PEDIATRIC SUCCESS COMPREHENSIVE EXAM CHAPTER 15

23. The nurse on the previous shift charted that a newborn demonstrated cutis marmorata. The nurse now caring for the baby should check which vital sign? 1. Blood pressure. 2. Respirations. 3. Skin color. 4. Temperature.

4. Cutis marmorata is transient mottling of the body when the infant is exposed to cold. It is important to check the baby's temperature. Cutis marmorata is a change in the color of the skin.

100. Which approach gives the most support to parents grieving over a terminally ill newborn? 1. State "You are both still young and will be able to have more children." 2. Avoid the parents; let them ask you questions. 3. Offer rationalizations for the child's terminal illness. 4. State "You are still feeling all the pain of your child's illness."

100. 1. State "You are both still young and will be able to have more children." 2. Avoid the parents; let them ask you questions. 3. Offer rationalizations for the child's terminal illness. 4. State "You are still feeling all the pain of your child's illness." Support to grieving families varies with the needs of the family. General guide lines in support of grieving families are to deal openly with their feelings and ac cept the family's grief response. Avoid judgmental or rationalizing statements. Focus on their feelings. Provide referral to self-help groups or professional help if appropriate. TEST-TAKING HINT: The test taker should

12. Parents are told by the genetic counselor that they have a 1:4 probability of having a second child with cystic fibrosis (CF). They already have one child who is affected. The parents state their risk is lower now than when they had the previous child. What should the nurse tell the parents about the 1:4 probability? 1. Each pregnancy is an independent event. 2. The probability of having another child with CF is twice as likely as it was when they had the first child. 3. The probability of having a healthy child is twice as likely with this pregnancy. 4. The probability of miscarrying is greater now than with the previous pregnancy.

12. 1. In a probability equation, chance has no memory, and each pregnancy is an independent event.

94. According to Freud, the most significant achievement of toddlers is _______________.

94. Toilet training. Freud believed that during the anal-urethral stage of psychosexual development, a child must achieve toilet training. Freud believed that children may have long-lasting difficul ties if they do not master toilet training.

95. Seizures that originate in one hemisphere are called _________________.

95. Partial or focal seizures. Seizures originating in both hemispheres are called generalized seizures.

96. The term __________________ is commonly defined as stiffness of the neck.

96. Nuchal rigidity. Nuchal rigidity is assessed when a child has a fever or appears septic.

65. A child with moderate asthma is wheezing and coughing. Before the physician sees the child, the nurse should perform which test? 1. Skin testing for allergens. 2. PCO 2 levels. 3. Metered dose inhaler. 4. Peak flowmeter.

4. The Expert Panel recommends that peak flow monitoring be used inchildren with asthma to determine the severity of an exacerbation and to guide therapeutic decision making.

19. A child assigned to the nurse's floor has dysfluencies. The nurse should recognize what symptoms? 1. Stuttering. 2. Substitution of one sound for another. 3. Speaking in a monotone. 4. Hypernasal speech.

19. 1. Dysfluency is speech with abnormal rhythms, such as repetitions in sounds or words. A stutter is described as tense repetitions of sounds or complete blockages of sounds.

15. The nurse is working in a large clinic for low-income children in Florida. In the clinic are many families of different cultures. The families are first-generation and have many beliefs about health that were learned in their native countries. Match the culture with the health-care belief. 1. Haitians A. Religion and medicine strongly interwoven 2. Cubans B. Nutrition is important in good health 3. Latinos, Chicanos C. Illness has a supernatural origin (voodoo) 4. Puerto Ricans D. Believe hot-cold theory of illness 5. Native Americans E. Seek help from curandero (healer)

15. 1, C; 2, B; 3, E; 4, D; 5, A.

2. The average newborn weighs 3400 g. The nurse will tell the parents that the baby weighs_________________ lb.

2. 7.5.

86. Which of the following best describes the type of seizure displayed in the figure? 1. Tonic-clonic. 2. Absence. 3. Atonic. 4. Akinetic. 5. Myoclonic. 6. Infantile spasm.

2. Absence seizures are characterized by a blank stare and no muscle activity.

75. While assisting with a lumbar puncture procedure on an infant or small child, the nurse should do which of the following? 1. Have the patient in a clean diaper to avoid contamination of the site. 2. Monitor the patient's cardiorespiratory status at all times. 3. Position the patient in the prone position with the head to the left. 4. Start an intravenous line to facilitate use of conscious sedation.

2. Airway, breathing, and circulation are always the priority during procedures.

5. The parent of a newborn wants to know what the newborn screening test does. What is the nurse's best response? 1. "Not all states do newborn screening." 2. "All states test for phenylketonuria and hypothyroidism." 3. "Babies are screened at 48 hours of age." 4. "The baby who is taken home within 24 hours is not screened."

2. All states currently do screening for phenylketonuria and hypothyroidism.

69. Parents of a 2-year-old with Down syndrome are told the child should be screened for atlantoaxial instability. The nurse tells the parents that which of the following are symptoms of this instability? 1. Mental retardation. 2. Neck pain and torticollis. 3. Vision and hearing loss. 4. Delayed secondary sexual development.

2. Atlantoaxial instability is ligamentous laxity of the atlantoaxial joint. The symptoms of neck pain, torticollis, and loss of bowel and bladder control indi cate that instability is already present. The purpose of the x-rays is to prevent symptoms by limiting activities if instability is present.

22. A 3-month-old is brought to the public clinic, and the parent tells the nurse that the baby is fussy, spits up constantly, and has a lot of gas, and that there is a family history of allergies. The nurse knows that these symptoms are related to which diagnosis? 1. Failure to thrive. 2. Sensitive to cow's milk. 3. Phenylketonuria. 4. Pancreatic insufficiency.

2. Babies taking Neocate formula have sensitivity to cows' milk proteins as well as soy and hydrolyzed proteins. The parent is describing symptoms of a cows' milk allergy and mentions there are many family members with allergies.

20. Parents confide to the nurse that their child, who is 35 months old, does not talk and spends hours sitting on the floor watching the ceiling fan go around. They are concerned their child may have autism. The nurse should ask the parents which question? 1. "Does your child have brothers or sisters?" 2. "Does your child seek you out for comfort and love?" 3. "Do you have trouble getting babysitters for your child?" 4. "Does your child receive speech therapy?"

2. Children with autistic-like features lack many social skills, such as seeking reciprocity and comfort from parents and maintaining eye contact when someone is speaking with them. They have an inability to develop peer relationships.

88. A 14-year-old sustained a grade III concussion while playing football. Which of the following statements made by the parents indicates that further patient education is needed? 1. "Our child will not be able to play football until recovery is complete." 2. "Our child needs to get back to school quickly, as there are midterms next week." 3. "Our child's headaches may continue for the next 6 months; we should call the physician if the headaches get worse." 4. "If our child suffers another concussion before recovery is complete, brain injury will be compounded."

2. Short-term memory loss is a frequent side effect of concussions. Until effects of the concussion have subsided and the child is cleared by a physician, the child should not take school tests that often rely on short-term memory.

51. The nurse is assisting with a sports physical session at a local grade school. A fixed splitting of the S2 sound is heard in an otherwise healthy child. The nurse knows that this is a diagnostic sign of which cardiac defect? 1. Mitral regurgitation. 2. Atrial septal defect. 3. Functional murmur. 4. Pericardial friction rub.

2. The S 2 sound is caused by the closure of the pulmonic and aortic valves. A fixed splitting of the S2 sound is indica tive of an atrial septal defect.

36. Parents are frustrated with toilet training their 2-year-old. Both parents work full time and claim they do not have time to spend on toilet training. What suggestions can the nurse give the parents to decrease their frustration? 1. "You will have to invest some time if the child is to be toilet trained." 2. "A child needs to be both physically and psychologically ready to learn the skills needed to be continent." 3. "Do you think your child is stubborn?" 4. "Have the child sit on the toilet until the child voids."

2. The child is 2 years old and may not be physically, emotionally, or psychologi cally ready to toilet train.

58. Three preschool children and their Middle East-born parents come to a homeless shelter. The family has been homeless for 3 months. The children appear somewhat unkempt but nourished. One of the children has several enlarged cervical lymph nodes and is running a low-grade fever. Which chronic infectious illness should be suspected in the child? 1. Chlamydial pneumonia. 2. Tuberculosis. 3. Pertussis (whooping cough). 4. Asthma.

2. The chronic infectious illness for which this child is at risk is tuberculo sis. The disease may present as asymp tomatic or include fever, enlarged lymph nodes, anorexia, weight loss, night sweats, and, occasionally, hemop tysis. It is recommended that Mantoux skin tests be performed annually for at risk populations such as the homeless, first-generation immigrants, and resi dents of correctional facilities.

44. The parent of a school-aged child who is a paraplegic and uses a wheelchair states that the child is allergic to latex. The nurse knows that the most important interven tion for this child is which of the following? 1. Giving antihistamines and steroids after procedures. 2. Prevention of contact with latex products. 3. Doing a radioallergosorbent test before each procedure. 4. Using only latex-free gloves when doing procedures.

2. The most important intervention for any person with latex allergy or sensi tivity is to prevent contact with latex products.

49. What are the two organizations in the United States that make and govern the rec ommendations for immunization policies and procedures? 1. National Advisory Committee on Immunization and American Medical Association. 2. U.S. Public Health Service Centers for Disease Control and American Academy of Pediatrics. 3. National Immunization Program and Pediatric Infectious Disease Association. 4. National Institutes of Health and Minister of National Health and Welfare.

2. The two organizations in the United States that govern the recommenda tions on immunization practices are the Advisory Committee on Immunization Practices (ACIP) of the U.S. Public Health Service and the Committee on Infectious Diseases of the American Academy of Pediatrics.

11. A pregnant teen is to have prenatal genetic testing. She is afraid of needles and wants to know the least invasive way she can get the genetic testing done. The nurse should suggest which testing procedure? 1. Triple marker screen. 2. Ultrasound examination. 3. Amniocentesis. 4. Chorionic villus sampling.

2. The ultrasound is appropriate for a noninvasive procedure. It would detect multiple gestations and structural ab normalities, but it would not detect biochemical abnormalities.

84. A child arrives at the pediatric emergency department, having had a generalized seizure at home and a recent sore throat and mild fever. During the nurse's assess ment, the child begins to have generalized tonic-clonic seizure activity. The drug of choice and method of administration the nurse expects the physician to order are which of the following? 1. Lorezapam and diazepam, combined in an intravenous solution of D5W. 2. Lorezapam given intravenously or diazepam given directly into a vein. 3. Phenobarbital administered in an intravenous solution of D 5W, 0.45 normal saline. 4. Phenytoin in a dextrose solution given intravenously over 1 hour.

2. These continue to be the drugs of choice for in-hospital management of tonic-clonic activity. These are the rec ommended methods of administration; diazepam compromises intravenous tubing.

1. Which outcome is expected in a breast-fed newborn? 1. Voids spontaneously within 12 hours of life. 2. Loses 10% of body weight in the first 5 days. 3. Regains birth weight by the 10th day of life. 4. Awakens spontaneously for all feedings.

3. All infants, whether breastfed or bottle fed, should regain their birth weight by 10 days of life.

25. A 2-day-old baby is being readied for discharge but looks jaundiced. This is the mother's first baby. The nurse reviews the baby's birth records and notes that the baby has A+ blood type, and the mother has O+ blood type The nurse should check which blood test? 1. Hepatitis B titer. 2. Total bilirubin. 3. Complete blood count. 4. Sedimentation rate.

2. This baby has an ABO blood incom patability, with the mother being O and the baby being A. The total bilirubin is a value that combines the unconjugated and the conjugated bilirubin levels. The newborn would have an increase in the unconjugated bilirubin (lipid-soluble) as a result of the presence of antibodies to the mother's blood type.

24. The nurse is caring for a newborn with Erb palsy and a phrenic nerve paralysis. The most effective way to promote respiratory effort is for the nurse to position the newborn in what way? 1. Supine. 2. On the affected side. 3. On the unaffected side. 4. Prone.

2. To optimize the baby's breathing, posi tion the baby with the affected side down. In this way, the good lung can expand fully. Babies are primarily tho racic breathers, so it is important to maximize use of the good lung. The baby also has an Erb/brachial palsy, which further limits the function on the affected side.

16. The nurse is working in a clinic, and the next patient is an infant with deaf parents. In addition to providing an interpreter for the deaf, the nurse should incorporate what additional aid in her communication with the family? 1. Talk as done with hearing families. 2. Maintain good eye contact to let them read the nurse's lips. 3. Explain procedures thoroughly. 4. Recommend a trained hearing dog.

2. When communicating with parents who are hearing-impaired, maintain good eye contact, and allow them to read lips.

21. The nurse in the emergency department is caring for an 8-month-old who suffered a concussion from an automobile accident. The infant was in the car seat at the time. The nurse should assess the infant for which symptoms? 1. Sweating, irritability, and pallor. 2. Plethora and hyperthermia. 3. Crying with fear. 4. Negative Babinski reflex.

21. 1. Post-concussion syndrome is a com mon finding in children who have suf fered a head injury. Symptoms in the infant include pallor, sweating, irri tability, and sleepiness. The symptoms begin within minutes to hours.

27. A baby is brought into the clinic for follow-up review of phenylketonuria. The baby is 9 months old and weighs 22 lb. If the recommendation is to limit the phenylala nine in the diet to 25 mg/kg, this infant should have no more than _________/day.

27. 250 mg.

28. The nurse working in the newborn nursery has to draw a heel-stick blood sample be fore an infant's discharge. What can the nurse do to decrease the pain the infant feels from this procedure? Select all that apply. 1. Wrap the heel in a warm, damp cloth. 2. Use EMLA before doing the stick. 3. Swaddling the infant. 4. Have the infant do non-nutritive sucking. 5. Do the stick while the infant is asleep.

3 28. 1, 3, 4. 1. Wrapping the foot in a warm wash cloth increases the vasodilation and makes obtaining the sample easier. 2. Using EMLA cream on the heel before the stick has not been shown to decrease the pain response of the infant. 3. Swaddling appears very effective in decreasing neonatal pain. 4. Non-nutritive sucking appears very ef fective in decreasing neonatal pain. 5. The baby will feel the pain whether asleep or awake.

46. A 4-week-old infant has a hip dysplasia and is wearing a Pavlik harness. The nurse notices what when the infant's diapers are changed? 1. Diaper dermatitis. 2. Talipes equinovarus. 3. Leg shortening and limited abduction. 4. Pain.

3. An infant wearing a Pavlik harness is at risk of leg shortening on the affected side and limited abduction. The straps on the harness may need adjustment and lengthening frequently.

4. The nurse is working in the newborn nursery and accidentally bumps the crib of one of the babies. This baby demonstrates an asymmetric tonic neck reflex. The nurse sees this baby in which posture? 1. Extends trunk upward and lifts head. 2. Oscillating movements of the ankles and knees. 3. A "fencing" posture. 4. Extension and abduction of extremities and fanning of fingers.

3. A fencing posture describes an asym metric tonic neck reflex and should disappear by 3 to 4 months of age.

10. Parents are concerned that their provider suspects Turner syndrome in their newborn. What physical characteristics can the nurse point out that lead to this suspicion? 1. Cleft lip and palate. 2. Weak, high-pitched cry. 3. Webbed neck and lymphedema. 4. Long arms and small genitalia.

3. A low-set posterior hairline, webbing of the neck, and lymphedema of the hands and feet are characteristic of Turner syndrome.

17. A teenager is legally blind. The teen is wearing thick glasses and is carrying some school books. What question should the nurse ask the teen? 1. "Just how blind are you?" 2. "Can you see enough to read those books?" 3. "Tell me what you can see in this room." 4. "Is your vision worse than 20/200 in either of your eyes?"

3. Having the teenager explain what can be seen will assist in learning the teen's vi sual capabilities. Asking the teenager to explain initiates rapport and builds trust.

83. A child is admitted to the nurse's unit with a suspected diagnosis of meningitis. The nurse should tell the parent which of the following? 1. Antibiotics are not initiated until the cerebrospinal fluid cultures are definitive for specificity to prevent resistance. 2. Antibiotics are useless against viral infections, so they are not used for meningitis. 3. Antibiotics should be started before the cerebrospinal fluid cultures are definitive because culture results may take up to 3 days. 4. Antibiotic initiation is based on the age, signs, and symptoms of the patient, not on the causative agent.

3. Immediate antibiotic therapy is neces sary to prevent death and avoid disabilities.

68. The parents of a 19-year-old ask the nurse what they should do in terms of long term care placement for their severely disabled child. Which of the following is the nurse's best response? 1. "How much care do you want?" 2. "Do you have other children who could take your child into their home?" 3. "Do you have a detailed plan of care?" 4. "Are you working with an agency or social worker about this matter?"

3. It is always best to ask the parents what plan of care has already been instituted.

64. The high-school nurse is setting up a smoking prevention campaign for the students. Which of the following is the nurse's best approach? 1. Discuss health consequences of smoking. 2. Use scare tactics and point out the negative effects of smoking. 3. Offer alternatives to smoking such as chewing gum and doing activities that distract. 4. Have the adolescents talk with their parents about smoking.

3. It is always best to focus on prevention of smoking, and take a positive ap proach to how a teen might resist smoking. Peer support groups work well in redefining the teens' peer groups and gives them tactics to use against smoking.

34. Parents are told they must start taking their toddler to the dentist. They are con cerned their child is too young and that the dentist will be too harsh with the child. The nurse suggests the parents do which of the following before the dental visit? 1. Tell the child it will not hurt. 2. Warn that they will have the dentist give a needle in case of bad behavior. 3. Tell the child they will go along to the dentist so that they can model comfortable, safe behavior. 4. Offer the child a treat for good behavior.

3. Modeling appropriate behavior for the child by having the child go with a par ent creates a positive preparation for attending the dentist.

72. Which of the following is immediate postoperative care for an infant diagnosed with hydrocephalus who had a shunt placed? 1. Wet-to-dry dressing changes at both the shunt insertion site and the abdominal incision site. 2. Inform the parents they will have to measure the child's head at least once a day. 3. Position the infant's head off the shunt site for the first 2 postoperative days. 4. Complete vital signs and neurological checks every 4 hours.

3. Position the head on the side opposite the surgical site to prevent pressure on the shunt and valve. This provides bet ter visibility to watch for signs of bleeding or infection.

57. An 11-month-old was born at 28 weeks' gestation and required 2 weeks of ventila tion. The baby is currently well and is being seen in the clinic. The physician recom mends that the baby receive preventive therapy for respiratory syncytial virus for the next 5 months. The nurse knows that the physician will order which medication? 1. RespiGam. 2. Ribavirin. 3. Palivizumab (Synagis). 4. Pneumococcal vaccine.

3. The American Academy of Pediatrics recommends that infants born before 32 weeks gestation and younger than 2 years who have chronic lung disease should receive palivizumab (Synagis) monthly as a prophylactic to prevent respiratory syncytial virus during the winter months.

26. An infant at 12 hours of age has a positive Coombs test result and a bilirubin level of 18 mg/dL. The provider has ordered an exchange transfusion for the infant. As the transfusion is proceeding, the nurse should watch for which sign? 1. Increasing jaundice. 2. Lethargy. 3. Temperature instability. 4. Irritability.

3. The signs of a blood exchange transfusion reaction are focused on an unstable temperature. If the newborn becomes too cool, the infant could develop respiratory distress or bradycardia. If the baby's temperature becomes too high, there would be a dramatic change in blood pressure, with either hypertension or hypotension causing vascular collapse. If the baby becomes hyper thermic, the donor red blood cells could also be damaged, further increasing the jaundice.

50. A nurse is working in a well-child clinic administering immunizations to preschoolers. The nurse should do which procedure to minimize local reactions to the biological drugs? 1. Apply EMLA cream 1 hour before. 2. Change the needle on the syringe after drawing up the biological drug. 3. Inject into the vastus lateralis or ventrogluteal muscle. 4. Use distraction such as telling the child to hold the breath.

3. The vastus lateralis and the ventro gluteal muscles are recommended sites for a child of any age. The deltoid muscle can be used in children over 18 months of age.

87. Which of the following best describes the type of seizure displayed in the figure? 1. Infantile spasm. 2. Febrile seizure. 3. Simple partial seizure with motor signs. 4. Simple partial seizure with sensory signs. 5. Atonic partial seizure. 6. Absence seizure.

3. There is no change in the level of consciousness; motor symptoms are evident.

32. Parents are concerned that their toddler refuses to sleep in the new toddler bed and wonder what to do. The nurse explains that the child is using "global organization." What does the nurse mean by this term? 1. "The preoperational phase of developing cognitive thought starts around 3 years old." 2. "The child is self-centered and does not want to learn." 3. "The child sees changing to a toddler bed as changing the whole process of sleeping and going to bed." 4. "The toddler may have a phobia to the bed."

3. Toddlers think in very broad terms; it is difficult for them to see that chang ing the bed will not change the entire process of sleeping. Global organiza tion is when change in one part of the whole changes the entire whole.

13. A nurse is working in the obstetrics/gynecology clinic, and a young woman tells the nurse she is pregnant. She states she is concerned that her boyfriend may be "slow" mentally. The nurse should do which activity first? 1. Develop a pedigree. 2. Take a family history. 3. Inform the provider about the concern. 4. Refer the client for genetic counseling.

3. Working as a team with the provider and sharing this information enables the provider to make appropriate decisions.

30. A child on the nurse's floor is having a polysomnogram. The parent wants to know what types of data are obtained from the sleep study. The nurse knows that which data can be provided? Select all that apply. 1. Heart rate and respirations. 2. Brain waves. 3. Eye and body movements. 4. Cyanosis or plethora. 5. End-tidal carbon dioxide.

30. 1, 2, 3, 5. 1. A polysomnogram can record the heart rate and respirations. 2. A polysomnogram can record the brain waves. 3. A polysomnogram can record the eye movements and body movements. 4. Unless the child is being videotaped while asleep, the polysomnogram is not able to pick up cyanosis or plethora. 5. A polysomnogram can record the end-tidal carbon dioxide.

31. Parents tells the nurse that their 18-month-old is always curious about the environ ment and is learning new words every day. The nurse knows the baby is entering a phase of rapid _________________ development.

31. Cognitive.

33. Parents express concern about their 5-year-old who has started having more temper tantrums. The parents want to know if this is normal for this age. What should the nurse ask the parents about the tantrums? Select all that apply. 1. "Does the child do anything right in front of you?" 2. "Are the tantrums related to one specific aspect of life?" 3. "Are the tantrums causing any harm to self or others?" 4. "Have you consulted the Internet for any suggestions?" 5. "How do you handle your child during a tantrum?"

33. 1, 2, 3, 5. 1. Many children who have difficulty with temper tantrums are described by the family as "bad" or "difficult" in all aspects of their life. This descrip tion often carries over into all the activities and conversations that the family has with the child and degrades the positive aspects of the child's personality. 2. Tantrums are frequently associated with only one aspect of a child's life, and this should be identified quickly so that changes can be instituted in the approach to the problem. 3. Tantrums that result in harm to the child or to others should be dealt with quickly; professional help may be needed. 4. The Internet is a frequent source of con flicting information, but families frequently seek help from it. Not all the information on the Internet is appropriate or correct. 5. Discipline and inappropriate behavior management techniques may worsen the temper tantrums.

35. A 17-month-old is brought into the clinic, and the nurse notes the toddler has tooth decay on the maxillary upper incisors. The toddler is holding a bottle of juice, and the parent says the child cannot seem to be weaned from the bottle. The nurse could suggest which of the following tactics to assist the parent in weaning the toddler? Select all that apply. 1. Hide the bottle, and tell the toddler that it is not needed anymore. 2. Put only tap water in the bottle. 3. Give the bottle only at night. 4. Give the toddler a pacifier and take the bottle away. 5. Do not give any bottles before bed.

35. 1, 2, 5. 1. Hiding the bottle and offering a cup is a good way to start to wean a toddler. 2. Putting only drinking water in the bot tle is a good way to start to wean a toddler. 3. Nighttime bottles should be discontinued as soon as the child is able to drink fluids from the cup. Nighttime bottles allow the milk or formula to coat the teeth all night long, encouraging tooth decay. 4. Starting to use a pacifier with a toddler who should be weaned from the bottle by 11 to 12 months of age is inappropriate. 5. Nighttime bottles should be discontin ued as soon as the child is able to drink fluids from the cup. Nighttime bottles allow the milk or formula to coat the teeth all night long, encouraging tooth decay.3. Modeling appropriate behavior for the child by having the child go with a par ent creates a positive preparation for attending the dentist.

37. Parents are interested in switching their child from a booster seat to a regular seat belt. The child is 7 years old and weighs 51 lb. What can the nurse tell the parents about switching the child to a seat belt? Select all that apply. 1. The safest place to ride in the car is in the front seat. 2. The child needs to weigh 60 lb and be 8 years old to qualify legally for a seat belt. 3. The seat belt should be worn low on the hips. 4. Use a shoulder belt only if it does not cross the child's neck. 5. Tether straps are optional.

37. 2, 3, 4. 1. The safest place for a child to ride in a car is in the middle of the back seat. 2. Legally, a child must weigh 60 lb and be 8 years old to ride in a seat belt without a booster. 3. The seat belt, whether in a booster or on a seat, should be worn low on the hips and not across the abdomen. 4. The shoulder strap, for safety pur poses, should be across the chest and not across the face or neck. 5. Tether straps help to secure the seat belt in position when using a car seat or booster seat and should not be optional.

39. The clinic is doing a lead screening program for children in a low-income Hispanic community. The nurse working in the program wants to tell the parents the reasons to have their children screened for lead poisoning. Select all the following reasons that apply. 1. Young children absorb 10% of the lead to which they are exposed. 2. Homes built between 1900 and 1950 may contain lead-based paint. 3. The blood level of lead should be below 12.8 mcg/dL. 4. Lead can affect any part of the body, but the brain and kidneys are at greatest risk. 5. Foods such as fruit, candy, and antacids contain lead.

39. 2, 4. 1. Young children absorb most of the lead that enters their body. 2. Homes built between 1900 and 1950 most likely contain lead-based paints. 3. The acceptable blood level is 2.3 mcg or less. 4. Lead can affect any part of the body, but the brain, nervous system, kidneys, and blood are likely to be most affected. 5. In Hispanic and Arabic cultures, some painted jars in which candy is stored are painted with lead paints. Some medicinals, such as Azarcon, Greta, Paylooh, Surma, and Lozeena, are sources of lead.

70. Early signs and symptoms of hydrocephalus in infants include which of the following? 1. Confusion, headache, diplopia. 2. Rapid head growth, poor feeding, confusion. 3. Papilledema, irritability, headache. 4. Full fontanels, poor feeding, rapid head growth.

4. Previously undiagnosed, one of the first signs of hydrocephalus is a bulging fontanel, followed by irritability, poor feeding, and overall rapid head growth.

3. The posture of a healthy term newborn is described by which word? 1. Hypotonic. 2. Asymmetric. 3. Opisthotonic. 4. Flexion.

4. A full-term, healthy newborn initially has a flexion posture because it has been curled up in the uterus.

78. An adolescent Hispanic is complaining of knees swelling and hurting, hands and feet being cold all the time, frequent headaches, and a red rash on the cheeks and nose. The nurse suspects which of the following? 1. Multiple sclerosis. 2. Normal adolescent concerns. 3. Myasthenia gravis. 4. Systemic lupus erythematosus.

4. Butterfly rash, arthritic symptoms, Raynaud phenomenon (cold hands and feet), and headaches when all are seen together, are indicative of systemic lupus erythematosus.

18. The nurse is working in a school health clinic, and a child comes in complaining of "something" in my eye." What should the nurse do first? 1. Have the child wash hands. 2. Refer the child to an ophthalmologist. 3. Wash out the affected eye with tap water. 4. Examine the eye for a foreign body.

4. Examine the eye, and check for a for eign body before attempting to treat the injury or determining the plan of action.

85. Parents of a child with generalized seizures ask the nurse for information to give their child's teachers. Which of the following should be included? 1. A soft-padded spoon should be kept nearby to put between the child's teeth at the onset of a seizure. 2. Roll the child onto the abdomen, with the head to the left, so any contents can flow from the mouth. 3. If a seizure lasts longer than 10 minutes, the parents or an ambulance should be called. 4. As the child grows, medication dosages may need to be adjusted to control seizure activity.

4. Growth spurts occur, and medications will need to be adjusted. Teachers should be made aware and notify a parent or guardian if they notice even mild seizure activity.

14. The nurse is caring for a school-aged child with leukemia. The child's complete blood count is very low. The parents are Jehovah's Witness. The nurse should recognize that the family faces which dilemma? 1. Numerous dietary kosher laws exist. 2. A belief that only Allah cures illness. 3. The parents may want the child to have anointing of the sick. 4. Opposed to transfusions and vaccines.

4. Jehovah's Witnesses eat nothing that has come in contact with blood. They are opposed to transfusions, and many are opposed to albumin, globulin, and factor replacement. Generally, they are not opposed to non-blood plasma expanders.

29. The nurse's unit is using the POPS pain scale for measuring pain in infants. The nurse knows this tool is which of the following? 1. Pain Assessment Tool for infants 27 weeks to term gestation. 2. The neonatal Postoperative Pain Measurement Scale for infants 32 to 60 weeks gestation. 3. Premature Infant Pain Profile for infants 28 to 40 weeks gestation. 4. Postoperative Pain Score for infants 1 to 7 months.

4. The acronym POPS stands for Post-Operative Pain Score.

38. The nurse goes to the kindergarten classroom to evaluate a rash. A 5-year-old has patches of vesicles on the chest and face rather than on the arms and legs. The child says it is very itchy. The teacher tells the nurse the child had a runny nose a couple of days ago. The nurse suspects that the rash is caused by which virus? 1. Fifth disease (erythema infectiosum) 2. Roseola (exanthema subitum) 3. Scarlet fever (group A-B hemolytic streptococcus) 4. Chickenpox (varicella zoster)

4. The most likely diagnosis for this child is chickenpox, which is caused by the varicella zoster virus. This is commonly seen in young children and is highly contagious to others in the classroom and at home. It initially presents with a high fever for 3 to 4 days.

60. A 7-year-old child in a classroom is disruptive with loud talking, short attention span, difficulty organizing work, unable to finish assigned class work, and moodiness. Which of the following is the most likely diagnosis for this child? 1. Enuresis. 2. Sexual abuse. 3. Learning disability. 4. Attention deficit/hyperactivity disorder.

4. The most likely diagnosis is attention deficit/hyperactivity disorder because the child has the classic symptoms.

47. Which of the following is the primary goal for a newborn with a cleft of the soft palate? 1. Prevent ear infections. 2. Help the mother bond with the baby. 3. Repair the cleft palate. 4. Establish feeding and sucking.

4. The primary goal of any newborn with a cleft palate is to establish feeding and sucking.

71. A newborn with suspected hydrocephalus is transferred to the intensive care unit for further evaluation and treatment. The baby's nurse knows which of the following? 1. To use sedation as needed to keep the baby from crying or being fussy. 2. To keep the crib in a flat and neutral position. 3. To expect the infant to sleep more than a baby without hydrocephalus. 4. To not use any scalp veins for intravenous infusions.

4. These may interfere with surgery and shunt placement.

56. An 18-month-old, who attends day care, has been having a barking, hoarse-sounding cough that comes in spasms with very noisy respirations for the last 2 nights. The parent is concerned that the child has picked up an infection at day care. The day-care staff indicates the child does not cough during the day, has no fever, and is eating and drinking well. The nurse knows that this description is most likely which condition? 1. Laryngotracheobronchitis. 2. Bacterial tracheitis. 3. Asthma. 4. Acute spasmodic laryngitis.

4. This is the history of a child with acute spasmodic laryngitis. Symptoms of in flammation are absent or mild. Some children are thought to be predisposed to this with allergy or psychogenic fac tors as an underlying cause.3. The American Academy of Pediatrics recommends that infants born before 32 weeks gestation and younger than 2 years who have chronic lung disease should receive palivizumab (Synagis) monthly as a prophylactic to prevent respiratory syncytial virus during the winter months.

40. A 9-year-old boy is brought to the clinic for a physical. The child's weight is 95 lb (95th percentile), and the height is 4 feet, 4 inches (50th percentile). Systolic blood pressure is 118 mm Hg, and diastolic blood pressure is 75 mm Hg. Reading the blood pressure graph in the following figure, the boy is in the __________ percentile for systolic and in the ____________ percentile for diastolic readings for his age.

40. 95th/90th. The blood pressure table for boys 1 to 17 years is based on height for age. The vertical column represents the percentiles for a specific age. The horizontal columns represent the per centiles of blood pressure for a specific height. Locating the blood pressure percentile shows the systolic pressure to be in the 95th per centile and the diastolic pressure to be in the 90th percentile.

41. The nurse is working in a school health clinic, and a teen mentions that her older sis ter just had a baby born with an open spine (myelomeningocele). The teen is won dering if there is anything she can do to prevent this from happening to her baby when she decides to have children. The best response the nurse can offer this teen is to do what about her daily diet? 1. Take a multivitamin with folic acid daily. 2. Eat more fruits and vegetables daily. 3. Have breakfast every morning. 4. There is nothing that can be done to decrease the risk.

41. 1. The American Academy of Pediatrics recommends a daily intake of 0.4 mg of folic acid daily for all women of childbearing age.

42. A 16-year-old comes into the clinic for a physical examination. The teen weighs 180 lb and is 5 feet, 5 inches tall. According to the following figure, the basal metabolic index is ______________.

42. 30.

43. A 12-year-old girl with a thoracic myelomeningocele has had numerous urinary tract infections and has difficulty doing her clean intermittent self-catheterization. She and her parents are seeking an alternative way to empty her bladder. The surgeon has of fered to do a Mitrofanoff procedure. The nurse knows that the surgeon will use the _________ to create a continent conduit between the bladder and the abdominal wall.

43. appendix.

45. A 5-month-old with a lumbar myelomeningocele is admitted to the unit with an Arnold-Chiari malformation. The nurse knows this infant has which diagnosis? 1. Hydrocephalus. 2. Anencephaly. 3. Tethering of the spinal cord. 4. Perinatal hemorrhage.

45. 1. Arnold-Chiari malformation is a herni ation of the brainstem into the cervical spinal canal through the foramen magnum.

48. When an infant is born with a herniation of the abdominal wall with intestine present and the peritoneal sac absent, it is called a _______________.

48. gastroschisis. A herniation of the abdominal wall without a peritoneal sac and intestines penetrating out side the abdominal cavity is a gastroschisis.

52. During a 15-month well-child examination, the physician hears an innocent murmur. The nurse knows which of the following about such a murmur? Select all that apply. 1. It is short in duration. 2. It is an S 2 murmur. 3. It is loudest in the pulmonic area. 4. It is fixed and can be heard in many positions. 5. It is grade III or less.

52. 1, 3, 5. 1. An innocent murmur does not have an anatomic or physiological abnormality; it is a sound of short duration, grade III or less, and is best heard in the pul monic area of the chest (second inter costal space close to the sternum). 2. An S 2 murmur is considered pathological until proved otherwise. 3. An innocent murmur does not have an anatomic or physiological abnormality; it is a sound of short duration, grade III or less, and is best heard in the pul monic area of the chest (second inter costal space close to the sternum). 4. Murmurs that are innocent or functional vary in their intensity and the position in which they can be heard. Pathological murmurs are fixed and radiate throughout the chest. 5. An innocent murmur does not have an anatomic or physiological abnormality; it is a sound of short duration, grade III or less, and is heard best in the pul monic area of the chest (second inter costal space close to the sternum).

53. A child is giggling and laughing, and the nurse gently places one hand on the child's front and back of their chest. The sounds can be felt through the skin. This finding is called vocal _______________.

53. fremitus. The conduction of voice sounds through the chest and respiratory tract is called vocal fremitus. The decrease in fremitus indicates obstruction in the airways, as would occur with asthma or pneumothorax. The increase in fremitus occurs with pneumonia.

54. A child returns from surgery, having had tonsils and adenoids removed. When the parents are getting ready for discharge, the nurse instructs them to do what to care for their child. Select all that apply. 1. Some secretions may be blood-tinged for a few days. 2. Run a cool mist vaporizer in the bedroom. 3. Pain relief should be provided every 4 hours. 4. The child can resume a normal diet. 5. The child should blow the nose and cough every 4 hours.

54. 1, 2, 3. 1. The nurse should alert the parents to the fact that the child may have some blood-tinged secretions for a few days afterwards. 2. Using a cool mist vaporizer helps to decrease the viscosity of the secretions. Pain relief every 4 hours is indicated. 3. Using a cool mist vaporizer helps to decrease the viscosity of the secretions. Pain relief every 4 hours is indicated. 4. The child should not be eating foods that are rough or fibrous but rather stay on a soft or liquid diet for a few days to allow healing. 5. Blowing the nose and coughing are con traindicated because this may loosen the clot that has formed over the surgical site.

55. A 2-year-old is brought to the emergency department for fever and ear pain. The parents note the child has had many ear infections and that polyethylene tubes have been recommended, but the parents cannot afford surgery. The child is diagnosed with bilateral otitis media. The toddler is carrying a baby bottle full of juice, and a parent is carrying a pack of cigarettes. What one preventive measure could be taught the parents to decrease the incidence of ear infections? 1. Wean the toddler from the bottle. 2. Give the toddler a decongestant before bedtime. 3. Encourage the parent to smoke outside the house. 4. Have the child's hearing checked.

55. 1. Weaning the toddler off the bottle is the best tactic.

59. A teacher has a pupil with head lice (pediculosis capitis). The nurse should see what to diagnose the infestation? Select all that apply. 1. Crawling insects. 2. White flakes in the hair. 3. Nits attached close to scalp. 4. Inflammatory papules. 5. Dark brown hair.

59. 1, 3, 4. 1. The lice can be seen crawling about on the scalp. 2. The nits can be described as "looking like dandruff," but it could also be dandruff or seborrhea that is seen. 3. Nits can be seen, especially behind the ears and the nape of the neck and close to the hair shaft. 4. Often there are scratch marks and in flammatory papules as a result of the itching and scratching of the scalp. 5. Head lice can be found in short and long hair and even in coarse curly hair.

6. A family is adopting a 3-year-old child from Russia. What suggestions can be given to the parents for incorporating the child? Select all that apply. 1. Learn as much about the child as possible before adoption. 2. Expect conflict and determine how to work through it with the child. 3. Do not discuss the biological parents with the child. 4. Discuss your expectations with the child. 5. Try to maintain a part of the child's original family name.

6. 1, 2, 4, 5. 1. Learn as much as possible about the child. 2. Expect to have some conflict with cul tural differences and age. 3. Children who are adopted when they are older than 2 years of age know their biolog ical families and have feelings about their adoption. It is best to discuss this openly with the child. 4. Setting clear behavioral expectations for the child will aid in the assimilation to the family. 5. It is always good to retain some part of their original name, such as a middle name, to maintain the link with their previous family and culture.

61. A child is diagnosed with schizophrenia. The child is taking haloperidol (Haldol), and the family has been instructed to watch for extrapyramidal side effects. The nurse knows that extrapyramidal side effects include which symptoms in a child? 1. Abnormal movements and twitches. 2. Inappropriate behaviors. 3. Excessive aggressiveness. 4. Thoughts of suicide.

61. 1. Extrapyramidal symptoms are motor neuron responses that go from the brain to the spinal cord and present as tics, jerkiness, incoordination, and loss of involuntary muscle control.

62. A sports physical is being performed on a 12-year-old male. He is evaluated as a Tanner stage II. The nurse sees which of the following physical characteristics? 1. Enlarging penis. 2. Height spurt. 3. Gynecomastia. 4. Deepening voice.

62. 1. A Tanner stage II male (early puberty) shows signs of an enlarging penis and loosening of scrotal skin. Puberty oc curs from 91/2 to 14 years for typical growing boys.

63. A 15-year-old girl who is an avid basketball player comes to the clinic for menstrual irregularities. She skips meals and has lost some weight. She mentions that she has menstrual periods every 2 weeks. The nurse knows that women who have menstrual periods less often than every 21 days are ________________.

63. anovular. Young women who have periods more fre quently than every 21 days, after ruling out sexually transmitted diseases, are anovulatory. These young women have adequate estrogen levels but inadequate progesterone levels. Unopposed estrogen can place a young woman at risk for endometrial carcinoma.

66. The physician orders montelukast (Singulair) for a 10-year-old who has moderate, persistent asthma. The nurse should instruct the child and parents about which characteristic of the medication? Select all that apply. 1. This is an add-on medication to the child's regular medications. 2. The child is too young to be taking this medication. 3. It is not to be used to treat acute episodes.

66. 1, 3. 1. Leukotriene modifiers such as mon telukast are given orally and are indi cated for add-on to low-dose inhaled corticosteroids in moderate persistent asthma. 2. The leuketriene modifiers are appropriate for children as young as 2 years old. 3. The leukotriene modifiers are not to be used for acute asthma attacks. 4. Although the parents should give up smok ing and for the sake of their child's asthma, it is not affected by the medication. 5. Chest physiotherapy is beneficial for chil dren who are motivated and can help with respiratory distress. It is not affected by the use of montelukast.

67. The nurse is caring for a child dying from leukemia. The parents want to know how comfortable the nurse is in giving doses of pain medication that are larger than customary to their child. The nurse knows that the parents are asking about which ethical principle of care? 1. Double effect. 2. Cultural influences. 3. Honesty. 4. Withholding pain medication.

67. 1. The ethical principle of double effect states that an action has good inten tions and that a bad intention is per missible if the action itself is good or neutral, the good effect must not be produced by the bad effect, and there is a compelling reason to allow the bad effect to occur if the good effect is the primary reason for the action. The child may require doses of pain relievers higher than is considered safe in order to relieve the pain. If the child dies during this treatment, the overwhelming reason for the excess medication was to make the child com fortable and decrease the intense pain.

7. When the parents of a 5-year-old tell the child they are divorcing, the parents need to be aware of behaviors that the child may demonstrate. Select all that apply. 1. Increased self-esteem, bragging. 2. Changes in sleep and appetite. 3. Feelings of abandonment. 4. Develops dictatorial attitude. 5. Verbalizes feelings about divorce-related changes.

7. 2, 3, 5. 1. Young children who are experiencing a di vorce have very poor self-esteem and blame themselves for the separation. 2. They exhibit loss of appetite and poor sleep patterns. 3. Preschool and early school-aged chil dren feel the parent who is leaving the family is abandoning them. They also develop increased anxiety. 4. Older school aged-children may become dictatorial and aggressive and show a de cline in school performance. 5. The 5-year-old can verbalize feelings about divorce and the changes that are going to take place within the family.

73. In preparing the patient and family for hospital discharge, which of the following signs and symptoms of shunt malfunction and infection should the nurse include in the teaching plan? Select all that apply. 1. Emesis, lethargy. 2. A change in neurological behavior. 3. Fever, irritability. 4. Diarrhea or constipation. 5. Redness along the shunt system.

73. 1, 2, 3, 5. 1. Emesis and lethargy can be signs of increased intracranial pressure and may indicate an infectious process. 2. A change in behavior can be a sign of increased intracranial pressure and can be a sign of shunt malfunction. 3. Fever and irritability can be an indication of a possible shunt infection. 4. Although diarrhea may be a sign of illness it is usually not a shunt complication, nor is constipation. 5. Redness along the shunt system can be an indication of a possible infectious process.

74. The parents of an infant with hydrocephalus ask about future activities in which their child can participate in school and as an adolescent. The nurse should tell the parents which of the following? 1. A helmet should be worn during any activity that could lead to head injury. 2. Only non-contact sports should be pursued, such as swimming or tennis. 3. Because of the risk of shunt system infection, swimming is not a sports option. 4. The child should wear a life alert bracelet; then there is no need to be aware of the shunt system.

74. 1. The risk of shunt breakage or obstruc tion is extremely low.

76. A 10-month-old has fallen out of the high chair and is brought to the emergency department. Put the following components of the nurse's assessment into the correct order. 1. Airway____ 2. Bleeding____ 3. Appetite____ 4. Breathing____ 5. Circulation____ 6. Level of consciousness____

76. 1, 4, 5, 6, 2, 3. 1. Always first priority to assess. 4. Second aspect of ABC priority. 5. Third aspect of ABC priority. 6. Important after stabilization of the "ABC." 2. Important but not first priority. 3. Least important.

77. Guillain-Barré is a progressive motor weakness secondary to an autoimmune re sponse from a viral illness or immunizations. Guillain-Barré shows which of the fol lowing symptoms? Select all that apply. 1. Always fatal after 18 to 24 months. 2. Progresses cephalocaudally. 3. Complications are associated with immobility. 4. Respiratory support is a nursing priority. 5. Tube feedings or total parental nutrition may become necessary.

77. 3, 4, 5. 1. Progressive but full recovery is possible, taking months to years. 2. Neuromuscular progression is from feet to head. 3. Due to the progressive paralysis, immobility is a major concern. 4. The respiratory tract muscles may become compromised with the progression. 5. Adequate calorie intake is essential to prevent catabolism.

79. As a component of discharge teaching, the nurse knows that treatment regimen for a 15-year-old with systemic lupus erythematosus includes which of the following? Select all that apply. 1. High-protein diet. 2. Low salt intake. 3. Exposure to the sun. 4. Killed-virus vaccines. 5. Systemic corticosteroids. 6. Antimalarials.

79. 2, 4, 5, 6. 1. Low protein to keep BUN within normal range. 2. Low salt to help control blood pressure. 3. Worsens butterfly rash. 4. More susceptible to infections and a lowered immune response. 5. First line therapy. 6. Indicated treatment.

93. According to Piaget, the school-age child is in the ____________________________ stage of cognitive development.

93. Concrete operations. During the concrete operations stage of cognitive development, the school-age child is able to take into account another person's point of view. School-age children are also able to classify, sort, and organize facts in order to use them for problem solving.

8. The mother of a 6-month-old is going back to work. The nurse should make which of the following suggestions for ways to evaluate day care. Select all that apply. 1. Larger day-care centers with more services. 2. High health and safety requirements. 3. Caretakers who are loving and kind. 4. Challenging activities for all the children. 5. Child care ratios that maximize staff use. 6. Small class size.

8. 2, 3, 6. 1. Larger day cares do not necessarily have qualified staff and age-appropriate activi ties for the child or infant. 2. In choosing a day care, it is important for parents to see that the health and safety requirements of the law are maintained. 3. Each child gets the attention that is re quired for maintaining a healthy, happy child. Caretakers should be loving and supportive of the children and parents. 4. Activities should be age-appropriate for the child. 5. Child-care ratios should be small, as well as class size, and staff should not feel they have more work to do than they can manage. 6. Child-care ratios should be small, as well as class size, and staff should not feel they have more work to do than they can manage. 1

80. A 12-year-old cut a hand while climbing a barb-wired fence. What should the nurse discuss with the parents regarding need for tetanus vaccine? Select all that apply. 1. No tetanus vaccine is necessary; it is too soon. 2. Tetanus is a potentially fatal disease. 3. Puncture wounds are less susceptible to tetanus. 4. There will be mild soreness at the injection site. 5. Tdap should be administered. 6. Td should be administered.

80. 2, 5. 1. Required tetanus boosters are given at 5 years of age. If a "dirty" wound occurs before 10 years after the last dose, a booster is necessary. 2. Tetanus is a potentially fatal disease. 3. Puncture wounds are more susceptible to tetanus, especially in rural areas. 4. This is a possible side effect of tetanus vaccine. 5. Due to the increase in incidence of pertussis in adolescents and adults, this is the vaccine of choice. 6. No longer the vaccine of choice, tetanus/ diphtheria/pertussis is the vaccine used to help control the growing incidence of pertussis.

81. A parent calls the nurse for dosing information for Pepto-Bismol and aspirin for chil dren who are 8 and 9 years old and are ill. The nurse states which of the following? Select all that apply. 1. 1 tbs of Pepto-Bismol after every diarrhea stool. 2. 81-mg baby aspirin every 4 hours. 3. No medications are necessary. 4. Pepto-Bismol contains aspirin. 5. Diet as tolerated. 6. Reye syndrome is associated with aspirin use.

81. 3, 4, 5, 6. 1. Pepto-Bismol contains bismuth subsalicylate, an aspirin component, and is contraindicated in children. 2. Aspirin is contraindicated in children with viral symptoms due to the association with Reye syndrome. 3. Allow the body to rid itself of harmful agents. This is first-line advice. 4. Pepto-Bismol contains bismuth subsalicylate, an aspirin component. 5. This is first-line advice if there is no vomiting. 6. Reye syndrome is associated with aspirin use and viral illness in children.

82. In children with meningitis, there is the potential for many complications occurring from damage to the nervous system. Which of the following is/are the most common, nonlethal complication(s)? 1. Cranial nerve deficits. 2. Epilepsy. 3. Bleeding intracranially. 4. Cerebral palsy.

82. 1. If infection extends into the area of the cranial nerves, increased pressure may cause sensory deficits.

89. The nurse is doing discharge teaching for a 3-month-old with a new shunt that was placed for hydrocephalus. Which of the following are signs and symptoms of hydro cephalus that the parents may see if the shunt malfunctions? Select all that apply. 1. Vomiting. 2. Irritability. 3. Poor feeding. 4. Headache. 5. Sunken fontanel. 6. Seizures. 7. Inability to wake up infant. 8. Hyperactivity.

89. 1, 2, 3, 6, 7. 1. As the shunt malfunctions and cerebrospinal fluid builds up, the child will exhibit symptoms of increased intracranial pressure. Vomiting is one of the possible signs of increased intracranial pressure. 2. As the shunt malfunctions and cerebrospinal fluid builds up, the child will exhibit symptoms of increased intracranial pressure. Irritability and change in neurological status are two of the possible signs of increased intracranial pressure. 3. As the shunt malfunctions and cerebrospinal fluid builds up, the child will exhibit symptoms of increased intracranial pressure. Poor feeding is one of the possible signs of increased intracranial pressure. 4. As the shunt malfunctions and cerebrospinal fluid builds up, the child will exhibit symptoms of increased intracranial pressure. Headache is very difficult to assess in an infant. 5. A sunken fontanel is a sign of dehydration. With increased intracranial pressure, the brain is edematous and expands in size. This would result in an enlarged rather than a sunken fontanel. 6. As the shunt malfunctions and cere brospinal fluid builds up, the child will exhibit symptoms of increased intracra nial pressure. Seizure is one possible sign of increased intracranial pressure. 7. As the shunt malfunctions and cere brospinal fluid builds up, the child will exhibit symptoms of increased intracra nial pressure. A declining neurological status evidenced by the inability to wake a child up is one of the possible signs of increased intracranial pressure. 8. A declining neurological status is a sign of increased intracranial pressure. Hyperactiv ity is not a sign of a declining neurological status.

9. Match each genetic term with its definition and function. 1. Congenital A. Morphogenic defect of an organ 2. FISH analysis B. Recognized pattern of malformation 3. Genome C. Present at birth 4. Malformation D. Clinically exhibited characteristic 5. Phenotype E. Fluorescent in situ hybridization 6. Syndrome F. Complete genetic information of organism

9. 1, C; 2, E; 3, F; 4, A; 5, D; 6, B.

90. When introducing solid foods into an infant's diet, it is important to introduce one food at a time in order to rule out __________________.

90. Allergies. Infants should be introduced to solid foods af ter 6 months of age. Iron-fortified infant cere als are recommended first, followed by the introduction of vegetables, then fruits. New foods should be introduced about every 3 to 5 days so the caregiver has the opportunity to identify any food allergies the baby may have.

91. The injection site of choice for a 6-month-old receiving immunizations is the _________________.

91. Vastus lateralis. The vastus lateralis muscle can be used for immunizations of children of all ages. It is a particularly good choice for infants because it is the most developed muscle for this age group. This area is also appealing because it has few major nerves and blood vessels.

92. Infants should ride in a _______________ car seat until they weigh 9 kg and are approximately 1 year old.

92. Rear-facing. An infant should always ride in a rear-facing car seat until older than 1 year and over 9 kg.

97. Which of the following applies to brain tumors? Select all that apply. 1. Brain tumors are the most common malignancy in the United States. 2. Although an exact cause is unknown, an association has been linked to paints and radiation. 3. All children with brain tumors present with very similar manifestations. 4. Brain tumors in children usually occur below the cerebellum. 5. Symptoms of brain tumors always appear rapidly.

97. 2, 4. 1. Brain tumors are the most common solid tumor. Leukemia is the most common malignancy in the United States. 2. Although an exact cause is unknown, an association has been linked to paints and radiation. 3. The manifestations can vary depending on where the tumor is located. 4. Brain tumors in children usually occur below the cerebellum. Brain tumors in adults usually occur above the cerebellum. 5. Symptoms of brain tumors can appear rapidly or slowly, depending on whether the tumor is fast- or slow-growing.

98. Which of the following applies to cerebral palsy? Select all that apply. 1. It is the most common chronic disorder of childhood. 2. Hyperbilirubinemia increases the risk of cerebral palsy. 3. It is a progressive chronic disorder. 4. Most children do not experience any learning disabilities. 5. There is a familial tendency seen in children with cerebral palsy.

98. 1, 2. 1. Cerebral palsy is the most common chronic disorder of childhood. 2. There is an increased risk of cerebral palsy in infants with hyperbilirubinemia. 3. Cerebral palsy is a nonprogressive chronic disorder. 4. Approximately 75% of children with cerebral palsy experience learning disabilities. 5. There is no familial tendency seen in children with cerebral palsy.

99. Which of the following applies to encephalitis? Select all that apply. 1. Usually caused by a bacterial infection. 2. A chronic disease. 3. Most commonly seen after a varicella infection in the newborn population. 4. Newborns diagnosed with encephalitis often have extensive neurological problems. 5. Can be seen with meningitis.

99. 4, 5. 1. Although it can be caused by a variety of organisms, encephalitis is usually a viral infection. 2. Encephalitis is an acute disease. 3. Encephalitis is most commonly seen after a herpes infection in the newborn population. It is often seen after a varicella infection in older children. 4. Newborns diagnosed with encephali tis often have extensive neurological problems. 5. Encephalitis can be seen with meningitis.