PED #4 (Chp 43, 48, 49, 50, 55, 57)

7) The nurse is assessing a child with Down syndrome. Which illness should the nurse monitor for due to the increased risk for children with Down syndrome? 1. Rheumatic heart disease 2. Glomerulonephritis 3. Leukemia 4. Hepatitis

3 Explanation: 1. Heart defects might be seen with Down syndrome, but not rheumatic heart disease, which is associated with group A beta-hemolytic streptococcus infection. 2. Glomerulonephritis is not seen in association with Down syndrome. 3. Children with Down syndrome have a significantly higher than average risk of developing leukemia. 4. Hepatitis is not associated with Down syndrome.

2) Which finding noted by the school nurse while conducting pediculosis capitis (head lice) checks would indicate the need for treatment? 1. White, flaky particles throughout the entire scalp region 2. Lesions on the scalp that extend to the hairline or neck 3. Maculopapular lesions behind the ears 4. Silver/white sacs attached to the hair shafts in the occipital area

4 Explanation: 1. Lice and nits must be distinguished from dandruff, which appears as white, flaky particles. 2. Lesions might be present from itching, but the positive sign of head lice is evidence of nits. 3. Lesions might be present from itching, but the positive sign of head lice is evidence of nits. 4. Evidence of pediculosis capitis includes silver/white sacs (nits) that are attached to the hair shafts, frequently in the occiput area.

26) Which functions of red blood cells (RBCs) should the nurse include in a teaching session for the family of a pediatric client who is diagnosed with anemia? Select all that apply. 1. Carry oxygen from the lungs to the tissues 2. Return carbon dioxide from the tissues to the lungs 3. Assist the body to fight infection 4. Assist the body to fight allergens 5. Form hemostatic plugs to stop bleeding

1, 2 Explanation: 1. A function of RBCs is to carry oxygen from the lungs to the tissues. 2. A function of RBCs is to return carbon dioxide from the tissues to the lungs. 3. A function of the white blood cells, not the RBCs, is to fight infection. 4. A function of the white blood cells, not the RBCs, is to fight allergens. 5. A function of platelets, not RBCs, is to form hemostatic plugs to stop bleeding.

30) Which injury prevention topics should the nurse include in the plan of care for a pediatric client who has received hematopoietic stem cell transplantation (HSCT)? Select all that apply. 1. Medication storage strategies 2. Needle and syringe disposal 3. Immunization schedule 4. Yearly influenza vaccination 5. Routine dental appointments

1, 2 Explanation: 1. Medication storage strategies is a topic the nurse should include in the plan of care related to injury prevention strategies. 2. Needle and syringe disposal is an area the nurse should include in the plan of care related to injury prevention strategies. 3. An altered immunization schedule is a topic related to infection, not injury, prevention. 4. Yearly influenza vaccination is a topic related to infection, not injury, prevention. 5. Routine dental appointments are an important topic to include regarding oral health, not injury prevention

17) Which clinical manifestations should the nurse expect when conducting an assessment for a child who is diagnosed with autism spectrum disorder (ASD)? Select all that apply. 1. Arm flapping 2. Language delays 3. Ritualistic behavior 4. Impulsive behavior 5. Sleep disturbances

1, 2, 3 Explanation: 1. Arm flapping is a clinical manifestation associated with ASD. 2. Language delay is a clinical manifestation associated with ASD. 3. Ritualistic behavior is a clinical manifestation associated with ASD. 4. Impulsive behavior is a clinical manifestation associated with attention deficit hyperactivity disorder, not ASD. 5. Sleep disturbance is a clinical manifestation associated with attention deficit hyperactivity disorder, not ASD.

11) The nurse is providing care to a pediatric client who is receiving chemotherapy to treat acute lymphocytic leukemia (ALL). Which nursing diagnoses should the nurse include in the plan of are based on the side effects associated with the treatment? Select all that apply. 1. Risk for Injury 2. Impaired Skin Integrity 3. Risk for Electrolyte Imbalance 4. Risk for Infection 5. Sleep Deprivation

1, 2, 3, 4 Explanation: 1. Risk for Injury is an appropriate nursing diagnosis for a pediatric client due to the potential hemorrhagic cystitis, a common side effect for chemotherapy. 2. Impaired Skin Integrity is an appropriate nursing diagnosis for the pediatric client due to mouth sores, a common early side effect of chemotherapy. 3. Nausea and vomiting are common early side effects of chemotherapy; therefore, Risk for Electrolyte Imbalance is an appropriate nursing diagnosis for this pediatric client. 4. Risk for Infection is an appropriate nursing diagnosis as chemotherapy due to bone marrow suppression. 5. Sleep Deprivation is not a nursing diagnosis related to the administration of chemotherapy for a pediatric client.

1) The nurse is assessing a 4-year-old child with a possible alteration in mental health. Which findings indicate a need for further investigation? Select all that apply. 1. Fails to make eye contact 2. Flinches when touched on the arm 3. History of limited prenatal care and precipitate delivery 4. Head circumference has not changed in over 1 year 5. Flat facial expressions

1, 2, 3, 5 Explanation: 1. Making eye contact with the nurse and caregiver is part of the child's overall affect and social skills. A child who fails to make eye contact may have an alteration in mental health. 2. Flinching may indicate a desire to avoid contact; this can indicate a mental health issue and should be further evaluated. 3. History of prenatal care and delivery can help determine potential alterations in mental health in a child. 4. Head circumference is not measured in a 4-year-old. 5. Affect can be determined by facial expression and response to the nurse, helping to determine mental health. Page Ref: 1487

19) Which interventions should the nurse include in the plan of care for a child who is diagnosed with an intellectual disability? Select all that apply. 1. Providing emotional support to the family 2. Maintaining a safe environment for the client 3. Educating the family that maintenance of activities of daily living (ADL) is impossible to achieve 4. Participating in the individualized education program (IEP) process 5. Recommending permanent institutionalization

1, 2, 4 Explanation: 1. The nurse should include interventions in the plan of care for a child diagnosed with an intellectual disability that support the family. 2. The nurse should include interventions in the plan of care for a child diagnosed with an intellectual disability that maintain a safe environment. 3. Maintenance of ADL will be determined by the severity of the intellectual disability. 4. The nurse should participate in the IEP process for a child who is diagnosed with an intellectual disability. 5. Permanent institutionalization is no longer recommended for children diagnosed with an intellectual disability.

20) The mother of an immunocompromised child expresses concern that her child will "catch" a disease from the scheduled vaccination. Which vaccines should be administered to this child as they carry no risk for acquiring the infection? (Select All That Apply) 1. Toxoid 2. Killed virus vaccine 3. Live virus vaccine 4. Attenuated vaccine 5. Immunoglobulins

1, 2, 5 Explanation: 1. A toxoid is not an organism but a chemical produced by the organism. The toxoid has been treated to weaken its toxic effect. 2. The immunization contains organisms that are dead and incapable of reproducing. 3. This immunization contains live but weakened organisms. These organisms can mutate and reproduce and may cause disease in a weakened immune system. 4. An attenuated vaccine is the same as a live virus vaccine. 5. Immunoglobulins are the antibodies produced by others against a disease. They do not contain the live or killed virus.

28) Which communicable diseases, preventable through childhood immunization, should the nurse include in a presentation to families at a local community center wellness fair? (Select all that apply.) 1. Measles 2. Chickenpox 3. Fifth disease 4. Mononucleosis 5. Whooping cough

1, 2, 5 Explanation: 1. Measles is a communicable disease that can be prevented through childhood immunization. 2. Chickenpox is a communicable disease that can be prevented through childhood immunization. 3. Fifth disease, while a communicable disease, is not preventable through childhood immunization. 4. Mononucleosis, while a communicable disease, is not preventable through childhood immunization. 5. Whooping cough, or pertussis, is a communicable disease that can be prevented through childhood immunization.

21) Which interventions should the nurse include in the plan of care for a hospitalized child who is diagnosed with rheumatoid arthritis (RA)? Select all that apply. 1. Performing passive range-of-motion (ROM) exercises with the child 2. Discouraging the child from completing activities of daily living (ADLs) 3. Encouraging periods of rest for the child 4. Placing cool compresses on the child's joints 5. Performing daily weights

1, 3, 5 Explanation: 1. Active and passive ROM is encouraged as this decreases joint stiffness and inflammation. 2. The child should be encouraged, not discouraged, to be as independent as possible with ADLs. 3. Exacerbations of RA often cause fatigue; therefore, it is appropriate for the nurse to encourage rest periods. 4. Warm, not cool, compresses should be placed on the joints. 5. Daily weights are needed, as it is not uncommon for the child with RA to experience reduced activity and metabolic needs yet maintain the same diet, which places the child at risk for overweight and obesity.

9) After a severe allergic reaction, an EpiPen is prescribed for the school-age child. Which instructions should the nurse provide to this child's parents based on the current data? Select all that apply. 1. "It is important that your child always has access to this medication." 2. "Your child is too young to self-administer this medication." 3. "If you are able to administer the medication, there is no need for follow-up care." 4. "It is important to check the expiration date on the medication and replace if expired." 5. "Your child should wear a Medic Alert bracelet at all times."

1, 4, 5 Explanation: 1. This is appropriate care. 2. Both the child and family members should be taught administration of the EpiPen. 3. The EpiPen effect is good for approximately 20 minutes. The child should be transported to the hospital immediately after administering the EpiPen. 4. An expired EpiPen may have less than desired effects. 5. If the child is unable to speak due to anaphylaxis, it is important that rescuers have information about the child's allergies.

6) The nurse is preparing to administer a prescribed, as needed, antiemetic drug for a child who is diagnosed with cancer. Which action by the nurse is most appropriate? 1. Administering the drug only if the child is nauseated 2. Administering the drug prophylactically prior to the next dose of chemotherapy 3. Administering the drug after the next dose of chemotherapy 4. Administering the drug only if the child is experiencing diarrhea

2 Explanation: 1. Administering the prn dose of the antiemetic drug only if the child is nausea is not the best use of this medication. 2. The antiemetic should be administered before chemotherapy and every 4 hours during the administration of chemotherapy, as a prophylactic measure. 3. Administering the prn dose of the antiemetic drug after the next dose of chemotherapy may not provide adequate coverage for nausea. 4. Antiemetic drugs are not administered to treat diarrhea. They are administered to treat nausea and vomiting.

13) Which is the priority nursing action when providing care to a child who is bitten by a snake? 1. Measuring the circumference of the extremity twice per hour 2. Monitoring respiratory status 3. Assessing vital signs 4. Evaluating response to pain medication

2 Explanation: 1. In order to track progression in swelling and response to treatment, the extremity with the bite is measured every 20 to 30 minutes. However, this does not take priority over airway, breathing, and circulation. 2. Emergency intervention for airway, breathing, and circulation takes priority and has a high probability of occurrence. 3. Vital signs and neurovascular status of the distal extremities should be monitored but do not take priority over airway, breathing, and circulation. 4. Pain medication will need to be given and the response to the treatment monitored; however, this should not take priority over airway, breathing, and circulation.

29) The nurse is providing care to a pediatric client who is diagnosed with leukopenia. Which disorders should the nurse suspect based on this information? Select all that apply. 1. Cardiovascular 2. Immune 3. Bone marrow 4. Respiratory 5. Neurologic

2, 3 Explanation: 1. Cardiovascular disorders are not associated with leukopenia. 2. Immune disorders are associated with leukopenia. 3. Bone marrow disorders are associated with leukopenia. 4. Respiratory disorders are not associated with leukopenia. 5. Neurologic disorders are not associated with leukopenia.

17) The nurse is providing discharge instructions to the family of a child who experienced an anaphylactic reaction. Which parental statements indicate accurate understanding of the action that histamine plays during this type of reaction? Select all that apply. 1. "Histamine releases IgE antibodies, which help to stop the reaction." 2. "Histamine causes smooth muscle contraction, which causes the wheezing." 3. "Histamine causes increased capillary permeability, which is what causes difficulty breathing." 4. "Histamine causes vasoconstriction leading to respiratory issues." 5. "Histamine causes the destruction of red blood cells, which is why we administer the EpiPen."

2, 3 Explanation: 1. IgE antibodies cause the release of histamine, not the other way around. 2. Smooth muscle contraction causes the constriction of the bronchioles, which causes the wheezing and respiratory distress. 3. Increased capillary permeability causes the plasma to leak into surrounding tissues, including the lungs, leading to pulmonary edema. 4. Anaphylaxis causes vasodilation, not vasoconstriction. 5. Histamine does not cause red cell destruction.

21) Which nursing actions allow a child to acquire active immunity against a disease? (SATA) 1. Administering a dose of immunoglobulins 2. Administering a killed virus vaccine 3. Administering a toxoid vaccine 4. Administering antibiotic therapy 5. Administering antiviral therapy

2, 3 Explanation: 1. Immunoglobulins provide passive immunity. No active immunity is acquired. 2. This immunization will stimulate antibody production in the child which is active immunity. 3. This immunization will also stimulate antibody production in the child. 4. Antibiotic therapy provides no immunity. 5. Antiviral therapy provides no immunity.

4) Which parental statements regarding precipitating factors for sickle-cell disease indicate correct understanding of the discharge information presented by the nurse? Select all that apply. 1. "My child should avoid regular exercise." 2. "We should provide acetaminophen or ibuprofen to treat fever." 3. "Our child needs to drink lots of fluid to avoid dehydration when playing sports." 4. "High altitudes can cause exacerbation and should be avoided." 5. "Fluid restriction is necessary to avoid exacerbations from occurring."

2, 3, 4 Explanation: 1. Regular exercise and increased fluid intake are recommended activities for a child with sickle-cell disease and will not contribute to a sickle-cell crisis. 2. Fever, dehydration, and altitude are all precipitating factors contributing to a sickle-cell crisis. 3. Fever, dehydration, and altitude are all precipitating factors contributing to a sickle-cell crisis. 4. Fever, dehydration, and altitude are all precipitating factors contributing to a sickle-cell crisis. 5. Regular exercise and increased fluid intake are recommended activities for a child with sickle-cell disease and will not contribute to a sickle-cell crisis.

4) Which statement from the parent of a child diagnosed with attention deficit/hyperactivity disorder (ADHD) indicates the need for further education by the nurse? 1. "I will develop a reward system for desired behaviors." 2. "I will take my child to the physician every 3 months for a weight and height check." 3. "I will let him do his homework while he is watching his favorite television show." 4. "I will stick to the same routine each day after school."

3 Explanation: 1. A reward system is a part of behavior modification and is appropriate to help the child behave appropriately. 2. Children with ADHD should be screened regularly for height and weight to monitor growth, which can be affected by medication. 3. This child should do homework in a quiet environment, away from distractions. 4. Maintaining the same daily routine helps the child know expectations, and a nighttime routine helps counteract insomnia.

12) Which activities should the nurse include in the plan of care for a child diagnosed with attention deficit/hyperactivity disorder (ADHD) to improve behavior and learning? Select all that apply. 1. Asking the mother to seek a prescription for methylphenidate (Ritalin) for the child 2. Placing the child's desk at the back of the room to reduce distractions 3. Developing a consistent routine for the classroom 4. Limiting the decorations in the classroom 5. Determining areas where the child performs well and using these areas to promote self-esteem

3, 4, 5 Explanation: 1. It is not the nurse's or teacher's place to suggest medications for this child. 2. The child's desk should be placed at the front of the room to promote attention. 3. Consistency is important for the child with ADD/ADHD and reduces impulsive behavior. 4. Decorations are distracting and should be limited. 5. This is appropriate and will help reduce "acting out" behaviors.

26) There has been an outbreak of communicable diseases in the community. To reduce parental anxiety, the nurse presents information about disease at the school's Parent Teacher Association meeting. Which vectorborne diseases, not communicable from person to person, should the nurse include in the teaching session? Select all that apply. 1. Measles 2. Whooping cough 3. Rocky Mountain spotted fever 4. West Nile virus 5. Lyme disease

3, 4, 5 Explanation: 1. Rubeola, or measles, is caused by a virus and is transmitted person to person. 2. Pertussis, or whooping cough, is caused by a gram-positive coccobacillus called Bordetella pertussis and is spread person to person. 3. Rocky mountain spotted fever is a vectorborne disease spread by a tick. 4. West Nile virus is transmitted by a mosquito, a vector, and is not transmitted person to person. 5. Lyme disease is also a vectorborne disease spread by a tick.

21) Which adolescent statements indicate the need for further education related to the prevention and treatment of acne? Select all that apply. 1. "I should wash my face each day with an approved cleanser." 2. "I should wash my hands frequently and avoid touching my face." 3. "I should stay away from greasy foods, such as pizza." 4. "I should shampoo my hair only once per week." 5. "I should use my topical medication only when acne is present."

3, 4, 5 Explanation: 1. Washing the face with an approved cleanser each day indicates appropriate understanding of prevention and treatment for acne. 2. Performing frequent hand hygiene and not touching the face indicates appropriate understanding of prevention and treatment for acne. 3. There is no evidence to suggest that greasy foods, such as pizza, cause acne. This statement indicates the need for further education. 4. Hair should be shampooed frequently, as the oil hair can cause acne. This statement indicates the need for further education. 5. Prescribed topical medication should be used daily and spread over the entire face. This statement indicates the need for further education.

22) The heatlthcare provider prescribes a unit of packed red blood cells for a pediatric client. Which intravenous fluid should the nurse hang during the blood transfusion? 1. D5W 2. D5LR 3. D5 1/4NS 4. NS

4 Explanation: 1. Dextrose should not be hung, as it will cause packed cells to clot. 2. D5 lactated Ringer solution also contains dextrose and should not be hung with packed cells. 3. Dextrose is inappropriate no matter what is the other component of the intravenous fluids. 4. Normal saline is appropriate to hang prior to initiating blood.

8) Which children should the nurse identify as exhibiting a delay in meeting developmental milestones? Select all that apply. 1. An 18-month-old toddler who is unable to speak in sentences 2. A 2-year-old child who is unable to cut with scissors 3. A 2-year-old child who cannot recite her phone number 4. A 6-year-old child who is unable to sit still for a short story 5. A 5-year-old child who is unable to button his shirt

4, 5 Explanation: 1. An 18-month-old toddler is not usually able to speak in sentences. This is a skill to be accomplished by the age of 2.5 years. 2. A child who cannot cut with scissors by kindergarten age is considered abnormal. 3. A 2-year-old child is not expected to be able to recite a phone number. 4. A 6-year-old child should be able to sit still for a short story. A 3- to 5-year-old child should be able to sit still through a short story. 5. A 5-year-old child should be able to button his shirt.

18) Which clinical manifestations should the nurse expect when conducting an assessment for a child who is diagnosed with attention deficit/ hyperactivity disorder (ADHD)? Select all that apply. 1. Arm flapping 2. Language delays 3. Ritualistic behavior 4. Impulsive behavior 5. Sleep disturbances

4, 5 Explanation: 1. Arm flapping is a clinical manifestation associated with autism spectrum disorder, not ADHD. 2. Language delay is a clinical manifestation associated with autism spectrum disorder, not ADHD. 3. Ritualistic behavior is a clinical manifestation associated with autism spectrum disorder, not ADHD. 4. Impulsive behavior is a clinical manifestation associated with ADHD. 5. Sleep disturbance is a clinical manifestation associated with ADHD.

19) A school-age child diagnosed with classic hemophilia is admitted to the hospital for hemorrhage into the knee joint. Which nursing diagnosis should the nurse use to plan care for this child? 1. Risk for Impaired Physical Mobility related to joint stiffness and contractures 2. Risk for Impaired Tissue Perfusion (cerebral) related to blood loss. 3. Activity Intolerance related to bleeding 4. Disturbed Body Image related to swollen knee

1 Explanation: 1. A bleed into the joint can lead to permanent contracture of the joint. Bone changes can result from the immobility associated with the bleed. 2. Bleeding into the knee joint tends to be limited and decreased blood flow to the brain is unlikely. 3. Activity intolerance is not the best diagnosis for this child. 4. Although the knee will be swollen, body image is not the priority diagnosis at this time.

9) A child diagnosed with hemophilia presents to the emergency department (ED) with multiple injuries following a motor vehicle crash. Which injury is the priority when conducting the nursing assessment? 1. Occipital hematoma 2. Radial fracture 3. Dislocated shoulder 4. Abdominal abrasions

1 Explanation: 1. A potential intracranial bleed would receive highest priority because of the danger of increased intracranial pressure and potential neurologic damage. 2. Although at risk for bleeding, this would not take priority over a head injury. 3. A dislocation is not at high risk for bleeding or tissue ischemia. 4. Although at risk for bleeding, this would not take priority over a head injury.

16) The nurse is providing care for the family of a child who is diagnosed with acquired immunodeficiency syndrome (AIDS). Which priority nursing diagnosis should the nurse include in the plan of care? 1. Anticipatory Grieving 2. Risk for Impaired Parenting 3. Compromised Family Coping 4. Parental Role Conflict

1 Explanation: 1. AIDS is not curable, so the problem nurses can anticipate, for all families, is Anticipatory Grieving. 2. AIDS is not curable, so the problem nurses can anticipate, for all families, is Anticipatory Grieving. Risk for Impaired Parenting might be present, but further information is needed to anticipate this problem. 3. AIDS is not curable, so the problem nurses can anticipate, for all families, is Anticipatory Grieving. Compromised Family Coping might be present, but further information is needed to anticipate this problem. 4. AIDS is not curable, so the problem nurses can anticipate, for all families, is Anticipatory Grieving. Parental Role Conflict might be present, but further information is needed to anticipate this problem.

8) A child is prescribed oral corticosteroid for a rash caused by graft-versus-host disease. Which should the nurse monitor the child for after administering the drug? 1. Hyperglycemia 2. Hepatic toxicity 3. Seizures 4. Renal toxicity

1 Explanation: 1. Hyperglycemia is a side effect of steroid therapy. 2. Hepatic toxicity is not a side effect associated with steroid therapy. 3. Seizures are not a side effect associated with steroid therapy. 4. Renal toxicity is not a side effect associated with steroid therapy.

9) Which should the nurse include in the plan of care for a child with a minor burn to enhance nutrition and healing? 1. Protein 2. Minerals 3. Carbohydrates 4. Fats

1 Explanation: 1. Parents should be taught that management of a minor burn requires a high-calorie, high-protein diet. This is necessary to meet the increased nutritional requirements of healing. 2. A high-calorie, high-protein diet is required to meet the increased nutritional requirements for healing. 3. The family should be taught that a high-calorie, high-protein diet is best to meet the increased nutritional requirements for healing. 4. A high-calorie, high-protein diet is best to meet the increased nutritional requirements for healing.

7) A child who has not had a tetanus immunization steps on a rusty nail. Which term should the nurse use to identify the tetanus immunization when teaching the parents about the vaccine? 1. Toxoid 2. Live virus 3. Killed virus 4. Recombinant

1 Explanation: 1. Toxoids are chemicals normally associated with a disease that stimulate the production of immunity. A tetanus immunization is an example of a toxoid vaccine. 2. A live virus vaccine contains a microorganism that is live but attenuated, or in a weakened form. A varicella immunization is an example of a live virus vaccine. 3. A killed virus vaccine contains a microorganism that has been killed but is still capable of causing the human body to produce antibodies. This term is used to describe an inactivated poliovirus vaccine. 4. A recombinant vaccine used a genetically altered organism. A hepatitis B immunization is an example of this type vaccine.

23) The nurse is providing care to a child who experienced an anaphylactic reaction to an unknown allergen. Which high-risk foods should the nurse question the family about regarding recent consumption? 1. Peanut butter 2. Shrimp 3. Eggs 4. Milk 5. Soda

1, 2, 3 Explanation: 1. Peanut products, such as peanut butter, are considered a high-risk food allergen. The nurse should question the family about the consumption of this product. 2. Shellfish, such as shrimp, is considered a high-risk food allergen. The nurse should question the family about the consumption of this product. 3. Egg whites are considered a high-risk food allergen. The nurse should question the family about the consumption of this product. 4. While milk allergies are common, they rarely cause anaphylaxis. 5. Soda is not a high risk for the nurse to include in the assessment process.

24) Which topics should be include included in a teaching session with parents of school-age children to prevent sunburn? Select all that apply. 1. Playing in the shade 2. Wearing a hat while outdoors 3. Restricting outside activities between 10 a.m. and 2 p.m. 4. Using sunscreen with an SPF of 30 or higher 5. Avoiding sunglasses

1, 2, 4 Explanation: 1. The nurse should recommend that school-age children play in the shade while outdoors to decrease the risk for sunburn. 2. The nurse should recommend that school-age children wear a hat while outdoors to decrease the risk for sunburn. 3. Outdoor activities should be restricted between 10 a.m. and 4 p.m. to decrease the risk for sunburn. 4. The nurse should recommend that school-age children use sunscreen with an SPF of 30 or higher to decrease the risk for sunburn. 5. Sunglasses should be encouraged, not discouraged, to decrease the risk for sunburn around the eyes.

23) A school-age child is admitted to the hospital in a sickle-cell crisis. Which actions should the nurse include in the plan of care to address the child's pain? 1. Administering opioid analgesics, per order 2. Administering nonsteroidal anti-inflammatory drugs (NSAIDs), per order 3. Applying cold packs to affected joints, prn 4. Encouraging oral fluid intake 5. Maintaining bed rest

1, 2, 4, 5 Explanation: 1. Narcotics, such as morphine, are used to control the pain and reduce sickling. 2. NSAIDs may be used in combination with narcotics to control the pain. 3. Cold application is inappropriate in this situation as it would increase the sickling. 4. Oral fluids will help "thin" the blood and reduce sickling. 5. Bed rest will reduce the oxygen requirements of the body and prevent further sickling.

9) The nurse is planning care for a school-age child diagnosed with separation anxiety disorder. Which aspects of cognitive-behavior therapy (CBT) should the nurse include in the teaching plan for the child's family? Select all that apply. 1. Self-talking 2. Relaxation 3. Hypnosis 4. Antidepressant medications 5. Recognition of feelings

1, 2, 5 Explanation: 1. Self-talking helps a child to focus the inner thoughts on the desired behavior. 2. Teaching self-relaxation skills can help the child to reduce anxiety. 3. Hypnosis is not a component of cognitive-behavioral therapy. 4. Although medications may be a part of the treatment plan, it is not a component of cognitive-behavioral therapy. 5. Recognition and acceptance of feelings helps the child to move forward toward a desired behavior.

31) Which vaccines should the nurse prepare to administer to a 6-month-old infant during a scheduled well-child visit? Select all that apply. 1. DTaP vaccine 2. Hib vaccine 3. HPV4 vaccine 4. MMR vaccine 5. PCV13 vaccine

1, 2, 5 Explanation: 1. The DTap vaccine is appropriate for the nurse to administer to a 6-month-old infant during a scheduled well-child visit. 2. The Hib vaccine is appropriate for the nurse to administer to a 6-month-old infant during a scheduled well-child visit. 3. The HPV4 vaccine is not appropriate to administer to a 6-month-old infant during a scheduled well-child visit. This vaccine is not administered until a child is 11 to 12 years of age. 4. The MMR vaccine is not appropriate to administer to a 6-month-old infant during a scheduled well-child visit. This vaccine is not administered until a child is 12 to 15 months of age. 5. The PCV13 vaccine is appropriate for the nurse to administer to a 6-month-old infant during a scheduled well-child visit.

20) Which items noted in a pediatric client's medical record indicate the child may be experiencing a learning disability? Select all that apply. 1. Dyslexia 2. Dysphagia 3. Dyspraxia 4. Scoliosis 5. Hypotonia

1, 3 Explanation: 1. Dyslexia is the medical term indicating problems with reading, writing, and spelling. This indicates the child may be experiencing a learning disability. 2. Dysphagia is a medical term indicating problems with swallowing. This would not indicate the child is experiencing a learning disability. 3. Dyspraxia is the medical term indicating problems with manual dexterity and coordination. This indicates the child may be experiencing a learning disability. 4. Scoliosis is curvature of the spine. This does not indicate the child may be experiencing a learning disability; however, this is often associated with Down syndrome. 5. Hypotonia is decreased muscle tone. This does not indicate the child may be experiencing a learning disability; however, this is often associated with Fragile X syndrome.

20) Which rationale should the nurse include in the teaching session, related to infant iron deficiency anemia, when a parent asks why it is inappropriate to switch from formula to cow's milk prior to 1 year of age? Select all that apply. 1. Cow's milk is a poor source of iron. 2. The child may be exposed to an antibiotic in processed milk. 3. Cow's milk has a high fat content. 4. In young children, cow's milk can lead to bleeding from the gastrointestinal tract. 5. Cow's milk contains no vitamin C, which is necessary for iron absorption.

1, 4 Explanation: 1. This information is correct. 2. This would not be a reason for delaying the entry of milk into the diet. 3. Because there are low-fat varieties of cow's milk, this would not be a reason to delay introducing it. 4. This information is correct. 5. While the amount of vitamin C in milk is limited, this is not the reason for delaying introducing cow's milk into the child's diet.

21) The nurse is preparing to administer a blood transfusion to a child with a severe anemia. Which type of transfusion reaction can be avoided by the nurse's assessment? 1. Allergic 2. Hemolytic 3. Febrile 4. Septic

2 Explanation: 1. Allergic reactions are due to a protein in the donated blood to which the child reacts. The nurse cannot prevent this type of reaction. 2. A hemolytic reaction results from mismatched blood, a preventable error. This error is most likely to occur at the bedside if the nurse does not carefully identify the unit of blood and the patient. 3. A febrile reaction is related to contamination of blood. The nurse has no control over this type of reaction. 4. Septic is another name for a febrile reaction and is not preventable by the nurse.

6) A child who has beta-thalassemia is receiving numerous blood transfusions and deferoxamine (Desferal) therapy. The parents ask how the deferoxamine will help their child. Which response by the nurse is accurate? 1. "It stimulates red blood cell production." 2. "It prevents iron overload." 3. "It provides vitamin supplementation." 4. "It decreases the risk of transfusion reactions."

2 Explanation: 1. Desferal does not stimulate red blood cell production. 2. Iron overload can be a side effect of a hypertransfusion therapy. Desferal is an iron-chelating drug that binds excess iron so it can be excreted by the kidneys. It does not prevent blood transfusion reactions, stimulate red blood cell production, or provide vitamin supplementation. 3. Desferal does not provide vitamin supplementation. 4. Desferal does not prevent blood transfusion reactions.

2) A premature neonate is at greater risk for infection than a full-term newborn because of a reduced number of which immunoglobulin? 1. IgE 2. IgG 3. IgA 4. IgM

2 Explanation: 1. IgE does not cross the placenta and is not present at birth in either preterm or full-term infants. 2. Maternal IgG crosses the placenta. Newborns' levels are similar to their mothers'. Premature infants have lower levels of IgG obtained from their mothers and are at greater risk for infection. 3. IgA does not cross the placenta and is not present at birth in either preterm or full-term infants. 4. IgM does not cross the placenta. The levels are low at birth in both preterm and full-term infants.

6) The nurse is teaching parents how to prevent the spread of infectious disease. Which is the priority health promotion strategy the nurse should recommend for all age groups of children? 1. Decreasing environmental exposure to pathogens 2. Performing hand hygiene 3. Ensuring all toys are clean and free from germs 4. Keeping child away from sick adults

2 Explanation: 1. It is not possible to keep children free from colds. 2. Proper hand hygiene is one of the most important health promotion strategies for all age groups of children as well as child care providers. 3. Keeping all toys clean and free from germs is not possible. 4. It is not always possible to keep children away from sick adults.

17) Which adolescent statement regarding skin care and acne prevention would indicate the need for further education by the nurse? 1. "I shouldn't squeeze my blackheads or pimples." 2. "I need to watch my diet and cut out all chocolates." 3. "I should avoid applying drying materials, such as astringents, to my face" 4. "I should wash my hands frequently and avoid touching my face."

2 Explanation: 1. This practice can introduce organisms into the lesions and should be avoided. This statement needs no clarification. 2. There has been no research that connects diet to acne. A healthy diet with protein is recommended, but chocolate does not have to be excluded. This statement needs to be clarified. 3. This statement is accurate and needs no clarification. 4. This is an important means of reducing facial irritation.

5) The nurse is teaching a preschool-age child and parents the importance of hand washing after using the toilet. Which rationale for this practice should the nurse include in the teaching session? 1. Children's immune systems are not fully developed. 2. It is the main way to limit the transmission of disease. 3. Not all bathrooms are clean. 4. Children do not like to have dirty hands.

2 Explanation: 1. Underdeveloped immune systems will not transmit disease. 2. The fecal-oral and respiratory routes are the most common sources of transmission in children. 3. Children usually do not wash their hands after toileting unless they are closely supervised. 4. This is not a reason for washing hands after using the toilet.

3) The 10-year-old child is admitted to the hospital following an accident at school that resulted in a puncture wound of the abdomen. Two days after the injury, the child continues in the inflammation phase of healing. What would the nurse expect to see while changing the child's dressing and assessing the wound? 1. The wound is contracting, and the edges are growing together. 2. A blood clot has formed, sealing the wound. 3. Epithelial cells are growing into the wound. 4. The wound is pale and weepy.

2 Explanation: 1. Wound contraction and inward movement of the wound edge occur during the reconstruction phase of wound healing. 2. Clot formation to seal the wound with fibrin and trapped cells and platelets occurs during the inflammation phase of wound healing, in the first 3 to 5 days. 3. Epithelial cells growing into the wound occurs in the reconstruction phase of wound healing. 4. During the initial phase of healing, there is increased blood flow, giving the area an "inflamed" appearance.

25) The nurse administers the flu vaccine to a school-age child. Which should the nurse include in the documentation for the administration of this vaccine? Select all that apply. 1. The date of the last flu vaccine 2. The site of the vaccination 3. The lot and serial number of the vaccine 4. The date and time of administration. 5. Who assisted in restraining the child

2, 3, 4 Explanation: 1. This information is not pertinent. 2. The site should be recorded. 3. This information should be recorded in case a problem develops. 4. This should be recorded. 5. This information is not pertinent.

20) Which interventions should the nurse include in the plan of care to address nutrition for a child who is diagnosed with acquired immunodeficiency syndrome (AIDS)? Select all that apply. 1. Encourage three large meals each day. 2. Eliminate unpleasant odors from the environment during meals. 3. Weigh the child each day, using the same scale. 4. Assess skin turgor every 4 hours. 5. Include favorite foods in the meal plan.

2, 3, 5 Explanation: 1. Children diagnosed with AIDS who are experiencing impaired nutrition should be offered small frequent meals to meet nutritional needs. 2. Unpleasant stimuli and odors often decrease the desire for food. 3. Taking daily weights, using the same scale, is an appropriate intervention to monitor the child's nutritional status. 4. Skin turgor should be assessed each shift, not every 4 hours, in order to monitor hydration status. 5. Allowing children to eat their favorite foods encourages intake.

23) The nurse is preparing to assist with a lumbar puncture for a pediatric client who is diagnosed with cancer. Which statements should the nurse include in the teaching session for the client and family? Select all that apply. 1. "This procedure assesses the bone marrow." 2. "This procedure assesses cerebrospinal fluid." 3. "This procedure confirms the diagnosis of acute lympoblastic leukemia." 4. "The procedure determines if malignant cells are affecting the nervous system." 5. "This procedure assesses cellular components of the blood."

2, 4 Explanation: 1. A bone marrow aspiration, not a lumbar puncture, is used to assess bone marrow. 2. A lumbar puncture is used to assess cerebrospinal fluid. 3. A bone marrow aspiration, not a lumbar puncture, is used to confirm the diagnosis of acute lymphoblastic leukemia. 4. A lumbar puncture is used to assess if malignant cells are affecting the central nervous system. 5. A complete blood count with differential, not a lumbar puncture, is used to assess the cellular components of the blood. Page Ref: 1316

16) Which statements should the nurse include in the definition of mental health during a health maintenance fair for pediatric clients? Select all that apply. 1. Mental health is the change in thought that occurs during childhood. 2. Mental health is foundational to a sense of personal well-being. 3. Mental health does not impact physical health. 4. Mental health involves successful engagement in activities. 5. Mental health changes over time.

2, 4 Explanation: 1. Cognition, not mental health, is the change in thought that occurs during childhood; therefore, the nurse should not include this information. 2. Mental health is foundational to a sense of personal well-being; therefore, the nurse should include this information in the presentation. 3. Mental health does impact physical health; therefore, the nurse should not include this information. 4. Mental health does involve successful engagement in activities; therefore, the nurse should include this information in the presentation. 5. Cognition, not mental health, changes over time; therefore, the nurse should not include this information.

22) The nurse is preparing to administer a vaccine to a 14-month-old toddler. Which assessment factor would warrant a delay in the scheduled vaccination during the well-child visit? 1. The child is allergic to a substance in the vaccine. 2. The child has a low-grade fever and a runny nose. 3. The child received a dose of immune globulin 2 months ago. 4. The child is on antibiotics.

3 Explanation: 1. A vaccine allergy contradicts the administration of the vaccine for life. This factor does not warrant a delay. The child should not receive the vaccine at the next well-child visit or at any other time. 2. A mild upper respiratory infection would not be a contraindication for vaccine administration. 3. The antibodies in the immune globulin will prevent the child from developing immunity to the vaccination. By the next well-child visit, the immune globulins will not prevent immunity from developing. 4. Antibiotic administration will not prevent the development of active immunity.

7) A child diagnosed with aplastic anemia is admitted to the hospital. The parents ask the nurse what aplastic anemia is. Which response by the nurse is accurate? 1. "Aplastic anemia causes a proliferation of white blood cells." 2. "Aplastic anemia is characterized by abnormally shaped red blood cells." 3. "Aplastic anemia is caused the bone marrow producing inadequate cells." 4. "Aplastic anemia is a disorder that occurs after a viral illness."

3 Explanation: 1. All blood cells, not just white blood cells, are affected by aplastic anemia. 2. Aplastic anemia does not cause abnormally shaped red blood cells; this is a description of sickle-cell disease. 3. In aplastic anemia, the bone marrow does not produce sufficient numbers of circulating blood cells. 4. There is no known association between aplastic anemia and viral illness.

4) An adolescent female client is diagnosed with systemic lupus erythematosus (SLE). Which action by the client indicates acceptance of the body changes that occur because of SLE? 1. Attends school but does not stay for after-school activities 2. Discusses the body changes with healthcare providers only 3. Discusses the body changes with her best friend 4. Only attends small parties at friends' homes

3 Explanation: 1. Avoiding social activities does not show acceptance of body changes. 2. Discussing changes only with healthcare providers does not indicate the teen has adjusted to the body image changes. 3. Peer interaction is important to the teen. Being able to discuss the changes to her body with a peer indicates acceptance of the changes in her body image. 4. Avoiding social activities other than those involving immediate friends indicates the teen is still concerned with body image.

5) A child diagnosed with autism spectrum disorder (ASD) is admitted to the hospital with dehydration. Which should the nurse include in the plan of care for this child? 1. Discourage the parents from bringing favorite toys from home that might be lost. 2. Take the child on a tour of the pediatric unit. 3. Assign the child to a single-bed hospital room. 4. Take the child to the playroom for arts and crafts.

3 Explanation: 1. Children with autism often carry a special toy. This should be kept with the child. 2. Taking a child with autism on a tour of the pediatric unit would be too much stimulation for this child. A quiet, controlled environment is best for a child with autism. 3. A single room is the best place for an autistic child if the child must be hospitalized. 4. Arts and crafts might be appropriate for an autistic child if they are done in the child's room. Going to the playroom would be too much stimulation for this child.

8) The child is receiving chemotherapy for acute lymphocytic leukemia (ALL). Which assessment data should the nurse immediately report to the healthcare provider due to a metabolic emergency? 1. Thrombocytopenia 2. Leukocytosis 3. Oliguria 4. Edema

3 Explanation: 1. Thrombocytopenia is a clinical manifestation associated with a hematologic, not metabolic, emergency. 2. Leukocytosis is a clinical manifestation associated with a hematologic, not metabolic, emergency. 3. Tumor lysis causes a metabolic emergency caused by an electrolyte imbalance. Clinical manifestations associated with this include oliguria and altered levels of consciousness. 4. Edema is not indicative of a metabolic emergency. Page Ref: 1307

5) The nurse is administering packed red blood cells to a child with sickle-cell disease (SCD). When should the nurse monitor the child closely due to the risk of reaction? 1. Six hours after the transfusion is given. 2. At the end of the administration of the transfusion. 3. The first 20 mL of blood administered. 4. Never; children with SCD do not have reactions.

3 Explanation: 1. Transfusion reaction does not occur this long after the transfusion. 2. Reactions generally occur at the onset or during the first 20 minutes of transfusion. 3. Blood reactions can occur as soon as the blood transfusion begins. The nurse should administer the first 20 mL of blood slowly and monitor for a reaction during this time frame. 4. Anyone can have a transfusion reaction during any transfusion.

27) Which functions of white blood cells (WBCs) should the nurse include in a teaching session for the family of a pediatric client who is diagnosed with human immunodeficiency virus (HIV)? Select all that apply. 1. Carry oxygen from the lungs to the tissues 2. Return carbon dioxide from the tissues to the lungs 3. Assist the body to fight infection 4. Assist the body to fight allergens 5. Form hemostatic plugs to stop bleeding

3, 4 Explanation: 1. A function of red blood cells, not WBCs, is to carry oxygen from the lungs to the tissues. 2. A function of red blood cells, not WBCs, is to return carbon dioxide from the tissues to the lungs. 3. A function of the WBCs is to fight infection. 4. A function of the WBCs is to fight allergens. 5. A function of platelets, not WBCs, is to form hemostatic plugs to stop bleeding.

32) Which vaccines should the nurse prepare to administer to an 11-year-old child during a scheduled well-child visit? Select all that apply. 1. DTaP vaccine 2. Hib vaccine 3. HPV4 vaccine 4. MMR vaccine 5. MenACWY-D

3, 5 Explanation: 1. The DTap vaccine is not appropriate for the nurse to administer to an 11-year-old child during a scheduled well-child visit. 2. The Hib vaccine is not appropriate for the nurse to administer to an 11-year-old child during a scheduled well-child visit. 3. The HPV4 vaccine is appropriate to administer to an 11-year-old child during a scheduled well-child visit. 4. The MMR vaccine is not appropriate for the nurse to administer to an 11-year-old child during a scheduled well-child visit. 5. The MenACWY-D vaccine is appropriate to administer to an 11-year-old child during a scheduled well-child visit.

13) A nurse is planning care for a child with human immunodeficiency virus (HIV). Which is the priority nursing diagnosis for this child? 1. Ineffective Peripheral Tissue Perfusion 2. Ineffective Thermoregulation 3. Risk for Fluid Volume Deficit 4. Risk for Infection

4 Explanation: 1. A child with HIV is at risk for a myriad of bacterial, viral, fungal, and opportunistic infections because of the effect of the virus on the immune system. Risk for Ineffective Tissue Perfusion, peripheral, would not be a priority problem with this disease process. 2. A child with HIV is at risk for a myriad of bacterial, viral, fungal, and opportunistic infections because of the effect of the virus on the immune system. Risk for Ineffective Thermoregulation would not be a priority problem with this disease process. 3. A child with HIV is at risk for a myriad of bacterial, viral, fungal, and opportunistic infections because of the effect of the virus on the immune system. Risk for Fluid Volume Deficit would not be a priority problem with this disease process. 4. A child with HIV is at risk for a myriad of bacterial, viral, fungal, and opportunistic infections because of the effect of the virus on the immune system. Risk for Infection is the priority nursing diagnosis.

12) Which is the priority nursing intervention for a pediatric client, diagnosed with leukemia, who has a granulocyte count of 250/mm3 and a platelet count of 150,000/mm3? 1. Fluid restriction 2. Mouth care 3. Neutropenic precautions 4. Hand hygiene

4 Explanation: 1. A fluid restriction is not a priority nursing intervention based on the current data. Fluids should continue to be encouraged. 2. Platelet count is normal; mouth care should include brushing with a soft toothbrush and frequent rinsing. 3. The child should be isolated from anyone infectious, but neutropenic isolation is not necessary. 4. Hand hygiene is vital for preventing the spread of infection.

5) A school-age client diagnosed with rheumatoid arthritis (RA) wants to participate in the school sports programs. The client asks the nurse to recommend a sporting activity that is appropriate. Which activity would be the most appropriate for the nurse to recommend? 1. Baseball 2. Basketball 3. Football 4. Swimming

4 Explanation: 1. Baseball places stress on the knee joints. 2. Basketball involves running, which will stress the joints. 3. All positions in football will cause stress to the joints. 4. Swimming helps to exercise all the extremities without putting undue stress on joints

11) Which child should the nurse refer for further assessment due to a probable diagnosis for autism spectrum disorder (ASD)? 1. A 4-year-old girl who doesn't make eye contact with mother and resists the mother's touch 2. A 3-year-old boy who joins one group of children, then moves to another group of children without joining their activities 3. An 18-month-old child who walks around the area using the furniture to provide balance 4. A 6-year-old boy who chatters constantly to anyone who will listen

1 Explanation: 1. Although boys are affected more often than girls, lack of eye contact and resistance to physical touch are common symptoms of autism. 2. Although this child is not interacting with other children, it is obvious that the child is aware of other children and interested in their activities, actions that are not indicative of autism. 3. This child may be developmentally delayed, as this behavior is typical of a 10- to 12-month-old child. 4. Children with autism often have language delays and impairment. This child does not have any obvious language issues.

6) Which is the priority nursing diagnosis when planning care for an infant who is diagnosed with a severe case of oral thrush (Candida albicans)? 1. Ineffective Infant Feeding Pattern related to discomfort 2. Ineffective Breathing Pattern related to oral thrush 3. Activity Intolerance related to oral thrush 4. Ineffective Airway Clearance related to mucus

1 Explanation: 1. An infant with oral thrush might refuse to nurse or feed because of discomfort and pain. Prompt treatment is necessary so the infant can resume a normal feeding pattern. 2. Ineffective breathing pattern is not usually associated with oral thrush. An infant with oral thrush might refuse to nurse or feed because of discomfort and pain. Prompt recognition and treatment are necessary so that a normal feeding pattern can be resumed. 3. Activity intolerance is not usually associated with oral thrush. An infant with oral thrush might refuse to nurse or feed because of discomfort and pain. Prompt recognition and treatment are necessary so that a normal feeding pattern can be resumed. 4. Ineffective airway clearance is not usually associated with oral thrush. An infant with oral thrush might refuse to nurse or feed because of discomfort and pain. Prompt recognition and treatment are necessary so that a normal feeding pattern can be resumed.

15) A 2-year-old child with a fever is prescribed amoxicillin clavulanate 250 mg/5 mL 3 times daily by mouth for 10 days for otitis media. Which is the priority teaching instruction for the parents of this child? 1. Giving the antibiotic for the full 10 days 2. Measuring the prescribed dose in a household teaspoon 3. Spreading the dose evenly during daylight hours 4. Stopping the antibiotic when the child is afebrile

1 Explanation: 1. Antibiotics must be administered for the full number of days ordered to prevent mutation of resistant strains of bacteria. 2. A household teaspoon could contain less than 5 mL, and the full dose must be given. 3. The antibiotic should be administered around the clock to maintain a blood level. 4. Stopping the antibiotic before the prescribed time will permit remaining bacteria to reproduce, and the otitis media will return, possibly with antibiotic-resistant organisms.

2) A nurse is providing education to a group of new mothers regarding immunity and infection. Which information regarding the development of immunity should the nurse include in the teaching session? 1. Acquired through immunization or exposure to the natural disease 2. Acquired through exposure to diseases from family members 3. Acquired through diseases from other children 4. Newborns being born with diseases already in their systems

1 Explanation: 1. As children grow, they develop immunity through immunization or exposure to the natural disease. As children mature and become more active, they interact more frequently with other children and adults and increase their exposure to infectious agents. 2. Children cannot acquire diseases from family members who have had the disease 3. Acquiring disease from other children would not give children immunity. 4. Newborns are not born with diseases in their systems.

3) The nurse is teaching the mother of a newborn how the immune system functions. Which statement regarding the process that occurs when healthy children are exposed to infection indicates accurate understanding of the information presented? 1. "Children who are exposed to infection naturally develop antibodies." 2. "Children who are exposed to infection are found to be healthier." 3. "Children who are exposed to infection will acquire terminal illnesses." 4. "Children who are exposed to infection will have weakened immune systems."

1 Explanation: 1. As healthy children are exposed to more infections, they naturally develop antibodies. 2. Being exposed to infections will not lead to healthy children. 3. Exposure to infections will not lead children to acquire terminal illnesses. 4. Exposure to infectious disease will not weaken children's immune systems.

14) Which parental statement regarding preventative strategies for insect bites and stings indicate the need for further education? 1. "If my child wears bright colors and floral prints when outdoors, she will blend in with the surroundings, and the stinging insects will not sting her." 2. "We should remove any items with standing water from our yard and surrounding area to prevent mosquito reproduction." 3. "My child can use insect repellent containing DEET of 10% or less." 4. "My child should avoid heavy colognes, perfumes, and soaps so that insects are not attracted to them."

1 Explanation: 1. Bright-colored clothing and floral prints attract the insects. White and light-colored clothing should be worn. This statement requires clarification. 2. Standing water is a breeding ground for mosquitoes. Rid yards of all bird baths, stagnant pools, and any standing water that mosquitoes could use for breeding. No clarification is needed. 3. DEET is an appropriate insect repellent and can be used in children. A concentration of 10% or less is recommended due to neurotoxic effects at greater concentrations. No clarification is needed. 4. Heavy colognes, perfumes, soaps, and detergents resemble flowers and plants and will attract the stinging insects. This statement is correct.

1) Which is the most likely cause for a bright red perianal inflammation with scaly plaques and small papules noted by the nurse during the assessment of a 12-month-old infant? 1. Candida albicans (yeast) 2. Impetigo (staphylococcus) 3. Infrequent diapering 4. Urine and feces

1 Explanation: 1. Candida albicans is frequently the underlying cause of severe diaper rash. When a primary or secondary infection with C. albicans occurs, the rash has bright red, scaly plaques with sharp margins. Small papules and pustules might be seen, along with satellite lesions. 2. Even though diaper dermatitis can be caused by impetigo, urine, feces, and infrequent diapering, the lesions and persistent characteristics are common for Candida infection. 3. Infrequent diapering, along with urine and feces, can cause diaper dermatitis, but the persistence and characteristics of the lesions are common for Candida infection. 4. Urine and feces can cause diaper dermatitis, but the persistence and characteristics of the lesions are common for Candida infection.

11) The nurse is providing care to a child diagnosed with hemophilia who states, "I am going to join a bike club at school." Which recommendation should the nurse give to the child? 1. Wear knee pads, elbow pads, and a helmet while bicycling. 2. Consider a swim club instead of the bicycling club. 3. Do not join the club. 4. Participate only in the social activities of the club.

1 Explanation: 1. Children with hemophilia should be encouraged to participate in noncontact sports activities. Bicycling is an excellent option, and is recommended, along with swimming. However, the child should always use knee pads, elbow pads, and a helmet when participating in any physical sport. 2. Biking is an acceptable sport as long as protective equipment is worn, and the child should be encouraged to make choices when possible. 3. Discouraging a child from joining a club would not foster growth and development. 4. Participating only in the social aspects of the club would not encourage physical activity.

10) Which is the priority nursing diagnosis during the acute phase of a third-degree circumferential burn of the right arm for a pediatric client? 1. Altered Tissue Perfusion, Risk for 2. Infection, Risk for 3. Impaired Physical Mobility 4. Altered Nutrition: Less than body Body requirementsRequirements, Risk for

1 Explanation: 1. Circumferential burns can restrict blood flow due to edema, resulting in tissue hypoxia. Altered Tissue Perfusion to the extremity is the greatest risk and therefore the priority diagnosis. 2. When the burn is circumferential, blood flow can become restricted due to edema and can result in tissue hypoxia; therefore, the priority diagnosis is Altered Tissue Perfusion, Risk for, to the extremity. Risk of infection would be a secondary priority in this case. 3. Impaired physical mobility is a secondary priority for the child with a circumferential burn. Edema to the area can result in restricted blood flow and tissue hypoxia, making the priority diagnosis Altered Tissue Perfusion, Risk for. 4. Infection, nutrition, and mobility would have secondary priority in this case.

8) Which symptoms should the nurse include in the teaching plan for the family of a recently child diagnosed with aplastic anemia? 1. Fatigue and fever 2. Runny nose and cough 3. Nausea and vomiting 4. Cyanosis and bradycardia

1 Explanation: 1. Fatigue secondary to anemia and fever related to infection secondary to neutropenia are common symptoms. 2. Aplastic anemia is not associated with upper respiratory infections. 3. Nausea and vomiting are not symptoms of aplastic anemia. 4. The child would exhibit tachycardia rather than bradycardia, and there is no reason for cyanosis.

10) Which nursing action is appropriate when treating a school-age child, diagnosed with hemophilia, for a superficial wound above the knee? 1. Applying pressure to the area 2. Applying a warm, moist pack to the area 3. Performing some passive range-of-motion to the affected leg 4. Keeping the affected extremity in a dependent position

1 Explanation: 1. If a child with hemophilia experiences a bleeding episode, superficial bleeding should be controlled by applying pressure to the wound. 2. Heat would increase the bleeding by dilating the superficial blood vessels. A cool compress should be applied. 3. The extremity should be immobilized to prevent further bleeding; passive range-of-motion could cause further bleeding at the site. 4. The extremity should be elevated, if possible, to prevent swelling at the site.

1) The nurse prepares to administer a vitamin K injection during the admission assessment for a newborn. The father asks, "Why does my baby need a shot?" Which rationale for administering this injection should the nurse include in the response? 1. Activates clotting factors 2. Dissolves blood clots 3. Promotes gas exchange 4. Promotes the production of hemoglobin

1 Explanation: 1. Levels of clotting factors are lower in infants, so vitamin K is given prophylactically to activate essential clotting factors. 2. Vitamin K promotes clotting; it is not administered to dissolve blood clots. 3. Vitamin K does not promote gas exchange. 4. Vitamin K has no effect on the production of hemoglobin.

1) A parent of a newborn asks the nurse why young children seem to become ill so often when compared with older children and adults. Which is the best response by the nurse? 1. "Newborns have lower numbers of natural killer cells." 2. "Newborns have high levels of IgA in their systems." 3. "Newborns are lacking lymphoid tissue." 4. "Newborns have an immature thymus gland."

1 Explanation: 1. Newborns have lower numbers of natural killer cells than do older children and adults, decreasing their ability to respond to certain antigens. 2. IgA is not present at birth. Development of IgA begins at 2 weeks of age but does not reach adult levels until the age of 6. 3. Lymphoid tissue, such as the spleen and tonsils, is present at birth. 4. The thymus is large at birth and grows during childhood, decreasing by adulthood.

20) Which is the priority nursing intervention for a 4-year-old client brought to the emergency department (ED) for treatment of frostbite? 1. Administer analgesics. 2. Immerse the hands in extremely warm water (120°F). 3. Do not remove clothing. 4. Place the extremity in a dependent position.

1 Explanation: 1. Nursing interventions for frostbite include removing wet clothing, using mildly warm water (at 100 to 104°F) to warm the extremity, administering analgesics to decrease pain of the rewarming process, and raising the affected extremity to improve venous return. 2. Nursing interventions for frostbite include removing wet clothing, using mildly warm water (at 100 to 104°F) to warm the extremity, administering analgesics to decrease pain of the rewarming process, and raising the affected extremity to improve venous return. 3. Nursing interventions for frostbite include removing wet clothing, using mildly warm water (at 100 to 104°F) to warm the extremity, administering analgesics to decrease pain of the rewarming process, and raising the affected extremity to improve venous return. 4. Nursing interventions for frostbite include removing wet clothing, using mildly warm water (at 100 to 104°F) to warm the extremity, administering analgesics to decrease pain of the rewarming process, and raising the affected extremity to improve venous return.

7) Which parental statement indicates to the nurse accurate understanding regarding the care of their child with tinea capitis (ringworm of the scalp)? 1. "We will give the griseofulvin with milk or peanut butter." 2. "We're glad ringworm isn't transmitted from person to person." 3. "Once the lesion is gone, we can stop the griseofulvin." 4. "Well, at least we don't have to worry about the family cat getting the ringworm."

1 Explanation: 1. Parents are advised to give oral griseofulvin with fatty foods such as milk or peanut butter to enhance absorption. 2. All members of the family and household pets should be assessed for fungal lesions because person-to-person transmission is common. 3. The medication must be used for the entire prescribed period, even if the lesions are gone. 4. Dogs and cats can develop the fungal lesions and be sources of spread of the organism.

19) Which nursing action is most appropriate to decrease the risk of transmitting viral infections by clients and family members at a local clinic? 1. Sanitizing toys, telephones, and doorknobs to kill pathogens 2. Teaching parents safe food preparation and storage 3. Withholding immunizations for children with compromised immune systems 4. Allowing all children to congregate in the same waiting room

1 Explanation: 1. Sanitizing toys and all contact surfaces, separating children with infections, and teaching children to wash their hands all control the growth and spread of microorganisms. 2. Teaching parents safe food preparation and storage is another tool to prevent the spread of microorganisms, but it is not related to the flu virus. 3. Immunizations should not be withheld from immunocompromised children, and this is not an infection-control strategy. 4. Children should be separated in different waiting rooms when seeking care at a pediatric clinic.

15) Which teaching topic should the nurse include in the discharge instructions for the family of child diagnoses with sickle-cell disease to prevent crisis? 1. Respiratory infection and dehydration 2. Mid-range altitudes 3. Weight loss without dehydration 4. Overhydration

1 Explanation: 1. The child with sickle-cell disease is at risk for infection, and dehydration can precipitate crisis. 2. High altitudes with lower oxygen concentrations pose a risk; mid-altitude is not a risk factor. 3. Weight loss is acceptable as long as hydration is maintained. 4. Hydration should be encouraged; risk of overhydration is minimal.

14) The child is admitted to the hospital unit newly diagnosed with retinoblastoma. Which clinical manifestation does the nurse anticipate upon assessment? 1. A white reflex 2. Blue-tinged sclerae 3. A red reflex 4. Yellow-tinged sclerae

1 Explanation: 1. The first sign of retinoblastoma is a white pupil. The red reflex is absent. This is known as leukocoria, or "cat's eye" reflex. 2. Blue-tinged sclerae are a sign of osteogenesis imperfecta, not retinoblastoma. 3. Red reflex is absent in retinoblastoma. 4. Yellow sclerae are a sign of jaundice, not retinoblastoma.

1) A nurse is providing information to a group of new mothers. Which rationale, indicating increased susceptibility for infant infection, should the nurse include in the teaching session? 1. Low levels of antibodies 2. High levels of maternal antibodies to diseases to which the mother has been exposed 3. Passive transplacental immunity from maternal immunoglobulin G 4. Exposure to microorganisms during the birth process

1 Explanation: 1. The infant's immune system is not fully developed at birth, and the infant has low levels of antibodies due to lack of exposure to antigens. 2. Newborns and young infants do have high levels of maternal antibodies, but this answer is incorrect because it does not explain the susceptibility of newborns and young infants to infection. 3. Newborns and young infants do have passive transplacental immunity, but this answer is incorrect because it does not explain the susceptibility of newborns and young infants to infection. 4. Newborns and young infants do have exposure to microorganisms during the birth process, but this answer is incorrect because it does not explain the susceptibility of newborns and young infants to infection.

10) The pediatric clinic has set a goal that 95% or more of the children attending the clinic will be fully immunized. Which should the clinic nurses teach the families to meet this goal? 1. The benefits of immunizations outweigh the risks of communicable diseases. 2. Immunizations should be completed by the time the child starts school. 3. Once a child receives a vaccination, that individual has lifelong immunity against that disease. 4. Vaccinations are 100% safe.

1 Explanation: 1. The risks and benefits of vaccines far outweigh the risks from communicable diseases and resulting complications. 2. The immunization schedule is not completed by the time the child starts school. Immunizations continue throughout the life of the individual. 3. It is important that the families realize that to be fully protected, many vaccinations will need to be repeated at specified times. 4. Vaccinations can cause illness or injury. No medication is 100% safe.

11) Which is the priority nursing action when providing care to a pediatric client who has documented allergies to cow's milk, peanuts, and latex? 1. Evaluating the hospital room for equipment containing latex 2. Ordering an EpiPen for the child 3. Notifying dietary of the milk and peanut allergy 4. Placing a sign on the door which identifies all allergies

1 Explanation: 1. This is appropriate as latex allergies can be life threatening. Many pieces of medical equipment may contain latex. 2. Nurses do not prescribe or dispense medication, so this is inappropriate. 3. This action should be taken but is not the priority. 4. Depending on hospital policy, there may be some sign to indicate allergies, but this is not the priority.

10) Which information should the nurse include in the teaching plan for the parents of a child who is diagnosed with autism spectrum disorder (ASD) as methods to increase the child's socialization? 1. Create a reward system when the child interacts with a person. 2. Punish the child when the child's social behaviors are inappropriate. 3. Use dolls to demonstrate appropriate social interactions to the child. 4. Enroll the child in a day care facility to encourage interaction with other children.

1 Explanation: 1. This is appropriate treatment involving behavior modification. 2. Behavior modification uses positive, not negative, reinforcement to encourage the desired behavior. 3. This activity would be a component of play therapy. 4. Enrolling the child in a day care facility may help with interactions, but this is not a description of behavior modification.

8) Which nursing action is accurate when applying a 5% permethrin lotion to a toddler with scabies? 1. Applying the lotion to the scalp, forehead, and everywhere below the chin 2. Applying the lotion only on the areas with evidence of activity 3. Applying the lotion only to the hands 4. Applying the lotion only to the scalp only

1 Explanation: 1. Treatment of scabies involves application of a scabicide, such as 5% permethrin lotion, over the entire body from the chin down. The scabicide is also applied to the scalp and forehead of younger children, avoiding the rest of the face. 2. Treatment of scabies involves application of a scabicide, such as 5% permethrin lotion, over the entire body from the chin down, as well as the scalp and forehead. 3. Treatment of scabies involves application of a scabicide, such as 5% permethrin lotion, over the entire body from the chin down, including the scalp and forehead. 4. Treatment of scabies involves application of a scabicide, such as 5% permethrin lotion, over the entire body from the chin down, as well as the scalp and forehead. Page Ref: 1574

12) Which should the nurse use when reconstituting vaccines? 1. The diluents provided 2. Normal saline 3. Any solution available 4. Sterile water

1 Explanation: 1. When reconstituting vaccines, it is important to use the solution provided and follow the manufacturer's directions. 2. Not all medications are compatible with normal saline. 3. Only use what is suggested by the manufacturer. 4. Unless otherwise suggested, use what is suggested by the manufacturer. Page Ref: 1056-1059

7) Which nursing intervention is contraindicated for a pediatric client who is experiencing thrombocytopenia secondary to chemotherapy treatments? 1. Administering intramuscular injections 2. Monitoring intake and output 3. Palpating during the assessment 4. Providing oral hygiene

1 Explanation: 1. When the child is thrombocytopenic (decreased platelets) from chemotherapy, the nurse should not administer intramuscular injections because of the risk of bleeding. 2. Monitoring intake and output is not contraindicated for a pediatric client who is experiencing thrombocytopenia as a result of chemotherapy treatments. 3. Palpation during the assessment is not contraindicated due to thrombocytopenia. This action is contraindicated for a child who is diagnosed with Wilms tumor. 4. Providing oral hygiene is not contraindicated for a pediatric client who is experiencing thrombocytopenia as a result of chemotherapy treatments.

24) Which assessment findings, indicative of a hematologic emergency, should the nurse report to the healthcare provider due to the need for immediate intervention? Select all that apply. 1. Anemia 2. Thrombocytopenia 3. Disseminated intravascular coagulation 4. Cardiac arrhythmias 5. Tetany

1, 2, 3 Explanation: 1. Anemia is a clinical manifestation associated with a hematologic emergency necessitating the need for immediate intervention. 2. Thrombocytopenia is a clinical manifestation associated with a hematologic emergency necessitating the need for immediate intervention. 3. Disseminated intravascular coagulation is a clinical manifestation associated with a hematologic emergency necessitating the need for immediate intervention. 4. Cardiac arrhythmias are associated with metabolic, not hematologic, emergencies. 5. Tetany is associated with metabolic, not hematologic, emergencies.

25) Which topics should be includedinclude in a teaching session with parents of school-age children to prevent frostbite? Select all that apply. 1. Dressing in layers 2. Having extra clothing available 3. Removing wet gloves immediately 4. Applying sunscreen twice per day 5. Wearing sunglasses while outside

1, 2, 3 Explanation: 1. Dressing in layers is a topic the nurse should include in the teaching session with parents of school-age children to prevent frostbite. 2. Having extra clothing available is a topic the nurse should include in the teaching session with parents of school-age children to prevent frostbite. 3. Removing wet gloves immediately is a topic the nurse should include in the teaching session with parents of school-age children to prevent frostbite. 4. Application of sunscreen is an appropriate topic to prevent sunburn, not frostbite. 5. Wearing sunglasses while outside is an appropriate topic to prevent sunburn, not frostbite.

22) Which pain interventions should the nurse include in the plan of care for a pediatric client who suffered a full-thickness burn injury? Select all that apply. 1. Using an age-appropriate assessment scale 2. Covering the affected skin as much as possible 3. Providing analgesics prior to wound care 4. Keeping the skin as clean and dry as possible 5. Clipping hair around the wound

1, 2, 3 Explanation: 1. Pain assessment with an age-appropriate scale is an appropriate intervention for the nurse to include in the plan of care for a client with a full-thickness burn injury. 2. Covering the affected area to prevent temperature changes and air movement is an appropriate intervention for the nurse to include in the plan of care for a client with a full-thickness burn injury. 3. Analgesics administration prior to wound care is an appropriate intervention for the nurse to include in the plan of care for a client with a full-thickness burn injury. 4. Keeping the skin as clean and dry as possible is an appropriate intervention to decrease infection, not pain. 5. Clipping hair around the wound is an appropriate intervention to decrease infection, not pain.

17) Which concepts should the nurse include in the discharge instructions for a child who has undergone a hematopoietic stem cell transplantation (HSCT)? Select all that apply. 1. Keeping the child on a high-calcium diet 2. Practicing good hand washing 3. Avoiding live plants and fresh vegetables 4. Avoiding influenza vaccinations 5. Returning the child to school within 6 weeks

1, 2, 3 Explanation: 1. The child should be placed on calcium supplements to reduce the risk of osteopenia. Hand washing is essential to prevent the spread of infection. Live plants and fresh vegetables can carry bacteria; they should be avoided to decrease the risk of infection. 2. The child should be placed on calcium supplements to reduce the risk of osteopenia. Hand washing is essential to prevent the spread of infection. Live plants and fresh vegetables can carry bacteria; they should be avoided to decrease the risk of infection. 3. The child should be placed on calcium supplements to reduce the risk of osteopenia. Hand washing is essential to prevent the spread of infection. Live plants and fresh vegetables can carry bacteria; they should be avoided to decrease the risk of infection. 4. The child cannot return to school for 6 to 12 months after an HSCT. In-hospital or in-home schooling is required. The child and the family should be encouraged to get a yearly influenza vaccination. 5. The child cannot return to school for 6 to 12 months after an HSCT. In-hospital or in-home schooling is required. The child and the family should be encouraged to get a yearly influenza vaccination

19) Which preventative strategies for tinea pedis, a fungal infection, also known as athlete's foot, should the nurse include in a teaching session for an adolescent client? Select all that apply. 1. Wear 100% white cotton socks, changed twice a day. 2. Use talc on feet daily. 3. Use an over-the-counter corticosteroid cream to treat the area. 4. Wear foot covers such as flip flops in the locker room and shower. 5. Apply heat to the area twice a day.

1, 2, 4 Explanation: 1. The socks will wick moisture away from the feet to promote healing. 2. This process will help keep the feet dry. 3. Corticosteroids will not destroy the organism. An antifungal medication is required. 4. This will reduce the spread of the organism among team members. 5. Heat will not treat the problem. Antifungal medications are required.

4) A child had an appendectomy and was discharged home at 48 hours postoperative. A week later, the child is readmitted for delayed wound healing. Which causes of delayed wound healing will the nurse review prior to assessing the child? Select all that apply. 1. Infection 2. Predisposing chronic condition, such as diabetes 3. Hypervolemia 4. Inadequate nutrition 5. Hypoxemia

1, 2, 4, 5 Explanation: 1. Infection can affect healing and cause excessive scarring. 2. Conditions such as diabetes affect circulating blood volume and are known to affect healing. 3. Hypovolemia, not hypervolemia, would inhibit inflammation due to low circulating blood volume. 4. Poor nutrition without proper protein and calorie intake will affect healing. 5. Hypoxemia makes tissues susceptible to infection due to insufficient oxygenation.

22) Which nursing actions will decrease the risk of extravasation when administering chemotherapy to a pediatric client through a peripheral line? Select all that apply. 1. Ensuring that the intravenous line is a free flowing line 2. Administering the medication by infusion pump 3. Checking for blood return before and during chemotherapy administration 4. Diluting the medication with normal saline 5. Administering the vesicant drug last

1, 3 Explanation: 1. This is critical, as extravasation is leaking into the tissues. 2. An infusion pump does not ensure that the line is free flowing; this is inappropriate. 3. This checks for intravenous administration and is appropriate. 4. Not all medications can be mixed with normal saline, and this does not protect against extravasation. 5. The vesicant drug should be administered first.

16) Which risks should the nurse closely assess a pediatric client for during the posttransplant phase of hematopoietic stem cell transplantation (HSCT)? (Select All That Apply.) 1. Hemorrhage 2. Thrombosis 3. Pancytopenia 4. Infection 5. Fluid volume overload

1, 3, 4 Explanation: 1. Suppression of platelets increases the risk for bleeding. 2. There is no increased risk for thrombosis. 3. It takes 2 to 4 weeks for the bone marrow to begin producing cells; the client will show evidence of suppression until that time. 4. Suppression of white blood cells increases the client's risk for infection. 5. There is no increased risk of excess fluid; the client is at greater risk for dehydration.

2) Which general manifestations should the nurse monitor for when conducting a physical assessment for a pediatric client who is diagnosed with cancer? Select all that apply. 1. Infection 2. Polycythemia 3. Petechiae 4. Pain 5. Cachexia

1, 3, 4, 5 Explanation: 1. Infection is often a general manifestation associated with cancer caused by altered immune function. 2. Anemia, not polycythemia, is a general manifestation associated with cancer. 3. Hemorrhagic spots, or petechiae, are general manifestations associated with cancer. 4. Pain is often a general manifestation of cancer resulting from neoplasms directly or indirectly affecting nerve receptors. 5. Cachexia is a state that is often associated with cancer. Specific symptoms include anorexia, nausea, and vomiting.

25) Which pediatric cancer diagnoses necessitate priority assessment by the nurses for clinical manifestations associated with emergencies related to space-occupying lesions? Select all that apply. 1. Hodgkin disease 2. Leukemia 3. Neuroblastoma 4. Melanoma 5. Lymphoma

1, 3, 5 Explanation: 1. A pediatric client diagnosed with Hodgkin disease is at risk for emergencies related to space-occupying lesions. 2. Leukemia is not a pediatric cancer associated with emergencies related to space-occupying lesions. 3. A pediatric client diagnosed with neuroblastoma is at risk for emergencies related to space-occupying lesions. 4. Melanoma is not a pediatric cancer associated with emergencies related to space-occupying lesions. 5. A pediatric client diagnosed with lymphoma is at risk for emergencies related to space-occupying lesions.

22) The nurse is providing education to a family whose child experiences anaphylaxis when exposed to any amount of latex. Which items, often found in the home or school environment, should the nurse include in the teaching session? Select all that apply. 1. Art supplies 2. Toothpaste 3. Balloons 4. Perfumes 5. Chewing gum

1, 3, 5 Explanation: 1. Art supplies often contain latex; therefore, the nurse should include this item in the teaching session. 2. Toothbrushes, not tooth paste, are known to contain latex. The nurse should not include this item in the teaching session. 3. Balloons often contain latex; therefore, the nurse should include this item in the teaching session. 4. Perfumes are not known to contain latex. The nurse should not include this item in the teaching session. 5. Chewing gum often contains latex; therefore, the nurse should include this item in the teaching session.

16) Which skin conditions should the nurse identify as having a genetic or inherited component during a presentation to the staff nurses who work in the integument clinic? Select all that apply. 1. Atopic dermatitis 2. Seborrheic dermatitis 3. Epidermolysis bullosa 4. Molluscum contagiosum 5. Psoriasis

1, 3, 5 Explanation: 1. Atopic dermatitis is an allergic skin disorder. Allergies have an inherited component. 2. Seborrheic dermatitis is thought to be an overgrowth of yeast and is influenced by hormones. It is not inherited. 3. Epidermolysis bullosa is inherited either as autosomal dominant or autosomal recessive depending on type. 4. Mulluscum Molluscum is caused by a poxvirus and is transmitted person to person. 5. Psoriasis is usually seen in clients with a family history. A multifactorial inheritance is suspected.

27) The nurse is providing care to a pediatric client who will require radiation as a portion of the treatment regimen. Which topics should the nurse include in the teaching session related to long- term ramifications associated with this treatment option? 1. Scoliosis 2. Adhesions 3. Hypothyroidism 4. Visual impairment 5. Cardiotoxicity

1, 3, 5 Explanation: 1. Scoliosis is a long-term ramification associated with radiation treatment for cancer. 2. Adhesions are a long-term ramification associated with surgical intervention, not radiation treatment, for cancer. 3. Hypothyroidism is a long-term ramification associated with radiation treatment for cancer. 4. Visual impairment is a long-term ramification associated with surgical intervention, not radiation treatment, for cancer. 5. Cardiotoxicity is a long-term ramification associated with radiation treatment for cancer.

19) Which infection control measures should the nurse include in the discharge instructions for the family of a child who is immunodeficient? Select all that apply. 1. "It is important that your child does not share cups with other members of the family." 2. "You should avoid washing your child's utensils in the dishwasher." 3. "You should allow your child to eat fresh fruit with the skin intact." 4. "It is important that everyone practices hand hygiene before touching your child." 5. "You should use alcohol wipes to cleanse your child's diaper area."

1, 4 Explanation: 1. Children who are immunodeficient should not share cups with other members of the family, as this increases the child's risk for developing an infection. 2. Utensils should be washed in warm water or placed in the dishwasher to ensure that contaminates are properly cleansed. 3. Fresh fruit should be washed and peeled prior to allowing the child who is immunocomprised to eat it. 4. Hand hygiene before handling the child, after changing diapers, and prior to feeding the child is essential to decrease the risk for infection. 5. The diaper area should be cleaned with mild soap and allowed to dry. The use of alcohol will increase the risk for skin breakdown and infection.

19) A school-age child, diagnosed with rhabdomyosarcoma, is experiencing nausea and vomiting related to the prescribed chemotherapy in spite of the use of antiemetics. The mother is pushing the child to eat the food. Which statement by the nurse is appropriate to address this situation? 1. "Since your child is receiving IV fluids, it is not important to push oral intake of food." 2. "A food aversion may occur if you continue to force your child to eat." 3. "Emesis that is caused by your child being force-fed can damage the stomach." 4. "A psychologic conflict could occur between you and your child if you continue to push eating."

2 Explanation: 1. Intravenous fluids do not replace normal food intake. 2. If the child is forced to eat and then vomits, the child can develop a food aversion in which the child associates that food with vomiting. 3. Vomiting is unpleasant but does not usually lead to stomach damage. 4. This is not a correct statement. Parents and children often disagree, but the child will still relate to the parent.

15) A child with human immunodeficiency virus (HIV) is diagnosed with oral candidiasis. Which should the nurse include in the plan of care related to oral care based on this information? 1. Listerine 2. Normal saline 3. Viscous lidocaine 4. Scope

2 Explanation: 1. Listerine is a commercial mouth rinse that can have an alcohol base and cause drying of the membranes. 2. The mouth care should be with a nonalcohol base. Normal saline can keep the child's lips and mouth moist. 3. Viscous lidocaine causes numbing, and could depress the gag reflex in a younger child. 4. Scope is a commercial mouth rinse that can have an alcohol base and cause drying of the membranes.

24) The healthcare provider orders laboratory tests following the initiation of treatment for a child diagnosed with iron deficiency anemia. Which laboratory result should the nurse share with the child's family as an indication of improvement? 1. Low hemoglobin 2. Normal platelet count 3. High reticulocyte count 4. Low hematocrit

3 Explanation: 1. Low hemoglobin is a typical finding in iron deficiency anemia. 2. Platelet count is unrelated to iron deficiency anemia. 3. Reticulocytes are immature red blood cells and indicate new cells are being produced. 4. This would be a typical finding in iron deficiency anemia.

13) A child with rhabdomyosarcoma is prescribed radiation therapy after surgical removal of the tumor. Which intervention should the nurse include in the child's plan of care? 1. Apply lotion to the area before radiation therapy. 2. Apply sunscreen to the area when the child is exposed to sunlight. 3. Remove any markings left after each radiation treatment. 4. Vigorously scrub the area when bathing the child.

2 Explanation: 1. Lotion can increase the chance of a radiation burn when applied before the treatment. 2. Radiation therapy causes the skin in that area to be sensitive. Sunscreen should be applied so that sunburns are avoided. 3. Radiation markings are to guide the radiologist and should not be removed. 4. Vigorous scrubbing is not recommended.

4) Which common mode of infectious disease should the nurse include in a teaching session with parents within the community? 1. Playing with the same toy 2. Coughing without covering the mouth 3. Sitting together eating meals 4. Playing board games

2 Explanation: 1. Microorganisms might be left on toys that children share, but this is not the most common mode of transmission of infectious diseases. 2. The fecal-oral and respiratory routes are the most common sources of transmission in children. 3. Eating together will not transmit infectious disease. 4. Playing with board games will not transmit infectious disease.

17) The hospital has instructed its nurses that they must participate in disease surveillance associated with infectious agents. Which disease(s) are likely to be the weapons of terrorists? 1. Rocky Mountain spotted fever and Lyme disease 2. Plague, anthrax, and smallpox 3. Rubella, mumps, and chickenpox 4. Severe acute respiratory syndrome (SARS)

2 Explanation: 1. Rocky Mountain spotted fever and Lyme disease are caused by ticks endemic to wooded areas. 2. Plague, anthrax, and smallpox are choices of terrorists because they are highly contagious, lethal diseases that can kill large numbers of people in a relatively short time. 3. Rubella, mumps, and chickenpox are childhood communicable diseases that are not usually fatal. 4. SARS is a rare infectious disease.

16) Which is the priority nursing action when it is suspected that an infectious agent has been used as a weapon by terrorists? 1. Separating clients according to age 2. Initiating airborne and contacts precautions 3. Separating clients according to level of development 4. Disposing of blood-contaminated needles in the lead-lined container

2 Explanation: 1. Separating clients according to age will do nothing to stop terrorism. 2. When clients present with the same type of infectious symptoms, the priority nursing action is to initiate airborne and contact precautions prior to diagnosis. 3. Separating clients according to level of development will do nothing to stop terrorism. 4. Proper disposal of blood-contaminated needles in the sharps container is appropriate nursing actions but does not relate to terrorism.

14) The nurse is providing care to a child who is diagnosed with Lyme disease. The mother wants to know how to protect her other children from contracting this disease from the infected child. Which should the nurse include in the teaching session regarding the transmission of this disease process? 1. Lyme disease is passed from person to person. 2. Lyme disease is passed from animals to person. 3. Lyme disease is passed from adults to children. 4. Lyme disease is passed from person to insects.

2 Explanation: 1. Some infectious diseases are transmitted by insects or animals and are not communicable from person to person. Lyme disease is not communicable from person to person. 2. Zoonosis describes infectious diseases that are transmitted by animals and are not communicable from person to person. Lyme disease is an example of this type of infectious disease. 3. Some infectious diseases are transmitted by insects or animals and are not communicable from person to person. Lyme disease is not communicable from adults to children. 4. Some infectious diseases are transmitted by insects or animals and are not communicable from person to person. Lyme disease is not passed from people to insects.

12) The nurse explains to the parents of a child with a severe burn that wearing an elastic pressure garment (Jobst stocking) during the rehabilitative stage can help prevent which complication? 1. Pain 2. Hypertrophic scarring 3. Poor circulation 4. Formation of thrombus in the burn area

2 Explanation: 1. The Jobst stockings, or pressure garments, do not prevent pain. They are used to prevent development of hypertrophic scarring and contractures. 2. During the rehabilitation stage, Jobst stockings, or pressure garments, are used to reduce development of hypertrophic scarring and contractures. 3. The Jobst pressure garments are used to prevent or minimize the development of hypertrophic scarring and contractures. 4. The elastic pressure garments are used to prevent development of hypertrophic scarring and contractures. They do not prevent the formation of thrombus in the burn area.

7) In which position should the nurse place a child who is experiencing an anaphylactic shock reaction? 1. Trendelenburg position 2. Flat, with legs slightly elevated 3. High Fowler position 4. Reverse Trendelenburg position

2 Explanation: 1. The Trendelenburg position has the head of the bed lowered and is no longer recommended for the treatment of shock, as it causes abdominal organs to press against the diaphragm, which impedes respirations and decreases coronary artery filling. 2. Flat, with legs slightly elevated, is the position that is used for a client experiencing shock. This allows for the blood pressure to be maintained during this critical time. 3. The high Fowler position has the head of the bed elevated and will not be effective to maintain a blood pressure when shock is occurring. 4. The reverse Trendelenburg position has the head of the bed elevated and will not be effective to maintain a blood pressure when shock is occurring.

18) Which clinical therapy should the nurse anticipate when planning care for a toddler-age client who is admitted to the hospital unit with cellulitis of the neck? 1. Topical antibiotics 2. Intravenous antibiotics 3. Incision and drainage 4. Oral corticosteroids

2 Explanation: 1. This is an infection of the deeper tissues including the dermis and supporting connective tissues. Topical antibiotics will not reach the infection. 2. This infection usually requires parenteral antibiotics. 3. The infection is not consolidated into an abscess, so an incision and drainage would not be performed. 4. Corticosteroids are anti-inflammatories and would not be used to treat this infection.

21) The school-age child is admitted to the pediatric neurologic unit with a suspected craniopharyngioma. Which assessment data collected by the nurse supports the suspected diagnosis? Select all that apply. 1. Evening nausea 2. Excessive urination 3. Nystagmus 4. Headaches 5. Orbital ecchymosis

2, 3, 4 Explanation: 1. Nausea is a common symptom of a brain tumor due to effect on the vomiting center of the brain. However, it occurs primarily in the morning on arising. 2. Diabetes insipidus is common in tumors involving the pituitary gland, such as craniopharyngioma. 3. Nystagmus is a symptom of pressure on the optic nerve chiasm. 4. The headaches may be due to the increased bulk in the cranium and/or the ventricular blockage leading to hydrocephalus. 5. Orbital ecchymosis is seen in neuroblastoma secondary to metastasis to the bone.

26) The nurse is providing care to a pediatric client who will require surgery as a portion of the treatment regimen. Which topics should the nurse include in the teaching session related to long- term ramifications associated with this treatment option? 1. Scoliosis 2. Adhesions 3. Hypothyroidism 4. Visual impairment 5. Cardiotoxicity

2, 4 Explanation: 1. Scoliosis is a long-term ramification associated with radiation, not surgical, intervention for cancer. 2. Adhesions are a long-term ramification associated with surgical intervention for cancer. 3. Hypothyroidism is a long-term ramification associated with radiation, not surgical, intervention for cancer. 4. Visual impairment is a long-term ramification associated with surgical intervention for cancer. 5. Cardiotoxicity is a long-term ramification associated with radiation, not surgical, intervention for cancer.

6) A school-age child is diagnosed with a learning disorder that is characterized by problems with manual dexterity and coordination. Which term should the nurse use when documenting this child's disorder in the medical record? 1. Dysgraphia 2. Dyscalculia 3. Dyspraxia 4. Dyslexia

3 Explanation: 1. Children with dysgraphia have difficulty with writing, spelling, and composition. 2. Children with dyscalculia have problems with mathematics and computation problems. 3. Children with dyspraxia have problems with manual dexterity and coordination. 4. Children with dyslexia have difficulty with writing, reading, and spelling.

8) The nurse prepares a DTaP (diphtheria, tetanus toxoid, and acellular pertussis) immunization for a 6-month-old infant. Which nursing action is accurate to safely administer this vaccine to the infant? 1. Administering the vaccine by ID (intradermal) injection 2. Administering the vaccine by SQ (subcutaneous) injection 3. Administering the vaccine by IM (intramuscular) injection 4. Administering the vaccine via a nasal spray

3 Explanation: 1. DTaP is not administered by an ID injection. 2. DTaP is not administered by a SQ injection. 3. DTaP is administered by an IM injection. 4. DTaP is not administered via a nasal spray.

20) The school-age child, diagnosed with a medulloblastoma, will receive intrathecal chemotherapy injections after surgery. Which rationale for this type of chemotherapy administration should the nurse include in the medication teaching? 1. It reduces side effects. 2. It does not require the child being "stuck." 3. Many chemotherapy drugs do not cross the blood-brain barrier. 4. Intrathecal administration is less expensive than intravenous administration.

3 Explanation: 1. Intrathecal administration does not reduce side effects. 2. Intrathecal administration is through a spinal tap, so the child will be "stuck" for administration. 3. This is correct for the selection of intrathecal administration of chemotherapy. 4. This is not accurate and would not be a reason to change administration modes.

3) The nurse is planning care for a child with acquired immune deficiency syndrome (AIDS). Which vaccines should be avoided in the child with AIDS? 1. Inactivated polio vaccine 2. Tetanus toxoid vaccination 3. Varicella vaccine 4. Acellular pertussis vaccine

3 Explanation: 1. Killed virus vaccines are safe to administer to the child with AIDS as there is no risk of acquiring an infection. 2. A toxoid vaccination is made of a toxin that has been produced by the organism but does not include living organisms. 3. A child with an immune disorder should not be immunized with a live varicella vaccine because of the risk of contracting the disease. 4. Acellular pertussis vaccine contains a protein from pertussis rather than the whole cell.

12) Which is the rationale for ensuring the irrigation of blood products and ensuring that they are cytomegalovirus (CMV)-negative prior to administering a blood transfusion for a pediatric client diagnosed with severe combined immune deficiency (SCID)? 1. Transfusion reaction from lymphocytes and platelets in the donor blood. 2. Transfusion reaction and infection from lymphocytes in the donor blood. 3. Infection and graft-versus-host disease from lymphocytes in the donor blood. 4. Infection and graft-versus-host disease from erythrocytes in the donor blood.

3 Explanation: 1. Lymphocytes in the donor blood are responsible for infection and graft-versus-host disease. 2. Lymphocytes in the donor blood are responsible for infection and graft-versus-host disease. 3. Lymphocytes in the donor blood are responsible for infection and graft-versus-host disease. 4. Lymphocytes in the donor blood are responsible for infection and graft-versus-host disease.

10) An adolescent female client is diagnosed with systemic lupus erythematosus (SLE). Which should the nurse include in the teaching session regarding an activity that should be avoided? 1. Receiving a manicure and a pedicure 2. Washing the hair with shampoo daily 3. Using a tanning bed 4. Attending late night parties and dances

3 Explanation: 1. Manicures and pedicures do not place the teenager at any risk. 2. Although one symptom of SLE can be alopecia, gentle shampooing is not a cause of this symptom. 3. Individuals with SLE have photosensitivity, and tanning beds can lead to exacerbations as well as skin damage from sun burns. 4. Although adequate rest is important for the teenager with SLE, the teenager can "catch up" on her sleep the next day. Page Ref: 1248

2) Which factor, noted by the nurse during the pediatric health history portion of the assessment process, would indicate the child is at risk for attention deficit/hyperactivity disorder (ADHD)? 1. Measles, mumps, and rubella vaccine 2. Advanced parental age 3. Prenatal exposure to smoke 4. Immune response

3 Explanation: 1. Measles, mumps, and rubella vaccine has been thought to be associated with autism spectrum disorder, though a relationship has never been established through research. 2. Advanced parental age has been associated with autism spectrum disorders. 3. Research shows that a mother's use of cigarettes during pregnancy can increase the risk for ADHD. 4. Immune response can be associated with autism spectrum disorders.

14) Which nursing action assists in the diagnosis of mental health and cognitive disorders that occur during childhood? 1. Monitoring vital signs 2. Administering prescribed medications 3. Conducting a developmental assessment 4. Documenting an accurate history and physical

3 Explanation: 1. Monitoring vital signs is not a nursing action that assists in the diagnosis of mental health and cognitive disorders in pediatric clients. 2. Administering prescribed medications is not a nursing action that assists in the diagnosis of mental health and cognitive disorders in pediatric clients. 3. Conducting a developmental assessment is a nursing action that assists in the diagnosis of mental health and cognitive disorders in pediatric clients. 4. Documenting an accurate history and physical is not a nursing action that assists in the diagnosis of mental health and cognitive disorders in pediatric clients

18) Which parental action indicates accurate understanding of information presented by the nurse to treat a fever related to otitis media? 1. Putting the child in a tub of cold water to reduce the fever 2. Alternating acetaminophen with ibuprofen every 2 hours 3. Offering generous amounts of fluids frequently 4. Using aspirin every 4 hours to reduce the fever

3 Explanation: 1. Putting the child in a tub of cold water will chill the child and cause shivering, a response that will increase body temperature. 2. Alternating acetaminophen with ibuprofen every 2 hours could result in an overdose. 3. The body's need for fluids increases during a febrile illness. 4. Aspirin has been associated with Reye syndrome and should not be given to children with a febrile illness unless prescribed by the healthcare provider.

14) Which is the priority teaching point for the nurse to include in the discharge instructions for the parents of a child who was admitted in a sickle-cell crisis? 1. Rapid weaning of pain medications 2. A diet high in protein 3. Adequate hydration 4. Restriction of activities

3 Explanation: 1. Rapid weaning is not necessary; reduction of pain medication should proceed at a rate dictated by the child's pain. 2. A high-protein diet is not necessary; a well-balanced diet should be promoted. 3. Adequate hydration will help prevent further sequestration and crisis. 4. Normal activities are not restricted.

13) A school-age client presents to the pediatric clinic with a history of abdominal pain 3 to 4 mornings per week over the last 2 months. The mother states the child usually complains on school days and always seems to be better by afternoon. Which mental health disorder does the nurse suspect? 1. Separation anxiety 2. Depression 3. School phobia 4. Bipolar disorder

3 Explanation: 1. Separation anxiety is most common in girls between the ages of 7 and 9 and may be accompanied by depression when separated. The child was able to successfully separate for a nonschool activity. 2. Depression is often manifested by sleep issues, avoidance of social interactions, and low energy. 3. The child is using somatic complaints to avoid attending school. 4. Bipolar disorder involves periods of hyperactivity alternating with periods of lethargy.

15) The mother of a 22-month-old child states, "My child does not seem to be developing like my sister's daughter, who is the same age." Which screening test should the nurse plan to conduct based on the current data? 1. Magnetic resonance imaging (MRI) of the head 2. An electroencephalogram (EEG) 3. A Denver II 4. Chromosomal study

3 Explanation: 1. The MRI is a diagnostic test, not a screening test, and it is not performed by the nurse. 2. An electroencephalogram evaluates brains wave activity of the brain. It does not evaluate the child's behavior. 3. The Denver Developmental Screening Test II is a tool used by the nurse that evaluates language and development. 4. A chromosomal test is not a screening test but a diagnostic test. It is not performed to determine developmental delay.

15) Which discharge instruction is appropriate for an adolescent client who is a paraplegic due to a motor vehicle accident, in order to prevent decubitus ulcer formation on the buttock? 1. Contract the muscles 5 times every 2 hours. 2. Increase fat in the diet to provide a protective coating over the boney bony prominences. 3. Do wheelchair push-ups every 15 to 30 minutes. 4. Avoid use of sheepskin, as it prevents air from reaching the area.

3 Explanation: 1. The child is a paraplegic and therefore unable to contract the buttock muscles. 2. Extra weight will add to pressure on the boney bony prominences and should be avoided. 3. Lifting the buttocks with the arms can help with blood flow to the buttocks and reduce the risk of breakdown. 4. Sheepskin can reduce pressure on the buttocks; it is one of many pressure reducing materials available.

2) Which parental statement indicates correct understanding of information presented regarding the treatment for infant anemia? 1. "We will add green leafy vegetables to our child's low-iron formula." 2. "We will discontinue the use of vitamin C supplements by 6 months of age." 3. "We will begin an iron-fortified infant cereal at 4 to 6 months of age." 4. "We will introduce cow's milk by 6 months of age."

3 Explanation: 1. The infant's maternal iron stores are depleted by 6 months. Infants who are not breastfed should get iron-fortified formula. Green leafy vegetables, while iron fortified, are not appropriate for the infant. 2. Vitamin C should be started at 6 to 9 months of age and continued because foods rich in vitamin C improve iron absorption. 3. Starting iron-fortified infant cereal at 4 to 6 months of age is recommended for prevention of iron deficiency in children. 4. Cow's milk should not be introduced until 12 months of age.

11) A mother brings in her 4-month-old infant for a routine checkup and vaccinations. The mother reports that her child was exposed to the flu. Which nursing action is accurate based on the current data? 1. Withhold the DTaP vaccination but give the others as scheduled. 2. Give the infant the flu vaccination but withhold the others. 3. Give the vaccinations as scheduled. 4. Withhold the vaccinations.

3 Explanation: 1. There is no reason to withhold any of the vaccinations due at this time. 2. The flu vaccination would not routinely be given to a 4-month-old infant. 3. Giving the vaccine as scheduled will keep the infant properly immunized. 4. Recent exposure to an infectious disease is not a reason to defer a vaccine.

24) Which vaccine reaction, noted by the mother during a telephone conversation with a nurse, would require activation of emergency medical services? 1. A few hives are noted around the injection site. 2. The child is running a slight temperature. 3. The child has swelling of the face. 4. Fever and joint pains occurring within hours of the vaccination.

3 Explanation: 1. This is a mild allergic reaction and does not require calling 911. 2. A slight temperature does not require calling 911. 3. This could be the onset of anaphylaxis, and immediate response is essential to the survival of the child. The mother should call 911. 4. This is a common reaction to immunizations and does not indicate anaphylaxis. Page Ref: 1058

3) Which is a therapeutic nursing response when the mother of a pediatric client diagnosed with cancer states, "I regret not seeking medical attention earlier for my child."? 1. "You may feel guilty, but you should not blame yourself." 2. "Most cancers can be treated easily." 3. "Many types of cancer are difficult to diagnose and might not show early symptoms." 4. "Early diagnosis is not significant in the diagnosis and management of cancer."

3 Explanation: 1. This is not a therapeutic response. It is not appropriate for the nurse to tell the family how they should feel. 2. This answer is not accurate, as cancer is generally prolonged and difficult for both the child and family. 3. Many cancers do not present significant findings until late and can progress rapidly. Giving such information is a communication tool. 4. Outcomes for many cancers are improved with early diagnosis.

29) Which live virus vaccines should the nurse teach to parents as being used to decrease the risk of communicable diseases? Select all that apply. 1. Poliovirus 2. Tetanus 3. Measles 4. Varicella 5. Hepatitis B

3, 4 Explanation: 1. Poliovirus is an example of a killed virus vaccine that is used to decrease the risk of communicable diseases. 2. Tetanus is an example of a toxoid vaccine that is used to decrease the risk of communicable diseases. 3. Measles is an example of a live virus vaccine that is used to decrease the risk of communicable diseases. 4. Varicella is an example of a live virus vaccine that is used to decrease the risk of communicable diseases. 5. Hepatitis B is an example of a recombinant vaccine that is used to decrease the risk of communicable diseases.

3) Which data, noted by the nurse during the physical assessment, would indicate the need to refer an adolescent client for further treatment due to possible depression? Select all that apply. 1. Agoraphobia 2. Somatic complaints 3. Focus on violence 4. Poor self-care 5. Poor school performance

3, 4, 5 Explanation: 1. Agoraphobia, which is a fear of being in places or situations from which escape might be difficult or embarrassing, is seen in children with a panic disorder, not with depression. 2. Somatic complaints are more commonly associated with depression in the younger school-age child. 3. Focus on violence can be associated with depression in the adolescent. 4. Poor self-care can be associated with depression in an adolescent. 5. Poor school performance is associated with depression in the adolescent with depression.

17) The parent of a child diagnosed with Ewing sarcoma asks why multiple drugs are needed to treat this cancer. Which rationale should the nurse use when responding to the client's mother? 1. The prescribed drug protocol is needed due to the aggressive nature of the cancer. 2. The prescribed drug protocol decreases side effects. 3. The prescribed drug protocol is used in specifically in children. 4. The prescribed drug protocol involves a group of drugs that work in different modes.

4 Explanation: 1. A multiple drug protocol is not prescribed due to aggressive nature of Ewing sarcoma. 2. A multiple drug protocol is not prescribed to decrease side effects. 3. A multiple drug protocol is used in both children and adults. 4. A multiple drug protocal is used to attack the cancer cells from all angles.

5) Which urine specific gravity, and corresponding pH, should the nurse include in a goal statement for a pediatric client receiving chemotherapy in the treatment of cancer? 1. Specific gravity 1.030 and pH 7.5 2. Specific gravity 1.005 and pH 6 3. Specific gravity 1.030 and pH 6 4. Specific gravity 1.005 and pH 7.5

4 Explanation: 1. A specific gravity higher than 1.010 can mean fluid intake is not high enough. 2. A pH of less than 7 means acidosis. 3. A specific gravity higher than 1.010 can mean fluid intake is not high enough, and a pH of less than 7 means acidosis. 4. Because the breakdown of malignant cells releases intracellular components into the blood and electrolyte imbalance causes metabolic acidosis, the patient should remain well hydrated, with the urine specific gravity at less than 1.010 and the pH at 7.0 to 7.5.

13) Which is the priority nursing diagnosis for the child diagnosed with idiopathic thrombocytopenic purpura (ITP)? 1. Ineffective Breathing Pattern 2. Nausea 3. Fluid Volume Deficit 4. Risk for Injury

4 Explanation: 1. Although in an advanced state thrombocytopenic purpura can impact breathing, it does not usually cause ineffective breathing patterns. 2. Nausea is not a symptom of ITP. 3. Fluid-volume deficits are not likely to occur with ITP. 4. ITP is the most common bleeding disorder in children, so risk for injury and subsequent bleeding is the priority nursing diagnosis

27) Which medication should the nurse include in a pamphlet to educate parents about methods to reduce the risk of children developing Reye syndrome? 1. Antibiotics 2. Acetaminophen 3. Ibuprofen 4. Aspirin

4 Explanation: 1. Antibiotics are not associated with Reye syndrome. 2. Acetaminophen is not associated with Reye syndrome. 3. Ibuprofen use is not associated with Reye syndrome. 4. Administering aspirin to a child with a viral illness has been found to be associated with Reye syndrome.

5) Which is the priority intervention when planning care for an infant who is diagnosed with eczema? 1. Applying antibiotics to lesions 2. Keeping the baby content 3. Maintaining adequate nutrition 4. Preventing infection of lesions

4 Explanation: 1. Antibiotics are not routinely applied to the lesions, since the lesions are not related to infection. However, impaired skin barrier function and cutaneous immunity place the infant at greater risk for the development of skin infection. 2. Keeping the infant content is not as high a priority as is prevention of infection. An infant with eczema is at a greater risk for the development of skin infection. 3. Maintaining adequate nutrition is important, but it is not as high a priority. Due to impaired skin barrier function and cutaneous immunity, an infant with eczema is at greater risk for the development of skin infection. 4. Nursing care should focus on preventing infection of lesions. Due to impaired skin barrier function and cutaneous immunity, an infant with eczema is at greater risk for the development of skin infections by organisms.

11) The toddler pulled a pot of boiling water off the stove and suffered partial- and full-thickness burns to the chest. The child is now in the recovery-management phase of burn treatment. Which common complication should the nurse assess this client for based on the current data? 1. Asphyxia 2. Metabolic acidosis 3. Shock 4. Wound infection

4 Explanation: 1. Asphyxia is not a common complication during the recovery-management phase of burn treatment. Infection of the burned area is a frequent complication. 2. Metabolic acidosis is not common in the recovery-management phase of burn treatment. Infection of the burned area is a frequent complication. 3. Shock is not the most common complication during the recovery-management phase of burn treatment. Infection of the burned area is a frequent complication. 4. Infection of the burned area is a frequent complication in the recovery-management phase. A goal of burn-wound care is protection from infection.

13) A parent reports that her 5-year-old child, who has had all recommended immunizations, had a mild fever 1 week ago and now has bright red cheeks and a lacy red maculopapular rash on the trunk and arms. Which diagnosis does the nurse anticipate based on the current data? 1. Rubeola (measles) 2. German measles (rubella) 3. Chickenpox (varicella) 4. Fifth disease (erythema infectiosum)

4 Explanation: 1. Children with rubeola have a high temperature and a blotchy maculopapular rash. Because there is a vaccination for rubeola, it is unlikely the child has it. 2. The rash of rubella is a pink, maculopapular rash that begins on the face and progresses downward to the trunk and extremities. The child is fully vaccinated, making this unlikely. 3. Varicella (chickenpox) and rubella (German measles) are unlikely if the child has had all recommended immunizations. 4. Fifth disease manifests first with a flu-like illness, followed by a red "slapped-cheek" sign. Then a lacy maculopapular erythematous rash spreads symmetrically from the trunk to the extremities, sparing the soles and palms.

12) Which is the priority nursing intervention when providing care to a pediatric client who is experiencing disseminated intravascular coagulation (DIC)? 1. Preparing the child for radiographic procedures 2. Implementing the prescribed fluid restriction for the child 3. Encouraging the child to frequently ambulate 4. Monitoring the child's oxygen saturation and vital signs

4 Explanation: 1. DIC is not diagnosed with a radiographic examination but by serum laboratory studies. 2. Fluids need to be monitored but will not be restricted. 3. Ambulation places stress on joints and can promote bleeding. The child with DIC should be placed on bed rest. 4. In a child who has a bleeding and clotting disorder, the priority nursing intervention would be monitoring for life-threatening complications.

6) The nurse is caring for a child with rheumatoid arthritis. Which nonpharmacologic intervention should the nurse include in the plan of care for joint pain? 1. Elevation of the extremity 2. Immobilization 3. Massage 4. Application of moist heat

4 Explanation: 1. Elevation of the extremity would not have an effect on reducing pain in rheumatoid arthritis. 2. Immobilization can lead to contractures. Range of motion to the involved joint should be maintained. 3. Massage of extremities should be avoided because of potential risk for emboli. 4. Moist heat can promote relief of pain and decrease joint stiffness.

4) A child diagnosed with cancer is prescribed chemotherapy. Recent laboratory data show a low white blood cell (WBC) count. Which prescription should the nurse anticipate based on the current data? 1. Epoetin alfa (Epogen) 2. Ondansetron (Zofran) 3. Oprelvekin (Neumega) 4. Filgrastim (Neupogen)

4 Explanation: 1. Epoetin alfa (human recombinant erythropoietin) stimulates red blood cell (RBC) production. 2. Ondansetron (Zofran) is an antiemetic. 3. Oprelvekin (Neumega) increases platelets. 4. Filgrastim (Neupogen) increases production of neutrophils, a specific WBC, by the bone marrow.

1) The nurse is providing care for a pediatric client who is diagnosed with a Wilms tumor. Which laboratory test result should the nurse monitor prior to administering the prescribed chemotherapy dose? 1. Hemoglobin 2. Red blood cell count 3. Platelets 4. Absolute neutrophil count (ANC)

4 Explanation: 1. Hemoglobin indicates oxygen-carrying capacity, not immune response. 2. Red blood cell count has no correlation with immune function. 3. Platelets are associated with clotting, not immune function. 4. The absolute neutrophil count uses both the segmented (mature) and bands (immature) neutrophils as a measure of the body's infection-fighting capability.

18) When teaching a pregnant client about antibodies that are passed from mother to newborn, which antibody should the nurse include? 1. IgM 2. IgA 3. IgD 4. IgG

4 Explanation: 1. IgM is the first antibody produced with primary immune response. It does not cross the placenta. 2. IgA does not cross the placenta. 3. Although the function of IgD is not fully understood, it is not thought to cross the placenta. 4. IgG crosses the placenta and provides the newborn with passive immunity.

15) A preschool-age child is being seen in the oncology clinic. Which reaction should the nurse anticipate based on the child's stage of development? 1. Unawareness of the illness and its severity 2. Acceptance, especially if able to discuss the disease with children their own age 3. Understanding of what cancer is and how it is treated 4. Thoughts that they caused their illness and are being punished

4 Explanation: 1. Infants and toddlers are unaware of the severity of the disease. 2. Immediate acceptance will not occur with children of any age. Adolescents find contact with others who have gone through their experience helpful. 3. School-age children can understand a diagnosis of cancer. 4. Preschool-age children are egocentric and have magical thinking, and thus they might believe they caused their own illness.

9) The adolescent client is receiving methotrexate chemotherapy after undergoing limb-salvage surgery for osteogenic sarcoma. The healthcare provider also prescribes leucovorin therapy. Which adolescent statement indicates correct understanding for the administration schedule for this newly prescribed drug? 1. "I do not have any pain, so I will not need to take the leucovorin this time." 2. "I do not have any nausea, so I .will not need the leucovorin." 3. "I am glad I only need one dose of the leucovorin." 4. "It is important that I receive my leucovorin on time, as it protects my body from the methotrexate."

4 Explanation: 1. Leucovorin is not administered for pain. 2. Leucovorin is administered for nausea. 3. One dose is not the recommended therapy. 4. Leucovorin (citrovorum factor) is a form of folic acid that helps to protect normal cells from the destructive action of methotrexate. It is started within 24 hours of methotrexate administration and is given along with hydration therapy. Usual administration is every 6 hours times 72 hours or until serum methotrexate is at the desired level.

18) An adolescent female client, diagnosed with osteosarcoma, has a below-the-knee amputation as part of the treatment regimen. Which behavior, assessed by the nurse, indicates the client is beginning to accept the amputation? 1. Complaints of pain in the missing leg 2. Insists that a prosthetic be applied prior to participating in physical therapy. 3. Insists on covering the lower portion of the body prior to peer visitation. 4. Watches the dressing change

4 Explanation: 1. Phantom pain is an expected finding after an amputation; however, this does not indicate acceptance. 2. This indicates she wants to return to mobility but has not yet accepted the stump. 3. Being in a wheelchair with a blanket cover indicates she doesn't want her friends to be aware of her amputation. 4. This indicates the girl is willing to look at the stump, which is a step toward acceptance.

10) The sibling of a pediatric client diagnosed with leukemia expresses feelings of anger and guilt to the nurse. Which explanation should the nurse provide to the client's parents regarding the reaction of the sibling? 1. Abnormal; the sibling should be referred to a psychologist. 2. Unexpected; the cancer is easily treated. 3. Unusual; the illness does not affect the sibling. 4. Normal; the sibling is affected, too, and anger and guilt are expected feelings.

4 Explanation: 1. Siblings are generally affected to some degree, but this a normal reaction. 2. Cancer is not easily treated and will affect the entire family. 3. A diagnosis of cancer affects the entire family; siblings will be affected to some degree. 4. A diagnosis of cancer affects the whole family, and initial feelings experienced by the sibling might be anger and guilt.

23) Which statement regarding what was found during the nurse's daily check of the vaccine refrigerator would cause concern about the potency of the vaccines? 1. The vaccine was frozen as labeled. 2. The vaccines have been stored in a refrigerator where the temperature has been maintained between 35 and 46° F. 3. The vaccine's expiration date expires within the next month. 4. The vaccine is stored in the door of the refrigerator.

4 Explanation: 1. Some vaccines are stored in the freezer. 2. This is appropriate to maintain potency. 3. The vaccine is still effective until the expiration day. 4. The door will not maintain the temperature of the vaccine. Vaccines should be stored in the middle of the refrigerator.

16) A pediatric client diagnosed with cancer is to receive 2 months of chemotherapy that is separated by a 6-week period. The mother asks why the child cannot receive the medication for 2 months straight. Which rationale should the nurse include when responding to the client's mother? 1. Prevention of nausea and vomiting from the drugs 2. Schedule requirement of the infusion center 3. Decrease incidence of heart failure 4. Allows normal cells to repair themselves while the cancer cells die

4 Explanation: 1. The 6-week break will not decrease the side effects of nausea and vomiting. 2. Necessary treatment should never be delayed for the convenience of the medical personnel. 3. The 6-week break is not to decrease the incidence of heart failure, as this is not an adverse effect to chemotherapy. 4. Cancer cells have lost the ability to repair themselves, so medications allow the normal cells to repair while the cancer cells die.

25) Which topic should the nurse include in the discharge instructions for the family of a child who has undergone hematopoietic stem cell transplantation (HSCT)? 1. Avoiding influenza vaccination 2. Returning to school within 6 weeks 3. Maintaining a low-calcium diet 4. Practicing diligent hand hygiene

4 Explanation: 1. The child and the family should be encouraged to get yearly influenza vaccinations. 2. The child cannot return to school for 6 to 12 months after an HSCT. In-hospital or in-home schooling is required. 3. The child should be placed on calcium supplements to reduce the risk of osteopenia. 4. Handwashing is essential to prevent the spread of infection.

18) During a natural disaster, a child diagnosed with hemophilia is injured and bleeding internally. Which blood product should the nurse plan to administer if the appropriate factor is not available? 1. Platelets 2. Whole blood 3. Packed cells 4. Fresh or fresh frozen plasma

4 Explanation: 1. The child has adequate platelets, and administration of platelets will not promote clotting. 2. Whole blood will increase the blood volume without promoting clotting. 3. A unit of packed cells will provide red blood cells (RBCs) but not the factor needed to clot. 4. Factors are located in the plasma. Fresh or fresh frozen plasma will provide the best source of factor available.

14) A child is receiving a nucleoside reverse transcriptase inhibitor for human immunodeficiency virus (HIV). Which laboratory value should the nurse include in the plan of care as needing to monitor? 1. Glucose 2. Sodium 3. Potassium 4. Red blood cell count

4 Explanation: 1. The glucose value is a laboratory test for checking diabetes. A nucleoside transcriptase inhibitor does not affect glucose values. 2. Sodium is an electrolyte. A nucleoside transcriptase inhibitor does not affect sodium values. 3. Potassium is an electrolyte. A nucleoside transcriptase inhibitor does not affect potassium values. 4. A nucleoside transcriptase inhibitor causes bone marrow suppression with resulting anemia. Red blood cell counts are monitored at least monthly for changes.

3) The parents of an infant diagnosed with sickle-cell disease ask, "How did our child get this disease? Neither one of us has it." Which should the nurse consider when responding to the parents? 1. The father is not the biologic father of the infant. 2. The mother of the child has the trait, but the father does not. 3. The father of the child has the trait, but the mother does not. 4. The mother and the father of the child have the sickle-cell trait.

4 Explanation: 1. There is no indication that the father is not the actual parent. Both parents could be carriers of the disorder but unaware of their status. 2. Both parents must have the trait for the child to have a 25% chance of having this disease. 3. Both parents must have the trait for the child to have a 25% chance of having this disease. 4. Sickle-cell disease is an autosomal recessive disorder; both parents must have the trait in order for a child to have a 25% chance of having this disease.

9) A mother refuses to have her child immunized with the measles, mumps, and rubella (MMR) vaccine because she believes that letting her infant get these diseases will help him fight off other diseases later in life. Which is an appropriate response by the nurse? 1. Telling the mother that by not immunizing the child she may be exposing pregnant women to the virus, which could cause fetal harm 2. Honoring the mother's request because she is the parent 3. Telling the mother that she is wrong and should have her child immunized 4. Explaining the potential complications of measles, mumps, and rubella infections

4 Explanation: 1. This mother is not concerned about other women; she is concerned about what is best for her child. 2. Nurses are responsible for helping parents make informed decisions. It is important that the mother has all the facts before she makes a decision. 3. The mother has the right to make the decisions for her child. The nurse's role is not to tell the parents what to do but to give them the information they need to make decisions. 4. Explaining that if her child contracts measles, mumps, or rubella, the child could have very serious and permanent complications from these diseases is correct; measles, mumps, and rubella all have potentially serious sequelae, such as encephalitis, brain damage, and deafness.

28) A child is diagnosed with lymphocytopenia. Which parental statements indicate understanding of this diagnosis? Select all that apply. 1. "My child may be prone to allergic reactions." 2. "My child may have trouble initiating an inflammatory response." 3. "My child may require iron supplements to treat this disorder." 4. "My child may require further testing for leukemia." 5. "My child may have been exposed to tuberculosis."

4, 5 Explanation: 1. Lymphocytopenia does not cause a child to be prone to allergic reactions. This statement indicates the need for further education regarding the diagnosis. 2. Lymphocytopenia does not impact the ability to mount an inflammatory response. This statement indicates the need for further education regarding the diagnosis. 3. Lymphocytopenia is not treated with iron supplements. This statement indicates the need for further education regarding the diagnosis. 4. Lymphocytopenia may indicate leukemia. This statement indicates correct understanding of the diagnosis. 5. Lymphocytopenia is often an indication of exposure to tuberculosis. This statement indicates correct understanding of the diagnosis.

23) Which interventions should the nurse include in the plan of care for a pediatric client who suffered a full-thickness burn injury to decrease the risk for infection? Select all that apply. 1. Using an age-appropriate assessment scale 2. Covering the affected skin as much as possible 3. Providing analgesics prior to wound care 4. Keeping the skin as clean and dry as possible 5. Clipping hair around the wound

4, 5 Explanation: 1. Pain assessment with an age-appropriate scale is an appropriate intervention to address pain, not infection. 2. Covering the affected area to prevent temperature changes and air movement is an appropriate intervention to address pain, not infection. 3. Analgesics administration prior to wound care is an appropriate intervention to address pain, not infection. 4. Keeping the skin as clean and dry as possible is an appropriate intervention to decrease infection. 5. Clipping hair around the wound is an appropriate intervention to decrease infection.

30) Which recombinant vaccines should the nurse teach to parents as being used to decrease the risk of communicable diseases? Select all that apply. 1. Poliovirus 2. Tetanus 3. Measles 4. Acellular pertussis 5. Hepatitis B

4, 5 Explanation: 1. Poliovirus is an example of a killed virus vaccine that is used to decrease the risk of communicable diseases. 2. Tetanus is an example of a toxoid vaccine that is used to decrease the risk of communicable diseases. 3. Measles is an example of a live virus vaccine that is used to decrease the risk of communicable diseases. 4. Acellular pertussis is an example of a recombinant vaccine that is used to decrease the risk of communicable diseases. 5. Hepatitis B is an example of a recombinant vaccine that is used to decrease the risk of communicable diseases.