Test 1

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

ANS: C Visual fixation and following a target should be present by ages 3 to 4 months. Ages 1 to 2 months are is too young for this developmental milestone. If the infant is not able to fix and follow by 6 months of age, further ophthalmologic evaluation is needed.

141 Which parameter correlates best with measurements of the body's total protein stores? a. Height b. Weight c. Skin-fold thickness d. Upper arm circumference

ANS: D Upper arm circumference is correlated with measurements of total muscle mass. Muscle serves as the body's major protein reserve and is considered an index of the body's protein stores. Height is reflective of past nutritional status. Weight is indicative of current nutritional status. Skin-fold thickness is a measurement of the body's fat content.

216 Which pain scale would be most appropriate to assess a 3 year old? A. Numeric Scale B. FACES C. CRIES D. Modified Behavioral Pain Scale

B. FACES

198 When using the pediatric triangle during a physical assessment which of the following is not part of the triangle. A. Appearance B. Height and Weight C. Work of Breathing D. Circulation

B. Height and Weight

236 Which of the following should you NOT do when talking with a child who you suspect has been abused? A. Provide the child with privacy. B. Promise that you will not tell anyone what they say. C. Use their vocabulary to discuss body parts. D. Reassure them that they are doing the right thing by telling.

B. Promise that you will not tell anyone what they say.

182 Mild cases of cognitive impairment are primarily associated with: A. Familiar causes B. Social causes C. Environmental causes D. All of the above

D. All of the above

217 A child is hyperventilating with gasping and labored respirations. The nurse would document this as what type of respirations? A. Tachypnea B. Hyperpnea C. Cheyne-Stokes respirations D. Kussmaul respirations

D. Kussmaul respirations

349 Seborrheic Dermatitis

-A skin condition that causes scaly patches and red skin, mainly on the scalp.

359 A nurse is evaluating the developmental level of a 2-year-old. Which of the following does the nurse expect to observe in this child?

-Uses a cup to drink -can also use spoons but not forks or knives

269 What puts child at risk for vitamin d deficiency rickets?

-a family that uses yogurt as primary source of milk

313 Some preschoolers may view hospitalization as

-a punishment

310 posterior fontanelle closes

-between 6-8 weeks

255 Finger to nose test tests for..

-cerebellar function

304 What is a leading cause of death of infants less than a year old?

-congenital anomalies

273 most common child food allergies are

-eggs, cows milk, peanuts

342 when do teeth usually start coming in

-first 2 years of life

301 marasmus is which of the following

-not confined to georgraphic areas where food supplies are inadequate

324 fine motor 10 months

-pincer grasp

261 in terms of fine motor development, a 7 month old should be able to..

-transfer object from one hand to the other

262 according to erickson, infancy is concerned with acquiring a sense of which of the following?

-trust

303 during 2 month old well-child checkup, child should respond to sound by:

-turning head to side where sound is heard at ear level

270 Deficiency of which vitamin is correlated with increased morbidity/mortality and complications from diarrhea and infections

-vitamin A

256 Denver test tells us

-what a child can do at a certain age

334 Munchausen Syndrome by Proxy

-when a person induces or fabricates an illness on another person -can take many forms and is difficult to prove -mother is usually the perpetrator -unexplained, prolonged, recurrent, or extremely rare illnesses

250 Which is descriptive of a family systems theory?

-when the system is interrupted, change can occur at any point in the system

362 The mother of a toddler asks a nurse when it is safe to place the car safety seat in a face-forward position. The best nursing response is which of the following?

-when toddler weighs 20 pounds

-4 years usually start swim lessons

345 most infant deaths occur at what ages

-6-12 months

346 What is kwashiorkor?

331 What is neglect?

failure to provide child with basic needs (food, clothing, shelter) emotional needs (love, nurturing), educational needs (development and cognitive intellectual skills)

13 A nurse is conducting an admission interview with the mother of a 2 year old child. What history question is most important at this time? a. How many children are in the family? b. What is your child's normal routine? c. Does your child attend daycare? d. What toys are most important to your child?

b. What is your child's normal routine?

16 A six year old is in the recovery room following an appendectomy. He is not yet fully awake, though he opens his eyes when his name is called. Which pain assessment tool would be most effective for the nurse to use at this time? a. OUCHER assessment tool. b. Wong's FACES assessment tool. c. FLAACC pain assessment tool. d. 1-10 verbal assessment scale.

c. FLAACC pain assessment tool.

319 height should increase by ___ each month for first 6 months

-1 inch

315 toddlers can drown in

-1/4 inch of water

328 when does meaning of words start to occur?

-10-11 months

368 The nurse would advise a parent when introducing solid foods to:

-4-7 days apart to determine tolerance

340 Child will experience separation anxiety at

-4-8 months

366 The parent of a 3-month-old infant asks the nurse, "At what age do infants usually begin drinking from a cup?" The nurse would reply:

-5 months

312 at what age to infants usually fear strangers

-6 months

352 What is some necessary anticipatory guidance at 12 to 18 Months?

-Prepare parent for expected behavioral changes -Weaning from bottle and increase of solids -Sleep patterns- familiar items -Discipline -limit eye contact -Time-outs -Need for periodic separation Toys

356 A mother of a 3-year-old tells a clinic nurse that the child is rebelling constantly and having temper tantrums. The nurse most appropriately tells the mother to:

-Set limits on the child's behavior even though this is normal behavior for the age group

332 What is sexual abuse?

-The employment, use, or persuasion, endusement, entisement, or coersion to engage in or assist any person to engage in sexually explicit conduct or any simulation of sexual conduct to produce visual depiction of sexual acts

263 which behavior shows that a child has devleoped object permanence

-actively searching for a hidden objectt

333 What is emotional abuse?

-acts or omissions that have caused or couldcause serious behavioral cognitive emotional or mental disorders.

309 At what age would a child feel guilty or responsible for their parents' divorce?

-age 4

293 When interviewing a 14 year old..

-allow an opportunity to express feelings

339 More likely to develop ______ at 2-3 months of age because of shortened lifespan of RBC

-anemia

321 fine motor development 2-3 months

-can grasp an object

299 where do eczematous lesions most commonly occur in the infant

-cheeks, extensor surfaces of arms and legs

276 one child grabs a toy from another child... this most likley occurs because

-child is egocentric

266 if a mother is discontinuing breast feeding to her 5 month old, nurse should recommend..

-commercial iron fortified formula

369 When assessing development in a 9-month-old infant, the nurse would expect to observe the infant:

-creeping along the floor

290 9 year old boy states he does not want to lose blood before a blood draw. action by nurse:

-discuss with him how the body is always making new blood

320 height is _____ by 1 year old

-doubled

296 mother says "all this baby does is scream and cry, it is a constant worry" nurse response:

-encourage the mother to verbalize feelings

271 what are good sources of potassium

-grains and legumes

272 which is most descriptive of kwashiorkor

-has a multifactorial etiology

325 gross motor 4 months

-head control

291 most important criteria to base decision of whether to report abuse on a child is ..

-incompatibility between history and injury observed

285 most important step for kids with special needs

-incorporating them into the normal classroom

327 gross motor 10 months

-infant can move from prone to sitting

279 preschooler fears can be best dealt with by..

-involving them in finding practical methods to deal with frightening experience

265 infants become less difficult if..

-kept on scheduled feedings and structured routines

317 what is a low birth weight?

-less than 2500 g

367 The nurse would expect a 4-month-old to be able to:

-lift head and shoulders.A parent brings a 6-month-old infant to the pediatric clinic for her well-baby examination. Her birth weight was 8 pounds, 2 ounces. The nurse weighing the infant today would expect her weight to be at least _____ pounds. about 16 pounds -birth weight should be doubled

347 What is marasmus?

-malnutrition of both calories and protein, gradual wasting, flabby and wrinkled, atrophy

252 Which is an example of secondary prevention

-mental health counseling

251 What is a characteristic of children who are the youngest in their family

-more affectionate than firstborn

246 What are the leading unintential cause of death in children

-motor vehicles

341 should you microwave breast milk?

-no because it separates and nutrients die

372 A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. The nurse should interpret this as:

-normal development

292 6 month old child begins sucking thumb. This is..

-normal for this age

249 The father of hospitalized child says "he can't have meat, we are buddhist and vegetarian. What is the appropriate nursing action?

-order him a meatless tray

277 best action to deal with temper tantrums

-parents should stay close by but ignore the behaviors

247 What is an example of nursing intervention for atraumatic care in children

-preparing child before any unfamiliar tx or procedure

288 initial indication of puberty in girls is..

-pubic hair and breast development

264 parents complain about fussy 10-week old child even after feedings and when dry. nurse response is:

-random fussiness at this age is normal

336 What is the rate of head circumference growth?

-rapid from birth date to 3 years, then slows

363 A mother calls the pediatrician's office because her infant is "colicky." The helpful measure the nurse would suggest to the parent is to:

-rock the fussy infant slowly and gently. -be careful to avoid sudden movements!!!

267 what info should nurse tell a mother introducing solid foods during infancy

-should be tried every 5-7 days

302 which are leading causes of death in adolescents and young adults ages 15-24

-suicide, homocide

282 moral development in younger school aged child

-they know the rules but may not understand why they are in place

365 Earliest age when a child should be able to walk independently

12-15 months

364 Infant should be able to sit up alone at ____ months

8 months

229 At what age do infants become eligible to receive the DTaP vaccination? A. 2 months B. Birth C. 1 month D. 19 months

A. 2 months

208 Birth defects occur in ___ to ___% of all live-born children. A. 2-4 B. 10-15 C. 7-12 D. 17-20

A. 2-4

178 At what age can children begin receiving their yearly influenza vaccine? A. Beginning at 6 months B. beginning at 2 months C. Beginning at 2 years old D. Beginning at 5 years old

A. Beginning at 6 months

196 This communicable disease gives children a slapped face appearance: A. Fifth Disease B. Scarlet Fever C. Measles D. Roseola

A. Fifth Disease

212 The most common symptom of Giardiasis is _________ . A. Perirectal itching B. Nausea & Vomiting C. Fever D. Rash

A. Perirectal itching

215 One of the most common concerns of parents relates to: A. Sleep B. Eating C. Genitourinary problems D. Growth & Development

A. Sleep

205 Which of the following symptoms would you expect to see in a child with lead poisoning? A. Sleepiness B. Tinnitus C. Increased appetite D. High fever

A. Sleepiness

168 What type of family is one in which all members are considered "blood relatives"? a. Consanguineous c. Family of origin b. Affinal d. Household

ANS: A A consanguineous family is one of the most common types and consists of members who have a blood relationship. The affinal family is one made up of marital relationships. Although the parents are married, they may each bring children from a previous relationship. The family of origin is the family unit that a person is born into. Considerable controversy has been generated about the newer concepts of families (i.e., communal, single-parent or homosexual families). To accommodate these other varieties of family styles, the descriptive term household is frequently used.

174 When assessing a family, the nurse determines that the parents exert little or no control over their children. This style of parenting is called: a. Permissive. c. Democratic. b. Dictatorial. d. Authoritarian.

ANS: A Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their children's actions. Dictatorial or authoritarian parents attempt to control their children's behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their children's behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect the child's individual nature.

44 The nurse is preparing a 12-year-old girl for a bone marrow aspiration. She tells the nurse that she wants her mother with her "like before." The most appropriate nursing action is to: a. Grant her request. b. Explain why this is not possible. c. Identify an appropriate substitute for her mother. d. Offer to provide support to her during the procedure.

ANS: A The parents' preferences for assisting, observing, or waiting outside the room should be assessed, as well as the child's preference for parental presence. The child's choice should be respected. If the mother and child are agreeable, the mother is welcome to stay. An appropriate substitute for the mother is necessary only if the mother does not wish to stay. Support is offered to the child regardless of parental presence.

150 The nurse has just started assessing a young child who is febrile and appears very ill. There is hyperextension of the child's head (opisthotonos) with pain on flexion. The most appropriate action is to: a. Refer for immediate medical evaluation. b. Continue assessment to determine cause of neck pain. c. Ask parent when neck was injured. d. Record "head lag" on assessment record and continue assessment of child.

ANS: A These symptoms indicate meningeal irritation and needs immediate evaluation. Continuing the assessment is not necessary. No indication of injury is present. This is not descriptive of head lag.

172 Nicole and Kelly, age 5 years, are identical twins. Their parents tell the nurse that the girls always want to be together. The nurse's suggestions should be based on knowing that: a. Some twins thrive best when they are constantly together. b. Individuation cannot occur if twins are together too much. c. Separating twins at an early age helps them develop mentally. d. When twins are constantly together, pathologic bonding occurs.

ANS: A Twins work out a relationship that is reasonably satisfactory to both. They develop a remarkable capacity for cooperative play and considerable loyalty and generosity toward each other. Parents should foster individual differences and allow the children to follow their natural inclinations. Individuation does occur. In twinship one member of the pair is more dominant, outgoing, and assertive than the other. Early separation may produce unnecessary stresses for the children. There is no evidence that pathologic bonding occurs.

157 What type of breath sound is normally heard over the entire surface of the lungs except for the upper intrascapular area and the area beneath the manubrium? a. Vesicular b. Bronchial c. Adventitious d. Bronchovesicular

ANS: A Vesicular breath sounds are heard over the entire surface of lungs, with the exception of the upper intrascapular area and the area beneath the manubrium. Bronchial breath sounds are heard only over the trachea near the suprasternal notch. Adventitious breath sounds are not usually heard over the chest. These sounds occur in addition to normal or abnormal breath sounds. Bronchovesicular breath sounds are heard over the manubrium and in the upper intrascapular regions where trachea and bronchi bifurcate.

52 The nurse wore gloves during a dressing change. When the gloves are removed, the nurse should: a. Wash hands thoroughly. b. Check the gloves for leaks. c. Rinse gloves in disinfectant solution. d. Apply new gloves before touching the next patient.

ANS: A When gloves are worn, the hands are washed thoroughly after removing the gloves because both latex and vinyl gloves fail to provide complete protection. Gloves should be disposed of after use and hands should be thoroughly washed again before new gloves are applied.

133 When the nurse interviews an adolescent, it is especially important to: a. Focus the discussion on the peer group. b. Allow an opportunity to express feelings. c. Emphasize that confidentiality will always be maintained. d. Use the same type of language as the adolescent.

ANS: B Adolescents, like all children, need an opportunity to express their feelings. Often they will interject feelings into their words. The nurse must be alert to the words and feelings expressed. Although the peer group is important to this age group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently.

55 A venipuncture will be performed on a 7-year-old girl. She wants her mother to hold her during the procedure. The nurse should recognize that this: a. Is unsafe. b. May help the child relax. c. Is against hospital policy. d. Is unnecessary because of the child's age.

ANS: B Both the mother's preference for assisting, observing, or waiting outside the room and the child's preference for parental presence should be assessed. The child's choice should be respected. This will most likely help the child through the procedure. If the mother and child are agreeable, the mother is welcome to stay. Her familiarity with the procedure should be assessed, and potential safety risks identified (mother may sit in chair). Hospital policies should be reviewed to ensure that they incorporate family-centered care

145 Which tool measures body fat most accurately? a. Stadiometer b. Calipers c. Cloth tape measure d. Paper or metal tape measure

ANS: B Calipers are used to measure skin-fold thickness, which is an indicator of body fat content. Stadiometers are used to measure height. Cloth tape measures should not be used because they can stretch. Paper or metal tape measures can be used for recumbent lengths and other body measurements that must be made.

135 The nurse is taking a health history on an adolescent. What best describes how the chief complaint should be determined? a. Ask for detailed listing of symptoms. b. Ask adolescent, "Why did you come here today?" c. Use what adolescent says to determine, in correct medical terminology, what the problem is. d. Interview parent away from adolescent to determine chief complaint.

ANS: B The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. Because the adolescent is the focus of the history, this is an appropriate way to determine the chief complaint. A listing of symptoms will make it difficult to determine the chief complaint. The adolescent should be prompted to tell which symptom caused him to seek help at this time. The chief complaint is usually written in the words that the parent or adolescent uses to describe the reason for seeking help. The parent and adolescent may be interviewed separately, but the nurse should determine the reason the adolescent is seeking attention at this time.

164 Kimberly is having a checkup before starting kindergarten. The nurse asks her to do the "finger-to-nose" test. The nurse is testing for: a. Deep tendon reflexes. b. Cerebellar function. c. Sensory discrimination. d. Ability to follow directions.

ANS: B The finger-to-nose-test is an indication of cerebellar function. This test checks balance and coordination. Each deep tendon reflex is tested separately. Each sense is tested separately. Although this test enables the nurse to evaluate the child's ability to follow directions, it is used primarily for cerebellar function.

107 Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period? a. Codeine b. Morphine c. Methadone d. Meperidine

ANS: B The most commonly prescribed medications for PCA are morphine, hydromorphone, and fentanyl. Parenteral use of codeine is not recommended. Methadone is not available in parenteral form in the United States. Meperidine is not used for continuous and extended pain relief.

156 The appropriate placement of a tongue blade for assessment of the mouth and throat is the: a. Center back area of tongue. b. Side of the tongue. c. Against the soft palate. d. On the lower jaw.

ANS: B The side of the tongue is the correct position. It avoids the gag reflex yet allows visualization. Placement on the center back area of the tongue elicits the gag reflex. Against the soft palate and on the lower jaw are not appropriate places for the tongue blade.

165 The nurse must check vital signs on a 2-year-old boy who is brought to the clinic for his 24-month checkup. Which criteria should the nurse use in determining the appropriate-size blood pressure cuff? Choose all that apply. a. The cuff is labeled "toddler." b. The cuff bladder width is approximately 40% of the circumference of the upper arm. c. The cuff bladder length covers 80% to 100% of the circumference of the upper arm. d. The cuff bladder covers 50% to 66% of the length of the upper arm.

ANS: B, C Research has demonstrated that cuff selection with a bladder width that is 40% of the arm circumference will usually have a bladder length that is 80% to 100% of the upper arm circumference. This size cuff will most accurately reflect measured radial artery pressure. The name of the cuff is a representative size that may not be suitable for any individual child. Choosing a cuff by limb circumference more accurately reflects arterial pressure than choosing a cuff by length.

143 With the National Center for Health Statistics (NCHS) criteria, which body mass index (BMI)-for-age percentile indicates a risk for being overweight? a. 10th percentile b. 9th percentile c. 85th percentile d. 95th percentile

ANS: C Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children in the 9th and 10th percentiles are within normal limits. Children who are greater than or equal to the 95th percentile are considered overweight.

46 In some genetically susceptible children anesthetic agents can trigger malignant hyperthermia. The nurse should be alert in observing that, in addition to an increased temperature, an early sign of this disorder is: a. Apnea. b. Bradycardia. c. Muscle rigidity. d. Decreased blood pressure.

ANS: C Early signs of malignant hyperthermia include tachycardia, increasing blood pressure, tachypnea, mottled skin, and muscle rigidity. Apnea is not a sign of malignant hyperthermia. Tachycardia, not bradycardia, is an early sign of malignant hyperthermia. Increased, not decreased, blood pressure is characteristic of malignant hyperthermia.

167 Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? a. Family systems theory c. Family stress theory b. Developmental theory d. Family assessment

ANS: C Family stress theory explains the reaction of families to stressful events. In addition, crisis intervention strategies are used to help family members cope with the challenging event. In the family systems theory, the focus is on the interaction of family members within the larger environment. In the developmental theory the nurse provides anticipatory guidance to help family members cope with the challenging event. Family assessment is not a theory. An assessment is necessary to discover the family's dynamics, strengths and weaknesses.

142 An appropriate approach to performing a physical assessment on a toddler is to: a. Always proceed in a head-to-toe direction. b. Perform traumatic procedures first. c. Use minimal physical contact initially. d. Demonstrate use of equipment.

ANS: C Parents can remove clothing, and the child can remain on the parent's lap. The nurse should use minimal physical contact initially to gain the child's cooperation. The head-to-toe assessment can be done in older children but usually must be adapted in younger children. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for this age group.

148 Where is the best place to observe for the presence of petechiae in dark-skinned individuals? a. Face b. Buttocks c. Oral mucosa d. Palms and soles

ANS: C Petechiae, small distinct pinpoint hemorrhages, are difficult to see in dark skin unless they are in the mouth or conjunctiva.

40 What should the nurse consider when having consent forms signed for surgery and procedures on children? a. Only a parent or legal guardian can give consent. b. The person giving consent must be at least 18 years old. c. The risks and benefits of a procedure are part of the consent process. d. A mental age of 7 years or older is required for a consent to be considered "informed."

ANS: C The informed consent must include the nature of the procedure, benefits and risks, and alternatives to the procedure. In special circumstances such as emancipated minors, the consent can be given by someone younger than 18 years without the parent or legal guardian. A mental age of 7 years is too young for consent to be informed.

82 Because of their striving for independence and productivity, which age group of children is particularly vulnerable to events that may lessen their feeling of control and power? a. Infants b. Toddlers c. Preschoolers d. School-age children

ANS: D When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurps individual power and identity. This is especially detrimental to school-age children, who are striving for independence and productivity and are now experiencing events that lessen their control and power. Infants, toddlers, and preschoolers, although affected by loss of power, are not as significantly affected as are school-age children.

151 The nurse should expect the anterior fontanel to close at age: a. 2 months b. 2 to 4 months c. 6 to 8 months d. 12 to 18 months

ANS: D Ages 2 through 8 months are too early. The expected closure of the anterior fontanel occurs between ages 12 and 18 months; if it closes at these earlier ages, the child should be referred for further evaluation.

159 The nurse must assess a child's capillary filling time. This can be accomplished by: a. Inspecting the chest. b. Auscultating the heart. c. Palpating the apical pulse. d. Palpating the skin to produce a slight blanching.

ANS: D Capillary filling time is assessed by pressing lightly on the skin to produce blanching and then noting the amount of time it takes for the blanched area to refill. Inspecting the chest, auscultating the heart, and palpating the apical pulse will not provide an assessment of capillary filling time.

134 The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique might be most helpful? a. Suggest that the child keep a diary. b. Suggest that the parent read fairy tales to the child. c. Ask the parent if the child is always uncommunicative. d. Ask the child to draw a picture.

ANS: D Drawing is one of the most valuable forms of communication. Children's drawings tell a great deal about them because they are projections of the child's inner self. It would be difficult for a 6-year-old child to keep a diary, since the child is most likely learning to read. Reading fairy tales to the child is a passive activity involving the parent and child. It would not facilitate communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers, not necessarily uncommunicative.

171 What applies to the rate of frequency of monozygotic (identical) twins being born? a. The rate is affected by heredity. c. It varies among races. b. The rate is affected by maternal age. d. It occurs uniformly in all populations.

ANS: D Monozygotic twins occur with the same frequency uniformly in all populations. The tendency toward monozygotic twins is unaffected by heredity. Monozygotic twins are not affected by maternal age, but higher-order births are. The frequency is uniform among races.

105 Physiologic measurements in children's pain assessment are: a. The best indicator of pain in children of all ages. b. Essential to determine whether a child is telling the truth about pain. c. Of most value when children also report having pain. d. Of limited value as sole indicator of pain.

ANS: D Physiologic manifestations of pain may vary considerably, not providing a consistent measure of pain. Heart rate may increase or decrease. The same signs that may suggest fear, anxiety, or anger also indicate pain. In chronic pain the body adapts, and these signs decrease or stabilize. These are of limited value and must be viewed in the context of a pain-rating scale, behavioral assessment, and parental report. When the child states that pain exists, it does. That is the truth.

149 When palpating the child's cervical lymph nodes, the nurse notes that they are tender, enlarged, and warm. The best explanation for this is: a. Some form of cancer. b. Local scalp infection common in children. c. Infection or inflammation distal to the site. d. Infection or inflammation close to the site.

ANS: D Small nontender nodes are normal. Tender, enlarged, and warm lymph nodes may indicate infection or inflammation close to their location. Tender lymph nodes do not usually indicate cancer. A scalp infection usually does not cause inflamed lymph nodes. The lymph nodes close to the site of inflammation or infection would be inflamed.

154 The most frequently used test for measuring visual acuity is the: a. Denver Eye Screening test. b. Allen picture card test. c. Ishihara vision test. d. Snellen letter chart.

ANS: D The Snellen letter chart, which consists of lines of letters of decreasing size, is the most frequently used test for visual acuity. Single cards (Denver—letter E; Allen—pictures) are used for children age 2 years and older who are unable to use the Snellen letter chart. The Ishihara vision test is used for color vision.

104 Kyle, age 6 months, is brought to the clinic. His parent says, "I think he hurts. He cries and rolls his head from side to side a lot." This most likely suggests which feature of pain? a. Type b. Severity c. Duration d. Location

ANS: D The child is displaying a local sign of pain. Rolling the head from side to side and pulling at ears indicate pain in the ear. The child's behavior indicates the location of the pain. The behavior does not provide information about the type, severity, or duration.

188 Identify which response is appropriate from a nurse who is constantly answering with "No." A. "May I listen to your heart?" B. "I am going to take your temperature now." C. "Will you tell me your name?" D. "Do you want to eat ice cream?"

B. "I am going to take your temperature now."

204 When interviewing an adolescent what is not a correct communication technique? A. "When you say you have been "messing around", do you mean you have been having sex?" B. "You have never smoked or drank alcohol, have you?" C. "Help me better understand why you think you are different than your classmates?" D. "You stated you can't sleep at night because you are nervous, what are you nervous about?"

B. "You have never smoked or drank alcohol, have you?"

209 Children possess the physiologic ability to control the release of their sphincters beginning between ages ___ and ___ months. A. 12-18 B. 18-24 C. 24-32 D. 24-36

B. 18-24

228 Which is normal growth and development for an 8 month old infant? A. Sits for short periods using hands for support. B. Anxiety with strangers. C. Expressions like "dada" may be heard. D. Can bring objects to mouth at will.

B. Anxiety with strangers.

176 What growth and development skills go along with a 4-year old? A. Ties shoes, dresses without help, and skips on alternate feet B. Brushes teeth, 1500 word vocabulary, and can lace their own shoes C. Undresses without help and walks down stairs without help D. 2100 word vocabulary, beginning cooperative play, and runs well

B. Brushes teeth, 1500 word vocabulary, and can lace their own shoes

244 A cognitive process through which the nurse appreciates and is sensitive to the cultural values of the patient and family is A. Cultural knowledge B. Cultural awareness C. Cultural desire D. Cultural skill

B. Cultural awareness

239 Which childhood communicable disease is caused by Paramyxovirus? A. Exanthem Subitum (Roseola Infantum) B. Mumps C. Scarlet Fever

B. Mumps

201 Level of prevention that includes screening and early diagnosis A. Primary B. Secondary C. Tertiary D. All of the above

B. Secondary

218 A child could get lead poisoning from all of the following except: A. Paint B. Sexual contact C. Water D. Pottery and/or Dishes

B. Sexual Contact

193 A woman takes her one year old child to the emergency room after reporting that she shook her baby to make him stop crying. What kind of injury would cause the ER nurse the most concern? A. Bruising on abdomen B. Subdural hematoma C. Broken ribs D. Abdominal lacerations

B. Subdural hematoma

195 Amniocentesis is an invasive prenatal diagnostic test that: A. Obtains a small sample of chorionic villi. B. Tests fetal skin cells that are present in the amniotic fluid. C. Obtains a sample of the fetus's blood. D. None of the above

B. Tests fetal skin cells that are present in the amniotic fluid.

226 What is one community sponsored service for latchkey children? A. classes for these children to learn self-help skills B. after school programs C. counseling on maintaining relationships wiht peers D. readily availible child care services

B. after school programs

220 By 2.5 years birth weight should be? A. doubled B. quadrupled C. tripled D. 5x

B. quadrupled

Which is an important consideration when using the FACES Pain Rating Scale with children? 181 A. Children color the face with the color they choose to best describe their pain B. The scale can be used with most children as young as 3 years of age C. The scale is not appropriate for use with adolescents D. The scale is useful in pain assessment but is not as accurate when assessing physiologic responses

B. the scale can be used with most children as young as 3 years of age

237 What is an example of a good "I" message? A. "I think that it is a good idea to eat happy meals for dinner every night." B. "I hear that you are skipping class and drinking with your friends." C. "I am concerned about your high salt intake and how it is increasing your blood pressure."

C. "I am concerned about your high salt intake and how it is increasing your blood pressure."

234 Which of the following questions would be appropriate to ask a child who is experiencing negativism? A. "Do you want vegetables with your lunch?" B. "Can I take your temperature?" C. "Would you rather have carrots or green beans with your supper?" D. "Can you pick up your toys?"

C. "Would you rather have carrots or green beans with your supper?"

232 How much weight schould school-age children generally gain each year? A. 1-2 lbs B. 3.5-4.5 lbs C. 4.5-6.5 lbs D. 7-9 lbs

C. 4.5-6.5 lbs

242 Families with children make up what percentage of the homeless population? A. 10% B. 20% C. 40% D. 50%

C. 40%

245 The normal resting heart rate for children 2-10yrs old is A. 100-220 B. 80-150 C. 70-110 D. 55-90

C. 70-110

243 The nurse is teaching the parents of a school-aged child. What teahing topic should take priority? A. Keep a night light on to allay fears B. Encouraging the child to dress without help C. Accident prevention D. Explain the normalcy of fears about body integrity

C. Accident prevention

214 This Dietary Reference Intake set is based on estimates of nutrient intake by healthy groups? A. Estimated Average Requirement B. Recommended Dietary Allowance C. Adequate Intake D. Tolerable Upper Intake Level

C. Adequate Intake

185 A 2 year old is in for a yearly check-up. What would the nurse expect the toddler to have a fear of? A. Loud noises, sudden movements B. Death, being alone C. Animals, strangers D. Ghosts, heights

C. Animals, strangers

206 A 2 year old is in for a yearly check-up. What would the nurse expect the toddler to have a fear of? A. Loud noises, sudden movements B. Death, being alone C. Animals, strangers D. Ghosts, heights

C. Animals, strangers

177 At what age should routine lab work of Hb/Hct be performed? A. After 18 months B. Between 18 months and 2 years and again between 4 and 6 years C. Between 6 and 9 months and again between 12 and 18 months D. Between 2 and 4 months and again at age 5

C. Between 6 and 9 months and again between 12 and 18 months

199 Which childhood illness presents with a "slapped face" appearance? A. Roseola B. Mumps C. Erythema Infectiosum (Fifth Disease) D. Rubeola (Measles)

C. Erythema Infectiosum (Fifth Disease)

179 Which of the following is not an example of a behavior exhibited by an adolescent related to divorce? A. Worry about themselves, parents, siblings B. May engage in acting-out behavior C. Panic reactions D. Feelings of a profound sense if loss - of family, childhood

C. Panic reactions

222 A signature manifestation of which disease is the appearance of a red strawberry tongue? A. Strep Throat B. Rubella (German Measles) C. Scarlet Fever D. Chicken Pox

C. Scarlet Fever

202 A child is having issues with sudden bed wetting accidents. The nursing intervention should be...? A. No action needed this is normal. B. The nurse should educate the parent on scolding techniques. C. This may be a sign of a urinary tract infection (UTI) and the nurse should assess the child. D. Nurse should recognize regression and assess the parent-child relationship.

C. This may be a sign of a urinary tract infection (UTI) and the nurse should assess the child.

238 What is the significance of softening of cranial bones, prominence of frontal bone, skull flat and depressed toward middle, and delayed fusion of sutures? A. Vitamin D excess B. Vitamin B deficiency C. Vitamin D deficiency

C. Vitamin D deficiency

227 What are three ways to promote healthy eating for teenagers? A. drink low-fat milk; make sure to pick healthy foods for the school cafeteria; think positively B. eat 3 meals and 3 snacks a day; take second helpings of fruits and vegetables only; use whole grain breads, pastas, and cereals C. try the plate method; slow down meal times to at least 20-30 minutes; enlist family involvement and support D. eat low-fat foods; buy healthy foods for snacking; do not skip meals

C. try the plate method; slow down meal times to at least 20-30 minutes; enlist family involvement and support

113 Guidelines for a nurse using an interpreter in developing a care plan for an 8-year-old admitted to rule out epilepsy include: A. Explaining to the interpreter what information is necessary to obtain from the patient and family. B. Encouraging the interpreter to ask several questions at a time to make the best use of time. C. Not giving the interpreter too much information so the interview evolves. D. Discouraging the interpreter and client from discussing topics that are deemed irrelevant to the original intent of the interview.

Correct Answer: A

122 Which method should the nurse use to view the tonsils and oropharynx of a cooperative 6-year-old child? A. Ask child to open mouth wide & say "aah" B. Ask child to open mouth wide and then place the tongue blade in the center back area of the tongue C. Examine the mouth when the child is crying to avoid use of tongue blade D. Pinch nostrils closed until the child opens his or her mouth and then insert tongue blade

Correct Answer: A

78 A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath, he asks for Mommy. The nurse's best reply is: A. "Mommy will be here after lunch." B. "Mommy always comes back to see you." C. "Your Mommy told me yesterday that she would be here today about noon." D. "Mommy had to go home for a while, but she will be here today."

Correct Answer: A

99 Nonpharmacologic strategies for pain management: A. May reduce pain perception. B. Make pharmacologic strategies unnecessary. C. Usually take too long to implement. D. Trick children into believing that they do not have pain.

Correct Answer: A

101 A child who has been receiving morphine intravenously will now start receiving it orally. The nurse should anticipate that, to achieve equianalgesia (equal analgesic effect), the oral dose will be: A. The same as the intravenous (IV) dose. B. Greater than the IV dose. C. One half of the IV dose. D. One fourth of the IV dose.

Correct Answer: B

102 Transdermal fentanyl (Duragesic) is being used for an adolescent with cancer who is in hospice care. The adolescent has been comfortable for several hours but now complains of severe pain. The most appropriate nursing action is to: A. Administer meperidine (Demerol) intramuscularly (IM). B. Administer morphine sulfate immediate release (MSIR) intravenously (IV). C. Use a nonpharmacologic strategy. D. Place another fentanyl patch on the adolescent.

Correct Answer: B

116 The nurse is ready to begin a physical examination on an 8-month-old infant. The child is sitting contentedly on his mother's lap, chewing on a toy. What should the nurse do first? A. Elicit reflexes B. Auscultate heart and lungs C. Examine eyes, ears, and mouth D. Examine head, systematically moving toward feet

Correct Answer: B

120 What explains the importance of detecting strabismus in young children? A. Color vision deficit may result. B. Amblyopia, a type of blindness, may result. C. Epicanthal folds may develop in affected eye. D. Ptosis may develop secondarily.

Correct Answer: B

115 Which statement explains why it can be difficult to assess a child's dietary intake? A. No systematic assessment tool has been developed for this purpose. B. Biochemical analysis for assessing nutrition is expensive. C. Families usually do not understand much about nutrition. D. Recall of children's food consumption is frequently unreliable.

Correct Answer: D

118 The nurse needs to take the blood pressure of a small child. Of the cuffs available, one is too large, and one is too small. The best nursing action is to: A. Use the small cuff. B. Use the large cuff. C. Use either cuff, using palpation method. D. Locate the proper-size cuff before taking the blood pressure.

Correct Answer: D

223 A women brings her 6 year old son into the clinic for a follow up visit for enuresis. Which comment if made by the mother would the nurse want to correct? A. "We make sure he does not drink any caffeinated drinks after 4 pm." B. "He takes the medication prescribed as directed every day." C. "We have alarm clocks set at certain intervals in order for him to wake up and use the restroom." D. "We scold him when he does wet the bed in order to reduce the behavior."

D. "We scold him when he does wet the bed in order to reduce the behavior."

189 What are common areas of stress in adolescence? A. Decisions about present and future roles B. Relationships with parents, siblings, and peers C. Body image D. All of the above

D. All of the above

190 A five year old girl came into the clinic for a kindergarten well check. She will be receiving then required immunizations for a child going to kindergarten, and she is up to date in all her prior immunizations. What immunizations will she be receiving? A. TDap, IPV, MMR, and Varicella B. DTap and MMR C. DTap, IPV, and MMR D. DTap, IPV, MMR, and Varicella

D. DTap, IPV, MMR, and Varicella

194 Which of the following is not a creative technique to enhance communication between a nurse and a child? A. Third-Person Technique B. What-if Questions C. Word Association Game D. Environmental Manipulation

D. Environmental Manipulation

213 What should be measured until the child is up to 36 months of age? A. Skinfold thickness B. Recumbent length C. Weight D. Head Circumference

D. Head Circumference

283 average age for menarche

-12.55 years

284 by what age should there be concern for pubertal delay in boys??

-13.5-14 years

258 when should clear liquids be stopped before surgery

-2 hours before

344 begin water readiness at what age

-2-4 years

329 when does a child start to recognize objects?

-3 months

316 lifelong habits are usually established at

-3 years

254 Binocularity, the ability to fixate on one visual field with both eyes is usually developed at what age..

-3-4 months

298 when should child be able to fix her vision and follow a target?

-3-4 months

335 By age 1, head is _____ % bigger than birth

-33%

318 weight gain should be

-5-7 ounces a week

280 normal physical development change for school-aged child is..

-5cm/ 2 inches per year

300 a parent states that their child always let people hold him until recently. you respond that fear of strangers begins at

-6 months of age

343 how many hours will a typical 3-4 month old sleep

-9-11 hours in a night, and usually 15 hours for the whole day

350 What is diaper dermatitis?

-A patchwork of inflamed, bright red skin on the buttocks.

358 The mother of a 3-year-old is concerned because her child still is insisting on a bottle at nap time and at bedtime. Which of the following is the most appropriate suggestion to the mother?

-Allow the bottle if it contains water because a child should never be allowed to fall asleep with a bottle of milk or juice

351 Atopic Dermatitis

-An itchy inflammation of the skin-typically appears on the arms and behind the knees, but can also appear anywhere.

337 Why do young children get ear infections more commonly?

-Because their flat eustachian tubes allow drainage from throat to drain into ear

268 what vaccine is recommended at birth

-Hep. B

353 What is some necessary anticipatory guidance at 18 to 24 Months?

-Importance of peer play Additional sibling? -Disclipline -Toilet training -Fears

354 What is some necessary anticipatory guidance at 24 to 36 Months?

-Need to include child in activities -Toddler's thought processes- through language, causal relationships, etc -Discipline -Preschool or daycare

357 The parents of a 2-year-old arrive at a hospital to visit their child. The child is in the playroom when the parents arrive. When the parents enter the playroom, the child does not readily approach the parents. The nurse interprets this behavior as indicating that:

-This is a normal pattern

360 A clinic nurse assesses the communication patterns of a 5-month-old infant. The nurse determines that the infant is demonstrating the highest level of developmental achievement expected if the infant:

-Uses monosyllabic babbling -using words such as mama occurs between 9 and 12 months of age

295 What is colic?

-a condition where there are repeated bouts of excessive crying in a baby who is otherwise healthy. The definition doctors use is: a baby crying for more than three hours a day, for more than three days a week, for at least one week.

330 What is abuse?

-any act or failure to act that results in imminent risk of death, serious physical or emotional harm, sexual abuse, or exploitation under the age of 18

311 anterior fontanelle closes

-at 14 months

306 By allowing an adolescent to make own decisions.. nurse is allowing for

-autonomy

348 What is the "colic carry"?

-baby cradled in arms facing away from you

361 A nurse is preparing to care for a 5-year-old who has been placed in traction following a fracture of the femur. The nurse plans care, knowing that which of the following is the most appropriate activity for this child?

-crayons and a coloring book

338 How to pull ear for examination for young child

-down and back

278 3 years old should be expected to..d

-draw single line shapes such as circles

371 The nurse explains that by the age of 6 months an iron-rich formula should be offered because the infant has:

-exhausted maternal iron stores

286 greatest threat to hospitalized adolescent

-fear of altered body image

281 psychosocial development of school-age children..

-feeling of inferiority/lack of worth can be caused by other children or environment

257 when child asks for presence of their parent in the room..

-follow their request

287 common reaction of parents to initial illness or injury

-frustration

370 The nurse would advise a mother who is concerned because her 10-month-old is lethargic to:

-go to the ER

297 mark age 6 is recieving antibiotic therapy and will barely eat bc he says he doesn't like his normal food, he wants pizza and icecream. nurse should:

-order these foods for him

275 what exemplifies cognitive development for 20 month child

-out of sight does not mean out of reach

322 fine motor 6 months

-palmar grasp

326 gross motor 7 months

-parachute flex, can sit alone

260 which reflexes occur at about 7-9 months of age

-parachute reflex (in older babies, stick arms out to protect fall)

308 Identify characteristics of childhood morbidity:

-resp illness (50% of acute conditions) -infections (11% ) -injuries (15%)

248 Maria is a spanish speaking 5 year old who started kindergarden in an English speaking school. crying most of the time, she seems helpless. explanation is that:

-she is experiencing culture shock

-deficiency of protein with adequate supply of calories

-skin usually dry and scaly, blindness, severe wasting in limbs, protruding abdomen because there is a fluid shift.

274 what decreases infants risk of getting SIDS

-sleeping in supine position

314 Is it normal for twins to always be together

-some twins thrive together

294 8 year old needs to drink nulytely before abdominal surgery. encourage this by..

-splitting it into cups and creating a game to award him for every cup he drinks

259 child has a fever of 102 even tho she took acetaminophen 2 hours ago. nurse should say..

-this is common with viral illnesses

355 Which age group has the greatest potential to demonstrate regression when they are sick?

-toddlers

323 fine motor 7 months

-transfer project between hands

305 What is the leading cause of death for kids older than 1 year

-unintentional injuries

253 Which approach is most appropriete when first assessing a toddler

-use minimum physical contact initially

72 MATCHING The nurse is preparing to insert a nasogastric tube into a 4-year-old child for intermittent suctioning after abdominal surgery. Place in correct sequence the steps for inserting a nasogastric tube. a. Lubricate the nasogastric tube with water-soluble lubricant. b. Tape the nasogastric tube securely to the child's face. c. Check the placement of the tube by aspirating stomach contents. d. Place the child in the supine position with head slightly hyperflexed. e. Insert the nasogastric tube through the nares. f. Measure the tube from the tip of the nose to the ear lobe to midpoint between the xiphoid process and the umbilicus.

1. Place the child in the supine position with head slightly hyperflexed. 2. Measure the tube from the tip of the nose to the ear lobe to midpoint between the xiphoid process and the umbilicus. 3. Lubricate the nasogastric tube with water-soluble lubricant. 4. Insert the nasogastric tube through the nares. 5. Check the placement of the tube by aspirating stomach contents. 6. Tape the nasogastric tube securely to the child's face. 1. ANS: D 2. ANS: F 3. ANS: A 4. ANS: E 5. ANS: C 6. ANS: B

9 A nurse is performing a developmental assessment on an 11-month-old. Which of the following findings is of the most concern? 1. Able to stand up alone. 2. Double the birth weight. 3. Head circumference greater than chest circumference. 4. Unable to walk alone.

2. Double the birth weight. Rationale: Birth weight should be doubled by 6 months and be tripled by 12 months. This is cause for concern and should be investigated. The ability to stand up alone may happen at this age, but is usually accomplished by 20-24 months. This is not worrisome. A head circumference is larger than chest is normal for this age and is not alarming. The nurse would not be worried about an 11-month-old unable to walk alone.

2 A nurse is performing an assessment on an infant. Which assessment should be performed last? 1. Check heart and respiratory rates. 2. Assess deep tendon reflexes. 3. Assess ears and mouth. 4. Evaluate genitalia.

3. Assess ears and mouth. Uncomfortable examinations may induce crying and should be done last. The nurse should perform auscultation and less upsetting assessments first while the patient is calm and quiet.

7 The mother of an 8-year-old expresses surprise that her son is finally becoming more cooperative and understanding the consequences of his actions. This describes which of the following stages of development? 1. Trust vs. Mistrust 2. Identity role vs. Confusion 3. Industry vs. Inferiority 4. Initiative vs. Guilt

3. Industry vs. Inferiority Rationale: School-aged children become more cooperative and reasonable. They better understand cause and effect, and they feel the desire to win approval by becoming competent in ways that are valued by society. If their initiative is encouraged, they feel industrious and confident and begin to develop a sense of pride in their accomplishments (industry). If this initiative is restricted, the child begins to feel inferior, doubting his abilities (inferiority).

6 A nurse is leading a class about immunizations? Which statement by the student is correct? 1. Vaccinations do decrease hospitalizations. 2. Pneumococcal vaccine prevents all complications from lung disease. 3. Pneumococcal and influenza vaccine can be given together. 4. Influenza vaccine is contraindicated if the patient is allergic to eggs.

3. Pneumococcal and influenza vaccine can be given together. Rationale: Vaccines can be given simultaneously at different sites. The influenza vaccine can be given to persons with an allergy to eggs. Vaccines may decrease complications but it will not prevent complications. Immunizations decrease the rate of hospitalizations.

11 A mother brings her 7-year-old daughter to the clinic after several nights of bedwetting. The mother explains that her daughter never wet the bed until her baby brother was born. The nurse explains that this situation is considered the use of which ego defense mechanism? 1. Dissociation 2. Projection 3. Regression 4. Repression

3. Regression Rationale: Regression is the reversion to an earlier stage of development that may have felt like a less demanding or safer time, or a time they received care and attention. This is common in children when exposed to new stressors, such as a new sibling.

9-year-old girl is to receive amoxicillin/clavulanate. Which statement by the nurse is most likely to elicit cooperation from the child? 1. You can play after you take your medicine. 2. Would you like to take this medicine with juice? 3. This medicine tastes good. 4. Amoxicillin is antibiotic which will help you get well.

4. Amoxicillin is an antibiotic which will help you get well. Rationale: Discussion of facts is correct with school-age child. Medication should not be described as food or candy. Associating medication with food may cause the child to develop an aversion to that specific food.

4 A qu9iz-yleta.cro-omld/1g0ir4l7is67to79re4c/peeivdes-aemxaomxic-1il-lifnla/cslha-vcuadnsa/te. Which statement by the nurse is most likely to elicit cooperation from the child? 1. You can play after you take your medicine. 2. Would you like to take this medicine with juice? 3. This medicine tastes good. 4. Amoxicillin is antibiotic which will help you get well.

4. Amoxicillin is an antibiotic which will help you get well. qu9iz-yleta.cro-omld/1g0ir4l7is67to79re4c/peeivdes-aemxaomxic-1il-lifnla/cslha-vcualradnsa/te.

EXAM 1 STUDY QUESTIONS 1 A nurse is performing a developmental age assessment on a 10-month-old. Which will the nurse document as consistent with the infant's age? 1. Infant discriminates between pictures of objects. 2. Infant stands without support. 3. Infant builds a tower of 3 cubes. 4. Infant eats with fingers.

4. Infant eats with fingers Eating with fingers typically occurs between 10 and 12 months. The baby can build a tower of 3 cubes occurs between 16 and 18 months. Standing occurs at 15 months. Discrimination of pictures typically begins by 24 months.

231 A child comes in with an elevated temperature and pruritic rash relatively profse on trunk, but extending to limbs and face. Which communicable disease has the child acquired? A. Chickenpox (varicella) B. Erythema Infectiosum (Fifth Disease) C. Pertussis (whooping cough) D. Poliomyelitis

A. Chickenpox (varicella)

96 The most consistent indicator of pain in infants is:

A. Increased respirations. B. Increased heart rate. C. Clenching the teeth and lips. D. Facial expression of discomfort. Correct Answer: D

192 The most intense site of pain during an appendicitis is located at a point midway between the anterior superior iliac crest and the umbilicus is called A. McBurney Point B. Left Lower Quadrant C. Phlegmon D. Right Upper Quadrant

A. McBurney Point

184 Which of the following symptoms would you expect to see in a child with lead poisoning? A. Sleepiness B. Tinnitus C. Increased appetite D. High fever

A. Sleepiness

221 Which inborn errors of metabolism is a deficiency of hexosaminidase A, resulting in apathy, regression in motor and social development, and decreased vision? A. Tay-Sachs disease B. Turner's Syndrome C. Cystic Fibrosis D. Klinefelter's Syndrome

A. Tay-Sachs disease

203 A nurse is assessing a 15 year old female who has suicidal thoughts. Which warning sign is a direct indication of the patient carrying out suicide? A. The adolescent has a well thought out plan. B. She is willing to attend self-destructive prevention program. C. The adolescent's friend had recently committed suicide. D. The patient begins rebelling from her parents.

A. The adolescent has a well thought out plan.

219 Which are contraindications to immunizations? (SATA) A. allergic response to vaccine B. severe febrile illness C. immunization is live virus D. recently acquired passive immunity (blood transfusion, immunoglobulin)

A. allergic response to vaccine B. severe febrile illness D. recently acquired passive immunity (blood transfusion, immunoglobulin)

152 During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is: a. A normal finding. b. An abnormal finding; child needs referral to ophthalmologist. c. A sign of possible visual defect; child needs vision screening. d. A sign of small hemorrhages, which usually resolve spontaneously.

ANS: A A brilliant, uniform red reflex is an important normal and expected finding. It rules out many serious defects of the cornea, aqueous chamber, lens, and vitreous chamber.

53 The nurse gives an injection in a patient's room. What should the nurse do with the needle for disposal? a. Dispose of syringe and needle in a rigid, puncture-resistant container in patient's room. b. Dispose of syringe and needle in a rigid, puncture-resistant container in an area outside of patient's room. c. Cap needle immediately after giving injection and dispose of in proper container. d. Cap needle, break from syringe, and dispose of in proper container.

ANS: A All needles (uncapped and unbroken) are disposed of in a rigid, puncture-resistant container located near the site of use. Consequently these containers should be installed in the patient's room. The uncapped needle should not be transported to an area distant from use.

88 Samantha, age 5 years, tells the nurse that she "needs a Band-Aid" where she had an injection. The best nursing action is to: a. Apply a Band-Aid. b. Ask her why she wants a Band-Aid. c. Explain why a Band-Aid is not needed. d. Show her that the bleeding has already stopped.

ANS: A Children at this age group still fear that their insides may leak out at the injection site. Provide the Band-Aid. No explanation should be required.

81 When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as: a. Punishment. b. Threat to child's self-image. c. An opportunity for regression. d. Loss of companionship with friends.

ANS: A If a toddler is not prepared for hospitalization, a typical preschooler fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds. Threat to child's self-image and loss of companionship with friends are reactions typical of school-age children. Regression is a response characteristic of toddlers when threatened with loss of control.

173 The nurse is teaching a group of new parents about the experience of role transition. Which statement by a parent indicates a correct understanding of the teaching? a. "My marital relationship can have a positive or negative effect on the role transition." b. "If an infant has special care needs, the parents' sense of confidence in their new role is strengthened." c. "Young parents can adjust to the new role easier than older parents." d. "A parent's previous experience with children makes the role transition more difficult."

ANS: A If parents are supportive of each other, they can serve as positive influences on establishing satisfying parental roles. When marital tensions alter caregiving routines and interfere with the enjoyment of the infant, the marital relationship has a negative effect. Infants with special care needs can be a significant source of added stress. Older parents are usually more able to cope with the greater financial responsibilities, changes in sleeping habits, and reduced time for each other and other children. Parents who have previous experience with parenting appear more relaxed, have less conflict in disciplinary relationships, and are more aware of normal growth and development.

42 Katie, 4 years old, is admitted to outpatient surgery for removal of a cyst on her foot. Her mother puts the hospital gown on her, but Katie is crying because she wants to leave on her underpants. The most appropriate nursing action is to: a. Allow her to wear her underpants. b. Discuss with her mother why this is important to Katie. c. Ask her mother to explain to her why she cannot wear them. d. Explain in a kind, matter-of-fact manner that this is hospital policy.

ANS: A It is appropriate for the child to leave her underpants on. This allows her some measure of control during the foot surgery. The mother should not be required to make the child more upset. Katie is too young to understand what hospital policy means.

106 Nonpharmacologic strategies for pain management: a. May reduce pain perception. b. Make pharmacologic strategies unnecessary. c. Usually take too long to implement. d. Trick children into believing they do not have pain.

ANS: A Nonpharmacologic techniques provide coping strategies that may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. Nonpharmacologic techniques should be learned before the pain occurs. With severe pain it is best to use both pharmacologic and nonpharmacologic measures for pain control. The nonpharmacologic strategy should be matched with the child's pain severity and taught to the child before the onset of the painful experience. Some of the techniques may facilitate the child's experience with mild pain, but the child will still know that discomfort is present.

87 Natasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What will help her most in her adjustment to the hospital? a. Explain hospital schedules such as mealtimes. b. Use terms such as "honey" and "dear" to show a caring attitude. c. Explain when parents can visit and why siblings cannot come to see her. d. Orient her parents, because she is young, to her room and hospital facility.

ANS: A School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for experiences that are unavoidable. The nurse should refer to the child by the preferred name. Telling the child about all of the limitations of visiting does not help her adjust to the hospital. At the age of 8 years the child and parent should be oriented to the environment.

137 The nurse is interviewing the mother of an infant. She reports, "I had a difficult delivery, and my baby was born prematurely." This information should be recorded under which heading? a. Birth history b. Present illness c. Chief complaint d. Review of systems

ANS: A The birth history refers to information that relates to previous aspects of the child's health, not to the current problem. The mother's difficult delivery and prematurity are important parts of the past history of an infant. The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. Unless chief complaint is directly related to the prematurity, this information is not included in the history of present illness. The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It would not include the birth information. The review of systems is a specific review of each body system. It does not include the premature birth. Sequelae such as pulmonary dysfunction would be included.

126 The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should the nurse do first? a. Introduce self. c. Explain the purpose of the interview. b. Make the family comfortable. d. Give an assurance of privacy.

ANS: A The first thing that nurses must do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. During the initial part of the interview the nurse should include general conversation to help make the family feel at ease. Next the purpose of the interview and the nurse's role should be clarified. The interview should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality.

80 What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Separation anxiety b. Loss of control c. Fear of bodily injury d. Fear of pain

ANS: A The major stress for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age group.

109 The nurse is caring for a child receiving intravenous (IV) morphine for severe postoperative pain. The nurse observes a slower respiratory rate, and the child cannot be aroused. The most appropriate management of this child is for the nurse to: a. Administer naloxone (Narcan). b. Discontinue IV infusion. c. Discontinue morphine until child is fully awake. d. Stimulate child by calling name, shaking gently, and asking to breathe deeply.

ANS: A The management of opioid-induced respiratory depression includes lowering the rate of infusion and stimulating the child. If the respiratory rate is depressed and the child cannot be aroused, IV naloxone should be administered. The child will be in pain because of the reversal of the morphine. The morphine should be discontinued, but naloxone is indicated if the child is unresponsive.

162 The nurse has a 2-year-old boy sit in "tailor" position during palpation for the testes. The rationale for this position is that: a. It prevents cremasteric reflex. b. Undescended testes can be palpated. c. This tests the child for an inguinal hernia. d. The child does not yet have a need for privacy.

ANS: A The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity. Undescended testes cannot be predictably palpated. Inguinal hernias are not detected by this method. This position is used for inhibiting the cremasteric reflex. Privacy should always be provided for children.

83 A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, "Wait a minute," and, "I'm not ready." The nurse should recognize that: a. This is normal behavior for a school-age child. b. This behavior is usually not seen past the preschool years. c. The child thinks the nurse is punishing her. d. The child has successfully manipulated the nurse in the past.

ANS: A This school-age child is attempting to maintain control. The nurse should provide the girl with structured choices about when the IV will be inserted. This can be characteristic behavior when an individual needs to maintain some control over a situation. The child is trying to have some control in the hospital experience.

130 When introducing hospital equipment to a preschooler who seems afraid, the nurse's approach should be based on which principle? a. The child may think the equipment is alive. b. The child is too young to understand what the equipment does. c. Explaining the equipment will only increase the child's fear. d. One brief explanation is enough to reduce the child's fear.

ANS: A Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. The child should be given simple concrete explanations about what the equipment does and how it will feel to the child. Simple, concrete explanations help alleviate the child's fear. The preschooler will need repeated explanations as reassurance.

71 The advantages of the ventrogluteal muscle as an injection site in young children include (choose all that apply): a. Less painful than vastus lateralis b. Free of important nerves and vascular structures c. Cannot be used when child reaches a weight of 20 pounds d. Increased subcutaneous fat, which increases drug absorption e. Easily identified by major landmarks

ANS: A, B, E Less painful, free of important nerves and vascular structures, and easily identifiable are advantages of the ventrogluteal muscle. The major disadvantage is lack of familiarity by health professionals and controversy over whether the site can be used before weight bearing. Cannot be used when a child is 20 pounds or more and increased subcutaneous fat are not advantages of the ventrogluteal muscle as an injection site in young children.

166 Which data would be included in a health history? Choose all that apply. a. Review of systems b. Physical assessment c. Sexual history d. Growth measurements e. Nutritional assessment f. Family medical history

ANS: A, C, E, F The review of systems, sexual history, nutritional assessment, and family medical history are part of the health history. Physical assessment and growth measurements are components of the physical examination.

139 The nurse is taking a sexual history on an adolescent girl. The best way to determine whether she is sexually active is to: a. Ask her, "Are you sexually active?" b. Ask her, "Are you having sex with anyone?" c. Ask her, "Are you having sex with a boyfriend?" d. Ask both the girl and her parent if she is sexually active.

ANS: B Asking the adolescent girl if she is having sex with anyone is a direct question that is well understood. The phrase sexually active is broadly defined and may not provide specific information to the nurse to provide necessary care. The word anyone is preferred to using gender-specific terms such as boyfriend or girlfriend. Because homosexual experimentation may occur, it is preferable to use gender-neutral terms. Questioning about sexual activity should occur when the adolescent is alone.

153 Binocularity, the ability to fixate on one visual field with both eyes simultaneously, is normally present by what age? a. 1 month b. 3 to 4 months c. 6 to 8 months d. 12 months

ANS: B Binocularity is usually achieved by ages 3 to 4 months. Age 1 month is too young for binocularity. If binocularity is not achieved by 6 months, the child must be observed for strabismus.

170 Studies about the ordinal position of children suggest that firstborn children tend to: a. Be praised less often. b. Be more achievement oriented. c. Be more popular with the peer group. d. Identify with peer group more than parents.

ANS: B Firstborn children, like only children, tend to be more achievement oriented. Later-born children are praised less often, are more popular with their peer group, and identify with their peer group more than with their parents.

41 The nurse is planning how to prepare a 4-year-old child for some diagnostic procedures. Guidelines for preparing this preschooler should include to: a. Plan for a short teaching session of about 30 minutes. b. Tell the child that procedures are never a form of punishment. c. Keep equipment out of the child's view. d. Use correct scientific and medical terminology in explanations.

ANS: B Illness and hospitalization may be viewed as punishment in preschoolers. Always state directly that procedures are never a form of punishment. Teaching sessions for this age group should be 10 to 15 minutes in length. Demonstrate the use of equipment and allow the child to play with miniature or actual equipment. Explain the procedure in simple terms and how it affects the child.

70 In preparing to give "enemas until clear" to a young child, the nurse should select: a. Tap water. b. Normal saline. c. Oil retention. d. Fleet solution.

ANS: B Isotonic solutions should be used in children. Saline is the solution of choice. Plain water is not used. This is a hypotonic solution and can cause rapid fluid shift, resulting in fluid overload. Oil-retention enemas will not achieve the "until clear" result. Fleet enemas are not advised for children because of the harsh action of the ingredients. The osmotic effects of the Fleet enema can result in diarrhea, which can lead to metabolic acidosis.

169 Birth position of children affects their personalities. What is considered to be a characteristic of children who are the youngest in their family? a. More dependent than firstborn children. b. More outgoing than firstborn children. c. Identify more with parents than with peers. d. Are subject to greater parental expectations.

ANS: B Later-born children are obliged to interact with older siblings from birth and seem to be more outgoing and make friends more easily than firstborns. Characteristics of firstborn children and only children include only children are more dependent than firstborn children, both types of children identify more with their parents than with their peers, and both types of children are subject to greater parental expectations.

147 The earliest age at which a satisfactory radial pulse can be taken in children is: a. 1 year b. 2 years c. 3 years d. 6 years

ANS: B Satisfactory radial pulses can be used in children older than 2 years. In infants and young children the apical pulse is more reliable. The radial pulse can be used for assessment at ages 3 and 6 years.

84 Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her, "We are sick of Mom always sitting with you in the hospital and playing with you. It isn't fair that you get everything and we have to stay with the neighbors." The nurse's best assessment of this situation is that: a. The siblings are immature and probably spoiled. b. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling. c. The family has ineffective coping mechanisms to deal with chronic illness. d. The siblings need to better understand their sister's illness and needs.

ANS: B Siblings experience loneliness, fear, worry, anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child. These are not uncommon responses by normal siblings. There is no evidence that the family has maladaptive coping.

129 What is an important consideration for the nurse who is communicating with a very young child? a. Speak loudly, clearly, and directly. b. Use transition objects such as a doll. c. Disguise own feelings, attitudes, and anxiety. d. Initiate contact with child when parent is not present.

ANS: B Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This facilitates communication with this age child. Speaking loudly, clearly, and directly tends to increase anxiety in very young children. The nurse must be honest with the child. Attempts at deception lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children.

47 The nurse is caring for an unconscious child. Skin care should include: a. Avoiding use of pressure reduction on the bed. b. Massaging reddened bony prominences to prevent deep tissue damage. c. Using draw sheet to move child in bed to reduce friction and shearing injuries. d. Avoiding rinsing skin after cleansing with mild antibacterial soap to provide a protective barrier.

ANS: C A draw sheet should be used to move the child in the bed or onto a gurney to reduce friction and shearing injuries. Do not drag the child from under the arms. Pressure-reduction devices should be used to redistribute weight. Bony prominences should not be massaged if reddened. Deep tissue damage can occur. Pressure-reduction devices should be used instead. The skin should be cleansed with mild nonalkaline soap or soap-free cleaning agents for routine bathing.

127 What action is most likely to encourage parents to talk about their feelings related to their child's illness? a. Be sympathetic. b. Use direct questions. c. Use open-ended questions. d. Avoid periods of silence.

ANS: C Closed-ended questions should be avoided when attempting to elicit parents' feelings. Open-ended questions require the parent to respond with more than a brief answer. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in the helping relationship. Direct questions may obtain limited information. In addition, the parent may consider them threatening. Silence can be an effective interviewing tool. It allows sharing of feelings in which two or more people absorb the emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions.

108 A lumbar puncture is needed on a school-age child. The most appropriate action to provide analgesia during this procedure is to apply: a. Tetracaine-adrenaline-cocaine (TAC) 15 minutes before procedure. b. Transdermal fentanyl (Duragesic) patch immediately before procedure. c. Eutectic mixture of local anesthetics (EMLA) 1 hour before procedure. d. EMLA 30 minutes before procedure.

ANS: C EMLA is an effective analgesic agent when applied to the skin 60 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. TAC provides skin anesthesia about 15 minutes after application to nonintact skin. The gel can be placed on the wound for suturing. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control. For maximal effectiveness EMLA must be applied approximately 60 minutes in advance.

50 Tepid water or sponge baths are indicated for hyperthermia in children. The nurse should: a. Add isopropyl alcohol to the water. b. Direct a fan on the child in the bath. c. Stop the bath if the child begins to chill. d. Continue the bath for 5 minutes.

ANS: C Environmental measures such as sponge baths can be used to reduce temperature if tolerated by the child and if they do not induce shivering. Shivering is the body's way of maintaining the elevated set point. Compensatory shivering increases metabolic requirements above those already caused by the fever. Ice water and isopropyl alcohol are inappropriate, potentially dangerous solutions. Fans should not be used because of the risk of the child developing vasoconstriction, which defeats the purpose of the cooling measures. Little blood is carried to the skin surface, and the blood remains primarily in the viscera to become heated. The child is placed in a tub of tepid water for 20 to 30 minutes.

146 By what age do the head and chest circumferences generally become equal? a. 1 month b. 6 to 9 months c. 1 to 2 years d. 2.5 to 3 years

ANS: C Head circumference begins larger than chest circumference. Between ages 1 and 2 years, they become approximately equal. Head circumference is larger than chest circumference at ages 1 month and 6 to 9 months. Chest circumference is larger than head circumference at age 2.5 to 3 years.

138 When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. This should be considered because these milestones are: a. Unnecessary information because the child is age 3 years. b. An important part of the family history. c. An important part of the child's past growth and development. d. An important part of the child's review of systems.

ANS: C Information about the attainment of developmental milestones is important to obtain. It provides data about the child's growth and development that should be included in the history. Developmental milestones provide important information about the child's physical, social, and neurologic health. The developmental milestones are specific to this child. If pertinent, attainment of milestones by siblings would be included in the family history. The review of systems does not include the developmental milestones.

92 The nurse is caring for an adolescent who had an external fixator placed after suffering a fracture of the wrist during a bicycle accident. Which statement by the adolescent would be expected about separation anxiety? a. "I wish my parents could spend the night with me while I am in the hospital." b. "I think I would like for my siblings to visit me but not my friends." c. "I hope my friends don't forget about visiting me." d. "I will be embarrassed if my friends come to the hospital to visit."

ANS: C Loss of peer-group contact may pose a severe emotional threat to an adolescent because of loss of group status; friends visiting are an important aspect of hospitalization for an adolescent and would be very reassuring. Adolescents may welcome the opportunity to be away from their parents. The separation from siblings may produce reactions from difficulty coping to a welcome relief.

60 An appropriate method for administering oral medications that are bitter to an infant or small child would be to mix them with: a. A bottle of formula or milk. b. Any food the child is going to eat. c. A small amount (1 teaspoon) of a sweet-tasting substance such as jam or ice cream. d. Large amounts of water to dilute medication sufficiently.

ANS: C Mix the drug with a small amount (about 1 teaspoon) of sweet-tasting substance. This will make the medication more palatable to the child. If the child does not finish drinking/eating, it is difficult to determine how much medication was consumed. Medication should not be mixed with essential foods and milk. The child may associate the altered taste with the food and refuse to eat in future.

160 What heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood? a. S1, S2 b. S3, S4 c. Murmur d. Physiologic splitting

ANS: C Murmurs are the sounds that are produced in the heart chambers or major arteries from the back-and-forth flow of blood. S1 is the closure of the tricuspid and mitral valves, and S2 is the closure of the pulmonic and aortic valves, and both are considered normal heart sounds. S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If heard, medical evaluation is required. Physiologic splitting is the distinction of the two sounds in S2, which widens on inspiration. It is a significant normal finding.

59 A nurse must do a venipuncture on a 6-year-old child. An important consideration in providing atraumatic care is to: a. Use an 18-gauge needle if possible. b. If not successful after four attempts, have another nurse try. c. Restrain the child only as needed to perform venipuncture safely. d. Show the child equipment to be used before procedure.

ANS: C Restrain the child only as needed to perform the procedure safely; use therapeutic hugging. Use the smallest gauge needle that permits free flow of blood. A two-try-only policy is desirable, in which two operators each have only two attempts. If insertion is not successful after four punctures, alternative venous access should be considered. Keep all equipment out of sight until used.

131 Which age group is most concerned with body integrity? a. Toddler b. Preschooler c. School-age child d. Adolescent

ANS: C School-age children have a heightened concern about body integrity. They place importance and value on their bodies and are overly sensitive to anything that constitutes a threat or suggestion of injury. Body integrity is not as important a concern to children in the toddler, preschooler, and adolescent age groups.

132 An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to: a. Ask her why she wants to know. b. Determine why she is so anxious. c. Explain in simple terms how it works. d. Tell her she will see how it works as it is used.

ANS: C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. A nurse should respond positively for requests for information about procedures and health information. By not responding the nurse may be limiting communication with the child. The child is not exhibiting anxiety, just requesting clarification of what will be occurring. The nurse must explain how the blood pressure cuff works so the child can then observe during the procedure.

68 The nurse must suction a child with a tracheostomy. Interventions should include: a. Encouraging the child to cough to raise the secretions before suctioning. b. Selecting a catheter with a diameter three fourths as large as the diameter of the tracheostomy tube. c. Ensuring that each pass of the suction catheter take no longer than 5 seconds. d. Allowing the child to rest after every five times the suction catheter is passed.

ANS: C Suctioning should require not longer than 5 seconds per pass. Otherwise the airway may be occluded for too long. If the child is able to cough up secretions, suctioning may not be indicated. The catheter should have a diameter one-half the size of the tracheostomy tube. If it is too large, it might block the child's airway. The child is allowed to rest for 30 to 60 seconds after each aspiration to allow oxygen tension to return to normal. Then the process is repeated until the trachea is clear.

58 The Allen test is performed as a precautionary measure before which procedure? a. Heel stick b. Venipuncture c. Arterial puncture d. Lumbar puncture

ANS: C The Allen test assesses the circulation of the radial, ulnar, or brachial arteries before arterial puncture.

45 The emergency department nurse is cleaning multiple facial abrasions on 9-year-old Mike. His mother is present. He is crying and screaming loudly. The nurse should: a. Ask him to be quieter. b. Have his mother tell him to relax. c. Tell him it is okay to cry and scream. d. Suggest that he talk to his mother instead of crying.

ANS: C The child should be allowed to express feelings of anger, anxiety, fear, frustration, or any other emotion. The child needs to know that it is all right to cry. There is no reason for him to be quieter. He is too upset and needs to be able to express his feelings.

140 When doing a nutritional assessment on an Hispanic family, the nurse learns that their diet consists mainly of vegetables, legumes, and starches. The nurse should recognize that this diet: a. Indicates that they live in poverty. b. Is lacking in protein. c. May provide sufficient amino acids. d. Should be enriched with meat and milk.

ANS: C The diet that contains vegetable, legumes, and starches may provide sufficient essential amino acids, even though the actual amount of meat or dairy protein is low. Many cultures use diets that contain this combination of foods. It does not indicate poverty. Combinations of foods contain the essential amino acids necessary for growth. A dietary assessment should be done, but many vegetarian diets are sufficient for growth.

136 Where in the health history should the nurse describe all details related to the chief complaint? a. Past history b. Chief complaint c. Present illness d. Review of systems

ANS: C The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. The focus of the present illness is on all factors relevant to the main problem, even if they have disappeared or changed during the onset, interval, and present. Past history refers to information that relates to previous aspects of the child's health, not to the current problem. The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It does not contain the narrative portion describing the onset and progression. The review of systems is a specific review of each body system.

128 What is the single most important factor to consider when communicating with children? a. The child's physical condition b. The presence or absence of the child's parent c. The child's developmental level d. The child's nonverbal behaviors

ANS: C The nurse must be aware of the child's developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Although the child's physical condition is a consideration, developmental level is much more important. The parents' presence is important when communicating with young children, but it may be detrimental when speaking with adolescents. Nonverbal behaviors vary in importance based on the child's developmental level.

158 What term is used to describe breath sounds that are produced as air passes through narrowed passageways? a. Rubs b. Rattles c. Wheezes d. Crackles

ANS: C Wheezes are produced as air passes through narrowed passageways. The sound is similar when the narrowing is caused by exudates, inflammation, spasm, or tumor. Rubs are the sound created by the friction of one surface rubbing over another. Pleural friction rub is caused by inflammation of the pleural space. Rattles is the term formerly used for crackles. Crackles are the sounds made when air passes through fluid or moisture.

163 During examination of a toddler's extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is: a. Abnormal and requires further investigation. b. Abnormal unless it occurs in conjunction with knock-knee. c. Normal if the condition is unilateral or asymmetric. d. Normal because the lower back and leg muscles are not yet well developed.

ANS: D Lateral bowing of the tibia (bowlegged) is common in toddlers when they begin to walk, not an abnormal finding. It usually persists until all of their lower back and leg muscles are well developed. Further evaluation is needed if it persists beyond ages 2 to 3 years, especially in African-American children.

48 An appropriate intervention to encourage food and fluid intake in a hospitalized child is to: a. Force child to eat and drink to combat caloric losses. b. Discourage participation in noneating activities until caloric intake is sufficient. c. Administer large quantities of flavored fluids at frequent intervals and during meals. d. Give high-quality foods and snacks whenever child expresses hunger.

ANS: D Small, frequent meals and nutritious snacks should be provided for the child. Favorite foods such as peanut butter and jelly sandwiches, fruit yogurt, cheese, pizza, and macaroni and cheese should be available. Forcing a child to eat only meets with rebellion and reinforces the behavior as a control mechanism. Large quantities of fluid may decrease the child's hunger and further inhibit food intake.

144 The nurse is using the NCHS growth chart for an African-American child. The nurse should consider that: a. This growth chart should not be used. b. Growth patterns of African-American children are the same as for all other ethnic groups. c. A correction factor is necessary when the NCHS growth chart is used for non-Caucasian ethnic groups. d. The NCHS charts are accurate for U.S. African-American children.

ANS: D The NCHS growth charts can serve as reference guides for all racial or ethnic groups. U.S. African American-children were included in the sample population. The growth chart can be used with the perspective that different groups of children have varying normal distributions on the growth curves. No correction factor exists.

51 The nurse approaches a group of school-age patients to administer medication to Sam Hart. To identify the correct child, the nurse should: a. Ask the group, "Who is Sam Hart?" b. Call out to the group, "Sam Hart?" c. Ask each child, "What's your name?" d. Check the patient's identification name band.

ANS: D The child must be correctly identified before the administration of any medication. Children are not totally reliable in giving correct names on request; identification bracelets should always be checked. Asking the group to identify the child, calling out the child's name, and asking each child to give their name are not acceptable ways to identify a child. Older children may exchange places, give an erroneous name, or choose not to respond to their name as a form of a joke.

161 Examination of the abdomen is performed correctly by the nurse in this order: a. Inspection, palpation, and auscultation b. Palpation, inspection, and auscultation c. Palpation, auscultation, and inspection d. Inspection, auscultation, and palpation

ANS: D The correct order of abdominal examination is inspection, auscultation, and palpation. Palpation is always performed last because it may distort the normal abdominal sounds.

54 An 8-month-old infant is restrained to prevent interference with the intravenous infusion. The nurse should: a. Remove the restraints once a day to allow movement. b. Keep the restraints on constantly. c. Keep the restraints secure so infant remains supine. d. Remove restraints whenever possible.

ANS: D The nurse should remove the restraints whenever possible. When parents and/or staff are present, the restraints can be removed, and the intravenous site protected. Restraints must be checked and documented every 1 to 2 hours and should be removed for range of motion on a periodic basis. The child should not be securely restrained in the supine position because of risks of aspiration.

175 What is most characteristic of the physical punishment of children, such as spanking? a. Psychologic impact is usually minimal. b. Children rarely become accustomed to spanking. c. Children's development of reasoning increases. d. Misbehavior is likely to occur when parents are not present.

ANS: D Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake but rather out of fear of punishment. Spanking can cause severe physical and psychologic injury and interfere with effective parent-child interaction. Children do become accustomed to spanking, requiring more severe corporal punishment each time. The use of corporal punishment may interfere with the child's development of moral reasoning.

235 Which of the following does not increase during adolescence? A. Systolic Blood Pressure B. Basal Heat Production C. Blood Volume D. Size of the Heart

B. Basal Heat Production

191 A 3 year old boy has been diagnosed with a cognitive impairment and displays learning disabilities and developmental delays. According to the classification level of cognitive impairment, he is currently in the severe level. What actions would he display? A. Noticeable delays in motor development especially in speech response to training in various self-help activities B. Marked delay in motor development, little or no communication skills C. May respond to trains in elementary self-care D. Minimum capacity for functioning in sensorimotor areas

B. Marked delay in motor development, little or no communication skills

240 Which childhood communicable disease can produce a red or white strawberry tongue as a clinical manifestation? A. Measles B. Scarlet Fever C. Chickenpox D. Diphtheria

B. Scarlet Fever

211 Conjuctivitis is an infection of the _________ . A. Liver B. Gums C. Eye D. Connective Tissue

C. Eye

200 Which theory makes the family the "patient" and the focus of care? A. Developmental Theory B. Family Stress Theory C. Family Systems Theory D. None of the above

C. Family Systems Theory

183 How should a nurse care for a hospitalized cognitively impaired child? A. Ignore the child B. Isolate the child C. Mutual participation in planning the child's care D. Let the parents do most of the care

C. Mutual participation in planning the child's care

187 A preschooler has sexual curiosity, and the parents are concerned. The parents ask the nurse for help in dealing with the situation. What is an appropriate response from the nurse? A. Tell the parents to accept the behavior B. Tell the parents to tell the child to stop doing the behavior because it is wrong C. Tell the parents to tell the child to ask questions and encourage the child to engage in other activities D. Tell the parents to ignore the behavior

C. Tell the parents to tell the child to ask questions and encourage the child to engage in other activities

100 The nurses caring for a child are concerned about the child's frequent requests for pain medication. During a team conference a nurse suggests that they consider administering a placebo instead of the usual pain medication. This decision should be based on knowledge that: A. This practice is unjustified and unethical. B. This practice is effective in determining whether a child's pain is real. C. The absence of a response to a placebo means the child's pain has an organic basis. D. A positive response to a placebo will not occur if the child's pain has an organic basis.

Correct Answer: A

121 During an otoscopic examination on an infant, in which direction is the pinna pulled? A. Down and back B. Down and forward C. Up and forward D. Up and back

Correct Answer: A

103 The nurse is caring postoperatively for an 8-year-old child with multiple fractures and other trauma resulting from a motor vehicle injury. The child is experiencing severe pain. An important consideration in managing the child's pain is to: A. Give only an opioid analgesic at this time. B. Increase the dosage of analgesic until the child is adequately sedated. C. Plan a preventive schedule of pain medication around the clock. D. Give the child a clock and explain when he or she can have pain medications.

Correct Answer: C

111 Which statement is true concerning the increased use of telephone triage by nurses? A. Telephone triage has led to an increase in health care costs. B. Emergency department visits are not recommended by nurses and thus are not a component of telephone triage. C. Access to high-quality health care services has increased through telephone triage. D. Home care is often recommended when it is not appropriate.

Correct Answer: C

112 The nurse is interviewing the mother of Adam, age 9 years. As the nurse begins to assess Adam's school performance, the most appropriate question to ask is: A. "Did Adam go to preschool?" B. "Does Adam have problems at school?" C. "How is Adam doing in school?" D. "How well does Adam seem to be doing in school?"

Correct Answer: C

114 What assessment tool would help the nurse assess a family member's satisfaction with the family's functional state? A. Genogram B. Sociogram C. Family ECOMAP D. Family Apgar

Correct Answer: D

117 The most accurate method of determining the length of a child less than 12 months of age is: A. Standing height. B. Estimation of length to the nearest centimeter or ½ inch. C. Recumbent length measured in the prone position. D. Recumbent length measured in the supine position.

Correct Answer: D

119 The nurse is assessing skin turgor in a child. The nurse grasps the skin on the abdomen between the thumb and index finger, pulls it taut, and quickly releases it. The tissue remains suspended, or tented, for a few seconds, then slowly falls back on the abdomen. Which evaluation can the nurse correctly assume? A. The tissue shows normal elasticity. B. The child is properly hydrated. C. The assessment is done incorrectly. D. The child has poor skin turgor.

Correct Answer: D

123 When assessing a preschooler's chest, the nurse would expect: A. Respiratory movements to be chiefly thoracic. B. Anteroposterior diameter to be equal to the transverse diameter. C. Intercostal retractions on respiratory movement. D. Movement of the chest wall to be symmetric bilaterally and coordinated with breathing.

Correct Answer: D

124 Superficial palpation of the abdomen is often perceived by the child as tickling. Which measure by the nurse is most likely to minimize this sensation and promote relaxation? A. Palpating another area simultaneously B. Asking the child not to laugh or move if it tickles C. Beginning with deeper palpation and gradually progressing to superficial palpation D. Having the child "help" with palpation by placing his or her hand over the palpating hand

Correct Answer: D

125 The nurse needs to give an injection in the deltoid to a 4-year-old child. The best approach to use is to: A. Smile while giving the injection to help child relax. B. Tell the child that you will be so quick that the injection won't even hurt. C. Explain that the child will experience "a little stick in the arm." D. Explain with concrete terms such as "putting medicine under the skin."

Correct Answer: D

29 The nurse is doing preoperative teaching with a child and his parents. The parents say that he is "dreading the shot" for premedication. The nurse's response should be based on the knowledge that: A. Preanesthetic medication can only be given intramuscularly. B. In children the intramuscular route is safer than the intravenous (IV) route. C. The child will have no memory of the injection because of amnesia. D. Preanesthetic medication should be "atraumatic," using oral, existing intravenous, or rectal routes.

Correct Answer: D

197 A 2 year old has a vocabulary of approximately ______ words and approximately _____% of their speech is understandable. A. 500 and 50% B. 200 and 75% C. 400 and 45% D. 300 and 65%

D. 300 and 65%

180 Panic occurs in middle school-age children (ages 6-8 years) The nurse is planning care for a pediatric patient with a different ethnic background from the nurse's own. The most appropriate goal for the nurse in caring for this patient is: A. Strive to keep ethnic background from influencing health care B. Encourage continuation of ethnic practices in the hospital setting C. Attempt, in a nonjudgmental way, to change ethnic beliefs D. Adapt, as necessary, ethnic practices to health needs

D. Adapt, as necessary, ethnic practices to health needs

186 A 6 month old just received a DTaP injection. Which of the following is a serious side effect? A. Deafness B. Shortness of breath C. Rash D. Continuous Screaming

D. Continuous Screaming

207 A 6 month old just received a TDaP injection. Which of the following is a serious problem? A. Deafness B. Shortness of breath C. Rash D. Continuous screaming

D. Continuous screaming

224 In regards to the concept of conservation, which of the following would the school-aged child master first? A. Weight B. Mass C. Volume D. Height

D. Height

230 Which of Erikson's developmental tasks is a 3-6 year old child experiencing? A. Trust vs. Mistrust B. Integrity vs. Despair C. Industry vs. Inferiority D. Initiative vs. Guilt

D. Initiative vs. Guilt

210 During the assessment of a 2 year old you notice that his vitals are HR 140, Temp 98.9, BP 85/50, Resp 50. Which finding is most worrisome? A. HR 140 B. Temp 98.9 C. BP 85/50 D. Resp 50

D. Resp 50 Should be 25

233 According to Piaget's theory of cognitive development, which state of intellectual development consists of ages birth to 2 yrs? A. Concrete operations B. Formal operations C. Peroperational D. Sensorimotor

D. Sensorimotor

241 Which of the following symptoms are found on assessment of a child with aspirin poisoning? A. Constipation B. Jaundice & coagulation abnormalities C. Irritability, sleepiness, decreased activity D. Tinnitus, nausea, sweating, dizziness, headache

D. Tinnitus, nausea, sweating, dizziness, headache

225 School aged peer groups have all of the following except: A. secrets B. culture C. code of ethics D. dependence on adults

D. dependence on adults

307 What is the difference between a nightmare and sleep terror?

Nightmares are dreams with vivid and disturbing content. They are most common in children during REM sleep, but they can happen to adults as well. They usually involve and immediate awakening and good recall of the dream Sleep terrors usually include arousal, agitation, large pupils, sweating, and increase blood pressure. Usually the child screams and appears terrified for several minutes until they eventually relax and return to sleep. Sleep terrors usually take place early in the night and may be combined with sleepwalking. The child typically does not remember or only has a vague memory of their dream

289 when preparing for a physical assessment, nurse asks mother of 10 year old if she is staying in room or leaving. this action is..

appropriate because of child's age

19 What nursing intervention would be most appropriate for a 10-year-old child with type I diabetes in order to meet their needs (as described by Erikson). a. Explain carefully to the mother the need to rigidly adhere to dietary modifications. b. Allow the child to eat whatever he or she wants and administer insulin to maintain optimum glucose levels. c. Allow the child to perform his or her own Accuchecks and administration of insulin. d. Perform Accuchecks four times a day and at bedtime.

c. Allow the child to perform his or her own Accuchecks and administration of insulin.

373 In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? a. Roll from abdomen to back b. Put feet in mouth when supine c. Roll from back to abdomen d. Sit erect without support e. Move from prone to sitting position f. Adjust posture to reach an object

c. roll from abdomen to back b. put feet in mouth when supin.

95 A child who is terminally ill with bone cancer is in severe pain. Nursing interventions should be based on knowledge that: A. Children tend to be overmedicated for pain. B. Giving large doses of opioids causes euthanasia. C. Narcotic addiction is common in terminally ill children. D. Large doses of opioids are justified when there are no other treatment options.

Correct Answer: D

30 Maria, age 10, requires daily medications for a chronic illness. Her mother tells the nurse that she is always nagging her to take her medicine before school. What is the most appropriate nursing action to promote Maria's compliance? A. Establishing a contract with her, including rewards B. Suggesting time-outs when she forgets her medicine C. Discussing with her mother the damaging effects of nagging D. Asking Maria to bring her medicine containers to each appointment so they can be counted

Correct Answer: A

35 The nurse observes erythema, pain, and edema at a child's intravenous (IV) site with streaking along the vein. What should the nurse do first? A. Immediately stop the infusion. B. Check for a good blood return. C. Ask another nurse to check the IV site. D. Increase the IV drip for 1 minute and recheck.

Correct Answer: A

73 Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? A. Inactivity B. Clings to parent C. Depressed, sad D. Regression to earlier behavior

Correct Answer: B

97 The nurse is starting an intravenous (IV) line on a school-age child with cancer. The child says, "I have had a million IVs. They hurt." The nurse's response should be based on the knowledge that: A. Children tolerate pain better than adults. B. Children become accustomed to painful procedures. C. Children often lie about experiencing pain. D. Children often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

Correct Answer: D

76 The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering intravenous antibiotics. The child starts to cry and tells the nurse, "Do it later, O.K.?" The nurse should: A. Start the IV line because allowing the child to manipulate the nurse is bad. B. Start the IV line because unlimited procrastination results in heightened anxiety. C. Postpone starting the IV line until the child is ready so that the child experiences a sense of control. D. Postpone starting the IV line until the child is ready so the child's anxiety is reduced.

Correct Answer: B

98 An important consideration when using the FACES Pain Rating Scale with children is: A. Children color the face with the color they choose to best describe their pain. B. The scale can be used with most children as young as 3 years of age. C. The scale is not appropriate for use with adolescents. D. The scale is useful in pain assessment but is not as accurate when assessing physiologic responses.

Correct Answer: B

32 Standard Precautions for infection control include: A. Gloves are worn any time a patient is touched. B. Needles are capped immediately after use and disposed of in a special container. C. Gloves are worn to change diapers when there are loose or explosive stools. D. Masks are needed only when caring for patients with airborne infections.

Correct Answer: C

34 Several types of long-term central venous access devices are used. A benefit of using an implanted port (e.g., Port-a-cath) is that it: A. Is easy to use for self-administered infusions. B. Does not need to pierce the skin for access. C. Does not need to limit regular physical activity, including swimming. D. Cannot dislodge from the port, even if child plays with port site.

Correct Answer: C

39 A neonate had corrective surgery 3 days ago for esophageal atresia. The nurse notices that after the child receives his gastrostomy feeding, there is often a backup of formula feeding into the tube. As a result, the nurse should: A. Position the child in a supine position after feedings. B. Position the child on his or her left side after feedings. C. Leave the gastrostomy tube open and suspended after feedings. D. Leave the gastrostomy tube clamped after feedings.

Correct Answer: C

75 The psychosexual conflicts of preschool children make them extremely vulnerable to: A. Separation anxiety. B. Loss of control. C. Bodily injury and pain. D. Loss of identity.

Correct Answer: C

10 A pediatric nurse is assessing children in a community outreach clinic. The nurse would expect an infant's first primary teeth to erupt at age: 1. 12 months. 2. 4 months. 3. 6 months. 4. 8 months.

3. 6 months Rationale: The first 2 primary teeth (central incisors) usually erupt around age 6 months, but this may vary. All primary teeth are usually visible by 3 years of age.

3 A pediatric clinic nurse teaches about behavior modification for young children. It is most important to emphasize which points? 1. Once the child has calmed down, review what occurred. 2. If a child cries and refuses time-out, add another time-out period. 3. Time-outs should be 1 minute for each year of age. 4. Explain to the child why an act is wrong.

3. Time-outs should be 1 minute for each year of age. One minute of time-out for each year of the child's age is the recommended practice for time-outs. For toddlers the concept of time is limited and 1 minute can seem like hours. For preschoolers, time is still not fully understood. A kitchen timer with an audible bell can be useful for timing time-outs.

77 A 4-year-old child will be having cardiac surgery next week. The child's parents call the hospital, asking about how to prepare her for this. The nurse's reply should be based on knowledge that: A. Preparation at this age will only increase the child's stress. B. Preparation needs to be at least 2 to 3 weeks before hospitalization. C. Children who are prepared experience less fear and stress during hospitalization. D. Children who are prepared experience overwhelming fear by the time hospitalization occurs.

Correct Answer: C

74 The most consistent indicator of pain in infants is: A. Increased respirations. B. Increased heart rate. C. Squirming and jerking. D. Facial expression of discomfort.

Correct Answer: D

65 When caring for a child with an intravenous infusion, the nurse should: a. Use a macrodropper to facilitate reaching the prescribed flow rate. b. Avoid restraining the child to prevent undue emotional stress. c. Change the insertion site every 24 hours. d. Observe the insertion site frequently for signs of infiltration.

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

5 The mother of a 9-year-old boy with the mental age of 4 years old asks the clinic nurse, "what should my child be able to do?" Which is correct? 1. Your child should be able to load and start the dishwasher. 2. Your child should be able to join a baseball team. 3. Your child should be able to take care of his dog. 4. Your child should be able to dress himself.

4. Your child should be able to dress himself. Rationale: A child with moderate intellectual disorder should be able to perform ADLs with supervision. Moderate intellectual disorder is an IQ of 35-55. These children can learn self-care activities and simple manual skills.

12 A nurse is performing a developmental assessment on a 4-and-a-half-year-old. Which of the following findings is of the most concern? 1. The child is unable to balance on each foot for 4 seconds. 2. The child is unable to brush teeth without help. 3. The child is unable to prepare cereal. 4. The child's speech is not completely understandable.

4. The child's speech is not completely understandable. According to the Denver II Developmental Screen: Speech should be completely understandable by age 4 and a half years. The child may be developmentally delayed, but further assessment is needed. All other developmental tasks should be achieved by age 5.

8 A toddler's parents ask the nurse how long the child is required to use a front facing car seat. How should the nurse respond? 1. The child can stop using the front facing car seat when he is mature enough. 2. The child must be at least 6-years-old to use a regular seat belt. 3. Your child must be at least 2 years old. 4. Your child should use a car seat with a harness as long as possible until he outgrows the car seat.

4. Your child should use a car seat with a harness as long as possible until he outgrows the car seat. Rationale: Child should be rear-facing until 2 years old or until he or she has outgrown the maximum height and weight allowed by the manufacturer of their rear-facing car seat. Forward facing car seats with a harness should be used for the maximum time possible until the child outgrows the height and weight allowed by the manufacturer. A belt-positioning-booster seat should be used for children whose weight or height is about the forward facing limit, typically when they have reached 4 feet 9 inches in height and are between 8 and 12 years of age.

21 The maternity nurse is providing instructions to a new mother regarding the psychosocial development of the newborn infant. Using Erikson's psychosocial development theory, the nurse instructs the mother to take which measure? A. Allow the newborn infant to signal a need. B. Anticipate all the needs of the newborn infant. C. Attend to the newborn infant immediately when crying. D. Avoid the newborn infant during the first 10 minutes of crying.

A. Allow the newborn infant to signal a need. Rationale: According to Erikson, the caregiver should not try to anticipate the newborn infant's needs at all times but must allow the newborn infant to signal needs. If a newborn infant is not allowed to signal a need, the newborn will not learn how to control the environment. Erikson believed that a delayed or prolonged response to a newborn infant's signal would inhibit the development of trust and lead to mistrust of others.

24 A 4-year-old child diagnosed with leukemia is hospitalized for chemotherapy. The child is fearful of the hospitalization. Which nursing intervention should be implemented to alleviate the child's fears? A. Encourage the child's parents to stay with the child. B. Encourage play with other children of the same age. C. Advise the family to visit only during the scheduled visiting hours. D. Provide a private room, allowing the child to bring favorite toys from home.

A. Encourage the child's parents to stay with the child.

23 A parent of a 3-year-old tells a clinic nurse that the child is rebelling constantly and having temper tantrums. Using Erikson's psychosocial development theory, which instructions should the nurse provide to the parent? SELECT ALL THAT APPLY A. Set limits on the child's behavior. B. Ignore the child when this behavior occurs. C. Allow the behavior, because this is normal at this age period. D. Provide a simple explanation of why the behavior is unacceptable. E. Punish the child every time the child says "no" to change the behavior.

A. Set limits on the child's behavior. D. Provide a simple explanation of why the behavior is unacceptable. Rationale: According to Erikson, the child focuses on gaining some basic control over self and the environment and independence between ages 1 and 3 years. Gaining independence often means that the child has to rebel against the parents' wishes. Saying things like "no" or "mine" and having temper tantrums are common during this period of development. Being consistent and setting limits on the child's behavior are necessary elements. Providing a simple explanation of why certain behaviors are unacceptable is an appropriate action. Options 2 and 3 do not address the child's behavior. Option 5 is likely to produce a negative response during this normal developmental pattern.

61 When liquid medication is given to a crying 10-month-old infant, which approach minimizes the possibility of aspiration? a. Administering the medication with a syringe (without needle) placed along the side of the infant's tongue b. Administering the medication as rapidly as possible with the infant securely restrained c. Mixing the medication with the infant's regular formula or juice and administer by bottle d. Keeping the child upright with the nasal passages blocked for a minute after administration

ANS: A Administer the medication with a syringe without needle placed alongside of the infant's tongue. The contents are administered slowly in small amounts, allowing the child to swallow between deposits. Medications should be given slowly to avoid aspiration. The medication should be mixed with only a small amount of food or liquid. If the child does not finish drinking/eating, it is difficult to determine how much medication was consumed. Essential foods also should not be used. Holding the child's nasal passages increases the risk of aspiration.

86 Four-year-old Brian appears to be upset by hospitalization. An appropriate intervention is to: a. Let him know that it is all right to cry. b. Give him time to gain control of himself. c. Show him how other children are cooperating. d. Tell him what a big boy he is to be so quiet.

ANS: A Crying is an appropriate behavior for the upset preschooler. The nurse provides support through physical presence. Giving the child time to gain control is appropriate, but the child must know that crying is acceptable. The preschooler does not engage in competitive behaviors.

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

ANS: A For postural drainage and percussion, the child should be dressed in a light shirt to protect the skin and placed in the appropriate postural drainage positions. The chest wall is struck with a cupped-hand, not a flat-hand position. The procedure should be done over the rib cage only. Positioning precedes the percussion.

90 Matthew, age 18 months, has just been admitted with croup. His parent is tearful and tells the nurse, "This is all my fault. I should have taken him to the doctor sooner so he wouldn't have to be here." What is appropriate in the care plan for this parent who is experiencing guilt? a. Clarify the misconception about the illness. b. Explain to the parent that the illness is not serious. c. Encourage the parent to maintain a sense of control. d. Assess further why the parent has excessive guilt feelings.

ANS: A Guilt is a common response of parents when a child is hospitalized. They may blame themselves for the child's illness or for not recognizing it soon enough. The nurse should clarify the nature of the problem and reassure parents that the child is being cared for. Croup is a potentially very serious illness. The nurse should not minimize the parents' feelings. Encouraging the parent to maintain a sense of control would be difficult for the parents while their child is seriously ill. No further assessment is indicated at this time—guilt is a common response for parents.

49 Kimberly, age 3 years, has a fever associated with a viral illness. Her mother calls the nurse, reporting a fever of 102° F even though she had acetaminophen 2 hours ago. The nurse's action should be based on knowing that: a. Fevers such as this are common with viral illnesses. b. Seizures are common in children when antipyretics are ineffective. c. Fever over 102° F indicates greater severity of illness. d. Fever over 102° F indicates a probable bacterial infection.

ANS: A Most fevers are of brief duration, have limited consequences, and are viral. Little evidence supports the use of antipyretic drugs to prevent febrile seizures. Neither the increase in temperature nor its response to antipyretics indicates the severity or etiology of infection.

63 When teaching a mother how to administer eye drops, where should the nurse tell her to place them? a. In the conjunctival sac that is formed when the lower lid is pulled down b. Carefully under the eye lid while it is gently pulled upward c. On the sclera while the child looks to the side d. Anywhere as long as drops contact the eye's surface

ANS: A The lower lid is pulled down, forming a small conjunctival sac. The solution or ointment is applied to this area. The medication should not be administered directly on the eyeball.

93 Ryan has just been unexpectedly admitted to the intensive care unit after abdominal surgery. The nursing staff has completed the admission process, and Ryan's condition is beginning to stabilize. When speaking with the parents, the nurses should expect which stressors to be evident? Choose all that apply. a. Unfamiliar environment b. Usual day-night routine c. Strange smells d. Provision of privacy e. Inadequate knowledge of condition and routine

ANS: A, C, E Intensive care units, especially when the family is unprepared for the admission, are a strange and unfamiliar place. There are many pieces of unfamiliar equipment, and the sights and sounds are much different from a general hospital unit. Also, with the child's condition being more precarious, it may be difficult to keep the parents updated and knowledgeable about what is happening. Lights are usually on around the clock, seriously disrupting the diurnal rhythm. There is usually little privacy available for families in intensive care units.

85 An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler is to: a. Provide for privacy. b. Encourage parents to room in. c. Explain procedures and routines. d. Encourage contact with children the same age.

ANS: B A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room in as much as possible. Maintaining routines and ensuring privacy are helpful interventions, but they would not substitute for the parents. Contact with same-aged children would not substitute for having the parents present.

64 A 2-year-old child comes to the emergency department with dehydration and hypovolemic shock. What best explains why an intraosseous infusion is started? a. It is less painful for small children. b. Rapid venous access is not possible. c. Antibiotics must be started immediately. d. Long-term central venous access is not possible.

ANS: B In situations in which rapid establishment of systemic access is vital and venous access is hampered such as peripheral circulatory collapse and hypovolemic shock, intraosseous infusion provides a rapid, safe lifesaving alternative. The procedure is painful, and local anesthesia and systemic analgesia are given. Antibiotics could be given when vascular access is obtained. Long-term central venous access is time consuming, and intraosseous infusion is used in an emergency situation.

43 Using knowledge of child development, the best approach when preparing a toddler for a procedure is to: a. Avoid asking the child to make choices. b. Demonstrate the procedure on a doll. c. Plan for the teaching session to last about 20 minutes. d. Show necessary equipment without allowing child to handle it.

ANS: B Prepare toddlers for procedures by using play. Demonstrate on a doll, but avoid the child's favorite doll because the toddler may think the doll is really "feeling" the procedure. In preparing a toddler for a procedure, the child is allowed to participate in care and help whenever possible. Teaching sessions for toddlers should be about 5 to 10 minutes. Use a small replica of the equipment and allow the child to handle it.

69 A child is receiving total parenteral nutrition (TPN; hyperalimentation). At the end of 8 hours the nurse observes the solution and notes that 200 ml/8 hr is being infused rather than the ordered amount of 300 ml/8 hr. The nurse should adjust the rate so that how much will infuse during the next 8 hours? a. 200 ml b. 300 ml c. 350 ml d. 400 ml

ANS: B The TPN infusion rate should not be increased or decreased without the practitioner being informed because alterations in rate can cause hyperglycemia or hypoglycemia. Any changes from the prescribed flow rate may lead to hyperglycemia or hypoglycemia.

57 An important nursing consideration when performing a bladder catheterization on a young boy is to: a. Use clean technique, not Standard Precautions. b. Insert 2% lidocaine lubricant into the urethra. c. Lubricate catheter with water-soluble lubricant such as K-Y Jelly. d. Delay catheterization for 20 minutes while anesthetic lubricant is absorbed.

ANS: B The anxiety, fear, and discomfort experienced during catheterization can be significantly decreased by preparing the child and parents, selecting the correct catheter, and using appropriate insertion technique. Generous lubrication of the urethra before catheterization and use of lubricant containing 2% lidocaine may reduce or eliminate the burning and discomfort associated with this procedure. Catheterization is a sterile procedure, and Standard Precautions for body-substance protection should be followed. Water-soluble lubricants do not provide appropriate local anesthesia. Catheterization should be delayed only 2 to 3 minutes. This provides sufficient local anesthesia for the procedure.

62 Guidelines for intramuscular administration of medication in school-age children include to: a. Inject medication as rapidly as possible. b. Insert the needle quickly, using a dartlike motion. c. Penetrate the skin immediately after cleansing the site, before skin has dried. d. Have the child stand, if possible, and if he or she is cooperative.

ANS: B The needle should be inserted quickly in a dartlike motion at a 90-degree angle unless contraindicated. Inject medications slowly. Allow skin preparation to dry completely before skin is penetrated. Place the child in a lying or sitting position.

89 Kimberly, age 3 years, is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her "a lot of new toys because she will be in the hospital." The nurse's reply should be based on an understanding that: a. New toys make hospitalization easier. b. New toys are usually better than older ones for children of this age. c. At this age children often need the comfort and reassurance of familiar toys from home. d. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.

ANS: C Parents should bring favorite items from home to be with the child. Young children associate inanimate objects with significant people; they gain comfort and reassurance from these items. New toys will not serve the purpose of familiar toys and objects from home. The parents may experience some guilt as a response to the hospitalization, but there is no evidence that it is maladaptive.

56 Frequent urine testing for specific gravity and glucose are required on a 6-month-old infant. The most appropriate way to collect small amounts of urine for these tests is to: a. Apply a urine-collection bag to perineal area. b. Tape a small medicine cup to the inside of the diaper. c. Aspirate urine from cotton balls inside the diaper with a syringe. d. Aspirate urine from a superabsorbent disposable diaper with a syringe.

ANS: C To obtain small amounts of urine, use a syringe without a needle to aspirate urine directly from the diaper. If diapers with absorbent material are used, place a small gauze dressing or cotton balls inside the diaper to collect the urine, and aspirate the urine with a syringe. For frequent urine sampling, the collection bag would be too irritating to the child's skin. Taping a small medicine cup to the inside of the diaper is not feasible; the urine will spill from the cup. Diapers with superabsorbent gels absorb the urine, so there is nothing to aspirate.

66 It is important to make certain that sensory connectors and oximeters are compatible since wiring that is incompatible can cause: a. Hyperthermia. b. Electrocution. c. Pressure necrosis. d. Burns under sensors.

ANS: D It is important to make certain that sensor connectors and oximeters are compatible. Wiring that is incompatible can generate considerable heat at the tip of the sensor, causing second- and third-degree burns under the sensor. Incompatibility would cause a local irritation or burn. A low voltage is used, which should not present risk of electrocution. Pressure necrosis can occur from the sensor being attached too tightly, but this is not a problem of incompatibility.

91 The nurse is doing a prehospitalization orientation for Diana, age 7, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that she will not be able to talk because of an endotracheal tube but that she will be able to talk when it is removed. This explanation is: a. Unnecessary. b. The surgeon's responsibility. c. Too stressful for a young child. d. An appropriate part of the child's preparation.

ANS: D This is a necessary part of preoperative preparation that will help reduce the anxiety associated with surgery. If the child wakes and is not prepared for the inability to speak, she will be even more anxious. It is a joint responsibility of nursing, medical staff, and child life personnel. This is a necessary component of preparation that will help reduce the anxiety associated with surgery.

22 The mother of an 8-year-old child tells the clinic nurse that she is concerned about the child because the child seems to be more attentive to friends than anything else. Using Erikson's psychosocial development theory, the nurse should make which response? A. "You need to be concerned." B. "You need to monitor the child's behavior closely." C. "At this age, the child is developing his own personality." D. "You need to provide more praise to the child to stop this behavior."

C. "At this age, the child is developing his own personality." Rationale: According to Erikson, during school-age years (6 to 12 years of age), the child begins to move toward peers and friends and away from the parents for support. The child also begins to develop special interests that reflect his or her own developing personality instead of the parents. Therefore options 1, 2, and 4 are incorrect responses.

27 It is time to give 3-year-old David his medication. Which approach is most likely to receive a positive response? A. "It's time for your medication now, David. Would you like water or apple juice afterward?" B. "Wouldn't you like to take your medicine, David?" C. "You must take your medicine, David, because the doctor says it will make you better." D. "See how nicely John took his medicine? Now take yours."

Correct Answer: A

28 When should clear liquids be stopped before scheduled surgery? A. 2 hours before surgery B. 6 hours before surgery C. The night before surgery, at 8 PM D. The night before surgery, at midnight

Correct Answer: A

31 Allison, age 7 years, has a fever associated with a viral illness. She is being cared for at home. The nurse should recognize that the principal reason for treating fever in this child is: A. Relief of discomfort. B. Reassurance that illness is temporary. C. Prevention of secondary bacterial infection. D. Prevention of life-threatening complications.

Correct Answer: A

36 The best explanation for why pulse oximetry is used on young children is that it: A. Is noninvasive. B. Is better than capnography. C. Is more accurate than arterial blood gases. D. Provides intermittent measurements of O2.

Correct Answer: A

37 When is bronchial (postural) drainage generally performed? A. Immediately before all aerosol therapy B. Before meals and at bedtime C. Immediately on arising and at bedtime D. Thirty minutes after meals and at bedtime

Correct Answer: B

94 The nurse is using the C.R.I.E.S. pain assessment tool on a preterm infant in the neonatal intensive care unit. A component of this tool is: A. Color. B. Reflex. C. Oxygen saturation. D. Posture of arms and legs.

Correct Answer: C

26 The nurse needs to take the blood pressure of a preschool boy for the first time. Which action would be best in gaining his cooperation? A. Taking his blood pressure when a parent is there to comfort him B. Telling him that this procedure will help him get well faster. C. Explaining to him how the blood flows through the arm and why the blood pressure is important D. Permitting him to handle equipment and see the dial move before putting the cuff in place

Correct Answer: D

33 The nurse is preparing a plan to teach a mother how to administer 1½ teaspoons of medicine to her 6-month-old child. The nurse should recommend using: A. A household measuring spoon. B. A regular silverware teaspoon. C. A paper cup measure in 5-ml increments. D. A plastic syringe (without needle) calibrated in milliliters.

Correct Answer: D

38 The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. What should be the next action by the nurse? A. Notifying the surgeon B. Performing oral intubation C. Trying to insert a larger-size tube D. Trying to insert smaller-size tube

Correct Answer: D

79 The nurse working in an outpatient surgery center for children should understand that: A. Children's anxiety is minimal in such a center. B. Waiting is not stressful for parents in such a center. C. Accurate and complete discharge teaching is the responsibility of the surgeon. D. Families need to be prepared for what to expect after discharge.

Correct Answer: D

25 A 16-year-old is admitted to the hospital for acute appendicitis and an appendectomy is performed. Which nursing intervention is most appropriate to facilitate normal growth and development postoperatively? A. Encourage the child to rest and read. B. Encourage the parents to room in with the child. C. Allow the family to bring in the child's favorite computer games. D. Allow the child to interact with others in his or her same age group.

D. Allow the child to interact with others in his or her same age group. Rationale: Adolescents often are not sure whether they want their parents with them when they are hospitalized. Because of the importance of their peer group, separation from friends is a source of anxiety. Ideally, the members of the peer group will support their ill friend. Options 1, 2, and 3 isolate the child from the peer group.

17 A nurse enters the room of an 8-year-old child newly admitted and diagnosed with type I diabetes. His mother is sitting in a chair at his bedside. What should the nurse do first? a. Go the bedside and meet the child. b. Stand by the door, and say "I am the assigned nurse today." c. Go over to the mother and ask what brought the child into the hospital today. d. Explain the use of the call light to child.

a. Go the bedside and meet the child.

14 A 9 month old is sitting on his father's lap at the bedside. The nurse needs to do a shift assessment. How should the nurse proceed? a. Ask the father to put the child in bed, and proceed with the exam. b. Talk with the father for a few minutes, before examining child. c. Listen to the heart and lungs of the child. d. Take the child from the father, and proceed with the exam.

b. Talk with the father for a few minutes, before examining child.

18 Which hospitalized child would the nurse be most worried about as needing support or follow-up? a. The 9-month-old that cries when the nurse walks in the room. b. The 2-year-old that holds still during an IV start. c. An adolescent that asks her father to leave the room during an assessment. d. A school-age child that angrily throws his food tray on the floor.

b. The 2-year-old that holds still during an IV start.

15 Which nursing intervention best supports the concept of atraumatic care for a hospitalized child? a. Allowing parents to visit once every shift. b. Encouraging six year old to be brave during an IV start. c. Allowing adolescent to keep the hospital door shut. d. Asking parents of baby to wait outside treatment room door during spinal tap.

c. Allowing adolescent to keep the hospital door shut.

20 A 16 year old female comes for a sport's physical in the clinic. During the nursing history, the teenage states she is bothered that she "towers over her companions and everyone is staring at her at school." What would be the most therapeutic response by the nurse? a. "Just ignore the other kids at school." b. "You are so lucky to be tall. You can play basketball or whatever you want." c. "This will resolve itself in time." d. "Tell me more about how this embarasses you."

d. "Tell me more about how this embarasses you."