Peds: Final Exam NCLEX Questions (Renal/Neuro/GI/Heme/Onc)

The nurse is performing an assessment on a 10-year-old child suspected to have Hodgkin's disease. Which assessment findings are specifically characteristic of this disease? Select all that apply. 1. Abdominal pain 2. Fever and malaise 3. Anorexia and weight loss 4. Painful, enlarged inguinal lymph nodes 5. Painless, firm, and movable adenopathy in the cervical area

1. Abdominal pain 5. Painless, firm, and movable adenopathy in the cervical area Hodgkin's disease (a type of lymphoma) is a malignancy of the lymph nodes. Specific clinical manifestations associated with Hodgkin's disease include painless, firm, and movable adenopathy in the cervical and supraclavicular areas and abdominal pain as a result of enlarged retroperitoneal nodes. Hepatosplenomegaly also is noted. Although fever, malaise, anorexia, and weight loss are associated with Hodgkin's disease, these manifestations are seen in many disorders.

When caring for a child with submersion injury, the nurse should do which of the following? (Select all that apply.) 1. Administer oxygen as ordered. 2. Administer furosemide as ordered. 3. Maintain mechanical ventilation. 4. Monitor child for increased intracranial pressure. 5. Monitor electrolyte status.

1. Administer oxygen as ordered. 2. Administer furosemide as ordered. 3. Maintain mechanical ventilation. 4. Monitor child for increased intracranial pressure. 5. Monitor electrolyte status. Children with submersion injury will require nursing care specific to their symptomatology.

Which of the following should be avoided if the child has hypospadias? 1. Circumcision 2. Catheterization 3. Surgery 4. Intravenous pyelography (IVP)

1. Circumcision Hypospadias refers to a condition in which the urethral opening is located below the glans penis or anywhere along the ventral surface (underside) of the penile shaft. The ventral foreskin is lacking, and the distal portion gives an appearance of a hood. Early recognition is important so that circumcision is avoided; the foreskin is used for the surgical repair. Catheterization may be used to ensure urinary elimination. Surgery is the procedure of choice to improve the child's ability to stand when urinating, improve the appearance of the penis, and preserve sexual adequacy. IVP is contraindicated if the child has an allergy to iodine or shellfish.

Which of the following is the most useful tool in diagnosing seizure disorder? 1. EEG 2. Lumbar puncture 3. Brain scan 4. Skull radiographs

1. EEG The EEG detects abnormal electrical activity in the brain. The pattern of various spikes can aid in the diagnosis of specific seizure disorders. Lumbar puncture confirms problems related to cerebrospinal fluid infection or trauma. Brain scans confirm space-occupying lesions. Skull radiographs can detect fractures and structural abnormalities.

When caring for a child awaiting surgery for a Wilms' tumor, which of the following nursing actions would be most important? 1. Handling the child with care, particularly during bathing 2. Placing the child on low blood count precautions and isolation 3. Monitoring bowel sounds for vincristine-induced ileus 4. Placing the child in high Fowler's position to facilitate breathing

1. Handling the child with care, particularly during bathing Handling the child carefully is essential to prevent rupture of an encapsulated tumor. The child usually does not undergo myelosuppression before surgery. In fact, the child may be suffering from polycythemia due to increased production of erythropoietin. Vincristine usually is administered postoperatively. Respiratory difficulty is not a common problem with Wilms' tumor.

A neonate's failure to pass meconium within the first 24 hours after birth may indicate which of the following? 1. Hirschsprung's disease 2. Celiac disease 3. Intussusception 4. Abdominal wall defect

1. Hirschsprung's disease Failure to pass meconium within the first 24 hours after birth may be an indication of Hirschsprung's disease, a congenital anomaly resulting in mechanical obstruction due to inadequate motility in an intestinal segment. Failure to pass meconium is not associated with celiac disease, intussusception, or abdominal wall defect.

The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 mm3 (19.5 × 109/L). On the basis of this laboratory result, which intervention should the nurse include in the plan of care? 1. Initiate bleeding precautions. 2. Monitor closely for signs of infection. 3. Monitor the temperature every 4 hours. 4. Initiate protective isolation precautions.

1. Initiate bleeding precautions. Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). If a child is severely thrombocytopenic and has a platelet count less than 20,000 mm3 (20.0 × 109/L), bleeding precautions need to be initiated because of the increased risk of bleeding or hemorrhage. Precautions include limiting activity that could result in head injury, using soft toothbrushes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. In addition, suppositories, enemas, and rectal temperatures are avoided. Options 2, 3, and 4 are related to the prevention of infection rather than bleeding.

The nurse notes documentation that a child is exhibiting an inability to flex the leg when the thigh is flexed anteriorly at the hip. Which condition does the nurse suspect? 1. Meningitis 2. Spinal cord injury 3. Intracranial bleeding 4. Decreased cerebral blood flow

1. Meningitis Meningitis is an infectious process of the central nervous system caused by bacteria and viruses. The inability to extend the leg when the thigh is flexed anteriorly at the hip is a positive Kernig's sign, noted in meningitis. Kernig's sign is not seen specifically with spinal cord injury, intracranial bleeding, or decreased cerebral blood flow.

What should the nurse do first after noting that a child with Hirschsprung's disease has a fever and watery explosive diarrhea? 1. Notify the health care provider immediately. 2. Administer an antidiarrheal. 3. Monitor the child every 30 minutes. 4. Nothing. (This is characteristic of Hirschsprung's disease.)

1. Notify the health care provider immediately. For the child with Hirschsprung's disease, fever and explosive diarrhea indicate enterocolitis, a life-threatening situation. Therefore, the health care provider should be notified immediately. Generally, because of the intestinal obstruction and inadequate propulsive intestinal movement, antidiarrheals are not used to treat Hirschsprung's disease. The child is acutely ill and requires intervention, with monitoring more frequently than every 30 minutes. Hirschsprung's disease typically presents with chronic constipation.

The nurse is performing an assessment on a child admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which assessment findings should the nurse expect to observe? Select all that apply. 1. Pallor 2. Edema 3. Anorexia 4. Proteinuria 5. Weight loss 6. Decreased serum lipids

1. Pallor 2. Edema 3. Anorexia 4. Proteinuria Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, elevated serum lipids, anorexia, and pallor. The child gains weight.

The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid which during the physical assessment? 1. Palpating the abdomen for a mass 2. Assessing the urine for the presence of hematuria 3. Monitoring the temperature for the presence of fever 4. Monitoring the blood pressure for the presence of hypertension

1. Palpating the abdomen for a mass Wilms' tumor is the most common intra-abdominal and kidney tumor of childhood. If Wilms' tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause seeding of the tumor and spread of the cancerous cells. Hematuria, fever, and hypertension are clinical manifestations associated with Wilms' tumor.

When planning a client education program for sickle cell disease, the nurse should include which of the following topics? 1. Proper hand washing and infection avoidance 2. A high-iron, high-protein diet 3. Fluid restriction to 1 qt (1 l)/day 4. Aerobic exercises to increase oxygenation

1. Proper hand washing and infection avoidance Prevention of infection is an important measure in the prevention of sickle cell crisis. A high-iron, high-protein diet would have no effect on the disease or prevention of a crisis. Proper hydration should be encouraged to prevent crisis secondary to dehydration. Strenuous exercise and activity should be avoided to reduce the risk of increased tissue ischemia.

The nurse is reviewing a health care provider's prescriptions for a child with sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescriptions documented in the child's record should the nurse question? Select all that apply. 1. Restrict fluid intake. 2. Position for comfort. 3. Avoid strain on painful joints. 4. Apply nasal oxygen at 2 L/minute. 5. Provide a high-calorie, high-protein diet. 6. Give meperidine, 25 mg intravenously, every 4 hours for pain.

1. Restrict fluid intake. 6. Give meperidine, 25 mg intravenously, every 4 hours for pain. Sickle cell anemia is one of a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the red blood cell; insufficient oxygen causes the cells to assume a sickle shape, and the cells become rigid and clumped together, obstructing capillary blood flow. Oral and intravenous fluids are an important part of treatment. Meperidine is not recommended for a child with sickle cell disease because of the risk for normeperidine-induced seizures. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. The nurse would question the prescription for restricted fluids and meperidine for pain control. Positioning for comfort, avoiding strain on painful joints, oxygen, and a high-calorie and high-protein diet are also important parts of the treatment plan.

The nurse is planning care for a child with hemolytic-uremic syndrome who has been anuric and will be receiving peritoneal dialysis treatment. The nurse should plan to implement which measure? 1. Restrict fluids as prescribed. 2. Care for the arteriovenous fistula. 3. Encourage foods high in potassium. 4. Administer analgesics as prescribed.

1. Restrict fluids as prescribed. Hemolytic-uremic syndrome is thought to be associated with bacterial toxins, chemicals, and viruses that result in acute kidney injury in children. Clinical manifestations of the disease include acquired hemolytic anemia, thrombocytopenia, renal injury, and central nervous system symptoms. A child with hemolytic-uremic syndrome undergoing peritoneal dialysis because of anuria would be on fluid restriction. Pain is not associated with hemolytic-uremic syndrome, and potassium would be restricted, not encouraged, if the child is anuric. Peritoneal dialysis does not require an arteriovenous fistula (only hemodialysis).

While assessing a neonate with cleft lip (CL), the nurse would be alert that which of the following will most likely be compromised? 1. Sucking ability 2. Respiratory status 3. Locomotion 4. GI function

1. Sucking ability Because of the defect, the child will be unable to form the mouth adequately around the nipple, thereby requiring special devices to allow for feeding and sucking gratification. Respiratory status may be compromised if the child is fed improperly or during postoperative period. Locomotion would be a problem for the older infant because of the use of restraints. GI functioning is not compromised in the child with a CL.

The nurse is creating a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? Select all that apply. 1. Time the seizure. 2. Restrain the child. 3. Stay with the child. 4. Place the child in a prone position. 5. Move furniture away from the child. 6. Insert a padded tongue blade in the child's mouth.

1. Time the seizure. 3. Stay with the child. 5. Move furniture away from the child. A seizure is a disorder that occurs as a result of excessive and unorganized neuronal discharges in the brain that activate associated motor and sensory organs. During a seizure, the child is placed on his or her side in a lateral position. Positioning on the side prevents aspiration because saliva drains out the corner of the child's mouth. The child is not restrained because this could cause injury to the child. The nurse would loosen clothing around the child's neck and ensure a patent airway. Nothing is placed into the child's mouth during a seizure because this action may cause injury to the child's mouth, gums, or teeth. The nurse would stay with the child to reduce the risk of injury and allow for observation and timing of the seizure.

The development of Reye's syndrome has been associated with the use of aspirin and which of the following? 1. Varicella 2. Meningitis 3. Encephalitis 4. Strep throat

1. Varicella Reye's syndrome has been associated with the ingestion of aspirin in children with viral infections such as varicella. There is no association between meningitis or bacterial infections such as strep throat and the development of Reye's syndrome. Encephalitis is a component of Reye's syndrome.

The nurse is monitoring a 3-year-old child for signs and symptoms of increased intracranial pressure (ICP) after a craniotomy. The nurse plans to monitor for which early sign or symptom of increased ICP? 1. Vomiting 2. Bulging anterior fontanel 3. Increasing head circumference 4. Complaints of a frontal headache

1. Vomiting The brain, although well protected by the solid bony cranium, is highly susceptible to pressure that may accumulate within the enclosure. Volume and pressure must remain constant within the brain. A change in the size of the brain, such as occurs with edema or increased volume of intracranial blood or cerebrospinal fluid without a compensatory change, leads to an increase in ICP, which may be life-threatening. Vomiting, an early sign of increased ICP, can become excessive as pressure builds up and stimulates the medulla in the brainstem, which houses the vomiting center. Children with open fontanels (posterior fontanel closes at 2 to 3 months; anterior fontanel closes at 12 to 18 months) compensate for ICP changes by skull expansion and subsequent bulging fontanels. When the fontanels have closed, nausea, excessive vomiting, diplopia, and headaches become pronounced, with headaches becoming more prevalent in older children.

Which of the following parameters would the nurse monitor to evaluate the effectiveness of thickened feedings for an infant with gastroesophageal reflux (GER)? 1. Vomiting 2. Stools 3. Urine 4. Weight

1. Vomiting Thickened feedings are used with GER to stop the vomiting. Therefore, the nurse would monitor the child's vomiting to evaluate the effectiveness of using the thickened feedings. No relationship exists between feedings and characteristics of stools and urine. If feedings are ineffective, this should be noted before there is any change in the child's weight.

The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement by the child's parent should the nurse expect that is associated with this diagnosis? 1. "I'm so glad they didn't find any protein in his urine." 2. "I noticed his urine was the color of coca-cola lately." 3. "His health care provider said his kidneys are working well." 4. "The nurse who admitted my child said his blood pressure was low."

2. "I noticed his urine was the color of coca-cola lately." Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored or brown-colored urine, is a classic symptom of glomerulonephritis. Blood urea nitrogen levels and serum creatinine levels may be elevated, indicating that kidney function is compromised. A mild to moderate elevation in protein in the urine is associated with glomerulonephritis. Hypertension is also common due to fluid volume overload secondary to the kidneys not working properly.

The nurse provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information? 1. "The femur is the most common site of this sarcoma." 2. "The child does not experience pain at the primary tumor site." 3. "Limping, if a weight-bearing limb is affected, is a clinical manifestation." 4. "The symptoms of the disease in the early stage are almost always attributed to normal growing pains."

2. "The child does not experience pain at the primary tumor site." Osteosarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur. Osteosarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site. By the time these children receive medical attention, they may be in considerable pain from the tumor. Options 1, 3, and 4 are accurate regarding osteosarcoma.

Which of the following would be the lowest priority when caring for a child with a seizure disorder? 1. Teaching the family about anticonvulsant therapy 2. Assessing for signs and symptoms of increased intracranial pressure (ICP) 3. Ensuring safety and protection from injury 4. Observing and recording all seizures

2. Assessing for signs and symptoms of increased intracranial pressure (ICP) Signs and symptoms of increased ICP are not associated with seizure activity and therefore would be the lowest priority. Improper administration of and incomplete compliance with anticonvulsant therapy can lead to status epilepticus; thus, education is a priority. Safety is always a priority in the care of a child with a seizure disorder because seizures may occur at any given time. Careful observation and documentation of seizures provide valuable information to aid prevention and treatment.

The nurse would prepare the parents of a child with suspected leukemia for which of the following tests that would confirm this diagnosis? 1. Lumbar puncture 2. Bone marrow aspiration 3. Complete blood count (CBC) with differential 4. Blood culture

2. Bone marrow aspiration A bone marrow aspiration is performed to confirm the diagnosis of leukemia through the examination of abnormal cells in the bone marrow. A lumbar puncture is performed to detect spread into the central nervous system, but it is not used to confirm the diagnosis. An abnormal CBC may suggest leukemia, but it is not used to confirm the diagnosis. A blood culture may be performed if infection is suspected.

A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed because acute lymphocytic leukemia is suspected. The nurse determines that which laboratory result confirms the diagnosis? 1. Lumbar puncture showing no blast cells 2. Bone marrow biopsy showing blast cells 3. Platelet count of 350,000 mm3 (350 × 109/L) 4. White blood cell count 4500 mm3 (4.5 × 109/L)

2. Bone marrow biopsy showing blast cells Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The confirmatory test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspirate and biopsy, which is considered positive if blast cells are present. An altered platelet count occurs as a result of the disease, but also may occur as a result of chemotherapy and does not confirm the diagnosis. The white blood cell count may be normal, high, or low in leukemia. A lumbar puncture may be done to look for blast cells in the spinal fluid that indicate central nervous system disease.

The nurse is caring for an infant with a diagnosis of bladder exstrophy. To protect the exposed bladder tissue, the nurse should plan which intervention? 1. Cover the bladder with petroleum jelly gauze. 2. Cover the bladder with a nonadhering plastic wrap. 3. Apply sterile distilled water dressings over the bladder mucosa. 4. Keep the bladder tissue dry by covering it with dry sterile gauze.

2. Cover the bladder with a nonadhering plastic wrap. In bladder exstrophy, the bladder is exposed and external to the body. In this disorder, one must take care to protect the exposed bladder tissue from drying, while allowing the drainage of urine. This is accomplished best by covering the bladder with a nonadhering plastic wrap. The use of petroleum jelly gauze should be avoided because this type of dressing can dry out, adhere to the mucosa, and damage the delicate tissue when removed. Dry sterile dressings and dressings soaked in solutions (that can dry out) also damage the mucosa when removed.

The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome? 1. Hypertension 2. Generalized edema 3. Increased urinary output 4. Frank, bright red blood in the urine

2. Generalized edema Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipemia, and edema. Other manifestations include weight gain; periorbital and facial edema that is most prominent in the morning; leg, ankle, labial, or scrotal edema; decreased urine output and urine that is dark and frothy; abdominal swelling; and blood pressure that is normal or slightly decreased.

Which of the following interventions would be included in the care plan of a child with sickle cell disease? 1. Administration of an anticoagulant to prevent sickling 2. Health teaching to help reduce sickling crises 3. Observation of imposed fluid restrictions 4. Avoidance of the use of opioids

2. Health teaching to help reduce sickling crises Because there is no cure for sickle cell disease, prevention is one of the main goals of therapeutic management. Thus, health teaching to help reduce sickling crises is key. Anticoagulants do not prevent sickling. Fluids are encouraged to increase the fluid volume and prevent sickling. Opioids usually are needed for pain control.

When providing immediate postoperative care for the child with a cleft palate (CP), the nurse should position the child in which of the following positions? 1. In the supine position 2. In the prone position 3. In an infant seat 4. On his side

2. In the prone position Postoperatively, children with a CP should be placed on their abdomens to facilitate drainage. If the child is placed in the supine position, aspiration is a concern. Using an infant seat does not facilitate drainage. Sidelying does not facilitate drainage as well as the prone position.

Which of the following would not be a focus of a teaching plan for an adolescent with a seizure disorder? 1. Ability to obtain a driver's license 2. Increased risk of infections 3. Drug and alcohol use 4. Peer pressure

2. Increased risk of infections Adolescents with seizure disorders are at no greater risk for infections than other adolescents. The ability to obtain a driver's license may be influenced by the adolescent's seizure history. Drug and alcohol use may interfere with or cause adverse reactions from anticonvulsants. Peer pressure may put the child at risk for increased risk-taking behaviors that may exacerbate seizure activity.

Secondary vesicoureteral reflux usually results from which of the following? 1. Congenital defects 2. Infection 3. Acidic urine 4. Hydronephrosis

2. Infection Infection is the most common cause of secondary vesicoureteral reflux. Congenital defects cause primary vesicoureteral reflux. Acidic urine is normal and helps to prevent infection. Hydronephrosis may result from vesicoureteral reflux.

A 4-year-old child with leukemia is admitted to the health care facility because of pneumonia. Which of the following is the most likely cause of his current condition? 1. Anemia 2. Leukopenia 3. Thrombocytopenia 4. Eosinophilia

2. Leukopenia Leukopenia, the decrease in functioning white blood cells in leukemia, causes the increased risk of infection in children with leukemia. Anemia would result in fatigue. Thrombocytopenia, decreased platelet count, would result in bleeding. An increased eosinophil count is not related to leukemia.

Which of the following is considered the most common assessment finding associated with a brain tumor in a child? 1. Projectile vomiting 2. Increased intracranial pressure (ICP) 3. Headache 4. Diminished reflexes

3. Headache In children with a brain tumor, the most common symptom is a headache. It is typically described as intermittent and most common after the child wakes up. It may also be described as occurring with sneezing, coughing, and straining during a bowel movement. Vomiting, which usually is projectile and occurs in the morning, is not as common, but it may be present. The tumor as it increases in size obstructs the circulation of cerebrospinal fluid, resulting in increased ICP. Decreased reflexes are commonly reported in cerebellar tumors.

When developing a teaching plan to prevent urinary tract infection, which of the following should be included? (Select all that apply.) 1. Wearing underwear made of synthetic material such as nylon 2. Maintaining adequate fluid intake 3. Keeping urine alkaline by avoiding acidic beverages 4. Avoiding urination before and after intercourse 5. Avoiding bubble baths and tight clothing 6. Emptying bladder with each urination

2. Maintaining adequate fluid intake 5. Avoiding bubble baths and tight clothing 6. Emptying bladder with each urination Fluid intake helps dilute urine and minimize infection potential, bubble baths and tight clothing may act as irritants, and emptying the bladder fully with each urination prevents stasis. Children and teens should wear cotton underwear, keep their urine acidic, and void before and after intercourse (if sexually active).

A 4-year-old boy is about to be discharged after undergoing surgery and follow-up treatment for a Wilms' tumor. Which of the following points would be a vital part of the teaching program for the child's parents? 1. Allowing him to resume activity, including contact sports 2. Monitoring for signs and symptoms of urinary tract infection 3. Making arrangements for a return visit in 6 months 4. Arranging for hospice care, because Wilms' tumor is fatal

2. Monitoring for signs and symptoms of urinary tract infection Urinary tract infections pose a threat to the remaining kidney. Therefore, the parents should be instructed to monitor the child for signs and symptoms of infection. Rough play and contact sports should be discouraged because of the residual effect of radiation to the abdomen and because the child needs to protect his lone kidney. Follow-up at 6 months is too late; children receive chemotherapy for 6 to 15 months after surgery. Wilms' tumor is the most curable solid tumor of childhood; prognosis is usually favorable.

The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which intervention should the nurse perform immediately? 1. Reinforce the dressing. 2. Notify the health care provider (HCP). 3. Document the findings and continue to monitor. 4. Circle the area of drainage and continue to monitor.

2. Notify the health care provider (HCP). Colorless drainage on the dressing in a child after craniotomy indicates the presence of cerebrospinal fluid and should be reported to the HCP immediately. Options 1, 3, and 4 are not the immediate nursing intervention because they do not address the need for immediate intervention to prevent complications.

A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse notes that the child is restless, the pulse rate is elevated, and the blood pressure has decreased significantly from the baseline value. The nurse suspects that the child is in shock. Which is the most appropriate nursing action? 1. Place the child in a supine position. 2. Notify the health care provider (HCP). 3. Place the child in Trendelenburg position. 4. Increase the flow rate of the intravenous fluids.

2. Notify the health care provider (HCP). In the event of shock, the HCP is notified immediately before the nurse changes the child's position or increases intravenous fluids. After craniotomy, a child is never placed in the supine or Trendelenburg position because it increases intracranial pressure (ICP) and the risk of bleeding. The head of the bed should be elevated. Increasing intravenous fluids can cause an increase in ICP.

The nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On assessment, which data would the nurse expect to obtain when asking the parent about the child's symptoms? 1. Watery diarrhea 2. Projectile vomiting 3. Increased urine output 4. Vomiting large amounts of bile

2. Projectile vomiting In pyloric stenosis, hypertrophy of the circular muscles of the pylorus causes narrowing of the pyloric canal between the stomach and the duodenum. Clinical manifestations of pyloric stenosis include projectile vomiting, irritability, hunger and crying, constipation, and signs of dehydration, including a decrease in urine output.

Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply. 1. Maintain the child in a semiprivate room. 2. Reduce exposure to environmental organisms. 3. Use strict aseptic technique for all procedures. 4. Ensure that anyone entering the child's room wears a mask. 5. Apply firm pressure to a needle-stick area for at least 10 minutes.

2. Reduce exposure to environmental organisms. 3. Use strict aseptic technique for all procedures. 4. Ensure that anyone entering the child's room wears a mask. Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). A common complication of treatment for leukemia is overwhelming infection secondary to neutropenia. Measures to prevent infection include the use of a private room, strict aseptic technique, restriction of visitors and health care personnel with active infection, strict hand washing, ensuring that anyone entering the child's room wears a mask, and reducing exposure to environmental organisms by eliminating raw fruits and vegetables from the diet and fresh flowers from the child's room and by not leaving standing water in the child's room. Applying firm pressure to a needle-stick area for at least 10 minutes is a measure to prevent bleeding.

An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period? 1. Test the urine for protein. 2. Reposition the infant frequently. 3. Provide a stimulating environment. 4. Assess blood pressure every 15 minutes.

2. Reposition the infant frequently. Hydrocephalus occurs as a result of an imbalance of cerebrospinal fluid absorption or production that is caused by malformations, tumors, hemorrhage, infections, or trauma. It results in head enlargement and increased intracranial pressure (ICP). In infants with hydrocephalus, the head grows at an abnormal rate, and if the infant is not repositioned frequently, pressure ulcers can occur on the back and side of the head. An egg crate mattress under the head is also a nursing intervention that can help to prevent skin breakdown. Proteinuria is not specific to hydrocephalus. Stimulus should be kept at a minimum because of the increase in ICP. It is not necessary to check the blood pressure every 15 minutes.

A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden, and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother? 1. "I have a vase in the utility room, and I will get it for you." 2. "I will get the vase and wash it well before you put the flowers in it." 3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." 4. "When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible."

3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). For a hospitalized neutropenic child, flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas aeruginosa, to which the child is susceptible. In addition, fresh fruits and vegetables harbor molds and should be avoided until the white blood cell count increases.

The parents of a child recently diagnosed with cerebral palsy ask the nurse about the limitations of the disorder. The nurse responds by explaining that the limitations occur as a result of which pathophysiological process? 1. An infectious disease of the central nervous system 2. An inflammation of the brain as a result of a viral illness 3. A chronic disability characterized by impaired muscle movement and posture 4. A congenital condition that results in moderate to severe intellectual disabilities

3. A chronic disability characterized by impaired muscle movement and posture Cerebral palsy is a chronic disability characterized by impaired movement and posture resulting from an abnormality in the extrapyramidal or pyramidal motor system. Meningitis is an infectious process of the central nervous system. Encephalitis is an inflammation of the brain that occurs as a result of viral illness or central nervous system infection. Down syndrome is an example of a congenital condition that results in moderate to severe intellectual disabilities.

The nurse collects a urine specimen preoperatively from a child with epispadias who is scheduled for surgical repair. When analyzing the results of the urinalysis, which should the nurse most likely expect to note? 1. Hematuria 2. Proteinuria 3. Bacteriuria 4. Glucosuria

3. Bacteriuria Epispadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. The urethral opening is located anywhere on the dorsum of the penis. This anatomical characteristic facilitates entry of bacteria into the urine. Options 1, 2, and 4 are not characteristically noted in this condition.

The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record? 1. Incessant crying 2. Coughing at nighttime 3. Choking with feedings 4. Severe projectile vomiting

3. Choking with feedings In esophageal atresia and tracheoesophageal fistula, the esophagus terminates before it reaches the stomach, ending in a blind pouch, and a fistula is present that forms an unnatural connection with the trachea. Any child who exhibits the "3 Cs"—coughing and choking with feedings and unexplained cyanosis—should be suspected to have tracheoesophageal fistula. Options 1, 2, and 4 are not specifically associated with tracheoesophageal fistula.

A lumbar puncture is performed on a child suspected to have bacterial meningitis, and cerebrospinal fluid (CSF) is obtained for analysis. The nurse reviews the results of the CSF analysis and determines that which results would verify the diagnosis? 1. Clear CSF, decreased pressure, and elevated protein level 2. Clear CSF, elevated protein, and decreased glucose levels 3. Cloudy CSF, elevated protein, and decreased glucose levels 4. Cloudy CSF, decreased protein, and decreased glucose levels

3. Cloudy CSF, elevated protein, and decreased glucose levels Meningitis is an infectious process of the central nervous system caused by bacteria and viruses; it may be acquired as a primary disease or as a result of complications of neurosurgery, trauma, infection of the sinus or ears, or systemic infections. Meningitis is diagnosed by testing CSF obtained by lumbar puncture. In the case of bacterial meningitis, findings usually include an elevated pressure; turbid or cloudy CSF; and elevated leukocyte, elevated protein, and decreased glucose levels.

The nurse is caring for a newborn with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which is a clinical manifestation associated with this disorder? 1. Bile-stained fecal emesis 2. The passage of currant jelly-like stools 3. Failure to pass meconium stool in the first 24 hours after birth 4. Sausage-shaped mass palpated in the upper right abdominal quadrant

3. Failure to pass meconium stool in the first 24 hours after birth Imperforate anus is the incomplete development or absence of the anus in its normal position in the perineum. During the newborn assessment, this defect should be identified easily on sight. However, a rectal thermometer or tube may be necessary to determine patency if meconium is not passed in the first 24 hours after birth. Other assessment findings include absence or stenosis of the anal rectal canal, presence of an anal membrane, and an external fistula to the perineum. Options 1, 2, and 4 are findings noted in intussusception.

When assessing a child for possible intussusception, which of the following would be least likely to provide valuable information? 1. Stool inspection 2. Pain pattern 3. Family history 4. Abdominal palpation

3. Family history Because intussusception is not believed to have a familial tendency, obtaining a family history would provide the least amount of information. Stool inspection, pain pattern, and abdominal palpation would reveal possible indicators of intussusception. "Currant jelly" stools, containing blood and mucus, are an indication of intussusception. Acute, episodic abdominal pain is characteristic of intussusception. A sausage-shaped mass may be palpated in the right upper quadrant.

An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse should place the infant in which best position at this time? 1. Prone position 2. On the stomach 3. Left lateral position 4. Right lateral position

3. Left lateral position A cleft lip is a congenital anomaly that occurs as a result of failure of soft tissue or bony structure to fuse during embryonic development. After cleft lip repair, the nurse avoids positioning an infant on the side of the repair or in the prone position because these positions can cause rubbing of the surgical site on the mattress. The nurse positions the infant on the side lateral to the repair or on the back upright and positions the infant to prevent airway obstruction by secretions, blood, or the tongue. From the options provided, placing the infant on the left side immediately after surgery is best to prevent the risk of aspiration if the infant vomits.

Which of the following is the most common form of childhood cancer? 1. Lymphoma 2. Brain tumors 3. Leukemia 4. Osteosarcoma

3. Leukemia Leukemia is the most common type of cancer in children, followed by brain tumors, lymphoma, and kidney tumors. Brain tumors are the second most common childhood cancer, but they are the most common form of solid tumor cancer in childhood. Bone cancers account for 5%, with osteosarcoma being the most common type.

In children with sickle cell disease, tissue damage results from which of the following? 1. A general inflammatory response due to an autoimmune reaction from hypoxia 2. Air hunger and respiratory alkalosis due to deoxygenated red blood cells 3. Local tissue damage with ischemia and necrosis due to obstructed circulation 4. Hypersensitivity of the central nervous system (CNS) due to elevated serum bilirubin levels

3. Local tissue damage with ischemia and necrosis due to obstructed circulation Characteristic sickle cells tend to clump, which results in poor circulation to tissue, local tissue damage, and eventual ischemia and necrosis. In sickle cell anemia, damage is not due to an inflammatory response. Air hunger and respiratory alkalosis are not present. The CNS effects result from ischemia.

A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem? 1. Diarrhea 2. Metabolic acidosis 3. Metabolic alkalosis 4. Hyperactive bowel sounds

3. Metabolic alkalosis Vomiting causes the loss of hydrochloric acid and subsequent metabolic alkalosis. Metabolic acidosis would occur in a child experiencing diarrhea because of the loss of bicarbonate. Diarrhea might or might not accompany vomiting. Hyperactive bowel sounds are not associated with vomiting.

Which of the following signs and symptoms are characteristic of minimal-change nephrotic syndrome? 1. Gross hematuria, proteinuria, fever 2. Hypertension, edema, hematuria 3. Poor appetite, proteinuria, edema 4. Hypertension, edema, proteinuria

3. Poor appetite, proteinuria, edema Clinical manifestations of nephrotic syndrome include loss of appetite due to edema of intestinal mucosa, proteinuria, and edema. Gross hematuria is not associated with nephrotic syndrome. Fever would occur only if infection also existed. Hypertension alone or accompanied by hematuria is associated with glomerulonephritis.

When performing a procedure related to a genitourinary (GU) problem, the nurse would anticipate that which of the following age groups would find it especially stressful? 1. Infants 2. Toddlers 3. Preschoolers 4. School-age children

3. Preschoolers In general, preschoolers have more fears because of their fantasies, contributing to fears of the simplest procedures. Castration fears also are prominent at this age and may be heightened by procedures related to GU problems. Typically, GU procedures do not create greater stress in infants, toddlers, and school-age children.

When caring for a child with leukemia, which of the following goals should be considered primary? 1. Meeting developmental needs 2. Promoting adequate nutrition 3. Preventing infection 4. Promoting diversionary activities

3. Preventing infection The child is at high risk for infection due to immunosuppression from both the disease and the treatment, and infection is the leading cause of death in leukemia. Meeting developmental needs, promoting adequate nutrition, and promoting diversionary activities are important goals. However, they are not the primary goal in caring for a child with leukemia.

While assessing a child with pyloric stenosis, the nurse is likely to note which of the following? 1. Regurgitation 2. Steatorrhea 3. Projectile vomiting 4. "Currant jelly" stools

3. Projectile vomiting Projectile vomiting is a key sign of pyloric stenosis. Regurgitation is seen more commonly with gastroesophageal reflux. Steatorrhea occurs in malabsorption disorders such as celiac disease. "Currant jelly" stools are characteristic of intussusception.

The nurse is reviewing the record of a child with increased intracranial pressure and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse expects to note which characteristic of this type of posturing? 1. Flaccid paralysis of all extremities 2. Adduction of the arms at the shoulders 3. Rigid extension and pronation of the arms and legs 4. Abnormal flexion of the upper extremities and extension and adduction of the lower extremities

3. Rigid extension and pronation of the arms and legs Decerebrate (extension) posturing is characterized by the rigid extension and pronation of the arms and legs. Option 1 is incorrect. Options 2 and 4 describe decorticate (flexion) posturing.

Which of the following definitions most accurately describes meningocele? 1. Complete exposure of the spinal cord and meninges 2. Herniation of the spinal cord and meninges into a sac 3. Sac formation containing meninges and spinal fluid 4. Spinal cord tumor containing nerve roots

3. Sac formation containing meninges and spinal fluid Meningocele is a sac formation containing meninges and cerebrospinal fluid (CSF). Meningocele doesn't involve complete exposure of the spinal cord and meninges; this is a massive defect that's incompatible with life. Myelomeningocele is a herniation of the spinal cord, meninges, and CSF into a sac that protrudes through a defect in the vertebral arch. Tumor formation is not associated with this defect.

When teaching parents about the early signs and symptoms of lead toxicity, which of the following if stated by the parents would indicate the need for additional teaching? 1. Anorexia 2. Irritability 3. Seizures 4. Anemia

3. Seizures Seizures usually are associated with encephalopathy, a late sign of lead toxicity. Typically, lead levels have already exceeded 70 mg/dl. Anorexia, irritability, and anemia are early signs.

The nurse is reviewing a treatment plan with the parents of a newborn with hypospadias. Which statement by the parents indicates their understanding of the plan? 1. "Caution should be used when straddling the infant on a hip." 2. "Vital signs should be taken daily to check for bladder infection." 3. "Catheterization will be necessary when the infant does not void." 4. "Circumcision has been delayed to save tissue for surgical repair."

4. "Circumcision has been delayed to save tissue for surgical repair." Hypospadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. In hypospadias, the urethral orifice is located below the glans penis along the ventral surface. The infant should not be circumcised because the dorsal foreskin tissue will be used for surgical repair of the hypospadias. Options 1, 2, and 3 are unrelated to this disorder.

Which question should the nurse ask the parents of a child suspected of having glomerulonephritis? 1. "Did your child fall off a bike onto the handlebars?" 2. "Has the child had persistent nausea and vomiting?" 3. "Has the child been itching or had a rash anytime in the last week?" 4. "Has the child had a sore throat or a throat infection in the last few weeks?"

4. "Has the child had a sore throat or a throat infection in the last few weeks?" Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Group A β-hemolytic streptococcal infection is a cause of glomerulonephritis. Often, a child becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1 to 2 weeks. The assessment data in options 1, 2, and 3 are unrelated to a diagnosis of glomerulonephritis.

Which of the following would the nurse expect to assess as the most common presenting manifestation of Wilms' tumor? 1. Hematuria 2. Pain on voiding 3. Nausea and vomiting 4. Abdominal mass

4. Abdominal mass The most common sign of Wilms' tumor is a painless palpable mass, sometimes marked by an increase in abdominal girth. Gross hematuria is uncommon, although microscopic hematuria may be present. Pain on voiding is not associated with Wilms' tumor. Tumor encroachment should not cause abdominal obstruction and resulting nausea and vomiting.

Which of the following nursing interventions can help prevent or reduce nausea and vomiting during chemotherapy? 1. Providing a high-fiber diet before chemotherapy 2. Administering allopurinol 30 minutes before chemotherapy 3. Encouraging the child to increase his intake of fluid before and during therapy 4. Administering an antiemetic 30 minutes before chemotherapy

4. Administering an antiemetic 30 minutes before chemotherapy Antiemetics counteract nausea most effectively when given before administration of an agent that causes nausea. Antiemetics also work best when given on a continuous basis, rather than as needed. A high- fiber diet has no effect on reducing nausea and vomiting. Allopurinol, a xanthine oxidase inhibitor, is thought to prevent renal damage due to large releases of uric acid during chemotherapy; however, it has no antiemetic properties. High fluid intake during periods of nausea exaggerates the symptoms and may exacerbate vomiting.

Which of the following would the nurse identify as normal when assessing infantile reflexes in a 9-month-old? 1. Absent Moro reflex 2. Unilateral grasp 3. Persistent rooting 4. Bilateral parachute

4. Bilateral parachute The parachute reflex appears at about 9 months of age and is normal. All of the following are considered abnormal when evaluating infantile reflexes: reflexes that are absent when they should be present (Moro), reflexes that are unilateral (grasp), and reflexes that persist after they should have disappeared (rooting).

For a child with recurring nephrotic syndrome, which of the following areas of potential disturbances should be a prime consideration when planning ongoing nursing care? 1. Muscle coordination 2. Sexual maturation 3. Intellectual development 4. Body image

4. Body image Because of the edema associated with nephrotic syndrome, potential self-concept and body image disturbances related to changes in appearance and social isolation should be considered. Muscle coordination, sexual maturation, and intellectual function are not affected.

A mother arrives at the emergency department with her 5-year-old child and states that the child fell off a bunk bed. A head injury is suspected. The nurse checks the child's airway status and assesses the child for early and late signs of increased intracranial pressure (ICP). Which is a late sign of increased ICP? 1. Nausea 2. Irritability 3. Headache 4. Bradycardia

4. Bradycardia Head injury is the pathological result of any mechanical force to the skull, scalp, meninges, or brain. A head injury can cause bleeding in the brain and result in increased ICP. In a child, early signs include a slight change in level of consciousness, headache, nausea, vomiting, visual disturbances (diplopia), and seizures. Late signs of increased ICP include a significant decrease in level of consciousness, bradycardia, decreased motor and sensory responses, alterations in pupil size and reactivity, posturing, Cheyne-Stokes respirations, and coma.

The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which sign of this disorder documented? 1. Watery diarrhea 2. Ribbon-like stools 3. Profuse projectile vomiting 4. Bright red blood and mucus in the stools

4. Bright red blood and mucus in the stools Intussusception is a telescoping of 1 portion of the bowel into another. The condition results in an obstruction to the passage of intestinal contents. A child with intussusception typically has severe abdominal pain that is crampy and intermittent, causing the child to draw in the knees to the chest. Vomiting may be present, but is not projectile. Bright red blood and mucus are passed through the rectum and commonly are described as currant jelly-like stools. Watery diarrhea and ribbon-like stools are not manifestations of this disorder.

After teaching the parents about their child's unique psychological needs related to a seizure disorder and possible stressors, which of the following concerns voiced by them would indicate the need for additional teaching? 1. Poor self-image 2. Dependency 3. Feeling different from peers 4. Cognitive delays

4. Cognitive delays Children with seizure disorders do not necessarily have cognitive delays. Poor self-image, dependency, and feelings of being different from peers can put additional stress on a child trying to understand and manage chronic illness.

What is the most likely underlying pathophysiology of primary enuresis? 1. Urinary tract infection 2. Psychogenic stress 3. Vesicoureteral reflux 4. Delayed bladder maturation

4. Delayed bladder maturation The most likely cause of PE is delayed or incomplete maturation of the bladder. UTIs may cause either primary or secondary enuresis, but they are not the leading cause of PE. Psychogenic stress may cause either primary or secondary enuresis, but it is not the leading cause of PE. Vesicoureteral reflux may cause either primary or secondary enuresis, but it is not the leading cause of PE.

Early clinical manifestations of increased intracranial pressure (ICP) in older children include which of the following? 1. Macewen's sign 2. Setting sun sign 3. Papilledema 4. Diplopia

4. Diplopia Diplopia is an early sign of increased ICP in an older child. The Macewen's sign (cracked-pot sound) and the setting sun appearance of the eyes are noted in infants with increased ICP. Papilledema is a late sign of increased ICP.

Which of the following instructions would be included in a sexually active adolescent's preventive teaching plan about urinary tract infections? 1. Wiping back to front 2. Wearing nylon underwear 3. Avoiding urinating before intercourse 4. Drinking acidic juices

4. Drinking acidic juices Drinking acidic juices, such as cranberry juice, helps keep the urine at its desired acid pH and reduces the chance of infection. The client should wipe from front to back, wear cotton underwear, and void before and after intercourse.

Which of the following would the nurse expect when assessing a child with cystitis? 1. High fever 2. Flank pain 3. Costovertebral tenderness 4. Dysuria

4. Dysuria Dysuria is a symptom of a lower urinary tract infection (UTI) such as cystitis. High fever, flank pain, and costovertebral tenderness are signs and symptoms of pyelonephritis, an upper UTI.

Which of the following organisms is the most common cause of urinary tract infection (UTI) in children? 1. Staphylococcus 2. Klebsiella 3. Pseudomonas 4. Escherichia coli

4. Escherichia coli E. coli is the most common organism associated with the development of UTI. Although Staphylococcus, Klebsiella, and Pseudomonas species may cause UTIs, the incidence of UTIs related to each is less than that for E. coli.

The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the need for further instruction? 1. Stress 2. Trauma 3. Infection 4. Fluid overload

4. Fluid overload Sickle cell crises are acute exacerbations of the disease, which vary considerably in severity and frequency; these include vaso-occlusive crisis, splenic sequestration, hyperhemolytic crisis, and aplastic crisis. Sickle cell crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional stress. The mother of a child with sickle cell disease should encourage fluid intake of 1½ to 2 times the daily requirement to prevent dehydration.

The clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the mother to seek health care for the infant? 1. Diarrhea 2. Projectile vomiting 3. Regurgitation of feedings 4. Foul-smelling ribbon-like stools

4. Foul-smelling ribbon-like stools Rationale: Hirschsprung's disease is a congenital anomaly also known as congenital aganglionosis or aganglionic megacolon. It occurs as the result of an absence of ganglion cells in the rectum and other areas of the affected intestine. Chronic constipation beginning in the first month of life and resulting in pellet-like or ribbon-like stools that are foul-smelling is a clinical manifestation of this disorder. Delayed passage or absence of meconium stool in the neonatal period is also a sign. Bowel obstruction, especially in the neonatal period; abdominal pain and distention; and failure to thrive are also clinical manifestations. Options 1, 2, and 3 are not associated specifically with this disorder.

Which of the following would be an appropriate nursing diagnosis for a child who is receiving chemotherapy? 1. Ineffective breathing pattern 2. Constipation 3. Impaired skin integrity 4. Impaired oral mucous membrane

4. Impaired oral mucous membrane Chemotherapy destroys rapidly growing cells, including those in the GI tract, resulting in stomatitis, an inflammatory condition of the mouth. In general, chemotherapy should have no effect on the respiratory system. Because chemotherapy affects the GI tract, the child most likely would have diarrhea, not constipation. In general, chemotherapy should have no effect on skin integrity.

Which of the following nursing diagnoses would be inappropriate for the infant with gastroesophageal reflux (GER)? 1. Deficient fluid volume 2. Risk for aspiration 3. Imbalanced nutrition: Less than body requirements 4. Impaired oral mucous membrane

4. Impaired oral mucous membrane GER is the backflow of gastric contents into the esophagus resulting from relaxation or incompetence of the lower esophageal (cardiac) sphincter. No alteration in the oral mucous membranes occurs with this disorder. Fluid volume deficit, risk for aspiration, and imbalanced nutrition are appropriate nursing diagnoses.

When teaching parents about known antecedent infections in acute glomerulonephritis, which of the following should the nurse cover? 1. Herpes simplex 2. Scabies 3. Varicella 4. Impetigo

4. Impetigo Impetigo, a bacterial infection of the skin, may be caused by streptococci and may precede acute glomerulonephritis. Although most streptococcal infections do not cause acute glomerulonephritis, when they do, a latent period of 10 to 14 days occurs between the infection, usually of the skin (impetigo) or upper respiratory tract, and the onset of clinical manifestations. Herpes, scabies, and varicella are not associated with acute glomerulonephritis.

When caring for a child with increased intracranial pressure (ICP), which of the following if stated by the parents would indicate a need to reexplain the purpose for elevating the head of the bed at a 10- to 20-degree angle? 1. Maintain a neutral position. 2. Help alleviate headache. 3. Reduce intra-abdominal pressure. 4. Increase intrathoracic pressure.

4. Increase intrathoracic pressure. Head elevation decreases, not increases, intrathoracic pressure. Elevating the head of the bed in a child with increased ICP helps to maintain neutral position, alleviate headache, and reduce intra- abdominal pressure, which may contribute to increased ICP.

The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which precautionary intervention should be included in the plan of care? 1. Maintain enteric precautions. 2. Maintain neutropenic precautions. 3. No precautions are required as long as antibiotics have been started. 4. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics.

4. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics. Meningitis is an infectious process of the central nervous system caused by bacteria and viruses; it may be acquired as a primary disease or as a result of complications of neurosurgery, trauma, infection of the sinus or ears, or systemic infections. A major priority of nursing care for a child suspected to have meningitis is to administer the antibiotic as soon as it is prescribed. The child also is placed on respiratory isolation precautions for at least 24 hours while culture results are obtained and the antibiotic is having an effect. Enteric precautions and neutropenic precautions are not associated with the mode of transmission of meningitis. Enteric precautions are instituted when the mode of transmission is through the gastrointestinal tract. Neutropenic precautions are instituted when a child has a low neutrophil count.

A 7-year-old child is seen in a clinic, and the health care provider documents a diagnosis of primary nocturnal enuresis. The nurse should provide which information to the parents? 1. Primary nocturnal enuresis does not respond to treatment. 2. Primary nocturnal enuresis is caused by a psychiatric problem. 3. Primary nocturnal enuresis requires surgical intervention to improve the problem. 4. Primary nocturnal enuresis is usually outgrown without therapeutic intervention.

4. Primary nocturnal enuresis is usually outgrown without therapeutic intervention. Primary nocturnal enuresis occurs in a child who has never been dry at night for extended periods. The condition is common in children, and most children eventually outgrow bed-wetting without therapeutic intervention. The child is unable to sense a full bladder and does not awaken to void. The child may have delayed maturation of the central nervous system. The condition is not caused by a psychiatric problem.

Long-term complications of childhood cancer include which of the following? (Select all that apply.) 1. Strabismus 2. Chronic pancreatitis 3. Hypopituitarism 4. Pulmonary fibrosis 5. Gonad dysfunction 6. Second malignancies

4. Pulmonary fibrosis 5. Gonad dysfunction 6. Second malignancies Long-term effects of childhood cancer include pulmonary fibrosis, ovarian or testicular dysfunction, and second malignancies. Cataracts, chronic cirrhosis, and hypothyroidism are also possible.

The nurse creates a plan of care for a child at risk for tonic-clonic seizures. In the plan of care, the nurse identifies seizure precautions and documents that which item(s) need to be placed at the child's bedside? 1. Emergency cart 2. Tracheotomy set 3. Padded tongue blade 4. Suctioning equipment and oxygen

4. Suctioning equipment and oxygen A seizure results from the excessive and unorganized neuronal discharges in the brain that activate associated motor and sensory organs. A type of generalized seizure is a tonic-clonic seizure. This type of seizure causes rigidity of all body muscles, followed by intense jerking movements. Because increased oral secretions and apnea can occur during and after the seizure, oxygen and suctioning equipment are placed at the bedside. A tracheotomy is not performed during a seizure. No object, including a padded tongue blade, is placed into the child's mouth during a seizure. An emergency cart would not be left at the bedside, but would be available in the treatment room or nearby on the nursing unit.

A diagnosis of Hodgkin's disease is suspected in a 12-year-old child. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test result will confirm the diagnosis of Hodgkin's disease? 1. Elevated vanillylmandelic acid urinary levels 2. The presence of blast cells in the bone marrow 3. The presence of Epstein-Barr virus in the blood 4. The presence of Reed-Sternberg cells in the lymph nodes

4. The presence of Reed-Sternberg cells in the lymph nodes Hodgkin's disease (a type of lymphoma) is a malignancy of the lymph nodes. The presence of giant, multinucleated cells (Reed-Sternberg cells) is the classic characteristic of this disease. Elevated levels of vanillylmandelic acid in the urine may be found in children with neuroblastoma. The presence of blast cells in the bone marrow indicates leukemia. Epstein-Barr virus is associated with infectious mononucleosis.

The nurse provides feeding instructions to a parent of an infant diagnosed with gastroesophageal reflux disease. Which instruction should the nurse give to the parent to assist in reducing the episodes of emesis? 1. Provide less frequent, larger feedings. 2. Burp the infant less frequently during feedings. 3. Thin the feedings by adding water to the formula. 4. Thicken the feedings by adding rice cereal to the formula.

4. Thicken the feedings by adding rice cereal to the formula. Gastroesophageal reflux is backflow of gastric contents into the esophagus as a result of relaxation or incompetence of the lower esophageal or cardiac sphincter. Small, more frequent feedings with frequent burping often are prescribed in the treatment of gastroesophageal reflux. Feedings thickened with rice cereal may reduce episodes of emesis. If thickened formula is used, cross-cutting of the nipple may be required.

The primary reason for surgical repair of a myelomeningocele is which of the following? 1. To correct the neurologic defect 2. To prevent hydrocephalus 3. To prevent seizure disorders 4. To decrease the risk of infection

4. To decrease the risk of infection Surgical closure decreases the risk of infection stemming from damage to the fragile sac, which can lead to meningitis. The neurologic deficit cannot be corrected. However, some surgeons believe that early surgery reduces the risk of stretching spinal nerves and preventing further damage. Surgical repair does not help relieve hydrocephalus. In fact, some researchers believe that repair exaggerates the Arnold- Chiari malformation and decreases the absorptive surface for cerebrospinal fluid, leading to more rapid development of hydrocephalus. Surgical repair of the sac doesn't prevent seizure disorder, an impairment of the brain neuron tissue.

When assessing a child with encopresis, the interview is most likely to reveal a history of: 1. psychological disorder 2. sexual abuse 3. recurrent diarrhea 4. painful bowel movements

4. painful bowel movements In most cases of encopresis, children have a history of painful bowel movements or constipation. There is no good evidence to suggest that a psychological disorder, and most children with encopresis have not been sexually abused.