Peds Chapter 24-35 Evolve Questions

Which of the following clinical manifestations in an infant would be suggestive of spinal muscular atrophy (Werdnig-Hoffmann disease)? Hypertonicity Lying in the frog position Hyperactive deep tendon reflexes Motor deficits on one side of body

Lying in the frog position The infant lies in the frog position with the legs externally rotated, abducted and flexed at knees. The child has hypotonia and inactivity as the most prominent features. The deep tendon reflexes are absent. The motor deficits are bilateral.

A 6-month-old infant does not smile, has poor head control, has a persistent Moro reflex, and often gags and chokes while eating. These findings are most suggestive of hypotonia. cerebral palsy. spinal cord injury. neonatal myasthenia gravis.

cerebral palsy. Poor head control, a persistent Moro reflex, and feeding difficulties in a 6-month-old infant are suggestive of cerebral palsy. Not smiling, poor head control, a persistent Moro reflect, and gagging and choking while eating are not consistent with hypotonia, spinal cord injury, or neonatal myasthenia gravis.

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, play baseball, and swim. The nurse's response should be based on knowledge that exercise is contraindicated. the level of activity depends on the type of insulin required. exercise is not restricted unless indicated by other health conditions. soccer and baseball are too strenuous, but swimming is acceptable.

exercise is not restricted unless indicated by other health conditions. Exercise is encouraged for children with diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure that the child has sufficient energy for exercise. Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available. The level of activity is not dependent on the type of insulin used. Long- and short-acting insulin both may be used to compensate for the effects of training and sporting events. Sports are encouraged to help regulate the insulin, and food should be adjusted according to the amount of exercise. The child needs to be cautioned to monitor responses to the exercise.

Which of the following is a clinical manifestation of increased intracranial pressure (ICP) in infants? Irritability Photophobia Vomiting and diarrhea Pulsating anterior fontanel

Irritability Irritability is one of the changes that may indicate increased ICP. Photophobia is not indicative of increased ICP in infants. A pulsing anterior fontanel is normal. Vomiting is one of the signs of increased ICP in children, but when present with diarrhea, it is indicative of a gastrointestinal disturbance.

Which of the following occurs in septic shock? Massive vasodilation Increased respiratory rate Decreased capillary permeability Increased systemic vascular resistance

Massive vasodilation In septic shock, an infection triggers an inflammatory response, which results in massive vasodilation and increased capillary permeability. Respirations are not affected (really???). Capillary permeability is increased. Vasodilation results in decreased systemic vascular resistance.

Dialysis or transplantation becomes necessary for chronic renal failure when anemia develops. acidosis develops. glomerular filtration rate falls below 50% of normal. glomerular filtration rate falls below 10% to 15% of normal.

glomerular filtration rate falls below 10% to 15% of normal. Treatment with dialysis or transplantation is required when the glomerular filtration rate falls below 10% to 15% of normal. Anemia and acidosis may be present as part of the underlying disorder. The glomerular filtration rate determines the need for dialysis. The kidneys are able to maintain the chemical composition of fluids within normal limits until more than 50% of functional renal capacity is destroyed by disease or injury.

Which of the following would cause a nurse to suspect that an infection has developed under a cast? Cold toes Increased respirations Complaint of paresthesia "Hot spots" felt on the cast surface

"Hot spots" felt on the cast surface If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so that a window can be made in the cast to observe the site. Cold toes may indicate 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. 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.

To prevent burns from hot water in the home, the nurse should recommend that families set their water heater thermostat to 38º C (100º F). 49º C (120º F). 60º C (140º F). 71º C (160º F).

49º C (120º F). The recommended temperature to set water heaters is 120º F. A water heater can be set 10 degrees higher and still be safe. Temperatures of 60º C (140º F) to 71º C (160º F) are too high. At 140º F, submersion for 5 seconds will cause a burn.

Nursing interventions for the child after a cardiac catheterization would include which of the following? Allow ambulation as tolerated. Monitor vital signs every 2 hours. Assess the affected extremity for temperature and color. Check pulses above the catheterization site for equality and symmetry.

Assess the affected extremity for temperature and color. The involved extremity is carefully assessed for signs of complications. Pulses below the catheterization site are monitored for equality and symmetry. Temperature and color are also monitored. The child is maintained on bed rest or in parent's lap for 4 to 6 hours after the procedure. Initially, vital signs are taken every 15 minutes. Pulses are checked distal to the catheterization site.

The nurse is preparing an adolescent girl for surgery to treat scoliosis. Which of the following should the nurse include? Blood administration may be an option. Ambulation will not be allowed for up to 3 months. Surgery eliminates the need for casting and bracing. Discomfort can be controlled with nonpharmacologic methods.

Blood administration may be an option. Spinal surgery usually involves considerable blood loss. Several options are considered for blood replacement. Ambulation is allowed as soon as possible. Depending on the instrumentation used, most patients are walking 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.

The nurse is explaining to a parent how to care for a child with vomiting associated with a viral illness. Which of the following should the nurse include? Give nothing by mouth for 24 hours. Avoid carbohydrate-containing liquids. Brush teeth or rinse mouth after vomiting. Give plain water until vomiting ceases for at least 24 hours.

Brush teeth or rinse mouth after vomiting. It is important to emphasize the need for the child to brush the teeth or rinse the mouth after vomiting to dilute the hydrochloric acid that comes in contact with the teeth. Ad libitum administration of glucose-electrolyte solution to an alert child will help restore water and electrolytes satisfactorily. It is important to include carbohydrates to spare body protein and avoid ketosis.

Which of the following types of diarrhea is commonly seen in malabsorption syndromes because the intestine cannot absorb nutrients or electrolytes? Chronic Secretory Acute Intractable diarrhea of infancy

Chronic Chronic diarrhea is commonly seen in malabsorption syndromes. In disorders such as lactose intolerance, the intestine cannot absorb nutrients or electrolytes. Secretory diarrhea is usually caused by bacterial enterotoxins that stimulate fluid and electrolyte secretion. Acute diarrhea is caused by infectious agent in the gastrointestinal tract. Intractable diarrhea of infancy is a syndrome that occurs in the first few months of life and persists longer than 2 weeks with no recognized pathogens.

The nurse should recommend medical attention if a child with a slight head injury experiences which of the following? Vomiting Sleepiness Headache, even if slight Confusion or abnormal behavior

Confusion or abnormal behavior Altered mental status is a clinical manifestation that the damage from the head injury is progressing. Medical evaluation is necessary. Vomiting may occur after a minor head injury. Observation is required for changes in behavior or vital signs that indicate progression. Sleepiness may occur after a minor head injury. Observation is required to ensure that the child is arousable. Headache is common after a head injury and does not require medical evaluation unless accompanied by other signs of progression.

An adolescent girl is cooking on a gas stove when her bathrobe catches fire. Her father smothers the flames with a rug and calls an ambulance. She has sustained major burns over much of her body. Which of the following is also important in her immediate care? Cool with a single application of tepid water. Encourage her to drink clear liquids. Remove her burned clothing and jewelry. Leave the rug in place until the ambulance arrives.

Cool with a single application of tepid water. In major burns, additional applications of cool water lead to a drop in body temperature and potential circulatory collapse. Nothing is given by mouth because of the risk of aspiration in the presence of a paralytic ileus. As much of her clothing should be removed as possible.

The nurse is caring for a 2-year-old girl who is unconscious but stable after a car accident. Her parents are staying at the bedside most of the time. Which of the following is an appropriate nursing intervention? Suggest that the parents go home until she is alert enough to know they are present. Encourage the parents to hold, talk, and sing to her as they usually would. Use ointment on her lips but do not attempt to cleanse her teeth until swallowing returns. Position her with proper body alignment and the head of the bed lowered 15 degrees.

Encourage the parents to hold, talk, and sing to her as they usually would. The parents should be encouraged to interact with their daughter. Senses of hearing and tactile perception may be intact, and stimulation of these senses is important. The daughter may be able to hear that they are present. Oral care is essential in an unconscious child. Mouth care should be done at least twice daily. The head of the bed should be elevated, not lowered.

The Glasgow Coma Scale consists of an assessment of pupil reactivity and motor response. level of consciousness and verbal response. eye opening and verbal and motor response. intracranial pressure and level of consciousness.

Eye opening and verbal response The scale is a three-part assessment that includes eye opening, verbal response, and motor response. It is an observational tool to detect a life-threatening complication such as cerebral edema. Pupil reactivity, level of consciousness, and intracranial pressure are not included in the scale.

What is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature? Give tepid water baths to reduce fever. Encourage food intake to maintain caloric needs. Have the child wear heavy clothing to prevent chilling. Give small amounts of favorite fluids frequently to prevent dehydration.

Give small amounts of favorite fluids frequently to prevent dehydration. Preventing dehydration by small, frequent feedings is an important intervention in a febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting. A febrile child should be dressed in light, loose clothing.

In which of the following conditions is the fluid requirement for children decreased? Burns Fever Vomiting Increased intracranial pressure

Increased intracranial pressure When there is a risk of increased intracranial pressure, the child's fluid balance is carefully monitored to ensure that only required fluids are given. With burns, fever, and vomiting, the child loses fluids at a greater than expected rate. Supplemental fluids need to be given to avoid the risk of dehydration.

Where are Wilms tumors (nephroblastomas) located? Bone Brain Kidney Lymphatic system

Kidney Wilms tumor, or nephroblastoma, is the most common intraabdominal and kidney tumor of childhood. Wilms tumors are encapsulated and are located in the abdomen.

Depression of the central nervous system (CNS), manifested by lethargy, delirium, stupor, and coma, is observed in which of the following? Metabolic acidosis Respiratory alkalosis Metabolic and respiratory acidosis Metabolic and respiratory alkalosis

Metabolic and respiratory acidosis Hydrogen ion imbalances result in CNS involvement. Depression of the CNS, as manifested by lethargy, delirium, diminished mental capacity, stupor, and coma, is found in acidosis that is either metabolic or respiratory in origin. Respiratory acidosis can also manifest these clinical findings. Respiratory and metabolic alkalosis are reflected clinically by CNS excitation and stimulation, nervousness, tingling sensations, and tetany that may progress to seizures.

Which of the following is the primary clinical manifestation of acute renal failure? Oliguria Hematuria Proteinuria Bacteriuria

Oliguria Oliguria is the primary clinical symptom of acute renal failure. Generally, urinary output is less than 1 ml/kg/hr. Hematuria, proteinuria, and bacteriuria may be present in renal disease, but they are not the primary manifestations of acute renal failure.

Therapeutic management of the child with acute diarrhea and dehydration usually begins with which of the following? Clear liquids such as fruit juice and soft drinks Adsorbents, such as kaolin and pectin Oral rehydration solution Antidiarrheal medications such as paregoric

Oral rehydration solution Oral rehydration solution is the first treatment for acute diarrhea. Clear liquids are not recommended because they usually have a high carbohydrate content, low electrolyte content, and high osmolality. Adsorbents are not recommended. Antidiarrheals are not recommended because they do not get rid of pathogens.

Which of the following results when ice is applied immediately after a soft tissue injury, such as a sprained ankle? Increases the pain threshold Increases metabolism in the tissues Produces deep tissue vasodilation Leads to release of more histamine-like substances

Produces deep tissue vasodilation Nine to 15 minutes of ice exposure produces deep tissue vasodilation without increased metabolism. Ice has a rapid cooling effect on tissues that reduces pain. The decreased temperature slows metabolism, thus reducing tissue oxygen requirements. Fewer histamine-like substances are released.

The nurse is caring for a 12-year-old boy who sustained major burns when he put charcoal lighter on a campfire. The nurse observes that he is "very brave" and appears to accept pain with little or no response. The most appropriate nursing action related to this is which of the following? Request a psychologic consultation. Ask the child why he doesn't have pain. Praise the child for ability to withstand pain. Encourage continued bravery as a coping strategy.

Request a psychologic consultation. A psychologic consultation will help the child verbalize fears. Children in this age group are concerned with physical appearance. The psychologists can help integrate the issues that the child is facing. It is likely that the child is having pain but not acknowledging the pain. If the child is feeling pain, the nurse should not praise him for hiding it. Encouraging continued bravery may not be an effective coping strategy if the child is in severe pain.

Which of the following factors predisposes the urinary tract to infection? Increased fluid intake Short urethra in girls Ingestion of highly acidic juices Frequent emptying of the bladder

Short urethra in girls The short urethra, which measures approximately 2 cm (0.8 in) in girls and 4 cm (1.6 in) in mature women, provides a ready pathway for invasion of organisms. Increased fluid intake results in frequent emptying of the bladder, preventing urinary stasis. Urine is bacteriostatic at pH of 5.0. This is not achievable by ingestion of juice. Frequent emptying of the bladder helps prevent urinary tract infections.

The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. Which of the following should be the nurse's next action? Notify the surgeon. Perform oral intubation. Try inserting a larger tube. Try inserting a smaller tube.

Try inserting a smaller tube. If the same size tube cannot be inserted, the nurse should try to insert a smaller tube. This will keep the stoma open. The priority is to reinsert a new tracheostomy as soon as possible. The stoma is maintained open until the practitioner can evaluate it. The nurse should attempt to keep the tracheostomy stoma open. A smaller tube is required.

An adolescent has sustained a spinal cord injury. The first stage, known as spinal shock syndrome, is characterized by increasing spasticity. spinal reflex activity. symptoms of hypertension. flaccid paralysis below level of damage.

flaccid paralysis below level of damage. Reflexes are absent at or below the cord lesion. There is flaccidity or limpness of the involved muscles. Spinal reflex activity occurs in the second stage. Symptoms of hypotension occur.

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child begins with intravenous fluids. oral rehydration solution. clear liquids, 1 to 2 oz at a time. administration of antidiarrheal medication.

intravenous fluids In children with severe dehydration, intravenous fluids are initiated. Oral rehydration solution is acceptable therapy if the dehydration is not severe. Diarrhea is not managed by using clear liquids by mouth. These fluids usually have a high carbohydrate content, low electrolyte content, and high osmolality. Antidiarrheal medications are not recommended for the treatment of acute infectious diarrhea.

Enteral feedings are ordered for a young child with burns covering 40% of total body surface area. The nurse should know that oral feedings are contraindicated. enteral feedings must be stopped during painful procedures. presence of a paralytic ileus does not preclude use of enteral feedings. the feedings will be high carbohydrate and low protein.

presence of a paralytic ileus does not preclude use of enteral feedings. Because the small bowel maintains mobility and absorptive capabilities, the placement of a small-bore feeding tube into the duodenum allows for safe delivery of enteral nutrition during periods of paralytic ileus associated with sepsis, trauma, and anesthesia. Oral feedings are not contraindicated. This is encouraged; however, most children with burns are unable to consume sufficient calories by mouth. Enteral feedings can continue during procedures. A high-protein, high-calorie diet is recommended.

The nurse should recognize that when a child develops diabetic ketoacidosis, this is which of the following? Expected outcome Best treated at home A life-threatening situation Best treated at practitioner's office or clinic

A life-threatening situation Diabetic ketoacidosis is the state of complete insulin deficiency. It is a medical emergency that must be diagnosed and treated. The child is usually admitted to an intensive care unit for assessment, insulin administration, and fluid and electrolyte replacement. Diabetic ketoacidosis is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment.

Which of the following statements is correct regarding sports injuries during adolescence? Rapidly growing bones, muscles, joints, and tendons offer some protection from unusual strain. The increase in strength and vigor during adolescence helps prevent injuries related to fatigue. More injuries occur during organized athletic competition than during recreational sports participation. Adolescents may not possess the insight and judgment to recognize when an activity is beyond their capabilities.

Adolescents may not possess the insight and judgment to recognize when an activity is beyond their capabilities. Children and adolescents may not possess the insight and judgment to recognize when an activity is beyond their capabilities. Rapidly growing bones, muscles, joints, and tendons are especially vulnerable to unusual strain. The increase in strength and vigor in adolescence may tempt adolescents to overextend themselves. More injuries occur during recreational sports participation than in organized athletic competition.

Therapeutic management of a child with tetanus includes the administration of which of the following? Nonsteroidal antiinflammatory drugs (NSAIDs) to reduce inflammation Muscle stimulants to counteract muscle weakness Bronchodilators to prevent respiratory complications Antibiotics to control bacterial proliferation at the site of injury

Antibiotics to control bacterial proliferation at the site of injury Antibiotics are administered to control the proliferation of the vegetative forms of the organism at the site of infection. Tetanus toxin acts at the myoneural junction to produce muscular stiffness and lowers the threshold for reflex excitability. NSAIDs are not routinely used. Sedatives or muscle relaxants are used to help reduce titanic spasm and prevent seizures. Respiratory status is carefully evaluated for any signs of distress because muscle relaxants, opioids, and sedatives that may be prescribed may cause respiratory depression. Bronchodilators would not be used unless specifically indicated.

A child, 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? This type of fracture is inconsistent with a fall. Bone growth can be affected by this type of fracture. This is an unusual fracture site in young children. Healing is usually delayed in this type of fracture.

Bone growth can be affected by this type of fracture. 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. The epiphysis is the weakest point of the long bones. This is a frequent site of damage during trauma. Healing of epiphyseal injuries is usually prompt.

A young child has recently been fitted with a knee, ankle, and foot orthosis (brace). Care of the skin should include which of the following? Apply lotion or cream to soften the skin. Contact a practitioner or orthotist if skin redness does not disappear. Place padding between the skin and brace if the child experiences a burning sensation under the brace. If a small blister develops, apply rubbing alcohol and place padding between the skin and the brace.

Contact a practitioner or orthotist if skin redness does not disappear. Redness is a sign of skin irritation from the brace. The brace needs to be adjusted to be functional. The skin should not be softened. The brace is specially designed for the child. Padding may alter the alignment of the brace. Rubbing alcohol would be painful. If the brace causes blisters, it needs to be adjusted.

The nurse is assessing a child with a cardiac problem. The child's extremities are cool with thready pulses, and urinary output is diminished. This is most suggestive of which of the following? Increased afterload Decreased contractility Increased stroke volume Decreased cardiac output

Decreased contractility Decreased contractility is suspected if the extremities are cool with thready pulses and urinary output is diminished. Certain states (e.g., hypoxia, acidosis) are known to depress contractility. Increased blood pressure is indicative of higher afterload. Increased stroke volume and decreased cardiac output will not produce the symptoms described.

The parents of a child with cerebral palsy ask the nurse if any drugs can decrease their child's spasticity. The nurse's response should be based on which of the following? Anticonvulsant medications are sometimes useful for controlling spasticity. Medications that would be useful in reducing spasticity are too toxic for use with children. Many different medications can be highly effective in controlling spasticity. Implantation of a pump to deliver medication into the intrathecal space decreases spasticity.

Implantation of a pump to deliver medication into the intrathecal space decreases spasticity. Baclofen, given intrathecally, is best suited for children with severe spasticity that interferes with activities of daily living and ambulation. Anticonvulsant medications are used when seizures occur in children with cerebral palsy. The intrathecal route decreases the side effects of the drugs that reduce spasticity. Few medications are currently available for the control of spasticity.

The nurse stops to assist a child who has been hit by a car while riding a bicycle. Someone has activated the emergency medical system. Until paramedics arrive, the nurse should consider which of the following in caring for this child who has experienced severe trauma? Rapid assessment should begin with ABC status: airway, breathing, and circulation. Assessment should begin with the area injured; assessment of other areas can wait. The possibility of spinal cord injury should be ruled out before transporting the child to the hospital. Temperature maintenance is more difficult than in adults because young children have a larger surface area related to body mass.

Rapid assessment should begin with ABC status: airway, breathing, and circulation. The first priority is always airway, breathing, and circulation. Assessment of the injured area occurs after the child's cardiopulmonary status has been addressed. Transport can occur by immobilizing the cervical spine. The head is maintained in a neutral position, and movement of the head or body is not allowed in any direction. Infants have the greatest discrepancy in body surface areas. Children old enough to ride bikes have similar body proportions to adults.

A young boy has just been diagnosed with pseudohypertrophic (Duchenne) muscular dystrophy. His care should include which of the following? Recommend genetic counseling. Explain that the disease is easily treated. Suggest ways to limit the use of muscles. Assist the family in finding a nursing facility to provide his care.

Recommend genetic counseling. Pseudohypertrophic (Duchenne) muscular dystrophy is inherited as an X-linked recessive gene. Genetic counseling is recommended for parents, female siblings, maternal aunts, and their female offspring. No effective treatment exists at this time for childhood muscular dystrophy. Maintaining optimum function of all muscles for as long as possible is the primary goal. It has been found that children who remain as active as possible are able to avoid the need for a wheelchair for a longer time. Finding a nursing facility is inappropriate at the time of diagnosis. When the child becomes increasingly incapacitated, the family may consider home-based care, a skilled nursing facility, or respite care to provide the necessary care.

An important nursing consideration when caring for a child with juvenile idiopathic arthritis is which of the following? Apply ice packs to relieve stiffness and pain. Administer acetaminophen to reduce inflammation. Teach the child and family the correct administration of medications. Encourage range of motion exercises during periods of inflammation.

Teach the child and family the correct administration of medications. The management of juvenile idiopathic arthritis is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of a regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that nonsteroidal antiinflammatory drugs should not be given on an empty stomach and to be alert for signs of toxicity. Warm, moist heat is best for relieving stiffness and pain. Acetaminophen does not have antiinflammatory effects. Range of motion exercises should not be done during periods of inflammation.

A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations include which of the following? Encourage normal activity for as long as possible. Explain the cause of the disease to the child and family. Prepare the child and family for long-term, permanent disabilities. Teach the family the care and management of the corrective appliance.

Teach the family the care and management of the corrective appliance. The family needs to learn the purpose, function, application, and care of the corrective device and the importance of compliance to achieve the desired outcome. The initial therapy is rest and non-weight-bearing activity, which help reduce inflammation and restore motion. Legg-Calvé-Perthes is a disease of unknown etiology. A disturbance of circulation to the femoral capital epiphysis produces an ischemic aseptic necrosis of the femoral head. The disease is self-limiting, but the ultimate outcome depends on early and efficient therapy and the age of the child at onset.

Which of the following heart defects causes hypoxemia and cyanosis because desaturated venous blood is entering the systemic circulation? Coarctation of the aorta Atrial septal defect Patent ductus arteriosus Tetralogy of Fallot

Tetralogy of Fallot Tetralogy of Fallot is a cardiac defect that has a mixed blood circulation. Coarctation of the aorta is an obstructive defect. There is no mixing of oxygenated and unoxygenated blood. Atrial septal defect and patent ductus arteriosus have increased flow of blood to the pulmonary system. The pressure gradient allows for oxygenated blood to return to the lungs.

Immobilization causes which of the following effects on the cardiovascular system? Venous stasis Increased vasopressor mechanism Normal distribution of blood volume Increased efficiency of orthostatic neurovascular reflexes

Venous stasis The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. A decreased vasopressor mechanism results in orthostatic hypotension, syncope, 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 with pooling of blood in the extremities in the upright position.

A 3-year-old child is hospitalized after submersion injury. The child's mother complains to the nurse, "This seems unnecessary when he is perfectly fine." The nurse's best reply would be which of the following? "He still needs a little extra oxygen." "I'm sure he is fine, but the doctor wants to make sure." "It is important to observe for possible physical reasons for the accident." "The reason for hospitalization is that complications could still occur."

"The reason for hospitalization is that complications could still occur." Complications such as respiratory compromise and cerebral edema can occur 24 hours after the incident. If the child needed oxygen, the mother would not state the child is perfectly fine. Telling the mother that the doctor wants to make sure the child is fine minimizes the role of the nurse and the need for observation for potential life-threatening complications. Physiologic causes may need to be identified in the case of a submersion injury, but it is not the reason for hospitalization.

A child is brought to the emergency department after experiencing a seizure at school. He has no history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurse's best response is which of the following? "Epilepsy is easily treated." "Very few children have actual epilepsy." "The seizure may or may not mean that your child has epilepsy." "Your child has had only one convulsion; it probably won't happen again."

"The seizure may or may not mean that your child has epilepsy." A single seizure event is not classified as epilepsy and is generally not treated with long-term antiepileptic drugs. It can be the result of an acute medical or neurologic disease. True epilepsy is not easily treated, so saying that it is easily treated minimizes the father's concern. The statistics on epilepsy do not address the father's issues about his child. The seizure may or may not mean that a child has epilepsy, so it may not happen again. The nurse needs to provide the information to the parent that the diagnosis is not based on one seizure episode.

Which of the following should the nurse recognize as an early clinical sign of compensated shock in a child? Confusion Sleepiness Hypotension Apprehension

Apprehension Early signs are vague and subtle, including apprehension, irritability, normal blood pressure, narrowing pulse pressure, thirst, pallor, and diminished urinary output. Confusion, sleepiness, and hypotension are later signs of shock.

Which of the following pediatric oncologic emergencies is caused by the rapid release of intracellular metabolites during the initial treatment of some cancers? Hyperleukocytosis Overwhelming infection Acute tumor lysis syndrome Superior vena cava syndrome

Acute tumor lysis syndrome Acute tumor lysis syndrome is caused by the rapid release of intracellular metabolites during the initial treatment of malignancies. Hyperleukocytosis, a white blood cell count greater than 100,000/mm3, can be present at diagnosis. It is not a result of the treatment. Infection may occur from bone marrow suppression that results from many chemotherapeutic agents. Superior vena cava syndrome can occur from compression of the mediastinal structures by Hodgkin disease and non-Hodgkin lymphoma.

Which of the following is an important nursing consideration when chest tubes will be removed from a child? Explain that it is not painful. Administer analgesics before procedure. Explain that only a Band-Aid will be needed. Expect bright red drainage for several hours after removal.

Administer analgesics before procedure. Removal of chest tubes can be an uncomfortable, frightening experience. Analgesics should be used. Children are forewarned that they will feel a sharp, momentary pain. A petrolatum-covered gauze dressing is immediately applied over the wound and securely taped to the skin on all four sides to form an airtight seal. No drainage is anticipated on the dressing.

The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. Which of the following is a priority of nursing care? Initiate isolation precautions as soon as diagnosis is confirmed. Provide environmental stimulation to keep the child awake. Administer antibiotic therapy as soon as it is available. Administer sedatives and analgesics on a preventive schedule to manage pain.

Administer antibiotic therapy as soon as it is available. Administering antibiotic therapy is the priority action. Antibiotics are begun as soon as possible to avoid resultant disabilities and to prevent death. Isolation should be instituted as soon as diagnosis is anticipated. It is important to decrease the external stimuli. The nurse should keep the room as quiet as possible. Antibiotics are the priority function; pain should be managed if it occurs.

Which of the following is an advantage of continuous cycling peritoneal dialysis or continuous ambulatory peritoneal dialysis for adolescents who require dialysis? Dietary restrictions are no longer necessary. Hospitalization is only required several nights per week. Adolescents can carry out procedures themselves. Insertion of a catheter does not require surgical placement.

Adolescents can carry out procedures themselves. Continuous cycling peritoneal dialysis or continuous ambulatory peritoneal dialysis provide the most independence for adolescents with end-stage renal disease and their families. Adolescents can carry out the procedure themselves. Dietary restrictions are still required but are less strict. The procedure can be done at home. The catheter is surgically implanted in the abdominal cavity.

Which of the following best describes the cause of most cases of acute glomerulonephritis? Renal vascular anomalies Antecedent streptococcal infection Results from a urinary tract infection Structural anomalies of genitourinary tract

Antecedent streptococcal infection Most cases are postinfectious and have been associated with pneumococcal, streptococcal, or viral infections. Renal vascular anomalies are not associated with acute glomerulonephritis. Urinary tract infections and structural anomalies can result in progressive renal injury, not acute glomerulonephritis.

A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of which of the following conditions? Parasitic infection Fat malabsorption Protein intolerance Bacterial gastroenteritis

Bacterial gastroenteritis Bacterial gastroenteritis is associated with neutrophils or red blood cells in the stool. The stool will be analyzed for ova and parasites when the bacterial and viral cultures are negative. Malabsorption is characterized by a pH of less than 6 and presence of reducing substances. Diarrhea that develops after introduction of cow's milk, fruits, or cereals may be related to protein intolerance.

One of the goals for children with asthma is to prevent respiratory tract infection. This is because respiratory tract infection does which of the following? Increases sensitivity to allergens Causes exercise-induced asthma Lessens effectiveness of medications Can trigger an episode or aggravate asthmatic state

Can trigger an episode or aggravate asthmatic state Viral respiratory tract infections can exacerbate asthma, especially in young children, whose airways are mechanically smaller and more reactive than those of older children. Respiratory tract infections do not affect sensitivity to allergens. Exercise precipitates exercise-induced asthma. The respiratory tract infection does not lessen the effectiveness of the medications.

Which of the following is defined as the forces that favor filtration from the capillary? Diffusion and osmosis Active transport Capillary hydrostatic pressure and interstitial oncotic pressure Hydrostatic pressure

Capillary hydrostatic pressure and interstitial oncotic pressure Capillary hydrostatic pressure and interstitial oncotic pressure are forces that favor filtration from the capillary. Diffusion is the random movement of molecules from a region of greater concentration to regions of lower concentration, and osmosis is the physical force created by a solution of higher concentration across a semipermeable membrane. Active transport is movement of a substance against a pressure gradient from an area of lesser or equal concentration to an area of greater or equal concentration. A carrier substance is needed. Hydrostatic pressure is the pressure in the arterial portion of the circulatory system, which can push fluid through the capillary walls.

The postoperative care of a preschool child who has had a brain tumor removed should include which of the following? Colorless drainage is to be expected. Analgesics are contraindicated because of altered consciousness. Positioning is on the operative side in the Trendelenburg position. Carefully monitor fluids because of cerebral edema.

Carefully monitor fluids because of cerebral edema. Because of cerebral edema and the danger of increased intracranial pressure postoperatively, fluids are carefully monitored. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported as soon as possible. Analgesics can be used for postoperative pain. The child should not be positioned in the Trendelenburg position postoperatively.

The parent of a 10-year-old child with diabetes asks the nurse why home blood glucose monitoring is being recommended. The nurse should base the explanation on which of the following? It is an easier method of testing. Parents are better able to manage the diabetes. Children have a greater sense of control over the diabetes. Fewer visits to the primary care provider will be necessary.

Children have a greater sense of control over the diabetes. Blood glucose monitoring affords the child a greater sense of control. The immediate feedback allows for regulation of insulin doses. Home blood glucose monitoring provides a more accurate assessment of control than urine testing. Although the parents are involved in the management, a 10-year-old child should take responsibility for testing. The same number of visits will be necessary, but the blood glucose monitoring will enable better control.

Which of the following is a measure of chest wall and lung distensibility? Resistance Ventilation Compliance Alveolar surface tension

Compliance Compliance is a measure of chest wall and lung distensibility. Resistance increases the work of breathing. Three major sources of resistance are airway size, tissue resistance in lung, and flow resistance in the airways. Ventilation is the exchange of gases in the lungs. Alveolar surface tension is one of several contributory factors to compliance.

A 2-month-old breastfed infant is successfully rehydrated with oral rehydration solutions for acute diarrhea. Instructions to the mother about breastfeeding should include which of the following? Continue breastfeeding. Stop breastfeeding until the breast milk is cultured. Stop breastfeeding until diarrhea is absent for 24 hours. Express breast milk and dilute it with sterile water before feeding it.

Continue breastfeeding Breastfeeding is recommended for infants with acute diarrhea. Continued breastfeeding results in a reduced severity and duration of the illness. There is no need to culture breast milk. Early introduction of nutrients improves outcomes. Diluting expressed breast milk with sterile water before feeding should never be done. It can contribute to an electrolyte imbalance.

Therapeutic management of nephrotic syndrome includes which of the following? Corticosteroids Long-term diuretics Antihypertensive agents Fluid and salt restrictions

Corticosteroids Most children with nephrotic syndrome respond to corticosteroids, making this group the drug of choice. Corticosteroid therapy is begun as soon as the diagnosis has been determined. Children with nephrotic syndrome usually do not respond to diuretics. Furosemide, in combination with metolazone, is useful for severe edema. Antihypertensive agents are not indicated in the management. Fluids are rarely restricted. The child is placed on a no-added-salt diet.

Which of the following is an important nursing responsibility when a dysrhythmia is suspected? Order an immediate electrocardiogram. Count the radial rate every 1 minute for 5 minutes. Count the apical rate for 1 full minute and compare with radial rate. Have someone else take the radial rate simultaneously with the apical rate.

Count the apical rate for 1 full minute and compare with radial rate. Counting the apical rate for 1 full minute and compare with radial rate is the nurse's first action. If a dysrhythmia is occurring, the radial pulse may be lower than the apical rate. Ordering an immediate electrocardiogram may be indicated after conferring with the practitioner. Radial pulse needs to be compared with the apical. It is the nurse's responsibility to check both rates, radial and apical.

Which of the following urine tests of renal function is used to estimate glomerular filtration? pH Creatinine Osmolality Protein level

Creatinine The most useful clinical estimation of glomerular filtration is the clearance of creatinine. The production and secretion of creatinine remain relatively constant from day to day, and its appearance in the urine is determined by the serum level. The pH is a measure of alkalinity, not glomerular filtration. Osmolality is a measure of concentration. The presence of protein is indicative of abnormal glomerular permeability.

In acute glomerulonephritis, the nurse is aware that an early warning sign of encephalopathy is which of the following? Seizures Psychosis Dizziness Transient loss of vision

Dizziness Acute and severe hypertension can cause the protective autoregulation of cerebral blood flow to fail, leading to hyperperfusion of the brain and cerebral edema. The premonitory signs of encephalopathy are headache, dizziness, abdominal discomfort, and vomiting. Seizures and transient loss of vision are signs that the condition is progressing. Psychosis is not an early warning sign of hypertensive encephalopathy. Seizures and transient loss of vision are signs that the condition is progressing.

Which of the following should the nurse include when discussing a child's precocious puberty with the parents? The child is not yet fertile. Heterosexual interest is usually advanced. Dress and activities should be appropriate to chronologic age. Appearance of secondary sexual characteristics does not proceed in the usual order.

Dress and activities should be appropriate to chronologic age. Because of the early sexual maturation of the child, both the family and child require extensive teaching. Included in this is the information that the child should be engaged in activities according to chronologic age. Functioning sperm or ova may be produced, thereby making the child fertile at an early age. Heterosexual interest is usually appropriate to chronologic age. Development of the secondary sexual characteristics proceeds in the usual order.

Several types of long-term central venous access devices are used. Which of the following is a benefit of using an implanted port (e.g., Port-a-Cath)? Accessed without piercing skin Easy to use for self-administered infusions Easy access for blood work Catheter unable to dislodge from port even if the child "plays" with the port site

Easy access for blood work The port is completely under the skin. Other advantages include cosmetic appearance and easy access for blood work and fluid and medication administration. The skin must be accessed with a special needle before the infusion can begin. Placement in the chest makes it difficult to use for self-administered injections. The catheter can be dislodged from the port if the child rubs the port site.

Which of the following procedures uses high-frequency sound waves obtained by a transducer to produce an image of cardiac structures? Echocardiography Electrophysiology Electrocardiography Cardiac catheterization

Echocardiography Echocardiography uses high-frequency sound waves. The child must lie completely still. With the improvements in technology, diagnosis can sometimes be made without cardiac catheterization. Electrophysiology is an invasive procedure in which catheters with electrodes are used to record the impulses of the heart directly from the conduction system. Electrocardiography is a tracing of the electrical path of the depolarization action of myocardial cells. Cardiac catheterization is an invasive procedure in which a catheter is threaded into the heart.

The school nurse is caring for a child with hemophilia who fell on his arm during recess. Which of the following supportive measures should the nurse do until factor replacement therapy can be instituted? Apply warm, moist compresses. Apply a tourniquet for at least 5 minutes. Elevate the arm above the level of the heart. Begin passive range of motion unless pain is severe.

Elevate the arm above the level of the heart. The initial response should include elevation. Cold should be applied to the arm. This will aid in vasoconstriction. Pressure is effective in small areas but would not work for an extremity. Passive range of motion is not recommended. The child can perform active range of motion after the bleeding episode has resolved.

Chelation therapy is begun on a child with α-thalassemia major. The purpose of this therapy is to do which of the following? Treat the disease. Eliminate excess iron. Decrease risk of hypoxia. Manage nausea and vomiting.

Eliminate excess iron. Iron overload (hemosiderosis) is a complication of blood transfusions. Chelation therapy is necessary to minimize the development of hemosiderosis and hemochromatosis. Blood transfusions are the primary medical management. Chelation therapy removes iron; it does not affect the disease process.

When planning care for a 4-month-old child admitted with respiratory distress caused by respiratory syncytial virus (RSV) and bronchiolitis, it is essential to include which of the following? Give antibiotics. Ensure adequate hydration. Administer cough syrup. Feed 4 oz of formula every 4 hours.

Ensure adequate hydration. When respiratory distress is present, hydration is an essential consideration. Usually infants cannot take fluids by the oral route because of the difficulty breathing. Intravenous fluid administration may be necessary. RSV is a virus, so antibiotics are not beneficial. Cough syrup is not routinely used in RSV. Although fluid and calories are important, an infant with respiratory distress is usually unable to drink this amount of fluid.

Nursing considerations related to the administration of oxygen in an infant include which of the following? Discontinue during feedings so child can be held. Assess infant to determine how much oxygen should be given. Ensure uninterrupted delivery of the appropriate oxygen concentration. Direct oxygen flow so that it blows directly into the infant's face in a hood.

Ensure uninterrupted delivery of the appropriate oxygen concentration. The nurse's responsibility is to ensure that the appropriate oxygen concentration is delivered uninterrupted. Oxygen delivery needs to be continued as ordered. Most children receiving oxygen will need the supplemental oxygen during the increased energy expenditure of eating. Ongoing assessment of the infant's respiratory status and oxygen saturation are necessary. Oxygen is a medication, and the amount is prescribed by the practitioner. Oxygen should not blow directly on the infant. Cold air applied to the face can result in the diving reflex, which causes bradycardia and shunting of blood from the periphery to central circulation.

Which of the following types of croup is always considered a medical emergency? Laryngitis Epiglottitis Spasmodic croup Laryngotracheobronchitis

Epiglottitis Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and upper respiratory tract infection symptoms. Spasmodic croup is treated with humidity. Laryngotracheobronchitis may progress to a medical emergency in some children.

The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. The nurse should do which of the following first? Determine what the child has eaten. Administer diphenhydramine (Benadryl). Move the child to the nurse's office or hallway. Have someone call for an ambulance or paramedic rescue squad.

Have someone call for an ambulance or paramedic rescue squad. Because the child is in severe respiratory distress, the nurse should remain with the child while someone else calls for the rescue squad. Because severe respiratory distress is occurring, treatment of the response is indicated first. The cause of the response can be determined later. Diphenhydramine will not be effective for this type of allergic reaction. The child should not be moved unless the child is in a place that puts the child at greater hazard.

The nurse is explaining blood components to an 8-year-old child. The nurse's best description of platelets is that they do which of the following? Make up the liquid portion of blood Help keep germs from causing infection Carry the oxygen you breathe from your lungs to all parts of your body Help your body stop bleeding by forming a clot (scab) over the hurt area

Help your body stop bleeding by forming a clot (scab) over the hurt area Platelets are involved in hemostasis. Plasma makes up the liquid portion of blood. White blood cells help keep germs from causing infection. Red blood cells carry the oxygen you breathe from your lungs to all parts of your body.

A 13-year-old girl is brought to the clinic with the complaint of insomnia and hyperactivity. Other symptoms include gradual weight loss despite a good appetite; warm, flushed, and moist skin; and unusually fine hair. These manifestations are most suggestive of which of the following? Hypothyroidism Hyperthyroidism Hypoparathyroidism Hyperparathyroidism

Hyperthyroidism These symptoms are suggestive of hyperthyroidism. Other symptoms include academic difficulties resulting from a short attention span and an inability to sit still, unexplained fatigue and sleeplessness, and difficulty with fine motor skills. Hypothyroidism is seen with decelerated growth from chronic deprivation of thyroid hormone. Other manifestations are myxedematous skin changes (dry skin, puffiness around the eyes, sparse hair), constipation, sleepiness, and mental decline. Early manifestations of hypoparathyroidism may be anxiety and mental depression followed by paresthesia and evidence of heightened neuromuscular excitability. Hyperparathyroidism results in hypercalcemia, which can be manifested by a change in behavior, gastrointestinal symptoms, and cardiac irregularities.

Rapid replacement of fluid is essential in the treatment of which of the following types of dehydration? Isotonic, osmotic Hypotonic, isotonic Osmotic, hypertonic Hypertonic, hypotonic

Hypotonic, isotonic In moderate to severe dehydration, rapid expansion of the intravascular space is necessary. Rapid replacement is indicated in isotonic dehydration. Osmotic is not a type of dehydration. Rapid replacement is contraindicated in hypertonic dehydration.

Which statement accurately expresses the genetic implications of cystic fibrosis (CF)? It is inherited as an autosomal dominant trait. It is a genetic defect found primarily in nonwhite population groups. If it is present in a child, both parents are carriers of the defective gene. There is a 50% chance that siblings of an affected child will also be affected.

If it is present in a child, both parents are carriers of the defective gene. CF is an autosomal recessive gene inherited from both parents. CF is inherited as an autosomal recessive, not autosomal dominant, trait. CF is found primarily in white populations. An autosomal recessive inheritance pattern means that there is a 25% chance a sibling will be infected but a 50% chance a sibling will be a carrier.

Which of the following helps nurses understand how the respiratory tract in children is different from that in adults? Infants rely almost entirely on diaphragmatic-abdominal breathing. Smooth muscle development in the airways increases until about age 12 years. The configuration of the chest at birth is not as round as it becomes by adulthood. With age there is a decrease in both number of alveoli and branching of terminal bronchioles.

Infants rely almost entirely on diaphragmatic-abdominal breathing. The ribs of an infant articulate with the vertebrae and sternum at a more horizontal angle. This contributes to the infant using primarily diaphragmatic-abdominal breathing. Smooth muscle development at approximately 4 months of age is sufficient to respond to irritating stimuli. The chest of an infant is more rounded than that of an adult. Alveoli steadily increase in number. By age 12 years, there are nine times as many alveoli as at birth.

What type of dehydration is defined as "dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion?" Isotonic dehydration Hypotonic dehydration Hypertonic dehydration All types of dehydration in infants and small children

Isotonic dehydration Isotonic dehydration is the correct term for this definition and is the most frequent form of dehydration in children. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic. Hypertonic dehydration results from water loss in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes. "Dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion" is a definition specific to isotonic dehydration.

Which of the following statements best describes Cushing syndrome? It is caused by excessive production of cortisol. Treatment involves replacement of cortisol. The major clinical features are exophthalmia and pigmentary changes. The diagnosis is suspected with findings of hypotension, hyperkalemia, and polyuria.

It is caused by excessive production of cortisol. Cushing syndrome is a description of the clinical manifestations caused by too much circulating cortisol. In children, this is caused by a tumor or excessive and prolonged steroid therapy. The treatment is reduction of circulating cortisol. If the cause is a pituitary tumor, surgery is indicated. Exophthalmia is a manifestation of hyperthyroidism, not Cushing syndrome. Hypertension and hypokalemia are expected findings.

Which of the following is a major complication of total parenteral nutrition in children? Anemia Asthma Liver disease Renal impairment

Liver disease Liver disease is the most important gastrointestinal complication of total parenteral nutrition. If present, anemia and asthma are not directly related to the total parenteral nutrition. Renal function is monitored to ensure electrolyte balance, but impairment is not an expected complication.

A child with lymphoma is receiving extensive radiotherapy. Which of the following is the most common side effect of this treatment? Malaise Seizures Neuropathy Lymphadenopathy

Malaise Malaise is the most common side effect of radiotherapy. For children, the fatigue may be especially distressing because it means they cannot keep up with their peers. Seizures are unlikely because irradiation would not usually involve the cranial area for treatment of lymphoma. Neuropathy is a side effect of certain chemotherapeutic agents. Lymphadenopathy is one of the findings of lymphoma.

Nursing considerations related to the administration of chemotherapeutic drugs include which of the following? Anaphylaxis cannot occur because the drugs are considered toxic to normal cells. Infiltration will not occur unless superficial veins are used for the intravenous infusion. Many chemotherapeutic agents are vesicants that can cause severe cellular damage if drug infiltrates. Good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary.

Many chemotherapeutic agents are vesicants that can cause severe cellular damage if drug infiltrates. Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and be prepared to treat extravasations if necessary. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents. Infiltration and extravasations are always a risk, especially with peripheral veins. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward.

An appropriate nursing intervention when caring for a child with pneumonia is which of the following? Avoid placing child on the affected side. Monitor the respiratory status frequently. Place in a Trendelenburg position. Administer antitussive agents around the clock.

Monitor the respiratory status frequently. The child's respiratory rate, status, oxygenation, general disposition, and level of activity are frequently monitored. Lying on the affected side may promote comfort by splinting the chest and reducing pleural rubbing. The child should be positioned with the unaffected side up to promote maximum expansion. Children should be placed in a semierect position or position of comfort. Antitussives are usually not indicated.

Why are infants particularly vulnerable to acceleration-deceleration head injuries? The anterior fontanel is not yet closed. The nervous tissue is not well developed. The scalp of the head has extensive vascularity. Musculoskeletal support of the head is insufficient.

Musculoskeletal support of the head is insufficient. The relatively large head size coupled with insufficient musculoskeletal support increases the risk to infants. The anterior fontanel, nervous tissue, and scalp of the head do not have an effect on this type of injury.

When caring for a child with an intravenous infusion, the nurse should do which of the following? Change the insertion site every 24 hours. Use a macrodropper to facilitate the prescribed flow rate. Observe the insertion site frequently for signs of infiltration. Avoid restraining the child to prevent undue emotional stress.

Observe the insertion site frequently for signs of infiltration. The nursing responsibility for intravenous therapy is to calculate the amount to be infused in a given length of time; set the infusion rate; and monitor the apparatus frequently, at least every 1 to 2 hours, to make certain that the desired rate is maintained, the integrity of the system remains intact, the site remains intact (free of redness, edema, infiltration, or irritation), and the infusion does not stop. Insertion sites do not need to be changed every 24 hours unless a problem is found with the site. This exposes the child to significant trauma. If an infusion pump is not used, a minidropper (60 drops/ml) is the recommended intravenous tubing in children. The intravenous site should be protected. This may require soft restraints on the child.

Nursing care of the infant and child with heart failure would include which of the following? Force fluids appropriate to age. Monitor respirations during active periods. Organize activities to allow for uninterrupted sleep. Give larger feedings less often to conserve energy.

Organize activities to allow for uninterrupted sleep. The child needs to be well rested before feeding. The child's needs should be met as quickly as possible to minimize crying. The nurse must organize care to minimize the child's energy expenditure. The child who has heart failure has an excess of fluid. Monitoring vital signs is appropriate, but minimizing energy expenditure is a priority. The child often cannot tolerate larger feedings.

Which of the following blood oxygenation tests is the photometric measurement of oxygen saturation? Oximetry Capnography Arterial puncture Transcutaneous oxygen and carbon dioxide monitoring

Oximetry Oximetry provides continuous noninvasive measurements of hemoglobin saturation. Photometric measurements are used to determine the oxygen saturation. Capnography measures carbon dioxide during inhalation and exhalation. Arterial puncture is the sampling method to obtain blood for gas analysis. Transcutaneous oxygen and carbon dioxide monitoring provides a continuous and reliable trend of arterial oxygen and carbon dioxide.

The most common signs and symptoms of leukemia related to bone marrow involvement are which of the following? Petechiae, fever, and fatigue Headache, papilledema, and irritability Muscle wasting, weight loss, and fatigue Decreased intracranial pressure, psychosis, and confusion

Petechiae, fever, and fatigue Signs of infiltration of the bone marrow are petechiae from lowered platelet count, fever related to infection from the depressed number of effective leukocytes, and fatigue from the anemia. Headache, papilledema, irritability, muscle wasting, weight loss, fatigue, decreased intracranial pressure, psychosis, and confusion are not signs of bone marrow involvement.

Which of the following is the primary clinical manifestation of diabetes insipidus? Oliguria Glycosuria Nausea, vomiting Polyuria, polydipsia

Polyuria, polydipsia Diabetes insipidus results from the hyposecretion of antidiuretic hormone. Because insufficient amounts are produced, excessive amounts of urine are produced. When allowed access to fluids, the child maintains balance with an almost insatiable thirst. Oliguria is diminished urinary output. Children with diabetes insipidus have increased urinary output. Glycosuria is not a manifestation of diabetes insipidus. It may be a manifestation of diabetes mellitus. Nausea and vomiting are not manifestations of diabetes insipidus. They can occur with oversecretion of antidiuretic hormone.

An immediate intervention when an infant chokes on a piece of food would be to do which of the following? Administer mouth-to-mouth resuscitation. Open the infant's mouth and perform a blind finger sweep. Have the infant lie quietly while a call is placed for emergency help. Position the infant in a head-down, prone position and administer five quick blows between the shoulder blades.

Position the infant in a head-down, prone position and administer five quick blows between the shoulder blades. Placing the infant in a head-down, prone position and administering five quick blows between the shoulder blades is the correct position and procedure for an infant who had choked on a piece of food or another object. Blowing into the infant's mouth might push the object into the lungs. Blind finger sweeps are avoided in infants and children younger than age 8 years. If the infant is choking, it is an emergency. Action must be taken.

The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. Because of the sudden, severe nature of the disease, the family needs a great deal of emotional support. The most appropriate nursing action is which of the following? Prepare the family for the child's impending death. Prepare the family for each procedure. Prepare the family for the long-term consequences of paralysis. Reassure the family that flaccid paralysis is not problematic.

Prepare the family for each procedure. By preparing the family for each procedure, the nurse is showing sensitivity to the family's emotional needs. Acute adrenocortical insufficiency is a reversible condition when associated with adrenocortical insufficiency. Flaccid paralysis is problematic if not reversible.

Nurses counseling parents regarding the home care of the child with a cardiac defect before corrective surgery should stress which of the following? Be extremely concerned about cyanotic spells. Relax discipline and limit setting to prevent crying. Reduce caloric intake to decrease cardiac demands. Promote normality within the limits of the child's condition.

Promote normality within the limits of the child's condition. The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child. Because cyanotic spells occur in children with some defects, the parents need to be taught how to manage these. The child needs discipline and appropriate limits. The child needs increased caloric intake.

The clinical manifestations of nephrotic syndrome include which of the following? Hematuria, bacteriuria, and weight gain Gross hematuria, albuminuria, and fever Hypertension, weight loss, and proteinuria Proteinuria, hypoalbuminemia, and edema

Proteinuria, hypoalbuminemia, and edema Edema, proteinuria, hypoalbuminemia, and hypercholesterolemia are the clinical manifestations of nephrotic syndrome in children. Bacteriuria is not a diagnostic criterion for nephrotic syndrome. Fever is not associated with nephrotic syndrome. Weight gain occurs secondary to the edema.

The nurse is doing a neurologic assessment on a child whose level of consciousness has been variable since sustaining a cervical neck injury 12 hours ago. Which of the following is the most essential in this assessment? Reactivity of pupils Doll's head maneuver Oculovestibular response Funduscopic examination to identify papilledema

Reactivity of pupils Pupil reactivity is an important indication of neurologic health. The pupils should be assessed for no reaction, unilateral reaction, and rate of reactivity. The doll's head maneuver should not be performed if there is a cervical spine injury. The oculovestibular response is a painful test that should not be done on a child who is having variable levels of consciousness. Papilledema does not develop until 24 to 48 hours into the course of unconsciousness.

Which of the following is the viral pathogen that frequently causes acute diarrhea in young children? Giardia organisms Shigella organisms Rotavirus Salmonella organisms

Rotavirus Rotavirus is the viral pathogen that most frequently causes diarrhea in young children. Giardia is a bacterial pathogen that causes diarrhea. Shigella is a bacterial pathogen that is uncommon in the United States. Salmonella is a bacterial pathogen that causes diarrhea.

Which of the following statements best describes hypopituitarism? Skeletal proportions are normal for age. Weight is usually more retarded than height. Growth is normal during the first 3 years of life. Most of these children have subnormal intelligence.

Skeletal proportions are normal for age. Skeletal proportions are normal for age, but these children appear young for their age. Growth in height is usually more delayed than in weight. Growth is normal for the first year of age, and then these children follow a slowed growth curve. Most of the children have normal intelligence. Often they are considered precocious because their educational ability seems to exceed their size. Emotional problems are common because of their small stature.

The nurse suspects a child is having an adverse reaction to a blood transfusion. The first action by the nurse should be which of the following? Notify the physician. Take the vital signs and blood pressure and compare them with baseline levels. Dilute infusing blood with equal amounts of normal saline. Stop transfusion and maintain a patent intravenous line with normal saline and new tubing.

Stop transfusion and maintain a patent intravenous line with normal saline and new tubing. Stopping the transfusion and maintaining a patent intravenous line with normal saline and new tubing is the priority nursing action. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused. Notifying a physician and taking vital signs and blood pressure should be performed after the blood transfusion is stopped and infusion of normal saline has begun. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred.

The nurse is assessing an infant brought to the clinic with diarrhea. He is lethargic and has dry mucous membranes. Which of the following should the nurse recognize as an early sign of dehydration? Tachycardia Bulging, tense fontanel Decreased blood pressure Capillary refill of less than 3 seconds

Tachycardia Tachycardia is the earliest manifestation of dehydration. Fever and infection can also result in tachycardia, so these should be included in the assessment data. A bulging fontanel may be indicative of increased intracranial pressure, not dehydration. Decreased blood pressure is a late sign of dehydration. Capillary refill is slowed and more than 3 seconds in dehydration.

Which of the following is an early sign of heart failure that the nurse should recognize? Tachypnea Bradycardia Inability to sweat Increased urinary output

Tachypnea Tachypnea is one of the early signs that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child may be diaphoretic. Urinary output usually will be decreased.

An important nursing consideration when caring for a child with sickle cell anemia is which of the following? Refer the parents and child for genetic counseling. Teach the parents and child how to recognize the signs and symptoms of crises. Help the child and family adjust to a short-term disease. Observe for complications of multiple blood transfusions.

Teach the parents and child how to recognize the signs and symptoms of crises. Parents need specific instructions on the need to watch for changes in the child's condition, including adequate hydration, and environmental concerns. Genetic counseling is important, but teaching care of the child is a priority. Sickle cell anemia is a long-term, chronic illness. Multiple blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is properly preparing the parents to care for them.

Which of the following best describes a neuroblastoma? The diagnosis is usually made after metastasis occurs. It is the most common brain tumor in young children. Older children have an improved likelihood of survival. Early diagnosis is usually possible because of the obvious clinical manifestations.

The diagnosis is usually made after metastasis occurs. Neuroblastoma is considered a "silent" tumor. In more than 70% of cases, the diagnosis is made after metastasis occurs. The neuroblastoma is usually located in the abdomen. Children younger than 1 year of age have a 75% survival rate; those older than age 1 year, only 50%. The diagnosis is not usually made until other sites have been invaded by the tumor.

In providing nourishment for a child with cystic fibrosis (CF), which of the following factors should the nurse keep in mind? Fats and proteins must be greatly curtailed. The diet should be high in calories and protein. Most fruits and vegetables are not well tolerated. The diet should be high in easily digested carbohydrates and fats.

The diet should be high in calories and protein. Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Fats and proteins are a necessary part of a well-balanced diet. A well-balanced diet containing fruits and vegetables is important. Enzyme supplementation helps digest foods; other modifications are not necessary.

Chemotherapeutic drugs to treat cancer are often given in combination because the drugs can be given by various routes. the drugs can be given at different times during the day. patients cannot tolerate extremely high doses of single drugs. The drugs allow for optimum cell destruction with minimum toxic effects.

The drugs allow for optimum cell destruction with minimum toxic effects. Combining drugs allows for synergistic effects. Optimum cell cycle destruction with minimum toxic effects and decreased resistance by the cancer cells to the agent are possible. Routes of administration depend on the pharmacologic attributes of the drug. The routes do not influence interactions. Combination therapy usually has specific intervals to maximize synergistic effect. High doses of drugs are indicated in different regimens.

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain which of the following concerning narcotic analgesics? They are often ordered but not usually needed. When they are medically indicated, children rarely become addicted. They are given as a last resort because of the threat of addiction. They are used only if other measures, such as ice packs, are ineffective.

When they are medically indicated, children rarely become addicted. Pain is the most common and debilitating symptom experienced by patients with sickle cell disease. The chronic nature of this pain can greatly affect the child's development. A multidisciplinary approach is best for its management. Patient-controlled analgesia or continuous intravenous administration is usually effective. Pharmacologic intervention is necessary for the pain of sickle cell crisis.

Which of the following statements regarding burn injuries in children is correct? Burns are the most frequent cause of accidental death during childhood. The prognosis for a burned child is directly related to the amount of tissue destroyed. The standard "rule of nines" chart is typically used for assessing the size of a burn in small children. Children younger than age 2 years have significantly lower mortality rates than older children with similar burns.

The prognosis for a burned child is directly related to the amount of tissue destroyed. The prognosis of a child with a burn is directly related to the amount of tissue destroyed. The location of the wounds, age of the child, causative agent, respiratory involvement, general health of the child, and other injuries are also considered. Burned clothing is removed to prevent further damage from smoldering fabric and hot beads of synthetic fabric. Jewelry is removed to stop the transfer of heat from the metal to the skin. Burn and fire injuries are the third leading cause of unintentional injury-related death in children younger than the age of 14 years. The body proportions of the child are different from those of an adult. Use of the standard adult rule of nines will give an inaccurate estimate of the burn area. Physiologic factors, including greater relative percentage body water, minimum protein stores, and an immature immune response, contribute to a significantly higher mortality in children younger than age 2 years.

Which of the following is most descriptive of the therapeutic management of osteogenic sarcoma? Intensive irradiation is the primary treatment. Amputation of the affected extremity is rarely necessary. Treatment usually consists of surgery and chemotherapy. Bone marrow transplantation offers the best chance of long-term survival.

Treatment usually consists of surgery and chemotherapy. Optimum treatment of osteosarcoma is surgery and chemotherapy. Surgical biopsy is followed by either limb salvage or amputation and chemotherapy. Radiation and bone marrow transplantation are not part of the therapy for osteosarcoma. Amputation is often required when limb salvage is not possible.

Therapeutic management of the child with rheumatic fever includes administration of penicillin. avoidance of salicylates (aspirin). strict bed rest for 4 to 6 weeks. administration of corticosteroids if chorea develops.

administration of penicillin. Penicillin remains the drug of choice (oral or intramuscular injections), with macrolides or cephalosporins as a substitute in penicillin-sensitive children. Initial therapy includes a full 10-day course of penicillin or an alternative antibiotic. Salicylates may be used to reduce the inflammatory process after diagnosis. Bed rest is not indicated. Children can resume regular activities after the febrile stage is over. The chorea is transient, and pharmacologic intervention is not indicated.

It is generally recommended that a child with acute streptococcal pharyngitis can return to school when his or her sore throat is better. if no complications develop. after taking antibiotics for 24 hours. 3 days after initial throat cultures.

after taking antibiotics for 24 hours. After children have taken antibiotics for 24 hours, they are no longer contagious to other children. Sore throat may persist longer than 24 hours of antibiotic therapy, but the child is no longer considered contagious. Complications may take days to weeks to develop. The time from throat culture does not affect the contagiousness of the infection. Antibiotics must be used.

Asthma is now classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include all of the following except lung function. associated allergies. frequency of symptoms. frequency and severity of exacerbations.

associated allergies. Associated allergies are not part of the classification system used in the Guidelines for the Diagnosis and Management of Asthma. The clinical features that are assessed in the classification system are frequency of daytime and nighttime symptoms, frequency and severity of exacerbations, and lung function.

The nurse is teaching a mother how to perform chest physiotherapy and postural drainage on her 3-year-old child, who has cystic fibrosis. To perform percussion, the nurse should instruct her to strike the chest wall with a flat-hand position. percuss before and after positioning for postural drainage. percuss over the entire trunk anteriorly and posteriorly. cover the skin with a shirt or gown before percussing.

cover the skin with a shirt or gown before percussing. The child should wear a light shirt to protect the skin from the percussion. The hand is cupped when the child's chest wall is struck. Percussion is done after the position change. There are identified positions and sequence for postural drainage.

The most profound complication of prolonged middle ear disorders is loss of hearing. failure to thrive. visual impairment. tympanic membrane rupture.

loss of hearing. Loss of hearing is the principal functional consequences of prolonged middle ear infections. Diminished hearing has an adverse effect on the development of speech, language, and cognition. During the active infection, loss of appetite typically occurs, and sucking or chewing tends to aggravate the pain. This is a short-term issue; when the otitis media resolves, the child resumes previous dietary intake. Ear infections do not have an effect on vision. Rupture of the eardrum may occur, but the loss of hearing and subsequent effect on speech are of greater concern.

The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry green color. The nurse should explain that this is a(n) symptom of iron deficiency anemia. adverse effect of the iron preparation. indicator of an iron preparation overdose. normally expected change resulting from the iron preparation.

normally expected change resulting from the iron preparation. An adequate dosage of iron turns the stools a tarry green color. Descriptions of iron-deficiency anemia, iron preparation, and iron preparation overdose are not relevant. If the stools do not become tarry green, it may be indicative of administration issues.

Skin testing for tuberculosis (TB) is recommended every year for all children older than 2 years. every year for all children older than 10 years. every 2 years for all children starting at age 1 year. periodically for children who are high-risk populations.

periodically for children who are high-risk populations. Children who are high risk for contracting the disease are monitored periodically. Annual testing is only indicated for children with human immunodeficiency virus infection and incarcerated adolescents. Testing is not necessary unless exposure is likely or an underlying medical risk factor is present.

A young child is diagnosed with vesicoureteral reflux. The nurse should know that this usually results in incontinence. urinary obstruction. recurrent urinary tract infections. infarction of renal vessels.

recurrent urinary tract infections. Reflux allows urine to flow back to the kidneys. When the urine is infected, this contributes to urinary tract infections and pyelonephritis. Incontinence may be associated with urinary tract infections. Reflux, when associated with vesicoureteral reflux, can cause renal scarring but not obstruction. Infarction of renal vessels does not occur.

The nurse is caring for a child with multiple injuries who is comatose. The nurse should recognize that pain cannot occur if the child is comatose. may occur if the child regains consciousness. requires astute nursing assessment and management. is best assessed by family members who are familiar with the child.

requires astute nursing assessment and management. Because the child cannot communicate pain through one of the standard pain rating scales, the nurse must focus on physiologic and behavioral manifestations. The child can be in pain while comatose. The family can provide insight into different responses, but the nurse should monitor physiologic and behavioral manifestations.

A child is developing respiratory failure. Signs that the hypoxia is becoming severe include tachypnea. tachycardia. somnolence. restlessness.

somnolence. Somnolence is a late sign indicating severe hypoxia. Tachypnea, tachycardia, and restlessness are cardinal signs of respiratory failure and are observed early.

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it liquefies secretions. improves oxygenation. promotes less labored ventilation. soothes inflamed mucous membranes.

soothes inflamed mucous membranes. Warm or cold mist is useful to soothe the inflamed mucous membranes. Humidification is most useful when hoarseness or laryngeal involvement occurs. Normal saline nose drops should be used to liquefy secretions. The mist particles do not penetrate in sufficient amounts to accomplish this. There is no additional oxygen in the mist therapy commonly used for respiratory tract infections. The primary effect of mist is to soothe the inflamed membranes. A reduction in swelling might ease ventilatory effort, but it is not the primary purpose of the therapy.

When hemoglobin falls sufficiently to produce clinical manifestations, the signs and symptoms are caused by phagocytosis. tissue hypoxia. pulmonary hypertension. depressed bone marrow.

tissue hypoxia. The signs and symptoms (e.g., weakness, fatigue, and a waxy pallor in severe anemia) are caused by tissue hypoxia. Phagocytosis is a function of white blood cells used in prevention of infection. Pulmonary hypertension is not associated with anemia. Severe anemia may contribute to cardiac compensation. Depressed bone marrow may be the cause of the low hemoglobin.

The primary therapy for secondary hypertension in children is a low-salt diet. weight reduction. increased exercise and fitness. treatment of underlying cause.

treatment of underlying cause. Secondary hypertension is a result of an underlying disease process or structural abnormality. It is usually necessary to treat the problem before the hypertension will be resolved. A low-salt diet, weight reduction, and increased exercise and fitness therapies are usually effective for essential hypertension.