school." D. "I understand that exercising and making good food choices are important."

"I usually eat whatever my grandma fixes for me."

The nurse is reviewing discharge instructions with the parents of a 2-year-old child admitted with gastroenteritis and dehydration. Which statement by the parents requires further follow-up by the nurse? A. "I will sing through 'Happy Birthday' in my head to ensure I am washing my hands long enough." B. "If my child becomes lethargic again, I should call the doctor." C. "As long as my child is eating and drinking, it is not necessary to give antipyretics." D. "Fussiness and irritability may mean that my child is not getting well."

"I will sing through 'Happy Birthday' in my head to ensure I am washing my hands long enough."

The nurse has just finished teaching the parents of a 7-year-old child with attention deficit hyperactivity disorder (ADHD) about the disorder and treatments. Which statement by the parents indicates a need for further teaching? A. "With medication and teaching, we can promote optimal growth and development in our child." B. "If our child takes the prescribed medication, we will not see signs of ADHD." C. "Medications should not be given after 6 pm, to allow our child to sleep." D. "Teachers will provide structure and decrease classroom stimuli to enhance school performance."

"If our child takes the prescribed medication, we will not see signs of ADHD."

The nurse is reviewing the side effects of chemotherapy with the parent of a 4-year-old child about to undergo treatment for acute lymphoblastic leukemia. Which statement requires further follow-up by the nurse? A. "If side effects occur, it means the treatment is taking effect." B. "Nausea, vomiting, and fatigue are common side effects." C. "Side effects that my child experiences may be different from another child with the same treatment." D. "Eating and drinking may become very difficult."

"If side effects occur, it means the treatment is taking effect."

A 7-year-old child with type 1 diabetes tested positive for influenza A and stayed home from school today. The parent calls the clinic reporting that the child does not have an appetite and only drank tea and ate toast. What instruction should the nurse give the parent regarding insulin dosage? A. "There is no need to test blood glucose, because the child is not eating much." B. "Test blood glucose every 3 to 4 hours and administer insulin as needed." C. "Test urine glucose every 2 hours." D. "Give short-acting insulin even if not eating."

"Test blood glucose every 3 to 4 hours and administer insulin as needed."

The nurse is assigned to a toddler with sickle cell anemia who is scheduled for an exchange transfusion. The parents ask about the purpose of the procedure. What is the nurse's best response? A. "The procedure reduces side effects of blood transfusions." B. "The procedure is routine for sickle cell crisis." C. "The procedure is done to prevent further sickling during vasoocclusive crisis." D. "When the spleen is removed, it is necessary to do exchange transfusions."

"The procedure is done to prevent further sickling during vasoocclusive crisis."

A parent of an infant diagnosed with bronchiolitis asks the nurse, "Why does my infant have to be in isolation?" Which response by the nurse is appropriate? A. "Your infant does not need to be in isolation." B. "We do not want your infant to become reinfected." C. "This condition is contagious only to immunocompromised people." D. "This condition is highly contagious and is easily spread to others."

"This condition is highly contagious and is easily spread to others."

The nurse is assessing a 4-year-old child whose parents are concerned the child has attention deficit hyperactivity disorder (ADHD). Which statement made by the nurse is correct? A. "To make a diagnosis, symptoms must occur for 2 months." B. "To make a diagnosis, symptoms must occur for 4 months." C. "To make a diagnosis, symptoms must occur for 5 months." D. "To make a diagnosis, symptoms must occur for 6 months."

"To make a diagnosis, symptoms must occur for 6 months."

The nurse is educating a 2-year-old child's parents about nutritional requirements appropriate for proper growth and development. The parents are concerned that the client is not eating enough. Which statement should the nurse include in the teaching? A. "Try to encourage eating and drinking nutritious foods, but do not worry as much about how much is eaten." B. "To meet a toddler's dietary requirements, it may be necessary to prepare meals different than what you eat as a family." C. "To ensure an adequate amount of calories is consumed, it is helpful to keep a nutritional diary." D. "Offer food and drinks high in healthy fats, such as whole milk, to support brain development."

"Try to encourage eating and drinking nutritious foods, but do not worry as much about how much is eaten."

The nurse is preparing to administer IV rehydration therapy for a 2-year-old child who is severely dehydrated. Based on the above diagnostic results, the nurse should prepare to administer which type of fluids? A. 0.9% normal saline solution B. 0.45% normal saline solution C. 0.33% normal saline solution D. 0.225% normal saline solution

0.9% normal saline solution

The nurse is demonstrating the steps of blood glucose testing with a 7-year-old child newly diagnosed with type 1 diabetes and the child's parents. Place the steps that the nurse will review with the child and parents in the correct order. Use all options. 1. Clean hands with soap and water, or alcohol wipes. 2. Load the lancet device. 3. Use the side of the fingertip to obtain a drop of blood with the lancet. 4. Place a drop of blood on the test strip in the glucometer. 5. Wait the appropriate amount of time and read the results. 6. Record the results in a logbook or journal.

1, 2, 3, 4, 5, 6

The nurse is calculating the required caloric intake for a 6-month-old infant who is underweight. The target weight for the infant is to be at the 25th percentile, which is 15 lb (6.8 kg). Given that a typically developing 6-month-old infant should consume 98 kcal/kg/d, how many kilocalories per day should the infant consume? Record your answer using one decimal place.

666.4 kcal

The nurse is creating a plan of care for an 11-year-old child with obesity. Which nursing intervention(s) should the nurse include in the plan of care? Select all that apply. A. Monitor weight. B. Monitor blood pressure. C. Teach the family how to incorporate healthy food options. D. Administer prescribed antidiabetic medications. E. Refer for bariatric surgery.

A, B, C

The nurse is performing an assessment on a 3-year-old client whose parents believe that the client has a urinary tract infection. What should the nurse include in the assessment? Select all that apply. A. palpation of the abdomen B. body temperature C. urine odor and appearance D. reflexes E. lower extremity strength

A, B, C

The nurse is reviewing techniques for medication dosing adherence with a 16-year-old client with epilepsy. Which technique(s) should the nurse review with the client? Select all that apply. A. using a pill box B. setting reminders on a mobile device C. incorporating medications into daily routine D. requesting reminder phone calls from the health care provider E. encouraging parents to give reminders

A, B, C

The nurse is reviewing the supplies required to perform an insulin injection with a 7-year-old child with type 1 diabetes and the child's parents. Which supplies should the nurse instruct the child and parents to gather to prepare for insulin administration? Select all that apply. A. syringe B. vial of correct insulin C. two alcohol pads D. sharps disposal container E. butterfly needle

A, B, C, D

The nurse is teaching the parents of a newborn client who has a ventricular septal defect (VSD) about safety in the home during a follow up visit. Which topic should the nurse include in the teaching? Select all that apply. A. sleeping B. handwashing C. immunizations D. monitoring for infections E. fall prevention

A, B, C, D

The nurse is creating a plan of care for an 11-year-old child with obesity and elevated cholesterol and triglycerides. What should the nurse include in the plan of care? Select all that apply. A. recommending foods to the family B. suggesting activities to increase exercise C. Reviewing the use of a pill case for organizing the client's medication doses D. instructing the child on self-administering subcutaneous injections E. referring to a dietitian

A, B, E

An assessment of a 4-year-old child reveals hyperactivity and inattention. The child tends to engage in disruptive behaviors such as interrupting others and is unable to play quietly. Based on this assessment, the nurse should suspect which of these disorders? A. oppositional defiant disorder B.conduct disorder C. attention deficit hyperactivity disorder D. reactive attachment disorder

ADHD

The nurse is caring for a 16-year-old client being evaluated for a new diagnosis of a seizure disorder. While collecting the client's medical history, the client and parents report episodes in which the client stares blankly and is unresponsive for several seconds. For which type of seizure disorder should the nurse anticipate treatment? A. absence B. atonic C. generalized tonic-clonic D. myoclonic

Absence

The nurse is educating an 11-year-old child with obesity on age-appropriate nutritional guidelines. Which action should the nurse take first? A. Ask for a description of typical breakfast, lunch, dinner, and snacks. B. Explain the importance of portion control. C. Review the use of "My Plate" to visualize proper food choices. D. Identify examples of healthy foods to include in each meal.

Ask for a description of typical breakfast, lunch, dinner, and snacks.

20 month-old child Height: 50% Weight 80% on growth chart Pale Physical exam: Normal Hct: 20% The nurse is caring for a child with the above assessment findings. Which question(s) should the nurse ask the parent to help determine a diagnosis of anemia? Select all that apply. A. "How much did your child weigh at birth?" B. "How many bowel movements does your child have per day?" C. "How much milk does your child drink per day?" D. "What does your child eat on a typical day?" E. "Is your child taking any new medications?"

C, D

The nurse is caring for a 16-year-old client with epilepsy who expresses to the nurse a fear of spending time with friends because a seizure might occur. What should the nurse suggest to the client? A. Give friends basic instructions on what to do in case of a seizure. B. Limit time spent with friends due to seizure risk. C. Always have an adult chaperone present who knows what to do. D. Inform friends that a seizure is unlikely while the client is receiving treatment.

Give friends basic instructions on what to do in case of a seizure.

The parent of an infant diagnosed with bronchiolitis asks the nurse, "What causes bronchiolitis?" What is the most accurate information about the cause of this lower respiratory tract virus? A. Haemophilus influenzae type b (Hib) B. a beta-hemolytic streptococcus C. Moraxella catarrhalis D. respiratory syncytial virus (RSV)

RSV

The nurse is caring for an 8-year-old child whose parent states the child is exhibiting impulsiveness, distraction, risk taking, and inability to follow directions, per the above nurse's note. What is the priority concern for the nurse to address with this child and parent? A. self-esteem B. safety C. social isolation D. personal identity

Safety

The nurse is performing a routine physical assessment on an 11-year-old child during an outpatient visit. Which age-related screening should the nurse include in the assessment? A. scoliosis B. reproductive C. psychosocial D. cardiac

Scoliosis

The nurse is reviewing safety with the parent of a 2-year-old client during an annual well-child visit. The client's parent is reviewing several day-to-day activities with the nurse to determine if the parent should be doing anything to promote the client's safety. Which activity requires further follow-up by the nurse? A. Tightening loose screws and covering sharp edges of outdoor playground equipment. B. Keeping all medications out of reach of the client. C. Supervising the client while riding a tricycle in the street. D. Not allowing the client to climb on furniture and other elevated surfaces.

Supervising the client while riding a tricycle in the street.

While the nurse is caring for a 7-year-old child hospitalized for diabetic ketoacidosis, the nurse notes that the child is experiencing shakiness, sweatiness, and irritability. The child reports feeling nauseated. Which action should the nurse take first? A. Test blood glucose level. B. Administer fast-acting insulin. C. Start IV bolus of normal saline. D. Monitor for changes in cognitive status.

Test blood glucose level.

The school nurse is working with the parents and teacher of an 8-year-old child who has been placed on medications for attention deficit hyperactivity disorder (ADHD). What is the priority for the child taking medications for ADHD in the school setting? A. The child shows sleeps more. B. The child concentrates for increasingly longer periods of time. C. The child displays more interest in solitary activities. D. The child displays more concern for self.

The child concentrates for increasingly longer periods of time.

The nurse is teaching a client and family about asthma. The parent of the client asks, "What is asthma?" What is the nurse's explanation? A. a sudden infection of the airways B. a reversible, diffuse, obstructive pulmonary disease C. a lower respiratory infection D. a thinning and destruction of the alveoli in the lung

a reversible, diffuse, obstructive pulmonary disease

The nurse is performing an assessment on an 11-year-old child during an annual exam. Based on Erikson's theory of psychosocial development, the nurse should make which consideration while performing the psychosocial assessment? A. developing a sense of pride and accomplishment in schoolwork, sports, social activities, and family life B. initiating activities and asserting control over the world through social interactions and play C. controlling actions, showing clear preferences to certain elements in the environment D. establishing meaningful and lasting relationships with others

developing a sense of pride and accomplishment in schoolwork, sports, social activities, and family life

While the nurse is performing an assessment on a 6-year-old child prior to being seen by the health care provider, the child and the child's parents report that the child has excessive thirst, is constantly eating, and is urinating far more frequently than usual. Which additional testing should the nurse anticipate first in the child's plan of care? A. fingerstick blood glucose B. liver function tests C. urinalysis D. nerve conduction tests

fingerstick blood glucose

x An adolescent client is receiving albuterol 2 puffs every 3 hours, for an exacerbation of asthma. What side effects should the nurse tell the adolescent to expect following medication administration? A. constipation, rash, and blurred vision B. increased appetite, increased risk for superinfection, and gum hyperplasia C. increased heart rate, insomnia, and restlessness D. decreased respirations, lethargy, and ringing of the ears

increased heart rate, insomnia, and restlessness

While assessing a 2-year-old child using the Clinical Dehydration Scale for Children 1 to 36 Months of Age, the nurse observes that the client is thirsty and irritable when touched, the eyes are very sunken, the mucous membranes are sticky, and tears are absent. Based on these findings, what level of dehydration should the nurse document? A. no dehydration B. some dehydration C. moderate/severe dehydration D. slight dehydration

moderate/severe dehydration

The nurse is caring for a 12-year-old client in the emergency department who has experienced an ulnar fracture. Which action should the nurse prioritize? A. monitoring circulation and perfusion B. performing a focused assessment to rule out child abuse (child maltreatment) C. obtaining orders for an X-ray D. administering codeine for pain control

monitoring circulation and perfusion

The nurse is reviewing the laboratory results with an 11-year-old child with obesity. Based on the above results, which action should the nurse include in the plan of care? A. reviewing food choices high in high-density lipoproteins (HDLs) B. tools for adhering to oral cholesterol-lowering agent regimen C. recommending recipes with low amounts of low-density lipoproteins (LDLs) to the family D. instructions for subcutaneous injection administration

recommending recipes with low amounts of low-density lipoproteins (LDLs) to the family

The nurse is performing an assessment on a 6-month-old infant for a well-child visit. Which finding requires further follow-up by the nurse? A. supports himself with arms while sitting B. grasps food with his whole hand C. occasionally fusses D. rolls to one side

rolls to one side

While performing an assessment on a 2-year-old child, the nurse asks the client's parents about developmental milestones. Which finding requires further follow-up by the nurse? A. speaks in single-word statements B. plays alongside other children without interacting C. has temper tantrums D. imitates both children and adults

speaks in single-word statements

Pulse: 222 BPM RR: 82 bpm BP: 68/34 mmHg Temp: 99*F The nurse is caring for a newborn client with a ventricular septal defect (VSD). Based on the above data, which intervention should the nurse anticipate at this time? A. surgery B. increased feeding frequency C. supplemental feeding D. oxygen administration via nasal cannula

surgery

The nurse is preparing to assess a 12-year-old client in the emergency department for a wrist injury. Which method should the nurse use to assess the client's pain? A. the numerical pain rating scale B. FACES pain rating scale C. FLACC pain rating scale D. mPAT pain assessment tool

the numerical pain rating scale