NCM 109 Quiz 4 Reviewer

Cheska, the mother of an 11-month-old girl, KC, is in the clinic for her daughter's immunizations. She expresses concern to the nurse that Shannon cannot yet walk. The nurse correctly replies that, according to the Denver Developmental Screen, the median age for walking is: A. 12 months. B. 15 months. C. 10 months. D. 14 months.

A. By 12 months, 50 percent of children can walk well.

Nurse Charlotte suspects that a child, age 4, is being neglected physically. To best assess the child's nutritional status, the nurse should ask the parents which question? A. "Has your child always been so thin?" B. "Is your child a picky eater?" C. "What did your child eat for breakfast?" D. "Do you think your child eats enough?"

"What did your child eat for breakfast?" The nurse should obtain objective information about the child's nutritional intake, such as by asking about what the child ate for a specific meal. In order to assess the adequacy of a child's nutritional intake, dietitians require detailed information about all food and drink consumed. As all children admitted to the hospital are at risk of nutritional deficit, a dietary record should be started on all in-patients, although this may subsequently be discontinued when deemed appropriate.

A pediatric nurse advises a parent how to best convey the circumstances surrounding the sudden death of an infant to a four-year-old sibling. The nurse anticipates that the sibling: A. may feel guilty about the infant's death. B. may mistrust the parent. C. understands the permanence of death. D. will role-play the infant's death.

A.

Nurse Mariane is caring for an infant with spina bifida. Which technique is most important in recognizing possible hydrocephalus? A. Measuring head circumference B. Obtaining skull X-ray C. Performing a lumbar puncture D. Magnetic resonance imaging (MRI)

Answer A. Measuring head circumference is the most important assessment technique for recognizing possible hydrocephalus, and is a key part of routine infant screening. Skull X-rays and MRI may be used to confirm the diagnosis. A lumber puncture isn't appropriate.

he mother of Gian, a preschooler with spina bifida tells the nurse that her daughter sneezes and gets a rash when playing with brightly colored balloons, and that she recently had an allergic reaction after eating kiwifruit and bananas. The nurse would suspect that the child may have an allergy to: A. Bananas B. Latex C. Kiwifruit D. Color dyes

Answer B. Children with spina bifida often develop an allergy to latex and shouldn't be exposed to it. If a child is sensitive to bananas, kiwifruit, and chestnuts, then she's likely to be allergic to latex. Some children are allergic to dyes in foods and other products but dyes aren't a factor in a latex allergy.

When planning care for a 8-year-old boy with Down syndrome, the nurse should: A. Plan interventions according to the developmental level of a 7-year-old child because that's the child's age B. Plan interventions according to the developmental levels of a 5-year-old because the child will have developmental delays C. Assess the child's current developmental level and plan care accordingly D. Direct all teaching to the parents because the child can't understand

Answer C. Nursing care plan should be planned according to the developmental age of a child with Down syndrome, not the chronological age. Because children with Down syndrome can vary from mildly to severely mentally challenged, each child should be individually assessed. A child with Down syndrome is capable of learning, especially a child with mild limitations.

When caring for an 11-month-old infant with dehydration and metabolic acidosis, the nurse expects to see which of the following? A. A reduced white blood cell count B. A decreased platelet count C. Shallow respirations D. Tachypnea

Answer D. The body compensates for metabolic acidosis via the respiratory system, which tries to eliminate the buffered acids by increasing alveolar ventilation through deep, rapid respirations, altered white blood cell or platelet counts are not specific signs of metabolic imbalance.

An infant is hospitalized for treatment of nonorganic failure to thrive. Which nursing action is most appropriate for this infant? A. Encouraging the infant to hold a bottle B. Keeping the infant on bed rest to conserve energy C. Rotating caregivers to provide more stimulation D. Maintaining a consistent, structured environment

Answer D. The nurse caring for an infant with nonorganic failure to thrive should maintain a consistent, structured environment that provides interaction with the infant to promote growth and development. Encouraging the infant to hold a bottle would reinforce an uncaring feeding environment. The infant should receive social stimulation rather than be confined to bed rest. The number of caregivers should be minimized to promote consistency of care.

Sudden infant death syndrome (SIDS) is one of the most common causes of death in infants. At what age is the diagnosis of SIDS most likely? A. At 1 to 2 years of age B. At I week to 1 year of age, peaking at 2 to 4 months C. At 6 months to 1 year of age, peaking at 10 months D. At 6 to 8 weeks of age

At I week to 1 year of age, peaking at 2 to 4 months SIDS can occur any time between 1 week and 1 year of age. The incidence peaks at 2 to 4 months of age. Sudden infant death syndrome (SIDS) is the abrupt and unexplained death of an infant less than 1-year old. Despite a thorough investigation (a careful review of clinical history, death scene investigation, and a complete autopsy), a cause for the patient's demise is not identified.

Will is being assessed by Nurse Lucas for possible intussusception. Which of the following would be least likely to provide valuable information? A. Abdominal palpation B. Family history C. Pain pattern D. Stool inspection

B. Family history Because intussusception is not believed to have familial tendencies, obtaining a family history would provide the least amount of information. The causes of intussusception are not clearly known. About 90% of cases of intussusception in children arise from an unknown cause. They can include infections, anatomical factors, and altered motility.

Baby Ellie is diagnosed with gastroesophageal reflux (GER). Which of the following nursing diagnoses would be inappropriate? A. Risk for aspiration B. Impaired oral mucous membrane C. Deficient fluid volume D. Imbalanced nutrition: Less than body requirements

B. Impaired oral mucous membrane GER is the backflow of gastric contents into the esophagus resulting from relaxation or incompetence of the lower esophageal (cardiac) sphincter. No alteration in the oral mucous membranes occurs with this disorder.

Dustin who was diagnosed with Hirschsprung's disease has a fever and watery explosive diarrhea. Which of the following would Nurse Joyce do first? A. Administer an antidiarrheal. B. Notify the physician immediately. C. Monitor the child every 30 minutes. D. Nothing. (These findings are common in Hirschsprung's disease.)

B. Notify the physician immediately. For the child with Hirschsprung's disease, fever and explosive diarrhea indicate enterocolitis, a life-threatening situation. Therefore, the physician should be notified directly. Further important pointers in the history of patients with suspected HD include clinical features of Hirschsprung's associated enterocolitis (HAEC), multiple episodes of overflow constipation, and soft distended abdomen.

Hannah's child is scheduled for surgery due to myelomeningocele; the primary reason for surgical repair is which of the following? A. To prevent hydrocephalus B. To reduce the risk of infection C. To correct the neurologic defect D. To prevent seizure disorders

B. To reduce the risk of infection Surgical closure decreases the risk of infection stemming from damage to the fragile sac, which can lead to meningitis. Prenatal surgery was proven to be more effective than postnatal surgery in lowering the occurrence of future complications.

A woman who is about to deliver a baby at home reports that the fluid was thick green when her bag of water broke. The most important treatment of the newborn is to: A. vigorously dry and warm the baby. B. copiously suction the mouth and nose. C. administer oxygen by nasal cannula at 4 L/min. D. calculate the APGAR score.

B. copiously suction the mouth and nose.

A 6-month-old infant who is being cared for by a babysitter is unresponsive and has warm, pink skin and respirations without increased work of breathing.. The babysitter appears anxious and frustrated and explains that the infant had been crying for hours and would not stop. The babysitter states, "I couldn t get her to stop crying. I tried everything. All of a sudden she got really quiet, and I couldn't wake her up. Please help her. I can't take her crying any more." The babysitter states that she does not think that the infant has been sick recently. The infant s altered level of consciousness is most likely due to: A. toxic exposure. B. shaken baby syndrome. C. seizures. D. respiratory failure.

B. shaken baby syndrome

While Lawrence is being assessed at the clinic, Nurse Rachel observed that the child appears to be small, with an immature face and chubby body build. Her parents stated that their child's rate of growth of all body parts is somewhat slow, but her proportions and intelligence remain normal. As a knowledgeable nurse, you know that the child has a deficiency of which of the following? A. Antidiuretic hormone (ADH) B. Parathyroid hormone (PTH) C. Growth hormone (GH) D. Melanocyte-stimulating hormone (MSH)

C. Growth hormone (GH) GH stimulates protein anabolism, promoting bone and soft-tissue growth. A lack of GH would lead to decreased synthesis of somatomedin, resulting in decreased linear growth and decreased fat metabolism, and increased glucose uptake in muscles, resulting in excessive subcutaneous fat hypoglycemia.

Mr. and Ms. Byers' child failed to pass meconium within the first 24 hours after birth; this may indicate which of the following? A. Celiac disease B. Intussusception C. Hirschsprung's disease D. Abdominal-wall defect

C. Hirschsprung's disease Failure to pass meconium within the first 24 hours after birth may be a sign of Hirschsprung's disease, a congenital anomaly resulting in mechanical obstruction due to weak motility in an intestinal segment. History of the colonic obstruction, which might occur during the early neonatal period till adulthood, along with failure to pass meconium during the first 48 hours of the life, which presents in up to 90% of the affected patients, is highly compatible with the impression of HD.

Nurse Karen is providing postoperative care for Dustin who has cleft palate (CP); she should position the child in which of the following? A. In an infant seat B. In the supine position C. In the prone position D. On his side

C. In the prone position Postoperatively, children with a CP should be placed on their abdomens to facilitate drainage. A child who has had a cleft lip repair should be positioned on their side or back to keep them from rubbing their face in the bed. A child with only a cleft palate repair may sleep on their stomach. It is important to keep the stitches clean and without crusting.

Spina bifida is one of the possible neural tube defects that can occur during early embryological development. Which of the following definitions most accurately describes meningocele? A. Complete exposure of spinal cord and meninges B. Herniation of the spinal cord and meninges into a sac C. Sac formation containing meninges and spinal fluid D. Spinal cord tumor containing nerve roots

C. Sac formation containing meninges and spinal fluid. Meningocele is a sac formation containing meninges and cerebrospinal fluid (CSF). Meningocele is the simplest form of open neural tube defects characterized by cystic dilatation of meninges containing cerebrospinal fluid without any neural tissue. A complex meningocele is associated with other spinal anomalies. Meningocele is a typically asymptomatic spinal anomaly and is not associated with acute neurologic conditions.

Baby Jonathan was born with cleft lip (CL); Nurse Barbara would be alert that which of the following will most likely be compromised? A. GI function B. Locomotion C. Sucking ability D. Respiratory status

C. Sucking ability Because of the defect, the child will be unable to form a mouth adequately around the nipple, thereby requiring special devices to allow for feeding and sucking gratification. Patients with cleft lips inherently will have some degree of alveolar cleft with potential for collapse of the maxillary arch and class III malocclusion (the maxillary teeth sit posterior to the mandibular teeth). These hard and soft tissue anatomic changes translate to the various changes in appearance, speech, and swallowing/feeding seen in cleft lip patients.

The nurse is assessing a 9-month-old boy for a well-baby check-up. Which of the following observations would be of most concern? A. The baby cannot say "mama" when he wants his mother. B. The mother has not given him finger foods. C. The child does not sit unsupported. D. The baby cries whenever the mother goes out.

C. The child does not sit unsupported. Over 90% percent of babies can sit unsupported by nine months. At 4 months, a baby typically can hold his/her head steady without support, and at 6 months, he/she begins to sit with a little help. At 9 months he/she sits well without support, and gets in and out of a sitting position but may require help.

A child with a poor nutritional status and weight loss is at risk for a negative nitrogen balance. To help diagnose this problem, the nurse in charge anticipates that the doctor will order which laboratory test? A. Total iron-binding capacity B. Hemoglobin C. Total protein D. Serum transferrin

C. Total protein A negative nitrogen balance may result from inadequate protein intake and is best detected by measuring the total protein level. An increase in the protein intake produces an increase in nitrogen losses via higher amino acid oxidation, especially in the fed state, and a trend toward positivation of the nitrogen balance. Nitrogen balance and nitrogen levels at four levels of nitrogen intake in healthy adult subjects (data from Price et al. 1994).

The nurse is giving instructions to a mother with a child receiving a liquid oral iron supplement. The nurse tells the mother to: A. Take it with meals. B. Mix it with food. C. Mix it with milk. D. Administer it using a straw.

D. Administer it using a straw. An oral liquid iron supplement should be given with a straw because the medicine will stain the teeth. Mix each dose in water, fruit juice, or tomato juice. You may use a drinking tube or straw to help keep the iron supplement from getting on the teeth.

Which of the following infants is least probable to develop sudden infant death syndrome (SIDS)? A. Baby Angela who was premature B. A sibling of Baby Angie who died of SIDS C. Baby Gabriel with prenatal drug exposure D. Baby Gabby who sleeps on his back

D. Baby Gabby who sleeps on his back Infants who sleep on their back are least likely to develop SIDS. However, SIDS has been associated with infants who sleep on their abdomens. The incidence of SIDS declined by more than 50 percent in the United States after physicians began to promote "On the back to sleep." After the American Academy of Pediatrics (AAP) issued a recommendation for supine sleeping in 1992, the incidence of SIDS decreased.

Which of the following is the best method for performing a physical examination on a toddler A. From head to toe B. Distally to proximally C. From abdomen to toes, the to head D. From least to most intrusive

D. From least to most intrusive When examining a toddler or any small child, the best way to perform the exam is from least to most intrusive. Stay at the child's level as much as possible. Do not tower. Examine painful areas last-get general impression of overall attitude. Be honest. If something is going to hurt, tell them that in a calm fashion.

The nurse is assessing a newborn who had undergone vaginal delivery. Which of the following findings is least likely to be observed in a normal newborn? A. uneven head shape B. respirations are irregular, abdominal, 30-60 bpm C. (+) Moro reflex D. heart rate is 80 bpm

D. Heart rate is 80 bpm Normal heart rate of the newborn is 120 to 160 bpm. The high heart rate (120 to 160 beats per minute) seen in newborn infants can be attributed to the high metabolic rate of activity to main breathing, feeding, and thermogenesis.

How does the nurse appropriately administer Mycostatin suspension in an infant? A. Have the infant drink water, and then administer myostatin in a syringe B. Place Mycostatin on the nipple of the feeding bottle and have the infant suck it C. Mix Mycostatin with formula D. Swab Mycostatin on the affected areas

D. Swab Mycostatin on the affected areas. Mycostatin suspension is given as a swab. Mycostatin is given for an infection caused by Candida, which is called thrush. These spots come together and form "cheesy" white patches that may cover the tongue, the gums or sides, and roof of the mouth.