exam 05 peds

Which type of seizure may be difficult to detect? a. Absence b. Generalized c. Simple partial d. Complex partial

ANS: A Absence seizures may go unrecognized because little change occurs in the childs behavior during the seizure. Generalized, simple partial, and complex partial seizures all have clinical manifestations that are observable.

Which problem is most often associated with myelomeningocele? a. Hydrocephalus b. Craniosynostosis c. Biliary atresia d. Esophageal atresia

ANS: A Hydrocephalus is an associated anomaly in 80% to 90% of children. Craniosynostosis is the premature closing of the cranial sutures and is not associated with myelomeningocele. Biliary and esophageal atresias are not associated with myelomeningocele.

A hospitalized child has been diagnosed with hyperthyroidism and has a calcium level of 6.8 mg/dL. Which action by the nurse takes priority? A. Administer calcium. B. Apply telemetry. C. Pad the side rails. D. Start an IV.

ANS: B All actions are appropriate for this child. However, hypocalcemia can cause fatal cardiac dysrhythmias, and the child needs to be placed on telemetry monitoring so the nurse can assess and intervene immediately if this occurs.

A nurse on an inpatient endocrine unit has received report on a group of four patients. Which patient should the nurse see first? A. Blood glucose of 78 mg/dL, 12-year-old child B. Had Humalog injection and is not eating C. Needs teaching on giving insulin injections D. NPH insulin given, waiting an hour to eat

ANS: B Humalog is a rapid-acting insulin, and a meal must be eaten within about 15 minutes of the injection, so the nurse needs to assess this patient first. The 12-year-olds blood sugar is normal, and if it gets lower the child is old enough to recognize hypoglycemia and call the nurse. NPH has an onset of action of 24 hours, so waiting an hour to eat will not cause a problem. The child who needs teaching will need an extended amount of time, so the nurse ensures all the other patients are stable prior to beginning the teaching session.

The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complications should the nurse monitor? a. Hypocalcemia b. Decreased metabolic rate c. Positive nitrogen balance d. Increased production of stress hormones

ANS: B Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake, leads to hypercalcemia, and causes a negative nitrogen balance secondary to muscle atrophy. A decreased production of stress hormones occurs with decreased physical and emotional coping capacity.

A nurse is caring for several patients with acute lymphocytic leukemia (ALL). Which children does the nurse understand have the best prognosis? A. Infant B. < 10 years of age C. > 25% abnormal cells in bone marrow aspirate D. White count 4,200/mm3 E. White count 25,000/mm3

ANS: B, D The best prognosis for ALL occurs in children 2 to 9 years of age and in children whose initial white blood cell count is < 5,000/mm3. Children 10 and older and whose initial white blood cell counts are ?= 50,000/mm3 have worse prognoses. Infants have a very poor prognosis.

The nurse is providing care to a pediatric patient admitted for a workup of bone deformity. The latest laboratory values indicate calcium at 6.6 mg/dL and phosphorus at 2.1 mg/dL. Which condition does the nurse correlate with these values? A. Muscular dystrophy B. Osgood-Schlatter disease C. Rickets D. Scoliosis

ANS: C Normal calcium is 8.511 mg/dL, and normal phosphorus is 34.5 mg/dL. Low values for both are seen in rickets.

Which immunization should not be given to a child receiving chemotherapy for cancer? a. Tetanus vaccine c. Diphtheria, pertussis, tetanus (DPT) b. Inactivated poliovirus vaccine d. Measles, rubella, mumps

ANS: D The vaccine used for measles, mumps, and rubella is a live virus and can result in an overwhelming infection. Tetanus vaccine, inactivated poliovirus vaccine, and DPT are not live virus vaccines.

What is characteristic of the immune-mediated type 1 diabetes mellitus? a. Ketoacidosis is infrequent. b. Onset is gradual. c. Age at onset is usually younger than 18 years. d. Oral agents are often effective for treatment.

NS: C The immune-mediated type 1 diabetes mellitus typically has its onset in children or young adults. Peak incidence is between the ages of 10 and 15 years. Infrequent ketoacidosis, gradual onset, and treatment with oral agents are more consistent with type 2 diabetes.

A nurse is caring for an 8-year-old child hospitalized 2 days after open reduction and internal fixation (ORIF) of a femur fracture sustained in a motor vehicle crash. The child is now in a long-leg cast. Which assessment finding prompts the nurse to notify the health-care provider? A. A foul odor coming from the cast B. Child eating only 20% of meals C. Old dried drainage marked on the cast D. Request for pain medicine every 4 hours

ANS: A A foul odor coming from the cast may indicate an infection at the surgical site or at the fracture site. The nurse should notify the health-care provider. Loss of appetite may be from several causes: fatigue, stress, side effect of medications, dislike of hospital food, loss of industry (child is in Eriksons stage of industry vs. inferiority), trying to regain some control, pain, or fear of pain. The nurse needs to assess this situation further to determine the cause of this issue. Old drainage would not be worrisome; if the drainage continues to increase, the nurse should notify the health-care provider. At 2 days since surgery, wanting pain medication every 4 hours is not unreasonable.

Which clinical manifestations would suggest hydrocephalus in a neonate? a. Bulging fontanel and dilated scalp veins b. Closed fontanel and high-pitched cry c. Constant low-pitched cry and restlessness d. Depressed fontanel and decreased blood pressure

ANS: A Bulging fontanel, dilated scalp veins, and separated sutures are clinical manifestations of hydrocephalus in neonates. Closed fontanel and high-pitched cry, constant low-pitched cry and restlessness, and depressed fontanel and decreased blood pressure are not clinical manifestations of hydrocephalus, but all should be referred for evaluation.

Therapeutic management of nephrosis includes: a. Corticosteroids. b. Antihypertensive agents. c. Long-term diuretics. d. Increased fluids to promote diuresis.

ANS: A Corticosteroids are the first line of therapy for nephrosis. Response is usually seen within 7 to 21 days. Antihypertensive agents and long-term diuretic therapy are usually not necessary. A diet that has fluid and salt restrictions may be indicated.

Which drug would be used to treat a child who has increased intracranial pressure (ICP) resulting from cerebral edema? a. Mannitol c. Atropine sulfate b. Epinephrine hydrochloride d. Sodium bicarbonate

ANS: A For increased ICP, mannitol, an osmotic diuretic, administered intravenously, is the drug used most frequently for rapid reduction. Epinephrine, atropine sulfate, and sodium bicarbonate are not used to decrease ICP.

An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma. The nurses approach should include: a. Answering questions with straightforward honesty. b. Avoiding discussing the seriousness of the condition. c. Explaining that, although the amputation is difficult, it will cure the cancer. d. Assisting the adolescent in accepting the amputation as better than a long course of chemotherapy.

ANS: A Honesty is essential to gain the cooperation and trust of the child. The diagnosis of cancer should not be disguised with falsehoods. The adolescent should be prepared in advance for the surgery so that there is time for reflection about the diagnosis and subsequent treatment. This allows questions to be answered. To accept the need for radical surgery, the child must be aware of the lack of alternatives for treatment. Amputation is necessary, but it will not guarantee a cure. Chemotherapy is an integral part of the therapy with surgery. The child should be informed of the need for chemotherapy and its side effects before surgery.

Spastic cerebral palsy is characterized by: a. Hypertonicity and poor control of posture, balance, and coordinated motion. b. Athetosis and dystonic movements. c. Wide-based gait and poor performance of rapid, repetitive movements. d. Tremors and lack of active movement.

ANS: A Hypertonicity and poor control of posture, balance, and coordinated motion are part of the classification of spastic cerebral palsy. Athetosis and dystonic movements are part of the classification of dyskinetic/athetoid cerebral palsy. Wide-based gait and poor performance of rapid, repetitive movements are part of the classification of ataxic cerebral palsy. Tremors and lack of active movement may indicate other neurologic disorders.

The most common problem of children born with a myelomeningocele is: a. Neurogenic bladder. b. Intellectual impairment. c. Respiratory compromise. d. Cranioschisis.

ANS: A Myelomeningocele is one of the most common causes of neuropathic (neurogenic) bladder dysfunction among children. Risk of intellectual impairment is minimized through early intervention and management of hydrocephalus. Respiratory compromise is not a common problem in myelomeningocele. Cranioschisis is a skull defect through which various tissues protrude. It is not associated with myelomeningocele.

A child is in the clinic for follow-up after starting recombinant growth hormone for growth hormone deficiency. After obtaining the childs height, which assessment is the priority? A. Blood pressure B. Bowel function C. Respiratory effort D. Urinary osmolality

ANS: A One of the side effects of human growth hormone administration is hypertension. The nurse should assess the childs blood pressure. Bowel function, respiratory effort, and urine osmolality are not affected.

A parent calls the clinic to report that his childs cast seems to be looser than it was yesterday. Which instruction is most appropriate for the nurse to provide to the parent? A. Bring your child in so we can evaluate the cast. B. If the cast is loose, circulation wont be compromised. C. Pad the top of the cast with a small towel so it fits. D. This is not unusual; just keep your next appointment.

ANS: A Parents should be instructed to take their child to a health-care provider if a cast appears loose, damaged, or soft. The other answers are not appropriate.

The priority nursing intervention when a child is unconscious after a fall is to: a. Establish an adequate airway. b. Perform neurologic assessment. c. Monitor intercranial pressure. d. Determine whether a neck injury is present.

ANS: A Respiratory effectiveness is the primary concern in the care of the unconscious child. Establishing an adequate airway is always the first priority. A neurologic assessment and determination of neck injury are performed after breathing and circulation are stabilized. Intracranial, not intercranial, pressure is monitored if indicated after airway, breathing, and circulation are maintained.

An adolescent boy is brought to the emergency department after a motorcycle accident. His respirations are deep, periodic, and gasping. There are extreme fluctuations in blood pressure. Pupils are dilated and fixed. What type of head injury should the nurse suspect? a. Brainstem b. Skull fracture c. Subdural hemorrhage d. Epidural hemorrhage

ANS: A Signs of brainstem injury include deep, rapid, periodic or intermittent, and gasping respirations. Wide fluctuations or noticeable slowing of the pulse, widening pulse pressure, or extreme fluctuations in blood pressure are consistent with a brainstem injury. Skull fracture and subdural and epidural hemorrhages are not consistent with these signs.

The nurse is conducting an assessment on a school-age child with urosepsis. Which assessment finding should the nurse expect? a. Fever with a positive blood culture c. Oliguria and hypertension b. Proteinuria and edema d. Anemia and thrombocytopenia

ANS: A Symptoms of urosepsis include a febrile urinary tract infection coexisting with systemic signs of bacterial illness; blood culture reveals the presence of a urinary pathogen. Proteinuria and edema are symptoms of minimal change nephrotic syndrome. Oliguria and hypertension are symptoms of acute glomerulonephritis. Anemia and thrombocytopenia are symptoms of hemolytic uremic syndrome.

Which information does the nurse provide the teen with type 2 diabetes mellitus regarding exercise? A. Aim for physical activity each day. B. Continue to exercise when sick. C. Exercise with caution, if at all. D. You need strenuous activity.

ANS: A The American Diabetes Association has a goal of 3060 minutes of physical activity a day. When ill, the diabetic should rest. Strenuous activity is not required.

Four-year-old David is placed in Bucks extension traction for Legg-Calv-Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. What should the nurse do first? a. Notify the practitioner of the changes noted. b. Give the child medication to relieve the pain. c. Reposition the child and notify the physician. d. Chart the observations and check the extremity again in 15 minutes.

ANS: A The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner. Pain medication should be given after the practitioner is notified. This is an emergency condition; immediate reporting is indicated. The findings should be documented with ongoing assessment.

A toddler fell out of a second-story window. She had brief loss of consciousness and vomited four times. Since admission, she has been alert and oriented. Her mother asks why a computed tomography (CT) scan is required when she seems fine. The nurse should explain that the toddler: a. May have a brain injury. c. May start having seizures. b. Needs this because of her age. d. Probably has a skull fracture.

ANS: A The childs history of the fall, brief loss of consciousness, and vomiting four times necessitate evaluation of a potential brain injury. The severity of a head injury may not be apparent on clinical examination but will be detectable on a CT scan. The need for the CT scan is related to the injury and symptoms, not the childs age, and is necessary to determine whether a brain injury has occurred.

The primary clinical manifestations of acute renal failure are: a. Oliguria and hypertension. c. Proteinuria and muscle cramps. b. Hematuria and pallor. d. Bacteriuria and facial edema.

ANS: A The principal feature of acute renal failure is oliguria. Hematuria and pallor, proteinuria and muscle cramps, and bacteriuria and facial edema are not principal features of acute renal failure.

A 5-year-old child is 3 hours postoperative after a total thyroidectomy. The nurse notes hand spasms as the blood pressure cuff is inflated, and the child reports numbness around her lips. After notifying the health-care provider, which action by the nurse takes priority? A. Bring the crash cart to the room. B. Call the laboratory to have blood work drawn. C. Prepare to administer oral vitamin D. D. Raise the head of the childs bed.

ANS: A This child is demonstrating manifestations of critical hypocalcemia, a known complication of thyroid surgery. The nurse ensures emergency equipment is available, as the child may progress to laryngospasm and be unable to breathe. Alternatively, the nurse stays with the patient while a coworker brings the crash cart. Blood work will be done but is not the priority. In a child with a potential airway problem developing, oral meds and nutrition are not given. Raising the head of the bed may help with comfort, but it is not the priority.

A child being treated for hyperthyroidism has been admitted following a seizure. Once the child has been stabilized, which action by the nurse is the most appropriate? A. Assess the child for noncompliance. B. Determine childs nutritional intake. C. Refer the family to a social worker. D. Teach the parents how to treat seizures.

ANS: A Untreated hyperthyroidism leads to low calcium, high phosphate, and low magnesium levels. Seizures can occur due to these imbalances. The nurse should assess the child and family for noncompliance. The other actions may be appropriate, but this is the priority to prevent further problems from occurring.

An important nursing intervention when caring for a child who is experiencing a seizure is to: a. Describe and record the seizure activity observed. b. Restrain the child when seizure occurs to prevent bodily harm. c. Place a tongue blade between the teeth if they become clenched. d. Suction the child during a seizure to prevent aspiration.

ANS: A When a child is having a seizure, the priority nursing care is observation of the child and seizure. The nurse then describes and records the seizure activity. The child should not be restrained, and nothing should be placed in his or her mouth. This may cause injury. To prevent aspiration, if possible, the child should be placed on his or her side, facilitating drainage.

A student is learning about the process of hematopoiesis and how it is affected by leukemia. Which information does the student discover? (Select all that apply.) A. Blast cells multiply faster than mature cells. B. Leukemia disrupts normal hematopoiesis. C. Lymphoid cells differentiate into B and T cells. D. Myeloid cells crowd out normal cells in bone marrow. E. Pancytopenia occurs from proliferation of mast cells.

ANS: A, B, C Blast, or immature, cells have an increased rate of proliferation and multiply at the expense of normal cells. Leukemia does disrupt normal hematopoiesis (production and development of blood cells). Lymphoid cells differentiate into B and T cells. Myeloid cells differentiate into red blood cells, monocytes, granulocytes, and platelets; they do not reproduce and crowd out normal cells in the marrow. Pancytopenia occurs when large numbers of blast cells reproduce and crowd out normal marrow components.

The nurse in the neonatal intensive care unit is caring for an infant with myelomeningocele scheduled for surgical repair in the morning. Which early signs of infection should the nurse monitor on this infant (Select all that apply)? a. Temperature instability b. Irritability c. Lethargy d. Bradycardia e. Hypertension

ANS: A, B, C The nurse should observe an infant with unrepaired myelomeningocele for early signs of infection, such as temperature instability (axillary), irritability, and lethargy. Bradycardia and hypertension are not early signs of infection in infants.

The pediatric nurse caring for a 3-year-old child with cerebral palsy (CP) prepares a home care teaching plan for the caregivers on discharge. Which items will the nurse include in the teaching plan? (Select all that apply.) A. Apply splints and braces to facilitate muscle control. B. Buy toys that are appropriate for the childs abilities. C. Encourage the child to perform self-care tasks. D. Ensure the clothing has buttons to stimulate dexterity. E. Use skeletal muscle relaxants for short-term control.

ANS: A, B, C, D The child with CP has some degree of muscular dysfunction. The nurse encourages the child to perform self-care tasks. The child may exhibit muscular hypotonia (low tension) or hypertonia (high tension). Splints and braces may be necessary to facilitate muscle control and to improve body functioning. Clothing should be easy to manipulate. Skeletal muscle relaxants may be used for short-term control with older children and adolescents.

The staff nurse is educating nursing students on the long-term effects of childhood chemotherapy. Which problems does the nurse include in the educational session? (Select all that apply.) a. Cardiac dysfunction b. Hearing loss c. Increased risk of multiple-gestation pregnancies d. Learning disabilities e. Peripheral neuropathy

ANS: A, B, D, E The list of long-term effects of chemotherapy is lengthy and includes cardiac dysfunction, hearing loss, learning disabilities, and peripheral neuropathy, among others. Sterility, not an increased risk for multiple- gestation pregnancies, is also an effect.

9. The nurse is teaching parents about the importance of good nutrition for their child who has cancer. Which components does the nurse include as important for this childs diet? (Select all that apply.) a. High calories b. High carbohydrates c. High vitamins d. Low minerals e. Low protein

ANS: A, C The child with cancer needs optimal nutrition, including a diet high in calories, fatty acids, vitamins, protein, and minerals.

A nurse assesses an infant for signs of increased intracranial pressure. Which signs would lead the nurse to notify the rapid response team? (Select all that apply.) A. Bulging fontanels B. Change in LOC C. Irregular respirations D. Posturing E. Seizures

ANS: A, C, D Bulging fontanels, irregular respirations, and posturing are among the late signs of increased intracranial pressure and would lead the nurse to intervene quickly by notifying the health-care provider or by activating the rapid response team. The other signs are early indicators of increased intracranial pressure.

A nurse should expect which cerebrospinal fluid (CSF) laboratory results on a child diagnosed with bacterial meningitis (Select all that apply)? a. Elevated white blood cell (WBC) count b. Decreased protein c. Decreased glucose d. Cloudy in color e. Increase in red blood cells (RBCs)

ANS: A, C, D The CSF laboratory results for bacterial meningitis include elevated WBC counts, cloudy or milky in color, and decreased glucose. The protein is elevated and there should be no RBCs present. RBCs are present when the tap was traumatic.

A nurse is teaching a new diabetic child and family about sick-day management. What information does the nurse plan to include? (Select all that apply.) A. Check blood sugars every 4 hours. B. Hold insulin if the child is vomiting. C. Provide plenty of rest and sleep. D. Offer calorie-containing liquids. E. Try to follow the usual meal plan.

ANS: A, C, D, E Sick-day rules are important to prevent diabetic ketoacidosis (DKA). The child should take the normal dose of medication (the liver continues to produce glucose even when not eating) while trying to follow the meal plan. If solids are not tolerated, then offer liquids that contain calories. Check blood sugars every 4 hours while the child is ill, and check ketones with each instance of voiding. Be sure to notify the physician for any concerns.

The nurse is providing care to a pediatric patient who suffered an ankle sprain. Which interventions are appropriate to include in the patients plan of care? (Select all that apply.) A. Apply an Ace wrap to apply pressure and reduce swelling of the joint. B. Apply heat to the extremity for the first 48 hours at 15-minute intervals. C. Elevate and move the affected joint to reduce swelling and stiffness. D. Immediately perform range-of-motion exercises on the extremity. E. Place ice on the injury for 15 minutes at a time for the first 1 to 2 days.

ANS: A, C, E The nurse should teach the RICE acronym: Rest the injured extremity to prevent further injury and allow the ligament to heal; ice for the first 48 hours, keeping ice packs in place for 15-minute intervals to decrease swelling; compression with an Ace wrap or some other method to apply pressure to the affected joint to help reduce swelling of the joint; and elevation and early motion of the affected joint (elevation reduces swelling; early motion of the affected joint helps maintain full range of motion).

The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestations would be observed (Select all that apply)? a. Vomiting b. Jaundice c. Failure to gain weight d. Swelling of the face e. Back pain f. Persistent diaper rash

ANS: A, C, F Vomiting, failure to gain weight, and persistent diaper rash are clinical manifestations observed in an infant with a urinary tract infection. Jaundice, swelling of the face, and back pain would not be observed in an infant with a urinary tract infection.

An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which interventions should be included in the childs postoperative care (Select all that apply)? a. Observe closely for signs of infection. b. Pump the shunt reservoir to maintain patency. c. Administer sedation to decrease irritability. d. Maintain Trendelenburg position to decrease pressure on the shunt. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention.

ANS: A, E, F Infection is a major complication of ventriculoperitoneal shunts. Observation for signs of infection is a priority nursing intervention. Intake and output should be measured carefully. Abdominal distention could be a sign of peritonitis or a postoperative ileus. Pumping the shunt reservoir, administering sedation, and maintaining Trendelenburg position are not interventions associated with this condition.

An advantage to using a fiberglass cast instead of a plaster cast is that a fiberglass cast: a. Is less expensive. b. Dries rapidly. c. Molds closely to body parts. d. Has a smooth exterior.

ANS: B A synthetic casting material dries in 5 to 30 minutes as compared with a plaster cast, which takes 10 to 72 hours to dry. Synthetic casts are more expensive. Plaster casts mold closer to body parts. Synthetic casts have a rough exterior, which may scratch surfaces.

A young child with human immunodeficiency virus is receiving several antiretroviral drugs. The purpose of these drugs is to: a. Cure the disease. b. Delay disease progression. c. Prevent spread of disease. d. Treat Pneumocystis jiroveci pneumonia.

ANS: B Although not a cure, these antiviral drugs can suppress viral replication, preventing further deterioration of the immune system, and delay disease progression. At this time cure is not possible. These drugs do not prevent the spread of the disease. Pneumocystis jiroveci prophylaxis is accomplished with antibiotics

A child is admitted and is scheduled to receive intravenous asparginase (Elspar). Which action by the nurse is most important when administering this medication? a. Arranging an outpatient hearing test b. Having emergency drugs on hand c. Monitoring the childs intake and output d. Providing anti-emetic drugs as needed

ANS: B Anaphylaxis is a possible side effect of this drug. Emergency medications should be readily available. Ototoxicity can be caused by carboplatin (Paraplatin). Monitoring intake and output is important for any child on IV therapy. Anti-emetic drugs are important for any child receiving chemotherapy.

The nurse is caring for an infant with myelomeningocele scheduled for surgical closure in the morning. Which interventions should the nurse plan for the care of the myelomeningocele sac? a. Open to air b. Covered with a sterile, moist, nonadherent dressing c. Reinforcement of the original dressing if drainage noted d. A diaper secured over the dressing

ANS: B Before surgical closure, the myelomeningocele is prevented from drying by the application of a sterile, moist, nonadherent dressing over the defect. The moistening solution is usually sterile normal saline. Dressings are changed frequently (every 2 to 4 hours), and the sac is closely inspected for leaks, abrasions, irritation, and any signs of infection. The sac must be carefully cleansed if it becomes soiled or contaminated. The original dressing would not be reinforced but changed as needed. A diaper is not placed over the dressing because stool contamination can occur.

Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell off of a tree. When discussing this injury with her parents, the nurse should consider which statement? a. Healing is usually delayed in this type of fracture. b. Growth can be affected by this type of fracture. c. This is an unusual fracture site in young children. d. This type of fracture is inconsistent with a fall.

ANS: B Detection of epiphyseal injuries is sometimes difficult, but fractures involving the epiphysis or epiphyseal plate present special problems in determining whether bone growth will be affected. Healing of epiphyseal injuries is usually prompt. The epiphysis is the weakest point of the long bones. This is a frequent site of damage during trauma.

An adolescent is being seen in the clinic for evaluation of acromegaly. The nurse understands that which occurs with acromegaly? a. There is a lack of growth hormone (GH) being produced. b. There is excess GH after closure of the epiphyseal plates. c. There is an excess of GH before the closure of the epiphyseal plates. d. There is a lack of thyroid hormone being produced.

ANS: B Excess GH after closure of the epiphyseal plates results in acromegaly. A lack of growth hormone results in delayed growth or even dwarfism. Gigantism occurs when there is hypersecretion of GH before the closure of the epiphyseal plates. Cretinism is associated with hypothyroidism.

A nurse is teaching the parents of a child with growth hormone deficiency about medication administration. Which action charted by the nurse indicates that the goals for teaching have been met? A. Administers growth hormone using correct intramuscular technique B. Administers growth hormone using correct subcutaneous technique C. Demonstrates ability to properly mix growth hormone with liquids D. Rinses inhaler with warm water after each dose is administered

ANS: B Growth hormone is administered via subcutaneous injections. It is not given orally, intramuscularly, or by inhalation.

A nurse admits a 5-year-old child with bacterial meningitis to the pediatric intensive care unit. Which information obtained by the nurse during the intake history is most helpful for the nurse to document? A. Fell off swing hitting head 2 months ago B. History of recent sinus infection C. Mother with history of herpes simplex D. Sibling with upper respiratory infection

ANS: B In a child this age, common causes of bacterial meningitis include septicemia, surgical procedures involving the CNS, penetrating wounds, otitis media, sinusitis, cellulitis of the scalp or face, dental cavities, pharyngitis, and orthopedic diseases. Blunt trauma from falling off a swing and a sibling with a URI are noncontributory. Herpes simplex is an important cause of neonatal viral meningitis.

The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. The most appropriate way to position and feed this neonate is to place him: a. Prone and tube feed. b. Prone, turn head to side, and nipple feed. c. Supine in infant carrier and nipple feed. d. Supine, with defect supported with rolled blankets, and nipple feed.

ANS: B In the prone position, feeding is a problem. The infants head is turned to one side for feeding. If the child is able to nipple feed, no indication is present for tube feeding. Before surgery, the infant is kept in the prone position to minimize tension on the sac and risk of trauma.

A 6-week-old baby is brought to the clinic for a follow-up visit after having surgical repair of a myelomeningocele. His head circumference was 33 cm (12 inches) at birth. Now the nurse assesses his head circumference at 36 cm (14.1 inches). What action by the nurse is most appropriate? A. Assess the child for signs of hydrocephalus. B. Document the measurement in the childs chart. C. Educate the parents on possible shunt placement. D. Inquire about signs of increased intracranial pressure.

ANS: B Increasing head circumference is a sign of possible hydrocephalus. The average head circumference of an infant at birth is 3338 cm (1214 inches) and increases by 2 cm/month (0.75 inches/month). This childs head circumference is normal and the nurse should document the information; no other actions are needed.

The pediatric nurse caring for patients in a trauma center examines a patient who has increased intracranial pressure as a result of a motor vehicle crash. The nurse is aware that secondary brain injuries can result from which factor? A. Acidosis B. Ischemia C. Infections D. Reduced oxygen

ANS: B Primary brain injury is irreversible, immediate, and can result from traumatic injuries (e.g., a blow to the head) or nontraumatic injuries (e.g., a tumor or infection). Secondary brain injuries include ischemia from hypoxia, hypercapnia, hypotension, acidosis, and reduced oxygen delivery.

The diet of a child with nephrosis usually includes: a. High protein. b. Salt restriction. c. Low fat. d. High carbohydrate.

ANS: B Salt is usually restricted (but not eliminated) during the edema phase. The child has very little appetite during the acute phase. Favorite foods are provided (with the exception of high-salt ones) in an attempt to provide nutritionally complete meals.

Which term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation? a. Coma b. Stupor c. Obtundation d. Persistent vegetative state

ANS: B Stupor exists when the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Coma is the state in which no motor or verbal response occurs to noxious (painful) stimuli. Obtundation describes a level of consciousness in which the child can be aroused with stimulation. Persistent vegetative state describes the permanent loss of function of the cerebral cortex.

The Glasgow Coma Scale consists of an assessment of: a. Pupil reactivity and motor response. b. Eye opening and verbal and motor responses. c. Level of consciousness and verbal response. d. Intracranial pressure (ICP) and level of consciousness

ANS: B The Glasgow Coma Scale assesses eye opening and verbal and motor responses. Pupil reactivity is not a part of the Glasgow Coma Scale but is included in the pediatric coma scale. Level of consciousness and ICP are not part of the Glasgow Coma Scale.

Which immunization should be given with caution to children infected with human immunodeficiency virus? a. Influenza b. Varicella c. Pneumococcus d. Inactivated poliovirus

ANS: B The children should be carefully evaluated before giving live viral vaccines such as varicella, measles, mumps, and rubella. The child must be immunocompetent and not have contact with other severely immunocompromised individuals. Influenza, pneumococcus, and inactivated poliovirus are not live vaccines.

The nurse has received report on four children. Which child should the nurse assess first? a. A school-age child in a coma with stable vital signs b. A preschool child with a head injury and decreasing level of consciousness c. An adolescent admitted after a motor vehicle accident who is oriented to person and place d. A toddler in a persistent vegetative state with a low-grade fever

ANS: B The nurse should assess the child with a head injury and decreasing level of consciousness (LOC) first. Assessment of LOC remains the earliest indicator of improvement or deterioration in neurologic status. The next child the nurse should assess is a toddler in a persistent vegetative state with a low-grade fever. The school-age child in a coma with stable vital signs and the adolescent admitted to the hospital who is oriented to his or her surroundings would be of least worry to the nurse.

An objective of care for the child with nephrosis is to: a. Reduce blood pressure. b. Reduce excretion of urinary protein. c. Increase excretion of urinary protein. d. Increase ability of tissues to retain fluid.

ANS: B The objectives of therapy for the child with nephrosis include reduction of the excretion of urinary protein, reduction of fluid retention, prevention of infection, and minimizing of complications associated with therapy. Blood pressure is usually not elevated in nephrosis. Increased excretion of urinary protein and increased ability of tissues to retain fluid are part of the disease process and must be reversed.

Diabetes insipidus is a disorder of the: a. Anterior pituitary. c. Adrenal cortex. b. Posterior pituitary. d. Adrenal medulla.

ANS: B The principal disorder of posterior pituitary hypofunction is diabetes insipidus. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The adrenal cortex produces aldosterone, sex hormones, and glucocorticoids. The adrenal medulla produces catecholamines.

The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. The nurse should interpret this as: a. Eye trauma. b. Neurosurgical emergency. c. Severe brainstem damage. d. Indication of brain death.

ANS: B The sudden appearance of a fixed and dilated pupil(s) is a neurosurgical emergency. The nurse should immediately report this finding. Although a dilated pupil may be associated with eye trauma, this child has experienced a neurologic insult. Pinpoint pupils or fixed, bilateral pupils for more than 5 minutes are indicative of brainstem damage. The unilateral fixed and dilated pupil is suggestive of damage on the same side of the brain. One fixed and dilated pupil is not suggestive of brain death.

A mother brings her baby to the emergency department stating that the baby no longer makes tears when crying but is having multiple soaked diapers per day. Which assessment by the nurse takes priority? A. Last bowel movement B. Palpation of fontanels C. Prenatal history D. Time of last meal

ANS: B This child has manifestations of dehydration, and with the frequent soaked diapers, may have diabetes insipidus. Assessments of circulation take priority. The nurse assesses the other factors, but they can wait until more important assessments have been completed.

A parent brings a child to the clinic and reports that the child is reluctant to walk and has a new limp. The parent also reports that the child seems lethargic and tired all the time. The nurse notes that the child appears pale. Which other finding would warrant immediate notification of the health-care provider? a. Difficulty staying asleep at night b. Left-sided abdominal enlargement c. Polyphagia and polydipsia d. Swelling of the legs and feet

ANS: B This child has some manifestations of acute lymphocytic leukemia (ALL). Left-sided abdominal enlargement could be indicative of splenomegaly, which is another manifestation of this disease. The nurse should report these findings immediately. Difficulty staying asleep at night is vague and could be related to a number of causes, both physical and behavioral. Polydipsia and polyphagia are two of the three classic signs of diabetes. Swelling of the legs and feet is not a manifestation of ALL.

An appropriate nursing intervention when caring for a child in traction is to: a. Remove adhesive traction straps daily to prevent skin breakdown. b. Assess for tightness, weakness, or contractures in uninvolved joints and muscles. c. Provide active range-of-motion exercises to affected extremity 3 times a day. d. Keep child in one position to maintain good alignment.

ANS: B Traction places stress on the affected bone, joint, and muscles. The nurse must assess for tightness, weakness, or contractures developing in the uninvolved joints and muscles. The adhesive straps should be released/replaced only when absolutely necessary. Active, passive, or active with resistance exercises should be carried out for the unaffected extremity only. Movement is expected with children. Each time the child moves, the nurse should check to ensure that proper alignment is maintained.

A child is admitted with acute glomerulonephritis. The nurse would expect the urinalysis during this acute phase to show: a. Bacteriuria and hematuria. b. Hematuria and proteinuria. c. Bacteriuria and increased specific gravity. d. Proteinuria and decreased specific gravity.

ANS: B Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes in specific gravity are not usually present during the acute phase.

A child just had a long-leg cast placed after an open reduction and fixation of a femur fracture. What interventions are appropriate for the nurse to include in the childs plan of care? (Select all that apply.) A. Assess the 4 Ps every hour, with vital signs. B. Elevate the leg and apply ice for short periods. C. Ensure that the proximal edge of the cast stays clean. D. Handle the cast carefully when wet to prevent dents. E. Use a hand-held dryer to help the cast dry faster.

ANS: B, C, D Appropriate interventions for the child with a cast include assessing the 5 Ps along with vital signs, elevating and icing the leg, keeping the proximal edges clean as part of hygiene, handling the cast carefully when wet to prevent denting, and allowing the cast to air dry.

A nurse is teaching parents about caring for their child in a cast. Which information does the nurse provide? (Select all that apply.) A. Be sure the child does not move joints above and below the cast. B. Elevate the extremity above the heart as much as possible. C. Keep the child from playing with toys that have very small parts. D. Provide snacks high in calcium and vitamin D or provide supplements. E. Reinforce active or passive range of motion to unaffected joints.

ANS: B, C, D, E The nurse teaches parents how to care for a child in a cast, including moving the joints above and below the cast regularly, elevating the extremity above the heart as much as possible, keeping the child from putting objects down the cast (including toy parts), providing nutrition that encourages bone healing, and providing range of motion.

An 8-year-old girl has a third-degree sprain of the ankle. Based on this diagnosis, which teaching points will the nurse include in the teaching plan for this patient and family? (Select all that apply.) A. The ligament is only stretched and the affected joint is stable. B. The patient cannot bear weight or use the extremity. C. There is severe pain over the joint, making an exam difficult. D. There is full range of motion and weight bearing. E. Sprains and strains are unusual in a child this age.

ANS: B, C, E Sprains are less common in younger children than are fractures. In a third-degree sprain the injury is severe, the ligament is completely torn, and the joint is unstable. There is significant swelling and severe ecchymoses occurring within the first 30 minutes. There is also severe pain over the joint, making examination difficult. The person cannot bear weight or otherwise use the extremity.

A pediatric patient is receiving asparaginase (Elspar). What manifestations would lead the nurse to determine that the child is having a possible side effect from this drug? (Select all that apply.) a. Blistering at infusion site b. Increased PT and INR c. Potassium of 2.7 mEq/L d. Seizures e. Shortness of breath

ANS: B, D Some common side effects of Elspar include seizures, hyperglycemia, nausea/vomiting, rashes, coagulation abnormalities, hepatotoxicity, pancreatitis, and anaphylaxis. Blistering is common with daunorubicin (Daunomycin). Hypokalemia is seen with carboplatin (Paraplatin). Shortness of breath could be seen with bleomycin (Blenoxane), which causes pulmonary fibrosis and pneumonitis.

A school-age child has been admitted to the hospital with an exacerbation of nephrotic syndrome. Which clinical manifestations should the nurse expect to assess (Select all that apply)? a. Weight loss b. Facial edema c. Cloudy, smoky browncolored urine d. Fatigue e. Frothy-appearing urine

ANS: B, D, E A child with nephrotic syndrome will present with facial edema, fatigue, and frothy-appearing urine (proteinuria). Weight gain, not loss, is expected because of the fluid retention. Cloudy, smoky browncolored urine is seen with acute glomerulonephritis but not with nephrotic syndrome because there is no gross hematuria associated with nephrotic syndrome.

The student nurse caring for a child with type 1 diabetes mellitus learns which classic signs? (Select all that apply.) A. Polydactyly B. Polydipsia C. Polyneuritis D. Polyphagia E. Polyuria

ANS: B, D, E The classic signs of diabetes type 1 are polyuria (frequent urination), polyphagia (extreme hunger), and polydipsia (extreme thirst). Polydactyly is having more than five fingers or toes. Polyneuropathy is having an abnormal condition affecting multiple nerves.

Which statement is most descriptive of a concussion? a. Petechial hemorrhages cause amnesia. b. Visible bruising and tearing of cerebral tissue occur. c. It is a transient, reversible neuronal dysfunction. d. A slight lesion develops remote from the site of trauma.

ANS: C A concussion is a transient, reversible neuronal dysfunction with instantaneous loss of awareness and responsiveness resulting from trauma to the head. Petechial hemorrhages along the superficial aspects of the brain along the point of impact are a type of contusion but are not necessarily associated with amnesia. A contusion is visible bruising and tearing of cerebral tissue. Contrecoup is a lesion that develops remote from the site of trauma as a result of an acceleration/deceleration injury.

A nurse is preparing to administer an octreocide depot injection. Which information about this procedure does the nurse provide the parent? A. Octreocide stimulates growth hormone. B. The medication goes deep into a muscle. C. This shot lasts longer than a regular shot. D. Your child will need these shots weekly.

ANS: C A depot injection is one in which the medication effect lasts a longer time, such as 2 or 3 months. Octreocide suppresses growth hormone. Depot injections can be either subcutaneous or intramuscular. Because the medication lasts for months, the child does not need weekly injections.

A child has had an episode of lip smacking while staring into space, but did not seem to lose consciousness. She was confused afterward but said her hands felt tingly before the other symptoms started. How should the nurse document this event? A. Alteration in consciousness B. Convulsion C. Focal seizure D. Generalized seizure

ANS: C A focal seizure involves only one part of the brain and manifests with involuntary movements, sensory symptoms, possible staring into space, no loss of consciousness, and confusion afterward. Alteration in consciousness is too vague in this case to be a useful description. Convulsion is an outdated term. A generalized seizure involves both hemispheres of the brain and manifestations usually include loss of consciousness and tonic-clonic movements.

40. A 10-year-old boy has been hit by a car while riding his bicycle in front of the school. The school nurse immediately assesses airway, breathing, and circulation. The next nursing action should be to: a. Place on side. c. Stabilize neck and spine. b. Take blood pressure. d. Check scalp and back for bleeding.

ANS: C After determining that the child is breathing and has adequate circulation, the next action is to stabilize the neck and spine to prevent any additional trauma. The childs position should not be changed until the neck and spine are stabilized. Blood pressure is a later assessment. Less urgent, but an important assessment, is inspection of the scalp for bleeding.

A child has been admitted with bacterial meningitis. Which action by the nurse takes priority? A. Administering broad-spectrum antibiotics B. Assessing and treating pain aggressively C. Facilitating blood cultures and lumbar puncture D. Maintaining a quiet, nonstimulating environment

ANS: C All actions are appropriate for the child with acute bacterial meningitis. However, the priority is obtaining cultures so that appropriate therapy can be identified. After cultures are obtained, the nurse will administer broad-spectrum antibiotics until the culture and sensitivity results are known.

A nurse is caring for four patients who have Hodgkins lymphoma. Which child should the nurse see first? a. Anorexia for a week b. Enlarged cervical lymph nodes c. Fever of 102.1F (38.9C) d. Mediastinal mass

ANS: C All options are possible manifestations of Hodgkins lymphoma. However, the child with a fever may have another cause for the temperature, including infection, that needs to be ruled out. This is especially true of a child receiving chemotherapy, a standard treatment for this disorder.

The nurse is teaching parents of a child with chronic renal failure (CRF) about the use of recombinant human erythropoietin (rHuEPO) subcutaneous injections. Which statement indicates the parents have understood the teaching? a. These injections will help with the hypertension. b. Were glad the injections only need to be given once a month. c. The red blood cell count should begin to improve with these injections. d. Urine output should begin to improve with these injections.

ANS: C Anemia in children with CRF is related to decreased production of erythropoietin. Recombinant human erythropoietin (rHuEPO) is being offered to these children as thrice-weekly or weekly subcutaneous injections and is replacing the need for frequent blood transfusions. The parents understand the teaching if they say that the red blood cell count will begin to improve with these injections.

An 8-year-old child has been diagnosed with a brain tumor. Based on knowledge of childhood cancers, which intervention does the nurse plan to implement when the child is admitted to the hospital? a. Aspiration precautions b. Protective isolation c. Safety precautions d. Seizure precautions

ANS: C Brain tumors in children 1 to 10 years of age are usually infratentorial and involve the brainstem and cerebellum. Manifestations of brainstem tumors result from involvement of the cranial nerves and include hemiparesis, spastic gait, and frequent stumbling and falling. The nurse implements safety precautions for this child. The other precautions may or may not be needed depending on the childs specific condition, treatment, and side effects of treatment.

Which type of seizure involves both hemispheres of the brain? a. Focal b. Partial c. Generalized d. Acquired

ANS: C Clinical observations of generalized seizures indicate that the initial involvement is from both hemispheres. Focal seizures may arise from any area of the cerebral cortex, but the frontal, temporal, and parietal lobes are most commonly affected. Partial seizures are caused by abnormal electrical discharges from epileptogenic focilimited to a circumscribed region of the cerebral cortex. A seizure disorder that is acquired is a result of a brain injury from a variety of factors; it does not specify the type of seizure.

The diet of a child with chronic renal failure is usually characterized as: a. High in protein. b. Low in vitamin D. c. Low in phosphorus. d. Supplemented with vitamins A, E, and K.

ANS: C Dietary phosphorus is controlled to prevent or control the calcium/phosphorus imbalance by the reduction of protein and milk intake. Protein should be limited in chronic renal failure to decrease intake of phosphorus. Vitamin D therapy is administered in chronic renal failure to increase calcium absorption. Supplementation with vitamins A, E, and K is not part of dietary management in chronic renal disease.

A nurse in a well-child clinic notes that a 5-month-old is not able to hold her head up. Which action by the nurse is the most appropriate? A. Ask about other developmental milestones . B. Document the finding in the childs chart. C. Measure the childs head circumference. D. Obtain the childs length and weight.

ANS: C Difficulty holding the head up by an appropriate age is a manifestation of hydrocephalus. Another sign of this disorder is an enlarging head, so the nurse measures the childs head and compares it to age-related norms. The other actions are appropriate, but not as specifically associated with hydrocephalus as measuring head circumference.

A nurse is caring for a child who has acute lymphocytic leukemia and has been treated with doxorubicin (Adriamycin). Which assessment finding would the nurse report immediately? A. Loss of appetite B. Low WBC count C. Peripheral edema D. Temperature of 100.6F (38.1C), once

ANS: C Doxorubicin and other anthracycline drugs are known to cause heart damage. Peripheral edema may signal heart failure and should be reported right away. Loss of appetite and low WBC count are common findings for a child on chemotherapy. A single temperature of 100.6F does not need to be reported.

A nurse is caring for a child who has acute lymphocytic leukemia and has been treated with doxorubicin (Adriamycin). Which assessment finding would the nurse report immediately? a. Loss of appetite b. Low WBC count c. Peripheral edema d. Temperature of 100.6F (38.1C), once

ANS: C Doxorubicin and other anthracycline drugs are known to cause heart damage. Peripheral edema may signal heart failure and should be reported right away. Loss of appetite and low WBC count are common findings for a child on chemotherapy. A single temperature of 100.6F does not need to be reported.

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse should explain that: a. Exercise will increase blood glucose. b. Exercise should be restricted. c. Extra snacks are needed before exercise. d. Extra insulin is required during exercise.

ANS: C Exercise lowers blood glucose levels, which can be compensated for by extra snacks. Exercise is encouraged and not restricted unless indicated by other health conditions. Extra insulin is contraindicated because exercise decreases blood glucose levels.

When infants are seen for fractures, which nursing intervention is a priority? a. No intervention is necessary. It is not uncommon for infants to fracture bones. b. Assess the familys safety practices. Fractures in infants usually result from falls. c. Assess for child abuse. Fractures in infants are often nonaccidental. d. Assess for genetic factors.

ANS: C Fractures in infants warrant further investigation to rule out child abuse. Fractures in children younger than 1 year are unusual because of the cartilaginous quality of the skeleton; a large amount of force is necessary to fracture their bones. Infants should be cared for in a safe environment and should not be falling. Fractures in infancy are usually nonaccidental rather than related to a genetic factor.

Children receiving long-term systemic corticosteroid therapy are most at risk for: a. Hypotension. b. Dilation of blood vessels in the cheeks. c. Growth delays. d. Decreased appetite and weight loss.

ANS: C Growth delay is associated with long-term steroid use. Hypertension is a clinical manifestation of long-term systemic steroid administration. Dilation of blood vessels in the cheeks is associated with an excess of topically administered steroids. Increased appetite and weight gain are clinical manifestations of excess systemic corticosteroid therapy.

The most common clinical manifestation of brain tumors in children is: a. Irritability. c. Headaches and vomiting. b. Seizures. d. Fever and poor fine motor control.

ANS: C Headaches, especially on awakening, and vomiting that is not related to feeding are the most common clinical manifestations of brain tumors in children. Irritability, seizures, and fever and poor fine motor control are clinical manifestations of brain tumors, but headaches and vomiting are the most common.

An infant is suspected of having diabetes insipidus (DI) and is having diagnostic testing. Which action by the nurse is most important? A. Apply a urine collection bag. B. Facilitate DNA testing. C. Insert an indwelling urinary catheter. D. Start two large-bore IVs.

ANS: C Infants are tested for DI with desmopressin (DDAVP) instead of a water deprivation test. After administering the medication, urine osmolality is tested at baseline and every 30 minutes for the next 2 hours. The nurse must collect the urine. An indwelling catheter is needed to obtain samples so frequently. A urine collection bag collects the urine but the infant may not void every 30 minutes. If no increase is seen in the osmolality, the infant may have hereditary nephrogenic DI, which can be confirmed by subsequent DNA testing. Because the child is not deprived of water, there is no need for an IV.

The initial clinical manifestation of generalized seizures is: a. Being confused. b. Feeling frightened. c. Losing consciousness. d. Seeing flashing lights.

ANS: C Loss of consciousness is a frequent occurrence in generalized seizures and is the initial clinical manifestation. Being confused, feeling frightened, and seeing flashing lights are clinical manifestations of a complex partial seizure.

The high school nurse is teaching a healthy living class to high school seniors. One student asks why she should take folic acid now when she is not planning to become pregnant. Which response by the nurse is the most appropriate? A. It is a good habit to get into while you are young and can develop good habits. B. Most people in this country have a serious deficiency of vitamins and folic acid. C. Neural tube defects occur so early that you might not know you are even pregnant. D. There are no foods that contain folic acid so you have to take a supplement.

ANS: C Neural tube defects (NTDs) generally occur between the 18th and 28th days of pregnancy, often before the woman knows she is pregnant. All women of childbearing age should get 400 g/day of folic acid to help prevent NTDs. It is a good habit to get into prior to contemplating pregnancy, but this answer does not give specific information. Most people do not have a serious deficiency of folic acid; however, pregnant women (and those who could be pregnant) need to have a minimal amount of folic acid. Several foods are good sources of folic acid, including green leafy vegetables, liver, legumes, orange juice, and fortified breakfast cereals; it is also contained in multivitamins.

Which term is used to describe a childs level of consciousness when the child can be aroused with stimulation? a. Stupor b. Confusion c. Obtundation d. Disorientation

ANS: C Obtundation describes a level of consciousness in which the child can be aroused with stimulation. Stupor is a state in which the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Confusion is impaired decision making. Disorientation is confusion regarding time and place.

An appropriate nursing intervention when caring for an unconscious child should be to: a. Change the childs position infrequently to minimize the chance of increased intracranial pressure (ICP). b. Avoid using narcotics or sedatives to provide comfort and pain relief. c. Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. d. Give tepid sponge baths to reduce fever because antipyretics are contraindicated.

ANS: C Often comatose patients cannot cope with the quantity of fluids that they normally tolerate. Overhydration must be avoided to prevent fatal cerebral edema. The childs position should be changed frequently to avoid complications such as pneumonia and skin breakdown. Narcotics and sedatives should be used as necessary to reduce pain and discomfort, which can increase ICP. Antipyretics are the method of choice for fever reduction.

A parent calls the nursing call center stating that his child, who has a cast after surgical treatment of a clubfoot, is very fussy even after acetaminophen (Tylenol) administration and that the childs toes seem cool. What advice does the nurse give the parent? A. Elevate the affected extremity and apply ice for 20 minutes. B. Make four cuts to the top of the cast, each about 1 inch long. C. Take your child to the nearest emergency department now. D. Try giving your child a dose of ibuprofen (Pediaprofen) instead.

ANS: C Parents always need to observe for complications of casting, including neurovascular compromise. A child who is excessively fussy and whose toes are cool should be seen by a health-care provider to assess circulation and possibly modify or change the cast. The parent should be told to take the child to the nearest emergency department (ED). The other answers are inappropriate. If circulation is compromised, elevation and ice will make the problem worse. The parent should not be instructed to modify the cast. Although ibuprofen may manage the childs pain better than acetaminophen, the priority instruction is to send the parent to the ED.

A child is started on recombinant growth hormone. Which teaching point does the nurse provide the parents and child? A. Drink adequate fluids during the day. B. Encourage increased activity. C. Ensure proper oral hygiene. D. Weigh daily on the same scale.

ANS: C Proper oral hygiene and regular visits to the dentist are important because growth hormone treatments make the childs teeth softer and more prone to cavities. The other options do not address a specific issue related to this treatment.

A child is brought to the emergency department after experiencing a seizure at school. There is no previous history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurses best response is: a. Epilepsy is easily treated. b. Very few children have actual epilepsy. c. The seizure may or may not mean that your child has epilepsy. d. Your child has had only one convulsion; it probably wont happen again.

ANS: C Seizures are the indispensable characteristic of epilepsy; however, not every seizure is epileptic. Epilepsy is a chronic seizure disorder with recurrent and unprovoked seizures. The treatment of epilepsy involves a thorough assessment to determine the type of seizure the child is having and the cause of events, followed by individualized therapy to allow the child to have as normal a life as possible. The nurse should not make generalized comments like Very few children have actual epilepsy and Your child has had only one convulsion; it probably wont happen again until further assessment is made.

A current recommendation to prevent neural tube defects is the supplementation of: a. Vitamin A throughout pregnancy. b. Multivitamin preparations as soon as pregnancy is suspected. c. Folic acid for all women of childbearing age. d. Folic acid during the first and second trimesters of pregnancy.

ANS: C The widespread use of folic acid among women of childbearing age is expected to decrease the incidence of spina bifida significantly. Vitamin A and multivitamin preparations do not have a relation to the prevention of spina bifida. Folic acid supplementation is recommended for the preconceptual period and during the pregnancy. Only 42% of women actually follow these guidelines.

A hospitalized diabetic child is sweating, nauseated, and has a headache. What action by the nurse takes priority? A. Administer sliding-scale insulin. B. Call laboratory for a stat blood sugar. C. Give the child some orange juice. D. Perform a urine ketone test.

ANS: C This child is exhibiting signs of hypoglycemia. The nurse should first treat the child instead of waiting for the laboratory to come draw blood. If the nurse has bedside glucose monitoring available, check the glucose first, then treat, but do not wait the several minutes it will take for phlebotomy. Because the child has low blood sugar, do not give insulin. Do not delay by trying to get a urine sample; also, ketones are present in hyperglycemia.

A nursing student is caring for a child diagnosed with Wilms tumor. Which action by the student causes the faculty member to intervene? A. Assesses urinary output per protocol B. Involves the parents in the childs care C. Palpates the abdomen in all four quadrants D. Provides frequent nutritious snacks

ANS: C Wilms tumor is a solid, encapsulated mass that can rupture with palpation. Once the child is diagnosed with this cancer, palpation of the childs abdomen is prohibited. The other actions are appropriate.

The nurse is caring for a neonate with suspected meningitis. Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed (Select all that apply)? a. Headache b. Photophobia c. Bulging anterior fontanel d. Weak cry e. Poor muscle tone

ANS: C, D, E Assessment findings in a neonate with meningitis include bulging anterior fontanel, weak cry, and poor muscle tone. Headache and photophobia are signs seen in an older child.

Clinical manifestations of increased intracranial pressure (ICP) in infants are (Select all that apply): a. Low-pitched cry. b. Sunken fontanel. c. Diplopia and blurred vision. d. Irritability. e. Distended scalp veins. f. Increased blood pressure.

ANS: C, D, E Diplopia and blurred vision, irritability, and distended scalp veins are signs of increased ICP in infants. Low- pitched cry, sunken fontanel, and increased blood pressure are not clinical manifestations associated with ICP in infants.

The nurse is caring for a preschool child with a cast applied recently for a fractured tibia. Which assessment findings indicate possible compartment syndrome (Select all that apply)? a. Palpable distal pulse b. Capillary refill to extremity of <3 seconds c. Severe pain not relieved by analgesics d. Tingling of extremity e. Inability to move extremity

ANS: C, D, E Indications of compartment syndrome are severe pain not relieved by analgesics, tingling of extremity, and inability to move extremity. A palpable distal pulse and capillary refill to the extremity of <3 seconds are expected findings.

A nurse is caring for a child who only awakens to painful stimuli and produces no verbal responses. Which term is the most appropriate when documenting this childs status? A. Lethargy B. Obtundation C. Persistent vegetative state D. Stupor

ANS: D A child who is stuporous only responds to painful stimuli and has verbal responses that are either absent or slow. A lethargic patient opens his or her eyes to loud voices and appears confused and falls asleep without continued stimulation. Obtundation is demonstrated when a person is aroused by tactile stimulation, such as gentle shaking, but does not show great interest in surroundings. A persistent vegetative state is a coma-like condition that has lasted for over 4 weeks.

A pediatric nurse performs a physical examination on a neonate and notes a spinal lesion with the meninges protruding through the defect that contains spinal cord elements. The nurse documents which condition as being present? A. Hydrocephalus B. Meningitis C. Meningocele D. Myelomeningocele E. Spina bifida occulta

ANS: D A myelomeningocele is the most severe form of spina bifida and is evident on delivery. The meninges protrude through the defect, and they contain spinal cord elements. It appears as a very pronounced skin defect, usually covered by a transparent membrane, and neural tissue may be attached to the inner surface.

Which nursing intervention is appropriate to assess for neurovascular competency in a child who fell off the monkey bars at school and hurt his arm? a. The degree of motion and ability to position the extremity. b. The length, diameter, and shape of the extremity. c. The amount of swelling noted in the extremity and pain intensity. d. The skin color, temperature, movement, sensation, and capillary refill of the extremity.

ANS: D A neurovascular evaluation includes assessing skin color and temperature, ability to move the affected extremity, degree of sensation experienced, and speed of capillary refill in the extremity. The degree of motion in the affected extremity and ability to position the extremity are incomplete assessments of neurovascular competency. The length, diameter, and shape of the extremity are not assessment criteria in a neurovascular evaluation. Although the amount of swelling is an important factor in assessing an extremity, it is not a criterion for a neurovascular assessment.

A hospitalized child is having a seizure. Which action by the nurse takes priority? A. Apply oxygen and oximeter. B. Give anti-seizure medications. C. Pad the side rails of the bed. D. Turn the child on his or her side.

ANS: D All actions are appropriate when a patient has a seizure. The priority, however, is on maintaining the childs airway. Placing the child in a side-lying position decreases the risk of aspiration and airway obstruction.

31. A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurses best response should be that the: a. Blood pressure will stabilize. c. Urine will be free of protein. b. Child will have more energy. d. Urinary output will increase.

ANS: D An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output.

A common clinical manifestation of Hodgkins disease is: a. Petechiae. b. Bone and joint pain. c. Painful, enlarged lymph nodes. d. Enlarged, firm, nontender lymph nodes.

ANS: D Asymptomatic, enlarged, cervical or supraclavicular lymphadenopathy is the most common presentation of Hodgkins disease. Petechiae are usually associated with leukemia. Bone and joint pain are not likely in Hodgkins disease. The enlarged nodes are rarely painful.

The nurse is caring for a child with suspected diabetes insipidus. Which clinical manifestation would she or he expect to observe? a. Oliguria c. Nausea and vomiting b. Glycosuria d. Polyuria and polydipsia

ANS: D Excessive urination accompanied by insatiable thirst is the primary clinical manifestation of diabetes. These symptoms may be so severe that the child does little other than drink and urinate. Oliguria is decreased urine production and is not associated with diabetes insipidus. Glycosuria is associated with diabetes mellitus. Nausea and vomiting are associated with inappropriate antidiuretic hormone secretion.

Which symptom is considered a cardinal sign of diabetes mellitus? a. Nausea c. Impaired vision b. Seizures d. Frequent urination

ANS: D Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia. Nausea and seizures are not clinical manifestations of diabetes mellitus. Impaired vision is a long-term complication of the disease.

A neonate receives a diagnosis of hydrocephalus. The pediatric nurse assesses for congenital anomalies related to this condition. Which condition is inconsistent with the nurses knowledge of hydrocephalus? A. Aqueductal stenosis B. Chiari I and II malformations C. Dandy-Walker malformation D. Folic acid deficiency

ANS: D Hydrocephalus develops when an impedance to cerebrospinal fluid (CSF) flow or absorption is present. It rarely occurs as a result of the overproduction of CSF. Congenital anomalies, including Chiari I and II malformations, Dandy-Walker malformation, and aqueductal stenosis, are the most common causes of hydrocephalus during the neonatal and early infancy periods. Acquired hydrocephalus occurs after birth and in infancy, usually resulting from intraventricular hemorrhage due to prematurity. Folic acid deficiency is related to neural tube deficits.

The nurse is assisting the pediatric provider with a newborn examination. The provider notes that the infant has hypospadias. The nurse understands that hypospadias refers to: a. Absence of a urethral opening. b. Penis shorter than usual for age. c. Urethral opening along dorsal surface of penis. d. Urethral opening along ventral surface of penis.

ANS: D Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present, but not at the glans. Hypospadias does not refer to the size of the penis. When the urethral opening is along the dorsal surface of the penis, it is known as epispadias.

What would cause a nurse to suspect that an infection has developed under a cast? a. Complaint of paresthesia b. Cold toes c. Increased respirations d. Hot spots felt on cast surface

ANS: D If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so a window can be made in the cast to observe the site. The five Ps of ischemia from a vascular injury include pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection. Cold toes may be indicative of too tight a cast and need further evaluation. Increased respirations may indicate a respiratory infection or pulmonary emboli. This should be reported, and the child should be evaluated.

A nurse is teaching a parent group about caring for their infants and toddlers. What does the nurse teach to prevent a serious neurological problem in infants? A. Always treat any temperature elevation to prevent seizures. B. Avoid vaccinations with live, attenuated viruses. C. Do not use artificial sweeteners in your babys food. D. Never give honey to a child less than 1 year of age.

ANS: D Infant botulism can be caused by feeding honey to a child less than 12 months of age, so the nurse teaches parents to avoid this. The other statements are inaccurate.

Which diagnostic finding is present when a child has primary nephrotic syndrome? a. Hyperalbuminemia c. Leukocytosis b. Positive ASO titer d. Proteinuria

ANS: D Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane. Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the livers inability to synthesize proteins to balance the loss. ASO titer is negative in a child with primary nephrotic syndrome. Leukocytosis is not a diagnostic finding in primary nephrotic syndrome.

The pediatric nurse explains to the parents of a comatose child that which structure controls the childs level of consciousness? A. Basal ganglia B. Brainstem C. Central nervous system D. Reticular activating system

ANS: D Level of consciousness is controlled by the reticular activating system and the cerebral hemispheres of the brain. Cognitive cerebral function cannot occur without an active reticular activating system.

The nurse should recommend medical attention if a child with a slight head injury experiences: a. Sleepiness. c. Headache, even if slight. b. Vomiting, even once. d. Confusion or abnormal behavior.

ANS: D Medical attention should be sought if the child exhibits confusion or abnormal behavior; loses consciousness; or has amnesia, fluid leaking from the nose or ears, blurred vision, or unsteady gait. Sleepiness alone does not require evaluation. If the child is difficult to arouse from sleep, medical attention should be obtained. Vomiting more than three times requires medical attention. Severe or worsening headache or one that interferes with sleep should be evaluated

Which clinical manifestation may occur in the child who is receiving too much methimazole (Tapazole) for the treatment of hyperthyroidism (Graves disease)? a. Seizures c. Pancreatitis or cholecystitis b. Enlargement of all lymph glands d. Lethargy and somnolence

ANS: D Parents should be aware of the signs of hypothyroidism that can occur from overdosage of the drug. The most common manifestations are lethargy and somnolence. Seizures and pancreatitis are not associated with the administration of Tapazole. Enlargement of the salivary and cervical lymph glands occurs.

The nurse is caring for a child with severe head trauma after a car accident. Which is an ominous sign that often precedes death? a. Papilledema c. Dolls head maneuver b. Delirium d. Periodic and irregular breathing

ANS: D Periodic or irregular breathing is an ominous sign of brainstem (especially medullary) dysfunction that often precedes complete apnea. Papilledema is edema and inflammation of the optic nerve. It is commonly a sign of increased intracranial pressure. Delirium is a state of mental confusion and excitement marked by disorientation to time and place. The dolls head maneuver is a test for brainstem or oculomotor nerve dysfunction.

A pediatric nurse is caring for a 1-year-old child who is in a spica cast. The nurse teaches the parents that modifications need to be made for this child. Which modification does the nurse teach? A. Using a baby bath with shallow water to clean the child B. Using a car seat with sturdy sides to transport the child C. Using a sitting position on the floor to feed the child D. Using a wagon instead of a stroller to move the child

ANS: D Placing the child in the prone position on the floor makes it easier for feeding the child. Mobilizing a child in a wagon is a good modification for a stroller while the child is in the spica cast. Toddler car seats that do not have sides are also a good modification for a child in a spica cast. The parents will need to modify the bath by giving the child a sponge bath.

Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Moist skin c. Fluid overload b. Weight gain d. Poor wound healing

ANS: D Poor wound healing is often an early sign of type 1 diabetes mellitus. Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus.

A common side effect of corticosteroid therapy is: a. Fever. b. Hypertension. c. Weight loss. d. Increased appetite.

ANS: D Side effects of corticosteroid therapy include an increased appetite. Fever is not a side effect of therapy. It may be an indication of infection. Hypertension is not usually associated with initial corticosteroid therapy. Weight gain, not weight loss, is associated with corticosteroid therapy.

Several complications can occur when a child receives a blood transfusion. An immediate sign or symptom of an air embolus is: a. Chills and shaking. c. Irregular heart rate. b. Nausea and vomiting. d. Sudden difficulty in breathing.

ANS: D Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Air emboli should be avoided by carefully flushing all tubing of air before connecting to the patient. Chills, shaking, nausea, and vomiting are associated with hemolytic reactions. Irregular heart rate is associated with electrolyte disturbances and hypothermia.

Manifestations of hypoglycemia include: a. Lethargy. b. Thirst. c. Nausea and vomiting. d. Shaky feeling and dizziness.

ANS: D Some of the clinical manifestations of hypoglycemia include shaky feelings; dizziness; difficulty concentrating, speaking, focusing, and coordinating; sweating; and pallor. Lethargy, thirst, and nausea and vomiting are manifestations of hyperglycemia.

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by: a. Saturated and unsaturated fat. b. Fruit juice. c. Several glasses of water. d. Complex carbohydrate and protein.

ANS: D Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein. Saturated and unsaturated fat, fruit juice, and several glasses of water do not provide the child with complex carbohydrate and protein necessary to stabilize the blood sugar.

The pediatric nurse carefully monitors a patients status by assessing the childs level of consciousness. The nurse understands that the Glasgow Coma Scale provides clues to which of the following? A. Encephalitis B. Irreversible coma C. Neurological impairment D. Neurological status

ANS: D The childs level of consciousness and the use of the Pediatric Glasgow Coma Scale, pupil response, and overall activity provide clues to the childs neurological status

The nurse is teaching the parents of a 7-year-old child who has just had a cast applied for a fractured arm with the wrist and elbow immobilized. Which instructions should be included in the teaching? a. Swelling of the fingers is to be expected for the next 48 hours. b. Immobilize the shoulder to decrease pain in the arm. c. Allow the affected limb to hang down for 1 hour each day. d. Elevate casted arm when resting and when sitting up.

ANS: D The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return. Swelling of the fingers may indicate neurovascular damage and should be reported immediately. Permanent damage can occur within 6 to 8 hours. Joints above and below the cast on the affected extremity should be moved. The child should not engage in strenuous activity for the first few days. Rest with elevation of the extremity is encouraged.

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. The most essential part of the nursing assessment to detect early signs of a worsening condition is: a. Posturing. c. Focal neurologic signs. b. Vital signs. d. Level of consciousness.

ANS: D The most important nursing observation is assessment of the childs level of consciousness. Alterations in consciousness appear earlier in the progression of head injury than do alterations of vital signs or focal neurologic signs. Neurologic posturing indicates neurologic damage. Vital signs and focal neurologic signs are later signs of progression when compared with level-of-consciousness changes.

An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of: a. Air embolism. b. Allergic reaction. c. Hemolytic reaction. d. Circulatory overload.

ANS: D The signs of circulatory overload include distended neck veins, hypertension, crackles, dry cough, cyanosis, and precordial pain. Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Allergic reactions are manifested by urticaria, pruritus, flushing, asthmatic wheezing, and laryngeal edema. Hemolytic reactions are characterized by chills, shaking, fever, pain at infusion site, nausea, vomiting, tightness in chest, flank pain, red or black urine, and progressive signs of shock and renal failure.

During assessment of a 6-year-old child with meningitis, the nurse places the child supine and attempts to put the childs chin on her chest. The child cries out in pain and flexes her knees. How does the nurse document this assessment finding in the medical record? A. Absent Moro reflex B. Exaggerated Grey-Turner sign C. Negative Kernig sign D. Positive Brudzinski sign

ANS: D Two assessment tests are used in evaluating a patient with meningitis: the Kernig sign and the Brudzinski sign. The nurse has demonstrated a positive Brudzinski sign. The Kernig sign is elicited by placing the patient supine with hips flexed and raising and straightening the leg. Pain behind the knee and resistance are abnormal findings possibly indicative of meningitis. The Moro reflex is done on infants. The Grey-Turner sign is bruising of the flanks, often accompanying pancreatitis.

A new nurse is placing an elastic wrap on a patient with an ankle sprain. Which action by this nurse causes an experienced nurse to intervene? A. Exerts moderate pull on the wrap B. Instructs the patient on wrapping the injury C. Starts wrapping distal to the injury D. Wraps in a proximal-to-distal fashion

ANS: D When using an elastic wrap, start wrapping distal to the injury, work up over the injury, and end the wrapping proximal to the injury. The other actions are correct.

A Wilms tumor, what are expected findings on assessment for a Wilms tumor?

Wilms tumor post op care • The recovery period is usually rapid • Monitor GI activity (bowel sounds, bowel movements, distention, vomiting) • Risk for intestinal obstruction from • postsurgical adhesion formation • Side effects of chemo