PedFin1

Which nursing diagnosis is most important for a child with Ewing sarcoma who will be undergoing chemotherapy? 1. Risk for fluid volume deficit. 2. Potential for chronic pain. 3. Risk for skin impairment. 4. Ineffective airway clearance.

1. Chemotherapy can cause nausea, vomiting, and possibly diarrhea, which contribute to fluid volume defi cit.

Which are the most serious complications for a child with Kawasaki disease (KD)? Select all that apply. 1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. 4. Hypocoagulability. 5. Decreased sedimentation rate. 6. Hypoplastic left heart syndrome.

1, 2, 3 Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation.

The nurse tells the parent that other conditions can be associated with congenital clubfoot. Select all that apply. 1. Myelomeningocele. 2. Cerebral palsy. 3. Diastrophic dwarfism. 4. Breech position in utero. 5. Prematurity. 6. Fetal alcohol spectrum disorder

1, 2, 3. There is an association between myelomeningocele and congenital clubfoot. There is an association between some forms of cerebral palsy and congenital clubfoot. There is an association between diastrophic dwarfism and congenital clubfoot

Which of the following activities should a nurse suggest for a client diagnosed with hemophilia? Select all that apply. 1. Swimming. 2. Golf. 3. Hiking. 4. Fishing. 5. Soccer.

1, 2, 3, 4. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as swimming. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as golf. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as hiking. . Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as fi shing.

The parents of a 3-year-old are concerned that the child is having "more accidents" during the day. Which questions would be appropriate for the nurse to ask to obtain more information? Select all that apply. 1. "Has there been a stressful event in the child ' s life, such as the birth of a sibling?" 2. "Has anyone else in the family had problems with accidents?" 3. "Does your child seem to be drinking more than usual?" 4. "Is your child more fussy, and does your child seem to be in pain when urinating?" 5. "Is your child having difficulties at preschool?"

1, 2, 3, 4. Stressors such as the birth of a sibling can lead to incontinence in a child who previously had bladder control. A pattern of enuresis can often be seen in families. Increased thirst and incontinence can be associated with diabetes Fussiness and incontinence can be associated with UTIs

Which can occur in untreated developmental dysplasia of the hip (DDH)? Select all that apply. 1. Duck gait. 2. Pain. 3. Osteoarthritis in adulthood. 4. Osteoporosis in adulthood. 5. Increased flexibility of the hip joint in adulthood.

1, 2, 3. Due to abnormal hip joint function, the client's gait is stiff and waddling. Due to abnormal femoral head placement, the client may experience pain and decreased flexibility in adulthood. Due to abnormal femoral head placement, the client may experience osteoarthritis in the hip joint in adulthood.

Which should the nurse include in the teaching plan for a child who had surgery to correct bilateral clubfeet and had the casts removed? Select all that apply. 1. "Your child will need to wear a brace on the feet 23 hours a day for 12 months." 2. "Your child should see an orthopedic surgeon regularly until the age of 18 years." 3. "Your child will not be able to participate in sports that require a lot of running." 4. "Your child may have a recurrence of clubfoot in a year or more." 5. "Most children treated for clubfeet develop feet that appear and function normally." 6. "Most children treated for clubfeet require surgery at puberty."

1, 2, 4, 5. After the final casting, bracing is required for 12 months. This decreases the likelihood of a recurrence. Because clubfoot can recur, it is important to have regular follow-up with the orthopedic surgeon until age 18 years. Even with proper bracing, there may be a recurrence. Most children treated for clubfeet develop normally appearing and functioning feet.

A 13-year-old just returned from surgery for scoliosis. Which nursing intervention is appropriate in the first 24 hours? Select all that apply. 1. Assess for pain. 2. Logroll to change positions. 3. Get the teen to the bathroom 12 to 24 hours after surgery. 4. Check neurological status. 5. Monitor blood pressure.

1, 2, 4, 5. General postoperative nursing interventions include assessing for pain. Specific to scoliosis surgery, logrolling is the means of changing positions. It is essential to check neurological status in a patient who just had scoliosis surgery. General postoperative nursing interventions include assessing vital signs.

Tetralogy of Fallot (TOF) involves which defects? Select all that apply. 1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 3. Left ventricular hypertrophy. 4. Pulmonic stenosis (PS). 5. Pulmonic atresia. 6. Overriding aorta. 7. Patent ductus arteriosus (PDA).

1, 2, 4, 6 TOF is a congenital defect with a ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta

The mother of a child with Duchenne muscular dystrophy asks the nurse who in the family should have genetic screening. Who should the nurse say must be tested? Select all that apply. 1. Mother. 2. Sister. 3. Brother. 4. Aunts and all female cousins. 5. Uncles and all male cousins.

1, 2, 4. Genetic counseling is important in all inherited diseases. Duchenne muscular dystrophy is inherited as an X-linked recessive trait, meaning the defect is on the X chromosome. Women carry the disease, and males are affected. All female relatives should be tested. The X chromosome carries the disease, and males are affected. The sister should have genetic testing to determine whether she carries the gene and identify her risks for having male offspring with the disease. The X chromosome carries the disease and males are affected. All female relatives should be tested.

The nurse is assessing a child diagnosed with a brain tumor. Which of the following signs and symptoms should the nurse expect the child to demonstrate? Select all that apply. 1. Head tilt. 2. Vomiting. 3. Polydipsia. 4. Lethargy. 5. Increased appetite. 6. Increased pulse

1, 2, 4. Head tilt, vomiting, and lethargy are classic signs assessed in a child with a brain tumor. Clinical manifestations are the result of location and size of the tumor. Polydipsia is rare with a brain tumor. It is more often a sign of diabetes insipidus following a closed head injury. Increased appetite occurs during a growth spurt and is not necessarily a sign of a brain tumor. Increased pulse is a nonspecific sign and can occur with many illnesses, cardiac anomalies, fever, or exercise

One nursing diagnosis for juvenile idiopathic arthritis (JIA) is impaired physical mobility. Select all that apply. 1. Give pain medication prior to ambulation. 2. Assist with range-of-motion activities. 3. Encourage the child to eat a high-fat diet. 4. Provide oxygen as necessary. 5. Use nonpharmacological methods, such as heat.

1, 2, 5. Providing pain medication prior to ambulation helps decrease pain during ambulation. Children with JIA need to do range of-motion exercises to prevent joint stiffness. Using nonpharmacological methods such as heat helps with flexibility and pain

A nurse is assessing an 8-year-old with diabetes who is experiencing hyperglycemia. Which symptom (s) indicate (s) that the hyperglycemia requires immediate intervention? Select all that apply. 1. Weakness. 2. Thirst. 3. Shakiness. 4. Hunger. 5. Headache. 6. Irritability. 7. Dizziness.

1, 2, 7. Weakness, thirst, and dizziness are symptoms related to dehydration caused by excretion of large amounts of glucose and water in the urine. The nurse should notify the physician. Shakiness, hunger, headache, and irritability are related to hypoglycemia and result from the brain and other cells being starved for nutrients.

Which of the following factors need(s) to be included in a teaching plan for a child with sickle cell disease? Select all that apply. 1. The child needs to be taken to a physician when sick. 2. The parent should make sure the child sleeps in an air-conditioned room. 3. Emotional stress should be avoided. 4. It is important to keep the child well hydrated. 5. It is important to make sure the child gets adequate nutrition.

1, 3, 4, 5. Seek medical attention for illness to prevent the child from going into a crisis Stress can cause a depressed immune system, making the child more susceptible to infection and crisis. Parents and children are advised to avoid stress. The child needs good hydration and nutrition to maintain good health. The child needs good hydration and nutrition to maintain good health.

Which would the nurse expect a child with spastic CP to demonstrate? Select all that apply. 1. Increased deep tendon reflexes. 2. Decreased muscle tone. 3. Scoliosis. 4. Contractures. 5. Scissoring. 6. Good control of posture. 7. Good fine motor skills.

1, 3, 4, 5. Children with spastic CP have increased deep tendon reflexes. Children with spastic CP have scoliosis. When children with spastic CP have quadriplegia, they can also develop contractures of the Achilles tendons, knees, and adductor muscles. Children with spastic CP have scissoring when walking.

The parents of a preschooler diagnosed with muscular dystrophy are asking questions about the course of their child ' s disease. Which should the nurse tell them? Select all that apply. 1. "Muscular dystrophies usually result in progressive weakness." 2. "The weakness that your child is having will probably not increase." 3. "Your child will be able to function normally and not need any special accommodations." 4. "The extent of weakness depends on doing daily physical therapy." 5. "Your child may have pain in his legs with muscle weakness."

1, 5. Muscular dystrophies are progressive degenerative disorders. The most common is Duchenne muscular dystrophy, which is an X-linked recessive disorder The child may have pain due to loss of strength and muscle wasting

Prior to surgery, a nurse is positioning a neonate with a myelomeningocele. The nurse should position the neonate in which of the following ways? Select all that apply. 1. Place the neonate in a prone position. 2. Keep a diaper over the sac. 3. Allow the neonate's feet to hang over the mattress edge. 4. Use a foam pad to maintain hip adduction. 5. Use a soft pad over the mattress.

1, 3, 5. Prior to surgery, the neonate with a myelomeningocele should be placed in a prone position. The feet can hang over the edge of the mattress to prevent foot deformities. The neonate should rest on a soft surface to reduce pressure on the skin; the nurse can use a fleece pad or foam over the mattress. The meningeal sac should not be covered. The hips should be maintained in abduction using a diaper roll or small pillow

After the birth of an infant with clubfoot, the nursery nurse should do which of the following when instructing the parents? Select all that apply. 1. Speak in simple language about the defect. 2. Avoid the parents unless providing direct care so that they can grieve privately. 3. Keep the infant ' s feet covered at all times. 4. Present the infant as precious; emphasize the well-formed parts of the body. 5. Tell the parent that defects could be much worse. 6. Be prepared to answer questions multiple times

1, 4, 6. The parents will likely be shocked immediately after the birth of the child. To facilitate their understanding, the nurse should speak in simple terms. The baby should be shown to the parents as are all newborns, emphasizing the well-formed parts of the body. Information may need to be repeated as the family begins to absorb the information.

The nurse is caring for a child due for surgery on a Wilms tumor. The child's procedure will consist of which of the following? 1. Only the affected kidney will be removed. 2. Both the affected kidney and the other kidney will be removed in case of recurrence. 3. The mass will be removed from the affected kidney. 4. The mass will be removed from the affected kidney, and a biopsy of the tissue of the unaffected kidney will be done.

1. The treatment of a Wilms tumor involves removal of the affected kidney.

Which gross motor skills should the nurse assess in a 3-month-old with spina bifida? 1. Head control. 2. Pincer grasp. 3. Sitting alone. 4. Rolling over.

1. A 3-month-old should have good head control

The school nurse is talking to a 14-year-old about managing type 1 diabetes mellitus. Which statement indicates the student's understanding of the disease? 1. "It really does not matter what type of carbohydrate I eat as long as I take the right amount of insulin." 2. "I should probably have a snack right after gym class." 3. "I need to cut back on my carbohydrate intake and increase my lean protein intake." 4. "Losing weight will probably help me decrease my need for insulin."

1. A carbohydrate is a carbohydrate, and insulin dosing is based on blood sugar level and carbohydrates to be eaten.

Which statement by the mother of a child with Wilms' tumor tells the nurse that the mother understands what stage II tumor means? 1. "The tumor has extended beyond the kidney but was completely removed." 2. "Although the tumor was in the kidney, it has spread to the lung, liver, and bone." 3. "The tumor has extended outside the kidney to the lungs and the liver." 4. "The tumor was solely located in the kidney but it was totally removed."

1. A stage II tumor is one that extends beyond the kidney but is completely resected. The tumor staging is verified during surgery to maximize treatment protocols. The following criteria for staging are commonly used: stage I, tumor is limited to the kidney and completely resected; stage II, tumor extends beyond the kidney but is completely resected; stage III, residual nonhematogenous tumor is confined to the abdomen; stage IV, hematogenous metastasis occurs, with deposits beyond stage III (lung, bone and brain, liver); stage V, bilateral renal involvement is present at diagnosis

When explaining the plan of care to the parents of an infant with an undescended testis, the nurse should tell the parents about which of the following as a nonsurgical treatment method? 1. A trial of human chorionic gonadotrophic hormone. 2. A trial of adrenocorticotropic hormone. 3. Frequent stimulation of the cremasteric reflex. 4. Use of several warm baths each day

1. A trial of human chorionic gonadotrophin may be given to stimulate descent of the affected testis. A trial of adrenocorticotropic hormone will not cause the testis to descend. The cremasteric reflex results in the testis being drawn up, the opposite of the intended effect. Application of warmth, such as warm baths, although soothing and relaxing for the infant, would have little or no effect on stimulating the testis to descend.

A 13-month-old is discharged following repair of his epispadias. Which statement made by the parents indicates they understand the discharge teaching? 1. "If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage." 2. "If a mucous plug forms in the urinary drainage tube, we will allow it to pass on its own because this is a sign of healing." 3. "We will make sure the dressing is loosely applied to increase the toddler's comfort." 4. "If we notice any yellow drainage, we will know that everything is healing well."

1. Any mucous plugs should be removed by irrigation to prevent blockage of the urinary drainage system.

The parents of an infant with myelomeningocele ask the nurse about their child's future mental ability. What is the nurse's best response? 1. "About one-third are mentally retarded, but it's too early to tell about your child." 2. "About two-thirds are significantly retarded, and you'll know soon if this will occur." 3. "Your child will probably be of normal intelligence since he demonstrates signs of it now." 4. "You'll need to talk with the doctor about that, but you can ask later."

1. Approximately one-third of infants diagnosed with myelomeningocele are mentally retarded, but the degree of retardation is variable and it is difficult to predict intellectual functioning in neonates. The parents are asking for an answer now and should not be told to talk with the physician later

Which is the nurse's best response to the parents of a neonate with a meningocele who ask what can they expect? 1. "After initial surgery to close the defect, most children experience no neurological dysfunction." 2. "Surgery to close the sac will be postponed until the infant has grown and has enough skin to form a graft." 3. "After the initial surgery to close the defect, the child will likely have motor and sensory deficits." 4. "After the initial surgery to close the defect, the child will likely have future problems with urinary and bowel continence."

1. Because a meningocele does not contain any nerve endings, most children experience no neurological problems after surgical correction.

Because of the risks associated with administration of factor VIII concentrate, the nurse should teach the child's family to recognize and report which of the following? 1. Yellowing of the skin. 2. Constipation. 3. Abdominal distention. 4. Puffiness around the eyes.

1. Because factor VIII concentrate is derived from large pools of human plasma, the risk of hepatitis is always present. Clinical manifestations of hepatitis include yellowing of the skin, mucous membranes, and sclera. Use of factor VIII concentrate is not associated with constipation, abdominal distention, or puffiness around the eyes.

As part of the preoperative teaching for the family of a child undergoing a tetralogy of Fallot repair, the nurse tells the family upon returning to the pediatric floor that the child may: 1. Be placed on a reduced sodium diet. 2. Have an activity restriction for several days. 3. Be assigned to an isolation room. 4. Have visits limited to a select few.

1. Because of the hemodynamic changes that occur with open heart surgery repair, particularly with septal defects, transient congestive heart failure may develop. Therefore, the child's sodium intake typically is restricted to 2 to 3 g/day. Activity restrictions are inappropriate. Typically the child is encouraged to walk the halls and unit. Risk for infection after the repair is the same as any postoperative client, therefore isolation is not necessary. The child may be placed in a room with other children who are not contagious. Visitors are not restricted unless the pediatric unit has restrictive visiting policies.

Exposure to which illness should be a cause to discontinue therapy and substitute dipyridamole (Persantine) in a child receiving aspirin therapy for Kawasaki disease (KD)? 1. Chickenpox or influenza. 2. E. coli or Staphylococcus . 3. Candida or Streptococcus A. 4. Streptococcus A or staphylococcus

1. Both chickenpox and influenza are viral in nature, so consider stopping the aspirin because of the danger of Reye syndrome

After a child undergoes nephrectomy for a Wilms' tumor, the nurse should assess the child postoperatively for which early sign of a complication? 1. Increased abdominal distention. 2. Elevated blood pressure. 3. Increased respiratory rate. 4. Increased urine output.

1. Children who have undergone abdominal surgery are at risk for intestinal obstruction from a dynamic ileus. Indications of intestinal obstruction include abdominal distention, decreased or absent bowel sounds, and vomiting. Later signs of intestinal obstruction include tachycardia, fever, hypotension, increased respirations, shock, and decreased urinary output.

A child has had open heart surgery to repair a tetralogy of Fallot with a patch. The nurse should instruct the parents to: 1. Notify all health care providers before invasive procedures for the next 6 months. 2. Maintain adequate hydration of at least 10 glasses of water a day. 3. Provide for frequent rest periods and naps during the first 4 weeks. 4. Restrict the ingestion of bananas and citrus fruit.

1. Children who have undergone open heart surgery with a patch are at risk for infection, especially subacute bacterial endocarditis (SBE), for the fi rst 6 months following surgery. The newest evidence-based guidelines suggest once the patch has epithelialized, these precautions are no longer necessary. Therefore, parents are instructed about SBE precautions including the need to notify providers before invasive procedures so antibiotics can be prescribed for that time period. Having the child drink a very large amount of water may lead to fl uid overload. Children gear their rest schedule to their activities making it unnecessary to schedule frequent rest periods. Bananas and citrus fruit are high in potassium, but there is no evidence provided that the child has an elevated serum potassium requiring restriction.

The mother of a child with Duchenne's muscular dystrophy asks about the chance that her next child will have the disease. The nurse responds based on the understanding of which of the following? 1. Sons have a 50% chance of being affected. 2. Daughters have a 1 in 4 chance of being carriers. 3. Each child has a 1 in 4 chance of developing the disease. 4. Each child has a 50% chance of being a carrier

1. Duchenne's muscular dystrophy is an X-linked recessive disorder. The gene is transmitted through female carriers to affected sons 50% of the time. Daughters have a 50% chance of being carriers.

A 7-year-old is diagnosed with central precocious puberty. The child is to receive a monthly intramuscular (IM) injection of leuprolide acetate (Lupron). The child has great fear of pain and needles and requires considerable stress reduction techniques each time an injection is due. What could the nurse suggest that might help manage the pain? 1. Apply a eutectic mixture of local anesthetics (EMLA) of lidocaine and prilocaine to the site at least 60 minutes before the injection. 2. Have extra help on hand to help hold the child down. 3. Apply cold to the area prior to injection. 4. Identify a reward to bribe the child to behave during the injection.

1. EMLA cream works well for skin and cutaneous pain. Having the child assist in putting on the EMLA patch involves the child in the pain-relieving process.

The nurse is teaching an adolescent about Ewing sarcoma and indicates which as a common site? 1. Shaft. 2. Growth plate. 3. Ball of the femur. 4. Bone marrow.

1. Ewing sarcoma is a bone tumor that affects the shafts of long bones.

The mother of an infant with myelomeningocele asks if her baby is likely to have any other defects. The nurse responds based on the understanding that myelomeningocele is commonly associated with which disorder? 1. Excessive cerebrospinal fluid within the cranial cavity. 2. Abnormally small head. 3. Congenital absence of the cranial vault. 4. Overriding of the cranial sutures

1. Excessive cerebrospinal fluid in the cranial cavity, called hydrocephalus, is the most common anomaly associated with myelomeningocele. Microencephaly, an abnormally small head, is associated with maternal exposure to rubella or cytomegalovirus. Anencephaly, a congenital absence of the cranial vault, is a different type of neural tube defect. Overriding of the sutures, possibly a normal finding after a vaginal delivery, is not associated with myelomeningocele

The nurse is caring for a child with sickle cell disease who is scheduled to have an exchange transfusion. What information should the nurse teach the family? 1. The procedure is done to prevent further sickling during a vaso-occlusive crisis. 2. The procedure reduces side effects from blood transfusions. 3. The procedure is a routine treatment for sickle cell crisis. 4. Once the child ' s spleen is removed, it is not necessary to do exchange transfusions

1. Exchange transfusion reduces the number of circulating sickle cells and slows down the cycle of hypoxia, thrombosis, and tissue ischemia

Which intervention should be included in the plan of care for a newborn with a newly repaired myelomeningocele? 1. Offer formula/breast milk every 3 hours. 2. Turn the infant back to front every 2 hours. 3. Place a wet dressing on the sac. 4. Provide pain medication every 4 hours.

1. Following surgery, a newborn may want formula/breast milk every 2 to 4 hours. Be sure to monitor intake and output

A child who was intubated after a craniotomy now shows signs of decreased level of consciousness. The physician orders manual hyperventilation to keep the Paco2 between 25 and 29 mm Hg and the Pao2 between 80 and 100 mm Hg. The nurse interprets this order based on the understanding that this action will accomplish which of the following? 1. Decrease intracranial pressure. 2. Ensure a patent airway. 3. Lower the arousal level. 4. Produce hypoxia

1. Hypercapnia, hypoxia, and acidosis are potent cerebral vasodilating mechanisms that can cause increased intracranial pressure. Lowering the carbon dioxide level and increasing the oxygen level through hyperventilation is the most effective short-term method of reducing intracranial pressure. Although ensuring a patent airway is important, this is not accomplished by manual hyperventilation. Manual hyperventilation does not lower the arousal level; in fact, the arousal level may increase. Manual hyperventilation is used to reduce hypoxia, not produce it.

The parents of a child just diagnosed with juvenile idiopathic arthritis (JIA) tell the nurse that the diagnosis frightens them because they know nothing about the prognosis. What should the nurse include when teaching the parents about the disease? 1. Half of affected children recover without joint deformity. 2. Many affected children go into long remissions but have severe deformities. 3. The disease usually progresses to crippling rheumatoid arthritis. 4. Most affected children recover completely within a few years.

1. In half of the children diagnosed with JIA, recovery occurs without joint deformity. Approximately one third of the children will continue to have the disease into adulthood, and approximately one sixth will experience severe, crippling deformities

Which child would likely have experienced a delay in the diagnosis of a brain tumor? 1. A 3-month-old, because signs and symptoms would not have been readily apparent. 2. A 5-month-old, because signs and symptoms would not have been readily suspected. 3. School-age child, because signs and symptoms could have been misinterpreted. 4. Adolescent, because signs and symptoms could have been ignored and denied.

1. In infants, signs and symptoms may not be readily apparent because the open fontanel allows for expansion

Which of the following initial physical findings indicate the development of carditis in a child with rheumatic fever? 1. Heart murmur. 2. Low blood pressure. 3. Irregular pulse. 4. Anterior chest wall pain.

1. In rheumatic fever, the connective tissue of the heart becomes inflamed, leading to carditis. The most common signs of carditis are heart murmurs, tachycardia during rest, cardiac enlargement, and changes in the electrical conductivity of the heart. Heart murmurs are present in about 75% of all clients during the first week of carditis and in 85% of clients by the third week. Signs of carditis do not include hypotension or chest pain. The client may have a rapid pulse, but it is usually not irregular.

An 8-year-old child does well after infratentorial tumor removal and is transferred back to the pediatric unit. Although she had been told about having her head shaved for surgery, she is very upset. After exploring the child's feelings, which action should the nurse take? 1. Ask the child if she'd like to wear a hat. 2. Reassure the child that her hair will grow back. 3. Explain to the child's parents that her reaction is normal. 4. Suggest that the parents buy the child a wig as a surprise

1. It is not uncommon for a child to be concerned about a change in appearance when the entire head or only part of the head has been shaved. The child should be encouraged to participate in decisions about her care when possible. Asking her if she would like to wear a hat is one way to encourage this participation. Reassuring the child that her hair will grow back does not address the immediate change in appearance, and it ignores the child's current feelings. Explaining that this type of reaction is normal does not address the child's feelings. The child needs to be able to express feelings and be involved in care as much as possible. Buying the child a wig as a surprise does not address the child's feelings and does not allow her to participate in decision making. Rather, the parents should ask the child if she would like a wig and then work with the child to determine what kind of wig she would like.

The nurse assesses the family's ability to cope with the child's cerebral palsy. Which action should alert the nurse to the possibility of their inability to cope with the disease? 1. Limiting interaction with extended family and friends. 2. Learning measures to meet the child's physical needs. 3. Requesting teaching about cerebral palsy in general. 4. Not seeking financial help to pay for medical bills

1. Limited interaction or lack of interaction with friends and family may lead the nurse to suspect a possible problem with the family's ability to cope with others' reactions and responses to a child with cerebral palsy. Learning measures to meet the child's physical needs demonstrates some understanding and acceptance of the disease. Requesting teaching about the disease suggests curiosity or a desire for understanding, thus demonstrating the family dealing with the situation. Although not seeking financial help to pay for medical bills may be problem, it does not indicate the type of response the family is having to the child's problems

A child is going to receive radiation for Ewing sarcoma. Which of the following is the best nursing intervention to prevent skin breakdown during therapy? 1. Advise the child to wear loose-fitting clothes to minimize irritation. 2. Advise the child to use emollients to prevent dry skin. 3. Apply cold packs nightly to reduce the warmth caused by the treatments. 4. Apply hydrocortisone to soothe itching from dry skin.

1. Loose clothing helps reduce irritation on the sensitive irradiated skin.

The nurse teaches the mother of a young child with Duchenne's muscular dystrophy about the disease and its management. Which of the following statements by the mother indicates successful teaching? 1. "My son will probably be unable to walk independently by the time he is 9 to 11 years old." 2. "Muscle relaxants are effective for some children; I hope they can help my son." 3. "When my son is a little older, he can have surgery to improve his ability to walk." 4. "I need to help my son be as active as possible to prevent progression of the disease."

1. Muscular dystrophy is a progressive disease. Children who are affected by this disease usually are unable to walk independently by age 9 to 11 years. There is no effective treatment for childhood muscular dystrophy. Although children who remain active are able to avoid wheelchair confinement for a longer period, activity does not prevent disease progression

Which would the nurse teach a patient when NSAIDs are prescribed for treating juvenile idiopathic arthritis (JIA)? 1. Take with food. 2. Take on an empty stomach. 3. Blood levels are required for drug dosages. 4. Good oral hygiene is needed.

1. NSAIDs can cause gastric bleeding with long-term use; food helps to reduce the exposure of the drug on the stomach lining

After teaching the family of a child with scoliosis who needs to wear a Boston brace, which of the following activities, if stated by the child and family as occasions appropriate for removal of the brace, indicates successful teaching? 1. When bathing, for about 1 hour per day. 2. While eating, for a total of 3 hours a day. 3. During school, for about 8 hours a day. 4. When sleeping, for a total of 10 hours a day.

1. One of the most effective spinal braces for correcting scoliosis, the Boston brace should be worn for at least 16 to 23 hours a day, except when carrying out personal hygiene measures.

The parent of a 4-year-old brings the child to the clinic and tells the nurse the child ' s abdomen is distended. After a complete examination, a diagnosis of Wilms tumor is suspected. Which of the following is most important when doing a physical examination on this child? 1. Avoid palpation of the abdomen. 2. Assess the urine for the presence of blood. 3. Monitor vital signs, especially the blood pressure. 4. Obtain an accurate height and weight.

1. Palpating the abdomen of the child in whom a diagnosis of Wilms tumor is suspected should be avoided because manipulation of the abdomen may cause seeding of the tumor.

Which of the following statements made by the mother of a school-age child who has had a craniotomy for a brain tumor would warrant further exploration by the nurse? 1. "After this, I'll never let her out of my sight again." 2. "I hope that she'll be able to go back to school soon." 3. "I wonder how long it will be before she can ride her bike." 4. "Her best friend is eager to see her; I hope she won't be upset.

1. Parents of a child who has undergone neurosurgery can easily become overprotective. Yet the parents must foster independence in the convalescing child. It is important for the child to resume age appropriate activities, and parents play an important role in encouraging this. Statements about going back to school would be expected. Parents want the child to return to normal activities after a serious illness or injury as a sign that the child is doing well.

Which should be included in the plan of care for a child who has a neuroblastoma with metastasis to the bone marrow and pancytopenia? 1. Administer red blood cells. 2. Limit school attendance to less than 4 hours daily. 3. Administer warfarin (Coumadin). 4. Encourage a diet high in fresh fruits and vegetables.

1. Red blood cells will be needed to increase the red blood cell count.

An adolescent with insulin-dependent diabetes is being taught the importance of rotating the sites of insulin injections. The nurse should judge that the teaching was successful when the adolescent identifies which of the following as a result of using the same site? 1. Destruction of the fat tissue and poor absorption. 2. Destruction of nerves and painful neuritis. 3. Destruction of the tissue and too-rapid insulin uptake. 4. Development of resistance to insulin and need for increased amounts

1. Repeated use of the same injection site can result in atrophy of the fat in the subcutaneous tissue and lead to poor insulin absorption. The neuritis that develops from diabetes is related to microvascular changes that occur. Subcutaneous tissue is not destroyed and insulin is not rapidly absorbed. Resistance to insulin is caused by an immune response to the insulin protein

The most appropriate nursing diagnosis for a child with type 1 diabetes mellitus is which of the following? 1. Risk for infection related to reduced body defenses. 2. Impaired urinary elimination (enuresis). 3. Risk for injury related to medical treatment. 4. Anticipatory grieving.

1. Risk for infection is a correct nursing diagnosis. Understanding DM is understanding the effect it has on peripheral circulation and impairment of defense mechanisms.

When assessing a female adolescent for scoliosis, what should the nurse ask the client to do? 1. Bend forward at the waist with arms hanging freely. 2. Lie fl at on the floor and extend her legs straight from the trunk. 3. Sit in a chair while lifting her feet and legs to a right angle with the trunk. 4. Stand against a wall while pressing the length of her back against the wall

1. Scoliosis, a lateral deviation of the spine, is assessed by having the client bend forward at the waist with arms hanging freely, then looking for lateral curvature of the spine and a rib hump. The other positions will not reveal the deviation of the spine.

The parents of a 12-month-old with cerebral palsy (CP) ask the nurse if they should teach their child sign language because he has not begun to vocalize. The nurse bases the response on the knowledge that sign language: 1. May be a very beneficial way to help children with CP communicate. 2. May cause confusion and further delay vocalization. 3. Is difficult to learn for most children with CP. 4. Is beneficial to learn, but it would be best to wait until the child is older.

1. Sign language may help the child with CP communicate and ultimately decrease frustration. Children with CP may have diffi culty verbalizing because of weak tongue and jaw muscles. They may be able to have suffi cient motor skills to communicate with their hands.

A child with a repaired myelomeningocele is in the clinic for a regular examination. The child has frequent constipation and has been crying at night because of pain in the legs. After an MRI, the diagnosis of a tethered cord is made. Which should the nurse tell the parent? 1. Tethered cord is a postsurgical complication. 2. Tethered cord occurs during times of slow growth. 3. Release of the tethered cord will be necessary only once. 4. Offering laxatives and acetaminophen (Tylenol) daily will help control these problems.

1. Tethered cord is caused by scar tissue formation from the surgical repair of the myelomeningocele and may affect bowel, bladder, or lower extremity functioning. As the child grows, this will affect continence and mobility

The nurse teaches the parents of an infant with developmental dysplasia of the hip how to handle their child in a Pavlik harness. Which of the following is most appropriate? 1. Fitting the diaper under the straps. 2. Leaving the harness off while the infant sleeps. 3. Checking for skin redness under straps every other day. 4. Putting powder on the skin under the straps every day.

1. The Pavlik harness is worn over a diaper. Knee socks are also worn to prevent the straps and foot and leg pieces from rubbing directly on the skin. For maximum results, the infant needs to wear the harness continuously. The skin should be inspected several times a day, not every other day, for signs of redness or irritation. Lotions and powders are to be avoided because they can cake and irritate the skin.

An adolescent tells the nurse that the area below his knee has been hurting for several weeks. The nurse should obtain history information about participation in which of the following? 1. Soccer. 2. Golf. 3. Diving. 4. Swimming

1. The adolescent's complaint should alert the nurse to the possibility of Osgood-Schlatter disease. This disease, found primarily in boys 10 to 15 years of age and in girls 8 to 13 years of age, occurs when the infrapatellar ligament of the quadriceps muscle is not well anchored to the tibial tubercle. Excessive activity of the quadriceps muscle results in microtrauma, which causes swelling and pain. Track, soccer, and football commonly produce this condition. Osgood-Schlatter disease is self-limited and usually responds to rest and application of ice.

The nurse is teaching about congenital clubfoot in infants. The nurse evaluates the teaching as successful when the parent states that clubfoot is best treated when? 1. Immediately after diagnosis. 2. At age 4 to 6 months. 3. Prior to walking (age 9 to 12 months). 4. After walking is established (age 15 to 18 months).

1. The best outcomes for clubfoot are seen if casting begins as soon as the diagnosis is made, usually at birth.

The parents of a child with cerebral palsy (CP) are learning how to feed their child and avoid aspiration. The nurse would question which of the following when reviewing the teaching plan? 1. Place the food on the tip of the tongue. 2. Place the child in an upright position during feedings. 3. Feed the child soft and blended foods. 4. Feed the child slowly.

1. The food should be placed far back in the mouth to avoid tongue thrust.

The nurse tells a family of a child with cerebral palsy (CP) that since the 1960s the incidence of CP has: 1. Increased. 2. Decreased. 3. Remained the same. 4. Has decreased because of early misdiagnosis.

1. The incidence of CP has increased, partly as a result of the increased survival rate of extreme low-birth-weight and premature infants.

A 6-month-old child is discharged with a urinary stent after a procedure to repair a hypospadias. The nurse should tell the parents to: 1. Avoid tub baths until the stent is removed. 2. Measure output in the urinary bag. 3. Avoid drinking fruit juice. 4. Clean the tip of the penis 3 times a day with soap and water.

1. The parents should keep the penis as dry as possible until the stent is removed. Soaking in a tub bath is not recommended. Children this age typically go home voiding directly into a diaper. Infants may be started on juice at 6 months of age. Parents are advised to keep their child well hydrated after a hypospadius repair. Therefore, there is no reason to avoid juice. Cleaning the tip of the penis 3 times a day may cause unnecessary irritation.

When developing the plan of care for an infant diagnosed with myelomeningocele and the parents who have just been informed of the infant's diagnosis, which action should the nurse include as the priority when the parents visit the infant for the first time? 1. Emphasizing the infant's normal and positive features. 2. Encouraging the parents to discuss their fears and concerns. 3. Reinforcing the doctor's explanation of the defect. 4. Having the parents feed their infant

1. The parents should see the neonate as soon as possible, because the longer they must wait to see the neonate, the more anxiety they will feel. Because the parents are acutely aware of the deficit, the nurse should emphasize the neonate's normal and positive features during the visit. All parents, but especially those with a child who has a disability or defect, need to hear positive comments and comments that reflect how the infant is normal. Although the parents need to discuss their fears and concerns, the priority on the first visit is to emphasize the neonate's normal and positive features. Reinforcing the doctor's explanation of the defect may be necessary later. Reinforcing the explanation at this initial visit emphasizes the defect, not the child. The parents should spend time with or care for the neonate after birth because parent-infant contact is necessary for attachment. The parents cannot feed the neonate before the defect is repaired because the repair typically occurs within 24 hours. The infant will be prone in an isolette or warmed and watched closely. However, the parents can fondle and stroke the neonate.

A 12-year-old with rheumatic fever has a history of long-term aspirin use. Which statement by the client indicates that the nurse should notify the health care provider? 1. "I hear ringing in my ears." 2. "Is it alright to put lotion on my itchy skin?" 3. "My stomach hurts after I take that medicine." 4. "These pills make me cough."

1. Tinnitus is an adverse effect of prolonged aspirin therapy and the child should be examined by a health care provider for hearing loss. Itchy skin commonly accompanies the rash associated with rheumatic fever and the nurse can encourage lotion use. The nurse teaches clients to take aspirin with food or milk to avoid abdominal discomfort. The nurse can also address the fact that coughing after ingesting aspirin can be caused by inadequate fluid intake during administration.

Which of the following would be included in the plan of care for a hospitalized newborn following surgical repair of a myelomeningocele? Select all that apply. 1. Skull x-rays. 2. Daily head circumference measurements. 3. MRI scan. 4. Vital signs every 6 hours. 5. Holding to breastfeed.

2, 3 Daily head circumference measurements are done to assess for hydrocephalus. Diagnostic tests include MRI scan, CT scan, ultrasound, and myelography

Which is true of a Wilms tumor? Select all that apply. 1. It is also referred to as neuroblastoma. 2. It can occur at any age but is seen most often between the ages of 2 and 5 years. 3. It can occur on its own or can be associated with many congenital anomalies. 4. It is a slow-growing tumor. 5. It is associated with a poor prognosis.

2, 3 It can occur at any age but is seen most often between the ages of 2 and 5 years. It can occur on its own or can be associated with many congenital anomalies

A parent of a newborn diagnosed with myelomeningocele asks what is/are common long-term complication(s)? The nurse's best response is which of the following? Select all that apply. 1. Learning disabilities. 2. Urinary tract infections. 3. Hydrocephalus. 4. Decubitus ulcers and skin breakdown. 5. Nutrition issues. 6. Attention deficit disorders

2, 3 Urinary tract infections are the most common complication of myelomeningocele. Nearly all children with myelomeningocele have a neurogenic bladder that leads to incomplete emptying of the bladder and subsequent urinary tract infections. Frequent catheterization also increases the risk of urinary tract infection. About 90% to 95% of children with myelomeningocele experience hydrocephalus

A child with spastic cerebral palsy is to begin botulinum toxin type A (Botox) injections. Which treatment goals should the health care team set for the child related to Botox? Select all that apply. 1. Improved nutritional status. 2. Decreased pain from spasticity. 3. Improved motor function. 4. Enhanced self-esteem. 5. Reduced caregiver strain and improved selfcare. 6. Decreased speech impediments

2, 3, 4, 5. Botox injections can be used to improve many aspects of quality of life for the child with cerebral palsy. The injections can help decrease pain from spasticity. Injections improve motor status by reducing rigidity and allowing for more effective physical therapy to improve range of motion. Decreased spasms enhance self-esteem. Improved motor status facilitates the ability to provide some aspects of care, especially transfers. Botox does not significantly affect nutritional status or speech

Parents bring a 10-month-old boy born with myelomeningocele and hydrocephalus with a ventriculoperitoneal shunt to the emergency department. His symptoms include vomiting, poor feeding, lethargy, and irritability. What interventions by the nurse are appropriate? Select all that apply. 1. Weigh the child. 2. Listen to bowel sounds. 3. Palpate the anterior fontanel. 4. Obtain vital signs. 5. Assess pitch and quality of the child's cry

2, 3, 4, 5. Common shunt complications are obstruction, infection, and disconnection of the tubing. The signs presented by the child indicate increased intracranial pressure from a shunt malformation, which could be caused by an infection, such as peritonitis or meningitis. By listening to bowel sounds, the nurse will note if peritonitis might be a possibility. Palpating the fontanel would indicate increased intracranial pressure if it were bulging and taut. Obtaining vital signs would assess for signs of infection, such as elevated temperature or, possibly, Cushing's triad (elevated blood pressure, slow pulse, and depressed respirations). A high-pitched cry is a sign of increased intracranial pressure. Weighing the child at this time would not be a priority, nor would it add to identifying the cause of the signs and symptoms.

The nurse is teaching the parents of a child with myelomeningocele how to prevent urinary tract infections. What should the care plan include for this child? Select all that apply. 1. Provide meticulous skin care. 2. Use the Crede's maneuver to empty the bladder. 3. Encourage frequent emptying of the bladder. 4. Assure adequate fluid intake. 5. Use tight-fitting diapers around the meatus

2, 3, 4. Prevention of urinary tract infections includes adequate fluid intake, urine acidification, frequent emptying of the bladder including the use of the Crede's maneuver if needed. While the nurse should keep the skin clean and dry, this will not prevent urinary tract infections. Keeping urine close to the meatus with a tight-fitting diaper would increase the risk for infection

Nonsteroidal anti-inflammatory drugs are the first choice in treating a child with juvenile idiopathic arthritis. Which adverse effects should the nurse include in the teaching plan for the parents? Select all that apply. 1. Weight gain. 2. Abdominal pain. 3. Blood in the stool. 4. Folic acid deficiency. 5. Reduced blood clotting ability.

2, 3, 5. Adverse effects from nonsteroidal anti-inflammatory drugs include abdominal pain, blood in stool, and reduced clotting ability. Weight gain is common with corticosteroids. Folic acid deficiency is associated with methotrexate therapy

A child with Kawasaki disease is receiving low dose aspirin. The mother calls the clinic and states that the child has been exposed to influenza. Which recommendations should the nurse make? Select all that apply. 1. Increase fluid intake. 2. Stop the aspirin. 3. Keep the child home from school. 4. Watch for fever. 5. Weigh the child daily.

2, 4. Aspirin needs to be stopped because of its possible link to Reye's syndrome. Additionally, the parents need to watch for signs and symptoms of influenza. Children with influenza frequently present with fever, cold symptoms, and gastrointestinal symptoms. Increasing the child's fluid intake and weighing the child daily are not needed at this time because the child is not ill. Keeping the child home from school is not necessary, because the child is not ill and has already been exposed.

The nurse in a diabetic clinic sees a 10-year-old who is a new diabetic and has had trouble maintaining blood glucose levels within normal limits. The child's parent states the child has had several daytime "accidents." The nurse knows that this is referred to as which of the following? 1. Primary enuresis. 2. Secondary enuresis. 3. Diurnal enuresis. 4. Nocturnal enuresis.

2. Secondary enuresis refers to urinary incontinence in a child who previously had bladder control.

The nurse reports to the physician signs of increased intracranial pressure in an infant with a myelomeningocele who has which of the following? 1. Minimal lower extremity movement. 2. A high-pitched cry. 3. Overflow voiding only. 4. A fontanel that bulges with crying.

2. A Chiari malformation obstructs the flow of cerebral spinal fluid resulting in hydrocephalus. This is a common problem in infants with myelomeningocele and will require surgical intervention with a shunt. A high-pitched cry is one sign of increased intracranial pressure that may indicate the presence of a Chiari malformation and requires further evaluation. Minimal movement of the lower extremities is an expected finding associated with spinal cord damage. Overflow voiding comes from a neurogenic bladder, not increased intracranial pressure. It is normal for the fontanel to bulge with crying.

A child with a brain tumor is less responsive to verbal commands than he was when the nurse assessed the client the previous hour. The nurse should next: 1. Raise the head of the bed. 2. Notify the physician. 3. Administer an analgesic. 4. Obtain an oximeter reading

2. A decreasing level of consciousness, decerebrate positioning, or Cushing's triad (elevated systolic blood pressure, decreased pulse, and decreased respiratory rate) indicates that there is pressure on the brain stem and the client could require intubation and cardiac resuscitation unless the physician can order a medication or surgical procedure to reduce the intracranial pressure. Raising the head of the bed could offer some reduction in the intracranial pressure by increasing venous blood return from the head, but it is not the priority at this time. An analgesic administered at this time would mask the sign of decreasing level of consciousness and hinder assessment. An oximeter would measure the oxygen level in the blood, but not necessarily in the brain.

While assessing the penis of a child who has had surgery for repair of a hypospadias, the nurse observes the appearance of the penis. The nurse should report which aspect to the surgeon? 1. Swollen. 2. Dusky blue at the tip. 3. Somewhat misshapen. 4. Pink

2. A dusky blue color at the tip of the penis may indicate a problem with circulation, and the nurse should notify the surgeon. Following surgery, it is normal for the penis to be swollen and pink. The penis may be misshapen and is unlikely to look normal even after reconstruction.

The child in a new hip spica cast seems to be adjusting to the cast, except that after each meal the child tells the nurse that the cast is too tight. Which of the following should the nurse plan to do? 1. Administer a laxative prior to each meal. 2. Offer smaller, more frequent meals. 3. Give the child a mechanical soft diet. 4. Offer the child more fruits and grains.

2. A hip spica cast encircles the abdomen. When the child eats a large meal, abdominal pressure increases, causing the cast to feel tight. Therefore, the nurse should plan to offer smaller, more frequent meals to minimize abdominal distention. If the child's appetite were decreased in conjunction with a feeling of fullness, the nurse might suspect that the child was becoming constipated and plan to use laxatives or a higher-fiber diet. A mechanical soft diet is indicated when the child has difficulty chewing food adequately. Giving the child more fruits and grains would contribute to abdominal distention and complaints of the cast tightness after eating.

An infant is born with a sac protruding through the spine, containing cerebrospinal fluid (CSF), a portion of the meninges, and nerve roots. This condition is referred to as: 1. Meningocele. 2. Myelomeningocele. 3. Spina bifida occulta. 4. Anencephaly.

2. A myelomeningocele is a sac that contains a portion of the meninges, the CSF, and the nerve roots.

The mother of a child hospitalized with tetralogy of Fallot tells the nurse that the child's 3-year-old sibling has become quiet and shy and demonstrates more than a usual amount of genital curiosity since this child's hospitalization. The nurse should tell the mother: 1. "This behavior is very typical for a 3-yearold." 2. "This may be how your child expresses feeling a need for attention." 3. "This may be an indication that your child may have been sexually abused." 4. "This may be a sign of depression in your child."

2. According to Erikson, the central psychosocial task of a preschooler is to develop a sense of industry versus guilt. Any environmental situation may affect the child. In this situation the sibling is probably feeling less attention from the mother and trying to resolve the conflict in an inappropriate way. Three-year-olds are usually active and outgoing. These behaviors represent a change. Data are not sufficient to suggest the child has been exposed to a sexual experience. Symptoms of depression would include withdrawal and fatigue.

The primary health care provider orders pulse assessments through the night for a 12-yearold child with rheumatic fever who has a daytime heart rate of 120. The nurse explains to the mother that this is to evaluate if the elevated heart rate is caused by: 1. The morning digitalis. 2. Normal activity during waking hours. 3. A warmer daytime environment. 4. Normal variations in day and evening hours.

2. An above-average pulse rate that is out of proportion to the degree of activity is an early sign of heart failure in a client with rheumatic fever. The sleeping pulse is used to determine whether the mild tachycardia persists during sleep (inactivity) or whether it is a result of daytime activities. The environmental temperature would need to be quite warmer before it could influence the heart rate. Digitalis lowers the heart rate, so the rate would be decreased during the daytime.

Before placement of a ventriculoperitoneal shunt for hydrocephalus, an infant is irritable, lethargic, and difficult to feed. To maintain the infant's nutritional status, which of the following actions would be most appropriate? 1. Feeding the infant just before doing any procedures. 2. Giving the infant small, frequent feedings. 3. Feeding the infant in a horizontal position. 4. Scheduling the feedings for every 6 hours.

2. An infant with hydrocephalus is difficult to feed because of poor sucking, lethargy, and vomiting, which are associated with increased intracranial pressure. Small, frequent feedings given at times when the infant is relaxed and calm are tolerated best. Feeding an infant before any procedure is inappropriate because the stress of the procedure may lead to vomiting. Ideally, the infant should be held in a slightly vertical position when feeding to prevent backflow of formula into the eustachian tubes and subsequent development of ear infections. Most infants are fed on demand every 3 to 4 hours.

Which child is at increased risk for cerebral palsy (CP)? 1. An infant born at 34 weeks with an Apgar score of 6 at 5 minutes. 2. A 17-day-old infant with group B Streptococcus meningitis. 3. A 24-month-old child who has experienced a febrile seizure. 4. A 5-year-old with a closed-head injury after falling off a bike.

2. Any infection of the central nervous system increases the infant ' s risk of CP.

A diagnosis of hemophilia A is confirmed in an infant. Which of the following instructions should the nurse provide the parents as the infant becomes more mobile and starts to crawl? 1. Administer one-half of a children's aspirin for a temperature higher than 101° F (38.3° C). 2. Sew thick padding into the elbows and knees of the child's clothing. 3. Check the color of the child's urine every day. 4. Expect the eruption of the primary teeth to produce moderate to severe bleeding.

2. As the hemophilic infant begins to acquire motor skills, the risk of bleeding increases because of falls and bumps. Such injuries can be minimized by padding vulnerable joints. Aspirin is contraindicated because of its antiplatelet properties, which increase the infant's risk for bleeding. Because genitourinary bleeding is not a typical problem in children with hemophilia, urine testing is not indicated. Although some bleeding may occur with tooth eruption, it does not normally cause moderate to severe bleeding episodes in children with hemophilia. CN

When developing the teaching plan for parents using the Pavlik harness with their child, what should be the nurse's initial step? 1. Assessing the parents' current coping strategies. 2. Determining the parents' knowledge about the device. 3. Providing the parents with written instructions. 4. Giving the parents a list of community resources

2. Assessing the learner's knowledge level is the initial step in any teaching plan to promote the maximum amount of learning. This assessment also provides the nurse with a starting point for teaching. Assessing coping strategies can provide important information to the development of the teaching plan but is not the initial step. Giving parents written instructions or a list of community resources is appropriate once the parents' knowledge level has been determined and teaching has begun.

What associated manifestation might the nurse occasionally find in a child diagnosed with Wilms tumor? 1. Atrial fibrillation. 2. Hypertension. 3. Endocarditis. 4. Hyperlipidemia.

2. Because Wilms tumor sits on the kidney, it can be associated with secondary hypertension. It does not affect or cause the other conditions.

After surgical repair of a myelomeningocele, which position should the nurse use to prevent musculoskeletal deformity in the infant? 1. Placing the feet in flexion. 2. Allowing the hips to be abducted. 3. Maintaining knees in the neutral position. 4. Placing the legs in adduction

2. Because of the potential for hip dislocation, the neonate's legs should be slightly abducted, hips maintained in slight to moderate abduction, and feet maintained in a neutral position. The infant's knees are flexed to help maintain the hips in abduction

Which is the most likely reason an adolescent with diabetes has problems with low self-esteem? 1. Managing diabetes decreases independence. 2. Managing diabetes complicates perceived ability to "fit in." 3. Obesity complicates perceived ability to "fit in." 4. Hormonal changes are exacerbated by fluctuations in insulin levels.

2. Because the desire to fit in is so strong in adolescence, the need to manage one's diabetes can compromise the patient's perception of ability to do so. For example, an adolescent with type 1 DM has to plan meals and snacks, test blood sugar, limit choices of when and what to eat, and always be concerned with the immediate health consequences of actions as simple as eating. The fact that these limitations can negatively affect self-esteem is an essential concept for the nurse caring for adolescents with diabetes to understand.

Which should be the priority nursing diagnosis for a 12-hour-old newborn with a myelomeningocele at L2? 1. Altered bowel elimination related to neurological deficits. 2. Potential for infection related to the physical defect. 3. Altered nutrition related to neurological deficit. 4. Disturbance in self-concept related to physical disability.

2. Because this infant has not had a repair, the sac is exposed. It could rupture, allowing organisms to enter the CSF, so this is the priority

A child with cerebral palsy (CP) has been fitted for braces and is beginning physical therapy to assist with ambulation. The parents ask why he needs the braces when he was crawling without any assistive devices. Select the nurse ' s best response. 1. "The CP has progressed, and he now needs more assistance to ambulate." 2. "As your child grows, different muscle groups may need more assistance." 3. "Most children with CP need braces to help with ambulation." 4. "We have found that when children with CP use braces, they are less likely to fall."

2. CP can manifest in different ways as the child grows. It does not progress, but its clinical manifestations may change.

When developing the plan of care for a newly admitted 2-year-old child with the diagnosis of Kawasaki disease, which of the following should be the priority? 1. Taking vital signs every 6 hours. 2. Monitoring intake and output every hour. 3. Minimizing skin discomfort. 4. Providing passive range-of-motion exercises.

2. Cardiac status must be monitored carefully in the initial phase of KD because the child is at high risk for congestive heart failure (CHF). Therefore, the nurse needs to assess the child frequently for signs of CHF, which would include respiratory distress and decreased urine output. Vital signs would be obtained more often than every 6 hours because of the risk of CHF. Although minimizing skin discomfort would be important, it is does not take priority over monitoring the child's hourly intake and output. Passive range-of-motion exercises would be done if the child develops arthritis.

The nurse is caring for an infant with a myelomeningocele. The parents ask the nurse why the nurse keeps measuring the baby ' s head circumference. Select the nurse ' s best response: 1. "Babies 'heads are measured to ensure growth is on track." 2. "Babies with a myelomeningocele are at risk for hydrocephalus, which shows up as an increase in head size." 3. "Because your baby has an opening on the spinal cord, your infant is at risk for meningitis, which can show up as an increase in head size." 4. "Many infants with myelomeningocele have microcephaly, which can show up as a decrease in head size."

2. Children with myelomeningocele are at increased risk for hydrocephalus, which can be manifested with an increase in head circumference.

The nurse is caring for an 8-year-old girl whose parents indicate she has developed spastic movements of her extremities and trunk, facial grimace, and speech disturbances. They state it seems worse when she is anxious and does not occur while sleeping. The nurse questions the parents about which recent illness? 1. Kawasaki disease (KD). 2. Rheumatic fever (RF). 3. Malignant hypertension. 4. Atrial fibrillation

2. Chorea can be a manifestation of RF, with a higher incidence in females

Which of the following outcomes indicates that the activity restriction necessary for a 7-year-old child with rheumatic fever during the acute phase has been effective? 1. Joints demonstrate absence of permanent injury. 2. The resting heart rate is between 60 and 100 bpm. 3. The child exhibits a decrease in chorea movements. 4. The subcutaneous nodules over the joints are no longer palpable.

2. During the acute phase of rheumatic fever, the heart is inflamed and every effort is made to reduce the work of the heart. Bedrest with limited activity is necessary to prevent heart failure. Therefore, the most reliable indicator that activity restriction has been effective is a resting heart rate between 60 and 100 bpm, normal for a 7-year-old child. No permanent damage to the joints occurs with rheumatic fever. The chorea movements associated with rheumatic fever are self-limited and usually disappear in 1 to 3 months. They are unrelated to activity restrictions. Subcutaneous nodules that occur over joint surfaces also resolve over time with no treatment. Therefore, they are not appropriate for evaluating the effectiveness of activity restrictions

The nurse is discharging a baby with clubfoot who has had a cast applied. The nurse should provide additional teaching to the parents if they state: 1. "I should call if I see changes in the color of the toes under the cast." 2. "I should use a pillow to elevate my child's foot as he sleeps." 3. "My baby will need a series of casts to fix her foot." 4. "Having a cast should not prevent me from holding my baby."

2. Elevating the extremity at different points during the day is helpful to prevent edema, but pillows should not be used in the crib because they increase the risk of sudden infant death syndrome (SIDS). A change in the color of the toes is a sign of impaired circulation and requires medical evaluation. Children typically need a series of 5 to 10 casts to correct the deformity. Infants with club feet still need frequent holding like any other newborn

Which position initially is most beneficial for an infant who has just returned from having a ventriculoperitoneal (VP) shunt placed? 1. Semi-Fowler in an infant seat. 2. Flat in the crib. 3. Trendelenburg. 4. In the crib with the head elevated to 90 degrees.

2. Flat in the crib is the position usually used initially, with the angle gradually increasing as the child tolerates.

The parent of a child with hemophilia is asking the nurse what caused the hemophilia. Which is the nurse's best response? 1. It is an X-linked dominant disorder. 2. It is an X-linked recessive disorder. 3. It is an autosomal dominant disorder. 4. It is an autosomal recessive disorder.

2. Hemophilia is transmitted as an X-linked recessive disorder. About 60% of children have a family history of hemophilia. The usual transmission is by a female with the trait and an unaffected male.

Which should the nurse do first when caring for an infant who just had a repair of a myelomeningocele? 1. Weigh diapers for 24-hour urine output. 2. Measure head circumference. 3. Offer clear fluids. 4. Assess for infection.

2. Hydrocephalus occurs in about 90% of infants with myelomeningocele, so measuring the head circumference daily and watching for an increase are important. Accumulation of cerebrospinal fluid can occur after closure of the sac.

The nurse is teaching the parents of a child with sickle cell disease. To instruct them on how to prevent sickle cell crisis, she should include which instruction? 1. Restrict the child's fluid intake to less than 1 quart per day. 2. Drink at least 2 quarts of fluids per day. 3. Stay away from other teenagers. 4. Avoid physical activity.

2. Increasing fluid intake and being well hydrated will help prevent cell stasis in the small vessels. Restricting fl uids causes stasis of red blood cells and promotes obstruction and increases the chance of sickling with hypoxia and pain to the part that is involved. Clients with sickle cell disease should stay away from others who have infections. When the spleen of a client who has sickle cell disease has become fi brotic and nonfunctional, the client is more susceptible to infections. Clients with sickle cell disease should not avoid physical activity as long as the client stays well hydrated

The parent of an infant diagnosed with a neuroblastoma asks the nurse what the prognosis is. The nurse ' s best response is: 1. Excellent, because a neuroblastoma is always cured. 2. Excellent, because infants with a neuroblastoma have the best prognosis. 3. Poor, because infants with a neuroblastoma rarely survive. 4. Variable, depending on the site of origin.

2. Infants younger than 1 year have the best prognosis

The parent of a toddler newly diagnosed with CP asks the nurse what caused it. The nurse should answer with which of the following? 1. Most cases are caused by unknown prenatal factors. 2. It is commonly caused by perinatal factors. 3. The exact cause is not known. 4. The exact cause is known in every instance.

2. It is generally thought that the majority of infants with CP had an insult in utero. Some of the causes of perinatal insult include hypoxia, trauma, infections, or genetic abnormalities.

Aspirin has been ordered for the child with rheumatic fever (RF) in order to: 1. Keep the patent ductus arteriosus (PDA) open. 2. Reduce joint inflammation. 3. Decrease swelling of strawberry tongue. 4. Treat ventricular hypertrophy of endocarditis.

2. Joint inflammation is experienced in RF; aspirin therapy helps with inflammation and pain.

A child with Ewing sarcoma is undergoing a limb salvage procedure. Which statement indicates the parents understand the procedure? 1. "Our child will have a bone graft to save the limb." 2. "Our child will need follow-up lengthening procedures." 3. "Our child will need shorter shirt sleeves." 4. "Our child will not need chemotherapy."

2. Limb salvage requires lengthening procedures to encourage the bone to continue to grow so that the child will not have a short limb.

An 8-year-old with type 1 diabetes mellitus is complaining of a headache and dizziness and is visibly perspiring. Which of the following should the nurse do first? 1. Administer glucagon intramuscularly. 2. Offer the child 8 oz of milk. 3. Administer rapid-acting insulin lispro (Humalog). 4. Offer the child 8 oz of water or calorie-free liquid

2. Milk is best to give for mild hypoglycemia, which would present with the symptoms described.

A child with osteosarcoma is going to receive chemotherapy before surgery. Which statement by the parents indicates they understand the side effect of neutropenia? 1. "My child will be more at risk for diarrhea." 2. "My child will be more at risk for infection." 3. "My child ' s hair will fall out." 4. "My child will need to drink more."

2. Neutropenia makes a child more at risk for infection because the immune system is compromised by the chemotherapy.

A nurse instructs the parent of a child with sickle cell disease about factors that might precipitate a pain crisis in the child. Which of the following factors identified by the parent as being able to cause a pain crisis indicates a need for further instruction? 1. Infection. 2. Overhydration. 3. Stress at school. 4. Cold environment

2. Overhydration does not cause a crisis

In planning the discharge for a newborn diagnosed with torticollis (wry neck), the nurse should: 1. Teach the parent the side effects of botulinum toxin (BOTOX). 2. Coordinate outpatient physical therapy. 3. Verify the date for corrective surgery. 4. Demonstrate the use of positioning wedges for sleep.

2. Physical therapy is the most important part of the child's plan of care. Most cases of torticollis respond to gentle stretching exercises which the parents perform daily. Regular physical therapy is needed to monitor the infant's progress. Botox injections are not approved for children under the age of 2 and would not be an appropriate first-line treatment for an infant. Surgery is only done if physical therapy is not successful after several months. The use of wedges to position children during sleep is not recommended because they increase the risk of SIDS.

When developing the preoperative teaching plan for a 14-month-old child with an undescended testis who is scheduled to have surgery, which of the following methods is appropriate? 1. Telling the child that his penis and scrotum will be "fixed." 2. Explaining to the parents how the defect will be corrected. 3. Telling the child that he will not see any incisions after surgery. 4. Using an anatomically correct doll to show the child what will be "fixed."

2. Preoperative teaching would be directed at the parents, because the child is too young to understand the teaching. Telling the child that his penis and scrotum will be "fixed," telling the child he will not see incisions after surgery, and using a doll to illustrate the surgery are appropriate interventions for a preschool-age child

The mother of a 4-year-old child with juvenile idiopathic arthritis (JIA) is worried that her child will have to stop attending preschool because of the illness. Which of the following responses by the nurse would be most appropriate? 1. "It may be difficult for your child to attend school because of the side effects of the medications he will be prescribed." 2. "Your child should be encouraged to attend school, but he'll need extra time to work out early morning stiffness." 3. "You should keep your child at home from school whenever he experiences discomfort or pain in his joints." 4. "Your child will probably need to wear splints and braces so that his joints will be supported properly."

2. Socialization is important for this preschool-age child, and activity is important to maintain function. Because children with JIA commonly experience the most problems in the early morning after arising, they need more time to "warm up." Adverse effects may or may not occur. The child's normal routine needs to be maintained as much as possible. Although splints and braces may be needed, they are worn during periods of rest, not activity, to maintain function.

The nurse is caring for a child with sickle cell disease who is scheduled to have a splenectomy. What information should the nurse explain to the parents regarding the reason for a splenectomy? 1. To decrease potential for infection. 2. To prevent splenic sequestration. 3. To prevent sickling of red blood cells. 4. To prevent sickle cell crisis.

2. Splenic sequestration is a life-threatening situation in children with sickle cell disease. Once a child is considered to be at high risk of splenic sequestration or has had this in the past, the spleen will be removed.

The mother tells the nurse she will be afraid to allow her child with hemophilia to participate in sports because of the danger of injury and bleeding. After explaining that physical fitness is important for children with hemophilia, which of the following activities should the nurse suggest as ideal? 1. Snow skiing. 2. Swimming. 3. Basketball. 4. Gymnastics.

2. Swimming is an ideal activity for a child with hemophilia because it is a noncontact sport. Many noncontact sports and physical activities that do not place excessive strain on joints are also appropriate. Such activities strengthen the muscles surrounding joints and help control bleeding in these areas. Noncontact sports also enhance general mental and physical well-being. Falls and subsequent injury to the child may occur with snow skiing. Basketball is a contact sport and therefore increases the child's risk for injury. Gymnastics is a very strenuous sport. Gymnasts frequently have muscle and joint injuries that result in bleeding episodes.

A student with type 1 diabetes tells the nurse she is feeling light-headed. The student's blood sugar is 60 mg/dL. Using the 15-15 rule, the nurse should: 1. Give 15 mL of juice and give another 15 mL in 15 minutes. 2. Give 15 g of carbohydrate and retest the blood sugar in 15 minutes. 3. Give 15 g of carbohydrate and 15 g of protein. 4. Give 15 oz of juice and retest in 15 minutes

2. The 15-15 rule is a general guideline for treating hypoglycemia where the client consumes 15 g of carbohydrate and repeats testing the blood sugar in 15 minutes. Fifteen grams of carbohydrate equals 60 calories and is roughly equal to ½ cup of juice or soda, 6 to 8 lifesavers, or a tablespoon of honey or sugar. The general recommendation is if the blood sugar is still low, the client may repeat the sequence. Fifteen milliliters of juice would only provide 15 calories. This would not be sufficient carbohydrates to treat the hypoglycemia. Protein does not treat insulin-related hypoglycemia; however a protein-starch snack may be offered after the blood glucose improves. Fifteen ounces of juice would be almost 4 times the recommended 4 oz of juice

A child with hemophilia presents with a burning sensation in the knee and reluctance to move the body part. The nurse collaborates with the care team to provide factor replacement and: 1. Administer an aspirin-containing compound. 2. Institute Rest, Ice, Compression, and Elevation (RICE). 3. Begin physical therapy with active range of motion. 4. Initiate skin traction.

2. The child is displaying symptoms of bleeding in the joint and factor replacement is indicated. The RICE method is used additionally as a supportive measure to help control the bleeding. Aspirin containing compounds contribute to bleeding and should never be used to control pain. Physical therapy is instituted after the acute bleeding to prevent further damage. Orthopedic traction is considered in some rare cases during the rehabilitation phase, but not the acute phase.

When assessing a 2-year-old child with Wilms' tumor, the nurse should avoid 1. Measuring the child's chest circumference. 2. Palpating the child's abdomen. 3. Placing the child in an upright position. 4. Measuring the child's occipitofrontal circumference

2. The abdomen of the child with Wilms' tumor should not be palpated because of the danger of disseminating tumor cells. Techniques such as measuring the occipitofrontal circumference (which is done in children younger than 18 months of age because the anterior fontanel closes between 12 to 18 months of age), upright positioning, and measuring chest circumference are not necessarily contraindicated; however, the child with Wilms' tumor should always be handled gently and carefully

The nurse talks to an adolescent about how she can tell her friends about her new diagnosis of diabetes. Which of the following behaviors by the adolescent indicates that the adolescent has responded positively to the discussion? 1. She asks the nurse for material on diabetes for a school paper. 2. She introduces the nurse to her friends as "the one who taught me all about my diabetes." 3. She says, "I'll try to tell my friends, but they'll probably quit hanging out with me." 4. She asks her friends what they think about someone who has a lifelong illness.

2. The ability to talk about her diabetes indicates that the adolescent feels good enough about herself to share her problem with her peers. Asking for reference material does not specifically indicate that the client's self-esteem has improved or that she has accepted her diagnosis. Saying that her friends will probably desert her if she tells them about the illness indicates that the adolescent still needs to work on her self-esteem and her feelings about the disease. Asking her friends what they think of someone with a lifelong illness would not indicate that the nurse's interventions targeted toward improving self-esteem have been successful. Rather, this statement demonstrates the adolescent's uncertainty about herself.

A transfusion of packed red blood cells has been ordered for a 1-year-old with a sickle cell anemia. The infant has a 25 gauge I.V. infusing dextrose with sodium and potassium. Using the Situation, Background, Assessment, Recommendation (SBAR) method of communication, the nurse contacts the physician and recommends: 1. Starting a second I.V. with a 22 gauge catheter to infuse normal saline with the blood. 2. Using the existing I.V., but changing the fluids to normal saline for the transfusion. 3. Replacing the I.V. with a 22 gauge catheter to infuse the ordered fluids. 4. Starting a second I.V. with a 25 gauge catheter to infuse normal saline with the transfusion

2. The best evidence indicates that a catheter as small as 27 gauge may safely be used for transfusion in children, but blood must be infused with normal saline, not dextrose. A 1-year-old should be able to maintain their blood glucose for the 2 hour duration of the infusion without the need for a second I.V.

After surgery to correct a tetralogy of Fallot, the child's parents express concern to the nurse that their 4-year-old child wants to be held more frequently than usual. The nurse recommends: 1. Introducing a new skill. 2. Play therapy. 3. Encouraging the behavior. 4. Having the volunteer hold the child.

2. The child is exhibiting regression. During periods of stress, children frequently revert to behaviors that were comforting in earlier developmental stages; play therapy is one way to help the child cope with the stress. Teaching a new skill most likely would add more stress. Parents should be instructed to praise positive behaviors and ignore regressive behaviors rather than calling attention to them through encouragement or discouragement. Having someone else hold the child does not encourage coping with the stress or promoting appropriate development.

A child has been diagnosed with a midline brain tumor. In addition to showing signs of increased intracranial pressure (ICP), she has been voiding large amounts of very dilute urine. Which medication does the nurse expect to administer? 1. Mannitol (Osmitrol). 2. Vasopressin. 3. Furosemide (Lasix). 4. Dopamine (Intropin)

2. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Vasopressin is a hormone that is used to help the body retain water.

A 10-year-old with severe factor VIII deficiency falls, injures an elbow, and is brought to the ED. The nurse should prepare which of the following? 1. An IM injection of factor VIII. 2. An IV infusion of factor VIII. 3. An injection of desmopressin. 4. An IV infusion of platelets.

2. The child is treated with an IV infusion of factor VIII to replace the missing factor and help stop the bleeding.

A nurse is teaching an 8-year-old with diabetes and her parents about managing diabetes during illness. The nurse determines the parents understand the instruction when they indicate that, when the child is ill, they will provide: 1. More calories. 2. More insulin. 3. Less insulin. 4. Less protein and fat.

2. The child needs more insulin during an illness, because the cells becomes more insulin resistant during illness and need more insulin to achieve a normal blood glucose level. During an acute illness, simple carbohydrates and fluids are usually tolerated best

The nurse is helping a family plan for the discharge of their child, who will be going home in a spica cast. Which of the following points of information should be most important for the nurse to consider? 1. The bathrooms are all on the second floor. 2. The child's bedroom is on the second floor. 3. A 16-year-old sister will care for the child during the day. 4. There are three steps up to the front door.

2. The child with a hip spica cast who is going home and has a bedroom on the second floor of the home needs to have the bed moved to an area that is more central to family life. Negotiating a flight of steps at least twice a day (on awakening in the morning and before going to bed at night) with a child in a hip spica cast would be difficult and most likely dangerous. Because the child in a hip spica cast will need to use a bedpan or urinal, the bathrooms can be on any floor. Because the family is involved in the discharge, the 16-year-old sister should be taught appropriate care along with the rest of the family. The child can be carried up and down the three steps to the house the few times necessary after discharge.

Which of the following should the nurse include when completing discharge instructions for the parents of a 12-month-old child diagnosed with Kawasaki disease (KD) and being discharged to home? 1. Offer the child extra fluids every 2 hours for 2 weeks. 2. Take the child's temperature daily for several days. 3. Check the child's blood pressure daily until the follow-up appointment. 4. Call the physician if the irritability lasts for 2 more weeks.

2. The child's temperature should be taken daily for several days after discharge, because recurrent fever may develop. Offering the child fluids every 2 hours is not necessary. Doing so increases the child's risk for CHF. Checking the child's blood pressure at home usually is not included as part of the discharge instructions because, by the time of discharge, the child is considered stable and the risk for cardiac problems is minimal. Most children with KD recover fully. Irritability may last for 2 months after discharge.

Over the past week, an infant with a repaired myelomeningocele has had a highpitched cry and been irritable. Length, weight, and head circumference have been at the 50th percentile. Today, length is at the 50th percentile, weight is at the 70th percentile, and head circumference is at the 90th percentile. The nurse should do which of the following? 1. Tell the parent this is normal for an infant with a repaired myelomeningocele. 2. Tell the parent this might mean the baby has increased intracranial pressure. 3. Suspect the baby's intracranial pressure is low because of a leak. 4. Refer the baby to the neurologist for follow-up care.

2. The increase in head size is one of the first signs of increased intracranial pressure; other signs include high pitched cry and irritability.

Which child requires continued follow-up because of behaviors suspicious of cerebral palsy (CP)? 1. A 1-month-old who demonstrates the startle reflex when a loud noise is heard. 2. A 6-month-old who always reaches for toys with the right hand. 3. A 14-month-old who has not begun to walk. 4. A 2-year-old who has not yet achieved bladder control during waking hours.

2. The clinical characteristic of hemiplegia can be manifested by the early preference of one hand. This may be an early sign of CP.

The parents of a neonate with hypospadias and chordee wish to have him circumcised. Which of the following explanations should the nurse incorporate into the discussion with the parents concerning the recommendation to delay circumcision? 1. The associated chordee is difficult to remove during circumcision. 2. The foreskin is used to repair the deformity surgically. 3. The meatus can become stenosed, leading to urinary obstruction. 4. The infant is too small to have a circumcision.

2. The condition in which the urethral opening is on the ventral side of the penis or below the glans penis is referred to as hypospadias. Chordee refers to a ventral curvature of the penis that results from a fibrous band of tissue that has replaced normal tissue. Circumcision is delayed because the foreskin, which is removed with a circumcision, often is used to reconstruct the urethra. The chordee is corrected when the hypospadias is repaired. Circumcision is performed at the same time. Urethral meatal stenosis, which can occur in circumcised infants, results from meatal ulceration, possibly leading to urinary obstruction. It is not associated with hypospadias or circumcision. The infant is not too small to have a circumcision, which is commonly performed on the fi rst or second day of life.

Which should the nurse tell the parent of an infant with spina bifida? 1. "Bone growth will be more than that of babies who are not sick because your baby will be less active." 2. "Physical and occupational therapy will be helpful to stimulate the senses and improve cognitive skills." 3. "Nutritional needs for your infant will be calculated based on activity level." 4. "Fine motor skills will be delayed because of the disability."

2. The increase in head size is one of the first signs of increased intracranial pressure; other signs include high pitched cry and irritability.

After teaching the parents about the urethral catheter placed after surgical repair of their son's hypospadias, the nurse determines that the teaching was successful when the mother states that the catheter in her child's penis accomplishes which of the following? 1. Decreases pain at the surgical site. 2. Keeps the new urethra from closing. 3. Measures his urine correctly. 4. Prevents bladder spasms.

2. The main purpose of the urethral catheter is to maintain patency of the reconstructed urethra. The catheter prevents the new tissue inside the urethra from healing on itself. However, the urethral catheter can cause bladder spasms. Recently, stents have been used instead of catheters. The urethral catheter will have no effect on the child's pain level. In fact, because bladder spasms are associated with its use, the child's complaints of pain may actually increase. Urine output can be measured through the suprapubic catheter because it provides an alternative route for urinary elimination, thus keeping the bladder empty and pressure-free.

A 9-year-old is in a spica cast and complains of pain 1 hour after receiving intravenous opioid analgesia. What should the nurse do first? 1. Give more pain medication. 2. Perform a neuromuscular assessment. 3. Call the surgeon for orders. 4. Change the child's position.

2. The nurse looks for the source of the pain by performing a neuromuscular assessment

While the nurse is examining the infant for presence of testes, the father paces around the room shaking his head. Which of the following would be the most appropriate response by the nurse? 1. "I'm sure everything will work out for the best, and he'll be fine." 2. "You seem upset; please tell me how you're feeling." 3. "Don't worry; his testes will probably descend on their own." 4. "Would you like to talk with a parent of a child who has the same problem?"

2. The nurse needs more information about the father's perceptions and feelings before providing any information or taking action. Determining the exact nature of the father's concern rather than making an assumption about it is essential. Therefore, the nurse should identify what is observed and ask the father how he is feeling. Telling the father that everything will be fi ne or not to worry is inappropriate and provides false reassurance. It also devalues the father's concern. Later on it may be appropriate for the father to talk to a parent of a child with the same problem for support.

After placing an infant with myelomeningocele in an isolette shortly after birth, which indicator should the nurse use as the best way to determine the effectiveness of this intervention? 1. The partial pressure of arterial oxygen remains between 94 and 100 mm Hg. 2. The axillary temperature remains between 97° and 98° F (36.1° and 36.7° C). 3. The bilirubin level remains stable. 4. Weight increases by about 1 oz (28.35 g) per day

2. The nurse places the neonate with myelomeningocele in an isolette shortly after birth to help to maintain the infant's temperature. Because of the defect, the neonate cannot be bundled in blankets. Therefore, it may be difficult to prevent cold stress. The isolette can be maintained at higher than room temperature, helping to maintain the temperature of a neonate who cannot be dressed or bundled. Body temperature readings, not arterial oxygen levels, are the best indicator. Typically, an infant loses 5% to 10% of body weight before beginning to regain the weight.

Which of the following should the nurse expect to include in the plan of care for a child who is diagnosed with rheumatic fever and carditis and admitted to the hospital? 1. Ensuring continuous parental presence at the child's bedside. 2. Providing the child with periods of rest. 3. Encouraging participation in age-appropriate activities. 4. Advising the child to eat as much as possible

2. The nurse should encourage and plan to provide periods of rest for the child with rheumatic fever and carditis to allow the heart to rest. The parents should be made to feel that they can come and go as they need to. The child is not in critical condition, so the parents do not need to be present at the child's bedside continuously. The child should be allowed to participate in nonstrenuous activities that avoid overtaxing the heart, thus allowing the heart time to rest. There is no reason to encourage the child to eat as much as possible; in fact, overeating should be discouraged because it taxes the heart muscle

A 1-year-old child is scheduled for surgery to correct hypospadias and chordee. The nurse explains to the parents that this is the preferred time for surgical repair based on which of the following? 1. At this age, the child will experience less pain. 2. The child is too young to have developed castration anxiety. 3. The child will not remember the surgical experience. 4. The repair is easier to perform after the child is toilet trained

2. The preferred time for surgery is between the ages of 6 and 18 months, before the child develops castration and body image anxiety. Children learn early on about society's emphasis on the importance of genitals. Pain is different for each child and is not related to the preferred time for repair of the hypospadias or chordee. Although the child will probably not remember the experience, this is not the basis for having the surgery at this age. If the condition is not repaired, the child will have difficulty with toilet training because urine is not eliminated through the tip of the penis.

The mother asks the nurse about using a car seat for her toddler who is in a hip spica cast. The nurse should tell the mother: 1. "You can use a seat belt because of the spica cast." 2. "You will need a specially designed car seat for your toddler." 3. "You can still use the car seat you already have." 4. "You'll need to get a special release from the police so that a car seat won't be needed."

2. The toddler in a hip spica cast needs a specially designed car seat. The one that the mother already has will not be appropriate because of the need for the car seat to accommodate the cast and abductor bar. Legally, all children younger than 4 years of age are required to be restrained in a car seat.

Why are chemotherapeutic agents such as methotrexate (Trexall) and cyclophosphamide (Cytoxan) sometimes used to treat juvenile idiopathic arthritis (JIA)? 1. Are effective against cancer-like JIA. 2. Suppress the immune system. 3. Are similar to NSAIDs. 4. Are absorbed into the synovial fluid.

2. These drugs affect the immune system to reduce its ability to attack itself, as in the case of JIA.

A 3-year-old child with CP is admitted for dehydration following an episode of diarrhea. The nurse ' s assessment follows: awake; pale, thin child lying in bed; multiple contractures; drooling; coughing spells noted when parent feeds. T 97.8°F (36.5°C), P 75, R 25, weight 7.2 kg, no diarrheal stool for 48 hours. Which nursing diagnosis is most important? 1. Potential for skin breakdown: lying in one position. 2. Alteration in nutrition: less than body requirements. 3. Potential for impaired social support: parent sole caretaker. 4. Alteration in elimination: diarrhea.

2. This child is severely underweight and malnourished for a 3-year-old. The coughing episodes while feeding put the child at risk for aspiration and pneumonia. A thorough history, physical examination, and a feeding study should be performed to determine whether it is even safe to feed the child orally. This is the priority nursing diagnosis for this severely underweight child. Weight is average for a 4-month-old. The coughing episodes while feeding may indicate aspiration. The parent needs help to learn how to feed so that less coughing occurs

A child with spastic cerebral palsy receiving intrathecal baclofen therapy is admitted to the pediatric fl oor with vomiting and dehydration. The family tells the nurse that they were scheduled to refi ll the baclofen pump today, but had to cancel the appointment when the child became ill. The nurse should: 1. Explain that the medication should be discontinued during illness. 2. Arrange for the pump to be refilled in the hospital. 3. Reschedule the pump refill for the day of discharge. 4. Instruct caregivers to call for a refill when the low-volume alarm sounds.

2. To prevent a baclofen withdraw, pump refills are scheduled several days before anticipated low-volume alarms. The nurse should make it a high priority to have the pump refilled as soon as possible. Discontinuing baclofen suddenly can result in a high fever, muscle rigidity, change in level of consciousness, and even death. Waiting until the child leaves the hospital for a refi ll may lead to a low dose or withdraw. Waiting for the low-volume alarm puts the client at risk because medication and team members who can refi ll the pump may not be readily available under all circumstances.

The parents of a 3-month-old ask why their baby will not have an operation to correct a ventricular septal defect (VSD). The nurse ' s best response is: 1. "It is always helpful to get a second opinion about any serious condition like this." 2. "Your baby's defect is small and will likely close on its own by 1 year of age." 3. "It is common for health-care providers to wait until an infant develops respiratory distress before they do the surgery." 4. "With a small defect like this, they wait until the child is 10 years old to do the surgery."

2. Usually a VSD will close on its own within the first year of life.

When assessing a child after heart surgery to correct tetralogy of Fallot, which of the following should alert the nurse to suspect a low cardiac output? 1. Bounding pulses and mottled skin. 2. Altered level of consciousness and thready pulse. 3. Capillary refill of 2 seconds and blood pressure of 96/67 mm Hg. 4. Extremities warm to the touch and pale skin

2. With a low cardiac output and subsequent poor tissue perfusion, signs and symptoms would include pale, cool extremities; cyanosis; weak, thready pulses; delayed capillary refi ll; and decrease in level of consciousness.

Which of the following is the most effective treatment for pain in a child with sickle cell crisis? Select all that apply. 1. Meperidine (Demerol). 2. Aspirin. 3. Morphine. 4. Behavioral techniques. 5. Acetaminophen (Tylenol) with codeine.

3, 4, 5 Morphine is the drug of choice for a child with sickle cell crises. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine. When that is not sufficient to alleviate pain, stronger narcotics are prescribed, such as morphine. Ketorolac (Toradol) may be indicated for short-term use for moderate-severe pain. Behavioral techniques such as positive self-talk, relaxation, distraction, and guided imagery are helpful when pain is occurring. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine when pain is described as mild to moderate.

Which signs best indicate increased intracranial pressure (ICP) in an infant? Select all that apply. 1. Sunken anterior fontanel. 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite. 5. Sleeping more than usual

3, 5 A high-pitched cry is often indicative of increased ICP in infants. The infant may be sleeping more than usual because of increased ICP.

Which statement by the mother of a child with rheumatic fever (RF) shows she has good understanding of the care of her child? Select all that apply. 1. "I will apply heat to his swollen joints to promote circulation." 2. "I will have him do gentle stretching exercises to prevent contractures." 3. "I will give him his ordered anti-inflammatory medication for pain and inflammation." 4. "I will apply cold packs to his swollen joints to reduce pain." 5. "I will take my child every month to the health-care provider's office for his penicillin shot."

3, 5 Anti-inflammatory medications are the drugs of choice for treatment of RF because RF is a systemic inflammatory disease that can follow strep infections. The parent will take the child to the clinic monthly for a penicillin injection to prevent recurrent strep infections.

The nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems is (are) associated with sickle cell disease? Select all that apply. 1. Polycythemia. 2. Hemarthrosis. 3. Aplastic crisis. 4. Thrombocytopenia. 5. Vaso-occlusive crisis.

3, 5 Aplastic crisis, temporary cessation of red blood cell production, is associated with sickle cell anemia. Vaso-occlusive crisis is the most common problem in children with sickle cell disease

The nurse should tell the parents of a child with Duchenne (pseudohypertrophic) muscular dystrophy that some of the progressive complications include: Select all that apply. 1. Dry skin and hair, hirsutism, protruding tongue, and mental retardation. 2. Anorexia, gingival hyperplasia, dry skin and hair. 3. Contractures, obesity, and pulmonary infections. 4. Trembling, frequent loss of consciousness, and slurred speech. 5. Increasing difficulty swallowing and shallow breathing.

3, 5 The major complications of muscular dystrophy include contractures, disuse atrophy, infections, obesity, respiratory complications, and cardiopulmonary problems. The muscles of a child with MD tend to show increasing weakness and atrophy over time. The children are at risk for swallowing, aspiration, and pneumonia

Which would the nurse expect to assess on a 3-week-old infant with developmental dysplasia of the hip (DDH)? Select all that apply. 1. Excessive hip abduction. 2. Femoral lengthening of an affected leg. 3. Asymmetry of gluteal and thigh folds. 4. Pain when lying prone. 5. Positive Ortolani test

3, 5. In DDH, asymmetrical thigh and gluteal folds are frequently present. 5. The Ortolani maneuver moves a dislocated hip back into the socket with a distinct clunk

During a developmental screening, the nurse finds that a 3-year-old child with cerebral palsy has arrested social and language development. The nurse tells the family: 1. "This is a sign the cerebral palsy is progressing." 2. "Your child has reached his maximum language abilities." 3. "I need to refer you for more developmental testing." 4. "We need to modify your therapy plan."

3. It is important to identify primary developmental delays in children with cerebral palsy and to prevent secondary and tertiary delays. The arrested development is worrisome and requires further investigation. It is possible the lack of development indicates hearing loss or may be a sign of autism. The brain damage caused by cerebral palsy is not progressive. The brain of a young child is quite plastic; assuming the child's development has peaked at age 3 would be a serious mistake. The therapy plan will need to be modifi ed, but a better understanding of the underlying problem will lead to the greatest chance of creating a successful therapy plan

When teaching the family of an older infant who has had a hip spica cast applied for developmental dysplasia of the hip, which information should the nurse include when describing the abduction stabilizer bar? 1. It can be adjusted to a position of comfort. 2. It is used to lift the child. 3. It adds strength to the cast. 4. It is necessary to turn the child.

3. The abduction bar is incorporated into the cast to increase the cast's strength and maintain the legs in alignment. The bar cannot be removed or adjusted, unless the cast is removed and a new cast is applied. The bar should never be used to lift or turn the client, because doing so may weaken the cast.

After teaching the parents of an infant with clubfoot requiring application of a plaster cast how to care for the cast, which of the following statements would indicate that the parents have understood the teaching? 1. "If the cast becomes soiled, we'll clean it with soap and water." 2. "We'll elevate the leg with the cast on pillows, so the leg is above heart level." 3. "We will check the color and temperature of the toes of the casted leg frequently." 4. "The petals on the edge of the cast can be removed after the first 24 hours."

3. A cast that is too tight can cause a tourniquet effect, compromising the neurovascular integrity of the extremity. Manifestations of neurovascular impairment include pain, edema, pulselessness, coolness, altered sensation, and inability to move the distal exposed extremity. The toes of the casted extremity should be assessed frequently to evaluate for changes in neurovascular integrity. Wetting a plaster cast with water and soap softens the plaster, which may alter the cast's effectiveness. There is no reason to elevate the casted extremities when a child with clubfoot is being treated with nonsurgical measures. The legs would be elevated if swelling were present. Petals, which are applied to cover the rough edges of the cast, are to be left in place to minimize the risk for skin irritation from the cast edges

A 13-year-old child has seen the school nurse several times with headache, vomiting, and difficulty walking. When calling the adolescent's mother about these symptoms, what should the nurse suggest the mother do first? 1. Schedule an appointment with the eye doctor. 2. Begin psychological counseling for her adolescent. 3. Make an appointment with the adolescent's physician. 4. Meet with the adolescent's teachers to determine academic progress.

3. A child who has symptoms of vomiting, headaches, and problems walking needs to be evaluated by a health care provider to determine the cause. Unexplained headaches and vomiting along with complaints of difficulty walking (e.g., ataxia) may suggest a brain tumor. Evaluation by an eye doctor would be appropriate once a complete medical evaluation has been accomplished. Psychological counseling may be indicated for this adolescent, but only after medical evaluation to determine that she is physically healthy. Meeting with the child's teachers would be appropriate after medical evaluation.

While preparing to examine a 6-week-old infant's scrotal sac and testes for possible undescended testes, which of the following would be most important for the nurse to do? 1. Check the diaper for recent urination. 2. Give the infant a pacifier. 3. Ensure that the room is kept warm. 4. Tap lightly on the left inguinal ring.

3. A cold environment can cause the testes to retract. Cold and touch stimulate the cremasteric refl ex, which causes a normal retraction of the testes toward the body. Therefore, the nurse should warm the hands and make sure that the environment also is warm. Checking the diaper for urination provides information about the infant's voiding and urinary function, not information about the testes. Giving the infant a pacifi er may help to calm the infant and possibly make the examination easier, but the concern here is with the temperature of the environment. Tapping on the inguinal ring would not be helpful in assessing the infant.

A 10-year-old with scoliosis has to wear a brace. The nurse should develop a teaching plan with the client to include which of the following instructions? 1. Wear the brace during waking hours. 2. Use lotions to relieve skin irritations. 3. Wear a form-fitting, sleeveless T-shirt under the brace. 4. Bathe the skin under the brace once per week.

3. A form-fitting, sleeveless T-shirt can be worn under the brace to prevent skin irritation and collect perspiration. Braces are worn 23 hours each day. Lotions may cause irritation and should not be used. The skin under the brace should be bathed daily to help prevent irritation from the brace. The brace can be removed for bathing so all the skin can be bathed

The physician orders a urinalysis for a child who has undergone surgical repair of a hypospadias. Which of the following results should the nurse report to the physician? 1. Urine specific gravity of 1.017. 2. Ten red blood cells per high-powered field. 3. Twenty-five white blood cells per highpowered field. 4. Urine pH of 6.0.

3. A normal white blood cell count in a urinalysis is 1 to 2 cells/mL. A white blood cell count of 25 per high-powered fi eld indicates a urinary tract infection. A urine specific gravity of 1.017 is within the normal range of 1.002 to 1.030. After urologic surgery, it is not unusual for a small number of red blood cells to appear in the urine. The child's urine pH is within the normal range of 4.6 to 8. C

After a child undergoes a craniotomy for an infratentorial brain tumor, the nurse should place the child in which of the following positions to prevent undue strain on the sutures? 1. Prone. 2. Semi-Fowler's. 3. Side-lying. 4. Trendelenburg

3. After surgery for an infratentorial tumor, the child is usually positioned flat on either side, with the head and neck in midline and the body slightly extended. Pillows against the back, not the head, help maintain position. Such a position helps avoid pressure on the operative site. Placing the child in a prone or semi-Fowler's position will cause pressure on the operative site. The Trendelenburg position is usually contraindicated because keeping the head below the level of the heart increases intracranial pressure as well as the risk of hemorrhage

The nurse is caring for a child receiving radiation therapy for a brain tumor. The parents ask if their child will likely have any learning disabilities. Select the nurse's best answer. 1. "All children who receive radiation have some amount of learning disability. As long as they receive extra tutoring, they usually do well in school." 2. "Because your child is so young, she will likely do well and have no problems in the future." 3. "Response varies with each child, but younger children who receive radiation tend to have some amount of learning disability later in life." 4. "Response varies with each child, but younger children who receive radiation tend to have fewer problems later in life than older children."

3. Although variable, younger children tend to experience more learning difficulties than do older children

A newborn with a repaired myelomeningocele is assessed for hydrocephalus. Which would the nurse expect in an infant with hydrocephalus? 1. Low-pitched cry and depressed fontanel. 2. Low-pitched cry and bulging fontanel. 3. Bulging fontanel and downwardly rotated eyes. 4. Depressed fontanel and upwardly rotated eyes.

3. An alteration in the circulation of the cerebrospinal fluid causes hydrocephalus. The anterior fontanel bulges because of an increase in cerebrospinal fluid, and an increase in intracranial pressure causes a high-pitched cry in infants and downward deviation of the eyes, also called sunset eyes. With sunset eyes, the sclera can be seen above the iris

When developing the discharge plan for a child who had a nephrectomy for a Wilms' tumor, the nurse identifies outcomes to prevent damage to the child's remaining kidney and accomplish which of the following? 1. Minimize pain. 2. Prevent dependent edema. 3. Prevent urinary tract infection. 4. Minimize sodium intake

3. Because the child has only one kidney, measures should be recommended to prevent urinary tract infection and injury to the remaining kidney. Severe pain and dependent edema are not associated with surgery for Wilms' tumor. Dietary sodium is not restricted because function in the remaining kidney is not impaired.

The nurse prepares baclofen for a child with cerebral palsy (CP) who just had her hamstrings surgically released. The child ' s parents ask what the medication is for. Select the nurse's best response. 1. "It is a medication that will help decrease the pain from her surgery." 2. "It is a medication that will prevent her from having seizures." 3. "It is a medication that will help control her spasms." 4. "It is a medication that will help with bladder control."

3. Baclofen is given to help control the spasms associated with CP.

An adolescent with a history of surgical repair for an undescended testis comes to the clinic for a sports physical. Anticipatory guidance for the parents and adolescent should focus on which of the following as most important? 1. The adolescent's sterility. 2. The adolescent's future plans. 3. Technique for monthly testicular self examinations. 4. Need for a lot of psychological support.

3. Because the incidence of testicular cancer is increased in adulthood among children who have had undescended testes, it is extremely important to teach the adolescent how to perform the testicular self-examination monthly. The undescended testicle is removed to reduce the risk of cancer in that testicle. Removal of a testis would not necessarily make the adolescent sterile because the other testicle remains. Although discussing the adolescent's future plans is important, it is not the priority at this time. Because the adolescent has been dealing with the situation for a long time, the need for a sports physical at this time should not be a cause of emotional distress requiring a lot of psychological support.

When teaching a preschool-age child how to perform coughing and deep-breathing exercises before corrective surgery for tetralogy of Fallot, which of the following teaching and learning principles should the nurse address first? 1. Organizing information to be taught in a logical sequence. 2. Arranging to use actual equipment for demonstrations. 3. Building the teaching on the child's current level of knowledge. 4. Presenting the information in order from simplest to most complex.

3. Before developing any teaching program for a child, the nurse's first step is to assess the child to determine what is already known. Most older preschool children have some understanding of a condition present since birth. However, the child's interest will soon be lost if familiar material is repeated too often. The nurse can then organize the information in a sequence, because there are several steps to be demonstrated. These exercises do not require the use of equipment. The nurse should judge the amount and complexity of the information to be provided, based on the child's current knowledge and response to teaching.

The parent of a 3-week-old states that the infant was recasted this morning for clubfoot and has been crying for the past hour. Which intervention should the nurse suggest the parent do first? 1. Give pain medication. 2. Reposition the infant in the crib. 3. Check the neurocirculatory status of the foot. 4. Use a cool blow-dryer to blow into the cast to control itching.

3. Checking the neurocirculatory status of the foot is the highest priority.

When positioning a neonate with an unrepaired myelomeningocele, which of the following positions is most appropriate? 1. Supine with the hips at 90-degree flexion. 2. Right side-lying position with the knees flexed. 3. Prone with hips in abduction. 4. Supine in semi-Fowler's position with chest and abdomen elevated

3. Before surgery, the infant is kept flat in the prone position to decrease tension on the sac. This allows for optimal positioning of the hips, knees, and feet because orthopedic problems are common. The supine position is unacceptable because it causes pressure on the defect. Flexing the knees when side lying will increase tension on the sac, as will placing the infant in semi-Fowler's position, even though the chest and abdomen are elevated.

Which is most important to discuss with an adolescent who is going to have a leg amputation for osteosarcoma? 1. Pain. 2. Spirituality. 3. Body image. 4. Lack of coping

3. Body image is a developmental issue for adolescents and influences their acceptance of themselves and by peers.

The nurse explains to the parents of a 1-yearold child admitted to the hospital in sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following? 1. Autoimmune reaction complicated by hypoxia. 2. Lack of oxygen in the red blood cells. 3. Obstruction to circulation. 4. Elevated serum bilirubin concentration

3. Characteristic sickle cells tend to cause "log jams" in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis. The basic defect in sickle cell disease is an abnormality in the structure of the red blood cells. The erythrocytes are sickle-shaped, rough in texture, and rigid. Sickle cell disease is an inherited disease, not an autoimmune reaction. Elevated serum bilirubin concentrations are associated with jaundice, not sickle cell disease.

Family discharge teaching has been effective when the parent of a toddler diagnosed with Kawasaki disease (KD) states: 1. "The arthritis in her knees is permanent. She will need knee replacements." 2. "I will give her diphenhydramine (Benadryl) for her peeling palms and soles of her feet." 3. "I know she will be irritable for 2 months after her symptoms started." 4. "I will continue with high doses of Tylenol for her infl ammation."

3. Children can be irritable for 2 months after the symptoms of the disease start

A 12-year-old diagnosed with scoliosis is to wear a brace for 23 hours a day. What is the most likely reason the child will not wear it for that long? 1. Pain from the brace. 2. Difficulty in putting the brace on. 3. Self-consciousness about appearance. 4. Not understanding what the brace is for.

3. Children this age are very conscious of their appearance and fitting in with their peers, so they might be very resistant to wearing a brace

Which of the following statements by the mother of an infant with a repaired upper lumbar myelomeningocele indicates that she understands the nurse's teaching at the time of discharge? 1. "I can apply a heating pad to his lower back." 2. "I'll be sure to keep him away from other children." 3. "I will call the doctor if his urine has a funny smell." 4. "I will prop him on pillows to keep him from rolling over."

3. Children with a myelomeningocele are prone to urinary tract infections (UTI) and foul smelling urine is one symptom of a UTI. Because of the level of defect, the child may be insensitive to pressure or heat. Using a heating pad may lead to thermal injury because the child may not be able to sense if the pad is too hot. Keeping the child away from other children is unnecessary and can retard social development. Using pillows as props increases the risk of sudden infant death syndrome

A preschooler with a history of repaired lumbar myelomeningocele is in the emergency department with wheezing and skin rash. Which of the following questions should the nurse ask the mother first? 1. "Is your child taking any medications?" 2. "Who brought your child to the emergency department?" 3. "Is your child allergic to bananas or milk products?" 4. "What are you doing to treat your child's skin rash?

3. Children with myelomeningocele are at high risk for development of latex allergy because of repeated exposure to latex products during surgery and bladder catheterizations. Cross-reactions to food items such as bananas, kiwi, milk products, chestnuts, and avocados also occur. These allergic reactions vary in severity ranging from mild (such as sneezing) to severe anaphylaxis. While the child could have allergies to medications that caused the wheezing, the latex and food allergies are more common. Asking about the skin rash is not a priority when a child is wheezing. Who brought the child to the emergency department is irrelevant at this time.

The parent of a child diagnosed with Wilms tumor asks the nurse what the treatment plan will be. The nurse explains the usual protocol for this condition. Which information should the nurse give to the parent? 1. The child will have chemotherapy and, after that has been completed, radiation. 2. The child will need to have surgery to remove the tumor. 3. The child will go to surgery for removal of the tumor and the kidney and will then start chemotherapy. 4. The child will need radiation and later surgery to remove the tumor.

3. Combination therapy of surgery and chemotherapy is the primary therapeutic management. Radiation is done depending on clinical stage and histological pattern

Which of the following is the priority nursing diagnosis during a toddler's vasoocclusive sickle cell crisis? 1. Ineffective coping related to presence of a lifethreatening disease. 2. Decreased cardiac output related to abnormal hemoglobin formation. 3. Pain related to tissue anoxia. 4. Excess fluid volume related to infection

3. For the child in sickle cell crisis, Pain is the priority nursing diagnosis because the sickled cells clump and obstruct the blood vessels, leading to occlusion and subsequent tissue ischemia. Although Ineffective coping may be important, it is not the priority. Decreased cardiac output is not a problem with this type of vasoocclusive crisis. Typically, a sickle cell crisis can be precipitated by a fluid volume deficit or dehydration.

Which action should the nurse do first when noting clear drainage on the child's dressing and bed linen after a craniotomy for a brain tumor? 1. Change the dressing. 2. Elevate the head of the bed. 3. Test the fluid for glucose. 4. Notify the physician

3. Glucose in this clear, colorless fluid indicates the presence of cerebrospinal fluid. Excessive fluid leakage should be reported to the physician. The nurse should not change the dressing of a postoperative craniotomy client unless instructed to do so by the surgeon. Ordinarily, the head of the bed would not be elevated because this would put pressure on the sutures. The nurse should notify the physician after testing the fluid for glucose.

A child with spastic CP had an intrathecal dose of baclofen (Lioresal) in the early afternoon. What is the expected result 3½ hours post-dose that suggests the child would benefit from a baclofen pump? 1. The ability to self-feed. 2. The ability to walk with little assistance. 3. Decreased spasticity. 4. Increased spasticity.

3. If baclofen (Lioresal) were to work for this child, one could tell because spasticity would be decreased.

When caring for an infant who has undergone surgical repair of a myelomeningocele, which of the following should the nurse report to the surgeon? 1. Seizures and vomiting. 2. Frontal bossing and sunset eyes. 3. Increased head circumference and bulging fontanel. 4. Irritability and shrill cry.

3. In a neonate with open cranial sutures, increasing head circumference is the predominant and earliest sign of increased intracranial pressure and the nurse should report this to the surgeon. Bulging fontanels also are seen. However, some neonates may exhibit bulging fontanels without head enlargement. Seizures and vomiting are associated with hydrocephalus, but most often these are seen in an older child with closed cranial sutures. Shortly after increasing head circumference and bulging fontanels occur, other signs and symptoms, such as frontal bossing or enlargement with depressed eyes and the sunset sign (sclera visible above the iris), may develop. Although irritability is an early sign, a brief, shrill cry is a later sign of increasing intracranial pressure associated with the development of hydrocephalus

The nurse is caring for a 2-month-old infant who is at risk for cerebral palsy (CP) due to extreme low birth weight and prematurity. His parents ask why a speech therapist is involved in his care. Select the nurse ' s best response. 1. "Your baby is likely to have speech problems because of his early birth. Involving the speech therapist now will ensure vocalization at a developmentally appropriate age." 2. "The speech therapist will help with tongue and jaw movements to assist with babbling." 3. "The speech therapist will help with tongue and jaw movements to assist with feeding." 4. "Many members of the health-care team are involved in your child's care so that we will know if there are any unmet needs."

3. It is important to involve speech therapy to strengthen tongue and jaw movements to assist with feeding. The infant who is at risk for CP may have weakened and uncoordinated tongue and jaw movements

The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. Which is the nurse ' s best response? 1. "Circumcision is a fading practice and is now contraindicated in most children." 2. "Circumcision in children with hypospadias is recommended because it helps prevent infection." 3. "Circumcision is an option, but it cannot be done at this time." 4. "Circumcision can never be performed in a child with hypospadias."

3. It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may be needed for repair of the defect.

The parent of a 7-year-old voices concern over the child ' s continued bed-wetting at night. The parent, on going to bed, has tried getting the child up at 11:30 p.m., but the child still wakes up wet. Which is the nurse ' s best response about what the parent should do next? 1. "There is a medication called DDAVP that decreases the volume of the urine. The physician thinks that will work for your child." 2. "When your child wakes up wet, be very firm and indicate how displeased you are. Have your child change the sheets to see how much work is involved." 3. "Limit fluids in the evening and start a reward system in which your child can choose a reward after a certain number of dry nights." 4. "Bed-wetting alarms are readily available, and most children do very well with them."

3. Limiting the child's fluids in the evening will help decrease the nocturnal urge to void. Providing positive reinforcement and allowing the child to choose a reward will increase the child's sense of control

The parent of an infant with CP asks the nurse if the infant will be mentally retarded. Which is the nurse ' s best response? 1. "Children with CP have some amount of mental retardation." 2. "Approximately 20% of children with CP have normal intelligence." 3. "Many children with CP have normal intelligence." 4. "Mental retardation is expected if motor and sensory deficits are severe."

3. Many children with CP have normal intelligence.

After 6 months of treatment with diet and exercise, a 12-year-old with type 2 diabetes still has a fasting blood glucose level of 140 mg/dL. The primary care provider has decided to begin metformin (Glucophage). The adolescent asks how the medication works. The nurse should tell the client that the medicine decreases the glucose production and: 1. Replaces natural insulin. 2. Helps the body make more insulin. 3. Increases insulin sensitivity. 4. Decreases carbohydrate adsorption.

3. Metformin is currently approved by the FDA to treat type 2 diabetes in children. The medication decreases glucogenesis in the liver and increases insulin sensitivity in the peripheral tissues. Only insulin can actually replace insulin. This treatment is reserved for clients with type 1 diabetes or those with type 2 who do not respond to diet, exercise, and an oral diabetic agent. Other oral medications used to treat diabetes augments insulin production or decreases carbohydrate absorption, but those medications are primarily used in adults.

Which action should the nurse take when providing postoperative nursing care to a child after insertion of a ventriculoperitoneal shunt? 1. Administer narcotics for pain control. 2. Check the urine for glucose and protein. 3. Monitoring for increased temperature. 4. Test cerebrospinal fluid leakage for protein.

3. Monitoring the temperature allows the nurse to assess for infection, the most common and most hazardous postoperative complication after ventroperitoneal shunt placement. Typically, pain after insertion of a ventriculoperitoneal shunt is mild, requiring the use of mild analgesics. Usually narcotics are not administered because they alter the level of consciousness, making assessment of cerebral function difficult. Neither proteinuria nor glycosuria is associated with shunt placement. Cerebrospinal fluid leakage commonly occurs with head injury. It is not usually associated with shunt placement

Which statement by the mother of a child with rheumatic fever (RF) shows an understanding of prevention for her other children? 1. "Whenever one of them gets a sore throat, I will give that child an antibiotic." 2. "There is no treatment. It must run its course." 3. "If their culture is positive for group A Streptococcus, I will give them their antibiotic." 4. "If their culture is positive for Staphylococcus A, I will give them their antibiotic."

3. RF is caused by a streptococcal infection, not by Staphylococcus

An 8-year-old with diabetes is placed on neutral protamine Hagedorn (NPH) and regular insulin before breakfast and before dinner. She will receive a snack of milk and cereal at bedtime. The snack will: 1. Help her regain lost weight. 2. Provide carbohydrates for immediate use. 3. Prevent late night hypoglycemia. 4. Help her stay on her diet.

3. NPH insulin peaks in 6 to 8 hours, which would occur during sleep. A bedtime snack is needed to prevent late night hypoglycemia. The snack is not given to help regain weight. Milk contains fat and protein which cause delayed absorption into the blood stream and maintains the blood glucose level at night when the NPH insulin will peak. The snack is not used to provide carbohydrates for immediate use because NPH insulin, unlike regular insulin, does not peak immediately. The snack has nothing to do with a diet

Where is the primary site of origin of the tumor in children who have neuroblastoma? 1. Bone. 2. Kidney. 3. Abdomen. 4. Liver.

3. Neuroblastoma tumors originate from embryonic neural crest cells that normally give rise to the adrenal medulla and the sympathetic nervous system. The majority of the tumors arise from the adrenal gland or from the retroperitoneal sympathetic chain. Therefore, the primary site is within the abdomen.

A 16-month-old child diagnosed with Kawasaki disease (KD) is very irritable, refuses to eat, and exhibits peeling skin on the hands and feet. The nurse should do which of the following first? 1. Apply lotion to the hands and feet. 2. Offer foods the toddler likes. 3. Place the toddler in a quiet environment. 4. Encourage the parents to get some rest.

3. One of the characteristics of children with KD is irritability. They are often inconsolable. Placing the child in a quiet environment may help quiet the child and reduce the workload of the heart. Although peeling of the skin occurs with KD, the child's irritability takes priority over applying lotion to the hands and feet. Children with KD usually are not hungry and do not eat well regardless of what is served. There is no indication that the parents need rest. Additionally, in this situation, the child takes priority over the parents

The nurse is examining an infant for hip placement and has abducted her flexed legs. The nurse should next: 1. Rotate the hips. 2. Extend the legs. 3. Listen for a "click." 4. Palpate the hips for a mass.

3. Ortolani's manipulation is used to detect congenital hip dysplasia. The infant is supine and a "click" is heard when flexed legs are abducted. This results from pressure causing the femoral head to slip out of the acetabulum. The other maneuvers will not determine the position of the femoral head in the acetabulum

Which does the nurse include in the postoperative plan of care for a child with myelomeningocele following ligament release? 1. Encourage the child to resume a regular diet, beginning slowly with bland foods that are easily digested, such as bananas. 2. Encourage the child to blow balloons to increase deep breathing and avoid postoperative pneumonia. 3. Assist the child to change positions to avoid skin breakdown. 4. Provide education on dietary requirements to prevent obesity and skin breakdown.

3. Preventing skin breakdown is important in the child with myelomeningocele because pressure points are not felt easily.

Which medication should the nurse give to an infant diagnosed with transposition of the great vessels? 1. Ibuprofen (Motrin). 2. Betamethasone. 3. Prostaglandin E. 4. Indomethacin (Indocin).

3. Prostaglandin E inhibits closing of the PDA, which connects the aorta and pulmonary artery.

An infant is scheduled for a hypospadias and chordee repair. The parent asks the nurse, "I understand why the hypospadias repair is necessary, but do they have to fix the chordee as well?" Which is the nurse ' s best response? 1. "I understand your concern. Parents do not want their children to undergo extra surgery." 2. "The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages." 3. "The repair is done to optimize sexual functioning when he is older." 4. "This is the best time to repair the chordee because he will be having surgery anyway."

3. Releasing the chordee surgically is necessary for future sexual function.

A 14-year-old is being screened for scoliosis. Which of the following statements about scoliosis screening is true? 1. Teenagers ages 14 to 16 should be screened yearly. 2. A shirt and shorts are worn for screening. 3. The girl is assessed standing and bending forward. 4. The girl should refrain from eating 8 hours before the examination.

3. Screening is done with the child wearing minimal clothing, standing and bending forward. The examination should be done on girls ages 10 to 12 years old so a diagnosis can be made early and the scoliosis can be treated with exercises or bracing. Only underwear should be worn for the examination so that symmetry of the shoulders and hips can be observed. If the deviation on the scoliometer is less than 20 degrees, no treatment is indicated. The child does not need to refrain from eating prior to this test

When developing the teaching plan for the mother and a child with insulin-dependent diabetes about sick-day management, which of the following instructions should the nurse include? 1. Adhere to the same schedule and type and amount of insulin. 2. Immediately call the physician for information about what to do. 3. Adjust insulin based on more frequent testing of blood glucose levels. 4. Take the child to the emergency department for immediate care.

3. Sick-day management requires more frequent monitoring of the child's blood glucose to evaluate for changes associated with a decreased intake and absorption of food, commonly associated with illness. Based on the child's glucose levels, insulin adjustments may be needed. In this case, regular insulin is used. Adhering to the same schedule, type, and amount of insulin is inappropriate because the child's ability to take in food and absorb nutrients can change rapidly. Typically, the child and parents are provided with specifi c instructions about sick-day management rules. Commonly the .physician will prescribe adjustments to insulin (e.g., on a sliding scale) based on the child's blood glucose levels. Therefore, calling the physician to report that the child is ill and ask what to do is inappropriate. However, the parents do need to notify the physician should any problems arise with management of the child's blood glucose levels. The child who can tolerate oral feedings of simple sugars can be kept at home as long as the parents monitor the child's blood glucose levels frequently for changes.

Which would the nurse teach an adolescent is a complication of corticosteroids used in the treatment of juvenile idiopathic arthritis (JIA)? 1. Fat loss. 2. Adrenal stimulation. 3. Immune suppression. 4. Hypoglycemia.

3. Steroids cause immune suppression, which is the reason behind its use in JIA; it reduces the body ' s attack on itself

The nurse is developing a plan of care for a child recently diagnosed with cerebral palsy (CP). Which should be the nurse ' s priority goal? 1. Ensure the ingestion of sufficient calories for growth. 2. Decrease intracranial pressure. 3. Teach appropriate parenting strategies for a special-needs child. 4. Ensure that the child reaches full potential.

3. Teaching appropriate parenting strategies for a special-needs child is important and is done so that the child can maximize her personal skills and minimize her limitation

The parent of a 17-year-old boy, who is hospitalized for complications related to type I diabetes, requests to review the adolescent's medical record. The client reported receiving mental health counseling during the admission history, but did not want his parent to know. The nurse, who is uncertain of how to protect the adolescent's privacy and accommodate the parent's request, should consult: 1. The unit nurse manager. 2. The primary care provider. 3. The organization's privacy officer. 4. The customer service representative.

3. The Health Insurance Portability and Accountability Act (HIPAA) specifi es that institutions designate a "privacy offi cer" who is responsible for developing and implementing privacy policies. This person or offi ce also handles HIPAA complaints. This would be the very best resource for the nurse to contact. Depending on the nurse manager's experience, he or she may or may not know the answer and may have to consult the privacy offi cer. While primary care providers would have an understanding of HIPAA, it is unlikely they understand the specifi cs of nursing policies. The customer service representatives typically address client concerns or complaints. At this time, the family has not voiced a complaint.

Which would the nurse expect to find on assessment in a child with Wilms tumor? 1. Decreased blood pressure, increased temperature, and a fi rm mass located in one flank area. 2. Increased blood pressure, normal temperature, and a fi rm mass located in one flank area. 3. Increased blood pressure, normal temperature, and a fi rm mass located on one side of the midline of the abdomen. 4. Decreased blood pressure, normal temperature, and a fi rm mass located on one side or the other of the midline of the abdomen.

3. The blood pressure may be increased if there is renal damage. The mass will be located on one side or the other of the midline of the abdomen. There is no reason for the child ' s temperature to be affected.

The nurse is interviewing the parent of a 9-year-old girl. The parent expresses concern because the daughter already has pubic hair and is starting to develop breasts. Which statements would be most appropriate? 1. "Your daughter should get her period in approximately 6 months." 2. "Your daughter is developing early and should be evaluated for precocious puberty." 3. "Your daughter is experiencing body changes that are appropriate for her age." 4. "Your daughter will need further testing to determine the underlying cause." 5. "Your daughter will need sexual counseling now."

3. The changes described in the question are normal for a healthy 9-year-old female.

A child diagnosed with Wilms' tumor undergoes successful surgery for removal of the diseased kidney. When the child returns to the room, the nurse should place the child in which position? 1. Modified Trendelenburg. 2. Sims'. 3. Semi-Fowler's. 4. Supine.

3. The child who has undergone abdominal surgery is usually placed in a semi-Fowler's position to facilitate draining of abdominal contents and promote pulmonary expansion. The modified Trendelenburg position is used for clients in shock. The Sims' position is likely to be uncomfortable for this child because of the large transabdominal incision. The supine position, without the head elevated, puts the child at increased risk for aspiration.

The parents of a child with meningitis and multiple seizures ask if the child will likely develop cerebral palsy (CP). Select the nurse's best response. 1. "When your child is stable, she'll undergo computed tomography (CT) and magnetic resolution imaging (MRI). The physicians will be able to let you know if she has CP." 2. "Most children do not develop CP at this late age." 3. "Your child will be closely monitored after discharge, and a developmental specialist will be able to make the diagnosis." 4. "Most children who have had complications following meningitis develop some amount of CP."

3. The child will be given a chance to recover and will be monitored closely before a diagnosis is made.

What should the nurse include when developing the teaching plan for the parents of a child with juvenile idiopathic arthritis who is being treated with naproxen (Naprosyn)? 1. Anti-inflammatory effect will occur in approximately 8 weeks. 2. Within 24 hours, the child will have antiinfl ammatory relief. 3. The nurse should be called before giving the child any over-the-counter medications. 4. If a dose is forgotten or missed, that dose is not made up.

3. The first group of drugs typically prescribed is the nonsteroidal anti-inflammatory drugs, which include naproxen. Naproxen is included in only a few over-the-counter medications but aspirin is in several. The family should check with the nurse before giving any over-the-counter medications. Once therapy is started, it takes hours or days for relief from pain to occur. However, it takes 3 to 4 weeks for the anti-inflammatory effects to occur, including reduction in swelling and less pain with movement. The missed dose will need to be made up to maintain the serum level and to maintain therapeutic effectiveness of the drug.

When interacting with the mother of a child who has Duchenne's muscular dystrophy, the nurse observes behavior indicating that the mother may feel guilty about her child's condition. The nurse interprets this behavior as guilt stemming from which of the following? 1. The terminal nature of the disease. 2. The dependent behavior of the child. 3. The genetic mode of transmission. 4. The sudden onset of the disease.

3. The guilt that mothers of children with muscular dystrophy commonly experience usually results from the fact that the disease is genetic and the mother transmitted the defective gene. Although many children die from the disease, the disease is considered chronic and progressive. As the disease progresses, the child becomes more dependent. However, guilt typically stems from the knowledge that the mother transmitted the disease to her son rather than the dependency of the child. The disease onset is usually gradual, not sudden.

The mother asks the nurse whether her child with hemiparesis due to spastic cerebral palsy will be able to walk normally because he can pull himself to a standing position. Which of the following responses by the nurse would be most appropriate? 1. "Ask the doctor what he thinks at your next appointment." 2. "Maybe, maybe not. How old were you when you first walked?" 3. "It's difficult to predict, but his ability to bear weight is a positive factor." 4. "If he really wants to walk, and works hard, he probably will eventually."

3. The nurse needs to respond honestly to the mother. Most children with hemiparesis due to spastic cerebral palsy are able to walk because the motor deficit is usually greater in the upper extremity. There is no need to refer the mother to the physician. The age at which the mother walked may be important to elicit, but this does not influence when the child will walk. The will to walk is important, but without neurologic stability the child may be unable to do so.

A nurse is planning care for a 12-year-old with rheumatic fever. The nurse should teach the parents to: 1. Observe the child closely. 2. Allow the child to participate in activities that will not tire him. 3. Provide for adequate periods of rest between activities. 4. Encourage someone in the family to be with the child 24 hours a day.

3. The nurse should teach the parents to provide for sufficient periods of rest to decrease the client's cardiac workload. The client's condition does not warrant close observation unless cardiac complications develop. The child's activity level will be based on the results of the sedimentation rate, c-reactive protein, heart rate, and cardiac function. The family does not need to be with the client 24 hours a day unless carditis develops and his condition deteriorates.

The parent of a child with spastic cerebral palsy and a communication disorder tells the nurse, "He seems so restless. I think he is in pain." The nurse should: 1. Assess the child for pain using the Faces, Legs, Activity, Cry, Consolability (FLACC) scale. 2. Assess the child using the pediatric FACES scale. 3. Administer the pain medication which is ordered to be given as needed and assess the response. 4. Notify the primary care provider of the change in behavior.

3. The parent is the child's primary care provider and may be very in tune to subtle changes in the child's behavior. If the parent thinks the child is in pain, it is very likely to be so. The nurse should administer the pain medication and evaluate if the medication affected the child's behavior. The FLACC scale may be difficult to interpret when the child has spasticity. The FACES scale requires self report. The physician should be contacted regarding the change in behavior only if other available interventions are unsuccessful

The parent of a young child with CP brings the child to the clinic for a checkup. Which parent ' s statement indicates an understanding of the child ' s long-term needs? 1. "My child will need all my attention for the next 10 years." 2. "Once in school, my child will catch up and be like the other children." 3. "My child will grow up and need to learn to do things independently." 4. "I ' m the one who knows the most about my child and can do the most for my child."

3. The parent of a child with a disability should have the goal of assisting the child in achieving as much self-care as he is capable of, given his particular limitations

When developing the plan of care for a child with early Duchenne's muscular dystrophy, which of the following nursing goals is the priority? 1. Encouraging early wheelchair use. 2. Fostering social interactions. 3. Maintaining function of unaffected muscles. 4. Prevent circulatory impairment.

3. The primary nursing goal is to maintain function in unaffected muscles for as long as possible. There is no effective treatment for childhood muscular dystrophy. Children who remain active are able to forestall being confined in wheelchair. Remaining active also minimizes the risk for social isolation. Preventing rather than encouraging wheelchair use by maintaining function for as long as possible is an appropriate nursing goal. Children with muscular dystrophy become socially isolated as their condition deteriorates and they can no longer keep up with friends. Maintaining function helps prevent social isolation. Circulatory impairment is not associated with muscular dystrophy

The parent of a child with neuroblastoma asks the nurse what the typical signs and symptoms are at first. Select the nurse's best answer. 1. "Most children complain of abdominal fullness and difficulty urinating." 2. "Many children in the early stages of a neuroblastoma have joint pain and walk with a limp." 3. "The signs and symptoms vary depending on where the tumor is located, but typical symptoms include weight loss, abdominal distention, and fatigue." 4. "The signs and symptoms are fairly consistent regardless of the location of the tumor. They include fatigue, hunger, weight gain, and abdominal fullness."

3. The signs and symptoms vary depending on where the tumor is located, but typical symptoms include weight loss, abdominal distention, and fatigue.

The nurse judges that the mother understands the term cerebral palsy when she describes it as a term applied to impaired movement resulting from which of the following? 1. Injury to the cerebrum caused by viral infection. 2. Malformed blood vessels in the ventricles caused by inheritance. 3. Nonprogressive brain damage caused by injury. 4. Inflammatory brain disease caused by metabolic imbalances.

3. The term cerebral palsy (CP) refers to a group of nonprogressive disorders of upper motor neuron impairment that result in motor dysfunction due to injury. In addition, a child may have speech or ocular difficulties, seizures, hyperactivity, or cognitive impairment. The condition of congenital malformed blood vessels in the ventricles is known as arteriovenous malformations. Viral infection and metabolic imbalances do not cause CP

A child diagnosed with a Wilms tumor is scheduled for an MRI scan of the lungs. The parent asks the nurse the reason for this test as a Wilms tumor involves the kidney, not the lung. Which is the nurse's best response? 1. "I ' m not sure why your child is going for this test. I will check and get back to you." 2. "It sounds like we made a mistake. I will check and get back to you." 3. "The test is done to check to see if the disease has spread to the lungs." 4. "We want to check the lungs to make sure your child is healthy enough to tolerate surgery."

3. The test is done to see if the disease has spread to the lungs.

During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which position? 1. Sitting. 2. Supine. 3. Squatting. 4. Standing.

3. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow

The nurse is caring for an infant with myelomeningocele who is going to surgery later today for closure of the sac. Which would be a priority nursing diagnosis before surgery? 1. Alteration in parent-infant bonding. 2. Altered growth and development. 3. Risk of infection. 4. Risk for weight loss

3. The unrepaired myelomeningocele is oftentimes a thin membrane that covers the neural contents of the spine. A normal saline dressing is placed over the sac to prevent tearing. The tearing would allow the CSF to escape and microorganisms to enter. The infant is at high risk for spinal cord infections. The priority nursing diagnosis is risk of infection.

A nurse is making an initial visit to a family with a 3-year-old child with early Duchenne's muscular dystrophy. Which of the following findings is expected when assessing this child? 1. Contractures of the large joints. 2. Enlarged calf muscles. 3. Difficulty riding a tricycle. 4. Small, weak muscles.

3. Usually the first clinical manifestations of Duchenne's muscular dystrophy include difficulty with typical age-appropriate physical activities such as running, riding a bicycle, and climbing stairs. Contractures of the large joints typically occur much later in the disease process. Occasionally enlarged calves may be noted, but they are not typical findings in a child with Duchenne's muscular dystrophy. Muscular atrophy and development of small, weak muscles are later signs

A 3-year-old child receiving chemotherapy after surgery for a Wilms' tumor has developed neutropenia. The parent is trying to encourage the child to eat by bringing extra foods to the room. Which food would not be appropriate for this child? 1. Fudge. 2. French fries. 3. Fresh strawberries. 4. A milk shake.

3. When a client receiving chemotherapy develops neutropenia, eating uncooked fruits and vegetables may pose a health risk due to possible bacterial contamination. All other foods are either cooked or pasteurized and would not produce a health risk.

When assessing an infant with an undescended testis, the nurse should be alert for which of the following? 1. Abnormal lower extremity reflexes. 2. A history of frequent emesis. 3. A bulging in the inguinal area. 4. Poor weight gain.

3. When an anomaly is found in one system, such as the genitourinary system, that system requires a more focused assessment to reveal other conditions that also may be occurring. A bulging in the inguinal area may suggest an inguinal hernia. Also, hydrocele or an upper urinary tract anomaly may occur on the same side as the undescended testis. A neuromuscular problem, not a genitourinary problem such as undescended testes, would most likely be the cause of abnormal lower extremity reflexes. A history of frequent emesis may be caused by pyloric stenosis or viral gastroenteritis. Poor weight gain might suggest a metabolic or feeding problem.

The parents of a neonate born with congenital clubfoot express feelings of helplessness and guilt, exhibiting anxiety about how the neonate will be treated. Which of the following actions by the nurse would be most appropriate initially? 1. Ask them to share these concerns with the physician. 2. Arrange a meeting with other parents whose infants have had successful clubfoot treatment. 3. Discuss the problem with the parents and the current feelings that they are experiencing. 4. Suggest that they make an appointment to talk things over with a counselor.

3. When an infant is born with an unexpected anomaly, parents are faced with questions, uncertainties, and possible disappointments. They may feel inadequate, helpless, and anxious. The nurse can help the parents initially by assessing their concerns and providing appropriate information to help them clarify or resolve the immediate problems. Referring the parents to the physician is not necessary at this time. The nurse can assist the parents by listening to their concerns. Having them talk with other parents would be helpful a little bit later, once the nurse assesses their concerns and discusses the problem and the parents' current feelings. If the parents continue to have difficulties expressing and working through their feelings, referral to a counselor would be appropriate.

Which foods would be best for a child with Duchenne muscular dystrophy? Select all that apply. 1. High-carbohydrate, high-protein foods. 2. No special food combinations. 3. Extra protein to help strengthen muscles. 4. Low-calorie foods to prevent weight gain. 5. Thickened liquids and smaller portions that are cut up.

4, 5 As the child becomes less ambulatory, moving the child will become more of a problem. It is not good for the child to become overweight for several health reasons in addition to decreased ambulation. As the child loses muscle control, the need for thickened liquids and small, well-cut-up solids becomes essential.

Which should the nurse stress to the parents of an infant in a Pavlik harness for treatment of developmental dysplasia of the hip (DDH)? 1. Put socks on over the foot pieces of the harness to help stabilize the harness. 2. Use lotions or powder on the skin to prevent rubbing of straps. 3. Remove harness during diaper changes for ease of cleaning diaper area. 4. Check under the straps at least two to three times daily for red areas.

4. Checking under straps frequently is suggested to prevent skin breakdown

When assessing the development of a 15-month-old child with cerebral palsy, which of the following milestones should the nurse expect a toddler of this age to have achieved? 1. Walking up steps. 2. Using a spoon. 3. Copying a circle. 4. Putting a block in cup

4. Delay in achieving developmental milestones is a characteristic of children with cerebral palsy. Ninety percent of 15-month-old children can put a block in a cup. Walking up steps typically is accomplished at 18 to 24 months. A child usually is able to use a spoon at 18 months. The ability to copy a circle is achieved at approximately 3 to 4 years of age

During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to: 1. Lay the child flat to promote hemostasis. 2. Lay the child flat with legs elevated to increase blood flow to the heart. 3. Sit the child on the parent's lap, with legs dangling, to promote venous pooling. 4. Hold the child in knee-chest position to decrease venous blood return

4. The increase in the SVR would increase afterload and increase blood return to the pulmonary artery

Which of the following measures should the nurse teach the parent of a child with hemophilia to do first if the child sustains an injury to a joint causing bleeding? 1. Give the child a dose of acetaminophen (Tylenol). 2. Immobilize the joint and elevate the extremity. 3. Apply heat to the area. 4. Administer factor per the home-care protocol.

4. Administration of factor should be the fi rst intervention if home-care transfusions have been initiated.

Which should the nurse prepare the parents of an infant for following surgical repair and closure of a myelomeningocele shortly after birth? The infant will: 1. Not need any long-term management and should be considered cured. 2. Not be at risk for urinary tract infections or movement problems. 3. Have continual drainage of cerebrospinal fluid, needing frequent dressing changes. 4. Need lifelong management of urinary, orthopedic, and neurological problems.

4. Although immediate surgical repair decreases infection, morbidity, and mortality rates, these children will require lifelong management of neurological, orthopedic, and elimination problems

The nurse is caring for a child with cerebral palsy (CP) whose weight is in the fifth percentile and who has been hospitalized for aspiration pneumonia. His parents are anxious and state that they do not want a G-tube placed. Which would be the nurse ' s best response? 1. "A G-tube will help your son gain weight and reduce his risk for future hospitalizations due to pneumonia." 2. "G-tubes are very easy to care for and will make feeding time easier for your family." 3. "Are you concerned that you will not be able to care for his G-tube?" 4. "Tell me your thoughts about G-tubes."

4. An open-ended question will encourage family members to share what they know and potentially clear up any misconceptions

The nurse is admitting a child who has been diagnosed with bacterial meningitis to the pediatric unit. The nurse should implement which type of isolation? 1. Standard precautions. 2. Contact precautions. 3. Airborne precautions. 4. Droplet precautions

4. Bacterial meningitis is caused by one of three organisms, Haemophilus influenzae type b, Neisseria meningitidis, or Streptococcus pneumoniae. All three organisms may be transmitted through contact with respiratory droplets. These droplets are heavy and typically fall within 3 feet of the client. Droplet precautions require, in addition to standard precautions, that health care providers wear masks when coming into close contact with the client. Standard precautions, previously referred to as universal precautions, are general measures used for all clients. Contact precautions are used when direct or indirect contact with the client causes disease transmission. Gowns and gloves are needed but not masks. Airborne precautions differ from droplet in that the particles are smaller and may stay suspended in the air for longer periods of time. These clients require negative pressure rooms and all heath care workers must wear respirators.

A preschool-age child with juvenile idiopathic arthritis (JIA) has become withdrawn, and the mother asks the nurse what she should do. Which of the following suggestions by the nurse would be most appropriate? 1. Introduce the child to other children her age who also have JIA. 2. Tell the mother to spend extra time with the child and less time with her other children. 3. Recommend that the mother send the child to see a counselor for therapy. 4. Encourage the mother to be supportive and understanding of the child.

4. Because the child is dealing with grief and loss associated with a chronic illness, parents need to be supportive and understanding. The child needs to feel valued and worthwhile. Introducing the child to others of the same age who also have JIA most probably would be ineffective because preschoolers are developmentally egocentric. Although the child needs to feel valued, the mother's spending more time with the child and less time with her other children is inappropriate because the child with JIA may experience secondary gain from the illness if the family interaction patterns are altered. Also, this action reinforces the child's withdrawal behavior. Psychological counseling is not needed at this time because the child's reaction is normal

An 8-year-old with newly diagnosed diabetes is in the hospital for regulation of diet and medications. The child is using an exchange method for the diet. The nurse should instruct the client that the American Diabetes Association's (ADA's) exchange method for dietary regulation includes: 1. Choosing food from each exchange list. 2. Using a scale to weigh all food. 3. Selecting from lists that group food according to protein, fat, and carbohydrate content. 4. Carbohydrate counting for each meal and snack

4. Carbohydrate counting identifies the number of grams of carbohydrate to be eaten at each meal and snack. The ADA's exchange diet allows the substitution of one food for another on the same diet list. The exchange list does not require that all food is weighed. Choices are made from lists referred to as carbohydrate, meat or meat substitute, and fat. The client's prescription identifies how many items from each food group are to be consumed at each meal and snack. The exchange assumes that foods with similar nutrient content affect blood glucose levels in a similar manner.

Which can elicit the Gower sign? Have the child: 1. Close the eyes and touch the nose with alternating index fingers. 2. Hop on one foot and then the other. 3. Bend from the waist to touch the toes. 4. Walk like a duck and rise from a squatting position.

4. Children with muscular dystrophy display the Gower sign, which is great difficulty rising and standing from a squatting position because of the lack of muscle strength.

The parent of an infant asks the nurse what to watch for to determine whether the infant has CP. Which is the nurse ' s best response? 1. "If the infant cannot sit up without support before 8 months." 2. "If the infant demonstrates tongue thrust before 4 months." 3. "If the infant has poor head control after 2 months." 4. "If the infant has clenched fists after 3 months."

4. Clenched fists after 3 months of age may be a sign of upper motor injury and CP

What is the most appropriate method to use when drawing blood from a child with hemophilia? 1. Use finger punctures for lab draws. 2. Be prepared to administer platelets for prolonged bleeding. 3. Apply heat to the extremity before venipunctures. 4. Schedule all labs to be drawn at one time.

4. Coordinating labs to minimize sticks reduces trauma and the risk of bleeding. Finger sticks in general are more painful and associated with more bleeding than venipunctures. In hemophilia, platelets are typically normal. Heat would increase vasodilatation and increase bleeding.

When teaching the child with scoliosis being treated with a Boston brace about exercises, the nurse explains that the exercises are performed primarily for which of the following purposes? 1. To decrease back muscle spasms. 2. To improve the brace's traction effect. 3. To prevent spinal contractures. 4. To strengthen the back and abdominal muscles.

4. Exercises are prescribed for the child with scoliosis wearing a Boston brace to help strengthen spinal and abdominal muscles and provide support. Typically, children wearing a Boston brace do not complain of muscle spasms. Performing exercises provides no effect on the brace's traction ability. Spinal contractures do not occur when a Boston brace is worn.

Which of following should the nurse perform to help alleviate a child's joint pain associated with rheumatic fever? 1. Maintaining the joints in an extended position. 2. Applying gentle traction to the child's affected joints. 3. Supporting proper alignment with rolled pillows. 4. Using a bed cradle to avoid the weight of bed linens on joints.

4. For a child with arthritis associated with rheumatic fever, the joints are usually so tender that even the weight of bed linens can cause pain. Use of a bed cradle is recommended to help remove the weight of the linens on painful joints. Joints need to be maintained in good alignment, not positioned in extension, to ensure that they remain functional. Applying gentle traction to the joints is not recommended because traction is usually used to relieve muscle spasms, not typically associated with rheumatic fever. Supporting the body in good alignment and changing the client's position are recommended, but these measures are not likely to relieve pain

A 4-year-old child with hydrocephalus is scheduled to have a ventroperitoneal shunt in the right side of the head. When developing the child's postoperative plan of care, the nurse should place the preschooler in which of the following positions immediately after surgery? 1. On the right side, with the foot of the bed elevated. 2. On the left side, with the head of the bed elevated. 3. Prone, with the head of the bed elevated. 4. Supine, with the head of the bed fl at.

4. For at least the first 24 hours after insertion of a ventriculoperitoneal shunt, the child is positioned supine with the head of the bed flat to prevent too rapid a decrease in cerebrospinal fluid pressure. Although elevating the head increases cerebrospinal fluid drainage and reduces intracranial pressure, a rapid reduction in the size of the ventricles can cause subdural hematoma. Positioning on the operative or right side is avoided because it places pressure on the shunt valve, possibly blocking desired drainage of the cerebrospinal fluid. Elevating the foot of the bed could increase intracranial pressure. With continued increased intracranial pressure, the child would be positioned with the head of the bed elevated to allow gravity to aid drainage. The child should be kept off the nonoperative side (side opposite the shunt), or the left side, to help prevent rapid decompression leading to a cerebral hematoma.

The nurse is caring for a child who complains of constant hunger, constant thirst, frequent urination, and recent weight loss without dieting. Which can the nurse expect to be included in care for this child? 1. Limiting daily fluid intake. 2. Weight management consulting. 3. Strict intake and output monitoring. 4. Frequent blood glucose testing

4. Frequent blood glucose testing is included in the care of a child with type 1 DM. The symptoms described in the question are characteristic of a child just prior to the diagnosis of type 1 DM.

A 14-year-old girl with sickle cell disease has her fourth hospitalization for sickle cell crisis. Her family is planning a ski vacation in the mountains. What should the nurse tell the parents? 1. Encourage them to go on the trip. 2. Go on the trip, but fi nd a sitter for the 14-yearold. 3. Suggest the trip be postponed until next year. 4. Explain that the high altitude may cause a crisis

4. High altitude causes deoxygenation, which might precipitate a crisis. In clients with sickle cell anemia, cells sickle when the client experiences any situation where increased demand for oxygen is needed, such as in an infection or dehydration, or when low oxygen concentration is experienced, such as in high altitudes or deep sea diving. Crises can commonly be prevented by maintaining hydration. It would be unsafe to encourage the family, or to say nothing about taking the client to high altitude areas, but giving the parents adequate information will allow them to make an appropriate decision. Postponing the trip or leaving the child at home does not address the immediate concern for the child's health.

A nurse evaluates discharge teaching as successful when the parents of a school-age child with a ventriculoperitoneal shunt insertion identify which sign as signaling a blocked shunt? 1. Decreased urine output with stable intake. 2. Tense fontanel and increased head circumference. 3. Elevated temperature and reddened incisional site. 4. Irritability and increasing difficulty with eating

4. In a school-age child, irritability, lethargy, vomiting, difficulty with eating, and decreased level of consciousness are signs of increased intracranial pressure caused by a blocked shunt. Decreased urine output with stable fluid intake indicates fluid loss from a source other than the kidneys. A tense fontanel and increased head circumference would be signs of a blocked shunt in an infant. Elevated temperature and redness around incisions might suggest an infection

A 16-month-old child is seen in the clinic for a checkup for the first time. The nurse notices that the toddler limps when walking. Which of the following would be appropriate to use when assessing this toddler for developmental dysplasia of the hip? 1. Ortolani's maneuver. 2. Barlow's maneuver. 3. Adam's position. 4. Trendelenburg's sign.

4. In a toddler, weight bearing causes the pelvis to tilt downward on the unaffected side instead of upward as it would normally. This is Trendelenburg's sign, and it indicates developmental dysplasia of the hip. Ortolani's maneuver is used during the neonatal period to assess developmental dysplasia of the hip in infants. With the infant quiet, relaxed, and lying on the back, the hips and knees are flexed at right angles. The knees are moved to abduction and pressure is exerted. If the femoral head moves forward, then it is dislocated. Barlow's maneuver is used to assess developmental dysplasia of the hip in infants. As the femur is moved into or out of the acetabulum, a "clunk" is heard, indicating dislocation. Adam's position is used to evaluate for structural scoliosis. The child bends forward with feet together and arms hanging freely or with palms together

The nurse is teaching the family about caring for their 7-year-old, who has been diagnosed with type 1 diabetes mellitus. What information should the nurse provide about this condition? 1. Best managed through diet, exercise, and oral medication. 2. Can be prevented by proper nutrition and monitoring blood glucose levels. 3. Characterized mainly by insulin resistance. 4. Characterized mainly by insulin deficiency

4. Individuals with type 1 DM do not produce insulin. If one does not produce insulin, type 1 DM is the diagnosis

The nurse is teaching the parent of a child newly diagnosed with juvenile idiopathic arthritis (JIA). The nurse would evaluate the teaching as successful when the parent is able to say that the disorder is caused by the: 1. Breakdown of osteoclasts in the joint space causing bone loss. 2. Loss of cartilage in the joints. 3. Buildup of calcium crystals in joint spaces. 4. Immune-stimulated inflammatory response in the joint.

4. JIA is caused by an immune response by the body on the joint spaces.

The nurse is discharging a child who has just received chemotherapy for neuroblastoma. Which of the following statements made by the child ' s parent indicates a need for additional teaching? 1. "I will inspect the skin often for any lesions." 2. "I will do mouth care daily and monitor for any mouth sores." 3. "I will wash my hands before caring for my child." 4. "I will take a rectal temperature daily and report a temperature greater than 101°F (38.3°C) immediately to the health-care provider."

4. Monitoring the child ' s temperature and reporting it to the physician are important, but the temperature should not be taken rectally. The risk of injury to the mucous membranes is high. Rectal abscesses can occur in the damaged rectal tissue. The best method for taking the temperature is axillary, especially if the child has mouth sores

Which is included in the plan of care for a newborn who has a myelomeningocele? 1. Place the infant in the prone position with a sterile dry dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 2. Place the infant in the prone position with a sterile dry dressing over the defect. Begin intravenous fluids to prevent dehydration. 3. Place the infant in the prone position with a sterile moist dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 4. Place the child in the prone position with a sterile moist dressing over the defect. Begin intravenous fluids to prevent dehydration.

4. The child is placed in the prone position to avoid any pressure on the defect. A sterile moist dressing is placed over the defect to keep it as clean as possible. Intravenous fl u

A father brings his 4-week-old son to the clinic for a checkup, stating that he believes his son's testicle is missing. Which of the following explanations would be most appropriate? 1. "Although the testes should have descended by now, it is not a cause for worry." 2. "The testes often do not descend until age 6 months, but let's check to see whether the testes are present." 3. "The testes are present in the scrotal sac at birth, but surgery can remedy the situation." 4. "Although the testes normally descend by 1 year of age, I can understand your concern."

4. Normally the testes descend by 1 year of age; failure to do so may indicate a problem with patency or a hormonal imbalance. By age 4 weeks, descent may not have occurred. However, telling the father that lack of descent is not a cause for worry is inappropriate and uncaring. Additionally, a statement such as this may be false reassurance. By acknowledging the father's concern, the nurse indicates acceptance of his feelings. If the testes have not descended, then they will not be palpable in the scrotal sac. Surgery is not discussed until after a full assessment is completed.

When teaching parents about osteosarcoma, the nurse knows instruction has been successful when a parent says that this type of cancer is common in which age-group? 1. Infants. 2. Toddlers. 3. School-age children. 4. Adolescents.

4. Osteosarcoma is a common cancer of adolescents.

An overweight adolescent has been diagnosed with type 2 diabetes. To increase the client's self-efficacy to manage their disease, the nurse should: 1. Provide the client with a written daily food and exercise plan. 2. Discuss eliminating junk food in the home with the parents. 3. Arrange for the school nurse to weigh the child weekly. 4. Utilize a peer with type 2 diabetes to role model lifestyle changes

4. Self-efficacy, or the belief that one can act in a way to produce a desired outcome, can be promoted through the observation of role models. Peers are particularly effective role models because clients can more readily identify with them and believe they are capable of similar behaviors. Providing a written plan alone does not promote self-efficacy. Having parents eliminate junk food and having the school nurse weigh the adolescent can be part of the plan, but these actions do not empower the client

The mother asks the nurse why her child's hemoglobin was normal at birth but now the child has S hemoglobin. Which of the following responses by the nurse is appropriate? 1. "The placenta bars passage of the hemoglobin S from the mother to the fetus." 2. "The red bone marrow does not begin to produce hemoglobin S until several months after birth." 3. "Antibodies transmitted from you to the fetus provide the newborn with temporary immunity." 4. "The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."

4. Sickle cell disease is an inherited disease that is present at birth. However, 60% to 80% of a newborn's hemoglobin is fetal hemoglobin, which has a structure different from that of hemoglobin S or hemoglobin A. Sickle cell symptoms usually occur about 4 months after birth, when hemoglobin S begins to replace the fetal hemoglobin. The gene for sickle cell disease is transmitted at the time of conception, not passed through the placenta. Some hemoglobin S is produced by the fetus near term. The fetus produces all its own hemoglobin from the earliest production in the first trimester. Passive immunity conferred by maternal antibodies is not related to sickle cell disease, but this transmission of antibodies is important to protect the infant from various infections during early infancy.

The nurse caring for a client with type 1 diabetes mellitus is teaching how to self administer insulin. Which is the proper injection technique? 1. Position the needle with the bevel facing downward before injection. 2. Spread the skin prior to intramuscular injection. 3. Aspirate for blood return prior to injection. 4. Elevate the subcutaneous tissue before injection.

4. Skin tissue is elevated to prevent injection into the muscle when giving a subcutaneous injection. Insulin is only given subcutaneously

Which of the following will be abnormal in a child with the diagnosis of hemophilia? 1. Platelet count. 2. Hemoglobin level. 3. White blood cell count. 4. Partial thromboplastin time (PTT).

4. The abnormal laboratory results in hemophilia are related to decreased clotting function. Partial thromboplastin time is prolonged.

A child diagnosed with tetralogy of Fallot becomes upset, crying and thrashing around when a blood specimen is obtained. The child's color becomes blue and the respiratory rate increases to 44 breaths/minute. Which of the following actions should the nurse do first? 1. Obtain an order for sedation for the child. 2. Assess for an irregular heart rate and rhythm. 3. Explain to the child that it will only hurt for a short time. 4. Place the child in a knee-to-chest position

4. The child is experiencing a tet or hypoxic episode. Therefore the nurse should place the child in a knee-to-chest position. Flexing the legs reduces venous fl ow of blood from the lower extremities and reduces the volume of blood being shunted through the interventricular septal defect and the overriding aorta in the child with tetralogy of Fallot. As a result, the blood then entering the systemic circulation has a higher oxygen content, and dyspnea is reduced. Flexing the legs also increases vascular resistance and pressure in the left ventricle. An infant often assumes a knee-to-chest position in the crib, or the mother learns to put the infant over her shoulder while holding the child in a knee-to-chest position to relieve dyspnea. If this position is ineffective, then the child may need a sedative. Once the child is in the position, the nurse may assess for an irregular heart rate and rhythm. Explaining to the child that it will only hurt for a short time does nothing to alleviate the hypoxia.

The nurse is caring for a school-age child with Duchenne muscular dystrophy in the elementary school. Which would be an appropriate nursing diagnosis? 1. Anticipatory grieving. 2. Anxiety reduction. 3. Increased pain. 4. Activity intolerance.

4. The child would not be able to keep up with peers because of weakness, progressive loss of muscle fibers, and loss of muscle strength

Which priority item should be placed at the bedside of a newborn with myelomeningocele? Select all that apply. 1. A bottle of normal saline. 2. A rectal thermometer.3. Extra blankets. 4. A blood pressure cuff. 5. Latex-free gloves.

4. The child would not be able to keep up with peers because of weakness, progressive loss of muscle fibers, and loss of muscle strength 5. Latex-free clean gloves would be used for all care of this infant. A box should be kept at the infant ' s bedside. Children with spina bifida are at risk for latex allergy and should not be exposed to latex.

When developing the discharge plan for the parents of an infant who has undergone a myelomeningocele repair, what information is most important for the nurse to include? 1. A list of available hospital services. 2. Schedule for daily home health care. 3. Chaplain referral for psychological support. 4. Daily care required by the infant

4. The most important aspect of the discharge plan is to ensure that the parents understand what the daily care of their infant involves and to provide teaching related to carrying out this daily care. In addition to the routine care required by the infant, care also may include physical therapy to the lower extremities. Providing a list of available hospital services may be helpful to the parents, but it is not the most important aspect to include in the discharge plan. Usually, home health care is not needed because the parents are able to care for their child. A referral for counseling is initiated whenever the need arises, not just at discharge

When developing the teaching plan for the parents of a 12-month-old infant with hypospadias and chordee repair, which of the following should the nurse expect to include as most important? 1. Assisting the child to become familiar with his dressings so he will leave them alone. 2. Encouraging the child to ambulate as soon as possible by using a favorite push toy. 3. Forcing fl uids to at least 2,500 mL/day by offering his favorite juices. 4. Preventing the child from disrupting the catheters by using soft restraints

4. The most important consideration for a successful outcome of this surgery is maintenance of the catheters or stents. A 12-month-old infant likes to explore his environment but must be prevented from manipulating his dressings or catheters through the use of soft restraints. Allowing the infant to become familiar with the dressings will not prevent him from pulling at them. After surgery the child is allowed limited activity, possibly with sitting in the parent's lap. A 12-month-old infant may or may not be walking. If he is, most likely he will be clumsy and possibly injure himself. Although increasing fluids is important, 2,500 mL/day is an excessive amount for a 12-month-old. Fluid requirements would be 115 mL/kg

The father of a preschool-age child with a tentative diagnosis of juvenile idiopathic arthritis (JIA) asks about a test to definitively diagnose JIA. The nurse's response is based on knowledge of which of the following? 1. The latex fixation test is diagnostic. 2. An increased erythrocyte sedimentation rate is diagnostic. 3. A positive synovial fl uid culture is diagnostic. 4. No specific laboratory test is diagnostic.

4. The nurse's response to the father is based on the knowledge that there is no definitive test for JIA. The latex fixation test, which is commonly used to diagnose arthritis in adults, is negative in 90% of children. The erythrocyte sedimentation rate may or may not be increased during active disease. This test identifi es the presence of infl ammation only. Synovial fl uid cultures are done to rule out septic arthritis, not to diagnose JIA

The nurse evaluates teaching of parents of a child newly diagnosed with CP as successful when the parents state that CP is which of the following? 1. Inability to speak and uncontrolled drooling. 2. Involuntary movements of lower extremities only. 3. Involuntary movements of upper extremities only. 4. An increase in muscle tone and deep tendon reflexes.

4. The primary disorder is of muscle tone, but there may be other neurological disorders such as seizures, vision disturbances, and impaired intelligence. Spastic CP is the most common type and is characterized by a generalized increase in muscle tone, increased deep tendon reflexes, and rigidity of the limbs on both flexion and extension.

The parent of a 3-year-old is shocked to hear the diagnosis of Wilms tumor and says, "How could I have missed a lump this big?" Which is the nurse ' s best response? 1. "Do not be hard on yourself. It's easy to overlook something that has probably been growing for months when we see our children on a regular basis." 2. "I understand you must be very upset. Your child would have had a better prognosis had you caught it earlier." 3. "It really takes a trained professional to recognize something like this." 4. "Do not blame yourself. This mass grows so fast that it was probably not noticeable a few days ago."

4. The tumor is fast-growing and could very easily not have been evident a few days earlier

A child with a ventriculoperitoneal (VP) shunt complains of headache and blurry vision and now experiences irritability and sleeping more than usual. The parents ask the nurse what they should do. Select the nurse ' s best response. 1. "Give her some acetaminophen (Tylenol), and see if her symptoms improve. If they do not improve, bring her to the health-care provider's office." 2. "It is common for girls to have these symptoms, especially prior to beginning their menstrual cycle. Give her a few days, and see if she improves." 3. "You are probably worried that she is having a problem with her shunt. This is very unlikely because it has been working well for 9 years." 4. "You should immediately take her to the emergency department because these may be symptoms of a shunt malfunction."

4. These are symptoms of a shunt malfunction and should be evaluated immediately

A child has been diagnosed with valvular disease following rheumatic fever (RF). During patient teaching, the nurse discusses the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth. The parents indicate they understand when they say: 1. "She will need to take the antibiotics until she is 18 years old." 2. "She will need to take the antibiotics for 5 years after the last attack." 3. "She will need to take the antibiotics for 10 years after the last attack." 4. "She will need to take the antibiotics for the rest of her life."

4. Valvular involvement indicates significant damage, so antibiotics would be taken for the rest of her life.

A school-age child is admitted to the hospital with the diagnosis of probable infratentorial brain tumor. During the child's admission to the pediatric unit, which action should the nurse anticipate taking first? 1. Eliminating the child's anxiety. 2. Implementing seizure precautions. 3. Introducing the child to other clients of the same age. 4. Preparing the child and parents for diagnostic procedures

4. When a brain tumor is suspected, the child and parents are likely to be very apprehensive and anxious. It is unrealistic to expect to eliminate their fears; rather, the nurse's goal is to decrease them. Preparing both the child and family during hospitalization can help them cope with some of their fears. Although the nurse may be able to decrease some of the child's anxiety, it would be impossible to eliminate it. Children with infratentorial tumors seldom have seizures, so seizure precautions are not indicated. Although introducing the child to other children is a positive action, this action would be more appropriate once the nurse has decreased some of the child's and parents' anxiety by preparing them.

The nurse observes as a child with Duchenne's muscular dystrophy attempts to rise from a sitting position on the floor. After attaining a kneeling position, the child "walks" his hands up his legs to stand. The nurse documents this as which of the following? 1. Galeazzi's sign. 2. Goodell's sign. 3. Goodenough's sign. 4. Gower's sign.

4. With Gower's sign, the child walks the hands up the legs in an attempt to stand, a common approach used by children with Duchenne's muscular dystrophy when rising from a sitting to a standing position. Galeazzi's sign refers to the shortening of the affected limb in congenital hip dislocation. Goodell's sign refers to the softening of the cervix, considered a sign of probable pregnancy. Goodenough's sign refers to a test of mental age