Chapter 33: Alterations in Cognitive and Mental Health, Chapter 29: Alterations in Integumentary Function, Chapter 27: Alterations in Musculoskeletal Function, Chapter 30: Alterations in Immune Function, Chapter 31: Alterations in Endocrine Function,...

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A school-age child is hospitalized with a fractured left femur. The child is in balanced skeletal traction and is in pain. Orders read "Morphine 2.5 mg IV q 3 hours for severe pain." How many mL of morphine would the nurse administer if the medication on hand is morphine 8 mg/1 mL? Record your answer using two decimal places.

0.31

A child diagnosed with cancer is prescribed chemotherapy. The latest lab value indicates the white-blood-cell count is very low. Which medication order does the nurse anticipate? 1. Filgrastim (Neupogen) 2. Ondansetron (Zofran) 3. Oprelvekin (Neumega) 4. Epoetin alfa (human recombinant erythropoietin)

A child is diagnosed with a Wilms tumor. Which nursing action is most appropriate prior to surgery? 1. Careful bathing and handling 2. Monitoring of behavioral status 3. Maintenance of strict isolation 4. Administration of packed red-blood cells

A child is diagnosed with rhabdomyosarcoma. Which nursing intervention is most appropriate for this child? 1. Position the child with the head elevated. 2. Monitor for hematuria. 3. Demonstrate the use of a conformer. 4. Administer oxygen.

A child is diagnosed with thrombocytopenia secondary to chemotherapy treatments. Which action by the nurse is the most appropriate? 1. Administer intramuscular injections (IM). 2. Perform oral hygiene. 3. Monitor intake and output. 4. Use palpation as a component of assessment.

The child has been diagnosed with rickets. The child's mother is educated about the importance of providing the child with 10 micrograms (400 International Units) of an oral vitamin D supplement each day. The child's mother purchases over-the-counter vitamin D drops. The supplement is noted to contain 5 mcg of vitamin D in each 0.5 mL. How much of the supplement should the mother administer to the child each day? Record your answer using one decimal place

The pediatric nurse is providing care to a school-age child receiving chemotherapy to treat cancer. Which interventions are appropriate to include in the plan of care in order to monitor for oncologic emergencies? SATA 1. Monitor complete blood count (CBC). 2. Document intake and output. 3. Observe for behavioral changes. 4. Refer for psychosocial support. 5. Implement neutropenic precautions.

1, 2, 3

The pediatric nurse educator is conducting an in-service for novice nurses who will begin working on the pediatric oncology unit. The educator wants to include the common clinical manifestations of cancer. Which manifestation will the educator include in the presentation? SATA 1. Cachexia 2. Anemia 3. Gene abnormalities 4. Palpable mass 5. Chromosomal abnormalities

1, 2, 4

A seasoned nurse is precepting a novice nurse on a pediatric oncology unit. The seasoned nurse would like to review the ongoing physiologic and psychosocial care of the children who survive cancer. Which topics will the seasoned nurse include in the discussion with the novice nurse? SATA 1. Developing other cancers 2. Recommending regular office visits 3. Encouraging school-age clients to manage their own care 4. Needing weekly laboratory tests 5. Providing educational and psychosocial support

1, 2, 5

A 24-hour urine collection for vanillylmandelic acid (VMA) has been ordered on a child suspected of having neuroblastoma. When is the most appropriate time for the nurse to begin the collection? 1. At 0700 2. After the next time the child voids 3. At bedtime 4. When the order is noted

A child with a brain tumor is admitted to the pediatric intensive care unit (PICU)after brain surgery to remove the tumor. Which postoperative order would the nurse question? 1. Antibiotics 2. Sodium levels every 24 hours 3. Anticonvulsants 4. Hourly intake and output

A preschool child is seen in the clinic, and the nurse anticipates a diagnosis of leukemia. Which reaction does the nurse anticipate this child will exhibit upon diagnosis? 1. Acceptance, especially if able to discuss the disease with children their own age 2. Thoughts that they caused their illness and are being punished 3. Understanding of what cancer is and how it is treated 4. Unawareness of the illness and its severity

A preschool-age child is brought to the clinic by the mother, who says the child has been lethargic and anorexic lately and complains of bone pain. On exam, the nurse notes petechiae, joint pain, and an enlarged liver. Which diagnosis does the nurse anticipate for this child? 1. Hodgkin disease 2. Leukemia 3. Rhabdomyosarcoma 4. Ewing sarcoma

A child undergoing chemotherapeutic treatment for cancer is being admitted to the hospital for fever of 102 degrees F and possible sepsis. Cultures, antibiotics, and acetaminophen (Tylenol) along with bed rest have been ordered for this child. Place the following steps in order from first to last. Response 1. Administer the antibiotics. Response 2. Administer the acetaminophen (Tylenol). Response 3. Obtain the cultures. Response 4. Ensure the child has bed rest.

2, 1, 3, 4

A child diagnosed with a Wilms tumor is prescribed chemotherapy. Which laboratory test will the nurse monitor prior to administering the chemotherapy to determine the childs infection-fighting capability? 1. Hemoglobin 2. Red-blood-cell count 3. Absolute neutrophil count (ANC) 4. Platelets

An adolescent is receiving methotrexate chemotherapy after undergoing limb-salvage surgery for osteogenic sarcoma. Which statement by the adolescent indicates understanding of the purpose of leucovorin therapy after the methotrexate? 1. Im glad I only need one dose of the leucovorin. 2. I dont have any pain so I wont need to take the leucovorin this time. 3. I know I will be taking the leucovorin every 6 hours for about the next 3 days. 4. I dont have any nausea so I wont need the leucovorin.

The antiemetic drug ondansetron (Zofran) is administered to a child receiving chemotherapy. When should the nurse administer this medication? 1. Only if the child experiences nausea 2. After the chemotherapy has been administered 3. Before chemotherapy administration as a prophylactic measure 4. Never; this antiemetic is not effective for controlling nausea and vomiting associated with chemotherapy.

The child is admitted to the hospital after being diagnosed with retinoblastoma. Which assessment finding does the nurse anticipate for this child? 1. A red reflex 2. Yellow sclera 3. A white pupil 4. Blue-tinged sclera

A child who is diagnosed with leukemia has a sibling who is expressing feelings of anger and guilt. How would the nurse characterize this reaction by the sibling? 1. Abnormal; the sibling should be referred to a psychologist. 2. Normal; the illness doesnt affect the sibling. 3. Unexpected; the cancer is easily treated. 4. Normal; the sibling is affected too, and anger and guilt are expected feelings.

The nurse is monitoring the urine specific gravity and pH on a child receiving chemotherapy. Which urinalysis result is the goal for this child? 1. Spec gravity 1.030; pH 6 2. Spec gravity 1.030; pH 7.5 3. Spec gravity 1.005; pH 6 4. Spec gravity 1.005; pH 7.5

A 3-year-old demonstrates lateral bowing of the tibia. Which signs would indicate that the boy's condition is Blount disease rather than the more typical developmental genu varum? A. A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray B. The medial surfaces of the knees are more than 2 in apart C. The malleoli are touching D. The condition is bilateral

A. A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray

A nurse is working with a 12-year-old girl with osteomyelitis who is recovering from surgery. What nursing interventions should be implemented? Select all that apply. A. Administration of IV antibiotics at the hospital B. Instruct the parents on how to care for an IV line at home C. Instruct the parents regarding the importance of maintaining bed rest D. Institute infection-control precautions related to drainage tubes E. Cast care of the affected limb F. Instruction to the parents regarding proper traction of the limb

A. Administration of IV antibiotics at the hospital B. Instruct the parents on how to care for an IV line at home C. Instruct the parents regarding the importance of maintaining bed rest D. Institute infection-control precautions related to drainage tubes

The nurse is caring for a child diagnosed with a sprain of the lower extremity. Which health care prescription(s) would the nurse clarify with the provider before implementing? Select all that apply. A. Apply a heating pad four times daily for 20 minutes per application B. Offer aspirin (ASA) three times daily orally to the child for pain and inflammation C. Avoid bearing weight on the affected extremity for 3 to 4 days D. Compress the site using an elastic bandage to wrap the area E. Assure the parents understand when to return and to call or follow-up with concerns

A. Apply a heating pad four times daily for 20 minutes per application B. Offer aspirin (ASA) three times daily orally to the child for pain and inflammation

The nurse is creating a care plan for a child with a leg cast. What interventions would be appropriate for the nursing diagnosis of Risk for ineffective peripheral tissue perfusion related to pressure from cast? Select all that apply. A. Assess foot and toes every 4 hours for color, warmth, and presence of pedal pulses. B. Keep leg elevated by a pillow at all times. C. Remind the parents to not allow the child to put anything in the cast. D. Assess capillary refill of toes every 4 hours. E. Educate the child's parents on use of good body mechanics when repositioning the child.

A. Assess foot and toes every 4 hours for color, warmth, and presence of pedal pulses. B. Keep leg elevated by a pillow at all times. D. Assess capillary refill of toes every 4 hours.

The student nurse is preparing a presentation on bones and bone growth. What information should the student include? Select all that apply. A. Calcium and vitamin D play important roles in bone growth and bone breakdown. B. Calcitonin plays a role in remodeling of bone. C. Adipose cell formation happens in the red bone marrow. D. Periosteum is the outer covering of the bone. E. The diaphysis is the rounded end portion of the bone.

A. Calcium and vitamin D play important roles in bone growth and bone breakdown. B. Calcitonin plays a role in remodeling of bone. D. Periosteum is the outer covering of the bone.

A 17-year-old adolescent is found wandering around. The adolescent is confused, sweaty, and pale. Which test would the nurse expect to be performed first? A. Blood glucose level B. CT scan C. Arterial blood gases D. Blood cultures

ANS: A Rationale: It is important to draw a blood glucose level on the adolescent because the client is exhibiting signs of hypoglycemia and needs to be treated as soon as possible. Once the adolescent is stabilized,

The nurse is conducting a routine physical examination of a newborn to screen for developmental DDH. The nurse correctly assesses the infant by placing the infant: A. In a prone position, noting asymmetry of the thigh or gluteal folds. B. With both legs extended and observes the hip and knee joint relationship. C. With both legs extended and observes the feet. D. In a supine position with both legs extended and observes the tibia/fibula.

A. In a prone position, noting asymmetry of the thigh or gluteal folds.

The nurse is caring for a school-age child recovering from an open reduction for a fractured femur. Which assessment findings indicate that the child is developing an infection? Select all that apply. A. Lethargy B. Increased pulse rate C. Reduced pulse in the ankle D. Cyanosis of the casted foot E. Increased body temperature

A. Lethargy B. Increased pulse rate E. Increased body temperature

The nurse is caring for a school-age child recovering from an open reduction for a fractured femur. Which assessment findings indicate that the child is developing an infection? Select all that apply. A. Lethargy B. Increased pulse rate C.Reduced pulse in the ankle D. Cyanosis of the casted foot E. Increased body temperature

A. Lethargy B. Increased pulse rate E. Increased body temperature

After teaching a class of students about genetics and inheritance, the instructor determines that the teaching was successful when the students identify this as the basic unit of heredity. A. Gene B. Chromosome C. Allele D. Autosome

ANS: A Rationale: A gene is the basic unit of heredity of all traits. A chromosome is a long, continuous strand of DNA that carries genetic information. An allele refers to one of two or more alternative versions of a gene at a given position on a chromosome that imparts the same characteristic of that gene. An autosome is a non-sex chromosome.

A group of nursing students are reviewing information about neonatal screenings. The students demonstrate understanding of the information when the students identify which system of most consistently affected by metabolic disorders? A. Nervous system B. Cardiovascular system C. Gastrointestinal system D. Respiratory system

ANS: A Rationale: Although any system can be affected, the nervous system is most consistently affected by metabolic disorders. The physical examination should focus on evaluating neurodevelopmental functions. Abnormalities commonly revealed include impaired states of alertness and arousal, tremors, posturing, clonic jerking, tonic spasms, or seizures.

Which nursing intervention is priority when caring for a child with HIV? A. Administer prescribed medications. B. Assist the child with daily activities. C. Assess pain after invasive procedures. D. Review laboratory CD4 counts daily.

ANS: A Rationale: Although assisting with activities, assessing pain, and reviewing CD4 counts are all important, the priority when caring for a child with HIV is to administer prescribed medications. Prescribed medications prevent progressive deterioration of the immune system and provide prophylaxis against opportunistic infections.

A child with attention deficit hyperactivity disorder (ADHD) is prescribed methylphenidate hydrochloride. What should the nurse instruct the parents regarding an adverse effect of this medication? A: Anorexia B: Sleepiness C: Garbled speech D: Rapid increase in height

ANS: A Rationale: An adverse effect of methylphenidate hydrochloride is anorexia. Sleepiness and garbled speech are not adverse effects of this medication. Children taking this medication can develop growth suppression and not accelerated growth in height.

A 9-year-old child with leukemia is scheduled to undergo an allogenic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include? A "We'll need to have a match to a donor." B "The risk for rejection is much less with this type of transplant." C "You won't need to receive the high doses of chemotherapy before the transplant." D "You'll need to have an incision in your hip area to instill the cells."

ANS: A Rationale: An allogenic hematopoietic stem cell transplantation (HSCT) refers to transplantation using stem cells from another individual that are harvested from the bone marrow, peripheral blood, or umbilical cord blood. With this type of transplant, human leukocyte antibody (HLA) matching must occur. Therefore, the lesser the degree of HLA matching in the donor, the higher the risk for graft rejection and graft-versus-host disease (GVHD). Regardless of the type of transplant, a period of purging of abnormal cells in the child is necessary and accomplished through high-dose chemotherapy or irradiation. The procedure is accomplished by intravenously infusing hematopoietic stem cells into the child.

The nurse is assessing an 8-week-old infant in the clinic. The parent states the infant was feeding well and gaining weight until a few weeks ago and now is noted to have lost weight and "isn't doing well" per the parent. What action would the nurse take next? A. Assess the infant further for an inborn error of metabolism B. Advise the parent to decrease the feedings daily to every 6 hours C. Suggest the child be fed in a supine position, using a car seat or carrier D. Refer the parents to a dietitian for education on increasing the child's appetite

ANS: A Rationale: An infant who was otherwise healthy begins to show signs of deterioration, the nurse would further assess for an inborn error of metabolism. A dietary consult would be needed if a diagnosis of inborn error of metabolism was confirmed to educate the family on the appropriate diet, but not specifically for increasing the child's appetite. Position changes and schedule changes will are beneficial for a child with an inborn error of metabolism.

A 7-year-old child is rushed into the emergency room after being stung by a yellow jacket. The child is nauseated and vomiting and is experiencing itching and swelling on the arm where stung. He is having trouble breathing. Which type of hypersensitivity response is the child experiencing? A. Type I: anaphylaxis B. Type II: cytotoxic response C. Type III: immune complex D. Type IV: cell-mediated hypersensitivity

ANS: A Rationale: Anaphylactic shock is an immediate, life-threatening, type I hypersensitivity reaction that occurs after exposure to an allergen in a previously sensitized child. Anaphylactic shock must be treated immediately as it can be fatal. Initially, a child may become nauseated, with vomiting and diarrhea, because of the sudden increase in gastrointestinal secretions produced by the stimulation of histamine. This is followed by urticaria (itching) and angioedema (swelling). Bronchospasm can become so severe the child becomes dyspneic, hypoxemic, and then hypoxic.

Antiemetics are ordered to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications? A Administer the antiemetic before starting chemotherapy B Provide the antiemetic as needed (PRN) when nausea and vomiting are reported C Use the antiemetic after it is clear that nonpharmacologic methods are not effective D Start the antiemetic on a scheduled basis when the chemotherapy begins to cause nausea

ANS: A Rationale: Antiemetics are most effective when given before chemotherapy begins and then on a regular schedule to prevent nausea and vomiting throughout administration of chemotherapy. Nonpharmacologic measures can be used in conjunction with antiemetics but not in place of them.

An 11-year-old boy has recently been prescribed methylphenidate. The mother calls the pediatrician's office to speak with the advanced practice pediatric nurse practitioner. This mother has been extremely resistant to medication and insists that the medication is not working. How should the nurse respond? A: "Tell me what makes you think the medication is not working" B: "Do you want to try a different medication?" C. "Are you sure you are administering it properly" D. "Do you want to increase the dosage?"

ANS: A Rationale: Asking the mother to explain why she believes the medicine is not working will offer important insights to the mother's definition of effectiveness. It is important for both the mother and the advanced practice pediatric nurse practitioner to develop a shared definition of effectiveness and improvement. Once this is established, the nurse can suggest the next step in the treatment plan. Asking if the mother wants to try a different medication or increase the dosage does not provide any information about the child's response to the current medication. Asking the mother whether she is administering it properly could cause her to take offense and does not provide the necessary information.

The nurse is speaking with the parents of a school-aged child recently diagnosed with diabetes mellitus regarding the differences between hypoglycemia and hyperglycemia. Which statement by a parent indicates a need for further teaching? A. "If I notice changes in my son like tearfulness or irritability, his blood sugar may be high." B. "When my son's breath smells fruity, it almost always indicates high blood sugar." C. "If my son says he feels shaky, his blood sugar may be low." D. "Dry flushed skin may be a sign if high blood sugar."

ANS: A Rationale: Behavior changes such as tearfulness, irritability, confusion and slurred speech are indications of hypoglycemia, not hyperglycemia. Tremors and diaphoresis are also indications of low blood sugar. Dry flushed skin, fatigue, weakness, nausea, vomiting and fruity breath odor are all symptoms of hyperglycemia.

A 17-year-old girl has been diagnosed with bulimia nervosa. Which complication should the nurse carefully assess for in this client? A: Severe erosion of teeth B: Hypertension C: Diabetes mellitus D: Atherosclerosis

ANS: A Rationale: Bulimia refers to recurrent and episodic binge eating and purging by vomiting, accompanied by awareness that the eating pattern is abnormal yet the child is not able to stop the pattern. Adolescents with bulimia may develop severe erosion of their teeth because of the constant exposure to acidic gastrointestinal juices from vomiting. Esophageal tears may also result from forceful vomiting. Hypertension, diabetes mellitus, and atherosclerosis are not associated with bulimia nervosa.

3. The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority? A Calling the doctor if the child gets a sore throat B Keeping a written copy of the treatment plan C Writing down phone numbers and appointments D Using acetaminophen if the child needs an analgesic

ANS: A Rationale: Calling the doctor if the child gets a sore throat is the priority. Because of the child's impaired immune system, any sign of potential infection, such as sore throat, must be evaluated by a physician. Using acetaminophen if the child needs an analgesic, writing down phone numbers and appointments, and keeping a written copy of the treatment plan are important teaching points but secondary to guarding against infection.

An adolescent is recovering from surgery, radiation, and chemotherapy following a diagnosis of Ewing sarcoma. Which statement by the family indicates that reteaching is needed? A. "Our child is looking forward to playing football again." B. "We will remind our child to care for the skin following radiation." C. "Our child's friends shaved their heads in solidarity to show their support." D. "We will watch for signs of infection and report it to our health care provider."

ANS: A Rationale: Caution adolescents to continue to be careful about activities that cause stress on an extremity that has received radiation (for example, football or weight lifting) because it may not be as strong as usual afterward. The family will need reteaching because they say their child is looking forward to playing football again. Skin care, supportive friends, and reporting infections are all good foNr UhiRs SreIcoNvGer-y

Diabetes insipidus a disorder of the posterior pituitary resulting in deficient secretion of which hormone? A. Antidiuretic hormone B. Adrenocorticotropic hormone C. Thyroid stimulating hormone D. Luteinizing hormone

ANS: A Rationale: Central diabetes insipidus (DI), also called neurogenic, vasopressin-sensitive, or hypothalamic DI, is a disorder of the posterior pituitary that results from deficient secretion of ADH. Nephrogenic DI is a result of the inability of the kidney to respond to ADH.

The nurse is reviewing the medical record of a child with a mental health disorder and finds that the child is receiving cognitive behavioral therapy. How does the nurse interprets this information? A: Process that requires the individual to view a situation from a different perspective B: Interventions that address family dynamics and family coping C: Individual exploration of the person's conflicts and stressors D: Use of play to explore problems, issues, and conflicts

ANS: A Rationale: Cognitive behavioral therapy helps the individual reframe perceptions, change ideas about a situation, or view a situation from a different perspective. Next, the patient is helped to see the relations among his or her thoughts and beliefs and his or her emotional responses. Finally, the patient is encouraged to use problem solving to identify alternative solutions or ways of behaving. Individual therapy is an interpersonal process in which the patient and care provider together discover, explore, and resolve the patient's perceived and/or actual stressors, conflicts, behavioral responses, doubts, and anxieties. Family therapy focuses on family dynamics. Interventions may be designed to develop family-based coping strategies, such as problem solving or stress management. Play therapy involves the exploration of life's problems, developmental issues, and interpersonal conflicts.

A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug? A. That the infant's skin has greater permeability than that of an adult B. That there is less body surface area to be concerned about. C. That there is decreased absorption rates of topical drugs in infants. D. That there is a lower concentration of water in an infant's body compared with an adult.

ANS: A Rationale: Compared to adult skin, infants' skin exhibits greater permeability. This can result in increased absorption, which may result in adverse effects that usually do not occur in the adult patient. The nurse must consider this fact before administering skin ointment. Infants have greater, not lesser, body surface area. Greater body surface area plus increased permeability results in increased absorption of topical agents. Infants tend to have a higher concentration of water in their bodies than do adults.

A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state: A "We should administer the drug on an empty stomach." B "We should check our son's urine for glucose." C "He might develop a rounded face from this drug." D. "We will need to gradually decrease the dosage."

ANS: A Rationale: Corticosteroids are commonly administered with food to decrease the risk for gastrointestinal upset. Corticosteroids can disrupt glucose balance, so urine should be checked for glucose. A moon face is an adverse effect of corticosteroids. Corticosteroids need to be tapered gradually to reduce the risk of adrenal insufficiency.

The nurse is caring for a child who is scheduled for bone scan. It is suspected that the child has a growth hormone deficiency. Which finding would support this medical diagnosis? A. The bone scan would show bone age would be two or more deviations below normal. B. The bone scan would show a brain tumor. C. The bone scan would show bone age would be three or more deviations above normal. D. The bone scan would a tumor on the child's kidney.

ANS: A Rationale: Diagnostic testing used in children with suspected GH deficiency include bone age will be two or more deviations below normal. CT or MRI scans would be used to rule out tumors or structural abnormalities, not bone scans.

Which statement by the parent of a 12-month-old child diagnosed with Down syndrome shows the need for further education? A. "I will need to delay any further immunizations." B. "Thyroid testing is needed every year." C. "In a couple of years, my child will need an x-ray of the neck." D. "I will watch closely for development of respiratory infection."

ANS: A Rationale: Down syndrome children are at higher risk for infection because of a lowered immune system. Delaying immunizations may expose the child to illnesses that could have been prevented. Down syndrome children are at greater risk for developing thyroid disorders, 1st and 2nd vertebrae disorders, and respiratory infections.

A 19-year-old client with hypothyroidism asks the nurse if she will need to take thyroid medication if she becomes pregnant. The nurse integrates understanding of which of the following when responding to the client? A. Regulation of thyroid medication is more difficult because the thyroid gland increases in size during pregnancy B. There is no need to take a thyroid medication because the fetus's thyroid produces thyroid-stimulating hormone C. It is more difficult to maintain thyroid regulation during pregnancy due to the slowing of metabolism D. Fetal growth is arrested if the thyroid medications are continued during pregnancy.

ANS: A Rationale: During the pregnancy the thyroid gland triples n size which makes it more difficult to regulate thyroid medication. Thyroid function does not slow during pregnancy. The fetus might produce TSH but it does not reach the mother. Fetal growth is not arrested if medication is continued during the pregnancy.

A child receiving chemotherapy is experiencing significant reduction in red blood cells secondary to myelosuppression. Which agent would the nurse most likely expect to be ordered? A Epoetin alfa B Filgrastim C Sargramostim D Gamma interferon

ANS: A Rationale: Epoetin alfa is a colony-stimulating factor used to stimulate production of red blood cells. Filgrastim is a colony-stimulating factor used to stimulate production of granulocytes. Sargramostim is a colony-stimulating factor used to stimulate production of granulocytes. Gamma interferon is used to stimulate macrophage production to fight bacteria and fungus.

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which skin condition best describes erythema? A. Redness of the skin produced by congestion of the capillaries B. Small, circumscribed, solid elevation of the skin C. Discolored skin spot not elevated at the surface D. Small elevation of epidermis filled with a viscous fluid

ANS: A Rationale: Erythema is redness of the skin produced by congestion of the capillaries.

When describing the negative feedback system that controls endocrine function, the nurse explains that a decreased secretion of which correlates with a decrease in blood glucose levels? A. Insulin B. Glucagon C. Adrenocorticotropic hormone D. Glycogen

ANS: A Rationale: Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body. As a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted.

When teaching about Turner's syndrome, what should the nurse include? A. Timing and use of growth hormone B. Use of hormone therapy to prevent infertility C. Long-term effects of decreased intellectual ability D. Treatment for gynecomastia

ANS: A Rationale: Growth hormone is used once the child has fallen below the 5th percentile on the growth charts. Hormone therapy will be used to initiate puberty, not to prevent infertility. Gynecomastia is a common finding in children suffering from Klinefelter, not Turner's, syndrome.

The parents of a 5-year-old have just found out that their child has head lice. Which statement by the parents would support the nursing diagnosis of deficient knowledge? A. "I can't believe it. We're not unclean, poor people." B. "We'll have to get that special shampoo." C. "Everybody in the house will need to be checked." D. "That explains his complaints of itching on his neck."

ANS: A Rationale: Head lice is not an indication of poor hygiene or poverty. It occurs in all socioeconomic groups. Thus, the parents' statement about being unclean and poor reflects a lack of knowledge about the infection. A pediculicide is used to wash the hair to treat the infestation. Household contacts need to be examined and treated if affected. Extreme pruritus is the most common symptom, with nits or lice especially behind the ears or at the nape of the neck.

The nurse is assessing the eyes of a 6-month-old and notices that she has wide-spaced eyes and bilateral epicanthal folds. Which condition associated with these findings should also be assessed for in this child? A. Low-set, malformed ears B. Amblyopia C. Strabismus D. Ptosis

ANS: A Rationale: Hypertelorism is congenital, abnormally wide-spaced eyes. Detecting true hypertelorism in children is important, because this condition is associated with chromosomal abnormalities such as Cri-du-chat syndrome. Cri-du-chat syndrome is an abnormality on chromosome 5 and is associated with intellectual and developmental disability. Children with this syndrome also have short stature, microcephaly, a simian crease and a weak, cat-like cry during infancy. None of the other conditions is associated with hypertelorism.

A child with Addison's disease has been admitted with a history of nausea and vomiting for the past 3 days. The client is receiving IV glucocorticoids. Which intervention would the nurse implement? A. Take glucometer readings as ordered B. Measure intake and output C. Monitor sodium and potassium levels D. Weigh daily

ANS: A Rationale: IV glucocorticoids raise the glucose levels and often require coverage with insulin. Measuring the intake and output at this time is not necessary. Sodium and potassium would be monitored when the client is receiving mineralcorticoids. Daily weights are not necessary at this time.

Which type of diet should be included in the plan of care for a child diagnosed with Addison disease? A. High-protein, low-carbohydrate, high-sodium diet B. High-protein, high-carbohydrate, low-sodium diet C. Low-calorie, low-carbohydrate, low-sodium diet D. Low-calorie, low-cholesterol, low-saturated fat di

ANS: A Rationale: In Addison disease, the body produces inadequate hepatic glucagons. A high-protein, low-carbohydrate, and high-sodium diet prevents fatigue, hypoglycemia, and hyponatremia. The child with Cushing syndrome needs low calories, carbohydrates, and sodium. The child with hypothyroidism needs low calories, cholesterol, and saturated fat.

A 15-year-old boy visits his primary care physician's office with fever, headache, and malaise, along with complaints of pain on chewing and pain in the jawline just in front of the ear lobe. The boy asks his mother to leave the exam room for a minute and then tells the nurse that he is also experiencing testicular pain and swelling. The nurse recognizes that this client most likely has which condition? A. Mumps B. Infectious mononucleosis C. Poliomyelitis D. Herpes zoster

ANS: A Rationale: Initial symptoms of mumps include fever, headache, anorexia, and malaise. Within 24 hours, pain on chewing and an "earache" occurs. When the child points to the site of the earache, however, he points to the jawline just in front of the ear lobe, the site of the parotid gland. By the next day, the gland appears swollen and feels tender; the ear becomes displaced upward and backward. Boys may also develop testicular pain and swelling (orchitis). None of the other conditions listed matches the symptoms indicated.

The nurse is preparing to post a sign above the crib of an infant with a Wilms tumor. Which statement should the nurse post immediately? A. "Do not palpate abdomen." B. "No intramuscular injections." C. "No milk or milk products allowed." D. "No blood sampling in lower extremities."

ANS: A Rationale: It is important that the child's abdomen not be palpated any more than is necessary for diagnosis because handling appears to aid metastasis. Place a sign reading "No Abdominal Palpation" over the child's crib to help prevent this. Intramuscular injections, milk products, or blood sampling in the lower extremities are not contraindicated for this health problem.

A nurse is communicating with a family about palliative care. Which of the following would be the best approach to take? A. Ask the family what they know, what they wish to know and be prepared to repeat the information you give to them several times B. Give the family as much information as possible to promote better decision-making C. Provide information during a crisis when the parent's senses are heightened and memory is improved D. Avoid pushing the family by asking too many questions.

ANS: A Rationale: It is important to ask what the family knows, what they are ready to hear, and be prepared to repeat the information over the course of time. An essential component of communication is to realize that it is a dynamic ongoing process and that too much information can be delivered at one time. It is important to ask what the family knows, what they are ready to hear, and be prepared to repeat the information over the course of time. In times of crisis or stress, concentration and understanding may be impaired due to overwhelming feelings of loss and helplessness.

1. 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? A. Educating parents about how to deal with seizures B. Explaining developmental milestones to parents C. Promoting annual vision and hearing tests D. Describing the importance of a high-fiber diet

ANS: A Rationale: 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.

Nursing students correctly label the group of cells whose job is to ingest, engulf, and neutralize pathogens as: A. macrophages. B. immunogens. C. immunoglobins. D. red blood cells.

ANS: A Rationale: Macrophages (mature white blood cells) engulf, ingest, and neutralize pathogens. Red blood cells do not fight infection. They carry hemoglobin and carry oxygen from the lungs to the tissues. In the immune response, immunoglobulins are antibodies and immunogens are antigens.

A 10-year-old who is receiving chemotherapy has received ondansetron before this therapy session. About an hour later, the child tells the nurse that his mouth feels really dry. The child has urinated several time and his skin turgor is normal. Which response by the nurse would be most appropriate? A "The drug you got to help with the nausea can cause dry mouth." B "Let me increase your intravenous fluids." C "You might be having a severe allergic reaction. Are you itchy?" D "This indicates an infection. We need to start antibiotics."

ANS: A Rationale: Ondansetron is associated with dry mouth. Increasing IV fluids may or may not be appropriate. The child is urinating and his skin turgor is normal so it doesn't appear that he is dehydrated and in need of extra fluid. A severe allergic reaction would more likely be manifested by itching, hives, and increasing respiratory distress. Dry mouth is not an indicator of infection.

The nurse is conducting an assessment of a 5-year-old client. During the assessment, the nurse notes that the child does not maintain eye contact or speak. The nurse suspects an autism spectrum disorder. Which additional finding would help support the nurse's suspicion? A: The child constantly opens and closes the hands. B: The child is highly active and inattentive. C: The child has a slight decrease in head circumference. D: The child has a long face and a prominent jaw.

ANS: A Rationale: Repetitive motor mannerisms such as constantly opening and closing the hands are a typical behavior pattern for autism spectrum disorder. A high level of activity and inattentiveness are typical symptoms of intellectual disability. Decrease in head circumference suggests malnutrition or decelerating brain growth. A long face and prominent jaw are symptoms of fragile X syndrome.

The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided? A. Encourage rest and relaxation. B. Antibiotic therapy may be initiated. C. Antiviral medications can be prescribed. D. Range of motion to prevent contractures.

ANS: A Rationale: Rubella infection is usually mild and self-limited. The care given is normally supportive. Rest is encouraged. Medications administered are normally limited to anti-pyretics and analgesics. Antibiotic and antiviral therapies are not normally included in the plan of treatment. Range of motion is not needed as mobility of the client is not limited.

A newborn was screened for hereditary metabolic disorder at 8 hours old. Which action by the nurse is most appropriate? A. Instruct the parent to have another screening in 1 to 2 weeks B. No further intervention is needed C. Repeat screening in 8 hours D. If the infant is premature, screening needs to be done every 8 hours for 48 hours

ANS: A Rationale: Screening for hereditary metabolic disorders should be done after the first 24 hours of life because of the higher incidence of false-positive results. Repeating the screening in 8 hours or every 8 hours for 48 hours would yield the same increased risk for false-positives.

The nurse is preparing teaching materials for a family whose child is prescribed somatropin for a growth hormone deficiency. What should the nurse instruct the parents about the administration of this medication? A. This medication must be given by injection. B. This medication must be given in the morning before school. C. Hip or knee pain is an expected adverse effect of this medication. D. This medication does not interact with any other types of medication.

ANS: A Rationale: Somatropin is administered by injection. It is best given at hour of sleep because that is when growth hormone is released. Hip or knee pain could indicate a slipped capital epiphysis and should be reported to the health care provider. The nurse should urge the parents to inform all health care providers that the child is receiving this medication to avoid medication interactions.

The parent of a child with mumps on one side of the face is concerned that the disease can develop on the other side in the future. How should the nurse respond to the mother about this concern? A. The child is immune to further attacks of the disease. B. It does not matter because mumps in adulthood is not serious. C. The child should receive active immunization against mumps. D. There is nothing that can be done to prevent another attack of mumps in the future.

ANS: A Rationale: Some parents worry that because their child had swelling only on one side, the child will develop mumps on the opposite side in the future. One attack of mumps gives lasting immunity, and the child will not contract the disease again. Mumps is a potentially dangerous disease and should not be minimized. The child does not need immunization against mumps.

A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms? A. Syndrome of inappropriate antidiuretic hormone B. Diabetes insipidus C. Hyposecretion of somatotropin D. Hypersecretion of somatotropin

ANS: A Rationale: Syndrome of inappropriate antidiuretic hormone (SIADH) is a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level. It can be caused by central nervous system infections such as bacterial meningitis. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Diabetes insipidus is characterized by polyuria, not decreased urine production. Hyposecretion of somatotropin, or growth h

The nurse is teaching a group of parents about head lice. Which statement is essential to include during the presentation? A. Head lice are becoming very resistant to treatment. B. Send your child to school even if you suspect head lice, but have the school nurse check the child. C. Discourage the children from going to sleepovers. D. Wash the bed linens in hot water to kill the lice.

ANS: A Rationale: The accurate advice is that head lice are becoming resistant to treatment. Children with head lice do not need to stay home, but parents should follow school policies regarding whether children are allowed in school until they are nit-free. Children should be allowed to participate in sleepovers, preferably bringing their own pillows. Head lice do not survive long once they have fallen off. Most children can be treated effectively without treating their bedding and clothing.

A 10-year-old child is newly diagnosed with type 1 diabetes. The child's hemoglobin A1C level is being monitored. The nurse determines that additional intervention is needed with the child based on which result? A. 8.5% B. 6.5% C. 7.5 % D. 7.0%

ANS: A Rationale: The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%. Therefore, a result of 8.5% would indicate that additional intervention is needed to achieve the recommended goal.

The nurse is educating an 18-year-old female client with Turner syndrome. What information will the nurse include in the teaching plan? A. Resources regarding infertility and family planning B. Requirements for post secondary educational needs C. The need to eliminate amino acids from the diet D. The options for a cure as the client enters adulthood

ANS: A Rationale: The older adolescent female will need education on infertility and family planning, because most women with Turner syndrome are infertile but spontaneous pregnancy may occur. If the adolescent wishes to have children in the future, information on alternatives reproduction strategies should be introduced. There is no cure for Turner syndrome. The other responses are not specific to Turner syndrome.

The nurse is teaching the parents of a child with varicella about the disorder. The nurse determines that the teaching was successful when the parents state which of the following? A. "We will make sure to remind him not to scratch the lesions." B. "We can give him aspirin for fever." C. "We should put him in a warm bath if he is itchy." D. "We can use salt solutions to help heal his oral lesions."

ANS: A Rationale: The parents understand the teaching when they state that they will help make sure to remind him not to scratch the lesions. Acetaminophen should be administered for fever, not aspirin, due to the link with Reye's syndrome. The best treatment for skin discomfort is a cool bath with soothing colloidal oatmeal every 3 to 4 hours for the first few days. The child should avoid citrus, spicy, or salty foods.

The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system? A Child reports of facial palsy and vision problems B Observing petechiae, purpura, or unusual bruising C Noting adventitious breath sounds during auscultation D Palpation of abdomen reveals enlarged

ANS: A Rationale: The presence of facial palsy and vision problems indicates that the central nervous system has been infiltrated by leukemia cells. The petechiae, purpura, or unusual bruising results from decreased platelet levels and may be present regardless of metastasis. Adventitious breath sounds may indicate pneumonia, and may be present whether the disease has metastasized or not. Hepatomegaly and splenomegaly result from infection, not metastasis.

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

ANS: A Rationale: 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

A child with a diagnosis of Down syndrome has had which of the following chromosome abnormalities occur? A. 1 copy of the chromosome 8 has occurred instead of 2 copies. B. 3 copies of trisomy 21 has occurred instead of 2 copies. C. 3 copies of trisomy 18 has occurred instead of 2 copies. D. 3 copies of trisomy 13 has occurred instead of 2 copies.

ANS: B Rationale: A child with Down syndrome has trisomy 21, which means 3 copies of chromosome 21 has occurred instead of 2 copies. If this occurs with chromosome 18, it leads to Edward's syndrome, and if it occurs with chromosome 13, it leads to Patau syndrome.

The nurse identifies the nursing diagnosis of risk for infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply. A. Having the child sleep in a single bed and room B. Encouraging frequent, thorough handwashing C. Providing a low-carbohydrate, low-protein diet D. Encouraging frequent close contact with numerous visitors E. Cheering up the environment with fresh flowers and plants

ANS: A, B Rationale: To reduce the risk of infection, the nurse should teach the child and parents about minimizing the child's exposure to potentially infectious situations. The nurse should encourage the parents to arrange for the child to sleep in a single bed and room and, if possible, avoid close contact with other family members who may be developing upper respiratory tract infections. Thorough and frequent handwashing, especially after using the bathroom and before eating, is essential. A high-calorie, high-protein diet helps to rebuild white blood cells and should be encouraged. If possible, the child's exposure to large crowds and visitors should be limited because of the increased risk of infection from these individuals. Fresh flowers and plants should be avoided because they could harbor mold spores.

The nurse is caring for a teenager recently diagnosed with Addison disease. Which findings can be anticipated by the nurse? Select all that apply. A. Sodium level 128 mEq/L B. Potassium level 5.6 mEq/L C. Muscular weakness D. Rapid weight gain E. Facial acne

ANS: A, B, C Rationale: Hyponatermia, hyperkalemia and muscle weakness are all symptoms of Addison

A nurse is teaching the parents of a child diagnosed with attention-deficit/hyperactivity disorder about the condition. The nurse determines that the teaching was successful when the parents make which statements? Select all that apply. A: "We need to set clear limits for our child's behavior." B: "A reward system would be useful to give our child positive feedback." C: "We need to limit the number of choices our child has." D: "We need to give our child all directions at once in case the child gets distracted." E: "If the child acts out, we can explain that this is being bad."

ANS: A, B, C Rationale: The child with ADHD needs clear limits and a limited number of choices to prevent the child from becoming overwhelmed. Positive feedback is essential, such as with a reward or token system. Directions should be broken down into steps that are clear and short. Parents should avoid negative comments that label the child as bad.

The nurse is caring for a child admitted to the pediatric medical unit with chickenpox who has infected vesicles. What personal protective equipment should the nurse use when measuring the child's vital signs? A. Gloves B. Gown C. N95 respirator D. Face mask E. Eye wear

ANS: A, B, C Rationale: Transmission of chickenpox (Varicella zoster) occurs through direct contact with infected persons' nasopharyngeal secretions or via air-borne spread, to a lesser degree by contact with unscabbed lesions. Airborne and contact precautions (gloves, gown, N95 respirator) should be used with the hospitalized child for a minimum of 5 days after onset of rash and as long as vesicular lesions are present. A simple face mask is used for droplet precautions. Eye wear would only be necessary if splashing was likely.

A child comes to the clinic for evaluation of skin lesions and is diagnosed with impetigo. Which medications are potentially ordered with instructions placed on the discharge summary? Select all that apply. A. Penicillin B. Erythromycin C. Mupirocin D. Tetracycline E. Lindane

ANS: A, B, C Rationale: Treatment of impetigo includes oral administration of penicillin or erythromycin or the application of mupirocin. Tetracycline is not used. Lindane is used to treat tinea infections.

A 9-year-old girl has just been diagnosed with graves disease. Which symptom should the nurse expect in this child? Select all that apply. A. Exophthalmos (protruding eyes) B. Moist skin C. Nervousness D. Increased basal metabolic rate E. Obesity F. Lethargy

ANS: A, B, C, D Rationale: In Graves disease, children gradually experience nervousness, tremors, loss of muscle strength, and easy fatigue. Their basal metabolic rate, blood pressure, and pulse all increase. Their skin feels moist and they perspire freely. An exophthalmos-producing pituitary substance causes the prominent-appearing eyes that accompany hyperthyroidism in some children. Obesity and lethargy are symptoms of hypothyroidism, not of Graves disease (hyperthyroidism).

The nurse is performing a physical examination of a 5-year-old boy. Which documented findings would most strongly indicate maltreatment of the child? Select all that apply. A: Cuts and bruises on the hands B: Burns on the dorsal surface of the hand C. A curved laceration on the backD. Linear lesions across the chest and abdomen D. Linear lesions across the chest and abdomen E: A bruise on the child's knee D: A scab on the child's elbow

ANS: A, B, C, D Rationale: Several injuries in children clearly signal probable child maltreatment. Children who are maltreated have a higher incidence of hand injury. Children who are beaten with electrical cords, belts, or clotheslines have peculiar circular and linear lesions. Children who are beaten with a belt buckle may have additional curved lacerations from the imprint of the buckle; few other objects produce such contusions. When children burn their hand by accident, they usually burn the palm; burns from maltreatment are often on the dorsal surface. However, it is normal for preschoolers who actively play to have bruises on multiple bony spots (shin, elbows, knees, etc.).

A 6-month-old girl is seen with retinoblastoma. When taking a health history from her father, which symptom would you expect him to report he has noticed? A The infant always keeps her eyes tightly closed. B He has noticed one pupil appears white. C. His daughter tugs and pulls at one ear. D. His daughter's eye appears to be protruding.

ANS: B Rationale: As the tumor grows against the retina of the eye, the red reflex is no longer visible; the pupil appears white

During a routine well-child visit, the mother of a preadolescent patient asks the nurse to explain signs of sexual abuse. The mother is concerned because an older male neighbor has been making comments and overtly admiring the child when playing outdoors. What signs of sexual abuse should the nurse tell the mother to look out for? Select all that apply. A: Child reports abdominal pain. B: Child has a change in school performance. C: Child demonstrates anxiety or trouble sleeping. D: Child does not want to be left alone with a certain adult. E: Child spends a great deal of time with peer-group friends.

ANS: A, B, C, D Rationale: Signs of sexual maltreatment include vague reports of abdominal pain, a change in school performance, anxiety or trouble sleeping, and not wanting to be left alone with a certain adult. Spending time with peer-group friends is an expected preadolescent behavior and is not a sign of sexual maltreatment.

A nursing instructor teaching a class about immunity asks the students to identify the organs of the immune system. Which would the nursing instructor want them to include? (Select all that apply.) A. lymph nodes B. bone marrow C. thymus D. liver E. spleen F. tonsils

ANS: A, B, C, E, F Rationale: The organs of the immune system consist of the lymph nodes, bone marrow, thymus, spleen, and tonsils.

After an assessment, the nurse is concerned that a school-age child is at risk for developing a mental health disorder. Which assessment data will the nurse use to develop an appropriate plan care? Select all that apply. A: The parents recently divorced B: The father is unemployed and mother is infrequently home C: The child is learning to play the clarinet in music class in school D: The child is expected to care for younger siblings while mother sleeps E: There is history of multiple injuries obtained from a motor vehicle crash

ANS: A, B, D, E Rationale: Various factors have been associated with an increased risk for mental health disorders in children, including trauma, poverty or neglect, difficult temperament or attachment problems, medical illness, or major losses to the family such as divorce. Learning to play the clarinet in school has not been associated with an increased risk for mental health disorders in children.

The nurse is caring for a child who has been hospitalized for maltreatment. When reviewing the child's records which findings may have placed the child at an increased risk for abuse? Select all that apply. A: The child's mother has a history of substance use disorder. B: Both parents work outside of the home. C: The child was born prematurely. D: The child has cerebral palsy. E: The child's father is the primary care taker.

ANS: A, C, D Rationale: Although not every child abused or child abuser will fit a profile of characteristics, many will. Child abuse occurs across all socioeconomic levels, but the findings are more prevalent in those experiencing poverty. Additional risk factors include prematurity, chronic illnesses, parental substance use disorder, cerebral palsy and cognitive impairment. Parents working outside the home and paternal caregivers are not families facing increased risk for abuse.

A nurse is teaching parents of a child with a nursing diagnosis of pain related to pruritus from skin lesions. Which of the following would the nurse include in the instructions? Select all that apply. A. "Keep the child's fingernails short." B. "Wrap your child up snugly with blankets." C. "Bathe the child in lukewarm water and baking soda." D. "Have the child press on the itching area instead of scratching it." E. "Avoid having your child wear cotton clothing."

ANS: A, C, D Rationale: Measures to reduce pruritus include keeping the child's fingernails short to prevent injury from scratching; bathing the child in lukewarm water with oatmeal or baking soda; dressing the child in loose, light cotton clothing to prevent overheating and perspiration, which can intensify the itching; having the child press on the itching area rather than scratching it; and avoiding wool, which can irritate the skin and worsen the itching.

Which nursing diagnosis will the nurse select as appropriate for the child with atopic dermatitis? Select all that apply. A. Impaired skin integrity related to skin barrier function B. Delayed growth related to chronicity of immune disorder C. Ineffective breathing pattern related to allergic bronchospasm D. Anxiety related to continuing or uncontrolled allergic response E. Powerlessness related to difficulty determining cause of allergy

ANS: A, D, E Rationale: Atopic dermatitis (eczema) is a highly pruritic, chronic inflammatory skin disease. Nursing diagnoses should focus on impaired skin integrity, anxiety related to the allergic response, and powerlessness related to knowing cause of allergy. A nursing diagnosis of delayed growth is more appropriate for a child with HIV. A nursing diagnosis of ineffective breathing pattern is more appropriate for a child with asthma.

The nurse is reviewing the immunization schedule with the parent of a child who is HIV positive. What information should the nurse provide? Select all that apply. A: Pneumococcal vaccination can be given. B: The child should receive live vaccines only. C: The human papillomavirus vaccine should not be given. D: The varicella vaccine should not be given if the child is symptomatic. E: If the CD4 count is low, the measles, mumps, and rubella vaccine should not be given.

ANS: A, D, E Rationale: The nurse should emphasize that live vaccines should not be given to those infected with HIV. Children should receive routine immunizations according to the usual schedule with the killed virus vaccines, including pneumococcal and human papillomavirus vaccine. Symptomatic children should not receive the varicella vaccine, and those with low CD4 counts should not receive measles, mumps, and rubella vaccine.

A child receiving chemotherapy wants to have a large birthday party and invite all the classmates. When the parent asks the nurse about this, what is the nurse's best response? A. "That will be a good way to cheer your child up!" B. "It is better to avoid large groups right now." C. "What about taking your child to a movie instead?" D. "We can have the party here in the hospital play room."

ANS: B Rationale: A child receiving chemotherapy is particularly susceptible to contracting an infection and thus should be kept away from people with known infections. Therefore, having the child avoid large groups right now is best. Although it would possibly cheer up the client, it is not best for the client's health. Going to a movie would not be a good idea because it could lead to exposure to someone who is ill. A party in the hospital play room is a possibility for the children in the hospital, but it would not be possible to invite the child's entire class.

A 25-year-old client wants to know if her baby boy is at risk for Down syndrome because one of her distant relatives was born with it. Which information would the nurse share with the client while counseling her about Down syndrome? A. Instances of Down syndrome in the family greatly increases the risk for the baby also having Down syndrome. B. Children with Down syndrome have extra genetic material in the 21 chromosome that occurs during development of the sperm or egg. C. Down syndrome occurs only in females, and there is no risk as the baby is male. D. Children with Down syndrome are usually born to older mothers.

ANS: B Rationale: Down syndrome occurs because of the presence of an extra chromosome in the body that is in either the sperm or the egg. Down syndrome is not genetically inherited, except in incidences of translocation which are very rare. Both males and females are equally at risk for Down syndrome. Most children with Down syndrome are born to younger mothers.

The nurse has completed an education session with parents of children diagnosed with food allergies. Which statement by a parent would indicate a need for additional education? A. "I will make sure my daughter always has her EpiPen® with her all the time." B. "If we need to use the EpiPen® we will need to notify her physician's office the next business day." C. "I have found a website that makes medical alert bracelets in my daughter's favorite color." D. "The grey part of the EpiPen® should never be removed until right before we use it."V

ANS: B Rationale: If an EpiPen® is used, the child still needs immediate medical attention. EpiPens should be carried with the patient at all times. When administering an EpiPen, the grey safety cap should not be removed until immediately prior to using. Medical alert bracelets or necklaces should be worn by all children with severe allergies.

A 6-year-old is dealing with the death of a sibling. Which action should the nurse suggest to the family to best support the child with the grieving process? A. Having the child stay with a family friend instead of attending the funeral B. Assisting the child in drawing a picture to be placed in the sibling's casket C. Having the sibling stand in the receiving line with the parents at the funeral home D. Discouraging the child from interacting with family and friends while they express their sympathy

ANS: B Rationale: It is difficult for a 6-year-old child to understand the death of a sibling. Research supports having the presence of the sibling at the funeral and encouraging a token of love such as a drawing or note. Allowing the child to interact with others who provide comfort helps the child in this difficult time.

A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease? A. Measles B. Mumps C. Whooping cough D. Scabies

ANS: B Rationale: Mumps is an infectious disease with a primary symptom of a swollen parotid gland. It is a contagious disease spread by droplets. The child is contagious 1 to 7 days prior to the onset of the swelling and 4 to 9 days after the onset of the swelling. Pertussis is a respiratory disorder which causes severe paroxysmal coughing which produces a whooping sound. Measles is recognized by Koplick spots in the mouth and the classic maculopapular rash that starts on the head and spreads downward. Scabies is a skin condition where lice lay eggs under the skin. The rash is very puritic and is seen on the hands, feet, and folds of the skin.

A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? A. Restricting the child's visitors B. Placing a "no abdominal palpation" sign above the child's bed C. Ensuring that the child be allowed nothing by mouth D. Preparing the child for chemotherapy E. Preventing weight-bearing activities

ANS: B Rationale: Nephroblastoma (Wilms' tumor) metastasizes rapidly, so it is important that the child's abdomen not be palpated any more than necessary for diagnosis, because handling appears to aid metastasis. There is no need to restrict the child's visitors. Ensuring nothing by mouth would be appropriate prior to surgery. Preventing weight-bearing activities would be appropriate for a child with Ewing's sarcoma.

When providing support and education to the family of a child who is diagnosed with a serious genetic abnormality, what would be the priority? A. Assisting with scheduling follow-up visits B. Establishing a trusting relationship C. Teaching the family what to expect D. Using measures to promote growth and development

ANS: B Rationale: Regardless of the genetic abnormality, learning of a genetic abnormality may be shattering to the family. Therefore, the initial priority is to establish a trusting relationship. Once this is accomplished, other aspects of care, such as assisting with scheduling follow-up visits, teaching, and implementing measures to promote growth and development, can be addressed.

An adolescent client has just been diagnosed with systemic lupus erythematosus (SLE). Following client education about the disease, which statement by the client demonstrates understanding of SLE? A. "SLE is a rheumatic disease that mostly affects my joints." B. "SLE is an autoimmune disorder that I will always have, with times of flare- ups and times of minimal to no symptoms." C. "If my SLE has been found early enough in the disease process, there is a good chance that medication can cure it." D. "SLE only affects my skin. It seldom causes problems in any other organs."

ANS: B Rationale: SLE is a systemic autoimmune disease that can effect any organ system, including the skin. There is no cure for SLE, but with proper treatment and if the client cares for themselves properly, theNdiUseRaSseIcNanG-haTvEe SpeTriBoAdsNoKf.reCmOisMsion and fewer flare-ups.

The nurse is caring for a newborn diagnosed with an inborn error of metabolism with several referrals ordered. What referral would the nurse place as the priority for the infant? A. Spiritual advisor B. Dietitian C. Community support group D. Genetic counseling

ANS: B Rationale: The infant born with an inborn error of metabolism will have specific dietary guidelines, and the parents need to understand the dietary restrictions soon after birth to ensure the child is not harmed. The other referrals are important and should be addressed soon after birth.

The nurse is providing teaching about food substitutions when cooking for the child with an allergy to eggs. Which response indicates a need for further teaching? A: "I must not feed my child eggs in any form." B: "I can use the egg white when baking, but not the yolk." C: "1 tsp yeast and 1/4 cups warm water is a substitute in baked goods." D: "1.5 Tbsp each water and oil plus 1 tsp baking powder equals one egg in a recipe."

ANS: B Rationale: The parents must understand that their child cannot consume any part of an egg in any form. The other statements are accurate.

The nurse is evaluating outcomes for teaching provided to the mother of a school-age child with an itchy rash. Which outcome indicates that teaching has been effective? A. Mother applies hot compresses to itchy skin areas every few hours B. Child drinks a glass of water every 1 to 2 hours throughout the day C. Child showers in hot water and uses soap on the rash every morning D. Child wearing long denim pants and a long-sleeve shirt while playing outside

ANS: B Rationale: To relieve the itchiness of a rash, the child should be encouraged to have an adequate fluid intake to maintain good hydration because dry skin increases discomfort. Cold cloths or compresses applied to itchy areas are appropriate. Heat makes the itch worse. Baking soda should be used when bathing in lukewarm water. Hot water and harsh soap will irritate the rash. The child should be dressed in light cotton clothing so overheating and perspiration does not occur. Perspiration makes the itch worse. Denim pants and long-sleeved shirt would make the child very uncomfortable.

A young client is admitted to the hospital directly from the clinic. The physician suspects a problem with the child's immune system. What test does the nurse anticipate the physician will order for this client?A. Urine analysis B. Blood analysis C. EKG D. X-ray

ANS: B Rationale: When there is a deficiency of immunocompetent cells, an assessment will focus on analysis of blood components, particularly white blood cells.

A nurse is assessing a 5-year-old boy and suspects that the child may have an autism spectrum disorder. Which assessments would help support the nurse's suspicions? Select all that apply. A: Inability to make eye contact B: Hypersensitivity to touch C: Lack of facial expression D: Distinct interest in others around him E: Easily distracted from playing

ANS: B, C Rationale: Symptoms associated with autism spectrum disorder include deficits in nonverbal communicative behaviors such as abnormalities in eye contact and lack of facial expression and hyper- or hyposensitivity to sensory input such as touch. In addition, children, and stereotyped or repetitive motor movement, use of object or speech.

The child has a peanut allergy and accidentally ate food that contained peanuts. Which clinical manifestations of anaphylaxis should the nurse expect to find? Select all that apply. A: The child's pulse is 52 beats per minute. B: The child states that his tongue feels "too big" for his mouth. C: The child has developed hives on his face and trunk. D: The child states he feels like he might "throw up". E: The child states that he feels like he might faint.

ANS: B, C, D, E Rationale: The following are common signs and symptoms of anaphylaxis: tongue edema, urticaria, nausea, vomiting, and syncope. Typically, the child who has developed anaphylaxis will be tachycardic.

The nurse is preparing an educational program for members of the office staff. The topic is the warning signs of primary immunodeficiency. What information should be included? Select all apply. A. Two or more new episodes of acute otitis media in 1 year. B. Two or more episodes of severe sinusitis in 1 year. C. Failure to thrive in an infant. D. Two or more serious infections such as sepsis. E. History of infections requiring IV antibiotics to clear.

ANS: B, C, D, E Rationale: Warning signs of primary immunodeficiency include four, not two, or more new episodes of acute otitis media in 1 year. Other warning signs include failure to thrive in the infant, two or more episodes of severe sinusitis in 1 year, two or more serious infections such as sepsis and/or a history of infections requiring IV antibiotics to clear.

The nurse is instructing parents on how atopic disorders affect the child. For which disorder would the nurse provide information and counseling? Select all that apply. A. Serum sickness B. Allergic rhinitis C. Asthma D. Eczema E. Hay fever

ANS: B, C, D, E Rationale: Hay fever (or allergic rhinitis), asthma, and eczema (or atopic dermatitis) are classified as atopic disorders. Serum sickness is a type III hypersensitivity response of the body to a foreign serum antigen or drug.

The nurse is recording vital signs in the client diagnosed with complications of anorexia nervosa. Which findings are consistent with the condition? Select all that apply. A: Hyperthermia B: Orthostatic hypotension C: Weak pulse D: Hypertension E: Hypothermia

ANS: B, C, E Rationale: Anorexia nervosa is a condition most commonly seen in adolescents. In this condition the individual is obsessed with body weight. There is a noted loss of weight. The vital signs frequently display orthostatic hypotension, irregular and decreased pulse, or hypothermia.

A child is receiving chemotherapy and develops stomatitis. The nurse identifies a nursing diagnosis of impaired oral mucous membranes related to the effects of chemotherapy. What instructions would the nurse include in the child's plan of care? Select all that apply. A Vigorously rub the child's gums with gauze to clean them. B Provide various soft and bland foods to minimize further irritation. C Have the child rinse the mouth with lukewarm water three times a day. D Give the child acidic foods (e.g., orange juice) to cleanse the mouth. Apply a lip balm or petroleum jelly to prevent cracking.

ANS: B, C, E Rationale: For the child with stomatitis, the nurse should provide soft foods to prevent further abrasions, have the child rinse the mouth three times a day with lukewarm water to promote comfort and healing, avoid giving the child acidic foods that would further irritate the tissue, and apply a lip balm or petroleum jelly to prevent cracking of the lips. The nurse should offer a soft toothbrush to minimize discomfort.

The client has been prescribed antihistamines and a round of corticosteroids to treat an allergic reaction to an unknown food source. Which statement by the client indicates he understands the allergic condition and medication regimen? A. "The antihistamine will help the nasal swelling I am having." B. "Corticosteroids help the inflammation that goes along with an allergy." C. "I can stop taking my steroids as soon as I feel better in a couple of days." D. "I may have to undergo intradermal testing to determine what I am allergic to." E. "Once we figure out what I am allergic to, it is important for me to avoid that allergen."

ANS: B, D, E Rationale: Nasal swelling is seen with allergic rhinitis, not usually with a food allergy. The antihistamine is given to block histamine that is released when exposed to an allergen. It treats a rash or a hive that may occur with a food allergy. Corticosteroids help with inflammation cause by an allergic reaction, but they should always be tapered in order to prevent acute adrenal insufficiency. Skin testing to determine the allergan, then avoidance of the allergen is advised.

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which best describes a macule? A. Redness of the skin produced by congestion of the capillaries B. Small, circumscribed, solid elevation of the skin C. Discolored skin spot not elevated at the surface D. Small elevation of epidermis filled with a viscous fluid

ANS: C Rationale: A macule is a discolored skin spot not elevated above the surface.

A 16-year-old child suffering from alopecia related to chemotherapy treatment is refusing to let friends visit. Which action by the nurse is most appropriate? A Respect the child's wishes and document refusal B Have the parents explain the importance of letting friends visit C Provide opportunities for the child to discuss his or her body image changes D Allow friends to visit because socialization is important for adolescents

ANS: C Rationale: Being able to discuss body image changes is a pathway toward providing insight on adaptive measures to minimize the appearance of hair loss. The nurse should respect the child's wishes not to have visitors, but the nurse should recognize that this may be a result of altered body image.

An extremely thin preadolescent is being assessed by the nurse. Which clients statement should the nurse identify as being consistent with that of a person with anorexia nervosa? A: "I'd like to grow up to be a model." B: "I'd like to gain weight but just can't." C: "I feel chubby no matter what I wear." D: "I'm afraid that someone is poisoning my food."

ANS: C Rationale: Characteristics of a child with anorexia nervosa include a severely distorted body image with an intense fear of gaining weight or becoming fat. The goal to be a model is not consistent with that of anorexia nervosa. The inability to gain weight is not a characteristic of anorexia nervosa. The fear of food being poisoned is a characteristic of paranoid behavior.

What should be included in the teaching plan for a child with type 1 diabetes mellitus who is going home on insulin therapy? A. Children show an increased need for insulin during the first months after glucose control is established. B. Once glucose control is established, there will never be a need for an increase in the amount of insulin administered. C. It is absolutely normal for the growing child to require an increase in insulin; this does not mean his/her condition is getting worse. D. All children should be on at least two types of insulin to establish glucose control.

ANS: C Rationale: Children show a decreased need for insulin shortly after glucose control has been established, which is referred to by some as the "honeymoon phase" and should be described to parents so that they do not get any false hope that the child does not need insulin. As children grow, they will require increased doses of insulin to maintain glucose control, and not all children need to receive two types of insulin. Insulin treatment should be based on each individual child.

The nurse is caring for a 1-month-old girl with low-set ears and severe hypotonia who was diagnosed with trisomy 18. Which nursing diagnosis would the nurse identify as most likely? A. Interrupted family process related to the child's diagnosis B. Deficient knowledge deficit related to the genetic disorder C. Grieving related to the child's poor prognosis D. Ineffective coping related to stress of providing care

ANS: C Rationale: Grieving related to the child's prognosis is a diagnosis specific to this child's care. The prognosis for trisomy 18 is that the child will not survive beyond the first year of life. Ineffective coping related to the stress of providing care, deficient knowledge related to the genetic disorder, and interrupted family process due to the child's diagnosis could be appropriate for any family of a child with a genetic disorder.

The nurse realizes that the chemotherapy agents and radiation that a child is receiving are likely to irritate the bladder. What are the best measures that the nurse can take to diminish this risk? A Administer chemotherapy during sleep periods, including naps and overnight B Have the child wait to void until the bladder becomes full C Keep intravenous (IV) fluids running to maintain excellent hydration and frequent voids D Promote drinking of cranberry juice, making it an attractive oral fluid option

ANS: C Rationale: IV fluids are given before, during, and after radiation and chemotherapy drugs; bladder irritation results from the need to dilute and remove them from the body. This reduces the need for the child to drink large quantities. Administering the drug during sleep and having the child retain urine would cause irritating chemicals to be kept in contact with the bladder mucosa. No benefit is associated with providing cranberry juice.

The nurse is completing the physical assessment of a 12-year-old child who has a series of bruises in various stages of healing. When asked about the bruises the child appears frightened and offers inconsistent accounts about how the child got the bruises. The nurse suspectsabuse. Which initial action of the nurse is most appropriate? A: Take photographs of the bruises. B: Ask the child to provide a written statement of how he or she got the bruises. C: Document the bruises and any statements made by the child relating to them. D: Interview the child's parents about the origin of the bruises. E: Interview the child's parents about the origin of the bruises.

ANS: C Rationale: Nurses in each state have a legal requirement to report suspicions of child abuse or maltreatment. The nurse must document all findings. The medical record will be of importance in establishing the findings. Once the findings are documented, the nurse will need to closely follow the agency policies regarding the reporting process. The nursing supervisor will need to also be involved but that will take place after the documentation has been completed. The child cannot be photographed without appropriate approvals. The child may indeed be asked to provide a more detailed reporting of the bruising, but it is not the role of the nurse to request it. The child's parents will also become a part of the investigation but the interviewing process does not come before the documentation of the findings.

A nurse is assessing a child for the possible obsessive-compulsive disorder. Which question would be most helpful for obtaining information from the child? A. "Are you having any recurring dreams about the trauma you experienced?" B: "Has anything happened at home recently that has upset you?" C: "Is there anything that you do over and over again and can't resist doing?" D: "Do you have times when you wake up during the night without any reason?"

ANS: C Rationale: Obsessive-compulsive disorder is characterized by obsessions--unwanted, unrealistic, irrational recurring or persistent thoughts, impulses, or images beyond excessive worry and compulsions--repetitive behaviors, rituals, or mental acts. Thus, asking the child about doing anything over and over again would be more effective in obtaining additional information. Asking about recurring dreams related to a trauma might be appropriate for assessing posttraumatic stress disorder. Asking about home issues might help to shed light on possible separation anxiety. Asking about waking up at night without a reason provides information about sleep disorders.

A high-school football player has been diagnosed as having osteosarcoma of the femur. The parents are angry because they told the adolescent not to play football. Which health teaching points would the nurse include in the teaching plan for the adolescent and parents? A Osteosarcoma often follows trauma, such as a football injury. B You can expect some discoloration of the leg following chemotherapy. C Football injuries do not contribute to the development of a tumor. D Tumor growth is related to your dislike of milk.

ANS: C Rationale: Osteosarcoma is the most malignant form of bone cancer. It is caused from the embryonic mecenchymal tissue that forms in the bones. A football injury may predispose more scrutiny of a lesion but it will not be the cause of the cancer, nor will the dislike of milk. Osteosarcoma may be treated with chemotherapy and radiation. It may also involve an amputation. The parents who state they are angry at their adolescent for playing football is more likely projecting their fears of the diagnosis and the future for their adolescent.

A child with allergic rhinitis is prescribed a nasal antihistamine spray. When advising the parents about the use of the sprays, what should the nurse explain about the rebound phenomenon? A: It causes a permanent increase in nasal secretions. B: It causes reflux of gastric contents into the esophagus. C: It causes an increase in nasal secretions after an initial decrease. D: It causes a decrease in histamine release after an initial increase.

ANS: C Rationale: Review with the parents that if nasal antihistamine sprays are given for more than 3 days, a rebound effect can occur. The nasal mucosa becomes more edematous rather than less edematous, and symptoms will appear to worsen rather than improve. The rebound phenomenon does not cause a permanent increase in nasal secretions, reflux of gastric contents into the esophagus, or a decrease in histamine release after an initial increase.

The nurse is educating parents of a child admitted to the hospital with rubella (German measles). Which statement by the parents indicates the further education is needed? A. "Our child is contagious for 1 week after the rash appeared." B. "Acetaminophen or ibuprofen can be given to help with pain." C. "Antibiotics are needed to help our child recover from rubella." D. "Family members should wear a mask when coming to visit us."

ANS: C Rationale: Rubella (German measles) is caused by the rubella virus. Children will be contagious for 1 week before to approximately 1 week after the rash appears. Acetaminophen or ibuprofen can be given to help with pain or fever, and the child will be on droplet precautions (mask) while in the hospital.

For which child's behavior should the nurse identify as being characteristic of separation anxiety disorder? A: An 8-month-old who cries when left with strangers B: A 7-year-old who withdraws from contact with all strangers C: An 8-year-old who will not stay overnight at a friend's house D: A 10-year-old who reports headaches if there is to be a test in school

ANS: C Rationale: Separation anxiety is considered a disorder when an older child shows excessive anxiety about separation or the possibility of separation from parents. They experience acute distress and perhaps frequent nightmares bout separation and, when separated, show symptoms of nausea or vomiting or crying to such a degree it prevents them from visiting at friends' houses. For an 8-month-old, crying when being left with strangers is a normal behavior. A 7-year-old who withdraws from contact with strangers might have been instructed to do this as a form of safety or might be shy. A 10-year-old who reports headaches when a test is scheduled in school is demonstrating some other type of behavior. Separation anxiety would not occur just when a test is scheduled in school.

A child has been prescribed Stimate (esmopressin) acetate for the treatment of diabetes insipidus. The client and the parents ask the nurse how this drug works. What is the correct response by the nurse? A. Stimate (esmopressin) acetate works on your pancreas to stimulate insulin production B. Stimate (esmopressin) acetate is a synthetic form of insulin used to lower your blood sugar C. Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that will slow down your urine output D. Stimate (esmopressin) acetate works to help your kidneys work more efficiently

ANS: C Rationale: Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that promotes reabsorption of water by action on renal tubules; it is used to control diabetes insipidus by decreasing the amount of urine produced.

A 2-year-old client and the parents are at the office for a follow-up visit. The client has had excessive hormone levels in the recent blood work, and the parents question why this was not found sooner. Which response by the nurse would be most appropriate? A. "It takes time to determine the level of functioning of endocrine glands." B. "Have there been signs and symptoms that you should have reported to the doctor?" C. "As endocrine functions become more stable throughout childhood, alterations become more apparent." D. "Endocrine disorders are hard to detect and you are lucky that we have found it when we did."

ANS: C Rationale: The endocrine glands are all present at birth; however, endocrine functions are immature. As these functions mature and become stabilized during the childhood years, alterations in endocrine function become more apparent. Thus, endocrine disorders may arise at any time during childhood development.

A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse? A Tell the parent to administer acetaminophen every 4 hours until the fever dissipates. B Ask whether any family members or other close associates are ill. C Have the parent bring the child to the pediatric oncology clinic as soon as possible. D Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order.

ANS: C Rationale: The preschooler is considered immune suppressed following recent chemotherapy. A fever can mean sepsis, which would require immediate investigation of blood and other body fluids to identify the organism, plus prompt treatment with an IV antibiotic. This can be accomplished only by seeing the pediatric oncologist and is likely to result in hospitalization.

Which of the following women has the greatest risk of having a child with Down syndrome? A. 25-year-old B. 30-year-old C. 42-year-old D. 35-year-old

ANS: C Rationale: The risk of having a Down syndrome child increase with maternal age - it is 1 in 1250 at 25 years of age, 1 in 400 at 35 years, and 1 in 100 at 45 years of age.

The adoptive parents of a child who is 7 years old and HIV positive are concerned about telling their child about his condition. What information can be provided by the nurse? A. The child should not have information about their health provided at this age. B. Children at this age should have full disclosure of their condition. C. When providing health information to a child of this age it should be simplistic and at the child's level of understanding. D. Once a child is apprised of their health concerns they do not normally experience any after affects.

ANS: C Rationale: When a child has a chronic condition they often realize that they have special concerns even before they are fully able to understand them. Information should be provided that is developmentally appropriate. Excessive information and details should be limited. Children who have this type of information may experience problems anger, depression and difficulty in school.

A nurse assesses a client who is complaining of calf pain, has a temperature of 101°F (38.3°C) and reports that his leg is very sore. X-rays do not reveal any abnormalities but the client's white count is 21,000 cells and his erythrocyte sedimentation rate is elevated. What problem do these symptoms suggest? A. Muscular dystrophy B. Legg-Calves-Perth disease C. Osteomyelitis D. Compartment syndrome

C. Osteomyelitis

The nurse is caring for a pediatric client who has a compromised immune system. When reviewing laboratory results, which bone marrow component identifies a dysfunction in bone marrow production? Select all that apply. A. Macrophages B. Antigen C. T lymphocytes D. B lymphocytes E. Haptens

ANS: C, D Rationale: Bone marrow produces B lymphocytes and T lymphocytes. Macrophages are mature white blood cells involved with phagocytosis of an invading pathogen. Antigens are foreign substances capable of stimulating an immune response. Hapten formation occurs when a substance becomes antigenic when it combines with a higher weight molecule, usually a protein.

The nurse is examining a child with hypoparathyroidism. The nurse would expect to assess which signs and symptoms? Select all that apply. A. Capillary refill B. Polyphagia C. Chvostek D. Babinski E. Trousseau

ANS: C, E Rationale: A child with hypoparathyroidism would have a positive Chvostek or Trousseau sign, both of which indicate hypocalcemia. To test for the Chvostek sign, tap sharply over the facial nerve below the temple and anteriorly to the ear. The sign is positive when the mouth twitches (contraction of the lateral facial muscles). To check for the Trousseau sign, apply a blood pressure cuff to the child's upper arm. Inflate the cuff until the blood supply is occluded. If doing so causes carpal spasm (the fingers contract and the child is unable to open the hand), the Trousseau sign is positive. Capillary refill helps to evaluate tissue oxygenation. Polyphagia refers to excessive eating or hunger

The nurse is caring for a 12-month-old child diagnosed with an autism spectrum disorder. What information from the mother during the health history should the nurse identify as being consistent with the disorder? A: The child speaks in complete sentences. B: The child sleeps at least 12 out of every 24 hours. C: The child responds warmly to the father but not to the mother. D: The child constantly stares at a rotating wheel on the crib mobile.

ANS: D Rationale: A manifestation of an autism spectrum disorder is an abnormal response to sensory stimuli such as staring at a rotating wheel on the crib mobile. A child with an autism spectrum disorder will demonstrate repetitive words and failure to develop social relationships. The number of hours of sleep is not used to help identify an autism spectrum disorder.

19. The mother of a an 8-year-old boy with mumps tells the nurse that she does not understand how her son could have gotten mumps since he was immunized according to her physician's recommendations. What is the best response by the nurse? a. "I am sure it must be frustrating. Where did you have the immunizations performed?" b. "I am wondering if your physician followed the immunization schedule correctly?" c. "Are you sure your child received an immunization for mumps?" d. "While immunizations are highly effective they aren't 100% effective at preventing infectious diseases."

ANS: D Rationale: According to the CDC (2014d), one dose of MMR prevents 78% of cases and two doses prevent approximately 88% of cases. Questioning where the immunizations were given, if the immunization was given, and if the physician followed the guidelines correctly is accusatory and unlikely to be the cause of the child contracting the infection.

A nurse is conducting a physical examination of a 12-year-old girl with suspected systemic lupus erythematosus (SLE). How would the nurse best interview the girl? A: "Do you notice any wheezing when you breathe or a runny nose?" B: "Do you have any shoulder pain or abdominal tenderness?" C: "Have you noticed any new bruising or different color patterns on your skin?" D: "Have you noticed any hair loss or redness on your face?"

ANS: D Rationale: Alopecia and the characteristic malar rash (butterfly rash) on the face are common clinical manifestations of SLE. Rhinorrhea, wheezing, and an enlarged spleen are not hallmark manifestations of SLE. Petechiae and purpura are more commonly associated with hematological disorders, not SLE.

Parents usually ask when their child can return to school after having chickenpox. The correct answer would be: A. not until all lesions have completely faded. B. as soon as the temperature is normal. C. 10 days after the initial lesions appear. D. as soon as all lesions are crusted.

ANS: D Rationale: Chickenpox lesions are infectious until they crust.

The nurse is assessing a 30-month-old child during a routine well-child visit. Which statement by the parent would alert the nurse to further assess for a learning disorder? A: "My child seems to prefer playing with certain toys and will not play with other toys very much." B: "My child likes a certain type of food and does not want to try new foods very often." C: "My child gets restless when we go to a restaurant to eat and we have to wait for our food." D. "My child does not say more than one or two words and grunts to indicate needs."

ANS: D Rationale: Delayed language is often a first sign of an intellectual/learning disorder in a child. The nurse would expect the 30-month-old child to be a picky eater, prefer some toys over others and to be restless when required to sit for an extended period of time.

The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. Caring for a child who has issues with the anterior pituitary, the nurse would expect the child to have issues with which hormone? A. Vasopressin B. Antidiuretic hormone C. Oxytocin D. Growth hormone

ANS: D Rationale: Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adenohypophysis, is made up of endocrine glandular tissue and secretes growth hormone (GH), adrenocorticotropic hormone (ACTH), TSH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. The posterior lobe is called the neurohypophysis because it is formed of neural tissue. It secretes antidiuretic hormone (ADH; vasopressin) and oxytocin. Usually, several target organs are affected when there is a disorder of the pituitary gland, especially the adenohypophysis.

The nurse is educating the parents of a 6-year-old boy about his learning disorder. Which of the following facts would the nurse integrate into the discussion? A: Learning disorders indicate lower intelligence. B: Learning disorders are synonymous with learning deficits. C: The disorder requires comprehensive special education. D: The disorder is caused by a difference in brain architecture.

ANS: D Rationale: In most cases, the etiology of learning disorders is not known. However, it is believed that the brain architecture is different from that of children without a learning disorder. Children with a learning disability process information differently than children who respond to traditional teaching methods. The "wiring" or architecture of the brain differs from that of a child without a learning disorder, and the biochemical balance may differ as well. Learning disorders do not predict intelligence. They should not be considered deficits but rather different responses to information. Likewise, they can be limited to one area, allowing the child to excel in other areas.

The nurse is counseling a couple who suspect that they could bear a child with a genetic abnormality. What would be most important for the nurse to incorporate into the plan of care when working with this family? A. Gathering information from at least three generations B. Informing the family of the need for a wide range of information C. Maintaining the confidentiality of the information D. Presenting the information in a nondirective manner

ANS: D Rationale: It is essential to respect client autonomy and present information in a factual, nondirective manner. In these situations, the nurse needs to understand that the choice is the couple's to make. Gathering information for three generations obtains a broad overview of what has been seen in both sides of the family. Maintaining confidentiality of the information is as important as with any other client information gathered. Informing family of the need for information is necessary because of its personal nature.

The nurse is caring for a school-age child with varicella. What should the nurse observe about the rash that is associated with this infection? A.Dark red color B. Noticeable crusts but no pruritus C. Dark red, macular, very pruritic lesions D. Various stages of lesions present at the same time

ANS: D Rationale: Most of chickenpox lesions are found on the trunk, although the face, scalp, palate, and neck also may be involved. They appear in approximately three separate series or crops, with each new lesion moving through progressive stages. At some point, all four stages of lesions—macule, papule, vesicle, and crust—can be present. The lesions are not dark red in color. These lesions are very itchy.

17. A child is admitted to the pediatric medical unit with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). Based on the typical signs and symptoms of this disorder, which nursing diagnosis will the nurse identify as relating to this client? A. Delayed growth and development B. Imbalanced nutrition: More than body requirements C. Noncompliance D. Excess fluid volume

ANS: D Rationale: Syndrome of inappropriate antidiuretic hormone (SIADH) occurs when ADH (vasopressin) is secreted in the presence of low serum osmolality because the feedback mechanism that regulates ADH does not function properly. ADH continues to be released, and this leads to water retention, decreased serum sodium due to hemodilution, and extracellular fluid volume expansion; thus, Excess fluid volume from edema is the highest priority.

The nurse is educating a parent after the birth of a newborn who is diagnosed with phenylketonuria (PKU). Which parent statement indicates teaching has been effective? A. "I will supplement my breast milk with prescribed formula." B. "Once the baby is on solid foods, the dietary restriction will be gone." C. "The concern is the baby has an excess of a liver enzyme." D. "I will not breast feed the baby since breast milk contains phenylalanine."

ANS: D Rationale: The child will be on a low phenylalanine diet, which is found in breast milk and formula. The baby has a deficiency of the liver enzyme, not an excess. The baby will transition to solid food and still have dietary restrictions.

The nurse is providing teaching to the parents of a child with varicella. Which statement indicates that the parents have understood the instructions? A. "We should apply alcohol to the lesions every four hours." B. "If he has a fever, we can give him some aspirin." C. "The lesions should eventually form soft crusts that drain." D. "We need to make sure that he washes his hands frequently."

ANS: D Rationale: The child with varicella needs to wash his hands frequently with antibacterial soap to reduce bacterial colonization. A cool bath with soothing colloidal oatmeal may help the skin discomfort. Alcohol would be too drying to the skin. Acetaminophen, not aspirin, should be used to reduce fever. The lesions should eventually crust over. Soft crusts with drainage may suggest an infection.

The nurse is monitoring the CD4 count of an infant who has contracted HIV from the mother in utero. The nurse is concerned that treatment with antiretroviral therapy is not effective when noting which CD4 level? A. 1900/mm3 B. 1700/mm3 C. 1500/mm3 D. 1300/mm3

ANS: D Rationale: The number of CD4 T lymphocytes in the blood helps to determine the effectiveness of antiretroviral therapy. Normal is 1500/mm3 in the infant, so anything below that number may indicate that the therapy is not effective.

The parent of an infant born with trisomy 18 says to the nurse, "I am so lost...I can't even think about my baby not being healthy." How should the nurse respond? A. "I understand...we occasionally see clients with trisomy 18 and it is very sad." B. "This is a difficult time, but let's talk about the ways your baby will outgrow this." C. "I would encourage you to talk with the doctor about ways to cure this disorder." D. "This is a sad time for you. I will sit with you quietly in case you want to talk."

ANS: D Rationale: The prognosis is poor for children with trisomy 18 and therapeutic communication involves the nurse being available to offer support. The nurse shouldn't express understanding a parent's situation as each parent is unique and this response dismisses the parent's emotions. There is no cure and the child will not out grow the disorder, so the nurse shouldn't offer this as an option.

The nurse is caring for a child and notes periorbital edema on the left eye with urticaria. Which action by the nurse is priority? A. Administer a corticosteroid. B. Ask if the child has allergies. C. Evaluate fluid volume status. D. Assess lung sounds bilaterally.

ANS: D Rationale: When a child has signs of angioedema, the nurse's priority is to ensure the airway is patent, by assessing breathing sounds, because angioedema can cause laryngeal obstruction and asphyxiation. Evaluating fluid volume status, asking about allergies, and administering a corticosteroid are all actions that could be performed after first ensuring the child was breathing.

A nurse is teaching parents about erythema infectiosum and describing the progression of the disease from earliest to latest. Place the following manifestations in the order in which the nurse would describe them. A. Intense red rash on the face B. Rash on the flexor surfaces of extremities and trunk C. Rash on extremity extensor surfaces D. Fever and headache E. Lace-like lesion appearance

ANS: D, A, C, B, E Rationale: The first phase of the infection includes fever, headache, and malaise. A week later, a rash, which erupts in three stages, appears. The rash is intensely red and appears first on the face. The lesions are maculopapular and coalesce on the cheeks to form a "slapped face" appearance. The facial lesions fade in 1 to 120 days. A day after the facial lesions appear, a rash appears on the extensor surfaces of the extremities. One day later, the rash appears on the flexor surfaces and the trunk. These lesions last for 1 week or more. When they fade, they fade from the center outward, giving the lesions a lace-like appearance.

The nurse is comforting a family who were just informed by the health care provider that their baby will likely be born with a significant genetic abnormality. What actions by the nurse would be therapeutic? Select all that apply. A. Advise the parents to discuss their fears with only each other B. Discuss the nurse's personal beliefs regarding genetic abnormalities C. Encourage the family to ask questions after they have researched the disorder D. Refer the family to appropriate parent group or local family with similar needs E. Allow the family to discuss their emotions in an authentic and trusting environment

ANS: D, E Rationale: The nurse would encourage the family to discuss their emotions and fears in an authentic environment and in a trusting relationship as well as refer the to local parent groups or other families with a child with a similar need. The nurse would encourage family members to maintain open communication and ask questions rather than discourage this action. The nurse would avoid sharing personal beliefs, because this action is not therapeutic and may demonstrate personal biases and hinder a trusting relationship.

The mother of 2-month-old infant questions the nurse about autism. She reports a close family member has a child with this disorder and she is concerned about her child. What information can be provided to the child's mother? Select all that apply. A: "The cause of autism is largely considered to be related to immunizations administered in infancy." B: "Concerns are often noted as early as 3 to 6 months of age." C: "Once your child begins to speak it will be easier to make a determination." D: "In infancy, a lack of loving behaviors such as cuddling is concerning." E: "Infants who are on the autism spectrum may have difficulty establishing or maintaining eye contact."

ANS: D, E Rationale: The spectrum of autism disorder ranges from mild (e.g., Asperger syndrome) to severe. Autistic behaviors may be first noticed in infancy as developmental delays or between the age of 12 and 36 months when the child regresses or loses previously acquired skills. The exact etiology of autism continues to elude scientists, but it may be due to genetic makeup, brain abnormalities, altered chemistry, a virus, or toxic chemicals. Children with ASD display impaired social interactions and communication. They may fail to develop interpersonal relationships and experience social isolation.

The parents of a 1-year-old child with Down syndrome are at a follow-up clinic visit for their child. What information would the nurse review with the parents at this time? Select all that apply. A. Plan to have the child's vision and hearing tested at the age of 18 months B. The child should be consuming added calories now that he is growing more C. Dental visits should be scheduled yearly from this age to adolescence D. Cervical x-rays need to be scheduled for the next visit in 3 months E. Monitor for symptoms of respiratory infections and ear infections F. A thyroid test will be scheduled for this visit to monitor for high or low thyroid concerns

ANS: E, F Rationale: The nurse would encourage the parents to monitor the child for symptoms of respiratory and ear infections. Thyroid test should be done at 6 and 12 months of age and then yearly. The child should have routine hearing and vision testing already being completed by the age of 12 months. A regular diet is recommended for children with Down syndrome due to a risk of obesity not increased calories. Dental visits should be scheduled every 6 months. Cervical x-rays should be completed between 3 and 5 years of age.

The nurse is assessing an infant at a well-check visit. The infant's mother states that she is worried about her child's feet because they are so flat and wide. What the appropriate response by the nurse? A. "You don't need to worry about your child's feet. They will change as your child grows." B. "Your child's feet are normal for an infant. A child's longitudinal arch will not develop until the child is walking for several months." C. "Flat feet are normal in infants. Their longitudinal arch doesn't appear until they are 3 to 5 years old." D. "When your child starts walking, encourage walking on the heels. This will help to develop the arch more so your child doesn't have a problem with flat feet as an adult."

B. "Your child's feet are normal for an infant. A child's longitudinal arch will not develop until the child is walking for several months."

When performing physical assessments of children with musculoskeletal disorders, the nurse distinguishes normal variations in children's muscles versus adult muscles. Which of the following would be most important for the nurse to keep in mind? A. The infant's muscles account for 45% of total body weight as opposed to 25% of adult body weight. B. During adolescence, muscle growth is influenced by increased production of androgenic hormones. C. The young child has rigid soft tissue, so dislocations and sprains are common occurrences. D. Rapid bone and muscle growth in adolescents increase their agility, thereby decreasing the incidence of injuries.

B. During adolescence, muscle growth is influenced by increased production of androgenic hormones.

A school-age child with a supracondylar fracture of the humerus has been placed in a partial cast with the elbow region wrapped with an elastic bandage. What should the nurse explain to the parents and child regarding the reason for this type of casting approach? A. Encourages healing B. Ensures edema does not press on the nerves C. Keeps the bones of the forearm in alignment D. Provides additional stability until the bone heals

B. Ensures edema does not press on the nerves

Which nursing intervention is the priority for the immobilized child in an acute care setting? A. Ambulate the child up and down the hall twice a day. B. Offer age-appropriate toys and diversional activities. C. Take the child to the playroom at least once a day. D. Encourage active and passive range of motion exercises once a day.

B. Offer age-appropriate toys and diversional activities.

The child has been diagnosed with slipped capital femoral epiphysis. Which of the following characteristics about the patient is risk factor associated with the development of this condition? Select all that apply. A. The child is noted to be underweight by the nurse. B. The child is 13 years old. C. The child is African American. D. The child's parents state that the child has recently experienced a "growth spurt." E. The child is mal

B. The child is 13 years old. C. The child is African American. D. The child's parents state that the child has recently experienced a "growth spurt." E. The child is mal

The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education? A. "This medication will help to increase bone mineral density." B. "My child's risk for fractures will hopefully be decreased as by taking this medication." C. "This medication will cure my child of this disorder." D. "This medication doesn't prevent fractures from happening."

C. "This medication will cure my child of this disorder."

The nurse is assessing a toddler. The mother states that he constantly is tripping over his own feet. What is the best response by the nurse? A. "At this age, your child is still learning how to control all of the muscles in the legs. As your child grows older, this clumsiness will get better." B. "Tripping over feet is a symptom of a severe bone disorder, metatarsus adductus. We will need to refer you to an orthopedic surgeon." C. "We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet." D. "Turning in of feet or toeing in, is common at this age. As your child keeps walking, it will correct on its own."

C. "We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet."

A 3-year-old child is admitted to the hospital with osteomyelitis of the right femur. The nurse would expect to start an IV and antibiotic after blood is drawn for which lab test? A. Hemoglobin and hematocrit B. White blood cell count C. Culture D. Platelets

C. Culture

In the emergency room, the nurse is assessing a toddler who is currently being treated for a radius fracture and has a history of multiple fractures. The assessment reveals short stature, blue sclera, and no bruising or swelling at the fracture site. The nurse suspects: A. Child abuse. B. Attention deficit/hyperactivity disorder. C. Osteogenesis imperfecta. D. Lack of parental supervision.

C. Osteogenesis imperfecta.

The nurse receives a report from the admission department that a child with a slipped femoral epiphysis is en route to the care area. For which type of child should the nurse begin to plan care? A. Tall, thin female B. Preadolescent female C. Active school-age male D. Obese preadolescent male

D. Obese preadolescent male

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Chapter 33: Alterations in Cognitive and Mental Health, Chapter 29: Alterations in Integumentary Function, Chapter 27: Alterations in Musculoskeletal Function, Chapter 30: Alterations in Immune Function, Chapter 31: Alterations in Endocrine Function,...

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