EXAM 2 PEDS NCLEX Q'S

The nurse is caring for a child with a partial-thickness burn. What assessment findings would the nurse expect to observe? Peeling skin with eschar Edema with dry or waxy-looking skin Reddened and leathery skin Edema with wet blistering skin

ANSWER Partial-thickness burns are very painful and edematous and have a wet appearance or the presence of blisters. Full-thickness burns appear red, edematous, leathery, dry, or waxy and may display red or charred skin (eschar).

An 8-year-old child requires wet dressings four times a day as treatment for a skin disorder. What would be most important for the nurse to do? Elevate the area after performing the dressing change. Ensure that the temperature of the solution is 120°F. Premedicate the child before changing the dressing. Leave the dressing uncovered to allow air circulation.

ANSWER Premedicating the child before changing the dressing is crucial to providing atraumatic care. Elevating the area may or may not be appropriate depending on the problem and its location. A temperature of 120°F is the recommended maximal hot water heater temperature. The solution for a wet dressing should be lukewarm, not as high as 120°F. After the wet dressing is applied, it should be covered with a large dry dressing pad.

The nurse is caring for a 2-year-old child with a burn. What finding would warrant referral to a burn unit? A first-degree burn on the upper arm A chemical burn A superficial burn on his hand A superficial burn on his chest

ANSWER B According to the American Burn Association, chemical burns warrant referral to a burn unit. A partial-thickness burn greater than 10% of the body surface area would warrant a referral to a burn unit. A superficial burn on the chest or hands does not warrant a referral to a burn unit. A first-degree burn would most likely be classified as a superficial burn, which would not warrant a referral to a burn unit.

The nurse is caring for a 10-year-old boy with diphtheria. What would the nurse institute as a tier 2 precaution? Use of a protective gown Use of a protective mask Negative air pressure ventilation Use of a protective face shield

ANSWER B Use of a protective mask if within 3 feet of the child is a tier 2 precaution with diphtheria, which is transmitted through contact with droplets. Use of a protective gown is a tier 2 precaution for contact transmission. Negative air pressure ventilation is a tier 2 precaution for airborne transmission. Face shields are part of tier 1 precautions against contaminated splashes.

After teaching a class to a group of nursing students about reporting infectious diseases to the Centers for Disease Control and Prevention, the instructor determines a need for additional discussion when the students identify which infection as being reportable: Lyme disease Pertussis Gonorrhea Pinworm

ANSWER D Pinworm infections are not required to be reported. Gonorrhea is a reportable infectious disease. Lyme disease is a reportable infectious disease. Pertussis is a reportable infectious disease.

The nurse is caring for a 15-year-old adolescent with psoriasis. In addition to the plaques, what would the nurse expect to note? Lichenification Hyperpigmentation Fever and malaise Fissures and scaling on palms and soles

ANSWER D Rationale:Fissures and scaling on the palms and soles are common findings with psoriasis. Fever and malaise, lichenification, and hyperpigmentation are noted with other integumentary disorders but are not typical physical findings with psoriasis.

A 14-year-old child is diagnosed with tinea versicolor. What would the nurse expect the nurse practitioner to order? Oral griseofulvin Topical nystatin Diphenhydramine Selenium sulfide

ANSWER D Selenium sulfide is used to treat tinea versicolor. Topical nystatin is used to treat monilial diaper rash. Griseofulvin is used to treat tinea capitis. Diphenhydramine is an antihistamine used to treat hypersensitivity reactions, atopic dermatitis, or contact dermatitis that is highly pruritic.

The nurse is caring for a child with a suspected fungal infection. Which test would the nurse anticipate being ordered? Erythrocyte sedimentation rate (ESR) Potassium hydroxide (KOH) prep Culture of wound/drainage Patch or skin testing

ANSWER Potassium hydroxide (KOH) prep is indicated for identifying a fungal infection. Patch or skin testing is indicated for evaluation of atopic or contact dermatitis. ESR is a nonspecific test used to determine the presence of infection or inflammation. Culture of wound/drainage is used to identify the specific organism.

A group of nursing students are reviewing information about atopic dermatitis. Which answers indicate that the students understand the information? (Select all that apply.) The reaction occurs in response to specific allergens. Scratching initiates the reaction, which then becomes pruritic. Excessively humid environments often lessen the severity of the reaction. Changes in temperature can contribute to flare-ups. The disorder is chronic with periods of remissions.

ANSWER Rationale:Atopic dermatitis is a chronic disorder with a relapsing and remitting nature. The skin reaction occurs in response to specific allergens, usually foods, or environmental triggers. Changes in ambient temperature can contribute to flare-ups. Excessively humid or dry environments can cause the condition to worsen. When a trigger occurs, antigen-presenting cells stimulate interleukins to begin the inflammatory process. The skin begins to feel pruritic and then the child starts to scratch. Itchiness occurs first and then the rash appears.

What would the nurse include in the teaching plan for parents and their child with a pruritic rash? Select all that apply. Keeping fingernails trimmed short Encouraging pressure on the skin rather than scratching Using warm baths to soothe the skin Making sure the child's hands are clean Using distraction to prevent scratching

ANSWER To reduce pruritus, teaching would include keeping the child's nails trimmed short, using distraction to prevent scratching, using pressure on the skin rather than scratching, and making sure the child's hands are clean. Cool baths and compresses would help relieve itching.

The nurse is caring for a 7-year-old child with burns. Which finding would be highly suggestive that the burn is a result of child abuse? Stocking--glove pattern on hands or feet Splash patterns Spattering pattern Nonuniform pattern

ANSWER A A stocking--glove pattern on the hands or feet or a circumferential ring appearing around the extremity points to the caregiver forcefully holding the child under extremely hot water. A nonuniform pattern and splash or spattering patterns are not typical indicators of child abuse.

A topical corticosteroid is prescribed for a child with contact dermatitis. Which statement by the parent would indicate the teaching was successful? "I should not cover the area with plastic wrap after applying the cream." "I need to shake the preparation before using it." "I should apply the medicine at bedtime and rinse it off in the morning." "I should use the highest-potency steroid cream I can find."

ANSWER A An occlusive dressing such as plastic wrap over the area should not be used with topical corticosteroids. High-potency preparations should not be used. There is no need to shake topical corticosteroids. Benzoyl peroxide requires shaking before use. Applying the medication at night and rinsing off in the morning is used for coal tar preparations.

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

ANSWER A Cola contains caffeine, which is an associated trigger. Intense activity, not regular exercise, may be a trigger. Odors, such as strong perfumes, may be a trigger. Changes in sleeping patterns may be a trigger.

While assessing a child, the nurse notes a runny nose, temperature 100.4°F (38°C), and a whoop sound when the child coughs. On which diagnosis will the nurse anticipate providing education for this family? Correct optionPertussis Unanswered optionInfluenza Unanswered optionNasopharyngitis Unanswered optionTuberculosis

ANSWER A Pertussis, also known as whooping cough, begins as an upper respiratory illness and progresses to a persistent cough characterized by a whooping sound. Tuberculosis, influenza, and nasopharyngitis are not characterized by a whooping sound.

The mother brings her neonate to the emergency department and states, "My baby just doesn't look right. I know something is wrong." Based on an assessment, the nurse suspects the neonate is experiencing sepsis. Which finding in the client's medical record will help to confirm this diagnosis? Maternal membranes ruptured 20 hours before birth. Client's current heart rate is 155 beats per minute. Client born at 41-weeks gestation. White blood cell count is 9,000/μL (9x109/L)

ANSWER A Prolonged or premature rupture of membranes increases a neonate's risk for sepsis and would support the nurse's suspicion of sepsis. A heart rate of 110-160 beats per minute is within normal range for a neonate. Tachycardia, tachypnea or difficulty breathing, and hypotension are expected symptoms of sepsis. The client's gestation age at birth is not related to the development of sepsis. A white blood cell (WBC) count of 9,000/μL (9x109/L) is within normal range for a neonate. Neonates can have higher WBC count, up to 30,000/μL (30x109/L) initially following birth. The neonate's count will decrease to the expected adult range of 5,000/μL (5x109/L) to 10,000/μL (10x109/L) about 2 weeks after birth.

A mother has brought her 5-month-old son to the clinic because he has been drowsy and unresponsive. The child has hydrocephalus and had a shunt placed about a month previously. Which symptom indicates that the shunt is infected? The child is not responding or eating well. The fontanels are bulging or tense. The child's pupil reaction time is rapid and uneven. The child has a high-pitched cry.

ANSWER A Rationale:Poor feeding and decreased responsiveness are signs of an infection. The nurse might also observe localized inflammation along the shunt tract. Bulging or tense fontanels suggest a shunt malfunction that is causing increased intracranial pressure. A high-pitched cry suggests increased intracranial pressure due to a shunt malfunction. Decreased and uneven pupil reaction times are symptoms of a shunt malfunction that is causing increased intracranial pressure.

While observing a child, the nurse notes that the child's arms and legs are extended and pronated. During shift hand-off, the nurse reports potential damage to: the midbrain. the cerebral cortex. the meninges. the cranial nerves.

ANSWER A The observations indicate decerebrate posturing, which occurs with damage to the midbrain. Decorticate posturing as evidenced by arm adduction, elbow flexion with arms over the chest, and wrist flexion with fisted hands indicates damage to the cerebral cortex. Damage to the cranial nerves would be manifested by defects in motor and/or sensory function, depending on the cranial nerves affected. Meningeal irritation, as with bacterial meningitis, is manifested by opisthotonos in an infant. With this position, the head and neck are hyperextended to relieve discomfort.

The nurse is collecting data from a 14-year-old adolescent and parent who have come to the clinic for a check-up. The parent reports that the adolescent has had hives intermittently for the past 2 months. What is the priority action for this client? Determine the underlying cause. Discuss home remedies to manage the skin condition. Encourage the parent to purchase over-the-counter topical ointments to keep on hand in the event of another episode. Encourage the family to speak to the health care provider about prescribing topical steroids.

ANSWER A Urticaria, commonly called hives, is a type I hypersensitivity reaction caused by an immunologically mediated antigen--antibody response of histamine release from mast cells. Urticaria usually begins rapidly and may disappear in a few days or may take up to 6 to 8 weeks to resolve. The most common causes of this reaction are foods, drugs, animal stings, infections, environmental stimuli (e.g., heat, cold, sun, tight clothes), and stress. The priority is to determine the underlying cause. Over-the-counter topical agents, prescription strength medications, and home remedies may be discussed and employed but are not of greatest importance.

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

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

What finding is consistent with increased intracranial pressure (ICP) in an infant? Bulging fontanel (fontanelle) Increased appetite Narcolepsy Emotional lability

ANSWER A What finding is consistent with increased intracranial pressure (ICP) in an infant? Bulging fontanel (fontanelle) Increased appetite Narcolepsy Emotional lability

When assessing a neonate for seizures, what would the nurse expect to find? Select all that apply. Jitteriness Ocular deviation Tachycardia Elevated blood pressure Tonic-clonic contractions

ANSWER A-B-C-D Neonatal seizures may be difficult to recognize but may be manifested by tremors, jitteriness, tachycardia and elevated blood pressure, and ocular deviation. Tonic-clonic contractions typically are more common in older children.

The nurse is preparing to provide education on the prevention of infection to parents of children. Which intervention(s) will the nurse include? Select all that apply. Limiting exposure to sick persons Judicious antibiotic use Proper handling and preparation of foods Vaccination administration Proper handwashing

ANSWER A-B-C-D-E Interventions to limit the spread of infections and diseases include: proper handwashing, appropriate antibiotic use (take prescribed amount), follow the recommended vaccination schedule, limiting exposure to known sick persons, and proper handling and consumption of foods. The nurse would include all choices in the teaching.

A nurse is working as part of a response team caring for children who have been involved in an elementary school fire. Which children would the nurse identify as needing a referral to a burn unit? (Select all that apply.) 9-year-old with asthma and burns to the face 6-year-old with burns involving the knees and hips 7-year-old with superficial burns over 5% of the body 8-year-old with an inhalation injury 10-year-old with partial-thickness burns over 15% of the body

ANSWER A-B-D-E Rationale:Referral to a burn unit should occur for children with inhalation injuries, burns that involve the face, the hands and feet, genitalia, perineum, or major joints; partial-thickness burns greater than 10% of total-body surface; burns and pre-existing conditions that might affect the care (such as asthma), or burns and traumatic injuries such as rib fractures. Superficial burns over 5% of the body are not a criterion for referring a child to a burn unit.

The nurse is caring for a child who was injured in a bike accident. The nurse determines that a child is experiencing late signs of increased intracranial pressure based on which assessment findings? Select all that apply. Fixed dilated pupils Bradycardia Increased blood pressure Sunset eyes Irregular respirations

ANSWER A-B-E Late signs of increased intracranial pressure include bradycardia, fixed and dilated pupils, and irregular respirations. Increased blood pressure and sunset eyes are early signs of increased intracranial pressure.

A nurse is providing care to a child with status epilepticus. Which medications would the nurse identify as appropriate for administration? Select all that apply. Fosphenytoin Diazepam Carbamazepine Gabapentin Lorazepam

ANSWER A-B-E Commonly used medications for treating status epilepticus include lorazepam, diazepam, and fosphenytoin. Gabapentin and carbamazepine are anticonvulsants used to treat and prevent seizures in general.

The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. What would the nurse assess? Select all that apply. Eye opening Posture Motor response Verbal response Fontanels

ANSWER A-C-D The pediatric Glasgow Coma Scale assesses level of consciousness using three parts: eye opening, verbal response, and motor response.

The nurse is caring for a 3-year-old child who experienced a febrile seizure for the first time. What statements by the parents of the child should the nurse address further? Select all that apply. "I am afraid that our 10-year-old will start having febrile seizures." "We have never had anyone in our family have a febrile seizure so I was so surprised when this happened." "I am thankful that our child won't have to be on anti-seizure medication." "It is so scary to think that our child will likely develop epilepsy now." "It's important to manage fevers in the future in order to decrease the risk of febrile seizures."

ANSWER A-D It is very unlikely that the parents' 10-year-old child will develop febrile seizures. Febrile seizures usually affect children who are younger than 5 years of age, with the peak incidence occurring in children between 12 and 18 months old; it is rare to see febrile seizures in children younger than 6 months and older than 5 years of age. Children who experience one or more simple febrile seizures have a slightly greater risk of developing epilepsy than the general population, so it is not "likely" that the child will develop epilepsy.

A child is hospitalized and diagnosed with bacterial meningitis. What can the nurse anticipate will be included in the plan of care and treatment? Select all that apply. Administering tepid baths as needed Antiviral medications Ice packs to the back of the neck and feet to reduce body temperature Acetaminophen Antibiotic therapy

ANSWER A-D-E Bacterial meningitis involves a multifaceted plan of care and treatment. Ice packs will sharply reduce temperature and should not be used. Measures that promote shivering should be avoided as they will increase the metabolic rate. Acetaminophen will be prescribed in effort to reduce the body temperature. Tepid baths can be instituted as needed to reduce body temperature. Antibiotic therapy will be initiated to eradicate the pathogens. Antiviral medications are not indicated as this is not a viral infection.

A nurse is providing information to the parents of a child diagnosed with absence seizures. What information would the nurse expect to include when describing this type of seizure? Select all that apply. This type of seizure is usually short, lasting for no more than 30 seconds. Your child will probably sleep deeply for ½ to 2 hours after the seizure. The child will commonly report a strange odor or sensation before the seizure. This type of seizure is more common in girls than it is in boys. You might see a blank facial expression after a sudden stoppage of speech. You might have mistaken this type of seizure for lack of attention.

ANSWER A-D-E-F Absence seizures are more common in girls than boys and are characterized by a sudden cessation of motor activity or speech with a blank facial expression or rhythmic twitching of the mouth or blinking of the eyelids. This type of seizure lasts less than 30 seconds and may have been mistaken for inattentiveness because of the subtle changes. Absence seizures are not associated with a postictal state.

A child is brought to the clinic with fever, cough, and coryza. The nurse inspects the child's mouth and observes what look like tiny grains of white sand with red rings. How would the nurse document these findings? Lymphadenopathy Koplik spots Slapped cheek appearance Nits

ANSWER B Koplik spots are bright red spots with blue-white centers appearing primarily on the buccal mucosa and indicate rubeola (measles). They are often described as tiny grains of white sand surrounded by red rings. Lymphadenopathy is used to document enlargement of the lymph nodes. Slapped cheek appearance refers to the erythematous flushing associated with fifth disease. Nits refer to the adult eggs of pediculosis.

A 6-year-old child is diagnosed with tinea capitis and treatment is initiated. The nurse instructs the parents to have the child return to school within which time frame? 72 hours 1 week 24 hours 5 days

ANSWER B Once treatment is initiated for tinea capitis, the child can return to school or day care after 1 week.

The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem? Intracranial hemorrhaging Head trauma Positional plagiocephaly Congenital hydrocephalus

ANSWER B Rationale:A larger head size in relation to the rest of their body size gives young children a higher center of gravity, which causes them to hit their head more readily, thus placing them at risk for head trauma. Fragile capillaries in the periventricular area of the brain put preterm infants at risk for intracranial hemorrhage. Congenital hydrocephalus may be caused by abnormal intrauterine development or infection. Positional plagiocephaly is caused by an infant's head remaining in the same position for too long.

The nurse is caring for a child, weighing 100 lb (45.5 kg), on the burn unit who has partial-thickness burns on over 30% of the body. During the beginning shift assessment, which assessment finding is of most concern to the nurse? Refused dinner due to nausea Urine output of 15 mL per hour over the last 4 hours Weight gain of 0.9 kg over the last 2 days Pain at a 7 on a 0 to 10 scale

ANSWER B Rationale:Fluid and electrolyte imbalance is a primary concern when caring for the client with burns. The urine output should be a minimum of 1 mL/kg/hour. The client weighs 45.5 kg, so output should equal approximately 45 mL/hour. Pain is a major concern, but the higher priority at this time is the decreased output. Refusal of one meal is not a higher priority. Weight gain of 0.9 kg over 2 days is not a concern at this time.

The nursing diagnosis of risk for infection related to a disruption in the protective skin barrier is noted on a child's plan of care. Which action would be of priority importance? Assessing temperature every 4 hours Using appropriate hand hygiene Obtaining a culture of the impaired skin area Urging adequate nutritional intake

ANSWER B Rationale:Hand hygiene would be the priority because the child's risk for infection is increased and hand hygiene is crucial to preventing the transmission of infectious organisms. Monitoring the child's temperature is important to evaluate for possible fever and infection, but this would not be the most important action. Although nutritional status can influence wound healing, urging adequate nutritional intake would not be the most important action. Although obtaining a culture provides information about the cause of an infection, the child is at risk for infection, so a culture would not provide any information about the risk.

The parents of a 4-month-old diagnosed with sepsis tell the nurse that the physician explained sepsis to them but they don't really understand it. The parents state, "Could you please explain it to us?" What is the best response by the nurse? "Sepsis results in systemic inflammatory response syndrome (SIRS) due to infection." "The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys." "The pathogens cause an overproduction of proinflammatory cytokines. These cytokines are responsible for the clinically observable effects of the sepsis." "The pathophysiology of sepsis is complex."

ANSWER B Rationale:Keeping the answer to what sepsis is will help the parents understand the pathophysiology. While all answers are correct, the response: "The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys" provides the most understandable explanation and addresses the parent's question.

A 9-month-old child has been admitted to rule out sepsis. Which finding offers the most support to the presence of this disorder? The child's birth history indicates he was born at 42 weeks' gestation. The child has had 8 ounces of formula in the past 24 hours. The child cries when his mother is not in sight. The child has had 7 wet diapers in the past 24 hours.

ANSWER B Sepsis is a systemic overresponse to infection resulting from bacteria and viruses, which are the most common fungi, viruses, rickettsia, or parasites. It can lead to septic shock, which results in hypotension, low blood flow, and multisystem organ failure. Signs of sepsis include a lack of appetite, lethargy, hypotonia, and temperature elevations.

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

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

The nurse is taking a health history of a 6-year-old child with suspected Stevens--Johnson syndrome. During the physical examination, the nurse would expect to note which physical findings? Fiery red lesions, scaling in the skin folds, and satellite lesions Erythema multiforme with inflammatory bullae of at least two types of mucosa Red, raised hair follicles Red macules and bullous eruptions on an erythematous base

ANSWER B Stevens--Johnson syndrome rash involves erythema multiforme with the addition of inflammatory bullae of at least two types of mucosa. Fiery red lesions, scaling in the skin folds, and satellite lesions are associated with diaper candidiasis. Red macules and bullous eruptions on an erythematous base are common skin findings for bullous impetigo. Red, raised hair follicles are indicative of folliculitis.

The nursing is caring for a hospitalized child diagnosed with varicella-zoster virus. The child's parents ask how to prevent the child's siblings from contracting the virus. Which response by the nurse is best? "Vaccinating your other children is the only way to prevent them from contracting the virus." "We will place your child on contact and airborne precautions. It is best for the other children not to visit." "Since this is a virus, there is not anything you can do to prevent your other children from getting it." "As long as your other children wash their hands, they should not contract the virus."

ANSWER B The causative agent for chickenpox is the varicella-zoster virus, which is spread through contact and airborne methods. The client should be placed on precautions and limit visitors who are at risk. Vaccinating is the best way to prevent the spread of varicella; however, it is not the only way. Preventing exposure will work as well. Stating there is not anything that can be done is incorrect and handwashing is not effective against varicella.

The nurse at the pediatrician's office receives a call from the mother of a child who has just been bitten by the neighbor's dog. What action would be the priority? Explain how to educate the child about animals. Tell the mother to seek medical help immediately. Describe methods of managing a fever. Explain how to care for the dog bite.

ANSWER B The mother should seek medical help for her child immediately. Once the child has been seen by a physician, it can be determined whether immunoprophylaxis is necessary. Education about animals is important to prevent any recurrent bites, but this is appropriate only after the child has been seen and a plan has been determined. Flu-like symptoms such as fever occur early in rabies infection. However, the child must be seen first. Explaining how to care for the bite would be done only after the child is seen and an appropriate plan is determined.

The nurse is caring for a child with urticaria. What is the priority action? Obtaining a detailed history of new foods, medications, stress, or changes in environment Assessing the child's airway and breathing and noting any wheezing or stridor Noting whether hives are pruritic, blanch when pressed, or are migrating Inspecting the skin, noting evidence of raised, edematous hives anywhere on the body

ANSWER B Urticaria is a type I hypersensitivity reaction. Therefore, the priority nursing assessment is to carefully assess airway and breathing, as hypersensitivity reactions may affect respiratory status. A detailed history, skin inspection, and evaluation of the hives are other appropriate assessments, but determining respiratory status is the priority.

A nursing instructor is preparing a class discussion about pediatric skin variations, specifically related to differences in dark-skinned children. What information would the nurse most likely include? (Select all that apply.) Keloid formation occurs less often in dark-skinned children. Hypopigmentation often occurs after a skin condition heals. Papules often appear more prominent on the skin. Vesicles appear less visible in most dark-skinned children. Hypertrophic scarring is a common occurrence in dark-skinned children.

ANSWER B-C-E Rationale:Dark-skinned children often experience hypo- or hyperpigmentation of an affected area following healing of a dermatologic condition. Papules, follicular responses, lichenification, and vesicular or bullous reactions are more prominent and keloid formation occurs more often.

A nurse is preparing a presentation for a local mothers' group about common viral infections associated with a rash during childhood. When describing rubella, what information would the nurse include? Select all that apply. The rash typically begins on the trunk and spreads to the face. Incubation period usually ranges from 16 to 18 days. The disease most often occurs during late summer and early fall. The infection is communicable for a week before to a week after the rash appears. Any itching with the rash is usually mild.

ANSWER B-D-E Rubella has an incubation period ranging from 12 to 23 days, but usually 14 days. It is communicable for 7 days before the rash to 7 days after the onset of the rash. Itching is usually mild. It occurs most commonly during late winter and early spring and the rash typically begins on the face and spreads down the neck, trunk, and extremities.

The nurse is caring for a 7-year-old child in droplet precautions due to the diagnosis of pertussis. While visiting the child, which actions by the parents require the nurse to intervene? Select all that apply. The parents state, "We will be sure to finish any antibiotic if our child is sent home with a prescription." The parents state, "We have been limiting our child's fluids to help decrease the amount of coughing." The parents remove their personal protective equipment (PPE) at the door before exiting, then wash their hands. The parents wear a respiratory mask when entering their child's room. The parents state, "We should postpone immunizing our 5-year-old since there has been contact with the infection."

ANSWER B-E All close contacts who are younger than 7 years of age and who are unimmunized or underimmunized should have pertussis immunization initiated or the series completed according to the recommended dosing schedule. Fluids should be increased in order to help thin secretions and prevent dehydration during the infection. The parents are correct in removing their PPE at the door and washing their hands when leaving the room, and wearing a mask. All antibiotics should be finished in order to treat the infection adequately and prevent immunity to antibiotics.

The nurse is performing a physical examination for a 7-year-old girl who was bitten by a tick. What would alert the nurse to the possibility of early localized Lyme disease? Recurrent arthritis in the large joints Multiple erythema migrans on the skin Bull's-eye rash around the bite Cranial nerve palsies

ANSWER C A bull's-eye rash (ring-like rash) around the bite is typical of early localized Lyme disease. Multiple erythema migrans on the skin occurs during early disseminated disease. Cranial nerve palsies are indicative of early disseminated disease. Recurrent arthritis in the large joints occurs in the late stage of the disease.

During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which sign or symptom was observed? Posterior fontanel (fontanelle) is closed Pupil of one eye dilated and reactive Dramatic increase in head circumference Vertical nystagmus

ANSWER C A dramatic increase in head circumference is a symptom of hydrocephalus, suggesting that there is a build-up of fluid in the brain. Only one pupil that is dilated and reactive is a sign of an intracranial mass. Vertical nystagmus indicates brain stem dysfunction. A closed posterior fontanel (fontanelle) would be frequently seen by this age.

A child who developed parotid gland swelling on March 5 was diagnosed with mumps. The nurse determines that the child will no longer be contagious at which time? Unanswered optionMarch 8 Unanswered optionMarch 12 Correct optionMarch 14 Unanswered optionMarch 19

ANSWER C Children with mumps are no longer considered contagious 9 days following the onset of parotid swelling.

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

ANSWER C Decreased LOC is frequently the first sign of a major neurologic problems after a head trauma. The nurse would assess the client's LOC before notifying the health care provider. The child may need to be placed on fall precaution, depending on the results of the assessment. The child's eyes will correct themselves when the ICP is reduced; therefore, an eye patch is not necessary.

A child has been brought to the pediatric clinic. The assessment reveals the child has a temperature of 100.9°F (38.3°C), as well as a rash that is pink and has raised areas. When the area is palpated the skin blanches. Which disease is most associated with these findings? Varicella zoster Rubeola Exanthem subitum Rubella

ANSWER C Exanthem subitum or 6th disease is a member of the herpes viruses. It presents with a pinkish rash that may be flat or raised. The rash area blanches when palpated. A maculopapular rash that begins on face and spreads head to foot is consistent with rubella. Rubeola presents with bright red spots with blue white centers on mucous membranes, mainly on the buccal mucosa. It looks like tiny grains of white sand surrounded by red ring. Varicella zoster presents with erythematous macules that evolve to papules and then form clear, fluid-filled vesicles.

A child has been diagnosed with hookworm. The nurse is teaching the parent about the treatment for the condition. Which statement, made by the parent, confirms that further education is needed? "I should have my child eat more foods with iron." "The medications should be taken for 2 weeks." "My child can play outside bare footed when treatment is done." "I should have my other children tested."

ANSWER C Hookworms are found in soil, especially in areas with warmer climates. They enter the body through the skin, pores and hair follicles. The treatment is with the drug albendazole. The duration is from 7 to 14 days of treatment. Most importantly, besides medication, good handwashing and sanitation practices are needed. Children should wear shoes and not go barefoot outside since the worms can enter through the soles of the feet. The worms attach themselves to the walls of the small intestine where they feed and reproduce. This can cause anemia. The child's diet should include foods high in iron or iron supplements. All children who are suspected or at high risk should be evaluated for hookworms.

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

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

A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which intervention should the nurse take initially? Palpate the child's fontanels (fontanelles). Encourage the mother to hold and comfort the infant. Institute droplet precautions in addition to standard precautions. Educate the family about preventing bacterial meningitis.

ANSWER C Rationale:Bacterial meningitis is a medical emergency. The child must be placed on droplet precautions until 24 hours of antibiotics have been given. Encouraging the mother to hold and comfort the child is an intervention but not the priority one; the focus is to get the infant the appropriate medications to fight the infection and to prevent its spread. Educating the family about preventing bacterial meningitis would be appropriate later once the initial infection has been controlled. Palpating the fontanels (fontanelles) is used to assess for hydrocephalus.

The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures? Treating the child as though she did not have epilepsy Instructing her teacher how to respond to a seizure Understanding the side effects of medications Placing the child on her side on the floor

ANSWER C Rationale:The most common cause of breakthrough seizures is noncompliance with medication administration, which may occur if the parents do not understand what side effects to expect or how to deal with them. Treating the child as though she did not have epilepsy helps improve her self-image and self-esteem. Placing the child on her side on the floor is an intervention to prevent injury during a seizure. Instructing the teacher on how to respond when a seizure occurs will help relieve anxiety and provide a sense of control.

The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided? Antiviral medications can be prescribed. Antibiotic therapy may be initiated. Encourage rest and relaxation. Range of motion to prevent contractures.

ANSWER C Rubella infection is usually mild and self-limited. The care given is normally supportive. Rest is encouraged. Medications administered are normally limited to anti-pyretics and analgesics. Antibiotic and antiviral therapies are not normally included in the plan of treatment. Range of motion is not needed as mobility of the client is not limited.

A 6-year-old child is brought to the clinic by his parents. The parents state, "He had a sore throat for a couple of days and now his temperature is over 102°F (38.9°C). He has this rash on his face and chest that looks like sunburn but feels really rough." What would the nurse suspect? Diphtheria Pertussis Scarlet fever Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA)

ANSWER C Scarlet fever typically is associated with a sore throat, fever greater than 101° F (38.9° C), and the characteristic rash on the face, trunk, and extremities that looks like sunburn but feels like sandpaper. CAMRSA is typically manifested by skin and tissue infections. Diphtheria is characterized by a sore throat and difficulty swallowing but fever is usually below 102°F (38.9°C). Airway obstruction is apparent. Pertussis is characterized by cough and cold symptoms that progress to paroxysmal coughing spells along with copious secretions.

The nurse is teaching a group of parents about head lice. Which statement is essential to include during the presentation? Wash the bed linens in hot water to kill the lice. Discourage the child from going to sleepovers. Head lice are becoming very resistant to treatment. If you suspect head lice, have the school nurse check the child.

ANSWER C The accurate advice is that head lice are becoming resistant to treatment. Children with head lice do not need to stay home, but parents should follow school policies regarding whether children are allowed in school until they are nit-free. Children should be allowed to participate in sleepovers, preferably bringing their own pillows. Head lice do not survive long once they have fallen off. Most children can be treated effectively without treating their bedding and clothing.

The nurse is performing a physical examination for a 7-year-old girl who was bitten by a tick. What would alert the nurse to the possibility of early localized Lyme disease? Multiple erythema migrans on the skin Recurrent arthritis in the large joints Cranial nerve palsies Bull's-eye rash around the bite

ANSWER D A bull's-eye rash (ring-like rash) around the bite is typical of early localized Lyme disease. Multiple erythema migrans on the skin occurs during early disseminated disease. Cranial nerve palsies are indicative of early disseminated disease. Recurrent arthritis in the large joints occurs in the late stage of the disease.

The nurse is caring for an 8-year-old girl who was in a car accident. What would lead the nurse to suspect a concussion? The child has vomited and has bruising behind her ear. The child is bleeding from the ear and draining fluid from the nose. The child is weak and has blurry vision. The child is easily distracted and can't concentrate.

ANSWER D A child with a concussion will be distracted and unable to concentrate. Signs and symptoms of contusions include disturbances to vision, strength, and sensation. Vomiting and bruising behind the ear are signs of a subdural hematoma. Bleeding from the ear and otorrhea are signs of a basilar skull fracture.

A child is diagnosed with aseptic meningitis. The child's mother states, "I don't know where she would have picked this up." The nurse prepares to respond to the mother based on the understanding that this disorder is most likely caused by: Streptococcus group B. Escherichia coli. Haemophilus influenza type B. enterovirus.

ANSWER D Aseptic meningitis is the most common type of meningitis, and if a causative organism can be identified, it is usually a virus such as enterovirus. E. coli is a cause of bacterial meningitis. H. influenza type B is a cause of bacterial meningitis. Streptococcus group B is a cause of bacterial meningitis.

The nurse is providing education to the parents of a 2-year-old boy with hydrocephalus who has just had a ventriculoperitoneal shunt placed. Which information is most important for the parents to be taught? "Call the doctor if he gets a headache." "Limit the amount of television he watches." "Always keep his head raised 30 degrees." "Watch for changes in his behavior or eating patterns."

ANSWER D Changes in behavior or in eating patterns can suggest a problem with his shunt, such as infection or blockage. Irritability, lack of appetite, increased crying, or inability to settle down may indicate increased intracranial pressure. Any headache needs to be monitored, but if it goes away quickly, such as after eating, it probably isn't a problem. It is not necessary to keep the child's head raised 30 degrees. The child's shunt will not be affected by the amount of television viewed.

The nurse is teaching the parents of a 6-year-old child who has sustained a large laceration about providing care to the wound at home. The nurse determines that the parents need additional teaching when they state: "If we notice some yellowish drainage, we need to call the healthcare provider." "If our child starts telling us that the pain is increasing, we need to have it checked out." "We should call the healthcare provider if the wound becomes red and hot looking." "We need to keep the wound tightly bandaged for at least 3 days."

ANSWER D If a wound is large, it can be covered by a loose dressing, which is changed in about 12 hours and redressed after the wound is cleaned. The wound is then left open to the air after 24 hours have passed from the time of the injury. A wound that is red and hot looking or one with yellowish drainage or increased pain suggests infection, which needs to be evaluated by the healthcare provider.

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

ANSWER D Pinpoint pupils are commonly observed in poisonings, brain stem dysfunction, and opiate use. Dilated but reactive pupils are seen after seizures. Fixed and dilated pupils are associated with brain stem herniation. A single dilated but reactive pupil is associated with an intracranial mass.

The nurse has completed client teaching with a 16-year-old female who has been prescribed isotretinoin for cystic acne. Which client statements indicate learning has occurred? (Select all that apply.) "As long as I use two forms of birth control I don't need to have monthly pregnancy testing." "If I am sexually active I need to let my healthcare provider know." "I am young so I won't need to have the liver tests the pamphlet suggests." "It's important I get my CBC blood test when my healthcare provider orders it." "This is not a drug to be used for all forms of acne. My sister has minor acne so I told her this wasn't for her."

answer B-D-E Isotretinoin is a powerful medication used for severe forms of acne and cystic acne when other treatment methods are not effective. Sexual activity should be reported to the healthcare provider. Some healthcare providers may order monthly pregnancy tests even if the client says she is not sexually active because of the risk of birth defects to a fetus. No matter what form of birth control is used, pregnancy is possible, so monthly pregnancy tests are still necessary. Liver function tests are important regardless of age because of the side effects of the medication. Any labs ordered, such as the CBC, by the healthcare provider to monitor the medication's side effects should be obtained.

When assessing an adolescent for acne, what findings would lead the nurse to identify the acne as severe? (Select all that apply.) Presence of nodules Facial papules Evidence of cysts Comedones Widespread inflammatory lesions

ANSWER

When developing the plan of care for a 5-year-old boy with Rocky Mountain spotted fever, the nurse knows the cause of the illness is: the bite of a tick. infection with group A streptococcus. an animal bite. contact with contaminated sports equipment.

ANSWER

The nurse is caring for a 13-year-old adolescent with acne vulgaris and is teaching the adolescent about skin care. Which response by the adolescent indicates a need for further teaching? "It is best to avoid hats and headbands." "I must use my medicine daily so that it will work." "I should use a humectant moisturizer." "I should avoid eating any kind of chocolate."

ANSWER D Ingestion of chocolate has not been proven to contribute to the incidence or severity of acne. Adhering to the medication regimen, using a humectant moisturizer, and avoiding hats and headbands would be appropriate.

CHAPTER 38

CHAPTER 38

CHAPTER 45

Chapter 45

The physician has ordered ibuprofen 150 mg every 6 hours as needed for a 3-year-old child for a fever greater than 38 Celsius. The label of the ibuprofen bottle reads "ibuprofen oral suspension 100 mg/5 mL." How much ibuprofen liquid will the nurse administer if the child's temperature goes above 38 C? Record your answer using one decimal place.

answer 7.5 ml The dose ordered (150 mg) is divided by the available dosage (100 mg) then multiplied by 5 mL.

A child is brought to the emergency department by his parents. The parents report that he stepped on a rusty nail about a week and a half ago. The child is complaining of cramping in his jaw and some difficulty swallowing. The nurse suspects tetanus. When assessing the child, the nurse would be alert to which muscle groups being affected next? Stomach Legs Arms Neck

ANSWER Tetanus progresses in a descending fashion to other muscle groups, causing spasms of the neck, arms, legs, and stomach.

Arrange the answers into the correct order. Mouse users arrange by clicking and dragging each answer to the desired location. Keyboard users can arrange though drop down by selecting the right order. A nursing instructor has presented a class on the stages of an infectious disease to a group of students and asks the students to place the stages in their proper sequence from beginning to end. Place the stages in their proper sequence. Illness 1 2 3 4 Convalescence 1 2 3 4 Prodrome 1 2 3 4 Incubation

ANSWER 1) Incubation 2) Prodrome 3) Illness 4) Convalescence Rationale:An infectious disease begins with incubation, then progresses to the prodrome stage, then to illness, and finally to convalescence.

A nurse demonstrates understanding of the various levels of consciousness as they progress from most alert to least alert. Place the levels of consciousness in the order that reflects this progression. Obtundation 1 2 3 4 5 Coma 1 2 3 4 5 Oriented to person, place, and time 1 2 3 4 5 Stupor 1 2 3 4 5 Disorientation 1 2 3 4 5

ANSWER 1) Oriented to person, place, and time 2) Disorientation 3) Obtundation 4) Stupor 5) Coma Rationale:Levels of consciousness in order from most alert to least alert are orientated to person, place, and time (full consciousness); confusion (disorientation); obtundation; stupor; and finally coma.

An adolescent is to receive topical retinoid therapy for his moderately severe acne. The nurse would instruct the adolescent about which adverse effects? (Select all that apply.) Dryness Headache Burning Flu-like symptoms Photosensitivity

ANSWER A-C-E Adverse effects associated with topical retinoid therapy include burning, dryness, and photosensitivity. Flu-like symptoms and headache are associated with topical immune modulators.

After teaching a group of students about neural tube disorders, the instructor determines that additional teaching is needed when the students identify this as a neural tube defect. Spina bifida occulta Encephalocele Arnold-Chiari malformation Anencephaly

ANSWER C Arnold-Chiari malformation is a deformity of the cerebellar tonsils being displaced into the upper cervical canal. Anencephaly is a neural tube defect. Encephalocele is a neural tube defect. Spina bifida occulta is a neural tube defect.

The nurse is providing home care instructions for the parents of an infant with cradle cap. Which response by the parents indicates a need for further teaching? "We can massage his head with mineral oil first and then shampoo it." "We should wash or shampoo the scalp areas with mild soap." "We can safely use a selenium sulfide shampoo on his hair." "We can scrape off the crusts on his scalp with a cotton swab."

ANSWER D The crusts should not be forcibly removed with a cotton swab. The affected areas are washed or shampooed with a mild soap. In the infant, mineral oil is applied to the scalp, massaged in well with a washcloth, and then shampooed 10 to 15 minutes later using a brush to gently lift the crusts. Selenium shampoo can be used safely on an infant.

The nurse is providing education to an adolescent who has tinea pedis. What information should be included in the discussion? (Select all that apply.) Use talcum powder twice daily. Rinse feet daily with a solution of equal parts water and hydrogen peroxide. Apply petroleum jelly to affected areas of feet. Keep feet clean and dry. Wear cotton socks.

ANSWER D-E Tinea pedis is a fungal infection of the feet. Care recommended includes keeping the feet clean and dry. Cotton fiber socks should be worn. Feet should be rinsed with vinegar and water solution not hydrogen peroxide and water solution. Talcum powder and petroleum jelly are not recommended for this condition.

A 9-month-old child has been admitted to rule out sepsis. Which finding offers the most support to the presence of this disorder? The child has had 7 wet diapers in the past 24 hours. The child has had 8 ounces of formula in the past 24 hours. The child cries when his mother is not in sight. The child's birth history indicates he was born at 42 weeks' gestation.

answer B Sepsis is a systemic overresponse to infection resulting from bacteria and viruses, which are the most common fungi, viruses, rickettsia, or parasites. It can lead to septic shock, which results in hypotension, low blood flow, and multisystem organ failure. Signs of sepsis include a lack of appetite, lethargy, hypotonia, and temperature elevations.

An adolescent is prescribed isotretinoin. Which statement indicates that the adolescent understands the necessary precautions associated with this drug? "The drug might cause staining of my clothing." "This drug can affect my lungs so I need a chest radiograph done first." "I'm going to have to have a blood count done every couple of months." "I have to make sure that I do not become pregnant while taking this drug."

ANSWER D Adolescent females taking this drug who are sexually active must be on a pregnancy prevention program because the drug causes defects in fetal development. Monthly complete blood counts are required when taking isotretinoin. Isotretinoin is not associated with lung problems, so a chest radiograph is not necessary. Coal tar preparations are associated with staining of the clothing or fabrics. Isotretinoin does not stain clothes or fabrics.

A group of nursing students are reviewing the functions of white blood cells. The students demonstrate an understanding of the information when they identify which white blood cell as responsible for combating allergic disorders? Neutrophils Lymphocytes Monocytes Eosinophils

ANSWER D Eosinophils function to combat allergic disorders and parasitic infestations. Neutrophils function to combat bacterial infections. Lymphocytes function to combat viral infections. Monocytes function to combat severe infections.