Peds Evolve Questions CH 10, 13, 16, 18, 21, 24

An adolescent is accompanied by their mother for an annual physical examination. Based on the nurse's knowledge of this age group, the nurse should avoid questions on which topics? (Select all that apply.) A. Alcohol use B. Sexual activity C. Cigarette smoking D. School performance E. Use of car seat belts

A, B, C The nurse must maintain confidentiality, which is between the nurse and adolescent. Therefore, while the mother is in the room, the nurse should not ask personal questions. The nurse can ask general questions about academic performance and use of car seat belts without breaching confidentiality.

What is the most appropriate action to stop an occasional episode of epistaxis? A. Have the child sit up and lean forward. B. Apply ice under the nose and above the lip. C. Have the child lie down quietly with the feet elevated. D. Apply continuous pressure to the nose with the thumb and forefinger for at least 1 minute.

A. Sitting up and leaning forward is the position used to prevent the child from aspirating blood. Pressure, not ice, is indicated for an occasional episode of epistaxis. Lying the child down with the feet elevated can potentially lead to aspiration. Continuous pressure for 10 minutes is recommended; 1 minute would not be long enough.

What is appropriate mouth care for a toddler with mucosal ulceration related to chemotherapy? A. Lemon glycerin swabs for cleansing B. Mouthwashes with normal saline C. Mouthwashes with hydrogen peroxide D. Local anesthetic such as viscous lidocaine before meals

B. Normal saline mouthwashes are the preferred mouth care for this age group. The rinse will keep the mucosal surfaces clean without adverse effects on mucosa or problems if the child swallows the rinse. Lemon glycerin swabs can irritate eroded tissue and can decay teeth. Hydrogen peroxide delays healing by breaking down protein. Viscous lidocaine is not recommended for toddlers, because it depresses the gag reflex and the child may have resultant aspiration.

A parent with a toddler who has a respiratory infection wants to use the traditional method of topical vapor rub. Which statement by the parent indicates that additional teaching is needed with regard to administration of this treatment? A. The parent states that he will wash his hands before applying the medication. B. The parent will read the product label before administering the medication. C. The parent will inform the pediatrician that the medication is being used. D. Application of the medication will be given orally to avoid potential sneezing.

D. Topical vapor rubs should never be given orally or applied beneath the nose. All of the other options indicate appropriate action on the part of the parent in terms of medical asepsis, obtaining information by reading label and notifying the health care provider that a medication is being used in the current treatment plan.

A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a A. spacer B. nebulizer C. peak expiratory flow meter D. trial of chest physiotherapy

A. The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a mechanism to administer medications, but it cannot be used with metered-dose inhalers. Peak expiratory flow meters measure pulmonary function but are not related to medication administration. Chest physiotherapy is unrelated to medication administration.

During the rehabilitative phase of care, pressure dressings are primarily applied to burned areas to A. relieve pain. B. decrease blood supply to scar. C. limit motion during the healing process. D. encourage healing through scar formation.

B. Uniform pressure to the scar decreases the blood supply. The use of pressure garments serves to decrease the blood supply to the hypertrophic tissue. This is done to prevent scarring and contractures. The goal of the pressure dressing is to improve the appearance of scars by decreasing the blood supply to the area. Motion is encouraged because it prevents contractures. Movement should take place to the point of pain, but no further. The goal of the pressure dressing is to minimize the development of scar tissue.

A child with β-thalassemia is receiving numerous blood transfusions. In addition, the child is receiving deferoxamine (Desferal) therapy. The child's parents ask the nurse what deferoxamine does. The most appropriate response by the nurse is A. the medication helps to prevent blood transfusion reactions. B. the medication stimulates red blood cell production. C. the medication provides vitamin supplementation. D. the medication helps to prevent iron overload.

D. A side effect of hypertransfusion therapy is often iron overload. Deferoxamine is an iron-chelating drug that binds excess iron; therefore, it can be excreted by the kidneys. It does not prevent blood transfusions nor stimulate red bell production. It is not a vitamin supplement.

The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry black color. The nurse should explain that this is A. a symptom of iron-deficiency anemia. B. an adverse effect of the iron preparation. C. an indicator of an iron preparation overdose. D. a normally expected change due to the iron preparation.

D. An adequate dosage of iron turns the stools a tarry black color. This is considered a normal abnormal effect related to iron medication. Tarry black stools are not a sign of iron-deficiency anemia nor are they an indicator of iron preparation overdose.

What clinical manifestation would the nurse expect when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation? A. Barrel chest B. Wheezing C. Thermal instability D. Nasal flaring and retractions

D. Nasal flaring, retractions, and grunting are signs of respiratory distress in a neonate. Barrel chest develops with chronic obstructive pulmonary disease, not with acute pneumothorax. Wheezing has a greater association with bronchopulmonary dysplasia or an obstruction in the airways than with an acute pneumothorax. An acute pneumothorax would not affect the neonate's thermal stability.

The nurse suspects a child is having an adverse reaction to a blood transfusion. What should the nurse's first action be? A. Notify the physician. B. Take vital signs and blood pressure and compare them with baseline values. C. Dilute infusing blood with equal amounts of normal saline. D. Stop the transfusion and maintain a patent intravenous line with normal saline and new tubing.

D. The priority nursing action is to stop the transfusion and maintain a patent intravenous line with normal saline and new tubing. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused into the child. The physician should be notified after the blood transfusion is stopped and normal saline is infusing. Vital signs should be assessed after the blood transfusion is stopped and normal saline is infusing. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred.

The primary goal in caring for the child with cognitive impairment is to A. encourage play. B. promote optimum development. C. help families develop a care plan and have them stay with it. D. develop vocational skills.

B. A comprehensive approach is desirable to establish acceptable social behavior and feelings of self-worth and promote optimum development. Providing parents' guidance for the selection of developmentally appropriate activities is only one component in a comprehensive care plan. Care for the cognitively impaired child is an ongoing process that changes as the child meets developmental milestones. The development of vocational skills will be addressed as the child's capabilities are developing and is one component of the comprehensive care plan.

The school nurse is explaining to a child's kindergarten teacher that the child is allergic to peanuts. The nurse should include information that A. the child will most likely outgrow the allergy soon. B. the child should have an injectable epinephrine cartridge available at all times. C. the child allergic to peanuts can usually have peanut butter, but not whole peanuts. D. the child usually only shows skin signs such as hives when allergic.

B. Exposure to peanuts can result in a severe allergic, potentially life-threatening reaction, such as anaphylaxis and shock. Immediate treatment to prevent such reactions includes the injection of epinephrine; therefore, this should be available at all times wherever the child is within the school premises. Peanut allergies may be lifelong. Children allergic to peanuts are allergic to all peanut products, whole and processed. They should have no peanut-containing products at all. The signs and symptoms of an allergic reaction to peanuts may vary from individual to individual.

The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. Which response by the nurse is most accurate? A. "SCA is not inherited." B. "All siblings will have SCA." C. "There is a 25% chance of a sibling having SCA." D. "There is a 50% chance of a sibling having SCA."

C. SCA is inherited as an autosomal recessive disorder. In this inheritance pattern, there is a 25% chance that each subsequent child will have the disorder. SCA is an inherited hemoglobinopathy. In autosomal recessive disorders, there is a chance that 25% of the children

Which infant is at risk for developing vitamin D-deficient rickets? A. Lacto-ovo vegetarians B. Those who are breastfed exclusively C. Those using yogurt as a primary source of milk D. Those exposed to daily sunlight

C. Yogurt may not be supplemented with vitamin D; therefore, the infant may be at risk for the development of rickets. Individuals who follow this diet include milk and its products and therefore receive vitamin D. Breast milk provides sufficient vitamin D to the infant if the mother is not deficient in this vitamin. Lack of sunlight contributes to vitamin D-deficient rickets.

Therapeutic management of the patient with systemic lupus erythematosus (SLE) includes A. application of cold salts to suppress the inflammatory process. B. a high-protein, low-salt diet. C. a rigorous exercise regimen to build up muscle strength and endurance. D. administration of corticosteroids to control inflammation.

D. Corticosteroid administration is the primary mode of therapy currently for SLE. The application of cold salts will not affect the inflammatory process associated with SLE. A balanced diet without exceeding caloric expenditures is recommended. Exercise should be done in moderation.

The nurse is teaching a class on the dangers of "huffing." What information is included as a major side effect of "huffing?" A. Cardiac arrest B. Loss of vision C. Delay of growth D. Loss of consciousness

D. Skin discoloration is not a side effect of huffing. Cardiac arrest is not typically a major side effect of huffing. Loss of consciousness and respiratory arrest are major side effects of huffing. Delay of growth is not a side effect of huffing.

Which statement is accurate regarding Fragile X syndrome? A. It presents as autosomal recessive pattern B. Carrier states do not exist C. It presents as X-linked dominant with reduced penetrance D. It is transferred from carrier father to daughter

C. Fragile X syndrome presents as X-linked dominant with reduced penetrance. Carrier states exist and the disease is different from typical X-linked recessive presentations in that it is transmitted via the carrier mother to offspring.

The nurse is caring for a 12-year-old who sustained major burns when putting charcoal lighter on a campfire. The nurse observes that the child is "very brave" and appears to accept pain with little or no response. What is the most appropriate nursing action related to this? A. Request a psychological consultation. B. Ask the child why the child does not have pain. C. Praise the child for the ability to withstand pain. D. Encourage continued bravery as a coping strategy.

A. A psychological consultation will assist the child in verbalizing fears. This age group is very concerned with physical appearance. The psychologist can help integrate the issues the child is facing. It is likely that the child is having pain but not acknowledging the pain. Speaking with a psychologist might assist the child in relaying his or her fears and pain. If the child is feeling pain, the nurse should not praise the child for hiding the pain. The nurse should encourage the child to speak up during painful episodes so that the pain can be managed appropriately. Bravery may not be an effective coping strategy if the child is in severe pain.

Nursing considerations related to the administration of chemotherapeutic drugs include A. many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates. B. good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary. C. infiltration will not occur, unless superficial veins are used for the intravenous infusion. D. anaphylaxis cannot occur, because the drugs are considered toxic to normal cells.

A. Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and prepared to treat extravasations if necessary. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward. Infiltration and extravasations are always a risk, especially with peripheral veins. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents, including asparaginase (Elspar).

What is the most important nursing consideration when caring for a child with sickle cell anemia? A. Teach the parents and child how to minimize crises. B. Refer the parents and child for genetic counseling. C. Help the child and family to adjust to a short-term disease. D. Observe for complications of multiple blood transfusions.

A. Children and their families need specific instructions on how to minimize crises, including preventing infections; maintaining adequate hydration; and addressing environmental concerns, such as avoidance of extreme cold. Genetic counseling is important, but teaching care for 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 is that the child and the parents are properly prepared to manage the chronic disease.

A child with lymphoma is receiving extensive radiotherapy. What is the most common side effect of this treatment? A. Fatigue B. Seizures C. Neuropathy D. Lymphadenopathy

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

A child is brought into the hospital following a fire at his home. The child appears to be sleeping on the stretcher bed. No observable burn injuries are noted based on preliminary survey. However, the nurse would place a priority observation on the possibility of the child having? A. Inhalation Injury B. Thermal burns C. Decreased metabolism leading to hypovolemic shock D. Chemical burns

A. Inhalation injury in the form of carbon monoxide poisoning or smoke inhalation should be considered in this situation. It is critical for the nurse to make these observations in order to prevent further complications. Thermal and chemical burns would cause evident tissue destruction which would be found on preliminary survey. In burn states, increased metabolism would occur.

What are the most common signs and symptoms of leukemia related to bone marrow involvement? A. Petechiae, infection, fatigue B. Headache, papilledema, irritability C. Muscle wasting, weight loss, fatigue D. Decreased intracranial pressure, psychosis, confusion

A. Petechiae, infection, and fatigue are signs of infiltration of the bone marrow. Petechiae occur from a lowered platelet count, infection occurs from the depressed number of effective leukocytes, and fatigue occurs from the anemia. Headache, papilledema, irritability, muscle wasting, weight loss and fatigue are not signs of bone marrow involvement. Decreased intracranial pressure, psychosis, and confusion are not signs of bone marrow involvement.

A child is status post hematopoietic stem cell transplantation (HSCT) and is preparing for discharge home. Based on the nurse's knowledge of HSCT, which concepts are important to include in the discharge teaching plan of care? (Select all that apply.) A. Preparing the child to return to school within 6 weeks B. Keeping the child on a high-calcium diet C. Avoiding live plants and fresh vegetables D. Avoiding influenza vaccinations E. Practicing good hygiene

B, C, E Children should have a diet high in calcium or be placed on calcium supplements to reduce the risk of osteopenia. Live plants and fresh vegetables should be avoided because they carry bacteria. Practicing good hand hygiene is essential to prevent the spread of infection. Children cannot return to school for 6-12 months after HSCT. Either in-hospital or home schooling is required. Children and their families should be encouraged to get yearly influenza vaccination.

Critical safety considerations that must be included if parenteral iron injections are used as part of therapy include (Select all that apply.) A. type and cross match. B. no massage following injection. C. multiple injections are preferred over intravenous route. D. no more than 1 ml should be given via injection. E. there is no need for a test dose administration if administered intravenously.

B, D There is no need to perform a type and cross for iron replacement therapy. Administration via injection is done into a large muscle mass using Z track technique with no massage following. Preference is for intravenous route over intramuscular route if more than one injection is needed. No more than 1 ml is given via injection and a test dose is recommended if using intravenous route to high potential for allergic reaction.

A child has frequent nose bleeds without warning producing varying amount of blood. Inspection of the nose area reveals irritated mucosa but no evidence of picking or trauma. The child has no history of allergic rhinitis or upper respiratory infections. Denies taking any medication, either prescribed or over the counter. Based on this information the nurse would: A. maintain wait full management as most nose bleeds originate from anterior portion of nose. B. suggest that the patient use humidification to prevent dryness of nasal passages. C. consider referral to ENT for evaluation for other comorbidities. D. increase fluid content to maintain humidification as this may be due to environmental dryness.

C. Even though the majority of nose bleeds are considered to be from the anterior portion of the nose, the fact that the patient has frequent nose bleeds without warning in the absence of irritation or disease states alerts the nurse that there may be other underlying comorbidities such as vascular disorders, leukemia, thrombocytopenia, and clotting factor deficiencies. As such the patient should be referred for further evaluation.

A child has been diagnosed with aplastic anemia and undergoing therapeutic treatment. Therapeutic therapy would focus on A. palliative treatment to maintain comfort. B. initiation of steroid therapy. C. anticipation of bone marrow transplant. D. asking parents if they want to consider organ donation.

C. Although a clinical diagnosis of aplastic anemia can lead to increased morbidity and mortality treatment measures focusing on immunosuppressive therapy, removal of potential exacerbating etiology, and bone marrow replacement. Palliative treatment methods may be included but they are not the mainstay of therapeutic management. Steroid therapy is not indicated as that may lead to an increased susceptibility to infection. Asking the parents about organ donation at this time may cause considerable distress and anxiety.

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include to A. restrict oral fluids. B. institute strict isolation. C. use good hand washing technique. D. give immunizations appropriate for age.

C. Good hand washing technique is the most effective means to prevent disease transmission in children with myelosuppression. There is no indication to reduce fluids in children with myelosuppression. Strict isolation is not necessary in children with myelosuppression. The child should not receive any live vaccines, because the immune system is not capable of responding appropriately to them.

The school nurse is discussing prevention of acquired immunodeficiency syndrome (AIDS) with some adolescents. Which statement is appropriate to include? A. The virus is easily transmitted. B. The virus is transmitted only through blood. C. Intravenous drug users should not share needles. D. Condoms should be used if a person is sexually active and homosexual.

C. Human immunodeficiency virus (HIV) is spread through blood and body fluids. Intravenous needles that have been used should not be shared. They may be contaminated with the virus. The virus is not easily transmitted. It requires direct contact with blood or body fluids on a nonintact skin surface. Body fluids may also transmit the virus. Condoms should be used for both heterosexual and homosexual sex.

Sickle cell disease (SCD) occurs through a genetic mutation. Based on the understanding of this genetic form of transmission, the nurse understands that A. there are no carrier states associated with this disease. B. the disease is transmitted as part of a sex-linked mutation. C. SCD refers to a group of congenital disease expressions. D. it is a relatively uncommon disease as it is expressed as an autosomal recessive gene trait.

C. SCD refers to a group of heredity disease states in which there is variants exhibited in both heterozygous and homozygous expressions. It is expressed as an autosomal recessive trait and as such there are carrier states. It is not transmitted as a sex-linked mutation. It is one of the most common genetic disorders globally.

A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. The nurse's first action is to A. administer 100% oxygen to relieve hypoxia. B. administer pain medication to relieve symptoms. C. notify practitioner because chest syndrome is suspected. D. notify practitioner because child may be having a stroke.

C. Severe chest pain, fever, a cough, and dyspnea are the signs and symptoms of chest syndrome. The nurse must notify the practitioner immediately. Breathing 100% oxygen to relieve hypoxia may be ordered by the practitioner, but the first action is notification because these symptoms indicate a medical emergency. Pain medications may be indicated, but evaluation is necessary first. Severe chest pain, fever, cough, and dyspnea are not signs of a stroke.

The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measures should the nurse use until factor replacement therapy can be instituted? A. Apply warm, moist compresses. B. Apply pressure for at least 1 minute. C. Elevate the area above the level of the heart. D. Begin passive range-of-motion unless the pain is severe.

C. The initial response should include elevation of the arm to minimize bleeding. Cold should be applied to the arm. This will aid in vasoconstriction, minimizing blood loss. Pressure is effective in small areas but would not be as effective for an extremity. Passive range-of-motion is not recommended. The child can perform active range-of-motion after the bleeding episode has resolved.

A child is coming to the clinic with his parents for a sports physical. Upon reviewing the patient's history, there is a notation that the child has been recently treated six months ago for immune thrombocytopenia purpura (ITP). Based on this notation, the nurse would provide this recommendation? A. The child should not play any sports or participate in any physical activity while in school. B. The child should take art classes rather than participate in sporting events. C. The child will have to repeat blood work before any determination can be made. D. The child can play non-contact sports but will have to be monitored if any bruising or bleeding should occur.

D. Contact sports should be avoided in a patient who has had prior treatment for ITP. The nature of ITP being idiopathic, it is important to protect the patient from impending trauma related to contact. However, the child as part of normal growth and development should be able to engage in non-contact sports activities. Being that the treatment was recent and that ITP is idiopathic, prospective management and monitoring should be included in the plan of care at this time.

The nurse is explaining blood components to an 8-year-old child. Based on the nurse's knowledge of child development, the most appropriate description of platelets is that they A. help keep germs from causing infection. B. make up the liquid portion of blood. C. carry the oxygen you breathe from your lungs to all parts of your body. D. help your body stop bleeding by forming a clot (scab) over the hurt area.

D. Platelets are involved in homeostasis. White blood cells help protect the body from infection. The liquid portion of blood id known as plasma. Red blood cells are involved in oxygenation of tissues in the body.

The nurse is collecting history on a 16-year-old admitted for treatment of anorexia nervosa. The patient limits the answers to yes or no. What is the primary nursing goal for this patient at this time? A. Ask about favorite foods to provide for them to eat. B. Return to ask further questions when the patient wants to talk. C. Discuss the treatment plan and expected stay in the hospital. D. Develop a positive rapport with the patient.

D. The nurse would focus on development and establishing a positive rapport with the patient at the early stage. Eating disorders in children often stem from low self-esteem. Children with eating disorders may have low self-esteem and a lack of trust in others. It is important to establish a trusting relationship with the patient. Asking the patient about favorite foods is not a question that will build rapport with the patient. Returning to ask further questions when the patient wants to talk is not the primary nursing goal at this time. Discussing the treatment plan and expected stay in the hospital is not an appropriate goal because the patient is not open to discussion at this time.

In providing nutritional counseling for a family with children, which statement would indicate that the parents need additional teaching with regard to mineral balance? A. "I will give my child fortified milk products and avoid cow's milk." B. "I will avoid giving my children any mineral supplements so as to avoid the possibility of megadoses." C. "Spinach is not a very source of iron when considering mineral balance." D. "I don't have to worry about mineral balance since my child will be following a vegetarian diet."

D. Vegetarian diets are high in soy and plant foods and as such contain phytates which can form insoluble complexes leading to mineral imbalance. Fortified milk products are recommended along with avoidance of cow's milk. Mineral supplementation should be avoided in order to prevent megadose toxicity which can affect absorption of other minerals. Spinach while a source of iron has a high oxalate content which can affect absorption of minerals.

Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include (Select all that apply.) A. lung function B. associated allergies C. frequency of symptoms D. frequency and severity of exacerbations

A, C, D The peak expiratory flow rate is one of the diagnostic criteria for classifying severity. The frequency of symptoms is one of the diagnostic criteria for classifying severity. The frequency and severity of exacerbations are two of the diagnostic criteria for classifying severity. The clinical features that distinguish the categories of asthma do not include other allergies.

The primary goals in the nutritional management of children with failure to thrive (FTT) are (Select all that apply.) A. Allow for catch-up growth. B. Correct nutritional deficiencies. C. Achieve ideal weight for height. D. Restore optimum body composition. E. Educate the parents or primary caregivers on child's nutritional requirements.

A, B, C, D, E The goal is to provide sufficient calories to support "catch-up" growth, which is a rate of growth greater than the expected rate for age. Correction of nutritional deficiencies is another goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treating any coexisting medical problems. Accurate assessment of the child's initial weight and height are important as well as the daily recording of weight, food intake, and feeding behavior. Correction of nutritional deficiencies is another goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treating coexisting medical problems to optimize body composition.

A 5-year-old child is brought the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (Select all that apply.) A. Vital signs B. Throat culture C. Medical history D. Assessment of breath sounds E. Emergency airway equipment readily available

A, C, D, E Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis in addition to knowing immunization status. Assessment of breath sounds is important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway.

Based on the nurse's knowledge of wounds and wound healing, what are factors that can delay or cause dysfunctional wound healing? (Select all that apply.) A. Overweight B. Hypoxemia C. Hypervolemia D. Prolonged infection E. Corticosteroid therapy

A, E Poor nutrition without proper protein and calorie intake affects healing more than being overweight itself. Corticosteroid therapy or other immunocompromising therapy prevents macrophages from migrating to the site of injury, thus suppressing epithelialization. Hypovolemia, not hypervolemia, inhibits wound healing due to low circulating blood volume and oxygenation of tissues. Hypoxemia makes tissues more susceptible to infection due to insufficient oxygenation. Prolonged infection affects the healing process and causes increased scarring.

A nurse working with adolescents is aware of common drugs of abuse. Which of the following drugs is the most common drug of abuse in the adolescent population? A. Alcohol B. Morphine C. Cocaine D. Oxycontin

A. Alcohol is the drug most often used and abused by the adolescent population. The ease of access and the low cost make alcohol the drug of choice for many teenagers. Morphine is not the most common drug of abuse in the adolescent population. Cocaine and oxycontin are not the most common drugs of abuse in the adolescent population.

Apnea of infancy has been diagnosed in an infant scheduled for discharge with home monitoring. Part of the infant's discharge teaching plan should include? A. Cardiopulmonary resuscitation (CPR) B. Administration of intravenous (IV) fluids C. Foreign airway obstruction removal using the Heimlich maneuver D. Advice that the infant not be left with caretakers other than the parents

A. CPR is essential for all parents and caregivers to know, especially when an infant has a history of apnea of infancy that is being monitored at home. Most likely, the child will not be receiving home IV therapy as part of the discharge care. The Heimlich maneuver is used to intervene when a child or an adult is experiencing a choking episode. It would not be necessary for the parents to learn the maneuver at this time. (Back slaps and chest thrusts are used on the responsive infant for choking.) The parents should arrange for other caregivers to help when possible. There is no reason that the infant cannot be left with capable and trained individuals. Anyone caring for the infant will need to be taught to use equipment and how to perform CPR.

A sexually active adolescent asks the school nurse about prevention of sexually transmitted diseases (STDs). The most appropriate recommendation by the nurse is the use of A. condoms B. prophylactic antibiotics C. any type of contraception methods D. withdrawal method of contraception

A. Condoms provide a barrier to the organisms that cause STDs. Prophylactic antibiotics are not recommended to prevent STDs. Antibiotics are only effective against bacteria, not viruses. Only condoms create a physical barrier that prevents contact with the organisms that cause STDs.

Which is the most descriptive of kwashiorkor? A. Kwashiorkor has a multifactorial etiology. B. Kwashiorkor occurs primarily in breastfed infants. C. Kwashiorkor results from excessive amounts of vitamin K. D. Kwashiorkor is related to inadequate calories, not adequate protein.

A. Cultural, environmental, and infectious components contribute to kwashiorkor, a deficiency of protein with an adequate supply of calories. Kwashiorkor occurs in infants and children who are beyond the age of breastfeeding. There is no correlation between excessive amounts of vitamin K and kwashiorkor. Kwashiorkor is a disorder in which there are adequate calories but a deficiency of protein.

The most appropriate nursing intervention for a child following a tonsillectomy is to A. watch for continuous swallowing. B. encourage gargling to reduce discomfort. C. position the child on the back for sleeping. D. apply warm compresses to the throat.

A. Frequent swallowing is the most obvious early sign of bleeding from the operative site in a child who has had a tonsillectomy. Gargling should be avoided after a tonsillectomy because of potential trauma to the suture line. The child should be positioned on the side or abdomen to facilitate drainage after a tonsillectomy. Ice collars and cold liquids are encouraged for the child who has had a tonsillectomy. Cold therapy soothes and anesthetizes the area, decreasing the pain. Heat or warmth would increase the risk of bleeding.

Which food combination will generally provide the appropriate amounts of essential amino acids for an individual who is a vegetarian? A. Grains and legumes B. Grains and vegetables C. Legumes and vegetables D. Milk products and fruit

A. Grains and legumes form complete proteins when eaten together, providing appropriate amounts of essential amino acids. Grains should be eaten with milk products or legumes to provide appropriate amounts of essential amino acids. Legumes should be eaten with grains or seeds to provide appropriate amounts of essential amino acids. Milk products should be eaten with grains to provide appropriate amounts of essential amino acids.

An infant with a congenital heart defect is receiving palivizumab (Synagis). Based on the nurse's knowledge of medication, the purpose of this medication is to A. prevent respiratory syncytial virus (RSV) infection. B. make isolation of the infant with RSV unnecessary. C. prevent secondary bacterial infection. D. decrease toxicity of antiviral agents.

A. Palivizumab is a monoclonal antibody specifically used in the prevention of RSV. Monthly administration is expected to prevent infection with RSV. The goal of this drug is prevention of RSV. It will not affect the need to isolate the child if RSV develops. Palivizumab is specific to RSV, not bacterial infections. Palivizumab will have no effect on antiviral agents.

An adolescent girl is brought to the hospital emergency department by her parents after being raped. The girl is calm and controlled throughout the interview and examination. The nurse should recognize that this behavior is A. one of a variety of behaviors normally seen in rape victims. B. indicative of a higher-than-usual level of maturity in the adolescent. C. suggestive that a rape has not actually occurred. D. suggestive that the adolescent had severe emotional problems before the rape occurred.

A. Rape victims display a wide range of behaviors. A controlled manner may be an attempt to maintain composure and control while hiding inner turmoil. The responses described are indicative of those often assessed in rape victims. There are no data to support that a rape has not occurred. Physical assessment will provide valuable information. There are no data to support that the adolescent had prior emotional problems.

The nurse is providing education to a parent of a 10-month-old infant with the diagnosis of cow's milk allergy. What will be included in the teaching? (Select all that apply.) A. Reading of all food labels to avoid products with milk. B. Use of milk to desensitize the child. C. Introduction of soy-based products to replace milk. D. Signs and symptoms associated with potential accidental ingestion of milk.

A. Reading of all food labels to avoid products with milk will be included in the teaching. This infant will not be desensitized to milk. Milk and milk-based products should be avoided with this child. Introduction of soy-based products to replace milk will be included in the teaching. Signs and symptoms associated with potential accidental ingestion of milk will be included in the teaching.

A child is becoming increasingly anxious over attending school with increasing frequency as the school year has gone on. Now the child is also presenting with physical symptoms which subside when the child remains at home. Based on this finding, the nurse would suspect that the child has A. school phobia B. passive aggressive disorder C. psychosomatic complaints D. general anxiety disorder

A. School phobia (school refusal and school avoidance) refers to expression of fear or increasing anxiety related to the attendance of school. Physical symptoms may accompany this presentation and resolve when the child is not in attendance at school. The described behavior does not indicate passive aggressive disorder or general anxiety disorder. And while the child manifests psychosomatic complaints, these are correlated directly with the school environment as a trigger.

The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of A. pneumothorax B. bronchodilation C. carbon dioxide retention D. increased viscosity of sputum

A. The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. The child needs to be seen as soon as possible. Bronchodilation would not produce the described symptoms. Carbon dioxide retention would not produce the described symptoms. The increased viscosity of sputum is characteristic of cystic fibrosis. The change in respiratory status is potentially due to a pneumothorax.

A 6-year-old has difficulty hearing faint or distant speech. The child's speech is normal, but the child is having problems with school performance. This hearing loss would most likely be classified as A. slight B. severe C. moderate D. inattentiveness rather than hearing loss

A. The definition of a slight hearing loss includes normal speech with difficulty hearing faint and/or distant speech. With severe hearing loss, the child may hear a loud voice if nearby and may be able to identify loud environmental noises. Moderate hearing loss results in symptoms of being able to understand conversation at a distance of 3 to 5 feet. Children with difficulty hearing faint or distant speech, but who have normal speech themselves, are by definition experiencing slight hearing loss.

The most appropriate question to ask a rape victim prior to the start of the physical examination is A. Has she showered or bathed since the attack? B. Does she think rape is a violent crime? C. How many items did the attacker take? D. When the attack occurred, could she have prevented it?

A. The nurse needs to document if the patient has bathed or showered prior to collecting evidence from the rape. Cleaning the body could remove trace body secretions, such as saliva, semen, or blood, left by the perpetrator, which would be important to collect if possible. It is not appropriate to ask the patient if she thinks rape is a violent crime. It is not a priority to ask how many items the attacker took from her. It is not appropriate to ask the patient if she could have prevented the attack.

Which statement is correct about young children who report sexual abuse by one of their parents? A. They may exhibit various behavioral manifestations. B. In most cases, the child has fabricated the story. C. Their stories are not believed unless other evidence is apparent. D. They should be able to retell the story the same way to another person.

A. There is no diagnostic profile of the child who is being sexually abused. Many different behavioral manifestations may be exhibited, from outward sexual behaviors with others to withdrawal and introversion. It is never appropriate to assume that a child has fabricated the story of sexual abuse. Adults are reluctant to believe children, and sexual abuse often goes unreported. Physical examination is normal in approximately 80% of abused children. The child will usually try to protect their parents and may accept responsibility for the act.

Parents have brought their 6 months old daughter in for a 1 week follow up for treatment of diaper dermatitis. The parents state that they have followed all directions but that it just doesn't seem to be getting any better. The nurse examines the infant and finds no resolve of the condition. Based on this finding, the nurse suspects that A. The infant may also have a Candida infection. B. Additional teaching may be needed for the parents in order to validate that they followed through with instructions. C. Suggest to the parents that a heat lamp maybe needed to resolve the problem. D. Have the parents continue their treatment as it may take more than 1 week to resolve.

A. Unresolved treatment for diaper dermatitis is likely due to a Candida infection. There is no reason to suspect that the parents are not implementing the directions that were previously given. Use of a heat lamp can cause damage to the perineal area and buttocks. If the situation has not resolved, then the nurse should be alert to the possibility of additional infectious process.

A school-age child has undergone a tonsillectomy and is being cared for postoperatively in the hospital setting. The nurse assigned to the patient is developing a plan of care with regard to nutrition and hydration. What factors should be included in the postoperative plan of care for this patient? (Select all that apply.) A. Medicate for pain around the clock to ensure that the patient will be able to eat and maintain hydration. B. Restrict food and oral fluids initially making sure that the patient is fully alert and there is no evidence of bleeding. C. Avoid giving fluids that are color tinged red or brown. D. Provide milk to help maintain nutritional balance. E. Provide pudding to facilitate swallowing.

B, C Although the patient should receive appropriate analgesics to maintain comfort, medicating the patient around the clock typically is not indicated. Restricting food and oral fluids until fully awake with no evidence of bleeding is prudent proactive. Withholding fluids that are color tinged red or brown is also recommended as it will be hard to distinguish potential bleeding if there is emesis. Providing milk or pudding is not advised as it milk products can lead to clearing of throat as a result of coating effect and therefore may pose an irritation leading to potential bleeding.

Diagnostic testing for treatable inborn errors of metabolism in the newborn include confirmation of which disease processes? (Select all that apply.) A. Down's syndrome B. Galactosemia C. Phenylketonuria D. Hyperthyroidism E. Neural tube defect

B, C Galactosemia and phenylketonuria (PKU) can be diagnosed via Guthrie test as part of newborn diagnostic testing. Down's syndrome is confirmed via genetic testing. Determination of neural tube defects can be done via alpha fetoprotein biomarkers. Hyperthyroidism would be confirmed by serum blood tests.

Infants most at risk for sudden infant death syndrome (SIDS) are those (Select all that apply.) A. Who sleep supine B. Who sleep prone C. Who were preterm D. With prenatal drug exposure E. With a cousin that died of SIDS

B, C, D Infants at increased risk for SIDS are low birth weight, have low Apgar scores, sleep prone, cosleep, were preterm, and have a mother who smokes. It is recommended that infants sleep supine to reduce the risk of SIESTA cousin dying of SIDS does not present an increased risk for the infant.

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

D. Humidified inspired air soothes the membranes inflamed by the infection and dry air. The size of the droplets in humidified air is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation.

Autism is a complex developmental disorder. Diagnostic criteria for autism include delayed or abnormal functioning in which area(s) before 3 years of age? (Select all that apply.) A. Parallel play B. Social interaction C. Gross motor development D. Inability to maintain eye contact E. Language as used in social communication

B, D, E Children diagnosed with autism show delayed or abnormal functioning in social interactions. A hallmark characteristic of autism is the child's inability to make and maintain eye contact. A characteristic of autism is the child's delay of language at an early age or the sudden deterioration in extant expressive speech. Parallel play is not an area in which autistic children may show delay. When interacting with other children in other forms of play they display functional limitations. Gross motor development is not an area in which autistic children show delayed or abnormal functioning.

A child is brought to the emergency department after falling down the basement stairs. On assessment, what findings may cause the nurse to suspect child abuse? (Select all that apply.) A. The child's bruises are located only on the right arm and leg. B. The child is brought to the emergency department by an unrelated adult. C. The child has a history of a broken arm last year from falling off a swing. D. The child's caregiver is anxious that the child get immediate medical attention. E. The child has red, green, and yellow bruises on more than one plane of the body.

B, E A child brought to a health care provider for a trauma or suspicious injury by an unrelated adult or if the primary care provider is totally unavailable is a warning sign of abuse. Varying degrees of healing of bruises in more than one plane of the body is a warning of abuse. Falling down stairs can be an unintentional injury. A child with an isolated documented injury is not a warning sign of abuse. Multiple fractures of differing ages are a warning sign of abuse. An anxious caregiver is a normal response for an injured child. A delay in seeking care is a warning sign of abuse.

Which intervention lowers the risk of sudden infant death syndrome (SIDS)? A. Keeping the window open if one is smoking near the infant. B. Placing the infant in the supine position for sleeping. C. Letting the infant sleep with the parents instead of alone in the crib. D. Making certain the infant is kept very warm while sleeping.

B. The Back to Sleep Campaign is credited with reducing the rate of SIDS in the United States. Smoking increases the risk of SIDS by exposing the infant to pulmonary irritants. Having the infant sleep with the parents (co-sleeping) increases the risk of SIDS. Overheating increases the risk of SIDS.

A child is standing playing with toys and suddenly collapses. Attempts to engage the child in conversation are met with no response. Skin color indicates cyanosis. A preliminary assessment of the environment presents no specific issues. Based on this information, you would suspect that the child is? A. Experiencing seizure activity B. Potential aspiration of foreign body C. Potential allergic reaction D. Traumatic injury

B. A child who is in severe respiratory distress as a result of foreign body aspiration will not be able to speak, become cyanotic and collapse. This would be considered a medical emergency. Playing with a toy may potentially lead to aspiration if the toy parts are smaller than the child's airway. Within that age group, it is likely that the child may place items in his/her mouth. There is nothing to suggest seizure activity, allergic reaction or traumatic injury.

The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37º C (98.6º F). The mother states the child is not having difficulty breathing. The nurse suspects croup and should recommend A. controlling the fever with acetaminophen (Tylenol) and call the primary care provider if the cough gets worse tonight. B. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. C. trying over-the-counter cough medicine and coming to the clinic tomorrow if there is no improvement. D. bringing the child to the hospital to be admitted and to be observed for impending epiglottitis.

B. Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief because this therapy will assist in opening up the child's airways. The child does not have a temperature and, therefore, does not need management with acetaminophen. Cough suppressants are not indicated by symptom, and the American Pediatrics Association no longer recommends over-the-counter cough medicines for children under the age of 2 years. A barking cough is characteristic of laryngotracheobronchitis, not epiglottitis.

Macrominerals refer to those minerals with daily intake requirements greater than 100 mg. Which is a macromineral? A. Iron B. Calcium C. Fluoride D. Selenium

B. Calcium is a macromineral. Iron, fluoride, and selenium are microminerals.

Parents bring in their son for evaluation of hearing telling the nurse that he seems to hear what is going on around him but that at times the child is unable to fully understand what is being asked of him. Which observations by the nurse would lead to suspicion of sensorineural hearing loss? A. Child states that he hears things but they are not loud. B. Parents state that they listen to music in the home for several hours each evening. C. Child has a recent middle ear infection which was treated with antibiotics. D. Child denies having any ear pain or discomfort.

B. Causes of sensorineural hearing loss can occur from music or exposure to excessive noise. The nurse should investigate further at what level the music is being played and the exact length of exposure time. Conductive hearing loss is associated with middle ear infections and can manifest with level of sound. Sensorineural hearing loss involves distortion of sound and causes problems with discrimination.

A nurse is assessing a patient diagnosed with attention deficit hyperactive disorder (ADHD). What behavior would the nurse anticipate the patient to demonstrate? A. Ability to complete school work during class B. Requires reminders to keep focused and on task C. Is defiant with parents and refuses to complete chores at home D. Is aggressive with peers when asked to participate in team sports

B. Children with ADHD are often not able to remain focused and require frequent reminders to remain focused and complete an assigned task. They generally are not able to complete work at school and require extra time to complete assignments. The ability to complete school work during class is not something the nurse would anticipate this patient to demonstrate. Defiance with parents and refusal to complete chores at home are not behaviors the nurse would anticipate this patient to demonstrate. Aggression with peers when asked to participate in team sports is not typical of ADHD behavior.

The nurse is discussing health behaviors with a 14-year-old who recently began smoking cigarettes. An appropriate tactic for the nurse to use when discussing this lifestyle choice is A. cigarette smoking is only "cool" in high school and is not accepted in college. B. cigarette smoking can cause permanent damage to the lungs and can cause cancer as an adult. C. cigarettes are expensive, and a 14-year-old will not be able to afford them, so he should stop smoking. D. cigarettes contain nicotine, and this will cause addiction to other drugs.

B. Cigarette smoking can cause permanent damage to the lungs and can cause cancer as an adult. At 14, the child only thinks of the present. The nurse would need to include and explain, and even use pictures to illustrate, what might happen to the body if the child continues to smoke. Saying cigarette smoking is only cool in high school and is not accepted in college is not a useful tactic the nurse should use when discussing smoking cigarettes. Suggesting that cigarettes are not affordable and the 14-year-old should therefore stop smoking is not a healthy approach to teaching adolescents to stop smoking. Cigarettes contain nicotine, and this will cause addiction to other drugs. Adolescents are not often concerned with whether cigarette smoking will lead to other addictions.

What is the most important goal when caring for an individual with anorexia nervosa? A. Encourage weight gain B. Correct malnutrition C. Limit fluid intake D. Provide effective oral care

B. Correct malnutrition is the priority goal of treatment. The individual with anorexia nervosa would probably not be receptive to encouragement of weight gain because of the complex etiology of the disorder. Anorexics often have low self-esteem and have a need for control, which they meet by controlling their eating. Fluids are often restricted by the individual with anorexia. It is important to correct fluid and electrolyte imbalances if present and not restrict fluid intake. Oral and dental care is more of an issue with the bulimia nervosa patient secondary to the excessive purging or vomiting episodes.

A child has been stung by a bee and the parents call the walk in clinic asking for instructions on what to do as they make their way to the clinic. The nurse responds by stating? A. Tell the parents to remove all of the child's clothing and apply warm water to the affected area. B. Remove the stinger from the site. C. Encourage the child to take slow deep breaths to minimize associated anxiety that has occurred due to the event. D. Have the parents offer the child water.

B. First action is to remove the stinger, then cleanse the area with soap and water and apply a cool compress. There is no need to remove the child's clothing or provide fluid hydration. There is no indication that the child is experiencing any evidence of anxiety provided by the parent's communication.

A child relates that every time he eats a certain food, he gets a stomachache. No other discernable physical symptoms have been correlated with the food intake. Based on this information, the nurse would suspect that the child may be exhibiting? A. Food refusal behavior B. Food intolerance C. Food allergy D. Food preference

B. Food intolerance occurs when a food substance elicits a reproducible reaction without an immunological basis. Food allergies would have discernable symptoms accompanying the food intake due to an immunological response. There is no information to suspect that the child is exhibiting a food preference or food refusal behavior as the description of the food event is noted as being the same each time.

The management of adolescent obesity should include A. planning a low-calorie, low-protein diet. B. incorporating favorite foods into the diet. C. encouraging diversional activities during mealtimes. D. using nutritious foods as a method of reward.

B. Incorporating small amounts of the adolescent's favorite foods will increase adherence to the nutritional plan. A food plan high in nutrients with calories and fats at a healthy level is recommended. Adolescents need calories and protein in appropriate amounts to allow continued physical growth during a growth spurt and puberty. Diversional activities such as television watching may contribute to overeating and should be discouraged. Food should never be used as a reward.

When caring for the suicidal adolescent, the most important nursing intervention is A. emphasizing that a suicide attempt is an immature way of dealing with stress. B. paying particular attention to children who are withdrawn and are giving away their personal belongings. C. ignoring threats of suicide because they are usually bids for attention. D. recognizing a suicide attempt as an impulsive act resulting from a temporary crisis.

B. It is imperative that the nurse recognize warning signs of a potential suicide. For the depressed youngster, suicide may appear to be the only way out, and telling a child that he or she is immature in feelings or behavior will exacerbate an already crisis-laden situation. All threats of suicide must be taken seriously and should never be ignored. Even if the crisis is temporary, the child's perception may be that suicide is the only way out of it.

A newborn who is suspected of having atopy would most likely have which diagnostic finding? A. Small for gestational age (SGA) B. Increased levels of IgE in umbilical cord blood C. No family history of allergies D. Precipitous delivery

B. Newborns who have a hereditary component are more likely to present with atopy and as such would have increased levels of IgE noted in umbilical cord blood. SGA and a precipitous delivery would not be associated with atopy.

What is the most important nursing consideration in the management of cellulitis? A. Application of Burow solution compresses B. Administration of oral or parenteral antibiotics C. Topical application of an antibiotic D. Incision and drainage of severe lesions

B. Oral or parenteral antibiotics are indicated depending on the extent of the cellulitis. Warm water compresses may be indicated for limited cellulitis. Antibiotics need to be administered systemically (orally or parenterally), not topically. If incision and drainage are implemented, there is a risk of spreading infection or making the lesion worse.

A 1-month-old infant is admitted to the hospital for failure to thrive (FTT) secondary to a cardiac condition. Based on the nurse's knowledge of the different types of FTT, this type of FTT is categorized as A. nonorganic B. organic C. idiopathic D. generalized

B. Organic FTT is the result of a physical cause, such as a cardiac condition, neurologic condition, renal failure, endocrine system disorder, or other possible chronic or acute disease process. Nonorganic FTT is most often the result of psychosocial factors, such as inadequate nutritional information by the parent. Idiopathic FTT is unexplained by the usual organic and environmental etiologies. Generalized FTT is not a recognized term.

The parents of a 5-month-old child complain to the nurse that they are exhausted because the infant still wakes up as often as every 1 to 2 hours during the night. When the child awakens, they change the diaper and the mother nurses the child back to sleep. Which should the nurse suggest to help the parents deal with this problem? A. Put the child in the parents' bed to cuddle. B. Start putting the infant to bed while still awake. C. Allow the infant to cry for 30 minutes, and then rock the infant back to sleep before putting the infant back in the crib. D. Give the infant a bottle of formula instead of breastfeeding so often at night.

B. Parents need to develop bedtime rituals that involve putting the child in bed when awake. This will allow the infant to become accustomed to falling asleep somewhere besides the parent's arms or in the parent's presence. Having the infant in bed with them may still interfere with their sleep and increases the risk of injury to an infant of this age. The extinction of crying episodes should be done progressively, beginning with checking on the infant every 5 minutes during the first night and extending this interval by 5 minutes on subsequent nights. This will allow the infant to learn to self-soothe. Providing formula in a bottle at night will contribute to bottle-mouth caries. Additionally, 5-month-old infants generally do not wake up during the night to feed but rather to be soothed. Using feeding as a mechanism to soothe begins a pattern that may lead to eating problems later in childhood.

An immediate intervention to teach parents for when an infant chokes on a piece of food would be to A. have infant lie quietly while a call is placed for emergency help. B. position infant in a head-down, face-down position and administer five quick back slaps. C. administer mouth-to-mouth resuscitation. D. give some water by a cup to relieve the obstruction.

B. Positioning the infant head and face down while administering five quick blows between the shoulder blades is the correct initial sequence of actions for an infant with an obstructed airway. The infant needs to receive treatment immediately. Emergency help is called after attempting to remove the obstruction. Mouth-to-mouth resuscitation should not be used. This may push the object further into the child's respiratory system. If the child is obstructed, the water will not be able to pass. This will increase the risk of aspiration.

In working with a teenager who has symptomatic acne. Which dietary measure would the nurse suggest in order to prevent potential flare ups of clinical symptoms? A. Increase intake of dairy products. B. Eat foods that have a low glycemic index. C. Limit fluid intake. D. Drink whole milk instead of skimmed milk.

B. Research has shown there is an increased likelihood of acne breakout with ingestion of dairy products and foods that have a high glycemic index. Restriction of fluid intake and substitution of whole milk instead of skimmed milk does not afford any reduction in acne breakouts.

A mother is bringing her 4-month-old infant into the clinic for a routine well-baby check. The mother is exclusively breastfeeding. There are no other liquids given to the infant. What vitamin does the nurse anticipate the provider will prescribe for this infant? A. Vitamin B B. Vitamin D C. Vitamin C D. Vitamin K

B. The American Academy of Pediatrics recommends that infants who are exclusively breastfed receive 400 IU of vitamin D daily by age 2 months to decrease vitamin D deficiency. Vitamins B, C, and K are not needed.

Early detection of a hearing impairment is critical because of its effect on a variety of areas of a child's life. Which one is of primary importance? A. Reading development B. Speech development C. Relationships with peers D. Performance at school

B. The ability to hear sounds is essential for the development of speech. Babies imitate the sounds they hear as they begin to form sounds and eventually words as they grow and develop. The child will have greater difficulty reading, but the primary issue is the effect of hearing impairment on speech. Relationships with peers will be affected by the child's lack of hearing. The effect will be compounded by difficulties with oral communication. Performance at school will be affected by hearing impairment, but some schools are geared to children with hearing loss, and programs in regular schools address the needs of the hearing-impaired child.

The most appropriate time to perform bronchial postural drainage is A. immediately before all aerosol therapy. B. before meals and at bedtime. C. immediately on arising and at bedtime. D. 30 minutes after meals and at bedtime.

B. The most effective time for bronchial drainage is before meals and before bedtime to prevent the interaction of excessive amounts of mucus and food intake, thereby increasing the risk of vomiting. Bronchial drainage is more effective after other respiratory therapies such as bronchodilator or nebulizer treatments. These treatments open the airways, facilitating the movement of mucus with the positioning of bronchial drainage. Bronchial drainage should be done three or four times each day to be effective. When bronchial drainage is completed after meals, it may cause the child to vomit.

The nurse is providing education to parents of an infant diagnosed with colic. What would the nurse include in the discharge teaching? A. The child will have to be watched for gastrointestinal issues in the future. B. The symptoms of colic typically disappear by 3 months of age. C. Providing juice at the start of the fussy period will help decrease the length of the crying episodes. D. The feeding method needs to be changed to a hypoallergenic formula.

B. The symptoms of colic typically disappear by 3 months of age. The child will not have to be watched for gastrointestinal issues in the future, because colic is not related to long-term gastrointestinal problems. Providing juice at the start of the fussy period will help decrease the length of the crying episodes. There is no evidence that juice will decrease the length of crying in colicky babies. Changing the feeding method to a hypoallergenic formula is not typically recommended for the infant with colic.

A 16-year-old girl tells the school nurse that she has not started to menstruate. The most appropriate nursing intervention is to A. explain that this is not unusual. B. refer the adolescent for an evaluation. C. assume that the adolescent is pregnant. D. suggest the adolescent stop exercising until menarche occurs.

B. This meets the definition of primary amenorrhea and should be evaluated. Menstruation usually begins approximately 2 years after the beginning of secondary sex characteristics. Although pregnancy is a possibility, the nurse should not assume that the girl is pregnant until further assessment is performed. There is no indication that the adolescent is exercising excessively.

An adolescent patient is being treated for a Trichomonas infection with the appropriate antibiotic. Which instruction should be included in the plan of care? A. Only the person needs to be treated and not any sexual partners. B. Patient should refrain from drinking beer during treatment. C. Antibiotic must be administered via parenteral route. D. Topical medication in the form of an antifungal is also included in the treatment plan.

B. Treatment of Trichomonas is accomplished through use of Flagyl which is an ant infective agent. Alcohol should be avoided during the treatment phase and for a 48-hour period following treatment. Sexual partners should be treated as this is considered to be a sexually transmitted disease. Medication can be administered orally as well parenterally. Topical medication is not prescribed for treatment.

Which symptoms are commonly seen in a child with depression? (Select all that apply.) A. Focus on violence B. Excessive laughing C. Somatic complaints D. Increased motor activity E. Poor school performance

C, E Children with depression will complain of nonspecific complaints such as not feeling well. Children with depression will show a lack of interest in doing homework or achieving in school and getting lower grades than usual. Focus on violence can be associated with depression in the adolescent. A child with depression exhibits predominantly sad facial expression with absence or diminished range of affective response. Children with depression will have diminished motor activity and complain of being too tired.

Which finding if found in a male adolescent would indicate a medical priority for treatment? A. Epididymitis B. Varicocele C. Testicular torsion D. Gynecomastia

C. Testicular torsion if found in a male patient (regardless of age) would be considered to be a medical emergency and as such would require immediate intervention. Epididymitis is an infectious process that requires appropriate antibiotic therapy. Depending on the presentation of a varicocele with associated symptoms, intervention may be required. Gynecomastia requires investigational work up to identify the etiology but in some cases it is idiopathic and self-limiting.

Because the absorption of fat-soluble vitamins is decreased in cystic fibrosis, which vitamin supplementation is necessary? A. C, D B. A, E, K C. A, D, E, K D. C, folic acid

C. A, D, E, and K are the fat-soluble vitamins, which need to be supplemented in higher doses for the child with cystic fibrosis. C and folic acid are not fat-soluble vitamins. D also needs to be supplemented in children with cystic fibrosis.

A child is being treated for burns in the emergency room. The parents have provided information relative to the origin of the burn event but the patterns of injury are not consistent with their description. The nurse would suspect that A. the parents are too upset to provide information at this time, so additional questions can be answered later. B. the child may have not told the parents the truth about the event. C. there may be a potential for abuse and as such requires follow up. D. there is no real concern as the burn injuries are minimal and non life threatening.

C. Anytime burn pattern injuries do not correlate with the provided information of the event, there is a potential for suspecting abuse. As such the nurse should be cognizant of this fact and follow up accordingly. Being upset would be a reasonable parent response but the physical evidence should coincide with the provided description. Suspecting that the child (victim) is not telling the truth would not be a concern unless additional evidence would be presented that would support that conclusion. Even if the burn injuries are not considered to be life-threatening, health care providers take the issue of suspected abuse very seriously and it must be reported and followed through as part of professional practice guidelines.

A parent calls the health clinic stating that her child was just exposed to poison ivy and asks what she should do to prevent further complications? A. Have the parent contact the Health Department so they will be aware of a possible outbreak of this event. B. Quarantine the child until the rash disappears as the child is considered to be contagious. C. Wash the exposed area of contact with cold water to neutralize effects of oil exposure. D. Suggest to the parent that a tetanus booster is necessary to prevent further complications from this puncture exposure.

C. Best practice if this is a recent exposure is to wash the affected area with cold running water to minimize the effects by neutralizing the oil and possible bonding to skin areas. The Health Department does not have to be contacted as this is not considered to be a public health issues. The child does not have to be quarantined as poison ivy can only be spread by direct contact of oils associated with the plant. Tetanus booster is not required as this is associated with contact and not puncture.

Which strategy might be recommended to increase caloric intake in an infant with failure to thrive? A. Use developmental stimulation by a specialist during feedings. B. Avoid solids until after the bottle is well accepted. C. Be persistent through 10 to 15 minutes of food refusal. D. Vary the schedule for routine activities on a daily basis.

C. Calm perseverance is important. Parents often cannot persist through the child's refusals, but they should be encouraged to do so and supported. Feeding should take place in a nonstimulating environment so that the focus is on feeding, enhancing the chances of increasing caloric intake. Solids should be introduced slowly to decrease dependence on the bottle, beginning at 6 months of age. The feeding schedule should be structured for the infant to have consistency and develop a routine for feeding.

A nurse is working with teenagers and their parents in a school drug prevention program. Several of the parents ask how they can determine if their child has a problem with drugs. The most appropriate response by the nurse is: A. There is no way to know until they tell you. B. At some point, the child will develop depression and attempt suicide; then you can put them in rehab. C. It is common for them to withdraw and not achieve normal developmental tasks. You should then consult a professional. D. You should make your child take a home test for drugs. You can buy those at the drug store.

C. Children and teenagers who begin using drugs may often stop participating in routine activities and not continue to achieve the normal milestones of the adolescent period. If the parent ever has a question, they should seek information from a health care provider. Waiting for the child to tell the parent is not a way to determine if the child has a problem with drugs. It is a very passive approach to parenting. Waiting for the child to develop depression and attempt suicide is not a preventive approach to handling drug use. Taking a home test for drugs is not a measure that should be taken unless the child has been caught engaging in drug use.

Which statement best describes colic to parents who are inquiring as to whether their infant is experiencing this alteration? A. The infant will experience periods of abdominal pain, which result in weight loss. B. Periods of abdominal pain and crying occur in infants primarily over age 6 months. C. Infants with colic have paroxysmal abdominal pain or cramping manifested by episodes of loud crying. D. Colic is usually the result of poor or inadequate mothering.

C. Colic, or paroxysmal abdominal pain, occurs primarily in infants under the age of 3 months and is manifested by episodes of excessive crying and the infant drawing the legs up toward the abdomen. The infant with colic experiences abdominal pain but gains weight and usually thrives. Colic most commonly occurs in infants under 3 months of age. There is no identified relationship between mothering behavior and the development of colic.

According to evidenced based practice in a recent Cochrane database, which statement is most accurate with regard to the relationship between vitamin A and measles? A. It is correlated with an increased risk of blindness. B. Vitamin A supplementation should not be provided to children who have measles. C. There was no correlation between blindness in children who had measles and who also had vitamin A deficiency. D. Vitamin A supplementation in children with measles will lead to blindness.

C. Current research in Cochrane database reveals there is no relationship between ocular morbidities (blindness) and vitamin A deficiency in children who have measles. Research indicates that vitamin A supplementation can be given to children who have measles with no adverse outcomes.

Enteral feedings are ordered for a young child with burns covering 40% of the total body surface area. The nurse should know that A. Oral feedings are contraindicated. B. Enteral feedings must be stopped during painful procedures. C. Paralytic ileus precludes use of enteral feedings. D. The feedings will be high in carbohydrate and low in protein.

C. Enteral feedings can begin when the paralytic ileus resolves. Oral feedings are not contraindicated. Oral feedings are encouraged. Most children with burns are unable to consume sufficient calories by mouth, but every possible effort is made to encourage oral feeding. Enteral feedings can continue during procedures. A high-protein, high-calorie diet is recommended to compensate for the increased basal metabolic rate that occurs after a burn injury.

A nurse is providing education to a community group in preparation for a mission trip to a third world country with limited access to protein-based food sources. The nurse is aware that children in this country are at increased risk for A. rickets B. marasmus C. kwashiorkor D. pellagra

C. Kwashiorkor is defined as primarily a deficiency of protein with an adequate supply of calories. Rickets results from a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones. Marasmus results from general malnutrition of both calories and protein. Pellagra is a vitamin-deficiency disease most commonly caused by a chronic lack of niacin (vitamin B3) in the diet.

The correct interpretation of the notation, legally blind refers to? A. A medical diagnosis that indicates visual impairment is a priority problem B. Acuity tests reveal a finding of 20/100 in both eyes. C. A legal definition that determines whether the individual can receive benefits from government or ancillary agencies. D. That the individual requires glasses in order to be able to see properly.

C. Legally blind refers to the legal description confirmed by acuity test results of 20/200 that indicate severe permanent visual impairment. It allows for the individual to be able to receive assistance from government agencies and/or ancillary services. It is not a medical diagnosis. Prescriptive glasses will not restore visual sight for these individuals.

In reviewing potential susceptibility to respiratory infections for children, which statement is based on supportive physiological evidence? A. Newborns are more likely to develop respiratory infections in the neonatal period due to changes from intrauterine to external environment. B. With advancing age, immunity decreases leading to greater chances of developing respiratory infections. C. There is an increase in infection rate between 3 to 6 months due to loss of protective effects of maternal antibodies. D. Viral respiratory infections increase dramatically by 5 years of age.

C. Newborns have immune protection that lasts from 3 to 6 months due to maternal antibody transfer and are therefore less likely to develop a respiratory infection. Development of respiratory infection is not related to transitioning from intrauterine to external environments. With advancing age, immunity increases rather than decreases. Viral respiratory infections occur less frequently by 5 years of age.

The parents of a cognitively impaired child ask the nurse for guidance with discipline. The most appropriate recommendation by the nurse is that A. discipline is ineffective with cognitively impaired children. B. discipline is not necessary for cognitively impaired children. C. behavior modification is an excellent form of discipline. D. physical punishment is the most appropriate form of discipline.

C. Positive behaviors and desirable actions should be reinforced with cognitively impaired children. Behavior modification with positive reinforcement is effective in children with cognitive impairment. Discipline is essential to assist the child in developing boundaries. Most children with cognitive impairment will not be able to understand the reason for the physical punishment, and the behavior will not change. Physical punishment is not an acceptable form of discipline.

What is defined as reduced visual acuity in one eye despite appropriate optical correction? A. Myopia B. Hyperopia C. Amblyopia D. Astigmatism

C. The definition of amblyopia is the reduction of visual acuity in one eye despite appropriate optical correction. Myopia is near-sightedness, which is the ability to see objects up close but not clearly at a distance. Hyperopia is far-sightedness, which is the ability to clearly see distant objects but not close ones. Astigmatism is an alteration in vision caused by unequal curvature in the eye's refractive apparatus.

Which action should be included in a plan of care for an adolescent who is being treated for depression with tricyclic antidepressants? A. Restriction of fluids is needed to prevent fluid overload. B. Recording of daily weight. C. Make sure that dental hygiene is being performed on a routine basis. D. Increase in caloric intake to maintain weight.

C. The use of tricyclic antidepressants exerts a significant effect on dentition ranging to increased incidence of dental caries and decreased amount of saliva. Therefore, a dental hygiene program should be included as part of therapeutic management in order to avoid potential complications. Fluid intake should be encouraged and there is no need for documented daily weights or increase in caloric intake to maintain weight.

The parents of a 9-month-old infant tell the nurse that they are worried about their baby's thumb sucking. What should the nurse's reply be based on? A. A pacifier should be substituted for the thumb. B. Thumb sucking should be discouraged by age 12 months. C. Thumb sucking should be discouraged when permanent teeth begin to erupt. D. There is no need to restrain nonnutritive sucking during infancy.

C. Thumb sucking reaches its peak at 18 to 20 months of age; it should be discouraged if it persists beyond 4 to 6 years of age. Evidence is inconclusive over whether a pacifier or a thumb better satisfies sucking needs and what the impact of either is on tooth eruption. Thumb sucking reaches its peak at 18 to 20 months of age; it should be discouraged if it persists beyond 4 to 6 years of age. Nonnutritive sucking reaches its peak at about 18 to 20 months of age. Most toddlers give up nonnutritive sucking on their own.

Which statement by a student nurse indicates that additional instruction is needed regarding topical agents being used to treat burns? A. They eliminate bacterial growth but do not remove the bacteria from the skin B. They are not considered to be toxic substances C. They are associated with electrolyte derangement of surronding tissues D. They are able to penetrate through eschar levels to reach the wound

C. Topical agents used in the treatment of burns should provide minimal electrolyte derangement. The other options stated are all consistent with the expected actions of topical agents used in the treatment of burns.

Treatment methods used for status asthmaticus focus on A. supportive oxygen therapy to maintain saturation at 90%. B. resolving acid-base disturbances that have led to alkalosis. C. restoring hydration. D. decreasing airway compliance.

C. Treatment methods for status asthmaticus are aimed at improving ventilation, decreasing airway resistance, relieving bronchospasm, correcting dehydration and acidosis, decreasing anxiety and treating any underlying concurrent infection. Oxygen saturation should be maintained at greater than 90%, typical acid-base disturbances result in acidosis, not alkalosis.

You are taking care of a middle aged child who has a hearing deficit in the hospital setting and uses lipreading as part of her communication pattern. Which factor would help to enhance this interaction? A. Make sure that one of her parents and/or family members is in the room with her at all times to facilitate communication. B. Stand approximately 50 feet away from the child so that she can best visualize your face. C. Keep sentence structure short. D. Speak at a fast paced rate.

C. Using short sentences will help facilitate lipreading. It is not feasible that the child will have her parents and/or family members present with her at all times while in the hospital. One is advised to stand close to the patient to facilitate lipreading. Speaking at a slow and even rate is recommended to facilitate understanding.

The school nurse is seeing a child who brought poison ivy to school in a leaf collection. The child says that only hands touched it. The most appropriate nursing action is to A. Apply Burow solution compresses immediately. B. Soak hands in warm water. C. Rinse hands in cold, running water. D. Scrub hands thoroughly with antibacterial soap.

C. Washing the child's hands in cold running water is the recommended first action. Once contact has been made, it is desirable to flush the skin with cold running water within 15 minutes of exposure to neutralize the effect. Applying Burrow solution is effective for soothing the skin lesions once the dermatitis has begun. Antibacterial soap is not recommended as it removes protective skin oils, and may allow spread of contact.

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 first action by the nurse is to A. determine what the child has eaten. B. administer diphenhydramine (Benadryl) PO stat. C. move the child to the nurse's office or hallway. D. have someone call for an ambulance and paramedic rescue squad or 9-1-1.

D. Because the child is in severe respiratory distress, the nurse should have someone call for a rescue squad or 9-1-1. Because severe respiratory distress is occurring, treatment of the response is indicated. What the child has eaten can be determined later. Diphenhydramine by mouth will not be effective for this type of emergency allergic reaction. The child should not be moved, unless the child is currently in a place that puts him or her at greater hazard.

A 5-year-old has bilateral eye patches in place after surgery one day earlier. Today, the child can be out of bed. The most appropriate nursing intervention is to A. reassure the child and allow the parents to stay. B. allow the child to assist in self-feeding. C. speak to the child when entering the room. D. orient the child to the immediate surroundings.

D. Because the child is out of bed with both eyes patched, the immediate safety concern is for the child to be familiar with his or her immediate surroundings. Reassurance of the child is essential throughout the hospitalization, as is allowing the parents to stay with their child. Orientation to the room now that the child is out of bed with both of the eyes patched is the priority at this time. The child should be allowed to self-feed with assistance as needed. The child should always be referred to by name and spoken to when entering the room.

Cystic fibrosis may affect one system or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations? A. Atrophic changes in the mucosal wall of the intestines B. Hypoactivity of the autonomic nervous system C. Hyperactivity of the apocrine glands D. Mechanical obstruction caused by increased viscosity of exocrine gland secretions

D. Children with cystic fibrosis have thick exocrine gland secretions. The viscous secretions obstruct small passages in organs such as the lungs and pancreas. Thick mucous secretions are the probable cause of the multiple body system involvement, not atrophic changes in the intestinal mucosal walls. There is an identified autonomic nervous system anomaly, but it is not hypoactivity. The apocrine, or sweat, glands are not hyperactive. The child loses a greater amount of salt due to abnormal chloride movement.

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent A. otitis media B. diabetes insipidus C. nephrotic syndrome D. acute rheumatic fever

D. Children with group A β-hemolytic streptococci (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis. Otitis media is not a complication of acute streptococcal pharyngitis. Diabetes insipidus is not a complication of acute streptococcal pharyngitis. Children who have had acute streptococcal pharyngitis are at risk for acute glomerulonephritis, not nephrotic syndrome.

A nurse is caring for a 2-month-old exclusively breastfed infant with an admitting diagnosis of colic. Based on the nurse's knowledge of breastfed infants, what type of stool is expected? A. Dark brown and small hard pebbles B. Loose with green mucus streaks C. Formed and with white mucus D. Semiformed, seedy, yellow

D. Colic does not change the appearance, texture, or color of stools. The color, consistency, and texture of the stools would be normal for the type of feeding. In a breastfeeding infant, that would be semiformed, seedy, and yellow. Dark brown, small hard pebbles are not a typical bowel movement of an exclusively breastfed infant. Loose stool with green mucus streaks is not a typical bowel movement of an exclusively breastfed infant. Formed stool with white mucus is not a typical bowel movement of an exclusively breastfed infant.

A 15-year-old female is in a free clinic seeking information on birth control. The girl tells the nurse that she is sexually active with multiple partners. She states that she does not want to have to remember to take a pill every day. The most appropriate birth control option for this patient is A. an intrauterine device B. abstinence C. diaphragm D. condom

D. Condom use is recommended for birth control in teens who are sexually active with multiple partners. An intrauterine device is not a method of birth control that protects from sexually transmitted diseases. Abstinence is not an effective approach to birth control for a teen who is sexually active with multiple partners. A diaphragm is not a method of birth control that protects from sexually transmitted diseases.

The nurse is interviewing the parents of a 4-month-old infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in the crib with a blanket over the head, lying face down in bloody fluid from the nose and mouth. The parents indicate no problems when the infant was placed in the crib asleep. Which of the following causes of death does the nurse suspect? A. Suffocation B. Child abuse C. Infantile apnea D. Sudden infant death syndrome (SIDS)

D. Death is consistent with the appearance of SIDS. The infant is usually found in a disheveled bed; with blankets over the head; huddled into a corner and clutching the sheets; with frothy, blood-tinged fluid in the mouth and nose; and lying face down. The diaper is also usually full of stool, indicating a cataclysmic type of death. Although the child was found under the blanket, the other findings are consistent with SIDS. The findings as reported are consistent with SIDS, not child abuse. The history and physical findings are consistent with SIDS, not infantile apnea.

The parents of a child with fragile X syndrome want to have another baby. They tell the nurse that they worry another child might be similarly affected. What is the most appropriate nursing action? A. Reassure them that the syndrome is not inherited. B. Assess for family history of the syndrome. C. Recommend that they do not have another child. D. Explain that prenatal diagnosis of the syndrome is now available.

D. Fragile X syndrome can now be detected prenatally. The family should be referred for genetic counseling. Fragile X syndrome is inherited on the X chromosome. This should be done, but it does not address the parents' concern and need for genetic counseling. Nurses do not make recommendations related to whether parents should become pregnant and have other children. A referral for genetic counseling is indicated, and, based on findings, the geneticist can present family planning options, but the decision is strictly up to the family.

A 2-week-old infant with Down syndrome is being seen in the clinic. The mother tells the nurse that the infant is difficult to hold. "The baby is like a rag doll and doesn't cuddle up to me like my other babies did." The nurse interprets the infant's behavior as a A. sign of maternal deprivation. B. sign of detachment and rejection. C. sign of autism associated with Down syndrome. D. result of the physical characteristics of Down syndrome.

D. Lack of clinging (or molding) between child and mother is a result of the muscle hypotonicity and hyperextensibility of the joints associated with Down syndrome. Mothers may have difficulty with attachment to their child due to the lack of clinging or molding behavior characteristic of Down syndrome. The nurse should recommend swaddling and wrapping the baby before picking up. There is no indication of maternal deprivation. Lack of clinging or molding is not symptomatic of detachment and rejection. These physical signs are characteristic of Down syndrome. Autism is not associated with Down syndrome.

A 9-month-old infant is seen in the emergency department after developing urticaric rash with cough and wheezing. When collecting the history of events prior to the sudden onset of the rash with cough and wheezing, the mother states they were "feeding the baby new foods." Which food is the possible cause of this type of reaction in the infant? A. Potatoes B. Green beans C. Spinach D. Peanut butter

D. Nuts of any type, including peanuts, have a high allergy index in children and infants. The infant has demonstrated the cutaneous and respiratory type of reaction after possible ingestion of peanut butter. Potatoes are not a highly allergenic food. Green beans are not a highly allergenic food. Spinach is not a highly allergenic food.

One of the goals for children with asthma is to prevent respiratory tract infection because infections A. lessen effectiveness of medications. B. encourage exercise-induced asthma. C. increase sensitivity to allergens. D. can trigger an episode or aggravate asthmatic state.

D. Respiratory tract infections can trigger an asthmatic attack. An annual influenza vaccine is recommended. All respiratory equipment should be kept clean. Respiratory tract infection affects the asthma, not the medications. Exercise-induced asthma is caused by vigorous activity, not a respiratory tract infection. Sensitivity to allergens is independent of respiratory tract infection.

A 4-year-old child is brought to the emergency department. The child has a "froglike" croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. The priority action by the nurse is to A. examine the child's oropharynx and report the assessment to the health care provider. B. make the child lie down and rest quietly. C. auscultate the child's lungs and make preparations for placement in a mist tent. D. notify the health care provider immediately and be prepared to assist with a tracheostomy or intubation.

D. Sitting upright, drooling, agitation, and a froglike cough are indicative of epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary. Examination of the oropharynx may cause total obstruction and should not be done when a child manifests signs indicating potential epiglottitis. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase the respiratory distress and anxiety. Interventions should be planned once the diagnosis of epiglottitis has been made or ruled out.

A child with asthma is having pulmonary function tests. What explains the purpose of the peak expiratory flow rate (PEFR)? A. Confirms the diagnosis of asthma B. Determines the cause of asthma C. Identifies the "triggers" of asthma D. Assesses the severity of asthma C

D. The PEFR measures the maximum amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared with the child's baseline. The diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination, not pulmonary function tests such as the PEFR. The cause of asthma is inflammation, bronchospasm, and obstruction, which are not identified by the PEFR. Some of the triggers of asthma are identified with allergy testing, not with the PEFR.

The diagnosis of intellectual disability is based on the presence of A. intelligence quotient (IQ) of 75 or less. B. IQ of 70 or less. C. subaverage intellectual functioning, deficits in adaptive skills, and onset at any age. D. subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age.

D. The diagnosis of intellectual disability is made with the presentation of subaverage intellectual functioning, deficits in adaptive skills, and an onset before age 18. IQ is only one component of the diagnosis of intellectual disability. The onset of the deficit in adaptive skills and subaverage intellectual functioning must occur before age 18 years to meet the diagnosis of intellectual disability.

A 3-month-old bottle-fed infant is allergic to cow's milk. Which is the best substitute to teach the parents to use? A. Goat's milk B. Soy-based formula C. Skim milk diluted with water D. Casein hydrolysate milk formula

D. The milk protein is broken down in casein hydrolysate milk formulas, making them a safe alternative for the infant who has an allergy to cow's milk. The milk protein in goat's milk cross-reacts with cow's milk protein, and goat's milk is therefore not a safe alternative. Soy-based formulas are avoided due to the cross-reaction with cow's milk protein; they are not a safe alternative. Cow's milk protein is contained in skim milk, making it an unsafe alternative.

The genetic testing of a child with Down syndrome showed that the disorder was caused by chromosomal translocation. The parents ask about further genetic testing. Based on the nurse's knowledge of genetics, the most appropriate recommendation is A. no further genetic testing of the family is indicated. Incorrect B. the child should be retested to confirm the diagnosis of Down syndrome. C. the mother should be tested if she is over age 35. D. the parents can be tested, since it might be hereditary.

D. The parents and any siblings should be tested. Down syndrome resulting from a translocation may be inherited. This type of chromosomal abnormality presents issues for future pregnancies. The child does not require further genetic testing, but the parents and siblings should be further evaluated with genetic testing. There is no need to retest the child at a later date, because the diagnosis has been validated with chromosomal testing. This type of chromosomal abnormality occurs in children of parents of all ages.

What is characteristic of children with posttraumatic stress disorder (PTSD)? A. Denial as a defense mechanism is unusual. B. Traumatic effects cannot remain indefinitely. C. Previous coping strategies and defense mechanisms are not useful. D. Children often play out the situation over and over again in an attempt to come to terms with their fear.

D. This is an expected response by a child to a traumatic event. Play is often the safest means of communication for children and should be encouraged as a means of expression with a child experiencing PTSD. Denial is a defense mechanism commonly used by children and adolescents. Professional help is indicated if the stages of response are prolonged. Coping strategies and defense mechanisms that have been effective previously may be effective for PTSD.