Pediatric success, Saunders & Davis test 2 questions
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 of the following is correct regarding prognostic factors for determining survival for a child newly diagnosed with ALL? 1. The initial WBC count on diagnosis. 2. The race of the child. 3. The amount of time needed to initiate treatment. 4. The allergy history of the child.
1. Children with a normal or low WBC count who do not have not-T, non-B acute lymphoblastic leukemia, and who are CALLA-positive have a much better prognosis that those with high cell counts or other cell types.
Which of the following lab tests will be ordered to determine the presence of the HIV virus antigen in an infant whose parent is HIV positive? 1 CD4 cell count. 2. Western blot. 3. IgG levels. 4. p24 antigen assay.
4. Detection of HIV virus in infants is confirmed by a p24 antigen assay, viral culture of HIV virus or polymerase chain reaction.
Which of the following is the most common opportunistic infection in children infected with HIV? 1. CMV 2. Encephalitis. 3. Meningitis. 4. Pneumocystic pneumonia.
4. Pneumocystic carinii pneumonia is the most common opportunistic infection that can occur in HIV infected children, and such children are treated prophylactically for this.
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.
4. The abnormal lab results in hemophilia are related to decreased clotting function. Partial thromboplastin time is prolonged.
The nurse is preparing a plan of care for a child with a head injury. On review of the records, the nurse notes that the health care provider has documented decorticate posturing. The nurse plans care knowing that this type of posturing indicates which finding? 1. Damage to the pons 2. Damage to the midbrain 3. Damage to the diencephalon 4. A lesion in the cerebral hemisphere
4 Decorticate posturing indicates a lesion in the cerebral hemisphere or disruption of the corticospinal tracts. Decerebrate posturing indicates damage in the diencephalon, midbrain, or pons.
The nurse is caring for an infant with spina bifida (myelomeningocele type) who had the sac on the back containing cerebrospinal fluid, the meninges, and the nerves (gibbus) surgically removed. The nursing plan of care for the postoperative period should include which nursing action to maintain the infant's safety? 1. Covering the back dressing with a binder 2. Placing the infant in a head-down position 3. Strapping the infant in a baby seat sitting up 4. Elevating the head with the infant in the prone position
4 Elevating the head will decrease the chance that cerebrospinal fluid will accumulate in the cranial cavity. The infant needs to be prone or side-lying to decrease the pressure on the surgical site on the back. Binders and a baby seat should not be used because of the pressure they would exert on the surgical site.
Brain damage in a child who sustained a closed-head injury can be caused by which factor? 1. Increased perfusion to the brain and increased metabolic needs of the brain. 2. Decreased perfusion to the brain and decreased metabolic needs of the brain. 3. Increased perfusion to the brain and decreased metabolic needs of the brain. 4. Decreased perfusion of the brain and increased metabolic needs of the brain.
4. Decreased perfusion of the brain and increased metabolic needs of the brain.
Select the best room assignment for a newly admitted child with bacterial meningitis. 1. Semiprivate room with a roommate who also has bacterial meningitis. 2. Semiprivate room with a roommate who has bacterial meningitis but has received IV antibiotics for more than 24 hours. 3. Private room that is dark and quiet with minimal stimulation. 4. Private room that is bright and colorful and has developmentally appropriate activities available.
3. A quiet private room with minimal stimulation is ideal as the child with meningitis should be in a quiet environment to avoid cerebral irritation
Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis? 1. Maintain isolation precautions until 24 hours after receiving IV antibiotics. 2. IV fluids at 1 1/2 times regular maintenance. 3. Neurological checks every hour. 4. Administer acetaminophen for temperatures higher that 38 degrees (100.4F).
2. IV fluids at 1 1/2 times regular maintenance could cause fluid overload and lead to increased ICP.
Which of the following should the nurse expect to administer to a child with ITP and a platelet count of 5000/mm3? 1. platelets 2. Intravenous immunoglobulin 3. Packed RBCs 4. WBCs
2. IV immunoglobulin is given because the cause of platelet destruction is believed to be an autoimmune response to disease-related antigens. Treatment is usually supportive. Activity is restricted at the onset because of the low platelet count and risk for injury that could cause bleeding.
The nurse knows that young infants are at risk for injury from SBS because: 1. The anterior fontanel is open. 2. They have insufficient musculoskeletal support and a disproportionate head to body ratio. 3. They have an immature vascular system with veins and arteries that are more superficial. 4. The nurse knows there is immature myelination of the nervous system in a young infant.
2. Insufficient musculoskeletal support and a disproportionate head size place the infant at risk because the head cannot be supported during a shaking episode.
A child with leukemia is receiving chemotherapy and is complaining of nausea. The nurse has been giving the scheduled antiemetic. Which of the following should the nurse do when the child is nauseated? 1. Encourage low-protein foods. 2. Encourage low-caloric foods. 3. Offer the child's favorite foods. 4. Offer cool, clear liquids.
4. Cool, clear liquids are better tolerated. Milk-based products can cause secretions to be thick and cause vomiting.
Which of the following can be manifestations of leukemia in child? SATA 1. Leg pain 2. Fever 3. Excessive weight gain. 4. Bruising 5. Enlarged lymph nodes.
1,2,4,5 1. The proliferation of cells in the bone marrow can cause leg pain. 2. Fever is a result of the neutropenia. 4. A decrease in platelets causes the bruising 5. The lymph node are enlarged from the infiltration of leukemic cells.
A preschooler has been having periods during which he suddenly falls and appears to be weak for a short time after the event. The preschool teacher asks what she should do. Select the nurse's best response. 1. "Have the parents follow up with his pediatrician as this is likely an atonic seizure." 2. "Find out if there have been any new stressors in his life, as it could be attention-seeking behavior." 3. "Have the parents follow up with his pediatrician as this is likely an absence seizure." 4. "The preschool years are a time of rapid growth, and many children appear clumsy. It would be best to watch him, and see if it continues."
1. An atonic seizure is characterized by a loss of muscular tone, whereby the child may fall to the ground.
Which of the following measures should be implemented for a child with von Willebrand disease who has a nosebleed? 1. Apply pressure to the nose for at least 10 minutes. 2. Have the child lie supine and quiet. 3. Avoid packing of the nostrils. 4. Encourage the child to swallow frequently
1. Applying pressure to the nose may stop the bleeding. In von Willebrand disease, there is an increased tendency to bleed from mucous membranes, leading to nosebleeds commonly from the anterior part of the nasal septum.
The nurse is caring for an unconscious 6-year old who has had a severe closed-head injury and notes the following changes: HR has dropped from 120 to 55, BP has increased from 110/44 to 195/62, and Respirations are becoming more irregular. What should the nurse do first after calling the physician? 1. Call for additional help, and prepare to administer mannitol. 2.Continue to monitor the patient's vital signs, and prepare to administer a bolus of isotonic fluids. 3. Call for additional help, and prepare to administer an antihypertensive. 4. Continue to monitor the patient, and administer supplemental oxygen.
1. Cushing triad is characterized by a decrease in HR, an increase in BP, and changes in respirations. The triad is associated with severely increased ICP. Mannitol is an osmotic diuretic that helps decrease the increased ICP.
The parent of a teen with a diagnosis of Hodgkin disease asks what the child's prognosis will be with treatment. What information should the nurse give to the parent and child? 1. Clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stage of Hodgkin disease is excellent. 2. There is considerably better prognosis if the client is diagnosed early and is between the ages of 5 and 11 years. 3. The prognosis for Hodgkin disease depends on the type of chemotherapy. 4. The only way to obtain a good prognosis is by chemotherapy and bone marrow transplant.
1. Long-term survival for all stages of Hodgkin disease is excellent. Early stage disease can have a survival rate greater than 90%, with advanced stages having rates between 65% and 75%.
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 exam, a diagnosis of Wilms tumor is suspected. Which of the following is most important when doing a physical exam 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.
A child diagnosed with meningitis is having a generalized tonic-clonic seizure. Which should the nurse do first? 1. Administer blow-by oxygen and call for additional help. 2. Reassure the parents that seizures are common in children with meningitis. 3. Call a code and ask the parents to leave the room. 4. Assess the child's temperature and blood pressure.
1. The child experiencing a seizure usually requires more oxygen as the seizure increases the body's metabolic rate and demand for oxygen. The seizure may also affect the child's airway, causing the child to be hypoxic. It is always appropriate to give the child blow-by-oxygen immediately. The nurse should remain with the child and call for additional help.
A child recently diagnosed with epilepsy is being evaluated for anticonvulsant medication therapy. The child will likely be placed on which type of regimen? 1. Two to three oral anticonvulsant medications so that dosing can be low and side effects minimized. 2. One oral anticonvulsant medication to observe effectiveness and minimize side effects. 3. One rectal gel to be administer in the event of a seizure. 4. A combination of oral and IV anticonvulsant medications to ensure compliance.
2. One medication is the preferred way to achieve seizure control. The child is monitored for side effects and drug levels.
A nurse instructs the parent of a child with sickle cell anemia 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.
The parents of a child with altered consciousness ask if they can stay during the morning assessment. Select the nurses's best response. 1. "Your child is more likely to answer questions and cooperate with any procedures if you are not present." 2. "Most children feel more at ease when parents are present, so you are more than welcome to stay at the bedside." 3. "It is our policy to ask parents to leave during the first assessment of the shift." 4. "Many children fear that their parents will be disappointed if they do not do well with procedures, so we recommend that no parents be present at this time."
2. Parents should be encouraged to remain with their child for mutual comfort.
Which medication should the nurse anticipate administering first to a child in status epilepticus? 1. Establish and IV line, and administer IV lorazepam. 2. Administer rectal diazapam. 3. Administer an oral glucose gel to the side of the child's mouth. 4. Administer oral diazepam.
2. Rectal diazepam if first administered in an attempt to stop the seizure long enough to establish an IV, and then IV medication is administered.
A child has completed treatment for leukemia and comes to the clinic with the parents for a checkup. The parents express to the nurse that they are glad their child has been cured of cancer and is safe from getting cancer later in life. Which of the following should the nurse consider in responding? 1. Childhood cancer usually instills immunity to all other cancers. 2. Children surviving one cancer are at higher risk for a second cancer. 3. The child may have a remission of the leukemia but is immune to all other cancers. 4. As long as the child continues to take steroids, there will be no other cancers.
2. The most devastating late effect of leukemia treatment is development of secondary malignancy.
A nurse is caring for a 4-year-old child one day after the child consumed a bottle of Tylenol (acetaminophen). Which of the following laboratory values should the nurse carefully assess? 1. Phosphate level 2. Ferritin 3. Bilirubin 4. Ammonia level
3 The nurse should assess the child's bilirubin level.
A nurse is caring for a 5-year old with sickle cell vaso-occlusive crisis. Which of the following orders should the nurse question? SATA 1. Position the child for comfort 2. Apply hot packs to painful areas. 3. Give Demerol 25 mg IV every 4 hours as needed for pain. 4. Restrict oral fluids. 5. Apply oxygen per nasal cannula to keep oxygen saturations above 94%.
3, 4 3. Tissue hypoxia is very painful. Narcotics such as morphine are usually given for pain when the child is in a crisis. Demerol should be avoided because of the risk of Demerol-induced seizures. 4. The child should receive hydration because when the child is in crisis, the abnormal S-shaped red blood cells clump, causing tissue hypoxia and pain.
To treat a common manifestation of Reye syndrome, which medication would the nurse expect to have readily available? 1. Lasix 2. Insulin 3. Glucose 4. Morphine
3. A common manifestation is hypoglycemia, which is treated with the administration of IV glucose.
Which of the following should be done to protect the CNS from the invasion of malignant cells in a child newly diagnosed with leukemia? 1. Cranial and spinal radiation 2. IV and steroid therapy. 3. Intrathecal chemotherapy. 4. High-dose IV chemotherapy.
3. Giving chemotherapy via lumbar puncture allows the drugs to get to the brain and helps prevent metastasis of the disease.
A 4-year-old child is seen in the emergency department. The parents have reported that the child "fell from a swing in the playground." The nurse notifies the social worker that the nurse and primary health-care provider wish to report the child's caregivers on suspicion of child abuse. Which of the following findings has prompted the nurse's action? 1.Laceration on the left leg 2. Hematoma on the left calf 3. Abrasion of the left cheek 4. Spiral fracture of the left arm
4. It is unlikely that the child would suffer a spiral fracture from a fall from a playground swing.
The nurse is caring for an adolescent who remains unconscious 24 hours after sustaining a closed head injury in a motor vehicle accident. She responds to deep, painful stimulation with decorticate posturing and has an intracranial monitor that shows periodic increased ICP. All other vital signs remain stable. Select the most appropriate nursing action. 1. Encourage the teen's peers to visit and talk to her about school and other pertinent events. 2. Encourage the teen's parents to hold her hand and speak loudly and her in an attempt to help her again consciousness. 3. Attempt to keep a normal day/night pattern by keeping the teen in a bright, lively environment during the day and dark quiet environment at night. 4. Attempt to keep the environment dark and quiet, and encourage minimal stimulation.
4. A dark, quiet environment and minimal stimulation will decrease oxygen consumption and ICP.
The nurse is instructing the parent of a child with HIV about immunizations. Which of the following should the nurse tell the parent? 1. Hepatitis B vaccine will not be given to this child. 2. Members of the family should be cautioned not to receive the varicella vaccine. 3. The child will need to have a Western blot test done prior to all immunizations. 4. Pneumococcal and influenza vaccines are recommended.
4. Immunizations against childhood illnesses are recommended for children exposed to or infected with HIV virus. Pneumococcal and influenza vaccines are recommended.
The mother of an unconscious child has been calling her name repeatedly and gently shaking her shoulders in an attempt to wake her up. The nurse notes that the child is flexing her arms and wrists while bringing her arms closer to the midline of her body. The child's mother asks, "What is going on?" Select the nurse's best response. 1. "I think your daughter hears you, and she is attempting to reach out to you." 2. "Your child is responding to you; please continue trying to stimulate her." 3. "It appears that your child is having a seizure." 4. "Your child is demonstrating a reflex that indicates she is overwhelmed with the stimulation she is receiving."
4. Posturing is a reflex that often indicates that the child is receiving too much stimulation.
The nurse is assigned to care for an 8-year-old child with a diagnosis of a basilar skull fracture. The nurse reviews the health care provider's (HCPs) prescriptions and should contact the HCP to question which prescription? 1. Suction as needed. 2. Obtain daily weight. 3. Provide clear liquid intake. 4. Maintain a patent intravenous line.
1 A basilar skull fracture is a type of head injury. Nasotracheal suctioning is contraindicated in a child with a basilar skull fracture: Because of the nature of the injury, there is a possibility that the catheter will enter the brain through the fracture, creating a high risk of secondary infection. Fluid balance is monitored closely by daily weight determination, intake and output measurement, and serum osmolality determination to detect early signs of water retention, excessive dehydration, and states of hypertonicity or hypotonicity. The child is maintained on NPO status or restricted to clear liquids until it is determined that vomiting will not occur. An intravenous line is maintained to administer fluids or medications if necessary.
A school-age child with Down syndrome is brought to the ambulatory care center by the mother. The child has bruising all over the body. To work most effectively with this child, the nurse first addresses which complication associated with Down syndrome? 1. Children with Down syndrome are more likely to develop acute leukemia than the average child. 2. Children with Down syndrome fall down easily as a result of hyperflexibility and muscle weakness. 3. Children with Down syndrome are at risk for physical abuse because of their low intellectual functioning. 4. Children with Down syndrome scratch themselves a lot because of dry, cracked, and frequently fissuring skin.
1 Children with Down syndrome have an increased risk for developing leukemia compared with the average child. The other statements also could be true, but the nurse should first gather baseline data to determine the cause of the bruising before making other assumptions.
Hepatitis A vaccine is recommended for which of the following groups? Select all that apply. 1. Child care workers 2. Food handlers 3. Adolescents with risk factors, such as body piercings and multiple partners 4. Children with chronic illnesses who are likely to receive multiple blood transfusions 5. All children at one year of age
1, 2, 5 Feedback 1: Hepatitis A is transmitted via fecal-oral route, and those at highest risk include food handlers and child care workers. Feedback 2: Hepatitis A is transmitted via fecal-oral route, and those at highest risk include food handlers and child care workers. Feedback 3: Adolescents with body piercings and multiple sex partners are at risk of hepatitis B. Hepatitis B virus is found in blood or other body fluids. Feedback 4: Hepatitis C is transmitted parenterally through exposure to blood and blood products from hepatits C-infected persons. Feedback 5: The CDC recommends that all children receive hepatitis A vaccine at 1 year of age.
A nurse is caring for a 15-year-old boy who has just been diagnosed with non-Hodgkin's lymphoma. Which of the following should the nurse include in teaching the mother regarding this lymphoma? Select all that apply. 1. The malignancy originates in the lymphoid system. 2. The presence of Reed-Sternberg cells in the biopsy is considered diagnostic. 3. Mediastinal involvement is typical. 4. The disease is nodular rather than diffuse. 5. Treatment includes chemotherapy and radiation.
1, 3, 5 Feedback 1: Non-Hodgkins lymphoma originates in the lymphoid system. Feedback 2: The presence of Reed-Sternberg cells is diagnostic for Hodgkin's disease. Feedback 3: Masses in the mediastinal area is typical. Feedback 4: The disease is diffuse rather than nodular. Feedback 5: Chemotherapy and radiation are treatments for non-Hodgkins lymphoma.
The nurse reviews the laboratory results for a child with rheumatic fever and would expect to note which findings? Select all that apply. 1. Presence of Aschoff's bodies 2. Absence of C-reactive protein 3. Elevated antistreptolysin O titer 4. Presence of Reed-Sternberg cell 5. Elevated erythrocyte sedimentation rate
1, 3, 5 Rheumatic fever usually develops after a group A beta-hemolytic streptococcal infection, particularly pharyngitis. Initial diagnosis is made by noting the presence of Aschoff's bodies, or hemorrhagic bullous lesions, in the heart, joints, skin, and central nervous system; an elevated C-reactive protein level; an elevated antistreptolysin O titer; and an elevated erythrocyte sedimentation rate. Reed-Sternberg cells are found in Hodgkin's disease.
Which of the following best describes the action of chemotherapeutic agents used in the treatment of cancer in children? 1. Suppresses the function of normal lymphocytes in the immune system. 2. Are alkylating agents and are cell-specific. 3. Cause a replication of DNA and are cell-specific. 4. Interrupt cell cycle, thereby causing cell death.
1. All chemotherapy is immunosuppressive as most childhood cancers affect the immune system.
The nurse is caring for a child with a diagnosis of ALL who is receiving chemotherapy. The nurse notes that the child's platelet count is 20,000/mm3. Based on the lab finding what information should the nurse provide to the child and parents? 1. A soft toothbrush should be used for mouth care. 2. Isolation precautions should be started immediately. 3. The child's vital signs, including blood pressure, should be monitored every 4 hours. 4. All visitors should be discouraged from coming to see the family.
1. Because the platelet count is decreased, there is a significant risk of bleeding, especially in soft tissue. The use of the soft toothbrush should help prevent bleeding of the gums.
The nurse is caring for a 6-month-old infant diagnosed with meningitis. When the child is place in the supine position and flexes his neck, the nurse notes he flexes his knees and hips. This is referred to as: 1. Brudizinski sign. 2. Cushing triad. 3. Kerning sign. 4. Nuchal rigidity
1. Brudzinski sign occurs when the child response to a flexed neck with and involuntary flexion of the hips and/or knees.
The nurse is caring for a child being treated for ALL. Lab results indicate that the child has a WBC count of 5000/mm3 with 5% polls and 3% bands. Which of the following analysis's is most appropriate? 1. The absolute neutrophil count is 400/mm3, and the child is neutropenic. 2. The absolute neutrophil count is 800/mm3, and the child is neutropenic. 3. The absolute neutrophil count is 4000/mm3, and the child is not neutropenic. 4. The absolute neutrophil count is 5800/mm3, and the child is not neutropenic.
1. The calculated absolute neutrophil count is 400/mm3 (0.08 x5000) and is neutropenic as it is less than 500/mm3.
A nurse is caring for a child who sustained a head injury after falling from a tree. On assessment of the child, the nurse notes the presence of a watery discharge from the child's nose. The nurse should immediately test the discharge for the presence of which substance? 1. Protein 2. Glucose 3. Neutrophils 4. White blood cells
2 After a head injury, bleeding from the nose or ears necessitates further evaluation. A watery discharge from the nose (rhinorrhea) that tests positive for glucose is likely to be cerebrospinal fluid (CSF) leaking from a skull fracture. On noting watery discharge from the child's nose, the nurse should test the drainage for glucose using reagent strips such as Dextrostix. If the results are positive, the nurse will contact the health care provider. The items in options 1, 3, and 4 are not normally found in CSF.
The nurse is providing home care instructions to the parents of a child with a seizure disorder. Which statement indicates to the nurse that the teaching regarding seizure disorders has been effective? 1. "We're glad we only have to give our child the medication for 30 days." 2. "We will make appointments for follow-up blood work and care as directed." 3. "We're glad there are no side effects from taking the antiseizure medications." 4. "After our child has been seizure free for 1 month, we can discontinue the medication."
2 Antiseizure medications are continued for a prolonged time even if seizures are controlled. Periodic reevaluation of the child is important to assess the continued effectiveness of the medication, check serum medication levels, and determine the need to alter the dosage if indicated. Antiseizure medications have potential side effects, and parents should be informed of such effects specific to the medication the child will be taking. Withdrawal of medication follows a predesigned protocol, usually begun when the child has been seizure free for at least 2 years. When a medication is discontinued, the dosage should be reduced gradually over 1 to 2 weeks.
A 6-year-old child is admitted to the pediatric intensive care unit with a diagnosis of increased intracranial pressure following a severe head injury. The primary care practitioner has prescribed Osmitrol (mannitol) for the child. The nurse advises the parents that the medication will have which of the following actions? 1. Increase the child's serum glucose levels 2. Increase the child's urinary output 3. Decrease the child's serum ammonia levels 4. Decrease the child's head circumference
2 Mannitol is a diuretic. It will increase the child's urinary output.
Which of the following is a reason to do a lumbar puncture on a child with a diagnosis of leukemia? SATA 1. Rule out meningitis 2. Assess the central nervous system for infiltration 3. Give intrathecal chemotherapy. 4. Determine increased intracranial pressure. 5. Stage the leukemia.
2,3 2. A lumbar puncture is done to assess the central nervous system by obtaining a specimen that can determine the presence of leukemic cells. 3. Chemotherapy can also be given with a spinal tap
Which of the following would be included in the plan of care for a hospitalized newborn following surgical repair of a myelomeningocele. SATA 1. Skull x-rays 2. Daily head circumference measurements 3. MRI scan 4. Vital signs every 6 hours. 5. Holding to breastfeed.
2,3 2. Daily head circumference measurements are done to assess for hydrocephalus. 3. Diagnostic tests include MRI scan, CT scan, ultrasound, and myelography.
An infant is born with a sac protruding through the spine, counting cerebrospinal fluid, 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 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 in increase in head size. 4. Many infants with myelomenigocele have microcephaly, which can show up as a decrease 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 providing discharge teaching to the parents of a toddler who experienced a febrile seizure. The nurse knows clarification is needed when the mother says: 1. "My child will likely have another seizure." 2. "My child's 7-year-old brother is also at high risk for a febrile seizure." 3. "I'll give my child acetaminophen when ill to prevent the fever from rising too high too rapidly." 4. "Most children with febrile seizures do not require seizure medication."
2. Most children over the age of 5 years do not have febrile seizures.
The nurse is aware that cloudy cerebrospinal fluid (CSF) most likely indicates: 1. Viral meningitis 2. Bacterial meningitis 3. No infections, as CSF is usually cloudy. 4. Sepsis
2. The CSF in bacterial meningitis is usually cloudy.
Which is the best action for the nurse to take during a child's seizure? 1. Administer the child's rescue dose of oral Valium(diazepam). 2. Loosen the child's clothing, and call for help. 3. Place a tongue blade in the child's moth to prevent aspiration. 4. Carry the child to the infirmary to call 911 and start an IV line.
2. The nurse should remain with the child and observe the seizure. The child should be protected from his environment, and clothing should be loosened.
The nurse is developing a plan of care for a newborn infant with spina bifida (myelomeningocele type). The nurse includes assessment measures in the plan to monitor for increased intracranial pressure. Which assessment technique should be performed that will best detect the presence of an increase in intracranial pressure? 1. Check urine for specific gravity. 2. Monitor for signs of dehydration. 3. Assess anterior fontanel for bulging. 4. Assess blood pressure for signs of hypotension.
3 A bulging or taut anterior fontanel would indicate the presence of increased intracranial pressure. Urine concentrating ability is not well developed at the newborn stage of development. Monitoring for signs of dehydration will not provide data related to increased intracranial pressure. Blood pressure is difficult to assess during the newborn period and is not the best indicator of intracranial pressure.
The nurse is reviewing the record of a child with increased intracranial pressure and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse expects to note which characteristic of this type of posturing? 1. Flaccid paralysis of all extremities 2. Adduction of the arms at the shoulders 3. Rigid extension and pronation of the arms and legs 4. Abnormal flexion of the upper extremities and extension and adduction of the lower extremities
3 Decerebrate (extension) posturing is characterized by the rigid extension and pronation of the arms and legs. Option 1 is incorrect. Options 2 and 4 describe decorticate (flexion) posturing.
A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed on the child because acute lymphocytic leukemia is suspected. The nurse understands that which diagnostic study should confirm this diagnosis? 1. Platelet count 2. Lumbar puncture 3. Bone marrow biopsy 4. White blood cell count
3 Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The confirmatory test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspirate and biopsy. A lumbar puncture may be done to look for blast cells in the spinal fluid that indicate central nervous system disease. The white blood cell count may be normal, high, or low in leukemia. An altered platelet count occurs as a result of the disease, but also may occur as a result of chemotherapy and does not confirm the diagnosis.
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 form 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.
The nurse knows further education is needed about Reye syndrome when a mother states. 1. "I will have my children immunized again varicella and influenza." 2. "I will make sure not to give my child any products containing aspirin." 3. "I will give aspirin to my child to treat a headache." 4. "Children with Reye syndrome are admitted to the hospital."
3. The administration of aspirin or products containing aspirin has been associated with the development of Reye syndrome. A headache can be the first sign of a viral illness followed by other symptoms. It is best not to use aspirin or aspirin-containing products in children.
The nurse receives a call for a parent of a child with leukemia in remission. The parent says the child has been exposed to chickenpox. The child has never had chickenpox. Which of the following responses is most appropriate for the nurse? 1. "You need to monitor the child's temperature frequently and call back if the temperature is greater than 101." 2. "At this time there is no need to be concerned." 3. "You need to bring the child to the clinic for a chickenpox immunoglobulin vaccine." 4. "Your child will need to be isolated for the next 2 weeks."
3. The child should receive varicella zoster immune globulin within 96 hours of the exposure.
The nurse assists a health care provider in performing a lumbar puncture on a 3-year-old child with leukemia in whom central nervous system disease is suspected. In which position will the nurse place the child during this procedure? 1. Lithotomy position 2. Modified Sims position 3. Prone with knees flexed to the abdomen and head bent with chin resting on the chest 4. Lateral recumbent position with the knees flexed to the abdomen and head bent with the chin resting on chest
4 A lateral recumbent position with the knees flexed to the abdomen and the head bent with the chin resting on the chest is assumed for a lumbar puncture. This position separates the spinal processes and facilitates needle insertion into the subarachnoid space. Options 1, 2, and 3 are incorrect positions
A nurse caring for a child who has sustained a head injury in an automobile crash is monitoring the child for signs of increased intracranial pressure (ICP). For which early sign of increased ICP should the nurse monitor? 1. Increased systolic blood pressure 2. Abnormal posturing of extremities 3. Significant widening pulse pressure 4. Changes in level of consciousness (LOC)
4 An altered level of consciousness is an early sign of increased ICP. Late signs of increased ICP include tachycardia leading to bradycardia, apnea, systolic hypertension, widening pulse pressure, and posturing.
A woman, who is human papillomavirus positive, gives birth vaginally. During the infancy period, the child should be monitored for which of the following physiological findings? 1. Spastic posturing 2. Elevated liver enzymes 3. Paralysis of the limbs 4. Laryngeal warts
4 Laryngeal warts may be detected in infants exposed to human papillomavirus during birth.
The nurse is performing an assessment on a child with a head injury. The nurse notes an abnormal flexion of the upper extremities and an extension of the lower extremities. What should the nurse document that the child is experiencing? 1. Decorticate posturing 2. Decerebrate posturing 3. Flexion of the arms and legs 4. Normal expected positioning after head injury
1 Decorticate posturing is an abnormal flexion of the upper extremities and an extension of the lower extremities with possible plantar flexion of the feet. Decerebrate posturing is an abnormal extension of the upper extremities with internal rotation of the upper arms and wrists and an extension of the lower extremities with some internal rotation.
A child has been tentatively diagnosed with rheumatic fever. The nurse interprets that this diagnosis is consistent with which laboratory result obtained for this child? 1. Elevated antistreptolysin O (ASO) titer 2. Decreased erythrocyte sedimentation rate (ESR) 3. Negative result on antinuclear antibody (ANA) assay 4. Negative result on C-reactive protein (CRP) determination
1 In the presence of rheumatic fever, the child will exhibit an elevated ASO titer, an elevated ESR, leukocytosis, and a positive result on CRP determination. A positive result on ANA testing is used to diagnose a wide variety of connective-tissue, vascular, and immune complex disorders and also will be positive with rheumatic fever.
A nurse reviews the plan of care for a child with Reye's syndrome. Which priority intervention should the nurse include in the plan of care? 1. Monitor for signs of increased intracranial pressure. 2. Immediately check the presence of protein in the urine. 3. Reassure the parents hyperglycemia is a common symptom. 4. Teach the parents signs and symptoms of a bacterial infection.
1 Intracranial pressure and encephalopathy are major symptoms of Reye's syndrome. Protein is not present in the urine. Reye's syndrome is related to a history of viral infections, and hypoglycemia is a symptom of this disease.
A clinic nurse is assessing the status of jaundice in a child with hepatitis. Which anatomical area will provide the best data regarding the presence of jaundice? 1. The nail beds 2. The skin in the sacral area 3. The skin in the abdominal area 4. The membranes in the ear canal
1 Jaundice, if present, is best assessed in the sclera, nail beds, and mucous membranes. Generalized jaundice will appear in the skin throughout the body. The membranes of the ear canal are not an appropriate area to assess for the presence of jaundice.
The nurse is reviewing the laboratory test results for an infant suspected of having hypertrophic pyloric stenosis. The nurse should expect to note which value as the most likely laboratory finding in this infant? 1. Blood pH of 7.50 2. Blood pH of 7.30 3. Blood bicarbonate of 22 mEq/L 4. Blood bicarbonate of 19 mEq/L
1 Laboratory findings in an infant with hypertrophic pyloric stenosis include metabolic alkalosis due to vomiting. These include increased blood pH and bicarbonate level, decreased serum potassium and sodium levels, and a decreased chloride level. The normal pH is 7.35 to 7.45. The normal bicarbonate is 22 to 27 mm Hg.
A child is admitted to the hospital with a diagnosis of acute bacterial meningitis. In reviewing the health care provider's prescriptions, which would the nurse question as appropriate for a child with this diagnosis? 1. Administer an oral antibiotic. 2. Maintain strict intake and output. 3. Draw blood for a culture and sensitivity. 4. Place the child on droplet precautions in a private room.
1 Medication to treat acute bacterial meningitis is administered intravenously, not orally. A culture and sensitivity is done to determine if the diagnosis is bacterial or viral. Until meningitis is ruled out, the child is placed in isolation on droplet precautions because the disease is spread by airborne means. Strict intake and output should be maintained.
A nurse is monitoring a 7-year-old child who sustained a head injury in a motor vehicle crash for signs of increased intracranial pressure (ICP). The nurse should assess the child frequently for which early sign of increased ICP? 1. Nausea 2. Papilledema 3. Decerebrate posturing 4. Alterations in pupil size
1 Nausea is an early sign of increased ICP. Late signs of increased ICP include a significant decrease in level of consciousness, Cushing's triad (increased systolic blood pressure and widened pulse pressure, bradycardia, and irregular respirations), and fixed and dilated pupils. Other late signs include decreased motor response to command, decreased sensory response to painful stimuli, posturing, Cheyne-Stokes respirations, and papilledema.
The nurse is reviewing a chart for a child with a head injury. The nurse notes that the level of consciousness has been documented as obtunded. Which finding should the nurse expect to note on assessment of the child? 1. Not easily arousable and limited interaction 2. Loss of the ability to think clearly and rapidly 3. Loss of the ability to recognize place or person 4. Awake, alert, interacting with the environment
1 Obtunded indicates that the child sleeps unless aroused and once aroused has limited interaction with the environment. Confusion indicates that the ability to think clearly and rapidly is lost. Disorientation indicates that the ability to recognize place or person is lost. Full consciousness indicates that the child is alert, awake, orientated, and interacts with the environment.
A nurse is performing an admission assessment on a child with a seizure disorder. The nurse is interviewing the child's parents to determine their adjustment to caring for their child, who has a chronic illness. Which statement, if made by the parents, would indicate a need for further teaching? 1. "Our child sleeps in our bedroom at night." 2. "We worry about injuries when our child has a seizure." 3. "Our child is involved in a swim program with neighbors and friends." 4. "Our babysitter just completed cardiopulmonary resuscitation [CPR] training."
1 Parents are especially concerned about seizures that might go undetected during the night. The nurse needs to decrease parental overprotection and should suggest the use of a baby monitor at night. Options 3 and 4, involvement in a swim program and knowing CPR identify parental understanding of the disorder. Worrying about injuries when a child has a seizure is a common concern. The parents need to be reminded that as the child grows, they cannot always observe their child, but their knowledge of seizure activity and care is appropriate to minimize complications.
A 10-year-old attending summer camp is admitted to the pediatric intensive care unit with a diagnosis of meningococcal meningitis. Which of the following assessments would indicate to the nurse that the child was developing a serious complication of the disease? 1. Purpuric rash 2. Positive Kernig sign 3. Positive Brudzinski sign 4. Nasal bleeding
1 Purpuric rash is characteristic of meningococcemia.
A 12-year-old is admitted to the hospital with a low-grade fever and joint pain. Which diagnostic test finding will assist to determine a diagnosis of rheumatic fever? 1. Presence of Aschoff's bodies 2. Absence of C-reactive protein 3. Presence of Reed-Sternberg cells 4. Decreased antistreptolysin O titer
1 Rheumatic fever develops after a group A β-hemolytic streptococcal infection, particularly pharyngitis. Initial diagnosis is made by noting the presence of Aschoff's bodies, or hemorrhagic bullous lesions, in the heart, joints, skin, and central nervous system; an elevated antistreptolysin O titer; an elevated C-reactive protein level; and an elevated erythrocyte sedimentation rate. Reed-Sternberg cells are found in Hodgkin's disease.
A nursing student is assisting a school nurse in performing scoliosis screening on the children in the school. The nurse assesses the student's preparation for conducting the screening. The nurse determines that the student demonstrates understanding of the disorder when the student states that scoliosis is characterized by which finding? 1. Abnormal lateral curvature of the spine 2. Abnormal anterior curvature of the lumbar spine 3. Excessive posterior curvature of the thoracic spine 4. Abnormal curvature of the spine caused by inflammation
1 Scoliosis is defined as an abnormal lateral curvature in any area of the spine. The region of the spine most commonly affected is the right thoracic area, where it results in rib prominence. Option 2 describes lordosis, which usually is exaggerated during pregnancy, in obesity, or in persons with large tumors. Option 3 describes kyphosis, which also is known as humpback. Scoliosis does not occur as a sequela of inflammation.
A 3-month-old infant with a diagnosis of pertussis is being cared for by the nurse. Which of the following actions should the nurse perform? 1. Assess the weight daily. 2. Monitor the progression of the rash each day. 3. Administer antihistamine medications as ordered. 4. Maintain contact isolation.
1 The child is high risk for dehydration from insensible fluid loss as a result of the respiratory symptoms. The child's weight should be monitored daily.
The nurse is caring for a newborn infant with spina bifida (myelomeningocele) who is scheduled for surgical closure of the sac. In the preoperative period, which is the priority problem? 1. Infection 2. Choking 3. Inability to tolerate stimulation 4. Delayed growth and development
1 A myelomeningocele is a type of spina bifida that results from failure of the neural tube to close during embryonic development. With a myelomeningocele, protrusion of the meninges, cerebrospinal fluid, nerve roots, and a portion of the spinal cord occurs. The newborn with spina bifida is at risk for infection before the closure of the sac, which is done soon after birth. Initial care of the newborn with myelomeningocele involves prevention of infection. A sterile normal saline dressing is placed over the sac to maintain moisture of the sac and its contents and to prevent tearing or breakdown of the skin integrity at the site. Any opening in the sac greatly increases the risk of infection of the central nervous system. Choking and inability to tolerate stimulation are not priority problems with this defect. Delayed growth and development is a problem for the infant with myelomeningocele, but preventing infection has priority in the preoperative period.
The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 cells/mm3. On the basis of this laboratory result, which intervention should the nurse include in the plan of care? 1. Initiate bleeding precautions. 2. Monitor closely for signs of infection. 3. Monitor the temperature every 4 hours. 4. Initiate protective isolation precautions.
1 Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). If a child is severely thrombocytopenic and has a platelet count less than 20,000 cells/mm3, bleeding precautions need to be initiated because of the increased risk of bleeding or hemorrhage. Precautions include limiting activity that could result in head injury, using soft toothbrushes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. In addition, suppositories, enemas, and rectal temperatures are avoided. Options 2, 3, and 4 are related to the prevention of infection rather than bleeding.
The nurse is monitoring a 3-year-old child for signs and symptoms of increased intracranial pressure (ICP) after a craniotomy. The nurse plans to monitor for which early sign or symptom of increased ICP? 1. Vomiting 2. Bulging anterior fontanel 3. Increasing head circumference 4. Complaints of a frontal headache
1 The brain, although well protected by the solid bony cranium, is highly susceptible to pressure that may accumulate within the enclosure. Volume and pressure must remain constant within the brain. A change in the size of the brain, such as occurs with edema or increased volume of intracranial blood or cerebrospinal fluid without a compensatory change, leads to an increase in intracranial pressure (ICP), which may be life-threatening. Vomiting, an early sign of increased ICP, can become excessive as pressure builds up and stimulates the medulla in the brainstem, which houses the vomiting center. Children with open fontanels (posterior fontanel closes at 2 to 3 months; anterior fontanel closes at 12 to 18 months) compensate for ICP changes by skull expansion and subsequent bulging fontanels. When the fontanels have closed, nausea, excessive vomiting, diplopia, and headaches become pronounced, with headaches becoming more prevalent in older children.
The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment of subjective data, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid which during the physical assessment? 1. Palpating the abdomen for a mass 2. Assessing the urine for the presence of hematuria 3. Monitoring the temperature for the presence of fever 4. Monitoring the blood pressure for the presence of hypertension
1 Wilms' tumor is the most common intraabdominal and kidney tumor of childhood. If Wilms' tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause seeding of the tumor and spread of the cancerous cells. Hematuria, fever, and hypertension are clinical manifestations associated with Wilms' tumor.
Which of the following activities should a nurse suggest for a child diagnosed with hemophilia? Select all that apply. 1. Swimming 2. Golf 3. Hiking 4. Fishing 5. Soccer
1, 2, 3, 4 Feedback 1: Children with hemophilia should be encouraged to take part in noncontact activities such as swimming, golf, hiking, and fishing that allow for social, psychological, and physical growth. Feedback 2: Children with hemophilia should be encouraged to take part in noncontact activities such as swimming, golf, hiking, and fishing that allow for social, psychological, and physical growth. Feedback 3: Children with hemophilia should be encouraged to take part in noncontact activities such as swimming, golf, hiking, and fishing that allow for social, psychological, and physical growth. Feedback 4: Children with hemophilia should be encouraged to take part in noncontact activities such as swimming, golf, hiking, and fishing that allow for social, psychological, and physical growth. Feedback 5: Contact sports such as soccer should be discouraged.
A nurse is caring for a child with von Willebrand disease. The nurse is aware that which of the following is a clinical manifestation of von Willebrand disease? SATA 1. Bleeding of the mucous membranes. 2. The child bruises easily. 3. Excessive menstruation. 4. The child has frequent nosebleeds. 5. Elevated creatinine levels. 6. The child has a factor IX deficiency.
1, 2, 3, 4 1. Von Willebrand diseae is a hereditary bleeding disorder characterized by deficiency of or defect in a protein, The disorder causes adherence of platelets to damaged endothelium and a mild deficiency of factor VIII. One of the manifestations of this disease is bleeding of the mucous membranes. 2. Bruising is a common manifestation of this disease. 3. Excessive menstruation may be a manifestation of this disease. 4. Frequent nosebleeds are a common manifestation of this disease.
A girl who is playing in the playroom experiences a tonic-clonic seizure. During the seizure, the nurse should take which actions? Select all that apply. 1. Remain calm. 2. Time the seizure. 3. Ease the child to the floor. 4. Loosen restrictive clothing. 5. Keep the child on her back. 6. Place a pillow under the child's head.
1, 2, 3, 4, 6 When a child is having a seizure, the nurse should remain calm, time the seizure, ease the child to the floor if the child is standing or seated, keep the child on the side, loosen restrictive clothing, and place a pillow under the child's head.
Cerebral palsy (CP) is a term applied to a disorder that impairs movement and posture. The effects on perception, language, and intellect are determined by the type that is diagnosed. What are the potential warning signs of CP? Select all that apply. 1. The infant's arms or legs are stiff or rigid. 2. A high risk factor for CP is very low birth weight. 3. By 8 months of age, the infant can sit without support. 4. The infant has strong head control but a limp body posture. 5. The infant has feeding difficulties, such as poor sucking and swallowing. 6. If the infant is able to crawl, only one side is used to propel himself or herself.
1,2,5,6 Options 1, 2, 5, and 6 are potential warning signs of CP. By 8 months of age, if the infant cannot sit up without support, this would be considered a potential warning sign, because this developmental task should be completed by this time. The infant with a potential diagnosis of CP has poor head control by 3 months of age, when head control should be strong.
The nurse is developing a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? Select all that apply. 1. Time the seizure. 2. Restrain the child. 3. Stay with the child. 4. Place the child in a prone position. 5. Move furniture away from the child. 6. Insert a padded tongue blade in the child's mouth.
1,3,5 A seizure is a disorder that occurs as a result of excessive and unorganized neuronal discharges in the brain that activate associated motor and sensory organs. During a seizure, the child is placed on his or her side in a lateral position. Positioning on the side prevents aspiration because saliva drains out the corner of the child's mouth. The child is not restrained because this could cause injury to the child. The nurse would loosen clothing around the child's neck and ensure a patent airway. Nothing is placed into the child's mouth during a seizure because this action may cause injury to the child's mouth, gums, or teeth. The nurse would stay with the child to reduce the risk of injury and allow for observation and timing of the seizure.
Which nursing actions apply to the care of a child who is having a seizure? Select all that apply. 1. Time the seizure. 2. Restrain the child. 3. Stay with the child. 4. Insert an oral airway. 5. Place the child in a lateral side-lying position. 6. Loosen clothing around the child's neck.
1,3,5,6 During a seizure, the child is placed on his or her side in a lateral position. Positioning on the side prevents aspiration because saliva drains out the corner of the child's mouth. The child is not restrained because this could cause injury to the child. The nurse should loosen clothing around the child's neck and ensure a patent airway. Nothing is placed in the child's mouth during a seizure because this could injure the child's mouth, gums, or teeth. The nurse should stay with the child to reduce the risk of injury and allow for observation and timing of the seizure.
Which is the nurse's best response to the parents of a neonate with a meningocele who ask what they can 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.
The diet that produces anticonvulsant effects from ketosis consists of: 1. High-fat and low-carbohydrate foods. 2. High-fat and high-carbohydrate foods. 3. Low-fat and low-carbohydrate foods. 4. Low-fat and high-carbohydrate foods.
1. High fat and low carbohydrates are the components of the kerogenic diet.
School-age children with cancer often have a body image disturbance related to hair loss, moon face, or debilitation. Which of the following interventions is most appropriate? 1. Encourage them to wear a wig similar to their worn hairstyle. 2. Emphasize the benefits of the therapy they are receiving. 3. Have them play only with other children with cancer. 4. Use diversional techniques to avoid discussing changes in the body because of the chemotherapy.
1. Wearing a wig is a good way for the child to keep personal identity despite the loss of hair.
The nurse should place a child who had a medulloblastoma brain tumor (infratentorial) removed in which position postoperatively? 1. Trendelenburg's 2. Flat, on either side 3. With the head of the bed elevated above heart level 4. With the head of the bed elevated in low Fowler's position
2 If an infratentorial tumor has been removed, the child is positioned flat on either side. The pillow is placed behind the child's back for comfort and to maintain the position. The pillow is not placed behind the head because when the pillow is behind the head, proper alignment is not maintained, and this misalignment can impair circulation. The child should never be placed in a Trendelenburg's position (head down) because this position increases intracranial pressure. The head is elevated when the tumor is a supratentorial one.
Which is the most important home-care consideration for a special needs child? 1. Respite care 2. Safety 3. VNA nurse 4. Follow-up plan
2 Safety is the most important home-care consideration for a special needs child.
The nursing student is assigned to care for a child with a brain injury who has a temporal lobe herniation. The nursing instructor determines that the student needs to further research this type of injury if the student states that which finding is a characteristic of this type of herniation? 1. It can cause ipsilateral pupil dilation. 2. It produces compression of the sixth cranial nerve. 3. A shifting of the temporal lobe laterally across the tentorial notch occurs. 4. Flaccid paralysis, pupil fixation, and death can occur if the intracranial pressure continues to rise.
2 Temporal lobe herniation or uncal herniation refers to a shifting of the temporal lobe laterally across the tentorial notch. This produces compression of the third cranial nerve and ipsilateral pupil dilation. If pressure continues to rise, flaccid paralysis, pupil fixation, and death will result.
The nursing student is caring for a child with increased intracranial pressure. On review of the chart, the student nurse notes that a transtentorial herniation has occurred. The nursing instructor asks the student about this type of herniation. Which statement by the student indicates a need for further research about this condition? 1. "The herniation can be unilateral or bilateral." 2. "It involves only anterior portions of the brain." 3. "It can cause death if large amounts of tissue are involved." 4. "The brain herniates downward and around the tentorium cerebelli."
2 Transtentorial herniation occurs when part of the brain herniates downward and around the tentorium cerebelli. It can be unilateral or bilateral and may involve anterior or posterior portions of the brain. If a large amount of tissue is involved, the risk of death is increased because vital brain structures are compressed and become unable to perform their function.
The school nurse notices a third-grade girl with long pants and long-sleeved fully buttoned shirt walking to the lunchroom on a very hot day in June. The nurse asks the child to go to the nursing office for a few minutes. Which of the following actions would be important for the nurse to perform at this time? 1. Check to make sure that the child is drinking enough fluids. 2. Ask the child if it would be okay to look at the skin under her shirt and pants. 3. Ask the child if she always feels cold on such hot days. 4. Check to make sure that the child has a normal temperature and pulse rate.
2 Children who are clothed in attire that completely covers their bodies, especially on days that are very warm or hot, may have injuries on their bodies that the parents, or child, are trying to hide. The nurse should question the child and/or assess the area for signs of physical abuse.
An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period? 1. Test the urine for protein. 2. Reposition the infant frequently. 3. Provide a stimulating environment. 4. Assess blood pressure every 15 minutes.
2 Hydrocephalus occurs as a result of an imbalance of cerebrospinal fluid absorption or production that is caused by malformations, tumors, hemorrhage, infections, or trauma. It results in head enlargement and increased intracranial pressure. In infants with hydrocephalus, the head grows at an abnormal rate, and if the infant is not repositioned frequently, pressure ulcers can occur on the back and side of the head. An egg crate mattress under the head is also a nursing intervention that can help prevent skin breakdown. Proteinuria is not specific to hydrocephalus. Stimulus should be kept at a minimum because of the increase in intracranial pressure. It is not necessary to check the blood pressure every 15 minutes.
A 14-month-old child is seen in the pediatrician's office. The mother states, "He doesn't seem to be himself lately. He doesn't run as much as he used to and he even seems to beg for his naps." Which of the following additional information provided by the mother may be related to the child's behavior? 1. Child goes to daycare 3 mornings a week. 2. Child drinks five 8-ounce bottles of milk a day. 3. Child is put to bed at 9 o'clock every evening. 4. Child has five older brothers and sisters
2 Milk is an excellent source of vitamins D and A and calcium. It is, however, devoid of iron. Characteristic symptoms of iron deficiency anemia are lethargy and fatigue. Milk contains no iron. This child is consuming large quantities of milk.
The pediatric nurse specialist provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information? 1. "The femur is the most common site of this sarcoma." 2. "The child does not experience pain at the primary tumor site." 3. "Limping, if a weight-bearing limb is affected, is a clinical manifestation." 4. "The symptoms of the disease in the early stage are almost always attributed to normal growing pains."
2 Osteosarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur. Osteosarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site. By the time these children receive medical attention, they may be in considerable pain from the tumor. Options 1, 3, and 4 are accurate regarding osteosarcoma.
The nurse is caring for a child after surgical removal of a brain tumor. The nurse should assess the child for which sign that would indicate that brainstem involvement occurred during the surgical procedure? 1. Inability to swallow 2. Elevated temperature 3. Altered hearing ability 4. Orthostatic hypotension
2 Vital signs and neurological status are assessed frequently after surgical removal of a brain tumor. Special attention is given to the child's temperature, which may be elevated because of hypothalamic or brainstem involvement during surgery. A cooling blanket should be in place on the bed or readily available if the child becomes hyperthermic. Inability to swallow and altered hearing ability are related to functional deficits after surgery. Orthostatic hypotension is not a common clinical manifestation after brain surgery. An elevated blood pressure and widened pulse pressure may be associated with increased intracranial pressure, which is a complication after brain surgery, but is not related to brainstem involvement.
The nurse is working with a 6-year-old child who is being evaluated for autism spectrum disorder (ASD). When discussing his history with his mother, the nurse would expect to hear which of the following? Select all that apply. 1. "He really likes to stare at my eyes when he talks to me. He just doesn't want to look away." 2. "He never really smiled, even as an infant." 3. "He often repeats words that other people say." 4. "He's always the center of attention and surrounded by playmates."5. "He falls apart if we change our routines."
2, 3, 5 Feedback 1: The parent of a child with autism will often report that the child does not maintain eye contact. Feedback 2: The parents of a child with autism will often give examples of behavior that represent deficits in social interactions, such as a lack of social smile. Feedback 3: Repeating speech that is heard is referred to as echolalia. This is one of the common communication impairments reported in autism. Feedback 4: The nurse would not expect the parent to report that the child has a large circle of friends, because the child with autism often does not develop peer relationships that would be expected based on the child's developmental level. Feedback 5: The parent of a child with autism will often report that the child desires a very rigid schedule and is inflexible in regards to rituals.
Which of the following describe idiopathic thrombocytopenia purpura (ITP)? SATA 1. ITP is a congenital hematological disorder. 2. ITP causes excessive destruction of platelets. 3. Children with ITP have normal bone marrow. 4. Platelets are small in ITP. 5. Purpura is observed in ITP.
2, 3, 5 2. ITP is characterized by excessive destruction of platelets. 3. The bone marrow is normal in children with ITP. 5. ITP is characterized by purports, which are areas of the hemorrhage under the skin.
Which test provides a definitive diagnosis of aplastic anemia? 1. Complete blood count with differential. 2. Bone marrow aspiration. 3. Serum gig levels. 4. Basic metabolic panel.
2. Definitive diagnosis is determined from bone marrow aspiration, which demonstrates the conversion of red bone marrow to yellow fatty marrow.
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 2 year old who is HIV positive questions the nurse about placing the child in day care. Which of the following is the best response? 1. The child should not go to day care until older, because there is a high risk for transmission of the disease. 2. The child can be admitted to day care without restrictions and should be allowed to participate in all activities. 3. The child can go to day care but should avoid physical activity. 4. The child may go to day care, but the parent must inform all the parents at the day care that the child is HIV positive.
2. The child can attend day care without any limitations but should not attend with a fever.
A 10-year old with severe factor VIII deficiency falls, injures an elbow, and is brought to the ER. The nurse should prepare which of the following? 1. An IM injection of factor VIII 2. An IV injection 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
Which activity should an adolescent just diagnosed with epilepsy avoid? 1. Swimming, even with a friend. 2. Being in a car at night 3. Participating in any strenuous activities. 4. Returning to school right away.
2. The rhythmic reflection of other car lights can trigger a seizure in some children.
When caring for a child with lymphoma, the nurse needs to be aware of which of the following? 1. The same staging system is used for lymphoma and Hodgkin disease. 2. The aggressive chemotherapy with CNS prophylaxis will give the child a good prognosis. 3. All children with lymphoma need a bone marrow transplant for a good prognosis. 4. Despite high-dose chemotherapy, the prognosis is very poor for most children with a diagnosis of lymphoma.
2. The use of aggressive combination chemotherapy has a major impact on the survival rates for children with a diagnosis of lymphoma. Because there is usually bone marrow involvement, there is a need for CNS prophylaxis.
A child's primary health-care practitioner has diagnosed a child with rubeola. Which of the following physiological findings would the nurse expect the child to exhibit? 1. Desquamation of the hands and feet 2. Paroxysmal coughing 3. White spots on the buccal mucosa 4. Marked hypertension
3
The nurse is assessing a client with fragile X syndrome. The nurse anticipates to note which physical assessment finding? 1. Low, straight palate 2. Short, narrow protruding ears 3. Long, narrow face with a prominent jaw 4. Short, rounded face with an indiscernible jaw
3 Fragile X syndrome is a genetic condition that causes developmental problems including learning disabilities and cognitive impairment. Physical assessment findings of fragile X syndrome include long, wide, and/or protruding ears; a long, narrow face with a prominent jaw; large protruding ears; and large testes. Therefore, options 1, 2, and 4 are incorrect.
The nurse receives a telephone call from the admissions office and is told that a child with acute bacterial meningitis will be admitted to the pediatric unit. The nurse prepares for the child's arrival and plans to implement which type of precautions? 1. Enteric 2. Contact 3. Droplet 4. Neutropenic
3 A major priority in nursing care for a child with suspected meningitis is to administer the appropriate antibiotic as soon as it is prescribed. The child will be placed in a private room, with droplet transmission precautions, for at least 24 hours after antibiotics are given. Enteric, contact, and neutropenic precautions are not associated with the mode of transmission of meningitis. Enteric precautions are instituted when the mode of transmission is through the gastrointestinal tract. Contact precautions are instituted when contact with infectious items or materials is likely. Neutropenic precautions are instituted when the client has a low neutrophil count
A baby is diagnosed with sickle cell anemia at birth. Which of the following information should the nurse convey to the parents regarding the daily care of the baby? The parents must: 1. put sunscreen on the baby whenever he is in the sun. 2. check the baby's axillary temperature every morning. 3. measure the amount of formula the baby drinks each day. 4. monitor the baby's skin every day for signs of bruising.
3 Although applying sunscreen to children is an important action, it will not protect a baby with SCA from crises. Maintaining adequate fluid intake, however, is essential for the health of children with sickle cell disease.
The nurse is reviewing the health care provider's prescriptions for a child with rheumatic fever (RF) who is suspected of having a viral infection. The nurse notes that acetylsalicylic acid (aspirin) is prescribed for the child. Which nursing action is most appropriate? 1. Administer the aspirin if the child's temperature is elevated. 2. Administer the aspirin if the child experiences any joint pain. 3. Consult with the health care provider to verify the prescription. 4. Administer acetaminophen (Tylenol) for temperature elevation.
3 Anti-inflammatory agents, including aspirin, may be prescribed for the child with RF. Aspirin should not be given to a child who has chickenpox or other viral infections. Therefore, the nurse should consult with the health care provider to verify the prescription. The nurse would not administer acetaminophen (Tylenol) without specific health care provider's prescriptions. Options 1 and 2 are not appropriate actions.
A nurse is examining the skin of a child who has been diagnosed with chickenpox. Which of the following findings would the nurse expect to see? 1. Bright red, macular rash in the creases of the body. 2. Confluent rash that blanches when compressed. 3. Multiple lesions in four stages of eruption. 4. Painful, vesicular rash on an erythematous base.
3 Chickenpox is characterized by a rash including multiple lesions in four stages of eruption.
The nurse is monitoring a child with a brain tumor for complications associated with increased intracranial pressure (ICP). Which finding, if noted by the nurse, would indicate the presence of diabetes insipidus (DI)? 1. Weight gain 2. Hypertension 3. High urine output 4. Urine specific gravity greater than 1.020
3 DI can occur in a child with increased ICP. Weight gain, hypertension and a urine specific gravity greater than 1.020 are indications of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion, not DI. A high urine output would be indicative of DI.
A nurse is reviewing the record of a child with increased intracranial pressure and notes that the child has exhibited signs of decerebrate posturing. Which assessment finding should the nurse expect if this type of posturing were present? 1. Flexion of the upper extremities and extension of the lower extremities 2. Unilateral or bilateral postural change in which the extremities are rigid 3. Abnormal extension of the upper and lower extremities with some internal rotation 4. Arms are adducted with fists clenched and the legs are flaccid with external rotation
3 Decerebrate (extension) posturing is an abnormal extension of the upper extremities, with internal rotation of the upper arm and wrist and extension of the lower extremities with some internal rotation. Option 1 describes decorticate posturing. Options 2 and 4 are incorrect and not characteristics of decerebrate posturing.
The nurse is caring for a child diagnosed with Down's syndrome. In describing the disorder to the parents, what characteristics are most closely associated with the syndrome and serve as the basis for the nurse's explanation? 1. Subaverage intellectual functioning with a congenial nature 2. Above-average intellectual functioning with deficits in adaptive behavior 3. Moderate to severe retardation and linkage to an extra chromosome 21, group G 4. Average intellectual functioning and the absence of deficits in adaptive behavior
3 Down's syndrome is a form of mental retardation and is a congenital condition that results in moderate to severe mental retardation. Most cases are attributable to an extra chromosome (group G)-hence the name trisomy 21. Options 1, 2, and 4 are incorrect characteristics of this syndrome
The nurse is providing instructions to the parents of an infant with a ventriculoperitoneal shunt. The nurse should include which instruction? 1. Expect an increased urine output from the shunt. 2. Notify the health care provider if the infant is fussy. 3. Call the health care provider if the infant has a high-pitched cry. 4. Position the infant on the side of the shunt when the infant is put to bed.
3 If the shunt is malfunctioning, the fluid from the ventricle part of the brain will not be diverted to the peritoneal cavity. The cerebrospinal fluid will build up in the cranial area. The result is increased intracranial pressure, which then causes a high-pitched cry in the infant. The infant should not be positioned on the side of the shunt because this will cause pressure on the shunt and skin breakdown. This type of shunt affects the gastrointestinal system, not the genitourinary system, and an increased urinary output is not expected. Being fussy is a concern only if other signs indicative of a complication are occurring.
On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? 1. Cracked lips 2. Normal appearance 3. Conjunctival hyperemia 4. Desquamation of the skin
3 Kawasaki disease, also known as mucocutaneous lymph node syndrome, is an acute systemic inflammatory illness. In the acute stage, the child has a fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of the cervical lymph nodes. In the subacute stage, cracking lips and fissures, desquamation of the skin on the tips of the fingers and toes, joint pain, cardiac manifestations, and thrombocytosis occur. In the convalescent stage, the child appears normal, but signs of inflammation may be present.
Rheumatic fever usually develops after a group A beta-hemolytic streptococcal infection, particularly pharyngitis. Initial diagnosis is made by noting the presence of Aschoff's bodies, or hemorrhagic bullous lesions, in the heart, joints, skin, and central nervous system; an elevated C-reactive protein level; an elevated antistreptolysin O titer; and an elevated erythrocyte sedimentation rate. Reed-Sternberg cells are found in Hodgkin's disease.
3 Nursing care initially centers on observing for signs of HF. The nurse monitors for increased respiratory rate, increased heart rate, dyspnea, crackles, and abdominal distention. Options 1, 2, and 4 are not conditions directly associated with this disorder.
Four 3-year-old children are admitted to the pediatric inpatient unit with broken femurs. The nurse reports a suspicion of child abuse to the primary health-care provider regarding the child whose parent provided which of the following explanations for the injury? 1. "My child jumped down from the top bunk of his brother's bunk bed." 2. "My child and I were just in a terrible traffic accident and my car is totaled." 3. "My child tripped over a rock when we were walking in the park." 4. "My child was riding on the back of my bicycle when we ran into a tree."
3 One of the most important questions a nurse should ask himself or herself when a child enters the health-care system with an injury is, "Does the story provided by the parents regarding the injury make sense?" If the story is inconsistent with the injuries, the injuries may have been inflicted by the parent. It is unlikely that a 3-year-old child would break his femur when tripping over a rock during a walk in the park.
Which of the following injuries would make the nurse suspect that the child may have been abused? 1. A 6-month-old with a linear skull fracture who reportedly fell off a changing table 2. A 13-month-old with a fractured collarbone who reportedly fell off a chair 3. A 2-year-old with a spiral femur fracture who reportedly fell down the stairs 4. A 2-year-old with a tibia/fibula comminuted fracture who reportedly fell out of a second-story window
3 Spiral fractures occur with a strong twisting motion, which does not occur as the result of a fall.
A nurse is monitoring an infant for signs of increased intracranial pressure (ICP). On assessment of the fontanelles, the nurse notes that the anterior fontanelle bulges when the infant is sleeping. Based on this finding, which is the priority nursing action? 1. Increase oral fluids. 2. Document the finding. 3. Notify the health care provider. 4. Place the infant supine in a side-lying position.
3 The anterior fontanelle is diamond shaped and is located on the top of the head. It should be soft and flat in a normal infant, and it normally closes by 12 to 18 months of age. A larger-than-normal fontanelle may be a sign of increased ICP within the skull. Although the anterior fontanelle may bulge slightly when the infant cries, bulging at rest may indicate increased ICP. Options 1 and 4 are inaccurate interventions and will not be helpful. Although the nurse would document the finding, the priority action would be to report the finding to the health care provider.
The nurse is performing a Glasgow Assessment on a 4-month-old infant who is admitted with suspected Shaken Baby Syndrome. Which of the following verbal responses by the baby is most concerning? 1. Cries spontaneously 2. Cries when pricked with a pin 3. Moans when pinched hard 4. Babbles when jostled
3 The nurse would expect the baby to cry when pinched hard. A moan may indicate that the baby is in a state of reduced consciousness.
A 2-month-old infant is seen in the pediatrician's office for a well child visit. The nurse advises the mother that the child is due to receive vaccinations at the visit. The mother states, "My husband and I are thinking about not having our child immunized." Which of the following is the most appropriate response for the nurse to give? 1. "I should advise you that public health laws require that all children be immunized." 2. "It is important to know that many children died of preventable illnesses before there were vaccinations." 3. "I will be happy to answer any questions that you might have about the vaccinations." 4. "You may have heard on the news that some immunizations cause autism but that is not true."
3 This is the best response for the nurse to give.
A preschooler with a history of cleft palate repair comes to the clinic for a routine well-child checkup. To determine if this child is experiencing a long-term effect of cleft palate, which question should the nurse ask? 1. "Was the child recently treated for pneumonia?" 2. "Does the child play with an imaginary friend?" 3. "Is the child unresponsive when given directions?" 4. "Has the child had any difficulty swallowing food?"
3 Unresponsiveness may be an indication of hearing loss. A child who has a history of cleft palate should be routinely checked for hearing loss. Options 1 and 4 are unrelated to cleft palate after repair. Option 2 is normal behavior for a preschool child. Many preschoolers with vivid imaginations have imaginary friends.
A neonate is post-op 1 hour from a ventriculoperitoneal shunt insertion. Which of the following actions should the nurse in the post-anesthesia care unit perform? 1. Elevate the head of the crib or bassinet. 2. Assess any drainage for high ammonia levels. 3. Monitor the child for distended abdomen. 4. Check the axillary temperature every hour.
3 VP shunts drain excess cerebral spinal fluid from the ventricles of the brain and deposit the fluid in the peritoneal cavity. After a shunt is inserted, the patient must be monitored for peritoneal distension indicating that an excessive quantity of fluid is being drained into the cavity.
A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother? 1. "I have a vase in the utility room, and I will get it for you." 2. "I will get the vase and wash it well before you put the flowers in it." 3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." 4. "When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible."
3 Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). For a hospitalized neutropenic child, flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas aeruginosa, to which the child is susceptible. In addition, fresh fruits and vegetables harbor molds and should be avoided until the white blood cell count increases.
A lumbar puncture is performed on a child suspected to have bacterial meningitis, and cerebrospinal fluid (CSF) is obtained for analysis. The nurse reviews the results of the CSF analysis and determines that which results would verify the diagnosis? 1. Clear CSF, decreased pressure, and elevated protein level 2. Clear CSF, elevated protein, and decreased glucose levels 3. Cloudy CSF, elevated protein, and decreased glucose levels 4. Cloudy CSF, decreased protein, and decreased glucose levels
3 Meningitis is an infectious process of the central nervous system caused by bacteria and viruses; it may be acquired as a primary disease or as a result of complications of neurosurgery, trauma, infection of the sinus or ears, or systemic infections. Meningitis is diagnosed by testing cerebrospinal fluid obtained by lumbar puncture. In the case of bacterial meningitis, findings usually include an elevated pressure; turbid or cloudy cerebrospinal fluid; and elevated leukocyte, elevated protein, and decreased glucose levels.
The nurse is educating the parents of an infant who is newly diagnosed with hemophilia A. Which of the following information should the nurse include in the teaching session? The nurse should advise the parents immediately to notify the child's primary health-care provider if the child: 1. develops a temperature above 101° F. 2. has a thick nasal discharge. 3. is difficult to arouse. 4. sleeps less than 3 hours at a time.
3 The parents should report immediate to the child's primary health-care provider if the child is difficult to arouse.
A 5-year old is admitted to the hospital with complaints of leg pain and fever. On physical exam, the child is pale and has bruising over various areas of the body. The physician suspects that the child has ALL. The nurse informs the parent that the diagnosis will be confirmed by which of the following? 1. Lumbar puncture 2. WBC count 3. Bone marrow aspirate 4. Bone scan
3 The diagnostic test that confirms leukemia is microscopic examination of the bone marrow aspirate.
The nurse enters a child's room and discovers that the child is having a seizure. Which actions should the nurse take? Select all that apply. 1. Call a code. 2. Run to get the crash cart. 3. Turn the child on her side. 4. Loosen any restrictive clothing. 5. Check the child's respiratory status. 6. Place an airway into the child's mouth.
3,4,5 During a seizure the child is placed on his or her side in a lateral position. Positioning on the side will prevent aspiration because saliva will drain out the corner of the child's mouth. The child is not restrained because this could cause injury to the child. The nurse would loosen clothing around the child's neck and ensure a patent airway by checking respiratory status. A code would be called if the child was not breathing or the heart is not beating. There are no data in the question indicating that this is the case. The nurse would stay with the child to reduce the risk of injury and allow for observation and timing of the seizure. Nothing is placed into the child's mouth during a seizure because this could injure the child's mouth, gums, or teeth.
A child fell off his bike and sustain a closed-head injury. The child is currently awake and alert, but his mother states that he "passed out" for approximately 2 minutes. The mother appears highly anxious and is very tearful. The child was not wearing a helmet. Which is a priority for the triage nurse to say at this time? 1. "Was anyone else injured in the accident?" 2. "Tell me more about the accident." 3. "Did he vomit, have a seizure, or display any other behavior that was unusual when he woke up?" 4. "Why was he not wearing a helmet?"
3. Asking specific questions will give the nurse the information needed to determine the level of care for the child.
The nurse is caring for a child who has been in a motor vehicle accident (MVA). The child falls asleep unless her name is called or she is gently shaken. This state of consciousness is referred to as: 1. Coma 2. Delirium 3. Obtunded 4. Confusion
3. Obtunded describes a state of consciousness in which the child has a limited response to the environment and can be aroused by verbal or tactile stimulation.
A nurse is collecting data on a 7-year-old child who is suspected of having episodes of absence seizures. Which question should the nurse ask the parents to identify the symptoms associated with these types of seizures? 1. "Does the muscle twitching occur on one side of the body?" 2. "Does the muscle twitching occur on both sides of the body?" 3. "Does the sensation of twitching occur in the face and neck?" 4. "Does the child have a blank expression during these episodes?"
4 Absence seizures are very brief episodes of altered awareness. There is no muscle activity except eyelid fluttering or twitching. The child has a blank facial expression. These seizures last only 5 to 10 seconds but may occur one after another several times a day. Myoclonic seizures are brief, random contractions of a muscle group that can occur on one or both sides of the body. Simple partial seizures consist of twitching of an extremity, the face, or the neck, or the sensation of twitching or numbness in an extremity, the face, or the neck.
The nurse is caring for a child who has sustained a femur fracture due to a motor vehicle accident. The child also has autism. Based on the diagnosis of autism, which of the following should be incorporated into the child's plan of care? 1. The nurse should plan to sit at the child's bedside for as much time as possible so the child does not feel threatened during assessments. 2. The child should be placed in a room with another child with autism so that he will not feel isolated. 3. The child should be placed near the playroom so that his anxieties will decrease as he hears and sees appropriate activities. 4. The nurse should plan to avoid touching the child to minimize physical contact.
4 Although care should be individualized, the nurse should minimize touch and interaction, because many children with autism find physical contact to be very stressful.
A nurse caring for an infant with a diagnosis of hydrocephalus should monitor the infant for which sign of increased intracranial pressure (ICP)? 1. Proteinuria 2. Bradycardia 3. A drop in blood pressure 4. A bulging anterior fontanel
4 An elevated or bulging anterior fontanel indicates an increase in cerebrospinal fluid collection in the cerebral ventricle. Proteinuria, bradycardia, and a drop in blood pressure are not specific signs of increased ICP. Changes in the level of consciousness and a widened pulse pressure are additional signs of increased ICP.
The nurse is providing home care instructions to the mother of a child who is recovering from Reye's syndrome. Which instruction should the nurse provide to the mother? 1. Increase stimuli in the home environment. 2. Avoid daytime naps so that the child will sleep at night 3. Give the child frequent small meals, if vomiting occurs. 4. Check the skin and eyes every day for a yellow discoloration.
4 Checking for jaundice will assist in identifying the presence of liver complications, which are characteristic of Reye's syndrome. Decreasing stimuli and providing rest decrease stress on the brain tissue. If vomiting occurs in Reye's syndrome, it is caused by cerebral edema and is a sign of intracranial pressure
A nurse notes that an infant with the diagnosis of hydrocephalus has a head that is heavier than that of the average infant. The nurse should determine that special safety precautions are needed when moving the infant with hydrocephalus. Which statement should the nurse plan to include in the discharge teaching with the parents to reflect this safety need? 1. "Feed your infant in a side-lying position." 2. "Place a helmet on your infant when in bed." 3. "Hyperextend your infant's head with a rolled blanket under the neck area." 4. "When picking up your infant, support the infant's neck and head with the open palm of your hand."
4 Hydrocephalus is a condition characterized by an enlargement of the cranium because of an abnormal accumulation of cerebrospinal fluid in the cerebral ventricular system. This characteristic causes the increase in the weight of the infant's head. The infant may experience significant head enlargement. Care must be exercised so that the head is well supported when the infant is fed or moved to prevent extra strain on the infant's neck, and measures must be taken to prevent the development of pressure areas. Supporting the infant's head and neck when picking up the infant will prevent the hyperextension of the neck area and the infant from falling backward. The infant should be fed with the head elevated for proper motility of food processing. A helmet could suffocate an unattended infant during rest and sleep times, and hyperextension of the infant's head could put pressure on the neck vertebrae, causing injury.
A nurse is assessing a child with a diagnosis of suspected appendicitis. In assessing the intensity and progression of the pain, the nurse palpates the child at McBurney's point. In performing this assessment, the nurse understands that McBurney's point is located midway between which area? 1. Left anterior inferior iliac crest and umbilicus 2. Left anterior superior iliac crest and umbilicus 3. Right anterior inferior iliac crest and umbilicus 4. Right anterior superior iliac crest and umbilicus
4 McBurney's point is midway between the right anterior superior iliac crest and the umbilicus. It is usually the location of greatest pain in the child with appendicitis. Therefore, the remaining options are anatomical locations.
The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that which laboratory study would assist in confirming the diagnosis? 1. Immunoglobulin 2. Red blood cell count 3. White blood cell count 4. Anti-streptolysin O titer
4 Rheumatic fever is an inflammatory autoimmune disease that affects the connective tissues of the heart, joints, skin (subcutaneous tissues), blood vessels, and central nervous system. A diagnosis of rheumatic fever is confirmed by the presence of two major manifestations or one major and two minor manifestations from the Jones criteria. In addition, evidence of a recent streptococcal infection is confirmed by a positive anti-streptolysin O titer, Streptozyme assay, or anti-DNase B assay. Options 1, 2, and 3 would not help to confirm the diagnosis of rheumatic fever.
A child with rheumatic fever will be arriving in the nursing unit for admission. On admission assessment, the nurse should ask the parents which question to elicit assessment information specific to the development of rheumatic fever? 1. "Has the child complained of back pain?" 2. "Has the child complained of headaches?" 3. "Has the child had any nausea or vomiting?" 4. "Did the child have a sore throat or fever within the last 2 months?"
4 Rheumatic fever is an inflammatory autoimmune disease that affects the connective tissues of the heart, joints, skin (subcutaneous tissues), blood vessels, and central nervous system. Rheumatic fever characteristically manifests 2 to 6 weeks after an untreated or partially treated group A b-hemolytic streptococcal infection of the upper respiratory tract. Initially, the nurse determines whether the child had a sore throat or an unexplained fever within the past 2 months. Options 1, 2, and 3 are unrelated to rheumatic fever.
The community health nurse is providing information to parents of children in a local school regarding the signs of meningitis. The nurse informs the parents that the classic signs/symptoms of meningitis include which findings? 1. Nausea, delirium, and fever 2. Severe headache and back pain 3. Photophobia, fever, and confusion 4. Severe headache, fever, and a change in the level of consciousness
4 The classic signs/symptoms of meningitis include severe headache, fever, stiff neck, and a change in the level of consciousness. Photophobia also may be a prominent early manifestation and is thought to be related to meningeal irritation. Although nausea, confusion, delirium, and back pain may occur in meningitis, these are not the classic signs/symptoms.
The nurse is assessing a child with increased intracranial pressure. On assessment, the nurse notes that the child is now exhibiting decerebrate posturing. The nurse should modify the client's plan of care based on which interpretation of the client's change? 1. An insignificant finding 2. An improvement in condition 3. Decreasing intracranial pressure 4. Deteriorating neurological function
4 The progression from decorticate to decerebrate posturing usually indicates deteriorating neurological function and warrants health care provider notification. Options 1, 2, and 3 are inaccurate interpretations.
The nurse is assessing for Kernig's sign in a child with a suspected diagnosis of meningitis. Which action should the nurse perform for this test? 1. Tap the child's facial nerve and assess for spasm. 2. Compress the child's upper arm and assess for tetany. 3. Bend the child's head toward the knees and hips and assess for pain. 4. Raise the child's leg with the knee flexed and then extend the leg at the knee and assess for pain.
4 To test for Kernig's sign, the client's leg is raised with the knee flexed and then extended at the knee. If any resistance is noted or pain is felt, the result is a positive Kernig's sign. This is a common finding in meningitis. Chvostek's sign, seen in tetany, is a spasm of the facial muscles elicited by tapping the facial nerve in the region of the parotid gland. Trousseau's sign is a sign for tetany in which carpal spasm can be elicited by compressing the upper arm and causing ischemia to the nerves distally. Brudzinski's sign occurs when flexion of the head causes flexion of the hips and knees.
The nurse develops a plan of care for a child at risk for tonic-clonic seizures. In the plan of care, the nurse identifies seizure precautions and documents that which item(s) need to be placed at the child's bedside? 1. Emergency cart 2. Tracheotomy set 3. Padded tongue blade 4. Suctioning equipment and oxygen
4 A seizure results from the excessive and unorganized neuronal discharges in the brain that activate associated motor and sensory organs. A type of generalized seizure is a tonic-clonic seizure. This type of seizure causes rigidity of all body muscles, followed by intense jerking movements. Because increased oral secretions and apnea can occur during and after the seizure, oxygen and suctioning equipment are placed at the bedside. A tracheotomy is not performed during a seizure. No object, including a padded tongue blade, is placed into the child's mouth during a seizure. An emergency cart would not be left at the bedside, but would be available in the treatment room or nearby on the nursing unit.
The nurse is performing an assessment of a 7-year-old child who is suspected of having episodes of absence seizures. Which assessment question to the mother will assist in providing information that will identify the symptoms associated with this type of seizure? 1. "Does twitching occur in the face and neck?" 2. "Does the muscle twitching occur on one side of the body?" 3. "Does the muscle twitching occur on both sides of the body?" 4. "Does the child have a blank expression during these episodes?"
4 Absence seizures are brief episodes of altered awareness or momentary loss of consciousness. No muscle activity occurs except eyelid fluttering or twitching. The child has a blank facial expression. These seizures last only 5 to 10 seconds, but they may occur one after another several times a day. Simple partial seizures consist of twitching of an extremity, face, or neck, or the sensation of twitching or numbness in an extremity or face or neck. Myoclonic seizures are brief random contractions of a muscle group that can occur on one or both sides of the body.
The parents of a child recently diagnosed with cerebral palsy ask the nurse about the disorder. The nurse bases the response on the understanding that cerebral palsy is which type of condition? 1. An infectious disease of the central nervous system 2. An inflammation of the brain as a result of a viral illness 3. A congenital condition that results in moderate to severe retardation 4. A chronic disability characterized by impaired muscle movement and posture
4 Cerebral palsy is a chronic disability characterized by impaired movement and posture resulting from an abnormality in the extrapyramidal or pyramidal motor system. Meningitis is an infectious process of the central nervous system. Encephalitis is an inflammation of the brain that occurs as a result of viral illness or central nervous system infection. Down syndrome is an example of a congenital condition that results in moderate to severe retardation.
A mother arrives at an emergency department with her 5-year-old child and states that the child fell off a bunk bed. A head injury is suspected, and the nurse checks the child's airway status and assesses the child for early and late signs of increased intracranial pressure (ICP). Which is a late sign of increased ICP? 1. Nausea 2. Irritability 3. Headache 4. Bradycardia
4 Head injury is the pathological result of any mechanical force to the skull, scalp, meninges, or brain. A head injury can cause bleeding in the brain and result in increased intracranial pressure (ICP). In a child, early signs include a slight change in level of consciousness, headache, nausea, vomiting, visual disturbances (diplopia), seizures. Late signs of increased ICP include a significant decrease in level of consciousness, bradycardia, decreased motor and sensory responses, alterations in pupil size and reactivity, posturing, Cheyne-Stokes respirations, and coma.
The nurse notes documentation that a child with meningitis is exhibiting a positive Kernig's sign. Which observation is characteristic of this sign? 1. The child complains of muscle and joint pain. 2. Petechial and purpuric rashes are noted on the child's trunk. 3. Neck flexion causes adduction and flexion movements of the lower extremities. 4. The child is not able to extend the leg when the thigh is flexed anteriorly at the hip.
4 Meningitis is an infectious process of the central nervous system caused by bacteria and viruses. The inability to extend the leg when the thigh is flexed anteriorly at the hip is a positive Kernig's sign, noted in meningitis. Muscle and joint pain is characteristic of meningococcal infection and H. influenzae infection. A petechial or purpuric rash is characteristic of meningococcal infection. A positive Brudzinski's sign is noted when neck flexion causes adduction and flexion movements of the lower extremities in children and adolescents. This is also a characteristic of meningitis.
The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which precautionary intervention should be included in the plan of care? 1. Maintain enteric precautions. 2. Maintain neutropenic precautions. 3. No precautions are required as long as antibiotics have been started. 4. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics.
4 Meningitis is an infectious process of the central nervous system caused by bacteria and viruses; it may be acquired as a primary disease or as a result of complications of neurosurgery, trauma, infection of the sinus or ears, or systemic infections. A major priority of nursing care for a child suspected to have meningitis is to administer the antibiotic as soon as it is prescribed. The child also is placed on respiratory isolation precautions for at least 24 hours while culture results are obtained and the antibiotic is having an effect. Enteric precautions and neutropenic precautions are not associated with the mode of transmission of meningitis. Enteric precautions are instituted when the mode of transmission is through the gastrointestinal tract. Neutropenic precautions are instituted when a child has a low neutrophil count.
A child is diagnosed with Reye's syndrome. The nurse develops a nursing care plan for the child and should include which intervention in the plan? 1. Assessing hearing loss 2. Monitoring urine output 3. Changing body position every 2 hours 4. Providing a quiet atmosphere with dimmed lighting
4 Reye's syndrome is an acute encephalopathy that follows a viral illness and is characterized pathologically by cerebral edema and fatty changes in the liver. A definitive diagnosis is made by liver biopsy. In Reye's syndrome, supportive care is directed toward monitoring and managing cerebral edema. Decreasing stimuli in the environment by providing a quiet environment with dimmed lighting would decrease the stress on the cerebral tissue and neuron responses. Hearing loss and urine output are not affected. Changing the body position every 2 hours would not affect the cerebral edema directly. The child should be positioned with the head elevated to decrease the progression of the cerebral edema and promote drainage of cerebrospinal fluid.
The nurse expects which of the following clinical manifestations in a child diagnosed with SCID? 1. prolonged bleeding 2. Failure to thrive 3. Fatigue and malaise. 4. Susceptibility to infection.
4. SCID is characterized by an absence of cell-mediated immunity, with the most common clinical manifestation being infection in children from age 3 months. These children do not usually recover from these infections.
Which of the following factors need to be included in the teaching plan for a child with sickle cell anemia? SATA 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 1. Seek medical attention for illness to prevent the child from going into a crisis. 3 Stress can cause a depressed immune system, making the child more susceptible to infection and crisis. Parents and children are advised to avoid stress. 4. The child needs good hydration and nutrition to maintain good health. 5. The child needs good hydration and nutrition to maintain good health.
Which of the following activities should a nurse suggest for a client diagnosed with hemophilia. SATA 1. Swimming 2. Golf 3. Hiking 4. Fishing 5. Soccer
1,2,3,4 1. Children with hemophilia should be encouraged to take part in non contact activities that allow for social, psychological and physical growth, such as swimming. 2. Children with hemophilia would be encouraged to take part in non contact activities that allow for social, psychological, and physical growth, such as golf. 3. Children with hemophilia should be encouraged to take part in non contact activities that allow for social, psychological, and physical growth, such as hiking 4. Children with hemophilia should be encouraged to take part in non contact activities that allow for social, psychological, and physical growth, such as fishing.
A child with hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. Which of the following measures should be taken to stop the bleeding? SATA 1.The extremity should be immobilized. 2. The extremity should be elevated. 3. Warm moist compresses should be applied to decrease pain. 4. Passive range-of-motion exercises should be administered to the extremity. 5. Factor VIII should be administered.
1,2,5 1. Measures are needed to induce vasoconstriction and stop the bleeding, including immobilization of the extremity. 2. Measures are needed to induce vasoconstriction and stop the bleeding. Treatment should include elevating the extremity. 5. Hemophilia A is a deficiency in factor VIII which causes delay in clotting when there is a bleed.
Which of the following can lead to a possible diagnosis of human immunodeficiency virus (HIV) in a child? SATA 1. Repeated respiratory infections 2. Intermittent diarrhea 3. Excessive weight gain 4. Irregular heartbeat 5. Poor weight gain
1,2,5 1. Symptoms of HIV include frequent respiratory infections. The symptoms present based on the underlying cellular immunodeficiency-related disease. 2. Symptoms of HIV include intermittent diarrhea. The symptoms present based on the underlying cellular immunodeficiency-related disease. 5. Symptoms of HIV include poor weight gain.
The nurse is caring for a child who is receiving a transfusion of packed RBCs. The nurse is aware that if the child had a hemolytic reaction to the blood, the signs and symptoms would include which of the following? SATA 1. Fever 2. Rash 3. Oliguria 4. Hypotension 5. Chills
1,3,4 1. Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock. 3. Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock. 4. Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock.
A 2 month old infant is brought to the ER after experiencing a seizure. The infant appears lethargic with very irregular respirations and periods of apnea. The parents report the baby is no longer interested in feeding and before the seizure, rolled off the couch. What additional testing should the nurse immediately prepare for? 1. CT scan of the head and dilation of the eyes. 2. CT scan of the head and EEG. 3. X-rays of the head. 4. X-rays of all long bones.
1. A computed tomography scan of the head will reveal trauma. Dilating the eyes is performed to check for retinal hemorrhages that are seen in an infant who has experienced SBS.
The nurse is caring for a child with a skull fracture who is unconscious and has severely increased ICP. The nurse notes the child's temperature to be 40 degrees C. Which should the nurse do first? 1. Place a cooling blanket on the child. 2. Administer Tylenol via nasogastric tube. 3. Administer Tylenol rectally. 4. Place ice packs in the child's axillary areas.
1. A cooling blanket will help cool the child quickly and at a controlled temperature.
Which of the following confirms a diagnosis of Hodgkin disease in a 15-year old? 1. Reed-Sternberg cells in the lymph nodes. 2. Blast cells in the blood. 3. Lymphocytes in the bone marrow. 4. VMA in the urine.
1. A lymph node biopsy is done to confirm a histological diagnosis and staging of Hodgkin disease. The presence of Reed-Sternberg cells is characteristic of the disease.
A child with a seizure disorder has been having episodes during which she drops her pencil and simply appears to be daydreaming. This is most likely an: 1. Absence seizure 2. Akinetic seizure 3. Non-epileptic seizure 4. Simple spasm seizure
1. Absence seizures occur frequently and last less than 30 seconds. The child experiences a brief loss of consciousness during which she may have a change in activity. These children rarely fall, but they may drop an object. The condition is often confused with daydreaming.
The nurse is caring for a child with sickle cell anemia who is scheduled to have an exchange transfusion. What information should the nurse explain to the parents regarding the reason for a splenectomy? 1. The procedure is done to prevent further sickling during a vast-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 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.
The nurse is caring for a 3-year-old with an altered state of consciousness. The nurse determines that the child is oriented by asking the child to: 1. Name the president of the United States. 2. Identify her parents and state her own name. 3. State her full name and phone number. 4. Identify the current month but not the date.
2. Asking the 3-year-old to identify her parents and state her name is a developmentally appropriate way to assess orientation.
Which of the following is the best method to prevent the spread of infection to an immunosuppressed child? 1. Administer antibiotics prophylactically to the child. 2. Have people wash their hands prior to contact with the child. 3. Assign the same nurses to care for the child each day. 4. Limit visitors to family members only.
2. Hand-washing is the best method to prevent the spread of germs and protect the child from infection.
Which signs best indicate increased intracranial pressure (ICP) in an infant? SATA 1. Sunken anterior fontanel 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite. 5. Sleeping more than usual.
3,5 3. A high pitched cry is often indicative of increased ICP in infants. 5. The infant may be sleeping more than usual sure to increased ICP.
Which of the following analgesics is most effective for a child with sickle cell pain crisis? 1. Demerol 2. Aspirin 3. Morphine 4. Excedrin
3. Morphine is the drug of choice for a child with sickle cell crises. Usually the child is started on oral doses of Tylenol with codeine. When that is not sufficient to alleviate pain, stronger narcotics are prescribed such as morphine.
A child in the PICU with a head injury is comatose and unresponsive. The parent asks if he needs pain medication. Select the nurse's best response. 1. "Pain medication is not necessary as he is unresponsive and cannot feel pain." 2. "Pain medication may interfere with his ability to respond and may mask any signs of improvement." 3. "Pain medication is necessary to make him comfortable." 4. "Pain medication is necessary for comfort, but we use it cautiously as it increases the demand for oxygen."
3. Pain medication promotes comfort and ultimately decreases ICP.
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 Tylenol. 2. Immobilize the joint, and elevate the extremity. 3. Apply heat to the area. 4. Administer factor per the home-crd protocol.
4. Administration of factor should be the first intervention if home-care transfusions have been initiated.
A child with a ventriculoperitoneal (VP) shunt complains of a 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, and see if her symptoms improve. If they do not improve, bring her to the pediatrician's office." 2. "It is common for girls to have these symptoms, especially prior to beginning their menstrual cycle. Giver he 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 as it has been working well for 9 years." 4. "You should immediately take her to the emergency room as these may be symptoms of a shunt malfunction."
4. These are symptoms of a shunt malfunction and should be evaluated immediately.
A child diagnosed with HIV is prescribed a combination of antiretroviral drugs to delay
Drug resistance A combination of antiretroviral medications is prescribed for a child who is HIV positive to delay development of drug resistance. HIV drugs work on different stages of the HIV life cycle to prevent reproduction of new virus particles.
The nurse is caring for a child with leukemia. The nurse would be aware that children being treated for leukemia may experience which of the following complications? SATA 1. Anemia 2. Infection 3. Bleeding tendencies 4. Bone deformities 5. Polycythemia
1,2 1. Anemia is caused by decreased production of red blood cells. 2. Infection risk in leukemia is secondary to the neutropenia.
Which of the following measures should the nurse implement to help with the nausea and vomiting from chemotherapy? SATA 1. Give an antiemetic 30 minutes prior to the start of therapy. 2. Continue the antiemetic as ordered until 24 hours after the chemotherapy is complete. 3. Remove food that has a lot of odor. 4. Keep the child on a nothing-by-mouth status. 5. Wait until the nausea begins to start the antiemetic.
1,2,3 1. The first dose would be given 30 minutes prior to the start of the therapy. 2. Antiemetic should be administered around the clock until 24 hours after the chemotherapy is completed. 3. It is also helpful to remove foods with odor so the smell of the food does not make the child nauseated.
A nurse is caring for a 15-year old who has just been diagnosed with non-Hodgkin lymphoma. Which of the following should the nurse include in teaching the parents about this lymphoma? SATA 1. The malignancy originates in the lymphoid system. 2. The presence of Reed-Sternberg cells in the biopsy is considered diagnostic. 3. Mediastinal involvement is typical. 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation.
1,3,4,5 1. Non-Hodgkin disease originates in the lymphoid system. 3. Mediastinal involvement is typical 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation.
A child diagnosed with leukemia is receiving allopurinol as part of the treatment plan. The parents ask why their child is receiving this medication. What information about the medication should the nurse provide? 1. Helps reduce the uric acid level caused by cell destruction. 2. Used to make the chemotherapy work better. 3. Given to reduce the nausea and vomiting associated with chemotherapy. 4. Helps decrease pain in the bone marrow.
1. Allpurinol reduces serum uric acid. When there is lysis of cells from chemotherapy, there will be an increase in serum uric acid.
The nurse is caring for a 10-year old with leukemia who is receiving chemotherapy. The child is on neutropenic precautions. Friends of the child come to the desk and ask for a vase for flowers. Which f the following is the best response? 1. "I will get you a special vase that we use on this unit." 2. "The flowers from your garden are beautiful but should not be placed in the room at this time." 3. "As soon as I can wash a vase, I will put the flowers in it and bring it to the room." 4. "Get rid of the flowers immediately. You could harm the child."
2. A neutropenic client should not have flowers in the room because the flowers may harbor Aspergillus or Pseudomonas aeruginosa. Neutropenic children are susceptible to infection. Precautions need to be taken so the child does not come in contact with any potential sources of infection. Fresh fruits and vegetables can also harbor molds and should be avoided. Telling the friend that the flowers are beautiful but that the child cannot have them is a tactful way not to offend the friend.
The nurse is caring for a child with sickle cell disease who is scheduled to have a splenectomy. What information would 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 RBCs 4. To prevent sickle cell crisis
2. Splenic sequestration is a life threatening situation in children with sickle cell anemia. Once a child is considered to be a high risk of splenic sequestration or has had this in the past, the spleen will be removed.
What are the clinical manifestations of non-Hodgkin lymphoma? 1. Basically the same as those in Hodgkin disease. 2. Depends on the anatomical site and extent of involvement. 3. Those that affect the abdomen, as non-Hodgkin lymphoma is a fast-growing cancer in very young children. 4. Changes that occur in the the lower extremities.
2. The clinical manifestations include symptoms of involvement. Rarely is a single sign or symptom diagnostic. Metastasis to the bone marrow or CNS may produce manifestations of leukemia.
The nurse is caring for a child diagnosed with thalessemia major who is receiving the first chelation therapy. What information should the nurse teach the parent regarding the therapy? 1. Decreases the risk of bleeding. 2. Eliminates excess iron 3. Prevents further sickling of the RBCs 4. Provides an iron supplement.
2. chelation therapy is used to rid the body of excess iron stores that result from frequent blood transfusions.
An 18-month old male is brought to the clinic by his mother. His height is in the 50th percentile, and weight is in the 80th percentile. The child is pale. The physical examination is normal, but his hematocrit level is 20%. Which of the following questions would asset the nurse in making a diagnosis. SATA 1. "How many bowel movements a day does your child have?" 2. " How much did your baby weight at birth?" 3. " What does your child eat every day?" 4. " Has the child been given any new medications?" 5. " How much milk does your child drink per day?"
3,5 3. A diet history is necessary to determine the nutritional status of the child and whether the child is getting sufficient sources of iron. 5. By asking how much milk the child consumes, the nurse can determine whether the child is filling up on milk and then not wanting to take food.
The nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems are associated with sickle cell disease. Select all that apply 1. Polycythemia 2. Hemarthrosis 3. Aplastic crisis 4. Thrombocytopenia 5. Splenic sequestration 6. Vaso-occlusive crisis
3,5,6 3. Aplastic crisis is associated with sickle cell anemia. 5. Splenic sequestration is associated with sickle cell anemia 6. Vaso- occlusive crisis is the most common problem in children with sickle cell disease.
The school nurse sees a 6-year-old child in the cafeteria during lunch time who is taking food items out of the garbage can. Which of the following would be the best comment for the nurse to make at this time? 1. "Put the food back into the garbage can. Don't you realize that it could make you sick?" 2. "I'm going to have to call your parents if you don't stop picking through the garbage!" 3. "Are you hungry? Why don't you come to my office and I will give you a snack." 4. "I want you to march yourself down to the principal's office and tell him what you did!"
3. This is the best comment. Children who pick food out of garbage cans may not be getting enough to eat at home. The nurse would be able to watch the child eat the snack in the nurse's office and to query the child regarding how much food the child is eating at home.
A teen is seen in the clinic for a possible diagnosis for Hodgkin disease. The nurse is aware that which of the following symptoms should make the physicians suspect Hodgkin disease? 1. Fever, fatigue, and pain in the joints. 2. Anorexia with weight loss. 3. Enlarged, painless, and movable lymph nodes in the cervical area. 4. Enlarged liver with jaundice.
3. Enlarged, painless, and movable lymph nodes in the cervical area are the most common presenting manifestation of Hodgkin disease.
A child with Reye syndrome is described in the nurse's notes as follows: 1200-comatose with sluggish pupils; when stimulated, demonstrates decerebrate posturing. 1400-unchanged except the now demonstrates decorticate posturing when stimulated. The nurse concludes that the child's condition is: 1. Worsening and progressing to a more advanced stage of Reye syndrome. 2. Worsening, and the child may likely experience cardiac and respiratory failure. 3. Improving and progressing to a less advanced stage of Reye syndrome. 4. Improving as the child's posturing reflexes are similar.
3. Progressing from decerebrate to decorticate posting usually indicates an improvement in the child's condition
The nurse is caring for a child who is receiving extensive radiation as part of the treatment for Hodgkin disease. Which intervention should be implemented? 1. Administer pain medication prior to the child's going to radiation therapy. 2. Assess the child for neuropathy since this is a common side effect. 3. Provide adequate rest, as the child may experience excessive malaise and lack of energy. 4. Encourage the child to eat a low-protein diet while on radiation therapy.
3. The most common side effect is extensive malaise, which may be from damage to the thyroid gland, causing hypothyroidism.
Which intervention should be implemented after a bone marrow aspiration? 1. Ask the child to remain in a supine position 2. Place the child in an upright position for 4 hours. 3. Keep the child nothing by mouth for 6 hours. 4. Administer analgesics as needed for pain.
4. Children may experience minor discomfort after the procedure, and analgesics should be given as needed.
A child is being admitted with the diagnosis of meningitis. Select the procedure the nurse should do first: 1. Administration of IV antibiotics 2. Administration of maintenance IV fluids 3. Placement of a Foley catheter 4. Send the spinal fluid and blood samples to the lab for cultures
4. Cultures of spinal fluid and blood should be obtained, followed by administration of IV antibiotics.
A nurse is doing discharge education with a parent who has a child with beta-thalassemia (Cooley anemia) The nurse informs the parent that the child is at risk for which of the following conditions? 1. Hypertrophy of the thyroid. 2. Polycythemia vera. 3. Thrombocytopenia. 4. Chronic hypoxia and iron overload.
4. In beta-thalassemia there is increased destruction of RBCs causing anemia. This results in chronic anemia and hypoxia. The children are treated with multiple blood transfusions, which can cause iron overload and damage to major organs.
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 month 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 immediately to the physician."
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 of taking the temperature is axillary, especially if the child has mouth sores.
Prednisone is given to children who are being treated for leukemia. Why is this medication given as part of the treatment plan? 1. Enhances protein metabolism. 2. Enhances sodium excretion. 3. Increases absorption of the chemotherapy. 4. Destroys abnormal lymphocytes.
4. Prednisone is used in many of the treatment protocols for leukemia because there is abnormal lymphocyte production. Prednisone is though to destroy abnormal lymphocytes.
A nurse educator is providing a teaching session for the nursing staff. Which of the following individuals is at greatest risk for developing beta-thalassemia (Cooley anemia)? 1. A child of Mediterranean descent. 2. A child of Mexican descent. 3. A child whose mother has chronic anemia. 4. a child who has a low intake of iron.
1. Beta-thalassemia is an inherited recessive disorder that is found primarily in individuals of Mediterranean descent. The disease has also been reported in Asian and African populations.
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 kinds 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.
The nurse is caring for a 1 year old who has just been diagnosed with viral encephalitis. The parents ask if their child will be admitted to the hospital. Select the nurse's best response. 1. "Your child will likely be sent home because encephalitis is usually caused by a virus and not bacteria." 2. "Your child will likely be admitted to the pediatric floor for IV antibiotics and observation." 3. "Your child will likely be admitted to the PICU for close monitoring and observation." 4. "Your child will likely be sent home because she is only 1 year old. We see fewer complications and a shorter disease process in the younger child."
3. The young child with encephalitis should be admitted to a PICU where close observation and monitoring are available. The child should be observed for signs of increased ICP and for cardiac and respiratory compromise.
