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3. The primary risk factor for the development of cerebral palsy is: A. Maternal chorioamnionitis B. Premature birth C. Birth asphyxia D. Intraventricular hemorrhage

5. The nurse caring for a 4-month-old infant with biliary atresia and significant urticaria can anticipate administering: A. Diphenhydramine B. Ursodiol (ursodeoxycholic acid) C. Loratidine D. Zantac

5. What is the 24-hour fluid requirement for a child weighing 32 kg? A. 1920 ml/day B. 1740 ml/day C. 1840 ml/day D. 1620 ml/day

3. You are working with a new graduate and explaining prevention of infection for a child with acute lymphoblastic leukemia. Which statement by this new nurse indicates understanding? A. "Prophylaxis against Pneumocystis pneumonia is routinely given to most children during treatment for cancer." B. "If blood is drawn, firm pressure should be applied to the area for a minimum of 10 minutes." C. "Having a roommate with a routine surgery would be acceptable for this child." D. "The child should be vaccinated completely to avoid childhood diseases."

1. A hallmark of cognitive development in the school-age child is in what Piaget describes as concrete operations. In this stage the child: A. Uses thought processes to experience events and actions B. Is unable to see things from another's point of view C. Has a limited perspective of how others' interpretations of a given event differ D. Makes judgments based on what he or she sees

1. When administering a medication to a child, the nurse knows that: A. The most accurate means for measuring small amounts of medication is the plastic disposable calibrated oral syringe. B. A teaspoon is often the unit of measurement for pediatric medication and is especially helpful when working with families. C. Using a dropper is also acceptable, remembering that thick fluids are easier to measure than viscous fluids. D. For more exact measuring, emptying dropper contents into a medicine cup can be helpful.

5. The type of play in which infants engage is called: A. Solitary B. Parallel C. Associative D. Cooperative

2. During hospitalization, there may be a reason to use restraints. Protocol for using restraints may include which of the following? Select all that apply. A. One finger breadth should be left between the skin and the device, and knots should be tied to allow for quick release. B. Elbow restraints fashioned from a variety of materials function well when a child's hands must be kept from his or her face—for example, after cleft lip or palate surgery. C. A papoose board with straps or a mummy wrap effectively controls the child's movements when an infant or small child requires short-term restraint for examination or treatment that involves the head and neck. D. Before initiating a behavioral restraint, the nurse should assess the patient's mental, behavioral, and physical status to determine the cause for the child's potentially harmful behavior. E. Unless state law is more restrictive, behavioral restraints for children must be reordered every 2 hours for children under 9 years of age and every 3 hours for children 9 to 17 years old

A B C D

1. The potential physiologic and psychologic effects of prolonged immobilization on a 9-year-old child who has experienced significant trauma in a motor vehicle crash include which of the following? Select all that apply. A. Orthostatic intolerance B. Deep vein thrombosis C. Pressure ulcer formation D. Pneumonia E. Diarrhea F. Kidney stones G. Sense of euphoria and elation H. Constipation

A B C D F H

2. A child with periorbital edema, decreased urine output, pallor, and fatigue is admitted to the pediatric unit. The child is being examined for acute glomerulonephritis. Which of the following nursing measures should be considered? Select all that apply. A. On examination there is usually a mild to moderate elevation in blood pressure compared with normal values for age, although severe hypertension may be present. B. Urinalysis during the acute phase characteristically shows hematuria, proteinuria, and increased specific gravity. C. The primary objective is to reduce the excretion of urinary protein and maintain protein-free urine. D. Assessment of the child's appearance for signs of cerebral complications is an important nursing function because the severity of the acute phase is variable and unpredictable. E. Because these children are particularly vulnerable to upper respiratory tract infection, protect them from contact with infected roommates, family, or visitors.

A B D

3. Because children with celiac disease must limit their intake of products containing gluten in wheat, rye, oats, and barley, they are at risk for which of the following nutritional deficiencies? Select all that apply. A. Iron deficiency anemia B. Folic acid deficiency C. Zinc deficiency D. Vitamin A, D, E, and K deficiency E. Vitamin B12 deficiency

A B D

3. You are working with a recent graduate on the pediatric unit. You are assigned to take care of an adolescent with β-thalassemia. The nurse needs more information about this disease if she states which of the following? Select all that apply. A. "We need to check the patient's iron level to make sure he is not anemic." B. "I believe this is most common in those of Hispanic descent, although this patient is Mediterranean." C. "The doctor will be prescribing deferasirox (Exjade) or defoxamine (Desferal) for chelation therapy." D. "This patient looks much younger than I would expect. I guess he's just a late bloomer." E. "I think a transfusion will be ordered, since his hemoglobin level is 9.0."

A B D

5. You are working with a family that brought their child into the pediatric clinic. The mother describes what may be a type of seizure. What subjective data will help you determine the type? Select all that apply. A. The presence or absence of an aura B. If the child appeared disoriented after the seizure C. Presence of vomiting after the seizure D. The duration of the seizure E. If the seizure was related to certain foods or occurred after a certain activity

A B D

3. Disordered eating patterns, which may be observed in the female athlete triad, may include which of the following? Select all that apply. A. Use of diet pills and laxatives B. Fasting C. Binge eating D. Restriction of certain foods E. Inadequate caloric intake F. Excessive vitamin consumption

A B D E

5. Which of these statements accurately describes Duchenne muscular dystrophy (DMD)? Select all that apply. A. The absence of dystrophin leads to muscle fiber degeneration. B. DMD is inherited as an X-linked recessive trait. C. Cognitive and intellectual impairment are rare in children with DMD. D. Affected children have a waddling gait and lordosis and fall frequently. E. Ambulation usually becomes impossible by 12 years of age, and affected children are confined to a wheelchair. F. Affected children must be hospitalized when ambulation becomes impossible.

A B D E

2. A 5-year-old is recovering from a tonsillectomy and adenoidectomy and is being discharged home with his mother. Home care instructions should include which of the following? Select all that apply. A. Observe the child for continuous swallowing. B. Encourage the child to take sips of cool, clear liquids. C. Administer codeine elixir as necessary for throat pain. D. Observe the child for restlessness or difficulty breathing. E. Encourage the child to cough every 4 to 5 hours to prevent pneumonia. F. Administer an analgesic such as acetaminophen for pain.

A B D F

3. Care of the child with a wound includes which of the following? Select all that apply. a. Applying occlusive dressings, such as hydrocolloid dressings. Dressings adhere best if a wide margin is left around the wound and the dressing is gently pressed against intact skin until it adheres. b. The safest solution for cleansing and loosening sticky dressings is normal saline. c. To remove a transparent or hydrocolloid dressing, use one hand to hold the skin to which the dressing is secured firmly, then gently raise both edges of the dressing and pull the dressing away from the skin in a parallel direction. d. Wounds covering a very large area (>25% of the body) need medical attention, with the child undergoing conscious sedation and analgesia. e. Puncture wounds should initially be irrigated with sterile saline, then soaked in a basin of warm soapy water for several minutes before applying a clean dressing.

A B E

5. A 2-month-old formerly healthy infant born at term is seen in the urgent care clinic with intercostal retractions, respiratory rate of 62, heart rate of 128, refusal to breastfeed, abundant nasal secretions, and a pulse oximeter reading of 88% in room air. The diagnosis of respiratory syncytial virus is made. The infant's oxygen saturation remains 95% in room air, and the respiratory rate is 54, with intercostal retractions; heart rate is 120 beats per minute. After 2 hours of observation and an intravenous bolus of fluids, the infant is being discharged home. The nurse provides which of the following home care instructions for this infant? Select all that apply. A. Continue breastfeeding infant. B. Discontinue breastfeeding and administer Pedialyte for 24 hours. C. Observe infant for labored breathing or apnea (cessation of breathing). D. Instill normal saline drops in both nares and suction thoroughly before feeding and before placing to sleep. E. Place infant to sleep on his side with the head of bed slightly elevated to facilitate breathing. F. Keep the infant out of day care or nursery.

A C D F

1. The nurse is caring for a 4-year-old girl with a history of frequent urinary tract infections. What should the nurse be aware of before obtaining a urine sample? Select all that apply. A. To obtain a clean-catch urine specimen, have the child sit on the toilet facing backward toward the tank. B. Because children who have a UTI will have painful urination, have the child drink a large amount of fluid before obtaining the sample. C. The specimen must be fresh—less than 1 hour after voiding with storage at room temperature or less than 4 hours after voiding with refrigeration. D. If a urinalysis obtained by a bag specimen is negative, a specimen still needs to be obtained by catheterization or suprapubic aspiration. E. The key to distinguishing a true UTI from asymptomatic bacteriuria is the presence of pyuria. F. Because the child is febrile, the nurse should immediately start an antimicrobial and then obtain a urine culture.

A C E

4. When giving discharge instructions to a parent post hypospadias repair, the nurse recognizes a need for more teaching when the mother says which of the following? Select all that apply. A. "I know I should never clamp off the catheter." B. "My child can take a tub bath when we arrive home because it will soothe the area." C. "An antibacterial ointment may be applied to the penis daily for infection control." D. "Fluids should be monitored and rationed to prevent fluid overload." E. "My child should avoid straddle toys, sandboxes, swimming, and rough activities until allowed by the surgeon."

A C E

4. A good understanding of enuresis will help the nurse work with children and their families. Which of the following teaching points should be included? Select all that apply. A. Enuresis is primarily an alteration of neuromuscular bladder functioning and as such is benign and self-limiting. B. Spontaneous remission of nocturnal enuresis occurs in approximately 35% of cases. C. Normal bladder capacity (in ounces) is the child's age plus 4; therefore normal bladder capacity for a 6-year-old is 10 ounces (600 ml). D. Success has also been achieved with desmopressin acetate nasal spray, which reduces nighttime urinary output to a volume less than functional bladder capacity. E. Parents need reassurance that bed-wetting is not a manifestation of emotional disturbance but just represents willful misbehavior.

A D

4. The parents of a child with Hodgkin disease ask how the physician will know what type of cancer their child has. Which of the following definitive signs and symptoms should the nurse describe? Select all that apply. A. The most common finding is enlarged, firm, nontender, movable nodes in the supraclavicular or cervical area. B. Tests include complete blood count, prothrombin time and G6PD, erythropoietin, and sedimentation rate. C. Generally a bone marrow biopsy is done to look for the presence of blast cells. D. The presence of Reed-Sternberg cells is considered diagnostic of Hodgkin disease. E. The presence of a white reflection as opposed to the normal red pupillary reflex in the pupil of a child's eye is a classic sign.

A D

5. Children and adolescents should be prepared for procedures according to their level of development and understanding. Which interventions by the nurse would be helpful? Select all that apply. A. Explain procedure in relation to what the child will see, hear, taste, smell, and feel. B. Although older children may associate objects, places, or persons with prior painful experiences, infants will not have a memory of past experiences. C. For school-age children, preparation can take several days in advance of the procedure to allow for processing of information. D. Provide privacy; describe how the body will be covered and what will be exposed. E. Allowing adolescents to talk with other adolescents who have had the same procedure may increase their level of anxiety and is not recommended.

A D

2. A 5-month-old infant is seen in the well-child clinic for a complaint of vomiting and failure to grow. His birth weight was 7 lb, and he now weighs 8 lb, 10 oz. The infant's mother reports that he is taking 4 to 7 oz of formula every 4 to 5 hours, but he "spits up a lot after eating and then is hungry again." The child is noted to be alert but appears malnourished. The mother reports that his stools are brown in color, and he has 1 to 2 bowel movements every day. Based on these findings, the nurse anticipates the infant has: A. Meckel diverticulum B. Hypertrophic pyloric stenosis C. Intussusception D. Hirschprung disease

2. The greatest threat to life as a result of dehydration in children is: A. Oliguria B. Shock C. Arrhythmia D. Hypotension

3. You are working with a pediatric nurse who has just transferred to the pediatric clinic. You are role-playing phone triage related to a child with a head injury. You ascertain that the nurse needs more teaching based on what response? A. "After initial physical examination, if there was no loss of consciousness with the head injury, the child can be observed at home." B. "If there is a language barrier, written instructions can be given, followed by discharge." C. "Another physical examination should take place in 1 or 2 days." D. "Parents should call the doctor if their child has any of these signs: blurred vision, walking unsteadily, or is hard to awaken."

4. A 9-year-old child in the emergency department is diagnosed with Lyme disease. The nurse anticipates that the health care provider's orders will include the administration of: a. Cefotaxime b. Aqueous penicillin c. Doxycycline d. Trimethoprim-sulfamethoxazole

4. Urinary system distress (neurogenic bladder) in children with spina bifida is managed by: A. DDAVP (1-deamino-8-D-arginine vasopressin) B. Clean intermittent catheterization C. Continuous urinary catheterization D. Mitrofanoff procedure

4. When obtaining a heelstick for laboratory results: A. The heelstick is performed because it is less invasive and less painful than a venipuncture. B. Breastfeeding during a neonatal heelstick is effective in reducing pain and has been found to be more effective than sucrose in some studies. C. Although safe for use in preterm infants when applied correctly, EMLA has been found to be much more effective than placebo in preventing pain during heel lancing. D. To avoid osteochondritis (underlying calcaneus bone, infection, and abscess of the heel), the puncture should be no deeper than 1 mm and should be made at the inner aspect of the heel.

5. A burn injury involving the epidermis and varying degrees of the dermal layer that is painful, moist, red, and blistered describes which of the following? A. Superficial or first-degree burn B. Partial-thickness or second-degree burn C. Full-thickness or third-degree burn D. Fourth-degree burn

5. You are working in the emergency department, and a 10-year-old child with type 1 diabetes mellitus has just been admitted. He has been diagnosed with diabetic ketoacidosis. Which assessment data will you expect to note in this child? A. Shallow or normal respirations, hypertension, and tachycardia B. Fruity breath odor and decreasing level of consciousness C. Headache, hunger, and excessive irritability D. Normal urine output with specific gravity less than 1.020 and a trace of ketones

1. Discharge teaching for parents of a school-age patient with diabetes insipidus (DI) should include which of the following? Select all that apply. A. Education and support regarding the rationale for fluid restrictions B. Information for school personnel regarding the diagnosis so they can grant children unrestricted use of the lavatory C. A thorough explanation regarding the condition with specific clarification that DI is a different condition from diabetes mellitus D. Understanding that treatment will only be needed until the child reaches puberty E. Knowing that school-age children may assume full responsibility for their care

B C E

6. Hepatitis A virus is transmitted by which of the following? Select all that apply. A. Breast milk from mother with HAV B. Ingestion of contaminated food C. Fecal-oral route D. Casual contact with infected person E. Blood transfusion

B C

1. Identify the interventions that can be safely used to manage diaper dermatitis. Select all that apply. a. Blow dry heat on skin with hair dryer. b. Apply a skin barrier paste such as zinc oxide. c. Keep skin surface irritants such as urine and stool off skin. d. Expose skin to air. e. Use only cloth diapers.

B C D

3. You are working with a new nurse to give an intramuscular injection. Which principles do you want to include when doing this teaching? Select all that apply. A. Usually 2 ml is the maximum volume that should be administered in a single site to small children and older infants. B. New evidence suggests that immunizations at the ventrogluteal site have been found to have fewer local reactions and fever. C. Distraction and prevention of unexpected movement may be more easily achieved by placing the child supine on a parent's lap for ventrogluteal site use. D. The deltoid muscle advantages are less pain and fewer side effects from the injectate compared with the vastus lateralis. E. Aspiration during intramuscular vaccine administration is always recommended.

B C D

5. You are discharging a patient with hemophilia. Which of the following responses by the parents indicate an understanding of this disorder? Select all that apply. A. "My child should remain active to decrease joint problems, and most children with hemophilia can participate in the same activities as peers." B. "Care should be taken to avoid bleeding of gums, and softening the toothbrush in warm water before brushing or using a sponge-tipped disposable toothbrush may be helpful." C. "Signs of internal bleeding should be recognized, such as headache, slurred speech, loss of consciousness (from cerebral bleeding), and black, tarry stools (from gastrointestinal bleeding)." D. "If there is bleeding in a joint, elevation, ice, and rest should help and may prevent the need for factor VIII replacement." E. "All of my son's teachers need to be aware of what to do if he gets a bloody nose."

B C E

5. You are working in the pediatric clinic, and a child presents with symptoms that are suspicious of the acute phase of Kawasaki disease. Which of the following symptoms are included? Select all that apply. A. Periungual desquamation (peeling that begins under the fingertips and toes) of the hands and feet is present. B. The bulbar conjunctivae of the eyes become reddened, with clearing around the iris. C. A temporary arthritis is evident, which may affect the larger weight-bearing joints. D. Inflammation of the pharynx and the oral mucosa develops, with red, cracked lips and the characteristic "strawberry tongue." E. Loud pansystolic murmur along with ECG changes are present.

B D

2. A child with sickle cell anemia is admitted in a vasoocclusive crisis. Which of the following interventions should the nurse expect to see ordered? Select all that apply. A. Cold compresses to painful joints B. IV fluids started, and oral fluids encouraged C. Meperidine ordered every 4 hours for pain D. High-calorie, high-protein diet E. Antibiotics ordered for any existing infection

B D E

2. The nurse taking care of a 5-year-old cancer patient with ulcerative stomatitis is getting ready to perform mouth care. Which of the following principles should be followed? Select all that apply. A. Due to pain of the stomatitis, viscous lidocaine should be used to swish the mouth three times per day. B. A soft, bland diet, although not the favorite of the child, will help with the pain. C. Lemon glycerine swabs are helpful because they remind children of lemon drops. D. Using a soft sponge-type toothbrush will decrease the tendency for gums to bleed. E. A solution of 1 tsp of baking soda and tsp of table salt in 1 quart of water is helpful for mouth rinse.

B D E

1. A 16-month-old has a history of diarrhea for 3 days with poor oral intake. He received intravenous fluids, has tolerated some oral fluids in the emergency department, and is being discharged home. Instructions for diet for this child should include: A. BRAT diet (bananas, rice, applesauce, and toast) for 24 hours, then a soft diet as tolerated B. Chicken or beef broth for 24 hours, then resume a soft diet C. Offer a regular diet as child's appetite warrants D. Keep on clear liquids and toast for 24 hours

1. A child is admitted to the pediatric unit. The mother reports that the doctor says her son is anemic. What laboratory findings/manifestations would the nurse expect to see to confirm iron deficiency anemia? A. Cyanosis, due to inadequate oxygen saturation of existing hemoglobin B. A decreased reticulocyte count C. A total iron-binding capacity (TIBC) that is elevated above the normal range D. Decreased blood pressure changes, which are an early sign because of the compensatory mechanisms

1. The most common complication that should be anticipated and observed for in an infant with myelomeningocele after surgical repair of the defect is: A. Urinary stress B. Chiari malformation C. Hydrocephalus D. Latex allergy

1. The most common type of dehydration in children occurs when electrolyte and water deficits are present in approximately balanced proportions. This is called ________________ dehydration. A. Hypotonic B. Hypertonic C. Isotonic D. Hyponatremic

1. What is the most common treatable cause of male-related impaired fertility, especially if diagnosed and treated early? A. Paraphimosis B. Trauma to the penis C. Idiopathic varicocele D. Epididymitis

2. As the nurse assigned to a child diagnosed with bacterial meningitis, you know that: A. The child will not need to be placed in isolation because antibiotics have been started B. Enteric precautions will remain in place for up to 48 hours C. Respiratory isolation will remain in place for 24 hours after antibiotics are started D. Due to headache, the child will want the head of the bed elevated with two pillows

3. A 3-year-old boy is seen in the clinic at 8:30 pm with a history of vomiting for 2 days and poor oral intake; he has voided once since the previous day. Examination reveals a lethargic child sitting on the mother's lap. He has a capillary refill of 4 seconds, apical heart rate of 128, respiratory rate of 32, and poor skin turgor. Stated body weight is 25 kg. Based on this information, the nurse anticipates performing which of the following? A. Demonstrating to the mother how to give 5 to 10 ml of Pedialyte by mouth every 5 to 10 minutes B. Administering an intravenous fluid bolus of 450 ml of 5% dextrose in water over 60 minutes C. Administering an intravenous fluid bolus of 500 ml of 0.9% normal saline over 20 minutes D. Administering an intravenous fluid bolus of 1000 ml of 5% dextrose and 0.45% normal saline over 30 minutes

4. A 4-day-old infant is seen in the emergency department for a possible seizure earlier in the day. The infant was being breastfed but without much success, so an aunt gave him a bottle of water. The infant continued to cry, and the mother was too exhausted to breastfeed, so another bottle of water was given while someone went to the store to purchase infant formula. The pregnancy, delivery, and postpartum history reveal no particular problems for this term infant that might contribute to seizures. The physical examination is unremarkable, with the exception of hypertonic reflexes. The infant is awake, alert, and sucking on his fists. Diagnostic studies are obtained, including an electrocardiogram. The nurse anticipates which of the following as the possible explanation for the infant's condition? A. Serum potassium of 3.9 mEq B. Serum glucose of 69 mg C. Serum sodium of 118 mEq D. Arterial pH of 7.34

4. A 5-year-old is seen in the urgent care clinic with the following history and symptoms: sudden onset of severe sore throat after going to bed, drooling and difficulty swallowing, axillary temperature of 102.2°F (39.0°C), clear breath sounds, and absence of cough. The child appears anxious and is flushed. Based on these symptoms and history, the nurse anticipates a diagnosis of: A. Group A β-hemolytic streptococcus (GABHS) pharyngitis B. Acute tracheitis C. Acute epiglottitis D. Acute laryngotracheobronchitis

4. A formerly preterm infant who had surgery for necrotizing enterocolitis is now 6 months old and has short-bowel syndrome. He is unable to absorb most nutrients taken by mouth and is totally dependent on parenteral nutrition, which he receives via a central venous catheter. The clinic nurse following this infant is aware that this infant should be closely observed for the development of: A. Gastroesophageal reflux B. Chronic diarrhea C. Cholestasis D. Failure to thrive

4. A nurse working on a pediatric unit is assigned to an infant with hypothyroidism. She knows that the assessment may include: A. Thyroid function tests that are usually normal, although thyroid-stimulating hormone (TSH) levels may be slightly or moderately elevated B. Increased secretion of pituitary TSH in response to decreased circulating levels of TH or from infiltrative neoplastic or inflammatory processes C. Dry skin, puffiness around the eyes, sparse hair, constipation, sleepiness, lethargy, and mental decline D. Clinical features, including irritability, hyperactivity, short attention span, tremors, insomnia, and emotional lability

4. After the sudden death of a 14-year-old seemingly healthy basketball player, his parents ask the school administration to install an automatic external defibrillator (AED) in a central area of the athletic center. The school nurse is asked to participate in a meeting with the parents in which the administrators insist that such a device is not necessary. The school nurse advocates by providing which information about AEDs and children? A. An AED should be used only by health care persons trained in its use. B. An AED provides too much of an energy shock dose for children under 12 years of age. C. An AED can be effective in the resuscitation of a child or adolescent with a shockable rhythm. D. An AED is more commonly used in adults who have heart attacks than in children with undiagnosed heart conditions.

4. Which is the most accurate genetic explanation for a family with hemophilia? A. It is a Y-linked dominant disorder. B. It is equally distributed among males and females. C. It is an X-linked recessive disorder. D. It is an autosomal recessive disorder.

5. A 2-day-old infant in the newborn nursery is diagnosed with developmental dysplasia of the hip, and treatment is started by the orthopedist. The nurse assists the parents by providing home care instructions that include: A. Return to the orthopedist's office in 2 weeks to remove the hip spica cast B. The infant's bilateral foot casts should be elevated on pillows as much as possible C. Remove the Pavlik harness once a day for no more than an hour and inspect skin D. Remove the Pavlik harness while the infant is awake to allow "tummy time"

2. One indication that the toddler is ready to begin toilet training is: A. Child recognizes urge to void and is able to communicate this sensation to the parent B. Child is able to stay dry all night C. Child demonstrates mastery of dressing and undresssing self D. Child asks parent to have wet or soiled diaper changed

2. Which childhood vaccine provides some protection against bacterial meningitis, epiglottitis, and bacterial pneumonia? A. Hib vaccine B. Hepatitis B vaccine C. Varicella vaccine D. Influenza vaccine

4. It is important to consider the child's developmental understanding of death when working with that child. Which option is the preschool child's developmental stage? A. Children of this age believe their thoughts are sufficient to cause death. B. They are still very much influenced by remnants of magical thinking and are subject to feelings of guilt and shame. C. They have a deeper understanding of death in a concrete sense. D. They can perceive events only in terms of their own frame of reference—living.

4. When assessing blood pressure in a child: A. Knowledge of normal mean is important: newborn, 65/41 mm Hg; 1 month to 2 years, 95/58 mm Hg; and 2 to 5 years, 101/57 mm Hg. B. Cuff size is the most important variable and should be measured using limb length. C. The child is considered normotensive if the BP is below the 95th percentile. D. Check upper- and lower-extremity BP to look for abnormalities such as aortic stenosis, which causes lower-extremity BP to be higher than upper-extremity BP.

5. A common cause of accidental death in children ages 1 to 19 years involves motor vehicle crashes. Evidence from test crashes indicates that the safest action to prevent accidental deaths in toddlers includes: A. Placing the child in a rear-facing weight-appropriate car restraint seat until the child has outgrown the car seat manufacturer's height and weight recommendations B. Allowing the child to ride in the front seat with a lap-shoulder seat restraint to avoid emotional outbursts C. Allowing the child to ride in a forward-facing booster restraint seat after 12 months of age D. Placing the child in the regular seat using the lap-shoulder belt as long as the child weighs at least 45 pounds

5. One of the key factors in addressing the health concerns and needs of the adolescent in a clinic or primary care office setting is to: A. Provide confidentiality B. Include the parent(s) in a discussion about the adolescent's sexual health C. Ask the adolescent if she or he is sexually active D. Discuss the negative effects of tobacco use

5. School-age children are prone to accidental injury primarily because of: A. Peer pressure and risk-taking behaviors B. Physical awkwardness and clumsiness C. Parents' lack of supervision D. Attempts to impress members of the opposite sex

The newest nurse on the pediatric unit is concerned about maintaining a professional distance in her relationship with a patient and the patient's family. Which comment indicates that she needs more mentoring regarding her patient-nurse relationship? A. "I realize that caring for the child means I can visit them on my days off if they ask me." B. "When the mother asks if I will care for her daughter every day, I explain that the assignments change based on the needs of the unit." C. "When the mother asks me questions about my family, I answer politely, but I offer only pertinent information." D. "I engage in multidisciplinary rounds and listen to the family's concerns."

3. These general approaches can be helpful when performing a physical examination. Select all that apply. A. With toddlers, restraint may be necessary, and requesting a parent's assistance is appropriate. B. When examining a preschooler, giving a choice of which parts to examine may be helpful in gaining the child's cooperation. C. With a school-age child, it is always best to have the parents present when examining. D. Giving explanations about body systems can make adolescents nervous due to their egocentricities. E. An infant physical examination is done head to toe, similarly to the adult.

A B

3. You are working with the family of a 4-year-old patient and have concerns about possible exposure to lead poisoning. Which information will determine whether follow-up is needed? Select all that apply. A. The child goes daily to the older home of a babysitter. B. One of the child's playmates in the neighborhood has lead poisoning. C. Although living in a newer neighborhood, one of the child's playmates' homes is being renovated. D. The child is out of the danger age range for screening (1 to 2 years old), so screening is not needed. E. Past BLL was 12, so no follow-up is needed at this time.

A B

4. Common causes of pelvic inflammatory disease in the United States include which of the following? Select all that apply. A. Neisseria gonorrhoea B. Chlamydia trachomatis C. Treponema pallidum D. Human papillomavirus

A B

1. Which of the following conditions may lead to the development of obesity in children? Select all that apply. A. Physical inactivity B. Low socioeconomic status C. Use of food as a positive reinforcement of desired behaviors D. Consumption of energy-dense foods and drinks E. Positive self-esteem

A B C D

3. A mother of a child born with Down syndrome is overwhelmed with the future and asks many questions. Which of the following facts should the nurse be aware of? Select all that apply. A. Eighty percent of infants with Down syndrome are born to women younger than 35 years old because younger women have higher fertility rates. B. When feeding infants and young children, use a small, straight-handled spoon to push food to the side and back of the mouth. Feeding difficulties occur due to a protruding tongue and hypotonia. C. Parents generally believe the experience of having this special child makes them stronger and more accepting of others. D. Although some placement in the regular classroom has occurred more recently, this has been found to be detrimental to the child with Down syndrome due to lack of one-on-one teaching. E. The child's lack of clinging or molding is a physical characteristic, not a sign of detachment or rejection. F. Development may be 3 to 4 years beyond the mental age, especially during early childhood.

A B C E

3. When parents consider genetic testing, especially after having a child born with an anomaly, which information could the nurse use to further instruct the family? Select all that apply. A. Genetic screening can provide early recognition of a disease, before signs and symptoms occur, for which effective intervention and therapy exists. B. Screening can occur at different times in a person's life: preconceptual, or newborn screening, depending on the circumstances. C. Genetic testing can help identify carriers of a genetic disease for the purpose of maximizing parenthood planning options. D. A thorough family history by the nurse will include the parents' siblings, the parents, and the grandparents. E. Recognizing a genetic disorder can further facilitate a genetic evaluation by collecting pregnancy, labor and delivery, perinatal, medical, and developmental histories.

A B C E

The following information relates to questions 3 and 4. An infant born at 27 weeks of gestation is now 3 weeks old and on supplemental oxygen by nasal cannula. Feedings are being administered by gavage: 12 ml of expressed breast milk and human milk fortifier every 2 hours. On assessment the nurse notes that the infant's abdomen appears slightly distended, the infant's activity is decreased from previous assessment, and there is a prefeeding gastric residual of 6 ml. The infant's core temperature is 35.8°C (it was 36.4°C 2 hours before). 3. Based on these findings, what are the nurse's priority interventions? Select all that apply. A. Obtain a full set of vital signs, including BP and pulse oximetry B. Withhold the next feeding (now due) C. Discuss findings with the primary practitioner D. Observe the infant closely and administer the current feeding E. Measure the infant's abdominal girth

A B C E

1. A mother comments to a nurse working on the pediatric unit, "My second child just does not seem to be acting like or responding the same way as my first child." Nursing interventions to respond to this inquiry should include which of the following? Select all that apply. A. Assessment for dysmorphic syndromes (e.g., multiple congenital anomalies, microcephaly) B. Inquiring about temperament: irritability or lethargy C. Explaining that all children are different and that it can be detrimental to compare them D. Noting language development appropriate for the child's age E. Meeting the siblings to assess similarities that may be familial rather than problematic

A B D

1. Which of the following are the primary causes of mortality among adolescents in the United States? Select all that apply. A. Injuries B. Suicide C. Congenital anomalies D. Homicide E. Chronic illness

A B D

1. Identify the anatomic changes that occur shortly after birth that affect the newborn's adaptation to extrauterine existence. Select all that apply. A. Closure of the foramen ovale B. Closure of the ductus arteriosus C. Increase in pulmonary vascular resistance D. Closure of the ductus venosus E. Decrease in pulmonary vascular resistance

A B D E

3. What does the Apgar scoring system assess? Select all that apply. A. Respiratory effort B. Heart rate C. Core temperature D. Reflex irritability E. Muscle tone F. Color

A B D E

3. Which of the following factors should a nurse consider when managing the pain of a terminally ill child? Select all that apply. A. Pain medications are given on an as-needed schedule, and extra doses for breakthrough pain are available to maintain comfort. B. Opioid drugs, such as morphine, are given for severe pain, and the dosage is increased as necessary to maintain optimum pain relief. C. Addiction is a factor in managing terminal pain in a child, and the nurse plays an important role in educating parents that their child may become addicted. D. Nurses often express concern that administering dosages of opioids that exceed those with which they are familiar will hasten the child's death; in the principle of double effect. E. In addition to pain medication, techniques such as music therapy, distraction, and guided imagery should be combined with medications to provide the child and family strategies to control pain.

A B D E

4. Toddlers are often known to be finicky eaters and may exhibit abnormal eating patterns that may concern parents. Which of the following actions for feeding toddlers should be suggested so adequate amounts of nutrients for growth and development are consumed? Select all that apply. A. Avoid placing large food portions on the toddler's plate B. Allow the child to graze on nutritious (not "junk" food) snacks during the day C. Insist that the child sit at the table until all persons have completed their meals D. Allow the child to make certain food choices (within reasonable limits)—for example, "Would you like a half peanut butter or ham sandwich?" E. Provide meals at the same time of day as much as possible so the toddler has a sense of consistency F. Make the child eat all of the food provided, and provide disciplinary actions such as a "time-out" if the plate is not cleaned

A B D E

1. The nurse caring for a preschool child understands which of the following developmental concepts? Select all that apply. A. Preschoolers have egocentric thought and believe that everyone thinks as they do. B. Play can be therapeutic and enlightening into a child's level of understanding. C. Explanations are helpful when using detail to allay the preschooler's stress. D. Preschoolers understand inferences and can relate to others' feelings with empathy. E. Preschoolers have magical thinking and believe their thoughts have power.

A B E

4. A school nurse in middle school (grades 6, 7, and 8) is preparing an outline for a sex education class. Which of these statements represent important concepts to be covered in discussing this topic with this age-group? Select all that apply. A. Consider separating the boys and girls into same-sex groups with a leader of the same sex. B. Answer questions matter-of-factly and honestly and appropriate to the children's level of understanding. C. Use vernacular or slang terms to describe human physiologic functions. D. Avoid discussing sexually transmitted diseases in this age-group. E. Discuss common myths and misconceptions associated with sex and the reproductive process. F. Avoid controversial topics such as birth control.

A B E

3. Which of the following hormones have the most impact on the development of puberty in females and males? Select all that apply. A. Follicle-stimulating hormone (FSH) B. Insulin C. Luteinizing hormone (LH) D. Estrogen E. Testosterone

A C

Lung maturity may be enhanced by which of the following? Select all that apply. A. Antenatal (maternal) glucocorticoid administration B. Maternal chorioamnionitis C. Neonatal administration of exogenous surfactant D. Maternal diabetes mellitus E. Maternal tobacco smoking

A C

3. Nursing care of a 2-day-old infant undergoing phototherapy in the mother's hospital room should include: A. Ensure proper fit of eye covering (patches) B. Monitor bilirubin levels with transcutaneous monitor every 8 hours C. Record number of infant voidings and stools D. Examine infant's eyes for presence of drainage every 8 hours or as warranted E. Avoid removing the infant from phototherapy except for brief periods of feeding and cuddling

A C D

2. Nursing care of a healthy term newborn aimed at preventing significant hyperbilirubinemia includes: A. Encourage mother to breastfeed the infant frequently B. If the mother cannot breastfeed at night, give the infant feedings of water and dextrose C. Observe the number of voids and stools, especially in the first 72 hours D. Promote newborn rooming-in with the mother E. Observe infant for appearance of jaundice and obtain transcutaneous bilirubin reading F. Feed the infant formula on a schedule of every 4 to 5 hours

A C D E

5. The nurse notes that a healthy term infant appears jaundiced at 12 hours of age. The nurse understands that there is probably an ABO incompatibility based on the following information: A. The direct Coombs test is weakly positive. B. The infant's hemoglobin is 11.3 mg/dl. C. The mother's blood type is O positive. D. This is the mother's first pregnancy. E. The infant's serum bilirubin (indirect) is 2.6 mg/dl

A C D E

2. When interacting with a parent at her child's well visit, which statement by the mother would be an indication for a speech referral? Select all that apply. A. Failure to speak any meaningful words spontaneously in a 2-year-old child B. Using different words or nicknames for certain people C. Failure to use sentences of three or more words in a 3-year-old D. Stuttering or any other type of dysfluency E. Omission of word endings (e.g., plurals, tenses of verbs) in a 3-year-old F. Frequent omission of final consonants in a 3-year-old

A C D F

1. The mother of a 4-year-old health clinic patient asks the nurse about night terrors. Which statement by the mother reveals a need for further teaching? Select all that apply. A. He will grow out of this stage when he is a little older. B. Getting into a specific routine is helpful and can be calming to my son. C. Watching TV with an adult is helpful so that he understands what is real. D. I can help my child with sleep by giving him his favorite stuffed animal or using a night-light. E. Our family often sleeps together, and this seems to help.

A C E

3. At the clinic appointment, a 4-year-old's mother wants to discuss several concerns. Which statements require more teaching by the nurse? Select all that apply. A. My husband feels that TV is okay as long as it is educational. B. I think it is okay for my son to play dress-up along with the girls. C. I told my son that his imaginary playmate moved away because it did not seem normal. D. My mother-in-law thinks I should be working around the house all the time, but I believe playing with my son is very important. E. My neighbor gave me some flash cards with letters and numbers for my son to use, but I said, "What's the rush? He's only 4."

A C E

4. When a child with a visual impairment is hospitalized, the nurse should ensure that which of the following interventions are carried out to decrease stress for the child during the hospitalization? Select all that apply. A. Because the child cannot see what may be taking place, the nurse needs to reassure the child and family throughout every phase of treatment. B. The nurse will make sure that the parents are comfortable with the placement of objects in the room. C. Whenever possible, the same nurse should care for the child to ensure consistency in the approach. D. To help the child feel safe, the nurses should take over most of the routine care of the child, unless the parent is present. E. Each health care provider should identify himself or herself as soon as entering the child's room.

A C E

3. You are working with a family whose 7-year-old has just been diagnosed with attention-deficit/hyperactivity disorder. Which statements by the mother indicate a need for further teaching? Select all that apply. A. "My child will respond best to verbal instructions, since that will help him learn to pay attention and listen intently." B. "A consistent schedule for homework and activities will help him be organized." C. "I need to bring him for routine checkups while he is taking his medication because the medication can affect his appetite and growth." D. "I am going to ask the principal if my son can change classrooms because his current teacher has too many rules and he seems to get in trouble." E. "We might consider counseling because this has been stressful for the whole family."

A D

2. A 10-year-old child with a peanut allergy would be expected to have which of these as an early manifestation of his allergy? Select all that apply. A. Wheezing B. Nausea C. Headache D. Trouble breathing E. Urticaria

A D E

5. Growth measurement is a key element of health status in children. One measurement is linear growth measurement. What should the nurse do to perfect this technique? Select all that apply. A. Understand the difference in measurement for children who can stand alone and for those who must lie recumbent. B. Use a length board or a tape measure to measure infant length. C. Two measurers are usually required for a recumbent child, although one measurer may be sufficient for a cooperative child. D. Reposition the child and repeat the procedure. Measure at least twice (ideally three times). Average the measurements for the final value. E. Demonstrate competency when measuring the growth of infants, children, and adolescents. Refresher sessions should be taken when a lack of standardization occurs.

A D E

5. A family you are caring for on the pediatric unit asks you about nutrition for their baby. What facts will you want to include in this nutritional information? Select all that apply. A. Breastfeeding provides micronutrients and immunologic properties. B. Eating preferences and attitudes related to food are established by family influences and culture. C. Most children establish lifelong eating habits by 18 months old. D. During adolescence, parental influence diminishes and adolescents make food choices related to peer acceptability and sociability. E. Because of the stress of returning to work, most mothers use this as a time to stop breastfeeding.

A,B,D

1. When caring for a 4-year-old with a disability, the nurse notes that while encouraging the child to take part in his care, the mother constantly gives into the child, allowing him to have his own way. What anticipatory guidance can the nurse give to promote normalization in this relationship? A. "Giving in" is not a detriment to the child when he or she has a disability and limitations. B. Explain that when parents establish reasonable limits, children are likely to develop independence that is appropriate for their age and achievement equal to their limitations. C. Advise the parent to wait to explain any procedure to the child until they are at the health care setting or just before the procedure to avoid unduly upsetting the child. D. Have the parent realize that it would be unfair to the siblings to expect similar rules to apply to all of the children in the family.

2. A 15-year-old female diagnosed previously with anorexia nervosa is admitted to the emergency department. Her mother states that her daughter has not voided in 24 hours and has been lethargic for the last 12 hours. The patient appears cachectic and pale, and her weight is recorded as 78 lb. She is minimally responsive to painful stimulation. A number of diagnostic tests are obtained. Which one of these represents the most immediate threat to her life requiring intervention? A. Serum sodium of 149 mEq B. Serum potassium of 2.6 mEq C. Hemoglobin of 6.8 mg D. Arterial pH of 7.30

2. A late-preterm infant (estimated 35 weeks of gestation) is admitted to the neonatal intensive care nursery at 2 hours of age with the following: respiratory rate 68; heart rate 132; bilateral nasal flaring; audible grunting on expiration; intercostal retractions; systolic blood pressure 35; hypotonia; and acrocyanosis and pulse oximetry reading of 89% on 30% inspired oxygen. The radiograph shows a diffuse ground glass appearance. The nurse recognizes these as signs of: A. Hypoglycemia B. Respiratory distress syndrome C. Meconium aspiration D. Apnea of prematurity

2. In the newly born infant thermogenesis is achieved by: A. Shivering B. Brown fat metabolism C. Overhead warming unit D. Skin-to-skin contact with mother

2. Pain scales for infants and their uses include but are not limited to: A. CRIES: Crying, Requiring increased oxygen, Inability to console, Expression, and Sleeplessness B. FLACC: child's face, legs, activity, cry, and consolability C. NCCPC: parent and health caregiver questionnaire assessing acute and chronic pain D. NPASS: neonatal pain, agitation, and sedation scale for infants from 3 to 6 months

2. The nurse may be called on to have knowledge about sex chromosome aneuploidies. In answering families' questions, the nurse can report: A. "Some of the most common genetic disorders caused by sex chromosome aneuploidies are Klinefelter, XXY, triple X female, and Turner syndromes." B. "Klinefelter syndrome is the most common of all sex chromosome aneuploidies, and mental development is normal in most cases." C. "Triple X females have premature menarche and delayed menopause." D. "Turner syndrome girls have a prepubertal growth spurt and then mostly stop growing."

2. When her preschool son is in the hospital, the parent tells the nurse, "I think there is something wrong with him because he is so skinny." The most appropriate answer by the nurse is: A. Most preschoolers weigh between 10 and 14 kilograms. B. The legs of a preschooler, rather than the trunk, increase in length, which may make him look slimmer. C. Preschoolers usually keep that pot-bellied appearance until about 4 years old. D. Most preschoolers gain 2 to 3 pounds per year.

3. As the nurse is getting Nathan ready for surgery, his doctor asked you to explain preemptive analgesic to Nathan's mother. Which response leads you to believe his mother needs more teaching? A. "I understand that preemptive analgesia is giving Nathan pain medication before he has pain and could be given before surgery." B. "This medication will control Nathan's pain so he doesn't feel anything." C. "Giving this medicine early may help prevent complications after surgery." D. "By controlling Nathan's pain, he will be more comfortable and may be able to go home sooner."

3. Characteristics of bullying include: A. Unintentional harm inflicted on another person that is part of the socialization process in childhood B. The infliction of repetitive physical, verbal, or emotional abuse on another person with intent to harm C. An attempt to gain acceptance and be liked by same-sex peers D. An early sign of a severely disturbed personality disorder that escalates in adulthood

3. The recommended treatment for cow's milk protein allergy is the substitution of cow's milk-based formula for: A. Goat's milk B. Soy milk or a hydrolyzed formula C. Whole milk D. Evaporated milk

4. One of the concerns of the preschool period is adequate nutrition. What can the nurse say to give anticipatory guidance to parents? A. Preschoolers are growing during this period and need to increase their caloric intake to 110 kcal/kg, for an average daily intake of 2200 calories. B. There is some evidence that children self-regulate their caloric intake. If they eat less at one meal, they compensate at another meal or snack. C. To monitor fat intake, dairy and meat should be limited to twice a day. D. For children who do not like milk, consumption of fruit juices is a healthy alternative.

4. What is the overriding goal of atraumatic care? A. Prevent or minimize the child's separation from the family B. Do no harm C. Promote a sense of control D. Prevent or minimize bodily injury and pain

4. When assessing a child's injury in the emergency department, a nurse suspects physical abuse. Based on this suspicion, the nurse's primary legal responsibility is to A. Assist the family in identifying resources for support B. Report the case in which the abuse is suspected to the local authorities C. Document the child's physical assessment findings accurately and thoroughly D. Refer the family to the hospital support group

5. A healthy infant is born to a mother with known high-risk behaviors whose HIV status is undetermined. The mother states that she wishes to breastfeed her infant. The nurse's response to the mother's request should be based on which of the following information? A. HIV is rarely transmitted to the newborn through maternal milk. B. Breastfeeding should be withheld until HIV status (maternal) is determined. C. Breastfeeding should be avoided completely in mothers with high-risk behaviors. D. In such infants antiretroviral medication should be started within 12 hours of birth

5. One of the most common intestinal parasitic pathogens in the United States acquired from a contaminated water source such as a lake or swimming pool is: A. Tinea capitis B. Giardia intestinalis C. Pediculosis capitis D. Enterobiasis

6. One of the primary reasons for monitoring the toddler's activities and intervening to prevent accidental injury is that: A. Toddlers have oppositional defiant behavior and negativism B. Toddlers do not understand the concept of "cause and effect," so explaining that certain actions will result in serious injury is useless C. Toddlers will often listen to reasoning about why an activity should be avoided D. Toddlers enjoy making their parents worry about their safety and like to see the parents' reactions to the behavior

2. Which of the following immunization booster vaccines should be considered for a 13-year-old adolescent who has completed all recommended routine childhood vaccinations? Select all that apply. A. DTaP vaccine B. Tdap vaccine C. Meningococcal vaccine D. Pneumococcal vaccine E. Hepatitis B vaccine F. Hib vaccine

B C

5. A 3-month-old is being seen in the well-child clinic for positional plagiocephaly. The nurse knows that the initial interventions for this condition involve which of the following? Select all that apply. A. Place the infant to sleep in the prone position. B. Place the infant in a prone position when awake (approximately 15 min). C. Alternate the infant's head position (side of head) when asleep. D. Have the infant wear a soft helmet for 23 to 24 hours a day. E. Place the infant to sleep in an infant seat twice a day.

B C

1. While interviewing parents who have just arrived in the health care clinic, the nurse begins the interview. Which of the following statements involve therapeutic communication techniques? Select all that apply. A. Allow the parents to direct the conversation so that they feel comfortable and in control. B. Use broad, open-ended questions so that parents can feel open to discuss issues. C. Redirect by asking guided questions to keep the parents on task. D. Use careful listening, which relies on the use of clues and verbal leads to help move the conversation along. E. Ask carefully worded, detailed questions to get accurate information.

B C D

3. Which of the following scenarios are concerning to health care workers? Select all that apply. A. An adolescent using marijuana once to fit in with peers at a party B. An adolescent binging on alcohol every weekend C. An adolescent using prescription drugs along with alcohol D. An adolescent reports feeling jittery until she drinks some alcohol

B C D

4. According to Jean Piaget, adolescent cognitive development is represented by the stage of formal operational thought that includes which of the following? Select all that apply. A. Believing that thoughts are all-powerful B. Thinking in abstract terms C. Thinking about hypotheses D. Using a future time perspective E. Thinking in the here and now

B C D

4. When teaching a 6-year-old child with sickle cell disease and his family about pain management, which of the following should the nurse discuss? Select all that apply. A. When pain medications are used, all pain will be eliminated. B. Nonpharmacologic methods of pain relief, including heat, massage, physical therapy, humor, and distraction. C. It is helpful to use a "passport card" that includes information about the diagnosis, any previous complications, and the pain regimen. D. Only the physician can decide the best course of treatment, and the other health care providers follow that plan. E. Long-term medication use considers many factors.

B C D

5. The pediatric nurse may be in the unique position to talk with a family about further genetic evaluation of their child. Which assessment findings by the nurse may alert the nurse to this need? Select all that apply. A. Digestive difficulties, especially after 6 months of age B. Skeletal abnormalities: limb abnormalities, asymmetry, hyperextendible joints C. Recurrent infection or immunodeficiency: ear infections, pneumonia, poor healing of the umbilicus D. Urinary tract issues: recurrent infections, delay in toilet training E. Development and speech delays or loss of developmental milestones

B C E

2. Which child should receive further diagnostic testing for chronic abdominal pain? Select all that apply. A. An 11-year-old boy with a 1-month history of generalized periumbilical pain B. An 8-year-old girl with a 1-week history of right lower quadrant pain C. A 12-year-old girl with a 6-week history of constipation D. A 6-year-old boy with a 1-month of diarrhea and a rectal fistula

B D

2. Children with disabilities or chronic illness and their families may have different methods of coping than those of healthy children. Often they have a resilience that is to be admired. Which of these statements reflect ways that they foster this resilience? Select all that apply. A. Protect the child from having to learn about his or her disability or illness on a repeated basis. B. Develop relationships with other children and their families with similar circumstances to build support. C. The parents set long-term goals to create a sense of hope. D. Focus on the child's strengths and encourage independence. E. Accept that chronic illness is part of living.

B D E

5. As a nurse caring for children, an understanding of childhood depression is essential. Some important information about depression includes which of the following statements? Select all that apply. A. Authorities agree that childhood depression exists, and the manifestations are often similar to adult depression. B. Identification of the depressed child requires a careful history taking (e.g., health, growth and development, social and family health); interviews with the child; and observations by the nurse, parents, and teachers. C. If antidepressants are prescribed, the child and family need to know that antidepressants must be at a therapeutic level for 4 to 6 weeks to achieve a beneficial effect. D. Depressed children often exhibit a distinctive style of thinking characterized by low self-esteem, hopelessness, poor social engagement with peers, and a tendency to explain negative events in terms of personal shortcomings. E. Nurses should be aware that depression is a problem that can be easily overlooked in the school-age child and one that can interrupt normal growth and development.

B D E

5. How can the nurse prepare a child for a painful procedure? Select all that apply. A. Be honest and use correct terms so that the child trusts the nurse. B. Involve the child in the use of distraction, such as using bubbles, music, or playing a game. C. Kindly ask parents to leave the room so they don't have to watch the painful procedure. D. Use positive self-talk such as "When I go home, I will feel better and be able to see my friends." E. Use guided imagery that involves recalling a previous pleasurable event.

B D E

4. Culture includes which of the following? Select all that apply. A. Cultural competence, which includes building skills in the health care provider, such as offering lists of common foods, health care beliefs, and important rituals B. Cultural humility, which requires that health care providers participate in a continual process of self-reflection and self-critique C. Recognizing the power of the health care provider role that views the patient and family as full members of the health care team D. A particular group with its values, beliefs, norms, patterns, and practices that are learned, shared, and transmitted from one generation to another E. A complex whole in which each part is interrelated, including beliefs, tradition, lifeways, and heritage

B,C,D,E

The National Children's Study is the largest prospective, long-term study of children's health and development in the United States. Which of these options are the goals of this study? Select all that apply A. Ensure that every child is immunized at the appropriate age. B. Provide information for families to eradicate unhealthy diets, dental caries, and childhood obesity. C. Enlist the help of school lunch programs to reach the goal of vegetables and fruits as 30% of each lunch. D. Significantly reduce violence, substance abuse, and mental health disorders among the nation's children. E. Decrease tardiness and truancy and increase the high school graduation rate in each state over the next 5 years.

B,D

1. In relation to developmental milestones, the infant can be expected to roll over from back to abdomen at approximately: A. 2 months B. 4 months C. 6 months D. 8 months

1. Separation anxiety is something that affects children when they are hospitalized. Each developmental stage has a somewhat different reaction as they deal with this difficulty. Which stage corresponds to the adolescent stage? A. May demonstrate separation anxiety by refusing to eat, experiencing difficulty in sleeping, crying quietly for their parents, continually asking when the parents will visit, or withdrawing from others. B. Separation anxiety comes in stages: protest, despair, and detachment. C. Loss of peer group contact may pose a severe emotional threat because of loss of group status, inability to exert group control or leadership, and loss of group acceptance. D. May need and desire parental guidance or support from other adult figures but may be unable or unwilling to ask for it.

2. A nurse looks over her assignment for the day, which includes an infant, a preschool-age child, a third-grader, and a sophomore in high school. Which techniques take into consideration developmental stages when working with pediatric patients? A. Be aware that infants will become agitated because of stranger anxiety around 4 months old. B. When a preschooler is having blood drawn, giving a detailed explanation will be helpful. C. Explain and demonstrate what the BP machine does to the third-grader before taking her blood pressure. D. Using a single consistent approach with the adolescent will help allay anger and hostility.

2. An important milestone in the infant's life is the development of object permanence. This milestone is represented by which of these statements? A. The infant smiles at the mother when she talks to him. B. The infant repeatedly flexes and extends his arms and legs when the mother picks him up. C. The infant turns and looks for the mother when she walks out of his view. D. The infant cries when the mother hands him to a babysitter.

2. Family systems theory includes: A. Direct causality, meaning each change affects the whole family B. Family systems react to changes as they take place, not initiate it C. A balance between morphogenesis and morphostasis is necessary D. Theory is used primarily for family dysfunction and pathology

3. A mother brings her 3-year-old daughter to the well-child clinic and expresses concern that the child's behavior is worrisome and possibly requires therapy or medication at minimum. The mother further explains that the child constantly responds to the mother's simple requests with a "no" answer even though the activity has been a favorite in the recent past. Furthermore, the child has had an increase in the number of temper tantrums at bedtime and refuses to go to bed. The mother is afraid her daughter will hurt herself during a temper tantrum because she holds her breath until the mother picks her up and gives in to her request. The nurse's best response to the mother is that: A. The child probably would benefit from some counseling with a trained therapist. B. The mother and father should evaluate their childrearing practices. C. The child's behavior is normal for a toddler and may represent frustration with control of her emotions; further exploration of events surrounding temper tantrums and possible interventions should be explored. D. The child's behavior is typical of toddlers, and the parents should just wait for the child to finish this phase because this will end soon.

3. An important nutritional supplement recommended to prevent rickets in infants who are exclusively breastfeeding is: A. Vitamin A B. Fluoride C. Vitamin D D. Folic acid

3. The nurse is explaining the strategy of consequences to a parent he is working with. Which response by the parent indicates that more teaching is needed when he describes the types of consequences? A. Natural: those that occur without any intervention B. Logical: those that are directly related to the rule C. Transforming: allowing the child to come to the conclusion on his or her own D. Unrelated: those that are imposed deliberately

4. A newborn whose mother is positive for Chlamydia trachomitis should be optimally treated with which of these to prevent ophthalmia? A. Silver nitrate solution (1%) B. Tetracycline ophthalmic ointment (1%) C. Oral erythromycin D. Erythromycin ophthalmic solution (0.5%)

4. An infant born at term and weighing 3.0 kg (6 lb, 6 oz) has Apgar scores of 8 and 9 at 1 and 5 minutes, respectively, and is in the nursery until the mother's blood pressure is stabilized. The infant has some tremors of the extremities but is otherwise alert and active at 4 hours of age with vital signs within normal limits for age. Prenatal history and delivery are uneventful, and the infant is appropriate for gestational age. A priority nursing intervention should include: A. Obtain vital signs every hour until stable B. Consider transferring the infant to a transitional unit for closer observation C. Obtain bedside serum glucose per standing orders D. Feed infant 20 ml of infant formula

4. The nurse is discharging an infant diagnosed with PKU from the hospital. Which statement made by the parents indicates a further need for teaching? A. "I can continue breastfeeding because breast milk is low in phenylalanine." B. "Since my baby will begin a reduced phenylalanine diet so early, it is very likely he will have little cognitive impairment." C. "I will bring my baby back to the doctor to obtain another blood sample by 4 weeks of age, since the first sample was drawn before he was 24 hours old." D. "My child should remain on the special diet, which is a diet restricted in protein and close monitoring of the phenylalineine levels."

4. The nurse recognizes that these symptoms are most likely associated with: A. Transient feeding intolerance B. Respiratory distress syndrome C. Necrotizing enterocolitis D. Bronchopulmonary dysplasia

4. Which childhood vaccine provides protection against streptococcal infections such as otitis media, sinusitis, and pneumonia? A. Rotavirus B. Hib C. Pneumococcal D. MMR

5. As the nurse caring for a culturally diverse population, it is important to understand cultural health beliefs of families. This can best be accomplished by: A. Asking the parents how their extended families feel about their child's illness B. Exploring the use of alternative medicines and therapies C. Understanding the parents' perception of the seriousness or severity of the illness or disability, as well as concerns and worries they have about the condition D. Acknowledging that language constraints may make it necessary for the health care team to make some decisions

5. Nursing care of a child in the hospital with suspected abuse should include which of the following actions? A. Assign a variety of nurses to the child so that he can get to know and trust the whole staff. B. Praise the child's ability to minimize feelings of shame and guilt. C. Treat the child as someone with a specific problem, not as an "abuse" victim, to promote self-esteem and minimize feelings of guilt. D. Talk with and ask questions as often as possible to show interest and get to know the child better.

5. Understanding autism spectrum disorders (ASDs) is very important for those who care for children. Goals of treatment for these children include: A. Helping with placement in a long-term care setting because most children cannot remain at home B. Putting the child hospitalized with an ASD in a room with another child to help him or her feel more comfortable in the strange environment C. Providing a structured routine, whether at home or in the health care setting D. Providing comfort for young children by holding or cuddling when able because the disruption of routine can be frightening

2. A child is brought to the emergency department by his parents after noted to be "acting funny" a few hours ago while he was being cared for by his grandmother. When she went to take her evening medication, the grandmother noted that her pill container had been opened and some pills were missing. The parents state that the grandmother has a heart condition. Anticipating the emergency care this child will receive, you know: A. The majority of medications have a specific antidote. B. In this case gastric lavage may be used. C. Activated charcoal will most likely be used, and it can be mixed with another drink (milk or juice) to make it more palatable. D. The main concerns are for vital sign assessment, assessment of mental status, and giving cardiac and respiratory support as needed.

3. Which vaccine do the Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists recommend that pregnant adolescents and women who are not protected against pertussis receive optimally between 27 and 36 weeks of gestation or postpartum before discharge from the hospital? A. DTaP B. Td C. IPV D. Tdap

4. Which factors are considered protective factors for sudden infant death syndrome (SIDS)? A. Side sleeping position, breastfeeding, updated childhood immunization status B. Supine sleeping position, breastfeeding, soft bedding C. Prone sleeping position, exposure to maternal tobacco use, updated childhood immunization status D. Supine sleeping position, breastfeeding, updated childhood immunization status

5. A warning sign of self-harm includes which one of the following? A. Multiple bruises on arms and legs B. Poor school performance C. Finding tobacco products hidden in the adolescent's room D. Spending long periods of time in a locked bedroom or bathroom

5. Ways to integrate spiritual practices into nursing care include: A. Explaining the religious practices you personally take part in B. Realizing that young children have little understanding regarding their spirituality C. Agreeing with children and their families when they explain their religious beliefs so they are not offended D. Becoming knowledgeable about the religious worldviews of cultural groups found in the patients you care for

2. You are working with a family with a child who has a congenital heart defect. Future surgery is planned, and you are teaching the parent how to reduce cardiac demands. The parent needs more teaching when she says which of the following? A. "I will wake my child for feeding every 2 hours so he can get enough calories to gain weight." B. "When I give the digoxin, I will listen to the pulse for 1 full minute." C. "I should protect my child from people who have respiratory infections." D. "I will count the number of wet diapers to be sure my child is not getting too much or too little fluid."

3. A 3-month-old infant is seen in the clinic with the following symptoms: irritability, crying, refusal to nurse for more than 2 to 3 minutes, rhinitis, and a rectal temperature of 101.8°F (38.8°C). The labor, delivery, and postpartum history for this term infant is unremarkable. The nurse anticipates a diagnosis of: A. Acute otitis media (AOM) B. Otitis media with effusion (OME) C. Otitis externa D. Respiratory syncitial virus (RSV)

3. When caring for a child with acute renal failure, which nursing measure requires immediate attention? A. Serum potassium concentrations in excess of 7 mEq/L B. Sodium level of 135 C. Transfusion for hemoglobin of 8 D. Mannitol and furosemide for a urine output of 2 ml/kg/hr

3. Which heart defect and hemodynamic change pairing is correct? A. Aortic stenosis and obstruction to blood flow out of the heart B. Ventricular septal defect and decreased pulmonary blood flow C. Tricuspid atresia and increased pulmonary blood flow D. Atrioventricular canal and mixed blood flow, in which saturated and desaturated blood mix within the heart or great arteries

2. In terms of social development, the school-age child does which of the following? Select all that apply. A. Begins to explore the environment beyond the family B. Has an increased interest in persons of the opposite sex (gender) C. May actively participate in same-sex groups or clubs D. Strives to be different from those in the peer group E. Begins to form strong relationships with persons of the same sex (gender)

A C E

4. You are discharging a 5-week-old infant with a congenital heart defect who will be going home on digoxin. Which of the following answers by the father indicate the need for more teaching? Select all that apply. A. "I know I give the drug carefully by slowly directing it to the side and back of the mouth." B. "I give the medication every 12 hours, and I can place it in a bit of formula so I know the baby will take it." C. "If I miss a dose, I don't give an extra dose, but I give the next dose as ordered." D. "If the baby vomits, I should give a second dose." E. "If more than two doses have been missed, I should call the doctor."

A C E

1. You are working with a new graduate on the pediatric unit and your patient is returning from the cardiac catheterization laboratory. You feel the graduate understands the important nursing interventions when she says which of the following? Select all that apply. A. "Check pulses, especially below the catheterization site, for equality and symmetry." B. "Check vital signs, which may be taken as frequently as every 30 to 45 minutes, with special emphasis on the heart rate, which is counted for 1 full minute for evidence of dysrhythmias or bradycardia." C. "Special attention needs to be given to the BP, especially for hypertension, which may indicate hemorrhage or bleeding from the catheterization site." D. "Check the dressing for evidence of bleeding or hematoma formation in the femoral or antecubital area." E. "Allow the child to ambulate because this will prevent skin breakdown from lying so long in one place."

A D

4. You tell the parent of a 4-year-old patient being admitted that you need to ask some questions. She asks, "Why do you have to ask so many questions?" Which explanations should you offer? Select all that apply. A. "It is something we are required to do for every child who is hospitalized." B. "By learning about your child's routines, we can try to minimize some of the changes he will be going through." C. "Knowing more about your child can help predict how the hospital stay will go and will also help us choose a good roommate for him when more children arrive at the hospital." D. "Gaining more information about your child, such as current medications she is taking, will help us provide the best care." E. "This will give you an opportunity to ask questions as well."

ABE

3. When discharging the pediatric patient from the outpatient setting, the nurse knows that which of the following responses indicate a need for more teaching? Select all that apply. A. "The physician said my son can have clear liquids when we return home, which would include Jell-O, pudding, and apple juice." B. "The other nurse explained that I can use other things to help with the pain, such as distraction (reading a book, music, or a movie), after the pain medication is given." C. "I can get my child's prescription tomorrow, so I can go to my regular pharmacy where they can explain the medication to me." D. "I am waiting for my husband to come so he can drive us, and I can watch my son in the car on the way home." E. "I understand that I will be contacted tomorrow for follow-up on my child but that I should not hesitate to call if I have any concerns before then."

2. Play is children's work, even in the hospital. Which of the following are functions of play? Select all that apply. A. Provides diversion and brings about relaxation B. Keeps the child occupied and directs concerns away from himself or herself C. Helps the child feel more secure in a strange environment D. Lessens the stress of separation and the feeling of homesickness E. Provides a means for release of tension and expression of feelings F. Allows the parents to have a break from the unit for a respite period

ACDE

1. Nursing care of a 9-month-old who has recently undergone cleft palate repair can be expected to include feeding with a(n): A. Plastic spoon B. Open cup C. Pigeon bottle D. Special Needs feeder

2. A 14-year-old male with a spinal cord injury is placed on a standing table and suddenly begins to sweat profusely and complain of a headache. The nurse takes a set of vital signs and notes a significant increase in systolic blood pressure and a heart rate of 50 beats per minute. The most helpful intervention in this situation would be for the nurse to: A. Place the adolescent back in his wheelchair and take him to his room B. Palpate the bladder for distention C. Administer a routine analgesic for his headache and discontinue the therapy D. Place the standing table in a horizontal position and allow the adolescent to rest for a few minutes

2. You are working with a nurse who is new to your endocrine unit and has never worked with an infant born with congenital adrenal hyperplasia (CAH). You want to make sure he has a full understanding of this diagnosis. Which statement by the nurse indicates a need for further teaching? A. "Definitive diagnosis is confirmed by evidence of increased 17-ketosteroid levels in most types of CAH." B. "Blood studies to identify elevated calcium and decreased phosphorus levels are routinely performed." C. "Another test that can be used to visualize the presence of pelvic structures such as female reproductive organs is ultrasonography." D. "This deficiency is an autosomal recessive disorder that results in improper steroid hormone synthesis."

3. A father calls the pediatrician's office concerned about his 5-year-old type 1 diabetic child who has been ill. He reports that on checking the child's urine, it was positive for ketones. What is the nurse's best response to this father? A. "Come to the office immediately." B. "Encourage the child to drink calorie-free liquids." C. "Hold the next dose of insulin." D. "Administer an extra dose of insulin now."

1. At a visit to the pediatric clinic, a mother is concerned by her 4-year-old's symptoms over the last few weeks. Which of the following symptoms described by the mother would lead the nurse to be concerned about an oncologic disorder? Select all that apply. A. Bruising in various stages, mainly on the legs B. Frequent complaints of respiratory infections, while siblings remain healthy C. Enlarged, firm lymph nodes D. Asthma symptoms with increase in wheezing E. Fever for more than 1 week

B C E

5. While orienting a new nurse to the ICU, she asks, "How do these children sleep and not become frightened with all the lights and noises?" How should you respond? Select all that apply. A. "These children are sicker than those on the pediatric unit, so the noises and lights are necessary." B. "We try to organize care into clusters so that infants and children can sleep and we can turn down lights." C. "We silence alarms to allow for periods of sleep, especially at night." D. "When possible, we allow for uninterrupted sleep cycles—for infants 90 minutes and for older children 60 minutes." E. "We encourage parents to sit with and touch their child as often as possible."

B E

1. Because injuries are the most common cause of death and disability in children in the United States, which stage of development correctly determines the type of injury that may occur? Select all that apply. A. A newborn may roll over and fall off an elevated surface. B. The need to conform and gain acceptance from his peers may make a child accept a dare. C. Toddlers who can run and climb may be susceptible to burns, falls, and collisions with objects. D. A preschooler may ride her two-wheel bike in a reckless manner. E. A crawling infant may aspirate due to the tendency to place objects in his mouth

B,C,E

1. Duvall's Developmental Stages of the Family include which of the following? Select all that apply. A. Stages an individual progresses through in his or her moral and spiritual development B. Stages families progress through in adulthood C. Stages that designate how parenting progresses as a child develops D. Stages that designate appropriate discipline related to developmental stages E. Stages that describe the journey a couple will take as their children mature

B,C,E

1. A 12-year-old child is in the urgent care clinic with a complaint of fever, headache, and sore throat. A diagnosis of group A β-hemolytic streptococcus (GABHS) pharyngitis is established with a rapid-strep test, and oral penicillin is prescribed. The nurse knows that which of the following statements about GABHS is correct? A. Children with a GABHS infection are less likely to contract the illness again after the antibiotic regimen is completed. B. A follow-up throat culture is recommended after the completion of antibiotic therapy. C. Children with a GABHS infection are at increased risk for the development of rheumatic fever and glomerulonephritis. D. Children with a GABHS infection are at increased risk for the development of rheumatoid arthritis in adulthood.

1. Which of the following should be used in the care of all pediatric patients to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection? A. Transmission-Based Precautions B. Airborne Precautions C. Standard Precautions D. Droplet Precautions

6. A 10-year-old child suffered extensive second- and third-degree burns in an apartment fire. His weight is 75 lb (34 kg). Fluid replacement therapy will optimally: A. Result in an hourly urine output of 1 ml/kg B. Result in an hourly urine output of 20 ml/kg C. Result in an hourly urine output of 30 ml/kg D. Maintain a systolic blood pressure in the 95th percentile for the child's weight

2. A new nurse is caring for a child with a wound and asks you to remind her about the phases of wound healing. You describe the order as: a. Contraction: Fibroblast movement causes contraction of the healing area, which helps bring wound edges closer together. b. Maturation: The scar becomes pale, does not tan when exposed to sunlight, will not sweat or produce hair, and may itch. c. Inflammatory phase: Erythema, heat, edema, pain, and functional disturbance occur. d. Proliferation: Fibroblasts, immature connective tissue cells, migrate to the healing site and begin to secrete collagen into the meshwork spaces.

C D A B

5. At an appointment at the pediatrician's office, a patient's mother states, "My son gets rough with some of the neighborhood kids. I am worried that he is becoming a bully." Which statements by the mother need more teaching? Select all that apply. A. When my son becomes aggressive, I feel he needs to be punished. B. I think it is good for him to bond with his dad, so they often watch TV together. C. I am trying to get him to learn to say what he is upset about in words. D. Boys will be boys, so I think this can be considered a normal stage in development. E. I am thinking that a time-out would be a better strategy than spanking when my son shows this behavior.

C E

1. When caring for their infant, a parent asks you, "Is Emily in a lot of pain? How would you know since she can't really tell you?" The best answer to this question is: A. "Infants don't feel pain as we do because their pain receptors are not fully developed yet." B. "The nurses give pain medication before she really feels the pain." C. "We assess her pain using an infant pain assessment tool and give the medicine as needed." D. "Although we try to give her medicine before she feels pain, we watch her very closely and use different techniques to help relieve the pain."

1. You are the nurse assigned to care for a child with a basilar skull fracture. Your most important nursing observation is change in level of consciousness. You will be highly alert for: A. Alterations in vital signs that often appear before alterations in consciousness or focal neurologic signs B. Bleeding from the ear, which is indicative of an anterior basal skull fracture C. Seizures that are relatively uncommon in children at the time of head injury D. Changes in posturing, such as any signs of extension or flexion posturing, unusual response to stimuli, and random versus purposeful movement

1.When caring for a child with a cleft lip, a parent asks the nurse, "Did I cause this defect in my child?" What is the best response by the nurse? A. "There are many things about embryo development we do not know; it is not you." B. "Cleft lip is an example of a disruption and occurs early in the pregnancy, often before you even know you are pregnant." C. "Is there something you took while you were pregnant?" D. "Early in the pregnancy there may be an abnormality in the developmental process; the reasons for this are largely still unknown."

2. A 12-year-old who was in an ATV accident has a long-leg fiberglass cast on his left leg for a tibia-fibula fracture. He requests pain medication at 2:00 AM for pain he rates at a 10/10 on the numeric scale. The nurse brings the pain medication and notes that he has removed the pillows that kept his leg elevated. He complains of pain in the left foot, and she notes that there is 3+ edema in the exposed leg and foot and she is unable to slip a finger under the cast. The nurse's priority interventions in this situation should include: A. Administer the pain medication and elevate the child's leg on the pillows B. Elevate the leg on the pillows and follow up within 2 to 3 hours to see if the edema has decreased C. Let the child know he cannot have any additional pain medication until 6:00 AM D. Notify the surgeon of the findings immediately

4. You are caring for a child with hydrocephalus who is postoperative from a shunt revision. Which assessment finding is your priority for increased intercranial pressure? A. Nausea and refusal to eat postoperatively B. Complaint of a headache C. Irritability and wanting to sleep D. Decrease in heart rate over the last hour

5. You are caring for a child on the pediatric unit with a suspected abdominal tumor. Which criterion would lead you to determine that this tumor is a neuroblastoma rather than a Wilms tumor? A. Most children present with neuroblastoma around age 4. B. Neuroblastoma is a firm, nontender, irregular mass confined to one side, generally deep in the flank. C. Hypertension is often noted due to secretion of excess amounts of rennin by the tumor. D. Most tumors develop in the adrenal gland or the retroperitoneal sympathetic chain.

1. Vitamin A may be administered in significant amounts to children with this childhood communicable illness to decrease morbidity and mortality: A. Pertussis B. Varicella C. Rubella D. Measles

D - RUBEOLA

5. In addition to hypoglycemia, the infant of a diabetic mother should be observed for: A. Hydrocephalus B. Hyperglycemia C. Respiratory distress D. Sepsis

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