Lipincott Questions

The nurse is doing an examination on an infant with a diagnosis of developmental dysplasia of the hip (DDH). Which finding would be an indication of this diagnosis? A. Gluteal fold higher on one side than the other B. Sac protruding on the lower back C. Respiratory rate of 30 breaths per minute D. Head circumference of 18 inches (46 cm)

A. Gluteal fold higher on one side than the other

A group of nurses is reviewing the cardiovascular system and its function. Which statement by one of the nurses demonstrates an understanding of a child's cardiovascular system? a. "At birth, the infant's right and left ventricle are about the same size." b. "Between the ages of 5 and 6, the child's left ventricle grows to about two times the size of the right." c. "The heart rate of the child decreases whenever the child experiences a fever." d. "The child's heart doesn't mature and function like an adult's until between 8 and 10 years of age."

a. "At birth, the infant's right and left ventricle are about the same size."

The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTIs). The caregiver is puzzled about why her daughter has had three urinary tract infections but her son has had none. She reports that their diets and fluid intake is similar. Which statement would be accurate for the nurse to tell this mother? a. "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." b. "Girls tend to urinate less frequently than boys, making them more susceptible to UTI's." c. "Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C." d. "It is unlikely that your daughter is practicing good cleaning habits after she voids."

a. "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily."

Which statement about cerebral palsy would be accurate? a. "Cerebral palsy is a condition that runs in families." b. "Cerebral palsy means there will be many disabilities." c. "Cerebral palsy is a condition that doesn't get worse." d. "Cerebral palsy occurs because of too much oxygen to the brain."

a. "Cerebral palsy is a condition that runs in families."

The nurse is taking a health history of a 6-week-old boy with a suspected cardiovascular disorder. Which response by the mother would lead the nurse to suspect that the child is experiencing heart failure? a. "He gets sweaty when he eats." b. "He does not seem short of breath." c. "He does not seem sick." d. "He seems to have a normal appetite."

a. "He gets sweaty when he eats."

The nurse is taking a health history of a toddler with a suspected congenital heart defect. Which response by the mother could indicate that the child is experiencing hypercyanotic spells? a. "He likes to stop and squat wherever he walks." b. "He walks very quickly and never stops moving." c. "He takes one nap a day and is fairly active." d. "He does not seem to have difficulty breathing."

a. "He likes to stop and squat wherever he walks."

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. What is the best response from the nurse? a. "It will determine if the heart is enlarged." b. "It will determine disturbances in heart conduction." c. "It will show if blood is being shunted." d. "This image will clarify the structures within the heart."

a. "It will determine if the heart is enlarged."

A nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed? a. "We can stop the penicillin when her symptoms disappear." b. "If she needs dental surgery, we might need additional medication." c. "She needs to take the drug for the full 14 days." d. "To prevent another episode, she'll need preventive antibiotic therapy for at least 5 years."

a. "We can stop the penicillin when her symptoms disappear."

An 8-year-old boy and his father visit the pediatrician's office with reports of a sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the boy's health history, the nurse learns that he had strep throat a little over a week ago. Which condition should the nurse suspect? a. Acute glomerulonephritis b. Kidney agenesis c. Polycystic kidney d. Nephrosis

a. Acute glomerulonephritis

Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis? a. Avoid making noise when in the child's room. b. Rock the child frequently. c. Have the child's 2-year-old brother stay in the room. d. Keep the lights on brightly so that he can see his mother.

a. Avoid making noise when in the child's room.

The nurse is caring for a child diagnosed with rheumatic fever. When addressing the child's pain, the nurse should perform which intervention(s)? Select all that apply. a. Carefully handle the child's knees, ankles, elbows and wrists when moving the child. b. Administer salicylates after meals or with milk. c. Teach the child how to use a patient-controlled analgesia system. d. Administer intravenous morphine as prescribed. e. Prioritize nonpharmacologic interventions over pharmacologic interventions.

a. Carefully handle the child's knees, ankles, elbows and wrists when moving the child. b. Administer salicylates after meals or with milk.

To detect complications as early as possible in a child with meningitis who's receiving IV fluids, monitoring for which condition should be the nurse's priority? a. Cerebral edema b. Renal failure c. Left-sided heart failure d. Cardiogenic shock

a. Cerebral edema

A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. What would be the best way to prevent this? a. Encourage the child to take all the antibiotics if diagnosed with strep throat. b. Tell parents to give ibuprofen if their child has a sore throat. c. All children in the child's class should be tested for strep throat if one child has a positive test. d. Prophylactic antibiotics after strep throat are important.

a. Encourage the child to take all the antibiotics if diagnosed with strep throat.

The nurse is caring for a child with nephrotic syndrome. The child is noted to have edema. The edema would most likely be seen where on this child? a. Eyes b.Fingers c. Abdomen d. Sacrum

a. Eyes

A school-aged child diagnosed with glomerulonephritis is in the physician's office for a 6-month follow-up visit. Hematuria is found in the urine. The parents are concerned and want to know why the glomerulonephritis is not gone. What is the best response by the nurse? a. Hematuria can remain in the urine for up to one year. b. This is unusual and further testing will need to be done. c. This is probably related to a UTI and not glomerulonephritis. c. The child will need treatment with antibiotics for strep throat.

a. Hematuria can remain in the urine for up to one year.

The nurse is caring for a 6-year-old child who has a history of febrile seizures and is admitted with a temperature of 102.2°F (39°C). What is the nurse's highest priority? a. Institute safety precautions. b. Offer age-appropriate activities. c. Provide family teaching related to the child's history. d. Encourage the child to do his or her own self-care.

a. Institute safety precautions.

A teacher sends a child to see the school nurse for irritability and bruising. Which symptom would be indicative of hemolytic uremic syndrome? a. Oliguria and jaundice b. Polyuria and diarrhea c. Weight gain and high fever d. Dysuria and lethargy

a. Oliguria and jaundice

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see? a. Peeling hands and feet; fever b. Decreased heart rate and impalpable pulse c. Irritability and dry mucous membranes d. Low blood pressure and decreased heart rate

a. Peeling hands and feet; fever

A 1-year-old with tetralogy of Fallot turns blue during a temper tantrum. What will the nurse do first? a. Place child in the knee-to-chest position. b. Assess for an irregular heart rate. c. Listen for an increased respiratory rate. d. Explain to the child the need to calm down.

a. Place child in the knee-to-chest position.

A nurse is giving discharge instructions to the parents of a newborn with a congenital heart disorder. What should the nurse instruct the parents to do in the event that the child becomes cyanotic? a. Place him in a knee-chest position b. Perform hands-on CPR c. Administer low-dose aspirin d. Administer prescribed amoxicillin

a. Place him in a knee-chest position

A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges? a. Positive Kernig sign b. Negative Brudzinski sign c. Positive Chadwick sign d. Negative Kernig sign

a. Positive Kernig sign

A parent brings an infant in for poor feeding and listlessness. Which assessment data would most likely indicate a coarctation of the aorta? a. Pulses weaker in lower extremities compared to upper extremities b. Pulses weaker in upper extremities compared to lower extremities c. Cyanosis with crying d. Cyanosis with feeding

a. Pulses weaker in lower extremities compared to upper extremities

A nursing instructor is preparing a discussion which will illustrate the different forms of spina bifida. The instructor determines the session is successful after the students correctly choose which form as being spina bifida with myelomeningocele? a. The spinal cord, meninges, and nerve roots protrude out the lower back. b. There's a cystic sac containing the spinal meninges protruding out the back. c. There is only soft-tissue inflammation without protrusion. d. There is a bony defect that occurs without soft-tissue involvement.

a. The spinal cord, meninges, and nerve roots protrude out the lower back.

An infant is diagnosed as having cerebral palsy. When planning care, which would the nurse stress to the parents? a. Their child probably will benefit from early schooling to increase ability for self-care. b. Administering an anti-acetylcholinergic drug to decrease muscle spasms is crucial. c. The parent should be tested during future pregnancies to predict similar involvement. d. The infant's disease will cause progressive brain cell degeneration with age.

a. Their child probably will benefit from early schooling to increase ability for self-care.

A child is having the urine checked for a routine well visit. When analyzing the results, what would positive leukocytes indicate? a. This may indicate a urinary tract infection. b. This determines the presence of sugar in the urine. c. This indicates renal disease. d. This determines the presence of red blood cells in the urine.

a. This may indicate a urinary tract infection.

A nurse is providing education to parents of a child diagnosed with vesicoureteral reflux (VUR). Which would be included in the parental education? a. This occurs when there is backflow of urine into the bladder and sometimes the kidneys. b. This occurs only when there is an obstruction of the ureteropelvic junction. c. This is diagnosed by abdominal x-ray. d. This is typically treated with a kidney transplant.

a. This occurs when there is backflow of urine into the bladder and sometimes the kidneys.

A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent? a. This test will check how blood is flowing through the heart. b. This noninvasive test will check the electrical impulses in the heart. c. This test will only determine the size of the heart. d. This invasive test will measure the blockage in the heart.

a. This test will check how blood is flowing through the heart.

A health care provider and other health team members are discussing congenital heart disorders that increase pulmonary blood flow. Which disorders are topics for this discussion? Select all that apply. a. Ventricular septal defect b. Patent ductus arteriosus c. Atrioventricular canal defect d. Pulmonary stenosis e. Coarctation of the aorta

a. Ventricular septal defect b. Patent ductus arteriosus c. Atrioventricular canal defect

The nurse is working with a child with altered genitourinary status. Which intervention would be included in the plan of care for the client with excess fluid volume? a. Weigh the child daily on the same scale. b. Hold all medication until the fluid retention is improving. c. Avoid administering IV therapies. d. Measure the amount of nitrates present in the urine

a. Weigh the child daily on the same scale.

A baby with developmental dysplasia of the hip is placed in a Pavlik harness. The harness positions the hip in which position? a. a flexed, abducted position to press the femur head against the acetabulum b. an extended, abducted position to stabilize the femur head and the acetabulum c. a flexed, adducted position to point the femur towards the acetabulum d. an extended, adducted position to relieve pressure from the femur against the acetabulum

a. a flexed, abducted position to press the femur head against the acetabulum

The nurse is observing a group of children diagnosed with various types of cerebral palsy. One of the children has an awkward and wide-based gait. The nurse recognizes this characteristic as common in which type of cerebral palsy? a. ataxic cerebral palsy b. athetoid cerebral palsy c. rigidity cerebral palsy d. spastic cerebral palsy

a. ataxic cerebral palsy

The nurse is collecting data on a child being evaluated for rheumatic fever. The caregiver reports that over the past several weeks the child seems to have lack of coordination, facial grimaces and repetitive involuntary movements. Based on these symptoms the nurse would suspect what condition? a. chorea b. carditis c. arthralgia d. polyarthritis

a. chorea

Assessment of a school-aged child reveals a sudden onset of hematuria. The parent states that the child has not felt well but the only recent past medical history is impetigo. Acute post-streptococcal glomerulonephritis is diagnosed and laboratory tests are performed. Which result would the nurse identify as supporting this diagnosis? Select all that apply. a. decreased blood protein level b. decreased erythrocyte sedimentation rate c. increased blood urea nitrogen level d. increased blood creatinine level e. elevated antistreptolysin O titer

a. decreased blood protein level c. increased blood urea nitrogen level d. increased blood creatinine level

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of: a. femoral pulse weaker than brachial pulse. b. bounding pulse. c. narrow pulse. d. hepatomegaly.

a. femoral pulse weaker than brachial pulse.

When caring for a child with Kawasaki disease, the nurse would know that: a. management includes administration of aspirin and IVIG. b. joint pain is a permanent problem. c. antibiotics should be administered every 8 hours by IV. d. steroid creams are used for the hand peeling.

a. management includes administration of aspirin and IVIG.

The prevention of cerebral palsy is the most important aspect of care. Which of the following are focus areas for the prevention of cerebral palsy? Select all that apply. a. prenatal care to improve nutrition b. postnatal prevention of infection c. perinatal monitoring to decrease birth trauma d. postnatal prevention of rubella e. prenatal prevention of gestational diabetes

a. prenatal care to improve nutrition b. postnatal prevention of infection c. perinatal monitoring to decrease birth trauma

A child diagnosed with acute glomerulonephritis will most likely have a history of: a. recent illness such as strep throat. b. a sibling diagnosed with the same disease. c. hemorrhage or history of bruising easily. d. hearing loss with impaired speech development.

a. recent illness such as strep throat.

A nurse is examining a boy with cerebral palsy (CP). He has hypertonic muscles and abnormal clonus in his legs and walks on his toes. Which of the following is the type of cerebral palsy that this boy is demonstrating? a. spastic b. dyskinetic c. athetoid d. ataxic

a. spastic

When assessing a newborn, the nurse observes dimpling and thickening of the newborn's skin over the lumbar spine and the presence of a tuft of hair. On further examination, the nurse notices no motor or sensory deficits in the newborn. The nurse interprets these findings as indicating which of the following? a. spina bifida occulta b. meningocele c. hydrocephalus d. myelomeningocele

a. spina bifida occulta

The nurse is caring for a child who has just been diagnosed with nephrotic syndrome. What health education should the nurse provide to the child and family? a. the need to avoid high-sodium foods b. the importance of increasing fluid intake c. the need for hemodialysis d. the advantage of peritoneal dialysis

a. the need to avoid high-sodium foods

Which laboratory test result would be most important for the nurse to assess in a child who is suspected of having a urinary tract infection? a. urinalysis b. chemical reagent strip testing c. urine specific gravity level d. serum blood urea nitrogen (BUN) level

a. urinalysis

While presenting a panel discussion to a group of parents about urinary tract infections (UTIs) in children, one of the parents asks the nurse, "Why would my daughter be more at risk than my son?" Which response by the nurse would be most accurate? a. "Girls have a smaller bladder size than boys do." b. "A girl's urethra is closer to the rectal opening." c. "A girl's urethra is longer than a boy's urethra." d. "Her kidneys are less well protected."

b. "A girl's urethra is closer to the rectal opening."

The nurse is collecting data from the caregivers of a child admitted with seizures. Which statement indicates the child most likely had an absence seizure? a. "His arms had jerking movements in his legs and face." b. "He was just staring into space and was totally unaware." c. "He kept smacking his lips and rubbing his hands." d. "He usually is very coordinated, but he couldn't even walk without falling."

b. "He was just staring into space and was totally unaware."

The nurse is taking a health history of a child with suspected acute poststreptococcal glomerulonephritis. Which response by the client's parent will the nurse highlight for the primary health care provider as an indicator for this condition? a. "My child has recently reported urinary frequency." b. "My child just got over a head cold with laryngitis." c. "My child's urine is pale yellow in color." d. "My child's eyes appear sunken to me."

b. "My child just got over a head cold with laryngitis."

The nurse instructs the parents of a child with Guillain-Barré syndrome on care that will be needed once the child is discharged home. Which statement made by the parents indicates that teaching has been effective? a. "We need to be sure to change our child's body position at least twice a day." b. "Our child might experience weakness even after recovering from the illness." c. "It will take about 10 days for our child to be back normal and return to school." d. "This disease affects the heart and lungs, so our child will have limited ability going forward."

b. "Our child might experience weakness even after recovering from the illness."

A nursing instructor has completed a class session on Guillain-Barré syndrome. Which statement by a student indicates a need for further education? a. "Children with this disorder may need mechanical ventilation as the disease progresses." b. "Paralysis peaks at about 3 weeks before recovery, but most do not completely recover from the paralysis." c. "These children may need nutritional support if they are unable to eat." d. "There is no medication available to treat this disorder."

b. "Paralysis peaks at about 3 weeks before recovery, but most do not completely

The nurse is caring for a pediatric client who is scheduled for the surgical removal of a Wilms tumor. Which action is contraindicated in the client's care? a. Intravenous fluids b. Abdominal palpation c. Foley catheter placement d. Supine positioning

b. Abdominal palpation

The nurse is collecting data on a school-aged child with the following symptoms: Abrupt beginning to urinary symptoms Gross hematuria VS: 99 (F), 39.2 (C), 92, 22, 142/92 Mild edema Which disease condition does the nurse anticipate? a. Urinary tract infection b. Acute glomerulonephritis c. Nephrotic syndrome d. Wilms tumor

b. Acute glomerulonephritis

Coarctation of the aorta demonstrates few symptoms in newborns. What is an important assessment to make on all newborns to help reveal this condition? a. Observing for excessive crying b. Assessing for the presence of femoral pulses c. Recording an upper extremity blood pressure d. Auscultating for a cardiac murmur

b. Assessing for the presence of femoral pulses

After teaching a class about the hemodynamic characteristics of congenital heart disease, the instructor determines that the teaching has been successful when the class identifies which defect as an example of a disorder involving increased pulmonary blood flow? a. Tetralogy of Fallot b. Atrial septal defect c. Hypoplastic left heart syndrome d. Transposition of the great vessels

b. Atrial septal defect

Which health care provider assessment technique does the nurse anticipate being used to determine developmental dysplasia of the hip (DDH) on a newborn? a. Full range of motion of the hip b. Barlow sign and Ortolani click c. Assessing leg kicks for extension d. Visual inspection of the hip

b. Barlow sign and Ortolani click

The nurse is visually inspecting a urine specimen from a 12-year-old boy. The nurse documents gross hematuria with a specimen of which color? a. Cloudy yellow b. Cola colored c. Pale to almost clear urine d. Light orange to moderately yellow colored

b. Cola colored

The nurse discovers a hypospadias during the physical assessment of a newborn. Which information is most important? Select all that apply. a. Hypospadias does not need any medical intervention. b. Delay the circumcision until the hypospadias is surgically repaired. c. This congenital anomaly will cause further problems for the child as he grows to an adult. d. Surgical repair is often completed between ages 6 and 12 months. e. Save the diapers so that output can be measured.

b. Delay the circumcision until the hypospadias is surgically repaired. d. Surgical repair is often completed between ages 6 and 12 months. e. Save the diapers so that output can be measured.

A nurse is preparing a presentation for a local parent group about urinary tract infections (UTIs) in children. Which organism would the nurse incorporate into the presentation as the most common cause? a. Klebsiella b. Escherichia coli c. Staphylococcus aureus d. Pseudomonas

b. Escherichia coli

An 8-month-old infant has a ventricular septal defect. Which nursing diagnosis would best apply? a. Ineffective airway clearance related to altered pulmonary status b. Ineffective tissue perfusion related to inefficiency of the heart as a pump c. Impaired gas exchange related to a right-to-left shunt d. Impaired skin integrity related to poor peripheral circulation

b. Ineffective tissue perfusion related to inefficiency of the heart as a pump

The nurse is caring for child who present to the emergency department with reports of a fever for 5 days. The nurse notes a diffuse maculopapular rash, reddened cracked lips, erythema of hands, and bilateral conjunctivitis and suspects Kawasaki disease. Which nursing action is priority? a. Place the child on a soft diet. b. Initiate intravenous access. c. Administer acetaminophen. d. Assess cervical lymph nodes

b. Initiate intravenous access.

The nurse is assessing a child with suspected rheumatic fever. What assessment findings are consistent with the disease process? Select all that apply. a. Diastolic murmur b. Involuntary limb movement c. Macular rash on trunk d. Tender swollen joints e. Nonpalpable subcutaneous nodules

b. Involuntary limb movement c. Macular rash on trunk d. Tender swollen joints

After teaching a group of students about acute rheumatic fever, the instructor determines that the teaching was successful when the students identify which assessment finding? a. Janeway lesions b. Jerky movements of the face and upper extremities c. Black lines d. Osler nodes

b. Jerky movements of the face and upper extremities

The nurse is assessing a newborn and suspects developmental dysplasia of the hip (DDH). For which sign is the nurse prioritizing in this potential diagnosis? a. Symmetry of the gluteal skin folds b. Limited abduction of the affected hip c. Lengthening of the femur d. Bilateral adduction of the legs

b. Limited abduction of the affected hip

Absence seizures are marked by what clinical manifestation? a. Brief, sudden onset of increased tone of the extensor muscle b. Loss of motor activity accompanied by a blank stare c. Sudden, brief jerks of a muscle group d. Loss of muscle tone and loss of consciousness

b. Loss of motor activity accompanied by a blank stare

When reviewing the record of a child with tetralogy of Fallot, what would the nurse expect to discover? a. Leukopenia b. Polycythemia c. Increased platelet level d. Anemia

b. Polycythemia

The nurse is preparing a nursing care plan for an infant who was born with spina bifida with myelomeningocele. Which nursing goal should the nurse prioritize for this child? a. Reducing family anxiety b. Preventing infection c. Providing caregiver teaching d. Promoting comfort measures

b. Preventing infection

When conducting a physical examination of a child with suspected Kawasaki disease, which finding would the nurse expect to assess? a. Hirsutism or striae b. Strawberry tongue c. Malar rash d. Café au lait spots

b. Strawberry tongue

The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis? a. Loose, dark stools b. Tea-colored urine c. Strawberry-red tongue d. Jaundiced skin

b. Tea-colored urine

A newborn has been diagnosed with congenital heart disease. Which of the following congenital heart diseases is associated with cyanosis? a. coarctation of the aorta b. Tetralogy of Fallot c. pulmonary stenosis d. aortic stenosis

b. Tetralogy of Fallot

Parents are told their infant has a hypoplastic left heart. How would the nurse explain this condition to the family? a. This is a problem where the right side of the heart did not develop properly. b. This is a problem where the left side of the heart did not develop properly. c. There are no surgeries that can help the child live with this heart defect. d. The infant will have immediate surgery to completely correct the heart defect.

b. This is a problem where the left side of the heart did not develop properly.

A mother asks why her infant with a cyanotic heart defect turns blue. What is the nurse's best explanation? a. This is due to the lack of oxygen to the brain. b. This is due to a decreased amount of oxygen to the peripheral tissue. c. This is a sign of heart failure. d. This is considered a medical emergency and the infant needs immediate surgery.

b. This is due to a decreased amount of oxygen to the peripheral tissue.

A female adolescent comes to the clinic for an evaluation. Assessment reveals a possible urinary tract infection. What would the nurse expect to be done to confirm this suspicion? a. Kidneys, ureter, and bladder x-ray b. Urine culture c. Renal ultrasound d. Intravenous pyelogram

b. Urine culture

A 3-year-old child is exhibiting irritability, fever, and decreased appetite. A recent history of which of the following would make the nurse suspicious of a urinary tract infection (UTI)? a. lymphadenopathy b. abdominal pain c. rash d. leg pain

b. abdominal pain

The nurse will administer what medication to children with Kawasaki disease both in the acute and later stages of the illness? a. penicillin b. aspirin c. intravenous immune globulin d. iron

b. aspirin

The nurse asks the caregivers of a child diagnosed with cerebral palsy whether the child "seems to be in a state of constant motion." The question is designed to identify what form of cerebral palsy? a. ataxic b. athetoid c. rigidity d. spastic

b. athetoid

The nurse is caring for a child diagnosed with a urinary tract infection. The caregiver asks the nurse why it is so important for the child to have so much fluid. The nurse tells the caregiver that the most important reason the child needs increased fluids is to: a. fill the bladder so a specimen can be obtained. b. dilute the urine and flush the bladder. c. prevent the child from developing a fever. d. decrease the pain of urination.

b. dilute the urine and flush the bladder.

A symptom often seen in the child diagnosed with Haemophilus influenzae meningitis occurs when the child has a stiff neck. This symptom is referred to as which of the following? a. opisthotonos b. nuchal rigidity c. encephalopathy d. purpuric rash

b. nuchal rigidity

The nurse is caring for a client newly diagnosed with acute glomerulonephritis? When receiving the pediatric client's history, which is anticipated? a. a sports injury to the kidney two weeks ago b. onset of a streptococcus infection last week c. increased thirst, sweating, and shakiness since yesterday d. fatigue from viral infection onset 3 days ago

b. onset of a streptococcus infection last week

A nursing student is caring for a newborn with a defect in the neural arch where the posterior laminae of the vertebrae have failed to close. The nurse knows that this infant is suffering from which disorder? a. hydrocephalus b. spina bifida c. cleft palate d. esophageal atresia

b. spina bifida

A 6-month-old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room? a. A room with a 12-month-old infant with a urinary tract infection b. A room with an 8-month-old infant with failure to thrive c. A private room near the nurses' station d. A two-bed room in the middle of the hall

c. A private room near the nurses' station

Immediately after birth, the nurse is caring for a newborn with a myelomeningocele. What intervention should the nurse provide to prevent drying out of the sac to avoid damage? a. Cover the sac with petroleum jelly and a dry sterile dressing. b. Cover the sac with a water-soluble lubricant and a dry sterile dressing. c. Apply a sterile dressing moistened in a warm, sterile saline solution. d. Allow the sac to dry out to "toughen" it.

c. Apply a sterile dressing moistened in a warm, sterile saline solution.

The nurse is assessing a 6-week-old at a pediatrician's appointment. What objective data gathered by the nurse indicates a diagnosis of possible developmental dysplasia of the hip? Select all that apply. a. Hip clicking b. Adduction of the hips c. Asymmetry of the gluteal skin folds d. Limited abduction of the affected hip e. Apparent shortening of the femur

c. Asymmetry of the gluteal skin folds d. Limited abduction of the affected hip e. Apparent shortening of the femur

A child is diagnosed with bacterial meningitis. The nurse would suspect which abnormality of cerebrospinal fluid (CSF)? a. Decreased leukocytes b. Decreased pressure c. Cloudy appearance d. Elevated sugar

c. Cloudy appearance

A newborn is diagnosed with patent ductus arteriosus. The nurse anticipates that the physician will most likely order which medication? a. Alprostadil b. Heparin c. Indomethacin d. Spironolactone

c. Indomethacin

The nurse is caring for a 6-year-old child with acute glomerulonephritis. When reviewing the client's laboratory results, which result is most important to review with the health care provider? a. White blood cells: 8,000/µL (8.0 ×109/L) b. Urine culture positive for contaminants c. Positive culture for group A streptococcus d. Negative for respiratory syncytial virus (RSV)

c. Positive culture for group A streptococcus

Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis? a. Onset and character of fever b. Degree and extent of nuchal rigidity c. Signs of increased intracranial pressure (ICP) d. Occurrence of urine and fecal contamination

c. Signs of increased intracranial pressure (ICP)

When caring for a child who has a diagnosis of acute glomerulonephritis, which nursing interventions would most likely be included in the child's plan of care? Select all that apply. a. The nurse encourages ambulation several times a day. b. The nurse promotes increased fluid intake. c. The nurse administers diuretics. d. The nurse administers antihypertensives. e. The nurse weighs the child every day using the same scale. e. The nurse dipsticks the child's urine to test for protein.

c. The nurse administers diuretics. d. The nurse administers antihypertensives. e. The nurse weighs the child every day using the same scale. e. The nurse dipsticks the child's urine to test for protein.

The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100℉ (37.8℃). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have: a. a urinary tract infection. b. lipoid nephrosis (idiopathic nephrotic syndrome). c. acute glomerulonephritis. d. rheumatic fever.

c. acute glomerulonephritis.

The nurse is checking a newborn for the presence of Ortolani maneuver and Barlow sign. For which health problem are these assessments used? a. club foot b. cleft palate c. hip dysplasia d. tracheoesophageal fistula

c. hip dysplasia

The premise behind using plasmapheresis in a client diagnosed with Guillain-Barré syndrome includes which of the following? a. prevention of joint contractures b. prevention of skin breakdown c. prevention of demyelination d. prevention of deep vein thrombosis

c. prevention of demyelination

The nurse is teaching a group of nursing students about genitourinary conditions. The nurse tells these students about a condition that occurs when there is an inflammation of the kidney and renal pelvis. The condition the nurse is referring to is: a. oliguria. b. amenorrhea. c. pyelonephritis. d. ascites.

c. pyelonephritis.

The nurse is caring for a newborn diagnosed with patent ductus arteriosus. Which finding will the nurse assess that is consistent with this diagnosis? a. slow heart rate b. expiratory grunt c. systolic murmur d. absent femoral pulses

c. systolic murmur

A nurse is caring for a child with spina bifida. The child's mother asks the nurse what she did to cause the birth defect. Which statement would be the nurse's best response? a. "Older age at conception is one of the major causes of the defect." b. "It's a common complication of amniocentesis." c. "It has been linked to maternal alcohol consumption during pregnancy." d. "The cause is unknown and there are many environmental factors that may contribute to it."

d. "The cause is unknown and there are many environmental factors that may contribute to it."

The nurse is reviewing the laboratory test results of a child with nephrotic syndrome. What would the nurse least likely expect to find? a. Hyperlipidemia b. Hypoalbuminemia d. Decreased blood urea nitrogen (BUN) d. Hypoproteinemia

d. Decreased blood urea nitrogen (BUN)

The nurse is planning care for a 6-month-old infant with a large ventricular septal defect. Which nursing diagnosis should the nurse use to help guide the care for this client? a. Impaired gas exchange related to a right-to-left shunt b. Impaired skin integrity related to poor peripheral circulation c. Ineffective airway clearance related to altered pulmonary status d. Ineffective tissue perfusion related to left heart dilation from increased pulmonary blood flow

d. Ineffective tissue perfusion related to left heart dilation from increased pulmonary blood flow

While in a pediatric client's room, the nurse notes that the client is beginning to have a tonic-clonic seizure. Which nursing action is priority? a. Administer lorazepam rectally to the client. b. Refer the client to a neurologist. c. Discuss dietary therapy with the client's caregivers. d. Protect the child from hitting the arms against the bed.

d. Protect the child from hitting the arms against the bed.

A child is getting a diagnostic work-up for nephrotic syndrome. Which lab results would the nurse expect to see? a. Proteinuria, hypoalbuminemia, and hypercholesterolemia b. Hematuria, proteinuria, and hyperalbuminemia c. Neutropenia, hematuria, and hypocholesterolemia d. Proteinuria, hyperalbuminemia, and hypocholesterolemia

d. Proteinuria, hyperalbuminemia, and hypocholesterolemia

To prevent further urinary tract infections in a preschooler, what measures would you teach her mother? a. Encourage her to be more ambulatory to increase urine output. b. Teach her to take frequent tub baths to clean her perineal area. c. Suggest she drink less fluid daily to concentrate urine. d. Teach her to wipe her perineum front to back after voiding.

d. Teach her to wipe her perineum front to back after voiding.

The nurse is preparing discharge education for the caregivers of a child with a seizure disorder. Which goal of treatment is priority for this client? a. The caregivers will be prepared to care for the child at home. b. The child will have an understanding of the disorder. c. The family will understand seizure precautions. d. The child will remain free from injury during a seizure.

d. The child will remain free from injury during a seizure.

A client has just been admitted to the unit with a history of recent strep infection, hematuria, and proteinuria. Based on these findings, the nurse would suspect which condition? a. renal failure b. urinary tract infection c. prune belly syndrome d. acute glomerulonephritis

d. acute glomerulonephritis

When assessing an infant born at 32 weeks' gestation, which finding would lead the nurse to suspect that the newborn has a patent ductus arteriosus (PDA)? a. weak, thready pulse b. decreased pulse rate c. high diastolic arterial pressure d. continuous murmur on auscultation

d. continuous murmur on auscultation

Which intervention prevents a 17-month-old child with spastic cerebral palsy from going into a scissoring position? a. keeping the child in leg braces 23 hours per day b. letting the child lie down as much as possible c. trying to keep the child as quiet as possible d. placing the child on your hip

d. placing the child on your hip

The nurse is doing an in-service training with a group of peers on the topic of the genitourinary system. Which function is a major task of the kidneys? a. produce white blood cells b. remove carbon dioxide c. circulate cerebrospinal fluid d. regulate blood pressure

d. regulate blood pressure

The caregivers of a child who has had difficulty learning to walk notice that when the child attempts to pull himself up to stand, he can't seem to get his legs uncrossed and beside each other. When he is in a standing position, he stays up on his toes. This is different from what they saw with their older children and they are concerned. Further diagnostic tests indicate the child has cerebral palsy. When instructing on the types of cerebral palsy, which type will the nurse present? a. ataxic cerebral palsy b. athetoid cerebral palsy c. rigidity cerebral palsy d. spastic cerebral palsy

d. spastic cerebral palsy