The point final chapters

chapter 49

Chapter 49

Chapter 39

Chapter 39

chapter 42

Chapter 42

Chapter 43

Chapter 43

The nurse is screening a 4-year-old child for vision problems. What problem could result in loss of vision? Exotropia Nystagmus Diplopia Amblyopia

Answer Rationale: Amblyopia, if untreated, will get worse in the poorer eye and will cause strain on the better eye, which may also lead to worsening of acuity in that eye. Eventually blindness will result in one or both eyes. Exotropia can develop into amblyopia but not lead to a loss of vision. Diplopia can cause vision impairment but not loss of vision. Nystagmus can cause vision impairment but not lead to a loss of vision.

A child is being prepared for discharge after sustaining a simple contusion of the eye. Which advice would the nurse expect to include in the discharge instructions? Teach the parents how to apply ophthalmologic antibiotic ointment properly. Encourage the parents to apply ice to the area for 20 minutes at a time for the first 24 hours. Inform the parents to call their pediatrician if the bruising persists for more than 2 days. Tell the parents that although the condition is frightening, no intervention is needed.

Answer

The nurse on a pediatric mental health unit notices one of the clients continually avoids joining the other clients in the dining room for meals. The nurse is aware that the client is demonstrating characteristics of which disorder? Separation anxiety Generalized anxiety disorder Selective mutism Social phobia

Answer 4 Rationale: Social phobia is a disorder characterized by the child or teen demonstrating a persistent fear of speaking or eating in front of others, using public restrooms, or speaking to authorities. Generalized anxiety disorder (GAD) is characterized by unrealistic concerns over past behavior, future events, and personal competence. Selective mutism refers to a persistent failure to speak. With separation anxiety the child may need to remain close to the parents, and the child's worries focus on separation themes.

When developing the plan of care for a child with a visual impairment, what would the nurse include? (Select all that apply.) Ensuring that the child's environment is familiar and secure Referring the child to early intervention after the age of 5 years Encouraging activities to stimulate development Encouraging the use of self-stimulatory behaviors Using touch and tone of voice to demonstrate affection

Answer A-C-E When caring for a child with a visual impairment, the nurse would ensure that the child's environment provides familiarity and security. The nurse would also encourage the parents to use activities to stimulate the child's development and use touch and tone of voice to demonstrate affection. The nurse would work with the parents to plan a strategy for the development of alternative behaviors specific to the child to minimize the use of self-stimulatory behaviors. Children younger than 3 years of age should be referred to early intervention to establish case management services for the child's developmental needs.

The nurse is caring for a 10-year-old boy with end-stage kidney disease (ESKD) with metabolic acidosis. What would the nurse expect to administer if ordered? Vitamin D Ferrous sulfate Sodium bicarbonate tablets Erythropoietin

Answer c Rationale: Bicitra or sodium bicarbonate tablets are used for the correction of acidosis. Ferrous sulfate is used for the treatment of anemia. Vitamin D and calcium are used for the correction of hypocalcemia and hyperphosphatemia. Erythropoietin stimulates red blood cell growth.

chapter 44

Chapter 44

chapter 48

Chapter 48

Chapter 50

Chapter 50

A group of nursing students are reviewing information about celiac disease. The students demonstrate understanding of this disorder when they identify which classic symptoms? (Select all that apply.) Constipation Polycythemia Failure to thrive Steatorrhea Sunken abdomen Diarrhea

Classic symptoms of celiac disease include steatorrhea, constipation, diarrhea, failure to thrive, weight loss, abdominal distention or bloating (not a sunken abdomen), and anemia (not polycythemia).

A nurse is assessing an infant who has been vomiting and experiencing diarrhea. Which findings would indicate to the nurse that the infant is experiencing severe dehydration? (Select all that apply.) Bradycardia Slightly decreased urine output Pink moist oral mucosa Sunken fontanels

Rationale:Severe dehydration would be indicated by sunken fontanels, increased heart rate progressing to bradycardia, cool mottled or dusky extremities, dry oral mucosa, and significantly decreased urine output of less than 1 mL/kg/hr. Pink moist oral mucosa and slightly decreased urine output would suggest mild dehydration.

The nurse is providing care to a child who has had an appendectomy for a perforated appendix. The nurse would anticipate intravenous antibiotic therapy for which time frame? 7 to 14 days 3 to 5 days 1 to 3 days 5 to 7 days

The child with a perforated appendix requires 7 to 14 days of intravenous antibiotic therapy. If the child has a suppurative or gangrenous appendix that was not perforated, 2 to 3 days of antibiotics would be most likely ordered.

A child with Turner syndrome is being seen in the clinic for an annual examination. What assessment would be most important for the nurse to complete? Auscultate heart sounds Measure the height Obtain blood pressure Conduct eye screening examination

answer

A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? Select all that apply. Left side lying Supine Right side lying Prone Semi-Fowler

Answer 1-3-4 Rationale: Postoperatively, the nurse would position the infant in the prone or side-lying position to allow the incision to heal.

A child is suspected of having bipolar disorder. What would the nurse identify if the child was experiencing a manic episode? (Select all that apply.) Decreased energy Flamboyant behavior Decreased sleep Pressured speech Loss of interest in activity

answer 2-3-4 Manifestations associated with a manic episode include rapid, pressured speech; increased energy; decreased sleep; flamboyant behavior; and irritability. The child also may demonstrate an increase in risk-taking behaviors, resulting in accidents and sexual promiscuity.

A child with a cognitive impairment is evaluated and found to have an intelligence quotient (IQ) of 65. The nurse interprets this as reflecting which category of impairment? Moderate Profound Mild Severe

answer 3 Mild cognitive impairment involves an IQ from 50 to 70. Moderate cognitive impairment involves an IQ from 35 to 50. Severe cognitive impairment involves an IQ from 20 to 35. A profound cognitive impairment involves an IQ less than 20.

A nurse is assessing a child and finds several major congenital anomalies. What might the nurse find? Select all that apply. Widow's peak Flat occiput Overlapping digits Limb asymmetry Cardiac conduction disorder Cleft lip

answer 4-5-6 Major congenital anomalies include cardiac conduction disorders, limb asymmetry, and cleft lip. Minor anomalies include flat occiput, widow's peak, and overlapping digits.

A child is diagnosed with hyperthyroidism. What finding would the nurse expect to assess? Facial edema Weight gain Constipation Heat intolerance

answer Hyperthyroidism is manifested by heat intolerance, nervousness or anxiety, diarrhea, weight loss and smooth, velvety skin. Constipation, weight gain, and facial edema are associated with hypothyroidism.

A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. What would the nurse expect to be administered? Calcium gluconate Desmopressin Levothyroxine Hydrocortisone

answer Intravenous calcium gluconate is used to treat acute or severe tetany. Hydrocortisone is used to treat congenital adrenal hyperplasia and Addison disease. Desmopressin is used to control diabetes insipidus. Levothyroxine is a thyroid hormone replacement used to treat hypothyroidism.

A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. What would the nurse expect to be administered? Hydrocortisone Levothyroxine Desmopressin Calcium gluconate

answer Intravenous calcium gluconate is used to treat acute or severe tetany. Hydrocortisone is used to treat congenital adrenal hyperplasia and Addison disease. Desmopressin is used to control diabetes insipidus. Levothyroxine is a thyroid hormone replacement used to treat hypothyroidism.

A child has been admitted to the acute care facility for the management of dehydration. The nurse is preparing to administer intravenous fluid replacement to the child. Which fluids are suitable for use? (Select all that apply.) Lactated Ringer 0.45% saline Normal saline 5% dextrose in water 10% dextrose in water

answer Intravenous fluids can be used to treat dehydration. The fluids used need to be isotonic. Examples of isotonic fluids include normal saline and ringer lactate solution.

A nurse is assessing a child diagnosed with Sturge-Weber syndrome. What finding would the nurse expect to find when assessing the skin? Café-au-lait spots Port wine stain Pigmented nevi Tumors

answer 2 Facial nevus or port wine stain is most often seen on the forehead and on one side of the face. Café-au-lait spots are commonly associated with neurofibromatosis. Tumors are associated with tuberous sclerosis and neurofibromatosis. Pigmented nevi are associated with neurofibromatosis

After teaching the parents of a 6-year-old child about caring for a sprained wrist, which statement by the parents indicates the need for additional teaching? "We'll apply a warm moist compress to the wrist for 20 minutes at a time." "We'll make sure she keeps her arm above heart level." "We can wrap the wrist in an elastic bandage to help reduce the swelling." "She'll need to limit any activity that involves the wrist."

Answer

The nurse is caring for a 20-month-old child with equivocal bacterial otitis media, a severe earache, and a temperature of 39°C (102.2°F). Which intervention would the nurse expect to implement? Administering antibiotics as soon as they're available Obtaining a culture of fluid from the middle ear Administering antivirals to ensure broad coverage of all organisms Determining if the child's balance is shaky when walking

Answer

The nurse is providing immediate postoperative care for a 3-month-old who had a cataract removed. Which intervention would be the priority? Explaining to the parents about patching the eye as therapy Instructing parents about using protective sunglasses Teaching the family how to use antibiotic eye drops Ensuring the protective eye patch is securely in place

Answer Rationale: The priority intervention is to protect the operative site with an eye patch. Teaching about the use of protective sunglasses would be done later in the postoperative period in preparation for the child's discharge. Teaching the parents about administering eye drops would be done later in the postoperative period in preparation for the child's discharge. Explaining about eye patching would be done later in the postoperative period in preparation for the child's discharge.

The nurse is performing an assessment on a child who is 6 days old. When assessing the eyes, the nurse notes the presence of a bluish tinge to the sclerae. What can the nurse infer about this finding? Blue hues noted in the sclerae in a child of this age is associated with a renal disorder. This is normal in infants up to several weeks of age. This may signal a connective tissue disorder. Autoimmune disorders are often preceded with these findings.

Answer At the time of birth the newborn's sclerae may have a bluish hue. This is a normal finding due to the thin nature of the tissue of the eye. This will begin to fade by the time the child is a few months of age, as the tissues begin to thicken. Finding this in a child who is 6 months of age may signal the presence of osteogenesis imperfecta type I, an inherited connective tissue disorder but is more rare.

A nurse is preparing a presentation for a health fair focusing on prevention of congenital neuromuscular disorders. What would the nurse emphasize as most important in preventing neural tube defects? Ultrasound screening at 16 weeks' gestation Genetic testing for gene identification Maternal serum α-fetoprotein levels screening Folic acid supplementation

Answer 4 Rationale: Strong evidence exists that folic acid supplementation by the mother before conception decreases the incidence of neural tube defects by 50%. Ultrasound screening at 16 to 18 weeks' gestation can help identify fetuses at risk, but this would not prevent neural tube defects. Screening of maternal serum α-fetoprotein levels can help identify fetuses at risk, but this would not prevent neural tube defects. Neural tube defects are not related to genetic dysfunction, so genetic testing would be of no value.

The nurse has performed client teaching to a 15-year-old child with Crohn disease, and parents regarding the cobblestone lesions in the child's small intestine. Which comment by the child indicates learning occurred? "It's unusual for someone my age to get Crohn disease." "I have to be careful because I am prone to not absorbing nutrients." "I have a lot of diarrhea every day because of how my small intestine is damaged." "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines."

Rationale: Crohn disease typically effects the small intestine more than the large intestine and it's onset is between the ages of 10 and 20 years. The cobblestone lesions in the small intestine prevent absorption of nutrients that normally occurs. The diarrhea is not directly related to the cobblestone lesions, and ulcerative colitis is characterized by the disease effecting the intestine(s) in a continuous pattern.

The nurse is teaching a 9-year-old child with type 1 diabetes mellitus and the parents about blood glucose monitoring. Which comment indicates a need for additional teaching? Unanswered option"The child should check glucose more often if ill." Correct option"The normal level is 70 to 110 mg/dL (3.9--6.1 mmol/L) before meals." Unanswered option"The child should check glucose before meals." Incorrect option"The normal level is 90 to 150 mg/dL (5.0--8.3 mmol/L) before bedtime."

Rationale:If the parents state that the normal level for their child is 70 to 110 mg/dL, they need to be reminded that the proper level for a 9-year-old child with type 1 diabetes is 90 to 130 mg/dL (5.0--7.2 mmol/L). The child is correct about needing to check glucose before meals; the child should also check it before bedtime snacks. The child is also correct about needing to check glucose level more often when ill, during prolonged exercise, after a larger-than-normal meal, and if nighttime hypoglycemia is suspected.

The nurse is caring for 1-month-old infant with thyrotoxicosis. What finding would the nurse expect to assess? The child is hypoactive and hypotonic. Skin is cool, dry, and scaly to the touch. Observation reveals lethargy and irritability. The infant has a strong appetite but fails to thrive.

Rationale:Infants with thyrotoxicosis may display hyperphagia but fail to gain weight. A combination of lethargy and irritability suggests congenital hypothyroidism. Cool, dry skin that is scaly to the touch suggests congenital hypothyroidism. Hypoactivity and hypotonicity are findings that suggest congenital hypothyroidism.

The nurse is caring for 1-month-old infant with thyrotoxicosis. What finding would the nurse expect to assess? The infant has a strong appetite but fails to thrive. The child is hypoactive and hypotonic. Skin is cool, dry, and scaly to the touch. Observation reveals lethargy and irritability.

Rationale:Infants with thyrotoxicosis may display hyperphagia but fail to gain weight. A combination of lethargy and irritability suggests congenital hypothyroidism. Cool, dry skin that is scaly to the touch suggests congenital hypothyroidism. Hypoactivity and hypotonicity are findings that suggest congenital hypothyroidism.

The nurse is providing care to a child who has had an appendectomy for a perforated appendix. The nurse would anticipate intravenous antibiotic therapy for which time frame? 5 to 7 days 3 to 5 days 1 to 3 days 7 to 14 days

answer 4 The child with a perforated appendix requires 7 to 14 days of intravenous antibiotic therapy. If the child has a suppurative or gangrenous appendix that was not perforated, 2 to 3 days of antibiotics would be most likely ordered.

A child with tuberous sclerosis is admitted to the hospital for elective surgery. What nursing intervention should the nurse complete first for the care of this child? Witness parents signature for surgical consent Insert a peripheral IV Provide seizure precautions Obtain cardiac clearance for surgery

answer c Tuberous sclerosis is a syndrome where there are benign tumors in the brain. It can also affect the skin, heart, eyes, lungs and bones. Because of the tumors in the brain, the largest problem associated with the syndrome is seizures. Many times the syndrome is diagnosed because it is thought to be a seizure disorder. When a child with tuberous sclerosis is admitted to the hospital, it is important to initiate seizure precautions. Having the parents sign the surgical consent and establishing an IV are interventions to prepare the child for surgery. Cardiac clearance would not be needed unless the child had a known cardiac defect.

A child needs to collect urine for 24 hours. The nurse explains to the parents and child that this test assesses glomerular filtration rate and how the kidneys are functioning. What results would be expected in this type of test? Casts and bacteria Red blood cell (RBC) casts Culture and sensitivity Creatinine clearance

Answer Rationale: A 24-hour urine collection is performed to obtain information about the creatinine clearance. This demonstrates information about the glomerular filtration rate. Urine is collected and kept on ice for a 24-hour period. During that time a serum creatinine is obtained. The presence of creatinine in the urine is compared with the serum to determine the amount of creatinine clearance. Casts, bacteria, and a culture and sensitivity are used to evaluate for infection and the antibiotics needed to treat the infection. RBCs are used to look for bleeding in the urine.

The nurse is caring for an 11-year-old with otalgia and fever. When reviewing the child's medical record, which would the nurse identify as a risk factor for acute otitis media? The child lives with the parents and older sister. The parent has had recurrent otitis media. The child was breastfed, not bottle-fed. The child had a first episode of acute otitis media 3 months ago.

Answer Rationale: A positive family history of acute otitis media, as evidenced by the report that the parent has had recurrent otitis media, is a risk factor. Breastfeeding is associated with decreasing the risk for otitis media. A first episode of acute otitis media before 3 months of age would be a risk factor. Crowding in homes or a large family size would be considered a risk factor.

The nurse is caring for a 20-month-old child with equivocal bacterial otitis media, a severe earache, and a temperature of 39°C (102.2°F). Which intervention would the nurse expect to implement? Administering antibiotics as soon as they're available Obtaining a culture of fluid from the middle ear Administering antivirals to ensure broad coverage of all organisms Determining if the child's balance is shaky when walking

Answer Rationale: Because of the severity of the symptoms, the child will be treated with antibiotics immediately. This decision is based on the clinical practice guideline developed by the American Academy of Pediatrics and American Academy of Family Physicians. This clinical practice guideline helps to eliminate the need for obtaining middle ear fluid for culture. It is unreasonable to obtain a culture of middle ear fluid with every episode of acute otitis media to determine the specific cause. A 20-month-old's gait would most likely appear as swaying from side to side while moving forward. It is not until the toddler is around 3 years of age that he or she demonstrates walking in a heel-to-toe fashion with a steady gait. Antiviral medications would be used if the diagnosis of a viral cause was confirmed and the child was older than the age of 2 years.

The nurse is educating the parents of a 7-year-old child who has hearing loss due to otitis media with effusion. Which statement by the parents indicates that further education is needed? "We need to face our child when we are speaking." "Using hand gestures as visual cues should help our child understand a little better." "We need to make sure we are speaking clearly." "We need to raise the volume of our voices significantly so our child can hear us."

Answer Rationale: It is not necessary for the parents to raise their voices more than slightly in order to be heard. Speaking clearly is an appropriate technique for communicating with the child. Facing the child when speaking is an effective method for communicating with the child. Using visual clues, such as hand gestures, is an effective technique for communicating with this child.

The nurse is caring for a 10-year-old child recently diagnosed with attention deficit hyperactivity disorder (ADHD). The nurse would expect to provide teaching regarding which medication? Incorrect option Fluoxetine Unanswered option Trazodone Correct option Methylphenidate Unanswered option Buspirone

Answer Rationale: Methylphenidate is a psychostimulant commonly prescribed for ADHD. Trazodone is used to treat depression. Buspirone is used for anxiety. Fluoxetine is used for depression.

A child returns to the clinic after an episode of otitis externa, which has resolved. What would the nurse emphasize as the priority for preventing future episodes? Avoiding upper respiratory tract infections Performing hand washing Adhering to regular follow-up to assess for hearing loss Keeping ear canals dry

Answer Rationale: Since moisture contributes to otitis externa, the priority is to keep the ear canals dry. Hand washing would be a priority for preventing infections such as conjunctivitis. Upper respiratory tract infections are associated with otitis media, not otitis externa. Hearing loss is not associated with otitis externa.

The emergency department nurse is caring for a 3-year-old girl with an arm injury. The mother is very upset because she believes she broke her daughter's arm. "I was lifting her by her hands and felt a pop in her wrist. She instantly started screaming." The child is now guarding and refusing to move her arm. Which response by the nurse would be most appropriate? "The popping noise was the ligament surrounding the radial head becoming entrapped." "Her arm isn't broken. This injury is common and easily fixed with no complications." "This is most likely nursemaid's elbow; you will have to be more careful in the future." "You probably dislocated her radial head when you lifted her."

Answer Rationale: The nurse should quickly reassure the mother that this is a common occurrence, seen every day in the emergency department, and is easily fixed and resolves with no complications. Although a popping noise indicates entrapment of the ligament, this response does not address the mother's concerns. Although the radial head most likely dislocated, this response does not address the mother's concern. Although this condition is called nursemaid's elbow, telling the mother she has to be more careful only serves to put blame on the mother and does not address her concerns.

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority? Risk for infection Excess fluid volume Activity intolerance Imbalanced nutrition less than body requirements

Answer Rationale: When vesicoureteral reflux is present, the primary goal is to avoid urine infection so that infected urine cannot gain access to the kidneys. Fluid volume typically is not a problem associated with VUR. Nutritional problems are not associated with VUR. Activity intolerance is not associated with VUR.

The nursing educator has completed an educational program for new nurses on eating disorders in adolescents. Which statement by a participant would indicate a need for further education? "Meal time should be structured but pleasant and relaxed without distractions." "If they refuse to eat, we need to sit with them and not let them leave the table until they do eat something." "We need to stay with them for at least 30 minutes after they eat so they don't try to vomit or dispose of the food." "We need to allow the client to participate in developing the treatment plan."

Answer Rationale: Withdraw attention if the child refuses to eat: secondary gain is minimized if refusal to eat is ignored rather than with continuous attention. Mutually establish a contract related to treatment to promote the child's sense of control. Provide mealtime structure, as clear limits let the child know what the expectations are. Provide continuous supervision during the meal and for 30 minutes following it so that the child cannot conceal or dispose of food or induce vomiting.

The nurse is performing double diapering for a male infant with hypospadias who has undergone a surgical repair. The nurse performs the following steps. Place the steps in the order in which the nurse performs them. Closes the larger diaperBrings the penis and catheter/stent through the hole in the smaller diaperUnfolds both diapers, placing smaller diaper inside larger diaperPlaces both diapers under the infantCloses the smaller diaperCuts a hole in the front of the smaller diaper

Answer 1) Cuts a hole in the front of the smaller diaper 2) Unfolds both diapers, placing smaller diaper inside larger diaper 3) Places both diapers under the infant 4) Brings the penis and catheter/stent through the hole in the smaller diaper 5) Closes the smaller diaper 6) Closes the larger diaper Rationale: When performing double diapering, the nurse cuts a hole or a cross-shaped slit in the front of the smaller diaper and then unfolds both diapers, placing the smaller diaper (with the hole) inside the larger one. Next, the nurse places both diapers under the child and carefully brings the penis (if applicable) and catheter/stent through the hole in the smaller diaper, closing the diaper. Finally, the nurse closes the larger diaper, making sure the tip of the catheter/stent is inside the larger diaper.

The nurse is discussing communication options with the parents of a 2-year-old child with congenital hearing loss. The nurse integrates knowledge of what form of communication as having no verbal component? Total communication Oral deaf education Cued speech American Sign Language

Answer Rationale: American Sign Language is entirely communicated through hand signs, gestures, and facial expression. It has its own grammar and syntax. Oral deaf education uses technology to boost auditory potential and teaches children to notice sound and give it meaning. It helps develop oral speech. Cued speech is a system using hand signs to clarify lip-reading. It gives the person clues about the sounds the speaker is making. Total communication combines auditory training and teaching spoken language with signing exact English, which corresponds to the words and syntax of English.

A 9-year-old child is scheduled for a computed tomography with contrast medium. What would be most important for the nurse to assess? Swelling Pain Allergies White blood cell count

Answer Rationale: Assessing for allergies would be the priority because a contrast medium is being used. Pain is an important assessment but is unrelated to the test scheduled. Swelling is an important assessment finding, but this is unrelated to the test scheduled. Although a white blood cell count is important for determining an infection, it is unrelated to the test scheduled.

A group of students are reviewing the role of neurotransmitters in the development of depression. The students demonstrate a need for additional study when they identify which neurotransmitter as being involved? Norepinephrine Serotonin ?-Aminobutyric acid (GABA) Dopamine

Answer Rationale: Both norepinephrine and dopamine play a role in mood. When alterations in the neurotransmission of norepinephrine and dopamine occur, the symptoms of depression (apathy, loss of interest and pleasure) result. Decreased levels of serotonin have also been implicated in depressive symptoms. GABA is associated with anxiety disorders.

The nurse is talking with the parents of a child who has been identified as having a learning disability. The parents state that their child performs well on oral examinations but struggles otherwise on exams. The nurse is aware that the parents are describing which disorder? Correct option Dyslexia Unanswered option Dysgraphia Unanswered option Dyspraxia Unanswered option Dyscalculia

Answer Rationale: Children with dyslexia have difficulty with reading, writing, and spelling. Children with dyscalculia have problems with mathematics and computation. Children with dyspraxia have problems with manual dexterity and coordination. Children with dysgraphia have difficulty producing the written word.

The nurse is preparing a 7-year-old girl for discharge after treatment for nephrotic syndrome. Which instructions would the nurse include in the discharge teaching plan for the parents? "Let's meet with the dietitian and plan some meals." "She should try to avoid protein." "She must severely restrict her sodium intake." "Here is some written information from the dietitian."

Answer Rationale: Consultation with a dietitian would be most helpful for meal planning because so many of children's favorite foods are high in sodium. Restricting sodium may not be necessary if the child is not edematous; in addition, the statement does not teach. Protein-rich snacks should be encouraged. The nurse needs to provide the parents with specific instructions, assistance, and resources in addition to simple written instructions.

A nurse is preparing a presentation for a group of parents about vision impairment. When describing the causes, what would the nurse include as a common cause? (Select all that apply.) Trauma Retinopathy of prematurity Conjunctivitis Refractive error Infantile glaucoma Amblyopia

Answer Rationale: In the United States, visual impairment and blindness are most often caused by refractive error, astigmatism, strabismus, amblyopia, nystagmus, infantile glaucoma, congenital cataract, retinopathy of prematurity, and retinoblastoma.

The nurse is assessing a 13-year-old adolescent with an eye injury. The nurse determines that evaluating pupillary response to light and accommodation is not appropriate based on the suspicion of a: foreign body. scleral hemorrhage. corneal abrasion simple contusion.

Answer Rationale: Scleral hemorrhage appears as erythema in the sclera and can be quite large initially, but vision is unaffected by it. A simple contusion can affect visual acuity and may cause diplopia or blurred vision. Therefore, the nurse needs to check pupillary response. A foreign body can affect vision, necessitating evaluation of pupillary response. Corneal abrasion can affect vision. Therefore, the nurse should check the adolescent's pupillary response.

A group of nursing students are reviewing the actions of various drugs used to treat mental health disorders in children. The students demonstrate understanding of the information when they identify which drug as potentiating the activity of serotonin in the brain? Buspirone Lithium Sertraline Trazodone

Answer Rationale: Sertraline is a selective serotonin reuptake inhibitor that potentiates serotonin activity in the brain. Trazodone is an atypical antidepressant that inhibits the reuptake of serotonin. Lithium influences the reuptake of serotonin and/or norepinephrine. Buspirone blocks the reuptake of dopamine.

The nurse is caring for a 6-year-old boy with myelomeningocele. The nurse is teaching the mother how to promote appropriate bowel elimination and avoid constipation. Which response from the mother indicates a need for further teaching? Unanswered option "I need to figure out his usual pattern for passing stool." Unanswered option "I can palpate his abdomen to assess for constipation" Correct option "My son's activity is too limited to stimulate his bowels." Unanswered option "He must have an adequate amo

Answer Rationale: The nurse needs to point out to the mother that even minimal activity increases peristalsis. Together they can come up with appropriate activities within the child's limits or restrictions to promote peristalsis. It is important to determine the usual pattern for passing stool so that the mother and nurse can determine the best program. Palpating the abdomen can reveal distention suggesting constipation. Adequate fluid is necessary to stimulate peristalsis.

The nurse is teaching the parents of a female child with a myelomeningocele how to perform clean intermittent catheterization. The nurse determines that the teaching was effective when the parents return demonstrate the procedure and state: "We need to apply some petroleum jelly to her labia and the catheter before we attempt to insert it." "Before inserting the catheter, we need to wipe her labia with normal saline from back to front." "We need to insert the catheter about 6 inches so that we make sure the catheter is in the bladder." "When the urine stops flowing, we should press on the lower belly to ensure the bladder is empty."

Answer Rationale: When the urine stops flowing, the parents should press on the lower abdomen or have the child lean forward to tense the abdominals to ensure that no more urine is in the bladder. For a female, the catheter is inserted about 2 to 3 inches. For a male, the catheter is inserted about 4 to 6 inches. Before the catheter is inserted, the labia is cleaned with a washcloth or disposable wipe from front to back. A generous amount of water-soluble lubricant, not petroleum jelly, is applied to the catheter. There is no need to apply the lubricant to the labia.

The nurse is assessing a child with a hordeolum. Which would the nurse be least likely to observe? Pain Lesion along the lid margin Reddened conjunctiva Eyelid edema

Answer The conjunctiva is clear with a hordeolum. A hordeolum is usually painful. Eyelid edema is present with a hordeolum. A hordeolum may be visible as an enlarged lesion along the lid margin.

The home care nurse is conducting an in-home visit for a child who had corrective surgery for hypospadias 3 days prior. What would alert the home care nurse to provide additional teaching? The parent indicates the child is fussy, but calms down when held on the parent's hip. The parent states, "I have had to buy more diapers since having to double diaper him." The parent states, "I cannot wait until I can bath him the tub again...he enjoys it so much." The parent expresses relief that the child was not also diagnosed with cryptorchidism at birth.

Answer 1 Rationale: Hypospadias is a condition in which the urethral opening in on the ventral surface of the penis. Surgical repair involves a catheter or stent left in place for 3 to 7 days postoperatively. Activities or play that involves straddling (such a being carried on the parent's hip) are discouraged to prevent trauma to the surgical site and catheter or stent. The child should be double diapered to prevent stool from contaminating the catheter or stent and operative site and causing an infection. The child should not be bathed in a tub until the catheter or stent is removed. Cryptorchidism is a common diagnosis along with hypospadias.

A nurse is conducting a physical examination of a 5-year-old boy with spinal muscular atrophy (SMA) type 2. What assessment findings would the nurse expect to find? Pectus excavatum Loss of strength in ankle dorsiflexion Loss of strength in hip extension Pseudohypertrophy of the calves

Answer 1 Rationale: Pectus excavatum develops in children with SMA type 1 and type 2 who exhibit paradoxical breathing. The chest becomes funnel shaped and the xiphoid process is retracted. Pseudohypertrophy of the calves is associated with Duchenne muscular dystrophy. Loss of strength in hip extension is associated with Duchenne muscular dystrophy. Loss of strength in ankle dorsiflexion is associated with Duchenne muscular dystrophy.

The nurse is caring for a 10-year-old child experiencing nocturnal enuresis with no physiologic cause. The child states, "I am embarrassed and I wish I could stop this right now!" How will the nurse respond? "There are several things we can do to help you achieve this goal." "You will grow out of this eventually; you just need to be patient." "You are not alone. There are almost 5 million people that have enuresis." "You can wear pull-ups to bed and, since they look like underwear, no one will know."

Answer 1 Rationale: The child wants to stop this problem immediately, so the nurse's most therapeutic response is to assure the child that enuresis is indeed solvable. For some children, learning about the high prevalence of the problem may provide consolation. However, this may not alleviate the child's embarrassment and it does not address the desire for solutions. Telling the child that he or she will "grow out of this" downplays the embarrassment and does not address the desire to solve the problem. Pull-ups conceal the consequences of enuresis but do not provide a solution.

A group of nursing students are reviewing the variations in the genitourinary system in children as compared with adults. The students demonstrate understanding of this information when they state: Bladder capacity reaches adult capacity by age 1 year. Glomerular filtration rate is faster in infants than in adults. A child's kidneys are surrounded by more fat padding than an adult's kidneys. The renal system usually reaches functional maturity by age 5 years.

Answer 1 Rationale: Bladder capacity is about 30 mL in the newborn and increases to the usual adult capacity of about 270 mL by 1 year of age. Glomerular filtration rate is slower in the infant and young toddler compared with the adult. The renal system usually reaches functional maturity by 2 years of age. The kidneys of a child are less well protected from injury by the ribs and fat padding than they are in the adult.

A child is in Buck traction to correct a hip problem. When caring for this child, it is most important for the nurse to implement which intervention? Remove the boot every 8 hours Provide diversionary activities Keep the affected leg on a pillow Administer antispasmodics every 4 hours

Answer 1 Rationale: Buck traction is a skin traction used to treat hip and knee problems. The traction is applied in a straight line with the extremity in a boot and weights attached that hang freely off the end of the bed. It is imperative the boot be removed every 8 hours for skin assessment. Due to the weight applied to the boot, skin integrity can easily become impaired. The affected leg should not be elevated on a pillow. Antispasmodics are generally prescribed but they would be used when needed, not scheduled. Diversionary activities should be provided but they do not take priority over skin assessment.

The nurse is assessing a hospitalized child diagnosed with nephrotic syndrome. What assessment(s) is most important for the nurse to complete to help identify hypoalbuminemia in this child? The heart rate and blood pressure The blood pressure and oxygen saturation The heart and lung sounds The respiratory rate and heart rate

Answer 1 Rationale: In nephrotic syndrome hyperalbuminemia occurs with a loss of protein and albumin in the blood stream. This causes many fluid shifts from the blood stream (intravascular) to the interstitial tissues. The result is edema as the fluid in the interstitial spaces increases. This leaves the intravascular fluid decreased or depleted causing hypovolemia. The best assessment for this condition is to assess the heart rate and the blood pressure. These will indicate hypovolemia from the fluid shifts occurring. The respiratory rate and the work of breathing are assessed for fluid overload in the lungs. The heart sounds and the lungs sounds are assessed for fluid overload, not decreased. Assessing the oxygen saturation is only necessary if there are adventitious lung sounds or increased work of breathing.

A nursing instructor is preparing a class presentation about tibia vara. What would the instructor include as a risk factor? Obesity Lack of sunlight exposure Late walking Hormonal alterations during puberty

Answer 1 Rationale: Obesity is a risk factor for the development of tibia vara. Tibia vara occurs most frequently in children who are early walkers. Limited or lack of exposure to sunlight may lead to rickets. Hormonal alterations during puberty may play a role in the development of slipped capital femoral epiphysis.

The nurse is educating the parents of a child requiring renal replacement. The parents express concern because they live in a remote, rural area with no access to pediatric specialty dialysis units. Which would the nurse recommend to the parents? Peritoneal dialysis Hemodialysis In home hemodialysis Renal transplant

Answer 1 Rationale: Peritoneal dialysis is performed in the home setting after proper training. Hemodialysis is completed several times a week at a dialysis center. Renal transplant would be a discussion if the child needed a kidney transplant.

The nurse is caring for a 6-year-old boy with Russell traction applied to his left leg. Which intervention would be most appropriate to prevent complications? Assess the popliteal region carefully for skin breakdown. Clean and massage his entire leg daily. Provide pin care as needed. Adjust the weights as needed.

Answer 1 Rationale: The nurse would assess the popliteal region carefully for skin breakdown from the sling. The nurse would adjust the weights only per physician orders. Cleaning and massaging the skin is unrelated to care of the child with Russell traction. Russell traction is a form of skin traction, so there is no pin care.

The nurse is educating the parents of an infant after a circumcision. The parents demonstrate understanding when they state that they need to report what to the physician? The infant does not urinate within 6 to 8 hours Appearance of granulation tissue Small spots of blood on diaper Bleeding that stops without pressure

Answer 1 Rationale: The parents should immediately notify the physician or nurse practitioner if the infant does not urinate within 6 to 8 hours after the procedure. Small spots of blood on the diaper, bleeding that stops without pressure, and granulation tissue are normal findings.

The nurse is caring for a 13-year-old adolescent with a nursing diagnosis of ineffective coping related to inability to deal with life stressors as evidenced by few or no meaningful friendships and low self-esteem. Which intervention would be the priority to promote coping skills? Encourage the adolescent to discuss thoughts and feelings. Demonstrate unconditional acceptance of the adolescent as a person. Set clear limits on behavior. Role model appropriate social and conversation skills.

Answer 1 Rationale: The priority intervention is to encourage the adolescent to discuss thoughts and feelings, as this is an initial step toward learning to deal with them appropriately. The other interventions are appropriate, but the priority intervention is to encourage discussion and obtain information from the adolescent. This way the nurse can develop and refine the interventions based on the adolescent's thoughts and feelings.

After teaching the parents of a child with Tourette syndrome about motor and vocal tics, the nurse determines that the teaching was successful when the parents state: "If we get our child focused on an activity, the tics will be less pronounced." "Our child can control the tics if our child really concentrates on doing so." "Drugs are the primary method for controlling the symptoms." "Vocal tics are harder to control than the motor tics are."

Answer 1 Rationale: Tics become more noticeable or severe during times of stress and less pronounced when the child is focused on an activity such as watching TV, reading, or playing a video game. The tics are not under voluntary control and either type can be difficult to control. Management is highly individualized and involves psychopharmacology and behavioral therapy.

While assessing a child with end-stage kidney disease, the nurse notes that the child has fallen into a coma. The nurse interprets this finding as resulting from which complication? Uremia Immunosuppression Hypocalcemia Metabolic acidosis

Answer 1 Rationale: Uremia may result in depression of the central nervous system leading to symptoms such as headache or coma or gastrointestinal or neuromuscular disturbances. Metabolic acidosis causes lethargy, dull headache, and confusion. Immunosuppression is not involved with end-stage kidney disease. Hypocalcemia is manifested by muscle twitching, or tetany.

The nurse is assessing a child with spastic cerebral palsy. What findings would the nurse expect to assess? Select all that apply. Exaggerated deep tendon reflexes Hypertonicity Hemiplegia Dysarthria Poor control of balance Drooling

Answer 1-2-3-5 Rationale: Spastic cerebral palsy is associated with exaggerated deep tendon reflexes; poor control of posture, balance, and movement; hypertonicity of the affected extremities; and hemiplegia, quadriplegia, or diplegia, based on the limbs affected. Drooling and dysarthria are associated with athetoid cerebral palsy.

The nurse is caring for a child diagnosed with acute post-streptococcal glomerulonephritis. When assessing the child, what findings does the nurse anticipate? Select all that apply. Weight gain Generalized edema Clear, straw colored urine Headache A recent gastrointestinal infection resulting in severe diarrhea

Answer 1-2-4 Rationale: Acute post-streptococcal glomerulonephritis often follows a respiratory infection caused by one of the strains of group A beta-hemolytic streptococcus. With kidney function being decreased the nurse expects to assess signs and symptoms such as weight gain from edema and headache. Urine will likely be concentrated causing it to be dark in color.

The nurse is reviewing the health history of a client suspected of having vesicoureteral reflux. What findings in the health history are consistent with this disorder? Select all that apply. Flank pain Hematuria Pyuria History or repeated urinary tract infections. Urinary frequency

Answer 1-2-4-5 Rationale: Vesicoureteral reflux (VUR) is a condition in which urine from the bladder flows back up the ureters. Primary VUR results from a congenital abnormality at the vesicoureteral junction that results in incompetence of the valve. Secondary VUR is related to other structural or functional problems such as neurogenic bladder, bladder dysfunction, or bladder outlet obstruction. Symptoms consistent with this condition include dysuria, urinary frequency, hematuria, back or flank pain, previous urinary tract infections, Pus in the urine is not associated with this condition

When assessing a child with hydronephrosis, what would the nurse expect to find? Select all that apply. Abdominal mass Proteinuria Intermittent hematuria Flank pain Foul-smelling urine

Answer 1-3 Rationale: Intermittent hematuria is a common symptom of hydronephrosis. An abdominal mass may be palpated with hydronephrosis. Foul-smelling urine is associated with obstructive uropathy. Flank pain is associated with obstructive uropathy and vesicoureteral reflux. Proteinuria is associated with nephritic syndrome.

The parents of an 8-year-old child with nocturnal enuresis bring the child to the clinic for a follow-up. History reveals that the parents have tried numerous behavioral and motivational therapies without success. The nurse anticipates medication therapy. Which agents would the nurse identify as being used? Select all that apply. Desmopressin Albumin Oxybutynin Imipramine Prednisone

Answer 1-3-4 Rationale: Medication therapy for treatment of nocturnal enuresis may include oxybutynin, imipramine, and desmopressin. These agents are prescribed only if behavioral and motivational therapies have been ineffective. Prednisone, a corticosteroid, would be ordered to induce remission and promote dieresis in children with nephritic syndrome. Albumin would be used to treat nephritic syndrome.

The nurse is reviewing the blood urea nitrogen (BUN) results of an assigned client. The test is elevated. What factors may be associated with this result? Select all that apply. There may be an infectious process in the child. The child has type 1 diabetes mellitus. The child's diet contains high levels of protein. The child may be dehydrated. The child may be experiencing water intoxication.

Answer 1-3-4 Rationale: Blood urea nitrogen may be elevated with a high-protein diet or dehydration, and may be decreased with overhydration or water intoxication. There is no direct link between this test and the presence of diabetes mellitus. BUN levels may be increased with an infectious process such as glomerulonephritis.

The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply. Correctoption Capillary refill Unansweredoption Vital signs Correctoption Color Correctoption Pulse Correctoption Sensation

Answer 1-3-4-5

The nurse is caring for an infant with myelomeningocele prior to having repair surgery. What nursing intervention(s) is necessary to include in this infant's plan of care? Select all that apply. Protect knees and elbows from skin breakdown Provide a pacifier for nonnutritive sucking Positioning of paralyzed legs to prevent contractures Use a high-calorie, concentrated formula for feeds Keep the skin clean and dry

Answer 1-3-5 Rationale: A myelomeningocele is a spinal cord defect. The sac protrudes through the skin. The spinal cord ends at the level of the defect causing no motor or sensory function below that point. The infant must remain in a prone position to keep from causing damage to the sac until repair can be done. This also means no diapers. Skin integrity and positioning are essential. This infant could have breakdown on the knees and elbows and even the side of the head. The infant needs to be cleaned regularly and kept dry. Different types of mattresses can be used to reduce pressure on bony prominences. The paralyzed lower extremities need to be repositioned regularly to prevent contractures. A high-calorie, concentrated formula is not necessary. Regular-calorie formula is adequate. A pacifier for nonnutritive sucking is a good idea and may be a comfort to the infant but it is not essential.

The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child's medical record? X-ray confirmation of adequate bone shape Low serum calcium levels Low alkaline phosphate levels High serum phosphate levels

Answer 2 Low calcium levels and low phosphates levels are present. Alkaline phosphate is elevated. X day shows change in bone

The nurse is caring for a 3-year-old boy with a fracture of the humerus. His chart indicates "fracture is partially through the physis extending into the metaphysis." The nurse identifies this as which Salter-Harris classification? Type V Type II Type IV Type I

Answer 2 Rationale: According to the Salter-Harris classification, a type II fracture is partially through the physis extending into the metaphysis. A type I fracture is through the physis, widening it. A type IV fracture is through the metaphysis, physis, and epiphysis. A type V fracture is a crushing injury to the physis.

The nurse is caring for an infant boy with grade IV vesicoureteral reflux. Which finding would lead the nurse to suspect that hydronephrosis is present? Unanswered option Swollen testes Correct option Abdominal mass Unanswered option Enlarged inguinal glands Unanswered option Purulent drainage from the penis

Answer 2 Rationale: An abdominal mass indicates hydronephrosis. Enlarged inguinal glands are not associated with hydronephrosis. Purulent drainage from the penis is not associated with hydronephrosis. Swollen testes are not associated with hydronephrosis.

A group of nursing students are reviewing medications used to treat attention deficit hyperactivity disorder (ADHD). The group demonstrates understanding of the information when they identify what as a nonstimulant norepinephrine reuptake inhibitor? Pemoline Atomoxetine Lisdexamfetamine Methylphenidate

Answer 2 Rationale: Atomoxetine is a nonstimulant norepinephrine reuptake inhibitor used to treat ADHD. Methylphenidate is a psychostimulant used to treat ADHD. Lisdexamfetamine is a psychostimulant used to treat ADHD. Pemoline is a psychostimulant used to treat ADHD.

The nurse is speaking with the parent of a 2-year-old child recently diagnosed with an autism spectrum disorder. The parent asks about educational programs for her child. What is the best response by the nurse? "Children with an autism spectrum disorder are able to function on their own and do not need any special support at school." "Children with an autism spectrum disorder enrolled in public schools can have an individualized educational plan to help meet their specific needs." "Children with an autism spectrum disorder are not eligible to participate in any of the local early educational programs provided since they are only open to children with cognitive impairment." "Children with an autism spectrum disorder can only go to special schools, not public schools, so you will need to get your name on a waiting list soon."

Answer 2 Rationale: Children enrolled in public schools need to have an individualized educational plan (IEP) in place. Children with an autism spectrum disorder can go to public or private schools. No matter the school setting, the child will need assistance of some kind. Children under 36 months can receive services via the local early intervention program.

The nurse is caring for a 10-year-old child with a history of inappropriate behavior. Which statement by the parent would lead the nurse to suspect possible conduct disorder? "Our child blames everyone else for his or her problems." "Our child recently trampled our neighbor's flower bed." "Our child has frequent temper tantrums." "Our child argues excessively with teachers."

Answer 2 Rationale: Destruction of the property of others points to conduct disorder. Frequent temper tantrums suggest oppositional defiant disorder. Blaming others for problems is an indicator of oppositional defiant disorder. Excessive arguing with adults suggests oppositional defiant disorder.

The nurse is caring for an infant with grade II vesicoureteral reflux (VUR). The parent is very fearful that the infant will have progressive renal damage. Which response by the nurse would be appropriate? "This problem must be carefully managed to avoid permanent damage." "This condition usually resolves spontaneously with no symptoms." "You can expect recurrent urinary tract infections along with progressive renal damage." "Your infant will most likely need surgical intervention."

Answer 2 Rationale: Grades I and II VUR usually resolves spontaneously. Grades III to V are generally associated with recurrent urinary tract infections, hydronephrosis, and renal damage. Typically, only grades III to V need surgical intervention.

The nurse is triaging clients as they come in to an express care facility. Which assessment finding is clinically significant for early nephrotic syndrome? Facial puffiness Periorbital edema Sacral edema Edema in the hands

Answer 2 Rationale: Periorbital edema and edema in the ankles are the initial presenting symptoms. As the swelling advances, the edema becomes generalized with a pendulous abdomen full of fluid. Edema in the scrotum also appears. Edema in the hands, sacrum and facial puffiness can be a progression of the disease.

The nurse is providing teaching about the potential side effects of lithium for the parents of a child recently diagnosed with bipolar disorder. Which statement by the parents indicates a need for additional teaching? "Our child may notice an increase in urination" "If our child loses weight, then we know the medication is working." "Tremors and nausea are common side effects." "Our child will probably tell us about being hungrier than usual."

Answer 2 Rationale: Weight gain, not weight loss, is a side effect of the drug. An increased appetite occurs with lithium. Lithium is associated with tremors and nausea. Polyuria occurs with lithium.

The nurse is obtaining the history of an adolescent who is suspected of having anorexia nervosa. What findings would the nurse expect? (Select all that apply.) Diarrhea Desire for perfectionism Syncope Warm hands and feet Secondary amenorrhea

Answer 2-3-5 Rationale: The adolescent with anorexia may have a history of constipation, syncope, secondary amenorrhea, abdominal pain, and periodic episodes of cold hands and feet. In addition, the child's self-concept reveals multiple fears, high need for acceptance, disordered body image, and perfectionism.

The nurse is caring for a child on a pediatric unit who has hemodialysis 3 times per week due to renal failure. On the days between dialysis treatment, which meal would be acceptable for the child? Cheeseburger, French fries, and lemonade Tomato soup, crackers, and diet soda Grilled chicken, half of a banana, and flavored water Three egg omelet, bacon, and orange juice

Answer 3 Rationale: Since hemodialysis is usually performed only every other day, larger amounts of waste products build up in the child's blood; therefore, the child must follow a stricter diet between hemodialysis treatments, though dietary restrictions are usually lifted while the child is actually undergoing the treatment. Since the kidneys are not functioning, foods high in sodium, protein, and potassium must be avoided.

A group of students are reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age? Toddlerhood School age Adolescence Preschool age

Answer 3 Ossification and conversion of cartilage to bone continue throughout childhood and are complete at adolescence.

A child with cirrhosis of the liver is admitted to the acute care facility in preparation for a liver transplant. When completing the physical examination, what would the nurse expect to assess? (Select all that apply.) Jaundice Fatty stools Spider angiomas Facial erythema Ascites

answer 1-3-5 Assessment findings associated with cirrhosis include jaundice, ascites, spider angiomas, and palmar erythema. Fatty stools are associated with celiac disease.

A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as: incomplete fracture. bone that breaks into two pieces. significant bending without actual breaking. bone buckling due to compression.

Answer 3 Rationale: A plastic or bowing deformity is one in which there is significant bending of the bone without breaking. A buckle fracture is one in which the bone buckles rather than breaks. This is usually due to a compression injury. An incomplete fracture of the bone is a greenstick fracture. A complete fracture is one in which the bone breaks into two pieces.

The nurse is assessing a 10-year-old girl recently fitted with a cast on her wrist. Which assessment finding would alert the nurse to a possible infection? Pallor of the fingers Diminished pulse Drainage on the cast Delayed capillary refill

Answer 3 Rationale: Drainage on the cast could indicate an infection. Pale fingers would suggest impaired circulation. Delayed capillary refill would suggest impaired circulation. Diminished pulse would suggest impaired circulation.

The nurse is caring for a child with attention deficit hyperactivity disorder (ADHD) who is experiencing insomnia related to the prescribed psychostimulant. The parents are considering stopping the medication and want to know if there are other options. Which response by the nurse would be most appropriate? "Ask the health care provider about long-acting methylphenidate." "Perhaps the health care provider will prescribe long-acting dextroamphetamine." "Speak to the healthcare provider about atomoxetine." "Talk to the health care provider about dextroamphetamine."

Answer 3 Rationale: The nurse could suggest that the parents speak to the healthcare provider about atomoxetine, a nonstimulant norepinephrine reuptake inhibitor that does not contribute to insomnia. Dextroamphetamine, long-acting dextroamphetamine, and long-acting methylphenidate are psychostimulants; the child is already taking a psychostimulant and having difficulty with insomnia, so these would not be good options.

A child is to undergo testing for suspected muscular dystrophy and is scheduled for the following tests. Which test would the nurse identify as most important to be completed first? Electromyogram Nerve conduction velocity Creatine kinase Muscle biopsy

Answer 3 Rationale: The sample for creatine kinase must be obtained before the electromyogram or muscle biopsy because those tests may lead to a release of creatine kinase and provide false results. Nerve conduction velocity tests could be done at any time.

The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding? Thin gray vaginal discharge with fishy odor Foul yellow-gray discharge White cottage cheese-like discharge Irritation of labia and vaginal opening

Answer 3 Rationale: White cottage cheese-like discharge indicates C. albicans. Thin gray discharge with a fishy odor points to Bordetella or Gardnerella. Foul yellow-gray discharge indicates Trichomonas vaginalis. Irritation of the labia and vaginal opening is commonly found with poor hygiene

The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism? Fluid detected in scrotal sac Testis can briefly be brought into scrotum Testis cannot be "milked" down inguinal canal Venous varicosity detected along the spermatic cord

Answer 3 Rationale: With true cryptorchidism, the retractile testis cannot be "milked" down the inguinal canal. Fluid in the scrotal sac is a hydrocele. A venous varicosity along the spermatic cord is a varicocele. Testis that can be brought into the scrotum refers to a retractile testis.

A 7-year-old boy is suspected of having transient synovitis of the hip. What findings would the nurse expect to assess? Select all that apply. High fever Internally rotated affected extremity History of recent otitis media Complaint of acute onset of moderate pain Pain worse in the morning on arising

Answer 3-4-5 Rationale: Assessment findings associated with transient synovitis of the hip include a recent upper respiratory tract infection, pharyngitis, and otitis media. Pain onset is acute and sudden, with pain ranging from moderate to severe that is worse in the morning. Temperature will be normal or a low-grade fever may be present. The child holds the affected hip flexed and externally rotated.

A group of students are reviewing information about bone healing in children. The students demonstrate understanding of this information when they state: the process of breaking down and forming new bone is decreased in children compared with adults. callus production is slower (but greater in amount) in children than in adults. a child's bones heal more quickly than those of an adult. a fracture closer to the growth plate heals much slower than one in the metaphysis.

Answer 4 Bone healing occurs in the same fashion as in the adult, but it occurs more quickly in children because of the rich nutrient supply to the periosteum. The closer a fracture is to the growth plate, the more quickly the fracture heals. The capacity for remodeling (the process of breaking down and forming new bone) is increased in children compared with adults. Children's bones produce callus more rapidly and in larger quantities than do adults' bones.

The nurse is providing care to a child with acute renal failure. What assessment would be a priority for the nurse to determine if this child is developing hyperkalemia? Abdominal pain The blood pressure Increased muscle tone Pulse rate and rhythm

Answer 4 Hyperkalemia occurs when the potassium levels rise above normal lab values. Although it may be different for different laboratories a normal potassium range is generally between 3.5 and 5 mmol/L. When the potassium levels rise the child will develop symptoms such as a weak, irregular pulse, muscle weakness and abdominal cramping. The priority assessment is the pulse rate and rhythm since potassium is directly linked to heart functioning. Increased muscle tone would be associated with hypocalcemia. The blood pressure is not directly affected by the potassium levels. It could be altered indirectly if arrhythmias occur or the heart starts to fail.

The nurse is caring for a child recently fitted with braces on both legs due to cerebral palsy (CP). What would the nurse emphasize in the discharge teaching? "If the brace is painful, feel free to take it off." "Please try and follow the therapist's on and off schedule." "It is very important to comply with the use of this brace." "Check the skin that is covered by the braces for redness and breakdown."

Answer 4 Rationale: Assessing skin integrity should be the priority, as braces can lead to pressure ulcers and infection. Compliance is important, but attention to skin care is the priority teaching. Following the schedule is important for compliance, but skin integrity is the priority. Advising the parents to remove the brace if it is painful is inaccurate; the child may require pain management or further consultation with the physical therapist.

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant? Lorazepam Prednisone Botulin toxin Baclofen

Answer 4 Rationale: Baclofen is a centrally acting skeletal muscle relaxant used to treat painful spasms and decrease spasticity in children with motor neuron lesions. Prednisone is a corticosteroid that is used to help slow the progression of Duchenne muscular dystrophy. Lorazepam is a benzodiazepine used for adjunctive relief of skeletal muscle spasm associated with cerebral palsy. Botulin toxin is a neurotoxin used to relieve spasticity in cerebral palsy.

The nurse is caring for a 10-year-old girl in traction. The girl is experiencing muscle spasms associated with the traction. What would the nurse expect to administer if ordered? Alendronate Narcotic analgesics Pamidronate Diazepam

Answer 4 Rationale: Diazepam is an antianxiety drug that also has the effect of skeletal muscle relaxation; it is used for the treatment of muscle spasm associated with traction or casting. Narcotic analgesics are used for pain relief. Alendronate increases bone mineral density for children with osteogenesis imperfecta. Pamidronate increases bone mineral density for children with osteogenesis imperfecta.

The nurse is caring for a 2-year-old boy with cerebral palsy (CP). The medical record indicates "hypertonicity and permanent contractures affecting both extremities on one side." Based on these findings, the nurse identifies this type of CP as: ataxic. mixed. athetoid or dyskinetic. spastic.

Answer 4 Rationale: Spastic involves hypertonicity and permanent contractures on both extremities on one side. Athetoid (dyskinetic) involves abnormal involuntary movements affecting all four extremities and sometimes the face, neck, and tongue. Ataxic affects balance and depth perception. Spastic affects the lower extremities. Mixed is a combination of spastic, athetoid and ataxic.

A nurse is assessing a newborn and observes webbing of the fingers and toes. The nurse documents this finding as: Unanswered option metatarsus adductus. Unanswered option polydactyly. Unanswered option pectus carinatum. Correct option syndactyly.

Answer 4 Rationale: Syndactyly refers to webbing of the fingers and toes. Polydactyly refers to the presence of extra digits on the hand or foot. Metatarsus adductus is a medial deviation of the forefoot. Pectus carinatum is a protuberance of the chest wall.

The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion? Enlarged inguinal glands and fever Hardened and tender epididymitis with edema and erythema of scrotum Fever, scrotal swelling, and urethral discharge Sudden onset of severe scrotal pain with significant hemorrhagic swelling

Answer 4 Rationale: Testicular torsion is characterized by a testicle that is abnormally attached to the scrotum and twisted. Signs and symptoms include sudden onset of severe scrotal pain with significant hemorrhagic swelling. Enlarged glands and fever point to infection. A hardened and tender epididymis points to epididymitis. Fever and urethral discharge suggest infection. Scrotal swelling is associated with testicular torsion, epididymitis, and hydrocele.

The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority? Ineffective coping related to diagnosis of chronic condition Risk for injury related to lack of muscle control Impaired physical mobility related to spinal cord defect Deficient knowledge related to diagnosis and condition

Answer 4 Rationale: The parents' statement indicates a lack of understanding about the condition. Spina bifida is a term that is often used to refer to all neural tube disorders that affect the spinal cord. This can be confusing and a cause of concern for parents. There are well-defined degrees of spinal cord involvement, and it is important for healthcare professionals to use the correct terminology. Spina bifida occulta is a defect of the vertebral bodies without protrusion of the spinal cord or meninges. This defect is not visible externally and in most cases has no adverse affects. In most cases, spina bifida occulta is benign and asymptomatic and produces no neurologic signs; it may be considered a normal variant. Mobility typically is not impaired with spina bifida occulta. The child is at no greater risk for injury as any other child. The parents demonstrate a lack of knowledge, not problems with coping.

An infant with a femur fracture is placed in Bryant traction. What would the nurse include in the infant's plan of care? Removing the traction boot every 8 hours Wrapping the bandages from the ankle to the knee Provide range of motion to the unaffected extremity Keeping the buttocks slightly elevated

Answer 4 Rationale: With Bryant traction, the buttocks should be slightly elevated and clear of the bed. The bandages are wrapped from the ankles to midthigh in Bryant traction. The legs are wrapped from the ankle to knee. A traction boot is not used with Bryant traction. This action would be appropriate for Buck traction. With Bryant traction, both legs are extended vertically, so range of motion would not be appropriate.

While obtaining the health history for an 11-year-old child, the nurse suspects the child may have myopia based on what information? (Select all that apply.) The child tells the nurse that they have problems seeing their hand held video games. The parent tells the nurse that the child always wants to set close to the movie screen, but never did in the past. The child tells the nurse that it is difficult to see the ball in the outfield when playing baseball. The parent tells the nurse that the child seems to hold books "closer and closer" to the face when reading. The child tells the nurse that they have to squint to see their teacher write on the white board at the front of the classroom.

Answer b-c-e Rationale: When the light entering the eye focuses in front of the retina, it results in myopia (nearsightedness). Children who are nearsighted may see well at close range but have difficulty focusing on objects at a distance, such as the baseball in the outfield, the white board at school, and the movie screen.

A group of students are reviewing information about delayed puberty in preparation for a class discussion. The students demonstrate understanding of this condition when they describe which as occurring in female adolescents? Menarche has not occurred by age 14. Pubic hair has not appeared by age 16. Growth spurt has not begun by age 12. Breast development has not occurred by age 13.

Rationale:Delayed puberty is a condition of delayed secondary sexual development. In female adolescents, it exists if the breasts have not developed by age 13, pubic hair has not appeared by age 14 or menarche has not occurred by age 16. Growth spurt is not a criterion for the disorders.

A child is hospitalized with dehydration as a result of rotavirus. When reviewing the plan of treatment, what can the nurse anticipate will be included? (Select all that apply.) Antidiarrheal agents IV fluid administration Antibiotic therapy Daily weight assessment Monitor of intake and output

Rationale:Rotavirus is viral in nature. Antibiotic therapy is not used in the care and treatment of a viral infection. Antidiarrhea medications are not utilized as they are not effective. Intake and output will be observed. Daily weight will aid in the determination of hydration status. IV fluids may be indicated in the rehydration process.

A group of students are reviewing information about oral diabetes agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver? Glipizide Metformin Nateglinide Glyburide

answer Rationale:Metformin, a biguanide, reduces glucose production from the liver. Glipizide stimulates insulin secretion by increasing the response of β cells to glucose. Glyburide stimulates insulin secretion by increasing the response of β cells to glucose. Nateglinide stimulates insulin secretion by increasing the response of β cells to glucose.

The nurse is caring for a neonate who has undergone an intestinal pull-through procedure for an imperforate anus. Which action would be most important for the nurse to do postoperatively? Turning the infant every 4 hours Listening for bowel sounds Observing the abdominal skin Determining the infant's ability to suck on a pacifier

answer Bowel sounds will allow the nurse to know how peristalsis is progressing after surgery. This will determine when the infant is able to receive nourishment other than through the intravenous route. Observing the perianal skin would be important because the perianal skin is at significant risk for breakdown because this will be the first time that stool has passed through the anal sphincter. The infant's ability to suck on the pacifier is important but is unrelated to the surgery. The infant should be turned at least every 2 hours.

A nurse is reviewing information about the various types of insulin that are used to treat type 1 diabetes mellitus. Integrating knowledge about the duration of action, place these types in the order from shortest to longest duration. Glargine 1 2 3 4 Aspart 1 2 3 4 Regular 1 2 3 4 NPH

answer 1) Aspart 2) Regular 3) NPH 4) Glargine Rationale:Aspart has a duration of action of 3 to 5 hours; regular insulin has a duration of 5 to 8 hours; NPH has a duration of 10 to 16 hours; and glargine has a duration of 12 to 24 hours.

The nurse is caring for a child with celiac disease. The parents and the child have attended a class with a group of other clients with the disorder. Which statements by the child or the parents indicate the need for further teaching? (Select all that apply.) "I love pasta, so as long as I only eat it occasionally I should be fine." "I must be careful to eat only 100% whole grain foods." "I hope they find a cure for celiac disease some day." "My brother and sister are more likely to develop celiac disease since I have it." "Celiac disease is the same as gluten intolerance that everyone is talking about these days."

answer Celiac disease is an immunologic disorder in which gluten, a product most commonly found in grains, causes damage to the small intestine. It is total gluten intolerance, which is different than what most people refer to as gluten intolerance in the general population. The child with celiac disease must follow a strict gluten free diet at all times. The disease does have familial tendencies. There is no cure for the disease but it can be managed with strict diet control.

The nurse has performed client teaching to a 15-year-old child with Crohn disease, and parents regarding the cobblestone lesions in the child's small intestine. Which comment by the child indicates learning occurred? "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines." "I have a lot of diarrhea every day because of how my small intestine is damaged." "I have to be careful because I am prone to not absorbing nutrients." "It's unusual for someone my age to get Crohn disease."

answer Crohn disease typically effects the small intestine more than the large intestine and it's onset is between the ages of 10 and 20 years. The cobblestone lesions in the small intestine prevent absorption of nutrients that normally occurs. The diarrhea is not directly related to the cobblestone lesions, and ulcerative colitis is characterized by the disease effecting the intestine(s) in a continuous pattern.

A child is diagnosed with short bowel syndrome. What would the nurse expect to be included in the child's plan of care? (Select all that apply.) Total parenteral nutrition Vitamin supplements Antibiotics Laxatives Immunosuppressants

answer For the child with short bowel syndrome, typically, antibiotics, vitamin and mineral supplements, antidiarrheal agents, and total parenteral nutrition are prescribed. Laxatives and immunosuppressants are not used.

The nurse is developing a teaching plan for the parents of an 11-month-old infant with gastroesophageal reflux disease (GERD). The child will be managed medically. What actions would the nurse incorporate into the teaching plan? (Select all that apply.) Keeping the child upright for 30 minutes after feeding Thinning the formula with water to ease flow Burping the infant at the end of the feeding Administering prokinetics to empty the stomach quickly Giving the child small frequent feedings

answer For the infant with GERD, the parents should give the child small, frequent feedings, with frequent burping to control reflux. The parents also should keep the child upright for 30 to 45 minutes after a feeding and thicken formula with rice or oatmeal cereal. Prokinetics may be used to help empty the stomach more quickly, minimizing the amount of gastric contents in the stomach that the child can reflux.

A nurse is conducting a physical examination on an 11-year-old boy with Legg-Calvé-Perthes disease. Which assessment finding would be expected? Lordosis Kyphosis Trendelenburg gait Loss of strength in ankle dorsiflexion

answer Rationale: The nurse would expect to note a Trendelenburg gait due to pain. Lordosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Kyphosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Loss of strength in ankle dorsiflexion is associated with some neuromuscular disorders but not this condition.

The nurse is teaching the parent of an infant with a temporary ileostomy about stoma care. What is the most important instruction to emphasize to the parent to avoid an emergency situation? "You must be meticulous in caring for the surrounding skin." "You may need adhesive remover to ease pouch removal." "Call the healthcare provider immediately if the stoma is not pink/red and moist." "Gather all of your supplies before you begin."

answer Rationale:A healthy stoma is pink and moist. If the stoma is dry or pale, the parent must notify the healthcare provider immediately because it could indicate compromised circulation. Gathering supplies is important but would not be involved in avoiding an emergency situation. All of the other instructions are valid, but emphasizing the color of the healthy stoma is most important to avoid an emergency situation. Adhesive remover may be needed to ease pouch removal, but this action would not necessarily avoid an emergency situation. Meticulous skin care is important, but this action would not necessarily avoid an emergency situation.

The nurse is caring for a 13-year-old adolescent with delayed puberty. When developing the plan of care for this adolescent, what would be the priority? Monitoring for therapeutic and side effects of medication Helping the child discuss feelings about the condition Encouraging the parents to discuss their concerns about the disorder Involving the child in the therapy to give a sense of control

answer The child will be receiving hormone supplementation; therefore, monitoring for therapeutic results and possible side effects of medications is key. The physiologic effects of the medications take priority over the psychosocial needs of the family or the child. Encouraging the parents to discuss their concerns about the disorder, involving the child in the therapy to give a sense of control, and helping the child discuss feelings about the condition would also be included in the plan of care but they would be addressed later.

The nurse is teaching the parents of a 3-year-old child with diabetes insipidus how to administer desmopressin acetate. Which comment indicates further need for teaching? "I check the specific gravity of our child's urine to see if the drug is working." "If our child sneezes the medicine out of the nose, I wait until the next dose." "First I suction the nostrils, if necessary, to help the drug be absorbed." "Once the tube is filled, I hold it closed until I insert it into the nostril."

answer The nurse must remind the parents that the medicine should be readministered immediately if the child sneezes. Proper intranasal administration of desmopressin acetate starts with clearing the nostril. The effectiveness of the drug is monitored by checking the specific gravity of the child's urine. Proper administration involves inserting the measured tubing into the bottle, filling it to the proper dosage, holding the tube closed until it is inserted into the child's nostril, then blowing the fluid out of the tube.

A nurse is providing care for a pregnant woman who will be scheduled for diagnostic testing. Place the tests in the order in which they would most likely be scheduled, starting with the earliest one. Chorionic villi sampling 1 2 3 4 Ultrasound 1 2 3 4 Quadruple screen 1 2 3 4 Fetal nuchal translucency

answer 1) Chorionic villi sampling 2) Fetal nuchal translucency 3) Quadruple screen 4) Ultrasound Rationale:The first test scheduled would be chorionic villi sampling, usually between 7 and 11 weeks' gestation. Then a fetal nuchal translucency test would be done at 11 to 14 weeks' gestation, followed by a quadruple screen at 16 to 19 weeks' gestation and finally an ultrasound between 18 and 20 weeks' gestation.

The nurse is caring for a 6-month-old child with diarrhea and dehydration. The parent is concerned because the child has some patches on the tongue. Which feature indicates a geographic tongue rather than thrush? There are plaques on the buccal mucosa. The patches are light in color on the tongue. The patches are thick, white plaques on the tongue. There are white patches on the erupted teeth.

answer A geographic tongue is a benign, noncontagious condition characterized by a reduction in the filiform papillae. Thrush is characterized by thick white plaques that form on the tongue. With thrush, plaques also appear on the buccal mucosa and often occur concomitantly in the diaper area. There would not be any patches on the few teeth the child might have by that age.

The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition? Preterm birth Mother age 42 with pregnancy Maternal use of acetaminophen in third trimester History of hypoxia at birth

answer Advanced maternal age is a risk factor for cleft lip and palate. Drugs such as anticonvulsants, steroids, and other medications during early pregnancy are considered risk factors. Acetaminophen is not associated with an increased risk for cleft lip and palate. Preterm birth is not a risk factor for the development of cleft lip and palate. Hypoxia or anoxia is a risk factor for the development of necrotizing enterocolitis.

A child with cirrhosis of the liver is admitted to the acute care facility in preparation for a liver transplant. When completing the physical examination, what would the nurse expect to assess? (Select all that apply.) Ascites Jaundice Spider angiomas Fatty stools Facial erythema

answer Assessment findings associated with cirrhosis include jaundice, ascites, spider angiomas, and palmar erythema. Fatty stools are associated with celiac disease.

The nurse is assessing an 8-year-old child who is performing at the second-grade level, reports feeling tired and weak, and is only 45 in (114 cm) tall. Which finding would be specific to hypothyroidism? The child reports that the exam room is cold. The parent reports that the child is always thirsty. The child has gained 20 lb (9 kg) in the past year. Observation shows only two of the 6-year molars.

answer Cold intolerance, manifested by the fact that the child was uncomfortably cold in the exam room, is a sign of hypothyroidism. Delayed dentition, with only two of the four 6-year molars having erupted, is typical of growth hormone deficiency. Reports of thirst may signal diabetes or diabetes insipidus. The dramatic weight gain could be due to hypothyroidism, Cushing syndrome, or syndrome of inappropriate antidiuretic hormone.

The nurse is reviewing the history of a child who has chronic oral lesions. What risk factors does the nurse expect to find when reviewing the child's history? (Select all that apply.) Recently finished the last chemotherapy treatment for leukemia Several episodes of tonsillitis Severe malabsorption from a GI disorder History of anemia Frequent bouts of constipation

answer Common risk factors for oral lesion include immune deficiency, cancer chemotherapy treatment, exposure to infectious agents, trauma, stress, or celiac or Crohn disease.

The parents of a child who was diagnosed with diabetes insipidus ask the nurse, "How does this disorder occur?" When responding to the parents, the nurse integrates knowledge that a deficiency of which hormone is involved? Growth hormone Antidiuretic hormone Thyroxine Insulin

answer Diabetes insipidus results from a deficiency in the secretion of antidiuretic hormone (ADH). This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland. Hypopituitarism or dwarfism involves a growth hormone deficiency. Diabetes mellitus involves a disruption in insulin secretion. Thyroxine is a thyroid hormone that if deficient leads to hypothyroidism.

The parents of a child who was diagnosed with diabetes insipidus ask the nurse, "How does this disorder occur?" When responding to the parents, the nurse integrates knowledge that a deficiency of which hormone is involved? Insulin Thyroxine Growth hormone Antidiuretic hormone

answer Diabetes insipidus results from a deficiency in the secretion of antidiuretic hormone (ADH). This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland. Hypopituitarism or dwarfism involves a growth hormone deficiency. Diabetes mellitus involves a disruption in insulin secretion. Thyroxine is a thyroid hormone that if deficient leads to hypothyroidism.

In the newborn nursery, the nurse assesses a newborn and sees the ears are low-set. What action will the nurse take first? Document the findings Assess for additional anomalies Report the finding to the health care provider Check the family history for genetic conditions

answer Low-set ears are considered a minor anomaly, but if they are present the nurse should further assess for additional anomalies. Low-set ears are associated with numerous genetic dysmorphisms. The nurse could assess for overlapping digits, syndactyly, a flat occiput, hemangioma, nevi, and ear lobe creases. The number of minor anomalies found increases the likelihood of a major anomaly. If three or more minor anomalies are found, the chances of a major anomaly or cognitive impairment increases 19% to 26%. The nurse should thoroughly assess the newborn first for all anomalies, then document the findings and report the them to the health care provider. The family history could provide clues as to why the newborn has the assessment findings, but exploring this history is not as imperative as conducting a thorough assessment.

A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition? Surgery Upper endoscopy Endoscopic retrograde cholangiopancreatography Barium enema

answer Rationale:A barium enema is successful in reducing a large percentage of intussusception cases. Other cases are reduced surgically. Upper endoscopy is used to visualize the upper gastrointestinal tract from the mouth to the upper jejunum. Endoscopic retrograde cholangiopancreatography is used to view the hepatobiliary system.

A 15-year-old adolescent is scheduled for a pelvic ultrasound to evaluate for a possible ovarian cyst. Which instruction by the nurse would be most appropriate? "You need to remain very still for the entire test." "You won't be able to drink any water before or during the test." "Drink plenty of fluids because you need to have a full bladder." "Limit your level of physical activity for one-half hour before the test."

answer Rationale:A full bladder is needed for an ultrasound of the pelvic region. The client needs to remain still for a computed tomography or magnetic resonance imaging scan, not an ultrasound. Water is withheld during a water deprivation test used to detect diabetes insipidus. Limiting stress and physical activity for 30 minutes before the test is required for the growth hormone stimulation test.

The nurse is conducting a physical examination of an 18-month-old with suspected intussusception. Which finding would the nurse identify as the hallmark of this condition? Abdominal pain and guarding Perianal skin tags A sausage-shaped mass in the upper midabdomen Skin tenting

answer Rationale:A sausage-shaped mass in the upper midabdomen is the hallmark of intussusception. Perianal skin tags are highly suspicious of Crohn disease. Abdominal pain and guarding are also common with intussusception but are seen with many other conditions. Tenting would indicate dehydration.

The nurse is conducting a physical examination of an 18-month-old with suspected intussusception. Which finding would the nurse identify as the hallmark of this condition? Skin tenting Abdominal pain and guarding A sausage-shaped mass in the upper midabdomen Perianal skin tags

answer Rationale:A sausage-shaped mass in the upper midabdomen is the hallmark of intussusception. Perianal skin tags are highly suspicious of Crohn disease. Abdominal pain and guarding are also common with intussusception but are seen with many other conditions. Tenting would indicate dehydration.

A 15-year-old adolescent is brought to the clinic by the parent because the adolescent has been experiencing irregular and sporadic menstrual periods and excessive body hair growth. Polycystic ovary syndrome is suspected. Which additional assessment finding would help to support this suspicion? Decreased serum levels of free testosterone Short stature Darkened pigmentation around the neck area Body mass index as normal

answer Rationale:Acanthosis nigricans (darkened, thickened pigmentation, particularly around the neck or in the axillary region) is associated with polycystic ovary syndrome. Serum levels of free testosterone typically are elevated with polycystic ovary syndrome. With polycystic ovary syndrome, body mass index indicates overweight or obesity. Short stature typically is associated with growth hormone deficiency.

The nurse is caring for a 14-year-old adolescent with hyperpituitarism. What would be the priority treatment? Administering octreotide acetate as ordered Treating the child according to chronological age Assessing the child's self-image due to the disorder Teaching the child and family about proper treatment

answer Rationale:Administering octreotide acetate as ordered is the priority intervention and treatment for acromegaly. Assessing the child's self-image is appropriate but would not be the priority. Treating the child according to chronologic age would be appropriate but not the priority. Teaching the child and family about proper treatment is appropriate and important but not the immediate priority.

The nurse is caring for a 14-year-old adolescent with hyperpituitarism. What would be the priority treatment? Treating the child according to chronological age Administering octreotide acetate as ordered Assessing the child's self-image due to the disorder Teaching the child and family about proper treatment

answer Rationale:Administering octreotide acetate as ordered is the priority intervention and treatment for acromegaly. Assessing the child's self-image is appropriate but would not be the priority. Treating the child according to chronologic age would be appropriate but not the priority. Teaching the child and family about proper treatment is appropriate and important but not the immediate priority.

The nurse is preparing an 18-month-old for discharge after treatment for dehydration following diarrhea. What instruction would the nurse most likely include in the discharge teaching? "Make sure she gets lots of clear liquids." "Give her plenty of fruit juice or soda." "Offer her flavored gelatin if she is hungry." "Encourage bananas, applesauce, and crackers."

answer Rationale:After rehydration is achieved, it is important to encourage the child to consume a regular diet in order to maintain energy and growth. The solid foods presented are easily digested and age appropriate. The parents should avoid prolonged use of clear liquids in the child with diarrhea because "starvation stools" might result. Fluids high in glucose such as fruit juice, gelatin, and soda may worsen diarrhea. Gelatin is high in glucose and may worsen diarrhea.

The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child is refusing fluids due to the pain and the parent is concerned about the child's hydration status. Which of the suggestions would be most appropriate? "Encourage your child to have some soda." "Try some benzocaine oral gel." "Offer your child some orange juice." "Offer 'magic mouthwash' followed by a popsicle."

answer Rationale:Children are more likely to cooperate with interventions if play is involved. "Magic" analgesic mouthwash followed by a popsicle is most likely to alleviate some pain and then provide hydration. Soda should be avoided because it can cause stinging and burning. Orange juice should be avoided because it can cause stinging and burning. A benzocaine oral gel might be helpful but it will likely be difficult to apply. Additionally, oral analgesics are often necessary.

The nurse is assessing an 8-year-old child who is performing at the second-grade level, reports feeling tired and weak, and is only 45 in (114 cm) tall. Which finding would be specific to hypothyroidism? Observation shows only two of the 6-year molars. The child has gained 20 lb (9 kg) in the past year. The parent reports that the child is always thirsty. The child reports that the exam room is cold.

answer Rationale:Cold intolerance, manifested by the fact that the child was uncomfortably cold in the exam room, is a sign of hypothyroidism. Delayed dentition, with only two of the four 6-year molars having erupted, is typical of growth hormone deficiency. Reports of thirst may signal diabetes or diabetes insipidus. The dramatic weight gain could be due to hypothyroidism, Cushing syndrome, or syndrome of inappropriate antidiuretic hormone.

The nurse is teaching a 12-year-old child with type 2 diabetes mellitus and parents about dietary measures to control the child's glucose levels. Which comment by the child indicates a need for additional teaching? "We should give her nonfat milk to drink." "I will be eating more breads and cereals." "I can have an apple or orange for snacks." "I can eat two small cookies with each meal."

answer Rationale:Cookies, cakes, candy, potato chips, and crackers are high in sugars and fats and should be eaten in moderation as special treats; they would not be included with each meal. An apple or orange makes a good snack. Nonfat milk is a better option than whole milk. Long-acting carbohydrates should be the largest category of foods eaten.

A child is prescribed glargine insulin. What information would the nurse include when teaching the child and parents about this insulin? "Do not mix this insulin with other insulins." Discard any opened vials after a week. Store the insulin in the refrigerator until just before giving it. "Give the dose first thing in the morning."

answer Rationale:Glargine is a long-acting insulin and is not to be mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month.

A child is diagnosed with hyperthyroidism. What finding would the nurse expect to assess? Constipation Heat intolerance Weight gain Facial edema

answer Rationale:Hyperthyroidism is manifested by heat intolerance, nervousness or anxiety, diarrhea, weight loss and smooth, velvety skin. Constipation, weight gain, and facial edema are associated with hypothyroidism.

A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement by the parents indicates that the teaching was successful? "We might notice some of the medication in her stool" "This drug helps to control the abdominal cramping." "She might lose some weight initially." "We should not stop this medication abruptly."

answer Rationale:Prednisone is a corticosteroid. Stopping the medication abruptly could lead to adrenal insufficiency. Weight gain would be associated with corticosteroid use. Weight loss is associated with the disease. Corticosteroids help to reduce inflammation and suppress the normal immune response. Typically, anti-inflammatory agents such as mesalamine may appear in the stool. This indicates poor absorption.

A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason? Confirm pancreatitis Determine esophageal contractility Evaluate gastric pH Detect Helicobacter pylori

answer Rationale:Urea breath test is used to detect the presence of H. pylori in the exhaled breath. This test does not evaluate gastric pH. Serum amylase and lipase levels are used to confirm pancreatitis. Esophageal manometry is used to evaluate esophageal contractile activity and effectiveness.

When reviewing the HbA1C results of a 3-year-old child with type 1 diabetes mellitus findings greater than what value, indicate the need for further action? 7.50% 6.50% 8.00% 7.00%

answer The American Association of Diabetes recommends that children and adolescents have a target HgA1C less than 7.5%

The nurse is caring for a 2-year-old child with an umbilical hernia and is teaching the parent about this condition. Which response from the parent indicates a need for further teaching? Correct option"I can tape a quarter over the hernia to reduce it." Unanswered option"I need to watch for pain, tenderness, or redness." Unanswered option"Incarceration is rare, but it can occur." Unanswered option"My child could have some appearance-related self-esteem issues."

answer The use of home remedies to reduce an umbilical hernia should be discouraged because of the risk of bowel strangulation. The parent needs to be aware that strangulation can occur, but it is rare with an umbilical hernia. Pain, tenderness, or redness indicates incarceration, which although rare with umbilical hernias, can occur. She needs to understand the signs of strangulation and understand that some children have self-esteem issues related to the large protrusion of the unrepaired umbilical hernia. Physical needs of the child have priority over any types of potential psychosocial issues. Self-esteem issues may arise due to a large protrusion of an unrepaired umbilical hernia.

The nurse is examining a 7-year-old child with suspected appendicitis. Which physical findings would indicate the possibility of appendicitis? Persistent, right lower quadrant pain with rebound tenderness Intermittent, left lower quadrant pain with rebound tenderness Tenderness that comes and goes in the lower abdomen Diffuse, intermittent abdominal pain

answer With appendicitis, symptoms typically do not come and go. They are usually persistent and intensify with time. With appendicitis, maximal tenderness occurs in the area of the McBurney point in the right lower quadrant, not the left. There is pain upon palpation with rebound tenderness. Pain is usually in the right lower quadrant, not the left, and is persistent. There is pain on palpation with rebound tenderness. Pain typically occurs in the right lower quadrant and is persistent and intensifies with time.

The nurse is to obtain a stool specimen from a 4-year-old child who has very liquid stool. The child is ambulatory but weak. Which collection method would be most effective for the nurse to use? Use a clean bedpan to collect the specimen. Have the child defecate into a container in the toilet. Apply a urine bag to the anal area. Use a tongue blade to scrape a specimen from a diaper.

answer With very liquid stool, applying a urine bag to the anal area is most effective in collecting the specimen. Using a tongue blade to scrape a specimen from a diaper would be appropriate if the stool is formed. However, putting a diaper on a 4-year-old would be demeaning. Defecating into a collection container that sits at the back of the toilet would be more appropriate for an older child who is ambulatory. A bedpan would be appropriate if the child was bedridden.

The nurse is caring for a 7-year-old child with conduct disorder. The child is very aggressive and at risk for self-harm. To promote the child's adaptive and social skills, the nurse refers the family to a therapist who specializes in which type of therapy? Milieu therapy Cognitive therapy Play therapy Family therapy

answer 1 The therapeutic goal of milieu therapy is to promote the child's adaptive and social skills. It is a safe and supportive environment for children who are at risk for self-harm, very ill, or very aggressive. Play therapy encourages children to act out feelings of sadness, fear, hostility, or anger. Cognitive therapy teaches children to change their reactions so that automatic negative thought patterns are replaced with healthier ones. Family therapy explores the emotional issues of the child and their effects on family members.

The nurse is caring for a 6-year-old girl who has been diagnosed with neurofibromatosis. What is the priority intervention? Providing postoperative care when tumors are removed Pointing out the child's positive attributes to her Urging the parents to schedule yearly physical examinations Referring the parents to a neurofibromatosis support group

answer Yearly physical examinations with blood pressure, scoliosis and developmental screening, ophthalmology, and neurologic examinations should be promoted. Most children with neurofibromatosis do not develop disfiguring tumors but rather have mild to moderate symptoms and lead normal lives. Postoperative care will be necessary if tumors need to be removed. The nurse does not need to build the child's self-esteem because the disease is not likely to have progressed very far at this age. The family may benefit from a support group, but the child's physiologic needs are more important.

The nurse is assessing a 3-month-old boy with abnormally small vertebrae who has had a colostomy. Which assessment finding would suggest the child has VATER association? Assessment shows the child was born with only one arm. Palpation reveals caudal narrowing of the spinal canal. Observation reveals a large forehead and down-slanting eyelids. Examination discloses colobomas and microphthalmos.

answer 1 Being born with only one arm is an associated abnormality of VATER association (also referred to as VACTERL association, the additional C and L standing for cardiac and limb abnormalities). Colobomas and microphthalmos are symptoms of CHARGE syndrome. A large forehead and down-slanting eyelids are indicative of Apert syndrome. Caudal narrowing of the spinal canal is a symptom of achondroplasia.

The nurse is speaking with the parent of a 2-year-old child recently diagnosed with an autism spectrum disorder. The parent asks about educational programs for her child. What is the best response by the nurse? "Children with an autism spectrum disorder enrolled in public schools can have an individualized educational plan to help meet their specific needs." "Children with an autism spectrum disorder can only go to special schools, not public schools, so you will need to get your name on a waiting list soon." "Children with an autism spectrum disorder are able to function on their own and do not need any special support at school." "Children with an autism spectrum disorder are not eligible to participate in any of the local early educational programs provided since they are only open to children with cognitive impairment."

answer 1 Children enrolled in public schools need to have an individualized educational plan (IEP) in place. Children with an autism spectrum disorder can go to public or private schools. No matter the school setting, the child will need assistance of some kind. Children under 36 months can receive services via the local early intervention program.

The nurse has performed client teaching to a 15-year-old child with Crohn disease, and parents regarding the cobblestone lesions in the child's small intestine. Which comment by the child indicates learning occurred? "I have to be careful because I am prone to not absorbing nutrients." "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines." "I have a lot of diarrhea every day because of how my small intestine is damaged." "It's unusual for someone my age to get Crohn disease."

answer 1 Crohn disease typically effects the small intestine more than the large intestine and it's onset is between the ages of 10 and 20 years. The cobblestone lesions in the small intestine prevent absorption of nutrients that normally occurs. The diarrhea is not directly related to the cobblestone lesions, and ulcerative colitis is characterized by the disease effecting the intestine(s) in a continuous pattern.

A nurse is preparing a presentation about genetic disorders in children. What cause would the nurse include as the most common inherited cause of intellectual disability? Fragile X syndrome Turner syndrome Trisomy 18 Klinefelter syndrome

answer 1 Fragile X syndrome is the most common inherited cause of intellectual disability. Klinefelter syndrome is the most common chromosomal abnormality. It does not result in intellectual disability. With Turner syndrome, intellectual disability is unlikely, but some learning disabilities may be present. Although trisomy 18 does cause intellectual disability, it is a less common cause.

The nurse is caring for a 10-year-old child with an anxiety disorder. During a physical examination, which physical finding would the nurse expect? Patches of hair loss Watery eyes Absence of nasal hair Dilated eyes

answer 1 Patches of hair loss that occur with repetitive hair twisting or pulling are associated with anxiety. Watery, dilated eyes and the absence of nasal hair are often signs of substance abuse.

The history of a 2-year-old child reveals ingestion of clay over the past 6 weeks. The nurse documents this as: pica. rumination. bulimia. anorexia.

answer 1 Pica is an eating disorder in which the child ingests over at least a 1-month period a nonnutritive material such as paint, clay, or sand. Rumination is an eating disorder occurring in infants in which the baby regurgitates partially digested food or formula and expels or swallows it. Anorexia nervosa is characterized by dramatic weight loss as a result of decreased food intake and sharply increased physical exercise. Bulimia refers to a cycle of normal food intake, followed by binge-eating and then purging.

A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition? Barium enema Surgery Endoscopic retrograde cholangiopancreatography Upper endoscopy

answer 1 Rationale:A barium enema is successful in reducing a large percentage of intussusception cases. Other cases are reduced surgically. Upper endoscopy is used to visualize the upper gastrointestinal tract from the mouth to the upper jejunum. Endoscopic retrograde cholangiopancreatography is used to view the hepatobiliary system.

The nurse is caring for a child who has been hospitalized repeatedly at multiple hospitals. There is no clear medical diagnosis and the parent is threatening to leave the hospital against medical advice. The nurse suspects what issue? Medical child abuse Bipolar disorder Sexual abuse Anxiety disorder

answer 1 Repeated hospitalizations that fail to produce a medical diagnosis, transfers to other hospitals, and discharges against medical advice are warning signs of Medical child abuse (Münchhausen syndrome by proxy).

The nurse is reviewing the history of a child who has chronic oral lesions. What risk factors does the nurse expect to find when reviewing the child's history? (Select all that apply.) Recently finished the last chemotherapy treatment for leukemia Frequent bouts of constipation Severe malabsorption from a GI disorder History of anemia Several episodes of tonsillitis

answer 1-3 Common risk factors for oral lesion include immune deficiency, cancer chemotherapy treatment, exposure to infectious agents, trauma, stress, or celiac or Crohn disease.

The nurse is caring for a 2-year-old child with an umbilical hernia and is teaching the parent about this condition. Which response from the parent indicates a need for further teaching? "I can tape a quarter over the hernia to reduce it." "I need to watch for pain, tenderness, or redness." "My child could have some appearance-related self-esteem issues." "Incarceration is rare, but it can occur."

answer 1 The use of home remedies to reduce an umbilical hernia should be discouraged because of the risk of bowel strangulation. The parent needs to be aware that strangulation can occur, but it is rare with an umbilical hernia. Pain, tenderness, or redness indicates incarceration, which although rare with umbilical hernias, can occur. She needs to understand the signs of strangulation and understand that some children have self-esteem issues related to the large protrusion of the unrepaired umbilical hernia. Physical needs of the child have priority over any types of potential psychosocial issues. Self-esteem issues may arise due to a large protrusion of an unrepaired umbilical hernia.

A nurse is describing the underlying cause of trisomy 21 to a group of parents, integrating knowledge that the disorder is due to: nondisjunction. translocation. duplication. deletion.

answer 1 Trisomy 21 is a disorder caused by nondisjunction or error in cell division. It is not due to the loss of a portion of the chromosome (deletion), an extra segment being present (duplication), or transfer of one part of the chromosome to another (translocation).

A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason? Detect Helicobacter pylori Confirm pancreatitis Evaluate gastric pH Determine esophageal contractility

answer 1 Urea breath test is used to detect the presence of H. pylori in the exhaled breath. This test does not evaluate gastric pH. Serum amylase and lipase levels are used to confirm pancreatitis. Esophageal manometry is used to evaluate esophageal contractile activity and effectiveness.

The nurse is examining a 7-year-old child with suspected appendicitis. Which physical findings would indicate the possibility of appendicitis? Persistent, right lower quadrant pain with rebound tenderness Intermittent, left lower quadrant pain with rebound tenderness Tenderness that comes and goes in the lower abdomen Diffuse, intermittent abdominal pain

answer 1 With appendicitis, symptoms typically do not come and go. They are usually persistent and intensify with time. With appendicitis, maximal tenderness occurs in the area of the McBurney point in the right lower quadrant, not the left. There is pain upon palpation with rebound tenderness. Pain is usually in the right lower quadrant, not the left, and is persistent. There is pain on palpation with rebound tenderness. Pain typically occurs in the right lower quadrant and is persistent and intensifies with time.

A child has been admitted to the acute care facility for the management of dehydration. The nurse is preparing to administer intravenous fluid replacement to the child. Which fluids are suitable for use? (Select all that apply.) Normal saline Lactated Ringer 10% dextrose in water 5% dextrose in water 0.45% saline

answer 1-2 isotonic fluids

A nurse is assessing an infant who has been vomiting and experiencing diarrhea. Which findings would indicate to the nurse that the infant is experiencing severe dehydration? (Select all that apply.) Bradycardia Cool mottled extremities Sunken fontanels Slightly decreased urine output Pink moist oral mucosa

answer 1-2-3 Severe dehydration would be indicated by sunken fontanels, increased heart rate progressing to bradycardia, cool mottled or dusky extremities, dry oral mucosa, and significantly decreased urine output of less than 1 mL/kg/hr. Pink moist oral mucosa and slightly decreased urine output would suggest mild dehydration.

The nurse cares for a newborn diagnosed with choanal atresia. What nursing intervention(s) will be important for the nurse to implement? Select all that apply. Insert a peripheral IV Elevate the head of the bed Initiate aspiration precautions Allow nonnutritive sucking Insert a nasogastric tube

answer 1-2-3-4 The nurse cares for a newborn diagnosed with choanal atresia. What nursing intervention(s) will be important for the nurse to implement? Select all that apply. Insert a peripheral IV Elevate the head of the bed Initiate aspiration precautions Allow nonnutritive sucking Insert a nasogastric tube

The nurse is developing a teaching plan for the parents of an 11-month-old infant with gastroesophageal reflux disease (GERD). The child will be managed medically. What actions would the nurse incorporate into the teaching plan? (Select all that apply.) Keeping the child upright for 30 minutes after feeding Giving the child small frequent feedings Burping the infant at the end of the feeding Administering prokinetics to empty the stomach quickly Thinning the formula with water to ease flow

answer 1-2-4 For the infant with GERD, the parents should give the child small, frequent feedings, with frequent burping to control reflux. The parents also should keep the child upright for 30 to 45 minutes after a feeding and thicken formula with rice or oatmeal cereal. Prokinetics may be used to help empty the stomach more quickly, minimizing the amount of gastric contents in the stomach that the child can reflux.

An infant was born with a genetic condition. The nurse is obtaining a neonatal health history from the parents. Which question(s) will the nurse ask the parents? Select all that apply. "Have you had problems feeding your infant?" "Has your infant ever experienced a seizure?" "Was your infant small for a term pregnancy?" "Did your infant require staying under the warmer or in an incubator to stay warm?" "Do you ever feel like your infant's muscle tone is not good?"

answer 1-2-4-5 A focused neonatal history can be helpful in identifying the cause of a genetic condition. This history should include factors such as the infant having difficulty in adapting to extrauterine life (temperature and heart rate instability and poor feeding), being large for gestational age without a reason (such as maternal diabetes), being hypotonic or hypertonic, seizures, and having persistent hypobilirubinemia. The neonatal history should also include whether the infant has had an abnormal newborn screening or if is hearing impaired.

The nurse is assessing an infant diagnosed with trisomy 13. What would the nurse expect to find? Select all that apply. Extra digits Small eyes Prominent occiput Fingernail hypoplasia Short sternum Wide sagittal suture

answer 1-2-6 An infant with trisomy 13 would exhibit wide sagittal suture and fontanels, small eyes, and extra digits. Short sternum, fingernail hypoplasia, and prominent occiput are associated with trisomy 18.

The nurse is obtaining the history of an adolescent who is suspected of having anorexia nervosa. What findings would the nurse expect? (Select all that apply.) Syncope Warm hands and feet Secondary amenorrhea Diarrhea Desire for perfectionism

answer 1-3-5 The adolescent with anorexia may have a history of constipation, syncope, secondary amenorrhea, abdominal pain, and periodic episodes of cold hands and feet. In addition, the child's self-concept reveals multiple fears, high need for acceptance, disordered body image, and perfectionism.

The nurse is performing the physical examination of a child with bulimia. What findings would the nurse identify as supporting this disorder? (Select all that apply.) Split fingernails Bradycardia Pink moist gums Eroded dental enamel Dry sallow skin

answer 1-4 The adolescent with bulimia will be of normal weight or slightly overweight. The hands will show calluses on the backs of the knuckles and split fingernails. The mouth and oropharynx will exhibit eroded dental enamel, red gums, and an inflamed throat from self-induced vomiting. Bradycardia and dry sallow skin suggest anorexia.

The nurse is preparing a teaching plan for the parents of a child diagnosed with achondroplasia. What information would the nurse include? Select all that apply. Middle ear infections may be a persistent problem. Chest deformities will interfere with respiratory capacity. Growth hormone is the gold standard of treatment. Limb-lengthening surgeries may need to be done. The child will probably average about 4 feet in height.

answer 1-4-5 Children with achondroplasia have small stature, reaching an average adult height of 4 feet for men and women. Middle ear dysfunctions and infections are a persistent problem. Limb-lengthening surgery may be done. However, the use of growth hormone is controversial and experimental. Chest deformities are associated with Marfan syndrome, not achondroplasia.

A child is diagnosed with short bowel syndrome. What would the nurse expect to be included in the child's plan of care? (Select all that apply.) Antibiotics Immunosuppressants Laxatives Vitamin supplements Total parenteral nutrition

answer 1-4-5 For the child with short bowel syndrome, typically, antibiotics, vitamin and mineral supplements, antidiarrheal agents, and total parenteral nutrition are prescribed. Laxatives and immunosuppressants are not used.

The nurse is teaching the parent of an infant with a temporary ileostomy about stoma care. What is the most important instruction to emphasize to the parent to avoid an emergency situation? "You may need adhesive remover to ease pouch removal." "Call the healthcare provider immediately if the stoma is not pink/red and moist." "You must be meticulous in caring for the surrounding skin." "Gather all of your supplies before you begin."

answer 2 A healthy stoma is pink and moist. If the stoma is dry or pale, the parent must notify the healthcare provider immediately because it could indicate compromised circulation. Gathering supplies is important but would not be involved in avoiding an emergency situation. All of the other instructions are valid, but emphasizing the color of the healthy stoma is most important to avoid an emergency situation. Adhesive remover may be needed to ease pouch removal, but this action would not necessarily avoid an emergency situation. Meticulous skin care is important, but this action would not necessarily avoid an emergency situation.

Parents have just given birth to a child diagnosed with trisomy 21 (Down syndrome). The couple are parents of 3 other children under the age of 8 years old with no genetic disorders. What would be a priority nursing diagnosis at this time? Interrupted family processes Deficient knowledge regarding trisomy 21 Decisional conflict Risk for delayed growth and development

answer 2 Based on the child just being born and the parents dealing with 3 other children, the highest priority is Deficient knowledge regarding trisomy 21, followed by interrupted family processes.

The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child is refusing fluids due to the pain and the parent is concerned about the child's hydration status. Which of the suggestions would be most appropriate? "Try some benzocaine oral gel." "Offer 'magic mouthwash' followed by a popsicle." "Encourage your child to have some soda." "Offer your child some orange juice."

answer 2 Children are more likely to cooperate with interventions if play is involved. "Magic" analgesic mouthwash followed by a popsicle is most likely to alleviate some pain and then provide hydration. Soda should be avoided because it can cause stinging and burning. Orange juice should be avoided because it can cause stinging and burning. A benzocaine oral gel might be helpful but it will likely be difficult to apply. Additionally, oral analgesics are often necessary.

The nurse is performing a physical examination on a 1-week-old girl with trisomy 13. What would the nurse expect to assess? Inspection reveals hypoplastic fingernails. Observation reveals a microcephalic head. Inspection shows a clenched fist with overlapping fingers. Observation discloses severe hypotonia.

answer 2 Children with trisomy 13 have microcephalic heads with malformed ears and small eyes. Severe hypotonia, hypoplastic fingernails, and clenched fists with index and small fingers overlapping the middle fingers are typical symptoms of trisomy 18.

A nurse is conducting a physical examination of a 5-year-old boy with spinal muscular atrophy (SMA) type 2. What assessment findings would the nurse expect to find? Pseudohypertrophy of the calves Pectus excavatum Loss of strength in ankle dorsiflexion Loss of strength in hip extension

answer 2 Pectus excavatum develops in children with SMA type 1 and type 2 who exhibit paradoxical breathing. The chest becomes funnel shaped and the xiphoid process is retracted. Pseudohypertrophy of the calves is associated with Duchenne muscular dystrophy. Loss of strength in hip extension is associated with Duchenne muscular dystrophy. Loss of strength in ankle dorsiflexion is associated with Duchenne muscular dystrophy.

A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement by the parents indicates that the teaching was successful? "This drug helps to control the abdominal cramping." "We should not stop this medication abruptly." "She might lose some weight initially." "We might notice some of the medication in her stool"

answer 2 Prednisone is a corticosteroid. Stopping the medication abruptly could lead to adrenal insufficiency. Weight gain would be associated with corticosteroid use. Weight loss is associated with the disease. Corticosteroids help to reduce inflammation and suppress the normal immune response. Typically, anti-inflammatory agents such as mesalamine may appear in the stool. This indicates poor absorption.

The nurse is caring for a neonate who has undergone an intestinal pull-through procedure for an imperforate anus. Which action would be most important for the nurse to do postoperatively? Observing the abdominal skin Listening for bowel sounds Determining the infant's ability to suck on a pacifier Turning the infant every 4 hours

answer 2 Rationale:Bowel sounds will allow the nurse to know how peristalsis is progressing after surgery. This will determine when the infant is able to receive nourishment other than through the intravenous route. Observing the perianal skin would be important because the perianal skin is at significant risk for breakdown because this will be the first time that stool has passed through the anal sphincter. The infant's ability to suck on the pacifier is important but is unrelated to the surgery. The infant should be turned at least every 2 hours.

The nurse is assessing a 6-year-old child with attention deficit hyperactivity disorder (ADHD). The nurse observes the child making repeated clicking noises and notes the child has a slight grimace. The nurse recommends the child receive further evaluation for: Asperger syndrome. Tourette syndrome. anxiety disorder. autism spectrum disorder.

answer 2 Repeated vocal tics such as sniffling, grunting, clicking, or word utterances are associated with Tourette syndrome. The syndrome consists of multiple motor tics and one or more motor tics occurring simultaneously at different times. ADHD and obsessive--compulsive disorder occur in 90% of children with Tourette syndrome. Vocal and motor tics are not typical indicators of Asperger syndrome, anxiety disorder, or autism spectrum disorder.

The nurse is performing an assessment of a 6-year-old girl with Turner syndrome. What finding would the nurse most likely assess? Pectus carinatum Short stature and slow growth Short, stubby trident hands Enlarged thyroid gland

answer 2 Short stature and slow growth are frequently the first indication of Turner syndrome. While children with Turner syndrome are more prone to thyroid problems, these problems are not as likely to occur as in other symptoms. Pectus carinatum is typical of children with Marfan syndrome. Short, stubby trident hands are typical of achondroplasia.

The nurse is taking a health history of a 2-year-old child presenting with a sudden onset of severe vomiting. Which description would suggest an obstruction? Effortless vomiting Bilious vomiting Bloody vomiting Projectile vomiting

answer 2 The contents and character of the vomitus may give clues to the cause of vomiting. Bilious vomiting is never considered normal and suggests an obstruction. Projectile vomiting is associated with pyloric stenosis. The gender and the age of the child are not consistent with pyloric stenosis. Effortless vomiting is often seen in gastroesophageal reflux. Bloody emesis can signify esophageal or gastrointestinal bleeding.

The nurse is caring for a child with attention deficit hyperactivity disorder (ADHD) who is experiencing insomnia related to the prescribed psychostimulant. The parents are considering stopping the medication and want to know if there are other options. Which response by the nurse would be most appropriate? "Ask the health care provider about long-acting methylphenidate." "Speak to the healthcare provider about atomoxetine." "Talk to the health care provider about dextroamphetamine." "Perhaps the health care provider will prescribe long-acting dextroamphetamine."

answer 2 The nurse could suggest that the parents speak to the healthcare provider about atomoxetine, a nonstimulant norepinephrine reuptake inhibitor that does not contribute to insomnia. Dextroamphetamine, long-acting dextroamphetamine, and long-acting methylphenidate are psychostimulants; the child is already taking a psychostimulant and having difficulty with insomnia, so these would not be good options.

A child with Turner syndrome is being seen in the clinic for an annual examination. What assessment would be most important for the nurse to complete? Obtain blood pressure Measure the height Conduct eye screening examination Auscultate heart sounds

answer 2 Turner syndrome is caused by an abnormality in the sex chromosome. The female will have only one X chromosome. The syndrome is associated with many problems such as cardiovascular, thyroid, skeletal, and renal systems and cognitive impairment. Most children are diagnosed at birth or in early childhood when there is slow growth or growth failure. It may also not be diagnosed until the pubertal growth spurt fails to occur. It is essential for the nurse to measure the child's height at each health care visit. The administration of growth hormone is the gold standard of care. It is started when the child's growth is less than 5% on the growth curve. Auscultating heart sounds should be done due to the possibility of cardiovascular problems but the problems associated with the syndrome are congenital defects, not unusually issues like murmurs or heart failure. Renal problems can occur with the syndrome, so blood pressure needs to be assessed each visit. Vision problems can also occur with the syndrome so periodic vision screening should be done. Not every child will have multiple defects with the syndrome, but every child will have growth retardation. This makes height measurement the most important.

A child is hospitalized with dehydration as a result of rotavirus. When reviewing the plan of treatment, what can the nurse anticipate will be included? (Select all that apply.) Antibiotic therapy Monitor of intake and output Antidiarrheal agents Daily weight assessment IV fluid administration

answer 2*4*5 Rotavirus is viral in nature. Antibiotic therapy is not used in the care and treatment of a viral infection. Antidiarrhea medications are not utilized as they are not effective. Intake and output will be observed. Daily weight will aid in the determination of hydration status. IV fluids may be indicated in the rehydration process.

A group of nursing students are reviewing information about celiac disease. The students demonstrate understanding of this disorder when they identify which classic symptoms? (Select all that apply.) Sunken abdomen Constipation Polycythemia Failure to thrive Diarrhea Steatorrhea

answer 2-4-5-6 Classic symptoms of celiac disease include steatorrhea, constipation, diarrhea, failure to thrive, weight loss, abdominal distention or bloating (not a sunken abdomen), and anemia (not polycythemia).

The nurse is assessing a newly admitted 14-year-old adolescent and notes that the adolescent makes very little eye contact, becomes very frustrated with questions and conversation, and does not smile or laugh. What nursing diagnoses will the nurse add to the care plan based on these assessment findings? (Select all that apply.) Disturbed thought process Impaired social interaction Delayed growth and development Imbalanced nutrition, less than body requirements Ineffective individual coping

answer 2-5 Limited eye contact, lack of smiling support the nursing diagnosis of impaired social interaction. Becoming frustrated easily with conversation supports both impaired social interaction and ineffective individual coping.

The nurse is caring for a 6-month-old child with diarrhea and dehydration. The parent is concerned because the child has some patches on the tongue. Which feature indicates a geographic tongue rather than thrush? There are plaques on the buccal mucosa. There are white patches on the erupted teeth. The patches are light in color on the tongue. The patches are thick, white plaques on the tongue.

answer 3 A geographic tongue is a benign, noncontagious condition characterized by a reduction in the filiform papillae. Thrush is characterized by thick white plaques that form on the tongue. With thrush, plaques also appear on the buccal mucosa and often occur concomitantly in the diaper area. There would not be any patches on the few teeth the child might have by that age.

The nurse is preparing an 18-month-old for discharge after treatment for dehydration following diarrhea. What instruction would the nurse most likely include in the discharge teaching? "Give her plenty of fruit juice or soda." "Offer her flavored gelatin if she is hungry." "Encourage bananas, applesauce, and crackers." "Make sure she gets lots of clear liquids."

answer 3 After rehydration is achieved, it is important to encourage the child to consume a regular diet in order to maintain energy and growth. The solid foods presented are easily digested and age appropriate. The parents should avoid prolonged use of clear liquids in the child with diarrhea because "starvation stools" might result. Fluids high in glucose such as fruit juice, gelatin, and soda may worsen diarrhea. Gelatin is high in glucose and may worsen diarrhea.

A child with Down syndrome is having a well child check-up. What is the best way for the nurse to assess this child's developmental milestones? Have the child demonstrate psychomotor skills Plot the milestones on a growth chart Assess the sequence of the milestones Assess the age at which each milestone occurred

answer 3 Children with Down syndrome are able to complete their developmental milestones, but the milestones are delayed as opposed to a child without the syndrome. It is important with assessing the milestones to look at the milestones in sequence rather than the age they were achieved. This is because each milestone represents a skill needed for the next stage of development. The child can demonstrate psychomotor skills to the nurse, but verbal skills and cognitive skills also need to be assessed. Growth charts are made for children with Down syndrome, but they are used to plot height and weight.

A hospitalized child with DiGeorge Syndrome has a low calcium level, a high phosphorus level, a low potassium level, and a low magnesium level. Based on these results, what is the priority of care for this child? Administer phosphate binders Correct the low potassium Administer calcium Correct the low magnesium

answer 3 DiGeorge Syndrome is a genetic defect that is manifested by hypoplasia of the thymus and the parathyroid glands. As such, the calcium levels would be low and the primary intervention would be to correct the low calcium. If the calcium is low, the phosphorus would normally be high. The correction for this is to administer calcium and bring it back into balance. Phosphate binders to lower the phosphate would not be needed. If the calcium is corrected, it will also indirectly correct the magnesium and the potassium.

The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be: Osgood-Schlatter disease. Sever disease. epiphysiolysis of the proximal humerus. epiphysiolysis of the distal radius.

answer 3 Epiphysiolysis of the proximal humerus is an overuse disorder that occurs with rigorous upper extremity activity such as pitching and causes tenderness in the shoulder. Osgood-Schlatter disease causes knee pain and painful swelling or prominence of the anterior portion of the tibial tubercle. Sever disease causes pain over the posterior aspect of the calcaneus. Epiphysiolysis of the distal radius is an overuse disorder that causes wrist pain. It is common in gymnasts.

The nurse is caring for a 1-year-old boy with Down syndrome. Which intervention would the nurse be least likely to include in the child's plan of care? Describing the importance of a high-fiber diet Promoting annual vision and hearing tests Educating parents about how to deal with seizures Explaining developmental milestones to parents

answer 3 It is unlikely that the parents will need to know how to deal with seizures. It will be helpful to provide parents with growth and developmental milestones that are unique to children with Down syndrome. More than 60% of children with Down syndrome have hearing loss, so promoting annual vision and hearing tests is the priority intervention. Special diets are usually not necessary; however, a balanced, high-fiber diet and exercise are important because constipation is frequently a problem.

The nurse is teaching the parents of a 14-year-old boy who has been diagnosed with Klinefelter syndrome. Which response by the parents indicates a need for more teaching? "So this condition may help explain some of his poor performance in school?" "Our son will need hormonal therapy for the rest of his life." "We could have also had a girl with male characteristics." "He may need to get breast reduction surgery in the future."

answer 3 The couple does not understand that this disorder does not occur in females. Klinefelter syndrome is an abnormality of the sex chromosome that affects only males. Klinefelter syndrome is caused by testosterone deficiency and is treated with testosterone replacement. Cognitive impairments do occur, sometimes in the form of learning disabilities, speech or language difficulties, or attention deficits. Breast reduction surgery may be necessary if gynecomastia occurs.

The nurse is providing teaching about the potential side effects of lithium for the parents of a child recently diagnosed with bipolar disorder. Which statement by the parents indicates a need for additional teaching? "Our child will probably tell us about being hungrier than usual." "Our child may notice an increase in urination" "If our child loses weight, then we know the medication is working." "Tremors and nausea are common side effects."

answer 3 Weight gain, not weight loss, is a side effect of the drug. An increased appetite occurs with lithium. Lithium is associated with tremors and nausea. Polyuria occurs with lithium.

The nurse is caring for a child with celiac disease. The parents and the child have attended a class with a group of other clients with the disorder. Which statements by the child or the parents indicate the need for further teaching? (Select all that apply.) "I hope they find a cure for celiac disease some day." "My brother and sister are more likely to develop celiac disease since I have it." "I must be careful to eat only 100% whole grain foods." "Celiac disease is the same as gluten intolerance that everyone is talking about these days." "I love pasta, so as long as I only eat it occasionally I should be fine."

answer 3-4-5 Celiac disease is an immunologic disorder in which gluten, a product most commonly found in grains, causes damage to the small intestine. It is total gluten intolerance, which is different than what most people refer to as gluten intolerance in the general population. The child with celiac disease must follow a strict gluten free diet at all times. The disease does have familial tendencies. There is no cure for the disease but it can be managed with strict diet control.

The nurse is conducting a physical examination of an 18-month-old with suspected intussusception. Which finding would the nurse identify as the hallmark of this condition? Abdominal pain and guarding Perianal skin tags Skin tenting A sausage-shaped mass in the upper midabdomen

answer 4 A sausage-shaped mass in the upper midabdomen is the hallmark of intussusception. Perianal skin tags are highly suspicious of Crohn disease. Abdominal pain and guarding are also common with intussusception but are seen with many other conditions. Tenting would indicate dehydration.

The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition? Maternal use of acetaminophen in third trimester History of hypoxia at birth Preterm birth Mother age 42 with pregnancy

answer 4 Advanced maternal age is a risk factor for cleft lip and palate. Drugs such as anticonvulsants, steroids, and other medications during early pregnancy are considered risk factors. Acetaminophen is not associated with an increased risk for cleft lip and palate. Preterm birth is not a risk factor for the development of cleft lip and palate. Hypoxia or anoxia is a risk factor for the development of necrotizing enterocolitis.

A group of nursing students are reviewing medications used to treat attention deficit hyperactivity disorder (ADHD). The group demonstrates understanding of the information when they identify what as a nonstimulant norepinephrine reuptake inhibitor? Methylphenidate Pemoline Lisdexamfetamine Atomoxetine

answer 4 Atomoxetine is a nonstimulant norepinephrine reuptake inhibitor used to treat ADHD. Methylphenidate is a psychostimulant used to treat ADHD. Lisdexamfetamine is a psychostimulant used to treat ADHD. Pemoline is a psychostimulant used to treat ADHD.

The nurse is describing some of the developmental milestones the mother of a 3-month-old boy with Down syndrome can expect to see in her child. Which statement describes the milestones that are expected in a child with Down syndrome? "He will be speaking in sentences at 21 months of age." "He'll be crawling all over the house by 9 months of age." "Bladder training can be expected by 2.5 to 3 years of age." "You can expect him to eat with his hands by age 12 months."

answer 4 Children with Down syndrome will accomplish eating with their hands by about 12 months of age. They will develop the skills of typical children, but at an older age. The child with Down syndrome will speak in sentences at 24 months rather than 21 months. Bladder training would occur by 48 months rather than 32 months. A child with Down syndrome will crawl at 11 months rather than 9 months.

The nurse is assessing a 7-year-old girl with Down syndrome. Which would the nurse be least likely to assess? Auscultation reveals a definite heart murmur. Palpation indicates that the child may be constipated. The child is significantly underweight. Inspection finds the nasal passages clear and open.

answer 4 It is least likely that the nurse would find the child's nasal passages clear and open. Children with Down syndrome have chronically stuffy noses due to underdeveloped nasal bones. Typically, children with Down syndrome are overweight. Children with Down syndrome often experience digestive problems such as constipation. Children with Down syndrome often experience cardiac problems, such as a heart murmur.

In the newborn nursery, the nurse assesses a newborn and sees the ears are low-set. What action will the nurse take first? Report the finding to the health care provider Check the family history for genetic conditions Document the findings Assess for additional anomalies

answer 4 Low-set ears are considered a minor anomaly, but if they are present the nurse should further assess for additional anomalies. Low-set ears are associated with numerous genetic dysmorphisms. The nurse could assess for overlapping digits, syndactyly, a flat occiput, hemangioma, nevi, and ear lobe creases. The number of minor anomalies found increases the likelihood of a major anomaly. If three or more minor anomalies are found, the chances of a major anomaly or cognitive impairment increases 19% to 26%. The nurse should thoroughly assess the newborn first for all anomalies, then document the findings and report the them to the health care provider. The family history could provide clues as to why the newborn has the assessment findings, but exploring this history is not as imperative as conducting a thorough assessment.

The parents of a 3-month-old bring their baby to the clinic with vomiting, irritability, and an eczema-like rash. The nurse notices that the infant's urine smells musty. The parents state the baby was born at home and this is the first time the infant has been seen by a health care practitioner. The nurse is aware that this infant is most likely exhibiting sign of which disorder? Achondroplasia Biotinidase deficiency Galactosemia Phenylketonuria

answer 4 Phenylketonuria (PKU) is a deficiency in a liver enzyme leading to inability to process the essential amino acid phenylalanine properly. Phenylalanine is found mostly in protein-containing foods such as meat and milk (including breast milk and formula). The disease has no symptoms at birth. Most cases are identified before symptoms are present due to newborn screening (PKU is screened for in all states). Since this child was born at home the disease was not diagnosed.

The nurse is caring for a 13-year-old adolescent with a nursing diagnosis of ineffective coping related to inability to deal with life stressors as evidenced by few or no meaningful friendships and low self-esteem. Which intervention would be the priority to promote coping skills? Demonstrate unconditional acceptance of the adolescent as a person. Role model appropriate social and conversation skills. Set clear limits on behavior. Encourage the adolescent to discuss thoughts and feelings.

answer 4 Rationale:The priority intervention is to encourage the adolescent to discuss thoughts and feelings, as this is an initial step toward learning to deal with them appropriately. The other interventions are appropriate, but the priority intervention is to encourage discussion and obtain information from the adolescent. This way the nurse can develop and refine the interventions based on the adolescent's thoughts and feelings.

The nurse is preparing a presentation for a local health fair on autism spectrum disorders. What statement would the nurse include as part of the presentation? Communication therapies are of little value in treating autism spectrum disorders. Scientific evidence supports the use of complementary therapies. Children respond best when the environment is less structured. Autism spectrum disorders cannot be cured.

answer 4 There are no medications or treatment available to cure autism spectrum disorders. Behavioral and communication therapies are very important in caring for a child with an autism spectrum disorder. Children with an autism spectrum disorder respond very well to highly structured educational environments. To date, complementary and alternative medical therapies have not been scientifically proven to improve autism spectrum disorders.

The nurse is to obtain a stool specimen from a 4-year-old child who has very liquid stool. The child is ambulatory but weak. Which collection method would be most effective for the nurse to use? Use a clean bedpan to collect the specimen. Have the child defecate into a container in the toilet. Use a tongue blade to scrape a specimen from a diaper. Apply a urine bag to the anal area.

answer 4 With very liquid stool, applying a urine bag to the anal area is most effective in collecting the specimen. Using a tongue blade to scrape a specimen from a diaper would be appropriate if the stool is formed. However, putting a diaper on a 4-year-old would be demeaning. Defecating into a collection container that sits at the back of the toilet would be more appropriate for an older child who is ambulatory. A bedpan would be appropriate if the child was bedridden.

The nursing educator has completed an educational program for new nurses on eating disorders in adolescents. Which statement by a participant would indicate a need for further education? "We need to stay with them for at least 30 minutes after they eat so they don't try to vomit or dispose of the food." "We need to allow the client to participate in developing the treatment plan." "Meal time should be structured but pleasant and relaxed without distractions." "If they refuse to eat, we need to sit with them and not let them leave the table until they do eat something."

answer 4 Withdraw attention if the child refuses to eat: secondary gain is minimized if refusal to eat is ignored rather than with continuous attention. Mutually establish a contract related to treatment to promote the child's sense of control. Provide mealtime structure, as clear limits let the child know what the expectations are. Provide continuous supervision during the meal and for 30 minutes following it so that the child cannot conceal or dispose of food or induce vomiting.

A previously healthy newborn has become lethargic, is having feeding difficulties and is failing to thrive. An inborn error of metabolism is suspected. What intervention will the nurse perform prior to testing for these errors? Feed the newborn a concentrated formula Correct any hypoglycemia Send a specimen for genetic testing Stop the newborn's feedings

answer 4 A previously healthy newborn has become lethargic, is having feeding difficulties and is failing to thrive. An inborn error of metabolism is suspected. What intervention will the nurse perform prior to testing for these errors? Feed the newborn a concentrated formula Correct any hypoglycemia Send a specimen for genetic testing Stop the newborn's feedings

The nurse is taking a health history of a 2-year-old child presenting with a sudden onset of severe vomiting. Which description would suggest an obstruction? Projectile vomiting Bloody vomiting Bilious vomiting Effortless vomiting

answer c The contents and character of the vomitus may give clues to the cause of vomiting. Bilious vomiting is never considered normal and suggests an obstruction. Projectile vomiting is associated with pyloric stenosis. The gender and the age of the child are not consistent with pyloric stenosis. Effortless vomiting is often seen in gastroesophageal reflux. Bloody emesis can signify esophageal or gastrointestinal bleeding.