Pediatrics EXAM 3

Varicella Rash

Pruritic macules, papules, and vesicles in crops

Communicability: Rubella

7 days before till 5 days after rash

What describes a child who is abused by the parent(s)? a. Unintentionally contributes to the abusing situation b. Belongs to a low socioeconomic population c. Is healthier than the nonabused siblings d. Abuses siblings in the same way as child is abused by the parent(s)

ANS: A A child's temperament, position in the family, additional physical needs, activity level, or degree of sensitivity to parental needs unintentionally contributes to the abusing situation. Socioeconomic status is an environmental characteristic. This child is less likely to be abused than one who is premature, disabled, or very young. The abused child does not in turn abuse his or her siblings. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1067, 1068 OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Assessment

The abuse of which of the following substances during pregnancy is the leading cause of cognitive impairment in the United States? a. Alcohol c. Marijuana b. Tobacco d. Heroin

ANS: A Alcohol abuse during pregnancy is recognized as one of the leading causes of cognitive impairment in the United States. PTS: 1 DIF: Cognitive Level: Knowledge REF: 757 OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Assessment

Which condition can result from the bone demineralization associated with immobility? a. Osteoporosis b. Urinary retention c. Pooling of blood d. Susceptibility to infection

ANS: A Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi. Urinary retention is secondary to the effect of immobilization on the urinary tract. Pooling of blood is a result of the cardiovascular effects of immobilization. Susceptibility to infection can result from the effects of immobilization on the respiratory and renal systems. p1534

Which term is used to describe a type of fracture that does not produce a break in the skin? a. Simple b. Compound c. Complicated d. Comminuted

ANS: A If a fracture does not produce a break in the skin, it is called a simple or closed fracture. A compound or open fracture is one with an open wound through which the bone protrudes. A complicated fracture is one in which the bone fragments damage other organs or tissues. A comminuted fracture occurs when small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue. These are rare in children. p1538

Impetigo ordinarily results in: a. No scarring. c. Slightly depressed scars. b. Pigmented spots. d. Atrophic white scars.

ANS: A Impetigo tends to heal without scarring unless a secondary infection occurs. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1642 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

The only symptom of pediculosis capitis (head lice) is usually: a. Itching. c. Scalp rash. b. Vesicles. d. Localized inflammatory response.

ANS: A Itching is generally the only manifestation of pediculosis capitis (head lice). Diagnosis is made by observation of the white eggs (nits) on the hair shaft. Vesicles, scalp rash, and localized inflammatory response are not symptoms of head lice. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1651 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

The nurse is preparing an adolescent with scoliosis for a Luque-rod segmental spinal instrumentation procedure. Which consideration should the nurse include? a. Nasogastric intubation and urinary catheter may be required. b. Ambulation will not be allowed for up to 3 months. c. Surgery eliminates the need for casting and bracing. d. Discomfort can be controlled with nonpharmacologic methods.

ANS: A Luque-rod segmental spinal instrumentation is a surgical procedure. Nasogastric intubation and urinary catheterization may be required. Ambulation is allowed as soon as possible. Depending on the instrumentation used, most patients walk by the second or third postoperative day. Casting and bracing are required postoperatively. The child usually has considerable pain for the first few days after surgery. Intravenous opioids should be administered on a regular basis.p1535

A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What should the nurse suggest to remove this material? a. Soak in a bathtub. c. Apply powder to absorb material. b. Vigorously scrub the leg. d. Carefully pick material off of the leg.

ANS: A Simple soaking in the bathtub is usually sufficient for the removal of the desquamated skin and sebaceous secretions. It may take several days to eliminate the accumulation completely. The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding. Oil or lotion, but not powder, may provide comfort for the child. p1542

A young girl has just injured her ankle at school. In addition to calling the child's parents, the most appropriate immediate action by the school nurse is to: a. Apply ice. b. Observe for edema and discoloration. c. Encourage child to assume a comfortable position. d. Obtain parental permission for administration of acetaminophen or aspirin.

ANS: A Soft-tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. Observing for edema and discoloration, encouraging the child to assume a comfortable position, and obtaining parental permission or administration of acetaminophen or aspirin are not immediate priorities. p1537

Acyclovir (Zovirax) is given to children with chickenpox to: a. Minimize scarring. c. Prevent aplastic anemia. b. Decrease the number of lesions. d. Prevent spread of the disease.

ANS: B Acyclovir decreases the number of lesions; shortens duration of fever; and decreases itching, lethargy, and anorexia; however, it does not prevent scarring. Preventing aplastic anemia is not a function of acyclovir. Only quarantine of the infected child can prevent the spread of disease. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1057 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Implementation

The nurse is examining 12-month-old Amy, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions that cross the inguinal folds. This is most likely caused by: a. Impetigo. c. Urine and feces. b. Candida albicans. d. Infrequent diapering.

ANS: B Candida albicans infection produces perianal inflammation and a maculopapular rash with satellite lesions that may cross the inguinal folds. Impetigo is a bacterial infection that spreads peripherally in sharply marginated irregular outlines. Eruptions involving the skin in contact with the diaper but sparing the folds are likely to be caused by chemical irritation, especially urine and feces. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1655 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Implementation

Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell off of a tree. When discussing this injury with her parents, the nurse should consider which statement? a. Healing is usually delayed in this type of fracture. b. Growth can be affected by this type of fracture. c. This is an unusual fracture site in young children. d. This type of fracture is inconsistent with a fall.

ANS: B Detection of epiphyseal injuries is sometimes difficult, but fractures involving the epiphysis or epiphyseal plate present special problems in determining whether bone growth will be affected. Healing of epiphyseal injuries is usually prompt. The epiphysis is the weakest point of the long bones. This is a frequent site of damage during trauma. p1554

The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complications should the nurse monitor? a. Hypocalcemia b. Decreased metabolic rate c. Positive nitrogen balance d. Increased production of stress hormones

ANS: B Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake, leads to hypercalcemia, and causes a negative nitrogen balance secondary to muscle atrophy. A decreased production of stress hormones occurs with decreased physical and emotional coping capacity. Ch48 Musculoskeletal/Articular Dysfunction p1531

Ringworm, frequently found in schoolchildren, is caused by: a. Virus. c. Allergic reaction. b. Fungus. d. Bacterial infection.

ANS: B Ringworm is caused by a group of closely related filamentous fungi that invade primarily the stratum corneum, hair, and nails. They are superficial infections that live on, not in, the skin. Virus and bacterial infection are not causative organisms for ringworm. Ringworm is not an allergic response. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1643 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

An important nursing consideration when caring for a child with impetigo contagiosa is to: a. Apply topical corticosteroids to decrease inflammation. b. Carefully remove dressings so as not to dislodge undermined skin, crusts, and debris. c. Carefully wash hands and maintain cleanliness when caring for an infected child. d. Examine child under a Wood lamp for possible spread of lesions.

ANS: C A major nursing consideration related to bacterial skin infections such as impetigo contagiosa is to prevent the spread of the infection and complications. This is done by thorough handwashing before and after contact with the affected child. Corticosteroids are not indicated in bacterial infections. Dressings are usually not indicated. The undermined skin, crusts, and debris are carefully removed after softening with moist compresses. A Wood lamp is used to detect fluorescent materials in the skin and hair. It is used in certain disease states such as tinea capitis. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1641 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Implementation

Which statement is accurate concerning a child's musculoskeletal system and how it may be different from an adult's? a. Growth occurs in children as a result of an increase in the number of muscle fibers. b. Infants are at greater risk for fractures because their epiphyseal plates are not fused. c. Because soft tissues are resilient in children, dislocations and sprains are less common than in adults. d. Children's bones have less blood flow.

ANS: C Because soft tissues are resilient in children, dislocations and sprains are less common than in adults. A child's growth occurs because of an increase in size rather than an increase in the number of the muscle fibers. Fractures in children younger than 1 year are unusual because a large amount of force is necessary to fracture their bones. A child's bones have greater blood flow than an adult's bones. p1536

Vitamin A supplementation may be recommended for the young child who has: a. Mumps. c. Measles (rubeola). b. Rubella. d. Erythema infectiosum.

ANS: C Evidence shows that vitamin A decreases morbidity and mortality associated with measles. Vitamin A will not lessen the effects of mumps, rubella or fifth disease. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1057 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Implementation

When does idiopathic scoliosis become most noticeable? a. Newborn period b. When child starts to walk c. During preadolescent growth spurt d. Adolescence

ANS: C Idiopathic scoliosis is most noticeable during the preadolescent growth spurt and is seldom apparent before age 10 years. p1557

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. What should be included? a. Apply lotion or powder to minimize skin irritation. b. Remove the harness several times a day to prevent contractures. c. Return to the clinic every 1 to 2 weeks. d. Place a diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.

ANS: C Infants have a rapid growth pattern. The child needs to be assessed by the practitioner every 1 to 2 weeks for possible adjustments. Lotions and powders should not be used with the harness. The harness should not be removed, except as directed by the practitioner. A thin disposable diaper can be placed under the harness. p1550

The primary method of treating osteomyelitis is: a. Joint replacement. b. Bracing and casting. c. Intravenous antibiotic therapy. d. Long-term corticosteroid therapy.

ANS: C Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus aureus. The treatment of choice is antibiotics. Joint replacement, bracing and casting, and long-term corticosteroids are not indicated for infectious processes. p1560

Which type of traction uses skin traction on the lower leg and a padded sling under the knee? a. Dunlop c. Russell b. Bryant's d. Buck's extension

ANS: C Russell traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position. Dunlop traction is an upper extremity traction used for fractures of the humerus. Bryant's traction is skin traction with the legs flexed at a 90-degree angle at the hip. Buck's extension traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, before surgery with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease. p1543

The primary clinical manifestation of scabies is: a. Edema. c. Pruritus. b. Redness. d. Maceration.

ANS: C Scabies is caused by the scabies mite. The inflammatory response and intense itching occur after the host has become sensitized to the mite. This occurs approximately 30 to 60 days after initial contact. In the previously sensitized person the response occurs within 48 hours. Edema, redness, and maceration are not observed in scabies. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1650 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

Nursing care of the infant with atopic dermatitis focuses on: a. Feeding a variety of foods. b. Keeping lesions dry. c. Preventing infection. d. Using fabric softener to avoid rough cloth.

ANS: C The eczematous lesions of atopic dermatitis are intensely pruritic. Scratching can lead to new lesions and secondary infection. The infant's nails should be kept short and clean and have no sharp edges. During periods of irritability these children tend to have a decreased appetite. The restriction of hyperallergenic foods such as milk, dairy products, peanuts, and eggs, may make adequate nutrition a challenge with these children. Wet soaks and compresses are used to keep the lesions moist and minimize the pruritus. Fabric softener should be avoided because of the irritant effects of some of its components. PTS: 1 DIF: Cognitive Level: Application REF: 1657 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

Herpes zoster is caused by the varicella virus and has an affinity for: a. Sympathetic nerve fibers. b. Parasympathetic nerve fibers. c. Posterior root ganglia and the posterior horn of the spinal cord. d. Lateral and dorsal columns of the spinal cord.

ANS: C The herpes zoster virus has affinity for posterior root ganglia, the posterior horn of the spinal cord, and skin, and does not involve sympathetic or parasympathetic nerve fibers, or lateral and dorsal columns of the spinal cord. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1644 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

Which nursing intervention is appropriate to assess for neurovascular competency in a child who fell off the monkey bars at school and hurt his arm? a. The degree of motion and ability to position the extremity. b. The length, diameter, and shape of the extremity. c. The amount of swelling noted in the extremity and pain intensity. d. The skin color, temperature, movement, sensation, and capillary refill of the extremity.

ANS: D A neurovascular evaluation includes assessing skin color and temperature, ability to move the affected extremity, degree of sensation experienced, and speed of capillary refill in the extremity. The degree of motion in the affected extremity and ability to position the extremity are incomplete assessments of neurovascular competency. The length, diameter, and shape of the extremity are not assessment criteria in a neurovascular evaluation. Although the amount of swelling is an important factor in assessing an extremity, it is not a criterion for a neurovascular assessment. p1545

Atopic dermatitis (eczema) in the infant is: a. Easily cured. b. Worse in humid climates. c. Associated with upper respiratory tract infections. d. Associated with allergy with a hereditary tendency.

ANS: D Atopic dermatitis is a type of pruritic eczema that usually begins during infancy and is associated with allergy with a hereditary tendency. It can be controlled but not cured. Manifestations of the disease are worse when environmental humidity is lower. Atopic dermatitis is not associated with respiratory infections. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1656 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

Which term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine? a. Scoliosis b. Ankylosis c. Lordosis d. Kyphosis

ANS: D Kyphosis is an abnormally increased convex angulation in the curve of the thoracic spine. Scoliosis is a complex spinal deformity usually involving lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis. Ankylosis is the immobility of a joint. Lordosis is an accentuation of the cervical or lumbar curvature beyond physiologic limits. p1556

Cellulitis is often caused by: a. Herpes zoster. b. Candida albicans. c. Human papillomavirus. d. Streptococcus or Staphylococcus organisms.

ANS: D Streptococcus, Staphylococcus, and Haemophilus influenzae are the organisms usually responsible for cellulitis. Herpes zoster is the virus associated with varicella and shingles. Candida albicans is associated with candidiasis or thrush. Human papillomavirus is associated with various types of human warts. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1642 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

The nurse is teaching the parents of a 7-year-old child who has just had a cast applied for a fractured arm with the wrist and elbow immobilized. Which of the following instructions should be included in the teaching? a. Swelling of the fingers is to be expected for the next 48 hours. b. Immobilize the shoulder to decrease pain in the arm. c. Allow the affected limb to hang down for 1 hour each day. d. Elevate casted arm when resting and when sitting up.

ANS: D The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return.

The nurse is teaching the parents of a 7-year-old child who has just had a cast applied for a fractured arm with the wrist and elbow immobilized. Which instructions should be included in the teaching? a. Swelling of the fingers is to be expected for the next 48 hours. b. Immobilize the shoulder to decrease pain in the arm. c. Allow the affected limb to hang down for 1 hour each day. d. Elevate casted arm when resting and when sitting up.

ANS: D The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return. Swelling of the fingers may indicate neurovascular damage and should be reported immediately. Permanent damage can occur within 6 to 8 hours. Joints above and below the cast on the affected extremity should be moved. The child should not engage in strenuous activity for the first few days. Rest with elevation of the extremity is encouraged. p1541

What may be given to high risk children after exposure to chickenpox to prevent varicella? a. Acyclovir b. Vitamin A c. Diphenhydramine hydrochloride d. Varicella zoster immune globulin (VZIG)

ANS: D VZIG is given to high risk children to help prevent the development of chickenpox. Immune globulin intravenous may also be recommended. Acyclovir is given to immunocompromised children to reduce the severity of symptoms. Vitamin A reduces morbidity and mortality associated with the measles. The antihistamine diphenhydramine is administered to reduce the itching associated with chickenpox. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1057 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Implementation

The nurse uses the palms of the hands when handling a wet cast for which of the following reasons? a. To assess dryness of the cast b. To facilitate easy turning c. To keep the patient's limb balanced d. To avoid indenting the cast

ANS: D Wet casts should be handled by the palms of the hands, not the fingers, to avoid creating pressure points.

The nurse uses the palms of the hands when handling a wet cast to: a. Assess dryness of the cast. c. Keep the patient's limb balanced. b. Facilitate easy turning. d. Avoid indenting the cast.

ANS: D Wet casts should be handled by the palms of the hands, not the fingers, to prevent creating pressure points. Assessing dryness, facilitating easy turning, or keeping the patient's limb balanced are not reasons for using the palms of the hand rather than the fingers when handling a wet cast. p1541

Rubeola /Measles Rash

Erythema, maculopapular eruption, may become confluent

In which communicable disease are Koplik spots present? a. Rubella c. Chickenpox (varicella) b. Measles (rubeola) d. Exanthema subitum (roseola)

ANS: B Koplik spots are small, irregular red spots with a minute, bluish white center found on the buccal mucosa 2 days before systemic rash. Koplik spots are not present with rubella, varicella, or roseola. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1061 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

Communicability: Varicella

1day before eruption till all crusts have formed (~6 days)

Communicability: Rubeola/Measles

4 days before rash till 5 days after rash

Isotretinoin (Accutane) is indicated for the treatment of acne during adolescence when: a. Acne has not responded to other treatments. b. The adolescent is or may become pregnant. c. The adolescent is unable to give up foods causing acne. d. Frequent washing with antibacterial soap has been unsuccessful.

ANS: A Accutane (isotretinoin) is reserved for severe cystic acne that has not responded to other treatments. Accutane has teratogenic effects and should never be used when there is a possibility of pregnancy. No correlation exists between foods and acne. Antibacterial soaps are ineffective. Frequent washing with antibacterial soap is not a recommended therapy for acne. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1660 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Implementation

What effect does immobilization have on the cardiovascular system? a. Venous stasis b. Increased vasopressor mechanism c. Normal distribution of blood volume d. Increased efficiency of orthostatic neurovascular reflexes

ANS: A Because of decreased muscle contraction, the physiologic effects of immobilization include venous stasis. This can lead to pulmonary emboli or thrombi. A decreased vasopressor mechanism results in orthostatic hypotension, syncope, hypotension, decreased cerebral blood flow, and tachycardia. An altered distribution of blood volume is found, with decreased cardiac workload and exercise tolerance. Immobilization causes a decreased efficiency of orthostatic neurovascular reflexes, with an inability to adapt readily to the upright position and pooling of blood in the extremities in the upright position. Ch48 Musculoskeletal/Articular Dysfunction p1533

A common characteristic of those who sexually abuse children is that they: a. Pressure the victim into secrecy. b. Are usually unemployed and unmarried. c. Are unknown to victims and victims' families. d. Have many victims that are each abused only once.

ANS: A Sex offenders may pressure the victim into secrecy, regarding the activity as a "secret between us" that other people may take away if they find out. Abusers are often employed upstanding members of the community. Most sexual abuse is committed by men and persons who are well known to the child. Abuse is often repeated with the same child over time. The relationship may start insidiously without the child realizing that sexual activity is part of the offer. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1069 OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Assessment

A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. Which of the following should the nurse suggest to remove this material? a. Soak in a bathtub. b. Vigorously scrub leg. c. Apply powder to absorb material. d. Carefully pick material off leg.

ANS: A Simple soaking in the bathtub is usually sufficient for the removal of the desquamated skin and sebaceous secretions. It may take several days to eliminate the accumulation completely.

During a prenatal examination, the woman reports having two cats at home. The nurse informs her that she should not be cleaning the litter box while she is pregnant. When the woman asks why, the nurse's best response would be: a. "Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child." b. "You and your baby can be exposed to the human immunodeficiency virus (HIV) in your cats' feces." c. "It's just gross. You should make your husband clean the litter boxes." d. "Cat feces are known to carry Escherichia coli, which can cause a severe infection in both you and your baby."

ANS: A Toxoplasmosis is a multisystem disease caused by the protozoal Toxoplasma gondii parasite, commonly found in cats, dogs, pigs, sheep, and cattle. About 30% of women who contract toxoplasmosis during gestation transmit the disease to their offspring. Clinical features ascribed to toxoplasmosis include hydrocephalus or microcephaly, chorioretinitis, seizures, or cerebral calcifications. HIV is not transmitted by cats. Although suggesting that the woman's husband clean the litter boxes may be a valid statement, it is not appropriate, does not answer the client's question, and is not the nurse's best response. E. coli is found in normal human fecal flora. It is not transmitted by cats. PTS: 1 DIF: Cognitive Level: Application REF: 749 OBJ: Client Needs: Safe and Effective Care Environment TOP: Nursing Process: Planning

The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations should the nurse expect to observe (Select all that apply)? a. Positive Ortolani sign b. Unequal gluteal folds c. Negative Babinski's sign d. Trendelenburg's sign e. Telescoping of the affected limb f. Lordosis

ANS: A, B A positive Ortolani sign and unequal gluteal folds are clinical manifestations of developmental dysplasia of the hip seen from birth to 2 to 3 months. Negative Babinski's sign, Trendelenburg's sign, telescoping of the affected limb, and lordosis are not clinical manifestations of developmental dysplasia of the hip. p1549

Strict isolation is required for a child who is hospitalized with (choose all that apply): a. Mumps. b. Chickenpox. c. Exanthema subitum (roseola). d. Erythema infectiosum (fifth disease). e. Parvovirus B19.

ANS: A, B, C, D Childhood communicable diseases requiring strict transmission-based precautions (contact, airborne, droplet) include: diphtheria, chickenpox, measles, mumps, tuberculosis, adenovirus, hemophilus B, mumps, pertussis, plague, streptococcal pharyngitis or scarlet fever. Strict isolation is not required for parvovirus B19. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1056, 1057 OBJ: Client Needs: Safe and Effective Care Environment TOP: Nursing Process: Implementation

Cleft lip or palate is a common congenital midline fissure, or opening, in the lip or palate resulting from failure of the primary palate to fuse. Multiple genetic and to a lesser extent environmental factors may lead to the development of a cleft lip or palate. Such factors include (choose all that apply): a. Alcohol consumption. b. Female gender. c. Use of some antiepileptics. d. Maternal cigarette smoking. e. Antibiotic use in pregnancy.

ANS: A, C, D Factors that are associated with the potential development of cleft lip or palate are maternal infections, radiation exposure, corticosteroids, anticonvulsants, male gender, Native American or Asian descent, and smoking during pregnancy. Cleft lip is more common in male infants. Antibiotic use in pregnancy is not associated with the development of cleft lip or palate. PTS: 1 DIF: Cognitive Level: Comprehension REF: 772 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

Where do the lesions of atopic dermatitis most commonly occur in the infant? Choose all that apply. a. Cheeks. b. Buttocks. c. Extensor surfaces of arms and legs. d. Back. e. Trunk. f. Scalp.

ANS: A, C, E, F The lesions of atopic dermatitis are generalized in the infant. They are most commonly on the cheeks, scalp, trunk, and extensor surfaces of the extremities. Lesions do not generally occur on the buttocks and the back. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1657 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

An advantage to using a fiberglass cast instead of a plaster cast is that a fiberglass cast: a. Is less expensive. c. Molds closely to body parts. b. Dries rapidly. d. Has a smooth exterior.

ANS: B A synthetic casting material dries in 5 to 30 minutes as compared with a plaster cast, which takes 10 to 72 hours to dry. Synthetic casts are more expensive. Plaster casts mold closer to body parts. Synthetic casts have a rough exterior, which may scratch surfaces. p1540

Which of the following is an advantage to using a fiberglass cast instead of a plaster of Paris cast? a. Cheaper b. Dries rapidly c. Molds closely to body parts d. Smooth exterior

ANS: B A synthetic casting material dries in 5 to 30 minutes as compared with a plaster cast, which takes 10 to 72 hours to dry.

The nurse is teaching a class on preventing diaper rash in newborns to a group of new parents. Which statement made by a parent indicates a correct understanding of the teaching? a. "I should wash my infant's buttocks with soap and water every time I change the diaper." b. "I will wash with a mild soap and water and dry thoroughly whenever my infant has a bowel movement." c. "I should wash my infant's buttocks with soap before applying a thin layer of oil." d. "I will apply baby oil and powder to the creases in my infant's buttocks."

ANS: B Change the diaper as soon as it becomes soiled. Gently wipe stool from skin with water and mild soap. Overwashing the skin should be avoided, especially with perfumed soaps or commercial wipes, which may be irritating. The skin should be thoroughly dried after washing. Application of oil does not create an effective barrier. Baby powder should not be used because of the danger of aspiration. PTS: 1 DIF: Cognitive Level: Application REF: 1656 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Implementation

Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell out of a tree. When discussing this injury with her parents, the nurse should consider which of the following? a. Healing is usually delayed in this type of fracture. b. Bone growth can be affected by this type of fracture. c. This is an unusual fracture site in young children. d. This type of fracture is inconsistent with a fall.

ANS: B Detection of epiphyseal injuries is sometimes difficult, but fractures involving the epiphysis or epiphyseal plate present special problems in determining whether bone growth will be affected.

With regard to the classification of neonatal bacterial infection, nurses should be aware that: a. Congenital infection progresses slower than nosocomial infection. b. Nosocomial infection can be prevented by effective handwashing; early-onset infections cannot. c. Infections occur with about the same frequency in boy and girl infants, although female mortality is higher. d. The clinical sign of a rapid, high fever makes infection easier to diagnose.

ANS: B Handwashing is an effective preventive measure for late-onset (nosocomial) infections because these infections come from the environment around the infant. Early-onset, or congenital, infections are caused by the normal flora at the maternal vaginal tract and progress more rapidly than nosocomial (late-onset) infections. Infection occurs about twice as often in boys and results in higher mortality. Clinical signs of neonatal infection are nonspecific and similar to noninfectious problems, making diagnosis difficult. PTS: 1 DIF: Cognitive Level: Comprehension REF: 747 OBJ: Client Needs: Safe and Effective Care Environment TOP: Nursing Process: Implementation

An appropriate nursing intervention when caring for a child in traction is to: a. Remove adhesive traction straps daily to prevent skin breakdown. b. Assess for tightness, weakness, or contractures in uninvolved joints and muscles. c. Provide active range-of-motion exercises to affected extremity 3 times a day. d. Keep child in one position to maintain good alignment.

ANS: B Traction places stress on the affected bone, joint, and muscles. The nurse must assess for tightness, weakness, or contractures developing in the uninvolved joints and muscles. The adhesive straps should be released/replaced only when absolutely necessary. Active, passive, or active with resistance exercises should be carried out for the unaffected extremity only. Movement is expected with children. Each time the child moves, the nurse should check to ensure that proper alignment is maintained. p1545

When is a child with chickenpox considered to be no longer contagious? a. When fever is absent c. 24 hours after lesions erupt b. When lesions are crusted d. 8 days after onset of illness

ANS: B When the lesions are crusted, the chickenpox is no longer contagious. This may be a week after onset of disease. The child is still contagious once the fever has subsided, after the lesions erupt, and may or may not be contagious any time after 6 days as long as all lesions are crusted over. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1058 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

An adolescent is in traction. The purpose of the traction is to fatigue the muscle and reduce muscle spasm so that the bones can be realigned. Nursing actions should include which of the following? a. Maintain continuous traction until muscle spasm ceases. b. Maintain continuous traction to prevent muscle from contracting. c. Release traction every hour to allow muscle to briefly regain its contractibility. d. Release traction once every 8 hours to allow muscle to briefly regain its contractibility.

ANS: B When the muscles are stretched, muscle spasm ceases and permits realignment of the bone ends. The continued maintenance of traction is important during this phase because releasing the traction allows the muscle's normal contracting ability to again cause of malpositioning of the bone ends.

The nurse is talking to a parent of an infant with severe atopic dermatitis. What should the nurse reinforce with the parent? Choose all that apply. a. "You can use warm wet compresses to relieve discomfort." b. "You will need to keep your infant's skin well hydrated by using a mild soap in the bath." c. "You should bathe your baby in a bubble bath two times a day." d. "You will need to prevent your baby from scratching the area by using a mild antihistamine." e. "You can try a fabric softener in the laundry to avoid rough cloth." f. "You should apply an emollient to the skin immediately after a bath."

ANS: B, D, F The eczematous lesions of atopic dermatitis are intensely pruritic. Scratching can lead to new lesions and secondary infection; an antihistamine can be used. Keeping the skin hydrated is a goal of treating atopic dermatitis. Applying an emollient immediately after a bath helps to trap moisture and prevent moisture loss. Using warm compresses to relieve discomfort, bathing the baby in a bubble bath, and using fabric softener are not appropriate suggestions for this condition. PTS: 1 DIF: Cognitive Level: Application REF: 1657, 1658 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

When infants are seen for fractures, which nursing intervention is a priority? a. No intervention is necessary. It is not uncommon for infants to fracture bones. b. Assess the family's safety practices. Fractures in infants usually result from falls. c. Assess for child abuse. Fractures in infants are often nonaccidental. d. Assess for genetic factors.

ANS: C Fractures in infants warrant further investigation to rule out child abuse. Fractures in children younger than 1 year are unusual because of the cartilaginous quality of the skeleton; a large amount of force is necessary to fracture their bones. Infants should be cared for in a safe environment and should not be falling. Fractures in infancy are usually nonaccidental rather than related to a genetic factor. p1537

A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, the nurse should explain that: a. Traction is tried first. b. Surgical intervention is needed. c. Frequent, serial casting is tried first. d. Children outgrow this condition when they learn to walk.

ANS: C Serial casting, the preferred treatment, is begun shortly after birth before discharge from the nursery. Successive casts allows for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention. p1551

Tretinoin (Retin-A) is a topical agent commonly used to treat acne. Nursing considerations with this drug include: a. Avoiding use of sunscreen agents. b. Using cosmetics with lanolin and petrolatum. c. Explaining that medication should not be applied until at least 20 to 30 minutes after washing. d. Explaining that erythema and peeling are indications of toxicity.

ANS: C The medication should not be applied for at least 20 to 30 minutes after washing to decrease the burning sensation. Avoiding sun and using sunscreen agents must be emphasized because sun exposure can result in severe sunburn. Cosmetics with lanolin, petrolatum, vegetable oil, lauryl alcohol, butyl stearate, and oleic acid can increase comedone production. Erythema and peeling are common local manifestation. PTS: 1 DIF: Cognitive Level: Analysis REF: 1660 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

Near the end of the first week of life an infant who has not been treated for any infection develops a copper-colored, maculopapular rash on the palms and around the mouth and anus. The newborn is showing signs of: a. Gonorrhea. c. Congenital syphilis. b. Herpes simplex virus infection. d. Human immunodeficiency virus.

ANS: C The rash is indicative of congenital syphilis. The lesions may extend over the trunk and extremities. PTS: 1 DIF: Cognitive Level: Analysis REF: 750 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

The nurse is caring for a preschool child with a cast applied recently for a fractured tibia. Which assessment findings indicate possible compartment syndrome (Select all that apply)? a. Palpable distal pulse b. Capillary refill to extremity of <3 seconds c. Severe pain not relieved by analgesics d. Tingling of extremity e. Inability to move extremity

ANS: C, D, E Indications of compartment syndrome are severe pain not relieved by analgesics, tingling of extremity, and inability to move extremity. A palpable distal pulse and capillary refill to the extremity of <3 seconds are expected findings. Ch48 Musculoskeletal/Articular Dysfunction p1540

When attempting to diagnose and treat developmental dysplasia of the hip (DDH), the nurse should: a. Be able to perform the Ortolani and Barlow tests. b. Teach double or triple diapering for added support. c. Explain to the parents the need for serial casting. d. Carefully monitor infants for DDH at follow-up visits.

ANS: D Because DDH often is not detected at birth, infants should be monitored carefully at follow-up visits. The Ortolani and Barlow tests must be performed by experienced clinicians to prevent fracture or other damage to the hip. Double or triple diapering is not recommended because it promotes hip extension, thus worsening the problem. Serial casting is done for clubfeet, not DDH. PTS: 1 DIF: Cognitive Level: Comprehension REF: 775 OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

What would cause a nurse to suspect that an infection has developed under a cast? a. Complaint of paresthesia c. Increased respirations b. Cold toes d. "Hot spots" felt on cast surface

ANS: D If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so a window can be made in the cast to observe the site. The "five Ps" of ischemia from a vascular injury include pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection. Cold toes may be indicative of too tight a cast and need further evaluation. Increased respirations may indicate a respiratory infection or pulmonary emboli. This should be reported, and the child should be evaluated. p1541

What bacterial infection is definitely decreasing because of effective drug treatment? a. Escherichia coli infection c. Candidiasis b. Tuberculosis d. Group B streptococcal infection

ANS: D Penicillin has significantly decreased the incidence of group B streptococcal infection. E. coli may be increasing, perhaps because of the increasing use of ampicillin (resulting in a more virulent E. coli resistant to the drug). Tuberculosis is increasing in the United States and Canada. Candidiasis is a fairly benign fungal infection. PTS: 1 DIF: Cognitive Level: Comprehension REF: 754 OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Evaluation

Matt's mother tells the nurse that he keeps scratching the areas where he has poison ivy. The nurse's response should be based on knowing that: a. Poison ivy does not itch and needs further investigation. b. Scratching the lesions will not cause a problem. c. Scratching the lesions will cause the poison ivy to spread. d. Scratching the lesions may cause them to become secondarily infected.

ANS: D Poison ivy is a contact dermatitis that results from exposure to the oil urushiol in the plant. Every effort is made to prevent the child from scratching because the lesions can become secondarily infected. The poison ivy produces localized, streaked or spotty, oozing, and painful impetiginous lesions. Itching is a common response. The lesions do not spread by contact with the blister serum or by scratching. PTS: 1 DIF: Cognitive Level: Application REF: 1647, 1648 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Implementation

Human immunodeficiency virus (HIV) may be perinatally transmitted: a. Only in the third trimester from the maternal circulation. b. By a needlestick injury at birth from unsterile instruments. c. Only through the ingestion of amniotic fluid. d. Through the ingestion of breast milk from an infected mother.

ANS: D Postnatal transmission of HIV through breastfeeding may occur. Transmission of HIV from the mother to the infant may occur transplacentally at various gestational ages. Transmission close to or at the time of birth is thought to account for 50% to 80% of cases. PTS: 1 DIF: Cognitive Level: Comprehension REF: 751 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

Rubella Rash

Face → neck, arms, trunk; maculopapular; covers body

Communicability: Mumps

Immediately before swelling begins

Mumps presentation

bilateral parotid swelling w/pain exacerbated by eating