Peds Exam 2

What is the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

a. Meconium ileus Rationale: The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration.

A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. Initial therapeutic approach to the mother should be: a. restating what the physician has told her about plastic surgery. b. encouraging her to express her feelings. c. emphasizing the normalcy of her baby and the baby's need for mothering. d. recognizing that negative feelings toward the child continue throughout childhood.

b. encouraging her to express her feelings.

A parent whose two school-age children have asthma asks the nurse in what sports, if any, they can participate. The nurse should recommend which of the following? a. Soccer b. Running c. Swimming d. Basketball

c. Swimming Rationale: Swimming is well tolerated in children with asthma because they are breathing air fully saturated with moisture and because of the type of breathing required in swimming.

Invagination of one segment of bowel within another is called: a. atresia. b. stenosis. c. herniation. d. intussusception.

d. intussusception.

Skin testing for tuberculosis (TB) (the Mantoux test) is recommended: a. every year for all children older than 2 years. b. every year for all children older than 10 years. c. every 2 years for all children starting at age 1 year. d. periodically for children who reside in high-prevalence regions.

d. periodically for children who reside in high-prevalence regions Rationale: Children who reside in high-prevalence regions for TB should be tested every 2 to 3 years.

Which of the following statements best describes Hirschsprung disease? A. The colon has an aganglionic segment. B. There is a passage of excessive amounts of meconium in the neonate. C. It results in excessive peristaltic movements within the gastrointestinal tract. D. It results in frequent evacuation of solids, liquid, and gas.

A. Hirschsprung disease is a mechanical obstruction caused by a lack of motility of a segment of the intestine as a result of the lack of ganglionic cells; thus it is referred to as aganglionic megacolon. Hirschsprung disease is associated with a neonate's inability to pass meconium or an older child's inability to pass feces. There is a lack of peristalsis in the affected segment of the infant or child with Hirschsprung disease. The infant or child with Hirschsprung disease will be seen with constipation or the passage of ribbonlike stools.

The nurse is caring for a boy with probable intussusception. He had diarrhea before admission, but while waiting for administration of air pressure to reduce the intussusception, he passed a normal brown stool. Which of the following is the most appropriate nursing action? A. Notify the physician. B. Measure the abdominal girth. C. Auscultate for bowel sounds. D. Take vital signs, including blood pressure.

A. Passage of a normal stool indicates that the intussusception has resolved. Notification of the physician is essential to determine whether a change in treatment plan is indicated. Measurement of the abdominal girth may be indicated, but notifying the physician is the priority. Auscultating for bowel sounds may be indicted, but notifying the physician is the priority.

An appropriate play activity for a 7-month-old infant to encourage visual stimulation is: a. Playing peek-a-boo. b. Playing pat-a-cake. c. Imitating animal sounds. d. Showing how to clap hands.

ANS: A Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation. Playing pat-a-cake and showing how to clap hands will help with kinetic stimulations. Imitating animal sounds will help with auditory stimulation.

The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37 C (98.6 F). The nurse suspects mild croup and should recommend which of the following? a. Admit to the hospital and observe for impending epiglottitis. b. Provide fluids that the child likes and use comfort measures. c. Control fever with acetaminophen and call if cough gets worse tonight. d. Try over-the-counter cough medicine and come to the clinic tomorrow if no improvement.

ANS: B In mild croup, therapeutic interventions include adequate hydration (as long as the child can easily drink) and comfort measures to minimize distress. The child is not exhibiting signs of epiglottitis. A temperature of 37 C is within normal limits. Although a return to the clinic may be indicated, the mother is instructed to return if the child develops noisy respirations or drooling.

A mother has just given birth to an infant with a cleft lip. Sensing that something is wrong, she starts to cry and asks the nurse, "What is wrong with my baby?" The most appropriate nursing action is to: a.encourage mother to express her feelings. b.explain in simple language that the baby has a cleft lip. c.provide emotional support until practitioner can talk to mother. d.tell mother a pediatrician will talk to her as soon as the baby is examined.

ANS: B It is best to explain in simple terms the nature of the defect and to reinforce and help clarify information given by the practitioner before the infant is shown to the parents. Parents may not be ready to talk about their feelings during the first few days after birth. The nurse should provide information about the child's condition while waiting for the practitioner to speak with the family after the examination. The mother needs simple explanations of what is wrong with her child during this period of waiting.

At what age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 12 months

ANS: C Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months an infant can sit with support. At age 6 months the infant will maintain a sitting position if propped. By 10 months the infant can maneuver from a prone to a sitting position.

At which age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 10 months

ANS: C Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months the infant can maneuver from a prone to a sitting position.

In terms of fine motor development, the infant of 7 months should be able to: a. Transfer objects from one hand to the other. b. Use thumb and index finger in crude pincer grasp. c. Hold crayon and make a mark on paper. d. Release cubes into a cup.

ANS: A By age 7 months infants can transfer objects from one hand to the other, crossing the midline. The crude pincer grasp is apparent at about age 9 months. The child can scribble spontaneously at age 15 months. At age 12 months the child can release cubes into a cup.

The parents of a 12-month-old child ask the nurse if the child can eat hot dogs. The nurse's reply should be based on knowing that: a. The child is too young to digest hot dogs. b. The child is too young to eat hot dogs safely. c. Hot dogs must be sliced into sections to prevent aspiration. d. Hot dogs must be cut into small, irregular pieces to prevent aspiration.

ANS: D Hot dogs are of a consistency, diameter, and round shape that may cause complete obstruction of the child's airway. If given to young children, the hot dog should be cut into small irregular pieces rather than served whole or in slices. The child's digestive system is mature enough to digest hot dogs. To eat the hot dog safely, the child should be sitting down, and the hot dog should be appropriately cut into irregularly shaped pieces.

Which statement best represents infectious mononucleosis? A. Human herpesvirus type 2 is the principal cause. B. Herpes-like Epstein-Barr virus is the principal cause C. Diagnosis is established by a complete blood count, which reveals a characteristic leukopenia. D. Diagnosis is established by clinical manifestations because diagnostic tests cannot confirm the diagnosis.

B

Management of the child with a peptic ulcer often includes which of the following? A. Milk at frequent intervals B. Proton pump inhibitors C. Antacids 1 and 3 hours before meals and at bedtime D. Coping with stress and adjusting to chronic illness

B. Proton pump inhibitors block the production of acid. They are well tolerated and have infrequent side effects. Milk is not beneficial in the management of peptic ulcer disease. Proton pump inhibitors are more effective than antacids. Coping with stress is beneficial, but peptic ulcer disease is treatable.

A 4-year-old child has ingested a toxic dose of iron. The parent reports that the child vomited and had gastric pain an hour ago but "feels fine" now. The parent is not certain when the child ingested the iron tablets. The nurse should instruct the parent to do which of the following? A. Observe the child closely for 2 more hours. B. Bring the child to the hospital immediately. C. Administer activated charcoal. D. Administer ipecac to induce vomiting if the child does not vomit again within 1 hour.

B. The child should be transported to hospital immediately for assessment and possible gastric lavage. The period of concern for complications of iron toxicity is from 30 minutes to 6 hours. Activated charcoal does not bind iron and thus is not a course of treatment for this child. Ipecac is not recommended for poisonings.

Which of the following clinical manifestations would the nurse expect to find in a newborn who has developed necrotizing enterocolitis (NEC)? A. Hyperthermia B. Gastric residual and melena C. The passage of ribbonlike stools D. Projectile vomiting

B. The most prominent signs of NEC are abdominal distention, gastric residuals, and blood in the stools (melena). NEC resembles septicemia; the newborn may "not look well," in addition to having nonspecific signs such as lethargy, poor feeding, hypotension, hypothermia, bile-stained vomitus, and oliguria.

An infant with neurologic impairment and delay is receiving several medications. A proton pump inhibitor is one of the medications the infant is receiving. Which medication(s) is/are proton pump inhibitor(s)? (Select all that apply.) A. Ranitidine (Zantac) B. Omeprazole (Prilosec) C. Pantoprazole (Protonix) D. Glycopyrrolate (Robinul) E. Bethanechol (Urecholine)

Omeprazole (Prilosec) Pantoprazole (Protonix)

A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solution (ORS). The child's mother calls the clinic nurse because the child is also occasionally vomiting. What should the nurse recommend? A. Bring the child to the hospital for intravenous fluids. B. Alternate giving ORS and carbonated drinks C. Continue to give ORS frequently in small amounts D. Institute a nothing by mouth (NPO) status for the child for 8 hours, and resume ORS if vomiting has subsided.

C

Which of the following diets would be appropriate for the child with celiac disease? A. Salt free B. Phenylalanine free C. Low gluten D. High calories, low protein, low fat

C. Celiac disease is characterized by intolerance of gluten, the protein found in wheat, barley, rye, and oats. A low-gluten diet is indicated for life. The diet for a child with celiac disease does not have to be salt free. Low-phenylalanine diet is indicated in phenylketonuria. The diet of a child with celiac disease should be high in calories and protein and low in fat, in addition to the low-gluten requirement.

What should the nurse include when teaching an adolescent with Crohn disease? A. Preventing the spread of illness to others and nutritional guidance B. Adjusting to chronic illness and preventing the spread of illness to others C. Coping with stress and adjusting to chronic illness D. Nutritional guidance and preventing constipation

C. Crohn disease is a chronic disease with life-altering complications. The nursing interventions include helping the child cope with stress and adjust to the illness. Nutritional guidance is necessary, but Crohn disease is not infectious. Adjustment to chronic illness is necessary, but Crohn disease is not infectious. Nutritional guidance is necessary, but constipation is not an issue.

Therapeutic management of the child with inflammatory bowel disease (IBD) includes a diet that has which of the following components? A. Low protein B. Low calorie C. High fiber D. Vitamin supplements

D. Multivitamins, iron, and folic acid supplementation are recommended for the child with IBD. A high-protein, high-calorie diet is needed to help correct nutritional deficits. A high-calorie, high-protein diet is needed to help correct nutritional deficits. A high-fiber diet is not recommended for IBD. Even small amounts of bran have been associated with a worsening of the child's condition.

A child has a nasogastric (NG) tube after surgery for acute appendicitis. The purpose of the NG tube is which of the following? A. Maintain electrolyte balance B. Maintain accurate record of output C. Prevent spread of infection D. Prevent abdominal distention

D. The NG tube is used to maintain gastric decompression until intestinal activity returns. The NG tube may adversely affect electrolyte balance by removing stomach secretions. NG drainage is one part of the child's output. The nurse would need to incorporate the NG drainage with other output. There is no relationship between the NG tube and prevention of the spread of infection.

When evaluating the extent of an infant's dehydration, the nurse should recognize that the symptoms of severe dehydration (15%) are: A. tachycardia, decreased tears, 5% weight loss. B. normal pulse and blood pressure, intense thirst. C. irritability, moderate thirst, normal eyes and fontanels D. tachycardia, parched mucous membranes, sunken eyes and fontanels

D. tachycardia, parched mucous membranes, sunken eyes and fontanels

A nurse is assessing a 6-month-old infant. The nurse recognizes the posterior fontanel usually closes at which age? a. 6 to 8 weeks b. 10 to 12 weeks c. 4 to 6 months d. 8 to 10 months

a. 6 to 8 weeks

An infant's parents ask the nurse about preventing OM. Which of the following should be recommended? a. Avoid tobacco smoke. b. Use nasal decongestant. c. Avoid children with OM. d. Bottle-feed or breastfeed in supine position.

a. Avoid tobacco smoke. Rationale: Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses.

The nurse is assessing a child with croup. Examining the child's throat by using a tongue depressor might precipitate which of the following? a. Inspiratory stridor b. Complete obstruction c. Sore throat d. Respiratory tract infection

b. Complete obstruction Rationale: If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place

The nurse is caring for a child with carbon monoxide poisoning associated with smoke inhalation. Which of the following is essential in this child's care? a. Monitor pulse oximetry. b. Monitor arterial blood gases. c. Administer oxygen if respiratory distress develops. d. Administer oxygen if child's lips become bright, cherry red.

b. Monitor arterial blood gases. Rationale: Arterial blood gases are the best way to monitor carbon monoxide poisoning.

Asthma in infants is usually triggered by: a. medications. b. a viral infection. c. exposure to cold air. d. allergy to dust or dust mites.

b. a viral infection. Rationale: Viral illnesses cause inflammation that causes increased airway reactivity in asthma.

A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. The purpose of this is to: a. prevent reflux. b. prevent hematemesis. c. reduce gastric acid production. d. increase gastric acid production.

c. reduce gastric acid production.

Which of the following best describes why children have fewer respiratory tract infections as they grow older? a. The amount of lymphoid tissue decreases. b. Repeated exposure to organisms causes increased immunity. c. Viral organisms are less prevalent in the population. d. Secondary infections rarely occur after viral illnesses.

b. Repeated exposure to organisms causes increased immunity. Rationale: Children have increased immunity after exposure to a virus

The mother of a toddler yells to the nurse, "Help! He is choking to death on his food." The nurse determines that lifesaving measures are necessary based on which of the following? a. Gagging b. Coughing c. Pulse over 100 beats/min d. Inability to speak

d. Inability to speak Rationale: The inability to speak is indicative of a foreign-body airway obstruction of the larynx. Abdominal thrusts are needed for treatment of the choking child.

The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as: a. A normal finding. b. A questionable finding—infant should be rechecked in 1 month. c. An abnormal finding—indicates need for immediate referral to practitioner. d. An abnormal finding—indicates need for developmental assessment.

ANS: A Because the anterior fontanel normally closes between ages 12 and 18 months, this is a normal finding, and no further intervention is required.

The nurse is interviewing the father of 10-month-old Megan. She is playing on the floor when she notices an electrical outlet and reaches up to touch it. Her father says "No" firmly and removes her from near the outlet. The nurse should use this opportunity to teach the father that Megan: a. Is old enough to understand the word "No." b. Is too young to understand the word "No." c. Should already know that electrical outlets are dangerous. d. Will learn safety issues better if she is spanked.

ANS: A By age 10 months children are able to associate meaning with words. The father is using both verbal and physical cues to alert the child to dangerous situations. The child should be old enough to understand the word "No." The 10-month-old is too young to understand the purpose of an electric outlet. The father is using both verbal and physical cues to teach safety measures. Physical discipline should be avoided.

When caring for a child after a tonsillectomy, the nurse should do which of the following? a. Watch for continuous swallowing. b. Encourage gargling to reduce discomfort. c. Apply warm compresses to the throat. d. Position the child on the back for sleeping.

ANS: A Continuous swallowing, especially while sleeping, is an early sign of bleeding. The child swallows the blood that is trickling from the operative site. Gargling is discouraged, since it could irritate the operative site. Ice compresses are recommended to reduce inflammation. The child should be positioned on the side or abdomen to facilitate drainage of secretion.

The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include which of the following? a. Arm restraints, postural drainage, mouth irrigations b. Cleansing suture line, supine and side-lying position, appropriate analgesia c. Mouth irrigations, prone position, cleansing suture line d. Supine and side-lying positions, postural drainage, arm restraints

ANS: B The suture line should be cleansed gently after feeding. The child should be positioned on back, on side, or in infant seat. The child is medicated with appropriate analgesia to calm him or her. Postural drainage is not indicated. This would increase the pressure on the operative site when the child is placed in different positions. There is no reason to perform mouth irrigations, and the child should not be placed in the prone position where injury to the suture site can occur. Arm restraints are used according to local practice.

During the 2-month well-child check-up the nurse expects the infant to respond to sound in the following manner: a. responds to name. b. reacts to loud noise with Moro reflex. c. turns head to side when sound is at ear level. d. locates sound by turning head in a curving arc.

ANS: C At 2 months the infant should turn head to the side when a noise is made at ear level. At birth infants respond to sound with a startle or Moro reflex. An infant responds to name and locates sound by turning head in a curving arc at age 6 to 9 months.

In terms of gross motor development, what would the nurse expect an infant age 5 months to do? a. Sit erect without support. b. Roll from back to abdomen. c. Turn from abdomen to back. d. Move from prone to sitting position.

ANS: C Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen is developmentally appropriate for an infant at age 6 months. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position.

At about what age does an infant start to recognize familiar faces and objects, such as own hand? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: C The child can recognize familiar objects at approximately age 3 months. For the first 2 months of life, infants watch and observe their surroundings. The 4-month-old infant is beginning to develop hand-eye coordination.

Parents bring their 15-month-old infant to the emergency department at 3:00 AM because the toddler has a temperature of 39o C (102.2o F), is crying inconsolably, and is tugging at the ears. A diagnosis of otitis media (OM) is made. In addition to antibiotic therapy, the nurse practitioner would instruct the parents to use: a. decongestants to ease stuffy nose. b. antihistamines to help the child sleep. c. aspirin for pain and fever management. d. benzocaine ear drops for topical pain relief.

ANS: D Analgesic ear drops can provide topical relief for the intense pain of OM. Decongestants and antihistamines are not recommended in the treatment of OM. Aspirin is contraindicated in young children because of the association with Reye syndrome.

Which of the following characteristics best describes the fine motor skills of an infant at age 5 months? a. Neat pincer grasp b. Strong grasp reflex c. Builds a tower of two cubes d. Able to grasp object voluntarily

ANS: D At age 5 months the infant should be able to voluntarily grasp an object. The grasp reflex is present in the first 2 to 3 months of life. Gradually, the reflex becomes voluntary. The neat pincer grasp is not achieved until age 10 months. At age 12 months an infant will attempt to build a tower of two cubes but will most likely be unsuccessful.

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent: a. otitis media. b. diabetes insipidus (DI). c. nephrotic syndrome. d. acute rheumatic fever.

ANS: D Group A -hemolytic streptococcal infection is a brief illness with varying symptoms. It is essential that pharyngitis caused by this organism be treated with appropriate antibiotics to avoid the sequelae of acute rheumatic fever and acute glomerulonephritis. The cause of otitis media is either viral or other bacterial organisms. DI is a disorder of the posterior pituitary. Infections such as meningitis or encephalitis, not streptococcal pharyngitis, can cause DI. Glomerulonephritis, not nephrotic syndrome, can result from acute streptococcal pharyngitis.

The nurse is assessing a six-month-old child. Which developmental skills are normal and should be expected? a. Speaks in short sentences. b. Sits alone. c. Can feed self with a spoon. d. Pulling up to a standing position.

Answer B. The child develops language skills between the ages of one and three. A six-month-old child is learning to sit alone. The child begins to use a spoon at 12-15 months of age. The baby pulls himself to a standing position about ten months of age.

Nurse Oliver s teaching a mother who plans to discontinue breast-feeding after 5 months. The nurse should advise her to include which foods in her infant's diet? a. Iron-rich formula and baby food b. Whole milk and baby food c. Skim milk and baby food d. Iron-rich formula only

Answer D. The American Academy of Pediatrics recommends that infants at age 5 months receive iron-rich formula and that they shouldn't receive solid food - even baby food - until age 6 months. The Academy doesn't recommend whole milk until age 12 months, and skim milk until after age 2 years.

An 18-month-old child is seen in the clinic with AOM. Trimethoprim-sulfamethoxazole (Bactrim) is prescribed. Which of the following statements made by the parent indicates a correct understanding of the instructions? a. "I should administer all of the prescribed medication." b. "I should continue medication until the symptoms subside." c. "I will immediately stop giving medication if I notice a change in hearing." d. "I will stop giving medication if fever is still present in 24 hours."

a. "I should administer all of the prescribed medication." Rationale: Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria

A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests which of the following? a. Asthma b. Pneumonia c. Bronchiolitis d. Foreign body in trachea

a. Asthma Rationale: Asthma may have these chronic symptoms.

A premature newborn requires oxygen and mechanical ventilation. Which complications should the nurse assess for? a. Bronchopulmonary dysplasia, pneumothorax b. Anemia, necrotizing enterocolitis c. Cerebral palsy, persistent patent ductus d. Congestive heart failure, cerebral edema

a. Bronchopulmonary dysplasia, pneumothorax

Which of the following is the most important consideration in managing TB in children? a. Skin testing b. Chemotherapy c. Adequate nutrition d. Adequate hydration

b. Chemotherapy Rationale: Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and two or three times a week for the remaining 4 months.

β-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. What is their action? a. Liquefy secretions b. Dilate the bronchioles c. Reduce inflammation of the lungs d. Reduce infection

b. Dilate the bronchioles Rationale: These medications work to dilate the bronchioles in acute exacerbations.

Which of the following types of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)

b. Epiglottitis Rationale: Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment.

Which information should the nurse give a mother regarding the introduction of solid foods during infancy? a. Solid foods should not be introduced until 8 to 10 months, when the extrusion reflex begins to disappear. b. Foods should be introduced one at a time, at intervals of 4 to 7 days. c. Solid foods can be mixed in a bottle to make the transition easier for the infant. d. Fruits and vegetables should be introduced into the diet first.

b. Foods should be introduced one at a time, at intervals of 4 to 7 days.

It is generally recommended that a child with acute streptococcal pharyngitis can return to school: a. when sore throat is better. b. if no complications develop. c. after taking antibiotics for 24 hours. d. after taking antibiotics for 3 days.

c. After taking antibiotics for 24 hours. Rationale: After children have taken antibiotics for 24 hours, they are no longer contagious to other children.

Which is used to treat moderate to severe inflammatory bowel disease? a. Antacids b. Antibiotics c. Corticosteroids d. Antidiarrheal medications

c. Corticosteroids

Chronic otitis media with effusion (OME) is differentiated from acute otitis media (AOM) because it is usually characterized by which of the following? a. Fever as high as 40° C (104° F) b. Severe pain in the ear c. Nausea and vomiting d. A feeling of fullness in the ear

d. A feeling of fullness in the ear Rationale: OME is characterized by feeling of fullness in ear or other nonspecific complaints.

Which clinical manifestation would be the most suggestive of acute appendicitis? a. Rebound tenderness b. Bright red or dark red rectal bleeding c. Abdominal pain that is relieved by eating d. Abdominal pain that is most intense at McBurney point

d. Abdominal pain that is most intense at McBurney point

A 2-month-old breastfed infant is successfully rehydrated with oral rehydration solutions (ORSs) for acute diarrhea. Instructions to the mother about breastfeeding should include to A. continue breastfeeding B. stop breastfeeding until breast milk is cultured. C. stop breastfeeding until diarrhea is absent for 24 hours. D. express breast milk and dilute with sterile water before feeding.

A

Which of the following factors will decrease iron absorption and therefore should not be given at the same time as an iron supplement? a.Milk b.Fruit juice c.Multivitamin d.Meat, fish, poultry

ANS: A Many foods interfere with iron absorption and should be avoided when the iron is consumed. These foods include phosphates found in milk, phytates found in cereals, and oxalates found in many vegetables. Vitamin C-containing juices enhance the absorption of iron. Multivitamins may contain iron; no contraindication exists to taking the two together. Meat, fish, and poultry do not affect absorption.

A mother tells the nurse that she doesn't want her infant immunized because of the discomfort associated with injections. The nurse should explain that: a. This cannot be prevented. b. Infants do not feel pain as adults do. c. This is not a good reason for refusing immunizations. d. A topical anesthetic, eutectic mixture of local anesthetic (EMLA), can be applied before injections are given.

ANS: D Several topical anesthetic agents can be used to minimize the discomfort associated with immunization injections. These include EMLA and vapor coolant sprays. Pain associated with many procedures can be prevented and minimized by using the principles of atraumatic care. With preparation the injection site can be properly anesthetized to decrease the amount of pain felt by the infant. Infants have the neural pathways to sense pain. Numerous research studies have indicated that infants perceive and react to pain in the same manner as do children and adults. The mother should be allowed to discuss her concerns and the alternatives available. This is part of the informed consent process.

The nurse is discussing home care with a mother whose 6-year-old child has hepatitis A. Which of the following should the nurse include? A. Bed rest is important until 1 week after the icteric phase. B. The child should not return to school until 3 weeks after the icteric phase. C. Reassure the mother that hepatitis A cannot be transmitted to other family members. D. Teach infection control measures to family members.

D. Hepatitis A is a contagious disease, transmitted through the fecal-oral route. The nurse should teach infection control measures to family members. Hepatitis A does not usually have an icteric phase and often is subclinical. The period of communicability for hepatitis A is the later half of the incubation period to 1 week after onset of clinical illness; thus the child can return to school after that time frame. Hepatitis A is infectious through fecal-oral route; thus family members may be susceptible to acquiring the disease if they fail to institute proper infection control measures.

Sara, age 4 months, was born at 35 weeks' gestation. She seems to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was term. The nurse should explain that: a. Infants' temperaments are part of their unique characteristics. b. Infants become less difficult if they are not kept on scheduled feedings and structured routines. c. Sara's behavior is suggestive of failure to bond completely with her parents. d. Sara's difficult temperament is the result of painful experiences in the neonatal period.

ANS: A Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant's unique temperament. Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. Sara's temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to Sara's temperament.

Clinical manifestations of failure to thrive (FTT) in a 13-month-old may include which of the following? a.Irregularity in activities of daily living b.Preferring solid food to milk or formula c.Weight that is at or below the 10th percentile d.Appropriate achievement of developmental landmarks

ANS: A One of the clinical manifestations of children with FTT is irregularity or low rhythmicity in activities of daily living. Children with FTT often refuse to switch from liquids to solid foods. Weight below the 5th percentile is indicative of FTT. Developmental delays, including social, motor, adaptive, and language, exist.

An important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS) would be which of the following? a.Discourage parents from making a last visit with the infant. b.Make a follow-up home visit to parents as soon as possible after the child's death. c.Explain how SIDS could have been predicted and prevented. d.Interview parents in depth concerning the circumstances surrounding the child's death.

ANS: B A competent, qualified professional should visit the family at home as soon as possible after the death. Printed information about SIDS should be provided to the family. Parents should be allowed and encouraged to make a last visit with their child. SIDS cannot always be prevented or predicted, but parents can take steps to reduce the risk (such as supine sleeping, removing blankets and pillows from the crib, and not smoking). Discussions about the cause only increase parental guilt. The parents should be asked only factual questions to determine the cause of death.

At what age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: B At age 2 months the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. The 3-month-old can recognize familiar faces. At age 4 months the infant can enjoy social interactions.

At what age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? a. 1 month c. 3 months b. 2 months d. 4 months

ANS: B At age 2 months the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. The 3-month-old can recognize familiar faces. At age 4 months the infant can enjoy social interactions.

Which one of the following strategies might be recommended for an infant with failure to thrive (FTT) to increase caloric intake? a.Vary schedule for routine activities on a daily basis. b.Be persistent through 10 to 15 minutes of food refusal. c.Avoid solids until after the bottle is well accepted. d.Use developmental stimulation by a specialist during feedings.

ANS: B Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. Children with FTT need a structured routine to help establish rhythmicity in their activities of daily living. Many children with FTT are fed exclusively from a bottle. Solids should be fed first. Stimulation is reduced during the mealtime to maintain the focus on eating.

A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse should recommend that the infant be given: a. Skim milk. b. Whole cow's milk. c. Commercial iron-fortified formula. d. Commercial formula without iron.

ANS: C For children younger than 1 year the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, iron-fortified commercial formula should be used. Cow's milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron-deficiency anemia.

The parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infant's stool. The nurse bases her explanation on knowing that: a. Child should not be given fibrous foods until digestive tract matures at age 4 years. b. Child should not be given any solid foods until this digestive problem is resolved. c. This is abnormal and requires further investigation. d. This is normal because of the immaturity of digestive processes at this age.

ANS: D The immaturity of the digestive tract is evident in the appearance of the stools. Solid foods are passed incompletely broken down in the feces. An excess quantity of fiber predisposes the child to large, bulky stools. This is a normal part of the maturational process, and no further investigation is necessary.

A 4-year-old girl is brought to the emergency department. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should do which of the following? a. Make her lie down and rest quietly. b. Examine her oral pharynx and report to the physician. c. Auscultate her lungs and prepare for placement in a mist tent. d. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

ANS: D This child is exhibiting signs of respiratory distress and possible epiglottitis. Epiglottitis is always a medical emergency requiring antibiotics and airway support for treatment. Sitting up is the position that facilitates breathing in respiratory disease. The oral pharynx should not be visualized. If the epiglottis is inflamed, there is the potential for complete obstruction if it is irritated further. Although lung auscultation provides useful assessment information, a mist tent would not be beneficial for this child. Immediate medical evaluation and intervention are indicated.

The mother of a 6-month-old states that she has started her infant on 2% milk. Which of the following would be the nurse's best response? A. "Your baby will probably be fine with this milk." B. "The baby should be switched to whole milk." C. "You need to keep the infant on formula." D. "You need to switch to formula right now."

Correct Answer: B The mother has already changed the infant from formula to cow's milk, so she probably will not change the infant back to formula. Therefore, the best the nurse can hope for is that the mother will switch to whole milk. Because cow's milk causes microscopic blood loss in the intestine, it is best for the infant to remain on formula until 1 year of age and then be switched to whole milk, which has a higher fat content than 2% milk. The fat is needed for brain growth.

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

d. Give small amounts of favorite fluids frequently to prevent dehydration Rationale: Preventing dehydration by small frequent feedings is an important intervention in the febrile child.

The nurse notes that an infant stares at an object placed in her hand and takes it to her mouth, coos and gurgles when talked to, and sustains part of her own weight when held in a standing position. The nurse correctly interprets these findings as characteristic of an infant at which of the following ages? A. 2 months. B. 4 months. C. 7 months. D. 9 months.

Ans: B Holding the head erect when sitting, staring at an object placed in the hand, taking the object to the mouth, cooing and gurgling, and sustaining part of her body weight when in a standing position are behaviors characteristic of a 4-month old infant. A 2-month-old typically vocalizes, follows objects to the midline, and smiles. A 7-month-old typically is able to sit without support, turns toward the voice, and transfers object from hand to hand. Usually, a 9-month-old can crawl, stand while holding on, and initiate speech sounds

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which of the following? a. Avoid using for more than 3 days. b. Keep drops to use again for nasal congestion. c. Administer drops until nasal congestion subsides. d. Administer drops after feedings and at bedtime.

a. Avoid using for more than 3 days Rationale: Vasoconstrictive nose drops such as phenylephrine (Neo-Synephrine) should not be used for more than 3 days to avoid rebound congestion.

Which of the following tests aid in the diagnosis of CF? a. Sweat chloride test, stool for fat, chest radiograph films b. Stool for fat, gastric contents for hydrochloride, chest radiograph films c. Sweat chloride test, bronchoscopy, duodenal fluid analysis d. Sweat chloride test, stool for trypsin, biopsy of intestinal mucosa

a. Sweat chloride test, stool for fat, chest radiograph films Rationale: A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal (GI) manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF.

A child is diagnosed with influenza, probably type A disease. Management includes which of the following? a. Clear liquid diet for hydration b. Aspirin to control fever c. Amantadine hydrochloride to reduce symptoms d. Antibiotics to prevent bacterial infection

c. Amantadine hydrochloride to reduce symptoms Rationale: Amantadine may reduce symptoms related to influenza A if administered within 24 to 48 hours of onset. It is ineffective against type B or C.

Pancreatic enzymes are administered to the child with CF. Nursing considerations should include which of the following? a. Do not administer pancreatic enzymes if child is receiving antibiotics. b. Decrease dose of pancreatic enzymes if child is having frequent, bulky stools. c. Administer pancreatic enzymes between meals if at all possible. d. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

d. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal. Rationale: Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole.

Which of the following drugs is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a. Ephedrine b. Theophylline c. Aminophylline d. Short-acting β2-agonists

d. Short-acting β2-agonists Rationale: Short-acting β2 agonists are the first treatment in an acute asthma exacerbation.

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant: a. becomes fussy. b. has a cough. c. has a fever over 99° F. d. shows signs of an earache.

d. Shows signs of an earache. Rationale: If an infant with nasopharyngitis shows signs of an earache, it may mean a secondary bacterial infection is present and should be referred to a practitioner for evaluation.

Which therapeutic management treatment is implemented for children with Hirschsprung disease? a. Daily enemas b. Low-fiber diet c. Permanent colostomy d. Surgical removal of affected section of bowel

d. Surgical removal of affected section of bowel

A nurse is admitting an infant with biliary atresia. Which is the earliest clinical manifestation of biliary atresia the nurse should expect to assess? a. Jaundice b. Vomiting c. Hepatomegaly d. Absence of stooling

a. Jaundice

What information could be given to the parents of a 12-month-old child regarding appropriate play activities for this age? a. Give large push-pull toys for kinetic stimulation. b. Place cradle gym across crib to facilitate fine motor skills. c. Provide child with finger paints to enhance fine motor skills. d. Provide stick horse to develop gross motor coordination.

ANS: A The 12-month-old child is able to pull to a stand and walk holding on or independently. Appropriate toys for this age child include large pull toys for kinesthetic stimulation. A cradle gym should not be placed across the crib. Finger paints are appropriate for older children. A 12-month-old child does not have the stability to use a stick horse.

The best play activity for a 6-month-old infant to provide tactile stimulation is to: a. Allow to splash in bath. b. Give various colored blocks. c. Play music box, tapes, or CDs. d. Use infant swing or stroller.

ANS: A The feel of the water while the infant is splashing provides tactile stimulation. Various colored blocks provide visual stimulation for a 4- to 6-month-old. Music box, tapes, and CDs provide auditory stimulation. Swings and strollers provide kinesthetic stimulation.

The nurse notices that a 10-month-old infant being seen in the clinic is wearing expensive, inflexible, high-top shoes. The nurse should explain that: a. Soft and flexible shoes are generally better. b. High-top shoes are necessary for support. c. Inflexible shoes are necessary to prevent in-toeing and out-toeing. d. This type of shoe will encourage the infant to walk sooner.

ANS: A The main purpose of the shoe is protection. Soft, well-constructed, athletic-type shoes are best for infants and children. High-top shoes are not necessary for support but may be helpful keeping the child's foot in the shoe. Inflexible shoes can delay walking, aggravate in-toeing and out-toeing, and impede development of the supportive foot muscles.

A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. The nurse should interpret this as: a. Normal development. b. Significant developmental lag. c. Slightly delayed development caused by prematurity. d. Suggestive of a neurologic disorder such as cerebral palsy.

ANS: A This indicates normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. No evidence of neurologic dysfunction is present.

The nurse is checking reflexes on a 7-month-old infant. When the infant is suspended in a horizontal prone position, the head is raised and legs and spine are extended. Which reflex is this? a. Landau b. Parachute c. Body-righting d. Labyrinth-righting

ANS: A When the infant is suspended in a horizontal prone position, the head is raised and legs and spine are extended; this describes the Landau reflex. It appears at 6 to 8 months and persists until 12 to 24 months. The parachute reflex occurs when the infant is suspended in a horizontal prone position and suddenly thrust downward; the infant extends the hands and fingers forward as if to protect against falling. This appears at 7 to 9 months and lasts indefinitely. Body-righting occurs when turning hips and shoulders to one side causes all other body parts to follow. It appears at 6 months of age and persists until 24 to 36 months. The labyrinth-righting reflex appears at 2 months and is strongest at 10 months. This reflex involves holding infants in the prone or supine position. They are able to raise their heads.

At what age would the nurse expect an infant to be able to say "mama" and "dada" with meaning? a. 4 months b. 6 months c. 10 months d. 14 months

ANS: C Beginning at about age 10 months, the infant is able to ascribe meaning to the words "mama" and "dada." Four to 6 months is too young for this behavior to develop. At 14 months the child should be able to attach meaning to these words. By age 1 year, the child can say three to five words with meaning and understand as many as 100 words.

Most infants begin to fear strangers at age: a. 2 months c. 6 months b. 4 months d. 12 months

ANS: C Between ages 6 and 8 months fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and nonfamiliar people. At age 2 months infants are just beginning to respond differentially to the mother. At age 4 months the infant is beginning the process of separation individuation when the infant begins to recognize self and mother as separate beings. Twelve months is too late and requires referral for evaluation if the child does not fear strangers at this age.

At what age do most infants begin to fear strangers? a. 2 months b. 4 months c. 6 months d. 12 months

ANS: C Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to the infants' ability to discriminate between familiar and unfamiliar people. At 2 months, infants are just beginning to respond differentially to the mother. The infant at age 4 months is beginning the process of separation-individuation, which involves recognizing self and mother as separate beings. Twelve months is too late; the infant requires referral for evaluation if he or she does not fear strangers by this age.

What behavior indicates that an infant has developed object permanence? a. Recognizes familiar face such as mother b. Recognizes familiar object such as bottle c. Actively searches for a hidden object d. Secures objects by pulling on a string

ANS: C During the first 6 months of life infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows that an object exists even when it is not visible. Between ages 8 and 12 weeks infants begin to respond differentially to the mother. They cry, smile, vocalize, and show distinct preference for the mother. This preference is one of the stages that influence the attachment process, but it is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object permanence. The ability to understand cause and effect is part of secondary schema development.

Which statement best describes the infant's physical development? a. Anterior fontanel closes by age 6 to 10 months. b. Binocularity is well established by age 8 months. c. Birth weight doubles by age 5 months and triples by age 1 year. d. Maternal iron stores persist during the first 12 months of life.

ANS: C Growth is very rapid during the first year of life. The birth weight has approximately doubled by age 5 to 6 months and triples by age 1 year. The anterior fontanel closes at age 12 to 18 months. Binocularity is not established until age 15 months. Maternal iron stores are usually depleted by age 6 months.

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant: a.has a cough. b.becomes fussy. c.shows signs of an earache. d.has a fever higher than 37.5 C (99 F).

ANS: C If an infant with nasopharyngitis shows signs of an earache, it may indicate respiratory complications and possibly secondary bacterial infection. The health professional should be contacted to evaluate the infant. Cough can be a sign of nasopharyngitis. Irritability is common in an infant with a viral illness. Fever is common in viral illnesses.

Which of the following is an appropriate action when an infant becomes apneic? a.Shake vigorously. b.Roll head side to side. c.Gently stimulate trunk by patting or rubbing. d.Hold by feet upside down with head supported.

ANS: C If the infant is apneic, the infant's trunk should be gently stimulated by patting or rubbing. If the infant is prone, turn onto the back. Vigorous shaking, rolling of the head, and hanging the child upside down can cause injury and should not be done.

According to Piaget, the 6-month-old infant would be in what stage of the sensorimotor phase? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata

ANS: C Infants are usually in the secondary circular reaction stage from age 4 months to 8 months. This stage is characterized by a continuation of the primary circular reaction for the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking. The use of reflexes is primarily during the first month of life. Primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from age 1 month to 4 months. The fourth sensorimotor stage is coordination of secondary schemata. This is a transitional stage in which increasing motor skills enable greater exploration of the environment.

By what age should the nurse expect that an infant will be able to pull to a standing position? a. 6 months b. 8 months c. 11 to 12 months d. 14 to 15 months

ANS: C Most infants can pull themselves to a standing position at age 9 months. Infants who are not able to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip. At 6 months the infant has just obtained coordination of arms and legs. By age 8 months infants can bear full weight on their legs.

A 4-month-old child is discharged home after surgery for the repair of a cleft lip. Instructions to the parents include: a. provide crib toys for distraction. b. breast- or bottle-feeding can begin immediately. c. give pain medication to infant to minimize crying. d. leave infant in crib at all times to prevent suture strain.

ANS: C Pain medication and comfort measures are used to minimize infant crying. Interventions are implemented to minimize stress on the suture line. Although crib toys are important, the child should not be left in the crib for prolonged periods. Feeding begins with alternative feeding devices. Sucking puts stress on the suture line in the immediate postoperative period. The infant should not be left in the crib, but should be removed for appropriate holding and stimulation.

An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires the following isolation: a. reverse isolation. b. airborne isolation. c. Contact Precautions. d. Standard Precautions.

ANS: C RSV is transmitted through droplets. In addition to Standard Precautions and hand washing, Contact Precautions are required. Caregivers must use gloves and gowns when entering the room. Care is taken not to touch their own eyes or mucous membranes with a contaminated gloved hand. Children are placed in a private room or in a room with other children with RSV infections. Reverse isolation focuses on keeping bacteria away from the infant. With RSV, other children need to be protected from exposure to the virus. The virus is not airborne.

Latasha is a breastfed infant being seen in the clinic for her 6-month checkup. Her mother tells the nurse that she recently began to suck her thumb. The best nursing intervention is to: a. Recommend that the mother substitute a pacifier for her thumb. b. Assess Latasha for other signs of sensory deprivation. c. Reassure the mother that this is very normal at this age. d. Suggest that the mother breastfeed Latasha more often to satisfy sucking needs.

ANS: C Sucking is an infant's chief pleasure, and she may not be satisfied by bottle-feeding or breastfeeding alone. During infancy and early childhood there is no need to restrict nonnutritive sucking. Dental damage does not appear to occur unless the use of the pacifier or finger persists after age 4 to 6 years. The nurse should explore with the mother her feelings about pacifier vs. thumb. This is a normal behavior to meet nonnutritive sucking needs. No data support that Latasha has sensory deprivation.

Caring for the newborn with a cleft lip and palate before surgical repair includes which of the following? a. Gastrostomy feedings b. Allowing little or no sucking c. Providing satisfaction of sucking needs d. Keeping infant in near-horizontal position during feedings

ANS: C Using special or modified nipples for feeding techniques helps to meet the infant's sucking needs. Gastrostomy feedings are usually not indicated. The child requires both nutritive and nonnutritive sucking. Feeding is best accomplished with the infant's head in an upright position.

The nurse is testing an infant's visual acuity. By what age should the infant be able to fix on and follow a target? a. 1 month b. 1 to 2 months c. 3 to 4 months d. 6 months

ANS: C Visual fixation and ability to follow a target should be present by ages 3 to 4 months. One to 2 months is too young for this developmental milestone. If the infant is not able to fix and follow by 6 months, further ophthalmologic evaluation is needed.

The association of cleft palate with otitis media is primarily the result of which of the following? a. Coexisting defects of middle ear and eustachian tube b. Lowered resistance because of poor nutritional status c. Plugging of the eustachian tube with food particles d. Inefficient function of eustachian tubes and improper middle ear drainage

ANS: D Improper drainage of the middle ear, as a result of inefficient function of the eustachian tube, contributes to recurrent otitis media with scarring of the tympanic membrane, which leads to hearing impairment. Coexisting defects of middle ear and eustachian tube, lowered resistance because of poor nutritional status, and plugging of the eustachian tube with food particles are not associated with recurrent otitis media.

Austin, age 6 months, has six teeth. The nurse should recognize that this is: a. Normal tooth eruption. b. Delayed tooth eruption. c. Unusual and dangerous. d. Earlier-than-normal tooth eruption.

ANS: D This is earlier than expected. Most infants at age 6 months have two teeth. The average number of teeth in 6-month-old infants is two. Six teeth at 6 months is not delayed; it is early tooth eruption. Although unusual, it is not dangerous.

A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of which of the following? a. Bronchitis b. Bronchiolitis c. Viral-induced asthma d. Acute spasmodic laryngitis

a. Bronchitis Rationale: Bronchitis is characterized by these symptoms and occurs in children older than 6 years.

In providing nourishment for a child with CF, which of the following factors should the nurse keep in mind? a. Diet should be high in carbohydrates and protein. b. Diet should be high in easily digested carbohydrates and fats. c. Most fruits and vegetables are not well tolerated. d. Fats and proteins must be greatly curtailed.

a. Diet should be high in carbohydrates and protein. Rationale: Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption.

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

a. If it is present in a child, both parents are carriers of this defective gene. Rationale: CF is an autosomal recessive gene inherited from both parents.

The parents of a 4-month-old infant tell the nurse that they are getting a microwave oven and will be able to heat the baby's formula faster. What should the nurse recommend? a. Never heat a bottle in a microwave oven. b. Heat only 10 ounces or more. c. Always leave bottle top uncovered to allow heat to escape. d. Shake bottle vigorously for at least 30 seconds after heating.

a. Never heat a bottle in a microwave oven.

Which of the following statements is the most descriptive of bronchial asthma? a. There is heightened airway reactivity. b. There is decreased resistance in the airway. c. The single cause of asthma is an allergic hypersensitivity. d. It is inherited.

a. There is heightened airway reactivity. Rationale: In bronchial asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function.

Why are cool-mist vaporizers rather than steam vaporizers recommended in home treatment of respiratory tract infections? a. They are safer. b. They are less expensive. c. Respiratory secretions are dried. d. A more comfortable environment is produced.

a. They are safer. Rationale: Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam.

A nurse is assessing a child with kwashiorkor disease. Which assessment findings should the nurse expect? a. Thin wasted extremities with a prominent abdomen b. Constipation c. Elevated hemoglobin d. High levels of protein

a. Thin wasted extremities with a prominent abdomen

A child with CF receives aerosolized bronchodilator medication. This medication should be administered: a. before chest physiotherapy (CPT). b. after CPT. c. before receiving 100% oxygen. d. after receiving 100% oxygen.

a. before chest physiotherapy (CPT). Rationale: Bronchodilators should be given before CPT to open bronchi and make expectoration easier.

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child should begin with: a. intravenous (IV) fluids. b. ORS. c. clear liquids, 1 to 2 ounces at a time. d. administration of antidiarrheal medication.

a. intravenous (IV) fluids.

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include which of the following? a. Force fluids. b. Monitor pulse oximetry. c. Institute seizure precautions. d. Encourage high-protein diet.

b. Monitor pulse oximet Rationale: Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS.

The nurse encourages the mother of a toddler with acute LTB to stay at the bedside as much as possible. The nurse's rationale for this action is primarily which of the following? a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease child's respiratory efforts. c. Separation from mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's respiratory efforts.

b. The mother's presence will reduce anxiety and ease child's respiratory efforts. Rationale: The family's presence will decrease the child's distress.

A child with CF is receiving recombinant human deoxyribonuclease (rhDNase). This drug: a. may cause mucus to thicken. b. may cause voice alterations. c. is given subcutaneously. d. is not indicated for children younger than 12 years.

b. may cause voice alterations. Rationale: One of the only adverse effects of DNase is voice alterations and laryngitis.

It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because which of the following may develop? a. Cough b. Osteoporosis c. Slowed growth d. Cushing syndrome

c. Slowed growth Rationale: The growth of children on long-term inhaled steroids should be assessed frequently to assess for systemic effects of these drugs.

Which of the following statements is characteristic of AOM? a. The etiology is unknown. b. Permanent hearing loss often results. c. It can be treated by intramuscular (IM) antibiotics. d. It is treated with a broad range of antibiotics.

d. It is treated with a broad range of antibiotics Rationale: Historically AOM has been treated with a range of antibiotics. However, new research shows that antibiotics do not improve outcomes in children with uncomplicated AOM.

A parent asks the nurse whether her infant is susceptible to pertussis. The nurse's response should be based on which statement concerning susceptibility to pertussis? a. Neonates will be immune the first few months. b. If the mother has had the disease, the infant will receive passive immunity. c. Children younger than 1 year seldom contract this disease. d. Most children are highly susceptible from birth.

d. Most children are highly susceptible from birth.

CF is suspected in a toddler. Which of the following tests is essential in establishing this diagnosis? a. Bronchoscopy b. Serum calcium c. Urine creatinine d. Sweat chloride test

d. Sweat chloride test Rationale: A sweat chloride test result greater than 60 mEq/L is diagnostic of CF.