Intro to maternity and peds 27,28,29,30,31

What would the nurse expect to find in a child admitted to the hospital for nonorganic failure to thrive?

Be limp like a rag doll R: Some children with failure to thrive have rag-doll limpness (hypotonia) and appear wary of their caregivers.

The rate of RBC production is regulated by _________________.

Erythropoietin R: Erythropoietin is a glycoprotein hormone that controls erythropoiesis or red blood cell production.

What important focus of nursing care for the dying child and the family should the nurse implement?

Families should be made aware that hearing is the last sense to stop functioning before death R: Hearing is intact even when there is a loss of consciousness.

What should the nurse closely assess in a child receiving a transfusion?

Fever R: The child receiving a blood transfusion is observed for signs of a transfusion reaction including chills, itching, fever, rash, headache, and back pain.

Which statement by a mother may indicate a cause for her 9-month-olds iron deficiency anemia?

Formula is so expensive. We switched to regular milk right away R: Because cows milk contains very little iron, infants should drink iron-fortified formula for the first year of life.

A child is diagnosed with iron deficiency anemia. What will the nurse explain can occur if this disorder goes untreated?

Heart failure R: Untreated iron deficiency anemias progress slowly, and in severe cases the heart muscle becomes too weak to function. If this happens, heart failure follows.

The nurse shows slides of red blood cells from a child with sickle cell disease, noting that in addition to their sickle shape, the cells contain the abnormal element of ______________ _____.

Hemoglobin S R: Hemoglobin S is the abnormal hemoglobin that makes red blood cells fragile and causes the walls of the cells to collapse, giving them the characteristic sickle shape.

A child with thalassemia major receives blood transfusions frequently. What is a complication of repeated blood transfusions?

Hemosiderosis R: As a result of repeated blood transfusions, excessive deposits of iron (hemosiderosis) are stored in tissues.

Which statement made by a parent alerts the nurse to the need for additional education about poison prevention?

I keep a bottle of syrup of ipecac handy. R: Traditionally, syrup of ipecac was the treatment of choice to remove some types of poisons from a childs system and parents were advised to keep a supply on hand in the home. However, the American Academy of Pediatrics (AAP) revised this policy in 2003. Parents are now advised to call the poison control center and bring the container of the substance ingested to the hospital emergency department as quickly as possible because stomach lavage is rarely effective 1 hour or more after ingestion. Ipecac syrup should not be kept in the home. Uncontrolled vomiting can cause serious complications.

Which statement made by a parent of a child with nephrotic syndrome indicates an understanding of discharge teaching?

I should check his urine for protein when he goes to the bathroom R: The parents should be instructed to keep a daily record of the childs urinary proteins.

An adolescent is diagnosed with Hodgkins disease. Lymph nodes on both sides of her diaphragm have been found to be involved, including cervical and inguinal nodes. Which disease stage is this?

III R: Lymph node regions on both sides of the diaphragm are consistent with a diagnosis of stage III Hodgkins disease.

A 2-year-old child has been diagnosed with hemophilia A. What information should the nurse include in a teaching plan about home care?

If bleeding occurs, apply pressure, ice, elevate, and rest the extremity R: When bleeding occurs, the traditional approach is to follow RICE rest, ice, compression, and elevation.

Which urinary diversion procedure is the least damaging to the body image of the adolescent?

Ileal conduit R: The ileal conduit diverts urine to the colon, and the urine is excreted with the feces. There is no external appliance, as is needed with the other diversion methods.

What will the nurse teach the parents of a child with a low platelet count to avoid?

Aspirin R: Aspirin interferes with platelet function and should be avoided to prevent the risk of prolonged bleeding.

On admission, a child with leukemia has widespread purpura and a platelet count of 19,000/mm3. What is the priority nursing intervention?

Assessing neurological status R: When platelets are low, the greatest danger is spontaneous intracranial bleeding. Neurological assessments are therefore a priority of care.

What is the treatment of choice for a child with intussusception?

A barium enema R: A barium enema is the treatment of choice for intussusception because the passage of the barium frequently un-telescopes the bowel. Surgery is scheduled only if reduction is not achieved.

An infant is admitted to the hospital with severe dehydration. Laboratory results show pH 7.32, PaCO2 40, HCO3 21. How does the nurse interpret these values?

Metabolic acidosis R: A pH lower than 7.35 indicates acidosis. If the childs pH falls in the same line as the HCO3, the problem is metabolic (see Table 27-4).

Why are infants more vulnerable to fluid and electrolyte imbalances than adults?

A greater percentage of body water in infants is extracellular. R: A greater percentage of body water is contained in the extracellular compartment of children under 2 years of age.

Parents ask the nurse how their infant developed a Meckels diverticulum. What condition, will the nurse explain, is present causing this diagnosis?

A pouch forms when the vitelline duct fails to disappear. R: If the vitelline duct fails to disappear completely after birth, a blind pouch may form.

A mother reports that her child has been scratching the anal area and complaining of itching. What does the nurse suspect based on this information?

Pinworms R: With pinworms, the nurse or parent may notice that the child scratches the anal area and complains of itchiness. The other choices do not cause this reaction.

A 5-year-old boy is admitted to the hospital with acute glomerulonephritis. In taking the childs history, what does the nurse recognize as the probable cause?

A sore throat 2 weeks ago R: Acute glomerulonephritis develops from 1 to 3 weeks after a streptococcal infection, which causes an allergic-type response that alters the effectiveness of the glomeruli.

The nurse notes that a 4-year-old childs gums bleed easily and he has bruising and petechiae on his extremities. Which lab value is consistent with these symptoms?

Platelet count of 25,000/mm3 R: The normal platelet count is 150,000 to 400,000/mm3. This finding is very low, indicating an increased bleeding potential.

Which is the most appropriate intervention for a 3-month-old infant who has gastroesophageal reflux?

Position the infant in the crib on his or her abdomen, with the head elevated. R: After feedings, the infant is placed in a prone position to avoid increased intraabdominal pressure.

Which assessment would the nurse report to the physician immediately?

2-month-old with a urine output of 150 mL in 24 hours R: The urine output of a 2-month-old should be between 400 and 500 mL/24 hours.

The nurse is caring for an 18-pound child who has had one stool of diarrhea. The nurse knows that the child needs to consume how many milliliters of oral fluid to make up for the fluid loss?

81 R: The formula for oral fluid replacement is 10 mL/kg. 18 pounds = 8.1 kg 10 = 81 mL.

Diuresis has not occurred on a child with nephrotic syndrome after a month on corticosteroids. What protocol can the nurse encourage to bring about diuresis?

Cyclophosphamide (Cytoxan), an antisuppressan R: A potent antisuppressant such as Cytoxan can bring about diuresis when corticosteroids have proven ineffective.

A child is brought to the pediatric clinic because he has been vomiting for the past 2 days. What acid-base imbalance would the nurse expect to occur from this persistent vomiting?

Alkalosis R: Hydrochloric acid and sodium chloride from the stomach are lost from persistent vomiting. This results in alkalosis.

Following surgery for pyloric stenosis, an infant awoke from anesthesia hungry and crying. What is the most appropriate nursing action?

Allow 1 ounce of glucose water at frequent intervals. R: Small oral feedings of glucose water are given after recovery from anesthesia. Feedings are gradually increased to larger amounts of regular formula.

The nurse is speaking to the parent of a 3-year-old child who has mild diarrhea. What dietary modification would the nurse advise?

An oral rehydrating solution, such as Pedialyte R: An oral rehydrating solution is recommended to replace fluids and electrolytes lost from frequent bowel movements.

Parents are speaking with the urologist about their sons undescended testicle. Which statement by the childs father causes the nurse to determine he understands the information presented?

An undescended testicle can reduce fertility R: Although orchiopexy improves the condition, the fertility rate among patients may be reduced even when only one testis is undescended.

The nurse is explaining to a 17-year-old female the actions to prevent urinary tract infection. Which is the best beverage for the nurse to recommend to keep urine acidic?

Apple juice R: Juices such as apple or cranberry help maintain acidity of urine.

What foods does the nurse recommend the child with acute glomerulonephritis avoid to prevent hyperkalemia?

Bananas R: Bananas are very high in potassium and should be avoided.

What does the nurse expect the appearance of the stools of a child with celiac disease to be?

Bulky, frothy R: Celiac disease causes malabsorption. Stools that are large, bulky, and frothy may indicate malabsorption.

The nurse confirms that sickle cell trait can be distinguished from sickle cell disease by a lab test called ________________.

Electrophoresis R: The hemoglobin electrophoresis is a blood test to check for different types of hemoglobin in the blood. Hemoglobin is the substance in red blood cells that carries oxygen. Electrophoresis uses an electrical current to separate normal and abnormal types of hemoglobin in the blood. Hemoglobin types have different electrical charges and move at different speeds. The amount of each hemoglobin type in the current is measured. An abnormal amount of normal hemoglobin or an abnormal type of hemoglobin in the blood may mean that a disease is present. A person with sickle cell disease has abnormal hemoglobin S cells.

What is an appropriate intervention for the edematous child with reduced mobility related to nephrotic syndrome?

Change the childs position frequently R: The child should be turned frequently to prevent respiratory tract infection and to prevent pressure on delicate skin.

Which finding in a newborn is suggestive of tracheoesophageal fistula?

Choking on the first feeding R:After birth, a newborn with tracheoesophageal fistula will vomit and choke when the first feeding is introduced.

What is the result of a deficiency of factor IX?

Christmas disease R: Christmas disease, or hemophilia B, is caused by the deficiency of factor IX.

The child receiving a transfusion complains of back pain and itching. What is the best initial action by the nurse?

Clamp off blood and keep line open with normal saline R: If a blood transfusion reaction occurs, the first action is to stop the blood infusion, keep the line open with normal saline, and notify the charge nurse.

What would the nurse include in a teaching plan about mouth care of a child receiving chemotherapy?a. Use commercial mouthwash.b. Clean teeth with a soft toothbrush.c. Avoid use of a Water-Pik.d. Inspect the mouth weekly for ulcerations.ANS: BA soft toothbrush reduces capillary damage and mucous membrane breakdown and prevents bleeding and infection. Commercial mouthwashes may kill oral flora that combat infection. Water-Pik is useful for toughening gums.

Clean teeth with a soft toothbrush R: A soft toothbrush reduces capillary damage and mucous membrane breakdown and prevents bleeding and infection. Commercial mouthwashes may kill oral flora that combat infection. Water-Pik is useful for toughening gums.

What will the nurse caution the parents of a child who has had a nephrectomy that he will have to avoid?

Contact sports R: Children who have only one kidney should avoid contact sports to prevent injury to that remaining organ.

The nurse is teaching the parents of a young child with iron deficiency anemia about nutrition. What food would the nurse emphasize as being a rich source of iron?

Cream of Wheat R: Good nutritional sources of iron include boiled egg yolk, liver, green leafy vegetables, Cream of Wheat, dried fruits, beans, nuts, and whole-grain breads.

What description of a childs stool characteristic leads the nurse to suspect intussusception?

Currant jelly R: Bowel movements of blood and mucus that contain no feces (currant jelly stools) are common about 12 hours after the onset of the obstruction.

Place the stages of dying in the usual order as detailed by Kbler-Ross (1975). Put a comma and space between each answer choice (a, b, c, d, etc.) a. Bargaining b. Acceptance c. Denial d. Anger e. Reaching out to help others f. Depression

Denial Anger Bargaining Depression Acceptance Reaching out to help others R: The stages of dying as detailed by Kbler-Ross (1975)denial, anger, bargaining, depression, acceptance, and reaching out to help otherscan be applied to parents and siblings as well as to the sick child. (Nurses may also respond with similar feelings.) It is important to accept and support each participant at whatever stage has been reached and to refrain from directing progress.

The nurse is planning a parent education program about lead poisoning prevention. What will be included regarding primary sources of lead in the community?

Deteriorating paint in older buildings R: The primary source of lead is paint from old, deteriorating buildings.

A newly married couple is seeking genetic counseling because they are both carriers of the sickle cell trait. How can the nurse best explain the childrens risk of inheriting this disease?

Each child has a one in four chance of having the disease and a two in four chance of being a carrier R: The sickle cell gene is inherited from both parents; therefore each offspring has a one in four chance of inheriting the disease.

A child has just been diagnosed with acute lymphoblastic leukemia. What is the result of an overproduction of immature white blood cells in the bone marrow?

Increased susceptibility to infection R: An overproduction of immature white blood cells increases the childs susceptibility to infection.

What is it important to assess in a child receiving prednisone to treat nephrotic syndrome?

Infection R: Prednisone depresses the immune response and increases susceptibility to infection. Because steroids mask signs of infection, the child must be assessed for more subtle symptoms of illness.

The parents of a newborn are concerned that their sons scrotum is enlarged and swollen on one side. What is the nurses best response?

It is a collection of fluid that will most likely correct itself in a year R: These signs are indicative of a hydrocele, a collection of fluid in the scrotum that usually corrects itself in a year.

The nurse discussed strategies with a parent to prevent a recurrence of urinary tract infection in the child. Which statement made by the parent indicates a need for further teaching?

It is acceptable to take frequent bubble baths R: Oils in bubble bath and similar products are known to irritate the urethra.

Which statement made by a parent indicates an understanding of health maintenance of a child with sickle cell disease?

It is important for my child to drink plenty of fluids R: Prevention of dehydration, which can trigger the sickling process, is a priority goal in the care of a child with sickle cell disease.

The nurse is presenting information on the congentital disorder of hemophilia A. What fact will the nurse include?

It is transmitted by symptom-free females R: Hemophilia A affects mostly males who received the sex-linked recessive trait from a symptom-free female. The defective gene is on the X chromosome.

What instruction will the nurse give to parents about preventing the spread and reinfection of pinworms?

Keep childrens nails short. R: One intervention to prevent the further spread of pinworms is to keep the childs fingernails short. Pinworms are not spread from person to person.

A child has been diagnosed with ascariasis (roundworm). Which statement made by her mother that may suggest a cause for her condition?

My child often goes out to the garden and pulls up a carrot to eat. R: The child can ingest roundworm eggs from contaminated soil.

A child is brought to the emergency department because he ingested an unknown quantity of acetaminophen (Tylenol). What does the nurse expect this child to receive following gastric lavage?

N-acetylcysteine R: Gastric lavage is followed by N-acetylcysteine (Mucomyst), the antidote for acetaminophen.

During a physical assessment of a hospitalized 5-year-old, the nurse notes that the foreskin has been retracted and is very tight on the shaft of the penis; the nurse is unable to return it over the head of the penis. What action should the nurse implement?

Notify the charge nurse R: Notify the charge nurse of this occurrence of paraphimosis. The tight foreskin can impede blood flow to the penis; this should be remedied immediately.

Which physical assessment technique will the nurse omit when caring for a 2-year-old diagnosed with Wilms tumor?

Palpating the abdomen R: Palpation of the abdomen could disturb the tumor and cause the malignancy to spread.

What is an initial sign of nephrosis that the nurse might note in a child?

Periorbital edema R: The edema of nephrotic syndrome is generalized and not readily noticed, even by the parents, but an early sign that can be assessed is periorbital edema.

The nurse, caring for a child receiving chemotherapy, notes that the childs abdomen is firm and slightly distended. There is no record of a bowel movement for the last 2 days. What do these assessment findings suggest?

Peripheral neuropathy R: Peripheral neuropathy may be signaled by severe constipation resulting from decreased nerve sensations in the bowel.

A 7-month-old infant is admitted to the hospital with a diagnosis of acute gastroenteritis. What will be the nursess priority goal of the infants care?

Prevent fluid and electrolyte imbalance. R: The priority goal of care in gastroenteritis is preventing fluid and electrolyte imbalance.

The nurse is interviewing parents of an infant with pyloric stenosis. What would the nurse expect the parents to report?

Projectile vomiting R: Vomiting is the outstanding symptom of pyloric stenosis. Food is ejected with considerable force, which is described as projectile vomiting.

A 7-year-old child with acute glomerulonephritis has gross hematuria and has been confined to bed. What is the most appropriate nursing intervention for this child?

Providing activities for the child on restricted activity R: Although children may feel well, activity is limited until hematuria resolves.

The nurse is teaching a parent about pyrvinium (Povan). What would be included in regard to potential side effects?

Red stool R: The nurse should advise parents that pyrvinium stains clothing and turns stools red.

The nurse has reviewed dietary restrictions for celiac disease with concerned parents. Which grain will the nurse explain can be eaten with celiac disease?

Rice R: Rice is a gluten-free grain that can be eaten by children afflicted with celiac disease. These children will have a lifelong restriction of wheat, oats, barley, and rye.

The most recent blood count for a child who received chemotherapy last week shows neutropenia. What is the priority nursing diagnosis for this child?

Risk for infection R: The child with neutropenia is at risk for infection.

An infant is admitted to the hospital with severe isotonic dehydration. For what is this child at the highest risk?

Shock R: Shock is the greatest threat to life in isotonic dehydration.

The mother of a 5-year-old child taking prednisone for nephrotic syndrome tells the nurse he needs to get immunizations to enter kindergarten. What does the nurse clarify about receiving immunizations while on prednisone?

Should be delayed R: No vaccinations or immunizations should be administered while the disease is active and during immunosuppressive therapy.

When asked about correcting the hypospadias of a newborn, what does the nurse explain about this condition?

Surgical repair of the hypospadias is done before 18 months of age R: Treatment of hypospadias consists of surgical repair and is usually performed before 18 months of age.

A frightened mother calls the pediatricians office because her child swallowed dishwashing detergent. What is the most appropriate action?

Take the child to the local emergency department. R: Inducing vomiting is no longer recommended because it may pose additional problems. The child should be taken immediately to the nearest emergency department along with the packaging of the ingested substance.

Which nursing interventions will be implemented for the mother of a 10-month-old infant with nonorganic failure to thrive?

Teaching the mother about the developmental milestones to expect in the next few months R: The nurse can increase parents knowledge of growth and development by providing anticipatory guidance about normal developmental milestones.

The nurse finds an adolescent with Hodgkins disease crying. The adolescent says, I am so scared. What is the most appropriate nursing response to this comment?

Tell me whats got you scared R: The nurse should encourage the adolescent to express her feelings and concerns.

The nurse is dealing with a preschool-age child with a life-threatening illness. What should the nurse remember the childs concept of death is at this age?

That a person becomes alive again soon after death R: The preschooler views death as reversible and temporary.

Why are rapid respirations a possible cause of dehydration?

They cause evaporation of fluid on the mucous membranes. R: Rapid respirations cause increased insensible fluid loss.

A 6-year-old child with daytime enuresis complains of dysuria and urgency. What does the nurse recognize these signs and symptoms indicate?

Urinary tract infection R: Urinary frequency and pain during micturition are symptoms of acute urinary tract infection.

The nurse is instructing a mother how to administer oral nystatin suspension prescribed to treat thrush. What will the nurse include?

Use a sterile applicator to swab the medication on the oral mucosa. R: An appropriate way to administer nystatin is to moisten a sterile applicator with the medication and then swab it on the inside of the mouth.

A 3-year-old child with sickle cell disease is admitted to the hospital in sickle cell crisis with severe abdominal pain. Which type of crisis is the child most likely experiencing?

Vaso-occlusive R: Vaso-occlusive crisis, or painful crisis, is caused by obstruction of blood flow by sickle cells, infarctions, and some degrees of vasospasm.

A parent tells the nurse that her child is scheduled for an x-ray of the bladder and urethra that is done while the child is urinating. What is this test known as?

Voiding cystourethrogram R: An x-ray examination of the bladder and urethra before and during micturition is called a voiding cystourethrogram.

Which statement by a mother may indicate a cause of her sons vitamin C deficiency?

We get our fruits from homemade preserves. R: Vitamin C is destroyed by heat.

On the second day of hospitalization for a 3-month-old brought in for treatment for gastroenteritis, the nurse makes all of the assessments listed below. Which assessment finding indicates ineffectiveness of treatment?

Weight loss of 4 ounces R: Weight loss is the most significant indicator of dehydration because an infants weight comprises 77% water.

The 6-year-old scheduled for an orchiopexy shyly asks the nurse, What are they going to do to me down there? What is the nurses best response?

What do you think your doctor is going to do R: Encourage the patient to talk about what he knows and what feelings he has about the surgery. School-age children have a fear of bodily harm.

A 6-year-old with leukemia asks, Who will take care of me in heaven? What is the best response by the nurse?

Who do you think will take care of you? R: This response gives the child an opportunity to verbalize his or her feelings and concerns, whereas closed responses shut off communication. The asking of a why question is not therapeutic as it calls for justification.

A mother reports that her 2-year-old child experiences constipation frequently. Which food would the nurse recommend to include in the childs diet?

Whole-grain cereal R: Dietary modifications for constipation include eating more high-roughage foods such as whole-grain breads and cereals.

What will the nurse administer with ferrous sulfate drops when providing them to a child on the pediatric unit?

With orange juice R: Vitamin C aids in the absorption of iron, whereas food and milk interfere with the absorption of iron.

What sign(s) indicate(s) moderate dehydration? (Select all that apply.) a. 10% weight loss b. Dry mucous membranes c. Normal anterior fontanel d. Increased urinary output e. Lethargy

a. 10% weight loss b. Dry mucous membranes c. Normal anterior fontanel R: The child that is moderately dehydrated will have lost 10% of his body weight, will have dry mucous membranes, normal (nonsunken) anterior fontanelle, decreased urine output, and will be irritable.

What should be included in the nursing care of a 12-year-old child receiving radiation therapy for Hodgkins disease? (Select all that apply.) a. Application of sunblock b. Appetite stimulation c. Conservation of energy d. Provision for expressions of anger e. Preparation for premature sexual development

a. Application of sunblock b. Appetite stimulation c. Conservation of energy d. Provision for expressions of anger R: Sun block should be applied to skin after radiation to prevent burning. Low energy levels produce anorexia and anger in many young patients. Radiation delays the development of secondary sex characteristics and menses.

How has synthetic recombinant antihemophilic factor improved the management of hemophilia? (Select all that apply.) a. Eliminates the need for frequent transfusions b. Can be administered by family at home c. Prevents hemorrhage d. Reduces cost of care of the hemophiliac e. Reduces risk of HIV and hepatitis A and B transmission

a. Eliminates the need for frequent transfusions b. Can be administered by family at home d. Reduces cost of care of the hemophiliac e. Reduces risk of HIV and hepatitis A and B transmission R: The drug can be given at home by the family. Because it supplies the missing factor, transfusions are not necessary and consequently the exposure to HIV and hepatitis A and B is reduced. Cost of care is greatly reduced because hospitalizations and transfusions are not as frequently required. The drug does not prevent hemorrhage; it makes hemorrhage manageable.

What are the classic symptoms of thalassemia major (Cooleys anemia)? (Select all that apply.) a. Hepatomegaly b. Jaundice c. Protruding teeth d. Pathological fractures e. Renal failure

a. Hepatomegaly b. Jaundice c. Protruding teeth d. Pathological fractures R: All of the options are classic signs of thalassemia major except renal failure.

The nurse is caring for a child with a low platelet count. What skin assessments would alert the nurse to bleeding? (Select all that apply.) a. Petichiae b. Purpura c. Ecchymosis d. Hematoma e. Lymphadenopathy

a. Petichiae b. Purpura c. Ecchymosis d. Hematoma R: The reduction or destruction of platelets in the body interferes with the clotting mechanism. Skin lesions that are common to these disorders include petechiae, a bluish, nonblanching, pinpoint-sized lesion; purpura, groups of adjoining petechiae; ecchymosis, an isolated bluish lesion larger than a petechia; and hematoma, a raised ecchymosis. Lymphadenopathy is an enlargement of lymph nodes that is indicative of infection or disease.

What assessment(s) would lead a nurse to suspect Hirschsprungs disease in a 1-month-old infant? (Select all that apply.) a. Ribbon-like stools b. Fever c. Failure to thrive d. Vomiting e. Diminished peristalsis

a. Ribbon-like stools b. Fever c. Failure to thrive d. Vomiting e. Diminished peristalsis R: All options are significant indicators of Hirschsprungs disease.

Why would the nurse urge the family of a dying 12-year-old boy to include his 8-year-old sister in care? (Select all that apply.) a. She will feel less neglected by the parents. b. She can make amends for past hostilities to her brother. c. She will feel increased helplessness. d. She can express her feelings through care. e. She can experience being supportive of her parents and brother.

a. She will feel less neglected by the parents. b. She can make amends for past hostilities to her brother. d. She can express her feelings through care. e. She can experience being supportive of her parents and brother. R: All options are potential benefits to including the sibling in the care of a dying child except increased helplessness. She would feel less helpless.

The family of a child receiving chemotherapy for leukemia should be taught to focus on which aspect(s) of the childs care? (Select all that apply.) a. Using a support group b. Stimulating appetite c. Maintaining adequate hydration d. Continuing with scheduled immunizations e. Reporting exposure to infectious diseases

a. Using a support group b. Stimulating appetite c. Maintaining adequate hydration e. Reporting exposure to infectious diseases R: Support groups are helpful for emotional support and realistic tips on care. The child on chemotherapy is anorexic and has no appetite. Maintenance of hydration is essential for the adequate therapeutic effect of the drugs. Because the drugs suppress the bone marrow, children are at risk for infection, and the suppression will not allow the antibody response needed for immunization.

The nurse explains that the COPP medical regimen for the treatment of Hodgkins disease uses a combination of which drugs? (Select all that apply.) a. Vincristine b. Cyclophosphamide c. Methotrexate d. Prednisone e. Procarbazine hydrochloride

a. Vincristine b. Cyclophosphamide d. Prednisone e. Procarbazine hydrochloride R: The COPP medical regimen includes the combination of cyclophosphamide, vincristine (Oncovin), prednisone, and procarbazine hydrochloride.

What interventions will the nurse perform when feeding a child with pyloric stenosis? (Select all that apply.) a. Give a formula thinned with water. b. Burp the infant before and during feeding. c. Give the feeding slowly. d. Refeed if the infant vomits. e. Position infant on left side after feeding.

b. Burp the infant before and during feeding. c. Give the feeding slowly. d. Refeed if the infant vomits. R: Children with pyloric stenosis are given formula thickened with cereal; the infant is burped before and during feeding to get rid of any gas in the stomach; the infant is fed slowly and refed if vomiting occurs. The infant is positioned on the right side to allow the weight of the feeding to stay in the stomach against the pyloric valve

A child is brought into the ED with suspected appendicitis. What signs and symptoms does the nurse expect to assess? (Select all that apply.) a. Left lower quandrant pain b. Guarding c. Rebound tenderness d. Decreased C-reactive protein e. Pain on lifting thigh when supine

b. Guarding c. Rebound tenderness e. Pain on lifting thigh when supine R: With appendicitis on examination, characteristic tenderness in the right lower quadrant known as McBurneys point will occur. Other diagnostic signs include guarding (tightening of the abdominal muscles or rigidity of the abdomen on palpation); rebound tenderness (pressing the RLQ with rapid release of pressure causes severe pain); pain on lifting the thigh while in the supine position is caused by muscle irritation. C-reactive protein levels will be increased after 12 hours if any infection is present.

A school-aged child is living with a chronic disease process. How would the nurse anticipate chronic illness will effect growth and development? (Select all that apply.) a. Delayed bonding with parents b. Delayed toilet training c. Impaired sense of belonging d. Decreased feelings of independence e. Impaired speech development

c. Impaired sense of belonging d. Decreased feelings of independence R: A school-age child is in the stage of industry versus inferiority. A chronic illness might experience loss of grade level in school because of illness and inability to participate or compete can lead to sense of inferiority. Sense of independence and accomplishment can be lost. Being different from peers may impede childs sense of belonging.

The nurse explains that because _________________ beverages cause diuresis, they are not good choices for fluid replacement in a child who is dehydrated.

caffeinated R: Cola or other caffeinated drinks cause diuresis and will further dehydrate an already dehydrated child.

To prevent ________________ ________________, the nurse warms the blood that is to be given as a transfusion through a central line.

cardiac arrhythmias R: Cold blood entering the heart via a central line can trigger an irregular heartbeat.

The nurse reminds parents of a child allergic to cows milk that they should avoid foods that list ______________ as part of their contents.

casein R: Food labels that list casein contain cows milk.

Hernias are successfully repaired by the surgical operation called a _____________.

herniorrhaphy R: Hernias are successfully repaired by the surgical operation called a herniorrhaphy. This is a relatively simple procedure and is well tolerated by the child. Most children are scheduled for procedures in same-day surgery units. The benefits of this method are both economic and psychological.

The nurse, assessing an elevated erythrocyte sedimentation rate (ESR) for an infant with gastroenteritis, recognizes that this confirms the _______________ process that is part of this disease.

inflammatory R: The ESR elevates in the presence of an inflammatory response.

he nurse explains the medically accepted definition of constipation is fewer than _____ bowel movements in a 2-week period.

seven R: The medically accepted definition of constipation is fewer than seven bowel movements in a 2-week period.