Chapter 27-29

A nurse is preparing a program for a parent group about various techniques that can be used to manage behavior. What would the nurse be least likely to include? A) Focus the child's attention on the negative behavior. B) Set limits with the child for responsible behavior. C) Ignore inappropriate behaviors. D) Provide positive feedback for self-control efforts.

Ans: A Feedback: Behavior management techniques include redirecting the child's attention when needed, setting limits for responsible behavior, ignoring inappropriate behaviors, and providing praise and positive feedback for the child's self-control efforts.

The nurse is obtaining the health history for a 15-month-old boy from the parents. The child is not yet speaking. Which finding would be eliminated as a risk factor for a possible genetic disorder? A) The child is male and Caucasian. B) The grandmother and father have hearing impairments. C) The child was a breech delivery 3 weeks early. D) The mother was 37 when she became pregnant.

Ans: A Feedback: Being male and Caucasian are risk factors for acute lymphoblastic leukemia, not genetic disorders. The fact that the child's grandmother and father have hearing impairments suggests a genetic disorder. The facts that the mother was 37 when she became pregnant and had a breech delivery 3 weeks early are also risk factors for genetic disorders.

A group of students are reviewing information about major and minor congenital disorders. The students demonstrate understanding of the information when they identify what condition as a minor disorder? A) Webbed neck B) Omphalocele C) Cutaneous hemangioma D) Facial asymmetry

Ans: A Feedback: A minor congenital anomaly is webbed neck. Omphalocele, cutaneous hemangioma, and facial asymmetry are considered major congenital anomalies.

A child is undergoing rapid sequence intubation and is receiving atropine. The nurse understands that this agent is used to: A) lessen the vagal effects of intubation. B) reduce intracranial pressure. C) induce amnesia. D) provide short-term paralysis.

Ans: A Feedback: Atropine is used to decrease respiratory secretions and mitigate the vagal effects of intubation. Thiopental reduces intracranial pressure and oxygen demand. Midazolam causes amnesia. Rocuronium or other neuromuscular blocking agents provide short-term paralysis during intubation.

The nurse is caring for an adolescent girl with a suspected anxiety disorder. The girl states that she is constantly double-checking that she has unplugged her curling iron and must make sure that everything is in perfect order in her room before she leaves the house. The nurse interprets these findings as indicating which disorder? A) Generalized anxiety disorder B) Posttraumatic stress disorder C) Social phobia D) Obsessive-compulsive disorder

Ans: D Feedback: Obsessive-compulsive disorder is characterized by compulsions (repetitive behaviors such as cleaning, washing, or checking something) to reduce anxiety about obsessions (unwanted and intrusive thoughts). Posttraumatic stress disorder is an anxiety disorder that occurs after a child is subjected to a traumatic event, later experiencing physiologic arousal when a stimulus triggers memories of the event. Generalized anxiety disorder is characterized by unrealistic concerns over past behavior, future events, and personal competency. Social phobia is characterized by a persistent fear of formal speaking, using public restrooms, or eating in front of others.

When describing Prader-Willi syndrome to a group of nursing students, the instructor would describe this condition as one affecting which chromosome? A) 4 B) 5 C) 11 D) 15

Ans: D Feedback: Prader-Willi syndrome involves an abnormality on chromosome 15. Cri-du-chat involves an abnormality on chromosome 5; Wolf-Hirschhorn syndrome involves an abnormality on chromosome 4; and Beckwith-Wiedemann syndrome involves an abnormality on chromosome 11.

A nursing student is preparing an oral presentation about autosomal recessive inheritance. What must occur for an offspring to demonstrate signs and symptoms of the disorder with this type of inheritance? A) Both parents must be heterozygous carriers. B) One parent must have the disease. C) The mother must be a carrier. D) The father must be affected by the disease.

Ans: A Feedback: Autosomal recessive inheritance occurs when two copies of the mutant or abnormal gene in the homozygous state are necessary to produce the phenotype. In other words, two abnormal genes are needed for the individual to demonstrate signs and symptoms of the disorder. Both parents of the affected person must be heterozygous carriers of the gene (clinically normal, but carriers of the gene).

A school-age child diagnosed with depression is receiving antidepressant therapy. What behavior would the nurse instruct the parents to watch for and to notify the physician immediately if the child demonstrates it? A) Loss of interest B) Gastric upset C) Sedation D) Urinary retention

Ans: A Feedback: Children taking antidepressants are at risk for the development of presuicidal behavior, which may be indicated by a loss of interest or pleasure. Gastric upset, sedation, and urinary retention may or may not occur, but none of these would be as important to report as the potential for self-harm.

The nurse is caring for 3-day-old girl with Down syndrome whose mother had no prenatal care. What is the priority nursing diagnosis? A) Imbalanced nutrition, less than body requirements related to the effects of hypotonia B) Deficient knowledge related to the presence of a genetic disorder C) Delayed growth and development related to a cognitive impairment D) Impaired physical mobility related to poor muscle tone

Ans: A Feedback: Children with Down syndrome may have difficulty sucking and feeding due to lack of muscle tone and the structure of their mouths and tongues. This can lead to poor nutritional intake and makes this the priority diagnosis. This also uses the strategy that physiologic needs have priority using Maslow's hierarchy of needs. Deficient knowledge due to lack of information about the disorder is a close second in priority, as the mother did not know of her daughter's condition before birth and has much to learn now. This child is at risk for a number of complications such as infection, heart disease, and leukemia and will require frequent assessment. Most children with Down syndrome experience some degree of intellectual disability, but early intervention will allow the child maximum development within the limits of the disease. Mobility is delayed but should not be a problem at this time.

A child is receiving therapy in which he is learning to replace automatic negative thought patterns with alternative ones. The nurse interprets this as which type of therapy? A) Cognitive therapy B) Behavioral therapy C) Milieu therapy D) Individual therapy

Ans: A Feedback: Cognitive therapy teaches children to change reactions so that automatic negative thought patterns are replaced with alternative ones. Behavioral therapy uses stimulus and response conditioning to manage or alter behavior, reinforcing desired behaviors and replacing the inappropriate ones. Milieu therapy involves a specially structured setting designed to promote the child's adaptive and social skills. With individual therapy, the child and therapist work together to resolve the conflicts, emotions, or behavior problems.

The parents bring their 3-year-old son to the emergency department after he ingested some of his mother's medicine. Which assessment would be of critical importance for this child? A) Assessing mental status and skin moisture and color B) Evaluating the effectiveness of the child's breathing C) Noting the child's pulse rate and quality D) Auscultating all lung fields for signs of edema

Ans: A Feedback: In cases of poisoning, clinical manifestations vary widely depending on the medication or chemical ingested. Therefore, it is important to pay particular attention to the child's mental status, skin moisture and color, and bowel sounds. Evaluating the effectiveness of the child's breathing and noting the child's pulse rate and quality are basic to any rapid cardiopulmonary assessment. Auscultating all lung fields for signs of pulmonary edema would be critically important for a child who is a near-drowning victim.

The nurse is providing care to a child experiencing shock. Which intravenous solution would the nurse expect to administer? A) Ringer lactate B) Dextrose 5% and water C) Dextrose 5% and normal saline D) Dextrose 10% and water

Ans: A Feedback: Isotonic fluids, such as Ringer lactate or normal saline, are the fluids of choice given rapidly to children experiencing shock. Dextrose solutions are contraindicated in shock because of the risk of complications such as osmotic diuresis, hypokalemia, hyperglycemia, and worsening of ischemic brain injury

What finding would lead the nurse to suspect that a child has Turner syndrome? A) Webbed neck B) Microcephaly C) Gynecomastia D) Cognitive delay

Ans: A Feedback: Manifestations of Turner syndrome include webbed neck, low posterior hairline, wide-spaced nipples, edema of the hands and feet, amenorrhea, and absence of secondary sex characteristics, along with short stature and slow growth. Microcephaly is commonly associated with trisomy 13. Gynecomastia and cognitive delay are associated with Klinefelter syndrome.

A nurse is reviewing an article about genetic disorders and patterns of inheritance. The nurse demonstrates understanding of the information by identifying which as an example of an autosomal dominant genetic disorder? A) Neurofibromatosis B) Cystic fibrosis C) Tay-Sachs disease D) Sickle cell disease

Ans: A Feedback: Neurofibromatosis is an example of an autosomal dominant genetic disorder. Cystic fibrosis, Tay-Sachs disease, and sickle cell disease are examples of autosomal recessive genetic disorders.

The nurse is caring for a 13-year-old boy with a history of inappropriate behavior. Which statement by the mother would lead the nurse to suspect oppositional defiant disorder rather than conduct disorder? A) "He has frequent temper tantrums." B) "He was pulling the neighbor's dog around by his leash." C) "He is constantly lying to me." D) "He has stolen hundreds of dollars from my purse."

Ans: A Feedback: Reports of frequent temper tantrums point to oppositional defiant disorder rather than conduct disorder. Reports of cruelty to animals, excessive lying, and stealing point to conduct disorder

A group of nursing students are reviewing information about neurocutaneous syndromes. What is an example of these disorders? A) Sturge-Weber syndrome B) Marfan syndrome C) Apert syndrome D) Achondroplasia

Ans: A Feedback: Sturge-Weber syndrome is an example of a neurocutaneous syndrome. Marfan syndrome, Apert syndrome, and achondroplasia are autosomal dominantly inherited genetic disorders.

A 5-year-old girl is cyanotic, dusky, and anxious when she arrives in the emergency department. Which action would be most appropriate? A) Ventilating the child with a bag-valve-mask B) Estimating the child's weight using a Broselow tape C) Providing therapy using automated external defibrillation D) Using rescue breathing and chest compressions

Ans: A Feedback: The child is exhibiting signs of ineffective oxygenation and ventilation. Therefore, ventilating the child with a bag-valve-mask and 100% oxygen would be effective and efficient. Estimating the child's weight with a Broselow tape is typically done by ambulatory care providers. According to the American Heart Association, automated external defibrillators are recommended for use in children who are older than age 1 year who have no pulse and have suffered a sudden, witnessed collapse outside the hospital setting. Rescue breathing and chest compressions are implemented for children who are not breathing and do not have a pulse or when the pulse rate is less than 60 beats per minute

A child weighing 51 lb (23.1 kg) requires defibrillation. How many joules would the nurse expect to give initially? A) 46 B) 92 C) 102 D) 204

Ans: A Feedback: The initial amount of energy or joules for defibrillation is 2 joules/kg. The child weighs 51 lb, which is 23 kg, so 46 joules would be used.

What would the nurse do first for a 5-year-old girl with profound bradycardia? A) Provide oxygen at 100% B) Administer epinephrine as ordered C) Use warming blankets D) Perform gastric lavage

Ans: A Feedback: The most common cause of profound bradycardia is respiratory compromise, hypoxia, and shock; thus, oxygenation and ventilation are the priorities. If the bradycardia persists, the next step would be to administer epinephrine or atropine as ordered. Hypothermia or toxic ingestion can cause bradycardia. Treating the underlying problem will relieve the bradycardia.

A child has a tracheal tube in place and will be receiving medications via this tube. Which medications would the nurse expect to be administered in this manner? Select all that apply. A) Lidocaine B) Adenosine C) Atropine D) Dopamine E) Epinephrine F) Naloxone

Ans: A, C, E, F Feedback: Medications that may be administered via a tracheal tube include lidocaine, epinephrine, atropine, and naloxone. Adenosine is given intravenously; dopamine is given intravenously or intraosseously.

The nurse identifies a nursing diagnosis of impaired social interaction related to altered social skills as evidenced by impulsivity and intrusive behavior. The nurse plans to identify factors that aggravate the child's behavior for which reason? A) Minimize stimuli that exacerbate the child's undesired behaviors. B) Improve the child's ability to deal with external stressors. C) Promote increased ability to follow through. D) Encourage the child to adopt expectations into his routine

Ans: A Feedback: The nurse identifies aggravating factors to help minimize stimuli that exacerbate the child's undesired behaviors. This must be accomplished first before any other interventions would be effective. Improving the child's ability to deal with external stressors is achieved by modifying the environment to decrease distracting stimuli. Actions such as speaking directly to the child and maintaining eye contact promote engagement and an increased ability to follow through. Providing positive feedback encourages the child to adopt expectations into his routine.

The nurse is caring for a child with bipolar disorder. The child is taking lithium as ordered. The parents inquire about the potential side effects. Which response by the nurse would be most appropriate? A) "You might see excessive urination and thirst, tremor, nausea, weight gain, and diarrhea." B) "He might experience a significant decrease in his appetite and difficulty sleeping." C) "You need to watch for dry mouth, urinary retention, and constipation." D) "This medication can cause seizures, agitation, headache, and nausea."

Ans: A Feedback: The nurse needs to explain that the potential side effects of lithium include polyuria, polydipsia, tremors, nausea, weight gain, and diarrhea. Decreased appetite and difficulty sleeping are associated with psychostimulants. Anticholinergic effects such as dry mouth, urinary retention, and constipation are often associated with tricyclic antidepressants as well as a-agonist antihypertensive agents such as clonidine. Seizures, agitation, headache, and nausea are associated with atypical antipsychotic agents.

The nurse is gathering the necessary equipment for tracheal intubation for a child who is 2 years old. Which tracheal tube size would the nurse obtain? A) 4.5 B) 5 C) 5.5 D) 6

Ans: A Feedback: To calculate tracheal tube size, divide the child's age by 4 and add 4. For a 2-year-old child, 2 divided by 4 equals 0.5 plus 4 equals 4.5. The nurse also should have one size smaller ready

When teaching a class about trisomy 21, the instructor would identify the cause of this disorder as: A) nondisjunction. B) X-linked recessive inheritance. C) genomic imprinting. D) autosomal dominant inheritance

Ans: A Feedback: Trisomy 21 is an example of a genetic disorder involving an abnormality in chromosomal number due to nondisjunction. X-linked recessive inheritance disorders, such as hemophilia and Duchenne muscular dystrophy, involve altered genes on the X chromosome. Genomic imprinting disorders, such as Prader-Willi syndrome, involve expression of only the maternal or paternal allele, with the other being inactive. Autosomal dominant inheritance disorders, such as neurofibromatosis and achondroplasia, involve a single gene in the heterozygous state that is capable of producing the phenotype, thus overshadowing the normal gene.

The nurse is preparing an educational program on behavioral management techniques used in children to help alter negative behavior. What information should the nurse include? Select all that apply. A) Set limits and hold the child responsible for their behavior. B) Do not argue, bargain or negotiate about the limits once established. C) Change caregivers occasionally so the child learns to respond to different people. D) Use a high-pitched voice and remain calm when speaking with the child. E) Ignore inappropriate behaviors.

Ans: A, B Feedback: Behavior management techniques include setting limits and holding the child responsible for his or her behavior. Not arguing, bargaining or negotiating about the limits once established. Inappropriate behaviors should be ignored. Provide consistent caregivers and establish a daily routine. Use a low-pitched, not high pitched voice and remain calm when speaking with the child.

The nurse is caring for a child who takes dextroamphetamine for treatment of ADHD. Which comments by the patient or family would concern the nurse? Select all that apply. A) "I take my sustained released capsule at night before I go to bed." B) "We have noticed that our child shows very little emotion over the last few weeks." C) "I haven't noticed any difference in my appetite." D) "Sometimes my head hurts a little for a short time after I take my medicine." E) "We notice our child gets a little irritable occasionally."

Ans: A, B Feedback: Psychostimulants, such as dextroamphetamine, should be taken in the morning in order to avoid difficulty sleeping. A flat affect is a sign of dosages that are too high. Decreased appetite, headache, and irritability are common side effects.

A nurse is preparing a teaching session for a group of parents with children newly diagnosed with attention deficit/hyperactivity disorder (ADHD). When explaining this disorder to the parents, what would the nurse include as being involved? Select all that apply. A) Impulsivity B) Inattention C) Distractibility D) Hyperactivity E) Defiance F) Anxiety

Ans: A, B, C, D Feedback: ADHD is characterized by inattention, impulsivity, distractibility, and hyperactivity. Anxiety disorder and oppositional defiant disorder may be comorbidities associated with ADHD.

A school nurse is working with the parents of an 8-year-old who has Tourette syndrome on how best to accommodate the child. What advice would be most helpful? Select all that apply. A) Allowing for breaks when tics occur B) Providing for "time-outs" during the day C) Using a tape recorder to take notes D) Ensuring a specified amount of time for test taking E) Implementing a reward system for behavior

Ans: A, C Feedback: Together the school nurse and parents should arrange for classroom accommodations such as allowing for "tic breaks," taking untimed tests or tests in another room, or using note takers or tape recorders. Time-outs and reward systems are more appropriate for the child with ADHD.

When the nurse is assessing a 2-day-old newborn and suspects Down syndrome, what factors would lead to this assessment? Select all that apply. A) Flat facial profile B) Downward slant to the eyes C) Large tongue compared to mouth D) Simian crease E) Epicanthal folds F) Rigid joints

Ans: A, C, D, E Feedback: Common clinical manifestations of Down syndrome include flat facial profile, upward slant to the eyes (oblique palpebral fissures), tongue that is large in comparison to the mouth size, simian, crease, epicanthal folds, and loose joints.

A group of students are reviewing information about respiratory arrest in children. The students demonstrate understanding of this information when they identify what common causes of respiratory arrest involving the upper airway? Select all that apply. A) Croup B) Asthma C) Pertussis D) Epiglottitis E) Pneumothorax

Ans: A, D Feedback: Common causes of respiratory arrest involving the upper airway include croup and epiglottitis. Asthma, pertussis, and pneumothorax are common causes involving the lower airway.

A 9-year-old girl who has fallen from a second-story window is brought to the emergency department. Which assessment would be the priority? A) Evaluating pupils for equality and reactivity B) Monitoring oxygen saturation levels C) Asking the child if she knows where she is D) Using the appropriate pain assessment scale

Ans: B Feedback: Airway is always the priority in any emergency situation. Therefore, monitoring oxygen saturation levels, part of the rapid cardiopulmonary assessment, would be performed before any of the other assessments. Evaluating pupils for equality and reactivity, asking the child if she knows where she is, and using an appropriate pain assessment scale are assessments that would follow the ABCs.

A nursing instructor is preparing a class discussion on the benefits and drawbacks associated with genetic advances and the Human Genome Project. What would the instructor address as a potential problem? A) Early detection possibilities B) Risk profiling C) Focus on causes D) Rapid diagnosis

Ans: B Feedback: Although current and potential applications of the Human Genome Project to health care are numerous, risk profiling presents a potential problem. Risk profiling based on an individual's unique genetic makeup can be used to tailor prevention, treatment, and ongoing management of health conditions, but it will raise issues associated with client privacy and confidentiality related to workplace discrimination and access to health insurance. Early detection possibilities, focus on causes, and rapid diagnosis are benefits to the information gained from the Human Genome Project.

The nurse is caring for a 7-year-old boy experiencing respiratory distress who is scheduled to have a chest radiograph. What would be most important for the nurse to include in the child's plan of care? A) Administering a sedative to help calm the child B) Assisting the child to lie still during the chest radiograph C) Accompanying the child to continue observation D) Informing the child that he might hear a loud banging noise

Ans: B Feedback: Chest radiographs that disclose alterations in normal anatomy or lung expansion, or evidence of pneumonia, tumor, or foreign body, are commonly performed for respiratory emergencies. Therefore, the nurse would need to assist the child in remaining still during the procedure. A sedative may be ordered for magnetic resonance imaging (MRI). Accompanying the child to continue observation would be necessary if the child was to undergo a computed tomography scan. Telling the child about a loud banging noise would be appropriate if the child was having an MRI

The nurse is teaching the parents of a 1-month-old girl with Down syndrome how to maintain good health for the child. Which instruction would the nurse be least likely to include? A) Getting cervical radiographs between 3 and 5 years of age B) Adhering to the special dietary needs of the child C) Getting an echocardiogram before 3 months of age D) Monitoring for symptoms of respiratory infection

Ans: B Feedback: Children with Down syndrome do not require a special diet unless underlying gastrointestinal disease is present. However, a balanced, high-fiber diet and regular exercise are important. Getting cervical radiographs between 3 and 5 years of age is the screening method for atlantoaxial instability, which is seen in about 14% of children with Down syndrome. Evaluation by a pediatric cardiologist before 3 months of age, including an echocardiogram, is important since children with Down syndrome are at higher risk for heart disease. The child will be more susceptible to infectious diseases.

A pregnant woman is to undergo testing to evaluate for chromosomal abnormalities. Which test would the nurse expect to be done the earliest? A) Amniocentesis B) Chorionic villi sampling C) Triple screen D) Fetal nuchal translucency

Ans: B Feedback: Chorionic villi sampling is performed at 7 to 11 weeks' gestation. Amniocentesis usually is performed after 15 weeks' gestation. A triple screen is usually done between 16 and 19 weeks' gestation. Fetal nuchal translucency must be performed between 11 and 14 weeks.

The nurse is providing care to a 4-year-old boy with a broken arm and an infected laceration from a fall. The nurse notes a significant elevation in the child's heart rate. Which intervention would be least appropriate? A) Administering antipyretics as ordered for fever B) Using a defibrillator to reduce the heart rate C) Administering analgesics to reduce pain D) Allowing the parents to comfort the child

Ans: B Feedback: Fever, fear, and pain are common explanations for significant increases in the heart rate of a child. This normal elevation in heart rate is known as sinus tachycardia and can be managed by treating the underlying causes. Antipyretics, analgesics, and comfort from the parents would be appropriate. However, defibrillation should be avoided.

The nurse is caring for an adolescent girl with anorexia nervosa. What findings would indicate to the nurse that the girl requires hospitalization? A) Weight gain of one-half pound per week B) Food refusal C) Body mass index of 18 D) Soft, sparse body hair and dry, sallow skin

Ans: B Feedback: Food refusal, severe weight loss, unstable vital signs, arrested pubertal development, and the need for enteral nutrition warrant hospitalization. Soft, sparse body hair and dry, sallow skin are signs of anorexia, but do not warrant hospitalization. A weight gain of one-half pound per week indicates progress toward therapeutic goals. A body mass index of 18 is on the low end of the normal range of body mass.

When teaching the parents of a child with phenylketonuria, the nurse would instruct them to include which food in the child's diet? A) Milk B) Oranges C) Meat D) Eggs

Ans: B Feedback: Foods that contain phenylalanine are to be avoided. These include milk, meat, and eggs. Foods such as oranges would be allowed.

What would lead the nurse to suspect that an adolescent has bulimia? A) Body mass index less than 17 B) Calluses on back of knuckles C) Nail pitting D) Bradycardia

Ans: B Feedback: The adolescent with bulimia would exhibit calluses on the back of the knuckles and split fingernails and would be of normal weight or slightly overweight. A body mass index of 17, nail pitting, and bradycardia would suggest anorexia.

The nurse is teaching a couple about X-linked disorders. They are concerned that they might pass on hemophilia to their children. What response by the couple indicates the need for further teaching? A) "The father can't be a carrier if he doesn't have hemophilia." B) "If the father doesn't have it, then his kids won't either." C) "If the mother is a carrier, her daughter could be one too." D) "If the mother is a carrier, her sons may have hemophilia."

Ans: B Feedback: Hemophilia is an X-linked recessive disorder. This means that both the father and the mother must have the gene for hemophilia to pass it on to their children. Also, their male children will have hemophilia, while their female children have only a 50% chance of having the disorder. If the father has hemophilia and the mother has hemophilia, their children will have the disease. If the father has hemophilia and the mother is a carrier, all their children have a 50% chance of getting the disease.

A child is brought to the emergency department with a suspected poisoning. What treatment would the nurse least likely expect to be used? A) Gastric lavage B) Syrup of ipecac C) Activated charcoal D) Whole bowel irrigation

Ans: B Feedback: Ipecac is rarely used in the health care setting to induce vomiting and is no longer recommended for use in the home setting. Gastric lavage, administration of activated charcoal (binds with the chemical substance in the bowel), or whole bowel irrigation with polyethylene glycol electrolyte solutions may be used.

A nurse is caring for a 5-year-old girl with depression. The girl is having difficulty coping with her feelings of sadness and fear, which stem from her parents' separation and recent divorce. The girl has been prescribed antidepressant medication but the mother thinks the girl would benefit from therapy. The nurse anticipates a referral to a therapist that specializes in: A) individual therapy. B) play therapy. C) behavioral therapy. D) hypnosis.

Ans: B Feedback: Play therapy is designed to change emotional status and encourages the child to act out feelings of sadness, fear, hostility, or anger. It is particularly beneficial for the younger child. Play therapy, rather than individual therapy, is recommended for the younger child. Hypnosis promotes deep relaxation, which is not the therapeutic goal for this child. Behavioral therapy is used to encourage appropriate behavior and would not address the girl's sadness.

The nurse working in a pediatric mental health clinic is assessing a 4-year-old child who has suffered from physical abuse. Which type of therapy does the nurse anticipate will be most helpful in developing a trusting relationship as well as assisting in determining the patient's current emotional state? A) Behavioral therapy B) Play therapy C) Cognitive behavioral therapy D) Family therapy

Ans: B Feedback: Play therapy will be most helpful, especially in the initial phase of assessment, because it encourages the child to act out feelings of sadness, fear, hostility, or anger.

A nurse has just transferred from an adult medical-surgical unit to a pediatric unit. When reviewing CPR skills, what it is important for the nurse to realize? A) The pediatric chain of survival and the adult chain of survival are the same B) Prevention of cardiac arrest and injuries is the first step in the chain of survival for children C) Integrated post-cardiac arrest care is not part of the chain of survival for children D) Early CPR should occur before any steps of the chain of survival are considered

Ans: B Feedback: Prevention of cardiac arrest and injuries is the first step in the chain of survival in children in contrast to early emergency medical system (EMS) activation in adults. Integrated post-cardiac arrest care is the last step in the chain for both adults and children. Early CPR is the second step in the chain for both adults and children.

When providing support and education to the family of a child who is diagnosed with a serious genetic abnormality, what would be the priority? A) Assisting with scheduling follow-up visits B) Establishing a trusting relationship C) Teaching the family what to expect D) Using measures to promote growth and development

Ans: B Feedback: Regardless of the genetic abnormality, learning of a genetic abnormality may be shattering to the family. Therefore, the initial priority is to establish a trusting relationship. Once this is accomplished, other aspects of care, such as assisting with scheduling follow-up visits, teaching, and implementing measures to promote growth and development, can be addressed.

The nurse is caring for a 5-year-old. The child's mother reports that he is extremely sensitive to sounds that most people do not notice and that he prefers complete silence. She explains that the boy is resisting going to school due to the noise and commotion. Additionally, the mother states that he will only wear 100% cotton clothing with all of the tags cut out. The nurse interprets these findings as indicating which disorder or condition? A) Anxiety disorder B) Sensory processing disorder C) Depression D) Obsessive-compulsive disorder

Ans: B Feedback: Sensory processing disorder (sensory integration dysfunction) results in overreaction to different textures and hypersensitivity or hyposensitivity to sensory input. The reported sensitivities to sound and clothing do not point to an anxiety disorder, depression, or obsessive-compulsive disorder.

What would lead the nurse to suspect that a 5-year-old child is experiencing supraventricular tachycardia? A) Heart rate 160 beats per minute B) Flattened P waves C) Normal QRS complex D) History of fever

Ans: B Feedback: Supraventricular tachycardia is manifested by flattened P waves, a heart rate greater than 180 beats per minute, a narrow QRS complex, and usually no significant history. A heart rate of 160 beats per minute, normal QRS complex, and history of fever, fluid loss, hypoxia, pain, or fear would suggest sinus tachycardia.

The nurse is providing care to a child who is intubated and the child's condition is deteriorating. What would the nurse do first? A) Check if the tracheal tube is obstructed B) Assess for displacement of the tracheal tube C) Look for signs of a possible pneumothorax D) Check the equipment for malfunction

Ans: B Feedback: The PALS mnemonic "DOPE" is useful for troubleshooting when the status of a child who is intubated deteriorates: D = Displacement: the tracheal tube is displaced from the trachea; O = Obstruction: the tracheal tube is obstructed (e.g., with a mucus plug); P = Pneumothorax: usually a pneumothorax results in a sudden change in the child's assessment manifested by decreased breath sounds and decreased chest expansion on the side of the pneumothorax, possible subcutaneous emphysema over the chest (with a tension pneumothorax, there may be a sudden drop in heart rate and blood pressure); E = Equipment failure: relatively simple problems such as a disconnected oxygen supply, leaks in the ventilator circuit, and loss of power can cause the child to deteriorate.

Two nurses are driving to work and have just come upon the scene of a motor vehicle accident (MVA) involving a child being hit by a car. The nurses decide to stop and find that only the child was injured. One of the nurses begins providing care. What is the first question the other nurse should ask the witnesses of the accident? A) "Can I get your name and numbers in case someone needs to contact you later?" B) "How did the accident happen?" C) "Do you know if the children have any health history I should know about?" D) "How long ago did someone activate the EMS?"

Ans: B Feedback: The first question should be asking how the accident occurred in order to get an idea of the types of injuries the children may have sustained. All other questions can be asked after establishing this information; however, asking names and numbers of the witnesses would be the last question asked by the nurse, and would most likely be asked by someone else.

When performing a physical examination on a small child, the nurse observes approximately 8 to 10 light-brown spots concentrated primarily on the trunk and extremities, two small lumps on the posterior trunk, and axillary freckling. What condition do these findings suggest? A) Klinefelter syndrome B) Neurofibromatosis C) Fragile X syndrome D) Sturge-Weber syndrome

Ans: B Feedback: The hallmark of neurofibromatosis is café-au-lait spots appearing all over the body, particularly the trunk and extremities. Additional findings include benign tumors, axillary freckling, and pigmented nevi. Klinefelter syndrome is associated with a lack of secondary sex characteristics, decreased facial hair, gynecomastia, decreased pubic hair, and hypogonadism. Fragile X syndrome is manifested by minor dysmorphic features and developmental delay. Sturge-Weber syndrome is associated with facial nevus, seizures, hemiparesis, and intracranial calcifications.

The nurse is teaching the mother of a 12-year-old boy about the risk factors associated with drug and alcohol abuse. Which response by the mother indicates a need for further teaching? A) "A family history of alcoholism is a risk factor for substance abuse." B) "Just because his friends are experimenting does not mean that he will." C) "If my husband or I have a substance abuse problem it could increase his risk." D) "Negative life events are a potential risk factor."

Ans: B Feedback: The nurse needs to emphasize that a peer group that abuses substances is a risk factor associated with substance abuse and increases the chances of a child experimenting. Other risk factors include a family history of substance abuse, current parental substance abuse, and negative life events.

The nurse is caring for a couple who have just learned that their infant has a genetic disorder. What would be least appropriate for the nurse to do at this time? A) Actively listening to the parents' concerns B) Teaching the parents about the child's medical needs C) Providing time for the parents to ask questions D) Offering suggestions for support services

Ans: B Feedback: The parents are most likely overwhelmed with learning the diagnosis and are dealing with a wide range of emotions and reactions. Therefore, it would be inappropriate at this time to attempt teaching them. Rather, the nurse would provide emotional support, actively listening to the parents, allowing time for questions, and offering suggestions for support to assist them in dealing with this new challenge. Teaching can be done at a later time.

A nurse is conducting a screening program for autism in infants and children. What would the nurse identify as a warning sign? A) Lack of babbling by 6 months B) Inability to say a single word by 16 months C) Lack of gestures by 8 months D) Inability to use two words by 18 months

Ans: B Feedback: Warning signs of autism include no babbling by 12 months, no pointing or using gestures by 12 months, no single words by 16 months, no two-word utterances by 24 months, and loss of language or social skills at any age.

A child is diagnosed with cri-du-chat syndrome. What findings would the nurse expect to assess? Select all answers that apply. A) Hypertonia B) Short stature C) Simian crease D) Wide and flat nasal bridge E) Hydrocephaly

Ans: B, C, D Feedback: Manifestations of cri-du-chat syndrome include hypotonia, short stature, microcephaly, moon-like round face, bilateral epicanthal folds, wide and flat nasal bridge, and simian crease

The pediatric nurse is conducting an information session for parents regarding genetic alterations in children. Which comments by the parents of a child with a cleft palate indicate learning occurred during the session? Select all that apply. A) "I can't believe that it is because of my genes that our child has this disorder." B) "Our child will need to be counseled when reaching adulthood since the risk for passing along the gene that causes cleft palate is increased." C) "While I'm not sure what they are, I know that environmental factors have likely played a role in our child's cleft palate." D) "I wish we had genetic testing before having children. We might have felt a little more prepared for the possibility of disorders in our children." E) "This makes it almost certain that if we have more children they will have cleft palate as well."

Ans: B, C, D Feedback: Many of the common congenital malformations, such as cleft palate, are attributed to multifactorial inheritance (a combination of genes from both parents, along with unknown environmental factors, produces the trait or condition). These disorders tend to have familial tendencies as well.

The nurse is teaching a CPR course for a group of nursing students. Which responses indicate an understanding of the content provided regarding the AED? Select all that apply. A) "When considering the use of the AED, the child must weigh at least 30 pounds (13.6 kg)." B) "An AED must only be employed if the collapse is witnessed." C) "To use the device the child must be at least 1 year of age." D) "The AED can be used only if the victim is demonstrates no heart rate." E) "The AED is safe for use prehospital."

Ans: B, C, D, E Feedback: An AED is an alternative to manually defibrillating an individual. The AED device consists of electrodes that are applied to the chest. These electrodes are used to monitor the heart rhythm and deliver the electrical current. AED devices are readily available in a variety of locations, such as airports, sports facilities, and businesses. Additionally, the AHA has recommended that an AED be used for children who are older than age 1 year who have no pulse and have suffered a sudden, witnessed collapse.

A nurse is reviewing the medical record of an 11-year-old child with a conduct disorder. What would the nurse identify as characteristics of this disorder? Select all answers that apply. A) Easily annoyed B) Initiator of physical fights C) Temper tantrums D) Truancy E) Arrest for arson

Ans: B, D, E Feedback: Behaviors associated with conduct disorder include initiation of physical fights, arson, and truancy. Becoming easily annoyed and experiencing temper tantrums are associated with oppositional defiant disorder.

After teaching a class about inborn errors of metabolism, the instructor determines that additional teaching is needed when the class identifies what as an example of an inborn error of metabolism? A) Galactosemia B) Maple syrup urine disease C) Achondroplasia D) Tay-Sachs disease

Ans: C Feedback: Achondroplasia is an autosomal dominant genetic disorder, not an inborn error of metabolism. Galactosemia, maple syrup urine disease, and Tay-Sachs are considered inborn errors of metabolism.

After teaching a group of nursing students about shock in children, the instructor determines that the teaching was successful when the students identify which type of shock as most common? A) Septic B) Cardiogenic C) Hypovolemic D) Distributive

Ans: C Feedback: Although septic, cardiogenic, hypovolemic, and distributive shock can occur in children, hypovolemic shock is the most common type of shock that occurs in children.

The nurse is caring for a 7-year-old with Tourette syndrome. The nurse would be alert for which comorbid condition? A) Depression B) Anxiety disorder C) Attention deficit/hyperactivity disorder D) Asperger syndrome

Ans: C Feedback: Attention deficit/hyperactivity disorder and obsessive-compulsive disorders occur in 50% of children with Tourette syndrome. Depression, anxiety disorder, and Asperger syndrome are not typical comorbid conditions associated with Tourette syndrome.

The nurse is speaking with a parent regarding their child's recent diagnosis of oppositional defiant disorder. Which statement by the parent would cause the nurse to question the diagnosis? A) "I am so tired of arguing with my daughter all the time." B) "My son purposely does exactly the opposite of what his father tells him to do." C) "I feel so bad that my daughter intentionally hurt the neighbor's cat." D) "My daughter gets so annoyed at me when she doesn't get her way."

Ans: C Feedback: Common behaviors in oppositional defiant disorder include excessive arguing with adults, active defiance, noncompliance with adult requests or limits and easily annoyed. Physical cruelty to animals or people is associated with conduct disorder, not oppositional defiant disorder.

The nurse is reviewing the medical record of a child who has dyspraxia. This child will experience difficulty with: A) reading and writing. B) mathematics and computation. C) manual dexterity and coordination. D) composition and spelling.

Ans: C Feedback: Dyspraxia refers to problems with manual dexterity and coordination. Dyslexia involves difficulty with reading, writing, and spelling. Dyscalculia involves problems with mathematics and computation. Dysgraphia involves difficulty producing the written word in composition, spelling, and writing.

A group of students are working on a presentation for a local health fair about safety for children. When developing this presentation, the students would address what cause as the most common in pediatric injury? A) Sports B) Firearm use C) Falls D) Automobile accidents

Ans: C Feedback: Falls are the most common cause of pediatric injury. Automobile accidents continue to cause deaths of about five children daily. Childhood trauma also results from pedestrian accidents, sporting and bicycle injuries, and firearm use.

A child with depression is prescribed fluoxetine. The nurse identifies this as belonging to which class of drugs? A) Atypical antidepressant B) Tricyclic antidepressant C) Selective serotonin reuptake inhibitor D) Psychostimulant

Ans: C Feedback: Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor. Trazodone is an atypical antidepressant; amitriptyline, desipramine, imipramine, and nortriptyline are tricyclic antidepressant. Methylphenidate and the amphetamines are psychostimulants.

As part of their orientation to their pediatric clinical rotation, an instructor is teaching a group of students how to perform cardiopulmonary resuscitation (CPR) on a child. Two students return demonstrate the skill using an infant manikin. What action indicates the proper technique? A) Compressing 30 times for every 2 breaths B) Placing the heel of the hand on the midsternum C) Giving 2 breaths followed by 15 compressions D) Using two hands to perform chest compressions

Ans: C Feedback: For two-person CPR on an infant, the rescuers would perform 15 compressions to 2 breaths, with two thumbs encircling the chest at the nipple line. The ratio of 30 compressions to 2 breaths is used for one-person CPR with an infant. The heel of the hand on the sternum at the nipple line is used for a child; two hands would be used for an older child.

The nurse is caring for a 1-month-old girl with low-set ears and severe hypotonia who was diagnosed with trisomy 18. Which nursing diagnosis would the nurse identify as most likely? A) Interrupted family process related to the child's diagnosis B) Deficient knowledge deficit related to the genetic disorder C) Grieving related to the child's poor prognosis D) Ineffective coping related to stress of providing care

Ans: C Feedback: Grieving related to the child's prognosis is a diagnosis specific to this child's care. The prognosis for trisomy 18 is that the child will not survive beyond the first year of life. Ineffective coping related to the stress of providing care, deficient knowledge related to the genetic disorder, and interrupted family process due to the child's diagnosis could be appropriate for any family of a child with a genetic disorder.

The nurse is assessing a 4-year-old boy whose mother was 40 years old when he was born. Which finding suggests this child has a genetic disorder? A) Inquiry determines the child had feeding problems. B) Observation shows nasal congestion and excess mucus. C) Inspection reveals low-set ears with lobe creases. D) Auscultation reveals the presence of wheezing.

Ans: C Feedback: Low-set ears are associated with numerous genetic dysmorphisms. Additionally, the mother's age during pregnancy is a risk factor for genetic disorders. Feeding problems could have been due to low birthweight, prematurity, or a variety of other reasons. The nasal congestion may be a cold. The wheezing could be bronchiolitis or asthma.

A 1-month-old infant admitted to the emergency department in respiratory distress exhibits a regular pattern of breathing followed by brief periods of apnea, then tachypnea for a short time, eventually returning to a normal respiratory rate. This type of breathing is: A) hypoventilation. B) hyperventilation. C) periodic breathing D) stridor.

Ans: C Feedback: Periodic breathing is regular breathing with occasional short pauses followed by rapid breathing for a short period, then eventually resumption of a normal respiratory rate. Hypoventilation refers to a decrease in the depth and rate of respirations. Hyperventilation refers to an increased depth and rate of respirations. Stridor refers to a high-pitched, easily audible inspiratory noise.

After teaching the parents of a child with attention deficit/hyperactivity disorder about ways to control the child's behavior, the nurse determines a need for additional teaching when the parents state: A) "If he starts to act out, we'll have him do a time-out to help him refocus." B) "We can use a reward system when he behaves appropriately." C) "If he misbehaves, we need to punish him instead of reward him." D) "We need to help him set realistic goals that he can achieve."

Ans: C Feedback: Punishment for misbehaving would be inappropriate because it would lead to negative feelings and further decrease self-esteem. Appropriate behavior management strategies include time-outs, positive reinforcement, reward or privilege withdrawal, or a token system. Setting realistic goals also is helpful to foster self-esteem and independence.

The nurse is caring for a 3-year-old boy. The parents are concerned that he is exhibiting signs of cognitive delays. Which statement by the parents would lead the nurse to suspect autism spectrum disorder rather than possible learning disability? A) "He is not speaking in complete sentences." B) "We can understand a lot of what he says, but no one else can." C) "He seems to be speaking words less and less frequently." D) "He is unable to sit still for a short story.

Ans: C Feedback: Reports of regression or the loss of previously acquired skills points to autism rather than intellectual disability. Not speaking in complete sentences, others not being able to understand what the child is saying, and an inability to sit still for a short story suggest a learning disability.

Which measure would be most appropriate for the nurse to do to ensure that a child's endotracheal (ET) tube is correctly positioned? A) Auscultate for abdominal breath sounds B) Mark the tracheal tube at the child's lip C) Watch for a yellow display on a CO2 monitor D) Inspect for water vapor in the tracheal tube

Ans: C Feedback: The best way to verify correct tracheal tube placement is to use a CO2 monitor. If the tube is properly placed, the monitor display will turn yellow with each exhalation. Auscultation for breath sounds and inspecting the tube for signs of water vapor are valid confirmations, but not as good as CO2 monitors. Marking the tube alerts the nurse if the tube becomes misplaced.

When caring for an 8-year-old boy injured in an automobile accident, the nurse demonstrates understanding of the principles of Pediatric Advanced Life Support (PALS) by which action? A) Assisting ventilation with a bag-valve-mask (BVM) device B) Treating ventricular fibrillation using a defibrillator C) Managing compensated shock to prevent decompensated shock D) Treating supraventricular tachycardia using cardioversion

Ans: C Feedback: The principles of PALS stress evaluating and managing compensated shock with the goal of preventing decompensated shock and thereby preventing cardiopulmonary arrest. Assisting ventilation with a BVM device, treating ventricular fibrillation using a defibrillator, and treating supraventricular tachycardia using cardioversion are interventions that may be used to treat both children and adults.

A nurse is caring for a 10-year-old boy with a nursing diagnosis of ineffective coping related to an inability to deal with stressors secondary to anxiety. What action should the nurse to take first? A) Set clear limits on the child's behavior B) Teach the child problem-solving skills C) Encourage a discussion of the child's thoughts and feelings D) Role model appropriate social and conversation skills

Ans: C Feedback: The priority action is to encourage the child to discuss his thoughts and feelings. This is the initial step toward learning to deal with them appropriately. Setting clear limits, teaching problem-solving skills, and role modeling skills would be appropriate as the child begins to learn how to acknowledge and deal with his feelings.

The nurse is assessing an infant and notes that the infant's urine has a mousy or musty odor. What would the nurse suspect? A) Maple syrup urine disease B) Tyrosinemia C) Phenylketonuria D) Trimethylaminuria

Ans: C Feedback: The urine of a child with phenylketonuria has a mousy or musty odor. For the child with maple syrup urine disease, excretions have a maple syrup odor. With tyrosinemia, excretions have a cabbage-like or rancid butter odor. With trimethylaminuria, excretions smell like rotting fish

A nurse determines that a child is exhibiting compensated supraventricular tachycardia (SVT). What action would be attempted first? A) Adenosine B) Synchronized cardioversion C) Vagal maneuvers D) Amiodarone

Ans: C Feedback: With compensated supraventricular tachycardia, vagal maneuvers are attempted first and then adenosine is used if vagal maneuvers fail. Adenosine or synchronized cardioversion is used to treat uncompensated SVT; synchronized cardioversion and IV amiodarone are used to treat ventricular tachycardia.

The nurse is caring for a couple who is having a triple screen done. The nurse would least likely expect what level to be tested? A) a-Fetoprotein B) Human chorionic gonadotropin C) Unconjugated estriol D) Testosterone

Ans: D Feedback: A triple screen tests a-fetoprotein (AFP), human chorionic gonadotropin (hCG), and unconjugated estriol (uE3). Testosterone is not included.

The nurse is teaching a couple about the pros and cons of genetic testing. Which statement best describes the capabilities of genetic testing? A) "Various genetic tests help the physician choose appropriate treatments." B) "Genetic testing helps couples avoid having children with fatal diseases." C) "Genetic tests identify people at high risk for preventable conditions." D) "Some genetic tests can give a probability for developing a disorder."

Ans: D Feedback: The fact that some tests only provide a probability for developing a disorder raises a problem. A serious limitation of these susceptibility tests is that some people who carry a disease-associated mutation never develop the disease. The other statements affirm the value of genetic tests.

When providing guidance to the parents of a child with Down syndrome, which interaction would be most appropriate? A) Encourage the parents to home-school the child. B) Advise the parents that the child will need monthly thyroid testing. C) Instruct them on the need for yearly dental visits. D) Teach the parents about the need for a high-fiber diet

Ans: D Feedback: A high-fiber intake is important for children with Down syndrome because their lack of muscle tone may decrease peristalsis, leading to constipation. Early intervention programs with special education are important to promote growth and development. The child should be integrated into mainstream education whenever possible. Children with Down syndrome should undergo thyroid testing yearly and see the dentist every 6 months.

The nurse is caring for a 9-year-old boy with achondroplasia. What will the nurse's assessment reveal? A) Narrow passages from the nose to the throat B) Slim stature, hypotonia, and a narrow face C) Craniosynostosis and a small nasopharynx D) Trident hand and persistent otitis media

Ans: D Feedback: Achondroplasia results in disordered growth with an average adult height of 4 feet for males or females. Other distinguishing symptoms are a separation between the middle and ring fingers, called trident hand, and persistent otitis media and middle ear dysfunction. Narrow passages from nose to throat are a symptom of CHARGE syndrome. Slim stature, hypotonia, and a narrow face are symptoms of Marfan syndrome. Craniosynostosis and a small nasopharynx are symptoms of Apert syndrome.

When assessing the adolescent with anorexia, what would the nurse expect to find? A) Tachycardia B) Hypertension C) Fever D) Sparse body hair

Ans: D Feedback: An adolescent with anorexia often exhibits a low body temperature; bradycardia; and hypotension; as well as soft, sparse body hair and thinning scalp hair.

Which intervention would be most helpful in preventing barotrauma when ventilating a 3-year-old girl with a bag-valve-mask? A) Choosing the correct size bag and face mask B) Setting the flow rate at exactly 10 L/minute C) Maintaining the airway in the open position D) Delivering one breath every 3 to 5 seconds

Ans: D Feedback: Barotrauma is often the result of physicians or nurse practitioners ventilating the child too rapidly using too much tidal volume. Therefore, delivering one breath every 3 to 5 seconds is the best way to prevent barotrauma. Choosing the correct size bag and face mask and setting the correct flow rate are important for effective ventilation, as is maintaining the airway in the open position. However, these actions would have little impact on preventing barotrauma.

The nurse is preparing a presentation to a local community group about genetic disorders and the types of congenital anomalies that can occur. What would the nurse include as a major congenital anomaly? A) Overlapping digits B) Polydactyly C) Umbilical hernia D) Cleft palate

Ans: D Feedback: Cleft palate is considered a major congenital anomaly, one that creates a significant medical problem or requires surgical or medical management. Overlapping digits, polydactyly, and umbilical hernia are considered minor congenital anomalies because they do not cause an increase in morbidity in and of themselves.

When reviewing the medical record of a child, what would the nurse interpret as the most sensitive indicator of intellectual disability? A) History of seizures B) Preterm birth C) Vision deficit D) Language delay

Ans: D Feedback: Due to the extent of cognition required to understand and produce speech, the most sensitive early indicator of intellectual disability is delayed language development. A history of seizures, preterm birth, and vision deficit may be associated with intellectual disability but are not the most sensitive indicators.

A child who weighs 53 lb is receiving fluid volume replacement as part of the treatment for shock. The nurse is evaluating the child's hourly urinary output to determine if the child's condition is improving. Which output would the nurse interpret as most indicative of improvement? A) 12 mL B) 15 mL C) 22 mL D) 30 mL

Ans: D Feedback: Improved urinary output of 1 to 2 mL/kg/hour is the goal. The child weighs 53 pounds, which is equivalent to 24 kg. Thus, improvement in this child would be noted by an hourly urinary output between 24 and 48 mL/hour.

The nurse is counseling a couple who suspect that they could bear a child with a genetic abnormality. What would be most important for the nurse to incorporate into the plan of care when working with this family? A) Gathering information from at least three generations B) Informing the family of the need for a wide range of information C) Maintaining the confidentiality of the information D) Presenting the information in a nondirective manner

Ans: D Feedback: It is essential to respect client autonomy and present information in a factual, nondirective manner. In these situations, the nurse needs to understand that the choice is the couple's to make. Gathering information for three generations obtains a broad overview of what has been seen in both sides of the family. Maintaining confidentiality of the information is as important as with any other client information gathered. Informing family of the need for information is necessary because of its personal nature.

A child with attention deficit/hyperactivity disorder is prescribed long-acting methylphenidate. What information would the nurse include when teaching the child and his parents about this drug? A) "Give the drug three times a day: morning, midday, and after school." B) "This drug may cause drowsiness, so be careful when doing things." C) "Some increase in appetite may occur, so watch how much you eat." D) "Take this drug every day in the morning when you wake up."

Ans: D Feedback: Long-acting methylphenidate is administered once daily in the morning, whereas the other forms are given three times a day. The drug typically causes difficulty sleeping and decreased appetite

What would be most appropriate to use to help maintain a patent airway in an infant experiencing a respiratory emergency? A) Neck hyperextension B) Head tilt-chin lift technique C) Jaw-thrust maneuver D) Small towel under shoulders

Ans: D Feedback: The infant will benefit from a small sheet or towel folded under the shoulders. This facilitates keeping the infant's airway in the sniff position as recommended by the American Heart Association's Basic Cardiac Life Support guidelines. Neck hyperextension and flexion should be avoided because these may occlude the airway. The head tilt-chin lift technique is appropriate to open the airway of a child older than age 1 year if a cervical spine injury is not suspected. The jaw-thrust maneuver is used if there is concern about the cervical spine.

The nurse is caring for a 6-year-old girl who was injured in a bicycle accident. Which question would be most important for the nurse to ask during the health history? A) "Has she been diagnosed with any chronic disorders?" B) "Is your daughter currently taking any medications?" C) "Is she allergic to any medications or drugs?" D) "Tell me how the bicycle accident happened."

Ans: D Feedback: The priority inquiry is to determine the nature of the emergency so that appropriate interventions may be initiated. This will also provide direction for obtaining more in-depth information as time permits. Information about allergic reactions to drugs, medications being taken, and chronic disorders that may affect treatment will be gathered next.

The nurse is preparing the plan of care for a child experiencing respiratory distress. What action would be the top priority? A) Providing supplemental oxygen B) Monitoring for changes in status C) Assisting ventilation D) Maintaining a patent airway

Ans: D Feedback: The priority when caring for any child with respiratory distress is to maintain a patent airway. Although providing supplemental oxygen, monitoring for changes in status, and assisting with ventilation are important, these measures would be futile if the child's airway was not patent.

A child is prescribed trazodone. What would the nurse be least likely to include in the plan of care related to this drug? A) Monitoring blood pressure for orthostatic hypotension B) Assessing the child for sedation and drowsiness C) Administering the drug with a snack D) Monitoring for tardive dyskinesia

Ans: D Feedback: Trazodone does not cause tardive dyskinesia; antipsychotics do. It can cause orthostatic hypotension, sedation, and drowsiness. It should be given after meals or with snacks to minimize gastrointestinal upset.